Med Surg 1 Cumulative Final Study Guide

Question 1

What are client rights regarding prescribed medications?

Answer 1

• Clients have the right to know the name, action, and possible side effects of their medications.
• They also have the right to refuse medications, unless a court order is in place. (If clients are endangering themselves or others or are considered a “medical emergency,” medications may be given against their will.)
• Clients also have the right to request the generic form of prescribed medications, if available.
  
  • Generic forms of medications are often less expensive than their brand name counterparts.

Question 2

What are the effects of aging on the nervous system?

Answer 2

• Losses in the thought process, reasoning, or learning are not normal.
• Person feels less rested; wakefulness periods at night are common.
  
  • Older individuals may start using sleeping aids.
• Person exhibits decrease in voluntary movements.
• Persons may be startled more easily.
• Reflexes may be slowed.
• Decision making may be slower.
• Older adults are more susceptible to heatstroke or effects of cold.
• Skin may remain pink, even if client is cold (may not become pale or blue).
• Person may be disoriented as to time and date.
• Person may lack dexterity.
• Falls may occur.
• Assess for CVA, Alzheimer’s disease, and conditions related to atherosclerosis (“hardening of the arteries”).
• Encourage older clients to get shingles immunization.

Question 3

What tube carries urine from the renal pelvis of the kidney to the bladder?

Answer 3

• Two Ureters

Question 4

Intake of which nutrient affects the function of thyroid gland?

Answer 4

• The thyroid stores an iodine-based hormone precursor, colloidal iodinated thyroglobulin, which is stimulated by TSH to form thyroid hormones.
• Because the thyroid requires iodine to form T 4 , a person’s diet must supply iodine.
  
  • The epithelial cells of the thyroid synthesize two hormones: thyroxine (tetraiodothyronine or T4 ) and triiodothyronine ( T 3 ) from the iodine. T 4 is the less potent form of thyroid hormone.
  • More T 4 (90%) is found in the blood, compared with T 3 .
  • It is believed that T 4 is converted to T 3 before it is effective.
  • Thyroid hormones regulate body metabolism, controlling the rate at which cells function.
  • Protein synthesis relies on these hormones, and they also affect sensitivity to catecholamines (important in stress responses) and sympathetic amines (e.g., dopamine and epinephrine).

Question 5

How do you properly perform passive range of motion exercises?

Question 6

What are Oral, Topical, Enteral and Sublingual Routes of Medication Administration?

Answer 6

• Oral Administration:
  
  • The oral route of medication administration is used most frequently.
  • A PO medication can be in many forms, including tablets, capsules, caplets, sprinkles, or in liquid or gel form to be swallowed or sprayed on the tongue or applied to the mucous membranes of the mouth.
• Topical Administration
  
  • Drugs given by the topical route (the administration of medications to the skin or mucous membranes) can be applied externally or internally.
  • Topically applied drugs have a local or systemic effect.
  • Many are administered to achieve a direct effect on the tissue to which they are applied.
• Enteral Administration
  
  • Enteral administration means through the gastrointestinal (GI) system (most commonly, this is PO or via NG tube).
• Sublingual Administration:
  
  • Sublingual ( SL ) medications (e.g., nitroglycerin) are placed under the tongue, where they are dissolved and absorbed.
  • Clients should not chew or swallow SL medications.

Question 7

What is Peristalsis, Deglutition, Mastication, and Ingestion?

Answer 7

• Mastication
  
  • Their chief function is to break food into smaller particles, accomplished through mastication, chewing.
• Deglutition
  
  • Voluntary movement of the tongue begins the swallowing process ( deglutition ), by lifting and pushing the bolus of food, mixed with saliva, into the pharynx, the next portion of the digestive tube.
  • The upper surface of the tongue appears rough because of visible indentations ( fissures ) and projections ( papillae ).
  • The taste buds are microscopic nipple-like projections located on the sides of the papillae.
  • They are specialized nerve endings allowing detection of various flavors, such as salty, bitter, sweet, sour, alkaline, and metallic.
  • The ability to taste food also depends on the sense of smell.
• Peristalsis
  
  • The smooth (involuntary) muscles pass food through the entire GI tube by waves of contractions, peristalsis , an alternating muscular relaxation and contraction, without which digestion cannot occur.
• Ingestion
  
  • the process of taking food, drink, or another substance into the body by swallowing or absorbing it.

Question 8

What are nursing interventions for a client with a newly applied forearm cast?

Answer 8

• Follow the healthcare provider’s instructions regarding physical activity and limitations.
• Exercise the muscles.
  
  • Move the fingers or toes frequently to reduce swelling, prevent joint stiffness, and maintain muscle strength.
  • Do muscle-setting exercises (contracting and relaxing without movement) inside the cast to maintain muscle mass, tone, and strength.
• With a foot or leg cast, wear a cast walking shoe at all times, except when sleeping or showering.
• Elevate the cast extremity to prevent swelling.
• Avoid bumping the cast. Never stick anything inside the cast. It could result in itching, infection, or decreased circulation. (This consideration is especially important for children.)
• Never trim or cut back the cast. Keep a plaster cast dry.
• If a synthetic cast becomes wet, pat it dry with a towel and dry it with a hair dryer, using the low setting.
• When resting the cast on furniture, protect the furniture with a pad.
• Contact your healthcare provider if any of the following problems develop:
  
  • unrelenting itching;
  • foul odor from cast;
  • drainage present through or around cast;
  • pain unrelieved by medication;
  • cast that feels very tight or too loose;
  • cast that breaks,
  • cracks, or
  • becomes dented;
  • painful rubbing or pressure inside the cast, especially in one particular place;
  • limb that constantly feels cold;
  • fingers or toes that are numb or tingling;
  • fingers or toes that are white, blue, or the color of which does not return when pressed.

Question 9

What are the Perimetrium, Endometrium, Chorionic membrane and Myometrium?

Answer 9

• The uterus three layers: serous, muscular, and mucous.
• The serous (outer) layer, the perimetrium, is a fold of the peritoneum.
• The muscular layer, the myometrium, is the smooth muscle that increases in size during pregnancy and contracts during labor and delivery.
• The mucous layer, the endometrium, forms the maternal portion of the placenta during pregnancy.
• The chorion is a membrane that surrounds a developing fetus in conjunction with the amnion. The chorion plays a key role in the exchange of blood and gases between mother and fetus and develops into the fetal aspect of the placenta.
• The chorion also functions to eliminate fetal waste.

