3. RPN Priority and Delegation Test (Answer).doc
- 1. RPN -Priority and Delegation Practice Test (A): 1. The PN is working in a medical unit. The PN would expect to be assigned to which of the following patients? a. A 67 y/o male patient who is going to be discharged to home. b. A 55 y/o male patient, newly admitted, had chest pain episodes while in the ER. c. A 70 y/o female, with fractured tibia, on buck’s traction. d. A 22 y/o female came in with iron deficiency anemia, receiving blood transfusion. Answer: C – the patient with fractured tibia and on buck’s traction is the most stable and must be assigned to the PN. 2. There are 4 patients in the surgical unit. Sandy, the PN who was floated from Geriatric Unit would be assigned to: a. Patient A, 2nd post-op day, needs abdominal packing and dressing change. b. Patient B, pre-op for bone surgery in the morning. c. Patient C, elderly lady, involved in a motor vehicle accident, needs to be catheterized PRN. d. Patient D, few hours post cholecystectomy. Answer: C- Sandy will be more comfortable with the care of elderly patient. 3. A PN was floated to the surgical unit. Which of the following patients will the PN take? a. Rudy, 5 y/o, needs to be admitted for tonsillectomy. b. Sammy, 15 y/o, for discharge to home, after a successful removal of a benign cyst on his neck. c. Zack, 15 y/o, 2 hours post tonsillectomy, stable condition. d. Danny, 12 y/o, admitted with abdominal pain; R/O appendicitis. Answer: C- the most stable patient must be assigned to the RPN. 4. The PN has appropriately assigned which of the following responsibilities to Cynthia, a nursing assistant? a. TPR, I/O’s, and bed bath of 2 patients 3 days postop. b. Feeding a CVA patient for the first time. c. Accompany the patient, with history of chest pain, to radiology department for CXR. d. Accompany the patient with chest tubes to X-ray. Answer: A – taking vital signs is within the scope of the nursing assistant’s scope of practice. 5. Which of the following responsibilities must be delegated to the PN? a. Discharge teaching. b. Change the PICC line dressing. c. Give IM injection. d. Change the TPN bag. Answer: C- the PN is allowed to perform IM injection. 6. A Registered Nurse will assign which of the following patients to the PN? a. Newly post-op patient. b. Elderly patient with long-standing CHF. c. Patient who is receiving chemotherapy. d. Patient with chest tube. Answer: B – this is the most stable patient that can be assigned to the PN. 7. Which of the following patients can be assigned to the PN? a. Kathy, diagnosis of cystic fibrosis, needs postural drainage 4X/day. b. Manny, diagnosis Hemophilia, has platelet count of 50,000; needs blood transfusion. c. Eric, 10 y/o, came in with fever of unknown origin, T 104 F. d. David, diagnosis COPD, pH 7.25. Answer: A – postural drainage can be performed by the PN.
- 2. 8. The PN is working in the clinic. Which of the following patients must be referred first to the physician? a. Raymond, infant, came in with diarrhea and vomiting. b. Vincent 65 y/o, complains of blood in the urine for 3 days now. c. Rodney 54 y/o, history of asthma, wheezy. d. Albert 56 y/o, needs 12-lead-EKG -- yearly evaluation. Answer: A – diarrhea and vomiting cause dehydration in infant; the infant’s total body fluid is about 80% of the total body weight, this makes the infant very sensitive to dehydration. 9. The PN will assign which of the following patient to the nursing assistant? a. Annie, 80 y/o, BUN 40 mg/dl, SG 1.040, has fever. b. Tony, 75 y/o, S/P fall, possible fracture of the R ankle. c. Donald, 23 y/o, complains of unbearable back pain, went jogging yesterday. d. Glady, 23 y/o, complains of bleeding, R/O threatened abortion. Answer: C- this is the most stable patient and can be safely assigned to the nursing assistant. 10. The PN who is doing home visits will see which of these patients first? a. Patient with DM, blood sugar 240 mg/dl, does not know how to monitor blood sugar. b. Patient with DM, has wound on R foot-with mucopurulent secretions. c. Patient with DM, needs wound dressing and foot soak. d. Patient with diabetes, has not eaten breakfast, does not know how to monitor blood sugar. Answer: D – the patient has DM and has not eaten breakfast, this can lead to hypoglycemia. If hypoglycemia is not treated immediately can lead to irreversible brain damage 11. The PN that works in the clinic receives 4 clients. Which of the clients should be referred first to the physician? a. Mario, sustains leg injury from a fall; pedal pulse not palpable and extremity is cold to touch. b. Kate sustains cut while working in her garden and needed tetanus shot. c. Mr. R, 75 years old, came in for his blood pressure pills; BP 160/95. d. Tommy, 5 years old, febrile, 38°C, history of sore throat for 3 days. Answer: A – the patient is showing signs of compartment syndrome. Within 6 hours the patient must treated to prevent irreversible damage (necrosis from lack of circulation). 