question

Order in which to extubate

answer

explain procedure, emerg. tube @ bs, hyperoxygenate, suction et & oral cavity, deflate cuff, tell pt to take deep breath, rapidly remove tube @ peek inspiration, tell pt to cough, give O2 face mask

question

Pt with gastorial intestinal ulcer, NPO with ng tube with suction, what type of shock do you look for?

answer

hypovolemic

question

What would lead you to believe pt with mi is in cardiogenic shock?

answer

decreased co & decreased map

question

How do you explain to a pt why they are receiving packed red blood cells to correct the lost of blood during surgery?

answer

going to improve your ability to carry O2

question

How do you reverse shock in a pt with acidosis and hypovolmeic shock?

answer

LR lactated ringer

question

Pt with hypovolemic shock on dopamine, what is the desired response to the drug?

answer

increased heart contractility, increased cardiac output

question

what are you going to monitor in a pt with distribututive shock from anaphylaxis?

answer

decreased bp/O2 edema, increased cap leakage, altered loc

question

Which pt is at risk for septic shock?

answer

68 yo with cancer tx with chemo

question

Teaching for pt at risk for sepsis secondary to immunosuppression?

answer

take temp daily, wash dishes with hot sudsy h2o, rinse toothbrush in liquid laundry bleach

question

What does p waves represent?

answer

atrial depolarization

question

What do you do for pr intervals of .14 sec?

answer

document this is a normal time

question

Pt has sinus bradycardia with hypotension and dizziness what will rn give?

answer

atropine

question

What do you treat a pt with who has a MI with frequent pvc's?

answer

lidocaine

question

What is the therapeutic response for adenocard?

answer

cardiac astoyle

question

Pt with 3rd degree block, widened qrs, hr 35, what physical assessment would be important?

answer

altered loc, O2 levels

question

What discharge instructions do you give a pt with an icd?

answer

stay away from magnet fields

question

Neurogenic shock has cervical collar, what will prepare to do?

answer

Admin atropine Obtain baseline temp Prepare for ventilation

question

Drug for patient with bee sting

answer

Epinephrine

question

Patient in motor vehicle accident to ED with cool, clammy skin, tachy, hypotension, which one first?

answer

Oxygenate

question

Patient in cardiogenic shock 86/50, 126 HR, 30 RR, PAWP inc, CO dec, give what meds

answer

Furosemide

question

the nurse prioritizes which intervention in the pt with xerostomia secondary to radiation therapy to the neck?

answer

oral care

question

Which lab value in a pt with cancer suggest SIADH?

answer

sodium of 120

question

Pt with septicemia has prolonged bleeding from a vena puncture site, blood in stool what is the most important action?

answer

call doc

question

Pt with possibly DIC in ed room bp 82/40, temp 102, sever back pain. Which order do you implement first?

answer

infuse 500 normal saline

question

Group of pt what to make appointment in an out pt clinic who do you schedule to be seen first first?

answer

19 yr old with lump in axillary area.

question

Received change of shift report on neutropenic pt's which would you see first?

answer

Pt with fever of a 100.8

question

Which topic do you discuss in discharge planing with a pt who has systolic heart failure an injection fracture of 38%? angiotensin meds

answer

benefits and side effect of an angiotensin med

question

Pt with bmi of 17, decrease albumin level, which assessment finding would you expect to find?

answer

pitting edema

question

Prenatal nutrition containing amino acids and dextrose was hang 24 hrs ago for a malnourished pt there is 50 ml left what is the best action to take?

answer

change container and keep tubing the same

question

After 96 hrs of prenatal nutrition, pt glucose is checked and is 120 what do you do?

answer

check again in 4 hrs

question

How many grams of protein will rn recommend to meet daily requirement for a pt whose weight is 145?

answer

53

question

Pt with a triple A repair has cool extremities, bloating feeling in abdomen, what do you do?

answer

measure abdominal girth, check pulses

question

Which monitoring technique should be questioned with a pt who has unrepaired abdominal aortic aneurysm?

answer

palpate abdomen

question

66 yr old pt with bmi of 31 normal c-reative protein level, decreased transferen and albumin level what pt teaching needs to done?

answer

Pt teaching on foods high in protein

question

What requires the rns attention with a pt who over dosed on cocaine?

