Medical Surgical Certification correctly answered 2023

Medical Surgical Certification correctly answered 2023What are the Kubler-Ross stages of grief? - correct answer denial, anger, bargaining, depression, acceptance Describe Lewin's change management model - correct answer Unfreeze, change, refreeze What changes are necessary for someone taking Coumadin (warfarin)? - correct answer Low 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 answer Example: 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 answer 0.8-2.0 ng/ml (greater than 2 is toxic) What are S/S of hypertensive crisis? - correct answer Headache, vision changes, confusion, nose bleeds (epistaxis), chest/back/abd pain, dyspnea, urinary frequency or oliguria Describe left sided heart failure - correct answer Results in fluid backing up into the lungs (pulmonary edema). S/S of pulmonary edema is pink, frothy sputum Treatment for pulmonary edema - correct answer oxygen, bipap, lasix, morphine (vasodilates vessels), dobutamine (helps with cardiac output) How is the progression of heart failure monitored? - correct answer Left ventricular ejection fraction (LVEF) on an echocardiogram What is the max amount of time an order for restraint usage may be utilized? - correct answer 4 hours (adults) S/S of a basilar skull fracture - correct answer Battle 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 answer May lead to bacterial meningitis (antibiotics may be given prophylactically to prevent this) What are the classic S/S of an epidural hematoma? - correct answer Patient appears lucent and then presents with decreased LOC (Surgical Emergency) What is an epidural hematoma? - correct answer Collection of blood between the dura and the skull Why should you avoid HYPOtonic solutions with brain injuries? - correct answer They cause fluid shifts and may increase cerebral edema (ex.: 1/2NS) What type of solutions are okay to use with brain injuries? - correct answer Isotonic (09%NS) is preferred, HYPERtonic is okay Cushing's Triad - correct answer severe hypertension, widened pulse pressure, bradycardia, abdnormal respiration (s/s of increased intracranial pressure) Cushing's triad indicates - correct answer Increased intracranial pressure (brain herniation) Risk factors for ischemic stroke - correct answer Tobacco, ETOH, illicit drug use, obesity, African-Americans, Age (>55), family history, hx of A-fib/CHF/MI Clinical findings of DKA - correct answer Hyperglycemia (glucose >250), blood pH is acidotic (<7.30), Bicarb: <15, high ketones in the urine or blood (ketonuria/ketonemia) S/S of DKA - correct answer lethargy, kussmauls (Deep/fast breathing, fruity breath), abdominal pain, N/V, postural hypotension HHS (Hyperglycemic Hyperosmolar State) - correct answer Occurs 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 answer liver biopsy What positive assessment finding would indicate cholecystitis? - correct answer Positive Murphy's sign What assessment finding is suggestive of paralytic ileus? - correct answer absent bowel sounds Describe labs on someone who has DIC? - correct answer Low 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 answer Stop the clotting -IV heparin PCO2 normal ABG range - correct answer PCO2 = carbon dioxide, 35-45 mmHg Respiratory Alkalosis causes - correct answer Respiratory distress (blowing off too much CO2), restrictive lung diseases, anxiety w/ excessive respiratory rate What is asterixis? - correct answer hand tremor, this is a classic sign of liver failure. Asterixis may resemble a bird flapping its wings (found in stage 1-3 hepatic encephalopathy) What labs are affected in metabolic acidosis? - correct answer Low HCO3 (<22) and low PH (acidotic, <7.35) What are s/s of pancreatic hemorrhage? - correct answer Cullens sign (bruising around umbilicus) and Turner's sign (flank or back bruising)