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Two hours ago the client had a left thoracotomy with a lobe resection. The sanguineous drainage in the chest tube collection chamber is 325 mL. The nurse recognizes that this is:
Normal chest tube drainage
Indicative of a pneumothorax
A sign of hemorrhage
Sanguineous drainage of greater than 100 mL/hr in the client who is in the immediate postoperative period following a thoracotomy indicates hemorrhage. The physician should be notified immediately. Normal chest tube drainage should be less than 100 mL/hr. A pneumothorax occurs when there is air between the visceral and the parietal pleura, which causes compression of the lung and results in acute respiratory distress. Chyle drainage is a milky color that results from disruption of the lymphatic drainage system.
65. In a client with right lung pneumonia, the nurse should encourage which position to facilitate optimal oxygenation?
Supine position with head elevated at 30 degrees
Positioned with the right side dependent
Positioned with the left side dependent
Positioned with the left side dependent. With unilateral lung disease, the example to remember is "good lung down." Since ventilation and perfusion are gravity dependent, enhancing ventilation and perfusion to healthy lung tissue and alveoli will enhance oxygenation. Supine positioning would provide near equal ventilation and perfusion to both lungs. In the diseased lung, excess fluid and fibrosis inhibit gas exchange at the pulmonary capillary membrane, thereby diminishing oxygenation.
What is a normal tidal volume for a client on a ventilator?
Normal tidal volume is 7-9 ml/kg or about 500 ml for an average-sized man (approximately 75 kg).
A client with a left leg fracture is to be taught the three-point gait before
discharge. Which instruction should the nurse give to this client?
"your right crutch, swing the left foot forward, advance the left crutch, and then bring the right foot forward."
"Move your right crutch and left foot forward together, and then swing the right foot and left crutch in one movement."
"While partially bearing weight on your left leg, advance both crutches and then bring your right leg forward."
"Using one movement, advance your left foot and both crutches and then bring
right leg forward."
In the three-point gait, both crutches and the affected "badÃ¢" leg and foot move together, with the unaffected "good"â¢ leg and foot following. Choices A and B are incorrect because the crutches are moved simultaneously, not independently. Choice C is incorrect because the client should not bear weight on the fractured leg when using the three-point gait.
Which assessment finding by the nurse has the most serious implication for a 70-year-old client with emphysema?
Increased anterior-posterior diameter of the chest
Bilateral crackles throughout the lung fields
Bilateral crackles throughout the lung fields indicate excessive pulmonary fluid requiring acute intervention. Increased anterior-posterior diameter of the chest, pursed-lip breathing, and circumoral cyanosis are chronic findings in clients with emphysema. They do not indicate acute changes in the client's condition.
The nurse is encouraging a client who has undergone an amputation to
immediately fit a prosthesis. The advantage for this immediate action is:
Ability to ambulate sooner
Less chance of phantom limb sensation
Dressing changes are not necessary
Better fit of the prosthesis
When the prosthesis is in place immediately following surgery, the client can stand up several hours postoperatively and walk the next day. The operative site is closed to outside contamination and benefits from improved circulation due to ambulation.
Mr. Sanchez visited a clinic for his timely medical check-up and brought with
him his hematology result. He informed the nurse that his physician is trying to assess him for polycythemia vera. The laboratory findings for a client with polycythemia vera include major and minor criteria. What is the major or defining
RBC count >6 million/mm3
Elevated leukocyte alkaline phosphatase
Polycythemia vera is a chronic myeloproliferative disorder characterized mainly by erythrocytosis (increased RBC mass). Hemoglobin and hematocrit will be elevated. Choices A, B, and D are also laboratory findings, but they are considered minor criteria in this condition.
Medical MSNCB Exam (MSNCB Medical-Surgical Nursing Certification) Detailed Information
MSNCB MSNCB Medical-Surgical Nursing Certification
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Test Code : MSNCB
Test Name : MSNCB Medical-Surgical Nursing Certification
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Q&A : 70 Real Questions
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MSNCB Medical-Surgical Nursing Certification book
how to overcome 5 challenges to med-surg certification | MSNCB Real Questions and VCE Practice Test
Mimi Haskins, DNP, RN, CNS, CMSRN
Mimi Haskins, RN
Mimi Haskins, DNP, RN, CNS, CMSRN, immediate previous president of the medical-Surgical Nursing Certification Board and a company nurse educator at Catholic health in Buffalo, N.Y., referred to fitting a certified clinical-Surgical Registered Nurse in the course of the MSNCB suggests nurses have received extra knowledge, advantage and competencies in the med-surg field. MSNCB also offers a 2nd credential: licensed in Care Coordination and Transition management.
