SWIFT RIVER FUNDAMENTALS: EXAM,
2025/2026 WITH CORRECT/ACCURATE
ANSWERS
Linda Pittmon Scenario 1
The patient presents to the unit with c/o numbness in the right
foot and ankle and toes "not looking the right color." All 5 toes on
the right foot are necrotic, absent pedal pulses, skin cold to touch,
appearance dry, cracked, and black up to mid-calf. Foul odor
noted with green drainage coming from toenail beds. The
provider is concerned that the patient may be septic. What can
you anticipate the patient's needs will be?
IV fluid challenge/bolus
Wound Cultures
Blood Cultures
IV Antibiotics
Linda Pittmon Scenario 2
The nurse has started the IV antibiotics (Vancomycin). The patient
is anxious, has developed hives, and has become more
hypotensive. What actions should the nurse take next?
Stop the infusion
Notify the provider after stopping the infusion
Linda Pittmon Scenario 3
The Vancomycin has been discontinued, and Mefoxin has been
started. The patient has become more confused. The patient is
fidgety and is observed picking at her skin and clothes. The
patient states, "I am sick to my stomach and feel like I have bugs
crawling all over me!!!" What should the nurse do?
,Notify the physician that the patient may be suffering from
alcohol withdrawal.
Check her blood glucose
Linda Pittmon Scenario 4
Surgery called to the unit to inform the nurse that Ms. Pittmon has
been scheduled at 1300 for a Below the Knee amputation. The
patient has become confused and combative and has pulled out
her IV. She is a tough IV stick, and it took several attempts
previously.The Preop nurse tells the floor nurse to have the
patient sign the consent, restart the IV, and anesthesia will see
the patient in the preop hold. What actions does the nurse take?
Wait until anesthesia evaluates the patient and have them assist
in restarting the IV.
Notify anesthesia to come to the floor to evaluate the patient.
Have the next of kin sign the operative consent if available.
Linda Pittmon Scenario 5
The day after surgery, Ms. Pittmon is very angry that her leg was
removed without her consent. She is alert and oriented and
recovering well. Her Blood glucose is 100, her white count is
normal. Her BP is 110/60, HR 89, Resp 16, and Temp 98.9. Her
dressing needs to be changed, but she won't let the nurse
perform a dressing change. She tells the nurse that she is going
to sue the hospital. What actions should the nurse take with this
patient.
Tell the patient that dressing must be changed
Use therapeutic communication to convey empathy
Notify HCP and nursing supervisor
Donald Lyles Scenario 4
Mr. Lyles falls while evacuating the room in the hallway
, Obtain vital signs
Notify HCP of fall
Assess for obvious injury
Donald Lyles Scenario 5
You are completing a documentation for Mr. Lyles fall, and
preparing him for an x-ray.
Complete an incident report and submit to risk management
Document in nurses' notes fall event and patient status
Ann Rails Scenario 1
The nurse is performing a Subjective, Objective, Assessment, Plan
(SOAP) note. Ms. Rails has bruises to her right forearm and face.
She complains of back pain 6/10 pain scale. She was medicated
with hydrocodone 5 mg PO two hours ago. Her vital signs are BP:
110/60, P: 74, R: 20, PaO2: 98%, T: 98.6 F, 37 C. Ms. Rails has told
you that she is concerned about returning home and is afraid her
boyfriend will return. She also expressed concern about finding a
new job. Please select subjective information to document.
Patient's concern about going home and finding a job
Pain assessment
Ann Rails Scenario 2
The nurse is performing a Subjective, Objective, Assessment, Plan
(SOAP) note. Ms. Rails has bruises to her right forearm and face.
She complains of back pain 6/10 pain scale. She was medicated
with hydrocodone 5 mg PO two hours ago. Her vital signs are BP:
140/80, P: 74, R: 20, PaO2: 98%, T: 98.6 F, 37 C. She is restless
and her BP and pulse have increased. Ms. Rails has told you that
she is concerned about returning home and is afraid her boyfriend
will return. She also expressed concern about finding a new job.
Please select objective information to document.
