Medical-Surgical RN A Prophecy Test / Relias Learning Answered 2023.

Medical-Surgical RN A Prophecy Relias Test, Answered

1.2 milligrams is equal to how many micrograms?

– 1200 mcg

Your post-op patient has a Jackson-Pratt (JP) drain in place. How do you ensure

effective drain function?

– Compress the drain, then plug the bulb to establish suction

Your male patient complains of discomfort while inflating the balloon during insertion

of an indwelling urinary catheter. What would be the MOST appropriate action?

– Deflate the balloon, advance the catheter further, then reinflate the balloon

Your patient has symptomatic anemia but is refusing a blood transfusion for religious

reason. What is an appropriate response?

– Respect his wishes and notify the provider

Your patient is admitted with diverticulitis. What type of diet do you expect to be

ordered for the patient?

– broth, jello, soft fruit no skin,

You were hired to work the medical unit and when you arrive at work the charge

nurse has assigned you to the post-surgical unit since they are understaffed. Which is

the MOST appropriate action?

– Report to the post-surgical unit.

What is a proton pump inhibitor, such as pantoprazole (Protonix) used for?

– Acid Reduction

Which adaptive equipment would be MOST appropriate to use for a severely

contracted patient who is unable to bear weight when transferring from the bed to the

chair?

– Patient lift (e.g., Hoyer)

Which tool should you use to assess pain in you 80-year-old patient with severe

dementia?

– PAINAD scale

Your patient is admitted from the ED with failure to thrive and advanced dementia.

You note he is extremely underweight, appears unbathed for some time, and has a

stage 4 pressure injury to his coccyx. You were told in report that he lives at home

with family members. What should you do?

– Notify the charge nurse and social worker of your concerns.

Your 85-year-old patient with atrial fibrillation fell at home 3 days ago. You notice

she has been having several episodes of acute confusion since being admitted to your

unit. What is the MOST important order you should anticipate from the provider?

– Stat CT of head

Your patient has a temp of 102.3 F, HR 122, and has had 15 mL of urine from the

indwelling urinary catheter in the last 2 hours. What is your patient MOST likely

experiencing.

– Sepsis

What type of personal protective equipment (PPE) is applied prior to entering a room

for a patient with C. diff?

– Gown and gloves

Your patient continues to pull at their IV site located in their left forearm despite

verbal reminders and increased observation. The nursing assistant recommends using

soft mitt restraints on the patient. What is your recommendation?

– Request an order for soft mitts as they are the least restrictive

Your patient was admitted for a hypertensive crisis and has a history of HTN,

Parkinson’s disease, depression, and alcohol use. On his second hospitalized day, you

notice he is more anxious and restless than his baseline. What would be your FIRST

nursing intervention?

– Ask the patient when his last drink of alcohol was.

What is the BEST indication of an acute neurological problem?

– Change in level of consciousness

While in a supine position your patient states, “I’m tired and cannot catch my breath.”

Physical assessment reveals jugular vein distention and a third heart sound (S3). These

symptoms are indicative of what condition?

– Heart failure

Your new admission presents with a cough, unintentional weight loss, frequent night

sweats, and bloody sputum. What type of isolation precautions should you initiate, if

any?

– Airborne precautions

Patients with diabetes are at high risk for complications from damage to what body

areas?

– Nerve and kidney damage

If your patient with a known history of diabetes is displaying symptoms of

diaphoresis, cool skin, lethargy, and shakiness. What is your first action?

– Check the patient’s blood glucose level.

Your patient tells you, “I hope I don’t die, but if I do I don’t want to be brought back.?

You notice on her chart and wrist band that she is a full code. What would be the

MOST appropriate action?

– Discuss code status with the patient and follow up with provider to ensure the

medical record reflects her wishes.

Your coworker posted photos on social media from a birthday party they had for her

in the unit breakroom. What should be your NEXT course of action?

– No action is necessary because no PHI was displayed.

Your new patient understands very limited English. How should you communicate

with them when completing the admission assessment?

– Use the organization’s interpreter services.

You are caring for a patient with a history of diabetes mellitus. You walk into the

room and find the patient lethargic and diaphoretic. What is your first action?

– Obtain capillary blood glucose level.

Your patient is 4 hours post open appendectomy and has not voided yet. You note his

lower abdomen is distended. What should you do NEXT?

– Perform a bladder scan

A patient with peritonitis presents with tachycardia, hypotension, and dehydration.

