Med Surg Case Study Questions and Answers

Med Surg Case Study Questions and Answers A patient with chronic heart failure is treated with hydrochlorothiazide, digoxin, and lisinopril. To prevent the risk of dig toxicity, what is most important that the nurse monitor in this patient? a. Blood pressure b. Heart rate c. GI function d. Potassium levels d Which physical assessment finding would the nurse expect to be present in a patient with acute right-sided heart failure? a. Jugular vein distention b. Bilateral crackles c. Pulmonary edema d. Bradypnea a What is a normal platelet count? 150,000-400,000 platelets per microliter What is a normal sodium level? (Include the units in your answer) 135-145 mEq/L What is a normal WBC count? 4-11^10^3 What is a normal potassium level? (Include the units in your answer) 3.5-5 mEq/L An important nursing responsibility related to pain is to a. leave the patient alone to rest b. believe what the patient says about pain c. help the patient appear to not be in pain d. assume responsibility for eliminating the patient's pain b A post-op patient has an order for hydrocodone 10mg/acetaminophen 325 mg 1-2 tabs q4hours PRN. The pharmacy placed a notation on the medication sheet that no more than 4 grams of acetaminophen may be administered per day. What is the maximum number of tablets that may be safely administered within a 24-hour period? (Enter your answer as a whole number only) 12 tablets A patient is to be started on a morphine drip at 2mg/hr. The pharmacy sends a bag with 100mg of Morphine in 200ml. At what rate would you set the IV pump at? Be sure to include units 4 mL/hr A patient with chronic kidney disease (CKD) has erythropoietin added to the medical administration record (MAR). What complication of CKD is the health care povider treating? a. Mineral and bone disorders b. Hypertension c. Hyperkalemia d. Anemia d A patient with chronic kidney disease (CKD) develops Kussmaul's respirations. What does the nurse know about CKD that could cause this respiratory pattern? a. Respiratory compensation for metabolic acidosis b. Pulmonary edema from heart failure and fluid overload c. Decreased pulmonary macrophage activity d. Uremic pleuritis is occurring a What is considered a normal 24 hour urine output? mL/day You are to administer Carafate 1 Gram a.c. Breakfast is scheduled at 0800, and the Carafate is dispensed as 200mg/ml. How many ml's would you administer and at what time should it be given? 5 mL & 0700 (1hr before breakfast) You are to administer 500mg of Kefzol diluted in 100ml of normal saline. The IVPB is to run over 15 minutes. What would you set the IV pump at (in ml/hr)? 400 mL/hr You are to administer 2 Grams of Unasyn IVPB over 1 hour. The medication is diluted in 250ml of 0.9NS. What should you set the pump at in ml/hour? 250 mL/hr What should the goals of nutritional therapy for the patient with type 2 diabetes include? a. Ideal body weight b. Five small meals per day with a bedtime snack c. Normal serum glucose and lipid levels d. A special diabetic diet using dietetic foods c Which medication is the first line of treatment for patients with type 2 diabetes? a. Metformin b. Glipizide c. Prandin d. Insulin a Which paitent should the nurse prioritize in teaching how to prevent or delay the development of diabetes? a. A 34-year-old woman whose parents both have type 2 diabetes b. A 20-year-old man whose father has type 1 diabetes c. A 12-year-old boy whose father has HTN and smokes d. An obese 40-year-old hispanic woman d What is a normal peripheral pulse? a. +3 b. +4 c. +2 d. +1 c What is a normal heart rate? 60-100 beats per min What is considered a normal capillary refill? 2 sec (less than 2 seconds) What is considered a normal oxygen saturation? 95-100 % What is a normal respiratory rate? 12-20 breaths per minute What is considered a normal blood pressure? 