Question 10

What are the functions of liver, kidney and red bone marrow?

Answer 10

• Functions of Liver
  
  • Absorption of bilirubin from old and destroyed red blood cells
  • Detoxification of the blood
  • Storage of fat-soluble vitamins (A, D, E, K) and iron
  • Storage of B complex, minerals, fat, and glycogen
  • Formation of plasma proteins and vitamin A
  • Formation of triglycerides and cholesterol
  • Production of urea, clotting factors, and immunoglobulin
  • Secretion of bile and heparin
  • Production of body heat
  • Storage of glucose in the form of glycogen
• Functions of Kidneys
  
  • The major role of the kidneys is the filtration of water-soluble wastes out of the blood.
  • Other major functions of the kidneys include hormonal secretion of renin and erythropoietin and activation of vitamin D.
    
    • The kidneys can precisely regulate and adjust electrolyte levels.
• Function of Red Bone Marrow
  
  • The red bone marrow manufactures blood cells, or “formed elements,” of blood. (In the embryo, red blood cells [RBCs] are produced in the liver and spleen as well.)

Question 11

What is Systolic pressure and diastolic pressure?

Answer 11

• Systolic
  
  • In less than 1 second, both atria contract as both ventricles relax.
  • Immediately, both ventricles contract as both atria relax.
  • This process is considered one cardiac cycle or one heartbeat.
  • This sequence of dual contractions, the atria followed by the ventricles, is called systole .
  • Systole takes up one-third of the cardiac cycle.
• Diastolic
  
  • Atrial relaxation, followed by ventricular relaxation, is called diastole.
  • Diastole takes up two-thirds of the cardiac cycle, allowing time for the chambers to fill adequately with blood.
  • One cardiac cycle is made up of systole of the atria and ventricles and diastole of the atria and ventricles.
  • These contraction and relaxation processes occur almost simultaneously on the left and right sides of the heart.
• The contraction that pumps blood from the heart is systole; the period of heart relaxation is diastole.
• The heart is actually in systole twice, once for the atria (atrial systole) and once for the ventricles (ventricular systole).
• In addition, both atria and ventricles have periods of diastole. Systole diastole = one cardiac cycle.
• The autonomic nervous system can respond to changes, such as increased exercise, and speed up the cardiac cycle.

Question 12

What are preoperative nurse interventions?

Answer 12

• Explain all procedures and their underlying rationales to the client/ family as they are performed (In Practice.
• Check the client’s record and note preoperative orders.
• Verify the client has completed at-home preparation.
• Verify that the client has remained NPO (nothing by mouth) for the designated time, usually at least 8 hr.
• Ensure that the client has signed the surgical permit and it has been witnessed. (Nursing students should not witness legal papers of any type.)
• Determine if the client has an advance directive, such as a living will.
• If so, a copy of this document must be in the client’s record.
• Review the client’s medical record chart for indications of a special situation, such as the client who refuses to receive blood;
  
  • the client must sign a disclaimer to that effect, and this must be in the client’s record.
• Prepare the operative area, as ordered.
  
  • Usually, nursing staff members in the preoperative area are responsible only for supervising a shower with a prescribed antimicrobial scrub.
  • The actual surgical preparations and hair removal are usually done in the OR.
• If the client is having brain surgery, the head will probably be shaved.
  
  • Make sure the client and family are aware of this.
  • Ask them if they want the hair to be saved to make a wig.
  • Let the client know if the eyebrows will be shaved or the eyelashes cut.
• Check the client’s medical history for any essential respiratory, cardiac, blood pressure, or other drugs they take routinely.
  
  • Notify the surgeon of these medications.
  • The client may need to take these drugs on the morning of surgery, despite NPO status.
• See that all specimens and blood samples have been collected and sent to the laboratory.
• Verify that the history and preoperative physical examination are recorded in the client’s record.
• Verify that results of all testing are on the chart; this includes laboratory tests, ECG, and sometimes a chest x-ray.
• Give a sedative, if ordered. (Make sure all permits are signed first.)
• Withhold fluids and foods, as directed.
• Verify that client allergies are noted and the client is wearing an “allergy” ID band, whether or not they have allergies.
• The client must also wear a facility identification band, usually on both wrists, to ensure proper identification.
• Give preoperative instructions and provide emotional support to the client and family.

Question 13

The purpose of NPO(nil per os)?

Answer 13

• To prevent nausea.
• To keep any food or liquid from getting into the lungs.

Question 14

What is the definitions/functions Ovulation, Puberty, Menopause, Mensuration, Menarche?

Answer 14

• Ovulation
  
  • About day 14, a surge of hormones causes the ovum to burst through the ovary.
  • It usually occurs in the middle of the 28-day menstrual cycle (about 14 days before the onset of the next menses).
• Puberty
  
  • The period during which adolescents reach sexual maturity and become capable of reproduction.
    
    • When a boy reaches puberty, the hypothalamus stimulates the secretion of both interstitial cell-stimulating hormone ( ICSH ) and follicle-stimulating hormone ( FSH ) from the anterior pituitary
    • The hypothalamus stimulates the secretion of gonadotropic hormones , which include luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in women.
• Menopause
  
  • Between approximately 40 and 55 years of age, the ovaries become less active because they no longer respond to FSH.
  • Thus, eggs no longer mature, and the ovaries stop producing estrogens.
  • This decrease in ovarian function occurs gradually.
  • The result is the lack of ability to become pregnant and the onset of menopause (climacteric, cessation of menstruation).
• Mensuration
  
  • The flow of blood and other materials from the uterus through the vagina.
• Menarche
  
  • The first menstrual period, menarche , marks the onset of female puberty.
  • This rhythmical series of changes (the menstrual period, menses, or period ) then occurs about every 28 days.

Question 15

How do you properly administer an ear drop medication into adults/infants?

Answer 15

• When administering ear medications for a child the nurse pulls the ear down and back.
• With an adult, the nurse pulls the ear up and back.

Question 16

What is the Vas deferens, Ejaculatory duct, Seminal vesicle, Epididymis, Sperm mobility?

