Nursing Foundations Interactive

Patient 1: Anna Williams

History

Age: 66

Diagnosis: Community-acquired pneumonia

Allergies: Penicillin (rash)

Medical History: Hypertension; mild osteoarthritis; ex-smoker.

Presentation: Shortness of breath, productive cough, mild confusion.

Care Plan

Monitor respiratory status and oxygen saturation.
Encourage incentive spirometry and deep breathing exercises.
Maintain hydration and monitor intake/output.

Labs/Diagnostics

WBC: 13,000/µL (elevated)
Chest X-ray: Right lower lobe consolidation
Basic Metabolic Panel: Slightly elevated BUN

Orders

IV Ceftriaxone and Azithromycin
Oxygen at 2 L/min via nasal cannula
Acetaminophen 650 mg PRN for fever

1. MCQ

Which intervention is least likely to improve respiratory status?

Elevating HOB to 45° and encouraging ambulation.
Providing oral fluids and monitoring hydration.
Administering antibiotics promptly as prescribed.
Strictly restricting fluid intake to dry out the lungs.

2. SATA

Which are actual risk factors for pneumonia exacerbation? (Select all that apply)

Age over 65.
Penicillin allergy.
Immobility and low fluid intake.
Consistently following antibiotic courses.

3. Fill in the Blank

If 1 liter of NS is given over 10 hours using a 15 gtt/mL set, how many drops per minute (gtt/min) is this?

4. Drag & Drop: Order from lowest priority (top) to highest priority (bottom).

Provide oral care twice daily

Check vital signs every 4 hours

Administer antibiotics promptly

Ensure patent airway (suction if needed)

(top = lowest, bottom = highest priority)

5. Matching: Match each antibiotic to its correct rationale in pneumonia.

Ceftriaxone

Azithromycin

Penicillin G

A broad-spectrum cephalosporin effective against many pathogens:

A macrolide antibiotic helpful for atypical respiratory infections:

A beta-lactam antibiotic often used for streptococcal pneumonia:

Patient 2: Robert Davis

History

Age: 45

Chief Complaint: Infected diabetic foot ulcer

Medical History: Type 2 Diabetes Mellitus (10 years), Hypertension, Dyslipidemia, Smoker, Overweight

Presentation: Poorly controlled blood sugar (BG 250–300 mg/dL), peripheral neuropathy, wound with purulent drainage.

Care Plan

Strict glycemic control and foot care education.
Monitor wound for signs of infection.
Administer sliding-scale insulin and IV vancomycin as prescribed.

Labs/Diagnostics

WBC: 14,000/µL (elevated)
Hemoglobin A1c: 10.2%
Fasting BG: ~250 mg/dL
Foot X-ray: Negative for osteomyelitis

Orders

IV Vancomycin
Sliding-scale insulin before meals
Lisinopril, Atorvastatin
Foot care consult

1. MCQ

What is the most accurate statement about safe vancomycin administration?

Run vancomycin as fast as possible to maximize effect.
Infuse slowly (over at least 60 minutes) to reduce the risk of Red Man Syndrome.
Dilution is unnecessary because vancomycin rarely irritates veins.
If patient complains of flushing, increase the rate further.

2. SATA

Which are incorrect ways to manage diabetes? (Select all that apply)

Skip insulin whenever feeling fine.
Check blood sugar only once a week.
Use sliding-scale insulin plus consistent diet control.
Binge on carbohydrates if BG < 150 mg/dL.

3. Fill in the Blank

You opened a new gauze package for the foot dressing but only used half. To maintain sterility, what must be done with the unused portion?

4. Drag & Drop: Sort insulins by longest onset (top) to shortest onset (bottom).

Glargine (long-acting)

NPH (intermediate-acting)

Regular (short-acting)

Lispro (rapid-acting)

Top = longest onset, Bottom = shortest onset

5. Matching: Match each lab test with its correct purpose.

Hemoglobin A1c

WBC count

Wound culture

Gives an average blood glucose over ~3 months:

Evaluates infection or immune response by counting leukocytes:

Identifies specific bacteria in the ulcer for targeted antibiotics:

Patient 3: Lisa Chen

History

Age: 29

Event: Postpartum Day 2 after vaginal delivery

Obstetric History: G2P1 with previous miscarriage

Presentation: Mild nipple soreness, episiotomy pain, moderate lochia rubra.

Care Plan

Provide breastfeeding support and pain management for episiotomy.
Monitor lochia and uterine involution.
Refer to lactation consultant if needed.

