Ordre des infirmières et des infirmiers du Québec (OIIQ) NURSING EXAMINATION IN MONTREAL, QUEBEC, CANADA
PREPARATION GUIDE FOR QUEBEC NURSING EXAMINATION
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Mr. X, age 72, admitted for exploratory laparotomy under general anesthesia. Hx: Hypertension, diabetes, kidney failure and hx of sleep apnea. What assessment finding must you enter to the TNP?
Mr. X post-op, on PCA. Pain: 2/10, RR: 10, SpO2: 94% R/A, BP: 128/72, HR: 78, level of sedation: drowsy. What priority intervention you will do before leaving Mr. X's room?
hydromorphone (Dilaudid) 1mg/tab, 1 tab PO q 3-4 h PRN.
acetaminophen 325 mg/tab, 2 tabs PO 4-6 h PRN.
Last taken acetaminophen is in the morning and states ineffective.
Patient pain now is 5/10 and ask for an analgesics.
What other information must you collect to assess the effectiveness of the acetaminophen Mr. X has taken in the last 8 hours?
The patient refuse to take his prescribed opioid, what recommendation must you give him to help manange his pain better?
What will you reply when Mr. X's ex-wife to ask when he will be discharged?
1. Risk for respiratory depression.
1. Remove the PCA device.
1. How often he has taken the acetaminophen.
2. How many tablets he has taken.
3. When he took the last dose.
4. Pain at the peak action time of the medication.
1. Take the acetaminophen q 4-6 h regularly or before the pain is at more than 4/10.
Rationale: To prevent the pain from peaking or to maintain optimal serum levels.
Any answer that indicate that Mr. X information cannot be disclosed without the patients' agreement.
Mrs. X, age 35, gave birth at 38 weeks gestation to her second baby. She had an extended labor, receive epidural anesthesia and a 3rd-degree perineal tear. When you're doing your initial assessment UF is at 1/0 and has deviated to the right. The patient complaints of "severe cramping" pain in her lower abdomen and perineal pain and her first void was 100 ml.
Based on your assessment, what is her problem?
What are the possible causes of her problem?
You intervene on the patient's problem. Identify two signs that your intervention was effective?
The patient perineum has moderate edema and complains of pain at the area 4/10. You administer two pain medications but the patient would like to know if there are other non-pharmacological ways she could relieve her pain and take fewer analgesics. What will be your response?
What is the difference between cold and lukewarm sitz bath?
Mrs. X has anemia. The MD prescribed iron supplement. What recommendation you tell her to improve the absorption of her iron supplement?
What priority problem you will add to the patient's TNP?
PRIORITY PROBLEM OR NEED
1. Vaginal delivery at 38 weeks.
2. 3rd-degree perineal tear.
Distended bladder or urinary retention.
2.Receive epidural anesthesia
3.3rd degree perineal tear or perineal pain
4. Extra: Difficult delivery.
1. UF: 0/0 or at the umbilicus or below the umbilicus.
2. UF: no longer deviated to the right or is midline.
3. No evidence of distended bladder to the right.
1. Apply ice to the perineum.
2. Take cold sitz baths or perineal showers during the first 24 hours.
3. Take lukewarm sitz baths or perineal showers after the first 24 hours.
4. Contract the buttocks and pelvic floor muscles before sitting down, then release them when she is sitting down.
1. Cold sitz bath or ice decrease inflammation on the first 24 hours while lukewarm sitz bath stimulates blood flow and promote tissue healing.
1. Take iron supplement at least 1 hour before meals or between meals.
2. Take iron supplement 1 to 2 hours after meals.
3. Take iron supplement at mealtimes with water or juice.
4. Wait 1 hour before consuming dairy products or tea and coffee or foods containing wheat or oxalate.
5. Take iron supplement with vitamin C.
A primipara patient gave birth vaginally without anesthesia to a healthy 3.4 kg boy.
The patient asks "Apart from the fact that it doesn't hurt, how will I know if my baby has latched on properly", what will be your response?
What is the importance of latching properly apart from helping the baby to suck effectively?
Apart from the fact that the baby is gaining weight and the baby should be nursed on demand, what will you tell the patient about two other signs that will indicate that her baby is getting enough milk?
Why does a breastfed baby can feed more frequently than a formula-fed baby?
The patient is reluctant to have her newborn vaccinated. She is concern about the dangers of vaccination. She states that vaccines can cause autism and breastfeeding can protect her baby. What information you will tell the patient for her to have an informed decision about whether or not to have her baby vaccinated.
The patient heard a lot about Sudden Infant Death Syndrome (SIDS) and the baby should always be placed on its back to sleep to prevent this problem. Give four recommendations on how to prevent Sudden Infant Death Syndrome.
The patient told you that her sister's newborn had developed jaundice. She then asks you how can she tell that her newborn develops jaundice apart from having the skin turning into yellow.
What is your advice to her sister with a newborn who developed a physiological jaundice?
1. The baby takes in a large part of the areola.
2. The baby opens its mouth very wide.
3. The baby's chin touches the breast and its nose remains clear.
4. The baby's lips are flanged outwards.
5. There are no smacking sounds during nursing.
6. The baby doesn't have dimples or its cheeks are not hallow when it nurses or its cheeks are rounded when it nurses.
1. To prevent or minimize injuries, such as cracked nipples.
2. Allows the baby to compress the mother's milk sinuses effectively.
1. Wet at least 1 diaper a day up to the 5th day, then at least 6 diapers a day.
2. Has at least 2 to 4 substantial very soft and seedy stools a day.
3. The integumentary system is well hydrated: skin and mouth.
4. Nurses at least 8-12 times in a 24-hour period.
5. Is vigorous during waking periods.
1. Breast milk is easier for a newborn to digest than commercial infant formula.
1. The vaccine can have side-effect but, in most cases, they are benign and short-lived.
2. Vaccination offers protection against diseases that could have severe complications.
3. Many studies have shown that there is no connection between vaccination and autism.
4. Breastfeeding does not protect against the diseases targeted by vaccination.
1. Have the baby sleep on a firm, flat surface.
2. Continue breastfeeding.
3. Do not use pillows, comforters, stuffed toys and bumper pads in the baby's bed.