MED SURG HESI EXAM (1) GRADED A

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Hesi Review Advanced Medical-Surgical Nursing (Miami Dade College) A client who has undergone abdominal surgery calls the nurse and reports that she just felt “something give way” in the abdom... inal incision. The nurse checks the incision and notes the presence of wound dehiscence. The nurse immediately: Click here for answers https://bit.ly/3jDsMn8 Contacts the physician In Documents the findings Places the client in a supine position with the legs flat Covers the abdominal wound with a sterile dressing moistened with sterile saline solution Click here for answers https://bit.ly/3jDsMn8 Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Perioperative Care Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., pp. 291, 292, 296). St. Louis: Saunders. A client who just returned from the recovery room after a tonsillectomy and adenoidectomy is restless and her pulse rate is increased. As the nurse continues the assessment, the client begins to vomit a copious amount of bright-red blood. The immediate nursing action is to: Notify the surgeon Continue the assessment Click here for answers https://bit.ly/3jDsMn8 Check the client’s blood pressure lOMoARcPSD|784381Obtain a flashlight, gauze, and a curved hemostat Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 657). St. Louis: Saunders. A client who has just undergone surgery suddenly experiences chest pain, dyspnea, and tachypnea. The nurse suspects that the client has a pulmonary embolism and immediately sets about: Preparing the client for a perfusion scan Click here for answers https://bit.ly/3jDsMn8 Attaching the client to a cardiac monitor Administering oxygen by way of nasal cannula Ensuring that the intravenous (IV) line is patent Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 680). St. Louis: Saunders. . 4.ID: 383738703 A nurse is assessing a client who has a closed chest tube drainage system. The nurse notes constant bubbling in the water seal chamber. What actions should the nurse take? (Select all that apply). Clamping the chest tube Changing the drainage system Assessing the system for an external air leak Reducing Click here for answers https://bit.ly/3jDsMn8 the degree of suction being applied Documenting assessment findings, actions taken, and client response lOMoARcPSD|784381A nurse is helping a client with a closed chest tube drainage system get out of bed and into a chair. During the transfer, the chest tube is caught on the leg of the chair and dislodged from the insertion site. The immediate priority on the part of the nurse is: Click here for answers https://bit.ly/3jDsMn8 Contacting the physician Click here [Show More]

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