1 :
Available Items
A 7-year-old child who has type 1 diabetes mellitus and is experiencing extreme hunger and shakiness
A 5-year-old child who is crying uncontrollably because of an incontinent bowel episode.
12-year-old child with history of asthma who is wheezing and complaining of shortness of breath.
A 10-year-old child with bleeding lacerations on both knees after falling on the playground
Arrange Your Answers

Drag items here to Arrange !

Hint : 📊Think in terms of who is most likely to deteriorate rapidly without immediate care.

Correct Order:

  • Order : 1 : No answer text available
  • Order : 2 : No answer text available
  • Order : 3 : No answer text available
  • Order : 4 : No answer text available
Rationale :

😮The child with a history of asthma who is wheezing and short of breath has a potential airway emergency and should be the highest priority for immediate assessment and intervention.

🍬The child with type 1 diabetes who feels shaky and extremely hungry is showing signs of hypoglycemia, which can lead to seizures or unconsciousness and requires prompt treatment.

🩹The child with bleeding lacerations should be seen after the more acute issues are addressed, as the bleeding appears non-life-threatening.

😢The child crying due to an incontinent bowel episode is experiencing emotional distress but has no physical health emergency, making them the lowest priority.

📌Core Message

When prioritizing care, focus on life-threatening issues first such as airway compromise, then address acute metabolic risks, followed by minor trauma and psychosocial needs.

2 :
Available Items
Open the medication package.
Compare the client's wristband to the medication administration record.
Obtain the client's apical heart rate.
Remove the medication from the dispensing system.
Document administration of the medication.
Arrange Your Answers

Drag items here to Arrange !

Hint : 🕒Start by ensuring it's safe to give the drug before retrieving or opening anything.

Correct Order:

  • Order : 1 : No answer text available
  • Order : 2 : No answer text available
  • Order : 3 : No answer text available
  • Order : 4 : No answer text available
  • Order : 5 : No answer text available
Rationale :

🩺Assessing the apical heart rate is the first priority because digoxin slows the heart, and it should be held if the heart rate is too low (<60 bpm in adults).

💊Next, the nurse should remove the medication from the dispensing system only after confirming it is safe to administer.

🆔Verifying the client's identity ensures patient safety and prevents medication errors.

📦Once verified, the nurse can then open the medication package to prepare for administration.

📝Lastly, the nurse should document the medication administration after it has been given, completing the medication process cycle.

📌Core Message

Administering digoxin safely involves checking the heart rate first, ensuring the right patient, then proceeding through proper retrieval, administration, and documentation steps.

3 :

Chief Complaint: Acute asthma attack after jogging; worsened by outdoor activity and exercise. 

Current Treatment: Used rescue inhaler three times, expired inhaler, worried about effectiveness

Temperature: 98.9°F (37.1°C) - Normal

Heart Rate: 112 beats/minute - Elevated (tachycardia)

Respirations: 28 breaths/minute - Elevated (tachypnea)

Blood Pressure: 130/86 mm Hg - Normal

Oxygen Saturation: 88% on room air - Low (hypoxemia)

Lung Sounds: Expiratory wheezes - Indicative of asthma or bronchospasm

Capillary Refill Time: 2 seconds – Normal

The nurse has identified the priority problem for the client and now must determine proper care interventions. Based on the client's history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.

Answer Options

Hint : 💡Choose actions that reduce symptoms and improve oxygenation while preparing for long-term management.

Correct Answers:

  • Administer medications as ordered.
  • Provide client teaching.
  • Ask the client for a list of current medications.
  • Apply oxygen via nasal cannula

Rationale :

💨Administering medications as ordered, such as bronchodilators and steroids, is essential for relieving bronchospasm and inflammation in an acute asthma attack.

📘Providing client teaching after stabilization helps address trigger avoidance and medication management, especially since the client was using an expired inhaler.

📋Asking for a list of current medications helps identify any discrepancies or expired prescriptions and guides future care.

🫁Applying oxygen via nasal cannula is a standard intervention for hypoxemia, helping restore adequate oxygen saturation.

📌Core Message

Effective asthma care includes administering prescribed medications, providing oxygen, gathering medication history, and initiating education while avoiding contraindicated interventions.

