Socrative review for Med Surg Exam #4
Which specialty needs to be informed first of any medication changes to the patient's home or inpatient MAR prior to surgery? A Anesthesia B Phlebotomy C Surgical resident D Respiratory
A Anesthesia Anesthesia needs to be aware of any medication changes (meds taken or refused) prior to surgery as it can affect their anesthesia medication choices.
Which of the following is due to the degeneration of the cholinergic system in the brain? A Alzheimer's disease B Cerebrovascular accidents C Parkinson's disease D Delirium
A Alzheimer's disease Alzheimer's disease is caused by the degeneration of the cholinergic system in the brain.
Your patient who is scheduled to have a tumor resection for an invasive brain tumor is being prepped for surgery after the surgeon obtained consent states that she doesn't understand why she needs to have surgery. What should your response be? A Call the surgeon to come back and explain the situation and treatment options to the patient again B Reiterate that the surgeon on her case is one of the best in the hospital and would only choose the best treatment option for her C Reassure the patient that surgery is the best course of action for her diagnosis D Acknowledge that the patient is having understandable second thoughts and request a psychiatric consult prior to surgery
A Call the surgeon to come back and explain the situation and treatment options to the patient again Regardless of whether the patient has signed a consent or not, any questions, misgivings, concerns, etc. need to be addressed with the operating physician before surgery occurs. Always call the surgeon back to discuss the situation/options with the patient.
Which of the following medications would a patient be started on post-embolic stroke, to prevent another episode? A Dabigatran (Pradaxa) B Enoxaparin (Lovenox) C Pantoprazole (Protonix) D Lisinopril (Zestril)
A Dabigatran (Pradaxa) Dabigatran (Pradaxa) is the anticoagulant used most often for secondary stroke prevention in patients with atrial fibrillation of non-heart valve origin.
Your patient is thrombocytopenic. Which of the following would be a sign or symptom of this condition? Select all that apply. A Epistaxis B Hyperthermia C Oliguria D Hematuria E Melena F Ecchymosis G Anuria
A Epistaxis D Hematuria E Melena F Ecchymosis Thrombocytopenia is a decrease in platelets, which puts the patient at risk for bleeding. Blood in the urine (hematuria), blood in the stool (melena), nosebleeds (epistaxis), and ecchymosis (bruising) are all signs of bleeding to assess for in a thrombocytopenic patient.
Which of the following is not recommended when working with an Alzheimer's or dementia patient? A Give multiple instructions to be carried out in sequence B Maintain a calm, gentle tone of voice and demeanor while assisting the patient C Let the patient move at their own pace; do not rush them D If the patient is seated, kneel beside them and speak at eye level
A Give multiple instructions to be carried out in sequence Patients with Alzheimer's or dementia cannot remember or follow instructions given all at once. Give them step-by-step direction and encouragement to prevent overwhelming them.
Which of the following are normal side effects of general anesthesia? Select all that apply. A Lethargy B Hyperthermia C Oliguria D Altered LOC E Shivering F Atrial fibrillation G Atelectasis
A Lethargy D Altered LOC E Shivering
After establishing a safe environment, which of the following activities are important to implement in a patient with delirium or dementia? Select all that apply. A Offering recreational activities for entertainment and rehabilitation B Instituting mandatory quiet times unit-wide C Enabling rest/sleep periods balanced with activities D Providing a calm, structured environment for the patient to function in E Encouraging and assisting with self-care needs F Distracting the patient from speaking to others
A Offering recreational activities for entertainment and rehabilitation C Enabling rest/sleep periods balanced with activities D Providing a calm, structured environment for the patient to function in E Encouraging and assisting with self-care needs
Which of the following is an example of palliative surgery? A Partial tumor resection for terminal brain cancer B Partial knee reconstruction after a skiing accident C Laparascopic cholecystectomy for cholelithiasis D Rhinoplasty for cosmetic imperfection
A Partial tumor resection for terminal brain cancer A palliative surgery is done to relieve symptoms of an incurable disease process and improve quality of life (not quantity).
