Download Mammoth Hospital Med/Surg Skills Competency Test

Mammoth Hospital Med/Surg Skills Competency Test
Employee Name__________________________________
Date_____________________________________________
1.
Where is the Kangaroo Pump for enteral tube feedings
located?____________________________________________________
2.
The placement of the feeding tube must be verified
by___________________prior to the initiation of a tube feeding.
3.
To prevent aspiration during a tube feeding
a. The head of the bed should remain elevated at least 30-60
minutes after the cessation of the tube feeding. Patients with
signs of reflux must remain upright for 2-4 hours.
b. The head of the bed should always be elevated 30 degrees or
greater at all times when the tube feeding is running.
c. The bed position does not influence risk of aspiration.
d. a & b
4.
Nurse Ellen is assessing her patient for the correct placement of a
NG tube. Knowing that auscultation over the abdomen with an air
bolus, listening for an "air whoosh" is not always a reliable indicator
of correct placement, she uses additional methods of verification,
such as visualization of the color of the gastric contents and
checking the pH. The nurse verifies the correct tube placement if
which of the following pH value is noted.
a. 3.5
b. 7.0
c. 9.0
d. 8.0
5.
With the head of the bed elevated (if it is not contraindicated by the
patient's condition) and the patient's head positioned in neutral,
the BEST way to aim the NG Tube for insertion is:
a.
b.
c.
d.
Upward towards the turbinate
Upward towards the midline of the body
Downward and toward the ear closest to the chosen nostril
No specific direction, any way you can get the tube to pass
6.
A nurse is inserting a nasogastric tube in an adult male client.
During the procedure, the client begins to cough and has difficulty
breathing. Which of the following is the appropriate nursing action?
a.
b.
c.
d.
Quickly insert the tube anyways
Notify the physician immediately
Remove the tube and reinsert when the respiratory
distress subsides
Stop briefly and check for tracheal placement by dipping
the proximal end of the NG Tube in a cup of water to
check for bubbling. If bubbling occurs, remove the
tube.
7.
Gastric tube feeding residuals should be checked every 4 hours and
should be held and reported to the physician if the volume of the
gastric residuals exceeds two times the current hourly feeding
rate. True or False
8.
Mr. Thompson is receiving a continuous gastric tube feeding at 30
ml/hr. Nurse Oliver checks residuals every four hours per policy.
He obtains a residual amount of 85 mls. What action should the
nurse take?
a. Hold the feeding and notify the physician
b. Reinstill the amount and continue with
administering the feeding
c. Elevate the client’s head at least 45 degrees and
administer the feeding
d. Discard the residual amount and proceed with
administering the feeding
9.
A client had a transurethral prostatectomy for benign prostatic
hypertrophy. He is currently being treated with continuous
bladder irrigation and is complaining of an increasing severity of
bladder spasms and "pressure in my lower abdomen." Which of the
following interventions should be done FIRST?
a.
b.
c.
d.
Administer an oral analgesic
Stop the irrigation and phone the physician
Administer an antispasmodic (Ditropan) as ordered by MD
Palpate the bladder for distention. Check outflow of urine
from the catheter. Check for presence of clots, and make
sure the catheter is not kinked and is draining properly. If
needed, hand irrigate to remove blockage from clots
10.
Proper maintenance of a continuous bladder irrigation system
includes which of the following interventions?
a. Regulate irrigant flow to maintain red urine
b. Regulate irrigant flow to maintain a good outflow of pink or
lighter urine
c. Maintain a slow flow rate of irrigant to prevent bladder
distention
d. Discontinue the irrigation if there is leakage of large amounts
of urine around the catheter and call the physician
11.
The nurse is caring for a client who has returned from the PACU
following prostatectomy. The nurse monitors the continuous
bladder irrigation to detect which of the following signs of catheter
blockage:
a.
b.
c.
d.
e.
12.
Post op continuous bladder irrigation and traction on a 3 way
catheter after TURP is indicated to:
a.
b.
c.
d.
