Lacharity Ch. 13, 19, Case Study 10, 19

Which of the six patients can be assigned to the new RN? (Select all that apply.) 1. Ms. R 2. Mr. L 3. Mr. O 4. Mr. H 5. Ms. J 6. Mr. A - Ms. R, a 55-year-old woman with rheumatoid arthritis, underwent shoulder arthroplasty 3 days ago. She reports morning stiffness in her joints. Swelling is noted in both wrists and proximal interphalangeal joints. - Mr. L, a 35-year-old man with a history of kidney stones, reports severe back and right-sided flank pain intermittently (rating 3 to 8 on a scale of 10). The night shift nurse reports episodic nausea and vomiting with hematuria and dysuria. Mr. L was admitted through the emergency department (ED) at 10:00 PM. He is using a patient-controlled analgesia (PCA) pump. - Mr. O, an 18-year-old man, sustained a right tibia-fibula fracture in a motorcycle accident 7 hours ago. He has extensive skin abrasions underneath the cast and on the right anterolateral body. Although obvious chest and abdominal trauma were ruled out in the ED, he is being monitored for occult trauma. He is receiving an analgesic via PCA pump. - Mr. H, a 28 year-old man, is currently in the operating room (OR) for an inguinal hernia repair. He should return from the oR later in the shift. - Ms. J, a 65-year-old woman with end-stage multiple myeloma, is receiving palliative pain management. The family is considering hospice care. She has been on the unit for 2 weeks. Her physician signed the do-not-resuscitate order 3 days ago. - Mr. A, a 55-year-old man, has been on the unit for 3 weeks. He is receiving IV antibiotics for bacterial pneumonia. He has a history of IV drug abuse and chronic back pain and has tested positive for human immunodeficiency virus (HIV) infection. Mr. A's oxygen saturation was decreasing during the night shift.

1, 2, 4

A nursing diagnosis for a patient with newly-diagnosed diabetes is Risk for Injury related to sensory alterations. Which key points should you include in the teaching plan for this patient? (Select all that apply) 1. "Clean and inspect your feet every day." 2. "Be sure that your shoes fit properly." 3. "Nylon socks are best to prevent friction on your toes from shoes." 4. "Only a podiatrist should trim your toenails." 5. "Report any non healing skin breaks to your health care provider."

1. "Clean and inspect your feet every day." 2. "Be sure that your shoes fit properly." 5. "Report any non healing skin breaks to your health care provider."

You are orienting a new graduate nurse who is providing diabetes education for a patient about insulin injection. For which teaching statement by the new nurse must you intervene? 1. "To prevent liphypertrophy, be sure to rate injection sites from the abdomen to the thighs." 2. "To correctly inject the insulin, lightly grasp a fold of skin and inject at a 90-degree angle." 3. "Always draw your regular insulin into the syringe first before your NPH insulin." 4. "Avoid injecting the insulin into scarred sites because those areas slow the absorption rate of insulin."

1. "To prevent liphypertrophy, be sure to rate injection sites from the abdomen to the thighs."

You have just received a change-of-shift report about these pediatric patients. Which patient will you assess first? 1. 1-year-old with hemophilia B who was admitted because of decreased responsiveness 2. 3-year-old with von Willebrand disease who has a dose of desmopressin (DDAVP) scheduled 3. 7-year-old with acute lymphocytic leukemia who has chemotherapy-induced thrombocytopenia 4. 16-year-old with sickle cell disease who reports acute right lower quadrant abdominal pain

1. 1-year-old with hemophilia B who was admitted because of decreased responsiveness

As the pediatric unit charge nurse, you are woking with a newly-graduated RN who has been on orientation in the unit for 2 months. Which patient should you assign to the new RN? 1. 2-year-old with a ventricular septal defect for whom digoxin (Lanoxin) 90 mcg by mouth has been prescribed 2. 4-year-old who had a pulmonary artery banding and has just been transferred in from the intensive care unit 3. 9-year-old with mitral valve endocarditis whose parents need teaching about IV antibiotic administration 4. 16-year-old with a heart transplant who was admitted with a low-tread fever and tachycardia

1. 2-year-old with a ventricular septal defect for whom digoxin (Lanoxin) 90 mcg by mouth has been prescribed

While working in the pediatric clinic, you receive a telephone call from the parent of a 13-year-old who is receiving chemotherapy for leukemia. The patient's sibling has chickenpox (varicella). Which action will you anticipate taking next? 1. Administer varicella-zoster immune globulin to the patient. 2. Teach the parent about the correct use of acyclovir (Zovirax). 3. Educate the parent about contact and airborne precautions. 4. Prepare to admit the patient to a private room in the hospital.

1. Administer varicella-zoster immune globulin to the patient.

You are caring for a diabetic patient who is developing diabetic ketoacidosis (DKA). Which task delegation is most appropriate? 1. Ask the unit clerk to page the physician to come to the unit. 2. Ask the LPN/LVN to administer IV push insulin according to a sliding scale. 3. Ask the UAP to hang a new bag of normal saline. 4. Ask the UAP to get the patient a cup of orange juice.

1. Ask the unit clerk to page the physician to come to the unit.

Which morning tasks can be delegated to the UAP? (Select all that apply.) 1. Assisting Mr. R, who has rheumatoid arthritis, with morning care 2. Reinforcing to Mr. L, who has a kidney stone, the need to save urine for straining 3. Preparing Mr. H's room for his return from the OR for hernia repair 4. Reporting on the condition of Mr. O's skin resulting from his motorcycle accident 5. Getting coffee for Ms. J's (end-stage multiple myeloma) family 6. Checking on the pulse oximeter reading for Mr. A, who has bacterial pneumonia

1. Assisting Mr. R, who has rheumatoid arthritis, with morning care 2. Reinforcing to Mr. L, who has a kidney stone, the need to save urine for straining 3. Preparing Mr. H's room for his return from the OR for hernia repair

Which morning tasks can be delegated to the UAP? (Select all that apply.) 1. Assisting Ms. R, who has rheumatoid arthritis, with morning care 2. Reinforcing to MR. L, who has a kidney stone, the need to save urine for straining 3. Preparing Mr. H's room for his return from the OR for hernia repair 4. Reporting on the condition of Mr. O's skin resulting from this motorcycle accident 5. Getting coffee for Ms. J's (end-stage multiple myeloma) family 6. Checking on the pulse oximeter reading for Mr. A, who has bacterial pneumonia