120/80 mmHg The nurse realizes that a patient is experiencing a 'warm and wet' acute decompensation when which of the following is noted? Select all that apply a. coarse breath sounds b. syncope c. urine output of 50 ml/hr d. cap refill 3 second e. cool, clammy extremities a, c A patient is wearing a continuous cardiac monitor, which begins to alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? a. call the healthcare provider b. call a code c. check the patient's status and lead placement d. press the recorder button on the electrocardiogram console check the patient's status and lead placement A patient is seen in an urgent care clinic. A diagnosis of hypertensive urgency is entered into the electronic medical record. The nurse knows that this diagnosis fits with which of the following scenarios a. BP 190/110, HR 108, decreased bowl sounds, abdominal distention b. BP 200/120, HR 98, A/O x3, blood glucose 115mg/dl c. BP 236/118, HR 104, A/O x3, Troponin 1 0.8ng/ml d. BP 212/118, urine output 30 ml/hr, complaints of being tired b A patient suffering from a STEMI is started on anticoagulant therapy. Which of the following indicates that reperfusion has occurred? a. Decrease in cardiac markers 2 hours following reperfusion b. INR of 2.5 IU c. resolution of chest pain d. increase in resp. rate c. resolution of chest pain A patient is admitted to the ER for a possible MI. Which physical assessment finding supports the diagnosis? a. resp rate of 12 bpm b. diaphoresis c. 3+ pedal pulses d. Troponin 1 of 0.6ng/ml b. diaphoresis 24 hours following a CABG, the nurse realizes that the patient is experiencing CABG related complications when the following is noted a. the patient has a temp of 99 F b. the surgical site has mild edema and bruising c. the patient has increased anxiety d. the patient has a new onset intermittent irregular heart beats d. the patient has a new onset intermittent irregular heart beats decrease fluid volume diuretics dilate renal arteries leading to increase perfusion and fluid excretion vasodilators inhibit SNS B adrenergic blockers increase contractility positive inotropes decrease anxiety morphine prevent thromboembolism anticoagulants A patient with a BP of 208/136 is admitted for further management of hypertensive emergency. The patient is confused and nauseous. IV Nitroprusside is ordered and administered. One hour later, the MAP has dropped 30%. Based on this information, the nurse realizes a. the nurse should check the MAR for an antiemetic b. the nitroprusside dose should be increased c. The MAP is dropping too quickly d. the patient should be monitored for increased urine output c. The MAP is dropping too quickly A patient experiencing a hypertensive crisis is started on IV sodium nitroprusside. During treatment, which of the following is most important for the nurse to include in the plan of care? a. maintain HOB at 45 degrees b. maintain bed rest c. blood glucose checks per order d. monitor resp rate b. maintain bed rest Which of the following patients are at risk for developing a dysrhythmia? Select all that apply a. A patient with renal failure b. a patient with a history of pneumonia 1 year ago c. a patient who smokes 1 pack per day d. a patient with a calcium of 9.4 mg/dl e. ejection fraction of 40% a,c,e A nurse just recieved shift report. Which client should the nurse assess first? a. a patient who is in sinus tachy following an elective cardioversion b. a patient with pulseless V tach c. a patient whose ICD fired once yesterday and is due for medications d. a patient whose BP is 190/126 with cap refill of 2sec and clear breath sounds b. a patient with pulseless v tach Which of the following statements best describes stroke volume? a. the amount of blood pumped by each ventricle/minute b. volume of blood leaving the heart with each contraction c. ventricular pressure at the end of systole d. amount of arterial blood flow to the extremities b. volume of blood leaving the heart with each contraction Which of the following findings would be the priority in caring for your patients? a. presence of a murmur with a cap refill of 2 sec b. potassium level of 3.4 with occasional irregular beats c. complaints of chest pain and a pulse ox of 88% d. +2 edema in the lower extremities while the patient is sitting in a chair c. complaints of chest pain and a pulse ox of 88% The nurse is reviewing the patient's morning labs. As a result of acute decompensation of heart failure, the nurse would expect to see which blood gas. a. respiratory acidosis b. metabolic acidosis c. metabolic