MED SURG NUR 440 Final Comp Exam

What are the clinical s/s of pulmonary emboli (PE)

*SOB* *Changes in LOC* ***sudden dyspnea ***tachypnea ***Tachycardia ***Anxiousness Feelings of impending doom Hemoptysis Changes in LOC Pleuritic chest pain Cough ***Pt may have abnormal EKG's and Troponin levels *** Pa02 will be lower than 80 *** PaCO2 will be lower than 35

Normal value of the PR interval?

0.12 to 0.20 seconds / 120 to 200 miliseconds

. A nurse is performing an assessment on a patient in the ED. The patient's gait is staggering and he is unable to perform rapid alternating movements. The nurse would suspect damage to which of the following? a.) Hypothalamus b.) Cerebellum c.) Thalamus d.) Cerebrum

B

A nurse comes in to do her morning assessments on her patient and notices that her heart rate is at 45 bpm. From this information, the nurse would know that which pacer site is conducting the heart rate? A. The SA node B. The AV node C. Bundle of His D. Purkinje Fibers

B - AV node

If your patient begins to experience malignant hyperthermia, which medication would you give? a. Diprivan b. Dantrium c. Demerol d. Danazol

B - Dantrium

Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. What is the most appropriate action for the nurse to take? Offer the patient to use the urinal/bedpan after explaining the need to maintain safety. Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done. Allow the patient to go to the bathroom since the onset of the medication will be more than 5 minutes. Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room. Offer the patient to use the urinal/bedpan after explaining the need to maintain

Bed pan

What signs/symptoms would the nurse expect to see for increased ICP after head trauma? a.) Lethargy b.) Bradycardia c.) Confusion d.) Widen pulse pressure

C

When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that: Using two drugs increases osmolality of plasma and the glomerular filtration rate This combination prevents dehydration and hypovolemia This combination promotes diuresis but decreases the risk of hypokalemia Moderate doses of two different types of diuretics are more effective than a large dose of one type

C - Promotes diuresis but decreases risk of HypoK

A knowledgeable nurse knows that a PVC is when the ventricles contract prematurely. The nurse knows that she needs to watch for what?. A. Nothing, this is never cause any issues B. Blood Clots C. A ventricle contraction on a T wave D. Ectopic Beats

C - Ventricle contraction on a T wave

Two types of volume expanders for the circulatory system?

CCrystalloids and Colloids

A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours? ✖ Creatine kinase (CK or CPK) LDH-2 Lactic dehydrogenase (LDH) LDH-1

CK or CPK

Magnesium WNL Value?

1.5 to 2.5 mEq/L

A patient with a recent diagnosis of a brain tumor presents to the ER with a new onset of confusion, positive for Cushing's triad, and impaired motor function. When the nurse enters the room she observes the patient projectile vomiting. The patient is experiencing? A. Increased intracranial Pressure B. Stroke C. Migraine D. Meningitis

A

In order to prevent the development of tolerance, the nurse instructs the patient to: Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night Use the nitroglycerin patch for acute episodes of angina only Apply the nitroglycerin patch every other day Switch to sublingual nitroglycerin when the patient's systolic blood pressure elevates to >140 mm Hg

A

The patient in the ED is complaining of a headache, stating "It's the worst headache of my life!". She can point to the exact location of where the headache is. What would the nurse suspect be occurring? a.) Hemorrhagic Stroke b.) Brain tumor c.) Migraine d.) Change in intracranial pressure

A

What is the best way to check for patency of the arteriovenous fistula for hemodialysis? A. Palpate the fistula throughout its length to assess for a thrill B. Pinch the fistula and note the speed of filling on release C. Use a needle and syringe to aspirate blood from the fistula D. Check the capillary refill on the extremity with the fistula

A

Which client would the nurse identify as being most at risk for experiencing a CVA? A. A 55-year-old African American, who smokes a pack a day. B. A 25-year-old female on oral contraceptives. C. A 85-year-old Japanese male. D. A 38-year-old pregnant women.

A

Which of the following values are considered normal for ICP? a.) 0 to 15 mm Hg b.) 25 mm Hg c.) 35 to 45 mm Hg d.) 20 mm Hg

A

Which of the following statements by the patient indicates an understanding of their diagnosis of Chronic Kidney Disease A. "I am receiving dialysis now becasuse conservative therapies such as drugs, diet, and fluid restriction can no longer manage my disease." B. "I need to increase my protein intake" C. "My Chronic kidney disease may be a result of diabetes and hypertension." D. "I should stop taking the diuretics once I am feeling better."

