- Medical–Surgical: Respiratory
A 56-year-old patient with a history of COPD and hypertension presents with increased shortness of breath and yellow sputum production for the past three days. His respiratory rate is 28 breaths per minute, oxygen saturation is 88% on room air, and bilateral wheezing is observed. Blood gases show a pH of 7.32, PaCO2 60 mmHg, and HCO3- 29 mEq/L. What should the ADN-level nurse prioritize?
A. Increase oxygen through a nasal cannula to 6 L/min immediately.
B. Prepare the patient for immediate intubation due to the elevated PaCO2.
C. Encourage the patient to drink 2 liters of fluid right away.
D. Administer a short-acting bronchodilator as ordered and reassess lung sounds.
- Medical–Surgical: Endocrine
A 40-year-old patient with Type 1 diabetes presents with excessive thirst, vomiting, and rapid breathing. Blood glucose is 465 mg/dL. The patient is lethargic but responsive, with a fruity odor to the breath. What is the most appropriate first action for the ADN-level nurse?
A. Administer subcutaneous regular insulin and check glucose in 4 hours.
B. Initiate an IV infusion of normal saline and begin insulin drip therapy.
C. Restrict oral intake until glucose falls below 250 mg/dL.
D. Encourage the patient to drink clear fluids to reduce ketones.
- Leadership/Delegation
At the start of a med-surg shift, the ADN-level nurse is assigning tasks. Which delegation is most appropriate?
A. Assign the LPN to perform the initial admission assessment for a new post-op patient.
B. Delegate the UAP to teach a stable patient about wound care at discharge.
C. Direct the LPN to administer scheduled oral medications to stable patients.
D. Ask the UAP to assess a patient’s breath sounds while the nurse is handling another task.
- Maternal–Newborn
A postpartum patient who delivered vaginally 2 hours ago reports dizziness and feeling warm. Her peripad is saturated within 15 minutes, and the fundus feels boggy, 2 cm above the umbilicus. What is the ADN-level nurse’s first action?
A. Increase the IV fluid rate to wide open.
B. Establish a second IV line with blood tubing.
C. Apply pressure to the perineum to stop the bleeding.
D. Perform a fundal massage to promote uterine contraction.
- Pediatric
A 2-year-old child with pneumonia is restless, crying, and tachypneic. The last breathing treatment was 3 hours ago, and pulse oximetry shows 89% oxygen saturation on room air. What is the next most appropriate intervention?
A. Prepare for immediate intubation due to the low oxygen saturation.
B. Administer a PRN bronchodilator nebulizer treatment and reassess.
C. Advise the parent to calm the child and wait an hour before rechecking vital signs.
D. Increase the child’s oral fluid intake to support oxygenation.
- Mental Health
A 22-year-old patient with bipolar disorder is admitted during a manic phase. The patient is talking rapidly, pacing the hallway, and refusing to eat. What initial intervention would be most beneficial?
A. Offer a group therapy session to address the manic behaviors.
B. Place the patient in seclusion to reduce hyperactivity.
C. Provide finger foods in a calm, low-stimulation environment.
D. Administer a scheduled antidepressant to stabilize the patient’s mood.
- Geriatrics: Dementia vs. Delirium
An 84-year-old resident in a long-term care facility, who has mild dementia, suddenly becomes confused, restless, and experiences fluctuating levels of consciousness. This began 24 hours ago. What should the ADN-level nurse suspect first?
A. The patient may be experiencing acute delirium.
B. This may be a progression of the dementia.
C. A new diagnosis of schizophrenia may be emerging.
D. The patient’s medication adherence may have improved.
- Pharmacology: High-Alert Medications
A patient with atrial fibrillation is receiving a continuous heparin infusion. The ADN-level nurse notes that the aPTT is 98 seconds (therapeutic range 60–80 seconds). The patient has mild gum bleeding. What should the nurse do first?
