Nursing Practical Test (Continued)

As we continue to celebrate Nurses Week and special efforts for humanity, here is the continuation of our Nursing Practical Test for you to still try on. In case you miss any questions, adequate explanations have been provided. We highly recommend you to take this test.

  1. 10 questions in all. There is no time constraint, so take your time. You need to score at least 80% to pass
  2. You can retake the test at any time. We recommend you share with friends too.
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#1. Matthew is a 26-year-old who has been admitted to the ICU following a motor vehicle accident. Upon assessment, it is noted that he has a positive Cullen sign. What does this indicate?

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A Cullen sign is defined as ecchymosis involving the umbilicus, and is an indication of retroperitoneal hemorrhage. Ecchymosis which involves the flanks is called the Grey Turner sign, and also indicates retroperitoneal hemorrhage. Retroperitoneal hemorrhage is difficult to diagnosis clinically, and these signs typically take hours or days to appear.

#2. If bowel sounds are audible when auscultating Matthew's lungs, what injury may he have sustained?

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If bowels sounds are audible when auscultating Matthew’s breath sounds, a diaphragmatic tear should be suspected. Assessment of the trauma victim must be very systematic, and focuses on priorities in resuscitation and diagnosis based on hemodynamic stability and amount of injury. The ACLS protocol is followed, which includes identifying and treating the most life-threatening injuries first. Significant blunt trauma injuries are easily missed if a systematic process is not followed, as more dramatic injuries may receive the most attention.

#3. If a patient sustains acute renal failure (ARF) secondary to cardiogenic shock, what type of renal failure is this considered?

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Acute renal failure (ARF) which occurs secondary to cardiogenic shock is considered prerenal failure. ARF, also known as acute kidney injury (AKI) is classified according to etiology: prerenal failure occurs as a response to hypotension and volume depletion, intrinsic failure occurs in response to damage within the kidney itself from various toxic, ischemic or inflammatory causes, and postrenal failure occurs from urinary flow obstruction of any cause.

#4. The RIFLE classification system provides a definition and classification system for acute renal failure (ARF). What does the "R" in the RIFLE acronym refer to?

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The “R”in RIFLE stands for Risk of renal dysfunction. The remainder of the acronym represents the following: Injury to the kidney, Failure or Loss of kidney function, and End-stage kidney disease. These indicators are used in the context of glomerular filtration rate (GFR) or urine output (UO) criteria, or both.

#5. Andrew is a 47-year-old with advanced amyotrophic lateralizing sclerosis (ALS). He requires total assistance for positioning, bathing and mobility. His swallowing is impaired, so he takes nothing by mouth and receives nutrition through tube feedings via a gastrostomy tube. Based on his current condition, what type of asphyxia may Andrew be most susceptible to?

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Due to his weakness and inability to position himself, Andrew is susceptible to positional asphyxia. Positional asphyxia is associated with compromised respiratory function due to external factors which impair chest expansion, or create occlusion of the upper airway due to abnormal body position. Victims of positional asphyxia are unable to remove themselves from situations which compromise their respiratory status for various reasons, including cognitive and coordination impairment due to intoxication, sedation, neurological abnormalities, impaired consciousness, physical impairment or restraint.

#6. Ramona is a 21-year-old who has been admitted to the ICU after suffering an anaphylactic reaction during dinner due to peanut sauce in a dish that the host didn't tell her about. She was stabilized in the emergency room with IV epinephrine and IV diphenhydramine. However, 4 hours after being admitted to the ICU she becomes anxious, develops hives and begins to have difficulty breathing. What is the most likely cause for Ramona's symptoms?

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Ramona is experiencing biphasic anaphylaxis. The onset of the late phase varies, but usually occurs within 8-10 hours. Risk factors associated with biphasic anaphylaxis include severity of the initial phase, delayed or subtherapeutic dosing of epinephrine, initial airway edema or hypotension, delayed onset of symptoms after exposure, and a history of previous episodes of biphasic anaphylaxis.

#7. Madge is a 91-year-old nursing home resident with a history of dementia and atrial fibrillation who has been admitted to the ICU for treatment of pneumonia. As you are performing her bed bath, you note bruising around her breasts and genital area. What potential issue should be of major concern in Madge's situation?

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Bruising around the breasts and genitals should trigger concern for sexual abuse. Elder abuse is a growing problem in America, and nurses are uniquely positioned to recognize and intervene on the behalf of vulnerable populations, such as the elderly. According to the National Center of Elder Abuse (NCEA), major types of elder abuse include physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, financial or material exploitation and self-neglect.

#8. Jerry is a 55-year-old veteran who has been admitted after a motor vehicle accident with multiple injuries. His friend reported that he had been using synthetic marijuana prior to the accident, and that he also sees a psychiatrist at the VA hospital for an unknown diagnosis. He stated that Jerry sometimes gets "hyper" for no reason, starts "ranting" and becomes violent. Of the following, which general psychiatric disorder is characterized by a pattern of aggression or violence which includes irritability, agitation, and violent behavior during manic or psychotic episodes?

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The pattern of aggression or violence of bipolar disorder includes irritability, agitation, and violent behavior during manic or psychotic episodes, which is highly co-morbid with substance use, which worsens the prognosis. The Diagnostic and Statistical Manual of Mental Disorders identifies several disorders which may carry a higher risk for violent and/or aggressive behaviors, which is a concern when patients with co-morbid psychiatric disorders are admitted to the ICU or general floor for medical-surgical needs.

#9. Emily has been admitted to the ICU after being found unconscious on the street. She was found to be in diabetic ketoacidosis (DKA) with a blood sugar of 785. Emily is homeless, has had multiple admissions for DKA, and could benefit from use of an insulin pump, but says she has been repeatedly told, "Those are for rich people." What ethical principle supports Emily's right to have an insulin pump?

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The ethical principle of justice supports Emily’s right to access of an insulin pump, since her socioeconomic status should not impact her ability to receive care. Nurses must advocate for equal treatment for all patients, regardless of circumstances.

#10. Tonya is a 44-year-old with a history of substance abuse who has been admitted to the ICU status-post left lateral thoracotomy. She has been clean and sober for 14 years, and discussed her status with her physician prior to her surgery. When she arrives from the operating room, she is in a great deal of pain. Post-operative pain management orders are for acetaminophen only. When you ask the surgeon for an opioid for pain management, he states, "She's an addict. She doesn't need anything for pain." What should your first response be?

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Discussing the situation with the doctor privately and professionally will allow the doctor the opportunity to feel less threatened by your concerns. This provides the opportunity for both parties to express viewpoints, understand each other’s perspectives, and build rapport, which will ultimately benefit the patient.




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