RN Comprehensive Predictor 2010

Management of Care (29 items) Advocacy (3 items)

o Professional Responsibilities: Family Concerns (RM L and M 5.0 Chp 3, Basic Concept)o Professional Responsibilities: Pain (Medication, RM L and M 5.0 Chp 3)

A patient has morphine 2 mg IV PRN Q4H ordered. He got 2 mg 3 hours ago and is complaining of pain. What does the nurse do? (1) Give 1 mg now and another mg 1 hr later (2) Contact the provider (3) Use non-pharmacologic pain techniques (4) Can’t remember. I picked #1.

Confidentiality/Information Security (3 items)o Professional Responsibilities: Confidentiality (Basic Concept, RM L and M 5.0 Chp 3)

Patient asks to view his chart, what do you tell him? (1) He has a legal right to view his chart (2) He must sign something in writing first (3) You must ask the provider for permission first (4) The nurse shows him the chart. I picked #3.

o Professional Responsibilities: Privacy (Basic Concept, RM L and M 5.0 Chp 3)A visitor tells the nurse that he heard 2 employees from the lab discussing information about his family member who is a patient. What should the nurse do? (1) report it to risk management (2) inform the charge nurse (3) document it in the patient’s chart (4) file an incident report. I picked #2.

Delegation (4 items)o Managing Client Care: Buck’s Traction (Basic Concept, RM L and M 5.0 Chp 1)

What would you delegate to assistive-licensed personnel for a patient in Buck’s traction waiting for surgery in 2 hours? (1) Take vital signs every 30 minutes (2) Give the patient a bed bath (3) Ask the patient to rate pain on a scale of 0-10 (4) Assess something. It’s not #2.

o Managing Client Care: Float Assignment (Basic Concept, RM L and M 5.0 Chp 1)New nurse just got off orientation on cardiac care unit. Charge nurse asks her to take an assignment on a pediatric unit but the new nurse has not been oriented to that unit before. What should the new nurse do? (1) Report the incident and leave the hospital (2) Tell another nurse to take the assignment (3) Ask to be floated to an adult care unit (4) Go to the pediatric unit and take care of assigned patients. I picked #4.

Establishing Priorities (6 items)o Coordinating Client Care: Transfer (Basic Concept, RM L and M 5.0 Chp 2)o Facility Protocols: Disaster Planning (Basic Concept, RM L and M 5.0 Chp 5)

Guy comes in with anthrax exposure, what is the priority nursing action? (1) Place the patient in isolation (2) Tell the patient to take his clothes off and put them in a bag (3) Examine the patient’s clothes for anthrax dust (4) Can’t remember. I picked #1.

o Managing Client Care: Report on Multiple Clients (Basic Concept, RM L and M 5.0 Chp 1)o Managing Client Care: Emergency Department (Basic Concept, RM L and M 5.0 Chp 1)o Managing Client Care: Priority Client (Basic Concept, RM L and M 5.0 Chp 1)

These are questions where they list a bunch of patients with different conditions and you have to pick which one is the least/most stable or who you are going to assess first. I got them all right apparently.

Ethical Practice (1 item)o Professional Responsibilities: Medication Error (Basic Concept, RM L and M 5.0 Chp 3)

Informed Consent (2 items)o Professional Responsibilities: Informed Consent (Basic Concept, RM L and M 5.0 Chp 3)

A nurse sees a doctor go into a patient’s room and comes out 5 minutes later with a signed informed consent. The client tells the nurse that he has questions about the procedure. What does the nurse do? (1) Postpone the procedure (2) Call the doctor and have him come back to the patient’s room (3) Answer the client’s questions (4) Can’t remember. I picked #2.

Legal Rights and Responsibilities (3 items)o Maintaining a Safe Environment: Restraints (Basic Concept, RM L and M 5.0 Chp 4)

Restraints should never be tied to bedrails!o Professional Responsibilities: Reporting Client Abuse (Basic Concept, RM L and M 5.0 Chp 3)

An older patient is being transferred from another facility and you notice red marks around his wrists and something else that is a sign of abuse. What do you do? Report it to the appropriate authorities

Performance Improvement/Quality Improvement (1 item)o Facility Protocols: Sterile Technique (Basic Concept, RM L and M 5.0 Chp 5)

You are a new nurse and see a staff nurse break sterile technique. Just notify her that there was a break in sterile technique. You don’t need to go behind her back and tell the boss. That’s not nice. Give the sista’ the benefit of the doubt.

