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Med Surg Final Exam ivy tech questions with
answers
Modifiable risk factors - CORRECT ANSWERS ✔✔Choices that can be altered to better health such as: weight, tobacco use, alcohol use, corticosteroid use and sedentary lifestyle Assess the airway - CORRECT ANSWERS ✔✔When a patient is deteriorating, this will be the nurse's number one priority. Systemic infection - CORRECT ANSWERS ✔✔An infection located throughout the body such as: fever, nausea and vomiting, swollen lymph nodes, fatigue and rapid pulse/breathing Localized infection - CORRECT ANSWERS ✔✔An infection located in a localized area only such as: pain, erythema, swelling, warmth and drainage Standard precaution - CORRECT ANSWERS ✔✔The believe that all body excretions, secretions and moist membranes and tissues excluding perspiration are potentially infectious. Requires use of hand hygiene and gloves Contact precaution - CORRECT ANSWERS ✔✔A precautionary measure requiring the use of a gown and gloves for patients who typically have: C. diff, MRSA/VRE, pediculosis, respiratory syncytial virus and scabies Droplet precaution - CORRECT ANSWERS ✔✔A precautionary measure requiring the use of a gown, gloves and mask for patients who typically have:
diphtheria, streptococcal pharyngitis, pneumonia, influenza, rubella, mumps and pertussis Airborne precaution - CORRECT ANSWERS ✔✔A precautionary measure requiring the use of a gown, gloves and N95 mask for patients who typically have: tuberculosis, measles, varicella Peripheral arterial disease - CORRECT ANSWERS ✔✔The most appropriate position for a patient to relieve pain is in the dependent position for this disease Patient should not wear compression stockings if this condition is present Magnetic resonance angiography - CORRECT ANSWERS ✔✔A diagnostic test for PVD that is commonly used to assess blood flow in the peripheral arteries with use of contrast medium to help visualize blood flow through arteries Doppler probe - CORRECT ANSWERS ✔✔A diagnostic test for PVD that is a segmental systolic blood pressure measurement of lower extremities at the thigh, calf and ankle Blood pressure readings in thigh and calf are normally higher than readings on the upper extremities. If pressures are lower than the brachial pressure, arterial disease may be present Ankle-brachial index (ABI) - CORRECT ANSWERS ✔✔A diagnostic test for PVD that is a comparison of ankle and brachial pressure. A reading of less than 0.90 in either leg is diagnostic of PAD. Patients with diabetes are known to have a falsely elevated reading
Fluid volume deficit: Respiratory - CORRECT ANSWERS ✔✔When referencing fluid volume, this condition present as:
- Increased respirations due to decreased blood volume reducing perfusion and gas exchange Fluid volume deficit: Skin - CORRECT ANSWERS ✔✔When referencing fluid volume, this condition present as:
- Poor skin turgor
- Dry and scaly Fluid volume deficit: Neurologic - CORRECT ANSWERS ✔✔When referencing fluid volume, this condition present as:
- Mental status change Fluid volume deficit: Kidneys - CORRECT ANSWERS ✔✔When referencing fluid volume, this condition present as:
- Decreased urine output
- Increased specific gravity (concentration) Fluid volume overload: Cardiovascular - CORRECT ANSWERS ✔✔When referencing fluid volume, this condition present as:
- Increased pulse rate with bounding pulse quality
- Elevated BP with decreased pulse pressure
- Elevated central venous pressure
- Distended neck/hand veins and engorged varicose veins
- Weight gain Fluid volume overload: Respiratory - CORRECT ANSWERS ✔✔When referencing fluid volume, this condition present as:
- Increased respiratory rate
- Shallow respirations
- Shortness of breath
- Moist crackles present on auscultation Fluid volume overload: Skin - CORRECT ANSWERS ✔✔When referencing fluid volume, this condition present as:
- Pitting edema in dependent areas
- Skin pale and cool to touch Fluid volume overload: Neuromuscular - CORRECT ANSWERS ✔✔When referencing fluid volume, this condition present as:
- Altered LOC
- Headache
Complete heart block - CORRECT ANSWERS ✔✔A type of rhythm seen in an EKG effecting the heart drastically leading to asystole (flat line) Na+ - CORRECT ANSWERS ✔✔When an NG is used for suctioning, this electrolyte is the biggest concern. Nurse should monitor for signs of this electrolyte shortage: LOC changes, mental status changes, weakness, lethargy, GI motility, N/V/D, decreased BP and blood volume Potassium chloride - CORRECT ANSWERS ✔✔When administering this fluid, only administer diluted via IV over extended period of time. Must monitor for hyperkalemia and infiltration of vein Isotonic solution - CORRECT ANSWERS ✔✔A type of fluid that pulls same amount of water going out of the cell that goes into the cell Hypertonic solution - CORRECT ANSWERS ✔✔A type of fluid that pulls water out of the cell Hypotonic solution - CORRECT ANSWERS ✔✔A type of fluid that puts water into the cell creating the potential to rupture if too much is taken in Paracentesis - CORRECT ANSWERS ✔✔A procedure in which the physician inserts a trocar catheter into the abdomen to remove and drain ascitic fluid from the peritoneal cavity. Usually performed with an ultrasound as a safety precaution. Risk factors include: hypovolemia and bladder perforation
