RN Adult Medical Surgical Online Practice 2023 B QUESTIONS WELL ELABORATED

A nurse is caring for a client in the emergency department (ED). Physical Examination Client presents to the ED with upper abdominal pain that radiates to the right shoulder. Client rates pain as 7 on a scale of 0 to 10. Client also reports nausea, vomiting, and dyspepsia. Client is awake, alert, and oriented x3. Lung sounds clear bilaterally, S1 and S2 heart tones noted. All pulses palpable. Bowel sounds active in all 4 quadrants. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. - ANSWER The nurse should plan to administer an opioid analgesic, such as morphine, for acute pain. Since the client is experiencing nausea and vomiting, the nurse should also ensure they are NPO. The client is likely experiencing cholecystitis, which typically presents with nausea, vomiting, upper abdominal pain that radiates to the right shoulder, fever, and dyspepsia. The client also has elevated liver enzymes and a WBC count, which is consistent with cholecystitis. Surgical management for cholecystitis might be indicated. The nurse should monitor the client's stool and urine color because a biliary obstruction from gallstones may cause clay-colored stools and dark urine. A nurse is caring for a client who was just admitted from the emergency department (ED). Nurses' Notes 0945: Client is experiencing a sickle cell crisis. Client states that they began experiencing pain in the lower extremities 3 days ago and is now experiencing pain in the chest, rating it as 4 on scale of 0 to 10. Oxygen at 3 L/min via nasal cannula in place. Oral mucosa pink, no cyanosis. Pulses palpable in all four extremities, no peripheral edema noted. Respirations even and slightly labored; lung sounds with slight wheezing in left upper lobe. Abdomen soft and nontender, bowel sounds active in all four quadrants. 0.45% sodium chloride IV at 200 mL/hr infusing to left hand with no reports of pain or swelling at the site. Drag words from the choices below to fill in each blank in the following sentence. - ANSWER Fluid volume overload is incorrect. While the client is experiencing an increased respiratory rate and shortness of breath, fluid volume overload typically includes moist crackles on auscultation, pitting edema in dependent areas, neck vein distension, and hypertension. Right-sided heart failure is incorrect. While clients who have sickle-cell disease are at risk for developing heart failure, the client does not have manifestations of right-sided heart failure. Right-sided heart failure typically presents with signs of fluid volume overload, which includes jugular vein distention, dependent edema, and blood pressure alterations. Acute chest syndrome is correct. The client is most likely experiencing acute chest syndrome, which can be caused by respiratory infections and debris from sickled cells. The client is displaying manifestations of acute chest syndrome, which include cough, shortness of breath, wheezing, tachypnea, fever, and chest pain. Pneumonia is correct. The client is most likely experiencing pneumonia as evidenced by the manifestations of cough, shortness of breath, fever, tachypnea, blood-tinged sputum, and chest pain. Pneumothorax is incorrect. While the client is experiencing increased respiratory distress, a pneumothorax typically presents with reduced or absent breath sounds and unequal chest expansion. A nurse is caring for a client. Nurses' Notes 1200: Client was admitted to the unit with shortness of breath, a nonproductive cough, chest discomfort, and myalgia. Prefers orthopneic position. Client reports that manifestations began about 2 days ago. For each assessment finding, click to specify if the finding is consistent with emphysema, asthma, or pneumonia. Each finding may support more than 1 disease process. - ANSWER Temperature is consistent with pneumonia. Fever is a manifestation of pneumonia and is related to inflammation or infection. Breath sounds are consistent with emphysema, asthma, and pneumonia. The client's wheezing is a manifestation of emphysema, asthma, and pneumonia. It is the result of narrowed airways and alveoli. ABG results are consistent with emphysema and pneumonia. The client's ABG results indicate respiratory acidosis, which is a manifestation of emphysema and pneumonia. Respiratory rate is consistent with emphysema, asthma, and pneumonia. The client's respiratory rate is a manifestation of emphysema, asthma, and pneumonia. Heart rate is consistent with emphysema and pneumonia. The client is experiencing tachycardia, which is a manifestation of emphysema and pneumonia. Cough is consistent with emphysema, asthma, and pneumonia. The client's cough is a manifestation of emphysema, asthma, and pneumonia. A nurse is caring for a client who is scheduled for a right knee arthroplasty. Nurses' Notes 0600: Client is admitted for surgery this a.m. Vital signs recorded. Consents reviewed. Client reports understanding of surgery and has no further questions for provider. The nurse provided preoperative teaching to the client. Which of the following statements by the client indicates an understanding of the teaching? Select all that apply. - ANSWER "Well, I guess there's no changing my mind about having surgery now" is incorrect. The nurse and the client reviewed the consents; therefore, the nurse has instructed the client that they have the right to refuse surgery at any time. "I will need to do the breathing exercises every 1 to 2 hours after the surgery" is correct. The client should cough and deep breathe and use the incentive spirometer every 1 to 2 hr to reduce the risk of postoperative complications, such as pneumonia. "I will be sure to ask for pain medication before my knee starts to hurt too bad" is correct. For optimal control of postoperative pain, the client should request analgesic medication before the pain becomes severe. "My physical therapy will start after I leave the hospital" is incorrect. Early ambulation leads to improved postoperative outcomes and reduces the risk of complications of immobility, such as pneumonia and atelectasis. The client should be informed that physical therapy will begin the day of, or the day following, surgery. "I will probably be going home with a walker" is correct. It can take 6 weeks for complete recovery from knee arthroplasty. Clients are often discharged with the use of a walker and will advance to a cane or crutch 4 to 6 weeks following surgery.