Med Surg/Peds Final
rentinal detatchment
"Flashing lights"
A client admitted to the medical-surgical unit with a venous thromboembolism (VTE) is started on intravenous heparin and warfarin (coumadin). The client asks the nurse why two medications are needed. Which response by the nurse is accurate?
"The Heparin will work immediately but the warfarin takes several days to achieve its full effect."
Kawasaki disease
(inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms. Red eyes, dry eyes, red mucousal membranes, swelling arms and feet, myocarditis Meds:IVGG, high dose aspirin, monitor I&Os, cardiac arrhythmias, no live immunizations!
Chest tube complications
-Air leak (continuous rapid bubbling in the water seal chamber) -No tidaling in water seal chamber
renal transplant rejection
-Fever > 100.0 -Pain or tenderness over site -Sudden weight gain: 2-3 lbs in 24 hrs -Edema -HTN -Malaise -Elevated BUN & Creatinine
Fat embolism
-Occurs with hip and pelvic fx (70-80 yos)usually within 48hrs following long bone fx or w/ total join arthoplasty
Which interventions are effective for a patient with the potential for pulmonary edema caused by heart failure:
-Sodium and fluid restriction -Administration of loop diuretics -Positioning in semi-fowlers to high-fowlers position
intussusception s/s
-Sudden onset of severe, intermittent abdominal pain -screaming and drawing up legs with periods of calm in between episodes -pain relieved once abdomen relaxes -currant jelly stools (blood and mucus) -sausage shaped mass in RUQ
urine microalbumin
-detects protein in urine -earliest sign of vascular damage to glomerulus in type 2 -indicates risk for cardiovascular disease
what happens if a infant doesn't pass meconium?
-the child is likely to develop Hirschburng Disease
The nurse on the medical unit assesses her patient's blood sugar at 0630 and finds it to be 156 mg/dl. The nurse follows the doctor's order correctional dose and gives the patient 5 units of Humalog (Lispro) insulin subcutaneous in the right thigh at 0730. The nurse should anticipate observing the patient for hypoglycemic reactions at?
0800 Humalog: Onset: less than 15 minutes Peak: 30-90 minutes Duration: 5 hours
Ankle-brachial index range
1-1.4 ratio of bp in legs to arms used to assess severity of PAD <1 indicates some degree of PAD
heart failure diagnosis
1. B-type (BNP) natriuretic peptide 2. CXR 3. Echocardiogram
A nurse is caring for a client with COPD. While reviewing breathing exercises, the nurse instructs the client to breathe in slowly through his nose, then pucker his lips as if preparing to whistle, and exhale slowly and gently through the puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals? Select all that apply.
1. Prevent airway collapse and 2. Control the rate and depth of respirations
A patient in the post anesthesia care unit has just regained consciousness after a right pneumonectomy. The nurse repositions the patient on their left side and the patient begins having difficulty breathing. The nurse knows:
1. The patient can be filling up with pulmonary fluid 2. The left lung expansion is compromised
Stage 3 CD4 count
200 & less
Stage 2 CD4 count
200-499
Down Syndrome (Trisomy 21)
3 copies of chromosome 21 has occurred instead of 2
normal t-tube drainage
300-500 mL 24hrs on first day - thick, blood tinged, bright yellow to dark green 4 days post op, less than 200 per day should be seen
Stage 1 CD4 count
500-600
Which data supports the presence of stage 1 HIV infection?
600 CD4 T cells, persistent generalized fatigue
CD4 T cells (helper T cells)
800-1000
heart failure BNP
<100 no HF 100-300 suggest HF present, > 300 is mild HF, >600 moderate >900 severe
thalessemia major
A child diagnosed with beta thalassemia presents with the classic findings of hyperbilirubinemia, splenomegaly, hepatomegaly, delayed growth and sexual maturation, and abnormal facial appearance. What category of the disease do these symptoms represent?
