Daily Question Archive
The last 30 days of free clinical questions, rotating across 16 nursing specialties. Tap any question to answer it.
Thirty minutes after arriving in PACU, a 68-year-old who received hydromorphone 2 mg in the OR becomes restless and is pulling at his gown. …
Four minutes after arriving in the PACU following a deep extubation for nasal septoplasty, a 34-year-old has high-pitched inspiratory noise,…
A patient with obstructive sleep apnea who uses CPAP at home had a laparoscopic hernia repair. After 70 minutes in PACU he scores 9 on the A…
A breastfed term newborn on day 3 is under LED phototherapy for a rising bilirubin. Eye shields are in place. The infant has lost 9% of birt…
A 30-week infant was placed on CPAP 6 cm H2O at birth for grunting and retractions. At 3 hours of life, FiO2 needs have climbed from 0.30 to…
A 29-week preterm infant on day 14 of life is on advancing feeds of fortified breast milk. Over the past 6 hours there have been two apnea a…
A telemetry patient with acute kidney injury has a potassium of 6.9 mEq/L and a glucose of 210 mg/dL. Over the past hour the T waves have be…
A telemetry patient's rhythm shows P waves at 84/min marching through independently of wide QRS complexes at 34/min. The patient is pale and…
A 66-year-old telemetry patient with a prior MI develops a regular wide-complex tachycardia at 176/min. He is alert, says he feels 'fluttery…
A patient on day 5 of vancomycin and piperacillin-tazobactam for pneumonia has a creatinine that has risen from 0.9 to 1.7 mg/dL. Urine outp…
Three hours after a total thyroidectomy, a patient's neck is visibly swollen above the dressing, her voice is hoarse and weak, and she says …
Twenty minutes into a 1 g vancomycin infusion running over 30 minutes, a patient develops intense itching and redness over the face, neck an…
Twenty minutes after a vaginal birth, a patient with chronic hypertension (BP 152/98) and moderate persistent asthma has a fundus that firms…
A multiparous patient at 37 weeks has spontaneous rupture of membranes with the fetal head at -3 station. The FHR drops from 140 to 70 and s…
A patient at 40 weeks is being induced with oxytocin at 12 mU/min, is 5 cm dilated, and has an epidural. Averaged over 30 minutes she has 6 …
During induction with sevoflurane and succinylcholine for a laparoscopic cholecystectomy, a 22-year-old develops masseter rigidity that make…
Three hours into a prone lumbar fusion, the circulating nurse notes only 15 mL of urine in the past 2 hours from a 70 kg patient's indwellin…
This question is back with our nurse reviewers and will return once it's confirmed.
An 82-year-old who takes apixaban, last dose this morning, fell at home and has a left intertrochanteric hip fracture. Her daughter says her…
A 52-year-old with type 2 diabetes who takes empagliflozin had a laparoscopic cholecystectomy 3 days ago and has eaten little since. She pre…
After a steering-wheel impact, a 45-year-old has BP 82/64, HR 124, distended neck veins, and equal breath sounds on both sides. The systolic…
A patient with an acute type B aortic dissection has BP 182/104 and HR 96. A nicardipine infusion and an esmolol infusion are both ordered, …
An 80 kg patient is ordered norepinephrine at 0.1 mcg/kg/min. The bag contains 16 mg in 250 mL. The previous bag was 4 mg in 250 mL, and the…
A septic shock patient has received 30 mL/kg of fluid and has a MAP of 58. Central access is expected in 2 to 3 hours because of coagulopath…
Right after a large-bore internal jugular CVC is placed, the nurse transduces the distal port and sees a pulsatile waveform reading 118/64. …
A patient with cirrhosis admitted for grade II hepatic encephalopathy has received lactulose 30 mL every 6 hours for 24 hours. He has had on…
A client with suspected pulmonary tuberculosis, cough, night sweats and upper-lobe infiltrates, is being moved from the ED to a negative-pre…
A 38-year-old with palpitations, weight loss and tremor has TSH 0.02 mIU/L (low), free T4 18 pmol/L (normal), and free T3 8.5 pmol/L (high).…
A 74-year-old with atrial fibrillation who stopped apixaban last month because of cost has had 4 hours of severe, constant abdominal pain. S…
A 52-year-old with chronic low back pain has taken oxycodone 10 mg three times a day for a year from the NP's practice. He asks for a 90-day…
A 5-month-old girl has a temperature of 39.4°C without a clear source. She isn't toilet-trained, and the provider orders a urinalysis and ur…
After an NG tube is placed in a 2-year-old for feeding, the nurse injects 5 mL of air and hears a 'whoosh' over the epigastrium. The aspirat…
An 8-year-old on methylphenidate for ADHD for a year has dropped from the 50th to the 25th percentile for weight, eats little at lunch, and …
