Only $35.99/year

Terms in this set (83)

John Wiggins

Scenario 1
You respond to Mr. Wiggins call light. He is complaining that his headache is worsening. You tell the pt that you must do a assessment before you can give him any medication. his Glasgow coma scale is 15. his VS are BP 168/80, T 98.9, P 98, R 24. Complete the neurological assessment.

Scenario 2
Your neurological assessment concludes the following: A/O x4 appears normal, left pupil is slightly larger than his right and is +3 to react to light, there is no evidence of any drainage, cranial checks are WNL, and extremity strength is slightly diminished. Glasgow coma scale is 13.

Scenario 3
After sharing findings w/ the provider, he orders the following: 1. Contact radiology for a stat CT scan of the head. 2. Start a saline lock. #. Neurological checks q30 minutes. 4. Hold coding, administer Tylenol 1g 5. NPO

Scenario 4
You accompany transport of Mr. Wiggins from radiology back to his room. You check his VS and they are: BP 185/75, P 58, R 28 and irregular, T 99.1, PaO2 98. His GCS is now 10. neuro check: A/O x2, left pupil is larger than his right and is +5 to react to light, their is no evidence of any drainage, cranial checks are all normal and pt is less cooperative for extremity strength assessment. Upon finishing the assessment, Mr. Wiggins experiences a generalized tonic/clinic seizure.

Scenario 5
The HCP has heard from the radiologist that there is a sub Duran hematoma on the left side of the brain. Pt needs emergency neuro surgery in order to stop the b led and relieve the pressure on the brain. His GCS is now 7. Prepare the pt for emergency neuro surgery.
Joyce Workman

Scenario 1
Mrs. Workman presented to the diabetes clinic and provided a 24-hr food recall. She was then sent to the lab for ordered lab tests. She is to notify the nurse upon return to the clinic from the lab. Pt has requested more information on her diabetes and states she does not understand why she "should be concerned" w/ blood glucose control in both the short and long term.

Scenario 2
The nurse is providing information on nutrition to assist Mrs. Workman in managing her DM II.

Scenario 3
Mrs. Workman presented to the Diabetes clinic for further evaluation of her diabetes, and lifestyle changes. She is planning on attending several of the classes that are being offered. Pt is requesting information on appropriate exercise programs. She has attendee the diabetic meal prep classes, but still struggles with her dx of diabetes.

Scenario 4
Day 3 of hospitalization at 12:30, Mrs. Workman calls the RN and complains of cool clammy skin, anxious, weak, hungry but nauseous, and slightly confused. April 10, 1245, Blood glucose level is 40 mg/dL HCP has ordered 1.) hypoglycemia protocols for BG level < 60 mb/dL 2.) regular insulin SQ 20 unit for BG level > 160 mg/dL 3.) monitor BG levels q 4 hours and PRN 4.) IVF D5 0.45% NS at 125 mL/hr 5.) 1800 calorie ADA dietary and teach pt about diet changes

Scenario 5
3 months later, Mrs. Workman has returned to the Diabetes clinic having lost 20 lbs and is requesting to stop taking the metformin (glucophage). HbA1C is 7.5%. She is also complaining of new onset diarrhea.
Scenario 1
Ask Mrs. Workman to explain what she knows about diabetes.
Explain in layman terms what diabetes is and how it can adversely affect the body if left untreated.
Discuss lifestyle choices that can lead to type II DM.
Discuss lifestyle choices that can be beneficial in the mgmt of type II DM
Document teaching and understanding of teaching using teach back process.

Scenario 2
Assess Mrs. Workman's knowledge of nutrition and preferred foods.
Ask Mrs. Workman for a. 24-hr diet recall
Educate Mrs. Workman on healthier options based on the 24-hr diet recall
Provide Mrs. Workman w/ a Mediterranean style diet plan
Ask Mrs. Workman to demonstrate understanding using the teach back method.

