RN Comprehensive Online Practice 2024
g g g g
B
g
Agnursegisgworryinggforgagfive-12gmonths-
antiquegtoddlergPhysicalgExamination:
1510:
Upongvisualginspection,gthroatgisginfected,gtonsilsgappeargpurple,greddenedgandgepiglottisgisg
edematousgandgcherrygpinkgingappearance.gSkingseemsglight.gStridorgreferredgtogupongnotio
ngwithgfadedgbilateralglunggsounds.
Nurse'sgNotes:
1500
Childgobservedgtogemergencygdepartmentgwithgthegaidgofgcaregiver.gCaregivergstatesgtoddle
rghasgagsoregthroatgandgreportsgthegkidghasg"achegongswallowing"gandgdeniesgcough.gChildg
isgagitatedgandgleang-gANSCondition:gEpiglottis
Actions:gInitiategdropletgprecautionsgandgrequestgagprescriptiongforgIVgantibioticsgMonit
ors:gBreathgsoundsgandgtemperature
Thegnurseghavegtoganticipategstartinggupgdropletgprecautionsgandgsolicitinggforgagprescriptio
ngforgIVgantibiotics.gTheginfantgisgmaximumgprobablygexperiencinggepiglottisgbecausegofgthe
gscientificgmanifestationsgofgagexcessivegfever,ginflammationgandgrednessgofgthegthroat,gpal
egskin,gstridorgwithgidea,gpainfulgswallowing,gnogcough,gisgsittinggingtripodgrole,gandgdrooling.
gThegnursegoughtgtogmonitorgthegkid'sgtemperaturegandgbreathgsounds.
Agnursegisgbeinggconcernedgforgagconsumergwhogisgongthegspinalgwiregdamageg(SCI)gunitgN
urses'gNotes
Daygthree,g1700
ClientgadmittedgtogSCIgunitgthreegdaysgingthegpastgfollowinggC7gharm.gSkingisgcool,gfaded,ga
ndgdrygtogthegtouch.gRespirationsgsmoothgandgunlabored.gLunggsoundsgdiminishedginglower
globes.gAbdomengsoftgandgnondistendedgwithglivelygbowelgsounds.gClientgsurpassedgagsmal
lgamountgofghardgshapedgstoolgthisgAM.gIndwellinggurinarygcathetergdraininggcleargyellowguri
ne.gDeepgtendongreflexesg(DTR)garegbicepsg1+,gtricepsg1+,gpag-
gANSThegcustomergisgmostgpossiblygexperiencinggmanifestationsgofgpneumoniagandgauton
omicgdysreflexia.
Thegnursegshouldgexaminegcuesgfromgthegpatron'sgmanifestationsgandgdecidegthatgthegcons
umergisgmaximumglikelygexperiencinggmanifestationsgofgpneumoniagandgautonomicgdysrefle
xia.gAgconsumergwhoghasgagcervicalgSCIgisgatgriskgforgrespiratorygheadachesgbecausegspina
lginnervationgtogthegbreathinggmusclegtissuesgisgdisrupted.gAdventitiousgbreathgsoundsgingthe
gdecreaseglobesgbilaterallygandgagdecreasegingoxygengsaturationgtoglessgthangninetygtwo%gc
angindicategpneumonia.gThegpatron'sgsuddengboomgingbloodgstress,gbradycardia,gflushinggo
fgthegskingabovegthegvicinitygofgtheginjury,gheadache,gandgblurredgvisiongaregmanifestationsg
ofgautonomicgdysreflexia,gwhichgmaygbegaglife-threateninggsituation.
,Agnursegisgbeinggconcernedgforgagcustomergwhoghasgstomachgpain
Nurses'gNotes
g0900
Clientgreportsglackgofgappetite,gweightgreduction,gandgfatiguegforg1gweek.gReportsgbellygach
e,g6gongagscalegfromgzerogtog10,gforg2gdays.gClientgisgagperioperativegnurse,glowergbackg1g
weekgagogfromgag2-weekgassignmentgtripgtogangunderdevelopedgug.gSg.
1200
Resultsgofgantibodygresearchgacquired.gProvidergprescriptiongforgantiviralgmedicinegpending.
