Advanced Medsurg Final for lucky students download score A+ 1.
Pt. receiving chemo with acute dehydration (nausea and vomiting), what to do to prevent to
... [Show More] Systemic inflammatory response syndrome (SIRS) and Multiple organ dysfunction syndrome (MODS) –
a. place patient in a private room (immunocompromised) 2.
When assessing hemodynamic of patient with shock of unknown etiology, don’t give large volumes of crystalloids when –
a. CO is high and CVP is low (septic shock) 3.
Diabetic patient vomiting and diarrhea for past 3 days, glucose is 748, urine output 120, cyanotic hands and feet–
a. progressive stage of hypovolemic shock 4.
Industrial acids at work spilled on patient, what to do before transporting to hospital –
a. flush burned area with large amounts of tap water 5. a. urine output 20-30 ml per hour 6.
During early emergent phase of burns –
a. give opioid IV so that medications will be rapidly effective 7.
Nurse caring for pt. admitted with burns, 30% of body surface recognized, emergent to acute phase – a. pt. has large quantities of pale urine
8. a. closely monitor serum sodium level 9.
Acute asthma attack, which info indicates pt. requires further teaching –
a. pt. has been using Proventil more frequently over the last 4 days
Pt. acute phase of burn injury requires frequent hydrotherapy sessions for wound debridement –
6 hours after thermal burn to arms and legs, important info to tell doctor
1 | P a g e10.
Asthma pt. admitted for acute
respiratory distress, notify HCP
immediately if –
a. decreased breath sounds and wheezing
11.
Intubation with mechanical ventilation
for pt. with status asthmaticus when –
a. fatigue and oxygen saturation of 88% develops
Asthma pt. has new
prescription for
Advair
and
a. one drug decreases inflammation, other is a
bronchodilator
diskus ,
12.
ask nurse for
purpose of 2 drugs –
13.
HCP prescribed MDI
q8h Maxair and Symbicort –
a. use spacer with MDI
14.
a. work of breathing
15.
a. wheezes are more easily heard
16.
Pt. has mild persistent asthma uses
Proventil has new prescription for
chromolyn –
a. use chromolyn for inflammatory airway changes, take several weeks for max
effect
17.
a. give meds to reduce airway narrowing
18.
Pt. with acute asthma attack comes to ER,
ABG’s are drawn, pH 7.4, co2 32, paO2 70,
teach pt use of peak flow meter –
a. take something before peak flow readings when asthma attack/symptoms
19.
a. chest expansion is diminished
20.
21.
COPD with barrel chest, why –
overinflation of the alveoli
Pulmonary function test for COPD pt –
increased residual volume
COPD pt. has dyspnea, cough, yellow
sputum, upon palpation of thorax
expected finding –
During assessment of asthma, has
wheezing and dyspnea –
Finding for acute asthma attack was
responding to bronchodilator therapy –
Activity intolerance for pt. with asthma –
2 | P a g e22.
Chronic hypoxemia 89-90 % caused by
COPD, compliance – arrange pt. spouse
to be present during teaching
23.
68 YO with COPD, cor pulmonale
manifestation – 3+ edema in lower
extremities
24.
COPD that smokes, tell them that smoking
– decreases area available for oxygen
absorption
25.
Acute COPD exacerbation, ph 7.32 paO2
58, co2 55, pulse ox 86 indicates –
respiratory acidosis
26.
Imbalanced nutrition less than body
requirement intervention –
a. offer high calorie snacks between meals and at bedtime
27.
COPD, info given by patient that confirms
chronic bronchitis –
a. productive cough every winter for 2 months
28.
29.
Pursed lip breathing purpose –
a. preventing airway collapse and trapping air in lung during expiration
Impaired gas exchange in COPD with
acute respiratory distress – pulse ox
86%
30.
31.
32.
COPD with cor pulmonale,
assess/monitor for – JVD
COPD receiving oxygen – maintain
oxygen at 90% or greater
COPD ask about home health oxygen
use – it can improve pt. long term
prognosis and quality of life
33.
RN observes students suctioning, when
to intervene – clean gloves when using a
sterile catheter
34.
35.
Pt. coughs violently and dislodges trach
tube – insert obturator
When inflating cough to appropriate
level – use manometer
3 | P a g e36.
