Medical-Surgical Nursing - NFDN 2003 Final Exams 2025-2026 Practice, Exams of Surgical Pathology

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Medical-Surgical Nursing - NFDN 2003 Final Exams 2025-2026 Practice

Fluid & Electrolyte Needs - ¢-- Homeostasis - Affected by digestion, absorption, metabolism of nutrients and excretion of waste Functions of Body Fluids - CORRECT. - 60-70% body weight is fluid [70% intracellular, 30% extracellular] - Transport nutrients and wastes to and from cells - Maintain body temp., acid-base balance, aids in digestion and elimination tL, me tions] - Physical exam [head to toe, weight [lke gain = 1L fluid gain], intake/output, assess edema, diagnostic tests] -- Electrolyte imbalance Problems of Fluid Imbalances - { - Acid-Base imbalance - Deficient fluid volume - Excess fluid volume [edema] victims [3rd degree] are most at Hypovolemia - CORRE’ - Rapid & weak pulse - Hypotension [bp] - Dry, sticky mucous membrane - U/O <30mI/h and constipation - Thirst and weakness -Inercase Heb, Hel, urine osmol Hypervolemia - - Bounding full pulse - Hypertension [bp] - Moist mucous membrane -U/O increased, specific gravity <1 - Cough/Dyspnea - Decreased Heb, Het, urine osmol Electrolytes - CORRECT ANSWER -- Sodium [133-145 mEq/L] - Polassinm [ - Calcium [4.5-3.5 mEq/L] - Magnesium [1.5-2.5 mEq/L] - Chloride [98-106 mEq/L] - Phosphorus [1.2-3 mEq/L] -> 7.45 alkalotic state PaCO2 - | blood -- Partial pressure of carbon dioxide in ARTERIAL - Normal range 35-45mmHg - Less than 35mmHg = hyperventilation - Greater then 45mmHg = hypoventilation [rate and depth of reps. decreases, less carbon dioxide is exhaled, more is retained increasing the concentration PaOQ2 - CORR! ANSWER -- Partial pressure of oxygen in ARTERIAL blood - Normal range 80-100mmHg -No real role in acid base imbalance - Less than 60mmHg can lead to anaerobic metabolism, leading to lactic acid production and metabolic acidosis - Reduction in vital capacity can lead to reduction Oxygen Sauuration - CORRECT ANSWER -- Nortnal range 95-99% - Hemoglobin saturation - Clients become hypoxic getting the reserve O2 stored in the Hgb, to provide tissue w/ 02 - 2 can be affected by pH and PaCO2 - When PaO2 falls below 60mmHg a large saturation results - Base excess reflects deviations of pH [7.4 neutral] - Higher values of base excess indicate alkalosis ~ Negative values of base excess indicates acidosis which may result in elimination of too many bicarbonate ion Bicarbonates - CORRECT AN; - Excreted/retained by the kidneys to maintain normal acid base environment - Also the principle buffer of the ECF’s of body - Anormal pH is maintained w/ a bicarbonate ratio 20 times that of the fluid concentration of carbonic acid Buffering System - CORRECT ANSWER -- Plasma - Respiratory system - Renal system tion of COZ and Respiratory Acidosis - C -- Results from decrease in pH - Pulmonary insnfficicney because of respiratory depression causing CO2 build up - S&S: Increased Pulse, resp, & BP, Mental cloudiness, Fullness in the head, Ventrical Arrythmias - Treatment: improve ventilation, bronchodilators to reduce bronco spasm - Thrombolytics or anlicoagulants for PE - Antibiotics for pneumonia - Place pt. in semi-fowlers for chest wall expansion Respiratory Alkalasis - ( ‘R-- Rapid or excess elimination of CO2 result in increase pH Isotonic Solution - CORRECT ANSWER -- Osmolality close to that of the blood plasma Ll or shrink and do not cause red blood 0 - Same salt concentration as the normal cells in the body and blood - Expand the Extracellular volume (give with volume deficit): 0.9% Sodium Chloride (Normal Saline), Dextrose 3% in water, Lactated Ringer’s Hypotonie Solutions - CORR! (ower salt concentration) - Replace intracellular fluid, causing cells to swell: 0.45% Sodium Chloride (half normal saline) Hypertonic Solutions - - Osmolality higher than that of the serum (Higher salt concentration than normal s and blood) - Draw {hud from the ICF and canse cells Lo shrink: Dextrose 10% in water, 3%-3% Sodium Chloride, Dextrose 5% in 0.9% Sodium Chloride, Dextrose 5% in 0.45% NaCl sodium chloride, Dextrose 5% in lactated Ringer's Intravenous Therapy - CORRECT ANSWER -- Injection or infusion into a vein - Pertaining to the inside of a vein - Types of solutions: isotonic, hypotonic, hypertonic vein - Comes in a variety of sizes, 20 and 22 gauge usually used - Large bore 18 and 16 used for trauma or large bleed, blood and blood products & some surgeries Purpose of IV Therapy - CORRECT ANSWER-- To maintain or restore fluid balance - Maintain or replace electrolytes - Replacement of blood or blood products - Administration of meds: Rapid drug effect, GI absorption is impaired. swallow or absorb meds by other routes, Oral intake is restricted, Maintain therapeutic blood levels IV Sites - short-term tx - Peripheral: superficial veins of the arm and hand, 2s, rehydrate - Central: jugular or subclavian veins PICC line, deliver large amt of solution, long-term Lx - Implanted ports: catheter tip into subclavian/iugular, sc pocket of chest wall. chemotherapy, antibiotics, TPN - Hypodermoclysis (HDC) - (Clysis) not an IV site but provides fluids to patient, max flow of 50ml/hr IV Therapy Complications - CORRECT ANSWER -- Infiltration - IV fluids enter the surrounding space (cold) - Phlebitis - inflammation of the vein (warm) - Infection (redness, pain, swelling) - Thrombus formation - Clots from blood or obstruction - Circulatory overload - excess fluids in short period of time - Allergic reaction - Distance from IV site - Position of extremity -Patency of site & tubing - Warm fluids drip faster - The higher the bag, the faster it flows - The larger the catheter diameter, the faster it flows Intravenous Therapy - TPN - CORRECT ANSWER -- Total parental nutrition [feeds - lipids & traversal] - Ahypertonic solution, that bypasses the GI tract to provide nutrients - Indicated for malnourishmont, Cancer, liver/rcnal failure, Gl/inllammatory bowel disease Provides proteins, fats, other electrolyte: Monitor for hyperglycemia and secondary polyuria (excessive amounts of urine) - Frequent monitoring of glucose Colloid Solution - CORRECT ANSWER -Used to replace circulating blood volume because suspended ma pull fluid from other compartments: Blood, Blood products (Plasma, Platelets), Plasma oxpanders (Pontaspan) - a blood derivative Intermittent Infusion Device - CORRECT ANSWER -- Soaled chamber allowing to vein - Otherwise known as saline or heparin lock - Kept patent by flushing lock q12h - Usnally have an extension Lubing added rather than just applying lock to IV catheter. Complications of Central Venous Catheters [CVC]- CORRECT ANSWER- Air on Embolism:Chest pain, cyanosis, tachycardia, hy pote - Catheter Dislodgement: Pain in ear or neck during infusion, Change in length of tubing, Fluid leaking from entry site - Nerve Injury:Numbness or tingling sensation in the arm - Infection: Fever, chills, elevated WBC, purulent drainage, erythema (redness) Assisting w/ ADL’s- CORRECT ANS - Changing a gown: keep IV bag above insertion site - Ambulation: hand with the IV no higher than the waist Intake and Output Form - CORRECT. Sc - Output:Urine, Diarrhea, Vomit, Suction, Wound drainage, Diaphoreses, Hyperventilation, Drainage, Insensible/Sensible fluid lass Blood Transfusions - CORRECT ANSWER -Religious or ethical consideration: Jehovah Witnesses -- willing to tal blood volume expanders but no blood products - Every product that is made out of human blood whether blood, plasma, immunoglobulins, clotting factors, albumin etc has a tracking system to identify it with the recipient [carbon copies made {client, blood bank, hospital!] Blood Products - - Blood: Whole blood (PRBC). Fresh frozen plasma (FFP) [Usually used for initial therapy only on coagulation deficiencies. Can be used if overdose of oral anticoagulation], Albumin 3%& 25%, Platelets, Immune Globulin eg: IVIG, Factor Concentrates (VIID Blood Assessments - CORRECT ANSWER -- V/S for baseline - Auscultation of lungs - Skin for rashes/edema - Crossmatch completed -IV patent -Y Blood tubing with filter Ordering Blood from Lab - | - Phone information must include patient’s:Last name, first name PHN munber OR hospital number, Product type/volume, Date & time required, Initial/last name of person phoning order, BB will say ey need blood sample if they do not already have one Cross Matching - CORR! -RH - Antibodies - Blood Bank numbers on bracelets are only good for 3 days for inpatients. If over 3 days blood needs to be redrawn by lab and new BB