alkalosis d. respiratory alkalosis a. respiratory acidosis A patient with Afib was started on Warfarin prophylactically one week ago. The nurse realizes that the treatment is effective when the a. INR 1.5 IU b. patient shows no evidence of stroke c. patient develops petechiae d. patient denies chest pain b. patient shows no evidence of stroke Which area on an EKG is affected by a MI ST segment Which of the following is a hypertensive emergency? a. BP 226/118 with urine output of 150mL/8 hours b. BP 200/120 with blood glucose 110 c. BP 210/110 with tremors d. BP 240/180 with hyperactive bowel sounds a. BP 226/118 with urine output of 150mL/8 hours The nurse should assess which of the following in a pt admitted with a hypertensive emergency? SATA a. PERRLA b. Bowel sounds c. Breath sounds d. Urine outpute. Heart rate/rhythm a,b,c,d,e The nurse becomes most concerned when a pt is admitted for management of hypertensive crisis develops which of the following? a. Urine output of 950 ml/day b. nausea/vomiting c. Changes on EKG d. Cap refill of 2-3 seconds c. Changes on EKG Nitroprusside is started to treat a hypertensive emergency. Which would be most appropriate to include in POC. STATA a. Quiet environment and tranquilizers to decrease BP b. Decrease MAP by 40% in one hour c. Continuous BP monitoring d. Assessment of cap refill, breath sounds, and LOC e. Insert of a foley cath. c,d As the nurse which intervention would be a priority for vtach? a. Beta blocker b. IV fluid resuscitation c. CPR and ACLS d. Antidysrhythmic medications c. CPR and ACLS A patient with Aflutter A/O x 4, cap refill is 2 seconds, and BP is 118/82. What intervention is a priority? a. Intubate and mechanically ventilation b. Cardioversion c. Medication d. IV fluids c. Medication A patient with aflutter is confused, O2 sat is 80% and blood pressure is decreasing, Which of the following would be the priority intervention? a. Cardioversion b. Beta blockers c. Amiodarone d. Ablation a. Cardioversion What intervention is a preventative measure to decrease the risk of a major complication with Afib? a. Pacemaker b. Warfarin c. Ca channel blocker d. Ablation b. Warfarin Why is Warfarin the best to decrease the risk of a major complication with Afib? - stroke is the major complication - vit k is the immediate reversal for warfarin - can monitor INR levels INR levels (therapeutic) 2-3 INR Normal 1.2 M.S. is a 32-year-old female. She has had a fever for 3 days. She has not been eating or drinking much the last few days. She feels dizzy and as though her heart is "racing." HR: 125 bpm, BP: 96/50, and O2 sat: 92%. Was put on a cardiac monitor in the ED when brought in by her family. EKG shows sinus tach.What would be included in her POC? STATA a. Antipyretics b. PO/IV fluids c. Cardioversion d. Digoxine. Nasal cannula a,b,e P.R. is 28-year-old male who's neighbor called 911 due to having SOB and him not making sense. Upon arrival, the paramedics say they cannot palpate any pulse. Vitals are RR 30 with coarse breath sounds, and BP 64/40. A cardiac monitor was put on and CPR was initiated on the way to the hospital. EKG shows Vtach. What intervention would be the priority? a. Administer fluids b. Repeat labs c. Defibrillate d. IV epinephrine c. Defibrillate P.R. is 28-year-old male who's neighbor called 911 due to having SOB and him not making sense. Upon arrival, the paramedics say they cannot palpate any pulse. Vitals are RR 30 with coarse breath sounds, and BP 64/40. A cardiac monitor was put on and CPR was initiated on the way to the hospital. EKG shows Vtach. They decide to defib the pt. In prepping the defibrillate PR you ensure that the synchronizer switch is a. On b. Off b Acute decompensation: ABGs a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic Alkalosis d. Metabolic acidosis a A pt was admitted for further treatment and evaluation of warm-wet acute cardiac decomp. What would the nurse expect on a physical assessment? STATA a. Cap refill 3 sec b. Coarse breath sounds c. Cold extremities d. RR of 14 bpm e. Dependent edema b,e What would be included in the POC for a patient with cold-wet acute cardiac decompensation? STATA a. Diuretics b. Morphine c. Vasopressors d. Inotropes