Download MedSurg 1 RN Final Exam Questions and Answers: A Comprehensive Review of Key Concepts and more Exams Nursing in PDF only on Docsity!
Jersey College MedSurg 1 RN FINAL
EXAM QUESTIONS AND ANSWERS,
NEW UPDATE!!
weight, smoking, sex practices, diet - CORRECT ANSWER -List four modifiable
risk factors. (general health promotion)
age, genetics, sex - CORRECT ANSWER -List three non-modifiable risk factors.
(general health promotion)
cultural assessment - CORRECT ANSWER -What type of assessment should
the nurse preform prior to initiating health teaching? physiological integrity safety and security belongingness and affection esteem and self-respect self-actualization -- physiologic needs and life threatening issues are a priority
-- confirm that these needs are met in the order listed above - CORRECT
ANSWER -Maslow's Hierarchy of Needs
--priorities? --what order?
Healthy People 2020 - CORRECT ANSWER -Organization that identifies health
promotion and disease prevention goals and lists strategies along with resources in an attempt to improve the nation's health
The Institute of Medicine's report on the Future of Nursing - CORRECT
ANSWER -Organization that recommends ways to strengthen the practice of nursing
in order to improve health care.
The National Patient Safety Goals - CORRECT ANSWER -The Joint
Commission lists the top patient safety concerns and includes medication safety, infection prevention, surgery-related mistakes, patient identification and improving staff communication. What is this list called?
Nurse Practice Acts - CORRECT ANSWER -This governs nursing practice and is
a law that is put into place to protect the public - nurses must follow and comply with their state's regulations
QSEN - Quality and Safety Education for Nurses Institute - CORRECT
ANSWER -Institute that seeks to strengthen the knowledge, skills, and attitudes of
nurses in providing continuous quality improvement in health care
whatever the patient says it is - CORRECT ANSWER -What is pain?
actual or potential tissue damage - CORRECT ANSWER -Pain is associated with
__________________________________.
the patient's self report - CORRECT ANSWER -The single most reliable indicator
of pain is _______.
blood pressure, heart rate, and respirations - CORRECT ANSWER -Pain
stimulates the sympathetic nervous system and could result in an increase in ___________, ___________, and ____________. increases glucagon production decreases insulin secretion depresses immune function
can lead to addictive behaviors - CORRECT ANSWER -physiologic effects of
unrelieved pain (4)
prostaglandins - CORRECT ANSWER -initiate inflammation and contribute to
tissue swelling and pain
NSAIDS - CORRECT ANSWER -______ primarily produce pain relief by
preventing prostaglandin formation.
Acetaminophen - CORRECT ANSWER -_____________ does not have anti-
inflammatory properties.
tissue damage - CORRECT ANSWER -______________ stimulates the
inflammatory response and puts the patient at risk for pain.
local anesthetics, non-opioids or opioids - CORRECT ANSWER -manage
nociceptive pain with?
allodynia - CORRECT ANSWER -pain that is associated with a noxious stimulus
provide PCA (patient controlled analgesia) - CORRECT ANSWER -Provide
____________ to help reduce complications related to pain. Used in postoperative patients as a preventative measure for pain.
around the clock - CORRECT ANSWER -Provide administration of analgesics
(frequency) for chronic and postoperative pain, never wait for chronic pain to reoccur.
aspirin or acetaminophen - CORRECT ANSWER -given for mild to moderate
pain
NSAIDS - CORRECT ANSWER -given for moderate pain
opioid analgesics (Morphine) - CORRECT ANSWER -given for severe pain
rectal route - CORRECT ANSWER -Avoid which medication administration route
for patients who are thrombocytopenic?
Acetaminophen - CORRECT ANSWER -Use of this analgesic could result in
hepatoxicity and should not exceed 4,000mg/day.
