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Med Surg Final.txt
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Med Surg Final Exam
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Med Surg Final Exam
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  1. In pulmonary edema the medical management will often include what?
    Furosemide (Lasix) IV, oxygen therapy , orthopenic position, and morphine sulfate to decrease respiratory rate.
  2. What would the nursing interventions be for a patient with pulmonary edema, excess fluid volume, and altered tissue permeability?
    Assess indicators of patient�s fluid volume status, such as breath sounds, skin turgor, and pedal/sacral/periorbital edema, mx I&O, administer diuretics as ordered, and weigh daily.
  3. What is the most common cause of pulmonary edema?
    Increased capillary pressure from left ventricular failure
  4. What does sputum look like in pulmonary edema?
    Frothy, pink sputum
  5. What type of diet is recommended for a pt with pulmonary edema?
    Low-sodium diet
  6. What is pulmonary embolism?
    Foreign substance causing obstruction to the blood supply to lung tissue
  7. What is the normal range for d-dimer?
    68-494
  8. How long is a pt on anticoagulant therapy for a pulmonary embolism?
    One year
  9. What is the most definite method of diagnosing a pulmonary embolism?
    pulmonary angiogram
  10. What is pulmonary edema?
    Accumulation of extravascular fluid in lung tissues and alveoli, caused by severe left ventricular dysfunction
  11. What are the signs and symptoms of pulmonary edema?
    Severe respiratory distress, frothy sputum, coughing, choking
  12. Most pulmonary embolisms (PEs) originate from where?
    deep vein thrombosis (DVT)
  13. Chest pain from pulmonary embolism (PE) is typically what?
    pleuritic and worsens upon inspiration
  14. What is the medical management and nursing interventions of the patient with pulmonary embolism?
    Bed rest, administration of IV Heparin per protocol, semi-fowlers position, and oxygen per mask or nasal cannula.
  15. What position will the nurse instruct the pt with emphysema to enhance the effectiveness of breathing during dyspnea periods?
    sitting on the side of the bed, leaning on an overbed table
  16. A nurse is caring for a client with emphysema who is receiving oxygen. The nurse checks the oxygen flow rate to ensure that it does not exceed what?
    2L/min
  17. What is the purpose of pursed lip breathing?
    Promote carbon dioxide elimination
  18. The low pressure alarm sounds on the ventilator. The nurse checks the client then attempts to determine the cause of the alarm but is unsuccessful. What initial action will the nurse take?
    Ventilate the client manually
  19. What does a pt w/emphysema become barrel chested?
    Because of over inflation of the lungs
  20. How much fluid should a pt w/emphysema consume each day?
    2-3 L
  21. What effective breathing technique is used for a pt w/emphysema?
    Pursed-lip breathing
  22. What does Peak-flow monitoring measure?
    how well air moves out of the lungs-during forceful exhalation
  23. Which type of medication is used as rescue medication in acute asthma exacerbation
    Short-acting beta,-agonists.
  24. Asthma is best characterized as what type of disease?
    an inflammatory disease
  25. What are the nursing interventions for a pt with ineffective breathing pattern related to decreased lung expansion during an acute attack of asthma?
    Administer oxygen therapy as ordered, remain with patient during acute attack to decrease fear and anxiety, incorporate rest periods into activities and interventions, and maintain semi-fowlers position to facilitate ventilation.
  26. How is TB spread?
    inhaling the TB bacteria after a person coughs, speaks, or sneezes
  27. What is the most common etiologic factor for this diagnosis in patients with Tb who do are not compliant?
    little or no motivation to adhere to a long-term drug regimen
  28. The appropriate nursing intervention for Mr. K age 40, diagnosed with active Tb would be what?
    place the patient in acid -fast bacilli (AFB) isolation precautions
  29. What diagnostic test that will confirm TB?
    Sputum culture
  30. What identifies the route of transmission of TB?
    The airborne route
  31. A nurse is reading the results of a Mantoux skin test on a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosed. What are the results of this test?
    Negative
  32. A nurse is caring for a client who had a Mantoux skin test implantation 48 hours ago on admission to the nursing unit and reads the result of the skin test as positive. What nursing action is priority?
    Report the findings
  33. A client being discharged from the hospital to home with a diagnosis of TB is worried about the possibility of infecting the family and others. What information would help the client get the most reassurance?
    The family will be treated prophylactically and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy.
  34. A nurse has reinforced discharge teaching with a client who was diagnosed with TB and has been on medication for 1� weeks. Which statement shows that the client has understood the teaching?
    �I should not be contagious after 2 to 3 weeks of medication therapy�
  35. A client with TB asks a nurse about precautions to take after discharge from the hospital to prevent infection of others. The nurse develops a response based on the understanding that TB is transmitted how?
    By droplet nuclei
  36. A nurse is preparing to give a bed bath to an immobilized client with TB. What should the nurse plan to wear when performing this care?
    Particulate respirator, gown, and gloves.
  37. A client with TB, whose status is being monitored in an ambulatory care clinic, asks the nurse when it is permissible to return to work. When does the nurse tell the pt he can return to work?
    After three sputum cultures are negative.
  38. What type of isolation is recommended for a patient w/TB?
    Acid-fast bacillus
  39. What type of masks do visitors of TB pts use?
    Particulate respiration mask
  40. Which of the following statements accurately describe the disease tuberculosis (TB)? Most people who become infected with TB organism do not progress to the active disease stage.
  41. Ms. C., age 45, is being evaluated to rule out pulmonary tuberculosis. Which finding is most closely associated with TB?
    Night Sweats
  42. The health care workers for Ms. C., who is diagnosed with active tuberculosis, are instructed in methods of protecting themselves from contracting tuberculosis. The centers of disease controls and prevention currently recommend that health care workers who care for TB-Infected patients wear what?
    a small micron fitted filtration mask
  43. A nurse is assigned to care for a patient following a left pneumonectomy. The nurse would avoid positioning the client how?
