RNSG 1538 FINAL EXAM
PCA pump - Answers :what order to have and monitor on pt = continuous pulse ox.
Which assessment is highest priority before administering PCA pump - Answers :rate
and depth of respiration, reassess pain q 4hrs, at least 16-18rpm
Compartment syndrome s/s of impending organ failure - Answers :dark, scanty urine
Who can push the PCA button? - Answers :Only the patient
Multiple Sclerosis (MS) - Answers :weak, fatigue, incontinence, swallowing difficulties =
always make sure to have suction at bedside with yonker.
Spastic cerebral palsy - will child be able to walk normally? - Answers :difficult to
predict, if he's able to bear weight, it's a positive sign.
Male client in terminal stage of ca, cared at home with family, takes morphine, pt wakes
and asks nurse for increased in morphine. RR is 10/min, what is nurses best action? -
Answers :increase morphine - titrate it up. Must provide comfort.
ADHD - what to expect to find with child with this - Answers :fidgeting, inable to
concentrate, up and around, can't sit still.
EOL - pt in hospice and gurgling on inspiration, what is nursing action with highest
priority? - Answers :inform family death is imminent.
S/s of ICP with baby? - Answers :bulging fontanelle, sunset eyes, bradycardia, irritabile,
high pitched cry.
Client with major depression and thinking suicide, what highest NI in plan of care? -
Answers :check bags to make sure nothing is in them.
nurse to teach pt with ED to alter lifestyle to avoid what? - Answers :Alcohol
Compartment syndrome - what to see where the cast is? - Answers :can't perform
active movements, intense throbbing pain, pulses absent distal to fx site.
Amputation pt - stump in first 24hrs - Answers :we elevate it. Supine, pain meds, take
away elevation. Give meds for phantom pain.
Bacterial meningitis, what as the nurse to do - Answers :neuro checks every 2-4 hours
PCA pump - Answers :what order to have and monitor on pt = continuous pulse ox.
Which assessment is highest priority before administering PCA pump - Answers :rate
and depth of respiration, reassess pain q 4hrs, at least 16-18rpm
Compartment syndrome s/s of impending organ failure - Answers :dark, scanty urine
Who can push the PCA button? - Answers :Only the patient
Multiple Sclerosis (MS) - Answers :weak, fatigue, incontinence, swallowing difficulties =
always make sure to have suction at bedside with yonker.
Spastic cerebral palsy - will child be able to walk normally? - Answers :difficult to
predict, if he's able to bear weight, it's a positive sign.
Male client in terminal stage of ca, cared at home with family, takes morphine, pt wakes
and asks nurse for increased in morphine. RR is 10/min, what is nurses best action? -
Answers :increase morphine - titrate it up. Must provide comfort.
ADHD - what to expect to find with child with this - Answers :fidgeting, inable to
concentrate, up and around, can't sit still.
EOL - pt in hospice and gurgling on inspiration, what is nursing action with highest
priority? - Answers :inform family death is imminent.
S/s of ICP with baby? - Answers :bulging fontanelle, sunset eyes, bradycardia, irritabile,
high pitched cry.
Client with major depression and thinking suicide, what highest NI in plan of care? -
Answers :check bags to make sure nothing is in them.
nurse to teach pt with ED to alter lifestyle to avoid what? - Answers :Alcohol
Compartment syndrome - what to see where the cast is? - Answers :can't perform
active movements, intense throbbing pain, pulses absent distal to fx site.
Amputation pt - stump in first 24hrs - Answers :we elevate it. Supine, pain meds, take
away elevation. Give meds for phantom pain.
Bacterial meningitis, what as the nurse to do - Answers :neuro checks every 2-4 hours
