CAPSTONE EXAM 1 ACTUAL EXAM 2023-2024 COMPLETE 200
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+
For care of a patient who has oral cancer, which task would be appropriate to
delegate to an LPN/LVN?
A- Assisting the patient to brush and floss
B- Explaining when brushing and flossing are contraindicated
C- Giving antacids and sucralfate suspension as ordered
D- Recommending saliva substitutes – ANSWER- C- Giving Antacids and
sucralfate as ordered
Rationale; *LPNs can’t teach
You are working in an AIDs hospice facility that is also staffed with LPNs and
UAPs. Which nursing action will you delegate to the LPN you are supervising?
A- Assessing patients’ nutritional needs and individualizing diet plans to improve
nutrition
B- Collecting data about the patients responses to medications used for pain and
anorexia
C- Teaching the UAPs about how to lower the risk for spreading infections
D- Assisting patients with personal hygeine and other activities of daily liging as
needed – ANSWER- B- Collecting data about the patients responses to medications
used for pain and anorexia
Rationale; *LPNs can’t asses or teach. They can assist with personal hygeine and
activities of daily living but so can a UAP
A hospitilized patient with AIDS has a nursing diagnosis of Imbalanced Nutrition:
Less than Body Requirements related to nausea and anorexia. Which nursing
action is most appropriate to delegate to an LPN who is providing care to this
patient?
A- Administering oxandrolone 5 mg daily
B- Assessing the patient for other nutritional risk factors
C- Developing a plan of care to improve the patient’s appetite
D- Providing instructions about a high-calorie, high protein diet – ANSWER- Aadministering oxandrolone 5 mg daily
Rationale; *LPNs can’t assess, develop care plans or teach
The client’s nursing diagnosis is deficient fluid volume realted to excessive fluid
loss. Which action related to fluid mamagement should be delegated to a UAP?
A- Administering IV fluids as prescribed by the physicians
B- Providing straws and offering fluids between meals
C- Developing a plan for added fluid intake over 24 hours
D- Teaching family members to assist the client with fluid intake – ANSWER- BProviding straws and offering fluids between meals
Rationale; *UAPs can’t administer IV fluids, develop care plans or teach
The nursing care plan for a client with dehydration includes interventions for oral
health. Which interventions are within the scope of practice for an LPN being
supervised by a nurse?
A- Reminding the client to avoid commercial mouthwashes
B- Encouraging mouth rinsing with warm saline
C- Observing the lips, tongue and mucous membranes
D- Providing mouth care every 2 hours wile the client is awake
E- Seeking a dietary consult to increase fluids on meal trays – ANSWER- A, B, C,
D
Rationale; *LPNs can’t seek out consults
The charge nurse assigned the care of a client with acute kidney failure and
hypernatremia to you, a newly graduated RN. Which action can you delegate to the
UAP?
A- Providing oral care every 3-4 hours
B- Monitoring for indications of dehydration
C- Aministering 0.45% saline by IV line
D- Assessing daily weights for trends – ANSWER- A- providing oral care every 3-
4 hours
Rationale; *UAPs can’t monitor for signs or trends and can’t do IVs
Which action should you delegate to a UAP for the client with diabetic
ketoacidosis?
A- checking fingerstick glucose results every hour
B- Recording intake and output every hour
C- Measuring vital signs every 15 minutes
D- Assessing for indicators of fluid imbalance
E- Notifying the provider of changes in glucose level – ANSWER- B, C
Rationale; *UAPs can obtain measurements but not analyze them or trend them in
any way.
You are caring for a client who has been admitted to the hospital with a leg ulcer
that is fected with vancomycin-resistant S. aureus (VRSA). Which nursing action
can you delegate to an LPN?
A- Planning ways to improve the client’s oral protein intake
B- Teaching the client about home care of the leg ulcer
C- Obtaining wound cultures during dressing changes
D- Assessing the risk for further skin breakdown – ANSWER- C- obtaining wound
cultures during dressing changes
Rationale; *can’t plans, teach or assess
A client with a vancomycin-resistant enterococcus (VRE) is admitted to the
medical unit. Which action can be delegated to the UAP who is assesting with the
client’s care?
A- Teaching the client and family members about means to prevent transmission of
VRE
B- Communicating with other departments when the client is transported for
ordered tests
C- Implementing contact precaustions when prociding care for the client
D- Monitoring the results of ordered laboratory culture and semsitivity tests –
ANSWER- C- Implementing contact precautions when providing care for the
client
Rationale; *can’t teach, communicate with other departments about tests or
monitor results
CAPSTONE EXAM 2 ACTUAL EXAM 2023-2024 COMPLETE 200
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+
- A child has fluid volume deficit. The nurse performs an assessment and
determines that the child is improving and the deficit is resolving if which finding
is noted? - The child has no tears.
