MED SURG 3 NURS 480 Advanced Med Surg Final Review 2024 A+ Grade.
NURS 480 Final Exam Review:
1. If I push the endotracheal tube too far, where will it... [Show More] go? Right lung so we will have absent
breath sound in the left lung. Right bronchus intubation
2. TIPS (Transjugular Intrahepatic Portosystemic Shunt): in Portal hypertension to decrease the
gastric varices bleeding by decreasing the portal venous pressure
a. This procedure reduces the portal venous pressure and decompresses the varices, thus controlling
bleeding
3. Difference between embolic and thrombotic stroke: how do you explain it to a patient in a way that
they understand?
a. Ischemic Stroke:
i. Inadequate blood flow to the brain from partial or complete occlusion of an artery causes
ischemia distal to the occlusion
ii. 80% of all stroked are ischemic strokes usually thrombolytic should work
iii. It can be thrombotic or embolic
iv. Atherosclerosis, a hardening and thickening of arteries, is the major cause of ischemic stroke. It
can lead to thrombus formation and contribute to emboli.
v. Thrombotic stroke: clot formation there
vi. Embolic stroke: it means it came from somewhere else
1. Thrombotic and embolic are almost the same except that embolic means the blood clot came
from somewhere else in the body you had clot in your carotid and it went to your brain
b. Thrombotic stroke:
i. Thrombosis occurs in relation to injury to a blood vessel wall and formation of a blood clot.
ii. Result of thrombosis or narrowing of the blood vessel
iii. Most common cause of stroke
iv. Lacunar strokes are typically asymptomatic lacunar infarcts can be seen in MRI
1. When we do the MRI in 60-70 years old patient we may see minor infarcts it means the
patient had lacunar strokes but it was totally asymptomatic
c. Embolic Stroke:
i. Occurs when an embolus lodges in and occludes a cerebral artery
ii. Second most common cause of stroke
iii. Rapid occurrence of severe clinical symptoms (loss of consciousness or neurologic deficits)
iv. Onset is usually sudden and may or may not be related to activity
v. Patient usually remains conscious, although he may have a headache
vi. Basically patient has big clot that immediately starts to travel to the brain symptoms:
dysarthria, weakness
vii. We will not miss the embolic stroke
4. If a person has anaphylactic shock, what is the best way to figure out if the patient is doing ok?
What is the first thing you want to check? Airway, Oxygen saturation
- Anaphylactic shock can lead to respiratory distress due to laryngeal edema or severe bronchospasm, and
circulatory failure from the massive vasodilation.8 The patient has a sudden onset of symptoms, including
dizziness, chest pain, incontinence, swelling of the lips and tongue, wheezing, and stridor. Skin changes include
flushing, pruritus, urticaria, and angioedema. In addition, the patient may be anxious and confused and have a
sense of impending doom.
5. Identify an infections process. Lab results will be given, look at the lab results and figure out what
is happening: if the WBC count is high, maybe there is an infection; if the WBC count is going too
low after you start antibiotics neutropenia
Normal WBC: 5,000 to 10,000 mm3
6. What is the concentration of epinephrine that we give for anaphylactic shock? 1:1,000; if we give
IV because there is no choice of giving it intramuscular then the concentration will be 1: 10,000
a. Remember:
i. 1 mg epi is in 10ml (preloaded syringe) usually we give 3-5 ml in anaphylactic shock
if we are giving IV 0.3-0.5mg.
ii. For ventricular fibrillation we give 1mg
iii. For anaphylactic shock: 0.3-0.5mg
iv. IV: 1:10,000; IM: 1:1,000
7. If someone has shock or cardiac failure especially in heart failure, what do we want to monitor
frequently? Breath sounds (very important) because the heart starts to fail
8. African American has jaundice, where do you check for it? Hard palate
9. Select all that apply, S/S of hyperthyroidism, and hypoglycemia
a. Hyperthyroidism:
i. Exophthalmos (bulging eyes),
ii. cannot sit in one place, hyperactivity, decreased attention span, emotional lability
iii. Sweating, diaphoretic
iv. Warm, sweaty, flushed skin with velvety-smooth texture
v. High HR, tachycardia
vi. losing weight, increased appetite
vii. Diarrhea,
viii. Anxiety,
ix. Irritability,
x. Insomnia, interrupted sleep
xi. Fatigue, exercise intolerance
xii. Tremors (place paper on hands and you will notice tremors), hyperreflexia, hyperkinesia,
xiii. Intolerance to heat,
xiv. Light or absent menstrual cycle
xv. Libido initially increased in both men and women, followed by a decrease in libido as the
condition progresses
xvi. Vision changes, retracted eyelids, global lag
xvii. Hair loss
xviii. Goiter
xix. Elevated systolic blood pressure and widened pulse pressure
xx. Auscultation of thyroid gland bruit. [Show Less]
