Advanced Med-Surg Principles Jersey College Exam 1 Questions and Answers

Advanced Med-Surg Principles Jersey College Exam 1 Questions and Answers What during labor increases the risk of neonate aquiring acute encephalitis? active herpes simplex virus-2 How do you administer meds? starting with the lowest dose and titrating up slowly What is pain is associated with? actual or potential tissue damage When pain stimulates the sympathetic nervous system, what does it result in? - increase in BP - increase in HR - increase in RR Where are catecholamines released from? adrenal medulla Where are steroid hormones (cortisol & aldosterone) released from? adrenal cortex What does unrelieved pain lead to? - increases glucagon production - decreases insulin secretion - depress immune function - can lead to addictive behaviors What initiates inflammation, contributes to tissue sweeling, and pain? Prostaglandins What can nerve root injury lead to? allodynia (pain that is associated with non-noxious stimuli) What is needed for renal blood flow? Prostaglandin Pain is? whatever the patient says it is What is the single most reliable indicator of pain? the patient's self-report How do NSAID's preimarily produce pain relief? by preventing prostaglandin formation What does acetaminphen not have? any inflammatory properties What do you manage nociceptive pain with? - local anesthetics - non-opioids - opioids What does 0 on the 0 - 10 numeric pain rating scale indicate? no pain What does the Wong-Baker FACES pain scale consist of? cartoon faces that the patient (ages 3 and up) selects to report thier pain level What does the visual analog 10cm scale represent? no pain to the worst pain, the patient marks a spot somewhere in between indicating their pain level What pain scale helps indiviuals describe the intensity of pain? verbal descriptor scale What does a comprehensive pain assessment consist of? - duration (when it started/lasted) - type (intensity/assoc factors/influencing fators) - location What patients do we avoid the rectal route for med administration? thrombocytopenic What type of effect do topical agents produce? local What type of effect do transdermal agents produce? drug absorption into the systemic circulation What would help reduce complications related to pain for patients? provide a PCA How do we administer around the clock pain relief for post-op and chronic pain? provide analgesics, never wait for chronic pain to reoccur What is provided for mild to moderate pain? aspirin or acetaminaphen What is provided for moderate pain? NSAID's What is provided for severe pain? morphine Why would you wake patients who have chronic pain or who have moderate to severe pain folowing surgery? to administer prescribed analgcsics What can excessive use of acetaminophen cause? hepatoxicity What does of acetaminophen could lead to hepatoxicity? 4,000 mg/day What can NSAID's meds result in? - gastric ulcers - contribute to CV events (MI or stroke) What can the use of NSAID's lead to in patients with volume depletion or who take it for chronic pain? acute renal failure What undesirable effects do opioids produce? - constipation - nausea - pupil constriction - respiratory distress Physical dependence and tolerance are not the same as what? addiction Why do you never apply heat over a transdermal patch? it could increase absorption and result in lethal complications How should you manage neuropathic pain? with adjuvant meds such as antidepressants or anticonvulsants What should not be used in a clincial practice that it would violate the nurse-patient relationship? placebos What are some non-pharmacologic pain management strategies? - physical modalities - mind-body methods - biologic and energy-based therapies What are the clinical manifestations of hyponatremia? - headaches - seizures - lethargy - tachycardia - decreased BP - thready pulse - hyperactive bowel sounds - abdominal cramps What are signs of hypoxia? - restlessness - confusion - pallor - tachycardia - tachypnea What can vagal stimulation be caused by? - vomiting - suctioning - severe pain all resulting in bradycardia What is a loss of transparency of the eye lens, results in blurry vision, decreased visual acuity, and sensitivity to glare? a cataract What are some risk reductions for catarats? - reducing weight - smoking cessation - optimizing blood sugars - using sunglasses when outdoors What are S/S of an endopthalmitis (infection) that can occur after catarat surgery? - marked by pain - decreasing vision - eyelid redness - eyelid edema - yellowish/green discharge from the eye Viral conjunctivitis is? highly contageous What are S/S of viral conjunctivitis? - marked by conjunctival hyperemia - lid edema - ptosis - foreign body sensation - watery discharge What cranial nerve has nerve fibers from the right and left eye that cross over before sending impulses to the occipital lobe? Cranial nerve II (optic nerve) What increases the risk for retinal artery or vein occlusion and loss of vision? - diabetes - glaucoma - aging - HTN - atherosclerosis What results in blurred distant vision myopia (nearsightedness) What results in blurred near vision? hyperopia (farsightedness) What safety mesaures are used when interacting with visually impaired patients? - keeping objects close by - identifying where objects are - not distracting their safety animal - using the clock method when ambulating - have the pt hold your arm above the elbow - walk a half step behind you When do you treat chemical by irragating water? immediately How do you remove an eye prosthesis? have the pt look upwards while the forefinger is pressing in, down and to the side of the lower eyelid When blood pressure is severe, during acute kidney failure, pheochromocytoma, pregnancy induced HTN, retinopathy what should you NOT do? lower the BP to quickly, it could result in ischemia to the optic disk and brain; BP should be lowered slowly What should the patient avoid when ocular meds are administered? blinking What can occur when ocular onintments are administered? - blurred vision - stinging - burning How do you instill opthalmics? - remove