DN
A nurse is preparing to administer capsaicin cream to a patient with diabetic peripheral neuropathy. The patient asks why it burns at first. Which response is most accurate?
A. The cream has alcohol which irritates the skin
B. It stimulates pain receptors and releases substance P; with repeated use, substance P depletes and pain decreases.
C. It is an allergic reaction and should be stopped
D. The burning means it is working immediately to stop all pain signals
B. It stimulates pain receptors and releases substance P; with repeated use, substance P depletes and pain decreases.
Rational
Capsaicin stimulates pain receptors and initially releases substance P. With consistent use, substance P is depleted from nerve terminals, reducing pain signal transmission over days to weeks. Initial burning is expected and normal.
A patient is admitted with a pH of 7.50, PaCO2 30, HCO3 22. The nurse identifies this as which acid-base imbalance?
A. Metabolic alkalosis, compensated
B. Respiratory alkalosis, uncompensated
C. Metabolic acidosis, compensated
D. Respiratory acidosis, uncompensated
B. Respiratory alkalosis, uncompensated
pH > 7.45 = alkalosis. PaCO2 < 35 = low (lungs losing CO2). HCO3 is normal at 22. ROME: Respiratory OPPOSITE: pH up, CO2 down = respiratory alkalosis. Normal HCO3 = no renal compensation yet = uncompensated.
A patient with heart failure has: weight gain of 3 lbs overnight, JVD, SpO2 91%, bounding pulse, and crackles. What is the nurse's priority action?
A. Encourage oral fluid intake to dilute sodium
B. Place in High Fowler's position and notify the provider; prepare to administer diuretics
C. Administer isotonic IV fluid bolus
D. Restrict all activities and perform daily weight in the evening
B. Place in High Fowler's position and notify the provider; prepare to administer diuretics
This is hypervolemia with respiratory compromise (SpO2 91%, crackles). Priority: High Fowler's improves breathing immediately; notify provider for diuretic order. IV fluids would worsen fluid overload. Daily weight should be morning (most accurate baseline).
A patient has a Type IV hypersensitivity reaction (delayed) after exposure to poison ivy. The nurse understands this reaction is mediated by which mechanism?
A. IgE antibodies and histamine release from mast cells
B. T-cell mediated response — occurs 24-48 hours after exposure
C. IgG antibodies attacking host cells
D. Immune complex deposition in tissues
B. T-cell mediated response — occurs 24-48 hours after exposure
Type IV (delayed) hypersensitivity is T-cell mediated — not antibody dependent. It takes 24-48 hours to develop (contact dermatitis, PPD test). Type I (anaphylaxis, eczema) is IgE/histamine. Type II is cytotoxic. Type III is immune complex.
A nurse is preparing to assist a post-op hip replacement patient to ambulate for the first time using a walker. The patient is on the left side of the bed. What is the correct sequence?
A. Move walker → strong leg → weak leg
B. Move walker → affected (weak) leg → then unaffected (strong) leg
C. Step with strong leg first → move walker → then weak leg
D. Move weak leg and walker simultaneously → then strong leg
B. Move walker → affected (weak) leg → then unaffected (strong) leg
Walker sequence: Move walker FIRST, then affected (weak) leg, then unaffected (strong) leg. Think 'walker and sick leg move together — strong leg follows.' For STAIRS: UP with the good (unaffected) leg first; DOWN with the bad (affected) leg first.
A nurse is teaching a patient prescribed gabapentin for neuropathic pain. Which instruction is the highest priority safety concern?
A. Take with a full glass of water
B. Do not stop the medication abruptly and avoid alcohol; fall precautions are essential
C. Take in the morning for best effect
D. Expect immediate pain relief within 24 hours
B. Do not stop the medication abruptly and avoid alcohol; fall precautions are essential
Gabapentin causes dizziness, drowsiness, and ataxia — significantly increasing fall risk. It must not be stopped abruptly (risk of seizures/withdrawal). Pain relief takes time. These safety points are the priority for patient teaching.