An 89-year-old LTC resident who had a stomach virus last week now has new confusion, dry mucous membranes and a 2 kg weight loss. She is sti…
A resident with advanced dementia is on a mechanical-soft diet with mildly thick liquids after a swallow study. Staff report that she coughs…
A long-term care resident with moderate dementia has become more confused and inattentive over 2 days and keeps pulling at her clothes. Oxyc…
A patient on glargine and glipizide calls the clinic at 1100. She felt shaky and sweaty, checked her glucose at 52 mg/dL, and drank 4 oz of …
A 24-year-old who fainted during his last two blood draws is back for labs. He is seated in the draw chair and says he is anxious. His BP is…
In the clinic waiting room, a 61-year-old reports 20 minutes of crushing chest pressure with nausea. EMS has been called. SpO2 is 98% on roo…
A patient with an acute PE is on a weight-based heparin infusion. The 0600 anti-Xa level is 1.2 units/mL (goal 0.3–0.7). Her gums ooze after…
A patient admitted 2 days ago with pneumonia, who reports drinking a fifth of vodka daily, is now tremulous, diaphoretic and picking at 'bug…
A 68 kg stepdown patient with pneumonia has received 2 L of crystalloid and broad-spectrum antibiotics in the past hour. BP is now 84/46 (MA…
Forty minutes into hemodialysis, a patient reports chest tightness and back pain. BP falls from 138/80 to 96/58. The blood in the venous ret…
A patient on hemodialysis three times weekly with a tunneled catheter has a temperature of 38.9°C and rigors starting 30 minutes into a sess…
A hemodialysis patient takes amlodipine, carvedilol and lisinopril, and has had symptomatic drops in BP during the last three sessions, whic…
During manual pressure for femoral sheath removal, a patient becomes pale and diaphoretic and says she is going to faint. HR has dropped fro…
Two hours after a transradial cath, a patient with a compression band on the right wrist reports increasing numbness and aching in the right…
The day after a femoral PCI, a patient has a tender, pulsatile mass at the access site with a bruit, and a groin hematoma that has grown sin…
Four minutes after arriving in the PACU following a deep extubation for nasal septoplasty, a 34-year-old has high-pitched inspiratory noise,…
A patient with obstructive sleep apnea who uses CPAP at home had a laparoscopic hernia repair. After 70 minutes in PACU he scores 9 on the A…
Thirty minutes after a general anesthetic with desflurane, a PACU patient has an EtCO2 of 68 mmHg on nasal capnography, a heart rate of 136 …
A term newborn is 18 hours old. The mother was GBS-positive and received penicillin only 2 hours before birth. The infant's temperature has …
A breastfed term newborn on day 3 is under LED phototherapy for a rising bilirubin. Eye shields are in place. The infant has lost 9% of birt…
A 30-week infant was placed on CPAP 6 cm H2O at birth for grunting and retractions. At 3 hours of life, FiO2 needs have climbed from 0.30 to…
A 66-year-old telemetry patient with a prior MI develops a regular wide-complex tachycardia at 176/min. He is alert, says he feels 'fluttery…
A 71-year-old with hypertension and diabetes is admitted with atrial fibrillation of unknown onset; he noticed palpitations 'sometime last w…
A 78-year-old with heart failure takes digoxin 0.25 mg daily and furosemide 40 mg twice daily. At 0800 the patient reports nausea and 'not f…
A patient with acute respiratory failure on mechanical ventilation has the following arterial blood gas: pH 7.28, PaCO2 58, PaO2 62, HCO3 26…
A patient on volume-control ventilation becomes agitated and the high-pressure alarm sounds repeatedly. SpO2 falls from 96% to 82%, breath s…
On the first day after a hip replacement, a 70-year-old develops sudden dyspnea and pleuritic chest pain. SpO2 is 88% on room air, HR 118, t…
A patient at 36 weeks with moderate persistent asthma arrives with BP 168/112 and a severe headache. Fifteen minutes later her BP is 166/110…
A patient with preeclampsia with severe features is on magnesium sulfate at 2 g/h. Four hours ago urine output was 50 mL/h; it is now 15 mL/…
Twenty minutes after a vaginal birth, a patient with chronic hypertension (BP 152/98) and moderate persistent asthma has a fundus that firms…
During induction with sevoflurane and succinylcholine for a laparoscopic cholecystectomy, a 22-year-old develops masseter rigidity that make…
Three hours into a prone lumbar fusion, the circulating nurse notes only 15 mL of urine in the past 2 hours from a 70 kg patient's indwellin…
This question is back with our nurse reviewers and will return once it's confirmed.
