Download NURSING 266 Med-Surg (Exam One) Study Guide Final (Latest Update) and more Exams Nursing in PDF only on Docsity!
Med-Surg Exam One
Study Guide (Fox)
What to Know For Exams:
● Test Yourself NCLEX Examination Challenge ● Know Nursing Safety Priority QSEN for the chapters (starts after multiple choice study guides-below) ● Know the type of IV to infuse for a patient with hypovolemia (in chart and in youtube link) ● The RN should assess patient manifestations for what in the patient with fluid volume deficit? ○ Loss of extracellular fluid volume exceeds intake of fluid ○ This is not dehydration ○ Urine output <30 mL/hr
○ Acute daily loss of 1 pound ○ Monitor fluid overload: shoes, belt, abdominal girth ○ Weak, rapid pulse, and postural hypotension ○ Tissue turgor decreased (not accurate in elderly) ○ Urine specific gravity: >1. ○ Increased BUN ○ Increased creatinine (normal = 0.7-1.4) better indicator of renal function than BUN ● The highest priority nursing for a patient with a serum potassium level of 2.2 mEq/L (Initiate cardiac monitoring) ● RN Pharmacology for Nursing ATI book (Chapter 27) will be on exam ● RN Medical Surgical Nursing will be on Exam 1 (2 ATI Chapters to study, BOTH are Chapter 27 but 2 ATI books=Pharmacology and Med-Surg, also see the beginning of each powerpoint for information to review for exams)
Left VS Right Sided-Heart Failure Video:
(Video to Help Explain Left VS Right-Sided Heart Failure) https://www.youtube.com/watch?v=Y1IUFGh2T_E
● Under-recognized, under-reported ● Confused with TRALI IV FLUID REPLACEMENT D5W Normal Saline (0.9% NaCl) 5% Albumin
0.45% NS
0.3% NS
Lactated Ringer’s Hypertonic Saline (3% or 5% NaCl) Colloids (Plasma, 25% Albumin) Hetastarch (plasma expander) Dextran Tonicity Isotonic Hypotonic Isotonic Hypertonic Hypertonic Hypertonic Hypertonic Uses Maintain volume Replaces mild loss For free water replaceme nt To correct mild hypernatr emia For max fluid and electrolyte replaceme nt Buffers acidosis Increases body fluid To correct severe hyponatrem ia Requires intensive monitoring To cause volume expansion in shock states For pts w/pulmonary edema, peripheral edema To cause volume expansion Volume expansion and/or to decrease platelet adhesion
Other Provides minimal calories Contraindic ated in patients with renal or liver disease and those in lactic acidosis Very rarely given Provides moderate protein replacement Used for short-term hemodynam ic stability. Will cause + amylase level Contraindicate d for patients with bleeding disorders
IV Solutions Made Easy (Video)
https://www.youtube.com/watch?v=51FkahHUBwc Remember that Na+ is the popular kid, and water is the quiet kid. Water follows wherever Na+ goes Isotonic Hypotonic Hypertonic Iso means equal Tonic -concentration of a solution Hypo means below/beneath Tonic -concentration of solution Hyper means excessive Tonic -concentration of solution ● 0.9% saline ● 5% Dextrose in water (D5W) - can be hypotonic too once the body absorbs the dextrose, it becomes a hypotonic solution ● 5% Dextrose in 0. saline ● Lactated Ringers Side Effects of having hypotonic cells: -Cell lyses, depletes circulatory system fluid (hypovolemic) ● 0.45% saline (½ NS) ● 0.2225 saline (¼ NS) ● 0.33% saline (⅓ NS) Side Effect of having hypertonic cells: -Cells will shrink! ● 3% saline ● 5% saline ● 10% dextrose in water ● 5% dextrose in 0.9% saline ● 5% dextrose in ½ NS ● 5% dextrose in Lactated Ringers **Given in central line. Also, watch closely, can quickly cause overload, which leads
Circle the Correct Answer:
- The movement of water through a semipermeable membrane is called diffusion/osmosis. (This is the principle of dialysis)
- The higher the osmolality (concentration) of a solution, the greater/lesser its pulling power for water.
- Two-thirds of fluid within the body is held in the intravascular/intracellular compartment.
- If an intravenous solution has a lesser osmolality than normal plasma, it is a isotonic/hypotonic solution.
- Hypotonic/hypertonic fluids are contraindicated in acute brain injuries because the cells are very sensitive to free water increasing cerebral edema.
- Colloid osmotic pressure/hydrostatic pressure is the pushing force of a fluid against the walls of the space it occupies. (In the shock patient experiencing third-spacing)
- Aldosterone is a hormone produced by the adrenal/thyroid gland that conserves sodium/potassium by causing the kidneys to retain this ion.
- An example of isotonic dehydration would be a patient suffering a traumatic hemorrhage/dysphagic client.
- A patient suffering from dehydration would have an increased/decreased urine specific gravity.
- Edema occurs when there is an increased hydrostatic/oncotic pressure forcing fluid to be pushed into tissues. 11.Sodium (Na+) is found predominantly in the intracellular/intravascular compartment.
