RN Adult Medical Surgical Online
Practice 2023 A NGN
0530:
Clientkiskawakekandkalert.
Arteriovenouskfistulak(AVF)ktokrightkforearmkwithkthrillkpalpatedkandkauscultatedkforkbruit.kL
ungksoundskclearkuponkauscultation;kclientkdenieskshortnesskofkbreath.kNokperipheralkede
maknoted;kcapillarykrefillkisklesskthank3kseconds;k+2kbilateralkpedalkandkradialkpulses.
AVFkaccesskpreparedkandkcannulatedktwicekwithknokdifficulty.kLineskarektapedkandksecured
;ktreatmentkiskinitiated.0600:
Clientkiskreadingkakbook.kAccesskiskvisible,kandklineskareksecure.kClientkreportsknokdiscomfo
rtkorkpain.0630:
Clientkreportskfeelingkwarm,knauseated,kandklightheaded;kappearskrestlesskandkslightlykco
nfused.k-kcorrectkanswer--Performkak12-leadkECGkisknotkindicated.
PlacekthekclientkinkTrendelenburgkpositionkiskindicated.
Administerkak0.9%ksodiumkchloridek200kmLkIVkboluskiskindicated.k
Applykoxygenkatk2kL/minkviaknasalkcannulakiskindicated
Notifykthekproviderkimmediatelykiskindicated
Obtainkthekclient'skbloodkglucoseklevelkisknotkindicated.
1000:ClientkpresentsktokthekEDkwithkvisualkdisturbances,kexpressivekaphasia,kandknumbne
sskandktinglingkofktheklips.kManifestationskstartedkaboutk30kminkago.kClientkreportskflashingkl
ightskinktheirkvision,kespeciallykonkthekrightkside.
Client'skpartnerkstateskthekclientkhadksomekdifficultykwithkfindingkwordskwhenkspeaking.
Clientkiskalertkandkorientedkxk3kandkappearskanxious.kNokfacialkdroopingknoted.kRightkhandk
graspkiskweakerkthankleft.kClientkdenieskpain.k-kcorrectkanswer--
Handkgraspskiskconsistentkwithkmigraine,kstroke,kandkmeningitis.
k
Numbnesskiskconsistentkwithkmigrainekandkstroke.k
Aphasiakiskconsistentkwithkmigrainekandkstroke.k
Visualkchangeskarekconsistentkwithkmigraine,kstroke,kandkmeningitis.k
Familykhistorykiskconsistentkwithkmigrainekandkstroke.
1800:
, Emergencykmedicalkteamkremovedkclient'skshirtkatkthekscenekandkinitiatedk18-
gaugekIVktherapykinkthekrightkantecubitalkspace.
Clientkhaskfull-thicknesskburnskoverkthekupperkhalfkofkthekchestkandkbothkforearms;kpartial-
thicknesskburnskarekpresentkonkthekclient'skfacekandkneck.
Sinusktachycardia,kpulsesktokbrachialkextremitieskpalpable.k1+kedemaktokupperkextremities
.
Respirationskeven,klaboredkwithkscatteredkrhonchi.kSootknotedktokthekclient'skmouthkandkno
se.kOxygenk40%kviakfacektentkapplied.
Hypoactivekbowelksounds.
16kFrenchkindwellingkurinarykcatheterkinsertedkwithkreturnkofk250kmLkofkyellowkurine.
LactatedkRinger'skinfusingktokrightkantecubital.kProviderkpreparingktokinsertkrightkfemoralkce
ntralklinekcatheter.
1830:
Client'skvoicekiskbecomingkhoarsekandkreportskdifficultykswallowing.kWheezeskpresentktoku
pperklobeskbilaterally.kProviderknotified.kClientkpositionedkupright,koxygenkviakfacektent.kBlo
odkcollectedk-kcorrectkanswer--
Duringkthekemergentkphasekofkburnkcare,kthekclientkiskatkriskkforkdevelopingk
hypovolemia
andk
respiratorykfailure
.
1NGN
000:ClientkpresentsktokthekEDkwithkvisualkdisturbances,kexpressivekaphasia,kandknumbnes
skandktinglingkofktheklips.kManifestationskstartedkaboutk30kminkago.kClientkreportskflashingkli
ghtskinktheirkvision,kespeciallykonkthekrightkside.
Client'skpartnerkstateskthekclientkhadksomekdifficultykwithkfindingkwordskwhenkspeaking.
Clientkiskalertkandkorientedkxk3kandkappearskanxious.kNokfacialkdroopingknoted.kRightkhandk
graspkiskweakerkthankleft.kClientkdenieskpain.1045:Clientkstateskthekflashingklights,knumbne
ss,kandktinglingkinktheklipskhavekgonekaway.kClientkstatesktheyknowkhavekthrobbingkpainkbeh
indkthekleftkeye,kphotophobia,kandknausea.kClientkiskrequestingkmedicationkforkpainkthatkisk7
konkakscalekofk0ktok10.
Handkgraspskarekequalkandkstrongkbilaterally.1300:Clientkreportskpainkask2konkakscalekofk0kt
ok10kandknauseakhaskresolved.
Providedkclientkwithkdischargekinstructionskregardingksumatriptankandkmigrainektriggers.k-
kcorrectkanswer--"Foodskthatkcontainktyraminekmightktriggerkmykheadaches"kiskcorrect.k
"Ikwillkkeepkakfoodkandkheadachekdiary"kiskcorrect.k
"IkwillkplacekakcoolkclothkonkmykforeheadkwhenkIkexperiencekakmigraine"kiskcorrect.k
"Ikwillktakektheksumatriptankoncekeverykday"kiskincorrect.k
"Ikshouldkstaykawakekuntilkmykheadachekiskgone"kiskincorrect.
