1. The charge nurse on the medical-surgical unit is completing the assignments for day shift.

Which of these patients would the charge nurse assign to the LPN/LVN? A) The patient with heart failure who has gained 3 pounds since the previous day B) The older patient with poor skin turgor who has a serum osmolarity of 300 mOsm/L C) The patient with chronic renal failure who has a serum potassium level of 6 mEq/L D) The older patient with 3+ peripheral edema who has crackles throughout the posterior chest Feedback: INCORRECT Although the patient has poor skin turgor, the serum osmolarity indicates that fluid balance is normal; this patient is the most stable of the four patients described. The data about the other patients indicate that they are less stable and that assessments and interventions by an RN are needed. Points Earned: 0.0/1.0 Correct Answer(s): B 2. When making staff assignments, which of these staff members is appropriate to assign to care for the 69year-old patient with uncontrolled diabetes, polyuria, and a blood pressure of 86/46? A) An RN who usually works as a diabetic educator B) An LPN/LVN who frequently administers medications to multiple patients C) An RN who has floated from the intensive care unit D) An LPN/LVN who has floated from the hospitals long-term care unit Feedback: INCORRECT The clinical manifestations suggest that the patient is experiencing hypovolemia and possible hypovolemic shock. The RN who floated from the intensive care unit will have extensive experience caring for patients with hypovolemia. The other staff members will not be as familiar with the care for critically ill patients. Points Earned: 0.0/1.0 Correct Answer(s): C

3. All of these nursing actions are included in the plan of care for a 72-year-old resident of a long-term care facility who has a history of dehydration. Which action can the RN delegate to a nursing assistant? A) Choose appropriate oral fluids for the resident. B) Monitor the residents skin turgor for tenting. C) Assess the residents oral mucosa for dryness. D) Offer the resident fluids to drink every hour. Feedback: INCORRECT Encouraging a patient to take oral fluids is within the scope of practice for nursing assistants. Choice of appropriate fluids and assessments of the patient's fluid status should be done by licensed nursing staff, who have the needed education and scope of practice to implement these more complex actions.

Points Earned:

0.0/1.0

Correct Answer(s): D

4. The RN is providing care for a patient with end-stage liver disease and ascites. Which of these duties can the RN delegate to a nursing assistant (NA)? A) Place the patient in a semi-Fowlers position. B) Assess skin integrity and abdominal distention. C) Draw blood from a central venous line for electrolyte studies. D) Evaluate laboratory study results for the presence of hypokalemia. Feedback: CORRECT Positioning the patient in a semi-Fowler's position is included in nursing assistant education and scope of practice, although the RN will need to supervise the NA's care and evaluate the effect of the semi-Fowler's position on patient comfort and breathing. Assessment, evaluation, and complex skills such as obtaining blood from a central line should be done by the RN. Points Earned: 1.0/1.0 Correct Answer(s): A 5. Which of these newly written physician prescriptions should the nurse implement first? A) Administration of oral calcium supplements to a patient with severe osteoporosis B) Administration of IV normal saline to a patient with a serum sodium of 132 mEq/L C) Administration of oral potassium supplements to a patient whose serum potassium is 3 mEq/L D) Administration of oral phosphorus supplements to a patient who has acute hypophosphatemia Feedback: INCORRECT Because minor changes in serum potassium level can cause life-threatening dysrhythmias, the first priority should be to administer the potassium supplements to the patient with hypokalemia. The electrolyte disturbances in the other patients are not immediately life threatening. Points Earned: 0.0/1.0 Correct Answer(s): C 6. The physician writes all of these prescriptions for a patient who has been admitted with a serum potassium level of 6.9 mEq/L. Which prescription should the nurse implement first? A) Request a potassium-restricted diet. B) Place the patient on a cardiac monitor. C) Teach the patient about which foods are high in potassium. D) Administer sodium polystyrene sulfonate (Kayexalate) orally.

