Medical Surgical-telemetry RN A

When assessing a patient, you notice crepitus on the right upper shoulder. You notify the physician and anticipate which diagnosis?

Subcutaneous emphysema

The Glasgow, scale ranges from:

3 to 15

The doctor ordered Lasix 40 mg IV push, 100mg/10 mL

4ml

Heart rate

80

Which of the following issues should be reported up the chain of command

A coworker arriving to work under the influence of alcohol

A postoperative laparoscopic appendectomy patient is receiving morphine PCA for pain findings with alert you to the potential of a narcotic overdose?

A respiratory rate of 8 breaths per minute

You are caring for your patient with a temporary hemodialysis catheter who has not required dialysis in 4 days. When you change the dressing you note the site appears red and edematous. What would you do NEXT?

(1) intravenous antibiotics alone (2) prompt catheter removal with delayed placement of a new tunneled catheter (3) exchange of the infected catheter with a new one over a guidewire (4) use of an antibiotic lock. NOT: Flush the catheters with 10 cc on normal saline

Calculate the 12 hour intake for a patient that has received the following during your shift: normal saline 750 ML, 24 ounces of sprite, Levaquin 50 ML, 650 ML urine in Foley catheter

1520

You're reviewing the discharge medication list of a patient diagnosed with gastric ulcer. Which of the following medication should you question?

Acetylsalicylic acid ( Bauer buffered aspirin)

You deserve the nurse aid removing her gloves and immediately using alcohol hand sanitizer in a room with a patient who has C-Diff. What education should you provide to the nurse aide

And washing with soap and water is mandatory because alcohol based hand sanitizers do not kill C-diff

You're a king for a patient who is postop after surgical removal of fibroids. She hears a pop sound after coughing in her surgical wound has dehisced

Apply sterile saline soap towels over the extruding site

Your inserting a urinary catheter into a male patient. As you inflate a balloon, the patient complains of discomfort what is the best action?

Aspirate the fluid, advance the catheter farther, then re-inflate the balloon

You went to the room of a 58-year-old female. You find that the patient's cardiac monitor shows asystolye, what should be your first action?

Assess the patient Not: start CPR

Your COPD patient is complaining of wheezing and increased shortness of breath

Assess your patient for a change in condition

Your patient fell and hit his head on the bed rail during a physical therapy session. Upon initial assessment you observe a blood pressure of 90/45, heart rate of 28, and a constricted pupil. The patient is lying in a supine position. What should be your first response?

Call a rapid response

You're preparing your patient for discharge need to provide dietary education related to his diagnosis what should you instruct the patient to avoid?

Canned meats

What is the first sign of increased intracranial pressure?

Change in LOC

You hear an alarm at the central monitor and see one of your patients with this rhythm. What would you do FIRST?

Check patient status and lead placement NOT: Call a code blue

Your patient was just returned from surgery with a Jackson-Pratt JP drain in place which of the following is the best nursing action?

Compress the drain, then plug the bulb to establish suction

Your patient complains of not being able to urinate since 0500. It is now 1900. What should be your next step?

Perform a bladder scan

Deposition has ordered for your patience to begin a 24 hour urine collection. Your patient voids for the first time two hours after the orders received. What should be done with this urine sample?

Discarded, then begin the 24 hour collection

You are taking care of a patient who is admitted for left flank pain with a kidney stone of 1.5 cm. He asks you about the procedure what would be the most therapeutic response?

Due to the size of the kidney stone it is an appropriate treatment? NOT:Print reading materials about the subject and give it to the patient

Patient is admitted for shortness of breath. Do you notice the spouse adjusting the oxygen on the wall and she states "she always takes care of my husband" what would be an appropriate response?

Educate the spouse on oxygen use as a medical device in the hospital

At 0500, you know your patient to be diaphoretic, clammy, and their hands are shaking. The patient's blood sugar is currently 60. Which of the following is the most appropriate intervention

Have the patient drink 120 ML's of orange juice

What information is vital for you to know prior to administering an ordered dose of digoxin

Heart rate

Cardiac strip

Sinus rhythm with PAC

You're reviewing the menu list of a patient on Warfran what food should they not eat?