What other assessment finding would you anticipate as part of your physical

assessment?

– Severe abdominal pain or rebound tenderness

What is the EARLIEST sign indicating increased intracranial pressure (ICP)?

– Level of consciousness

In addition to pain, pallor, and pulselessness, a neurovascular assessment also includes

checking for: – Paresthesia and paralysis

You received a report on a patient that sustained a right hemisphere CVA 48 hours

ago. What do you expect the patient to exhibit?

– Left sided weakness of the leg, arm, and face.

You are ordered to give digoxin (Lanoxin). Your patients vital signs are: BP 130/70,

Temp 97.9F, HR 52, RR 16, O2 Sat 100% on room air. What should you do NEXT?

– Hold digoxin (Lanoxin) and call the provider

Upon entry to your patient’s room, you find her sitting in High Fowler’s position and

complaining of shortness of breath. Her respiratory rate is 34 breaths/min and O2 sat

is 84%. Which mode of oxygen delivery would MOST likely reverse these

symptoms?

– Non-rebreather mask

Your patient is on contact precautions for active MRSA. What proper PPE should you

use before entering the room?

– Gown and gloves

Your patient recently had a G-tube placed and intermittent enteral feedings have been

initiated. What symptoms may indicate intolerance to the feedings?

– Vomiting and diarrhea

Upon entering your patient’s room, you note that they are having a seizure. What is

your FIRST action?

– Position the patient on their side to maintain the airway.

Your 18-year-old female patient was admitted with dehydration secondary to anorexia

nervosa. During your assessment you note she has a flat affect and says, “I just want

to die. I’m tired of my life.” What should be your FIRST intervention?

– Stay with the patient and ask fi she has a plan to carry out this wish.

Your patient has a non-productive cough and presence of secretions in his

tracheostomy. Prior to suctioning the patient, what should you do FIRST?

– Hyperoxygenate patient.

Your patient takes 5 mg of warfarn (Coumadin/Jantoven) dailyand reports having

black colored stool today. What do you most likely suspect?

– Gastrointestinal bleeding

Your new patient was admitted with blunt force trauma to the abdomen following a

motor vehicle accident (MVA). A NG tube is in place for decompression; however,

you note during the assessment that the stomach is rigid and hard during palpation.

What condition do you suspect?

– Hemorrhage

Which of the following nursing diagnoses is MOST important for a patient with

chronic obstructive pulmonary disease (COPD)?

– Impaired gas exchange

You have a patient going for dialysis. Their medications include lisinopril (Prinivil),

ondansetron (Zofran), famotidine (Pepcid), and atorvastatin (Lipitor). Which

medication would you possibly hold and seek clarification?

– famotidine (Pepcid)

What is an early symptom that the patient is developing a complication of heart

failure?

– Edema in the legs and feet

Black and tarry colored stools are CLASSIC symptoms of what condition?

– Bleeding gastric ulcer

You have 4 patients who have high priority needs. One needs to go to surgery, one

needs STAT lab draws from a PICC line, another has chest pain rated 8/10, and

another needs toileting. Which patient should you tend to FIRST?

– The patient with chest pain

Your patient with Hepatitis C exhibits signs of jaundice and a distended abdomen.

What procedure would you anticipate being performed by the provider at the bedside

for this patient?

– Paracentesis

What is clubbing of the fingers MOST likely associated with?

– Chronic oxygen deficiency

A patient on warfarin (Coumadin/Jantoven) has an INR of 6. Which medication would

you anticipate administering?

– Vitamin K

To reduce the risk of infection and phlebitis in an adult patient with a peripheral IV,

what is the MINIMUM duration the catheter should remain in place before ROUTINE

replacement?

– 72 hours

You are caring for a patient post lobectomy with a chest tube in place for drainage.

What is a priority in care for this patient?

– Encourage the patient to cough and deep breathe.

What patient population is the pneumococcal vaccine, PPSV23 indicated for?

– Adults aged 65 years and older

Your patient with stave IV terminal lung cancer continues to experience increasing

pain as each day passes. What would you anticipate the provider ordering for this

patient?

– Palliative care consult

The provider gives you a telephone order to explain a surgical procedure to your

patient and obtain surgical consent. How should you respond?

– Inform the provider that explaining the procedure is outside the nurse’s scope of

practice.

The patient has diltiazem HCl (Cardizem CD) ordered and is requesting the capsule be

mixed into her morning yogurt. How should you respond?

