1 :

1300:

Cardiac troponin T: less than 0.1 ng/mL (normal: less than 0.1 ng/mL)

LDL: 110 mg/dL (normal: less than 130 mg/dL)

Total cholesterol: 230 mg/dL (normal: less than 200 mg/dL)

1200:

A 58-year-old client reporting chest pain is admitted to the emergency department.

The client states the chest pain began this morning after breakfast and radiates to the left arm.

The client rates pain as 4 on a scale of 0 to 10.

Medical history: hypertension, type 2 diabetes mellitus, and hyperlipidemia.

Social history: denies alcohol use, smokes 1 pack per day for 35 years.

Lisinopril 20 mg PO daily

Glucophage 500 mg PO BID

Simvastatin 20 mg PO daily


Complete the following sentence by using the list of options. After notifying the provider, the nurse shouldand then.


Hint : πŸ’₯Start with an antiplatelet, then relieve pain and improve perfusion.

Correct Answers

  • Blank 1 Correct Option: first administer oxygen at 2 L/min via nasal cannula
  • Blank 2 Correct Option: administer sublingual nitroglycerin

Rationale :

πŸ’ŠAdministering aspirin is a priority intervention for a client with suspected acute coronary syndrome, as it helps inhibit platelet aggregation and reduce further clot formation.

❀️After aspirin, the nurse should give sublingual nitroglycerin to help relieve chest pain by vasodilation, improving coronary blood flow.

πŸ§ͺThe client’s troponin is currently normal, but the clinical presentation (chest pain, radiation, risk factors) strongly suggests a possible myocardial infarction, warranting urgent treatment.

✍️Other actions such as ambulation, meals, or general assessments are inappropriate priorities in acute chest pain management.

πŸ“ŒCore Message

Suspected cardiac ischemia requires prompt aspirin administration followed by nitroglycerin to reduce clot formation and relieve chest pain.

2 :

The adolescent was admitted to the pediatric unit following the application of a long leg cast to the right leg due to a femur fracture. Alert and oriented to time, person, place, and situation. Reports pain as 7 on a scale of 0 to 10. Pupils equal, round reactive to light and accommodation. Heart rate regular without murmur. Respirations easy, breath sounds clear throughout. Abdomen soft, nontender, nondistended with positive bowel sounds in all four quadrants. Right dorsalis pedis pulse 2+, capillary refill brisk, toes mildly edematous, denies numbness or tingling. Wiggles toes on command. Moves other three extremities well.

1245: Reports pain as 5 on a scale of 0 to 10. 

1515: Reports pain as 7 on a scale of 0 to 10. 

1600: Adolescent reports pain as 6 on a scale of 1 to 10. 

Dorsalis pedis pulse 2+, capillary refill 3 seconds, toes moderately edematous.


Select 1 condition and 1 finding to fill in each blank in the following sentence. The adolescent is at risk for developingas evidenced by.


Hint : 🧦Think of pressure building in a confined limb space after a fracture and casting.

Correct Answers

  • Blank 1 Correct Option: compartment syndrome
  • Blank 2 Correct Option: edema of toes

Rationale :

🦡Compartment syndrome is a serious complication of fractures and casting that results from increased pressure within a muscle compartment, impairing circulation and nerve function.

πŸ’₯Edema of the toes, especially when increasing, is an early indicator of circulatory compromise, and must be closely monitored for signs of worsening.

🩸The presence of brisk capillary refill and intact pulses is reassuring for now, but moderate edema and continued pain raise suspicion for early compartment syndrome.

πŸ“ˆOther conditions like pneumonia or DVT are less likely based on current data, and findings like decreased heart rate or absent bowel sounds do not align with the localized musculoskeletal concern.

πŸ“ŒCore Message

Compartment syndrome is a complication of fractures and casts, signaled by increasing pain and limb edema that can compromise circulation.

3 :

Hint : πŸ§‚Electrolytes are central to Addison’s disease management, especially in crises.

Correct Answers:

  • Sodium and potassium levels monitored


Rationale :

πŸ§ͺAddison’s disease leads to electrolyte imbalances, especially hyponatremia and hyperkalemia.

⚠️Vomiting worsens these imbalances, making serum monitoring essential.

πŸ’‰IV glucocorticoids can also affect electrolyte and glucose levels, but sodium/potassium shifts are most dangerous.

πŸ“ˆThis helps guide adjustments in fluid and steroid therapy.

πŸ“ŒCore Message

In Addison’s disease with vomiting, monitor sodium and potassium levels closely to prevent electrolyte crises.

4 :

Hint : πŸ§ͺAlways think β€œcalcium” when tingling appears post-thyroidectomy.

