Medical-Surgical RN A Prophecy Relias Test, Answered 2025
Your patient continues to pull at their IV site located in their left forearm despite verbal
reminders and increased observation. The nursing assistant recommends using soft
mitt restraints on the patient. What is your recommendation? - ANSWER-Request an
order for soft mitts as they are the least restrictive
Your patient was admitted for a hypertensive crisis and has a history of HTN,
Parkinson's disease, depression, and alcohol use. On his second hospitalized day, you
notice he is more anxious and restless than his baseline. What would be your FIRST
nursing intervention? - ANSWER-Ask the patient when his last drink of alcohol was.
What is the BEST indication of an acute neurological problem? - ANSWER-Change in
level of consciousness
While in a supine position your patient states, "I'm tired and cannot catch my breath."
Physical assessment reveals jugular vein distention and a third heart sound (S3). These
symptoms are indicative of what condition? - ANSWER-Heart failure
Your new admission presents with a cough, unintentional weight loss, frequent night
sweats, and bloody sputum. What type of isolation precautions should you initiate, if
any? - ANSWER-Airborne precautions
Patients with diabetes are at high risk for complications from damage to what body
areas? - ANSWER-Nerve and kidney damage
If your patient with a known history of diabetes is displaying symptoms of diaphoresis,
cool skin, lethargy, and shakiness. What is your first action? - ANSWER-Check the
patient's blood glucose level.
Your patient tells you, "I hope I don't die, but if I do I don't want to be brought back.?
You notice on her chart and wrist band that she is a full code. What would be the MOST
appropriate action? - ANSWER-Discuss code status with the patient and follow up with
provider to ensure the medical record reflects her wishes.
Your coworker posted photos on social media from a birthday party they had for her in
the unit breakroom. What should be your NEXT course of action? - ANSWER-No action
is necessary because no PHI was displayed.
1.2 milligrams is equal to how many micrograms? - ANSWER-1200 mcg
Your post-op patient has a Jackson-Pratt (JP) drain in place. How do you ensure
effective drain function? - ANSWER-Compress the drain, then plug the bulb to establish
suction
, Your male patient complains of discomfort while inflating the balloon during insertion of
an indwelling urinary catheter. What would be the MOST appropriate action? -
ANSWER-Deflate the balloon, advance the catheter further, then reinflate the balloon
Your patient has symptomatic anemia but is refusing a blood transfusion for religious
reason. What is an appropriate response? - ANSWER-Respect his wishes and notify
the provider
Your patient is admitted with diverticulitis. What type of diet do you expect to be ordered
for the patient? - ANSWER-broth, jello, soft fruit no skin,
You were hired to work the medical unit and when you arrive at work the charge nurse
has assigned you to the post-surgical unit since they are understaffed. Which is the
MOST appropriate action? - ANSWER-Report to the post-surgical unit.
What is a proton pump inhibitor, such as pantoprazole (Protonix) used for? - ANSWER-
Acid Reduction
Which adaptive equipment would be MOST appropriate to use for a severely contracted
patient who is unable to bear weight when transferring from the bed to the chair? -
ANSWER-Patient lift (e.g., Hoyer)
Which tool should you use to assess pain in you 80-year-old patient with severe
dementia? - ANSWER-PAINAD scale
Your patient is admitted from the ED with failure to thrive and advanced dementia. You
note he is extremely underweight, appears unbathed for some time, and has a stage 4
pressure injury to his coccyx. You were told in report that he lives at home with family
members. What should you do? - ANSWER-Notify the charge nurse and social worker
of your concerns.
Your 85-year-old patient with atrial fibrillation fell at home 3 days ago. You notice she
has been having several episodes of acute confusion since being admitted to your unit.
Your patient continues to pull at their IV site located in their left forearm despite verbal
reminders and increased observation. The nursing assistant recommends using soft
mitt restraints on the patient. What is your recommendation? - ANSWER-Request an
order for soft mitts as they are the least restrictive
Your patient was admitted for a hypertensive crisis and has a history of HTN,
Parkinson's disease, depression, and alcohol use. On his second hospitalized day, you
notice he is more anxious and restless than his baseline. What would be your FIRST
nursing intervention? - ANSWER-Ask the patient when his last drink of alcohol was.
What is the BEST indication of an acute neurological problem? - ANSWER-Change in
level of consciousness
While in a supine position your patient states, "I'm tired and cannot catch my breath."
Physical assessment reveals jugular vein distention and a third heart sound (S3). These
symptoms are indicative of what condition? - ANSWER-Heart failure
Your new admission presents with a cough, unintentional weight loss, frequent night
sweats, and bloody sputum. What type of isolation precautions should you initiate, if
any? - ANSWER-Airborne precautions
Patients with diabetes are at high risk for complications from damage to what body
areas? - ANSWER-Nerve and kidney damage
If your patient with a known history of diabetes is displaying symptoms of diaphoresis,
cool skin, lethargy, and shakiness. What is your first action? - ANSWER-Check the
patient's blood glucose level.
Your patient tells you, "I hope I don't die, but if I do I don't want to be brought back.?
You notice on her chart and wrist band that she is a full code. What would be the MOST
appropriate action? - ANSWER-Discuss code status with the patient and follow up with
provider to ensure the medical record reflects her wishes.
Your coworker posted photos on social media from a birthday party they had for her in
the unit breakroom. What should be your NEXT course of action? - ANSWER-No action
is necessary because no PHI was displayed.
1.2 milligrams is equal to how many micrograms? - ANSWER-1200 mcg
Your post-op patient has a Jackson-Pratt (JP) drain in place. How do you ensure
effective drain function? - ANSWER-Compress the drain, then plug the bulb to establish
suction
, Your male patient complains of discomfort while inflating the balloon during insertion of
an indwelling urinary catheter. What would be the MOST appropriate action? -
ANSWER-Deflate the balloon, advance the catheter further, then reinflate the balloon
Your patient has symptomatic anemia but is refusing a blood transfusion for religious
reason. What is an appropriate response? - ANSWER-Respect his wishes and notify
the provider
Your patient is admitted with diverticulitis. What type of diet do you expect to be ordered
for the patient? - ANSWER-broth, jello, soft fruit no skin,
You were hired to work the medical unit and when you arrive at work the charge nurse
has assigned you to the post-surgical unit since they are understaffed. Which is the
MOST appropriate action? - ANSWER-Report to the post-surgical unit.
What is a proton pump inhibitor, such as pantoprazole (Protonix) used for? - ANSWER-
Acid Reduction
Which adaptive equipment would be MOST appropriate to use for a severely contracted
patient who is unable to bear weight when transferring from the bed to the chair? -
ANSWER-Patient lift (e.g., Hoyer)
Which tool should you use to assess pain in you 80-year-old patient with severe
dementia? - ANSWER-PAINAD scale
Your patient is admitted from the ED with failure to thrive and advanced dementia. You
note he is extremely underweight, appears unbathed for some time, and has a stage 4
pressure injury to his coccyx. You were told in report that he lives at home with family
members. What should you do? - ANSWER-Notify the charge nurse and social worker
of your concerns.
Your 85-year-old patient with atrial fibrillation fell at home 3 days ago. You notice she
has been having several episodes of acute confusion since being admitted to your unit.
