Advanced Medical-Surgical Nursing Practice Exam
Course Introduction
Advanced Medical-Surgical Nursing is designed for students to deepen their knowledge and skills in the management of patients with complex health needs across various body systems. Emphasizing critical thinking and evidence-based practice, the course explores advanced pathophysiology, pharmacology, and clinical decision-making processes necessary for handling acute and chronic conditions. Students will engage with scenarios involving multi-system disorders, trauma, perioperative care, oncological emergencies, and organ failure, focusing on comprehensive patient assessment, interprofessional collaboration, and patient-centered interventions to promote optimal outcomes in diverse clinical settings.
Recommended Textbook
Introduction to Critical Care Nursing 6th Edition by Mary Lou Sole
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21 Chapters
756 Verified Questions
756 Flashcards
Source URL: https://quizplus.com/study-set/2011
Page 2
Chapter 1: Overview of Critical Care Nursing
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24 Verified Questions
24 Flashcards
Source URL: https://quizplus.com/quiz/39999
Sample Questions
Q1) Which of the following strategies will assist in creating a healthy work environment for the critical care nurse? (Select all that apply.)
A) Celebrating improved outcomes from a nurse-driven protocol with a pizza party
B) Implementing a medication safety program designed by pharmacists
C) Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio
D) Offering quarterly joint nurse-physician workshops to discuss unit issues
E) Using the Situation-Background-Assessment-Recommendation (SBAR) technique for handoff communication
Answer: A,D,E
Q2) The family members of a critically ill,90-year-old patient bring in a copy of the patient's living will to the hospital,which identifies the patient's wishes regarding health care.You discuss contents of the living will with the patient's physician.This is an example of implementation of which of the AACN Standards of Professional Performance?
A) Acquires and maintains current knowledge of practice
B) Acts ethically on the behalf of the patient and family
C) Considers factors related to safe patient care
D) Uses clinical inquiry and integrates research findings in practice
Answer: B
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Chapter 2: Patient and Family Response to the Critical Care Experience
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28 Verified Questions
28 Flashcards
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Sample Questions
Q1) Nursing strategies to help families cope with the stress of critical illness include: (Select all that apply.)
A) asking the family to leave during the morning bath to promote the patient's privacy.
B) encouraging family members to make notes of questions they have for the physician during family rounds.
C) if possible, providing continuity of nursing care.
D) providing a daily update of the patient's condition to the family spokesperson.
Answer: B,C,D
Q2) The constant noise of a ventilator,monitor alarms,and infusion pumps predisposes the patient to:
A) anxiety.
B) pain.
C) powerlessness.
D) sensory overload.
Answer: D
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Page 4
Chapter 3: Ethical and Legal Issues in Critical Care Nursing
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23 Verified Questions
23 Flashcards
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Sample Questions
Q1) The nurse is caring for a patient who is declared brain dead and is an organ donor.The following events occur: 1300 Diagnostic tests for brain death are completed.1330 Intensivist reviews diagnostic test results and writes in the progress note that the patient is brain dead.1400 Patient is taken to the operating room for organ retrieval.1800 All organs have been retrieved for donation.The ventilator is discontinued.1810 Cardiac monitor shows flatline.What is the official time of death recorded in the medical record?
A) 1300
B) 1330
C) 1400
D) 1800
E) 1810
Answer: B
Q2) Which of the following organizations requires a mechanism for addressing ethical issues?
A) American Association of Critical-Care Nurses
B) American Hospital Association
C) Society of Critical Care Medicine
D) The Joint Commission
Answer: D
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Page 5
Chapter 4: End-Of-Life Care in the Critical Care Unit
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26 Verified Questions
26 Flashcards
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Sample Questions
Q1) A patient with end-stage heart failure is experiencing considerable dyspnea.Appropriate pharmacological management of this symptom includes:
A) administration of 6 mg of midazolam ( Versed ) and initiation of a continuous midazolam infusion.
B) administration of morphine, 5 mg IV bolus, and initiation of a continuous morphine infusion.
C) hourly increases of the midazolam ( Versed ) infusion by 100% dose increments.
D) hourly increases of the morphine infusion by 100% dose increments.
Q2) Which statement is true regarding the impact of culture on end-of-life decision making?
