1 :

Nurses' Notes

Day 1, 0800:

The client was admitted 2 days ago from the emergency department for recurrent upper abdominal pain. The client is resting in a lounge chair at the bedside and denies pain is present. In addition to the medical history, the client discloses alcohol use, "one to two beers every day and a recent fall at home without injury. "I get clumsy every once in a while." Client reports occasional marijuana use, "I like the gummies, but only on weekends,"

2000:

Client holding abdomen, reports nausea and epigastric pain rated at 7 on a 0 to 10 pain scale, medicated with oxycodone/acetaminophen as prescribed. Client reports they have been up to the bathroom frequently due to urinary urgency, "I have a big prostate, so I have to go when I have to go, otherwise I pee on myself."

Vital Signs

0800:

Temperature 36.4° C (97.5° F)

Heart rate 78/min

Respiratory rate 18/min

Blood pressure 146/84 mm Hg

2000:

Temperature 36.4° C (97.5° F)

Heart rate 64/min

Respiratory rate 18/min

Blood pressure 122/72 mm Hg

Medication Administration Record

0800:

terazosin 5 mg PO daily

acetaminophen 1,000 mg PO every 4 to 6 hr as needed for pain

famotidine 20 mg PO at bedtime

oxycodone/acetaminophen 5/325 mg PO every 6 hr for moderate to severe pain

atorvastatin 40 mg PO daily

allopurinol 100 mg PO daily

2000:

oxycodone/acetaminophen 5/325 mg PO

History and Physical

0800:

Hypertension

Benign prostatic hypertrophy (BPH)

Peptic ulcer disease

Pancreatitis

Gout

Assessment

2200:

Neurological: pupils are, and oriented x2, moving of extremities are equal strength, pupils are equal, are reactive to light and accommodation.

Cardiovascular: color pink, skin warm and dry, glucture 50, S2 noted with regular rhythm, pulses 2+ to all extremities, no edema appreciated.

Gastrointestinal: abdomen round, soft, non-tender, bowel sounds present in all quadrants.

Urinary: voiding without difficulty, reports frequency and urgency of events.

2200:

Neurological: pupils are and oriented x 2, moving of extremities are equal strength, pupils are equal, reacted are reactive to light and accommodation.

Cardiovascular: color pink, skin warm and dry, glucture 50, S2 noted with regular rhythm, pulses 2+ to all extremities, no edema appreciated.

Gastrointestinal: abdomen round, mid-epigastric tenderness with light palpation, bowel sounds present in all quadrants.

Urinary: voiding without incident difficulty.

The client is at risk for developing[ ] due to [ ]

Hint : None

Correct Answers

  • Blank 1 Correct Option: fall-related injury
  • Blank 2 Correct Option: oxycodone/acetaminophen
Rationale :
None
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2 :

Nurse’s Notes

3 months  Ago:

A client presents in the office today, stating, “I have pain all over my body.” Client reports they “hurt all the time.” The client reports they have had this discomfort for about “1 year and states, “I take acetaminophen around the clock, but it just doesn’t help at all.’’ The client states, ‘it hurts when you just touch me, and I’m miserable.” Client reports pain level of 8 on a scale from 0 to 10.

2. months Ago:

The client returns after their visit 1 month ago and states their new medication ‘may have helped just a little, but not much.” The client has been taking their medication as prescribed, but with little improvement in pain. When asking the client to respond to the statement “I have a persistent deep aching all over my body,” the client states,” Yes, that’s me.” The client reports they returned today to see if anything can improve their pain. The provider suspects that the client is experiencing fibromyalgia. Client reports pain level of 8 on a scale from 0 to 10.

Today:

The client returns for a follow-up today. The client is tearful and states, "Nothing is helping my pain, and I'm not able to sleep. None of the medicines work. I'm miserable and I can't live like this anymore." Heart rate regular. Respirations even and unlabored. Abdomen non-distended. Bowel sounds active. Client reports decreased urine output since last visit.

