vSIM - Medical Scenario 1: Kenneth Bronson
POST Location: Medical UnitTime: 11:00Situation:The patient is Kenneth Bronson, a 27-year-old male who just arrived at the Medical Unit from the Emergency Department with the diagnosis of right lower lobe pneumonia confirmed by chest x-ray.Background:He presented to the Emergency Department 2 hours ago with chest tightness and difficulty breathing in addition to the productive cough, fever, and fatigue he's had for about a week. He has a history of smoking for 10 years.Assessment:He was given acetaminophen 650 mg orally in the Emergency Department for a temperature of 102.6 °F (39.2 °C). Heart rate has been in the 80s, respiratory rate is 24, and blood pressure is 132/80 at the right arm. SpO2 on room air was 90%, which increased to 93% with supplemental oxygen 2 L per nasal cannula. He has a 20-gauge IV in the left hand with normal saline infusing at 75 mL/hr.Recommendation:Provider's orders and lab results are available in the chart for you to view. Pharmacy just delivered the IV antibiotic that needs to be given and will bring the oral antibiotic within the next hour. Which of the following agents are responsible for causing the most serious anaphylactic reactions? (Select all that ap
Antibiotic medications Radiocontrast agents
POST Location: Medical UnitTime: 11:00Situation:The patient is Kenneth Bronson, a 27-year-old male who just arrived at the Medical Unit from the Emergency Department with the diagnosis of right lower lobe pneumonia confirmed by chest x-ray.Background:He presented to the Emergency Department 2 hours ago with chest tightness and difficulty breathing in addition to the productive cough, fever, and fatigue he's had for about a week. He has a history of smoking for 10 years.Assessment:He was given acetaminophen 650 mg orally in the Emergency Department for a temperature of 102.6 °F (39.2 °C). Heart rate has been in the 80s, respiratory rate is 24, and blood pressure is 132/80 at the right arm. SpO2 on room air was 90%, which increased to 93% with supplemental oxygen 2 L per nasal cannula. He has a 20-gauge IV in the left hand with normal saline infusing at 75 mL/hr.Recommendation:Provider's orders and lab results are available in the chart for you to view. Pharmacy just delivered the IV antibiotic that needs to be given and will bring the oral antibiotic within the next hour. Which of the following are the priority nursing interventions for the client in respiratory distress? (Select all that
Assess airway for patency. Assess respiratory rate and rhythm. Perform a cardiac assessment.
PRE What is the priority action by the nurse when a patient experiences sudden respiratory distress? Lower the head of bed Place an intravenous line Assess the airway Call the provider
Assess the airway Rationale:The priority action is to assess the airway. Raising the head of bed will improve lung expansion. The provider should be notified and IV line may be needed, but assessing the patient is the priority.
PRE A patient experiencing respiratory distress at home from pneumonia is brought to the hospital and upon presentation requires intubation. How would the nurse classify this type of pneumonia? Health care-associated pneumonia Community-acquired pneumonia Ventilator-associated pneumonia Hospital-acquired pneumonia
Community-acquired pneumonia Rationale:Community-acquired pneumonia (CAP) is pneumonia occurring in the community or within less than 48 hours of hospital admission. Health care-associated pneumonia (HCAP) occurs in a nonhospitalized patient with extensive health care contact. Hospital-acquired pneumonia (HAP) occurs 48 hours or more after hospital admission. Ventilator-associated pneumonia (VAP) is a type of HAP that develops 48 hours or more after intubation.
PRE The patient experiencing an anaphylactic reaction may experience which of the following signs and symptoms? (Select all that apply.) Pallor Dyspnea Laryngeal edema Pruritus Bronchospasm
Dyspnea Laryngeal edema Pruritus Bronchospasm Rationale:Mild systemic reactions consist of peripheral tingling, warmth, a sensation of fullness in the mouth and throat, nasal congestion, periorbital swelling, pruritus, sneezing, and tearing of the eyes. Moderate systemic reactions may include flushing and anxiety in addition to any of the milder symptoms. More serious reactions include bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension. Dysphagia (difficulty swallowing), abdominal cramping, vomiting, diarrhea, and seizures can also occur. Cardiac arrest and coma may follow.
PRE When a patient presents to the emergency department with pneumonia, which signs and symptoms would the nurse expect the patient to exhibit? (Select all that apply.) Night sweats Fever Dyspnea Fatigue Orthopnea
Fever Dyspnea Fatigue Orthopnea Rationale:Fever is present with the infection. Patients will exhibit dyspnea, preferring to be propped up or sitting up due to orthopnea (shortness of breath when reclining or supine). The patient is fatigued from the work of breathing.
