Tim JonesScenario 1You begin your shift assessment w/ Mr. JonesScenario 2Mr. Jones is scheduled for a full body CT scan. Mr. Jones stated to the nurse that he "was scared to leave the room." Further questioning and clarification revealed Mr. Jones does not want to be alone and is afraid of being hurtScenario 3Later in the evening Mr. Jones falls on his way to the bathroomScenario 4Mr. Jones is resting quietly in the bed, R 22, slightly labored, color pink. Eyes closed. Upon assessment, Mr. Jones was noted to have bilateral wheezing, R 24, some use of accessory muscles w/ respiration's, dullness to percussion in the left lower lobe, an an unproductive cough. Based on assessment, nebulizer tx administered per MD orders.Scenario 5Mr. Jones is now more alert and states he does not see the point in living anymore and wishes he would just die quietly. He asks to speak to a clergy member. He does not want to return to the nursing home, and does not wish to burden or live with his children. He insists that he is not hungry and refuses assistance with his meal. He requests no visitors at this time, but later asks for his family to be called to discuss a plan of care.

Jose MartinezScenario 1At 2200, you enter the room and the pt states pain is now 10/10 after not having any pain for 3 hrs. Call RRT, rapidly prioritize the followingScenario 2Mr. Martinez was taken emergently to the cath-lab and had 3 stents inserted in his heart. The pain was relieved post-op. He has been informed that for the next 18 months he should take antithrombotic therapy daily. Scenario 3Mr. Martinez will now start taking long term antithrombotic therapy. He is anxious that he will forget to take it or take the wrong dose. He tells you he wished he "had died from the attack...I'll never be the same."Scenario 4Mr. Martinez lab work comes back post-stent placement Scenario 5Mrs. Martinez is visiting her husband, who appears to be ignoring any attempts at conversation. Upon completion of the shift assessment, Mrs. Martinez quietly asked "my husband is telling me he is ready to get me home, that he is missing me. Should I be concerned about having sex w/ him? Could he have another heart attack?"

Mary BarkleyScenario 1Right after admission the nurse finds her walking down the hall trying to leave. Redirect the pt back to her room.Scenario 2Mrs. Barkley is becoming more adamant about leaving while her physical condition continues to deteriorate. Her temp is 100.8, BP 100/62, P 92, R 21, SpaO2 91. The nurse auscultation fine crackles in her lungs bilaterally, but her sputum is clear. She is oriented x3 but at times seems to be talking to someone in the room when no one is present. She told the nurse that she does not want a breathing tube, but her family has told the nurse by phone that they want every effort done to save her. She pulled out her IV and it will need to be restarted for her IV I pro dose that is due now. The nurse has another high acuity admission that has just arrived from the ER.Scenario 3Ms. Barkley continues to deteriorate and is shouting for her family. She is disoriented and believes the nursing staff is trying to kill her. Her temp is 101.3, BP 98/58, P98, R22, and PaO2 86%. the PCT is requesting to be relieved as the pt keeps pulling at the PCT's mask to see who she is. The RN calls the attending provider requesting that Ms. Barkley be txf to ICU but there are no rooms available. Instead the RN is told to put the pt on telemetry and call RT for a CPAP trial. Scenario 4The pt continues to be combative while attempting to initiated the CPAP trial. Healthcare provider has ordered Haldol in order to sedate the pt. VS are deteriorating, BP 90/58, P 116, R 28, PaO2 85%, T 102.0. Enter the room after taking VS.Scenario 5Ms. Barkley requires emergency intubation, and the HCP on scene suggests that the pt did not want to be intubated. You, the RN, are concerned because the family asked for everything to be done and the pt never signed a DNR order. The pt has now been sedated, and RT is temporarily maintaining their saturation's w/ effective valve mask ventilation.

Carlos ManciaScenario 1Mr. Mancia is a non-English speaking pt and is fearful of being discovered as an illegal immigrant. Upon entering the room ww/ a translator to admit him to the hospital, he is asked for address and phone number but refuses to complyScenario 2Upon entering the room, you wash/glove hands. Following isolation precautions, you notice several family members are by his bedside and none of them are wearing face masks as requested by the sign on the door.Scenario 3Before entering Carlos Mancia room to administer his antipyretic medication for his recent temp of 101.2Scenario 4The sister of Mr. Mancia calls from home to speak w/ you. She shares her concerns about the pt's wife who is now coughing and having night sweatsScenario 5Mr. Mancia is holding a Catholic Rosary in his hand is crying as you enter the room

