NCLEX Practice Set 7 (Case Study #1)
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Question 1 of 6
1. Question
Case Study Question 1 of 6
A 35-year-old female is brought to the emergency room via ambulance complaining of constant trembling and nausea/vomiting/diarrhea.
Nurse Notes:
1200.
Client with history of anxiety disorder and major depressive disorder, currently on paroxetine daily. She reports she was recently given a prescription for cyclobenzaprine for muscle spasms in her back from old tennis injury and has been using it around the clock for several days. No other significant medical history.Client reports feeling palpitations; general diaphoresis noted upon exam. Also reports nausea, vomiting, and diarrhea since yesterday evening. Hyperactive bowel sounds noted. She has a mild tremor in her hands. Reflexes +3 bilaterally and ankle clonus noted.
18-gauge IV started x2.
CBC, electrolytes, BUN and creatinine, creatinine phosphokinase, liver enzymes, drug screen collected.
1300.
Client becoming increasingly agitated and now disoriented to place and time. Cries out “my heart is beating so fast!” Significant muscle rigidity noted.Vital Signs:
Time: Admit 1200 1300 T 100F 104 F P 98 140 RR 20 26 B/P 130/80 170/100 Pulse oximeter 98% on RA 96% on RA Pain none none >Select the 5 findings that are most significant from the options below.
CorrectIncorrect -
Question 2 of 6
2. Question
Case Study Question 2 of 6
A 35-year-old female is brought to the emergency room via ambulance complaining of constant trembling and nausea/vomiting/diarrhea.
Nurse Notes:
1200.
Client with history of anxiety disorder and major depressive disorder, currently on paroxetine daily. She reports she was recently given a prescription for cyclobenzaprine for muscle spasms in her back from old tennis injury and has been using it around the clock for several days. No other significant medical history.Client reports feeling palpitations; general diaphoresis noted upon exam. Also reports nausea, vomiting, and diarrhea since yesterday evening. Hyperactive bowel sounds noted. She has a mild tremor in her hands. Reflexes +3 bilaterally and ankle clonus noted.
18-gauge IV started x2.
CBC, electrolytes, BUN and creatinine, creatinine phosphokinase, liver enzymes, drug screen collected.
1300.
Client becoming increasingly agitated and now disoriented to place and time. Cries out “my heart is beating so fast!” Significant muscle rigidity noted.Vital Signs:
Time: Admit 1200 1300 T 100F 104 F P 98 140 RR 20 26 B/P 130/80 170/100 Pulse oximeter 98% on RA 96% on RA Pain none none Labs:
Lab Results Reference range Hematocrit 35% Males: 42-52%
Females: 35-47%Hemoglobin 12 g/dL Males: 13-18 g/dL
Females:12-16 g/dLWBC 15,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Creatinine phosphokinase 375mcg/L 10-120mcg/L AST 50 U/L 8-33 U/L ALT 80 U/L 7-56 U/L Drug screen Negative Negative >For each client finding, click to indicate if the finding is consistent with neuroleptic malignant syndrome, serotonin syndrome, or anticholinergic toxicity. Each finding may support more than one type of respiratory condition.
CorrectIncorrect -
Question 3 of 6
3. Question
Case Study Question 3 of 6
A 35-year-old female is brought to the emergency room via ambulance complaining of constant trembling and nausea/vomiting/diarrhea.
Nurse Notes:
1200.
Client with history of anxiety disorder and major depressive disorder, currently on paroxetine daily. She reports she was recently given a prescription for cyclobenzaprine for muscle spasms in her back from old tennis injury and has been using it around the clock for several days. No other significant medical history.Client reports feeling palpitations; general diaphoresis noted upon exam. Also reports nausea, vomiting, and diarrhea since yesterday evening. Hyperactive bowel sounds noted. She has a mild tremor in her hands. Reflexes +3 bilaterally and ankle clonus noted.
18-gauge IV started x2.
CBC, electrolytes, BUN and creatinine, creatinine phosphokinase, liver enzymes, drug screen collected.
1300.
