Batch 1 — Cases 1–10 (Safety, Infection
Control & Basic Care)
Case 1 — Post-op PACU: Airway & Pain
Mr. A., a 62-year-old male, is in the PACU after an open
cholecystectomy. He is drowsy but arousable, respirations 8/min,
SpO₂ 88% on room air, O₂ via nasal cannula at 2 L/min ordered,
BP 130/78, HR 92. He received IV morphine 4 mg 30 minutes ago.
He is snoring between breaths.
Question 1
Which action should the nurse perform first?
A. Increase oxygen to 4 L/min.
B. Stimulate the patient and assess respiratory effort.
C. Administer naloxone per protocol.
D. Call the surgeon immediately.
Answer: B
Rationale: Immediate priority is airway/ breathing — stimulate
and assess to determine level of opioid-related respiratory
depression. Interventions (naloxone, escalate O₂) depend on
assessment.
Question 2
After stimulation the patient awakens but remains somnolent with
RR 10 and SpO₂ 94% on 2 L O₂. Which intervention is appropriate
now?
A. Continue monitoring; no further action needed.
B. Administer naloxone immediately.
C. Encourage deep breathing and incentive spirometry when able.
D. Remove the nasal cannula.
Answer: C
Rationale: Patient is improving; encourage pulmonary expansion
,to prevent atelectasis. Naloxone is reserved for significant
respiratory depression or persistent low RR/SpO₂.
Question 3
Which assessment finding would most concern the nurse as an
early sign of opioid toxicity?
A. Pinpoint pupils (miosis)
B. Dry mouth
C. Nausea
D. Pruritus at IV site
Answer: A
Rationale: Miosis plus decreased respiratory rate are classic
early signs of opioid toxicity requiring close monitoring or reversal
if severe.
Case 2 — Elderly Fall Risk
Mrs. B., 82, admitted for UTI and dehydration. History: HTN, mild
dementia. She is ambulatory with a walker but confused at night.
Meds include a thiazide diuretic and low-dose benzodiazepine for
sleep PRN. Nurses report she tried to get out of bed unassisted
twice last night.
Question 1
Which intervention is highest priority to reduce fall risk?
A. Keep side rails up at all times.
B. Place a bed alarm and ensure frequent rounding.
C. Encourage family to sit with patient overnight.
D. Discontinue all medications.
Answer: B
Rationale: Bed alarms + frequent rounding address immediate
safety while preserving patient mobility. Side rails up can increase
fall risk if patient attempts to climb; medication changes should
be evaluated but not immediately discontinued without provider
input.
,Question 2
Which medication-related change should the nurse discuss with
the provider?
A. Continuing thiazide diuretic unchanged.
B. Discontinuing low-dose benzodiazepine for sleep.
C. Adding a laxative.
D. Increasing thiazide dose to manage BP.
Answer: B
Rationale: Benzodiazepines increase sedation and fall risk in
elderly; discuss tapering or alternatives with provider.
Question 3 (S/A)
Select appropriate fall-prevention measures (select all that apply):
A. Keep call light within reach.
B. Keep the bed in lowest position with brakes engaged.
C. Place non-skid footwear on patient.
D. Leave the room dark so patient sleeps.
Answer: A, B, C
Rationale: Call light access, low bed with brakes, and non-skid
footwear reduce falls. Darkness increases fall risk.
Case 3 — Contact Isolation: MRSA Wound
Mr. C., 45, had an infected surgical wound cultured MRSA. He is
on contact precautions. Vital signs stable; wound dressing is
intact but drainage noted on dressing.
Question 1
Which PPE is required before providing wound care?
A. Surgical mask and gloves
B. Gown and gloves
C. N95 respirator only
D. No PPE necessary for intact wound
, Answer: B
Rationale: Contact precautions for MRSA require gown and
gloves to prevent contact transmission.
Question 2
When removing PPE after wound care, what is correct order?
A. Gown → Gloves → Hand hygiene
B. Gloves → Gown → Hand hygiene
C. Gloves → Hand hygiene → Gown
D. Gown and gloves together → Hand hygiene
Answer: B
Rationale: Remove most contaminated items first (gloves), then
gown; perform hand hygiene immediately after doffing.
Question 3
Which statement by the patient indicates understanding of
transmission prevention?
A. “I can use the same dressing supplies if I’m careful.”
B. “I should not share towels or razors with family.”
C. “It’s ok to shower without covering the wound.”
D. “My wound drainage won’t spread to others.”
Answer: B
Rationale: Personal items like towels or razors can transmit
MRSA. Avoid sharing them.
Case 4 — Oxygen Safety at Home
Ms. D., 58, with COPD, is being discharged home on 2 L/min
oxygen via nasal cannula. She smokes occasionally.
Question 1
What is the nurse’s most important discharge teaching?