A patient admitted with signs and symptoms of wheezing, anxiety and a tight chest sensation was diagnosed with asthma exacerbation. The health care provider has ordered a pulmonary function test to be performed. The nurse anticipates the pulmonary function test results show:
A decrease in FEV1 and an increase post bronchodilator
After receiving the shift report, which client should the nurse on the medical unit assess first? A. The 84 year old client diagnosed with COPD who is afebrile and getting restless B. The 38 year old client diagnosed with emphysema who has an equal anterior posterior to transvers diameter ratio You Answered C. The 56 year old client diagnosed with left side hemothorax with tidaling in the water seal compartment of the chest tube system D. The 25 year old client diagnosed with influenza who is febrile and has a headache
A. The 84 year old client diagnosed with COPD who is afebrile and getting restless----indicates COPD exacerbation. Keyword: RESTLESS
The nurse is caring for a patient with end stage liver disease with a history of esophageal varices. The patient complains of nausea and vomiting and begins to have a bloody emesis. Which of the following doctor orders would the nurse question?
Administer 25 grams of albumin intravenously
A client being treated for HIV/AIDS has a decreased appetite, almost to the point of anorexia. What is the best action by the nurse?
Administer megestrol acetate (megace)
A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 65% for a patient with COPD. What stage should the nurse document the patient is in?
All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%.
The nurse is caring for a patient admitted for COPD with a history of DM type I, hypertension and chronic renal failure. The patient is placed on correctional Humalog (Lispro) and a p.m. Glargine (Lantus) insulin dose. The doctor has changed the dose of prednisone from daily to twice a day. Which of the following does the nurse anticipates during the therapy with prednisone?
An increased dose of Humalog (lispro) insulin Rationale: Need to increase insulin due to corticosteroids leading to higher glucose levels in the blood.
The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains preload to the student then asks the student which nursing intervention might cause increased preload. Which response by the student indicates understanding?
Application of antiembolic stockings Rationale: They cause back flow to the heart causing increased preload
The nurse is admitting a client with wasting syndrome secondary to acquired immune deficiency syndrome (AIDS). Which intervention should the nurse implement?
Assess the client's body weight and ask what the client has been able to eat
Renal failure labs
BUN and creatinine
Opportunistic infections in HIV
Bacterial Infections Mycobacterium TB (airborne precautions), bacterial PNA Kaposi's sarcoma, Burkitts lymphoma, squamous cell carcinoma cervical CA Viral Disease: Cytomegalovirus (eyes - leads to blindness), herpes simplex Virus (HSV Type 1oral & type 2 genital herpes) Varicella-Zoster Virus (shingles painful contagious rash contact precautions) Fungal Diseases Candidiasis (mouth, throat, vagina) cryptococcosis Neoformans (severe meningoencephalitis CNS with cerebral edema -> seizures & hydrocephalus), coccidiomycosis (valley fever) Pneumocystis jiroveci (carini) pneumonia-PCP (dyspnea crackles) Protozoa Toxoplasmosis: brain - speech, gate, vision, confusion, seizures Cryptosporidiosis: (GI -N/V diarrhea, fluid & lyte imbalance)
While the nurse is talking with the postoperative thoracic surgery client, the client coughs and the chest tube collection water seal chamber bubbles. What does the nurse do?
Calmly continues talking
rheumatic fever
Caused by GABHS, ASO titered levels elevated & ERCP. Major: carditis, subcutaneous nodules, Minor: fever, arthalgia Admin Antibiotics
If untreated, the person with Cryptococcosis Neoformans infection is at increased risk for:
Cerebral edema, convulsions, or hydrocephalus
The night shift nurse is listening to report and one of his assigned patients has paroxysmal nocturnal dyspnea. What does the nurse plan?
Check on the patient several hours after bedtime and assist the patient to sit upright and dangle the feet when dyspnea occurs
When developing a plan of care for the person experiencing acute heart failure, it is important for the nurse to include which nursing diagnosis?
