Medical Surgical Certification
What are the Kubler-Ross stages of grief? Correct Answer: denial, anger, bargaining, depression,
acceptance
Describe Lewin's change management model Correct Answer: Unfreeze, change, refreeze
What changes are necessary for someone taking Coumadin (warfarin)? Correct Answer: Low or
moderate intake of green leafy vegetables, fish, liver or cauliflower. These foods are high in vitamin K
and may decrease INR level
ARBs Correct Answer: Example: losartan(Cozaar), valsartan (Diovan), olmesartan (Benicar). Used to
lower BP. May cause hyperkalemia. Contraindicated: renal artery stenosis
What is the therapeutic range for digoxin therapy? Correct Answer: 0.8-2.0 ng/ml (greater than 2 is
toxic)
What are S/S of hypertensive crisis? Correct Answer: Headache, vision changes, confusion, nose bleeds
(epistaxis), chest/back/abd pain, dyspnea, urinary frequency or oliguria
Describe left sided heart failure Correct Answer: Results in fluid backing up into the lungs (pulmonary
edema). S/S of pulmonary edema is pink, frothy sputum
Treatment for pulmonary edema Correct Answer: oxygen, bipap, lasix, morphine (vasodilates vessels),
dobutamine (helps with cardiac output)
How is the progression of heart failure monitored? Correct Answer: Left ventricular ejection fraction
(LVEF) on an echocardiogram
What is the max amount of time an order for restraint usage may be utilized? Correct Answer: 4 hours
(adults)
S/S of a basilar skull fracture Correct Answer: Battle Signs: bruising behind ears, CSF leaking from nose
(clear/colorless/+ for glucose), raccoon eyes
What is a serious complication of a basilar skull fracture? Correct Answer: ➤May lead to bacterial
meningitis (antibiotics may be given prophylactically to prevent this)
What are the classic S/S of an epidural hematoma? Correct Answer: Patient appears lucent and then
presents with decreased LOC (Surgical Emergency)
What is an epidural hematoma? Correct Answer: Collection of blood between the dura and the skull
Why should you avoid HYPOtonic solutions with brain injuries? Correct Answer: They cause fluid shifts
and may increase cerebral edema (ex.: 1/2NS)
,What type of solutions are okay to use with brain injuries? Correct Answer: Isotonic (09%NS) is
preferred, HYPERtonic is okay
Cushing's Triad Correct Answer: severe hypertension, widened pulse pressure, bradycardia, abdnormal
respiration
Cushing's triad indicates Correct Answer: Increased intracranial pressure (brain herniation)
Risk factors for ischemic stroke Correct Answer: Tobacco, ETOH, illicit drug use, obesity, African-
Americans, Age (>55), family history, hx of A-fib/CHF/MI
Clinical findings of DKA Correct Answer: Hyperglycemia (glucose >250), blood pH is acidotic (<7.30),
Bicarb: <15, high ketones in the urine or blood (ketonuria/ketonemia)
S/S of DKA Correct Answer: lethargy, kussmauls (Deep/fast breathing, fruity breath), abdominal pain,
N/V, postural hypotension
HHS (Hyperglycemic Hyperosmolar State) Correct Answer: Occurs in type II diabetics, does not cause
ketones, Hyperglycemia (>600). Results in Severe Dehydration. Pt has polydipsia, polyphagia, polyuria)
What test is the best way to rule out organ rejection or hepatitis in a liver transplant? Correct Answer:
liver biopsy
What positive assessment finding would indicate cholecystitis? Correct Answer: Positive Murphy's sign
What assessment finding is suggestive of paralytic ileus? Correct Answer: absent bowel sounds
Describe labs on someone who has DIC? Correct Answer: Low platelets (<100,000), high PT/PTT
(>15/>60-90) and high d-dimer (>2 mg/L)
What is the most important DIC medical intervention? Correct Answer: Stop the clotting -IV heparin
PCO2 normal ABG range Correct Answer: PCO2 = carbon dioxide, 35-45 mmHg
Respiratory Alkalosis causes Correct Answer: Respiratory distress (blowing off too much CO2),
restrictive lung diseases, anxiety w/ excessive respiratory rate
What is asterixis? Correct Answer: hand tremor, this is a classic sign of liver failure. Asterixis may
resemble a bird flapping its wings (found in stage 1-3 hepatic encephalopathy)
What labs are affected in metabolic acidosis? Correct Answer: Low HCO3 (<22) and low PH (acidotic,
<7.35)
What are s/s of pancreatic hemorrhage? Correct Answer: Cullens sign (bruising around umbilicus) and
