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Further assessment and a practical safety plan are needed."]},"reflection":"Describe how you can be honest about the need for urgent help while still communicating respect and support.","source":["https://openstax.org/books/psychiatric-mental-health/pages/3-1-therapeutic-communication-and-relationships","https://www.nimh.nih.gov/health/publications/5-action-steps-to-help-someone-having-thoughts-of-suicide","https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/adult-outpatient/adult-outpatient-brief-suicide-safety-assessment-guide","https://www.samhsa.gov/mental-health/trauma-violence/trauma-informed-approaches-programs","https://www.hhs.gov/civil-rights/for-individuals/faqs/may-an-lep-person-use-a-family-member-as-an-interpreter/index.html","https://www.hhs.gov/hipaa/for-professionals/faq/520/does-hipaa-permit-a-health-care-provider-to-disclose-information-if-the-patient-is-a-danger/index.html","https://www.ncsbn.org/public-files/ProfessionalBoundaries_Complete.pdf"],"topicId":"therapeutic-communication","itemIds":["v2-psych-001","v2-psych-002"],"status":"ready"}],"items":[{"id":"demo-single","familyId":"demo-single-family","type":"single","topicId":"item-mechanics","clientNeed":"health-promotion-and-maintenance","ncjmmStep":"recognize cues","difficulty":1,"readingLevel":6,"units":"both","status":"ready","bankRole":"format-practice","schemaVersion":2,"stem":"Which room is listed for the practice session?","task":"Format practice: Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["room-4"],"readingSection":{"unitId":"item-mechanics--openrn-nursingmhcc-033--1","chunkId":"chunk-3","index":2},"shard":"item-mechanics"},{"id":"demo-sata","familyId":"demo-sata-family","type":"multiple_response_sata","topicId":"item-mechanics","clientNeed":"health-promotion-and-maintenance","ncjmmStep":"recognize cues","difficulty":1,"readingLevel":6,"units":"both","status":"ready","bankRole":"format-practice","schemaVersion":2,"stem":"Which supplies does the notice ask learners to bring?","task":"Format practice: Select all that apply.","scoring":{"method":"plus_minus"},"answerKey":["notebook","pen"],"readingSection":{"unitId":"item-mechanics--openrn-nursingmhcc-033--1","chunkId":"chunk-3","index":2},"shard":"item-mechanics"},{"id":"demo-select-n","familyId":"demo-select-n-family","type":"multiple_response_select_n","topicId":"item-mechanics","clientNeed":"health-promotion-and-maintenance","ncjmmStep":"recognize cues","difficulty":1,"readingLevel":6,"units":"both","status":"ready","bankRole":"format-practice","schemaVersion":2,"stem":"Which two actions are requested before the session starts?","task":"Format practice: Select exactly 2 answers.","scoring":{"method":"zero_one"},"answerKey":["silence","name"],"selectN":2,"shard":"item-mechanics"},{"id":"demo-matrix-single","familyId":"demo-matrix-single-family","type":"matrix_single","topicId":"item-mechanics","clientNeed":"health-promotion-and-maintenance","ncjmmStep":"recognize cues","difficulty":1,"readingLevel":6,"units":"both","status":"ready","bankRole":"format-practice","schemaVersion":2,"stem":"For each task, choose whether it is complete or still needed. 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findings.","contextTags":["infection","urin"],"scoring":{"method":"zero_one"},"answerKey":{"condition":["a"],"actions":["a","b"],"parameters":["a","b"]},"readingSection":{"unitId":"safety-systems--openrn-nursingfundamentals-045--1","chunkId":"chunk-5","index":4},"targets":[{"id":"condition","label":"The problem to address"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"safety-systems-4"},{"id":"r7b-bow-008","familyId":"r7b-bowtie-delegation-decision","type":"bowtie","topicId":"delegation","clientNeed":"management-of-care","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which problem is this, which two tasks can be delegated to the assistant, and which two findings must the nurse evaluate herself?","task":"Choose 1 problem, 2 actions, 2 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findings.","scoring":{"method":"zero_one"},"answerKey":{"condition":["a"],"actions":["a","b"],"parameters":["a","b"]},"readingSection":{"unitId":"diagnostics--openrn-nursingadvancedskills-045--1","chunkId":"chunk-2","index":1},"targets":[{"id":"condition","label":"The client’s main problem"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"diagnostics"},{"id":"r7b-bow-011","familyId":"r7b-bowtie-hyperkalaemia","type":"bowtie","topicId":"lab-trends","clientNeed":"reduction-of-risk-potential","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which problem should be addressed first, and what should the nurse do and watch?","task":"Choose 1 problem, 2 actions, 2 findings.","contextTags":["kidney","spironolactone"],"scoring":{"method":"zero_one"},"answerKey":{"condition":["a"],"actions":["a","b"],"parameters":["a","b"]},"readingSection":{"unitId":"lab-trends--openrn-healthalts-044--2","chunkId":"chunk-4","index":3},"targets":[{"id":"condition","label":"The client’s main problem"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"lab-trends"},{"id":"r7b-bow-012","familyId":"r7b-bowtie-pulmonary-embolism","type":"bowtie","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which problem does Esperanza most likely have, and what should the nurse do and watch?","task":"Choose 1 problem, 2 actions, 2 findings.","scoring":{"method":"zero_one"},"answerKey":{"condition":["a"],"actions":["a","b"],"parameters":["a","b"]},"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-059--1","chunkId":"chunk-3","index":2},"targets":[{"id":"condition","label":"The client’s main problem"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"cardio-respiratory"},{"id":"r7b-mx-001","familyId":"r7b-matrix-postoperative-expected","type":"matrix_single","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"analyze cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each finding is expected at this stage or needs the nurse to follow up.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"pain-5-out-of-10-at-the-incision-relieved-by-analgesia":["a"],"temperature-37-6-c":["a"],"urine-output-15-milliliters-per-hour-for-the-last-three-hours":["b"],"no-bowel-sounds-and-no-flatus":["a"],"right-calf-swollen-and-tender":["b"]},"readingSection":{"unitId":"diagnostics--openrn-healthalts-017--1","chunkId":"chunk-3","index":2},"targets":[{"id":"pain-5-out-of-10-at-the-incision-relieved-by-analgesia","label":"Pain 5 out of 10 at the incision, relieved by analgesia"},{"id":"temperature-37-6-c","label":"Temperature 99.7 °F (37.6 °C)"},{"id":"urine-output-15-milliliters-per-hour-for-the-last-three-hours","label":"Urine output 15 mL/hr for the last three hours"},{"id":"no-bowel-sounds-and-no-flatus","label":"No bowel sounds and no flatus"},{"id":"right-calf-swollen-and-tender","label":"Right calf swollen and tender"}],"shard":"diagnostics"},{"id":"r7b-mx-002","familyId":"r7b-matrix-precaution-category","type":"matrix_single","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose the transmission-based precautions each client needs.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"confirmed-clostridioides-difficile-with-watery-diarrhea":["a"],"suspected-pulmonary-tuberculosis-with-weeks-of-cough-and-weight-loss":["c"],"laboratory-confirmed-influenza-a":["b"],"new-rash-fever-and-conjunctivitis-with-suspected-measles":["c"],"wound-colonised-with-a-carbapenem-resistant-organism":["a"]},"readingSection":{"unitId":"isolation--openrn-nursingfundamentals-078--2","chunkId":"chunk-1","index":0},"targets":[{"id":"confirmed-clostridioides-difficile-with-watery-diarrhea","label":"Confirmed Clostridioides difficile with watery diarrhea"},{"id":"suspected-pulmonary-tuberculosis-with-weeks-of-cough-and-weight-loss","label":"Suspected pulmonary tuberculosis with weeks of cough and weight loss"},{"id":"laboratory-confirmed-influenza-a","label":"Laboratory-confirmed influenza A"},{"id":"new-rash-fever-and-conjunctivitis-with-suspected-measles","label":"New rash, fever and conjunctivitis with suspected measles"},{"id":"wound-colonised-with-a-carbapenem-resistant-organism","label":"Wound colonized with a carbapenem-resistant organism"}],"shard":"isolation-2"},{"id":"r7b-mx-003","familyId":"r7b-matrix-delegation-assignment","type":"matrix_single","topicId":"delegation","clientNeed":"management-of-care","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose who may carry out each task.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"complete-the-admission-assessment-on-a-new-client":["a"],"change-a-routine-dressing-on-a-healing-wound-in-a-stable-client":["b"],"record-hourly-intake-and-output-for-a-stable-client":["c"],"teach-a-newly-diagnosed-client-to-inject-her-own-insulin":["a"],"assist-a-stable-client-to-walk-to-the-bathroom":["c"]},"readingSection":{"unitId":"delegation--openrn-nursingmpc-013--2","chunkId":"chunk-2","index":1},"targets":[{"id":"complete-the-admission-assessment-on-a-new-client","label":"Complete the admission assessment on a new client"},{"id":"change-a-routine-dressing-on-a-healing-wound-in-a-stable-client","label":"Change a routine dressing on a healing wound in a stable client"},{"id":"record-hourly-intake-and-output-for-a-stable-client","label":"Record hourly intake and output for a stable client"},{"id":"teach-a-newly-diagnosed-client-to-inject-her-own-insulin","label":"Teach a newly diagnosed client to inject her own insulin"},{"id":"assist-a-stable-client-to-walk-to-the-bathroom","label":"Assist a stable client to walk to the bathroom"}],"shard":"delegation"},{"id":"r7b-mx-004","familyId":"r7b-matrix-hold-or-give","type":"matrix_single","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether the nurse should give or hold each dose.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"metoprolol-a-beta-blocker-for-a-client-whose-heart-rate-is-48-beats-per-minute":["b"],"digoxin-for-a-client-whose-apical-heart-rate-is-72-beats-per-minute-and-potassium-is-4-2-millimoles-per-liter":["a"],"furosemide-a-loop-diuretic-for-a-client-whose-potassium-is-2-9-millimoles-per-liter":["b"],"spironolactone-for-a-client-whose-potassium-is-5-8-millimoles-per-liter":["b"],"lisinopril-an-angiotensin-converting-enzyme-inhibitor-for-a-client-whose-blood-pressure-is-134-82-millimeters-of-mercury":["a"]},"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-086--1","chunkId":"chunk-2","index":1},"targets":[{"id":"metoprolol-a-beta-blocker-for-a-client-whose-heart-rate-is-48-beats-per-minute","label":"Metoprolol, a beta blocker, for a client whose heart rate is 48 beats per minute"},{"id":"digoxin-for-a-client-whose-apical-heart-rate-is-72-beats-per-minute-and-potassium-is-4-2-millimoles-per-liter","label":"Digoxin for a client whose apical heart rate is 72 beats per minute and potassium is 4.2 mEq/L"},{"id":"furosemide-a-loop-diuretic-for-a-client-whose-potassium-is-2-9-millimoles-per-liter","label":"Furosemide, a loop diuretic, for a client whose potassium is 2.9 mEq/L"},{"id":"spironolactone-for-a-client-whose-potassium-is-5-8-millimoles-per-liter","label":"Spironolactone for a client whose potassium is 5.8 mEq/L"},{"id":"lisinopril-an-angiotensin-converting-enzyme-inhibitor-for-a-client-whose-blood-pressure-is-134-82-millimeters-of-mercury","label":"Lisinopril, an angiotensin-converting enzyme inhibitor, for a client whose blood pressure is 134/82 mmHg (millimeters of mercury)"}],"shard":"pharm-cardiac-2"},{"id":"r7b-mx-005","familyId":"r7b-matrix-report-now-or-later","type":"matrix_single","topicId":"lab-trends","clientNeed":"reduction-of-risk-potential","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each result needs reporting immediately or at the next routine round.","task":"Choose one answer in each row.","contextTags":["labor"],"scoring":{"method":"zero_one"},"answerKey":{"potassium-6-9-millimoles-per-liter":["a"],"hemoglobin-10-4-grams-per-deciliter-down-from-10-9-yesterday":["b"],"platelet-count-62-000-per-microliter-in-a-client-on-heparin-down-from-220-000-three-days-ago":["a"],"sodium-133-millimoles-per-liter":["b"],"blood-glucose-38-milligrams-per-deciliter":["a"],"white-cell-count-11-600-per-microliter":["b"]},"readingSection":{"unitId":"lab-trends--openrn-healthalts-082--1","chunkId":"chunk-2","index":1},"targets":[{"id":"potassium-6-9-millimoles-per-liter","label":"Potassium 6.9 mEq/L"},{"id":"hemoglobin-10-4-grams-per-deciliter-down-from-10-9-yesterday","label":"Hemoglobin 10.4 g/dL, down from 10.9 yesterday"},{"id":"platelet-count-62-000-per-microliter-in-a-client-on-heparin-down-from-220-000-three-days-ago","label":"Platelet count 62,000 per microliter in a client on heparin, down from 220,000 three days ago"},{"id":"sodium-133-millimoles-per-liter","label":"Sodium 133 mEq/L"},{"id":"blood-glucose-38-milligrams-per-deciliter","label":"Blood glucose 38 mg/dL"},{"id":"white-cell-count-11-600-per-microliter","label":"White cell count 11,600 per microliter"}],"shard":"lab-trends"},{"id":"r7b-mx-006","familyId":"r7b-matrix-shock-type","type":"matrix_single","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each client needs fluid replaced or needs the pump supported.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"flat-neck-veins-clear-lungs-pale-cold-skin-after-major-blood-loss":["a"],"crackles-through-both-lungs-distended-neck-veins-cold-hands-after-a-large-heart-attack":["b"],"dry-mucous-membranes-flat-neck-veins-and-no-urine-output-after-three-days-of-vomiting":["a"],"breathless-lying-flat-jugular-veins-visible-at-45-degrees-new-third-heart-sound":["b"]},"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-059--1","chunkId":"chunk-3","index":2},"targets":[{"id":"flat-neck-veins-clear-lungs-pale-cold-skin-after-major-blood-loss","label":"Flat neck veins, clear lungs, pale cold skin after major blood loss"},{"id":"crackles-through-both-lungs-distended-neck-veins-cold-hands-after-a-large-heart-attack","label":"Crackles through both lungs, distended neck veins, cold hands after a large heart attack"},{"id":"dry-mucous-membranes-flat-neck-veins-and-no-urine-output-after-three-days-of-vomiting","label":"Dry mucous membranes, flat neck veins and no urine output after three days of vomiting"},{"id":"breathless-lying-flat-jugular-veins-visible-at-45-degrees-new-third-heart-sound","label":"Breathless lying flat, jugular veins visible at 45 degrees, new third heart sound"}],"shard":"cardio-respiratory"},{"id":"r7b-mx-007","familyId":"r7b-matrix-multi-ppe","type":"matrix_multiple","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every item of protective equipment each task requires.","task":"In each row, select all that apply.","scoring":{"method":"plus_minus","groups":[{"id":"Suctioning a tracheostomy in a client with no known infection","optionIds":["suctioning-a-tracheostomy-in-a-client-with-no-known-infection:a","suctioning-a-tracheostomy-in-a-client-with-no-known-infection:b","suctioning-a-tracheostomy-in-a-client-with-no-known-infection:c","suctioning-a-tracheostomy-in-a-client-with-no-known-infection:d"],"keys":["suctioning-a-tracheostomy-in-a-client-with-no-known-infection:a","suctioning-a-tracheostomy-in-a-client-with-no-known-infection:b","suctioning-a-tracheostomy-in-a-client-with-no-known-infection:c"]},{"id":"Entering the room of a client on contact precautions to adjust an infusion 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tuberculosis","optionIds":["entering-an-airborne-infection-isolation-room-for-a-client-with-suspected-tuberculosis:a","entering-an-airborne-infection-isolation-room-for-a-client-with-suspected-tuberculosis:b","entering-an-airborne-infection-isolation-room-for-a-client-with-suspected-tuberculosis:c","entering-an-airborne-infection-isolation-room-for-a-client-with-suspected-tuberculosis:d"],"keys":["entering-an-airborne-infection-isolation-room-for-a-client-with-suspected-tuberculosis:d"]},{"id":"Taking an oral temperature with a covered probe in a client with no known 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a tracheostomy in a client with no known infection"},{"id":"entering-the-room-of-a-client-on-contact-precautions-to-adjust-an-infusion-pump","label":"Entering the room of a client on contact precautions to adjust an infusion pump"},{"id":"entering-an-airborne-infection-isolation-room-for-a-client-with-suspected-tuberculosis","label":"Entering an airborne infection isolation room for a client with suspected tuberculosis"},{"id":"taking-an-oral-temperature-with-a-covered-probe-in-a-client-with-no-known-infection","label":"Taking an oral temperature with a covered probe in a client with no known infection"}],"shard":"isolation-2"},{"id":"r7b-mx-008","familyId":"r7b-matrix-multi-finding-cluster","type":"matrix_multiple","topicId":"neuro-renal-endocrine","clientNeed":"physiological-adaptation","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every explanation each finding supports.","task":"In each row, select all that apply.","scoring":{"method":"plus_minus","groups":[{"id":"Cool clammy skin with shakiness","optionIds":["cool-clammy-skin-with-shakiness:a","cool-clammy-skin-with-shakiness:b","cool-clammy-skin-with-shakiness:c"],"keys":["cool-clammy-skin-with-shakiness:a"]},{"id":"New confusion","optionIds":["new-confusion:a","new-confusion:b","new-confusion:c"],"keys":["new-confusion:a","new-confusion:b","new-confusion:c"]},{"id":"Blood pressure rising with a falling heart rate","optionIds":["blood-pressure-rising-with-a-falling-heart-rate:a","blood-pressure-rising-with-a-falling-heart-rate:b","blood-pressure-rising-with-a-falling-heart-rate:c"],"keys":["blood-pressure-rising-with-a-falling-heart-rate:c"]},{"id":"Temperature 38.8 °C with a heart rate of 120 beats per 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beats per minute"}],"shard":"neuro-renal-endocrine"},{"id":"r7b-mx-009","familyId":"r7b-matrix-multi-consent","type":"matrix_multiple","topicId":"legal-ethics","clientNeed":"management-of-care","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every statement that is true of each situation.","task":"In each row, select all that apply.","scoring":{"method":"plus_minus","groups":[{"id":"A competent adult refuses a prescribed blood transfusion","optionIds":["a-competent-adult-refuses-a-prescribed-blood-transfusion:a","a-competent-adult-refuses-a-prescribed-blood-transfusion:b","a-competent-adult-refuses-a-prescribed-blood-transfusion:c"],"keys":["a-competent-adult-refuses-a-prescribed-blood-transfusion:a","a-competent-adult-refuses-a-prescribed-blood-transfusion:c"]},{"id":"A client says she does not know what her surgeon plans to remove","optionIds":["a-client-says-she-does-not-know-what-her-surgeon-plans-to-remove:a","a-client-says-she-does-not-know-what-her-surgeon-plans-to-remove:b","a-client-says-she-does-not-know-what-her-surgeon-plans-to-remove:c"],"keys":["a-client-says-she-does-not-know-what-her-surgeon-plans-to-remove:b","a-client-says-she-does-not-know-what-her-surgeon-plans-to-remove:c"]},{"id":"An unconscious adult needs emergency surgery and no decision-maker can be reached","optionIds":["an-unconscious-adult-needs-emergency-surgery-and-no-decision-maker-can-be-reached:a","an-unconscious-adult-needs-emergency-surgery-and-no-decision-maker-can-be-reached:b","an-unconscious-adult-needs-emergency-surgery-and-no-decision-maker-can-be-reached:c"],"keys":["an-unconscious-adult-needs-emergency-surgery-and-no-decision-maker-can-be-reached:a","an-unconscious-adult-needs-emergency-surgery-and-no-decision-maker-can-be-reached:c"]},{"id":"A client's daughter asks for her mother's biopsy 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says she does not know what her surgeon plans to remove"},{"id":"an-unconscious-adult-needs-emergency-surgery-and-no-decision-maker-can-be-reached","label":"An unconscious adult needs emergency surgery and no decision-maker can be reached"},{"id":"a-client-s-daughter-asks-for-her-mother-s-biopsy-result","label":"A client's daughter asks for her mother's biopsy result"}],"shard":"legal-ethics-2"},{"id":"r7b-mx-010","familyId":"r7b-matrix-multi-insulin-timing","type":"matrix_multiple","topicId":"pharm-endocrine","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"analyze cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every statement that applies to each insulin.","task":"In each row, select all that apply.","contextTags":["insulin"],"scoring":{"method":"plus_minus","groups":[{"id":"Rapid-acting insulin before a meal","optionIds":["rapid-acting-insulin-before-a-meal:a","rapid-acting-insulin-before-a-meal:b","rapid-acting-insulin-before-a-meal:c"],"keys":["rapid-acting-insulin-before-a-meal:a","rapid-acting-insulin-before-a-meal:b"]},{"id":"Long-acting basal insulin at bedtime","optionIds":["long-acting-basal-insulin-at-bedtime:a","long-acting-basal-insulin-at-bedtime:b","long-acting-basal-insulin-at-bedtime:c"],"keys":["long-acting-basal-insulin-at-bedtime:c"]},{"id":"Regular short-acting insulin before a meal","optionIds":["regular-short-acting-insulin-before-a-meal:a","regular-short-acting-insulin-before-a-meal:b","regular-short-acting-insulin-before-a-meal:c"],"keys":["regular-short-acting-insulin-before-a-meal:b"]},{"id":"Intravenous insulin infusion in intensive care","optionIds":["intravenous-insulin-infusion-in-intensive-care:a","intravenous-insulin-infusion-in-intensive-care:b","intravenous-insulin-infusion-in-intensive-care:c"],"keys":["intravenous-insulin-infusion-in-intensive-care:a"]}]},"answerKey":{"rapid-acting-insulin-before-a-meal":["a","b"],"long-acting-basal-insulin-at-bedtime":["c"],"regular-short-acting-insulin-before-a-meal":["b"],"intravenous-insulin-infusion-in-intensive-care":["a"]},"readingSection":{"unitId":"pharm-endocrine--openrn-pharmacology2e-115--1","chunkId":"chunk-3","index":2},"targets":[{"id":"rapid-acting-insulin-before-a-meal","label":"Rapid-acting insulin before a meal"},{"id":"long-acting-basal-insulin-at-bedtime","label":"Long-acting basal insulin at bedtime"},{"id":"regular-short-acting-insulin-before-a-meal","label":"Regular short-acting insulin before a meal"},{"id":"intravenous-insulin-infusion-in-intensive-care","label":"Intravenous insulin infusion in intensive care"}],"shard":"pharm-endocrine"},{"id":"r7b-mx-011","familyId":"r7b-matrix-multi-handoff-content","type":"matrix_multiple","topicId":"w1-handoff","clientNeed":"management-of-care","ncjmmStep":"generate solutions","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every part of the handoff each piece of information belongs in.","task":"In each row, select all that apply.","contextTags":["oxygen"],"scoring":{"method":"plus_minus","groups":[{"id":"Oxygen increased from 2 to 5 L per minute across the shift; saturation 91%","optionIds":["oxygen-increased-from-2-to-5-liters-per-minute-across-the-shift-saturation-91-percent:a","oxygen-increased-from-2-to-5-liters-per-minute-across-the-shift-saturation-91-percent:b","oxygen-increased-from-2-to-5-liters-per-minute-across-the-shift-saturation-91-percent:c"],"keys":["oxygen-increased-from-2-to-5-liters-per-minute-across-the-shift-saturation-91-percent:a"]},{"id":"Admitted two days ago with pneumonia; takes a daily inhaled steroid at home","optionIds":["admitted-two-days-ago-with-pneumonia-takes-a-daily-inhaled-steroid-at-home:a","admitted-two-days-ago-with-pneumonia-takes-a-daily-inhaled-steroid-at-home:b","admitted-two-days-ago-with-pneumonia-takes-a-daily-inhaled-steroid-at-home:c"],"keys":["admitted-two-days-ago-with-pneumonia-takes-a-daily-inhaled-steroid-at-home:b"]},{"id":"Recheck the oxygen saturation in an hour and call the clinician if she needs more than 5 L per minute","optionIds":["recheck-the-oxygen-saturation-in-an-hour-and-call-the-clinician-if-she-needs-more-than-5-liters-per-minute:a","recheck-the-oxygen-saturation-in-an-hour-and-call-the-clinician-if-she-needs-more-than-5-liters-per-minute:b","recheck-the-oxygen-saturation-in-an-hour-and-call-the-clinician-if-she-needs-more-than-5-liters-per-minute:c"],"keys":["recheck-the-oxygen-saturation-in-an-hour-and-call-the-clinician-if-she-needs-more-than-5-liters-per-minute:c"]},{"id":"I am worried she is tiring: her respiratory rate has crept up and she is using her neck muscles","optionIds":["i-am-worried-she-is-tiring-her-respiratory-rate-has-crept-up-and-she-is-using-her-neck-muscles:a","i-am-worried-she-is-tiring-her-respiratory-rate-has-crept-up-and-she-is-using-her-neck-muscles:b","i-am-worried-she-is-tiring-her-respiratory-rate-has-crept-up-and-she-is-using-her-neck-muscles:c"],"keys":["i-am-worried-she-is-tiring-her-respiratory-rate-has-crept-up-and-she-is-using-her-neck-muscles:a","i-am-worried-she-is-tiring-her-respiratory-rate-has-crept-up-and-she-is-using-her-neck-muscles:c"]}]},"answerKey":{"oxygen-increased-from-2-to-5-liters-per-minute-across-the-shift-saturation-91-percent":["a"],"admitted-two-days-ago-with-pneumonia-takes-a-daily-inhaled-steroid-at-home":["b"],"recheck-the-oxygen-saturation-in-an-hour-and-call-the-clinician-if-she-needs-more-than-5-liters-per-minute":["c"],"i-am-worried-she-is-tiring-her-respiratory-rate-has-crept-up-and-she-is-using-her-neck-muscles":["a","c"]},"readingSection":{"unitId":"w1-handoff--openrn-nursingfundamentals-014--1","chunkId":"chunk-4","index":3},"targets":[{"id":"oxygen-increased-from-2-to-5-liters-per-minute-across-the-shift-saturation-91-percent","label":"Oxygen increased from 2 to 5 L per minute across the shift; saturation 91%"},{"id":"admitted-two-days-ago-with-pneumonia-takes-a-daily-inhaled-steroid-at-home","label":"Admitted two days ago with pneumonia; takes a daily inhaled steroid at home"},{"id":"recheck-the-oxygen-saturation-in-an-hour-and-call-the-clinician-if-she-needs-more-than-5-liters-per-minute","label":"Recheck the oxygen saturation in an hour and call the clinician if she needs more than 5 L per minute"},{"id":"i-am-worried-she-is-tiring-her-respiratory-rate-has-crept-up-and-she-is-using-her-neck-muscles","label":"I am worried she is tiring: her respiratory rate has crept up and she is using her neck muscles"}],"shard":"w1-handoff"},{"id":"r7b-mx-012","familyId":"r7b-matrix-multi-fall-intervention","type":"matrix_multiple","topicId":"safety-systems","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"generate solutions","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every statement that applies to each measure.","task":"In each row, select all that apply.","scoring":{"method":"plus_minus","groups":[{"id":"Scheduled toileting every two hours through the night","optionIds":["scheduled-toileting-every-two-hours-through-the-night:a","scheduled-toileting-every-two-hours-through-the-night:b","scheduled-toileting-every-two-hours-through-the-night:c"],"keys":["scheduled-toileting-every-two-hours-through-the-night:a"]},{"id":"Keeping the bed in its lowest position with the wheels locked","optionIds":["keeping-the-bed-in-its-lowest-position-with-the-wheels-locked:a","keeping-the-bed-in-its-lowest-position-with-the-wheels-locked:b","keeping-the-bed-in-its-lowest-position-with-the-wheels-locked:c"],"keys":["keeping-the-bed-in-its-lowest-position-with-the-wheels-locked:a","keeping-the-bed-in-its-lowest-position-with-the-wheels-locked:b"]},{"id":"Raising all four side rails so she cannot get out of bed","optionIds":["raising-all-four-side-rails-so-she-cannot-get-out-of-bed:a","raising-all-four-side-rails-so-she-cannot-get-out-of-bed:b","raising-all-four-side-rails-so-she-cannot-get-out-of-bed:c"],"keys":["raising-all-four-side-rails-so-she-cannot-get-out-of-bed:c"]},{"id":"A floor mat beside the bed","optionIds":["a-floor-mat-beside-the-bed:a","a-floor-mat-beside-the-bed:b","a-floor-mat-beside-the-bed:c"],"keys":["a-floor-mat-beside-the-bed:b"]},{"id":"A soft wrist restraint at night","optionIds":["a-soft-wrist-restraint-at-night:a","a-soft-wrist-restraint-at-night:b","a-soft-wrist-restraint-at-night:c"],"keys":["a-soft-wrist-restraint-at-night:c"]}]},"answerKey":{"scheduled-toileting-every-two-hours-through-the-night":["a"],"keeping-the-bed-in-its-lowest-position-with-the-wheels-locked":["a","b"],"raising-all-four-side-rails-so-she-cannot-get-out-of-bed":["c"],"a-floor-mat-beside-the-bed":["b"],"a-soft-wrist-restraint-at-night":["c"]},"readingSection":{"unitId":"safety-systems--openrn-nursingfundamentals-047--1","chunkId":"chunk-5","index":4},"targets":[{"id":"scheduled-toileting-every-two-hours-through-the-night","label":"Scheduled toileting every two hours through the night"},{"id":"keeping-the-bed-in-its-lowest-position-with-the-wheels-locked","label":"Keeping the bed in its lowest position with the wheels locked"},{"id":"raising-all-four-side-rails-so-she-cannot-get-out-of-bed","label":"Raising all four side rails so she cannot get out of bed"},{"id":"a-floor-mat-beside-the-bed","label":"A floor mat beside the bed"},{"id":"a-soft-wrist-restraint-at-night","label":"A soft wrist restraint at night"}],"shard":"safety-systems-4"},{"id":"r7b-hl-001","familyId":"r7b-highlight-immediate-followup","type":"highlight_hotspot","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the phrases in the note that need the nurse to act now.","task":"Select every phrase that answers the question.","contextTags":["pneumonia"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d"],"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-059--1","chunkId":"chunk-3","index":2},"shard":"cardio-respiratory-2"},{"id":"r7b-hl-002","familyId":"r7b-highlight-immediate-followup","type":"highlight_hotspot","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the phrases in the note that suggest Pablo is bleeding internally.","task":"Select every phrase that answers the question.","scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d","e"],"readingSection":{"unitId":"diagnostics--openrn-healthalts-017--1","chunkId":"chunk-4","index":3},"shard":"diagnostics"},{"id":"r7b-hl-003","familyId":"r7b-highlight-infection-risk","type":"highlight_hotspot","topicId":"safety-systems","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"analyze cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the phrases that increase this client's risk of a catheter-associated urinary tract infection.","task":"Select every phrase that answers the question.","contextTags":["urin"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c"],"readingSection":{"unitId":"safety-systems--openrn-nursingfundamentals-045--2","chunkId":"chunk-1","index":0},"shard":"safety-systems-4"},{"id":"r7b-hl-004","familyId":"r7b-highlight-infection-risk","type":"highlight_hotspot","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the phrases that show practice the nurse needs to correct.","task":"Select every phrase that answers the question.","scoring":{"method":"plus_minus"},"answerKey":["a"],"readingSection":{"unitId":"isolation--openrn-nursingskills-033--1","chunkId":"chunk-3","index":2},"shard":"isolation-2"},{"id":"r7b-hl-005","familyId":"r7b-highlight-medication-risk","type":"highlight_hotspot","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the parts of this order set that the nurse must clarify before giving anything.","task":"Select every phrase that answers the question.","contextTags":["diabet"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d"],"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-010--1","chunkId":"chunk-2","index":1},"shard":"medication-safety-2"},{"id":"r7b-hl-006","familyId":"r7b-highlight-medication-risk","type":"highlight_hotspot","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the phrases that suggest digoxin toxicity.","task":"Select every phrase that answers the question.","contextTags":["furosemide","digoxin"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d"],"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-085--1","chunkId":"chunk-4","index":3},"shard":"pharm-cardiac-2"},{"id":"r7b-hl-007","familyId":"r7b-highlight-documentation-quality","type":"highlight_hotspot","topicId":"legal-ethics","clientNeed":"management-of-care","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the parts of this entry that should not appear in a client's record.","task":"Select every phrase that answers the question.","scoring":{"method":"plus_minus"},"answerKey":["a","b","c"],"readingSection":{"unitId":"legal-ethics--openrn-nursingmpc-029--2","chunkId":"chunk-1","index":0},"shard":"legal-ethics-2"},{"id":"r7b-hl-008","familyId":"r7b-highlight-discharge-gap","type":"highlight_hotspot","topicId":"advocacy","clientNeed":"management-of-care","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the parts of this plan that will stop the client following it at home.","task":"Select every phrase that answers the question.","contextTags":["heart failure","heart"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d"],"readingSection":{"unitId":"advocacy--openrn-nursingmpc-070--1","chunkId":"chunk-1","index":0},"shard":"advocacy"},{"id":"r7b-hl-009","familyId":"r7b-highlight-delegation-scope","type":"highlight_hotspot","topicId":"delegation","clientNeed":"management-of-care","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the parts of this report that describe work outside the assistant's scope.","task":"Select every phrase that answers the question.","scoring":{"method":"plus_minus"},"answerKey":["a","b"],"readingSection":{"unitId":"delegation--openrn-nursingmpc-013--2","chunkId":"chunk-2","index":1},"shard":"delegation"},{"id":"r7b-hl-010","familyId":"r7b-highlight-room-hazard","type":"highlight_hotspot","topicId":"w1-safety","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"recognize cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the findings the nurse must correct before she leaves the room.","task":"Select every phrase that answers the question.","scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d","e"],"readingSection":{"unitId":"w1-safety--openrn-pharmacology2e-018--1","chunkId":"chunk-2","index":1},"shard":"w1-safety"},{"id":"r7b-tr-001","familyId":"r7b-trend-compensated-shock","type":"trend","responseType":"single","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What does this chart show?