Exam 4 V1: NUR170 / NUR 170 (Latest 2026/2027 Update) Concepts of Medical-Surgical Nursing | Questions & Answers | 100% Correct | Galen

Exam 4 V1: NUR170 / NUR 170 (Latest 2026/2027 Update) Concepts of Medical-Surgical Nursing | Questions & Answers | 100% Correct | Galen NUR 170 EXAM 4 CONCEPTS OF MEDICAL-SURGICAL NURSING EXAM COVERAGE NUR 170 - Exam 4: Concepts of Medical-Surgical Nursing Cardiovascular System Heart anatomy and physiology Cardiac output, preload, afterload Common disorders: CAD, HF, MI, arrhythmias Diagnostic tests: ECG, labs, echocardiogram Medications: antihypertensives, antiarrhythmics, anticoagulants Nursing interventions: monitoring, patient education, lifestyle modification Peripheral Vascular System PAD vs. PVD, aneurysms, DVT Assessment: pulses, edema, skin changes Interventions: anticoagulation, compression therapy, surgical care Fluid & Electrolyte/Acid-Base Review Electrolyte imbalances common in cardiovascular patients Acid-base disturbances (respiratory vs metabolic) Shock & Circulatory Emergencies Types: hypovolemic, cardiogenic, septic, anaphylactic Early recognition and interventions Hemodynamic monitoring Diagnostic & Interventional Procedures Cardiac catheterization, angioplasty, pacemaker insertion Pre/post-procedure nursing care Patient Education & Lifestyle Management Diet, exercise, smoking cessation, medication adherence Symptom recognition and when to seek help Safety & Risk Management Fall prevention, medication safety, monitoring for complications The nurse is assessing a pt before hanging an IV solution of 0.9% NaCl with KCl in it. Which assessment finding should cause the nurse to hold the IV solution and contact provider Urine output 8 mL/hr The pt has recent bilateral, above the knee amputations and has developed C. difficile diarrhea. What assessments should the nurse use to detect fluid volume deficit in this pt The nurse is admitting an older adult with decompensated CHF. The nursing assessment reveals adventitious lung sounds, dyspnea, and orthopnea. Which physician order should the nurse question? -Observe for flatness of neck veins when supine -Measure rate and character of pulse -Test for skin testing Intravenous (IV) 500 mL of 0.9% NaCl at 125 mL/hr The pt is receiving tube feedings due to a jaw surgery. What change in assessment findings should prompt the nurse to request an order for serum sodium concentration Decreased level of consciousness A nurse is caring for a pt prescribed peripheral intravenous therapy. Which task will the nurse assign to the NA Recording intake and output A pt is experiencing dehydration. While planning care, the nurse considers that the majority of the pt's total water volume exists in with compartment -Intracellular A pt receiving chemotherapy has gained 5 lbs in 2 days. Which assessment question by the nurse is most appropriate "How many times a day do you urinate" Four patients arrive at the emergency department at the same time. Which pt will the nurse see first? An infant with temp of 102.2 F and diarrhea for 3 days The health care provider asks the nurse to monitor the fluid volume status of a heart failure pt and a pt at risk for clinical dehydration. Which is the most effective nursing intervention for monitoring both of these pts Weigh the pt's every morning before breakfast The nurse administers an intravenous hypertonic solution to a pt expects the fluid shift to occur in what direction From intracellular to extracellular The nurse is assessing a pt and notes crackles in the lung bases and neck vein distention. Which action will the nurse take first Raise HOB The nurse observes edema in a pt who is experiencing venous congestion as a result of right heart failure. Which type of pressure facilitated the formation of the pt's edema -Hydrostatic A nurse is reviewing prescriptions for a pt who needs IV fluid replacement therapy due to vomiting and diarrhea. Which of the following fluid prescriptions should the nurse expect to initiate. 