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NU265 Med surg /NUR 265 Exam 2 Questions & Answers. What is the normal arterial blood gas (ABG) range for the partial pressure of oxygen (PO2)? o What if it’s higher than 100? What if it’s lower than 80? What is the normal arterial blood gas (ABG) range for the partial pressure of (PaCO2)? o o What if it’s lower than 35? What is it’s higher than 45? What is the normal range for the compensatory arterial blood gas (ABG) (HCO3)? o o What is it’s higher than 28? What if it’s lower than 21? What is the normal range for glucose? What is the range of pre-diabetes for an impaired fasting glucose (IFG) test? What is the range of pre-diabetes for a 2 hour oral glucose tolerance (IGT) test? What is the normal range for a glycosylated hemoglobin (HbA1C) test? What is the reference range for the electrolyte phosphorus? What is the reference range for the electrolyte magnesium? What is the reference range for the electrolyte chloride? What is the reference range for the electrolyte calcium? What is the reference range for the electrolyte potassium? What is the reference range for the electrolyte sodium? What is the reference range for hemoglobin? What is the reference range for hematocrit? What is the reference range for blood osmolarity? What are the normal levels for serum creatinine? What are the normal levels for BUN? What are major risk factors for VTE? [Name 5] If a patient has a VTE, what are the priority nursing interventions? [Name all in order] If a patient is suspected of a VTE, when should you sit them in high-Fowler’s position? If a patient with a VTE is receiving fibrinolytics, what antidotes should be ready in case of overdose? [Name all] What are 4 priority problems for a patient with a PE? [Name all in order] What are the classic symptoms for a PE? [Name all] What conditions could cause a patient to be at risk for ventilatory failure? [Name 5] What is the hallmark of acute respiratory distress syndrome (ARDS)? If your patient is at risk for a PE, what symptoms would let you know to notify the rapid response team? [Name all] What method is most commonly used to diagnose a PE? Despite the different causes for acute lung injury, what triggers ARDS? What is the nursing priority in the prevention of ARDS? What kind of patients are considered at high risk for ARDS? o (1) patients with tube feeding and impaired swallow/gag reflex because of aspirating very acidic gastric contents (2) pancreatitis (3) transfusion reactions (4) trauma o What physical assessments indicate early symptoms of ARDS? What is FiO2? What ABG result will diagnose ARDS? o What does this value look like later? What are common interventions for a patient with ARDS? [Name all] What is refractory hypoxemia? What are 3 modes of mechanical ventilation? How does each work? What is the benefit of PEEP? What is an adverse reaction of PEEP? o How does this occur? What should you do if your patient, who is on a mechanical ventilator, goes into respiratory distress? When should you suction a patient with a mechanical ventilator? o (1) when there are secretions (2) wheezes from increased peak airway pressure (3) decreased breath sounds When would a high-pressure alarm on a mechanical ventilator sound? o When peak inspiratory pressure reaches its limit o What could cause this? [Name 3] When would a low-pressure alarm on a mechanical ventilator sound? o When there is a disconnection or leak in the ventilator circuit or in patient’s artificial airway cuff o What could cause this? What is a common GI problem for patients with mechanical ventilators? How can ventilator-associated pneumonia be avoided? [know both] What is the most common cause of pulmonary contusions? The force applied to the ribs, during blunt trauma to the chest, fractures them and drives the bone into the chest. Therefore, what deep chest injuries are this patient at risk for? [name all] What is the priority nursing focus for a patient with a fractured rib? What is flail chest? o The inward movement of the thorax during inspiration and outward movement during expiration (chest moves opposite of how it should) o What is the name of the movement? What causes flail chest? What interventions are done for a patient with flail chest? [name 3] o (1) mechanical ventilation (2) monitor ABGs (3) monitor vital capacity (4) monitor vital signs (5) monitor fluid status (6) monitor electrolytes (7) pain What is a