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tests comprehensive knowledge and clinical reasoning skills in medical-surgical nursing. Topics covered may include various diseases, conditions, treatments, and nursing interventions related to adult health and acute care settings. The questions are designed to assess understanding of pathophysiology, pharmacology, nursing assessments, interventions, and patient education strategies. Achieving a 100% pass indicates proficiency in applying medical-surgical nursing principles to clinical scenarios, ensuring readiness for real-world healthcare practice.
Typology: Exams
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b) Verify the presence of a signed consent form. c) Assess patient's response to interventions. d) Intervene to prevent complications. e) Assess effectiveness of teaching related to postoperative recovery. - Answer a) Identify potential or actual health problems. b) Verify the presence of a signed consent form. e) Assess effectiveness of teaching related to postoperative recovery.
stated that she had dyspnea, feeling like she was choking and couldn't breathe, chest pain, and sweating. Ginny reports that the symptoms started about 15 minutes before she came to the ED. Ginny's symptoms are consistent with: a) Myocardial Infarction b) Pneumonia c) Panic Attack d) Influenza - Answer c) Panic Attack
assessment, the urine output is 100mL in 8 hours, and has a dark, reddish brown color. Based on this assessment finding, the nurse will: a) Check to see if the myoglobin levels decreased b) Administer an ordered prn fluid bolus to reverse fluid volume deficit c) Nothing; this is an expected finding following surgery d) Assess the patient for signs of acute kidney injury - Answer d) Assess the patient for signs of acute kidney injury
b) Insert a urinary catheter to accurately measure urine output c) Avoid multiple procedures over a 24-48 hour time period d) Hydrate the patient before and after the procedure e) Administer high-dose NSAIDS prior to the procedure - Answer a) Use of low-osmolar contrast c) Avoid multiple procedures over a 24-48 hour time period d) Hydrate the patient before and after the procedure
g) Monitor serum electrolyte levels - Answer a) Take vital signs every four hours b) Perform a finger stick glucose twice a day c) Record accurate I & O e) Record daily weights g) Monitor serum electrolyte levels
b) Dilute thick exudate c) Promote collagen deposit d) Debride the wound - Answer d) Debride the wound
that normally his chest pain is relieved by rest. This time, the pain was not relieved by rest, so the patient came to the ED. The chest pain is relieved following administration of 2 sublingual nitroglycerin tablets. The nurse draws which conclusion about the patient's status? a) The patient most likely has stable angina. b) The patient has a knowledge deficit because he did not take his sublingual nitroglycerin. c) The patient most likely has unstable angina. d) The patient most likely has acute myocardial infarction - Answer c) The patient most likely has unstable angina.
hepatic, integumentary, musculoskeletal, immune, and electrolyte status, and nutritional status. What are the different physical status ratings for anesthesia Administration and what do they mean? - Answer P1 - normal healthy person P2 - patient with mild systemic disease P3 - patient with severe systemic disease P4 - patient with severe systemic disease that is a constant threat to life P5 - moribund patient who is not expected to survive without surgery P6- declared brain-dead patient whose organs are being removed for donor purpose What is the purpose of ABGs and pulse oximetry? - Answer Assesses respiratory and metabolic function, 02 status. What is the purpose of blood glucose? - Answer Assesses metabolic status, diabetes mellitus. What is the purpose of bun, creatinine? - Answer Assesses renal function. What is included in a CBC, and what is the purpose? - Answer Rbcs, hemoglobin, hematocrit, White blood count. Assesses immune status, infection What is the purpose of an electrocardiogram? - Answer Assesses cardiac disease, dysrhythmias Why do we check electrolytes? - Answer Assesses metabolic status, renal function, diuretic side effects. Why do we check HCG? - Answer Assesses pregnancy status What tests check coagulation studies? - Answer PT, PTT, INR, platelet count. What does serum albumin test? - Answer Nutritional status. What is the purpose for a type and cross- match? - Answer See if there is blood available for replacement.