Which of the following is not an intervention to prevent DVTs post-operatively? A Rapid IV hydration B SCD's C Compression hose D Early ambulation E Anticoagulation therapy (Enoxaparin, Heparin)
A Rapid IV hydration Rapid IV hydration does not prevent DVTs, and can cause flash pulmonary edema or heart failure.
Which of the following does not require a patient to be intubated and placed on a ventilator? Select all that apply A Spinal/nerve block B Moderate (conscious) sedation C Epidural anesthesia D General anesthesia
A Spinal/nerve block B Moderate (conscious) sedation C Epidural anesthesia
What does Epoetin Alfa do in the body? A Stimulates the bone marrow to increase production of RBCs B Stimulates the liver to produce more bile C Stimulates the spleen to destroy more RBCs D Stimulates the bone marrow to increase production of WBCs
A Stimulates the bone marrow to increase production of RBCs
Which of the following medications would be stopped prior to surgery? Select all that apply. A Warfarin B Clopidogrel C Apixaban D Salicylate acid E Levothyroxine F Metoprolol
A Warfarin B Clopidogrel C Apixaban D Salicylate acid
A nurse is assigned to four patients. Which patient should the nurse see first? A) A patient who is being prepared for a major surgery receiving clopidogrel. B) A patient who had open reduction internal fixation (ORIF) receiving fondaparinux. C) A patient with a low white blood cell count receiving pigfigrastim. D) A patient with acquired immunodeficiency receiving emticitabine.
A) A patient who is being prepared for a major surgery receiving clopidogrel.
he nurse is reviewing the platelet count of a patient with essential thrombocytopenia. What test confirms the diagnosis of this disorder? A) Bleeding time B) White blood cell count (WBC) C) Immunoglobulin (Ig) G level D) Prothrombin time (PT)
A) Bleeding time
Ms. Smith underwent a cholecystectomy early this morning and has returned to your medical surgical unit post-operatively. Ms. Smith is grandly obese and complaining of severe abdominal discomfort. In addition to anticoagulant therapy, what other care strategies would be essential for Ms. Smith to avoid a possible deep vein thrombosis (DVT)? Select all that apply. A) Early ambulation B) SCDs/TED Hose C) Increased periods of rest D) Leg exercises
A) Early ambulation B) SCDs/TED Hose D) Leg exercises
Which nursing intervention would help a patient with progressive memory deficit function in his environment? A) Help the patient do simple tasks by giving step-by-step directions B) Avoid frustrating the client by performing basic care routines for her C) Stimulate the patients intellectual functioning by discussing new topics daily D) Promote the patient's sense of humor by discussing cartoons in a magazine
A) Help the patient do simple tasks by giving step-by-step directions Patients with cognitive impairment should do tasks within their capabilities. By receiving simple directions in a step-by-step fashion, the patient can better process information ad perform tasks.
The family of a patient with increasing dementia asks the nurse, "How can we convince our sibling that dementia is causing our mother's personality to change?" Which information would help this sibling understand the personality changes that occur with dementia? Select all that apply. A) Loss of interest in surroundings B) Lack of consideration for others C) Difficulty learning new things D) Disregard for the concept of time E) Inability to do things in sequence F) Decreased performance of daily activities
A) Loss of interest in surroundings B) Lack of consideration for others Clients with dementia often manifest a loss of interest in their surrounding, a lack of consideration for others, and a tendency to be self-absorbed. Having difficulty learning new things and the loss, or disregard, for the concept of time are cognitive changes that occur with dementia.
Which is the nurse's priority goal for a client with dementia who lives in a long-term care facility? A) Maintaining the patient optimal level of functioning B) Having the patient identify copying methods to handle stress C) Facilitating patient conversation with nice people each day D) Having the patient use physical activity to work off aggressive energy
A) Maintaining the patient optimal level of functioning
Which of the following is an example of an elective, cosmetic surgery? A Laparascopic cholecystectomy for cholelithiasis B Partial tumor resection for terminal brain cancer C Rhinoplasty for cosmetic imperfection D Partial knee reconstruction after a skiing accident
C Rhinoplasty for cosmetic imperfection An elective, cosmetic surgery is done at the patient's choice for a purely appearance-related desire.