13.
Urine pale pink in appearance
Urine red in appearance
Bladder distention and spasms
Urine leakage around the three way catheter at the meatus
C&D
Prevent urinary tract infection
Prevent hemorrhage
Prevent TURP syndrome
Prevent electrolyte imbalances
The nurse is assigned to a client returning from the post anesthesia
care unit following transurethral prostatectomy. The nurse avoids
doing which of the following after this procedure?
a. Reporting signs of confusion
b. Monitoring hourly urine output
c. Removing the traction securement device on the three-way
catheter
d. Administering antispasmodic medications
14.
When recording intake and output on a client receiving continuous
bladder irrigation, the nurse must do the following:
a. Measure and record total urine output only.
b. Measure and record urine output each time a new bag of
irrigation fluid is hung. Measure total urine output in bag
(urine + irrigant), then subtract total of irrigant received and
record TRUE urine output on flow sheet. All three values
are recorded.
c. Measure and record urine output only when the urine bag is
full.
d. Measure urine output once every 12 hours per policy
15.
When should you ask the client to lower the head slightly (chin
towards chest) to close the trachea and open the esophagus and
begin sipping water from a cup through a straw while advancing
the NG tube?
a. Prior to the initial attempt of inserting the NG Tube
b. After the NG Tube reaches the nasopharynx and
resistance is felt. Rotate the tube 180 degrees toward the
opposite nostril so the tube won't enter the patient's
mouth at this time.
c. This is an outdated practice and is unnecessary
d. Only if the patient experiences coughing and respiratory
distress.
16.
It is important to mark the NG Tube's exit site from the nose at the
time of x-ray placement confirmation to help assess and monitor
for tube dislocation. TRUE or FALSE
17.
If vomiting occurs after NG Tube placement suspect:
a.
b.
c.
d.
18.
Tube obstruction
Not a cause for concern
Incorrect positioning of the NG Tube
A&C
Patients who are dependent on staff for repositioning should have
the following pressure ulcer prevention strategies in place EXCEPT:
a. Should be placed in a 30 degree lateral position to
decrease pressure on the trochanter
b. The head of the bed should not be elevated more than 30
degrees if applicable to patient condition
c. Provide a ring cushion (donut) for comfort and to reduce
pressure on the coccyx.
d. Should be repositioned every two hours and as needed
using a turn sheet to reduce shear forces.
19.
Sheepskin, heel and elbow protectors are not effective at
redistributing pressure. True or False
20.
Use vigorous massage to increase circulation over bony
prominences. True or False
21.
Care of the patient with potential for pressure ulcers should
include interventions to:
a.
b.
c.
d.
Redistribute pressure
Minimize the patient's skin's exposure to moisture
Maintain or improve nutrition and hydration status
All of the above
22.
A thorough skin assessment should be performed on admission
and reassessed _____________________________.
23.
The best time to change a colostomy pouch is:
a.
b.
c.
d.
e.
24.
When the bowel is least active, usually before breakfast
After the pouch is completely full
After any meal
Every 3-7 days or sooner if needed
a&d
The pouching system should be removed if the patient reports:
a. Burning or itching beneath it
b. Purulent drainage around the stoma
c. Allergic reaction to the adhesives & other ostomy
products
d. A leak in the pouch
e. All of the above
25.
The following are true about colostomies EXCEPT:
a. It may be necessary to use the measuring guide to
measure the size of the stoma with each pouch change
for the first 6-8 weeks after surgery, before the stoma
shrinks to its permanent size.
b. Applying a ring of stoma paste or a molded barrier ring
around the opening on the back of the skin barrier may
provide extra skin protection.
c. It is important to discourage the client from participating in
the pouch changing process because improper application
leads to skin breakdown.
d. Cutting an opening too big around a stoma may expose the
skin to moisture and fecal matter and cause excoriation and
skin breakdown.
26.
