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NUR 2790/NUR 2790 PN3 Final Exam Review Study Guide
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NUR 2790 PN3 Final Exam Review/Study Guide1. When to intervene, what could be wrong Steps to cardioversion:
• MUST be in SYNCHRONIZED mode (only deliver joule when senses R wave)
• 50-200 joules
• Turn OFF O2
• Sedate with Versed or Medazalam
2. Nurse in charge of new RN, on telemetry floor, patient suddenly into asystole, no pulse, no
respirations, which intervention would you question?
- Starts defib. …… Asystole means there is NO ELECTRICAL activity
o NEEDS TO START COMPRESSIONS
3. Priority - Which patient see first
-triage, which one to see first
Priority, manage assigned clients, which to see first
- - 3 priority questions in a row
4. Working in ICU and got a cardiac patient with new CABG 10hrs ago, mediastinal chest tube has
decreased from 100ml to 20ml in 1 hr. what would you do?
- Auscultate heart sounds (worried if the blood is building up around the pericardial sac; listen
for diminished heart sounds, pericardial friction rub)
5. Have 4 patients into ED – Priority (who we gonna see 1st?)
6. Burn patient – calculate BSA burn
7. Teaching patient with full thickness burns – need understand if the patient said something to you;
what would make you think they need additional teaching?
- Pt. is on the way to the rehab phase, what means they are ready for rehab phase
o Would they use lotion on burns? No due to infection
o Should they be doing range of motion?
o Should they go out and sunbathe? Avoid for a year
o Do they need pressure garments and if so, what use are the pressure garments? To
prevent further scarring
8. Patient with burns, what the burns look like – determine degree by description
9. ED patient admitted that was in a burning building and pts arms are chest are covered in dry leathery
charred skin. What would you do 1st?
- FLUIDS (there is such a major shift that occurs immediately we must replace immediately)
- Parkland formula - 4ml x kg x % BSA
10. ICU with partial thickness burns in the first 24hrs what is the priority assessment… What would we
be looking for?
, -Electrolyte imbalance: PEAKED T WAVES (due to the K being too high or too low)
11. Burn calculation (Parkland Formula)
12. Taking care of patient with burn injury, received fluid replacement, and now are diuresising (which
ends the emergent phase) What now is the highest priority?
-NUTRITION (HIGH protein diet), to aid with healing
13. Hypovolemic shock – Pt with vitals
-Do we use norepi? Yes, for vasoconstriction (to get push blood
- Walk in in the am and notice the bag is almost empty what would you do? MUST be titrated
OFF, call pharmacy to get it up to the pt. stat
14. If you were a nurse in ED – sent to MVA – come across patients complaining about neck and back
pain- what to do first?
- Lay on a FLAT, HARD surface and when we turn them use the Log roll (which takes 3 people!!
DON’T ever do it alone will do more damage to them than good)!!!
15. Taking care of a pt. on a mechanical ventilator and are supposed to draw ABG’s on them in 30 min.
What would u NOT do?
- DO NOT SUCTION (It decreases a pt. O2 level!!!!)
16. Taking care of immune compromised patient and his wife is getting education on caring for him,
teach her how to perform care and she is wearing artificial nails?
• She needs to remove the artificial nails because they harbor organisms (would not be ok for her
to take care of him with the artificial nails in place)
17. Malignant Neoplasm pt. with 10 lb weight loss in 2-3 weeks what is that r/t?
• Increased nutritional demand because of tumor metabolic demand
18. Stage cancer from T N M
19. Assessing several pt. in a clinic. Which client is highest risk for cancer?
20. Pt receiving bleomycin (antitumor antibiotic), what are you going to monitor for?
• Cardiac dysrhythmias: they need to be on a cardiac unit
21. Vincristine, what should the nurse avoid?
• Extravasation; will destroy vein and surrounding tissue (It is the HARDEST on the veins!!! Always
try to get a port for the pt. when administering Vincristine).
22. S/S for male patient taking estrogen
• Gynecomastia (breast enlargement)
23. Giving patient biological response modifier (BRM) in cancer for what reason?
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