Turner's sign (flank or back bruising)
,What are typical manifestations of diastolic heart failure? Correct Answer: shortness of breath,
tachypnea and pulmonary congestion
Friction rub is associated with what condition? Correct Answer: pericarditis or restrictive heart disease
What lab is indicative of the degree of heart failure a person is exhibiting? Correct Answer: BNP (Brain
natriuretic peptide): this hormone regulates BP and fluid volume levels. >51.2 is mild and >1000 pg/mL is
severe
Centriacinar emphysema Correct Answer: occurs in UPPER half of lung. Caused by long-term Cigarette
smoking, occurs in older people >50)
Troponin I Correct Answer: Elevation indicates an MI. >1.4 mcg/L. This lab stays elevated x14 days after
a heart attack
Digoxin toxicity Correct Answer: >2.0 n.g/mL. S/S: yellow/green halos in visual fields. Treatment:
Digibind
Cirrhosis leads to ______ which = increased risk for _________ Correct Answer: Portal HTN....increased
risk for varices
What is contraindicated in chronic ETOH cirrhosis patients? Correct Answer: NG tubes..due to risk of
varices
Multiple myeloma S/S Correct Answer: Increased calcium (calcium is pushed out of the bones), bone
pain, bones become fragile and lead to fractures
Assessment findings most consistent with peripheral vascular disease include Correct Answer: brown
pigmentation on ankles from iron deposits leaking from venous stasis, warm legs, venous ulcers, pain
with resting, distal edema
Assessment findings consistent with Peripheral Artery disease Correct Answer: pain with ambulation,
distal/digit ulcers and absent pulses
Reversal agent for heparin Correct Answer: protamine sulfate
Basophils Correct Answer: A granulocyte responsible for anaphylactic reactions
Shift to the left Correct Answer: elevated bands (immature neutrophils) >10%. This occurs with infection
/inflammation
How would you recognize a leak in a chest tube system? Correct Answer: bubbling in water seal
chamber. (don't confuse this with tidaling, the rise and fall with breath is normal)
Virchow's Triad Correct Answer: Venous stasis, vessel wall damage, hypercoaguable state
(cancer/dehydration). These place a person at a high risk of developing a pulmonary embolus
, The S1 sound represents the closure of the Correct Answer: Closure of mitral/tricuspid valves (start of
systole/squeeze) "LUB" sound
PaO2 normal ABG values Correct Answer: >60 mmHg
Adenocarcinoma Correct Answer: type of lung cancer, occurs mostly in women, causes lots of mucous
Describe neutrophils Correct Answer: 90% of granulocytes. Neutrophils fight infection and respond to
inflammation
What are the recommendations for BP in someone less than 50? Correct Answer: Less than 140/90
What are the recommendations for BP in someone 60+? Correct Answer: Less than 150/90
How long should you fast before cholesterol testing? Correct Answer: at least 8 hours or more
What is a normal range for LDL cholesterol? Correct Answer: <160 mg/dL
What is a normal range for HDL cholesterol? Correct Answer: >40 mg/dL
What is a normal level for total cholesterol? Correct Answer: <200 mg/dL
What is a normal level for triglycerides? Correct Answer: <150 mg/dL
"An S3 heart sound can be normal in which people?" Correct Answer: young people and athletes
An S3 heart sound is often associated with? Correct Answer: heart failure (when heard in the older
adult)
What is the definition of cardiac output? Correct Answer: the amount of blood pumped by the heart in
one minute
Acute lymphocytic leukemia (ALL) Correct Answer: dx age 2-4, s/s: anemia, bleeding, infection, elevated
WBC, joint/bone pain. The most common form of childhood leukemia. Overproduction of lymphocytes
Protonix Correct Answer: Management of GI bleeds. Begins with a bolus and then gtt
S/S of peritoneal irritation Correct Answer: rigid abdomen, absent bowel sounds, tenderness/guarding
of abdomen, severe focal pain, N/V
What are causes of peritoneal irritation Correct Answer: appendicitis, cholecystitis, pancreatitis,
obstruction, perforated viscous, inflammatory bowel disease
What drugs increase the risk of pancreatitis? Correct Answer: corticosteroids, cyclosporine,
sulfonamides, estrogens
DKA treatment Correct Answer: 1. fluids (NS, D5 1/2NS) 2. Replace K (drops with insulin) 3. Monitor
