Med-Surg (Exam One) Study Guide Final
l
Med-Surg (Exam One) Study Guide Final
Med-Surg Exam One A+
Study Guide (Fox)
What to Know For Exams:
● Test Yourself NCLEX Examination Challenge
● Know Nursing Safety Priority QSEN for the chapters (starts after multiple choice
study guides-below)
● Know the type of IV to infuse for a patient with hypovolemia (in chart and in
youtube link)
● The RN should assess patient manifestations for what in the patient with fluid
volume deficit?
○ Loss of extracellular fluid volume exceeds intake of fluid
○ This is not dehydration
○ Urine output <30 mL/hr
, Med-Surg (Exam One) Study Guide Final
1
○ Acute daily loss of 1 pound
○ Monitor fluid overload: shoes, belt, abdominal girth
○ Weak, rapid pulse, and postural hypotension
○ Tissue turgor decreased (not accurate in elderly)
○ Urine specific gravity: >1.020
○ Increased BUN
○ Increased creatinine (normal = 0.7-1.4) better indicator of renal function than
BUN
● The highest priority nursing for a patient with a serum potassium level of 2.2 mEq/L
(Initiate cardiac monitoring)
● RN Pharmacology for Nursing ATI book (Chapter 27) will be on exam
● RN Medical Surgical Nursing will be on Exam 1 (2 ATI Chapters to study, BOTH are
Chapter 27 but 2 ATI books=Pharmacology and Med-Surg, also see the beginning of
each powerpoint for information to review for exams)
Left VS Right Sided-Heart Failure Video:
(Video to Help Explain Left VS Right-Sided Heart Failure)
https://www.youtube.com/watch?v=Y1IUFGh2T_E
2
, Med-Surg (Exam One) Study Guide Final
TACO (transfusion associated circulatory overload) TRALI (transfusion related acute lung injury)
What Is It? What Is It?
-Hydrostatic pulmonary edema due to transfusion -Acute respiratory distress
(too much blood and non-sanguineous fluid,
transfused too rapidly):
-High rates of volume infusion
-Underlying cardiac or pulmonary pathology
Risk Factors: Risk Factors:
● Very young/old ● Onset: within 6 hours of a plasma
● Onset: <2 hours of transfusion containing transfusion
Signs: Signs:
● Increased BP ● Fever (1-2 degrees)
● Tachycardia ● Hypotension (DO NOT GIVE
● Gallop, JVD, systolic/diastolic HTN DIURETICS-COULD WORSEN)
● Pulmonary edema ● Hypoxemia (oxygen sat <90% on room air)
● Increased BNP ● Bilateral pulmonary edema (rapid onset)
● No evidence of circulatory overload
● May be accompanied by:
-Fever, hypothermia, BP instability
Diagnosis: Diagnosis:
● EKG-new ST segment and T wave changes ● Bilateral infiltrates on chest X-ray
● Lab-troponin T >0.1 ng.mL
● Hemodynamic-PAOP >18 mmHg, CVP (central
venous pressure) >12
Treatment: Treatment:
● Diuretics ● Aggressive respiratory support
● Inotropic agents ● Mechanical ventilation
● Supplemental oxygen therapy ● Applying restrictive tidal volume
● Nitrates ● Fluid restriction
Role of BNP:
● Neurohormone released from ventricular
myocardium in response to ventricular
volume
● First introduced to diagnose CHF
Summary:
● Associated with significant morbidity
● “New” complication of importance
3
, Med-Surg (Exam One) Study Guide Final
● Under-recognized, under-reported
● Confused with TRALI
IV FLUID REPLACEMENT
D5W Normal 0.45% NS Lactated Hypertonic Colloids Hetastarch Dextran
Saline (0.9% Ringer’s Saline (3% (Plasma, 25% (plasma
NaCl) 0.3% NS or 5% NaCl) Albumin) expander)
5% Albumin
Tonicity Isotonic Hypotonic Isotonic Hypertonic Hypertonic Hypertonic Hypertonic
Uses Maintain For free For max To correct To cause To cause Volume
volume water fluid and severe volume volume expansion
replaceme electrolyte hyponatrem expansion in expansion and/or to
nt replaceme ia shock states decrease
nt platelet
adhesion
For pts
Replaces mild Requires w/pulmonary
loss To correct Buffers intensive edema,
mild acidosis monitoring peripheral
hypernatr edema
emia
Increases
body fluid
4
l
Med-Surg (Exam One) Study Guide Final
Med-Surg Exam One A+
Study Guide (Fox)
What to Know For Exams:
● Test Yourself NCLEX Examination Challenge
● Know Nursing Safety Priority QSEN for the chapters (starts after multiple choice
study guides-below)
● Know the type of IV to infuse for a patient with hypovolemia (in chart and in
youtube link)
● The RN should assess patient manifestations for what in the patient with fluid
volume deficit?
