NSG223/ NSG 223 Exam 3: (New 2024/ 2025 Update) Med Surg II Review, Exams of Medicine

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NSG223/ NSG 223 Exam 3: (New 2024/ 2025 Update) Med Surg II Review| Questions and Verified Answers| 100% Correct| A Grade – Herzing Question syndrome of inappropriate antidiuretic hormone (SIADH) Answer: - too much antid- iuretic hormone (ADH) - holding onto fluid - SI (soaked inside) Question causes of SIADH Answer: - cancer (most common) - cells make ADH - head injury - CNS infections (meningitis) Question symptoms of SIADH Answer: - little to no urine output*** - very concentrated urine - hyponatremia*** - fluid overload*** - severe hypertension Question management of SIADH Answer: - more difficult to treat - restrict fluid - Furosemide - hypertonic IV fluids (3% NS) Question nursing management of SIADH Answer: - monitor fluid balance (I&O, daily weight)*** - vital signs - monitor labs - assess for neurologic changes - monitor LOC Question contusion Answer: soft tissue injury, bruise, closed skin Question strain Answer: muscle injury Question sprain Answer: - pain - pallor - pulselessness - paresthesia - paralysis Question nursing management of fractures Answer: - pain control - apply ice - elevate area - neurovascular assessment Question osteomyelitis Answer: infection of the bone Question risk factors for fracture complications Answer: - inadequate immobilization - inadequate blood supply - smoking - multiple traumas - extensive bone loss - diabetes - osteoporosis - non-compliance with treatment - older age Question early complications of fractures Answer: - shock - hemorrhage - fat embolism - compartment syndrome - DVT, PE - DIC Question delayed complications of fractures Answer: - delayed union - non-union - malunion - avascular necrosis Question compartment syndrome Answer: - compression of nerves and blood vessels caused by increase in volume (swelling, bleeding) or decrease in compartment size (cast) or both - THIS IS AN EMERGENCY Question symptoms of compartment syndrome Answer: - deep throbbing pain - pain not relieved with meds - pain disproportionate to injury - pain increases with passive ROM Question management of compartment syndrome Answer: - extremity elevated to heart level - release cast Question patient education for Ketonazole Answer: - hepatotoxic - take with water, juice, or food - do not take with antacid Question nursing management of Cushing's syndrome Answer: - decrease risk for injury (watch for muscle weakness, risk for falls, osteoporosis)*** - protect skin integrity (no tape) - diet: high protein, high calcium, high vitamin D*** - prevent infection - monitor blood glucose & electrolytes Question patient education for Cushing's syndrome Answer: - rest periods throughout the day Question education for Octreotide (Sandostatin) Answer: - synthetic somatostatin to stop GH production - long-term control of gigantism - IM administration every 4 weeks (intragluteal muscle)*** - SQ administration 3x per week Question diabetes insipidus (DI) Answer: - deficiency of antidiuretic hormone (ADH) aka Vaso- pressin*** - disorder of posterior pituitary gland - increased urine output - DI (dry inside) Question causes for diabetes insipidus Answer: - head trauma*** - brain tumor - surgery or radiation on pituitary gland - infection (meningitis, encephalitis) - nephrogenic (failure of kidneys to respond to ADH) Question symptoms of diabetes insipidus Answer: - increased urine output (>250mL/hr) - polydipsia (2-20L per day) - severe dehydration - hypernatremia - high plasma osmolarity (thick, sticky blood) Question diagnostics for diabetes insipidus Answer: - H&P (history of neurologic issues) - fluid deprivation test (withhold fluid, check urine concentration) - ADH level in blood - trial of desmopressin (synthetic Vasopressin) - if urine is still diluted, then positive for DI Question treatment of diabetes insipidus Answer: - replace ADH (long-term) - fluid replacement - Desmopressin (not for patients with creatinine clearance <30mL/min or nasal congestion***) - Thiazide diuretic (if patient has kidney origin) Question nursing management of diabetes insipidus Answer: - daily weight - I&O - educate about surgery and medications - prevent dehydration Question care of clavicle fractures Answer: - figure-8 strap - exercises for fingers, hand, elbow, wrist - do not elevate arm above head for 6 weeks Question care of humeral fractures Answer: - sling/brace - immobilization - pendulum exercises when tolerated Question care of elbow fractures Answer: - neurovascular assessment (prevent Volkmann con- tracture) - immobilization - gentle ROM Question care for pelvic fractures Answer: - assess for blood in urine - a few days of bed rest - early progressive mobilization Question Buck's extension traction Answer: - skin traction applied after a hip fracture to immo- bilize area - used if patient cannot go to OR immediately - psychological support - prevent complications (infection, bleeding) - prevent contractures (AKA must lie prone 20-30 min 3x/day) Question medications used for amputees Answer: - opioids initially - betablockers (dull burning pain) - anticonvulsants (cramping pain) - tricyclic antidepressants (phantom pain) Question multiple sclerosis Answer: - progressive autoimmune disease - destruction of fatty/protein layer around nerve fibers - unknown cause but can be genetic Question progression types of multiple sclerosis Answer: - relapsing-remitting (most common) - symptoms recur then go away, but do not return to baseline - primary progressive - secondary progressive - progressive-relapsing Question symptoms of multiple sclerosis Answer: - fatigue - weakness (usually starts in 1 foot or leg) - numbness/tingling (usually starts in 1 foot or leg) - ataxia - spasticity (stiffness/tightness) - pain - diplopia (double vision) Question systems affected by multiple sclerosis Answer: - emotional - cognitive - motor - sensory Question diagnostics of multiple sclerosis Answer: - MRI (visualization of plaques) - H&P (family history) - CSF (strands of immunoglobin G) Question treatment of multiple sclerosis Answer: - no cure - immunosuppressants - corticosteroids - Interferon (boosts immune system) - Baclofen/Lioresal oral or intrathecal (treats muscle spasticity) - stretching exercises Question Interferon B medication info Answer: - Interferon B-1a (Rebif) or B-1b (Betaseron) - SQ every other day - Interferon B-1a (Avonex) - IM once a week - crosses blood/brain barrier Question nursing management of multiple sclerosis Answer: - promote physical activity - daily stretching - alternate activity and rest - nutrition / maintain healthy weight - prevent illness (respiratory, UTI, pressure ulcer)*** - avoid extreme weather temperatures - hot (increases fatigue), cold (increases spasticity) Question myasthenia gravis Answer: - autoimmune disorder that affects neuromuscular junction (motor dysfunction only) - blocks acetylcholine from attaching to receptors - 75% of cause is thymic tumor Question symptoms of myasthenia gravis Answer: - ocular muscles initially (diplopia, ptosis) - mask-like face Question symptoms of cholinergic crisis Answer: - muscle overstimulation (too much acetyl- choline) - constricted pupils - vomiting - decreased HR - muscle weakness Question management of cholinergic crisis Answer: - correct underlying cause - atropine - hold myasthenia gravis meds - tensilon test worsens symptoms Question Guillain-Barre syndrome Answer: - autoimmune disorder that attacks peripheral nerve myelin - usually develops after a viral infection - numbness/tingling starts in the feet and rapidly moves upward symmetrically - paralysis peaks in 2-4 weeks, then subsides Question management of Guillain-Barre Answer: - respiratory support (suction, ventilator) - IV immunoglobulin - cardiovascular support/EKG monitoring - prevent DVT/PE (Enoxaparin SQ, SCDs) - skin care - nutritional support (prevent paralytic ileus) - assist with communication - rehabilitation Question management of fibromyalgia Answer: - NSAIDs (NO OPIOIDS) - antidepressants (tricyclics - Amitriptyline) - muscle relaxants (Cyclobenzaprine) - anticonvulsants (Gabapentin) Question hormones affected by Addison's disease Answer: - cortisol (decreased) - aldosterone (decreased) Question causes for Addison's disease Answer: - autoimmune disease (most common)*** - pituitary injury (decreased ACTH = decreased cortisol) - infections of adrenal gland (TB, histoplasmosis) - medications (long-term corticosteroids suppress body's normal production) Question symptoms of Addison's disease Answer: - dark pigmented skin on knuckles, knees, feet, elbows*** - HIGH potassium levels*** - muscle weakness*** - LOW sodium levels (salt craving)*** - hypotension - unstable emotionally - confusion - LOW blood glucose*** Question treatment of Addison's disease Answer: - steroid replacement (Prednisone, Fludrocor- tisone) - fluid replacement (especially in hot weather) - replace salt (watch potassium intake) - vasopressors - increase glucose level - limit stressors Question symptoms of Addison's crisis Answer: - dehydration - hypotension - severe hypoglycemia - severe nausea & vomiting - shock - syncope - headache Question causes of Addison's crisis