1. A COPD patient on 2L O₂ has SpO₂ 88%, RR 28, and drowsiness after receiving morphine for pain. Which documentation entry best demonstrates evaluation of intervention effectiveness?
Answer: B
Option B evaluates morphine's adverse effect (respiratory depression) and documents immediate corrective actions. Option A assumes naloxone need prematurely. Option C addresses symptoms but not medication cause. Option D defers intervention. CMSRN standards require evaluating medication responses and adjusting care accordingly.
2. An obese patient (BMI 38) with COPD has Braden friction/shear subscore of 1. During bed-to-chair transfer, the nurse notices the patient slides down in the chair. Which intervention prevents friction injury?
Answer: D
Low friction/shear subscore (1) and observed sliding confirm high shear injury risk. Option D reduces shear during transfers via mechanical aids. Option A increases friction during movement. Option B addresses pressure but not shear. Option C treats but doesn't prevent shear damage. Friction management requires mechanical lifting devices per AMSN standards, especially with obesity and impaired mobility.
3. A terminal COPD patient's same-sex partner requests exclusion of biological family from care discussions, citing estrangement. The nurse discovers no legal documentation of partnership. What is the most appropriate initial response?
Answer: C
Assessing patient capacity and preferences determines appropriate decision-makers before addressing family dynamics. Option A risks violating rights without capacity assessment. Option B disregards patient's relationship. Option D is premature before determining patient wishes. CMSRN standards require establishing decision-making parameters through patient evaluation.
4. A nurse evaluates a teaching plan for a patient with COPD and anxiety who lives alone. Which outcome indicates effective material design?
Answer: B
Living alone and anxiety require practical, self-efficacy-focused skills. Option B assesses psychomotor competency and emergency preparedness through performance. Option A tests recall, not application. Option C's self-report is unreliable for adherence. Option D's anatomy knowledge doesn't address safety needs. AMSN prioritizes observable, life-skill competencies for high-risk patients in unsupervised settings.
5. A COPD patient with opioid dependence post-appendectomy has shallow respirations (RR 8/min) and pain scores of 8/10. Which professional should optimize analgesia while minimizing respiratory depression?
Answer: C
The addiction specialist addresses both respiratory depression (RR 8/min) and opioid dependence, using buprenorphine for safer analgesia. Pulmonologists (A) manage COPD but not addiction. Pain nurses (B) lack authority for medication substitution. Respiratory therapists (D) address oxygenation but not opioid risks. Addiction specialists uniquely balance analgesia and respiratory safety per SAMHSA guidelines in opioid-tolerant patients.
6. A medical-surgical unit transitioning to a primary nursing model admits a 72-year-old patient with COPD exacerbation and limited English proficiency. The patient's daughter reports he becomes anxious when multiple caregivers provide conflicting instructions. Which approach best aligns with primary nursing principles while addressing these cues?
Answer: A
Primary nursing emphasizes continuity with one nurse coordinating care, reducing anxiety from multiple caregivers (discriminating cue: anxiety with conflicting instructions). Option A provides a consistent bilingual nurse (addressing language barrier) while coordinating with specialists. Option B increases caregiver changes, worsening anxiety. Option C uses appropriate tools but lacks personal continuity. Option D removes nursing involvement, contradicting primary nursing’s holistic responsibility. The model prioritizes relationship-based care, especially with communication barriers.
7. Three hours after a suspected ricin release at a train station, a patient presents with profuse sweating, pulmonary edema, and hypotension. Which clinical action demonstrates appropriate chemical exposure management?
Answer: D
Ricin causes irreversible cell damage with no antidote (CDC guidelines). Supportive care including respiratory support is primary management. Pulmonary edema and hypotension indicate severe toxicity requiring anticipated intubation. Antitoxin (A) doesn't exist for ricin. Vasopressors (B) may be needed but don't address respiratory failure. Gastric lavage (C) is ineffective for inhalational exposure. The rapid onset (3 hours) aligns with ricin's pathophysiology, distinguishing it from slower toxins.
8. During a scheduled hernia repair, the surgical technologist sneezes into their sterile mask. The patient has chronic obstructive pulmonary disease. What immediate action preserves sterility?
Answer: D
Sneezing generates airborne contaminants that compromise sterility, requiring the individual to rescrub per AORN. COPD increases pulmonary infection risk. Option A doesn't address airborne dispersion. Option B neglects that microorganisms may have settled on gown/gloves. Option C risks contaminating the field through droplet spread. Rescrubbing ensures full aseptic integrity.