– “Sorry, it is a slow-release medication that cannot be opened or crushed.”

Your 72-year-old male patient is admitted for colon cancer related complications and

has a history of CHF, stroke, and a recent knee replacement. Based on your patient’s

risk assessment, you determine he is at risk for venous thromboembolism (VTE).

What is an appropriate VTE prophylaxis order for this patient?

– Enoxaparin (Lovenox) once daily and intermittent pneumatic compressions (IPC)

You receive a provider’s order that is not consistent with evidence-based practice.

What is your FIRST step?

– Clarify the order with the provider.

When would sucralfate (Carafate) 4 times daily be scheduled for?

– 1 hour before meals and at bedtime

Your patient’s morning labs revealed a hemoglobin level of 6.3 and hematocrit of 18.

What blood product do you expect to administer?

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– PRBCs

Your 68-year-old patient is a Type 1 diabetic with a history of schizophrenia and

exhibits signs and symptoms of tardive dyskinesia. What long-term medication is

associated with signs and symptoms of tardive dyskinesia?

– risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone,

lurasidone, chlorpromazine, fluphenazine, haloperidol, perphenazine

Your 80-year-old patient is being discharged home post CVA. She lives alone, yet still

requires assistance with ADLs. What referral is MOST appropriate to ensure her

needs are met?

– Case Manager

Central Telemetry calls and tells you your patient is experiencing bradycardia. What is

the first thing you should do after entering the room?

– Assess the patient and take vital signs.

Your patient is currently under 1:1 observation for suicide precautions. He states he

needs to have a bowel movement and would like some privacy to use the bathroom.

What is the MOST appropriate response?

– “I must be within an arms’ length view of you at all times for your safety, including

while using the bathroom.”

A female patient requests a female nurse to provide care for her based on her religious

beliefs. What is the MOST appropriate action to take?

– Accommodate her request if possible.

Your patient is a 40-year-old female with a recent history of hair loss, extremely dry

skin, a nd a 20-point weight loss in the last 3 weeks. She also exhibits occasional

episodes of tremors in her upper extremities. What condition do these symptoms

MOST likely indicate?

– Hyperthyroidism

Insulin lispro (Humalog) is orders via sliding scale a.c. for your patient with diabetes.

When is the best time to administer insulin lispro (Humalog)?

– 15 min before the meal arrives

Which of the following would be used as part of the preop procedure to prevent

infection?

– Prophylactic antibiotics

Two days after surgery, your 72-year-old patient is showing signs of agitation and

confusion, which is not his baseline. The severity fluctuates throughout the day. His

medications include hydromorphone (Dilaudid), amlodipine (Norvasc), alprazolam

(Xanax), and carbidopa-levodopa (Sinemet). What condition do you MOST likely

suspect?

– Delirium

What is the proper technique when suctioning a tracheostomy?

– Suction in a circular motion while the catheter is being pulled out.

Your new patient admitted for cholecystitis expresses she has a history of anxiety

disorder. She is feeling panicked and does not think she can handle staying in the

hospital for her surgery. What action is MOST appropriate for you to take?

– Sit calmly next to her and offer her compassion and a sense of security.

The provider orders and IV infusion of D5W 1000 mL to infuse over the next 6 hours.

How manymLs per hour should the IV pump be set to?

– 167 mL/hr

You are assigned a new admission and note a Braden score of 11 after completing

your assessment. Which interventions would be MOST appropriate based on your

assessment?

– Turn q 2hours, request nutrition consult, request low airloss mattress.

Your patient may have tuberculosis TB) and is placed in airborne precautions. What

test would you expect to be ordered?

– Acid-fast bacilli sputum

Your patient starts to complain of difficulty breathing while laying down, and states

that he has been coughing up pink sputum. While performing your assessment, you

notice jugular vein distention and coarse crackles in both lungs on auscultation. What

diagnosis do you suspect?

– Congestive heart failure

You received a patient post op transurethral resection of the prostate (TURP). Which

of the following symptoms would cause you the MOST concern?

– Hemorrhage and hypotension

Your patient with C. diff (Clostridioides difficile) has a family member about to leave

the room. What education about performing hand hygiene should you give?

– Hand hygiene with soap and water

Your patient has a diagnosis of urinary tract infection (UTI) and is currently taking

medication that has recently made her urine reddish-orange. Which of the following

medications would cause this side effect?

– Phenazopyridine (Pyridium)

Your patient is taking digoxin (Lanoxin) and has a potassium level of 3.0. How might

this affect the patient?

