Med Surg II_ Midterm (Test)_Latest,100% CORRECT

Mrs. Jingle, 90-year-old, brought to Emergency Dept. by paramedics with a full code status lives in a Board & Care Facility that provides meals/medications. She's had flu symptoms for 2 days: nausea, vomiting, diarrhea; ...

Mrs. Jingle, 90-year-old, brought to Emergency Dept. by paramedics with a full code status lives in a Board & Care Facility that provides meals/medications. She's had flu symptoms for 2 days: nausea, vomiting, diarrhea;anorexia. Vital Signs: 92/60 mm Hg, Heart Rate (HR) 115 beats/min., Respiratory Rate (RR) 24/ min., SpO2 90% on room air, Temp PO 102.4°F/39.11°C. Medication HX: Lasix /Furosemide 20 mg PO daily; Lanoxin/Digoxin .25 mg PO daily; Lopressor/ Metoprolol 12.5 mg PO BID. Telemetry monitor shows Sinus Tachycardia. Admitted to ICU with a Mean Arterial Pressure (MAP) of 50 mm Hg. 1) The RN immediately identifies Mrs. Jingle's presenting problem as: A) Increased afterload B) Increased preload C) Decreased preload D) Decreased afterload ● Mrs. Jingle has dehydration → hypovolemia → shock ● caused by N,V, Diarrhea, temp of 102.4F potentially exacerbated by Furosemide (diuretic) ● Clinical manifestations = decreased preload, sinus tach, fever, MAP <60 mmHg, ↑HR, ↓BP, ↑RR, O2 sat↓ ● MAP reflects the average pressure by which vital organs r supplied, or perfused, w/ O2 + nutrients from the blood. ○ When the MAP goes too low it means there is less bld getting to the organs and could cause pt to go into shock. ○ 2) The RN expects that Mrs. Jingle's immediate medical orders will include: A) Nitroprusside Intravenous (IV) to decrease afterload B) Intravenous fluids (IVF) of 0.9% NaCl to increase preload C) Furosemide 20 mg Intravenous Push (IVP) to decrease preload D) Metoprolol 12.5 mg Intravenous Push (IVP) to increase preload 3) Nursing interventions for Mrs. Jingle include A) Arterial line, Chest X-ray, Cardiac Echo B) Bedrest, Swan-Ganz, IV Potassium Chloride C) Fall Risk Precautions, Cooling Measures, Intake & Output D) Complete Metabolic Panel, Urinary Analysis, ABGs 4) Mrs. Jingle's ABGs come back as follows: pH, 7.20; pO2, 106 mm Hg; pCO2, 35 mm Hg; and HCO3-, 11mEq/L. These values are most consistent with: A) Uncompensated Metabolic Acidosis B) Compensated Metabolic Acidosis C) Uncompensated Respiratory Acidosis D) Compensated Respiratory Acidosis The pH indicates acidosis, and the HCO3– is markedly decreased, indicating a metabolic disorder. Uncompensated metabolic acidosis values include a pH below 7.35, PACO2 of 35 to 45 mm Hg, and HCO3– above 22 mEq/L. Uncompensated respiratory acidosis values include a pH below 7.35, PACO2 above 45 mm Hg, and HCO3– of 22 to 26 mEq/L. Uncompensated respiratory alkalosis values include a pH above 7.45, PACO2 below 35 mm Hg, and HCO3– of 22 to 26 mEq/L. Uncompensated metabolic alkalosis values include a pH above 7.45, PACO2 of 35 to 45 mm Hg, and HCO3– above 26 mEq/L. 5) Before discharging Mrs. Jingle, the RN must ensure that A) Immunizations are current B) B&C level of care is appropriate to meet patients needs C) Discharge education is complete D) All of the above You receive report on Mr. Shim, a 35-year-old male being transferred to Stepdown from ICU status post tracheostomy. ICU reports he requires suctioning every 4-6 hrs. He is on humidified 40% FiO2 via tracheostomy collar. Vital signs are stable. 6) The RN ensures the following are available prior to Mr. Shim's arrival: A. Isolation room, wound consult, oxygen concentrator B. IV equipment, trach dressings, isolation room C. Isolation gowns, trach dressings, oxygen concentrator D. Trach replacement kit, suction equipment, manual resuscitation bag 7) To minimize hypoxia during Mr. Shim's suctioning, the RN pre-hyperoxygenates, A. Uses 12 Fr suction catheter B. Minimizes suction time C. Deflates tracheal cuff D. Answers A and B E. Answers A,B, and C 8) Priority nursing concerns for Mr. Shim includes Skin Integrity, A. Communication, Nutrition, Oxygenation B. Electrolytes, Oxygenation, and Weight C. Seizures, Oxygenation, and Fluid intake D. Fluid output, bowel management, and weight Mr. Crinkle, 26-year-old male, presents to the emergency department with severe facial trauma and bleeding after a street fight. 