Practice Questions I

Situation 1

Mrs. X is an 80-years-old patient has been confused since her hospitalization. The patient was oriented to all 3 spheres at home. Today, she tried to take out her IV twice and remove her

Foley catheter.

 

Question 1:

Her daughters are wondering if she will be confused like this forever. Yes or No?

1.

Justify:

 

Question 2:

Name 2 other interventions apart from adequate surveillance and a secure environment to prevent fall?

1.

2.

 

Question 3:

Her daughters are asking you why you aren’t using restraints. How will you respond?

1.

 

Situation 2

Mr. X is an 80-years-old, autonomous, oriented to all 3 spheres has some vision difficulties and has a history of type 2 Diabetes. He fell 3 times at home: once after tying his shoes, another time when getting out of bed and the third time when he stood up suddenly. According to him, he felt dizzy and then fell.

 

Question 1:

What problem do you suspect?

1.

 

Question 2:

What factors put him at an increased risk of falls?

1.

2.

 

The PAB went to see you at the nursing station and told you that the patient lifted up his own side rails.

 

Question 3:

What do you do?

1.

 

Question 4:

How would you arrange the patient’s environment to prevent falls (give 3 interventions)?

1.

2.

3.

 

Situation 3

Madame X is confused and was in restraints for the past few days. Today, she is calm and now the restraints are taken off.  The PAB went to you at the nursing station and tells you that not to worry because he has already installed restraints on to the patient.

 

Question 1:

How do you respond?

1.

 

Situation 4

You work in a psychiatric unit; you get a report from ER to receive a transfer of a male patient who has been aggressive and tried to hit other people and threatens everyone around him.

 

Medical orders:

Tranquilizers and seclusion PRN.  

 

Question 1:

What other information will you ask while getting the report?

1.

 

Question 2:

What interventions will you prepare prior to your patient’s arrival to the unit?

1.

2.

 

Question 3:

Following his arrival, he starts to get aggressive, you attempt to calm him down but you’re

unsuccessful. What do you do?

1.

 

Situation 5

Mr. X, is a 20-years-old who attempted to commit suicide by having a car accident. He has a fractured femur, isolates himself in his room, and he appears depressed. He states that “He does not see any point to living and would like to die!”

 

Question 1:

What is the patient’s current suicidal risk?

1.

 

Question 2:

What type of monitoring/surveillance will you implement?

1.

 

Question 3:

What will you do to ensure a safe environment in the patient’s room?

1.

 

Question 4:

The patient complains of leg pain and asks you for his analgesics. What will you verify when giving medication to the patient prior to leaving his room?

1.

 

Mr. X has been on antidepressants for 8 days. He rolls around in his wheel chair in the hallway; he is happy, cheerful, and was seen smiling. He also interacts with everybody.

 

Question 5:

Are his risks of suicide still present?

1.

Justify:

 

Situation 6

Mrs. X had a mass on her lung post bronchoscopy. A biopsy was taken; you present to her a

form of consent of the exam. She said she already signed a form like that similar on admission.

 

Question 1:

Do you make her sign the consent?

1.

 

Question 2:

Prior to starting the exam, you need to give her Scopolamine (Atropine) anticholinergic as

prescribed. What is the reason why this medication is given?

1.

 

Question 3:

Half an hour later, she returns from the exam and says that her throat is dry and she wants to

drink some more water. What do you tell her?

1.

 

Question 4:

Give two possible complications of bronchoscopy with biopsy?

1.

2.

 

Situation 7

Mr. X 20 years old is diagnosed with diabetes type 1 and is on regular insulin 5 units in the

morning and NPH 10 units with breakfast and dinner as prescribed.

 

Question 1:

The patient asks for his insulin to come in a pill form instead of subcutaneous. What is your response?

1.

 

Question 2:

He also asks you if when he will be able to stop taking his insulin. What is your response?

1.

 

Question 3:

You’re teaching him about the different sites to administer his insulin, what would you emphasize to the patient regarding insulin administration?

1.

 

Question 4:

The meal arrives and you’re getting ready for him to take his insulin. The patient is asking you to come back after dinner to give his insulin because he is very hungry and wants to eat

first. What do you tell him?

1.

 

Situation 8

Mrs. X, a patient who is on palliative care due to cancer is currently on comfort care as prescribed.

 

Question 1:

Identify two comfort cares that you need to do to Mrs. X?

1.

 

Question 2:

Her daughter states she is helpless and that she does not know what to do to help her mother.

What do you suggest to her?

1.

