Medical Surgical Certification Questions with Complete Solutions

What are the Kubler-Ross stages of grief? - CORRECT ANSWERdenial, anger, bargaining, depression, acceptance Describe Lewin's change management model - CORRECT ANSWERUnfreeze, change, refreeze What changes are necessary for someone taking Coumadin (warfarin)? - CORRECT ANSWERLow or moderate intake of green leafy vegetables, fish, liver or cauliflower. These foods are high in vitamin K and may decrease INR level ARBs - CORRECT ANSWERExample: losartan(Cozaar), valsartan (Diovan), olmesartan (Benicar). Used to lower BP. May cause hyperkalemia. Contraindicated: renal artery stenosis What is the therapeutic range for digoxin therapy? - CORRECT ANSWER0.8-2.0 ng/ml (greater than 2 is toxic) What are S/S of hypertensive crisis? - CORRECT ANSWERHeadache, vision changes, confusion, nose bleeds (epistaxis), chest/back/abd pain, dyspnea, urinary frequency or oliguria Describe left sided heart failure - CORRECT ANSWERResults in fluid backing up into the lungs (pulmonary edema). S/S of pulmonary edema is pink, frothy sputum Treatment for pulmonary edema - CORRECT ANSWERoxygen, bipap, lasix, morphine (vasodilates vessels), dobutamine (helps with cardiac output) How is the progression of heart failure monitored? - CORRECT ANSWERLeft ventricular ejection fraction (LVEF) on an echocardiogram What is the max amount of time an order for restraint usage may be utilized? - CORRECT ANSWER4 hours (adults) S/S of a basilar skull fracture - CORRECT ANSWERBattle Signs: bruising behind ears, CSF leaking from nose (clear/colorless/+ for glucose), raccoon eyes What is a serious complication of a basilar skull fracture? - CORRECT ANSWERMay lead to bacterial meningitis (antibiotics may be given prophylactically to prevent this) What are the classic S/S of an epidural hematoma? - CORRECT ANSWERPatient appears lucent and then presents with decreased LOC (Surgical Emergency) What is an epidural hematoma? - CORRECT ANSWERCollection of blood between the dura and the skull Why should you avoid HYPOtonic solutions with brain injuries? - CORRECT ANSWERThey cause fluid shifts and may increase cerebral edema (ex.: 1/2NS) What type of solutions are okay to use with brain injuries? - CORRECT ANSWERIsotonic (09%NS) is preferred, HYPERtonic is okay Cushing's Triad - CORRECT ANSWERsevere hypertension, widened pulse pressure, bradycardia, abdnormal respiration (s/s of increased intracranial pressure) Cushing's triad indicates - CORRECT ANSWERIncreased intracranial pressure (brain herniation) Risk factors for ischemic stroke - CORRECT ANSWERTobacco, ETOH, illicit drug use, obesity, African-Americans, Age (55), family history, hx of A-fib/CHF/MI Clinical findings of DKA - CORRECT ANSWERHyperglycemia (glucose 250), blood pH is acidotic (7.30), Bicarb: 15, high ketones in the urine or blood (ketonuria/ketonemia) S/S of DKA - CORRECT ANSWERlethargy, kussmauls (Deep/fast breathing, fruity breath), abdominal pain, N/V, postural hypotension HHS (Hyperglycemic Hyperosmolar State) - CORRECT ANSWEROccurs in type II diabetics, does not cause ketones, Hyperglycemia (600). Results in Severe Dehydration. Pt has polydipsia, polyphagia, polyuria) What test is the best way to rule out organ rejection or hepatitis in a liver transplant? - CORRECT ANSWERliver biopsy What positive assessment finding would indicate cholecystitis? - CORRECT ANSWERPositive Murphy's sign What assessment finding is suggestive of paralytic ileus? - CORRECT ANSWERabsent bowel sounds Describe labs on someone who has DIC? - CORRECT ANSWERLow platelets (100,000), high PT/PTT (15/60-90) and high d-dimer (2 mg/L) What is the most important DIC medical intervention? - CORRECT ANSWERStop the clotting -IV heparin PCO2 normal ABG range - CORRECT ANSWERPCO2 = carbon dioxide, 35-45 mmHg Respiratory Alkalosis causes - CORRECT ANSWERRespiratory distress (blowing off too much CO2), restrictive lung diseases, anxiety w/ excessive respiratory rate What is asterixis? - CORRECT ANSWERhand tremor, this is a classic sign of liver failure. Asterixis may resemble a bird flapping its wings (found in stage 1-3 hepatic encephalopathy)