Why do we get a urinalysis? - Answer Check renal status, hydration, urinary tract infection The presence of central perfusion is noted by? - Answer Heart rate and blood pressure measurements within normal limits. Cerebral tissue perfusion is indicated by? - Answer The patient's orientation to time, place, person, and situation; expected bilateral movement and sensation; clear speech; presence of carotid pulses; and absence of carotid bruit. Peripheral tissue perfusion is present when? - Answer The patient's extremities are warm comma radio and dorsalis pedis pulse rates are between 60 and 100 beats per minute, cap refill under 3 seconds, absence of continuous pain in fingers and toes, and absence of leg pain when walking. What are interventions for people with impaired tissue perfusion? - Answer Nutrition Therapy, activity, exercise, and positioning, smoking cessation What are pharmacotherapy options for people with impaired tissue perfusion? - Answer Vasodilators, vasopressors, diuretics, antidysrhythmics, anticoagulants, and they platelets, thrombolytics, lipid- lowering agents. What are procedures and surgical interventions for people with impaired tissue perfusion? - Answer Pacemaker insertion, electrical cardioversion, intra-aortic balloon pump, heart valve surgery, cardiac transplant, coronary artery bypass graft, peripheral artery revascularization, stent placement, angioplasty, endarterectomy How do you perform an assessment of gas exchange? - Answer Check Baseline history, check problem-based history, check Vital Signs, perform an inspection, auscultation, check lab tests such as abg's, CBC, sputum sampling, skin test, and pathological analysis, perform radiologic studies, pulmonary function test, and bronchoscopy. What are the 5 A's and 5 R's for tobacco use? - Answer A: for those who want to quit: ask, advised, assess, assist, and arrange.
R: for those unwilling to quit: relevance, risks, rewards, roadblocks, and repetition. What are the nicotine replacement agents? - Answer Nicotine gum (Nicorette 2-4mg), Nicotine lozenge (commit 2-4mg), and nicotine patch (NicoDerm CQ, Habitrol, nicotine transdermal system) What are the non nicotine agents? - Answer Bupropion (Zyban), varenicline (Chantix), nortriptyline (Aventyl), and Clonidine (catapres) What are the steps for providing proper patient positioning? - Answer Correct alignment, prevent undue pressure, provide adequate thoracic expansion, prevent occlusion of arteries and veins. What are the commonly used preoperative medications? - Answer 1. Antibiotics- cefazolin (Ancef) prevent postoperative infection
What are the four adjuncts to general anesthesia? - Answer Opiods: Dilaudid, fentanyl, and morphine sulfate Benzodiazepines (end in "AM"): diazepam (Valium) and lorazepam (Ativan) Neuromuscular Blocking Agents: Depolarizing - Succinylcholine (Anectine); Non Depolarizing (end in "IUM" ) - Vecuronium , pancuronium, doxacurium Antiemetics: Zofran, Reglan, Benadryl, scopolamine What are Phase 1 and Phase 2 of the post-op period? - Answer Phase 1: PACU, care during immediate post-anesthesia period, ECG and more intense monitoring, goal: prepare patient for transfer to phase 2 or inpatient care. Phase 2: inpatient unit, goal: prepare patient for discharge. What does the post-op assessment include? - Answer ABC's, neurological, genitourinary, gastrointestinal, surgical site, pain, and labs. What are the important points of ABC's? - Answer Airway: patency, artificial Airway. Breathing: respiration rate and quality, breath sounds, supplemental O2, continuous spo2 monitoring. Circulation: ECG monitoring, vitals, peripheral pulses, capillary refill, skin color and temperature. What is the number one thing that disrupts the airway? - Answer Tongue. What do you do if someone gets nauseous? - Answer Turn on side and get a emesis bag. What are the nursing interventions for Respiratory complications? - Answer OT therapy, cough and deep breathe, change positions every 1 to 2 hours, early mobilization, hydration, pain management, and just physical therapy. What is correct patient position to prevent respiratory complications? - Answer Lateral recovery position... Once conscious - supine. What are the nursing interventions to prevent neuropsychological complications? - Answer Monitor O2 levels and O2 therapy, pain management, reversal agents if not a rousing, assess for anxiety and
