NUR 170 Exam 3 (Latest 2024 / 2025 Update): Concepts of Medical-Surgical Nursing, Exams of Nursing

Download NUR 170 Exam 3 (Latest 2024 / 2025 Update): Concepts of Medical-Surgical Nursing and more Exams Nursing in PDF only on Docsity! NUR 170 Exam 3 (Latest 2024 / 2025 Update): Concepts of Medical-Surgical Nursing | Questions and Verified Answers 100% Correct | Grade A - Galen NUR 170 Concepts of Medical-Surgical Nursing Exam 3 Question: Do ACE inhibitors decrease preload, afterload, or both? Answer: Both Question: What lab values should be periodically monitored in a patient taking an ACE1 or ARB? Answer: Renal function needs to be monitored because in some patients these meds can induce renal failure. They also need potassium levels monitored because hyperkalemia can occur Question: What is Buerger's Disease? Answer: Claudication in feet and lower extremities worse at night; increase sensitivity to cold; ulcerations and gangrene on digits; cause unknown but associated with male smokers. Leads to ischemia which leads to autoamputation Question: Treatment of Buerger Disease Answer: Cessation of smoking Question: S/S of Peripheral Arterial Disease (PAD) Answer: numbness, non-healing ulcers, diminished/absent peripheral pulses, delayed cap refill, cool and pale extremities, less hair growth on affected extremity. Question: Stage 1 of peripheral arterial disease Answer: Asymptomatic Can also cause sx of low output (confusion, AMS, cool/pale extremities) Question: A client in your care is admitted with acute decompensated HF. The physician orders 2mg of bumetanide bid for diuresis. Shortly after receiving her second dose, she begins to manifest the following rhythm on the monitor Answer: Bumetanide is a loop diuretic. The rhythm on the monitor shows PVC (premature ventricular contraction). This is most likely caused by hypokalemia or hypomagnesemia. SUCTION: skeletal muscle weakness, U wave, Constipation and Cramping, Toxicity (Dig), Irregular heartbeat, Orthostatic hypotension, Numbness and tingling. STARVED: Seizures, Tetany, Anorexia/Arrhythmias, Rapid HR, Vomiting, Emotional lability, DTR's increased. Question: You are discharging a client home after treatment for a hypertensive crisis. What teaching should you include with respect to diet and lifestyle changes? Answer: DASH diet: Fresh fruits and veggies, low-fat dairy, eliminate caffeine and alcohol. Sodium should be <2.4 for a regular DASH diet or <1.5g for a sodium DASH diet. Stress management, exercise. Question: What is osteoporosis Answer: bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D. Question: What is Osteomalacia? Answer: a rare condition of the adult bone associated with vitamin D deficiency, resulting in decalcification and softening of bone. Food that provide vitamin D? Answer: Egg yolk, fatty fish, tofu, fortified milk/cereal, mushrooms, beef liver Question: What is the indication for the medication alendronate? Answer: osteoporosis; works by reducing osteoclast activity Question: What are the risks if alendronate is not taken according to instructions? Answer: Should be taken on an empty stomach with a full glass of water and the pt. needs to remain upright for 30 minutes to 1 hour after. If not, esophageal injury can occur Question: Heberden's nodes Answer: Swelling of distal interphalangeal finger joints, characteristic of osteoarthritis Common in twisting injury; in children suspect child abuse Question: Etiology of gout Answer: Uric acid is built up in the joint, causing inflammation. Question: Where does gout "attack"? Answer: Great toe (podagra), wrists, ankles, knees, finger joints What is phantom limb pain? Answer: Neuropathic pain: A pain originating in the amputated limb, common after amputations. Question: Pharmacological treatment for phantom limb pain Answer: TCA's, anticonvulsants, propranolol Question: What types of fractures place a patient at risk for a fat embolism? Answer: Long bone, pelvic, and hip fractures Question: What are the common systemic manifestations of fat emboli? Answer: Respiratory changes, neurologic changes, petechiae rash Treatment for fat embolism syndrome is Answer: O2 and fluids Question: You are rendering discharge education to a client who recently had surgery for carpal tunnel syndrome. What symptoms should the client be instructed to report to their healthcare provider immediately? Answer: Increasing pain, numbness, tingling, cyanosis Question: Which of the following are potential adverse reactions of alendronate (Fosamax) select all that apply. A.Difficulty swallowing B.drowsiness C.esophagitis D.constipation E. esophageal ulcer Answer: A<C<E A 40-year-old patient is admitted for acute osteomyelitis for the left lower leg. What