Tüm alıştırma soruları

A client with newly diagnosed severe coronary artery disease is scheduled for a coronary artery bypass graft. The nurse brings the informed consent document to the client's room for a signature. The client states, "The doctor said I need this surgery, but I do not really understand what the alternative treatments are or what will happen if I refuse it. I will sign it anyway because I want to get better." Which of the following is the most appropriate action by the nurse?

A client with an intra-abdominal infection is receiving a continuous intravenous infusion of metronidazole. The client reports severe nausea, and the healthcare provider prescribes a dose of intravenous ondansetron. The client has a single peripheral intravenous line. After consulting a pharmacological reference, the nurse identifies that metronidazole and ondansetron are incompatible at the Y-site. Which action should the nurse take to safely administer the prescribed antiemetic?

A 45-year-old client is admitted to the emergency department with a ruptured appendix and requires urgent surgery. Thirty minutes ago, the client received 2 mg of intravenous hydromorphone for severe pain. The surgeon explains the procedure, risks, and alternatives to the client and their spouse, who is the client's legally designated healthcare proxy. The client is lethargic but accurately repeats the surgical information and states, "I understand the risks. I want the surgery. Give me the pen to sign." Which action by the nurse is legally and ethically required?

The nurse receives the shift report for four clients on a medical-surgical unit. Which client should the nurse assess first?

A nurse is receiving the morning shift report for a group of clients on a medical-surgical unit. Which of the following clients should the nurse assess first?

A nurse in the emergency department is assessing a 4-year-old child and observes multiple circular, healing burns on the child's back that resemble cigarette burns. The parent states the child accidentally bumped into a hot radiator. Which of the following is the priority legally required nursing action?

A client is rushed into the trauma bay with severe respiratory distress, absent breath sounds on the right side, and a tracheal shift to the left. The client's blood pressure is 76/40 mm Hg and oxygen saturation is 81% on high-flow oxygen. The client is increasingly lethargic and unable to verbally respond. The attending physician prepares for an immediate tube thoracostomy and instructs the nurse to "get the consent form signed quickly" before the incision is made. Which is the most appropriate action by the nurse?

Upon receiving the handoff report on a cardiovascular step-down unit, the nurse is planning the initial client rounds. Which client requires the nurse's immediate assessment?

Following the morning shift report on a maternal-newborn unit, the registered nurse prepares to round on four assigned clients. Which client must the nurse assess first?

A nurse is preparing to telephone the healthcare provider to report a client's abnormal laboratory result. Arrange the nurse's planned statements in the correct sequence using the SBAR (Situation, Background, Assessment, Recommendation) communication tool. (Place the first statement at the top and the last statement at the bottom.)

A nurse is caring for a young adult client who was voluntarily admitted to an inpatient psychiatric unit three days ago with severe major depressive disorder. This morning, the client suddenly appears remarkably peaceful, gives their favorite watch to a peer, and states, 'Everything makes sense now. I am leaving this hospital today.' The client demands their personal belongings and attempts to exit the locked unit. Which of the following actions are legally and ethically required by the nurse? Select all that apply.

A 71-year-old client on a surgical unit is preparing for a bowel resection later today. The client received an intravenous (IV) dose of morphine 45 minutes ago to manage acute abdominal pain. The healthcare provider has asked the registered nurse (RN) to witness the client's signature on the informed consent document. Upon entering the room, the client states, "I am willing to have the surgery, but I honestly do not remember what other options the doctor discussed with me." Which actions should the RN take? Select all that apply.

During the mid-morning peak on a high-acuity step-down unit, an experienced registered nurse (RN) team leader is coordinating care with a licensed practical/vocational nurse (LPN/VN), a newly licensed RN, and an unlicensed assistive personnel (UAP). Several matters are brought to the team leader's attention simultaneously.

Arrange the following actions in the order the RN should perform them, prioritizing from the most urgent (first) to the least urgent (last).

A registered nurse is reviewing the transmission-based precaution requirements for clients on a medical-surgical unit. Which of the following clients require the nurse to don a fit-tested N95 respirator and ensure placement in a negative-pressure room? Select all that apply.

A nurse in the emergency department is caring for a 35-year-old client with a severe intellectual disability who was brought in by a group home caregiver. The client is highly agitated and attempting to pull away from the staff. The caregiver states, "We have permission to tie the client's arms down when they get like this; just do it so you can draw the blood." During the physical assessment, the nurse observes multiple unexplained circular burns on the client's upper back. Which action is the priority for the nurse to fulfill their legal responsibilities?

A staff nurse assigned to a pediatric unit is notified that their spouse has been admitted to the facility's intensive care unit (ICU) following a severe motor vehicle collision. The nurse is the documented durable power of attorney for healthcare for the spouse. Anxious for a clinical update while completing their pediatric shift, the nurse uses their employee login credentials to access the electronic health record (EHR) to view the spouse's recent computed tomography (CT) scan results. Which of the following statements most accurately evaluates the nurse's action?

While conducting an infection control audit across a multispecialty acute care facility, the nursing supervisor observes several staff members interacting with clients on transmission-based precautions. Which of the following observed actions require the nursing supervisor to intervene? (Select all that apply)

During morning rounds, the healthcare team is reviewing isolation protocols for an adult client with a sacral pressure injury that is actively draining and cultured positive for Methicillin-resistant Staphylococcus aureus (MRSA). Which of the following interventions must be included in the client's plan of care? (Select all that apply)

An infection control nurse is conducting a compliance audit on a pediatric unit. The nurse observes staff entering client rooms to perform routine vital signs. For which client presentation is it mandatory for the staff to don an N95 respirator, a disposable gown, and clean gloves before crossing the threshold into the room?

A nurse is coordinating the transition of care for a client recovering from a complex bowel resection with a newly placed colostomy who is being discharged to a home health agency. To ensure a safe and effective interprofessional transition, arrange the following nursing actions in the correct chronological order.