Advanced Medsurg Final Exam for lucky students. Complete With Questions And Answers
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NURS 120
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West Coast University
Advanced Medsurg Final Exam for lucky students. Complete With Questions And Answers.1. Pt. receiving chemo with acute dehydration (nausea and vomiting), what to do to prevent to Systemic
inflammatory response syndrome (SIRS) and Multiple organ dysfunction syndrome (MODS) –
a. place patient in a...
advanced medsurg final exam for lucky students complete with questions and answers
pt receiving chemo with acute dehydration nause
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Advanced Medsurg Final for lucky students ☺
1. Pt. receiving chemo with acute dehydration (nausea and vomiting), what to do to prevent to Systemic
inflammatory response syndrome (SIRS) and Multiple organ dysfunction syndrome (MODS) –
a. place patient in a private room (immunocompromised)
2. When assessing hemodynamic of patient with shock of unknown etiology, don’t give large volumes of
crystalloids when –
a. CO is high and CVP is low (septic shock)
3. Diabetic patient vomiting and diarrhea for past 3 days, glucose is 748, urine output 120, cyanotic
hands and feet–
a. progressive stage of hypovolemic shock
4. Industrial acids at work spilled on patient, what to do before transporting to hospital –
a. flush burned area with large amounts of tap water
5. 6 hours after thermal burn to arms and legs, important info to tell doctor
a. urine output 20-30 ml per hour
6. During early emergent phase of burns –
a. give opioid IV so that medications will be rapidly effective
7. Nurse caring for pt. admitted with burns, 30% of body surface recognized, emergent to acute phase –
a. pt. has large quantities of pale urine
8. Pt. acute phase of burn injury requires frequent hydrotherapy sessions for wound debridement –
a. closely monitor serum sodium level
9. Acute asthma attack, which info indicates pt. requires further teaching –
a. pt. has been using Proventil more frequently over the last 4 days
10. Asthma pt. admitted for acute respiratory distress, notify HCP immediately if –
a. decreased breath sounds and wheezing
11. Intubation with mechanical ventilation for pt. with status asthmaticus when –
a. fatigue and oxygen saturation of 88% develops
12. Asthma pt. has new prescription for Advair and diskus, ask nurse for purpose of 2 drugs –
a. one drug decreases inflammation, other is a bronchodilator
13. HCP prescribed MDI q8h Maxair and Symbicort –
a. use spacer with MDI
14. Activity intolerance for pt. with asthma –
a. work of breathing
15. Finding for acute asthma attack was responding to bronchodilator therapy –
a. wheezes are more easily heard
16. Pt. has mild persistent asthma uses Proventil has new prescription for chromolyn –
a. use chromolyn for inflammatory airway changes, take several weeks for max effect
17. During assessment of asthma, has wheezing and dyspnea –
a. give meds to reduce airway narrowing
,18. Pt. with acute asthma attack comes to ER, ABG’s are drawn, pH 7.4, co2 32, paO2 70, teach pt use of
