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RN Adult Medical Surgical Online Practice 2023 A NGN

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1. NGN 1000: Client is alert and oriented and reports not feeling well for a few days. Client is on continuous ambulatory peritoneal dialysis (CAPD) and reports dialysate appeared cloudy this morning. Reports abdominal pain as 4 on a scale of 0 to 10. Bowel sounds active in all quadrants. Peritoneal dialysis access site red, warm to touch, with a small amount of purulent drainage noted on dressing.1300: Client is lying in bed with the knees flexed, guarding the abdomen. Abdomen is slightly distended, hypoactive bowel sounds. Client reports nausea. Reports pain as 6 on a scale of 0 to 10. Provider notified and updated with client condition and diagnostic results.: The client is experiencing manifestations of peritonitis due to x-ray results

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Geüpload op
17 september 2024
Aantal pagina's
39
Geschreven in
2023/2024
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Voorbeeld van de inhoud

RN Adult Medical Surgical Online Practice 2023 A NGN

1. N

GN

1000:

Client is alert and oriented and reports not feeling well for a few days. Client

is on continuous ambulatory peritoneal dialysis (CAPD) and reports

dialysate appeared cloudy this morning.

Reports abdominal pain as 4 on a scale of 0 to 10.

Bowel sounds active in all quadrants.

Peritoneal dialysis access site red, warm to touch, with a small amount

of purulent drainage noted on dressing.1300:

Client is lying in bed with the knees flexed, guarding the abdomen. Abdomen

is slightly distended, hypoactive bowel sounds. Client reports nausea.

Reports pain as 6 on a scale of 0 to 10. Provider notified and updated with

client condition and diagnostic results.: The client is experiencing

manifestations of peritonitis

due to

x-ray results

.

2. NGN


, RN Adult Medical Surgical Online Practice 2023 A NGN

Client admitted to medical-surgical unit from PACU. Client reports

incisional pain as 2 on a scale of 0 to 10. Client appears restless and

frequently asks for water. Bilateral lower extremities cool with +1 pedal

pulses. Urine output is 40 mL for the past 2 hr. Moderate amount of bright

red drainage noted on surgical incision dressing.: Insert a large-gauge IV.

Initiate a fluid challenge.


Hypovolemia



Urine output

Blood

pressure

3. A nurse is caring for a client who has a potassium level of 3 mEq/L. Which

of the following assessment findings should the nurse expect?: Hypoactive

Bowel Sounds

4. N

GN

0900:

Client presents with abdominal pain in the upper left quadrant for the past

2 days. States pain became worse this morning and is radiating to the


, RN Adult Medical Surgical Online Practice 2023 A NGN

back.

Rates pain as 8 on a scale of 0 to 10.

Hypoactive bowel sounds; reports nausea, no vomiting; client is

passing flatus.






, RN Adult Medical Surgical Online Practice 2023 A NGN

Febrile, oriented to person, place, and

time. Tachypnea with diminished breath

sounds. Sinus tachycardia.

Client voids 300 mL of clear, amber

urine. 0930:

Client vomited 100 mL brown liquid.: The client is experiencing

manifestations of pancreatitis

as evidenced by

the amylase and

lipase

.

5. 0530:

Client is awake and alert.

Arteriovenous fistula (AVF) to right forearm with thrill palpated and

auscultat- ed for bruit. Lung sounds clear upon auscultation; client denies

shortness of breath. No peripheral edema noted; capillary refill is less than 3

seconds; +2 bilateral pedal and radial pulses.

AVF access prepared and cannulated twice with no difficulty. Lines are

taped and secured; treatment is initiated.0600:
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