PhysicalgExamination
g0930
Lunggsoundsgcleangbilaterally.gSkingwarmgtogthegtouchgandgjaug-
gANSHepatitisgA:gClient'sgchancegfromgfecal-
oralgtransmission,glaboratorygresults,gandgbodilygexaminationgfindings
HepatitisgB:gAntiviralgremedy,glaboratorygresults,gpurchaser'sgriskgfromgbloodbornegtransmissi
on,gphysicalgexaminationgfindings
HepatitisgC:gAntiviralgtreatment,glaboratorygconsequences,gcustomer'sghazardgfromgblo
odbornegtransmission,gandgbodilygexamgfindings
Whenganalyzinggcues,gthegnursegoughtgtogapprehendgthatgmanifestationsgofghepatitisgA,ghe
patitisgB,gandghepatitisgCgconsistgofgjaundice,gyellowgsclerae,gpropergtopgquandrantgachegu
pongpalpation,gdarkishgyellowgurine,gandgmultipliedgASTgandgALTgstages.gWhenganalyzingg
cues,gthegnurseghavegtogadditionallygrecognizegthegpurchaser'sgchancegforgcontractingghep
atitisgAgviagthegfecal-
oralgdirectiongthroughoutglatestgjourneygtogangunderdevelopedgusgofgagandgthegclient'sgoccu
pationalgthreatgasgagperioperativegnursegforgcontractingghepatitisgBgandghepatitisgCgviagbloo
dbornegtransmission.gThegnursegneedgtogapprehendgthatgthegpresentgdaygwellknowngofgexe
rcisegfor
Agnursegisgbeinggconcernedgforgagpatrongongagclinical-
surgicalgunitgVitalgSigns
0700
Temperatureg37.6gCg(ninetygnine.7gF)g
Heartgrategoneghundred/mingRespirato
rygchargeg22/min
Bloodgstraingaghundredgandgfifteen/70gmmHggOxyg
engsaturationg98%gongroomgair
Nurses'gNotes
g1100
Clientgalertgandgorientatedgtogcharacter,gregion,gandgtime.gClientghadgepisodegofgdiarrhea,gpr
ovidedgperinealgcare.gNotedg2gcmgxg2gcmg(zero.Eightgingxgzero.Eightgin)gpainfulgedematousgl
ocationgongsacrum.gClientgrepositionedgeveryg4ghr.g-
gANSClickgtogspotlightgthegfindingsgthatgrequiregobservegup.gTogdeselectgaglocating,gclickgon
gongthegfindinggoncegmore.
,- Notedg2gcmgxg2gcmg(zero.Eightgingxgzero.Eightgin)gpainfulgedematousgplacegongsacrum
- Clientgrepositionedgeachg4ghr
Whengrecognizinggcues,gthegnursegmustgdeterminegthatgthegconsumer'sgpainfulgedematous
gregiongongtheirgsacrumgandgthatgthegconsumerghasgmostgeffectivegbeengrepositionedgevery
g4ghrgrequiresgfollowgup.gThegconsumerghasgmanifestationsgofgagstressgharmgthatgneedgtogb
egaddressed.gThegconsumergneedgtogbegrepositionedgatgleastgeveryg2ghrgtogsavegyougworse
ninggofgthegstressginjurygandgtogalleviategstressgfromgthegsacralgarea.
Agnursegingangoutpatientgintellectualgfitnessgclinicgisgcaringgforgagclie
ntgVitalgSigns
threegmonthsgingthegpast
Bloodgstraing116/sixtygeightgmmHggHe
artgfeeg82/min
Respiratorygchargegsixteen/mingT
emperatureg36.7gCg(98.1gF)gSaO
2gninetygseven%gongroomgair
Today:
Bloodgpressureg128/seventygsixgmmHg
gHeartgfeeg104/min
Respiratorygpriceg22/min
Temperatureg37.4g(ninetygnine.FourgF)
gSaO2gninetygseven%gongroomgair
Nurses'gNotesgthre
egmonthsgago
Clientgrecentlygadmittedgwithgnewganalysisgofgschizophrenia.gReceivedginpatientgtreatmentgf
org10gdaysgandgbecamegdischargedg1gweekgingthegpast.g-
gANSSelectgthegthreegfindingsgthatgrequiregongthegspotgfollowgup:
- Auditoryghallucinations
- Speech
- Restlessness
Whengspottinggcues,gthegnursegneedgtogperceivegthatgthegfindingsgofgrestlessness,gauditoryg
hallucinations,gandgcompelledgspeechgrequiregimmediategcomplygwithgup.gThesegfindingsgare
gindicatorsgofgpsychosis.gThegnursegneedgtognotifygthegcompanygforgadditionalgevaluationgan
dgremedy.