    On the side
  44. What is the most common surgical treatment for lung cancer?
    Pneumonectomy
  45. What is a pneumonectly?
    Surgical removal of a lung
  46. The primary goal for the patient with bronchiectasis is that the patient will what?
    maintain removal of bronchial secretions.
  47. What is bronchiectasis?
    Irreversible chronic dilation of bronchi that destroys bronchial elastic & muscular elements
  48. What are the signs & symptoms of bronchiectasis?
    Dyspnea, cyanosis & clubbing of the fingers
  49. What volume is O2 delivered to the pt with bronchiectasis?
    Low flow
  50. What is the cure for bronchiectasis?
    Surgical removal of the lung
  51. What is a cystectomy?
    Surgical removal of the bladder
  52. What type of surgery is less invasive and less stressful for a pt with BPH?
    TURP
  53. How is tissue removed during TURP?
    Through the urethra
  54. What type of catheter is used on a pt with TURP?
    Closed bladder irrigation
  55. What type of solution is used in a closed bladder irrigation?
    An isotonic solution
  56. What should the pt expect after prostatic surgery?
    Hematuria
  57. Why should catheter drainage tubes be checked frequently?
    For kinks that would occlude urine and cause bladder spasms
  58. What diet is important for a pt with nephrotic syndrome?
    Protein replacement, low salt
  59. What meds are used to treat nehprotic syndrome?
    Corticosteroids, loop diurectics
  60. What is cystitis?
    Inflammation of the wall of the urinary bladder
  61. What are the signs and symptoms of cystitis?
    Dysuria, urinary frequency and pyuria
  62. Cystitis is confirmed by a u/a that reveals a bacterial count greater than what?
    100,000
  63. What is interstitial cystitis?
    A chronic pain disorder in the urinary bladder and surrounding region
  64. What statement by the client with Cushing�s syndrome indicates that the instructions related to dietary management were understood?
    �I can eat foods that contain potassium.�
  65. What is a feature of Cushing syndrome?
    Increased susceptibility to infection
  66. What causes Cushing Syndrome?
    Overstimulation of ACTH
  67. What is hypokalema?
    Not enough potassium
  68. What are the clinical manifestations of Cushing syndrome?
    Moonface, buffalo hump
  69. What is striae?
    A streak or linear scar that often results from stretching of the skin
  70. In the pt with Cushings syndrome, what results in hyperglycemia?
    Impaired carbohydrate metabolism
  71. What type of diet is indicated for a pt with Cushings syndrome?
    Low sodium, reduce calories and carbs, and high potassium
  72. When a nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thights, what information should the nurse obtain from the client?
    Plan of injection rotation.
  73. Which client complaint would alert the nurse to a possible hypoglycemic reaction?
    Tremors
  74. After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which symptom is indicative of this disorder?
    Polydipsia
  75. What should the pt avoid when taking tolbutamide (Orinase) for diabetes mellitus?
    Alcohol
  76. What disorder caused by secretion of insufficient amounts of antidiuretic hormone (ADH)?
    Diabetes insipidus
  77. What is the main problem with diabetes mellitus type 2?
    Abnormal resistance to insulin action.
  78. In caring for a patient with diabetes mellitus who is experiencing an acute hyperglycemic reaction (diabetic ketoacidosis), what interventions would be appropriate?
    Insulin IV via infusion pump
  79. What is diabetes insipidus?
    A disorder of the pituitary in which ADH is deficient
  80. How much urine can a pt with diabetes insipidus lose in an hour?
    200ml
  81. What are the characteristics of diabetes insipidus?
    Polyuria and polydipsia
  82. What is the normal serum sodium level?
    135-145
  83. What happens to urine specific gravity in a pt with diabetes insipidus?
    it drops below 1.003
  84. How much fluid should a pt with diabetes insipidus intake?
    2600 ml
  85. What causes polydipisa and polyuria related to diabetes?
    Fluid shifts resulting from the osmotic effect of hyperglycemia
  86. In planning care for a patient with type 2 diabetes admitted to the hospital with pneumonia, the nurse recognizes that the patient may have what?
    Sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar coma
  87. At what time of day is a diabetic pt at risk for hypoglycemia?
    In the late afternoon and at bedtime
  88. What is a diabetic diet designed to do?
    Help normalize blood glucose through a balanced diet
  89. What is an appropriate instruction or the pt with diabetes related to care of the feet?
    Inspect all surfaces of the feet daily
  90. Which oral hypoglycemic works primarily by reducing hepatic glucose production and lowers fasting blood glucose levels?
    Metformin (Glucophage)
  91. What types of insulin are used in an insulin pump?
    Regular and rapid-acting
  92. How long is the onset of regular insulin (Humulin R)?
    30 minutes to an hour
  93. How long is the onset of action of Lispro (Humalog)?
    15 minutes
  94. How long is the onset of action of NPH (Humulin N)?
    2 hours
  95. Why is caffeine restricted in a pt with diabetes insipidus?
    Because it acts as a diuretic
  96. What is deficient in a pt with diabetes insipidous?
    ADH
  97. What is diabetes mellitus?
    Improper metabolism of carbs, fats, and proteins
  98. When does insulin reach its peak level?
    30 minutes after meals and returns to normal in 2-3 hours
  99. What is the difference between type 1 and type 2 dibetes?
    Type 1 is insulin dependent (IDDM) and Type 2 is non insulin dependent (NIDDM)
