Health Promotion

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 patient is admitted to the hospital with systemic syphilis infection. The patient is ordered to receive a 14-day course of penicillin G 20 million units/day intravenously. Prior to administering the medication, the nurse checks the patient’s allergies and learns the patient experienced anaphylaxis after receiving ampicillin. Which action does the nurse take?

Which patient on the surgical floor is at the greatest risk for abdominal wound dehiscence?

The patient presents to the emergency department (ED) after being bitten by a friend’s dog with two puncture marks and an abrasion. Prior to dressing the wound, the nurse uses which substance to clean the wound?

The nurse requests analgesia for the 76-year-old patient who must undergo cleansing and dressing change for a healing stage 3 pressure ulcer on the coccyx. In response, the provider ordered topical EMLA cream to be applied to the wound 30 minutes before the procedure. Which action by the nurse is appropriate?

The patient returns from cholecystectomy surgery with a wound closed with sutures. There is no drainage from the wound. Which dressing does the nurse apply?

Which interventions increase the risk for impaired skin integrity in the patient with congestive heart failure who requires total care? Select all that apply.

Which patient is at highest risk for skin breakdown?

The nurse advocates for a guaiac test to be performed on the patient with which stool?

During routine tracheostomy cleaning and care, the nurse notes a strong smell of dirty gym socks coming from the dressing around the stoma. Which action by the nurse is most appropriate?

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.

A nurse is caring for a patient who is recovering from total hip replacement surgery. The patient has required increasing doses of IV morphine for pain control. The patient is again reporting 10/10 pain despite receiving 10 mg of morphine from the nurse, which is the top of the range ordered by the physician. The nurse monitors which of the following most closely?

The nurse is teaching the child with asthma how to use a metered-dose inhaler. Which instructions does the nurse include? Select all that apply.

Which statement is true regarding the nonstress test (NST)?

The nurse is teaching a woman ways to prevent mastitis. Which statement by the patient indicates that more teaching is needed?

The nurse is supervising the nursing student in the provision of a complete bed bath to the patient. Which action by the nursing student indicates successful learning?

The physical therapist trained a patient with stress incontinence how to perform pelvic floor muscle (Kegel) exercises. Which statement by the patient suggests more education is needed?

Which patients are at risk for restrictive pulmonary disease? Select all that apply.

The nurse is caring for a patient diagnosed with measles. Which precautions does the nurse utilize during the patient’s care? Select all that apply.

The nurse is supervising a student nurse in caring for a postoperative patient at high risk for surgical wound evisceration. The nurse prepares the student to perform which interventions if the wound eviscerates? Select all that apply.

The 40-week-gestation patient is brought to the emergency department in active labor. Which assessment alerts the nurse to an impending emergency?

The nurse is providing preoperative teaching to the patient who is scheduled for a total knee replacement next Tuesday at 1000. The nurse instructs the patient to have no solid food after which time?

The patient being treated for a skin wound and cellulitis is in a semi-private room with another patient; the hospital is near capacity. The culture of the wound has grown methicillin-resistant staphylococcus aureus. Which action is most appropriate? 

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 actions does the nurse take to prevent infection around the use of a peripheral IV? Select all that apply.

Which statements are true regarding peripherally inserted central catheters (PICCs)? Select all that apply.

The patient is being discharged from hospital on total parenteral nutrition (TPN). Which information does the nurse include in discharge teaching?

Which medication may be prescribed for the treatment of anorexia and cachexia related to cancer?

The American Cancer Society recommends the patient's initial cervical cancer screening occurs at which time?

The nurse is notified the patient's heart monitor shows ventricular fibrillation. Initial assessment reveals strong peripheral pulses and even, unlabored respirations with an oxygen saturation of 98%. Which action does the nurse take first?

Which statement is true regarding the provision of cardiopulmonary resuscitation (CPR) in the community with an automated external defibrillator (AED)?

The patient’s wound is producing copious amounts of exudate and the gauze dressing is saturated within two hours of placement. Which intervention does the nurse perform?

The nurse is reviewing the medication list of the patient who wishes to become pregnant. One of the medications is listed as Category X. The nurse knows this medication poses which level of risk to the fetus?

The patient is being evaluated for obstructive sleep apnea. For which test does the nurse prepare the patient?

The patient receiving sliding scale insulin requests the subcutaneous insulin to be injected into the abdomen. Immediately prior to administration, the nurse notes the site is stringy, slightly indurated, and has several fat masses. Which action by the nurse is appropriate?

Which statement is true regarding single use items?

The patient with dementia has experienced unintentional weight loss of 20 pounds due to decreased food intake. The patient's caregiver asks the nurse about nutritional drinks and shakes. Which response by the nurse is most appropriate?

A patient scheduled to undergo a Whipple procedure (pancreaticoduodenectomy) is extremely agitated and apprehensive, though still wants to undergo the procedure. Which interventions does the nurse employ to decrease the patient's anxiety? Select all that apply.

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. 

During the initial home visit, the home health nurse assesses which of the elderly patient's basic activities of daily living? Select all that apply.

Body mass index (BMI) is calculated using which measurement(s)?

The patient who eats a vegan diet requires assistance selecting meals while inpatient. Which items does the nurse select for the patient? 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?

The patient has Stage I pressure ulcers on her heels bilaterally. The patient's husband asks the nurse if he can massage her feet. Which is the most appropriate response by the nurse?