Medical Surgery and OB Questions

Assignment 1:

  1. Blood transfusion:  A patient is transfused new _____ via ____ access. 
  2. What are two reasons why someone might need a blood transfusion?    
  3. What are two examples of how someone may experience blood loss?   
  4. What are three reasons a patient may experience anemia?  
  5. What is the role of RBCs?    
  6. List four common signs and symptoms seen with low RBCs.    
  7. As a general guideline, a blood transfusion is recommended when the hemoglobin is between ______ g/dL.   
  8. A normal hemoglobin level for a male is between _______g/dL. 
  9. A normal hemoglobin level for a female is between______ g/dL. 
  10. Before a blood transfusion, prep work is essential in preventing ____. 
  11.  Who will match the blood and prepare the needed units?    
  12.  What type of blood is the universal donor?     
  13.  What blood type can receive blood from any donor?   
  14. True or False?  The nurse must obtain informed consent before administering blood products.   
  15. What items are important to ask the patient before administering a blood transfusion?   
  16. If a patient has had numerous blood transfusions in the past, what are they at risk for developing?    
  17. What is the cause of the reaction identified in question 16?   
  18. What might the nurse do to prevent this reaction from occurring?   
  19. What are two medications that a patient may be given to prevent a reaction?    
  20. How long before starting a transfusion should you pre-medicate the patient?    
  21. Why is it important to know if your patient has heart failure or renal failure before transfusing?   
  22. What medication(s) may be ordered before, between, or after a transfusion to help prevent fluid overload?   
  23. What size IV site is typically recommended for blood transfusions?  Why?   
  24. How long does it typically take to infuse a unit of blood?      
  25. What is the importance of having an additional or secondary IV site?   
  26. What type of tubing is required to transfuse blood?   
  27. True or False?  A completely new tubing and the fluid set are needed for every unit of blood infused. 
  28. What is the ONLY type of IV solution that should be used during blood transfusion?    
  29. What is the IV fluid used for during a transfusion?    
  30. What is the proper way to dispose of the empty blood bag and tubing after the transfusion?   
  31. How many units will the blood bank send you at one time?    
  32. Once the nurse receives the blood, how long does the nurse have before the infusion MUST be started?    
  33. What is the longest amount of time that one unit can be infused over?    
  34. What can happen if the blood is out of refrigeration longer than 4 hours?   
  35. If a patient needs large amounts of blood quickly, what can be done to reduce the risk of a hypothermic response?   
  36. True or False?  You can warm blood up in a microwave. 
  37. What MUST be done before starting the transfusion after everything is ready?   
  38. True or False?  You must complete the blood/patient verification process with EVERY unit of blood before starting the transfusion 
  39. What items are examined during the verification process?    
  40. True or False?  Baseline vital signs must be taken before starting the infusion 
  41. What assessment would be necessary to check before infusing blood?  (think fluid overload)    
  42. What should the nurse do before starting transfusion if the patient has a baseline temperature greater than 100.0 F?    
  43. What are the signs and symptoms of a transfusion reaction that the nurse needs to be aware of and educate the patient to observe for?   
  44. If the patient has any previous reactions, what should the nurse do IMMEDIATELY?   
  45. What is the recommended rate to start a blood transfusion?   
  46. How long does the transfusion stay at this rate?   
  47. Why is the transfusion run slowly at first?   
  48. What rate would you set the IV pump to achieve 2 mL/min?   
  49. True or False?  The nurse MUST stay with the patient during the first 15 minutes of a blood transfusion.   
  50. After the transfusion starts, when should the first set of vital signs be taken?   
  51. After the 15-minute vital sign check, if the patient is not having a reaction, what can be done at that time?   
  52. If the unit of blood is 362 mL in volume, approximately what rate should you set the IV pump at to ensure the infusion is complete within 4 hours?     
  53. If the unit of blood is 362 mL in volume, approximately what rate should you set the IV pump at to ensure the infusion is complete within 3 hours?     
  54. What are the types of reactions a patient can experience while receiving a donor blood transfusion?   
  55. How long after a blood transfusion can a patient experience a graft versus host disease (GvHD) transfusion reaction?   
  56. After a blood transfusion, what patient is at higher risk for circulatory overload?   
  57. Fill in the information to help you remember what adverse signs and symptoms to monitor for. 
  58. What is the recipient’s immune system doing to the donor blood during a hemolytic reaction?   
  59. This mismatch can lead to what adverse outcomes?   
  60. What is the recipient’s immune system doing to the donor blood during an allergic reaction?   
  61. True or False.  An allergic reaction to donor blood can lead to an anaphylactic reaction in the patient   
  62. During a febrile reaction, what is the recipient’s WBC’s doing to the donor’s WBC’s?   
  63. What symptoms would you observe during a febrile reaction?   
  64. During a GvHD reaction, what happens?   
  65. What are other complications that a patient can experience during or after a blood transfusion?   
  66. What is the FIRST thing you do if the patient develops a reaction to a transfusion?   
  67. What is the second step that should be done after stopping the transfusion?   
  68. True or False?  The nurse needs to notify the MD and the blood bank ASAP after a reaction occurs 
  69. Why might the MD order each of the following medications after a transfusion reaction? 
  70. Corticosteroids:  
  71. IV fluids: 
  72. Anti-histamines: 
  73. Antipyretics: 
  74. Vasopressors: 
  75. Diuretics: 

