Exam 3 V2: NUR170 / NUR 170 (Latest 2026/2027 Update) Concepts of Medical-Surgical Nursing | Questions & Answers | 100% Correct | Galen

Exam 3 V2: NUR170 / NUR 170 (Latest 2026/2027 Update) Concepts of Medical-Surgical Nursing | Questions & Answers | 100% Correct | Galen Q: Patient with type 2 diabetes who is scheduled for cardiac cath? Answer Immediately notify physician if patient took metformin Q: Patient with blood sugar of 256, sliding scale? Answer Give 6 units of Insulin Q: Caring for a patient with type 1 diabetes, what's essential? Answer Check blood sugar if confused and shaky (hypoglycemia) Q: Insulin administration of patient with a pre filled syringe device, correct understanding? Answer Attach a new needle every time Q: Somogyi phenomenon, what would you expect? Answer Morning sugar would be high Q: Watching a patient give them self insulin, correct technique? Answer Rotation of sites Q: Teaching a patient with diabetes about proper exercise, need for additional teaching? Answer They exercise when medication peaks Q: Screening patients for the risk of developing type 2 diabetes, patient at greatest risk? Answer Patient with elevated BMI and high blood pressure Q: Lab values for a glucose tolerance test, all high? Answer Demonstrates evidence of poor glucose control Q: Home health nurse talking about giving lispro? Answer Give while patient is actively eating Q: Visiting a type 2 diabetic recently prescribed Insulin, she begins to cry, "I can't stand the thought of giving myself Insulin Injections"? Answer What is it about giving yourself Insulin that's upsetting Q: Teaching a patient about doing own capillary blood glucose, correct understanding? Answer They will prick finger after washing hands with soap and water Q: You are teaching a new nurse about type 1 diabetes and insulin, correct statement? Answer Long acting Insulin is given if they are NPO Q: Assessing a patient with diabetes, how would you know they are severely hyperglycemic? Answer Decreased rapid respirations Q: Treatment of hyperglycemia at home, which of the following requires follow up? Answer Eat a banana if they become drowsy Q: Teaching a patient about foot care, need for further teaching? Answer Alternate shoes every other week Q: Patient who has been prescribed metformin, why would you call physician? Answer If serum creatinine was elevated Q: Work in an orthopedic unit, immediately notify the healthcare provider for which patient? Answer Fractured femur who's become restless and has petechiae Q: Above the knee amputation 2 days ago, complains of burning pain 8/10 in the right foot, what would you do? Answer Give the prescribed propranolol (beta blocker) Q: Preparing to give methotrexate to a patient with rheumatoid arthritis, what is the expected outcome of this medication? Answer Answer Decreased the inflammation Q: Ambulatory surgery center, discharge instructions after carpal tunnel release surgery? Answer It's important to stress to the patient they need to notify the surgeon if their hand goes numb Q: 65 year old that had hip replacement 1 day ago, priority assessment? Answer Dislocation Q: Patient with chronic gout, and has just been admitted with acute exacerbation, which medication would you give? Answer Colchicine Q: 10-hour post-op from having back surgery, which would require immediate follow-up? Answer 300 mL in hemavac Q: Assessing a newly diagnosed rheumatoid arthritis, which of the findings would be a early one? Answer Fatigue Q: Female client at highest risk for developing osteoporosis? Answer The 71 y/o who smoked and took steroids Acute compartment syndrome, what was the late manifestation? Answer Pulselessness Reviewing risk factors for the development of osteomalacia, client most at risk? Answer Patient with history of malabsorption syndrome of the bowel Medication instruction for osteoporosis; alendronate, indicated need for further teaching? Answer "I'll take this medication at least one hour after I take my medication for acid reflux" Discussing acute osteomyelitis with other staff members, correct understanding? Answer Fevers typically greater than 101 Nurse preceptor in the ER with a new grad who has a patient who has broken their left arm, you intervene? Answer If they leave jewelry on that arm Continuing education conference about older adults who are having hip surgery, need for further teaching? Answer You would't prescribe anticoagulants to them Caring for a 75 y/o client who just had their left hip fixed, correct care? Answer Using straps to hold the abduction pillow in place Reviewing the medical record for risk factors of