Info in pt with ARDS being treated with
PEEP indicates complication – pt. has
subcutaneous emphysema
37.
38.
39.
40.
PEEP purpose, explains to family –
a. PEEP prevents air sacs from collapsing during exhalation
Evaluate 02 ventilation for acute
respiratory – use ABG
Findings for acute respiratory failure –
partial pressure of Oxygen at 45 mmhg
Caring for patient developed ARDS as a
result of a UTI, how it happened?
a. – infection caused by generalized inflammation that damaged the lungs
41.
When prone position Is used for ARDS,
positioning is effective if – patients FIo2
is 90, and o2 stat is 92
42.
Nurse obtains vital signs of temp 101, bp
90/56, pulse 92, resp 34, whats next ? –
obtain pulse ox
43.
Monitor for clinical manifestations of
hypercapnia when pt. in ER has –
a. chest trauma and multiple rib fractures
44.
Pt. hypercapnia respiratory failure, resp.
8, pulse ox 89, extremely lethargic – ET
with PEEP
45.
46.
Protect pt. from aspiration pneumonia –
position pt. with altered level of
consciousness in lateral position
Drug overdose in ER, barbiturates,
potential complication–
a. hypercapnic respiratory failure related to decreased ventilator effort
47.
Pulmonary embolism, how to explain to
patient –
a. blood flow to some areas of your lungs is decreased even though you’re
taking adequate breaths
48.
Upper Lobectomy patient complains of
incisional pain 7/10, decreased left sided
breath sounds, 100 ML of bloody drainage
with large air leak, intervention –
a. medicate patient with ordered morphine
49.
HCP 2 chest tubes with Y-connector in
pneumothorax, nurse should be
concerned about –
a. 400 ml of blood in the collection chamber
4 | P a g e50.
Pt has right sided chest tube following
thoracotomy has continuous bubbling in
collection chamber –
a.
51.
52.
a. Ventricular tachycardia
53.
54.
a. increase in patient heart rate
55.
56.
Large MI has frequent PVC - monitor
apical heart rate
Pt. complains of racing heart, BP
102/68, puts on cardiac monitor –
a. obtain further info about possible cause for heart rate (STRIP)
57.
a. 3rd degree av block (STRIP)
58.
a. hep b vaccine and HBIG injection
59.
a. anti-hepatitis virus immunoglobulin
60.
a. anti Hep B are present in specimen
61.
62.
a. maintain adequate nutrition
63.
Acute hep B asks if treatment is available
–
5 | P a g e
Positive for anti HCV –
a. schedule patient for HCV genotype testing
Homeless patient, severe anorexia,
jaundice, diagnosed with hepatitis –
Evaluation of patient at outpatient clinic,
admin of hep B vaccine is effective when
–
Hepatitis from contaminated food,
serologic testing result –
Nurse gets stuck by a needle –
Dizziness and SOB for several days
50 second episode of v. tach –
a. administer IV antidysrhythmic drugs per protocol
MI develop symptomatic hypotension, hr
30, atropine is prescribed, effective when
–
take no action with collection device
Pre-op for left pneumonectomy for
cancer of lungs – use incentive
spirometer
Monitor strip for MI, no P wave, rate
162, R interval irregular, PR not
measurable, QRS wide and distorteda. no meds are available to treat acute viral hepatitis, adequate nutrition and
rest are the most important treatments (HB=NO MED)
64.
a. monitor lymphocyte count
65.
When taking history, what should make
you screen for hep C –
a. One time use of IV drugs from years ago
66.
Abrupt onset of jaundice, nausea,
vomiting, hepatomegaly, abnormal liver
function, what is the first question to ask
– are you taking any OTC drugs?
67.
Teaching pt. recovering from hep B,
further teaching –
a. when my jaundice is gone, my infection is cured, I’ve recovered
68.
69.
32 yo very alcoholic, cirrhosis, teach
them – abstinence from alcohol
Pt. with cirrhosis has 135 Na, 3.2 K, needs
aldactone and Lasix, before notifying HCP
– admin aldactone
70.
a.
71.
72.
When lactose is ordered for patient with
advanced cirrhosis, pt complains
diarrhea –
lactose improves nervous system function
Acute pancreatitis, severe ab pain, N/V,
expect – elevated amylase ☺
Caring for patient with acute pancreatitis
– assign highest priority to respiratory
(airway)
73.
a. To reduction of pancreatic enzymes
74.
