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Med/Surg Review
Med/Surg Review
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Hematological Complications, Endocrine, & Respiratory
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Questions
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Answers
1
If the patient has an elevated temperature prior to administration of blood, the nurse should
Administer the blood anyway
Refrigerate the blood for 35 minutes and check temperature
Call the pharmacy
Call the physician
2
All of the following are important for the nurse to know when placing an endotracheal
except
:
Assessing the patient’s PaO2 levels.
Auscultate the patient’s epigastric area and breath sounds.
Reviewing the patient’s chest X-Ray.
Check the patient’s end tidal CO2 levels.
3
What route does the nurse use to administer the Mantoux test?
Subcutaneous
Oral
Intradermal
Intramuscular
4
Pt. has fractured ribs. What is an early indication that the patient is in Resp. Failure
kussmaul respirations and hypotension
cyanosis and increased capillary refill
frequent positioning and agitation
tachycardia and pursed lip breath
5
The nurse knows a patient with Acute Resp Failure will have all of the following
EXCEPT
:
Severe morning headache and capillary refill <2seconds
agitation and normal RR
Agitation and normal RR
Agitation and increased CO2
6
Failure of oxygenation occurs in all the following conditions EXCEPT
Alveolar hypoventilation
V/q mismatch
Tissue Hypoxia
Decreased Cardiac Output
7
This is a type of mechanical ventilation that helps prevent respiratory muscle weakness.
Positive End Expiratory Pressure (PEEP)
Positive Pressure Ventilation (PPV)
Assist/Control Ventilation (A/C)
Synchronized Intermittent Mandatory Ventilation (SIMV)
8
A primary goal in all shock states is to:
Ensure adequate cellular hydration
Prevent third spacing
Maintain adequate tissue perfusion
Support mechanical ventilation
9
Pt. has developed ARDS. Which intervention should the nurse initiate to prevent stress ulcers?
Maintain head of bed elevated at 30-45 degrees
Observe stools for bleeding and occult blood
Begin enteral feedings as soon as bowel sounds are present
Administer prescribed Ativan to reduce anxiety and stress
10
The nurse knows a patient with aplastic anemia will most likely have what labs
WBC- 3,000, Hgb- 20, Platelets 400,000
WBC- 2,500, Hgb-8, Platelets 120,000
WBC – 10,000, Hgb- 10, Platelets 130,000
WBC – 6,000, Hgb- 14, Platelets 150,000
11
Fresh frozen plasma is administered to replace:
Leukocytes
Clotting factors
Erythrocytes
Platelets
12
A nurse will know that this risk factor is not part of Virchow's triad for a pulm. embolus.
Altered coagulability
Venous Statsis
Hx of a stroke
Damage to a vessel wall
13
Which finding is expected while weaning the patient from mechanical ventilation?
Patient is becoming anxious
The patient is having premature ventricular contractions
Patient’s respiratory rate is 32
The patient’s propofol has been discontinued.
14
The nurse knows in order to
completely
resolve DIC, the nurse must:
Replace fluid volume
Administer blood products
Resolve the underlying problem
Administer Heparin
15
You notice absent breath sounds on a pt on 12 cm of peep... What is most likely the cause
pneumothorax
decreased cardiac ouput
obstructed endotracheal tube
oxygen toxicity
16
What category of meds should the nurse expect to give to a pt. in Acute Respiratory Failure?
antibiotics
Oxygen
benzodiazepines
corticosteroids
17
The patients neutrophil count is 850 cell/ml The nurse will perform all of the following
except
Putting in a foley catheter
Put the patient in strict isolation
Monitor the patient’s vital signs
Obtaining stat blood cultures
18
What strategies should the nurse use while caring for a pt with ARDS? SELECT ALL THAT APPLY
kinetic therapy
Prone positioning
Continuous lateral positioning
supine positioning
19
In early stages of sepsis the best understanding of nutritional needs is:
Early enteral feeding may lead to diarrhea
Total parenteral nutrition is preferred.
