TEAS Practice Test 4

Critical Thinking Scenario: A patient's blood glucose reading is 45 mg/dL (normal: 70-100 mg/dL). The patient is conscious but reports feeling shaky and sweating. The standing order protocol states: "For blood glucose 50-69 mg/dL, give 15g simple carbohydrates and recheck in 15 minutes."

The nurse should:

End-of-Life Care: A terminally ill patient's family is struggling with the decision to transition to comfort care. They ask the nurse what "comfort care" means and how it differs from continuing aggressive treatment.

The nurse's best explanation is:

Infection Control Scenario: A patient with Clostridioides difficile infection requires contact precautions. A nursing student asks about proper procedure when entering and leaving the patient's room.

The correct sequence for entering the room is:

Medication Reconciliation: Upon admission, a patient reports taking "a heart pill, something for diabetes, and a blood thinner." Hospital records show prescriptions for metoprolol, metformin, and warfarin from six months ago. The patient states they stopped taking "the blood thinner" last month due to bruising.

The most important follow-up action is:

Quality Improvement Data: Month 1: Hand hygiene compliance 65% Month 2: Hand hygiene compliance 72% Month 3: Hand hygiene compliance 68% Month 4: Hand hygiene compliance 79% Month 5: Hand hygiene compliance 83%

What trend does this data suggest?

Nursing Assessment: A post-operative patient reports pain level 8/10 despite receiving prescribed pain medication 2 hours ago. The patient appears restless, has elevated blood pressure (150/95), heart rate 110 bpm, and is requesting additional pain relief.

Which nursing action is most appropriate?

Research Study: "A randomized trial compared two wound dressing protocols for post-surgical patients. Group A used traditional gauze dressings changed daily. Group B used hydrocolloid dressings changed every 3 days. Results showed Group B had 40% fewer dressing changes, 25% faster healing times, and 30% higher patient comfort scores. However, Group B had 15% higher material costs per patient."

This study demonstrates:

Patient Education Material: "After cardiac catheterization, keep the insertion site dry for 24 hours. Avoid lifting objects heavier than 10 pounds for one week. You may shower after 24 hours but avoid baths or swimming for one week. Call your doctor immediately if you notice bleeding, swelling, numbness, or color changes at the insertion site."

A patient asks when they can return to their job as a warehouse worker lifting 50-pound boxes. The appropriate response is:

Nursing Ethics Scenario: A competent adult patient refuses a blood transfusion due to religious beliefs, despite having severe anemia that could be life-threatening without treatment. The patient's family is pressuring them to accept the transfusion and has asked the nurse to convince the patient to change their mind.

The nurse's most appropriate action is to:

Clinical Practice Guideline: "Catheter-associated urinary tract infections (CAUTIs) can be prevented through proper catheter insertion technique, maintenance of closed drainage systems, securing catheters to prevent movement, and removing catheters as soon as medically appropriate. Daily assessment of catheter necessity is required."

According to this guideline, CAUTI prevention involves: (Select all that apply)

Patient Safety Event: "A patient received twice the prescribed dose of morphine due to a calculation error. The patient experienced respiratory depression requiring naloxone administration and transfer to intensive care. The patient recovered fully within 24 hours. Root cause analysis revealed inadequate calculation verification processes."

This event primarily illustrates the importance of:

Passage: Interprofessional collaboration in healthcare involves multiple disciplines working together to provide comprehensive patient care. Effective teams include clear communication, defined roles and responsibilities, mutual respect, and shared decision-making. Research demonstrates that strong interprofessional collaboration leads to improved patient outcomes, reduced medical errors, increased job satisfaction, and more efficient use of healthcare resources.

The passage suggests that interprofessional collaboration requires: (Select all that apply)

Medication Safety Alert: "High-alert medications require special safeguards to reduce risk of patient harm. These include insulin, anticoagulants, chemotherapy agents, and concentrated electrolytes. Safety measures include independent double-checks, standardized concentrations, smart pump technology, and clear labeling. Never abbreviate names of high-alert medications or use trailing zeros in dosing."

Based on this alert, which safety practice should be avoided?

