Exam (elaborations)

medsurg 2 midterm

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Course
Medsurg 2\\

Institution
Medsurg 2\\

The nurse is caring for a client with a new tracheostomy. Which assessment finding requires the nurse's immediate action? - answer-Crackling sensation around the neck when skin is palpated. A client has a new tracheostomy and is receiving 60% oxygen via tracheostomy collar. Which assessment find...

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medsurg 2 midterm

Institution Medsurg 2
Course Medsurg 2

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MEDSURG 2 MIDTERM EXAM WITH ANSWERS

The nurse is caring for a client with a new tracheostomy. Which assessment finding requires the nurse's immediate action?
- answer-Crackling sensation around the neck when skin is palpated.

A client has a new tracheostomy and is receiving 60% oxygen via tracheostomy collar. Which assessment finding requires
immediate action by the nurse? - answer-Constant, nonproductive coughing

A client who is receiving continuous oxygen therapy by nasal cannula for an acute respiratory problem is becoming
increasingly confused. What does the nurse do first? - answer-Assess the client's pulse oximetry.

A client is 24 hours postoperative after a tracheostomy has been performed. The nurse finds the client cyanotic, with the
tracheostomy tube lying on his chest. Which action by the nurse takes priority? - answer-Ventilate with a resuscitation bag
and mask.

When in 3rd degree block, what does the nurse implement? - answer-Atropine and external pacing (zoll pad)

Digoxin - answer-1. Class: Antiarrhythmics
2. Tx: increases CO for Heart failure, & A. Fib.

A client is to be discharged home on oxygen therapy. What information does the nurse teach the client? - answer-"The D
or C cylinder can be carried."

Adenocard (Adenosine) - answer-1. Class: Antiarrhythmic
2. Tx: Conversion of SVT to normal sinus rhythm when vagal maneuvers are unsuccessful

What is the treatment for pulseless Ventricular tachycardia? - answer-Defibrillate the patient immediately and CPR.

What are treatments for symptoms of bradycardia? - answer-Asymptomatic - monitor VS & patient. Symptomatic
Atropine, increase intravascular volume via IV fluids, apply oxygen. Pacing may be needed.

What are biggest risk factors for coronary artery disease? - answer-1. Nonmodifiable: age, gender, family hx, ethnicity
2. Modifiable: lifestyle choices, such as smoking and obesity

, What medication is given for PVC's? - answer-Lidocaine

What medication is given for V-Fib? - answer-Amiodarone

Know what to look out for post-op tracheostomy care. What assessment findings you need to be alert for - answer-1.
ensure patent airway & presence of bilateral breath sounds
2. Tachypnea indicates hypoxia and dyspnea indicates secretions in airway
3. cyanosis, especially around the lips
4. pulse oximetry for hypoxia
5. check skin around trache and neck for secretions because of skin breakdown
6. check mouth for ulcers, bacterial or fungal growth and dental caries
7. swallowing

Complications of tracheostomy - answer-1. tube obstruction as a result of secretions or cuff displacement
2. tube dislodgement & accidental decannulation can occur when the tube system is not secure
3. pneumothorax occurs if chest cavity is entered
4. subcutaneous emphysema occurs when air escapes into fresh tissue planes of the neck or face.
5. bleeding - constant oozing is abnormal
6. infection
7. tracheomalacia - constant pressure from the cuff causing tracheal dilation
8. tracheal stenosis - narrowed tracheal lumen due to scar formation
9. tracheoesophageal fistula (TEF) - excessive cuff pressure causes erosion of the posterior wall of the trachea
10. trachea-innominate artery fistula - malpositioned tube causes pressure on the lateral wall causing necrosis and erosion
of the artery

For safety after a tracheostomy what should you make sure is always at bedside? - answer-1. Tracheostomy tube of the
same type including obturator
2. Same size or one size smaller
3. Tracheostomy insertion tray

If the tube is dislodged on an immature tracheostomy (first 72 hours after surgery) what should you do? - answer-
Ventilate the patient using a manual resuscitation bag and face mask while another nurse calls the rapid response team

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