Management of Care

The nurse is reviewing the chart of the patient who is scheduled for a laparoscopic cholecystectomy in one hour. Signed consent is found, as well as blood transfusion consent, anesthesia evaluation, blood type, and emergency contacts. The nurse asks the patient, “Do you have any questions about your upcoming gallbladder removal surgery?” The patient replies, “Gallbladder removal? I thought they were just taking out my gallstones. I’ll be glad to get rid of those.” Which response by the nurse is most appropriate?

Which order does the nurse clarify for the patient in the intensive care unit following a hemorrhagic stroke?

The nurse is supervising the care of the patient who suffered an embolic stroke of the right middle cerebral artery after a clot formed on the patient’s prosthetic mitral valve. Which instruction does the nurse provide to the unlicensed assistive personnel that will be most important to prevent bacterial endocarditis?

Which circumstances are an indication for surgical management of a stone in the urinary tract? Select all that apply.

A patient tells the nurse in an outpatient endocrinology clinic that he is unhappy with his diabetes care and wants to see another physician. The nurse provides which advice?

The baby requires phototherapy for moderate hyperbilirubinemia, but the baby’s mother wants to breastfeed. Which response by the nurse is most appropriate?

The patient is brought to the floor from the post-anesthesia care unit following orthopedic surgery. Which action does the nurse take first?

The nurse caring for the patient with rheumatoid arthritis who is scheduled for an operation under general anesthesia advocates for which test prior to the procedure?

The patient is admitted to the hospital with acute diverticulitis. Which order does the nurse question?

The nurse receives vitals and information about four patients from the unlicensed assistive personnel an hour after shift report. With which patient does the nurse follow up first?

The woman who is 36-weeks pregnant reports sudden and severe abdominal pain. Which assessment does the nurse perform first?

The 76-year-old patient with atrial fibrillation tells the nurse in a slurred voice that the right arm “just isn’t working right.” Which action does the nurse take first?

Which breath sound is the most concerning after endotracheal extubation?

The patient with significant respiratory distress is diagnosed with a tension pneumothorax on portable chest x-ray. Which intervention is most appropriate for this patient? 

The nurse is caring for a patient after abdominal surgery and significant blood loss. A life-saving blood transfusion has been ordered but the patient refuses it. Which action does the nurse take first?

A mass casualty incident has occurred and the charge nurse must make beds available in the intensive care unit for incoming victims. Which patients can be safely downgraded to the floor? Select all that apply.

Following a major natural disaster, the charge nurse receives instruction from superiors to pair patients as roommates to increase the number of available rooms. The first patient to be paired is a 42-year-old patient with cellulitis who has a 103°C fever and tachycardia. The charge nurse places her in a room with which patient?

The unit is experiencing increased patient census. Which patients, if suggested for pairing with the 28-year-old patient with epilepsy, does the bedside nurse question? Select all that apply.

The nurse receives report on 4 patients by 0800. Which patient does the nurse assess first?

Which patient does the nurse advocate to be transferred to the intensive care unit?

The nurse is reviewing the arterial blood gases of 4 patients. The patient with which arterial blood gas result should be assessed first?

Which patient in the emergency department (ED) must be treated first?

Four patients have been ordered to receive a 12-lead electrocardiogram (ECG) but the floor only has one EKG machine. Which patient must receive the test first?

Which alarm does the nurse attend to first?

The nurse is a first responder after a gas explosion at an apartment complex. Which patient does the nurse mark to be treated first?

The nurse is assisting the provider in performing triage of 30 patients after a mass casualty incident. The nurse observes the resident changing the triage tag for the unresponsive patient with an open skull fracture who is not breathing spontaneously from black to red and calls the EMT over to transport the patient to the hospital. Which response by the nurse is most appropriate?

The nurse is first on the scene following a multivehicle accident. After activating emergency services and verifying the safety of the scene, the nurse begins the triage process. The first patient is unconscious and not breathing. Which action does the nurse take first?

The nurse has instituted a process improvement project to reduce the number of central line-associated bloodstream infections (CLABSI) in the intensive care unit. During the first month after instituting the process change, the incidence of CLABSIs dropped from 8 the previous month to 2 for the month. Which action by the nurse is most appropriate?

The nurse receives report of four issues at 0800. Which situation is addressed first?

The nurse preceptor is supervising the graduate nurse during shift handoff. Which statements by the graduate nurse would prompt the veteran nurse to clarify for the oncoming nurse? Select all that apply.

The nurse is supervising the student nurse who is making a call to the provider about a patient who is decompensating. The student states, “Hello, Dr. Smith. This is Carly and I’m taking care of Alex Wright in room 433. He is in the hospital after surgery for a ruptured appendix. Over my shift his temperature has increased by 4 degrees and his heart rate is elevated. His blood pressure is decreased from the previous shift as well. Could you please come examine him?” Which additional comments are the priority for the nurse to add? Select all that apply.

The patient is scheduled for a percutaneous liver biopsy at the bedside at 0730. The nurse is reviewing the patient’s chart prior to the procedure. Which initial statement by the nurse is most appropriate? Review the chart to determine the correct answer.

The registered nurse on the medical-surgical floor is delegating tasks to an unlicensed assistive personnel, certified medication assistant, and a licensed practical/vocational nurse. Which task does the nurse delegate to the LPN/LVN?

A baby is born precipitously to a mother who did not have prenatal care. The neonate requires only the initial steps of resuscitation but is found to have a bilateral cleft lip and palate. Review the patient’s assessment here: Position at rest: Complete flexion Square window: 0° Arm recoil: 75° Popliteal angle: 80° Scarf sign: Elbow does not cross midline Heel to ear: Foot does not reach the umbilicus Skin: No veins visible, cracking of skin at joints, dry Lanugo: Mostly bald skin Plantar surface: Creases over entire sole Breast: 4 mm bud with raised areola Ear: Formed pinna with instant recoil Genitals: Descended testes bilaterally, rugae over entire scrotum For which referrals does the nurse advocate for the baby prior to discharge? Select all that apply.

The 2-day-old full term child has been rooming in with the mother who reports successful breastfeeding. Which information is most important to report to the provider?

The nurse has observed the resident physician move between patients without performing hand hygiene on multiple occasions. Each time, the nurse asks the resident physician to perform hand hygiene before moving on to the next patient; the resident physician scoffs at the nurse and continues examining patients. Which action by the nurse is most appropriate?

The nurse is supervising the unlicensed assistive personnel (UAP) in the care of the patient who underwent surgical therapy for lung cancer in the right lower lobe one day prior. Which patient positions, if helped into by the UAP, prompt the nurse to intervene and provide additional education? 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 22-month-old child is brought to the emergency department with large, blistered burns to both buttocks by his mother’s boyfriend. The mother’s boyfriend states the child has been in his care while the mother is away on a business trip. He reports the child accidentally fell into the bath during the preparation before the water had had a chance to cool. The child’s second-degree wounds are dressed after intravenous morphine is administered. The nurse works with the healthcare team to perform which intervention? 

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? 

A nurse is nearing the end of her very busy shift. As she is about to leave she notices a nurse’s aide and LPN are playing cards in the break room. The nurse confirms they are both on shift and asks why they are playing instead of working. The LPN states they were not given any work tasks to complete. Which response from the nurse is most appropriate?