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-049--1","chunkId":"chunk-2","index":1},"shard":"cardio-respiratory-2"},{"id":"r7b-tr-002","familyId":"r7b-trend-oxygen-support-cost","type":"trend","responseType":"single","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"evaluate outcomes","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What should the nurse conclude from this record?","task":"Choose one answer.","contextTags":["pneumonia","respirat"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-059--1","chunkId":"chunk-2","index":1},"shard":"cardio-respiratory-2"},{"id":"r7b-tr-003","familyId":"r7b-trend-heparin-platelets","type":"trend","responseType":"single","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What does this trend most likely indicate?","task":"Choose one answer.","contextTags":["heparin"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-088--1","chunkId":"chunk-2","index":1},"shard":"pharm-cardiac-2"},{"id":"r7b-tr-004","familyId":"r7b-trend-glucose-pattern","type":"trend","responseType":"single","topicId":"pharm-endocrine","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What pattern should the nurse report?","task":"Choose one answer.","contextTags":["insulin","glucose"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"pharm-endocrine--openrn-pharmacology2e-116--1","chunkId":"chunk-2","index":1},"shard":"pharm-endocrine"},{"id":"r7b-tr-005","familyId":"r7b-trend-fluid-balance","type":"trend","responseType":"single","topicId":"lab-trends","clientNeed":"reduction-of-risk-potential","ncjmmStep":"analyze 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New information appears as the case develops.","scoring":{"method":"zero_one"},"readingSection":{"unitId":"legal-ethics--openrn-nursingfundamentals-006--1","chunkId":"chunk-4","index":3},"shard":"legal-ethics-2"},{"id":"r7b-case-consent-recognize","familyId":"r7b-case-consent-advocacy-recognize","type":"multiple_response_sata","topicId":"legal-ethics","clientNeed":"management-of-care","ncjmmStep":"recognize cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which findings tell the nurse that this consent is not valid?","task":"Select all that apply.","scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d"],"readingSection":{"unitId":"legal-ethics--openrn-nursingfundamentals-006--2","chunkId":"chunk-4","index":3},"shard":"legal-ethics-2"},{"id":"r7b-case-consent-analyze","familyId":"r7b-case-consent-advocacy-analyze","type":"single","topicId":"legal-ethics","clientNeed":"management-of-care","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"How should the nurse interpret the son's statement, \"Just go ahead, she always does what I tell her\"?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"legal-ethics--openrn-nursingfundamentals-006--1","chunkId":"chunk-4","index":3},"shard":"legal-ethics-2"},{"id":"r7b-case-consent-prioritize","familyId":"r7b-case-consent-advocacy-prioritize","type":"single","topicId":"legal-ethics","clientNeed":"management-of-care","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which action is the nurse's priority?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"legal-ethics--openrn-nursingfundamentals-006--1","chunkId":"chunk-4","index":3},"shard":"legal-ethics-2"},{"id":"r7b-case-consent-generate","familyId":"r7b-case-consent-advocacy-generate","type":"multiple_response_select_n","topicId":"legal-ethics","clientNeed":"management-of-care","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which two actions should the nurse arrange so that a valid consent can be obtained?","task":"Select exactly 2 answers.","scoring":{"method":"zero_one"},"answerKey":["a","b"],"selectN":2,"readingSection":{"unitId":"legal-ethics--openrn-nursingfundamentals-006--1","chunkId":"chunk-4","index":3},"shard":"legal-ethics-2"},{"id":"r7b-case-consent-act","familyId":"r7b-case-consent-advocacy-act","type":"single","topicId":"legal-ethics","clientNeed":"management-of-care","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What is the nurse's role as the new consent is signed?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"legal-ethics--openrn-nursingfundamentals-006--1","chunkId":"chunk-4","index":3},"shard":"legal-ethics-2"},{"id":"r7b-case-consent-evaluate","familyId":"r7b-case-consent-advocacy-evaluate","type":"single","topicId":"legal-ethics","clientNeed":"management-of-care","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What shows the nurse that the consent is now valid and informed?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"legal-ethics--openrn-nursingfundamentals-006--1","chunkId":"chunk-4","index":3},"shard":"legal-ethics-2"},{"id":"r7b-case-heparin","familyId":"r7b-case-heparin-hit","type":"case_study","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","children":["r7b-case-heparin-recognize","r7b-case-heparin-analyze","r7b-case-heparin-prioritize","r7b-case-heparin-generate","r7b-case-heparin-act","r7b-case-heparin-evaluate"],"schemaVersion":2,"stem":"Follow Tomás Carrillo through two days of a heparin infusion. New information appears as the case develops.","task":"Answer six linked questions about one client. New information appears as the case develops.","scoring":{"method":"zero_one"},"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-088--2","chunkId":"chunk-1","index":0},"shard":"pharm-cardiac-2"},{"id":"r7b-case-heparin-recognize","familyId":"r7b-case-heparin-hit-recognize","type":"single","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which result in this trend most concerns the nurse?","task":"Choose one answer.","contextTags":["heparin"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-088--1","chunkId":"chunk-2","index":1},"shard":"pharm-cardiac-2"},{"id":"r7b-case-heparin-analyze","familyId":"r7b-case-heparin-hit-analyze","type":"single","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What explanation best accounts for the platelet fall and the new calf findings together?","task":"Choose one answer.","contextTags":["heparin"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-088--1","chunkId":"chunk-2","index":1},"shard":"pharm-cardiac-2"},{"id":"r7b-case-heparin-prioritize","familyId":"r7b-case-heparin-hit-prioritize","type":"single","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which action is the nurse's highest priority?","task":"Choose one answer.","contextTags":["heparin"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-088--2","chunkId":"chunk-1","index":0},"shard":"pharm-cardiac-2"},{"id":"r7b-case-heparin-generate","familyId":"r7b-case-heparin-hit-generate","type":"multiple_response_sata","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which actions does the nurse take to carry out these orders safely?","task":"Select all that apply.","contextTags":["heparin"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d"],"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-088--1","chunkId":"chunk-1","index":0},"shard":"pharm-cardiac-2"},{"id":"r7b-case-heparin-act","familyId":"r7b-case-heparin-hit-act","type":"single","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"The non-heparin anticoagulant infusion is prepared. What should the nurse do before starting it?","task":"Choose one answer.","contextTags":["heparin"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-080--1","chunkId":"chunk-3","index":2},"shard":"pharm-cardiac-2"},{"id":"r7b-case-heparin-evaluate","familyId":"r7b-case-heparin-hit-evaluate","type":"matrix_single","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"evaluate outcomes","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each finding on day 6 shows the change in treatment is working or still needs attention.","task":"Choose one answer in each row.","contextTags":["heparin"],"scoring":{"method":"zero_one"},"answerKey":{"platelet-count-128-000-per-microliter-up-from-84-000":["a"],"doppler-confirms-a-clot-in-the-deep-veins-of-the-left-leg":["b"],"no-bleeding-anywhere":["a"],"oxygen-saturation-97-percent-on-room-air-heart-rate-84-beats-per-minute":["a"],"heparin-alert-visible-in-the-record-and-on-the-wristband":["a"]},"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-088--1","chunkId":"chunk-1","index":0},"targets":[{"id":"platelet-count-128-000-per-microliter-up-from-84-000","label":"Platelet count 128,000 per microliter, up from 84,000"},{"id":"doppler-confirms-a-clot-in-the-deep-veins-of-the-left-leg","label":"Doppler confirms a clot in the deep veins of the left leg"},{"id":"no-bleeding-anywhere","label":"No bleeding anywhere"},{"id":"oxygen-saturation-97-percent-on-room-air-heart-rate-84-beats-per-minute","label":"Oxygen saturation 97% on room air, heart rate 84 beats per minute"},{"id":"heparin-alert-visible-in-the-record-and-on-the-wristband","label":"Heparin alert visible in the record and on the wristband"}],"shard":"pharm-cardiac-3"},{"id":"r7b-case-hf","familyId":"r7b-case-heart-failure","type":"case_study","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","children":["r7b-case-hf-recognize","r7b-case-hf-analyze","r7b-case-hf-prioritize","r7b-case-hf-generate","r7b-case-hf-act","r7b-case-hf-evaluate"],"schemaVersion":2,"stem":"Follow Remedios Cano from a telephone call to a review two days later. New information appears as the case develops.","task":"Answer six linked questions about one client. New information appears as the case develops.","scoring":{"method":"zero_one"},"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-062--1","chunkId":"chunk-1","index":0},"shard":"cardio-respiratory-2"},{"id":"r7b-case-hf-recognize","familyId":"r7b-case-heart-failure-recognize","type":"highlight_hotspot","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"recognize cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the things Remedios reports that mean she needs to be seen today.","task":"Select every phrase that answers the question.","contextTags":["heart failure","heart"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d"],"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-049--1","chunkId":"chunk-5","index":4},"shard":"cardio-respiratory-2"},{"id":"r7b-case-hf-analyze","familyId":"r7b-case-heart-failure-analyze","type":"single","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What best explains the whole picture at the clinic?","task":"Choose one answer.","contextTags":["heart failure","heart"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-049--1","chunkId":"chunk-5","index":4},"shard":"cardio-respiratory-2"},{"id":"r7b-case-hf-prioritize","familyId":"r7b-case-heart-failure-prioritize","type":"single","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which problem should the team address first?","task":"Choose one answer.","contextTags":["heart failure","heart"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-059--1","chunkId":"chunk-3","index":2},"shard":"cardio-respiratory-2"},{"id":"r7b-case-hf-generate","familyId":"r7b-case-heart-failure-generate","type":"multiple_response_sata","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"generate solutions","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which nursing actions belong in Remedios's plan today?","task":"Select all that apply.","contextTags":["heart failure","heart"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d","e"],"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-049--1","chunkId":"chunk-5","index":4},"shard":"cardio-respiratory-2"},{"id":"r7b-case-hf-act","familyId":"r7b-case-heart-failure-act","type":"single","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"How should the nurse give the intravenous furosemide?","task":"Choose one answer.","contextTags":["heart failure","heart"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"cardio-respiratory--openrn-nursingfundamentals-122--3","chunkId":"chunk-3","index":2},"shard":"cardio-respiratory-2"},{"id":"r7b-case-hf-evaluate","familyId":"r7b-case-heart-failure-evaluate","type":"single","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What should the nurse conclude at the 48-hour review?","task":"Choose one answer.","contextTags":["heart failure","heart"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-059--1","chunkId":"chunk-2","index":1},"shard":"cardio-respiratory-2"},{"id":"r7g-mx-001","familyId":"r7g-matrix-newborn-expected","type":"matrix_single","topicId":"maternity-newborn","clientNeed":"health-promotion-and-maintenance","ncjmmStep":"analyze cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each finding is normal for a newborn this age or needs the nurse to follow up.","task":"Choose one answer in each row.","contextTags":["newborn"],"scoring":{"method":"zero_one"},"answerKey":{"hands-and-feet-slightly-blue-trunk-pink":["a"],"respiratory-rate-52-breaths-per-minute-no-grunting":["a"],"axillary-temperature-36-1-c-with-cool-hands":["b"],"a-soft-swelling-over-one-side-of-the-skull-that-stops-at-the-suture-line":["a"],"no-urine-passed-and-no-stool-in-four-hours":["a"],"one-episode-of-choking-and-colour-change-with-the-first-feed":["b"]},"readingSection":{"unitId":"maternity-newborn--openrn-healthpromo-110--1","chunkId":"chunk-1","index":0},"targets":[{"id":"hands-and-feet-slightly-blue-trunk-pink","label":"Hands and feet slightly blue, trunk pink"},{"id":"respiratory-rate-52-breaths-per-minute-no-grunting","label":"Respiratory rate 52 breaths per minute, no grunting"},{"id":"axillary-temperature-36-1-c-with-cool-hands","label":"Axillary temperature 97.0 °F (36.1 °C) with cool hands"},{"id":"a-soft-swelling-over-one-side-of-the-skull-that-stops-at-the-suture-line","label":"A soft swelling over one side of the skull that stops at the suture line"},{"id":"no-urine-passed-and-no-stool-in-four-hours","label":"No urine passed and no stool in four hours"},{"id":"one-episode-of-choking-and-colour-change-with-the-first-feed","label":"One episode of choking and color change with the first feed"}],"shard":"maternity-newborn"},{"id":"r7g-mx-002","familyId":"r7g-matrix-therapeutic-response","type":"matrix_single","topicId":"therapeutic-communication","clientNeed":"psychosocial-integrity","ncjmmStep":"generate solutions","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each reply keeps the conversation open or closes it down.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"tell-me-what-feels-impossible-right-now":["a"],"you-have-beaten-this-before-so-you-can-beat-it-again":["b"],"i-am-going-to-sit-with-you-for-a-few-minutes":["a"],"why-do-you-feel-that-way-you-are-in-good-hands-here":["b"],"it-sounds-like-you-are-exhausted-by-the-thought-of-more-treatment":["a"],"everyone-finds-this-part-hard-you-are-not-alone":["b"]},"readingSection":{"unitId":"therapeutic-communication--openrn-nursingmhcc-012--2","chunkId":"chunk-1","index":0},"targets":[{"id":"tell-me-what-feels-impossible-right-now","label":"\"Tell me what feels impossible right now.\""},{"id":"you-have-beaten-this-before-so-you-can-beat-it-again","label":"\"You have beaten this before, so you can beat it again.\""},{"id":"i-am-going-to-sit-with-you-for-a-few-minutes","label":"\"I am going to sit with you for a few minutes.\""},{"id":"why-do-you-feel-that-way-you-are-in-good-hands-here","label":"\"Why do you feel that way? You are in good hands here.\""},{"id":"it-sounds-like-you-are-exhausted-by-the-thought-of-more-treatment","label":"\"It sounds like you are exhausted by the thought of more treatment.\""},{"id":"everyone-finds-this-part-hard-you-are-not-alone","label":"\"Everyone finds this part hard. You are not alone.\""}],"shard":"therapeutic-communication-2"},{"id":"r7g-mx-003","familyId":"r7g-matrix-transfer-safety","type":"matrix_single","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each action the assistant takes is safe or needs to be corrected before the move continues.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"locks-the-wheels-on-the-bed-and-the-chair-before-starting":["a"],"places-the-chair-on-the-side-of-the-operated-hip":["b"],"puts-non-slip-footwear-on-him-before-he-stands":["a"],"lifts-him-under-the-arms-to-bring-him-upright":["b"],"lowers-the-bed-until-his-feet-are-flat-on-the-floor":["a"],"tells-him-to-cross-his-legs-once-he-is-seated-to-steady-himself":["b"]},"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-108--1","chunkId":"chunk-2","index":1},"targets":[{"id":"locks-the-wheels-on-the-bed-and-the-chair-before-starting","label":"Locks the wheels on the bed and the chair before starting"},{"id":"places-the-chair-on-the-side-of-the-operated-hip","label":"Places the chair on the side of the operated hip"},{"id":"puts-non-slip-footwear-on-him-before-he-stands","label":"Puts non-slip footwear on him before he stands"},{"id":"lifts-him-under-the-arms-to-bring-him-upright","label":"Lifts him under the arms to bring him upright"},{"id":"lowers-the-bed-until-his-feet-are-flat-on-the-floor","label":"Lowers the bed until his feet are flat on the floor"},{"id":"tells-him-to-cross-his-legs-once-he-is-seated-to-steady-himself","label":"Tells him to cross his legs once he is seated to steady himself"}],"shard":"comfort-care"},{"id":"r7g-mx-004","familyId":"r7g-matrix-immunization-hold","type":"matrix_single","topicId":"pediatrics-prevention","clientNeed":"health-promotion-and-maintenance","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each child may be vaccinated today or whether the dose is held.","task":"Choose one answer in each row.","contextTags":["child","vaccin"],"scoring":{"method":"zero_one"},"answerKey":{"a-6-month-old-with-a-runny-nose-and-a-temperature-of-37-4-c-feeding-well":["a"],"a-4-year-old-who-had-hives-and-difficulty-breathing-after-a-previous-dose-of-the-same-vaccine":["b"],"a-2-year-old-taking-a-10-day-course-of-amoxicillin-for-an-ear-infection-now-well":["a"],"an-18-month-old-receiving-high-dose-daily-steroids-for-the-last-three-weeks-due-for-a-live-vaccine":["b"],"a-5-year-old-whose-mother-is-pregnant-due-for-a-live-vaccine":["a"],"a-12-month-old-who-received-a-blood-transfusion-two-weeks-ago-due-for-a-live-vaccine":["b"]},"readingSection":{"unitId":"pediatrics-prevention--openrn-healthpromo-140--5","chunkId":"chunk-1","index":0},"targets":[{"id":"a-6-month-old-with-a-runny-nose-and-a-temperature-of-37-4-c-feeding-well","label":"A 6-month-old with a runny nose and a temperature of 99.3 °F (37.4 °C), feeding well"},{"id":"a-4-year-old-who-had-hives-and-difficulty-breathing-after-a-previous-dose-of-the-same-vaccine","label":"A 4-year-old who had hives and difficulty breathing after a previous dose of the same vaccine"},{"id":"a-2-year-old-taking-a-10-day-course-of-amoxicillin-for-an-ear-infection-now-well","label":"A 2-year-old taking a 10-day course of amoxicillin for an ear infection, now well"},{"id":"an-18-month-old-receiving-high-dose-daily-steroids-for-the-last-three-weeks-due-for-a-live-vaccine","label":"An 18-month-old receiving high-dose daily steroids for the last three weeks, due for a live vaccine"},{"id":"a-5-year-old-whose-mother-is-pregnant-due-for-a-live-vaccine","label":"A 5-year-old whose mother is pregnant, due for a live vaccine"},{"id":"a-12-month-old-who-received-a-blood-transfusion-two-weeks-ago-due-for-a-live-vaccine","label":"A 12-month-old who received a blood transfusion two weeks ago, due for a live vaccine"}],"shard":"pediatrics-prevention"},{"id":"r7g-mx-005","familyId":"r7g-matrix-withdrawal-urgency","type":"matrix_single","topicId":"crisis-care","clientNeed":"psychosocial-integrity","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each finding is an expected part of alcohol withdrawal at this stage or a sign that it is becoming dangerous.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"tremor-of-both-hands":["a"],"heart-rate-108-and-blood-pressure-158-94":["a"],"seeing-the-curtain-move-but-knowing-it-is-a-curtain":["a"],"a-witnessed-generalised-seizure":["b"],"temperature-38-9-c-with-heart-rate-136-and-no-contact-with-where-he-is":["b"],"reaching-for-insects-on-the-blanket-that-he-insists-are-real":["b"]},"readingSection":{"unitId":"crisis-care--openrn-nursingmhcc-110--1","chunkId":"chunk-3","index":2},"targets":[{"id":"tremor-of-both-hands","label":"Tremor of both hands"},{"id":"heart-rate-108-and-blood-pressure-158-94","label":"Heart rate 108 and blood pressure 158/94"},{"id":"seeing-the-curtain-move-but-knowing-it-is-a-curtain","label":"Seeing the curtain move but knowing it is a curtain"},{"id":"a-witnessed-generalised-seizure","label":"A witnessed generalized seizure"},{"id":"temperature-38-9-c-with-heart-rate-136-and-no-contact-with-where-he-is","label":"Temperature 102.0 °F (38.9 °C) with heart rate 136 and no contact with where he is"},{"id":"reaching-for-insects-on-the-blanket-that-he-insists-are-real","label":"Reaching for insects on the blanket that he insists are real"}],"shard":"crisis-care"},{"id":"r7g-mx-006","familyId":"r7g-matrix-diet-advance","type":"matrix_single","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"analyze cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each diet order fits the client described or needs to be questioned.","task":"Choose one answer in each row.","contextTags":["diet"],"scoring":{"method":"zero_one"},"answerKey":{"thickened-liquids-for-a-client-who-failed-a-swallow-screen-after-a-stroke":["a"],"a-regular-diet-for-a-client-who-is-hoarse-and-coughs-after-every-sip-of-water":["b"],"low-sodium-diet-for-a-client-with-heart-failure-and-swelling-of-both-legs":["a"],"high-protein-high-potassium-diet-for-a-client-on-dialysis-for-kidney-failure":["b"],"clear-liquids-for-a-client-four-hours-after-abdominal-surgery-with-no-bowel-sounds-yet":["a"],"grapefruit-juice-with-breakfast-for-a-client-starting-a-statin":["b"]},"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-108--1","chunkId":"chunk-2","index":1},"targets":[{"id":"thickened-liquids-for-a-client-who-failed-a-swallow-screen-after-a-stroke","label":"Thickened liquids for a client who failed a swallow screen after a stroke"},{"id":"a-regular-diet-for-a-client-who-is-hoarse-and-coughs-after-every-sip-of-water","label":"A regular diet for a client who is hoarse and coughs after every sip of water"},{"id":"low-sodium-diet-for-a-client-with-heart-failure-and-swelling-of-both-legs","label":"Low-sodium diet for a client with heart failure and swelling of both legs"},{"id":"high-protein-high-potassium-diet-for-a-client-on-dialysis-for-kidney-failure","label":"High-protein, high-potassium diet for a client on dialysis for kidney failure"},{"id":"clear-liquids-for-a-client-four-hours-after-abdominal-surgery-with-no-bowel-sounds-yet","label":"Clear liquids for a client four hours after abdominal surgery with no bowel sounds yet"},{"id":"grapefruit-juice-with-breakfast-for-a-client-starting-a-statin","label":"Grapefruit juice with breakfast for a client starting a statin"}],"shard":"comfort-care"},{"id":"r7g-mx-007","familyId":"r7g-matrix-report-or-document","type":"matrix_single","topicId":"advocacy","clientNeed":"management-of-care","ncjmmStep":"take action","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose what each situation requires the nurse to do.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"potassium-result-of-6-4-millimoles-per-liter-on-a-client-scheduled-for-surgery-tomorrow":["a"],"blood-pressure-118-72-unchanged-from-the-morning":["b"],"a-client-who-says-she-has-decided-not-to-have-the-planned-procedure":["a"],"pain-that-went-from-8-to-3-out-of-10-after-the-prescribed-analgesic":["b"],"a-new-rash-over-the-trunk-two-hours-after-the-first-dose-of-a-new-antibiotic":["a"],"urine-output-of-480-milliliters-over-eight-hours-in-a-client-with-no-fluid-restriction":["b"],"a-client-s-daughter-asking-why-her-mother-s-medicine-looks-different-from-last-week":["a"]},"readingSection":{"unitId":"advocacy--openrn-nursingmpc-048--1","chunkId":"chunk-6","index":5},"targets":[{"id":"potassium-result-of-6-4-millimoles-per-liter-on-a-client-scheduled-for-surgery-tomorrow","label":"Potassium result of 6.4 mEq/L on a client scheduled for surgery tomorrow"},{"id":"blood-pressure-118-72-unchanged-from-the-morning","label":"Blood pressure 118/72, unchanged from the morning"},{"id":"a-client-who-says-she-has-decided-not-to-have-the-planned-procedure","label":"A client who says she has decided not to have the planned procedure"},{"id":"pain-that-went-from-8-to-3-out-of-10-after-the-prescribed-analgesic","label":"Pain that went from 8 to 3 out of 10 after the prescribed analgesic"},{"id":"a-new-rash-over-the-trunk-two-hours-after-the-first-dose-of-a-new-antibiotic","label":"A new rash over the trunk two hours after the first dose of a new antibiotic"},{"id":"urine-output-of-480-milliliters-over-eight-hours-in-a-client-with-no-fluid-restriction","label":"Urine output of 480 mL over eight hours in a client with no fluid restriction"},{"id":"a-client-s-daughter-asking-why-her-mother-s-medicine-looks-different-from-last-week","label":"A client's daughter asking why her mother's medicine looks different from last week"}],"shard":"advocacy"},{"id":"r7g-mx-008","familyId":"r7g-matrix-glucose-emergency","type":"matrix_single","topicId":"neuro-renal-endocrine","clientNeed":"physiological-adaptation","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose which problem each set of findings points to.","task":"Choose one answer in each row.","contextTags":["diabet"],"scoring":{"method":"zero_one"},"answerKey":{"glucose-44-sweating-shaking-confused-took-insulin-and-skipped-lunch":["a"],"glucose-480-deep-rapid-breathing-fruity-breath-abdominal-pain-type-1-diabetes":["b"],"glucose-820-profoundly-dry-drowsy-normal-breathing-type-2-diabetes-recent-infection":["c"],"glucose-38-no-symptoms-found-on-a-routine-check-in-a-client-taking-a-long-acting-sulfonylurea":["a"],"glucose-510-ketones-in-the-urine-breathing-30-per-minute-newly-diagnosed-teenager":["b"]},"readingSection":{"unitId":"neuro-renal-endocrine--openrn-healthalts-074--1","chunkId":"chunk-5","index":4},"targets":[{"id":"glucose-44-sweating-shaking-confused-took-insulin-and-skipped-lunch","label":"Glucose 44, sweating, shaking, confused, took insulin and skipped lunch"},{"id":"glucose-480-deep-rapid-breathing-fruity-breath-abdominal-pain-type-1-diabetes","label":"Glucose 480, deep rapid breathing, fruity breath, abdominal pain, type 1 diabetes"},{"id":"glucose-820-profoundly-dry-drowsy-normal-breathing-type-2-diabetes-recent-infection","label":"Glucose 820, profoundly dry, drowsy, normal breathing, type 2 diabetes, recent infection"},{"id":"glucose-38-no-symptoms-found-on-a-routine-check-in-a-client-taking-a-long-acting-sulfonylurea","label":"Glucose 38, no symptoms, found on a routine check in a client taking a long-acting sulfonylurea"},{"id":"glucose-510-ketones-in-the-urine-breathing-30-per-minute-newly-diagnosed-teenager","label":"Glucose 510, ketones in the urine, breathing 30 per minute, newly diagnosed teenager"}],"shard":"neuro-renal-endocrine"},{"id":"r7g-mm-001","familyId":"r7g-matrix-third-trimester-findings","type":"matrix_multiple","topicId":"maternity-newborn","clientNeed":"health-promotion-and-maintenance","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every column that applies to each finding. A finding may belong in more than one column.","task":"In each row, select all that apply.","contextTags":["pregnan"],"scoring":{"method":"plus_minus","groups":[{"id":"Swelling of both ankles that is worst at the end of the day","optionIds":["swelling-of-both-ankles-that-is-worst-at-the-end-of-the-day:a","swelling-of-both-ankles-that-is-worst-at-the-end-of-the-day:b","swelling-of-both-ankles-that-is-worst-at-the-end-of-the-day:c"],"keys":["swelling-of-both-ankles-that-is-worst-at-the-end-of-the-day:a","swelling-of-both-ankles-that-is-worst-at-the-end-of-the-day:b"]},{"id":"Heartburn after meals","optionIds":["heartburn-after-meals:a","heartburn-after-meals:b","heartburn-after-meals:c"],"keys":["heartburn-after-meals:a","heartburn-after-meals:b"]},{"id":"Blood pressure 158/102 with a headache that paracetamol has not touched","optionIds":["blood-pressure-158-102-with-a-headache-that-paracetamol-has-not-touched:a","blood-pressure-158-102-with-a-headache-that-paracetamol-has-not-touched:b","blood-pressure-158-102-with-a-headache-that-paracetamol-has-not-touched:c"],"keys":["blood-pressure-158-102-with-a-headache-that-paracetamol-has-not-touched:c"]},{"id":"No fetal movement felt for the last twelve hours","optionIds":["no-fetal-movement-felt-for-the-last-twelve-hours:a","no-fetal-movement-felt-for-the-last-twelve-hours:b","no-fetal-movement-felt-for-the-last-twelve-hours:c"],"keys":["no-fetal-movement-felt-for-the-last-twelve-hours:c"]},{"id":"Occasional painless tightening of the uterus that settles with rest","optionIds":["occasional-painless-tightening-of-the-uterus-that-settles-with-rest:a","occasional-painless-tightening-of-the-uterus-that-settles-with-rest:b","occasional-painless-tightening-of-the-uterus-that-settles-with-rest:c"],"keys":["occasional-painless-tightening-of-the-uterus-that-settles-with-rest:a","occasional-painless-tightening-of-the-uterus-that-settles-with-rest:b"]},{"id":"Burning when passing urine, with urinary frequency","optionIds":["burning-when-passing-urine-with-urinary-frequency:a","burning-when-passing-urine-with-urinary-frequency:b","burning-when-passing-urine-with-urinary-frequency:c"],"keys":["burning-when-passing-urine-with-urinary-frequency:b","burning-when-passing-urine-with-urinary-frequency:c"]}]},"answerKey":{"swelling-of-both-ankles-that-is-worst-at-the-end-of-the-day":["a","b"],"heartburn-after-meals":["a","b"],"blood-pressure-158-102-with-a-headache-that-paracetamol-has-not-touched":["c"],"no-fetal-movement-felt-for-the-last-twelve-hours":["c"],"occasional-painless-tightening-of-the-uterus-that-settles-with-rest":["a","b"],"burning-when-passing-urine-with-urinary-frequency":["b","c"]},"readingSection":{"unitId":"maternity-newborn--openrn-healthpromo-096--1","chunkId":"chunk-3","index":2},"targets":[{"id":"swelling-of-both-ankles-that-is-worst-at-the-end-of-the-day","label":"Swelling of both ankles that is worst at the end of the day"},{"id":"heartburn-after-meals","label":"Heartburn after meals"},{"id":"blood-pressure-158-102-with-a-headache-that-paracetamol-has-not-touched","label":"Blood pressure 158/102 with a headache that acetaminophen has not touched"},{"id":"no-fetal-movement-felt-for-the-last-twelve-hours","label":"No fetal movement felt for the last twelve hours"},{"id":"occasional-painless-tightening-of-the-uterus-that-settles-with-rest","label":"Occasional painless tightening of the uterus that settles with rest"},{"id":"burning-when-passing-urine-with-urinary-frequency","label":"Burning when passing urine, with urinary frequency"}],"shard":"maternity-newborn"},{"id":"r7g-mm-002","familyId":"r7g-matrix-suicide-risk-reading","type":"matrix_multiple","topicId":"crisis-care","clientNeed":"psychosocial-integrity","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every column that applies to each thing Elena has said or done. A row may belong in more than one column.","task":"In each row, select all that apply.","scoring":{"method":"plus_minus","groups":[{"id":"\"I have been saving my sleeping tablets.