9) The priority nursing assessment for Mr. Crinkle is A. Loss of consciousness for neuro status B. “Battle sign” indicating skull fracture C. Hemorrhage decreasing preload D. Airway for gas exchange Mr. Crinkle is admitted to Stepdown post open reduction internal fixation (ORIF) of fractured maxilla and mandible. His jaw is wired closed; a liquid diet is ordered. 10) Identify the nursing priority for Mr. Crinkle post-operatively A. Fall safety risk, all side rails up on bed B. Infection prevention, neutropenic precautions C. Skin integrity, wound & skin consult D. Aspiration precaution, wire cutters at bedside Mrs. Blue, a 66-year-old on the surgical unit, is post total thyroidectomy. During rounds you note the patient is tachycardic, tachypneic, anxious, with SpO2 at 90% on O2 at 2L/min/nasal cannula. 11) Your first interventions for Mrs. Blue are A. Place patient in high-fowler position; assess for airway obstruction B. Place patient in semi-fowler position; assess for hemorrhage C. Place patient in supine position; assess for infection D. Place patient in prone position; assess for oxygen saturation Mrs. Blue becomes cyanotic with stridor. You call for the Charge Nurse and increase oxygen to 4 L/min/nasal canula. 12) The staff RN suspects A. Single closed vocal cord paralysis B. Single open cord paralysis C. Bilateral closed vocal cord paralysis D. Bilateral open vocal cord paralysis 13) The staff RN's priority intervention for Mrs. Blue is A. Call the Rapid Response Team (RRT) B. Initiate a non-rebreather mask C. Call the Provider D. Call Respiratory STAT Ms. Pax, 38-yr.-old, presents to Emergency Dept. with dyspnea, fatigue; angina-like chest pain. States she was on "Fen-Phen" for dieting 2 yrs. ago. Final diagnosis of Pulmonary Arterial Hypertension (PAH) was made following a right-sided heart catheterization showing elevated pulmonary pressures. 14) Ms. Pax increasing vascular resistance in the lung leads to A. Airway obstruction and upper respiratory infections B. Airway obstruction and lower respiratory infections C. Poor perfusion and gas exchange with hypoxemia D. Poor perfusion and gas exchange with hypercarbia 15) Drug therapy to help slow Ms. Pax' progression to cor pulmonale might include: A. Endothelin-receptor agonists like bosentan/Tracleer B. Prostacyclin agents like epoprosternol/Flolan C. Anticoagulants like warfarin/Coumadin D. All of the above Mr. Taps, 78-yr.-old, admits to Emergency Dept. Chief complaint of frank hemoptysis, persistent cough; dyspnea on minimal exertion. History of recent wt. loss, hoarseness, recurring pneumonia; 60-yr. history of smoking 1 cigarette pack/day. 16) Mr. Taps symptoms and history lead the RN to suspect the Medical Diagnosis of A. Pulmonary Arterial Hypertension B.. Lung Cancer C. Pulmonary Edema D. Stomach Cancer 17) Diagnostics for Mr. Taps will most likely include chest -ray, A. Thoracoscopy, and cytological [cellular] examination B. Cardiac catheterization, and thoracentesis C. Echocardiogram, and needle biopsy D. Paracentesis, and node biopsy 18) Mr. Taps goes to ICU post right lobectomy with a water seal chest tube drainage system. Identify chest tube management safety priorities: A. Check water seal every shift to ensure > 2 cm. water B. Strip chest tube every shift to prevent clotting C. Clamp chest tube for 1 hour each shift D. Clamp chest tube during physical therapy 19) The RN notifies the Rapid Response Team when A. Tidaling is observed in the water chamber B. Drainage is less than 70 mL/hr. C. Chest tube air leak is detected D. Tracheal deviation and dyspnea Mr. Chin, 67 yr. old, goes to Emergency Dept. with swollen, red, warm to touch left calf after a 5-hr. flight. Denies recent trauma, surgery, or major Medical HX. Vital Signs stable; SpO2 93%-room air. Doppler of lower extremities with deep venous thrombosis (DVT) in 3 left lower leg veins; D-dimer test is positive. Mr. Chin is admitted to telemetry. Transfer orders: telemetry monitoring, IV 0.9% NaCl @ 100 mL/hr., Heparin IV, O2 @ 2L/min./nasal cannula to keep SpO2 > 95%. 