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2. Your approaching nurse colleague will take over the patient care from you
soon. Which patient needs care the most right away?
A.) 62 year-old man with COPD who has just completed his scheduled bronchodilator
B.) 68 year-old woman with type 2 diabetes who had CVA 2 days ago
C.) 72 year-old woman with history of asthma with HR 90 and is due for her beta-
blocker
D.) 48 year-old man admitted with cellulitis of his right hand after a construction
accident, currently on IV antibiotics, with a temperature of 101.8
3. A 58-year-old guy whose heart angiography is planned for the same time as
your shift is given to your care. What steps ought you to take? Check all that
apply.
1. Explain that the patient will receive short-acting anesthesia
2. Review the patient's allergies, specifically checking to see if he has an allergy to
contrast dye
3. Inform the patient that his wife should stay at home until the procedure is finished, as
family members often distract the team in the cath lab
4. Review and reconcile his medications. Confirm that he did not take his warfarin
5. Check the patient's most recent labs paying particular attention to the PT INR
2, 4, 5: Contrast dyes contain iodine and allergy could lead to anaphylactic
response; might receive light sedation but needs to be awake and able to follow
directions
4. The cardiac stepdown unit is about to receive a 62-year-old male who is post-
coronary artery bypass surgery from the intensive care unit. What is the most
efficient manner for the cardiac stepdown nurse to receive critical patient
information from the ICU nurse who is reporting it?
A. A face-to-face verbal report with both nurses present in a quiet room
B. The ICU nurse will provide an audio-recorded report for future reference and
documentation
C. The ICU nurse will document essential transfer information in the patient's medical
record
D. The ICU nurse will accompany the patient to the stepdown unit and provide a face-
to-face report, using a unit-approved, standardized guide
6. A group of heart failure patients who have been released from the unit where
you work and are now being monitored in a clinic are the subject of data tracking
by the nurse. What is the most reliable sign that nursing interventions like
teaching and monitoring have been successful?
A. Eighty-five percent of patients have not gained weight
B. Seventy-five percent of family caregivers have reported watching an educational
DVD
C. Five percent of patients have been readmitted to the hospital in the last 90 days
D. Eighty percent report that they are taking their medications
3: All are important but lower resource utilization is best indicator and one used
by accrediting agencies, payors, etc.
7. You are the nurse getting ready to release a 46-year-old guy who was
diagnosed with hypertension and started taking chlorothiazide. You enquire of
the patient about how he perceives his new medication. Which of the following
claims best describes how well your lessons have gone? Select all that apply.
1. I will weigh myself every day at the same time.
2. I will notify Charles, the nurse practitioner in my primary care doctor's office if I gain 3
pounds or more, have increased swelling in my feet and ankles, or feel more tired than
usual.
3. I will reduce my medication if I feel very thirsty or dizzy.
4. I will wear sunscreen if I will be out in the sun for a long period of time.
5. If I want to drink alcohol, I will wait and take my medication right before I go to bed.
1, 2, 4
A: Rolled towels and sheets should not be used and may negate pressure-
reducing function of other pads
9. The MOST frequent reason for a surgical wound's slow healing is:
A. diabetes
B. surgical site infection
C. malnutrition
D. impaired circulation
B: Purlent discharge, signs of infection, open wound. Can occur <30 days up to 1
year post op
ANSWER: A This patients religion only permits fractions from red cells, white
cells, platelets, and plasma. Some JW request no blood products at all
11. Ms. Smith is receiving attention from the nurse. She is 85 years old, has a
history of severe dementia, congestive heart failure, and CVA. She was admitted
more than once for an aggravation of CHF. She continues to have dyspnea after
rigorous treatment and needs 10L of high flow oxygen. The team talks about
moving the patient to the intensive care unit (ICU) since she might require
mechanical ventilation. What should you do if, as a nurse, you feel that this
treatment strategy is ineffective?
