Disease Prevention

The nurse is supervising the student nurse in performing a cap change for a peripherally inserted central catheter (PICC) in a patient who recently sustained a traumatic brain injury. Which action by the student nurse best indicates effective learning?

At the beginning of the shift, the nurse assesses the patient receiving total parenteral nutrition (TPN) via a peripherally inserted central catheter and notes a crack in the tubing with TPN leaking. The nurse notifies the provider and anticipates receiving which order first? 

The nurse is supervising the graduate nurse in caring for intravenous lines. Which actions by the graduate nurse require intervention and further education? Select all that apply.  

The patient has undergone a cystectomy with ureterosigmoidostomy. Which nursing interventions are included in the care plan? Select all that apply. 

The nurse is caring for a patient in the intensive care unit with breast cancer who has a radiation implant in the right breast. The patient is also receiving a chemotherapy regimen. Which additional patient is most appropriate to be assigned to the nurse?

The nurse finds the patient’s vaginal radiation implant in the bed while turning the patient. Which action by the nurse is most appropriate?   

The patient had an unsealed radiation source instilled into the uterus on Tuesday. On Friday, the patient has an episode of incontinence and requires a full linen change. How does the nurse dispose of the soiled linens? 

On Monday, the patient receiving chemotherapy for cervical cancer has an unsealed radiation source instilled into the uterus. Tuesday morning, the patient vomits after breakfast. Which action does the nurse take while cleaning the emesis?  

The patient with uterine cancer has a sealed radiation implant placed into the uterus. Which action by the nurse promotes safety? 

The nurse is most concerned with encouraging the patient with multiple myeloma to ambulate frequently to prevent which complication? 

The nurse is selecting patients to receive a brochure about detecting testicular cancer. Which patient most needs the brochure? 

The nurse advocates for cervical cancer screening for patients with which complaints? Select all that apply. 

The patient is scheduled for a posterior pelvic exenteration and the nurse has provided preprocedural teaching. Which statement indicates a need for further teaching?  

The nurse provides which instructions to the unlicensed assistive personnel who is assisting in the care of a patient postoperative day one following a radical hysterectomy? Select all that apply. 

Which patient is most at risk for uterine cancer?  

The nurse is providing health promotion and disease prevention education to the 15-year-old patient receiving chemotherapy. Which statement does the nurse include?  

The parent of the 8-year-old with sickle cell disease (SCD) reports the child complains of constant generalized pain rated at 4/10. Which response by the nurse is most appropriate?  

The newborn male child experienced hemorrhage from a circumcision site at 2 days old. Coagulation studies revealed normal prothrombin time and a prolonged activated partial thromboplastin time (aPTT). The von Willebrand factor is found to be 0.5%. Which individuals need to undergo genetic testing?   

The 3-year-old with sickle cell disease is preparing for discharge following a crisis during which the patient received several blood transfusions. The nurse is providing teaching regarding appropriate food choices for the child. Which foods, if selected by the parents, indicate a need for further teaching? Select all that apply.  

The nurse is providing discharge education to the parents of the 7-day-old neonate who required a blood transfusion due to blood loss following circumcision. Which instruction is most important?  

The nurse is supervising the assessment of a 4-year-old patient with a Wilms tumor who was brought to the emergency department for profuse vomiting. Which statement by the student nurse requires prompt intervention by the nurse? 

The nurse is preparing to care for a baby antenatally diagnosed with type C esophageal atresia with tracheoesophageal fistula. Which interventions are the priority in the first day after birth?  

The 68-year-old patient is admitted after 5 days of extremely foul-smelling watery diarrhea with a temperature of 37.9°C, heart rate 118 bpm, and blood pressure 98/52 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which intervention is most important to prevent the spread of this condition to other patients? 

The 5-day-old 38-week-gestation neonate was born to a 25-year-old primigravida woman after a pregnancy and vacuum-assisted delivery complicated by gestational diabetes, large for gestational age fetus, and shoulder dystocia. The neonate required vigorous stimulation and positive pressure ventilation. Apgar scores were 3 and 8 at 1 and 5 minutes of life. At the pediatrician’s appointment after discharge, the neonate is found to have a large bruise at the back of the head that was sustained during birth and eyes glued shut with yellow, mucopurulent discharge. A gram stain of the drainage reveals gram-negative cocci in pairs. The mother states, “No matter what I do, it keeps coming back. I’ve used warm compresses and washed it away.” Additionally, the mother reports the infant is breastfeeding well with 4 wet diapers and 1 stool per day. The nurse informs the provider of the assessment and requests which order first?  

