RN ADULT MEDICAL SURGICAL NURSING

RN ADULT MEDICAL SURGICAL NURSING RN ADULT MEDICAL SURGICAL NURSING RN ADULT MEDICAL SURGICAL NURSING Application Exercises Key 1. A. Incorrect: The nurse should notify the provider. The situation does not indicate the beginning of a rapid decline in the client’s condition. B. Correct: Using the priority-setting framework of urgent vs. nonurgent, the nurse should call the rapid response team because the signs indicate the beginning of a rapid decline in the client’s condition. C. Incorrect: This assessment does not indicate the beginning of a rapid decline in the client’s condition at this time. The nurse should reassess the client and notify the provider if the bleeding increases. D. Incorrect: The nurse should notify the provider. The situation does not indicate the beginning of a rapid decline in the client’s condition. NCLEX® Connection: Physiological Adaptations, Medical Emergencies 2. A. Incorrect: Vomiting places the client at risk for aspiration. B. correct: This is an appropriate action by the nurse because activated charcoal adsorbs drugs and other chemicals, and the charcoal does not pass into the bloodstream. C. Correct: This is an appropriate action by the nurse because gastric lavage with aspiration removes the toxic substance when the instilled fluid is suctioned from the gastrointestinal tract. D. Incorrect: Administering syrup of ipecac induces vomiting, which increases the client’s risk for aspiration. E. Correct: This is an appropriate action by the nurse because a solution of polyethylene glycol with electrolytes is ingested or administered through an nasogastric tube, and the toxic agent and solution are eliminated from the bowels. NCLEX® Connection: Physiological Adaptations, Medical Emergencies 3. A. Correct: This is an appropriate action by the nurse because the body temperature can rise more quickly when heat is applied to dry skin. B. Incorrect: The nurse should increase the temperature of the room to help return the client to a normal body temperature. C. Correct: This is an appropriate action by the nurse because the client’s body temperature can rise more quickly when warm blankets are applied. D. Correct: This is an appropriate action by the nurse because the client’s body temperature can rise more quickly when a heat lamp is safely applied. E. Correct: This is an appropriate action by the nurse because the client’s body temperature can rise more quickly when warmed IV fluids are infused. NCLEX® Connection: Physiological Adaptations, Medical Emergencies