Exam 3
The Physician has opted to treat a patient with the complete spinal cord injury with glucocorticoids. The Physician orders 30 mg /kgs over 15 minutes followed in 45 minutes with an infusion of 5.4 mg/kg/hr for 23 hours. what is the total 24 hour dose for the 70kg patient?
10,794 mg
the patient is a new post a patient. She weighs 75 Kg. The nurse expects the minimal acceptable urine output to be?
37 ml's / hour
In using the rule of nine for measuring the percentage of burn? How much percentage does the whole right arm compromise?
9%
a normal glomerular filtration rate is within what range?
>90 (normal is 80 to 125ml/min????)
The nurse is caring for a patient with an ICP of 18 mm Hg and a GCS score of 3. Following the administration of mannitol (Osmitrol), which assessment finding by the nurse requires further action?
CVP of 2 mm Hg
this is a procedure that releases the burn wound surgically by incising the burned skin down to the Sub-Q fat?
Escharotomy
The nurse is caring for a mechanically ventilated patient with a brain injury. Arterial blood gas values indicate a PaCO, of 60 mm Hg. The nurse understands this value to have which effect on cerebral blood flow?
Increased cerebral blood flow due to vessel dilation
The nurse assesses a patient with a skull fracture to have a Glasgow Coma Scale score of 3. Additional vital signs assessed by the nurse include blood pressure 100/70 mm Hg, heart rate 55 beats/min, respiratory rate 10 breaths/min, oxygen saturation (SpO,) 94% on oxygen at 3 L per nasal cannula. What is the priority nursing action?
Monitor the patient's airway patency.
The nurse is caring for a patient who was hit on the head with a hammer. The patient was unconscious at the scene briefly but is now conscious upon arrival at the emergency department (ED) with a GCS score of 15. One hour later, the nurse assesses a GCS score of three. What is the priority nursing action?
Notify the Physician immediately
While caring for a patient with a basilar skull fracture, the nurse assesses clear drainage from the patient's left naris. What is the best nursing action?
Place a nasal drip pad under the nose
which patient being cared for in the emergency department should the charge nurse evaluate first?
a patient with a complete spinal injury at the C5 dermatome level
which of the following injuries would result in a greater likelihood of internal organ damage and risk for infection?
a shotgun wound to the abdomen
in determining the glomerular filtration rate GFR or creatinine clearance, a 24-hour urine is obtained. If a reliable 24-hour urine collection is not possible then what?
a standardized formula may be used to calculate GFR
the patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week. The patient complains of General malaise and is tachypneic . an arterial blood gas is ordered and shows that the patient's pH is 7.19 with a PCO of 30 and a bicarbonate level of 13 the nurse prepares to?
administer intravenous sodium bicarbonate
an elderly individual from an assisted living facility presents with severe scald Burns to the buttocks and back of the thighs. The caregiver from the ALF accompanies the patient to the emergency department and states that the bath water was too hot and that the patient sat in the water too long, what should the nurse do?
ask the caregiver to step out while examining a patient's burn injury
the correct order of actions in the management of the post-op surgical trauma patient who has been admitted to the critical care unit after surgery is?
assess Airway breathing and circulation, connect the patient to bedside monitor in mechanical ventilation, obtain Vital Signs Rhythm oxygen sat and neurological status, and reassess and evaluate patency of IV lines, and adjust flow rate of fluid administration as ordered
the patient is on intake and output as well as daily weights. The nurse knows that output is considerably less than intake over the last shift, and daily weight is 1 kilogram more than yesterday. The nurse should do what?
assess the patient's lungs
the patient is in Progressive Care Unit following arteriovenous fistula implantation in his left upper arm, and is due to have blood drawn with his next set of vital signs and assessment. When the nurse assesses the patient, the nurse should?
auscultate the left arm for a bruit and palpate for a thrill
the term used to describe an increase in blood urea nitrogen (BUN) and serum creatinine is?
azotemia
the nurse is caring for a patient who has undergone skin grafting of the face and arms for burn wound treatment. A primary nursing diagnosis is?
body image disturbance
the nurse is caring for a patient who has been struck by lightning. Because of the nature of the injury the nurse assesses the patient for which of the following?
central venous system deficits
the nurse is preparing to administer a routine dose of phenytoin (Dilantin). The physician orders he needs to join 500 mg IV every 6 hours what is the best action by the nurse?
contact the physician
the nurse is caring for a patient who has undergone major abdominal surgery. The nurse notices that the patient's urine output has been less than 20 ml / hour for the past 2 hours. it is 0200 in the morning. the patient's blood pressure is 100/60 in the pulse is 110 beats per minute. Previously, the pulse was 90 BPM with a blood pressure of 120 / 80. The nurse should?
contact the provider and expect an order for a normal saline bolus
which of the following statements about mass casualty triage during a disaster is true?
disaster victims with the greatest chances for survival receive priority for treatment
the patient has a temporary percutaneous catheter in place for treatment of acute kidney injury. The catheter has been in place for 5 days. The nurse should?
evaluate the patient for signs and symptoms of infection
the patient undergoes a cardiac catheterization that requires the use of contrast dyes during the procedure. To detect signs of contrast-induced kidney injury, the nurse should?
evaluate the patient's serum creatinine for up to 72 hours after the procedure
daily weights are being recorded for the patient. His urine output has been less than his intravenous and oral intake. His weight yesterday was 97.5 kilograms. This morning it is 99 kilograms. The nurse understands that this corresponds to?
