Mixed Deck — All RN Topics Flashcards
100 cards from real RN practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 20 Mixed Deck — All RN Topics flashcards as text
A nurse is using the SBAR communication tool to hand off a patient to the oncoming nurse. Which component of SBAR describes the patient's current vital signs and assessment data?
Answer: Assessment
The Assessment component of SBAR includes the nurse's clinical interpretation of the patient's condition, including current vital signs, lab values, and relevant findings.
A non-immune nurse must care for a patient with active varicella (chickenpox). Which combination of PPE is required?
Answer: N95 respirator, gown, and gloves
Varicella requires both airborne precautions (N95 respirator) and contact precautions (gown and gloves) because it spreads via airborne droplet nuclei and direct contact with lesions.
A patient's healthcare professional issues a Do-Not-Resuscitate (DNR) order following a discussion with the patient's family. When preparing treatment for this patient, what does the nurse comprehend?
Answer: Nursing care will continue with the treatment orders in place.
A Do-Not-Resuscitate (DNR) order means that in the event of cardiac or respiratory arrest, no resuscitative measures will be initiated. However, it does not mean that all medical care ceases. The nurse will continue to provide comfort care, manage symptoms, administer medications, and offer all other treatments aimed at improving the patient's quality of life, consistent with the patient's wishes and the established plan of care.
A nurse is caring for a client with a chest tube following a pneumothorax. The water-seal chamber shows continuous bubbling. What does this finding indicate?
Answer: A persistent air leak from the lung or system
Continuous bubbling in the water-seal chamber indicates an ongoing air leak, either from the lung itself or from a break in the closed drainage system.
A nurse is teaching a client newly prescribed warfarin (Coumadin). Which statement by the client indicates a need for further teaching?
Answer: I can take ibuprofen for my arthritis pain.
NSAIDs like ibuprofen increase bleeding risk when combined with warfarin and should be avoided; acetaminophen is the safer analgesic choice.
A nurse is performing a neurological assessment on a patient with a head injury. Which finding indicates a deteriorating neurological status?
Answer: GCS score decreasing from 14 to 11 over 2 hours
A declining GCS score indicates worsening neurological function and requires immediate provider notification.
A nurse observes that a client's surgical wound dressing is saturated with bright red blood 1 hour postoperatively. What is the priority action?
Answer: Apply direct pressure and notify the surgeon immediately
Bright red saturation 1 hour post-op indicates active arterial bleeding; applying pressure and alerting the surgeon addresses the life-threatening emergency.
A nurse is helping a client with chronic obstructive pulmonary disease (COPD) choose foods from the menu. Which option best reduces the work of breathing during meals?
Answer: Five to six small, low-carbohydrate meals
Small frequent meals reduce diaphragm elevation from a full stomach, and low-carbohydrate foods produce less CO₂ during metabolism, reducing respiratory demand in COPD.
A patient is admitted to the ICU after falling from a ladder and being diagnosed with traumatic brain damage (TBI). He is becoming more restless, the nurse notices, and his right arm is becoming weaker. He also reports feeling sick. What is the BEST thing the nurse can do right away?
Answer: Elevate the head of the bed to 30 degrees.
The patient's increasing restlessness, arm weakness, and nausea following a traumatic brain injury are concerning signs that suggest a potential increase in intracranial pressure (ICP). Elevating the head of the bed to 30 degrees promotes venous drainage from the brain, which can help to reduce ICP and is a crucial immediate nursing intervention to prevent further neurological damage.
A patient is prescribed phenytoin (Dilantin) for seizure control. Which finding requires immediate intervention?
Answer: Nystagmus, ataxia, and confusion
Nystagmus, ataxia, and confusion indicate phenytoin toxicity and require immediate provider notification.
A patient's serum sodium level is 122 mEq/L. Which clinical finding does the nurse anticipate?
Answer: Seizures and altered mental status
Severe hyponatremia causes cerebral edema, manifesting as neurological symptoms including confusion, seizures, and decreased level of consciousness.
Diabetes-afflicted pregnant women frequently experience issues with insulin's capacity to regulate their blood sugar levels throughout the second part of pregnancy. The nurse explains to the customer why this is so:
Answer: Increased human placental lactogen levels
During the second half of pregnancy, the placenta produces human placental lactogen (hPL), which acts as an insulin antagonist. This hormone increases maternal insulin resistance, ensuring a continuous supply of glucose to the fetus. This physiological change explains why pregnant women, especially those with diabetes, often experience issues with insulin's effectiveness and may require increased insulin dosages to maintain blood sugar control.
A nurse is caring for a patient receiving a blood transfusion who develops chills, flank pain, and dark-colored urine 30 minutes into the infusion. What is the priority action?
Answer: Stop the transfusion and infuse normal saline
These symptoms indicate an acute hemolytic transfusion reaction; the transfusion must be stopped immediately and NS infused to maintain kidney perfusion.
The nurse is caring for a patient with a serum sodium of 118 mEq/L receiving a hypertonic saline infusion. The nurse should monitor the patient most carefully for which complication?
Answer: Osmotic demyelination syndrome
Correcting hyponatremia too rapidly with hypertonic saline can cause osmotic demyelination syndrome, leading to permanent neurological damage.
A postoperative client refuses to use the incentive spirometer. Which response by the nurse is most therapeutic?
Answer: Explain that using it prevents serious lung complications such as pneumonia
Educating the client about the rationale (preventing atelectasis and pneumonia) supports informed decision-making and may improve adherence.
A patient is admitted with a Clostridium difficile (C. diff) infection. Which precautions should be initiated in addition to standard precautions?
Answer: Contact precautions
C. difficile spreads via the fecal-oral route through contact with spore-contaminated surfaces or hands, requiring contact precautions.
A nurse is caring for a patient receiving IV aminophylline. Which finding indicates toxicity?
Answer: Tachycardia, tremors, and seizures
Aminophylline (theophylline) toxicity manifests as tachycardia, tremors, seizures, and arrhythmias.
A nurse is caring for a postoperative patient and notes the Jackson-Pratt drain output has suddenly decreased and the site is swelling. What should the nurse do first?
Answer: Check that the drain bulb is compressed correctly
A sudden decrease in drain output with site swelling often indicates the bulb is not properly compressed, preventing suction; re-establishing suction resolves the issue.
A nurse is assessing a patient who has been receiving total parenteral nutrition (TPN) for 5 days. Which laboratory finding indicates the highest risk complication?
Answer: Phosphorus of 1.2 mg/dL
Severe hypophosphatemia in a patient receiving TPN suggests refeeding syndrome, a potentially fatal metabolic complication.
A nurse is caring for a patient with a chest tube. Which finding requires the most immediate intervention?
Answer: Continuous bubbling in the water-seal chamber
Continuous bubbling in the water-seal chamber indicates an air leak in the system that must be identified and corrected immediately.