- Sodium (Na+) is a(n) anion/cation. 13.A patient with a Na+ level less than 135 mEq/L would be hyponatremic/hypernatremic.
- 3% NaCl is a hypotonic/hypertonic solution
- K+ is primarily an intracellular/extracellular cation.
- A “tented T wave” on an ECG is indicative of hypokalemia/hyperkalemia.
- Release of parathyroid hormone (PTH) raises/lowers the plasma calcium level by promoting the transfer of calcium from bone to plasma.
- The active form of calcium is ionized/protein-bound calcium.
- Massive blood transfusions may result in hypokalemia/hyperkalemia.
- Massive blood transfusions may result in hypocalcemia/hypercalcemia. (99% of the calcium is in the skeletal system)
- Signs of hypocalcemia occur when levels of total serum calcium/ionized calcium fall below normal. (Ideally ionized calcium levels should be measured since this is the physiologically active form but often times the serum calcium level available is used) fall below normal, clinically the ionized level is often reported in the arterial blood gas analysis)
- A positive Chvostek’s/Trousseau’s sign is recorded when inflation of a blood pressure cuff on the upper arm to 20 mm above the systolic BP for about three minutes results in carpopedal spasm. 23.Chronic alcoholism is the most common cause of hypomagnesemia/hypermagnesemia.
- Overuse of antacids, cathartics or enemas may result in hypomagnesemia/hypermagnesemia. 25.The normal specific gravity range of a urinalysis is 1.003-1.030/ 1.030-1.
- Phosphorus is found in high/low amounts in red and organ meats, fish, poultry, eggs, milk and milk products, legumes, whole grains and nuts.
- Normal adult serum Osmolarity in the body is 270 to 300mOsm/L / 270 to 360 mOsm/L
- Thrombus is an inflammation of the vein / a blood clot in the vein
- Chloride___A________
- Bicarbonate____D_____ C) Promotes transmission of nerve impulses and causes contractility of muscle tissue
- Calcium___E______ D) Buffers the acidity of body fluids
- Magnesium ____F_____ E) Contracts heart muscle F) Aids in neuromuscular transmission and heart muscle contraction Some More Matching:(match correct values with labs):
- Sodium___B____ A) 3.5-5.0 mEq/L
- Potassium__A_____ B) 135-145 mEq/L
- Chloride___F____ C) 1.5-2.5 mEq/L
- Bicarbonate__E____ D) 2.5-4.5 mg/dL
- Calcium___G____ E) 22-30 mEq/L
- Magnesium__C___ F) 95-105 mEq/L
- Phosphorus___D____ G) 9-11 mg/dL
- Chvostek’s sign is positive when skin turgor remains tented in hypocalcemic states / the facial nerve twitches in hypocalcemic states
- Kayexalate is given to a person in renal failure for the purpose of excretion of calcium / potassium
- The following are causes of hyperkalemia : burns, crushing injuries & renal failure / loop diuretics, steroid use, & Cushing’s syndrome.
- A patient arrives in the emergency department following a motor vehicle accident with fluid volume deficit. The patient is a 45 yr. old male with history of Hepatitis. You need to start an IV for fluid replacement and choose from the following: 5% Dextrose in Lactated Ringers, 5% Dextrose and Water, Lactated Ringers, 0.9% Normal Saline. You select the IV bag labeled ____0.9% Normal Saline_____.
- You are the admitting RN for a Post operative patient and begin to gather the necessary IV equipment for the patient knowing that most Post-op patients in a general medical surgical unit are administered (hypertonic/hypotonic circle correct answer) IV solutions.
- You are the RN caring for a previously healthy 27 year old patient with severe acidosis and choose from the following IV bags (5% Dextrose and Water, Lactated Ringers, 0.9% Normal Saline). You select the IV bag labeled Lactated Ringers_.
- You are the RN caring for a patient newly diagnosed during your shift with mild hypernatremia and know that you will need to check your IV fluid stock to make sure that you the following is present in your stock and find the following: 0.45 Normal Saline, 0.9% Normal Saline, 5% albumin, 5% Normal Saline. You select the appropriate IV fluid for this patient and it is _____0.45% Normal Saline______. “Transfusion responsibilities” of the RN include the Following; True or False
- The transfusion of blood needs to be completed within 5 hours of removal from refrigeration. a. True b. False
- Verifying the patient with the patient’s room number a. True b. False
- Begin transfusion slowly, stay with the patient the first 15 to 30 minutes a. True b. False
● Fibrinogen
- People with Type O blood express which of the following antigens on their RBCs? ● Neither A nor B
- An example of a delayed transfusion reaction is: ● Post Transfusion purpura
- A manifestation of acute hemolytic transfusion reaction is: ● Chest pain
- In response to any acute transfusion reaction, which action should the nurse take first? ● Stop the blood transfusion
- A clinical manifestation of a severe systemic allergic reaction is: ● Abdominal pain
- Which of the following medications treats an anaphylactic transfusion reaction? ● Epinephrine
- Which of the following medications should the patient who requires transfusion therapy and are at risk for transfusion-associated circulatory overload receive? ● Diuretics
- Patients who develop TRALI have an acute onset of respiratory distress and pulmonary edema within how many hours of transfusion? ● 6 hours
- With TRALI, immune mediators may produce: ● Blood pressure instability
- Treatment for TRALI calls for aggressive respiratory support, possibly along with: ● Fluid restriction
- A clinical manifestation of transfusion-associated graft vs. host disease is: ● Diarrhea
- Prior to transfusion, which of the following is a preventative strategy for TA-GVHD? ● Irradiating donor lymphocytes
- Several of the additive solutions that preserve and store blood products put patients at risk for various imbalances including: ● Metabolic acidosis
Cardiac Review Questions
- The tricuspid valve is located between the right atrium and right ventricle.