Collaborative problem for acute
pancreatitis electrolyte imbalance –
a. muscle twitching and finger numbness
75.
When obtaining history about acute
pancreatitis – ask about alcohol
use/consumption
76.
6 | P a g e
During diuretic phase of ARF, fluid and
electrolyte –
Acute pancreatitis on NG tube, NPO,
suction purpose –
Combination therapy in HIV with
hepatitis C patient –a. hypovolemia
77.
a. assess bowel sounds
78.
Hypoglycemia awareness, what should
nurse ask to identify potential
hypoglycemia –
a. did you notice any bloating feeling after eating?
79.
a. helps her prevent increased ICP
80.
a. admin 5% hypertonic saline
81.
a. new onset of weakness in both legs
82.
a.
83.
a. pt. develops a terrible headache
84.
a.
85.
a. notify HCP about assessments
86.
Initial assessment hospitalized for stroke,
BP 180/90, which order to question –
Labetalol
87.
a. patient’s BP is 90/50 (notify)
88.
89.
C5 injury highest priority –
a. assessment of respiratory rate and depth
C8 spinal cord injury has weak cough
effort, bibasilar crackles, decreased
breath sounds –
a. place hand on epigastric area and push upwards until patient coughs
7 | P a g e
Subarachnoid hemorrhage in ICU, call
HCP if–
BP 120/60, ICP 24, CPP 56 (70-100) –
this patient indicates impaired brain flow
Head injury, BP 92/50 ICP 18 –
Neck is fractured at C5 admitted to ICU,
spinal shock assessment –
flaccid paralysis and lack of sensation below the level of injury
Aspirin order on patient with possible
stroke, don’t give it when –
Spinal cord tumor, which requires
immediate intervention –
Cerebral edema with sodium of 115
low, decrease LOC, complains of
headache –
Brain tumor receiving brain tumor after
craniotomy was prescribe solumedrol –
Before administering sodium polystyrene
(kayexelate) –90.
T1 injury, tell family that –
a. full function of patient’s arms will be retained
91.
IV solumedrol effectiveness for spinal
cord injury –
a. assess for motor and sensory function of the legs
92.
a. teach pt. how to self-catheterize
93.
a. take blood pressure
94.
95.
Long term goals with c6 spinal cord
injury –
a. push manual wheelchair on a flat smooth surface (it was blurry lol)
Sustained t1 becomes abusive to
nurses and staff, demands transfer –
a. ask patient’s input into the plan of care
96.
97.
C8 spinal cord, sex life – suggest sexual
counseling
25 yo patient following rehab for c8
injury, parent does all ADL – teach
patient to foster independence
98.
a. infuse 1 Liter of normal saline / hour
99.
a. insert large bore IV catheter
100.
101.
Bacterial meningitis, report if – BP is
86/42
65 yo patient in clinic, decrease stroke
risk address? – 150/80
(hypertension)
102.
103.
104.
8 | P a g e
ruptured aneurysm –
a. apply intermittent compression stockings, avoid coughing and sitting up
left sided hemiparesis – check
respiratory rate
right sided weakness – CT scan 1st
Hyperglycemic hyperosmolar
nonketotic syndrome (HHNC)
unresponsive in ER –
diabetic ketoacidosis intervention –
T2 spinal cord, I feel awful, head is
throbbing, sick to my stomach – I don’t
get this Q
Paraplegia T10 has neurogenic reflex
bladder teaching –105.
occlusion at left posterior cerebral
artery – pt may have visual defects (left
eye)
106. Transient ischemic attack (TIA) has hemiparesis – prepare for TPA infusion
107.
HCP prescribed plavix, patient teaching – call HCP if stools are tarry
108.
109.
110.
111.
112.
Nitroprusside – connected to cyanide poisoning
Oliguric= increased BUN/CRT, low urine output
Anuric- less than 40ml/hr
If K is low, give Aldactone
low sodium- fluid restriction
Stroke: Safety measure at meal time
………………………………………………………………………………………………………………
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Another one ☺ LOOK detail by detail
ADVANCE MED SURG FINAL – 100 Qs.
9 | P a g e1. See someone collapse in front of you, regardless of code blue or stroke, what will you do?