Correct Answers:

  • Check the calcium level


Rationale :

🧬Tingling and numbness are signs of hypocalcemia, which can occur if the parathyroid glands were damaged or removed.

🩺Low calcium after thyroid surgery is common and urgent, as it can lead to tetany or laryngospasm.

🚨Checking calcium confirms the diagnosis and guides rapid intervention.

πŸ’‰Other actions are important but not the immediate priority here.

πŸ“ŒCore Message

Tingling after thyroidectomy is an early sign of hypocalcemia, so the nurse should check calcium levels immediately.

5 :

Hint : ❀️Always prioritize cardiovascular stability when bradycardia and fatigue coexist.

Correct Answers:

  • Decreased cardiac output r/t bradycardia


Rationale :

πŸ’β€β™‚οΈBradycardia in hypothyroidism can reduce cardiac output, compromising oxygen delivery to tissues.

⚠️This presents the most immediate threat to life, making it a priority diagnosis.

πŸ“‰Other issues like mobility and cognition are secondary to the hemodynamic compromise.

🧬Managing the cardiac function is essential before addressing other concerns.

πŸ“ŒCore Message

In hypothyroidism with bradycardia, the primary concern is decreased cardiac output, which must be addressed first.

6 :

Hint : πŸ€¦β€β™‚οΈWarmth during contrast dye injection is typicalβ€”reassure without escalating concern.

Correct Answers:

  • "That feeling of warmth is normal when the dye is injected."


Rationale :

πŸ”₯The sensation of warmth is a common and expected response during contrast dye injection.

πŸ’‰This effect occurs as the dye passes through the vasculature, especially in large vessels.

🧠Reassuring the client reduces anxiety and avoids unnecessary alarm about normal procedural effects.

πŸ“‹There is no evidence of allergic reaction unless accompanied by rash, difficulty breathing, or hypotension.

πŸ“ŒCore Message

During an arteriogram, feeling warmth from contrast dye is a normal effect and should be calmly explained.

7 :

Hint : 🩺Gloves aren’t required for simple vital signs unless exposure to fluids is anticipated.

Correct Answers:

  • The nurse wears gloves to take the client’s vital signs.


Rationale :

🧀Wearing gloves for vital signs is unnecessary unless there is an expectation of contact with body fluids.

🧼Standard precautions require hand hygiene, but not gloves for routine, non-invasive procedures.

πŸ§ͺExcessive use of gloves can create barriers to proper technique and waste resources.

πŸ“‹The other actions represent proper infection control practices.

πŸ“ŒCore Message

Gloves are not needed when taking routine vital signs unless there's a risk of body fluid exposure.

8 :

Hint : πŸŒ™Nighttime perianal observation is key to identifying pinworms.

Correct Answers:

  • Examine the perianal area with a flashlight 2 or 3 hours after the child is asleep


Rationale :

πŸ”¦Pinworms are best detected when they emerge at night around the anus to lay eggs.

🧫The worms are visible with a flashlight, usually 2–3 hours after sleep onset.

πŸ“‰Stool and hair samples are ineffective in detecting pinworms.

πŸ‘ͺParents can directly visualize or use tape for sample collection as advised.

πŸ“ŒCore Message

Pinworms are detected by inspecting the perianal area at night, typically 2–3 hours after sleep.

9 :

Hint : πŸ€¦β€β™‚οΈHousehold treatment is standard practice due to high transmission rates.

Correct Answers:

  • The entire family should be treated.


Rationale :

πŸ‘¨β€πŸ‘©β€πŸ‘§Pinworm infections spread easily among household contacts, even if asymptomatic.

πŸ’ŠTreating the entire family prevents reinfection and cross-contamination.

πŸ§ͺTreatment usually involves oral antihelminthics, not IV antibiotics.

πŸ“…It is not prolongedβ€”typically a short course with a second dose after 2 weeks.

πŸ“ŒCore Message

In cases of enterobiasis, it's important to treat the entire household to prevent reinfection.

10 :

Hint : 🧷Sealed radiation implants are safe if there’s no contact with bodily fluids.

Correct Answers:

  • The client who returned from placement of iridium seeds for prostate cancer


Rationale :

☒️Iridium seeds for prostate cancer are a form of sealed internal radiation and pose minimal risk to caregivers.

πŸ‘ΆPregnant nurses must avoid clients with unsealed or high-dose radiation, such as radium or soluble isotopes.

🧬The radiation is localized and contained, with no significant exposure risk to others.

πŸ“‹Soluble therapy (like radioactive iodine) is contraindicated for pregnant caregivers.

πŸ“ŒCore Message

Pregnant nurses can safely care for clients with sealed radiation implants like iridium seeds.

Total Questions: 10

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