ATI RN Adult Medical Surgical Online Practice 2019 B NGN

1800: Emergency medical team removed client's shirt at the scene and initiated 18-gauge IV therapy in the right antecubital space. Client has full-thickness burns over the upper half of the chest and both forearms; partial-thickness burns are present on the client's face and neck. Sinus tachycardia, pulses to brachial extremities palpable. 1+ edema to upper extremities. Respirations even, labored with scattered rhonchi. Soot noted to the client's mouth and nose. Oxygen 40% via face tent applied. Hypoactive bowel sounds. 16 French indwelling urinary catheter inserted with return of 250 mL of yellow urine. Lactated Ringer's infusing to right antecubital. Provider preparing to insert right femoral central line catheter. During the emergent phase of burn care, the client is at risk for developing ____________ and _____________. - curling's ulcer - hypovolemia - hyperthermia - hypokalemia - respiratory failure - - hypovolemia - respiratory failure 2000: Client reports pain as 3 on a scale of 0 to 10. Breath sounds clear and present throughout. Three abdominal bandages to abdomen, dry and intact with no drainage noted. Client voided 90 mL of clear-yellow urine into bedpan. Perineal pad with small amount of blood, no clots; perineal pad changed at this time. 2400: Client sleeping, arouses to verbal stimuli. Reports pain as 2 on a scale of 0 to 10 with repositioning. Client voided 125 mL of blood-tinged urine into bedpan. Perineal pad saturated with blood, large clots present. Click to highlight the findings the nurse should report to the provider immediately. - Client sleeping, arouses to verbal stimuli - Respiratory rate 14/min - Oxygen saturation 95% on room air, breath sounds clear - Reports pain as 2 on scale of 0 to 10 - Perineal pad saturated with blood, large clots present - Change of blood pressure, heart rate of 102/min - - Perineal pad saturated with blood, large clots present - Change of blood pressure, heart rate of 102/min 0900: Client presents with abdominal pain in the upper left quadrant for the past 2 days. States pain became worse this morning and is radiating to the back. Rates pain as 8 on a scale of 0 to 10. Hypoactive bowel sounds; reports nausea, no vomiting; client is passing flatus. Febrile, oriented to person, place, and time. Tachypnea with diminished breath sounds. Sinus tachycardia. Client voids 300 mL of clear, amber urine. 0930: Client vomited 100 mL brown liquid. Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The client is experiencing manifestations of Condition as evidenced by the Client Finding. Condition: - a cerebral vascular accident (CVA) - cardiogenic shock - paralytic ileus - adult respiratory distress syndrome - pancreatitis Client finding: - blood pressure - amylase and lipase -oxygen saturation - platelets levels - urine output - Condition: - pancreatitis Client findings: - amylase and lipase History and Physical Client admitted to the medical-surgical unit with severe, acute abdominal pain, abdominal distention, diarrhea, mucus and small amount of blood in the stool, and a 12% weight loss over the past 2 months. Client's weight 2 months ago was 100.3 kg (221.1 lb). Client has a history of Crohn's disease and a seizure disorder that is managed with diet and medication. Respirations are equal and unlabored. S1S2 heart tones auscultated. Abdominal assessment performed with muscle guarding and tenderness in the right lower quadrant noted on palpation. Abdomen is firm and rigid upon examination. Abdominal pain rated as an 8 on a scale of 0 to 10. Client states that pain is constant and localized in the lower right abdominal quadrant. Reports anorexia. Hypoactive bowel sounds noted upon auscultation. Complete the following sentence by using the lists of options. After reviewing the findings in the client' - - abdominal distention - acute pain History and Physical Client admitted to the medical-surgical unit with severe, acute abdominal pain, abdominal distention, diarrhea, mucus and small amount of blood in the stool, and a 12% weight loss over the past 2 months. Client's weight 2 months ago was 100.3 kg (221.1 lb). Client has a history of Crohn's disease and a seizure disorder that is managed with diet and medication. Respirations are equal and unlabored. S1S2 heart tones auscultated. Abdominal assessment performed with muscle guarding and tenderness in the right lower quadrant noted on palpation. Abdomen is firm and rigid upon examination. Abdominal pain rated as an 8 on a scale of 0 to 10. Client states that pain is constant and localized in the lower right abdominal quadrant. Reports anorexia. Hypoactive bowel sounds noted upon auscultation. The nurse is performing an assessment on the client. For each assessment finding, click to specify if the f - Appendicitis - pain in right lower quadrant - nausea Diverticular Disease - blood in stool - nausea Crohn's disease - blood in stool - pain in right lower quadrant - diarrhea - nausea Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The nurse is caring for the client who has manifestations of Condition; therefore, the priority finding for the nurse to report is Client Finding. Condition: - peritonitis - hepatitis - pericarditis - gastroenteritis - peptic ulcer disease Client finding: - bowel sounds - weight loss - diarrhea - laboratory values - small amount of blood in stool - Condition: - peritonitis Client: - laboratory values The nurse is planning care for the client who has peritonitis and Crohn's disease. For each potential provider's prescription, click to specify if each potential prescription is anticipated or contraindicated for the client. - Potential Prescription: - Administer a hypotonic IV solution: contraindicated - Obtain vital signs every hour: anticipated - Insert a nasogastric tube: anticipated - Obtain blood cultures: anticipated The nurse is caring for the client who is preoperative for an exploratory laparotomy. Select the 4 actions that the nurse should take. - Administer gentamicin 100 mg IV. - Administer dextrose 5% in lactated Ringer's. - Provide the client with high-flow supplemental oxygen. - Administer phenytoin with a sip of water prior to the surgery. - Contact the wound, ostomy, and continence nurse. - - Administer gentamicin 100 mg IV. - Administer dextrose 5% in lactated Ringer's. - Administer phenytoin with a sip of water prior to the surgery. - Contact the wound, ostomy, and continence nurse. The nurse is providing discharge teaching to the client. Which of the following statements made by the client indicates an understanding of the teaching? Select all that apply. - "I can continue to drink coffee in the mornings." - "I can resume lifting objects after 2 weeks." - "I should alternate taking acetaminophen with my prescribed pain medication." - "I should notify my provider if my temperature is higher than 101 degrees Fahrenheit." - "I should schedule several rest periods throughout the day." - - "I should schedule several rest periods throughout the day" - "I should notify my provider if my temperature is higher than 101° F" Client admitted to medical-surgical unit from PACU. Client reports incisional pain as 2 on a scale of 0 to 10. Client appears restless and frequently asks for water. Bilateral lower extremities cool with +1 pedal pulses. Urine output is 40 mL for the past 2 hr. Moderate amount of bright red drainage noted on surgical incision dressing.