Medical-Surgical
A patient receiving blood transfusion develops chills. What is the FIRST action?
Answer: Stop transfusion
Reverses opioid-induced respiratory depression
Naloxone
Which patient should the nurse see first?
A. Post-op pain 8/10
B. O₂ sat 90% on 2L
C. New confusion
D. BP 150/90
B. O₂ sat 90% on 2L
COPD
A. Low-flow oxygen
B. Encourage pursed-lip breathing
C. High oxygen always
D. Monitor CO2 retention
A. Low-flow oxygen ✅
B. Encourage pursed-lip breathing ✅
C. High oxygen always ❌
D. Monitor CO2 retention ✅
😓🫀📈🩸
Hypertension
Which finding in a patient with DVT requires immediate action?
A. Leg swelling
B. Pain with walking
C. Sudden chest pain
D. Warmth in calf
C. Sudden chest pain
A patient is receiving warfarin for DVT. INR 5.0. Which of the following orders from the healthcare provider can the nurse anticipate?
A. Protamine sulfate IV
B. Administer oral Vit K
C. Infusion of fresh frozen plasma
D. Administer the next dose of warfarin at the scheduled time.
B. Administer oral Vit K.
Which patient requires immediate intervention?
A. Mg 2.0
B. K+ 6.5
C. Na 134
D. Glucose 180
B. K+ 6.5
Select all signs of hypoxia:
A. Restlessness
B. Cyanosis
C. Bradycardia
D. Confusion
A. Restlessness ✅
B. Cyanosis✅
C. Bradycardia ❌
D. Confusion✅
🫁❌💨
Respiratory Failure
Sudden SOB post-surgery—what is priority concern?
Pulmonary embolism
What are the manifestations of serotonin syndrome the patients should be taught to recognize?
Mental status changes, agitation, tachycardia, fever, muscle stiffness, and GI symptoms (nausea or diarrhea).
Which patient is MOST unstable?
A. BP 148/90
B. HR 54 and asymptomatic
C. No urine output for 24 hours
D. Mild jaundice
C. No urine output for 24 hours
Select all DKA findings:
A. Fruity breath
B. Deep respirations
C. Low glucose
D. Dehydration
A. Fruity breath✅
B. Deep respirations✅
C. Low glucose❌
D. Dehydration✅
🧠💥
Stroke
An elderly patient with a UTI becomes suddenly confused—what is this?
Delirium
A patient on digoxin has a heart rate of 54 bpm. What should the nurse do?
Hold medication.
You are assigned 4 patients. Who do you see FIRST?
C. Patient with O2 sat 89% and restlessness
Select all signs of increased ICP:
A. Decreased LOC
B. Vomiting
C. Hypertension
D. Bradycardia
Select all signs of increased ICP:
A. Decreased LOC✅
B. Vomiting✅
C. Hypertension✅
D. Bradycardia✅
🍬⬇️😰⚡
Hypogylcemia
A patient with a chest tube has continuous bubbling in the water seal chamber. What is the priority?
Assess for air leak
Which patient should NOT receive beta blockers?
Asthma patients
A patient with COPD is receiving oxygen. Which finding requires immediate intervention?
A. O₂ sat 90%
B. RR 10/min
C. Barrel chest
D. Chronic cough
B. RR 10 min (respiratory depression)
Neutropenia Precautions - Select all appropriate interventions:
A. Private room
B. Fresh flowers allowed
C. Hand hygiene
D. Avoid raw foods
E. Monitor temperature
A. Private room✅
B. Fresh flowers allowed❌
C. Hand hygiene✅
D. Avoid raw foods✅
E. Monitor temperature✅
🚽😣🔥💧⬇️
UTI