\"","optionIds":["i-have-been-saving-my-sleeping-tablets:a","i-have-been-saving-my-sleeping-tablets:b","i-have-been-saving-my-sleeping-tablets:c"],"keys":["i-have-been-saving-my-sleeping-tablets:a","i-have-been-saving-my-sleeping-tablets:b"]},{"id":"\"The thoughts come and go. I have not worked out how I would do it.\"","optionIds":["the-thoughts-come-and-go-i-have-not-worked-out-how-i-would-do-it:a","the-thoughts-come-and-go-i-have-not-worked-out-how-i-would-do-it:b","the-thoughts-come-and-go-i-have-not-worked-out-how-i-would-do-it:c"],"keys":["the-thoughts-come-and-go-i-have-not-worked-out-how-i-would-do-it:b"]},{"id":"\"My sister calls me every morning and I always answer.\"","optionIds":["my-sister-calls-me-every-morning-and-i-always-answer:a","my-sister-calls-me-every-morning-and-i-always-answer:b","my-sister-calls-me-every-morning-and-i-always-answer:c"],"keys":["my-sister-calls-me-every-morning-and-i-always-answer:c"]},{"id":"Has been drinking more than usual in the evenings","optionIds":["has-been-drinking-more-than-usual-in-the-evenings:a","has-been-drinking-more-than-usual-in-the-evenings:b","has-been-drinking-more-than-usual-in-the-evenings:c"],"keys":["has-been-drinking-more-than-usual-in-the-evenings:a","has-been-drinking-more-than-usual-in-the-evenings:b"]},{"id":"Gave her jewelry to her niece last week \"to keep\"","optionIds":["gave-her-jewellery-to-her-niece-last-week-to-keep:a","gave-her-jewellery-to-her-niece-last-week-to-keep:b","gave-her-jewellery-to-her-niece-last-week-to-keep:c"],"keys":["gave-her-jewellery-to-her-niece-last-week-to-keep:a","gave-her-jewellery-to-her-niece-last-week-to-keep:b"]},{"id":"Says her religious belief means \"it would be the one unforgivable thing\"","optionIds":["says-her-religious-belief-means-it-would-be-the-one-unforgivable-thing:a","says-her-religious-belief-means-it-would-be-the-one-unforgivable-thing:b","says-her-religious-belief-means-it-would-be-the-one-unforgivable-thing:c"],"keys":["says-her-religious-belief-means-it-would-be-the-one-unforgivable-thing:c"]}]},"answerKey":{"i-have-been-saving-my-sleeping-tablets":["a","b"],"the-thoughts-come-and-go-i-have-not-worked-out-how-i-would-do-it":["b"],"my-sister-calls-me-every-morning-and-i-always-answer":["c"],"has-been-drinking-more-than-usual-in-the-evenings":["a","b"],"gave-her-jewellery-to-her-niece-last-week-to-keep":["a","b"],"says-her-religious-belief-means-it-would-be-the-one-unforgivable-thing":["c"]},"readingSection":{"unitId":"crisis-care--openrn-nursingmhcc-021--1","chunkId":"chunk-3","index":2},"targets":[{"id":"i-have-been-saving-my-sleeping-tablets","label":"\"I have been saving my sleeping pills.\""},{"id":"the-thoughts-come-and-go-i-have-not-worked-out-how-i-would-do-it","label":"\"The thoughts come and go. I have not worked out how I would do it.\""},{"id":"my-sister-calls-me-every-morning-and-i-always-answer","label":"\"My sister calls me every morning and I always answer.\""},{"id":"has-been-drinking-more-than-usual-in-the-evenings","label":"Has been drinking more than usual in the evenings"},{"id":"gave-her-jewellery-to-her-niece-last-week-to-keep","label":"Gave her jewelry to her niece last week \"to keep\""},{"id":"says-her-religious-belief-means-it-would-be-the-one-unforgivable-thing","label":"Says her religious belief means \"it would be the one unforgivable thing\""}],"shard":"crisis-care"},{"id":"r7g-mm-003","familyId":"r7g-matrix-pressure-measure-purpose","type":"matrix_multiple","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every column that applies to each measure. A measure may do more than one thing.","task":"In each row, select all that apply.","contextTags":["mobil"],"scoring":{"method":"plus_minus","groups":[{"id":"Repositioning every two hours with a thirty-degree tilt","optionIds":["repositioning-every-two-hours-with-a-thirty-degree-tilt:a","repositioning-every-two-hours-with-a-thirty-degree-tilt:b","repositioning-every-two-hours-with-a-thirty-degree-tilt:c","repositioning-every-two-hours-with-a-thirty-degree-tilt:d"],"keys":["repositioning-every-two-hours-with-a-thirty-degree-tilt:a"]},{"id":"A barrier cream after each episode of incontinence","optionIds":["a-barrier-cream-after-each-episode-of-incontinence:a","a-barrier-cream-after-each-episode-of-incontinence:b","a-barrier-cream-after-each-episode-of-incontinence:c","a-barrier-cream-after-each-episode-of-incontinence:d"],"keys":["a-barrier-cream-after-each-episode-of-incontinence:b"]},{"id":"A silicone foam dressing over the sacrum","optionIds":["a-silicone-foam-dressing-over-the-sacrum:a","a-silicone-foam-dressing-over-the-sacrum:b","a-silicone-foam-dressing-over-the-sacrum:c","a-silicone-foam-dressing-over-the-sacrum:d"],"keys":["a-silicone-foam-dressing-over-the-sacrum:a","a-silicone-foam-dressing-over-the-sacrum:b","a-silicone-foam-dressing-over-the-sacrum:c"]},{"id":"A high-protein supplement twice a day with a calorie count","optionIds":["a-high-protein-supplement-twice-a-day-with-a-calorie-count:a","a-high-protein-supplement-twice-a-day-with-a-calorie-count:b","a-high-protein-supplement-twice-a-day-with-a-calorie-count:c","a-high-protein-supplement-twice-a-day-with-a-calorie-count:d"],"keys":["a-high-protein-supplement-twice-a-day-with-a-calorie-count:c"]},{"id":"Massaging the reddened skin around the wound to improve the circulation","optionIds":["massaging-the-reddened-skin-around-the-wound-to-improve-the-circulation:a","massaging-the-reddened-skin-around-the-wound-to-improve-the-circulation:b","massaging-the-reddened-skin-around-the-wound-to-improve-the-circulation:c","massaging-the-reddened-skin-around-the-wound-to-improve-the-circulation:d"],"keys":["massaging-the-reddened-skin-around-the-wound-to-improve-the-circulation:d"]},{"id":"A doughnut-shaped ring cushion under her sacrum","optionIds":["a-doughnut-shaped-ring-cushion-under-her-sacrum:a","a-doughnut-shaped-ring-cushion-under-her-sacrum:b","a-doughnut-shaped-ring-cushion-under-her-sacrum:c","a-doughnut-shaped-ring-cushion-under-her-sacrum:d"],"keys":["a-doughnut-shaped-ring-cushion-under-her-sacrum:d"]}]},"answerKey":{"repositioning-every-two-hours-with-a-thirty-degree-tilt":["a"],"a-barrier-cream-after-each-episode-of-incontinence":["b"],"a-silicone-foam-dressing-over-the-sacrum":["a","b","c"],"a-high-protein-supplement-twice-a-day-with-a-calorie-count":["c"],"massaging-the-reddened-skin-around-the-wound-to-improve-the-circulation":["d"],"a-doughnut-shaped-ring-cushion-under-her-sacrum":["d"]},"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-095--1","chunkId":"chunk-5","index":4},"targets":[{"id":"repositioning-every-two-hours-with-a-thirty-degree-tilt","label":"Repositioning every two hours with a thirty-degree tilt"},{"id":"a-barrier-cream-after-each-episode-of-incontinence","label":"A barrier cream after each episode of incontinence"},{"id":"a-silicone-foam-dressing-over-the-sacrum","label":"A silicone foam dressing over the sacrum"},{"id":"a-high-protein-supplement-twice-a-day-with-a-calorie-count","label":"A high-protein supplement twice a day with a calorie count"},{"id":"massaging-the-reddened-skin-around-the-wound-to-improve-the-circulation","label":"Massaging the reddened skin around the wound to improve the circulation"},{"id":"a-doughnut-shaped-ring-cushion-under-her-sacrum","label":"A doughnut-shaped ring cushion under her sacrum"}],"shard":"comfort-care"},{"id":"r7g-mm-004","familyId":"r7g-matrix-procedure-phase","type":"matrix_multiple","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every phase in which each action belongs. An action may belong in more than one phase.","task":"In each row, select all that apply.","scoring":{"method":"plus_minus","groups":[{"id":"Confirm that the consent form is signed and that he can say what is being done and why","optionIds":["confirm-that-the-consent-form-is-signed-and-that-he-can-say-what-is-being-done-and-why:a","confirm-that-the-consent-form-is-signed-and-that-he-can-say-what-is-being-done-and-why:b","confirm-that-the-consent-form-is-signed-and-that-he-can-say-what-is-being-done-and-why:c"],"keys":["confirm-that-the-consent-form-is-signed-and-that-he-can-say-what-is-being-done-and-why:a"]},{"id":"Check the platelet count and the clotting results","optionIds":["check-the-platelet-count-and-the-clotting-results:a","check-the-platelet-count-and-the-clotting-results:b","check-the-platelet-count-and-the-clotting-results:c"],"keys":["check-the-platelet-count-and-the-clotting-results:a","check-the-platelet-count-and-the-clotting-results:c"]},{"id":"Measure and record his vital signs","optionIds":["measure-and-record-his-vital-signs:a","measure-and-record-his-vital-signs:b","measure-and-record-his-vital-signs:c"],"keys":["measure-and-record-his-vital-signs:a","measure-and-record-his-vital-signs:b","measure-and-record-his-vital-signs:c"]},{"id":"Ask him to breathe out and then hold his breath","optionIds":["ask-him-to-breathe-out-and-then-hold-his-breath:a","ask-him-to-breathe-out-and-then-hold-his-breath:b","ask-him-to-breathe-out-and-then-hold-his-breath:c"],"keys":["ask-him-to-breathe-out-and-then-hold-his-breath:b"]},{"id":"Position him lying on his right side","optionIds":["position-him-lying-on-his-right-side:a","position-him-lying-on-his-right-side:b","position-him-lying-on-his-right-side:c"],"keys":["position-him-lying-on-his-right-side:c"]},{"id":"Watch for new pain in the right shoulder","optionIds":["watch-for-new-pain-in-the-right-shoulder:a","watch-for-new-pain-in-the-right-shoulder:b","watch-for-new-pain-in-the-right-shoulder:c"],"keys":["watch-for-new-pain-in-the-right-shoulder:c"]}]},"answerKey":{"confirm-that-the-consent-form-is-signed-and-that-he-can-say-what-is-being-done-and-why":["a"],"check-the-platelet-count-and-the-clotting-results":["a","c"],"measure-and-record-his-vital-signs":["a","b","c"],"ask-him-to-breathe-out-and-then-hold-his-breath":["b"],"position-him-lying-on-his-right-side":["c"],"watch-for-new-pain-in-the-right-shoulder":["c"]},"readingSection":{"unitId":"diagnostics--openrn-nursingadvancedskills-045--1","chunkId":"chunk-2","index":1},"targets":[{"id":"confirm-that-the-consent-form-is-signed-and-that-he-can-say-what-is-being-done-and-why","label":"Confirm that the consent form is signed and that he can say what is being done and why"},{"id":"check-the-platelet-count-and-the-clotting-results","label":"Check the platelet count and the clotting results"},{"id":"measure-and-record-his-vital-signs","label":"Measure and record his vital signs"},{"id":"ask-him-to-breathe-out-and-then-hold-his-breath","label":"Ask him to breathe out and then hold his breath"},{"id":"position-him-lying-on-his-right-side","label":"Position him lying on his right side"},{"id":"watch-for-new-pain-in-the-right-shoulder","label":"Watch for new pain in the right shoulder"}],"shard":"diagnostics"},{"id":"r7g-mm-005","familyId":"r7g-matrix-safety-teaching-age","type":"matrix_multiple","topicId":"pediatrics-prevention","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"take action","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every age at which each piece of safety teaching applies. A row may apply at more than one age.","task":"In each row, select all that apply.","contextTags":["child"],"scoring":{"method":"plus_minus","groups":[{"id":"Never leave the child alone near water, including a bath, a bucket or a pool","optionIds":["never-leave-the-child-alone-near-water-including-a-bath-a-bucket-or-a-pool:a","never-leave-the-child-alone-near-water-including-a-bath-a-bucket-or-a-pool:b","never-leave-the-child-alone-near-water-including-a-bath-a-bucket-or-a-pool:c"],"keys":["never-leave-the-child-alone-near-water-including-a-bath-a-bucket-or-a-pool:a","never-leave-the-child-alone-near-water-including-a-bath-a-bucket-or-a-pool:b","never-leave-the-child-alone-near-water-including-a-bath-a-bucket-or-a-pool:c"]},{"id":"Keep medicines and cleaning products locked away and out of sight","optionIds":["keep-medicines-and-cleaning-products-locked-away-and-out-of-sight:a","keep-medicines-and-cleaning-products-locked-away-and-out-of-sight:b","keep-medicines-and-cleaning-products-locked-away-and-out-of-sight:c"],"keys":["keep-medicines-and-cleaning-products-locked-away-and-out-of-sight:a","keep-medicines-and-cleaning-products-locked-away-and-out-of-sight:b","keep-medicines-and-cleaning-products-locked-away-and-out-of-sight:c"]},{"id":"Rear-facing car seat in the back seat","optionIds":["rear-facing-car-seat-in-the-back-seat:a","rear-facing-car-seat-in-the-back-seat:b","rear-facing-car-seat-in-the-back-seat:c"],"keys":["rear-facing-car-seat-in-the-back-seat:a","rear-facing-car-seat-in-the-back-seat:b"]},{"id":"A firm sleep surface, on the back, with nothing else in the sleep space","optionIds":["a-firm-sleep-surface-on-the-back-with-nothing-else-in-the-sleep-space:a","a-firm-sleep-surface-on-the-back-with-nothing-else-in-the-sleep-space:b","a-firm-sleep-surface-on-the-back-with-nothing-else-in-the-sleep-space:c"],"keys":["a-firm-sleep-surface-on-the-back-with-nothing-else-in-the-sleep-space:a"]},{"id":"A properly fitted helmet whenever riding a bicycle or a scooter","optionIds":["a-properly-fitted-helmet-whenever-riding-a-bicycle-or-a-scooter:a","a-properly-fitted-helmet-whenever-riding-a-bicycle-or-a-scooter:b","a-properly-fitted-helmet-whenever-riding-a-bicycle-or-a-scooter:c"],"keys":["a-properly-fitted-helmet-whenever-riding-a-bicycle-or-a-scooter:b","a-properly-fitted-helmet-whenever-riding-a-bicycle-or-a-scooter:c"]},{"id":"Teaching the child to tell a trusted adult if anybody asks them to keep a secret","optionIds":["teaching-the-child-to-tell-a-trusted-adult-if-anybody-asks-them-to-keep-a-secret:a","teaching-the-child-to-tell-a-trusted-adult-if-anybody-asks-them-to-keep-a-secret:b","teaching-the-child-to-tell-a-trusted-adult-if-anybody-asks-them-to-keep-a-secret:c"],"keys":["teaching-the-child-to-tell-a-trusted-adult-if-anybody-asks-them-to-keep-a-secret:b","teaching-the-child-to-tell-a-trusted-adult-if-anybody-asks-them-to-keep-a-secret:c"]}]},"answerKey":{"never-leave-the-child-alone-near-water-including-a-bath-a-bucket-or-a-pool":["a","b","c"],"keep-medicines-and-cleaning-products-locked-away-and-out-of-sight":["a","b","c"],"rear-facing-car-seat-in-the-back-seat":["a","b"],"a-firm-sleep-surface-on-the-back-with-nothing-else-in-the-sleep-space":["a"],"a-properly-fitted-helmet-whenever-riding-a-bicycle-or-a-scooter":["b","c"],"teaching-the-child-to-tell-a-trusted-adult-if-anybody-asks-them-to-keep-a-secret":["b","c"]},"readingSection":{"unitId":"pediatrics-prevention--openrn-healthpromo-139--1","chunkId":"chunk-2","index":1},"targets":[{"id":"never-leave-the-child-alone-near-water-including-a-bath-a-bucket-or-a-pool","label":"Never leave the child alone near water, including a bath, a bucket or a pool"},{"id":"keep-medicines-and-cleaning-products-locked-away-and-out-of-sight","label":"Keep medicines and cleaning products locked away and out of sight"},{"id":"rear-facing-car-seat-in-the-back-seat","label":"Rear-facing car seat in the back seat"},{"id":"a-firm-sleep-surface-on-the-back-with-nothing-else-in-the-sleep-space","label":"A firm sleep surface, on the back, with nothing else in the sleep space"},{"id":"a-properly-fitted-helmet-whenever-riding-a-bicycle-or-a-scooter","label":"A properly fitted helmet whenever riding a bicycle or a scooter"},{"id":"teaching-the-child-to-tell-a-trusted-adult-if-anybody-asks-them-to-keep-a-secret","label":"Teaching the child to tell a trusted adult if anybody asks them to keep a secret"}],"shard":"pediatrics-prevention"},{"id":"r7g-mm-006","familyId":"r7g-matrix-psychotropic-response","type":"matrix_multiple","topicId":"psychotropics","clientNeed":"psychosocial-integrity","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every column that applies to each finding. A finding may call for more than one response.","task":"In each row, select all that apply.","scoring":{"method":"plus_minus","groups":[{"id":"Vomiting, a coarse tremor and an unsteady walk in a client taking lithium","optionIds":["vomiting-a-coarse-tremor-and-an-unsteady-walk-in-a-client-taking-lithium:a","vomiting-a-coarse-tremor-and-an-unsteady-walk-in-a-client-taking-lithium:b","vomiting-a-coarse-tremor-and-an-unsteady-walk-in-a-client-taking-lithium:c"],"keys":["vomiting-a-coarse-tremor-and-an-unsteady-walk-in-a-client-taking-lithium:a","vomiting-a-coarse-tremor-and-an-unsteady-walk-in-a-client-taking-lithium:b"]},{"id":"A sore throat with a fever in a client taking clozapine","optionIds":["a-sore-throat-with-a-fever-in-a-client-taking-clozapine:a","a-sore-throat-with-a-fever-in-a-client-taking-clozapine:b","a-sore-throat-with-a-fever-in-a-client-taking-clozapine:c"],"keys":["a-sore-throat-with-a-fever-in-a-client-taking-clozapine:a","a-sore-throat-with-a-fever-in-a-client-taking-clozapine:b"]},{"id":"A dry mouth in the first week of a new antidepressant","optionIds":["a-dry-mouth-in-the-first-week-of-a-new-antidepressant:a","a-dry-mouth-in-the-first-week-of-a-new-antidepressant:b","a-dry-mouth-in-the-first-week-of-a-new-antidepressant:c"],"keys":["a-dry-mouth-in-the-first-week-of-a-new-antidepressant:c"]},{"id":"New stiffness of the neck and jaw three days into an antipsychotic","optionIds":["new-stiffness-of-the-neck-and-jaw-three-days-into-an-antipsychotic:a","new-stiffness-of-the-neck-and-jaw-three-days-into-an-antipsychotic:b","new-stiffness-of-the-neck-and-jaw-three-days-into-an-antipsychotic:c"],"keys":["new-stiffness-of-the-neck-and-jaw-three-days-into-an-antipsychotic:a"]},{"id":"A fine hand tremor two weeks into lithium, with a level of 0.8","optionIds":["a-fine-hand-tremor-two-weeks-into-lithium-with-a-level-of-0-8:a","a-fine-hand-tremor-two-weeks-into-lithium-with-a-level-of-0-8:b","a-fine-hand-tremor-two-weeks-into-lithium-with-a-level-of-0-8:c"],"keys":["a-fine-hand-tremor-two-weeks-into-lithium-with-a-level-of-0-8:c"]},{"id":"A weight gain of 6 kg over three months on an antipsychotic, with a fasting glucose of 118","optionIds":["a-weight-gain-of-6-kilograms-over-three-months-on-an-antipsychotic-with-a-fasting-glucose-of-118:a","a-weight-gain-of-6-kilograms-over-three-months-on-an-antipsychotic-with-a-fasting-glucose-of-118:b","a-weight-gain-of-6-kilograms-over-three-months-on-an-antipsychotic-with-a-fasting-glucose-of-118:c"],"keys":["a-weight-gain-of-6-kilograms-over-three-months-on-an-antipsychotic-with-a-fasting-glucose-of-118:a","a-weight-gain-of-6-kilograms-over-three-months-on-an-antipsychotic-with-a-fasting-glucose-of-118:c"]}]},"answerKey":{"vomiting-a-coarse-tremor-and-an-unsteady-walk-in-a-client-taking-lithium":["a","b"],"a-sore-throat-with-a-fever-in-a-client-taking-clozapine":["a","b"],"a-dry-mouth-in-the-first-week-of-a-new-antidepressant":["c"],"new-stiffness-of-the-neck-and-jaw-three-days-into-an-antipsychotic":["a"],"a-fine-hand-tremor-two-weeks-into-lithium-with-a-level-of-0-8":["c"],"a-weight-gain-of-6-kilograms-over-three-months-on-an-antipsychotic-with-a-fasting-glucose-of-118":["a","c"]},"readingSection":{"unitId":"psychotropics--openrn-nursingmhcc-047--1","chunkId":"chunk-3","index":2},"targets":[{"id":"vomiting-a-coarse-tremor-and-an-unsteady-walk-in-a-client-taking-lithium","label":"Vomiting, a coarse tremor and an unsteady walk in a client taking lithium"},{"id":"a-sore-throat-with-a-fever-in-a-client-taking-clozapine","label":"A sore throat with a fever in a client taking clozapine"},{"id":"a-dry-mouth-in-the-first-week-of-a-new-antidepressant","label":"A dry mouth in the first week of a new antidepressant"},{"id":"new-stiffness-of-the-neck-and-jaw-three-days-into-an-antipsychotic","label":"New stiffness of the neck and jaw three days into an antipsychotic"},{"id":"a-fine-hand-tremor-two-weeks-into-lithium-with-a-level-of-0-8","label":"A fine hand tremor two weeks into lithium, with a level of 0.8"},{"id":"a-weight-gain-of-6-kilograms-over-three-months-on-an-antipsychotic-with-a-fasting-glucose-of-118","label":"A weight gain of 6 kg over three months on an antipsychotic, with a fasting glucose of 118"}],"shard":"psychotropics"},{"id":"r7g-mm-007","familyId":"r7g-matrix-restraint-phase","type":"matrix_multiple","topicId":"safety-systems","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"take action","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every phase in which each requirement applies. A requirement may apply in more than one phase.","task":"In each row, select all that apply.","scoring":{"method":"plus_minus","groups":[{"id":"A current order for this episode, with a time limit on it","optionIds":["a-current-order-for-this-episode-with-a-time-limit-on-it:a","a-current-order-for-this-episode-with-a-time-limit-on-it:b","a-current-order-for-this-episode-with-a-time-limit-on-it:c"],"keys":["a-current-order-for-this-episode-with-a-time-limit-on-it:a","a-current-order-for-this-episode-with-a-time-limit-on-it:b"]},{"id":"Documented evidence that less restrictive measures were tried first","optionIds":["documented-evidence-that-less-restrictive-measures-were-tried-first:a","documented-evidence-that-less-restrictive-measures-were-tried-first:b","documented-evidence-that-less-restrictive-measures-were-tried-first:c"],"keys":["documented-evidence-that-less-restrictive-measures-were-tried-first:a"]},{"id":"Explaining to the client and the family what is happening and why","optionIds":["explaining-to-the-client-and-the-family-what-is-happening-and-why:a","explaining-to-the-client-and-the-family-what-is-happening-and-why:b","explaining-to-the-client-and-the-family-what-is-happening-and-why:c"],"keys":["explaining-to-the-client-and-the-family-what-is-happening-and-why:a","explaining-to-the-client-and-the-family-what-is-happening-and-why:b","explaining-to-the-client-and-the-family-what-is-happening-and-why:c"]},{"id":"Checking circulation, skin and limb position, and releasing the limbs on a schedule","optionIds":["checking-circulation-skin-and-limb-position-and-releasing-the-limbs-on-a-schedule:a","checking-circulation-skin-and-limb-position-and-releasing-the-limbs-on-a-schedule:b","checking-circulation-skin-and-limb-position-and-releasing-the-limbs-on-a-schedule:c"],"keys":["checking-circulation-skin-and-limb-position-and-releasing-the-limbs-on-a-schedule:b"]},{"id":"Reassessing whether the restraint is still necessary","optionIds":["reassessing-whether-the-restraint-is-still-necessary:a","reassessing-whether-the-restraint-is-still-necessary:b","reassessing-whether-the-restraint-is-still-necessary:c"],"keys":["reassessing-whether-the-restraint-is-still-necessary:b","reassessing-whether-the-restraint-is-still-necessary:c"]},{"id":"Recording the client's response and the condition of his skin and limbs","optionIds":["recording-the-client-s-response-and-the-condition-of-his-skin-and-limbs:a","recording-the-client-s-response-and-the-condition-of-his-skin-and-limbs:b","recording-the-client-s-response-and-the-condition-of-his-skin-and-limbs:c"],"keys":["recording-the-client-s-response-and-the-condition-of-his-skin-and-limbs:b","recording-the-client-s-response-and-the-condition-of-his-skin-and-limbs:c"]}]},"answerKey":{"a-current-order-for-this-episode-with-a-time-limit-on-it":["a","b"],"documented-evidence-that-less-restrictive-measures-were-tried-first":["a"],"explaining-to-the-client-and-the-family-what-is-happening-and-why":["a","b","c"],"checking-circulation-skin-and-limb-position-and-releasing-the-limbs-on-a-schedule":["b"],"reassessing-whether-the-restraint-is-still-necessary":["b","c"],"recording-the-client-s-response-and-the-condition-of-his-skin-and-limbs":["b","c"]},"readingSection":{"unitId":"safety-systems--openrn-nursingfundamentals-045--1","chunkId":"chunk-3","index":2},"targets":[{"id":"a-current-order-for-this-episode-with-a-time-limit-on-it","label":"A current order for this episode, with a time limit on it"},{"id":"documented-evidence-that-less-restrictive-measures-were-tried-first","label":"Documented evidence that less restrictive measures were tried first"},{"id":"explaining-to-the-client-and-the-family-what-is-happening-and-why","label":"Explaining to the client and the family what is happening and why"},{"id":"checking-circulation-skin-and-limb-position-and-releasing-the-limbs-on-a-schedule","label":"Checking circulation, skin and limb position, and releasing the limbs on a schedule"},{"id":"reassessing-whether-the-restraint-is-still-necessary","label":"Reassessing whether the restraint is still necessary"},{"id":"recording-the-client-s-response-and-the-condition-of-his-skin-and-limbs","label":"Recording the client's response and the condition of his skin and limbs"}],"shard":"safety-systems-5"},{"id":"r7g-mm-008","familyId":"r7g-matrix-lab-response","type":"matrix_multiple","topicId":"lab-trends","clientNeed":"reduction-of-risk-potential","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every action each result calls for. A result may call for more than one action.","task":"In each row, select all that apply.","scoring":{"method":"plus_minus","groups":[{"id":"Potassium 2.6 millimoles per liter in a client taking a daily diuretic","optionIds":["potassium-2-6-millimoles-per-liter-in-a-client-taking-a-daily-diuretic:a","potassium-2-6-millimoles-per-liter-in-a-client-taking-a-daily-diuretic:b","potassium-2-6-millimoles-per-liter-in-a-client-taking-a-daily-diuretic:c","potassium-2-6-millimoles-per-liter-in-a-client-taking-a-daily-diuretic:d"],"keys":["potassium-2-6-millimoles-per-liter-in-a-client-taking-a-daily-diuretic:a","potassium-2-6-millimoles-per-liter-in-a-client-taking-a-daily-diuretic:b","potassium-2-6-millimoles-per-liter-in-a-client-taking-a-daily-diuretic:c"]},{"id":"International normalized ratio 6.8 in a client taking warfarin, with no bleeding","optionIds":["international-normalised-ratio-6-8-in-a-client-taking-warfarin-with-no-bleeding:a","international-normalised-ratio-6-8-in-a-client-taking-warfarin-with-no-bleeding:b","international-normalised-ratio-6-8-in-a-client-taking-warfarin-with-no-bleeding:c","international-normalised-ratio-6-8-in-a-client-taking-warfarin-with-no-bleeding:d"],"keys":["international-normalised-ratio-6-8-in-a-client-taking-warfarin-with-no-bleeding:a","international-normalised-ratio-6-8-in-a-client-taking-warfarin-with-no-bleeding:c"]},{"id":"Digoxin level 2.8 nanograms per milliliter with a heart rate of 48 beats per minute","optionIds":["digoxin-level-2-8-nanograms-per-milliliter-with-a-heart-rate-of-48-beats-per-minute:a","digoxin-level-2-8-nanograms-per-milliliter-with-a-heart-rate-of-48-beats-per-minute:b","digoxin-level-2-8-nanograms-per-milliliter-with-a-heart-rate-of-48-beats-per-minute:c","digoxin-level-2-8-nanograms-per-milliliter-with-a-heart-rate-of-48-beats-per-minute:d"],"keys":["digoxin-level-2-8-nanograms-per-milliliter-with-a-heart-rate-of-48-beats-per-minute:a","digoxin-level-2-8-nanograms-per-milliliter-with-a-heart-rate-of-48-beats-per-minute:b","digoxin-level-2-8-nanograms-per-milliliter-with-a-heart-rate-of-48-beats-per-minute:c"]},{"id":"Hemoglobin A1c of 9.4% at a routine clinic visit","optionIds":["hemoglobin-a1c-of-9-4-percent-at-a-routine-clinic-visit:a","hemoglobin-a1c-of-9-4-percent-at-a-routine-clinic-visit:b","hemoglobin-a1c-of-9-4-percent-at-a-routine-clinic-visit:c","hemoglobin-a1c-of-9-4-percent-at-a-routine-clinic-visit:d"],"keys":["hemoglobin-a1c-of-9-4-percent-at-a-routine-clinic-visit:d"]},{"id":"Sodium 128 millimoles per liter in a client taking a thiazide diuretic","optionIds":["sodium-128-millimoles-per-liter-in-a-client-taking-a-thiazide-diuretic:a","sodium-128-millimoles-per-liter-in-a-client-taking-a-thiazide-diuretic:b","sodium-128-millimoles-per-liter-in-a-client-taking-a-thiazide-diuretic:c","sodium-128-millimoles-per-liter-in-a-client-taking-a-thiazide-diuretic:d"],"keys":["sodium-128-millimoles-per-liter-in-a-client-taking-a-thiazide-diuretic:a","sodium-128-millimoles-per-liter-in-a-client-taking-a-thiazide-diuretic:c"]},{"id":"Creatinine 1.1 mg/dL (milligrams per deciliter), unchanged from three months ago","optionIds":["creatinine-1-1-milligrams-per-deciliter-unchanged-from-three-months-ago:a","creatinine-1-1-milligrams-per-deciliter-unchanged-from-three-months-ago:b","creatinine-1-1-milligrams-per-deciliter-unchanged-from-three-months-ago:c","creatinine-1-1-milligrams-per-deciliter-unchanged-from-three-months-ago:d"],"keys":["creatinine-1-1-milligrams-per-deciliter-unchanged-from-three-months-ago:d"]}]},"answerKey":{"potassium-2-6-millimoles-per-liter-in-a-client-taking-a-daily-diuretic":["a","b","c"],"international-normalised-ratio-6-8-in-a-client-taking-warfarin-with-no-bleeding":["a","c"],"digoxin-level-2-8-nanograms-per-milliliter-with-a-heart-rate-of-48-beats-per-minute":["a","b","c"],"hemoglobin-a1c-of-9-4-percent-at-a-routine-clinic-visit":["d"],"sodium-128-millimoles-per-liter-in-a-client-taking-a-thiazide-diuretic":["a","c"],"creatinine-1-1-milligrams-per-deciliter-unchanged-from-three-months-ago":["d"]},"readingSection":{"unitId":"lab-trends--openrn-healthalts-082--1","chunkId":"chunk-2","index":1},"targets":[{"id":"potassium-2-6-millimoles-per-liter-in-a-client-taking-a-daily-diuretic","label":"Potassium 2.6 mEq/L in a client taking a daily diuretic"},{"id":"international-normalised-ratio-6-8-in-a-client-taking-warfarin-with-no-bleeding","label":"International normalized ratio 6.8 in a client taking warfarin, with no bleeding"},{"id":"digoxin-level-2-8-nanograms-per-milliliter-with-a-heart-rate-of-48-beats-per-minute","label":"Digoxin level 2.8 nanograms per milliliter with a heart rate of 48 beats per minute"},{"id":"hemoglobin-a1c-of-9-4-percent-at-a-routine-clinic-visit","label":"Hemoglobin A1c of 9.4% at a routine clinic visit"},{"id":"sodium-128-millimoles-per-liter-in-a-client-taking-a-thiazide-diuretic","label":"Sodium 128 mEq/L in a client taking a thiazide diuretic"},{"id":"creatinine-1-1-milligrams-per-deciliter-unchanged-from-three-months-ago","label":"Creatinine 1.1 mg/dL, unchanged from three months ago"}],"shard":"lab-trends"},{"id":"r7g-mm-009","familyId":"r7g-matrix-shock-finding","type":"matrix_multiple","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every cause each finding fits. A finding may fit more than one cause.","task":"In each row, select all that apply.","contextTags":["heart","antibiotic"],"scoring":{"method":"plus_minus","groups":[{"id":"A fast, weak pulse","optionIds":["a-fast-weak-pulse:a","a-fast-weak-pulse:b","a-fast-weak-pulse:c"],"keys":["a-fast-weak-pulse:a","a-fast-weak-pulse:b","a-fast-weak-pulse:c"]},{"id":"Cool, pale, clammy skin","optionIds":["cool-pale-clammy-skin:a","cool-pale-clammy-skin:b","cool-pale-clammy-skin:c"],"keys":["cool-pale-clammy-skin:a","cool-pale-clammy-skin:b"]},{"id":"Flat neck veins","optionIds":["flat-neck-veins:a","flat-neck-veins:b","flat-neck-veins:c"],"keys":["flat-neck-veins:a"]},{"id":"Crackles at both lung bases and distended neck veins","optionIds":["crackles-at-both-lung-bases-and-distended-neck-veins:a","crackles-at-both-lung-bases-and-distended-neck-veins:b","crackles-at-both-lung-bases-and-distended-neck-veins:c"],"keys":["crackles-at-both-lung-bases-and-distended-neck-veins:b"]},{"id":"Swelling of the lips and tongue with a wheeze and a tight throat","optionIds":["swelling-of-the-lips-and-tongue-with-a-wheeze-and-a-tight-throat:a","swelling-of-the-lips-and-tongue-with-a-wheeze-and-a-tight-throat:b","swelling-of-the-lips-and-tongue-with-a-wheeze-and-a-tight-throat:c"],"keys":["swelling-of-the-lips-and-tongue-with-a-wheeze-and-a-tight-throat:c"]},{"id":"Falling urine output","optionIds":["falling-urine-output:a","falling-urine-output:b","falling-urine-output:c"],"keys":["falling-urine-output:a","falling-urine-output:b","falling-urine-output:c"]}]},"answerKey":{"a-fast-weak-pulse":["a","b","c"],"cool-pale-clammy-skin":["a","b"],"flat-neck-veins":["a"],"crackles-at-both-lung-bases-and-distended-neck-veins":["b"],"swelling-of-the-lips-and-tongue-with-a-wheeze-and-a-tight-throat":["c"],"falling-urine-output":["a","b","c"]},"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-059--1","chunkId":"chunk-3","index":2},"targets":[{"id":"a-fast-weak-pulse","label":"A