Agnursegisgworryinggforgagcustomergwhogisgpostoperativegfollowinggcoronarygarterygski
pgsurgeryg(CABG)
LaboratorygResults
g0630
SodiumgoneghundredgfortygfivegmEq/Lg(136gtogoneghundredgfortygfivegmEq/
L)gPotassiumg3.2gmEq/Lg(three.5gtog5gmEq/L)
Chlorideg116gmEq/Lg(ninetygeightgtog106gmEq/L)
, BUNg24gmg/dLg(10gtog20gmg/dL)
Magnesiumg1.FivegmEq/Lg(1.Threegtogtwo.1gmEq/L)gTo
talgcalciumg9gmg/dLg(9gtog10.5gmg/dL)
Phosphategfour.6gmg/dLg(3gtog4.Fivegmg/dL)
Glucosegninetygfivegmg/dLg(seventygfourgtog106gmg/dL)
gWBCgcountgnine,500/mm3g(five,000gtogten,000/mm3)
Ig&gOg0
700
fourghrginputgfourghundredgmL
fourghrgoutputg-
gANSThegpurchasergisgatgfinestghazardgforgdevelopinggdysrhythmias,gasgevidencedgbygusing
gelectrolytegimbalance.
Thegnursegoughtgtogexaminegcuesgtogdecidegthegclientgisgatggreatestgriskgforggrowinggdysrhy
thmiasgassociatedgwithghypokalemia,gasgevidencedgwithgthegaidgofgtheglaboratorygrecordgan
dgthegpurchaser'sgfilegofgmusclegcramping.gPotassiumgandgmagnesiumgdepletiongaregcomm
ongmanifestationsgingcustomersgwhogaregpostoperativegfollowinggCABG.gDuegtogmedicinego
rghemodilation,git'sgfargcriticalgforgthegnursegtogcloselygdisplaygelectrolytes.
Agnursegisgbeinggconcernedgforgagpatrongwho'sgpregnantgingthegacutegcaregputtinggNur
ses'gNotes
1400
Clientgreportsgagconsistentglowgdullgbackachegandgpainlessgabdominalgtighteninggforgthegpas
tgthreeghr.gDeniesganygmodificationsgingvaginalgdischarge.gExternalgfetalgdisplaygapplied.
1430
Contractiongsample:gcontractionsgeachg4gtog5gmin,glastingg30gtog45gseconds,gpalpategmildgin
gdepth
Fetalgheartgrate:g150/mingtogoneghundredgfiftygfive/min,gmoderategvariability,gadequategacc
elerationsgpresent,gnogdecelerationsgstated.gProviderging-
gANSThegnursegneedgtogfirstgcopegwithgthegconsumer'sgbreathinggfee,gfollowedgwithgthegai
dgofgthegcustomer'sgdegreegofgfocus
Whengprioritizingghypotheses,gthegnursegoughtgtogrecognizegthatgmagnesiumgsulfategisgagre
levantgnervousgdevicegdepressantgthatgcouldghavegangeffectgongrespirations,gcognizance,ga
ndgreflexesgwhilstgpoisonousgbloodgdegreesgoccur.gUsinggthegairway,grespiratory,gmovegpre
cedencegframework,gthegnurseghavegtogplangtogfirstgtakegactiongtoghelpgrespirations,gfollowe
dgbygwaygofgmotiongtogincreasegthegclient'sglevelgofgawareness.gThegnursegmustgplangtogdis
continuegthegmagnesiumgsulfateginfusiongandgadministergcalciumggluconategasgang antidote.
