Lifestyle Choices and High Risk Behavior

The 32-year-old patient presents to the emergency department complaining of difficulty breathing, cough, and chills. Vital signs are notable for a temperature of 38.4°C, heart rate 118 bpm, respiratory rate 24, oxygen saturation 87% on room air, and blood pressure of 98/62 mmHg. Upon assessment, the nurse notes nasal flaring, diminished breath sounds in the right upper lobe, and subcostal retractions. Capillary refill time is 4 seconds. The patient admits waking up in a pool of vomit after binge drinking 3 nights ago. Which orders does the nurse anticipate? Select all that apply.

A patient with longstanding alcohol abuse problems is admitted for COPD exacerbation. After reaching the floor, the patient becomes disoriented, anxious, tachycardic, diaphoretic, and tremulous. His oxygen saturation is 95% on 2 L supplemental oxygen via nasal cannula. Which intervention is most appropriate for this patient?

The patient is hunched over in the emergency department waiting room, breathing slowly and shallowly. His wife insists he “took something”. The man has bradypnea and marked miosis. Which intoxicant does the nurse suspect?

The patient who has recurrent seizures and is no longer legally able to drive has developed a depressed mood and stays home almost all of the time. Which action by the nurse is most appropriate?

The patient is scheduled for bariatric surgery in one month. During the preoperative physical, the nurse notes the patient takes St. John's wort. The nurse instructs the patient to stop taking St. John's wort 5 days prior to the surgery for which reason?  

The patient with human immunodeficiency virus (HIV) presents to the clinic for a follow-up visit. The nurse provides education to the patient about which cardiovascular complication the patient is most likely to experience related to the disease process?

The 1.9 kg neonate is born precipitously via vaginal delivery to a 32-year-old mother who received no prenatal care or infectious disease serology testing before delivery. The mother has a history of intravenous drug use. Which intervention does the nurse perform first?

The public health nurse encourages which individuals to receive the hepatitis A vaccine? Select all that apply.

The 7-year-old child with pica is brought to the emergency room (ER) with decreased level of consciousness after ingesting lead paint. His blood lead level (BLL) is determined to be 72 mcg/dL. The nurse prepares to administer which medication?

Which initiative is a primary strategy to prevent lead toxicity?

The home care nurse visits the home of an elderly married couple who lives with their adult children. Medication bottles and loose pills are found throughout the house. The nurse provides which information about safe storage of medications? Select all that apply.

The nurse is advising a 20 pack-year smoker about smoking cessation. The patient knows about increased risk of lung cancer, but wants to know if smoking is linked to other forms of cancer. The nurse explains that smoking increases the risk of which cancers? Select all that apply.

The 35-year-old woman is interested in starting hormonal birth control. Which characteristic, if found in the patient's medical record, indicates the patient requires an alternative form of contraceptive?

The patient has come to the emergency department by ambulance for presumed heroin overdose. The nurse expects the patient to have received which medication in the field?

An acutely intoxicated child is brought to the ED because his parents suspect he has consumed antifreeze. The nurse anticipates administering which medication?

The patient wants to quit smoking before starting hormonal birth control. Using motivational interviewing, which statement by the nurse would best elicit change talk from the patient?

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?

A man who has remediated water-damaged basements for over thirty years presents to an acute care clinic for ongoing breathing problems. He has never smoked, has never been exposed to asbestos, and is afebrile. The nurse knows the man is most likely suffering from what condition?

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

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 patient has been prescribed enalapril and spironolactone for the treatment of hypertension. The nurse is providing medication education to the patient regarding diet. Which food, if selected by the patient, indicates a need for further teaching?

Which situations prompt the use of four-point restraints? Select all that apply.

The nurse is teaching a community health promotion class for older adults and includes a discussion on modifying which risks for hypertension?

Pregnancy is confirmed in the patient who states, “How did this happen? We were careful and wore condoms every time we had sex.” Which response by the nurse is most appropriate?

The 18-year-old female patient tells the nurse, “I would like to change my contraceptive method before I go away to college. I’m afraid I will forget to take the pill every day and I have had issues finding the right balance of hormones. Honestly, I don’t have a boyfriend and can’t see myself getting married or having kids until well after college.” The nurse reviews the chart and notes the patient’s medical history is negative for any infections or diseases. The patient’s BMI is 32 and metabolic panel is normal. Which contraceptive method does the nurse recommend to this patient?