  100. What causes IDDM?
    Destruction of beta-cell function
  101. What are the causes of NIDDM?
    Decreased tissue, overproduction of insulin, abnormal glucose regulation
  102. How is glucose stored?
    As glycogen in the liver
  103. What must be present for muscle cells and other body cells to utilize glucose?
    Insulin
  104. What is hyperglycemia?
    Excess glucose in the bloodstream
  105. How does the body get rid of excess glucose in the bloodstream?
    The kidneys will excrete it in urine, called glycosuria
  106. What is a sign of diabetic ketoacidosis?
    Fruity smell to the breath
  107. What causes diabetic ketoacidosis?
    Acute insulin deficiency, decreased peripheral glucose utilization, increased fat mobilization and ketogenesis
  108. What are the normal lab values for fasting blood sugar?
    60-110
  109. What amount is considered abnormal in an FBS?
    126 or more
  110. What does the HbA1c measure?
    The amount of glucose that has become incorporated into the hemoglobin within an erythrocyte
  111. What is the normal lab value for HbA1c?
    4%-6%
  112. When is a postprandial blood sugar taken?
    2 hours after a meal
  113. What level may indicate the presence of DM in a PPBS?
    Plasma glucose over 160
  114. What affects the accuracy of an oral glucose tolerance test?
    Adequate pt preparation and cooperation
  115. What is the medical management for DM?
    Education, monitoring, meal planning, medication, exercise
  116. What type of diet is recommended for a pt with DM?
    45%-50% carbs, 10%-20% proteins, no more than 30% fats
  117. What is important about food intake for pts with IDDM?
    It should be evenly distributed throughout the day
  118. How long does exercise reduce insulin and increase glucose uptake?
    72 hours
  119. How often should blood glucose be monitored during the times of stress or illness?
    Every 1-2 hours
  120. When should the pt with DM be instructed to contact their physician?
    When blood glucose level is 250 or more
  121. When is insulin given intramuscularly?
    During diabetic ketoacidosis
  122. What are the classifications of insulin?
    Rapid-acting, insulin apart, short-acting, intermediate acting, long acting
  123. What is a �peakless� insulin that provides a continous insulin level?
    Lantus
  124. What is lipodystrophy?
    The loss of local fat deposits
  125. How can a nurse prevent lipodystrophy?
    Administer insulin at room temp and rotate injection sites
  126. How does a nurse prevent medication errors when administering insulin?
    Have the dose drawn in the syringe and checked by another nurse
  127. What is hypoglycemia?
    Not enough glucose in the blood
  128. What are the signs of hypoglycemia?
    Faintness, weakness, excessive perspiration, irritability, hunger, palpitations, trembling, drowsiness
  129. What are the signs and symptoms of hyperglycemia?
    Polyuria, polydipsia, polyphagia
  130. Why is insulin not injected into the muscle?
    Because it enters the bloodstream too quickly and can cause hypoglycemia
  131. Which part of the body provides the fastest, least variable absorption?
    The abdomen
  132. What is as close a substitute to a healthy, working pancrease?
    An insulin pump
  133. What is a bolus of insulin?
    A quantity of insulin delivered to cover a carbohydrate meal
  134. What is the function of metformin (glucophage)?
    It reduces hepatic glucose production and lowers fasting blood glucose levels
  135. What must a pt have for oral hypoglycemics to be effective?
    Some function insulin production
  136. Why is calcium gluconate prescribed for a pt after a thyroidectomy?
    To treat hypocalcemic tetany
  137. What nursing action is appropriate for a pt after a thyroidectomy who has developed hoarseness and a weak voice?
    Reassure the client that this is usually a temporary condition.
  138. What would require the nurse�s immediate attention when caring for a postop thyroidectomy pt?
    Laryngeal stridor
  139. A nurse is caring for a client after thyroidectomy and monitoring for signs of thyroid storm. What manifestation is associated with this disorder?
    Hypotension
  140. What signs or symptoms should be reported immediately to the RN/MD for further evaluation in the pt who has undergone a thyroidectomy?
    Numbness in the fingers, Heart rate of 160, Noticeable arm twitching when you took patient's blood pressure
  141. How is a pt placed after a thyroidectomy?
    Supine with pillows supporting the head and shoulders
  142. What two conditions should the nurse monitor for after a thyroidectomy?
    Tetany and edema
  143. What is Chvotek�s sign?
    An abnormal spasm of the facial muscles elicited by light taps on the facial nerve
  144. What condition will cause a pt to have a positive Chvotek�s sign?
    Hypocalcemia
  145. What is Trousseau�s sign?
    A test in which a BP cuff is inflated to above systolic BP for 3 minutes.
  146. What will happen with a positive Trousseau�s sign?
    Carpal spasm in pts with hypocalcemia and hypomagnesemia
  147. What is a thyroid storm?
    A condition in which large amounts of thyroid hormones are released
  148. What is administered for the emergency treatment of tetany?
    Calcium gluconate
  149. When does a thyroid crisis generally occur?
    In the first 12 hours post op
  150. What are the signs and symptoms of a thyroid crisis?
    Nausea, vomiting, severe tachycardia, hyperthermia, exaggerated symptoms of hyperthyroidism
  151. What are the three goals of thyroid storm management?
    Induce normal thyroid state, prevent cardiovascular collapse, prevent excessive hyperthermia
  152. What is a sign that damage to the laryngeal nerve may have occurred in a pt who has had a thyroidectomy?
    The pt is becoming increasingly hoarse.
  153. What is hyperthyroidism?
    Overproduction of T4 and T3
  154. What are the clinical manifestations of hyperthyroidism?
    Edema of the anterior portion of the neck, bulging eyes
  155. What is the diet therapy for a patient with hyperthyroidism?
    Foods high n calories, vitamins, minerals, and carbs
  156. What does a radioactive iodine uptake test determine?
    Hyperthyroidism
  157. How is the radioactive iodine given?
    By mouth to the fasting patient
  158. What is important to obtain from a patient before a radioactive iodine uptake test?
    Allergies and signed consent
  159. What drugs are given to treat hyperthyroid?
    PTU, methimazole (Tapazole)
  160. What is the gold standard for treating hyperthyroidism?
    Ablation therapy using radioactive iodine
  161. How often is the thyroid checked during a RAIU?
    2, 6 & 24 hours
  162. What type of diet is important for a pt w/hyperthyroidism?
    Foods high in calories, vitamins, minerals, and carbs
  163. What is hypothyroidism?
    A condition in which the thyroid fails to secrete sufficient hormones, resulting in a slowing of all of the body�s metabolic processes
  164. What type of diet is important for a patient with hypothyroidism?
    High-protein, high-fiber, low-calorie
  165. Appropriate nursing care for the patient with hypothyroidism would include what?
    Encourage fluids
  166. What is severe hypothyroidism called?
    Myxedema
  167. What should the nurse watch for in a pt w/hypothyroidism that could indicate cardiac involvement?
    Chest pain, dyspnea, changes in rate and rhythm.
