NR 446 Medical Surgical Assessment

NR 446 Medical Surgical Assessment Latest 2023 / 2024

• A nurse is caring for a client following an infratemporal craniotomy. How should the

nurse position this client in the immediate post-operative period?• Closely monitor vital signs and neurological status, including using the Glasgow Scale.• Treat pain adequately • Supratentorial surgery - Elevate the HOB 30 degrees; Keep in neutral position to prevent increased ICP. Turn side on side or supine to decrease risk of pressure ulcers and pneumonia.• Infratentorial craniotomy – Lie flat and side-lying. Turn side to side every 2 hours for 24 to 48 hr.• Straining activities (moving up in bed and attempting to have a bowel movement should be avoided to prevent increased ICP.• Postoperative bleeding and seizure activity are the greatest risks.• Periorbital edema and ecchymosis is not unusual. Treat with cold compresses • Assess head dressing every 1 to 2 hr for drainage.

• A nurse is caring for a client following a bone marrow biopsy. What information should

the nurse include in the discharge education?• Education the client on how to check the biopsy site daily. Keep the dressing clean, dry, and intact.• Educate client on the symptoms of an infection. Notify provider if signs of infection or to report excessive bleeding.• If sutures are in place, remind the client to return in 7 to 10 days to have them removed.

• What dietary education should the nurse provide to a client diagnosed with a hiatal

hernia?Clients should consume a soft diet for the first week postoperatively. Avoid carbonated beverages. Ambulate, but avoid heavy lifting.• Avoid eating immediately prior to going to bed.• Avoid foods and beverages that decrease LES pressure (fatty and fried foods, chocolate, coffee, peppermint spicy foods, tomatoes, citrus fruits, and alcohol).

• What are the recommendations for vaccinations in the adult population?

• Herpes Zoster Vaccine: all adults older than 60

• HPV4: Males up to age 21; 26 if known risk factors, medical, occupational,

lifestyle

• Human papilloma virus (HPV2 or 4): Females up to age 26, not immunized as

children.• Influenza vaccine 1 / 2

• Hepatitis A & B: adults age 60 or younger who have DM.

• Pneumococcal Polysaccharide Vaccine, or PPSV

• Measles, Mumps, & Rubella Vaccine (MMR): ages 19,49,50

• Tetanus & diphtheria booster: every 10 years

• A nurse is providing education to a group of workers regarding risk factors for carpal

tunnel syndrome. What information should be provided?Carpal tunnel pain is often worse at night and can radiate to the arm, shoulder, and neck or chest. Paresthesia (painful tingling). Sensory changes occur weeks or months before motor.

RISK FACTORS INCLUDE:

• Some metabolic and connective tissue diseases such as rheumatoid arthritis (synovitis) and diabetes mellitus (reduced circulation) • Occupational injury from repetitive stress of hand activities such as pinching or grasping during wrist flexion (computer users) • Repetitive sports injury (tennis) • Children and adolescents due to use of computers and handheld devices.• Growth of a space occupying lesion such as a ganglia or lipoma

• A nurse is caring for a client who has been admitted with renal calculi. List three (3)

interventions the nurse will take in the management of renal calculi.• Assess pain status, monitor intake and output and evaluate urinary pH • The nurse should strain all urine to check for passage of calculus, and save calculus for laboratory analysis.• Encourage clients to increase oral fluids intake to 3L/daily, unless contraindicated.• Administer IV fluids and pain medication as prescribed • Provide preoperative and postoperative care as indicated.• Report laboratory and diagnostic findings to the provider.• Encourage ambulation to promote passage of the calculus

• A nurse is caring for a client experiencing metabolic acidosis. What are three (3) causes

of metabolic acidosis?• Excess production of hydrogen ions • Diabetic ketoacidosis (DKA) • Starvation

• Lactic acidosis can result from: Heavy exercise, Seizure activity, Hypoxia

• Excessive intake of acids: Ethyl alcohol, Methyl alcohol, Acetylsalicylic acid (aspirin) • Inadequate elimination of hydrogen Ions; Kidney failure, Severe lung problems • Inadequate production of bicarbonate; Kidney failure, Pancreatitis

• Impaired liver or pancreatic function: Liver failure

• Excess elimination of bicarbonate: Diarrhea

• / 2