1. Assisting Ms. R, who has rheumatoid arthritis, with morning care 2. Reinforcing to MR. L, who has a kidney stone, the need to save urine for straining 3. Preparing Mr. H's room for his return from the OR for hernia repair 5. Getting coffee for Ms. J's (end-stage multiple myeloma) family

The plan of care for a diabetic patient includes all of these interventions. Which intervention should you delegate to a UAP? 1. Checking to make sure that the patient's bath water is not too hot 2. Discussing community resources for diabetic outpatient care 3. Teaching the patient to perform daily foot inspection 4. Assessing the patient's technique for drawing insulin into a syringe

1. Checking to make sure that the patient's bath water is not too hot

Ms. J is receiving opiates to control her pain caused by end-stage multiple myeloma. Which side effect is a major concern for this patient? 1. Constipation 2. Respiratory depression 3. Nausea and vomiting 4. Sedation

1. Constipation

Which end-of-shift tasks can be delegated to the UAP? (Select all that apply.) 1. Emptying Ms. J's (end-stage multiple myeloma) trash can and placing personal items within reach. 2. Checking Mr. A's (bacterial pneumonia) linens for moisture and swelling and changing as needed. 3. Asking Mr. L (kidney stone) if he needs a dose of pain medication prior to shift change. 4. Assisting Ms. R (rheumatoid arthritis) to change position in bed to relieve pressure on joints 5. Ensuring Mr. O's leg is elevated and evaluating comfort 6. Emptying Mr. A's (bacterial pneumonia) urinal and recording the output

1. Emptying Ms. J's (end-stage multiple myeloma) trash can and placing personal items within reach. 2. Checking Mr. A's (bacterial pneumonia) linens for moisture and swelling and changing as needed. 4. Assisting Ms. R (rheumatoid arthritis) to change position in bed to relieve pressure on joints 6. Emptying Mr. A's (bacterial pneumonia) urinal and recording the output

The UAP reports to you that a patient with type 1 diabetes has a question about exercise. What important points would you be sure to teach this patient? (Select all that apply.) 1. Exercise guidelines are based on blood glucose and urine ketone levels. 2. Be sure to test your blood glucose only after exercising. 3. You can exercise vigorously if your blood glucose is between 100 and 250 mg/dL. 4. Exercise will hep resolve the presence of ketones in your urine. 5. A 5- to 10- minute warm-up and cool-down prod should be included in your exercise.

1. Exercise guidelines are based on blood glucose and urine ketone levels. 3. You can exercise vigorously if your blood glucose is between 100 and 250 mg/dL. 5. A 5- to 10- minute warm-up and cool-down prod should be included in your exercise.

A 58-year-old with type 2 diabetes was admitted to your unit with a diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation. When you prepare a care plan for this patient, what would you be sure to include? (Select all that apply.) 1. Fingerstick blood glucose checks before meals and at bedtime 2. Sliding-scale insulin dosing as ordered 3. Bed rest until the COPD exacerbation is resolved 4. Teaching about the Atkins diet for weight loss 5. Demonstration of the components of foot care

1. Fingerstick blood glucose checks before meals and at bedtime 2. Sliding-scale insulin dosing as ordered 5. Demonstration of the components of foot care

You have obtained this assessment information about a 3-year-old who has just returned to the pediatric unit after having a tonsillectomy. Which finding requires the most immediate follow-up? 1. Frequent swallowing 2. Hypotonic bowel sounds 3. Reports of a sore throat 4. Heart rate of 112 beats/min

1. Frequent swallowing

An LPN/LVN is to administer rapid-acting insulin (Lispro) to a patient with type 1 diabetes. What essential information would you be sure to tell the LPN/LVN? 1. Give this insulin after the patient's food tray has been delivered and the patient is ready to eat. 2. Only give this insulin if the patient's fingers tic glucose reading is above 200 mg/dL. 3. This insulin mimics the basal glucose control of the pancreas. 4. Rapid-acting insulin is the only insulin that can be given subcutaneously or IV.

1. Give this insulin after the patient's food tray has been delivered and the patient is ready to eat.

You are teaching a group of day-care workers about how to avoid transmission of hepatitis A in day-care settings. What is the single most effective measure to emphasize? 1. Hand hygiene should be performed often to prevent and control the spread of infection. 2. Children in whom hepatitis has been diagnosed should not share toys with others. 3. Children with episodes of fecal incontinence should be isolated from others. 4. Immunizations are recommended before children are admitted into day-care settings.

1. Hand hygiene should be performed often to prevent and control the spread of infection.

The ED receives multiple individuals, mostly children, who were injured when the roof of a day-care center collapsed because of a heavy snowfall. Based on physiologic differences in children compared with adults, for which injuries and complications will the nurse assess first? (Select all that apply.) 1. Head injuries 2. Bradycardia or junctional arrhythmias 3. Hypoxemia 4. Liver and spleen contusions 5. Hypothermia 6. Fractures of the long bones 7. Lumbar spines injuries

1. Head injuries 3. Hypoxemia 4. Liver and spleen contusions 5. Hypothermia

You are caring for an 81-year-pld adult with type 2 diabetes, hypertension, and peripheral vascular disease. Which admission assessment findings increase the patient's risk for development of hyperglycemic-hyperosmolar syndrome (HHS). (Select all that apply.) 1. Hydrochlorothiaze (HCTZ) prescribed to control her diabetes 2. Weight gain of 6 pounds over the past month 3. Avoids consuming liquids in the evening 4. Blood pressure of 168/94 mm Hg 5. Urine output of 50 to 75 mL/hr

1. Hydrochlorothiaze (HCTZ) prescribed to control her diabetes 3. Avoids consuming liquids in the evening

Mr. O is at risk for compartment syndrome because of the cast. Which pain assessment finding would alert you to compartment syndrome? 1. Pain on passive motion 2. Sudden increase in pain 3. Intense discomfort related to an itching sensation 4. Absence of pain despite no recent medication

1. Pain on passive motion

Which member's of the staff (pediatrician, APN student, RN, LPN/LVN, pediatric social worker, GN, and/or UAP) should perform each of these tasks and duties to ensure the the general work flow of the clinic is efficient and that each team member is being used in the most effective manner? (More than one staff member may be appropriate to list for some tasks.) 1, Perform well-baby physical examinations, including assessment of growth and developmental milestones. 2. Perform triage for walk in clients. 3. Give routine immunizations. 4. Obtain weight and height measurements. 5. Ensure that the play therapy area is stocked and organized. 6. Stock the treatment rooms with linens and supplies. 7. Perform a physical assessment of walk-in clients. 8. Supervise the APN student.