  168. Mr. A., age 71, is admitted with an exacerbation of COPD. He has dependent edema and ascites as well as dyspnea. A complication that may occur in CIPD is which some of the capillaries surrounding the alveoli are destroyed, resulting in pulmonary hypertension, blood returning to the right side of the heart, and signs and symptoms of right-sided HF is what?
    cor pulmonale
  169. A patient with COPD asks why the heart is affected by the respiratory disease. The nurse�s response to the patient is based on the knowledge that cor pulmonale is characterized by what?
    right ventricular hypertrophy secondary to increased pulmonary vascular resistance
  170. Ineffective airway clearance related to tracheobronchial obstruction and/or secretions is a nursing diagnosis for a patient with COPD. Which of the following are correct?
    Offer small, frequent, high-calorie, high-protein feedings. Encourage generous fluid intake. Have patient turn and cough every 2 hours;; teach effective coughing technique.
  171. A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note in evaluating the client?
    A hyper inflated chest on x-ray
  172. Mr. F., age 52, had a laryngectomy due to cancer of the larynx. Discharge instructions are give to Mr. F. and his family. Which response, by written communication from Mr. F, or verbal response by the family, will be a signal to the nurse that the instructions need to be decalcified?
    It is acceptable to take over-the-counter medications now that conditions are stable.
  173. What is orthopnea?
    A condition in which a person must sit or stand to breathe deeply or comfortably
  174. What are the signs and symptoms of left-sided heart failure?
    Crackles, SOB, pink-frothy sputum, orthopnea, pulmonary edema
  175. What is the number one dysrhythmia that occurs with an arterial embolism?
    A-fibb
  176. What is the most serious type of dysrhythmia?
    Ventricular fibrillation
  177. Why would a physician perform carotid massage on a patient with a diagnosis of rapid rate atrial fibrillation? The procedure may stimulate the vagus nerve to slow the heart rate.
  178. What is atrial fibrillation?
    A very rapid production of atrial impulses characterized by an atrial rate of 350 to 600 beats per minute (atria fibrillates or quivers rather than contracts)
  179. What is ventricular fibrillation?
    Occurs when the ventricular musculature of the heart is quivering
  180. What happens during atrial fibrillation?
    The atria quivers instead of contracts
  181. What is cardiomyopathy?
    A term used to describe a group of heart muscle diseases that primarily affects the structural or functional ability of the myocardium
  182. What are the primary forms of cardiomyopathy?
    Dilated (ventricular), hypertrophic (increased heart size), and restrictive (ventricular walls are rigid)
  183. What are the secondary forms of cardiomyopathy?
    Infective, metabolic, nutritional, alcohol, peripartum, drugs, lupus, rheumatoid arthritis, �crack� heart
  184. What are the most common signs and symptoms of cardiomyopathy?
    Angina, syncope, fatigue, and dyspnea on exertion
  185. What is a dysrhythmia?
    Any cardiac rhythm that deviates from normal sinus rhythm
  186. How is tachycardia characterized?
    Heartbeat of 100-150 or more per minute
  187. How is bradycardia characterized?
    By a pulse rate of fewer than 60 beats per minute
  188. What is supraventricular tachycardia?
    The sudden onset of a rapid heartbeat characterized by a pulse rate of 150-250 beats per minute.
  189. What is an arterial aneurysm?
    An enlarged, dilated portion of an artery
  190. Why is the aorta prone to aneurysm?
    Because it is continuously exposed to high pressures
  191. What is the first priority of care for a patient with an aneurysm?
    Control of hypertension
  192. What are the nursing interventions of a patient diagnose with acute infective endocarditis?
    Restricted activity for several weeks.
  193. What is endocarditis?
    An infection of inflammation of the inner membranous lining of the heart, valves
  194. What are the signs and symptoms of endocarditis?
    Flu-like symptoms, undue fatigue, chest pain, headaches, petechia, oral mucosa
  195. What is cardiogenic shock?
    Pump failure; Complication of MI and heart failure
  196. Why was the term �congestive heart failure� changed to just �heart failure�?
    Because not every patient suffering from heart failure has pulmonary congestion
  197. How is nitroglycerin administered?
    PO, 1 tablet every 5 minutes times 3.
  198. What is the first step to determine why a patient isn�t compliant with their meds?
    Ask them why they aren�t taking their meds
  199. What symptoms are seen in angina pectoris?
    Chest pain that radiates down the left arm, dypsnea, anxiety, apprehension, diaphoresis and nausea
  200. What would you expect to see in a patient with suspected cocaine use?
    An enlarged heart
  201. What should be assessed in a patient before they are sent to the cardiac cath lab?
    Any allergies
  202. When is the hormone b-type natriuretic peptide (BNP) released?
    It�s secreted by the heart in response to pressure overload as in a heart failure
  203. What type of medication is nitroglycerin?
    A vasodilator � it will lower BP
  204. What are the signs and symptoms of left-sided heart failure?
    Crackles, SOB, pink-frothy sputum, orthopnea, pulmonary edema
  205. What are the signs and symptoms of right-sided heart failure?
    Edema in legs, jugular vein distention, liver enlargement, ascites
  206. What are the signs and symptoms of right-sided heart failure?
    Edema in legs, jugular vein distention, liver enlargement, ascites
  207. What should a postmyocardial patient being prepared for discharge be instructed to do?
    Begin a cardiac rehab program
  208. What is the primary function of patient teaching following a myocardial infarction?
    To assist the patient to develop a healthy lifestyle
  209. What is an important nursing intervention when caring for a patient with remote telemetry?
    Never remove telemetry and allow patient to shower unless physician has written the order to allow a shower
  210. What is the name of the neurohormone released from the left ventricle in response to volume expansion and pressure overload that has emerged as the blood marker for the identification of individuals with CHF?
