Med Surge - Final Exam
If patient is a COPD patient and experiencing a code situation, what level of oxygen would you administer?
100%
How do you a treat a patient with Lupus?
Provide high dose of corticosteroids depending on the organ: heart, lungs, kidneys
Why shouldn't you give a COPD patient more than 2L of oxygen?
Pt already has high levels of CO2 in the body and has an overinflammation of the aveloli. Therefore, pt cannot sustain high amounts of oxygen
A nurse is teaching a client about medications that prevent osteoporosis. The nurse should instruct the client that which of the following medications is prescribed to prevent osteoporosis?
Raloxifene
What joints are affected with Rheumatoid Arthritis?
fingers, wrists, and small bones of the feet
What is GERD caused by?
GERD is caused by the spontaneous relaxing of the Lower Esophageal Sphincter (LES)
Patients who are taking NSAIDS are at risk for what?
Gastritis
What patient teaching will you provide to the patient who has asthma and using inhalers?
-Rinse the mouth after administration of inhaler -Hold breath for 10 seconds after inhaling medication
What are the post-op teachings about abdominal hysterectomy?
-Refrain from sexual intercourse -Follow up with physician at least 4-6 weeks -Monitor inciscion site for redness and drainage
What are some complications of Crohns Disease?
- fistula formation - abscess - gallstones - fatty liver - sacroiliitis
What is irratable bowel syndrom and what will the patient complain about?
-Abdominal pain -Intermittent abdominal pain cramping -Abdominal pain that is relieved by defacation
What are some risk factors for colon cancer?
-African American -Inflammatory Bowel Disease
How do you care for a patient in a cast?
-Always handle the cast with the palm of your hand -----Never get it wet -Never use fingers which can cause indentation. Indentation can cause patient to develop pressure sores.
What medication should you not give an asthma patient?
-Beta Blockers *ending in -olol
When a patient is on hormonal therapy for menopause, some of the side effects are
-Breast tenderness -Risk for developing cancer
When you suspect a patient comes in with pneumonia, what should you do?
-Collect a sputum culture or blood culture -Identify the causative bacteria to choose correct antibiotic
What are some of the findings of an elderly that comes in with pneumonia?
-Confusion,shortnessofbreath
A patient with Ulcerative colitis can become dehydrated. What manifestations can you expect?
-Dry skin -Dry mucous membranes -Sul
Once a patient has been diagnosed with pelvic inflammatory disease and treated, what should you do?
-Encourage patient to take full dose of antibiotic and complete therapy. -Pt must follow up with physician 2-3 days after to ensure treatment is effective
Male patients who have chlamydia, what signs and symptoms will be presented?
-Epididymis -Proxitis
What is asthma?
-It is bronchoconstriction of the bronchioles in which patient will experience wheezing
What are some signs and symptoms/early manifestations of Menopause?
-Night sweats -Urinary retention
HPV virus can also lead to
-Ovarian cancer and cervical cancer -Genital warts
What is peptic ulcer and where does a patient experience pain?
-Pain in the upper epigastric area. -organisms secrete ammonia to neutralize the acid environment
Why are STD's spread?
-People are not using condoms -people are using oral contraceptives and feel they do not need to use protection
A nurse is caring for a client who is 1 day postoperative following a mastectomy. Which of the following exercises should the nurse assist the client to perform on the affected side?
-Squeezing a rolled wash cloth -Flexing and extending her hand -Flexing and extending her elbow
What client teaching should you provide to a patient with COPD?
-Teach pt to do purssed lip breathing exercises -Give no more than 2L of oxygen -Always assessing respiratory status
What labs should we look at on a patient with Crohn's Disease and Ulcerative Colitis?
-WBC -ESR - Erythrocyte Sedimentary rate elevated *represents there is an infection
When you assess a patient with a partial bowel obstruction, you will note
-a visible paristalsis wave upon auscultation -high-pitched bowel sounds
How many stools does a patient with ulcerative colitis have?
15-20
How many stools does a patient with Crohn's disease have?
5-6
A nurse is preparing to administer cefazolin IVPB over 20 min. Available is cefazolin 1 g in 100 ml of dextrose 5% in water D5W. The drop factor of the manual IV tubing is 15 gtt/ml. The nurse should set the IV infusion to deliver how many gtt/min. (round to whole number)
75 gtt/min
What is GERD?
Gastroesophageal reflux disease. Flow of gastric secretions up into esophagus. Weakened lower esophageal pressure or increased intraabdominal pressure
Chlamydia
A sexually transmitted disease, both parties must get treated
A nurse is caring for an older adult client who has a fractured hip and will require rehabilitative care. The client's family asks the nurse for information about this type of care. Which of the following explanations should the nurse provide? A. This service began with the client's admission to the hospital B. This service focuses on teaching the primary caregiver to meet the client's needs. C. The emphasis is on the clients complete recovery from the illness to the injury D. Services are centered in long-term care facilities
A. This service began with the client's admission to the hospital
What types of medication will the patient take if he/she has genital herpes?
Acyclovir
What are the malignant tumors?
Adenocarcinomas Carcinomas Sarcomas
What are the benign tumors?
