Leadership and Management Simulator 1

Question 1 of 50

The nurse is assigned to care for four clients on a medical-surgical unit. Which client would the nurse assess first?

A client with COPD and an oxygen saturation of 89% on room air
A client with small bowel obstruction (SBO) and dementia who keeps touching the NG tube
A client with benign prostate hyperplasia (BPH) who reports not being able to void in 12 hours
A client with acute pancreatitis and epigastric pain rated as a 10 on a 0 to 10 pain scale; the client is reported to have a hard and rigid abdomen

Question 2 of 50

The nurse is triaging clients in the waiting room of the emergency department. In what order would the nurse triage the clients from highest priority to lowest?

Sort elements

A client who is complaining of paresthesia and of having difficulty when swallowing.
A client with a history of hypertension who is complaining of dizziness.
A client who fell off a ladder who has a superficial wound on the forehead.
A client who ran out of medication and is requesting to see a primary health care provider.

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Question 3 of 50

The nurse just received shift hand-off and is preparing for the day. Which client would the nurse see first?

A client with a Foley catheter who is complaining of bladder pressure
A client with a mean arterial pressure (MAP) reading of 100 mm Hg
A client with a productive cough who is requesting pain medication for chest pain
A client requiring a 12-lead electrocardiogram (ECG) for suspicion of ST-segment elevation, noted on the cardiac monitor

Question 4 of 50

The nurse has received the client assignment for the day. Which client would the nurse care for first?

A client asking to leave against medical advice (AMA)
A client who is a fall risk and needs assistance to the bathroom
A client needing medication before breakfast because it is a timed dose
A client recently admitted after a motor vehicle accident still in cervical spine precautions

Question 5 of 50

The nurse is working on a medical-surgical unit. Which client would the nurse see first based on the client’s risk for experiencing delirium?

A client being treated for hypertension
A client recovering from hip replacement surgery
A client being treated for a urinary tract infection (UTI)
A client transferred from the intensive care unit after being treated for sepsis

Question 6 of 50

The nurse just received the client assignments for the day. Which client would the nurse see first?

The client who is agitated following surgery
The client requesting to speak to the charge nurse
The client requesting medications before breakfast
The client slumped down in bed with an oxygen saturation of 94%

Question 7 of 50

After receiving client assignments for the day, the nurse prioritizes seeing which client first?

A client who needs help with bathing
A client awaiting discharge instructions and intravenous line removal
A client with pneumonia who complains about using the incentive spirometer
A client admitted for a gastrointestinal (GI) bleed with stable hemoglobin and hematocrit

Question 8 of 50

The nurse is caring for a client receiving hemodialysis. The client begins to experience dyspnea, tachypnea, chest pain, low oxygen saturation, and hypotension. The nurse suspects an air embolism. Place the actions that the nurse would take in order of priority. All options must be used.

Administer oxygen.
Assess vital signs.
Stop the hemodialysis.
Turn the client on the left side, with the head down.
Notify the primary health care provider.
Document the event and the client's response.

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Question 9 of 50

The nurse is triaging pediatric clients as they arrive to the emergency department after a school bus accident. In what order would the nurse triage the victims from highest priority to lowest? All options must be used.

Child with a closed head wound and multiple compound fractures of the arms and legs
Sobbing child with several minor lacerations on the face, arms, and legs
Child with a simple fracture of the arm complaining of arm pain
Confused child with bright red blood pulsating from a leg wound

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Question 10 of 50

The nurse working in the emergency department has four charts of clients who need to be assessed. Which client would be assessed first?

An elderly client who has obvious signs of neglect
A homeless client who has an open wound on his leg
A client with cancer being admitted for chemotherapy
A client with a history of schizophrenia threatening to harm themself

Question 11 of 50

Which client would the emergency department triage nurse classify as emergent?

A client with a displaced fracture who is crying
A client with a simple laceration and soft tissue injury
A client with crushing substernal pain who is short of breath
A client with a temperature of 101° F (38.3° C) with a productive cough

Question 12 of 50

The nurse in charge of a nursing unit is asked to select the hospitalized clients who can be discharged so that hospital beds can be made available for victims of a community disaster. Select the clients who can be safely discharged. Select all that apply.