Patient's vital sign
Color/size of bruises on the patient's face and right forearm
2025/2026 WITH CORRECT/ACCURATE
ANSWERS
Linda Pittmon Scenario 1
The patient presents to the unit with c/o numbness in the right
foot and ankle and toes "not looking the right color." All 5 toes on
the right foot are necrotic, absent pedal pulses, skin cold to touch,
appearance dry, cracked, and black up to mid-calf. Foul odor
noted with green drainage coming from toenail beds. The
provider is concerned that the patient may be septic. What can
you anticipate the patient's needs will be?
IV fluid challenge/bolus
Wound Cultures
Blood Cultures
IV Antibiotics
Linda Pittmon Scenario 2
The nurse has started the IV antibiotics (Vancomycin). The patient
is anxious, has developed hives, and has become more
hypotensive. What actions should the nurse take next?
Stop the infusion
Notify the provider after stopping the infusion
Linda Pittmon Scenario 3
The Vancomycin has been discontinued, and Mefoxin has been
started. The patient has become more confused. The patient is
fidgety and is observed picking at her skin and clothes. The
patient states, "I am sick to my stomach and feel like I have bugs
crawling all over me!!!" What should the nurse do?
,Notify the physician that the patient may be suffering from
alcohol withdrawal.
Check her blood glucose
Linda Pittmon Scenario 4
Surgery called to the unit to inform the nurse that Ms. Pittmon has
been scheduled at 1300 for a Below the Knee amputation. The
patient has become confused and combative and has pulled out
her IV. She is a tough IV stick, and it took several attempts
previously.The Preop nurse tells the floor nurse to have the
patient sign the consent, restart the IV, and anesthesia will see
the patient in the preop hold. What actions does the nurse take?
Wait until anesthesia evaluates the patient and have them assist
in restarting the IV.
Notify anesthesia to come to the floor to evaluate the patient.
Have the next of kin sign the operative consent if available.
Linda Pittmon Scenario 5
The day after surgery, Ms. Pittmon is very angry that her leg was
removed without her consent. She is alert and oriented and
recovering well. Her Blood glucose is 100, her white count is
normal. Her BP is 110/60, HR 89, Resp 16, and Temp 98.9. Her
dressing needs to be changed, but she won't let the nurse
perform a dressing change. She tells the nurse that she is going
to sue the hospital. What actions should the nurse take with this
patient.
Tell the patient that dressing must be changed
Use therapeutic communication to convey empathy
Notify HCP and nursing supervisor
Donald Lyles Scenario 4
Mr. Lyles falls while evacuating the room in the hallway
, Obtain vital signs
Notify HCP of fall
Assess for obvious injury
Donald Lyles Scenario 5
You are completing a documentation for Mr. Lyles fall, and
preparing him for an x-ray.
Complete an incident report and submit to risk management
Document in nurses' notes fall event and patient status
Ann Rails Scenario 1
The nurse is performing a Subjective, Objective, Assessment, Plan
(SOAP) note. Ms. Rails has bruises to her right forearm and face.
She complains of back pain 6/10 pain scale. She was medicated
with hydrocodone 5 mg PO two hours ago. Her vital signs are BP:
110/60, P: 74, R: 20, PaO2: 98%, T: 98.6 F, 37 C. Ms. Rails has told
you that she is concerned about returning home and is afraid her
boyfriend will return. She also expressed concern about finding a
new job. Please select subjective information to document.
Patient's concern about going home and finding a job
Pain assessment
Ann Rails Scenario 2
The nurse is performing a Subjective, Objective, Assessment, Plan
(SOAP) note. Ms. Rails has bruises to her right forearm and face.
She complains of back pain 6/10 pain scale. She was medicated
with hydrocodone 5 mg PO two hours ago. Her vital signs are BP:
140/80, P: 74, R: 20, PaO2: 98%, T: 98.6 F, 37 C. She is restless
and her BP and pulse have increased. Ms. Rails has told you that
she is concerned about returning home and is afraid her boyfriend
will return. She also expressed concern about finding a new job.
Please select objective information to document.
Patient's vital sign
Color/size of bruises on the patient's face and right forearm
