Exam (elaborations)
SWIFT RIVER MED SURG PT SCENARIOS QUESTIONS AND ANSWERS
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SWIFT RIVER MED SURG PT SCENARIOS QUESTIONS AND ANSWERS
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Name: Score:45 Multiple choice questions
,Term 1 of 45
Richard Dominec, A 47-year-old married father of three children has been admitted for an
emergent appendectomy in the evening as soon as there is space available in the OR. He is
currently febrile with temperature 100.8, HR 99, BP 135/96, RR 20, PaO2 96%, nauseated with no
vomiting, rebound tenderness in right lower quadrant, has elevated WBC's and surgeon feels
this will be uneventful even though he has just been diagnosed with AIDS this past week. His
overall health is good, and he has known he has been HIV positive for the past five years. He
has been taking his HIV medication daily. Recently he manifested an unusual black lesion on
his thigh and developed an opportunistic fungal mouth infection which was treated
successfully. The lesion was identified as Kaposi's Sarcoma. Now, meeting the CDC definition,
he has full blown AIDS but is asymptomatic at this time. Mr. Dominec has a male partner and
has been married for the past ten years and share their three children to the marriage.
Educational Needs Increased acuity
Fall Risk Increased acuity
Health Change Increased acuity
Pain Level Increased acuity
Psychological Needs Increased acuity
Sensorium Increased acuit
Educational Needs Increased acuity
Health Change Increased acuity
LOC Normal acuity
Pain Level Increased acuity
Safety Increased acuity
Educational Needs Increased acuity
Fall Risk Increased acuity
Health Change Increased acuity
Pain Level Increased acuity
Psychological Needs Normal acuity
Sensorium Normal acuity
Educational Needs Increased acuity
Health Change Increased acuity
LOC Increased acuity
Pain Level Increased acuity
Psychological Needs Normal acuity
Safety Increased acuity
,Term 2 of 45
Robert Domenic
Scenario 1
After two hours, Mr. Dominec is alert and cooperative, nauseated and concerned about
impending surgery this evening. His partner is at the bedside asking, "how much longer will he
have to wait until taken to surgery?"
Scenario 2
Mr. Dominec had his surgical procedure and is doing great. It is now the second day post op
and he is given discharge information. His partner is not with him at this time but will arrive
soon to facilitate his discharge home.
Scenario 3
Mr. Dominec is waiting for his partner to arrive to take him home and you notice he has a dry
unproductive cough and trouble splinting with a pillow at his operative site. You take his vital
signs which are: Temp 101.3, Pulse 88, Resp 24, B/P 116/84.
Scenario 4
Mr. Dominec decides he does not want to see Infectious Disease doctor about his new cough.
He chooses to go home and see the doctor tomorrow in his office. He states, "This is not
serious."
Scenario 5
Mr. Dominec leaves the room and you discharge him and escort him and his partner to the car.
You return to the break room on your floor. Your coworkers are asking you questions about Mr.
Dominec. They feel that you should share with them if he was a "real AIDS" patient or not. They
were also concerned about the next patient going into that room and the use of the lavatory.
They wanted to know and pressure you for the information. Two housekeepers, who were
refusing to clean the room, are in the break room. Your response to all of them would be:
Scenario 1
Perform neuro assess
Reorient Patient to person, place, & time
Assess for fall risk
Offer nutrition/toilet
Scenario 2
Explain reason for assessment and procedure
Vital sign assessments
Apply restraint
, Perform circulatory evaluation
Request sitter/family member to bedside
Scenario 3
Employ therapeutic communication: present reality
Release restraints/full range of motion
Reapply restraints
Perform circulatory evaluation
Document results
Scenario 4
Use therapeutic communication/active listening
Attempt to orient to person, place, and time
Perform circulatory evaluation
Offer nutrition and/ or toileting
Document results
Scenario 5
Check monitor
Apply nasal cannula
Vital re-assessment
Notify lead nurse/doctor
Remain with Patient
Scenario 1
Perform full assessment and provide anti-nausea medicine.
Provide comfort in pre-surgical room Mr. Dominec.
Check surgical consent for correct procedure and make sure operative site in marked.
Inform his partner that everything is being done to keep him comfortable.
Scenario 2
Educate about recovery from appendectomy and care to wound.
Discuss his understanding about the plan of care.
Discuss follow up with his doctor.
Offer assistance in providing more information about treatment options for newly
diagnosed AIDS patients.
Determine from medical record if partner is aware of his recent AIDS diagnosis.
Scenario 3
You discuss this cough with Mr. Dominec to determine how long he has had it.
Notify doctor of change in condition in particular: unproductive cough and low-grade
fever.
Explain to Mr. Dominec your concern for this opportunistic infection and usual
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