The 22-year-old woman has selected the Depo-Provera injection as her preferred method of contraception. Which information, if present in the patient’s chart, prompts the nurse to hold the medication and alert the physician?

The patient had a contraceptive implant placed 14 months ago. The implant must be replaced in how many months? Enter your answer using a whole number.

The patient had a copper intrauterine device placed at aged 21. At what age will the patient be when it must be replaced if the patient desires to continue contraception? Enter your answer using a whole number.

Which symptom can occur following vertical transmission of Neisseria gonorrhoeae?

The asymptomatic patient tested positive for Neisseria gonorrhoeae during routine screening for sexually transmitted infections (STI). The nurse anticipates administering which medications? Select all that apply.

The patient has had a positive rapid plasma reagin (RPR) test. Further testing will most likely reveal the presence of which organism?

The female patient tells the nurse, “I think the man I had unprotected sex with last night might have herpes. I’m so afraid I’m going to get it, too.” Which response by the nurse is most appropriate?

Which mother is at highest risk for passing herpes simplex virus (HSV) to her fetus/neonate?

The patient presents to the clinic complaining of a painful sore on his penis. Upon assessment, the nurse notes an ulceration with a yellow slough wound base that is soft with an irregular border. The inguinal lymph node on the ipsilateral side of the wound is enlarged and firm. The nurse suspects which organism is the cause of the wound?

The 32-weeks-pregnant woman who presents with genital lesions is diagnosed with herpes simplex virus-2. The nurse prepares a patient information handout for which medication for this patient?

The full-term neonate (3.2 kg) born precipitously to a mother of unknown infectious disease status has had a positive rapid plasma reagin (RPR) test. The nurse plans care to perform which intervention first?

The nurse is caring for a woman wearing a hijab. The woman does not speak English and has come to the emergency department (ED) with fever, vaginal bleeding, and abdominal pains. An interpreter is present for the interaction. Which question is appropriate for the nurse to ask first?

The unresponsive patient is brought to the emergency department via ambulance. During an abbreviated neurologic exam, the nurse notes the following pupils, estimated to be 1 mm and fixed: The nurse prepares to administer which medication?

The nurse is educating a middle-aged wellness group on lifestyle changes that may prevent Alzheimer’s disease. Which diet does the nurse recommend?

The patient presents with a blood pressure of 135/95 mm Hg and appears jaundiced. She has a history of alcoholism, cirrhosis, and untreated hepatitis C. While the oncoming nurse is receiving report, the patient begins vomiting a large amount of blood. The nurse knows which to be the most likely cause of the patient’s hematemesis?

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? 

The single parent of the child with a severe developmental disorder confides in the nurse that caring for the child is becoming impossible to do alone. Which actions by the nurse are most appropriate? Select all that apply. 

A home care nurse is visiting an elderly patient. The nurse performs an assessment of instrumental activities of daily living. Which of the following will be included in this assessment? Select all that apply.

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?

Patients with which characteristics are at increased risk for infective endocarditis? Select all that apply.

Following an industrial accident, the patient is immobile. The student nurse is creating a care plan for the patient to prevent respiratory decompensation. Which intervention, if included in the care plan for this nursing diagnosis, would prompt the nurse to provide additional education to the student nurse?

The 17-year-old patient is seeking advice on testing for sexually transmitted diseases. He states, “I kissed my girlfriend with my tongue inside her mouth. What do I need to be tested for?” Which is the most therapeutic response by the nurse?

The nurse is planning an informational session at the community center to help parents identify when their children are at an increased risk for suicide. The nurse includes information about which activities in the class? Select all that apply.

The community health nurse is teaching an outreach course on how parents can help to prevent suicide attempts in their at-risk children. Which statement by a parent indicates a need for further teaching?

The 17-year-old male patient is brought to the clinic for a yearly check-up. The nurse observes the patient to be unkempt, with greasy hair and significant body odor. The patient has a flat affect during questioning. When the nurse provides education on safety practices such as wearing a seatbelt when in the car, not driving with impaired persons, and using protection during sexual intercourse, the patient retorts, “I don’t really see the point in wearing a seatbelt, if it helps me die more quickly.” Which initial response by the nurse is most appropriate?