A patient is 12 hours post carotid

A patient is 12 hours post carotid endarterectomy with sbp consistently above 160 for the past hour despite vasodilator therapy. The patient suddenly complains of difficulty breathing, acute pain at incision site and has difficulty speaking. A nurse should assess for Change in level of consciousness Facial droop Surgical hematoma Wheezing An elderly patient admitted to the unit post chest trauma is anxiety irritability and tachycardia after intubation. The nurse should first Give the patient more time to calm down Initiate propofol infusion. Explain the purpose of mechanical ventilation. Administer lorazepam A nurse has responded to a rapid response call on a medical-surgical floor in the hospital. The nurse finds the patient with the following date Bp 72/30 Hr 132 Rr 24 T 102.3 Sp02 95 Ph 7.13 PaC02 14mE/l PaO2 88mmHg Na+ 142mEg/l The nurse should anticipate an order to administer which of the following? 8.4 sodium bicarbonate Phenylephrine Amiodarone 0.9 normal saline A patient admitted in hypertensive crisis on hospital day 2 experienced sudden onset severe headache and left upper extremity weakness, plus a right facial droop is assessed. Which order should the nurse anticipate? Administering tissue plasminogen activator (TPA) 50IV x 1 Obtaining a CT scan of the head and neck without IV contrast Administering 325mg tb aspirin An implantable cardioverter defibrillator (ICD) most likely benefit a patient with which of the following? Complete heart block Sick sinus syndrome Ventricular tachycardia Atrial tachycardia A patient with necrotizing fasciitis tells the nurse that a week long course of IV antibiotics will clear the infection. The nurse should provide education that the next treatment will be Surgical debridement Hyperbaric oxygenation Negative pressure therapy IV steroids A new employe starts orientation in the units. After several weeks the preceptor notices that the orientee is not grasping the basic competencies for unit. The most appropriate nursing action is to Use simulation-based education scenarios to increase orientee skills and knowledge recall. Meet with the unit manager to view the orientee’s weakness and area needing improvement Work with nursing leadership to identify a unit better suited for the orientee Schedule time for the orientee to meet with the critical care nurse educator to review unit competencies During the monthly code team review It is noted that regulators have been consistently missing from the oxygen tanks. Which of the following is a nurse’s best action Report the missing regulators to the shift supervisor Inform the nurse manager of the need for more regulators Form a task force to try to find a solution Document on the daily flow sheets when the regulator are missing Patient has visitors whose loud talking and laughing disrupts other patients and visitors in ICU. Which of the following is the most effective way for a nurse to address this situation? initiate discussion about a visiting plan that includes behavioral limits. Consult the social worker to create a visiting contract Discuss the development needs of the patient with the family Create a visiting contract that includes behavioral limits and present it to the family A patient who is mechanically ventilated suddenly develops hypotension increase airway pressure tracheal shift, and decreased breath sound unilaterally. A nurse should recognize the immediate need for A chest tube insertion An abg A stat chest x-ray An increase in fi02 A patient was admitted 3 days ago for an overdose of acetaminophen. The patient is developing a decreasing level of consciousness. Which of the following is the most likely finding? Decrease gfr Increase inr Cheyne-stroke respirations Splenomegaly A patient underwent a lift lower lobectomy 3 day ago. Upon assessment a nurse finds diminished breath sounds and patient is obtunded. Bp 1122/74 Hr 118 Rr 24 T 101.6 Sp02 91% Ph 7.2 Pac02 64mm hg paO2 82mmhg hco3 24mEg/l The nurse should anticipate initiation of antibiotics and intubation v/q perfusion scan and bipid therapy bipap therapy and chest tube insertion chest tube insertion and initiation of antibiotics an ecg indicates flattened t waves, prolonged p-r interval, widened qrs and tall peak t-waves. The critical care nurse would administer which of the following? Hypertonic saline Regular insulin and glucose Potassium chloride Magnesium sulfate A patient who underwent thyroidectomy is admitted with severe hypocalcemia in addition to calcium gluconate the nurse should anticipate Administration of 40 mg iv furosemide administration of 5 mg amlodipine replacing magnesium to a level of 2 m Eg/l replacing potassium to level of 4m/mol/l inhaled beta2 agonists are administrated to patient with status asthmatics primarily to decrease airway resistance stabilize capillary membrane suppress the inflammatory response and decrease mucus production dilate pulmonary vessels and decrease shunting A patient admitted for gastrointestinal bleeding has received prbc’s and fresh frozen plasma. A colonoscopy is performed, post procedure hgb value is 8.5g/dl and after volume administration the hgb is 7.4g/dl. Twelve hours later patient data is Hr 85 Rr 14 Bp 120/72 Hgb 7.8 g/dl Which of the following actions should a nurse anticipate? Transfuse prbc Begin preparation for another colonoscopy Administer volume replace Continue to monitor patient. Following a procedure a patient indicates an 8/10 pain score. The patient dose not want to take the opioid pain medication due to fear of addiction. Which of the following is a nurse best response? Opioid