0.9% sodium chloride solution A nurse is planning care for a pt who has hypernatremia. Which of the following IV solutions should the nurse plan to initiate. Dextrose 5% in water (D5W) A nurse is assessing a pt who is exhibiting signs of fluid and electrolyte imbalance. Which of the following findings should the nurse identify as a potential cause for the pt's fluid and electrolyte imbalance The pt reports that they performed yard work for 8 hr in 95 F temperature earlier that day At change of shift report, the nurse learns the medical diagnoses for four pt's. Which pt should the nurse assess most carefully for development of hyponatremia A pt who is receiving an excessive intake of hypotonic solution A pt has been diagnosed with hypovolemia. Which prescriptions for hydration should the nurse question? -D50W at 100 mL/hr -D5W solution at 100 mL/hr -D5W with 20 mEq potassium chloride (KCl) Identify the appropriate interventions for a pt with hypovolemia. -Monitor I&O daily -Encourage fluid intake -Monitor electrolyte balance -Monitor dly weights The nurse gathers the following data: BP 150/94, neck veins distended, P 104, pulse bounding, RR 20, T 98.6 F. What disorder should the nurse suspect Hypervolemia Which of the following is the most appropriate goal for a pt with the nursing diagnosis of deficient fluid volume Fluid balance restored, as evidenced by moist mucous membranes and urinating every 4 hours The nurse assessed four pt's at the beginning of the shift. Which finding should the nurse report immediately to the physician Positive Chvostek signs in pt with acute pancreatitis The pt's lab report today indicates severe hypokalemia, and the nurse has notified the physician. Nursing assessment indicates that heart rhythm is regular. What is the priority nursing intervention Institute fall precautions due to potential postural hypotension and weak leg muscles A nurse administering a diuretic to a pt is teaching about foods to increase in the diet. Which food choices by the pt will best indicate successful teaching Bananas A nurse is caring for a diabetic pt with a bowel obstruction has orders to ensure that the volume of intake matches the output. In the past 4 hours, the pt received dextrose 5% with 0.9% sodium chloride through a 22-gauge catheter infusing at 150 mL/hr and has eaten 200 mL of ice chips. The pt also has an NG suction tube set to low continuous suction that had 300 mL output. The pt has voided 400 mL of urine. After reporting these values to the health care provider, which order does the nurse anticipate Add a potassium supplement to replace loss from output Which assessment finding will the nurse expect for a pt with the following laboratory values: sodium 145 mEq/L, potassium 4.5 mEq/L, calcium 4.5 mg/dL Tingling of extremities with possible tetany In which pt will the nurse expect to see a positive Chvosteks sign A 24 year old adult admitted for chronic alcohol abuse The nurse is caring for a pt with hyperkalemia. Which body system assessment is the priority Cardiac A nurse is reviewing a pt's lab results. Which of the following results should the nurse report to the provider Magnesium 3 mEq/L A 60 year old woman complains of muscle weakness, constipation, nausea, and frequent urination and is displaying bizarre behavior. The woman takes prescribed thiazide diuretics and steroids for asthma. What statement made by the pt might indicate an additional cause of her symptoms "I take calcium supplements to prevent osteoporosis and eat lots of dairy foods" A nurse caring for a diabetic pt with a bowel obstruction has orders to ensure that the volume of intake matches the output. In the past 4 hours, the pt received dextrose 5% with 0.9% sodium chloride through a 22-gauge catheter infusing at 150 mL/hr and has eaten 200 mL of ice chips. The pt also has an NG suction tube set to low continuous suction that had 300 mL output. The pt has voided 400 mL of urine. After reporting these values to the health care provider, which order does the nurse anticipate Add a potassium supplement to replace loss from output A nurse is caring for a pt whose ECG presents with changes characteristics of hypokalemia. Which assessment finding will the nurse expect Abdominal distention The nurse observes that the pt's calcium is elevated. When checking the phosphate level, what does the nurse expect to see A decrease The home health nurse is caring for a pt with a diagnosis of acute immunodeficiency syndrome who has chronic diarrhea. Which assessments should the nurse use to detect the fluid and electrolyte imbalances for which the pt has the highest risk -Postural BP and HR -Positive trousseau sign -Weaker leg muscles than usual The nurse is assessing the pt with renal failure and notes that their respirations are depressed and they are lethargic with depressed respirations. Their BP is 80/40, P 58, RR 12, and hypoactive reflexes are present. Which of the following may be the cause of these symptoms The pt took frequent doses of