Exam (elaborations)
SWIFT RIVER MEDICAL-SURGICAL QUESTIONS AND ANSWERS
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SWIFT RIVER MEDICAL-SURGICAL QUESTIONS AND ANSWERS
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Name: Score:84 Multiple choice questions
Term 1 of 84
Paul Greer Scenario 4
Paul GreerThe emergency bathroom light goes off and the nurse finds Mr. Greer on the floor in
the bathroom. The patient got dizzy when he stood up from the commode. Mr. Greer is on the
floor still but is awake and oriented and is complaining of back pain below his right scapula.
1- Complete head-to-toe assessment while patient is on the floor.
2- Ensure patient privacy and call for help and assist patient to bed once help arrives
3- Complete secondary assessment once the patient is in bed focusing on complaint of
pain resulting from the fall
4- Reinforce to the patient to not get out of bed
5- Notify HCP of fall, complete incident report
1- Complete full assessment and inspect patient's wounds
2- Apply clean dressing to all wounds
3- Encourage patient to change body position and not lie on wounds
4- Continue to encourage nutrition and fluids
5- Document and inform HCP of wound changes
1- Complete full assessment, to include neuro
2- Use therapeutic communication/active listening
3- Attempt to orient to person, place, and time
4- Offer nutrition and/ or toileting
5- Ensure bed is in lowest position, and rails are in place
1- Ask the patient if it is okay to discuss his care in front of his children.
2- Explain that Docetaxel is a hormone therapy that suppresses the testosterone that
your testicles produce producing similar results as surgical intervention.
3- Explain that Radium-223 mimics calcium and is absorbed during new bone growth.
This will treat any cancer that may have metastasized to the bone.
4- Ask the patient to verbalize understanding of teaching and reassure them that
yourself or any member of their care team will be available to answer questions.
5- Evaluate patient's understanding of the teaching and discuss home support
,Term 2 of 84
Carlos Mancia
Carlos Mancia 48yr-old, Spanish speaking migrant worker with no known past medical Hx. r/o
Tuberculosis. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. Airborne Isolation. Neuro
WNL. Skin moist, respiratory bilateral wheezes and rhonchi. Blood-tinged mucous, productive
cough. Diet as tolerated. IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate
to 75 ml/hr. Expresses fatigue, fear, concern, and desire for recovery. Need frequent reminder
to stay in room and maintain mask precautions. If family/visitors come, will need education to
airborne precautions. Spanish interpreter available at extension 61178. Dr. Rondeau
Alteration in gas exchange
Exhaustion
Ineffectual airway clearance
Anxiety
Fear
Knowledge deficit
Potential for falls
Potential for becoming socially isolated
Noncompliance
Readiness for improved self-care
Alteration in comfort
Knowledge deficit
Potential for ineffective sexuality patterns
Educational Needs- Increased
Fall Risk- Increased
Health Change- Increased
Pain Level- Normal
Psychological Needs- Increased
Sensorium- Normal
Educational Needs- Increased
Fall Risk- Increased
Health Change- Increased
Neurological- Normal
Pain Level- Increased
Psychological Needs- Normal
,Term 3 of 84
John Duncan Scenario 2
John DuncanMr. Duncan is now complaining of feeling "dizzy" when he stands.
1- Full assessment including both lying/standing
2- Check input/output for possible dehydration
3- Teach patient about safety when getting out of bed
4- Document findings
1- Assess intake and output and possible reasoning
2- Construct dietary consult (plan)
3- Acquire daily weight and food intake
4- Evaluate outcome of dietary plan
1- Wash and glove hands
2- Provide emesis basin/cloth
3- Vital sign assessment
4- Administer antiemetic medication
5- Evaluate medication effectiveness
1- Full assessment, focused on mental status
2- Contact IV team
3- Set-up PCA
4- Contact HCP to see if they can apply a PureWick, female external catheter
5- Contact social services
, Term 4 of 84
Wight Goodman Scenario 3
Mr. Goodman is first day post-op from his suborbital rim fracture repair, and his orbital edema
has been greatly reduced. His CSF with rhinorrhea has subsided. The neurosurgeon has
decided to continue to observe his recovery, instead of surgical intervention to repair the
orbital roof fracture. The patients VS are stable, and he is afebrile. Patient does not have
medical insurance, so he is wanting to leave today. The patient is emotionally distraught, and
angry as face appears to have drooping of his eyelid and his visual acuities have not improved.
While the swelling has decreased there is still periorbital edema (Ptosis).
1- Assure patient that surgery is necessary to preserve his sight, and that this should not
be permanent
2- Take vital signs and position patient 30 degrees upright
3- Restart patients IV
4- Obtain surgical consent
5- Remain with patient
1- Complete Neurological assessment
2- Educate patient of plan of care
3- Evaluate patients understanding of care
4- Administer IV antibiotics
5- Sign additional surgical consent
1- Repeat Neurological assessment and contrast your latest findings
2- Reemphasize to patient that he cannot blow his nose
3- Approach Resident again, and explain that you feel his condition is worsening
4- Contact Nursing Supervisor of disagreement of patients readiness for discharge
5- Document
1- Complete Neurological Assessment
2- Educate patient and family of necessity for q2 hour neuro checks and visual acuities
3- Inform Healthcare Provider that patient is medically indigent, and wanting to go
home today
4- Contact social services to discuss options for payment
5- Extensive discharge planning and education
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