Nursing Foundations Interactive – Tricky Version (All 10 Patients)

Patient 1: Anna Williams (Pneumonia)

66 y/o with community-acquired pneumonia, mild confusion, IV ceftriaxone/azithromycin, O2 at 2 L/min, allergic to penicillin.

1. MCQ

Which intervention is least likely to improve her 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 (rash only) that immediately worsens pneumonia.
Immobility and inadequate fluid intake.
Taking full antibiotic courses as prescribed.

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?
(Trick: 10 hours = 600 minutes. Some might incorrectly use 1000 minutes!)

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

Reverse of usual! Be cautious.

Provide oral care twice daily

Check vital signs every 4 hours

Administer antibiotics promptly

Ensure patent airway (suction if needed)

Drag items here (top=lowest, bottom=highest priority)

5. Matching: Match the incorrect rationale to each antibiotic. All are false statements!

Ceftriaxone

Azithromycin

Penicillin G

“This is perfectly safe for severe penicillin allergy.”

“Must always be given with 2 liters of fluid to avoid toxicity.”

“Best antibiotic choice for those allergic to penicillin.”

Patient 2: Robert Davis (Diabetic Foot Ulcer)

45 y/o male, infected diabetic foot ulcer (MRSA), IV vancomycin, BG 250-300 mg/dL.

1. MCQ

What is the most accurate statement about safe vancomycin administration?

“Run vancomycin as quickly as possible to maximize effect.”
“Infuse slowly (at least 60 min) to avoid Red Man Syndrome.”
“Dilution is unnecessary; it doesn’t irritate veins.”
“If flushing occurs, 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 dietary control daily.
Binge on carbs if BG < 150 mg/dL.

3. Fill in the Blank

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

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

Glargine (long-acting)

NPH (intermediate)

Regular (short-acting)

Lispro (rapid-acting)

Top = longest onset, Bottom = shortest onset

5. Matching: Match each lab test with a wrong rationale for ordering it.

All statements are incorrect. Match ironically.

Hemoglobin A1c

WBC count

Wound culture

“Used to measure how quickly RBCs clot.”

“Tells us exactly which antibiotic to use, no further testing needed.”

“Measures only sodium in the blood.”

Patient 3: Lisa Chen (Postpartum Day 2)

29 y/o postpartum day 2, mild nipple soreness, episiotomy, stable vitals, moderate lochia rubra.

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.”
“Try lanolin or nipple 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 (red) with mild odor.

3. Fill in the Blank

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

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

Normal priority ordering here (top=most important first).

Assess uterine fundus and lochia

Assist with breastfeeding technique

Provide perineal ice packs for episiotomy pain

Encourage early ambulation

(top=highest priority, bottom=lowest)

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

All these descriptions are incorrect. Match them ironically!

Fundus

Lochia Rubra

Breast Engorgement

“Should be soft and boggy at all times.”

“Bright green discharge for up to 2 weeks postpartum.”

“Indicates low milk supply if breasts feel full.”

Patient 4: Mark Smith (CHF Exacerbation)

72 y/o male, IV furosemide, watch potassium, low-sodium diet, ejection fraction 35%.

1. MCQ

What dietary advice is worst for CHF management?

“Try to limit sodium to help reduce fluid retention.”
“Consume a large bag of potato chips daily to maintain energy.”
“Monitor fluid intake if swelling worsens.”
“Consider fresh fruits and vegetables as snacks.”

2. SATA

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

Decreased peripheral edema.
Sudden weight gain of 5 lbs 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 order (top=most urgent).

Administer diuretic (furosemide) as prescribed

Monitor daily weights

Reinforce low-sodium diet teaching

Encourage mild exercise

5. Matching: Match each med to a wrong rationale in CHF.

All statements are incorrect. Match ironically!

Furosemide

Metoprolol

Enalapril

“Increases fluid retention by stopping diuresis.”

“Raises the heart rate to improve cardiac output.”

“Causes extreme vasoconstriction to elevate BP.”

Patient 5: Patricia Gomez (Acute Psychotic Episode)

50 y/o female with schizoaffective disorder, paranoid delusions, on risperidone, 1:1 observation.

1. MCQ

Which communication technique is least therapeutic for paranoia?

Arguing with her delusions.
Acknowledging her feelings, offering reassurance of safety.
Keeping statements simple and direct.
Maintaining 1:1 observation as needed for safety.

2. SATA

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

Explaining medication purpose in simple terms.
Allowing abrupt discontinuation if side effects appear once.
Encouraging use of a pill organizer if memory is poor.
Involving the patient in deciding best times to take meds.