– Increase risk of digoxin toxicity

You are preparing to hang 1 unit PRBC’s to administer to your patient. The patient

states, “I don’t take blood products.” What is the MOST appropriate response?

– “You have the right to refuse the blood transfusion. I will inform the provider of

your decision.”

An older adult patient arrives on the unit looking emaciated, disheveled, and with

soiled clothes. The patient claims that his daughter cares for him at home. What would

you suspect?

– Neglect

You just left your patient’s room with her husband at bedside. You then receive a

phone call from someone states that she is your patient’s mother and demands updates

about your patient. What should you do NEXT?

– Verify your patient’s consent to release information to her mother.

The provider orders Heparin 4 units/kg SQ. Your patient weighs 176 pounds. How

many units should you administer?

– 320 units

What diagnostic finding would support a diagnosis of deep vein thrombosis?

– Positive D-dimer

You are caring for a combative 85-year-old male with a history of dementia, CHF,

UTI, and anemia. The family states he appears to be more confused than his baseline.

What tests do you expect the provider to order?

– Urinalysis with cultures, CBC

A patient has recently been diagnosed with terminal cancer. Her responses are caustic

and abrasive. What is the BEST way to respond?

– Acknowledge her feelings, understanding this is expected in the grieving process.

You notice your patient who recently had a stroke is coughing intermittently during

meals. What is the MOST likely cause of this?

– He could be aspirating.

A patient with acute diverticulitis is MOST likely to complain of abdominal pain with

what quadrant?

– Left lower quadrant

Which of the following is MOST important in preventing a catheter associated urinary

tract infection (CAUTI)?

– Using sterile technique when inserting the catheter

The provider orders a Heparin infusion of 900 units/hr. Your IV medication on hand

has 25,000 units of Heparin in 500 mL of D5W. How many mL/hr will you infuse?

– 18 mL/hr

Your patient has developed a productive cough and fever. The provider is suspecting

influenza. Which actions should you take FIRST?

– Initiate droplet precautions

What medication would you anticipate to be ordered for a patient who has a LDL >

200 mg/dL?

– Statin

Fifteen minutes after starting a blood transfusion, the patient complains of lower back

pain, shortness of breath, and chills. What is your FIRST action?

– Stop the tranfusion.

Your patient had a transurethral resection of the prostate (TURP) 24 hours ago. What

signs require further intervention?

– Bright red urine

What condition (not medication related) might cause an elevation in the patients

PT/INR level?

– Liver disease

Your patient admitted for small bowel obstruction has been vomiting for the last 3

days. What electrolyte imbalance would you expect to be associated with this patient?

– Hypokalemia

Digoxin (Lanoxin) 125 mcg is equivalent to how many mg?

– 0.125mg

As you are walking down the hallway you overhear your colleague discussing her

personal family issues with a patient. What would be the MOST appropriate response?

– Remind her later of her responsibility for establishing and maintaining professional

boundaries with patients.

Your patient, who has soft wrist restraints for safety (non-violent), is working with the

occupational therapist at the bedside. The nursing assistant enters and says, “The

patient is not allowed to have his restraints untied.” How do you respond?

– “Restraints can be temporarily off while directly working with staff. Let me know

when the therapy session is finished and I will re-apply them.”

Your patient suddenly develops signs and symptoms of shortness of breath,

restlessness, tachypnea, hemoptysis, and decreased oxygen saturations despite being

on 2L/min of O2 by nasal cannula. What do you expect is happening?

Pulmonary embolism

The dosage of which drug must be tapered down slowly to prevent acute adrenal

insufficiency?

– Prednisone

Your patient with CHF states, “I can still eat the same food, I just have to weight

myself everyday.” Based on this statement, which nursing diagnosis would be

appropriate?

– Knowledge Deficit

patient arrives on unit. you do an assessment and notice lice in her hair. what is your

first action?

