NSG 233 Med Surge 3 Final Exam Prep With 70Complete Questions and
Correct Verified Answers (newest!)
1. Chest Trauma- Complications: Flail chest is frequently a complication of blunt chest trauma, which may occu
from a steering wheel injury, motor vehicle crash involving a pedestrian or cyclist, a significant fall onto the
chest, or an assault with a blunt weapon. As with rib fracture, treatment of flail chest is usually supportive.
Management includes providing ventilatory support, clearing secretions from the lungs, and controlling pain. F
mild-to-moderate flail chest injuries, the underlying pulmonary contusion is treated by monitoring fluid intake a
appropriate fluid replacement while relieving chest pain. Pulmonary physiotherapy focusing on lung volume
expansion and secretion management techniques is performed. The patient is closely monitored for further
respiratory compromise.
For severe flail chest injuries, ET intubation and mechanical ventilation are required
to provide internal pneumatic stabilization of the flail chest and to correct abnormal- ities in gas exchange.
2. Shock Fluid: At least two large-gauge IV lines are inserted to establish access for fluid administration. Becau
the goal of the fluid replacement is to restore intravascular volume, it is necessary to administer fluids that will
remain in the intravascular compartment to avoid fluid shifts from the intravascular compartment into the
intracellular compartment. As discussed earlier, crystalloid solutions such as lactated Ringer's solution or 0.9%
sodium chloride solution are commonly used to treat hypovolemic shock, as large amounts of fluid must be
given to restore intravascular volume.
3. Hypovolemic Shock: Hypovolemic shock, the most common type of shock, is characterized by decreased
intravascular volume. Body fluid is contained in the intracellular and extracellular compartments. Intracellular
fluid accounts for about two thirds of the total body water. The extracellular body fluid is found in one of two
compartments: intravascular (inside blood vessels) or interstitial (surrounding tis- sues). The volume of intersti
fluid is about three to four times that of intravascular fluid. Hypovolemic shock occurs when there is a reduction
in intravascular volume by 15% to 30%, which represents an approximate loss of 750 to 1500 mL of blood in a
70-kg (154-lb) person
4. Cardiogenic Shock S&S: Cardiogenic shock occurs when the heart's ability to contract and to pump blood is
impaired and the supply of oxygen is inadequate for the heart and the tissues. In cardiogenic shock, cardiac
output, which is a function of both stroke volume and heart rate, is compromised. Patients in cardiogenic shoc
may experience the pain of angina, develop arrhythmias, complain of fatigue, express feelings of doom, and
show signs of hemodynamic instability.
5. Hemorrhage- Shock: If the patient is hemorrhaging, efforts are made to stop the bleeding. This may involve
applying pressure to the bleeding site or surgical interventions to stop internal bleeding. If the cause of the
hypovolemia is diarrhea
1|Page
,or vomiting, medications to treat diarrhea and vomiting are given while efforts are made to identify and treat the
cause. In older adult patients, dehydration may be the cause of hypovolemic shock.
6. Shock Septic- Dopamine: Dopamine, a naturally occurring precursor of norep- inephrine and epinephrine,
functions as a neurotransmitter. Dopamine is useful in hypovolemic and cardiogenic shock. Adequate fluid
therapy is necessary for maxi- mal pressor (increased blood pressure) effect. Acidosis decreases the
effectiveness of the drug. If fluid therapy alone does not effectively improve tissue perfusion, vasopressor
agents, specifically norepinephrine or dopamine, may be initiated to achieve a MAP of 65 mm Hg or higher
7. AAA- Tests: The most important diagnostic indication of an abdominal aortic aneurysm is a pulsatile mass in
the middle and upper abdomen. Most clinically significant aortic aneurysms are palpable during routine physic
examination; how- ever, the sensitivity depends upon the size of the aneurysm, abdominal girth of the patient
(i.e., more difficult to find in the patient with obesity), and the skill of the examiner. A systolic bruit may be hear
over the mass. Duplex ultrasonography or CTA is used to determine the size, length, and location of the
aneurysm. When
the aneurysm is small, ultrasonography is conducted at 6-month intervals until the aneurysm reaches a size so th
surgery to prevent rupture is of more benefit than the possible complications of a surgical procedure. Some
aneurysms remain stable over many years of monitoring.