Agnursegisgcaringgforgagyounggpersongingthegemergencygdepartmentg(ED)gN
urses'gNotes
0700
AdolescentgadmittedgtogED.gAdolescent'sgmothergandgfathergareginvolvedgaboutgleftglegghar
mgthatglooksgtogbeggettinggworse.gParentsgrecordgadolescentghasghadgfever,gdecreasedgurge
gfor
g g g g
B
g
Agnursegisgworryinggforgagfive-12gmonths-
antiquegtoddlergPhysicalgExamination:
1510:
Upongvisualginspection,gthroatgisginfected,gtonsilsgappeargpurple,greddenedgandgepiglottisgisg
edematousgandgcherrygpinkgingappearance.gSkingseemsglight.gStridorgreferredgtogupongnotio
ngwithgfadedgbilateralglunggsounds.
Nurse'sgNotes:
1500
Childgobservedgtogemergencygdepartmentgwithgthegaidgofgcaregiver.gCaregivergstatesgtoddle
rghasgagsoregthroatgandgreportsgthegkidghasg"achegongswallowing"gandgdeniesgcough.gChildg
isgagitatedgandgleang-gANSCondition:gEpiglottis
Actions:gInitiategdropletgprecautionsgandgrequestgagprescriptiongforgIVgantibioticsgMonit
ors:gBreathgsoundsgandgtemperature
Thegnurseghavegtoganticipategstartinggupgdropletgprecautionsgandgsolicitinggforgagprescriptio
ngforgIVgantibiotics.gTheginfantgisgmaximumgprobablygexperiencinggepiglottisgbecausegofgthe
gscientificgmanifestationsgofgagexcessivegfever,ginflammationgandgrednessgofgthegthroat,gpal
egskin,gstridorgwithgidea,gpainfulgswallowing,gnogcough,gisgsittinggingtripodgrole,gandgdrooling.
gThegnursegoughtgtogmonitorgthegkid'sgtemperaturegandgbreathgsounds.
Agnursegisgbeinggconcernedgforgagconsumergwhogisgongthegspinalgwiregdamageg(SCI)gunitgN
urses'gNotes
Daygthree,g1700
ClientgadmittedgtogSCIgunitgthreegdaysgingthegpastgfollowinggC7gharm.gSkingisgcool,gfaded,ga
ndgdrygtogthegtouch.gRespirationsgsmoothgandgunlabored.gLunggsoundsgdiminishedginglower
globes.gAbdomengsoftgandgnondistendedgwithglivelygbowelgsounds.gClientgsurpassedgagsmal
lgamountgofghardgshapedgstoolgthisgAM.gIndwellinggurinarygcathetergdraininggcleargyellowguri
ne.gDeepgtendongreflexesg(DTR)garegbicepsg1+,gtricepsg1+,gpag-
gANSThegcustomergisgmostgpossiblygexperiencinggmanifestationsgofgpneumoniagandgauton
omicgdysreflexia.
Thegnursegshouldgexaminegcuesgfromgthegpatron'sgmanifestationsgandgdecidegthatgthegcons
umergisgmaximumglikelygexperiencinggmanifestationsgofgpneumoniagandgautonomicgdysrefle
xia.gAgconsumergwhoghasgagcervicalgSCIgisgatgriskgforgrespiratorygheadachesgbecausegspina
lginnervationgtogthegbreathinggmusclegtissuesgisgdisrupted.gAdventitiousgbreathgsoundsgingthe
gdecreaseglobesgbilaterallygandgagdecreasegingoxygengsaturationgtoglessgthangninetygtwo%gc
angindicategpneumonia.gThegpatron'sgsuddengboomgingbloodgstress,gbradycardia,gflushinggo
fgthegskingabovegthegvicinitygofgtheginjury,gheadache,gandgblurredgvisiongaregmanifestationsg
ofgautonomicgdysreflexia,gwhichgmaygbegaglife-threateninggsituation.
,Agnursegisgbeinggconcernedgforgagcustomergwhoghasgstomachgpain
Nurses'gNotes
g0900
Clientgreportsglackgofgappetite,gweightgreduction,gandgfatiguegforg1gweek.gReportsgbellygach
e,g6gongagscalegfromgzerogtog10,gforg2gdays.gClientgisgagperioperativegnurse,glowergbackg1g
weekgagogfromgag2-weekgassignmentgtripgtogangunderdevelopedgug.gSg.
1200
Resultsgofgantibodygresearchgacquired.gProvidergprescriptiongforgantiviralgmedicinegpending.
