Galen College Med Surg (NUR170) Exams 1-4 (in 1 pdf File)
Complete Latest Exams Review Study guide_2026/27.
EXAM 1 STUDY GUIDE
Pain The 5th Vital Sign
Characteristics of Acute and Chronic Pain
▪ Acute Pain (sudden onset, trauma, accident) – usually hours to days
o Increased Heart Rate Blood Pressure and Respiratory Rate
o Dilated Pupils and Sweating
o Results from sudden, accidental trauma, surgery; ischemia, inflammation
▪ Chronic Pain (persistent long term) – usually longer than 3 months
o Dull, Burning Sensation
Types of Pain
▪ Nociceptive Pain (normal pain)
o Somatic Pain – Superficial or Subcutaneous Tissue felt by sharp, burning.
o Deep Somatic – Bone, Muscle, Blood Vessel, Connective Tissues.
o Visceral Pain – Organs and Linings of Body Cavities felt by deep cramping, splitting,
sharp.
▪ Neuropathic Pain (abnormal pain) Give Gabapentin
o Nerve Fibers, Spinal Cord, Central Nervous system felt by shooting, fiery, burning, sharp,
numbness.
o DM, phantom limb pain, HIV neuropathies
How to assess pain
• Wong-Baker faces pain rating scale – 0-10 uses visual appearance of face to determine pain
• Pain scales – 1. Numerical, 2. Descriptive, 3. Visual analog scale
• Non-verbal indicators of pain – moaning, crying, irritability, restlessness, grimacing or frowning,
inability to sleep, rigid posture, increased BP/HR/RR, nausea, diaphoresis
Considerations for Older Adults
o Pain is relative to the person, and it is what they say it is. Always take patients self-report
o Pain is not a part of getting older.
o Never give your patient a placebo.
o Start dose low and titrate slowly.
o Avoid Meperidine (Demerol) because it can cause nephron toxicity and chronic delirium.
o Home safety assessment and teach caregivers to help reduce falls and accidents.
o Do not use an older adults hand for IV’s. A nice plump vein in a younger adult is best.
PQRST Acronym
o Precipitates – what triggers the pain?
o Quality – what does it feel like?
o Radiate – is the pain localized or referred?
o Severity – how intense is the pain on a scale of 1-10?
o Treatment – what helps it go away and how long?
Non-Opioid Analgesics
o The first-line therapy for mild to moderate pain.
o Acetaminophen – Max dose 4G q24h, can cause hepatotoxicity and nephrotoxicity. Antidote is
Mucomyst (Acetylcysteine)
, o NSAID (nonselective cox-1-inhibitors) can cause stomach upset and worsen peptic ulcer disease.
o Aspirin / Ibuprofen / Naproxen ^
o NSAID (selective cox-2-inhibitor) doesn’t affect platelet aggregation(clumping) in stomach and
won’t worsen gastric ulcers
o Celecoxib / Meloxicam ^
o Lidocaine – patch and topical cream
Nonpharmacologic interventions
o Elevation of affected body part
o RICE acronym
o Relaxation
o Distraction
o Heat/cold – do not apply directly to skin, use barrier. No more than 15-30 minutes
o NEVER okay to deliver a placebo
o Complementary and alternative therapies – acupuncture/acupressure, chiropractor manipulation,
guided imagery/meditation techniques, herbal therapies, massage, laughter/humor, repositioning,
relaxation, therapeutic touch
Pharmacologic management of pain:
o Basic principle – prevent and control pain
o Multimodal analgesia – using two or more classes of analgesia to target different pain
mechanisms
o Post op pain – combination therapy
o Pre-medicate before procedures/activity
o Oral route is preferred, IV can be used if patient is NPO or nauseated, or if pain is severe or
escalating
Opioids (Block the release of neurotransmitters in the brain and spinal cord) – mainstay in management
of moderate to severe nociceptive types of pain
o Codeine – short-acting weak drug
o Hydrocodone – like codeine and is available as a combination with Tylenol.
o Oxycodone – recommended for both acute and chronic pain, available as IR and ER.
o Morphine – the gold standard for both acute and chronic pain.
o Hydromorphone – synthetic version of morphine and is 8 times stronger.
o Fentanyl – good for chronic pain and available as a patch also in PCA.
o Methadone – the only full opioid agonist with dual mechanism on mu and NMDA.
o Meperidine – not recommended for any type of pain, in older adult can cause acute delirium,
seizures, and psychosis
o Older adults – start low and go slow – starting dose should be 25-50% lower
Side effects of Opioids
• Constipation and/or urinary retention
o Assess previous bowel sounds, and movements, administer stool softeners / laxatives.
• Nausea and Vomiting
o Treat with antiemetic (Zofran / Reglan) prophylactically and prn.
