Nursing Assessment 2

Front

A 45-year-old patient was found unconscious. Upon assessment, the patient only responds to painful stimuli with abnormal flexion. What is the patient’s Glasgow Coma Scale (GCS) score?

Back

6

Front

Scenario: A neonate has a bulging fontanelle and high-pitched crying. What could this indicate?

Back

Increased intracranial pressure (ICP)

Front

Scenario: A 60-year-old patient has a BP of 80/50 mmHg, cold extremities, and a weak pulse. What is the priority intervention?

Back

Give IV fluids

Front

Scenario: A newborn has a heart rate of 90 bpm, weak pulses, and cyanosis. What is the immediate action?

Back

Perform chest compressions

Front

Scenario: A 35-year-old asthmatic patient is wheezing and has a respiratory rate of 32/min. What is the first intervention?

Back

Administer bronchodilator (salbutamol)

Front

Scenario: A premature infant is experiencing nasal flaring, grunting, and intercostal retractions. What condition should you suspect?

Back

Respiratory distress syndrome (RDS)

Front

Scenario: A patient with liver failure has ascites and is showing signs of confusion. What lab test should you prioritize? Options: Serum bilirubin, Lipase and amylase, Albumin levels

Back

Ammonia levels

Front

Scenario: A 2-day-old newborn has not passed meconium. What condition should you suspect?

Back

Hirschsprung’s disease

Front

Scenario: A patient with chronic kidney disease has a potassium level of 6.8 mEq/L. What is the priority action?

Back

Give IV calcium gluconate

Front

Scenario: A newborn has no urine output in the first 24 hours. What should you do?

Back

Check hydration status and consult neonatology