8. AAA- Post Op: The patient who has had an endovascular repair must lie supine for 6 hours; the head of the
bed may be elevated up to 45 degrees after two hours. The patient needs to use a bedpan or urinal while on
bed rest. Vital signs and Doppler assessment of peripheral pulses are performed initially every 15 minutes and
then at progressively longer intervals if the patient's status remains stable. The access site (usually the femora
artery) is assessed when vital signs and pulses are monitored. The nurse assesses for bleeding, pulsation,
swelling, pain, and hematoma formation. Skin changes of the lower extremity, lumbar area, or buttocks that
might indicate signs of embolization, such as extremely tender, irregularly shaped, cyanotic areas, as well as
any changes in vital signs, pulse quality, bleeding, swelling, pain, or hematoma, are immediately reported to th
primary provider. The patient's temperature should be monitored every four hours, and any signs of
postimplantation syndrome should be reported. Postimplantation syndrome typically begins within 24 hours of
stent-graft placement and consists of a spontaneously occurring fever, leukocytosis, and occasionally, transien
thrombocytopenia. This condition has been attributed to complex immunologic changes that occur because of
manipulations with sheaths and catheters with the aortic lumen, although the exact etiology is unknown. The
symptoms are thought to be related to the activation
2|Page
,of cytokines. They can be managed with a mild analgesic (e.g., acetaminophen [Tylenol]) or an anti-inflammatory
agent (e.g., ibuprofen [Motrin]) and usually subside within a week.
Because of the increased risk of hemorrhage, the primary provider is also notified of persistent coughing, sneezin
vomiting, or systolic blood pressure greater than 180 mm Hg. Most patients can resume their pre-proce
9. Asystole Drug Choice: In such cases, the treatment is the same as for asystole and pulseless electrical activ
(PEA) if the patient is in cardiac arrest or for bradycardia if the patient is not in cardiac arrest. Interventions
include identifying the underlying cause; administering IV epinephrine, atropine, and vasopressor medications
and initiating emergency transcutaneous pacing. In some cases, id- ioventricular rhythm may cause no
symptoms of reduced cardiac output. Ventricular asystole is treated the same as PEA.
10. Dysthythmias and Calium: A low calcium level could lead to severe ventricular dysrhythmias, prolonged
QT, and cardiac arrest. Calcium blood levels help maintain normal heartbeats, while low levels can
simultaneously cause polarization and depolarization of cardiac cells, and thereby predispose the heart to
arrhythmias.
***FROM GOOGLE
11. ETT Assessment: The nurse plays a vital role in assessing the patient's status and the functioning of
ventilator. In assessing the patient, the nurse evaluates the patient's physiologic status and how he or she
coping with mechanical ventilation.
Physical assessment includes systematic assessment of all body systems, with an in-depth focus on the
respiratory system. Respiratory assessment includes vital signs, respiratory rate and pattern, breath sounds,
evaluation of spontaneous ventilatory effort, and potential evidence of hypoxia (e.g., skin color). Increased
adventitious breath sounds may indicate a need for suctioning. The nurse maintains the patient's head of the bed
so that it is elevated 30° or higher unless contraindi- cated to prevent the risk of aspiration and VAP. The nurse
evaluates the settings and functioning of the mechanical ventilator, as described previously, and verifies
endotracheal tube position as applicable.
Assessment also addresses the patient's neurologic status and effectiveness of coping with the need for assisted
ventilation and the changes that accompany it. The nurse assesses the patient's comfort level and ability to
communicate as
well. Because weaning from mechanical ventilation requires adequate nutrition, it is important to assess the
patient's gastrointestinal system and nutritional status.
12. Thoracotomy- water seal functuality
Water Seal System: The traditional water seal system (or wet suction) for chest drainage has three chambers: a
collection chamber, a water seal chamber, and a
3|Page
Correct Verified Answers (newest!)