Referrals (3 items)o Coordinating Client Care: Referrals (Basic Concept, RM L and M 5.0 Chp 2)

What is the priority referral for a patient with a left-sided CVA with right-sided weakness and has difficulty with speech clarity who is being discharged home to the care of her spouse? The bathroom and bedroom are located on the 2nd floor. (1) Speech therapy (2) Physical therapy (3) Home health care (4) Respite care. I picked #2.

o Coordinating Client Care: Speech Therapy (Basic Concept, RM L and M 5.0 Chp 2)Which patient would be priority for a speech referral? (1) Newborn with poor sucking reflex and failure to thrive (2) Old client having difficulty swallowing fluids (3) Adolescent with anorexia nervosa and something weird (4) Can’t remember. I picked #2.

Supervision (3 items)o Managing Client Care: Orientation (Basic Concept, RM L and M 5.0 Chp 1)

The best way to familiarize a new staff member around the unit is by letting them follow around a staff nurse for the shift.

o Managing Client Care: Reassigning Task Assignment (Basic Concept, RM L and M 5.0 Chp 1)There’s a question about a nurse reassigning a task assignment for LPNs and UAPs doing different things and one of them is not appropriate for the scope of practice.

o Managing Client Care: Time Management (Basic Concept, RM L and M 5.0 Chp 1)

Safety and Infection Control (16 items) Emergency Response Plan (1 item)

o Communicable Diseases, Disasters, and Bioterrorism: Decontamination (Basic Concept, RM CH RN 5.0 Chp 6)The nurse knows that it is best for decontamination to occur where? (1) Outside (2) Nearest to the scene (3) At the hospital (4) Can’t remember. I picked #2.

Ergonomic Principles (2 items)o Ergonomic Principles: Lifts and Transfers (Basic Concept, RM Fundamentals 7.0 Chp 14)

Which nurse demonstrates proper body mechanics? (1) While picking up an object, bending hips and holding object close to body (2) Assisting patient to a wheelchair using slow gradual twist in position (3) Moving a client up in bed by tightening abdominal muscles and tucking pelvis in (4) While standing for long periods of time keep legs straight and lower back slightly curved in. I picked #2.

o Mobility and Immobility: Appropriate Use of Crutches (Nursing Skill, RM Fundamentals 7.0 Chp 40)What is the appropriate crutch walking technique for a patient with a fractured tibia who cannot put any pressure on his left leg? (1) Swing through (2) 2 point (3) 3 point (4) 4 point. I picked #3.

Home Safety (2 items)o Maintaining a Safe Environment: Dressings (Nursing Skill, RM L and M 5.0 Chp 4)

A nurse is changing the dressing on an open wound. Where does the nurse discard the dressing? (1) In the client’s bathroom and then notify housekeeping (2) in a biohazard bag and then tie it in a knot (3) in the soiled utility room in a special box (4) request a special trash can for the disposal of dressings. I picked #1.

Safe Use of Equipment (5 items)o Airway Management: Suctioning (Nursing Skill, RM AMS RN 8.0 Chp 20)

What demonstrates proper suctioning of a trach? (1) Instill Normal Saline prior to suctioning (2) Apply suction while advancing the catheter (3) After the client coughs immediately apply suction (3) Suction while withdrawing the catheter for 10 seconds. I picked #3.

o Airway Management: Tracheostomy Care (Nursing Skill, RM AMS RN 8.0 Chp 20)A client with a tracheostomy is being discharged home, the spouse will be caring for the client, what should the nurse include in discharge teaching? (1) Replace the disposable cannula daily (2) Proper use of the suctioning device (3) How to change the trach ties at the back of the neck (4) How to use clean technique for the trach dressing. I think I picked #4, not too sure though.

o Respiratory Management: Oxygen Therapy (Nursing Skill, RM Fundamentals 7.0 Chp 53)Make sure that you remove anything that can spark electricity away from someone who is on oxygen therapy. Don’t want them to blow up from one tiny spark.

o Vital Signs: Cooling Blanket (RM Fundamentals 7.0 Chp 27, System Disorder)A nurse is taking care of a child who is afebrile and gives him a cooling blanket. What is a sign that the patient is having an adverse reaction? Can’t remember all the choices except for the one I picked which was wrong – pallor.

Standard Precautions/Transmission-Based Precautions/Surgical Asepsis (3 items)o Communicable Diseases, Disasters, and Bioterrorism: Chlamydia (RM CH RN 5.0 Chp 6, System

Disorder)What advice would you give someone who has Chlamydia? (1) Give them an intermittent IV bolus of Rocephin (2) Tell them to get retested in a month (3) Tell them to abstain from having sex for at least 1 month. Wish I could remember the other one…I think I picked #3.

o Medical and Surgical Asepsis: Hand Hygiene (Nursing Skill, RM Fundamentals 7.0 Chp 10)A nurse is preparing to perform hand hygiene before entering a patient’s room, what is the correct action? (1) Keep hands pointed up (2) Rinse hands under warm water. Can’t remember the other two choices. I picked #1.

