MTC NUR 157 Med Surg Final Exam

Does the following indicate PAD or PVD? Dependent rubor.

PAD

Does the following indicate PAD or PVD? Leg pain when walking that is relieved by rest.

PAD

Does the following indicate PAD or PVD? Loss of hair.

PAD

Does the following indicate PAD or PVD? Pain is relieved in dependent position.

PAD

Does the following indicate PAD or PVD? Paresthesia

PAD

Does the following indicate PAD or PVD? Skin is cool/cold to the touch.

PAD

Does the following indicate PAD or PVD? Thickened brittle nails.

PAD

Does the following indicate PAD or PVD? Aching pain.

PVD

Does the following indicate PAD or PVD? Brown pigmentation of the legs.

PVD

Does the following indicate PAD or PVD? Edema around ankles.

PVD

Tissue damage as a result of PAD is related to which of the following? (Select all that apply). A. Extent of the arterial blockage. B. Length of time there is decreased blood flow. C. Location of the arterial blockage. D. Venous circulation.

A, B, C.

A nurse caring for a patient undergoing nasogastric suction would correctly assess for which complications? (Select All That Apply). A.Hypokalemia B.Fluid Volume Deficiency C.Respiratory Alkalosis D.Metabolic Acidosis E.Metabolic Alkalosis F.Hyperkalemia G.Increased fluid accumulation

A, B, E. Active loss of gastric acid through NG suction or vomiting can result in metabolic alkalosis, hypokalemia, and fluid volume deficits.

Fluid for blood loss

Isotonic solution

Abnormal EKG?

Look at pt potassium

Left sided heart failure

(Left=Lung edema) Pulmonary edema, crackles, pink frothy sputum, s3 heart sounds, cyanosis from impaired gas exchange.

Right sided heart failure

(Right=Rest of body edema) Swelling in feet, JVD, ascites, hepatomegaly.

ACE inhibitor

-"pril" promote vasodilation & diuresis, ultimately decreasing afterload & preload; blocks conversion of angiotensin I to angiotensin II

ARB

-"sartan" angiotensin receptor blocker, blocks vasoconstriction. Taken if pt can't take an ACE inhibitor because of dry cough, hyperkalemia, or angioedema.

Specific gravity of urine

1.005-1.030. Higher=dryer. Indicates hydration status.

COPD (chronic obstructive pulmonary disease)

A group of lung diseases that block airflow and make it difficult to breathe. Caused from smoking. Two types: emphysema and chronic bronchitis.

chronic bronchitis

Blue bloaters: a condition in which the bronchi in the lungs are constantly inflamed (constricted) and clogged with mucus. Cyanotic.

PUD treatment

Discontinue NSAIDs. Antibiotics to treat H. Pylori Bismuth salts to suppress H. Pylori PPI reduces stomach acid -"prazole" H2 blockers for ulcer healing -"tidine" (don't take with antacids)

Examples of what to give a pt who is hypoglycemic

FAST 15, 15 g of carbs. 1 slice of bread, 8 oz skim milk, mouth full of cake frosting, 5 life savors, 4 oz OJ. Recheck BG after 15 mins.

cholelithiasis

Gallstones from solid bile, more prevalent with age, pigment stones cannot be passed (remove surgically), cholesterol stones can be passed, mild to no symptoms- vague RUQ pain, changes in urine and stool color, jaundice, vitamin deficiency.

5% Dextrose in water (D5W)

HYPOTONIC when infused. Not good for pt with low electrolytes (because it doesn't contain any) and is not going to help low BP, will make it worse.

Ejection Fraction (EF)

How much blood a ventricle can eject with one contraction. Normal range is 55-65%. If below 40%, pt will be put on an ACE inhibitor.

Diet for diabetic pts

50% carbs, 30% fat, and 20% protein (give or take 10%). 45-75g (3-5 units) carbs for meals. Complex carbs are best. Starches such as pasta, rice, potatoes, corn, etc. Low fat, high carb. Encourage fiber to break down carbs.

What are the 6 P's that are assessed for after femoral-popliteal bypass surgery in relation to arterial flow and lack of oxygenation to the tissues?

1. Pain 2. Pallor 3. Paresthesia (pins & needles) 4. Pulselessness 5. Paralysis 6. Poikilothermia (inability to regulate temperature)

High BUN?

Indicates dehydration. Give Isotonic to maintain vasculature.

TB treatment

RIPE Rifampin- (kills bacteria) decreases effectiveness of BC, increases sun sensitivity, body fluids turn orange Isoniazid- (stops growth of bacteria) decreases B6 levels, monitor liver function, tingling in extremities (zzz) Pyrazinamide- (kills bacteria) monitor liver and kidney function (urrrric acid), GI upset Ethambutol- (stops reproduction of bacteria) vision changes

Dumping syndrome

Rapid emptying of gastric contents into small intestines. Usually after gastric resection. Client experience ab pain, nausea, vomiting, explosive diarrhea, diaphoresis, hypotension, hypoglycemia, palpitations & tachycardia. Instruct pt not to drink until an hour after meal, lie down for an hour after meal, avoid food high in salt, sugar, or liquid. Recommend 5 small meals.

