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Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph
Total Questions : 176
Showing 10 questions, Sign in for more0800: Client brought by ambulance to the ED with shallow breaths, slurred speech, confusion, and pupillary constriction. Minor abrasions noted on upper and lower extremities. Deep tendon reflexes (DTRs) 1 +. Client vomited twice while in the care of emergency medical services. Family member found the client lying on the sidewalk in front of the house. The client had not returned home last night, and the family member was going to see if the client's car was parked in the driveway. Client's family member stated the client has had a change in their mood recently and was fired from their job for lack of attendance. The client came to live with the family member about 3 weeks ago after the clients partner divorced them, and they were without housing. The family member reports the client has been struggling for about a year with their back pain.
0830:
- Temperature 35.1℃ (95.2° F)
- Heart rate 44/min
- Respiratory rate 10/min
- Blood pressure 84/45 mm Hg
- Oxygen Saturation 90% on room air
Client has a previous back injury 3 years ago. One year ago they had a laminectomy. The client was prescribed oxycodone for pain and received several refills. About 3 months after surgery the client continued to report back pain and was not able to return to work. Multiple modalities of pain relief were provided. The client reported that none had worked. Client has a 10-year history of alcohol use disorder, but a family member reports sobriety for the last year.
A nurse is caring for a client in the emergency department (ED).
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing 2 actions the nurse should take to address that condition and 2 parameters the nurse should monitor to assess the client's progress.
Explanation
Potential Condition:
Opioid Intoxication: The client’s respiratory depression, bradycardia, hypotension, and pinpoint pupils align with opioid overdose signs. The history of oxycodone use and mood changes further supports the likelihood of intentional or accidental overdose.
Actions to Take:
Obtain a prescription for naloxone: Naloxone is an opioid antagonist that reverses respiratory and CNS depression caused by opioids. It should be administered immediately to restore adequate breathing.
Prepare to initiate mechanical ventilation: The client’s RR 10/min and O₂ saturation 90% indicate respiratory compromise. The nurse must be prepared to support ventilation until naloxone takes effect.
Parameters to Monitor:
Pupillary reaction: Constricted pupils should dilate as opioid effects reverse. This serves as an indicator of neurologic improvement.
Respiratory rate: The primary determinant of opioid overdose severity. Monitoring ensures early detection of respiratory failure or response to naloxone.
Rationale for Incorrect Options:
Obtain prescription for restraints: Not indicated unless the client becomes violent post-reversal.
Collect a blood sample for ethanol level: Alcohol intoxication can depress CNS function, but pinpoint pupils are not typical.
Anticipate administering clonidine: Used for opioid withdrawal, not intoxication.
Opioid withdrawal: Causes opposite symptoms: dilated pupils, tachycardia, hypertension, hyperreflexia.
Stimulant intoxication: Causes dilated pupils, hyperactivity, hypertension, and tachycardia, not CNS depression.
Alcohol intoxication: Causes slurred speech and poor coordination, but not pinpoint pupils.
Hyperreflexia: Seen in stimulant use or withdrawal, not opioid intoxication.
Cardiac arrhythmias: May occur in stimulant overdose, not the main concern in opioid overdose.
Ethanol level: Not necessary unless co-ingestion of alcohol is suspected.
1 week ago;
Guardians report 2-day history of fever, congestion, and cough. Toddler fussy, moderate amount of dear, thick nasal drainage noted. Frequent loose non-productive cough. Lungs sound clear. Respirations easy and unlabored.
Today:
Guardians report toddler continues with a fever and is now vomiting and difficult to rouse. Guardians report administering aspirin and acetaminophen alternately during the past week. Toddler lethargic and frequently vomiting small amounts of clear fluid, Respirations easy and unlabored, nonproductive cough noted. Mucus membranes slightly dry. Guardians report no void today.
1 week ago
- Heart rate 114/min
- Respiratory rate 30/min
- Temperature 38.8℃ (101.8° F)
Today
- Heart rate 120/min
- Respiratory rate 22/min
- Temperature 39℃ (102.2° F)
1 week ago
Treat with antipyretics. Encourage fluid intake. Return to office if manifestations worsen. Start prescription for oseltamivir for 5 days.
1 week ago
Influenza A positive (negative)
Influenza B negative (negative)
A nurse is caring for a toddler in the outpatient setting.
Complete the following sentence by using the lists of options.
