Patient Profile:

• Name: Sarah Johnson
• Age: 54
• Diagnosis: Metastatic breast cancer, Stage IV, diagnosed six months ago with metastasis to the liver and bone

Treatment Plan:

• Surgery: Lumpectomy with axillary lymph node dissection
• Chemotherapy: Adriamycin and Cyclophosphamide (AC) regimen
• Radiation Therapy: Targeted treatment to the chest wall post-surgery

Clinical Presentation:

Subjective Data:

• Reports of nausea and vomiting, especially after chemotherapy sessions
• Expresses feelings of sadness and fear regarding her prognosis and the impact on her family
• States she has lost 10 pounds in the last month due to decreased appetite and nausea
• Describes pain in the surgical area and generalized body pain that worsens at night
• Mentions experiencing a red, itchy rash on her chest from radiation therapy

Objective Data:

• Vital signs: HR 78 bpm, BP 120/80 mmHg, Temp 98.6°F
• Weight: 135 lbs (down from 145 lbs)
• Physical examination reveals tenderness in the left breast and axilla

True or False: Emotional distress can decrease treatment adherence.

Patient Profile:

• Name: Mr. John Smith
• Age: 68 years
• Medical History: Osteoarthritis of the hip, Type 2 diabetes, hypertension, and atrial fibrillation
• Current Medications: Lisinopril, Metformin, Warfarin
• Surgical Procedure: Total hip replacement (THR) due to severe pain and limited mobility.

Preoperative Care:

• The nurse conducts a comprehensive assessment, including a physical examination, vital signs, and a review of Mr. Smith's medical history.
• Preoperative labs are ordered with the following abnormal values noted:
  • Complete Blood Count (CBC):
    1. Hemoglobin: 12.0 g/dL (normal range: 13.5-17.5 g/dL)
    2. Hematocrit: 36% (normal range: 38.8-50%)
  • Basic Metabolic Panel (BMP):
    1. Serum Creatinine: 3 mg/dL (normal range: 0.6-1.2 mg/dL)
    2. Blood Urea Nitrogen (BUN): 24 mg/dL (normal range: 7-20 mg/dL)

• • Coagulation Studies:
    1. INR: 5 (normal range: 0.8-1.1)

Intraoperative Care:

• The scrub nurse assists in positioning Mr. Smith on the operating table.
• The surgical team completes the time-out procedure.
• The surgeon states the estimated blood loss at 300 ml.
• The anesthesiologist reports a stable blood pressure of 120/64.

Postoperative Care:

• Mr. Smith is transferred to the Post Anesthesia Care Unit (PACU) for close monitoring of his recovery from anesthesia.
• Once fully recovered from surgery, Mr. Smith is transferred to the orthopedic unit where the orthopedic unit nurse starts the ordered morphine PCA.

Which medication should be held before surgery? Select all that apply.

Patient Profile:

• Age: 68 years
• Gender: Male
• Medical History: Hypertension, Type 2 Diabetes Mellitus, Atrial Fibrillation
• Medication History: Lisinopril, Metformin, Apixaban

Presenting Complaint:

• The patient was admitted to the hospital with shortness of breath, fatigue, and swelling in his legs. He reported a weight gain of 5 pounds over the past week.

Vital Signs on Admission:

• Blood Pressure: 160/95 mmHg
• Heart Rate: 110 bpm (tachycardia)
• Respiratory Rate: 24 breaths/min (tachypnea)
• Temperature: 98.6°F (37°C)
• Oxygen Saturation: 86% on room air

Physical Examination:

• General: Appears anxious and fatigued.
• Cardiovascular: Irregular heart rhythm
• Respiratory: Diminished breath sounds, crackles in lung bases bilaterally
• Abdomen: Soft, non-tender, no distension
• Extremities: Bilateral pitting edema (2+)

Diagnostic Tests:

1. Echocardiogram: Confirmed reduced ejection fraction (EF of 35%)
2. Chest X-ray: Showed cardiomegaly and bilateral pleural effusions
3. Electrocardiogram (ECG): Atrial fibrillation noted
4. B-type Natriuretic Peptide (BNP): 800 pg/mL
5. Arterial Blood Gas (ABG): pH 7.35, PaCO₂ 45 mmHg

Which of the following prescribed interventions would the nurse complete first?

Patient Profile:

• Age: 68 years
• Gender: Male
• Medical History: Hypertension, Type 2 Diabetes Mellitus
• Medications: Lisinopril, Metformin
• Allergies: None

Chief Complaint: The patient presents to the emergency department (ED) with sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Choose two actions the nurse should take to address the condition identified in the previous question.

Patient Profile:

• Age: 68 years
• Gender: Male
• Medical History: Hypertension, Type 2 Diabetes Mellitus
• Medications: Lisinopril, Metformin
• Allergies: None

Chief Complaint: The patient presents to the emergency department (ED) with sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Choose two actions the nurse should take to address the condition identified in the previous question.