ATI MED-SURG CMS EXAM QUESTIONS AND VERIFIED ANSWERS exam #5

ATI MED-SURG CMS EXAM QUESTIONS AND VERIFIED ANSWERS exam #5 Diet for Addison's Disease - ANSWER -high sodium, low potassium, and increased fluids; -small frequent meals to prevent hypoglycemia Addison's Disease - skin manifestations - ANSWER darkening or bronze pigmentation of skin in both exposed and unexposed parts of the body Cushing's disease - skin manifestations - ANSWER purple striae on chest and abdomen Atrial fibrillation - ANSWER -frequently occurs after CABG; -in A-Fib the atrial kick is lost and cardiac output is decreased by 30% Anti-embolic stockings - ANSWER Remove stockings 1 to 3 times per day for skin care and inspection hyponatremia -net gain of water or loss of sodium-rich fluids -sodium levels drop gradually over period of 48 hr or longer -Normal sodium: 135 to 145 - ANSWER -when the amount of sodium in fluids outside cells drops [hyponatremia], water moves into the cells to balance the levels. This causes the cells to swell with too much water Water moves from the ECF into the ICF, causing cells to swell (cerebral edema). -client is now in a fluid overload situation: Restrict water intake as prescribed by provider [to keep the blood from becoming more dilute and possibly causing more health problems] -to restore normal ECF volume: Administer isotonic I.V therapy [NS or LR] How is *acute* hyponatremia different from the normal hyponatremia [that we treat w/isotonic fluids], and how do we treat it? - ANSWER - in acute hyponatremia - sodium levels drop *rapidly* in *< 48 hrs* - water enters brain cells causing them to swell, resulting in deadly cerebral edema; -hypertonic fluids are used to pull water out of the cells and decrease the swelling fluid volume deficit is reflected in an *increase* of which lab values? - ANSWER -BUN; -hematocrit [remember this is ratio of cells to volume]; -urine specific gravity and osmolarity; -serum sodium [remember "sodium high, patient dry"] A nurse is caring for a client recently diagnosed w/diabetes mellitus (DM). Which of the following is the *physiologic basis for polyuria manifested by individuals with untreated DM*? - ANSWER Hyperosmolarity of the extracellular fluids secondary to hyperglycemia Is urine concentration increased or decreased in early-stage renal failure ? - ANSWER increased urine concentration + increased specific gravity What does it mean if a pacemaker is set at a ventricular rate of 70 beats per minute? - ANSWER 70 beats per minute is the rate at which the pacemaker will "kick in" to prevent the heart from going slower than this rate; -if patient has a heart rate slower than the set rate there is a problem and HCP needs to be notified If a patient is in chronic atrial fibrillation and the ventricle is going too slow, where is the pacemaker lead placed? - ANSWER a single lead is placed in the ventricle [because the fibrillating atrium cannot be paced] Why is it important to give COPD patients *low* concentrations [i.e., 2 to 3 liters] of O2? - ANSWER For clients with COPD the *stimulus to breathe is the low P.a.O2 level* so if this level is increased [with a higher concentration of O2] they won't have the stimulus to breathe High pressure alarm for a ventilator - ANSWER -Think *HOLD* - *H*igh alarm = *O*cclusion; *L*ow alarm = *D*isconnection; -examples: occlusion or partial occlusion of ETT tube or ventilator tubing, mucus plug, client biting tube, kinked tube and fluid collection in vent tubing; also if client is "bucking" the vent [fighting it] or coughing In the immediate postoperative period, what are priority interventions when caring for a client who has had a gastric resection to treat peptic ulcer disease? - ANSWER 1) assess NG tube for patency to prevent retention of gastric secretions; 2) secure tube to prevent movement; 3) monitor amount of blood draining fro