1. On a surgical unit, a patient post-hip replacement with diabetes develops sudden confusion. During interprofessional rounds, the nurse reports vital signs: BP 150/90, pulse 110, oxygen saturation 93% on room air. The surgical resident suggests anxiety. Which response by the nurse demonstrates effective interprofessional communication?
Answer: B
Option B uses structured communication (e.g., SBAR implied) by linking clinical cues (confusion, diabetes, hypoxia) to evidence-based protocols, promoting immediate action. Option A delays intervention despite acute changes. Option C introduces a plausible concern but lacks specificity for hypoglycemia (higher risk in diabetes). Option D prioritizes sedation over assessment, risking harm. Best practices require advocating for protocol-driven interventions during rounds when cues suggest time-sensitive complications.
2. During a staffing shortage, a charge nurse must assign one stable patient to a nurse already at a higher-than-safe acuity. Which patient assignment would be the *least* ethically justifiable, violating the principle of justice?
Answer: A
Justice (Provision 5) requires fair distribution of nursing resources. Option A poses the highest potential risk; missing neurovascular changes can lead to permanent limb damage quickly. Assigning this unstable patient to an overloaded nurse is unjust. Options B, C, and D represent patients with stable, chronic conditions where tasks are more predictable and delays, while undesirable, are less likely to cause immediate, irreversible harm compared to missing a compartment syndrome.
3. An 82-year-old with osteoporosis and gait instability is hospitalized after a fall. The care plan includes "Patient will ambulate safely." Which revision makes this goal SMART?
Answer: A
Option A adds specificity (distance/device), measurability (assist level), achievability (considering age/osteoporosis), relevance (fall prevention), and timeframe (day 3). Option B is not time-bound or measurable. Option C lacks specific functional outcomes. Option D focuses on confidence rather than physical capability. The cues of osteoporosis and gait instability necessitate concrete mobility metrics per NICE fall guidelines.
4. A 72-year-old patient with severe rheumatoid arthritis and osteoporosis is scheduled for a 4-hour open cholecystectomy. When positioning this patient supine on the OR table, which action best minimizes complication risks?
Answer: D
Rheumatoid arthritis increases vulnerability to joint dislocation and nerve compression, while osteoporosis raises fracture risk. Arm positioning with <90° abduction prevents brachial plexus stretch (critical for arthritic joints) and padded armboards reduce ulnar nerve pressure. Option A risks cervical hyperextension with a donut headrest and unnecessary wrist immobilization. Option B omits joint protection despite appropriate DVT prophylaxis. Option C's knee flexion could strain arthritic hips/lumbar spine, and occipital padding doesn't address upper extremity risks. AORN guidelines emphasize extremity alignment and pressure redistribution for arthritic patients.
5. An elderly patient with a hip fracture exhibits unexplained bruises and poor hygiene. The caregiver states, "She falls a lot," but the patient avoids eye contact. Vital signs are stable. Which initial interprofessional step is most appropriate?
Answer: B
Non-verbal cues and inconsistent explanations suggest possible abuse, requiring specialized assessment per Elder Justice Act. Social workers conduct forensic interviews and safety evaluations. Option A delays intervention. Option C/D address physical symptoms but ignore psychosocial risks. CMSRN protocols mandate immediate collaboration when abuse is suspected to ensure patient safety.
6. A diabetic patient with severe neuropathy and a new below-knee amputation is evaluated for home safety. The case manager reports the patient independently navigates stairs using crutches but has slippery throw rugs in the living room. Which standardized tool result most urgently warrants intervention?
Answer: B
A Morse score >45 signifies high fall risk (cue: amputation and environmental hazards like rugs). Amputation (cue: mobility alteration) combined with slippery rugs creates immediate danger. Braden score 16 (A) is moderate risk, not urgent. Cognitive score 20 (C) may need monitoring but doesn't directly cause falls. HbA1c (D) requires long-term management but isn't an acute safety threat. Per AMSN guidelines, fall risk with environmental hazards outweighs other concerns in safety evaluation. Distractors represent important but lower-acuity risks compared to the imminent fall hazard.
7. In a hospital surge tent during an earthquake, a Spanish-speaking child with a fractured femur arrives unaccompanied. Which reunification strategy demonstrates cultural and clinical appropriateness?
Answer: C
Pediatric reunification protocols (FEMA guidelines) prioritize creating safe, low-stimulation areas with age-appropriate comforts to reduce trauma while identification occurs. Option A disregards language barriers and may increase distress. Option B focuses on clinical needs over emotional safety. Option D violates privacy regulations by publicly sharing identifiers. The fracture necessitates a calm environment to prevent further injury, and language barriers require visual/non-verbal comfort strategies during verification.
8. A nurse documented initiating a fall prevention plan for an elderly patient with nocturia and gabapentin use but didn't document staff interventions. The patient has osteoporosis and a history of hip fracture. Which missing element poses the greatest risk?
Answer: A
Nocturia and gabapentin (causing dizziness) require specific action documentation to mitigate fall risk in osteoporosis patients. Option B focuses on education over implementation. Option C addresses technology but not toileting. Option D involves family without clinical actions. Joint Commission standards require documenting executed interventions for high-risk patients.