Enteral nutrition started in the first 24 -48 hours
The caloric needs are significantly lower
20
A nurse expects any of the following diagnostics ordered for a pt. with a pulm. embolus except:
D Dimer assay
Venrilation/perfusion scan
MRI
Pulmonary angiogram
21
The HIV patient knows the disease has become AIDS when which of the following becomes present
Positive Western Blot test
CD4 T cell count of 400cells/microliter
Detection of HIV antibodies and/or antigens in blood
Cryptococcal meningitis
22
The nurse knows a major difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma is
Non-Hodgkin’s lymphoma can manifest in multiple organs
Hodgkin’s lymphoma is considered potentially curable
Non-Hodgkins lymphoma is treated only with radiation therapy
Hodgkin’s lymphoma occurs only in young adults
23
When caring for an intubated patient, the nurse knows which finding requires immediate action
The endotracheal tubes reference line has shifted 8cm
The patients urine output for the last two hours is 60 mL.
The patient’s oxygen saturation is 90%.
The patient’s spouse is present at the bedside.
24
Which is not a symptom of active TB?
Tachycardia
Night Sweats
Afternoon temperature elevation
Cough
25
What potential risk could the patient with A/C have?
Hyperventilation
Decreased lung compliance
Risk for infection
Risk for developing a pulmonary embolism
26
The nurse interprets the following ABGs as what? PaO2(57), PaCO2(51), and pH(7.3).
Metabolic acidosis
Acute Respiratory Failure
Respiratory Acidosis
Acute Respiratory Distress Syndrome
27
What product secreted by the kidneys aids in the production of RBC & what is that hormones role
Bilirubin-destroys hemoglobin & block tubules of the kidneys
Bilirubin - stimulates the production of RBC
Erythropoietin - stimulates the production of RBC
Creatinine - secreted in the response of low RBC
28
To maintain adequate perfusion the nurse knows that the minimum (MAP) must be maintained above?
55mmHg
95mmHg
70mmHg
60 mmHg
29
The nurse caring for a patient with active TB will know to practice what type of isolation?
Contact
Airborne
Neutopenic
Universal
30
Which organ are we most concerned about with a diagnosis of Hemolytic anemia?
Kidneys
Heart
Liver
Spleen
31
All of the following will be found in the patient with multiple myeloma except:
Decreased serum creatinine
Hypercalcemia
Skeletal pain in the pelvis, spine, and ribs
Bence Jones protein in urine
32
In an emergency the physician indicates the pt needs intubation. What should the nurse do next?
Administer fentanyl and Nimbex
administer norcuron and Nimbex
administer atican and morphine
administer Nimbex and diprovan
33
Which dx finding would indicates that the pt has developed Acute Resp. Distress syndrome?
PaCO2 31 mmHg and pH 7.51
PaO2 of 42 mmHg on 80% FiO2
PaCO2 of 70 mmHg and pH 7.29
PaO2 of 64 mmHg on 24% FiO2
34
A nurse knows implementing these precautions will prevent ventilator acquired pneumonia except
Infection control with antibiotics
Frequent oral care
HOB 30-45 degrees
Continuous O2 monitoring
35
Platelets can be monitored by drawing a CBC. Which value would concern a nurse the most?
400,000
120,000
120,000
300,000
36
The following orders (hand hygiene,HOB 30-45, and suctioning trach) are used to prevent what:
Pneumonia
Peptic Ulcer Disease
Respiratory Failure
Pericarditis
37
The nurse can expect to see these in a patient's history as risk factors for lung cancer except
Coal dust & uranium
Asbestos
Chronic kidney failure
Smoking
38
PEEP ventilation is a type of ventilation that does the following
except
Decreases the need for FiO2 treatment
Prevents the patient from biting the endotracheal tube.
