MED SURG EXAM 1 – LPN QUESTIONS AND ANSWERS NEWEST UPDATE 2024/2025 A COMPLETE EXAM SOLUTI, Exams of Nursing

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fourth degree burn - CORRECT ANSWERS burn in which full thickness of the skin and underlying muscle and bone is damaged color varies visible charred in deepest areas extremity movement limited insensate respiratory issues in burn pts - CORRECT ANSWERS watch for - increasing restlessnes coughing hoarseness rapid shallow respirations stridor (high-pitched wheeze) falling o2 levels contractures in burn pt - CORRECT ANSWERS always a concern, tighness of the muscles or ligaments -proper positioning -regular excercise -must be excercise and stretched every day Roles and functions of the LPN - CORRECT ANSWERS - caretaker

• educator
• collaborator
  • advocate
• leader and delegator

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• promote health and prevent disease
• provide comfort measures
• assist to make decisions
• manage client care
• act as a resource person
• use resources in a cost effective manner

5 rights of delegation - CORRECT ANSWERS right task right circumstance right person right direction/communication right supervision/evaluation QSEN 5 competences - CORRECT ANSWERS - provide pt centered care - collaborate - Implement evidence based practice - use quality improvement - use informatics Factors that influence critical thinking - CORRECT ANSWERS attitude, communication skills, problem solving characteristics of a critical thinker - CORRECT ANSWERS *maintains and open mind and questioning attitude *recognizes own biases and limitations *separates relevant info form irrelevant

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*identifies missing info *considers all possibilities *admits what they do not know *reasons logically *strives for excellence *draws valid conclusions from evidence and data *sets priorities and makes careful decisions *is flexible, creative, humble, honest, curious, and insightful *admits what they do not know clinical judgement - CORRECT ANSWERS refers to the result (outcome) of critical thinking or clinical reasoning; the conclusion, decision, or opinion a nurse makes Data collection in the nursing process - CORRECT ANSWERS - LPN may be asked to assist with initial admission assessment which is the RN responsiblity

• LPN is responsible for ongoing assessment
• LPN systemically gather and review data
• determine whether there is a present life-threatening problem that needs addressing and act appropriately ADPIE - Diagnosis - LPN and medsurg - CORRECT ANSWERS -LPN reports data collection findings to the RN and assists in verifying, categorizing, and grouping the data in logical order
• the LPN also assist in analyzing the data to determine significant relationships among data, pt needs, and problems Planning (nursing process) - LPN and medsurg - CORRECT ANSWERS SMART goals (Specific, Measurable, Attainable, Realistic, Timely)

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assist the RN in the developement of expected outcomes and interventions for a patients plan of care Implementation in the nursing process - CORRECT ANSWERS provide planned nursing care to accomplish expected outcomes of nursing

• distinguish with activities you need to carry out and which ones the pt must learn to do to gain independence Evaluation in the nursing process - CORRECT ANSWERS compare actual outcomes of nursing care to expected outcomes and assist with update the nursing care plan Sources and information for the database - CORRECT ANSWERS *admission form if applicable --- reason for admission, allergies, home medications, etc.

• If the pt has been hospitalized in the past *medical diagnosis *preliminary lab work *imaging studies *chief complaint *level of pain *last bowel movement *problems with urination, eating, or difficulty sleeping *secondary sources of info from family Inspection - CORRECT ANSWERS - facial expression -posture -grimaces -movements

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-hair, skin, nails

• oral mucus membranes and teeth
• clean -evidence of a support system congruent - CORRECT ANSWERS match the feeling tone of what is said verbally olfaction - smelling - CORRECT ANSWERS -sweet fruity scent of acetone can indicate diabtetic acidosis -the smell of newly mown clovers can be present with hepatic coma
• the smell of alcohol ------ smells like aftershave, mouthwash, vanilla, sterno, or other strong odors -foul or metallic mouth usually means bad oral hygiene focused assessment - CORRECT ANSWERS -usually done daily at beginning of shift
• is directed to areas in which the pt is experiencing health problems
• based on identified problems, data from the report, and medical diagnosis Abdominal assessment - CORRECT ANSWERS begins is the right lower quad face sheet - CORRECT ANSWERS address, martial status, insurance coverage, age, date of birth, occupation, significant other, emergency contact Nursing care is based on - CORRECT ANSWERS priority nursing diagnosis statement - CORRECT ANSWERS problems, etiology, signs and symptoms