A client with dyspnea
A client experiencing sinus rhythm
A client receiving oral anticoagulants
A client with chronic atrial fibrillation
A client experiencing third-degree heart block
A client who has not voided since before surgery

Question 13 of 50

The nurse in charge of a nursing unit is asked to select those hospitalized clients who can be discharged so that hospital beds can be made available for victims of a community disaster. Which clients can the nurse plan to safely discharge? Select all that apply.

The client with heart failure (HF) who has bilateral rhonchi
The client who 24 hours earlier gave birth to a second child by cesarean delivery
The 48-hour postoperative client who has undergone an ileostomy because of ulcerative colitis
The client with peritonitis caused by a ruptured appendix who is febrile with a temperature of 102° F (38.9° C)
The 2-day postoperative client who has undergone total knee replacement and is ambulating with a walker
The 3-day postoperative client who has undergone coronary artery bypass grafting and is ready for rehabilitation

Question 14 of 50

The nurse in charge of a nursing unit is asked to select the hospitalized clients who can be discharged so that hospital beds can be made available for victims of a community disaster. Which clients can be safely discharged? Select all that apply.

A client with chest pain
A client with a Holter monitor
A client receiving oral antibiotics
A client experiencing sinus rhythm
A client newly diagnosed with atrial fibrillation
A client experiencing third-degree heart block who requires a pacemaker

Question 15 of 50

The nurse is the first responder at the scene of a six-car crash on a highway. Which victim would the nurse attend to first?

A victim experiencing dyspnea
A victim experiencing confusion
A victim experiencing tachycardia
A victim experiencing intense pain

Question 16 of 50

The nurse employed in an emergency department is assigned to triage clients coming to the emergency department for treatment on the evening shift. The nurse would assign priority to which client?

A client complaining of muscle aches, a headache, and history of seizures
A client who twisted the ankle when rollerblading and is requesting medication for pain
A client with a minor laceration on the index finger sustained while cutting an eggplant
A client with chest pain who states just ate pizza that was made with a very spicy sauce

Question 17 of 50

After correctly completing the rights of medication administration, performing hand hygiene, and ensuring the correct position of the client, which steps would the nurse take to administer medication via a volume control container? Arrange the actions in the order that they would be performed. All options must be used.

Close the clamp and check to be sure that clamp on air vent volume control container is open.
Dispose of the syringe in puncture-proof and leak-proof container. Discard supplies and perform hand hygiene.
Clean injection port on top of volume control container with an antiseptic swab.
Regulate intravenous (IV) infusion rate to allow medication to infuse in the time recommended by institutional policies.
Remove the needle cap and insert the needleless syringe tip through the port. Then inject the medication and label the volume control container with the name of the medication, dosage, total volume including diluents, and time of administration.
Fill volume control container with desired amount of IV fluid by opening clamp between volume control container and main IV bag.

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Question 18 of 50

The nurse is monitoring a client in labor who is receiving oxytocin and notes that the client is experiencing hypertonic uterine contractions. In order of priority, how would the nurse plan the actions to take? Arrange the actions in the order that they would be performed. All options must be used.

Reposition the client.
Administer medication as prescribed to reduce uterine activity.
Administer oxygen by face mask at 8 to 10 L/min.
Check the client's blood pressure.
Perform a vaginal examination.
Stop the oxytocin infusion.

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Question 19 of 50

A unit of packed red blood cells has been ordered for a client with low hemoglobin and hematocrit, and typing and crossmatching has been done. The nurse receives a telephone call from the blood bank and is informed that the unit of blood is ready for administration. In order of priority, how would the nurse plan the actions to take? Arrange the actions in the order that they would be performed. All options must be used.

Hang the bag of blood.
Insert an 18- or 19-gauge intravenous catheter into the client.
Ask a licensed nurse to assist in confirming blood compatibility and verifying client identity.
Ensure that an informed consent has been signed.
Obtain the unit of blood from the blood bank.
Verify the primary health care provider's (PHCP's) prescription for the blood transfusion.

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Question 20 of 50

A home health care nurse is planning client visits and nursing activities for the day. The nurse begins the visits at 9:00 a.m. All clients live within a 5-mile radius. In order of priority, how would the nurse plan the assignments for the day? Arrange the actions in the order that they would be performed. All options must be used.

A client with diabetes mellitus who needs a fasting blood glucose level drawn
The second dressing change for a client requiring twice-daily dressing changes
A client requiring supervision of a dressing change
The first dressing change for a client requiring twice-daily dressing changes
A client being visited by the home health aide at 10:30 a.m.
A client requiring an admission assessment to home health care

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Question 21 of 50

The nurse assigned to four clients reviews client data at the beginning of the shift. To which information would the nurse give highest priority?

Urine output 240 mL/8 hr
Pulse oximetry reading 89%
Hemoglobin 12.2 g/dL (122 mmol/L)
Potassium level 3.6 mEq/L (3.6 mmol/L)

Question 22 of 50

When planning care, which client would the nurse assess first?

The client with a chest tube for a pneumothorax
The client who had a cholecystectomy 2 days earlier
The client who is receiving total parenteral nutrition and lipids
The client who is on contact isolation for methicillin-resistant Staphylococcus aureus (MRSA)

Question 23 of 50

The nurse determines that which client has the highest priority needs?

The client who has a rectal temperature of 99.8° F
The client who has a blood pressure of 110/70 mm Hg
The client who has an oxygen saturation percentage of 95%
The client who has an irregular apical pulse of 120 beats per minute

Question 24 of 50

The nurse has received the client assignment for the day. Which client would the nurse care for first?

The 43-year-old client admitted for observation who has absence of bowel sounds
The 53-year-old client with heart failure who has gained 4 lb (1.8 kg) since yesterday and is short of breath
The 49-year-old client who is scheduled for surgery within the next 2 hours and will undergo a hysterectomy
The 12-hour postoperative client who has undergone pneumonectomy and is completing a blood transfusion

Question 25 of 50

The nurse is the first responder at the scene of an accident in which a tire blowout caused a bus to roll over several times. Which victim would the nurse attend to first?

The 11-year-old with burns to 10% of both legs
The sobbing 10-year-old with an obvious fracture of the forearm
The unconscious 14-year-old whose breathing is shallow at 12 respirations per minute
The confused 12-year-old with bright red blood pulsing from an open fracture of the femur

Question 26 of 50

The nurse manager of a medical-surgical unit is asked to select the hospitalized clients who can be discharged so that hospital beds can be made available for victims of a community disaster. Which clients can be safely discharged? Select all that apply.

Client postoperative day 1 after inguinal herniorrhaphy, vital signs stable
Client 5 days after a myocardial infarction, vital signs stable, absence of dysrhythmias
Client 1 day after cardiac catheterization, normal study results, groin site free of hematoma
Client who is vomiting, unable to take oral fluids, and receiving intravenous fluids at 125 mL/hr
Client on nasal oxygen at 3 L/min, bibasilar crackles, and pulse oximetry readings of 88% to 92%
Client with white blood cell count of 2200 mm3 (2.2 × 109/L), temperature of 102° F (38.9° C), and blood pressure of 90/40 mm Hg

Question 27 of 50

The nurse is a responder at the scene of a building collapse. Which victim would the nurse care for first?

Victim with an open fracture of the left lower extremity
Victim who is crying hysterically and complaining of pain in the right ankle
Victim who is unresponsive and not breathing and whose left pupil is fixed and dilated
Victim with an apparent chest wall defect and asymmetrical chest wall movement

Question 28 of 50

The nurse has received the client assignment for the day. Which client would the nurse check first?

A client experiencing severe pain
A client who is hearing voices
A client who is in four-point leather restraints
A client who has just returned from surgery

Question 29 of 50

The nurse has received the client assignment for the day. Which client would the nurse care for first?

The client receiving chemotherapy who is on day 3 of a 5-day regimen and has a question about nutrition
The client receiving external radiation who has complaints of dryness and itching skin at the treatment area
The client who had a radical mastectomy 36 hours ago and is complaining of tightness and pulling at the incision site
The client admitted with a medical diagnosis of neutropenia who is afebrile and is complaining of pain with urination

Question 30 of 50

The nurse has received the client assignment for the day. Which client would the nurse care for first?

