SWIFT RIVER MEDICAL SURGICAL CORE MAIN
EXAMS QUESTIONS AND ANSWERS SURE A+
✔✔Tom Richardson, 46yr-old. Dx- urinary stones with 3 episodes/5yrs. Allergic to sulfa
drugs. Vital signs -Temp 98.4,BP 178/105, P 112, RR 28, SaO2 94%; Neuro- WNL's.
Skin warm and pale. Generalized weakness, blood tinged urine and severe pain upon
urination, GI- n/v. Clear liquid diet. Strict I&O and strain all urine, filters in bathroom.
Patient demonstrates urine strain procedure. Severe pain (10/10) medicated q 30
minutes x4 with IV Morphine 2mg with little relief. IV D5 1/2 NS @150ml/hr. Dr. Small at
bedside with patient and family. Stat lithotripsy treatment ordered. Awaiting transport. -
✔✔Educational Needs Increased acuity
Fall Risk Increased acuity
Health Change Increased acuity
Pain Level Increased acuity
Psychological Needs Normal acuity
Sensorium Normal acuity
✔✔Tom Richardson - ✔✔Physiological
Acute Pain True
Electrolyte Imbalance False
Imbalanced Nutrition False
Impaired Mobility, Risk for True
Impaired Skin Integrity, Risk for False
Impaired Urinary Elimination True
Safety
Fall, Risk for True
Sleep Deprivation False
✔✔Tom Richardson
,Senario 1
Day 2 admission, Thomas Richardson is complaining of severe pain and is now begging
you for some relief; states pain scale 10/10.
Senario 2
Mr. Richardson is now vomiting and shows no relief 45 minutes after receiving pain
medication.
Senario 3
Mr. Richardson is requesting assistance to ambulate to bathroom.
Senario 4
Mr. Richardson is now pain free and questioning why he is plagued with recurring
urinary stones.
Senario 5
You are now preparing for discharge, place steps in order: - ✔✔Senario 1
Wash and glove hands
Vital assessment
Administer pain medications
Re-assess patient
Document results
Senario 2
Vital Assessment
Notify Doctor for pain medz
Administer new pain medz
Re-assess patient
Senario 3
Use therapeutic communication/Active Listening
Obtain urinary screen
Assist patient
Remain with patient
Document results and findings
Senario 4
Use therapeutic communication/Active Listening
Educate patient
Evaluate understanding
Contact dietary consult
Document results
Senario 5
Discharge instructions
, Evaluate understanding
Escort patient to vehicle
Document results
Notify housekeeping
✔✔John Duncan, 56yr-old male, Dx- Gastroenteritis, returned yesterday from Cancun,
c/o intractable diarrhea, weak, pale, and refusing to eat. No known allergies (NKA).
Non-significant past medical Hx. Vital signs Temp 99.4, BP 106/72, P 96, RR 20, SaO2
91%. Neuro WNL's, alert and cooperative. IV maintenance fluids with D5 1/2 NS at
125ml per hour in left forearm. c/o headache- medicated with Lortab 5mg PO at 0900,
takes Lomotil 10ml PRN q 4 hours last dose at 0834. Stools are decreasing but patient
remains very weak. Wife at bedside. Diet as tolerated. Dr. Jones. - ✔✔Educational
Needs Increased acuity
Fall Risk Increased acuity
Health Change Increased acuity
Pain Level Increased acuity
Psychological Needs Normal acuity
Sensorium Normal acuity
✔✔John Duncan - ✔✔Physiological
Deficient Fluid Volume True
Electrolyte Imbalance, Risk for True
Excess Fluid Volume, Risk for False
Fatigue True
Nausea False
Self-Care Deficit False
Safety
Fall, Risk for True
Infection, Risk for False
Esteem
Ineffective Coping False
Noncompliance True
✔✔John Duncan
Scenario 1
As you enter the room, Mr. Duncan is refusing to eat foods from bland diet.
Scenario 2
Mr. Duncan is now complaining of feeling "dizzy" when he stands.
Scenario 3
Several hours later, Mr. Duncan is now complaining of nausea.
