1 :

Hint : 📝Focus on converting the mg dose into mL using the available concentration.

Correct Answers:

  • 0.6


Rationale :

🧮The nurse must first calculate the total ordered dose by multiplying 0.044 mg/kg by the client's 50-kg weight, which yields 2.2 mg, demonstrating the importance of accurate medication calculation.

💉The available concentration is 4 mg/mL, so the nurse performs 2.2 mg ÷ 4 mg/mL, resulting in 0.55 mL, which rounds to 0.6 mL, emphasizing correct dose conversion.

📏Using a leading zero prevents medication errors, highlighting a crucial safety practice in clinical pharmacology.

⚠️Rounding to the nearest tenth ensures precise delivery of the ordered medication for safe client care.


📌Core Message

The nurse ensures safe administration by applying accurate medication calculation using weight-based dosing and available concentration.

2 :

Hint : 📚Look for the option that gives purely objective information without opinions.

Correct Answers:

  • “A 2 centimeter by 2-centimeter amount of purulent drainage was noted during a dressing change."


Rationale :

📝This statement provides objective data, which is a required element of proper clinical documentation.

📏The entry avoids judgmental language, which aligns with essential professional standards of charting.

🩺The nurse describes measurable and observable assessment findings, supporting accurate communication within the healthcare team.

⚖️This wording reduces risk of legal liability by ensuring factual and non-interpretive documentation.


📌Core Message

Accurate charting requires strictly objective documentation to support clear and professional communication.

3 :

Today:

Client is here today for a routine follow-up. Past medical history is significant for schizophrenia, diagnosed 1 year ago.

Client is alert and oriented x 3. Client's weight has increased 13.7 kg (30.1 lb) in the past 6 months. Abdomen is soft and non-tender, central abdominal weight gain visualized. Client reports fatigue, sore throat, dry mouth, and body aches.

6 months ago:

Temperature 37°C (98.6°F)

Heart rate 86/min

Respiratory rate 18/min

Blood pressure 120/80 mm Hg

SpO2 on room air

Today:

Temperature 38°C (100.4°F)

Heart rate 92/min

Respiratory rate 19/min

Blood pressure 124/76 mm Hg

O2 99% on room air

Today:

Clozapine 200 mg PO two times a day

Metformin 500 mg PO two times a day

12 months ago:

Absolute neutrophil count 2,500/mm3 (2,500 to 8,000/mm3)

Today:

Absolute neutrophil count 1,500/mm3 (2,500 to 8,000/mm3)


Select the 3 topics the nurse should include in the client's education.


Answer Options

Hint : 🧪Focus on effects related to hematologic monitoring and common medication side effects.

Correct Answers:

  • Instruct client to use sugarless gum or hard candy.
  • Instruct the client to continue taking clozapine.
  • Educate client to have neutrophil count drawn every month.


Rationale :

🧠Clozapine can cause anticholinergic effects such as dry mouth, so sugarless gum helps manage this adverse effect safely.

🩺Stopping clozapine abruptly can worsen schizophrenia symptoms, making continuation essential for maintaining psychiatric stability.

⚠️A declining absolute neutrophil count—now at 1,500/mm³—requires strict monthly monitoring because clozapine can cause agranulocytosis, a serious safety concern.

📉The weight gain and abdominal changes relate to metabolic effects, but monitoring neutrophils remains the top priority for maintaining treatment safety.


📌Core Message

Clients taking clozapine require education focused on managing anticholinergic effects and maintaining essential neutrophil monitoring.

4 :

1800:

Female client admitted to unit from emergency department. Client was diagnosed with bipolar disorder 1 year ago and is currently exhibiting manifestations of mania. Client is pacing and required frequent redirection in conversation during intak Coarse hand tremors noted. Client is exhibiting pressured speech and flight of ideas.

1900:

Client is pacing in hallway and has had an episode of vomiting. Client has consumed 160 mL of water but requires frequent prompting from staff. Did not consume any food from dinner tray. Client has voided twice since admission.

1800:

Risperidone 1 mg tablet PO twice daily

Lithium 600 mg capsule PO twice daily

Lorazepam 1 mg tablet PO every 4 hrs as needed for anxiety

1800:

Temperature 37°C (98.6°F)

Pulse rate 98/min

Respiratory rate 20/min

Blood pressure 144/96 mm Hg

SpO2 98% on room air

1900:

Temperature 37.2°C (99°F)

Pulse rate 104/min

Respiratory rate 20/min

Blood pressure 138/94 mm Hg

SpO2 99% on room air

1830:

Potassium 3.6 mEq/L (3.5 to 5 mEq/L)

Sodium 132 mEq/L (136 to 145 mEq/L).

WBC count 8,900/mm3 (5,000 to 10,000/mm3)

Platelet count 280,000/mm3 (150,000 to 400,000/mm3)

Hgb 14 g/dL (12 to 16 g/dL)

Hct (37% to 47%)

Lithium level 0.6 mEq/L (0.8 to less than 1.2 mEq/L)


Select words from the provided list of options to fill in the blank spaces. The client is at risk for developingdue to.