70.  True or false?  If a transfusion reaction occurs, you must send all the tubing and the blood back to the lab for additional testing 

Assignment 2:

Zheng Shuang is a 45-year-old female who, two years ago, was diagnosed with breast cancer and underwent a mastectomy of the affected breast and follow-up chemotherapy. Last month, Ms. Shuang experienced a recurrence of cancer in the lymph glands of the affected side. Surgery to remove the glands was performed, and chemotherapy started. She has a central line, a urinary catheter, and a surgical incision. The nurse enters Ms. Shuang’s room and finds her huddled in the middle of the bed, shivering violently.  

Her vital signs are T-103.2°, HR-112, RR-28, BP-108/62 

Skin-hot, dry, flushed with poor turgor Alert and oriented, restless, and anxious 

  1. Describe how Zheng Shuang’s current symptoms are related to the pathophysiology of shock and determine what type of shock the patient is experiencing.  
  • What stage of shock (if applicable)? 
  • What specific lab and diagnostic tests would be used to evaluate this patient?  
  • What is the focus of nursing care for this patient?  
  • Prioritize the most important Nursing Diagnosis R/T AEB with three interventions and one outcome criteria.  

Rufus Sewell, a 52-year-old truck driver, was admitted through the emergency room for chest pain earlier this morning. He was admitted to the CCU for r/o myocardial infarction (MI). He has no prior history of cardiac problems; however, he has been treated for the past five years for total cholesterol of 290 (HDL 34, LDL 210). He was prescribed Lovastatin, which he does not take regularly. He was recently diagnosed with hypertension with his normal BP 168/98 for which he does not take medication. He is overweight and exercises little. His father died of an MI at the age of 49. The nurse enters his room and finds him lethargic and dyspneic. 

His vital signs are  T-99.4°, HR-108, rapid, thready 

EKG sinus tachycardia with frequent premature ventricular contractions (PVC’s) 

R 32, labored, crackles, wheezing, current BP 104/64. 

Skin-pale, cyanotic, cold, and moist 

  • Describe how Rufus Sewell’s current symptoms are related to the pathophysiology of shock and determine what type of shock the patient is experiencing.  
  • What stage of shock (if applicable)? 
  • What specific lab and diagnostic tests would be used to evaluate this patient?  
  • What is the focus of nursing care for this patient?  
  1. Prioritize the most important Nursing Diagnosis R/T AEB with three interventions and one outcome criteria.  
  2. Page Break 

Segilola Ogidan, 20 years old, was admitted to the ER following a motor vehicle accident earlier in the day. She was an unrestrained passenger in an automobile that was T¬ boned by 30 minutes, and an emergency transport helicopter brought her to the ER. She suffered a partially severed leg, chest contusion, possible fractured pelvis, open head wound, and a fractured jaw. She has lost several units of blood. She has been in the post-anesthesia care unit (PACU) for the past hour following surgery to reattach her leg and close her head wound. Her vital signs have been stable. The nurse enters the room to find Segilola’s NG draining copious amounts of sanguineous fluid. 

