NSG 233 Med Surge 3 Final
Exam LATESTQUESTIONS
AND VERIFIED CORRECT
ANSWERS
AAA- Post Op - CORRECT ANSWER-The patient who has had an endovascular repair must lie
supine for 6 hours; the head of the bed may be elevated up to 45 degrees after two hours. The
patient needs to use a bedpan or urinal while on bed rest. Vital signs and Doppler assessment of
peripheral pulses are performed initially every 15 minutes and then at progressively longer
intervals if the patient's status remains stable. The access site (usually the femoral artery) is
assessed when vital signs and pulses are monitored. The nurse assesses for bleeding, pulsation,
swelling, pain, and hematoma formation. Skin changes of the lower extremity, lumbar area, or
buttocks that might indicate signs of embolization, such as extremely tender, irregularly shaped,
cyanotic areas, as well as any changes in vital signs, pulse quality, bleeding, swelling, pain, or
hematoma, are immediately reported to the primary provider.
The patient's temperature should be monitored every four hours, and any signs of
postimplantation syndrome should be reported. Postimplantation syndrome typically begins
within 24 hours of stent-graft placement and consists of a spontaneously occurring fever,
leukocytosis, and occasionally, transient thrombocytopenia. This condition has been attributed
to complex immunologic changes that occur because of manipulations with sheaths and
catheters with the aortic lumen, although the exact etiology is unknown. The symptoms are
thought to be related to the activation of cytokines. They can be managed with a mild analgesic
(e.g., acetaminophen [Tylenol]) or an anti-inflammatory agent (e.g., ibuprofen [Motrin]) and
usually subside within a week.
Because of the increased risk of hemorrhage, the primary provider is also notified of persistent
coughing, sneezing, vomiting, or systolic blood pressure greater than 180 mm Hg. Most patients
can resume their pre-proce
,Asystole Drug Choice - CORRECT ANSWER-In such cases, the treatment is the same as for
asystole and pulseless electrical activity (PEA) if the patient is in cardiac arrest or for bradycardia
if the patient is not in cardiac arrest. Interventions include identifying the underlying cause;
administering IV epinephrine, atropine, and vasopressor medications; and initiating emergency
transcutaneous pacing. In some cases, idioventricular rhythm may cause no symptoms of
reduced cardiac output. Ventricular asystole is treated the same as PEA.
Dysthythmias and Calium - CORRECT ANSWER-A low calcium level could lead to severe
ventricular dysrhythmias, prolonged QT, and cardiac arrest. Calcium blood levels help maintain
normal heartbeats, while low levels can simultaneously cause polarization and depolarization of
cardiac cells, and thereby predispose the heart to arrhythmias. ***FROM GOOGLE
ETT Assessment - CORRECT ANSWER-The nurse plays a vital role in assessing the patient's status
and the functioning of the ventilator. In assessing the patient, the nurse evaluates the patient's
physiologic status and how he or she is coping with mechanical ventilation. Physical assessment
includes systematic assessment of all body systems, with an in-depth focus on the respiratory
system. Respiratory assessment includes vital signs, respiratory rate and pattern, breath sounds,
evaluation of spontaneous ventilatory effort, and potential evidence of hypoxia (e.g., skin color).
Increased adventitious breath sounds may indicate a need for suctioning. The nurse maintains
the patient's head of the bed so that it is elevated 30° or higher unless contraindicated to
prevent the risk of aspiration and VAP. The nurse evaluates the settings and functioning of the
mechanical ventilator, as described previously, and verifies endotracheal tube position as
applicable.
Assessment also addresses the patient's neurologic status and effectiveness of coping with the
need for assisted ventilation and the changes that accompany it. The nurse assesses the
patient's comfort level and ability to communicate as well. Because weaning from mechanical
ventilation requires adequate nutrition, it is important to assess the patient's gastrointestinal
system and nutritional status.
Thoracotomy- water seal functuality
Water Seal System - CORRECT ANSWER-The traditional water seal system (or wet suction) for
chest drainage has three chambers: a collection chamber, a water seal chamber, and a wet
suction control chamber. The collection chamber acts as a reservoir for fluid draining from the
, chest tube. It is graduated to permit easy measurement of drainage. Suction may be added to
create negative pressure and promote drainage of fluid and removal of air. The suction control
chamber regulates the amount of negative pressure applied to the chest. The amount of suction
is determined by the water level. It is usually set at 20 cm H2O; adding more fluid results in
more suction. After the suction is turned on, bubbling appears in the suction chamber. A
positive-pressure valve is located at the top of the suction chamber that automatically opens
with increases in positive pressure within the system. Air is automatically released through a
positive-pressure relief valve if the suction tubing is inadvertently clamped or kinked.
