EXAMS QUESTIONS AND ANSWERS SURE A+
✔✔Glenn Massey - ✔✔Scenario #1
Ensure room was cleaned
Disinfect call light
Clean and obtain IV pole
Obtain burn sheets
Notify infection control nurse
Scenario #2
Obtain VS
Initial assessment
Administer pain meds
Educate pt.
Check pt's chart
Scenario #3
Hand hygiene
Set up supplies
Apply clean gloves
Gently peel off
Clean wound site
Apply new dressing
,Scenario #4
Notify HCP
Inform pt.
Initiate cardiac telemetry
Give 1L NS
Empty foley
Scenario #5
Explore why pt.
Educate pt.
Evaluate pt's understanding
Contact social services
Involve family
✔✔Hannah Knox - ✔✔Educational- increased
Fall Risk - increased
Health Change - increased
Pain - increased
PsychologicL Needs - increased
Neurological - normal
✔✔Hannah Knox - ✔✔Chronic pain
Impaired comfort
Deficient knowledge
Fear of death
Gas exchange, risk for
Infection, fisk for
✔✔Hannah Knox - ✔✔Scenario #1
Full assessment
Contact IV team
Contact HCP
Set up PCA
Contact social services
Scenario #2
Administer ABX & start morphine
Contact hospice/social work
Place pt. on continuous pulse ox
Reassess effectiveness
Document
Scenario #3
Reassess VS & elevate HOB
Continue to provide
,Seek clarification
Call respiratory therapy
Provide emotional support
Scenario #4
Full assessment
Place pt. on 100% non-rebreather
Review PCA pump history
DNR armband
Discuss with HCP
Scenario #5
Contact HCP
Contact chaplain
Take pt's family
Prepare Mrs. Knox's body
Notify social services
✔✔Hildegard Lowe - ✔✔Educational - increased
Fall Risk - increased
Health Change - increased
Pain - normal
Psychological Needs - normal
Neurological - normal
✔✔Hildegard Lowe - ✔✔Impaired mobility, risk for
Deficient knowledge
Impaired gas exchange, risk for
Peripheral neurovascular dysfunction, risk for
Risk for infection
Ineffective breathing pattern
✔✔Hildegard Lowe - ✔✔Scenario #1
Reposition HOB to semi-fowler's
Increase supplemental O2
Orient pt.
Initiate IS treatment
Retake VS
Scenario #2
WBC
Magnesium
RBC
Hemoglobin
BUN
, Scenario #3
Stop infusion
Don gloves
Inspect site
Collect supplies
Remove IV & document
Scenario #4
Have secretary
Review current
Discuss the policy
Ask Hildegard
Document teaching
Talk to daughter
Scenario #5
Don gloves & assist pt.
Assess stool
Assist pt. to bed
Anticipate need
Call the physician
Place pt. on enteric
✔✔Janene Whitmore - ✔✔Educational - increased
Fall Risk - increased
Health Change - increased
Pain - increased
Psychological Needs - increased
Neurological - normal
✔✔Janene Whitmore - ✔✔Acute pain
Bleeding
Impaired comfort
Deficient knowledge
Infection, risk for
✔✔Janene Whitmore - ✔✔Scenario #1
Explain to pt.
Medicate pt.
Initiate IV
Put an arm band
Ask pt.
Scenario #2
Explain to Mrs. Whitmore
Inform pt.