Decreased cardiac output related to ineffective pump
A client is admitted to the emergency room in a comatose state with the diagnosis of diabetic ketoacidosis (DKA). Which findings would the nurse expect to note confirming this diagnosis?
Deep respirations and a decrease in the pH level, An elevated anion gap
The nurse is providing care for a client who is 24 hours post cholecystectomy. The nurse notes the T tube has drained 750 mLs of greenish brown drainage since the surgery. Which nursing intervention is appropriate at this time?
Document the findings
The nurse cares for a client with gallstones that need to be removed but is not a surgical candidate or endoscopic candidate. What procedure does the nurse recognize as being a possible treatment option for the client?
ESWL
Stage 4 CD4 count
FULL BLOWN AIDS
A client with end-stage acquired immunodeficiency syndrome (AIDS) has profound manifestations of Cryptosporidium infection caused by the protozoa. What client need should the nurse focus on when planning this client's care?
Fluid Replacement
Providing postoperative care to a patient who has percutaneous transluminal angioplasty (PTA) with insertion of a stent for a femoral artery lesion includes assessment for the most serious complication of:
Hemmorhage!
The nurse is participating in a health screening clinic and is preparing teaching material related to colorectal cancer. The nurse includes which of the following in a list of risk factors for colorectal cancer?
History of ulcerative colitis and polyps
A client in the emergency room has a 5-cm thoracic aortic aneurysm discovered on a routine chest x-ray. When obtaining the client's history, which symptoms will it be most important for the nurse to inquire about?
Hoarse voice and difficulty swallowing
An ailing 70-year-old woman with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. The client's intake has been very poor, has a dry parched mouth, warm dry skin, urinating frequently, and is lethargic. She is admitted to the hospital for observation and management as needed. What is occurring with this patient?
Hyperglycemic hyperosmolar non-ketotic syndrome.
While assessing a client, the nurse notes the client's ankle-brachial index (ABI) of the right leg is 0.40 How should the nurse best follow-up with this assessment finding?
Implement interventions relevant to arterial narrowing.
mild dehydration
Infant 5% (50) Adolescent 3% (3) Dry mucous membranes, oliguria Pitfalls: Oral mucosa may be dry in chronic mouth breathers. Frequency and amount of urine are difficult to assess during diarrhea, esp with infants wearing diapers
A client is being treated for acute congestive heart failure with IV furosemide (Lasix). The vital signs are as follows: B/P 100/60 mm Hg, pulse 96 bpm, and respirations 24/min. After the initial dose, which of the following is a priority?
Monitoring blood pressure
The nurse suspects that a patient with diabetes has developed proliferative retinopathy. The nurse confirms this by the presence of which of the following diagnostic signs?
Neovascularization and hemorrhage in the vitreous humor
The nurse is assessing the neurovascular status of her client who returned to the surgical unit 2 hours after undergoing aortoiliac bypass graft. The surgical leg is warm, and the nurse notes redness and edema along the surgical site. The pedal pulses are palpable and equal. The nurse interprets the neurovascular status as:
Normal because of increased blood flow through the leg
A client with AIDS is having a recurrence of 10 to 12 loose stools a day. What medication may help this client control the chronic diarrhea?
Octreotide (Sandostatin)
Fat embolism syndrome s/s:
Petechiae, dyspnea, mental status changes
The client admitted on the medical floor is diagnosed with COPD. The nurse assesses the patient who is complaining of a headache, is irritable, and confused. The nurse expects the arterial blood gas results to be:
Ph 7.28 PaCO2 56 HCO3 29 PaO2 76
The client diagnosed with pneumocystis carinii (jiroveci) pneumonia (PCP) is being admitted to the intensive care unit. Which health care provider order should the nurse questions?
Place the client in respiratory isolation
The nurse is caring for a client who has been admitted for the treatment of AIDS. In the morning, the client tells the nurse that he experienced night sweats and recently "coughed up some blood." What is the nurse's most appropriate action?