POST Location: Medical UnitTime: 11:00Situation:The patient is Kenneth Bronson, a 27-year-old male who just arrived at the Medical Unit from the Emergency Department with the diagnosis of right lower lobe pneumonia confirmed by chest x-ray.Background:He presented to the Emergency Department 2 hours ago with chest tightness and difficulty breathing in addition to the productive cough, fever, and fatigue he's had for about a week. He has a history of smoking for 10 years.Assessment:He was given acetaminophen 650 mg orally in the Emergency Department for a temperature of 102.6 °F (39.2 °C). Heart rate has been in the 80s, respiratory rate is 24, and blood pressure is 132/80 at the right arm. SpO2 on room air was 90%, which increased to 93% with supplemental oxygen 2 L per nasal cannula. He has a 20-gauge IV in the left hand with normal saline infusing at 75 mL/hr.Recommendation:Provider's orders and lab results are available in the chart for you to view. Pharmacy just delivered the IV antibiotic that needs to be given and will bring the oral antibiotic within the next hour. Which of the following discharge instructions would be most important for the nurse to provide to a client who has exp
Obtain and always wear a medical alert bracelet for penicillin. Obtain and always carry an auto-injectable epinephrine device.
POST Location: Medical UnitTime: 11:00Situation:The patient is Kenneth Bronson, a 27-year-old male who just arrived at the Medical Unit from the Emergency Department with the diagnosis of right lower lobe pneumonia confirmed by chest x-ray.Background:He presented to the Emergency Department 2 hours ago with chest tightness and difficulty breathing in addition to the productive cough, fever, and fatigue he's had for about a week. He has a history of smoking for 10 years.Assessment:He was given acetaminophen 650 mg orally in the Emergency Department for a temperature of 102.6 °F (39.2 °C). Heart rate has been in the 80s, respiratory rate is 24, and blood pressure is 132/80 at the right arm. SpO2 on room air was 90%, which increased to 93% with supplemental oxygen 2 L per nasal cannula. He has a 20-gauge IV in the left hand with normal saline infusing at 75 mL/hr.Recommendation:Provider's orders and lab results are available in the chart for you to view. Pharmacy just delivered the IV antibiotic that needs to be given and will bring the oral antibiotic within the next hour. The nurse recognizes the clinical manifestations of anaphylaxis when the client exhibits which of the following signs
Severe dyspnea Abrupt onset Bronchospasm
PRE Which of the following represent initial signs and symptoms of a patient in respiratory distress? (Select all that apply.) Tachypnea Hypoxemia Dyspnea Cyanosis Fever
Tachypnea Hypoxemia Dyspnea Rationale:Dyspnea and tachypnea accompanied by low oxygen in the blood are associated with respiratory distress. Cyanosis is a very late indicator of hypoxia to the tissues. Fever is an indication of infection.
PRE The nurse is auscultating lung sounds. What lung sound is associated with narrowing of the airway? Bronchophony Egophony Crackles Wheezes
Wheezes Rationale:Wheezing is a high-pitched, musical sound associated with airway narrowing. Crackles are described as a popping sound heard during inspiration from fluid or delayed opening of collapsed alveoli. Bronchophony or egophony can be auscultated when there is increased lung density from pneumonia and pulmonary edema.
POST Location: Medical UnitTime: 11:00Situation:The patient is Kenneth Bronson, a 27-year-old male who just arrived at the Medical Unit from the Emergency Department with the diagnosis of right lower lobe pneumonia confirmed by chest x-ray.Background:He presented to the Emergency Department 2 hours ago with chest tightness and difficulty breathing in addition to the productive cough, fever, and fatigue he's had for about a week. He has a history of smoking for 10 years.Assessment:He was given acetaminophen 650 mg orally in the Emergency Department for a temperature of 102.6 °F (39.2 °C). Heart rate has been in the 80s, respiratory rate is 24, and blood pressure is 132/80 at the right arm. SpO2 on room air was 90%, which increased to 93% with supplemental oxygen 2 L per nasal cannula. He has a 20-gauge IV in the left hand with normal saline infusing at 75 mL/hr.Recommendation:Provider's orders and lab results are available in the chart for you to view. Pharmacy just delivered the IV antibiotic that needs to be given and will bring the oral antibiotic within the next hour. After initial identification of potential for anaphylaxis, the nurse's priority assessment is Choose Answer.. followe
auscultate lungs, assess BP
POST Location: Medical UnitTime: 11:00Situation:The patient is Kenneth Bronson, a 27-year-old male who just arrived at the Medical Unit from the Emergency Department with the diagnosis of right lower lobe pneumonia confirmed by chest x-ray.Background:He presented to the Emergency Department 2 hours ago with chest tightness and difficulty breathing in addition to the productive cough, fever, and fatigue he's had for about a week. He has a history of smoking for 10 years.Assessment:He was given acetaminophen 650 mg orally in the Emergency Department for a temperature of 102.6 °F (39.2 °C). Heart rate has been in the 80s, respiratory rate is 24, and blood pressure is 132/80 at the right arm. SpO2 on room air was 90%, which increased to 93% with supplemental oxygen 2 L per nasal cannula. He has a 20-gauge IV in the left hand with normal saline infusing at 75 mL/hr.Recommendation:Provider's orders and lab results are available in the chart for you to view. Pharmacy just delivered the IV antibiotic that needs to be given and will bring the oral antibiotic within the next hour. After administering Choose Answer.., which is the priority medication to treat anaphylaxis, the nurse recognizes that
epinephrine SpO2 increases