John WigginsScenario 1You respond to Mr. Wiggins call light. He is complaining that his headache is worsening. You tell the pt that you must do a assessment before you can give him any medication. his Glasgow coma scale is 15. his VS are BP 168/80, T 98.9, P 98, R 24. Complete the neurological assessment.Scenario 2Your neurological assessment concludes the following: A/O x4 appears normal, left pupil is slightly larger than his right and is +3 to react to light, there is no evidence of any drainage, cranial checks are WNL, and extremity strength is slightly diminished. Glasgow coma scale is 13. Scenario 3After sharing findings w/ the provider, he orders the following: 1. Contact radiology for a stat CT scan of the head. 2. Start a saline lock. #. Neurological checks q30 minutes. 4. Hold coding, administer Tylenol 1g 5. NPOScenario 4You accompany transport of Mr. Wiggins from radiology back to his room. You check his VS and they are: BP 185/75, P 58, R 28 and irregular, T 99.1, PaO2 98. His GCS is now 10. neuro check: A/O x2, left pupil is larger than his right and is +5 to react to light, their is no evidence of any drainage, cranial checks are all normal and pt is less cooperative for extremity strength assessment. Upon finishing the assessment, Mr. Wiggins experiences a generalized tonic/clinic seizure. Scenario 5The HCP has heard from the radiologist that there is a sub Duran hematoma on the left side of the brain. Pt needs emergency neuro surgery in order to stop the b led and relieve the pressure on the brain. His GCS is now 7. Prepare the pt for emergency neuro surgery.

Sarah Kathryn HortonScenario 1You hear a scream coming from Mrs. Horton's room. Upon entering the room, it was noted that she appeared to be asleep, eyes closed, possibly experiencing a bad dreamScenario 2Ms. Horton did not rest well last night, and woke up frequently w/ episodes of crying. This morning, at shift report, she states that she is scared to leave the hospital after the shooting incident. Pt is complaining of pain in her shoulder and thigh 7/10Scenario 3HCP orders 1.) Dressing change q 24 hours to RT thighs and rt shoulder. 2.) Pre medicate Morphine Sulfate 4mg IV 15 minutes prior to dressing change 3.) Wet to dry dressing w/ triple abx ointment to wounds. 4.) Sulfamethoxazole 800 mg, Trimethoprim 160 mg (Bactria DS) 1 tablet PO daily 5.) Consult Psychology for referral 6.) Encourage PO fluidsScenario 4Ms. Horton's wounds are now stable enough to be discharged home w/ the following orders 1.) d/c home 2.) Paroxetine (Paxil) 30mg PO everyday. 3.) Follow up w/ regular HCP in 1 week 4.) Sulfamethoxazole 800mg, Trimethoprim 160mg (Bactria DS) 1 tablet PO daily for 10 days 5.) Hydrocodone 5 mg Acetaminophen 325 mg (Norco 5mg) 1-2 tablets every 3-4 hrs PRN moderated to severe pain #30.Scenario 5The nurse has Ms. Horton in the wheelchair ready to be taken down to the lobby by the UAP. As Ms. Horton is waiting by the exterior hospital door, construction workers are on the road working w/ a jackhammer. Ms. Horton hears the jackhammer and then screams and dives to the floor.

Virginia SmithScenario 1Mrs. Smith shares w/ you that even though she signed the operative consent she was not sure if this was the right surgical procedure for her. Her husband who is present stats, "I thought it was just a lumpectomy she was having this morning."Scenario 2It is now 2 wks later; Mrs. Smith has returned. You question her while reviewing her operative consent and determine that everything is correct. She receives the pre-op medication. Her husband and children remain w/ her in the surgical holding area awaiting transport to the OR. Scenario 3Mrs. Smith's surgery has now ended. You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. Her chart reports she was exhibited upon arrival to the recovery area, received three units (3000 mL) of fluid, receiving O2 @ 4LNC, F/C in place draining QS clear yellow urine, responds to verbal stimuli, chest dressing in place remains dry and intact, and has just received a small dose of IV morphine for pain. VS are BP 112/78, T 97.4, R 16, and O2 94%. Scenario 4 You are about to call the Surgical ICU and give report. What order are you providing the information to the receiving nurse?Scenario 5You are now the Surgical ICU nurse assigned to her. She has just been transported from recovery. List the nursing care order.

Julia MonroeScenario 1Pt is scheduled for and ECG and MRI this AM. You are entering the room for the first time. After performing handy hygiene and introducing yourself to pt, you should...Scenario 2The dx tests were completed and Dr. Gray has informed the pt of the dx of HF and tx w/ digoxin. Upon entering the room, the pt is crying and asks when will the medication fix her heart.Scenario 3A few days later, you are assigned to the same pt. She receives her AM medications including levothyroxie, diltiazem and digoxin. After your AM assessment, the pt's call light goes on and she is complaining of nause, abd pain, and seeing "yellow circles". Upon entering the room, the pt is standing by the bed...Scenario 4The labs return w/ digoxin level of 10.5 ng/mL, K 5.3 mEq/L. Other labs were WNL. HCP orders digoxin immune fab to be given.Scenario 5Four hours later, the telemetry tech calls and states the pt is Sinus Tach 102 w/ occasional multi focal PVC's, pt is complaining of cramping in her legs. Her last K was 3.2 mEq/L. She appears short of breath when talking.