NSAIDS - CORRECT ANSWER -analgesic that could result in gastric ulcers or
contribute to cardiovascular events such as MI or stroke
NSAIDS - CORRECT ANSWER -analgesic that could lead to acute renal failure
in patients with volume depletion or who take it for chronic pain
prostaglandin - CORRECT ANSWER -needed for renal blood flow
constipation, nausea, pupil constriction, and respiratory depression - CORRECT
ANSWER -undesirable side effects of opioids
could increase absorption and result in lethal complications - CORRECT
ANSWER -Never apply heat over transdermal patches. Why?
antidepressants or anticonvulsants - CORRECT ANSWER -adjuvant medications
used to manage neuropathic pain
metabolic alkalosis - CORRECT ANSWER -Vomiting can lead to what acid-base
imbalance
metabolic acidosis - CORRECT ANSWER -Diarrhea can lead to what acid-base
imbalance
calcium - CORRECT ANSWER -Mineral that helps to regulate muscle
contraction and relaxation
high in calcium and low in phosphorus - CORRECT ANSWER -In the setting of
hypoparathyroidism, provide a diet that is high in _______ and low in __________.
osmotic pressure - CORRECT ANSWER -Chloride works with sodium to
determine _______________.
hypochloremic metabolic alkalosis - CORRECT ANSWER -If chloride levels drop,
bicarbonate is retained and results in _______________________________. action potentials
weakness or excitability - CORRECT ANSWER -Changes in electrolytes impair
_________________ resulting in ________ or ____________.
fluid volume deficit (FVD) - CORRECT ANSWER -Small shifts in intravascular
volume in children increases their risk for __________________.
albumin - CORRECT ANSWER -Proteins like _______ create an oncotic
pressure.
oncotic pressure - CORRECT ANSWER -________________ pulls fluid from the
interstitial compartment into the intravascular compartment to maintain volume.
D5W - CORRECT ANSWER -becomes a hypotonic solution as the cells absorb
the dextrose
dextrose - CORRECT ANSWER -________ should not be given to patients with
a head injury.
low Magnesium - CORRECT ANSWER -This mineral stimulates parathyroid
hormone secretion when low.
Magnesium - CORRECT ANSWER -This mineral helps with carbohydrate and
protein metabolism, affects neuromuscular function, and produces vasodilation.
abdominal cramps - CORRECT ANSWER -Clinical manifestations of
hyponatremia. (8)
electrolyte imbalance - CORRECT ANSWER -Assess patients for
_____________________ in the setting of vomiting, diarrhea, or suctioning.
elevate the HOB 30-45 degrees - CORRECT ANSWER -Place patient in what
position to prevent aspiration in the setting of mechanical ventilation, altered consciousness, or tube feedings? muscle weakness
coma - CORRECT ANSWER -hypercalcemia results in
muscle irritability
tetany - CORRECT ANSWER -hypocalcemia results in
Chvostek's and Trousseau's Signs - CORRECT ANSWER -Classic tests/signs
that are indicative of hypocalcemia.
osteoporosis - CORRECT ANSWER -Prolonged immobility contributes to shifting
of Ca out of the bones leading to ____________.
laryngospasms - CORRECT ANSWER -can occur with low Ca and is a medical
emergency
calcium gluconate - CORRECT ANSWER -given to reverse CNS depression
caused by magnesium
ADH (vasopressin) - CORRECT ANSWER -hormone that promotes fluid re-
absorption by the kidneys
aldosterone - CORRECT ANSWER -hormone that promotes sodium retention
and potassium excretion
angiotensin - CORRECT ANSWER -one of the most powerful vasoconstrictors in
the body
brain natriuretic peptide (BNP) - CORRECT ANSWER -hormone that triggers Na
excretion and a decrease in total fluid volume
hydrostatic pressure - CORRECT ANSWER -moves fluid from the intravascular
compartment to the intercellular compartment
edema - CORRECT ANSWER -An increase in hydrostatic pressure or a
decrease in oncotic pressure could result in _____.
delirium - CORRECT ANSWER -typical sign of dehydration in the elderly
pinching the skin over the sternum or the forehead - CORRECT ANSWER -how
to determine skin turgor
fever and burns - CORRECT ANSWER -_____ and _____ contribute to an
insensible(non-visible) water loss and contribute to dehydration drop in perfusion hypovolemic shock
death - CORRECT ANSWER -loss of fluid volume could result in? (3)
changes in LOC decreased urinary output dizziness dry mucosal membranes hypotension
tachycardia - CORRECT ANSWER -signs of fluid volume deficit
coughing and deep breathing
use of incentive spirometer - CORRECT ANSWER -Encourage patient to do
these things to help remove secretions and promote lung expansion.