3. Fill in the Blank

Risperidone is ordered at 2 mg BID. What is the total mg per day?

4. Drag & Drop: Put these acute psychosis management steps 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 a wrong rationale.

All are incorrect statements, ironically matched.

Calm, supportive communication

Reducing environmental stimuli

Medication education

“Causes immediate relapse by coddling the patient too much.”

“Overloads the patient with noise to distract from delusions.”

“Confuses the patient by explaining precisely how meds work.”

Patient 6: Isaiah Thompson (Post-op Hip Replacement)

60 y/o male, post-op day 1 L hip, hydromorphone PCA, enoxaparin prophylaxis.

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 sequential compression devices if ordered.

2. SATA

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

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

3. Fill in the Blank

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

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

Assess vital signs & surgical site

Manage pain (check PCA usage)

Encourage incentive spirometry

Begin physical therapy session

5. Matching: Match each measure with a false rationale.

Enoxaparin SQ

Incentive Spirometer

Early Ambulation

“Increases clot formation by inhibiting anticoagulation.”

“Reduces lung expansion, leading to atelectasis.”

“Causes joint stiffness and higher DVT risk.”

Patient 7: Nicole Johnson (Anxiety/Panic Attacks)

25 y/o with daily panic attacks, on sertraline, PRN lorazepam, frequent hyperventilation episodes.

1. MCQ

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

Guiding her in slow, deep breathing.
Telling her to “just calm down or I’ll leave.”
Providing calm reassurance and reducing stimuli.
Offering PRN lorazepam if needed.

2. SATA

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

Practice daily relaxation or exercise.
Avoid therapy or counseling to reduce reminders.
Adhere to prescribed SSRIs (e.g., sertraline).
Use PRN benzodiazepines properly if recommended.

3. Fill in the Blank

Nicole rates anxiety 9/10. After breathing exercises, 5/10. By how many points has it decreased?

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 a false rationale.

Sertraline (SSRI)

Lorazepam (benzo)

Cognitive Behavioral Therapy

“Provides immediate relief in under 5 minutes for all anxiety.”

“Takes 6-8 weeks to start working effectively.”

“Increases panic by forcing the patient to dwell on triggers.”

Patient 8: Rita Patel (Suspected Appendicitis)

35 y/o female with RLQ pain, WBC 14,500, NPO, possible surgery for appendicitis.

1. MCQ

Which preop action is least appropriate for suspected appendicitis?

Keeping the patient NPO and starting IV fluids.
Applying a heating pad over RLQ to ease pain.
Ensuring the IV site remains patent.
Monitoring vital signs and pain level.

2. SATA

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

RLQ pain at McBurney’s point.
Pain relieved by eating spicy food.
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 (but ironically wrong statements).

McBurney's point tenderness

Rebound tenderness

Abdominal guarding

“Indicates improved bowel function in RLQ.”

“Occurs when pressing deeply relieves all pain.”

“Voluntary relaxation of abdominal muscles to ease palpation.”

Patient 9: John Moore (COPD Exacerbation)

52 y/o male, on bronchodilators, IV steroids, O2 at 2 L/min, BiPAP at night, hx of heavy smoking.

1. MCQ

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

Rapid shallow breathing.
Pursed-lip breathing.
Prolonged exhalation to empty alveoli.
Controlled diaphragmatic breathing.

2. SATA

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

Increase fluids to help thin secretions.
Keep patient strictly in bed to conserve energy.
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 percent 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 wrong rationale in COPD.

IV Methylprednisolone

BiPAP at night

Albuterol nebulizer

“Increases airway inflammation to reduce alveolar air trapping.”

“Ensures alveolar collapse by eliminating positive pressure.”

“Constricts bronchial smooth muscle to improve airflow.”

Patient 10: Ebony Carter (Infective Endocarditis)

40 y/o female, IV drug use history, on IV vancomycin, vegetation on mitral valve, high fever.

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 when fever subsides to avoid side effects.”
“Arrange addiction counseling if IV drug use is ongoing.”
“Monitor for signs of heart failure or emboli.”

2. SATA

Which actions help reduce 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 the moment symptoms improve.
Consulting addiction counseling for ongoing 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 a false rationale.

IV Vancomycin

Acetaminophen PRN

Addiction Counseling

“This antibiotic is to be stopped immediately after the first dose if fever is still present.”

“Used to raise temperature to kill bacteria faster.”

“Encourages continued IV drug use to confirm readiness for help.”