medication are not addictive if taken for less than a month, addiction is more strongly associated with non-prescription medication. The pain management plan for opiods is that you take the pain medication every 6 hour. These time intervals prevents addiction. The pain treatment plain is for you to get strong pain medication for a short pain medicine for a short time this decrease the risk of addiction Opioid medication are most effective method of handling your acute pain addiction is not a concern. A patient with hypovolemia is receiving fluid therapy. Which of the following best indicates that the treatment has been effective? Decrease svr Increase preload Decrease stroke volume. Increase hr To evaluate the family response to a patient’s critical illness the best to ask is What is your understanding of the condition Do you have any Can I do anything for you Do you understand what is happening A physician tries three times to insert a central line, then say ” I think I can get it this time”. A nurse should Administer an analgesic Start a peripheral line Suggest that another physician insert to insert the line Allow the physician to try again Which of the following interventions is most appropriate for a patient at the end of the life who has a rr of 42 and sp02 of 89%? Positioning a cooling fan towards the patient Providing intravenous anxiolytics Administering a nebulizer treatment Increasing the room temperature A unit has lost five experienced nurses due to relocation, returning to school and promotion. Unit census and acuity level are high. The nurse manager has undated staff on recruiting and hiring efforts. Which of the following statements by the nurse manager would best demonstrate authentic leadership while staffing I am going to be helping with break and lunch relief I want to hear your ideas for how we might better organize our case delivery I am putt a hold on all performance improvement project. I am hiring four traveling nurses as an interim measure unit permanent staff can be hired Acute respirator failure is characterized by which of the following set of values. PaC02 less than 50 and Pa02 less than 70 PaC02 greater than 50 and Pa02 greater than 60 PaC02 greater than 50 and less than 60 PaC02 greater than 45 and Pa02 less than 70 A patient in an unwitnessed MVC sustained a devastating head injury. The patient is intubated and being ventilated. On initial assessment the patient has bilateral pupil 6cm non-reactive cough and gag reflexes are absent and movement to noxious stimuli is all extremities patient data are as follows. Bp 124/82 Hr 54 Rr 12 t 88.1 Based on discussion with the medical team and family a nurse should anticipate an apnea test for determination of brain death. Which of the following the first priority in the care of this patient Provide warm blankets and warm iv fluid Assess the patient cornel reflexes Contact the local organ Send a blood sample for baseline abg A patient who has been mechanically ventilated for 60 hour exhibits an increase in respiratory rate and oxygen requirements. The patient has a new leukocytosis and is febrile with moderate purulent sputum production. The abg result are Ph 7.35 Paco2 36 mmhg Pa02 75mm hg HC03 22mE/l Fi02 40% Sp02 88% What should the nurse suspect? Ards Vap Pneumothorax Pulmonary edema A trauma patient has a pelvic fracture and severe crush injury of right leg. A nurse should assess for which of the following to determine he potential for high risk of renal failure? Myoglobinuria Hemoglobinemia Ketonuria Proteinuria The follow date are available for patient with sepsis Bp 88/42 Paop 6mm hg Pap 31/11mm Co 9.5l/min Svr 432 dynes/sec/ml Ci 5.3l/min/mm2 The most appropriate intervention for this patient is to Reduce afterload Increase preload Restrict fluids Administered inotropic agent A nurse is performing medication reconciliation during a patient’s admission. To determine the current understanding of the medication furosemide which of the following is the best statement by the nurse Which is your medication help to remove extra fluid When is the best time of the day to take furosemide Do you take the furosemide for your hypertension Can you explain to me what furosemide rise for you? A patient is mechanically ventilated as a result of community- acquired pneumonia. Sedation and pain medication include propfol and morphine sulfate infusion. The patient is moving in response to physical stimuli the order sedation target is and maintaining awakening to voice. A nurse recognize that the patient current neurological status increases the patient risk for Cerebrovascular accident Impaired cerebrovascular Prolonged mechanical ventilation Impair gas exchange. A nurse has identified a head to change a practice based on current evidence. Which strategy should the nurse employment first employ first to best support the change? Develop policies and procedures Establish a stake holder committee Review literature related to the process Evaluate the lecture on investment. A patient on prolonged mechanical ventilation and an unresponsive state is showing no signs of progression towards recovery; the healthcare team suggested a court care approach. Family members are confiscated, and the patient has no advance directive. Which of the following should the nurse suggest as next course of action. Hospice consult to prepare the family for end-of-life care Meeting with the institutional ethics committee to examine the case Palliative care consult to assist with symptom management. Meeting with the stakeholder to discuss the issue and option

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