Med Surg Unit 1

Which of the following is a traditional definition of nursing by American Nurses Association (ANA)?

(Hint: think of ANA think of the words " human responses") Diagnosing and treating human responses to actual or potential health problems Explanation: The ANA traditionally defined nursing as "the diagnosis and treatment of human responses to actual or potential health problems." Florence Nightingale described the role of the nurse as putting "the patient in the best condition for nature to act upon him." Virginia Henderson envisioned the role of a nurse as helping people (sick or healthy) to carry out the activities that contribute to their health, recovery, or a peaceful death as well as the activities that they would do for themselves if they had the necessary strength, will, or knowledge.

Which of the following is a misconception about pain and analgesia?

(read question wrong) Chronic pain is due to physiological disturbance.

Bradykinin and prostaglandins

(remember - test knowledge) ACE inhibitors drugs can an increase in it. It is an inflammatory mediator. It is a peptide that causes BVs to dilate and causes blood pressure to fall. Prostaglandins are believed to increase sensitivity to pain receptors by enhancing the pain-provoking effect of bradykinin. Endorphins and enkephalins reduce or inhibit transmission or perception of pain. Morphine and other opioid medications inhibit the transmission of noxious stimuli by mimicking enkephalin and endorphin.

Somatic pain and deep somatic pain

(remember) Explanation: "Somatic" pain is caused by injury to skin, muscles, bone, joint, and connective tissues. Deep somatic pain is usually described as dull or aching, and localized in one area.

When would respiratory depression, if it were to happen, begin to start taking an effect in a patient with an opioid epidural?

6 to 12 hours

When receiving epidural opioids, respiratory depression generally peaks within which time frame?

6 to 12 hours Explanation: Respiratory depression generally peaks 6 to 12 hours after epidural opioids are administered, but it can occur earlier or up to 24 hours after the first injection.

Postherpetic neuralgia

A complication of the shingles which is caused by herpes zoster (chicken pox virus). It can cause burning pain that last longer after the rash and blisters have disappeared, it affects nerve fibers and the skin.

Consuming which of the following is a strategy to enhance health as part of health promotion?

A diet rich in grains Analogy: Health promotion means engaging in strategies like consuming a diet rich in grains and complex carbohydrates, exercising regularly, balancing work with leisure activities, and practicing stress-reduction techniques. Consuming a diet rich in vitamin A, vitamin B, and proteins is not a strategy of health promotion

Roles of nursing: practitioner, leader, researcher, and delegation.

A nurse who works in a community-based setting and provides education to clients is acting in the practitioner role. The leadership role involves those actions executed when assuming responsibility for the actions of others directed at determining and achieving client care goals. The researcher role involves identifying nursing problems and important issues related to client care and initiating and implementing timely, relevant studies. Delegating is a component of the leadership role

A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain? (pg. 222)

Administer analgesics around the clock. Explanation: Because assessing pain medication needs in a client with end-stage dementia is difficult, analgesics should be administered around the clock. Clients at this stage of dementia typically can't request oral pain medications when needed. They're also unable to use patient-controlled analgesia devices. Transdermal patches are used to manage chronic pain; not postoperative pain

How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client?

Administering the analgesics every three hours Explanation: Scheduling the administration of analgesics every three hours, rather than on an as-needed basis, often affords a uniform level of pain relief. Administering the analgesics intravenously or with increased dosage is not advisable unless prescribed by the physician

A certified nurse practitioner (CNP) working in the emergency department (ED) provides advanced cardiac life support (ACLS) to a patient experiencing asystole. Immediately following Intravenous (IV) access the CNP knows the first medication to be administered is epinephrine. When the patient remains in asystole the nurse knows to administer atropine. Which care planning tool is the nurse using to provide patient care?