A - Dialysis is started when diet, drugs, and fluid restriction is no longer able to compensate for renal function loss. Generally less than 15% renal function AEB GFR.

A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority? • Maintaining cardiac monitoring • Monitoring vital signs • Maintaining at least one IV access site • Completing a physical assessment

A - Maintain cardiac monitoring

4. What does a nurse look for when he/ she suspects their patient is having increased ICP (intercrainial pressure)? Select all that apply. *Hint known as crushings triad. A. Increase systolic BP B. Decrease respirations C. Decrease pulse D. Decrease BP

A B C

A nurse knows that the these symptoms that her patient is complaining about correlate with her rhythm of A.Fib... (Select All that Apply) A. Shortness of breath B. Increase of BP C. Decrease of BP D. Angina

A C D

Symptoms and Signs of HYPERmagnesemia? SATA A - hypotension B - Bradycardia C - Respiratory Depression D - Cardiac arrest E - Seizures

A, B, C, D Seizures are not commonly associated with hypermagnesemia.

When a patient is on TPN, what do you need to monitor (select all that apply) a. Blood sugar b. Potassium c. Creatinine d. Sodium

A, B, D

Which are potential omplications of IV Therapy (select all that apply) A. Thrombosis B. Vancomycin C. Amoxicillin D. Phlebitis

A, B, D

1) Of the following select all that apply of signs and symptoms of pneumothorax a. Sudden and sharp chest pain b. Elevated blood pressure c. Pushing trachea off midline d. Low Spo2

ACD

The nurse interviews a patient scheduled to undergo general anesthesia for a hernia repair. Which information is most important to communicate to the surgeon and anesthesiologist before surgery? a. The patient drinks 3 or 4 cups of coffee every morning before going to work. b. The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago. c. The patient drank 4 ounces of apple juice 3 hours before coming to the hospital. d. The patient's father died after receiving general anesthesia for abdominal surgery.

ANS: D The information about the patient's father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.

Which of the following terms describes the force against which the ventricle must expel blood? • Preload • Cardiac output • Afterload • Overload

Afterload

What will you anticipate the MD ordering for these PVC's (a run of six or more in one minute)?

Amiodarone

Volume expander that contains larger, insoluble molecules such as gelatin and human blood

Colloids - they are more expensive

What is the criteria for End-stage kidney disease?

Complete loss of kidney function for more than 3 months

Volume expander that includes normal saline, Ringer's lactate or Ringer's acetate, and D5W are all isotonic solutions; all used for large-volume replacements. These are grouped together as volume expanders called?

Crystalloids - Isotonic / each have unique prperties including varying osmolarities.

Per the SCIP protocol, when do you give the preoperative antibiotic and how long after surgery are they usually discontinued? a. Two hours before and within 48-hours after b. One hour before and within 48-hours after c. 30 minutes before and within 24-hours after d. One hour before and within 24-hours after

D

Which of the following patients is at highest risk for a stroke? a.) an obese 45-year-old Native American b.) a 35-year-old Asian American woman who smokes c.) a 32-year-old white woman taking oral contraceptives d.) a 65-year-old African American man with hypertension

D

You have a patient with the following +2 edema, irregular heart rhythm, is in metabolic acidosis, and K+ is 6.1, what do you suspect is happening a. Fluid overload b. Decrease cardiac output c. Small bowel obstruction d. Decrease kidney function

D

A patient arrives in the ED with c/o pain r/t edema in both legs. She has been taking spironolactone (Aldactone) at home for a few weeks. The ED assessment nurse notices which of the following data with the physician that indicates a need to withhold the spironolactone (Aldactone)? a. Blood glucose level of 168 b. Blood pressure of 118/75 c. Sodium level of 146 mEq/L d. Potassium of 5.9 mEq/L

D - potassium-sparing diuretic

Barocrecptors in the carotid artery walls and aorta respond to which of the following conditions? Changes in heart rate Chnanges in arterial oxygen tension Changes in arterial carbon dioxide tension Changes in blood pressure

Changes in blood pressure

What test do you use to test for hypocalcemia?

Chvostek sign -tap the side of neck gently and observe for facial twitching. Tests for hypocalcemia and tetany. Chvostek = Cheek

Which of the following foods should a patient with leukemia avoid?

Fresh fruits and vegetables - higher potential for pathogens

Gold standards for measuring renal function?

GFR / Creatinine

BUN WNL Value?

Generally - 7 to 20 mg / dl is within normal limits

Name two disease processes that would lead to left ventricular afterload?