Mary BarkleyScenario 1Right after admission the nurse finds her walking down the hall trying to leave. Redirect the pt back to her room.Scenario 2Mrs. Barkley is becoming more adamant about leaving while her physical condition continues to deteriorate. Her temp is 100.8, BP 100/62, P 92, R 21, SpaO2 91. The nurse auscultation fine crackles in her lungs bilaterally, but her sputum is clear. She is oriented x3 but at times seems to be talking to someone in the room when no one is present. She told the nurse that she does not want a breathing tube, but her family has told the nurse by phone that they want every effort done to save her. She pulled out her IV and it will need to be restarted for her IV I pro dose that is due now. The nurse has another high acuity admission that has just arrived from the ER.Scenario 3Ms. Barkley continues to deteriorate and is shouting for her family. She is disoriented and believes the nursing staff is trying to kill her. Her temp is 101.3, BP 98/58, P98, R22, and PaO2 86%. the PCT is requesting to be relieved as the pt keeps pulling at the PCT's mask to see who she is. The RN calls the attending provider requesting that Ms. Barkley be txf to ICU but there are no rooms available. Instead the RN is told to put the pt on telemetry and call RT for a CPAP trial. Scenario 4The pt continues to be combative while attempting to initiated the CPAP trial. Healthcare provider has ordered Haldol in order to sedate the pt. VS are deteriorating, BP 90/58, P 116, R 28, PaO2 85%, T 102.0. Enter the room after taking VS.Scenario 5Ms. Barkley requires emergency intubation, and the HCP on scene suggests that the pt did not want to be intubated. You, the RN, are concerned because the family asked for everything to be done and the pt never signed a DNR order. The pt has now been sedated, and RT is temporarily maintaining their saturation's w/ effective valve mask ventilation.

Robert SturgessScenario 1Mr. Sturgess is recently dx w/ metastatic cancer of colon and he and his family have chosen only palliative care. Upon entering the room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." Scenario 2It is determined that Mr. Sturgess could achieve better pain control w/ a PCA pumpScenario 3Mr. Sturgess does not have a living will or durable power of care completed.Scenario 4Mr. Sturgess is uncomfortable w/ experiencing urinary frequency that keeps him from restingScenario 5Mr. Sturgess is now declining, and family members are requesting to remain in room past normal visiting hours

Virginia SmithScenario 1Mrs. Smith shares w/ you that even though she signed the operative consent she was not sure if this was the right surgical procedure for her. Her husband who is present stats, "I thought it was just a lumpectomy she was having this morning."Scenario 2It is now 2 wks later; Mrs. Smith has returned. You question her while reviewing her operative consent and determine that everything is correct. She receives the pre-op medication. Her husband and children remain w/ her in the surgical holding area awaiting transport to the OR. Scenario 3Mrs. Smith's surgery has now ended. You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. Her chart reports she was exhibited upon arrival to the recovery area, received three units (3000 mL) of fluid, receiving O2 @ 4LNC, F/C in place draining QS clear yellow urine, responds to verbal stimuli, chest dressing in place remains dry and intact, and has just received a small dose of IV morphine for pain. VS are BP 112/78, T 97.4, R 16, and O2 94%. Scenario 4 You are about to call the Surgical ICU and give report. What order are you providing the information to the receiving nurse?Scenario 5You are now the Surgical ICU nurse assigned to her. She has just been transported from recovery. List the nursing care order.

John DuncanScenario 1As you enter the room, Mr. Duncan is refusing to eat foods from bland dietScenario 2Mr. Duncan is now complaining of feeling "dizzy" when he standsScenario 3Several hours later, Mr. Duncan is now complaining of nausea.Scenario 42-hrs later, Mr. Duncan is asked how frequent his stools have been today. He replies," six times in the past four hours". He also states he is feeling weakScenario 5Mr. Duncan's wife meets you in the hall asking what she could bring her husband to eat from home

Ramona StukesScenario 1Mrs. Stukes is a failed laparoscopic cholecystectomy that resulted in a bowel resection with a temporary ileostomy in place. Now, third day post-op, Mrs. Stukes appears sad and depressed upon entering the roomScenario 2Mrs. Stukes is feeling nauseated.Scenario 3Mrs. Stukes's appliance is leaking for the fourth time today and has been changed and reapplied each time. She is frustrated and overwhelmed with the new appliance not working properly.Scenario 4Mrs. Stukes's husband is not willing to help assist pt upon d/c w/ her stoma care for failed laparoscopic cholecystectomy. Scenario 5Three days after d/c, you receive a phone call from Mrs. Stuke's neighbor, who is helping take care of her. She is requesting the names and home phone number for the wound care nurse who saw Mrs. Stukes while she was an inpatient.