Client becoming increasingly agitated and now disoriented to place and time. Cries out “my heart is beating so fast!” Significant muscle rigidity noted.Vital Signs:
Time: Admit 1200 1300 T 100F 104 F P 98 140 RR 20 26 B/P 130/80 170/100 Pulse oximeter 98% on RA 96% on RA Pain none none Labs:
Lab Results Reference range Hematocrit 35% Males: 42-52%
Females: 35-47%Hemoglobin 12 g/dL Males: 13-18 g/dL
Females:12-16 g/dLWBC 15,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Creatinine phosphokinase 375mcg/L 10-120mcg/L AST 50 U/L 8-33 U/L ALT 80 U/L 7-56 U/L Drug screen Negative Negative >Choose the most appropriate word from the choices below to fill in the blank of the following sentences.
The nurse suspects that the client has (choose a, b, c, or d). The nurse must intervene quickly to prevent (choose e, f, g, or h).
CorrectIncorrect -
Question 4 of 6
4. Question
Case Study Question 4 of 6
A 35-year-old female is brought to the emergency room via ambulance complaining of constant trembling and nausea/vomiting/diarrhea.
Nurse Notes:
1200.
Client with history of anxiety disorder and major depressive disorder, currently on paroxetine daily. She reports she was recently given a prescription for cyclobenzaprine for muscle spasms in her back from old tennis injury and has been using it around the clock for several days. No other significant medical history.Client reports feeling palpitations; general diaphoresis noted upon exam. Also reports nausea, vomiting, and diarrhea since yesterday evening. Hyperactive bowel sounds noted. She has a mild tremor in her hands. Reflexes +3 bilaterally and ankle clonus noted.
18-gauge IV started x2.
CBC, electrolytes, BUN and creatinine, creatinine phosphokinase, liver enzymes, drug screen collected.
1300.
Client becoming increasingly agitated and now disoriented to place and time. Cries out “my heart is beating so fast!” Significant muscle rigidity noted.Vital Signs:
Time: Admit 1200 1300 T 100F 104 F P 98 140 RR 20 26 B/P 130/80 170/100 Pulse oximeter 98% on RA 96% on RA Pain none none Labs:
Lab Results Reference range Hematocrit 35% Males: 42-52%
Females: 35-47%Hemoglobin 12 g/dL Males: 13-18 g/dL
Females:12-16 g/dLWBC 15,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Creatinine phosphokinase 375mcg/L 10-120mcg/L AST 50 U/L 8-33 U/L ALT 80 U/L 7-56 U/L Drug screen Negative Negative The physician makes a working diagnosis of serotonin syndrome.
>Select the orders from each of the categories the nurse should include in the plan of care. Each category may have more than one order.
Order Categories Orders Transfer Orders a. Transfer to Intensive Care Unit b. Transfer to Medical Surgical Unit Fever Management c. Apply cooling blanket d. Obtain vitals every hour e. Administer Tylenol 650mg PO f. Administer Dantrolene Blood Pressure Management g. Administer propranolol h. Start esmolol IV infusion Other Orders i. Administer cyproheptadine j. Increase paroxetine dose k. Administer diazepam IV l. Continuous cardiac monitor CorrectIncorrect -
Question 5 of 6
5. Question
Case Study Question 5 of 6
A 35-year-old female is brought to the emergency room via ambulance complaining of constant trembling and nausea/vomiting/diarrhea.
Nurse Notes:
1200.
Client with history of anxiety disorder and major depressive disorder, currently on paroxetine daily. She reports she was recently given a prescription for cyclobenzaprine for muscle spasms in her back from old tennis injury and has been using it around the clock for several days. No other significant medical history.Client reports feeling palpitations; general diaphoresis noted upon exam. Also reports nausea, vomiting, and diarrhea since yesterday evening. Hyperactive bowel sounds noted. She has a mild tremor in her hands. Reflexes +3 bilaterally and ankle clonus noted.
18-gauge IV started x2.
CBC, electrolytes, BUN and creatinine, creatinine phosphokinase, liver enzymes, drug screen collected.
1300.
