MedSurg Final

A nurse is admitting a client who takes 40 mg first semi daily for heart failure and has experienced three days of vomiting. The nurses suspects hypokalemia. Which of the following medications should the nurse prepare to administer?

0.9% sodium chloride with 10mEq/L of potassium chloride at 100 mL/hr

A patient is to receive metoprolol 0.05 g PO daily. Each scored tablet contains 50 mg. How many tablets would the patient need to take?

1 tablet

A patient is to receive ranitidine 150mg BID via nasogastric tube. The medication is available as ranitidine 15mg/mL. How many milliliters does this nurse need to administer?

10mL

The nurse is caring for a client who has a sodium level of 15 5 AM is cute/L. Which of the following IV fluids of the nursing to speed the provider to prescribe?

0.45% sodium chloride

Leaders caring for a client who requires nasogastric suctioning. Which of the following sets of laboratory results indicates a client has metabolic alkalosis?

High pH, normal PaCO2, high HCO3

A nurse is assessing a client who has hypomagnesemia. Which of the following findings should the nurse expect?

Hyperactive deep tendon reflexes

GI bleeding assessment

If GI bleeding is found during an EGD, the physician can use clips, thermocoagulation, injection therapy, or a topical agent. GI bleeding is considered a medical emergency so a top priority.

While reviewing a client's laboratory results, a nurse notes a serum calcium level of 8.0 mg/dL. Which of the following actions should the nurse take?

Implement seizure precautions

NG tube suctioning and electrolyte imbalance

In gastroplasty procedures, the NG tube drains both the proximal pouch and the distal stomach. Closely monitor the tube for patency. NEVER REPOSITION THE LINE BECAUSE IT CAN DISRUPT THE LINE!!!! If the pt is passing flatus, remove it on the second day. Suctioning can cause hypokalemia!!!!

Pain control: acute pancreatitis

Includes fasting and rest, drug therapy, and comfort measures. NPO!!!! The provider prescribes IV isotonic fluid administration to maintain hydration. Monitor I & O.

Labs- Acute pancreatitis

Increases amylase levels. Lipase also helps determine the presence of acute pancreatitis. Increased serum trypsin and elastase. Increased serum glucose. Decreased calcium and magnesium. Elevated bilirubin, ALT, AST, and leukocyte count. Pg 1200

A nurse is caring for a client who is experiencing respiratory distress as a result of pulmonary edema. Which of the following actions should the nurse take first?

Initiate high flow oxygen therapy

EGD nursing assessments

Insertion of endoscope through the mouth into the esophagus, stomach, and duodenum to identify or treat areas of bleeding, dilate an esophageal stricture, and/or diagnose gastric lesions and celiac disease. Moderate sedation per IV access: topical anesthetic to suppress gag reflex, atropine to reduce secretions. Left side-lying with head of bed elevated. NPO 6 to 8 hours before the procedure.

Which of the following statements is true about the trade or brand name for a medication?

It may have several different names

Pancreatic cancer: features

Jaundice and related symptoms. Belly or back pain. Pain in the abdomen (belly) or back is common in pancreatic cancer, Weight loss, poor appetite, nausea, and vomiting, Gallbladder or liver enlargement, Blood clots, Diabetes

An older adult is in the hospital. The patient is ambulatory with no assistance needed. What intervention would be the most helpful in preventing falls in this patient?

Keep the light on in the bathroom at night

A nurse is reviewing the ABG results for four clients. Which of the following findings should the nurse identify as metabolic acidosis?

Low pH, normal PaCO2, low HCO3

Relieving enema pain

Lower the enema bag

A nurse answered the call light for a patient who is just admitted from the PACU. The patient stated there was a sudden gush of blood and the nurse notes the blood on the sheet. What action should the nurse take first?

Perform hand hygiene and apply gloves

A nurse is preparing a patient for discharge after surgery. The patient needs to change a large dressing and manage a drain at home. What instruction by the nurse is most important?

Perform hand hygiene and apply gloves

After teaching a patient to increase dietary potassium intake a nurse assesses the patients understanding. Which dietary selection indicates the patient understands the teaching?

Sausage, one slice of whole wheat toast, half a cup of raisins, and a glass of milk

A nurse is preparing to give a patient ketorolac (Toradol), and opioid, IV for pain. Which assessment finding would alert the nurse to contact the provider before administering the medication?

