You have been caring for a 58-year-old male who underwent a radical neck dissection. He is being transferred from the PACU to a step-down unit. You are giving handover to the nurse from the step-down unit. What is the main purpose of your report?
To anticipate patient needs and potential problems
To make the patient and family more comfortable, knowing that someone cares
To make sure that all post-op orders will be followed on the new unit
To help the new nurse make sure that s/he has a good understanding of the patient's tubes and drains
Which of the following statements is true regarding delayed awakening?
It is a form of delirium that requires swift intervention.
It is a medical emergency.
It may occur in patients with renal insufficiency.
It is always accompanied by other symptoms, such as hypoxemia, hypoventilation, and low BP.
Select all appropriate nursing interventions directed at preventing pulmonary complications post-operatively.
Encourage deep breathing and coughing
Place the patient in a supine position
Encourage early ambulation
Manage pain effectively
Teach the patient how to use an incentive spirometer
You are caring for a 72-year-old female who underwent a hysterectomy, salpingo-oopherectomy, and bilateral LND. She is post-op day 2. You received handover this morning and the night nurse told you that the patient has had a low urine output. During your assessment, you notice that her extremities are cold, her BP is low, her HR is high, and she seems restless. You suspect that the patient may be experiencing...
Of the following nursing interventions, which is the most important to prevent cardiac complications?
Encouraging leg exercises while in bed
Frequent turning and re-positioning (e.g. q2h)
Administering anticoagulants (e.g. heparin)
Encouraging early ambulation
What is the minimum amount of urine output we want patients to have?
Select all correct characteristics of pain.
always caused by identifiable tissue damage
the most common cause of disability among working-age adults in Canada
In Canada, nurses routinely administer the smallest prescribed dose of analgesics when a range of doses is prescribed.
The manifestations of acute pain reflect the ________ nervous system activation, whereas chronic pain manifests as predominantly ________ changes.
The intensity of acute postoperative pain is a significant predictor of the presence and severity of persistent postoperative pain.
What does the acronym PQRST stand for with regard to assessing pain?
provokes; quality; radiates; severity; time
provokes; quantity; region; severity; time
persistence; quality; radiates; severity; time
provokes; quality; region; severity; threshold
A patient's self report of pain is very unreliable; it is the responsibility of the nurse and other healthcare providers to corroborate self reporting with other data.
What is one of the most important the first signs that a patient may be developing a tolerance to a certain analgesic?
The patient begins to experience regular end-of-dose failure
The patient's self-report does not change (i.e. pre-dose 9/10, post-dose still 9/10)
The patient starts to exhibit signs of withdrawal
The family says that the patient needs to get a higher dose
You are caring for an 82-year-old female who is recovering from a hip replacement. The patient is experiencing acute pain in addition to her chronic pain. The daughter asks you, "Why aren't the doctors giving her naproxen? I use it all the time and it works for me." What is the best response to the daughter's question?
"Naproxen is a type of drug called a nonsteroidal anti-inflammatory drug and it isn't given to elderly patients because of the risk of it causing a bleed in the digestive system."
"Naproxen is an old class of drug that isn't prescribed much anymore."
"Naproxen is too weak of a drug and it wouldn't do anything to help your mother's pain."
"You should ask the physician when she comes by."
Which of the following is the best definition of "failure to rescue"?
Preventable injury to or death of a patient that resulted from our inability to detect, recognize, and prevent acute deterioration
The failure of the healthcare team to detect and recognize deterioration
The failure of nurses to regularly observe the patient (e.g. monitoring of vital signs is not prioritized)
Death that occurs after a patient develops a complication before admission to hospital
Which of the following is the most common cause of coronary artery disease (CAD)?
Previous myocardial infarction
Familial history of CAD
Select all modifiable risk factors from the following list.
serum lipid levels
You enter a patient's room at the start of your shift. The patient says, "Nurse, I have a funny feeling in my chest and I feel like I might throw up." What is the best course of action?
Begin a focused assessment based on your suspicion of myocardial infarction
Bring the patient a bucket in case he throws up and encourage the patient to drink lots of fluids
Check the patient's list of prescribed medications to rule out these symptoms as side effects
Call the Rapid Response Team because this patient is having a heart attack
Stable angina can progress to unstable angina.
Pain at rest is unusual for patients with chronic stable angina.
What is the cause of insufficient oxygen supply in patients with chronic stable angina?
What is the most common reported symptom of chronic stable angina?
Heaviness in the chest
Sharp pain in the chest
Radiating pain down the right arm
Nausea and vomiting
A patient reports feeling pressure, burning, and crushing sensation in their chest. You notice that their forehead is dotted with sweat. What might this patient be experiencing?
an episode of stable angina
an episode of unstable angina
A patient reports feeling episodes of heaviness in their chest that last 3-5 minutes. The pain goes away when they sit down and rest and feels similarly to heartburn. What is this patient most likely experiencing?
Gastro-esophageal reflux disease
Which form of atypical chronic stable angina is asymptomatic and is associated with diabetes mellitus?