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4 :

A 34-year-old male client presents to the emergency department (ED) for an acute asthma attack which began after jogging through a local park. The client is able to answer questions, pausing every few words to catch his breath. The client reports using a rescue inhaler three times, but he just couldn't catch his breath. The client reports that symptoms seem worse when outdoors and when exercising and that episodes like this make him extremely nervous. The client reports that it has been a couple of months since he had an asthma attack, and he came to the ED today because he noticed that his inhaler was expired and was worried the medication was not working.

Temperature 98.9" F (37.1" C).

Heart rate 112 beats/minute

Respirations 28 breaths/minute

Blood pressure 130/86 mm Hg.

Oxygen saturation 88% on room air

Lung sounds reveal expiratory wheezes

Capillary refill time 2 seconds

Administer albuterol 2.5 mg/ipratropium bromide 0.5 mg in 3 mL solution via nebulizer four times a day and PRN Administer prednisone 60 mg PO Administer oxygen to keep oxygen saturation greater than 94%, titrate as needed

After administration of medication, the client remains short of breath. Wheezes are noted bilaterally. Oxygen saturation is 91% with supplemental oxygen. Which action(s) should the nurse take next? Select all that apply.

Answer Options

Hint : 📈Consider actions that directly support better oxygen delivery and breathing effort.

Correct Answers:

  • Administer additional nebulizer treatment as ordered.
  • Take and monitor vital signs.
  • Increase oxygen flow.
  • Raise the head of the bed.

Rationale :

💨Administering an additional nebulizer treatment is appropriate because the medication is ordered PRN and the client's symptoms persist.

📈Taking and monitoring vital signs helps the nurse assess for ongoing or worsening respiratory distress and guides further interventions.

⛽Increasing the oxygen flow is necessary since the current therapy is not meeting the oxygen saturation goal (>94%).

🛏️Raising the head of the bed enhances lung expansion and is a non-invasive, supportive measure to ease breathing.

📌Core Message

When asthma symptoms persist despite treatment, the nurse should repeat nebulizer therapy, adjust oxygen flow, monitor vitals, and elevate the head of the bed to promote airway effectiveness.

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5 :

A 34-year-old male client presents to the emergency department (ED) for an acute asthma attack which began after jogging through a local park. The client is able to answer questions, pausing every few words to catch his breath. The client reports using a rescue inhaler three times, but he just couldn't catch his breath. The client reports that symptoms seem worse when outdoors and when exercising and that episodes like this make him extremely nervous. The client reports that it has been a couple of months since he had an asthma attack, and he came to the ED today because he noticed that his inhaler was expired and was worried the medication was not working.

The nurse performs an initial focused assessment of the client. Based on the client's history and assessment data, the nurse's hypothesis is that the client's vital signs are most likely the result of disease process, medication use, or neither.

Options Disease process Medication use Neither
Blood pressure 130/86 mmHg
Respirations 28 breaths/minute
Temperature 98.9°F (37.1°C)
Heart rate 112 beats/minute
Oxygen saturation 88% on room air

Hint : 🫁Focus on signs that reflect impaired breathing or gas exchange.

Correct Answers

  • Blood pressure 130/86 mmHg [ Neither ]
  • Respirations 28 breaths/minute [ Disease process ]
  • Temperature 98.9°F (37.1°C) [ Neither ]
  • Heart rate 112 beats/minute [ Disease process ]
  • Oxygen saturation 88% on room air [ Disease process ]
Rationale :

😮Tachypnea (28 breaths/min) is a hallmark sign of an acute asthma exacerbation, caused by narrowed airways and increased work of breathing.

💓Tachycardia (HR 112 bpm) also occurs in asthma due to hypoxemia, stress, and beta-agonist use, making it attributable to the disease process or treatment.

💨Low oxygen saturation (88%) clearly reflects impaired gas exchange, a primary manifestation of the asthmatic disease process.

🩺Blood pressure within the range of 130/86 is not directly influenced by the asthma or medication and is classified as "neither".

🌡️Normal body temperature (98.9°F) does not indicate fever or hypothermia, and is unrelated to asthma or its treatment, so it’s considered "neither".

📌Core Message

Abnormal vital signs like tachypnea, tachycardia, and low oxygen saturation are directly associated with the acute asthma disease process, while blood pressure and temperature remain unaffected.