fast, weak pulse"},{"id":"cool-pale-clammy-skin","label":"Cool, pale, clammy skin"},{"id":"flat-neck-veins","label":"Flat neck veins"},{"id":"crackles-at-both-lung-bases-and-distended-neck-veins","label":"Crackles at both lung bases and distended neck veins"},{"id":"swelling-of-the-lips-and-tongue-with-a-wheeze-and-a-tight-throat","label":"Swelling of the lips and tongue with a wheeze and a tight throat"},{"id":"falling-urine-output","label":"Falling urine output"}],"shard":"cardio-respiratory-2"},{"id":"r7g-mm-010","familyId":"r7g-matrix-infusion-check","type":"matrix_multiple","topicId":"iv-blood-tpn","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"take action","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select every infusion each check belongs to. A check may belong to more than one.","task":"In each row, select all that apply.","contextTags":["potassium","fluid","nutrition"],"scoring":{"method":"plus_minus","groups":[{"id":"Two people independently verify the product against the client and the order","optionIds":["two-people-independently-verify-the-product-against-the-client-and-the-order:a","two-people-independently-verify-the-product-against-the-client-and-the-order:b","two-people-independently-verify-the-product-against-the-client-and-the-order:c"],"keys":["two-people-independently-verify-the-product-against-the-client-and-the-order:a","two-people-independently-verify-the-product-against-the-client-and-the-order:b","two-people-independently-verify-the-product-against-the-client-and-the-order:c"]},{"id":"An infusion pump, never gravity","optionIds":["an-infusion-pump-never-gravity:a","an-infusion-pump-never-gravity:b","an-infusion-pump-never-gravity:c"],"keys":["an-infusion-pump-never-gravity:b","an-infusion-pump-never-gravity:c"]},{"id":"Normal saline only in the line; no dextrose-containing fluid","optionIds":["normal-saline-only-in-the-line-no-dextrose-containing-fluid:a","normal-saline-only-in-the-line-no-dextrose-containing-fluid:b","normal-saline-only-in-the-line-no-dextrose-containing-fluid:c"],"keys":["normal-saline-only-in-the-line-no-dextrose-containing-fluid:a"]},{"id":"A full set of vital signs before it starts and again after fifteen minutes","optionIds":["a-full-set-of-vital-signs-before-it-starts-and-again-after-fifteen-minutes:a","a-full-set-of-vital-signs-before-it-starts-and-again-after-fifteen-minutes:b","a-full-set-of-vital-signs-before-it-starts-and-again-after-fifteen-minutes:c"],"keys":["a-full-set-of-vital-signs-before-it-starts-and-again-after-fifteen-minutes:a"]},{"id":"Confirm the position of the central line before it runs","optionIds":["confirm-the-position-of-the-central-line-before-it-runs:a","confirm-the-position-of-the-central-line-before-it-runs:b","confirm-the-position-of-the-central-line-before-it-runs:c"],"keys":["confirm-the-position-of-the-central-line-before-it-runs:c"]},{"id":"Check the most recent potassium level and the urine output","optionIds":["check-the-most-recent-potassium-level-and-the-urine-output:a","check-the-most-recent-potassium-level-and-the-urine-output:b","check-the-most-recent-potassium-level-and-the-urine-output:c"],"keys":["check-the-most-recent-potassium-level-and-the-urine-output:b","check-the-most-recent-potassium-level-and-the-urine-output:c"]}]},"answerKey":{"two-people-independently-verify-the-product-against-the-client-and-the-order":["a","b","c"],"an-infusion-pump-never-gravity":["b","c"],"normal-saline-only-in-the-line-no-dextrose-containing-fluid":["a"],"a-full-set-of-vital-signs-before-it-starts-and-again-after-fifteen-minutes":["a"],"confirm-the-position-of-the-central-line-before-it-runs":["c"],"check-the-most-recent-potassium-level-and-the-urine-output":["b","c"]},"readingSection":{"unitId":"iv-blood-tpn--openrn-nursingadvancedskills-020--1","chunkId":"chunk-1","index":0},"targets":[{"id":"two-people-independently-verify-the-product-against-the-client-and-the-order","label":"Two people independently verify the product against the client and the order"},{"id":"an-infusion-pump-never-gravity","label":"An infusion pump, never gravity"},{"id":"normal-saline-only-in-the-line-no-dextrose-containing-fluid","label":"Normal saline only in the line; no dextrose-containing fluid"},{"id":"a-full-set-of-vital-signs-before-it-starts-and-again-after-fifteen-minutes","label":"A full set of vital signs before it starts and again after fifteen minutes"},{"id":"confirm-the-position-of-the-central-line-before-it-runs","label":"Confirm the position of the central line before it runs"},{"id":"check-the-most-recent-potassium-level-and-the-urine-output","label":"Check the most recent potassium level and the urine output"}],"shard":"iv-blood-tpn"},{"id":"r7g-cz-001","familyId":"r7g-cloze-priority-order","type":"cloze_dropdown","topicId":"prioritization","clientNeed":"management-of-care","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Complete the plan: The nurse sees ____ (1) first, because ____ (2).","task":"Choose one answer for each blank.","contextTags":["pain"],"scoring":{"method":"zero_one"},"answerKey":{"who":["a"],"why":["a"]},"readingSection":{"unitId":"prioritization--openrn-nursingmpc-004--1","chunkId":"chunk-5","index":4},"targets":[{"id":"who","label":"1. Who she sees first"},{"id":"why","label":"2. The reason that decides it"}],"shard":"prioritization-2"},{"id":"r7g-cz-002","familyId":"r7g-cloze-precautions-room","type":"cloze_dropdown","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Complete the plan: The client is placed in ____ (1), and the nurse wears ____ (2) to enter.","task":"Choose one answer for each blank.","scoring":{"method":"zero_one"},"answerKey":{"room":["a"],"ppe":["a"]},"readingSection":{"unitId":"isolation--openrn-nursingfundamentals-078--2","chunkId":"chunk-1","index":0},"targets":[{"id":"room","label":"1. The room she needs"},{"id":"ppe","label":"2. What the nurse wears"}],"shard":"isolation-3"},{"id":"r7g-cz-003","familyId":"r7g-cloze-preeclampsia-reading","type":"cloze_dropdown","topicId":"maternity-newborn","clientNeed":"physiological-adaptation","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Complete the interpretation: These findings together point to ____ (1), and the nurse's first action is to ____ (2).","task":"Choose one answer for each blank.","contextTags":["pregnan","urin"],"scoring":{"method":"zero_one"},"answerKey":{"problem":["a"],"action":["a"]},"readingSection":{"unitId":"maternity-newborn--openrn-healthpromo-229--1","chunkId":"chunk-2","index":1},"targets":[{"id":"problem","label":"1. What the findings point to"},{"id":"action","label":"2. What the nurse does first"}],"shard":"maternity-newborn"},{"id":"r7g-cz-004","familyId":"r7g-cloze-pain-assessment","type":"cloze_dropdown","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"recognize cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Complete the assessment: The nurse judges his pain using ____ (1), and treats the change in behavior as ____ (2).","task":"Choose one answer for each blank.","scoring":{"method":"zero_one"},"answerKey":{"tool":["a"],"meaning":["a"]},"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-108--1","chunkId":"chunk-2","index":1},"targets":[{"id":"tool","label":"1. How she judges his pain"},{"id":"meaning","label":"2. What the change in behavior means"}],"shard":"comfort-care"},{"id":"r7g-cz-005","familyId":"r7g-cloze-anticoagulation-reading","type":"cloze_dropdown","topicId":"lab-trends","clientNeed":"reduction-of-risk-potential","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Complete the interpretation: A result of 1.2 means ____ (1), so the nurse ____ (2).","task":"Choose one answer for each blank.","contextTags":["rhythm","warfarin","heart"],"scoring":{"method":"zero_one"},"answerKey":{"meaning":["a"],"action":["a"]},"readingSection":{"unitId":"lab-trends--openrn-healthalts-022--1","chunkId":"chunk-1","index":0},"targets":[{"id":"meaning","label":"1. What the result means"},{"id":"action","label":"2. What the nurse does"}],"shard":"lab-trends"},{"id":"r7g-cz-006","familyId":"r7g-cloze-blood-gas-reading","type":"cloze_dropdown","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Complete the interpretation: These gases show ____ (1), and the cause of his drowsiness is ____ (2).","task":"Choose one answer for each blank.","scoring":{"method":"zero_one"},"answerKey":{"pattern":["a"],"cause":["a"]},"readingSection":{"unitId":"cardio-respiratory--openrn-nursingfundamentals-122--2","chunkId":"chunk-2","index":1},"targets":[{"id":"pattern","label":"1. What the gases show"},{"id":"cause","label":"2. The cause of his drowsiness"}],"shard":"cardio-respiratory-2"},{"id":"r7g-cz-007","familyId":"r7g-cloze-digoxin-hold","type":"cloze_dropdown","topicId":"pharm-cardiac","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"take action","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Complete the decision: The nurse ____ (1), because ____ (2).","task":"Choose one answer for each blank.","contextTags":["potassium","digoxin","heart"],"scoring":{"method":"zero_one"},"answerKey":{"action":["a"],"reason":["a"]},"readingSection":{"unitId":"pharm-cardiac--openrn-pharmacology2e-085--1","chunkId":"chunk-4","index":3},"targets":[{"id":"action","label":"1. What the nurse does with the dose"},{"id":"reason","label":"2. 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answer.","contextTags":["pregnan"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"maternity-newborn--openrn-healthpromo-229--2","chunkId":"chunk-3","index":2},"shard":"maternity-newborn-2"},{"id":"r7g-case-preeclampsia-evaluate","familyId":"r7g-case-pregnancy-hypertension-evaluate","type":"matrix_single","topicId":"maternity-newborn","clientNeed":"physiological-adaptation","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each finding at 17:00 shows the treatment working or shows a new problem.","task":"Choose one answer in each 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Some measures belong in more than one space.","task":"Put each label in the space where it belongs.","contextTags":["stroke"],"scoring":{"method":"plus_minus"},"answerKey":{"treat":["a","d","e","f"],"prevent":["a","b","c","f"],"monitor":["g"]},"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-108--1","chunkId":"chunk-5","index":4},"targets":[{"id":"treat","label":"Treats the pneumonia she has now"},{"id":"prevent","label":"Prevents the next aspiration"},{"id":"monitor","label":"Measures whether the plan is working"}],"shard":"comfort-care-2"},{"id":"r7g-case-dysphagia-act","familyId":"r7g-case-unsafe-swallow-act","type":"drag_drop_extended","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Her swallow has been reassessed and breakfast is restarting. Put the nurse's steps in order. Choose one step for each position.","task":"Put the steps in order. Choose one step for each position.","contextTags":["stroke"],"scoring":{"method":"zero_one"},"answerKey":{"step-1":["a"],"step-2":["b"],"step-3":["c"],"step-4":["d"],"step-5":["e"],"step-6":["f"]},"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-095--1","chunkId":"chunk-1","index":0},"targets":[{"id":"step-1","label":"First step"},{"id":"step-2","label":"Second step"},{"id":"step-3","label":"Third step"},{"id":"step-4","label":"Fourth step"},{"id":"step-5","label":"Fifth step"},{"id":"step-6","label":"Sixth step"}],"shard":"comfort-care-3"},{"id":"r7g-case-dysphagia-evaluate","familyId":"r7g-case-unsafe-swallow-evaluate","type":"matrix_single","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each finding on day four shows the plan working or still needs attention.","task":"Choose one answer in each row.","contextTags":["stroke"],"scoring":{"method":"zero_one"},"answerKey":{"temperature-36-9-c-was-38-3-c":["a"],"oxygen-saturation-96-percent-in-room-air-was-92-percent":["a"],"voice-clear-after-fluids-and-no-coughing-at-breakfast":["a"],"oral-care-recorded-twice-a-shift":["a"],"weight-down-1-5-kilograms-since-admission":["b"],"crackles-at-the-right-base-reduced-but-still-present":["b"]},"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-108--1","chunkId":"chunk-6","index":5},"targets":[{"id":"temperature-36-9-c-was-38-3-c","label":"Temperature 98.4 °F (36.9 °C), was 100.9 °F (38.3 °C)"},{"id":"oxygen-saturation-96-percent-in-room-air-was-92-percent","label":"Oxygen saturation 96% in room air, was 92%"},{"id":"voice-clear-after-fluids-and-no-coughing-at-breakfast","label":"Voice clear after fluids and no coughing at breakfast"},{"id":"oral-care-recorded-twice-a-shift","label":"Oral care recorded twice a shift"},{"id":"weight-down-1-5-kilograms-since-admission","label":"Weight down 1.5 kg since admission"},{"id":"crackles-at-the-right-base-reduced-but-still-present","label":"Crackles at the right base reduced but still present"}],"shard":"comfort-care-3"},{"id":"r7g-case-pressure","familyId":"r7g-case-pressure-injury","type":"case_study","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","children":["r7g-case-pressure-recognize","r7g-case-pressure-analyze","r7g-case-pressure-prioritize","r7g-case-pressure-generate","r7g-case-pressure-act","r7g-case-pressure-evaluate"],"schemaVersion":2,"stem":"Follow Jacinto Beltrán from his ninth day in hospital to his twenty-fifth. New information appears in his record as the case develops.","task":"Answer six linked questions about one client. New information appears as the case develops.","scoring":{"method":"zero_one"},"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-108--1","chunkId":"chunk-2","index":1},"shard":"comfort-care-3"},{"id":"r7g-case-pressure-recognize","familyId":"r7g-case-pressure-injury-recognize","type":"highlight_hotspot","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"recognize cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the findings that show Jacinto is at high risk of his skin breaking down.","task":"Select every phrase that answers the question.","scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d","e","f","g","h"],"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-108--1","chunkId":"chunk-5","index":4},"shard":"comfort-care-3"},{"id":"r7g-case-pressure-analyze","familyId":"r7g-case-pressure-injury-analyze","type":"cloze_dropdown","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Complete the interpretation: On day 9 the sacral area was ____ (1), and by day 11 it has become ____ (2).","task":"Choose one answer for each blank.","scoring":{"method":"zero_one"},"answerKey":{"day9":["a"],"day11":["a"]},"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-095--1","chunkId":"chunk-4","index":3},"targets":[{"id":"day9","label":"1. What it was on day 9"},{"id":"day11","label":"2. What it has become by day 11"}],"shard":"comfort-care-3"},{"id":"r7g-case-pressure-prioritize","familyId":"r7g-case-pressure-injury-prioritize","type":"single","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"prioritize hypotheses","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which part of Jacinto's plan matters most for healing this wound?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-108--1","chunkId":"chunk-5","index":4},"shard":"comfort-care-3"},{"id":"r7g-case-pressure-generate","familyId":"r7g-case-pressure-injury-generate","type":"matrix_single","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each measure belongs in Jacinto's plan or should be left out.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"relieving-the-pressure":["a"],"protecting-the-skin-from-moisture":["a"],"building-the-tissue-back":["a"],"making-the-care-possible":["a"],"massaging-the-reddened-heels-to-improve-the-circulation":["b"],"a-ring-cushion-under-the-sacrum-so-he-is-not-lying-on-the-wound":["b"],"positioning-him-directly-on-his-side-at-ninety-degrees-to-keep-him-off-the-sacrum":["b"]},"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-108--1","chunkId":"chunk-6","index":5},"targets":[{"id":"relieving-the-pressure","label":"Relieving the pressure"},{"id":"protecting-the-skin-from-moisture","label":"Protecting the skin from moisture"},{"id":"building-the-tissue-back","label":"Building the tissue back"},{"id":"making-the-care-possible","label":"Making the care possible"},{"id":"massaging-the-reddened-heels-to-improve-the-circulation","label":"Massaging the reddened heels to improve the circulation"},{"id":"a-ring-cushion-under-the-sacrum-so-he-is-not-lying-on-the-wound","label":"A ring cushion under the sacrum so he is not lying on the wound"},{"id":"positioning-him-directly-on-his-side-at-ninety-degrees-to-keep-him-off-the-sacrum","label":"Positioning him directly on his side at ninety degrees to keep him off the sacrum"}],"shard":"comfort-care-3"},{"id":"r7g-case-pressure-act","familyId":"r7g-case-pressure-injury-act","type":"single","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"A nursing assistant tells the nurse that Jacinto refused his turn two hours ago because it hurt, so she left him. What should the nurse do first?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-142--1","chunkId":"chunk-4","index":3},"shard":"comfort-care-3"},{"id":"r7g-case-pressure-evaluate","familyId":"r7g-case-pressure-injury-evaluate","type":"trend","responseType":"single","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What should the nurse conclude from this record?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-135--1","chunkId":"chunk-4","index":3},"shard":"comfort-care-4"},{"id":"r7g-case-colonoscopy","familyId":"r7g-case-post-procedure-bleed","type":"case_study","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","children":["r7g-case-colonoscopy-recognize","r7g-case-colonoscopy-analyze","r7g-case-colonoscopy-prioritize","r7g-case-colonoscopy-generate","r7g-case-colonoscopy-act","r7g-case-colonoscopy-evaluate"],"schemaVersion":2,"stem":"Follow Arturo Peralta through the day after his colonoscopy. New information appears in his record as the case develops.","task":"Answer six linked questions about one client. New information appears as the case develops.","scoring":{"method":"zero_one"},"readingSection":{"unitId":"diagnostics--openrn-nursingadvancedskills-045--1","chunkId":"chunk-2","index":1},"shard":"diagnostics"},{"id":"r7g-case-colonoscopy-recognize","familyId":"r7g-case-post-procedure-bleed-recognize","type":"multiple_response_sata","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"recognize cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which findings at 13:30 suggest Arturo is losing blood?","task":"Select all that apply.","scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d","e"],"readingSection":{"unitId":"diagnostics--openrn-healthalts-017--1","chunkId":"chunk-4","index":3},"shard":"diagnostics"},{"id":"r7g-case-colonoscopy-analyze","familyId":"r7g-case-post-procedure-bleed-analyze","type":"single","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What best explains the change between 11:00 and 13:30?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"diagnostics--openrn-nursingadvancedskills-045--1","chunkId":"chunk-2","index":1},"shard":"diagnostics"},{"id":"r7g-case-colonoscopy-prioritize","familyId":"r7g-case-post-procedure-bleed-prioritize","type":"multiple_response_select_n","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which two actions from the new orders does the nurse carry out first?","task":"Select exactly 2 answers.","scoring":{"method":"zero_one"},"answerKey":["a","b"],"selectN":2,"readingSection":{"unitId":"diagnostics--openrn-nursingadvancedskills-004--1","chunkId":"chunk-1","index":0},"shard":"diagnostics"},{"id":"r7g-case-colonoscopy-generate","familyId":"r7g-case-post-procedure-bleed-generate","type":"matrix_single","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each action is correct for Arturo now or should not be done.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"keep-him-nothing-by-mouth":["a"],"keep-the-apixaban-held-and-do-not-give-the-evening-dose":["a"],"lie-him-flat-with-his-legs-raised-while-the-fluid-runs":["a"],"give-the-prescribed-oral-paracetamol-for-his-cramping":["b"],"insert-a-rectal-tube-to-measure-the-bleeding-accurately":["b"],"sit-him-upright-so-he-can-see-the-clinician-when-she-arrives":["b"]},"readingSection":{"unitId":"diagnostics--openrn-nursingadvancedskills-045--1","chunkId":"chunk-2","index":1},"targets":[{"id":"keep-him-nothing-by-mouth","label":"Keep him NPO"},{"id":"keep-the-apixaban-held-and-do-not-give-the-evening-dose","label":"Keep the apixaban held and do not give the evening dose"},{"id":"lie-him-flat-with-his-legs-raised-while-the-fluid-runs","label":"Lie him flat with his legs raised while the fluid runs"},{"id":"give-the-prescribed-oral-paracetamol-for-his-cramping","label":"Give the prescribed oral acetaminophen for his cramping"},{"id":"insert-a-rectal-tube-to-measure-the-bleeding-accurately","label":"Insert a rectal tube to measure the bleeding accurately"},{"id":"sit-him-upright-so-he-can-see-the-clinician-when-she-arrives","label":"Sit him upright so he can see the clinician when she arrives"}],"shard":"diagnostics"},{"id":"r7g-case-colonoscopy-act","familyId":"r7g-case-post-procedure-bleed-act","type":"single","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"At 18:00 Arturo asks when he can restart his apixaban, saying he is \"worried about a stroke\". What should the nurse do?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"diagnostics--openrn-nursingadvancedskills-045--1","chunkId":"chunk-2","index":1},"shard":"diagnostics"},{"id":"r7g-case-colonoscopy-evaluate","familyId":"r7g-case-post-procedure-bleed-evaluate","type":"matrix_single","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each finding at 18:00 shows the treatment worked or still needs attention.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"no-further-rectal-bleeding-since-15-00":["a"],"heart-rate-84-was-118":["a"],"blood-pressure-126-76-was-98-58":["a"],"urine-output-55-milliliters-per-hour":["a"],"hemoglobin-9-8-grams-per-deciliter-was-13-1":["b"],"apixaban-still-held-pending-review":["b"]},"readingSection":{"unitId":"diagnostics--openrn-healthalts-017--1","chunkId":"chunk-3","index":2},"targets":[{"id":"no-further-rectal-bleeding-since-15-00","label":"No further rectal bleeding since 15:00"},{"id":"heart-rate-84-was-118","label":"Heart rate 84, was 118"},{"id":"blood-pressure-126-76-was-98-58","label":"Blood pressure 126/76, was 98/58"},{"id":"urine-output-55-milliliters-per-hour","label":"Urine output 55 mL/hr"},{"id":"hemoglobin-9-8-grams-per-deciliter-was-13-1","label":"Hemoglobin 9.8 g/dL, was 13.1"},{"id":"apixaban-still-held-pending-review","label":"Apixaban still held pending review"}],"shard":"diagnostics"},{"id":"r7g-case-transfusion","familyId":"r7g-case-transfusion-reaction","type":"case_study","topicId":"iv-blood-tpn","clientNeed":"reduction-of-risk-potential","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","children":["r7g-case-transfusion-recognize","r7g-case-transfusion-analyze","r7g-case-transfusion-prioritize","r7g-case-transfusion-generate","r7g-case-transfusion-act","r7g-case-transfusion-evaluate"],"schemaVersion":2,"stem":"Follow Remedios Gálvez through one morning on the day unit. New information appears in her record as the case develops.","task":"Answer six linked questions about one client. New information appears as the case develops.","scoring":{"method":"zero_one"},"readingSection":{"unitId":"iv-blood-tpn--openrn-nursingadvancedskills-020--1","chunkId":"chunk-1","index":0},"shard":"iv-blood-tpn"},{"id":"r7g-case-transfusion-recognize","familyId":"r7g-case-transfusion-reaction-recognize","type":"highlight_hotspot","topicId":"iv-blood-tpn","clientNeed":"reduction-of-risk-potential","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the findings at 10:15 that point to the most serious kind of transfusion reaction.","task":"Select every phrase that answers the question.","scoring":{"method":"plus_minus"},"answerKey":["d","e","f","g"],"readingSection":{"unitId":"iv-blood-tpn--openrn-nursingadvancedskills-020--1","chunkId":"chunk-1","index":0},"shard":"iv-blood-tpn"},{"id":"r7g-case-transfusion-analyze","familyId":"r7g-case-transfusion-reaction-analyze","type":"single","topicId":"iv-blood-tpn","clientNeed":"reduction-of-risk-potential","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What is the most likely explanation for Remedios's findings?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"iv-blood-tpn--openrn-nursingadvancedskills-020--1","chunkId":"chunk-1","index":0},"shard":"iv-blood-tpn-2"},{"id":"r7g-case-transfusion-prioritize","familyId":"r7g-case-transfusion-reaction-prioritize","type":"drag_drop_extended","topicId":"iv-blood-tpn","clientNeed":"reduction-of-risk-potential","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Put the nurse's actions in order. Choose one step for each position.","task":"Put the steps in order. Choose one step for each position.","scoring":{"method":"zero_one"},"answerKey":{"step-1":["a"],"step-2":["b"],"step-3":["c"],"step-4":["d"],"step-5":["e"],"step-6":["f"]},"readingSection":{"unitId":"iv-blood-tpn--openrn-nursingadvancedskills-020--1","chunkId":"chunk-1","index":0},"targets":[{"id":"step-1","label":"First step"},{"id":"step-2","label":"Second step"},{"id":"step-3","label":"Third step"},{"id":"step-4","label":"Fourth step"},{"id":"step-5","label":"Fifth step"},{"id":"step-6","label":"Sixth step"}],"shard":"iv-blood-tpn-2"},{"id":"r7g-case-transfusion-generate","familyId":"r7g-case-transfusion-reaction-generate","type":"matrix_single","topicId":"iv-blood-tpn","clientNeed":"reduction-of-risk-potential","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each measure belongs in Remedios's care now or should be left out.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"protecting-her-kidneys":["a"],"monitoring-her":["a"],"finding-out-what-happened":["a"],"giving-the-second-prescribed-unit-since-her-hemoglobin-is-still-6-9":["b"],"giving-a-diuretic-to-clear-the-hemoglobin-from-her-kidneys-faster":["b"],"flushing-the-original-giving-set-with-saline-so-the-access-is-not-lost":["b"]},"readingSection":{"unitId":"iv-blood-tpn--openrn-nursingadvancedskills-020--1","chunkId":"chunk-1","index":0},"targets":[{"id":"protecting-her-kidneys","label":"Protecting her kidneys"},{"id":"monitoring-her","label":"Monitoring her"},{"id":"finding-out-what-happened","label":"Finding out what happened"},{"id":"giving-the-second-prescribed-unit-since-her-hemoglobin-is-still-6-9","label":"Giving the second prescribed unit, since her hemoglobin is still 6.9"},{"id":"giving-a-diuretic-to-clear-the-hemoglobin-from-her-kidneys-faster","label":"Giving a diuretic to clear the hemoglobin from her kidneys faster"},{"id":"flushing-the-original-giving-set-with-saline-so-the-access-is-not-lost","label":"Flushing the original giving set with saline so the access is not lost"}],"shard":"iv-blood-tpn-2"},{"id":"r7g-case-transfusion-act","familyId":"r7g-case-transfusion-reaction-act","type":"single","topicId":"iv-blood-tpn","clientNeed":"reduction-of-risk-potential","ncjmmStep":"take action","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"The blood bank reports that the unit was labeled for another client with the same surname. What should the nurse do about this information?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"iv-blood-tpn--openrn-nursingadvancedskills-020--1","chunkId":"chunk-1","index":0},"shard":"iv-blood-tpn-2"},{"id":"r7g-case-transfusion-evaluate","familyId":"r7g-case-transfusion-reaction-evaluate","type":"cloze_dropdown","topicId":"iv-blood-tpn","clientNeed":"reduction-of-risk-potential","ncjmmStep":"evaluate outcomes","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Complete the summary: By 14:00 the acute reaction ____ (1), and the problem that still needs managing is ____ (2).","task":"Choose one answer for each blank.","scoring":{"method":"zero_one"},"answerKey":{"acute":["a"],"ongoing":["a"]},"readingSection":{"unitId":"iv-blood-tpn--openrn-nursingadvancedskills-020--1","chunkId":"chunk-1","index":0},"targets":[{"id":"acute","label":"1. The acute reaction"},{"id":"ongoing","label":"2. What still needs managing"}],"shard":"iv-blood-tpn-2"},{"id":"r7g-case-shiftplan","familyId":"r7g-case-shift-replanning","type":"case_study","topicId":"prioritization","clientNeed":"management-of-care","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","children":["r7g-case-shiftplan-recognize","r7g-case-shiftplan-analyze","r7g-case-shiftplan-prioritize","r7g-case-shiftplan-generate","r7g-case-shiftplan-act","r7g-case-shiftplan-evaluate"],"schemaVersion":2,"stem":"Follow Nurse Ruvalcaba through one morning on a six-client unit. New information appears in her record as the shift develops.","task":"Answer six linked questions about one client. New information appears as the case develops.","scoring":{"method":"zero_one"},"readingSection":{"unitId":"prioritization--openrn-nursingmpc-007--1","chunkId":"chunk-1","index":0},"shard":"prioritization-2"},{"id":"r7g-case-shiftplan-recognize","familyId":"r7g-case-shift-replanning-recognize","type":"multiple_response_select_n","topicId":"prioritization","clientNeed":"management-of-care","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which two clients should the nurse assess first, before anything else on the handover?","task":"Select exactly 2 answers.","scoring":{"method":"zero_one"},"answerKey":["a","b"],"selectN":2,"readingSection":{"unitId":"prioritization--openrn-nursingmpc-004--1","chunkId":"chunk-2","index":1},"shard":"prioritization-2"},{"id":"r7g-case-shiftplan-analyze","familyId":"r7g-case-shift-replanning-analyze","type":"single","topicId":"prioritization","clientNeed":"management-of-care","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What best explains Mrs Delgadillo's findings at 07:20?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"prioritization--openrn-nursingmpc-004--2","chunkId":"chunk-1","index":0},"shard":"prioritization-2"},{"id":"r7g-case-shiftplan-prioritize","familyId":"r7g-case-shift-replanning-prioritize","type":"single","topicId":"prioritization","clientNeed":"management-of-care","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What should the nurse do about the order for 40 units of insulin glargine?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"prioritization--openrn-nursingmpc-004--1","chunkId":"chunk-4","index":3},"shard":"prioritization-2"},{"id":"r7g-case-shiftplan-generate","familyId":"r7g-case-shift-replanning-generate","type":"drag_drop_extended","topicId":"prioritization","clientNeed":"management-of-care","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Place each piece of the morning's work in the space for the lowest-level team member who may safely do it.","task":"Put each label in the space where it belongs.","scoring":{"method":"plus_minus"},"answerKey":{"rn":["a","b","c"],"lpn":["d","e"],"uap":["f","g"]},"readingSection":{"unitId":"prioritization--openrn-nursingmpc-004--2","chunkId":"chunk-3","index":2},"targets":[{"id":"rn","label":"Registered nurse only"},{"id":"lpn","label":"Practical nurse or registered nurse"},{"id":"uap","label":"Nursing assistant may do it"}],"shard":"prioritization-2"},{"id":"r7g-case-shiftplan-act","familyId":"r7g-case-shift-replanning-act","type":"single","topicId":"prioritization","clientNeed":"management-of-care","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"The nursing assistant returns and says bed 3 walked 65 feet but \"went very pale and had to sit down halfway\". What should the nurse do first?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"prioritization--openrn-nursingmpc-004--1","chunkId":"chunk-4","index":3},"shard":"prioritization-2"},{"id":"r7g-case-shiftplan-evaluate","familyId":"r7g-case-shift-replanning-evaluate","type":"matrix_single","topicId":"prioritization","clientNeed":"management-of-care","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each outcome at 13:00 shows the morning was managed well or shows something still outstanding.