198 Nursezone Med-surg Nursing Final Coaching (By Doc Tacs) Part 3 (25 To 46)
- 1.SITUATION: A 43 year old female was admitted to the hospital after a motor vehicle accident. She sustained fracture on the left side, pelvic fracture, and a left femoral fracture. She has a history of type 1 diabetes and breast cancer and is presently using birth control pills Which factor will place the patient at risk for developing ARDS?
- A.
Traumatic injury
- B.
History of diabetes
- C.
History of breast cancer
- D.
Use of birth control pills
- 2.SITUATION: A 43 year old female was admitted to the hospital after a motor vehicle accident. She sustained fracture on the left side, pelvic fracture, and a left femoral fracture. She has a history of type 1 diabetes and breast cancer and is presently using birth control pills A classic finding in the patient with ARDS is:
- A.
Sudden hypocalcemia with tetany
- B.
Severe hyperkalemia
- C.
Hypoxia resistant to oxygen therapy
- D.
Hypercapnia
- 3.SITUATION: A 43 year old female was admitted to the hospital after a motor vehicle accident. She sustained fracture on the left side, pelvic fracture, and a left femoral fracture. She has a history of type 1 diabetes and breast cancer and is presently using birth control pills What pathologic change is responsible for the development of pulmonary edema in patients with ARDS?
- A.
Right sided heart failure
- B.
Alveolocapillary membrane damage
- C.
Extravascular fluid volume excess
- D.
Pulmonary artery infarct
- 4.SITUATION: A 43 year old female was admitted to the hospital after a motor vehicle accident. She sustained fracture on the left side, pelvic fracture, and a left femoral fracture. She has a history of type 1 diabetes and breast cancer and is presently using birth control pills If the patient continues to show signs of hypoxemia, the nurse knows that the most appropriate medical treatment plan would be:
- A.
Prescribed mechanical ventilation
- B.
Prescribe chest physiotherapy
- C.
Prescribe low FiO2 concentrations
- D.
Insert a chest tube
- 5.SITUATION: A 43 year old female was admitted to the hospital after a motor vehicle accident. She sustained fracture on the left side, pelvic fracture, and a left femoral fracture. She has a history of type 1 diabetes and breast cancer and is presently using birth control pills A 21 year old patient with poorly controlled diabetes is brought to the ER with abnormally deep, gasping respiration. This breathing pattern is known as:
- A.
Bradypnea
- B.
Cheyne-Stokes Respiration
- C.
Biot’s respiration
- D.
Kussmaul’s respiration
- 6.SITUATION: A 40 year old male client is returned to the wards after tracheostomy insertion. His respirations are regular and unlabored but his tracheostomy is producing large amounts of sputum During the immediate post-op period, the priority nursing diagnosis would be:
- A.
Ineffective airway clearance related to bronchial secretions
- B.
Risk for infection related to new surgical incision
- C.
Risk for injury related to confusion from anesthesia
- D.
Body image disturbance related to tracheostomy insertion
- 7.SITUATION: A 40 year old male client is returned to the wards after tracheostomy insertion. His respirations are regular and unlabored but his tracheostomy is producing large amounts of sputum The patient requires tracheostomy care at each shift. When providing tracheostomy care, the nurse should:
- A.
Wash the suction catheter with soap and water
- B.
Suction the patient first using low wall suction
- C.
Replace the disposable inner cannula daily
- D.
Clean the stoma with equal parts saline solution and hydrogen peroxide
- 8.SITUATION: A 40 year old male client is returned to the wards after tracheostomy insertion. His respirations are regular and unlabored but his tracheostomy is producing large amounts of sputum The next day, the patient has coughing episodes while taking clear liquids by mouth. The nurse should immediately:
- A.
Check to see if the tracheostomy cuff is inflated
- B.
Check to see if the tracheostomy cuff is deflated
- C.
Consult speech therapy for swallowing studies
- D.
Place the patient in Trendelenburg position
- 9.SITUATION: A 40 year old male client is returned to the wards after tracheostomy insertion. His respirations are regular and unlabored but his tracheostomy is producing large amounts of sputum The nursing diagnosis of impaired gas exchange related to lung surgery was assigned after lobectomy. With this diagnosis, the expected outcome is that the patient will:
- A.