Adenoma Osteoma Papillomas
What is the priority nursing action for a patient in status asthmaticus?
Administer a short-acting beta 2 antagonist
A nurse is preparing a client who is receiving chemotherapy for treatment of ovarian cancer. Which of the following actions should the nurse plan to take
Administer an antiemetic prior to the procedure
A nurse is caring for a child who has asthma and a prescription for montelukast granules. Which of the following instructions should the nurse provide the client's parent on administering the medication.
Administer the medication 2hr before exercise.
When is the best time to perform a breat self-examination?
After period, perform in the shower.
A nurse is providing teaching to a client who has had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for uterine cancer. Which of the following instructions should the nurse include in the teaching? A Papanicolaou (Pap) test should be performed every 6 months. Artificial lubrication can be used to treat vaginal itching and dryness. Increased vaginal drainage typically occurs 5 days following surgery. Resume sexual intercourse in 2 to 3 weeks
Artificial lubrication can be used to treat vaginal itching and dryness.
What complication would you monitor for in a patient with GERD?
Aspiration
A home health nurse visits a client who has COPD and receives oxygen at 2L/min via nasal cannula. The client reports difficulty breathing. Which of the following actions is the nurse's priority?
Assess the client's respiratory status
What are BRCA genes?
Genes identified in family history, which can be passed down to daughters who may be at risk to get breast cancer.
Medication prescribed to patient with asthma?
Beclomethasone; inhaled medication
How is HIV trasmitted?
Bodily fluids, secretions and blood
What are some causes of osteoporosis? What can patients be at risk for?
Bone reabsorption due to the loss of calcium Frequent fractures Medications like thyroid hormone which can lead to developing osteoporosis
With Chlamydia, do you have to treat the male or female?
Both partners
What are the most common cancers in female patients?
Breast cancer Lung and bronchus Colon and rectum Corpus and uterus Thyroid
How do you confirm that a patient has AIDS vs HIV?
CD4+ count is less than 200
The nurse is caring for a client how has heart failure and a history of asthma. The nurse reviews the providers orders and recognizes that clarification is needed for which of the following medications?
Carvedilol
If a female patient has gonorrhea, what test do we use to diagnose?
Cervical specimen for Enzyme immunoacid test
If tumor is operable, the physican will take it out. Otherwise, if inoperable, what treatment will the patient undergo?
Chemotherapy, radiation
The nurse is caring for a client who is 4 days postoperative following a right radical mastectomy. Which activity should the nurse anticipate as being the most difficult at this time?
Combing her hair
A nurse in the emergency department is assessing an older adult client who has a community-acquired pneumonia. Which of the following findings should the nurse expect?
Confusion
How would we know that a patients appendix has perforated?
Decreased pain. Pain will suddenly stop
What is the most common cause of peptic ulcers?
H. pylori
What patient teaching should you provide a patient with Lupus?
Do not do things that will exacerbate their symptoms like sun exposure
A nurse is caring for a middle adult female who reports that her menstrual periods have become irregular and she has been having hot flashes. The nurse should expect the client to have which of the following manifestations associated with early menopause?
Dryness with intercourse
A patient is admitted and we suspect the patient has osteoporosis. What are some of the tests/diagnostic procedures that we would perform? What is a common examination done for patients with osteoporosis?
Dual energy x-ray assay, used to screen for osteoporosis.
Which diagnositc procedure is done FIRST to test for HIV?
ELISA test
Who is mostly at risk for Osteoarthritis?
Elderly people, or people who experienced trauma to an joints or area (athletes, or people in labor force).
Which virus that young people get that can lead to them getting cervical cancer?
HPV virus
What patient teaching should you provide a patient with HIV/AIDS?
Encourage patient to eat well (dietary needs) and exercise to build up their immune system
What are some risk factors for cancer?
Exposure to carcinogenics (pt works at a factory with chemicals/carcinogenic materials) First generation family history of cancer Immunal influence Smoking
When patient develops a malignant tumor, what process takes place? Cancers are carcinogenics. What does carcinogenics do?
Inhibit/supress apoptosis. Stops process from taking place.
What joints are most affected with Osteoarthritis?
Knees, hips, and feet, hands, lower back, neck
What kind of therapy do we use for pre-menopausal and menopausal women?
Hormonal replacement therapy
A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both my nebulizer. Which of the following statements by the client indicates a need for further teaching?
I will be sure to take the albuterol before taking the cromolyn.
What is osteoporosis and what causes it?
It is the deterioration of bone tissue and bone density. Loss of calcium in the bones which leads to osteoporosis.
Descirbe the features of a malignant tumor
Irregular borders Looks different
If the patient was diagnosed with breast cancer, what is one of the biggest concerns?
Is whether it has spread to other organs via the lymphatic system using a breast tissue. If negative, then it did not spread. Once it metastasize, it travels via the blood stream through lymphatic system, to a closer organ.
What is a adenoma tumor?
It is a benign tumor of glandular epithelial tissue
What is a Adenocarcinoma tumor?
It is a malignant tumor of glandular epithelial tissue
What is Rheumatoid arthirtis?