– Secure a private room

Patient presents dusky pallor and pulseless. First action

– Initiate facility code procedure

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Medical-Surgical RN A Prophecy Relias Exam

2022 latest update

1.2 milligrams is equal to how many micrograms? – answer1200 mcg

Your post-op patient has a Jackson-Pratt (JP) drain in place. Howdoyou ensure

effective drain function? – answerCompress the drain, then plug the bulb to establish

suction

Your male patient complains of discomfortwhile inflating the balloon during insertion

ofan indwelling urinary catheter. Whatwould be the MOSTappropriate action? –

answerDeflate the balloon, advance the catheter further, then reinflate the balloon

Your patient has symptomaticanemia but is refusing a blood transfusion forreligious

reason. What is an appropriate response? – answerRespect his wishes and notify the

provider

Your patient is admitted with diverticulitis. What type of dietdo you expect to be ordered

for the patient? – answerbroth, jello, soft fruit no skin,

You were hired towork the medical unit and when you arriveat work the charge nurse has

assigned you to the post-surgical unit since they are understaffed. Which is the MOST

appropriate action? – answerReport to the post-surgical unit.

What is a proton pump inhibitor, suchas pantoprazole (Protonix) used for? –

answerAcid Reduction

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Which adaptive equipment would be MOST appropriate to use for a severely contracted

patient who is unable to bearweight when transferring from the bed to the chair? –

answerPatient lift (e.g., Hoyer)

Which tool should you use to assess pain in you 80-year-old patient with severe

dementia? – answerPAINAD scale

Your patient is admitted from the ED with failure to thrive and advanced dementia. You

note he is extremely underweight, appears unbathed forsome time, and has a stage 4

pressure injury to his coccyx. You were told in report that he lives at home with family

members. What should you do? – answerNotify the charge nurseand social worker of your

concerns.

Your 85-year-old patient with atrial fibrillation fell at home 3 days ago. You notice she has

been having several episodesof acute confusion since being admitted to your unit. What

is the MOST important order you should anticipate from the provider? – answerStat CT

of head

Your patient has a temp of 102.3 F, HR 122, and has had 15 mL of urine from the indwelling

urinary catheter in the last 2 hours. What is your patient MOST likely experiencing. –

answerSepsis

What type of personal protective equipment (PPE) is applied prior to entering a room for a

patient with C. diff? – answerGown and gloves

Your patient continues to pull at theirIV site located in their left forearm despiteverbal

reminders and increased observation. The nursing assistant recommends using soft mitt

restraints on the patient. Whatisyour recommendation? – answerRequest an order for soft

mitts as they are the least restrictive

Your patient was admitted fora hypertensive crisis and hasa history of HTN, Parkinson’s

disease, depression, and alcohol use. On his second hospitalized day, you notice he is

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

more anxious and restless than his baseline. What would beyour FIRST nursing

intervention? – answerAsk the patient when his last drink of alcohol was.

What is the BEST indication of an acute neurological problem? – answerChange in

levelof consciousness

While in a supine position your patient states, “I’m tired and cannot catch my breath.”

Physical

assessment reveals jugularvein distention and a third heart sound (S3). These

symptoms are indicative of what condition? – answerHeart failure

Your new admission presents with a cough, unintentional weight loss, frequent night

sweats, and bloodysputum. What type of isolation precautions should you initiate, if any?

– answerAirborne precautions

Patients withdiabetes are at high risk forcomplications from damage towhat body

areas? – answerNerve and kidney damage

Ifyour patient with a known historyof diabetes is displaying symptoms of diaphoresis, cool

skin, lethargy, and shakiness. What is your first action? – answerCheck the patient’s blood

glucose level.

Your patient tells you, “I hope I don’t die, but if I do I don’t want to be brought back.? You

notice on herchart and wrist band that she isa full code. What would be the MOST

appropriate action? – answerDiscuss code status with the patient and follow up with

provider to ensure the medical record reflects her wishes.

Your coworker posted photos on social media froma birthday party they had for her in the

unit breakroom. What should be your NEXTcourse ofaction? – answerNo action is

necessary because no PHI was displayed.

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Your new patient understands very limited English. How should you communicate with

them when completing the admission assessment? – answerUse the organization’s

interpreter services.

You are caringfor a patient with ahistory of diabetes mellitus. You walkinto the room

and find the patient lethargic and diaphoretic. Whatis your first action? – answerObtain

capillary blood glucose level.

Your patient is 4 hours post open appendectomy and has not voided yet. You note his

lower abdomen is distended. What should you do NEXT? – answerPerforma bladder

scan

A patient with peritonitis presents with tachycardia, hypotension, and dehydration.

What other assessment finding would you anticipate as part of your physical

assessment? – answerSevere abdominal pain or rebound tenderness

What is the EARLIESTsign indicating increased intracranial pressure (ICP)? –

answerLevel of consciousness

In addition to pain, pallor, and pulselessness, a neurovascular assessmentalso includes

checking for: – answerParesthesia and paralysis

You received a report on a patient that sustained a right hemisphere CVA 48 hours ago.

