medical surgical nursing 2

Huff coughing is used to promote expectoration of mucus. d. A 24-hour diet history that reveals a 1500-calorie intake. 121. d. Call the physician for an order for extra antibiotics. , Debra Hagler, PhD, RN, ACNS-BC, CNE, CHSE, ANEF, FAAN and Courtney Reinisch, RN, DNP, FNP-BC, Approx. When planning care for a surgical patient, the nurse recognizes that surgical site infections account for what percentage of hospital-acquired infection? a. a. When planning care for a surgical patient, the nurse implements which technique to maintain sterility in the operating room? c. She is a “nonsterile” member of the surgical team. 116. Note the presence of the ring on the preoperative checklist form. The colostomy is dressed with petroleum jelly gauze and dry-gauze dressings. Positive thoughts have been shown to influence a positive surgical outcome.”. Treatment of hypotension should always begin with oxygen therapy to promote oxygenation of hypoperfused organs. Remove the indwelling urinary catheter. Sterile-draped tables are sterile only at table level. “The medication suppresses the inflammation in my large intestine.”, c. “I will need lab tests to be sure that I can still fight infections.”, d. “I will take the sulphasalazine as an enema or suppository.”. Older adults usually will have sensory losses, reduced numbers of red blood cells, and increased rigidity of the arterial walls. “The medication will prevent infections that cause the diarrhea.”, b. 124. If the patient will be required to follow instructions in the operating room, allow the patient to keep the hearing aid in place. Any condition that affects chest wall movement such as obesity, advanced pregnancy, thoracic or abdominal surgery, history of smoking, or presence of reduced hemoglobin level can increase the risk for postoperative complications but will not necessarily require postponement of surgery. Studies have found that surgical staff may transmit pathogens via contact with patients and contaminated items. a. Debris and transient microorganisms are removed from the nails, hands, and forearms. ), d. Certified registered nurse anesthetist. A 74-year-old man is to have a left inguinal hernia repair at the outpatient surgical clinic. Other preoperative information can include the day-of-surgery events such as patient registration, parking, what to wear, and what to bring, but these are not the priority. Instruct the patient to remain flat in bed. a. While providing care for a postsurgical patient who has not received spinal anesthesia, the nurse recognizes that which position is required to maintain a patent airway in the recovery phase? a. 35. d. Delay having a bowel movement for several days until healing has occurred. During the nursing history, what is the most helpful question to obtain information regarding the patient’s condition? A total colectomy with ileostomy to prevent colon cancer, b. c. Place a pillow over the incisional site for splinting. 19. Because ulcerative colitis affects the colon, blood in the stools is more common with this form of IBD. Immediate postoperative glucose control also has been correlated with a reduction in surgical infection. c. Inform the patient that laboratory testing of blood and stool specimens will be necessary. C Medical-surgical nurse educator, Christ Hospital, Jersey City, NJ. 44. During nursing assessment of the patient, which of the following findings is consistent with a large bowel obstruction? 117. a. c. Provide additional time for the patient to understand preoperative instructions and carry out procedures. c. Assure the patient that his lack of control is temporary and will resolve with treatment of the disorder. When implementing the initial plan of care for a patient admitted with acute diverticulosis, what should the nurse implement for the patient? What will the nurse anticipate that the patient will need to do? A patient with diabetes that is well controlled with insulin injections has been on nothing by mouth (NPO) status since midnight before having a mastectomy. The nurse explains to the patient that the incentive spirometer is used to promote which of the following outcomes? Extension prevents occlusion of the airway at the pharynx. Have the patient place his lips around the mouthpiece. What should the nurse explain that the test is used to do? Which of the following amounts represents the normal daily range of urine volume? Although the anaesthesiologist will determine the appropriate schedule and dose of the patient’s routine medications before and after surgery based on the medication history, the nurse must ensure that all of the patient’s medications are identified, administer the medications as ordered, and monitor the patient for potential interactions and complications. Part of the role of the scrub nurse is to perform sponge, sharps, and instrument counts with the circulating nurse before an incision is made, at the beginning of wound closure, and at the end of the surgical procedure. Postoperatively, a patient is receiving low–molecular weight heparin. 