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NCLEX > Med-Surg 4 > Flashcards

Med-Surg 4 Flashcards

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1
Q

A client who is newly prescribed carvedilol. Which client statement causes the nurse to withhold the medication and contact the health care provider (HCP)?
a) Eating a lot of shrimp or lobster can cause my lips to swell
b) Scented candles and strong perfumes trigger my asthma
c) I smoked 2 packs of cigarettes a day for 15 years.
d) I drink a glass of wine before bed most nights to help me relax

A

b
b-blocker is a contraindication for asthma pt d/t bronchoconstriction that makes exacerbate asthma.

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2
Q

A pt who suspected cholelithiasis. Which info in the pt’s health history indicated a risk? SATA

a) African American
b) BMI 21
c) Given birth to 3 children
d) Being 50 years of age
e) fasting for religious reasons

A

c,d,e
Risk factor includes
Multipartite, Over 40 years, female and fasting
Fasting decrease gallbladder movement, and bile can become overly concentrated with cholesterol

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3
Q

What is the best dietary action a DM2 should take?
a) Restrict calories(1200,1400,1600 cal)
b) Divide meal into 6 feedings a day

A

a
because pt can eat 6 meals but does not limit the Cal with each meal
also frequency
But still, pt should eat 6 smaller feeding, more frequent meals keeps blood sugar more stable

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4
Q

The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement would the nurse make to try to motivate the client to quit smoking?
a) None of the cardiovascular effects are reversible, but quitting might prevent lung cancer
b) If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years

A

b
The risks to the cardiovascular system from smoking are noncumulative and are not permanent.

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5
Q

A client with thromboangiitis obliterans (Buerger’s disease) need help for cope with lifestyle changes. Which member refer to?
a) Dietitian
b) Medical social worker
c) Pain management clinic
d) Smoking cessation program

A

d

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6
Q

hypoglycemia S/S

A

Think of a Drunk pt in shock!!
-staggering gait (unstable)
-slurred speech
-labile (something that is easily or frequently changed)
-slow reaction time
-decrease social inhabitation
then shock stats
-tachycardia
-Low BP
-cold/clammy

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7
Q

Hypoglycemia tretmen when a pt is unconsiouus?

A

Glucogon IM
Dextrose IV (D10,D50)

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8
Q

DKA
a) What is the #1 cause?
b) s/s?
c) what is Kussmauls respiratory?

A

a) acute viral upper respiratory infection within last 2 eek
b) D!K!A!
Dehydration
Ketone in serum, Kussumauls, High K
Acidosis, Acetone breath, Anorexia
c) deep, rapid=hyperventolate

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9
Q

HHS
s/s?

A

Think just D=dyhydration

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10
Q

Long term complication of DM
What are two complication?

A

Poor tissue perfusion
(gangrene=body tissue dies due to a lack of blood supply)
Peripheral neuropathy

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11
Q

Phenytoin
a) what this for?
b) toxic level
c) side effect

A

a) for sizure
b) grater than 20
less than 10=seizure risk
c) Ataxia
Skin rash
Gingival hyperplasia (over growth og gum, risk for gum bleeding) no need to report

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12
Q

Hiatal Hernia
s/s?

A

Similar to GERD
Heartburn, indigestion if lying down after eating
If not eat and laying down, hiatal hernia won’t occur

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13
Q

Hiatal Hernia
Treatment

A

want to emputy stomach ASAP
Elevate HOB during and 1 hr after meals
Increase fluid with meals
Increase carb

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14
Q

Acute abdominal distress s/s?Dumping syndrome
s/s

A

Drunk + shock + acute abdominal distress
n/v, diarrhea, cramping, guarding, borborygmi (hyperactive), bloating, distention
Drunk- staggering gate, impaired judgment, labile
shock- cold/clammy, tach, pale

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15
Q

A client who is newly prescribed metronidazole.

➤Which client statement indicates the need for additional teaching? SATA
a) I notify the doctor if my urine turns brown while on this medicine
b) I will reduce my intake of wine to only a 2 times per week
c) I will contact the doctor if my skin starts peeling.
d) I will contact the doctor if I experience a metallic taste in my mouth
e) I can resume my intake of alcohol a week after I finish taking this medication

A

a,b,d
a-expected findings
b,d-. This medication interacts with alcohol causing abdominal cramps, emesis, facial flushing, and nausea; therefore, alcohol should not be consumed
c-Steven-Johnson syndrome which manifests with skin rashes; therefore, peeling skin is reported to the HCP

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16
Q

laminectomy
(back surgery)

pre-ope care
a) Cervical
b) Thoracic
c) Lumbar

A

a) neck
First, assess for breathing
Next, the functions of arms and hands
b) upper back
Assess cough and bowels
c) Lower back
urinary retention(when voided last?)