Algorithm Explanation: Algorithms are used in acute situations to determine treatment based on patient information or response to treatment. Nursing care plans utilize the nursing process (assessment, analysis, planning, implementation, and evaluation) to direct nursing care. Care maps along with clinical guidelines, and multidisciplinary action plans (MAPs) facilitate coordination of care and education throughout hospitalization and after discharge. Bundles are set of three to five evidence-based practices used to improve patient outcomes

The physician has ordered a mu opioid analgesic for a patient with pain. What drug does the nurse anticipate administering?

Fentanyl (good to know) Explanation: Opioid analgesic agents are divided into two major groups: (1) mu agonist opioids (also called morphine-like drugs) and (2) agonist-antagonist opioids. The mu agonist opioids comprise the larger of the two groups and include morphine, hydromorphone, hydrocodone, fentanyl, oxycodone, and methadone, among others. The agonist-antagonist opioids include buprenorphine (Buprenex, Butrans), nalbuphine (Nubain), and butorphanol (Stadol)

A client who fell at home is hospitalized for a hip fracture. The client is in Buck's traction, anticipating surgery, and reports pain as "2" on a pain intensity scale of 0 to 10. The client also exhibits moderate anxiety and moves restlessly in the bed. The best nursing intervention to address the client's anxiety is to

Assess the reason for the client's anxiety Explanation: Following the steps of the nursing process, the nurse needs to assess the reason for the client's anxiety. The client could be anxious about impending surgery, an unattended pet, a sick family member, etc. Then, the nurse intervenes appropriately by obtaining the assistance the client may need or administering anti-anxiety medication. The question is asking about treatment for anxiety. Pain medication should not be administered for anxiety. The nurse will not assist the client to a chair, because the client is on bedrest and in Buck's traction

Which of the following is an advantage of primary nursing?

Assurance of a caregiver who provides holistic care Explanation: Primary nursing is highly expensive because it relies entirely on RNs. An advantage, however, is that the patient is assured of having a caregiver who caters to all needs and provides holistic and comprehensive care. Total care refers to assignments in which a nurse assumes all the care for a small group of patients.

When administering a fentanyl patch, the last dose of sustained-release morphine should be administered at what point?

Be administered at the same time. Explanation: The skin must be clean and dry prior to patch application; no shower is required. Respiratory assessment must be conducted prior to applying the fentanyl patch. Because it takes 12 to 24 hours for the fentanyl levels to increase gradually from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied. The other time frames are incorrect.

Which of the following programs focus on processes used to provide care?

Continuous Quality Improvement Explanation: CQI focuses on the processes used to provide care, with the aim of improving quality by assessing and improving those interrelated processes that most affect patient care outcomes and patient satisfaction. Quality Assurance focuses on individual incidents or errors and minimal expectations. PPOs and HMOs are types of health care delivery systems

Nurse Case Manager

Coordination of care between nurses, other health care personnel, and insurance companies are roles of the nurse case manager

Quality assurance (QA) programs were put into place in the 1980s by the Joint Commission to establish and maintain accountability to the public. These programs are responsible to the public for maintaining certain standards. Choose all of the activities that apply to QA programs.

Cost of health care services • Quality delivery of services • Appropriate standards of care Analogy: Quality Assurance programs have made progress in putting systems into place that have made hospitals more accountable to the public. These programs establish minimal criteria for the quality, appropriateness and cost of health services. However, regardless of nursing research studies that show that improved patient care outcomes are positively correlated with nurse-patient staffing ratios, the Joint Commission is unwilling or unable to establish guidelines.

With the changing population of health care consumers, it has become necessary for nurses to work more closely with other nurses across disciplines. What nursing function has increased in importance because of this?

Discharge planning Analogy: The importance of effective discharge planning and quality improvement cannot be overstated. The other answers are incorrect because evidence-based interventions and therapeutic communication in the patient's care have not grown in importance. Making and maintaining collegial relationships has become a necessity in working in the health care delivery system. Effective discharge planning aids in getting patients out of the inpatient setting sooner, cutting costs, and making rehabilitation in the community and home setting possible.