Urdu next output of 25mL in 3 hours

Assessment: stomach pain

inspect, auscultate, percuss, palpate; RUQ, LUQ, LLQ,RLQ OR if pain in one area, move from the following area, auscultating the area of pain last

Communicating with a nervous patient

keep them calm and explain what is wrong with them and why it is happening. Ask them why they are nervous and why they feel that way.

Pernicious anemia

lack of vitamin B12

Assessment jaundice

look for yellowing of the skin, light-colored stools, dark-colored urine, itching of the skin

Ulcerative colitis and anemia - the link

low iron levels can be caused by ulcerative colitis during flare-ups that cause bleeding. It can also cause problems with absorbing iron because of inflammation and diarrhea that is from ulcerative colitis.

Types of stool by colostomy placement

lower left side near sigmoid- more solid and regular, Ascending- liquid to semi liquid, Transverse- semifluid, descending-semiformed/solid Higher- watery stool Lower- formed stool

Post op paralytic ileus

obstipation and intolerance of oral intake after abdominal surgery

Diverticular disease: pain location

pain location- intermittent pain in the left lower quadrant. Large intestine.

Prevention of gastritis

quit smoking, manage and avoid stress, maintain a healthy weight, avoid alcohol and high in acid foods, avoid abusing OTC meds

Oral Cholangiogram

radiologic procedure for diagnosing gallstones. A cholangiogram is a special x-ray procedure that is done with contrast media to visualize the bile ducts after the cholecystectomy

New colostomy - concerns

sexual dysfunction and urinary incontinence, improper sitting, vascular compromise, retraction, peristomal skin irritation, altered self image

Pancreatitis -risk factors

tobacco use, being overweight, diabetes, chronic pancreatitis, age, gender, race, family history, diet, inactivity, coffee, alcohol, infections

Diet: diverticulitis

want high fiber foods; eggs and fish, milk, yogurt, and cheese, fruit juices

Fluid overload: findings

you find swelling (edema) in the feet, ankles, wrist, and face. S/S: cramping, headache, High Blood pressure, shortness of breath, and stomach bloating.

A nurse is teaching nutritional strategies to a client who has a low calcium level and an allergy to milk. Which of the following statements by the client indicates an understanding of the teaching?

" I will add broccoli and kale to my diet."

A nurse is providing teaching to a client who is at risk for developing respiratory acidosis following surgery. Which of the following statements by the client indicates an understanding of teaching?

" I will use the incentive spirometer every hour."

A nurse is giving a patient instruction for showering with a special antimicrobial soap the night before surgery. What instruction is best?

"Be sure to wash the area where you will have surgery very thoroughly."

A patient is being discharged from the hospital after surgery on hydrocodone/acetaminophen (Lortab). What discharge instructions are most important regarding the prevention of adverse effects related to this medication for this patient?

"Check and OTC medications for acetaminophen"

A nurse is caring for a patient with COPD who appears thin and disheveled. Which question should the nurse ask first regarding their appearance?

"Do you experience shortness of breath with basic activities?"

A nurse assesses that the patient's AP chest diameter is the same as the lateral diameter. Which question should the nurse ask the patient in response to this morning?

"Do you have any chronic breathing problems?"

A nurse is teaching a patient who is at risk for mild hypernatremia. Which statement should the nurse include in the patient education?

"Read food labels to determine sodium content"

A nurse is providing teaching to a client who has Venus insufficiency to the lower extremities which of the following statements by the client indicates an understanding of the teaching?

"When I sit down to watch television, I'll be sure to put my feet up."

Nurses working with an older adult admitted with mild dehydration. What teaching does a nurse provide that is BEST for this patient?

"You need between 1-2L to drink a day or have something to drink every 1-2 hours."

A nurse on the MedSurg unit has received handoff report. What patient should the nurse see first?

Patient with new onset abdominal pain

A nurse checks the patients blood glucose level and obtains a reading of 314. The patient has the following sliding scale for regular insulin ordered: <200: 0 units 201-250: 4 units 251-300: 6 units 301-350: 8 units 351-399: 10 units >400: call provider. Per the sliding scale ordered, how many units of regular insulin should this patient receive?

8 units

Nurse is assessing patients on the MedSurg unit. Which patients are the nurse identify as being at the greatest risk for insensible water loss?

Patient with tachypnea

Peristalsis assessment

Assess peristalsis by listening to bowel sounds in all four quadrants. Bowel sounds are only considered to be absent if there are no sounds heard over 5 minutes.