1. Chest Trauma- Complications: Flail chest is frequently a complication of blunt chest trauma, which may occu
from a steering wheel injury, motor vehicle crash involving a pedestrian or cyclist, a significant fall onto the
chest, or an assault with a blunt weapon. As with rib fracture, treatment of flail chest is usually supportive.
Management includes providing ventilatory support, clearing secretions from the lungs, and controlling pain. F
mild-to-moderate flail chest injuries, the underlying pulmonary contusion is treated by monitoring fluid intake a
appropriate fluid replacement while relieving chest pain. Pulmonary physiotherapy focusing on lung volume
expansion and secretion management techniques is performed. The patient is closely monitored for further
respiratory compromise.
For severe flail chest injuries, ET intubation and mechanical ventilation are required
to provide internal pneumatic stabilization of the flail chest and to correct abnormal- ities in gas exchange.
2. Shock Fluid: At least two large-gauge IV lines are inserted to establish access for fluid administration. Becau
the goal of the fluid replacement is to restore intravascular volume, it is necessary to administer fluids that will
remain in the intravascular compartment to avoid fluid shifts from the intravascular compartment into the
intracellular compartment. As discussed earlier, crystalloid solutions such as lactated Ringer's solution or 0.9%
sodium chloride solution are commonly used to treat hypovolemic shock, as large amounts of fluid must be
given to restore intravascular volume.
3. Hypovolemic Shock: Hypovolemic shock, the most common type of shock, is characterized by decreased
intravascular volume. Body fluid is contained in the intracellular and extracellular compartments. Intracellular
fluid accounts for about two thirds of the total body water. The extracellular body fluid is found in one of two
compartments: intravascular (inside blood vessels) or interstitial (surrounding tis- sues). The volume of intersti
fluid is about three to four times that of intravascular fluid. Hypovolemic shock occurs when there is a reduction
in intravascular volume by 15% to 30%, which represents an approximate loss of 750 to 1500 mL of blood in a
70-kg (154-lb) person
4. Cardiogenic Shock S&S: Cardiogenic shock occurs when the heart's ability to contract and to pump blood is
impaired and the supply of oxygen is inadequate for the heart and the tissues. In cardiogenic shock, cardiac
output, which is a function of both stroke volume and heart rate, is compromised. Patients in cardiogenic shoc
may experience the pain of angina, develop arrhythmias, complain of fatigue, express feelings of doom, and
show signs of hemodynamic instability.
5. Hemorrhage- Shock: If the patient is hemorrhaging, efforts are made to stop the bleeding. This may involve
applying pressure to the bleeding site or surgical interventions to stop internal bleeding. If the cause of the
hypovolemia is diarrhea
1|Page
,or vomiting, medications to treat diarrhea and vomiting are given while efforts are made to identify and treat the
cause. In older adult patients, dehydration may be the cause of hypovolemic shock.
6. Shock Septic- Dopamine: Dopamine, a naturally occurring precursor of norep- inephrine and epinephrine,
functions as a neurotransmitter. Dopamine is useful in hypovolemic and cardiogenic shock. Adequate fluid
therapy is necessary for maxi- mal pressor (increased blood pressure) effect. Acidosis decreases the
effectiveness of the drug. If fluid therapy alone does not effectively improve tissue perfusion, vasopressor
agents, specifically norepinephrine or dopamine, may be initiated to achieve a MAP of 65 mm Hg or higher
7. AAA- Tests: The most important diagnostic indication of an abdominal aortic aneurysm is a pulsatile mass in
the middle and upper abdomen. Most clinically significant aortic aneurysms are palpable during routine physic
examination; how- ever, the sensitivity depends upon the size of the aneurysm, abdominal girth of the patient
(i.e., more difficult to find in the patient with obesity), and the skill of the examiner. A systolic bruit may be hear
over the mass. Duplex ultrasonography or CTA is used to determine the size, length, and location of the
aneurysm. When
the aneurysm is small, ultrasonography is conducted at 6-month intervals until the aneurysm reaches a size so th
surgery to prevent rupture is of more benefit than the possible complications of a surgical procedure. Some
aneurysms remain stable over many years of monitoring.
