Health Promotion

The nurse is educating the patient with a spinal cord injury on safe wheelchair use. Which important features does the nurse emphasize to the patient? Select all that apply.

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 nurse recommends removal of which items from the home of the patient who will be discharged home in a wheelchair? 

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 patient with laryngitis requests tips on nonpharmacological symptom management. The nurse makes which suggestion?

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 58-year-old patient with chronic obstructive pulmonary disorder (COPD) presents to the clinic requesting the pneumococcal vaccine. Which response by the nurse is appropriate?

The nurse is providing education to the patient recently diagnosed with Raynaud’s phenomenon. Which information does the nurse include in teaching?

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?

Which evening meal choice is appropriate for this patient? Look at the patient’s chart to make a selection.

Which food items does the nurse encourage the patient to eat? Look at the patient’s chart to make selections and select all that apply.

Which meal selection is appropriate for this patient? Review the patient’s chart to make a selection.

The patient with a subtotal gastrectomy has been advanced to a regular diet. Which information does the nurse provide the patient? 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.

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?

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 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 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 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 nurse notes the patient’s nails appear to curl upwards like spoons. Which statement by the nurse is most appropriate?

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 adult child of the patient with dementia who is the patient’s in-home caregiver reports the patient exhibits increased confusion and agitation after 1600 each day. Which statement by the nurse will be most helpful to the caregiver?

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 is scheduled to undergo a Wood’s light examination. Which instruction does the nurse include in preprocedure teaching?

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

The 74-year-old otherwise healthy patient presents to the clinic complaining of severe pain and burning of the skin over the right flank. Upon assessment, the nurse notes two lines of vesicles that curve laterally away from the spine on the right side. The nurse provides which instruction to the patient regarding treatment?

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 nurse is supervising the care of a patient with a stage II pressure injury on the coccyx. Which intervention by the student nurse prompts the nurse to intervene with further education?

Several tenants from an apartment building are brought to the emergency department with concern for carbon monoxide poisoning. One patient presents with reddish-purple skin, a blood pressure of 94/48 mmHg, heart rate of 118 bpm, and altered consciousness (arouses when his name is shouted). The nurse anticipates testing will reveal which carbon monoxide level?

The nurse is creating a screening form to determine which patients are at heightened risk for laryngeal cancer. Which professions does the nurse include? Select all that apply.  

The nurse is providing preoperative education regarding total laryngectomy to the patient with laryngeal cancer. Which statement indicates a need for further teaching?   

The nurse is preparing an informational session for individuals at risk for prostate cancer. Which statement does the nurse include in the talk?  

The patient with high cholesterol reports forgoing the prescribed statin medication for an herbal remedy. The nurse assesses the patient for which adverse effects? Select all that apply. 

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 patient with short stature associated with Noonan syndrome is being considered for somatropin injections. The nurse ensures which test is performed before therapy is started? 

The 21-year-old patient with a body mass index of 10.1 undergoes placement of a peripherally inserted central catheter (PICC) at 1000 and total parenteral nutrition (TPN) is initiated at 1200. At 1600, 160 mL have infused and the patient is noted to be breathing shallowly, there is blood oozing from the PICC insertion site, and the patient is exhibiting confusion. Which action does the nurse perform first? 

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 nurse is most concerned with encouraging the patient with multiple myeloma to ambulate frequently to prevent which complication? 

Which interventions does the nurse include in care for the patient who underwent a total pelvic exenteration for a cancer diagnosis one day ago? Select all that apply.