RN Adult Medical Surgical Online
Practice 2024 A NGN
NGN
a thousand:
Client is alert and oriented and reviews not feeling nicely for some days. Client is on
continuous ambulatory peritoneal dialysis (CAPD) and reports dialysate appeared cloudy
this morning.
Reports stomach pain as 4 on a scale of 0 to 10.
Bowel sounds lively in all quadrants.
Peritoneal dialysis get entry to web site crimson, heat to the touch, with a small amount of
purulent drainage referred to on dressing.1300:
Client is lying in bed with the knees flexed, guarding the stomach. Abdomen is slightly
distended, hypoactive bowel sounds. Client reviews nausea. Reports ache as 6 on a scale of
0 to 10. Provider notified and updated with patron circumstance and diagnostic outcomes. -
ANSThe customer is experiencing manifestations of
peritonitis
due to
x-ray outcomes
.
NGN
Client admitted to clinical-surgical unit from PACU. Client reviews incisional ache as 2 on a
scale of zero to ten. Client appears stressed and frequently asks for water. Bilateral
decrease extremities cool with +1 pedal pulses. Urine output is forty mL for the beyond 2 hr.
Moderate amount of vibrant purple drainage mentioned on surgical incision dressing. -
ANSInsert a massive-gauge IV.
Initiate a fluid task.
Hypovolemia
Urine output
Blood pressure
A nurse is worrying for a client who has a potassium level of 3 mEq/L. Which of the following
evaluation findings ought to the nurse count on? - ANSHypoactive Bowel Sounds
NGN
0900:
Client offers with belly ache within the upper left quadrant for the beyond 2 days. States pain
became worse this morning and is radiating to the lower back. Rates pain as eight on a
scale of zero to 10.
Hypoactive bowel sounds; reviews nausea, no vomiting; consumer is passing flatus.
Febrile, orientated to character, vicinity, and time.
, Tachypnea with faded breath sounds.
Sinus tachycardia.
Client voids 300 mL of clean, amber urine.
0930:
Client vomited 100 mL brown liquid. - ANSThe customer is experiencing manifestations of
pancreatitis
as evidenced via the
amylase and lipase
.
0530:
Client is unsleeping and alert.
Arteriovenous fistula (AVF) to proper forearm with thrill palpated and auscultated for bruit.
Lung sounds clear upon auscultation; patron denies shortness of breath. No peripheral
edema noted; capillary refill is less than 3 seconds; +2 bilateral pedal and radial pulses.
AVF access organized and cannulated twice and not using a issue. Lines are taped and
secured; remedy is initiated.0600:
Client is analyzing a e book. Access is visible, and contours are at ease. Client reviews no
pain or ache.0630:
Client reports feeling warm, nauseated, and lightheaded; seems restless and slightly
confused. - ANSPerform a 12-lead ECG isn't always indicated.
Place the patron in Trendelenburg function is indicated.
Administer a zero.Nine% sodium chloride 2 hundred mL IV bolus is indicated.
Apply oxygen at 2 L/min through nasal cannula is indicated
Notify the company without delay is indicated
Obtain the customer's blood glucose degree is not indicated.
1800:
Emergency medical team eliminated client's blouse at the scene and initiated 18-gauge IV
remedy within the right antecubital area.
Client has complete-thickness burns over the upper 1/2 of the chest and each forearms;
partial-thickness burns are gift at the consumer's face and neck.
Sinus tachycardia, pulses to brachial extremities palpable. 1+ edema to higher extremities.
Respirations even, labored with scattered rhonchi. Soot noted to the purchaser's mouth and
nostril. Oxygen 40% thru face tent carried out.
Hypoactive bowel sounds.
16 French indwelling urinary catheter inserted with go back of 250 mL of yellow urine.
Lactated Ringer's infusing to right antecubital. Provider getting ready to insert right femoral
significant line catheter.
1830:
Client's voice is turning into hoarse and reports problem swallowing. Wheezes present to top
lobes bilaterally. Provider notified. Client placed upright, oxygen through face tent. Blood
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