Progressive Care RN A 2024

What is an adequate amount of urine output?

30 mL/hr

Which patient would you ask about the language they would prefer to use for communication purposes?

A patient who is newly admitted

Your patient has left ventricular heart failure and chest pain. The transport team is ready to take them to their echocardiogram. What would be your nursing PRIORITY for safe transportation?

Accompany patient to their destination

A patient presents with blood pressure of 90/60, creatinine of 3.0, and decreased urinary output. What is a possible cause for these findings?

Acute kidney injury

Your patient is receiving an amiodarone (Pacerone®) drip. When would you reduce the dose from 1 mg/mL to 0.5 mg/mL?

After 6 hours

What are the MOST common causes of acute onset pancreatitis?

Alcoholism and gallstones

What would you check before administering digoxin (Lanoxin®)?

Apical pulse

Your patient has returned from the cath lab post angioplasty. Upon assessment you note a large hematoma at the sheath site. What would be your immediate action?

Apply manual pressure to the site and call for help.

Your patient's epicardial wires were pulled 30 minutes ago. They now report acute chest pain. What would you do NEXT?

Call cardio-thoracic surgeon and report symptoms.

You are caring for your patient with an order for furosemide (Lasix®) 80 mg BID. What would be your MOST appropriate action?

Call provider to clarify the order.

You enter your patient's room. You notice the telemetry box and the IV catheter on the bed. You last saw your patient 1 hour ago. Who would you notify immediately?

Charge nurse

Your patient has new onset seizures. They ask you what they should know about taking levetiracetam (Keppra®). What would be your BEST response?

Common side effects are fatigue and depression

You complete a mental status assessment on your patient. You notice they are oriented some of the time but not all of the time as their attention drifts when you ask them questions. What would be an appropriate screening tool based on your assessment findings?

Confusion Assessment Method (CAM)

What are PRIMARY goals in diabetic ketoacidosis therapy?

Correct fluid deficit and replace potassium.

Your coworker mistakenly gives 2 units of insulin to a patient. The patient is stabilized and the provider is informed. What would be your NEXT step?

Create an incident report

Your patient has mitral stenosis. What abnormal heart sound would you expect to hear?

Diastolic murmur

Your patient has left ventricular failure. What clinical manifestations would you expect to see?

Dyspnea, distant heart sounds, bilateral crackles

Your patient has a new onset of atrial fibrillation with a blood pressure of 80/60. What treatment would be MOST appropriate?

Electrical cardioversion

Your patient is post left pneumonectomy. They have a chest tube in place for drainage. What would be a PRIORITY in your care?

Encourage patient to cough and deep breathe

You are working with the code team to resuscitate a patient in ventricular fibrillation. Chest compressions are ongoing and the patient has been shocked twice. What emergency medication, if any, would you administer at this juncture?

Epinephrine (Adrenaline) 1 mg IV

What is the MOST common symptom of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Fluid retention

What is the reversal agent for benzodiazepines?

Flumazenil (Romazicon)

Upon arrival to the ED a patient's lab results indicate a BNP of 2000. They are transferred to the PCU. What treatment plan would you expect from the attending provider?

Furosemide (Lasix®) 40 mg IV BID

A patient is status post video-assisted thorascopic surgery (VATS) with lobectomy. You are preparing to admit them. What equipment should be placed in their room prior to their arrival?

High flow oxygen

Your patient is on the midday schedule for hemodialysis. They have 100 mg metoprolol XL (Toprol®) ordered for this morning. Their blood pressure is 150/98. What would be your MOST appropriate action?

Hold the metoprolol because of the upcoming dialysis.

Your patient reports nausea, vomiting, and diarrhea. Their blood pressure is 89/55, heart rate 122 bpm, and temperature 100.8°F. What condition do you expect?

Hypovolemic shock

Your patient was diagnosed with atrial fibrillation. They are being discharged on anticoagulant therapy every evening. Which patient statement indicates a need for further teaching?

I cannot wait to get back to riding my horse.

Which statement by your patient would concern you the MOST that they are seriously considering suicide?

I have 10 pills set aside if things get really bad.

Your patient is on anticoagulant medication. You are discharging them and provide patient education. Which statement by your patient indicates an understanding of the education?

I will not take ibuprofen (Motrin®) every day

When should the trough for vancomycin (Firvanq®) be measured?

Immediately before the next scheduled dose

You want to help your patient wean from the BiPap. You are collaborating with the healthcare team. What is a sign that your patient is fatiguing and you would communicate to the respiratory therapy team?

Increased PaCO2

You receive your patient with pneumonia from the ED. Antibiotics and steroids have been initiated by the provider. The patient reports abdominal pain and has a large loose bowel movement. They inform you this is their third bowel movement in the last two hours. What would you do FIRST?

Initiate enteric contact isolation precautions for possible C. diff

Your patient is acutely ill. What route of medication administration would likely be LEAST effective?

Intramuscular

Your patient is in cardiac arrest. Chest compressions are being performed. Capnography indicates the end-tidal CO2 is 18 mmg. What do the capnography results indicate about the chest compressions?

No changes. These are high quality compressions.

Your patient has a history of renal insufficiency. What class of analgesics would MOST likely be contraindicated for them?

Nonsteroidal anti-inflammatory medications

Your patient had an IVC filter placed 2 days ago. They start to complain of sharp pain in the chest, shortness of breath, anxiety, and heart palpitations. What would you do NEXT?

Notify provider and prepare for a CT scan.

Your patient is on a patient-controlled analgesia (PCA) pump infusing morphine. They are not getting relief. What would be your FIRST intervention?

Obtain order from provider for an additional dose.

Your patient is in third degree heart block. What treatment would you MOST likely expect to be implemented?

Pacemaker

What ethical principle is the foundation of end-of-life care?

Patient autonomy

Your patient with triple cardiac bypass surgery is post-op day 3. Chest tubes have been removed. They suddenly report palpitations. Their blood pressure is 130/76 and heart rate is 140 bpm. What would you do NEXT?

Perform a bedside EKG

What is an effective nursing intervention for reducing central line-associated bloodstream infections (CLABSIs)?

Perform a daily assessment of line necessity.

What is the FIRST step of the PDSA quality improvement cycle?

Plan

You are performing auscultation on your patient. You note an absence of breath sounds in the right lower lobe. What would you suspect?

Pneumothorax

You want to assess for jugular vein distention (JVD). What position would be BEST?

Position patient on their back with head of bed at 30 to 45 degrees.

Which finding would assist in the diagnosis of deep vein thrombosis?

Positive D-dimer

Your patient has an upper GI bleed. They have a hemoglobin of 6.1 g/dL. What order would you perform FIRST?

Prepare to administer 2 units PRBCs.

Your patient has developed sepsis from an indwelling urinary catheter. What would be your PRIORITY intervention?

Remove catheter.

You walk into your patient's room. You notice that the chest tube collection chamber has been knocked over onto its side. There appears to be drainage dispersed throughout the chambers. What would you do NEXT?

Replace chamber with a new one.

Your patient is newly diagnosed with asthma. What would be your MAIN goal when providing patient education?

Self-management for symptom control

Your patient is admitted from the ED for syncope for a ground level fall. You note their heart rate is 50 and they are confused. Their child states they think your patient has dementia but has not been diagnosed yet. Patient's blood pressure is stable. What order do you expect?

Stat head CT

Your patient is experiencing left-sided weakness from a meningioma. What would be the MOST likely treatment for their brain tumor?

Surgical resection

What is required before making a report of elder abuse?

Suspicion of abuse

Your patient reports chest pain. Which lab orders would you anticipate the provider ordering?

Troponin

Your patient has advanced COPD with an oxygen saturation level of 80%. What would you do to promote adequate gas exchange?

Use a venturi mask to delivery oxygen as ordered

What would be your BEST method for dressing a venous stasis ulcer?

Use gauze wrap covered by a compression bandage

Your patient with cardiac bypass surgery is post-op day 2. The nursing assistant reports that your patient has a temp of 101.3°F and blood pressure of 82/56. Their urine output has decreased to less than 30 mL in the past 4 hours. You suspect a post-surgery complication. After calling the physician you receive orders for STAT CBC, CMP, and coagulation test. What results would you expect to see after these labs are completed?

WBC greater than 19,000

What are 2 nursing interventions to prevent venous thromboembolism?

• Adequate hydration and early mobilization. • Hemodynamic monitoring and early mobilization. (Wrong) • Adequate hydration and encouraging a steady amount of green leafy vegetables in diet. • Hemodynamic monitoring and encouraging a steady amount of green leafy vegetables in diet.

What is an early hemodynamic change associated with stroke?

• Bradycardia • Widened pulse pressure • Hypotension (Wrong) • Hypertension

Your patient has nephrotoxicity. At discharge what education would be MOST important for you to provide?

• Establish an exercise routine. • Implement smoking cessation. • Review your medications with the primary care provider. • Create a meal plan to maintain kidney health. (Wrong)

What is the importance of proper cuff inflation for tracheostomy tubes?

• To decrease the flow of supplemental oxygen. (Wrong) • To facilitate mechanical ventilation. • To prepare the patient for extubation. • To allow the patient to speak.

A patient is status post video-assisted thorascopic surgery (VATS) with lobectomy. You are preparing to admit them. What equipment should be placed in their room prior to their arrival?

• Trach collar • High flow oxygen (Wrong) • Incentive spirometer • Sterile suctioning catheter

You are administering 1 unit of packed red blood cells (PRBC) to your patient. They develop shortness of breath, tachycardia, and distended jugular veins in the first 15 minutes of PRBC administration. What type of transfusion reaction are they likely experiencing?

• Transfusion related hemolytic reaction (Wrong) • Septic transfusion reaction • Transfusion related fluid overload • Anaphylaxis

Your non-verbal patient is alert. What type of pain assessment would be appropriate?

• Visual pain scale • Verbal descriptive scale • Vital signs assessment to approximate pain • Behavioral pain scale (Wrong)