HESI RN MED SURG Next Gen_Updated Fall

MED-SURGE HESI RN
1. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a
rapid ventricular response. Based on this finding, the nurse anticipates
assisting the physician with which treatment?
A. Administer lidocaine, 75 mg intravenous push.
B. Perform synchronized cardioversion.
C. Defibrillate the client as soon as possible.
D. Administer atropine, 0.4 mg intravenous push.
Rationale:
With uncontrolled atrial fibrillation, the treatment of choice is synchronized
cardioversion to convert the cardiac rhythm back to normal sinus rhythm. Option A
is a medication used for ventricular dysrhythmias. Option C is not for a client with
atrial fibrillation; it is reserved for clients with life-threatening dysrhythmias, such
as ventricular fibrillation and unstable ventricular tachycardia. Option D is the drug
of choice in symptomatic sinus bradycardia, not atrial fibrillation.
2.A practical nurse (PN) tells the charge nurse in a long-term facility that she does
not want to be assigned to one particular resident. She reports that the male client
keeps insisting that she is his daughter and begs her to stay in his room. What is the
best managerial decision?
A. Notify the family that the resident will have to be
discharged if his behavior does not improve.
B. Notify administration of the PN's insubordination
and need for counseling about her statements.
C. Ask the PN what she has done to encourage the
resident to believe that she is his daughter.
D. Reassign the PN until the resident can be assessed
more completely for reality orientation.
Rationale:
Temporary reassignment is the best option until the resident can be examined and
his medications reviewed. He may have worsening cerebral dysfunction from an
infection or electrolyte imbalance. Option A is not the best option because the
family cannot control the resident's actions. The administration may need to know
about the situation, but not as a case of insubordination. Implying that the PN is
somehow creating the situation is inappropriate until a further evaluation has been
conducted.