A) African-Americans prefer more conservative, less invasive care options during the end of life.
B) Caucasians prefer aggressive and more invasive care options during the end of life.
C) Culture and religious beliefs may affect end-of-life decision making.
D) Perspectives regarding end-of-life care are similar between and within religious groups.
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6
Chapter 5: Comfort and Sedation
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33 Verified Questions
33 Flashcards
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Sample Questions
Q1) Anxiety differs from pain in that: (Select all that apply.)
A) it is confined to neurological processes in the brain.
B) it is linked to reward and punishment centers in the limbic system.
C) it is subjective.
D) there is no actual tissue injury.
Q2) Choose the items that are common to both pain and anxiety.(Select all that apply.)
A) Cyclical exacerbation of one another
B) Require good nursing assessment for proper treatment
C) Response only to real phenomena
D) Subjective in nature
Q3) The nurse is caring for a patient with hyperactive delirium.The nurse focuses interventions toward keeping the patient:
A) comfortable
B) nourished
C) safe
D) sedated
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Chapter 6: Nutritional Support
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30 Verified Questions
30 Flashcards
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Sample Questions
Q1) The nurse identifies which patient at greatest risk for malabsorption of protein?
A) The patient with gallbladder obstruction
B) The patient with ileitis
C) The patient with distal colon resection
D) The patient with jejunal tumor
Q2) A patient with a history of emphysema,diabetes,and hyperlipidemia is in the critical care unit on a ventilator.The nutrition assessment notes that the patient has a protein and vitamin deficiency and is underweight.Which formula for nutritional assessment is most appropriate?
A) Elemental protein formula
B) Fiber-added formula
C) High medium-chain triglyceride formula
D) Lactose-free formula
Q3) Objective data designating that the nutrition goals are not being met include:
A) hyperglycemia, normovolemia, and increased protein level.
B) overhydration, hypoglycemia, and weight gain.
C) weight gain, inconsistent glucose, and normovolemia.
D) weight loss, elevated glucose, and dehydration.
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Chapter 7: Dysrhythmia Interpretation and Management
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59 Verified Questions
59 Flashcards
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Sample Questions
Q1) The patient is in chronic junctional escape rhythm with no atrial activity noted.Studies have demonstrated normal AV node function.This patient may be a candidate for which type of pacing?
A) Atrial pacing
B) Ventricular pacing
C) Dual-chamber pacing
D) Transcutaneous pacing
Q2) When assessing the 12-lead electrocardiogram (ECG)or a rhythm strip,it is helpful to understand that the electrical activity is viewed in relation to the positive electrode of that particular lead.When an electrical signal is aimed directly at the positive electrode,the inflection will be:
A) negative.
B) upside down.
C) upright.
D) equally positive and negative.
Q3) The normal rate for the SA node when the patient is at rest is:
A) 40 to 60 beats per minute.
B) 60 to 100 beats per minute.
C) 20 to 40 beats per minute.
D) more than100 beats per minute.
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Chapter 8: Hemodynamic Monitoring
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35 Verified Questions
35 Flashcards
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Sample Questions
Q1) The nurse returns from the cardiac catheterization laboratory with a patient following insertion of a pulmonary artery catheter and assists in transferring the patient from the stretcher to the bed.Prior to obtaining a cardiac output,which action is most important for the nurse to complete?
A) Document a pulmonary artery catheter occlusion pressure.
B) Zero reference the transducer system at the phlebostatic axis.
C) Inflate the pulmonary artery catheter balloon with 1 mL air.
D) Inject 10 mL of 0.9% normal saline into the proximal port.
Q2) Which nursing actions are most important for a patient with a right radial arterial line? (Select all that apply.)
A) Checking the circulation to the right hand every 2 hours
B) Maintaining a pressurized flush solution to the arterial line setup
C) Monitoring the waveform on the monitor for dampening
D) Restraining all four extremities with soft limb restraints
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Chapter 9: Ventilatory Assistance
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36 Verified Questions
36 Flashcards
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Sample Questions
Q1) The nurse is caring for a mechanically ventilated patient.The physicians are considering performing a tracheostomy because the patient is having difficulty weaning from mechanical ventilation.Related to tracheostomy,the nurse understands which of the following?