A. Store oxygen cylinders in an enclosed cabinet.
B. Continue smoking but only outdoors.
Control & Basic Care)
Case 1 — Post-op PACU: Airway & Pain
Mr. A., a 62-year-old male, is in the PACU after an open
cholecystectomy. He is drowsy but arousable, respirations 8/min,
SpO₂ 88% on room air, O₂ via nasal cannula at 2 L/min ordered,
BP 130/78, HR 92. He received IV morphine 4 mg 30 minutes ago.
He is snoring between breaths.
Question 1
Which action should the nurse perform first?
A. Increase oxygen to 4 L/min.
B. Stimulate the patient and assess respiratory effort.
C. Administer naloxone per protocol.
D. Call the surgeon immediately.
Answer: B
Rationale: Immediate priority is airway/ breathing — stimulate
and assess to determine level of opioid-related respiratory
depression. Interventions (naloxone, escalate O₂) depend on
assessment.
Question 2
After stimulation the patient awakens but remains somnolent with
RR 10 and SpO₂ 94% on 2 L O₂. Which intervention is appropriate
now?
A. Continue monitoring; no further action needed.
B. Administer naloxone immediately.
C. Encourage deep breathing and incentive spirometry when able.
D. Remove the nasal cannula.
Answer: C
Rationale: Patient is improving; encourage pulmonary expansion
,to prevent atelectasis. Naloxone is reserved for significant
respiratory depression or persistent low RR/SpO₂.
Question 3
Which assessment finding would most concern the nurse as an
early sign of opioid toxicity?
A. Pinpoint pupils (miosis)
B. Dry mouth
C. Nausea
D. Pruritus at IV site
Answer: A
Rationale: Miosis plus decreased respiratory rate are classic
early signs of opioid toxicity requiring close monitoring or reversal
if severe.
Case 2 — Elderly Fall Risk
Mrs. B., 82, admitted for UTI and dehydration. History: HTN, mild
dementia. She is ambulatory with a walker but confused at night.
Meds include a thiazide diuretic and low-dose benzodiazepine for
sleep PRN. Nurses report she tried to get out of bed unassisted
twice last night.
Question 1
Which intervention is highest priority to reduce fall risk?
A. Keep side rails up at all times.
B. Place a bed alarm and ensure frequent rounding.
C. Encourage family to sit with patient overnight.
D. Discontinue all medications.
Answer: B
Rationale: Bed alarms + frequent rounding address immediate
safety while preserving patient mobility. Side rails up can increase
fall risk if patient attempts to climb; medication changes should
be evaluated but not immediately discontinued without provider
input.
,Question 2
Which medication-related change should the nurse discuss with
the provider?
A. Continuing thiazide diuretic unchanged.
B. Discontinuing low-dose benzodiazepine for sleep.
C. Adding a laxative.
D. Increasing thiazide dose to manage BP.
Answer: B
Rationale: Benzodiazepines increase sedation and fall risk in
elderly; discuss tapering or alternatives with provider.
Question 3 (S/A)
Select appropriate fall-prevention measures (select all that apply):
A. Keep call light within reach.
B. Keep the bed in lowest position with brakes engaged.
C. Place non-skid footwear on patient.
D. Leave the room dark so patient sleeps.
Answer: A, B, C
Rationale: Call light access, low bed with brakes, and non-skid
footwear reduce falls. Darkness increases fall risk.
Case 3 — Contact Isolation: MRSA Wound
Mr. C., 45, had an infected surgical wound cultured MRSA. He is
on contact precautions. Vital signs stable; wound dressing is
intact but drainage noted on dressing.
Question 1
Which PPE is required before providing wound care?
A. Surgical mask and gloves
B. Gown and gloves
C. N95 respirator only
D. No PPE necessary for intact wound
, Answer: B
Rationale: Contact precautions for MRSA require gown and
gloves to prevent contact transmission.
Question 2
When removing PPE after wound care, what is correct order?
A. Gown → Gloves → Hand hygiene
B. Gloves → Gown → Hand hygiene
C. Gloves → Hand hygiene → Gown
D. Gown and gloves together → Hand hygiene
Answer: B
Rationale: Remove most contaminated items first (gloves), then
gown; perform hand hygiene immediately after doffing.
Question 3
Which statement by the patient indicates understanding of
transmission prevention?
A. “I can use the same dressing supplies if I’m careful.”
B. “I should not share towels or razors with family.”
C. “It’s ok to shower without covering the wound.”
D. “My wound drainage won’t spread to others.”
Answer: B
Rationale: Personal items like towels or razors can transmit
MRSA. Avoid sharing them.
Case 4 — Oxygen Safety at Home
Ms. D., 58, with COPD, is being discharged home on 2 L/min
oxygen via nasal cannula. She smokes occasionally.
Question 1
What is the nurse’s most important discharge teaching?
A. Store oxygen cylinders in an enclosed cabinet.
B. Continue smoking but only outdoors.