developing osteoarthritis, indicators? Answer Occupation that requires climbing a ladder everyday Heart failure patient who developed sinus bradycardia and SOB, what would you do? Answer Get a prescription for atropine Assessing a client with right sided heart failure, what would you expect to find? JVD Medication instruction to a patient taking valsartan? Call physician if they develop dizziness Taking care of a group of patients on the telemetry floor, immediately follow up first with? The patient with A-Fib and slurred speech Client diagnosed with burgers disease, which lifestyle modifications? Smoking cessation Caring for a patient who's having hypertensive crisis, which s/s do you expect? Dizziness Patient developing the following cardiac rhythm (v-fib) put actions in order? Assess the pulse, call a code, perform CPR, and defibrillate Assessing clients who are most at risk for DVTs? The heart failure patient with pitting edema Teaching a group of clients about varicose veins and home management, what should include? Perform ankle flexion exercise if they have to sit for long periods of time Assessing a client with peripheral arterial disease, what would you expect? Decreased or absent pulses with coolness of legs Caring for a client who had a DVT, receiving heparin after 48 hours? Caring for a client who appears to have heart failure, what would be the lab test to confirm? BNP Teaching a hypertensive patient about furosemide, what would you include in the teaching? Report any dizziness upon standing to the healthcare provider Visiting a client with heart failure who was recently discharged from the hospital, which of the following would be priority for follow up? The cold symptoms Assessing a patient with atherosclerosis disease, which of the following would you expect to find? Cool extremity Caring for a patient with a right femoral bypass surgery 5 hours ago, you would immediately notify the physician if? The pulse has decreased in that extremity Normal postprandial glucose Below 180 mg/dL blood sugar level after eating Postprandial blood sugar Is it normal for your postprandial blood sugar to be higher after you eat? Yes, will be higher for everyone after eating. Normal A1C goal level 6 Normal blood sugar level 70-110 what are we looking for in a urine screen ketones Onset peak and duration of rapid-acting insulin Onset: 15-30 minutes Peak: 1 hr Rapid-acting insulin medication Lispro (Humalog) Aspart (NovoLog) When is rapid-acting insulin given? prior to a meal during a meal within 20 minutes after a meal Onset, Peak and Duration of short acting insulin Onset: 30min-1hr Peak: 2-4hr Duration: 5-7hr Short acting insulin medication Regular human insulin (Humulin R) (Novolin R) Onset, peak, and Duration of intermediate acting insulin Onset: 1-2 hr Peak: 4-12 hr Duration: 18-24 Intermediate acting insulin medication NPH (Humulin N) (Novolin N) Onset, Peak, and Duration of long acting insulin Onset: 2-4 hours Peak: slow release Duration: 24 hours Long-acting insulin medication Glargine (Lantus) Lantus Interventions -Cannot be mixed with any other insulin -May be ordered twice a day, but needs to be given within 30 minutes of the same time each day. -Optimum dose will not cause hypoglycemia even when NPO What is the only kind of insulin that can be used IV, is used on a sliding scale, and treats DKA? short acting (regular humulin R, novolin R) Which insulin can be given bolus? rapid acting (lispro/humalog) which insulin can be given SQ & IV Short-acting insulin (Humulin R/ Novolin R) Sick Day Rules (Diabetes) S - stick yourself every 4 hrs I - insulin (or other meds) C - continue to eat K - ketones (check em) check your urine When should you check ketones? if blood sugar is greater than 240 If a patient with diabetes has an elevated bun and creatine where do they need to go? Cath lab before giving iv potassium containing solutions to correct hypoglycemia caused by an electrolyte imbalance, you should make sure the urine output is atleast how much per hour 30ml/hr Which insulin does not need to be held when pt is NPO? Lantus Which type of insulin can not be mixed? Lantus What do alpha cells do? produce glucagon and prevent hypoglycemia what do beta cells do? produce insulin and amylin which prevents hyperglycemia Type 1 diabetes body does not produce insulin; insulin dependent Type 2 diabetes body doesn't use insulin properly How can you teach a pt to manage diabetes lose weight, diet Type 2 diabetes risk factors weight, fam hx, obese, hx of gestational diabetes, insidious (slower) onset type 2 diabetes s/s 3 p's, weight gain, symptoms not