9. While positioning an elderly patient with mild dementia for total hip arthroplasty in lateral decubitus, the surgical team notes hip instability. Which action takes priority?
Answer: A
Hip instability during lateral positioning risks dislocation and vascular injury, especially in elderly patients with osteoporotic bones. Stabilizers maintain surgical access while preventing movement-related trauma. Dementia increases agitation risk, necessitating secure yet padded immobilization. Option B addresses trunk alignment but not the unstable joint. Option C is important for corneal protection but less urgent than preventing dislocation. Option D prevents peroneal nerve injury but doesn't address the primary instability. AAOS guidelines highlight joint stabilization during orthopedic procedures.
10. A 70-year-old post-hip replacement with epidural ropivacaine develops BP 82/46 mmHg and dizziness upon standing. History includes controlled hypertension. Which intervention aligns with safety guidelines?
Answer: B
Hypotension from sympathetic blockade requires fluid resuscitation first (B) per ASA guidelines. Vasopressors (A) are second-line for fluid-refractory cases. Reducing infusion (C) doesn't correct acute hypotension. Leg elevation (D) is temporary but insufficient; crystalloids address hypovolemia from vasodilation. Standing dizziness confirms orthostatic instability, and hypertension history necessitates cautious fluid management over immediate vasopressors.
11. An 85-year-old with dementia and dysphagia is ordered regular oral oxycodone 5 mg every 4 hours PRN for hip fracture pain. Which nursing action follows high-alert medication safety for opioids?
Answer: C
Crushing extended-release opioids (implied by "regular" formulation) alters pharmacokinetics, risking overdose per ISMP. Option C provides safe alternative for dysphagia. Option A violates high-alert standards by modifying release mechanism. Option B withholds necessary pain control. Option D is unsafe as not all formulations are PEG-compatible; liquid concentrate ensures accurate dosing. Dementia increases aspiration/medication error risks; liquid formulation maintains therapeutic intent while accommodating dysphagia.
12. During a staged evacuation due to rising floodwaters, a nurse must prioritize patients for vertical evacuation. Patient A has new-onset atrial fibrillation with RVR at 130 bpm on a heparin drip. Patient B has an unstable pelvic fracture with 1,200 mL blood loss in 24 hours. Patient C has Guillain-Barré syndrome with ascending paralysis now affecting respiratory muscles. Patient D has stage 4 pressure injuries requiring air-fluidized bed therapy. Which patient requires evacuation first?
Answer: C
Patient C's respiratory muscle involvement poses imminent risk of airway compromise during evacuation delays, aligning with ABC (airway, breathing, circulation) prioritization. Patient A's arrhythmia is managed with IV therapy but isn't immediately life-threatening. Patient B's hemorrhage is significant but stable with monitoring. Patient D's equipment dependency complicates transport but doesn't threaten immediate survival. The Joint Commission standards emphasize evacuating patients with escalating airway/breathing issues first in disasters since minutes impact outcomes.
13. Post-hip replacement, a patient receiving enoxaparin reports sudden dyspnea and pleuritic pain. SpO2 is 92% on RA, HR 120, and BP 100/60. The rapid response team is en route. Which action is essential?
Answer: A
High-flow oxygen addresses potential pulmonary embolism hypoxia (dyspnea, pleuritic pain, SpO2 92%) while awaiting advanced care. Option B focuses on cardiac causes, less likely with pleuritic pain and anticoagulant use. Option C requires team orders and shouldn't delay oxygenation. Option D assesses but doesn't intervene for respiratory distress. Crisis algorithms prioritize oxygen for abnormal saturation and respiratory symptoms before diagnostic confirmation.
14. A Mandarin-speaking patient post-hip replacement grimaces when repositioned but repeatedly says "fine" through their adult daughter's interpretation. The daughter appears stressed and rushes explanations. Which action best addresses communication needs?
Answer: B
The Joint Commission mandates professional interpreters for clinical discussions to ensure accuracy and confidentiality. Family interpreters may omit/modify information due to emotional stress or bias, as suggested by rushed explanations and discordant nonverbal cues. While pain medications might be indicated, option B addresses the root communication barrier for comprehensive assessment. Option A risks misinterpretation; option C lacks nuance for complex symptoms; option D bypasses patient self-report, violating patient-centered care standards despite apparent distress indicators.
15. A 72-year-old patient with advanced dementia, osteoporosis, and a recent left hip hemiarthroplasty is agitated when repositioned. The nurse notes involuntary hip adduction during turns. Which repositioning technique maximizes comfort while preventing dislocation?
Answer: A
Post-hip replacement requires maintaining hip abduction to prevent dislocation, especially with osteoporosis and dementia increasing dislocation risk. Option A uses an abduction pillow during log-rolling to stabilize joints and reduce shear forces. Option B risks dislocation by extending the operative hip. Option C is contraindicated post-hip surgery due to hyperextension stress. Option D exceeds safe flexion limits. The National Pressure Injury Advisory Panel emphasizes abduction devices for hip precautions during repositioning.
