NSG223/ NSG 223 Exam 2: (New 2024/ 2025 Update) Med Surg II Review| Q&A, Exams of Nursing

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NSG223/ NSG 223 Exam 2: (New 2024/ 2025 Update) Med Surg II Review| Questions and Verified Answers| 100% Correct| A Grade – Herzing Question causes for respiratory acidosis Answer: - pneumonia - pulmonary edema - cardiac arrest - chronic obesity (due to sleep apnea)*** - COPD - emphysema Question treatment for respiratory acidosis Answer: - improve ventilation - apply oxygen - semi-Fowler position Question symptoms of respiratory acidosis Answer: - low pH, high PaCO2 - suddenly increased heart rate, respirations, and BP - shallow breaths - disorientation - hyperkalemia - hypercalcemia Question causes for respiratory alkalosis Answer: - hyperventilation - anxiety - pain Question treatment for respiratory alkalosis Answer: - breathe into a bag to get the acid back - rebreather mask - correct cause of hyperventilation Question symptoms of respiratory alkalosis Answer: - high pH, low PaCO2 - light headedness - hypokalemia - hypocalcemia - fast respirations - seizures - tingling in the extremities Question causes for metabolic acidosis Answer: - diabetes - diarrhea Answer: - wash hands - vaccination - wash fruits and vegetables Question management of hepatitis A Answer: - IV fluids - rest - nutritious diet Question risk factors for hepatitis B Answer: - frequent exposure to blood, blood products, or other body uids - healthcare worker - getting tattoos - male homosexual activity - IV drug use - multiple sexual partners Question transmission of hepatitis B Answer: - blood - bodily fluids Question prevention of hepatitis B Answer: - vaccination - safe sex - avoid risky behaviors Question management of hepatitis B Answer: - high protein, low fat diet - monitor liver enzymes - rest Question risk factors for hepatitis C Answer: - IV drug use - healthcare worker - receiving frequent blood transfusions - multiple sex partners Question prevention of hepatitis C Answer: - avoid risky behavior - screen blood donations Question transmission of hepatitis C Answer: - blood - sexual contact Question management of hepatitis C Answer: - antiviral medications (Olysio, Sovaldi) - no vaccine Question symptoms of drug induced hepatitis Answer: - fever - rash - nausea - jaundice - enlarged liver Question causes of drug induced hepatitis Answer: - acetaminophen - rheumatic agents - statins - NSAIDs Question venous thrombus emboli (VTE)*** Answer: includes pulmonary embolism (PE) and deep vein thrombosis (DVT) Answer: - no history of hemorrhagic stroke - no recent MI - not pregnant - normal platelet level Question patient education for preventing PE Answer: - assess for risks - active and passive leg exercises/leg pumps*** - ambulation*** - do not dangle legs - use Ted hose/SCDs - do not cross legs - do not leave large IV catheters in place long-term Question pH depends on concentration of what in the blood? Answer: hydrogen (more H = more acidic, lower pH, less H = less acidic, higher pH) Question acid-base balance normal ranges Answer: - pH: 7.35 - 7.45 - PaCO2: 45 - 35 - HCO3: 22 - 26 - PaO2: 80 - 100 Question What is used to figure out what is causing metabolic acidosis? Answer: anion gap Question buffer systems within the body Answer: - chemical buffers (NaHCO3) - works within seconds - respiratory - regulates CO2 - works within minutes - metabolic - regulates HCO3 - may take days to regulate Question What occurs when patient is experiencing metabolic acidosis? Answer: patient will breathe faster and deeper to expel CO2 Question What occurs when patient is experiencing respiratory acidosis? Answer: kidneys hold onto bicarbonate to compensate for increased CO2 in the lungs Question How do the kidneys regulate pH? Answer: - excreting or reabsorbing H+ and HCO3 - if pH is acidotic, excrete H+ and keep HCO3 - if pH is alkalotic, excrete HCO3 and keep H+ Question ABG Example #1 pH 7.36 PaCO2 48 HCO3 28 Answer: respiratory acidosis fully compensated Question ABG example #2 pH 7.48 PaCO2 46 HCO3 30 Answer: metabolic alkalosis partially compensated Question ABG example #3 pH 7.44 PaCO2 32 HCO3 20 Answer: respiratory alkalosis fully compensated Question ABG example #4 pH 7.32 PaCO2 37 HCO3 21 Answer: metabolic acidosis uncompensated - infection control - DO NOT USE NGT (due to esophageal varices) Question pancreas functions Answer: - secretes digestive enzymes