You Are What You Absorb
A patient with COVID-19 presents with dehydration and the provider orders normal saline 0.9% IV What type of fluid is this solution?
A. Isotonic
B. Hypotonic
C. Hypertonic
D. Colloid
A - Isotonic
True or False: I need to palpate the radial pulse for a full minute for CPE
True
I could fail my CPE if I check carotid pulses bilaterally at the same time
True
What would you see in a blood pressure reading if the blood pressure cuff is too loose?
False reading - decreased BP
A nurse is inspecting a 58-year-old client’s chest wall to locate the apical impulse. Where should the nurse look?
A. At the fifth intercostal space medial to the left midclavicular line
B. Over the base of the heart
C. Over the aortic area
D. At the third intercostal space to the left of the sternum
A - left midclavicular at the 5th intercostal space
A patient with Guillain-Barré syndrome develops syndrome of inappropriate antidiuretic hormone, which puts the patient at risk for hyponatremia. Which serum sodium level indicates hyponatremia?
A. 128 mEq/L
B. 135 mEq/L
C. 142 mEq/L
D. 150 mEq/L
A - normal range is 135-145
True or False: I can be 4 points above or below the set reading for pulse and BP and 2 points above or below RR for CPE and still pass
True
From your syllabus:
Obtain accurate Vital Signs by:
a. measuring the systolic and the diastolic BP within +/- 4 mmHg
b. measuring radial pulse within +/- 4 bpm, counting for one full minute
c. measuring respirations within +/- 2 respirations counting for one full minute
d. measuring temperature accurately
e. assessing pain using appropriate pain scale
f. assessing oxygen saturation
Name 3 different types of abnormal breath sounds.
Crackles, stridor, wheezes, rhonchi, pleural friction rub
Tachycardia means _______________ and bradypnea means _______________.
Rapid heart rate (above 100)
Slowed breathing (less than 12)
You suspect that your patient has a pericardial friction rub but you have trouble hearing it. What should you do?
A. Ask the patient to hold his breath
B. Ask the patient to exhale forcefully
C. Ask the patient to lie on his left side
D. Ask the patient to lie flat on his back
A - have the patient hold their breath
A patient with hypercalcemia may experience:
A. Peak T-waves on cardiac monitor
B. Negative Chvostek's Sign
C. Kidney stones
D. Flattened T-waves on cardiac monitor
C - kidney stones
True or False:
It is okay for patients to sit with their legs crossed when obtaining a blood pressure.
False - this can increase pressure by inhibiting proper flow back to the heart and result in false readings
When you auscultate the lower lobes of a healthy patient's lungs, you would expect to hear:
A. tracheal breath sounds
B. bronchial breath sounds
C. vesicular breath sounds
D. bronchovesicular breath sounds
C - Vesicular - vesicular breath sounds are soft, low-pitched, and prolonged during inspiration and can be heard over the lower lobes
You are unable to palpate a patient's dorsalis pedis pulse. What is the next thing you should do?
A. Immediately notify the provider
B. Keep trying, surely it's there
C. Assess using a doppler
D. Assess the radial pulse
C - try using a doppler first
If you cannot assess using a doppler, it is time to call the doc!
After giving birth, a patient with preeclampsia is given IV magnesium. Which finding suggests that a patient has received too much magnesium sulfate?
A. Muscle weakness
B. Tetany
C. Tachycardia
D. Hyperreflexia
A - Muscle weakness
Which nutrient deficiency most impacts wound healing?
Protein
Bonus - which lab can we draw to look at nutritional status?
The nurse is preparing to take a patient’s oral temperature with an electronic thermometer. When asking the patient temperature pre-assessment questions, which answer would allow the nurse to continue with taking the oral temperature?
A. I just smoked a cigarette.
B. I just had a cup of hot coffee.
C. I just had a sip of room-temperature water.
D. Do I need to spit my gum out?
C - room temp water is technically okay. Avoid cold or hot beverages, chewing gum, or smoking right before taking an oral temp.
List the order of abdominal assessment.
Inspect
Auscultate
Percuss
Palpate
A 98-year-old patient is admitted to the hospital from a skilled nursing facility with dehydration related to COVID-19. The patient has been vomiting for 2 days and is unable to keep down food or drink. During the assessment, the nurse notes dry mucous membranes and weakness. Which of the following is another common assessment finding for older adult patients with hypovolemia?
A. Elevated blood pressure
B. Confusion
C. Jugular venous distention
D. Bounding pulses
B - confusion - decreased perfusion to the brain
All other options are indicative of fluid volume overload or excess
A 52-year-old client is admitted with unstable angina. The nurse assigned to the client notes an irregular rhythm when assessing pulse. To further assess the irregular pulse, the nurse knows it is necessary to determine the client’s pulse deficit. Which pulses help identify pulse deficit?
A. Carotid and apical
B. Apical and radial
C. Radial and brachial
D. Carotid and radial
B - apical and radial
A 39-year-old with a history of Graves disease and goiter causing dysphagia has undergone a total thyroidectomy. After surgery, they experience hypotension, irritability, and circumoral paresthesia. Their speech and breathing are unimpaired. Based on the patient’s signs and symptoms, their serum calcium level is likely to be:
A. 11 mg/dl
B. 10 mg/dl
C. 9 mg/dl
D. 8 mg/dl
D - hypocalcemia as a result of thyroidectomy
normal calcium range 9-10.5
A nurse is preparing to take a patient’s blood pressure. Which of the following patient assessments would indicate that the nurse could not use the patient’s arm for a blood pressure measurement? (Select all that apply.)
A.Mastectomy
B.Hemodialysis shunt
C.Peripherally inserted central catheter (PICC)
D.Immunization injection 1 week prior
A, B, C
Capillary refill time is normally:
A. 1 to 3 seconds.
B. 4 to 6 seconds.
C. 7 to 10 seconds.
D. 11 to 15 seconds.
A - 1-3 seconds
Bonus - what does delayed cap refill indicate?
A nurse is inspecting a 10-year-old child’s pupils as part of a routine eye examination. When the nurse shines indirect light into the child’s right eye, the normal response would be:
A. both eyes dilate.
B. both eyes constrict.
C. the right eye constricts, and the left eye dilates.
D. no response.
B - both eyes constrict (reactive to light and acommodating)
A patient receiving total parenteral nutrition (TPN) requires a transfusion of packed red blood cells. Before beginning the transfusion, the nurse should:
A. infuse the blood directly into the TPN line.
B. start a separate IV line for the blood transfusion.
C. stop the TPN, infuse the blood at the TPN site, and then restart the TPN.
D. use a Y connector and infuse the blood simultaneously with the TPN.
B - TPN should only be run by itself and it cannot be suddenly stopped for risk of rebound hypoglycemia. Starting a new line is the best way to proceed with giving blood.