[Music] hi guys it's me professor d and welcome back to my channel on this video we're going to be covering medical surgical nursing topics they're going to be mixed so if you're preparing for your next med surg exam ati nclex hessie you're in the right place all right guys without any further ado let's get started first question the nurse is initiating a blood transfusion which interaction should the nurse implement select all that applies now guys if you've been following me for any amount of time you know that we treat select all that applies is what true or false so that's exactly what we're going to do all right one assess the client's lung fields true we absolutely are going to do that before you give a patient fluids whether it's fluids normal saline dextrose blood you better listen to those lungs you better be listening for crackles be watching out for signs and symptoms of fluid overload such as jugular vein distension societies you're about to put fluids into this patient's body so absolutely we're going to listen to the lung fields yes true we're going to keep that two have the client sign a consent form absolutely a consent form must be signed before blood is given three start an iv with the 22 gauge iv catheter false the gauge we get for blood is 18 to 20 not anything higher than that why the higher that number goes the smaller that little hole is at the tip of the bevel so if you give a 22 remember we're giving blood blood those are huge cells that blood trying to get through that tiny tiny little hole at the tip of the bevel it's gonna license it's gonna it's gonna break up those blood cells okay so when it comes to blood we give 18 to 20 20 is the highest we are not going to be giving 22. so that's false we don't give that for blood choice 4 hang 250 milliliters of d5w at keep open rate false dextrose that in d5w that d stands for dextrose that is not compatible with blood absolutely not we're not going to give that that's false and five check the chart for the doctor's order true absolutely you have to have a doctor's order to give blood absolutely next question the nurse is assessing the clients the nurses assessing the client with psoriasis which data supports this diagnosis one appearance of red elevated plaques with silvery white scales two burning prickly world vesicles along the torso three raised flesh-colored papules with rough surface area four an overgrowth of tissue with an excessive amount of collagen and the correct answer guys is one appearance of red elevated plaques with silvery scales how do we know this when you see silvery scales or silvery plaques the first thing that needs to go into your mind is psoriasis okay so that's how we know that's the answer next question which comment by the client diagnosed to rule out gillian beret syndrome is most significant when completing the admission interview one i had a case of gastroenteritis a few weeks ago two i never use sunblock and i use a tanning bed often three i started smoking cigarettes about 20 years ago four i was out of the united states army for the last two months and the correct answer guys is one i had a bad case of gastroenteritis a few weeks ago so gilliam beret syndrome guys that is when the patient's own immune system is attacking their um their nerves okay and there's been many studies on this and we don't know a hundred percent but what we found is that there is a correlation and we believe that um gillian beret syndrome is triggered by either bacterial or a viral infection so what i'll see on a lot of test questions is you know they're suspecting the patient has gillian beret what's a good question to ask you know have you had an upper uh respiratory infection lately or have you been sick lately why because it's thought that gillian beret syndrome is triggered by a bacterial or a viral infection a recent bacterial or viral infection which laboratory result warrants immediate intervention by the nurse for the female client diagnosed with systemic lupus arithmetic arithmetosis sle one a hemoglobin hematocrine of 13 and 40. two an arithmetic erythrocyte sedimentation rate of nine three albumen of four point five or four a wbc of fifteen thousand and the correct answer is four that wbc of fifteen thousand guys this patient has lupus they are already immunocompromised we are already watching them very closely because we don't want them to get an infection and here they go with a wbc of 15 000. the normal range is 5 to 10 000 so what are we suspecting an infection we're suspecting this patient has an infection next question the client reports a twisting motion of the knee during a baseball game during a basketball game excuse me the client is scheduled scheduled for arthroscopic surgery to repair the injury which information should the nurse teach the client about post-operative care one the client should begin strengthening the surgical leg two the client should take pain medication routinely three the client should remain on bed rest for two weeks or four the client should return to the doctor in six months now guys even if you did not know what surgery this was you should you still should have gotten the right answer if you've been following my videos for any amount of time the correct answer is one the client should begin strengthening the surgical leg immediately guess what guys we know after surgery there's four concerns what we're worried about the most after patient has surgery we don't care what kind of surgery i don't care if it's surgeon abdomen if if it's in the lungs kidneys whatever we're worried about hemorrhage then bleeding to death we're worried about the opposite dvt them developing clots we're worried about those clots traveling going to the lungs and that patient getting a pulmonary embolism and we're worried about infection right so this patient just had a knee knee in the surgery we want them exercising that in the immediately we want to strengthen the joint and we also want to make sure that blood just doesn't sit there because when blood just sits blood pools when blood pulls it clots and the last thing we need is this patient to develop a dvt or a pulmonary embolism now let's look at the uh answer the other choices on this question two the client should take pain medication routinely we don't give pain medication routinely pain medications given as needed okay you get pain medication routinely that's how patients develop habits pain medication is given as needed not routinely or the other choices uh three the clients remain on bed rest absolutely not we're not trying to get them to develop uh pneumonia or dvt or pulmonary embolism no really really so they should return to see the doctor in six months this patient just had surgery this is an invasive surgery and we're going to have them come back in six months no they're gonna come back that following week or even that week that they had surgery outpatient to follow up all right next question which assessment data indicates the client has developed a dvt in the left leg one a negative home and sign two increase left