to break down lipids (lipase), carbs (amylase), and protein (trypsin) - produces hormones (insulin, somatostatin) Question diagnostic labs for pancreatitis Answer: - amylase HIGH - lipase HIGH - calcium LOW - WBC high Question acute pancreatitis Answer: - obstruction of pancreatic duct - sudden inflammation of pancreas - autodigestion of pancreas (eats itself) Question chronic pancreatitis Answer: - progressive inflammatory disorder - destruction of pancreas with replacement by fibrous tissue Question causes of chronic pancreatitis Answer: - alcohol (mostly men)*** - gallbladder disease (mostly women) - smoking - obesity Question mild pancreatitis Answer: interstitial edematous pancreatitis Question severe pancreatitis Answer: necrotizing pancreatitis Question symptoms of acute pancreatitis Answer: - severe abdominal pain (usually after eating or drinking alcohol) - rigid board-like abdomen (danger of peritonitis or hemorrhage) - low-grade fever - jaundice - cyanosis - clammy skin Question symptoms of chronic pancreatitis*** Answer: - recurring abdominal and back pain after eating or drinking alcohol - risk of opioid dependence due to recurring attacks - anorexia/weight loss - steatorrhea (frothy stool) Question treatment for pancreatitis Answer: - NPO (need to rest abdomen) - NGT - high protein, low fat diet*** - opioids (if pain is not relieved, pt may have peritonitis, hemorrhage)*** - H2 receptor blockers - PPIs - IV fluids - assess for paralytic ileus Question nursing management of pancreatitis Answer: - oral care - pain control - semi-Fowler position - daily weight - care of NGT Question acute kidney disease classification (RIFLE)*** Answer: Question treatment for AKI Answer: - treat underlying cause - daily weight - high carb, low protein, low potassium, low phosphorus diet (no bananas, potatoes, citrus fruits, coffee, no SODA) - skin care (itchy skin) Question What is used to treat hyperkalemia in AKI? Answer: sodium polystyrene sulphonate (Kayexalate)*** Question symptoms of chronic kidney disease / end-stage kidney failure Answer: - asterixis (uncontrolled hand flap) - confusion - gray-bronze skin color** - hyperkalemia*** - tachypnea - ammonia odor to breath*** - anemia - muscle cramps Question management of chronic/end-stage kidney failure Answer: - calcium & phosphorus binders - antihypertensive agents - erythropoietin (Epoetin Alfa) - high carb, low protein, low potassium, low sodium diet (no soda) - fluid restrictions - dialysis - kidney transplant Question calcium binders to treat high phosphorus levels Answer: - calcium carbonate (Os-cal) - calcium acetate (Phos-Lo) - sevelamer hydrochloride (Renagel) - give prior to dialysis Question 3 types of hemodialysis access Answer: - vascular - arteriovenous fistula - arteriovenous graft Question nursing considerations for arteriovenous fistula and graft*** Answer: - assess for patency (bruit/thrill) - do not use arm for BP, IV, blood draw - ensure dressing is not too tight - do not apply restraints to affected arm Question nursing considerations for peritoneal dialysis Answer: - assess abdomen - assess for signs of infection - aseptic technique - watch for leaks - assess drainage (should be straw-colored, no blood) - assess electrolytes - warm dialysate with heat pad, NOT MICROWAVE*** Question What is the most comfortable position for patient with pulmonary edema?- Answer: dangling legs*** Question pulmonary edema Answer: accumulation of fluid in the lungs, alveolar space, or both Question symptoms of pulmonary edema Answer: - dyspnea - cough - crackles - blood-tinged sputum*** - crackles - tachycardia - retractions Question risk factors for ARDS Answer: - history of lung injury - history of infection (pneumonia 2 weeks ago) - sepsis - major surgery - prolonged inhalation of smoke, corrosive substances Question treatment for ARDS Answer: - intubation*** - PEEP*** (positive end expiratory pressure) setting - prevents alveoli from collaps- ing - vasopressors (increase BP) - sedatives (lorazepam, versed, propofol) - neuromuscular agents for paralysis (pavulon, norcuron*** - relaxes jaw and vocal cords) - frequent respiratory and cardiac assessments - prone position - train of 4 (electrical stimulation to check for sedation - no twitches means 100% sedation) Question goals for patient with ARDS Answer: - PaO2 is >60 mmHg - V/Q balance (amount of air reaching alveoli/amount of blood reaching alveoli - ideal 4L/5L)