12. The PN will expect to be assigned to which of the following patients? a. 3-year-old admitted yesterday with croup. b. 5-year-old, post gastric lavage for ASA poisoning. c. 6-year-old admitted few days ago with acute hepatitis A. d. 10-year-old admitted for observation following an acute asthmatic attack. Answer: C – this is the least complicated and most stable patient. 13. The PN is making decisions regarding patient room assignment on a pediatric unit. Which possible roommate would be most appropriate for a 3 year-old child with leukemia? a. 2 year-old with acute bronchitis. b. 3 year-old who came in with chickenpox. c. 4 year-old who is recovering from tonsillectomy. d. 6 year-old with whooping cough. Answer: C - The nurse must know that children with sickle cell crisis are at high risk for development of infections. Therefore, these children must be protected from sources of possible infection. D is incorrect because whooping cough is due to a potentially infectious process. 14. Following change-of-shift report on an orthopedic unit, which client should the PN see first? a. Mercy, 56 years old, post hip replacement, complaining of pain on her left calf. b. John, 56 years old, with long leg cast, complaining of itchy skin under the cast. c. Mitz, 25 years old, newly admit from the recovery room, on skeletal traction. d. Lorie, 72 year-old, has laminectomy 4 hours ago.
- 3. Answer: A- pain on the left calf, post hip replacement is an indication of a serious complication, DVT. 15. Which of the following patients may need an order for wrist restraints? a. A 45-year-old ♂ who refuses to have an intravenous line started. b. An 18-month-old child who keeps pulling herself up and trying to climb out of her crib. c. A 55-year-old ♀ who is on bed rest and who tries to get up during the night. d. An 80-year-old ♀ who is confused and who tries to pull out her intravenous line. Answer: D – wrist restraint is needed on this patient to keep the IV in place. 16. Which of the following patients would be of most concern and cause for a lawsuit? a. A 75-year old patient confused and a jacket restraint was applied. b. A 55-year old patient who developed stage 4 decubitus ulcer in the hospital. c. A 40-year old obese patient with hypertension. d. An 80-year old who sustained large hematoma in her previous IV site. Answer: B – skin breakdown is usually preventable. 17. The PN on the evening shift begins rounds at 3:00 PM, which of the following patients should the PN address first? a. A patient who received an injection of Morphine in the morning. b. A patient who received NPH insulin before breakfast. c. An elderly patient who is soaking wet from urinary incontinence. d. A patient with cardiac problem just came back from echocardiogram. Answer: B – due to the peak effect of NPH, this patient must be assessed for possible hypoglycemia. 18. Which of the following reflects a violation of patient confidentiality? a. The PN informs the unit’s supervisor that a patient was tested positive for HIV. b. The PN informs the staff of a patient’s hepatitis B status. c. The PN explains to the spouse that the patient was newly diagnosed with HIV. d. The PN reports the case of the patient who died of AIDS to the coroner. Answer: C – the patient’s diagnosis, HIV, cannot be disclosed without the patient’s permission. 19. Which of the following clients is at greater risk for developing Laryngeal CA? a. A baseball player who is consistently uses smokeless tobacco. b. A businessman drinks 2 cans of beer before dinner daily. c. A company manager with chronic smoking habit. d. A young man working in an asbestos company. Answer: C – combined long-term use of alcohol & cigarettes substantially increases the risk of head and neck cancer. 20. The PN would expect to be assigned to which of the following patients? a. 3-year-old admitted just admitted with croup. b. 5-year-old, admitted with sickle cell crisis, being discharge today. c. 6-year-old with leg cast applied 2 days ago. d. 10-year-old admitted for observation following an acute asthmatic attack. Answer: C – this is the least complicated patient. 21. The nurse has performed the initial assessments of 4 patients admitted with an acute episode of asthma. Which assessment finding would cause the PN to inform the nurse immediately? a. The patient becomes more “wheezy”. b. The nurse cannot hear any wheezing in both lungs. c. The patient’s HR went up to 110 following the administration of albuterol. d. The patient coughed up large amount of bronchial secretions. Answer: B - Acute asthma is characterized by expiratory wheezes caused by obstruction of the airways. Wheezes are a high-pitched musical sound produced by air moving through narrowed airways. Patients often associate wheezes with the feeling of tightness in the chest. However, sudden cessation of wheezing is an ominous or bad sign that indicates an emergency -- the small airways are now collapsed.