A) Patient outcomes are better if the tracheostomy is done within a week of intubation.
B) Percutaneous tracheostomy can be done safely at the bedside by the respiratory therapist.
C) Procedures performed in the operating room are associated with fewer complications.
D) The greatest risk after a percutaneous tracheostomy is accidental decannulation.
Q2) The nurse notes that the patient's arterial blood gas levels indicate hypoxemia.The patient is not intubated and has a respiratory rate of 22 breaths/min.The nurse's first intervention to relieve hypoxemia is to:
A) call the physician for an emergency intubation procedure.
B) obtain an order for bilevel positive airway pressure (BiPAP).
C) notify the provider of values and obtain order for oxygen.
D) suction secretions from the oropharynx.
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Chapter 10: Rapid Response Teams and Code Management
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31 Verified Questions
31 Flashcards
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Sample Questions
Q1) During cardioversion,the nurse would synchronize the electrical charge to coincide with which wave of the ECG complex?
A) P
B) R
C) S
D) T
Q2) During a code situation,the nurse would prepare to use which preferred intravenous fluid?
A) 5% Dextrose in 0.45 normal saline
B) 5% Dextrose in water
C) Dopamine infusion
D) Normal saline
Q3) What is the major reason for using a treatment to lower body temperature after cardiac arrest to promote better neurological recovery?
A) Hypothermia decreases the metabolic rate by 7% for each decrease of 1° C.
B) Lower body temperatures are beneficial in patients with low blood pressure.
C) Temperatures of 40° C may reduce neurological impairment.
D) The lower body temperature leads to decreased oxygen delivery.
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Chapter 11: Shock, sepsis, and Multiple Organ Dysfunction Syndrome
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34 Verified Questions
34 Flashcards
Source URL: https://quizplus.com/quiz/40009
Sample Questions
Q1) The nurse is caring for a patient in cardiogenic shock who is being treated with an infusion of dobutamine (Dobutrex).The physician's order calls for the nurse to titrate the infusion to achieve a cardiac index of >2.5 L/min/m².The nurse measures a cardiac output,and the calculated cardiac index for the patient is 4.6 L/min/m².What is the best action by the nurse?
A) Obtain a stat serum potassium level.
B) Order a stat 12-lead electrocardiogram.
C) Reduce the rate of dobutamine (Dobutrex).
D) Assess the patient's hourly urine output.
Q2) The nurse is caring for a patient admitted with cardiogenic shock.Hemodynamic readings obtained with a pulmonary artery catheter include a pulmonary artery occlusion pressure (PAOP)of 18 mm Hg and a cardiac index (CI)of 1.0 L/min/m².What is the priority pharmacological intervention?
A) Dobutamine (Dobutrex)
B) Furosemide (Lasix)
C) Phenylephrine (Neo-Synephrine)
D) Sodium nitroprusside (Nipride)
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Chapter 12: Cardiovascular Alterations
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37 Verified Questions
37 Flashcards
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Sample Questions
Q1) A patient is admitted with an acute myocardial infarction (AMI).The nurse knows that an angiotensin-converting enzymes (ACE)inhibitor should be started within 24 hours to reduce the incidence of which process?
A) Myocardial stunning
B) Hibernating myocardium
C) Myocardial remodeling
D) Tachycardia
Q2) A patient is admitted with an angina attack.The nurse anticipates which drug regimen to be initiated?
A) ACE inhibitors and diuretics
B) Morphine sulfate and oxygen
C) Nitroglycerin, oxygen, and beta-blockers
D) Statins, bile acid, and nicotinic acid
Q3) A patient is admitted with the diagnosis of unstable angina.The nurse knows that the physiological mechanism present is most likely which of the following?
A) Complete occlusion of a coronary artery
B) Fatty streak within the intima of a coronary artery
C) Partial occlusion of a coronary artery with a thrombus
D) Vasospasm of a coronary artery
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Page 14
Chapter 13: Nervous System Alterations
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35 Verified Questions
35 Flashcards
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Sample Questions
Q1) The nurse is caring for a patient who has a diminished level of consciousness and who is mechanically ventilated.While performing endotracheal suctioning,the patient reaches up in an attempt to grab the suction catheter.What is the best interpretation by the nurse?