Spinach

Which of the following assessment findings should you report immediately to the physician for a patient who just had a bronchoscopy and biopsy?

Sputum with streaks of blood NOT: increased salivation

Your patient has been diagnosed with a hemorrhagic CVA

Heparin infusion per pharmacy protocol

The nurse is taking care of a patient who is terminally ill and has a DNR on file. Their patient has a sudden cardiac arrest and family wants CPR initiated. How should you respond?

Honor the patient's wishes

You're providing discharge instructions to a CHF patient.

Increase shortness of breath

Your patient was admitted with severe dehydration. Which of the following orders would you question

KCI 40 mEq IV push STAT

You're caring for a 12 hour postoperative parathyroidectomy patient. Which assessment finding would indicate an emergency?

Laryngeal strider

Which of the following lab values would you expect to see in a patient diagnosed with?....

Lipase - 196

When taking care of a patient with pancreatitis, which of the following lab should be reviewed?

Lipase and amylase

Which of the following actions would be considered a violation of Hyppa?

Looking through the chart of a coworker admitted to your unit

Which of the following antidiabetic medication is contraindicated 48 hours after receiving contrast dye

Metformin

A patient suddenly complains of new onset of chest pain. The doctor is suspecting a possible?... What is most likely to be ordered?

Morphine Duramorph, oxygen, nitrates, Aceticsalicylic acid, bayer buffered aspirin

What is the cardiac rhythm?

NOT: Sinus rhythm with first-degree AV block

After a patient completes dialysis, you should anticipate seeing an improvement in which of the following lab values?

NOT: ammonia

The patient has a morphine PCA post operatively. On rounding you notice respirations at eight per minute O2 saturation of 82%. What medication would be given in the situation?

Narcan

You are caring for your 80-year-old patient admitted for pneumonia. They have a history of heart failure, cataracts, arthritis, and anxiety. They are receiving scheduled furosemide (Lasix®) and IV antibiotics. What are they at the HIGHEST risk for?

Ototoxicity Lung dryness Hypotension, dehydration, and electrolyte depletion NOT: VTE (DVT/PE)

Which of the following electrolyte value should be Addressed immediately by the nurse

Potassium 2.5 mEq/L

When caring for a patient experiencing a tonic clonic seizure, the most appropriate nursing intervention is:

Protecting the patient's head and extremities from contact with surrounding objects

You are providing patient education to a patient prior to administering IV Protonix.... When there is no history of GERD

Protonix is given as G.I. prophylaxis to prevent stress ulcers

One of the signs of left sided heart failure is:

Pulmonary edema NOT: pedal edema

You were caring for a patient who is 18 hours postop after a right BKA a. They report sudden chest pain pulse ox at 86%. The patient may be experiencing:

Pulmonary embolism

A 56-year-old man has an acute onset of shortness of breath, chest pain, apprehension, rapid pulse, cough with bloody sputum, diaphoresis, and syncope. The symptoms are indicative of:

Pulmonary embolism? NOT: tuberculosis

While performing the narcotic count at the end of the shift, my coworker admits to something, coworker to sign for the ways that you did not witness

Refused to sign for the waste

Your post-op patient has nausea, hypoactive bowel sounds, and repeated vomiting of dark brown emesis despite antiemetics. What order do you anticipate from the provider?

Rehydration Labs NG tube NOT: Obtain MRI of the abdomen

Which of the following medication may cause urine discoloration

Rifampin

Your patient had a TB skin test done on Thursday at 2:45 PM

Saturday at 3 PM

Your patient with asthma is prescribed budesonide and formoterol (Symbicort®) twice daily. What would you include in your patient education?

