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Advanced Med-Surg Principles Jersey College
Exam 1 with CORRECT ANSWER ✔✔ s
What during labor increases the risk of neonate aquiring acute encephalitis? - CORRECT ANSWER✔✔S ✔✔active herpes simplex virus- How do you administer meds? - CORRECT ANSWER✔✔S ✔✔starting with the lowest dose and titrating up slowly What is pain is associated with? - CORRECT ANSWER✔✔S ✔✔actual or potential tissue damage When pain stimulates the sympathetic nervous system, what does it result in? - CORRECT ANSWER✔✔S ✔✔- increase in BP
- increase in HR
- increase in RR Where are catecholamines released from? - CORRECT ANSWER✔✔S ✔✔adrenal medulla Where are steroid hormones (cortisol & aldosterone) released from? - CORRECT ANSWER✔✔S ✔✔adrenal cortex What does unrelieved pain lead to? - CORRECT ANSWER✔✔S ✔✔- increases glucagon production
- decreases insulin secretion
- depress immune function
- can lead to addictive behaviors What initiates inflammation, contributes to tissue sweeling, and pain? - CORRECT ANSWER✔✔S ✔✔Prostaglandins What can nerve root injury lead to? - CORRECT ANSWER✔✔S ✔✔allodynia (pain that is associated with non-noxious stimuli) What is needed for renal blood flow? - CORRECT ANSWER✔✔S ✔✔Prostaglandin Pain is? - CORRECT ANSWER✔✔S ✔✔whatever the patient says it is What is the single most reliable indicator of pain? - CORRECT ANSWER✔✔S ✔✔the patient's self-report How do NSAID's preimarily produce pain relief? - CORRECT ANSWER✔✔S ✔✔by preventing prostaglandin formation What does acetaminphen not have? - CORRECT ANSWER✔✔S ✔✔any inflammatory properties What do you manage nociceptive pain with? - CORRECT ANSWER✔✔S ✔✔- local anesthetics
What type of effect do transdermal agents produce? - CORRECT ANSWER✔✔S ✔✔drug absorption into the systemic circulation What would help reduce complications related to pain for patients? - CORRECT ANSWER✔✔S ✔✔provide a PCA How do we administer around the clock pain relief for post-op and chronic pain?
- CORRECT ANSWER✔✔S ✔✔provide analgesics, never wait for chronic pain to reoccur What is provided for mild to moderate pain? - CORRECT ANSWER✔✔S ✔✔aspirin or acetaminaphen What is provided for moderate pain? - CORRECT ANSWER✔✔S ✔✔NSAID's What is provided for severe pain? - CORRECT ANSWER✔✔S ✔✔morphine Why would you wake patients who have chronic pain or who have moderate to severe pain folowing surgery? - CORRECT ANSWER✔✔S ✔✔to administer prescribed analgcsics What can excessive use of acetaminophen cause? - CORRECT ANSWER✔✔S ✔✔hepatoxicity What does of acetaminophen could lead to hepatoxicity? - CORRECT ANSWER✔✔S ✔✔4,000 mg/day
What can NSAID's meds result in? - CORRECT ANSWER✔✔S ✔✔- gastric ulcers
- contribute to CV events (MI or stroke) What can the use of NSAID's lead to in patients with volume depletion or who take it for chronic pain? - CORRECT ANSWER✔✔S ✔✔acute renal failure What undesirable effects do opioids produce? - CORRECT ANSWER✔✔S ✔✔- constipation
- nausea
- pupil constriction
- respiratory distress Physical dependence and tolerance are not the same as what? - CORRECT ANSWER✔✔S ✔✔addiction Why do you never apply heat over a transdermal patch? - CORRECT ANSWER✔✔S ✔✔it could increase absorption and result in lethal complications How should you manage neuropathic pain? - CORRECT ANSWER✔✔S ✔✔with adjuvant meds such as antidepressants or anticonvulsants What should not be used in a clincial practice that it would violate the nurse- patient relationship? - CORRECT ANSWER✔✔S ✔✔placebos
all resulting in bradycardia What is a loss of transparency of the eye lens, results in blurry vision, decreased visual acuity, and sensitivity to glare? - CORRECT ANSWER✔✔S ✔✔a cataract What are some risk reductions for catarats? - CORRECT ANSWER✔✔S ✔✔- reducing weight
- smoking cessation
- optimizing blood sugars
- using sunglasses when outdoors What are S/S of an endopthalmitis (infection) that can occur after catarat surgery? - CORRECT ANSWER✔✔S ✔✔- marked by pain
- decreasing vision
- eyelid redness
- eyelid edema
- yellowish/green discharge from the eye Viral conjunctivitis is? - CORRECT ANSWER✔✔S ✔✔highly contageous What are S/S of viral conjunctivitis? - CORRECT ANSWER✔✔S ✔✔- marked by conjunctival hyperemia
- lid edema
- ptosis
- foreign body sensation
- watery discharge What cranial nerve has nerve fibers from the right and left eye that cross over before sending impulses to the occipital lobe? - CORRECT ANSWER✔✔S ✔✔Cranial nerve II (optic nerve) What increases the risk for retinal artery or vein occlusion and loss of vision? - CORRECT ANSWER✔✔S ✔✔- diabetes
- glaucoma
- aging
- HTN
- atherosclerosis What results in blurred distant vision - CORRECT ANSWER✔✔S ✔✔myopia (nearsightedness) What results in blurred near vision? - CORRECT ANSWER✔✔S ✔✔hyperopia (farsightedness) What safety mesaures are used when interacting with visually impaired patients?
