DECISION MAKING

Question 1

You notice there have been less favorable outcomes and satisfaction surveys in patients treated for sickle cell anemia. How do you approach this problem?

Answer 1

Form a standardized Tx plans for all pts that can be used by all healthcare staff

Question 2

You have transferred a pt to the SNF. The MD in charge at that facility calls for info about the pt’s medical care. What do you do?

Answer 2

Share the information he requests

Question 3

Your patient has refused human blood products based on religious beliefs. He is now rapidly destabilizing. What do you do?

Answer 3

Continue to research alternative treatments

Question 4

What is the best way to make sure a patient will follow up as instructed?

Answer 4

Schedule the appointment for the patient

Question 5

Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserve life, but states that the patient would not want to be on a ventilator. What should you do?

Answer 5

Call the Ethics Committee

Question 6

A patient visits your clinic for sinusitis. She requests a PAP smear since she has not had one in “years.” You:

Answer 6

Schedule her to come back next week for the PAP at another appt.

Question 7

A patient visits your cardiology clinic. She requests a PAP smear since she has not had one in “years.” You:

Answer 7

Refer her to a gynecologist

Question 8

Discharge planning is underway for a pt who has been very debilitated after treatment for end-stage liver cancer. His wife is also debilitated and the children live out of state. What is the best choice?

Answer 8

SNF

Question 9

Your patient presents to ED w/R wrist pain. She states, “It’s my fault; I should have had dinner ready on time.” What do you do?

Answer 9

XR the wrist

Question 10

Now the husband presents to ED with drug overdose. What is your action?

Answer 10

Treat him without prejudice

Question 11

The medical resident obtained consent for an operative procedure. On your visit, the pt is confused/refusing the procedure.

Answer 11

Call the resident to clarify the patient was not confused when he signed the first consent

Question 12

Your HIV positive patient is preparing to discharge when he tells you not only that he has passed the virus to his wife, but also that he plans to kill her when he gets home. How do you respond?

Answer 12

consult psych

Question 13

Your clinical student breaks the sterile field. How do you handle this situation?

Answer 13

Discuss it with the student

Question 14

You are the NP on call for the night. The nurse calls you to report the patient is decompensating. Who do you direct her to call?

Answer 14

the attending MD who is at home

Question 15

A code you are in does not go well, and staff members afterwards are criticizing each other. How do you deal with the situation?

Answer 15

Meet with all who participated in the code and have a one-time briefing

Question 16

Your patient is not doing well and family/wife is at bedside crying. You are preparing to talk to the family. What do you do first?

Answer 16

Ask if the patient has an advanced directive

Question 17

Your patient is not conscious. His advance directive states he wants to be a DNR, but his family says they want him to be a full code. How do you respond?

Answer 17

Tell her you can’t go against the advanced directives

Question 18

A patient comes to the ED at a community hospital who is 29 weeks pregnant. She says her water has broken. Her VS are stable. What do you do?

Answer 18

Transfer her to a tertiary facility

Question 19

Your 51F patient is getting ready to discharge when she tells you she hasn’t had a mammogram in 3 years. What do you do?

Answer 19

Refer to PCP for outpatient discharge

Question 20

Your patient’s imaging reveals he has metastatic cancer. The family, in accordance with their culture, request that you not share the test results to spare him distress. How do you respond?

Answer 20

Ask the patient what he wants to know about his prognosis

Question 21

35 yo F presents with c/o bilateral wrist pain. You suspect spouse abuse. You notice a handgun in her purse. What would be your next action?

Answer 21

Call security to ensure safety

Question 22

Adult child of a pt reports that her father has expressed desire to commit suicide and has a hx of EOTH and depression. The best response would be to?

Answer 22

Hospitalize the pt and start psychotherapy

Question 23

You notice that another NP in your group is frequently contacted by pharmacy for prescription errors. How do you handle the situation?

Answer 23

Address it directly with the NP

Question 24

Your patient voices concerns because he has lost his insurance and worries his children will no longer have coverage for medical expenses. What do you do?

Answer 24

Consult case management

Question 25

80-year-old patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of a hip fracture. To prepare the patient for discharge, the NP:

Answer 25

provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery.

Question 26

A 40-year-old female patient w/no PMH is admitted with bilateral pulmonary emboli. W/U reveals a positive result for lupus anticoagulant, and anticoagulant therapy is planned. The patient verbalizes concern about her ability to manage the appointments and the follow-up care. The NPs most effective intervention is to:

Answer 26

arrange follow-up appointments for the patient at the warfarin (Coumadin) clinic and PCP after discharge.

Question 27

What procedure does the AGACNP perform to evaluate cytology, only, in the tumor?

Answer 27

Fine needle biopsy

Question 28

A patient has fully recovered from septic shock due to bacteremia and has been accepted to a LTC facility for continuation of abx. ID has not seen the patient in two days. The NP:

Answer 28

contacts the ID MD to determine the appropriate abx duration

Question 29

32 yo M presented with a gunshot wound (GSW) to the FA. Injuries are negligible and pt is stable. Pt. reports the shot was an accident during hunting. What should the NP do?

Answer 29

Report to the police. ALL GSW must be reported

Question 30

What is most important when assessing status?

Answer 30

Level of alertness or hx of symptoms

Question 31

A woman of child-bearing age c/o abdominal pain. What level of exam do you document?

Answer 31

Detailed

Question 32

A diabetic pt complains of abd pain. Which type of exam do you conduct?

Answer 32

Comprehensive

Question 33

What qualifies pt for HHC

Answer 33

home bound, has a prescription, requires care services, wound care, select care

Question 34

Pt is refusing care, what do you do

Answer 34

let them refuse, educate, and search for alternatives

Question 35

Guy in ER needs refill on Ritalin:

Answer 35

research alternatives

Question 36

Knowledge deficit in ICU, what would you for nurses:

Answer 36

In-service

Question 37

A patient has advanced dementia, ESRD, and HF, what do you do for him?

Answer 37

Transfer from acute to palliative care