Charlie RaymondScenario 1The next day, he tests positive for COVID-19 and his condition has deteriorated as he is now in respiratory distress. Mr. Raymond weighs 260 lbs. VS: BP 92/58, P 102, R 30 and labored, T 101.3, SaO2 91%. He has bilateral lower lobe atelectasis w/ bronchial vesicular wheezing.Scenario 2Mr. Raymond continues to deteriorate and becomes confused. In his confusion, he becomes combative and pulls out his IV. He is on a 100% nonrebreather and he keeps pulling his mask off. Just received an order to initiate 20mg of Furosemide (Lasix) IVP, BID. Scenario 3Order for a Foley catheter has been obtained and Lucy Jones, LPN, is their to assist. Both RN have donned appropriate PPE and have entered the room. Scenario 4Rank as most concerning for labsScenario 5Mr. Raymond is stabilized w/ RRT. Give an SBAR to hospitalist

Lithia MonsonScenario 1You arrive in room to find Ms. Monson talking to herself. Upon assessment, you determined that she is confused to person, time, and place but is easily directable.Scenario 2There is an order to apply a waist belt restraint if needed. You determine to apply the restraint now.Scenario 3Ms. Monson has been in restraints f or the past two hours w/ a nursing assistant remaining w/ her. You arrive in room to check on her, after washing hands...Scenario 4After 3 hours Ms. Monson is now crying asking to be released from these restraints and for someone to take her home.Scenario 5In reassessing Ms. Monson, her VS are BP 106/82, T 98.2, P 106, R 18, SaO2 88

Donald Lyles Scenario 1Mr. Lyles calls you via the call light. Upon entering the room, he asks if you have medication for "heartburn". He says, "I take TUMS at home when this happens." You tell the pt you will be glad to check-on what is available for relief of his "heartburn" after you complete his physical assessment. You begin his assessment, and he falls back in the bed and becomes unresponsive. You shouldn't, "Are you okay? Are you okay?" Scenario 2The CODE-blue team arrives w/ a crash cart, Physician, anesthetist, and 2 critical-care nurses and 1 respiratory therapist.Scenario 3You have now been assigned to document the ongoing event as the CODE team continues w/ the resuscitation.Scenario 4After 15 minutes, the pts rhythm returns, but he is still unresponsive. He is now in V-tach w/ a weak pulse and BP 70/40. Prepare to initiate cardioversion. Scenario 5Mr. Lyles responded to the first cardioversion, and is now in a sinus-Brady w/ a second-degree heart block. He is still unresponsive. VS are BP 80/40, P 46, R 16, (pt now intubated and ventilated by Respiratory Therapy)

Richard DominecScenario 1After two hours, Mr. Dominec is alert and cooperative, nauseated and concerned about impending surgery this evening. His partner is at the bedside asking, "How much longer will he have to wait until taken to surgery?"Scenario 2Mr. Dominec had his surgical procedure and is doing great. It is now the second day post op and his is given discharge information. His partner is not with him at this time but will arrive soon to facilitate his discharge home. Scenario 3Mr. Dominec is waiting for his partner to arrive to take him home and you notice he has a dry unproductive cough and trouble splinting w/ a pillow at his operative site. you take his vital signs which are T 101.3, P 88, R 24, BP 116/84Scenario 4Mr. Dominec decides he does not want to see the ID MD about his new cough. he chooses to go home and see the dr tomorrow in his office. He states, "thiss is not serious."Scenario 5Mr. Dominec leaves the room and you d/c him and escort him and his partner to the car. You return to the break room on your floor. Your coworkers are asking you questions about mr. Dominec. They feel that you should share w/ them if he was a "real AIDS" pt or not. They were also concerned about the next pt going into that room and the use of the lavatory. They wanted to know and pressure you for the information. Two housekeepers, who were refusing to clean the room, are in the break room. Your response to all of them would be:

Sarah Kathryn HortonScenario 1You hear a scream coming from Mrs. Horton's room. Upon entering the room, it was noted that she appeared to be asleep, eyes closed, possibly experiencing a bad dreamScenario 2Ms. Horton did not rest well last night, and woke up frequently w/ episodes of crying. This morning, at shift report, she states that she is scared to leave the hospital after the shooting incident. Pt is complaining of pain in her shoulder and thigh 7/10Scenario 3HCP orders 1.) Dressing change q 24 hours to RT thighs and rt shoulder. 2.) Pre medicate Morphine Sulfate 4mg IV 15 minutes prior to dressing change 3.) Wet to dry dressing w/ triple abx ointment to wounds. 4.) Sulfamethoxazole 800 mg, Trimethoprim 160 mg (Bactria DS) 1 tablet PO daily 5.) Consult Psychology for referral 6.) Encourage PO fluidsScenario 4Ms. Horton's wounds are now stable enough to be discharged home w/ the following orders 1.) d/c home 2.) Paroxetine (Paxil) 30mg PO everyday. 3.) Follow up w/ regular HCP in 1 week 4.) Sulfamethoxazole 800mg, Trimethoprim 160mg (Bactria DS) 1 tablet PO daily for 10 days 5.) Hydrocodone 5 mg Acetaminophen 325 mg (Norco 5mg) 1-2 tablets every 3-4 hrs PRN moderated to severe pain #30.Scenario 5The nurse has Ms. Horton in the wheelchair ready to be taken down to the lobby by the UAP. As Ms. Horton is waiting by the exterior hospital door, construction workers are on the road working w/ a jackhammer. Ms. Horton hears the jackhammer and then screams and dives to the floor.