magnesium-based laxative The nurse should assess for which of the following classic manifestations in a pt with a magnesium level of 2.8 mEq/L Diminished deep tendon reflexes A nurse is assessing a pt for signs of hypocalcemia. Which action should the nurse perform to assess for the presence of Chvostek sign Tap the facial nerve anterior to the earlobe and just below the zygomatic arch, and observe for the facial twitching on the same side as the stimulus A nurse assesses a pt who has CHF and is taking the following meds; digoxin and furosemide. Which assessment finding should the nurse act on immediately Dysrhythmias Which lab result on a pt's health record should alert the nurse to a potential problem Potassium is 5.6 mEq/L The pt with which diagnosis should have the highest priority for teaching regarding foods that are high in magnesium Oliguric renal disease The nurse is providing care to the adult pt in the acute care center. When the nurse began to assess the pt's BP, the pt's hand began to cramp and involuntary flex. Which is the possible to the phenomenon The pt is displaying signs of hypocalcemia A pt is admitted to the PACU. Which nursing action is most important during the Pt's stay in this unit suctioning mucus from respiratory passages A pt has abdominal surgery. Which should the nurse do to best assess for a sign of post op ileus in this pt after surgery Auscultate for bowel sounds Four days after abdominal surgery, while being transferred from a bed to a chair, a pt says to a nurse, "my incision feels funny all of a sudden." which should the nurse do first Place the pt in low fowlers position Which factor places a pt at the highest risk for postoperative nausea and vomiting after receiving general anesthesia Obesity The nurse is caring for a post op pt. Which action is effective in preventing post op UTIs Drinking an adequate amount of fluid Which pt having emergency surgery should the nurse anticipate to be at the highest risk for post op mortality Individual who has alcoholism The nurse is caring for a pt who had an abdominal hysterectomy. Which intervention best prevents post op thrombophlebitis Leg exercises 10 times per hour while awake A pt with obesity has abdominal surgery for removal of the gallbladder. Which should the nurse be most concerned about if exhibited by the pt Shallow breathing The nurse is caring for several pts who have received general anesthesia. A pt with which concurrent health problem poses the highest risk for the development of a post op complication emphysema Which clinical manifestations are potential post op complications for hypovolemia Hypotension, tachycardia, decreased urine output A pt spikes a fever during the first post op day after major abdominal surgery. The nurse suspects that the fever indicates an infection. Which site does the nurse conclude is most likely the source of the infection Lungs Which intraoperative team member maintains a safe and comfortable environment, communicates with the family, and responds to emergencies Circulating nurse The law requires that the pt signs an informed consent before any surgical procedure. What is the nurses role in obtaining informed consent Verifying that the consent is signed and witnessed One hour after the reduction of a compound fracture of the ulna and radius and application of a cast, the nurse observes a cm circle of drainage on the pt's cast. Which should the nurse do first Circle the spot with a pen and date, time, and initial the area The nurse is caring for a pt recovering from abdominal surgery. Which nursing action is effective in facilitating ventilation. -Encourage fluid intake -Preventing abdominal distention -Ensure that an incentive spirometer is used every hour when awake A pt had a hiatal hernia repair earlier today and is now in the PACU rather than back in their room on the post surgical unit. What should the nurse inform the family Pt's recover from the effects of anesthesia in the PACU and then return to the post surgical unit for further care A pt had a colon resection for removal of a cancerous tumor. Post op, on the surgical floor, which of the following activities would the nurse perform for the purpose of decreasing the risk of post op complications -Assist the pt to turn, breathe deeply, and cough q2h -Assist the pt with ambulation and use sequential compression devices -Monitor VS -Use an incentive spirometer A pt is to have a SCD applied on the post op unit. The pt is wearing knee high elastic (anti