2.2 pounds - CORRECT ANSWER -A weight gain of __pounds is equivalent to a
liter of fluid retention.
supine - CORRECT ANSWER -What position promotes renal blood flow and the
formation of urine?
impaired thirst mechanism - CORRECT ANSWER -Why are the elderly at an
increased risk for hypernatremia?
LR(Lactated Ringer's Solution) - CORRECT ANSWER -should never be given
with metabolic alkalosis, lactic acidosis, or renal failure
3% NaCl - CORRECT ANSWER -infuse ______ slowly because it could lead to
pulmonary edema
Potassium (NO IM either) - CORRECT ANSWER -These two electrolytes MUST
be administered IV via a pump. One must not be given IM either.
could cause asystole - CORRECT ANSWER -Why must magnesium be
administer via IV pump?
deep tendon reflexes and respirations - CORRECT ANSWER -with
hypermagnesmia or when administering magnesium sulfate the nurse should assess ______ and ______.
Digitalis/Digoxin - CORRECT ANSWER -This cardiac drug's effects are
increased in the presence of hypokalemia - monitor patients closely.
cardiac arrest - CORRECT ANSWER -_____________ is more likely with
hyperkalemia. low sodium low fat
low cholesterol - CORRECT ANSWER -In the management of cardiovascular
disease what diet should be ordered? vomiting suctioning
severe pain - CORRECT ANSWER -causes of vagal stimulation
bradycardia - CORRECT ANSWER -vagal stimulation results in _____________.
corticosteroids and alcohol - CORRECT ANSWER -in the perioperative setting
these substances may increase the risk of infection
2 weeks - CORRECT ANSWER -herbal medicine cessation time prior to a
surgical procedure?
7-10 days - CORRECT ANSWER -Aspirin cessation time prior to a surgical
procedure? venous thromboembolism surgical site infection
cardiovascular & respiratory complications - CORRECT ANSWER -Surgery
increases ones risk for ________________, __________________, and ______________________&________________.
hemmorhage - CORRECT ANSWER -All surgical procedures have the risk of
__________.
False - CORRECT ANSWER -T/F - All patients need to be NPO prior to surgery.
raise side rails - CORRECT ANSWER -Following administration of pre-anesthetic
medications what should the nurse do to increase patient safety?
metabolic acidosis - CORRECT ANSWER -When glucose metabolism is reduced
this acid-base imbalance may occur.
epidural anesthesia - CORRECT ANSWER -This type of anesthesia could result
in life-threatening hypotension and respiratory depression.
regional or local anesthesia - CORRECT ANSWER -When using these two types
of anesthesia the patient is awake.
moderate/conscious sedation - CORRECT ANSWER -This type of anesthesia
allows ventilation and protective airway reflexes to be maintained.
aspirating vomitus - CORRECT ANSWER -may trigger an asthma-like reaction
bowel preps - CORRECT ANSWER -increase the risk for fluid and electrolyte
deficits
the chest to the level of the table and 2 inches above the elbow - CORRECT
ANSWER -What part of surgical gowns are considered sterile?
tachycardia and muscle rigidity - CORRECT ANSWER -early signs of malignant
hyperthermia (2)
dantrolene - CORRECT ANSWER -antidote for malignant hyperthermia
anaphylaxis - CORRECT ANSWER -life threatening sudden allergic reaction
hypothermia - CORRECT ANSWER -decreases cellular oxygen requirements
hyperglycemia - CORRECT ANSWER -What physiologic condition can increase
the risk for surgical site infection?
use lotion assess for signs of skin breakdown change incontinence pads frequently void after intercourse pneumococcal and influenza vaccine cough and deep breathing exercises
sit up when eating - CORRECT ANSWER -Nursing interventions to reduce the
risk of skin breakdown in the elderly prior to discharge
many postoperative infections are not evident until after discharge - CORRECT
ANSWER -When does the nurse educate the patient on signs and symptoms of
infection? Why? SNS Response: increased BP, HR, RR*** pupils dilate bronchodialation vasodilation of cardiac vessels vasoconstriction of peripheral vessels
inhibits GI/GU (peristalsis) - CORRECT ANSWER -Pain stimulates the
sympathetic nervous system. What physiologic effects does this have on the body?