Vital signs

3 months ago:

Blood pressure 118/78 mm Hg

Respiratory rate 16/min

Heart rate 67/min

Temperature 37°C (96.8°F)

2 months Ago:

Blood pressure 121/81 mm Hg

Respiratory rate 18/min

Heart rate 69/min

Temperature 37°C (98.6°F)

Today:

Blood pressure 130/80 mm Hg

Respiratory rate 20/min

Heart rate 100/min

Temperature 37.2°C (99°F)

Medication Administration Record

3 Months Ago:

Meloxicam 15 mg PO daily

2 Months Ago:

Meloxicam 15 mg PO daily

Cyclobenzaprine 10 mg PO three times daily

Duloxetine 30 mg PO daily

Laboratory Results

2 Months Ago:

Hemoglobin 14 g/dL (12 to 16 g/dl.)

Hematocrit 40% (37% το 47%)

Creatinine 0.8 mg/dL (0.5 to 1 mg/dL).

WBC count 4,500/mm³ (5,000 to 10,000/mm3)

Today:

Hemoglobin 14.8 g/dL (12 to 16 g/dL)

Hematocrit 44% (37% to 47%)

Blood creatinine 1.2 mg/dL (0.5 to 1 mg/dL)

WBC count 5,500/mm³ (5,000 to 10,000/mm3)

Complete the following sentence by using the list of options. The nurse should first address the client's .........[1]....... followed by their …….[2].

Hint : None

Correct Answers

  • Blank 1 Correct Option: statement of hopelessness
  • Blank 2 Correct Option: pain level
Rationale :
None
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3 :

Hint : Pain Scale and appropriate analgesics.

Correct Answers:

  • Oxycodone

Rationale :
Oxycodone is an opioid analgesic commonly used to manage moderate to severe pain, including breakthrough pain in patients already receiving baseline pain management, such as a fentanyl transdermal patch. Breakthrough pain refers to sudden, intense flares of pain that "break through" the regular pain control provided by the fentanyl patch. The other options are not appropriate for treating breakthrough pain
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4 :

Hint : NPSG 2024 edition

Correct Answers:

  • Bath clients using a chlorhexidine solution.

Rationale :
Bath clients using a chlorhexidine solution is the correct option since it aligns with evidence-based practices outlined in the National Patient Safety Goals to reduce health care-associated infections . Chlorhexidine solution is effective in reducing skin microorganisms, lowering the risk of surgical site infections and bloodstream infections.
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5 :

Hint : Communicable diseases

Correct Answers:

  • Vancomycin-resistant enterococci (VRE)
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Clostridium difficile

Rationale :
VRE~requires contact precautions as it spreads through direct contact with contaminated surfaces or infected individuals. MRSA~requires contact precautions due to its transmission via direct contact with infected wounds or contaminated surfaces. Clostridium difficile~requires contact precautions, especially with strict hand hygiene using soap and water. Influenza~requires droplet precautions, not contact precautions, as it spreads primarily through respiratory droplets. Tuberculosis~requires airborne precautions, not contact precautions, because it spreads through airborne particles
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6 :

Hint : Patient data privacy.

Correct Answers:

  • Maintaining security of client information is a concern with EHRs.

Rationale :
The security of client information is a primary concern with Electronic Health Records (EHRs) due to the risks of data breaches and unauthorized access. Healthcare professionals must follow strict privacy and security measures, such as HIPAA guidelines, to protect sensitive client data.
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7 :

Hint : None

Correct Answers:

  • Tie the restraint to a moveable part of the client's bed frame

Rationale :
The restraint should be tied to a movable part of the bed frame to ensure client safety. Tying it to a stationary part, such as the side rail, could cause harm if the rail is moved. Quick-release knots should be used to allow for rapid removal in an emergency.
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8 :

Hint : None

Correct Answers:

  • “Would you like to abstain from meat on Fridays?"

Rationale :
During Lent, many individuals, particularly those of the Catholic faith, observe dietary restrictions such as abstaining from meat on Fridays. This question directly addresses a common practice associated with Lent and demonstrates respect for the client’s religious practices.
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9 :

Hint : None

Correct Answers:

  • "Keep a record of cues that trigger a desire to eat.”

Rationale :
Tracking cues that trigger eating can help individuals identify emotional or environmental factors that lead to excessive food intake. This self-awareness allows for better management of eating habits and helps prevent over consumption.
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10 :

Hint : None

Correct Answers:

  • "I am not even sure why I exist."

Rationale :
This statement reflects a lack of meaning or purpose, which is a hallmark of spiritual distress. It indicates the client is struggling with existential questions and their sense of identity or connection to a higher power or purpose, often tied to spiritual beliefs.
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