PhysicalgExamination
g0930
Lunggsoundsgcleangbilaterally.gSkingwarmgtogthegtouchgandgjaug-
gANSHepatitisgA:gClient'sgchancegfromgfecal-
oralgtransmission,glaboratorygresults,gandgbodilygexaminationgfindings
HepatitisgB:gAntiviralgremedy,glaboratorygresults,gpurchaser'sgriskgfromgbloodbornegtransmissi
on,gphysicalgexaminationgfindings
HepatitisgC:gAntiviralgtreatment,glaboratorygconsequences,gcustomer'sghazardgfromgblo
odbornegtransmission,gandgbodilygexamgfindings
Whenganalyzinggcues,gthegnursegoughtgtogapprehendgthatgmanifestationsgofghepatitisgA,ghe
patitisgB,gandghepatitisgCgconsistgofgjaundice,gyellowgsclerae,gpropergtopgquandrantgachegu
pongpalpation,gdarkishgyellowgurine,gandgmultipliedgASTgandgALTgstages.gWhenganalyzingg
cues,gthegnurseghavegtogadditionallygrecognizegthegpurchaser'sgchancegforgcontractingghep
atitisgAgviagthegfecal-
oralgdirectiongthroughoutglatestgjourneygtogangunderdevelopedgusgofgagandgthegclient'sgoccu
pationalgthreatgasgagperioperativegnursegforgcontractingghepatitisgBgandghepatitisgCgviagbloo
dbornegtransmission.gThegnursegneedgtogapprehendgthatgthegpresentgdaygwellknowngofgexe
rcisegfor
Agnursegisgbeinggconcernedgforgagpatrongongagclinical-
surgicalgunitgVitalgSigns
0700
Temperatureg37.6gCg(ninetygnine.7gF)g
Heartgrategoneghundred/mingRespirato
rygchargeg22/min
Bloodgstraingaghundredgandgfifteen/70gmmHggOxyg
engsaturationg98%gongroomgair
Nurses'gNotes
g1100
Clientgalertgandgorientatedgtogcharacter,gregion,gandgtime.gClientghadgepisodegofgdiarrhea,gpr
ovidedgperinealgcare.gNotedg2gcmgxg2gcmg(zero.Eightgingxgzero.Eightgin)gpainfulgedematousgl
ocationgongsacrum.gClientgrepositionedgeveryg4ghr.g-
gANSClickgtogspotlightgthegfindingsgthatgrequiregobservegup.gTogdeselectgaglocating,gclickgon
gongthegfindinggoncegmore.
,- Notedg2gcmgxg2gcmg(zero.Eightgingxgzero.Eightgin)gpainfulgedematousgplacegongsacrum
- Clientgrepositionedgeachg4ghr
Whengrecognizinggcues,gthegnursegmustgdeterminegthatgthegconsumer'sgpainfulgedematous
gregiongongtheirgsacrumgandgthatgthegconsumerghasgmostgeffectivegbeengrepositionedgevery
g4ghrgrequiresgfollowgup.gThegconsumerghasgmanifestationsgofgagstressgharmgthatgneedgtogb
egaddressed.gThegconsumergneedgtogbegrepositionedgatgleastgeveryg2ghrgtogsavegyougworse
ninggofgthegstressginjurygandgtogalleviategstressgfromgthegsacralgarea.
Agnursegingangoutpatientgintellectualgfitnessgclinicgisgcaringgforgagclie
ntgVitalgSigns
threegmonthsgingthegpast
Bloodgstraing116/sixtygeightgmmHggHe
artgfeeg82/min
Respiratorygchargegsixteen/mingT
emperatureg36.7gCg(98.1gF)gSaO
2gninetygseven%gongroomgair
Today:
Bloodgpressureg128/seventygsixgmmHg
gHeartgfeeg104/min
Respiratorygpriceg22/min
Temperatureg37.4g(ninetygnine.FourgF)
gSaO2gninetygseven%gongroomgair
Nurses'gNotesgthre
egmonthsgago
Clientgrecentlygadmittedgwithgnewganalysisgofgschizophrenia.gReceivedginpatientgtreatmentgf
org10gdaysgandgbecamegdischargedg1gweekgingthegpast.g-
gANSSelectgthegthreegfindingsgthatgrequiregongthegspotgfollowgup:
- Auditoryghallucinations
- Speech
- Restlessness
Whengspottinggcues,gthegnursegneedgtogperceivegthatgthegfindingsgofgrestlessness,gauditoryg
hallucinations,gandgcompelledgspeechgrequiregimmediategcomplygwithgup.gThesegfindingsgare
gindicatorsgofgpsychosis.gThegnursegneedgtognotifygthegcompanygforgadditionalgevaluationgan
dgremedy.