What do you expect the patient to exhibit? – answerLeft sided weakness of the leg, arm,

and face.

You areordered to give digoxin (Lanoxin). Your patientsvital signs are: BP 130/70, Temp

97.9F, HR 52, RR 16, O2 Sat 100% on room air. What should youdo NEXT? – answerHold

digoxin (Lanoxin) and call the provider

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Upon entry to your patient’s room, you find her sitting in High Fowler’s position and

complaining of shortness of breath. Her respiratory rate is 34 breaths/min and O2 satis

84%. Which mode of oxygen delivery would MOST likely reverse these symptoms? –

answerNon-rebreather mask

Your patient is on contact precautions foractive MRSA. What proper PPE should you use

before entering the room? – answerGown and gloves

Your patient recently had a G-tube placed and intermittent enteral feedings have been

initiated. What symptoms may indicate intolerance to the feedings? – answerVomiting

and diarrhea

Upon entering your patient’s room, you note that theyare having a seizure. What is your

FIRST action? – answerPosition the patient on their side to maintain the airway.

Your 18-year-old female patient was admitted with dehydration secondary to anorexia

nervosa.

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Duringyourassessmentyounote shehasaflataffectandsays,”Ijustwanttodie.I’m

tired ofmy life.” What should be your FIRST intervention? – answerStay with the patient

and ask fi she has a plan to carry out this wish.

Your patient has a non-productive cough andpresence ofsecretions in his tracheostomy.

Priorto suctioning the patient,what should you do FIRST? -answerHyperoxygenate

patient.

Your patient takes 5 mg of warfarn (Coumadin/Jantoven) daily and reports having black

colored stool today. What do you most likely suspect? – answerGastrointestinal bleeding

Your new patient was admitted with blunt force trauma to the abdomen following a motor

vehicle accident (MVA). A NG tube is in place for decompression; however, you note during

the assessment that the stomach is rigid and hard during palpation. What condition do

you suspect? – answerHemorrhage

Which of the following nursing diagnoses is MOST important fora patientwith

chronic obstructive pulmonary disease (COPD)? – answerImpaired gasexchange

You have a patient going fordialysis. Their medications include lisinopril (Prinivil),

ondansetron (Zofran), famotidine (Pepcid), and atorvastatin (Lipitor). Which medication

would you possibly hold and seek clarification? – answerfamotidine (Pepcid)

What is an early symptom that the patient isdeveloping a complication of heart

failure? – answerEdema in the legs and feet

Black and tarry colored stools are CLASSIC symptoms of what condition? – answerBleeding

gastric ulcer

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Recommended for you

Document continues below

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

You have 4 patients whohave high priority needs. One needs to go to surgery, one needs

STAT lab draws from a PICC line, another has chest pain rated 8/10, and another needs

toileting. Which patient should you tend to FIRST? – answerThe patient with chest pain

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Your patient with Hepatitis C exhibitssigns of jaundiceand a distended abdomen. What

procedurewould you anticipate being performed by the provider at thebedside for this

patient? – answerParacentesis

What is clubbing of the fingers MOST likely associated with? – answerChronic oxygen

deficiency

A patient onwarfarin (Coumadin/Jantoven) has an INR of 6. Which medication

would you anticipate administering? – answerVitamin K

To reduce the risk of infection and phlebitis in an adult patient witha peripheral IV,

what is the MINIMUM duration the cathetershould remain in place before ROUTINE

replacement? – answer72 hours

You arecaring for a patient post lobectomywith a chest tube in place for drainage.

What is a priority in care for this patient? – answerEncourage the patient to cough

and deep breathe.

What patient population is the pneumococcal vaccine, PPSV23 indicated for? –

answerAdults aged 65 years and older

Your patient with stave IV terminallung cancer continues to experience increasing pain

as each day passes. What would you anticipate theprovider orderingfor thispatient?-

answerPalliative care consult

The provider gives you a telephone order to explain a surgical procedure to your patient

and obtain surgical consent. How should you respond? – answerInform the provider that

explaining the procedure is outside the nurse’s scope of practice.

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

ThepatienthasdiltiazemHCl(CardizemCD)orderedandisrequestingthecapsulebe

mixedinto hermorningyogurt.Howshouldyourespond?-answer”Sorry,itisaslow-

release medication that cannot be opened orcrushed.”