increased left leg calf circumference three elephantitis of the left lower leg four brownish pigmentation of the left lower leg and the correct answer guys is two increased left leg circumference why do you think the circumference on that left leg has increased because of dvt that's why it's getting bigger and bigger okay look how they tried to trick you with number one you saw a holman sign and they wanted you to jump on it but it said negative home and sign and even a positive home and sign that's not indicative of a dvt but it is indicative that further uh screening needs to be done on this patient if they have a positive home inside not a negative the unlicensed assistive personnel notifies the nurse that the client diagnosed with chronic obstructive pulmonary disease is complaining of shortness of breath and would like his oxygen level increased which intervention should the nurse implement one notify the respiratory therapist two ask the uap to increase the oxygen three obtain a stat pulse ox on the oximeter reading or four tell the uap to leave the oxygen alone and the answer is four you're going to tell that uap you but not touch that thing you tell them to leave it alone then immediately after you tell the uap to leave it alone go check your patient okay this is the copd patient where if we increase their oxygen more than four what are we doing what are we doing we're making their brain tell their lungs to stop breathing right we turn off that drive to breathe so we are not going to increase the oxygen but remember i told you whenever somebody comes and tells you something about your patient you never send them back to check the patient you go check the patient but if the the the cna the uap just said something to you are you just going to leave them standing go to your patient no you're going to tell the uap do not touch that oxygen machine then you go check on your patient okay so the answer is four the client diagnosed with cancer of the larynx has had a partial laryngectomy which client problem has the highest priority one impaired communication two ineffective coping three risk for aspiration or 4 social isolation and the correct answer is risk for aspiration why that will kill the patient you see choices 1 two and four they will not kill a patient but risk for aspiration absolutely that can kill a patient so that's gonna have the highest priority and we're gonna do everything that we can to prevent that from happening the client receiving a continuous heparin trip complains of sudden chest pain on inspiration and tells the nurse something is really wrong with me which intervention should the nurse implement first one increase the heparin drip rate two notify the doctor three assess the client's lung sounds or four apply oxygen via nasal cannula the answer is four apply oxygen via nasal cannula and i know as students you wanted to run to three to assess lung sounds but they gave us enough information in the question for us to intervene there's enough information let's go back to the question they're getting a heparin drip why are we giving patients heparin to prevent dvts and preventing that dvt from traveling and going to the lung and now becoming a pulmonary embolism so they're on a heparin drip next thing they have sudden chest pain why do you think they have the chest pain pulmonary embolism third it says that the patient um says something's really wrong with me when patients develop pulmonary embolism they get a sense of doom like they're going to die all right pulmonary embolism that blocks oxygen so yes you want to listen to that patient's lung sounds but why would you listen to their lung sounds while they're dying does that make any type of sense absolutely not you're going to put that oxygen on their face and then you're going to listen to their lungs all right next question the client has gastroesophageal reflux disease which healthcare provider order should the nurse question one elevate the head of the bed with blocks two administer pantoprazole protonox protonox protonix four times a day three a regular diet with no citrus or spicy foods or four activity as tolerated and sit up in a chair for all meals when the question asks you which one would you question that means which one's the wrong one and the correct answer here is two that proton is four times a day first of all protons is given once maybe twice a day and twice a day that's the max we usually give it once a day okay it's given once a day in the morning before the patient eats so you see an order for protonix four times a day you're going to question that order proton if that's a ppi we don't give that four times a day okay the client's diagnosed with acute exacerbation of crohn's disease which assessment data warns immediate attention one the client's wbc count is ten two the client serum amylase is a hundred three the client's potassium levels 3.3 or four the client's blood glucose is 148. and the correct answer is three you guys know you do not play with the potassium okay potassium has a very narrow therapeutic range 3.5 to 5. 3.5 to 5. i'm going to say once more 3.525 that is it anything outside of that can throw that patient into dysrhythmia and kill them okay so that's why three is the correct answer which information should the nurse discuss with the client to prevent an acute exacerbation of diverticulosis one increase fiber in the diet two drink at least a thousand milliliters of water per day three encourage sedentary activities four take cathartic laxatives daily and the correct answer guys is one increased fiber in the diet why because fiber pulls all of that crap that's just been sitting in the gi tract it pulls all of it so when the patient goes to the bathroom they have a bowel movement all of that stuff that was just sitting there and fermenting it leaves that patient's body because remember what's happening in diverticulosis that patient has a weakening and out pouching in the track and the food such as corn or nuts or whatever it is gets stuck in that out pouching and it sits there for days weeks months it starts to ferment and it causes inflammation in that area and then you have diverticulitis so in order to avoid that that patient needs to eat lots of fiber because fiber says come with me everywhere fiber goes it says come with me come with me come with me come with me all of that bad stuff that's not even supposed to be in your gi tract it says come with me all of those carcinogens come with me it pulls it all out so when the patient has a bowel movement it comes out of their system and guys that was our last question i can't believe how quickly this went i hope that you found these questions uh helpful just so you know i am now on tick tock so you can find me on tick tock same handle next is nursing and you can also find me on instagram same handle next is nursing thank you so much for spending this time with me guys please if you want to support this channel and see more content share my content please help my channel grow thank you so much and i'll see you on the next video