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6 :

A 34-year-old male client presents to the emergency department (ED) for an acute asthma attack which began after jogging through a local park. The client is able to answer questions, pausing every few words to catch his breath. The client reports using a rescue inhaler three times, but he just couldn't catch his breath.

The client reports that symptoms seem worse when outdoors and when exercising and that episodes like this make him extremely nervous. The client reports that it has been a couple of months since he had an asthma attack, and he came to the ED today because he noticed that his inhaler was expired and was worried the medication was not working.

Click the assessment data which indicates the interventions were successful and which assessment data provides no indication that the interventions were successful.

Options Successful Not successful
Lung sounds clear
Client can now speak in full sentences without pausing
Respirations 16 breaths/minute
Client reports, "It's a lot easier to breathe now."
Blood Pressure 122/84 mmHg

Hint : 🎯Look for both subjective and objective signs of improved breathing.

Correct Answers

  • Lung sounds clear [ Successful ]
  • Client can now speak in full sentences without pausing [ Successful ]
  • Respirations 16 breaths/minute [ Successful ]
  • Client reports, "It's a lot easier to breathe now." [ Successful ]
  • Blood Pressure 122/84 mmHg [ Not successful ]
Rationale :

🫁Clear lung sounds indicate that bronchospasms have resolved, signifying successful bronchodilator and anti-inflammatory therapy.

🗣️Speaking in full sentences without dyspnea is a major improvement from previous gasping between words, showing increased airway patency.

🌬️A respiratory rate of 16 breaths/min is within normal limits, confirming the client's improved ventilation status.

😊The client’s own report of easier breathing is a reliable and subjective indicator that interventions have worked.

🩺Blood pressure (122/84 mmHg), while normal, does not reflect respiratory improvement and is therefore not a reliable indicator of success in asthma care.

📌Core Message

Improvements in lung sounds, respiratory rate, ability to speak, and client feedback all point to effective asthma intervention, while blood pressure is not a direct respiratory indicator.

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7 :

Hint : 🧫Think about infection risk where the skin is breached by hardware.

Correct Answers:

  • Assess the pin sites for signs of infection.

Rationale :

🧼Pin site care is critical in clients with skeletal traction, as open pins through the skin provide a direct entry point for infection.

🧪Monitoring for redness, swelling, drainage, or odor allows for early detection of osteomyelitis or cellulitis.

🚫Removing traction is never done by nurses unless ordered; this could disrupt bone alignment and compromise healing.

🩹Pain medication should be given as needed, but strict around-the-clock dosing is not required unless indicated for unrelieved pain.

🩻Pulses proximal to the site are not as useful as distal pulses in assessing for neurovascular compromise in traction.

📌Core Message

For clients in skeletal traction, pin site assessment is essential for early detection of infection, a serious risk due to the presence of invasive fixation devices.

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8 :

A 59-year-old male client presents to the clinic reporting pain in the right great toe. The client says that the pain feels like it is another attack of gout, which he has had on 2 other occasions in the last 4 months. The client tells the nurses that the pain started about 9 days ago in the evening and that it got very painful and swollen shortly thereafter. In the past, the gout attacks have resolved without treatment after about 5 days, but the client reports that his condition has not improved and that he is unable to walk or work without excruciating pain in the great toe joint. The client has type 2 diabetes mellitus, osteoarthritis, hypertension, obesity, and sleep apnea. Currently, the client takes daily metformin, daily aspirin, daily enalapril, and ibuprofen as needed for pain. The client reports that he has never smoked or used tobacco products. He does not use recreational drugs. Typically, he drinks 2 to 3 dark beers nightly.

The healthcare provider is considering medications to treat the client's gout. For each medication used to treat gout, choose the most likely therapeutic outcome and the teaching associated with the medication.

Options Decreases Pain Manages Pain Reduces Inflammation Lowers Uric Acid Levels Minimize Alcohol Consumption Avoid Grapefruit Juice
Colchicine
Naproxen
Prednisone
Allopurinol

Hint : 🕵️Focus on which medications treat acute pain versus those that help prevent future flare-ups.