HTN and aortic valve disease

A patient is showing a positive Chvostek sign. What is this a sign of? A. hyerpkalemia B. hypocalcemia C. hypercalcemia D. hypokalemia

Hypocalcemia

One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect? Hypernatremia Hypermagnesemia Hypocalcemia Hypokalemia

Hypokalemia

When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the: Impulse to begin atrial contraction SA node to discharge the impulse to begin atrial depolarization Impulse to travel to the ventricles Impulse to transverse the atria to the AV node

Impulse to travel to te ventricles

Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage? Electrocardiogram (ECG) Cardiac catherization Cardiac enzymes Echocardiogram

EKG / ECG

Hypocalcemia common cause

Lack of vitamin D; can also single pathologies involving the pancreas, kidneys, and paprthyroid glands.

Creatinine WHN Value?

Males 0.6 mg/dl to 1.2 mg/ld Females 0.5 mg/dl to 1.1 mg/dl

NON-STEMI

MI caused by severely narrowed artery of the heart by not 100% occluded

Hypercalcemia S/S

Polydipsia, polyuria, abdominal pain, skeletal weakness, confusion, fatigue.

Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole? ✖ Preload Cardiac index Afterload Cardiac output

Preload

STEMI

ST-elevation MI = 100% blockage of coronary artery

What does an elevated ST segment on an EKG represent?

STEMI / Acute MI

What does a sinus rhythm with a inverted T wave indicate?

Ischemia

Upon assessment, you notice your patient has a decreased urinary output, skin tneting and bounding pulses. What type of fluids do you anticipate the doctor will order?

Isotonic - the patient's assessment infers they are dehydrated - isotonic solutinos would be used to rehydrate the patient.

Which of the following types of pain is most characteristic of angina? Sharp Knifelike Tightness Shooting

Tightness

What other test can you use to test for hypocalcemia?

Trousseau's Sign

4) Spontaneous pneumothorax occur without warning, and commonly seen with patients with COPD and smokers, True or False? a. True b. False

True

5) When diagnosing a pulmonary embolism, if the D dimer is elevated other diagnostic tests need to be completed to confirm diagnosis, True or False? a. True b. False

True

Which of the following parameters is the major determinate of diastolic blood pressure? Renal function Baroreceptors Cardiac output Vascular resistance

Vascular resistance

Hypomagnesemia S/S

Weakness, muscle cramps, tremors, nausea, anxiety, HTN

perioperative

entire surgical experience

What can you administer to treat hypercalcemia?

Calcitonin

If the chest tube drainage is greater than 100 ml/hr what do you need to do?

Call attending

Hypercalcemia can indicate cancers, espically if the ? has infiltrated bones to break down

Cancer of the bone - multiple myeloma, leukemia

1. What is a priority nursing assessment in the first 24 hours after the admission of the client with a thrombolytic stroke? 1. Enunciation of vowel sounds 2. Cholesterol levels 3. Pupil size and response 4. Echocardiogram

C

Hypocalcemia S/S

Muscle cramps, confusion, tingling in the lips and fingers.

Hypercalcemia common cause

Overactive parathyroid gland

Magnesium WNL blood serum concentration?

5 to 6 meq/L

You have a patient who was admitted from the ER, which labs should you notify the doctor about a. Sodium 142 b. BUN 23 c. Creatinine 1.5 d. Potassium 4.0

Answer: B, C, D Normal range of sodium is 135 to 145

Mrs. Floyd, and 85 year old woman, is brought into the E.R. complaining of severe muscle cramping, numbness, and tingling. She states that she had been sick a few days ago with severe diarrhea and vomiting. Which of the following electrolyte deficiencies is Mrs. Floyd experiencing? A.Hypercalcemia B.Hypomagnesia C. Hypermagnesia D. Hypocalcemia

Answer: D. Hypocalcemia can be caused by loss of body fluids and is characterized by muscle cramping, numbness and tingling

Defined as having: Irregular respirations (caused by impaired brainstem function) Bradycardia. Systolic hypertension (Widening Pulse Pressure) What is this called and what is a common cause?

Cushing's Triad - Increase in Intracranial Pressure ICP

4. Which of the following respiratory patterns indicates increased ICP? 1. Asymmetric chest expansion 2. Nasal flaring 3. Rapid, shallow respirations 4. Slow, irregular respirations

D

The PR interval on an EKG indicates what action in the heart?

The time it tekas the impulse to reach the ventricles from the sinus node.