A nurse is monitoring a patient for compensation in metabolic acidosis. Which finding indicates the lungs are attempting to compensate?
A. Decreased respiratory rate and shallow breathing
B. Deep, rapid Kussmaul respirations
C. Bradycardia and hypotension
D. Increased urine bicarbonate excretion
B. Deep, rapid Kussmaul respirations
In metabolic acidosis, the lungs compensate by blowing off CO2 through Kussmaul respirations — deep, rapid breathing. This eliminates carbonic acid and raises the pH. The kidneys compensate slowly (days); lungs respond in minutes.
Best indicator of fluid status:
A. Blood pressure
B. Daily weight
C. Heart rate
D. Skin turgor
B. Daily weight
✔️ Why daily weight is best:
What causes allergy symptoms?
A. IgG
B. Histamine release
C. RBC destruction
D. Platelets
B. Histamine release
Allergy symptoms happen because your immune system overreacts to something harmless (like pollen, dust, food).
A patient with impaired mobility has been bedbound for 5 days. The nurse assesses diminished breath sounds in bilateral lower lobes and a productive cough. Which complication has occurred, and what is the priority intervention?
A. Pulmonary embolism — administer anticoagulants immediately
B. Hypostatic pneumonia from reduced lung expansion — initiate deep breathing, incentive spirometry, and position changes
C. Pleural effusion — prepare for thoracentesis
D. Atelectasis only — this is expected and requires no intervention
B. Hypostatic pneumonia from reduced lung expansion — initiate deep breathing, incentive spirometry, and position changes
Immobility causes hypostatic pneumonia — secretions pool in dependent lung fields due to shallow breathing and reduced cough. Priority: deep breathing exercises, incentive spirometry, turning q2h, early ambulation, and hydration to thin secretions. TCDB (Turn, Cough, Deep Breathe) is essential.
A patient with diabetic neuropathy is prescribed duloxetine (Cymbalta). Which finding requires the nurse to hold the medication and notify the provider?
A. Mild nausea on the first day
B. Patient reports yellowing of skin and eyes
C. Patient asks if they can take it with food
D. Complaint of dry mouth
B. Patient reports yellowing of skin and eyes
Yellow skin/eyes (jaundice) indicates hepatotoxicity — a serious adverse effect of duloxetine. This requires immediate notification. Nausea and dry mouth are common expected side effects. Duloxetine can be taken with food.
A patient's ABG results: pH 7.28, PaCO2 52, HCO3 24. Using the ROME method, how does the nurse interpret this?
A. Metabolic acidosis, uncompensated
B. Respiratory acidosis, uncompensated
C. Respiratory alkalosis, partially compensated
D. Metabolic alkalosis, uncompensated
B. Respiratory acidosis, uncompensated
pH < 7.35 = acidosis. PaCO2 > 45 = elevated (respiratory problem). HCO3 is normal at 24. Respiratory OPPOSITE: pH down, CO2 up = respiratory acidosis. HCO3 is normal, so no compensation has occurred yet = uncompensated.
A nurse is about to administer IV potassium replacement for K+ of 2.9. Which action is essential before and during administration?
A. Administer as an IV push for fastest effect
B. Never administer K+ IV push — dilute in IV fluid and give slowly; monitor EKG continuously
C. Mix with calcium gluconate in the same IV line
D. Give orally even in emergencies to prevent cardiac arrest
B. Never administer K+ IV push — dilute in IV fluid and give slowly; monitor EKG continuously
Potassium is NEVER pushed IV — it causes fatal cardiac dysrhythmias (ventricular fibrillation). It must be diluted and infused slowly with continuous EKG monitoring. This is one of the most critical medication safety rules in nursing.
A patient develops sudden hypotension, stridor, urticaria, and wheezing 10 minutes after receiving IV penicillin. What is the nurse's FIRST action?