answer

hr of 120

question

Rn notes prenatal nutrition bag only has 20 ml left and new prenatal nutrition hasn't arrived what should you administer?

answer

dextrose up to 10%

question

Which of the following pt is the most important to refer to a dietitian?

answer

pt with history of wt gain and loss pt with debridement of infected surgical wound pt with rheumatoid arthritis taking prednisone

question

Comatose pt has continuous prenatal nutrition though a soft ng tube, has new crackle sound in lungs, in which order will the rn take the following actions?

answer

turn off tube feeding , check o2 sat, check tube feedings residual amount, call doc

question

Pt with sever burns is on a crystalloid fluid plan 50000ml for the first 24 hrs, what is the initial rate and the rate for the next 16 hrs?

answer

initial 2500 16 hrs 1250

question

Pt with deep partial thickness burns on face and neck is treated with open method what rn action is included in care?

answer

gown, gloves, mask

question

Pt with burns on both arms has a decreased radial pulse, numbness in finger, what do you encourage pt to do?

answer

notify provider

question

Which action will be included in the plan of care in a pt with burns on ears, head, neck , right arm/hand?

answer

Elevate arm and hand on pillow and extend fingers

question

Renadine is prescribed to a[t for burns acquired 5 days ago which info will the rn collect to evaluate to effectiveness of the medication?

answer

stool for occult blood

question

Industrial acid spill on arms and legs at work what is the priority action the occupational health rn should do?

answer

flush burns with water

question

Pt with burns on back and chest 9 hrs later is restless and agitated, what action should you take first?

answer

use pulse ox to check o2 sat

question

Pt with electrical burn in ed what intervention should rn do first?

answer

cardiac monitor

question

Which one do you assess first?

answer

pt with smoke inhalation

question

Which pt should the burn rn give to an rn who is floated from another unit?

answer

Pt with 15% weight loss on is on prenatal nutrition

question

Preparing a risk reduction cancer pamphlet for African American men it is important for rn to included which cancer prevention and early detection?

answer

lung and prostate

question

Which pt will the rn assess first?

answer

leukemia pt order to receive antibiotic medication before treatment

question

Prioritize which rn diagnosis in a pt with late stage colon cancer that has metastasis to bone and spine for treatment at home?

answer

acute pain

question

Which interventions is the most important to prevent compilations from tumor lysis syndrome during chemo?

answer

fluid intake of 3000-5000

question

Order of process of admitting/disposition in an emergency care?

answer

emt provides o2 & monitoring parametric starts iv & arrives in er rn preforms assessment lab tech get blood samples ed rn gives report pt sent to med surg floor

question

Which traumatic event is classified as penetrating trauma mechanism injury?

answer

gun short & stabbing

question

Which of the following interventions will be preformed during priority survey in a trauma?

answer

remove wet clothing, iv fluids, decompression, endotracheal intubation

question

Stabbing pt assessment bp80/60, hr 130, r 35, bleeding from site, lethargic, based on assessment what is the priority traumatic level?

answer

1

question

RN needs to triage a group of patients, which pt is non urgent?

answer

left arm fracture

question

What is rn's priority action during triage after an explosion?

answer

Rapid assessment

question

Who would be a red tag after an explosion?

answer

multiple rib fracture with shortness of breath

question

Man comes into hospital with a can of anthrax and pours it on the floor. What is the rn priority action?

answer

evacuate

question

What is the priority action in a mass casualty?

answer

bring in rn's from other floors to take care of pt in ed so ed rn's can prepare to receive victims from casualty

question

What color tag do you give a man with sever chest pain, hr 120, diaphoretic?

answer

red

question

Pt with a rash says they have small poxs what is the rn priority action?

answer

put pt in a negative air pressure rm

question

Ed is expecting a large amount of victims which is a priority consideration for the ed leadership?

answer

unexpected victims with minor injuries

question

Large number of victims arrive after bus/train accident which intervention are preformed immediately for red tag victims?

answer

intubation, fluids, pacemaker

question

What assessment questions should a triage rn ask during a mass casualty to determine appropriate triage?

answer

ab or back pain, wiggle toes, difficult breathing, can you tell me what day it is

question

EMS bring in a large amount of victims which pt are id right with yellow tags?

answer

burns on both legs, neck injury with numbness in legs, scrape mental in both eyes, bruise pain in rlq

question

Which pt is at the greatest risk for pulmonary embolism?

