Med Surg - Test 1 Flashcards
1
Q
What is donepezil used for?
A
Anti-Alzheimers agent - lessens dementia associated with Alzheimers disease
2
Q
What makes up the CNS?
A
Brain and spinal cord
3
Q
What is the occipital lobe primarily responsible for?
A
Vision
4
Q
The ______ _______ _______ protects the brain by separating blood volume from extracellular fluid
A
Blood brain barrier
5
Q
A nurse recognizes a change in a patients personality. They most likely have damage to which lobe?
A. frontal
B. occipital
C. parietal
D. temporal
A
A.
6
Q
This medication is an antipsychotic that can cause dizziness and drowsiness. Make sure to check that the patient is safe before administration and after.
A
haloperidol (name brand is haldol)
7
Q
This medication may cause nausea and dizziness, increases memory, works by raising or maintaining levels of acetylcholine in the brain.
A
donepezil (name brand is aricept)
8
Q
What are things that decrease in geriatric patients?
A
reaction times, body movements, muscle mass and flexibility, sense of touch, smell, temperature and pain sensation
9
Q
When assessing pulse what is considered normal? bounding? thready?
A
Normal is 2+, bounding is 3+, thready is 1+
10
Q
What renal issues should you watch for in our geriatric patients?
A
Higher risk of UTI, dehydration, medication overload because they have slower blood filtering.
11
Q
In older patients, their ______ and coordination are impaired it puts them at a higher risk for _______.
A
balance, falls
12
Q
Loss of smell in older patients can lead to a ___________.
A
loss of appetite
13
Q
This medication is an SSRI, takes time to build up to its full potential, can cause sexual dysfunction, assess for suicidal ideation.
A
sertraline (name brand is zoloft)
14
Q
This medication is an antidepressant, SNRI, assess for suicidal tendencies, may cause drowsiness.
A
venlafaxine (name brand is effexor)
15
Q
An acute process that results in altered awareness and attention.
A
Delerium
16
Q
______ is when a patient has 2 or more chronic medical conditions.
A
Multimorbidity
17
Q
_________ is the use of 5 or more medications.
A
Polypharmacy
18
Q
What can be used for delirium prevention?
A
pain management, family involvement of care, minimizing anxiety, reorientation, use of assistive devices
19
Q
______ is a cognitive decline that affect’s a persons social and occupational functioning. It is the loss of ability to think, reason and remember that interferes with communicating with others.
A
Dementia
20
Q
Unlike dementia, ________ has an acute onset and is reversible, common in older population,
A
delerium
21
Q
Low energy, difficulty sleeping, less of an appetite, aches and pains are all signs and symptoms of ______.
A
depression
22
Q
The progression of dementia is _____.
A
slow
23
Q
In patients with _________, they have cognitive failure but their awareness is clear.
A
dimentia
24
Q
What is TBI?
A
traumatic brain injury
25
What medication can slow the onset of dimentia?
donepezil
26
_______ is when a patient is in a constant state of confusion.
Delirium
27
A patient has dementia, at change of shift what would you want to know about him?
A&O baseline, POA and contact information, his schedule/routine, eating and bathroom habits, mood changes or aggression, ability to perform ADLs
28
Patients with this almost present as if they are intoxicated; disoriented, disorganized.
Delirium
29
Patients with ______ can have poor hygiene, lack of motivation, tendency to isolate themselves.
Depression
30
Mr. Brown was depressed yesterday but as happy as could be today. He is giving away his sentimental watch. What is this a sign of?
A plan to commit suicide
31
What are the two types of restraints?
Chemical and physical
32
What are types of physical restraints?
mitts, lap belt, posey bed, vest, 2 or 4 point restraints, 4 side rails up
33
What are three examples of chemical restraints that could be used?
haloperidol (haldol), lorazepam (ativan), diphenhydramine (benadryl)
34
This medication diminishes signs and symptoms of psychoses, used in patients that have aggressive behavior, antipsychotic
haloperidol (Haldol)
35
This is an anti-anxiety medication also used for sedation. This med decreases the CNS, regular assessments need to be performed, risk of addiction
lorazepam (Effexor)
36
If a patient has trouble distinguishing reality do they have dementia or delerium?
Delerium
37
What do you need before using restraints?
DR orders
38
How often do you check a patient with restraints?
Every 2 hours
39
How do you tie restraings?