Scenario 3
Assess the pt's preferred exercise regimen
Ensure the pt does not have a pre-existing conditions that would limit exercise routines
Provide an exercise routine that has been developed in conjunction w/ Mrs. Workman
Review w/ Mrs. Workman safety measures related to. Blood glucose levels when exercising.
Use teach back method and document education provided

Scenario 4
Assess pt blood glucose level
Provide a 20 gram carbohydrate liquid for consumption
Provide another 20 ram carbohydrate liquid for consumption in 15 minutes for unresolved symptoms
Reassess the blood glucose level in 15 minutes
Provide additional teaching to the pt regarding prevention strategies for hypoglycemia

Scenario 5
Assess Mrs. Workman's understanding of her medication, diet, and exercise regimen
Explain to Mrs. Workman about carbohydrate foods causing GI upset
Explore new ways of cooking for diabetes mgmt
Provide information to Mrs. Workman on support groups for diabetes
Document education provided
Mary Barkley

Scenario 1
Right after admission the nurse finds her walking down the hall trying to leave. Redirect the pt back to her room.

Scenario 2
Mrs. Barkley is becoming more adamant about leaving while her physical condition continues to deteriorate. Her temp is 100.8, BP 100/62, P 92, R 21, SpaO2 91. The nurse auscultation fine crackles in her lungs bilaterally, but her sputum is clear. She is oriented x3 but at times seems to be talking to someone in the room when no one is present. She told the nurse that she does not want a breathing tube, but her family has told the nurse by phone that they want every effort done to save her. She pulled out her IV and it will need to be restarted for her IV I pro dose that is due now. The nurse has another high acuity admission that has just arrived from the ER.

Scenario 3
Ms. Barkley continues to deteriorate and is shouting for her family. She is disoriented and believes the nursing staff is trying to kill her. Her temp is 101.3, BP 98/58, P98, R22, and PaO2 86%. the PCT is requesting to be relieved as the pt keeps pulling at the PCT's mask to see who she is. The RN calls the attending provider requesting that Ms. Barkley be txf to ICU but there are no rooms available. Instead the RN is told to put the pt on telemetry and call RT for a CPAP trial.

Scenario 4
The pt continues to be combative while attempting to initiated the CPAP trial. Healthcare provider has ordered Haldol in order to sedate the pt. VS are deteriorating, BP 90/58, P 116, R 28, PaO2 85%, T 102.0. Enter the room after taking VS.

Scenario 5
Ms. Barkley requires emergency intubation, and the HCP on scene suggests that the pt did not want to be intubated. You, the RN, are concerned because the family asked for everything to be done and the pt never signed a DNR order. The pt has now been sedated, and RT is temporarily maintaining their saturation's w/ effective valve mask ventilation.
Scenario 1
Have pt put on a mask
Wash hands and don PPE
Use therapeutic communication to comfort pt.
Guide her back to her room while teaching her that her isolation is to protect others including her family.
Set her up w/ a video chat w/ her family

Scenario 2
Alert the charge nurse that Ms. Barkley is deteriorating and you need to remain with her. Ask the charge nurses to assign another nurse to the new admission.
Wash hands and dawn PPE and restart IV and secure w/ gauze wrap.
Have an aide sit w/ Ms. Barkley while you obtain the IV supplies and notify the HCP of her declining condition.
Initiate O2 @ 2LNC
Secure sitter to stay w/ Ms. Barkley after the insertion of the new IV.

Scenario 3
Contact RT for a stat CPAP trial
Obtain telemetry set-up and take to pts room
Ask PCT to secure mask better, and inform her that there is no replacement for her.
Don PPE and have PCT assist w/ connecting the pt to telemetry
Assist RT to initiate CPAP trial

Scenario 4
Call rapid response, RRT
Continue to assist RT in ventilation.
Give SBAR to RRT upon arrival
Call for crash-cart for possible intubation
Ensure documentation of time and events of RRT

Scenario 5
Encourage the HCP to consider intubation in the absence of signed DNR.
Offer to contact family for HCP.
Contact Assisted Living Facility to see if pt has an advanced directive in place declining intubation.
Notify the HCP of absence of Advanced Directive and the families request to intubate.
Assist w/ intubation and logistics of managing the critical pt on the floor.
Scenario 1
Perform full assessment and provide anti-nausea medicine.
Provide comfort in pre-surgical room Mr. Dominec.
Check surgical consent for correct procedure and make sure operative site is marked.
Inform his partner that everything is being done to keep him comfortable.

Scenario 2
Educate about recovery from appendectomy and care to wound.
Discuss his understanding about the plan of care.
Discuss follow up with his doctor.
Offer assistance in providing more information about treatment options for newly dx AIDS pts.
Determine from medical record if partner is aware of his recent AIDS dx.