contact lens - hold the lower lid down - instill eye drops before ointments - apply gentle pressure to the inner canthus to occlude it for about 1-2 mins - wait 5 mins before instilling another med - wait 10 mins before instilling ointments What increases the outflow of aqueous humor by constricting the pupil but this could also make it difficult to see in the dark (pupil dilation is needed when lighting is low)? miotics (pilocarpine) What decreases the production of aqueous humor and systemic effects could be observed (bradycardia and hypotension)? beta-blockers (timolol) What are contraindicated in the setting of asthma, COPD, or HF since bronchodilation is inhibited and the HR is decreased? beta-blockers Acetazolamide (Diamox) has diuretic effects and contains sulfa, what would you monitor for and/or avoid? - monitor electrolytes - avoid it with a sulfa allergy What measures for intraocular pressure and screens for glaucoma? tonometry What are the S/S of glaucoma? - may be absent (slient thief of sight) - blurred vision - difficulty focusing - decreased peripheral vision What is associated with a quick rise in intraocular pressure and is an ocular emergency? acute angle closure (pupillary block) glaucoma What is accompanied by periocular pain, conjunctival hyperemia, and a fixed semi-dilated pupil? acute angle closure glaucoma What actions would you tell a patient will increase intraocular pressure? - sneezing - coughing - holding their breath - squeezing the eyelids - valsalva maneuver How is intraocular pressure (10-21 mm Hg) determined? by the amount of aqueous humor that is produced and drained What conditions could increased intraocular pressure result in? - impair blood flow to the retina - damage the optic nerve - lead to blindness What activities would you avoid after eye surgery that would increase intraocular pressure? - lifting - pushing or pulling objects 10 lbs - bending or stooping for prolonged periods - strenuous activity - lying on the affected side - limit walking - limit reading - limit watching TV - limit vacuuming What is the area of the retina that provides central vision? macula What damage results in central vision loss? macular degeneration What test is used to detect macular degeneration and patients should be taught to use it to detect changes early? Amsler grid What type of meds decrease aqueous humor production? - alpha-adrenergic agonists (brimonidine) - carbonic anhydrase inhibitors (acetazolamide) What drug can repair mydriasis (pupil dilation)? alpha-antagonists (tamsulpsin [Flomax]) What increases the risk of retinal detachment? severe myopia (nearsightedness) What are the S/S of retinal detachment? - sudden flashing lights - floaters (spots or strings) - decrease in vision - curtain sign (covering of a portion of one's vision) Why do you place patients in a prone position following a pneumatic retinopexy? so the injected bubble is able to float and serve as a tamponade over the retinal detachment What do we do with impaled objects in the eye? NEVER remove them What happens when assessing unilateral hearing loss with a Weber test? - sound is heard better in the affected ear with conductive deafness - sound is heard better in the unaffected ear with sensorineural deafness How do you asses hearing loss with the Rinne test? a tunning fork is placed on the mastoid bone and then in front of the ear canal; normally air conduction is bone conduction which is a positive Rinne test; with conductive hearing loss air conduction is bone conduction Injury to what part of the ear could impair hearing? tympanic membrane Why should you assess how an individual with hearing loss wants to communicate (writing, sign language, or gestures)? NEVER pretend to understand if you don't Why should you avoid using water when irrigating foreign bodies in the canal? insects and foreign veggies bodies can swell; you should use mineral oil instead Why should we assess for the ability to communicate with our patient? Otoclerosis can lead to conduction hearing loss What condition prevents the bones in the middle ear from moving typicallt impair hearing? otoscerosis How do you care for a hearing aid? - clean the ear mold with soap and water before attaching it to the receiver - instructing that whistling may be heard if the device is worn imprperly How do you remove cerumen (earwax)? - use warm water - use gentle irrigation (in order to avoid perforating the tympanic membrane - also AVOID cold water in can stimulate vomiting) Where is audiometry testing done? - in a sound proof room - it is the single most important diagnostic for detecting hearing loss What 2 nerves joing to form the vestibulocochlear nerve (cranial nerve VIII)? - acoustic - vestibular Where does the eustachian tube connect? the naspharynx to the middle ear and opens when yawning, swallowing, or the valsalve maneuver How do you teach a patient to prevent otitis externa? - use the hair dryer on low heat to dry the external canal - use alcohol drops (acts as an astringent) to help prevent infection - avoid using foreign objects in the external canal What is acute otitis media marked by? -unilateral otalgia (earache) - fever - hearing loss - buldging red tympanic membrane - otorrhea (ear drainage) if the tympanic mem perforates Facial nerve injury is a rare complication of what type of surgery? mastoid surgery ; and you should assess cranial nerve VII After ear surgery to reduce complicationsthe patient should? - not blow nose - not get water in the operative ear for 2-3 wks - keeping the mouth open when sneezing/coughing - not lift 10lbs, bend or strain when lifting - promptly report excessive purulent ear drainage After ear surgery what is normal? temporary hearing loss in the middle ear After ear surgery what should the pt report? crackling and popping sounds in the ear When assessing cranial nerve VII you should note? facial symmetry by having the pt perform different facial expressions How should you communicate with a pt who speech reads? - face the individual - communicate in a well lit room without obscuring your face - inform the pt of the topic