A. Discuss the concern with the physician and treatment team and recommend
consultation with palliative care
B. Call the patient's proxy and schedule a meeting with the physician
C. Initiate an ethics consult immediately
D. Communicate the concerns to the oncoming nurse during hand off of care
12. Mother of two, 42-year-old Jill Green has been married for 17 years. Two years
ago, she received an ovarian cancer diagnosis. Jill underwent a complete
hysterectomy following the first diagnosis. For the last 2 years she has
undergone intense chemotherapy and radiation. Despite receiving treatment, the
ovarian cancer reached a late stage and spread to the bones and lungs. Jill has
opted to seek palliative care with an emphasis on comfort care after consulting
with her healthcare professionals. The home hospice RN is tasked with
overseeing Jill's care. A plan of care is established by the RN at the initial
assessment. Which issue ought the nurse to tackle first?
A. The client's bowel and urination elimination pattern, the priority concern of the health
care provider.
B. The problem that the client identifies as the first priority, the problem that most
concerns the client.
C. The client's need for help with hygienic activities, the primary nursing diagnosis
identified by the RN.
D. The stages of grief the family will face, the difficulty of grieving reported by the family.
B
13. When Jill is awake, she frequently exhibits signs of restlessness and starts to
rip and pick at the sheets. Jill's sister worries about how to control her agitation
at home. If there are any non-pharmacological interventions that their family may
undertake, she asks the nurse. Which restlessness treatments need the RN to
advise Jill's family to try?
A. Keep the lights in Jill's room dimmed.
B. Read a favorite poem or passage aloud.
C. Apply restraints to prevent injury
D. Gently rub back or stroke arms
E. Play soothing music
F. Avoid talking when at the bedside.
A, B, D, E
14. Jill claims that when her doctor told her she had 4-6 months to live, she felt as
though she had been given a "expiration date" stamp. She tells Stacy that she
feels overburdened since she still has so much she wants to impart on her
children before she passes away. Which course of action should the nurse take?
A. Urge the client not to give up hope because a curse is always a possibility.
B. Encourage the client to focus on herself for now and to try not to worry about the
children.
C. Ask the client if she is interested in having a volunteer help her record her thoughts.
D. Assure the client that her husband will be there for the children when she is not.
15. The patient's (Jill) and her family's hospice care is overseen by the nurse.
Jill's physical health worsens throughout the course of the following two months,
and she becomes unable to get out of bed. At her bedside, her sister opts to
sleep in a recliner. Jill wakes up in the middle of the night in pain, she says to the
nurse, but she is hesitant to give her pain medicine for fear that Jill won't wake up
in the morning. How ought the nurse to react to the sister's worries?
A. It is impossible to overdose a client who is dying of cancer because they have built
up a tolerance to the medication
B. We can collaborate with the primary healthcare provider to try to find a dose of pain
medication that works for Jill.
C. It is very difficult for clients with terminal cancer to have all of their pain relieved, so
Jill may have to endure pain during the night.
D. You may give Jill pain medication anytime unless her respirations are less than 12
breaths per minute.
16. The Institute of Medicine Report (IOM) from 2001 lists six essential
components of high-quality healthcare. Which one(s) of the following is(are) NOT
included in the list? (Check all that apply).
A. Patient-centered care
B. Highly specialized care delivered exclusively in specialty care clinics
C. Care that emphasizes patient safety
D. Efficiency
E. Care provided exclusively by physician-led teams
B, E
17. The following are the key components of patient-centered care (PCC) in the
fields of health policy, medicine, and nursing, according to Kitson et al. (Check all
that apply)
D. Open, effective communication between patient and provider and among members
of health care team
E. A "zero tolerance" policy for deviations from established protocols, policies, and
procedures
A, B, D
18. Kitson and colleagues came to the conclusion that while there was agreement
on some aspects of PCC, there were disparities in the disciplines' areas of
emphasis. Which phrase best encapsulates the special focus of nursing as it
relates to PCC?
A. Primary importance on the individual nurse-patient relationship
B. Personal qualities such as politeness, being respectful, and having good manners,
are more important than competence in delivering patient care
C. Focus on the patient, not on the caregiver or family members
D. Protecting the patient from interference by other disciplines
E. The need for a systematic and comprehensive assessment of patient needs and
respect for patient values and preferences
B, C, E
20. What are some instances of transitions in care (TC)? (Check all that apply).
A. Patient is admitted to the hospital from home
B. Patient is transferred from the Cardiac Intensive Care Unit to a general medical floor
within the same hospital
C. Nursing change of shift
D. Patient is discharged home
E. Patient is transferred to a skilled nursing facility for rehab following a hip
replacement.
A, B, C, D, E