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17
Q

laminectomy
post-ope

A

Log roll
Do not allow to sit for more than 30 minutes
Sitting in bed during a meal is OK. they may finish less than 30min

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18
Q

You are caring for a pt with a lumbar oligodendrogliocytoma. What is the #1 problem?
a) Airway
b) IIleus
c) Cardiac arrhythmia
d) Urinary retention

A

d
Surgery doesn’t matter, lumbar=urinary retantion

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19
Q

laminectomy
discharge teaching?

A

Avoid for 6wks
Do not sit for more than 30 mins
Lie flat log roll
Don’t drive
Don’t lift more than 5lbs

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20
Q

Lab values
What are the Ds?
What lab must report?

A

K+ in the 6’s
pH in th e 6s’
CO2 in the 60’
PO2 in the 60’
Platelet below 40,000

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21
Q

What do we need to worry about if hematocrit and hemoglobin is high?
what is the normal range?

A

Dehydration(濃い=number up)
Hematocrit 36-54
Hemoglobin 12-18

22
Q

Normal range
WBC
Absolute neutrophil count
CD4

A

5000-11,000
greater tahn 500
Grater than 200

23
Q

Sertraline
Fluoxetine
Citalopram
SSRI
Side effect?

A

ABCD
Anticholinergic
Blurred vision
Constipation
Drowsiness
Cause insomnia so NOT bedtime
Monitor suicide risk in adolescents(need to change the dose and adolescents)

24
Q

Sertraline
Fluoxetine
Citalopram
SSRI
Complication?

A

Serotonin syndrome SAD Head
Sweating
Agitation(impending sense of doom, apprehensive)
Dizziness
Headache
2-72 hrs after treatment
DO NOT take w/st. John’s wort, MAOI, TCA
DO NOT use warfarin

25
Q

Phenelizine(Nardil)
Traylcypromine(Parnate)
MARplan, NARdil, PARnate
s/s of MAO?
what food should avoid?

A

s/s-ABCD
Fruits and veggies are OK except BAR
Banana, Avocados, Raisins
No chocolate, caffeine, beer, wine and soy sauce

26
Q

Amitriptyline
Imipramine
TCA
s/s?

A

ABCD
A-especially dry mouth

27
Q

Alprazolam
Diprazolam
Lorazepam
Ends Lam or Pam
a) Pros and cons?
b) S/S?
c) Reverse?

A

Benzodiazepines
pros- act quick
cons-Higley addictive
b) ABCD
c) Flumazenil

28
Q

Buspirone
pros and cons?

A

pros-NO addictive
NO withdrwal
Good for long time use (Not PRN)
cons-take 2-4 wks for full effect
Like bus, keep going

29
Q

Lithium
a) s/s?
b) toxic sign?
c) monitor what lab value?
d) fluid education? avid what med?

A

a) 3 Ps
Peeing(polyuria), Pooping(diarrhea) and Paresthesia(numbness, tingling)
b) Tremors, metallic taste, severe diarrhea
c) sodium level
Hyponatremia cause toxicity
d) increase fuid, avoid diuretics

30
Q

Chlorpromazine
Haloperidol
First generation all end in “ZINE”
If all other won’t work then use this med
Side effect?

A

ABCDEFG
Anticholinergic (dry mouth, urinary retention)
Blurred vision
Constipation
Dizziness
EPS(tremors, Parkinson)
Foto sensitivity
G aGranulocytosis(low WBC count)
Pt need to report sore throat(s/s infection)

31
Q

A pt is being treated with Haloperidol. PT becomes anxious and presents with tremors. What is the nurse intervention to differentiate NMS from ESP?

A

If temp is OK, ESP
If tem is greater than 102, it is NMS.
Call the emergency response team and notify HCP.

32
Q

Clozapine
Olanzapine
Risperidone
2nd generation ends “zapine”
a) Clozapine s/s?
b) Risperidone

A

a) agranulocytosis
Monitor WBC and s/s of infection
This meds worse than chemo
b) doe dementia pt

33
Q

transsphenoidal hypophysectomy
pre-ope teaching?

A

Brushing your teeth needs to be avoided for at least 2 weeks after surgery

34
Q

a client in skin traction. The nurse would monitor for which priority finding in this client?
a) Signs of skin breakdown
b) Signs of infection around the pin sites

A

a
skin traction doesn’t have pin

35
Q

A client with acute pancreatitis and is monitoring the client for paralytic ileus. Which piece of assessment data would alert the nurse to this occurrence?
a) Inability to pass flatus
b) Firm, nontender mass palpable at the lower right costal margin

A

a
An inflammatory reaction such as acute pancreatitis can cause paralytic ileus, the most common form of nonmechanical obstruction
b
description of the physical finding of liver enlargement.

