Management of Care

What is the role of PEEP (positive end expiratory pressure) in managing mechanically ventilated patients? 

The lab calls the nurse and reports an adult patient’s serum calcium of 5.9 mg/dL and serum potassium of 6.2 mEq/dL. Which action by the nurse is appropriate?

Which are components of informed consent? Select all that apply.

The nurse is caring for the woman in labor whose body temperature is 102.8°F and heart rate is 114 bpm. Which order does the nurse carry out first?

Which patient is triaged first in the emergency department? 

The elderly patient is brought to the ER by ambulance for confusion, slurred speech, and right-sided weakness. Vital signs, including body temperature and blood pressure, are normal. As the patient is waiting for an urgent head CT, the nurse performs which test first?

The patient with advanced liver disease is being evaluated for moderate hematemesis, tachycardia, and hypotension. An esophagogastroduodenoscopy (EGD) confirms the patient has esophageal varices. Which is the priority action by the nurse?

The 19-year-old female patient is brought to the emergency department by her mother for severe abdominal pain. The patient denies being sexually active, but a point of care pregnancy test is positive. Which action does the nurse take next?

The nurse is assessing the patient’s ability to live independently. The patient ambulates with a cane but cannot manage stairs (lives in a one-level home). Due to advancing macular degeneration, the patient has forfeited her driving license. The patient has a daughter who is able to assist with transport to doctor appointments but cannot visit regularly. The macular degeneration is affecting the patient’s ability to tell the difference between her many pills. Which level of nursing care is appropriate for the patient?

The nurse receives report on four patients at the start of the shift. Which patient does the nurse visit first?

There are four patients with hyperglycemia in the emergency department triage. One treatment room has become available. The patient with which additional symptom is moved into the available room first?

Which is the focus of a shift report?

The nurse orders which items for the patient who has been ordered to receive a clear liquid diet? Select all that apply.

A multidisciplinary team has been assembled to treat the patient who is hospitalized for a diabetic foot ulcer. Adherence to treatment, lifestyle, and dietary strategies has been an ongoing issue. The team includes an endocrinologist, primary care physician, a podiatrist, a registered nurse, and a dietitian. The addition of which provider to the multidisciplinary team will most positively impact outcomes for this patient?

The nurse receives shift report on four patients. Which patient does the nurse see first?

The nurse know which statement best describes a multidisciplinary team?

A patient with signs and symptoms of cardiac chest pain arrives in the ED. Which ECG rhythm is most worrisome and requires emergent intervention?

Which patient statement is most appropriate to report to the social worker?

The nurse is caring for the patient who was admitted to the hospital in septic shock due to Escherichia coli bacteremia. Which patient assessment is most appropriate to report to the inpatient pharmacist on the patient’s medical team?

The patient admitted with asthma is receiving beclomethasone HFA PRN and nebulized albuterol PRN. Which patient assessment is most appropriate to report to the respiratory therapist assigned to care for the patient?

The patient tells the nurse, “When is Sally working again? She has been my favorite nurse so far.” Which response by the nurse is appropriate?

The nurse is riding the staff elevators with several other healthcare professionals and overhears a provider discussing the lab results for another nurse’s patient. Which response by the nurse is most appropriate?

The provider left a patient’s electronic health record (EHR) open on the computer screen in the nurse’s station when he left to assess a patient. Which action by the nurse is most appropriate?

The patient in the rehabilitation hospital following a spinal cord injury sustained in a motor vehicle accident is preparing for discharge home. The patient tells the nurse, “I had a huge support network back home. Since I moved to this new state for my husband’s job, I feel so out of touch. I don’t know how I’ll get to my therapy and doctor appointments when my husband is at work.” To which interdisciplinary team member does the nurse report the patient’s comments?

The nurse receives report that the patient will undergo brain death testing and is aware the patient must meet which criteria to be diagnosed with brain death? Select all that apply.

The patient is awake and alert when being admitted directly to the unit from the cardiac catheterization lab after transferring from the primary care doctor. The patient’s spouse calls the unit looking for the patient. Which response by the nurse is most appropriate?

The nurse receives an alert that a packed red blood cell transfusion has been ordered for the patient who was admitted after a laparoscopic cholecystectomy. Which is the nurse’s initial action?

The nurse is caring for a patient on the night shift in respiratory distress due to influenza. Over the last few hours, the patient has become increasingly confused, perfusion has decreased, and urine output has fallen to zero. The nurse contacts the resident physician to come assess the patient and requests an order for transfer to the intensive care unit. The physician orders the nurse to administer 1L 0.9% NaCl via IV infusion. One hour after the infusion is complete, the patient has made no improvement. What is the nurse’s next action?

To which team member does the registered nurse delegate a fecal occult blood test for the patient who requires assistance to ambulate to the restroom?

Which patient does the nurse assess first?

The patient is being transferred from a nursing home to an acute care facility. The receiving nurse performs which actions during the medication reconciliation process? Select all that apply.

The nurse mistakenly administered a long-acting benzodiazepine to the patient with end-stage liver disease, a drug that was not ordered. As a result, the patient had to remain in the hospital an extra night. The nurse wants to apologize to the patient for the mistake. Which of the following is most accurate?

The nurse makes which patient top priority?

The patient with terminal cancer was placed on hospice care; although he has deteriorated, he is still alive after 6 months. How is the patient’s hospice care affected?

The nurse is supervising the care of the patient who is alert but has increased intracranial pressure following head trauma. Which action by the unlicensed assistive personnel (UAP) prompts the nurse to intervene immediately?

The nurse volunteers to be on the quality improvement team examining shift change safety and patient satisfaction. Which is the best suggestion for this quality improvement project?

The nurse receives report at the beginning of the shift. Which task is appropriate to delegate to the unlicensed assistive personnel?

The patient underwent surgery for creation of a colostomy 2 days ago. Upon assessment, which stoma color prompts the nurse to document the finding and continue with the assessment?

The nurse does not administer a physician-ordered medication because it is contraindicated for the patient. This is an example of which principle?

During an active shooter situation, the nurse closes patient’s rooms and bars entry to the unit. This is an example of which ethical principle?

The patient with severe, symptomatic anemia who is a Jehovah's Witness refuses a blood transfusion for religious reasons. The nurse instructs the provider to discontinue the order. This is an example of which ethical principle? 

After a mass casualty event, the nurse triages care of dozens of patients in the emergency department (ED) based on the severity of their injury and likelihood of survival. This is an example of which principle?

Which is a patient responsibility?

Which situation prompts the patient to be compelled to a healthcare facility without consent?

Which patient is seen first in the emergency department?

Which patients are seen first in the hospital following a mass casualty event?

The nurse is caring for the patient on methadone treatment as an outpatient. The provider has ordered a dose of methadone that is far higher than what the nurse has ever administered. Which action by the nurse is appropriate?

The nurse learns the patient's blood drawn on admission was positive for human immunodeficiency virus (HIV). Which action by the nurse is appropriate?

The triage nurse is assessing patients in the emergency department (ED). Which patient is seen first?

The patient has been unconscious for 36 hours after a massive stroke. The nurse enters the room to see the unlicensed assistive personnel (UAP) cleaning the patient after an episode of fecal incontinence. The UAP states, “I can’t imagine not even being able to clean myself. What a sad existence.” Which response by the nurse is most appropriate?