Practice 2023 A NGN
0530:
Clientkiskawakekandkalert.
Arteriovenouskfistulak(AVF)ktokrightkforearmkwithkthrillkpalpatedkandkauscultatedkforkbruit.kL
ungksoundskclearkuponkauscultation;kclientkdenieskshortnesskofkbreath.kNokperipheralkede
maknoted;kcapillarykrefillkisklesskthank3kseconds;k+2kbilateralkpedalkandkradialkpulses.
AVFkaccesskpreparedkandkcannulatedktwicekwithknokdifficulty.kLineskarektapedkandksecured
;ktreatmentkiskinitiated.0600:
Clientkiskreadingkakbook.kAccesskiskvisible,kandklineskareksecure.kClientkreportsknokdiscomfo
rtkorkpain.0630:
Clientkreportskfeelingkwarm,knauseated,kandklightheaded;kappearskrestlesskandkslightlykco
nfused.k-kcorrectkanswer--Performkak12-leadkECGkisknotkindicated.
PlacekthekclientkinkTrendelenburgkpositionkiskindicated.
Administerkak0.9%ksodiumkchloridek200kmLkIVkboluskiskindicated.k
Applykoxygenkatk2kL/minkviaknasalkcannulakiskindicated
Notifykthekproviderkimmediatelykiskindicated
Obtainkthekclient'skbloodkglucoseklevelkisknotkindicated.
1000:ClientkpresentsktokthekEDkwithkvisualkdisturbances,kexpressivekaphasia,kandknumbne
sskandktinglingkofktheklips.kManifestationskstartedkaboutk30kminkago.kClientkreportskflashingkl
ightskinktheirkvision,kespeciallykonkthekrightkside.
Client'skpartnerkstateskthekclientkhadksomekdifficultykwithkfindingkwordskwhenkspeaking.
Clientkiskalertkandkorientedkxk3kandkappearskanxious.kNokfacialkdroopingknoted.kRightkhandk
graspkiskweakerkthankleft.kClientkdenieskpain.k-kcorrectkanswer--
Handkgraspskiskconsistentkwithkmigraine,kstroke,kandkmeningitis.
k
Numbnesskiskconsistentkwithkmigrainekandkstroke.k
Aphasiakiskconsistentkwithkmigrainekandkstroke.k
Visualkchangeskarekconsistentkwithkmigraine,kstroke,kandkmeningitis.k
Familykhistorykiskconsistentkwithkmigrainekandkstroke.
1800:
, Emergencykmedicalkteamkremovedkclient'skshirtkatkthekscenekandkinitiatedk18-
gaugekIVktherapykinkthekrightkantecubitalkspace.
Clientkhaskfull-thicknesskburnskoverkthekupperkhalfkofkthekchestkandkbothkforearms;kpartial-
thicknesskburnskarekpresentkonkthekclient'skfacekandkneck.
Sinusktachycardia,kpulsesktokbrachialkextremitieskpalpable.k1+kedemaktokupperkextremities
.
Respirationskeven,klaboredkwithkscatteredkrhonchi.kSootknotedktokthekclient'skmouthkandkno
se.kOxygenk40%kviakfacektentkapplied.
Hypoactivekbowelksounds.
16kFrenchkindwellingkurinarykcatheterkinsertedkwithkreturnkofk250kmLkofkyellowkurine.
LactatedkRinger'skinfusingktokrightkantecubital.kProviderkpreparingktokinsertkrightkfemoralkce
ntralklinekcatheter.
1830:
Client'skvoicekiskbecomingkhoarsekandkreportskdifficultykswallowing.kWheezeskpresentktoku
pperklobeskbilaterally.kProviderknotified.kClientkpositionedkupright,koxygenkviakfacektent.kBlo
odkcollectedk-kcorrectkanswer--
Duringkthekemergentkphasekofkburnkcare,kthekclientkiskatkriskkforkdevelopingk
hypovolemia
andk
respiratorykfailure
.
1NGN
000:ClientkpresentsktokthekEDkwithkvisualkdisturbances,kexpressivekaphasia,kandknumbnes
skandktinglingkofktheklips.kManifestationskstartedkaboutk30kminkago.kClientkreportskflashingkli
ghtskinktheirkvision,kespeciallykonkthekrightkside.
Client'skpartnerkstateskthekclientkhadksomekdifficultykwithkfindingkwordskwhenkspeaking.
Clientkiskalertkandkorientedkxk3kandkappearskanxious.kNokfacialkdroopingknoted.kRightkhandk
graspkiskweakerkthankleft.kClientkdenieskpain.1045:Clientkstateskthekflashingklights,knumbne
ss,kandktinglingkinktheklipskhavekgonekaway.kClientkstatesktheyknowkhavekthrobbingkpainkbeh
indkthekleftkeye,kphotophobia,kandknausea.kClientkiskrequestingkmedicationkforkpainkthatkisk7
konkakscalekofk0ktok10.
Handkgraspskarekequalkandkstrongkbilaterally.1300:Clientkreportskpainkask2konkakscalekofk0kt
ok10kandknauseakhaskresolved.
Providedkclientkwithkdischargekinstructionskregardingksumatriptankandkmigrainektriggers.k-
kcorrectkanswer--"Foodskthatkcontainktyraminekmightktriggerkmykheadaches"kiskcorrect.k
"Ikwillkkeepkakfoodkandkheadachekdiary"kiskcorrect.k
"IkwillkplacekakcoolkclothkonkmykforeheadkwhenkIkexperiencekakmigraine"kiskcorrect.k
"Ikwillktakektheksumatriptankoncekeverykday"kiskincorrect.k
"Ikshouldkstaykawakekuntilkmykheadachekiskgone"kiskincorrect.