36
Q

Which one is a violation of their right?

a) Performing a procedure without consent
b) Threatening to give a pt a meds
c) Telling the pt they cannot leave the hospital
d) Observing care provided to the pt without pt’s permission

A

d
a-battery
b-assault
c-false imprisonment

37
Q

A client is admitted following a severe burn. What changes related to fluid status would the nurse anticipate?
a) Fluid volume excess
b) Hypovolemia
c) Third spacing
d) Increased urine output
e) Low CVP
f) Increased urine specific gravity

A

b,c,e,f
Burns can result in fluid loss from the burn area as well as the third spacing, which increases the risk for hypovolemia and shock. As the fluid volume decreases, the BP and CVP both decrease. Remember, less volume, less pressure. Also, when the fluid volume becomes depleted, the urine output will decrease in an effort to hold on to the fluid (compensate) or the kidneys are not being perfused

38
Q

baclofen
cyclobenzaprine
s/s?
teaching?

A

a) Fatigue/drowsiness
Muscle weakness
b) Don’t drive
Don’t drink
Don’t operate heavy machinery

39
Q

a) PT is under vegan diet, which vitamin is lacking?
b) OJ has which vitamin rich?

A

a) Vitamin B12
b) Vitamin C
Iron+OJ=incrase effectivness

40
Q

What are clear liquid diet?

A

Coffee
Broth
Gelatin(Jello)
Popsicles
Soda
Hard candy

41
Q

What are full liquid diet?

A

Ice cream
Pudding
Milk
Coffee and tea with cream
Butter
Cream soups

42
Q

Conductive hearing loss

A

happens when sounds cannot get through the outer and middle ear d/t obstructions (earwax, foreing object)

43
Q

Which pt should use an electric razor for shaving?
a) a pt with leukocytosis
b) a pt with thrombocytopenia
c) a pt with thrombocytopenia
d) a pt receives an antiplatelet meds
f) A pt receiving acetaminophen PRN

A

c,d
electric razors need ot be used for pt who are at risk for bleeding

44
Q

A pt with a urinary stoma about how to change the collection bag. Which one indicates an understanding?
a) The stoma needs to be cleaned with only water
b) The best time to change the appliance is at night
c) The pouch need to be changed every 5-7 days
d) I’ll cut the skin barrier 10 mm lager than the stoma

A

c
a-with soap and water
b-in the moring
d- not more than 3mm

45
Q

A pt with a new colostomy was created 2 days ago to pass malodorous flatus from the stoma. What is the correct interpretation?
a) This is a normal, expected event
b) The pt is experiencing early signs of ischemic bowel

A

a
First, they will pass malodorous flatus and this is expected. Within 72hurs preope, the pt should begin passing still via colostomy

46
Q

DVT
a) patho
b) what is embolisum?
c) DVTs/s
PE s/s

A

a) Damage blood vassal then platelet come along— forming the damaged area
b) Clot leaves the blood vassal now its call embolism
c) DVT swelling on one side(unilateral)
PE SOB

47
Q

a) waht lab value will elavated?
b) treatment during DVT
c) after resolved clots

A

a) D-dimer
b) DO NOT walk or massage
DO NOT applay SCD
Elevated leg
c) Walk asap,calf exercise
increase fluid intake

48
Q

A pt with DKA, blood glucose is 950. A continuous IV short-acting is given along with IV normal saline. Glucose is now down to 240. The nurse would next prepare to administer which medication?
a) An ampule of 50% dextrose
b) NPH insulin sub
c) IV fluid containing dextrose
d) Phenytoin for the prevention of seizures

A

c
If correction occur too quickly, serious consequences including hypoglycemia and cerebral edema can occur. Dextrose is added to maintain a blood glucose level of about 250

49
Q

In the acute phase of DKA, what nurse to do first?
a) Correct acidosis
b) Administer 5% dextrose iv
c) Apply a monitor for an electrocardiogram
d) administer short act insulin IV

A

d
lack of insulin is the primary cause of DKA
Apply ECG is important d/t alternated in potassium leaves associated with DKA but this is not priority

50
Q

Hyperparathyroidism s/s
a) Polyuria
b) Headache
c) Bone pain
d) Nervousness
e) Weight gain

A

a,c
PTH maintains serum calcium homeostasis. PTH levels are high means cause bone resorption(calcium is pulled from the bones)

NCLEX (12 decks)

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