• Sedation and Confusion
o Watch for other antianxiety meds and hypnotics.
o Watch for caffeine intake and consider opioid rotation.
o If patient is not easily aroused or somnolent, STOP medication and contact provider
• Respiratory Depression
, o Monitor respiratory rate, and pulse oximeter
o Decrease dosage if respiratory rate begins to slow, and note that respiratory depression
occurs before sedation
o Resp. assessment is done before arousing sleeping patient – if difficult to arouse, stop
opioid, stay with patient, continue to try to arouse, call for help
o Can cause falls
o (Narcan) Naloxone is the antidote to Opioids
o Flumazenil is antidote for Benzodiazepines
Patient Controlled Analgesic Pump (PCA)
• Usually with morphine, fentanyl or hydromorphone
• Basal Rate = Continuous Infusion
• On-Demand = Button controlled
• Maxiumum of 10 mg/hr
• Make sure to do frequent vital, neuro, and respiratory checks
• Always continuous pulse oximeter
• STOP and report a 15-20mmHg drop in blood pressure or a respiratory rate less than 9
• Post procedure headache must be reported to surgeon or physician immediately
• Only patient controls device
Epidural
• Respiratory depression can occur – monitor closely with pulse ox
• Infection – mental status changes, pyrexia, nuchal rigidity
• Assess patients receiving epidural for their ability to bend their knees and lift their buttocks off the
mattress – if not prohibited by surgical procedure
• Do not delegate assessment
• No anticoagulants
• Monitor site for REED
• Post procedure headache – REPORT PROMPTLY
TENS unit – physical intervention
• Adjuvant therapy – used in addition to other pain management measures
• Placed directly over or near site of pain – not on bone
• Starts to work immediately
Miscellaneous analgesics
• Dual mechanism – tramadol, ultracet
• Anticonvulsants – carbamazepine, topiramate, gabapentinoids – first line for persistent
neuropathic pain
• ^When used for seizure management produce analgesia by blocking sodium and calcium
channels in the CNS, thereby diminishing the transmission of pain. Increasingly being added to
postop treatment plans to address the neuropathic component of surgical pain.
• Antidepressants – TCAs poor choice for older adults, SSRIs, SNRIs
• ^Relieve pain on the descending modulatory pathway by blocking the body’s reuptake of the
inhibitory neurochemical’s norepinephrine and serotonin.
Older adult considerations
• Start low titrate up
• Avoid meperidine
, • Teach caregivers about fall risks.
Perioperative Care
Pre-Operative
• Prophylactic antibiotic received within one hour prior to surgery and then discontinued after 24hr
• Call physician for medication orders for Endocrine, Beta-Blockers, Anti-Convulsant, and Steroids
• Do NOT give Insulin or Diabetic Meds if patient is NPO unless doctor specifies parameters
• Urinary catheter should be removed post-op day one or two at the latest
• Beta-Blocker prior to surgery to prevent hypertension – do not stop
• Venous Thromboembolism (VTE) prevention within 24 hours before and after surgery
• Patient needs to be NPO 6-8 hours prior to procedure to prevent aspiration
• Smoking Cessation at least 24hours before surgery
• Any potassium imbalance must be corrected before surgery, contact the doctor immediately!
• DVT prophylaxis is a must Lovenox, as well as up and walking (if surgery allows patient to do so)
• Stool softener and anti-emetic on the MAR
• DO FULL VITAL ASSESSMENT to establish a baseline and to ensure it is safe to proceed with
the surgery
• Have patient void prior to transfer because the drugs that are given could put the patient at risk
for a fall
• Diagnostics – lab work (HCG, CBC, Coags, CMP, type and screen, UA/UDS), pulmonary
functioning tests, EKG, chest x-ray, electrolytes
• Start post-op teaching in pre-op setting: Incentive spirometry, C & DB, SCD’s, splinting, pain
management
• Skin prep- hair removal by clippers not razors to prevent infection
• Pre op meds: Promote relaxation (sedatives, hypnotics) diazepam, lorazepam, Vistaril,
midazolam
Ensuring Informed Consent
• Reason for procedure, who will be performing, and present during
• Nurse is ONLY the witness, and consent MUST be done prior to sedation and surgery (before
diazepam, lorazepam, vistaril, midazolam)
• All available options and risk associated with each
• Translator phone is a must if language barrier NOT a family member
• Risks associated with surgical procedure and potential outcomes and anesthesia.
• No ABBREVIATIONS on the consent form – whatsoever
• ANY special considerations there must be TWO nurse witnesses (emergency phone
authorization)
• Patient may sign with an “X” if unable to sign full name
• Physician is able to override in emergent situations
• Client can withdraw consent AT ANY TIME
Pre-Op Teaching
• Fears and Anxieties
• Surgical Procedure
Complete Latest Exams Review Study guide_2026/27.