20) Nursing intervention(s) on telemetry for Mr. Chin include(s) A. Institute bleeding precautions B. Implement oxygen therapy C. Administer IV antibiotics D. Answers a, and b 21) Goal(s) for Mr. Chin's heparin therapy include(s) A. PTT between 1.5-2.5 times the control value B. Absence of bleeding, bruising, petechiae C. Hemoglobin, hematocrit, and platelet count within normal range D. All of the above 22) Mr. Chin abruptly develops dyspnea, cough, and sharp, stabbing chest pain. He is restless, anxious, tachypneic, tachycardic, and diaphoretic. SpO2 on O2 @ 2L/min/nasal canula is 90%. The RN suspects this Medical Diagnosis A. Pulmonary Embolism B. Myocardial Infarction C. Acute Respiratory Failure D. Pulmonary Edema 23) The RN's priority intervention for Mr. Chin is to call A. Code Blue B. Stroke Code C. Rapid Response Team D. Respiratory Therapist 24) The Preceptor explains the patient in Acute Respiratory Failure always has A. Absence of positive inspiratory pressure B. Collapse of the alveoli in the lung C. Hypoxemia, or low blood oxygen levels D. Poor inspiratory efforts E. Cardiogenic Shock 25) The Preceptor explains that Ventilatory Failure involves A. Inadequate air movement into and out of the lungs B. Air moves in and out of the lungs adequately, but does not oxygenate blood C. Extrapulmonary causes like spinal cord injuries, sleep apnea, & stroke D. Answers a, and c 26) The new grad knows the hallmark symptom and medical treatments for Acute Respiratory Failure as A. Dyspnea, treated with oxygen therapy, bronchodilators, and anti-inflammatory meds B. Insomnia, treated with anxiolytics, sedatives, and sleeping pills C. Anxiety, treated with anxiolytics, analgesics, and sedatives D. Infection, treated with antibiotics, analgesics, and anti-inflammatory meds Mr. Hyster, 34-yr.-old, is brought to the Emergency Dept. by paramedics during the Lilac Fire with smoke inhalation. He presents with ? work of breathing as evidenced by intercostal and substernal retractions, noisy 24/min. respirations, cyanosis, pallor, sweating; mental confusion. Lung sounds are normal. Sinus Tachycardia - 120 beats/min. BP in high fowler's, left arm 92/64 mm Hg, oxygen @ 4L/min./nasal canula; SpO2 90%. Peripheral IV of 0.9% NaCl @ 75 mL/ hr. 27) Identify STAT priority diagnostics for Mr. Hyster A. Urinalysis, and Complete Blood Count B. Arterial Blood Gas, and chest x-ray C. Basic Metabolic, and Liver Panels D. Thyroid Panel, and Chest X-Ray Mr. Hyster's SpO2 drops to 86% on 8 L/min./mask. The RN calls for the ED Physician and reviews diagnostics. Chest x-ray shows a diffuse haziness, "whited out", ground-glass appearance. ABG shows lowered partial pressure of arterial oxygen (PaO2) despite increased oxygenation. 12 Lead ECG is normal. The ED Physician performs a Rapid Sequence Intubation (RSI). Mr. Hyster is started on a ventilator and transferred to ICU. 28) Mr. Hyster's Medical Diagnosis is A. Acute Respiratory Failure B. Cardiogenic Shock C. Acute Respiratory Distress Syndrome D. Pulmonary Edema 29) ICU intervention(s) for Mr. Hyster include(s) A. Positive End Expiratory Pressure (PEEP); ventilator alarms "on" B. Turning > every 2 hrs. (including prone position) to promote gas exchange C. Conservative fluid therapy with diuretics and nutrition therapy D. All of the above Mr. Aka's labs are: urine specific gravity of 1.003; low osmolarity of 150 mOsm/kg. Electrolytes show hypernatremia. The RN notifies the Provider of lab abnormalities. Within the last 24 hrs., total input was 3,000 mL; urinary output was 5,000 mL. 30) Mr. Aka is medically diagnosed with A. Syndrome of Inappropriate Antidiuretic Hormone B. Cushing's Disease C. Diabetes insipidus D. Adrenal Crisis 31) The Neuro Attending will add the following drug to Mr. Aka to start daily A. Vasopressin antagonist conivaptan/Vaprisol B. Sodium chloride 3% IV C. Oral antibiotic, demeclocycline/Declomycin D. Synthetic vasopressin, desmopressin acetate/DDAVP Mr. Xing, 56 yr.