Recalls 4 NP3

A. Prepare and administer intravenous Dantrolene Sodium immediately.

Thirty minutes into a surgical procedure utilizing inhaled Isoflurane and intravenous Succinylcholine, the patient's end-tidal carbon dioxide (EtCO2) suddenly spikes, the heart rate jumps to 150 bpm, and the jaw muscles become rigidly clamped. The anesthesiologist declares a Malignant Hyperthermia crisis. Aside from immediately stopping the triggering agents and hyperventilating with 100% oxygen, what is the absolute priority pharmacological intervention?*

0/1

A. Prepare and administer intravenous Dantrolene Sodium immediately.

B. Administer an intravenous bolus of Atropine Sulfate to stabilize the heart rate.

 C. Rapidly infuse iced intravenous 0.9% Sodium Chloride to lower the core temperature.

D. Administer intravenous Calcium Gluconate to reverse the severe muscle tetany.

C. The Peroneal Nerve

A patient is positioned in the extreme lithotomy position for a prolonged vaginal hysterectomy. Nurse Adrian ensures the patient's legs are padded and placed into the stirrups simultaneously. He knows that improper positioning and prolonged pressure in this specific stance place the patient at highest risk for permanent damage to which specific nerve?

A. The Sciatic Nerve

B. The Femoral Nerve

C. The Peroneal Nerve

D. The Pudendal Nerve

C. Administering a prescribed oral bisacodyl (Dulcolax) stimulant laxative to force a bowel movement.

A patient is on postoperative day 3 following a sigmoid colectomy. The patient complains of severe, constant abdominal bloating, nausea, and has not passed flatus. Nurse Bianca assesses the abdomen and finds it tightly distended and completely silent upon auscultation for 5 full minutes in all four quadrants. Based on the suspicion of a Paralytic Ileus, which intervention must the nurse strictly avoid?

A. Initiating strict Nothing by Mouth (NPO) status immediately.

B. Preparing for the insertion of a Nasogastric (NG) tube attached to low intermittent wall suction.

C. Administering a prescribed oral bisacodyl (Dulcolax) stimulant laxative to force a bowel movement.

D. Encouraging the patient to ambulate frequently in the hospital hallway.

C. Quickly grasp the retention sutures to pull the stoma open, and attempt to reinsert the sterile obturator and replacement tube kept at the bedside.

A patient with a newly formed, two-day-old tracheostomy is coughing violently. Nurse Cedric hears a sudden rushing sound of air, enters the room, and sees that the entire tracheostomy tube has been completely dislodged and is lying on the patient's chest. The patient is gasping and turning cyanotic. What is the nurse's most appropriate, immediate life-saving action?

A. Wait for the respiratory therapist to arrive with a new tracheostomy tube to ensure a sterile reinsertion.

B. Blindly insert a standard oral endotracheal tube into the stoma to secure the airway.

C. Quickly grasp the retention sutures to pull the stoma open, and attempt to reinsert the sterile obturator and replacement tube kept at the bedside.

D. Cover the stoma tightly with an occlusive dressing and begin strictly ventilating the patient through the mouth and nose with a bag-valve mask.

A. The high PEEP drastically increases intrathoracic pressure, which physically compresses the vena cava, severely decreasing venous blood return to the heart.

A patient with severe Acute Respiratory Distress Syndrome (ARDS) is placed on mechanical ventilation with Positive End-Expiratory Pressure (PEEP) set at 15 cm H2O. One hour later, Nurse Cedric notes the patient's blood pressure has plummeted from 110/70 to 75/40 mmHg, and urine output has dropped to 10 mL/hr. What is the exact pathophysiological mechanism causing this severe complication?*

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A. The high PEEP drastically increases intrathoracic pressure, which physically compresses the vena cava, severely decreasing venous blood return to the heart.

B. The high PEEP causes massive systemic vasodilation, leading to profound distributive shock and hypotension.

C. The high PEEP forces fluid out of the alveoli and into the systemic circulation, causing immediate volume overload and heart failure.

D. The high PEEP damages the alveolar-capillary membrane, triggering massive pulmonary hemorrhage and hypovolemia.

C. "You are considered non-contagious only after you submit three consecutive morning sputum samples that test negative for the bacteria."

