swift river med surg pt scenarios Updated 2024/2025 Actual Questions and answers with complete solutions

Ann Rails Scenario 1 You enter patient's room. After washing and gloving hands, you then identify yourself and the patient, Ann Rails. You notice she is crying and is expressing fear that she "will always have this pain and numbness" and she doesn't think she can cope. Scenario 2 Ms. Rails was medicated with hydrocodone 5 mg PO two hours ago and is now complaining of pain (8/10 pain scale). Scenario 3 Ms. Rails shares with you her fear of being discharged home to an abusive husband. Scenario 4 Upon entering the room, you find Ms. Rails sleeping. She has received a dose of Hydrocodone for PRN pain 20 minutes ago. Scenario 5 Ms. Rails states that she has not had a bowel movement (BM) in the past two days. - Scenario 1 Use therapeutic communication/Active Listening Educate patient regarding patient care Evaluate patient learning Place call light and check bed for safety Document results and findings Scenario 2 Wash and glove hands AssessProvide comfort measures Notify doctor Document results and findings Scenario 3 Listen to patient concerns Reassure patient of options Notify lead nurse/doctor Contact Social Services Document results Scenario 4 Wash and glove hands Visual assessment Do not disturb Verify Call Light/Bed Safety precautions Document results Scenario 5 Assess for bowel sounds Encourage fluids/fiber/ambulation Evaluate patient understanding Attain fluids/fiber diet and assisted ambulation Document results Ann Rails - Physiological Acute Pain TrueBleeding, Risk for False Chronic Pain False Impaired Comfort True Impaired Mobility True Nausea False Safety Deficient Knowledge False Disturbed Sensory Perception True Fall, Risk for True Grieving False Infection, Risk for False Peripheral Neurovascular Dysfunction True Ann Rails, 38 years old, c/o back pain, non-significant past medical history. No known allergies (NKA). Vital signs -BP 124/82, Temp 98.2, P 84, RR 22, SaO2 96%. Pain and numbness in legs for one week. Abnormal left leg weakness, gait unsteady, 5/10 on numeric pain scale. Neuro WNL, except leg pain upon movement. Activity as tolerated with assistance. D/C plan- decrease pain and restore normal gait. Regular diet. Dr. Suculo - Educational Needs Increased acuity Fall Risk Increased acuity Health Change Increased acuity Pain Level Increased acuity Psychological Needs Normal acuity Sensorium Normal acuity Arthur Thomason Scenario 1You enter his room and recognize that Mr. Thomason appears to be talking to himself and appears confused. Scenario 2 Mr. Thomason appears now better oriented and MD arrives unexpectedly to examine him. Scenario 3 You enter room one hour after the physician has left the patient. Your notice Mr. Thomason is lying supine, appears slightly cyanotic in his lips, is exhibiting more effort to breathe, and is increasingly restless. Lung sounds are worse. Scenario 4 Rapid Response team arrived including anesthesia. The MD on site makes the decision to intubate the patient and start ventilatory assistance and move the patient to Respiratory Intensive Care. Scenario 5 Family arrive one hour after event to his prior room and find Mr. Thomason's room is empty and have no idea of the events that have just occurred. You, his prior nurse, notice the family and respond to them. - Scenario 1 Replace oxygen nasal cannula that had become disconnected Therapeutic communication Assess Notify doctor and charge nurse Scenario 2 Remind physician to wash his hands before examining the patient Explain to physician what interventions you have recently initiated Assist physician in physical exam of patient Obtain recent chest X-ray reports and recent ABG's for physician to review Reassure patient and help explain any new orders from physician to patientScenario 3 Tap patient and ask, "Are you okay?" Elevate head of bed Call Rapid Response protocol initiated Start secondary large bore IV line Remain with patient and reassure Scenario 4 Provide verbal report to team members who respond to rapid response Emergency intubation and assisted breathing is provided for Mr. Thomason Assume role in response team of documenter Obtain patient record and follow patient as he is transferred to ICU Provide information for MD to call family at home and explain what has just happened Scenario 5 You explain that his condition has worsened and now he has been taken to ICU. You explain that he is receiving a higher level of care and was he was sedated before leaving the floor to make him more comfortable. You have them remain with you, seated in comfortable place, while you call ICU and attempt to locate physician for them. You escort them with you to the ICU. You call his doctor to inform him the family has arrived. Arthur Thomason - Physiological At Risk, Impaired Comfort False Impaired Gas Exchange True Ineffective airway clearance True Shock FalseSafety Chronic Confusion False Love and Belonging ExplanationAnxiety/ fear True Failure to Thrive False Arthur Thomason, 56-year-old MVA victim, fourth day post op with a splenectomy and femur repair. He is experiencing new onset of shortness of breath and has a nasal cannula with 2L of Oxygen in place. He is restless with slight confusion but is easily orientated with attempts from nurse. Temperature spiked during the night to 102.4, BP now 146/94 which is slightly elevated, respirations at 30 bpm and slightly labored, heart rate 102 versus 84 from last night shift. Skin cool to touch and appears pale. His coughing, to clear his airway, appears ineffective. Recent chest X-ray shows diffuse bilateral interstitial infiltrates in all lobes. Recent blood gases demonstrate falling PaO2 (hypoxemia) and increasing CO2 (Hypercapnia). Mr. Thomason is anxious and is obviously worsened from the shift before in overall condition. - Educational Needs Increased acuity Health Change Increased acuity LOC Increased acuity Pain Level Increased acuity Psychological Needs Normal acuity Safety Increased acuity Carlos Mancia Scenario 1 Mr. Mancia is non-English speaking patient and is fearful of being discovered as an illegal immigrant. Upon entering the room with a translator to admit him to the hospital, he is asked for address and phone number but refuses to comply.Scenario 2 Upon entering room, you wash/glove hands. Following isolation precautions, you notice several family members are by his bedside and none of them are wearing face masks as requested by sign on door. Scenario 3 Mr. Mancia's vital signs upon assessment are Temp 101.2, P 94, RR 20, BP 122/82, SaO2-91%. Scenario 4 The sister of Mr. Mancia calls from home to speak with you. She shares concern about patient's wife who is now coughing and having night sweats. Scenario 5 Mr. Mancia is holding Catholic Rosary in hand and is crying as you enter the room. - Scenario 1 Don Personal Protective Equipment Allow for non-compliance of request Do not probe further Verify call Light/bed safety precautions Document results Scenario 2 Obtain translator Offer masks to visitors Educate patient Evaluate understanding Obtain Spanish signs & brochure Scenario 3 Obtain translatorT Wash and glove handsGown and mask Administer antipyretic medication Encourage fluids Scenario 4 Educate caller regarding HIPAA Evaluate caller understanding Refer call to contact health department Notify doctor Document conversation Scenario 5 Obtain translator Use therapeutic communication/Active Listening Educate patient Evaluate learning Document teaching