1. Pediatrician 2. RN 3. RN 4. UAP 5. UAP 6. UAP 7. RN 8. Pediatrician

Which team members (RN, UAP, physical therapist) should perform the following tasks related to Mr. A's pain management? 1. Instruct in and supervise use of a transcutaneous electrical nerve stimulation (TENS) unit. 2. Administer non-opioid pain medication. 3. Answer questions about medication side effects. 4. Identify contributing factors such as fatigue or anxiety. 5. Suggest that relatives bring personal comfort items. 6. Assist the patient to change position every 2 hours. 7. Reinforce the use of a pillow to splint when coughing.

1. Physical therapist 2. RN 3. RN 4. RN 5. RN 6. UAP 7. UAP

You are the pediatric unit charge nurse working with a new RN. Which action by the new RN requires the most immediate action on your part? 1. Placing a child who has chemotherapy-induced neutropenia into a negative-pressure room 2. Wearing goggles to change the linens of a patient who has diarrhea caused by Clostridium difficile 3. Instructing UAPs to us an N95 respirator mask when caring for a child who has pertussis 4. Admitting a new patient with respiratory syncytial virus (RSV) infection to a room with another child who has RSV

1. Placing a child who has chemotherapy-induced neutropenia into a negative-pressure room

In the care of a patient with type 2 diabetes, which actions can you delegate to a UAP? (Select all that apply.) 1. Providing the patient with extra packets of artificial sweetener for coffee 2. Assessing how well the patient's shoes fit 3. Recording the liquid intake from the patient's breakfast tray 4. Teaching the patient what to do if dizziness or lightheadedness occurs 5. Checking and recording the patient's blood pressure

1. Providing the patient with extra packets of artificial sweetener for coffee 3. Recording the liquid intake from the patient's breakfast tray 5. Checking and recording the patient's blood pressure

Which intervention for the 5-year-old child who wets the bed would be best assigned to the UAP? 1. Reminding the child to use the bathroom before going to bed 2. Teaching the mother about moisture alarm devices 3. Administering the prescribed dose of imipramine (Tofranil) 4. Discussing research related to the use of hypnosis with the mother

1. Reminding the child to use the bathroom before going to bed

Which tasks related to pain management can you delegate to the UAP? (Select all that apply.) 1. Reporting on grimacing seen an unresponsive patients 2. Asking about the location quality and radiation of pain 3. Reminding patients to report pain as necessary 4. Observing for relief after medication is given 5. Asking patients directly, "Are you having pain?" 6. Determining if position change relieves pain

1. Reporting on grimacing seen an unresponsive patients 3. Reminding patients to report pain as necessary 5. Asking patients directly, "Are you having pain?"

You are. caring for a diabetic patient admitted with hypoglycemia that occurred at home. Which teaching points for treatment of hypoglycemia at home would you include in a teaching plan for the patient and family before discharge? (Select all that apply.) 1. Signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL. 2. Treat hypoglycemia with 4 to 8 g carbohydrate such as glucose tablets or 1/4 cup of fruit juice. 3. Retest. blood glucose in 30 minutes. 4. Repeat the carbohydrate treatment if the symptoms do not resolve. 5. Eat a small snack of carbohydrate and protein if the next meal is more than an hour away.

1. Signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL. 4. Repeat the carbohydrate treatment if the symptoms do not resolve. 5. Eat a small snack of carbohydrate and protein if the next meal is more than an hour away.

You are preparing to care for a 6-year-old who has just undergone allogeneic stem cell transplantation and will need protective environmental isolation. Which nursing tasks will you delegate to the UAP? (Select all that apply.) 1. Stocking the patient's room with the needed personal protective equipment items 2. Teaching the patient to perform thorough hand washing after using the bathroom 3. Reminding visitors to wear a respirator mask, gloves, and gown 4. Posting the precautions for protective isolation on the door of the patient's room 5. Talking to the family members about the reasons for the isolation

1. Stocking the patient's room with the needed personal protective equipment items 3. Reminding visitors to wear a respirator mask, gloves, and gown 4. Posting the precautions for protective isolation on the door of the patient's room

A tearful parent brings a child to the ED after the child takes an unknown amount of children's chewable vitamins at an unknown time. The child is currently alert and asymptomatic. What information should be immediately reported to the physician? 1. The ingested children's chewable vitamins contain iron. 2. The child has been treated previously for ingestion of toxic substances. 3. The child has been treated several times before for accidental injuries. 4. The child was nauseated and vomited once at home.

1. The ingested children's chewable vitamins contain iron.

During the shift, the following events occur at the same time. Prioritize the order for addressing these problems. 1. Mr. A is calling out loudly about right-sided flank pain caused by his kidney stone. 2. Mr. O, who was in a motorcycle accident, is calling, "The pump tipped over and it's broken." 3. Another nurse needs opioids wastage witnessed. 4. Mr. A, with bacterial pneumonia, is urinating in the corner of his room.

2, 1, 4, 3

A teenager arrives in the triage area alert and ambulatory, but his clothes are covered with blood. His friends are yelling, "We were goofing around and he got poked in the abdomen with a stick!" Which comment would be of most concern? 1. "There was a lot of blood and we used three bandages." 2. "He pulled the stick out, just now, because it was hurting him." 3. "The stick was really dirty and covered with mud." 4. "He's a diabetic, so he needs attention right away."

2. "He pulled the stick out, just now, because it was hurting him."

You are the preceptor for a senior nursing student who will teach a diabetic patient about self-care during sick days. For which statement by the student must you intervene? 1. "When you are sick, be sure to monitor your blood glucose at least every 4 hours." 2. "Test your urine for ketones whenever your blood glucose level is less Thant 240 mg/dL." 3. "To prevent dehydration, drink 8 ounces of sugar-free liquid every hour while you are awake." 4. "Continue to eat your meals and snacks at the usual times."

2. "Test your urine for ketones whenever your blood glucose level is less Thant 240 mg/dL."

While you are performing an admission assessment on a patient with type 2 diabetes, he tells you that he routinely drinks 3 beers a day. What is your priority follow-up question at this time? 1. "Do you have any days when you do not drink?" 2. "When during the day do you drink your beers?" 3. "Do you drink any other forms of alcohol?" 4. "have you ever had a lipid profile completed?"