We requested Haskins for suggestions on how to overcome typical challenges that nurses may additionally face when for the reason that certification:
1 2nd-guessing your capabilities
Doing a good job as a med-surg nurse is one factor, but some nurses may additionally query their capability to flow a certification exam.
Haskins spoke of nurses who have labored in med-surg for at least two years and who study for certification usually do very neatly and suppose an extreme feel of pride after passing.
I nevertheless be aware how excited i used to be when I passed the exam, Haskins observed. It truly validates every thing youve learned as a nurse and demonstrates to your corporation, patients and their households that you have the potential, capabilities and talents to deliver the absolute best care.
2 Financing the process
We present a FailSafe Certification program, where a healthcare facility concurs that inside a 12 monthss time, 10 of its nurses will sign up to take both the MSNCB certification tests (CMSRN and the CCCTM for those nurses working in care coordination), Haskins talked about.
As a participant within the FailSafe application, hospitals get a discount on the AMSN review direction.
furthermore, Haskins mentioned the Academy of scientific-Surgical Nurses provides delivers for licensed medical-Surgical Registered Nurse certification and recertification to AMSN individuals via its provide program. each and every grant is awarded semi-annually and covers the full can charge of software at the member fee.
both AMSN and the American Academy of Ambulatory Care Nursing offer grants for the CCCTM exam, as well, Haskins referred to.
3 Overcoming verify anxiousness
For nurses who havent taken an examination in ages or who've look at various anxiousness, Haskins recommends taking a practice verify to prepare for the certification exam.
Haskins mentioned the FailSafe program presents a fine strategy to help enhance confidence for nurses who may well be frightened about taking an exam or are unfamiliar with desktop-based trying out.
Nurses who have taken a certification assessment path were proven to do more advantageous on the exam than people that havent, Haskins observed. in addition, nurses consider much less pressure when they know that if for any purpose they dont move the examination on the primary try, the FailSafe application enables them to repeat the exam.
4 Feeling sick-organized
For nurses who were out of school a long time, the idea of a verify may also appear daunting.
Haskins talked about going into the examine feeling prepared can make a big change and he or she recommends the free 15-question sample verify on MSNCB.org.
together with the 15-query pattern examine, there are additionally overview questions in the stores, Haskins said. We offer an online practice look at various along with seventy five distinct-choice questions according to the blueprint of the CMSRN examination. AMSN also presents a examine query overview e-book and the Core Curriculum for medical-Surgical Nursing, fifth version.
moreover, Haskins recommends joining a look at community and refreshing your potential through taking a practice examination to aid raise self assurance.
Were proud to have a reasonably excessive flow expense for the certification verify, she talked about.
5 Overlooking human components
Forming a study group and getting ready for the examination together with colleagues can give nurses self assurance as they put together to take the test.
Haskins said discovering within a group also makes it possible for nurses to establish issues where they could need to dedicate further time gaining knowledge of. for instance, a nurse may suppose assured about diabetic care however think she might use a refresher on respiratory issues.
body of workers at my facility obtained collectively and fashioned a look at neighborhood with every adult taking a section from the Core Curriculum and reviewing with their colleagues at weekly meetings, she noted.
after you have got certification, which lasts for five years, you will need to maintain your certification. To be eligible for re-certification, nurses need to cling a present med-surg certification, cling a present RN license, have accumulated 1,000 practice hours in a med-surg atmosphere in the ultimate 5 years and have earned ninety contact hours within the remaining 5 years.
AMSN presents their individuals a free CE article month-to-month, and carrying on with training credits can also be bought through attending the AMSN annual countrywide conference, Haskins talked about. this is true for the CCCTM certification as well.
in addition, college courses additionally can be used for continuing schooling. Haskins noted directions for how to try this are located on the MSNCB site.
Most professional nursing journals additionally present CE articles that can be utilized to meet the 90 CEs in five years, Haskins said. Many native chapters of professional nursing businesses even have tutorial classes all over the yr that have CEs connected to them as smartly.
Get more suggestions on med-surg nursing in our digital version.
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