Laboratory Results Interpretation: Patient A: WBC 15,000/μL (normal: 4,000-11,000) Patient B: Hemoglobin 8.2 g/dL (normal: 12-16 g/dL for women) Patient C: Platelet count 450,000/μL (normal: 150,000-400,000) Patient D: Creatinine 0.9 mg/dL (normal: 0.6-1.2 mg/dL)

Which patients have laboratory values outside normal ranges? (Select all that apply)

Passage: Sepsis is a life-threatening condition resulting from the body's response to infection. Early recognition and treatment are critical, as delays can lead to septic shock, organ failure, and death. The Sepsis-3 criteria help identify patients at risk using clinical indicators such as altered mental status, systolic blood pressure ≤100 mmHg, and respiratory rate ≥22 breaths per minute. Immediate treatment includes fluid resuscitation, broad-spectrum antibiotics, and source control when possible.

The passage emphasizes that sepsis management depends most critically on:

Research Findings: "A study of 1,200 nurses found that those working 12-hour shifts had 23% higher rates of medication errors compared to those working 8-hour shifts. However, patient satisfaction scores were 15% higher on units with 12-hour shifts, and nurse turnover was 30% lower. Hospital administrators must weigh these competing factors when determining optimal shift lengths."

This research presents:

Nursing Documentation: "Patient ambulated 50 feet with steady gait, no shortness of breath noted. Vital signs stable: BP 128/82, HR 76, RR 18, O2 sat 97% on room air. Patient reported pain level 3/10 at incision site, states 'feeling much better today.' Incision clean, dry, and intact with no signs of infection."

This documentation primarily reflects which aspect of patient care?

Passage: Healthcare-associated infections (HAIs) cost the U.S. healthcare system approximately $28-33 billion annually. The most common HAIs include central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and ventilator-associated pneumonia (VAP). Many of these infections are preventable through evidence-based practices such as proper hand hygiene, aseptic technique, and timely removal of invasive devices.

What does the passage suggest about healthcare-associated infections?

Data Table: Medication Administration Times Scheduled: 0800, Administered: 0815 (15 minutes late) Scheduled: 1200, Administered: 1245 (45 minutes late)
Scheduled: 1800, Administered: 1755 (5 minutes early) Scheduled: 2200, Administered: 2200 (on time)

According to most hospital policies allowing 30-minute windows for medication administration, which administration times would be considered errors?

Passage: Advance directives are legal documents that allow individuals to specify their healthcare preferences in case they become unable to communicate their wishes. These documents typically include a living will, which outlines treatment preferences for end-of-life care, and a healthcare power of attorney, which designates someone to make healthcare decisions. Healthcare providers must respect these directives while also considering current medical circumstances and discussing options with designated decision-makers.

The primary purpose of advance directives is to:

Clinical Guidelines: "Hand hygiene should be performed before and after patient contact, before aseptic procedures, after contact with potentially infectious materials, and after removing gloves. Use alcohol-based hand rub for 15-20 seconds when hands are not visibly soiled, or soap and water for 40-60 seconds when hands are visibly soiled or after contact with spore-forming organisms."

According to these guidelines, soap and water should be used when: (Select all that apply)

Passage: Quality improvement initiatives in healthcare focus on systematic approaches to enhance patient outcomes, safety, and satisfaction. The Plan-Do-Study-Act (PDSA) cycle provides a framework for testing changes on a small scale before full implementation. Key principles include patient-centered care, evidence-based practice, continuous monitoring, and stakeholder engagement throughout the improvement process.

The PDSA cycle is described as a method for:

Patient Scenario: Mrs. Chen, age 78, was admitted with pneumonia. Her medications include warfarin for atrial fibrillation, metformin for diabetes, and lisinopril for hypertension. Laboratory results show elevated INR (4.2), normal glucose (95 mg/dL), and elevated creatinine (2.1 mg/dL).

Based on this information, which medication requires immediate attention?

Research Abstract: "A meta-analysis of 15 studies examined the effectiveness of aromatherapy in reducing postoperative nausea and vomiting (PONV). Results showed a statistically significant reduction in PONV incidence (RR=0.68, 95% CI: 0.52-0.89, p=0.004) compared to placebo controls. Peppermint and ginger aromatherapy showed the strongest effects. No adverse events were reported in any included studies."

Based on this research, aromatherapy for postoperative nausea:

Passage: Falls are the leading cause of injury among hospitalized patients, with approximately 700,000-1,000,000 falls occurring annually in U.S. hospitals. Risk factors include age over 65, medication effects, cognitive impairment, mobility limitations, and environmental hazards. Prevention strategies involve comprehensive fall risk assessment, environmental modifications, medication review, patient education, and implementation of individualized fall prevention plans.