Nurse Diana is providing discharge education to a patient newly diagnosed with active, highly contagious pulmonary Tuberculosis (TB). The patient is started on the standard RIPE (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) regimen. The patient asks, "Exactly when will I no longer be contagious so I can safely return to work and hug my grandchildren?" What is Nurse Diana's most scientifically accurate response?*

A. "You will be safe to return to work exactly two weeks after starting the medication, regardless of symptoms."

B. "You are no longer contagious as soon as your chest x-ray comes back completely clear of any cavities."

C. "You are considered non-contagious only after you submit three consecutive morning sputum samples that test negative for the bacteria."

D. "You will be contagious until your Tuberculin Skin Test (PPD) shows a negative reaction."

C. Fat Embolism Syndrome (FES) caused by fat droplets released from the broken bone marrow into the bloodstream.

A 28-year-old male is recovering at home after an open reduction and internal fixation of a severe femur fracture. He suddenly calls Nurse Diana reporting acute, severe shortness of breath, a feeling of impending doom, and sharp chest pain. When Nurse Diana arrives, she assesses him and notices a distinctive rash of small, red, non-blanching pinpoint dots (petechiae) localized precisely over his upper chest and neck. Based on the history and exact presentation, what physiological crisis is occurring?

A. A massive anaphylactic reaction to the oral antibiotics prescribed for the fracture.

B. A deep vein thrombosis (DVT) that has traveled and completely blocked the main pulmonary artery.

C. Fat Embolism Syndrome (FES) caused by fat droplets released from the broken bone marrow into the bloodstream.

D. Acute respiratory failure secondary to opiate overdose from his pain management regimen.

B. 0.9% NaCl at 125 mL/hr

Which intravenous fluid should the nurse anticipate administering first to correct the client’s primary fluid and electrolyte disturbance?  

A. 0.45% NaCl with 20 mEq KCl 

B. 0.9% NaCl at 125 mL/hr

C. 5% in water

D. Lactated Ringer’s solution

A. Urine output 45 mL/hr with specific gravity 1.015

Which assessment finding would indicate the client’s fluid volume deficit is improving?  

A. Urine output 45 mL/hr with specific gravity 1.015

B. Urine output 20 mL/hr with specific gravity 1.035

C. Bounding pulses and moist crackles in lung bases

D. Serum sodium rising to 155 mEq/L

B. Rapid free-water replacement can cause cerebral edema in hypernatremia

The client’s wife asks why the nurse is restricting free water intake initially. The nurse’s best response is based on the understanding that:  

A. Free water will correct the sodium level faster

B. Rapid free-water replacement can cause cerebral edema in hypernatremia

C. The client prefers flavored oral rehydration solutions

D. Free water is contraindicated in all dehydration states

D. “I will report any increase in shortness of breath immediately so my CO2 does not build up.”

Which statement by the client indicates understanding of discharge teaching to prevent future acid-base imbalance?  

look at the situation

A. “I will increase my sodium intake to prevent low sodium.” 

B. “Diarrhea is harmless and will correct itself.”

C. “I can stop my breathing treatments when I feel better.”

D. “I will report any increase in shortness of breath immediately so my CO2 does not build up.”

B. Pneumocystis jirovecii

Based on the client’s severe immunosuppression and distinct radiological and clinical manifestations, the nurse anticipates that pharmacological therapy is primarily targeting which opportunistic pathogen?*

A. Cytomegalovirus (CMV)

B. Pneumocystis jirovecii

C. Toxoplasma gondii

D. Mycobacterium avium complex (MAC)

A. Airborne precautions

While awaiting definitive sputum culture results, the infection control nurse mandates which specific isolation protocol, considering the client's undiagnosed pulmonary infiltrates and profound immunosuppression?

A. Airborne precautions

B. Standard precautions with an N95 respirator during aerosol-generating procedures

C. Contact precautions in a positive-pressure room

D. Droplet precautions utilizing a surgical mask within 3 feet

 B. Stop the drug and notify the provider immediately

Forty-eight hours after initiating trimethoprim-sulfamethoxazole (TMP-SMX), the client exhibits a rapidly spreading erythematous macular rash involving the oral mucosa. What is the nurse's priority intervention?