2. "When during the day do you drink your beers?"

You are serving as preceptor to a nurse who has recently graduated and passed the RN licensure examination. The new nurse has only been on the unit for 2 days. Which patient would you assign to the new nurse? 1. 68-year-old with diabetes who is showing signs of hyperglycemia 2. 58-year-old with diabetes who has cellulitis of the left ankle 3. 49-year-old with diabetes who has just returned from the post anesthesia care unit after a below-knee amputation 4. 72-year-old with diabetes with DKA who is receiving IV insulin

2. 58-year-old with diabetes who has cellulitis of the left ankle

Which actions can the school nurse delegate to UAP's who are working with a 7-year-old child with type 1 diabetes in an elementary school? (Select all that apply.) 1. Obtaining information about the child's usual insulin use from the parents 2. Administering oral glucose tablets when blood glucose falls below 60 mg/dL 3. Teaching the child about what foods have high carbohydrate levels 4. Obtaining blood glucose readings using the child, blood glucose monitor 5. Reminding the child to have a snack after the physical education class

2. Administering oral glucose tablets when blood glucose falls below 60 mg/dL 4. Obtaining blood glucose readings using the child, blood glucose monitor 5. Reminding the child to have a snack after the physical education class

The UAP reports that the new nurse is undermedicating the patients. What is the best way to handle this situation? 1. Ignore her; the UAP is not qualified to judge an RN. 2. Ask the UAP to give specific examples. 3. Go to the new nurse in question her. 4. Do an assessment on all of the nurse's patience.

2. Ask the UAP to give specific examples.

Before giving a child an immunization, you notice that the child is flushed and warm, is acting fussy, and has rhinorrhea. What is the priority action? 1. Notify the pediatrician and obtain an order for an antipyretic. 2. Assess the child for additional symptoms of febrile illness. 3. Advise the mother that fever is a contraindication and reschedule the appointment. 4. Give cool fluids to reduce fever and apply an anesthetic cream to the injection site.

2. Assess the child for additional symptoms of febrile illness.

A mother brings her 12-month-old child to the clinic for an influenza vaccination. The nurse tells the mother that the child is also due for doses of measles-mumps-rubella, varicella, and hepatitis A vaccines. The mother declines the nurse's advice because "he has already had enough of those." What is the priority action? 1. Encourage a follow-up appointment and notify Child Protective Services. 2. Assess the mother's concerns and current level of knowledge about immunization. 3. Emphasize the benefits of immunization; explain the purpose and schedule. 4. Respect the mother's decision and alert the pediatrician to the situation.

2. Assess the mother's concerns and current level of knowledge about immunization.

The health care provider has ordered cooling measures for a child with fever who is likely to be discharged when the temperature comes down. Which task will you delegate to the UAP? 1. Providing explanations of nursing actions to the family 2. Assisting the child in removing outer clothing 3. Advising the parent to use acetaminophen (Tylenol) instead of aspirin 4. Monitoring the child's level of consciousness and orientation level

2. Assisting the child in removing outer clothing

Mr. A has a single-lumen peripherally inserted central catheter, and he has the following scheduled medications and IV solution that need to be given now: vancomycin (Vancocin) 1.5 g in 250 mL of dextrose 5% over 90 minutes; levofloxacin (Levaquin) 750 mg in 150 mL of normal saline over 90 minutes; dextrose 5% and 0.45% saline 1000 mL with 20 mEq of potassium at 1.25 mL/hr; and an IV bolus dose of morphine 3 mg. What is your priority action? 1. Call the physician and ask if the medication times can be staggered. 2. Call the pharmacy and inquire about the compatibility of medications and solutions. 3. Give a bolus dose of morphine because it will take the least amount of time. 4. Establish an additional peripheral IV site.

2. Call the pharmacy and inquire about the compatibility of medications and solutions.

Mr. H is asking for pain medication, and the healthcare provider has ordered 10 mg of oxycodone controlled-release (OxyContin) as needed. The pharmacy has stocked 5 mg tablets of oxycodone immediate-release in the medication cabinet. What is your first action? 1. Call the healthcare provider for clarification of the order. 2. Call the pharmacy and obtain the controlled-release form of the drug. 3. Ask the patient if that immediate or controlled release action is preferred. 4. Give two of the 5-mg tablets to achieve the correct dose.

2. Call the pharmacy and obtain the controlled-release form of the drug.

Which pediatric pain patient should be assigned to a newly-graduated RN? 1. Adolescent who has sickle cell disease and was recently weaned from morphine delivered via a patient-controlled analgesia device to an oral analgesic; he has been continually asking for an increased dose 2. Child who needs premedication before reduction of a fracture; the child has been crying and is resistant to any touch to the arm or other procedures 3. Child who is receiving palliative end-of-life care; the child is receiving narcotics around the clock to relieve suffering, but there is a progressive decrease in alertness and responsiveness 4. Child who has chronic pain and whose medication and nonpharmacologic regimen has recently been changed the mother is anxious to see if the new regimen is successful

2. Child who needs premedication before reduction of a fracture; the child has been crying and is resistant to any touch to the arm or other procedures

An excited mother calls you for advice. "My child got cleaning solution in her eyes and I rinsed her eyes with water for a few minutes. What should I do? She is still screaming!" What do you instruct the caller to do first? 1. Comfort the child and check her vision. 2. Continue to irrigate the eyes with water. 3. Call the Poison Control Center. 4. Call 911 to request an ambulance.

2. Continue to irrigate the eyes with water.

You receive the following shift report on an adolescent with anorexia: The patient is 5 kg under her target weight. Her self-esteem has improved, but she continues to refer to herself as "fatty." She is able to appropriately verbalize a diet and exercise plan. What is the priority nursing diagnosis? 1. Imbalanced Nutrition: Less than Body Requirements 2. Disturbed Body Image 3. Risk for Situational Low Self-Esteem 4. Ineffective Health Maintenance

2. Disturbed Body Image

A patient with diabetes has hot, dry skin; rapid and deep respirations; and a fruity odor to his breath. As charge nurse, you observe a newly-graduated RN preforming all the following patient tasks. Which one requires that you intervene immediately? 1. Checking the patient's fingers stick glucose level 2. Encouraging the patient to drink orange juice 3. Checking the patient's order for sliding-scale insulin dosing 4. Assessing the patient's vital signs every 15 minutes

2. Encouraging the patient to drink orange juice

You are a public school nurse. Which action will you take to have the most impact on the incidence of infectious diseases in the school? 1. Make soap and water readily available in the classrooms. 2. Ensure that students are immunized according to national recommendations. 3. Provide written information about infection control to all parents. 4. Teach students how to cover their mouths when they cough or sneeze.