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"bed-2-saturation-95-percent-rate-20-900-milliliters-of-urine-speaking-full-sentences":["a"],"bed-6-glucose-96-after-breakfast-and-14-units-given-at-08-40":["a"],"bed-4-troponin-raised-transferred-to-the-cardiac-unit-at-11-20":["a"],"bed-5-discharge-teaching-done-with-teach-back-completed":["a"],"bed-3-walked-20-metres-pain-3-of-10-dressing-changed":["b"],"incident-report-filed-on-the-40-u-order":["b"]},"readingSection":{"unitId":"prioritization--openrn-nursingmpc-004--2","chunkId":"chunk-1","index":0},"targets":[{"id":"bed-2-saturation-95-percent-rate-20-900-milliliters-of-urine-speaking-full-sentences","label":"Bed 2: saturation 95%, rate 20, 900 mL of urine, speaking full sentences"},{"id":"bed-6-glucose-96-after-breakfast-and-14-units-given-at-08-40","label":"Bed 6: glucose 96 after breakfast and 14 units given at 08:40"},{"id":"bed-4-troponin-raised-transferred-to-the-cardiac-unit-at-11-20","label":"Bed 4: troponin raised, transferred to the cardiac unit at 11:20"},{"id":"bed-5-discharge-teaching-done-with-teach-back-completed","label":"Bed 5: discharge teaching done with teach-back completed"},{"id":"bed-3-walked-20-metres-pain-3-of-10-dressing-changed","label":"Bed 3: walked 65 feet, pain 3 of 10, dressing changed"},{"id":"incident-report-filed-on-the-40-u-order","label":"Incident report filed on the \"40 u\" order"}],"shard":"prioritization-2"},{"id":"r7g-case-cdiff","familyId":"r7g-case-hospital-acquired-diarrhoea","type":"case_study","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","children":["r7g-case-cdiff-recognize","r7g-case-cdiff-analyze","r7g-case-cdiff-prioritize","r7g-case-cdiff-generate","r7g-case-cdiff-act","r7g-case-cdiff-evaluate"],"schemaVersion":2,"stem":"Follow Rogelio Mustieles from his eighth day in hospital to his fourteenth. New information appears in his record as the case develops.","task":"Answer six linked questions about one client. New information appears as the case develops.","scoring":{"method":"zero_one"},"readingSection":{"unitId":"isolation--openrn-nursingfundamentals-078--2","chunkId":"chunk-2","index":1},"shard":"isolation-3"},{"id":"r7g-case-cdiff-recognize","familyId":"r7g-case-hospital-acquired-diarrhoea-recognize","type":"multiple_response_sata","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"recognize cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which findings suggest Rogelio has developed a Clostridioides difficile infection?","task":"Select all that apply.","contextTags":["infection"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d","e","f"],"readingSection":{"unitId":"isolation--openrn-nursingfundamentals-078--3","chunkId":"chunk-3","index":2},"shard":"isolation-3"},{"id":"r7g-case-cdiff-analyze","familyId":"r7g-case-hospital-acquired-diarrhoea-analyze","type":"single","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"analyze cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What explains why eight days of antibiotics have led to this?","task":"Choose one answer.","contextTags":["infection"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"isolation--openrn-nursingfundamentals-078--3","chunkId":"chunk-3","index":2},"shard":"isolation-3"},{"id":"r7g-case-cdiff-prioritize","familyId":"r7g-case-hospital-acquired-diarrhoea-prioritize","type":"single","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which action protects the other clients most, and is therefore done first?","task":"Choose one answer.","contextTags":["infection"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"isolation--openrn-nursingskills-033--1","chunkId":"chunk-3","index":2},"shard":"isolation-3"},{"id":"r7g-case-cdiff-generate","familyId":"r7g-case-hospital-acquired-diarrhoea-generate","type":"matrix_single","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each measure belongs in Rogelio's plan or should be left out.","task":"Choose one answer in each row.","contextTags":["infection"],"scoring":{"method":"zero_one"},"answerKey":{"hand-hygiene":["a"],"the-room-and-the-equipment":["a"],"his-treatment-and-fluid":["a"],"alcohol-hand-gel-on-leaving-the-room-since-it-is-quicker":["b"],"an-antidiarrhoeal-medicine-to-reduce-the-number-of-stools":["b"],"continuing-the-original-broad-spectrum-antibiotic-to-treat-his-bone-infection":["b"]},"readingSection":{"unitId":"isolation--openrn-nursingfundamentals-078--1","chunkId":"chunk-3","index":2},"targets":[{"id":"hand-hygiene","label":"Hand hygiene"},{"id":"the-room-and-the-equipment","label":"The room and the equipment"},{"id":"his-treatment-and-fluid","label":"His treatment and fluid"},{"id":"alcohol-hand-gel-on-leaving-the-room-since-it-is-quicker","label":"Alcohol hand gel on leaving the room, since it is quicker"},{"id":"an-antidiarrhoeal-medicine-to-reduce-the-number-of-stools","label":"An antidiarrheal medicine to reduce the number of stools"},{"id":"continuing-the-original-broad-spectrum-antibiotic-to-treat-his-bone-infection","label":"Continuing the original broad-spectrum antibiotic to treat his bone infection"}],"shard":"isolation-3"},{"id":"r7g-case-cdiff-act","familyId":"r7g-case-hospital-acquired-diarrhoea-act","type":"single","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Rogelio says he is embarrassed to be in isolation and that visitors look frightened putting the gowns on. What should the nurse do?","task":"Choose one answer.","contextTags":["infection"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"isolation--openrn-nursingfundamentals-078--2","chunkId":"chunk-5","index":4},"shard":"isolation-3"},{"id":"r7g-case-cdiff-evaluate","familyId":"r7g-case-hospital-acquired-diarrhoea-evaluate","type":"trend","responseType":"multiple_response_sata","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select the conclusions the nurse can draw from this record.","task":"Select all that apply.","contextTags":["infection"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d"],"readingSection":{"unitId":"isolation--openrn-nursingfundamentals-078--2","chunkId":"chunk-3","index":2},"shard":"isolation-4"},{"id":"r7g-case-insulin","familyId":"r7g-case-insulin-error","type":"case_study","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","children":["r7g-case-insulin-recognize","r7g-case-insulin-analyze","r7g-case-insulin-prioritize","r7g-case-insulin-generate","r7g-case-insulin-act","r7g-case-insulin-evaluate"],"schemaVersion":2,"stem":"Follow Natalia Berriozábal through one morning after a medicine error. New information appears in her record as the case develops.","task":"Answer six linked questions about one client. 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What is causing her findings"},{"id":"why","label":"2. Why the error happened"}],"shard":"medication-safety-2"},{"id":"r7g-case-insulin-prioritize","familyId":"r7g-case-insulin-error-prioritize","type":"drag_drop_extended","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Put the nurse's actions at 08:15 in order. Choose one step for each position.","task":"Put the steps in order. Choose one step for each position.","contextTags":["insulin","diabet"],"scoring":{"method":"zero_one"},"answerKey":{"step-1":["a"],"step-2":["b"],"step-3":["c"],"step-4":["d"],"step-5":["e"],"step-6":["f"]},"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-009--1","chunkId":"chunk-2","index":1},"targets":[{"id":"step-1","label":"First step"},{"id":"step-2","label":"Second step"},{"id":"step-3","label":"Third step"},{"id":"step-4","label":"Fourth step"},{"id":"step-5","label":"Fifth step"},{"id":"step-6","label":"Sixth step"}],"shard":"medication-safety-2"},{"id":"r7g-case-insulin-generate","familyId":"r7g-case-insulin-error-generate","type":"matrix_single","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each action is correct for Natalia now or should not be done.","task":"Choose one answer in each row.","contextTags":["insulin","diabet"],"scoring":{"method":"zero_one"},"answerKey":{"keep-dextrose-50-percent-and-glucagon-at-the-bedside":["a"],"check-her-glucose-every-30-minutes-for-four-hours-then-hourly":["a"],"tell-her-what-happened-in-plain-words-once-she-is-out-of-danger":["a"],"give-her-a-glass-of-diet-soda-since-she-says-she-is-thirsty":["b"],"give-the-glargine-dose-early-so-her-glucose-does-not-rebound-high-later":["b"],"wait-for-her-symptoms-to-resolve-before-rechecking-the-glucose":["b"]},"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-010--1","chunkId":"chunk-2","index":1},"targets":[{"id":"keep-dextrose-50-percent-and-glucagon-at-the-bedside","label":"Keep dextrose 50% and glucagon at the bedside"},{"id":"check-her-glucose-every-30-minutes-for-four-hours-then-hourly","label":"Check her glucose every 30 minutes for four hours, then hourly"},{"id":"tell-her-what-happened-in-plain-words-once-she-is-out-of-danger","label":"Tell her what happened, in plain words, once she is out of danger"},{"id":"give-her-a-glass-of-diet-soda-since-she-says-she-is-thirsty","label":"Give her a glass of diet soda, since she says she is thirsty"},{"id":"give-the-glargine-dose-early-so-her-glucose-does-not-rebound-high-later","label":"Give the glargine dose early so her glucose does not rebound high later"},{"id":"wait-for-her-symptoms-to-resolve-before-rechecking-the-glucose","label":"Wait for her symptoms to resolve before rechecking the glucose"}],"shard":"medication-safety-3"},{"id":"r7g-case-insulin-act","familyId":"r7g-case-insulin-error-act","type":"single","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"take action","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Natalia asks the nurse directly: \"Did something go wrong with my medicine this morning?\" What should the nurse say?","task":"Choose one answer.","contextTags":["insulin","diabet"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-009--1","chunkId":"chunk-5","index":4},"shard":"medication-safety-3"},{"id":"r7g-case-insulin-evaluate","familyId":"r7g-case-insulin-error-evaluate","type":"multiple_response_sata","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which conclusions does the 12:30 record support?","task":"Select all that apply.","contextTags":["insulin","diabet"],"scoring":{"method":"plus_minus"},"answerKey":["a","b","c","d"],"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-018--1","chunkId":"chunk-3","index":2},"shard":"medication-safety-3"},{"id":"r7g-case-dka","familyId":"r7g-case-ketoacidosis","type":"case_study","topicId":"neuro-renal-endocrine","clientNeed":"physiological-adaptation","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","children":["r7g-case-dka-recognize","r7g-case-dka-analyze","r7g-case-dka-prioritize","r7g-case-dka-generate","r7g-case-dka-act","r7g-case-dka-evaluate"],"schemaVersion":2,"stem":"Follow Fernanda Icaza through her first eight hours in hospital. 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the fluid has begun?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"neuro-renal-endocrine--openrn-healthalts-084--1","chunkId":"chunk-4","index":3},"shard":"neuro-renal-endocrine"},{"id":"r7g-case-dka-generate","familyId":"r7g-case-ketoacidosis-generate","type":"matrix_single","topicId":"neuro-renal-endocrine","clientNeed":"physiological-adaptation","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose whether each measure belongs in Fernanda's plan or should be left out.","task":"Choose one answer in each 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normal"},{"id":"adding-potassium-to-the-fluid-now-while-the-level-is-5-6","label":"Adding potassium to the fluid now, while the level is 5.6"}],"shard":"neuro-renal-endocrine-2"},{"id":"r7g-case-dka-act","familyId":"r7g-case-ketoacidosis-act","type":"single","topicId":"neuro-renal-endocrine","clientNeed":"physiological-adaptation","ncjmmStep":"take action","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What should the nurse do first about Fernanda’s headache, falling heart rate and rising blood pressure?","task":"Choose one answer.","contextTags":["heart","develop"],"scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"neuro-renal-endocrine--openrn-nursingfundamentals-121--1","chunkId":"chunk-2","index":1},"shard":"neuro-renal-endocrine-2"},{"id":"r7g-case-dka-evaluate","familyId":"r7g-case-ketoacidosis-evaluate","type":"trend","responseType":"single","topicId":"neuro-renal-endocrine","clientNeed":"physiological-adaptation","ncjmmStep":"evaluate outcomes","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"What should the nurse conclude from the eight-hour record?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["a"],"readingSection":{"unitId":"neuro-renal-endocrine--openrn-healthalts-074--1","chunkId":"chunk-4","index":3},"shard":"neuro-renal-endocrine-2"},{"id":"r8c-calc-001","familyId":"r8c-weight-based-single-dose","type":"calc_fill_in","topicId":"w1-units","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"take action","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"The first enoxaparin dose is 1 mg/kg SubQ (under the skin) once, STAT (right away). 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watch"}],"shard":"maternity-newborn-2"},{"id":"r8q2-bow-006","familyId":"r8q2-bowtie-pediatric-dehydration","type":"bowtie","topicId":"pediatrics-prevention","clientNeed":"health-promotion-and-maintenance","ncjmmStep":"analyze cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose what Tomás’s findings show, the two actions to take now, and the two findings to watch.","task":"Choose the problem, then the two actions, then the two findings to watch.","scoring":{"method":"zero_one"},"answerKey":{"condition":["d"],"actions":["b","c"],"parameters":["a","b"]},"readingSection":{"unitId":"pediatrics-prevention--openrn-healthpromo-140--5","chunkId":"chunk-1","index":0},"targets":[{"id":"condition","label":"The client’s main problem"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"pediatrics-prevention-2"},{"id":"r8q2-bow-007","familyId":"r8q2-bowtie-stroke-window","type":"bowtie","topicId":"neuro-renal-endocrine","clientNeed":"physiological-adaptation","ncjmmStep":"recognize cues","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose the problem Esteban most likely has, the two actions to take now, and the two findings to watch.","task":"Choose the problem, then the two actions, then the two findings to watch.","scoring":{"method":"zero_one"},"answerKey":{"condition":["c"],"actions":["a","b"],"parameters":["b","c"]},"readingSection":{"unitId":"neuro-renal-endocrine--openrn-healthalts-103--1","chunkId":"chunk-2","index":1},"targets":[{"id":"condition","label":"The client’s main problem"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"neuro-renal-endocrine-2"},{"id":"r8q2-bow-008","familyId":"r8q2-bowtie-febrile-transfusion-reaction","type":"bowtie","topicId":"iv-blood-tpn","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"analyze cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose what Patricia is most likely having, the two actions to take now, and the two findings to watch.","task":"Choose the problem, then the two actions, then the two findings to watch.","scoring":{"method":"zero_one"},"answerKey":{"condition":["b"],"actions":["a","d"],"parameters":["c","d"]},"readingSection":{"unitId":"iv-blood-tpn--openrn-nursingadvancedskills-019--2","chunkId":"chunk-1","index":0},"targets":[{"id":"condition","label":"The client’s main problem"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"iv-blood-tpn-2"},{"id":"r8q2-bow-009","familyId":"r8q2-bowtie-opioid-naloxone-after","type":"bowtie","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"evaluate outcomes","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose what Gabriel’s situation now is, the two actions to take, and the two findings to watch.","task":"Choose the problem, then the two actions, then the two findings to watch.","contextTags":["respirat"],"scoring":{"method":"zero_one"},"answerKey":{"condition":["a"],"actions":["c","d"],"parameters":["a","d"]},"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-018--1","chunkId":"chunk-5","index":4},"targets":[{"id":"condition","label":"The client’s main problem"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"medication-safety-3"},{"id":"r8q2-bow-010","familyId":"r8q2-bowtie-postoperative-delirium","type":"bowtie","topicId":"crisis-care","clientNeed":"psychosocial-integrity","ncjmmStep":"generate solutions","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose what Ernestina most likely has, the two actions to take now, and the two findings to watch.","task":"Choose the problem, then the two actions, then the two findings to watch.","scoring":{"method":"zero_one"},"answerKey":{"condition":["c"],"actions":["a","b"],"parameters":["b","c"]},"readingSection":{"unitId":"crisis-care--openrn-nursingmhcc-110--1","chunkId":"chunk-3","index":2},"targets":[{"id":"condition","label":"The client’s main problem"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"crisis-care-2"},{"id":"r8q2-bow-011","familyId":"r8q2-bowtie-anaphylaxis-first-dose","type":"bowtie","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"take action","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose what is happening to Noé, the two actions to take first, and the two findings to watch.","task":"Choose the problem, then the two actions, then the two findings to watch.","contextTags":["antibiotic"],"scoring":{"method":"zero_one"},"answerKey":{"condition":["b"],"actions":["a","d"],"parameters":["c","d"]},"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-010--1","chunkId":"chunk-2","index":1},"targets":[{"id":"condition","label":"The client’s main problem"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"medication-safety-3"},{"id":"r8q2-bow-012","familyId":"r8q2-bowtie-hyperkalemia-dialysis","type":"bowtie","topicId":"neuro-renal-endocrine","clientNeed":"reduction-of-risk-potential","ncjmmStep":"prioritize hypotheses","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose the problem Ramona has, the two actions to take first, and the two findings to watch.","task":"Choose the problem, then the two actions, then the two findings to watch.","contextTags":["kidney","dialysis"],"scoring":{"method":"zero_one"},"answerKey":{"condition":["a"],"actions":["c","d"],"parameters":["a","d"]},"readingSection":{"unitId":"neuro-renal-endocrine--openrn-healthalts-084--1","chunkId":"chunk-4","index":3},"targets":[{"id":"condition","label":"The client’s main problem"},{"id":"actions","label":"Two actions to take now"},{"id":"parameters","label":"Two findings to watch"}],"shard":"neuro-renal-endocrine-2"},{"id":"r8q2-mx-001","familyId":"r8q2-matrix-sepsis-expected","type":"matrix_single","topicId":"cardio-respiratory","clientNeed":"physiological-adaptation","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Decide for each finding whether it shows the treatment is working or that it is not.","task":"Choose one answer in each row.","contextTags":["sepsis"],"scoring":{"method":"zero_one"},"answerKey":{"lactate-fell-from-4-2-to-2-1-mmol-l":["a"],"urine-output-15-milliliters-in-the-last-hour":["b"],"mean-arterial-pressure-held-at-68-millimeters-of-mercury":["a"],"capillary-refill-still-4-seconds-at-the-fingertips":["b"],"she-now-answers-questions-and-knows-the-date":["a"],"temperature-fell-from-38-9-to-36-1-c-97-0-f":["b"]},"readingSection":{"unitId":"cardio-respiratory--openrn-nursingfundamentals-122--1","chunkId":"chunk-4","index":3},"targets":[{"id":"lactate-fell-from-4-2-to-2-1-mmol-l","label":"Lactate fell from 4.2 to 2.1 mmol/L"},{"id":"urine-output-15-milliliters-in-the-last-hour","label":"Urine output 15 milliliters in the last hour"},{"id":"mean-arterial-pressure-held-at-68-millimeters-of-mercury","label":"Mean arterial pressure held at 68 millimeters of mercury"},{"id":"capillary-refill-still-4-seconds-at-the-fingertips","label":"Capillary refill still 4 seconds at the fingertips"},{"id":"she-now-answers-questions-and-knows-the-date","label":"She now answers questions and knows the date"},{"id":"temperature-fell-from-38-9-to-36-1-c-97-0-f","label":"Temperature fell from 38.9 to 36.1 °C (97.0 °F)"}],"shard":"cardio-respiratory-3"},{"id":"r8q2-mx-002","familyId":"r8q2-matrix-post-op-expected","type":"matrix_single","topicId":"diagnostics","clientNeed":"reduction-of-risk-potential","ncjmmStep":"analyze cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Decide for each finding whether it is expected after this surgery or needs reporting now.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"pain-of-5-out-of-10-relieved-by-the-ordered-analgesia":["a"],"heart-rate-risen-from-84-to-120-beats-per-minute":["b"],"absent-bowel-sounds-in-all-four-quadrants":["a"],"urine-output-18-milliliters-an-hour-for-three-hours":["b"],"small-amount-of-serosanguinous-drainage-on-the-dressing":["a"],"oxygen-saturation-97-percent-on-room-air-at-rest":["a"]},"readingSection":{"unitId":"diagnostics--openrn-healthalts-017--1","chunkId":"chunk-4","index":3},"targets":[{"id":"pain-of-5-out-of-10-relieved-by-the-ordered-analgesia","label":"Pain of 5 out of 10 relieved by the ordered analgesia"},{"id":"heart-rate-risen-from-84-to-120-beats-per-minute","label":"Heart rate risen from 84 to 120 beats per minute"},{"id":"absent-bowel-sounds-in-all-four-quadrants","label":"Absent bowel sounds in all four quadrants"},{"id":"urine-output-18-milliliters-an-hour-for-three-hours","label":"Urine output 18 milliliters an hour for three hours"},{"id":"small-amount-of-serosanguinous-drainage-on-the-dressing","label":"Small amount of serosanguinous drainage on the dressing"},{"id":"oxygen-saturation-97-percent-on-room-air-at-rest","label":"Oxygen saturation 97 percent on room air at rest"}],"shard":"diagnostics-2"},{"id":"r8q2-mx-003","familyId":"r8q2-matrix-delegation-rn-ap","type":"matrix_single","topicId":"delegation","clientNeed":"management-of-care","ncjmmStep":"generate solutions","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose who may carry out each of these tasks.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"bathing-a-stable-client-and-reporting-the-skin-condition-seen":["a"],"teaching-a-newly-diagnosed-client-how-to-inject-insulin":["c"],"giving-a-scheduled-oral-medication-to-a-stable-client":["b"],"taking-the-first-assessment-of-a-client-admitted-an-hour-ago":["c"],"recording-intake-and-output-and-reporting-the-totals":["a"],"changing-the-dressing-on-a-stable-healing-surgical-wound":["b"]},"readingSection":{"unitId":"delegation--openrn-nursingmpc-013--2","chunkId":"chunk-3","index":2},"targets":[{"id":"bathing-a-stable-client-and-reporting-the-skin-condition-seen","label":"Bathing a stable client and reporting the skin condition seen"},{"id":"teaching-a-newly-diagnosed-client-how-to-inject-insulin","label":"Teaching a newly diagnosed client how to inject insulin"},{"id":"giving-a-scheduled-oral-medication-to-a-stable-client","label":"Giving a scheduled oral medication to a stable client"},{"id":"taking-the-first-assessment-of-a-client-admitted-an-hour-ago","label":"Taking the first assessment of a client admitted an hour ago"},{"id":"recording-intake-and-output-and-reporting-the-totals","label":"Recording intake and output and reporting the totals"},{"id":"changing-the-dressing-on-a-stable-healing-surgical-wound","label":"Changing the dressing on a stable, healing surgical wound"}],"shard":"delegation-2"},{"id":"r8q2-mx-004","familyId":"r8q2-matrix-precautions-by-organism","type":"matrix_single","topicId":"isolation","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"generate solutions","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose the transmission-based precautions each of these clients requires.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"suspected-pulmonary-tuberculosis":["d"],"clostridioides-difficile-diarrhea":["b"],"confirmed-influenza":["c"],"a-healing-pressure-injury-with-no-drainage-and-no-organism-identified":["a"],"suspected-meningococcal-meningitis":["c"],"colonization-with-a-drug-resistant-organism-in-the-urine":["b"]},"readingSection":{"unitId":"isolation--openrn-nursingfundamentals-078--2","chunkId":"chunk-1","index":0},"targets":[{"id":"suspected-pulmonary-tuberculosis","label":"Suspected pulmonary tuberculosis"},{"id":"clostridioides-difficile-diarrhea","label":"Clostridioides difficile diarrhea"},{"id":"confirmed-influenza","label":"Confirmed influenza"},{"id":"a-healing-pressure-injury-with-no-drainage-and-no-organism-identified","label":"A healing pressure injury with no drainage and no organism identified"},{"id":"suspected-meningococcal-meningitis","label":"Suspected meningococcal meningitis"},{"id":"colonization-with-a-drug-resistant-organism-in-the-urine","label":"Colonization with a drug-resistant organism in the urine"}],"shard":"isolation-5"},{"id":"r8q2-mx-005","familyId":"r8q2-matrix-insulin-onset-timing","type":"matrix_single","topicId":"pharm-endocrine","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"analyze cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Choose when the nurse should most expect a low blood glucose with each insulin.","task":"Choose one answer in each row.","contextTags":["insulin"],"scoring":{"method":"zero_one"},"answerKey":{"rapid-acting-insulin-given-with-breakfast":["a"],"short-acting-regular-insulin-given-before-lunch":["b"],"intermediate-acting-nph-insulin-given-at-07-00":["b"],"long-acting-basal-insulin-given-at-bedtime":["c"]},"readingSection":{"unitId":"pharm-endocrine--openrn-pharmacology2e-115--1","chunkId":"chunk-3","index":2},"targets":[{"id":"rapid-acting-insulin-given-with-breakfast","label":"Rapid-acting insulin given with breakfast"},{"id":"short-acting-regular-insulin-given-before-lunch","label":"Short-acting regular insulin given before lunch"},{"id":"intermediate-acting-nph-insulin-given-at-07-00","label":"Intermediate-acting NPH insulin given at 07:00"},{"id":"long-acting-basal-insulin-given-at-bedtime","label":"Long-acting basal insulin given at bedtime"}],"shard":"pharm-endocrine"},{"id":"r8q2-mx-006","familyId":"r8q2-matrix-pregnancy-findings","type":"matrix_single","topicId":"maternity-newborn","clientNeed":"health-promotion-and-maintenance","ncjmmStep":"recognize cues","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Decide for each finding whether it is an expected change of pregnancy or a warning sign.","task":"Choose one answer in each row.","scoring":{"method":"zero_one"},"answerKey":{"swelling-of-both-ankles-at-the-end-of-the-day":["a"],"a-headache-that-has-lasted-all-day-and-will-not-lift":["b"],"practice-braxton-hicks-tightenings-that-stop-when-she-walks":["a"],"sudden-swelling-of-the-face-and-hands-this-morning":["b"],"shortness-of-breath-when-climbing-one-flight-of-stairs":["a"],"reduced-fetal-movements-compared-with-yesterday":["b"]},"readingSection":{"unitId":"maternity-newborn--openrn-healthpromo-123--1","chunkId":"chunk-5","index":4},"targets":[{"id":"swelling-of-both-ankles-at-the-end-of-the-day","label":"Swelling of both ankles at the end of the day"},{"id":"a-headache-that-has-lasted-all-day-and-will-not-lift","label":"A headache that has lasted all day and will not lift"},{"id":"practice-braxton-hicks-tightenings-that-stop-when-she-walks","label":"Practice (Braxton Hicks) tightenings that stop when she walks"},{"id":"sudden-swelling-of-the-face-and-hands-this-morning","label":"Sudden swelling of the face and hands this morning"},{"id":"shortness-of-breath-when-climbing-one-flight-of-stairs","label":"Shortness of breath when climbing one flight of stairs"},{"id":"reduced-fetal-movements-compared-with-yesterday","label":"Reduced fetal movements compared with yesterday"}],"shard":"maternity-newborn-2"},{"id":"r8q2-mx-007","familyId":"r8q2-matrix-dka-actions-by-phase","type":"matrix_multiple","topicId":"neuro-renal-endocrine","clientNeed":"physiological-adaptation","ncjmmStep":"generate solutions","difficulty":5,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select, in each row, every phase of care the action belongs in.","task":"In each row, select every answer that applies.","contextTags":["acidosis","diabet"],"scoring":{"method":"plus_minus","groups":[{"id":"Isotonic intravenous fluid replacement","optionIds":["isotonic-intravenous-fluid-replacement:a","isotonic-intravenous-fluid-replacement:b","isotonic-intravenous-fluid-replacement:c"],"keys":["isotonic-intravenous-fluid-replacement:a"]},{"id":"Adding dextrose to the intravenous fluid","optionIds":["adding-dextrose-to-the-intravenous-fluid:a","adding-dextrose-to-the-intravenous-fluid:b","adding-dextrose-to-the-intravenous-fluid:c"],"keys":["adding-dextrose-to-the-intravenous-fluid:b"]},{"id":"Continuous insulin infusion","optionIds":["continuous-insulin-infusion:a","continuous-insulin-infusion:b","continuous-insulin-infusion:c"],"keys":["continuous-insulin-infusion:a","continuous-insulin-infusion:b"]},{"id":"Potassium replacement guided by the serum level","optionIds":["potassium-replacement-guided-by-the-serum-level:a","potassium-replacement-guided-by-the-serum-level:b","potassium-replacement-guided-by-the-serum-level:c"],"keys":["potassium-replacement-guided-by-the-serum-level:a","potassium-replacement-guided-by-the-serum-level:b"]},{"id":"Routine sodium bicarbonate for the acidosis","optionIds":["routine-sodium-bicarbonate-for-the-acidosis:a","routine-sodium-bicarbonate-for-the-acidosis:b","routine-sodium-bicarbonate-for-the-acidosis:c"],"keys":["routine-sodium-bicarbonate-for-the-acidosis:c"]}]},"answerKey":{"isotonic-intravenous-fluid-replacement":["a"],"adding-dextrose-to-the-intravenous-fluid":["b"],"continuous-insulin-infusion":["a","b"],"potassium-replacement-guided-by-the-serum-level":["a","b"],"routine-sodium-bicarbonate-for-the-acidosis":["c"]},"readingSection":{"unitId":"neuro-renal-endocrine--openrn-healthalts-074--1","chunkId":"chunk-4","index":3},"targets":[{"id":"isotonic-intravenous-fluid-replacement","label":"Isotonic intravenous fluid replacement"},{"id":"adding-dextrose-to-the-intravenous-fluid","label":"Adding dextrose to the intravenous fluid"},{"id":"continuous-insulin-infusion","label":"Continuous insulin infusion"},{"id":"potassium-replacement-guided-by-the-serum-level","label":"Potassium replacement guided by the serum level"},{"id":"routine-sodium-bicarbonate-for-the-acidosis","label":"Routine sodium bicarbonate for the acidosis"}],"shard":"neuro-renal-endocrine-2"},{"id":"r8q2-mx-008","familyId":"r8q2-matrix-heart-failure-teaching","type":"matrix_multiple","topicId":"cardio-respiratory","clientNeed":"health-promotion-and-maintenance","ncjmmStep":"evaluate outcomes","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select, in each row, every judgment that applies to what Alberto said.","task":"In each row, select every answer that applies.","contextTags":["heart failure","heart"],"scoring":{"method":"plus_minus","groups":[{"id":"“I will weigh myself every morning after I use the bathroom.”","optionIds":["i-will-weigh-myself-every-morning-after-i-use-the-bathroom:a","i-will-weigh-myself-every-morning-after-i-use-the-bathroom:b","i-will-weigh-myself-every-morning-after-i-use-the-bathroom:c"],"keys":["i-will-weigh-myself-every-morning-after-i-use-the-bathroom:a"]},{"id":"“If I gain two kilograms in two days I will call the clinic.”","optionIds":["if-i-gain-two-kilograms-in-two-days-i-will-call-the-clinic:a","if-i-gain-two-kilograms-in-two-days-i-will-call-the-clinic:b","if-i-gain-two-kilograms-in-two-days-i-will-call-the-clinic:c"],"keys":["if-i-gain-two-kilograms-in-two-days-i-will-call-the-clinic:a"]},{"id":"“If my ankles swell I will just take an extra water pill.”","optionIds":["if-my-ankles-swell-i-will-just-take-an-extra-water-pill:a","if-my-ankles-swell-i-will-just-take-an-extra-water-pill:b","if-my-ankles-swell-i-will-just-take-an-extra-water-pill:c"],"keys":["if-my-ankles-swell-i-will-just-take-an-extra-water-pill:b","if-my-ankles-swell-i-will-just-take-an-extra-water-pill:c"]},{"id":"“I will use the salt substitute instead of table salt.”","optionIds":["i-will-use-the-salt-substitute-instead-of-table-salt:a","i-will-use-the-salt-substitute-instead-of-table-salt:b","i-will-use-the-salt-substitute-instead-of-table-salt:c"],"keys":["i-will-use-the-salt-substitute-instead-of-table-salt:b"]},{"id":"“I will halve my pills on the days I feel completely well.”","optionIds":["i-will-halve-my-pills-on-the-days-i-feel-completely-well:a","i-will-halve-my-pills-on-the-days-i-feel-completely-well:b","i-will-halve-my-pills-on-the-days-i-feel-completely-well:c"],"keys":["i-will-halve-my-pills-on-the-days-i-feel-completely-well:b","i-will-halve-my-pills-on-the-days-i-feel-completely-well:c"]}]},"answerKey":{"i-will-weigh-myself-every-morning-after-i-use-the-bathroom":["a"],"if-i-gain-two-kilograms-in-two-days-i-will-call-the-clinic":["a"],"if-my-ankles-swell-i-will-just-take-an-extra-water-pill":["b","c"],"i-will-use-the-salt-substitute-instead-of-table-salt":["b"],"i-will-halve-my-pills-on-the-days-i-feel-completely-well":["b","c"]},"readingSection":{"unitId":"cardio-respiratory--openrn-healthalts-059--1","chunkId":"chunk-3","index":2},"targets":[{"id":"i-will-weigh-myself-every-morning-after-i-use-the-bathroom","label":"“I will weigh myself every morning after I use the bathroom.”"