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How are nursing care plans formulated? - CORRECT ANSWERS Nursing care plans are formulated using the data and the diagnosis from the nursing process and combined with an reasonable expected outcome that the patient is willing and capable of doing and what nursing interventions required to achieve that goal. Goals and Expected Outcomes - CORRECT ANSWERS Determine if the goals were appropriate, realistic, and time-appropriate goals - CORRECT ANSWERS state a general intent about what the pt will achieve expected outcomes - CORRECT ANSWERS describe a specific result expected at a certain point in time. Once you receive your assignments - - CORRECT ANSWERS - look up required pt chart and pc printout -look up required drug info for each routine and PRN drug listed

• list focused assessments you will make and data you will collect -list procedures that will be performed and a list of equipment for each
• attend report, make notes, and ask questions
• make round on all your assigned pt -consider a plan for your shift Quality Improvement - CORRECT ANSWERS focuses on systems , processes, that significantly contribute to client safety and effective client care outcomes without attaching or looking for blame the nurse is responsible for recognizing trends in nursing practice, identifying recurrent problems, reporting these problems, and initiating opportunities to improve the quality of care

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Evidence based practice - CORRECT ANSWERS approach to client care in which the nurse integrates the client's preferences, clinical expertise, and the best research evidence to deliver quality care determining the clients personal, social, cultural, and religious preferences ensure individualization and is a component of implementing evidence based practice

1. What are the characteristics necessary to think critically? - CORRECT ANSWERS - maintain and open mind and questioning things that don't make sense to you critically.

• always looking for solutions
• able to identify important information and recognizing when more information is needed.
• empathic
• verify accuracy and reliability of data
• takes into consideration all possibilities before drawing a conclusion
• being able to ask questions about things they do not know.
• logical reasoning
• uses evidence based information
• flexible, realistic, creative, humble, curious, and insightful critical thinking - CORRECT ANSWERS · Problem solving involves obtaining info and using it to reach an acceptable solution · Decision making involves identifying a problem and deciding which alternatives can be best achieved Priority setting - CORRECT ANSWERS The ordering of nursing diagnoses or patient problems using determinations of urgency and/or importance to establish a preferential order for nursing actions.

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Guidelines for priority setting - CORRECT ANSWERS - the nurse and the client mutually rank the clients needs in order of importance based on the clients preference, expectations, and physical and psychological needs.

• priorities are classified as high, intermediate, and low
• client needs that are life-threatening or harmful are high priorities
• non emergency (non-life threatening) and non urgent client need are intermediate
• client needs not related directly to the the clients illness are low
• the nurses needs to consider which needs are of high priority and which are not
• life threatening > potential health threatening
• must consider time constraints
• problems identified by the patient must be labeled high priority
• use the ABCs as a guide when determining priority --- needs relating to airway are top priority
• can also use CAB (cpr) BEFORE abc as a guide if applicable
• use maslows hierarchy of needs - basic needs are met first
• use the steps to the nursing process as a guide - data collection is the first step Delegating UAP - CORRECT ANSWERS non invasive interventions
• skin care -ROM excersizes
• ambulation -grooming and hygiene

delegating to LPN - CORRECT ANSWERS - dressing changes

• suctioning
• urinary catherterization
• med administration

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• injections, IV management, and some piggyback
• review teaching plans CAM (complementary and alternative medicine) - CORRECT ANSWERS therapies that are used in addition to conventional treatment to provide healing resources and focus on the mind-body connection high and low risk therapies are included in CAM - invasive/non-invasive 5 categories -
• whole medicine
• mind-body medicine -biologically based practices -manipulative and body-based practices
• energy medication Medicare - CORRECT ANSWERS A federal program of health insurance for persons 65 years of age and older Medicare Part A (aka Hospital Insurance or HI) - CORRECT ANSWERS Provides hospital insurance automatically @ age 65 (if FICA qualified) @ no fee but may have deductible & co- pay. Medicare Part B - CORRECT ANSWERS Outpatient care. Extends Medicare to supplemental treatments, and physicians Medicare part c - CORRECT ANSWERS managed care health plans offered to medicare beneficiaries under the medicare advantage program