Health Promotion and Maintenance (14 items) Aging Process (1 item)

o Health Promotion of the Toddler (1 to 3 Years): Food Choices (Growth and Development, RM NCC RN 8.0 Chp 4)Graham crackers! Don’t give popcorn, grapes, or hot dogs because they are choking hazards.

Ante/Intra/Postpartum and Newborn Care (7 items)o Labor and Delivery Processes: Latent Phase (RM MN RN 8.0 Chp 11, System Disorder)

Your patient will be 0-3cm dilated. I think one of the options is 2cm. That’s the one I picked.o Normal Physiological Changes During Pregnancy: Nagele's Rule (Nursing Skill, RM MN RN 8.0

Chp 3)January 19th I think? Subtract 3 months from 1st day of LMP then add 7 days.

o Nursing Care of the Newborn: Care at Delivery (RM MN RN 8.0 Chp 24, System Disorder)Newborn is lethargic, jittery. I said check his BGL but that was wrong I guess. One of the other options I remember is put him under the warmer which didn’t make sense but who knows.

o Therapeutic Procedures to Assist With Labor and Delivery: Amniotomy (RM MN RN 8.0 Chp 15, System Disorder)What would you report to the provider immediately after an amniotomy? (1) FHR 100/min (2) Temp 38.4. I picked #2 but that was wrong. I knew that the FHR was low but was stuck between the two.

Developmental Stages and Transitions (4 items)o Health Promotion of the Infant (Birth to 1 Year): Fontanels (Growth and Development, RM NCC

RN 8.0 Chp 3)Patient is 8 months old, what are expected findings? Posterior fontanel should be closed, anterior fontanel should be open

o Normal Physiological Changes During Pregnancy: Acceptance (RM MN RN 8.0 Chp 3, System Disorder)Adolescent 22wks pregnant, what action shows she has accepted the physiological changes of pregnancy? She went out and bought maternity clothing.

Health and Wellness (1 item)o Guidelines for Healthy Eating: Weight Reduction (Basic Concept, RM Nutrition 4.0 Chp 4)

If you cut out 500 calories/day you can lose 1lb/week. Self Care (1 item)

o Spinal Cord Injury: Self-Care (RM AMS RN 8.0 Chp 17, System Disorder)Psychosocial Integrity (13 items)

Abuse/Neglect (2 items)o Family and Community Violence: Domestic Partner Abuse (System Disorder, RM MH RN 8.0 Chp

30)Help the patient to identify a safe place to go if needed and identify characteristics of escalating behavior to avoid abuse.

Behavioral Interventions (2 items)o Anger Management: Managing the Aggressive client (RM MH RN 8.0 Chp 29, System Disorder)

Get them away from other people.o Group and Family Therapy: Facilitating (Basic Concept, RM MH RN 8.0 Chp 8)

Use modeling? Coping Mechanisms (1 item)

o Coping: Body Image Change (RM Fundamentals 7.0 Chp 33, System Disorder)Client with permanent left facial droop doesn’t want to see family or friends. Establish small goals that will lead to the patient looking at himself in a mirror.

Crisis Intervention (2 items)o Crisis Management: Priority Actions (RM MH RN 8.0 Chp 27, System Disorder)o Suicide: Appropriate Nursing Response (RM MH RN 8.0 Chp 28, System Disorder)

Do you have a plan to end your life? Tell me more… End of Life Care (1 item)

o Care of Those Who are Dying and/or Grieving: Terminal Illness (RM MH RN 8.0 Chp 25, System Disorder)

Grief and Loss (1 item)o Care of Those Who are Dying and/or Grieving: Client with Cancer (RM MH RN 8.0 Chp 25,

System Disorder) Mental Health Concepts (2 items)

o Personality Disorders: Expected Findings (RM MH RN 8.0 Chp 15, System Disorder)Histrionic personality - seductive

o Schizophrenia: Expected Findings (RM MH RN 8.0 Chp 14, System Disorder)Lack of problem solving skills

Therapeutic Environment (1 item)o Anxiety Disorders: Priority Intervention (RM MH RN 8.0 Chp 11, System Disorder)

Basic Care and Comfort (13 items) Assistive Devices (1 item)

o Mobility and Immobility: Fractured Tibia (Nursing Skill, RM Fundamentals 7.0 Chp 40) Elimination (4 items)

o Disorders of Female Reproductive Tissue: Pelvic Surgery (Nursing Skill, RM AMS RN 8.0 Chp 74)What is the purpose for an indwelling catheter during abdominal surgery? To decompress the bladder and prevent it from getting nicked.

