Exam 2- Med Surg:Pedi:OB:Mental with Answers

MED SURG Exam 2 Questions & Answers CARDIOVASCULAR DISORDERS-CONTENT REVIEW • Understand EKG’s (e.g. interpretation, S/S, treatments o Atrial ▪ SB ▪ ST ▪ SVT ▪ A-Fib ▪ A-Flutter ▪ PACs ▪ Paced-beats ▪ 1st, 2nd, 3rd degree heart blocks • Atropine, adenosine, synchronized cardioversion, coumadin, pacing o Ventricular ▪ PVCs (unifocal, multifocal, bigeminy, trigemini,) ▪ VT (pulse/pulseless) ▪ VF ▪ Asystole • O2, amiodarone, lidocaine, defibrillate, CPR, epinephrine • Understand S/S, assessment findings, priority interventions, treatments, and teaching for CHF (Right and Left), STEMI, Acute Pericarditis, Angina, MI, Cardiogenic Shock, CAD, and Hypertension o Know how to calculate the MAP and Priority nursing interventions o (2X Diastolic + Systolic) divided by 3 • Laboratory finding associated with cardiovascular disorders o Potassium o Calcium o Sodium o CK, CKMB, Troponin o LDL, HDL, Cholesterol • Understand cardiac medications (e.g., Atropine, adenosine, diltiazem, amiodarone, coumadin, lidocaine, Lopressor, isuprel, dopamine, digoxin, NTG (SL), HCTZ • Understand care for a client with a central venous catheter o Aseptic care o S/S of infection o Removal care • DVT nursing interventions o Assessment findings o Medical care • Understand S/S, nursing interventions, medical interventions (surgeries, care pre- and post-op, medications) for various valve disorders: o Aortic o Mitral o Tricuspid Which of the following interventions are a priority during exacerbation of left sided heart failure? (Select all that apply) A. Metered dose inhaler of albuterol B. High Fowler’s position C. Oxygen D. IV Fluids E. Incentive spirometer F. Diuretics The nurse should monitor a client after a coronary angioplasty for which of the following clinical manifestations indicating cardiac tamponade? (Select all that apply) A. Muffled heart sounds B. Headache C. Hypotension D. Vision changes E. Cool, diaphoretic skin F. Tachycardia Which of the following should the nurse include in the plan of care for the client experiencing pain from a DVT of the left who is receiving heparin and warfarin (Coumadin)? Administration of: A. Aspirin 325mg PO every 4 hours B. Patient controlled analgesic of morphine C. Meperidine (Demerol) 50mg IM every 3 hours D. Ibuprofen (Motrin) 400mg PO every 6 hours PRN A client is brought to the emergency room with a third degree heart block after experiencing an acute anterior MI. Which of the following interventions is the priority on an emergency basis? A. Temporary pacemaker B. Administer lidocaine C. Cardioversion D. Administer atropine During a routine physical examination, a client reports recent occipital headaches, blurred vision, fatigue, and increasing edema. The nurse reports these findings as indicative of A. Endocarditis B. Hypovolemic shock C. Hypertension D. Ventricular tachycardia Immediately after receiving cefazolin (Ancef) IV for prophylaxis for a pacemaker insertion, the client becomes restless, tachycardic, and hypotensive. Which of the following interventions should the nurse implement as the priority? A. Administer epinephrine B. Obtain stat blood culture C. Administer thrombolytic therapy D. Administer atropine After a client with coronary artery disease develops heavy, substernal chest pain, which of the following interventions should the nurse do first? A. Administer 2 puffs of albuterol (Proventil) by mouth. B. Administer 1 tablet of nitroglycerin under the tongue every 5 minutes; call 911 if no relief after 15 minutes. C. Administer 0.04 mg IV push nitroglycerin slowly over 1-2 minutes. D. Administer immediate synchronized cardioversion. ENDOCRINE DISORDERS-CONTENT REVIEW • Understand the dynamic between the utilization of insulin and steroids • Understand testing to determine long-term IDDM control o Fasting blood glucose level o Ketones/albumin in urine o Glycosylated hemoglobin • Understand worsening manifestations for patients with pituitary adenoma • Know S/S of syndrome of inappropriate antidiuretic hormone (SIADH), lab values, and treatments. o Neurological considerations • Understand the pathophysiology of DKA, clinical manifestations, priority interventions, and evaluative criteria for improvement o Kussmal respirations • Understand DI, S/S and nursing considerations • Understand S/S of HYPO and HYPERthyroidism and thyroid storm o Common medication prescribed (PTU) and side-effects/adverse actions, nursing interventions, and priority care o Know nursing priority actions for patients undergoing an adrenalectomy • Understand Addison’s Disease, assessment findings, priority interventions (especially with Addison’s Crisis) • Understand hypo/hyper parathyroidism s/s, treatments, medications, and nursing considerations. • Understand s/s and nursing assessment and considerations for Cushing’s Syndrome caused by adrenal tumor o (BP, I&O, WBC, glucose, Na, K, and Ca levels, meticulous skin care, radiation therapy care, etc.). • Understand nursing considerations for a patient taking Synthroid, Insulin (regular and NPH o [including onset, peak, and duration]), Decadron, oral glucose, Prednisone, and hormone