SWIFT RIVER: WEEK 1 - MEDICAL-SURGICAL EXAM
QUESTIONS AND 100% VERIFIED SOLUTIONS | LATEST
IUPDATED 2026/2027 | GHRADED A+ | ASSURED PASS.
Nathaniel Gonzalez | Room 301
Patient Overview
Nathaniel_Gonzalez.jpgNathaniel Gonzalez, a 58-year-old male
patient presents to the ER CO CP 10/10. He is pale, weak,
diaphoretic, and appears anxious. He has a history of well controlled
GERD with over-the-counter Tagamet (Cimetidine), and Tums. He
also has a history of hypertension and takes Tenormin (Atenolol) and
Atorvastatin (Lipitor). He was recently treated for a URI with a Z
pack, prednisone, and Motrin for pain. BP 154/89, P 94 F, R 22, T
Educational- Increased
Fall Risk- Increased
Health Change- Increased
Pain Level- Increased
Neurological Status- Normal
Psychological Needs- Increased
Nathaniel Gonzalez
Nathaniel Gonzalez , a 58-year-old male patient presents to the ER
CO CP 10/10. He is pale, weak, diaphoretic, and appears anxious. He
has a history of well controlled GERD with over-the-counter Tagamet
(Cimetidine), and Tums. He also has a history of hypertension and
takes Tenormin (Atenolol) and Atorvastatin (Lipitor). He was recently
Page 1 of 20
,treated for a URI with a Z pack, prednisone, and Motrin for pain. BP
154/89, P 94 F, R 22, T 98.3F, SaO2 95% on room air. The patient
was plac
Acute discomfort
Knowledge deficit
Potential for falls
Nathaniel Gonzalez Scenario 2
Nathaniel GonzalezMr. Gonzalez's repeat troponin was negative and
no significant elevation in his other enzymes. He has been ruled out
for an MI. He told the nurse that he has had some changes in his
bowel habits and his stools have been very dark. The patient has been
scheduled for an EGD today and has an order for Omeprazole
(Prilosec) and Carafate (sucralfate). When the nurse enters the room
later that day to inform him that the procedure is scheduled for 1430, t
1- Explain to the patient that he has a procedure, and he cannot eat.
2- Remove the lunch tray from patient and reinforce the risk if
patient has not been NPO and ask the patient when the last time they
ate.
3- Administer the medication with a small sip of water and place
an NPO sign at the entrance of the patient's room.
4- Assess if the contents of lunch tray are intact. Tell the provider
that he had been served his lunch tray and when the patient may have
last eaten.
5- Ensure pre-operative consent has been signed. Remind the
nursing staff that the patient is NPO.
Page 2 of 20
, Nathaniel Gonzalez Scenario 3
Nathaniel GonzalezMr. Gonzalez has returned from his EGD and is
still sleeping from the sedation. He was initially sedated with versed
2mg, and Fentanyl 100 mg by the EGD nurse, but the patient was not
tolerating the procedure, so anesthesia was called to administer
propofol. The nurse was told by the gastroenterology nurse that they
really struggled before they called anesthesia and they may have
caused an esophageal abrasion. Due to this, the provider would like h
1- Assess patient LOC, by waking patient and asking them to take
deep breaths.
2- Elevate head of bed and place the patient on Pulse oximetry.
3- Reapply the NC that he was admitted with at 2L
4- Remove the dinner tray and make sure the diet is soft food.
5- Reassess patient q 5 minutes until awake, then 15 minutes until
they are fully awake (not Drowsy).
Nathaniel Gonzalez Scenario 1
Nathaniel GonzalezMr. Gonzalez has been admitted to the floor to
determine that his chest pain is not related to a cardiac event. The ER
nurse reports that his cardiac enzymes were borderline and the GI
cocktail given in the ER did relieve his CP but not completely.
1- Tell the patient that they are being admitted to r/o any cardiac
issues
2- Remove the lunch tray from patient and reinforce the risk if
patient has not been NPO and ask the patient when the last time they
ate.
3- Tell the patient to call immediately if the chest pain gets worse
or they become short of breath
4- Explain to the patient that because of his weakness and
unknown cardiac status as well as the IV, he is a fall risk and should
not get out of bed without assistance.