Answer 16

• Vas deferens (Ductus Deferens)
  
  • Transports sperm from the epididymis to the ejaculatory duct
• Ejaculatory duct
  
  • The ejaculatory duct delivers sperm into the urethra, adding secretions and additives from the prostate necessary for sperm function, while providing an interface between the reproductive and urinary systems in men.
• Seminal vesicle
  
  • Produce semen, the fluid medium for sperm
• Epididymis
  
  • Location of final stages of maturation of sperm cells
• Sperm mobility
  
  • Glandular prostate tissue adds an alkaline secretion to semen, which increases sperm motility.

Question 17

What is the purpose of Kegel exercises and correct nursing instructions?

Answer 17

• Regular practice of Kegel exercises can restore muscle tone.
• Benefits include control of stress incontinence, increased vaginal lubrication during sexual arousal, relief of constipation, increased flexibility of episiotomy scars, and stronger gripping of the base of the penis during intercourse.
• Locate the muscles surrounding the vagina by sitting on the toilet and starting and stopping the flow of urine.
• Test the baseline strength of the muscles by inserting a finger in the opening of the vagina and contracting the muscles.
• Exercise A: Squeeze the muscles together and hold the squeeze for 3 s. Relax the muscles. Repeat.
• Exercise B: Contract and relax the muscles as rapidly as possible 10–25 times. Repeat.
• Exercise C: Imagine sitting in a pan of water and sucking water into the vagina. Hold for 3 s.
• Exercise D: Push out as during a bowel movement, only with the vagina. Hold for 3 s. Repeat exercises A, C, and D 10 times each and exercise B once. Repeat the entire series three times a day.

Question 18

What is the purposes of secretion of testosterone?

Answer 18

Testosterone helps promote second sexual characteristics.

• Secondary sexual characteristics that appear in pubescent boys are:
  
  • Development of a beard
  • Pubic and axillary hair
  • Increase in hair growth all over the body
  • Development of musculature
  • Broadening of the shoulders
  • Deepening of the voice

Question 19

How does aging affect the Integumentary system?

Answer 19

• Melanin is either lost or migrates and clusters in the epidermal layer
  
  • “Age spots” or “liver spots” (senile lentigo) result White areas (vitiligo) may appear
• Epidermal and dermal layers flatten, skin becomes thinner.
  
  • Skin tends to tear (“fragile” or friable skin).
• Glandular secretion decreases
  
  • More susceptible to skin breakdown and infection. Slower healing.
• Capillary bed in dermis becomes more friable (fragile), blood can ooze into dermis
  
  • Dark red patches in the skin (purpura) are commonly seen on arms of older adults
  • Person may bruise easily
• Capillaries leak small amounts of blood into tissues
  
  • Petechiae occur (small red dots on the skin [senile angioma])
• Individual may have loss of sensation
  
  • Person is unable to detect or treat the cause of ulcerated areas; pressure wounds may develop more quickly May be more susceptible to falls. May not sense heat or cold
• Loss of elasticity in dermis, loss of subcutaneous layer of fat, and loss of collagen fibers
  
  • Wrinkles. Decreased strength of skin layer. Women’s skin is thinner and dryer; thus, wrinkles appear earlier. Skin may sag
• Skin turgor (tension or fullness) is lost
  
  • Wrinkles Pinched skin does not return to normal position. “Tenting”
  • on some areas can give false-positive (for dehydration) results
• Some insulating function is lost with loss of subcutaneous fat
  
  • Heat is lost more rapidly. Older person may be chilly
• Dermal layer thins
  
  • Skin becomes transparent and less elastic
• Changes occur in hair distribution, influenced by heredity and other factors.
• General loss of body hair occurs. Hair pigment (melanin) decreases
  
  • Axillary, pubic, and scalp hair thins Men may develop thicker hair in nose, ears, and eyebrows; hair on head becomes thinner Hair appears white or gray
• Female and male hormones are lost
  
  • Women may develop facial hair (hirsutism)
  • Males have decrease in beard and scalp hair (male pattern baldness)
• Nails grow more slowly and become thicker
  
  • Nails, especially toenails, become thick and brittle.
  • May be malformed or discolored
• Glands in skin decreases secretions
  
  • Less perspiration and less oily skin than before; skin may become very dry (may appear scaly [senile keratosis]). Hair becomes coarser
• Thermoregulation abilities lost
  
  • More susceptible to heatstroke or chilling
• Circulation reduced Mucous membranes dryer;
  
  • Decreased number and output of sweat glands
  • Wound healing takes longer
  • Old or damaged cells not readily replaced
  • More difficult to maintain body temperature;
  • Painful intercourse (dyspareunia);
  • Dry eyes;
  • Dry mouth

Question 20

How does aging affect the Nervous System?

Answer 20

• Losses in the thought process, reasoning, or learning are not normal.
• Person feels less rested; wakefulness periods at night are common.
• Older individuals may start using sleeping aids.
• Person exhibits decrease in voluntary movements.
• Persons may be startled more easily.
• Reflexes may be slowed.
• Decision making may be slower.
• Older adults are more susceptible to heatstroke or effects of cold.
• Skin may remain pink, even if client is cold (may not become pale or blue).
• Person may be disoriented as to time and date.
• Person may lack dexterity.
• Falls may occur.
• Assess for CVA, Alzheimer’s disease, and conditions related to atherosclerosis (“ hardening of the arteries”).
• Encourage older clients to get shingles immunization.

Question 21

How does aging affect the Musculoskeletal system?

Answer 21

• Osteoporosis
• Fractures
• Hunched posture (kyphosis: humpback; lordosis: swayback)
• Back pain Brittle bones Decrease in height (demineralization of bones)
• Arthritis (degenerative joint disease)
• Osteoarthropathy
• Joint stiffness, muscle aches, back pain
• Loss of muscle strength
• Gain of fat tissue (and weight)
• Loss of flexibility
• Easy fatigability
• Resting tremors may occur

Question 22

How does aging affect the Sensory system?