always obvious Three P's in diabetes polydipsia - drink too much polyuria - pee too much polyphagia - eat too much type 1 diabetes risk factors less than 30 years of age, fam hx, autoimmune, genetics, issues w beta cells, abrupt onset type 1 diabetes s/s 3 P's, weight loss, cold sweaty, rapid deep respirations(kusmaul), fruit breath, clammy, anxious type 1 diabetes therapeutic management insulin, diet type 2 diabetes therapeutic management diet, exercise, possible medication what is the glucose tolerance test for? pregnant women Complications that can occur with diabetes Cataracts / retinal issues skin integrity shiny, thin, pale skin thick nails weak pulses angina MI edema Collaborative problems with diabetes amputation heart attack stroke insidious onset gradual development over time Secretagogues (metformin) medication that stimulates the pancreas to help produce insulin Sensitizers Medications that increase insulin sensitivity Dawn phenomenon "down insulin" an increase in blood glucose in the early morning, most likely due to increased glucose production in the liver after an overnight fast Somogyi effect "so much" early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes treatment for dawn phenomenon? increase in insulin or an adjustment in administration time treatment for somogyi effect? a bedtime snack, reducing the dose of insulin, or both Sick day rules treatment eat a snack Hyperglycemia S/S fruity breath odor, warm, dry, vasodilated, possible rapid deep respirations (kussmaul) Hypoglycemia S/S cool, clammy, sweaty, anxious, irritable, confusion, nervous, (think hangry) Hypoglycemia blood glucose level 70 (severe 50) risk factors for hypoglycemia excess insulin, deficient food intake, exercise, alcohol how does exercise and alcohol effect someone with diabetes? exercise will drop your sugar alcohol will increase your sugar Therapeutic management for hypoglycemia eat drink 15-20 fast acting carbs (OJ) have a snack or meal monitor blood sugar Medical management for hypoglycemia glucose tablets glucagon glucose IV infusion complications of hypoglycemia seizures, can cause a decrease of glucose supply to the brain Why is hypoglycemia considered emergent? once in that state, it can progress quickly and pt can lose consciousness and suffer adverse effects What are electrical conductions known as? they are disruptions and are known as dysrhythmias Normal PR interval time 0.12-0.20 seconds ST elevation (STEMI) indicates myocardial infarction (MI) Is there a P wave for every QRS? Yes, it is a 1:1 ratio When will a P wave be absent? during A-fib Normal QRS time 0.06-0.10 How do you determine the heart rate on an ECG? Count the QRS complexes in a 6 second strip. Multiply that number by 10 to estimate rate for 1 minute What is the 1st thing you do when determining an ECG rhythm measure heart rate What are the steps when determining an ECG rhythm? 1. measure heart rate & multiply 2. Is the rhythm reg / irreg 3. is the P wave reg / irreg 4. measure PR interval 5. Measure QRS 6. Measure S wave 7. Asses the T wave what is the last thing you do when determining an ECG rhythm? measure QRST sinus brady Slow heart rate 60 originating from the sinus node Sinus brady s/s syncope, dizzy, chest pain, SOB, exercise intolerance, cool clammy skin Syncope fainting sinus brady interventions assess, are they symptomatic? give oxygen atropine is drug of choice monitor bp and hr notify dr Sinus tachy fast heart rate of 100 sinus tachy s/s dizzy, sob, lightheaded, increase pulse, palpitations, chest pain, syncope sinus tachy causes blood loss trauma stress exercise caffeine nicotine sinus tachy interventions assess, are they symptomatic? give oxygen monitor bp and hr notify dr What heart rhythm is considered an ectopic beat? PVC because it should not be started in the ventricle premature ventricular contraction (PVC) premature firing of a ventricular cell. A PVC is not usually a perfusing beat (one that ejects blood) and is felt as a "skipped beat" when palpating the pulse. PVC causes stress caffeine electrolyte imbalances hypoxia PVC s/s palpitations weakness dizziness hypotension PVC Tx oxygen, if ordered treat the cause monitor for poor perfusion What should you monitor when a pt has PVC? poor perfusion and monitor for frequency ventricular tachycardia (VTACH) Ventricle continuously contracts and doesn't let any blood in which leads to no blood going out either Untreated VTACH lethal rhythm, untreated leads to v-fib which then leads to death Causes of vtach heart disease ischemia or infarction meds electrolyte imbalances vtach s/s angina, syncope, lightheaded, palpitations, sob, absent