embolism) stockings. When applying for the SCDs, what should the nurse do Apply the SCD over the knee high antiembolism stockings In the OR, the anesthesiologist is administering general anesthesia and controlling the airway via an endotracheal tube. The nurse understands that the priority nursing responsibility at this time to Pad bony prominences The pt asks the pre op nurse why all of the team members took a time out before starting the procedure. Which of the following is the nurses best response "This is one of our safety steps to verify you and your surgical procedure" The nurse is assessing the pt who is status 4 hours post total knee arthroplasty. the assessment is as follows: BP 90/60, P 94, RR 16, T 98.6 F, dressing is saturated with frank red blood. The nurse reinforces the dressing and contacts the surgeon. The nurse recognizes that this scenario indicates The pt may be hemorrhaging The post op pt returned to the surgical nursing unit at 1:30pm. The evening shift nurse receives the report and begins working at 3:30pm. How often will the evening shift nurse take this pt's VS Immediately, then every 30 minutes 2 more times, then hourly To promote deep breathing, coughing, and turning by a post op pt on the first post op day, what would be the best action by the nurse Assess the pt's pain level before these activities A nurse is admitting a pt to the PACU. Which of the following actions should the nurse take first Check the pt's airway A nurse is caring for a pt who is experiencing post op nausea and vomiting. The nurse should monitor the pt for which of the following complications of vomiting Dehydration What are the symptoms for GERD or a Hiatal Hernia? -Heartburn -Indigestion -Pain -N&V What are ways to manage the symptoms of GERD or a Hiatal Hernia? -Lifestyle changes (diet=Low residue or bland) -Nutrition -Medications Which patients are at risk for GERD? -Obese -Older adults -Pregnant women -Tight clothing Patients with GERD are at risk for what? Aspiration Can a patient have GERD and not have a hernia? Yes Can a patient have a hernia and not have GERD? No If a patient has GERD, how should they lay in bed? On their right side or with the head of the bed at 30 degree angle What are common causes of peptic ulcer disease? - H. Pylori - NSAIDS - Stress How is the patient with an upper GI bleed managed? - 2-4L of oxygen nasal canula -Two large bore IV's -Isotonic solution - N/G tube - EGD with cauterization What is a sign of peritonitis? Boardlike abdomen What are the vital signs for a patient with an active bleed? Low BP, High pulse What part of the body does Crohns disease affect? "Gum to Bum"= Mouth all the way through the digestive tract is inflammed What part of the body does Ulcerative Colitis affect? Rectum/ Sigmoid colon Which disease is highly genetic? --Ulcerative Colitis -- Crohns Ulverative Colitis Which disease is more immune? --Ulcerative Colitis -- Crohns Crohns Describe the diarrhea in a patient with Ulcerative Colitis - Bloody/ Mucus stools - 10-20 stools a day - Urgent sensation to defecate Describe the diarrhea in a patient with Crohns disease -Steatorrhea (fatty and floating) - 5-6 stool a day - Rarely any bloody stools Which patient has strictures and Fistulas? Crohns disease What is the surgical intervention for Ulcerative Colitis? Removal of the colon resulting in a ileostomy What is the surgical intervention for Crohns? There is none. Only surgery is performed if something is wrong (perforations, strictures, or fistulas) Describe the stool of an illeostomy? Watery. Located on the right side of body Describe the stool of a colostomy? Formed. Located on the left side of the body If a colostomy is not draining, what should be done? - Moist warm towels on abdomen - Hot tea - Flexing knees to abdomen - DO NOT ADD FIBER How should an ostomy site (stoma) look? Reddish, pink, moist, soft -Should not be deep red, blue, black, dry, or firm What are the symptoms of IBS? - Diarrhea or Constipation - Soft, watery stool - Nausea when eating or defecating - Abnormal pain or bloating - ***Normal weight & nutrition - ***Normal labs What are some treatment options for IBS? - Probiotics - Fiber 30-40g per day - Immodium - Metamucil What is Diverticulosis? Pouching of the colon What is Diverticulitis? Inflammation of the pouch in the stomach What are the lab signs for diverticulitis? Increased WBC and decreased H&H Low or High fiber for Diverticulitis? Low (think litis= little) Low or High fiber for Diverticulosis? High