Nutrition and Oral Hydration (6 items)o Acute and Chronic Glomerulonephritis: Dietary Choices (RM AMS RN 8.0 Chp 67, System

Disorder)I got this one wrong for some reason but the appropriate diet is low sodium, low protein, and fluid restrictions. Bagel, egg, banana, some type of meat. I picked banana but that was wrong apparently.

o Cultural, Ethnic, and Religious Influences: Kosher Observance (Basic Concept, RM Nutrition 4.0 Chp 6)Do not eat meat and milk in the same meal.

o Nutrition and Oral Hydration: Findings to Report (RM Fundamentals 7.0 Chp 39, System Disorder)It’s basically one of the several assessment findings on this list for dehydration. Decreased hematocrit maybe?There is another question I think in this section about a child getting oral electrolyte replacement fluids and then you are asked what to give him next. I picked gelatin and got it right I think. The other choice I thought about picking was fruit juice.Another question is about a patient with TPN and the nurse it’s getting low. What do you do? I picked start dextrose 10%. Also remember that you cannot give anything else through a TPN line.

Personal Hygiene (1 item)o Spinal Cord Injury: Perineal Care (Nursing Skill, RM AMS RN 8.0 Chp 17)

Proper male perineal care of spinal cord injury? (1) Discard the washcloth after cleaning the urethra (2) Wipe from scrotum to urethra in a circular motion. (3) Do not use soap because it will cause irritation to the skin (4) Can’t remember. I picked #1.

Pharmacological and Parenteral Therapies (24 items) Adverse Effects/Contraindications/Side Effects/Interactions (13 items)

o Antibiotics Affecting the Bacterial Cell Wall: Penicillin Allergy (Medication, RM Pharm RN 5.0 Chp 44)Do not give with cephalosporins!

o Bipolar Disorders: Lithium Level (Medication, RM MH RN 8.0 Chp 13)Lithium level is 1.6, you will see coarse hand tremors.

o Cardiac Glycosides and Heart Failure: Laboratory Values (Medication, RM Pharm RN 5.0 Chp 21)Which lab test is indicative of heart failure as opposed to myocardial infarction? CK-MB, BNP, Troponin, CrP. I think I picked BNP.

o Chronic Neurologic Disorders: Medication Interactions (Medication, RM Pharm RN 5.0 Chp 13)o Early Onset of Labor: Magnesium Sulfate (Medication, RM MN RN 8.0 Chp 10)o Medications Affecting Blood Pressure: Calcium Channel Blockers (Medication, RM Pharm RN 5.0

Chp 20)Reflexive Tachycardia is an adverse reaction to Calcium Channel Blockers

o Medications for Depression: Phenelzine (Nardil) (Medication, RM MH RN 8.0 Chp 20)Don’t eat any smoked cheese!

o Medications for Psychoses: Withholding Dose (Medication, RM MH RN 8.0 Chp 22)Patient taking Clozaril, which assessment finding would cause you to withhold the dose. One of them is a low WBC count.

o Rheumatoid Arthritis: Long-Term Therapy (Medication, RM Pharm RN 5.0 Chp 33)Patient on prednisone for 10 months, what is a side effect? I picked thin extremities and rounded abdomen

Blood and Blood Products (2 items)o Blood and Blood Products: Chronic Anemia (Nursing Skill, RM Pharm RN 5.0 Chp 27)

Make sure you prime the line with normal saline before running the blood through it.o Blood and Blood Products: Positive Response (RM Pharm RN 5.0 Chp 27, System Disorder)

The question asks how can the nurse determine the blood transfusion has been effective. Increase in Hemoglobin.

Central Venous Access Devices (1 item)o Cardiovascular Diagnostic and Therapeutic Procedures: Expected Findings for Central Line

(Nursing Skill, RM AMS RN 8.0 Chp 31)Catheter tip is inserted into lower/upper third of vena cava.

