Medical Surgical Nursing Exam Questions and Answers, Exams of General Surgery

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Medical Surgical Exam Four questions

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Modifiable Risk Factors of Stroke - ANSWER>>Hypertension Diabetes Hyperlipidemia (low cholesterol diet & increase fiber) Smoking Obesity Stress Diet (bad-high fat, processed) & Exercise

Non-Modifiable Risk Factors of Stroke - ANSWER>>Age (55+) Gender (Male) Race (African American & Hispanic) Family History/Genetics

Stroke Nursing Assessment - ANSWER>>CT Scan- Rapid! (25 min) (check renal function) Neuro Assessment Balance & Coordination Speech

Hemiplegia & Hemiparesis Definitions - ANSWER>>Hemiplegia (half of body paralyzed) Hemiparesis (half of body weakness)

Dysarthria & Apraxia Definitions - ANSWER>>Dysarthria (slurred speech) Apraxia (substitutes wrong words)

Dysphasia & Dysphagia - ANSWER>>Dysphasia (difficulty speaking) Dysphagia (difficulty swallowing)

Aphasia: Expressive vs. Receptive - ANSWER>>Aphasia: difficulty communicating Expressive: Cannot ANSWER, knows ANSWER but cannot get it out Receptive: Do not understand what you are saying Global: Both

Loss of Proprioception - ANSWER>>Loss of proprioception: ability to perceive the position of your body in space

Ischemic Stroke Symptoms - ANSWER>>Hemiplegia Hemiparesis Dysarthria Apraxia Dysphasia Dysphagia Aphasia: difficulty communicating Expressive: Cannot ANSWER, knows ANSWER but cannot get it out Receptive: Do not understand what you are saying Global: Both Loss of proprioception: ability to perceive the position of your body in space Facial Droop

Hemorrhagic Stroke Nursing Assessment - ANSWER>>CT MRI to determine extent of damage Under 40- Drug Screen No Lumbar Puncture Aneurysm Precautions: bed rest laying down, dim lights, SCD (leg squeezers), need them to turn still, stool softeners Environment: Quiet, head of bed 30 degrees Bowel/Bladder Lighting Prevention Bed Rest Sedation If INR high, use Vitamin K and plasma

Hemorrhagic Pharmacological Treatment - ANSWER>>If caused by elevated INR due to Warfarin Reverse INR with FFP and Vitamin K If caused by NOACs: Idarucizumab (Praxbind) reverses dabigatran (Pradaxa) Seizures: phenytoin (Dilantin) (more likely for seizures) Anti-hypertensives (ACE favored) Analgesics for pain Acetaminophen for fever

Glaucoma Cholinergic Medications - ANSWER>>Cholinergic (Miotics) (Pilocarpine & Carbachol): Increase aqueous fluid outflow by contracting the ciliary muscle and causing constriction of pupil and opening up meshwork. Side Effects: Periorbital pain, blurry vision, difficulty seeing in dark. Implications: Caution patients about diminished vision in dim lit areas. Pilocarpine can be stored at room temp for up to 8 weeks, then should be discarded.

Glaucoma Beta Blockers - ANSWER>>Beta-Blockers (Timolol Maleate): Decrease aqueous humor production. Side Effects: Systemic effects like bradycardia, exacerbation of pulmonary disease, and hypotension. Implications: Contraindicated in patients with asthma, COPD, heart block, bradycardia, heart failure, and education patients about punctual occlusion to limit systemic effects.

Glaucoma Alpha-Adrenergic Agonists - ANSWER>>Alpha-Adrenergic Agonists (Apraclonidine & Brimonidine): Decrease aqueous humor production. Side Effects: Eye redness, dry mouth, and nasal passages. Implications: Education about punctual occlusion to limit systemic effects.

Glaucoma Caronic Anhydrase Inhibitors - ANSWER>>Carbonic Anhydrase Inhibitors (Acetazolamide & Dorzolamide) Decrease aqueous humor production. Implications: Do not give to patients with sulfa allergies and monitor electrolyte levels.

