FINAL EXAM - FINAL STUDY MED SURG III

The nurse is planning the care of a patient with a TBI in the neurosurgical ICU. In developing the plan of care, what interventions should be a priority? (Select all that apply.)

While providing mouth care to a patient with late-stage cirrhosis, you note a pungent, sweet, musty smell to the breath. This is known as:

Which medication is a calcium channel blocker typically used to treat atrial fibrillation & atrial flutter?

The nurse is caring for a patient who sustained a full-thickness burn to the arm after being scalded with boiling water. How did the nurse determine that the patient’s burns are full-thickness burns?

A patient with acquired immune deficiency syndrome (AIDS) informs the nurse of difficulty eating and swallowing, and shows the nurse white patches in the mouth. What problem related to AIDS does the nurse understand the patient has developed?

The nurse is working in the Emergency Department and is assigned a client who suffered a near-drowning. Which expected outcome should the nurse include in the plan of care for this client?

What is the PRIORITY treatment of hypovolemic shock?

What is the PRIORITY treatment of cardiogenic shock

What is the PRIORITY treatment of septic shock?

Which types of shock should NOT receive fluids -- or fluids should be used with EXTREME caution? Select all that apply

A nurse is working as a camp nurse during the summer. A camp counselor comes to the clinic after receiving a snake bite on the arm. What is the first action by the nurse? 

For a patient who is experiencing multiple injuries , which sequence of medical or nursing management would the nurse identify as a priority? 

The nurse assesses a patient in the compensatory shock whose lungs had decompensated. What clinical manifestations would the nurse expect to find? Select all that apply 

Which of the following medications are often used to treat cardiogenic shock? Select all that apply

The nurse is caring for a client with increased intracranial pressure as a result of a head injury. The nurse would note which trend in vital signs if the intracranial pressure is rising?

Which of the following are risk factors for hypovolemic shock? Select all that apply

A clients family member asks the nurse why DIC occurs. Which statement by the nurse correctly explains the cause?

Cerebral Edema peaks at which time point after intracranial surgery?

You’re precepting a new nurse. You ask the new nurse to list the purpose of why a patient with cardiogenic shock may benefit from an intra-aortic balloon pump. What responses below indicate the new nurse understands the purpose of an intra-aortic balloon pump? Select all that apply:

The nurse is assigned to care for clients with SCI on a rehabilitation unit. Which signs does the nurse recognize as clinical manifestations of autonomic dysreflexia? Select all that apply.

Which of the following are risk factors for septic shock? Select all that apply

The nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway, and making aggressive and belligerent gestures at other clients. Which statement would be most appropriate to make to this client?

The nurse has been closely observing a client that has been displaying aggressive behaviors. The nurse observes that the behavior displayed by the client is escalating. Which nursing intervention is most helpful to this client at this time? Select all that apply

A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube (NGT). The nurse would take which most appropriate action?

The new graduate nurse is caring for a client with pericarditis. She knows that tamponade is a common complication of pericarditis. Which of the following would suggest that the client is experiencing cardiac tamponade? Select all that apply

Most common Solid organ injured in intra-abdominal injuries?

The nurse has just admitted to the nursing unit a client with a basilar skull fracture who is at risk for increased intracranial pressure (ICP). Pending specific primary health care provider prescriptions, the nurse would place the client in which positions? Select all that apply.

At the time of a burn injury, even though there is blood loss, it is common that the hematocrit level is elevated

Which sign is characteristic of cardiac tamponade?