What is the treatment for diverticulosis? -No laxatives or enemas -Avoid strenuous activities -Avoid seeds and nuts -Meds: Flagyl, Bactrim, Cipro What is the difference between a small and large bowel obstruction? Has to do with the small and large intestine Give examples of a mechanical bowel obstruction - Tumors - Scar tissue - Feces - Intussusception (when bowel pushes together) - Volvulus (twisting of the bowel) Give examples of a non-mechanical bowel obstruction Typically post op: paralytic illeus (section of the intestine where its not moving) Symptoms of a small bowel obstruction -Upper abdominal distention -Nausea and vomitting (possibly containing fecal material) -Obstipation (Severe or complete constipation) -Severe fluid and electrolyte imbalance Symptoms of a large bowel obstruction -Lower abdominal cramping -Lower abdominal distention -Ribbon like stools or obstipation Treatment (non-surgical) for a bowel obstruction - N/G tubes to decompress - Enemas and laxatives - IV fluids - Reposition the patient What medications are used to increase peristalsis? Reglan/Metoclopramide Who is at risk for Cholecystitis/Cholelithiasis? The "4 F's" -Forties -Fat -Female -Fertile What is cholecystitis? Inflammation of the gallbladder What is cholelithitis? Gallstones What is biliary colic? A stuck stone What are the symptoms of a biliary colic? -Tachycardia -Pallor -Diaphoresis (sweating) -Severe pain in the upper right quadrant - Call Rapid Response Team What are symptoms of cholecystitis? -N/V -Abdominal pain -Indigestion -Flatulence What treatments (nonsurgical) are used for Cholelithitis/ Cholecystitis? -Meds: Toradol and Opioids -Avoid fatty food if at home -NPO at hospital What is Hepatitis? inflammation of the liver Describe Hepatitis A "ANAL" -Oral-Fecal route -Ingestion of contaminated food/water -15-50 days for incubation -Standard precautions -Disinfect with bleach to clean surfaces Describe Hepatitis B 'BLOOD' -Transmitted through semen, mucus, saliva, open sores - 25-180 days for incubaton - Standard precautions -After infection immunity is developed Describe Hepatitis C "BLOOD TO BLOOD" -Multiple sexual partners -Unsterile tattoos -Once diagnosed no sharing: needles, toothbrushes -Incubation period of 7 weeks -Most are asymptomatic -Standard precautions Describe Hepatitis D - Must have B to get D - Exclusively in IV drug users - Vaccinations for B protect from D - Standard precautions What are the symptoms for hepatitis? N/V, fever, fatigue, dark urine, light stool, joint pain How should hepatitis be managed? - Treat the symptoms - Rest - Nutrition - Prevent further damage - Do not give medications metabolized by the liver (narcotics, Tylenol, or alcohol) Standard precautions Gloves Contact precautions Gloves and gown Patient is in private room (respiratory infections, wound infections, skin infections) Droplet precautions Standard precautions + Mask Patient is in private room (flu, sepsis, rubella) Airborne precautions Put on before entering room: Negative air pressure room, N95 mask (shingles, TB, measles, chickenpox) How to prevent a pressure ulcer - In a chair, turn the pt every hour - In bed, turn the pt every 2 hours - Float the heals - Pad bony prominence - Use skin barrier cream How to stage a pressure ulcer Stage 1: Just a sore, blanching Stage 2: Skin breaks open Stage 3: Extends into the tissue beneath skin Stage 4: Reaches to muscle and bone How do you assess for skin cancer? ABCDE -Asymmetry of shape -Boarder irregularity -Color variation within lesion -Diameter greater than 6mm -Evolving or changing When do you do a skin assessment on a patient? When you are doing a head to toe assessment How do you assess a wound? The wound bed and surrounding tissue What are signs of a suspected wound infection? Red, Temperature, Drainage What is the normal range for WBC's? 5-10 thousand What is the normal range for Albumin? 3.5-5 What is the normal range for Total Protein? 