Clinical Knowledge and Skills Flashcards

A nurse notices a patient's SpO2 drops to 88% while sleeping. What is the most appropriate initial intervention?

Answer: Apply supplemental oxygen at 2-4 L/min via nasal cannula and reassess

Initial supplemental oxygen via nasal cannula and reassessment is appropriate for mild hypoxia before escalating interventions.

When performing a capillary blood glucose check, which site is preferred for an adult patient?

Answer: The lateral aspect of the fingertip

The lateral aspect of the fingertip has fewer nerve endings, causing less pain while still providing an adequate blood sample.

A patient is prescribed vancomycin. Which lab value must be monitored to prevent nephrotoxicity?

Answer: Serum creatinine and BUN

Vancomycin is nephrotoxic, so serum creatinine and BUN must be monitored to detect renal impairment early.

Which assessment finding in a post-operative patient warrants immediate notification of the physician?

Answer: Urine output of 20 mL over 2 hours

Urine output less than 30 mL/hour indicates oliguria and potential renal hypoperfusion requiring urgent intervention.

A patient with COPD is receiving oxygen therapy. The nurse should titrate oxygen to maintain SpO2 at which target range?

Answer: 88-92%

COPD patients may rely on hypoxic drive; SpO2 88-92% prevents both hypoxia and suppression of the respiratory drive.

When inserting a urinary catheter in a female patient, which step is critical to prevent infection?

Answer: Cleansing the urethral meatus with antiseptic solution before insertion

Cleansing the urethral meatus with antiseptic solution before insertion is a key aseptic technique to prevent catheter-associated UTI.

A patient's ECG shows a prolonged PR interval (>0.20 seconds). This finding is consistent with which condition?

Answer: First-degree AV block

A PR interval greater than 0.20 seconds indicates delayed conduction through the AV node, characteristic of first-degree AV block.