NSG233/ NSG 233 Exam 4 Review: (New 2024/ 2025 Update) Med Surg III | Q&A, Exams of Nursing

Download NSG233/ NSG 233 Exam 4 Review: (New 2024/ 2025 Update) Med Surg III | Q&A and more Exams Nursing in PDF only on Docsity! NSG233/ NSG 233 Exam 4 Review: (New 2024/ 2025 Update) Med Surg III | Questions and Verified Answers| 100% Correct| A Grade – Herzing QUESTION Colon Cancer Diagnostic Answer: Because colonoscopy is the only screening test that can also simultaneously remove precancerous polyps, thus preventing colorectal cancer, other experts recommend 10-year colonoscopies beginning at the age of 50 years as the major screening test for colorectal cancer. QUESTION Chemo/Capecitabine Adverse Effects Answer: The most common adverse effects of capecitabine include anemia, neutropenia, fatigue, diarrhea, and palmar-plantar erythrodysesthesia (PPE; hand-foot syndrome), which manifests by reddening, pain, and swelling of the palms of the hands and soles of the feet QUESTION Medications Pancreatic Cancer Answer: Although pancreatic tumors may be resistant to standard radiation therapy, the patient may be treated with radiation and chemotherapy (5-fluorouracil [5-FU, Adrucil], leucovorin [Wellcovorin], and gemcitabine [Gemzar]). Currently, gemcitabine is the standard of care for patients with metastatic pancreatic cancer and has been found to lengthen survival. The targeted anticancer drug erlotinib (Tarceva) has demonstrated a slight improvement in advanced pancreatic cancer survival when used in combination with gemcitabine. QUESTION Colon Cancer Metastasis Answer: When metastasis occurs, the liver is implicated half the time. Therapy targeted to treat metastases to the liver can include surgical resection, radiofrequency ablation, and intra-arterial chemotherapy QUESTION Surgical management of pancreatic cancer Answer: A pancreaticoduodenectomy (Whipple procedure or resection) is used for potentially resectable cancer of the head of the pancreas. This procedure involves removal of the gallbladder, a portion of the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. Reconstruction involves anastomosis of the remaining pancreas and stomach to the jejunum. If the tumor cannot be excised, the jaundice may be relieved by diverting the bile flow into the jejunum by anastomosing the jejunum to the gallbladder, a procedure known as cholecystojejunostomy. QUESTION Treating pancreatic cancer Answer: If the tumor is resectable and localized (typically tumors in the head of the pancreas), the surgical procedure to remove it is usually extensive. However, total excision of the lesion often is not possible for two reasons: (1) extensive growth of tumor before diagnosis and (2) probable widespread metastases (especially to the liver, lungs, and bones). More often, treatment is limited to palliative measures. Although pancreatic tumors may be resistant to standard radiation therapy, the patient may be treated with radiation and chemotherapy QUESTION Interventions for gastric cancer Answer: Answer: For patients with liver cancer anticipating surgery, support, education, and encouragement are provided to help them prepare psychologically for the surgery. After surgery, potential problems related to cardiopulmonary involvement may include vascular complications and respiratory and liver dysfunction. Metabolic abnormalities require careful attention. Because extensive blood loss may occur as well, the patient receives infusions of blood and IV fluids. The patient requires constant, close monitoring and care for the first 2 or 3 days, similar to postsurgical abdominal and thoracic nursing care. If the patient is to receive chemotherapy or radiation therapy in an effort to relieve symptoms, they may be discharged home while still receiving one or both of these therapies. The patient may also go home with a biliary drainage system or hepatic artery catheter in place. In most cases, the hepatic artery catheter has been inserted surgically and has a prefilled infusion pump implanted subcutaneously that delivers a continuous chemotherapeutic dose until completed. A hepatic artery port may also be inserted to provide access for intermittent chemotherapy infusion. This port dwells under the skin, but because it provides direct arterial access, it is not used for continuous infusion therapy in the home environment; the access line is discontinued once the chemotherapeutic agent has been infused. The patient and family require education about care of the biliary catheter and the effects and side effects of hepatic artery chemotherapy. This education is necessary because of