NSG123/ NSG 123 Exam 4: (New 2024/ 2025 Update) Med Surg 1 Review, Exams of Medicine

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NSG123/ NSG 123 Exam 4: (New 2024/ 2025 Update) Med Surg 1 Review| Questions and Verified Answers| 100% Correct| All Units Covered| A Grade – Herzing QUESTION considerations for epilepsy in women Answer: - increased seizure activity during menses - anticonvulsant medication decreases effectiveness of oral contraceptives - diagnosis of epilepsy puts fetus at 3x higher risk for malformations - careful monitoring required during pregnancy QUESTION non-pharmacological treatment options for refractory seizures Answer: - vagal nerve stimulator (implanted under clavicle, patient controls when they feel an aura, diminishes the severity and duration of seizure, DOES NOT prevent seizures) - responsive neurostimulation system (electrodes implanted in brain, interrupts brain activity, prevents seizures) QUESTION medications for seizures Answer: - carbamazepine/Tegretol (grand mal/tonic-clonic) - clonazepam/Klonopin (children) - phenytoin/Dilantin (multiple types) - valproate/Depakote (tonic-clonic) QUESTION Phenytoin (Dilantin) information Answer: - 10-20mcg/mL therapeutic level - must be given on time - increases risk for osteoporosis (take calcium and vitamin D) - causes gingival hyperplasia (expected side effect, do not stop medication) - encourage good dental hygiene - do not take oral contraceptives - do not stop abruptly QUESTION status epilepticus Answer: - prolonged seizure activity - medical emergency - goal is to stop the seizures ASAP - give IV medications (diazepam/Valium, lorazepam/Ativan, fosphenytoin/Cerebyx) QUESTION thyroid hormones Answer: T3, T4, calcitonin QUESTION diagnosis of hyperthyroidism Answer: - physical assessment is done from behind patient, feeling for structures moving up and down as the patient swallows - TSH, T3, T4 blood tests (affected by oral contraceptives, corticosteroids, aspirin, carbamazepine, Lasix, heparin) - gastric irritation QUESTION nursing considerations for sodium or potassium iodine solutions Answer: - give with fruit juice or milk - use a straw to avoid staining teeth - watch for cardiac symptoms QUESTION nursing considerations for thyroid surgery Answer: - monitor airway - monitor calcium levels/hypocalcemia QUESTION signs and symptoms of hypocalcemia Answer: - tingling in toes, fingers, around mouth - difficulty speaking - Chvostek and Trousseau's signs - life-threatening condition QUESTION treatment for hypocalcemia Answer: - IV calcium gluconate - IV isotonic saline - calcium & vitamin D tablets (short and long-term) QUESTION post-operative care following thyroidectomy Answer: - semi-fowler position - monitor respirations (have trach tray available) - check patient's back for pooling of blood - discourage talking - frequent vital signs - monitor labs - calcium, T3, T4, TSH (may be high at first b/c hypothalamus is still releasing TSH) - provide pain relief measures QUESTION causes of hypothyroidism Answer: - low T3 and T4, high TSH - autoimmune disease (Hashimoto's disease) - atrophy of thyroid gland - medications - radiation exposure - iodine levels QUESTION signs and symptoms of hypothyroidism Answer: everything is slowed down - lethargy - cold intolerance - weight gain - anorexia - brittle hair and nails - edema - constipation - cardiac system slows down (increased risk for heart disease) QUESTION myxedema Answer: - life-threatening complication of hypothyroidism - mask-like face - facial edema - constipation - confusion - coma QUESTION treatment of myxedema Answer: - IV T3 and T4 hormone replacement (STOP med if patient has chest pain or cardiac symptoms) - passive warming - turn and reposition frequently QUESTION patient education for Synthroid Answer: - lifelong treatment - take on empty stomach 2 hours before meal - interacts with other medications (antacids, Maalox) - always pack in carry-on when traveling - avoid sedatives - minimize constipation QUESTION QUESTION medical management of diabetes Answer: - nutritional therapy - exercise - monitoring - pharmacological therapy - education QUESTION nutritional recommendations for diabetes Answer: - carbohydrates 50-60% - fat 30% (saturated fats <10%) - non-animal sources for protein - increase fiber - do not skip meals - maintain consistent caloric & carbohydrate intake - eat foods with lower glycemic index (raw, whole rather than juice) - combine starchy foods with protein and fat to slow absorption and glycemic response QUESTION What medication should be avoided when taking levodopa/carbidopa (SInemet)? Answer: MAOIs (Nardil, Emsam) QUESTION non-pharmacological treatment for Parkinson's disease Answer: - deep brain stimulation (most common) - improves tremors and rigidity, will not cure Parkinson's - ablation of brain cells in specific areas - transplantation of neural stem cells QUESTION nursing interventions for Parkinson's disease Answer: - maintain good health - encourage independence - avoid complications (aspiration, falls)*** - promote physical activity (swimming, stationary bike, stretching, gardening, NO JOGGING/RUNNING) - exaggerate steps as if they are stepping over something - walk to a beat - good sleep hygiene - manage speech problems (face person, short sentences) - dietary considerations (nutrient dense, avoid constipation) - provide support for caregivers QUESTION delerium Answer: - temporary acute mental confusion - due to acute injury (SURGERY, dehydration, medication reaction, UTI) ex: patient returns to med/surg floor after hip replacement surgery and cannot focus on anything, cannot follow directions QUESTION nursing intervention for delerium Answer: - fall prevention - hydration - watch patient cues (if getting up, they may need to use the bathroom) - manage the family (they are upset because patient was not like this before) QUESTION dementia Answer: - progressive mental deterioration - neurologic degeneration: gradual onset - vascular dementia: abrupt onset (stroke) QUESTION things to consider regarding diagnosis for dementia Answer: - focus on determining the cause - rule out other diseases (medical, neurologic) - evaluate judgment (elderly person should not be getting a puppy or building a new house) - is patient still interested in hobbies/activities - assess ability to handle finances - medication use (analgesics, anticholinergics, psychotropics, sedatives) QUESTION nursing interventions for patients with dementia Answer: - maintain patient safety - provide calm environment/avoid lots of noise - consistency in caregivers - encourage physical activity in a chair - provide simple instructions - assess for signs of elder abuse/neglect QUESTION QUESTION Seizure Triggers "STOP SEIZURE" Answer: - Stress - Trauma - Overexertion - Period/Pregnancy - Sleep loss - Electrolyte issues - Illness - visualiZation disturbances - Undermedicated - Recreational drugs - ETOH QUESTION nursing management during/after a seizure Answer: - what was happening when the seizure occurred (flickering lights, loud sound, illness) - ask patient about any aura - assist patient to the floor if standing or sitting - remove dangerous items (tables, chairs) - turn patient on their side if able - do not put anything in patient's mouth (NO SUCTIONING) - observe body movements (what part of the body) - are the patient's eyes open - document time of onset and when it ended - place in recovery position (on their side) QUESTION seizure precautions include Answer: - side rails up and padded - side lying position - bed in low position - pillow for patient's head - side lying position - curtain for privacy - have suction and oxygen available QUESTION When will a nurse check blood glucose levels? Answer: peak time of insulin medica- tion QUESTION insulin preparation steps Answer: - agitate cloudy insulin - scrub top of insulin vial with alcohol - inject air equal to dosage into cloudy (NPH) (do not touch solution with needle) - inject air equal to dosage into clear (regular) - invert clear insulin vial and draw up clear - invert cloudy insulin vial and draw up cloudy (do not push plunger while in the vial) QUESTION patient education for blood glucose monitoring Answer: - wash hands - engage needle - insert test strip in machine - clean finger with alcohol and let dry - prick finger, wipe away blood - obtain blood sample QUESTION patient education for self-injection of insulin Answer: - stabilize skin - use 90 degree angle - rotate injection sites - do not rub injection site QUESTION patient education for insulin pumps Answer: - only use rapid acting insulin - needle will be subcutaneous - rotate sites every 3 days - check glucose level several times per day - may disconnect from pump when needed - cannot be used on patients with decreased mental status QUESTION rapid acting insulin, onset, peak, duration Answer: Onset: 10-30 min Peak: 30 min-3 hr Duration: 3-5 hr 15 minutes feels like an hour after 3 rapid responses. QUESTION short acting (regular) insulin onset, peak, duration Answer: Onset: 30 min-1 hr Peak: 2-5 hr Duration: 5-8 hr - common cause for headache in the older population - inflammation of the temporal artery (pain in the temple area) - treated with corticosteroids QUESTION primary headache Answer: a headache for which no specific organic cause can be found (ex: migraine, cluster, tension) QUESTION secondary headache Answer: headache identified as a symptom of another organic disorder (ex: brain tumor, hypertension) QUESTION Phases of migraines Answer: - premonitory (days before - depression, feeling cold, no appetite) - aura (visual disturbances, hand tingling) - headache (nausea, vomiting, light & sound sensitivity) - post drome (pain subsides, weakness, tiredness) QUESTION cluster headache Answer: - unilateral (one side of the head) - rapid onset - can occur 1-8 times per day QUESTION tension headache Answer: - constant pain - band-like around the head QUESTION Assessment questions to ask patient with headaches Answer: - how have headaches changed - when did headaches start (childhood or adolescence - migraines) - is there a family history of headaches - do headaches interfere with activities of daily living - what medications do you take - do you have contact with toxic substances - OLDCARTS QUESTION treatment for headaches Answer: - provide comfort measures - quiet dark room (photophobia very common) - massage - anti-emetic - local heat for tension headache - cold compress for migraines QUESTION Preventive measures for migraines Answer: - avoid bright light - stress reduction techniques - good sleep routine - avoid chocolate - avoid oral contraceptives - avoid caffeine QUESTION migraine medications Answer: - triptans (Sumatriptan/Imitrex) - vascoconstrictor - ergotamines (Cafergot, Ergomar) - vasoconstrictor - depakote - prophylactic - topamax - prophylactic - anticonvulsants - beta blockers - antidepressants QUESTION patient education for headache medication Answer: - do not take triptans and ergot- amines together - be cautious with cardiac patients when taking triptans - use triptans at the onset of migraine (aura phase) - if pregnant, avoid aspirin, Tylenol, and Naproxen - use corticosteroids for cranial arteritis QUESTION Parkinson's disease Answer: - slow, progressive neurological movement disorder - exact cause is unknown - decreased levels of dopamine (relaxation) and increased acetylcholine (excitatory)