RN101
Home of the Registered Nurses (RN) and
Licensed Practical Nurses (LPN)

SITUATION I

Mrs. A is admitted to the emergency department with a fractured arm. She explains to you that her injury resulted when she provoked her drunken husband, Mr. B, who then pushed her.see answer 

 

Question 1:

What best describes your understanding about Mrs. A's explanation?

1. _____________________________________________________________________________________________________________________________.

 

SITUATION II

Patient B is a 25-year-old  post-partum mother who is willing to breastfeed and would give supplemental feedings with formula to her infant. She also states that she would like to increase her intake of vitamin C and do the feedings frequently.

see answer 

Question 1:

What factor that might result in a decreased supply of breast milk to this patient?

1. _____________________________________________________________________________________________________________________________.

 

A few days later the patient experiences engorgement.

 

Question 2:

What will you teach the mother to promote let down of milk and will give her temporary relief?

1. _____________________________________________________________________________________________________________________________.

 

SITUATION III

A patient who delivered her first baby via caesarean who is on opioid analgesics for pain (PRN)and is taking antibiotics for mastitis is concerned about breast feeding her neonate.see answer 

 

Question 1:

What recommendation should be given to this patient?

1. _____________________________________________________________________________________________________________________________.

 

For the past 3 days you noticed that the patient is often anxious, sad, irritable, cry at times and feeling overwhelmed despite the help offered by the nursing team.

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Question 2:

What do you suspect is happening to the patient?

1. _____________________________________________________________________________________________________________________________.

 

SITUATION IV

Three hours after vaginal delivery with episiotomy, the patient rings the call bell and states that she needs to void. Her muscle tones are all good and she doesn't complain of any pain.see answer 

 

Question 1:

What will you assess first before helping the patient to get up from the bed?

1. _____________________________________________________________________________________________________________________________.

Justify: ________________________________________________________________________________________________________________________.

 

Question 2:

Before giving the patient rubella vaccine, what teaching should you include that the patient should understand?

1. _____________________________________________________________________________________________________________________________.

 

Question 3:

The patient asked if she can continue to breastfeed her infant after the vaccination of rubella. What would be your response?

1. _____________________________________________________________________________________________________________________________.

 

SITUATION V

The patient told you that she admires of what nurses do to their patients and would like to take a nursing course after she finishes high school. Because of that, she posts a lot of questions to you. She asked you about Rh incompatibility. You responded that:see answer 

 

Rh incompatibility can only happen when the mother is Rh ___________ and the fetus is Rh __________. And that the first pregnancy the baby would be probably not affected. To prevent maternal antibody production Rhogam is given at ____ weeks of pregnancy and ____hours after delivery.

 

SITUATION VI

Following a difficult 12 hours labor, patient C develops a 3rd degree perineal tear. The next day, her perineum is a little edematous and she states that she has pain 3/10. You administered Tylenol 650 mg for her pain.see answer 

 

Question 1:

She asks  you if there are any other ways  to relieve the pain apart from taking medication. Identify three.

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

 

SITUATION VII

You are a nurse teaching a group of primigravida patients about the discomforts of pregnancy. A client asks you, “What are the causes of my nausea and vomiting?” You responded that the contributing factor to first-trimester emesis is:see answer 

­­­­­­­­­­­­­­­­________________________________________________________________________________________________________________________________

 

Question 2:

You instructed this client what to do about her nausea and vomiting. Identify two (2) interventions.

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

 

SITUATION VIII

Yesterday evening, Mrs. D, age 29, primipara, gave birth to a baby girl with cleft lip by vaginal delivery at 37 weeks gestation. Mrs. D did not sleep a lot but is recovering well physically. It's 8:00 am and you go into the patient’s room for the first time. She's alone with her baby. While you’re talking to her, she started to cry and states, “I hope my husband will accept our baby. ” You noticed that her husband haven’t visited them yet and when you asked why, she then opens up to you that her husband is not very supportive in the entire pregnancy and states that he is verbally abusive and sometimes he's hurting her when he's  drunk. You reported this problem to your head nurse and MD. You also offered support group for her like “Shield of Athena” who serves for emergency shelter for abused woman to all ethnicity, external counselling, listening service, support and intervention and prevention for victims of domestic violence.see answer 

 

Question 1:

You encourage Mrs. D to prepare in advance in case she goes back home. Identify four (4) instructions you will advise her to do?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

4. _____________________________________________________________________________________________________________________________.

 

SITUATION IX

Marian, a 29-year-old, telephones the emergency room department stating that she thinks that she is in labor. You are the nurse who answered her call, you told her that labor should probably started when she has signs and symptoms of true labor: Identify three.see answer 

 

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

 

SITUATION X

You are a nurse in a CLSC, patient X is a 24-year-old female who reports that she is taking oral contraceptives and soon starts her antibiotic therapy.see answer 

 

Question 1:

What teaching should you include to patient X?

1. _____________________________________________________________________________________________________________________________.

Justify: ________________________________________________________________________________________________________________________.

 

SITUATION XI

A client hospitalized for premature labor tells you that she's having occasional contractions.see answer 

 

Question 1:

What nursing interventions are most appropriate?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

 

SITUATION XII

You're a nurse measuring the fundal height on a patient who is 36 weeks gestation when the patient suddenly complains of feeling lightheaded.see answer 

 

Question 1:

You determine that the patient's complaint is mostly caused by what?

1. _____________________________________________________________________________________________________________________________.

 

Question 2:

What is your intervention according to the patient's complaint?

2. _____________________________________________________________________________________________________________________________.

 

SITUATION XIII

A nurse is collecting data during an admission assessment of a patient who is pregnant with twins. The patient has a healthy 5-year-old child that was delivered at 37 weeks and tells the nurse that she doesn’t have any history of abortion or fetal demise.see answer 

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Question 1:

The nurse would document the GTPAL for this client as:

1. _____________________________________________________________________________________________________________________________.

 

SITUATION XIV

A patient arrives at a prenatal clinic for the first prenatal assessment. The patient tells you that the first day of her last menstrual period was September 19th, 2016 and lasted for 5 days. Using Nagele’s rule, you determine the estimated date of confinement as:see answer 

________________________________________________________________________________________________________________________________