ATC - around the clock - CORRECT ANSWER -How often should the nurse
administer analgesics for chronic and postoperative pain?
PCA - CORRECT ANSWER -Type of analgesic administration that helps reduce
complications related to pain.
less than 90 - CORRECT ANSWER -The nurse should report a systolic blood
pressure immediately if it is less than ____.
shock - CORRECT ANSWER -This reaction creates a state where the cells are
not perfused. Types of shock: (a) heart pump fails (b) intravascular volume drops
(c) widespread vasodilation along with increased permeability - CORRECT
ANSWER -Types of shock:
(a) cardiogenic
(b) hypovolemic (c) distributive
weak thready pulse - CORRECT ANSWER -The patient has a decrease in
cardiac output. What will the pulse feel like?
volume replacement - CORRECT ANSWER -Nursing priority during hypovolemic
shock flat on their back with legs elevated at a 20-degree angle (knees kept straight) -
CORRECT ANSWER -How should the nurse position the patient when the
patient is in shock?
intravascular fluid - CORRECT ANSWER -This type of fluid contributes to one's
blood pressure or perfusion pressure.
urinary output - CORRECT ANSWER -___________ decreases with
hemmorhage.
the elderly - CORRECT ANSWER -This age group has a greater risk for
hypothermia.
30 mL/hour - CORRECT ANSWER -Report urinary output less that
________mL/hour.
hemoglobin and hematocrit - CORRECT ANSWER -A drop in _________ and
__________ could result in bleeding or hemodilution. <13.5 g/dL males
<12g/dL females - CORRECT ANSWER -Normal values for Hemoglobin (g/dL)
Male Female
hemorrhage - CORRECT ANSWER -Large amounts of bloody drainage in a
wound drain could suggest __________ and must be reported immediately!
hypercoagulation - CORRECT ANSWER -Stress increases the risk for this
clotting disorder. lower cardiac reserve
depressed renal and liver function - CORRECT ANSWER -The elderly have a
greater risk of complications following surgery. Why? (physiological)
A.. as we age, the capacity to diffuse oxygen decreases and results in a lower level of
oxygen in the arterial circulation. - CORRECT ANSWER -Which patient is
expected to have a lower level of oxygen in the arterial circulation? a. An 84 year old male with HTN. b. A 42 year old female with a recent fracture. c.. A 22 year old male with asthma.
to remove secretions and protect the lungs from foreign bodies - CORRECT
ANSWER -Why do we have a cough reflex?
hypoventilation obesity pain
abdominal distention - CORRECT ANSWER -Any condition that restricts chest
expansion could result in _______________. List three examples.
5g/dL - CORRECT ANSWER -Cyanosis occurs when there is a minimum loss of
______g/dL of unoxygenated hemoglobin in the blood.
True - CORRECT ANSWER -T/F - Cyanosis is a late sign of hypoxia.
atelectasis - CORRECT ANSWER -Prolonged hypoventilation could result in
____________.
culture - CORRECT ANSWER -What lab test should be done before an antibiotic
is prescribed?
Bleeding - CORRECT ANSWER -________ is always a risk of angiography and
procedures ending in -oscopy.
egophony - CORRECT ANSWER -This adventitious breath sound changes the E
to an A sound with consolidation.
a secure connection - CORRECT ANSWER -Tidaling in the water seal chamber
of a traditional water seal chest drainage system indicates what?
long-standing hypoxia - CORRECT ANSWER -Clubbing of the nails could be
indicative of what?
grayish cast in darker complexion mouth lips cheekbones
earlobes - CORRECT ANSWER -Where should the nurse assess the patient for
cyanosis? What color will the skin be if the patient has a darker complexion?
peak flow meters - CORRECT ANSWER -These devices can be used to
determine the adequacy of interventions to improve expiratory function. restlessness confusion pallor tachycardia
tachypnea - CORRECT ANSWER -Signs of hypoxia (5)
before meals - CORRECT ANSWER -When is postural drainage performed in
relation to meals?