Client becoming increasingly agitated and now disoriented to place and time. Cries out “my heart is beating so fast!” Significant muscle rigidity noted.Vital Signs:
Time: Admit 1200 1300 T 100F 104 F P 98 140 RR 20 26 B/P 130/80 170/100 Pulse oximeter 98% on RA 96% on RA Pain none none Labs:
Lab Results Reference range Hematocrit 35% Males: 42-52%
Females: 35-47%Hemoglobin 12 g/dL Males: 13-18 g/dL
Females:12-16 g/dLWBC 15,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Creatinine phosphokinase 375mcg/L 10-120mcg/L AST 50 U/L 8-33 U/L ALT 80 U/L 7-56 U/L Drug screen Negative Negative Orders:
- Transfer client to the ICU
- Vital signs and core temp hourly
- Stop paroxetine and cyclobenzaprine
- Cooling blanket now to bring core temp to <100.4
- Start esmolol IV with loading dose of 500mcg/kg and then maintenance infusion of 50mcg/kg/min
- Start 0.9% normal saline @ 150ml/hr
- Administer 3 mg diazepam IVP for muscle rigidity
- Insert Foley catheter
- Administer cyproheptadine 8mg PO
The nurse manages the transfer to the ICU.
>Of the orders listed below, select the 4 orders the nurse should implement first
CorrectIncorrect -
Question 6 of 6
6. Question
Case Study Question 6 of 6
A 35-year-old female is brought to the emergency room via ambulance complaining of constant trembling and nausea/vomiting/diarrhea.
Nurse Notes:
1200.
Client with history of anxiety disorder and major depressive disorder, currently on paroxetine daily. She reports she was recently given a prescription for cyclobenzaprine for muscle spasms in her back from old tennis injury and has been using it around the clock for several days. No other significant medical history.Client reports feeling palpitations; general diaphoresis noted upon exam. Also reports nausea, vomiting, and diarrhea since yesterday evening. Hyperactive bowel sounds noted. She has a mild tremor in her hands. Reflexes +3 bilaterally and ankle clonus noted.
18-gauge IV started x2.
CBC, electrolytes, BUN and creatinine, creatinine phosphokinase, liver enzymes, drug screen collected.
1300.
Client becoming increasingly agitated and now disoriented to place and time. Cries out “my heart is beating so fast!” Significant muscle rigidity noted.1315.
Cooling blanket applied.1320.
Esmolol loading dose of 500mcg/kg IVP over 1 minute.1323.
Esmolol maintenance infusion of 50mcg/kg/min started.1325.
Cyproheptadine 8mg PO given.1330.
Transferred to ICU1345.
Patient less diaphoretic. Diazepam 3mg IVP given. Foley catheter insertedVital Signs:
Time: Admit 1200 1300 1345 1530 T 100F 104 F 103 F 101.8 F P 98 140 125 110 RR 20 26 22 18 B/P 130/80 170/100 150/96 138/88 Pulse oximeter 98% on RA 96% on RA 96% on RA 97% on RA Urine Output – – – 70ml Muscle Rigidity – Significant Significant Significant Labs:
Lab Results Reference range Hematocrit 35% Males: 42-52%
Females: 35-47%Hemoglobin 12 g/dL Males: 13-18 g/dL
Females:12-16 g/dLWBC 15,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Creatinine phosphokinase 375mcg/L 10-120mcg/L AST 50 U/L 8-33 U/L ALT 80 U/L 7-56 U/L Drug screen Negative Negative Orders:
- Transfer client to the ICU
- Vital signs and core temp hourly
- Stop paroxetine and cyclobenzaprine
- Cooling blanket now to bring core temp to <100.4
- Start esmolol IV with loading dose of 500mcg/kg and then maintenance infusion of 50mcg/kg/min
- Start 0.9% normal saline @ 150ml/hr
- Administer 3 mg diazepam IVP for muscle rigidity
- Insert Foley catheter
- Administer cyproheptadine 8mg PO
The nurse re-evaluates the client’s status at 1530.
>Complete the following sentence by choosing from the list of options.
The nurse determines the client’s status is (choose a, b, or c). As evidenced by (choose d, e, or f).
CorrectIncorrect