Hypovolemia - CORRECT ANSWERS ✔✔During a paracentesis, albumin levels can drop due to removal of peritoneal fluid, which contains a large amount of protein. Removal of protein-rich fluid can cause shifting of intravascular volume resulting in this condition Bladder perforation - CORRECT ANSWERS ✔✔During a paracentesis, a rare, but possible complication with manifestations including: hematuria, low or no urine output, suprapubic pain or distention, symptoms of cystitis and fever Dressing - CORRECT ANSWERS ✔✔With any surgical procedure, always reinforce a _____________ that is becoming saturated Total parenteral nutrition - CORRECT ANSWERS ✔✔A provision of intensive nutrition support for an extended time that is delivered to the patient through access to central veins, usually the subclavian or internal jugular veins
- TPN can be hung for 24 hours, but after 24 hours, the bag and tubing must be replaced
- Medications can be added to TPN Enteral nutrition - CORRECT ANSWERS ✔✔Administered as "tube feedings" through one of the available GI tubes, either through a nasoenteric or enterostomal tube Gastroesophageal reflux disease (GERD) - CORRECT ANSWERS ✔✔The most common chronic upper GI disorder that occurs as a result of backward flow of stomach contents into the esophagus
- Eat 4-6 small meals per day
- Avoid eating 3 hours before bed
- Elevate HOB 6-12 inches
- Use of CPAP
- Weight reduction Fundoplication - CORRECT ANSWERS ✔✔A procedure for clients who fail to respond to other treatments of GERD. The fundus of the stomach is wrapped around and behind the esophagus through a laparoscope to create a physical barrier Used primarily for obese patients Diet - CORRECT ANSWERS ✔✔Discharge education to be given to patient with after a fundoplication procedure would be:
- Avoid offending foods
- Avoid large meals
- Remain upright after eating
- Avoid eating before bedtime
- Consume 4-6 small meals throughout the day Lifestyle - CORRECT ANSWERS ✔✔Discharge education to be given to patient with after a fundoplication procedure would be:
- Avoid clothing that is tight fitting around abdomen
- Lose weight, if applicable
- Elevate the HOB 6-8 inches with blocks Peptic Ulcer Disease - CORRECT ANSWERS ✔✔The impairment of gastric mucosal defenses so that they no longer protect the epithelium from the effects of acid and pepsin The Triple Threat - CORRECT ANSWERS ✔✔If H. pylori is present, a combination of a PPI and 2 antibiotics must be taken for 10-14 days to treat o (lansoprazole + metronidazole and tetracycline) o (lansoprazole + clarithromycin and amoxicillin) If allergic to amoxicillin, use bismuth subsalicylate Esomeprazole - CORRECT ANSWERS ✔✔A medication aiding in the treatment of H. pylori. If taken for a long period of time, can lead to osteoporotic fractures Peritonitis - CORRECT ANSWERS ✔✔An acute inflammation of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity or peritoneum H. pylori - CORRECT ANSWERS ✔✔Contacted through stool, saliva, or contact with an infected person, is a bacteria that can cause ulcers by producing urease, which neutralizes acidity of the stomach and can be treated using broad spectrum antibiotics Narcotics - CORRECT ANSWERS ✔✔Constipation, respiratory depression, addiction and difficulty staying awake are side effects of this medication
- Transferrin
- Total lymphocyte count
- Low hematocrit
- Pre-albumin
- Cholesterol Complementary therapies - CORRECT ANSWERS ✔✔These are forms of this therapy type: Dietary therapy, non-pharmacological interventions, physical/occupational therapy Protein - CORRECT ANSWERS ✔✔The most important nutrient to promote healing is ______________ Cholecystitis - CORRECT ANSWERS ✔✔Inflammation of the gall bladder triggered by high fat and high cholesterol foods caused by gall stones, obstructions or trapped bile. Educate patient to reduce the incidence of cholecystitis to avoid high fatty foods Laparoscopic vs. Open Cholecystectomy - CORRECT ANSWERS ✔✔Two alternative operations for the removal of the gall bladder. There are no significant difference in mortality and complications between the laparoscopic and open techniques Educate patients regarding lifestyle changes such as diet high in fiber and low fat
Kidney, ureter and bladder x-rays - CORRECT ANSWERS ✔✔An x-ray of the kidneys, ureters and bladder is a plain film of the abdomen obtained without any specific patient preparation. Used to screen for presence of two kidneys, measure kidney size and detect gross obstruction in kidneys or urinary tract Inform patient there is no discomfort or risk with procedure and that the patient will be laying in a supine position during the x-ray Bleeding - CORRECT ANSWERS ✔✔During a kidney biopsy, the most immediate risk is _____________ Acute glomerulonephritis - CORRECT ANSWERS ✔✔An inflammation of the glomerulus that develops suddenly from an excess immunity response within the kidney tissues. Primary GN causes are infectious, while secondary GN can be caused by multi-system diseases Glomerulonephritis - CORRECT ANSWERS ✔✔Infectious Agents Associated with ______________________