A nurse is assessing a patient who is recovering from a lung biopsy. Which assessment finding requires immediate action?

Absent breath sounds

A nurse is planning care for a client who has experienced excessive fluid loss. Which of the following interventions should the nurse include in the plan of care? (select all that apply.)

Administer IV fluids to the client evenly over 24 hours, encourage the client to rise slowly when standing up, with a client every eight hours.

Post op bariatric surgery

After weight-loss surgery, you generally won't be allowed to eat for one to two days so that your stomach and digestive system can heal. Then, you'll follow a specific diet for a few weeks. The diet begins with liquids only, then progresses to pureed, very soft foods, and eventually to regular foods

A patient is ordered for units of regular insulin and 15 units of NPH. Which of the following is the correct order for making these insulin's?

Air cloudy, air clear, draw clear, draw cloudy

A postoperative patient has been admitted to the PACU. What assessment by the PACU nurse takes priority?

Airway

A nurse is assessing a patient who has suffered a nasal fracture. Which assessment should the nurse perform first?

Airway potency

A post operative patient is refusing to participate in physical therapy. What action by the nurse is best?

Ask the patient about pain goals and if they are being met

A nurse is caring for a client who is receiving furosemide daily. During the morning assessment the client tells the nurse that "he is feeling weak in the legs." which of the following actions should the nurse take first?

Auscultate the clients lungs

A new nurse reports to the precepting nurse that a patient has requested pain medication. When the nurse brought the medication in, the patient was sleeping. The new nurse states the patient cant be in severe pain since they are sleeping. What response from the preceptor is best?

Being able to sleep doesn't mean pain doesn't exist

A nurse is caring for a client who has dehydration and is receiving IV fluids. When assessing for complications the nurse should recognize which of the following manifestations as a sign of fluid overload?

Bounding peripheral pulses

A patient is going to be admitted for a scheduled surgical procedure. What action does the nurse include that is the BEST to prevent errors?

Bring a list of medications and conditions they are used to treat

A nurse is assessing a client who has a calcium level of 8.1mg/dL. Which of the following findings is the priority for the nurse to assess?

Cardiac rhythm

New colostomy Pt Ed

Chart 57-4 pg 1157. skin protection- use skin barriers to protect skin from contact with contents from ostomy. watch skin for irritation and redness. Pouch-care- empty when ⅓ full or ½ full. Change pouch during inactive times (before meals, before going to bed, waking up of a morning, changing the entire pouch every 3-7 days.) nutrition- chew food thoroughly. High-fiber, high-cellulose foods cause severe problems (diarrhea, constipation or blockages). Drug therapy- don't take enteric-coated and capsule meds, no laxatives or enemas. Symptoms to watch for include swollen stoma, abdominal cramping or distention. If these occur try removing the pouch with faceplate, lie down knee-chest position, begin abdominal massage, apply moist towel to abdomen, drink hot tea, if none of these work contact Healthcare provider immediately

I nurse is assessing a client who has respiratory acidosis. Which of the following findings should the nurse expect?

Confusion

A nurse is caring for a patient who has a serum calcium of 14 mg/dL. Which order should the nurse perform first?

Connect the patient to a cardiac monitor

Gerd: Client self care

Consume small, frequent meals, and limit intake of fried, fatty, and spicy foods, and caffeine. Sitting upright for at least 1 hour after eating can promote proper digestion and reduce the risk for reflux. Stop smoking.

A nurse performed passive range of motion exercises in a semiconscious patient and meets resistance while attempting to extend the right elbow beyond 45°. What action should the nurse take next?

Continue to only move the joint to the point at which resistance is met

A nurse is caring for an older adult who is admitted with dehydration. Which intervention should the nurse implement to prevent falls?

Dangle the patient on the bedside before ambulating

A nurse is assessing a client who has hyperkalemia. Which of the following findings should the nurse expect?

Decreased muscle strength

A patient has severe pain when coughing and deep breathing after abdominal surgery despite taking pain medications. What action by the nurse is best?

Demonstrate how to splint the incision

NG tube use with Pyloric obstruction

First, the stomach must be decompressed with nasogastric suction. Next, interventions are directed at correcting metabolic alkalosis and dehydration. The NGT is then clamped for 72 hours.