A) The patient is exhibiting extension posturing.
B) The patient is exhibiting flexion posturing.
C) The patient is exhibiting purposeful movement.
D) The patient is withdrawing to stimulation.
Q2) The nurse has just received a patient from the emergency department with an admitting diagnosis of bacterial meningitis.To prevent the spread of nosocomial infections to other patients,what is the best action by the nurse?
A) Implement droplet precautions upon admission.
B) Wash hands thoroughly before leaving the room.
C) Scrub the hub of all central line ports prior to use.
D) Dispose of all bloody dressings in biohazard bags.
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Chapter 14: Acute Respiratory Failure
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36 Verified Questions
36 Flashcards
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Sample Questions
Q1) Which of the following acid-base disturbances commonly occurs with the hyperventilation and impaired gas exchange seen in severe exacerbation of asthma?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Q2) Select the strategies for preventing deep vein thrombosis (DVT)and pulmonary embolus (PE).(Select all that apply.)
A) Graduated compression stockings
B) Heparin or low-molecular weight heparin for patients at risk
C) Sequential compression devices
D) Strict bed rest
Q3) The nurse is caring for a postoperative patient with chronic obstructive pulmonary disease ( COPD ).Which assessment would be a cue to the patient developing postoperative pneumonia?
A) Bradycardia
B) Change in sputum characteristics
C) Hypoventilation and respiratory acidosis
D) Pursed-lip breathing
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Page 16
Chapter 15: Acute Kidney Injury
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50 Verified Questions
50 Flashcards
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Sample Questions
Q1) The patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week.The patient complains of general malaise and is tachypneic.An arterial blood gas is ordered and shows that the patient's pH is 7.19,with a PCO<sub>2</sub> of 30 mm Hg and a bicarbonate level of 13 mEq/L.The nurse prepares to:
A) administer morphine to slow the respiratory rate.
B) prepare for intubation and mechanical ventilation.
C) administer intravenous sodium bicarbonate.
D) cancel tomorrow's dialysis session.
Q2) An advantage of peritoneal dialysis is that:
A) peritoneal dialysis is time intensive.
B) a decreased risk of peritonitis exists.
C) biochemical disturbances are corrected rapidly.
D) the danger of hemorrhage is minimal.
Q3) Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis:
A) is more frequently used for acute kidney injury.
B) uses the patient's own semipermeable membrane (peritoneal membrane).
C) is not useful in cases of drug overdose or electrolyte imbalance.
D) is not indicated in cases of water intoxication.
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17
Chapter 16: Hematological and Immune Disorders
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55 Verified Questions
55 Flashcards
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Sample Questions
Q1) Erythrocytes (RBCs)are generated from precursor stem cells under the influence of a growth factor called:
A) reticulocytes.
B) hemoglobin.
C) 2,3-DPG.
D) erythropoietin.
Q2) When caring for a patient with HIV,the nurse should:
A) not focus on the mouth, as infections of the mouth are rare.
B) assure the patient that infections are not a major problem at this point.
C) inform the patient that the disease does not affect the respiratory system.
D) monitor the patient's medication regimen.
Q3) The nurse is assessing a patient being admitted with complaints of fatigue and shortness of breath as well as abdominal tenderness.The nurse notes that the patient is jaundiced; the physical examination reports an enlarged liver The nurse suspects that the patient has
A) aplastic anemia.
B) hemolytic anemia.
C) sickle cell anemia.
D) anemia due to acute blood loss.
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Page 18
Chapter 17: Gastrointestinal Alterations
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52 Verified Questions
52 Flashcards
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Sample Questions
Q1) The patient is being treated for an H.pylori infection with proton pump inhibitor,metronidazole,and tetracycline but is not responding.The nurse expects that:
A) bismuth will be added to the current triple therapy.
B) a 6-day course of levofloxacin may be used.
C) a second-line therapy is not usually effective.
D) the proton pump inhibitor will be changed to a higher dose.
Q2) The patient is admitted with upper GI bleeding following an episode of forceful retching following excessive alcohol intake.The nurse suspects a Mallory-Weiss tear and is aware that:
A) a Mallory-Weiss tear is a longitudinal tear in the gastroesophageal mucosa.