phosphorous 4. Insulin drip
What are the Kubler-Ross stages of grief? Correct Answer: denial, anger, bargaining, depression,
acceptance
Describe Lewin's change management model Correct Answer: Unfreeze, change, refreeze
What changes are necessary for someone taking Coumadin (warfarin)? Correct Answer: Low or
moderate intake of green leafy vegetables, fish, liver or cauliflower. These foods are high in vitamin K
and may decrease INR level
ARBs Correct Answer: Example: losartan(Cozaar), valsartan (Diovan), olmesartan (Benicar). Used to
lower BP. May cause hyperkalemia. Contraindicated: renal artery stenosis
What is the therapeutic range for digoxin therapy? Correct Answer: 0.8-2.0 ng/ml (greater than 2 is
toxic)
What are S/S of hypertensive crisis? Correct Answer: Headache, vision changes, confusion, nose bleeds
(epistaxis), chest/back/abd pain, dyspnea, urinary frequency or oliguria
Describe left sided heart failure Correct Answer: Results in fluid backing up into the lungs (pulmonary
edema). S/S of pulmonary edema is pink, frothy sputum
Treatment for pulmonary edema Correct Answer: oxygen, bipap, lasix, morphine (vasodilates vessels),
dobutamine (helps with cardiac output)
How is the progression of heart failure monitored? Correct Answer: Left ventricular ejection fraction
(LVEF) on an echocardiogram
What is the max amount of time an order for restraint usage may be utilized? Correct Answer: 4 hours
(adults)
S/S of a basilar skull fracture Correct Answer: Battle Signs: bruising behind ears, CSF leaking from nose
(clear/colorless/+ for glucose), raccoon eyes
What is a serious complication of a basilar skull fracture? Correct Answer: ➤May lead to bacterial
meningitis (antibiotics may be given prophylactically to prevent this)
What are the classic S/S of an epidural hematoma? Correct Answer: Patient appears lucent and then
presents with decreased LOC (Surgical Emergency)
What is an epidural hematoma? Correct Answer: Collection of blood between the dura and the skull
Why should you avoid HYPOtonic solutions with brain injuries? Correct Answer: They cause fluid shifts
and may increase cerebral edema (ex.: 1/2NS)
,What type of solutions are okay to use with brain injuries? Correct Answer: Isotonic (09%NS) is
preferred, HYPERtonic is okay
Cushing's Triad Correct Answer: severe hypertension, widened pulse pressure, bradycardia, abdnormal
respiration
Cushing's triad indicates Correct Answer: Increased intracranial pressure (brain herniation)
Risk factors for ischemic stroke Correct Answer: Tobacco, ETOH, illicit drug use, obesity, African-
Americans, Age (>55), family history, hx of A-fib/CHF/MI
Clinical findings of DKA Correct Answer: Hyperglycemia (glucose >250), blood pH is acidotic (<7.30),
Bicarb: <15, high ketones in the urine or blood (ketonuria/ketonemia)
S/S of DKA Correct Answer: lethargy, kussmauls (Deep/fast breathing, fruity breath), abdominal pain,
N/V, postural hypotension
HHS (Hyperglycemic Hyperosmolar State) Correct Answer: Occurs in type II diabetics, does not cause
ketones, Hyperglycemia (>600). Results in Severe Dehydration. Pt has polydipsia, polyphagia, polyuria)
What test is the best way to rule out organ rejection or hepatitis in a liver transplant? Correct Answer:
liver biopsy
What positive assessment finding would indicate cholecystitis? Correct Answer: Positive Murphy's sign
What assessment finding is suggestive of paralytic ileus? Correct Answer: absent bowel sounds
Describe labs on someone who has DIC? Correct Answer: Low platelets (<100,000), high PT/PTT
(>15/>60-90) and high d-dimer (>2 mg/L)
What is the most important DIC medical intervention? Correct Answer: Stop the clotting -IV heparin
PCO2 normal ABG range Correct Answer: PCO2 = carbon dioxide, 35-45 mmHg
Respiratory Alkalosis causes Correct Answer: Respiratory distress (blowing off too much CO2),
restrictive lung diseases, anxiety w/ excessive respiratory rate
What is asterixis? Correct Answer: hand tremor, this is a classic sign of liver failure. Asterixis may
resemble a bird flapping its wings (found in stage 1-3 hepatic encephalopathy)
What labs are affected in metabolic acidosis? Correct Answer: Low HCO3 (<22) and low PH (acidotic,
<7.35)
What are s/s of pancreatic hemorrhage? Correct Answer: Cullens sign (bruising around umbilicus) and