Echinacea , willow, and kava interactions with Tylenol Gingko interactions with Tylenol

Echinacea, willow, and kava can cause hepatotoxicity and nephrotoxicity, while Gingko can cause enhance the risk for bleeding

Which healthcare trends should the nurse include when speaking about the efficiency of today's health care system at a community health fair? Select all that apply

Encourage the increase use of outpatient and ambulatory services. • Emphasize the need to focus on health promotion and prevention. Analogy: Some of today's trends that increase efficiency in health care system include a shift toward outpatient and ambulatory services and a model of health promotion and preventive care which help to achieve cost-effectiveness. Also the increase in technology using a computerized medical record system allows practioners and consumers to access health care information and resources more efficiently and effectively. Physicians no longer control all the health care decision making allowing insurance companies to play an increasingly stronger role. While the expansion of genetic research is a current health care trend, it does not impact the efficiency of the health care system.

A nursing instructor is describing to a class the various roles that nurses assume. The instructor determines that teaching has been effective when the students identify which of the following as the focus of the nursing researcher role? (read question carefully..)

Establishment of a scientific basis for action Explanation: The primary task of nursing research is to contribute to the scientific basis of nursing practice. While achievement of patient outcomes through direct intervention can be affected by information gained through nursing research, this is not the focus of nursing research. Cost-effective, high-quality nursing care is the goal of continuous quality improvement (CQI). Health promotion through screening and early detection is a component of the practitioner role.

The client is scheduled for surgery. The nurse is reviewing with the client about postoperative pain management. The client states her goal after receiving treatment is "0." The first action of the nurse is to

Explain to the client that this goal might not be achievable. . Explanation: The client's goal of complete elimination of pain may be unrealistic. The nurse needs to first teach the client about setting an achievable goal. The nurse will plan to use a combination of pharmacologic and nonpharmacologic interventions for pain relief. The nurse may need to notify the surgeon of the client's goal of "0" for pain relief. The nurse does not ensure large doses of opioids are prescribed for the client. Many factors go into the prescription of medication for pain relief, including the client's response to the medication.

The National Center for Health Statistics maintains data from healthcare agencies and issues reports on a quarterly and annually basis on performance related to goals for improving the health of the U.S. population. Which initiative is targeted with improving the health of all Americans?

Healthy People 2020 Analogy: The Healthy People 2020 campaign provides an overall action plan to improve the health and quality of life of people living in the United States. The initiative includes 26 leading health indicators for measuring the overall health of the U.S. population. The Joint Commission is an independent agency that accredits and certifies healthcare organizations and programs in the United States. The AHRQ is the organization that developed standardized quality indicators used to measure healthcare quality at the federal, state, and local levels. Quality indicators are not an initiative; they are standards for measuring healthcare quality.

How long does it take fentanyl patch to start gradually causing an effect?

It takes fentanyl patches 12 to 24 hours to start gradually working and because of this other medication, like sustained release morphine, can be given at the same time.

The hospital is having a problem with healthcare-associated infections. A committee has been established to study the problem and make recommendations. The nurse working on the committee knows that this work addresses what?

National Patient Safety Goals Analogy: The Joint Commission has established National Patient Safety Goals that are updated annually. These safety goals have changed how patients are identified and prevent adverse effects. Some of the 2012 goals include reducing the risk of healthcare-associated infections. Patient safety indicators reflect the quality of care in hospitals but focus on potentially avoidable complications. Prevention indicators identify hospital admissions that could be avoided through high-quality outpatient care. Inpatient indicators reflect quality of care inside the hospital.

A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing?

Neuropathic pain Explanation: An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Chronic pain sufferers may have periods of acute pain, which is referred to as breakthrough pain. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is a term used to describe discomfort that is perceived in a general area of the body but not in the exact site where an organ is anatomically located.

Which of the following is a physiologic response to pain?

Pallor Explanation: Physiologic responses to pain include pallor, tachycardia, diaphoresis, and hypertension.

Which of the following, approved by the U.S. Food and Drug Administration, is the only use for lidocaine 5% (Lidoderm) patch? pg. 231 in Med Surg 13th Ed.