Agnursegisgworryinggforgagcustomergwhogisgpostoperativegfollowinggcoronarygarterygski
pgsurgeryg(CABG)
LaboratorygResults
g0630
SodiumgoneghundredgfortygfivegmEq/Lg(136gtogoneghundredgfortygfivegmEq/
L)gPotassiumg3.2gmEq/Lg(three.5gtog5gmEq/L)
Chlorideg116gmEq/Lg(ninetygeightgtog106gmEq/L)
, BUNg24gmg/dLg(10gtog20gmg/dL)
Magnesiumg1.FivegmEq/Lg(1.Threegtogtwo.1gmEq/L)gTo
talgcalciumg9gmg/dLg(9gtog10.5gmg/dL)
Phosphategfour.6gmg/dLg(3gtog4.Fivegmg/dL)
Glucosegninetygfivegmg/dLg(seventygfourgtog106gmg/dL)
gWBCgcountgnine,500/mm3g(five,000gtogten,000/mm3)
Ig&gOg0
700
fourghrginputgfourghundredgmL
fourghrgoutputg-
gANSThegpurchasergisgatgfinestghazardgforgdevelopinggdysrhythmias,gasgevidencedgbygusing
gelectrolytegimbalance.
Thegnursegoughtgtogexaminegcuesgtogdecidegthegclientgisgatggreatestgriskgforggrowinggdysrhy
thmiasgassociatedgwithghypokalemia,gasgevidencedgwithgthegaidgofgtheglaboratorygrecordgan
dgthegpurchaser'sgfilegofgmusclegcramping.gPotassiumgandgmagnesiumgdepletiongaregcomm
ongmanifestationsgingcustomersgwhogaregpostoperativegfollowinggCABG.gDuegtogmedicinego
rghemodilation,git'sgfargcriticalgforgthegnursegtogcloselygdisplaygelectrolytes.
Agnursegisgbeinggconcernedgforgagpatrongwho'sgpregnantgingthegacutegcaregputtinggNur
ses'gNotes
1400
Clientgreportsgagconsistentglowgdullgbackachegandgpainlessgabdominalgtighteninggforgthegpas
tgthreeghr.gDeniesganygmodificationsgingvaginalgdischarge.gExternalgfetalgdisplaygapplied.
1430
Contractiongsample:gcontractionsgeachg4gtog5gmin,glastingg30gtog45gseconds,gpalpategmildgin
gdepth
Fetalgheartgrate:g150/mingtogoneghundredgfiftygfive/min,gmoderategvariability,gadequategacc
elerationsgpresent,gnogdecelerationsgstated.gProviderging-
gANSThegnursegneedgtogfirstgcopegwithgthegconsumer'sgbreathinggfee,gfollowedgwithgthegai
dgofgthegcustomer'sgdegreegofgfocus
Whengprioritizingghypotheses,gthegnursegoughtgtogrecognizegthatgmagnesiumgsulfategisgagre
levantgnervousgdevicegdepressantgthatgcouldghavegangeffectgongrespirations,gcognizance,ga
ndgreflexesgwhilstgpoisonousgbloodgdegreesgoccur.gUsinggthegairway,grespiratory,gmovegpre
cedencegframework,gthegnurseghavegtogplangtogfirstgtakegactiongtoghelpgrespirations,gfollowe
dgbygwaygofgmotiongtogincreasegthegclient'sglevelgofgawareness.gThegnursegmustgplangtogdis
continuegthegmagnesiumgsulfateginfusiongandgadministergcalciumggluconategasgang antidote.
Agnursegisgcaringgforgagyounggpersongingthegemergencygdepartmentg(ED)gN
urses'gNotes
0700
AdolescentgadmittedgtogED.gAdolescent'sgmothergandgfathergareginvolvedgaboutgleftglegghar
mgthatglooksgtogbeggettinggworse.gParentsgrecordgadolescentghasghadgfever,gdecreasedgurge
gfor
