Operative
This legal document verifies that the patient understands the procedure, risks, benefits, and alternatives before surgery.
What is informed consent?
A patient says, "My leg hurts when I walk, but the pain goes away after I rest for a few minutes."
Question:
What vascular disorder is this patient most likely experiencing?
Peripheral arterty disease with intermittent claudication
A patient with Type 1 diabetes suddenly becomes pale, diaphoretic, shaky, and states, "I forgot to eat after taking my insulin."
Question:
What complication is the patient experiencing, and what should the nurse do first?
Hypoglycemia; if the patient is awake and able to swallow, administer 15 g of a fast-acting carbohydrate and recheck the blood glucose in 15 minutes.
A patient says,
"By the end of the day, my eyelids droop, my speech becomes slurred, and chewing dinner becomes difficult."
Question:
What neurological disorder is most consistent with these symptoms?
A patient says,
"By the end of the day, my eyelids droop, my speech becomes slurred, and chewing dinner becomes difficult."
Question:
What neurological disorder is most consistent with these symptoms?
A patient with a urinary tract infection reports burning with urination, urinary frequency, and urgency.
Question:
What additional assessment finding would suggest the infection has progressed from cystitis to pyelonephritis?
Fever, flank pain (costovertebral angle tenderness), chills, nausea/vomiting, or systemic symptoms.
A patient states,
"It's like a curtain is coming down over one of my eyes."
Question:
What vision disorder should the nurse suspect?
Retinal detachment.
A patient receiving chemotherapy asks,
"Why does my doctor keep checking my white blood cell count?"
Question:
What complication is the healthcare team monitoring for?
Neutropenia (increased risk for infection due to a low neutrophil count).
A patient with iron-deficiency anemia asks,
"Why do I always feel so tired and short of breath?"
Question:
How should the nurse explain these symptoms?
Iron-deficiency anemia decreases hemoglobin, reducing the blood's ability to carry oxygen to the body's tissues, resulting in fatigue and shortness of breath.
A patient with acute cholecystitis asks,
"Why does eating a cheeseburger make my pain so much worse?"
Question:
How should the nurse explain this?
Fatty foods stimulate the gallbladder to contract. An inflamed gallbladder causes increased pain when it attempts to release bile.
A patient scheduled for surgery arrives wearing acrylic nails, contact lenses, and a wedding ring. Which item is the highest priority for the nurse to address before the patient goes to the operating room?
What are acrylic nails?
A patient with peripheral artery disease asks, "Should I stop walking because my legs hurt?"
Question:
What teaching should the nurse provide?
Encourage a structured walking program. Walk until discomfort develops, rest until the pain subsides, then continue walking to improve collateral circulation.
A patient with Type 2 diabetes has followed diet and exercise recommendations for six months. Today's laboratory results are:
Question:
What change in treatment should the nurse anticipate?
he provider will likely initiate or intensify pharmacologic therapy (such as starting diabetes medication and/or insulin) because lifestyle changes alone are not adequately controlling blood glucose.
A patient with Parkinson's disease asks,
"Why is it so important that I take my carbidopa-levodopa at the same time every day?"
Question:
What teaching should the nurse provide?
Taking the medication on time helps maintain a consistent drug level, improving mobility and reducing "off" periods when symptoms worsen.
DAILY DOUBLE!!
A patient with chronic kidney disease asks,
"Why am I so tired all the time?"
Question:
Explain why patients with chronic kidney disease commonly develop anemia.
Diseased kidneys produce less erythropoietin (EPO), resulting in decreased red blood cell production and anemia.
A patient is diagnosed with open-angle glaucoma and asks,
"My vision seems fine. Why do I have to keep using these eye drops?"
Question:
What teaching should the nurse provide?
The eye drops help lower intraocular pressure and prevent permanent vision loss. Glaucoma often has no early symptoms, so the medication should be used even when vision seems normal.
A patient receiving chemotherapy has an absolute neutrophil count (ANC) of 450 cells/mm³.
Question:
What is the priority nursing teaching for this patient?
Prevent infection by practicing meticulous hand hygiene, avoiding sick individuals and crowds, monitoring temperature, and reporting a fever immediately.
