Delegation, Prioritization and Leadership

Which patient is seen first in the emergency department?

The nurse is creating fire safety flyers for the hospital. What does the E in RACE signify?

The nurse is creating fire safety flyers for the hospital. What does the R in RACE signify?

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

The provider orders albumin for a patient with traumatic amputation and hemorrhage. Which patient characteristic prompts the nurse to clarify the order with the provider?

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?

Which patient with dyspnea is seen first in the emergency department?

The patient has been diagnosed with an arteriovenous malformation (AVM) and is scheduled to undergo surgery in the morning. Which nursing intervention is the most important to promote safety in the patient?

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

The patient developed toxic epidermal necrolysis after receiving phenytoin for seizures. The nurse prioritizes nursing interventions to address which life-threatening comorbidities? Select all that apply.

The nurse is auditing the use of personal protective equipment (PPE) on the unit. Which provider removes the PPE correctly?

The nurse intervenes if the provider attempts to remove which article of personal protective equipment first after contact with the patient with active tuberculosis?

The nurse is observing the student nurse in the care of the patient with a wound infected with methicillin-resistant Staphylococcus aureus. Prior to exiting the room, the student nurse removes the gloves and grasps the front of the gown to remove it. Which response by the nurse is most appropriate?

The registered nurse is observing the licensed practical/vocational nurse (LPN/LVN) administering pantoprazole during morning medication rounds. Which action by the LPN/LVN prompts the nurse to intervene and provide additional education?

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?

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?

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?

The nurse is supervising the student nurse in the irrigation of the patient’s right eye. Which action by the student nurse prompts the nurse to intervene with additional education?

The 7-month-old infant is sitting quietly on the mother’s lap. Which assessment does the nurse perform first?

Rank these conditions from most (1) to least (4) life-threatening.

Which respiratory assessment in the patient who has an oxygen saturation of 96% on room air is most concerning?

The nurse is vigilant for which symptoms of a life-threatening complication of the woman's precipitous vaginal delivery?

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 is performing an assessment on the patient with long, thin limbs and fingers who presents for a yearly check-up in no acute distress. The patient is extremely thin and has pectus excavatum. For which assessment finding is the nurse most vigilant in this patient?

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?

Following traumatic bilateral leg amputations, the 5-year-old child requires a STAT blood transfusion to treat hemorrhagic shock. The child's blood type is unknown. Which action is most appropriate? 

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 patient with a history of hypertension and atherosclerosis presents to the emergency department (ED) complaining of severe lower back pain. Which question by the nurse is most important?

Which is the drug of choice for treatment of Raynaud syndrome?

After reviewing the patient’s chart, which instruction does the nurse give the unlicensed assistive personnel working with the patient?

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.

Review the chart and decide the best room for the patient.