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Med Surg Exam 4 Flashcards | StudBud
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Med Surg Exam 4
Med Surg Exam 4
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1
What info is important to discuss w/ a pt who has a hx of atherosclerotic heart disease before he uses OTC decongestant
Headache and dysrhythmias
Vasoconstriction and increased arterial pressure
Bradycardia and diarrhea
Urinary frequency and diuresis
2
RN is assisting the PCP to care for a pt who has developed a spontaneous pneumothorax. Which action should be done FIRST
Assess the clients pain
Administer lorazepam
Prepare for chest tube insertion
Obtain a large bore IV needle for decompression
3
What statement indicates that a pt understands new prescription for prednisone for asthma?
I will monitor weight loss while on this med
I will expect to have black tarry stools
I will decrease fluid intake while taking this medication
I will take my medication with meals
4
A pt just had a CT/ drainage system placed. The RN observed that it was accidentally removed. What is the first action?
Obtain a chest x-ray
Apply sterile gauze to the insertion site
Place tape around the insertion site
Assess respiratory status
5
RN is caring for pt on mechanical ventilation & on pressure support ventilation (PSV) mode. What indicates understanding
It keeps the alveoli open and prevents atelectasis
It delivers a preset ventilators rate&tidal volume to the pt
It guarantees minimal minute ventilator
It’s allows preset pressure delivered during spontaneous ventilation
6
What is the purpose of administering vecuronium to a pt who has acute respiratory distress syndrome (ARDS)?
This medication is given to decrease inflammation
This medication is given to treat infection
This medication is given to facilitate ventilation
This medication is given to reduce anxiety
7
What are expected findings when assessing a chest tube and drainage system?
Continuous bubbling in the water seal chamber
Exposed sutures without dressing
Rise&fall in level of H2O in the H2O seal chamber w inspiration/expiration
Gentle constant bubbling in the suction control chamber
8
A RN is preparing to care for a pt following chest tube placement. Which items should be available in the room?
Enclosed hemostat clamps
Occlusive dressing
Sterile water
Oxygen
9
RN is assessing a pt who has a history of asthma. Which factors should the RN identify as a risk for asthma?
Alcohol use
History of diabetes
Sex
Environmental allergies
10
RN is reviewing rx for pt who has acute Dyspnea/diaphoresis. VS: HR 117,RR 38,temp 101.2, BP 100/54. What is priority?
Administer heparin via IV infusion
Notify the provider
Administer oxygen therapy
Obtain a CT scan
11
Prioritize nursing intervention for pt with pneumonia. Temp: 100/ RR: 30/ BP: 130/76 - HR: 100 / SaO2: 91% on RA
2. Perform a sputum culture
1. Administer oxygen therapy
3. Administer antibiotics
4. Instruct the pt the obtain a yearly influenza vaccine
12
RN is teaching a group about influenza. Which statement indicates an understanding of the teaching?
I should wash my hands after blowing my nose to prevent spreading the virus
I should cover my mouth with my hand when I sneeze
I need to avoid drinking fluids if I develop symptoms
I need a flu shot every two years because of different flu strains
13
RN is assessing a pt following a gunshot wound to chest. Which findings should RN monitor to detect a pneumothorax?
Decreased use of accessory muscles
Pleuritic pain
Tachypnea
Devotion of the trachea
14
RN is assessing a pt who has a pulmonary embolism. Which manifestations should the RN expect?
Tachycardia
Bradypnea
Pleural friction rub
Petechiae
15
RN is administering new rx for isoniazid (INH) to a light skinned pt who has TB. Which adverse reaction is expected?
Loss of appetite
Pain in joints
Yellowing of the skin
Tingling of hands
16
RN is providing info about TB to a group of pts at a local community center. Which manifestations should be included?
Purulent sputum
Night sweats
Persistent cough
Fatigue
17
RN is caring for a group of pts. Which pts are at risk for a pulmonary embolism?
A client who has chronic atrial fibrillation
A female client who is postmenopausal
A client who has a BMI of 30
A client who has a fractured femur
18
What class of meds should be given to a pt w an SaO2 of 91%, audible wheezes, & use of accessory muscles when breathing
Antiviral
Beta blocker
Antibiotic
Beta-2 agonist
19
Which actions should RN include when planning care for a pt who has severe acute respiratory distress syndrome (SARS)?
Administer antibiotics
Maintain ventilatory support
Provide supplemental oxygen
Administer of bronchodilators
20
What are EARLY manifestations of hypoxemia in a pt experiencing respiratory distress?
Bradycardia
Confusion
Elevated blood pressure
Pale skin
21
For a client with COPD what is the main risk factor for pulmonary infection?
Decreased fluid intake and loss of body weight
Fluid imbalance with pitting edema
Decreased anterior -posterior diameter of the chest
Pooling of respiratory secretions
22
A pt being D/C with COPD, is concerned about not being able to leave the house due to continuous O2. What should RN say
There are portable O2 systems that you can take with you
You probably will not be able to out as much as you used to
When you go out, you can remove the O2, then reapply when you get home
Home health services will come to you so you won’t need to go out
23
Pts w COPD receive low-dose O2 via cannula. The RN understands that which problem may occur if the pt gets too much O2
Increased snoring
Hyperventilation
Tachypnea
Hypoventilation or apnea
24
RN is reviewing D/C instructions for a or who has COPD & experienced a pneumothorax. Which statement should RN include?