A patient receiving a blood transfusion suddenly develops chills, fever, low back pain, and dark-colored urine 15 minutes after the transfusion begins.
Question:
What transfusion reaction is occurring, and what is the nurse's first action?
Acute hemolytic transfusion reaction; stop the transfusion immediately while maintaining IV access with normal saline using new tubing.
A patient with cirrhosis becomes increasingly confused and develops asterixis during the morning assessment.
Question:
What complication should the nurse suspect, and what medication is commonly used to treat it?
Hepatic encephalopathy; lactulose (accept rifaximin as an additional therapy).
During surgery, the circulating nurse notices that the patient's end-tidal CO₂ is rising rapidly, heart rate has increased, and muscle rigidity is developing. What life-threatening complication should the nurse suspect, and what medication should be anticipated?
What is malignant hyperthermia? Administer Dantrolene
A patient arrives in the emergency department with a cool, pale leg, absent pedal pulse, numbness, and inability to move the toes. Symptoms began one hour ago.
Question:
What complication is occurring, and what treatment should the nurse anticipate?
Acute arterial occlusion (acute limb ischemia); anticipate immediate vascular intervention such as thrombectomy, thrombolytic therapy or emergency surgery
A patient with diabetic peripheral neuropathy tells the nurse,
"Since I can't feel my feet very well, I soak them in hot water every night."
Question:
Why is this practice dangerous, and what should the nurse recommend instead?
Neuropathy decreases sensation, increasing the risk of burns. The patient should check the water temperature with a thermometer or elbow, wash feet in lukewarm water, inspect feet daily, and wear properly fitting shoes.
A patient with multiple sclerosis reports that symptoms become worse after spending time outside on a hot summer day.
Question:
Why do the patient's symptoms temporarily worsen, and what teaching should the nurse provide?
Heat slows nerve conduction in demyelinated nerves (Uhthoff's phenomenon). The patient should avoid overheating, stay cool, and pace activities.
A patient with chronic kidney disease has the following laboratory results:
The patient reports muscle weakness.
Question:
Which laboratory value is the greatest immediate concern, and why?
Potassium of 6.4 mEq/L because severe hyperkalemia can cause life-threatening cardiac dysrhythmias.
A patient underwent cataract surgery this morning and says,
"Can I bend over to tie my shoes when I get home?"
Question:
What should the nurse teach this patient?
Avoid bending at the waist, heavy lifting, and straining because these activities can increase intraocular pressure and interfere with healing.
A patient receiving chemotherapy develops redness, swelling, burning, and pain at the IV site while the medication is infusing.
Question:
What complication should the nurse suspect, and what is the first nursing action?
Vesicant extravasation; stop the infusion immediately (leave the catheter in place per protocol) and follow institutional extravasation guidelines.
A patient with vitamin B12 deficiency asks,
"Why are my hands and feet numb? I thought anemia only made people tired."
Question:
How should the nurse explain this symptom?
Vitamin B12 is necessary for normal nerve function. A deficiency can damage the myelin surrounding nerves, causing numbness, tingling, and balance problems in addition to anemia.
A patient with acute pancreatitis asks,
"Why can't I eat anything? I'm starving!"
Question:
Why is keeping this patient NPO an important part of treatment?
Eating stimulates pancreatic enzyme secretion, increasing pancreatic inflammation and pain. Keeping the patient NPO allows the pancreas to rest and heal.
Name four responsibilities of the circulating nurse during surgery
Assisting with patient positioning
Performing sponge, sharps, and instrument counts.
Maintaining patient safety
Opening sterile supplies
Documenting the procedure
Handling and labeling specimens
A patient with long-standing atherosclerosis suddenly develops severe chest pain, a blood pressure of 210/118 mm Hg, and new-onset left-sided weakness.
Question:
What two body systems are most likely being affected by the patient's vascular disease?
Heart or brain
A patient has the following assessment findings:
Question:
What is the underlying reason these symptoms occur when blood glucose remains elevated?
Hyperglycemia causes excessive urination and dehydration. Chronic elevated glucose also damages blood vessels and nerves, resulting in poor circulation, delayed wound healing, and other long-term complications.