pneumothorax? o Any chest injury that allows air to enter the pleural space o How does this affect the lungs? How is pneumothorax treated? What are the assessment findings associated with pneumothorax? [name all] o (1) reduced breath sounds (2) hyper-resonance on percussion (3) affected side moved poorly during respirations (4) affected sided is prominent (5) tracheal deviation Which chest trauma poses most life-threatening? o What is this? ▪ When air is forced in the pleural space during inspiration, but doesn’t exit on expiration ▪ How is this a problem? What are the assessment findings of tension pneumothorax? [name 5] o (1) asymmetrical thorax (2) trachea deviates toward unaffected side (3) respiratory distress (4) unilateral absent breath sounds (5) jugular vein distention (6) cyanosis (7) hypertympanic sound on affected side o What abnormals could you expect to see in their ABGs? What does bubbling in a water seal chest tube indicate? o What would cause all bubbling to stop? o What would cause excessive bubbling? What should happen to the water level if the water seal chest tube is working correctly? o What would an absence of the fluctuation mean? What is chamber one in a water seal chest tube? o Collects fluid draining from the patient What is chamber two in a water seal chest tube? What is chamber three in a water seal chest tube? What should a nurse do if a chest tube get pulled out of a patient’s chest? What should a nurse do If a chest tube disconnects from the drainage system? • What is the order of nursing interventions (5) to monitor for manifestations for DKA? o Check airway, level of consciousness, hydration status, electrolytes, and blood glucose levels o What is given in an IV? o What should you check for? o What could the IV therapy cause to happen? What are the classic signs and symptoms resulting from DKA? o What will occur if the kidneys are working? o What will occur if the kidneys are not functioning properly? After a DKA patient has begun treatment, what should you watch for? What would the laboratory findings look like for a patient with DKA? [read words in parentheses] What is normal urine output levels? How would the nurse know when DKA is resolved? What condition do the signs and symptoms of Hyperglycemic-Hyperosmolar Nonketotic Syndrome resemble? What would the laboratory findings look like for a patient with HHNS? [read words in parentheses] What interventions are done from someone with HHNS? What causes hyperglycemic-hyperosmolar nonketotic syndrome? What causes diabetic ketoacidosis? What classifies someone as hypoglycemic? For severe hypoglycemia, when a patient become unconscious, what should be done? Which disorder of the pituitary is a primary disorder? Which disorder of the pituitary can be a primary or secondary disorder or complication of something else? What does ADH do? What causes diabetes insipidus? What causes Syndrome of Inappropriate ADH (SIADH)? What imbalances are associated with DI? What can you expect the urine of a DI patient to be like? What imbalances are associated with SIADH? What can you expect the urine of an SIADH patient to be like? What are the interventions for a patient with DI? What are the interventions for a patient with SIADH? o ( Ehat should you observe for in a patient with SIADH whose sodium levels are below 120? Monitor closely for the development of hypernatremia when administering what drug? What does the parathyroid do? What happens in hyperparathyroidism? What can be done during patient care to avoid injury in a patient with hyperparathyroidism? What are the interventions for hyperparathyroidism? o (1) diuretic and hydration therapy to reduce calcium (2) calcitonin – to reduce the release of skeletal bone calcium and excrete blood calcium o What diuretic is used and why? What happens in hypo-parathyroidism? What could cause hypo-parathyroidism? What are the interventions for a patient with hypo-parathyroidism? o How long does this treatment last? What disease is characterized by acute adrenal insufficiency? o What happens when the body is lacking the adrenal hormone cortisol? What are the signs and symptoms of Addison’s disease (the 5 H’s)? o Hypoglycemia, hyponatremia, hypovolemia, hypotension, hyperkalemia (5 H’s = sugar, salt, volume, blood pressure…potassium is opposite) What interventions are used to treat Addison’s? o What should the nurse monitor if the patient is receiving these interventions? o