Health Care Quality

The nurse is attempting to perform an irrigation of the patient’s indwelling urinary catheter but it is unable to instill the irrigant with normal force. Which action does the nurse take?

The patient has a peritoneal dialysis catheter. The nurse notes the dressing is saturated and prepares to change it. Upon removing the dressing, the nurse notes a foul odor and purulent drainage around the site, which is red. Which action does the nurse take next?

The nurse is providing discharge teaching to the patient who will be discharged with a peritoneal dialysis catheter. Which statement indicates a need for further teaching?

The grown child of an elderly woman with dementia is trying to provide his mother with in-home hospice. The caregiver providing in-home hospice for the elderly patient with dementia reports nearly constant verbal and physical abuse at the hands of the patient including degrading talk, biting, and scratching. How does the nurse manage this situation?

The patient who was admitted overnight is scheduled to receive an assortment of oral medications in the morning. The patient tells the nurse he does not recognize these pills. Which response by the nurse is appropriate?

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 nurse provides which instruction to the patient prescribed incentive spirometry following lower limb orthopedic surgery? 

The elderly patient with hypertension, hyperlipidemia, arthritis, diabetes, and improving cellulitis is being discharged home after a stay in a sub-acute care facility. The caregiver asks the nurse about the patient's risk for falls. The nurse reviews the patient's medical history for which risk factors for falls? Select all that apply.

The nurse working in the pediatric unit finds the two-year-old patient crying on the floor near his hospital crib. The child's parents were present for the fall, are visibly upset, and tell the nurse that she crawled over the edge and fell to the floor. Which action by the nurse is appropriate?

A high school wide receiver suffered substantial head trauma during a tackle. The school nurse is concerned about concussion. The nurse provides which information to the adolescent and parents? Select all that apply.

The patient states, “I’m trying to be healthy, so I’ve taken twice the daily recommended doses of all my vitamins for years to ensure I get even more effect from them.” The nurse assesses for signs of toxicity from overconsumption of which nutrients? Select all that apply.

A patient seeing her primary care physician responds “no” to the domestic violence screening question, “Do you feel safe in your home?” Which action does the nurse take next?

The nurse is caring for a patient transitioning to hospice care and completing his admission assessment. Which question will help the nurse most effectively attend to his spiritual needs?

A Muslim man becomes ill on a cruise ship and is transported to a hospital in Anchorage, Alaska. While conducting his history, the nurse asks, “Are there any spiritual needs we can help you address?” The man replies that he is Muslim and will pray five times a day and asks, “Which way do I face to pray to Mecca?” Which is the best response by the nurse?

The patient with bilateral leg amputations is being fitted for a new wheelchair. The nurse knows that the patient’s center of gravity is offset in which direction?

The older adult patient recently diagnosed with a spinal cord injury and limited mobility is referred to a physical therapist to discuss using a wheelchair for increased mobility. The patient asks the nurse, “Do I really have to see the physical therapist? I broke my leg as a kid and used one then.” Which response by the nurse is appropriate?

The patient presents to the emergency department (ED) and states, “I don’t know what happened! I was walking and ran into a door with my right shoulder. I closed my right eye and my vision was normal, but when I closed my left eye, I couldn’t see anything at all!” The patient’s assessment is otherwise normal. The nurse reports this to the provider immediately for assessment. Which question is most important for the nurse to ask the patient while waiting for the provider to write orders for treatment?

The nurse is caring for a patient with left-sided weakness in the hospital who had vocal cord surgery this morning. Which intervention is most important to promote safety?

The American Academy of Pediatrics recommends children remain in rear-facing car seats away from airbags until which age?

The nurse is creating a bladder retraining program for the 74-year-old female patient who is incontinent of urine. Which aspect of the training program is most important?

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.

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

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?

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 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 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 postpartum nurse is supervising new parents placing their newborn into the car seat to drive home during a snowstorm. Which observation is most concerning?

Which information does the nurse include when preparing an informational session for expectant first-time parents about car seat safety? Select all that apply

A fire breaks out on multiple floors of the hospital and the charge nurse has been instructed to evacuate the patients. In which order are the patients evacuated?

The patient in the intensive care unit who was intubated with a central venous catheter, peripheral arterial catheter, and chest tube has expired. Which question by the nurse who enters the room to assist the patient care nurse is most appropriate?

The nurse is providing post-mortem care to a patient on hospice after being treated for stage 4 colon cancer that metastasized to the bladder. Which action by the nurse is most appropriate?

A bodybuilder is brought to the emergency room after being found unresponsive. The patient is found to have no brain activity due to hypoxia caused by a massive myocardial infarction. Care is withdrawn and the patient passes away. Which statements does the nurse make to the nursing student who is assisting in providing post-mortem care? Select all that apply.

The nurse is creating a tool to screen for patients who are risk for vitamin A deficiency. The nurse includes which conditions in the screening tool? Select all that apply.

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?

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 is performing an admission assessment and interview of the patient diagnosed with paranoid schizophrenia. Which therapeutic communication techniques are used by the nurse to conduct the interview? Select all that apply.

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 patient receiving which medication is most likely to also require a prescription for miconazole?

The patient in Arizona calls the nurse line to report being stung by a scorpion. Which follow-up question by the nurse is most important?

The 3-year-old patient with acute pyelonephritis has the following orders:  Medications: 8 mg/kg ciprofloxacin IV q8h  Activity level: ambulatory as tolerated  Intravenous fluids: Infuse D5W with 0.25% NaCl via peripheral IV at 50 mL/h  Diet: Normal   The nurse is coordinating care for the patient with the unlicensed assistive personnel. Which statement by the UAP prompts further education by the nurse? 

During a routine physical, the patient states, “I feel more comfortable taking herbal remedies than prescription medications for my high blood pressure.” Which response by the nurse is most important?  

The nurse is helping to recruit patients for a study about the effectiveness of a new delivery system for somatropin. The nurse filters the records for patients with which conditions? Select all that apply.

The nurse is supervising a nursing student in the emergency department. Which actions by the nursing student indicate effective learning? Select all that apply.  

The nurse places a call to the provider that the 74-year-old patient’s potassium level is 7.1 mEq/dL. The nurse is prepared to answer which questions from the provider? Select all that apply.  

The patient is started on subcutaneous heparin injections 7500 units q12h for deep vein thrombosis prophylaxis at 0900. When does the nurse plan to obtain the activated partial thromboplastin time (aPTT) to determine effectiveness of therapy?  

The patient on bowel rest has been prescribed 10% dextrose total parenteral nutrition at 50 mL/h, intravenous lipids 3 grams/kg/day, and 10 mg intravenous famotidine every other day. Which information in the patient’s chart prompts the nurse to contact the provider? 

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?

During a routine physical, the 58-year-old patient reports aching chest pain that occurs only when doing yardwork or heavy cleaning. However, it does not occur every time he is performing these chores. He denies regular exercise and reports a sedentary lifestyle. The nurse anticipates providing which instruction to the patient related to the patient's new prescription for this condition?