fluid retention of 1.5 L
the optimal measurement of intravascular fluid status during the immediate fluid resuscitation phase of burn treatment is?
hourly in intake and urine output
in the trauma patient symptoms of decreased cardiac output are most likely caused by?
hypovolemia
when paramedics notice singed hairs in the nose of a burn patient, it is recommended that the patient be intubated. What is the reasoning for the immediate intubation?
inhalation injury above the glottis may cause significant edema that obstructs the airway
the patient is admitted with complaints of General malaise and fatigue, along with a decreased urinary output. The patient's urine analysis shows course, muddy Brown granular casts and hematuria. The nurse determines that this patient has?
intra renal disease, probably acute tubular necrosis
a patient from a fire incident is presented to ED with facial Burns Strider hoarse voice with a brassy cough and tachypnea what should you suspect?
intubation?????? dont know this one
a twenty-four-year-old unrestrained driver who sustained multiple traumatic injuries from a motor vehicle crash has a blood pressure of 80/60 at the scene the primary survey of this patient upon arrival to the ED is?
is done quickly in the first few minutes to get a baseline assessment and establish priorities
an eighteen-year-old unrestrained passenger who sustained multiple traumatic injuries from a motor vehicle crash has a blood pressure of 80 / 60 at the scene the patient should be treated at which level trauma center?
level 1
the nurse admits a patient to the emergency department with a suspected cervical spine injury. What is the priority nursing action?
maintain proper head and neck alignment
the nurse is caring for a patient 3 days selling a complete cervical spine injury at the C3 level. The patient is in spinal shock. Following emergent intubation in mechanical ventilation, what is the priority nursing
monitor blood pressure
what is the best measure of tissue perfusion in the major Burns patient?
monitor fluid loss (hypovolemia) and decreased cardiac output which can happen before any significant change in blood volume???????dont know
describe the ways of assisting with minimizing edema and increasing perfusion?
movement, repositioning, promote revascularizing
during the treatment and management of the trauma patient, maintaining tissue perfusion, oxygenation, and nutritional support our strategies to prevent?
multi-system organ failure
the nurse is caring for a patient who sustained rib fractures after hitting the steering wheel of his car. The patient is spontaneously breathing and receiving oxygen via face mask the oxygen sat is 95%. During the nurses assessment, the oxygen sat drops to 80%. The patient's blood pressure has dropped from 128 / 76 to 84 / 60. The nurse assesses that breath sounds are absent throughout the left lung Fields. The nurse notifies The Physician and anticipates what?
needle thoracostomy and chest tube insertion
the nurse is assessing a patient with a new arteriovenous fistula, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable. The nurse should?
notify the provider immediately
acute kidney injury from post renal etiology is caused by what?
obstruction of the flow of urine
the nurse is having difficulty inserting a large-caliber IV catheter to facilitate fluid resuscitation to a hypotensive trauma patient. The nurse recommends which of the following emergency procedures to facilitate rapid fluid administration?
placement of an intraosseous catheter
when providing information on trauma prevention, it is important to realize that individuals aged 35 to 54 years are most likely to experience which type of trauma incident?
poisonings from prescription or illegal drugs
the nurse has admitted a patient to the Ed following a fall from a first-floor hotel balcony. The patient is 22 years old and smells of alcohol. The patient begins to vomit in the Ed. Which of the following interventions is most appropriate?
prepare to suction the oropharynx while maintaining cervical spine immobilization
while caring for a patient with a closed head injury, the nurse assesses the patient to be alert with a blood pressure 130/90, heart rate 60, restoration 18, and it's temperature of 102. To reduce the risk of increased intracranial pressure in this patient what is the priority nursing action?
reduce ambient room temperature and administer antipyretics
the nurse is caring for a patient with an electrical injury. The nurse understands that patients with electrical injury are at high risk for acute kidney injury secondary to?
release of myoglobin from injured tissues
the nurse understands that negative pressure wound therapy may be used in the treatment of partial thickness burn wounds to do which of the following?
remove excessive wound fluid in promote moist wound healing
the need for fluid resuscitation can be assessed best in the trauma patient by monitoring and trending which of the following test?
serum lactate level
which of the following interventions is a strategy to prevent fat embolism syndrome?
stabilize extremity fractures early
the correct priority order of actions in pre-hospital primary survey for burn injuries is / are?
stop the burning process and prevent further injury, assess ABC's in cervical spine, provide oxygen therapy if smoke inhalation is suspected, make rapid head to toe assessment to rule out additional trauma
the nurse is caring for a patient who has a diminished level of Consciousness and who is mechanically ventilated while performing endotracheal suctioning, the patient reaches up in an attempt to grab the suction catheter. What is the best interpretation by the nurse?
the patient is exhibiting purposeful movement
after receiving the handoff report from the day shift charge nurse, which patient should the evening charge nurse assess first?
the patient with inter-cranial pressure of 20 mmHg and an oral temperature of 100 f.
peritoneal dialysis is different from hemodialysis in that peritoneal dialysis?
uses the patient's own semi- permeable membrane (peritoneal membrane
which of the following patients is at the greatest risk of developing acute kidney injury? A patient who
was discharged 2 weeks earlier after amnioglycoside therapy of two weeks
who among the following groups are the most likely to commit suicide?
young males???????