- Urine specific gravity is 1.035.
- Capillary refill is less than 2 seconds.
- Urine output is less than 1 mL/kg/hr. – ANSWER- 3. Capillary refill is less than
2 seconds. - The nurse has just administered ibuprofen to a child with a temperature of
102° F (38.8° C). The nurse should also take which action? - Withhold oral fluids for 8 hours.
- Sponge the child with cold water.
- Plan to administer salicylate in 4 hours.
- Remove excess clothing and blankets from the child. – ANSWER- 4. Remove
excess clothing and blankets from the child. - A child with type 1 diabetes mellitus is brought to the emergency department
by the mother, who states that the child has been complaining of abdominal pain
and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of
care, the nurse prepares to administer which type of intravenous (IV) infusion? - Potassium infusion
- PH insulin infusion
- 5% dextrose infusion
- Normal saline infusion – ANSWER- 4. Normal saline infusion
- A mother brings her 2-week-old infant to a clinic for a phenylketonuria
rescreening blood test. The test indicates a serum phenylalanine level of 1 mg/di
(60.5 mcmol/L). The nurse reviews this result and makes which interpretation? - It is positive.
- It is negative.
- It is inconclusive.
- It requires rescreening at age 6 weeks. – ANSWER- 2. It is negative.
- An adolescent client with type 1 diabetes mellitus is admitted to the
emergency department for treatment of diabetic ketoacidosis. Which assessment
findings should the nurse expect to note? - Sweating and tremors
- Hunger and hypertension
- Cold, clammy skin and irritability
- Fruity breath odor and decreasing level of consciousness – ANSWER- 4. Fruity
breath odor and decreasing level of consciousness - A pediatrician prescribes an intravenous (IV) solution of 5% dextrose and
half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with
hypotonic dehydration. The nurse performs which priority assessment before
administering this IV prescription? - Obtains a weight
- Takes the temperature
- Takes the blood pressure
- Checks the amount of urine output – ANSWER- 4. Checks the amount of urine
output - The mother of a 6-year-old child who has type 1 diabetes mellitus calls a
clinic nurse and tells the nurse that the child has been sick. The mother reports that
she checked the child’s urine and it was positive for ketones. The nurse should
instruct the mother to take which action? - Hold the next dose of insulin.
- Come to the clinic immediately.
- Encourage the child to drink liquids.
- Administer an additional dose of regular insulin. – ANSWER- 3. Encourage the
child to drink liquids. - A school-age child with type 1 diabetes mellitus has “soccer practice and the
school nurse provides instructions regarding how to prevent hypoglycemia during
practice: Which should the school nurse tell the child to do? - Eat twice the amount normally eaten at lunchtime.
- Take half the amount of prescribed insulin on practice days.
- Take the prescribed insulin at noontime rather than in the morning.
- Eat a small box of raisins or drink a cup of orange juice before soccer practice. –
ANSWER- 4. Eat a small box of raisins or drink a cup of orange juice before
soccer practice. - The clinic nurse reviews the record of an infant and notes that the primary
health care provider (PH CP) documented a diagnosis of suspected Hirschypnings
disease. The nurse reviews the assessment finding documented in the record,
knowing that which is most likely led the mother to seek health care for this infant? - Diarrhea
- Projectile vomiting
- Regurgitation of feedings
- Foul-smelling ribbon-like stools – ANSWER- 4. Foul-smelling ribbon-like stools
- An infant has just returned to the nursing unit after surgical repair of a cleft lip
on the right side. The nurse should place the infant in which best position at this
time? - Prone position
- On the stomach
- Left lateral position
- Right lateral position – ANSWER- 3. Left lateral position
- The nurse reviews the record of a newborn infant an expected a diagnosis of
esophageal atresia with tracheoesophageal fistula. The nurse expected which most
likely sign of this condition documented in the record? - Incessant crying
- Coughing at nighttime
- Choking with feedings
- Severe projectile vomiting – ANSWER- 3. Choking with feedings
- The nurse provides feeding instructions to a parent of an infant diagnosed
with gastro esophageal reflux disease which instructions should the nurse give to
the parent to assist in reducing the episodes of emesis? - Provide less frequent, larger feedings.
- Burp the infant less frequently during feedings.
- Thin the feedings by adding water to the formula.
4.Thicken the feedings by adding rice cereal to the formula. – ANSWER4.Thicken the feedings by adding rice cereal to the formula. - A child is hospitalized because of persistent vomiting. The nurse should
monitor the child closely for which problem?