Postherpetic Neuralgia

A patient is complaining of a headache during epidural administration of an anesthetic agent. Which of the following nursing interventions should be completed?

the head of the bed should be flat Explanation: If a headache develops, the patient should remain flat in bed, should be given large amounts of fluids (provided the medication condition allows), and the physician should be notified.

According to the American Nurses Association (1995), the advanced practice registered nurse is distinguished from other registered nurses according to scope of practice. Select the activity that would distinguish the advanced practice nurse from other RNs.

Prescribes medications Analogy: All registered nurses are responsible for interpreting health care provider orders, developing nursing care plans and reporting abnormal diagnostic test results. Only RNs with a master's or doctoral degree and credentialed by the American Nurses Credentialing Center or a Specialties National Certification Body can function as advanced practice nurses and prescribe medications.

A type of nursing which includes individualized care provided by the same nurse throughout the period of care is defined as...

Primary nursing Analogy: Primary nursing refers to comprehensive, individualized care provided by the same nurse throughout the period of care. Case management is not a type of nursing care delivery. Patient-focused nursing is characterized by assigning a nurse to manage the care of a caseload of patients during a given shift, who may then delegate activities to other nursing personnel. Functional nursing is not individualized to the extent that one nurse cares for the patient throughout the entire period of care

Primary prevention, secondary prevention, tertiary prevention, and prevalence.

Primary prevention is prevention of the development of disease in a susceptible or potentially susceptible population and includes health promotion and immunization. Secondary prevention is the early diagnosis and treatment to shorten duration and severity of an illness, reduce contagion, and limit complications. Tertiary prevention is healthcare to limit the degree of disability or promote rehabilitation in chronic, irreversible diseases. Prevalence is the number of cases of a disease in a specific population during a specific period.

A nurse is caring for a patient who is experiencing fear, anxiety, and feelings of powerlessness after receiving a diagnosis of cancer. The nurse develops a teaching plan focusing on the patient's diagnosis and treatment options to promote the patient's sense of control over the situation. Using Maslow's Hierarchy of Human Needs, which of the following categories is the nurse attempting to meet?

Safety and security Analogy: Safety and security needs reflect protection from actual or potential physical and emotional harm. Thus, feelings of anxiety, fear, and powerlessness indicate interference with this level of needs. The nurse's teaching plan reflects the nurse's attempt to meet these needs. Physiologic needs are those needed to maintain life, such as oxygen, food, elimination, activity, and rest. Esteem and self-respect needs reflect a person's need to feel good about himself or herself and to feel a sense of pride and accomplishment. Belongingness and affection needs reflect a feeling of belonging to families, peers, friends, and community

Which of the following is a tool often used by case managers?

Standards of care Analogy: Case managers usually make use of tools, such as critical pathways, practice guidelines, and standards of care to help them plan and coordinate care. Insurance companies measure the costs of services provided to the case manager's patients as a means of assessing his or her effectiveness. One of the complaints about case management is that the "bottom line" will become more important than quality. For this reason, and because they are in the best position to collect outcome data, case managers usually are integral members of hospital-based and insurance-based quality improvement programs.

The nurse caring for a HIV patient diagnosed with acute pneumonia demonstrates understanding of the nurse's role in the current focus on management of chronic illness and disability in which of the following situations?

Teaching the patient to avoid crowds Explanation: Current focus on chronic disease conditions is focused on disease prevention. Teaching the patient to avoid crowds encourages the patient to take control of their health and reduce the risk of pneumonia exacerbations. Administering prescribed antibiotics is indicated in this situation; however, it does not promote independence in the patient. Making a referral to a HIV support group is indicated in this situation; however, the focus is on actions of the nurse not the patient. Reviewing the patient's CD4 count is important but does not indicate the patient's ability to control his or her health

A client reports abdominal pain as "8" on a pain intensity scale of 0-10 30 minutes after receiving an opioid intravenously. Her past medical history includes partial-thickness burns to approximately 60% of her body several years ago. The nurse assesses