EXAM 1 STUDY GUIDE
Pain The 5th Vital Sign
Characteristics of Acute and Chronic Pain
▪ Acute Pain (sudden onset, trauma, accident) – usually hours to days
o Increased Heart Rate Blood Pressure and Respiratory Rate
o Dilated Pupils and Sweating
o Results from sudden, accidental trauma, surgery; ischemia, inflammation
▪ Chronic Pain (persistent long term) – usually longer than 3 months
o Dull, Burning Sensation
Types of Pain
▪ Nociceptive Pain (normal pain)
o Somatic Pain – Superficial or Subcutaneous Tissue felt by sharp, burning.
o Deep Somatic – Bone, Muscle, Blood Vessel, Connective Tissues.
o Visceral Pain – Organs and Linings of Body Cavities felt by deep cramping, splitting,
sharp.
▪ Neuropathic Pain (abnormal pain) Give Gabapentin
o Nerve Fibers, Spinal Cord, Central Nervous system felt by shooting, fiery, burning, sharp,
numbness.
o DM, phantom limb pain, HIV neuropathies
How to assess pain
• Wong-Baker faces pain rating scale – 0-10 uses visual appearance of face to determine pain
• Pain scales – 1. Numerical, 2. Descriptive, 3. Visual analog scale
• Non-verbal indicators of pain – moaning, crying, irritability, restlessness, grimacing or frowning,
inability to sleep, rigid posture, increased BP/HR/RR, nausea, diaphoresis
Considerations for Older Adults
o Pain is relative to the person, and it is what they say it is. Always take patients self-report
o Pain is not a part of getting older.
o Never give your patient a placebo.
o Start dose low and titrate slowly.
o Avoid Meperidine (Demerol) because it can cause nephron toxicity and chronic delirium.
o Home safety assessment and teach caregivers to help reduce falls and accidents.
o Do not use an older adults hand for IV’s. A nice plump vein in a younger adult is best.
PQRST Acronym
o Precipitates – what triggers the pain?
o Quality – what does it feel like?
o Radiate – is the pain localized or referred?
o Severity – how intense is the pain on a scale of 1-10?
o Treatment – what helps it go away and how long?
Non-Opioid Analgesics
o The first-line therapy for mild to moderate pain.
o Acetaminophen – Max dose 4G q24h, can cause hepatotoxicity and nephrotoxicity. Antidote is
Mucomyst (Acetylcysteine)
, o NSAID (nonselective cox-1-inhibitors) can cause stomach upset and worsen peptic ulcer disease.
o Aspirin / Ibuprofen / Naproxen ^
o NSAID (selective cox-2-inhibitor) doesn’t affect platelet aggregation(clumping) in stomach and
won’t worsen gastric ulcers
o Celecoxib / Meloxicam ^
o Lidocaine – patch and topical cream
Nonpharmacologic interventions
o Elevation of affected body part
o RICE acronym
o Relaxation
o Distraction
o Heat/cold – do not apply directly to skin, use barrier. No more than 15-30 minutes
o NEVER okay to deliver a placebo
o Complementary and alternative therapies – acupuncture/acupressure, chiropractor manipulation,
guided imagery/meditation techniques, herbal therapies, massage, laughter/humor, repositioning,
relaxation, therapeutic touch
Pharmacologic management of pain:
o Basic principle – prevent and control pain
o Multimodal analgesia – using two or more classes of analgesia to target different pain
mechanisms
o Post op pain – combination therapy
o Pre-medicate before procedures/activity
o Oral route is preferred, IV can be used if patient is NPO or nauseated, or if pain is severe or
escalating
Opioids (Block the release of neurotransmitters in the brain and spinal cord) – mainstay in management
of moderate to severe nociceptive types of pain
o Codeine – short-acting weak drug
o Hydrocodone – like codeine and is available as a combination with Tylenol.
o Oxycodone – recommended for both acute and chronic pain, available as IR and ER.
o Morphine – the gold standard for both acute and chronic pain.
o Hydromorphone – synthetic version of morphine and is 8 times stronger.
o Fentanyl – good for chronic pain and available as a patch also in PCA.
o Methadone – the only full opioid agonist with dual mechanism on mu and NMDA.
o Meperidine – not recommended for any type of pain, in older adult can cause acute delirium,
seizures, and psychosis
o Older adults – start low and go slow – starting dose should be 25-50% lower
Side effects of Opioids
• Constipation and/or urinary retention
o Assess previous bowel sounds, and movements, administer stool softeners / laxatives.
• Nausea and Vomiting
o Treat with antiemetic (Zofran / Reglan) prophylactically and prn.
