Patient Introduction
Mr. Watkins is a 69-year-old male who presented to the Emergency Department 4
days ago with complaints of nausea, vomiting, and severe abdominal pain and was
admitted for emergent surgery for bowel perforation. He underwent a
hemicolectomy. He has a midline abdominal incision without redness, swelling, or
drainage. He is tolerating a soft diet without nausea or vomiting. Bowel sounds are
present in all four abdominal quadrants. He had a bowel movement yesterday. Last
urinary output was 400 ml at 6 a.m. He is reluctant to use the incentive spirometer,
but his wife encourages him to do his deep breathing. Abdominal pain has been
controlled with morphine. He has refused to ambulate this morning because of
fatigue and a sore leg. He is ringing the call light requesting to see his nurse.
Medical-Surgical Nursing Care
Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th EditionMedical-
Surgical Nursing
Care of the Postoperative Patient, Chapter 19, pp. 456-476
Pulmonary Embolism, Chapter 23, pp. 614-618
Diagnostics
Expert Clinical Content from Lippincott Advisor
Arterial blood gas analysis
D-dimer test
Prothrombin time
International normalized ratio
Pharmacology
Clinical Content from Lippincott Advisor
Heparin
Morphine
Pre-Sim Quiz
1. Which of the following nursing assessment findings are excluded for a pulmonary
embolism? (Select all that apply.)
Response: Gradual onset chest pain, Bradycardia, Hot dry skin
Rationale: Signs and symptoms of pulmonary embolism (PE) can include dyspnea,
sudden chest pain, anxiety, fever, tachycardia, hemoptysis, and diaphoresis.
Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition, p. 615
2. The nurse understands that heparin acts in which of the following ways?
Response: It prevents conversion of fibrinogen to fibrin.
This study source was downloaded by 100000839380065 from CourseHero.com on 06-28-2022 00:21:58 GMT -05:00
https://www.coursehero.com/file/82203467/VernonWatkins-Pre-Post-Sim-Quizdocx/
, Rationale: Heparin accelerates formation of antithrombin III-thrombin complex and
deactivates thrombin, preventing conversion of fibrinogen to fibrin.
Remediation: Lippincott Advisor, Heparin sodium: mono_heparin_sodium
3. What measure would the nurse take after interpreting the following arterial blood
gas (ABG) results for a postoperative patient on a 40% oxygen face mask? pH 7.34
PaCO2 46 mm Hg HCO3 26 mEq/L PaO2 86 mm Hg
Response: Monitor the respiratory rate and depth closely
Rationale: The ABG reveals an uncompensated respiratory acidosis. The PaCO2 is
slightly elevated. CO2 retention can result from a decreased respiratory rate or
depth. The PaO2 is within normal limits, so an increase in oxygen is not needed. The
provider should be notified of the ABG results, but it is not an emergency or
requiring intubation.
Remediation: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th
Edition, pp. 286-287
Lippincott Advisor, Arterial blood gas analysis: CD.978-1-58255-514-0. chapter52
4. Morphine is administered by the nurse in the patient experiencing pulmonary
embolism in order to accomplish which of the following? (Select all that apply.)
Response: Decrease anxiety, decrease pain, Decrease preload
Rationale: Small doses of IV morphine are administered to relieve the patient's pain
and ease adaption to mechanical ventilation, if needed, which may also assist in
reducing anxiety. Morphine also decreases preload due to its venous vasodilation
effects.
Remediation: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th
Edition, p. 616
5. The nurse knows that death from an acute pulmonary embolism commonly
occurs within how many hours after the onset of symptoms?
Response:1
Rationale: Death for acute pulmonary embolism (PE) commonly occurs within one
hour after onset of symptoms.
Remediation: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th
Edition, p. 616
Which of the following diagnostic tools can the nurse expect to be used when a
pulmonary embolism is suspected? (Select all that apply.)