The water seal chamber has a one-way valve or water seal that prevents air from moving back
into the chest when the patient inhales. There is an increase in the water level with inspiration
and a return to the baseline level during exhalation; this is referred to as tidaling. Intermittent
bubbling in the water seal chamber is normal, but continuous bubbling can indicate an air leak.
Bubbling and tidaling do not occur when the tube is placed in the mediastinal space; however,
fluid may pulsate with the patient's heartbeat. If the chest tube is connected to gravity drainage
only, suction is not used. The pressure is equal to the water seal only. Two-chamber chest
drainage systems (water seal chamber and collection chamber) are available for use with
patients who need only gravity drainage.
The water level in the water seal chamber reflects the negative pres
Thoracotomy- water seal functuality
Dry Suction Water Seal System - CORRECT ANSWER-Dry suction water seal systems, also
referred to as dry suction, have a collection chamber for drainage, a water seal chamber, and a
dry suction control regulator. The water seal chamber is filled with water to the 2-cm level.
Bubbling in this area can indicate an air leak. The dry suction control regulator provides a dial
that conveniently regulates the vacuum to the chest drain. The system does not contain a
suction control chamber filled with water. Without a water-filled suction chamber, the machine
is quieter. However, if the container is knocked over, the water seal may be lost.
Once the tube is connected to the suction source, the regulator dial allows the desired level of
suction to be set; the suction is increased until an indicator appears. The indicator has the same
function as the bubbling in the traditional water seal system—that is, it indicates that the
vacuum is adequate to maintain the desired level of suction. Some drainage systems use a
bellows (a chamber that can be expanded or contracted) or an orange-colored float device as an
indicator of when the suction control regulator is set.
When the water in the water seal rises above the 2-cm level, intrathoracic pressure increases.
Dry suction water seal systems have a manual high-negativity vent located on top of the drain.
Exam LATESTQUESTIONS
AND VERIFIED CORRECT
ANSWERS
AAA- Post Op - CORRECT ANSWER-The patient who has had an endovascular repair must lie
supine for 6 hours; the head of the bed may be elevated up to 45 degrees after two hours. The
patient needs to use a bedpan or urinal while on bed rest. Vital signs and Doppler assessment of
peripheral pulses are performed initially every 15 minutes and then at progressively longer
intervals if the patient's status remains stable. The access site (usually the femoral artery) is
assessed when vital signs and pulses are monitored. The nurse assesses for bleeding, pulsation,
swelling, pain, and hematoma formation. Skin changes of the lower extremity, lumbar area, or
buttocks that might indicate signs of embolization, such as extremely tender, irregularly shaped,
cyanotic areas, as well as any changes in vital signs, pulse quality, bleeding, swelling, pain, or
hematoma, are immediately reported to the primary provider.
The patient's temperature should be monitored every four hours, and any signs of
postimplantation syndrome should be reported. Postimplantation syndrome typically begins
within 24 hours of stent-graft placement and consists of a spontaneously occurring fever,
leukocytosis, and occasionally, transient thrombocytopenia. This condition has been attributed
to complex immunologic changes that occur because of manipulations with sheaths and
catheters with the aortic lumen, although the exact etiology is unknown. The symptoms are
thought to be related to the activation of cytokines. They can be managed with a mild analgesic
(e.g., acetaminophen [Tylenol]) or an anti-inflammatory agent (e.g., ibuprofen [Motrin]) and
usually subside within a week.
Because of the increased risk of hemorrhage, the primary provider is also notified of persistent
coughing, sneezing, vomiting, or systolic blood pressure greater than 180 mm Hg. Most patients
can resume their pre-proce
,Asystole Drug Choice - CORRECT ANSWER-In such cases, the treatment is the same as for
asystole and pulseless electrical activity (PEA) if the patient is in cardiac arrest or for bradycardia
if the patient is not in cardiac arrest. Interventions include identifying the underlying cause;
administering IV epinephrine, atropine, and vasopressor medications; and initiating emergency
transcutaneous pacing. In some cases, idioventricular rhythm may cause no symptoms of
reduced cardiac output. Ventricular asystole is treated the same as PEA.