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Medicare part d - CORRECT ANSWERS Prescription drug coverage Medicaid - CORRECT ANSWERS A federal and state assistance program that pays for health care services for people who cannot afford them. DRGs - CORRECT ANSWERS Diagnosis Related Groups - pays hospitals flat rate for medicare services Associated conditions not paid for by medicare and medicaid - CORRECT ANSWERS - foreign object left in the body

• air embolism
• blood incompatibility
• stages 3 and 4 pressure wounds
• falls and trauma - fracture, dislocation, intracranial injuries, crushing, burns
• poor gylcemic control
• ketoacidosis
• catheter-related urinary/vascular infection
• surgical site infections after coronary artery bypass, graft, mediastinitis (chest infection)
• deep vein thrombosis or pulmonary embolism after total knee replacement or hip replacement
• surgical site infections after cardiac implantable electronic device insertion
• latrogenic pneumonthorax with venous catherterization critical thinking, clinical judgement, applied to LPN - CORRECT ANSWERS -purposeful, informed, and outcome focused
• requiring careful identification of pt problems, issues, and risks, and making accurate decisions
• driven by pt, family, and community health care needs
• based on principles of the nursing process and scientific method

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• focused on using both logic and intuition based off knowledge, skill, and experience
• guided by the nursing standards and ethical codes
• interested in strategies that make the most of human potential
• committed to constantly reevaluating, self-correcting, and striving to improve problem solving and decision making in regards to critical thinking - CORRECT ANSWERS integral to critical thinking, incorporeates the scientific method
• defines the problem
• gathers info
• analyze info
• develop solutions
• make a decision
• implement LPN standards in medical surgical nursing - CORRECT ANSWERS ADPIE -
• The LPN assists the RN with steps 1,3,4,
• The RN is responsible for formulating the diagnosis ADPIE: Assessment, LPN and med surg - CORRECT ANSWERS - LPN may be asked to assist with initial admission assessment which is the RN responsiblity
• LPN is responsible for ongoing assessment
• LPN systemically gather and review data
• determine whether there is a present life-threatening problem that needs addressing and act appropriatly Skin Structure - CORRECT ANSWERS - consists of 2 layers; epidermis and dermis and a hypodermis (subcutaneous fat)
• is attached to underlying structures by subcutaneous tissue

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• largest sensory organ
• acts as a protective covering skin functions - CORRECT ANSWERS -keratin in skin makes it waterproof and preventing water loss
• provides a barrier to bacteria and invading organisms
• protects underlying tissues from thermal, chemical, and mechanical injury.
• helps regulate body temp by dilating and constricting blood vessels and activating sweat glands
• when exposed to UV - molecules in the cells convert the rays to vitamin D
• nerve receptors transmit feelings of temp, pain, touch, and pressure
• melanin absorb light and acts to protect from UV

sebum - CORRECT ANSWERS secreted by the sebaceous glands

• keeps hair and skin soft and pliable
• inhibits bacterial growth on the surface of the skin oily nature prevents water loss from the skin fiberblasts - CORRECT ANSWERS contained in the dermis and produce cells that heal the skin glands within the skin - CORRECT ANSWERS sebaceous (sweat producing) ceruminous (wax producing) epidermis - CORRECT ANSWERS - consists of squamous epithelium and contains no blood vessels

