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

Hint : 🫁 Airway always first

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 :

🔷 A (Asthma with wheezing): Indicates compromised airway and breathing, which must be addressed first.

🔷 B (Hypoglycemia symptoms): Urgent but less critical than airway; untreated low glucose can lead to seizures.

🔷 C (Bleeding lacerations): Needs wound care but is not immediately life-threatening.

🔷 D (Crying from incontinence): Stable with no urgent physical needs, lowest priority.


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

Hint : 🫀 Always assess HR first

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 :

🔶 E (Apical HR): Required before giving digoxin due to risk of bradycardia.

🔶 A (Remove medication): Ensures medication is ready and accessible.

🔶 B (Compare ID): Verifies correct patient identity, prevents errors.

🔶 D (Open package): Done after confirming all checks.

🔶 C (Document): Final and necessary legal step.


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3 :

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 reviews the client's history of the presenting illness in the electronic medical record. Click to highlight the two pieces of key subjective data which indicate the client is in need of health interventions.


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.

Hint : 🌬️ Look for ineffective relief

Correct Highlights :
  • The client reports using a rescue inhaler three times, but he just couldn't catch his breath.
  • he noticed that his inhaler was expired and was worried the medication was not working.

Rationale :

💠 A (Inhaler not working): Shows treatment ineffectiveness, needs medical intervention.

💠 E (Expired inhaler): Client is using a potentially ineffective or unsafe medication.

💠 Both indicate poor asthma control and urgent need for updated treatment.


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4 :

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


Based on the client's history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.


Answer Options

Hint : 🫁 Oxygen + bronchodilators

Correct Answers:

  • Administer medications as ordered.
  • Provide client teaching.
  • Apply oxygen via nasal cannula


Rationale :

💎 Administer meds: Bronchodilators and steroids relieve bronchospasm and inflammation.

💎 Apply oxygen: Corrects hypoxemia (SpO₂ at 88%).

💎 Ask for med list: Ensures accurate medication history.

💎 Provide teaching: Helps client manage triggers and long-term care.


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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. Each column must have at least one, but may have more than one answer selected.


Options Neither disease process nor medication use Disease process Medication use
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 : 🔬 Link cause to sign.

Correct Answers

  • Blood pressure 130/86 mmHg [ Neither disease process nor medication use ]
  • Respirations 28 breaths/minute [ Disease process ]
  • Temperature 98.9" F (37.1°C) [ Neither disease process nor medication use ]
  • Heart rate 112 beats/minute [ Medication use ]
  • Oxygen saturation 88% on room air [ Disease process ]

Rationale :

🔷 Oxygen saturation 88% is below normal and reflects hypoxemia, directly caused by the impaired gas exchange in asthma—another disease-related abnormality.

🔷 Heart rate 112 bpm reflects tachycardia, likely due to albuterol or beta-agonist use, a known medication side effect.

🔷 Blood pressure 130/86 mmHg is within normal range for many adults and doesn’t indicate a pathological or pharmacological cause—classified as neither.

🔷 Temperature 98.9°F is a normal reading, showing no evidence of infection or fever, and isn’t influenced by medication—also neither.


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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. Each column must have at least one, but may have more than one answer selected.


Options No Indication that the Interventions Were Successful Indicates the Interventions Were Successful
Lung sounds clear
Client can now speak in full sentences without pausing successful
Respirations 16 breaths/minute
Client reports, "It's a lot easier to breathe now.":
Blood Pressure 122/84 mmHg

Hint : 🌬️ Breathing = key outcome.

Correct Answers

  • Lung sounds clear [ Indicates the Interventions Were Successful ]
  • Client can now speak in full sentences without pausing successful [ Indicates the Interventions Were Successful ]
  • Respirations 16 breaths/minute [ Indicates the Interventions Were Successful ]
  • Client reports, "It's a lot easier to breathe now.": [ Indicates the Interventions Were Successful ]
  • Blood Pressure 122/84 mmHg [ No Indication that the Interventions Were Successful ]

Rationale :

🔶 Lung sounds clear reflects resolution of bronchospasm and effective air movement, showing a positive response to nebulizer treatment.