Labs/Diagnostics

Postpartum hemoglobin: 11 g/dL (slightly low)
Prenatal labs were normal

Orders

Prenatal vitamins (continued postpartum)
Ibuprofen for pain
Sitz baths and perineal care instructions

1. MCQ

Which statement is least helpful for breastfeeding comfort and success?

Use warm compress or a warm shower before feeding.
Ensure correct latch to reduce nipple trauma.
Restrict fluids to reduce engorgement.
Consider lanolin or creams if soreness occurs.

2. SATA

Which findings are normal on postpartum day 2? (Select all that apply)

Firm, midline uterus about 2 finger-breadths below umbilicus.
Foul-smelling lochia with large clots.
Mild nipple soreness while breastfeeding.
Lochia rubra with mild odor.

3. Fill in the Blank

Lisa's postpartum hemoglobin is 11 g/dL; normal range (female) ~12–16 g/dL. How many g/dL below the lower limit is she?

4. Drag & Drop: Put these postpartum interventions in highest priority (top) to lowest priority (bottom).

Assess uterine fundus and lochia

Assist with breastfeeding technique

Provide perineal ice packs

Encourage early ambulation

(top=highest priority, bottom=lowest)

5. Matching: Match each postpartum assessment to its correct description.

Fundus

Lochia Rubra

Breast Engorgement

Should be firm and midline, descending about 1 cm/day:

Red discharge in early postpartum, with mild odor:

Fullness or swelling of breasts as milk production increases:

Patient 4: Mark Smith

History

Age: 72

Diagnosis: Exacerbation of CHF

Medical History: CHF (5 years), CAD with stent, former smoker

Presentation: Dyspnea on exertion, bilateral edema, orthopnea.

Care Plan

Monitor respiratory status and fluid balance.
Administer IV diuretics and educate on a low-sodium diet.
Monitor potassium and overall cardiac status.

Labs/Diagnostics

BNP: Elevated (600 pg/mL)
Electrolytes: Low-normal potassium
Ejection fraction: 35%

Orders

IV Furosemide
Beta-blocker and ACE inhibitor adjustments
Low-sodium diet instructions

1. MCQ

What dietary advice is worst for CHF management?

Limit sodium to help reduce fluid retention.
Eat a large bag of salty chips daily for energy.
Monitor fluid intake if swelling worsens.
Include fresh fruits and vegetables.

2. SATA

Which findings suggest improvement in CHF? (Select all that apply)

Decreased peripheral edema.
Sudden 5-lb weight gain in 2 days.
Reduced dyspnea on exertion.
Crackles shifting from bases to apexes.

3. Fill in the Blank

Provider orders 40 mg IV furosemide. The vial is 10 mg/mL. How many mL do you administer?

4. Drag & Drop: Put these CHF interventions in highest to lowest priority (top=most urgent).

Administer diuretic (furosemide)

Monitor daily weights

Reinforce low-sodium diet teaching

Encourage mild exercise

5. Matching: Match each medication with its rationale for CHF treatment.

Furosemide

Metoprolol

Enalapril

Decreases fluid overload by promoting diuresis:

Reduces heart rate and myocardial workload:

Blocks angiotensin II formation to lower BP and reduce afterload:

Patient 5: Patricia Gomez

History

Age: 50

Diagnosis: Acute psychotic episode in schizoaffective disorder

Presentation: Paranoid delusions, auditory hallucinations, noncompliance with meds

Care Plan

Maintain 1:1 observation and ensure safety.
Administer antipsychotic medication as prescribed.
Provide psychoeducation regarding medication adherence.

Labs/Diagnostics

Basic labs: Within normal limits
Psychiatric evaluation ongoing

Orders

Risperidone 2 mg BID
PRN lorazepam for agitation
1:1 observation

1. MCQ

Which communication technique is least therapeutic for paranoia?

Arguing with her delusions.
Acknowledging her feelings and ensuring safety.
Keeping statements simple and clear.
Maintaining 1:1 observation if necessary.

2. SATA

Which actions promote medication adherence in psychosis? (Select all that apply)

Explain the purpose of each medication in simple terms.
Stop meds abruptly at first sign of improvement.
Encourage use of a pill organizer for forgetfulness.
Involve patient in deciding best times to take meds.

3. Fill in the Blank

Risperidone is ordered at 2 mg BID. How many mg total are given per day?