2. Ensure that students are immunized according to national recommendations.

At the end of the shift, the opioid count shows that two tablets of oxycodone (OxyContin) are unaccounted for. You have spoken to all of the nurses and pharmacists who had access to the medication cabinet during the shift, but no one will admit to removing those two tablets. What should you do? (Select all that apply.) 1. Inform the staff that no one can leave until the matter is resolved. 2. Fill out an incident report and include facts about what you found and what you did. 3. Interview all of the patients who have orders for oxycodone (OxyContin). 4. Discuss the matter with the unit manager and review potential problems of the current system. 5. Review available records of access and medication retrieval for the past 24 hours. 6. Ask the staff if they saw any other people (e.g., students, positions, instructors) who may have accessed the cabinet during the shift.

2. Fill out an incident report and include facts about what you found and what you did. 4. Discuss the matter with the unit manager and review potential problems of the current system. 5. Review available records of access and medication retrieval for the past 24 hours. 6. Ask the staff if they saw any other people (e.g., students, positions, instructors) who may have accessed the cabinet during the shift.

You are reviewing the complete blood count for a 3-year-old who has been diagnosed with idiopathic thrombocytopenic purpura. Which information should you report immediately to the health care provider? 1. Increased eosinophil level 2. Hemoglobin level of 6.1 g/dL 3. Platelet count of 40m000/mm3 4. Elevated reticulocyte count

2. Hemoglobin level of 6.1 g/dL

Mr. H returns from the OR following a hernia repair. He says that he is "afraid to walk because it will make the pain really bad." What will you explain as being the best option? 1. Pain medication every 4 hours if he needs it 2. Medication 45 minutes before ambulation or dressing changes 3. Around-the-clock pain medication even if he has no report of pain 4. Talking to the physician for reassurance about the treatment plan

2. Medication 45 minutes before ambulation or dressing changes

You are the charge nurse on the pediatric unit when a pediatrician calls wanting to admit a child with rubble (measles). Which factor is of most concern in determining whether to admit the child to your unit? 1. The unit is staffed with fewer RNs than usual. 2. No negative-airflow rooms are available. 3. The infection control nurse liaison is not present today. 4. There are several children receiving chemotherapy.

2. No negative-airflow rooms are available.

A 2-year-old child who has abdominal pain is diagnosed with intussusception. A hydrostatic reduction has been performed and the health care provider has informed the parents that surgery is the next step. Which finding should be reported immediately before surgery proceeds? 1. Palpable sausage-shaped abdominal mass 2. Passage of normal brown stool 3. Passage of currant jelly-like stools 4. Frequent nausea and vomiting

2. Passage of normal brown stool

You are the charge nurse on the pediatric neurologic unit when the health care provider calls with new medication prescriptions for several patients with seizure disorders. Which prescription is most important to verify with the provider? 1. Ibuprofen (Motrin) 10 mg/kg for a 2-year-old having a febrile seizure 2. Phenytoin (Dilantin) 300 mg/day for a 6-year-old with tonic-clonic seizures 3. Valproic acid (Depakote) 15 mg/kg/day for an 11-year-old with absence seizures 4. Carbamazepine (Tegretol) 100 mg every 8 hours for a 70 kg 17-year-old with complex seizures

2. Phenytoin (Dilantin) 300 mg/day for a 6-year-old with tonic-clonic seizures

You are working with an LPN/LVN who is caring for a 10-year-old who has severe abdominal, hip, and knee pain caused by a sickle cell crisis. Which action taken by the LPN/LVN requires that you intervene immediately? 1. Suggesting genetic counseling to the patient 2. Positioning cold packs on the patient's knees 3. Placing a "No Visitors" sign on the patient's door 4. Checking the patient's temperature every 2 hours

2. Positioning cold packs on the patient's knees

In the emergency department during initial assessment of a newly-admitted patient with diabetes, the nurse discovers all of these findings. Which finding should be reported to the health care provider immediately? 1. Hammer toe of the left second metatarsophalangeal joint 2. Rapid respiratory rate with deep inspirations 3. Numbness and tingling bilaterally in the feet and hands 4. Decreased sensitivity and swelling of the abdomen

2. Rapid respiratory rate with deep inspirations

You are assisting with the delivery of a 31-week gestational age premature newborn who requires intubation for RDS. Which medication will you anticipate will be needed first for this infant? 1. Theophylline (Theolair, Theochron) 2. Surfactant (Exosurf) 3. Dexamethasone (Decadron) 4. Albuterol (Proventil)

2. Surfactant (Exosurf)

The new nurse tells you that she cannot find any documentation that shows the time of Mr. L's (kidney stone) last dose of pain medication. What action should occur first? 1. Help the new nurse look at the chart and medication administration record. 2. Tell the new nurse to ask the night nurse before she leaves. 3. Speak to the night shift nurse about the documentation. 4. Have the new nurse ask Mr. L when he last had medication.

2. Tell the new nurse to ask the night nurse before she leaves.

You are caring for a 3-year-old who has returned to the pediatric intensive care unit after insertion of a ventriculoperitoneal shunt to correct hydrocephalus. Which assessment finding is most important to communicate to the surgeon? 1. The child is crying and says, "it hurts!" 2. The right pupil is 1 mm larger than the left pupil. 3. The cardiac monitor shows a heart rate of 130 beats/min. 4. The head dressing has a 2-cm area of bloody drainage.

2. The right pupil is 1 mm larger than the left pupil.

A parent calls in for advice because her 18-month-old toddler has stumbled and bumped his head on the coffee table. Which symptom is cause for the greatest concern? 1. A swelling the size of a golf ball that is tender to the touch 2. Two episodes of vomiting a small amount of undigested food 3. Continuous crying for 2 hours, unrelieved by familiar comfort measures 4. Gaping 4-cm laceration on the forehead, with bleeding controlled by pressure

2. Two episodes of vomiting a small amount of undigested food

You are giving the end-of-shift report about Ms. R (rheumatoid arthritis) to the oncoming nurse. Place the following information in the correct order. 1. "She had shoulder pain (4 of 10) and was reluctant to move around." 2. "Do you have any questions for me?" 3. "Ms. R is a 55-year-old woman." 4. "She had shoulder arthroplasty 3 days ago." 5. "She received a PRN dose of Tylenol with codeine, and pain is now a 1 of 10." 6. "The physical therapist must speak to Ms. R's daughter, so page him when she arrives."

3, 4, 1, 5, 6, 2

You are caring for a 5-year-old whose mother asks why he still wets the bed. What is your best response? 1. "He is old enough that he should no longer be wetting the bed." 2. "Most children outgrow bed-wetting by the time they start school." 3. "His bed-wetting may be due to an immature bladder or deep sleep pattern." 4. "He will probably stop once he realizes how embarrassing it is to wet the bed."

3. "His bed-wetting may be due to an immature bladder or deep sleep pattern."

The patient with type 2 diabetes is "nothing by mouth" (NOP) for a cardiac catheterization. An LPN/LVN who is administering medications to this patient asks you (the supervising RN) whether the patient should receive his ordered repaglinide (Prandin). What is your best response? 1. "Yes, because this drug will increase the patient's insulin recreation and prevent hyperglycemia." 2. "No, because this drug may cause the patient to experience gastrointestinal symptoms such as nausea." 3. "No, because this drug should be given 1 to 30 minutes before meals and the patient is NPO." 4. "Yes, because this drug should be taken 3 times a day whether the patient eats or not."

3. "No, because this drug should be given 1 to 30 minutes before meals and the patient is NPO."

In caring for a 3-year-old with pain, which assessment question would be the most useful? 1. "Can you point to the pain with one finger and tell me what that plan feels like inside of you?" 2. "If number 1 were a little pain and number 10 were a big pain, what number would your pain be?" 3. "The smiling face has 'no hurting'; the lying face has a 'really big hurting.' Which face is most like your hurting?" 4. "One chip is 'a little bit of hurt' and four chips are 'the most hut.' How many chips would you take for your hurt?"

3. "The smiling face has 'no hurting'; the lying face has a 'really big hurting.' Which face is most like your hurting?"

As the pediatric unit charge nurse, you are making patient assignments for the evening shift. Which patient is most appropriate to assign to an experienced LPN/LVN? 1. 1-year-old with severe combined immunodeficiency disease who is scheduled to receive chemotherapy in preparation for a stem cell transplant 2. 2-year-old with Wiskott-Aldrich syndrome who has orders for a platelet transfusion 3. 3-year-old who has chronic graft-versus-host disease and is incontinent of loose stools 4. 6-yaer-old who received chemotherapy a week ago and is admitted with increasing lethargy and temperature of 101.1 degrees F /938.3 degrees C)

3. 3-year-old who has chronic graft-versus-host disease and is incontinent of loose stools

After receiving the change-of-shift report, which patient should you assess first? 1. 18-month-old with coarctation of the aorta who has decreased pedal pulses 2. 3-year-old with rheumatic fever who reports severe knee pain 3. 5-yera-old with endocarditis who has crackles audible throughout both lungs 4. 8-year-old with Kawasaki disease who has a temperature of 102.2 degrees F (39 degrees C)

3. 5-yera-old with endocarditis who has crackles audible throughout both lungs

Mr. L reports that the pain has decreased compared with earlier, but now he's having other symptoms. Which symptom is of greatest concern? 1. Painless hematuria with small clots 2. Dull pain that radiates into the genitalia 3. Absence of pain but scant urine output 4. Sensation of urinary urgency

3. Absence of pain but scant urine output

A patient has newly-diagnosed type 2 diabetes. Which action should you assign to an LPN/LVN instead of a UAP? 1. Measuring the patient's vital signs every shift 2. Checking the patient's glucose level before each meal 3. Administering subcutaneous insulin on a sliding scale as needed 4. Assisting the patient with morning care

3. Administering subcutaneous insulin on a sliding scale as needed

Which nonpharmacologic pain measure to help Ms. R relieve her early morning stiffness should be delegated to the UAP? 1. Assisting Ms. R to get in a bathtub full of warm water 2. Sharing some relaxation techniques with Ms. R 3. Assisting Mr. R to take a warm shower 4. Evaluating the effectiveness of paraffin therapy

3. Assisting Mr. R to take a warm shower

Mr. H is given a dose of pain medication. One hour later he is anxious and appears uncomfortable and asks, "What's the matter? Is something wrong? I'm still hurting." What action should you take first? 1. Call the physician for a change in medication or dose. 2. Initiate "nothing by mouth" status in case surgery is needed. 3. Check for a bladder distention and last voiding. 4. Reassure the patient that the hernia is not recurring.

3. Check for a bladder distention and last voiding.

For Mr. O, in addition to pain medication, which action will help the most to relieve pain associated with the tibia-fibula fracture caused by his motorcycle accident? 1. Instruct him to periodically move his toes. 2. Used diversion therapy. 3. Elevate the injured leg above the heart. 4. Place the patient in high Fowlers position.

3. Elevate the injured leg above the heart.

You are caring for several children with cancer and are reviewing morning laboratory results for all of your patients. Which of these patient conditions combined with the indicated laboratory result causes you the greatest immediate concern? 1. Nausea and vomiting with a potassium level of 3.3 mEq/L 2. A nose bleed with a platelet count of 100,000 3. Fever with an absolute neutrophil count of 450/mm3 4. Fatigue with a hemoglobin level of 8 g/dL

3. Fever with an absolute neutrophil count of 450/mm3

Mr. L calls for pain medication. He describes the pain caused by his kidney stone as excruciating. He is crying out, diaphoretic, and pacing around the room. What is your priority action? 1. Instruct Mr. A to do deep breathing exercises. 2. Remind Mr. L to use the PCA pump. 3. Give Mr. A an "as needed" IV bolus dose as ordered. 4. Call the physician immediately.

3. Give Mr. A an "as needed" IV bolus dose as ordered.

You are preparing to review a teaching plan for a patient with type 2 diabetes mellitus. To determine the patient's level of compliance with his prescribed diabetic regimen, which value would you be sure to review? 1. Fasting glucose level 2. Oral glucose tolerance test results 3. Glycosylated hemoglobin (HgbA1c) level 4. Fingerstick glucose findings for 24 hours

3. Glycosylated hemoglobin (HgbA1c) level

It is the end of the shift, and the new nurse is trying to give pain medication to one patient, provide comfort measures for another patient, and redo pain assessment on all her patients. Her documentation is incomplete. What should you do? 1. Offer to help her by performing the comfort measures. 2. Let her struggle through so she can find her own way. 3. Help her to prioritize and delegate the tasks. 4. Ask someone from the oncoming shift to help her.

3. Help her to prioritize and delegate the tasks.

Ms. J is having severe pain and admits to it; however, she becomes very anxious when certain family members come and go and refuses to take the pain medication. Which adjunct medication would be most useful to Ms. J to help her manage these episodes? 1. Naproxen (Naprosyn) 2. Doxepin (Sinequan) 3. Lorazepam (Ativan) 4. Dicyclomine (Bentyl)

3. Lorazepam (Ativan)

These medications have been prescribed for a 9-year-old with deep partial- and full-thickness burns. Which medication is most important to double-check with another licensed nurse before administration? 1. Silver sulfadiazine (Silvadone) ointment 2. Famotidine (Pepcid) 20 mg IV 3. Lorazepam (Ativan) 0.5 mg PO 4. Multivitamin (Centrum Kids) 1tablet PO

3. Lorazepam (Ativan) 0.5 mg PO

A 4-year-old with acute lymphocytic leukemia has these medications ordered. Which one is most important to double-check with another licensed nurse? 1. Prednisone (Deltasone) 1mg by mouth (PO) 2. Amoxicillin (Amoxil) 250 mg PO 3. Methotrexate (Rheumatrex) 10 mg PO 4. Filgrastim (Neupogen) 5mcg subcutaneously

3. Methotrexate (Rheumatrex) 10 mg PO

A new nurse is caring for a child with a foreign body in the ear canal who has not yet been evaluated by the health care provider. You would intervene if the new nurse performs which action? 1. Inspects the pinna for trauma 2. Obtains a history for type of object 3. Prepares to irrigate the canal with warm water 4. Uses an otoscope to check for perforation

3. Prepares to irrigate the canal with warm water

An LPN/LVN's assessment of two diabetic patients reveals all of these findings. Which would you instruct the LPN/LVN to report immediately? 1. Fingerstick glucose reading of 185 mg/dL 2. Numbness and tingling in both feet 3. Profuse perspiration 4. Bunion on the left great toe

3. Profuse perspiration

A 16-year-old with cystic fibrosis is admitted with increased shortness of breath and possible pneumonia. Which nursing activity is most important to include in the patient's care? 1. Allowing the patient to decide whether she needs aerosolized medications 2. Placing the patient in a private room to decrease the risk of further infection 3. Scheduling postural drainage and chest physiotherapy (CPT) every 4 hours 4. Planning activités to allow for at least 8 hours of uninterrupted sleep

3. Scheduling postural drainage and chest physiotherapy (CPT) every 4 hours

Mr. O reports an increasing pain in the right abdomen. On physical exam, you note hyperactive bowel sounds, a tense abdomen with guarding, and exquisite tenderness with gentle palpation. What is your priority action? 1. Give a PRN pain medication. 2. Notify the physician of your findings. 3. Take the complete set of vital signs. 4. Assist him to change positions.

3. Take the complete set of vital signs.

You are preparing a child for IV conscious sedation before repair of a facial laceration. What information should you immediately report to the health care provider? 1. The parent is unsure about the child's tetanus immunization status. 2. The child is upset and pulls out the IV. 3. The parent declines the IV conscious sedation. 4. The parent wants information about the IV conscious sedation.

3. The parent declines the IV conscious sedation.

You are providing nursing care for a newborn infant with respiratory distress syndrome (RDS) who is receiving nasal continuous positive airway pressure ventilation. Which assessment finding is most important to report to the health care provider? 1. Apical pulse rate of 156 beats/min 2. Crackles audible in both lungs 3. Tracheal deviation to the right 4. Oxygen saturation of 93%

3. Tracheal deviation to the right

A parent calls the emergency department (ED), saying "I think my toddler might have swallowed a little toy. He is breathing okay, but I don't know why to do." What is the most essential question to as the caller? 1."Has he vomited?" 2. "Have you been checking his stools?" 3. "What do you think he swallowed?" 4. "Has he been coughing?"

4. "Has he been coughing?"

You are preparing to give Mr. Al pain medication, but you know that the IV site is infiltrated, so you inform him that the IV catheter will have to be reinserted. He yells at you, "What's wrong with you people?! Can't you do anything right?!" What is the best response? 1. "Let me call the physician, and I can get an order for an oral medication." 2. "This is not my fault, but if you will just give me a couple of minutes I can fix it." 3. "Let me call the nursing supervisor and you can talk to her about the situation." 4. "I know you're having pain. Let me restart your IV line right now."

4. "I know you're having pain. Let me restart your IV line right now."

You are talking to Ms. R (rheumatoid arthritis) about discharge plans and follow-up appointments. She begins to cry and says, "I was so active and athletic when I was younger." Whats the most therapeutic response? 1. "Your shoulder will get progressively better with time and patience. Don't cry." 2. "I can see that you are really upset. Is your shoulder hurting a lot right now?" 3. "I know what you mean. I used to be able to do a lot more when I was younger too." 4. "It is difficult to deal with changes. What types of activities did you used to do?"

4. "It is difficult to deal with changes. What types of activities did you used to do?"

One of the staff members is talking about Mr. A, who has bacterial pneumonia, in the medication room. "He complains all the time about pain everywhere. Well, he's going to have pain. He's a drug addict, so what does he expect?" What is your best response to this comment? 1. "All patients have a right to care regardless of race, creed, or other traits." 2. "I'll take Mr. A; I don't mind taking care of him." 3. "You should think about how he really feels." 4. "What can we do to help Mr. A help with his pain?"

4. "What can we do to help Mr. A help with his pain?"

Mr. A reports left-sided anterior chest pain. What is your priority action? 1. Obtain an order for an electrocardiogram and continuous telemetry monitoring. 2. Auscultate the lung fields and compare to baseline assessments. 3. Give a PRN pain medication and reevaluate after 30 minutes. 4. Ask him to describe the pain and measure all vital signs.

4. Ask him to describe the pain and measure all vital signs.

A 16-year-old in the adolescent health clinic tells you that she has been sexually active for 6 months, "but only with my boyfriend." Screening for which sexually transmitted disease (STD) will be most important for this patient? 1. Syphilis 2. Genital herpes simplex 3. Human papillomavirus 4. Chlamydia

4. Chlamydia

A 6-year-old who received chemotherapy and had anorexia is now cheerfully eating peanut butter, yogurt, and applesauce. When the mother arrives, the child refuses to eat and throws the dish on the floor. What is your best response to this behavior? 1. Remind the child that foods tasted good today and will help the body to get strong. 2. Allow the mother and child time alone to review and control the behavior. 3. Ask the mother to leave until the child can finish eating and then invite her back. 4. Explain to the mother that the behavior could be a normal expression of anger.

4. Explain to the mother that the behavior could be a normal expression of anger.

The experience UAP has been delegated to take vital signs and check finger stick glucose on a diabetic patient who is postoperative. Which vital sign change would you instruct the UAP to report immediately? 1. Blood pressure increase from 132/80 mm Hg to 138/84 mm Hg 2. Temperature increase from 98.4 degrees F (36.8 degrees C) to 99 degrees F (37.2 degrees C) 3. Respiratory rate increase from 18 breaths/min to 22 breaths/min 4. Glucose increase from 190 mg/dL to 236 mg/dL

4. Glucose increase from 190 mg/dL to 236 mg/dL

An 8-year-old child has stomatitis secondary to chemotherapy. Which task would be best to delegate to the UAP? 1. Reporting evidence of severe mucosal ulceration 2. Assisting the child in swishing and spitting an anesthetic mouthwash 3. Assessing the child's ability and willingness to drink through a straw 4. Helping the patient to eat a bland, moist, soft diet

4. Helping the patient to eat a bland, moist, soft diet

While working in the diabetes clinic. you obtain this information about an 8-year-old with type 1 diabetes. Which finding is most important to address home planning child and parent education? 1. Most recent hemoglobin A1c level of 7.8% 2. Many questions about diet choices from the parents 3. Child's participation in soccer practice after school 2 days a week 4. Morning preprandial glucose range of 55 to 70 mg/dL

4. Morning preprandial glucose range of 55 to 70 mg/dL

Ms. J's son repeatedly insists that Ms. J is not getting enough pain medication. He threatens to sue. You have used therapeutic communication skills with the son and advocated for the patient with the physician. The physician says to you, "I'll be in tomorrow. Just tell the son to chill out." What is your best action? 1. Call another physician. 2. Continue to use the current orders. 3. Have the son call the physician. 4. Notify the unit manager.

4. Notify the unit manager.

A patient hs newly diagnosed type 2 diabetes. Which task should you delegate to a UAP? 1. Arranging a consult with the dietitian 2. Assessing the patient's insulin injection technique 3. Teaching the patient to use a glucometer to monitor glucose at home 4. Reminding the patient to check glucose level before each meal

4. Reminding the patient to check glucose level before each meal

A UAP tells you that, while assisting with the morning care of a postoperative patient with type 2 diabetes who has been given insulin, the patient asked if she will always need to take insulin now. What is your priority? 1. Explain to the patient that she is now considered to have type 2 diabetes. 2. Tell the patient to monitor fingers tick fluke level every 4 hours after discharge. 3. Teach the patient that a person with type 2 diabetes does not always need insulin. 4. Talk with the patient about the relationship between illness and increased glucose levels.

4. Talk with the patient about the relationship between illness and increased glucose levels.

You are caring for a newborn with a myelomeningocele who is awaiting surgical closure of the defect. Which assessment finding is of most concern? 1. Bulging of the sac when the infant cries 2. Oozing of stool from the anal sphincter 3. Flaccid paralysis of both legs 4. Temperature of 101.8 degrees F (38.8 degrees C)

4. Temperature of 101.8 degrees F (38.8 degrees C)

You are obtaining the history and physical information for a child who is recovering from Kawasaki disease and receives aspirin therapy. Which information about this patient will concern you most? 1. This child attends a day-care center 5 days a week. 2. The child's fingers have areas of peeling skin. 3. The child is very irritable and cries frequently. 4. The child has not received any immunizations.

4. The child has not received any immunizations.

You obtain this information when assessing a 3-year-old with uncorrected tetralogy of Fallot who is crying. Which finding requires immediate action? 1. The apical pulse rate is 118 beats/min. 2. A loud systolic murmur is heard in the pulmonic area. 3. There is marked clubbing of all the child's nail beds. 4. The lips and oral mucosa are dusky in color.

4. The lips and oral mucosa are dusky in color.

A patient with type 1 diabetes reports feeling dizzy. What should the nurse do first? 1. Check the patient's blood pressure. 2. Give the patient some orange juice. 3. Give the patient's morning dose of insulin. 4. Use a glucometer to check the patient's glucose level.

4. Use a glucometer to check the patient's glucose level.

You decide to do a brief round of all the patients before shift report, to ensure safety and to help determine acuity and assignments. List the order in which you should briefly check in on these patients. 1. Ms. R 2. Mr. L 3. Mr. O 4. Mr. H 5. Ms. J 6. Mr. A - Ms. R, a 55-year-old woman with rheumatoid arthritis, underwent shoulder arthroplasty 3 days ago. She reports morning stiffness in her joints. Swelling is noted in both wrists and proximal interphalangeal joints. - Mr. L, a 35-year-old man with a history of kidney stones, reports severe back and right-sided flank pain intermittently (rating 3 to 8 on a scale of 10). The night shift nurse reports episodic nausea and vomiting with hematuria and dysuria. Mr. L was admitted through the emergency department (ED) at 10:00 PM. He is using a patient-controlled analgesia (PCA) pump. - Mr. O, an 18-year-old man, sustained a right tibia-fibula fracture in a motorcycle accident 7 hours ago. He has extensive skin abrasions underneath the cast and on the right anterolateral body. Although obvious chest and abdominal trauma were ruled out in the ED, he is being monitored for occult trauma. He is receiving an analgesic via PCA pump. - Mr. H, a 28 year-old man, is currently in the operating room (OR) for an inguinal hernia repair. He should return from the oR later in the shift. Ms. J, a 65-year-old woman with end-stage multiple myeloma, is receiving palliative pain management. The family is considering hospice care. She has been on the unit for 2 weeks. Her physician signed the do-not-resuscitate order 3 days ago. - Mr. A, a 55-year-old man, has been on the unit for 3 weeks. He is receiving IV antibiotics for bacterial pneumonia. He has a history of IV drug abuse and chronic back pain and has tested positive for human immunodeficiency virus (HIV) infection. Mr. A's oxygen saturation was decreasing during the night shift.

6, 3, 2, 1, 5