Her vital signs are T-97.9°,  HR-118, rapid, thready, RR-32,  BP-82/64 

Skin-cool, pale, moist, with dependent edema  

  1. Describe how Segilola Ogidan’s current symptoms relate to the pathophysiology of shock and determine what type of shock the patient is experiencing.  
  1. What stage of shock (if applicable)? 
  1. What specific lab and diagnostic tests would be used to evaluate this patient?  
  1. What is the focus of nursing care for this patient?   
  1. Prioritize the most important Nursing Diagnosis R/T AEB with three interventions and one outcome criteria.  
  2. Page Break 

Chuck Bunbury, 25 years old, was admitted to ICU earlier today from ER following a diving injury. He and his friends were swinging from a rope into a creek below when his head struck the bottom of the creek resulting in a cervical fracture and paralysis from his neck down. He has been alert and oriented, but his vital signs have been labile. He was placed on a ventilator on CMV at 12 breaths per minute. His neck is immobilized in a cervical collar. The nurse enters the room because the ventilator alarms are going off. 

His vital signs are T- 98.8°, HR-62 and bounding, BP-84/62, RR-30, he is bucking the ventilator.  Skin- warm and dry. Anxious, extremely restless. 

  1. Describe how Chuck Bunbury’s current symptoms relate to the pathophysiology of shock and determine what type of shock the patient is experiencing.  
  1. What stage of shock (if applicable)? 
  1. What specific lab and diagnostic tests would be used to evaluate this patient?  
  1. What is the focus of nursing care for this patient?   
  • Prioritize the most important Nursing Diagnosis R/T AEB with three interventions and one outcome criteria.  

Paul Mercier is a 76-year-old same-day surgery patient admitted to the unit a few minutes ago from PACU following left hip hemiarthroplasty. The nurse started the dose of Ancef IV five minutes ago. He calls the nurse’s station and complains of itching and shortness of breath. The nurse arrives in his room and finds him extremely restless, anxious, and gasping. 

His vital signs are T-100.2°, HR-126, irregular, RR-36, dyspneic, stridor, wheezing, BP-60 with a doppler. Skin-warm, generalized edema. Anxious, extremely restless. 

  • Describe how Paul Mercier’s current symptoms relate to the pathophysiology of shock and determine what type of shock the patient is experiencing.  
  • What stage of shock (if applicable)? 
  • What specific lab and diagnostic tests would be used to evaluate this patient?  
  • What is the focus of nursing care for this patient?   
  • Prioritize the most important Nursing Diagnosis R/T AEB with three interventions and one outcome criteria.  

Assignment 3:

Huang Mei Lan is a 43-year-old unmarried female who lives alone in a major West Coast city. Three years ago, she was diagnosed with breast cancer and underwent a mastectomy of the affected breast and follow-up chemotherapy. Last month, Ms. Lan experienced a recurrence of cancer in the lymph glands of the affected side. Surgery to remove the glands was performed, and chemotherapy started. Ms. Lan has a central line, a urinary catheter, and a surgical incision. The nurse enters Ms. Lan’s room and finds her huddled in the middle of the bed, shivering violently.  

Her vital signs are T-104°, HR-110, RR-30, BP-106/66 

Skin-hot, dry, flushed with poor turgor Alert and oriented, restless, and anxious 

  1. Describe how Huang Mei Lan’s current symptoms are related to the pathophysiology of shock and determine what type of shock the patient is experiencing.  
  • What stage of shock (if applicable)? 
  • What would be the specific lab and diagnostic tests used to evaluate this patient?  
  • What is the focus of nursing care for this patient?  
  • Prioritize the most important Nursing Diagnosis R/T AEB with 3 interventions and one outcome criteria.  

