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Ati Med Surg Complex 2 Final Proctored Exam
Total Questions : 101
Showing 10 questions, Sign in for moreWhy is it important for the nurse caring for a patient experiencing a stroke to establish the onset of the stroke before administering tissue plasminogen activator?
Which finding(s) would the nurse expect to assess on a patient with a diagnosis of diabetic ketoacidosis (DKA) recently admitted to the emergency department? (Select all that apply)
Burns noted on:
- Entire anterior torso (chest and abdomen)
- Entire left arm
- Anterior portion of right leg
- Face and neck
- Weight: 80 kg
- Time of injury: 1 hour ago
- HR: 135 bpm
- BP: 88/60 mmHg
- RR: 30
- SpO2: 94% on room air
- Temp: 36.2°C
- Urine output: 15 mL/hr
A 25-year-old male is brought to the Emergency Department via EMS after being involved in a motor vehicle collision with fire entrapment. The patient is conscious and in visible pain. You, a student nurse, are assigned to assist with his initial assessment and care.
Calculate the fluid requirements using the Parkland formula. What is the total fluid needed in the first 24 hours?
Explanation
Rationale:
Step 1: % of body burned:
- Front of chest and abdomen: 18%
- Left arm: 9%
- Front of right leg: 4.5%
- Face and neck: 4.5%
Total burned = 36%
Step 2: Parkland formula:
4 × weight (kg) × % burned = 4 × 80 × 36 = 11,520 ml in 24 hours
Step 3: Give fluids:
- First 8 hours: half → 5,760 ml
- Next 16 hours: half → 5,760 ml
Total 24-hour fluid requirement = 11,520 ml
Answer: 11,520 ml
The nurse is caring for a patient who sustained rib fractures with dropping Sa02 and BP. The nurse assesses that breath sounds are absent throughout the left lung fields. The nurse notifies the physician and anticipates which order?
Which of the following lab values would be most important to monitor during the fluid resuscitation phase? (Select All that Apply.)
What are some ethical dilemma warning signs? (Select All that Apply.)
The nurse understands that the most common reasons for initiating dialysis in acute kidney injury include which of the following? (Select all that apply)
The nurse is caring for a patient who was hit on the head with a hammer. The patient was unconscious at the scene briefly but is now conscious upon arrival at the emergency department (ED) with a GCS score of 15. One hour later, the nurse assesses a GCS score of 3. What is the priority nursing action?
A nurse caring for a patient with neurological impairment often must use painful stimuli to pressure. She neither slaps the patient nor pinches the nipple to elicit a response to pain. In this scenario, the nurse is exemplifying the ethical principle of
The nurse caring for a patient on a ventilator knows the amount of effort needed to maintain a given level of ventilation is called what?
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