The nurse is preparing the otherwise healthy 54-year-old patient for a right knee replacement surgery and checks to see if the patient is allergic to which medication? 

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. Vital signs are normal and the patient seems to be breathing well. There is increased protein in the cerebrospinal fluid found after a lumbar puncture. The patient is admitted to the intensive care unit for further management and observation. The ICU nurse includes which interventions in the plan of care? Select all that apply.  

The 31-year-old patient G2P1 woman presents to the clinic for 30 week appointment. She was diagnosed at 24 weeks with gestational diabetes. For 6 weeks, she changed her diet and exercised more regularly while checking her blood sugars. She logged fasting glucose levels of 108-135 mg/dL. She has no proteinuria or glycosuria. The nurse provides which information to the patient?  

The 50-year-old previously healthy patient complains of shortness of breath, especially on exertion or when laying down to sleep. She takes over-the-counter allergy medicine for seasonal allergies and melatonin to help her sleep sometimes. Her vital signs are heart rate of 64 bpm, respirations 22, oxygen saturation 99%, and blood pressure 114/68 mmHg. Her assessment is notable for crackles over the bilateral lung bases and a moderate diastolic apical murmur. Her electrocardiogram is normal. Her echocardiogram shows normal function of the left ventricle and severe stenosis of the mitral valve. The nurse provides which information to the patient?  

The 38-year-old patient who strictly adheres to a vegan diet complains of weakness and tingling in her lower extremities. She retains the strength in her lower extremities but proprioception is decreased.  Her complete blood count revealed a hemoglobin of 10.2 mg/dL, white blood cell count of 9 x 10³ cells/µL, and a mean corpuscular volume of 110. Which information does the nurse provide to the patient?  

The 58-year-old patient presents to the emergency department complaining of worsening back pain that started a few days ago. He states, “I thought maybe I had slept wrong and gotten a spasm, but I’m not sure. I didn’t fall or get hit or anything. The ibuprofen I took definitely didn’t help.” His blood pressure is 174/96 mmHg and heart rate is 96 bpm. He reports being out of his antihypertensive medication for the past week while he was out of town. Other history is notable for arthritis in the hands and a 44-pack-year smoking history. He drinks socially but denies illicit drug use. Which assessment is most important? 

The 58-year-old patient presents to the emergency department of a community hospital complaining of worsening back pain that started a few days ago. He states, “I thought maybe I had slept wrong and gotten a spasm, but I’m not sure. I didn’t fall or get hit or anything. The ibuprofen I took definitely didn’t help.” His blood pressure is 174/96 mmHg and heart rate is 96 bpm. He reports being out of his antihypertensive medication for the past week while he was out of town. Other history is notable for arthritis in the hands and a 44-pack-year smoking history. He drinks socially but denies illicit drug use. A pulsating abdominal mass is noted; otherwise, his assessment is benign. The nurse advocates for which treatment option? 

The 21-year-old intoxicated patient presents to the emergency department after sustaining an injury to the right hand during an altercation in a bar. He reports punching another individual in the face. An x-ray of the hand reveals a broken 4th proximal phalange and metacarpal. The corresponding knuckle has an open laceration. The nurse prepares the patient for which treatment?  

During the provider’s exam of the 6-hour-old neonate, the provider reports observing a red reflex in the neonate’s right eye, but not the left. The provider observes whiteness at the back of the eye. Enucleation is performed and the diagnosis of retinoblastoma with clear tumor margins is confirmed. No chemotherapy or radiation is required. The infant is ready to be discharged home as a healthy baby. Which health screening information is most relevant to this family? 

The nurse is providing education to the parents of a child who was admitted with abdominal pain, fatigue, and yellow-tinged skin and sclera that was determined to be due to hemolysis. The liver dysfunction has resolved and the child is ready to be discharged, but the cause of the child’s hemolysis is still unknown at this time. Out of an abundance of caution, the nurse instructs on the list of medications/food the child must not receive to prevent possible recurrence. Which items are included on the list? Select all that apply.

The nurse is teaching a community class on cardiopulmonary resuscitation (CPR). Which rationale is best to give the class for the difference between infant CPR with one rescuer, infant CPR with two rescuers, adult CPR with one rescuer, and adult CPR with two rescuers?

 The nurse is the first responder after a child is pulled unresponsive from the pool. There is no pulse and no breathing. The nurse sends someone for the AED, instructs another person to call 911, and begins chest compressions. By looking transversely at the chest, select the depth to which the nurse compresses the chest, if each line represents an inch of compression.