B) this type of bleeding is treated by giving chewable aspirin.
C) the bleeding, although impressive, is self-limiting with little actual blood loss.
D) is not usually associated with alcohol intake or retching.
Q3) The patient is admitted with acute pancreatitis.The nurse should:
A) assess pain level because pancreatic pain is unique in character.
B) examine laboratory values for low amylase levels.
C) expect lipase levels to decrease within 24 hours.
D) evaluate C-reactive protein as a gauge of severity.
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19
Chapter 18: Endocrine Alterations
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35 Verified Questions
35 Flashcards
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Sample Questions
Q1) A 20-year-old female with a history of type 1diabetes and an eating disorder is found unconscious.In the emergency department,the following lab values are obtained: Glucose648 mg/dL PH6)88
PaCO<sub>2</sub>20 mm Hg
PaO<sub>2</sub>95 mm Hg
HCO<sub>3-</sub>undetectable
Anion gap>31
Na<sup>+</sup>127 mEq/L
K<sup>+</sup>3.5 mEq/L
Creatinine1.8 mg/dL
After the patient's airway and ventilation have been established,the next priority for this patient is:
A) administration of a 1-L normal saline fluid bolus.
B) administration of 0.1 unit of regular insulin IV push followed by an insulin infusion.
C) administration of 20 mEq KCl in 100 mL.
D) IV push administration of 1 amp of sodium bicarbonate.
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Chapter 19: Trauma and Surgical Management
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31 Verified Questions
31 Flashcards
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Sample Questions
Q1) Prevention of hypothermia is crucial in caring for trauma patients.The correct order of actions for the preparation for the trauma patient is:
_.(Put a comma and space between each solve choice.)
A) Remove wet clothing.
B) Warm fluids and blood products before administration.
C) Cover the patient with an external warming device.
D) Warm the ED or intensive care unit (ICU) room before the patient's arrival.
Q2) A near-infrared spectroscopy (NIRS)probe is placed in a trauma patient during the resuscitation phase to:
A) assess severity of metabolic acidosis.
B) determine intraperitoneal bleeding.
C) determine tissue oxygenation.
D) prevent complications of over-resuscitation.
Q3) Range-of-motion exercises,early ambulation,and adequate hydration are interventions to prevent:
A) catheter-associated infection.
B) venous thromboembolism.
C) fat embolism.
D) nosocomial pneumonia.
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Chapter 20: Burns
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31 Verified Questions
31 Flashcards
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Sample Questions
Q1) An autograft is used to optimally treat a partial- or full-thickness wound that: (Select all that apply.)
A) involves a joint.
B) involves the face, hands, or feet.
C) is infected.
D) requires more than 2 weeks for healing.
Q2) The nurse is caring for a burn-injured patient who weighs 154 pounds,and the burn injury covers 50% of his body surface area.The nurse calculates the fluid needs for the first 24 hours after a burn injury using a standard fluid resuscitation formula of 4 mL/kg/% burn of intravenous (IV)fluid for the first 24 hours.The nurse plans to administer what amount of fluid in the first 24 hours?
A) 2800 mL
B) 7000 mL
C) 14 L
D) 28 L
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22
Chapter 21: Solid Organ Transplantation
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35 Verified Questions
35 Flashcards
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Sample Questions
Q1) The charge nurse is reviewing the status of patients in the critical care unit.Which patient should the nurse notify the organ procurement organization to evaluate for possible organ donation?
A) A 36-year-old patient with a Glasgow Coma Scale score of 3 with no activity on electroencephalogram
B) A 68-year-old male admitted with unstable atrial fibrillation who has suffered a stroke
C) A 40-year-old brain-injured female with a history of ovarian cancer and a Glasgow Coma Scale score of 7
D) A 53-year-old diabetic male with a history of unstable angina status post resuscitation
Q2) A family member approaches the nurse caring for their gravely ill son and states,"We want to donate our son's organs." What is the best action by the nurse?
A) Arrange a multidisciplinary meeting with physicians.
B) Consult the hospital's ethics committee for a ruling.
C) Notify the organ procurement organization (OPO).
D) Obtain family consent to withdraw life support.
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