The nurse recognizes the toddler has likely developed
Explanation
Rationale for Correct Answer:
Reye syndrome presents with vomiting, lethargy, confusion, and rapid progression to decreased consciousness or coma, all of which are evident in this toddler. The toddler was recovering from influenza A (a viral illness) and received aspirin alternated with acetaminophen for fever management.
The use of aspirin during a viral infection is the primary risk factor for developing Reye syndrome. The manifestations of vomiting, lethargy, and difficulty to rouse reflect cerebral edema and hepatic dysfunction, hallmark features of Reye syndrome.
Rationale for Incorrect Options:
Bronchitis: Characterized by productive cough, wheezing, or chest congestion, not vomiting or altered consciousness. The lungs are clear and respirations unlabored, ruling this out.
Gastroenteritis: Typically presents with diarrhea and dehydration, not altered level of consciousness or neurologic symptoms.
Oseltamivir administration: This antiviral is used for influenza treatment and is not associated with Reye syndrome.
Acetaminophen administration: Overdose can cause liver toxicity, but not encephalopathy with vomiting and lethargy after viral illness in the absence of overdose symptoms.
Aspirin administration: The correct cause; aspirin triggers mitochondrial dysfunction in the liver and brain following viral infections, leading to Reye syndrome.
4 weeks ago:
21-year-old client reports increased stress and worry for the last 3 months. Client is worried about academic performance due to inability to focus on studies. School performance is suffering. Denies illicit drug use and drinks in moderation socially on the weekends.
Discussed lifestyle modifications to reduce stress. Instructed client to return in 1 month to reevaluate symptoms.
Today:
Client reports a slight improvement in stress but is now having loss of appetite and difficulty sleeping.
Instructed client to begin trazodone per provider's prescription.
4 weeks ago:
Weight 54.4 kg (120 1b)
Height 162.6 cm (64 in)
BMI 20.6
Today:
weight (1141b)
Height 162.6 cm (64 in)
BMI 19.6
A nurse is caring for a client in the outpatient health clinic.
For each potential nursing Intervention. click to specify if the intervention is indicated or not indicated.
Explanation
Indicated:
Encourage high-calorie finger food: The client has experienced weight loss and decreased appetite, which can occur with depression. Offering high-calorie, easy-to-eat foods helps maintain adequate nutrition and prevents further weight loss.
Advise client to rise slowly from a sitting position: Trazodone can cause orthostatic hypotension due to its alpha-adrenergic blocking effects. Advising the client to rise slowly reduces the risk of dizziness or falls when standing.
Advise client to notify the provider if pregnant: Trazodone is contraindicated in pregnancy due to potential risks to the fetus. The client should inform the provider if pregnancy occurs or is suspected.
Encourage a regular sleep-wake schedule
Maintaining a consistent bedtime and wake time improves sleep hygiene, supports trazodone’s effectiveness for insomnia, and helps regulate mood and energy levels.
Not Indicated:
Instruct client to avoid foods that have been fermented or aged: This dietary restriction is necessary for clients taking monoamine oxidase inhibitors (MAOIs), not trazodone. Trazodone does not require tyramine restriction, so this intervention is unnecessary.
Encourage naps during the day when the client is tired: Daytime napping can disrupt nighttime sleep and worsen insomnia. The focus should be on promoting a consistent sleep routine rather than allowing extra daytime sleep.
Encourage client to sleep until later in the morning: Sleeping late can interfere with the circadian rhythm and reduce sleep quality. A consistent wake-up time is more beneficial for improving sleep patterns and mood.
A nurse is caring for a client who is to undergo a bilateral prophylactic mastectomy. The client states that her family opposes her decision. Which of the following responses should the nurse make?
A nurse is caring for a client who has an allergy to penicillin. The health care provider has prescribed amoxicillin. Which of the following actions should the nurse take?
A nurse is teaching participants at a community center about advance directives. Which of the following information should the nurse include in the teaching?
A nurse is caring for a client who has cancer and is being transferred to hospice care. The client's daughter tells the nurse, "I'm not sure what to say to my morn if she asks me about dying," Which of the following responses by the nurse is appropriate? (Select all that apply.)
A nurse is teaching a client who has a newly documented latex allergy. Which of the following statements by the client indicates an understanding of the teaching?
A community health nurse is performing a home visit for a client and is evaluating the home environment for safety. Which of the following findings would indicate to the nurse that the client has a proper understanding of safety in the home?
A nurse in an outpatient clinic is assessing a client who is pregnant for unsafe behaviors during pregnancy. Which of the following findings indicates a need for further evaluation?
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