After a motorcycle crash, a patient has a distending abdomen, BP 84/52, HR 132, and cool, mottled skin. The FAST exam shows free fluid in Mo…
A restrained driver arrives after a high-speed collision. RR is 34, SpO2 84% on a non-rebreather, BP 78/50, and HR 138. Breath sounds are ab…
A patient with DKA has received 2 L of normal saline. The provider orders an insulin infusion at 0.1 units/kg/h. The labs just back show glu…
A septic ICU patient with DIC is oozing from IV sites and the nasogastric tube. Platelets are 45,000/µL, INR 1.9, and fibrinogen 90 mg/dL. O…
A septic shock patient on norepinephrine 30 mcg/min shows persistent hypotension (MAP 58 mmHg) despite adequate fluid resuscitation. The pat…
A septic shock patient on norepinephrine has been on vasopressin at 0.04 units/min for 30 hours. MAP is 68. The nurse now finds the fingerti…
A physician gives a verbal order for a medication during a code situation. What is the required documentation process?
A patient develops sudden hypotension and distended neck veins 30 minutes after subclavian central line placement. Breath sounds are equal b…
A 66-year-old telemetry patient with a prior MI develops a regular wide-complex tachycardia at 176/min. He is alert, says he feels 'fluttery…
A nurse practitioner is managing four postoperative patients on a surgical unit. All require interventions within the next hour. Which patie…
An 18-kg child is ordered vancomycin 15 mg/kg IV every 8 hours. The pharmacy supplies vancomycin 500 mg in 100 mL, and the protocol says to …
A patient with atrial fibrillation stable on warfarin 5 mg daily (INR 2.5) is started on amiodarone by cardiology. The NP managing the warfa…
A 4-month-old who isn't yet rolling over is brought in for fussiness. The nurse notices a small bruise on the right ear and two fingertip-si…
Six days after a tonsillectomy, a 5-year-old is brought back because he keeps swallowing frequently and spat up a small amount of bright red…
A 7-year-old has had 2 days of abdominal pain that started near the umbilicus and moved to the right lower quadrant, with vomiting and a low…
A bedbound LTC resident on continuous tube feeding has an area of non-blanchable redness over the sacrum with intact skin. The head of the b…
An 84-year-old LTC resident has fallen twice this month, both times walking to the bathroom around 0200. She takes zolpidem at bedtime, lisi…
An 89-year-old LTC resident who had a stomach virus last week now has new confusion, dry mucous membranes and a 2 kg weight loss. She is sti…
A 64-year-old with new atrial fibrillation started warfarin 2 weeks ago, and his INR today is 2.4. He gardens, eats salads most days, takes …
Ten minutes after an allergy immunotherapy injection, a patient in the clinic developed hives, throat tightness and wheezing, and received e…
A patient on glargine and glipizide calls the clinic at 1100. She felt shaky and sweaty, checked her glucose at 52 mg/dL, and drank 4 oz of …