A client requiring a preoperative intravenous antibiotic
A client with emphysema who has shortness of breath after just ambulating
A client with serous drainage on an incisional spinal wound post laminectomy
A client with postoperative pain reported at 7 out of 10, with 10 being the worst

Question 31 of 50

The nurse is assigned to care for four clients. Which client would the nurse assess first?

A client who has a tympanic temperature of 99.8° F
A client who has a regular radial pulse of 96 beats/min
A client who has a supine resting blood pressure of 148/90 mm Hg
A client who has a peripheral (index finger) oxygen saturation percentage of 85%

Question 32 of 50

An emergency department nurse is preparing to receive four clients as a result of a motor vehicle crash. Which victim would the nurse attend to first?

A child with a bleeding laceration
A client with a fractured wrist
A client with first-degree burns on the hands and arms
A client with chest pain, shortness of breath, and diaphoresis

Question 33 of 50

A hospitalized client with type 1 diabetes mellitus received Humulin N and Humulin R insulin 2 hours ago (at 7:30 a.m.). The client calls the nurse and reports is feeling hungry, shaky, and weak. The client ate breakfast at 8:00 a.m. and is due to eat lunch at noon. Arrange the actions that the nurse will take in the order that they would be performed. All options must be used.

Retest the blood glucose level.
Take the client's vital signs.
Document the client's complaints, actions taken, and outcome.
Give the client a small snack of carbohydrate and protein.
Check the client's blood glucose level.
Give the client ½ cup (118 mL) of fruit juice to drink.

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Question 34 of 50

The nursing instructor asks the nursing student to identify the priorities of care for an assigned client. The nursing instructor determines that the nursing student understands the client’s needs when which statement is made?

"Actual or life-threatening concerns are the priority."
"Completing care in a reasonable time frame is the priority."
"Time constraints related to the client's needs are the priority."
"Obtaining the needed supplies to care for the client is the priority."

Question 35 of 50

The emergency department nurse is caring for a child with suspected epiglottitis and has ensured that the child has a patent airway. Which action is the next priority in the care of this child?

Prepare the child for tracheotomy.
Prepare to administer epinephrine.
Prepare the child for a chest radiograph.
Assist the primary health care provider with intubation.

Question 36 of 50

The nurse is assigned to four clients on a postoperative surgical unit at a rural hospital. When prioritizing the care, the nurse recognizes that the highest priority is focused on which client?

The client who lacks knowledge regarding postoperative home care
The client with problems clearing the airway related to abdominal incision pain
The client with tissue perfusion alterations related to postoperative venous stasis
The client who is at risk for infection related to a history of smoking for 20 years

Question 37 of 50

The nurse is caring for four pediatric clients. After receiving reports from the night shift, which child would the nurse assess first?

A 6-year-old child being treated for bacterial meningitis and on the 10th day of antibiotic treatment
A 6-week-old infant admitted to the hospital for decreased level of consciousness; shaken baby syndrome is suspected
A 2-year-old child with cerebral palsy being admitted to the hospital for surgical placement of a gastrostomy feeding tube the next day
A 16-year-old child with a ventriculoperitoneal shunt that was placed at birth for hydrocephalus; possible shunt malfunction is suspected, and the child is scheduled and ready for a computed tomography (CT) scan of the head

Question 38 of 50

The nurse notes blanching, coolness, and edema at a client’s peripheral intravenous (IV) site. Which nursing action is the priority?

Remove the IV catheter.
Apply a warm compress.
Check for a blood return.
Measure the area of infiltration.

Question 39 of 50

A client with breast cancer is receiving intravenous morphine sulfate for pain. When writing the plan of care for this client, the nurse would include which action as the priority action?

Monitor temperature.
Monitor urine output.
Monitor respiratory status.
Encourage increased fluids.

Question 40 of 50

The nurse has developed a teaching plan for a client with hypertension regarding the administration of prescribed medications. What is the initial nursing action?

Set priorities for the client.
Assess the client's readiness to learn.
Find out whether anyone lives with the client.
Use only one teaching method to prevent confusion.

Question 41 of 50

The labor and delivery room nurse has just received reports on four clients. After reviewing the client data, the nurse would assess which client first?