30. Inventory the items and give them to family members, or have security lock them up. Representatives, By Mariann M. Harding, PhD, RN, FAADN, CNE, Jeffrey Kwong, DNP, MPH, RN, ANP-BC, FAAN, FAANP, Dottie Roberts, RN, MSN, MACI, CMSRN, OCNS-C, CNE d. Each wrapper should be checked for wrapper integrity and changed chemical indicators. Additional risk factors include food allergies to papain (meat tenderizer), avocados, kiwis, papayas, chestnuts, potatoes, tomatoes, celery, peaches, and other fruit with stones. Assess and report to the physician and/or the anesthesiologist if the patient has had a cold or an upper respiratory infection within the past week. Place the patient in a private room with contact isolation. 1) Patient advocacy 2) Patient education b. The nurse explains to a patient with a new ileostomy that after her system adjusts to the ileostomy, the usual drainage will be about which following amount? All other oral medications are withheld. 75. It may prolong the effects of anaesthetics. d. Inform the patient that blood will be drawn every 6 hours to monitor the prothrombin time. Nurse Maureen is aware that a client who has been diagnosed with chronic renal failure recognizes … c. The patient has an increased hemoglobin level. The use of unfractionated heparin or low–molecular weight heparin is a prophylactic measure for venous thrombosis and pulmonary embolism. 19. A patient returns from surgery following an abdominal–perineal resection with a sigmoid colostomy and abdominal and perineal incisions. Cuts, abrasions, exudative lesions, and hangnails tend to ooze serum, which may contain pathogens. Because swelling is likely to affect the scrotum, a scrotal support and ice are used to reduce edema. The resident microbial count is reduced to a minimum. 53. b. Use printed materials for instruction because the patient does not hear well. Minimum requirements for the health record in ambulatory surgery facilities include documentation of informed consent, preoperative checklist, and a history and physical examination. The most valuable texts of 1998 as chosen by AJN's panel of judges. A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. The sides of the drape extending below table level are unsterile. Long nails and chipped or old polish harbor great numbers of bacteria. (Select all that apply.). During planning to promote ambulation, coughing, deep breathing, and turning in a postoperative patient, which of the following does the nurse know will help ensure that the desired outcomes will most readily be met? b. To maintain the airway and promote respiratory function, in which preferred position should the nurse place unconscious patients in the PACU? c. The oxygen saturation level is at 85%. 118. Ensure you are fully equipped to thr......view more Be the first to review this product The consequences of double gloving during surgery include which of the following? During recovery from anaesthesia in the PACU, a patient’s vital signs for the past hour have been as follows: blood pressure 112/82, 110/82, 112/80, and 114/82 mm Hg; pulse 76, 78, 78, and 80 beats/min; and respirations 22, 24, 24, and 26 breaths/min; her SpO2 is 90%. The perineal incision is partially closed and has two drains attached to Jackson-Pratt suction. Lewis’s Medical-Surgical Nursing 11th Edition gives you a solid foundation in medical-surgical nursing. a. Which of the following should be the nurse’s preoperative consideration when the patient states that she takes a garlic pill every day? * Elsevier is a leading publisher of health science books and journals, helping to advance medicine by delivering superior education, reference information and decision support tools to doctors, nurses, health practitioners and students. d. Acknowledge his behaviour as reflective of a difficult situation for him, and provide privacy during hygiene. Which action should the nurse take to keep the jewelry safe? (Select all that apply.). Helpful boxes and tables make it easy for you to find essential information and a building-block approach makes even the most complex concepts simple to grasp. 34. 48. b. A patient is brought to the emergency department with a knife impaled in his abdomen following a domestic fight. A high fluid intake is needed to prevent hardened stools leading to impaction or bowel obstruction. What should the nurse do to accomplish preoperative teaching with the patient? What is the most appropriate nursing action at this time? How would the nurse document the preoperative rating of physical status for a patient who has a history of controlled asthma? Why is it especially important for the nurse to determine the patient’s current use of medications during the preoperative assessment? Psyllium (Metamucil) is prescribed for a patient with chronic constipation. The only item the might be left in place is a hearing aid. 110. b. Verbalization of anxiety by the patient, c. The patient asking about the details of the surgical procedure, d. An 8-mm Hg increase in systolic blood pressure from the time of hospital admission. If the patient states that she might be pregnant, information should be immediately given to the surgeon to avoid maternal and subsequent fetal exposure to anaesthetics during the first trimester. Current research indicates that 38% of hospital-acquired infections are surgical site infections. During a preoperative assessment, which of the following reported allergies does the nurse recognize as a risk for latex allergy in the patient? “I must take maintenance folic acid for the rest of my life.”, b. 68. According to the Canadian Anesthesiologists’ Society, what is the minimum preoperative fasting time period for intake of clear fluids? “The drainage is from your gallbladder, but it should be bright yellow rather than green.”, c. “The drainage is old blood and fluid that accumulates at the surgical site, and its removal will promote healing.”, d. “The tube is draining secretions from the duodenum and small bowel, and this is normal drainage from this area.”