A. Administer prescribed PRN intravenous diphenhydramine and monitor airway

 B. Stop the drug and notify the provider immediately

C. Document the expected hypersensitivity reaction and apply a topical corticosteroid

D. Switch to oral dapsone without orders

B. Blood glucose

The client is concurrently receiving adjunctive high-dose intravenous corticosteroids to mitigate pulmonary inflammation. The nurse should meticulously monitor which laboratory parameter to prevent a compounded metabolic complication?*

A. Serum sodium

B. Blood glucose

C. Absolute neutrophil count (ANC) - since the patient already has an infection, it is normal that this is found at below normal levels

D. Serum creatinine

B. Monitor for signs of renal involvement

Given the client's current laboratory profile, including a serum creatinine of 1.8 mg/dL, the nurse should prioritize which assessment to identify the most critical and life-threatening SLE complication?*

A. Auscultation of a pericardial friction rub indicative of serositis

B. Monitor for signs of renal involvement

C. Assessment of cognitive changes signaling neuropsychiatric lupus

D. Inspection of the integument for progressing discoid lesions

B. Obtain blood and urine cultures before any antipyretic

On hospital day 2, the client spikes a core temperature of 38.9°C (102°F). Recognizing the client's immunosuppressive pharmacological regimen and underlying pathology, what is the nurse's imperative first action?

A. Administer prescribed antipyretics to prevent seizure activity

B. Obtain blood and urine cultures before any antipyretic

C. Anticipate an immediate increase in the systemic corticosteroid dose

D. Apply cooling blankets and minimize ambient light exposure

B. Sudden cessation may cause adrenal crisis

When preparing discharge teaching regarding the client's maintenance dose of oral prednisone, the nurse emphasizes the profound danger of abrupt cessation. This instruction is primarily intended to avert which catastrophic event?

A. A rebound systemic inflammatory response syndrome (SIRS)

B. Sudden cessation may cause adrenal crisis

C. Sudden onset of severe, irreversible steroid-induced myopathy

D. Uncontrolled hypertensive crisis from fluid shifts

D. Red

Following the administration of an aerosolized salbutamol treatment via a metered-dose inhaler and spacer, the nurse must dispose of the empty pressurized aluminum canister. According to standard health care waste management guidelines, into which color of receptacle must this be discarded?

A. Yellow

B. Black

C. Green

D. Red

C. It can worsen renal function in CKD

Despite its cardioprotective properties, the nurse identifies that lisinopril requires vigilant monitoring or potential discontinuation in this specific client primarily because:

A. It synergistically exacerbates metformin-induced lactic acidosis 

B. It antagonizes the loop diuretic efficacy of intravenous furosemide

C. It can worsen renal function in CKD

D. It induces severe hypokalemia when combined with furosemide

A. Virginia Henderson

A rehabilitation nurse creates a comprehensive care plan for a client with hemiplegia, specifically targeting interventions that temporarily substitute for the client's deficits in 14 fundamental human needs, with the ultimate goal of restoring the client's independence. This illustrates the application of the model developed by:*

A. Virginia Henderson

B. Faye Abdellah

 C. Dorothy Johnson

D. Ida Jean Orlando

C. Jean Watson

While providing palliative care to a terminally ill client, a hospice nurse prioritizes establishing a deeply transpersonal caring relationship, utilizing authentic presence, compassion, and spiritual integration to promote inner harmony despite the client's physical decline. This holistic approach aligns seamlessly with the theoretical tenets of:*

A. Madeleine Leininger

 B. Rosemarie Parse

C. Jean Watson

D. Nola Pender

C. Keep the patient flat in bed with the head of the bed at 0 degrees and allow small, gentle movements of the extremities

Situation: Nurse Eli is assigned to care for Mrs. Santos, a 30-year-old patient who just returned to the post-anesthesia care unit (PACU) after a cesarean section.