After you see that they’re having a stroke, CALL 911
2. Types of strokes: ischemic and hemorrhagic
a. Hemorrhagic major causes- HTN and aneurysm
b. Ischemic 2 types: embolic and thrombotic
i. 1st you do, assess s/s. Differentiate between R and L. Then give thrombolytic
therapy within 4 or 4 ½ hours.
3. Glasgow Coma Scale
4. Giving hemodynamic patient meds and develop allergic reaction, give Epinephrine.
a. See ax reaction and see BP dropping – epi
b. If hemodynamic was okay and ax reaction – Benadryl
5. Pancreatitis
a. PAIN
i. Pain management – morphine and/or dilaudid. However, morphine can cause
sphincter spasms.
ii. Positions to relieve pain – side lying, knee to chest (fetal)
6. Pneumothorax s/s
a. tachypnea, absent breath sounds, tracheal deviation, asymmetrical chest expansion
7. IV calculations.
8. Morphine – adverse effects: respiratory depression and N/V.
9. Suctioning patient on vent – hyperoxygenate patient b/c of induced hypoxia
(tachycardia, tachypnea, elevated BP)
a. Go in and suction fast while going out. Cause if you go slowly, you’re inducing
hypoxia.
b. When do you suction a Pt? high pressure on vents, auscultation of crackles or
rhonchi, visible secretions, tachypnea,
i. Coughing is not a sign to suction.
10. EKG changes for chest pain.
a. T wave inversion = ischemia
b. ST depression = ischemia or injury
c. ST elevation = MI (Non Q wave MI, nontransmural MI)
i. Q wave with ST elevation = STEMI (transmural MI).
ii. Silent MI are seen in DM patients. iii. When STEMI is treated, you will see
only a pathological Q wave. You know thrombolytic did its job when ST goes
down. If it does not go down, it did not open the coronary artery. You want
revascularization.
11. Improve oxygenation position: Fowler’s
12. Renal failure, liver cirrhosis, and CHF patients – you must do daily weight. Same time of
day (am), same clothes, same scale. If pt was bed ridden, weigh them in bed and use the
same everything.
13. Cardiac enzymes – troponin, CPK or CKMB, or myoglobin. KNOW TIMES. Patient comes in
with chest pain, monitor for 24 hours.
a. Troponin
i. Detectable within 4-6 hours, peaks at 10-24 hours, and can be detected for
up to 10-14 days.
b. CK-MB or CPK
i. Rises around 6 hours, peaks in 18 hours, and returns to baselines around
24-36 hours after an MI.
10 | P a g ec. Myoglobin
i. Rises within 2 hours, peaks in 3-15 hours.
d. Who is worse? Troponin 5 is worse than 0.5
e. Tells you the damage to the myocardium and when the MI happened.
f. Golden time for thrombolytic therapy – up to 4 hours.
i. Contraindication: active bleeding, status post-surgery, thrombolytic stroke,
blood thinners.
14. DM patient teaching
15. Priority Q – which one is the sickest patient.
a. One with hypervolemia (fluid overload, crackles, respiration, pulmonary edema)
***ABC
b. One with hypovolemia (dehydration, fluid replacement, electrolyte imbalance, poor
perfusion) at risk: elderly, DM, burn pts, vomiting, diarrhea, fever. ABC
16. Renal failure diet – low protein b/c kidneys cannot break it down and it will accumulate
in blood stream and it’ll become urea aka toxic af.
17. Hot spots pulses
18. Blood transfusion reaction – what will you do?
a. Stop infusion, sodium chloride, take tubing out, VS
19. Renal failure pts
a. Major complications: hypervolemia (fluid overload- tachypnea, tachycardia, HTN)
or cardiac dysrhythmias (hyperkalemia).
20. A-fib patients
a. Tx: anticoagulants (heparin and warfarin at the same damn time, heparin half-life
is 72 hours), antiarrhythmic (amiodarone, diltiazem), digoxin (increase myocardial
contractility and decrease HR).
i. If amiodarone doesn’t work give cardioversion.
21. Prioritizing Qs – burn patients which one should you assess first. Go right away with ABC
– intubate give oxygen.
a. Pain and fluids are priority
22. ARDS
a. a systemic inflammatory response injures alveolar-capillary membrane.