Expected Actions/Outcomes (3 items)o Antibiotics Affecting Protein Synthesis: Gentamicin (Garamycin) (Medication, RM Pharm RN 5.0

Chp 45)o Medications Affecting Cardiac Rhythm: Dopamine (Medication, RM Pharm RN 5.0 Chp 23)

Dopamine causes increased cardiac output. Medication Administration (2 items)

o Airflow Disordres: Leukotriene Modifiers (Medication, RM Pharm RN 5.0 Chp 17)Reduction of Risk Potential (20 items)

Diagnostic Tests (3 items)o Angina and Myocardial Infarction: Elevated Troponin Level (RM AMS RN 8.0 Chp 35, System

Disorder) I think one of the choices is Troponin 0.6, so that is definitely elevated.

o Angina and Myocardial Infarction: Priority Diagnostic Test (RM AMS RN 8.0 Chp 35, System Disorder)

o Diagnostic and Therapeutic Procedures for Female Reproductive Disorders: Cervical Cancer (Diagnostic Procedure, RM AMS RN 8.0 Chp 72)

Laboratory Values (7 items)o Cardiovascular Diagnostic and Therapeutic Procedures: Interventions for Central Line (Nursing

Skill, RM AMS RN 8.0 Chp 31)A patient has bleeding at the site of a recent heart cath. You want to apply continuous pressure above the site.

Potential for Alterations in Body Systems (2 items)o Fractures: Skeletal Traction (RM AMS RN 8.0 Chp 82, System Disorder)

Potential for Complications of Diagnostic Tests/Treatments/Procedures (3 items)o Pain Management: Priority Finding (Medication, RM MN RN 8.0 Chp 12)

Patient is prescribed Morphine. What will you be assessing for to report to the physician? Decreased respirations

Potential for Complications from Surgical Procedures and Health Alterations (2 items)o Disorders and Cancers of the Male Reproductive System: Postoperative Care (RM AMS RN 8.0

Chp 77, System Disorder)Patient has a TURP. It is 24hrs post-op and what finding would you report to the MD? Burgundy colored urine.

Systems Specific Assessment (1 item)o Complications of Diabetes Mellitus: Fluid Management (RM AMS RN 8.0 Chp 97, System

Disorder)Physiological Adaptation (21 items)

Alterations in Body Systems (10 items)o Cancer Treatment Options: Skin Care (RM AMS RN 8.0 Chp 104, System Disorder)

No lotion. Don’t wash off the tattoo. You can use mild soap and water.

o Complications Related to the Labor Process: Umbilical Cord Prolapse (RM MN RN 8.0 Chp 16, System Disorder)Priority intervention? Turn the patient to the side, put on a sterile glove and stick your hand in her vajayjay to relieve pressure on the cord. I said monitor patient vital signs, FHR, and increase IV fluid rate so I was wrong.

o HIV/AIDS: Transmission (RM AMS RN 8.0 Chp 100, System Disorder)I said use a condom with petroleum lubricant, wrong. I think the answer is clean contaminated areas with bleach. Another option was clean clothing/sheets with cold water.

o Medications Affecting Coagulation: Treatment Effectiveness (Medication, RM Pharm RN 5.0 Chp 25)Something about PTT or INR

o Oxygen Therapy and Mechanical Ventilation: Low-Pressure Alarm (Nursing Skill, RM AMS RN 8.0 Chp 21)I had no idea what the low-pressure alarm meant so I got this wrong. I picked suction secretions. I think another option was check for kinks or tubing disconnections.

o Skin Infections and Infestations: Findings to Report (RM NCC RN 8.0 Chp 30, System Disorder)All I have to say about this one is look at the chart. It asks you what to report. I picked red scaly lesions, which was wrong. Other options were red round rings and clusters of erythema papules.

Fluid and Electrolyte Imbalances (1 item)o Fluid and Electrolyte Imbalances: Assessment Findings (Nursing Skill, RM Fundamentals 7.0 Chp

56) Hemodynamics (2 items)

o Cardiovascular Diagnostic and Therapeutic Procedures: Pulmonary Artery Wedge Pressure (Diagnostic Procedure, RM AMS RN 8.0 Chp 31)What does increased PAWP indicate? Left ventricular failure

Illness Management (2 items)o Diabetes Mellitus: Diabetic Ketoacidosis (RM NCC RN 8.0 Chp 33, System Disorder)

Priority intervention: Start a line Medical Emergencies (1 item)

o Burns: Priority Action (RM NCC RN 8.0 Chp 32, System Disorder)Check the mouth for soot or smoke inhalation

Unexpected Response to Therapies (3 items)o Head Injury: Complication (RM AMS RN 8.0 Chp 15, System Disorder)

Perform GCS first. Increasing restlessness can indicate increased ICP.o Oxygen and Inhalation Therapy: Toxicity (RM NCC RN 8.0 Chp 16, System Disorder)

Hypoventilation