Richard Tanner, a 49-year-old truck driver, was admitted earlier this morning through the ER for chest pain. He was admitted to the CCU for r/o myocardial infarction (MI). He has no prior history of cardiac problems; however, he has been treated for the past 5 years for a total cholesterol of 285 (HDL 35, LDL 212). He was prescribed Lovastatin, which he does not take regularly. He was recently diagnosed with hypertension with his normal BP 160/96 for which he does not take medication. He is overweight and exercises little. His father died of an MI at the age of 50. The nurse enters his room and finds him lethargic and dyspneic. 

His vital signs are  T-99.2°, HR-110, rapid, thready 

EKG sinus tachycardia with frequent premature ventricular contractions (PVC’s) 

R 30, labored, crackles, wheezing BP 106/66 

Skin-pale, cyanotic, cold, and moist 

  • Describe how Richard Tanner’s current symptoms are related to the pathophysiology of shock and determine what type of shock the patient is experiencing.  
  • What stage of shock (if applicable)? 
  • What would be the specific lab and diagnostic tests used to evaluate this patient?  
  • What is the focus of nursing care for this patient?  
  1. Prioritize the most important Nursing Diagnosis R/T AEB with 3 interventions and one outcome criteria.  
  2. Page Break 

Jane House, 20 years old, was admitted to the ER following a motor vehicle accident earlier in the day. She was an unrestrained passenger in an automobile that was T¬ boned by 30 minutes, and an emergency transport helicopter brought her to the ER. She suffered a partially severed leg, chest contusion, possible fractured pelvis, open head wound, and a fractured jaw. She has lost several units of blood. She has been in the post-anesthesia care unit (PACU) for the past hour following surgery to reattach her leg and close her head wound. Her vital signs have been stable. The nurse enters the room to find Jane’s NG draining copious amounts of sanguineous fluid. 

Her vital signs are T-98°,  HR-120, rapid, thready, RR-30,  BP-80/60 

Skin-cool, pale, moist, with dependent edema  

  1. Describe how Jane House’s current symptoms related to the pathophysiology of shock and determine what type of shock the patient is experiencing.  
  1. What stage of shock (if applicable)? 
  1. What would be the specific lab and diagnostic tests used to evaluate this patient?  
  1. What is the focus of nursing care for this patient?   
  1. Prioritize the most important Nursing Diagnosis R/T AEB with 3 interventions and one outcome criteria.  
  2. Page Break 

Timothy Murphy, 30 years old, was admitted to ICU earlier today from ER following a diving injury. He and his friends were swinging from a rope into a creek below when his head struck the bottom of the creek resulting in a cervical fracture and paralysis from his neck down. He has been alert and oriented, but his vital signs have been labile. He was placed on a ventilator on CMV at 12 breaths per minute. His neck is immobilized in a cervical collar. The nurse enters the room because the ventilator alarms are going off. 

His vital signs are T- 99.6°, HR-60 and bounding, BP-82/60, RR-28, he is bucking the ventilator.  Skin- warm and dry. Anxious, extremely restless. 

  1. Describe how Jane House’s current symptoms related to the pathophysiology of shock and determine what type of shock the patient is experiencing.  
  1. What stage of shock (if applicable)? 
  1. What would be the specific lab and diagnostic tests used to evaluate this patient?  
  1. What is the focus of nursing care for this patient?   
  • Prioritize the most important Nursing Diagnosis R/T AEB with 3 interventions and one outcome criteria.  

Steve Cron is a 76-year-old same-day surgery patient admitted to the unit a few minutes ago from PACU following left hip hemi-arthroplasty. The nurse started the dose of Ancef IV five minutes ago. He calls the nurse’s station and complains of itching and shortness of breath. The nurse arrives in his room and finds him extremely restless, anxious, and gasping. 

His vital signs are T-100°, HR-130, irregular, RR-40, dyspneic, stridor, wheezing, BP-60 with a doppler. Skin-warm, generalized edema. Anxious, extremely restless. 