Preston WrightScenario 1Mr. Wright reports pain 6/10, and is requesting medication prior to dressing changeScenario 2Mr. Wright insists that he watches TV from the Hight Fowler's position. The nurse repositioned the pt to the left side to decrease pressure on the sacrum and rt heel. Sacrum pressure injury demonstrates underlying bone exposure wound measures 4cm x 6cm x 3cm depth w/ tunneling noted on the rt side. The rt heel demonstrates a blister 2cm x 1cm w/ clear fluid noted.Scenario 3The HCP is requesting an update on sacral wound healing.Scenario 4It is now times for Mr. Wright's sacral dressing change as the dressing seal is compromised and drainage is visible on the outer layer. see the plan of care: 1.) Sterile NS wet-to-dry dressing changes daily 2.) Apply triple abx ointment to edges of wound each dressing change 3.) Notify MD of worsening changes to wound based on measurements and appearance 4.) Medicate w/ Demerol 100mg w/ Phenegran 25mg IM prior to dressing changes 5.) change diet to HH 6.) DC DocuCare sodium if pt complains of diarrhea 7.) Change IV fluids to 75ml/hr 8.) Encourage PO fluids 9.) Nutrition consultScenario 510 days later, Mr. Wright's wounds are healing, and you have orders to prepare for d/c w/ home healthcare. Mr. Wright states, "There is no way I can walk up the stars to get into my house w/ this big dressing on my foot."

Virginia SmithScenario 1Mrs. Smith shares w/ you that even though she signed the operative consent she was not sure if this was the right surgical procedure for her. Her husband who is present stats, "I thought it was just a lumpectomy she was having this morning."Scenario 2It is now 2 wks later; Mrs. Smith has returned. You question her while reviewing her operative consent and determine that everything is correct. She receives the pre-op medication. Her husband and children remain w/ her in the surgical holding area awaiting transport to the OR. Scenario 3Mrs. Smith's surgery has now ended. You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. Her chart reports she was exhibited upon arrival to the recovery area, received three units (3000 mL) of fluid, receiving O2 @ 4LNC, F/C in place draining QS clear yellow urine, responds to verbal stimuli, chest dressing in place remains dry and intact, and has just received a small dose of IV morphine for pain. VS are BP 112/78, T 97.4, R 16, and O2 94%. Scenario 4 You are about to call the Surgical ICU and give report. What order are you providing the information to the receiving nurse?Scenario 5You are now the Surgical ICU nurse assigned to her. She has just been transported from recovery. List the nursing care order.

Ramona StukesScenario 1Mrs. Stukes is a failed laparoscopic cholecystectomy that resulted in a bowel resection with a temporary ileostomy in place. Now, third day post-op, Mrs. Stukes appears sad and depressed upon entering the roomScenario 2Mrs. Stukes is feeling nauseated.Scenario 3Mrs. Stukes's appliance is leaking for the fourth time today and has been changed and reapplied each time. She is frustrated and overwhelmed with the new appliance not working properly.Scenario 4Mrs. Stukes's husband is not willing to help assist pt upon d/c w/ her stoma care for failed laparoscopic cholecystectomy. Scenario 5Three days after d/c, you receive a phone call from Mrs. Stuke's neighbor, who is helping take care of her. She is requesting the names and home phone number for the wound care nurse who saw Mrs. Stukes while she was an inpatient.

Sarah GettsScenario 1Ms. Getts is requesting water to drink. Her pitcher has already been filled three times this shift.Scenario 2Three hours later, Ms. Getts is unsteady when standing by her bedside.Scenario 3You observe Ms. Getts being assisted by another nurse who is being blatantly rude and disrespectful to her.Scenario 4Ms. Getts is now complaining of sudden sharp, substernal chest pain, very short of breath and is profusely diaphoretic.Scenario 5Ms. Getts is being transferred as an emergency to Critical Care. Your responsibilities are:

Marcella ComoScenario 1Ms. Como is first day after sexual assault. Upon entering the room, she is quiet and shows little emotion.Scenario 2Later in morning care, Ms. Como requests o take a shower stating she feels 'dirty'.Scenario 3In the afternoon, Ms. Como is stating that she does not want to see her husband or any visitors.Scenario 4Marcella Como is now more talkative and shares with you that she is going to cooperate and wants to press charges against the assailant.Scenario 5Marcella is very worried about STD's and posssible pregnancy

Robert SturgessScenario 1Mr. Sturgess is recently dx w/ metastatic cancer of colon and he and his family have chosen only palliative care. Upon entering the room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." Scenario 2It is determined that Mr. Sturgess could achieve better pain control w/ a PCA pumpScenario 3Mr. Sturgess does not have a living will or durable power of care completed.Scenario 4Mr. Sturgess is uncomfortable w/ experiencing urinary frequency that keeps him from restingScenario 5Mr. Sturgess is now declining, and family members are requesting to remain in room past normal visiting hours