answer

women on oral birth control who had surgery

question

Manifestations of pulmonary embolism?

answer

dyspnea, chest pain on inhalation, tachycardia, hemarthrosis

question

Pt on mechanical vent following settings:assist mode 8, total volume 700, fio2 35. Pt has 12 breathes per minute, how many vent breaths are they receiving?

answer

12

question

Which values are expected with hypoxia & hyperventilation?

answer

ph 7.55, paco2 32, pao2 60

question

Pt with sever respiratory insufficiency becomes short of breath well doing adl's what do you do?

answer

Space out activities

question

Which assessment finding is associate with flail chest?

answer

area on left chest is sucked in on inhalation and puffes out on exhalation

question

The rn assess a pt with dyspnea,tracheal deviation, pulse ox reading 86% what is the rn's interpretation of the findings?

answer

pneumothorax

question

Which finding indications suctioning is required in a pt being mechanical ventilated?

answer

wheezing

question

What abg's are expected in a pt with pulmonary embolism found 6 hrs ago?

answer

ph 7.30, 22, 60, 66

question

What do you do first for a pt with no pulse?

answer

defib

question

Pt with 3rd degree block has hr 40 what is the priority rn diagnosis?

answer

decrease cardic output

question

Pt has unstable v-tach and is getting iv amiodarone has decreased hr of 68 to 50 asymptomatic what is the priority intervention?

answer

slow down infusion

question

What pt is most at risk for a-fib?

answer

CABG cardiac disease

question

What disrhythmia may develop if pt has frequent pvc's?

answer

v-tac

question

What can you give to a pt with chronic atrial fib at high risk for systemic emboli?

answer

warfin, heprin, anticoagulant

question

Pt with septic shock develops tachycardia and an increase of 20ml in systolic bp which pathophysiology factors of hyper dynamic shock is responsible for these manifestations?

answer

inflammatory response in circulating endotoxins

question

Community required pneumonia which wbc count and differential are associated with an increased risk for septic shock?

answer

neutrophil 400, wbc 2000

question

Which pt is at the highest risk for septic shock?

answer

pt with iv antibiotics via triple lumen

question

The rn correlates which clinical manifestations with early stages of hypovolemic shock?

answer

increased heart rate & increased bp

question

Put in order what you would do with a septic shock pt?

answer

blood culture urine culture vancomycin vasopressors normal saline o2

question

Pt in unknown shock bp 92/54, hr64, increased pulmonary wedge, what interventions would you question?

answer

infuse normal saline at 250 an hr

question

Norepinephrine is given to a pt with hypertension & dehydration what has the rn consult the doc before giving medication?

answer

the pt has a cvp is 3

question

Pt with septic shock has bp 70/46, hr 136, r 32, temp 104, glucose 246, which interventions do you do first?

answer

normal saline 500ml

question

The charge rn is evaluating the skills of a new rn what tells her she needs more teaching with caring for pt with shock?

answer

turning the temp up and down

question

Order to care for a pt with a left leg fracture

answer

assess lungs bp check pedal plses apply splint x-ray administer tentis

question

Which observation see by the rn on pt with no weight bearing , shows pt can use crutch?

answer

move crutches with injured leg

question

Pt in car crash has right leg swelling what do you look for?

answer

check leg pulses and sensations

question

Priority rn diagnosis for pt with meniere's disease?

answer

risk for falls

question

Which medication do you give first for a pt with acute angle closure glaucoma?

answer

100ml/gram iv mannitol

question

Camp rn has pt with bilateral eye pain after a log in fire exploded and sent pieces in to eyes, what action does the rn take first?

answer

cover with sterile gauze and protective eye shield

question

Four pt's come in after plane crash, what order do you assess them?

answer

22yr with multiple fractures to face & jaw 72yr with chest pain 45 yr with 6 out of 10 ab pain 30 yr with a misaligned right leg with intacted pulses

question

Following an earth quake patients are triaged and transported to hospital who do you assess first?

answer

red tages

question

Pt admitted with multiple bee stings to hands what do you do first?

answer

Remove ringes

question

Pt took 20-30 acetaminophen tablets which action does rn take?

answer

give acetylcysteine

question

Pt is unconscious after fall is taken to ed by family during the primary survey the rn should?

answer

obtain a glasgow coma scale

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