A patient with Guillain-Barré syndrome reports increasing weakness. During assessment, the nurse notes the weakness has progressed from the legs to the arms, and the patient has developed a weak cough.
Question:
What complication is the nurse most concerned about, and what should be monitored closely?
Impending respiratory failure; closely monitor respiratory status (vital capacity, breathing effort, oxygenation, ability to clear secretions).
The nurse is caring for a patient with chronic kidney disease who has the following assessment findings:
Question:
What complication is the patient most likely experiencing, and what nursing intervention would you anticipate?
Fluid volume overload due to decreased kidney function; anticipate interventions such as fluid restriction, diuretics (if appropriate), oxygen, and/or dialysis depending on the severity and provider orders.
A patient with Ménière's disease reports severe vertigo, nausea, and difficulty maintaining balance.
Question:
What nursing intervention is the priority during an acute episode?
Protect the patient from injury by assisting them to bed, minimizing movement, and implementing fall precautions until the vertigo subsides.
DAILY DOUBLE!!
A patient asks,
"What's the difference between primary, secondary, and tertiary cancer prevention?"
Question:
Give one example of each level of prevention.
A patient with sickle cell disease is admitted with severe pain in both legs after becoming dehydrated while working outside.
Question:
What caused this pain crisis, and what nursing interventions should be anticipated?
Dehydration promoted sickling of red blood cells, leading to vaso-occlusion and tissue ischemia. Anticipate aggressive hydration, pain management, oxygen if indicated, and measures to reduce further sickling.
The nurse is caring for four patients:
Question:
Which patient requires immediate intervention, and why?
The patient with cirrhosis who is vomiting bright red blood, because this suggests bleeding esophageal varices, a life-threatening emergency requiring immediate intervention.
During head and neck surgery, the patient is receiving supplemental oxygen. The surgeon is preparing to activate the electrocautery device immediately after an alcohol-based skin preparation was applied.
What major safety hazard exists, and what two nursing actions should be taken to reduce the risk?
Operating room fire. Ensure the prep solution is completely dry and coordinate with anesthesia to minimize oxygen concentration when appropriate.
A patient with critical limb ischemia has the following assessment findings:
Question:
What stage of peripheral artery disease is the patient experiencing, and what is the greatest priority for treatment?
Critical limb ischemia; immediate vascular evaluation to restore blood flow and prevent limb loss (possible revascularization or amputation if tissue is nonviable).
A nurse reviews the laboratory results of a patient with long-standing diabetes:
Question:
Identify three chronic complications of diabetes that are suggested by these findings.
DAILY DOUBLE!!
A patient's family asks,
"How can we tell the difference between delirium and dementia?"
Question:
Name two differences between delirium and dementia.
A patient with kidney stones asks,
"Now that this stone has passed, how can I reduce my chances of getting another one?"
Question:
What is the most important teaching the nurse should provide?
ncrease fluid intake (unless contraindicated) to produce at least 2–3 liters of urine per day. (Accept limiting sodium or dietary changes if discussed in class.)
A patient asks,
"What's the difference between cataracts and macular degeneration? They both affect vision."
Question:
Describe one major difference between cataracts and macular degeneration.
A patient with leukemia begins chemotherapy. Twelve hours later, the patient develops:
Question:
What oncologic emergency is occurring, and why is it life-threatening?
Tumor lysis syndrome. Rapid destruction of cancer cells releases intracellular electrolytes into the bloodstream, causing severe metabolic abnormalities that can lead to life-threatening cardiac dysrhythmias and acute kidney injury.
A patient has been receiving a blood transfusion for one hour. The nurse notes:
Question:
What transfusion complication is occurring, and what nursing interventions should the nurse anticipate?
Transfusion-associated circulatory overload (TACO). Stop or slow the transfusion per protocol, place the patient in high-Fowler's position, administer oxygen as needed, notify the provider, and anticipate diuretic therapy.
A patient newly diagnosed with ulcerative colitis asks,
"How is my disease different from Crohn's disease?"
Question:
Name one major difference between ulcerative colitis and Crohn's disease.