    B-type natriuretic peptide (BNP)
  211. What is the normal range for B-type natriuretic peptide (BNP)?
    0 to 100 pg/ml
  212. What is a myocardial muscle protein released into circulation after myocardial injury and is useful in diagnosing a myocardial infarction?
    Tropin l
  213. What typical vital signs will display in a patient presenting with a myocardial infarction?
    Hypertension, tachycardia, weakened pulse, temperature elevation
  214. What cardiac markers is specific to the heart, not influenced by skeletal muscle trauma or renal failure, and rises 3 hours following a myocardial infarction?
    Troponin I
  215. What nursing care is followed for a patient with myocardial infarction?
    Bedrest with commode privileges for 24 to 48 hours.
  216. What breath sounds would a nurse expect to hear in a patient with myocardial infarction who suddenly becomes tachycardic and shows signs of air hunger?
    Crackles
  217. What is a myocardial infarction?
    An occlusion of a major coronary artery
  218. How long does it take myocardial cells to die?
    4-6 hours
  219. Jaundice results when there is an excess amount of what in the bloodstream?
    Bilirubin
  220. What is the preferred diagnostic test for visualizing the biliary tree in a pt with jaundice?
    Gallbladder ultrasound
  221. What is multiple myeloma?
    Bone marrow cancer that metastasizes to the bone
  222. What labs should the nurse monitor in a pt with multiple myeloma?
    Calcium�watch for hypercalcemia
  223. What is the best food item to administer with oral iron supplements?
    Orange juice
  224. What nursing intervention should be incorporated into the plan of care for a child with aplastic anemia with WBC of 6000 and platelet of 27,000/mm?
    Encourage quiet play activities
  225. What test is used to detect pernicious anemia?
    Schilling test
  226. What would a nurse expect to specifically note with in a pt with a diagnosis of multiple myeloma?
    Increased calcium level
  227. What is a priority nursing intervention for the client with multiple myeloma?
    Encourage fluids
  228. What intervention is a priority in the nursing plan of care for a pt with thrombocytopenia?
    Monitor the client for bleeding
  229. What medication is given to the patients with sickle cell anemia?
    IV Dulodid
  230. What does anemia cause?
    Delivery of insufficient amounts of oxygen to tissues and cells
  231. What is pernicious anemia?
    The absence of a glycoprotein intrinsic factor secreted by the gastric mucosa
  232. What is thrombocytopenia?
    Blood platelets below 150,000
  233. What is sickle cell anemia?
    An illness in which the blood cells shape in crescents and get stuck to one another and occlude vessels
  234. What would the nurse expect to find during the physical assessment of a pt with thrombocytopenia?
    Petechiae and purpura
  235. What is an important nursing intervention goal to establish for a person who has iron deficiency anemia?
    Alternate periods of rest and activity to balance oxygen supply and demand
  236. What is a nursing intervention for a pt during a sickle cell crisis?
    Administration of large doses of continuous opioid analgesics
  237. What foods should be included in the diet of a pt with iron deficiency anemia?
    Dark green leafy veggies ad organ meats
  238. In addition to the general symptoms of anemia, the pt with pernicious anemia also manifests what?
    Neurological symptoms
  239. What statement by the pt with pernicious anemia would indicate the she has understood the teaching?
    �I�ll have to take B12 shots for the rest of m life.�
  240. What type of data indicates that iron deficiency anemia is not currently managed effectively?
    Pallor
  241. In a pt with sickle cell anemia, why does the sickling crisis not stop when oxygen therapy is started?
    when red cells sickle, they occlude small vessels, which causes more local hypoxia and more sickling
  242. How is a pt positioned during a needle liver biopsy?
    Supine with the right arm over the head
  243. What is the most common form of hepatitis, having an incubation period of 10-40 days.
    Hepatitis A
  244. What snack choices would be appropriate for a pt suffering from acute pancreatitis?
    Reduced fat cheese and whole wheat crackers
  245. What is the preferred diagnostic test for visualizing the biliary tree in a pt with jaundice?
    Gallbladder ultrasound
  246. How is the pt instructed to breathe during a needle liver biopsy?
    Exhale fully and not breathe while the needle is inserted
  247. What causes jaundice in a pt?
    An excess of bilirubin
  248. What is a needle liver biopsy?
    A test in which a needle is inserted into the liver between the 6 & 7 or 7 & 8 intercostal spaces
  249. After a cholesysectomy, why would a pt complain about shoulder pain?
    Diaphragmatic irritation secondary to residual carbon dioxide
  250. What is jaundice?
    The appearance of yellowish skin, discoloration of the sclera and mucous membranes
  251. What is the best form of preventing hepatitis A & B?
    Vaccinations
  252. What is a critical aspect nursing interventions following a liver transplantation?
    Monitor for infection
  253. What vitamins are given intravenously with fluids for the dehydrated hepatitis pt?
    C (healing), B (assists liver to absorb vit), K (blood clotter)
  254. What can happen to a pt after a liver transplant, who has liver disease secondary to viral hepatitis?
    They often experience reinfection of the transplanted liver with hepatitis B or C
  255. What are the signs and symptoms of hepatitis?
    General malaise, aching muscles, headaches, chills, abdominal pain, dyspepsia, nausea, diarrhea and constipation.