Keeps the airways open during expirations
Provide oxygenation and limit the risk of oxygen toxicity
39
A patient has a GSW & blood loss but the hgb/hct are WDL, what orders will the nurse expect
Redraw the labs to ensure accurate levels
Find the lunch menu so the patient has a well balanced diet
Prepare to give the patient blood products
Nothing, lab values should be continued to be monitored
40
Which of the following therapies may be incorporated for a patient with ITP?
Platelet transfusions, Corticosteroids, & Plasmapheresis
Plasmapheresis, IV immunoglobulin, & Argatroban
IV immunoglobulin, Direct thrombin inhibitor, & Splenectomy
Splenectomy, IV immunoglobulin, & Corticosteroids
41
The nurse assesses a patient with ARF due to asthma. The nurse observes these symptoms except
Initial hypertension
Rhonchi
Chest tightness
Wheezing
42
Which of the following is the diagnostic hallmark of chronic myelogenous leukemia
High hemoglobin, hematocrit, and RBC count
Philadelphia chromosome
Reid Sternberg cell
Bence Jones protein
43
Acute unilateral absent breath sounds, dec. chest movement, low O2 sat., dyspnea. Diagnosis?
Lung cancer
Tuberculosis
Pulmonary embolism
Pneumothorax
44
Which foods are appropriate for a patient with iron deficiency anemia?
Steak, potatoes, & spinach
Dried bananas, yogurt, & grapes
Leafy greens, whole grain spaghetti, & an apple
Eggs, yogurt, & toast
45
What is recognized as one of the main indications for a tracheotomy?
Patients who are experiencing intestinal obstruction.
Patients requiring long-term mechanical ventilation.
Patients requiring conventional (open) suctioning.
Patients suffering from chronic bleeding of unknown source.
46
What is the most common diagnostic testing performed for ARDS?
Arterial blood gas
Pulse Oximetry
Pulmonary function test
Chest X-ray
47
Which is not an intervention for acute respiratory failure secondary to COPD?
Beta agonists
Suction as needed
Ambulation
Ventilatory assistance
48
A nurse would expect to prepare a patient diagnosed with pleural effusion for which treatment?
Radiation therapy
Thoracentesis
Lobectomy
Chesy x-ray
49
A massive GI bleed led to hypovolemic shock. What is the priority nursing diagnosis?
Acute pain
Ineffective tissue perfusion
Decreased cardiac output
Impaired tissue integrity
50
Which of the following nursing interventions are critical for Acute Resp. Fail? SELECT ALL
maintain patent airway
Manage stress ulcers
obtain an arterial blood gas every 2 hours
optimize O2 delivery
51
Which signs and symptoms are most consistent with the anemic patient?
Decreased HR, decreased BP, & fatigue
Increase HR, decreased BP, pt reports always being tired
Pallor, decreased HR, Increased BP, decreased O2 saturation
Patient reports being restless, anxious, and having SOB
52
A nurse cares for a patient with a pleural effusion. An assessment reveals all of these except:
Decreased breath sounds
Chest pain
Dyspnea, & low O2 sat
one sided explansion
53
Which risk factors increase a pts chances of developing ARDS? SELECT ALL THAT APPLY
cancer
sepsis
pneumonia
aspiration
54
Which of these findings indicate that a possible unplanned extubation has occurred?
The tube is absent of secretions
Increased peak inspiratory pressure (PIP)
Temperature has decreased from 98.9 to 98.0
The patient asks the nurse what the time is
55
Pt is in tripod position, 75% O2 sat, states he can not breath. What is the highest nursing Dx?
give antisecretary agents as ordered
administer bronchodilators as ordered
administer antibiotics as ordered
give supplemental oxygen therapy as ordered
56
Which of the following is the correct interpretation of the following: ph: 7.26 CO2: 22 HCO3:10
Partially compensated metabolic acidosis.
Fully compensated respiratory acidosis.
Fully compensated metabolic acidosis.
Partially compensated respiratory acidosis.