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• receives nutrients by diffusion from vessels in underlying tissue
• cell growth occurs from the bottom of the epidermis and pushes cells above to the surface
• bottom layer of epidermis contains melonocytes that contribute skin color stratum corneum - CORRECT ANSWERS the most superficial layer of the epidermis consisting of dead cells dermis - CORRECT ANSWERS - contains both elastic and collagenous fibers that give it strength
• contains blood vessels, nerves, hair follicles, glands, Hair structure - CORRECT ANSWERS consists of a shaft and a root made up of keratinized epithelial cells assists the body in retaining heat Hair root - CORRECT ANSWERS -The part of the hair located below the surface of the epidermis.
• is enclosed in a hair follicle that is embedded in the dermis Nails - CORRECT ANSWERS dead stratum coreum with a very hard type of kerotine cover the distal ends of the fingers and toes Age related skin changes - CORRECT ANSWERS - reduced elastic fibers -adipose tissue diminishes causing the skin to wrinkle and sag
• loss of collagen fibers making the skin increasing fragile and slower to heal
• reduced sebaceous glands causing dry skin that may be itchy

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• thinned skin and decreased sweat gland activity reduces temp control
• a reduction of melancyte activity increases the risk of sunburn and skin cancer -number of hair follicles decreases and the growth rate of hair declines
• nail growth decreases senile lentigines - age spots or liver spots - CORRECT ANSWERS dark-yellow or brown spots that develop on the skin as aging occurs herpes zoster - CORRECT ANSWERS A history of chicken pox or shingles is caused by the reactivation of the varicella-zoster virus -replicate in the peripheral nerve ganglia of the sensory cranial and spinal nerves
• can be reactivated by ---- trauma ---- malignancy ---- stress ---- local radiation
• usually only affect one side of the body
• shingles pain can be severe
• can persist from several days to weeks after lesions are completely healed Herpes zoster signs and symptoms - CORRECT ANSWERS - fatigue
• low grade fever
• possibly loss of appetite
• aching and discomfort along nerve pathway
• puritus (itchy) -paraesthesia (tingling or pricking)

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after about 3-5 days onset -

• small groups of vesicles appear on skin
• usually found on the trunk, thorax, or face and spread halfway around the body following the nerve endings
• eventually change from small blisters to scaly lesions accompanied by pain and itching Herpes zoster - diagnosis - CORRECT ANSWERS diagnosis by history and physical exam
• no cure
• can be persistant for months
• recurrent because complete immunity does not occur
• contagious to those who have not had chicken pox or have not been vaccinated Herpes Zoster treatment and interventions - CORRECT ANSWERS - analgestic for pain
• capsaicin - topical analgestic up to 5x a day -use air mattress and bed cradle
• antibiotics maybe prescibed for secondary infection of lesions ----- acyclovir, famciclovir, valacyclovir (only in healthy pts)
• famciclovir given in the first 2-3 days seems to shorten duration
• tricyclic antidepressants and gabapentin for shingles pain -astringent compresses -corticosteriods -iv vidarabine for immune deficiency -distraction activities airborne and contact precautions until all the blisters are crusted over

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Dermatitis (contact) - CORRECT ANSWERS - a delayed allerigic response involving cell- mediated immunity

• on contact t cells become senitized to antigen *contact irritants
• chemicals
• soaps
• cosemetics
• latex
• poision ivy, oak, sumac Symptoms -
• erthema (red)
• swelling -pruritus (itching)
• vesicular lesions Atopic Dermatitis (Eczema) - CORRECT ANSWERS results from a complex activation process that involves mast cells, T lymphocytes, langerhans cells, monocytes, b cells, E and other inflammatory cells that release histamine stasis dermatitis - CORRECT ANSWERS occurs in the lower leg when varicose veins slow the return of blood and the accumulation of fluid interferes with the nourishment of the skin seborrheic dermatitis - CORRECT ANSWERS dandruff Dermatitis treatment - CORRECT ANSWERS anti-inflammatory creams, allergy creams, avoidance

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disseminated - CORRECT ANSWERS to disburse; to spread around Mycoses - CORRECT ANSWERS fungal infections acne - CORRECT ANSWERS -chronic papular and pustular eruption of the skin with increased production of sebum