6.4-8.3 If a patient has a low albumin and low protein, what are they at an increased risk for? Infection What should be done if a patient has a low albumin and low protein? Call dietary How often should a wet to dry dressing be changed? Every 8 hours at least What is the ending of a medication for an enzymatic agent? "ase" What is pediculosis? Lice What are the precautions for pediculosis? Contact. They are put in isolation What are scabies and what are their precautions? Skin mites. Contact precautions and isolation. Wash with warm water.. What are bedbugs and what are their precautions? Bugs found in mattresses. Contact precautions What is another name for shingles? Decimated Herpes Zoster What are the precautions for shingles? Airborne How are shingles treated? Antiviral medications What is uticaria? Hives What is pruritis? Itching What is the drug of choice if a patient is having an allergic skin reaction? Epi What are signs of an allergic skin reaction? -Uticaria (hives) -Pruritus (itching) -Wheezing/SOB What is psoriasis? An overgrowth of skin cells Is psoriasis contagious? No. They are on standard precautions What is psoriasis caused by? Its an autoimmune disorder. Stress can cause a flareup. What are common triggers for psoriasis? Stress Cold weather Infections Smoking What are the key features of psoriasis? Scaley, dry, red patches that may itch and burn What is the treatment for psoriasis? -Topical corticosterioids -UV light and sun (10-15 minutes at most)4 -Immunosuppressants What are the signs and symptoms of a UTI? -Frequency -Urgency -Pain -Nocturia -Incontinence -Burning -Fever and Chills (rare) What are abnormalities in a urinalysis? -Odor -Cloudy -Protein -RBC -WBC -Bacteria -Leukoesterase (E. Coli) (WWW or fistula) What is the normal pH of the urine? 5-7 What is the normal specific gravity of the urine? 1.005-1.030 What does it indicate if the specific gravity is high? The patient is dehydrated How do you perform a clean-catch mid stream (CCMS urinalysis? -Wipe with an antimicrobial wipe -Urinate tiny amount -Catch middle of the stream -Finish urinating the rest in the toilet What medications are used to treat a UTI? -Antibiotics -Bladder Analgesics -Antispasmodics What is the drug of choice for a UTI? Cipro What are ways to prevent a UTI? -2-3L of fluid a day -Empty bladder before and after intercourse -Empty as soon as you feel the urge -No baths/ bubble baths -Empty bladder at least every 4 hours -Cranberry juice and Vitamin C What is urolithiasis? Formation of stones in the bladder or urinary tract What does the ending, "Lithiasis" mean? Stones What are reasons that stones can form? -Slow urine flow -High urine acidity/alkalinity -Hypercalciuria What is a way to prevent stones? Drinking plenty of water What are the symptoms of renal calculi? -Severe pain -N/V -Pallor -Diaphoresis -Frequency and urgency when in the bladder What urine output is considered anuria? 100ml What urine output is considered oliguria? 100-400ml If the patient has a kidney stone, what should be done? -Ambulate often -Increase fluid intake to 2-3L per day -Low protein diet -Low Sodium diet When should you not give Toradol? If the creatnine level is 1.4 What is lithotripsy (ESWL)? Shock therapy used to break up stones Describe the nursing considerations for lithotripsy. -Moderate sedation -Bed rest for 2-3 hours after the procedure -Bruising may occur over the site for several weeks -Continuous monitoring by ECG -Hematuria up to one week -*Make sure they strain the urine* What are symptoms of Benign Prostatic Hyperplasia? -Residual urine -Chronic Retention -Leaks/dribbling -Nocturia -Urgency -Trouble starting stream How is BPH diagnosed? -Digital rectal exam -PSA levels -Cystoscopy (scope inside bladder) What medication is used to treat BPH? Proscar (Finasteride) What is a common side effect of Proscar? Orthostatic Hypotension. Teach the patient to stand up slowly, Dangle on the side of the bed and then get up. What is the typical surgery for BPH? TURP What should you teach the patient with BPH? -Avoid alcohol, diuretics, and caffeine - No OTC herbs or vitamins -How to do kegel exercises What is the typical post-op routine for a patient that just received the TURP? -24 Fr. foley (anchored to abdomen) -CBI with normal saline to prevent clots (adjust as needed) -Clean foley with mild soap and water 2x per day At home: -No baths -Change foley bag once a week - No lifting more than 15 lbs What is pyelonephritis? Bacterial infection in kidney and renal pelvis What are the symptoms of pyelonephritis? *Same as UTI plus these* -Tachycardia -Fever/Chills -Fatigue -Abdominal discomfort What is glomerulonephritis? An infection of the glomerus What are the signs and symptoms of glomerulonephritis? -Fluid overload -SOB/Crackles -Blood and protein in urine -Fatigue -Anorexia -N/V -Elevated BUN and specific gravity With acute glomerulonephritis, what is treated first? The underlying infection and then treat the symptoms With chronic glomerulonephritis what does the patient end up on? Dialysis