- CORRECT ANSWER✔✔S ✔✔- keeping objects close by
- identifying where objects are
- not distracting their safety animal
- using the clock method when ambulating
- have the pt hold your arm above the elbow
- walk a half step behind you
- wait 10 mins before instilling ointments What increases the outflow of aqueous humor by constricting the pupil but this could also make it difficult to see in the dark (pupil dilation is needed when lighting is low)? - CORRECT ANSWER✔✔S ✔✔miotics (pilocarpine) What decreases the production of aqueous humor and systemic effects could be observed (bradycardia and hypotension)? - CORRECT ANSWER✔✔S ✔✔beta- blockers (timolol) What are contraindicated in the setting of asthma, COPD, or HF since bronchodilation is inhibited and the HR is decreased? - CORRECT ANSWER✔✔S ✔✔beta-blockers Acetazolamide (Diamox) has diuretic effects and contains sulfa, what would you monitor for and/or avoid? - CORRECT ANSWER✔✔S ✔✔- monitor electrolytes
- avoid it with a sulfa allergy What measures for intraocular pressure and screens for glaucoma? - CORRECT ANSWER✔✔S ✔✔tonometry What are the S/S of glaucoma? - CORRECT ANSWER✔✔S ✔✔- may be absent (slient thief of sight)
- blurred vision
- difficulty focusing
- decreased peripheral vision
What is associated with a quick rise in intraocular pressure and is an ocular emergency? - CORRECT ANSWER✔✔S ✔✔acute angle closure (pupillary block) glaucoma What is accompanied by periocular pain, conjunctival hyperemia, and a fixed semi-dilated pupil? - CORRECT ANSWER✔✔S ✔✔acute angle closure glaucoma What actions would you tell a patient will increase intraocular pressure? - CORRECT ANSWER✔✔S ✔✔- sneezing
- coughing
- holding their breath
- squeezing the eyelids
- valsalva maneuver How is intraocular pressure (10-21 mm Hg) determined? - CORRECT ANSWER✔✔S ✔✔by the amount of aqueous humor that is produced and drained What conditions could increased intraocular pressure result in? - CORRECT ANSWER✔✔S ✔✔- impair blood flow to the retina
- damage the optic nerve
- lead to blindness What activities would you avoid after eye surgery that would increase intraocular pressure? - CORRECT ANSWER✔✔S ✔✔- lifting
What increases the risk of retinal detachment? - CORRECT ANSWER✔✔S ✔✔severe myopia (nearsightedness) What are the S/S of retinal detachment? - CORRECT ANSWER✔✔S ✔✔- sudden flashing lights
- floaters (spots or strings)
- decrease in vision
- curtain sign (covering of a portion of one's vision) Why do you place patients in a prone position following a pneumatic retinopexy?