What does Florinef do? If a patient is taking prednisone (Deltasone) for Addison’s disease, what should the nurse monitor? Why should the nurse advise and Addison’s patient to NEVER ever stop taking prednisone (Deltasone) abruptly, but to taper the doses to discontinue instead? What is the benign tumor of the adrenal medulla called? o What condition does this cause? What caution should be taken considered when a patient has pheochromocytoma? What is the only treatment for pheochromocytoma? o What should be done prior to surgery? How is phenochromocytoma diagnosed? What disease is characterized overproduction of cortisol? o What happens when there is too much cortisol in the blood? [name 6] How is Cushing’s diagnosed? What are priority problems associated with Cushing’s? What drug can you expect to be prescribed for a patient with Cushings? What actions are taken prior to surgery for a patient with Cushing’s? o (1) balanced electrolytes (2) high-calorie, high-protein diet (3) glucocorticoids to prevent Addisonian crisis o What patient teaching should be done? What actions are taken after surgery to care for a patient with Cushing’s? What is a common GI problem for a Cushing’s patient? What is done to protect a patient with Cushing’s from infection? What are, at least, 8 symptoms of hyPERthyroidism? True or False: The increase of a hyperthyroid patient’s temperature by only 1 degree could be the first sign of thyroid storm? o What other symptoms are associated with it? Why is thyroid storm life-threatening? What do the interventions for thyroid storm focus on? Would you expect to assess dyspnea without exertion, blurred vision, amenorrhea, mood swings, and muscle weakness in a patient with hyperthyroidism or hypothyroidism? A patient is admitted with hyPERthyroidism and is fidgeting with the bedcovers and talking extremely fast. What should you do? Why? What drug is hyPERthyroidism treated with? o What does this do? o What is PTU’s black box warning against? What drug is used to treat hypothyroidism? o Levothyroxine (lev-O-thigh-rocks-in) (Synthroid) o What should the nurse teach the patient about taking Levothyroxine? o What condition is caused by an overdose of Levothyroxine (lev-O-thigh-rocks-in) (Synthroid)? Chest pain, palpitations, excessive sweating What is the most important educational need for a patient with hypothyroidism about hormone replacement therapy? What is a myxedema coma? o The hypothyroid version of thyroid storm; the heart becomes flabby and the chambers enlarge resulting in decreased cardiac output o What can treat this? Should you monitor a patient with hyper- or hypothyroidism for eyelid or global lag? A patient is returning from a thyroidectomy, so what 4 items are important to have available? Why? o (1) Oxygen – in case of respiratory distress from swelling or laryngeal spasm (2) Suction equipment – in case of increased secretions (3) Emergency tracheotomy – in case of hemorrhage or edema that blocks the airway (4) Calcium Gluconate – to treat hypocalcemia and tetany in case the parathyroids were injured ▪ What are the signs of hypocalcemia? What should a nurse take notice to that is an alert for laryngeal nerve damage?

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PH-7.35-7.45
PaCO2-35-45
HCO3- 22-26 (bicarb)
K- 3.5-5.0
CA- 9.0-10.5
NA- 135-145
MAG- 1.5-2.5
PHOS- 2-4.5
TSH 0.5-5

NUR 265 Exam 2 Study Questions
➢ What is the normal arterial blood gas (ABG) range for the partial pressure of oxygen (PO2)?
o 80-100 mmHg
o What if it’s higher than 100? What if it’s lower than 80?
▪ Higher = too much oxygenation … lower = hypoxia
➢ What is the normal arterial blood gas (ABG) range for the partial pressure of (PaCO2)?
o
o What if it’s lower than 35? What is it’s higher than 45?
▪ Decreased = Respiratory alkalosis … increased = Respiratory Acidosis
➢ What is the normal range for the compensatory arterial blood gas (ABG) (HCO3)?
o
o What is it’s higher than 28? What if it’s lower than 21?
▪ Higher = respiratory acidosis (compensation for metabolic alkalosis) … Lower = respiratory alkalosis (compensating for metabolic acidosis)
➢ What is the normal range for glucose?
o 60-100 mg/dL
➢ What is the range of pre-diabetes for an impaired fasting glucose (IFG) test?
o 100-125 mg/dL
➢ What is the range of pre-diabetes for a 2 hour oral glucose tolerance (IGT) test?
o 140-199 mg/dL
➢ What is the normal range for a glycosylated hemoglobin (HbA1C) test?
