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NSG123/ NSG 123 Exam 4: (New 2024/ 2025
Update) Med Surg 1 Review| Questions and
Verified Answers| 100% Correct|All Units
Covered| A Grade – Herzing
QUESTION
considerations for epilepsy in women Answer:
- increased seizure activity during menses
- anticonvulsant medication decreases effectiveness of oral contraceptives
- diagnosis of epilepsy puts fetus at 3x higher risk for malformations
- careful monitoring required during pregnancy
QUESTION
non-pharmacological treatment options for refractory seizures Answer:
- vagal nerve stimulator (implanted under clavicle, patient controls when they feel an aura, diminishes the severity and duration of seizure, DOES NOT prevent seizures)
- responsive neurostimulation system (electrodes implanted in brain, interrupts brain activity, prevents seizures)
QUESTION
medications for seizures Answer:
- carbamazepine/Tegretol (grand mal/tonic-clonic)
- clonazepam/Klonopin (children)
- phenytoin/Dilantin (multiple types)
- valproate/Depakote (tonic-clonic)
QUESTION
Phenytoin (Dilantin) information Answer:
- 10 - 20mcg/mL therapeutic level
- must be given on time
- increases risk for osteoporosis (take calcium and vitamin D)
- causes gingival hyperplasia (expected side effect, do not stop medication)
- encourage good dental hygiene
- do not take oral contraceptives
- do not stop abruptly
QUESTION
status epilepticus Answer:
- prolonged seizure activity
- medical emergency
- goal is to stop the seizures ASAP
- give IV medications (diazepam/Valium, lorazepam/Ativan, fosphenytoin/Cerebyx)
QUESTION
thyroid hormones Answer: T3, T4, calcitonin
QUESTION
diagnosis of hyperthyroidism Answer:
- physical assessment is done from behind patient, feeling for structures moving up and down as the patient swallows
- TSH, T3, T4 blood tests (affected by oral contraceptives, corticosteroids, aspirin, carbamazepine, Lasix, heparin)
QUESTION
What is the priority action for a thyroid storm? Answer:
- decrease the fever (passive cooling, Tylenol)
- IV fluid with glucose
- betabolcker
- hydrocortisone
QUESTION
causes for thyroid storm Answer:
- stressful event (surgery, illness, trauma)
- patient did not seek treatment for hyperthyroidism
- patient did not take thyroid medication
QUESTION
management of hyperthyroidism Answer:
- radiation treatment (may increase T3 & T4 levels)
- medications (PTU, methimazole, sodium or potassium iodine solution)
- surgery (subtotal thyroidectomy)
QUESTION
nursing considerations for PTU and methimazole Answer:
- lab values must be checked before administration due to agranulocytosis
- sore throat
- ecchymosis
- rash
- nausea
QUESTION
nursing considerations for sodium or potassium iodine solutions Answer:
- give with fruit juice or milk
- use a straw to avoid staining teeth
- watch for cardiac symptoms
QUESTION
nursing considerations for thyroid surgery Answer:
- monitor airway
- monitor calcium levels/hypocalcemia
QUESTION
signs and symptoms of hypocalcemia Answer:
- tingling in toes, fingers, around mouth
- difficulty speaking
- Chvostek and Trousseau's signs
- life-threatening condition
QUESTION
treatment for hypocalcemia Answer:
- IV calcium gluconate
- IV isotonic saline
- calcium & vitamin D tablets (short and long-term)
- cardiac system slows down (increased risk for heart disease)
QUESTION
myxedema Answer:
- life-threatening complication of hypothyroidism
- mask-like face
- facial edema
- constipation
- confusion
- coma
QUESTION
treatment of myxedema Answer:
- IV T3 and T4 hormone replacement (STOP med if patient has chest pain or cardiac symptoms)
- passive warming
- turn and reposition frequently
QUESTION
patient education for Synthroid Answer:
- lifelong treatment
- take on empty stomach 2 hours before meal
- interacts with other medications (antacids, Maalox)
- always pack in carry-on when traveling
- avoid sedatives
- minimize constipation
QUESTION
treatment for hypothyroidism Answer: Hormone replacement - Levothyroxine (Syn- throid)
QUESTION
diabetes Answer: hyperglycemia caused by not enough insulin in the body or there is insufficient insulin action or a combination of both
QUESTION
types of diabetes Answer:
- type 1 (early onset) - autoimmune disease, body attacks the pancreas where insulin is produced
- results in lack of insulin
- type 2 (later onset) - body does not make enough insulin
- latent autoimmune (mimics type 2 at first but then starts to look like type 1)
- gestational - occurs during pregnancy, greater chance of type 2 later in life
QUESTION
complications of diabetes Answer:
- diabetic ketoacidosis - type 1 complication
- hyperglycemic hyperosmolar syndrome (HHS) - type 2 complication
QUESTION
type 1 diabetes information Answer:
- usually early onset (8- 11 years of age)
- autoimmune disease (pancreas does not make insulin)
QUESTION
medical management of diabetes Answer:
- nutritional therapy
- exercise
- monitoring
- pharmacological therapy
- education
QUESTION
nutritional recommendations for diabetes Answer:
- carbohydrates 50 - 60%
- fat 30% (saturated fats <10%)
- non-animal sources for protein
- increase fiber
- do not skip meals
- maintain consistent caloric & carbohydrate intake
- eat foods with lower glycemic index (raw, whole rather than juice)
- combine starchy foods with protein and fat to slow absorption and glycemic response
QUESTION
What medication should be avoided when taking levodopa/carbidopa (SInemet)? Answer: MAOIs (Nardil, Emsam)