 

Situation 9

Mrs. X postoperative cesarean patient who is on fentanyl in NS under epidural, the pump is set at x cc/hr, there is a protocol which gives the possibility to increase the dose if the patient is not relieved. At 12:00, her vital signs are stable, she has 0/10 pain when mobilizing she can bend her legs. It is 14:30, the patient tells you she has a pain 5/10.

 

Question 1:

What must you verify before increasing the dose to the pump?

1.

 

Question 2:

You are getting ready for her first walk out of bed. What must you ensure before she gets out of bed?

1.

 

Situation 10

Mrs. X is an 80-years old patient who lives in a CHSLD. She is autonomous and lucid, has a history of diabetes type 2. In her chart, it states that she has been feeling malaise for the past few days; she says she has been tired and has a dry throat.

 

This morning, on arrival, you find Mrs. X in her bed, she is diaphoretic. Her blood pressure, heart rate, and respiratory rate are all high and has a temperature of 38.2 by mouth.

 

Question 1:

What other findings do you need to obtain to have a complete assessment of the patient?

1.

 

Question 2:

What problem do you suspect?

1.

 

Question 3:

The physician is now aware of the patient’s condition and ordered to transfer the patient. What interventions must you do prior to the arrival of the ambulance?

1.

 

Question 4:

You are filing in the transfer-inter-institutional form. Apart from her actual problems, her

medications and her level of autonomy, what other information must you write on the form?

1.

 

Question 5:

Mrs. X has received her discharge from the hospital; she is going back to her nursing home. The Emergency nurse tells you the patient’s diagnosis and status. What valuable information the emergency nurse should ask regarding the patient’s transfer?

1.

Situation 11

Mr. X who had a left CVA suffers from dysphagia, hemiplegia, and aphasia. Oral food intake is

prescribed.

 

Question 1:

In which position do you place the patient to eat?

1.

 

Question 2:

At meal time, how do you know if he has no difficulty swallowing?

1.

 

Question 3:

Available foods are:

Orange juice, oatmeal, yogurt, toast, and tea.

Name the foods that you would not give to the patient?

1.

 

Question 4:

After dinner how will you reposition the patient? For how much time? Justify.

1.

Situation 12

Mr. X with congestive heart failure. He has an IV at 100 cc/hr with an intake greater than output. His oxygen saturation ranges from 92%-96%. Three hours later the patient complaints of dyspnea and his oxygen saturation went down to 83% in room air. Vital signs reveal respirations of 25 bpm, heart rate 92 regular, and blood pressure of 150/90.

 

Question 1:

What physiological problem do you suspect?

1.

 

Question 2:

What will be your interventions?

1.

 

Question 3:

Mr. X is anxious, he states that “he can’t breathe and feels he is choking.” What will you say to reassure him?

1'

Situation 13

Mr. X 30 years old just had a left leg above-the-knee amputation (AKA).

 

Question 1:

Which intervention is done by the nurse that is incorrect, encircle your answer and justify:

a) Mobilize patient regularly

b) Put a pillow underneath the left amputated leg for comfort.

c) Keep the amputated leg aligned.

Justification:

 

The patient told you that he does not understand why he has to take the breakthrough doses pharmacological analgesic as needed.

 

Question 2:

What would you do in this case?

1.

Justification:

 

The patient has difficulty accepting his surgery. Yesterday he was yelling at the staff, very

aggressive and states “he doesn’t need to cooperate for his care.”

 

Question 3:

Explain briefly the patient’s behavior?

1.

 

Question 4:

What interventions that you can implement to help the patient accept his situation?

1.

 

Question 5:

From a relational perspective, what do you suggest to him to help him accept his

Current condition?

1.

 Situation 14

Mr. X 40 years old was burned at different areas on his body. You take off his dressings and

you see that they stay glued to the wound.

 

Medical orders:

Clean the wounds with normal saline during dressing change.

 

Question 1:

What do you do with the dressing that glues to the wound?

1.

 

Question 2:

One of the wounds on his abdomen has green discharge with foul odor. What do you do after cleaning the wound with normal saline?

 1.

 

Question 3:

The patient looks at himself in the mirror and says he finds himself ugly and does not want

anyone to see him. What do you do?

1.

 

Question 4:

Mr. X received his discharge this morning. He calls his roommate and asks him to bring him a

shirt with a rolled-up collar. What elements in this situation tell you that he has begun to accept his condition?

1.

