Exam (elaborations) Advanced Med-Surg Final for Lucky students download (Score A+)

Exam (elaborations) Advanced Med-Surg Final for Lucky students download (Score A+) 1. Pt. receiving chemo with acute dehydration (nausea and vomiting), what to do to prevent to 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. 6 hours after thermal burn to arms and legs, important info to tell doctor 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. Pt. acute phase of burn injury requires frequent hydrotherapy sessions for wound debridement – 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 10. 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 12. Asthma pt. has new prescription for Advair and diskus, ask nurse for purpose of 2 drugs – a. one drug decreases inflammation, other is a bronchodilator 13. HCP prescribed MDI q8h Maxair and Symbicort – a. use spacer with MDI 14. Activity intolerance for pt. with asthma – a. work of breathing 15. Finding for acute asthma attack was responding to bronchodilator therapy – 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. During assessment of asthma, has wheezing and dyspnea – a. give meds to reduce airway narrowing Advanced Medsurg Final for lucky students download score A+ 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. COPD pt. has dyspnea, cough, yellow sputum, upon palpation of thorax expected finding – a. chest expansion is diminished 20. COPD with barrel chest, why – overinflation of the alveoli 21. Pulmonary function test for COPD pt – increased residual volume 22. 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. Pursed lip breathing purpose – a. preventing airway collapse and trapping air in lung during expiration 29. Impaired gas exchange in COPD with acute respiratory distress – pulse ox 86% 30. COPD with cor pulmonale, assess/monitor for – JVD 31. COPD receiving oxygen – maintain oxygen at 90% or greater 32. 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. Pt. coughs violently and dislodges trach tube – insert obturator 35. When inflating cough to appropriate level – use manometer 36. Info in pt with ARDS being treated with PEEP indicates complication – pt. has subcutaneous emphysema 37. PEEP purpose, explains to family – a. PEEP prevents air sacs from collapsing during exhalation 38. Evaluate 02 ventilation for acute respiratory – use ABG 39. Findings for acute respiratory failure – partial pressure of Oxygen at 45 mmhg 40. 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. Protect pt. from aspiration pneumonia – position pt. with altered level of consciousness in lateral position 46. 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 50. Pt has right sided chest tube following thoracotomy has continuous bubbling in collection chamber – a. take no action with collection device 51. Pre-op for left pneumonectomy for cancer of lungs – use incentive spirometer 52. Monitor strip for MI, no P wave, rate 162, R interval irregular, PR not measurable, QRS wide and distorted a. Ventricular tachycardia 53. 50 second episode of v. tach – a. administer IV antidysrhythmic drugs per protocol 54. MI develop symptomatic hypotension, hr 30, atropine is prescribed, effective when – a. increase in patient heart rate 55. Large MI has frequent PVC - monitor apical heart rate 56. Pt. complains of racing heart, BP 102/68, puts on cardiac monitor – a. obtain further info about possible cause for heart rate (STRIP) 57. Dizziness and SOB for several days a. 3rd degree av block (STRIP) 58. Nurse gets stuck by a needle – a. hep b vaccine and HBIG injection 59. Hepatitis from contaminated food, serologic testing result – a. anti-hepatitis virus immunoglobulin 60. Evaluation of patient at outpatient clinic, admin of hep B vaccine is effective when – a. anti Hep B are present in specimen 61. Positive for anti HCV – a. schedule patient for HCV genotype testing 62. Homeless patient, severe anorexia, jaundice, diagnosed with hepatitis – a. maintain adequate nutrition 63. Acute hep B asks if treatment is available – a. no meds are available to treat acute viral hepatitis, adequate nutrition and rest are the most important treatments (HB=NO MED) 64. Combination therapy in HIV with hepatitis C patient – 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. 32 yo very alcoholic, cirrhosis, teach them – abstinence from alcohol 69. Pt. with cirrhosis has 135 Na, 3.2 K, needs aldactone and Lasix, before notifying HCP – admin aldactone 70. When lactose is ordered for patient with advanced cirrhosis, pt complains diarrhea – a. lactose improves nervous system function 71. Acute pancreatitis, severe ab pain, N/V, expect – elevated amylase ☺ 72. Caring for patient with acute pancreatitis – assign highest priority to respiratory (airway) 73. Acute pancreatitis on NG tube, NPO, suction purpose – 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. During diuretic phase of ARF, fluid and electrolyte – a. hypovolemia 77. Before administering sodium polystyrene (kayexelate) – 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. Brain tumor receiving brain tumor after craniotomy was prescribe solumedrol – a. helps her prevent increased ICP 80. Cerebral edema with sodium of 115 low, decrease LOC, complains of headache – a. admin 5% hypertonic saline 81. Spinal cord tumor, which requires immediate intervention – a. new onset of weakness in both legs 82. Neck is fractured at C5 admitted to ICU, spinal shock assessment – a. flaccid paralysis and lack of sensation below the level of injury 83. Aspirin order on patient with possible stroke, don’t give it when – a. pt. develops a terrible headache 84. BP 120/60, ICP 24, CPP 56 (70-100) – a. this patient indicates impaired brain flow 85. Head injury, BP 92/50 ICP 18 – a. notify HCP about assessments 86. Initial assessment hospitalized for stroke, BP 180/90, which order to question – Labetalol 87. Subarachnoid hemorrhage in ICU, call HCP if– a. patient’s BP is 90/50 (notify) 88. C5 injury highest priority – a. assessment of respiratory rate and depth 89. 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 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. Paraplegia T10 has neurogenic reflex bladder teaching – a. teach pt. how to self-catheterize 93. T2 spinal cord, I feel awful, head is throbbing, sick to my stomach – I don’t get this Q a. take blood pressure 94. Long term goals with c6 spinal cord injury – a. push manual wheelchair on a flat smooth surface (it was blurry lol) 95. Sustained t1 becomes abusive to nurses and staff, demands transfer – a. ask patient’s input into the plan of care 96. C8 spinal cord, sex life – suggest sexual counseling 97. 25 yo patient following rehab for c8 injury, parent does all ADL – teach patient to foster independence 98. diabetic ketoacidosis intervention – a. infuse 1 Liter of normal saline / hour 99. Hyperglycemic hyperosmolar nonketotic syndrome (HHNC) unresponsive in ER – a. insert large bore IV catheter 100. Bacterial meningitis, report if – BP is 86/42 101. 65 yo patient in clinic, decrease stroke risk → address? – 150/80 (hypertension) 102. ruptured aneurysm – a. apply intermittent compression stockings, avoid coughing and sitting up 103. left sided hemiparesis – check respiratory rate 104. right sided weakness – CT scan 1st 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. Nitroprusside – connected to cyanide poisoning Oliguric= increased BUN/CRT, low urine output 109. Anuric- less than 40ml/hr 110. If K is low, give Aldactone 111. low sodium- fluid restriction 112. Stroke: Safety measure at meal time ………………………………………………………………………………………………………………………………….. Another one ☺ LOOK detail by detail ADVANCE MED SURG FINAL – 100 Qs. 1. 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. c. 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 b. 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.