QUESTION
non-pharmacological treatment for Parkinson's disease Answer:
- deep brain stimulation (most common) - improves tremors and rigidity, will not cure Parkinson's
- ablation of brain cells in specific areas
- transplantation of neural stem cells
QUESTION
nursing interventions for Parkinson's disease Answer:
- maintain good health
- encourage independence
- avoid complications (aspiration, falls)***
- promote physical activity (swimming, stationary bike, stretching, gardening, NO JOGGING/RUNNING)
- exaggerate steps as if they are stepping over something
- walk to a beat
- good sleep hygiene
- manage speech problems (face person, short sentences)
- dietary considerations (nutrient dense, avoid constipation)
- provide support for caregivers
QUESTION
delerium Answer:
- temporary acute mental confusion
- due to acute injury (SURGERY, dehydration, medication reaction, UTI) ex: patient returns to med/surg floor after hip replacement surgery and cannot focus on anything, cannot follow directions
QUESTION
nursing intervention for delerium Answer:
- fall prevention
- hydration
- watch patient cues (if getting up, they may need to use the bathroom)
Alzheimer's disease Answer:
- progressive degeneration of the brain
- cause is unknown
- not a normal aging process
- familial (early onset) or sporadic (late onset)
QUESTION
signs of Alzheimer's disease Answer:
- forgetfulness
- decreased memory function
- decreased orientation
- personality changes
- loss of ability to do activities of daily living
- unable to recognize family members
QUESTION
diagnostic studies for dementia/Alzheimer's Answer:
- CBC
- electrolytes
- vitamin B12***
- thyroid levels***
- MRI
- CT scan
- cerebrospinal fluid
- definitive diagnosis can only be made with autopsy
QUESTION
management options for dementia/Alzheimer's Answer:
(Aricept) (interferes with acetylcholine uptake) - watch for liver disease***
- memantine (Namenda) (calms the brain) - watch for renal disease***
- behavioral therapy
- frequent re-evaluation as symptoms change
QUESTION
classifications of seizures Answer:
- focal/partial (one hemisphere)
- generalized (both hemispheres)
- provoked (related to reversible condition - high fever, brain injury, hypoglycemia)
QUESTION
signs of seizure Answer:
- staring off into space
- tremor of one arm/leg or both arms/legs
- falling to the floor and shaking
- foaming at the mouth
QUESTION
causes of seizures Answer:
- head injury
- alcohol withdrawal
- fever (childhood)
- hypertension
- stroke
- hypoxemia
- CNS infection
- brain tumor
- bed in low position
- pillow for patient's head
- side lying position
- curtain for privacy
- have suction and oxygen available
QUESTION
When will a nurse check blood glucose levels? Answer: peak time of insulin medica- tion
QUESTION
insulin preparation steps Answer:
- agitate cloudy insulin
- scrub top of insulin vial with alcohol
- inject air equal to dosage into cloudy (NPH) (do not touch solution with needle)
- inject air equal to dosage into clear (regular)
- invert clear insulin vial and draw up clear
- invert cloudy insulin vial and draw up cloudy (do not push plunger while in the vial)
QUESTION
patient education for blood glucose monitoring Answer:
- wash hands
- engage needle
- insert test strip in machine
- clean finger with alcohol and let dry
- prick finger, wipe away blood
- obtain blood sample
QUESTION
patient education for self-injection of insulin Answer:
- stabilize skin
- use 90 degree angle
- rotate injection sites
- do not rub injection site
QUESTION
patient education for insulin pumps Answer:
- only use rapid acting insulin
- needle will be subcutaneous
- rotate sites every 3 days
- check glucose level several times per day
- may disconnect from pump when needed
- cannot be used on patients with decreased mental status
QUESTION
rapid acting insulin, onset, peak, duration Answer: Onset: 10-30 min Peak: 30 min-3 hr Duration: 3 - 5 hr 15 minutes feels like an hour after 3 rapid responses.
QUESTION
short acting (regular) insulin onset, peak, duration Answer: Onset: 30 min-1 hr Peak: 2 - 5 hr Duration: 5 - 8 hr
Answer:
- polyuria
- polydipsia
- polyphagia
- fruity smell to breath
QUESTION
patient education for sulfonylureas (glipizide) Answer:
- monitor for hypoglycemia
- watch for GI symptoms
- avoid alcohol
QUESTION
patient education for biguanides (metformin) Answer:
- monitor for hypoglycemia
- watch for GI symptoms
- stop 48 hours prior to contrast dye
QUESTION
treatment for hypoglycemia Answer: rules of 15
- give 15g of concentrated carbohydrate (juice or soda)
- retest blood glucose in 15 minutes
- repeat if <70 mg/dL if unable to swallow
QUESTION
cranial arteritis Answer:
- common cause for headache in the older population
- inflammation of the temporal artery (pain in the temple area)
- treated with corticosteroids
QUESTION
primary headache Answer: a headache for which no specific organic cause can be found (ex: migraine, cluster, tension)
QUESTION
secondary headache Answer: headache identified as a symptom of another organic disorder (ex: brain tumor, hypertension)
QUESTION
Phases of migraines Answer:
- premonitory (days before - depression, feeling cold, no appetite)
- aura (visual disturbances, hand tingling)
- headache (nausea, vomiting, light & sound sensitivity)
- post drome (pain subsides, weakness, tiredness)
QUESTION
cluster headache Answer:
- unilateral (one side of the head)
- rapid onset
- can occur 1 - 8 times per day
