1 :

Hint : 😴 CPAP = better sleep + lower CV risdk

Correct Answers:

  • Improves quality of sleep.
  • Reduces daytime sleepiness.
  • Lowers risk of stroke.
  • Prevents hypertension.


Rationale :

🌿Improves quality of sleep CPAP prevents airway collapse, allowing continuous airflow throughout sleep.

🌿 Restores normal sleep cycles, especially REM sleep.

🌿 Reduces nighttime arousals, improving rest.

🌿 Clients report longer periods of deep sleep.

🌿 Enhances overall sleep efficiency.

🌿Reduces daytime sleepiness Treats the repeated oxygen drops caused by OSA.

🌿 Prevents nighttime micro-arousals responsible for fatigue.

🌿 Promotes stable sleep architecture, improving alertness.

🌿 Reduces the risk of accidents due to somnolence.

🌿 Improves cognitive function and mood.

🌿Lowers risk of stroke OSA increases cardiovascular strain, raising stroke risk.

🌿 CPAP improves oxygenation, relieving vascular stress.

🌿 Consistent nighttime ventilation reduces blood pressure spikes.

🌿 Helps maintain better cerebral perfusion.

🌿 Evidence links CPAP to reduced ischemic events.

🌿Prevents hypertension OSA causes sympathetic overactivation, elevating BP.

🌿 CPAP decreases nighttime vasoconstriction.

🌿 Improves overall hemodynamic stability. 🌿 Reduces episodes of nocturnal hypoxemia.

🌿 Long-term use correlates with improved blood pressure control.

Lowers serum cholesterol

🌿 CPAP does not directly affect cholesterol metabolism.

🌿 Cholesterol changes require diet, exercise, or medication.


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2 :

Hint : 🧠 CT first — patient on warfarin

Correct Answers:

  • Administer a beta-blocker medication.
  • Transfer to radiology for a computed tomography (CT) scan of the head.
  • Obtain the client's international normalized ratio (INR).


Rationale :

💠Administer a beta-blocker Atrial fibrillation with rapid ventricular response (HR 120) needs rate control.

💠 Beta-blockers reduce myocardial oxygen demand.

💠 Prevents worsening of stroke perfusion.

💠 Stabilizes hemodynamics for safe imaging/treatment.

💠 Standard first-line approach.

💠CT scan of the head Must determine ischemic vs hemorrhagic stroke immediately.

💠 Warfarin increases bleed risk → CT is urgent.

💠 Treatment (tPA, antiplatelets) depends on imaging findings.

💠 Prevents unsafe medication administration.

💠 First step in all acute stroke evaluations.

💠Obtain INR Client takes warfarin, requiring assessment of coagulation.

💠 High INR increases risk of intracranial hemorrhage.

💠 Determines if aspirin or heparin is safe to give.

💠 Guides reversal decisions if bleed is present.

💠 Critical stroke safety measure.

Incorrect Options (2 points each)

Administer aspirin Unsafe until CT confirms no bleeding.

💠 Warfarin increases hemorrhage risk.

Start heparin infusion

💠 A-fib stroke requires heparin ONLY after ruling out brain bleed.

💠 Warfarin + heparin = dangerous combo if bleed present.

Prepare for emergency cardioversion

💠 Cardioversion risks embolizing clots in uncontrolled A-fib.

💠 NEVER performed emergently during acute stroke


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3 :

Client presents with progressive weakness over 14 days, beginning in the legs and moving upward. No prior history of muscle weakness. Over the past few days, the client has experienced difficulty in handling cutlery and clumsiness with fine finger movements. Reports difficulty chewing and swallowing over past 24 hours. The client denied any sensory symptoms. Denies bowel or bladder changes. First noticed difficulty climbing stairs, with symptoms progressing to include both upper and lower extremities.

Electromyography (EMG) demonstrates slowing of nerve conduction velocities and prolongation of distal latencies in motor nerves.

The nurse reviews the client's history and physical exam. The nurse reviews the client's assessment data to prepare the client's plan of care.

Hypertension, arthritis.

Client reports a history of gastroenteritis three weeks ago.