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Your 72-year-old male patient is admitted forcolon cancer related complications and has a

history of CHF, stroke, and a recent knee replacement. Based on your patient’s risk

assessment, you determine he is at risk forvenous thromboembolism (VTE). What is an

appropriate VTE prophylaxis order for this patient? – answerEnoxaparin (Lovenox)once

daily and intermittent pneumatic compressions (IPC)

You receive a provider’s order that is not consistent with evidence-based practice. What

is your FIRST step? – answerClarify the order with the provider.

When would sucralfate (Carafate) 4 times daily be scheduled for? – answer1 hour before

mealsand at bedtime

Your patient’s morning labs revealed a hemoglobin level of 6.3 and hematocrit of 18.

What blood product do you expect to administer? – answerPRBCs

Your 68-year-old patient is a Type 1 diabetic with a history of schizophrenia and exhibits

signsand symptoms of tardive dyskinesia. What long-term medication is associated with

signsand symptoms of tardive dyskinesia? – answerrisperidone, olanzapine, quetiapine,

ziprasidone, aripiprazole, paliperidone, lurasidone, chlorpromazine, fluphenazine,

haloperidol, perphenazine

Your 80-year-old patient is being discharged home post CVA. She lives alone, yet still

requires assistance with ADLs. Whatreferral is MOST appropriate to ensure her needs

are met? – answerCase Manager

Central Telemetrycalls and tells youyour patient is experiencing bradycardia. What is

the first thing you should do after entering the room? – answerAssess the patient and

take vital signs.

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Your patient is currently under 1:1 observation forsuicide precautions. He states he needs to

have a bowel movement and would like some privacy to use the bathroom. What is the

MOST appropriate response? – answer”I must be within an arms’ length view of you at all

times foryour safety, including while using the bathroom.”

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

A female patient requests a female nurse to provide care for her based on her religious

beliefs. What is the MOST appropriate action to take? – answerAccommodate her

request if possible.

Your patient is a 40-year-old female with a recent history of hair loss, extremelydry skin,

a nd a 20-point weight loss in the last 3 weeks. She also exhibits occasional episodes of

tremors in her upper extremities. What condition do these symptoms MOST likely

indicate? – answerHyperthyroidism

Insulin lispro (Humalog) isorders via sliding scalea.c. for your patientwith diabetes.

When is the best time to administer insulin lispro (Humalog)? – answer15 min before the

meal arrives

Which of the following would be used as part of the preop procedure to prevent

infection? – answerProphylactic antibiotics

Two days after surgery, your 72-year-old patient is showing signsof agitationand

confusion, which is not his baseline. The severity fluctuates throughout the day. His

medications include hydromorphone (Dilaudid), amlodipine (Norvasc), alprazolam

(Xanax), and carbidopa-levodopa (Sinemet). What condition do you MOST likely

suspect? – answerDelirium

What is the proper technique when suctioning a tracheostomy? – answerSuction in a

circular motion while the catheter is being pulled out.

Your new patient admitted for cholecystitisexpresses she hasa history of anxietydisorder.

She is feeling panicked and does not think she can handle staying in the hospital for her

surgery. What action is MOST appropriate foryou to take? – answerSit calmly next to her

and offer her compassion and a sense of security.

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

The provider orders and IV infusion of D5W 1000 mL to infuse over the next 6 hours.

How many mLs per hour should the IV pump be set to? – answer167 mL/hr

You areassigned a new admission and note a Braden score of 11 after completing your

assessment. Which interventions would be MOST appropriate based on your assessment?

– answerTurn q

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

2hours, request nutrition consult, request low airloss mattress.

Your patient mayhave tuberculosis TB) and is placed in airborne precautions. What test

would you expect to be ordered? – answerAcid-fast bacilli sputum

Your patient starts to complain of difficulty breathing while laying down, and states that

he has been coughing up pink sputum. While performing your assessment, you notice

jugularvein distentionand coarsecracklesin both lungs onauscultation. What diagnosis

doyou suspect? – answerCongestive heart failure

You received a patient post op transurethral resection of the prostate (TURP). Which of

the following symptoms would cause you the MOST concern? – answerHemorrhage and

hypotension

Your patient with C. diff (Clostridioidesdifficile) has a family memberabout to leave the

room. What education about performing hand hygiene should you give? – answerHand

hygiene with soap and water

Your patient has a diagnosis of urinary tract infection (UTI) and is currently taking

medication that has recently made herurine reddish-orange. Whichof the following

medicationswould cause this side effect? – answerPhenazopyridine (Pyridium)

Your patient is taking digoxin (Lanoxin) and has a potassium level of 3.0. How might this

affect the patient? – answerIncrease risk of digoxin toxicity

You are preparing to hang 1 unit PRBC’s to administer toyour patient. The patient states,

“I don’t take blood products.” What is the MOST appropriate response? – answer”You

have the right to refuse the blood transfusion. I will inform the provider of your

decision.”