It is the destruction of the tissue between the cartilage and the sub- bone. With Rheumatoid Arthritis, there is permanent disability. A patient will develop inflammation at the site where the ligament insert into the bone.
What are some assessment findings of osteoporosis?
Lose height Kyphosis Hump/hunch appearance to upper back
What is Lupus and is there a cure?
Lupus is an autoimmune disease, there is NO cure. You treat the symptoms, not the disease itself
What are the most common cancers in male patients?
Prostate Lung and Bronchus Colon and Rectum Urinary bladder Melanoma of the skin
What is the difference between malignancy and benign in cancer?
Malignancy is undifferentiated tends to be deadly and spreads to the lymphatic system and then to other organs. CAN replicate. Benign is well differentiated, and loses the ability to control cell replication, does not spread. Still dangerous to patient and can grow within area. Cansupress and cause destruction to surrounding organ.
Which tumors metastasize?
Malignant tumors
A patient who has a bowel obstruction, what are they at risk for?
Metabolic alkosis
Who is at risk for colon cancer?
Most curable cancer if it is discovered on time.
We suspect a patient as breast cancer, what will the physician do to confirm this?
Needle biopsy and send it to the lab
Stage IV cancer means?
Negative outcome, treatment may be irreversible.
Does genital herpes every go away?
No, they lay dormant. At times, warts itself may not be active. But once they are inflammed, they become contagious and can spread to others
A nurse is implementing a plan of care for a client who has AIDS with reoccuring pneumonia. Which of the following actions should the nurse take?
Obtain a sputum culture
An assistive personnel (AP) reports to the nurse that a client who is 3 days postoperative following an abdominal hysterectomy has a dressing that is saturated with blood. Which of the following tasks should the nurse delgate to the AP?
Obtain vital signs
A nurse is assessing a client who is being admitted from the PACU following an abdominal hysterectomy. Which of the following assessments is the nurses' priority?
Oxygen saturation *to determine adequate gas exchange
How do we diagnose cervical cancer on female patients?
Papanicolaou smear (pap smear)
Patients with osteoporosis get what kind of fracture?
Pathologic fracture
What do Rheumatoid Arthritis and osteoarthritis have in common?
Patients will always have pain.
What is the drug of choice for syphilis?
Penicillin
When a patient is in a cast, what is a priority and what should you perform on the patient FIRST?
Perform a neurovascular check/assessment. You always want to ensure circulation. If breathing/airway clearance is a choice, then airway is always priority, otherwise its neurovascular check.
Stage 1 Cancer means?
Positive outcome, the treatment can be effective and is possible
If a patient has early bronchitis and you listen to the patient's lungs, what sound would you hear?
Resonance
Which disease has permanent deformity/disability? Rheumatoid arthritis or osteoarthirtis?
Rheumatoid arthirits
What is the drug of choice and leng of time for tuberculosis (TB)?
Rifampin
A nurse is teaching a client about risk factors for osteoporosis. Which of the following factors should the nurse include in the teaching?
Sedentary lifestyle Aging Caffeine intake Secondhand smoke
When a patient is on an antibiotic and experience a reaction/anaphylaxis, what should you do?
Stop immediately and notify the HCP
We should always teach a patient with bronchitis to
Stop smoking
What is apoptosis?
The body's ability to rid itself from unwanted cells or invaded organism in the body.A form of programmed cell death to eliminate unwanted cells
With Rheumatoid, what clinical manifestations do you see?
There is symmetrical joint swelling in 3 or more joints. Experience morning stiffness for the first 30 minutes in the morning.
What should you monitor in a patient that is taking rifampin for TB?
Urine color will be red
If a patient has syphilis, what test is done to confirm this diagnosis?
VBRL; if positive, it means the patient has had it in the past
What lab would you monitor for in a patient with appendicitis and how much would it be?
WBC will be elevated; greater than 10,000
What patient teaching do we provide regarding Mammograms?
We encourage patients to get mammograms as they age and reach 40's-60's. Along with breast self-examination
We know that the older the client gets, the higher risk they're at for developing osteoporosis. What should the patient do to assist with osteoporosis?
Weight-bearing exercises.
Which diagnositc test is done to confirm HIV?
Western Blot
When would a patient develop osteoarthritis?
When there is a constant pressure or force within the joints that results in the decrease of synovial fluid. This causes pain
Gonorrhea can affect
Womens fertility
Who is at risk for pelvic inflammatory disease, and what is the treatment?
Young adults; oral antibiotics
community acquired pneumonia
a type of pneumonia that results from contagious infection outside of a hospital or clinic
What are clinical manifestations of Lupus?
butterfly rash (back of hands, sun exposed areas and face), fatigue, fever, joint arthralgia/arthritis/synovitis, hemolytic anemia, leukopenia, thrombocytopenia, pericarditis, myocarditis, pleurisy, raynaud's nephritis, psychosis, seizure, pleuritits, profuse proteinuria
What is appendicitis?
inflammation of the appendix
What is bronchitis?
inflammation of the bronchioles
What are the signs and symptoms of genital herpes?
influenza-like symptoms (flu-like)
What is a carcinoma?
malignant tumor of epithelial tissue