  256. What would be an appropriate nursing intervention in a pt with viral hepatitis and no appetite?
    Offer small, frequent meals
  257. What immunosuppressant drug is utilized in the success of a liver transplant?
    Cyclosporine
  258. What are the major postop complications of a liver transplant?
    Rejection and infection
  259. How is hepatitis diagnosed?
    A normal lab test will be negative for the presence of the antigen
  260. How is hepatitis G spread?
    Unsafe tattooing or piercing; coinfection of Hepatitis C
  261. How is hepatitis B spread?
    Through contaminated blood transfusion, direct contact with body fluids, sexual contact
  262. What are the nursing interventions following a liver biopsy?
    Ensure that platelet, clotting or bleeding time or okay and report any abnormal lab values to the doc; observe for the symptoms of bleeding
  263. How is hepatitis A spread?
    Through the fecal-oral route, usually by contaminated food
  264. How is hepatitis E spread?
    Oral-fecal route; spreads through fecal contamination of water
  265. Following a liver biopsy, how long is a pt to lay on their right side?
    A minimum of 2 hours to splint the puncture site
  266. How is hepatitis D spread?
    Coinfection of hepatitis B
  267. What infection control method would be priority to include in the plan of care to prevent hepatitis B in a pt considered to be at high risk for exposure?
    Hepatitis B vaccine
  268. What type of hepatitis is contracted from contaminated food?
    Hepatitis A
  269. What should the nurse encourage in order to provide adequate nutrition to a pt with viral hepatitis, who is complaining of loss of apetite?
    Increase intake of fluids
  270. What signs or symptoms would a nurse expect to note in a pt with acute viral hepatitis?
    Fatigue
  271. What physician order would a nurse verify on the chart of a pt with acute pancreatitis?
    Morphine sulfate for pain
  272. What position will aggravate the pain in a pt with acute pancreatitis?
    Lying flat
  273. What foods are allowed for a pt with hepatic encephalopathy?
    Toast, cereal, rice, tea, fruit, juice, and hard candies
  274. What nursing interventions are included in planning care for a pt with metastatic cancer of the liver?
    Focus primarily on symptomatic and comfort measures
  275. What is the treatment for cancer of the liver?
    Palliative
  276. What do most pts already have when diagnosed with cancer of the liver?
    Cirrhosis
  277. What are the signs and symptoms of cirrhosis?
    Dyspepsia, changes in bowel habits, gradual weight loss, ascites, enlarged spleen and spider telangiectases
  278. What causes ascites?
    Portal hypertension and hypoalbumin
  279. What is the number one drug of choice for alieving pain of pancreatitis?
    Demerol
  280. What is cirrhosis?
    A chronic, degenerative disease of the liver in which the lobes are covered with fibrous tissue and the lobules are infiltrated with fat
  281. What are the signs and symptoms of cholecystitis and cholelithiasis?
    Low grade fever, elevated leukocyte count, clay-colored stools that contain fat, dark amber urine
  282. What is hepatic encephalopathy?
    Brain damage caused by liver disease where there is ammonia intoxication
  283. What are the various forms of cirrhosis?
    Alcoholic, postnecrotic, primary biliary, secondary biliary, cardiac
  284. What type of diet is prescribed for a pt with hepatic encephalopathy?
    Very low protein to no protein diet
  285. What is ascites?
    An accumulation of fluid and albumin in the peritoneal cavity
  286. What is cholecystitis?
    An inflammation of the gallbladder
  287. How can pain from pancreatitis be alleviated?
    By flexing the trunk, leaning forward from a sitting position, or by assuming the fetal position
  288. Why is it especially important for the pt to cough and deep breathe postoperatively following an open cholecystectomy?
    The pt tends to take shallow breaths due to the placement of the incision
  289. What will the administration of analgesic morphine cause in pts with acute pancreatitis?
    Spasms of the sphincter of Oddi
  290. Hepatitis types B,C,D, & G are spread mainly through which routes?
    Blood transfusions, contaminated needles and instruments, direct contact with body fluids from infected people
  291. What nursing diagnoses could be related to a liver needle biopsy?
    Pain, related to leakage of blood and bile into the peritoneal cavity
  292. When caring for a pt with hepatic encephalopathy the nurse may give enemas, provide a low-protein diet, and limit physical activity. Why are these measures taken?
    To decrease the production of ammonia
  293. In hepatic encephalopathy, what is the nurse assessing for when she requests the pt stretch out the arm and hyperextend the wrist with the fingers separated, relaxed, and extended to see whether rapid, irregular flexion and extension (flapping) of the wrist occur?
    Asterixis
  294. Which types of hepatitis now have vaccines for prevention?
    A & B
  295. Why is a T-tube inserted during a cholecystectomy?
    To keep the duct open and allow drainage
  296. What type of food is limited in a pt with advanced cirrhosis of the liver?
    Meats
  297. Following a laparoscopic cholecystecomty, what should the pt report?
    Bile-colored drainage or pus from any incision
  298. Why is lactulose given to a pt with hepatic encephalopathy?
    It decreases the bowel�s pH thus decreasing the production of bacteria within the bowel
  299. What is the stool and urine color of a pt who is jaundiced?
    Dark tea-colored urine and clay-colored stools
  300. When caring for a pt with acute pancreatitis, what lab reports may be anticipated?
    Hypoalbuminemia, hyperglycemia, and elevated hematocrit and leykocytosis
  301. What is the nurses response to a pt with advanced cirrhosis who asks why his abdomen is so swollen?
    Portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space
  302. What labs are taken for cirrhosis?
    PT INR
  303. What is the post op care for an open cholecystectomy?
    Monitor vital signs and observe dressing for exudates or hemorrhage
  304. What is hepatitis?
    An inflammation of the liver resulting from several types of viral agents or exposure to toxic substances