participation of the patient and family in patient care in the home setting. QUESTION Surgical Treatment of Lung Cancer Answer: Surgical resection is the preferred method of treating patients with localized non-small cell tumors, no evidence of metastatic spread, and adequate cardiopulmonary function. If the patient's cardiovascular status, pulmonary function, and functional status are satisfactory, surgery is generally well tolerate Types of Lung Resection Lobectomy: a single lobe of the lung is removed Bilobectomy: two lobes of the lung are removed Sleeve resection: cancerous lobe(s) is removed and a segment of the main bronchus is resected Pneumonectomy: removal of entire lung Segmentectomy: a segment of the lung is removed Wedge resection: removal of a small, pie-shaped area of the segment Chest wall resection with removal of cancerous lung tissue: for cancers that have invaded the chest wall QUESTION Complication of HIV Answer: Diagnosis of KS is confirmed by biopsy of suspected lesions. Prognosis depends on the extent of the tumor, the presence of other symptoms of HIV infection, and the CD4+ count. Death may result from tumor progression. More often, however, it results from other complications of HIV infection. KS is caused by human herpesvirus-8 (HHV-8); affects eight times more men than women; and may spread through sexual contact. It involves the epithelial layer of blood and lymphatic vessels. AIDS-related KS exhibits a variable and aggressive course, ranging from localized cutaneous lesions to disseminated disease involving multiple organ systems. Cutaneous signs may be the first manifestation of HIV; they can appear anywhere on the body and are usually brownish pink to deep purple. QUESTION Priority nursing diagnoses in care of HIV/AIDs Answer: The list of potential nursing diagnoses is extensive because of the complex nature of HIV/AIDS. However, based on the assessment data, major nursing diagnoses may include the following: Impaired skin integrity related to cutaneous manifestations of HIV infection, excoriation, and diarrhea Diarrhea related to enteric pathogens or HIV infection Risk for infection related to immune deficiency Activity intolerance related to weakness, fatigue, malnutrition, impaired fluid and electrolyte balance, and hypoxia associated with pulmonary infections Chronic confusion related to cognitive changes associated with HIV encephalopathy Ineffective airway clearance related to infection, increased bronchial secretions, and decreased ability to cough related to weakness and fatigue Acute and chronic pain related to impaired perianal skin integrity secondary to diarrhea, KS, and peripheral neuropathy Imbalanced nutrition: less than body requirements related to decreased oral intake Social isolation related to stigma of the disease, withdrawal of support systems, isolation procedures, and fear of infecting others Grieving related to changes in lifestyle and roles and unfavorable prognosis Deficient knowledge related to HIV infection, means of preventing HIV transmission, ART, and self-management strategies QUESTION HIV patient education Answer: Patients, families, and friends are educated about the routes of transmission of HIV. As discussed earlier, the nurse discusses precautions the patient can use to avoid transmitting HIV sexually (see Charts 36-2 and 36-3) or through sharing of body fluids, especially blood. Patients and their families or caregivers must receive instructions about how to prevent disease transmission, including handwashing techniques and methods for safely handling and disposing of items soiled with body fluids. Clear guidelines about avoiding and controlling infection, keeping regular health care appointments, symptom management, nutrition, rest, and exercise are necessary. The importance of personal and environmental hygiene is emphasized. Caregivers are taught hand hygiene and appropriate infection prevention precautions. Kitchen and bathroom surfaces should be cleaned regularly with disinfectants to prevent growth of fungi and bacteria. Patients with pets are encouraged to have another person clean areas soiled by animals, such as birdcages and litter boxes. If this is not possible, patients should use gloves to clean the area and then wash their hands afterward. Patients are advised to avoid exposure to others who are sick or who have been recently vaccinated, especially with live vaccine. The importance of avoiding smoking, excessive alcohol, and over-the-counter and street drugs is emphasized. Patients who are HIV positive or who inject drugs are instructed not to donate blood. IV/injection drug users who are unwilling to stop using drugs are advised to avoid sharing drug equipment with others.Caregivers in the home are taught how to administer medications, including IV preparations. The medication regimens used for patients with HIV infection and AIDS are often complex and expensive. QUESTION Fluid Resuscitation Formula Answer: 2 mL LR × patient's weight in kilograms × %TBSA second-, third-, and fourth-degree burns Timing is one of the most important considerations in calculating fluid needs in the first 24 hours post burn. The starting point is the time of injury—not the time of arrival to the treating facility (ABA, 2011). The infusion is regulated so that one-half of the total calculated volume is given in the first eight hours post-burn injury. The second half of the calculated volume is given over the next 16 hours. QUESTION Burn Graft Care QUESTION Incidence of Burns Answer: A burn injury can affect people of all ages and socioeconomic groups. An estimated 486,000 people are treated for burns and approximately 40,000 are hospitalized annually. Of those admitted to burn centers, men have more than twice the incidence of burn injury than women; for both men and women, the most frequent age group for burns is between 20 and 30 years. Burn centers in the United States reported the race and ethnicity of patients treated is as follows: 59% Caucasian, 20% African American QUESTION Nursing Mangement of Electrical Burns Answer: If the burn source is electrical, the electrical source must be disconnected safely before moving the patient. If the patient has an electrical burn, a baseline electrocardiogram is also obtained and continuous cardiac monitoring is initiated. Because burns are contaminated wounds, tetanus prophylaxis is given if the patient's immunization status is not current or is unknown. Red- colored urine suggests the presence of hemochromogens from damage to red blood cells and myoglobin resulting from muscle damage. These are associated with deep burns caused by electrical injury or prolonged contact with heat or flame. Glycosuria, a common finding in the early post-burn hours, results from the release of liver glycogen stores in response to stress. QUESTION HIV Transmission Answer: Inflammation and breaks in the skin or mucosa result in the increased probability that HIV exposure will lead to infection. Human immune deficiency virus type 1 (HIV-1) is transmitted in body fluids (blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk) that contain infected cells. Higher amounts of HIV and infected cells in the body fluid are associated with the probability that the exposure will result in infection. Mother-to-child transmission of HIV-1 may occur in utero, at the time of delivery, or through breastfeeding, but most perinatal infections are thought to occur after exposure during delivery. HIV is not transmitted through casual contact. Blood and blood products can transmit HIV to recipients. However, the risk associated with transfusions has been virtually eliminated as a result of voluntary self-deferral, completion of a detailed health history, extensive testing, heat treatment of clotting factor concentrates, and more effective virus inactivation methods. Donated blood is tested for antibodies to HIV-1, human immunodeficiency virus type 2 ([retrovirus identified in 1986 in patients with AIDS in Western Africa]), and the p24 antigen; since 1999, additional testing has been performed. QUESTION Risk Factors with HIV Answer: Sharing infected injection drug use equipment Having sexual relations with infected individuals (both male and female) Infants born to mothers with HIV infection and/or who are breastfed by HIV-infected mothers People who received organ transplants, HIV-infected blood, or blood products (especially between 1978 and 1985) QUESTION Prevention HIV Overview Answer: Prevention of HIV infection is achieved through: (a) behavioral interventions that have been effective in reducing the risk of acquiring or transmitting HIV by ensuring that people have the information, motivation, and skills necessary to reduce their risk; (b) HIV testing, because most people change behaviors to protect their partners if they know they are infected with HIV; and (c) linkage to treatment and care, which enables individuals with HIV to live longer, healthier lives and reduce their risk of transmitting HIV. Other than abstinence, consistent and correct use of condoms (see Chart 36-4) is the only effective method to decrease the risk of sexual transmission of HIV infection. When latex male condoms are used consistently and correctly