depression, adequate nutrition, adequate sleep, fluid electrolyte balance, and monitor fall risk. What is the most common complication of hypertension? - Answer Target organ damage. What is a hypertensive emergency? - Answer BP above 220/140 comma develops over hours to days, evidence of Target organ damage What drug is used in a hypertensive emergency? - Answer Sodium nitroprusside What is hypertensive urgency? - Answer BP above 180/110 comma develops over days to weeks, no evidence of Target organ damage What drug is used in a hypertensive urgency? - Answer Oral agents - captopril, labetalol, clonidine, amlodipine What are the levels for troponin I? - Answer Negative - <0.5 ng/ml Indeterminate - 0.5-2.3 ng/ml Positive - >2.3 ng/ml What are the levels for troponin t? - Answer <0.1 ng/ml What is troponin? - Answer Contractile proteins that are released after an MI. What is CK-MB? - Answer Cardio specific enzyme that is released in the presence of MI What are the concentrations of CK-MB? - Answer >4%-6% of total creatine kinase what is myoglobin? - Answer Low-molecular-weight protein that is 99 - 100% sensitive for MI. Rise 30 - 60 minutes after MI. What are the normal levels for myoglobin for male and female? - Answer male - 15.2-91.2 mcg/L Female - 11.1-57.5 mcg/L
What is c - reactive protein? - Answer Marker of inflammation that can predict the risk of cardiac disease and cardiac events. What are the levels for c - reactive protein? Lowest risk, moderate risk, High Risk. - Answer Lowest risk - <1 mg/L Moderate risk - 1-3 mg/L High risk - >3 mg/L What is homocysteine? - Answer Amino acid produced during protein catabolism which is a risk for cardiovascular disease What are the normal levels for homocysteine for a male and female? - Answer Male - 5.2-12.9 mol/L Female - 3.7-10.4 mol/L What is b-type natriuretic peptide? - Answer Causes natriuresis. Elevation distinguishes between cardiac vs. Respiratory cause of dyspnea What is the lab value for b-type natriuretic peptide that indicates heart failure? - Answer diagnostic for heart failure >100 pg/mL What is NT-Pro-BNP? - Answer AIDS in assessing the severity of heart failure in symptomatic and asymptomatic patients. What are the lab values for NT-Pro-BNP? - Answer <74 years old: < pg/mL
75 years old: <449 pg/mL
What does elevated cholesterol mean and what is a good level for cholesterol? - Answer A risk factor for cardiovascular disease. <200 mg/dL What does triglyceride elevation mean and what is a good level for triglycerides? - Answer Cardiovascular disease and diabetes. <150 mg/dL What are the two types of lipoproteins? - Answer HDL and LDL What are the levels for HDL? What levels show low risk for CAD and what levels show high risk for CAD? - Answer Male - >40 mg/dL Female - >50 mg/dL Low risk for CAD - >60 mg/dL
High risk for CAD - <40 mg/dL What are the levels for LDL? Recommended, near optimal, moderate risk for CAD, high risk for CAD. - Answer Recommended - <100 mg/dL Near optimal - 100-129 mg/dL Moderate risk for CAD - 130-159 mg/dL High risk for CAD - >160 mg/dL What is lipoprotein a? What is the level of lipoprotein a? - Answer Elevated levels are associated with an increased risk of premature CAD and stroke. What is lipoprotein Associated phospholipid A2? What is the lab value for it? - Answer <30 mg/dL What is the purpose of a 12 lead ECG? And what can it ID? - Answer Electrodes are placed on the chest and extremities, they record electrical activity from 12 different views. Can ID: dysrhythmias, position of heart, cardiac hypertrophy, pericarditis, Mi, pacemaker activity, and effectiveness of drug therapy. What is a signal averaged ECG? - Answer High-resolution that can I be late potentials indicating patient is at risk for ventricular dysrhythmias What is Holter monitoring? - Answer Recording of ECG Rhythm for 24 to 48 hours and then correlating Rhythm changes with symptoms and activities recorded in Diary. What is an event monitor or loop recorder? - Answer Recordes Rhythm disturbances that are not frequent enough to be recorded and one 24-hour period. It allows more freedom than a Holter monitor. What is an exercise or stress test? - Answer Various protocols used to evaluate the effect of exercise Tolerance on cardiovascular function What is an echocardiogram? - Answer Transducer that emits and receives ultrasound waves. Recordes Direction and flow of blood through the heart and transforms it to an audio and graphic data. What is a stress echocardiogram? - Answer Combination of exercise test and echocardiogram
