Exam 1: NSG233/ NSG 233 (Latest 2023/ 2024 Update) Med Surg 3 Exam| Guide with Questions and Verified Answers| 100% Correct- Herzing

Exam 1: NSG233/ NSG 233 (Latest 2023/

2024 Update) Med Surg 3 Exam| Guide with

Questions and Verified Answers| 100%

Correct- Herzing

Q: Triage patients in the ED

Answer:

Use ESI (emergency severity index) tool

Responsibilities of triage nurse:

Assess, reassess, initiate treatment, manage and communicate, edu tients, transport them

Q: Meds for managing sexual assault

Answer:

Prophylaxis for gonorrhea

Ceftriaxone + 1% lidocaine

Prophylaxis for syphilis and chlamydia: Single dose metronidazole

Single dose azithromycin

7-day oral regimen doxycycline

Anti-pregnancy:

Levonorgestrel and ethinyl estradiol

Give within 12-24 hours, no more than 72 hours post-intercourse

Antiemetic for side effects

Q: Tension pneumothorax care

Answer:

Immediate needle decompression

Followed by chest tube insertion

S/S: chest pain, dyspnea, tachycardia, anxiety, air hunger, increased use of acces- sory muscles,

decreased/absent breath sounds on affected side, deviated trachea to unaffected side

Q: Subcutaneous emphysema care

Answer:

Leaked air pockets under skin, feels like

"rice crispies"

Part of spontaneous pneumothorax

Not usually serious Report to provider Monitor airway

Absorbs once pneumothorax is treated

Q: Intra-abdominal injury care

Answer:

Risk for hemorrhage - monitor for shock

Liver - right shoulder pain

Spleen - left shoulder pain

If stable --> CT

If unstable --> FAST exam (focused assessment with sonography for trauma) Management:

ABCs, C-spine precautions, NPO, antibiotics/tetanus, monitoring, surgery PRN

Q: Pneumothorax assessment

Answer:

Tracheal alignment - midline (simple pneumoth- orax)

Chest expansion - decreased

Breath sounds - diminished/absent

Chest percussion - normal/hyper-resonant

Q: Pneumothorax care

Answer:

Goal: to evacuate air/blood from pleural space

A small chest tube (28 Fr) is inserted near second intercostal space

If hemothorax, large tube (32 Fr or greater) is inserted in fourth or fifth intercostal space

Suction is applied

Pleural cavity is decompressed (drainage of air/blood)

Q: Patient-controlled analgesia (PCA)

Answer:

Has programmable settings

Delivers morphine at a preset bolus

Can program a lockout period (control frequency)

HCP gives loading dose to attain therapeutic blood levels quickly (with continuous

IV infusion)

Assess pain scores after initiation, after any change in pump setting, and periodically

Q: Assessment for appropriateness of PCA

Answer:

Pre-procedure cognitive assess- ment

If opioid-tolerant* or opioid-naive* Pain assessment

Sedation assessment (precedes resp depression) Respiratory assessment

*Tolerant - 60 mg for a week or longer

*Naive - less than tolerant criteria

Q: Crush injuries

Answer:

At risk for rhabdomyolysis (crush syndrome) and compartment syndrome

Observe for: Hypovolemic shock Spinal cord injury

Erythema and skin blistering

Fractures

Acute kidney injury (from acute tubular necrosis)

Q: Rhabdomyolysis

Answer:

Destroyed skeletal muscle cells empty contents into circula- tion, causing kidney problems

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