You need to wear a mask when in crowded areas
Notify your provider if you experience a productive cough
Notify your provider if you experience weakness
You should be able to return to work in 1 week
25
Pt w/ a new dx of tuberculosis and is on a multimed regimen. Which instruction should RN give for ethambutol?
Watch for a change in the sclera of your eyes
Your urine can turn dark orange
Watch for any changes in vision
Take vitamin B6 daily
26
What nursing observation indicates that an unplanned extubation of an endotracheal tube has occurred?
The high-pressure ventilator alarm activates
Increased crackles(rales) over left lung field
Increased swallowing efforts by client
Client is able to speak
27
What is the primary cause of wheezing in a patient with asthma?
Movement of air through narrowed airways
Dilation of the respiratory bronchioles and increased mucus
Increased pulmonary compliance
Increased inspiratory pressure in the upper airways
28
Continuous positive airway pressure (CPAP) is used for patients that are able to breathe spontaneously
False
True
29
A pt has Dyspnea and will revive O2 continuously. What O2 devices should the RN use to deliver a precise amt of O2 to pt
Nasal cannula
Non-rebreather mask
Venturi mask
Simple facemask
30
RN is monitoring a group of pts for increased risk of getting pneumonia. What pts are expected to be at risk?
Client who has dysphasia
Client who has AIDS
Pt who has a closed head injury & is receiving mechanical ventilation
Client who has myasthenia gravis
31
A RN is caring for a pt having an acute asthma attack. He is dyspneic/ has Orthopnea, HR: 120. List the order of actions
3 - provide nebulous treatment with bronchodilator
1 - administer humidified oxygen
2 - place in semi-coolers position
4 - discuss factors that precipitate attack
32
Which assessments indicate that the respiratory status is declining in a patient experiencing an acute asthma attack?
Retraction of sternal muscles
Wheezing
Pink mucous membranes
Tachycardia
33
A nurse is teaching a client who has tuberculosis, which of the following statements should the nurse include?
You will need to provide sputum samples Q4 weeks
To monitor the effectiveness of the medication
34
RN is caring for pt who has new rx for heparin. Which statement by pt should indicate an immediate concern for the RN?
I had a blood clot in my leg several years ago
It hurts to take a deep breath
I am allergic to morphine
I take anti-acid several times a day for my ulcer
35
Plan of care for it on mechanical ventilation. What ventilator modes will increase the pts work of breathing?
Pressure support ventilation
Independent lung ventilation
Continuous positive airway pressure
Synchronized intermittent mandatory ventilation
36
A RN is assessing a pt following a bronchoscopy. Which of the following findings should the RN report to the provider?
Dry, nonproductive cough
Sore throat
Bronchospasms
Blood tinged sputum
37
What info confirms that an endotracheal tube has migrated too far into the trachea?
Increased rhonchi are present at the lung bases bilaterally
Ventilator pressure alarm continues to sound
Client is able to speak and coughs excessively
Decreased breath sounds are heard over the left side of the chest
38
RN is preparing to administer an initial dose of prednisone for a pt w COPD. The RN should monitor for which adverse SE?
Fluid retention
Tachycardia
Black tarry stools
Hypokalemia
39
A pt was in a MVA, breath sounds in LLL w/ dyspnea. BP 118/68,HR 124, R 38, T 101.4, O2 92%. What is the FIRST action?
Obtain a chest x-ray
Administer oxygen via a high flow mask
Initiate IV access
Prepare for chest tube insertion
40
RN is caring for pt who is to receive thrombolytic therapy. Which factors should RN recognize as a contraindication?
Hip arthroplasty, two weeks ago
Elevated platelet count
Incident of exercise-induced asthma one week ago
Elevated sedimentation rate
41
Intermittent suction is applied during withdraw when suctioning an endotracheal tube
False
True
42
RN is assessing a pt with sinusitis. Which technique should the RN use to identify manifestation of this disorder?
Auscultation of the trachea
Palpation of the orbital areas
Inspection of the conjunctiva
Percussion of posterior lobes of lungs
43
What observations would indicate an improvement in the clients condition during an acute asthma attack?
Productive cough with rapid breathing
Pulse rate of 110 bpm
Respiratory rate of 18 breaths per minute
Pulse ox of 88%
44
Which information should the nurse include for a patient scheduled for pulmonary function tests (PFTs)?
Do not smoke tobacco for 6 to 8 hours prior to the test
You will be asked to bear down and hold your breath during the test
The arterial blood flow to your hand will be evaluated as part of the test
Do not use inhaler medication’s for six hours following the test
45
A wife of a pt with COPD is worried about caring for her husband at home. Which statement by RN provides valid info?