Turner's sign (flank or back bruising)
,What are typical manifestations of diastolic heart failure? Correct Answer: shortness of breath,
tachypnea and pulmonary congestion
Friction rub is associated with what condition? Correct Answer: pericarditis or restrictive heart disease
What lab is indicative of the degree of heart failure a person is exhibiting? Correct Answer: BNP (Brain
natriuretic peptide): this hormone regulates BP and fluid volume levels. >51.2 is mild and >1000 pg/mL is
severe
Centriacinar emphysema Correct Answer: occurs in UPPER half of lung. Caused by long-term Cigarette
smoking, occurs in older people >50)
Troponin I Correct Answer: Elevation indicates an MI. >1.4 mcg/L. This lab stays elevated x14 days after
a heart attack
Digoxin toxicity Correct Answer: >2.0 n.g/mL. S/S: yellow/green halos in visual fields. Treatment:
Digibind
Cirrhosis leads to ______ which = increased risk for _________ Correct Answer: Portal HTN....increased
risk for varices
What is contraindicated in chronic ETOH cirrhosis patients? Correct Answer: NG tubes..due to risk of
varices
Multiple myeloma S/S Correct Answer: Increased calcium (calcium is pushed out of the bones), bone
pain, bones become fragile and lead to fractures
Assessment findings most consistent with peripheral vascular disease include Correct Answer: brown
pigmentation on ankles from iron deposits leaking from venous stasis, warm legs, venous ulcers, pain
with resting, distal edema
Assessment findings consistent with Peripheral Artery disease Correct Answer: pain with ambulation,
distal/digit ulcers and absent pulses
Reversal agent for heparin Correct Answer: protamine sulfate
Basophils Correct Answer: A granulocyte responsible for anaphylactic reactions
Shift to the left Correct Answer: elevated bands (immature neutrophils) >10%. This occurs with infection
/inflammation
How would you recognize a leak in a chest tube system? Correct Answer: bubbling in water seal
chamber. (don't confuse this with tidaling, the rise and fall with breath is normal)
Virchow's Triad Correct Answer: Venous stasis, vessel wall damage, hypercoaguable state
(cancer/dehydration). These place a person at a high risk of developing a pulmonary embolus
, The S1 sound represents the closure of the Correct Answer: Closure of mitral/tricuspid valves (start of
systole/squeeze) "LUB" sound
PaO2 normal ABG values Correct Answer: >60 mmHg
Adenocarcinoma Correct Answer: type of lung cancer, occurs mostly in women, causes lots of mucous
Describe neutrophils Correct Answer: 90% of granulocytes. Neutrophils fight infection and respond to
inflammation
What are the recommendations for BP in someone less than 50? Correct Answer: Less than 140/90
What are the recommendations for BP in someone 60+? Correct Answer: Less than 150/90
How long should you fast before cholesterol testing? Correct Answer: at least 8 hours or more
What is a normal range for LDL cholesterol? Correct Answer: <160 mg/dL
What is a normal range for HDL cholesterol? Correct Answer: >40 mg/dL
What is a normal level for total cholesterol? Correct Answer: <200 mg/dL
What is a normal level for triglycerides? Correct Answer: <150 mg/dL
"An S3 heart sound can be normal in which people?" Correct Answer: young people and athletes
An S3 heart sound is often associated with? Correct Answer: heart failure (when heard in the older
adult)
What is the definition of cardiac output? Correct Answer: the amount of blood pumped by the heart in
one minute
Acute lymphocytic leukemia (ALL) Correct Answer: dx age 2-4, s/s: anemia, bleeding, infection, elevated
WBC, joint/bone pain. The most common form of childhood leukemia. Overproduction of lymphocytes
Protonix Correct Answer: Management of GI bleeds. Begins with a bolus and then gtt
S/S of peritoneal irritation Correct Answer: rigid abdomen, absent bowel sounds, tenderness/guarding
of abdomen, severe focal pain, N/V
What are causes of peritoneal irritation Correct Answer: appendicitis, cholecystitis, pancreatitis,
obstruction, perforated viscous, inflammatory bowel disease
What drugs increase the risk of pancreatitis? Correct Answer: corticosteroids, cyclosporine,
sulfonamides, estrogens
DKA treatment Correct Answer: 1. fluids (NS, D5 1/2NS) 2. Replace K (drops with insulin) 3. Monitor
phosphorous 4. Insulin drip
