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SWIFT RIVER MED SURG TEST 3 QUESTIONS AND ANSWERS
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SWIFT RIVER MED SURG TEST 3 QUESTIONS AND ANSWERS
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Name: Score:18 Multiple choice questions
,Term 1 of 18
Nathaniel Gonzalez
Scenario 1
Mr. Gonzalez has been admitted to the floor to determine that his chest pain is not related to a
cardiac event. The ER nurse reports that his cardiac enzymes were borderline, (Troponin?,
CK/CKMB?) and the GI cocktail given in the ER did relieve his CP but not completely. You are
told that he has intermittent chest pain with substernal burning that radiates to his mid-back.
The patient describes this pain as a heavy pressure with intermittent stabbing. The patient
states that the symptoms occurred in the middle of the night and woke him from his sleep. The
pain makes him short of breath. The heartburn has become worse since he started treatment
for his URI. His CP is 7/10 and his BP is 165/96, P 92, R 18, SaO2 98 on 2L NC. He is questioning
the nurse as to why he has been admitted for heartburn. He has not had his BP medication
today.
Scenario 2
Mr. Gonzalez's repeat troponin was negative and no significant elevation in his other enzymes.
He has been ruled out for an MI. He told the nurse that he has had some changes in his bowel
habits and his stools have been very dark. The patient has been scheduled for an EGD today
and has an order for Omeprazole (Prilosec) and Carafate (sucralfate). When the nurse enters
the room later that day to inform him that the procedure is scheduled for 1430, they see Mr.
Gonzalez is sitting in front of a lunch tray. He is excited and tells the nurse he is starving and
glad that he finally gets to eat.
Scenario 3
Mr. Gonzalez has returned from his EGD and is still sleeping from the sedation. He was initially
sedated with versed 2mg, and Fentanyl 100 mg by the EGD nurse, but the patient was not
tolerating the procedure, so anesthesia was called to administer propofol. The nurse was told
by the gastroenterology nurse that they really struggled before they called anesthesia and
they may have caused an esophageal abrasion. Due to this, the provider would like him to stay
in the hospital for observation. The dinner tray is waiting for the patient in his room, and the
nurse notices it is a regular diet. His VS are BP 122/64, P 89, R 12, SpO2 93%.
Scenario 4
The nest morning the gastroenterologist informs Mr. Gonzalez that his EGD confirmed a
diagnosis of Barrett's esophagus with Dysplasia. The provider explains that it is a pre-
cancerous stage in where the cell develops abnormal features. However, these abnormal cells
do not have the capability to spread to other parts of the body. Biopsies were sent to
determine the treatment. The patient is being prepared for discharge and his IV has been
removed. When the nurse retunes to the room the patient tells the nurse that when he went to
,the bathroom he became very lightheaded. He also complains that his throat is still very sore.
The nurse performs tilt test, Patient vital signs lying flat, BP 118/62, P 92, R 20, T 98.5, SpO2 97.
Sitting, BP 109/60, P 114, Standing the patient becomes very lightheaded and the nurse has
them lay back down. The provider advises the Nurse to draw a stat CBC, give a liter bolus of
NS, and repeat CBC.
Scenario 5
Mr. Gonzales H/H is 12.7/38. His orthostasis is normalized after a second liter of NS was
administered. The pathology report shows no cancerous lesions. Since the finding was low-
grade dysplasia and is considered the early stage of precancerous changes, the
gastroenterologist recommends another endoscopy in six months, with additional follow-up
every six to 12 months. He warns the patient that if he does not comply with the treatment and
preventive measures, he will need other treatments that may include. Endoscopic resection,
which uses an endoscope to remove damaged cells to aid in the detection of dysplasia and
cancer. Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue.
Radiofrequency ablation may be recommended after endoscopic resection. Cryotherapy,
which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. The
cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing
damages the abnormal cells. After leaving the room the provider tells the nurse that he hopes
that he scared him into compliance with the treatment options. The patient will be discharged
today, and he will be ordering new prescriptions. When you enter the room, the patient is
having chest pain again, and they are pale and diaphoretic.
Scenario 1
-Wash hands and assess
-Complete Neurological assessment
-Check the blood from his nose for CSF (Halo test)
-Pre-op education
-Ask Surgeon to discuss with patient the potential facial scarring
Scenario 2
-Complete Neurological assessment
-Educate patient of plan of care
-Evaluate patients understanding of care
-Administer IV antibiotics
-Sign additional surgical consent
Scenario 3
-Complete Neurological Assessment
-Educate patient and family of necessity for q2 hour neuro checks and visual acuities
-Inform Healthcare Provider that patient is medically indigent, and wanting to go home
today
, -Contact social services to discuss options for payment
-Extensive discharge planning and education
Scenario 4
-Repeat Neurological assessment and contrast your latest findings
-Reemphasize to patient that he cannot blow his nose
-Approach Resident again, and explain that you feel his condition is worsening
-Contact Nursing Supervisor of disagreement of patients readiness for discharge
-Document
Scenario 5
-Take vital signs and postion patient 30 degrees upright
-Restart patients IV
-Obtain surgical consent
-Assure patient that surgery is necessary to preserve his sight, and that this should not
be permanent
-Remain with patient
Scenario 1
-Complete initial post-op assessment
-Check patency of Foley catheter, urine color, and ensure it is secure to the patient's leg
-Medicate for pain
-Explain to patient why his throat may be sore
-Inform patient to not get out of bed without assistance and place call light in reach
Scenario 2
-Tell the wife that you will speak to the husband, and this is apprehension is expected
with this surgery/diagnosis.
-Explain to Mr. Greer that it may take several days for healing, and he may have
temporary incontinence, but it will resolve over time.
-Teach the patient that there are several interventions for complications post-
prostatectomy to include erectile dysfunction, post-op prostatectomies, and self-care
involved with a foley catheter at home.
-Evaluate patient's understanding of teaching
-Continue to observe urine for hematuria and document findings
Scenario 3
-Using therapeutic communication inform Mr. Greer that there are many treatment
options, and not to leave until the HCP can come and speak with him
-Contact HCP to determine when they are available to speak with the patient
-Provide the patient with the time when HCP will come discuss options with him
-Provide a diversional activity to pass the time while waiting on the HCP and inform wife
that the HCP will be coming soon
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