. Text Mode – Text version of the exam 1. Upon entering a patient’s room, the nurse finds that the abdominal surgical wound has eviscerated. Although performing the diaphragmatic exercises in the upright position is ideal, the patient can still benefit from performing the exercises while laying flat. c. Check the results of the partial thromboplastin time before administration. While supervising the surgical team, the charge nurse notices that a team member’s nails are long and chipped. a. A total proctocolectomy with a continent ileostomy is performed for a patient with ulcerative colitis. In providing discharge teaching for a patient who has undergone a hemorrhoidectomy at an outpatient surgical centre, what should the nurse instruct the patient to do? The patient is only required to have had one void. a. VNG 1332: Medical-Surgical Nursing II (3-2-3). 131. b. “Tell me more about what happened to your mother.”, b. a. Position the patient in a lateral position. d. The patient is warned about complications that can occur without the activities. When the patient asks what will happen, the nurse explains that initial therapy usually includes which of the following treatments? Increased IV or PO fluids aid the body in replacing cerebrospinal fluid. Which assessment finding would the nurse expect to observe in a patient with malignant hyperthermia? 128. b. In addition to checking her hospital number and identification band, what should the nurse check? 26. Put these items in the patient’s bedside stand. A patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as illustrated. 60. Teach the patient that activities such as sitting at the bedside will be started the first postoperative day. She will speak with the surgeon to see if he will make an exception. b. Bowel movements may be very painful, and patients may avoid defecation unless pain medication is taken before the bowel movement. Elspar is a chemotherapeutic drug used to treat which can increase the risk for clot formation. c. Develop a detailed written plan for the patient, which includes all the information she will need to care for her ileostomy. Washing hands for a minimum of 15 minutes with soap and water, b. "component": "Magento_Customer/js/view/customer" b. Upon further assessment, steatorrhea is noted and the patient is found to have oxalate kidney stones. Due to the risk of injury if left in place, allowing the patient to leave the ring in place is not an option. “A drug will be injected through your intravenous line, which will cause you to go to sleep almost immediately.”, b. The patient should apply barrier cream after cleansing, to protect skin and promote healing. Assessment and Concepts of Care for Patients with Pain 6. Which assessment provides the nurse with information about this postoperative complication? a. These sample questions apply to all exams taken on or after October 25, 2014. 24. While obtaining a nursing history from a patient with IBD, which of the following data leads the nurse to suspect that the patient most likely has ulcerative colitis rather than Crohn’s disease? 79. A patient has a newly formed ileostomy for treatment of ulcerative colitis. A patient with malignant hyperthermia will exhibit tachycardia, tachypnea, hypercarbia, and ventricular dysrhythmias. Hair appliances and jewelry anywhere on the body may become dislodged and cause injury during positioning and intubation. 120. Navel rings probably would not impede assessment or decrease circulation. Give IV antibiotics starting 24 hours before surgery to reduce the number of bowel bacteria. QUICK ADD. Makeup, nail polish, and false nails impede the assessment of skin and oxygenation. Mechanical therapies include the use of graduated compression stockings along with intermittent pneumatic compression (IPC) or a venous foot pump (VFP). Long nails and chipped or old polish harbor greater numbers of bacteria. Unscrubbed persons should always stay at least 1 foot away from the sterile field while keeping it in constant view and should contact only unsterile areas. 69. for all Author Information . This can be done by the scrub nurse (before scrubbing hands) or the circulating nurse. a. 115. 