NUR 3219 Care Management II Exam 4 Winter 2020 Cohort 8 STUDY GUIDE

1. A patient must sign an informed consent for all scheduled operative procedures, which must be placed in the patient’s record. a. A client is scheduled to have a tracheostomy placed in an hour. What action by the nurse is the priority? Ensure informed consent is on the chart. 2. A nurse notes that the patient’s face is puffy and the eyelids are swollen 3 days after having a tracheostomy. Look up subcutaneous emphysema assessment and interventions. a. A client has a tracheostomy that is 3 days old. Upon assessment, the nurse notes the clients face is puffy and the eyelids are swollen. What action by the nurse takes priority? Assess the client’s oxygen saturation. 3. What is the priority action I a patient with a tracheostomy begins coughing and choking when eating? a. A client has a tracheostomy tube in place. When the nurse suctions the client, food particles are noted. What action by the nurse is best? Measure and compare cuff pressures. 4. Review the steps for suctioning a tracheostomy. View the ATI Skills video. a. A student is practicing suctioning a tracheostomy in the skills laboratory. What action by the student demonstrates that more teaching is needed? a. Applying suction while inserting the catheter 5. Re: Unlicensed Assistive Personnel (UAP) can only perform and assist general ADLs for patients. Oxygen can be drying, so the UAP can apply water-soluble lubricant to the patient’s lips and nares. The UAP would not adjust the oxygen flow rate or remove the tubing. Turning the patient is not related to comfort measures for oxygen. a. An unlicensed assistive personnel (UAP) was feeding a client with a tracheostomy. Later that evening, the UAP reports that the client had a coughing spell during the meal. What action by the nurse takes priority? Assess the client’s lung sounds. b. A client is receiving oxygen at 4 liters per nasal cannula. What comfort measure may the nurse delegate to unlicensed assistive personnel (UAP)? Apply water-soluble ointment to nares and lips. 6. A patient is wearing a venturi mask to deliver oxygen and the dinner tray has arrived. What action by the nurse is best to promote eating and continuing to provide supplemental oxygen? a. A client is wearing a Venturi mask to deliver oxygen and the dinner tray has arrived. What action by the nurse is best? Determine if the client can switch to a nasal cannula during the meal. 7. A nurse is assessing a patient who has suffered a nasal fracture. Which assessment would the nurse perform first? a. A nurse is assessing a client who has suffered a nasal fracture. Which assessment should the nurse perform first? Airway patency b. A nurse assesses a client who has a nasal fracture. The client reports constant nasal drainage, a headache, and difficulty with vision. Which action should the nurse take next? Collect the nasal drainage on a piece of filter paper. 8. List the pre-disposing factors for obstructive sleep apnea a. A nurse assesses a client who reports waking up feeling very tired, even after 8 hours of good sleep. Which action should the nurse take first? Ask the client if he or she has ever been evaluated for sleep apnea. 9. A nurse cares for a patient who is scheduled for a total laryngectomy. The communication method the client will use after the surgery needs to be discussed pre-operatively. a. A nurse cares for a patient who had a partial laryngectomy 10 days ago. It is normal for foods to taste bland. Taste will return in weeks to months. A nurse cares for a client who had a partial laryngectomy 10 days ago. The client states that all food tastes bland. How should the nurse respond? This is normal after surgery. What types of food do you like to eat? b. A nurse cares for a client who is scheduled for a total laryngectomy. Which action should the nurse take prior to surgery? Assist the client to choose a communication method. 10. Modafinil (Provigil) is prescribed for your patient who has sleep apnea. Why is this medication prescribed? a. A nurse is caring for a client who has sleep apnea and is prescribed modafinil (Provigil). The client asks, How will this medication help me? How should the nurse respond? This medication will promote daytime wakefulness. 11. When a patient needs a humidifier it is imperative for the nurse to explain that the machine must be cleaned frequently to prevent infection? a. A nurse teaches a client to use a room humidifier after a laryngectomy. Which statement should the nurse include in this clients teaching? Make sure you clean the humidifier to prevent infection 12. From several patients, select the patient that need to be seen first. Refer to priority setting. a. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for development of obstructive sleep apnea? A 55-year-old woman who is 50 pounds overweight 13. Your patient has developed esophagitis after undergoing radiation therapy for lung cancer. Select the most appropriate dinner for him/her. bland, soft, high-calorie foods are best, along with liquid nutritional supplements. a. A nurse cares for a client who has developed esophagitis after undergoing radiation therapy for lung cancer. Which diet selection should the nurse provide for this client? Omelet, soft whole wheat bread 14. Review the medication Salmeterol that is designed to prevent an asthma attack; it does not relieve or reverse symptoms. Salmeterol has a slow onset of action; therefore, it would not be used as a rescue dr ug. The drug must be shaken well because it has a tendency to separate easily. Salmeterol is a long-acting β2 adrenergic receptor agonist (LABA) used in the maintenance and prevention of asthma symptoms and maintenance of chronic obstructive pulmonary disease (COPD) symptoms. a. After teaching a client who is prescribed salmeterol (Serevent), the nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? It may take a while before I notice a change in my asthma A nurse is teaching a client who has cystic fibrosis (CF). Which statement should the nurse include in this clients teaching? Eat a well-balanced, nutritious diet Patients with CF often are malnourished due to vitamin deficiency and pancreatic malfunction. Maintaining nutrition is essential. Eat a well-balanced, nutritious diet. 15. fluticasone (Flovent) and notes white lesions in the month. What action would the nurse take? a. A nurse assesses a client who is prescribed fluticasone (Flovent) and notes oral lesions. Which action should the nurse take? Encourage oral rinsing after fluticasone administration. 16. Encourage oral rinsing after fluticasone administration as it can cause candida albicans (Thrush). 17. A nurse cares for a patient who is infected with Burkholderia cepacian. Burkholderia cepacia infection is spread through casual contact between cystic fibrosis patients, thus the need for these patients to be separated from one another. a. A