▪ 4-6%
➢ What is the reference range for the electrolyte phosphorus?
o 3 – 4.5 mg/deciLiter
➢ What is the reference range for the electrolyte magnesium?
o 1.3 – 2.1 milli-Equivalents/Liter
➢ What is the reference range for the electrolyte chloride?
o 98 – 106 milli-Equivalents/Liter
➢ What is the reference range for the electrolyte calcium?
o 9 – 10.5 mg/deciLiter
➢ What is the reference range for the electrolyte potassium?
o 3.5 – 5 milli-Equivalents/Liter
➢ What is the reference range for the electrolyte sodium?
o 136 – 145 milli-Equivalents/Liter

, ➢ What is the reference range for hemoglobin?
o 14-18 gram/deciliter
➢ What is the reference range for hematocrit?
o 42-52%
➢ What is the reference range for blood osmolarity?
o 285-295 mOsm/kg
➢ What are the normal levels for serum creatinine?
o 0.6-1.2
➢ What are the normal levels for BUN?
o 10-20
➢ What are major risk factors for VTE? [Name 5]
o (1) prolonged immobility (2) central venous catheter (3) surgery (4) obesity (5) older age (6) blood prone to clotting (7) prior history
➢ If a patient has a VTE, what are the priority nursing interventions? [Name all in order]
o (1) oxygen therapy (2) anticoagulant or fibrinolytic therapy (3) monitoring patient’s response
➢ If a patient is suspected of a VTE, when should you sit them in high-Fowler’s position?
o Immediately after putting them on oxygen
➢ If a patient with a VTE is receiving fibrinolytics, what antidotes should be ready in case of overdose? [Name all]
o (1) clotting factors (2) fresh frozen plasma (3) aminocaproic acid (Amicar)
➢ What are 4 priority problems for a patient with a PE? [Name all in order]
o (1) hypoxemia (2)hypotension (3) potential for bleeding related to anticoagulant/fibrinolytic therapy (4) anxiety
➢ What are the classic symptoms for a PE? [Name all]
o (1) sudden onset of dyspnea (2) sharp, stabbing chest pain (3) restlessness (4) feeling of impending doom (5) cough (6) hemoptysis
o What other symptoms may they experience? [Name 3]
▪ (1) tachypnea (2) crackles (3) pleural friction rub (4) tachycardia (5) sweating (6) low-grade fever (7) decreased O2 Saturation (8) S3 or S4 heart sounds/gallop
(9) petechiae all over chest
➢ What conditions could cause a patient to be at risk for ventilatory failure? [Name 5]
o (1) COPD (2) Pulmonary Embolism or PE (3) ARDS (4) pulmonary edema (5) stroke (6) increased intracranial pressure (7) opioids (8) spinal cord injury (9) massive obesity
(10) sleep apnea
➢ What is the hallmark of acute respiratory distress syndrome (ARDS)?
o Hypoxemia that persists even with 100% oxygen
➢ If your patient is at risk for a PE, what symptoms would let you know to notify the rapid response team? [Name all]
o (1) jugular vein distention (2) syncope (3) cyanosis (4) hypotension
➢ What method is most commonly used to diagnose a PE?
o CT scan
➢ Despite the different causes for acute lung injury, what triggers ARDS?
o Systemic inflammatory response
➢ What is the nursing priority in the prevention of ARDS?
o Early recognition in high risk patients
➢ What kind of patients are considered at high risk for ARDS?
o (1) patients with tube feeding and impaired swallow/gag reflex because of aspirating very acidic gastric contents (2) pancreatitis (3) transfusion reactions (4) trauma
o What physical assessments indicate early symptoms of ARDS?
▪ (1)assess breathing – (a) for increased rate (b) noisy respirations (c) retractions (d) increased effort; (2) cyanosis (3) mental status (4) pallor (5) hypotension
(6) tachycardia (5) dysrhythmias
▪ Why don’t you assess for abnormal lung sounds?
• Because it occurs in the interstitial spaces first and not the airways
➢ What is FiO2 ?

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