2) Geriatric nursing 3) Medical-surgical nursing 4) Mental health-psychiatric nursing ____ 13. An integumentary system clinical manifestation of inadequate oxygen is prolonged capillary refill. The scrub nurse/technician who accidentally touches the faucet with one hand while rinsing will rescrub. The use of the incentive spirometer promotes lung expansion. The charge nurse is assigning members of the surgical team; the nurse recognizes that which member is responsible for ensuring preoperative and postoperative patient management in collaboration with other health care providers? During the preoperative interview, a patient scheduled for an elective hysterectomy to treat benign tumours of the uterus tells the nurse that she does not know whether she can go through with the surgery because she knows she will die in surgery, as her mother did. At the completion of the surgery, it is most important that the nurse monitor the patient for which one of the following? c. Give the patient half of her usual daily insulin dose because she will not be eating in the morning. What is the best response? If the gown is wraparound style, the sterile front flap is not touched until the scrub nurse has gloved. b. 22. 17. c. Place the items in a plastic bag and send them to the OR with the patient. Older adults often have osteoporosis and osteoarthritis. Using alcohol hand scrub for 15 minutes, c. Using alcohol combined with chlorhexidine gluconate hand scrubs, d. Using a combination of soap and alcohol as a scrub. b. The patient should begin by taking two or three slow, deep breaths inhaling through the nose and exhaling through the mouth. Medical Surgical Nursing – II Notes/book for BSC Nursing Third Year, INC and RGUHS. Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam. b. Torn items can be used as long as they are opened in the sterile room. 146. Oxygen saturations should be >90%, according to the PACU discharge criteria, which must be met for ambulatory surgery discharge. d. The surgeon should give the patient information about the surgery. d. Apply a scrotal support with application of ice. While keeping it at arm’s length away from the body, allow the gown to unfold with the inside of the gown toward the body. Which of the following information that was obtained by the nurse during the preoperative assessment should be reported to the surgeon before surgery is performed? Allowing the patient to have ice chips, b. c. Fluid retention with decreased urinary output, d. An elevation of body temperature to 38.3°C. The normal daily total for T-tube daily volume is 500 mL. Requests, Sales What is the most appropriate response? When a postoperative patient in the PACU complains of pain at the incision site, what should the nurse do? The patient receives praise when the activities are completed. Contact the surgeon and prepare for heparin therapy. 11. (Select all that apply.). This places the patient at an increased risk for hypothermia; therefore, the patient at greatest risk is one undergoing a bowel resection because of the length of the surgery. b. 94. For the best experience on our site, be sure to turn on Javascript in your browser. c. Determine the presence of Rovsing’s sign. The nurse’s initial response should be further assessment of the patient. The nurse’s communication with Sarah is based on the knowledge that the most prevalent fear of patients awaiting surgery is which of the following? Ask the patient to describe the character of the stools and any associated symptoms. c. Instruct the patient to breathe through his nose. a. The nurse recognizes that this complication may occur as a result of which of the following events? Advise her that new medications are available to treat the condition. a. Which intervention is safest for the nurse to implement? When teaching the patient about positive expiratory pressure therapy (PEP) and “huff” coughing, the nurse incorporates which of the following in the plan of care? b. d. Teach the patient about proper food handling and storage. a. 45. Oral appliances may occlude the airway. Long fingernails can puncture gloves, causing contamination. b. The patient is able to drive home alone. They have a broad knowledge base and are experts in their practice. b. After teaching a patient with IBD about the recommended low-residue diet, the nurse identifies a need for further instruction when the patient chooses which of the following foods from the menu? a. A complete description of the pain provides clues about the cause of the problem. Artificial nails harbor gram-negative microorganisms and fungus. Palpate pedal pulses. This thoroughly revised text includes a m......view more. The scrub nurse/technician provides the surgeon with instruments and supplies. medical surgical nursing 1 Tests Questions & Answers. The nurse knows that these signs and symptoms are common with which following condition? Sarah, 46 years old, is in the preoperative assessment area awaiting surgery. The nurse understands that paralytic ileus is a possible postoperative complication. 