Med Surg Final Exam

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Med Surg Final Exam
2012-04-23 12:17:05

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  1. A pt receiving external radiation and chemotherapy for oropharyngeal carcinoma. Interventions for oral mucosa that is denuded and edematous, ulcerations of bucca and tongue, and thick and ropey saliva:
    pt has stomatitis; asst pt with frequent and careful oral hygiene and hydration using soft toothbrush; admin antifungal meds; give soothing oral lozanges, ice chips, and frequent sips of ice water; avoid hot beverages; use lip balm
  2. Name types of biopsies:
    aspiration, excision, needle, incision
  3. 1) What is PSA? 2) What are the normal levels? 3) What is a DRE? 4) What is Transrectal US?
    • 1) a biological marker specific for cellular activity in the prostate gland
    • 2) 0-4 mg/L for men over 40
    • 3) digital rectal exam--recommended for asymptomatic men over 40
    • 4) transrectal ultrasonography--used when increased PSA requires further evaluation to assess cause of high levels
  4. Chemotherapeutic agents work by:
    interfering with the cell's replication process; reduces the size or slows the growth of metastatic cancer; drugs damage the cell and cause cellular death; majority of side effects are from destruction of the normal cells
  5. What is cachexia and the characteristics of it?
    profound state of ill health and malnutrition marked by weakness and emaciation
  6. What is the normal WBC? A person with leukopenia needs a special nursing intervention...what is it?
    5000-10,000 mm3; protect against infection--especially from other people; advise pt to avoid crowds; monitor for signs of infection
  7. What action is recommended when a pt finds a lump during her self-exam?
    bring to the attention of dr immediately; any delay is a waste of valuable time if cancer is present
  8. What is autologous bone marrow transplant?
    removed from individual for own personal use
  9. Know the TNM staging classification system:
    • 1) T subclasses: Primary Tumor
    • 2) N subclasses: Regional Lymph Nodes
    • 3) M subclasses: Distant Metastasis
    • 4) Histopathalogy (G)

    • x= cannot be assessed (Tx)
    • 0= none (No)
    • 1-4= presence (M1)
    • Tis= carcinoma in situ
  10. What is Hodgkin's? If they are receiving chemo, and have stomatitis, what nursing intervention would be important?
    a malignant lymphoma distinguished by painless, progressive enlargement of lymphoid tissue; assis pt with frequent and careful oral hygiene; admin antifungal meds as ordered; give soothing oral lozenges, ice chips and frequent sips of ice water; avoid hot beverages; use lip balm
  11. What are the 7 warning signs of cancer?
    • 1) Changes in bowel or bladder habits
    • 2) A sore throat that does not heal
    • 3) Unusual bleeding or discharge
    • 4) Thickening or lump in breast or elsewhere
    • 5) Indigestion or difficulty swallowing
    • 6) Obvious changes in warts or moles
    • 7) Nagging cough or hoarseness
  12. What foods are recommended to reduce cancer?
    • a) vegetables from cabbage family
    • b) vegetables and fruits high in beta-carotene (ex. carrots, peaches, apricots, squash, broccoli)
    • c) rich sources of vitamin C (ex. grapefruit, oranges, cantaloupe, strawberries, red and green peppers, broccoli, and tomatoes)

    *have at least 5 svgs of fruits and vegetables in the daily diet
  13. What is Kytril and how is it given?
    (granisetron) an antiemetic; admin dose over 5 min period, beginning 30 min before chemo
  14. What is palliative surgery?
    therapy designed to relieve uncomfortable sx, but that does not produce a cure

    * if the cancerous legion has already metastisized, surgery may provide palliation by relieving some assoc problems such as obstruction, ulceration, hemorrhage, and pain
  15. What is care for internal radiation therapy?
    • 1) place pt in private room with "Radiation in use" sign on door
    • 2) keep pt on strict bed rest--do not turn from side to side or onto abdomen--do not raise head >45 degrees
    • 3) do not give complete bed bath while application is in place--do not change bed linens unless necessary
    • 4) encourage pt to do ROM exercises with both arms and mild foot and leg exercises to minimize hazards of immobility---use antiembolism stockings
    • 5)moniter VS every 4 hrs---watch for increased temp, pulse, respirations---report temp >100F
    • 6) observe for and report any rash or skin eruption
    • 7) keep accurate I&O record--encourage fluid intake of at least 3 L/day--indwelling catheter in place
    • 8) serve diet as ordered--usually low residue to minimize peristalsis and BM
    • 9) check position of application q4h
    • 10) use (keep) long-handled forceps and special lead container in pts room for use by radiologist should implant become dislodged--NEVER TOUCH any linens, dressings, or pads for pt--must be checked with radiation survey meter before being removed from pts room
    • 11) make sure pt has access to call light