Becomes permeable to large molecules and the lung gets filled with fluid.
Reduction in surfactant weakens alveoli edema
b. Respiration is a big deal b/c lungs are damaged. They’re usually on the ventilator.
You’ll never see ARDS patient without ventilator unless they are DNR.
c. Deteriorating can be determined by O2Sat below 91% 23. Pain is a priority and is
included with VS.
24. Rapid Response Team is called when patient is starting to deteriorate.
a. Altered LOC, bradycardia, hypotension, hypertension, seizures.
b. If patient was non responsive and blood sugar is 30, you can call RRT.
25. Coumadin (Warfarin) – therapeutic INR is 2-3. If INR is up to 4, hold the dose and notify
MD or pharmacist.
26. Assist for pain while pt is unconscious: pen on nail bed
27. Thrombolytic therapy – when giving, have crash cart with you. They might go into vfib or
vtach, internal bleeding.
28. Thoracentesis – what do you have to do, position, meds, equipment. SATA*
a. Pulse ox, O2, crash cart, suction
11 | P a g eb. Position sitting upright with arms and shoulders raised and supported on pillows
and/or on over-bed table with his feet and legs well-supported. Must be still.
c. Local anesthetic
d. Can only remove 1L at a time.
i. You took too much tachycardia, headache.
e. Sterile dressing
29. hbA1c – normal value is < 6 | 6 – 6 ½ is prediabetes | 6 ½ and above is DM. If it stays up,
pt will develop complications. Goal to stay < 7.
30. Vasopressors – vasopressin, levophed, norepinephrine, dopamine, dobutamine,
epinephrine. You expect increase in SVR, CO, BP, cardiac index, HR.
a. Dopamine major side effect is tachycardia.
31. Sinus Tachycardia
a. Always rule out WHY it happens – stress, coffee, lack of sleep, Yousef Zarkarni, etc.
32. Hemodynamics for acute heart failure. Think of volume – fluid accumulates.
a. What do you expect? #1: CVP will increase. CO and cardiac index will decrease.
33. Hot spots EKG
34. Autonomic dysreflexia s/s
a. Usually triggered by stimulus to lower part of the body.
b. S/S: extreme HTN, sudden severe headache, pallor below the level of the spinal
cord’s lesion dermatome, blurred vision, diaphoresis, restlessness, nausea, and
piloerection.
c. Determine the cause: distended bladder, fecal impaction, cold stress or drafts, tight
clothing, undiagnosed injury.
35. Esophageal and gastric varices. The tube we put orally to stop bleeding temporarily is
Blakemore Tube (balloon tamponade). These patients cannot swallow – so you need to
provide oral care every 2 hours.
36. BiPAP machine – take off and do oral care every 4 hours.
a. Used for sleep apnea.
b. Effective for clients w/ COPD and need ventilator assistance
c. Machine provides positive pressure during inspiration and expiration (low
expiratory rate)
d. CPAP for sleep apnea
37. Hypocalcemia
a. s/s: Convulsions, Arrhythmias, Tetany, Stridor and Spasms,
Trousseau’s/Chvostek’s, deep tendon reflexes, prolonged QT interval, muscle
cramps.
b. Give calcium gluconate
38. Hemodialysis – when do you do dialysis? Select which patient will need it the most.
a. Indications: renal insufficiency, AKI, CKD, drug overdose, persistent hyperkalemia,
hypervolemia unresponsive to diuretics.
39. Cyanosis = bluish discoloration due to excessive concentration of deoxyhemoglobin in the
blood caused by deoxygenation.
a. Central cyanosis = around core, lips and tongue. Low O2, hypoxia.
b. Peripheral cyanosis = only the extremities or fingers. Poor circulation b/c of
peripheral vasoconstriction. Look at the nail beds.
40. Chest Tubes
a. Set up with suction chamber, how to identify leaks (continuous bubbling it is close
to 5; 1-2 bubbling is normal).
12 | P a g e41. Burns – depending on where the burn is, what’re you going to worry about.
a. Neck – breathing and circulatory compromise
b. Legs – compartment syndrome
c. Face, neck, chest
respiratory obstruction
d. Ears nose butt perineum infection
e. Hands feet joints eyes
self-care
42. DKA description o Patho: Start with lack of insulin blood sugar will increase
(hyperglycemia) body will break down the fat body will produce ketones/lactic acid.