Home Medication

Hydrochlorothiazide 12.5 mg PO Celecoxib Dose 200 mg PO Route Frequency Once daily

Allergies

Penicillin, causes a rash. Once daily

Social History

Married with two adolescent children.

Works as an accountant.

Non-smoker.

Physical Examination

Client conscious and alert. Orientation to person, place, time, and situation intact. Pupils are equal, round, and reactive to light and accommodation. Deep tendon reflexes (DTRs) absent in lower extremities. Upper extremities DTRS 1. Bilateral weakness, 1/5 lower extremities, 2/5 upper extremities. Respiratory and cardiovascular exam unremarkable. Abdomen soft and non-tender. No rashes or joint abnormalities noted. No apparent lymphadenopathy


Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.


Hint : 🦵 Ascending weakness = GBS

Correct Answers

  • Blank 1 Correct Option: Guillain Barré syndrome (GBS)
  • Blank 2 Correct Option: Discuss mechanical ventilation and Encourage active ROM
  • Blank 3 Correct Option: Muscle strength and Pulmonary function

Rationale :

🌟 Progressive ascending weakness with absent reflexes strongly indicates GBS.

🌟 History of recent gastroenteritis fits known immune trigger.

🌟 EMG shows slowed nerve conduction, confirming demyelination.

🌟 Monitoring respiratory effort is critical—GBS can cause respiratory failure.

🌟 Encouraging ROM prevents contractures and supports recovery.

ALS

🌟 ALS is slow-progressing, not acute.

🌟 Does NOT start abruptly with ascending weakness.

Bell palsy

🌟 Only affects facial nerve.

🌟 No ascending motor paralysis.

Peripheral neuropathy

🌟 Usually involves sensory loss, which is absent here.


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4 :

Hint : ✋ Positive = good ulnar flow

Correct Answers:

  • There is good blood flow in the ulnar artery.


Rationale :

✨ A positive Allen test means the hand flushes pink after releasing ulnar pressure.

✨ Indicates adequate collateral circulation via ulnar artery.

✨ Safe to perform radial artery puncture for ABG.

✨ Ensures that if radial artery is damaged, hand will still receive blood.

✨ Positive = normal finding.

Notify provider

✨ There is no emergency — this is a normal result.

Insufficient radial blood flow

✨ Negative test indicates poor ulnar flow, not radial issues.

Good femoral artery flow

✨ Allen test does not assess femoral artery.


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5 :

Hint : 🧪 ALT = liver damage marker

Correct Answers:

  • Alanine aminotransferase (ALT) of 2,600 U/L (43.42 mckat/L).


Rationale :

🌼 ALT is the most liver-specific enzyme for hepatocellular damage.

🌼 ALT 2,600 U/L indicates massive hepatocyte injury.

🌼 Viral hepatitis typically elevates ALT more than AST.

🌼 Extremely high levels signal risk for acute liver failure.

🌼 Must be reported immediately for urgent intervention.

AST 2,200 U/L

🌼 Elevated but less liver-specific than ALT.

🌼 Still concerning, but ALT is more critical.

Platelets 460,000

🌼 Elevated platelets do not indicate liver failure.

🌼 Not the priority.

Ammonia 55

🌼 Mildly elevated; concerning but not the highest urgency.

🌼 ALT signals more severe liver injury.


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6 :

Hint : 💉 Crisis = steroids first

Correct Answers:

  • Administer a parenteral corticosteroid medication


Rationale :

🌿 Severe nausea, vomiting, hypotension, and hyperpigmentation indicate an Addisonian crisis requiring immediate steroid replacement.

🌿 Parenteral corticosteroids (hydrocortisone IV) are lifesaving because they replace missing cortisol.

🌿 Low cortisol leads to vascular collapse, so rapid steroid administration restores blood pressure.

🌿 Steroids also correct electrolyte abnormalities, especially hyperkalemia and hyponatremia.

🌿 This intervention treats the ** underlying cause**, not just symptoms.

Administer an antiemetic

🌿 Does not treat the life-threatening cortisol deficiency.

🌿 Only manages symptoms.

