Med Surg 2 Final Exam Study Guide
Questions With 100% Pass
What is the correct order for mixing insulin?
Per nurse pat handout
- Clear insulin first, then cloudy insulin:
- Roll NPH, clean both vials
- Withdraw enough air equal to the total amount of insulin
- Inject the air into the NPH without touching the insulin
- Inject the remaining air into the regular insulin, then withdraw the regular
dosage.
- Withdraw the NPH dosage.
What is the onset and peak time for NPH insulin?
Per nurse pat handout
Onset: 1-2 hours, Peak: 6-14 hours.
What are Kussmaul respirations?
pg. 584
- Deep, rapid, labored breathing in an attempt to excrete carbon dioxide and acid due
to metabolic acidosis (DKA).
What equipment is needed at the bedside post-thyroidectomy?
pg. 564
- Suction equipment
- Tracheostomy tray
- Humidified oxygen
- Make sure IV calcium gluconate or calcium chloride is immediately available.
What is the drug category of Levothyroxine?
pg. 568
- A synthetic (thyroxine [T4]) thyroid hormone replacement that is taken for life.
- Your dosage will be increased every 2-3 weeks, depending on your TSH levels.
- Take your medication on an empty stomach 30-60 minutes before breakfast
- Do not stop taking this medication or change the dose or brand name
-For hypothyroidism (everything low & slow)
Levothyroxine side effects
- nervousness/irritability
- hand tremors
- tachycardia
- palpitations
- SOB
- Heat intolerance
- dysrhythmias
- angina/chest pain
- rapid weight loss
, - sweating
- hyperthyroidism
What lab value indicates hepatic encephalopathy?
pg. 368
Elevated ammonia levels.
Elevated potassium, LFT
(Treatment: Lactulose)
What is the plan of care for acute gastritis?
pg. 327
- NO IBUPROFEN
- Rest the bowels
- NPO initially, then progress to clear liquids, then bland diet as tolerated
- IV fluids and medications to reduce stomach acid.
- PPIs (omeprazole) or H2 blockers (famotidine) are prescribed to protect the stomach
lining.
- Sucralfate → coats and protects the gastric mucosa.
- Monitor for GI bleeding, anemia
- Avoid: caffeine, spicy foods, alcohol, tobacco, NSAIDs
- Report dark/tarry stools, coffee-ground emesis, or severe abdominal pain (signs of
bleeding)
Effects of NSAIDs on gastric ulcer
pg. 321, 325
- Should avoid (causes erosive gastritis, direct irritation to the GI [stomach lining],
and more GI bleeding)
What should be monitored in a client with a nasogastric tube (NGT)?
pg. 336
- Document the NG drainage with the client's output
- Monitor bowel sounds
- Ensure the client is in semi-Fowler's position
- Monitor NG tube for placement via X-ray or pH gastric test
- Irrigate q4hr
- Monitor v/s, daily weight, and nasal area for skin breakdown
- Provide oral hygiene q2hr
- Maintain intermittent suction PRN
What are the signs and symptoms of bowel perforation post-paracentesis?
pg. 306
- Fever
- Sudden severe abdominal pain
- Rigid board-like abdomen/distention, rebound tenderness
- Hypovolemia, Hypotension, absent bowel sounds
- Change in mental status
- Bleeding or leakage of fluid
What are the expected findings with pancreatitis?
(place in side-lying position)
pg. 355
Questions With 100% Pass
What is the correct order for mixing insulin?
Per nurse pat handout
- Clear insulin first, then cloudy insulin:
- Roll NPH, clean both vials
- Withdraw enough air equal to the total amount of insulin
- Inject the air into the NPH without touching the insulin
- Inject the remaining air into the regular insulin, then withdraw the regular
dosage.
- Withdraw the NPH dosage.
What is the onset and peak time for NPH insulin?
Per nurse pat handout
Onset: 1-2 hours, Peak: 6-14 hours.
What are Kussmaul respirations?
pg. 584
- Deep, rapid, labored breathing in an attempt to excrete carbon dioxide and acid due
to metabolic acidosis (DKA).
What equipment is needed at the bedside post-thyroidectomy?
pg. 564
- Suction equipment
- Tracheostomy tray
- Humidified oxygen
- Make sure IV calcium gluconate or calcium chloride is immediately available.
What is the drug category of Levothyroxine?
pg. 568
- A synthetic (thyroxine [T4]) thyroid hormone replacement that is taken for life.
- Your dosage will be increased every 2-3 weeks, depending on your TSH levels.
- Take your medication on an empty stomach 30-60 minutes before breakfast
- Do not stop taking this medication or change the dose or brand name
-For hypothyroidism (everything low & slow)
Levothyroxine side effects
- nervousness/irritability
- hand tremors
- tachycardia
- palpitations
- SOB
- Heat intolerance
- dysrhythmias
- angina/chest pain
- rapid weight loss
, - sweating
- hyperthyroidism
What lab value indicates hepatic encephalopathy?
pg. 368
Elevated ammonia levels.
Elevated potassium, LFT
(Treatment: Lactulose)
What is the plan of care for acute gastritis?
pg. 327
- NO IBUPROFEN
- Rest the bowels
- NPO initially, then progress to clear liquids, then bland diet as tolerated
- IV fluids and medications to reduce stomach acid.
- PPIs (omeprazole) or H2 blockers (famotidine) are prescribed to protect the stomach
lining.
- Sucralfate → coats and protects the gastric mucosa.
- Monitor for GI bleeding, anemia
- Avoid: caffeine, spicy foods, alcohol, tobacco, NSAIDs
- Report dark/tarry stools, coffee-ground emesis, or severe abdominal pain (signs of
bleeding)
Effects of NSAIDs on gastric ulcer
pg. 321, 325
- Should avoid (causes erosive gastritis, direct irritation to the GI [stomach lining],
and more GI bleeding)
What should be monitored in a client with a nasogastric tube (NGT)?
pg. 336
- Document the NG drainage with the client's output
- Monitor bowel sounds
- Ensure the client is in semi-Fowler's position
- Monitor NG tube for placement via X-ray or pH gastric test
- Irrigate q4hr
- Monitor v/s, daily weight, and nasal area for skin breakdown
- Provide oral hygiene q2hr
- Maintain intermittent suction PRN
What are the signs and symptoms of bowel perforation post-paracentesis?
pg. 306
- Fever
- Sudden severe abdominal pain
- Rigid board-like abdomen/distention, rebound tenderness
- Hypovolemia, Hypotension, absent bowel sounds
- Change in mental status
- Bleeding or leakage of fluid
What are the expected findings with pancreatitis?
(place in side-lying position)
pg. 355