 

Situation 15

An 8-month-old infant who weighs __ kg. Comes to Emergency Room for gastroenteritis, he has diarrhea, his skin and mucous membranes are dry. He has persistent skin folds, sunken eye balls, and brittle nails.

 

Question 1:

What problem do you suspect?

1.

 

Question 2:

Name other signs and symptoms that are associated with the problem that the bb can present with? (4)

1.

2.

3.

4.

 

The baby is having normal stools now, you assess the baby and noticed that the IV was infiltrated. The medical order states to stop IV solution if intake PO is well tolerated.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Question 3:

Do you reinsert the IV?

 1. 

Justify:

Situation 16

Mrs. X underwent a blood test today caused by dehydration. Using the lab values below put an X in each element if increase, decrease, or normal.

 

 

 

 

 

 

Situation 17

Mrs. X is a 70-years-old patient who lives in a semi-autonomous residence. She is lucid and comes to Emergency Department caused by a fall. The patient is somnolent, with complaints of vertigo. She also has a history of tachycardia and hypertension. She came in with a list of her medications that she takes at home.

Prescribed medications:

Lopressor QD at AM

Losec QD: The patient states “she stopped taking it because it costs too much

money”, the bottle of medication is empty.

Coumadin q HS

Ativan q HS

Over the counter medications: Entrophen PRN

Calcium supplements QD

Medications that are given by daughter in law:

Serax: takes 3-4 times per week

 

Question 1:

What priority information must you obtain to complete your evaluation of the patient's situation?

1.

 

Question 2:

Which two medications are causing the current problem of the patient?

1.

2.

 

Question 3:

Name 2 interactions and their side effects

1.

2.

 

Question 4:

What could be the origin to her noncompliance with pharmaceutical treatment in this patient? Name 4

1.

2.

3.

4.

 

Question 5:

What recommendations would you give the patient when returning home regarding compliance to her medications?

1.

 

Situation 18

Mr. X is a 54 years old patient who is admitted to your unit. The patient is currently on Coumadin daily for his atrial fibrillation. He told you that he occasionally takes Tylenol and Advil together for his arthritis pain as needed.

 

Question 1:

What do you recommend to Mr. X when he takes his two other medications with Coumadin?

1.

Justify.

 

Question 2:

At 21:00, the patient told you that he forgot to take his Coumadin this afternoon at 17:00.

What do you answer?

1.

 

Question 3:

Prior to his discharge, the physician advised him to modify his consumption of broccoli. The patient asked you why. What is your response?

1.

 

Situation 19

Mr. X was admitted to your unit due to angina this morning. During your shift, he comes to see you at the nursing station and tells you that he has chest pain and describes it as crushing. The patient appears diaphoretic.

 

Question 1:

What additional information do you need to complete your pain assessment?

1.

2.

 

Question 2:

What priority nursing interventions will you do prior to calling the physician?

1.

2.

 

Question 3:

The physician prescribes nitroglycerin spray, what recommendations would you tell Mr. X when taking the spray?

1.

2.

 

Situation 20

Mrs. X is a 53-year-old CHSLD volunteer. She refuses to get the flu vaccine because she

says she rarely gets sick.

 

Question 1:

Given the patient’s situation above, why should Mrs. X get vaccinated against by the flu?

1.

2.

 

Mrs. X is hesitant because she has heard about the side effects of the flu vaccine.

 

Question 2:

What could be the systemic benign effects occur after giving the flu vaccine?

1.

 

Give two interventions:

1.

2.

 

Situation 21

Mrs. X is a 60 years old says she has difficulty sleeping in the evenings, she states that she usually drinks 1-2 cans of soft drinks while watching television in the evening.

 

Question 1:

Other than taking the medication, what can you recommend to Mrs. X to aid in her sleeping?

1.

.

Situation 22

Mr. X is 60 years old patient who was operated for a colostomy located in the descending colon with resection of the rectum. In the following picture, you see the abdomen where the intestines, large colon, and rectum.

 

Question 1:

Write an X where the stoma would be placed?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Question 2:

What will be the stool consistency from the stoma site?

 

Question 3:

Mr. X asks you if his skin surrounding the stoma will burn due to contact with stool. How will you respond, Yes or No?

1.

Justify:

 

Question 4:

Mr. X asks you why the dietician told him to avoid cauliflower, onions, and spicy foods. How do you respond?

1.

 

Situation 23

Mr. X is a 70 years old patient who is hospitalized for diarrhea. He was diagnosed with C-difficile and you moved him to a private room under isolation to avoid contamination.

 

Question 1:

Name other signs and symptoms of C-difficile?