Risks: stomach cancer

H. Pylori, obesity, smoking, red meat, alcohol, and having a low socioeconomic status

A nurse is reviewing the laboratory report of a patient has fluid volume excess. Which of the following laboratory values should the nurse expect?

Hematocrit 34%

Frequent bruising - why?

Hematoma: localized bleeding outside of the blood vessels (i don't know what else we would find for this... I have looked everywhere)

Pt Ed: Stomatitis

May experience excess mouth dryness, use oral care, saliva substitutes, and have regular dental visits. Avoid highly seasoned foods, make gravies, high protein foods instead of soft meats. If the patient is undergoing radiation, skin will be sensitive. Avoid sun exposure, avoid perfumed lotions and powders, clean face/neck with gentle non-deodorant soap. Males should use an electric razor and an alcohol-based aftershave.

A nurse is assessing a client who has dehydration. Which of the following assessment is priority?

Mental Status

Care of paralytic ileus

NPO, NG Tube, Enema, IV fluid replacement, exploratory laparotomy. Monitor vitals and other measures of fluid status every 2 to 4 hours, frequent mouth care.

A nurse is caring for a patient who has the following lab results: potassium 3.6 mEq/L, magnesium 1.8mEq/L, calcium 8.5mEq/L, and sodium 144mEq/L. How would the nurse interpret these findings?

Normal lab findings

A nurse plans care for a patient who is immobile. What assessment is priority in preventing pressure ulcer formation?

Nutritional intake and prealbumin levels

A nurse is providing dietary teaching to a client who has heart failure and is receiving furosemide. Which of the following foods should the nurse recommend as containing the greatest amount of potassium?

One cup plain yogurt

A nurse is providing dietary teaching to a client who has kidney disease. Which of the following food choices should the nurse include in the teaching as containing the lowest amount of magnesium?

One hard boiled egg

A nurse is planning care for a client who has a potassium level of 3.0mEq/L. The nurse should plan to monitor the client for which of the following findings?

Orthostatic hypotension

A nurse is caring for a client who reports difficulty breathing and tingling in both hands. His respiratory rate is 36 per minute and he appears very restless. Which of the following values should the nurse anticipate to be outside the expected reference range if the client is experiencing respiratory alkalosis?

PaCO2

A patient has just arrived in the PACU. What action by the nurse takes priority?

Participating in hand-off report

Post care - laparoscopic cholecystectomy

Patient may feel discomfort from CO2 retention in the abdomen- the pain may be felt throughout the thorax and shoulders (normally hurts one side). Teach pt to use ice and oral opioids for incisional pain if needed. Typically allowed to bathe the day after surgery. Rest 24 hours after surgery. Most patients are able to resume normal activities after one week. Introduce high-fat foods one at a time to determine which foods should be tolerated.

The PACU nurse notes vital signs on for postoperative patients. What patient should the nurse see first?

Patient with a respiratory rate of 6 breaths/min

After teaching a patient how to perform diaphragmatic breathing, the nurse assesses the patients understanding. Which action demonstrated the patient understands the teaching?

Places hands on the abdomen

Post op care after traditional cholecystectomy

Post-op incision pain is controlled with opioids using a PCA pump. Encourage patients to use coughing and deep breathing exercises when pain is controlled and the incision is splinted. May need to administer antiemetic. The patient is NPO until fully awake. Advance diet from clear liquids to solid foods as peristalsis returns.

A nurse is caring for a client who requires continuous cardiac monitoring. The nurse identify as a prolonged PR interval and a widened QRS complex. Which of the following laboratory values supports is finding?

Potassium 6.1 mEq/L

A nurse who posting a client who is using PCA at following a thoracotomy. The client is short of breath appears restless and has a respiratory rate of 28 bpm the clients ABG results are pH 7.5, PaO2 89mmHG, PaCO2 28 mmHG, and HCO3 24mEq/L. What should the following actions should the nurse take?

Provide calming measures

Foods: High Iron

Red meat, shellfish, spinach, turkey, prune juice

A circulating nurse wants to provide emotional support to a patient who has just entered the OR. What action is best?

Remain with the patient

A nurse is admitting a client who has a status asthmaticus. The clients ABG results are pH 7.32, PA02 74 mmHG, PaCO2 56 mmHG, and HCO3 26mEq/L. The nurse should interpret his laboratory values as which of the following and balances?

Respiratory acidosis

A student asks the nurse what is the best way to assess a patients pain. Which response by the nurse is best?