does the nurse expect to find documented in the patient's admitting assessment? A.Temperature greater than 101 swelling, tenderness, erythema, and warmth of the area B.ulceration resulting with sinus tract formation localized pain and drainage C.pain is aching, poorly described, deep, and worsened by pressure and weight-bearing D.shortening of the extremity with pain during weight-bearing or deep palpitations Answer: A Question: If you were patient with osteoporosis comes to the ED after falling suddenly while opening her car door. She said she felt as though her leg gave way and caused her to fall. What type of fracture does this patient likely have? A.Pathologic B.spiral C. impacted D. Incomplete Answer: A A patient is a middle-age man with a history of uncontrolled diabetes. His right foot is a dark brownish purple color and there are no palpable dorsalis pedis or posterior tibial pulse. The nurse prepares the patient for which diagnostic test? A.This position will help your lungs expand better B. lying on your stomach will help prevent contractures C.many times this will help decrease pain in the limb D.this position will take pressure off your backside Answer: B The client one day postop total hip replacement complains of hearing a popping sound when turning. Which assessment finding should the nurse report immediately to the surgeon? A. Dark red purple discoloration B.equal length of lower extremities C.groin pain in the affected leg D.edema the incision site Answer: C Question: The clinic nurse assesses a client with complaints of pain and numbness in the left hands and fingers. Which question should the nurse asked the client? A.Do you smoke or use any type of tobacco products B.do you have to wear gloves when you are out in the cold C.do you do repetitive movements with your left fingers D. do you have tremors or involuntary movements of your hands Answer: C The client sustained a fracture femur in a MVA. Which data require immediate intervention by the nurse? Select all that apply A. the client request pain medication to sleep B. the client has a hemoglobin level of 13.1 g/dL C. the client has petechiae over the neck and chest D.the client has an arterial oxygen level of 60 Answer: C<D Question: The client with a long arm cast is complaining of unrelenting severe pain and feeling as if the fingers are asleep. Which complication should the nurse suspect the client is experiencing? A.Fat embolism B.compartment syndrome C.pressure ulcer under the cast D.surgical incision infection Answer: B The nurse is conducting health screening for osteoporosis. Which client is at greater risk of developing this problem? A. A 25-year- old woman who runs B.a 36-year-old man who has asthma C.A 70-year-old man who consumes an excess alcohol D. a sedentary 65 year old woman who smoke cigarettes Answer: D Question: The nurse is caring for a client with a long bone fracture at risk for fat embolism. The nurse specifically monitors for the earliest signs of this complication by performing an assessment of which item? A The clients mobility status B.the renal and endocrine systems C.the cardiovascular and renal systems D. the neurological and respiratory systems Answer: D The nurse has a prescription to place a client with a herniated lumbar intervertebral disc on bed rest in Williams position to minimize the pain. The nurse should put the bed in what position? A.Flat with the knees raised B. in high Fowlers position with the foot of the bed flat C. In semi Fowlers position with the foot of the bed flat D. In semi Fowlers position with the knee slightly flexed Answer: D Usual onset of age for Type 1 DM? Answer: Children and people under the age of 30 Risk factors for Type 2 DM Answer: Obesity, poor diet, smoking, sedentary lifestyle, cardiovascular diseases, elevated triglycerides, low HDL, HTN, gestational diabetes, birthing a baby weighing 9 pounds or more, elevated fasting glucose, racial minorities (Native Americans, African Americans, Hispanics, Pacific Islanders Question: Please explain the steps for preparing a mixed dose of insulin. Which insulin is cloudy, and which is clear? Which insulin must be "rolled" before use to ensure the suspension is mixed? Answer: Air into cloudy (NPH), Air into clear (regular), Draw up clear, Draw up cloudy. NPH needs to be rolled but not shaken Question: Discuss some of the recommendations and precautions regarding physical activity and exercise in individuals with diabetes. Answer: Exercise can cause hypoglycemia. Adjustments: carry a rescue carb, prior to exercise carry and use a complex carb snack. Don't exercise during peak hours or w/in 1 hour of insulin injection. Check glucose beforehand and often on days when