Your husband with be more SOB when he walks, but that will not hurt him
Help your husband arrange activities so that he does little walking
46
Which medication should be administered with vecuronium for a pt during mechanical ventilation?
Furosemide
Fentanyl
Dexamethasone
Midazolam
47
RN in ED is assessing a pt who has sustained multiple rib fractures & has a flail chest. Which findings are expected?
Dyspnea
Paradoxical chest movement
Cyanosis
Hypotension
48
RN is planning to instruct a pt on how to perform pursed-lip breathing. Which statements should be included by RN?
Take a deep breath in through your nose
Take quick breaths upon inhalation
Place your hand over your stomach
Pass your cheeks upon exhalation
49
What should be included in the plan of care w a pt following a chest tube and drainage system?
Strip the drainage tubing every four hours
Check for continuous bubbling in the section chamber
Encourage the client to cough and deep breathe
Obtain a chest x-ray
50
Which clients are at risk for developing acute respiratory distress syndrome (ARDS)?
A client following coronary artery bypass graft surgery
A client who experienced a near drowning incident
A client who has dysphasia
A client who experienced acute drug toxicity
51
A RN is caring for a pt following a thoracentesis. Which manifestation should be recognized as risks for complications?
Fever
Report of pain at the puncture site
Dyspnea
Hypotension
52
Pt is disoriented to person, place, time. Pt reports chills/chest pain worse on inspiration. Which action is PRIORITY?
Obtain a complete history from the client
Obtain a sputum culture
Provide a pneumococcal vaccine
Obtain baseline vital signs and oxygen saturation
53
What finding on the nursing assessment would be associated with a diagnosis of pneumonia in the older adult?
Hypertension
Acute confusion
Dry hacking cough at night
Hematemesis in the morning
54
A pt with COPD is newly prescribed Albuterol. Which statement indicates the pt understands discharge teaching?
This med can increase my blood sugar levels
This medication decrease my immune response
I can have an increase in my HR while taking this medication
I can have mouth sores while taking this medication
55
RN is reinforce teaching w a pt on the purpose of taking a bronchodilator. Which statement indicates an understanding?
I take this medication to prevent asthma attacks
This med has a slow onset to treat my symptoms
This med can decrease my immune response
I need to take this medication with food
56
Which statement indicates understanding of med regimen for isoniazid, rifampin, pyrazinamide, & etambutol for active TB?
I will wash my hands each time I cough
I am glad I don’t have to have any more sputum specimen’s
I can substitute one med for another if I run out bc all fight infection
I will wear a mask when I am in the public area
57
What position does a patient need to be in post-op after a tonsillectomy?
Semi Fowlers position with the head, turned to the side
On the abdomen with the head turned to the side
Prone position with the head of the bed slightly elevated
On the back with the head turned to the right side
58
What nursing observation indicates inadequate clearing of secretions following a RLL lobectomy?
Chest x-ray film showing right-sided pleural fluid
Increase in Paco2 from 35 to 45 mm Hg
A few scattered crackles on RLL on auscultation
Decrease in forced vital capacity
59
What symptoms would the RN expect to observe in a 19-month-old pt with a dx of laryngotracheobronchitis (LTB)
Expiratory wheezing
Hemoptysis
Paroxysmal coughing
Stridor on inspiration
60
RN is instructing a pt on the use of an incentive spirometer. Which statement by pt indicates an understanding?
I will place the adapter on my finger to read my blood O2 saturation level
I will take in a deep breath and hold it before exhaling
I will lay on my back with my knees bent
You will rest my hand over my abdomen to create resistance
61
What position does a pt need to be in during a thoracentesis during a bedside procedure?
Sitting with upper torso over bedside table
Semi Fowlers position with lower torso flat
Prone position with feet elevated
Lying on left side with right knee bent
62
RN is caring for pt who is getting mechanical ventilation via endotracheal tube. What action should the RN take?
Assess breath sounds every four hours
Document tube placement in cm at the angle of jaw
Apply a vest restraint if self extubation is attempted
Monitor ventilator settings every eight hours
63
A pt with COPD is to be discharged home while receiving continuous O2 at a rate of 2L/min via cannula. Education?
The use of oxygen will eliminate the clients shortness of breath
Because of his need for O2, the pt will have to limit activity at home
Use oxygen during activity to relieve the strain on the clients heart
Precautions are necessary bc O2 can spontaneously ignite and explode
64
Which action should the RN take when assisting a provider with the removal of a chest tube?
Place occlusive dressing over site once the tube is removed
Instruct the client to lie prone with arms by sides
Complete a surgical checklist on the client
Remind the pt that there is minimal discomfort during the removal process
65
A RN is caring for a pt scheduled for a thoracentesis. Which of the following supplies should be in the room?
Incentive spirometer
Pulse oximeter
Oxygen equipment
Sterile dressing
66
The nurse understands clamping a chest tube may cause what problem?
Decrease in the rate and death of respirations
Bacterial infections in the pleural cavity
Tension pneumothorax
Atelectasis
67
When suctioning an endotracheal tube the cath is inserted into the endotracheal tube to a point of resistance
False
True