(moving from aerobic to anaerobic metabolism). when there’s too much lactic acid, pH
will decrease, patient will develop metabolic acidosis 3 Ps -- decrease volume fluid
(hypo) dehydration
o >250 mg/dL
43. Pancreatitis labs expectation: enzymes go up except for Ca 44. Spinal Cord Injury – how to
classify it.
a. Above and below C4
45. MRI – claustrophobia, pacemaker, metal implant, jewelry.
46. Feeding patient – always practice safety. Head of bed up.
47. Thoracentesis – done b/c too many fluids. What do you look for after and worry?
Tachycardia (pull too much fluids-hypovolemic).
a. Complications: mediastinal shift, pneumothorax (tachycardia), bleeding, infection.
48. After angiogram, make sure pt is not bleeding from the side (L femoral). Apply sandbag
pressure at the same time make sure they have palpable pedal pulses. Keep patient flat for
4-6 hours. If catheter is in, they cannot walk.
49. Diabetes Insipidus – pt might go into dehydration due to polyuria.
50. DKA SATA – how to manage pt.
a. 0.9%, 0.45%, when glucose approaches 250 – add glucose to IV fluids, administer
regular insulin IV bolus and then IB infusion of regular insulin. Once out of DKA,
stop IV and give insulin subQ.
51. Incentive spirometry – encouraged after surgery to increase lung expansion.
52. Types of insulin – when it works, when it doesn’t, peak.
53. How do you do vital signs and how you check
54. Atrial de, vent de, vent re
55. Patient complaining of chest pain, give nitro while he’s sitting down. If walking and has
chest pain, sit him down.
56. Glasgow coma scale – decerebration and decortication
13 | P a g ea. Less than 8, requires ICP monitoring. Pt will not be walking or talking – total care in ICU.
b. E-4, V-5, M-6
57. Med math –gtt/min/hr mL/min x gtt/mL = gtt/mins 58. Vasopressor – we give to improve CO. the major concern when giving multiple vasopressors is kidney shut down because it’ll cause renal artery constriction and go into renal failure. Always monitor urine output* a. When you have hypoperfusion, you worry about kidneys. Urine output will be decrease and urine specific gravity will increase.
b. If CO low, perfusion is low. First sign of hypoperfusion: kidneys – low urine output.
59. AV graft – hear bruit and feel thrill. 60. Stroke patients – how do you assess rehab, the effects of rehab. a. So you can see what they CAN do
61. Head injury – VS, cushing’s triad, ICP s/s 62. Hypoglycemia s/s – what do you do as an RN 63. Chest pain – give nitro, what do you expect afterwards. 64. Chest tube – nursing management a. Can you pull it up to patient level? No.
65. Modifiable and nonmodifiable risk factors for MI 66. Digitalis (digoxin) toxicity – blurred vision and n/v 67. Low pressure alarm on vent; high pressure alarm. What does it tell you and what do you do?
68. How to manage burns in ER. What do you look at? a. Polyuric phase (lots of urine but kidney function will be up), oliguric phase, anuric phase (< 30-40 mL/day)
69. DIETS 70. Patient not waking up cause of increased ammonia. Give lactulose. 71. Renal failure complication – hyperkalemia 72. Hyperkalemia – cardiac dysrhythmias v fib v tach a. Get rid permanently of it by using hemodialysis. b. Acutely, kayexalate bicarb insulin albuterol
73. Conscious sedation so patient is comfortable and doesn’t feel pain while doing procedures. They shouldn’t be totally asleep, should be responsive. Colonoscopy, upper endoscopy, EGD, or cardioversion.
74. Meds for DI – DDAVP a. Look at I&O b. #1 specific gravity.
75. MI patient – cardiac cath – can never bring myocardium back to its normal level even with rehab.
76. Hypervolemia and hypovolemia – what do you do 77. TPN – electrolytes and glucose. Monitor electrolytes, glucose levels. If patient is hypokalemia, give K. Adjust according to labs.
78. Managing MI in ER – MONA 79. Cranial Nerves 80. Stroke patients – increase their strength, range of motion, put them up in bed. 81. Burn patient – bad burn – escaratomies, to improve [Show Less]