A. Stop the heparin infusion and administer protamine sulfate.
B. Increase the infusion rate to achieve aPTT >100 seconds for improved anticoagulation.
C. Document the aPTT as normal since it is near therapeutic range.
D. Slow the heparin rate according to protocol and reassess the aPTT in 6 hours.
- Medical–Surgical: Cardiac
A 70-year-old patient complains of chest pressure radiating to the left arm for 30 minutes, unrelieved by rest. ECG shows ST elevations in leads II, III, and aVF. What is the highest priority intervention?
A. Administer sublingual nitroglycerin every 5 minutes for up to three doses.
B. Obtain consent for an immediate coronary artery bypass graft.
C. Educate the patient about low-cholesterol diets to prevent future issues.
D. Prepare to initiate a heparin infusion after consulting with the provider.
- Mental Health: Therapeutic Communication
A 33-year-old patient hospitalized for severe depression says, “I feel like everyone would be better off if I weren’t alive.” What is the most appropriate initial response by the ADN-level nurse?
A. “I’m sure you’re exaggerating—your family does care about you.”
B. “Let’s talk more about these thoughts. Are you considering harming yourself?”
C. “Have you mentioned this to your doctor?”
D. “You shouldn’t say things like that. It will upset your family.”
- Pediatrics: Vaccines
An 18-month-old child is brought to a well-child visit and is due for immunizations. Which set of vaccines should the ADN-level nurse prepare?
A. MMR, Varicella, Polio (IPV)
B. DTaP, Hib, Hepatitis B
C. Pneumococcal (PCV), Rotavirus, MMR
D. MMR, Varicella, Hepatitis A
- Leadership/Delegation: Prioritization
The ADN-level nurse receives report on four clients. Which client should the nurse assess first?
A. A client with peripheral artery disease experiencing mild intermittent claudication.
B. A client with type 2 diabetes and a blood glucose of 145 mg/dL before breakfast.
C. A client one day post-op hip replacement, reporting sudden dyspnea and chest tightness.
D. A client with COPD reporting increased sputum production but stable oxygen saturation of 90%.
- Maternal–Newborn: Labor Complication
A pregnant woman at 38 weeks arrives with strong contractions every 2 minutes, severe abdominal pain, and a rigid, board-like abdomen. The fetal heart rate is 100 bpm with late decelerations. What is the most likely complication?
A. Placenta Previa
B. Uterine Rupture
C. Abruptio Placentae
D. Cord Prolapse
- Medical–Surgical: Oncology
A 45-year-old patient receiving chemotherapy for breast cancer develops severe neutropenia (ANC <500). The patient reports a mild sore throat. What should the ADN-level nurse do first?
A. Obtain a stat order for IV antibiotics.
B. Advise increased fluid intake and rest.
C. Reassure the patient that a mild sore throat is common and check tomorrow.
D. Arrange for an antiemetic to control nausea from the chemotherapy.
- Geriatrics: Polypharmacy
An 82-year-old patient with hypertension, osteoarthritis, and mild dementia is on eight medications. The spouse reports increased confusion and frequent falls. What is the best intervention for the ADN-level nurse?
A. Increase the patient’s fluid intake to aid medication metabolism.
B. Tell the spouse that confusion is common in the elderly and to continue the medication regimen.
C. Advise the spouse to withhold the antihypertensive if the patient appears dizzy.
D. Consult with the pharmacist or provider for medication reconciliation and possible simplification.
Answer Key and Rationale
1. Answer: D. Administer a short-acting bronchodilator as ordered and reassess lung sounds.
Using a bronchodilator first targets the underlying bronchoconstriction in COPD exacerbations. Administering high-flow oxygen without addressing airway narrowing may lead to worsening CO2 retention. Improving airflow with medication first helps support ventilation before titrating oxygen therapy or reassessing ABGs.