Scenario 3
You discuss this cough w/ Mr. Dominec to determine how long he has had it.
Notify Dr of change in condition in particular; unproductive cough and low-grade fever.
Explain to Mr. Dominec your concern for this opportunistic infection and usual tx.
Explain that he will probably not be going home at least until his Dr. sees him
Notify charge nurse that d/c will probably not occur today.

Scenario 4
Inform pt about the progression and risk a PCP infection has for a pt w/ AIDS.
Obtain and provide the ID MD contact information for him.
Encourage Mr. Dominec to discuss w/ his partner his best tx options.
Take VS before leaving the hospital again
Document and provide copy for Mr. Dominec to share w/ his follow up appointment tomorrow.

Scenario 5
This information is HIPAA protected and you cannot share anything w/ them.
Remind staff that Universal Precautions are practiced at this hospital for all pts regardless of known ID's.
Leave the break room and not continue in conversation.
Report this activity immediately to the hospital privacy officer.
report to charge nurse/head nurse the need for staff education.
Sarah Kathryn Horton

Scenario 1
You hear a scream coming from Mrs. Horton's room. Upon entering the room, it was noted that she appeared to be asleep, eyes closed, possibly experiencing a bad dream

Scenario 2
Ms. Horton did not rest well last night, and woke up frequently w/ episodes of crying. This morning, at shift report, she states that she is scared to leave the hospital after the shooting incident. Pt is complaining of pain in her shoulder and thigh 7/10

Scenario 3
HCP orders 1.) Dressing change q 24 hours to RT thighs and rt shoulder. 2.) Pre medicate Morphine Sulfate 4mg IV 15 minutes prior to dressing change 3.) Wet to dry dressing w/ triple abx ointment to wounds. 4.) Sulfamethoxazole 800 mg, Trimethoprim 160 mg (Bactria DS) 1 tablet PO daily 5.) Consult Psychology for referral 6.) Encourage PO fluids

Scenario 4
Ms. Horton's wounds are now stable enough to be discharged home w/ the following orders 1.) d/c home 2.) Paroxetine (Paxil) 30mg PO everyday. 3.) Follow up w/ regular HCP in 1 week 4.) Sulfamethoxazole 800mg, Trimethoprim 160mg (Bactria DS) 1 tablet PO daily for 10 days 5.) Hydrocodone 5 mg Acetaminophen 325 mg (Norco 5mg) 1-2 tablets every 3-4 hrs PRN moderated to severe pain #30.

Scenario 5
The nurse has Ms. Horton in the wheelchair ready to be taken down to the lobby by the UAP. As Ms. Horton is waiting by the exterior hospital door, construction workers are on the road working w/ a jackhammer. Ms. Horton hears the jackhammer and then screams and dives to the floor.
Scenario 1
Wash hands and don gloves
Obtain blood for lab testing and blood culture #1
Obtain blood for lab testing and blood culture #2
Initiate IV fluids to peripheral site
Administer levofloxacin as ordered

Scenario 2
Ask the pt if she knows where the syringe came from and what was in the syringe
Assess VS and perform a neurological focused assessment
Place the syringe in a biohazard bag and place a pt id label on bag
Notify the charge nurse and house supervisor of the syringe found in bed
Notify the physican of assessment findings and await further orders

Scenario 3
Assess VS and perform head to toe assessment
Therapeutic communication w/ pt
Call HCP for change in health status and receive orders for anxiety medication
Prescribed medication for anxiety must be administered
Assess for therapeutic response to medications

Scenario 4
Ask Mrs. Pittman if she remembers the conversation w/ the physician and if she has any further questions that need to be addressed.
Perform pre op checklist
Ensure signed consents are on the chart
Ensure type and cross match for blood products is complete and results are in electronic medical record
Have IV abx amiable to administer when surgery calls for the pt to be transferred to pre op area.

Scenario 5
Pre-medicate for pain w/ prescribed medication
Don clean gloves to remove old dressing
Monitor neurovascular status assessing skin color, temp, sensation and pulses above amputation.
Don 2nd set of clean gloves to provide stump care. The wound has been sutured and is not and open wound/stump.
Elevate stump and reward w/ a dry clean dressing.