• can be related to chemicals in the enviroment
• 2 major types - rosacea and vulgaris Acne rosacea (facial flushing) - CORRECT ANSWERS -usually begins around age 30-50 years old -characterized by: --- erythema, papules, pustules, and telangiectases
• occurs on the face, over the cheeks, and bridge of the nose causes -
• tea
• coffee
• alcohol (especially wine)
• caffeine
• spicy foods
• emotional stress ance rosacea treatment - CORRECT ANSWERS - avoidance of triggers
• topical antibiotics
• metronidazole (metro gel)
• retinoids

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• remove blackheads and white heads by promoting dryness and peeling off the top layer of skin, telangiectases (vascular lesions) - CORRECT ANSWERS dilation of capillaries causing small red or purple cluster or spider veins Acne vulgaris treatment - CORRECT ANSWERS -Retinoids (e.g., tretinoin)
• a topical comedolytic agent
• benzoyl peroxide -azelaic acid 2x a day
• veltin gel pt over 12 years
• antibiotics like tetrcycline and erythromycin for cystic acne
• isotretinoin foe extreme cases of cystis acne only due to adverse effects including organ damage and mental problems
• large areas can be treated with lasers or light treatment call photodynamic therapy
• scarring and pitting can be treated with dermabrasion ance vulgaris - CORRECT ANSWERS Factors - hereditary increased androgen levels premenstrual hormonal fluctuauions use of heavy creams certain drugs exposure to increased heat typically begins at puberty and continues through teens and begins to subside but occasionally can reoccurr several years later

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Acne Interventions - CORRECT ANSWERS - educate pt about the nature of their skin disease -face should be wash gently with mild soap

• squeezing pimples and pustules is not reccommended -recommend dermatologist Stevens-Johnson Syndrome - CORRECT ANSWERS An allergic reaction that can include rashes, and involve the inside of the mouth. May be due to drug sensitivity. Can lead to uveitis and keratitis. Other factors related to SJS include: pneumonia, fever, myalgia and hepatitis. SJS can be extremely similar to varicella zoster and pemphigus vulgaris conditions. There may also be the presence of herpes virus or Mycoplasma pneumoniae. Cellulitis - CORRECT ANSWERS infection of the dermis and subcutaneous tissue and is generally caused by staphylococcus furuncles - CORRECT ANSWERS boils - skin abscesses are inflammations of the hair follicle carbuncles - CORRECT ANSWERS a collection of boils that have a "pus head" characteristics of basal cell carcinoma - CORRECT ANSWERS -arises from the basal cells contained in the epidermis -rarely metastasize -causes underlying tissue destruction and can progress to organ tissue

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• usually appears first as a small, scaly area and tends to become larger as the disease progresses -most common on the face and trunk -scales shed and bleeding occurs and a scab will form. this is how it grows, the scab will shed and the process continues -bordered by a waxy, translucent, raised area treated with removal or radiation skin cancer - CORRECT ANSWERS possibly causes: overexpsosure to the sun skin damage from repeated injury and irratation genetic dispostion ionizing radiation light-skinned race age greater than 60 outdoor occupation exposure to chemical carcingens squamous cell carcinoma - CORRECT ANSWERS malignant tumor of the squamous epithelial cells in the epidermis, caused by sunlight can infiltrate surrounding structures and metastasize to lymph nodes -appears on head and neck most frequently -begins as a small nodule and rapidly becomes ulcerated

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-treatment needs to begin early if the condition is to be relieved before the skin cells sustain extensive damage

• total removal or lesion destruction
• treatments- --- cyrotherapy --- topical chemo --- laser surgery --- either topical or injected immune response modifiers Melanoma - CORRECT ANSWERS - may occur any place on the body, especially where birthmarks or new moles are apparent
• highly metastatic to the brain, lungs, bone, and liver with survival depending on early diagnosis and treatment -arises from pigment-producing cells possible causation -
• genetic predispostion -solar radiation -steroid hormone influence
• 3 major types -- superficial spreading - can be cured --- nodular --- lentigo maligna always requires surgical removal of the tumor and excision of adjacent tissues and possibly nearby lymphatic structures
• chemo may be affective to kill cancer cells that have spread other places