},{"id":"if-i-gain-two-kilograms-in-two-days-i-will-call-the-clinic","label":"“If I gain two kilograms in two days I will call the clinic.”"},{"id":"if-my-ankles-swell-i-will-just-take-an-extra-water-pill","label":"“If my ankles swell I will just take an extra water pill.”"},{"id":"i-will-use-the-salt-substitute-instead-of-table-salt","label":"“I will use the salt substitute instead of table salt.”"},{"id":"i-will-halve-my-pills-on-the-days-i-feel-completely-well","label":"“I will halve my pills on the days I feel completely well.”"}],"shard":"cardio-respiratory-3"},{"id":"r8q2-mx-009","familyId":"r8q2-matrix-falls-interventions","type":"matrix_multiple","topicId":"safety-systems","clientNeed":"safety-and-infection-prevention-and-control","ncjmmStep":"generate solutions","difficulty":4,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Select, in each row, every judgment that applies to the fall-prevention measure.","task":"In each row, select every answer that applies.","scoring":{"method":"plus_minus","groups":[{"id":"Place the bed in its lowest position with the brakes on","optionIds":["place-the-bed-in-its-lowest-position-with-the-brakes-on:a","place-the-bed-in-its-lowest-position-with-the-brakes-on:b","place-the-bed-in-its-lowest-position-with-the-brakes-on:c"],"keys":["place-the-bed-in-its-lowest-position-with-the-brakes-on:a","place-the-bed-in-its-lowest-position-with-the-brakes-on:b"]},{"id":"Put the call bell and her water within reach on her strong side","optionIds":["put-the-call-bell-and-her-water-within-reach-on-her-strong-side:a","put-the-call-bell-and-her-water-within-reach-on-her-strong-side:b","put-the-call-bell-and-her-water-within-reach-on-her-strong-side:c"],"keys":["put-the-call-bell-and-her-water-within-reach-on-her-strong-side:a"]},{"id":"Apply a vest restraint so she cannot get out of 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Which finding requires immediate intervention?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["o4"],"readingSection":{"unitId":"prioritization--openrn-nursingmpc-007--1","chunkId":"chunk-1","index":0},"shard":"prioritization-4"},{"id":"openrn-nursingmpc-3-663ecdabce","familyId":"openrn-nursingmpc-3-663ecdabce","type":"single","topicId":"prioritization","clientNeed":"reduction-of-risk-potential","ncjmmStep":"take action","difficulty":3,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"When examining an adult client’s preoperative laboratory results, the nurse notes that the potassium level is 6.2 mEq/L. 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At the next family dinner the nurse mentions it."},{"id":"b3","label":"The nurse takes hygiene supplies from the floor stock to take on their upcoming vacation and charges them to a client’s account."},{"id":"b4","label":"The nurse forgets to set the bed alarm on a falls risk client causing them to fall and break their hip which ultimately leads to the client’s death."},{"id":"b5","label":"The nurse places a urinary catheter for a client who is alert, oriented, and who verbally refused a catheter."}],"shard":"legal-ethics-4"},{"id":"openrn-nursingskills-101-9278bbb4f3","familyId":"openrn-nursingskills-101-9278bbb4f3","type":"single","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"generate solutions","difficulty":3,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which type of enteral tube fits Noemí’s two weeks of feeding?","task":"Choose one answer.","contextTags":["stroke"],"scoring":{"method":"zero_one"},"answerKey":["o1"],"readingSection":{"unitId":"comfort-care--openrn-nursingfundamentals-095--1","chunkId":"chunk-2","index":1},"shard":"comfort-care-8"},{"id":"openrn-nursingskills-101-3a332dee15","familyId":"openrn-nursingskills-101-3a332dee15","type":"drag_drop_cloze","topicId":"comfort-care","clientNeed":"basic-care-and-comfort","ncjmmStep":"recognize cues","difficulty":3,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Complete the passage below. 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Choose the word that belongs in each numbered blank.","task":"Choose one answer for each blank.","contextTags":["insulin"],"scoring":{"method":"zero_one"},"answerKey":{"b1":["o1"],"b2":["o2"]},"readingSection":{"unitId":"pharm-endocrine--openrn-pharmacology2e-115--1","chunkId":"chunk-2","index":1},"targets":[{"id":"b1","label":"Drawn into the syringe first"},{"id":"b2","label":"Added second"}],"shard":"pharm-endocrine-2"},{"id":"openrn-pharmacology2e-33-99edd02527","familyId":"openrn-pharmacology2e-33-99edd02527","type":"single","topicId":"pharm-endocrine","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"recognize cues","difficulty":3,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"A client takes insulin glargine at bedtime and insulin NPH was discussed as an alternative. Which difference should the nurse explain?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["o1"],"readingSection":{"unitId":"pharm-endocrine--openrn-pharmacology2e-115--2","chunkId":"chunk-1","index":0},"shard":"pharm-endocrine-2"},{"id":"openrn-pharmacology2e-37-4813494d13","familyId":"openrn-pharmacology2e-37-4813494d13","type":"drag_drop_cloze","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"generate solutions","difficulty":3,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"Which medicine does each job belong to?","task":"Choose one answer for each blank.","scoring":{"method":"zero_one"},"answerKey":{"b1":["o1"],"b2":["o2"],"b3":["o3"],"b4":["o4"],"b5":["o5"],"b6":["o6"],"b7":["o7"],"b8":["o8"]},"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-010--1","chunkId":"chunk-2","index":1},"targets":[{"id":"b1","label":"_____ is used to treat severe pain."},{"id":"b2","label":"_____ reverses CNS & respiratory depression caused by opioids."},{"id":"b3","label":"_____ is used for mild pain and fever, but does not include anti-inflammatory properties."},{"id":"b4","label":"_____ produces analgesia and reduces inflammation and fever by inhibiting the production of prostaglandins."},{"id":"b5","label":"_____ specifically inhibits the enzyme COX-2 that is required for the synthesis of prostaglandins."},{"id":"b6","label":"_____ inhibits reflexes at the spinal level."},{"id":"b7","label":"_____ reduces tonic somatic muscle activity at the level of the brainstem."},{"id":"b8","label":"_____ acts as an agonist at central alpha-adrenergic receptor sites. It reduces spasticity by increasing presynaptic inhibition of motor neurons."}],"shard":"medication-safety-5"},{"id":"openrn-pharmacology2e-38-3a332dee15","familyId":"openrn-pharmacology2e-38-3a332dee15","type":"single","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"analyze cues","difficulty":3,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"A client is being assessed for possible fibromyalgia. Which pain pattern fits that diagnosis?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["o3"],"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-010--1","chunkId":"chunk-2","index":1},"shard":"medication-safety-5"},{"id":"openrn-pharmacology2e-38-fe79e81a96","familyId":"openrn-pharmacology2e-38-fe79e81a96","type":"single","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"take action","difficulty":3,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"A client with gout asks why his pain comes and goes rather than staying the same. Which explanation should the nurse give?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["o4"],"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-018--1","chunkId":"chunk-6","index":5},"shard":"medication-safety-5"},{"id":"openrn-pharmacology2e-38-da23b41a55","familyId":"openrn-pharmacology2e-38-da23b41a55","type":"single","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"analyze cues","difficulty":3,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"A client has an acute gout attack in the left great toe. Which finding should the nurse expect on examination?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["o1"],"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-018--1","chunkId":"chunk-3","index":2},"shard":"medication-safety-5"},{"id":"openrn-pharmacology2e-38-68d11ebbd6","familyId":"openrn-pharmacology2e-38-68d11ebbd6","type":"single","topicId":"medication-safety","clientNeed":"pharmacological-and-parenteral-therapies","ncjmmStep":"prioritize hypotheses","difficulty":3,"readingLevel":8,"units":"both","status":"ready","schemaVersion":2,"stem":"A client who works outdoors reports frequent leg muscle spasms. Which contributing factors should the nurse assess first?","task":"Choose one answer.","scoring":{"method":"zero_one"},"answerKey":["o2"],"readingSection":{"unitId":"medication-safety--openrn-pharmacology2e-010--1","chunkId":"chunk-2","index":1},"shard":"medication-safety-5"}],"cards":[{"id":"hy-lab-units","topicId":"lab-trends","front":"Besides the value, which three things must you check before acting on a laboratory result?","back":"The unit, the collection time, and the reporting laboratory’s reference interval. Interpret all of them with the patient’s symptoms and trend.","tags":["lab"],"source":["https://medlineplus.gov/lab-tests/how-to-understand-your-lab-results/"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Three things travel with every value: the unit, the clock and the laboratory. Picture the result as a parcel with three labels — what it is measured in, when it was collected, and who measured it. A parcel missing a label is not delivered, and a value missing one of the three is not acted on."},{"id":"hy-lab-potassium","topicId":"lab-trends","front":"Why can two references list slightly different potassium ranges?","back":"Laboratories and methods differ. Use the range supplied with the result; do not replace it with a memorized cutoff.","tags":["lab"],"source":["https://medlineplus.gov/ency/article/003484.htm"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"A reference interval is not a law of nature, it is one laboratory describing its own machine and its own population. Read the range printed beside the value, not the one you memorized — the number on the page always wins."},{"id":"hy-lab-a1c","topicId":"lab-trends","front":"How does an A1c treatment goal differ from the laboratory reference interval?","back":"A reference interval describes a healthy population. A treatment goal is set for one patient. Interpret the number against the prescribed plan, not against the laboratory range.","tags":["lab"],"source":["https://www.niddk.nih.gov/health-information/diagnostic-tests/a1c-test/"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"A reference interval answers \"is this unusual?\" A treatment goal answers \"is this where we want her?\" Two different questions, so two different numbers — and a patient can sit inside one and outside the other at the same time."},{"id":"hy-isolation-airborne","topicId":"isolation","front":"What does Airborne Precautions require for pulmonary TB?","back":"Use an airborne infection isolation room and an appropriately fitted respirator under the facility’s respiratory protection program. Apply source control during necessary transport.","tags":["isolation"],"source":["https://www.cdc.gov/infection-control/hcp/isolation-precautions/precautions.html"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Airborne is the only kind of precaution where the room is part of the equipment. A mask that seals to your face and air that is pulled inward — if a question gives you one without the other, the protection is not complete."},{"id":"hy-isolation-droplet","topicId":"isolation","front":"When is the mask worn for Droplet Precautions?","back":"Wear the appropriate mask on entry to the patient’s room or space. Follow organism-specific precautions and transport source control.","tags":["isolation"],"source":["https://www.cdc.gov/infection-control/hcp/isolation-precautions/precautions.html"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"The mask goes on before you cross the doorway, not when you reach the bed. Droplets do not wait for you to be close enough — they are already in the air between the door and the pillow."},{"id":"hy-isolation-contact","topicId":"isolation","front":"Which protective equipment and which equipment practice do Contact Precautions require?","back":"Gown and gloves as indicated, removed safely and followed by hand hygiene, plus dedicated or properly disinfected patient equipment.","tags":["isolation"],"source":["https://www.cdc.gov/infection-control/hcp/isolation-precautions/precautions.html"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Contact precautions cover what touches: your hands, your sleeves, and anything you carry in. The part that is forgotten is the equipment — a stethoscope that leaves the room has taken the organism with it."},{"id":"hy-isolation-varicella","topicId":"isolation","front":"Which precautions does the CDC recommend for a client with varicella?","back":"Airborne and Contact Precautions, in addition to Standard Precautions. Follow the full organism-specific recommendation, not Airborne alone.","tags":["isolation"],"source":["https://www.cdc.gov/infection-control/hcp/isolation-precautions/appendix-a-type-duration.html"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Chickenpox is one of the few conditions that needs two kinds of precaution at once, because it travels two ways: in the air from the lungs and on contact with the fluid in the blisters. Two routes, two sets of equipment."},{"id":"hy-hand-soil","topicId":"isolation","front":"When hands are visibly soiled, which hand-hygiene method must you use?","back":"Soap and water, not alcohol rub. Gloves do not replace hand hygiene.","tags":["isolation"],"source":["https://www.cdc.gov/clean-hands/hcp/clinical-safety/index.html"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Alcohol kills, water removes. When there is something on your hands you can see, there is nothing to kill — there is something to take off, and only soap, water and friction take things off."},{"id":"hy-delegation-rights","topicId":"delegation","front":"Which five things must the nurse check before delegating a task?","back":"The task, the circumstance, the person, the directions and communication, and the supervision and evaluation. Nursing judgment stays with the licensed nurse.","tags":["delegation"],"source":["https://www.ncsbn.org/public-files/NCSBN_Delegation_Guidelines.pdf"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Five rights, one task, one sentence: the right task, in the right circumstance, to the right person, with the right directions, under the right supervision. Say it out loud over the task in front of you — the one you stumble on is the one that stops the delegation."},{"id":"hy-delegation-lpn","topicId":"delegation","front":"Before you delegate an IV task to an LPN, which three things must you check?","back":"The scope of practice in that state, the person’s demonstrated competence, and the employer’s policy. The task has to be allowed by all three.","tags":["delegation"],"source":["https://www.ncsbn.org/nursing-regulation/practice/delegation.page"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Scope has three layers and all three have to agree: what the state board allows, what the facility policy allows, and what this particular nurse has been prepared to do. An answer can clear two layers and still be wrong."},{"id":"hy-delegation-followup","topicId":"delegation","front":"After you delegate a task, which two responsibilities stay with you?","back":"Supervision and evaluation. Say what must be reported back and when, then check the result yourself.","tags":["delegation"],"source":["https://www.ncsbn.org/public-files/NCSBN_Delegation_Guidelines.pdf"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Hand over the keys, keep the car. The activity moves; the accountability does not. That is why the last two of the five rights happen after you have already let go of the task."},{"id":"hy-priority-word","topicId":"prioritization","front":"When a question asks what the nurse should do “first”, what is it asking you to choose?","back":"The immediate action for the situation described. A useful later action does not answer the timing the question asked for.","tags":["stem_word","prioritization"],"source":["https://www.nclex.com/files/2026_RN_Test%20Plan_English-F.pdf"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Every option in a \"first\" question is usually something you would really do. That is what makes it hard: you are not finding the right action, you are putting four right actions in order. Ask what each one costs you if it waits ten minutes."},{"id":"hy-priority-evidence","topicId":"prioritization","front":"Which four things in a question decide the priority, instead of a memorized rule?","back":"The urgent threat, the assessment cues you were given, the protocol that applies, and the decision the question actually asks for.","tags":["prioritization"],"source":["https://wtcs.pressbooks.pub/nursingfundamentals/chapter/4-3-assessment/"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"A memorized order of letters cannot see this patient. The findings in front of you can: what changed, how fast, how far from her own baseline, and how long you have. Read the four, then reach for the rule."},{"id":"hy-units-temperature","topicId":"dosage-calculation","front":"How are Celsius and Fahrenheit related?","back":"°F = (°C × 1.8) + 32. Keep the unit with the answer and round only as instructed.","tags":["units"],"source":["https://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.365-2024.pdf"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Two anchors and the rest is arithmetic: 37 °C is 98.6 °F and 40 °C is 104 °F. A fever in Celsius starts with a 3 and a fever in Fahrenheit starts with a 10 — if a chart shows 39 and you expected 102, you are reading the other scale."},{"id":"hy-units-weight","topicId":"dosage-calculation","front":"Before a kilogram-based calculation, what must happen to a weight in pounds?","back":"Convert the weight to kilograms with the required conversion precision. Do not insert pounds directly into a kg-based formula.","tags":["units"],"source":["https://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.365-2024.pdf"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Pounds are the bigger number and kilograms are the smaller one, always, because a kilogram is more than two pounds. If the number you calculated with is larger than the number on the scale in pounds, you divided the wrong way."},{"id":"hy-units-ounce","topicId":"dosage-calculation","front":"Which two different quantities can the abbreviation “oz” mean?","back":"Mass, as an ounce of weight, and volume, as a US fluid ounce. Clarify which one the question uses before you convert.","tags":["units"],"source":["https://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.365-2024.pdf"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"An ounce can be a weight or a volume, and the kitchen uses both. Ask what is being measured, not what the label says: a fluid ounce fills a cup, a dry ounce sits on a scale, and a dose calculated from the wrong one is wrong by a factor you cannot see."},{"id":"hy-brand-ingredient","topicId":"medication-safety","front":"What should you verify when a patient brings a medicine from Mexico?","back":"Read and verify the active ingredient, strength and formulation. A familiar brand name alone is not enough to substitute a US product.","tags":["drug_brand_map"],"source":["https://www.fda.gov/drugs/safe-use-over-counter-pain-relievers-and-fever-reducers/acetaminophen"],"status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"The same box can hold different medicines in two countries, and the same medicine can come in two different boxes. The generic name is the only thing that crosses the border unchanged — so that is the name you write down and the name you ask for."},{"id":"hy-paracetamol","topicId":"medication-safety","front":"What is the US generic name for acetaminophen?","back":"Acetaminophen — the same active ingredient. Check every combination product so the ingredient is not taken twice.","tags":["drug_brand_map"],"source":["https://www.fda.gov/drugs/safe-use-over-counter-pain-relievers-and-fever-reducers/acetaminophen"],"status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-medication-list","subject":"pharmacology","front":"Besides prescription medicines, what else belongs on a complete medication list?","back":"Over-the-counter medicines, vitamins, supplements, and relevant allergy or reaction information.","tags":["medication_safety","reconciliation"],"source":["https://www.fda.gov/consumers/consumer-updates/create-and-keep-medication-list-your-health"],"topicId":"medication-safety","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-two-identifiers","subject":"pharmacology","front":"Which identifiers must match before you give a medicine, and which one never counts?","back":"Match the approved patient-specific identifiers against the order. A room number or bed location never identifies the patient.","tags":["medication_safety","identification"],"source":["https://www.jointcommission.org/en-us/knowledge-library/support-center/standards-interpretation/standards-faqs/000001463"],"topicId":"medication-safety","status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"The room number identifies the room. The bed identifies the bed. Only something the patient carries with her — her name, her date of birth, her record number — identifies the patient, because she is the one thing in the room that can be moved."},{"id":"v2-card-duplicate-ingredient","subject":"pharmacology","front":"A patient takes two different brand-name products. What must you read on each label?","back":"The active ingredients, to find the same drug listed twice. Acetaminophen is called acetaminophen outside the United States.","tags":["medication_safety","drug_brand_map"],"source":["https://www.fda.gov/drugs/safe-use-over-counter-pain-relievers-and-fever-reducers/acetaminophen"],"topicId":"medication-safety","status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Brand names are marketing; the ingredient list is the medicine. Two boxes that look nothing alike can both be acetaminophen, and the patient takes the full dose of each. Read the small print on both labels, not the large print on either."},{"id":"v2-card-insulin-pen","subject":"pharmacology","front":"How many patients may use one insulin pen?","back":"One. Changing the needle does not make a pen safe to share.","tags":["medication_safety","insulin"],"source":["https://www.fda.gov/media/90757/download"],"topicId":"medication-safety","status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"An insulin pen is a toothbrush, not a water cooler. Tissue and blood are drawn back into the cartridge at every injection, so the pen belongs to one person for its whole life — a new needle does not make it a new pen."},{"id":"v2-card-potassium-concentrate","subject":"pharmacology","front":"How must potassium chloride concentrate be given?","back":"Diluted and infused according to the verified order and protocol. It is never given by direct IV injection.","tags":["high_alert","potassium"],"source":["https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=559a0a8c-a8fe-40a5-b196-21f9308780ab"],"topicId":"medication-safety","status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Potassium is the ion used on purpose to stop a heart. That single fact is the reason behind every rule around it, and it is why there is no rate at which concentrated potassium may be pushed — \"slowly\" is not an answer."},{"id":"v2-card-naloxone","subject":"pharmacology","front":"What remains necessary after a response to naloxone?","back":"Continue respiratory assessment and emergency care. Opioid effects can return; repeat treatment may be needed.","tags":["antidote","opioid"],"source":["https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=724df050-5332-4d0a-9a5f-17bf08a547e1&type=display"],"topicId":"medication-safety","status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Naloxone begins with \"no\": it says no to the opioid at the receptor. The part that gets missed is that it says no for less time than the opioid says yes, so the patient who wakes up and asks to go home is the one you keep watching."},{"id":"v2-card-protamine","subject":"pharmacology","front":"Which reversal agent is used for heparin?","back":"Protamine. Dose, timing, and monitoring depend on the exposure and prescribed treatment plan.","tags":["antidote","anticoagulant"],"source":["https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e1964129-33f4-4e4e-86e3-8e6a4e65bd83"],"topicId":"medication-safety","status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Protamine is positively charged and heparin strongly negative, so the antidote works like a magnet: the two click together and heparin stops being heparin on contact. Nothing has to be manufactured, which is why it works in minutes."},{"id":"v2-card-idarucizumab","subject":"pharmacology","front":"Which anticoagulant does idarucizumab specifically reverse?","back":"Dabigatran, when urgent reversal is indicated. It does not reverse every anticoagulant.","tags":["antidote","anticoagulant"],"source":["https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c7400f8a-dcf4-a6df-6d07-983081b1bf34"],"topicId":"medication-safety","status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Idarucizumab is dabigatran with an \"i\" in front of it and an antibody on the end. The resemblance is the hook: the antidote is named after the one drug it reverses, and it reverses nothing else."},{"id":"v2-card-acetylcysteine","subject":"pharmacology","front":"What is acetylcysteine used for after acetaminophen overdose?","back":"To prevent or reduce liver injury as part of a clinically assessed treatment plan.","tags":["antidote","acetaminophen"],"source":["https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5ae53725-1abb-4122-9c85-f26c2c31566c"],"topicId":"medication-safety","status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Acetaminophen and acetylcysteine share their first four letters, which no other poison and antidote on the list do. Hold the pair as one word and add the clock: the liver is already being injured while she still looks well."},{"id":"v2-card-lithium-symptoms","subject":"pharmacology","front":"Which findings in a patient taking lithium need prompt assessment even when the level is in range?","back":"Vomiting, diarrhea, tremor and unsteady movement. Toxicity is judged on current findings, not on yesterday’s level.","tags":["medication_safety","lithium"],"source":["https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=bfececc8-b2ab-47d1-b126-1c6592bc9c26"],"topicId":"medication-safety","status":"ready","task":"Think of the answer, then flip the card to check.","memoryTrick":"Lithium leaves by the kidney, so anything that dries her out raises the level without a single extra tablet: a stomach bug, a hot day, a low-salt diet, a new water pill. Ask what changed about her water, not about her dose."},{"id":"v2-card-open-question","subject":"psychosocial","front":"What does an open question invite the patient to do?","back":"Describe the situation in their own words — what matters most to them, or what concerns them.","tags":["therapeutic_communication"],"source":["https://openstax.org/books/psychiatric-mental-health/pages/3-1-therapeutic-communication-and-relationships"],"topicId":"therapeutic-communication","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-boundary","subject":"psychosocial","front":"Which channel should a nurse use for patient follow-up?","back":"An approved professional channel. Keep personal social accounts separate from patient care.","tags":["professional_boundary"],"source":["https://www.ncsbn.org/public-files/ProfessionalBoundaries_Complete.pdf"],"topicId":"therapeutic-communication","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-suicide-question","subject":"psychosocial","front":"Which question do you ask a patient who says everyone would be better off without them?","back":"“Are you thinking about suicide?” Ask plainly and without judgment. Asking does not cause suicidal thoughts.","tags":["suicide_safety"],"source":["https://www.nimh.nih.gov/health/publications/5-action-steps-to-help-someone-having-thoughts-of-suicide"],"topicId":"therapeutic-communication","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-current-suicide","subject":"psychosocial","front":"What does a report of current suicidal thoughts require?","back":"Urgent evaluation and safety measures. Do not leave the patient alone while arranging help.","tags":["suicide_safety"],"source":["https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/adult-outpatient/adult-outpatient-brief-suicide-safety-assessment-guide"],"topicId":"therapeutic-communication","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-safety-plan","subject":"psychosocial","front":"What takes the place of a “no-harm promise” when you plan discharge after a suicide risk screen?","back":"A written safety plan made with the patient: coping steps, people to contact, crisis numbers, and means safety.","tags":["suicide_safety"],"source":["https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/adult-outpatient/adult-outpatient-brief-suicide-safety-assessment-guide"],"topicId":"therapeutic-communication","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-means-safety","subject":"psychosocial","front":"What is means safety?","back":"Making access to potentially lethal items less available through a specific, collaborative plan.","tags":["suicide_safety"],"source":["https://www.nimh.nih.gov/health/publications/5-action-steps-to-help-someone-having-thoughts-of-suicide"],"topicId":"therapeutic-communication","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-trauma-choice","subject":"psychosocial","front":"How can a nurse make a nonurgent examination more predictable?","back":"Explain the next step, ask permission, and offer a way to pause.","tags":["trauma_informed"],"source":["https://www.samhsa.gov/mental-health/trauma-violence/trauma-informed-approaches-programs"],"topicId":"therapeutic-communication","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-interpreter","subject":"psychosocial","front":"Who should interpret a complex medical discussion?","back":"A qualified interpreter. Being bilingual alone does not establish interpreting competence.","tags":["language_access"],"source":["https://www.hhs.gov/civil-rights/for-individuals/faqs/may-an-lep-person-use-a-family-member-as-an-interpreter/index.html"],"topicId":"therapeutic-communication","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-command-voices","subject":"psychosocial","front":"What should be clarified when a patient reports commanding voices?","back":"What the voices are saying and whether the patient or anyone else is in danger.","tags":["psychosis","safety"],"source":["https://openstax.org/books/psychiatric-mental-health/pages/15-1-schizophrenia"],"topicId":"therapeutic-communication","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"v2-card-delusion-response","subject":"psychosocial","front":"How can a nurse respond to a frightening delusion?","back":"Acknowledge distress, present reality calmly, and assess safety without arguing or affirming the belief.","tags":["psychosis","therapeutic_communication"],"source":["https://openstax.org/books/psychiatric-mental-health/pages/15-1-schizophrenia"],"topicId":"therapeutic-communication","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"brand-tylenol","topicId":"medication-safety","front":"TYLENOL is sold in Mexico and the United States. What is its generic drug name?","back":"Acetaminophen is the US generic name for acetaminophen. Verify the exact product, strength and combination ingredients.","tags":["drug_brand_map"],"source":["https://medlineplus.gov/druginfo/meds/a681004.html"],"status":"ready","verifiedAt":"2026-10-09","task":"Think of the answer, then flip the card to check."