Page 3 of 20
QUESTIONS AND 100% VERIFIED SOLUTIONS | LATEST
IUPDATED 2026/2027 | GHRADED A+ | ASSURED PASS.
Nathaniel Gonzalez | Room 301
Patient Overview
Nathaniel_Gonzalez.jpgNathaniel Gonzalez, a 58-year-old male
patient presents to the ER CO CP 10/10. He is pale, weak,
diaphoretic, and appears anxious. He has a history of well controlled
GERD with over-the-counter Tagamet (Cimetidine), and Tums. He
also has a history of hypertension and takes Tenormin (Atenolol) and
Atorvastatin (Lipitor). He was recently treated for a URI with a Z
pack, prednisone, and Motrin for pain. BP 154/89, P 94 F, R 22, T
Educational- Increased
Fall Risk- Increased
Health Change- Increased
Pain Level- Increased
Neurological Status- Normal
Psychological Needs- Increased
Nathaniel Gonzalez
Nathaniel Gonzalez , a 58-year-old male patient presents to the ER
CO CP 10/10. He is pale, weak, diaphoretic, and appears anxious. He
has a history of well controlled GERD with over-the-counter Tagamet
(Cimetidine), and Tums. He also has a history of hypertension and
takes Tenormin (Atenolol) and Atorvastatin (Lipitor). He was recently
Page 1 of 20
,treated for a URI with a Z pack, prednisone, and Motrin for pain. BP
154/89, P 94 F, R 22, T 98.3F, SaO2 95% on room air. The patient
was plac
Acute discomfort
Knowledge deficit
Potential for falls
Nathaniel Gonzalez Scenario 2
Nathaniel GonzalezMr. Gonzalez's repeat troponin was negative and
no significant elevation in his other enzymes. He has been ruled out
for an MI. He told the nurse that he has had some changes in his
bowel habits and his stools have been very dark. The patient has been
scheduled for an EGD today and has an order for Omeprazole
(Prilosec) and Carafate (sucralfate). When the nurse enters the room
later that day to inform him that the procedure is scheduled for 1430, t
1- Explain to the patient that he has a procedure, and he cannot eat.
2- Remove the lunch tray from patient and reinforce the risk if
patient has not been NPO and ask the patient when the last time they
ate.
3- Administer the medication with a small sip of water and place
an NPO sign at the entrance of the patient's room.
4- Assess if the contents of lunch tray are intact. Tell the provider
that he had been served his lunch tray and when the patient may have
last eaten.
5- Ensure pre-operative consent has been signed. Remind the
nursing staff that the patient is NPO.
Page 2 of 20
, Nathaniel Gonzalez Scenario 3
Nathaniel GonzalezMr. Gonzalez has returned from his EGD and is
still sleeping from the sedation. He was initially sedated with versed
2mg, and Fentanyl 100 mg by the EGD nurse, but the patient was not
tolerating the procedure, so anesthesia was called to administer
propofol. The nurse was told by the gastroenterology nurse that they
really struggled before they called anesthesia and they may have
caused an esophageal abrasion. Due to this, the provider would like h
1- Assess patient LOC, by waking patient and asking them to take
deep breaths.
2- Elevate head of bed and place the patient on Pulse oximetry.
3- Reapply the NC that he was admitted with at 2L
4- Remove the dinner tray and make sure the diet is soft food.
5- Reassess patient q 5 minutes until awake, then 15 minutes until
they are fully awake (not Drowsy).
Nathaniel Gonzalez Scenario 1
Nathaniel GonzalezMr. Gonzalez has been admitted to the floor to
determine that his chest pain is not related to a cardiac event. The ER
nurse reports that his cardiac enzymes were borderline and the GI
cocktail given in the ER did relieve his CP but not completely.
1- Tell the patient that they are being admitted to r/o any cardiac
issues
2- Remove the lunch tray from patient and reinforce the risk if
patient has not been NPO and ask the patient when the last time they
ate.
3- Tell the patient to call immediately if the chest pain gets worse
or they become short of breath
4- Explain to the patient that because of his weakness and
unknown cardiac status as well as the IV, he is a fall risk and should
not get out of bed without assistance.
Page 3 of 20