Feedback: INCORRECT Because hyperkalemia can lead to life-threatening bradycardia, the initial action should be to place the patient on a cardiac monitor. The other actions are also appropriate but will not immediately decrease the serum potassium level and do not need to be implemented as quickly as monitoring the cardiac rhythm. Points Earned: 0.0/1.0 Correct Answer(s): B 7. The nurse manager of the medical-surgical unit assigns which of these patients to the LPN/LVN? A) The patient who was admitted with dehydration who has a heart rate of 126 B) The patient who was admitted with hyperkalemia and who takes a potassium-sparing diuretic at home C) The patient who was admitted yesterday with heart failure and who still has dependent pedal edema D) The patient who has just been admitted with severe nausea, vomiting, and diarrhea Feedback: INCORRECT Because the patient with heart failure is the most stable of the four patients, this patient is most appropriate to assign to the LPN/LVN. The data about the other patients indicate that they are more unstable and should be cared for by RN staff members. Points Earned: 0.0/1.0 Correct Answer(s): C 8. The RN delegates which of these nursing actions to a nursing assistant who is helping with the care of a patient admitted with a fluid volume deficit that requires a blood transfusion? A) Inserting a small-gauge IV access B) Explaining the purpose of the blood transfusion C) Obtaining the baseline vital signs before blood administration D) Evaluating a headache that develops during the transfusion Feedback: INCORRECT Nursing assistant education includes assessment of vital signs. The other actions require more education and scope of practice and should be done by licensed staff members. Points Earned: 0.0/1.0 Correct Answer(s): C 9. The RN delegates which of these nursing actions to the nursing assistant who is assisting with the care of a patient with fluid volume deficit? A) Provide oral care every 1 to 2 hours. B) Infuse 500 mL of normal saline over 60 minutes. C) Monitor IV fluid to maintain the drip rate at 75 mL/hr. D) Apply a jacket restraint to protect the patient from falling.

Feedback: CORRECT Frequent oral care is an important intervention for a patient with fluid volume deficit and is appropriate to delegate to a nursing assistant. The other actions are more complex and should be accomplished by licensed personnel. Points Earned: 1.0/1.0 Correct Answer(s): A 10. After receiving change-of-shift report, which of these patients should the RN assess first? A) The patient admitted with nausea and vomiting who complains of dizziness when standing B) The patient with a nasogastric tube who has dry oral mucosa and complains of thirst C) The patient who has been receiving IV diuretics whose blood pressure is 95/52 mm Hg D) The patient who has normal saline infusing at 150 mL/hr whose urine output is 100 mL/hr Feedback: INCORRECT The patient's history of receiving IV diuretics and low blood pressure indicate that the patient may be experiencing hypoperfusion caused by hypovolemia and that immediate assessment and interventions are needed. The data about the other patients indicates that they have less-urgent problems. Points Earned: 0.0/1.0 Correct Answer(s): C 11. The RN is assessing a 70-year-old patient admitted to the nursing unit with fluid volume deficit. Which of these assessments requires the most immediate intervention by the nurse? A) Urine output of 950 mL for the past 24 hours B) Poor skin turgor with tenting remaining for 2 minutes after pinching the skin C) Deep furrows on the surface of the tongue D) Patient behavior that changes from anxious and restless to lethargic and confused Feedback: INCORRECT The patient's change in level of consciousness suggests poor cerebral blood flow or shrinkage or swelling of brain cells caused by fluid shifts within the brain cells. These changes indicate a need for immediate intervention to prevent further damage to cerebral function. The other assessment data also are caused by the fluid volume deficit but do not indicate complications of dehydration that are immediately life threatening. Points Earned: 0.0/1.0 Correct Answer(s): D 12. The nurse manager of the medical-surgical unit is completing the assignments for day shift. Which of these patients is most appropriate to assign to the LPN/LVN? A) The patient with a calcium level of 9.5 mg/dL B) The patient with a sodium level of 120 mEq/L