That the client's past experiences with pain may influence her perception of current pain Explanation: Clients who have had previous experiences with pain are usually more frightened about subsequent painful events, as in the client who experienced partial-thickness burns to more than 60% of her body. The clients in these situations are less able to tolerate pain. Insufficient data in the stem support that the client is dependent on drugs or that this current pain is related to the client's previous burn injuries

A patient has been admitted in the emergency care unit with conditions of respiratory distress, coupled with pneumonia. The patient's condition worsens and he is placed on mechanical ventilation. While visiting this patient in the hospital, his family observes the members of the healthcare team washing their hands when entering and leaving the room. By implementing recommended hand hygiene measures which of the following organizations is the healthcare team supporting?

The Joint Commission Analogy:

The nursing student over hears a patient talking with the rehabilitation nurse stating, "I plan to recover to the best of my ability after having a stroke. I know I will always have some limitations; however, I will not let the limitations slow me down." Which description of health is the patient exemplifying in this situation?

The concept of health wellness-illness continuum Analogy: The concept of a health-illness continuum allows for a greater range in describing a person's health than the definition provided by the WHO. On the health-illness continuum, even people with a chronic illness or disability may attain a high level of wellness if they are successful in meeting their health potential within the limits of their chronic illness or disability The WHO definition does not allow for any variations in the degrees of wellness and illness. Hood and Leddy discuss wellness as having four components. Risk reduction is a strategy of health promotion.

Which of the following would least likely impact health care delivery and nursing?

The decline in genetic focus Analogy: Factors impacting health care delivery and nursing include growth in the population, increasing cultural diversiy, increased consumer knowledge, and advances in technology and genetics.

The nurse caring for a 74-year-old man who has just returned to the surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment, in which the patient stated that he has "gotten confused" in the past when he takes pain medications. The nurse should recognize which of the following principles of pain management among older adults?

The elderly may require lower doses of medication and are easily confused with new medications. Explanation: The elderly often require lower doses of medication and are easily confused with new medications. The elderly have slowed metabolism and excretion, and therefore the elderly should receive a lower dose of pain medication given over a longer period time, which may help to limit the potential for confusion. Unfortunately, the elderly are often given the same dose as younger adults, and the resulting confusion is attributed to other factors, like environment. The elderly may have altered absorption and metabolism, but the use of lower-dose opiates is encouraged for pain. Confusion following surgery is never normal. With the elderly, give medication at a low dose and slowly increase the dose until the pain is managed.

Goals of care management:

The goals of care management are quality, appropriateness, and timeliness of services as well as cost reduction.

An advanced practice registered nurse (APRN) specializing in adult-gerontology has accepted a new position in a different state. Which governing body does the APRN need to consult to verify prescriptive authority in the new state?

The new states boards of nursing Analogy: Individual states have their own distinct state boards of nursing (and sometimes state boards of medicine) regulations that govern APRN practice. Individual states do not have APRN advisory committees. The APRN Consensus Model promotes a new APRN regulatory model that addresses the essential elements of APRN licensure, accreditation, certification, and education (LACE). The NCSBN provides state boards of nursing an organization allowing them to act and counsel together on matters of common interest related to the public health, safety and welfare, including the development of licensing examinations in nursing. The board of directors guides nursing care within the rules for nursing practice established by the State Board of Nursing

A nurse working in the emergency department (ED) reviews arterial blood gas (ABG) values for a patient diagnosed with heatstroke. Blood gas values are pH 7.48, pCO2 34, pO2 95, CO2 23, HCO2 22, and SO2 98%. Which of the following nursing interventions demonstrate the nurse's understanding of the patient's ABG's and knowledge of Maslow's hierarchy of needs when providing care for this patient?