8. AAA- Post Op: The patient who has had an endovascular repair must lie supine for 6 hours; the head of the
bed may be elevated up to 45 degrees after two hours. The patient needs to use a bedpan or urinal while on
bed rest. Vital signs and Doppler assessment of peripheral pulses are performed initially every 15 minutes and
then at progressively longer intervals if the patient's status remains stable. The access site (usually the femora
artery) is assessed when vital signs and pulses are monitored. The nurse assesses for bleeding, pulsation,
swelling, pain, and hematoma formation. Skin changes of the lower extremity, lumbar area, or buttocks that
might indicate signs of embolization, such as extremely tender, irregularly shaped, cyanotic areas, as well as
any changes in vital signs, pulse quality, bleeding, swelling, pain, or hematoma, are immediately reported to th
primary provider. The patient's temperature should be monitored every four hours, and any signs of
postimplantation syndrome should be reported. Postimplantation syndrome typically begins within 24 hours of
stent-graft placement and consists of a spontaneously occurring fever, leukocytosis, and occasionally, transien
thrombocytopenia. This condition has been attributed to complex immunologic changes that occur because of
manipulations with sheaths and catheters with the aortic lumen, although the exact etiology is unknown. The
symptoms are thought to be related to the activation
2|Page
,of cytokines. They can be managed with a mild analgesic (e.g., acetaminophen [Tylenol]) or an anti-inflammatory
agent (e.g., ibuprofen [Motrin]) and usually subside within a week.
Because of the increased risk of hemorrhage, the primary provider is also notified of persistent coughing, sneezin
vomiting, or systolic blood pressure greater than 180 mm Hg. Most patients can resume their pre-proce
9. Asystole Drug Choice: In such cases, the treatment is the same as for asystole and pulseless electrical activ
(PEA) if the patient is in cardiac arrest or for bradycardia if the patient is not in cardiac arrest. Interventions
include identifying the underlying cause; administering IV epinephrine, atropine, and vasopressor medications
and initiating emergency transcutaneous pacing. In some cases, id- ioventricular rhythm may cause no
symptoms of reduced cardiac output. Ventricular asystole is treated the same as PEA.
10. Dysthythmias and Calium: A low calcium level could lead to severe ventricular dysrhythmias, prolonged
QT, and cardiac arrest. Calcium blood levels help maintain normal heartbeats, while low levels can
simultaneously cause polarization and depolarization of cardiac cells, and thereby predispose the heart to
arrhythmias.
***FROM GOOGLE
11. ETT Assessment: The nurse plays a vital role in assessing the patient's status and the functioning of
ventilator. In assessing the patient, the nurse evaluates the patient's physiologic status and how he or she
coping with mechanical ventilation.
Physical assessment includes systematic assessment of all body systems, with an in-depth focus on the
respiratory system. Respiratory assessment includes vital signs, respiratory rate and pattern, breath sounds,
evaluation of spontaneous ventilatory effort, and potential evidence of hypoxia (e.g., skin color). Increased
adventitious breath sounds may indicate a need for suctioning. The nurse maintains the patient's head of the bed
so that it is elevated 30° or higher unless contraindi- cated to prevent the risk of aspiration and VAP. The nurse
evaluates the settings and functioning of the mechanical ventilator, as described previously, and verifies
endotracheal tube position as applicable.
Assessment also addresses the patient's neurologic status and effectiveness of coping with the need for assisted
ventilation and the changes that accompany it. The nurse assesses the patient's comfort level and ability to
communicate as
well. Because weaning from mechanical ventilation requires adequate nutrition, it is important to assess the
patient's gastrointestinal system and nutritional status.
12. Thoracotomy- water seal functuality
Water Seal System: The traditional water seal system (or wet suction) for chest drainage has three chambers: a
collection chamber, a water seal chamber, and a
3|Page