Correct Answers

  • Colchicine [ Decreases Pain ; Reduces Inflammation ; Minimize Alcohol Consumption ]
  • Naproxen [ Decreases Pain ; Manages Pain ; Reduces Inflammation ]
  • Prednisone [ Decreases Pain ; Reduces Inflammation ]
  • Allopurinol [ Lowers Uric Acid Levels ; Minimize Alcohol Consumption ; Avoid Grapefruit Juice ]
Rationale :

🧪Colchicine is used in the management of acute gout attacks, specifically for its ability to decrease pain and reduce inflammation by inhibiting neutrophil activity.

🍺Clients taking colchicine should be taught to minimize alcohol consumption, as alcohol raises serum uric acid levels and can worsen gout symptoms.

💊Naproxen, a nonsteroidal anti-inflammatory drug, works by managing pain, decreasing inflammation, and relieving discomfort during acute flares.

🌀Prednisone, a corticosteroid, is indicated when NSAIDs or colchicine are contraindicated, offering anti-inflammatory and pain-relieving effects.

🧬Allopurinol is not used for acute attacks but is crucial in long-term management as it lowers uric acid levels by inhibiting xanthine oxidase.

🚫Clients on allopurinol should avoid grapefruit juice, which may interfere with its metabolism, and limit alcohol, which increases uric acid levels.

📌Core Message

Colchicine, naproxen, and prednisone are used to relieve pain and inflammation during acute gout episodes, while allopurinol is used to lower uric acid and prevent recurrence, with important lifestyle precautions like avoiding grapefruit juice and limiting alcohol.

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9 :

Day 1, 1000

Serum uric acid, blood urea nitrogen (BUN), creatinine (Cr)

X-ray of right foot

 Day 1, 1015

Acetaminophen 650 mg PO now

Day 1, 1130

 Serum uric acid

9.1 mg/dL (0.54 mmol/L)

4.0 to 8.5 mg/dL (0.24 to 0.51 mmol/L)

Blood urea nitrogen 18 mg/dL (6.43 mmol/L)

 Reference range 10 το 20 mg/dL (3.6 to 7.1 mmol/L)

 Creatinine 0.9 mg/dL (80 µmol/L)

 Reference range 0.6 to 1.2 mg/dL (53 to 106 µmol/L)

The healthcare provider places orders to determine the extent of the client condition. Drag from Word Choices to complete the sentence. Based on the client's laboratory findings, the nurse recognizes that the client is having an acute gout attack and is most at risk forandin his affected joint

Hint : 🔬Look for local changes caused by uric acid crystal buildup, not trauma or infection.

Correct Answers

  • Blank 1 Correct Option: Inflammation
  • Blank 2 Correct Option: Erythema
Rationale :

🔥A serum uric acid level of 9.1 mg/dL confirms hyperuricemia, and the client’s signs and symptoms align with an acute gout attack, which is marked by inflammatory changes.

🌡️The client describes swelling and redness, and is unable to walk due to intense joint inflammation, the cardinal feature of gout.

🔴Erythema, or redness, commonly occurs over the affected joint due to vasodilation and local inflammatory processes.

🩺There is no sign of infection, bruising, or cyanosis, and the client's symptoms have persisted beyond the usual duration, making inflammatory gout the most likely process.

📌Core Message

The client’s clinical picture and elevated uric acid indicate acute gout, with expected findings of joint inflammation and erythema from the local immune response to urate crystals.

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10 :

Day 1, 1100

X-ray of right foot erosion of first metatarsal joint and preservation of joint space consistent with gout

The nurse is reviewing the client's dietary choices for opportunities to pro better outcomes by limiting gout attacks. Select the 3 dietary choices that are not part of the recommended diet gout.

Answer Options

Hint : 🐖Watch out for seafood and organ meats that release nitrogen waste after digestion.

Correct Answers:

  • Shrimp
  • Sardines
  • Liver

Rationale :

🐟Shrimp and sardines are high in purines, which are metabolized into uric acid, increasing the risk of gout flare-ups.

🥩Liver is an organ meat that contains an extremely high purine content, and its regular consumption is strongly discouraged in patients with gout.

📈Reducing dietary purines is essential to minimize the frequency and severity of gout attacks, especially in clients with recurrent episodes.

🥗Low-purine foods like quinoa, fruits, vegetables, and whole grains can help promote better metabolic outcomes and decrease uric acid buildup.

📌Core Message

High-purine foods such as shrimp, sardines, and liver increase uric acid production and should be avoided to prevent recurrent gout attacks.

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Total Questions: 10

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