Take 2 puffs of SYMBICORT in the morning and 2 puffs in the evening Take your SYMBICORT inhaler out of the foil pouch and write the date on the box. If you are using your inhaler for the first time, you need to prime it. TO PRIME YOUR INHALER: Hold it in the upright position as shown Shake your inhaler well for 5 seconds Remove the mouthpiece cover by squeezing gently at both sides, then pulling out Hold the inhaler facing away from you, and release a test spray Shake it again for 5 seconds and release a second test spray TO USE YOUR INHALER: Step 1: Shake your inhaler well for 5 seconds. Remove the mouthpiece cover by squeezing gently at both sides, then pulling out. Check the mouthpiece for foreign objects. Step 2: Breathe out fully (exhale). Hold the inhaler up to your mouth. Place the white mouthpiece fully into your mouth and close your lips around it. Make sure that the inhaler is upright and that the opening of the mouthpiece is pointing toward the back of your throat. Step 3: Breathe in (inhale) deeply and slowly through your mouth. Press down firmly and fully on the top of the counter on the inhaler to release the medicine. Step 4: Continue to breathe in (inhale) and then hold your breath for about 10 seconds, or for as long as it is comfortable. Before you breathe out (exhale), release your finger from the top of the counter. Keep your inhaler upright and remove it from your mouth. Step 5: Shake your inhaler again for 5 seconds and repeat steps 2 to 4. After using your SYMBICORT inhaler: Put the cover back on Rinse your mouth with water and spit it out Don't swallow the water Reading the actuation counter The actuation counter on top of the inhaler helps to monitor the amount of medication remaining and helps you know when to refill your prescription. The arrow points to the number of inhalations, or puffs remaining. Here's how to read it: After you have primed the inhaler for the first time, the counter will read either 120 or 60, depending on which size was provided to you Each time you release a puff from the inhaler, the counter will count down When the arrow gets close to 20, you will notice the beginning of the yellow zone, indicating that it is time to call for a refill Discard the inhaler when the arrow points to the red zone and reads zero (0), or 3 months after it is taken out of its pouch, whichever comes first Your inhaler may not feel empty and may continue to operate, but you will not get the right amount of medicine if you keep using it How to clean your SYMBICORT inhaler You should clean the white mouthpiece of the SYMBICORT inhaler every 7 days Remove the gray mouthpiece cover by squeezing gently at both sides, then pulling out Use a clean, dry cloth to wipe the inside and outside of the white mouthpiece When you are finished cleaning the mouthpiece, place the cover back over the mouthpiece NOTE: Never put your SYMBICORT inhaler into water. Do not try to take the inhaler apart. NOT: Take one inhalation of Symbicort in the morning and one at night.

You are to obtain informed consent for a Spanish-speaking patient scheduled for surgery. You do not speak Spanish and are having difficulty communicating with your patient. Which of the following resources would be most appropriate to utilize in order to obtain consent?

The hospitals language interpreter

Your patient with cancer has a left upper arm PICC line. They report pain in their left arm, shoulder, and tingling in their left hand. Upon assessment you note the left arm is significantly larger than the right arm. The left arm is red and warm to the touch. What do you suspect?

Thrombosis (Blood Clot) Air Embolism NOT: Infiltration

Furosemide (Lasix®) IV should be pushed no faster than 10 mg/min to avoid what?

Tinnitus -Ringing, buzzing or other unexplained noise in the ears Other: Pancreatitis Dehydration Electrolyte Imbalance Increased blood glucose Decreased urination Dry mouth Thirst Nausea; vomiting Weakness; Drowsiness; Confusion; muscle pain or cramps; or rapid or pounding heartbeats NOT: Dizziness

Cardiac strip

Unable to determine

You were caring for a patient admitted with abdominal pain. Your patient has a bowel movement and you know dark tarry stool what would be the diagnosis?

Upper G.I. bleed

Which of the following food items would you question in the menu of your patient who is diagnosed with celiac disease?

Wheat bread

Didn't nurse ask you about the typical signs and symptoms of myocardial infarction

Women could have pain in their arm, neck, back or jaw

Your patient presents with CHF and has a potassium level of 5.8. What diuretic do you anticipate being ordered by the provider?

bumetanide (Bumex) NOT: Spironolactone (Aldactone)