Lithia MonsonScenario 1You arrive in room to find Ms. Monson talking to herself. Upon assessment, you determined that she is confused to person, time, and place but is easily directable.Scenario 2There is an order to apply a waist belt restraint if needed. You determine to apply the restraint now.Scenario 3Ms. Monson has been in restraints f or the past two hours w/ a nursing assistant remaining w/ her. You arrive in room to check on her, after washing hands...Scenario 4After 3 hours Ms. Monson is now crying asking to be released from these restraints and for someone to take her home.Scenario 5In reassessing Ms. Monson, her VS are BP 106/82, T 98.2, P 106, R 18, SaO2 88

Donald Lyles Scenario 1Mr. Lyles calls you via the call light. Upon entering the room, he asks if you have medication for "heartburn". He says, "I take TUMS at home when this happens." You tell the pt you will be glad to check-on what is available for relief of his "heartburn" after you complete his physical assessment. You begin his assessment, and he falls back in the bed and becomes unresponsive. You shouldn't, "Are you okay? Are you okay?" Scenario 2The CODE-blue team arrives w/ a crash cart, Physician, anesthetist, and 2 critical-care nurses and 1 respiratory therapist.Scenario 3You have now been assigned to document the ongoing event as the CODE team continues w/ the resuscitation.Scenario 4After 15 minutes, the pts rhythm returns, but he is still unresponsive. He is now in V-tach w/ a weak pulse and BP 70/40. Prepare to initiate cardioversion. Scenario 5Mr. Lyles responded to the first cardioversion, and is now in a sinus-Brady w/ a second-degree heart block. He is still unresponsive. VS are BP 80/40, P 46, R 16, (pt now intubated and ventilated by Respiratory Therapy)

Estelle HatcherScenario 1Ms. Hatcher is second day post-op and has a NG tube set to gravity drainage only. She presses the call light w/ questions about who her RN will be and her NG-tube.Scenario 2During the follow up nursing assessment, Ms. Hatcher complains about the NG-tube causing her pain in her nasal area. She has active bowel soundsScenario 3Dr. Brown gives orders to remove NG-tube set to gravity and to begin a clear liquid dietScenario 4Mrs. Hatcher appears restless, diaphoretic and calls the nurse for help. Upon entering the room, what is the appropriate order of events for the RN to take?Scenario 5Several hours later, Mrs. Hatcher is feeling much better. She puts her call light and asks to see a RN. Upon enter the room, she asks you if she will be able to drive when she gets home tomorrow.

Kathy GestaltScenario 1Ms. Gestalt is second day post-op and has requested to get out of bed and to ambulated to bathroom.Scenario 2Ms. Gestalt is now complaining of fever and chillsScenario 3After 24 hrs, Ms. Gestalt fever and chills have subsided but now states she is feeling like her cast is too tightScenario 4Ms. Gestalt capillary refilling is now 6 seconds below cast site, extremity is swollen and cold to the touchScenario 5You enter room and find Ms. Gestalt crying because she has just learned her medical insurance has lapsed and she is already two months behind on her car payments.

Ramona StukesScenario 1Mrs. Stukes is a failed laparoscopic cholecystectomy that resulted in a bowel resection with a temporary ileostomy in place. Now, third day post-op, Mrs. Stukes appears sad and depressed upon entering the roomScenario 2Mrs. Stukes is feeling nauseated.Scenario 3Mrs. Stukes's appliance is leaking for the fourth time today and has been changed and reapplied each time. She is frustrated and overwhelmed with the new appliance not working properly.Scenario 4Mrs. Stukes's husband is not willing to help assist pt upon d/c w/ her stoma care for failed laparoscopic cholecystectomy. Scenario 5Three days after d/c, you receive a phone call from Mrs. Stuke's neighbor, who is helping take care of her. She is requesting the names and home phone number for the wound care nurse who saw Mrs. Stukes while she was an inpatient.

Robert SturgessScenario 1Mr. Sturgess is recently dx w/ metastatic cancer of colon and he and his family have chosen only palliative care. Upon entering the room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." Scenario 2It is determined that Mr. Sturgess could achieve better pain control w/ a PCA pumpScenario 3Mr. Sturgess does not have a living will or durable power of care completed.Scenario 4Mr. Sturgess is uncomfortable w/ experiencing urinary frequency that keeps him from restingScenario 5Mr. Sturgess is now declining, and family members are requesting to remain in room past normal visiting hours

Virginia SmithScenario 1Mrs. Smith shares w/ you that even though she signed the operative consent she was not sure if this was the right surgical procedure for her. Her husband who is present stats, "I thought it was just a lumpectomy she was having this morning."Scenario 2It is now 2 wks later; Mrs. Smith has returned. You question her while reviewing her operative consent and determine that everything is correct. She receives the pre-op medication. Her husband and children remain w/ her in the surgical holding area awaiting transport to the OR. Scenario 3Mrs. Smith's surgery has now ended. You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. Her chart reports she was exhibited upon arrival to the recovery area, received three units (3000 mL) of fluid, receiving O2 @ 4LNC, F/C in place draining QS clear yellow urine, responds to verbal stimuli, chest dressing in place remains dry and intact, and has just received a small dose of IV morphine for pain. VS are BP 112/78, T 97.4, R 16, and O2 94%. Scenario 4 You are about to call the Surgical ICU and give report. What order are you providing the information to the receiving nurse?Scenario 5You are now the Surgical ICU nurse assigned to her. She has just been transported from recovery. List the nursing care order.