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

An older adult patient arrives on the unit looking emaciated, disheveled, and with soiled

clothes. The patient claims that hisdaughter cares for him at home. Whatwould you

suspect? – answerNeglect

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Youjustleft your patient’sroom withherhusbandat bedside.Youthenreceiveaphone

callfrom someonestatesthatsheisyourpatient’smotheranddemandsupdatesabout

your patient. What should you do NEXT? – answerVerify your patient’s consent to release

information to her mother.

The provider orders Heparin 4 units/kg SQ. Your patient weighs 176 pounds. How

many units should you administer? – answer320 units

What diagnostic finding would support a diagnosis of deep vein thrombosis? –

answerPositive D-dimer

You arecaring for a combative 85-year-old male with a history ofdementia, CHF, UTI,

and anemia. The family states he appears to be more confused than his baseline. What

tests do you expect the provider toorder? – answerUrinalysis with cultures, CBC

A patient has recently been diagnosed with terminal cancer. Her responses are causticand

abrasive. What is the BEST way to respond? – answerAcknowledge her feelings,

understanding this is expected in the grieving process.

You notice your patient who recently had a stroke iscoughing intermittently during

meals. What is the MOST likely cause of this? – answerHe could be aspirating.

A patient withacute diverticulitis is MOST likely tocomplain ofabdominal pain

with what quadrant? – answerLeft lower quadrant

Which of the following is MOST important in preventing a catheterassociated

urinary tract infection (CAUTI)? – answerUsing sterile technique when inserting the

catheter

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

The provider orders a Heparin infusion of 900 units/hr. Your IV medication on hand has

25,000 units of Heparin in 500 mL of D5W. How many mL/hr will you infuse? –

answer18 mL/hr

Your patient has developed a productive cough and fever. The provider is suspecting

influenza.

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

Which actions should you take FIRST? – answerInitiate droplet precautions

What medication would you anticipate to be ordered fora patient who has a LDL > 200

mg/dL? – answerStatin

Fifteen minutes after starting a blood transfusion, the patientcomplains of lower

back pain, shortness of breath, and chills. What is your FIRST action? – answerStop

the tranfusion.

Your patient had a transurethral resection of the prostate (TURP) 24 hours ago.

What signs require further intervention? – answerBright red urine

What condition (not medication related) might cause an elevation in the patients PT/INR

level? – answerLiver disease

Your patient admitted for small bowel obstruction has been vomiting for the last 3 days.

What electrolyte imbalance would you expect to be associated with this patient? –

answerHypokalemia

Digoxin (Lanoxin) 125 mcg is equivalent to how many mg? – answer0.125mg

As you are walking down the hallway you overhear your colleague discussing her personal

family issues with a patient. What would be the MOST appropriate response? –

answerRemind her later of her responsibility for establishing and maintaining

professional boundaries with patients.

Your patient, who has soft wrist restraints for safety (non-violent), isworking with the

occupational therapist at the bedside. The nursing assistantenters and says, “The

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

patient isnot allowed to have his restraints untied.” How doyou respond? –

answer”Restraints can be temporarily off while directly working with staff. Let me know

when the therapy session is finished and I will re-apply them.”

Your patient suddenly developssignsandsymptoms ofshortnessofbreath,restlessness,

tachypnea, hemoptysis,and decreased oxygensaturations despite being on 2L/min of O2

by nasal

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

cannula. What do you expect is happening? – answerPulmonary embolism

Thedosage of which drug must be tapered down slowly to prevent acute adrenal

insufficiency? – answerPrednisone

Your patient with CHF states, “I can still eat the same food, I just have to weight myself

everyday.” Based on this statement, which nursing diagnosis would be appropriate? –

answerKnowledge Deficit

patientarrives on unit. you doan assessmentand notice lice in her hair. what isyour first

action? – answerSecure a private room

– answer

Medical-Surgical RN A Prophecy Relias Exam 2022 latest update

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