-old, has small cell lung cancer. His wife drove him to the Emergency Dept. complaining of recent headaches, lethargy, and disorientation. Physical Assessment: decreased deep tendon reflexes, full and bounding pulses, hypothermia; no dependent edema. Diagnostics are ordered including: serum osmolarity, complete metabolic panel, urine specific gravity and sodium. He has not voided in the last 16 hrs. 32) The RN expects Mr. Xing’s labs will show A. Hyponatremia, low plasma osmolarity, increase urine specific gravity & sodium B. Hypernatremia, high plasma osmolarity, decrease urine specific gravity & sodium C. Hypokalemia, high plasma osmolarity, decrease urine specific gravity & sodium D. Hyperkalemia, high plasma osmolarity, high urine specific gravity & sodium 33) Mr. Xing's labs come back: blood panel shows Sodium of 116 mEq/L; plasma osmolarity is low, urine osmolarity is high with elevated sodium. Mr. Xing's medical diagnosis is A. Adrenal Crisis B. Diabetes Insipidus C. Cushing's Disease D. Syndrome of Inappropriate Antidiuretic Hormone 34) Nursing identifies the following problems and interventions for Mr. Xing A. Safety Risks related to falls - implement fall precautions B. Safety Risks related to anticoagulation - implement bleeding precautions C. Safety Risks related to seizures-implement seizure precautions D. Answers a, and c 35) Drug therapy for Syndrome of Inappropriate Antidiuretic Hormone (SIADH) include(s) A. Vasopressin antagonists that promote water excretion without sodium loss B. Hypertonic saline, 3% Sodium Chloride IV C. Synthetic vasopressin, desmopressin acetate/DDAVP D. Answers a, and b 36) Nursing intervention(s) for Mr. Xing include(s) A. Daily intake & output B. Fluid restrictions C. Weigh daily D. All of the above Mr. Chaos, 45 yr.-old, is admitted to Telemetry with fatigue, muscle weakness, nausea, vomiting, diarrhea, and abdominal pain for 3 days. He was diagnosed with Acquired Immune Deficiency Syndrome (AIDS) 3 yrs. ago. The Emergency Dept. started a peripheral IV of dextrose 5% in Normal Saline @ 150 mL/hr.; 100 mg Solu-cortef IV bolus was given. RN reports the labs (listed below) to the Provider: 37) The Medical Diagnosis for Mr. Chaos is life threatening A) Adrenal/Addisonian Crisis, Acute Renal Insufficiency B) Hypercortisolism, Cushing's Disease C) Secondary Diabetes Insipidus D) Primary Syndrome of Inappropriate Antidiuretic Hormone 38) The Nurse's priority assessment for Mr. Chaos' current status is A. Cardiac function B. Airway management C. Monitoring for fluid deficit D. Monitoring for glucose regulation 39) Mr. Chaos will require cortisol and aldosterone deficiency drug replacement for life. The most common drug given in divided doses is A. Prednisolone B. Cortisone C. Hydrocortisone D. Prednisone Mrs. Potts is admitted to the telemetry unit with Cushing's Disease. She has bilateral adrenal hyperplasia (most common etiology). 40) Your assessment of Mrs. Potts notes: A. Truncal obesity, abdominal striae B. Moon face, buffalo hump C. Muscular arms and legs D. Answers a, and b 41) Non-surgical interventions for Mrs. Potts include patient safety, drug therapy, and monitoring for A. Fluid Volume Deficit B. Sleep Deficit C. Fluid Volume Overload D. Impaired Gas Exchange 42) Preoperative care for Mrs. Potts involves: A. Correcting fluid & electrolyte balance B. Infection prevention & hand hygiene C. Giving glucocorticoid preparations D. All of the above 43) Postoperative care for Mrs. Potts involves: A. Critical Care monitoring every 15 mins. for shock B. Giving glucocorticoid preparations C. Monitoring electrolytes, weight, intake & output D. All of the above 44) A 60 year-old male patient who was admitted to the coronary care unit develops ventricular fibrillation. The first action the nurse should take is to A. Administer IV antidysrhythmic drugs per protocol. B. Perform defibrillation. C. Prepare for synchronized cardioversion. D. Initiate cardiopulmonary resuscitation. 45) A patient’s cardiac rhythm is sinus bradycardia with a heart rate of 32 beats/minute. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit: A. Palpitations B. HTN C. SOB D. Warm, flushed skin