C) The patient with a potassium level of 6.0 mEq/L D) The patient with a magnesium level of 4.1 mEq/L Feedback: CORRECT Because this patient's calcium level is within normal limits, it is appropriate to assign the patient to an LPN/LVN. The other patients have abnormalities in their electrolytes that could cause serious complications and will need assessments and/or interventions by the RN. Points Earned: 1.0/1.0 Correct Answer(s): A 13. A 90-year-old patient with hypermagnesemia is admitted to the emergency department (ED). The ED charge nurse will anticipate that the patient will be admitted to which inpatient unit? A) Telemetry unit B) Medical unit C) Dialysis unit D) Geriatric unit Feedback: CORRECT Because hypermagnesemia causes changes in the electrocardiogram that may result in cardiac arrest, the patient should be admitted to the telemetry unit. Medical, geriatric, and dialysis units typically do not have cardiac monitoring capabilities. Points Earned: 1.0/1.0 Correct Answer(s): A 14. The home health care RN will delegate which of these to the home care aide for the care of the patient discharged home with mild hypokalemia caused by diuretic use? A) Instruction on the proper use of drugs B) Assessment of the muscle tone and strength C) Education about potassium-rich foods D) Measurement of the patients urine output Feedback: INCORRECT A home care aide may measure the patient's intake and output, which would then be reported to the RN. Education and assessment are higher-level nursing actions that should be done by the RN. Points Earned: 0.0/1.0 Correct Answer(s): D 15. The plan of care for a patient with hypocalcemia includes all of these nursing actions. Which action is appropriate for the RN to delegate to a nursing assistant? A) Transferring the patient from the bed to a stretcher using a lift sheet B) Implementing seizure precautions

C) Collaborating with the dietitian to provide calcium-rich foods for the patient D) Evaluating laboratory results Feedback: CORRECT Transferring patients is a nursing skill that is included in nursing assistant education and scope of practice. The other actions require more education and scope of practice and should be done by licensed nursing personnel. Points Earned: 1.0/1.0 Correct Answer(s): A 16. Which of these assessments should be completed first for the patient admitted to the nursing unit with a diagnosis of hypokalemia? A) Determine the level of consciousness. B) Check the deep tendon reflexes. C) Obtain the pulse oximetry. D) Listen for bowel sounds. Feedback: INCORRECT Because hypokalemia may cause respiratory insufficiency and respiratory arrest, the patient's respiratory status should be assessed first. The other assessment data may also change in a patient with hypokalemia but are not immediately life threatening. Points Earned: 0.0/1.0 Correct Answer(s): C

1. The charge nurse on the medical-surgical unit is completing the assignments for day shift. Which of these patients would the charge nurse assign to the LPN/LVN? A) The patient with heart failure who has gained 3 pounds since the previous day B) The older patient with poor skin turgor who has a serum osmolarity of 300 mOsm/L

C) The patient with chronic renal failure who has a serum potassium level of 6 mEq/L D) The older patient with 3+ peripheral edema who has crackles throughout the posterior chest 2. When making staff assignments, which of these staff members is appropriate to assign to care for the 69-year-old patient with uncontrolled diabetes, polyuria, and a blood pressure of 86/46? A) An RN who usually works as a diabetic educator B) An LPN/LVN who frequently administers medications to multiple patients C) An RN who has floated from the intensive care unit D) An LPN/LVN who has floated from the hospitals long-term care unit 3. All of these nursing actions are included in the plan of care for a 72-year-old resident of a long-term care facility who has a history of dehydration. Which action can the RN delegate to a nursing assistant? A) Choose appropriate oral fluids for the resident. B) Monitor the residents skin turgor for tenting. C) Assess the residents oral mucosa for dryness. D) Offer the resident fluids to drink every hour. 4. The RN is providing care for a patient with end-stage liver disease and ascites. Which of these duties can the RN delegate to a nursing assistant (NA)? A) Place the patient in a semi-Fowlers position. B) Assess skin integrity and abdominal distention. C) Draw blood from a central venous line for electrolyte studies. D) Evaluate laboratory study results for the presence of hypokalemia. 5. Which of these newly written physician prescriptions should the nurse implement first? A) Administration of oral calcium supplements to a patient with severe osteoporosis B) Administration of IV normal saline to a patient with a serum sodium of 132 mEq/L