4. Drag & Drop: Steps to manage acute psychosis in order (top=first).

Ensure safety (1:1 observation)

Acknowledge delusions without reinforcing them

Administer antipsychotic medication

Encourage adherence to ongoing treatment

5. Matching: Match each approach to its correct rationale in psychosis management.

Calm, supportive communication

Reducing environmental stimuli

Medication education

Helps reduce anxiety and agitation by providing reassurance:

Prevents sensory overload, improving focus and safety:

Ensures understanding of the drug regimen to improve adherence:

Patient 6: Isaiah Thompson

History

Age: 60

Procedure: Left total hip replacement (post-op day 1)

Presentation: Stable in PACU, using PCA for pain.

Care Plan

Monitor pain levels and vital signs.
Encourage early ambulation and physical therapy.
Prevent DVT with prophylactic enoxaparin and exercises.

Labs/Diagnostics

CBC: Within normal limits (post-op)
Coagulation profile: Normal

Orders

Hydromorphone PCA
Enoxaparin 40 mg SQ daily
Acetaminophen for pain as needed

1. MCQ

Which measure is least likely to prevent DVT post-hip replacement?

Encourage ankle pumps and ambulation.
Administer enoxaparin as prescribed.
Apply continuous warm compress to the surgical site only.
Use SCDs if ordered.

2. SATA

Which interventions reduce respiratory complications post-op? (Select all that apply)

Encourage incentive spirometry regularly.
Restrict all fluids to avoid edema.
Promote coughing and deep breathing.
Ambulate early if feasible.

3. Fill in the Blank

Pain is 4/10 at rest and 6/10 with movement. By how many points does it increase?

4. Drag & Drop: Rank post-op care tasks from first to last.

Assess vital signs & surgical site

Manage pain (check PCA)

Encourage incentive spirometry

Begin physical therapy session

5. Matching: Match each measure with its rationale post-hip replacement.

Enoxaparin SQ

Incentive Spirometer

Early Ambulation

Helps prevent DVT by inhibiting clot formation:

Promotes lung expansion and prevents atelectasis:

Reduces joint stiffness and improves circulation:

Patient 7: Nicole Johnson

History

Age: 25

Diagnosis: Anxiety and panic attacks

Presentation: Daily panic attacks, hyperventilation, on sertraline with PRN lorazepam.

Care Plan

Implement nonpharmacological interventions (e.g., deep breathing).
Provide a calm environment and reassurance.
Monitor for escalation of anxiety and administer PRN meds if needed.

Labs/Diagnostics

Thyroid panel: Normal
EKG: Normal sinus rhythm

Orders

Sertraline 50 mg daily
PRN lorazepam for acute episodes
Referral to group therapy

1. MCQ

During an acute panic attack, which response is least helpful?

Guide slow, deep breathing.
Tell her to “just calm down or I’ll leave.”
Provide calm reassurance and reduce stimuli.
Offer PRN lorazepam if needed.

2. SATA

Which interventions help manage chronic anxiety? (Select all that apply)

Practice daily relaxation or exercise.
Avoid any therapy or counseling.
Adhere to prescribed SSRIs (e.g., sertraline).
Use PRN benzodiazepines as directed.

3. Fill in the Blank

Nicole rates anxiety 9/10. After guided breathing, 5/10. By how many points did it decrease?

4. Drag & Drop: Steps for helping a patient through a panic attack (top=first).

Provide calm reassurance

Guide slow, deep breathing

Offer PRN anxiolytic if needed

Discuss triggers/coping after acute phase

5. Matching: Match each intervention to its correct rationale in anxiety management.

Sertraline (SSRI)

Lorazepam (benzodiazepine)

Cognitive Behavioral Therapy

Helps regulate serotonin long-term for anxiety control:

Provides short-term relief of acute panic or anxiety symptoms:

Addresses thought patterns and coping strategies:

Patient 8: Rita Patel

History

Age: 35

Chief Complaint: Severe right lower quadrant pain

Presentation: Nausea, low-grade fever, suspected appendicitis.

Care Plan

Keep the patient NPO.
Monitor pain and vital signs closely.
Prepare for possible surgical intervention.

Labs/Diagnostics

WBC: 14,500/µL (elevated)
Abdominal ultrasound: Findings suggestive of appendicitis

Orders

NPO status
IV fluids (0.9% NS)
Ketorolac for pain, Ondansetron for nausea
Surgical consult

1. MCQ

Which preop action is least appropriate for suspected appendicitis?