What is a pharmacologic echocardiogram? - Answer Used as a substitute for the exercise stress test and individuals who are unable to exercise. What is a transesophageal echocardiogram? - Answer A probe with an ultrasound transducer at the tip is swallowed. It sends back clear images of heart size, wall motion, abnormalities, and source of thrombi. What is nuclear Cardiology? - Answer IV injection of radioactive isotopes. What is pharmacologic nuclear Imaging? - Answer Adenosine used to produce vasodilation when patients are unable to tolerate exercise What is magnetic resonance angiography? - Answer Used for Imaging vascular occlusive disease and abdominal aortic aneurysms. What is a cardiac Cath? - Answer Insertion of catheter into heart to obtain info about O2 levels and pressure readings within the heart chambers What are the subjective factors in a skin assessment? - Answer Previous trauma, surgery, or disease involving the skin, have they noticed jaundice, cyanosis? Any allergies? Any exposure to UV light? Skin related issues related to medications? Any drugs used for skin problems? Health practices related to integumentary systems comma family history of skin diseases, any changes, ask obese patients if they have any areas of chafing or rashes in folds. Any dehydration edema or itching? What are the objective factors in a skin assessment? - Answer Inspect for General color and pigmentation, vascularity, bruising, and lesions. Want to look for change. Note tattoos or piercings. or piercings. Note bruising. Note distribution of hair. Note thickening of nails. What is a vascular response? - Answer Cell injury leads to a release of chemical mediators like histamine, kindness, or prostaglandins period the mediators initiate local basal dilation and hyperemia, which increases capillary permeability and causes local edema. This leads to inflammatory exudate. What is a cellular response? - Answer Cell injury elicits chemotaxis or margination and diapedesis of blood leukocytes. This then leads to
migration of leukocytes to the site of injury. The lymphocytes are responsible for the immune response while the neutrophils and monocytes are responsible for phagocytosis which leads to inflammatory exudate. What is the formation of exudate response? - Answer When fluid and leukocytes move from circulation to the site of injury. What is serous fluid? - Answer Outpouring of fluid, early stages, mild injury. What is serosanguineous? - Answer Midpoint in helium, rbcs and serous fluid, post-surgical What is fibrinous? - Answer Increased vascular permeability and fibrinogen leakage into interstitial spaces, excessive fibrin coats tissue surfaces potentially causing them to adhere. What is hemorrhagic? - Answer Rupture of necrosis of blood vessel walls. Example hematoma. What is purulent? - Answer White blood cells, microorganisms, dead cells, and debris. What is catarrhall? - Answer In tissues where cells produce mucus accelerated by inflammatory response. Example: a runny nose with upper respiratory tract infection. What are the local and systemic responses to inflammation? - Answer Local response: redness, heat, pain, swelling, and loss of function. Systemic response: increased white blood cell count, malaise, nausea and anorexia comma increased pulse and respiratory rate, and fever How is negative pressure wound therapy or vacuum-assisted wound closure used and what are nursing implications of its use? - Answer The nurse must monitor the patient's serum protein levels and fluid and electrolyte balance because of the losses from the wound. Also watch coagulation studies. What are the different stages of a pressure ulcer? - Answer Stage one, two, three, four, unstageable.