In a quick release knot
40
How tight should restraints be?
Should be able to fit 2 fingers between skin and restraint
41
What are you checking for every 2 hours in a patient with restraints?
Drink, bathroom, skin and circulation checks
42
Why would a patient need to have an IV?
For meds, to receive fluids, for procedures.
43
What are you assessing with IV care?
Assess skin, leaking, dressing clean and intact, what is infusing
44
How would you chart that nothing is infusing through an IV?
IV noted to right/left hand saline locked
45
How would you chart a dirty dressing with dried blood?
Small amount of dried blood noted.
46
How would you chart a 20 gauge IV to the right hand with NS infusing at 90mL/hr and no issues?
20g IV noted to R hand NS infusing at 90mL/hr as ordered. 0 S&S of infection or infiltration noted at this time. Transparent dressing clean, dry and intact.
47
What is phlebitis?
Infection of vein
48
What are the S&S of phlebitis?
Warm, streaks and lines of redness
49
What is IV infiltration?
IV pokes through and infuses into the tissue, feels cool in most cases, signs of edema
50
What are signs and symptoms of infection at an IV site?
Red, hot, swelling, tender, drainage
51
Uncontrolled, sudden, excessive discharge of electrical activity
seizure
52
Chronic disorder, characterized by two seizures unprovoked by any immediately identifiable cause occurring more than 24 hours apart.
Epilepsy
53
In sterile gloves you never put your hands below your ______
waist
54
What is the highest score for the GCS (glascow comma score)?
15
55
Is a higher GCS a good or bad thing?
The higher the score, the better
56
What is the preictal phase of a seizure?
The time before a seizure
57
What is the postictal phase of a seizure?
A period after a seizure
58
A patient with a history of seizures experiences lip smacking and daydreams during a seizure with no loss of consciousness. The nurse recognizes these clinical manifestations as associated with which type of seizure?
A. absence seizure
B. complex partial seizure
C. atonic seizure
D. myoclonic seizure
A
59
What is used to diagnose a seizure disorder? (Select all that apply.)
A. Electroencephalogram
B. Lumbar puncture
C. Metabolic panel
D. Coagulation studies
E. Electromyogram
A, B, C
60
A nurse is caring for a client who is receiving morphine to relieve severe pain. The nurse should monitor the client for which of the following adverse drug reactions? (Select all that apply.)
A. Diarrhea
B. Urinary retention
C. Respiratory depression
D. Sedation
E. Orthostatic hypotension
B, C, D, E
61
What is used to diagnose a seizure disorder? (Select all that apply.)
A. Electroencephalogram
B. Lumbar puncture
C. Metabolic panel
D. Coagulation studies
E. Electromyogram
A, B, C
62
A nurse is caring for a client who has dementia due to Alzheimer's disease and was admitted to a long-term care facility following the death of her partner of 40 years. The client states, "I want to go home; my husband is waiting for me to cook dinner." Which of the following responses by the nurse is appropriate?
A. This is a safer place for you to live
B. Tell me what you like to cook for dinner
C. Your family said there is no one to care for you at home
B
63
A charge nurse is supervising a newly licensed nurse provide care for a client who has a PCA pump. Which of the following statements made by the nurse requires further action by the charge nurse?
A. I discarded the remaining 2mg of morphine from the PCA pump. Please document you witnessed it
B. I noted that my client pushed the PCA button six times in the last hour, and the PCA lockout is set for 10 minutes.
C. I gave my client a bolus dose of morphine when I initiated the PCA pump.
D. I told the client's family that they must not push the PCA button for the client.
A
64
Something the patient sees, experiences, smells before the onset of a visible seizure.
Aura
65
Jerking, either symmetric or asymmetric, that is regularly repetitive and involves the same muscle groups
Clonic
66
A seizure provoked by other disorders and conditions and are sometimes described as secondary seizures
nonepileptic seizure
67
Antiepileptic drugs (AEDs) or anticonvulsants almost always provide _______ control of the seizures
complete
68
This med works for partial and tonic clonic seizures, monitor for loss of appetite and ataxia
levetiracetam (name brand keppra)
69
What is ataxia?
a neurological condition that causes a loss of muscle control and coordination
70
This med works for tonic-clonic, complex partial and simple partial seizures, side effects could be nystagmus, ataxia, gingival hyperplasia
phenytoin (name brand Dilantin)
71
What is nystagmus?
involuntary, rhythmic eye movement
72
What is hydrocephalus?