},{"id":"brand-aspirina","topicId":"medication-safety","front":"Aspirina is sold in Mexico. What is its generic drug name?","back":"Aspirin is the US generic name. Verify strength and release formulation; brand recognition is not a substitution instruction.","tags":["drug_brand_map"],"source":["https://medlineplus.gov/druginfo/meds/a682878.html"],"status":"ready","verifiedAt":"2026-10-09","task":"Think of the answer, then flip the card to check."},{"id":"brand-motrin","topicId":"medication-safety","front":"MOTRIN Infantil is sold in Mexico. What is its generic drug name?","back":"Ibuprofen is the US generic name. Pediatric and infant formulations can differ in concentration; check the actual label.","tags":["drug_brand_map"],"source":["https://medlineplus.gov/druginfo/meds/a682159.html"],"status":"ready","verifiedAt":"2026-10-09","task":"Think of the answer, then flip the card to check."},{"id":"brand-advil","topicId":"medication-safety","front":"Advil Tabletas is sold in Mexico. What is its generic drug name?","back":"Ibuprofen is the US generic name. Verify the actual product label and avoid duplicate active ingredients.","tags":["drug_brand_map"],"source":["https://medlineplus.gov/druginfo/meds/a682159.html"],"status":"ready","verifiedAt":"2026-10-09","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-sodium","topicId":"lab-trends","tags":["lab","electrolyte"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What is the usual adult reference interval for serum sodium, and what does a value outside it do to the brain?","back":"About 135–145 mEq/L. Sodium pulls water, so a low sodium swells brain cells and causes confusion, headache and seizures; a high sodium shrinks them and causes thirst, restlessness and weakness. Check the laboratory’s own interval on the report.","memoryTrick":"Sodium is the one electrolyte whose normal window is a round ten wide: 135 to 145. Picture the numbers stamped on the base of a salt shaker. And remember which way the water goes: water follows salt, so the brain follows the sodium — low sodium, swollen brain.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-potassium-range","topicId":"lab-trends","tags":["lab","electrolyte"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What is the usual adult reference interval for serum potassium, and at what point does it become a cardiac emergency?","back":"About 3.5–5.0 mEq/L. Both ends are dangerous to the heart: values below about 2.5 or above about 6.5 mEq/L can produce lethal rhythms, and the electrocardiogram changes before the patient feels anything.","memoryTrick":"Lay a banana across a clock face from 3:30 to 5:00. Potassium’s whole normal range fits inside that hour and a half, which is why 6 is an alarm and not a rounding error. Any potassium you can mistake for a sodium — a number in the hundreds — means you are reading the wrong row.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-calcium","topicId":"lab-trends","tags":["lab","electrolyte"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What is the usual adult reference interval for total serum calcium, and which finding suggests it is low?","back":"About 8.5–10.5 mg/dL. A low calcium makes nerves and muscles irritable: tingling around the mouth and in the fingers, cramps, and twitching. Check the albumin as well, because most calcium travels bound to it.","memoryTrick":"Calcium is bone and you have ten fingers, so the range sits around ten: 8.5 to 10.5. Now curl the fingers. That curl is the trick — low calcium means spasm, so a hand that cramps when you take a blood pressure is a calcium question.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-magnesium","topicId":"lab-trends","tags":["lab","electrolyte"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What is the usual adult reference interval for serum magnesium, and which bedside finding is checked before each dose of magnesium sulfate?","back":"About 1.5–2.5 mEq/L. Deep tendon reflexes are checked before each dose, with the respiratory rate and the urine output. Reflexes disappear before breathing slows, so a lost reflex is the signal to hold the dose and tell the provider.","memoryTrick":"Magnesium is the brake pedal of the body — it slows nerves, muscle and the uterus. Its range is the narrowest of the four electrolytes, one point wide, which is why it goes in by pump and is watched by reflex. Lose the reflex, lose the brake: hold the dose.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-phosphate","topicId":"lab-trends","tags":["lab","electrolyte"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What is the usual adult reference interval for serum phosphate, and how does it move with calcium?","back":"About 2.5–4.5 mg/dL. Phosphate and calcium move in opposite directions: when one rises the other tends to fall. In kidney failure phosphate climbs and calcium drops.","memoryTrick":"Calcium and phosphate sit on a see-saw. Phosphate is the low seat, 2.5 to 4.5; calcium is the high seat, 8.5 to 10.5. One goes up, the other comes down — so a phosphate result tells you which way to expect the calcium to have moved before you look.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-bun-creatinine","topicId":"lab-trends","tags":["lab","kidney"],"source":["https://medlineplus.gov/lab-tests/"],"front":"Blood urea nitrogen (BUN) is about 7–20 mg/dL and creatinine about 0.6–1.2 mg/dL. Which one tells you the kidney itself has changed?","back":"Creatinine. The blood urea nitrogen also rises with dehydration, a high-protein intake, bleeding into the gut and steroids, so it can climb with a normal kidney. A rising creatinine points at the kidney.","memoryTrick":"Picture the BUN as a cork bobbing on the fluid level: dry her out and it floats up even though the kidney never moved. Creatinine is bolted to the kidney floor — when it rises, the floor itself has shifted.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-fasting-glucose","topicId":"lab-trends","tags":["lab","endocrine"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What fasting plasma glucose values separate normal, prediabetes and diabetes in US practice?","back":"Normal is below 100 mg/dL. 100–125 mg/dL is prediabetes. 126 mg/dL or higher, confirmed on a second test or with another abnormal result, is diabetes.","memoryTrick":"Three doors in a row: under 100 you are in the clear, 100 to 125 is the waiting room, 126 is the diagnosis — and it has to be unlocked twice, because one number is never a diagnosis. Seventy is the separate number: the floor you catch her on, not a door.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-a1c-targets","topicId":"lab-trends","tags":["lab","endocrine"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What does hemoglobin A1c measure, and what A1c level is diagnostic of diabetes?","back":"The average blood glucose over about the last three months, as the percentage of hemoglobin with glucose attached. 6.5% or higher is diagnostic; 5.7–6.4% is prediabetes. A single glucose reading cannot replace it.","memoryTrick":"A red blood cell lives about three months, so the A1c is the diary that cell kept. One glucose is a photograph of this minute; the A1c is the whole season. That is why a patient can show you a good morning number and still have an A1c of 9%.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-hgb-hct-rule","topicId":"lab-trends","tags":["lab","blood"],"source":["https://medlineplus.gov/lab-tests/"],"front":"Hemoglobin and hematocrit are reported together. What is the usual relationship between the two numbers?","back":"The hematocrit runs roughly three times the hemoglobin. A hemoglobin of 12 g/dL goes with a hematocrit near 36%; 15 g/dL goes with about 45%. A pair that does not fit raises a question about the specimen or the hydration.","memoryTrick":"Multiply the hemoglobin by three and you should land on the hematocrit. Use it as a check on yourself, not on the patient: when the two do not fit, you have probably read one of them off the wrong line.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-platelets","topicId":"lab-trends","tags":["lab","blood"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What is the usual adult platelet count, and which thresholds change nursing care?","back":"About 150,000–400,000/mm³. Below about 50,000/mm³ she bruises and bleeds from small injuries, so invasive procedures and intramuscular injections are reconsidered. Below about 20,000/mm³ spontaneous bleeding becomes a real risk.","memoryTrick":"Two numbers for the doorframe, 150 and 400 thousand, and two for the floor giving way, 50 and 20 thousand. Count down the halves: 400, 150, 50, 20. The last two are the ones that change what your hands are allowed to do.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-wbc","topicId":"lab-trends","tags":["lab","infection"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What is the usual adult white blood cell count, and what does a count below it mean for the patient’s room?","back":"About 5,000–10,000/mm³. A low count means she cannot mount a normal response to infection, so a fever may be the only sign and even a small exposure matters. A high count means the body is responding to something.","memoryTrick":"Five thousand guards at the door, ten thousand at most. Above ten the body has called for help; below five it has sent nobody, and the room has to do the defending instead — which is why neutropenia changes the visitors, the flowers and the food before it changes the drugs.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-abg-numbers","topicId":"lab-trends","tags":["lab","acid-base"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What are the normal adult arterial values for pH, PaCO₂ and bicarbonate?","back":"pH 7.35–7.45, PaCO₂ 35–45 mmHg, bicarbonate (HCO₃⁻) 22–26 mEq/L. PaCO₂ is the lung’s number and bicarbonate is the kidney’s.","memoryTrick":"Two of the three ranges are the same digits: pH 7.35–7.45 and PaCO₂ 35–45. Only bicarbonate is different, 22 to 26. Learn the matching pair and you have one set of numbers left to hold.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-abg-direction","topicId":"lab-trends","tags":["lab","acid-base"],"source":["https://medlineplus.gov/lab-tests/"],"front":"In a blood gas, how do you tell a lung problem from a kidney problem?","back":"Compare the direction of the pH with each value. If the pH and the PaCO₂ move in opposite directions, the lung is the cause. If the pH and the bicarbonate move in the same direction, the kidney or the metabolism is.","memoryTrick":"Think of CO₂ as an acid you breathe out. Hold it in and the pH drops; blow it off and the pH rises — always opposite. Bicarbonate is a base you keep, so it rides with the pH. Opposite means lungs, together means kidneys.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-inr-aptt","topicId":"lab-trends","tags":["lab","anticoagulation"],"source":["https://medlineplus.gov/lab-tests/"],"front":"Which laboratory test monitors warfarin, and which monitors unfractionated heparin?","back":"Warfarin is monitored with the prothrombin time and international normalized ratio (INR); a common therapeutic range is 2.0–3.0. Unfractionated heparin is monitored with the activated partial thromboplastin time (aPTT), usually kept at about 1.5–2.5 times the control value.","memoryTrick":"Short word, short test: heparin goes with aPTT and both act in minutes. Long word, long test: warfarin goes with INR and both take days to move. If a question gives you an INR, it is asking about warfarin, whatever else is on the chart.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-digoxin-level","topicId":"lab-trends","tags":["lab","pharmacology"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What is the therapeutic serum digoxin range, and which findings suggest toxicity?","back":"About 0.5–2.0 ng/mL, and lower in heart failure. Toxicity usually shows first as nausea, vomiting, loss of appetite and visual changes such as yellow-green haloes, then as dysrhythmias. A low potassium increases the risk at any level.","memoryTrick":"Digoxin’s whole window is narrower than two units, and the first warning does not come from the heart — it comes from the stomach and the eyes. Picture her pushing the breakfast tray away and squinting at a yellow-green ring around the lamp. Then check the potassium, because a low potassium makes a normal level behave like a high one.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-lithium-level","topicId":"lab-trends","tags":["lab","psychotropic"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What is the therapeutic serum lithium range, and what raises the level without any change in dose?","back":"About 0.6–1.2 mEq/L. Anything that reduces body water or sodium raises it: vomiting, diarrhea, sweating in heat, a low-salt diet, dehydration, and thiazide diuretics or nonsteroidal anti-inflammatory drugs.","memoryTrick":"Lithium’s window looks exactly like a normal creatinine, 0.6 to 1.2 — and that resemblance is the fact worth keeping, because lithium leaves by the kidney. Anything that dries her out raises the level without one extra tablet.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-albumin","topicId":"lab-trends","tags":["lab","nutrition"],"source":["https://medlineplus.gov/lab-tests/"],"front":"What is the usual adult serum albumin, and why does it change how you read a calcium result?","back":"About 3.5–5.0 g/dL. Most calcium in the blood travels bound to albumin, so a low albumin lowers the total calcium while the active, ionized calcium can be normal. Check the albumin before treating a low total calcium.","memoryTrick":"Albumin is the bus and calcium is the passenger. Count fewer buses and you count fewer passengers, even though nobody left the station. The ionized calcium is the passenger count that does not depend on the buses.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-acetaminophen","topicId":"medication-safety","tags":["antidote","pharmacology"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which medicine treats acetaminophen overdose, and what decides whether it works?","back":"Acetylcysteine. Timing decides the outcome: it works best within 8–10 hours of ingestion, before liver injury is established, and the decision uses the time since ingestion and the serum acetaminophen level, not how well the patient looks.","memoryTrick":"Acetaminophen and acetylcysteine share their first four letters — the only poison and antidote on this list that do. Hold the pair as one word, \"acet–acet\", and add the clock: she can look completely well while the liver is already being injured, so the time since the tablets decides, not the face in front of you.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-opioid","topicId":"medication-safety","tags":["antidote","opioid"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which medicine reverses opioid respiratory depression, and why is the patient watched afterward?","back":"Naloxone. It acts within minutes but wears off sooner than most opioids, so the breathing can slow again and repeat doses or an infusion may be needed. Continued respiratory monitoring is part of the treatment.","memoryTrick":"Naloxone begins with \"no\": it says no to the opioid at the receptor. The part that gets missed is that it says no for less time than the opioid says yes — so the patient who wakes up and asks to go home is the patient you keep watching.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-benzodiazepine","topicId":"medication-safety","tags":["antidote","pharmacology"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which medicine reverses benzodiazepine sedation, and what is the risk of giving it?","back":"Flumazenil. In a patient who takes benzodiazepines regularly, or who has also taken a tricyclic antidepressant, reversal can precipitate seizures, so it is used selectively and never routinely for undifferentiated sedation.","memoryTrick":"Flumazenil flushes the benzodiazepine off the receptor — and the risk is in that word. Flush it off a brain that has been bathed in it for months and you flush the seizure threshold out with it. The antidote that can cause a seizure is the one worth hesitating over.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-heparin","topicId":"medication-safety","tags":["antidote","anticoagulation"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which medicine reverses unfractionated heparin, and how fast does it work?","back":"Protamine sulfate, within minutes. It neutralizes heparin directly in the blood, so the effect is immediate — unlike warfarin reversal with vitamin K, which depends on the liver making new clotting factors.","memoryTrick":"Protamine carries a strong positive charge and heparin a strong negative one, so the antidote works like a magnet: the two click together and heparin stops being heparin on contact. That is why it is fast — nothing has to be manufactured.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-warfarin","topicId":"medication-safety","tags":["antidote","anticoagulation"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which medicine reverses warfarin, and why is it slow?","back":"Vitamin K (phytonadione). Warfarin works by blocking vitamin K, so the antidote is the vitamin handed back — but the liver still has to build new clotting factors, which takes hours. Serious bleeding is treated with a factor concentrate or plasma as well.","memoryTrick":"The antidote is simply the thing the drug was blocking, handed back. That one sentence gives you the drug and the reason it is slow in the same breath: you have returned the raw material, and the factory still has to run.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-dabigatran","topicId":"medication-safety","tags":["antidote","anticoagulation"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which anticoagulants have specific reversal agents, and what are they?","back":"Dabigatran is reversed by idarucizumab. The factor Xa inhibitors apixaban and rivaroxaban are reversed by andexanet alfa. Warfarin is reversed by vitamin K with a factor concentrate; heparin by protamine sulfate.","memoryTrick":"Each name points at its target. Idarucizumab is dabigatran with an \"i\" in front of it. Andexanet has \"xa\" sitting in the middle, and factor Xa is exactly what the \"-xaban\" drugs block. Read the antidote and you can say what it reverses.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-digoxin","topicId":"medication-safety","tags":["antidote","cardiac"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which treatment is used for life-threatening digoxin toxicity?","back":"Digoxin immune Fab, an antibody fragment that binds digoxin and removes it from its site of action. It is reserved for serious toxicity such as a dangerous dysrhythmia or a severely raised potassium, not for a level alone.","memoryTrick":"This antidote is named after the poison, which makes it the easiest one on the list: if the drug is digoxin, the antidote has \"digoxin\" in its name. The judgment is not which drug — it is whether the patient is sick enough to need it.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-magnesium","topicId":"maternity-newborn","tags":["antidote","obstetrics"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"A patient on a magnesium sulfate infusion has absent deep tendon reflexes and a respiratory rate of 10. What is the nurse’s action, and which medicine is kept at the bedside?","back":"Stop the infusion, stay with the patient, support breathing and notify the provider. Calcium gluconate is the antidote and is kept at the bedside whenever magnesium sulfate is running.","memoryTrick":"Magnesium is the brake and calcium is the accelerator. When the brake has jammed on — reflexes gone, breathing slow — you reach for the accelerator, and it is already in the room. Stopping the infusion comes first, because the antidote does nothing while more magnesium is still arriving.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-iron","topicId":"pediatrics-prevention","tags":["antidote","poisoning"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which medicine is used for acute iron poisoning?","back":"Deferoxamine, a chelator that binds iron so the kidneys can remove it. Iron tablets are a common serious poisoning in small children because they look like candy.","memoryTrick":"Look at the middle of the word: defer-OX-amine carries \"fer\", the Latin ferrum, iron. The antidote wears the name of the metal it takes away. A chelator is a claw — it grabs the metal and walks it out through the urine.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-organophosphate","topicId":"emergency-care","tags":["antidote","poisoning"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"A farm worker arrives with pinpoint pupils, drooling, tearing, vomiting and incontinence after a pesticide spill. Which two medicines treat this, and in what order of purpose?","back":"Atropine first, to dry the secretions and protect the airway and the heart rate, then pralidoxime, to free the acetylcholinesterase enzyme the organophosphate has blocked. Decontamination and staff protection come before both.","memoryTrick":"Organophosphates flood the body with acetylcholine, so the patient is wet everywhere: tears, saliva, sweat, vomit, urine, stool. Hold the picture of a patient who is soaking. Atropine dries her; pralidoxime unsticks the enzyme. Dry the patient first — the wet airway is what kills her.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-beta-blocker","topicId":"pharm-cardiac","tags":["antidote","pharmacology"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"A patient who took an overdose of metoprolol has a heart rate of 38 and a blood pressure of 70/40 that has not responded to atropine. Which medicine is used next?","back":"Glucagon. It raises heart rate and contractility through a pathway that does not need the beta receptor, which is why it still works when the beta receptors are blocked. Intravenous fluids and pacing may also be needed.","memoryTrick":"A beta-blocker has locked the beta door and is standing in front of it. Glucagon does not argue with the lock — it comes in through a different door and still speeds the heart. It is the one hormone on the list that does not need the beta receptor.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-calcium-blocker","topicId":"pharm-cardiac","tags":["antidote","pharmacology"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which medicine is given first for calcium channel blocker overdose with bradycardia and hypotension?","back":"Intravenous calcium — calcium chloride or calcium gluconate — to overcome the blocked channels. Fluids, vasopressors and high-dose insulin with glucose may follow.","memoryTrick":"The drug blocked the calcium channel, so you push more calcium at the channel. Antidote by crowd: with enough calcium waiting at the door, some of it gets through. The name of the drug tells you the name of the antidote.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-methotrexate","topicId":"medication-safety","tags":["antidote","pharmacology"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which medicine is used as rescue after high-dose methotrexate?","back":"Leucovorin (folinic acid). Methotrexate blocks the use of folate; leucovorin supplies a form of folate that normal cells can use, which limits damage to bone marrow and gut.","memoryTrick":"Picture a lifeguard who can only reach the healthy swimmers. Leucovorin hands folate back to normal cells while the tumor cells, which cannot take it up the same way, stay in the water. \"Rescue\" is the word used in practice, and it describes exactly who gets rescued.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-isoniazid","topicId":"pharm-respiratory","tags":["antidote","tuberculosis"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which vitamin is given with isoniazid, and why?","back":"Pyridoxine, vitamin B6. Isoniazid depletes it, and a low B6 causes peripheral neuropathy during treatment and seizures in overdose. The same vitamin is the treatment for isoniazid-induced seizures.","memoryTrick":"Isoniazid eats vitamin B6, and B6 is what the brain uses to keep itself calm. So one vitamin covers two questions: the tingling feet during months of treatment, and the seizure in an overdose. Prevention and antidote are the same bottle.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-hypoglycemia","topicId":"pharm-endocrine","tags":["antidote","diabetes"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"A patient on insulin is shaky, sweating and confused with a glucose of 54 mg/dL. What is the treatment if she can swallow, and what if she cannot?","back":"If she can swallow safely, give 15 grams of fast-acting carbohydrate and recheck in 15 minutes, repeating until the glucose is above 70 mg/dL, then give a meal or a snack with protein. If she cannot swallow, give intravenous dextrose or intramuscular glucagon.","memoryTrick":"Fifteen and fifteen: fifteen grams, fifteen minutes, then look again. The only thing that changes the answer is whether she can swallow — and that is the first thing to decide, because sugar in the mouth of someone who cannot swallow goes into the lungs.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-alcohols","topicId":"emergency-care","tags":["antidote","poisoning"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which medicine is used for ethylene glycol or methanol poisoning, and what does it do?","back":"Fomepizole. It blocks alcohol dehydrogenase, the liver enzyme that converts these alcohols into the acids that damage the kidney and the eye. Hemodialysis removes what has already been absorbed.","memoryTrick":"Antifreeze is not the poison — what the liver makes out of it is. Fomepizole closes the kitchen so the liver never cooks it. That one idea explains why the treatment is urgent even in a patient who looks only mildly drunk.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-antidote-cyanide","topicId":"emergency-care","tags":["antidote","poisoning"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"A patient rescued from an enclosed house fire has a severe metabolic acidosis and will not improve with oxygen. Which antidote is considered, and what visible effect does it have?","back":"Hydroxocobalamin, for cyanide poisoning from burning synthetic materials. It binds cyanide so the cells can use oxygen again, and it turns the skin and urine red, which can also interfere with some laboratory readings.","memoryTrick":"Cyanide stops the cell from using oxygen, which is why oxygen alone changes nothing. Hydroxocobalamin is a relative of vitamin B12, and like B12 it is deep red — so the red skin and red urine are the sign that the trade happened, not a new problem.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-iso-four-types","topicId":"isolation","tags":["isolation","infection"],"source":["https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html"],"front":"What are the three transmission-based precautions, and what does each one add to standard precautions?","back":"Contact adds gown and gloves with dedicated equipment. Droplet adds a surgical mask near the patient and a private room. Airborne adds a fit-tested N95 respirator and an airborne infection isolation room with negative pressure. Standard precautions continue underneath all three.","memoryTrick":"Name each one by what it is protecting. Contact is what your hands and sleeves touch, so it covers your hands and sleeves. Droplet is something that falls, so a mask and a closed door are enough. Airborne is something that floats, so the mask has to seal to your face and the room has to pull the air inward.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-iso-airborne-which","topicId":"isolation","tags":["isolation","infection"],"source":["https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html"],"front":"Which conditions require airborne precautions?","back":"Tuberculosis of the lung or larynx, measles, chickenpox (varicella) and disseminated herpes zoster. Each needs a fit-tested N95 or higher respirator and a negative-pressure airborne infection isolation room; varicella and disseminated zoster need contact precautions as well.","memoryTrick":"Three of the four come with a picture you can hold: a cough that will not go away, a rash that spreads down from the face, and blisters at every stage at once. Air is small enough to go around a surgical mask, which is why these four and only these four need a respirator that seals.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-iso-droplet-which","topicId":"isolation","tags":["isolation","infection"],"source":["https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html"],"front":"Which conditions require droplet precautions, and how close must you be to need the mask?","back":"Influenza, pertussis, mumps, rubella, group A streptococcal pharyngitis and meningococcal disease. The mask is worn on entering the room; droplets travel a short distance, generally within about 3–6 feet (1–2 m), and then fall.","memoryTrick":"A droplet is heavy. It travels about the width of a hospital curtain and then drops to the floor, so a surgical mask and a closed curtain are the whole intervention — no fitted respirator, no special airflow. If a question offers you an N95 for influenza, it is offering you more than the organism needs.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-iso-cdiff-hygiene","topicId":"isolation","tags":["isolation","hand-hygiene"],"source":["https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html"],"front":"Which hand-hygiene method is required after caring for a patient with Clostridioides difficile, and why?","back":"Soap and water with friction. C. difficile forms spores that alcohol-based hand rub does not kill, so the spores have to be physically washed off. Gloves and a gown are worn, and the room and equipment are cleaned with a sporicidal agent.","memoryTrick":"Picture the spore as a seed in a hard shell. You cannot burn a seed off your hands with alcohol — you have to wash it down the drain. Any question that pairs diarrhea with hand gel is testing exactly this, and gel is the wrong answer every time.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-iso-protective","topicId":"isolation","tags":["isolation","neutropenia"],"source":["https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html"],"front":"A patient after stem cell transplant is placed in a protective environment. How does the room airflow differ from an isolation room, and why?","back":"The pressure is positive, so air flows out of the room instead of into it, and incoming air is filtered through a high-efficiency (HEPA) filter. Every other precaution keeps an organism in; this one keeps organisms out, because the danger is to the patient.","memoryTrick":"Ask one question of any isolation room: who is being protected? If it is everyone else, the air is pulled in. If it is the patient, the air is pushed out. One question tells you the pressure, and the pressure tells you the room.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-iso-doffing-order","topicId":"isolation","tags":["isolation","ppe"],"source":["https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html"],"front":"In what order is personal protective equipment removed after leaving a patient with contact precautions?","back":"Gloves first, then goggles or face shield, then the gown — all inside the room — then leave and remove the respirator or mask outside the door. Hand hygiene is performed after removing gloves and again at the end.","memoryTrick":"Order by how dirty the item is: the gloves have touched everything, so they come off first, and the mask has touched almost nothing, so it comes off last — and outside, where the air is clean. Putting the equipment on runs the other way: gloves go on last because at that moment they are the cleanest thing you own.