    *no more than 10 minutes in pts room
  16. What would a nursing dx--Interrupted family processes r/t effect of illness on family members--mean?
    family and/or pt may be irritable and angry with caregivers and/or with each other; understanding and continued warm, responsive caring are the best approaches; dx of cancer has a profound effect of pt and family members--they experience shock, disbelief, denial, anger, fear, anxiety, and a sense of helplessness
  17. What is effective teaching on pain management?
    pain is whatever the pt says it is--existing whenever the pt says it does; educate pt and family about response to pain and management of pain
  18. Imbalanced Nutrition: less than body requirements r/t anorexia from changes in taste and smell would be a nursing dx given to a pt with what dx process?
    pt undergoing chemo
  19. You need to know all about external radiation:
    • 1) specific area on body is marked to indicate the port at which the external radiation will be directed
    • 2) instruct pt on markings (see #22)
    • 3) no ointments, lotions, or powders on that area
    • 4) use only dr approved lotions or creams for dry skin
    • 5) protect radiated area from direct sunlight
    • 6) avoid applications of heat or cold because these would increase erythema, drying, and pruritis of skin which is common in irradiated area
    • 7) encourage diet high in protein and high in calories and fluid intake of 2-3 L/day
    • 8) reassure that lethargy and fatigue are common during tx--frequent rest periods are helpful
  20. How long can a nurse be present in a room with a pt having internal radiation?
    no more than 10 minutes
  21. What would be appropriate goals for pt with Hodgkins receiving external radiation therapy that is really tired and complains of not being able to get OOB?
    let pt know that fatigue and lethargy are normal side effects; pt will have frequent rest periods to improve sx of fatigue and lethargy
  22. What instruction will you give a pt with radiation markings?
    • 1) markings must not be washed off
    • 2) if area becomes wet, skin should be patted with absorbent towel
    • 3) protect area
    • 4) avoid lotions, ointments, or powder on area
  23. Nursing interventions for imbalanced nutrition less than body requirements would be:
    • a) provide adequate, easily digestible, soft, bland diet; avoid spicy foods
    • b) small, frequent high nutritional meals to meet extra demands created by energy used by malignant cells
    • c) allow extra time to eat
    • d) keep room free of odors and clutter
  24. Methods of early cancer detection include:
    Females: PAP, BSE, HPV vaccine

    Males: PSE, PSA tests

    * FOBT, colonoscopy, skin examinations, mammograms
  25. If initial tx has not been successful for tumor lysis syndrome, what would be the next step:
  26. What is appropriate teaching for thrombocytopenia?
    Pt teaching measures to prevent injury and hemorrhage due to low platelets include:

    • 1) use soft toothbrush or swab for mouthcare
    • 2) keep mouth clean and free of debris
    • 3) avoid intrusions into rectum (enemas or rectal meds)
    • 4) used electric shaver
    • 5) apply direct pressure for 5-10 minutes if bleeding occurs
    • 6) avoid contact sports, elective surgery and tooth extraction
    • 7) avoid picking or blowing nose frequently
    • 8) avoid trauma, falls, bumps, and cuts
    • 9) avoid use of aspirin or aspirin preparations
    • 10) use adequate lubrication and gentleness during sex
  27. What are the differences between a benign tumor and a malignant tumor?
    Benign: not recurrent or progressive; nonmalignant; may become serious b/c increase in size damages surrounding tissues (brain)

    Malignant: grows worse resisting tx as in cancerous growths; may progress and destroy surrounding tissues; may also metastisize from primary site of organ to distant sites; when a cell becomes malignant, it carries a tumor-specific antigen on its membranes that is recognized by the body as nonself and destroyed
  28. Why do people delay seeking medical tx when they have s/s of cancer?
    --a common reason for delay in dx of cancer is that early malignant changes do not produce pain and may be far advanced before the pt has any sx

    --seeking med attn when signs occur are also frequently delayed b/c people fear the possible dx of cancer and hope the s/s will just go away
  29. Characteristics of malignant tumors:
    • 1) rate of growth varies--usually rapid
    • 2) mestastisizes
    • 3) rarely contained within a capsule
    • 4) irregular--more mobile when palpated
    • 5) little resemblance to parent tissue
    • 6) invades normal tissue
    • 7) may recur after removal
    • 8) fatal without tx
  30. Definitive way to determine presence of malignant cells is to:
    perform tissue biopsy
  31. Characteristics of a benign tumor:
    • 1) slow, steady growth
    • 2) remains localized
    • 3) usually contained within a capsule
    • 4) smooth, well-defined--movable when palpated
    • 5) resembles parent tissue
    • 6) crowds normal tissue
    • 7) rarely fatal
  32. Following foods recommended to prevent colorectal cancer in men:
    plenty of fruits, vegetables, and whole-grain foods and limit intake of high fat foods