Glaucoma Prostaglandin Analogics - ANSWER>>Prostaglandin Analogics (Latanoprost & Bimatoprost): Increase uveoscleral outflow. Side Effects: Darkening of the iris, conjunctival redness, possible rash. Implications: Instruct patients to report any side effects

Glaucoma Laser Trabeculoplasty - ANSWER>>In laser trabeculoplasty for glaucoma, a laser beam is applied to the inner surface of the trabecular meshwork to open the intratrabecular spaces and widen the canal of Schlemm, promoting outflow of aqueous humor and decreasing IOP.

Glaucoma Peripheral Iridotomy - ANSWER>>Peripheral iridotomy for pupillary block glaucoma, an opening is made in the iris to eliminate the pupillary blockage

Glaucoma Filtering - ANSWER>>Filtering procedures for glaucoma are used to create an opening or fistula in the trabecular meshwork to drain aqueous humor from the anterior chamber to the subconjunctival space into a bleb (fluid collection on the outside of the eye), thereby bypassing the usual drainage structures. This allows the aqueous humor to flow and exit by different routes (i.e., absorption by the conjunctival vessels or mixing with tears).

Trabeculectomy is the standard filtering technique used to remove part of the trabecular meshwork

Glaucoma Drainage Implants/Shunts - ANSWER>>Drainage implants or shunts are tubes implanted in the anterior chamber to shunt aqueous humor to the episcleral plate in the conjunctival space. Implants are used when failure has occurred with one or more trabeculectomies in which antifibrotic agents were used

Risk Factors for Glaucoma - ANSWER>>African American race Cardiovascular disease Diabetes Family history of glaucoma Migraine syndromes Nearsightedness (myopia) Older age Previous eye trauma Prolonged use of topical or systemic corticosteroids Thin cornea

General Nursing Guidelines for the Administration of Topical Ophthalmic Medications - ANSWER>>Topical application is the most common route of administration for ophthalmic drugs, and correct administration is essential for optimal therapeutic effects. Systemic absorption of eyedrops can be decreased by closing the eye and applying pressure over the tear duct (nasolacrimal occlusion) for 3 to 5 minutes after instillation. When multiple eyedrops are required, there should be an interval of 5 to 10 minutes between drops because of limited eye capacity and rapid drainage into tear ducts. Absorption of eye medications is increased in eye disorders associated with hyperemia and inflammation. Many ophthalmic drugs are available as eyedrops (solutions or suspensions) and ointments. Ointments are administered less frequently than drops and often produce higher concentrations of drugs in target tissues. However, they also cause blurred vision, which limits their daytime use, at least for ambulatory patients. For some patients, drops may be used during waking hours and ointments at bedtime. Topical ophthalmic medications should not be used after the expiration date; cloudy, discolored solutions should be discarded. Topical eye medications contain a number of inactive ingredients, such as preservatives, buffers, tonicity drugs, antioxidants, and so on. Some contain sulfites, to which some people may have an allergic reaction.

Known hypersensitivity to timolol is also a contraindication. (do not give asthmatics or bradycardic patients)

The most common adverse effects associated with timolol are burning and stinging.

Ocular Disorder Patient Education - ANSWER>>Wear sunglasses Keep blood pressure down Eye exams Do not share eye makeup or medications Treat symptoms with over the counter for 3 days then go to doctor If they have multiple eye drops they must be given 5-10 min apart, pressure on lacrimal duct 3- 5 min

Symptoms of Meningitis - ANSWER>>Headache and fever are frequently the initial symptoms. Fever tends to remain high throughout the course of the illness. The headache is usually either steady or throbbing and very severe as a result of meningeal irritation A stiff and painful neck (nuchal rigidity) can be an early sign, and any attempts at flexion of the head are difficult because of spasms in the muscles of the neck Positive Kernig sign: When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended Rash Photophobia Positive Brudzinski Sign

Meningitis Can Be - ANSWER>>Bacterial, viral, fungal

What medications are given to meningitis patients? - ANSWER>>Broad spectrum antibiotics

Dexamethasone: steroid to decrease inflammation, helps absorption of antibiotic Give 15-20 min before IV antibiotics

What cannot be done in meningitis with increased ICP - ANSWER>>Lumbar Puncture

Viral Meningitis Medications - ANSWER>>Antipyretic Pain Meds Increase risk of seizures Cooling Blanket