or rapid pulse, loc, hypotension DVT deep vein thrombosis Heart failure Inability of the heart to eject enough blood with each heart beat to meet the demands of the heart and the other body tissues. Left sided HF fluid backs up into the lungs but should pump forward to body (left/lungs) left sided HF pathophysiology The fluid back up causes edema. In the lungs, edema can be assessed by hearing crackles and seeing the client behave in a way that shows they are short of air. (alveoli full of fluid) Left sided HF s/s S3 Ascites crackles, sob/cough, frothy pink sputum, hypoxia, pallor, restless, fatigue left sided HF causes diabetes, fam hx, substance abuse, vascular disease, congenital defects, coronary artery disease, rheumatic heart disease, obesity, htn, previous MI Right sided HF fluid backs up into body but should pump into the lungs (right/rest of body) Right sided HF pathophysiology The fluid back up causes edema. In the body, this edema is noticed when assessing the client and noticing edema in the dependent areas (lower half of the body). Right sided HF s/s dependent edema, ascites, JVD, drastic weight changes Ascites abnormal accumulation of fluid in the abdomen right sided HF causes primary cause is left-sided heart failure, MI, pulmonary htn, COPD, ARDS Acute respiratory distress syndrome (ARDS) fluid issue in the lungs (difficult to bag) Chronic Heart Failure: FACES F - fatigue A - activities limited C - chest congestion & cough E - edema S - SOB What is needed to diagnose heart failure? BNP peripheral vascular disease (PVD) Alterations to natural flow of blood through the arteries or veins usually as a result of atherosclerosis what needs to be monitored when a pt has heart failure weight, electrolytes, kidney function, and I&O's heart failure U/A is ordered to look for what? proteinuria & high specific gravity Heart failure Tx U - upright position N - nitrates L - Lasix O - O2 A - Ace inhibitors D - digoxin F - fluid decrease A - afterload decrease S - sodium decreased T - test Heart failure interventions walking limit sodium monitor weight 6 key signs of arterial insufficiency pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia(coolness) Peripheral Vascular Disease (PVD) Alterations to natural flow of blood through the arteries or veins usually as a result of atherosclerosis Interventions for PVD elevate legs, no smoking, antiplatelets, control htn, stents, fem pop bypass PVD s/s decreased pedal pulses, claudification, numbness, burning pain, rubor, necrosis, gangrene, cold extremities peripheral artery blood is not getting to the foot effectively (sitting on your foot) Peripheral artery intermittent claudication pain the occurs even while at rest (numbness and tingling) peripheral venous blood cannot leave the foot (rubber band on fingertip) peripheral artery and venous goal improve circulation Fem pop bypass teaching must assess circulatory or lower extremity, occlusion may occur, pt will complain of severe pain and will not have pulse and may feel cold Paripheral artery vs peripheral venous arterial- blood is not getting to the foot venous- blood is not leaving the foot Atherosclerosis prevention of blood flow due to the buildup of plaque in the arteries Claudication Pain or cramping in the legs due to poor circulation Atherosclerosis risk factors fam hx, heart disease, obese, diabetes, high cholesterol, lack of exercise Atherosclerosis symptoms bruit, decreased pulses or no pulse, decreased cap refill, cool extremities, high lipid levels Atherosclerosis interventions must try to decrease plaque buildup, diet, exercise, statins Atherosclerosis medication statins (simvastatin) (Atorvastatin) Emboli risk factors surgeries, prolonged sitting, obesity, oral contraceptives, pregnancy, cardiac issues, smoking Emboli symptoms calf or groin pain/tenderness with sudden onset of swelling, hardness and warmth Emboli blood vessel obstruction treatment for emboli anticoagulants, rest, elevate leg, ivc filter, compression stockings pulmanary embolism (PE) if clot travels from leg to lungs it can block a vessels in the lungs, which can cause tissue death in lungs, and can cause decreased oxygen exchange. Stroke if clot travels from leg to brain it can lead to a CVA. Which can lead to cell death in the brain. Emboli heparin drip levels ptt 20-30 aptt 30-40 1.5-2.5x is normal Emboli warfarin drip levels pt 11-12.5 inr 0.9-1.2 2-3x is normal PT value 11-12.5 seconds INR value 0.9-1.2 seconds PTT value 20-30 seconds aPTT 30-40 seconds how long does it take for a therapeutic Coumadin level 5 days When can you stop a