Which statement best summarizes the passage's main point?

Passage: Pain is considered the "fifth vital sign" and should be assessed regularly in all patients. Subjective pain reporting using numeric scales (0-10) is considered the gold standard, but objective indicators such as facial expressions, body positioning, and physiological changes may supplement assessment. Cultural factors, previous pain experiences, and individual coping mechanisms can significantly influence how patients express and report pain.

The passage indicates that effective pain assessment should include: (Select all that apply)

Passage: Infection control practices in healthcare settings must address both contact and airborne transmission routes. Standard precautions include hand hygiene, personal protective equipment use, and safe injection practices for all patients. Additional precautions are required for specific pathogens: contact precautions for drug-resistant organisms, droplet precautions for influenza, and airborne precautions for tuberculosis. Proper implementation requires ongoing staff training and monitoring compliance.

Which type of precaution would be most appropriate for a patient with active tuberculosis?

Two Research Studies: Study A: "Nurse-to-patient ratios of 4:1 resulted in 14% fewer medication errors compared to 6:1 ratios." Study B: "Hospitals with nurse-to-patient ratios of 4:1 showed 20% higher nurse satisfaction scores than those with 6:1 ratios."

What do these studies suggest about nurse-to-patient ratios?

Passage: Hospital-acquired pressure injuries have decreased by 25% over the past five years due to implementation of comprehensive prevention protocols. These protocols include systematic risk assessment using the Braden Scale, regular repositioning schedules, specialized support surfaces, and staff education programs. However, certain patient populations including ICU patients, elderly individuals, and those with spinal cord injuries continue to show higher incidence rates despite preventive measures.

What can be concluded about pressure injury prevention efforts?

Patient Education Material: "Managing Type 2 Diabetes requires daily attention to blood glucose monitoring, medication adherence, dietary choices, and physical activity. Check blood sugar levels as prescribed by your healthcare provider, typically before meals and at bedtime. Take medications exactly as directed, even when feeling well. Focus on a balanced diet with controlled carbohydrate intake. Engage in at least 150 minutes of moderate exercise weekly, as approved by your doctor."

According to this material, when should diabetic patients typically check their blood glucose?

Passage: Evidence-based practice (EBP) integrates the best available research evidence with clinical expertise and patient preferences to guide healthcare decisions. This approach requires nurses to critically evaluate research studies, considering factors such as sample size, methodology, and applicability to their patient population. EBP helps ensure that nursing interventions are effective, safe, and based on current scientific knowledge rather than tradition or personal experience alone.

The passage suggests that evidence-based practice:

Graph: Medication Error Reports by Type (Bar Chart) Wrong dose: 35%, Wrong medication: 28%, Wrong time: 20%, Wrong route: 12%, Wrong patient: 5%

Based on this graph, which statements are accurate? (Select all that apply)

Passage: Pressure ulcers, also known as bedsores or decubitus ulcers, develop when sustained pressure restricts blood flow to tissue areas. High-risk patients include those with limited mobility, poor nutrition, advanced age, or medical conditions affecting circulation. Prevention strategies include regular position changes every two hours, use of pressure-redistributing surfaces, skin assessment, and maintaining adequate nutrition and hydration. Once formed, pressure ulcers can be difficult to heal and may lead to serious complications including infection.

Which factor is NOT mentioned as contributing to pressure ulcer development?

Passage: The Glasgow Coma Scale (GCS) is a neurological assessment tool used to evaluate consciousness level in patients with brain injuries. It measures three components: eye opening response (1-4 points), verbal response (1-5 points), and motor response (1-6 points). The total score ranges from 3-15, with lower scores indicating more severe impairment. A GCS score of 8 or below typically indicates severe brain injury requiring immediate intervention.

Based on this passage, a patient with a GCS score of 6 would be classified as having:

Passage: Medication reconciliation is a formal process of comparing a patient's medication orders to all medications the patient has been taking. This process occurs at every transition of care including admission, transfer between units, and discharge. Discrepancies such as omissions, duplications, dosing errors, or drug interactions must be identified and resolved. Studies indicate that medication reconciliation can prevent up to 70% of medication errors at care transitions.