1.

2.

 

Question 2:

Other than the consistency, name other characteristics of the stool that you need to monitor?

1.

2.

 

Question 3:

Mr. X says that he was never in contact with anybody who had the disease and he doesn’t

understand how he caught the illness. Give 2 reasons that could explain how he caught the disease?

 

Question 4:

You’re about to leave the room after taking the patient’s oxygen saturation, you take off your gloves and gown. What else will you do before leaving the room?

1.

 

Situation 24

Mrs. X is a 30 years old patient who comes to the Emergency Department for a fractured right humerus. You noticed ecchymoses on the affected arm and she avoids looking at her arm. Her husband stares at her arm and says, “This happened when she fell down the stairs.” These signs lead you to suspect that Mrs. X is a victim of violence.

 

Question 1:

What intervention will you put into place to allow Mrs. X to confide in you?

1.

 

Question 2:

After admitting that her husband hits her, Mrs. X feels guilty. She says this wouldn’t have happened if she took better care of her husband to make him happy.

What is your response to Mrs. X?

1.

 

Question 3:

What information do you need to gather that would lead you to conclude that Mrs. X is at high risk of ending up in a violent situation again?

1.

 

Question 4:

What do you recommend to Mrs. X once she returns home with her husband?

1.

 

Situation 25

Mrs. X, primipara is hospitalized for premature labor at 32 weeks of pregnancy. She had contractions at 9-10 minutes apart. After assessing the fetus, FHR is 130, fetal movement is normal. All vital signs are normal. The cervix shows no effacement and is not dilated. The physician gives Mrs. X her discharge.

 

Question 1:

What do you tell her concerning her physical activity at home since she is discharged?

1.

 

Question 2:

Mrs. X calls you on the obstetrical unit the following week and tells you that she feels pressure at the pelvic region and has pain at the lumbar area. She mentions she had some vaginal pink discharge.

 

Question 3:

What do you tell her to do?

1.

Justify:

 

Situation 26

Mrs. X had her first baby and is breastfeeding. She complains of pain to her chapped nipples. The baby’s position is correct when breastfeeding and she humidifies her breast with a bit of colostrum after breastfeeding that she lets air dry.

 

Question 1:

What other information could help you find the source of her pain?

1.

 

Question 2:

Mrs. X asks you how she will know if the baby is getting enough milk.

1.

2.

 

Situation 27

Mrs. X 60 years old with Congestive Heart Failure is taking Lanoxin (Digoxin)

 

Question 1:

What must you verify prior to giving the medication?

1.

 

Situation 28

A 20-years old patient who is admitted to a psychiatric unit for anorexia. A plan of care was created specifically for the patient. According to the plan, there will be restrictions and rewards if proper behavior is seen. You find the plan to be too restrictive, you feel uncomfortable in implicating this plan.

 

Question 1:

What can you do to feel more comfortable with this plan?

1.

 

She eats well for suffer after giving her permission to make a phone call. In the afternoon, you see her crying and asks if she can use the phone to call her mom before she eats because it is her birthday and this is very important to her.

 

Question 2:

Do you comply with her demand?

1.

Justify:

 

Situation 29

A female patient was admitted due to Crohn’s disease. She is in a semi-private room where the 2nd bed is not occupied. You’re waiting for a transfer of another patient from the Emergency Department who has pneumonia?

 

Question 1:

Do you allow the transfer of the patient from the Emergency Department to share the same room with the patient?

1.

Justify:

 

Situation 30

A 55-year-old patient with osteoporosis is taking Fosamax (Alendronate), calcium supplements and Vitamin D. She also has a good appetite with a well-balanced diet.

 

Question 1:

What additional advice would you recommend to the patient in this situation?

1.

The physician recommends hormonal replacement therapy. After researching about hormonal replacement therapy, the patient hesitates to accept the treatment.

 

Question 2:

What can you do to help the patient make an informed decision?

1.

 

Situation 31

A 30 years old male patient is hospitalized with renal calculi. He has a prescribed Dilaudid 2mg/ml 1-2mg s/c q4h PRN and Tylenol 325mg 1-2 tabs Q4H PRN for pain. At 13:00, he receives his Dilaudid for flank pain. It is 18:00, the patient complains of 8/10 on pain scale.

 

Question 1:

What is your intervention?

1.

 

Question 2:

At 19:00, he says he still has pain 4/10 on pain scale. What is your next intervention?

1.

4000 Avenue De Courtrai,

Montreal, Quebec

H3S 1C3 ROOM 201

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