9. During sepsis protocol revision, the committee notes inconsistent lactate monitoring in patients with COPD exacerbations. Which policy change best integrates comorbidities and rapid response criteria?
Answer: B
Option B targets the high-risk comorbidity (COPD cue) with specific SIRS indicators (tachycardia/mentation changes), aligning with Surviving Sepsis guidelines. Option A overlooks COPD-specific risks. Option C uses a single non-specific vital sign. Option D lacks acute clinical triggers. Policies must link assessment to condition-specific deterioration signs.
10. During a hospital-wide functional exercise simulating a mass casualty incident from a chemical spill, the medical-surgical nurse is assigned to the decontamination tent. An ambulatory patient arrives reporting exposure, exhibiting mild dyspnea and tearing eyes. Which action should the nurse prioritize based on the exercise objectives and safety protocols?
Answer: A
The core objective in a chemical exposure decontamination drill is preventing secondary contamination and removing the hazard, prioritizing safety over assessment. While assessing (D) or history (B) is needed later, initiating decon first aligns with CDC guidelines and drill focus. Escorting an un-decontaminated patient inside (C) risks contaminating the ED, violating containment principles. Full decon (A) directly addresses the exposure cues (dyspnea, tearing) and drill context.
11. Which patient is at highest risk for wound evisceration based on multifactorial assessment?
Answer: C
Hypoalbuminemia severely impairs collagen synthesis, while emergency surgeries increase infection risk. POD 8 aligns with peak dehiscence timing. Option A's laparoscopic approach minimizes tension. Option B's COPD raises cough risk but hernia repairs have lower dehiscence rates. Option D's mastectomy rarely involves fascial layers. Surgical literature identifies malnutrition and emergency procedures as key risk multipliers for evisceration.
12. A nurse requests additional staffing due to high-acuity assignments including a deteriorating COPD patient. The charge nurse denies the request, citing budget constraints. Later, the COPD patient develops acute respiratory distress. What action demonstrates correct chain of command application?
Answer: C
After addressing the immediate emergency (rapid response), escalating to the supervisor (C) follows protocol for unresolved resource issues. Option A manages the crisis but neglects systemic reporting. Option B bypasses nursing leadership hierarchy. Option D delays accountability for denied staffing despite known acuity risks. The budget constraint context and patient deterioration validate escalation per AMSN advocacy guidelines.
13. An elderly patient with COPD lives in a low-income apartment with mold exposure. He uses a food bank and has no primary care provider. Which initial care coordination step is most critical?
Answer: B
This confronts both cues: environmental hazard (mold remediation) and healthcare access (establishing primary care). Option A addresses symptoms but not root causes. Option C places burden on patient for unsafe housing fixes. Option D manages nutrition/oxygen but ignores mold-induced exacerbations. AMSN emphasizes upstream interventions; housing safety and continuous care prevent readmissions more than reactive measures for socially complex COPD cases.
14. A postoperative patient with a history of PE develops sudden pleuritic chest pain and shortness of breath. The RN delegates tasks to an LPN and UAP. Which delegation decision requires correction?
Answer: C
Enoxaparin is contraindicated in suspected PE (requires therapeutic anticoagulation, not prophylaxis). RNs must reassess orders in acute events. Auscultation (A) and SpO2 checks are appropriate LPN tasks. UAP can apply preset oxygen (B) and position patients (D). Discriminating cues: acute pleuritic pain + SOB suggest possible PE, requiring RN to suspend routine prophylaxis and initiate higher-level care.
15. A pregnant patient at 32 weeks with asthma reports shortness of breath when lying supine. Fetal heart rate is 140 bpm. Which technique optimizes maternal-fetal oxygenation without provoking bronchospasm?
Answer: A
Left-lateral positioning improves placental perfusion and reduces aortocaval compression in pregnancy while diaphragmatic breathing maximizes ventilation without increasing airway resistance. High Fowler's (B) may not alleviate uterine pressure on diaphragm. Forward-lean (C) can compress the abdomen. Humming exhalations (D) may trigger bronchospasm in asthma. ACOG recommends left positioning and diaphragmatic breathing as first-line for pregnancy-related dyspnea in asthmatics to support fetal oxygenation.