EXAMS QUESTIONS AND ANSWERS SURE A+
✔✔Tom Richardson, 46yr-old. Dx- urinary stones with 3 episodes/5yrs. Allergic to sulfa
drugs. Vital signs -Temp 98.4,BP 178/105, P 112, RR 28, SaO2 94%; Neuro- WNL's.
Skin warm and pale. Generalized weakness, blood tinged urine and severe pain upon
urination, GI- n/v. Clear liquid diet. Strict I&O and strain all urine, filters in bathroom.
Patient demonstrates urine strain procedure. Severe pain (10/10) medicated q 30
minutes x4 with IV Morphine 2mg with little relief. IV D5 1/2 NS @150ml/hr. Dr. Small at
bedside with patient and family. Stat lithotripsy treatment ordered. Awaiting transport. -
✔✔Educational Needs Increased acuity
Fall Risk Increased acuity
Health Change Increased acuity
Pain Level Increased acuity
Psychological Needs Normal acuity
Sensorium Normal acuity
✔✔Tom Richardson - ✔✔Physiological
Acute Pain True
Electrolyte Imbalance False
Imbalanced Nutrition False
Impaired Mobility, Risk for True
Impaired Skin Integrity, Risk for False
Impaired Urinary Elimination True
Safety
Fall, Risk for True
Sleep Deprivation False
✔✔Tom Richardson
,Senario 1
Day 2 admission, Thomas Richardson is complaining of severe pain and is now begging
you for some relief; states pain scale 10/10.
Senario 2
Mr. Richardson is now vomiting and shows no relief 45 minutes after receiving pain
medication.
Senario 3
Mr. Richardson is requesting assistance to ambulate to bathroom.
Senario 4
Mr. Richardson is now pain free and questioning why he is plagued with recurring
urinary stones.
Senario 5
You are now preparing for discharge, place steps in order: - ✔✔Senario 1
Wash and glove hands
Vital assessment
Administer pain medications
Re-assess patient
Document results
Senario 2
Vital Assessment
Notify Doctor for pain medz
Administer new pain medz
Re-assess patient
Senario 3
Use therapeutic communication/Active Listening
Obtain urinary screen
Assist patient
Remain with patient
Document results and findings
Senario 4
Use therapeutic communication/Active Listening
Educate patient
Evaluate understanding
Contact dietary consult
Document results
Senario 5
Discharge instructions
, Evaluate understanding
Escort patient to vehicle
Document results
Notify housekeeping
✔✔John Duncan, 56yr-old male, Dx- Gastroenteritis, returned yesterday from Cancun,
c/o intractable diarrhea, weak, pale, and refusing to eat. No known allergies (NKA).
Non-significant past medical Hx. Vital signs Temp 99.4, BP 106/72, P 96, RR 20, SaO2
91%. Neuro WNL's, alert and cooperative. IV maintenance fluids with D5 1/2 NS at
125ml per hour in left forearm. c/o headache- medicated with Lortab 5mg PO at 0900,
takes Lomotil 10ml PRN q 4 hours last dose at 0834. Stools are decreasing but patient
remains very weak. Wife at bedside. Diet as tolerated. Dr. Jones. - ✔✔Educational
Needs Increased acuity
Fall Risk Increased acuity
Health Change Increased acuity
Pain Level Increased acuity
Psychological Needs Normal acuity
Sensorium Normal acuity
✔✔John Duncan - ✔✔Physiological
Deficient Fluid Volume True
Electrolyte Imbalance, Risk for True
Excess Fluid Volume, Risk for False
Fatigue True
Nausea False
Self-Care Deficit False
Safety
Fall, Risk for True
Infection, Risk for False
Esteem
Ineffective Coping False
Noncompliance True
✔✔John Duncan
Scenario 1
As you enter the room, Mr. Duncan is refusing to eat foods from bland diet.
Scenario 2
Mr. Duncan is now complaining of feeling "dizzy" when he stands.
Scenario 3
Several hours later, Mr. Duncan is now complaining of nausea.