Which form of atypical chronic stable angina occurs only while lying down and is relieved by standing or sitting?
The etiology of acute coronary syndrome is the deterioration of a once stable plaque that stimulates platelet aggregation and local vasoconstriction with thrombus formation. Which of the following result(s) in partial occlusion of the coronary arteries?
non-ST segment elevation myocardial infarction
ST segment elevation myocardial infarction
You are caring for a patient who has unstable angina. The patient's son asks you, "Why did my dad have a heart attack?" Which of the following is the best response?
"Unstable angina is not a heart attack. It is a condition that leads to a narrowing of the arteries that deliver oxygen-rich blood to the heart. It is important that your father seek medical attention if his chest pain gets worse and is accompanied by other new symptoms."
"Your father had a heart attack because he has a history of coronary artery disease in his family."
"Certain risk factors, such as abdominal obesity, smoking, and high cholesterol, can lead to problems, such as a heart attack. It will be very important for your father to make alterations to his lifestyle."
"You should ask the physician."
What is the first line of treatment for patients with a confirmed MI?
Percutaneous coronary intervention (PCI)
Oxygen delivered via non-rebreather mask
_______ is the term for a state of decreased partial pressure of oxygen in arterial blood, whereas ________ is the term for a state of increased partial pressure of carbon dioxide in arterial blood.
Pneumonia, pulmonary edema, and ventilator-induced lung injury are all common causes of...
COPD, drug overdoses with CNS depressants, and trauma to the spinal cord are all common causes of...
the progression of stable angina to unstable angina
A patient reports having morning headaches, feeling disoriented, and generalized weakness. You note that the patient exhibits dyspnea and shallow respirations. You suspect that this client is exhibiting signs of....
A patient reports feeling agitated. She is unable to speak without pausing and has a prolonged expiration. You suspect that she is exhibiting signs of...
Your patient is tachycardic, tachypnic, and has a decreased O2 saturation. You note an audible stridor and nasal flaring. You suspect that this patient...
has an airway obstruction
is experiencing an inflammatory response
Select all of the subjective forms of data from the following:
past health history
laboratory results (e.g. blood work)
While performing preoperative teaching, a patient asks when she needs to stop drinking water before the surgery. Based on the most recent practice guidelines, the nurse tells the patient that:
she must be NPO after breakfast
she need to be NPO after midnight
she can drink clear fluids up to 2 hours before surgery
she can drink clear fluids up until she is moved to the OR
Choose the term that matches this description: "a minimally depressed level of consciousness with maintenance of the patient's protective airway reflexes."
Choose the term that best matches the following description: "The technique of choice for surgical procedures requiring significant skeletal muscle relaxation, control of respirations, or long procedures."
Choose the term that best matches the following description: "Injection of anesthetic into the CSF below L2."
How much blood is in the average human body?
The three main components of blood are plasma, erythrocytes, and the buffy coat. Plasma makes up __% of the blood, whereas erythrocytes make up __% of blood. The remainder is the buffy coat.
Health Canada is responsible for regulating blood donation, whereas it is the responsibility of the Canadian Blood Services and Hema-Quebec to actually screen donations.
How much whole blood is collected per donation?
__ is known as the "universal donor" of RBCs, whereas __ is known as the "universal recipient" of RBCs.
Bob's blood type is O. Maria is type B. In theory, can Bob donate blood to Maria?
No, however, Maria could in theory donate blood to Bob.
Peter's blood type is AB. Susan's blood type is B. In theory, could Peter donate plasma to Susan?
No, however, Susan could donate plasma to Peter.
You are caring for a patient who has thrombocytopenia. You suspect that this patient may be ordered a transfusion of which of the following?
Fresh Frozen Plasma
You are caring for a patient who needs treatment for a massive bleed, who also has a low fibrinogen concentration. You suspect that this patient may be ordered a transfusion of which of the following?
Can an RN independently obtain informed consent prior to a procedure or surgery?
No, however, it is the nurse's responsibility to ensure that consent has been given.
No. It is not the nurse's responsibility to deal with consent.
Yes, an RN can obtain informed consent from a patient.
Yes, an RN can obtain informed consent from a patient so long as there is another nurse who can sign the form as a witness.
When administering blood products, the nurse knows that s/he can only use _____ to administer, as other solutions will cause hemolysis.
2/3 + 1/3 with 20 KCl
Blood products should be administered over a period of ___ if tolerated. The maximum infusion time for a blood product is ___.
2 hours; 4 hours
30 minutes; 1 hour
4 hours; 6 hours
1 hour; 2 hours
Select all common signs of a transfusion reaction:
You are administering a blood product to your patient. 15 minutes after the start of the infusion, the patient reports nausea. You notice he is experiencing dyspnea, urticaria, and a fever. You suspect he is having a transfusion reaction. What should you do first?
Stop the transfusion.
Document your findings.
Recheck patient ID and blood product tags.
Notify the MD and the blood bank.