peak flow meter –
a. take something before peak flow readings when asthma attack/symptoms
19. COPD pt. has dyspnea, cough, yellow sputum, upon palpation of thorax expected finding –
a. chest expansion is diminished
20. COPD with barrel chest, why – overinflation of the alveoli
21. Pulmonary function test for COPD pt – increased residual volume
22. Chronic hypoxemia 89-90 % caused by COPD, compliance – arrange pt. spouse to be present during
teaching
23. 68 YO with COPD, cor pulmonale manifestation – 3+ edema in lower extremities
24. COPD that smokes, tell them that smoking – decreases area available for oxygen absorption
26. Imbalanced nutrition less than body requirement intervention –
a. offer high calorie snacks between meals and at bedtime
27. COPD, info given by patient that confirms chronic bronchitis –
a. productive cough every winter for 2 months
28. Pursed lip breathing purpose –
a. preventing airway collapse and trapping air in lung during expiration
29. Impaired gas exchange in COPD with acute respiratory distress – pulse ox 86%
30. COPD with cor pulmonale, assess/monitor for – JVD
31. COPD receiving oxygen – maintain oxygen at 90% or greater
32. COPD ask about home health oxygen use – it can improve pt. long term prognosis and quality of life
33. RN observes students suctioning, when to intervene – clean gloves when using a sterile catheter
34. Pt. coughs violently and dislodges trach tube – insert obturator
35. When inflating cough to appropriate level – use manometer
36. Info in pt with ARDS being treated with PEEP indicates complication – pt. has subcutaneous
emphysema
37. PEEP purpose, explains to family –
a. PEEP prevents air sacs from collapsing during exhalation
38. Evaluate 02 ventilation for acute respiratory – use ABG
39. Findings for acute respiratory failure – partial pressure of Oxygen at 45 mmhg
40. Caring for patient developed ARDS as a result of a UTI, how it happened?
a. – infection caused by generalized inflammation that damaged the lungs
41. When prone position Is used for ARDS, positioning is effective if – patients FIo2 is 90, and o2 stat is 92
42. Nurse obtains vital signs of temp 101, bp 90/56, pulse 92, resp 34, whats next ? – obtain pulse ox
,43. Monitor for clinical manifestations of hypercapnia when pt. in ER has –
a. chest trauma and multiple rib fractures
44. Pt. hypercapnia respiratory failure, resp. 8, pulse ox 89, extremely lethargic – ET with PEEP
45. Protect pt. from aspiration pneumonia – position pt. with altered level of consciousness in lateral
position
46. Drug overdose in ER, barbiturates, potential complication–
a. hypercapnic respiratory failure related to decreased ventilator effort
47. Pulmonary embolism, how to explain to patient –
a. blood flow to some areas of your lungs is decreased even though you’re taking adequate
breaths
48. Upper Lobectomy patient complains of incisional pain 7/10, decreased left sided breath sounds, 100 ML of
bloody drainage with large air leak, intervention –
a. medicate patient with ordered morphine
49. HCP 2 chest tubes with Y-connector in pneumothorax, nurse should be concerned about –
a. 400 ml of blood in the collection chamber
50. Pt has right sided chest tube following thoracotomy has continuous bubbling in collection chamber –
a. take no action with collection device
51. Pre-op for left pneumonectomy for cancer of lungs – use incentive spirometer
52. Monitor strip for MI, no P wave, rate 162, R interval irregular, PR not measurable, QRS wide and
distorted
a. Ventricular tachycardia
53. 50 second episode of v. tach –
a. administer IV antidysrhythmic drugs per protocol
54. MI develop symptomatic hypotension, hr 30, atropine is prescribed, effective when –
a. increase in patient heart rate
55. Large MI has frequent PVC - monitor apical heart rate
56. Pt. complains of racing heart, BP 102/68, puts on cardiac monitor –
a. obtain further info about possible cause for heart rate (STRIP)
57. Dizziness and SOB for several days
a. 3rd degree av block (STRIP)
58. Nurse gets stuck by a needle –
a. hep b vaccine and HBIG injection
59. Hepatitis from contaminated food, serologic testing result –
a. anti-hepatitis virus immunoglobulin
60. Evaluation of patient at outpatient clinic, admin of hep B vaccine is effective when –
a. anti Hep B are present in specimen
61. Positive for anti HCV –
a. schedule patient for HCV genotype testing
62. Homeless patient, severe anorexia, jaundice, diagnosed with hepatitis –
a. maintain adequate nutrition
63. Acute hep B asks if treatment is available –
a. no meds are available to treat acute viral hepatitis, adequate nutrition and rest are the most
important treatments (HB=NO MED)
, 64. Combination therapy in HIV with hepatitis C patient –
a. monitor lymphocyte count
65. When taking history, what should make you screen for hep C –
a. One time use of IV drugs from years ago
66. Abrupt onset of jaundice, nausea, vomiting, hepatomegaly, abnormal liver function, what is the first
question to ask – are you taking any OTC drugs?
67. Teaching pt. recovering from hep B, further teaching –
a. when my jaundice is gone, my infection is cured, I’ve recovered
68. 32 yo very alcoholic, cirrhosis, teach them – abstinence from alcohol
69. Pt. with cirrhosis has 135 Na, 3.2 K, needs aldactone and Lasix, before notifying HCP – admin aldactone
70. When lactose is ordered for patient with advanced cirrhosis, pt complains diarrhea –
a. lactose improves nervous system function
71. Acute pancreatitis, severe ab pain, N/V, expect – elevated amylase ☺
72. Caring for patient with acute pancreatitis – assign highest priority to respiratory (airway)
73. Acute pancreatitis on NG tube, NPO, suction purpose –
a. To reduction of pancreatic enzymes
74. Collaborative problem for acute pancreatitis electrolyte imbalance –
a. muscle twitching and finger numbness
75. When obtaining history about acute pancreatitis – ask about alcohol use/consumption
76. During diuretic phase of ARF, fluid and electrolyte –
a. hypovolemia
77. Before administering sodium polystyrene (kayexelate) –
a. assess bowel sounds
78. Hypoglycemia awareness, what should nurse ask to identify potential hypoglycemia –
a. did you notice any bloating feeling after eating?
79. Brain tumor receiving brain tumor after craniotomy was prescribe solumedrol –
a. helps her prevent increased ICP
80. Cerebral edema with sodium of 115 low, decrease LOC, complains of headache –
a. admin 5% hypertonic saline
81. Spinal cord tumor, which requires immediate intervention –
a. new onset of weakness in both legs
82. Neck is fractured at C5 admitted to ICU, spinal shock assessment –
a. flaccid paralysis and lack of sensation below the level of injury
83. Aspirin order on patient with possible stroke, don’t give it when –
a. pt. develops a terrible headache
84. BP 120/60, ICP 24, CPP 56 (70-100) –
a. this patient indicates impaired brain flow
85. Head injury, BP 92/50 ICP 18 –
a. notify HCP about assessments
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