Treatment for Anemia

Reverse whatever it was caused by.

Electrolyte to look at for water problem

Sodium

High Creatinine?

Specific to kidneys. Give Isotonic fluids to help excrete whatever is too much.

TB diagnosis

Sputum culture for acid fast bacilli confirms diagnosis (taken before administering PO meds, rinse mouth first) Mantoux test Chest xray will show lesions

Ostomies

Surgically created opening on the surface of the body. Examine for swelling (slight edema from surgical manipulation is normal), color (a healthy stoma is red or pink), discharge (a small amount of oozing is normal), bleeding (an abnormal sign if bright red or beyond trace amounts).

Trousseau's sign

T=Thumb A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.

skeletal traction

The most effective means of traction, applying to a bone with wire pins or tongs. It is important to check pin sites for infection.

Hematocrit low?

Too much water, not enough RBCs.

PVD

elevate legs above heart level

What to give an unconscious hypoglycemic pt

glucose gel, shot of glucagon, or 50 mL D50

PAD

keep legs below heart level

Diet for pt in HF

low sodium, chicken instead of red meat, no can foods, no soup, no processed foods.

TURP

transurethral resection of the prostate gland. for BPH.

A walking program to build collateral arterial circulation in the legs is advised only for patients with: a. severe pain at rest b. venous ulcers c. gangrene d. intermittent claudication

D

A complication that can result from severe PAD includes which of the following? (Select all the apply). A. Gangrene B. Varicose veins C. Septicemia D. Amputation

A, C, D.

The nurse is preparing to discharge a patient who has a new prescription for Torsemide. Which of these discharge instructions should be included in the patient's teaching? (Select All That Apply). A.Report weakness to your physician immediately B.Please increase your intake of dairy products C.You will need to increase your intake of fresh fruits and vegetables D.You should take this medication with your evening meal E.This drug may cause heart palpitations which should be reported

A, C, E. Torsemide, a loop diuretic, causes renal excretion of potassium. This may result in weakness and heart palpitations which should be immediately reported to the physician. The patient should also be instructed to eat fresh fruits and vegetables to replenish potassium.

Which of the following best demonstrates a patient's fluid status? A.Hematocrit B.Intake/Output C.Blood Pressure D. Skin Turgor

A. The serum hematocrit and urine specific gravity are both very reliable is determining fluid status because they show a measurement of solvent/solute. I/O, VS, and skin turgor may indicate fluid status but are less reliable and more likely to change because of other variables.

Relationship between Phosphorus and Calcium

ANTAGONISTS. Hyperphosphatemia=hypocalcemia. Hypophosphatemia=hypercalcemia.

BNP

Above 100 could indicate heart failure (HF).

Magnesium and Calcium

Act as sedatives when too high (muscle relaxants). Act as stimulants when too low (twitches and spasms).

Differentiate between atherosclerosis and arteriosclerosis.

Atherosclerosis- accumulation of plaque in the lining of the intimal artery. Arteriosclerosis- hardening of the arteries.

You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless shelter and is a vague historian. The patient appears malnourished and on day 3 of the patient's admission total parenteral nutrition (TPN) has been started. Why would you know to start the infusion of TPN slowly? A) Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly. B) Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively. C) Malnourished patients who receive fluids too rapidly are at risk for hypernatremia. D) Patients receiving TPN need a slow initiation of treatment in order to allow digestive enzymes to accumulate.

B

Place the sequence of the development of atherosclerosis in the correct order. A. Fibrous plaque develops. B. Intimal layer of the artery is injured. C. Calcification, thrombosis, ulceration of fibrous lesions. D. Deposit of fatty streak on intimal layer.

B, D, A, C.

A client is receiving monthly doses of chemotherapy for treatment of stage III colon cancer. Which laboratory results should the nurse report to the oncologist before the next dose of chemotherapy is administered? Select all that apply. A.Hemoglobin 14.5 g/dL B.Platelet count 40,000/mm³ C.Blood urea nitrogen 12 mg/dL D.WBC 2.3 X 10 g/L E.Temperature 101.2 ̊ F F.Urine specific gravity 1.02

B, D, E. Chemotherapy causes bone marrow suppression and risk of infection. A platelet count of 40,000 and a WBC of 2.3 are low. A temperature of 101.2 is high and could indicate an infection. Further assessment and examination should be performed to rule out infection. The BUN, HGB, and specific gravity values are normal.

A 22 year old woman who is 12 weeks pregnant is admitted with intractable (unrelieved) vomiting. Which of the following treatments are priorities in this patient's care? (Select all that apply). A.Reassuring her that everything will be okay B.Reviewing electrolyte levels C.Administering D51/2 Normal Saline D.Encouraging intake of oral fluids E.Administering 0.9% Normal Saline

B, E. Excessive vomiting in this patient depletes potassium and fluids. Assessments would include reviewing electrolyte levels and hydration status. Appropriate interventions would include restoring isotonic fluids intravenously.