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-iso-n95-seal","topicId":"isolation","tags":["isolation","ppe"],"source":["https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html"],"front":"Before entering an airborne isolation room, what must the nurse do with the N95 respirator every single time?","back":"Perform a user seal check: cover the respirator with both hands and breathe out, then in, feeling for leaks at the edges and adjusting the straps and nose clip. Fit testing is done separately and periodically; the seal check is done at every use.","memoryTrick":"A seal check is not a comfort check. Cover it, breathe out, and feel the edges: if air escapes, the respirator is a surgical mask with extra steps, whatever size is printed on the box. Facial hair, a lost strap and a bent nose clip all break the same seal.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-fire-race","topicId":"safety-systems","tags":["fire","emergency"],"source":["https://www.nfpa.org/"],"front":"What are the four steps of the RACE fire response, in order?","back":"Rescue anyone in immediate danger, Activate the alarm, Confine the fire by closing doors and windows, and Extinguish or Evacuate. People come before the fire itself.","memoryTrick":"The letters follow where your feet go. You move to the patient, then to the pull station, then to the door, and only then to the extinguisher. Anyone who reaches for the extinguisher first has walked past three people to get to it.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-fire-pass","topicId":"safety-systems","tags":["fire","emergency"],"source":["https://www.nfpa.org/"],"front":"What are the four steps of using a fire extinguisher, and where is it aimed?","back":"Pull the pin, Aim at the base of the fire, Squeeze the handle, and Sweep side to side. Aiming at the flames rather than the base is the common error.","memoryTrick":"The middle letter is the one people get wrong. Aim at the base, because the flame is the smoke of the fire, not the fire — spraying the flame wets the air above something that is still burning.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-fire-classes","topicId":"safety-systems","tags":["fire","emergency"],"source":["https://www.nfpa.org/"],"front":"What do extinguisher classes A, B and C each put out?","back":"Class A is ordinary combustibles — paper, cloth, wood. Class B is flammable liquids and gases. Class C is electrical equipment. An ABC extinguisher covers all three, which is why it is the usual one in a hospital corridor.","memoryTrick":"A is for ash, B is for barrel, C is for current. Three words, three pictures: a pile of ash, a drum of liquid, a wall socket. The wall unit says ABC because a hospital corridor has all three within ten steps.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-fire-oxygen","topicId":"safety-systems","tags":["fire","oxygen"],"source":["https://medlineplus.gov/"],"front":"Why is a patient on oxygen a particular fire risk, and what is the first action if fire breaks out in that room?","back":"Oxygen does not burn, but it makes everything near it burn faster and hotter. Rescue the patient and remove or turn off the oxygen source as part of confining the fire; sparks, electric razors, petroleum ointments and smoking are kept away from it.","memoryTrick":"Oxygen is not fuel, it is an accelerant — it is the difference between a match and a blowtorch. Hold that one distinction and the whole list of rules follows from it without being memorized.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-fire-evacuation-order","topicId":"safety-systems","tags":["fire","emergency"],"source":["https://www.nfpa.org/"],"front":"In what order are patients moved during an evacuation, and which direction is used first?","back":"Patients who can walk go first, then those who need a wheelchair, then those confined to bed. Horizontal evacuation — moving to another area on the same floor behind fire doors — comes before vertical evacuation down stairwells.","memoryTrick":"The order is the same as the number of staff each patient costs you. One nurse can move many walking patients at once and only one bedbound patient at a time, so you spend the cheap moves first and buy yourself hands for the expensive ones. Same floor before stairs, for the same reason.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-triage-disaster-tags","topicId":"emergency-care","tags":["triage","disaster"],"source":["https://medlineplus.gov/"],"front":"In mass-casualty triage, what do the red, yellow, green and black tags mean?","back":"Red is immediate: a life-threatening injury that is survivable with prompt treatment. Yellow is delayed: serious, but can wait. Green is minimal: walking wounded. Black is expectant: injuries not survivable with the resources available.","memoryTrick":"This is the one place where \"sickest first\" is the wrong rule. Red is not the most injured person — it is the person who lives if you act now. Hold the colors as a traffic light with one extra: go, wait, walk away, and let go. That last one is the hardest and it is what the system is for.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-deleg-five-rights-check","topicId":"delegation","tags":["delegation"],"source":["https://www.ncsbn.org/public-files/NCSBN_Delegation_Guidelines.pdf"],"front":"What are the five rights of delegation, and what do you do when you cannot answer one of them?","back":"The right task, the right circumstance, the right person, the right directions and communication, and the right supervision and evaluation. If any one cannot be answered, the task is not delegated; it stays with the nurse.","memoryTrick":"Say it as one sentence about one task: the right task, in the right circumstance, to the right person, with the right directions, under the right supervision. Each of the five is a question you can answer out loud before you let go. If the answer is \"I am not sure\", you have your answer.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-deleg-four-verbs","topicId":"delegation","tags":["delegation","scope"],"source":["https://www.ncsbn.org/public-files/NCSBN_Delegation_Guidelines.pdf"],"front":"Which nursing activities can never be delegated to assistive personnel?","back":"Assessment, nursing judgment, patient teaching, and evaluation of outcomes. Care of an unstable patient also stays with the nurse. Assistive personnel may collect data and report it, but interpreting it is nursing judgment.","memoryTrick":"Four verbs stay with the license: assess, teach, evaluate, judge. Read the task in the question and look for one of those four words or its disguise — \"check whether she understands\" is teaching, \"see how she is doing\" is assessment. If the verb is on the list, no answer that hands it to an aide is correct.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-deleg-uap-scope","topicId":"delegation","tags":["delegation","scope"],"source":["https://www.ncsbn.org/public-files/NCSBN_Delegation_Guidelines.pdf"],"front":"Which tasks are appropriate to delegate to unlicensed assistive personnel?","back":"Activities of daily living such as bathing, feeding, grooming and toileting; measuring and recording vital signs and intake and output in a stable patient; positioning; ambulating; and routine, predictable tasks with a known outcome. The nurse still interprets the findings.","memoryTrick":"The test is in two words: routine and predictable. If you already know what the result should be and nothing about this patient makes it uncertain, it can go. The moment the patient is unstable, the same task comes back to you — the task did not change, the circumstance did.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-deleg-lpn-scope","topicId":"delegation","tags":["delegation","scope"],"source":["https://www.ncsbn.org/public-files/NCSBN_Delegation_Guidelines.pdf"],"front":"How does what may be assigned to a licensed practical or vocational nurse differ from what may be delegated to assistive personnel?","back":"An LPN or LVN may give most medications, perform sterile dressing changes, insert catheters, monitor findings and reinforce teaching the registered nurse has already given, for patients whose condition is stable and predictable. The initial assessment, the care plan, patient teaching and the care of an unstable patient remain with the registered nurse, and some tasks — including intravenous push medications and blood products in many states — are restricted by state law and facility policy.","memoryTrick":"One sentence separates the two: an LPN can carry out and reinforce, a registered nurse decides and teaches first. And one caution behind it — scope is written by the state board, so an answer that would be right in one state can be wrong in another. The exam tests the national pattern; your license follows your state.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-deleg-after","topicId":"delegation","tags":["delegation"],"source":["https://www.ncsbn.org/public-files/NCSBN_Delegation_Guidelines.pdf"],"front":"After delegating a task, which responsibilities stay with the nurse?","back":"Supervision and evaluation. The nurse checks that the task was done, interprets what was found, and remains accountable for the outcome. Delegation transfers the activity, never the accountability.","memoryTrick":"Think of handing someone your car keys. The driving is theirs; the car is still yours. That is why \"I delegated it\" is never a defense, and why the last two of the five rights are about what happens after you let go.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-deleg-float-nurse","topicId":"delegation","tags":["delegation","staffing"],"source":["https://www.ncsbn.org/public-files/NCSBN_Delegation_Guidelines.pdf"],"front":"A nurse floated from another unit and a new graduate are both on the shift. Which patients are assigned to each?","back":"Assign the most stable and predictable patients to the nurse who is unfamiliar with the unit, and patients whose care matches the orientation already completed to the new graduate. The charge nurse keeps the least stable patients with the most experienced staff and stays available to both.","memoryTrick":"Competence is not the same as license. Both of these nurses hold a full license and neither has the experience this unit needs tonight, so the right person right is about this person on this unit today — not about the letters after the name.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-neuro-cushing-triad","topicId":"neuro-renal-endocrine","tags":["neurologic","icp"],"source":["https://medlineplus.gov/"],"front":"Which three findings together suggest rising intracranial pressure, and in which direction does each move?","back":"Blood pressure rises with a widening pulse pressure, the pulse slows, and respirations become irregular. Together they are Cushing’s triad and they are a late sign; report them immediately.","memoryTrick":"Picture the skull squeezing. The body shoves blood in harder — pressure up — and the brainstem slows down under the squeeze — pulse down, breathing ragged. Up, down, ragged. Any two of the three is a phone call, not a note in the chart.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-endo-insulin-timing","topicId":"pharm-endocrine","tags":["insulin","diabetes"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"How do rapid-acting, regular, NPH and long-acting insulins differ in onset and peak, and what does that change at the bedside?","back":"Rapid-acting insulin starts in about 15 minutes and peaks in 1–2 hours, so the food must be in front of the patient. Regular insulin starts in about 30 minutes and peaks in 2–3 hours. NPH starts in 1–2 hours and peaks in roughly 4–12 hours. Long-acting insulin has no pronounced peak and lasts about 24 hours. The peak is when hypoglycemia appears.","memoryTrick":"Line the insulins up by how fast they arrive: rapid is a sprinter, regular jogs, NPH walks, long-acting never really arrives — it just stands there all day. Then ask one question of any insulin order: when does this one peak? Because that hour, not the hour of the injection, is when she is at risk.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-transfusion-first-action","topicId":"iv-blood-tpn","tags":["transfusion","priority"],"source":["https://medlineplus.gov/"],"front":"Fifteen minutes into a transfusion the patient has chills, back pain and a fever. What does the nurse do first?","back":"Stop the transfusion immediately. Keep the intravenous line open with normal saline through new tubing, stay with the patient, take vital signs, and notify the provider and the blood bank. Return the unit and the tubing as directed.","memoryTrick":"Every transfusion-reaction question has the same first answer and it is not a medicine: stop the blood. The detail that is easy to lose is the new tubing — saline through the old tubing pushes the rest of the unit in. And the first fifteen minutes are the ones you stay in the room for, because that is when the worst reactions start.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-psych-eps-timeline","topicId":"psychotropics","tags":["antipsychotic","adverse-effect"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which four movement problems follow antipsychotic treatment, and what does the time since starting tell you?","back":"Acute dystonia appears within hours to days as a sustained muscle spasm. Akathisia appears within days to weeks as an inability to sit still. Parkinsonism appears over weeks as tremor, stiffness and slow movement. Tardive dyskinesia appears after months to years and may not resolve.","memoryTrick":"They arrive in order of how long the drug has been on board: hours, days, weeks, years. So the question tells you the answer before you read the findings — \"started yesterday\" can only be dystonia, \"on it for three years\" can only be tardive dyskinesia. Read the clock first.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-psych-nms-vs-serotonin","topicId":"psychotropics","tags":["antipsychotic","emergency"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Both neuroleptic malignant syndrome and serotonin syndrome cause fever and rigidity. How do you tell them apart?","back":"Neuroleptic malignant syndrome comes on over days after an antipsychotic, with lead-pipe rigidity, very high fever, altered consciousness and a raised creatine kinase. Serotonin syndrome comes on within hours of a serotonergic drug or a dose increase, with overactive reflexes, clonus, tremor, agitation and diarrhea. Both require stopping the drug and emergency care.","memoryTrick":"Two words sort them: hours and twitchy means serotonin; days and stiff means neuroleptic malignant syndrome. The reflexes are the giveaway — serotonin syndrome turns them up, the neuroleptic one locks the muscle solid.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-maternity-decelerations","topicId":"maternity-newborn","tags":["fetal-monitoring","obstetrics"],"source":["https://medlineplus.gov/"],"front":"How do you tell early, variable and late fetal heart rate decelerations apart, and which is most concerning?","back":"Line the deceleration up with the contraction. An early deceleration mirrors the contraction and reflects head compression; it is benign. A late deceleration begins after the contraction peaks and returns after it ends, and reflects placental insufficiency; it is the concerning one. A variable deceleration comes at any time in any shape and reflects cord compression.","memoryTrick":"One action sorts all three: put a finger on the contraction and a finger on the dip. Together is the head. After is the placenta. Anywhere, any shape, is the cord. You do not have to recall which is dangerous if you recall what each one is caused by — a failing placenta is the only one of the three that is about oxygen supply.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-maternity-lochia","topicId":"maternity-newborn","tags":["postpartum","obstetrics"],"source":["https://medlineplus.gov/"],"front":"What are the three stages of lochia, and what does a return to bright red bleeding after it has lightened suggest?","back":"Lochia rubra is dark red for about the first three days, lochia serosa is pink-brown for about days four to ten, and lochia alba is cream or yellow-white for up to about six weeks. A return to bright red after it has lightened suggests retained placental fragments or new bleeding and is reported.","memoryTrick":"The colors only move one way: red, pink, white — like a stain fading in the wash. A stain that gets darker again did not fade; something new was spilled. That is the whole fact, and it is the part the exam asks about.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-maternity-pph-first","topicId":"maternity-newborn","tags":["postpartum","priority"],"source":["https://medlineplus.gov/"],"front":"Two hours after delivery the uterus is soft and above the umbilicus and the pad is soaked. What does the nurse do first?","back":"Massage the fundus. A soft uterus cannot clamp its own vessels, so firming it is the first action; then empty the bladder, estimate the blood loss, check vital signs and notify the provider. Uterotonic medication follows the assessment and the order.","memoryTrick":"The uterus stops its own bleeding by squeezing. So a soft uterus is an open tap, and your hands close it faster than any drug can be drawn up. A full bladder is the second suspect, because it pushes the uterus up and out of position — which is exactly what \"above the umbilicus\" is telling you.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-burns-rule-of-nines","topicId":"emergency-care","tags":["burns","assessment"],"source":["https://medlineplus.gov/"],"front":"In the adult rule of nines, what percentage of body surface does each region represent?","back":"Head and neck 9%, each arm 9%, the front of the torso 18%, the back of the torso 18%, each leg 18%, and the perineum 1%. The proportions differ in children, whose heads are relatively larger.","memoryTrick":"Everything is nine or double nine, and one single percent is left over for the perineum. Count nines up the body: head nine, arm nine, arm nine — then the big surfaces are two nines each. The leftover 1% is the giveaway that you have the rest right, because the whole thing has to reach a hundred.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-maoi-tyramine","topicId":"psychotropics","tags":["maoi","diet"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Which foods must be avoided with a monoamine oxidase inhibitor, and what happens if they are not?","back":"Foods high in tyramine: aged cheeses, cured and smoked meats, fermented foods such as sauerkraut, soy sauce and miso, draft beer, and overripe or spoiled food. Tyramine with an MAOI can cause a hypertensive crisis with severe headache, a very high blood pressure and risk of stroke.","memoryTrick":"Four words cover the entire list: aged, cured, fermented, spoiled. If the food was deliberately left to change, it is off the plate. Fresh cheese is fine; the same cheese after six months is not. One sentence replaces a page of foods.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-chest-tube-bubbling","topicId":"cardio-respiratory","tags":["chest-tube","assessment"],"source":["https://medlineplus.gov/"],"front":"What does continuous bubbling in the water-seal chamber of a chest drainage system mean, and what must never be done to the tubing?","back":"Continuous bubbling in the water seal means an air leak in the system or at the insertion site; gentle rise and fall with breathing (tidalling) is expected. Never clamp the tube for more than a moment and never milk or strip it, because trapped air can build up into a tension pneumothorax.","memoryTrick":"Tidalling is breathing; bubbling is a hole. The dangerous move is the one that feels helpful: clamping the tube to \"check\" it turns an open leak into a trapped one, and the pressure then has nowhere to go but the chest.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-steroid-rules","topicId":"pharm-endocrine","tags":["corticosteroid","teaching"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"What are the key teaching points for a patient taking long-term oral corticosteroids?","back":"Never stop the medicine abruptly; the dose is tapered, because the adrenal glands need time to resume their own production. Take it with food, monitor blood glucose, report signs of infection early because fever and inflammation may be blunted, and report black stools or new weakness.","memoryTrick":"Steroids borrow the adrenal gland’s job, and the gland stops showing up for work. Stop the tablets suddenly and nobody is doing the job at all. Hold that image and the taper, the stress-dose rule and the medical alert bracelet all follow from it.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-digoxin-hold","topicId":"pharm-cardiac","tags":["digoxin","medication-safety"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"Before giving digoxin to an adult, which measurement is taken, and what finding means the dose is held?","back":"Count the apical pulse for a full minute. Hold the dose and notify the provider if the adult heart rate is below 60 beats per minute, or outside the limit the prescriber has set. Check the potassium and the digoxin level as well, because a low potassium increases toxicity.","memoryTrick":"Digoxin’s job is to slow the heart and strengthen the squeeze, so the thing you measure is the thing the drug does. One minute, apical, every dose. The number 60 is the floor — and the reason you count for a full minute is that this is the drug most likely to make the rhythm irregular.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-restraint-rules","topicId":"legal-ethics","tags":["restraint","safety"],"source":["https://medlineplus.gov/"],"front":"What conditions must be met before and during the use of physical restraints?","back":"Less restrictive measures are tried first and documented. A provider’s order is required, it is time-limited, and it is never written as a standing or as-needed (PRN) order. The patient is monitored and released at set intervals for circulation, skin, toileting, fluids and range of motion, and the need is reassessed and re-ordered according to policy.","memoryTrick":"A restraint is a treatment, not a piece of equipment — and treatments need an order, a dose and a stop date. The one rule to carry into any question: the answer that tries something else first is almost always right, and \"as needed\" is never a legal restraint order.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-ng-verification","topicId":"comfort-care","tags":["enteral","safety"],"source":["https://medlineplus.gov/"],"front":"How is the position of a newly placed nasogastric feeding tube confirmed before the first feeding?","back":"By X-ray. Bedside checks such as measuring the external length, checking the marking and testing the aspirate pH are used to monitor the tube afterwards, but auscultating an air bolus is not reliable and radiographic confirmation is required before the first use.","memoryTrick":"The sound of air does not tell you where the air went. A tube in the lung makes a noise too, and the only check that sees the tube is the one that takes a picture of it. Bedside checks watch a tube you already know is in the right place.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-potassium-never-push","topicId":"iv-blood-tpn","tags":["potassium","medication-safety"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"How is intravenous potassium chloride given, and what is never done with it?","back":"Always diluted and always by infusion pump at a controlled rate, with the site watched for pain and infiltration and the patient on cardiac monitoring at higher rates. Concentrated potassium is never given by intravenous push and never added to a hanging bag.","memoryTrick":"Potassium is the ion that stops a heart in the operating room on purpose. That is the whole reason for every rule around it: push it and you have given a cardiac arrest drug. There is no dose of concentrated potassium that is safe to push, so \"slowly\" is not an answer either.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-tb-med-side-effects","topicId":"pharm-respiratory","tags":["tuberculosis","pharmacology"],"source":["https://dailymed.nlm.nih.gov/dailymed/"],"front":"What are the key adverse effects to teach for the four first-line tuberculosis medicines?","back":"Isoniazid: liver injury and peripheral neuropathy, so vitamin B6 is given. Rifampin: liver injury and harmless orange-red discoloration of urine, sweat and tears, which stains soft contact lenses and reduces the effect of oral contraceptives. Pyrazinamide: liver injury, raised uric acid and joint pain. Ethambutol: changes in vision and in red-green color discrimination.","memoryTrick":"Three of the four hurt the liver, so the liver is the default answer and you only have to remember what each one adds on top: nerves for isoniazid, orange for rifampin, joints for pyrazinamide, eyes for ethambutol. Two of those are harmless and two are not — the orange is expected, the eyes are a reason to call.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-positioning-after","topicId":"comfort-care","tags":["positioning","procedure"],"source":["https://medlineplus.gov/"],"front":"Which position is used after a lumbar puncture, after a liver biopsy, and for a suspected air embolism?","back":"After a lumbar puncture, lie flat to reduce headache. After a liver biopsy, lie on the right side to put pressure on the biopsy site. For a suspected air embolism, place the patient on the left side with the head lowered, so the air stays in the right atrium and away from the pulmonary outflow.","memoryTrick":"Each position is doing one mechanical job, so name the job and the position follows. Flat keeps the fluid pressure even. Right side puts your body weight on the liver, which is on the right. Left and head-down traps a bubble on the far side of the heart from the lungs — you are using gravity on air.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-lab-therapeutic-levels","topicId":"lab-trends","tags":["lab","pharmacology"],"source":["https://medlineplus.gov/lab-tests/"],"front":"Which four commonly monitored medicines have narrow therapeutic ranges, and what are they?","back":"Digoxin about 0.5–2.0 ng/mL, lithium 0.6–1.2 mEq/L, phenytoin 10–20 mcg/mL and theophylline 10–20 mcg/mL. A vancomycin trough is also monitored, commonly at about 10–20 mcg/mL depending on the indication. Confirm the range on the laboratory report.","memoryTrick":"Two of the four share the same numbers: phenytoin and theophylline are both 10 to 20. That leaves only two to hold separately, and both of those are under 2 — digoxin under 2 nanograms, lithium under 1.2. Group the pair, then learn the two small ones.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-neutropenic-precautions","topicId":"isolation","tags":["neutropenia","teaching"],"source":["https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html"],"front":"Which precautions are taught to a patient going home with a low neutrophil count?","back":"Check the temperature and report a fever immediately, because fever may be the only sign of infection. Avoid crowds and people who are sick, avoid live vaccines, wash hands often, wash raw fruit and vegetables well and avoid undercooked meat and eggs, avoid cleaning up after animals, and avoid gardening and standing water. Dental and skin care are kept scrupulous.","memoryTrick":"With no white cells, the usual signs of infection cannot be produced — no pus, little redness, sometimes no pain. Fever is the whole alarm system she has left, which is why the thermometer is the teaching point and not the mask.","status":"ready","task":"Think of the answer, then flip the card to check."},{"id":"r8-priority-airway-first","topicId":"prioritization","tags":["priority","abc"],"source":["https://medlineplus.gov/"],"front":"Four patients need attention at once. Which finding is attended to first, and what rule decides it?","back":"The threat to airway, then breathing, then circulation — in that order — and within those, an actual change now outranks a risk of change later. A new finding outranks an expected one, and a problem that will kill in minutes outranks one that will harm over hours.","memoryTrick":"Ask the four patients one question each: how long do I have? Minutes beats hours and hours beats days, and airway is almost always the shortest clock. The trap is the sickest-looking patient whose findings are expected for the diagnosis — stable and terrible still waits behind new and small.","status":"ready","task":"Think of the answer, then flip the card to check."}],"weeks":[{"week":1,"focus":"Patient data, measurements, safety and handoff","strategy":"Read a patient chart, keep units straight, spot safety risks and hand off clearly","questionTarget":150,"checkpoint":"Finish Week 1 readings and one practice set per topic"},{"week":2,"focus":"Prioritization and the six clinical judgment steps","strategy":"First, priority and best; begin linked cases","questionTarget":150,"checkpoint":null},{"week":3,"focus":"Delegation, assignment and supervision","strategy":"Negative stems and limits of RN, LPN and UAP roles","questionTarget":175,"checkpoint":null},{"week":4,"focus":"Legal duties, ethics, advocacy and communication","strategy":"Clarify idioms; question unsafe orders","questionTarget":175,"checkpoint":"Mixed checkpoint"},{"week":5,"focus":"Safety and infection prevention","strategy":"Begin practice across at least three topics","questionTarget":200,"checkpoint":null},{"week":6,"focus":"Medication principles, calculations, IV therapy and antidotes","strategy":"US and metric unit practice","questionTarget":200,"checkpoint":null},{"week":7,"focus":"Cardiac, endocrine, respiratory and antimicrobial medicines","strategy":"Timed practice toward 60–108 seconds per item","questionTarget":200,"checkpoint":null},{"week":8,"focus":"Therapeutic communication, mental health and psychotropics","strategy":"Move toward authentic English wording","questionTarget":225,"checkpoint":"Midpoint practice exam"},{"week":9,"focus":"Crisis care, substance misuse, cardio, respiratory and shock","strategy":"Fully mixed practice weighted to the test plan","questionTarget":250,"checkpoint":null},{"week":10,"focus":"Neurologic, renal, fluid, endocrine and emergency care","strategy":"Bowtie and trend practice","questionTarget":250,"checkpoint":null},{"week":11,"focus":"Laboratory trends, diagnostics and procedure complications","strategy":"English-only explanations during practice","questionTarget":250,"checkpoint":null},{"week":12,"focus":"Maternity, newborn, pediatrics, prevention and basic care","strategy":"Linked case practice","questionTarget":250,"checkpoint":"Practice exam and case set"},{"week":13,"focus":"Remediation from the error log","strategy":"Build stamina with longer practice blocks","questionTarget":250,"checkpoint":"Practice exam 3"},{"week":14,"focus":"Management and pharmacology review","strategy":"Full-length simulation with timed breaks","questionTarget":225,"checkpoint":"Practice exam 4"},{"week":15,"focus":"Final remediation and due reviews","strategy":"Study criteria and exam-day preparation","questionTarget":200,"checkpoint":"Practice exams 5 and 6"},{"week":16,"focus":"Light review, rest and exam preparation","strategy":"Calm rehearsal. If you are not where you want to be, move your exam date back rather than sitting it early","questionTarget":90,"checkpoint":"Exam or extension"}],"coverage":{"questionTarget":3000,"practiceExamTarget":6,"status":"draft_seed","reviewedItemCount":0,"note":"The target describes the full program. It is not the size of this seed bank. 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