Excessive accumulation of CSF in the brain
73
Which seizure involves seizure activity lasting longer than 5 minutes or two or more seizures without full recovery of consciousness? Can be caused by head trauma, drug or alcohol withdrawal, metabolic disturbances, abrupt withdrawal of anticonvulsant drugs.
Epilepticus
74
What would a nurse assess on a patient who is in the hospital for seizures?
Airway (during and after)
Vital Signs
Seizure activity
Presence of an aura (before)
75
You are getting a new patient admit. The patient is being admitted for a seizure early in the day. What actions would you take with this patient?
Setup suction equipment bedside, have oxygen available bedside, bed in lowest position, place an IV if ordered for faster administration of meds, documents all specifics regarding new seizure activity
76
What are things you can educate a seizure patient on?
Wear a medical alert bracelet, stick to a medication regimen, adhere to driving restrictions
77
With age, _________ involves the ciliary muscles and lens losing their elasticity, causing people over the age of 40 to need “reading glasses” at some point.
presbyopia
78
What are signs and symptoms of a partial seizure?
Repetitive behavior
79
What are signs and symptoms of a general seizure?
Impaired awareness, shaking, could have an aura
80
What is another name for nearsightedness?
Myopia
81
What is another name for farsightedness?
Hyperopia
82
What would you want to make sure when taking care of patients with glasses?
They have enough light, have regular eye checkups
83
What could you do when taking care of someone with presbyopia?
Print literature in large font
84
What is it called when a patient has foggy vision resembling a film over their eyes?
Cataracts
85
_______ patients may complain of blurred vision, sensitivity to light, decreased vision in the dark.
Cataract
86
An eye condition when there is too much pressure due to drainage?
Glaucoma
87
IOP
interocular pressure
88
When a patient has glaucoma what would you want to educate them on?
Avoid blowing noise, lying flat, bending over, straining, take laxative to avoid straining and take medications to avoid blindness.
89
What would you want to educate a patient on when using eye drops?
Drop into conjunctiva, don't touch the applicator to the eyeball, wipe from inner to outer eye, have the patient demonstrate back.
90
If a patient has a hearing device, what should you check?
That they are on, clean, charged and inserted correctly
91
How do you assess pain with a verbal patient?
Ask them to rate on a scale of 1-10
92
What are the things you ask about pain?
Where is the pain, what does it feel like, rate the pain
93
What are non-pharmacological ways to control pain?
Reposition, massage (ask first), ice or heat therapy, distract
94
What are pharmacological drugs for pain?
Oxycodone, hydrocodone, morphine, tylenol
95
What's the best way to assess pain after meds?
Ask what the pain level is now
96
How would you be able to tell if a nonverbal patient is in pain?
Irritable, grimacing, vitals are elevated, gaurding
97
What is the maximum amount of Tylenol a middle age patient should take in a day?
4 grams (3 grams for older population)
98
When administering opioids (analgesics) what should you monitor?
Monitor HR and respirations, they can cause constipation so drink water, eat fiber, be somewhat active and if needed stool softner
99
When applying a pain patch what would you want to educate the patient on?
It won't help right away, apply as prescribed, keep out of reach of children
100
PCA
patient controlled analgesia
101
What does a PCA do?
Allows a patient to give themselves IV medications as needed to keep the pain level at a level you can tolerate.
102
What is the Snellen chart used for?
To evaluate distance vision (the eye chart)
103
The clinic nurse is preparing to check a patient’s vision. The nurse knows that nearsightedness or myopia causes light rays:
A. from distant objects to focus before they reach the retina.
B. to focus improperly on the retina in the front of the eye.
C. to diverge to focus on the retina.
D. to reflect off the macula.
A
104
True or False: Patients with diabetes, both type 1 and type 2, are at a higher risk for developing cataracts and are more likely to develop them at a younger age.
True
105
What is the most effective treatment for cataracts?
Surgical removal of the opaque lens
106
How are cataracts diagnosed?
Physical exam of the patient with a visual acuity test and ophthalmologist exam
107
Postoperative cataract patients need to be educated about what for the first 24-48 hours following their surgery?
Do not strain, do not rub or apply pressure to eye, contact MD if severe pain, visual change or increase in discharge
108
The nurse suspects a cataract in a 68-year-old White male patient with lupus based on which information?