Report loss of chest pain
- B.
Assume the semi-fowler’s position
- C.
Request pain medication frequently
- D.
Exhibit a pulse oximetry of 94% or above
- 10.SITUATION: A 40 year old male client is returned to the wards after tracheostomy insertion. His respirations are regular and unlabored but his tracheostomy is producing large amounts of sputum When teaching the patient about skin care after radiotherapy, the nurse should encourage him to:
- A.
Use skin lotions and powders on the irradiated area
- B.
Avoid washing off the marks placed on his skin to guide radiation therapy
- C.
Wear constrictive clothing
- D.
Massage the irradiated area to increase circulation
- 11.SITUATION: A 54 year old male has had a persistent cough for about 4 months. One week ago, he noted blood in his sputum. He was admitted to the hospital where diagnostic testing confirmed lung cancer The patient’s wife is concerned about his poor appetite and weight loss. The nurse explains that radiotherapy, anxiety, and the disease itself can cause anorexia. The nurse encourage the patient to:
- A.
Limit his activities before and after meals
- B.
Force fluids
- C.
Eat high calorie foods
- D.
Eat hot meat dishes with special sauces
- 12.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital Which initial clinical manifestation would the nurse expect the patient to exhibit?
- A.
Paradoxical respiration
- B.
Crackles heard in the right lung base
- C.
A clicking sensation during inspiration
- D.
Shallow, painful breathing
- 13.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital The patient becomes increasingly irritable and short of breath. Chest x-ray shows 30% of his right lung has collapsed. At this point, the nurse should assess for which early sign of hypoxia?
- A.
Bradycardia
- B.
Restlessness
- C.
Hypotension
- D.
Glycosuria
- 14.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital The doctor orders diazepam IV before chest tube insertion. The nurse understands that his is primarily to:
- A.
Alleviate pain
- B.
Increase respiratory rate
- C.
Relieve anxiety and tension
- D.
Increase muscle activity
- 15.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital While the client is connected to the chest drainage device, the nurse should immediately report:
- A.
Excessive bubbling in the water-seal chamber
- B.
Fluctuation of fluid in the water-seal chamber
- C.
Dark red drainage in the collection chamber
- D.
A fluid level of 20 cm in the suction control chamber
- 16.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital Which observation would most likely indicate that the patient’s chest tube should be removed?
- A.
120 ml of chest tube drainage in 24 hours
- B.
Cessation of pain and dyspnea
- C.
Absence of fluid fluctuation in the water-seal chamber
- D.
Lung re-expansion on chest x-ray
- 17.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital Which method would best prevent air from entering the pleural cavity when the chest tube is removed?
- A.
Breathing through pursed lips
- B.
Inhaling quickly and shallowly
- C.
Breathing with an opened mouth
- D.
Performing valsalva maneuver
- 18.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital A client has right pneumothorax on the basis of chest x-ray and dyspnea. Which will indicate to the nurse that the client’s condition is deteriorating?
- A.
Tracheal deviation to the left
- B.
Wheezes
- C.
Hypertension
- D.
Painful respirations
- 19.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital The nurse is caring for a client admitted with acute laryngotracheobronchitis (LTB). Because of the possibility of complete obstruction of the airway, which of the following should the nurse have available?
- A.
Intravenous access supplies
- B.
Emergency intubation
- C.
Intravenous fluid-administration pump
- D.
Supplemental oxygen
- 20.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital What clinical manifestation is most indicative of possible carbon monoxide poisoning?
- A.
Pulse oximetry reading of 80%
- B.
Expiratory stridor and nasal flaring
- C.
Cherry red color to the mucous membranes
- D.
Presence of carbonaceous particles in sputum
- 21.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital The nurse is caring for a client with pneumonia who is allergic to penicillin. Which antibiotic is safest to administer to this client?
- A.
Cefazolin
- B.
Amoxicillin
- C.
Erythromycin
- D.
Ceftriaxone
- 22.SITUATION: A 19 year old male college student is sustained fractures on the right side of the thorax. He was taken to the emergency department of a local hospital During the first 72 hours the nurse recognizes that the most severe complication among tracheostomized patients is:
- A.
Tube dislodgment
- B.
Tube obstruction
- C.
Pneumothorax
- D.
Bleeding
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