A. Administer diphenhydramine (Benadryl) IV
B. Stop the medication, call for help, and administer epinephrine 0.3-0.5mg IM in the mid-outer thigh
C. Administer IV corticosteroids and start O2
D. Place in High Fowler's and prepare for intubation
B. Stop the medication, call for help, and administer epinephrine 0.3-0.5mg IM in the mid-outer thigh
This is anaphylaxis — a life-threatening emergency. Epinephrine IM (mid-outer thigh) is the FIRST and most critical medication. It reverses bronchospasm, vasoconstriction, and prevents cardiovascular collapse. Stopping the drug and calling for help happen simultaneously. Benadryl and steroids are secondary.
PRIORITY: A patient in traction — what is most important?
A. Remove weights for comfort
B. Ensure weights hang freely
C. Reposition frequently
D. Add extra weight
Correct answer: B. Ensure weights hang freely
✔️ Why this is PRIORITY:
SATA: Which are autonomic neuropathy findings?
A. Orthostatic hypotension
B. Gastroparesis
C. Foot ulcers
D. Urinary retention
E. Tingling feet
A. Orthostatic hypotension
B. Gastroparesis
D. Urinary retention
SATA: Causes of metabolic alkalosis include:
A. Vomiting
B. NG suction
C. DKA
D. Diuretics
E. Diarrhea
Causes of metabolic alkalosis (think: loss of acid or too much base):
SATA: Causes of respiratory alkalosis:
A. Anxiety
B. Fever
C. COPD
D. Hyperventilation
E. Opioids
Causes of respiratory alkalosis (↓ CO₂ from hyperventilation):
A parent brings a 10-month-old with eczema. The infant has been scratching constantly, causing skin breakdown. What is the priority nursing intervention?
A. Recommend stopping all moisturizers to dry out the rash
B. Keep fingernails short, apply prescribed topical steroids, and moisturize immediately after bathing
C. Give diphenhydramine every 4 hours around the clock
D. Advise the parent to use scented lotion for comfort
B. Keep fingernails short, apply prescribed topical steroids, and moisturize immediately after bathing
Eczema is 'the itch that rashes' — scratching causes skin breakdown and infection. Priority: trim nails (reduce trauma), apply prescribed topical steroids to reduce inflammation, and moisturize after lukewarm baths to restore the skin barrier. Scented products are triggers.
A nurse is performing a newborn assessment and notes asymmetrical gluteal folds and unequal knee heights when the hips are flexed. Which test should the nurse perform next, and what finding confirms DDH?
A. Babinski test — positive fanning of toes confirms DDH
B. Ortolani and Barlow maneuvers — a clunk sensation with hip abduction (Ortolani: in) or adduction (Barlow: out) confirms instability
C. Kernig's sign — resistance to knee extension confirms the diagnosis
D. Romberg test — swaying confirms hip instability
B. Ortolani and Barlow maneuvers — a clunk sensation with hip abduction (Ortolani: in) or adduction (Barlow: out) confirms instability
SATA: Which findings indicate worsening peripheral neuropathy?
A. Burning pain at night
B. Decreased reflexes
C. Improved vibration sense
D. Foot ulcers
E. Increased sensation
A. Burning pain at night
B. Decreased reflexes
D. Foot ulcers
SATA: Which are signs of acidosis?
A. Confusion
B. Lethargy
C. Hyperkalemia
D. Tetany
E. Irritability
Signs of acidosis:
SATA: Signs of fluid volume deficit:
A. Tachycardia
B. Hypotension
C. Dry mouth
D. Bounding pulse
E. Confusion
SATA: Signs of anaphylaxis:
A. Airway swelling
B. Hypotension
C. Bradycardia
D. Wheezing
E. Rash
Signs of anaphylaxis (life-threatening allergic reaction):
SATA: Signs of DDH:
A. Unequal leg length
B. Symmetrical folds
C. Limited abduction
D. Positive Ortolani
E. Equal knee height
Signs of Developmental Dysplasia of the Hip (DDH):