🔶 Speaking in full sentences without pausing shows that oxygenation and ventilation have improved, confirming that respiratory distress has resolved.

🔶 Respirations of 16/min indicate that the client's breathing rate has normalized, reducing the risk of fatigue or respiratory failure.

🔶 The client stating it's easier to breathe is a subjective indicator of relief from symptoms and improved comfort level.

🔶 BP 122/84 mmHg, although within normal limits, does not specifically reflect improvement in respiratory status—hence not a valid marker of intervention success.


Distractor Analysis :

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7 :

Hint : 🦴 Watch for pin infection.

Correct Answers:

  • Assess the pin sites for signs of infection.


Rationale :

♦ Skeletal traction involves invasive pins or wires, which carry a high risk of infection at the insertion sites.

♦ Monitoring for redness, swelling, drainage, or other signs of local infection is essential for early detection and prevention of complications such as osteomyelitis.

♦ Including pin site assessment in the care plan ensures the nurse is proactively reducing risks associated with orthopedic hardware and immobilization.


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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 Low Uric Acid Levels Minimize Alcohol Consumption Avoid Grapefruit Juice
Colchicine
Naproxen
Predinosone
Allopurinol

Hint : 🔷Know which meds treat now vs. prevent later

Correct Answers

  • Colchicine [ Decreases Pain ; Reduces Inflammation ; Minimize Alcohol Consumption ; Avoid Grapefruit Juice ]
  • Naproxen [ Decreases Pain ; Manages Pain ; Reduces Inflammation ; Minimize Alcohol Consumption ]
  • Predinosone [ Manages Pain ; Reduces Inflammation ]
  • Allopurinol [ Low Uric Acid Levels ; Minimize Alcohol Consumption ]

Rationale :

🔷Allopurinol

✅It used for long-term gout management and works by inhibiting xanthine oxidase, an enzyme involved in uric acid production. ✅It is not for acute pain relief but is essential in preventing recurrent attacks by lowering serum uric acid.

Alcohol intake should be limited because it increases uric acid levels and reduces medication effectiveness

🔷 Colchicine

✅ is effective in acute gout flare-ups due to its ability to interrupt the inflammatory cycle of urate crystal deposition. ✅It doesn't relieve pain directly but reduces inflammation that contributes to pain.

✅Patients should avoid grapefruit juice, which can interfere with drug metabolism and increase toxicity.

🔷 Naproxen

✅A nonsteroidal anti-inflammatory drug (NSAID), is appropriate for acute pain and inflammation management.

✅ It should be used cautiously with alcohol due to the risk of gastrointestinal bleeding.

🔷 Prednisone,

✅ A corticosteroid, is indicated in acute flares when NSAIDs or colchicine are contraindicated, and it provides both pain and inflammation relief through immunosuppressive effects.



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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

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)


Based on the client's laboratory findings, the nurse recognizes that the client is having an acute gout attack and is most at risk forand in his affected joint.


Hint : 🔥Think redness and immune activity

Correct Answers

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

Rationale :

◈ The client’s uric acid level of 9.1 mg/dL confirms hyperuricemia, a diagnostic feature of gout.

◈ The joint symptoms described—persistent pain and swelling—are typical of acute inflammatory response due to urate crystal deposition.

◈ Erythema is a visible indicator of localized inflammation and vasodilation at the joint.

◈ These features signify a classic gout flare, distinguishing it from joint conditions like osteoarthritis or trauma.


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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


Select the 3 dietary choices that are not part of the recommended diet gout


Answer Options

Hint : 🐟 Avoid seafood and organ meats

Correct Answers:

  • Liver
  • Shrimp
  • Sardine


Rationale :

◆ These foods are high in purines, which metabolize into uric acid, the main substance accumulating in gout.

◆ Liver and sardines, in particular, have a high purine concentration and are known to provoke flares.

◆ Dietary modification is a critical aspect of managing chronic gout and reducing attack frequency.

◆ Limiting purine-rich foods helps lower serum urate and reduces dependency on medication.


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Total Questions: 10

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