A. The patient’s sex and history of angina
B. The patient’s use of high-dose steroids to treat the lupus
C. The patient’s race and history of high blood pressure
D. The patient’s history of long-term exposure to zinc and obesity
B
109
A 76-year-old patient was recently diagnosed with primary open-angle glaucoma. What part of the past medical history places the patient at risk for developing glaucoma?
A. History of a recent facial trauma
B. Prolonged antibiotic therapy
C. Prolonged corticosteroid usage
D. History of angina
C
110
The medical management of glaucoma includes which interventions? (Select all that apply.)
A. Beta-blocker eye drops
B. Steroid eye drops
C. Strict bedrest
D. Routine appointments with healthcare provider
E. Antibiotic eye drops
A, D
111
Which is the most common examination used to assess a patient’s auditory function?
A. Examination using the tuning fork
B. Assessment of all the cranial nerves
C. Examination using the otoscope
D. Evaluation of a written questionnaire
C
112
The nurse recognizes which medication as ototoxic?
A. Non-salicylate pain medications
B. Calcium channel blockers
C. Antibiotics such as gentamicin
D. Beta blockers
C
113
Certain medications are known to have the potential to cause damage to some of the sensitive structures of the ear and are said to be ______
ototoxix
114
What are some ways to assess for hearing loss?
Patient frequently asks others to repeat what they said, avoids social interactions, disturbance in patients speech, arguing with family over hearing related difficulties, withdrawal from conversations, turning up volume on electronics
115
___________ is most commonly described as a noise or ringing in the ears and is a relatively common affliction that is often a manifestation of an underlying disorder
tinnitus
116
What are the two types of tinnitus?
Subjective and objective
117
_______ tinnitus is defined as sounds that are heard only by the patient and is the most common form
Subjective
118
The nurse recognizes which risk factors for the development of tinnitus?
A. Overuse of medications containing salicylate
B. Family history of chronic respiratory infections
C. Involvement in water sports activities
D. History of migraine headaches
A
119
_______ tinnitus is defined as sounds that the provider may actually hear on examination of the patient
Objective
120
Which type of seizure affects the entire brain? Which type of seizure affects a specific area of the brain?
Generalized - total
Specific area - partial
121
A nurse is caring for a client with Alzheimer's disease. A family member of the client asks the nurse about risk factor should be included in the nurse's response? (Select all that apply)
A. Exposure to metal
B. Long-term estrogen therapy
C. Sustained use of vitamin E
D. Previous head injury
E. History of herpes infection
D
122
The nurse recognizes that the primary indication for the administration of an opioid med is which outcome?
A. To reduce anxiety
B. To relieve pain
C. To diminish respiratory effort
D. To decrease level of consciousness
Answer: B
The principal indication for morphine is relief of moderate to severe pain. The drug can relieve postoperative pain, chronic pain of cancer, and pain associated with labor and delivery. Morphine may also be administered preoperatively for sedation and reduction of anxiety.
123
The nurse recommends treatment with transdermal fentanyl for which patient?
A. Severe pain due to cancer metastasis to bone
B. Postoperative pain after gastric bypass
C. Intermittent lower back pain associated with lumbar strain
D. Initial treatment for migraine headaches
Answer: A
Transdermal fentanyl is indicated
only for persistent severe pain in patients who are already opioid tolerant. Use in nontolerant patients can cause fatal respiratory depression. The patch should not be used in children under 2 years old, or in anyone under 18 who weighs less than
110 pounds. Also, the patch should not be used for postop pain, intermittent pain, or pain that responds to a less powerful analgesic.
124
In preparing an in-service about pain management, the nurse includes which finding as the most serious adverse effect of opioids?
A. Profound sedation
B. Suppressed cardiac automaticity
C. Respiratory depression D. Hyperthermia
Answer: C
Respiratory depression is the most serious adverse effect of the opioids. At equianalgesic doses, all of the pure opioid agonists depress respiration to the same extent. Death following overdose is almost always from respiratory arrest
125
A patient is admitted for evaluation and treatment of generalized tonic-clonic seizures. Which clinical manifestations does the nurse assess for in this type of seizure disorder?