2. Answer: B. Initiate an IV infusion of normal saline and begin an insulin drip protocol.
The patient shows signs of diabetic ketoacidosis, where aggressive hydration and insulin via IV are essential to stabilize blood sugar and reverse acidosis. Subcutaneous insulin acts too slowly in critical cases like this, and oral hydration isn’t appropriate until acute management begins.
3. Answer: Direct the LPN to administer scheduled oral medications to stable patients.
This task matches the LPN’s training and licensure. Initial assessments and education require RN involvement, while UAPs are not licensed to evaluate or teach. Delegating tasks appropriately ensures safe and efficient patient care.
4. Answer: D. Perform a fundal massage to promote uterine contraction.
A soft, elevated uterus after delivery signals uterine atony, a common cause of postpartum hemorrhage. Prompt fundal massage is needed to stimulate contraction and reduce bleeding. Fluid resuscitation may follow, but first, the uterus must be firmed.
5. Answer: B. Administer a PRN bronchodilator nebulizer treatment and reassess.
The child’s symptoms reflect respiratory distress, likely from bronchospasm. Immediate use of a bronchodilator can help improve oxygen levels. Other supportive measures may be useful later, but quick action is needed to reverse hypoxia.
6. Answer: C. Provide finger foods in a calm, low-stimulation environment.
During manic episodes, patients are often too distracted for full meals or group sessions. Simple foods they can eat while on the move, combined with a quiet setting, helps meet nutritional and environmental needs without overstimulation.
7. Answer: A. The patient may be experiencing acute delirium.
A rapid change in behavior and alertness strongly indicates delirium, especially in the elderly. Unlike dementia, which progresses slowly, delirium is abrupt and potentially reversible with treatment of the underlying cause, such as infection or medication side effects.
8. Answer: D. Slow the heparin rate according to protocol and reassess the aPTT in 6 hours.
The lab value and bleeding suggest mild over-anticoagulation. Rather than stopping the infusion completely or reversing it, decreasing the rate allows for safer management while monitoring for improvement, minimizing unnecessary risks.
9. Answer: Administer sublingual nitroglycerin every 5 minutes for up to three doses.
The patient shows signs of an acute myocardial infarction. Immediate nitroglycerin can ease chest discomfort and improve circulation. It’s a rapid, non-invasive intervention that can be given while awaiting further orders or provider evaluation.
10. Answer: B. “Let’s talk more about these thoughts. Are you considering harming yourself?”
This direct question opens the door for the patient to discuss suicidal thoughts, allowing for immediate risk assessment. Responses that dismiss or delay the issue fail to address potential danger. Early intervention is critical.
11. Answer: D. MMR, Varicella, Hepatitis A
At 18 months, children often receive these vaccines according to the standard schedule. The nurse should prepare for this expected combination unless catch-up or other immunization needs are identified. Other vaccines like DTaP may have been completed earlier or scheduled differently.
12. Answer: C. A client one day post-op hip replacement, reporting sudden dyspnea and chest tightness.
These symptoms are red flags for a potential pulmonary embolism, a post-op emergency. Unlike stable complaints, this situation requires immediate evaluation to prevent deterioration. Time-sensitive complications should always take priority.
13. Answer: C. Abruptio Placentae
Classic signs include intense pain, a tense abdomen, and signs of fetal compromise. Unlike placenta previa, which is usually painless, abruptio placentae involves placental detachment, disrupting oxygen to the fetus and requiring urgent intervention.
14. Answer: A. Obtain a stat order for IV antibiotics.
In neutropenic patients, minor symptoms can progress quickly into life-threatening infections. Early antibiotic treatment is critical even before full symptoms appear. Waiting or providing comfort measures delays potentially life-saving care.
15. Answer: D. Consult with the pharmacist or provider for medication reconciliation and possible simplification.
Managing multiple medications in elderly patients is challenging and often leads to adverse effects. Rather than adjusting doses based on symptoms alone, reviewing and possibly adjusting the overall regimen can reduce confusion and prevent falls.
Apperture Labs 