e. High-fowler's position a,b,d,e A pt is being treated for cold-dry acute cardiac decompensation. What physical assessment findings would demonstrate improvement of pt condition? STATA a. RR of 22 bpm b. Cap refill 3 sec c. Coarse breath sounds d. Decreased urine output e. ABG with a PaO2 of 88 b F.M. is a 70-year-old caucasian male with a 12 yr history of CAD and hypertension. He has a history of type 2 diabetes mellitus, sleep apnea, a chronic renal insufficiency, His father dies of sudden cardiac death at 44. His hypertension is treated with hydrochlorothiazide and metoprolol and takes metformin to control his diabetes. He has been smoking since age 17. He is 5'10" tall, weighs 240 lbs, and does not regularly exercise. He travels a lot as a pharmaceutical sales manager and it is difficult to maintain a healthy, diabetic diet when he is out of town.Presents to ED with chest pain and complaints of nausea. What are the risk factors for MI for F.M.? Age,Diabetes,Diet,Family Hx,Not much exercise,CAD,Smoking,Obese,HTN,Gender,OSA,Lifestyle,Stress F.M. is a 70-year-old caucasian male with a 12 yr history of CAD and hypertension. He has a history of type 2 diabetes mellitus, sleep apnea, a chronic renal insufficiency, His father dies of sudden cardiac death at 44. His hypertension is treated with hydrochlorothiazide and metoprolol and takes metformin to control his diabetes. He has been smoking since age 17. He is 5'10" tall, weighs 240 lbs, and does not regularly exercise. He travels a lot as a pharmaceutical sales manager and it is difficult to maintain a healthy, diabetic diet when he is out of town.Presents to ED with chest pain and complaints of nausea. What would be included in the immediate care of F.M. STATA a. Supplemental O2 b. Labs c. Nitroglycerin d. Placement of 2 IVs e. EKG a,b,c,d,e F.M. is a 70-year-old caucasian male with a 12 yr history of CAD and hypertension. He has a history of type 2 diabetes mellitus, sleep apnea, a chronic renal insufficiency, His father dies of sudden cardiac death at 44. His hypertension is treated with hydrochlorothiazide and metoprolol and takes metformin to control his diabetes. He has been smoking since age 17. He is 5'10" tall, weighs 240 lbs, and does not regularly exercise. He travels a lot as a pharmaceutical sales manager and it is difficult to maintain a healthy, diabetic diet when he is out of town.Presents to ED with chest pain and complaints of nausea. Following administration of Nitroglycerin, what side effects does the nurse need to monitor the pt for? STATA a. Headache b. Hypotension c. Bradycardia d. Flushing e. Dizziness a,b,d,e F.M. is a 70-year-old caucasian male with a 12 yr history of CAD and hypertension. He has a history of type 2 diabetes mellitus, sleep apnea, a chronic renal insufficiency, His father dies of sudden cardiac death at 44. His hypertension is treated with hydrochlorothiazide and metoprolol and takes metformin to control his diabetes. He has been smoking since age 17. He is 5'10" tall, weighs 240 lbs, and does not regularly exercise. He travels a lot as a pharmaceutical sales manager and it is difficult to maintain a healthy, diabetic diet when he is out of town.Presents to ED with chest pain and complaints of nausea.Following 2 doses of nitroglycerin, F.M. still complaints of chest pain. Which med would the RN give?a. Morphine b. Hydromorphone c. Ketorolac d. Fentanyl a What is the treatment of choice for a STEMI? a. Fibrinolytics b. CABAG c. PCI d. Anticoagulants c. PCI What is the treatment for NSTEMI? Anticoagulants Antiplatelet PCI if needed HCP orders heparin for F.M. based on his weight of 240 lbs you administer a bolus of 4000 units of heparin. The order also states that the pt should receive heparin 12 units/kg/hr as a continuous infusion following the bolus. How many units/hour will you administer? 1308 units/hr 2.2 lbs = 1 kg(240/2.2) x 12 = 1308 units/hr What are indications of reperfusion following treatment on a pt who suffered a STEMI? STATA a. Return of ST-segment to baseline b. Decrease in cardiac markers c. Decrease in chest pain d. Increase O2 saturation e. Decrease RR and HR a,c,d,e What does MONAS stand for? Morphine Oxygen Nitro Aspirin (4 baby aspirin) Statins