Answer 22

• Vision/Eye Changes
• Lens accommodation decreases: lens loses elasticity
  
  • Presbyopia (farsighted); difficulty seeing close objects or reading
  • Depth perception decreases
  • Difficulty judging height of curbs and steps Falls common
    
    • Peripheral vision decreases
    • Driving may be dangerous
• Pupil size decreases: ability to react to darkness and bright light decreases; night vision decreases
  
  • Takes longer for eyes to adjust when entering a dark room or bright sunlight May require additional light for reading
• Color perception decreases Depth perception decreases
• Clouding of lens
  
  • Difficulty discerning hues of blue, green, and violet and distances Cataract (may occur at any age)
• Grayish white ring (arcus senilis ) forms around iris due to deposits of calcium and cholesterol salts
  
  • May lower self-esteem and body image (does not affect vision)
  • Vitreous gel liquefies
  • Posterior visual detachment (PVD), causing “floaters” in eyeball
  • Tear formation decreases
    
    • Dry, itchy eyes More susceptible to infections
    • Fluid circulation in eye decreases
      
      • Increased risk for glaucoma

Question 23

How does aging effect the reproductive system? (Male)

Answer 23

• Degeneration of testicles; reduction in size
• Decrease in sperm production
• Difficulty in achieving and maintaining an erection;
  
  • longer refractory period after orgasm
• Frequency of erection decreases
• May result in weight gain or changes in body shape
• More susceptible to atherosclerosis and/ or osteoporosis
• May be benign or malignant (prostate cancer);
  
  • may have difficulty voiding (retention) or urinary incontinence or difficulty in attaining erection
• May be sexually impotent
• Decrease in frequency and strength of erection
• May require additional lubrication for intercourse

Question 24

How does aging effect the reproductive system? (Female)?

Answer 24

• Lose ability to become pregnant
• Menstruation ceases
  
  • woman may have hot flashes, headaches, dizziness, or heart palpitations
• May need estrogen (hormone) replacement therapy (ERT or HRT)
• Uterus and ovaries get smaller
• Vaginal mucosal wall shortens and thins
• Vaginal secretions decrease
  
  • intercourse may become painful (dyspareunia)
• More susceptible to vaginal infections
• Breasts get smaller and softer
  
  • fatty tissue increases
• Hair thins on scalp, axillae, and external genitalia
• Hair may grow on upper lip or chin
• Muscles of upper arms and legs may lose tone
• Weight gain around midline often occurs
• Skin dries; skin may itch; client may develop psoriasis or excessive dandruff
• Risk of atherosclerosis increases
• Osteoporosis risk increases;
  
  • bones become subject to fractures if they demineralize and become porous and brittle
  • spontaneous fractures are possible
• Genital structures may sag; may fall (prolapse) into vagina Incontinence may occur

Question 25

What are the functions and secretions of the intrinsic factor?

Answer 25

• The stomach’s parietal cells also secrete intrinsic factor, enabling the body to absorb vitamin B 12.
• The intrinsic factor is essential for life, because it is required for:
  
  • Vitamin B 12 absorption
  • Needed to develop red blood cells in bone marrow.
• Vitamin B 12 deficiency results in pernicious anemia.
  
  • (Pernicious anemia is a type of vitamin B12 anemia)

Question 26

What is the R-A-A mechanism?

Answer 26

• Renin is very important in blood pressure regulation.
• If blood pressure or circulating blood volume falls too low, cells of the JGA secrete renin into the bloodstream.
• This activates the renin–angiotensin–aldosterone (RAA) mechanism , to raise blood pressure.
• Renin stimulates the formation of angiotensin I, which, in the presence of a converting enzyme, converts to angiotensin II.
• Angiotensin II causes blood vessel constriction, directly raising blood pressure, and stimulates the adrenal cortex to secrete aldosterone .
  
  • (The adrenal cortex secretes corticosteroids and androgens; the medulla secretes epinephrine [adrenalin] and norepinephrine.)
  • Angiotensin II also stimulates the thirst center in the hypothalamus, encouraging a person to increase fluid intake, resulting in an increase in blood volume and, subsequently, a rise in blood pressure.
• Aldosterone promotes sodium and water retention, increasing blood volume, again elevating blood pressure.
  
  • A mineralocorticoid hormone, aldosterone responds to blood levels high in potassium or low in sodium.
  • In these cases, aldosterone stimulates excretion of potassium ions and reabsorption of sodium ions.
  • Sodium ions return to the blood, water follows the salt via osmosis, and potassium ions are excreted in urine.

Question 27

What are the functions of Cochlear, Semicircular canals, Mastoid cells?

Answer 27

• Cochlea
  
  • The cochlea is shaped like a hollow snail shell.
  • Inside the bony cochlea lies the cochlear duct, containing the organ of Corti, a very small but very intricate structure. It is approximately 1.5 in. (3.75 cm) long and contains approximately 7,500 separate parts.
  • This organ is referred to as the “true organ of hearing” because transmission of nerve stimuli related to sound begins here.
• Semicircular canals
  
  • Shaped like horseshoes, they lie behind the cochlea and are primarily concerned with balance when the body is moving (acceleration/ deceleration or head movements).
  • At the end (ampulla) of each semicircular canal is a receptor, the crista (crista ampullaris), which contains sensory hairs.
  • Movement activates endolymph within the canals, which sets in motion the tiny hairs of the crista, transmitting information about the body’s position to the brain.
  • Sensory receptors for equilibrium (balance) in the moving body are on nerve endings in the semicircular canals (active balance).
• Mastoid cells
  
  • The mastoid air cells are thought to protect the delicate structures of the ear, regulate ear pressure and possibly protect the temporal bone during trauma.

Question 28

What are the AV node, Purkinje fibers, SA node, Bundle of His?

