Medical Surgical Nursing Final Exam
with Complete Solutions
COPD Exercises - ANS--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 - ANS--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 - ANS--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 - ANS--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 - ANS--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 - ANS-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 - ANS--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 - ANS--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
-smoking cessation
-instruct pt to sleep in right side-lying position
-avoid wearing tight-fitting clothes and working in bent-over or stooped position
with Complete Solutions
COPD Exercises - ANS--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 - ANS--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 - ANS--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 - ANS--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 - ANS--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 - ANS-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 - ANS--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 - ANS--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
-smoking cessation
-instruct pt to sleep in right side-lying position
-avoid wearing tight-fitting clothes and working in bent-over or stooped position
