Prophecy PACU RN A V1, Exams of Health sciences

Download Prophecy PACU RN A V1 and more Exams Health sciences in PDF only on Docsity! Prophecy PACU RN A V1 Questions And Answers; Graded A Meperidine (Demerol) 12.5mg every 15 minutes, IV prn is ordered for shivering in the PACU. Meperidine is available in 50mg/1ml. How many mililiters should be given? Correct Ans:- 0.25 mililiters Upon inspecting a patient's epidural insertion site, you notice swelling around the catheter. What should you do? Correct Ans:- ***D) Contact the anesthesia provider A) Position the patient on their side B) Place the patient in a prone position C) Check the epidural line for kinks ***D) Contact the anesthesia provider What set of findings indicates a patient is likely to be ready for phase 1 discharge? Correct Ans:- ***C) Drowsy, oxygen saturation of 96%, able to cough, and move all extremities A) Has received discharge instructions, pain level 9 out 10, shortness of breath B) Drowsy, blood pressure returned to preoperative levels, on 6 liters oxygen via face mask ***C) Drowsy, oxygen saturation of 96%, able to cough, and move all extremities D) Fully alert, shallow breathing, on 3 liters via T-piece, can move 2 extremities What do you consider to be a safe dose of intravenous fentanyl for an adult who does not have tolerance to opioids? Correct Ans:- ***B) 25 micrograms A) 1.5 miligrams ***B) 25 micrograms C) 100 micrograms D 25 miligrams Your patient in the PACU has a blood pressure of 171/92 mmHg, a heart rate of 120, respiratory rate of 24, is grimacing, restless, and moaning in bed. What medication should you prepare to give FIRST? Correct Ans:- A) 10 mg hydralazine IV push ***B) 50 mcg fentanyl IV push C) 2 mg lorazepam IV push D) 5 mg metoprolol IV push You are about to discharge a day surgery patient with aphasia and you discover the family members are not available for the discharge instructions and are not responding to your phone calls. Business hours are over and the PACU is about to close. How will you handle the situation? Correct Ans:- ***A) Wait until the family returns B) Leave the discharge education on voicemail and discharge patient C) Discharge patient with non-emergency transport D) Take patient home yourself You received a patient from OR post hip replacement surgery. The anesthesiologist is planning a nerve block in PACU, but the patient did not sign the consent for the nerve block. How will you proceed? Correct Ans:- A) Wake up the patient to sign the consent B) Ask a friend to sign the consent ***C) Obtain the consent from medical POA D) Proceed with the procedure What position would help alleviate headaches after spinal anesthesia? Correct Ans:- A) Prone B) Trendelenburg C) Semi-fowlers ***D) Flat to supine ***WRONG*** What is a physical manifestation of neuromuscular blockade (Roc, succinylcholine)? Correct Ans:- A) Decreased consciousness B) Decreased pupillary light reflex C) Decreased respiratory effort ***WRONG***D) Decreased sensation of pain The surgeon has ordered ampicillin (Ancef) for a patient. When you check their chart, you see an allergy to penicillin. What is the BEST action? Correct Ans:- A) Administer the medication with diphenhydramine B) Ask the patient to describe their reaction to penicillin C) Contact the pharmacist to clarify the order ***D) Contact the provider to question the order You are receiving report for a patient who had a percutaneous transluminal angioplasty for right lower extremity peripheral vascular disease and is now recovering in the PACU. What type of surgical dressing do you expect to find for this patient? Correct Ans:- A) JP drain sutured in place near the lateral calf B) Several small incisions in calf groin covered with gauze ***C) Clear dressing applied to the right groin D) 3 in incision on the right upper thigh with bulky dressing You are receiving a report on a post op patients from the OR nurse and during the report when you asked for clarifications, the OR nurse became angry, belligerent, and rude. She ended up not answering your question. How will you proceed? Correct Ans:- ***A) Report the incident to your charge nurse B) Refuse to take the patient C) Take the report as she gave it to you D) Figure out the clarifications from computer ***C) The patient can maintain their airway D) The patient's vital signs have been monitored for 60 minutes You were called in at 2am and did not leave the hospital until 4am. However, your regular shift starts at 7am, and you are extremely tired. What is the appropriate action? Correct Ans:- D) Call your manager and ask for the unit protocol **WRONG** You are caring for a patient in Phase 1 recovery and they appear ready to transfer except that their blood pressure continues to stay 50mmHg above their pre- anesthetic SBP. At home the patient takes a diuretic and beta-blocker for hypertension. What should you do? Correct Ans:- A) Evaluate the patient's pain level (probs correct) **WRONG**B) Administer 20mg furosemide orally C) Transfer the patient to the unit D) Contact the anesthesia provider You receive a patient to Phase I recovery from IR status post cerebral aneurysm clipping. Which assessment is most important for you to perform? Correct Ans:- A) Cardiac rhythm, heart rate, blood pressure ***B) Pupil response, facial and extremity movement C) Bowel sounds, urinary output, and oral cavity D) RR, BP, Temp Which patient is MOST at risk for developing