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WorksheetsTelemetry May Quarterly
Total questions: 11
Worksheet time: 2mins
Your patient is confused to place, time, and situation. They are attempting to pull out their IV line and are unable to follow safety commands. You receive an order for non-violent restraints and initiate soft-bilateral wrist restraints and mittens. The doctor has 1 hour to assess the patient face-to-face to perform an evaluation.
True
False
Your patient presents with new onset of chest pain. When asked to describe it, the patient states it is 7/10 sharp pain to the center of the chest. What are your next steps?
Administer Tylenol
Initiate CP Standardized Procedure
Call MD for Nitroglycerin PO
Call an RRT
You are at conducting a head-to-toe assessment on a patient that is admitted for sepsis. You notice that the patient has some mild swelling at the IV site but no pain. What is your FIRST intervention?
Stop the infusion
Call the MD
Document your finding
Continue medication administration
You notice a change in a patient's condition, you let the nurse know but she replies, "I am with another patient, I will go there in 10 minutes." What would you do next?
(a)
You patient is placed on contact isolation for C.Diff, you leave the room and clean your vital signs machine with Orange Top wipes for how long to disinfect?
4 minutes
As long as you want
1-minute up and down and 1-minute side to side
2 minutes vigorously
What is an alternative measure prior to resorting to restraints?
Call a family member to come in
De-escalate
Distract the patient
Bring closer to the unit
All of the above
The monitor tech alerts you that your patient's heart rate is trending down. Currently, the HR is 43, what would you do next?
Call the primary RN
Do nothing
Call a code
Assess the patient
Your patient has an unwitnessed fall, what is the RN responsible for?
Call a code lift
Take vital signs
Leave the patient alone
Ignore because patient is non-compliant
Initiate Fall bundle and call MD
You attempt to call the MD for a change in rhythm with no success, it is okay to endorse to the next nurse to follow up with.
True
False
Is the CNA able to empty out a colostomy bag?
Yes, it is within their scope
No, the CNA should call the RN to do it
Your patient presents with a venous ulcer that is red and dark purple in areas, you stage it as a...
Unstageable
Stage 1
DTI
Unsure, call Violetta
None
