MEDICAL SURGICAL NURSING FINAL ACTUAL EXAM RETAKE 2023/2024(NUR 1211)

MEDICAL SURGICAL NURSING FINAL ACTUAL EXAM RETAKE 2023/2024(NUR 1211) COPD Exercises - CORRECT ANSWER--position patient to provide lung expansion with elevated back rest, pillows, and chair sitting -Breathing techniques: diaphragmatic or abdominal breathing, pursed lip breathing -collaborate with patient and PT to develop exercise plan -remind patient to perform exercises 2-3 times each week COPD- energy conservation techniques - CORRECT ANSWER--daily schedule for rest/work periods -avoid working with arms raised or reaching above head -adjust work heights to reduce back strain -prevent jerky movements that waste energy -adaptive tools for housework -organize work space -no talking when engaging in physical acitivity to conserve energy -avoid breath-holding when performing activities COPD- assessment - CORRECT ANSWER--respiratory changes: rapid, shallow, paradoxical, use of accessory muscles, excursion, abnormal lung sounds, increased chest diameter, cough w/mucous production -cardiovascular changes: HR and rhythm, swelling of feet/ankles, cyanosis, delayed cap refill, clubbing of fingers -psychosocial issues: social isolation, exposure to smoke or crowded living situations, role changes, decreased self esteem, anxiety and fear r/t dyspnea, patient/family expression of feelings and awareness and use of support groups. -diagnostic and lab tests: serial ABG for hypoxemia and hypercarbia, oxygen saturation, sputum cultures, hct and hgb for polycythemia, electrolyte levels, serum AAT levels for those with family history, chest x-ray, PFT, peak expiratory flow rates, carbon monoxide diffusion test Vit B12 Deficiency Symptoms - CORRECT ANSWER--Weakness, tiredness, or lightheadedness -Heart palpitations and shortness of breath -Pale skin -A smooth tongue -Constipation, diarrhea, loss of appetite, or gas -Nerve problems like numbness or tingling, muscle weakness, and problems walking -Vision loss -Mental problems like depression, memory loss, or behavioral changes Risk factors for Cholelithiasis - CORRECT ANSWER--FEMALE, FAT, FORTY -Being age 40 or older -Being a Native American -Being a Mexican-American -Being overweight or obese -Being sedentary -Being pregnant -Eating a high-fat diet -Eating a high-cholesterol diet -Eating a low-fiber diet -Having a family history of gallstones -Having diabetes -Losing weight very quickly -Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs -Having liver disease GI Age-related Changes - CORRECT ANSWER-Stomach-atrophy of gastric mucosa, decrease in HCl acid levels Large intestine-peristalsis decreases and nerve impulses are dulled Pancreas-distention and dilation of pancreatic ducts, calcification of pancreatic vessels occurs with a decrease in lipase production Liver-Decrease in number and size of hepatic cells leads to decreased liver weight. Increase in fibrous tissue. Decreased protein synthesis and changes in enzymes. cholesterol synthesis diminished. Ascites- possible treatments - CORRECT ANSWER--A low-sodium diet and bed rest. -Diuretics. -Removal of ascitic fluid (therapeutic paracentesis) -Sometimes surgery to reroute blood flow (portosystemic shunting) or liver transplantation. -For spontaneous bacterial peritonitis, antibiotics. GERD- Care of Patient - CORRECT ANSWER--Explore patient's meal plan and food preferences -Collaborate with dietician, pt, and family to plan dietary modifications -Limit/eliminate foods that decrease pressure of lower esophageal sphincter and irritate inflamed tissue. -avoid chocolate, peppermint, fatty fried foods, carbonated beverages -eat small meals that aren't spicy or acidic -avoid eating for 3+ hours before bed -eliminate alcohol and tobacco -remain upright after meals 1-2 hours -weight reduction