A primigravida client in the active stage of labor
A multigravida client who was admitted for induction of labor
A client who is not contracting but has suspected premature rupture of the membranes
A client who has just received an intravenous loading dose of magnesium sulfate to stop preterm labor

Question 42 of 50

A child with an autism spectrum disorder (ASD) is being admitted to the hospital for diagnostic tests. Which room assignment is the most appropriate for the child?

Private room
Semiprivate room
Four-bed ward room
Contact isolation room

Question 43 of 50

The clinic nurse is caring for a client complaining of a foreign agent splashed into the eye. What intervention would the nurse employ before treatment?

Put on gloves.
Evaluate the client's visual acuity.
Place the client in a supine position.
Place a strip of pH paper in the lower sac of the client's affected eye.

Question 44 of 50

The nurse is conducting a session about the principles of first aid and is discussing the interventions for a snakebite to an extremity. The nurse would inform those attending the session that the first priority intervention in the event of this occurrence is which action?

Immobilize the affected extremity.
Remove jewelry and constricting clothing from the victim.
Place the extremity in a position so that it is at heart level.
Move the victim to a safe area away from the snake and encourage the victim to rest.

Question 45 of 50

The nurse is assigned to care for four clients. In planning client rounds, which client would the nurse assess first?

A postoperative client preparing for discharge with a new medication
A client requiring daily dressing changes of a recent surgical incision
A client scheduled for a chest x-ray after insertion of a nasogastric tube
A client with asthma who requested a breathing treatment during the previous shift

Question 46 of 50

A client involved in a head-on automobile crash has awakened from a coma and asks for the spouse,, who was killed in the same accident. The family does not want the client to know at this time that the spouse has died. The family wants all nursing staff to tell the client that the spouse was taken by helicopter to another hospital, has a head injury, and is in the intensive care unit (ICU). Because the American Nurses Association Code of Ethics requires the nurse to preserve integrity, but the nurse wants to follow the family’s instruction, the nurse faces an ethical dilemma. Which steps would the nurse take to systematically process this ethical dilemma? Arrange in order the steps for systematic processing of the ethical dilemma. All options must be used.

Examine and determine one's own values on the issues.
Gather all information relevant to the case.
Evaluate the action.
Consider possible courses of action.
Negotiate the outcome.
Verbalize the problem.

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Question 47 of 50

The nurse manager is reviewing documentation describing a client’s progress in terms of a critical path (Care Map) for postoperative colon resection recovery. The nurse manager notes that, although the documentation is complete, the client has made minimal progress in the areas of mobility and pain control during the prior 48 hours. Who would the nurse manager contact next?

Assigned nurse, to increase client care interventions
Family, to determine what is wrong and provide suggestions
Case manager, to determine whether the predicted variance has been negotiated with the health insurer
Primary health care provider (PHCP) and assigned nurse, to determine measures to discharge the client

Question 48 of 50

The client with a perforated gastric ulcer who is scheduled for emergency surgery cannot sign the operative consent form because of sedation with opioid analgesics. The nurse would take which priority action?

Send the client to surgery without the consent form being signed.
Have the hospital chaplain sign the informed consent immediately.
Notify the primary health care provider (PHCP) to obtain a court order for the surgery.
Obtain telephone consent from a family member witnessed by two authorized individuals.

Question 49 of 50

A homeless client comes to the emergency department complaining of severe pain in the toes of both feet. On assessment, it is found that all of the toes are black in color and that amputation is necessary. The client refuses the surgery and insists on returning to street living. Which describes the next appropriate action to take?

Obtain a court order for the surgical procedure.
Restrain the client and transport to the operating room for surgery.
Call the police to identify the client and to arrest the client until permission for surgery is granted.
Discuss the surgical procedure and its purpose with the client, and encourage the client to talk about concerns and feelings.

Question 50 of 50

The nurse hears a client calling out for help and finds the client lying on the floor. The nurse performs an assessment and assists the client back to bed. The primary health care provider is notified of the incident, and the nurse completes an incident (occurrence) report. What would the nurse document on the incident report?

The client fell out of bed last night.
The client climbed over the side rails.
The client was found lying on the floor.
The client was restless and tried to get up.