○ Loss of extracellular fluid volume exceeds intake of fluid
○ This is not dehydration
○ Urine output <30 mL/hr
, Med-Surg (Exam One) Study Guide Final
1
○ Acute daily loss of 1 pound
○ Monitor fluid overload: shoes, belt, abdominal girth
○ Weak, rapid pulse, and postural hypotension
○ Tissue turgor decreased (not accurate in elderly)
○ Urine specific gravity: >1.020
○ Increased BUN
○ Increased creatinine (normal = 0.7-1.4) better indicator of renal function than
BUN
● The highest priority nursing for a patient with a serum potassium level of 2.2 mEq/L
(Initiate cardiac monitoring)
● RN Pharmacology for Nursing ATI book (Chapter 27) will be on exam
● RN Medical Surgical Nursing will be on Exam 1 (2 ATI Chapters to study, BOTH are
Chapter 27 but 2 ATI books=Pharmacology and Med-Surg, also see the beginning of
each powerpoint for information to review for exams)
Left VS Right Sided-Heart Failure Video:
(Video to Help Explain Left VS Right-Sided Heart Failure)
https://www.youtube.com/watch?v=Y1IUFGh2T_E
2
, Med-Surg (Exam One) Study Guide Final
TACO (transfusion associated circulatory overload) TRALI (transfusion related acute lung injury)
What Is It? What Is It?
-Hydrostatic pulmonary edema due to transfusion -Acute respiratory distress
(too much blood and non-sanguineous fluid,
transfused too rapidly):
-High rates of volume infusion
-Underlying cardiac or pulmonary pathology
Risk Factors: Risk Factors:
● Very young/old ● Onset: within 6 hours of a plasma
● Onset: <2 hours of transfusion containing transfusion
Signs: Signs:
● Increased BP ● Fever (1-2 degrees)
● Tachycardia ● Hypotension (DO NOT GIVE
● Gallop, JVD, systolic/diastolic HTN DIURETICS-COULD WORSEN)
● Pulmonary edema ● Hypoxemia (oxygen sat <90% on room air)
● Increased BNP ● Bilateral pulmonary edema (rapid onset)
● No evidence of circulatory overload
● May be accompanied by:
-Fever, hypothermia, BP instability
Diagnosis: Diagnosis:
● EKG-new ST segment and T wave changes ● Bilateral infiltrates on chest X-ray
● Lab-troponin T >0.1 ng.mL
● Hemodynamic-PAOP >18 mmHg, CVP (central
venous pressure) >12
Treatment: Treatment:
● Diuretics ● Aggressive respiratory support
● Inotropic agents ● Mechanical ventilation
● Supplemental oxygen therapy ● Applying restrictive tidal volume
● Nitrates ● Fluid restriction
Role of BNP:
● Neurohormone released from ventricular
myocardium in response to ventricular
volume
● First introduced to diagnose CHF
Summary:
● Associated with significant morbidity
● “New” complication of importance
3
, Med-Surg (Exam One) Study Guide Final
● Under-recognized, under-reported
● Confused with TRALI
IV FLUID REPLACEMENT
D5W Normal 0.45% NS Lactated Hypertonic Colloids Hetastarch Dextran
Saline (0.9% Ringer’s Saline (3% (Plasma, 25% (plasma
NaCl) 0.3% NS or 5% NaCl) Albumin) expander)
5% Albumin
Tonicity Isotonic Hypotonic Isotonic Hypertonic Hypertonic Hypertonic Hypertonic
Uses Maintain For free For max To correct To cause To cause Volume
volume water fluid and severe volume volume expansion
replaceme electrolyte hyponatrem expansion in expansion and/or to
nt replaceme ia shock states decrease
nt platelet
adhesion
For pts
Replaces mild Requires w/pulmonary
loss To correct Buffers intensive edema,
mild acidosis monitoring peripheral
hypernatr edema
emia
Increases
body fluid
4