Linda PittmanScenario 1Pt presents to the unit c/o numbness in the rt foot and ankle and toes "not looking the right color". All 5 toes on the right foot are necrotic, absent pedal pulses, skin cold to touch, appearance dry, cracked and black up to mid-calf. Foul odor noted w/ green drainage coming from toenail beds. Doctor orders 1.) IVF 0.9% NS peripheral line @ 100mL/hr 2.) CBC, CMP, Blood culture x 2, Hgb A1C 3.) CT scan of rt lower leg 4.) Blood lab tests 5.) Levofloxacin (Levaquin) 750 mg IV q 24hrsScenario 2Pt speaking incoherently and is exhibiting rapid eye movement w/ a blank stare. An empty syringe is noted in the bed. Pt does respond partially to commands. Brisk peripheral reflexes, eyes equal, round, dilatedScenario 38 hrs later, pt is fidgety and is observed picking at her skin and clothes. The pt states, "I am sick to my stomach and feel like I have bugs crawling all over me!!!"Scenario 4Surgery called to the unit the Ms. Pittman is scheduled at 1300 for a BKA.Scenario 5Post op day 3 time for dressing change stump. Pt sates pain has been managed through the night. Pulses above the stump are palpable at 2+, skin is warm and dry. Pt states she has noted some "toe pain" but that it has been <3 on a scale of 1-10.

Richard DominecScenario 1After two hours, Mr. Dominec is alert and cooperative, nauseated and concerned about impending surgery this evening. His partner is at the bedside asking, "How much longer will he have to wait until taken to surgery?"Scenario 2Mr. Dominec had his surgical procedure and is doing great. It is now the second day post op and his is given discharge information. His partner is not with him at this time but will arrive soon to facilitate his discharge home. Scenario 3Mr. Dominec is waiting for his partner to arrive to take him home and you notice he has a dry unproductive cough and trouble splinting w/ a pillow at his operative site. you take his vital signs which are T 101.3, P 88, R 24, BP 116/84Scenario 4Mr. Dominec decides he does not want to see the ID MD about his new cough. he chooses to go home and see the dr tomorrow in his office. He states, "thiss is not serious."Scenario 5Mr. Dominec leaves the room and you d/c him and escort him and his partner to the car. You return to the break room on your floor. Your coworkers are asking you questions about mr. Dominec. They feel that you should share w/ them if he was a "real AIDS" pt or not. They were also concerned about the next pt going into that room and the use of the lavatory. They wanted to know and pressure you for the information. Two housekeepers, who were refusing to clean the room, are in the break room. Your response to all of them would be:

Joyce WorkmanScenario 1Mrs. Workman presented to the diabetes clinic and provided a 24-hr food recall. She was then sent to the lab for ordered lab tests. She is to notify the nurse upon return to the clinic from the lab. Pt has requested more information on her diabetes and states she does not understand why she "should be concerned" w/ blood glucose control in both the short and long term. Scenario 2The nurse is providing information on nutrition to assist Mrs. Workman in managing her DM II.Scenario 3Mrs. Workman presented to the Diabetes clinic for further evaluation of her diabetes, and lifestyle changes. She is planning on attending several of the classes that are being offered. Pt is requesting information on appropriate exercise programs. She has attendee the diabetic meal prep classes, but still struggles with her dx of diabetes.Scenario 4Day 3 of hospitalization at 12:30, Mrs. Workman calls the RN and complains of cool clammy skin, anxious, weak, hungry but nauseous, and slightly confused. April 10, 1245, Blood glucose level is 40 mg/dL HCP has ordered 1.) hypoglycemia protocols for BG level < 60 mb/dL 2.) regular insulin SQ 20 unit for BG level > 160 mg/dL 3.) monitor BG levels q 4 hours and PRN 4.) IVF D5 0.45% NS at 125 mL/hr 5.) 1800 calorie ADA dietary and teach pt about diet changesScenario 53 months later, Mrs. Workman has returned to the Diabetes clinic having lost 20 lbs and is requesting to stop taking the metformin (glucophage). HbA1C is 7.5%. She is also complaining of new onset diarrhea.

Jose MartinezScenario 1At 2200, you enter the room and the pt states pain is now 10/10 after not having any pain for 3 hrs. Call RRT, rapidly prioritize the followingScenario 2Mr. Martinez was taken emergently to the cath-lab and had 3 stents inserted in his heart. The pain was relieved post-op. He has been informed that for the next 18 months he should take antithrombotic therapy daily. Scenario 3Mr. Martinez will now start taking long term antithrombotic therapy. He is anxious that he will forget to take it or take the wrong dose. He tells you he wished he "had died from the attack...I'll never be the same."Scenario 4Mr. Martinez lab work comes back post-stent placement Scenario 5Mrs. Martinez is visiting her husband, who appears to be ignoring any attempts at conversation. Upon completion of the shift assessment, Mrs. Martinez quietly asked "my husband is telling me he is ready to get me home, that he is missing me. Should I be concerned about having sex w/ him? Could he have another heart attack?"