What is a stage 1 pressure ulcer? - Answer Intact skin with non blanchable redness of a localized area. What is a stage 2 pressure ulcer? - Answer Partial thickness loss of dermis manifesting as a shallow open ulcer with red pink wound bed, without slough What is a stage 3 pressure ulcer? - Answer Full thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon, and muscle are not exposed. What is a stage 4 pressure ulcer? - Answer Full thickness tissue loss with exposed bone, tendon, or muscle with Slough or eschar possibly present. What is an unstageable pressure ulcer? - Answer Full thickness tissue loss in which the bone of the ulcer is covered by slough or eschar making the stage of the ulcer unstageable until enough eschar and slough removed What interventions would you implement to promote healing and prevent further skin breakdown on a patient who has a pressure ulcer? - Answer Assess the pressure ulcer and determine its measurements and identify the stage. Take note of the patient's potential risk factors and what you as the nurse can do to minimize them What is a woods lamp? - Answer Blacklight or immunofluorescence. What is a tissue biopsy? - Answer Different type such as punch, incision, excision, and shave. When skin lesions are suspected to be malignant What is the pharmacotherapy for panic attacks? - Answer B - adrenergic receptor antagonists, benzodiazepines, SSRIs, SNRIs, tricyclic antidepressants, MAOIs, anxiolytics What is epistaxis? Who does at most commonly affect? And what usually causes it? - Answer It is a nosebleed, common in kids 2-10 and over 50. Caused by low humidity, allergies, upper respiratory tract infections, sinusitis, trauma, foreign bodies, hypertension, chemical irritants, facial or nasal surgery, anatomic malformation, and tumors
How do you treat epistaxis? - Answer Keep patient quiet, place a patient in sitting position leaning forward, apply direct pressure by pinching... If bleeding does not stop in 15-20 minutes seek medical attention for possible packing. What is acute pharyngitis? - Answer Inflammation of the pharyngeal walls. May include tonsils, palette, uvula. Most common is strep throat. What causes head and neck cancer, how is it classified? - Answer Most arise from squamous cells that line the mucosal surfaces of the head and neck. 85% caused by tobacco. Classified by tumor size, involve nodes, and extent of metastasis How do you assess pneumonia? - Answer Patients receive one point for each of the following indicators: (CURB-65) confusion, Bun over 20, respiratory rate over 30, blood pressure under 90/60, patient is older than
What are the nursing interventions for idiopathic pulmonary arterial hypertension? - Answer Administer diuretics, anticoagulant, and low-flow oxygen What is a urinary tract infection? - Answer Inflammation of the urinary tract may be caused by a variety of disorders but bacterial infection is most common What are the symptoms of an upper UTI? - Answer Fever, chills chills, and flank pain What are the symptoms for a lower UTI? - Answer Usually do not have systemic manifestations of symptoms. Could include frequent urination, agency, or pressure when urinating. What is urosepsis? - Answer A UTI that has spread systemically and is life-threatening condition requiring emergency treatment. What are the First Choice drugs for UTI? - Answer Trimethoprim / sulfamethoxazole (TMP/SMX) (Bactrim, Septra), nitrofurantoin (macrodantin), fosfomycin (monurol) What are the nursing interventions for a UTI? - Answer Ensuring adequate fluid intake, application of local heat to Super pubic area or lower back may decrease Comfort, instruct patient on prescribed drug therapy. What are the most widely used drugs for lipid-lowering? - Answer Statin drugs. How do statin drugs work? - Answer Inhibit synthesis of cholesterol in the liver, increase LDL receptors to decrease ldls, and some increase HDL levels. They are well tolerated with few side effects. What does Niacin / nicotinic acid do to cholesterol? - Answer Inhibit synthesis and secretion of vldl and LDL period decrease LDL, increase HDL, decrease triglycerides. How does fibric acid derivatives work to lower cholesterol? What are two examples? - Answer Fenofibrate (TriCor) and Gemfibrozil (Lopid) Decrease of headaches synthesis and decrease vldl. Decreases