- CORRECT ANSWER✔✔S ✔✔so the injected bubble is able to float and serve as a tamponade over the retinal detachment What do we do with impaled objects in the eye? - CORRECT ANSWER✔✔S ✔✔NEVER remove them What happens when assessing unilateral hearing loss with a Weber test? - CORRECT ANSWER✔✔S ✔✔- sound is heard better in the affected ear with conductive deafness
- sound is heard better in the unaffected ear with sensorineural deafness How do you asses hearing loss with the Rinne test? - CORRECT ANSWER✔✔S ✔✔a tunning fork is placed on the mastoid bone and then in front of the ear canal; normally air conduction is > bone conduction which is a positive Rinne test; with conductive hearing loss air conduction is < bone conduction
Injury to what part of the ear could impair hearing? - CORRECT ANSWER✔✔S ✔✔tympanic membrane Why should you assess how an individual with hearing loss wants to communicate (writing, sign language, or gestures)? - CORRECT ANSWER✔✔S ✔✔NEVER pretend to understand if you don't Why should you avoid using water when irrigating foreign bodies in the canal? - CORRECT ANSWER✔✔S ✔✔insects and foreign veggies bodies can swell; you should use mineral oil instead Why should we assess for the ability to communicate with our patient? - CORRECT ANSWER✔✔S ✔✔Otoclerosis can lead to conduction hearing loss What condition prevents the bones in the middle ear from moving typicallt impair hearing? - CORRECT ANSWER✔✔S ✔✔otoscerosis How do you care for a hearing aid? - CORRECT ANSWER✔✔S ✔✔- clean the ear mold with soap and water before attaching it to the receiver
- instructing that whistling may be heard if the device is worn imprperly How do you remove cerumen (earwax)? - CORRECT ANSWER✔✔S ✔✔- use warm water
- use gentle irrigation (in order to avoid perforating the tympanic membrane - also AVOID cold water in can stimulate vomiting)
After ear surgery to reduce complicationsthe patient should? - CORRECT ANSWER✔✔S ✔✔- not blow nose
- not get water in the operative ear for 2-3 wks
- keeping the mouth open when sneezing/coughing
- not lift > 10lbs, bend or strain when lifting
- promptly report excessive purulent ear drainage After ear surgery what is normal? - CORRECT ANSWER✔✔S ✔✔temporary hearing loss in the middle ear After ear surgery what should the pt report? - CORRECT ANSWER✔✔S ✔✔crackling and popping sounds in the ear When assessing cranial nerve VII you should note? - CORRECT ANSWER✔✔S ✔✔facial symmetry by having the pt perform different facial expressions How should you communicate with a pt who speech reads? - CORRECT ANSWER✔✔S ✔✔- face the individual
- communicate in a well lit room without obscuring your face
- inform the pt of the topic What could malabsorption of endolymph (Meniere's) result in? - CORRECT ANSWER✔✔S ✔✔sensorineural hearing loss What are the classic signs of Menier's disease? - CORRECT ANSWER✔✔S ✔✔periodic episodes of:
- tinnitus
- vertigo
- hearing loss What should you educate pts with Meniere's disease on? - CORRECT ANSWER✔✔S ✔✔- limit salt
- limit alcohol intake
- stay hydrated
- avoid caffeine (diuretic effect)
- MSG
- limit aspirin (may increase tinnitus) What increases the risk for hearing loss? - CORRECT ANSWER✔✔S ✔✔- ototoxic meds (aminoglycosides, loop diuretics)
- perforation of the tympanic membrane
- chronic exposure to loud noises
- frequent ear infections What meds are used to treat vertigo and disturbances in balance? - CORRECT ANSWER✔✔S ✔✔antihistamines (meclizine [Antivert]) What does the Snellen eye chart assess for? - CORRECT ANSWER✔✔S ✔✔- cranial nerve II
- to determine visual disturbances
What cranial nerves could be a result of an increased risk for aspiration? - CORRECT ANSWER✔✔S ✔✔dysfunction of cranial nerves IX & X What does a 4+ DTR with sustained clonus always indicate? - CORRECT ANSWER✔✔S ✔✔central nervous system impairment Why is contrast medium nephrotoxic and contraindicated in a pt? - CORRECT ANSWER✔✔S ✔✔- allergies to iodine
- allergies to shellfish/seafood
- pregnant
- elevated creatinine What do you provide fluids after using IV contrast? - CORRECT ANSWER✔✔S ✔✔to facilitate renal clearnace of the agent What pts are MRI's contraindicated for? - CORRECT ANSWER✔✔S ✔✔- aneurysm clips
- pacemakers
- internal defibrillators What must be noted prior to cerebral angiography since contrast medium is used? - CORRECT ANSWER✔✔S ✔✔- renal function
- pulses What do you do for a pt following a myelogram? - CORRECT ANSWER✔✔S ✔✔- maintain HOB at 30-45 degrees for 3 hours
- note signs of meningitis (headace, nuchal rigidity, photophobia, seizures, fever) In what position do you place a pt in after a lumbar puncture? - CORRECT ANSWER✔✔S ✔✔prone for 6 hours if more than 20 mL of CSF is removed How do you avoid lumbar headaches from a lumbar puncture? - CORRECT ANSWER✔✔S ✔✔use a small-guage needle How do you assess the mental status of a pt? - CORRECT ANSWER✔✔S ✔✔- observing appearance, dress, posture
- observing facial expressions
- noting orientation to person, place, and time How do you assess congitive function and damage to the frontal cortex? - CORRECT ANSWER✔✔S ✔✔perform the serial 7's (counting down from one hundred by sevens) What is the major neurotransmitter of of the parasymapethic nervous system? - CORRECT ANSWER✔✔S ✔✔acetylcholine What has inhibitory effects and helps to inhibit pain pathways, control mood, and sleep? - CORRECT ANSWER✔✔S ✔✔serotonin What is typically inhibitory and affects behavoir and fine movement? - CORRECT ANSWER✔✔S ✔✔dopamine