Hint : 🧂Consider how electrolyte imbalance affects renal handling of certain mood-stabilizing medications.

Correct Answers

  • Blank 1 Correct Option: Lithium toxicity
  • Blank 2 Correct Option: Sodium level

Rationale :

💧A low sodium level (132 mEq/L) increases renal reabsorption of lithium, raising the risk for lithium toxicity, a dangerous complication.

🧠The client's manic behavior and poor intake can worsen dehydration, further concentrating lithium levels in the bloodstream.

📉The recorded lithium level of 0.6 mEq/L is subtherapeutic, but the physiologic trend of declining sodium raises future toxicity risk.

⚠️Lithium and sodium have a direct relationship, making hyponatremia a critical factor in predicting drug toxicity.


📌Core Message

A low sodium level increases the risk of lithium toxicity, requiring close monitoring during treatment.

5 :

Hint : 👤Identify the option that supports client autonomy rather than restricting it.

Correct Answers:

  • "Clients can appoint a health care surrogate for when they are unable to make decisions."


Rationale :

📋Clients with schizophrenia maintain legal rights to create advance directives, including naming a health-care surrogate.

👥This option supports client autonomy, which remains intact unless legally removed by a court.

⚖️The statement aligns with legal expectations surrounding decision-making capacity, which is not automatically restricted in schizophrenia.

🧠Advance directives empower clients to express their preferences despite chronic mental illness, promoting ethical care.


📌Core Message

Clients with schizophrenia retain the right to appoint a health-care surrogate through advance directives.

6 :

Hint : 🧪Select the option that identifies a test used in evaluating fetal structural development.

Correct Answers:

  • Serum alpha-fetoprotein levels can assist in identifying neural tube defects.


Rationale :

🧬Serum alpha-fetoprotein testing is performed during early pregnancy to screen for neural tube defects, a key congenital concern.

📈Abnormally high AFP levels may indicate defects such as spina bifida, reinforcing the importance of early prenatal screening.

🔬This test is appropriate during the first trimester for clients with a family history of chromosomal abnormalities, aiding risk evaluation.

⚕️The other listed tests do not relate to neural tube detection or are scheduled at incorrect gestational ages.


📌Core Message

Maternal alpha-fetoprotein screening helps identify potential neural tube defects early in pregnancy.

7 :

Hint : 🧤Pick the option that enhances protection from unnoticed injuries related to decreased sensation.

Correct Answers:

  • Wear gloves when washing dishes.


Rationale :

🧤Chemotherapy-induced peripheral neuropathy reduces sensation, making protection from thermal injury essential when using hot water.

⚠️Clients with neuropathy are at increased risk of burns, so protective gloves maintain skin safety.

🦶Loose-fitting shoes increase fall and injury risk due to diminished proprioception, showing why they are unsafe.

👣Frequent foot inspection supports injury prevention, but weekly checks are insufficient for compromised sensation.


📌Core Message

Peripheral neuropathy requires protective behaviors that prevent thermal injury and enhance safety.

8 :

Hint : 🧠Consider which finding indicates impaired GI motility that opioids could further worsen.

Correct Answers:

  • Absent bowel sounds


Rationale :

🚫Morphine is contraindicated in clients with absent bowel sounds because opioids reduce peristalsis, worsening potential obstruction.

⚠️Administering morphine in this situation can cause severe gastrointestinal complications, making this the highest-priority finding.

🩺A respiratory rate of 14/min and blood pressure of 100/60 are within acceptable ranges for opioid administration, showing they are not contraindications.

💧Urine output of 100 mL/hr reflects adequate renal perfusion, meaning it does not restrict opioid use.


📌Core Message

Morphine must be withheld when a client has absent bowel sounds due to risk of worsening intestinal obstruction.

9 :

Hint : 🤦‍♂️Identify the manifestation caused by depressed neuromuscular activity.

Correct Answers:

  • Bradypnea


Rationale :

💤Hypermagnesemia depresses neuromuscular activity, leading to bradypnea, a hallmark respiratory manifestation.

⚠️Magnesium acts as a central nervous system depressant, slowing respiratory effort as serum levels rise.

🩺Other symptoms such as personality change or cardiac abnormalities occur with different electrolyte disturbances, not classic hypermagnesemia.

❤️Peaked T-waves are associated with hyperkalemia, not excess magnesium.


📌Core Message

Hypermagnesemia commonly causes bradypnea due to depressed neuromuscular function.

10 :

Hint : 🩺Choose the documentation that avoids unsafe abbreviations.

Correct Answers:

  • Enoxaparin 30 mg subcut every 12 hr


Rationale :

📝This documentation uses the correct abbreviation for milligrams and the accepted spelling of subcut, promoting safe communication.

⚕️It avoids unsafe abbreviations such as SC, SQ, or q HS, which can cause medication-related errors.

📋The time interval of every 12 hr is clearly written, supporting precise administration timing.

⚠️Using unapproved abbreviations increases risk of misinterpretation, making the chosen option the safest.


📌Core Message

Clear medication orders require standardized notation to prevent administration errors and ensure safe communication.

Total Questions: 10

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