  305. How is hepatitis C spread?
    Needle sticks, contaminated blood transfusions
  306. Why is neomycin given to a pt with hepatic encephalopathy?
    To reduce the bacterial flora of the colon
  307. What is pancreatitis?
    Inflammation of the pancreas and may be acute or chronic
  308. What types of drugs are avoided until the liver regains adequate function?
    Drugs that are normally detoxified in the liver
  309. What is a cholesystectomy?
    A procedure to remove the gallbladder
  310. What two major factors are most commonly associated with pancreatitis?
    Alcoholism and biliary tract disease
  311. What are the signs and symptoms of pancreatitis?
    Severe abdominal pain radiating to the back; low-grade fever, vomiting, jaundice, weight loss, steatorrhea, and tachycardia
  312. What is the primary use of nonabsorbable antibiotics as preparation for bowel surgery?
    To reduce the bacterial flora in the colon
  313. What is the most important nursing intervention to decrease post op edema and pain in a male pt following an inguinal herniorraphy?
    Elevation of the scrotum with a support or small pillow
  314. How is hernia reduced?
    Returned to its original position by manipulation
  315. When can a temp colostomy be closed?
    6 weeks to 3 months after the initial procedure
  316. What is the treatment of diverticulus disease when muscle atrophy is responsible?
    Low-residue diet, stool softeners, and bed rest
  317. How can dumping syndrome be relieved?
    Eating 6 small meals without fluids and by lying down after eating to slow the movement of food
  318. What are the types of hernias?
    Ventral, femoral, inguinal and umbilical
  319. What is a hernia?
    A protrusion of a viscus through an abnormal opening or a weakened area in the wall of a cavity
  320. What is an incarcerate hernia?
    One that cannot be returned to its original position
  321. What is the difference between ulcerative colitis and Crohn�s disease?
    Ulcerative colitis is curable with a colectomy; Chrohn�s often recurs after surgery
  322. How would a stoma appear if a prolapse occurred?
    Protruding and swollen
  323. Dumping syndrome is a disorder associated with what condition?
    Following gastric resection or peptic ulcer surgery
  324. What is a nursing diagnosis for a pt with ulcerative colitis?
    Imbalanced nutrition, less than body related to bowel hyper
  325. What is diverticulitis?
    The inflammation of one or more diverticula
  326. What are the sings and symptoms of dumping syndrome?
    Diphoresis, nausea, vomiting, explosive diarrhea, borborygmi and dyspepsia
  327. Which nursing measure will the nurse instruct the pt to follow to help prevent dumping syndrome?
    Limit the fluids taken with meals
  328. What recommendations for food choices would you give a pt who has been diagnosed with diverticulosis as a result of muscle thickening and increased intracolonic pressure?
    Bran, fruits and vegetables
  329. What are the difficulties of the hiatal hernia pt?
    Gastroesophageal reflux, heartburn, strangulation, infarction and ulceration
  330. What is diverticulosis?
    The presence of pouchlike herniations
  331. What is a hiatal hernia?
    A protrusion of the stomach through the diaphragm
  332. What symptoms will indicate the occurrence of dumping syndrome?
    Sweating and pallor
  333. What is ulcerative colitis?
    Abcessess in the rectum and up through the large intestine
  334. What is dumping syndrome?
    A condition of weakness and sweating following eating related to rapid emptying of the stomach
  335. What is the treatment for diverticulus when muscle thickening is responsible?
    High-fiber diet of bran, fruits and veggies
  336. What lab values are decreased as a sign of a fat embolism?
    Hemoglobin and hematocrit
  337. What are the signs and symptoms of a fat embolism?
    Chest pain, localized muscle weakness, spasticity and rigidity, all especially if a pt has multiple broken bones
  338. What medications are used to control RA?
    Antiinflammatory drugs and aspirin
  339. When may a prothesis be fitted?
    2 or 3 weeks post op
  340. Besides joints, what other systems can RA affect?
    Lung, heart, blood vessels, muscles, eyes and skin
  341. Why is it necessary to warp an amputated extremity?
    To facilitate proper fit and use of a prothesis
  342. What type of disease is RA?
    A chronic, systemic disease that�s also though of as an autoimmune disorder
  343. How are flexion hip contractures prevented postoperatively?
    By raising the foot of the bed slightly
  344. How much sleep is recommended for a pt with RA?
    8-10 hours a nig and a 2 hour nap during the day
  345. What is the most common type of fracture treated in the hospital?
    Hip fracture
  346. How is a fat embolism formed?
    When a bone breaks, the fat deposits in the marrow are released into the bloodstream
  347. What is an extracapsular fracture?
    When a fracture occurs outside of the hip joint capsule
  348. What is an impacted fracture?
    Where one bone fragment is forcibly impacted into another bone fragment
  349. What is compartment syndrome?
    The progressive development of arterial vessel compression and reduced blood supply to an extremity
  350. What are signs of a hip fracture?
    Inability to move the leg voluntarily, and shortening or external rotation of the leg
  351. What is a transverse fracture?
    A break that runs directly across the bone
  352. What are the signs of compartment syndrome?
    inability to flex the fingers or toes, coolness of the extremity and absence of a pulse
  353. What is an oblique fracture?
    A break along the slant of the bone at a 45 degree angle
  354. What is an intrascapular fracture?
    When the femur is broken inside the joint
  355. What is a comminuted fracture?
    The bone is splintered into three or more fragments at the site of the break
  356. What is the maximum elevation for the head of bed on a hip fracture patient?
    45 degrees
  357. How high can a limb with compartment syndrome be elevated?
    No higher than the heart
  358. What is a complete fracture?
    A fracture entirely through the bone
  359. Why does phantom pain occur?
    Because the nerve tracks that register pain in the amputated area continue to send a message to the brain
