WorksheetsNursing and Medical Scenarios Quiz
Total questions: 20
Worksheet time: 10mins
The nurse is administering a transfusion of packed RBCs. Which interventions should the nurse implement? Select all that apply.
Verify the client has signed consent
Obtain the blood from the laboratory
Assess the IV site for size and patency
Start the transfusion slowly
Check the blood with another nurse at the bedside
A client undergoing assessment of cranial nerve VIII is likely to have which of the following included in his examination?
Babinski and Kernig signs
Weber, Rinne, and Romberg test
Snellen and Ishihara charts
Whispered voice and pupillary light reflex
A nurse is caring for a client recently diagnosed with hypothyroidism. The client noticed thinning hair
and a change in bowel movements from everyday to every other day. She also reports a new preference
for warmer environments and a profound decrease to her energy levels. Which of the following nursing
diagnoses would be priority for this client?
Disturbed body image related to physical appearance changes
Chronic pain related to muscle cramping
Risk for imbalanced nutrition: more than body requirements
Activity intolerance related to insufficient physiologic energy
The client in the medical units begins to experience a severe anaphylactic reaction after an initial dose of
IV penicillin, an antibiotic. Which intervention would least likely be implemented as an immediate
response to this development?
Establish airway and provide oxygen
Administer IM epinephrine
Start IV line and administer normal saline
Request and obtain a routine chest x-ray
Which of the following clients is most at risk for developing a deep vein thrombosis?
A 22-year-old postpartum client 2 days after delivery
A 76-year-old male client on bedrest for pneumonia
A 40-year-old client who smokes and uses oral contraceptives
A 55-year-old client with atrial fibrillation taking anticoagulants
A nurse’s forearm is splattered with blood while inserting an IV catheter. Which action should the nurse take?
Wash the forearm with soap and water
Apply alcohol-based sanitizer only
Notify the client’s physician
Cover the area with a sterile bandage
A nurse is admitting a client who has influenza accompanied by severe nausea and vomiting. Client
reports numbness and tingling of the toes and fingers. The nurse should recognize the client is
experiencing which of the following acid-base imbalances?
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis
Mixed respiratory/metabolic alkalosis
A client has a nasogastric tube following a subtotal gastrectomy. What should the nurse do?
Monitor for nausea, vomiting, and abdominal distention
Remove the NG tube if the patient reports discomfort
Clamp NG tube to encourage bowel sounds
Administer laxatives every 6 hours
A nurse is caring for a client with emphysema. Which of the following would the nurse NOT expect to assess?
Use of accessory muscles
Barrel-shaped chest
Deep respirations
Decreased breath sounds
A client on an inpatient psychiatric unit angrily says to a nurse “ Peter is not cleaning up after himself in
the community bathroom. You need to address the problem.” Which is the appropriate nursing response?
I will talk to Peter for you.
Just clean up after him this time.
Ignore it—he’ll eventually stop.
I can see that you are angry. Let’s discuss ways to approach Peter with your concerns.
A nurse is admitting an adult client who has a newly applied fiberglass cast for a fractured tibia. What is the priority action for the nurse to take?
Elevate the extremity above heart level
Perform a neurovascular assessment
Administer PRN pain medications
Apply a warm compress over the cast
A nurse is caring for a client who is using a PCA pump for post-op pain management. The nurse enters
the room to find the client asleep and his wife pressing the button to dispense another dose. Which of the
following responses should the nurse make?
I’ll give the medication for him if he’s sleeping
He can have another dose when the machine allows it
Only your husband should decide when more medication is needed
The machine is locked for safety; you cannot overdose him
A client has complaint of incontinent episodes when sneezing, coughing, laughing or changing body
position. Which type of incontinence should the nurse document in the EMR?
Overflow
Urge
Functional
Stress
The nurse assesses the client’s stoma during the initial post-op period. Which of the following
observations should be reported immediately to the physician?
The stoma is bright red and moist
The stoma is draining small amounts of mucus
The stoma is dark red to purple
The stoma has a mild odor
Which of the following statements is true regarding the difference between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)?
HHS occurs more frequently in children with Type 1 diabetes
DKA has a slower onset than HHS
HHS develops over the course of days while DKA has a rapid onset
DKA presents with higher blood glucose levels than HHS
A client with a history of angina pectoris is admitted to the medical surgical unit for treatment of peptic
ulceration. After lunch, the client calls nurse and reports an 8/10 crushing pain in his chest. The nurse’s
first action is:
Call the provider immediately
Reposition the client and reassess in 5 minutes
Administer nitrates and aspirin as prescribed
Take vital signs and document the episode
A nurse is assessing a client who has developed atelectasis postoperatively. Which finding should the nurse expect?
Decreased respiratory rate
Increasing dyspnea
Loud crackles throughout the lung fields
Cyanosis of the lips and tongue only
A client was admitted following a motor vehicle accident. The nurse notes a Glasgow Coma Scale score of 3. What should be the nurse’s primary concern?
Preventing pressure injuries from immobility
Reducing environmental stimuli
Protecting the airway and respiratory function
Administering pain medication to increase comfort
A nurse discovers a client’s suicide note that includes time, place, and method. What is the priority nursing intervention?
Notify the physician to change medications
Increase observation to every 15 minutes
Place the client on one-on-one suicide precautions
Encourage the client to talk about his feelings
Which of the following interventions may help prevent a urinary tract infection?
Limit fluid intake to reduce frequency
Consume cranberry juice
Wash the perineum with hydrogen peroxide
Take antibiotics prophylactically without prescription
