All Things Brain
WWYD?
MISC
Skin What?
Meds, Meds, & Meds
100

What safety precautions would you advise family members to implement for a patient with Alzheimer's disease at various stages?

Remove rugs, turn down water heater temp, put safeties over oven knobs, place locks at top or bottoms of doors, install alarms, keep home free of clutter, get rid of hazardous items (toxic liquids, dangerous eletrical appliances, etc), keep medications in a safe place

100

A 32 year old patient in labor expresses feeling very anxious because her family is not there yet. She asks if you can help her set up aromatherapy. What is your best response as the nurse?

That can be an excellent relaxation and calming technique. How can I best help you to get it set up? Let me check with the HCP to ensure this won't interfere with your medications or interventions.

100

A patient asks if they can remove the hard yellowish crusts on their face. What is the best response?

Do not scratch or pick at them. Wash your hands after immediately touching them or applying the topical cream on it. You can soak off the hard crusts before applying the topical cream.

100

A 22 year old athletic patient is wanting to prevent a recurrence of tinea pedis. What patient education would you provide?


Drying feet after they get wet, proper hygiene, using shower shoes in the locker room

100

What should be assessed before giving a patient alteplase as ordered?

Assess for bleeding/open wounds, Hct, platelet count, PT, aPTT, VS

200

An 71 year old patient with a family history of Parkinson's disease is concerned that they might also have it and are experiencing symptoms. You perform an assessment. What possible findings 

Bradykinesia, tremors, restlessness, drooling, difficulty swallowing, loss of coordination and balance, shuffling steps with a stooped position, blank masklike expression, rigidity with jerky movements, monotonous speech

200

You have been treating a patient with a stroke on and off for the last month. During that time the patient explained to you that they have religious practices that are very important to them especially relating to death. This patient unexpectedly passes and their family asks if they could have some time with their loved one to perform these religious rituals. What is your best therapuetic response as the nurse? 

Yes, you can definitely spend time with your loved one. You are welcome to perform the rituals and I will just be over here if you need anything. 

200

Name the 4 stages of pressure ulcers and provide a brief description of each stage. (Bonus-Name the other 2 types of pressure wounds)

Stage 1-Nonblanchable redness, intact skin; Stage 2-Partial thickness, intact or open skin; Stage 3-Full thickness and may include tunneling, Stage 4-Full thickness with exposed tendon, muscle, or bone; may have tunneling or eschar/slough; Bonus-Unstageable and Deep Tissue Injury

200
An 7 year old patient complains of a sore throat, it hurts to eat, and that their tongue looks a weird color. What do you expect to find when you do your physical assessment?

White spots or patches on the tongue and mouth, redness, and maybe some bleeding if the patches/spots have been recently scraped 

200

A family member, who is caring for an 83 year old patient with moderate stage Alzheimer's, makes the following statement, "I can let them stop taking memantine as soon as we see their symptoms improve." Does this statement indicate a need for further teaching?

Yes (bonus-why? you can't abruptly stop taking memantine)

300

A 69 year old patient who was admitted yesterday for a cerebrovascular accident has been NPO. What test should be performed before this client has a diet modification? Bonus: Who performs this test?

Swallow test; speech therapy

300

During shift report, the handoff nurse informs you that one of your patients speaks very little English. As you care for this patient today, what would be considered culturally competent care?

Get a translator or translation machine. 

300

In a follow-up appointment for a 85 year old patient with a primary diagnosis of Parkinson's disease, their family member remarks that they've noticed that the patient seems to look really frail and has lost a lot a weight. What focused assessments would you perform?

VS (always assess vital signs, can include getting a daily weight), Nutritional (daily diet-how much, what do they eat?), GI (last BM, normal BM patterns, N/V); Urinary (last void, how often); Muscular (potential problems with dysphagia); Possible Labs (F&E, H&H, CMP, etc); Mental Health (depression)

300

You previously treated a 6 year old patient for impetigo who returns for a follow-up visit. What is a clinical manifestation(s) that the patient's condition isn't improving?

Blisters have spread to other parts of the body and are not contained to original site

300

One of your patients is prescribed Nystatin via PO route. What are some education points would you make sure the patient and their caregiver understand?

Take the full course of the medication since it is an abx (don't stop when you feel better); Report immediately to the HCP any S/S of an allergic reaction; do not give extra doses; can be given with or without food; Notify the HCP if they experience tachycardia, or have N/V, stomach pain, or diarrhea that doesn't stop. 

400

The mother of a 5 year old patient with a diagnosis of Down's syndrome has noticed that her child struggles to dress themselves and becomes frustrated. How would you respond as the nurse? What interventions would you implement?

Velcro straps for shoes, easy snap buttons for pants and shirts

400

If you are caring for a patient with either Jewish or Islamic beliefs and their dinner tray comes with a porkchop, what is your best response as a nurse?

Kindly ask for a new tray without any pork products. 

400

A 14 year old patient with psoriasis comes in for treatment of their psoriasis flare-up. They ask you what they can do keep a flare up from happening again. What is your best response?

Stress can be a trigger for flare-ups. Is there anything that is stressing you out right now?

400

You arrive for your shift and during report are presented with a 72 year old patient who is incontinent and presenting with non-blanchable redness on their sacral region. What interventions will you employ to prevent further impairment to their skin integrity?

Repositioning q2h, use of wedges, cleaning them and changing bed linens right after episodes of incontinence, keeping the area clean and dry, apply protective barrier and/or dressing, making sure they are getting adequate nutrition

400

A patient is prescribed mupirocin. The mother of the patient states, "It's normal for my child to have a severe rash, swelling of their face, or severe diarrhea while using this medication so I don't need to report those to the healthcare provider." Is this an appropriate understanding of the side effects of the medication?

No, severe rash and swelling of face can indicate an allergic reaction and severe diarrhea is an unexpected side effect of the medication so it needs to be reported immediately to the HCP.

500

For a patient in the late stages of Parkinson's disease, what are they at a high risk for? What foods should their diet include?

At high risk for aspiration due to dysphagia which can lead to complications of pneumonia, infection and other severe respiratory problems. In later stages it will be thickened liquids to prevent aspiration and they need to be sitting up when they are eating. Speech therapy may also need to reevaluate and perform another swallow test. 

500

You are treating a 16 year old patient with severe bleeding and the HCP advises that they might need to receive a blood transfusion if their H&H continues to decline. After the HCP leaves the room, the patient says they will do whatever the doctor recommends, but the patients' parents state that due to their beliefs as Jehovah's Witnesses they will not let their child receive blood transfusion. What is the most appropriate response?

I will let the healthcare provider know. Can you tell me more about your beliefs? What specifically is concerning for you about this particular intervention?

500

What groups of patients are at highest risk for pressure wounds?

Immobile or very limited mobility (unable to reposition themselves), incontinent, poor nutritional habits, sedentary lifestyle, clients w/extended hospitalization or bedrest. 

500

A school nurse is evaluating some elementary school classrooms, what instructions will she give to the teachers and students to prevent spreading of pediculosis?

Do not share headbands, brushes/combs, hats, headphones, etc. 

500

You are treating a patient that has just been prescribed a topical hydrocortisone cream. What patient education would you give?

Do not abruptly stop using the cream when your skin looks better. Report any fever, sore throat, muscle aches, etc. Avoid contact with eyes, and apply after shower or bath.