- 4. 22. Which of the following statements made by the patient should the PN include in her documentation at the end of the shift? a. ‘That red, small pill is not given to me anymore.’ b. ‘I’ve never seen my attending physician since after surgery.’ c. ‘I did not have any bowel movement for the last 3 days.’ d. ‘It seems that I will never get over with the death of my husband.’ Answer: D – the patient is depressed and has a suicidal tendency. 23. You were about to give AM care, when the patient requested for pain medication after returning from surgery 24 hours ago. Which of the following group of nursing care should be the priority? a. Take VS; assess pain; do AM care. b. Give medication; take VS; assess pain; do AM care. c. Take VS; give medication; do AM care. d. Perform AM care; give medication; assess pain. Answer: C – vital signs must be assessed before pain medication is given. 23. Which of the following would PN do first? a. Pain medication, IM stat for severe, acute pain. b. Take blood sugar on a patient receiving TPN. c. Tracheostomy care. d. Insertion of foley catheter on a newly admitted patient. Answer: A—all other choices can wait. 24. Which of the following individuals is at greatest risk for experiencing cerebral vascular accident? a. A 50-year-old African-American male with history of hypertension. b. A 55-year-old Caucasian female who is obese. c. A 60-year-old African-American female who smokes. d. A 45-year-old Caucasian male with hypertension. Answer: A - This patient has the most factors of CVA: black race, gender, age, and cholesterol. 25. The team consists of one PN and 3 RN’s. The PN will expect to be assigned to which of the following patients? a. A recently extubated patient transferred from the ICU. b. A patient who is admitted with possible appendicitis. c. A newly admitted patient who requires initial physical assessment. d. A patient with pending surgery, developed urinary tract infection. Answer: D – this is the most stable patient. 26. The PN is assessing all these patients, which patient should be given priority? a. An 48-year-old admitted with DM, have tremors on hands. b. A 55-year old with prostate cancer. c. A 24-year-old for pre- op for cholecystectomy. d. A 45-year-old with possible abdominal aortic aneurysm, BP to be closely monitored. Answer: A – the patient has diabetes and showing symptoms of hypoglycemia. Hypoglycemia if not promptly treated may results to CNS damage. 27. The PN appropriately delegates which patient to the nurse’s aide: a. Taking a client’s vital signs before starting a blood transfusion. b. Changing a client’s central line dressing. c. Taking a blood pressure on a client complaining of chest pain. d. Obtaining specimen for culture from an infected wound. Answer: A – the nursing assistant is allowed to take vital signs on a stable patient
- 5. 28. Thirty-minutes after the blood transfusion was started, the patient complains of urticaria in the chest, abdomen and both thighs. The PN will implement which nursing action as a priority? a. Stop the infusion b. Slow the rate of infusion c. Take vital signs and observe for further deterioration d. Administer Benadryl and continue the infusion Answer: A - This is an indication of an allergy to the plasma protein. The priority action of the nurse is to stop the transfusion. 29. On the first following the application of long leg cast, the young girl complains of excruciating pain on the affected leg. Neurovascular assessment was performed. The PN would report which of the following findings to the charge nurse? a. Capillary refill 20 seconds. b. The child moves her toes but has difficulty raising the leg with cast. c. Light touch was perceived on the affected leg. d. The toes were cold to touch; toes wiggled. Answer: A - The findings are indicative of circulatory impairment. The health care provider (or practitioner) must be notified immediately. 30. At the well-baby clinic, the PN follows certain sequence of the baby’s assessment, this include: a. Weight; TPR b. RR, HR. weight c. TPR; weight d. Temp; weight; RR; HR Answer: B – perform the least invasive assessment to prevent agitation on the baby, thus, a more favorable results will be obtained. 