bracelet applied with a new number. - Outpatients can be cross matched for a longer period than 3 days - Even if patient knows blood type and Rh factor it still needs to be cross-matched to make sure that a donor supply will not cause a reaction in the patient. Need to know:Mix both bloods together on slide and observe [or hemolysis --- TEST for virnses Picking up Blood from BB - CORRE‘ ‘R-Only the following can pick up blood from BB: Physicians, Medical House Staff, LPN’s, RN’s, student nurses, NA's, Unit Clerk, porter, ward aide - You need hard copy info of patient’s name, PHN#, BBIN# Product requested (Label works well) - BB technician needs your ID and you may sign for the blood. - Verbal confirmation of correct patient, name PHN # - Only 1 unit at a time - Blood is good for up to four hours (then becomes contaminated) - Once picked up from special BB refrigeration must start immediately Blood Transfusion Steps - CORRECT ANSWER -- Drs Orders - Correct pauicni/ready - Blood hung within 30mins of pick-up from BB - Maximum of 4 hours to infuse - Change Administration set every 8 hours or AFTER 2 units of Blood -ID the patient [Two identifiers] - Check BBIN and PHN and name - Check Blood Group and RH-must match the patient's ABO RH factor - Donor number on blood tag agrees with number on blood product (trackable) - ANY DOUBTS! - DO NOT TRANSFUSE - Two identifiers sign blood lag - Start date, time - Pre-lransfusion vilals signs - Re-check 15 mins after start of blood - Minerals: Essential as catalysts in biochemical reactions Nutrition Problems - CORRECT ANSWER -- Malnutrition - nutritional problems, Imbalanced, insufficient or e nutrients, Nausea & vomiting, difficulty swallowing, or inability to obtain food - Starvation causes catabolism (breakdown of protein), urine positive for ketones, and nitrogen balance negative Types of Diets - CORRECT ANSWER-- DAT - Regular - 1800 CDA diet - Clear fluids/full fluids/thickened - Pureod - Soft - Low residuc/high fibre - Low sodium - Low cholesterol - Heart Healthy - Renal ANSWER — Age - Physiological Factors: Ingestion Digestion & Absorption, Metabolism - Cultural and Lifestyle - Psychological Factors ive diet by impaired absorption or metabolism of - Dental / oral problems - Nausea / Vomiting - Wound Drainage - Pain - Fever - Alcoholism - Disease process - Medication - Mobility IRRE Factors Contributing to Malnutrilion - C ER -- Eating disorders - Anorexia - Bulimia - Cancer - AIDS - Chronic Diarrhea - Cystic Fibrosis - Fad dicts - Vegetarian diets [may not be adequate for vitamins/proteins] - Depression, Starvation - CORRECT ANSWER -- Causes catabolism [breakdown of proteins] - Urine positive for ketones - Nitrogen balance negative Household consumption Problems Evaluation of food intake: Food groups, Canada Guide, Nutritional Composition analysis, Calorie count] - Head to toe [Clinical signs of nutritional status, Vitamin and mineral deficiency, Actual physical exam, Ht, Wt, BMI, Composition, Etiology and factors affecting problems, Severily of issues] - Physical exam Indications for NG Tube Insertion - CO: SWER --Bowel Ilius - Bowel Obstruction - Gastric Decompression - Gl surgery - Temporary Enteral Foed Measuring an NG Tube - CORRECT ANSWER -- Tip or nose to Lhe earlobe - Earlobe to xiphoid process -- Mark on the tubing Lo indicale desired length with ink or tape Placement of NG - CORRECT placement - Aspiratc - Visually asses: Gastric aspirate = cloudy and green, tan or off-white, or bloody or brown. Intestinal aspirate = clear and yellow to bile-coloured. Pleural fluid = pale ycllow and serous. Tracheobronchial secretions = tan or off-white mucous - Measure pH: Gastric aspirate = 1-4 pH Intestinal aspirate = 6 or greater Respiratory aspirate =7 or greater Maintaining NG Tube - ANSWER -- Attach to suction - Monitor output - Replace losses - Provide oral and nasal care - Monitor for complications - Administer prescribed medications Complications of NG Tubes - CORRECT. Mucus / esophageal (vari - Nasal irritation - Mucosal irritation - Dry throat - Difficulty swallowing with drainage coating tube constant throat clearing - Reflux ( improper placement) Coughing or throat clearing - Aspiration - Blockage stomach - Tube inserted for prolonged tube feeding - Less chance of aspiration