therapy. • Understand the s/s of acute transplant rejection in the client with Type I diabetes who had kidney transplant. • Understand pheochromocytoma s/s and nursing considerations (e.g., pain control). o Know the procedure transsphenoidal hypophysectomy and nursing considerations. The client with an endocrine disorder complains of weight loss and diarrhea, and says that he can “feel his heart beating in his chest.” The nurse interprets that which of the following glands is most likely responsible for these symptoms? A. Thyroid B. Pituitary C. Parathyroid D. Adrenal cortex The client with diabetes experiences breakdown of fats for conversion to glucose. The nurse determines that this response is occurring if the client has elevated levels of which of the following substances? A. Glucose B. Ketones C. Glucagon D. Lactic dehydrogenase A client is admitted to the hospital with a diagnosis of Addison’s disease. The nurse would monitor for which of the following problems associated with this disease? Select all that apply. A. Edema B. Obesity C. Syncope D. Hirsutism E. Hypotension F. Muscle weakness The nurse assesses which of the following assessments in a client with severe anterior pituitary deficiency caused by the growth of a tumor? (Select all that apply) A. Intolerance to heat B. Hyperglycemia C. Polyuria D. Bradycardia E. Hypoglycemia F. Dehydration The nurse should include which of the following in preoperative instructions for a client with an anterior pituitary tumor who is scheduled for a total hypophysectomy using the transsphenoidal approach? A. Avoid sneezing or blowing the nose after surgery. B. Drink 10 glasses of fluids the day before surgery. C. Do not rinse the mouth with any solutions until the packing is removed. D. Support the neck when getting out of bed. The nurse should include which of the following in the discharge instructions of a client with diabetes insipidus? A. Follow-up appointments are not necessary with the physician unless there is an acute illness. B. The prescribed hormone drugs will need to be taken for a lifetime. C. Extra fluids should be taken cautiously when experiencing a major stressor. D. Changes in diet and exercise may require changes in medication dosages. Which of the following client statements should the nurse report to the physician prior to scheduling a radioactive iodine uptake and excretion test? A. “I’ve been taking over-the-counter cough medicine for the past two weeks.” B. “My husband and I are vegetarians.” C. “We like to drink a glass of wine with our meals.” D. “I take a baby aspirin every day since my heart attack last year.” The nurse develops a plan of care for the immediate postoperative period for a client who had a thyroidectomy. The plan should include measures to: A. Correct fluid and electrolyte balance. B. Administer medications to decrease vascularity of the thyroid glands. C. Promote range-of-motion exercises to the neck. D. Prevent complications of respiratory obstruction. Which of the following is a priority for the nurse to monitor in a client with pheochromocytoma? A. Weight. B. Serum glucose level. C. Blood pressure. D. Temperature. RESPIRATORY DISORDERS: CONTENT REVIEW • Understand assessment, common findings, ABGs and medications for hypoxemic respiratory failure o ARDS, pneumonia, pulmonary edema • Understand assessment, common findings, ABGs and medications for hypercapnic respiratory failure o COPD, asthma, drug overdose • ABG interpretation, priority nursing interventions, and common causes of abnormal findings o Respiratory acidosis/alkalosis o Metabolic acidosis/alkalosis • Understand the care for a client with pulmonary hypertension o Swan Ganz o PVR o PAWP o SVR o CVP • Know the technique for tracheal suctioning as well as nursing assessment o Lung sounds, SaO2, sterile procedure, inline suctioning • Oral airway insertion technique to protect the airway • Hemothorax, pneumothorax, hemopneumothorax, pulmonary contusion, rib fracture, flail chest • Know chest tubes • Understand TB, priority nursing interventions and medical treatment • Understand the following medications o Mucomsyt o Maxair o Cromolyn o Azmacort o Beclomethasone A client is admitted to the ICU 26 hours ago following extensive pulmonary trauma. Which clinical manifestation would first alert the nurse that the client is experiencing ARDS? A. Blood-tinged, frothy sputum B. Dense pulmonary infiltrates with a “whited-out” appearance on x-ray C. An increase in respiratory rate D. Increasing hypoxemia A client with a history of asthma presents in the physician’s office with complaints of difficulty breathing. While performing the initial assessment, the nurse becomes concerned that the client’s respiratory status has worsened based on which of the following? A. Wheezing throughout the lung fields B. Noticeably diminished breath sounds C. Loud wheezing only on expiration D. Mild wheezing on inspiration A client with pulmonary edema is currently receiving 4 L/min of oxygen per nasal cannula. The most recent ABG results indicate the following: pH – 7.30, pCO2 – 50 mmHg, pO2 – 56 mmHg, HCO3 – 24 mmHg. The nurse anticipates that the phys