NSG 233 MED SURGE FINAL EXAM 1

NSG 233 MED SURGE FINAL EXAM 1

LATEST VERSION 2024 WITH 200

QUESTIONS AND ANSWERS GRADED A+/

NSG 233 MED SURGE ACTUAL FINAL EXAM

QUESTIONS AND CORRECT ANSWERS

LATEST 2024 (BRAND NEW!!)

Scenario: The nurse notes that Mr. U has tracheal deviation. Tension

pneumothorax is suspected because of the sudden onset respiratory distress and the presence of the chest tube, which is a risk factor.Which signs and symptoms would the nurse expect to observe with a tension pneumothorax? Select all that apply.

• Tachypnea
• Paradoxical chest movement
• Hemoptysis
• Profuse diaphoresis
• Distended jugular veins
• Decreased or absent breath sounds on the affected side
• Bradycardia
• Lateral or medial shift in the point of maximum impulse
• Severe dyspnea
• Progressive cyanosis
• Extreme agitation - ANSWER-1, 4, 5, 6, 8, 9, 10, 11

Rational:

Tension pneumothorax is a medical emergency that occurs when air enters the pleural space but cannot escape. Pressure builds up on the affected lung, heart, and 1 / 4

the great vessels. A mediastinal shift occurs when continued pressure pushes against the unaffected lung and oxygenation and perfusion are further compromised. For Mr. U, the tension pneumothorax is most likely to be as- sociated with the chest tube. Tachycardia, not bradycardia, is expected.Hemoptysis is more likely to occur with a hemopneumothorax. Paradoxical chest movements are associated with flail chest secondary to rib fractures.

The nurse sees that Mr. B (bladder cancer) has received docusate for the past 2 days. Which question is the nurse most likely to ask to evaluate the effectiveness of the docusate?

• "Has the medication helped to relieve the nausea?"
• "Are you experiencing any burning with urination?"
• "Were you able to sleep soundly the last couple of nights?"
• "Did you have a bowel movement today or yesterday?" - ANSWER-D. "Did

you have a bowel movement today or yesterday?"

Rational:

Docusate is a stool softener that is given for occasional constipation.

Which two patients are the most critical and likely to require frequent assessment and skilled care through-out the shift? Select two.

• Mr. U (pulmonary resection)
• Ms. G (breast lumpectomy)
• Mr. N (non-Hodgkin lymphoma)
• Mr. B (bladder cancer)
• Mr. L (tracheostomy and partial laryngectomy)
• Ms. C (bowel resection and colostomy) - ANSWER-1 and 5

Rational:

Mr L and Mr U have the most critical conditions. Mr. L requires tracheostomy care and frequent suctioning. In addition, he is still learning to cope with impaired 2 / 4

communications, changes in breathing, and managing his own secretions. He has tube feedings and is receiving chemotherapy. His energy level will be low, and he needs assistance for most ADLs. Mr. U had major chest surgery. He has a chest tube and requires frequent respiratory assessment. He is having significant pain that is not well controlled. Mr. U is also likely to have little energy to accomplish ADLs and has a risk for post-surgical complications.

The team leader is reviewing the pain management plan for Mr. U. He is having significant pain related to the cancer and the pulmonary resection. Which option would be the best for Mr. U?

• Mr. U has a high risk for respiratory distress, so opioids are not prescribed.
• Mr. U should be offered the non-opioid medication first to see it if works.
• Mr. U should receive around-the-clock fixed doses of opioid analgesics.
• Mr. U is instructed to ask for pain medication whenever he needs it. -

ANSWER-C. Mr. U should receive around-the-clock fixed doses of opioid analgesics.

Rational:

Patients who have continuous pain should be placed on around-the-clock analgesics. Non-opioid analgesics or as needed opioid administration may also be appropriate for situations such as breakthrough pain, but they are not the best solution for continuous pain. Patients should always be monitored for respiratory depression, especially if they are opioid naïve; however, this patient has advanced cancer, and he is also having postoperative pain, so opioids should not be withheld.

Mr. N (non-Hodgkin lymphoma) shyly asks, "Do doctors have a special way that they wash their hands? Everybody washes their hands and then rewashes their hands before they touch me or any of my personal items. Everybody—except that one doctor." What is the team leader's priority action?

• Contact the infection control person because the HCP probably needs a review

of infection control procedures. 3 / 4

• Reassure the patient that the HCP probably washed his hands just before

entering the room.

• Approach the HCP and explain what the patient noticed and the patient's

concerns about the hand washing.

• Tell the patient that the staff 's actions to protect against infection are based on

the latest laboratory results. - ANSWER-C. Approach the HCP and explain what the patient noticed and the patient's concerns about the hand washing.

Rational:

The nurse must use a professional and nonaccusatory tone of voice and manner in approaching the HCP. Patient data are communicated to improve patient care.Neutropenic precautions are usually based on laboratory results, but best practices would still include washing hands upon entering the room and then again before touching the patient. The infection control nurse could be contacted if the issue cannot be resolved and the HCP's behavior continues to place patients at risk for infection.

Mr. L (tracheostomy and partial laryngectomy) needs to receive a dose of IV chemotherapy during the shift. What is the most important action to take to prevent extravasation?

• Call the pharmacy to find out if the prescribed medication has vesicant

properties.

• Hold the medication until an implanted port or central line is established.
• Ensure that a chemotherapy-certified nurse is as-signed to care for the patient.
• Carefully monitor the access site during the administration of the medication. -

ANSWER-D. Carefully monitor the access site during the administration of the medication.

Rational:

If a very small amount (less than 0.5 mL) of a vesicant (chemical that damages the skin on contact) has leaked into skin, the likelihood of damage is lower. Thus very close monitoring can prevent larger amounts of leakage into the tissues. The chemotherapy-certified nurse has the knowledge to safely administer

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