Place the client on respiratory isolation and inform the physician.
A client is treated for gastrointestinal problems related to chronic cholecystitis. What pathophysiological process related to cholecystitis does the nurse understand is the reason behind the client's GI problems?
Rationale: Reduced or absent bile as a result of obstruction impacts digestion
A 56 yr old male patient has had a right pneumonectomy and is repeatedly refusing to do his breathing and arm exercises due to the extreme pain on the right side. What should the nurse include on the patient's plan of care to promote compliance with the rehabilitation regime?
Schedule the patient's exercises 30 minutes after his IVP pain medication. Rationale: Pain needs to be addressed first!
compartment syndrome
Serious complication- Occurs from increased pressure in a confined space- Compromises blood flow - Ischemia and irreversible damage can occur within hours ■ Dx: Clinical assessment of 6 Ps; pain is the early indicator■ Treatment: Notify physician, cast may be removed, and emergency fasciotomy may be necessary
Pelvic infection is most commonly caused by which of the following?
Sexual transmission
Octreotide (Sandostatin)
Somatostatin analog - reduces GI hormone secretion, intestinal & pancreatic fluids, ant pituitary hormones, and slows motility. Tx: Severe diarrhea in ppl w endocrine tumors, *shortened bowel syndrome, and AIDS pts.* 45x > potent on inh GH, but only 2x on insulin. 80 min half-life. SE: gall stones, brady, B12 deficiency
complete compensation
The unmatched value is out of normal range BUT the pH is in normal range.
A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient continues to have bleeding. The nurse prepares the patient for which procedure to lower portal pressure?
Transjugular intrahepatic portosystemic shunting (TIPS)
A 48-year-old male patient complaining of frequent urination and increased thirst is visiting his primary care physician. The physician suspected DM type II. The physician ordered which lab value to assist in early identification of diabetic nephropathy?
Urine microalbumin
The nurse is caring for a 26 year old female client diagnosed with a past medical history of Crohn's disease and is now admitted with an acute exacerbation and fistula creation. The nurse reviews her mterm-100edications and concludes that the following medications are for the treatment of acute Crohn's with complications:
You are correct the medications are: metronidazole (Flagyl) and glucocorticoid (Prednisone)
Crepitus
a crackling or grating sound usually of bones
Hyperosmolar Hyperglycemic Syndrome (HHS)
a life threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion. glucose: 800mg/dL ketones: negative s/s: dehydration, ALTERED mental status Ph: >7.4 poor fluid intake, occurs secondary to infection
Crytococcus neoformans precautions
airborne precautions
Megestrol acetate MOA?
appetite stimulant
A client in her 30's has two young children and has just had a modified radical mastectomy with immediate reconstruction. The client shares with the nurse that she is somewhat worried about her future, but she appears to be adjusting well overall to her diagnosis and surgery.What nursing intervention is most appropriate to support this client's coping?
arrange a referral to a community based support group
A patient has informed the home health nurse that she has recently noticed distortions when she looks ant the Amsler grid that she has mounted on her refrigerator. What is the nurse's most appropriate action?
arrange for the patient to be assessed macular degeneration
Legge Calve Perthes disease is ___________________ of the femoral head?
avascular necrosis
severe dehydration
cap over 4 sec tachycardia extreme thirst dry membranes tenting no tearing sunken eyes olig/anuria
The nurse is caring for a client experiencing hearing loss. The nurse uses the otoscope to assess the ear canal tympanic membrane and notes a significant accumulation of cerumen. Which documentation of hearing loss type would be most accurate?
cerumen
what is the treatment for compartment syndrome?
contact the provider, emergency fasciotomy!
the main refracting area of the eye
cornea
The nurse is conducting a physical exam on an 18 month old with intussusception, which finding would the nurse identify as a sign of this condition?
currant jelly like stools
what does the barlow and ortani test measure?