Self-report

A nurse is reviewing the medical record of a client who has diabetes mellitus and is receiving regular insulin by continuous IV infusion to treat diabetic ketoacidosis. Which of the following findings should the nurse report to the provider?

Serum potassium 3.0mEq/L

A nurse is assessing pain in an older adult. What action by the nurse is most appropriate?

Sit down, ask one question at a time, and allow the patient time to answer

A nurse is assessing a client who has a phosphorus level of 2.4mg/dL. Which of the following findings should the nurse expect?

Slow peripheral pulses

A nurse is testing a client who is receiving hydrochlorothiazide in notes of the patient is confused and lethargic. Which of the following laboratory values should the nurse report to the provider?

Sodium 128 mEq/L

A nurse is evaluating a client who is receiving IV fluids to treat dehydration. Which of the following laboratory findings indicates that the fluid therapy has been effective?

Sodium 142 mEq/L

Upper GI bleeding findings with suction

Tachycardia,tachypnea, hypotension, dizziness, hypovolemia.

Ulcer. Colitis and Crohn's - commonalities

The etiology for both is unknown. A complication of both diseases is nutritional deficit. The beginning peak age is 15 years old for both. Both have the same meds for treatment, might experience weight loss with both because the large intestine can't absorb nutrients properly.

Diet: chronic cholecystitis

The patient's diet should be high in fiber and low in fat. Gas-producing foods should be avoided. Small, frequent meals are preferred compared to three big meals.

A preoperative nurse is assessing a patient prior to surgery. Which information would be most important for the nurse to relate to the team?

Use of herbals and supplements

A nurse is teaching a patient who has a flaccid bladder. What bladder training technique sure the nurse teach first?

Valsalva maneuver

A nurse assesses a patient recovering from coronary artery bypass graft surgery. Which assessment should the nurse complete to evaluate the patient's activity intolerance?

Vital signs before, during, and after activity

The nurse is caring for an older adult and provided education on high fiber foods. Which menu selection is NOT the best for this patient?

White rice

A nurse is preparing to administer oral potassium to a client who has a potassium level of 5.5 mEq/L. Which of the following actions should the nurse take first?

Withhold the medication

s/s of malnourishment

a lack of appetite or interest in food or drink. tiredness and irritability. an inability to concentrate

McBurney's Point

a point on the abdominal wall that lies between the navel and the right anterior superior iliac spine and that is the point where most pain is experienced with acute appendicitis

Assessment obstruction of bile duct

assess for gallstones (most common cause!!), trauma, severe liver damage, infections (including hepatitis), enlarged lymph nodes, pancreatitis, inflammation of the bile duct, cysts, or an injury related to gallbladder or liver surgery. Obtain history of obesity, pancreatic cancer, chronic pancreatitis, or a history of gallstones. Symptoms include light colored stool, dark urine, jaundice, nausea, vomiting, weight loss, itching, pain in the upper right quadrant of abdomen, and fever.

Indicators of fluid status

fluid overload: weight gain, crackles, dyspnea, increase in bp, bounding pulse. excessive diarrhea can lead to dehydration. fluid volume expansion can result in increased renal excretion of water leading to dehydration

Safety: enteral feedings

chart 60-5 pg. 1222- never use cranberry juice. if clogged use 30ml of water flush using gentle pressure with a 50ml piston syringe. only use carbonated drinks when water won't flush out clog. use liquid medications when possible. consider use of an automatic-flush feeding pump. flush the tube with 20-30ml of water-at least every 4 hours during continuous tube feeding, before and after each intermittent tube 5feeding, (warm water flush) after med admin

malnourishment: interventions

diet, nutrition supplementation, meal delivery programs, and nutrition education or counseling.

Diet IBS

dietary fiber and bulk help produce bulky, soft stools and establish regular bowel habits. The patient should ingest about 30 to 40 g of fiber every day. Eating regular meals, and drinking 8-10 glasses of water a day and chewing food slowly

Delegation of Care - general

don't delegate what you can eat: Evaluate, Assess, Teach.

Diet: GERD

eat 4-6 meals a day. Limit fatty foods, coffee, tea, cola, and chocolate. Reduce spices or any food that causes gastric acid. Do not snack in the evening. Eat slow and chew food. Remain upright after eating. Elevate the head 6-12 inches when sleeping.

Management of pancreatitis

fasting and short-term intravenous feeding, fluid therapy, and pain management with narcotics or NSAIDs