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Skin cancer data collection - CORRECT ANSWERS change in color, size or shape of preexisting lesion pruritus local soreness biopsy pathology study basal cell carcinoma characteristics - CORRECT ANSWERS slowly enlarging, firm, scaly papule crusted or ulcerated center that may be depressed, has pearly semitranslucent border -bordered by a waxy, translucent, raised area squamous cell carcinoma characteristics - CORRECT ANSWERS commonly seen as well defined, irregularly shaped nodule or plaque

• may be elevated, nodular mass, fungated mass varying amounts of scale and crusting may have ulcerated center predominantly on sun-exposed areas - head, cheeks, neck, hands spreads rapidly Superficial spreading melanoma - CORRECT ANSWERS -appears in a variety of colors - white, red, gray, black, blue over brown or black background
• has irregular surface and notched border -small tumor nodules may ulcerate and bleed -horizontal growth can continue for years -vertical growth worsen prognosis

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Nodular Malignant Melanoma - CORRECT ANSWERS -Nodule with uniformly grayish black color, resembles a blackberry

• maybe flesh colored with specks of pigment around base of nod
• itching, oozing, and bleeding may occur
• prognosis less favorable then superficial Lentigo maligna melanoma - CORRECT ANSWERS relatively rare, arises from a lesion that resembles a large, flat, freckle, that is a variable color from tan to black.
• has irregular spaced black nodules on the surface -typically located on back of the hand, face, and neck -develops very slowly -may ulcerate Acral lentiginous melanoma - CORRECT ANSWERS rarest types of melonma -located on the palms, soles of feet, or under the fingernails and toenails -not related to sun exposure -appears as a dark streak under the nail -on other areas presents as an odd-shaped black, gray, tan, or brown mark with irregular borders shearing action - CORRECT ANSWERS superficial layers of tissue are pulled and stretched across deeper layers of tissue Pressure Ulcers Risk Factors - CORRECT ANSWERS - frail, fragile skin
• Immobility, decreased mobility
• incontinence
• poor nutrition
• impaired sensation

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• impaired cognition
• obesity
• advanced age -edema
• excessive sweating -dehydration Pressure injury prevention - CORRECT ANSWERS -pressure relief -padding -positioning -pressure relief devices -adequate nutrition
• excellent skin care Pressure injury prevention interventions - CORRECT ANSWERS - assess the skin of all pts every 8-24 hrs, paying particular attention to boney prominence's -reposition patient on bed rest at least every 2 hrs ---- use written schedule to keep track -use position devices
• pt who are on best rest and completely immobile, use devices that totally relieve pressure on the heels by raising the heels off the bed - DO NOT USE DONUT DEVICES
• when in side lying postion, avoid positioning directly on the trochanter -pts on bed rest, maintain the head of the bed at the lowest degree permittded by the medical condition and try to limit the time the head is elevated
• use lifting devices - trapeze or bed linens to move pt -DO NOT DRAG PT -for pt with limited mobility, use pressure reducing bed devices - foam, static air, gel, water mattress

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-minimize skin injury caused by friction and shear forces by proper positioning and correct transferring and turning techniques -use lubricants, protective films, protective dressings, and protective padding -skin cleansing should occur at the time of soiling and at routine intervals based on pt need and preference -do not use hot water and use a mild cleansing agent that minimize irritation and dryness of the skin

• keep the environmental humidity above 40% and prevent exposure to cold -treat dry skin with moisturizers -do not massage boney prominences
• minimize skin exposure to moisture from incontinence, perspiration, and wound drainage
• when moisture cannot be controlled, use underpads or briefs that present a quick drying surface to the skin
• check for incontinence every 2 hrs -use a pressure reducing device such as foam, gel, air, or a combination of items
• positioning of wheelchair bound pts should include consideration of postual alignment, distribution of weight, balance and stability, and pressure relief by device or repositioning

positioning devices - CORRECT ANSWERS pillows foam wedges padding air matress water matress fel Braden Scale - CORRECT ANSWERS sensory perception, moisture, activity, mobility, nutrition, friction and shear