Dysthythmias and Calium - CORRECT ANSWER-A low calcium level could lead to severe
ventricular dysrhythmias, prolonged QT, and cardiac arrest. Calcium blood levels help maintain
normal heartbeats, while low levels can simultaneously cause polarization and depolarization of
cardiac cells, and thereby predispose the heart to arrhythmias. ***FROM GOOGLE
ETT Assessment - CORRECT ANSWER-The nurse plays a vital role in assessing the patient's status
and the functioning of the ventilator. In assessing the patient, the nurse evaluates the patient's
physiologic status and how he or she is coping with mechanical ventilation. Physical assessment
includes systematic assessment of all body systems, with an in-depth focus on the respiratory
system. Respiratory assessment includes vital signs, respiratory rate and pattern, breath sounds,
evaluation of spontaneous ventilatory effort, and potential evidence of hypoxia (e.g., skin color).
Increased adventitious breath sounds may indicate a need for suctioning. The nurse maintains
the patient's head of the bed so that it is elevated 30° or higher unless contraindicated to
prevent the risk of aspiration and VAP. The nurse evaluates the settings and functioning of the
mechanical ventilator, as described previously, and verifies endotracheal tube position as
applicable.
Assessment also addresses the patient's neurologic status and effectiveness of coping with the
need for assisted ventilation and the changes that accompany it. The nurse assesses the
patient's comfort level and ability to communicate as well. Because weaning from mechanical
ventilation requires adequate nutrition, it is important to assess the patient's gastrointestinal
system and nutritional status.
Thoracotomy- water seal functuality
Water Seal System - CORRECT ANSWER-The traditional water seal system (or wet suction) for
chest drainage has three chambers: a collection chamber, a water seal chamber, and a wet
suction control chamber. The collection chamber acts as a reservoir for fluid draining from the
, chest tube. It is graduated to permit easy measurement of drainage. Suction may be added to
create negative pressure and promote drainage of fluid and removal of air. The suction control
chamber regulates the amount of negative pressure applied to the chest. The amount of suction
is determined by the water level. It is usually set at 20 cm H2O; adding more fluid results in
more suction. After the suction is turned on, bubbling appears in the suction chamber. A
positive-pressure valve is located at the top of the suction chamber that automatically opens
with increases in positive pressure within the system. Air is automatically released through a
positive-pressure relief valve if the suction tubing is inadvertently clamped or kinked.
The water seal chamber has a one-way valve or water seal that prevents air from moving back
into the chest when the patient inhales. There is an increase in the water level with inspiration
and a return to the baseline level during exhalation; this is referred to as tidaling. Intermittent
bubbling in the water seal chamber is normal, but continuous bubbling can indicate an air leak.
Bubbling and tidaling do not occur when the tube is placed in the mediastinal space; however,
fluid may pulsate with the patient's heartbeat. If the chest tube is connected to gravity drainage
only, suction is not used. The pressure is equal to the water seal only. Two-chamber chest
drainage systems (water seal chamber and collection chamber) are available for use with
patients who need only gravity drainage.
The water level in the water seal chamber reflects the negative pres
Thoracotomy- water seal functuality
Dry Suction Water Seal System - CORRECT ANSWER-Dry suction water seal systems, also
referred to as dry suction, have a collection chamber for drainage, a water seal chamber, and a
dry suction control regulator. The water seal chamber is filled with water to the 2-cm level.
Bubbling in this area can indicate an air leak. The dry suction control regulator provides a dial
that conveniently regulates the vacuum to the chest drain. The system does not contain a
suction control chamber filled with water. Without a water-filled suction chamber, the machine
is quieter. However, if the container is knocked over, the water seal may be lost.
Once the tube is connected to the suction source, the regulator dial allows the desired level of
suction to be set; the suction is increased until an indicator appears. The indicator has the same
function as the bubbling in the traditional water seal system—that is, it indicates that the
vacuum is adequate to maintain the desired level of suction. Some drainage systems use a
bellows (a chamber that can be expanded or contracted) or an orange-colored float device as an
indicator of when the suction control regulator is set.
When the water in the water seal rises above the 2-cm level, intrathoracic pressure increases.
Dry suction water seal systems have a manual high-negativity vent located on top of the drain.