Keep NPO and ensure IV site is patent.
Apply heating pad over RLQ to ease pain.
Monitor vital signs and pain level closely.
Start IV fluids to maintain hydration.

2. SATA

Which signs are commonly associated with appendicitis? (Select all that apply)

RLQ pain at McBurney’s point.
Pain relieved by eating spicy foods.
Rebound tenderness in RLQ.
Low-grade fever with elevated WBC.

3. Fill in the Blank

Her temperature is 37.8°C. Convert to °F (rounded to one decimal). Formula: °F = °C × 9/5 + 32

4. Drag & Drop: Priority steps for suspected appendicitis (top=first, bottom=last).

Keep patient NPO

Start IV fluids

Obtain labs (CBC)

Notify surgeon

5. Matching: Match each sign with its typical meaning in appendicitis.

McBurney's point tenderness

Rebound tenderness

Abdominal guarding

Localized RLQ tenderness associated with appendicitis:

Pain upon release of pressure rather than application:

Tensing of abdominal muscles when palpated due to inflammation:

Patient 9: John Moore

History

Age: 52

Diagnosis: COPD exacerbation

History: Heavy smoking history; frequent exacerbations.

Presentation: Increased shortness of breath, productive cough.

Care Plan

Monitor respiratory status and oxygen saturation.
Administer bronchodilators and steroids as ordered.
Coach in pursed-lip breathing techniques.

Labs/Diagnostics

ABG: pH 7.35, PaCO2 48 mmHg, PaO2 60 mmHg
Chest X-ray: Hyperinflation

Orders

Bronchodilator (albuterol) treatments
IV steroids
Oxygen therapy 2 L/min
BiPAP as needed

1. MCQ

Which breathing technique does not help reduce air trapping in COPD?

Rapid, shallow breathing.
Pursed-lip breathing.
Prolonged exhalation to empty alveoli.
Diaphragmatic breathing.

2. SATA

Which are appropriate COPD interventions? (Select all that apply)

Increase fluids to help thin secretions.
Keep patient strictly on bedrest at all times.
Administer bronchodilators as ordered.
Encourage pursed-lip breathing.

3. Fill in the Blank

His SpO2 is 90% on 2 L/min; goal is 92%. By how many percentage points must it improve?

4. Drag & Drop: Put these COPD management steps in order (top=first).

Assess respiratory status & vitals

Administer bronchodilator

Encourage pursed-lip breathing

Reassess oxygen saturation

5. Matching: Match each therapy to its rationale in COPD management.

IV Methylprednisolone

BiPAP at night

Albuterol nebulizer

Helps reduce airway inflammation:

Provides positive pressure to keep alveoli open while sleeping:

Relaxes bronchial smooth muscle to improve airflow:

Patient 10: Ebony Carter

History

Age: 40

Diagnosis: Infective endocarditis

History: IV drug use history with recurrent infections.

Presentation: High fever, chills, malaise; vegetation on mitral valve.

Care Plan

Maintain full course of IV antibiotics.
Monitor for signs of embolic events.
Coordinate addiction counseling.

Labs/Diagnostics

WBC: 18,000/µL (elevated)
ESR/CRP: Elevated
Echocardiogram: Vegetation on mitral valve

Orders

IV Vancomycin (with peak and trough monitoring)
Acetaminophen PRN for fever
Addiction counseling and social work consult

1. MCQ

What is the worst advice for a patient with infective endocarditis?

Complete the full course of IV antibiotics to prevent relapse.
Stop antibiotics as soon as fever subsides to avoid side effects.
Consider addiction counseling if IV drug use is ongoing.
Monitor for signs of heart failure or emboli.

2. SATA

Which actions help reduce the risk of recurrent endocarditis? (Select all that apply)

Completing the antibiotic regimen fully.
Using clean needles or seeking help to stop IV drug use.
Quitting antibiotics as soon as symptoms improve.
Consulting addiction counseling for support.

3. Fill in the Blank

Ebony’s temperature drops from 39.0°C to 38.2°C. By how many °C did it decrease?

4. Drag & Drop: Rank these endocarditis interventions from first to last.

Obtain blood cultures

Begin IV antibiotic therapy

Monitor temperature and WBC

Coordinate addiction counseling referral

5. Matching: Match each measure with its rationale in infective endocarditis.

IV Vancomycin

Acetaminophen (PRN)

Addiction Counseling

Treats gram-positive bacteria like Staphylococcus aureus:

Lowers fever and relieves discomfort:

Addresses IV drug use and reduces the risk of relapse: