Clinical Judgment
Pharm
OB
SATA
Potpourri
100

A postoperative client is 6 hours post-op bowel resection. The nurse notes:

  • HR 124
  • BP 88/50
  • RR 28
  • Cool, clammy skin
  • Urine output 15 mL/hr

The nurse recognizes the client is likely developing

Hypovolemic Shock

100

A client taking warfarin has an INR of 5.8.

The nurse anticipates a provider order for ___________.

Vitamin K (phytonadione)

100

A client with severe preeclampsia begins seeing spots and complains of a worsening headache.

The nurse's priority action is to initiate ___________.

Seizure precautions

100

A client with left-sided heart failure develops worsening symptoms.

Name four assessment findings the nurse would expect.

  • Crackles
  • Pulmonary edema
  • Dyspnea
  • Orthopnea
  • Tachypnea
  • Decreased oxygen saturation
  • Fatigue
  • Cough
100

A client with major depressive disorder states, "My family would be better off without me."

The nurse should identify this statement as a possible indicator of ___________.

Suicidal ideation

200

A client with COPD is receiving oxygen at 2 L/min via nasal cannula.

The client's oxygen saturation decreases from 92% to 84%, and the client becomes increasingly restless.

The nurse should prioritize assessing ___________.

Airway patency and respiratory status

(Or oxygenation/ventilation status)

200

A client receives IV morphine.

Thirty minutes later, respirations decrease from 16/min to 8/min.

The priority medication is ___________.

Naloxone

200

A postpartum client saturates a pad in 15 minutes.

The fundus is boggy and displaced to the right.

The nurse should immediately ___________.

Massage the fundus

(Also assess/empty bladder)

200

A client develops septic shock.

List three findings that indicate worsening tissue perfusion.

Any three:

  • Hypotension
  • Altered mental status
  • Oliguria
  • Elevated lactate
  • Cool extremities
  • Tachycardia
200

A client with acute kidney injury has the following assessment findings:

  • Potassium 6.7 mEq/L
  • Muscle weakness
  • Peaked T waves
  • HR 52/min

The nurse determines the client is at highest risk for ___________.

Cardiac arrest

300

A laboring client suddenly reports severe abdominal pain.

The fetal monitor shows recurrent late decelerations and the uterus remains rigid between contractions.

The nurse suspects ___________.

Placental abruption

300

Before administering digoxin, the nurse notes the apical pulse is 52 beats/min.

The nurse should ___________.

Hold the medication and notify the provider

300

A newborn of a diabetic mother is jittery and difficult to arouse.

The nurse suspects neonatal ___________.

Hypoglycemia

300

A nurse reviews the laboratory results and assessment findings of a client with kidney failure.

Which findings are consistent with hyperkalemia

  • Muscle weakness
  • Paresthesias
  • Peaked T waves
  • Bradycardia
  • Cardiac dysrhythmias
  • Flaccid muscles
  • ECG changes
300

A client admitted with pancreatitis has received aggressive IV fluid replacement for the past 24 hours.

Current assessment findings include:

  • Crackles at the lung bases
  • SpO₂ 89%
  • RR 30/min
  • New onset dyspnea
  • BP 138/84

The nurse recognizes the client's condition is most likely complicated by ___________.

Fluid volume overload (pulmonary edema)

400

A client with heart failure develops:

  • Crackles throughout the lungs
  • Pink frothy sputum
  • SpO₂ 82%
  • Severe dyspnea

The nurse recognizes these findings as

Acute pulmonary edema

400

A client receiving magnesium sulfate develops:

  • Respirations 8/min
  • Absent reflexes
  • Decreased urine output

These findings indicate ___________.

Magnesium toxicity

400

The most common cause of postpartum hemorrhage is ___________.

Uterine atony

400

A nurse is caring for a client diagnosed with right-sided heart failure.

Which assessment findings would the nurse expect to observe?

  • Jugular venous distention (JVD)
  • Peripheral edema
  • Ascites
  • Hepatomegaly
  • Weight gain
  • Dependent edema
  • Increased abdominal girth
  • Anorexia/nausea related to abdominal congestion
  • Elevated central venous pressure (CVP)
400

A client receiving broad-spectrum antibiotics for 6 days develops:

  • Watery diarrhea
  • WBC 18,000/mm³
  • Abdominal cramping
  • Temperature 100.8°F

The nurse suspects the client may have developed ___________.

Clostridioides difficile (C. diff) infection

500

Which client should be seen first?

  • Client with blood glucose 62 mg/dL drinking juice
  • Client reporting chest pain rated 8/10 that began 15 minutes ago
  • Client awaiting discharge instructions
  • Client requesting pain medication

The client with chest pain

500

A client prescribed furosemide has the following laboratory results:

  • Sodium 138 mEq/L
  • Potassium 2.9 mEq/L
  • Calcium 9.2 mg/dL
  • Magnesium 2.0 mg/dL

The nurse should recognize the client is at greatest risk for developing ___________.

Cardiac dysrhythmias

500

A laboring client at 39 weeks has been receiving oxytocin for induction. The nurse notes the following:

  • Contractions every 1 minute lasting 100 seconds
  • Fetal heart rate baseline 170 bpm
  • Recurrent late decelerations
  • Minimal variability

The nurse recognizes the fetus is showing evidence of ___________.

Uteroplacental insufficiency with fetal distress (fetal hypoxia)

500

A nurse receives report on a client whose condition may be deteriorating.

Which findings indicate impaired tissue perfusion and require immediate follow-up? 

  • Blood pressure 82/48 mmHg
  • Urine output 20 mL/hr
  • Altered level of consciousness
  • Cool, clammy skin
  • Lactate 4.8 mmol/L
  • Tachycardia
  • Delayed capillary refill
500

A client diagnosed with schizophrenia suddenly stops talking, stares at the wall, and remains motionless in bed for several hours despite repeated attempts at interaction.

The nurse recognizes these behaviors as manifestations of ___________.

Catatonia