TIA Risk Factors - ANSWER>>Same as stroke

LPN Delegation - ANSWER>>Give meds No care plans No Education No IV Push Meds No IV sedation Can do head to toe, but you look at info as RN

First Line Treatments of Cancer - ANSWER>>Adjuvant treatment and symptom management Continues education and support Home Care PT Toxicity assessment and management

Second & Third Line Treatments Cancer - ANSWER>>Increasing acuity, Increasing symptom experience, Changes in functional status and quality of life Palliative care Continued education and support Home Care Pt Nutrition Toxicity assessment and management

Hemorrhagic Stroke 2 Meds - ANSWER>>Mannitol & Hypertonic Solution: 3% NS

Death & Dying Medications - ANSWER>>Morphine Ativan (no benzos with delirium) Haldol if they cannot have benzo Atropine eye drops that go sublingual Scopolamine

Hospice Things to Know - ANSWER>>Chey-Stokes Respiratory Might get more energy right before death Nutrition they might not want to eat as much, give them whatever they want but do not push too much Make room free of odors Give pain meds on schedule

Antimetabolites (What to know) - ANSWER>>Methotrexate: toxic to kidneys Bone marrow suppression, nausea, vomiting, diarrhea

Antitumor Antibiotics (names) - ANSWER>>Doxorubicin (Adriamycin) Epirubicin

Antitumor Antibiotics (Mechanism of Action) - ANSWER>>Interfere with DNA synthesis by binding DNA and preventing RNA synthesis

Antitumor Antibiotics (What to know) - ANSWER>>Doxorubicin: Can cause red urine Bone marrow suppression Alopecia Cardiac Toxicity

Miotic Spindle Inhibitors (names) - ANSWER>>Vincristine, Paclitaxel

Miotic Spindle Inhibitors (MOA) - ANSWER>>Arrest metaphase by inhibiting tubulin depolymerization

Miotic Spindle Inhibitors (side effects) - ANSWER>>Bone marrow suppression Stomatitis Peripheral Neuropathy

Hormonal Agents & Cancer - ANSWER>>Hormonal Agents Estrogen, progestin, steroids, aromatase inhibitors. Bind to hormone receptor sites that alter cellular growth.

Lethal Tumor Dose - ANSWER>>Dose that will eradicate 95% of the tumor and preserve normal tissue

Stages of Grief (Kubler-Ross) - ANSWER>>Denial Anger Bargaining Depression Acceptance

Advanced Directive - ANSWER>>Written documents that allow the individual of sound mind to document preferences regarding end-of-life care that should be followed when the signer is

terminally ill and unable to verbally communicate their wishes. The documents are generally completed in advance of serious illness but may be completed after a diagnosis of serious illness if the signer is still of sound mind. The most common types are the durable power of attorney for health care and the living will.

Palliative Care - ANSWER>>Palliative: Holistic care of patients whose disease is not responsive to curative treatment. 'Symptom Management'

Palliative Care & Hospice Setting: - ANSWER>>Hospital Skilled Nursing Facilities and Assisted Living Facilities Home Inpatient Hospice Center

Palliative & Hospice - ANSWER>>Bridge between cure-oriented treatment and the needs of terminally ill patients and their families for comprehensive care in the final years, months, or weeks of life Optimize quality of life by anticipating, preventing, and treating suffering ALL symptoms: physical, psychosocial, spiritual Offered concurrently with or independent of curative or life-prolonging care Goal: improve patient's and family's quality of life All hospice care is palliative care, but not all palliative care is hospice care

What to know about teaching for internal radiation - ANSWER>>No pregnant people or children in the room Visitors have max of 30 min per day in the room Radioactive sign on door with door closed Stay 6 feet away from patient Wear a device that measures radiation

Cancer Surgical Treatments - ANSWER>>Biopsy: Obtain a sample to perform pathology on. May also take sample of nearby lymph nodes. Help determine if tumor is malignant and grade/stage of the tumor Surgical removal of the entire cancer remains the ideal and most frequently used treatment method Prophylactic Surgery: HIGH RISK patients. Ex: Breast CA with BRCA1 or BRCA2 genes. Colectomy, mastectomy, oophorectomy (examples) Palliative Surgery: Surgical cure not possible. Goal is to relive symptoms and make patient as comfortable as possible