Answer 28

• SA node
  
  • The first of these bundles, the sinoatrial node (SA node or sinus node), is embedded in the endocardial wall of the right atrium where it is joined by the SVC.
  • It is also considered the heart’s “pacemaker.”
  • Normal heartbeat originates in the SA node (electrical coil systole— the QRS impulse), typically at a rate of 60– 80 beats per minute.
  • The normal sinus impulse is transmitted over the myocardial electrical tree within the heart, via specialized fibers, the conduction system or syncytium. (A syncytium is a merging of cells interconnected by cytoplasmic bundles.
  • This meshwork allows an electrical stimulus in one cell to spread through the network to the other cells.)
  • These impulses stimulate the heart’s chambers to contract.
  • The SA node sets the pace, and the rest of the heart follows.
  • This swift message is first sent out over the internodal pathways to the muscular tissue of the atria, which causes the atria to contract.
  • The person with a poorly functioning SA node usually requires the implant of an electronic pacemaker.
• AV node
  
  • The AV node picks up the message from the SA node like a receiving station and holds onto it until the atria have contracted and emptied blood into the ventricles.
  • When the ventricles are ready to receive the impulse, the AV node transmits it through the AV bundle (the bundle of His— pronounced hiss) and down the interventricular septum to the right and left bundle branches.
  • From there, the fibers penetrate the ventricular muscle and terminate in the subendocardial branches (Purkinje fibers), which fan out across the ventricles and conduct the impulse, causing the ventricles to contract.
  • The heart then rests for a short period and begins the process again.
  • Should the SA node fail to fire an impulse, escape beats from other pacemaker cells within the AV node or ventricles will usually take over to keep the heart beating.
  • Thus, the heartbeat becomes slower.
  • If the SA node and AV node fail to fire an impulse, the ventricles must fire an impulse to maintain heartbeat.
  • Ventricular contraction in this case will only occur about 20– 40 beats per minute; a heart rate this slow (bradycardia) might not support life.
  • If the ventricles do not fire a backup impulse, cardiac arrest (heart stoppage) will occur.

Question 29

How is Sperm formed, storage and how mobility works.

Answer 29

• Sperm is formed in the testes.
• The fluid then more into the epididymis where they mature.
• When sexually stimulated, sperm mixes with fluids that come from secretions from the prostate and seminal vesicles to create ejaclatory fluid.
• When ready, the ejaclatory fluid is ejaculated from the urethra.
• Sperm gain mobility in the epididymis
• Sperm is stored in the Epididymis until fully mature.

Question 30

How is an Ovum formed, how does it move and procedures for fertilization.

Answer 30

• As the ovum bursts from the ovary into the pelvic cavity, the oviduct catches it in structures called fimbriae , fringe-like ends of the oviducts.
• Cilia on the inner surfaces of the fimbriae, and the lining of the oviducts, as well as peristaltic waves of the oviducts’ smooth muscles, help move the ovum toward the uterus.
• The inner layer of the oviducts contains mucus-secreting cells that lubricate the oviducts and may also provide nutrients for the ovum.
• (The transit of the ovum from ovary to uterus may occur in a few hours or may take several days.)
• Fertilization of the ovum (the meeting of sperm and ovum) normally occurs about midway in the oviduct (discussed later).
• If fertilization does not occur, the ovum dissolves.

Question 31

What are the functions, of bile and gallbladder?

Answer 31

• Bile
  
  • Bile is a fluid that is made and released by the liver and stored in the gallbladder.
  • Bile helps with digestion.
  • It breaks down fats into fatty acids, which can be taken into the body by the digestive tract.
• Gallbladder
  
  • Its major functions are storage and release of bile, as needed in the small intestine for fat emulsification.
  • It also concentrates bile by absorbing water and salts

Question 32

What are different types of joints and examples and examples of them?

Answer 32

• Synarthroses: immovable, fibrous
  
  • No motion
    
    • Example:
      
      • Bones of the skull fitted together with interlocking notches (in adults)
• Amphiarthroses: slightly movable, cartilaginous
  
  • Slight degree of motion or flexibility
  • Example:
    
    • Vertebral column
    • Symphysis pubis
• Diarthroses: freely movable (synovial)
  
  • freely movable, allowing movement in various directions, as at the ends of long bones;
  • they are the most common joints in the body.
  • Examples:
    
    • knees, shoulders, elbows, and hips,
• Hinge joints
  
  • Motion like a door on hinges
  • Examples:
    
    • Finger, elbow, and knee joints
• Ball-and-socket joints
  
  • Motion like that of turning a doorknob
  • Rotation
  • Examples:
    
    • Shoulders and hips
• Pivot joints
  
  • Gliding motion
  • Examples:
    
    • Wrist (turns forearm)
• Gliding joints
  
  • Allow motions in two planes at right angles
  • Examples:
    
    • Wrist, foot, hand
• Condyloid joints/ Saddle joints
  
  • Opposing surfaces are concavo-convex (fit together like two saddles with riding surfaces together); allow a wide range of movements
  • Example:
    
    • Thumb

Question 33

What are the Ovulation and uterine cycles?

Answer 33

• Ovulation Cycle:
  
  • The three phases of the ovarian cycle are:
    
    • The follicular phase
    • Ovulation
    • The luteal phase
• Ovulation
  
  • About day 14, a surge of hormones causes the ovum to burst through the ovary, ovulation.
  • It usually occurs in the middle of the 28-day menstrual cycle (about 14 days before the onset of the next menses (period)).
  • Some fertility control and fertility enhancement methods are based on calculation of the time of ovulation.
  • Some women experience sharp pains or cramps when ovulation occurs.
  • This is known as mittelschmerz (meaning “middle pain” in German).
• Luteal Phase
  
  • During the luteal phase, the empty, ruptured Graafian follicle becomes the corpus luteum and begins to secrete progesterone and estrogen.
  • These hormones cause the endometrium (the endometrial lining of the uterus) to become greatly thickened and vascular (engorged).
  • If the ovum is fertilized, it becomes embedded in the endometrium and becomes a fetus.
  • If the ovum is not fertilized, the secretion of progesterone decreases, the corpus luteum begins to decline, and menstruation occurs.
  • Levels of FSH start to rise on about day 2 of the cycle, to begin preparation for the next cycle.
• Uterine Cycle:
  
  • The three phases of the uterine cycle are the proliferative phase, the secretory phase, and the menstrual (menstruation) phase.
    
    • Proliferative (Buildup) Phase
      
      • While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth.
      • It thickens from about day 4 to about day 14.
    • Secretory Phase
      
      • If fertilization does not occur, the corpus luteum degenerates and hormonal levels fall.
      • Withdrawal of hormones causes the endometrial cells to change, and menstruation begins.
    • Menstruation
      
      • The sloughing off of the endometrium and unfertilized ovum causes menstruation.
      • Menstruation averages 3– 5 days but may last 2– 8 days.
      • During menstruation, FSH levels rise and several ovarian follicles begin to develop again.
      • Thus begins the next endometrial cycle
  • The endometrium of the uterus has a similar cycle, the uterine cycle or endometrial cycle.
  • This process prepares the uterus for implantation of an ovum (egg).
  • The uterine cycle is controlled by the ovarian cycle and will vary, depending on whether or not fertilization of the ovum occurs.