Which of the following resolves in less than 24 hours (usually within 30-60min)? A Delirium B Hemorrhagic stroke C Transient ischemic attack (TIA) D Ischemic stroke
C Transient ischemic attack (TIA)
What type of dementia occurs due to a series of small TIAs over time? A Parkinson's dementia B Drug-induced delirium C Vascular dementia D Alzheimer's dementia
C Vascular dementia
How often should a patient be taught to use the incentive spirometer? A Continuously while awake B 10x/hour while awake C Once an hour while awake D Whenever they think of it
B 10x/hour while awake
What is the proper definition for the term "thrombocytopenia"? A Decreased WBC count B Decreased platelet count C Decreased RBC count D Decreased Hct
B Decreased platelet count Thrombocytopenia is decreased platelet count. Anemia is decreased RBC count or decreased Hct. Leukopenia is decreased WBC.
Which of the following is an example of curative surgery? A Partial tumor resection for terminal brain cancer B Laparascopic cholecystectomy for cholelithiasis C Partial knee reconstruction after a skiing accident D Rhinoplasty for cosmetic imperfection
B Laparascopic cholecystectomy for cholelithiasis A curative surgery is done to cure a patient of a disease process, like cholelithiasis.
If the RN wants to prevent pulmonary emboli, interventions need to begin at which part of the body? A Arms B Legs C Lungs D Surgical site
B Legs PEs are a result of DVTs in the legs that break loose and travel to the lungs. Preventive measures need to begin in the legs.
Which of the following is not a medication for dementia? A Rivastigmine (Exelon) B Quetiapine (Seroquel) C Donepezil (Aricept) D Memantine (Namenda)
B Quetiapine (Seroquel)
Which of the following are known symptoms of vascular dementia? Select all that apply. A Hyperextension of the neck B Shuffling gait C Restless legs D Loss of bladder/bowel control E Inappropriate laughter F Insomnia
B Shuffling gait D Loss of bladder/bowel control E Inappropriate laughter
Which of the following is true regarding Informed Consent? Select all that apply. A The consent can be obtained by any member of the healthcare team, including PCAs and RNs B The disease process/surgery intervention/other options must be explained to the patient in common (layman's) terms C The patient must receive financial compensation for participating in the surgery. D The consent must be witnessed by another healthcare professional, like an RN E The patient must be given all possible treatment options, including the surgery
B The disease process/surgery intervention/other options must be explained to the patient in common (layman's) terms D The consent must be witnessed by another healthcare professional, like an RN E The patient must be given all possible treatment options, including the surgery
How can we promote respiratory function in a post-operative patient? Select all that apply. A Put their nasal cannula on anytime they choose B Turn, cough, and deep breathe C Use the incentive spirometer D Stay hydrated E Lay flat as often as possible F Sit upright, in an unrestricted position
B Turn, cough, and deep breathe C Use the incentive spirometer D Stay hydrated F Sit upright, in an unrestricted position
For which type of anesthesia is the client intubated with an endotracheal tube? A) Nerve block B) Conscious sedation C) General anesthesia D) Epidural anesthesia
C) General anesthesia
The home nurse is speaking to the wife of a pateint with neurocognitive disorder due to Alzheimer's disease. The client has been taking donezepil. The nurse is most concerned when the caregiver states: A) "In the last few days, the main thing that my husband wants to eat is bread." B) "Yesterday, I managed to weigh my husband, and he lost 8lbs. this month." C) "Somehow, this medication has been making my husband sleep longer in the morning." D) "My husband no longer has any interes in listening to the radio with me."
B) "Yesterday, I managed to weigh my husband, and he lost 8lbs. this month."
A patient has a terminal malignant brain tumor and is scheduled for a partial tumor resection. What surgical classification is this? A) Diagnostic B) Palliative C) Curative D) Reparative
B) Palliative
What is the most common cause of embolic stroke? A Oral contraceptives B Frequent surgeries C Atrial fibrillation D DVTs
C Atrial fibrillation
Your patient has developed swelling in her arm after a thromboembolic left hemispheric stroke. What intervention can the nurse implement to help with this? A Begin the patient on a diuretic to push out extra fluid B Apply a splint to prevent contractures C Elevate the limb above the heart to improve venous return and decrease swelling D Call the MD; something is seriously wrong
C Elevate the limb above the heart to improve venous return and decrease swelling When a patient is post-thromboembolic stroke, weakness/immobility of a limb(s) can occur. This lack of muscle contraction can lead to swelling. When swelling is noted in an extremity, elevating it above the heart will assist with blood return and decrease swelling, and is a nurse-driven intervention.