• Sedation and Confusion
o Watch for other antianxiety meds and hypnotics.
o Watch for caffeine intake and consider opioid rotation.
o If patient is not easily aroused or somnolent, STOP medication and contact provider
• Respiratory Depression
, o Monitor respiratory rate, and pulse oximeter
o Decrease dosage if respiratory rate begins to slow, and note that respiratory depression
occurs before sedation
o Resp. assessment is done before arousing sleeping patient – if difficult to arouse, stop
opioid, stay with patient, continue to try to arouse, call for help
o Can cause falls
o (Narcan) Naloxone is the antidote to Opioids
o Flumazenil is antidote for Benzodiazepines
Patient Controlled Analgesic Pump (PCA)
• Usually with morphine, fentanyl or hydromorphone
• Basal Rate = Continuous Infusion
• On-Demand = Button controlled
• Maxiumum of 10 mg/hr
• Make sure to do frequent vital, neuro, and respiratory checks
• Always continuous pulse oximeter
• STOP and report a 15-20mmHg drop in blood pressure or a respiratory rate less than 9
• Post procedure headache must be reported to surgeon or physician immediately
• Only patient controls device
Epidural
• Respiratory depression can occur – monitor closely with pulse ox
• Infection – mental status changes, pyrexia, nuchal rigidity
• Assess patients receiving epidural for their ability to bend their knees and lift their buttocks off the
mattress – if not prohibited by surgical procedure
• Do not delegate assessment
• No anticoagulants
• Monitor site for REED
• Post procedure headache – REPORT PROMPTLY
TENS unit – physical intervention
• Adjuvant therapy – used in addition to other pain management measures
• Placed directly over or near site of pain – not on bone
• Starts to work immediately
Miscellaneous analgesics
• Dual mechanism – tramadol, ultracet
• Anticonvulsants – carbamazepine, topiramate, gabapentinoids – first line for persistent
neuropathic pain
• ^When used for seizure management produce analgesia by blocking sodium and calcium
channels in the CNS, thereby diminishing the transmission of pain. Increasingly being added to
postop treatment plans to address the neuropathic component of surgical pain.
• Antidepressants – TCAs poor choice for older adults, SSRIs, SNRIs
• ^Relieve pain on the descending modulatory pathway by blocking the body’s reuptake of the
inhibitory neurochemical’s norepinephrine and serotonin.
Older adult considerations
• Start low titrate up
• Avoid meperidine
, • Teach caregivers about fall risks.
Perioperative Care
Pre-Operative
• Prophylactic antibiotic received within one hour prior to surgery and then discontinued after 24hr
• Call physician for medication orders for Endocrine, Beta-Blockers, Anti-Convulsant, and Steroids
• Do NOT give Insulin or Diabetic Meds if patient is NPO unless doctor specifies parameters
• Urinary catheter should be removed post-op day one or two at the latest
• Beta-Blocker prior to surgery to prevent hypertension – do not stop
• Venous Thromboembolism (VTE) prevention within 24 hours before and after surgery
• Patient needs to be NPO 6-8 hours prior to procedure to prevent aspiration
• Smoking Cessation at least 24hours before surgery
• Any potassium imbalance must be corrected before surgery, contact the doctor immediately!
• DVT prophylaxis is a must Lovenox, as well as up and walking (if surgery allows patient to do so)
• Stool softener and anti-emetic on the MAR
• DO FULL VITAL ASSESSMENT to establish a baseline and to ensure it is safe to proceed with
the surgery
• Have patient void prior to transfer because the drugs that are given could put the patient at risk
for a fall
• Diagnostics – lab work (HCG, CBC, Coags, CMP, type and screen, UA/UDS), pulmonary
functioning tests, EKG, chest x-ray, electrolytes
• Start post-op teaching in pre-op setting: Incentive spirometry, C & DB, SCD’s, splinting, pain
management
• Skin prep- hair removal by clippers not razors to prevent infection
• Pre op meds: Promote relaxation (sedatives, hypnotics) diazepam, lorazepam, Vistaril,
midazolam
Ensuring Informed Consent
• Reason for procedure, who will be performing, and present during
• Nurse is ONLY the witness, and consent MUST be done prior to sedation and surgery (before
diazepam, lorazepam, vistaril, midazolam)
• All available options and risk associated with each
• Translator phone is a must if language barrier NOT a family member
• Risks associated with surgical procedure and potential outcomes and anesthesia.
• No ABBREVIATIONS on the consent form – whatsoever
• ANY special considerations there must be TWO nurse witnesses (emergency phone
authorization)
• Patient may sign with an “X” if unable to sign full name
• Physician is able to override in emergent situations
• Client can withdraw consent AT ANY TIME
Pre-Op Teaching
• Fears and Anxieties
• Surgical Procedure