postoperative cardiogenic shock? Correct Ans:- A) A 78 year old male adult with CKD ***B) Pt with recent MI C) Female pt with ES liver disease D) Pediatric patient with metastatic lymphadenopathy ***WRONG*** When setting up a morphine PCA pump for a 5'10'' female patient recovering from hip surgery who is 49 years old, 180 lb, and has no history of sleep apnea, what is an expected 4-hr dose limit? Correct Ans:- ***WRONG**A) 5 mg B) 20 mg (probs correct) C) 3 mg D) 40 mg You are caring for a postoperative thyroidectomy patient in the PACU. What is the least likely finding for this patient? Correct Ans:- A) Paresthesia of the fingers and toes ***B) Low Hgb C) Muscle Cramps D) Tingling in hands and feet **WRONG*** After a 6-hour abdominal surgery during which a patient was on their back, a patient reports persistent lower back pain. What should you do next? Correct Ans:- ***WRONG***A) Help them to a new position B) Administer pain medication C) Inspect their lower back (probs correct, pt might be bleeding into back) D) Check their hematocrit What is a result of shivering? Correct Ans:- A) Decreased oxygen consumption ***B) Increased oxygen demand C) Peripheral vasoconstriction D) Elevated end tidal CO2 ***WRONG*** What combination of medications is an example of multi-modal pain management? Correct Ans:- A) IV PCA morphine with IV fentanyl ***WRONG***B) Oral morphine ER and IV morphine C) IV hydromorphone and IV acetaminophen (probs correct, one is opioid, other is not) D) IV hydromorphone and IV morphine You are caring for a patient with a brachial plexus block after surgery. The patient begins to report chest discomfort on the side where the block was placed. A 12 lead EKG was normal. What order do you expect to be completed NEXT for this patient? Correct Ans:- A) Echo B) Cardiac biomarkers C) CMP ***D) Chest X-ray You need to obtain consent from a sedated patient post hip replacement surgery for a regional block. Two women showed up at bedside as next of kin. One has a child with patient and the other is the patient's girlfriend. How will you obtain the consent? Correct Ans:- A) Proceed with patient signature ***B) Look for patient's parents or immediate family members C) Allow one of the women to sign D) Allow both women to sign ***WRONG*** What instructions for care should you include when educating a patient about their Penrose drain? Correct Ans:- ***WORNG***A) You will have bright red drainage from the tube for several days B) Change your dressing 2 times a day or when it becomes wet (very probs correct) C) This drainage tube helps prevent accumulation of bile D) Remove the safety pin at the end of the tube when you get home You are caring for a patient with a continuous basal rate PCA infusion when the patient becomes difficult to awaken. What should you do FIRST? Correct Ans:- ***A) Hold the PCA infusion B) Elevate the head of bed 45 degrees C) Stay with patient D) Contact anesthesia provider Which factor puts a patient MOST at risk for confusion upon awakening from general anesthesia? Correct Ans:- B) Advanced Age You are providing care for a diabetic patient in the PACU. What care should you provide to decrease their risk of surgical site infections? Correct Ans:- B) Maintain blood glucose levels per protocol and hand hygiene What department approves and reviews medical aspects of care in the PACU including policies and procedures? Correct Ans:- Department of Anesthesia When providing care to a patient in the PACU who is receiving placement of a new permanent vascular access graft, what finding should you report immediately to the surgeon? Correct Ans:- Inability to palpate a thrill While helping to prepare a patient for surgery, you notice that their medical record indicates DNR. What should you do? Correct Ans:- Ask the patient to explain their wishes about resuscitation A patient's DNR order was revoked during surgery. When can it be reinstated? Correct Ans:- Per institutional policy A patient who received general anesthesia tells you that their throat is sore and you notice their voice is hoarse. What should you do? Correct Ans:- provide ice chips and sips of water ***WRONG*** There are 4 patients in PACU: a patient who received surgery to repair their maxilla bone fracture, a patient recovering from esophageal resection for squamous cell cancer, a patient who is recovering from surgical placement of a tracheostomy, and a patient who is recovering from Roux-en Y gastric bypass surgery. For which of the patient is the insertion of a nasopharyngeal airway contraindicated? Correct Ans:- C) Maxilla bone fracture (probs correct) ***WRONG*** D) Patient recovering from tracheostomy ***WRONG*** You are caring for a patient when suddenly their ECG monitor shows coarse ventricular fibrillation. They become unable to rouse and pulseless. What is the PRIORITY intervention for this patient? Correct Ans:- A) IV Epi B) IV Amio C) Chest compressions (probs correct) ****WRONG***D) Defib You're about to discharge a patient who speaks a Vietnamese dialect. The patient has a friend who speaks that same dialect but this friend is at home. What will you do in order to give patient appropriate discharge instructions? Correct Ans:- Use your organization's designated translating system What do you consider to be the SAFEST initial dose of IV hydromorphone for a 70 year-old without renal impairment? Correct Ans:- A) 0.5 mg B) 1 mg ***C) 0.2 mg D) 0.5 mcg