you exercise. If the client is doing unplanned exercise, they need to consume more carbs, if it is planned exercise, they need less insulin. Question: Adverse effects of the following antidiabetic drug Metformin Answer: Diarrhea. It is known to not cause hypoglycemia. Cannot be given to anyone with renal impairment. Question: Adverse effects of the following antidiabetic drug Glipizide Answer: is a Sulfonylureas. Known to cause weight gain and hypoglycemia. Question: Adverse effects of the following antidiabetic drug Rosiglitazone Answer: is a TZD. Contraindicated in people with HF, monitor liver with frequent liver function tests. Adverse effects of the following antidiabetic drug Exenatide Answer: Monitor for signs of pancreatitis (epigastric pain radiating to the back, N/V) Question: What are the s/s of hypoglycemia? Answer: Diaphoresis, tachycardia, tremors, anxiety, irritability, blurred vision, AMS, slurred speech, numbness/tingling, hunger. The "rule of 15's" for hyperglycemia management (15-15 rule) Answer: 15 grams of rapid-acting carbs and recheck in 15 minutes (juice, soda, honey, life savers). (Cold and clammy give some candy) Question: Under what circumstances should the nurse administer glucagon to treat hypoglycemia? Answer: Glucagon should be given if a patient has severe hypoglycemia. Question: Hemoglobin A1C gives the healthcare provider an indication of glycemic control over the past ___________? Answer: 3 months Question: An A1C of less than ______ indicates your diabetic patient has achieved good glycemic control. Answer: 7% How often should people with diabetes have their A1C tested? Answer: Twice a year Question: A patient in your care receives 10 units of regular insulin at 1130am. When would you expect it to peak? What is the significance of an insulin peak? Answer: It will peak within 2-4 hours; because the peak is when the pt. is at risk for hypoglycemia. Question: NPH peak time Answer: 4-12 hrs Question: Rapid acting peak time Answer: (Lispro)1 hour Long acting peak time Answer: (Lantus)no peak Question: What effect does illness have on blood glucose? Answer: Illness raises BG. Question: What additional steps should the diabetic patient follow when they are sick? Answer: Check glucose every 4 hours at least, and stay hydrated (8-12 oz. every hour they are awake). Client needs to notify the provider if the client cannot tolerate any PO fluids or foods. They need consistent carbs Question: Short acting peak time Answer: (Regular) 2-4 hours What is the proper sequence for rhythm interpretation? Answer: Determine the HR, Determine the heart rhythm, Analyze the P waves, Measure the PR interval, Measure the QRS duration, Examine the ST segment, Assess the T wave, Measure the QT interval Question: Cardioversion Preparation Answer: Hold anticoagulants 4-6 weeks before and after, conscious sedation. Attached to cardiac monitor and pulse oximetry Ventricular Asystole Treatment Answer: CPR x3min & 1mg epi Q3-5 min Question: CHF pharmacological treatment Answer: -Loop diuretics: Furosemide, Bumetanide. *Always check BP first and watch K+ and Mg levels. -ACEI and ARB -Digoxin: if ACE-I, ARB, or BB aren't working. -Spironolactone: if Loops, ACEI, ARB, or BB aren't working. -NO NSAIDS! Question: Pulmonary (flash) edema treatment Answer: loop diuretics, nitrates, and morphine Hypertension pharmacology treatment Answer: Hydrochlorothiazide (Diuril) ACE-I: Enalapril (Vasotec), Fosinopril (Monopril), Lisinopril (Zestril) ARBs: Valsartan (Diovan), Irbesartan (Avapro), Losartan (Cozaar) CCB: Amlodipine (Norvasc) Central alpha agonist: Clonidine (Catapres) PRN Question: Hypertensive crisis pharmacological treatment Answer: IV Nicardipine, IV nitro, or a BB. Augmentation with IV labetalol Question: Peripheal Arterial Disease (PAD) pharmacological treatment Answer: anti-platelets, PDE inhibitors to dilate the vessels (Cilostazol) DVT/PE pharmacological treatment Answer: anticoagulation (heparin/warfarin), IVC filter if anticoagulation is contraindicated Question: Rheumatoid Arthritis pharmacological treatment Answer: Methotrexate or Biologics: ends in "mab" and "cept", Infliximab, Etanercept, Adalimumab) Question: Post Hip Replacement care Answer: Anticoagulation (warfarin) and will go home with patient for 30 days. Pain management use opioids but never meperidine Question: Treatment of gout Answer: bed rest, analgesics, anti-inflammatory drugs, low-purine diet (meat, fish, chicken, mushrooms, peas, asparagus, etc.), hydration Osteomyelitis treatment Answer: IV antibiotics for a minimum of 6 weeks via PICC line Question: Pharmacological treatment for back pain Answer: NSAIDs, tramadol Question: Acute Compartment Syndrome (ACS) treatment Answer: