Progressive Care RN A

A patient is admitted to the PCU with COPD exacerbation. Which of the following assessment findings would you expect to find knowing that the patient has been taking prednisone 40 mg PO once daily for 18 years?

Hyperglycemia

Your patient is complaining of nausea, vomiting, and diarrhea. His blood pressure is 89/55, heart rate is 122 bpm, and the temperature is 100.8 F. What condition is this patient most likely experiencing?

Hypovolemic shock

You admit a patient to the PCU that was rear-ended in a motor vehicle accident. As they sit up in bed you notice bruising to the right flank area. What immediate action should be taken?

Notify the provider of assessment findings and possible retroperitoneal bleeding

Which of the following has been found to be linked to a diagnosis of endocarditis?

Recent invasive dental procedures

Your 28 year old patient is being discharged on warfarin 5 mg every evening after being diagnosed with atrial fibrillation. Which of the following statements indicates a need for further teaching?

"I cant wait to get back to riding on my horse."

You are educating your patient about reducing sodium intake. You know that the patient understands when they make the statement:

"I will avoid canned food because it's salty"

The provider has written an order for diltiazem 125 mg in 100 mL D5W at 10 mg/hour. The vial of diltiazem contains 5mg/mL. Which of the following is the correct volume to add to the bag of D5W?

25 mL

What is the MOST important intervention for a patient with non-blanching redness and intact skin to their coccyx?

Turning the patient every two hours, alternating from side to side

A patient is on strict I&Os with an indwelling urinary catheter. 4 hours into your shift you notice that there is a total of 50 mL of urine in the bag. You notify the provider because you recognize that adequate urine output should be:

30 mL/hr

Your patient is receiving an amiodarone drip. You should reduce the dose from 1 mg/mL to 0.5 mg/mL after:

6 hours

Of the following patients, which one would you see FIRST?

A 30 year suicidal female that took an unknown number of alprazolam with an O2 saturation of 85%

Which of the following patients would you see FIRST?

A 57 year old male complaining of worsening chest tightness

Upon arrival to the unit, you receive report on four PCU patients. Which patient should you attend to FIRST?

A patient complaining of shortness of breathe on continuous BiPAP with a BP of 189/109

Which of the following medications is MOST commonly indicated for patients with CHF?

Ace inhibitors

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

Acute kidney injury

A patient is admitted for a NSTEMI and ST depression is noted in leads II, III, and AVF. Two hours after admission you notice the patient now has ST elevation in each of those leads. What should you do NEXT?

Administer O2 and morphine 2mg IV???

You enter a patient's room and notice the telemetry box on the bed and the IV on the floor connected to running IV fluids. You last saw the patient 1 hour ago. Who should be notified immediately?

Charge nurse

Your patient was admitted for a hypertensive crisis and has a history of HTN, Parkinson's Disease, CAD, and depression. The patient reports drinking 3-4 alcoholic drinks/night. This is your third day caring for this patient and you suddenly notice that he is more anxious and restless than his baseline. What would be your INITIAL nursing intervention?

Check CIWA score

Unstable angina is characterized by which of the following?

Chest pain, usually while at rest

You are delegating wound care to a LPN. The LPN states that she has never performed this type of wound care before. Which of the following components of delegation have you neglected?

Competency

Which of the following are primary goals in diabetic ketoacidosis therapy?

Correct fluid deficit and replace potassium

You are caring for a patient with a chest tube that has become dislodged. Which of the following would you do FIRST?

Cover the insertion site immediately with Vaseline gauze

The trough for vancomycin is measured:

Immediately before the next scheduled dose

Your patient is post-op day 3 after triple bypass surgery. Chest tubes have been removed. The patient suddenly complains of palpitations. His blood pressure is 130/76 and heart rate is 140 bpm. What would you do NEXT?

Immediately perform a bedside EKG

You are assigned a patient who recently traveled outside of the United States. He has a fever of 101.9 F and excessive diarrhea. You suspect he may have been exposed to Ebola. What type of PPE would you expect to use?

High level PPE

Your patient is on the midday schedule for hemodialysis. He has 100 mg of metoprolol XL ordered for this morning and his blood pressure if 150/98. Which of the following would be an appropriate action?

Hold the metoprolol because of the upcoming dialysis

Which of the following is an early indication of a stroke?

Ptosis

You are caring for a patient complaining of chest pain. Which of the following troponin I levels requires provider notification?

0.5 ng/mL???

What is the most common cause of acute onset pancreatitis?

Alcoholism and galstones

Which of the following should be checked before administering digoxin?

Apical pulse

You are caring for a patient that has returned from the cath lab post angioplasty. Upon assessment, you note a large hematoma at the sheath site. Which of the following would you do immediateley?

Apply manual pressure to the site and call for help

You are caring for a patient with an order for "furosemide 80 mg BID". Which of the following actions is the MOST appropriate?

Call the provider to clarify the order

What abnormal heart sound would you expect to hear in a patient with mitral stenosis?

Diastolic murmur

A patient was involved in a motor vehicle accident and CAT scan results reveal a right sided SDH. What would be an expected neurological assessment finding in this patient?

Dilated right pupil

The provider has ordered a 24-hour urine collection for your patient. The patient voids 275 cc, 2 hours after the order is given. This specimen should be:

Discarded, then begin collection with the next void

Which of the following are clinical manifestations typically seen in a patient with left ventricular failure?

Dyspnea/distant heart sounds/bilateral crackles???

You are caring for a patient with new onset atrial fibrillation with a blood pressure of 80/60. Which of the following treatment options is MOST appropriate?

Electrical cardioversion

You are caring for a patient post left pneumonectomy with a chest tube in place for drainage. Which of the following is a priority in caring for this patient?

Encourage the patient to cough and deep breathe

What is the most common symptom of SIADH?

Fluid retention

You are caring for a patient with a Do Not Resuscitate (DNR) order. The patient goes into cardiac arrest and the patient's daughter states "Do whatever you can to save my dad." Which of the following is the BEST response?

Follow the patient's wishes and honor the DNR

The patient's lab test results indicate a BNP of 2,000 upon arrival to the ED. The patient has been transferred to PCU. What treatment plan would you anticipate from the attending provider?

Furosemide 40 mg IV BID

A patient is admitted with a diagnosis of "rule out GI bleed." Which of the following lab values supports confirmation of this diagnosis?

Hgb of 5.2

You receive an 84 year old patient from the ED with pneumonia. Antibiotics and steroids have already been initiated by the provider. The patient complains of abdominal pain and has a large, loose bowel movement and notifies you this is the third one. What should you do FIRST?

Initiate contact isolation precautions for possible C. difficile

A patient with a history of acute seizure activity of unknown etiology is admitted to the PCU from the ED. Which of the following orders would you expect to receive from the admitting provider?

Levetiracetam (Keppra) 500 mg IV every 12 hours and seizure precautions

You have completed a blood transfusion and are unsure of how to dispose of the empty bag. What should you do?

Locate the MSDS book to find policy and procedures

What acid-base imbalance would you expect to see in a patient with an acute kidney injury?

Metabolic acidosis

Your patient has an IVC filter placed two days ago and starts to complain of sharp pain in the chest, shortness of breath, anxiety, and heart palpitations. What should you do NEXT?

Notify the provider and prepare for a CT scan

You receive a patient from the emergency department with a fever, cough for 3 weeks, night chills, and fatigue. During the admission assessment the patient reports recent travel out of the country. What should be your FIRST action?

Notify the provider, apply a mask to the patient, and transfer to a negative pressure room

You are caring for a patient in third degree heart block. Which of the following treatment options will MOST likely be implemented?

Pacemaker

A patient with new onset seizures is most likely to have which of the following in their room?

Padded side rails and suction at the bedside

A 16 year old patient was admitted to the unit for asthma exacerbation. The patient has a suicide attempt the previous shift and states "I want to die because I am being bullied at school." Which of the following is the MOST important action?

Place the patient on suicide precautions to prevent a second suicide attempt

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

Pneumothorax

Which of the following positions is the BEST way to assess for JVD?

Position the patient on his/her back with the head of bed 30-45 degrees

Which of the following findings assist in the diagnosis of deep vein thrombosis?

Positive D-dimer

Which of the following supplemental medications is frequently ordered in conjunction with furosemide?

Potassium

A patient with an upper GI bleed has a hgb of 6.1 g/dL. Which of the following orders should you do FIRST?

Prepare to administer 2 units PRBCs

A co-worker administered a narcotic earlier in the shift, but failed to get a witness for the portion of medication that was wasted. The co-worker asks that you sign off as the witness. What is the BEST response?

Refuse to witness the waste and ask the co-worker to notify the charge nurse

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

Replace the chamber with a new one

You are taking care of a patient who is scheduled for ablation to treat atrial fibrillation. While obtaining consent , the patient asks multiple questions about the procedure. What is the BEST response?

Request the provider come and discuss the procedure with the patient

An 18 year old female is admitted from PACU after a cholecystectomy. She has a 22 gauge peripheral IV in her left hand and is due to void. She had morphine 8 mg and Zofran 4 mg in recovery, and is complaining of nausea. She has Phenergan 50 mg IV every 6 hours/PRN. What should you do first?

Start a new IV line in the antecubital region or obtain an order for Phenergan IM

A 78 year old male is admitted from the ED for syncope with ground level fall. You note his heart rate is 50 and the patient is confused. His daughter states she thinks he has dementia but he has not been diagnosed yet. Blood pressure is stable. What order do you anticipate?

Stat head CT

You are transfusing PRBCs into a patient with a hgb of 7.7 g/dL. Fifteen minutes into the transfusion, the patient complains of lower back pain, shortness of breath, and chills. Which of the following would you do FIRST?

Stop the transfusion

You are caring for an 80 year old male with advanced COPD with an oxygen saturation level of 80%. Which of the following would you do to promote adequate oxygen exchange?

Use a high-flow venturi mask to deliver oxygen as ordered

You are caring for a patient taking warfarin for atrial fibrillation. The lab calls reporting that the patient has an INR of 6.4. What medication do you anticipate being ordered by the provider?

Vitamin K

Then nursing assistant reports that your post-op day 2 CABG patient has a temp of 101.3 and BP of 82/56. The patient's output has decreased to < 30 cc in the past 4 hours. You suspect a post surgical complication. After calling the doctor, you receive the orders for STAT CBC, CMP, and coagulation test. Which of the following results would you expect to see after these labs are completed?

WBC greater than 19,000