A client underwent a colostomy for a ruptured diverticulum. He did
well throughout the surgery and returned to the Med/Surg unit in
stable condition. The nurse assesses the client's colostomy stoma
two days after surgery. Which assessment finding should the nurse
report immediately to the physician?
a.
b.
c.
d.
Stoma secreting watery effluent
Edematous stoma
Reddish-pink stoma
Brownish-black stoma
27.
Putting all 4 (four) patient bed side rails up constitutes as a
restraint and must be accompanied by an appropriate physician
restraint order. True or False
28.
Identify 6 out of 12 possible nursing interventions which are
considered least restrictive or lesser alternatives to the application
of restraints.
1.___________________________________________________
2.___________________________________________________
3.___________________________________________________
4.___________________________________________________
5.___________________________________________________
6.___________________________________________________
29.
Restraint orders are time limited and must be reordered or
discontinued on adults every ____________________ for a maximum
time of ______________________hours.
30.
The ordering physician must conduct a face to face evaluation of
the patient within _____________________hour of application of
restraints.
31.
Assess the need for restraints every____________________ and
provide for the patient's physical needs (exercise, nourishment,
toileting and skin care) every _____________________________.
32.
What should be done routinely after central line placement?
a. Chest radiography to verify line placement
b. The occlusive dressing should be left alone until the line
is changed to avoid dislodging the line
c. The central line should be changed to a new position
periodically to reduce the risk for infection
d. Prophylactic antibiotics are useful to reduce the risk of
catheter related blood stream infection
33.
Central venous access device dressing changes should be
performed using sterile technique every:
a. 48 hours when gauze dressings are used
b. 7 days when transparent dressing is used
c. Whenever soiled or the integrity of the dressing is
compromised.
d. All of the above
34.
Which side is UP on the Biopatch? Should it be used on infants
younger than 2 months? White side or Blue Side? Yes or No?
35.
How long should you scrub a central line insertion site with
Chloraprep during a sterile dressing change?
a. 10 seconds, then fan or blow to aid drying
b. 1 full minute
c. 30 seconds in back and forth motion, then allow to
completely air dry. No FANNING.
d. Depends on how much debris is present
36.
During a central venous catheter cap change, it is important to:
a. Clamp the catheter and have patient perform Valsalva
maneuver.
b. Thoroughly disinfect the connection site using an
antiseptic pad and friction.
c. Air purge the injection cap using saline
d. Monitor for air embolism
e. All of the above
37.
What size of syringe is most appropriate for flushing a central
venous access catheter with saline or Heparin?
a.
b.
c.
d.
38.
10 ml syringe
5 ml syringe
TB syringe
1 ml syringe
During an epidural infusion the nurse assesses an increase in
sensorimotor loss (numbness and leg weakness). The nurse
should:
a. Reposition the patient to redistribute the epidural
medication
b. Give Narcan per MD order
c. Notify the Anesthesiologist to lower the epidural dosage
to provide adequate pain control without excessive
numbness or weakness.
d. No action is needed. This is the intended purpose of the
epidural.
39.
Being careful while moving patients with epidural catheters
containing medication with narcotics and anesthetics (caines) is
important because epidural catheter migration may cause:
a. Increasing numbness and paralysis
b. Respiratory distress leading to apnea
c. Overdosage of medication, leading to unconsciousness
and possible cardiac arrest
d. All of the above
40.
Which statement is correct about medications administered
through the epidural catheter?
a. Most IV medications can be given safely via the epidural
catheter.
b. Only the Anesthesiologist may bolus preservative free
medication into an epidural catheter.
c. Medications wear off rapidly after the epidural infusion is
turned off. Therefore, IV access post infusion is not
necessary.
d. It is an acceptable practice to administer oral narcotics or
IV narcotics through a peripheral IV line WITHOUT an
order from the Anesthesiologist.
41.
Which of the following is an adverse effect of an epidural infusion
with medication containing a narcotic and an anesthetic?
a. Pruritus
b. Nausea
c. Orthostatic hypotension
d. Motor blockade
e. Hypoxia and respiratory depression
f. All of the above