  360. What diagnostic tests are performed prior to an amputation?
    CBC, BUN, potassium levels, urinalysis
  361. In a pt with gout, what is the fluid intake increased to?
    2000 ml
  362. What is gout?
    A metabolic disease resulting from an accumulation of uric acid in the blood
  363. What is a greenstick fracture?
    An incomplete fracture; the bone is only broken on one side
  364. What is a spiral fracture?
    Where the break coils around the bone
  365. What are the three compartment of the knee?
    Medial (inside), lateral (outside), patello-femoral (kneecap)
  366. What is a unicompartmental knee arthroplasty?
    A partial knee replacement
  367. What is a knee arthroplasty?
    Total knee replacement
  368. What is seen in patients with compartmental syndrome?
    Absence of pulsation in the affected extremity
  369. When does physical therapy begin following a partial knee replacement?
    The first day after surgery
  370. Who is a partial knee replacement recommended for?
    Select pts 50 years and older
  371. What is colchine used for?
    To treat gout
  372. Which diagnostic test is used to assist in the confirmation of RA?
    ESR
  373. Who is not a candidate for a partial knee replacement?
    Pts with RA or lupus
  374. When can a pt bear weight on the leg following a prosthetic hip replacement?
    6 weeks to 3 months
  375. What causes gout?
    Eating too many organ meats, yeast, herring, mackerel and scallops
  376. What is RA?
    Most serious form of arthritis and leads to severe crippling
  377. What is the preoperative preparations focused on prior to an amputation?
    The pts physical and emotional status
  378. When is a lumbar puncture contraindicated?
    In a pt with suspected brain tumor or ICP
  379. What is the earliest sign of ICP?
    Change in level of consciousness
  380. What happens to vital signs in ICP?
    Increased BP, decreased Pulse, decreased respirations
  381. What is the first, most subtle clue to trouble in ICP?
    Pupils reacting sluggishly
  382. What type of pupil should be reported immediately?
    A blown pupil
  383. What is Cushing�s response?
    Widened pulse pressure, increased systolic BP, & bradycardia
  384. What type of respirations are related to the level of brainstem compression or failure?
    Sterterous or Cheyne-stokes
  385. What is the first step to manage ICP?
    Ensuring adequate oxygenation to support brain function
  386. What three types of medications are used to treat ICP?
    Osmotic diuretics, corticosteroids, and anticonvulsants
  387. How is a pt with ICP placed?
    Head of bed 30-45 degrees to promote venous return
  388. Why is hip flexion avoided in a pt with ICP?
    It causes increased pressure
  389. What medication actually reduces ICP?
    Mannitol
  390. How should a pt with ICP breathe when moving?
    They should exhale
  391. What is atelectasis?
    The collapse of lung tissue that prevents respiratory exchange of CO2 & O2 most often occurring after surgery
  392. How often is incentive spirometer recommended for a pt with atelectasis?
    10 x�s every hour while awake
  393. How does chemotherapy work?
    By interfering with the cells� ability to multiply or reproduce
  394. What is a common problem for a pt receiving chemo?
    Leukopenia
  395. What does a temp of 100 or more indicate in the pt receiving chemo?
    An impending infection
  396. What is one of the most common complications of the mouth of a chemo pt?
    Swallowing problems and systemic infections
  397. What should the chemo pt rinse their mouth with every 2-4 hours?
    Normal saline or sodium bicarbonate
  398. What should the pt taking chemo do to prevent lung infection?
    Cough, deep breathe, use incentive spirometer
  399. What two types of colony-stimulating factors can prevent or manage neutropenia?
    G-CSF & GM-CSF
  400. Why is fatigue a major problem for pts on chemo who have anemia?
    Decreased oxygenation to tissues from the decreased hemoglobin
  401. What is tumor lysis syndrome?
    Rapid lysis of malignant cells as a result of chemotherapy
  402. When is a pillow placed under a pt�s head postoperatively?
    After the pt is fully conscious
  403. Why is the postop pts head of bed raised to a 45 degree angle?
    To prevent aspirating of vomit
  404. What is the first thing a nurse should do if she notices her pt going into shock?
    Administer oxygen
  405. What is dehiscence?
    Separation of a surgical incision or rupture of a wound closure
  406. What are the signs and symptoms of atelectasis?
    Chest pain, fever, productive cough or dyspnea
  407. What is the acceptable urine output level postoperatively?
    30 ml per hour
  408. Why is preoperative teaching important?
    Wound healing then occurs more rapidly
  409. When is preoperative pt teaching completed?
    1-2 days before surgery
  410. What type of drugs reduce spasms of smooth muscles and decrease gastric, bronchial, and salivary secretions?
    Anticholinergics
  411. What is urticaria?
    Presence of wheals or hives in an allergic reaction
  412. What are wheals?
    Round elevations of the skin that are white in the center and pale red peripherally
  413. What are the clinical manifestations of urticaria?
    Pruritus, edema and burning pain
  414. What drugs can provide relief from urticaria?
    Antihistamine and epinephrine
  415. What is hypovolemic shock?
    Severe blood and fluid loss makes the heart unable to pump enough blood to the body
  416. What are the signs and symptoms of hypovolemic shock?
    Cool, clammy skin, anxiety, confusion, decreased urine output
  417. What medications are given to a pt to treat hypovolemic shock?
    Dopamine, dobutamine, epinephrine and norepinephrine
  418. What causes hypovolemic shock?
    Blood loss from injuries, burns, diarrhea, vomiting
  419. What is the most common sign of a UTI in an elderly patient?
    Confusion
  420. What chronic conditions can predispose a pt to recurrent UTI�s?
    DM, MS, spinal cord injuries, hypertension, kidney disease
  421. What are the common signs and symptoms of a UTI?
    Urgency, frequency, burning, hematuria
  422. What type of UTI is a bladder infection?
    Lower
  423. What type of UTI is a kidney infection?
    Upper
  424. What is urosepsis?
    Septic poisoning due to retention and absorption of urinary products in the tissues