Question 34

What are nursing instructions for a Bronchoscopy?

Answer 34

• Before the test, the person’s throat is anesthetized and medications (e.g., midazolam) are administered intravenously (IV) to promote relaxation.
• These medications may cause a client to experience amnesia about the test.
• Alert the client to this possibility before the test to prevent concern later.
• Food and fluids are withheld for 6–8 hr before a bronchoscopy.
• Give mouth care immediately before the procedure.
• Explain the procedure to the client, who will most likely remain awake.
• Be sure that any dentures are removed.
  
  • Note any loose natural teeth because the bronchoscope may loosen or dislodge a tooth, which could lead to aspiration.
• After bronchoscopy, the client takes nothing by mouth (NPO) until the gag reflex returns.
• The anesthetic numbs the throat, so reflexes are not functional and do not allow the person to cough out secretions.
• The client needs to be in a side-lying position.
  
  • Rationale: Doing so keeps the airway open and helps to prevent choking and aspiration.
• The side-lying position also helps to facilitate drainage.
  
  • Note any edema of the throat, bleeding, or dyspnea because if the airway becomes obstructed, an emergency tracheostomy (opening into the trachea) may be needed.
• A sterile endotracheal tube is kept at the bedside until the client is fully awake and reflexes return.
• In a respiratory emergency, the endotracheal tube can be inserted to assist in keeping the airway open temporarily.
• After the client’s gag reflex returns, offer clear liquids and monitor the client’s ability to tolerate them.
• Gradually increase the client’s diet to soft foods.
• Encourage the client to rest and to eat soft foods for 24 hr after this procedure.
• Because most bronchoscopy procedures are done on an outpatient basis, be sure to teach the client and family to be alert for possible complications, especially the following:
  
  • Swelling of the throat
  • Difficulty swallowing
  • Difficulty breathing
  • Bleeding

Question 35

Food route in the GIT and functions of the organs of GIT?

Answer 35

• Mouth
  
  • Chews and mixes food with saliva
• Pharynx
  
  • Directs food from mouth to esophagus
• Salivary glands
  
  • Secrete saliva
• Epiglottis
  
  • Protects airways during swallowing
• Trachea
  
  • Allows air to pass to and from lungs
• Esophagus
  
  • Passes food from the mouth to the stomach
• Esophageal sphincters
  
  • Allow the passage from mouth to esophagus and from esophagus to stomach, prevent back flow from stomach to esophagus and from esophagus to mouth
• Diaphragm
  
  • Separates the abdomen from the thoracic activity
• Stomach
  
  • Churns, mixes, and grinds food to a liquid mass
  • Adds acid, enzymes, and fluid pyloric sphincter
  • Allows passage from stomach to small intestine
  • Prevents back flow from small intestine
• Liver
  
  • Manufactures bile salts, detergent
  • Like substances, to help digest fats
• Gallbladder
  
  • Stores bile until needed
• Bile Duct
  
  • Conducts bile from the gallbladder to the small intestine
• Appendix
  
  • House bacteria and lymph cells
• Small intestine
  
  • Secretes enzymes that digest all energy
  • Yielding nutrients to smaller nutrient particles
  • Cells of wall absorb nutrients into blood and lymph ileocecal valve (sphincter)
  • Allows passage from small to large intestine prevents back flow from large intestine
• Pancreas
  
  • Manufactures enzymes to digest all energy
  • Yielding nutrients and releases bicarbonate to neutralize acid chyme that enters the small intestine
• Pancreatic duct
  
  • Conducts pancreatic juice from the pancreas to the small intestine
• Large intestine
  
  • Absorbs water and minerals; passes waste along with water to rectum
• Rectum
  
  • Stores water prior to elimination anus
  • Holds rectum closed; opens to allow elimination

Question 36

Nursing instructions in Oxygen administration?

Answer 36

• Be sure the client has no matches, cigarettes, or smoking materials in the bedside table.
• Make sure that warning signs are posted on the client’s door and above the client’s bed.
• Use caution with all electrical devices, such as heating pads, electric blankets, or the ordinary call light.
• Turn the oxygen on before applying the mask with all oxygen delivery systems.
• Instruct the client not to change the position of the mask, the cannula, or any of the equipment after it is in place.
• Maintain a constant oxygen concentration for the client to breathe.
• Watch for respiratory depression or distress.
• Make sure the tubing is patent at all times and
• that the equipment is working properly.
• Provide frequent mouth care to the client.
• Wear gloves any time there is a possibility of
• coming into contact with the client’s respiratory secretions.

Question 37

What is Therapeutic communication?

Answer 37

• Therapeutic communication is an interaction that is helpful and healing for one or more of the participants;
  
  • The client benefits from knowing that someone cares and understands, and the nurse derives satisfaction from knowing that they have been helpful.

Question 38

What are fractures?

Answer 38

• Any break or crack in a bone is called a fracture (Fx).
• Fractures occur when stress placed on a bone is greater than the bone can withstand.
• Pathologic fractures are bones that break spontaneously or with nominal trauma, in diseases such as osteomalacia, osteoporosis, bone cancer, and osteomyelitis.
• An older adult client may experience a pathologic fracture to an ankle, hip, or wrist by the ordinary act of getting up out of a chair.
• Most fractures, however, result from significant trauma.
• Usually surrounding structures, such as muscles, blood vessels, ligaments, and tendons, are injured as well.
• Traumatic events that cause fractures include striking a hard surface, a hard fall, or being subject to an indirect force that exerts a strong pulling force on the bone, such as getting a foot caught between rocks and the body falling away from the rocks.
• Until age 45 years, more men than women have fractures; however, after this time, more women are affected because menopausal changes may cause decalcification of bones (osteoporosis).
• Many women take oral calcium in an effort to prevent osteoporosis.
• Some healthcare providers advise women to take the hormones estrogen and progesterone.
• A bisphosphonate, alendronate (Fosamax), increases bone density and reduces the risk of fractures and deformities.

Question 39

What are the types of neurons?