On arrival:

●     Patient is drowsy but arousable

●     Airway is patent; breathing is shallow

●     Vital signs: BP 95/60 mmHg, HR 118 bpm, RR 24 breaths/min, SpO₂ 89% on 3 L O₂ via nasal cannula

●     Surgical dressing shows slight oozing

●     Patient complains of thirst and mild abdominal discomfort

What is the appropriate postoperative positioning for this patient?

A. Assist the patient to a semi-Fowler’s position immediately to facilitate breathing

B. Allow the patient to sit up as soon as she feels comfortable to prevent hypotension

C. Keep the patient flat in bed with the head of the bed at 0 degrees and allow small, gentle movements of the extremities

D. Elevate the head of the bed to 30 degrees and place a pillow under the knees

A. Provide supplemental oxygen via nasal cannula at 2–3 L/min and monitor saturation

Ms. Reyes continues to have SpO₂ of 88% on room air after initial SABA therapy. Which action is most appropriate?

A. Provide supplemental oxygen via nasal cannula at 2–3 L/min and monitor saturation

B. Wait and recheck SpO₂ in 30 minutes

C. Encourage the patient to take deep breaths without oxygen 

D. Apply a non-rebreather mask at 15 L/min immediately

 C. Left lateral Trendelenburg position

The patient suddenly develops shortness of breath, chest pain, and hypotension, and an air embolism is suspected. Which patient position should the nurse immediately place the patient? 

A. Supine position

B. High Fowler’s position

 C. Left lateral Trendelenburg position

D. Prone position

Durant’s Maneuver - allows the air to move toward the right atrium and trap it there + o2 infusion to slowly dissolve the air. This maneuver allows the prevention of pulmonary embolism, which is more fatal.

B. Asking a nutritionist to visit the client to present information and handouts about the diabetic diet

Which of the following is the most optimal way to help a client newly diagnosed with diabetes to learn the dietary requirements associated with the disease?

A. Providing a videotape that addresses the dietary requirements associated with the disease 

B. Asking a nutritionist to visit the client to present information and handouts about the diabetic diet

C. Assisting the client to determine how to work favourite foods into the diabetic diet

D. Having the client attend a group meeting for diabetic clients to discuss adapting to this chronic health condition

B. A 3-year-old child whose parents have read her a storybook about going to the hospital

Nurse Jacob is scheduling a teaching session. Which of the following clients is most likely ready to learn?

A. A 45-year-old man whose doctor just informed him that he has cancer

B. A 3-year-old child whose parents have read her a storybook about going to the hospital

C. A 60-year-old woman who received medication 5 minutes ago for relief of abdominal pain

D. A 70-year-old man who is recovering from a stroke and has returned from physical therapy

A. Chocolate pudding, tomato juice, hard candy, cream of wheat cereal, and fruit smoothies

Nurse Jam is caring for a client who is on a full liquid diet. Which of the following selections would be appropriate for the client?

A. Chocolate pudding, tomato juice, hard candy, cream of wheat cereal, and fruit smoothies

B. Scrambled eggs, tomato juice, mashed potatoes, and fruit smoothies

C. Scrambled eggs, tomato juice, mashed potatoes, cream of wheat cereal, and oatmeal cereal

D. Tomato juice, cream of wheat cereal, oatmeal cereal, and fruit smoothies

C. 225 mg

Nurse Shaun is caring for Hei who is 4 years old and weighs 15 kg, and has been admitted for bacterial respiratory infection. The health care provider orders IV cefotaxime sodium 60 mg/kg/day. What amount of medication should the nurse administer every 6 hours?

*

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A. 175 mg

B. 200 mg

C. 225 mg

D. 250 mg

A. “I need to make sure that I get my flu shot at least every 2 years.”

Nurse Oyi has been reviewing the vaccination status of a geriatric client in a community clinic. Which of the following statements by a 73-year-old client with no major health problems requires further teaching?

A. “I need to make sure that I get my flu shot at least every 2 years.”

B. “I don’t think I need to get vaccinated against hepatitis A unless I plan on travelling to risky areas.”

C. “I had one dose of a vaccine against pneumonia when I turned 65, so I think I am fine with that.” 

D. “I need to get a tetanus booster every 10 years.”