Title RECALLS 7 - NP5 - SC ✅

D. Case report 64. What is the population? A. All post-op patients B. Orthopedic post-op patients C. Physiotherapy staff D. Nursing students 65. Which instrument measures pain intensity? A. Morse Fall Scale B. Numeric pain rating scale C. Apgar score D. GCS Situation: You are the charge nurse on a medical-surgical unit during a busy shift. Four patients need attention: (1) a patient with COPD reporting shortness of breath, (2) a patient with blood glucose 320 mg/dL waiting for insulin, (3) a post-op cholecystectomy patient with pain score 8/10, and (4) a patient with stage 2 hypertension waiting for medications. 66. Which patient do you see first? A. COPD patient with dyspnea B. Hyperglycemic patient C. Post-op pain patient D. Hypertensive patient 67. Which action for the COPD patient is most urgent? A. Administer pain medication B. Position in high Fowler’s C. Provide orange juice D. Offer emotional support 68. Which task can be delegated to a nursing assistant? A. Blood glucose monitoring B. Adjusting oxygen flow C. Pain assessment D. Teaching breathing techniques 69. Which intervention for the hypertensive patient is correct? A. Encourage fluid restriction immediately B. Administer antihypertensives as ordered C. Place in Trendelenburg position D. Give a high-sodium snack 70. Which documentation is a priority for the post-op patient? A. Surgical site drainage B. Pain score and intervention C. Family’s questions D. Time of last meal Situation: A 65-year-old diabetic patient presents to the ER with foot ulcers, fever 38.5°C, and BP 90/60 mmHg. Blood glucose is 420 mg/dL. The patient is confused and has poor peripheral pulses. 71. What is the first priority? A. Treat the fever B. Start fluid resuscitation C. Administer sliding-scale insulin D. Obtain wound culture 72. What does confusion most likely indicate? A. High anxiety B. Pain C. Hypoperfusion D. Neuropathy 73. Which wound assessment is most important? A. Wound color B. Wound odor C. Wound size D. Surrounding tissue perfusion 74. Which order should the nurse question? A. IV normal saline bolus B. Sliding scale insulin C. High-dose corticosteroids D. Wound culture before antibiotics 75. Which complication is most likely? A. Retinopathy B. Sepsis C. Osteoarthritis D. Cushing’s syndrome Situation: You are assigned to four post-operative patients after abdominal surgeries. One client has an NG tube connected to suction, one has a urinary catheter draining minimal urine, one reports increasing abdominal pain unrelieved by analgesics, and one is requesting discharge teaching about wound care. 76. Which patient should you assess first? A. Patient with unrelieved abdominal pain B. Patient requesting discharge teaching C. Patient with NG tube to suction D. Patient with minimal urine output 77. What does minimal urine output after surgery usually indicate? A. Infection is present B. Patient has renal failure C. Low perfusion or hypovolemia D. Catheter obstruction is expected 78. Which action is safe to delegate to a nursing assistant? A. Assess abdominal distention B. Empty the urinary catheter bag C. Evaluate NG tube placement D. Perform discharge teaching 79. Which teaching point is priority for the client with an NG tube? A. Frequent hand hygiene B. Avoidance of chewing gum C. Need to maintain tube placement and suction D. Taking laxatives to prevent constipation 80. What is the best documentation for the client with pain? A. “Patient seems uncomfortable” B. “Patient complains of pain” C. “Pain score 8/10, analgesic given, reassessment planned in 30 min” D. “Gave morphine” Situation: You are working in the ED with multiple trauma clients after a bus accident: (1) a client with suspected cervical spine injury and shallow respirations, (2) a client with an open femur fracture bleeding heavily, (3) a client with abdominal pain rating 7/10, and (4) a client with minor scalp lacerations. 81. Which client do you assess first? A. Cervical spine injury client B. Femur fracture client C. Abdominal pain client D. Scalp laceration client 82. Which intervention is priority for the femur fracture client? A. Give pain medication B. Apply direct pressure to the wound C. Elevate the head of the bed D. Perform neurological checks 83. Which client is stable and can wait? A. Cervical spine client B. Femur fracture client C. Abdominal pain client D. Scalp laceration client 84. Which team member is best for splint application under supervision? A. Experienced nursing assistant B. Student nurse C. Respiratory therapist D. Charge nurse only 85. What is most important to document for the cervical spine injury client? A. Pain score and medication B. Neuro status and airway management C. Patient’s emotional response D. Time of arrival Situation: On a medical-surgical floor, you have patients with different conditions: (1) pneumonia on IV antibiotics, (2) post-thyroidectomy client reporting hoarseness, (3) diabetic with foot ulcers awaiting dressing change, (4) client with chronic back pain requesting additional opioids. 4 | Page