Answer 39

• Sensory (afferent) neurons:
  
  • Receive messages from all parts of the body and transmit these messages (about hormone levels, blood pH, touch, sound, light, and pressure) to the central nervous system.
  • Sensory neurons usually have long dendrites and a short axon.
• Motor (efferent) neurons:
  
  • Receive messages from the central nervous system (CNS) and transmit them, as motor output, causing an action, to muscles and glands in all parts of the body.
  • Signals carried by these neurons alter muscle activity or cause glands to secrete.
  • Motor neurons usually have short dendrites and a long axon.
• Interneurons (connectory, association neurons, or integrators)
  
  • Function as a link between the two other types of neurons.
  • They are interconnecting neurons and are located only within the central nervous system.

Question 40

What are nursing instructions on prevention of urinary tract infection?

Answer 40

• Teach preventative measures, such as the importance of fluids, avoiding tight-fitting nonabsorbent underwear, and avoiding irritants, such as soaps and bubble baths.
• Also explain that diets high in sugar promote bacterial growth and cystitis.
• Explain to women that sexual activity increases the risk of acquiring a UTI;
• Voiding immediately after sexual intercourse reduces the risk.
• Teach women and girls to wipe the perineal area from front to back, which minimizes contamination of the urinary meatus with microorganisms from the rectum or vaginal areas.
• Tell the client that warm packs can help alleviate the pain associated with infection.
  
  • Explain the importance of taking antibiotics as ordered to eliminate the causative agents.
• During antibiotic treatment, fluid intake of 3–4 L daily is recommended, unless contraindicated.
  
  • Rationale: Additional fluid helps dilute the urine, thus lessening burning on urination.
• Fluid intake also encourages elimination, thus preventing urinary stasis, in which bacteria can multiply.
• Flushing out the urinary system prevents the formation of crystals that may develop from sulfonamide therapy.
• Inform clients of the possibility of a change in color of urine to orange-red when taking phenazopyridine hydrochloride (Pyridium).
• This discoloration may stain fabric and toilet fixtures.

Question 41

What is the route of the blood flow in the circulatory system?

Answer 41

1. Blood travels through the mitral valve and into the left ventricle.
2. Blood then passes through the tricuspid valve into the right ventricle.
3. Blood then enters the pulmonary artery and lungs, where it receives oxygen.
4. It moves on through the pulmonic valve
   during ventricular contraction.
5. The right atrium receives deoxygenated blood from the superior and inferior vena cava and the coronary sinus.
6. It then returns to the left atrium via the
   pulmonary veins.

Question 42

What is the axial skeleton and its functions?

Answer 42

• The axial skeleton contains the bones in the center (axis) of the body, such as the skull, vertebral column, and rib cage.
• Provides support and cushioning for your brain, spinal cord and organs in your body

Question 43

How do you administer insulin?

Answer 43

• When administering insulin in a prefilled syringe to a client, roll and invert the syringe before administration to mix the solution well.
• Roll and invert insulin between the hands.
• Do not shake a vial.
• Shaking causes air bubbles to form, which would alter the dosage.
• Vials or prefilled syringes should be crystal clear (regular insulin or lispro) or milky white, depending on the type of insulin.
• Discard if the liquid is discolored.
• Also discard vials that do not easily resuspend when you roll them.
• Other signs of unusable insulin are frosting or coating on the bottle (especially with NPH) and any settling or clumping.
  
  • Note the expiration date printed on the side of the vial and do not use contents after that date.
• Make sure insulin is not decomposed.
• If in doubt, throw it out!
• Double-checking insulin dosages helps to prevent errors in the healthcare facility

Question 44

What do the kidneys do when there is low Blood pressure?

Answer 44

• Likely problems associated with the juxtaglomerular apparatus (JGA) are:
  
  • Blood pressure regulation issues (Low and high Blood pressures)
  • Cardiac Issues
• A structure within the kidney called the juxtaglomerular apparatus produces a hormone called renin (part of the renin–angiotensin–aldosterone [RAA] mechanism), which acts on the vascular system to assist in blood pressure control.

Question 45

What are lifestyle practices that impact a client’s cardiovascular health?

Answer 45

• Amount, type, and regularity of exercise
• Quality of rest and sleep
• Weight, in relation to optimal weight
• Stress factors
• Salt intake, particularly in non-caucasian people
• Fat intake and cholesterol levels
• Carbohydrate intake
• Medication compliance
• Oral contraceptives and other hormone-based medications
• Use of OTC (over-the-counter) cold remedies, particularly those containing pseudoephedrine
• Use of moderate to large amounts of OTC aspirin, ibuprofen, and other related medications
• Smoking and smokeless tobacco use
• Use of street drugs
• Anorexia/bulimia and other eating disorders

Question 46

What does a Pulse Oximeter measure?

Answer 46

• It is a convenient monitor that measures the amount (percentage) of oxygen saturation in the blood.

Question 47

What are the functions of The Reparatory System?

Answer 47

• Takes in oxygen from outside air
• Exchanges carbon dioxide for oxygen in lungs
• Exchanges oxygen for carbon dioxide at the cellular level
• Eliminates carbon dioxide from body
• Assists in regulating body’s pH
• Eliminates some water
• Protection Warms and moistens air before it enters lungs .
• Mucus in nose traps foreign particles
• Coughing and sneezing dislodge foreign particles
• Yawning and swallowing help equalize pressures between inner ear and atmosphere
• Air passes over vocal cords to produce sound

Question 48

What are the functions of The Cardiovascular System?

Answer 48

• Pumps blood to body and lungs
• Receives blood from body and lungs
• Influences blood pressure
• Provides channels through which blood and lymph travel
• Provides areas (capillaries) where transfer of gases, nutrients, fluids, electrolytes, and wastes can occur

Question 49

What are the functions of the hematologic system?

Answer 49

• Transports oxygen to body cells and carbon dioxide away from body cells
• Exchanges oxygen for carbon dioxide at cellular level
• Transports water, nutrients, and other needed substances, such as salts (electrolytes) and vitamins, to body cells
• Aids in body heat transfer
• Transports waste products from cells to be removed from the circulation (e.g., kidney removes excess water, electrolytes, and urea; liver removes bile pigments and drugs; lungs remove carbon dioxide)
• Transports hormones from sites of origin to organs they affect
• Transports enzymes
• Contributes to regulation of body temperature
• Assists in maintenance of acid– base balance
• Assists in maintenance of fluid– electrolyte balance
• Fights disease and infection (leukocytes)
• Promotes clotting of blood (platelets and specialized factors)
• Provides immunity due to antibodies and antitoxins (specialized cells)

Question 50

What are the functions of Lymphatic System?