Response: Chest x-ray, Arterial blood gas, Ventilation-perfusion scan,
Electrocardiogram
This study source was downloaded by 100000839380065 from CourseHero.com on 06-28-2022 00:21:58 GMT -05:00
https://www.coursehero.com/file/82203467/VernonWatkins-Pre-Post-Sim-Quizdocx/
Mr. Watkins is a 69-year-old male who presented to the Emergency Department 4
days ago with complaints of nausea, vomiting, and severe abdominal pain and was
admitted for emergent surgery for bowel perforation. He underwent a
hemicolectomy. He has a midline abdominal incision without redness, swelling, or
drainage. He is tolerating a soft diet without nausea or vomiting. Bowel sounds are
present in all four abdominal quadrants. He had a bowel movement yesterday. Last
urinary output was 400 ml at 6 a.m. He is reluctant to use the incentive spirometer,
but his wife encourages him to do his deep breathing. Abdominal pain has been
controlled with morphine. He has refused to ambulate this morning because of
fatigue and a sore leg. He is ringing the call light requesting to see his nurse.
Medical-Surgical Nursing Care
Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th EditionMedical-
Surgical Nursing
Care of the Postoperative Patient, Chapter 19, pp. 456-476
Pulmonary Embolism, Chapter 23, pp. 614-618
Diagnostics
Expert Clinical Content from Lippincott Advisor
Arterial blood gas analysis
D-dimer test
Prothrombin time
International normalized ratio
Pharmacology
Clinical Content from Lippincott Advisor
Heparin
Morphine
Pre-Sim Quiz
1. Which of the following nursing assessment findings are excluded for a pulmonary
embolism? (Select all that apply.)
Response: Gradual onset chest pain, Bradycardia, Hot dry skin
Rationale: Signs and symptoms of pulmonary embolism (PE) can include dyspnea,
sudden chest pain, anxiety, fever, tachycardia, hemoptysis, and diaphoresis.
Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition, p. 615
2. The nurse understands that heparin acts in which of the following ways?
Response: It prevents conversion of fibrinogen to fibrin.
This study source was downloaded by 100000839380065 from CourseHero.com on 06-28-2022 00:21:58 GMT -05:00
https://www.coursehero.com/file/82203467/VernonWatkins-Pre-Post-Sim-Quizdocx/
, Rationale: Heparin accelerates formation of antithrombin III-thrombin complex and
deactivates thrombin, preventing conversion of fibrinogen to fibrin.
Remediation: Lippincott Advisor, Heparin sodium: mono_heparin_sodium
3. What measure would the nurse take after interpreting the following arterial blood
gas (ABG) results for a postoperative patient on a 40% oxygen face mask? pH 7.34
PaCO2 46 mm Hg HCO3 26 mEq/L PaO2 86 mm Hg
Response: Monitor the respiratory rate and depth closely
Rationale: The ABG reveals an uncompensated respiratory acidosis. The PaCO2 is
slightly elevated. CO2 retention can result from a decreased respiratory rate or
depth. The PaO2 is within normal limits, so an increase in oxygen is not needed. The
provider should be notified of the ABG results, but it is not an emergency or
requiring intubation.
Remediation: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th
Edition, pp. 286-287
Lippincott Advisor, Arterial blood gas analysis: CD.978-1-58255-514-0. chapter52
4. Morphine is administered by the nurse in the patient experiencing pulmonary
embolism in order to accomplish which of the following? (Select all that apply.)
Response: Decrease anxiety, decrease pain, Decrease preload
Rationale: Small doses of IV morphine are administered to relieve the patient's pain
and ease adaption to mechanical ventilation, if needed, which may also assist in
reducing anxiety. Morphine also decreases preload due to its venous vasodilation
effects.
Remediation: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th
Edition, p. 616
5. The nurse knows that death from an acute pulmonary embolism commonly
occurs within how many hours after the onset of symptoms?
Response:1
Rationale: Death for acute pulmonary embolism (PE) commonly occurs within one
hour after onset of symptoms.
Remediation: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th
Edition, p. 616
Which of the following diagnostic tools can the nurse expect to be used when a
pulmonary embolism is suspected? (Select all that apply.)
Response: Chest x-ray, Arterial blood gas, Ventilation-perfusion scan,
Electrocardiogram
This study source was downloaded by 100000839380065 from CourseHero.com on 06-28-2022 00:21:58 GMT -05:00
https://www.coursehero.com/file/82203467/VernonWatkins-Pre-Post-Sim-Quizdocx/
