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NCLEX Sample Questions: Patient Mix-Up and Elevated Temperature

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1. A nurse working for an agency gives 12 units of insulin to a nursing home resident who the nurse believes is Resident A. A few minutes later, she discovers she has given it to Resident B by mistake; Resident B was in Resident A’s bed. Both residents also have moderate dementia. No residents in the nursing home have any identifying information on them. The nurse notifies the physician and nursing supervisor and monitors Resident B’s blood glucose for several hours after the incident and gives Resident B a snack. There appear to be no unusual effects from the insulin. What could be a possible outcome for the nurse in this situation?

a. The nurse could be sued for malpractice by Resident B’s family.
b. The nurse could be successfully sued for negligence by Resident B’s family.
c. The nurse’s action was below the standards of nursing practice based on the nurse practice act and she could have her license revoked.
d. The relatives of Resident B could sue the nurse for negligence, but as there were no adverse outcomes, the case would probably be dismissed.

2. A 33-year-old man is admitted through the ER with a temperature of 103°F. Respiratory rate is 24 breaths per minute; pulse rate is 110 and regular.  Blood pressure is 120/80. He denies any other symptoms. Which of the following would be an appropriate step for the admitting nurse to take that might be ordered by the physician?

a. Obtain a WBC and erythrocyte sedimentation rate (ESR).  
b. Obtain a WBC and serum albumin.
c. Obtain a serum albumin and throat culture.
d. Obtain a chest X-ray to rule out pneumonia.



1. d

Rationale: The family could sue for negligence, but there were no apparent adverse effects, so it is likely the case would be dismissed.  Malpractice is a special type of negligence that results in injury or harm; no harm was incurred in this situation.  The family could sue the nurse for negligence, but as no harm was experienced by the patient, it is unlikely the suit would be successful.  License revocation is unlikely; no harm to the patient was incurred.

2. a

Rationale: Fever is the main symptom.  WBC and ESR may be elevated if there is an underlying infectious process.  WBC could be elevated if there is an infectious process, but serum albumin is generally not related to an infectious process and elevated temperature.  Serum albumin level is generally not associated with an infectious process; the man has no complaints of a sore throat, which would warrant a throat culture.  Initial symptoms do not indicate a diagnosis of pneumonia; more questioning would be warranted before ordering a chest X-ray.

Sample questions courtesy of our partner, The College Network.