heparin drip? not until after coumadin is at a therapeutic level (5 days) what helps decrease risk of blood clots after surgery ambulating What is Buerger's disease? disruption of blood flow is due to swelling and inflammation of vessels, causing a decrease in vascular space allowing blood flow buergers disease s/s pain tissue damage, gangrene, pale red bluish color, decreased sensitivty to cold, burning tingling what should you teach a pt wit buergers disease to practice smoking cessation, any nicotine makes symptoms worse varicose vein causes prolonged standing, over 30, family Hx, obesity varicose vein s/s Can see the veins. The legs experience leg heaviness and pain varicose vein Tx compression socks, exercise, elevation medical interventions for varicose veins ligation, stripping, injections, laser surgery s/s of rheumatoid arthritis fatigue, loss of appetite, muscle joint stiffness, loss of ROM, red swollen joints, deformity, fever varicose veins abnormally swollen and twisted veins what med is used for rheumatoid arthritis methotrexate Methotrexate teaching Avoid people who are sick, periodic lab tests, report bruising or Petechia, avoid drinking alcohol What is Raynaud's disease? Vasospasms of arteries of the upper/ lower extremities what should the pt avoid with raynauds disease cold weather, nicotine, chocolate, caffeine Hypertension 1 & 2 primary (essential) - has no cause secondary - cause is medical condition or disease Hypertension s/s SILENT KILLER (often asymptomatic), headache, facial flushing, drowsiness, MI, vision changes, stroke, kidney failure hypertension diagnostic tests ECG Kidney function test UA Hypertension Medications for volume Diuretics- 1st line for excessive fluid, cause urination and decrease in cardiac volume Thiazide diuretic hydrochlorothiazide Loop Diuretic Furosemide (Lasix) Potassium sparing diuretic Spironolactone (Aldactone) Hypertension medications to prevent vasocontriction ACE inhibitors ARBs Ace Inhibitor Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Zestril ARBs Valsartan (Diovan) Irbesartan (Avapro) Losartan (Cozaar When taking ACE inhibitors, the nurse should monitor what? kidney function what is valsartan used for? hypertension, heart failure Teaching for taking valsartan get up slowly and tell dr is you get dizzy s/s of hypertensive crisis BP 180/120 blurred vision, SOB, epistaxis, chest pain, headache interventions for hypertensive crisis monitor bp, position in semi fowlers, calm environment, needs critical care Med for acute gout Colchicine Med for chronic gout Allopurinol What is is called when the median nerve is compressed likely by repetitive activities carpal tunnel if a patient with carpal tunnel has surgery, what should they report to the PCP? an increase in pain osteoporosis risk factors low calcium and vit d intake Osteoporosis loss of bone mass which can be caused by lack of calcium and sexual hormones osteoclasts Bone-destroying cells osteoblasts bone forming cells when a patient has an injury, what should be assessed? neurovascular assessment distal to injury what med can be used to treat osteoporosis bisphosphonates (alendronate & Risedronate) Take meds first thing in morning before eating or taking other meds Pt teaching for bisphosphonates - Take Empty stomach when you first awake - stay sitting up so it absorbs - do not take with any other meds expected findings with a pt with osteoporosis post menopausal women, kyphosis of spine, compression fractures of spine, loss of height osteomalacia softening of the bone due to a vit d deficiency how to diagnose and treat osteomalacia x-rays and increase calcium and vit d What is osteomyelitis? a severe infection of bone osteomyelitis risk factors long term iv drug use, chronic wounds, periodontal, UTI if you're patient is diagnosed with osteomyelitis, what should you prepare them for? a central line long term antibiotics pain medication infection s/s redness swelling fever (101) after surgery, how do you prevent hip disloaction? with an abductor pillow Fractures complications hemorrhage, compartment syndrome, fat embolism, infection, dvt what a pt is at risk for a fat embolism, what should you monitor for? tachypnea, lethargy, petechiae, hypoxemia how do you diagnose a complex fracture? xray of the fractured area What is osteoarthritis? progressive loss of cartilage risk factors of osteoarthritis aging, smoking, obesity, trauma, repetitive stress of joints how position do you place a patient in who is at risk of contractures? prone complications of amputations hemorrhage, infection, phantom limb pain, neuroma, flexion contracture