What is the main purpose of medication reconciliation?

Medical Study Abstract: "A randomized controlled trial of 500 post-operative patients compared standard pain management protocols with patient-controlled analgesia (PCA). Results showed PCA patients reported 23% lower pain scores (p<0.05), required 18% fewer nursing interventions for pain management, and demonstrated 15% shorter hospital stays. No significant differences in side effects were observed between groups."

Which outcomes support the effectiveness of patient-controlled analgesia? (Select all that apply)

Passage: Telemetry monitoring allows continuous observation of patients' cardiac rhythms and vital signs through wireless technology. Nurses trained in telemetry interpretation can quickly identify life-threatening arrhythmias such as ventricular fibrillation or complete heart block. The central monitoring station displays multiple patients simultaneously, enabling rapid response to cardiac emergencies. However, false alarms due to patient movement or loose electrodes can lead to alarm fatigue among nursing staff.

The passage suggests that telemetry monitoring:

Two Passages:

Passage A: "Electronic health records (EHRs) have revolutionized healthcare documentation by providing instant access to patient information, reducing medical errors, and improving care coordination among providers."

Passage B: "While EHRs offer potential benefits, their implementation has created new challenges including decreased face-to-face patient interaction, increased documentation burden on providers, and concerns about data security breaches."

How do these passages differ in their perspective on electronic health records?

Passage: Pain assessment in pediatric patients presents unique challenges due to developmental differences in communication abilities. Children under three years cannot reliably self-report pain intensity, requiring healthcare providers to rely on behavioral indicators such as crying, facial expressions, and body movements. Various pediatric pain scales have been developed, including the FLACC scale (Face, Legs, Activity, Cry, Consolability) for non-verbal children and numeric rating scales for older children who can communicate verbally.

What is the relationship between age and pain assessment methods in pediatric patients?

Passage: Nosocomial infections, also called healthcare-associated infections (HAIs), occur in patients during the course of receiving healthcare treatment. These infections can develop 48 hours or more after admission or within 30 days after discharge. Common types include surgical site infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia. Prevention strategies focus on hand hygiene, proper use of personal protective equipment, environmental cleaning, and antimicrobial stewardship.

Which of the following can be inferred from the passage?

Chart: Hospital Emergency Department Wait Times by Day of Week Monday: 45 minutes, Tuesday: 38 minutes, Wednesday: 41 minutes, Thursday: 52 minutes, Friday: 67 minutes, Saturday: 89 minutes, Sunday: 78 minutes

Based on this data, what can be concluded about emergency department wait times?

Instructions: To properly collect a midstream urine sample, follow these steps precisely: 1) Wash hands thoroughly with soap and water. 2) Clean the genital area with provided antiseptic wipes, wiping from front to back. 3) Begin urinating into the toilet. 4) Without stopping the urine stream, position the collection container to catch the middle portion of urine. 5) Remove the container before completing urination. 6) Secure the lid tightly and label with patient information.

According to these instructions, when should the collection container be positioned?

Passage: The circadian rhythm, commonly known as the body clock, regulates numerous physiological processes including sleep-wake cycles, hormone production, and body temperature fluctuations. This internal timing system is synchronized by external cues, primarily light exposure. Disruption of circadian rhythms, often caused by shift work or jet lag, can lead to sleep disorders, metabolic dysfunction, and increased susceptibility to various health conditions.

The author's primary purpose in this passage is to:

Passage: Clinical research protocols require strict adherence to ethical guidelines established by institutional review boards (IRBs). These guidelines ensure participant safety, informed consent, and scientific validity. Researchers must demonstrate that potential benefits outweigh risks, that participant selection is equitable, and that data privacy is protected. Violations of these protocols can result in study termination, legal consequences, and loss of research privileges.

Based on the passage, which of the following are requirements for ethical clinical research? (Select all that apply)

Passage: The phenomenon of antibiotic resistance represents one of the most pressing challenges in modern medicine. When bacteria are exposed to antibiotics, those with natural resistance survive and reproduce, passing their resistance genes to offspring. This process, accelerated by overuse and misuse of antibiotics, has led to the emergence of "superbugs" - bacteria resistant to multiple antibiotics. Healthcare facilities have implemented strict protocols including antimicrobial stewardship programs, isolation procedures, and enhanced surveillance systems to combat this growing threat.

What is the main idea of this passage?