ATI CAPSTONE QUESTIONS MEDSURG

ATI CAPSTONE QUESTIONS MEDSURG 1.A nurse is caring for a client following a bone marrow biopsy. What information should the nurse include in the discharge education? You should try to rest for the remainder of the day after your biopsy. For at least 2-3 days, you will feel sore. For the first 24 hrs, it’s best to keep the operative site clean and dry. If the bandage becomes soiled, be sure to change it as soon as possible. Contact your doctor if the you have pain in the biopsy site that becomes severe for more than a day. Contact your doctor if the biopsy area becomes swollen, red, warm to touch, or if it begins draining pus like fluid, because this may indicate infection in the area. Other signs and symptoms of infection include coughing and body aches. What are three (3) risk factors for testicular cancer? List three (3) subjective and objective findings in the client with testicular cancer? Risk Factors 1) HIV infection 2) Undescended testis 3) Genetic disposition o Also Metastases, Age 20-54 (occur at any age) Subjective Findings 1) Lumps/swelling of testes 2) Feeling of heaviness in testicles 3) Evidence of metastasis (i.e. abdominal masses, gynecomastia, back pain) Objective Findings 1) Enlarged testes without pain 2) Palpable lump (assessed by provider) 3) Swelling of lymph nodes in groin What are the recommendations for vaccinations in the adult population? Td booster o Give booster every 10 years. For adults 19-64 y/o who didn’t receive Tdap o Adults 65 y/o who haven’t received Tdap o Pregnant women after 20 weeks GA may receive vaccine MMR vaccine o 1-2 doses at 19-49 y/o & 1 dose at 50 y/o Varicella vaccine o 2 doses to adults who don’t have evidence of previous infection PPSV o Adults who are immunocompromised who have chronic disease, smoking cigarettes, who life in long-term facilty Hep A vaccine o 2 doses for high-risk individuals Hep B vaccine o 3 doses for high-risk individuals o Recommended for adults 60 y/o or younger Influenza vaccine o Recommended for all adults annually Herpes Zoster vaccine o Recommended for 60 y/o Define the following types of urinary incontinence: Stress, urge, overflow, reflex, functional, total. Stress Incontinence: urine leaks due to weakened pelvic floor muscles and tissues. It can happen when pressure on your bladder increases -- such as when you exercise, laugh, sneeze, or cough. Pregnancy and childbirth can stretch and weaken a woman’s pelvic floor muscles. Other things that can lead to stress incontinence are being overweight or obese, taking certain medications or, in men, having prostate surgery. Urge Incontinence: occurs when the need to urinate comes on so quickly that you might fail to make it to the bathroom in time. Also known as overactive bladder or spastic bladder, this sudden need to urinate can be intense and frequent. The amount of urine in the bladder does not matter when it comes to urge incontinence. The nerves communicate a need to urinate, and the ability to inhibit this urge is compromised. The bladder spasms on its own and pushes the urine out. Urge incontinence can affect anyone at any age, but it appears to be more prevalent in the elderly. It can be caused by diabetes or a urinary tract infection, or by a nerve-affecting disorder like stroke, Alzheimer's disease, or multiple sclerosis. In some cases, it can be an early sign of bladder cancer. Overflow Incontinence: Overflow urinary incontinence is the opposite of urge incontinence. The urge to urinate isn’t felt, but the bladder begins uncontrollably leaking small amounts of urine anyway. The bladder is too full, and the urine is escaping to relieve pressure. It occurs often in men. It can be caused by a tumor or an enlarged prostate gland blocking the flow of urine, preventing the bladder from ever emptying completely. Diabetes, spinal cord injuries, and medications also can cause overflow incontinence. Reflex incontinence. A variation on urge incontinence in which you feel no need to urinate but urine is lost when your bladder begins to contract uncontrollably Functional Incontinence: This type of urinary incontinence really has nothing to do with diseases or problems with the bladder. You just have a hard time getting to the bathroom in time, due to arthritis or some other problem that makes it difficult to move around. Total incontinence. The complete loss of bladder control, usually due to fistula — an abnormal connection between the skin and urinary tract. A nurse is caring for a client with Rheumatoid arthritis who is prescribed a non-steroidal anti-inflammatory drug (NSAID) for the treatment of joint pain. Provide three (3) teaching points in client education the nurse should provide regarding this medication therapy. • Advise patients that NSAIDS may worsen breathing, and many specialists recommend that people who have asthma not take certain NSAIDs. • Advise to use NSAIDs with caution if they have kidney or liver disease, heart failure, high blood pressure, diabetes, lupus, asthma, or ulcers. They can reduce blood flow to the kidneys, which may cause them not to work as well. This makes fluid build-up in the