  • Describe how Jane House’s current symptoms related to the pathophysiology of shock and determine what type of shock the patient is experiencing.  
  • What stage of shock (if applicable)? 
  • What would be the specific lab and diagnostic tests used to evaluate this patient?  
  • What is the focus of nursing care for this patient?   
  • Prioritize the most important Nursing Diagnosis R/T AEB with 3 interventions and one outcome criteria.  

Assignment 4:

  1. Describe the post-delivery vaginal discharge over a 2-week period. Define your understanding of the
    scale in determining the lochia amount noted on the peri-pad.

  2. 2. Describe your discharge teaching with regards to mom.
    3. Describe your discharge teaching with regards to the newborn.
    4. Describe how you would instruct a new mom in caring for her circumcised son. What signs and
    symptoms may indicate infection?
    5. Describe how you would instruct a new mom in caring for her female child’s vaginal discharge. Is this
    normal?
    6. Does your clinical facility have post-discharge follow-up care like a lactation program? How does that
    benefit the patient?
    7. Your postpartum patient has an IV.  What would assess you before DC and why?

Assignment 5:


1. Name and describe selected physical characteristics of the newborn used in the Dubowitz gestational
assessment tool. Relate it to your own newborn assessment.
2. Many of the infants are placed under a radiant warmer. Why is this done? Include the various routes of
heat loss and their significance to the newborn.
3. Explain why a newborn is given vitamin K.
4. Describe proper latching during breastfeeding. Describe ways to help patients having difficulty with
breastfeeding. Include ways to help with breast engorgement.
5. How is the care of the infant affected if the mother is infected with HBV?
6. Describe Safe Sleep positioning for the newborn?
7. Describe the difference between Cephalohematoma and Caput Succedaneum?
8. What signs and symptoms would be concerning after a prolonged rupture of membranes?

Assignment 6:

1. Describe your nursing interventions on a patient you have found to have a non-palpable uterus. Explain.
(include medications and its purpose)
2. Describe in order, using applicable landmarks, the technique for massaging a post-delivery uterus.
3. A patient is a fresh C-Section. List the nursing interventions that are essential to her care during the first 24
hours and why?
4. Compare your interventions with a fresh vaginal delivery.
5. On your assessment of an 8-hour postpartum patient, you find that her uterus is non-palpable.  List in
order your nursing interventions and explain why you have chosen these nursing interventions.
6. Describe the post-delivery vaginal discharge over a 2-week period.
7. Your patient complains that she is changing her pad quite often.  State some of the questions you would
ask her and why?  Define your understanding of the scale in determining the lochia amount noted on a
peri-pad.
8. You are about to help your freshly delivered vaginal patient to the BR for the first time when she says, “I
fainted the first time they got me up after my last delivery, and before I fainted, I felt a gush of fluid from
my vagina when I stood up.  Is that normal?”  How would you answer this patient?  What precautions
would you take prior to getting her up and why?
9. You are assigned to the patient in room 202.  On your initial visit to her room that morning, she grumbled
that she never slept a wink because she was up all night, either changing her nightgown because she was
sweating so much or getting up to urinate.  What questions would you ask her, and what would you say to
her in response to the information she just gave you?
10. A patient is breastfeeding her baby.  She seems puzzled and says to you, “first, there was just a little bit of
yellow liquid coming out of my breast.  Now my breast hurts, and it’s hard to get the baby on.  What would
you assess this patient for, and how would you answer her question?
11. While assessing a patient, you elicit a positive Homan’s sign? What does that mean?  How would you
explain your findings to the patient, and why?

Assignment 7:

1. Define physiological jaundice in the newborn.  Include when jaundice first appears and the signs and
symptoms that should be included in the nursing assessment.
2. Define direct and indirect measurements of bilirubin in the newborn and the significance of each.
3. Define Coomb’s test and the significance of the results.
4. How is bilirubin eliminated from the newborn?
5. Define the purpose and theory of phototherapy.  Include the nursing interventions of the newborn
that is having phototherapy.

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