The nurse prepares for endotracheal intubation and mechanical ventilation for the patient Explanation: This patient is experiencing respiratory alkalosis related to heatstroke. The pH level is elevated in hyperventilation; the patient's hyperventilation will "blow off" more CO2, leading to lower pCO2 levels. Decreased pCO2 is caused by hyperventilation. Decreased CO2 levels are seen in renal failure. Renal failure is a sign of heatstroke. With rapid breathing SO2 can be increased with deep or rapid breathing. Acute airway management is indicated to improve tissue oxygenation. Airway support meets the patient's physiologic need for a clear airway. Spiritual support is a higher level (self-actualization) on Maslow's hierarchy. Providing IV management for circulatory support is a basic physiologic need; however, airway management is priority.

You are a nurse employed by a community organization engaged in health promotion. In this role, you teach clients steps they can take toward achieving wellness. How would you explain "wellness" to a client?

Wellness is an ongoing and intentional effort to achieve the highest potential for total well-being. Analogy: Wellness involves lifestyle choices that result in a balance in the physical, mental, spiritual, emotional, and social aspects of a person's life. Wellness is a state of being that goes beyond the mere absence of disease. This is the definition of health. Try again. Viewing one's health in terms of a balance of body, mind, and spirit is the definition of holism. Try again.

PCA pump

there is a pre-set lockout time (note to remember)

The preferred route of administration of medication in the most acute care situations is through which of the following routes?

intravenous Explanation: The IV route is the preferred parenteral route in most acute care situations because it is much more comfortable for the patient, and peak serum levels and pain relief occur more rapidly and reliably. Epidural administration is used to control postoperative and chronic pain. Subcutaneous administration results in slow absorption of medication. Intramuscular administration of medication is absorbed more slowly than intravenously administered medication.

A client is receiving morphine through a patient-controlled analgesia (PCA) system following surgery. The nurse states to the client

only you are to push the button for medication Explanation: With a PCA machine, clients control the administration of their pain medication within prescribed parameters. Family members or other visitors should not push the button on the PCA machine for the client; doing so overrides the safety features of the machine. Clients may become frustrated if pushing the button frequently does not result in pain relief. The nurse needs to instruct the client about time limits. Other instructions include not waiting until the pain is severe before pushing the button and that the PCA machine is used to control pain.

A preferred provider organization is described as a

preferred arrangement between the hospital and the physician Analogy: PPOs usually contract to provide health care to subscribers, usually businesses, for a negotiated fee that often is discounted. A prepaid group health practice system is termed a health maintenance organization. Insurance is a cost payment system of shared risk, not a health care delivery system. A health care savings account program is an incentive program to consumers, not a health care delivery system

Fentanyl patch

starts working within 12 to 18 hours, another medication can be give for pain and should be replaced every 72 hours (remember)

A nurse asks a chronic obstructive pulmonary disease (COPD) patient to breathe in slowly through the nose, taking in a normal breath. Then, she asks the patient to pucker his lips as if preparing to whistle. Finally, she asks him to exhale slowly and gently through the puckered lips. The nurse recognizes that teaching the patient pursed-lip breathing helps the patient relax and gain control of dyspnea, reducing the feelings of panic they experience. Which of the ANA tenets characteristic of all nursing practice is the nurse demonstrating? Select all that apply.

• Individualized nursing practice • Caring • Using the nursing process Analogy: Teaching pursed-lip breathing to a patient with COPD is individualized based on the patient's diagnosis. The nurse demonstrates caring by providing education to support desired patient outcomes. The nurse uses the nursing process of assessment and analysis to determine the need to teach the client pursed-lip breathing. The nurse's actions do not indicate work place environment changes or interdisciplinary collaboration. Evidence-based nursing is not an ANA tenet characteristic of all nursing practice

A nurse is interviewing for prospective employment in a managed care organization. When considering this type of health care delivery system, which of the following would be most important for the nurse to keep in mind? Select all that apply.

• Precertification for procedures is required. • The choice of providers for services is often limited. • Utilization review is a key factor to determine cost-effectiveness. Explanation: Managed care typically includes prenegotiated payment rates, manadatory precertification, utlization review, limited choice of providers, and fixed-price reimbursement.