________ is a medication to give immediately when an ischemic stroke is in progress; _______ is a medication to give long term for ischemic stroke prevention. A Alteplase; Heparin B Aspirin; Alteplase C Heparin; Aspirin D Alteplase; Aspirin
D Alteplase; Aspirin Alteplase or tPA is given immediately when an ischemic stroke is suspected to "bust up" the clot and restore blood flow. Aspirin is a low-dose, antiplatelet medication that can be used for prevention of ischemic stroke related to thrombosis.
Your patient is post-op an exploratory laparatomy. You're the PACU nurse receiving report from the OR RN. Which of the following findings would require an MD order to intervene? A SpO2 93% on 5L NC B BP 126/84 C Urine output 36mL/hr D Estimated blood loss 750mL intraoperatively
D Estimated blood loss 750mL intraoperatively Any blood loss >/= 500mL in surgery requires replacement, via isotonic fluid or blood product infusion.
_________ is the universal donor for blood; _________ is the universal recipient. A AB, Rh +; O, Rh - B AB, Rh -; O, Rh + C O, Rh +; AB, Rh - D O, Rh -; AB, Rh +
D O, Rh -; AB, Rh +
Which of the following is an example of reparative surgery? A Rhinoplasty for cosmetic imperfection B Partial tumor resection for terminal brain cancer C Laparascopic cholecystectomy for cholelithiasis D Partial knee reconstruction after a skiing accident
D Partial knee reconstruction after a skiing accident A reparative surgery is done to repair damage done via accident, degenerative disease process, etc.
What is a commonly seen side effect of Donepezil? A Insomnia B Headache C Dizziness D Weight loss
D Weight loss
Which intervention should help a client, diagnosed with neurocognitive disorder due to Alzheimer's disease, perform activities of daily living? A) Have the patient perform all basic care without help B) Tell the patient that morning care must be completed by 9am C) Give the client a written list activities he is expected to do D) Encourage the patient, and give ample time to complete basic tasks
D) Encourage the patient, and give ample time to complete basic tasks
Heparin/Enoxaparin "thin" the blood, making it less likely to clot. True or False
False Anticoagulants like Heparin/Enoxaparin slow the amount of time it takes for blood to clot, preventing DVTs.
Ginkgo biloba and other herbal medications/remedies don't have an affect on prescribed or OTC medications. True or False
False Herbs like Ginkgo biloba can interfere with body processes that are exacerbated by medications (Rx and OTC). Ex: Aspirin and Ginkgo biloba should not be taken together, as it increases bleeding risk.
Personality changes and cognitive changes in patients with dementia are the same thing. True or False
False Personality changes include things like loss of interest in their surroundings or hobbies they once loved, lack of consideration of others, rude behavior, agitation, etc. Cognitive changes include difficulty learning new things, inability to follow steps in sequence, decrease performance of ADLs, etc.
Inhaled anesthesia often results in headaches. True or False
False Spinal or epidural anesthesia often results in headaches.
Elevated temperature is the early sign of Malignant Hyperthermia. True or False
False The early sign of MH is tachycardia (>150 bpm). The late sign of MH is hyperthermia.
When the nurse first assesses a post-operative patient and notes drainage on the dressing, he/she does not need to do anything; this is a normal finding. True or False
False When an RN first assesses a dressing and see drainage, the RN should circle the drainage, date/time/initial it, and monitor for an increase in drainage.
Anticoagulants like Heparin and Enoxaparin are used post-operatively to prevent post-op blood clots. True or False
True
Bleeding is the highest risk for a patient after receiving tPA. True or False
True
It is a priority for the RN to screen a patient for any implants (pacemaker, prostheses), earrings, or tattoos prior to the patient going to MRI. True or False
True