body, which can raise blood pressure. NSAIDs also can increase ones risk of developing or worsening stomach bleeding and ulcers. • Instruct them to tell doctor about all drugs and supplements they take. NSAIDs may interact with blood thinners, cyclosporine, lithium, or methotrexate. A nurse is caring for a client experiencing metabolic acidosis. What are three (3) causes of metabolic acidosis? • Excess production of hydrogen ions such as: diabetic ketoacidosis, fever, hypoxia, heavy exercise. • Inadequate elimination of hydrogen ions such as: kidney failure • Inadequate production of bicarbonate such as: kidney failure, pancreatitis, liver failure, dehydration. A nurse is caring for a client after a knee arthroplasty procedure. What are three (3) interventions to implement to aid with recovery? • Pain management: Control pain, do not chase pain. Instructing patients to report unrelieved pain "promptly" is critical to effective pain management. • Postoperative patients need the opportunity to mobilize and ambulate. TKA patients should mobilize as soon as it is possible. Postoperative complications are prevented with ambulation. Physical therapy should be an important part of the multidisciplinary team to teach the patient how to use assistive devices and adhere to any weight-bearing restrictions that are ordered. • Another aspect of therapy for knee replacement patients is use of continuous passive motion (CPM) machines that are used to gently flex and extend the knee. They are used to help the patient make progress by increasing range of motion postoperatively. Prophylaxis of DVT and PE is an important part of postoperative care for the TKA patient. Intermittent compression devices should be applied to the TKA patient's legs either intraoperatively or immediately postoperatively. All members of the multidisciplinary team should ensure that the compression devices are on the legs at all times, even when the patient is out of bed. A nurse is evaluating the client's understanding of post cataract surgery instructions. The client needs further education when they state."I will report any yellow drainage to my provider"."I can return to my normal activities like cleaning my house and vacuuming.""I will report any nausea or vomiting"."My vision will improve over the next 4 to 6 weeks". The answer to this question should be: "i can return to my normal activities like cleaning my house and vacuuming" A post cataract surgery patient will be prone to an airborne allergen such as dust so it is not recommended to do any cleaning or be in a place with much dust. Vacuuming will increase the amount of the dust in the room and this might cause damage to the patient eye. What are the expected assessment findings for a herniated lumbar disk? Limited ability to bend forward, posture favoring the affected side, gait difficulty, tenderness over affected region and radicular pain with straight leg raising A nurse is caring for a client with multiple risk factors for peripheral vascular disease. List four (4) risk factors associated with peripheral vascular disease. Hypertension, hyperlipidemia, diabetes mellitus, and smoking A nurse is caring for a client post-laryngectomy. What three (3) postoperative interventions should be provided? 1) Monitor VS frequently for risk of hemorrhage & respiratory compromise 2) Enable patient use of communication (i.e. dry-erase board) 3) Assess stoma hourly & provide care frequently A nurse is caring for a client with a history of migraines with auras. What are the stages of this type of migraine? Prodromal, Aura, Second, Third, and Recovery Fill in the Blank Multiple sclerosis can cause vision changes including Diplopia, Changes in peripheral vision, and decreased visual acuity. What are some common complications related to internal pacemaker insertion? • Infection/Hematoma at insertion site o Assess incision site for redness, pain, drainage, or swelling o Admin Anti-Bx as prescribed o Monitor PT, PTT, & CBC • Pneumothorax/Hemothorax o Assess breath sounds, O2 Sat, & chest movement o Obtain a CXR after procedure • Arrhythmias r/t ventricular irritation from pacemaker electrode o Monitor ECG & BP o Admin antiarrhythmics as prescribed o Have emergency resuscitation equipment & meds readily available A nurse is caring for a client with a tension pneumothorax. What is a tension pneumothorax and what manifestations should the nurse expect? A tension pneumothorax occurs when air enters the pleural space during inspiration through a One way valve and is not able to exit upon expiration. The trapped air causes pressure on the heart and the lung. As a result, the increase in pressure compresses blood vessels and limits venous return, leading to a decrease in cardiac output. Death can result if not treated immediately As a result of a tension pneumothorax, air and pressure continue to rise in the pleural cavity, which causes a mediastinal shift tachypnea, tachycardia, hypoxia, cyanosis ,dyspnea, and use of accessory muscles. Tracheal deviation to unaffected side Rreduced or absent lung sounds on affected side Asymmetrical chest wall movement Hyerresonance Subcutaneous emphysema