triglycerides and LDL, increases HDL. May increase bleeding in patients taking Warfarin. How does low dose aspirin treat CAD? - Answer Antiplatelet medications prevent blood clots from forming in the artery which can prevent Mi or stroke. What is the medication for increased lipoprotein removal? - Answer Bile acid sequestrants: Cholestyramine (Questran), Colesevelam (WelChol), and Colestipol (Colestid) What is the medication for Decreased cholesterol absorption? - Answer Cholesterol absorption inhibitor: Ezetimibe (Zetia) What does pqrst stand for? - Answer P- Precipitating Events: what activities precipitated the pain? Q- Quality of pain: what does the pain feel like? Ie-squeeze, tightness, heavy R- Radiation of pain: Where is the pain located? Does the pain radiate anywhere? S- Severity of pain: On a scale of 0-10, how bad is the pain T-Timing: When did the pain start? Have you ever had pain like this? Has the pain changed characteristics since it started? How do you treat chronic stable angina? ABCDEF - Answer A: antiplatelet therapy / anticoagulation therapy, ace inhibitor / Angiotensin receptor blocker B: b - adrenergic blocker, blood pressure control C: cigarette smoke secession, cholesterol / lipid management, calcium channel blockers, cardiac rehabilitation D: diet, diabetes management, depression / stress screening. E: education, exercise F: flu vaccination What is the first line of defense for the treatment of angina? - Answer Short-acting nitrates. (Nitroglycerin) How do short-acting nitrates work? How do you use it? - Answer Work by basil dilation of the peripheral blood vessels, dilation of coronary arteries
and collateral vessels. Usually administered by sublingual tablet or sprays. Take one for pain relief, repeat after five minutes a maximum of three times What is the second line of defense for Angina? How does it work? - Answer Isosorbide dinitrate (isordil) and isosorbide mononitrate (imdur) Dilation of cerebral blood vessels. What are the pharmacological methods for treating chronic stable angina? - Answer Short-acting nitrates, long-acting nitrates, Angiotensin - converting enzyme inhibitors, beta-adrenergic blockers, calcium channel blockers, sodium current inhibitors. What are the two types of angiotensin converting enzyme Inhibitors used for treating chronic stable angina? And how do they work? - Answer Captopril (capoten) and losartan (cozar) What causes an acute MI? - Answer Coronary vessel is blocked by a thrombus or Platte, reduce blood flow causes ischemia, infected tissue causes infection. Scar tissue forms if client survives. What are complications of an acute MI? - Answer Dysrhythmias, CHF, cardiogenic shock, thromboembolism. What is the most common cause of death due to an acute MI? - Answer Dysrhythmias What is the treatment for an acute MI? - Answer Oxygen, nitroglycerin, aspirin, morphine. What would an ECG look like after an acute MI? - Answer Changes in the QRS, ST segment, and T wave caused by ischemia and infarction develop quickly. Inverted T waves indicate ischemia, elevated ST segment represents injury, Q wave represents infarction. What are the important blood studies looked at after an acute MI, what do they mean? - Answer Serum lipids: proteins released into the bloodstream from The necrotic heart muscle, troponin T and troponin I: cardiac specific troponin increased 4 to 6 hours after MI, WBCs: these levels usually increase one day after an MI, myoglobin: released two hours after MI
Which patients use thrombolytic therapy? - Answer Patients with st- segment elevation, or left bundle branch block What is the drug therapy treatment after initial MI? - Answer Nitroglycerin, morphine, oxygen, beta blockers, ACE inhibitors, antidysrhythmic drugs, lipid-lowering drugs, and stool softeners What do beta blockers do for treatment after initial MI? - Answer Reduce need to cardiac oxygen demand, decrease preload What do ACE inhibitors do for treatment after initial MI? - Answer Can prevent ventricular modeling and prevent heart failure, they decrease cardiac afterload What do antidysrhythmic drugs do for treatment after initial MI? - Answer Reduce dysrhythmia complications What do lipid-lowering drugs do for treatment after initial MI? - Answer For patient with elevated triglycerides and LDL What do stool softeners do for treatment after initial MI? - Answer Reduce the risk of valsalva maneuver Identify the significant differences between the two types of diabetes mellitus. - Answer Type 1: Young people, abrupt symptoms, 5-10%, virus/toxins, decreased insulin production, 3 Ps, weight loss, insulin required Type 2: 35 or older, undiagnosed for years, 90-95%, obesity, insulin resistance, no symptoms usually, insulin sometimes required What are the counterregulatory hormones and what role do they play in maintaining blood glucose levels? - Answer Glucagon, epinephrine, growth hormone, and cortisol. They increase blood glucose levels by stimulating glucose production and output by the liver and by decreasing the movement of glucose into the cells. What might the presence of C - peptide in the urine indicate? - Answer Pancreatic beta cell function