Unlock your potential in Advanced Medical-Surgical Nursing with this meticulously crafted study guide for NURS 476 Exam III. Designed for nursing students and professionals, this comprehensive resource offers an in-depth exploration of complex medical-surgical concepts, including advanced pathophysiology, surgical interventions, critical care management, and multisystem disorders. The guide features a robust collection of practice questions that mirror the exam’s format and difficulty, paired with expert-tested answers and detailed explanations to solidify understanding. Topics include perioperative care, cardiovascular and respiratory emergencies, neurological disorders, and endocrine imbalances, all aligned with the latest clinical guidelines. This study guide not only prepares you for exam success but also enhances your clinical reasoning skills for real-world patient care scenarios.
Preview
A nurse just received a patient presenting to the ED who is exhibiting signs of a stroke. The
patient is an 81 yo female who weight 64 kgs. The husbands states she started slurring her
words and had left sided weakness about 30 minutes ago. The patient CT scan comes back
and the report reads “There is 2/3rds of brain tissue that is affected by the ischemia”. The
provider writes a prescription to start alteplase. Select the next correct nursing option.
A. Administer the 57.6 mg over 1 hour
B. Have another nurse check your dosage calculation
C. Call the provider to question the prescription
D. Educate the patient about adverse effects of the medication – – correct ans- -Answer: C
Rational: The nurse should identify that alteplase is contraindicated in this client due to the
age and imaging report. The other answers would be correct if the medication was
indicated. Contraindications to alteplase: Age > 80, anticoagulation regardless of INR,
ischemic injury involving more than 1/3 of the brain tissue, NIHSS score >25, and evidence
of active blleding
A nurse is preparing to administer alteplase to Becky, a 65 yo female who weights 61 kg.
Select the correct options regarding correct alteplase administration. For dosage calc,
round to the nearest tenth. (sata)
A. The nurse draws up 54.9 mg of the alteplase
B. The nurse administers 5.5 mg as a bolus over the first minute via IVP
C. The nurse sets the infusion to run over 60 minutes
D. The nurse alternates taking the BP on the patients upper arm and forearm
E. The nurse calls the doctor to obtain a CT scan after initiating the alteplase – – correct ans- -Answers: A, C, & E
Rational: The dose of alteplase is based off the patients weight, 0.9 mg/kg and is
administered over 60 minutes with the first 10% given as a bolus. There is a maximum dose
of 90 mg. B would be correct if the nurse were to use an infusion pump for the bolus, you
never can manually push alteplase. 0.9 mg x 61 = 54.9, 10% of that is 5.49 (or rounded to
5.5 in this case). A nurse must be consistent with the BP device used. It must be used in the
same location as not to cause alterations in readings.
The nurse is administering alteplase and at the 30 minute mark the patients blood pressure
spikes to 201/108 and complains of a severe HA and nausea. What is the nurses priority
action?
A. Notify the healthcare provider
B. Administer vitamin K
C. Administer FFP
D. Discontinue the infusion – – correct ans- -Answer: A
Rational: Discontinuing the infusion is the priority, then the nurse would notify the HCP and
anticipate a likely prescription for FFP. Vitamin K is the reversal for warfarin not alteplase
patient is an 81 yo female who weight 64 kgs. The husbands states she started slurring her
words and had left sided weakness about 30 minutes ago. The patient CT scan comes back
and the report reads “There is 2/3rds of brain tissue that is affected by the ischemia”. The
provider writes a prescription to start alteplase. Select the next correct nursing option.
A. Administer the 57.6 mg over 1 hour
B. Have another nurse check your dosage calculation
C. Call the provider to question the prescription
D. Educate the patient about adverse effects of the medication – – correct ans- -Answer: C
Rational: The nurse should identify that alteplase is contraindicated in this client due to the
age and imaging report. The other answers would be correct if the medication was
indicated. Contraindications to alteplase: Age > 80, anticoagulation regardless of INR,
ischemic injury involving more than 1/3 of the brain tissue, NIHSS score >25, and evidence
of active blleding
A nurse is preparing to administer alteplase to Becky, a 65 yo female who weights 61 kg.
Select the correct options regarding correct alteplase administration. For dosage calc,
round to the nearest tenth. (sata)
A. The nurse draws up 54.9 mg of the alteplase
B. The nurse administers 5.5 mg as a bolus over the first minute via IVP
C. The nurse sets the infusion to run over 60 minutes
D. The nurse alternates taking the BP on the patients upper arm and forearm
E. The nurse calls the doctor to obtain a CT scan after initiating the alteplase – – correct ans- -Answers: A, C, & E
Rational: The dose of alteplase is based off the patients weight, 0.9 mg/kg and is
administered over 60 minutes with the first 10% given as a bolus. There is a maximum dose
of 90 mg. B would be correct if the nurse were to use an infusion pump for the bolus, you
never can manually push alteplase. 0.9 mg x 61 = 54.9, 10% of that is 5.49 (or rounded to
5.5 in this case). A nurse must be consistent with the BP device used. It must be used in the
same location as not to cause alterations in readings.
The nurse is administering alteplase and at the 30 minute mark the patients blood pressure
spikes to 201/108 and complains of a severe HA and nausea. What is the nurses priority
action?
A. Notify the healthcare provider
B. Administer vitamin K
C. Administer FFP
D. Discontinue the infusion – – correct ans- -Answer: A
Rational: Discontinuing the infusion is the priority, then the nurse would notify the HCP and
anticipate a likely prescription for FFP. Vitamin K is the reversal for warfarin not alteplase
Reviews
There are no reviews yet.