cardiac disrhythmias and death - CORRECT ANSWER -Hypoxia can lead to
___________________ and _______.
onto the operative side - CORRECT ANSWER -Following a pneumonectomy
how should the nurse position the patient?
onto the unaffected side - CORRECT ANSWER -Following a lobe resection how
should the nurse position the patient?
milking the chest tube - CORRECT ANSWER -This action by the nurse helps
prevent obstructions but could increase negative pressure and damage pleural tissue.
q2h - CORRECT ANSWER -The nurse instructs the client to perform coughing
and deep breathing exercises to prevent atelectasis. How often should the client perform these exercises? (ventilation - perioperative care)
inflate the cuff on the trach - CORRECT ANSWER -While using mechanical
ventilation, the nurse can do this to the tracheostomy device to help prevent aspiration.
obstruction - CORRECT ANSWER -What does a high pressure alarm on a
mechanical ventilator signal?
positive-pressure ventilation - CORRECT ANSWER -This type of ventilation
could lead to a decrease in venous return and cardiac output.
15 seconds - CORRECT ANSWER -Suctioning for longer than _____ could lead
to dysrhythmias and cardiac arrest.
air leak - CORRECT ANSWER -Bubbling in the water seal chamber of a dry
suction water seal system may indicate a(n)__________________.
15-20mmHg - CORRECT ANSWER -Cuff pressures on an endotracheal tube
should be maintained at what level?
laryngeal swelling - CORRECT ANSWER -Accidental removal of the
endotracheal tube could cause laryngeal swelling.
PRN - as needed - CORRECT ANSWER -How often should the nurse suction
the patient with an endotracheal tube?
Acute Respiratory Failure - CORRECT ANSWER -Manifested by a decrease in
PaO2(<50mmHg) and an increase in PaCO2(>50mmhg) with respiratory acidosis.
elevate the head of the bed - CORRECT ANSWER -If the patient is
hemodynamically stable, the nurse can do this intervention to promote lung excursion.
negative pressurized room with the door kept closed - CORRECT ANSWER -The
patient on airborne precaution should have what type of room? elevate HOB 30-45 degrees provide histamine-2 blockers daily
administering oral care with chlorhexidine rinses - CORRECT ANSWER -Nursing
interventions to reduce ventilator associated pneumonia. surgery pregnancy crossing the legs
prolonged immobility - CORRECT ANSWER -Factors that increase ones risk for
developing a thrombus.
vasoconstrictor - CORRECT ANSWER -Norepinephrine is a
powerful______________________. vasodilator/vasoconstrictor
TB exposure, but not necessarily disease - CORRECT ANSWER -A positive
Mantoux test suggests what?
delayed hypersensitivity (type IV) - CORRECT ANSWER -The tuberculin
(Mantoux) test is a classic example of this type of hypersensitivity.
- puritis - itching
- vesicles - A small, superficial, circumscribed elevation of the skin, less than 1 cm, that contains serous fluid. (herpes)
- erythema - redness/bumps - localized eruption of the skin with minimal or no mucosal
involvement. - CORRECT ANSWER -Delayed hypersensitivity (Type IV) follows
direct skin contact with an allergen and induces what clinical manifestations in the patient? (3)
Fremitus - CORRECT ANSWER -In the presence of consolidation, what
becomes more pronounced. indicates denser or inflamed lung tissue
can be caused by diseases such as pneumonia. - CORRECT ANSWER -
Increase in tactile fremitus indicates that lung tissue is ________ or _________, which can be caused by diseases such as _________. decreasing pleural
COPD or Asthma - CORRECT ANSWER -A decrease in tactile fremitus suggests
that lung tissue density is __________ or that there is air or fluid in the _______ spaces, which can be caused by diseases such as _________ or __________.
5mm or larger - CORRECT ANSWER -Positive Mantoux reaction for patients
with HIV, who are immunocompromised, or had close contact with an infected individual appear as _____mm or larger on the patient's skin?
sputum culture - CORRECT ANSWER -This diagnostic test confirms the
diagnosis of TB. coughing wheezing increased mucous production
dyspnea - CORRECT ANSWER -Physiologic clinical manifestations of an
asthmatic attack. (4)
peak flow meter - CORRECT ANSWER -Device used to determine the patient's
highest airflow during a forced exhalation.
