NSG 233 MEDICAL SURGICAL NURSING
EXAM QUESTIONS AND ANSWERS
Nurse caring for a patient on mechanical ventilation. Alarms goes off and patient does not appear to be
in distress. What does nurse do next?
check the ventilator
What treatment is ordered for COPD patient refusing ventilator?
BIPAP - non-invasive positive pressure
What should nurse do if intubated patient suddenly becomes tachycardic with thrashing and sweating?
respiratory assessment
5 key elements to prevent ventilator associated pneumonia (SATA)
- H2 blockers / PPI (peptic ulcer disease prophylaxis)
- daily oral care with CHG every 2 hours
- elevation of HOB at 30-45 degrees
- DVT prophylaxis
- decrease sedation periodically and assess readiness to extubate
Criteria for weaning patient from ventilator
- vital capacity of 10-15mL/kg
- minute ventilation normal 6L/min (TV x RR)
,- normal ABGs
- maximum inspiratory pressure > -20cm H2O
- tidal volume 7-9mL/kg
Complications of mechanical ventilation (SATA)
- barotrauma
- decreased cardiac output
- ineffective airway clearance
- ventilator associated pneumonia
- hypotension / hypertension
- hypo / hyperventilation
optimal cuff pressure for ventilator
20-25 cm of water (checked every 8 hours)
What is first thing nurse should do if chest tube becomes disconnected?
place end in sterile water
Differentiate the types of diabetes mellitus and their respective risk factors in pregnancy.
1) type 1 DM - usually have an absolute insulin defiency. Caused by autoimmune or unknown. Prone to
ketoacidosis.
2) type 2 DM- individuals who are insulin resistant and usually relative insulin deficiency. Etiology is
unknown. Classic signs polyuria, polydipsia, and polyphagia. Many people with type 2 are obese or have
an increase of fat in the abdominal area. other risk factors aging, sedentary lifestyle, hypertension, and
prior gestational diabetes.
, 3) Pregestational diabetes - is the label sometimes given to type 1 or 2 diabetes that existed before
pregnancy.
4) GDM - is any degree of glucose intolerance with its onset or first recognition during pregnancy.
Compare insulin requirements during pregnancy, the postpartum period, and lactation.
A) first trimester - Insulin need is reduced because of increased insulin production by the pancreas and
increased peripheral sensitivity; nausea, vomiting, and decreased food intake by mother and glucose
transfer to embryo/fetus contributes to hypoglycemia.
B) Second trimester: Insulin need increases as placental hormones, cortisol, and insulinase act as insulin
antagonists, decreasing the effectiveness of insulin.
C)Third trimester: insulin requirements gradually increase increase until about 36 wks of gestation.
D) Day of delivery: maternal insulin requirement drop drastically to approach prepregnancy levels.
E) Breastfeeding mother maintains lower insulin requirements, as much as 25% less than prepregnancy;
insulin need of nonbreastfeeding mother returns to prepregnancy levels in 7 to 10 days.
F) at weaning of breastfeeding infant, mother's insulin need returns to prepregnancy levels.
Identify maternal and fetal risks or complications associated with diabetes in pregnancy.
A) Maternal risks/complications: GDM with an A1c > 6 there is a 28% increase in early pregnancy loss.
Cesarean birth - failure to progress or failure of descent. Preterm birth & labor. Ketoacidosis in 2nd &
3rd trimesters. Hypoglycemia occurs during sleep early in pregnancy when hepatic production of glucose
is dimished and peripheral use of glucose is enhanced. Hyadramnios - 10x more likely. Hypertensive
disorders - preeclampsia, eclampsia. UTI. severe diabetes.
EXAM QUESTIONS AND ANSWERS
Nurse caring for a patient on mechanical ventilation. Alarms goes off and patient does not appear to be
in distress. What does nurse do next?
check the ventilator
What treatment is ordered for COPD patient refusing ventilator?
BIPAP - non-invasive positive pressure
What should nurse do if intubated patient suddenly becomes tachycardic with thrashing and sweating?
respiratory assessment
5 key elements to prevent ventilator associated pneumonia (SATA)
- H2 blockers / PPI (peptic ulcer disease prophylaxis)
- daily oral care with CHG every 2 hours
- elevation of HOB at 30-45 degrees
- DVT prophylaxis
- decrease sedation periodically and assess readiness to extubate
Criteria for weaning patient from ventilator
- vital capacity of 10-15mL/kg
- minute ventilation normal 6L/min (TV x RR)
,- normal ABGs
- maximum inspiratory pressure > -20cm H2O
- tidal volume 7-9mL/kg
Complications of mechanical ventilation (SATA)
- barotrauma
- decreased cardiac output
- ineffective airway clearance
- ventilator associated pneumonia
- hypotension / hypertension
- hypo / hyperventilation
optimal cuff pressure for ventilator
20-25 cm of water (checked every 8 hours)
What is first thing nurse should do if chest tube becomes disconnected?
place end in sterile water
Differentiate the types of diabetes mellitus and their respective risk factors in pregnancy.
1) type 1 DM - usually have an absolute insulin defiency. Caused by autoimmune or unknown. Prone to
ketoacidosis.
2) type 2 DM- individuals who are insulin resistant and usually relative insulin deficiency. Etiology is
unknown. Classic signs polyuria, polydipsia, and polyphagia. Many people with type 2 are obese or have
an increase of fat in the abdominal area. other risk factors aging, sedentary lifestyle, hypertension, and
prior gestational diabetes.
, 3) Pregestational diabetes - is the label sometimes given to type 1 or 2 diabetes that existed before
pregnancy.
4) GDM - is any degree of glucose intolerance with its onset or first recognition during pregnancy.
Compare insulin requirements during pregnancy, the postpartum period, and lactation.
A) first trimester - Insulin need is reduced because of increased insulin production by the pancreas and
increased peripheral sensitivity; nausea, vomiting, and decreased food intake by mother and glucose
transfer to embryo/fetus contributes to hypoglycemia.
B) Second trimester: Insulin need increases as placental hormones, cortisol, and insulinase act as insulin
antagonists, decreasing the effectiveness of insulin.
C)Third trimester: insulin requirements gradually increase increase until about 36 wks of gestation.
D) Day of delivery: maternal insulin requirement drop drastically to approach prepregnancy levels.
E) Breastfeeding mother maintains lower insulin requirements, as much as 25% less than prepregnancy;
insulin need of nonbreastfeeding mother returns to prepregnancy levels in 7 to 10 days.
F) at weaning of breastfeeding infant, mother's insulin need returns to prepregnancy levels.
Identify maternal and fetal risks or complications associated with diabetes in pregnancy.
A) Maternal risks/complications: GDM with an A1c > 6 there is a 28% increase in early pregnancy loss.
Cesarean birth - failure to progress or failure of descent. Preterm birth & labor. Ketoacidosis in 2nd &
3rd trimesters. Hypoglycemia occurs during sleep early in pregnancy when hepatic production of glucose
is dimished and peripheral use of glucose is enhanced. Hyadramnios - 10x more likely. Hypertensive
disorders - preeclampsia, eclampsia. UTI. severe diabetes.