during vaginal or anal intercourse, they are highly effective in preventing the sexual transmission of HIV. The polyurethane female condom, which is an effective contraceptive, provides a physical barrier that prevents exposure to genital secretions containing HIV, such as semen and vaginal fluid, and is inserted by the woman. QUESTION Protecting Against HIV Infection All patients should be advised to: Answer: Abstain from exchanging sexual fluids (semen and vaginal fluid). Reduce the number of sexual partners to one. Always use latex condoms. If the patient is allergic to latex, nonlatex condoms should be used; however, they will not protect against HIV infection. Not reuse condoms. Avoid using cervical caps or diaphragms without using a condom as well. Always use dental dams for oral-genital or anal stimulation. Avoid anal intercourse, because this practice may injure tissues; if not possible, use lubricant— there are water and silicone-based products designed for anal sex. Avoid manual-anal intercourse ("fisting"). Avoid sharing needles, razors, toothbrushes, sex toys, or blood-contaminated articles. Consider PrEP if regularly engage in high-risk behaviors. QUESTION Patients who are HIV seropositive should also be advised to: Answer: Take ART regularly to achieve viral suppression. Inform previous, present, and prospective sexual and drug-using partners of their HIV-positive status. If the patient is concerned for their safety, advise the patient that many states have established mechanisms through the public health department in which professionals are available to notify exposed contacts. Avoid having unprotected sex with another HIV-seropositive person. Cross-infection with that person's HIV can increase the severity of infection. Not donate blood, plasma, body organs, or sperm. QUESTION Standard precautions for reducing risk of HIV tranmission to healthcare workers Answer: Recommendations for Standard Precautions Hand hygiene: Use after touching blood, body fluids, secretions, excretions, or contaminated items; immediately after removing gloves; and between patient contacts. Personal protective equipment:Gloves: Use for touching blood, body fluids, secretions, excretions, and contaminated items, and for touching mucous membranes and nonintact skin.Gown: Use during procedures and patient care activities when contact of clothing/exposed skin with blood or body fluids, secretions, and excretions is anticipated.Mask, eye protection (goggles), face shield1: Use during procedures and patient care activities likely to generate Answer: <1 year: >1,500 cells >34% 1-5 years: >1,000 cells >30% >6 years: >500 cells >26% QUESTION Stage 2 HIV Answer: <1 year: 750-1,499 cells 36-33% 1-5 years: 500-999 cells 22-29% >6 years: 200-499 cells 14-25% QUESTION Stage 3 HIV Answer: <1 year: <750 cells <26% 1-5 years: <500 <22% >6 years: <200 cells <14% QUESTION HIV Treatment ART: Lab tests and achieving viral suppression Answer: Achieving viral suppression requires the use of ART with at least two, and preferably three, active drugs from two or more drug classes and should occur within the first 12 to 24 weeks of therapy especially if the patient is new to ART. Laboratory tests evaluate whether ART is effective for a specific patient. An adequate CD4+ response for most patients on ART is an increase in CD4+ count in the range of 50 to 150 mm3 per year, generally with an accelerated response in the first three months QUESTION Types of ART Meds Answer: These six classes include the nucleoside/nucleotide reverse transcriptase inhibitors (step 3), non- nucleoside reverse transcriptase inhibitors (step 3), protease inhibitors (step 6), a fusion inhibitor (step 1), a CCR5 antagonist (step 1), and integrase strand transfer inhibitors (step 4). In addition, two drugs (cobicistat and ritonavir) are used to improve the pharmacokinetic profiles of some of the other ART drugs. Nucleoside Reverse Transcriptase: The NRTIs are structurally similar to DNA components (adenosine, cytosine, guanosine, and thymidine) and thus easily enter human cells and viruses in human cells. For example, zidovudine (AZT, Retrovir), the prototype, is able to substitute for thymidine. They do not cure HIV infection or prevent transmission of the virus through sexual contact or blood contamination Protease Inhibitors: The PIs are antiretroviral drugs that exert their effects against HIV at a different phase of its life cycle than reverse transcriptase inhibitors. Fusion Protein Inhibitors: The drugs in this new class inhibit the HIV virus from binding to, fusing with, and entering the human cell. Enfuvirtide (Fuzeon) is the only drug in this class. This drug is for use only by patients who have previously been treated with antiretroviral agents. Antiretroviral therapy-naïve patients should not use it. QUESTION Adverse Effects of ART Therapy Answer: Adverse effects associated with all HIV treatment regimens include hepatotoxicity, nephrotoxicity, and osteopenia, along with increased risk of cardiovascular disease and myocardial infarction QUESTION First Degree Burn Answer: First-degree burns are superficial injuries that involve only the outermost layer of skin. These burns are erythematous, but the epidermis is intact; if rubbed, the burned tissue does not separate from the underlying dermis. This is known as a negative Nikolsky's sign. A typical first-degree burn is a sunburn or superficial scald. QUESTION Second Degree Burn Answer: Second-degree burns involve the entire epidermis and varying portions of the dermis. They are painful and are typically associated with blister formation. Healing time depends on the depth of dermal injury and typically ranges from 2 to 3 weeks. Hair follicles and skin appendages remain intact. QUESTION Third Degree Burn Edema forms rapidly after a burn injury. A superficial burn will cause edema to form within 4 hours, whereas a deeper burn will continue to form edema up to 18 hours post-injury. This is caused by increased perfusion to the injured area in the presence of increased capillary permeability and reflects the amount of microvascular and lymphatic damage to the tissue. In burns greater than 30% TBSA, inflammatory mediators stimulate local and systemic reactions resulting in extensive shift of intravascular fluid, electrolytes, and proteins into the surrounding interstitium. Treatments for edema may include elevation of the extremity or, in severe cases, removal of eschar (i.e., devitalized tissue) via escharotomy (i.e., surgical incision through eschar), or decompression of edema formation via fasciotomy (i.e., surgical incision through fascia to relieve constricted muscle) to restore tissue perfusion. Reabsorption of edema begins at about four hours post-injury and is complete by four days post-burn injury. However, the rate of reabsorption depends on the depth of injury to the tissue. Although adequate fluid resuscitation is paramount to maintaining tissue perfusion, excessive fluid administration increases edema formation in both burned and unburned tissue causing ischemia and necrosis. Immediately after burn injury, hyperkalemia (excessive potassium) may result from massive cell destruction. Hypokalemia (potassium depletion) may occur later with fluid shifts and inadequate potassium replacement. Serum sodium levels vary in response to fluid resuscitation. Hyponatremia (serum sodium depletion) may be present as a result of plasma loss or may also occur during the first week of the acute phase, as water shifts from the interstitial space and returns to the vascular space. QUESTION Emergent/Resuscitative Phase of Burn Answer: Emergent/Resuscitative Phase: from onset of injury to completion of fluid resuscitation. Primary Survey. Prevention of shock and respiratory distress, detection/treatment of concomitant injuries and wound assessment The first step in management is to remove the patient from the source of injury and stop the burning process while preventing injury to the rescuer. Rescue workers' priorities include establishing an airway, supplying oxygen (100% oxygen if carbon monoxide poisoning is suspected), inserting at least one large-bore IV line, and covering the wound with a clean, dry cloth or gauze. Continuous irrigation of chemical injury must begin immediately. An immediate primary survey of the patient is carried out to assess the ABCDEs: airway (A) with consideration given to protecting the cervical spine, gas exchange or breathing (B), circulatory and cardiac status (C), disability (D) including neurologic deficit, and expose and examine (E) while maintaining a warm environment QUESTION Fluid Resuscitation Burns Answer: Once urgent respiratory needs are appropriately addressed, fluid resuscitation is initiated in burns greater than 20% TBSA to maintain adequate organ perfusion. In order to facilitate fluid administration, peripheral IV access may be initially obtained; however, in larger burns, central venous access is recommended due to the large volume required. TBSA is calculated and fluid resuscitation with lactated Ringers (LR) should be initiated using ABA fluid resuscitation formulas. LR is the crystalloid of choice because its pH and osmolality most closely resemble human plasma