- The AV node is the part of the heart’s conduction system that has an inherent rate of 40-60 BPM.
- A normal cardiac output is 4 L/min to 8 L/min.
- The component of stroke volume that is the amount of tension on the ventricles at the end of diastole is called _____preload______.
- The _____Sympathetic_____ nervous system has a positive chronotropic effect on the heart.
- The Purkinje system has an inherent heart rate of ___20-40____ BPM.
- The ____Pulmonary____ artery carries deoxygenated blood.
- The inner layer of the heart muscle is called the ____endocardium____.
- Normal sinus rhythm has a heart rate between 60 and 100 BPM. Circle the appropriate bracketed option to complete the sentence correctly.
- The sympathetic nervous system [increases/decreases] the inotropic effect on the heart.
- Preload is [increased/decreased] if the patient has lost most of their blood volume on the ER floor.
- The QRS complex represents ventricular [depolarization/repolarization] on the ECG.
- The SA node is located in the [right/left] atrium.
- The valve that is located between the left atrium and left ventricle is the [mitral/tricuspid] valve.
- Lanoxin will [increase/decrease] the PR interval on an ECG.
- If we place a patient in Trendelenburg position, we [increase/decrease] ventricular preload.
- Hypothermia would [increase/decrease] ventricular afterload.
- Primary hypertension would [increase/decrease] ventricular afterload.
- If heart rate is decreased and stroke volume is unchanged, cardiac output would be [increased/decreased].
- Coarctation of the aorta [increases/decreases] afterload.
- Beta blockers [increase/decrease] contractility of the heart.
- A myocardial infarction (MI) that encompasses the entire wall of the heart muscle is called a subendocardial/transmural] MI.
- ST segment elevation on the ECG is indicative of [injury/ischemia].
- ST segment depression and/or inverted T waves are signs of ischemia and are considered [normal/abnormal] with exercise.
- There are five basic steps in arrhythmia interpretation including: 1) rhythm, 2) rate,
- P wave presence, 4) PR interval and 5) [QRS complex duration/QT interval duration].
- Atropine is an anticholenergic medication that affects the [sympathetic/parasympathetic] nervous system.
- In anaphylaxis, the afterload is [increased/decreased].
- Ventricular preload of the right ventricle is called the [CVP-central venous pressure/PCWP].
- The most common rhythm associated with Sudden Cardiac Arrest (SCA) is [atrial fibrillation/ventricular fibrillation].
- Data suggests that the caregiver immediately resuming chest compressions after a shock [will/will not] trigger another bout of ventricular fibrillation. Fill in the blanks
- The RN should thoroughly evaluate the nature and characteristics of chest pain. Ask the patient if he or she has ____discomfort_____, heaviness, pressure, and indigestion.
- Following a cardiac catheterization the rapid response team or physician should be called if the patient experiences symptoms of cardiac ischemia such as, dysrhythmias, bleeding, hematoma, or a dramatic change in _peripheral pulses of extremity.
- For patients with sinus tachycardia, assess for fatigue, weakness, shortness of breath, orthopnea, decreased __oxygen saturation__and decreased _blood pressure.
- Palpate the femoral arteries while observing the monitor for widened complexes or auscultating apical heart sounds. Acute MI PVCs may be a warning , possibly triggering life-threatening VT or VF.
- In some patients , VT causes cardiac arrest.
- In the above patient it is important for the RN to assess the patient’s airway, breathing , circulation, LOC, and oxygenation level.
- The next step for the patient in #57 if the patient is stable is to administer ____ and confirm the rhythm via a 12 Lead EKG.
- Defibrillation (asynchronous counter-shock) is the treatment of choice for unstable supraventricular tachycardia. True or False-cardioversion-synchronous
- You are caring for a patient with heart valve disease, thus RN teaching prior to dental procedures includes stressing the importance of prophylactic antibiotic therapy.
- You are an RN caring for a patient post op with an aortic valve replacement. You know this group of patients has a higher risk of post-op hemorrhage. Therefore you will immediately call the Rapid Response Team or other healthcare provider immediately if _heart rate_or _blood pressure_decreases.
- Bleeding after CABG surgery requires monitoring by the RN. Measure mediastinal and pleural chest tube drainage at least hourly. Report amounts over __>150__cc per hour or drastic decreases abruptly to the surgeon.
- Check CABG patient’s neurologic status every 30 to 60 minutes until awakened from anesthesia. Then check patient per agency policy.
Cardiac Auscultation Pages:
