Nursing and Mrs. Newman

Mrs. Newman has been experiencing hoarseness and a change in her junction, exactly she did non seek medical answer until she began to take away difficulty swallowing. After creation seen by her wellness c are provider, she is scheduled for outpatient surgery for a direct laryngoscope to incur a culture and take a biopsy. Mrs. Newman arrives at the outpatient surgical plane section at 630 am and is escorted to her room. The admitting prevail begins her discernment 1. Which dubiety is most alpha for the accommodate to ask Mrs. Newman? A) Have you had allthing to eat or fuddle since midnight?B) Are you taking either medications? C) Have you potd any cigarettes in the last 24 hours? D) When was the last cartridge clip you drank any alcoholic drink? The ad little girlion defend completes the admission assessment and starts an IV. Mrs. Newman is taken to the operating room for the biopsy. Sifter the procedure, Mrs. Newman is admitted into the PACU. 2. Which interventio n pass on the PACU shield implant first? A) impede the health care providers prescriptions B) Monitors Mrs. Newmans pulse OX C) Contain Mrs. Newmans vital signs D) Assess Mrs. Newmans gag re wrick After 2 eld Mrs.Newman calls the oncologist and reluctantly agrees to a come in laryngectomy. Mrs. Newman comes to the oncology office to meet with the oncology suck in specializations to discuss the preoperative and postoperative care. Mrs. Newman tells them that she is actually scared round having this surgery. She says that she has no questions about the medical aspects of the procedure, but states she is upholded about how her life give change. She tells the take up she realizes she need to have the surgery but is ambivalent and doesnt know is she will be able to go by means of with it after all. . Which nur prattle intervention is most helpful to deflower Newman? A) Refer damage Newman to a psychologist to discuss her fears about having this surgery B) Give Mrs. Newman l iterature provided by the Ameri behind fundamentcer society C) Ask Mrs. Newman if she would identical to spill to someone who has had this surgery D) Tell Mrs. Newman iota is OK to be scared and birth her croaks Mrs. Newman is concerned about telling in the country and westerly club and asks the ONS how long do you think it will be forrader I can sing with my band again 4. How should the ONS RESPOND?A) need that the oncologist visit with Mrs. Newman and explain the procedure to her again B) Explain that her vocal pile will be removed, and that she will non be able to sing C) Reassure her that she will be able to sing with the band, but her voice may be different D) Ask Mrs. Newman if she understands what a total laryngectomy is The ONS has give verbal and written information to Mrs Newman answered any questions and is complete the physical assessment 5. Which question is important for the shelter to ask Mrs. Newman?A) When did you first notice any hoarseness in your voice? B) How long did you say have you been singing w/the band? C) How much alcohol do u drink a week? D) What foods are difficult for you to wallow? Mrs. Newman reports that she drinks occasionally, mainly on the weekends with friends. The suckle is more concerned that Ms Newman smokes one pack of cigarettes a day. She discusses this issue with damage Newman, who says Dont annoying about my smoking. I will never smoke another cigarette again 6. How should the deem respond to help Mrs.Newman in her attempt to stop smoking? A) I know it will be hard and I am very proud of u B) You will kit be able to smoke after urn surgery C) anyone else in urn ho procedurehold smoke D) What steps is u going to take to stop smoking? Mrs. Newman discusses the surgery with her family and a char from a laryngectomy support throng. Mrs. Newman decides to go ahead and he a total larygectomy. 7. A referral to which member of the indiciplinary team will be most important for imp air travel Newman p rior to surgery A) Case mangerB) Social work uper C) visible therapist D) Speech therapist The speech therapist discusses with mars Newman utility(a) tech inquest for restoring her speech after surgery. Selection of the surmount techniques varies from person to person depending on their age and personal preferences. Esophageal speech is popular among laryngectomies because it be less and can provide a more popular look voice than some of the other options. 8. Which statement describes esophageal speech?A) rootage held to the neck seduces vibrations those form words when the client speaks B) Swallowed air used to create around and words in a controlled belch C) Vibration and die are used to form words by occluding a valve all over the pore D) A handheld device delivers tone via a bendable pipe that is inserted into the mouth After discussing her options with a speech therapist mars Newman demonstrates her ability to use esophageal speech she comments I used to name my son and his friends rack like this. Wont he be surprised? Two days later, mars Newman is admitted to the hospital accompanied by her husband and her two grown children.She is in the preoperative holding area. 9. Which interventions will the nurse follow through? A) ask mars Newman if she has any concerns about the forthcoming surgery B) state the surgeon that mars Newman has been admitted to the hospital C) Reassure mars Newman that her family can stay with her until surgery D) Retrained if mars Newman has any problems hearing or writing Mrs. Newman shares with the nurse that she is scared that no one will help her if she needs help and that she will not be able to give tongue to anymore. 10. Which intervention should the nurse implement? A) Assure Mrs.Newman that someone will be with her at all times B) Provide a bell that she can ring as another means of communication C) Show her how to work the nurses call light and have her perform a return display D) Tell her that whiles h er fears are justified she should not try to worry. Following a seven hour surgery mars Newman was first placed in the PACU, before being transferred to the intensive care unit. 11. Which care for intervention should the intensive care unit nurse implement? A) Discourage cough uping for the first 24 hrs B) Notify the healthcare provider during roundsC) Determine when mars Newman get her last antibiotic D) avail mars Newman to gargle w/warm salty water supply The nurse is completing the shift assessment and notes that Mrs. Newman has discolour and dark dark-brown patchy areas on her tongue and oral mucosa. 12. Which action should the nurse implement? A) Document this finding and take no action B) Notify the health care provider during rounds C) Determine when Mrs. Newman received her last antibiotic D) Assist Mrs. Newman to gargle with warm water, salty water Because of the cancer mars Newman is at risk for potential complications, such as neck would fistula and carotid arty b lowout 13.When anticipating these possible complications, the nurse should place which equipment at miss newness bedside? A) Several packages of sterilized 44 netting B) Two non unfertile hemostats C) A syringe filled w/calcium glaciate D) The intensive care unit crash cart While assessing mars Newman, the nurse notices that Mrs. Newmans birth pressure is 92/60 and her pulse is 112. Mrs. Newman reports spirit very tired. 14 What action should the nurse implement first? A) Check mars Newmans pervious vital signs B) Suction mars Newman tracheostomy C) Administer oxygen via nasal cannula D) Slip a gloved hand under the clients neckThe nurse also calls the nurses station and requests a CBC stat 15 which laboratory result consistent w/blood loss through hemorrhaging A) A hematocrit 40 % B) Erythrocyte sediment rate 8 mm/hr C) Red blood electric cell count 5. 2 million/mm3 D) Hemoglobin 11. 3g/dl. Mrs. Newmans gag reflex has returned and she is preparing to eat her first meal. 16 wh ich action should the nurse implement A) Place cold packs around the clients neck prior to take B) Remind her to place the food on the front of the tongue and flex her head backward to swallow C) Ensure the client has a material body of thin liquids to drink D) Provide Mrs.Newman with soft foods when eating for the first time after surgery 17. What action should the nurse take regarding Mrs. Newmans concern? A) Explain to the client that this is normal following this type of surgery B) He the client tone of voice a variety of aromas to ensure that the client cannot smell C) Reassure he client that these senses will return after post-operative dropsy subsides D) Notify the healthcare provider about these findings when making rounds Mrs.Newman has a tracheotomy that has an knowledgeable canola. The nurse is performing routine tracheotomy care 18 Which action should the nurse implement first? A) wash the flange of the outer(prenominal) cannula with normal saline B) Pour hydrogen peroxide and normal saline into separate containers C) unaccentedse the inner cannula using a small pipage brush D) Remove the tracheotomy dressing with clean disposable gloves What should the nurse do before inserting the inner canola? A) Tap or shake inner cannula to remove excess moistureB) Dry the outside of the inner cannula with non sterile gauze C) Remove the outer cannula, reinsert the inner cannula, then place back into stoma D) Clean it w/hydrogen peroxide An unlicensed assistive personnel department UAP is assisting the surgical floor nurse w/morning care for mars Newman 20. Which task should the nurse delegate to the UAP? A) Empty the Foley and record the output B) Clean Mrs. Newmans bathroom C) Change the intravenous bag on the philia D) Perform the routine tracheotomy careThe charge nurse notices that the uncomplicated nurse caring for mars Newman is racetrackting 44 gauze to use as a tracheotomy dressing 21. What action should the charge nurse implant? A) Prais e the primary nurse for using a court saving technique B) Instruct the primary nurse not to cut gauze for the tracheotomy dressing C) Take no action since Mrs. Newman is the primary nurses responsibility D) Determine why commercially watchful dressings arent being used The night nurse is preparing to administer the 1200 midnight dose of gentamicin, an intravenous amino glycoside antibiotic that was started when Mrs.Newman was in the PACU. The nurse notices the moldinesser out IV antibiotic bag that was administered during the day shift is labeled ampicilllin. The nurse checks the medication administration record and realizes client does not have a prescription for ampicillin. 22. Which action should the night nurse implement? A) Notify the apothecary about the medication illusion B) Complete a medication error report c) Call the day nurse to determine what occurred D) Asses Mrs. Newmans white blood cell count WBC The next time the nurse enters Mrs. Newman room Mrs.Newman writes on the communication inboard is there something malign? I heard someone in the hall say something about me receiving the wrong medication? 23. How should the nurse respond? A) Please dont worry about anything. I am sorry you overheard that conversation B) No Mrs. Newman you did not receive the wrong medication C) C) You are concerned that you might have received the wrong medication D) you were supposed to receive gentamcin but you received ampicillin 24. Which intervention should the nurse provide to Mrs. Newman?A) Insert a suction tube into the stoma while applying suction, the remove while twisting the tube B) Take a deep breath, occlude the tracheotomy with urn finger cough and remove your finger C) Insert a small amount of sterile normal saline into the stoma and cough in a normal manner D) Take a deep broth in through the nose, cough and expel the secretions through the tracheostomy The nurse is discussing activities of daily victuals with Mrs. Newman. Which instruction s hould the nurse include? A) Caution Mrs. Newman to take only tub baths B) Encourage Mrs.Newman to use aerosol deodorants C) Advise Mrs. Newman not to wear any types of perfumes D) Explain the need to wear a plastic bib when demonstrate 26. Which intervention has highest priority to discharge? A) encourage the client to wear pleasing coverings over stoma B) Ensure that Mrs. Newman carries a special identification flier C) Stress the importance of returning to as normal a modus vivendi as possible D) Discuss the importance of attending support group meetings Mrs. Newman is being discharged radical today after five days in the hospital.Mr. Newman stops the nurse in the hallway and says that he is real scared about taking his wife home 27 what is the best response by the nurse? A) Have you discussed your fears w/ur wife B) It sounds like you cant take care of her C) I know this must be very scary but u and ur wife are strong D) Lets sit down and discuss what u are worried about Mr. Newman hesitantly shares with the nurse that he is mysophobic to touch his wife How should the nurse respond? A) Would u like to talk to your wifes doctor, I can call him for u?B) You can touch ur wife all u want, u will not hurt her C) You are worried about touching ur wife but she needs ur support right now D) Tell me more about what you mean by touching ur wife A home healthcare nurse has been assigned to care for Mrs. Newman and is making the initial visit. After completing the admission assessment the home healthcare nurse develops a nursing care plan for Mrs. Newman 29 of the nursing diagnosis included in Mrs. Newmans careplan, which one has the highest priority? A) Deficient of knowledge B) Anticipatory grievingC) uneffective airway clearance D) Impaired verbal communication Then home healthcare nurse is discussing the plan of care with Mrs. Newman and her husband, she instructs them to keep the rooms humidified at all times. Mr. Newman asks why this is important. 30. Whic h explanation should the nurse provide? A) It will step-down the amt of foreign material that enters the stoma B) Humidified air decreases the need for oral fluids C) Humidified air will keep mucous membranes and secretions moist D) The lower airway responsible for(p) for humidification was removed during surgery