developmental dyplasia of the hip DDH
FEV1/FVC ratio
dividing of value for FEV1 by value for FVC; useful in differentiation obstructive and restrictive pulmonary dysfunction
The nurse is preparing to post a sign above the crib of an infant with a wilms tumor. Which statement should the nurse post immediately?
do not palpate the abdomen
cerumen
ear wax
ESWL (extracorporeal shock wave lithotripsy)
electrohydraulic shock waves used to break apart calcifications in the urinary system
The nurse is assessing a child who is experiencing an acute splenic sequestration secondary to sickle cell disease. What treatment would be a priority ?
emergent transfusion
The nurse is conducting a physical exam of an infant with suspected pyloric stenosis, which finding indicates pyloric stenosis?
hard, moveable, " olive like mass" in the upper right quadrant area
Preterm infants have more fragile capillaries in the periventricular area than term infants. This puts these infants at risk for which problem?
intracranial hemorrhaging
creatinine clearance
measurement of the rate at which creatinine is cleared from the blood by the kidney
ABGs...ROME
pH 7.35- 7.45 HCO3 (Bicarbonate) normal values 22-26 mEq/L PaCO2 ( CO2 or carbon dioxide content) 35-45 mm Hg PaO2 (oxygen saturation in arteria blood)- 80-100 mm Hg
respiratory acidosis values
pH lower than 7.35 pCO2 higher than 45 HCO3 higher than 26
partial compensation
pH, CO2, and HCO3 are all off
Albumin
protein in blood; maintains the proper amount of water in the blood
A child is getting a diagnostic work up for nephrotic syndrome. Which lab results would the nurse expect to see?
proteinuria, hypoalbuminemia,and hypercholesterolemia
Meds that reduce afterload
reduce BP, reduce workload of heart, reduce O2 consumption ACEIs ARBs Vasodilators (nitrates, nitroprosside, alpha 1 blockers, CCBs)
hallus valgus
the great toe is angled away from the midline; toward the remaining toes
transjugular intrahepatic portosystemic shunt
the therapy for portal hypertension that involves the placement of a stent between the portal veins and hepatic veins to reduce portal systemic pressure
Cryptosporidium
transmitted via feces; causes waterborne illness
Meds that reduce preload
¨Diuretics: increase urine output, causing a decrease in blood volume return, reduces preload ¨Loop diuretics and thiazide needs K+ supplements or food high in K+
meds that decrease preload and afterload:
¨Vasodilators: Nitroglycerin dilates both arteries and veins and also increases oxygen supply. Reduce preload and afterload
pnuemectomy post op care:
•Position pt on back or operative side: surgeon preference •If operative side up, risk of bronchial stump leak down to unaffected lung -> filling of pulmonary fluid...possible decrease in lung expansion. •Access trachea daily for midline position •Positioning: •flat or HOB 20 degrees until B/P is stable. -> semi-fowlers with pillow not under shoulder and back d/t incision pain if posterolateral incision •TCDB: •q1hr x24 hrs -> q2-4 hrs to prevent atelectasis and facilitate lung expansion. Support incision with pillow, medicate & use huff coughing technique to move secretions •Arm exercises: •Prevent arm stiffness, Passive ROM 2-3x daily. Pre-medicate
colorectal cancer risk factors
■ History of FAMILIAL polyposis (multiple POLYPS on colon). ■ FIRST-degree RELATIVE with colon cancer. ■ CROHN's disease (ULCERATIVE colitis).
Med for ulcerative colitis and crohn's disease
■Antidiarrheal drugs: inhibit peristalsis. -Diphenoxylate hydrochloride with atropine sulfate (Lomotil) loperamide (Imodium): Aspirin-inhibits prostaglandins Corticcosteriods: reduces inflammation Immunosuppressants: "Sandimmune & Rheumatrex" Immunomodulators: "mab" reduces tumor necrosis--(Except mab IGg) for Crohn's