C) Administration of oral potassium supplements to a patient whose serum potassium is 3 mEq/L D) Administration of oral phosphorus supplements to a patient who has acute hypophosphatemia

6. The physician writes all of these prescriptions for a patient who has been admitted with a serum potassium level of 6.9 mEq/L. Which prescription should the nurse implement first? A) Request a potassium-restricted diet. B) Place the patient on a cardiac monitor. C) Teach the patient about which foods are high in potassium. D) Administer sodium polystyrene sulfonate (Kayexalate) orally. 7. The nurse manager of the medical-surgical unit assigns which of these patients to the LPN/LVN? A) The patient who was admitted with dehydration who has a heart rate of 126 B) The patient who was admitted with hyperkalemia and who takes a potassium-sparing diuretic at home C) The patient who was admitted yesterday with heart failure and who still has dependent pedal edema D) The patient who has just been admitted with severe nausea, vomiting, and diarrhea 8. The RN delegates which of these nursing actions to a nursing assistant who is helping with the care of a patient admitted with a fluid volume deficit that requires a blood transfusion? A) Inserting a small-gauge IV access B) Explaining the purpose of the blood transfusion C) Obtaining the baseline vital signs before blood administration D) Evaluating a headache that develops during the transfusion 9.

The RN delegates which of these nursing actions to the nursing assistant who is assisting with the care of a patient with fluid volume deficit? A) Provide oral care every 1 to 2 hours. B) Infuse 500 mL of normal saline over 60 minutes. C) Monitor IV fluid to maintain the drip rate at 75 mL/hr. D) Apply a jacket restraint to protect the patient from falling. 10. After receiving change-of-shift report, which of these patients should the RN assess first? A) The patient admitted with nausea and vomiting who complains of dizziness when standing B) The patient with a nasogastric tube who has dry oral mucosa and complains of thirst C) The patient who has been receiving IV diuretics whose blood pressure is 95/52 mm Hg D) The patient who has normal saline infusing at 150 mL/hr whose urine output is 100 mL/hr

11. The RN is assessing a 70-year-old patient admitted to the nursing unit with fluid volume deficit. Which of these assessments requires the most immediate intervention by the nurse? A) Urine output of 950 mL for the past 24 hours B) Poor skin turgor with tenting remaining for 2 minutes after pinching the skin C) Deep furrows on the surface of the tongue D) Patient behavior that changes from anxious and restless to lethargic and confused 12. The nurse manager of the medical-surgical unit is completing the assignments for day shift. Which of these patients is most appropriate to assign to the LPN/LVN? A) The patient with a calcium level of 9.5 mg/dL B) The patient with a sodium level of 120 mEq/L

C) The patient with a potassium level of 6.0 mEq/L D) The patient with a magnesium level of 4.1 mEq/L 13. A 90-year-old patient with hypermagnesemia is admitted to the emergency department (ED). The ED charge nurse will anticipate that the patient will be admitted to which inpatient unit? A) Telemetry unit B) Medical unit C) Dialysis unit D) Geriatric unit 14. The home health care RN will delegate which of these to the home care aide for the care of the patient discharged home with mild hypokalemia caused by diuretic use? A) Instruction on the proper use of drugs B) Assessment of the muscle tone and strength C) Education about potassium-rich foods D) Measurement of the patients urine output 15. The plan of care for a patient with hypocalcemia includes all of these nursing actions. Which action is appropriate for the RN to delegate to a nursing assistant? A) Transferring the patient from the bed to a stretcher using a lift sheet B) Implementing seizure precautions C) Collaborating with the dietitian to provide calcium-rich foods for the patient D) Evaluating laboratory results

16. Which of these assessments should be completed first for the patient admitted to the nursing unit with a diagnosis of hypokalemia? A) Determine the level of consciousness. B) Check the deep tendon reflexes.

C) Obtain the pulse oximetry. D) Listen for bowel sounds.