Virginia SmithScenario 1Mrs. Smith shares w/ you that even though she signed the operative consent she was not sure if this was the right surgical procedure for her. Her husband who is present stats, "I thought it was just a lumpectomy she was having this morning."Scenario 2It is now 2 wks later; Mrs. Smith has returned. You question her while reviewing her operative consent and determine that everything is correct. She receives the pre-op medication. Her husband and children remain w/ her in the surgical holding area awaiting transport to the OR. Scenario 3Mrs. Smith's surgery has now ended. You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. Her chart reports she was exhibited upon arrival to the recovery area, received three units (3000 mL) of fluid, receiving O2 @ 4LNC, F/C in place draining QS clear yellow urine, responds to verbal stimuli, chest dressing in place remains dry and intact, and has just received a small dose of IV morphine for pain. VS are BP 112/78, T 97.4, R 16, and O2 94%. Scenario 4 You are about to call the Surgical ICU and give report. What order are you providing the information to the receiving nurse?Scenario 5You are now the Surgical ICU nurse assigned to her. She has just been transported from recovery. List the nursing care order.

Donald Lyles Scenario 1Mr. Lyles calls you via the call light. Upon entering the room, he asks if you have medication for "heartburn". He says, "I take TUMS at home when this happens." You tell the pt you will be glad to check-on what is available for relief of his "heartburn" after you complete his physical assessment. You begin his assessment, and he falls back in the bed and becomes unresponsive. You shouldn't, "Are you okay? Are you okay?" Scenario 2The CODE-blue team arrives w/ a crash cart, Physician, anesthetist, and 2 critical-care nurses and 1 respiratory therapist.Scenario 3You have now been assigned to document the ongoing event as the CODE team continues w/ the resuscitation.Scenario 4After 15 minutes, the pts rhythm returns, but he is still unresponsive. He is now in V-tach w/ a weak pulse and BP 70/40. Prepare to initiate cardioversion. Scenario 5Mr. Lyles responded to the first cardioversion, and is now in a sinus-Brady w/ a second-degree heart block. He is still unresponsive. VS are BP 80/40, P 46, R 16, (pt now intubated and ventilated by Respiratory Therapy)

Linda PittmanScenario 1Pt presents to the unit c/o numbness in the rt foot and ankle and toes "not looking the right color". All 5 toes on the right foot are necrotic, absent pedal pulses, skin cold to touch, appearance dry, cracked and black up to mid-calf. Foul odor noted w/ green drainage coming from toenail beds. Doctor orders 1.) IVF 0.9% NS peripheral line @ 100mL/hr 2.) CBC, CMP, Blood culture x 2, Hgb A1C 3.) CT scan of rt lower leg 4.) Blood lab tests 5.) Levofloxacin (Levaquin) 750 mg IV q 24hrsScenario 2Pt speaking incoherently and is exhibiting rapid eye movement w/ a blank stare. An empty syringe is noted in the bed. Pt does respond partially to commands. Brisk peripheral reflexes, eyes equal, round, dilatedScenario 38 hrs later, pt is fidgety and is observed picking at her skin and clothes. The pt states, "I am sick to my stomach and feel like I have bugs crawling all over me!!!"Scenario 4Surgery called to the unit the Ms. Pittman is scheduled at 1300 for a BKA.Scenario 5Post op day 3 time for dressing change stump. Pt sates pain has been managed through the night. Pulses above the stump are palpable at 2+, skin is warm and dry. Pt states she has noted some "toe pain" but that it has been <3 on a scale of 1-10.

Julia MonroeScenario 1Pt is scheduled for and ECG and MRI this AM. You are entering the room for the first time. After performing handy hygiene and introducing yourself to pt, you should...Scenario 2The dx tests were completed and Dr. Gray has informed the pt of the dx of HF and tx w/ digoxin. Upon entering the room, the pt is crying and asks when will the medication fix her heart.Scenario 3A few days later, you are assigned to the same pt. She receives her AM medications including levothyroxie, diltiazem and digoxin. After your AM assessment, the pt's call light goes on and she is complaining of nause, abd pain, and seeing "yellow circles". Upon entering the room, the pt is standing by the bed...Scenario 4The labs return w/ digoxin level of 10.5 ng/mL, K 5.3 mEq/L. Other labs were WNL. HCP orders digoxin immune fab to be given.Scenario 5Four hours later, the telemetry tech calls and states the pt is Sinus Tach 102 w/ occasional multi focal PVC's, pt is complaining of cramping in her legs. Her last K was 3.2 mEq/L. She appears short of breath when talking.