Assess skin for a rash

🌿 Skin changes are expected in Addison disease and not priority.

🌿 Does not address shock.

Assess breathing pattern

🌿 Assessment is important but does not correct hypotension or crisis.

🌿 Steroids must be given first.


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7 :

Hint : 🩸 A– → A– or O– only

Correct Answers:

  • The unit can be A or O negative and be transfused.


Rationale :

🔷 A negative clients can only receive Rh-negative blood.

🔷 Type A negative accepts A negative (same type) and O negative (universal donor).

🔷 Giving Rh-positive blood to Rh-negative clients causes hemolytic reactions.

🔷 Type O negative contains no A or B antigens, making it safest.

🔷 This follows standard ABO and Rh compatibility rules.

A positive can be used

🔷 Contains Rh-positive, unsafe for Rh-negative clients.

🔷 May trigger immune reaction.

B negative

🔷 Contains B antigens, incompatible with Type A.

🔷 Causes hemolysis.

AB negative

🔷 Contains A and B antigens.

🔷 Not compatible with Type A recipients.


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8 :

Hint : ❤️ Improved CO = more activity

Correct Answers:

  • The client will have increased exercise tolerance.


Rationale :

💠 An EF of 22% indicates severe systolic heart failure.

💠 The primary treatment goal is improving cardiac output, which increases exercise tolerance.

💠 Increased tolerance means improved forward flow and better functional capacity.

💠 It is an objective measure of stabilized heart function.

💠 Evidence-based therapies (ACE inhibitors, beta-blockers, diuretics) focus on this goal.

Decreased nocturia

💠 Nocturia varies and is not the primary goal of HF management.

Decreased dyspnea at rest

💠 Dyspnea at rest indicates late-stage HF — improvement is ideal but not the primary goal.

No peripheral edema

💠 Complete elimination is unrealistic and not the top measurable goal.


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9 :

Hint : 🔥 Crisis = pain + hypoxia signs

Correct Answers:

  • Hematuria.
  • Severe joint pain.
  • Tachycardia.
  • Dyspnea


Rationale :

🌟Hematuria Sickle cells block renal vessels causing renal ischemia → blood in urine.

🌟 Common during vaso-occlusive crisis.

🌟 Indicates vascular complications.

🌟 Shows end-organ involvement.

🌟 Must be monitored for acute kidney injury.

🌟Severe joint pain Hallmark of vaso-occlusive crisis due to blocked microvasculature.

🌟 Joints become hypoxic and painful.

🌟 Often requires opioid management.

🌟 This is the most frequent reported symptom.

🌟 Indicates widespread sickling.

🌟Tachycardia Anemia causes compensatory increased heart rate.

🌟 Helps maintain oxygen delivery.

🌟 Common physiologic response.

🌟 Can escalate into cardiac strain.

🌟 Expected during painful crises.

🌟Dyspnea Low hemoglobin causes poor oxygen transport → shortness of breath.

🌟 Chest involvement may suggest acute chest syndrome.

🌟 Hypoxia worsens sickling.

🌟 Dyspnea is a red-flag symptom.

🌟 Requires close monitoring.

Thrombocytopenia

🌟 SCD typically causes increased platelet activation, not low platelets.

🌟 Thrombocytopenia is not typical in vaso-occlusive crisis.


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10 :

Hint : 🚻 UAP = toileting OK

Correct Answers:

  • Assist the client to void immediately before transport.


Rationale :

✨ Voiding before surgery prevents bladder distention during anesthesia.

✨ It is a safe, routine task appropriate for UAP.

✨ Requires no specialized nursing judgment.

✨ Enhances client comfort and reduces postoperative urinary issues.

✨ Frees the nurse to complete preoperative assessments.

Provide hand-off report

✨ Nursing-only task requiring clinical judgment.

✨ UAP cannot report patient condition.

Witness consent

✨ Only licensed nurses or providers may verify legal consent.

✨ Beyond UAP scope.

Teach breathing and coughing

✨ Teaching requires RN-level education and evaluation.

✨ Not delegated to UAP.


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Total Questions: 10

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