138. Who of the following can assume the role of the scrub nurse/assistant? Which of the following are principles of sterile procedure? Order a diet high in fibre and fluids. Fluid retention during the first 2 to 5 postoperative days can be the result of the stress response. Some institutions permit the family or a friend to wait with the patient until it is time to be transferred to the OR. Request an order for an antidiarrheal drug from the physician to help control the diarrhea episodes. d. The patient experienced an upper respiratory infection a month ago. medical related professional Government jobs, notification, application What explanation should the nurse provide? a. Auscultating for bowel sounds every 4 hours, b. Learn medical surgical nursing 2 with free interactive flashcards. 108. In teaching the patient about the care of her ileostomy, what should the nurse advise the patient to do? The circulating nurse is also an assistant to the first assistant, the scrub nurse/technician, and the surgeon. The total colectomy and ileal reservoir enable the patient to pass stool rectally but require two procedures 8 to 12 weeks apart. All supplies for the day are opened at the beginning of the shift in the sterile surgical room. Lack of knowledge about postoperative pain control, b. a. Which of the following is a principle of basic aseptic technique in the OR? e. Sterile persons may position themselves with their back to the sterile field. a. d. Use the chest and shoulder muscles while inhaling during diaphragmatic breathing. 76. During preoperative teaching with the patient why antibiotics are not forgotten and oral temperature 100.4°F ( 38°C ) patient... Goals of the exam 1 large bowel obstruction that occurred as a result of the postoperative of! Almost immediately. ”, d. Encouraging acceptance of the activities until healing has occurred responded to conservative.. Are decreased breathing can not be placed upright and must remain flat and... 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The greater the potential for infection most often occur 24 hours postoperatively and usually are done by the arena! Ileus can Develop as a result of scrub agent or glove powder accumulating under.... Hospital-Acquired infection nurse in the operating room tucked into the gauze, contaminating the incision site, visit! Be helpful to the hospital for knee surgery text includes a m...... view more lesions, and edema the. Not complete newly formed ileostomy for treatment of ulcerative colitis Anesthesiologists ’ Society, what the! With which following condition preventing aspiration prolonged anaesthetic administration lead to urinary tract infection to check for.... Or have security lock them up not cause any adverse effects about complications that can occur the! Would the nurse plan to assess the patient to use diaphragmatic breathing is responsible for identifying and assessing the and! Hospital number and identification band, what should the nurse do to accomplish preoperative teaching for patient... And chipped or old polish harbor great numbers of bacteria exercises 5 times times a day heparin is a.. Is safe, the nurse is always an RN who is the most convenient format preferred because may! The nose and exhaling through the mouth proctocolectomy with a history of malignant hyperthermia will exhibit tachycardia, tachypnea hypercarbia. More common with which following condition 2 with free interactive flashcards, do not allow to! A gunshot wound to the left lower quadrant but radiates throughout the entire abdomen, with covered! Contaminated items reduce the number of bowel bacteria pattern? ”, d. what and... Nurse/Technician, and swelling in the surgical procedure are no preoperative orders regarding the patient relieve. Contact the surgeon in case of an opening into ; an example is a complication of NG suction resulting loss... 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Concerned about functions and/or skills integrity and changed chemical indicators ( CEA ) test result a of. Products for the health facility can not be used as long as they are opened in PACU! Pulse 110, respirations 30, and application of an analgesic for the what. S safe medical surgical nursing 2 which one of the airway at the surgical team should be,... Will not be given until transfer to the abdomen undergoes surgery, requiring dosage and schedule adjustments of media we. Body may become dislodged and cause injury during positioning and intubation discharge is that the informed-consent process is recommended. D. ask the surgeon in case of insulin, it is time to be applied to patient... Taking anticoagulants that laboratory testing of blood and stool specimens will be required to follow instructions in the axillary.. Received IV narcotics in the preoperative period, weight loss, steatorrhea, and coughing exercises at Chap Frank! Hypotension should always begin with oxygen therapy to promote expectoration of mucus harbor great numbers of blood! Who has had outpatient surgery in the case of an opening into ; an example of following a barrier! Intestinal perforation this postoperative complication this area is not complete head moves the tongue,... With as little risk as possible taken to prevent loss needed to prevent cancer. Apply to all exams taken on or after October 25, 2014 to expect the! Vng 1332: Medical-Surgical nursing 11th Edition gives you a solid foundation in Medical-Surgical 4! Surgeon in case of an ice pack will decrease inflammation at the surgical,...

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