31. On the second day of surgery, the mother reported fever and rapid respirations on her child. The PN checks the child’s temperature and it was 39°C. The first action taken by the PN should be to a. inform the charge nurse ASAP. b. encourage the child to drink more fluids. c. give a tepid sponge bath. d. administer the prescribed acetaminophen Answer: A – fever on the second day of surgery may indicate infection. The physician must be informed immediately to perform appropriate diagnostic testing and initiate prompt treatment. 32. The PN would question which of the following orders prescribed on the patient with ketocidosis? a. Run IV NS at 100 ml/hour. b. Perform acu checks for blood sugar every 2 hours. c. Administer NPH 20 units SC. d. Monitor hourly urine output. Answer: C - Regular insulin is fast acting insulin and it is given in ketoacidosis. NPH is intermediate acting and is not usually given in ketoacidosis. 33. Gastrostomy tube was placed on the patient with terminal stage of throat cancer. Feeding is started today. Prior to initiating the first gastrostomy feeding, the PN should perform which of the following? a. Measure residual feeding. b. Palpate the abdomen. c. Assess for breath sounds. d. Flush the tube with 50 ml of NS. Answer: D - Tube patency should be checked prior to all feedings. The feeding should not be attempted if the tube is not patent.
- 6. 34. Which of the following patients should you take care of first? a. A patient who is incontinent and needs to be changed. b. A patient who needs to be suctioned. c. A patient who needs her dressing changed. d. A patient who needs pain medication. Answer: B – airway is the top priority. 35. Two days postpartum, a patient who had a C-section delivery, complains of pain in the right leg. The PN should instruct the patient to a. apply warm compresses. b. massage the affected area. c. encourage range of motion exercises to promote circulation. d. maintain bed rest and notify the physician. Answer: D—this is a sign of DVT, the patient must be kept on bedrest to prevent embolism. 36. The PN may appropriately delegate which of the following to the nursing assistant? a. Take the patient’s vital signs before starting a blood transfusion. b. Change the patient’s central line dressing. c. Take blood pressure on a patient complaining of chest pain. d. Suction the patient’s tracheostomy tube. Answer: A – nursing assistants are allowed to take vital signs on stable patients. 37. The PN is delegating the tasks for effective team working with two nursing assistants and one PN. Appropriate task assignment was justified when the NA handles: a. Post-op client, s/p appendectomy 72 hours ago and needs to use the bedpan. b. MI client who needs to use the washroom. c. Newly admitted patient with a diagnosis of fever of unknown origin. d. Patient with swallowing difficulty and will start NG feedings for the first time. Answer: A - this is the most stable patient appropriate for the NA. 38. The PN assesses the patient’s IV site and finds that it is red, hot, and tender to touch. The most appropriate first nursing action is: a. Stop the infusion and remove the IV. b. Apply a warm soak to the site and reevaluate. c. Stop the infusion and restart the IV in the same area. d. Call the physician to evaluate. Answer: A – Stopping the infusion and removing the IV are actions taken for both local and systemic complication. 39. The nursing intervention that should be instituted immediately to relieve the symptoms associated with the patient’s hypoglycemic reaction include: a. Giving 8 oz of fruit juice with 2 tablespoon of sugar. b. Administering 5% dextrose solution IV. c. Withholding a subsequent dose of insulin. d. Providing a snack of cheese and dry crackers. Answer: A – this a simple CHO used in hypoglycemia. 40. At the end of the shift, the PN should include which of the following report as significant to the incoming shift? a. The client asked for NTG b. The client did not have bowel movement during the shift c. The client was tired after nursing care was provided d. The client refused to get out of bed Answer: A – this is an indication that the patient had chest pain episode during your shift.
- 7. 41. A patient has a bone marrow aspiration performed. Immediately after the procedure, the PN should: a. Position the patient on the affected side. b. Begin frequent monitoring of vital signs. c. Cleanse the site with an antiseptic solution. d. Briefly apply pressure over the aspiration site. Answer: D – brief pressure is generally enough to prevent bleeding