The triage nurse is assessing a patient who has come to the emergency room stating that he feels like he is having a heart attack. He is anxious even though EKG readings are normal indicating that he is not having a heart attack. The arterial blood gas findings include pH 7.48, PaO2 110, PaCO2 25, HCO3 24. The nurse would anticipate which initial intervention to correct this problem? A. Administer oxygen through a simple mask. B. Encourage the patient to inhale and exhale slowly into a paper bag. C. Prepare to start normal saline intravenously. D. Anticipate the administration of intravenous sodium bicarbonate.

B. This patient is suffering from hyperventilation resulting in loss of carbon dioxide leading to respiratory alkalosis. To replenish carbon dioxide and decrease the pH, the patient should use a paper bag to rebreathe his own exhaled CO2.

Parkinson's symptoms

Bradykinesia, resting tremor, small handwriting, poor speech, poor posture, rigid muscles, stoic expression (mask-like), shuffling gait, depression, dysphagia, decreased blinking. Rarely occurs in black population.

You are called to your patient's room by a family member who voices concern about the patient's status. On assessment, you find the patient tachypenic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this patient's signs and symptoms? A) Hypocalcemia B) Hyponatremia C) Hyperchloremia D) Hypophosphatemia

C. The signs and symptoms of hyperchloremia are the same as those of metabolic acidosis: hypervolemia and hypernatremia. Tachypnea; weakness; lethargy; deep, rapid respirations; diminished cognitive ability; and hypertension occur. If untreated, hyperchloremia can lead to a decrease in cardiac output, dysrhythmias, and coma.

Chovstek's sign

C=Cheek Sign of hypocalcemia or hypomagnesemia; abnormal functioning of the facial nerve causes a twitch on the same side of the face

Which of the following vital signs would alert the nurse to the development of hypermagnesmia? A.T-99.7 HR-144 RR-20 B/P-167/87 B.T-99.0 HR-110 RR-18 B/P-98/52 C.T-98.6 HR-88 RR-16 B/P-128/70 D.T-97.8 HR-68 RR-12 B/P-104/62

D. Excess magnesium results in an overall sedative effect, lowering the respiratory rate, heart rate and blood pressure.

Fluid for high pulse and low blood pressure

Isotonic IV. After you stabilize vasculature, then you give hypotonic.

Anemia in chronic kidney disease

Labs will indicate if kidneys were the cause. Treat with synthetic form of erythropoietin.

furosemide

Lasix. Diuretic. Lowers potassium level. Given to pull fluid off of HF.

diet for gallbladder disease

Low fat (no fried food), no gas forming veggies. Diet after episode is low fat liquids.

Hematocrit high?

Not enough water. Indicates dehydration.

Does the following indicate PAD or PVD? Decreased peripheral pulses

PAD

Does the following indicate PAD or PVD? Pain occurs in distal portion of extremity.

PAD

Does the following indicate PAD or PVD? Elevation helps relieve discomfort.

PVD

Does the following indicate PAD or PVD? Neurologic assessment intact in legs.

PVD

Does the following indicate PAD or PVD? Skin color is pale, dusky, and mottled.

PVD

Intermittent Claudication

Pain in the leg muscles that occurs during exercise and is relieved by rest. Trental (pentoxifylline)- antiplatelet, vasodilator, antiinflammatory. Pletal (cilostazol)- antiplatelet, vasodilator. AVOID GRAPEFRUIT.

Emphysema

Pink puffers: hyperinflation of air sacs with destruction of alveolar walls (lose elasticity). Barrel chest.

What medication causes a concern for diabetics?

The use of BETA BLOCKERS (-"lol") in diabetics can decrease the symptoms of hypoglycemia which could put the patient at risk for hypoglycemic coma or "insulin shock."

Hypertension in pregnancy

Treated with magnesium

When to not give lactated ringers (LR)

When the pt has elevated electrolytes. LR contains electrolytes so this would be contraindicated.

Neutropenia

abnormally low neutrophil count. Precautions: NO fresh fruit or veggies, NO flowers.

CBI

continuous bladder irrigation. after TURP to prevent clots.

Low H&H

could indicate a bleed NOT an increased risk for bleeding.

Hypertension (HTN)

no signs/symptoms, silent killer. Complications: stroke, kidney failure, heart attack (MI), vision problems (including blindness). 120/80 is normal BP.

skin traction

pulling mechanisms are attached to skin. This is a COMFORT MEASURE to reduce muscle spasms. Don't need to monitor for infection.

Upper GI Bleed

tarry/dark stool (melena), bright red or dark coffee ground vomitus appearance, dizziness or fainting. Look at H&H to evaluate extent of loss. VS: low BP, high HR, high RR, pale, low urine output.

Uses for sodium bicarbonate IV

to treat acidosis, prevent acidosis (tumor lysis syndrome), or if pt has kidney dysfunction. Giving this IV for anything besides these problems will result is alkalosis.

PUD: Duodenal

ulcer of the intestine. Pain 2-4 hr after eating, eating relieves pain, wakes with pain at night. S/S: melena.

PUD: Gastric

ulcer of the stomach. Pain upon eating, weight loss. S/S: hemetomesis.