Answer 50

• Carries fluid away from tissues
• Carries wastes away from tissues
• Absorbs fats and transports fats to blood (lacteals)
• Stores blood (spleen)
• Destroys worn-out erythrocytes
• Filters waste products out of blood
• Filters foreign substances out of blood (including dead blood cells, bacteria, smoke by-products, cancer cells)
• Destroys bacteria
• Participates in antibody production to fight foreign invasion
• Manufactures lymphocytes and monocytes
• Manufactures erythrocytes (spleen in fetus)

Question 51

What are the functions of the digestive system?

Answer 51

• Breaks down food into smaller particles (mechanical digestion)
• Converts food into substances that can be absorbed (chemical digestion)
• Moves food materials through the gastrointestinal tract (peristalsis)
• Stores nutrients until needed
• Manufactures enzymes, hydrochloric acid, intrinsic factor, mucus, and other materials to assist in digestion
• Manufactures regulatory hormones in stomach
• Manufactures vitamin K and some B-complex vitamins in large intestine
• Provides absorption of nutrients, mainly from small intestine, into capillaries
• Reabsorbs water for reuse by the body
• Reabsorbs minerals and vitamins
• Forms feces from remaining waste products
• Produces defecation

Question 52

What are the functions of the endocrine system?

Answer 52

• Regulates growth and maturation
• Regulates body’s response to stress
• Regulates metabolism
• Regulates absorption of nutrients
• Regulates use of glucose in cellular respiration
• Maintains body pH by maintaining fluid and electrolyte concentrations
• Produces sexual characteristics
• Controls reproductive and birth processes
• Promotes normal growth and development

Question 53

What are the functions of the Nervous System?

Answer 53

• Monitors impressions and information from external stimuli
• Monitors information from internal stimuli Responds to danger, pain, and other situations
• Responds to internal and external changes
• Helps maintain homeostasis
• Responds to conscious decisions and thoughts
• Coordinates processing of new learning
• Stores and retrieves memories, including previous learning
• Facilitates judgment, reasoning, and decision making
• Directs all body activities
• Maintains blood pressure, respiration, and other vital functions
• Regulates body systems (in coordination with endocrine system)
• Coordinates reflex actions
• Controls instinctual behaviors
• Controls conscious movement and activities
• Stores unconscious thoughts

Question 54

What are the functions of the Sensory System?

Answer 54

• Visual sense receives images (light). Hearing receptors process sound waves (auditory sense).
• Through proprioceptors and the inner ear, the system helps to maintain a sense of balance, equilibrium, and position in space.
• Chemoreceptors in the mouth obtain information about tastes (gustatory sense).
• Chemoreceptors in the nose receive sensations of odors (olfactory sense).
• Touch receptors receive information about the surrounding world (e.g., touch, pressure, hot, cold, pain).
• Internal organs receive sensations of pain, pressure, fullness, and vibration.
• The brain interprets most of these sensations.

Question 55

What are the functions of the Integumentary system?

Answer 55

• Provides a physical barrier against microorganisms and foreign materials
• Helps prevent absorption of harmful substances from outside the body
• Defends against many chemicals
• Protects against water loss or gain
• Protects underlying structures, such as fragile organs
• Protects against excessive sun exposure (ultraviolet rays)
• Cushions internal organs against trauma
• Produces secretions for protection and water regulation
• Absorbs helpful medicines
• Prevents nutrients from being washed out of the body
• Serves as a containment structure to give shape and form to the body
• Controls body temperature by convection, evaporation, conduction, and radiation, as well as changes in size of superficial blood vessels
• Helps body adjust to external changes in temperature
• Helps dissipate heat during exercise
• Produces shivering and “goose flesh” to keep body warm in cool temperatures
• Provides insulation (skin hairs, subcutaneous fat)
• Helps produce and use vitamin D Helps the body eliminate certain waste products
• Contributes to changes in cardiac output and blood pressure
• Absorbs gases; some oxygen, nitrogen
• Perceives stimuli: heat, cold, pain, pressure, touch, vibration, injury
• Provides social and sexual communication
• Allows for physical intimacy
• Communicates feelings and moods through facial expressions
• Portrays feelings of anger, embarrassment, or fear (e.g., flushing, sweating, pallor)
• Communicates cultural and sexual differences through skin and hair color
• Portrays body image via skin’s general appearance
• Stores water Stores fat Stores vitamin D

Question 56

What are the functions of the Reproductive System? (Male)

Answer 56

• Secretes hormones that initiate puberty
• Maintains specific male characteristics
• Secretes mucus, spermatic fluid, and other substances
• Produces sperm
• Passes genetic information to offspring
• Participates in copulation and fertilization

Question 57

What are the functions of the Reproductive System? (Female)

Answer 57

• Secrete hormones that initiate puberty
• Maintain specific female sexual characteristics
• Secrete mucus, vaginal fluids, and other substances
• Produce ova
• Pass genetic information to offspring
• Participate in copulation and fertilization
• Maintain and nourish fetus until birth
• Produce breast milk

Question 58

What are the functions of the Urinary System?

Answer 58

• Controls water and blood volume
• Maintains blood pressure
• Regulates electrolyte levels; reabsorbs some electrolytes
• Maintains pH balance
• Helps maintain acid/ base balance
• Activates vitamin D (for bone calcification)
• Secretes renin and erythropoietin
• Filters blood
• Forms urine (kidneys) Stores urine (bladder)
• Eliminates protein wastes, excess salts, and toxic materials

Question 59

What are the functions of the Musculoskeletal System?

Answer 59

• Supports the body
• Provides framework for the body
• Gives shape to the body
• Protects vital organs
• Protects soft tissues
• Provides locomotion (walking, movement) by attachment of muscles, tendons, and ligaments
• Produces red blood cells
• Produces white blood cells
• Produces platelets
• Provides calcium
• Provides phosphorus