- Syphillis
- Tuberculosis
- Hepatitis B and C
- Herpes
- Infectious mononucleosis
- Malaria
- Varicella
- Women who are pregnant require immediate and effective treatment to prevent pyelonephritis resulting in preterm labor UTI prevention - CORRECT ANSWERS ✔✔Patient education for
- Avoid bubble baths
- Do not hold urine in bladder
- Wear breathable cotton underwear
- Hygiene before and after sexual intercourse
- Older adults are more at risk Micturition - CORRECT ANSWERS ✔✔Voiding; urination Renal angiogram - CORRECT ANSWERS ✔✔To view the kidneys and see how well the blood is flowing to them. Helps to identify an aneurysm (ballooning of a blood vessel), stenosis (narrowing of a blood vessel) or blockage in a blood vessel Bladder scanner - CORRECT ANSWERS ✔✔A portable device ultrasound scanner that is noninvasive method of estimating bladder volume. Used for post- void residual volumes and determine the need for intermittent catheterization based on amount of urine in the bladder Voiding cystogram - CORRECT ANSWERS ✔✔When a catheter is placed into the patient and fluid is injected into the bladder. Have the patient inform you when they have the first urge to go to the bathroom and hold it. Fill up bladder until patient states when they can no longer hold it in
Renal scan - CORRECT ANSWERS ✔✔Used to examine the perfusion, function and structure of the kidneys by the IV administration of a radioisotope. It does not use an iodinated contrast.
- No fasting or sedation is used and patient will lie in a prone or sitting position
- May be given furosemide or captopril to better visualize kidney function and blood flow Total - CORRECT ANSWERS ✔✔A type of incontinence that is continuous, unpredictable loss of urine Urge - CORRECT ANSWERS ✔✔A type of incontinence with an inability to stop urine flow long enough to reach the bathroom Functional - CORRECT ANSWERS ✔✔A type of incontinence caused by factors outside the urinary tract (Ex. broken leg, obstacles in path to bathroom) Stress - CORRECT ANSWERS ✔✔A type of incontinence where loss of small amount of urine from increased abdominal pressure such as laughing, sneezing, coughing, lifting Renal calculi (kidney stones) - CORRECT ANSWERS ✔✔Patients with this condition will present with:
- Severe pain (renal colic); flank pain that radiates to the abdomen, scrotum, testes or vulva suggests calculi in ureter or bladder due to obstruction of the urinary tract
- Urinary frequency or dysuria
Open surgery - CORRECT ANSWERS ✔✔A treatment for renal calculi that uses a surgical incision to remove the calculus. Used for large or impacted calculi (staghorn calculi) or for calculi not removed by other approaches o Ureterolithotomy: into the ureter o Pyelolithotomy: into the kidney pelvis o Nephrolithotomy: into the kidney Stenting - CORRECT ANSWERS ✔✔A treatment for renal calculi. The placement of a small tube in the ureter during a ureteroscopy to dilate the ureter and allow passage of a calculus Percutaneous ureterolithotomy/nephrolithotomy - CORRECT ANSWERS ✔✔A treatment of renal calculi. The insertion of an ultrasonic or laser lithotripter into the ureter or kidney to grasp and extract the calculus Arthroscopy - CORRECT ANSWERS ✔✔A sterile procedure that allows visualization of internal structures of a joint, most commonly the knee or shoulder joints Nursing intervention fo arthroscopy - CORRECT ANSWERS ✔✔Teach client post-procedure exercises or refer to physical therapy Patient Education - CORRECT ANSWERS ✔✔Advise patient to do the following after an arthroscopy:
o Provide post-operative joint exercises and reinforce explanation of procedure o Apply ice for first 24 hours o Elevate the extremity 12-24 hours o Instruct client to take analgesic for pain o Apply splint/sling o Have patient use crutches if provider allows limited weight bearing o Monitor color, temperature, pain and sensation of extremity o Notify MD of swelling, increased joint pain, thrombophlebitis or infection Nuclear scans - CORRECT ANSWERS ✔✔Bone scans evaluate the entire skeletal system, while gallium and thallium scans are more sensitive for detecting bone problems; observe for allergies to shellfish due to iodine
- Used to detect tumors, arthritis, osteomyelitis, osteoporosis, vertebral fractures and unexplained bone pain
- A patient with any other the following above would receive a bone scan Fractures - CORRECT ANSWERS ✔✔A break or disruption in the continuity of a bone. Nurse must assess the 6 P's: pain, pressure, pulselessness, paralysis, paresthesia, pallor Early stages of Neurovascular Compromise - CORRECT ANSWERS ✔✔This stage of neuromuscular compromise shows signs of: heat, swelling and pulselessness