A. Persistent jerking movement of one half of the body
B. Unilateral jerking movement of one extremity
C. Muscle flaccidity followed by tremors of all extremities
D. Stiffening of muscles of arms and legs, followed by jerking movements
Answer: D
Rationale: Tonic-clonic seizures are characterized
by loss of consciousness, a tonic phase marked by rigidity, followed by rhythmic jerking of all extremi- ties that reflect the clonic phase. Unilateral jerking is characteristic of myoclonic seizures. Muscle flaccidity is associated with absence seizures.
126
A nurse is providing teaching to the partner of a client who has Alzheimer's disease and a new prescription for donepezil. Which of the following statements indicates the teaching is effective?
A. This med should increase my spouse's appetite
B. This med should help my spouse sleep better
C. This med should help my spouse's daily function
D. This med should increase my spouse's energy level
C
127
A nurse is assisting a client who is ambulating to the bathroom. The client begins to have a seizure. Which actions should the nurse take? (Select All)
A. Provide privacy
B. Ease the client to the floor
C. Move furniture away from the client
D. Loosen client's clothing
E. Protect the client's head
F. Restrain the client
ABCDE
128
A nurse is providing discharge instructions to a client who has a prescription for phenytoin. Which of the following information should the nurse include?
A. Discontinue the medication if there is no seizure activity for 6 months
B. Watch for receding gums when taking the meds
C. Take the medication at the same time every day
D. Provide a urine sample to determine therapeutic levels of the medication
C
129
This med is a anti-pyretic, anti-inflammatory, analgesic, anti-platelet, do not take if bleeding disorders or Vitamin K deficiencies are present, side effects include nausea, vomiting, diarrhea
Aspirin
130
This med given in low doses can be a clot prophylaxis
Aspirin
131
What is a patient teaching for taking ibuprofen?
Take with meals (not on an empty stomach)
132
This med is used for mild to moderate pain, fever, flu-like symptoms, limit dosage to 3,000 mg or less per day, can cause GI upset or impaired liver function
Acetaminophen
133
What patient education should be taught for patients taking opioids?
Watch for respiratory depression less than 12, if patient is unarousable it is a medical emergency, take fiber and fluids to help offset changes of constipation
134
I'm a benzodiazepine, change positions slowly, don't operate heavy machinery, I have a calming and relaxing effect?
Lorazepam
135
A nurse is caring for a patient who has a new diagnosis of cataracts. Which of the following manifestations should the nurse expect? (Select all)
A. Eye pain
B. Floating spots
C. Blurred vision
D. White pupils
E. Bilateral red reflexes
C, D
136
A nurse is providing postoperative teaching to a client following cataract surgery. Which of the following statements should the nurse include in the teaching?
A. You can resume playing golf in 2 days
B. You need to tilt your head back when washing your hair
C. You can get water in your eyes in 1 day
D. You need to limit your housekeeping activities
D. because it can cause an increased IOP
137
A nurse is caring for a male older adult client who has a new diagnosis of glaucoma. Which of the following should the nurse recognize as risk factors associated with the disease? (Select All)
A. Sex
B. Genetic predisposition
C. Hypertension
D. Age
E. Diabetes mellitus
B, C, D, E
138
A nurse is caring for a client who has diabetes mellitus and reports a gradual loss of peripheral vision. The nurse should recognize this is a manifestation of which of the following diseases?
A. Cataracts
B. Open-angle glaucoma
C. Macular degeneration
D. Angle-closure glaucoma
B
139
A nurse is reviewing the health record of a client who has severe otitis media. Which of the following are expected findings? (Select All)
A. Enlarged adenoids
B. Report of recent colds
C. Client prescription for daily furosemide
D. Light reflex visible on otoscopic exam in the affected ear
E. Ear pain relieved by meclizine
A, B
140
A nurse is performing an otoscopic examination of a client. Which of the following is an unexpected finding?
A. Pearly gray tympanic membrane
B. Malleus visible behind the tympanic membrane
C. Present of soft cerumen in the external canal
D. Fluid or bubbles seen behind the tympanic membrane
D
141
142
The nurse is preparing a teaching plan for a postop cataract patient. What is the most important instruc- tion the nurse should communicate to the patient and his family?
A. Do not eat any foods containing caffeine for at least 48 hours postop.
B. Avoid bending over and lifting heavy objects.
C. Pain, sometimes severe, is expected in the first 48 hours postop.
D. Elevation of body temperature to 102°F (38.9°C) is normal the first 24 hours postop.
Answer: B
Rationale: Bending below the waist increases intraocular pressure and increases risk for intraocular hemorrhage.
143
