Med Surg Test 4 Flashcards by Kelsey Sapp

There is a strong association between _____ and Type II Diabetes, heart disease, airway obstruction, chronic kidney disease, nonalcoholic fatty liver disease, infertility issues, gastroesophageal reflux disease (GERD), cancer, increased medication prescription for pain relief, and psychiatric disorders.

Obesity

How well did you know this?

Not at all

Perfectly

A BMI range of __ to ___ is considered overweight.

25-29.9

How well did you know this?

Not at all

Perfectly

___ is calculated by weight in kilograms divided by height in meters squared

BMI

How well did you know this?

Not at all

Perfectly

Weight gain occurs when the intake of _____ exceeds energy expenditure.

calories

How well did you know this?

Not at all

Perfectly

What is basal metabolic rate?

the amount of energy required to maintain vital organ function

How well did you know this?

Not at all

Perfectly

What are risk factors for obesity?

Genetics, environmental factors (such as food availability and automation of human tasks), lack of physical activity

How well did you know this?

Not at all

Perfectly

Labs are used to identify secondary causes of obesity. What are possible secondary causes?

Diabetes, dyslipidemia, thyroid function, fatty liver disease

How well did you know this?

Not at all

Perfectly

What lab tests can be done to rule out diabetes in an obese patient?

Hemoglobin A1c and fasting blood glucose test

How well did you know this?

Not at all

Perfectly

What lab would we look at to identify thyroid issues as a secondary cause of obesity?

TSH (elevated would show hypothyroidism)

How well did you know this?

Not at all

Perfectly

All patients with a BMI greater or equal to ___ should be assisted with developing weight related goals and treatments.

How well did you know this?

Not at all

Perfectly

A calorie reduction of 500-1000 calories a day results in ____ lb weight loss per week.

1 to 2

How well did you know this?

Not at all

Perfectly

What type of patient would qualify for bariatric surgery?

Patient with BMI greater than 40, patient with BMI greater than 35 with comorbidities or significant reduction in quality of life BUT diet, activity, meds and behavioral therapy must have been ineffective.

How well did you know this?

Not at all

Perfectly

What are the signs and symptoms of pancreatitis?

Weight loss, nausea and vomiting, relief with positioning, ascites

How well did you know this?

Not at all

Perfectly

What 3 positions give relief from pancreatitis pain?

Sitting upright, fetal position, bending forward

How well did you know this?

Not at all

Perfectly

The signs and symptoms are sharp RUQ pain that can radiate to the right shoulder, fever and gas. What is this?

Cholecystitis

How well did you know this?

Not at all

Perfectly

What are risk factors for cholecystitis?

female, estrogen therapy, birth control use, obesity, high triglycerides, rapid weight loss, Native American and Mexican American

How well did you know this?

Not at all

Perfectly

What labs can help identify cholecystitis?

Elevated WBCs, elevated bilirubin, raised AST, ALP, LDH can indicate an obstruction

How well did you know this?

Not at all

Perfectly

The pathology of this is that gastric content and enzyme back flow from stomach into the esophagus. This exposes esophageal tissue to acidic fluids.

GERD

How well did you know this?

Not at all

Perfectly

What are risk factors for GERD?

hiatal hernia, motility problems, incompetent sphincters, obesity, older age, NG tube

How well did you know this?

Not at all

Perfectly

What are interventions for GERD?

diet and lifestyle change, low fat diet, avoid coffee, chocolate, citrus, alcohol

How well did you know this?

Not at all

Perfectly

What are three complications of GERD

inflammation, Barrett’s esophagus, adenocarcinoma of esophagus

How well did you know this?

Not at all

Perfectly

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect?
A. Pain in RUQ radiating to right shoulder
B. Report of pain being worse when sitting upright
C. Pain relieved with defecation
D. Epigastric pain radiating to the left shoulder

D. The nurse should expect that a client who has pancreatitis will report severe, boring epigastric pain that radiates to the back, left flank, or left shoulder.

How well did you know this?

Not at all

Perfectly

A nurse is assessing a client who has pancreatitis. Which of the following findings should the nurse identify as a manifestation of pancreatitis?
A. Generalized cyanosis
B. Hyperactive bowel sounds
C. Gray-blue discoloration of the skin around the umbilicus
D. Wheezing in the lower lung fields

C. - The nurse should recognize gray-blue discoloration in the periumbilical area, generalized jaundice, absent or decreased bowel sounds, diminished breath sounds as well as dyspnea or orthopnea.

How well did you know this?

Not at all

Perfectly

A nurse is reviewing the admission lab results of a client who has acute pancreatitis. Which findings should the nurse expect?
A. decreased blood lipase
B. decreased blood amylase
C. Increased blood calcium
D. Increased blood glucose

D. The blood glucose will be elevated due to pancreatic cell injury, which results in impaired metabolism of carbs due to a decrease in the release of insulin.

How well did you know this?

Not at all

Perfectly

A nurse is planning care for an older adult client who has pancreatitis. Pick YES (the nurse should plan to) or NO (the nurse should not plan to) for each option below. A. Admin meperidine to the client for acute pain B. Monitor the client's blood glucose C. Encourage client to decrease alcohol intake D. Ensure the client remains NPO E. Place client in a side-lying or semi-fowlers position.

A. No (contraindicated) B. Yes C. No (stop instead of decrease!) D. Yes E. Yes

A nurse is completing nutrition teaching to a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? (select all) A. I plan to eat small, frequent meals B. I will eat easy-to-digest foods with limited spice C. I will use skim milk when cooking D. I plan to drink regular cola E. I will limit alcohol to 2 drinks per day

A, B, C

A nurse is teaching a class about peptic ulcer disease. Sort the following into features associated with a Gastric Ulcer or with a Duodenal Ulcer A. Pain occurs 30-60 minutes after a meal B. Pain occurs 1.5-3 hours after a meal C. Melena (blood in stool) D. Hematemesis (bloody emesis) E. Pain exacerbated by ingestion of food F. Pain relieved by ingestion of food

A. Gastric B. Duodenal C. Gastric D. Duodenal E. Gastric F. Duodenal

A nurse is teaching a client who has an infection due to h. pylori. Which of the following statements by the client indicates understanding of the teaching? A. I will stop taking my meds as soon as I feel better B. I will take my meds with my morning coffee C. I will take a combo of medications for treatment D. I will take an antacid at the same time as my antibiotic medications

C. The nurse should identify that the patient understands they nedd to take multiple medications such as a proton pump inhibitor and antibiotics

Identify which of the following is a risk factors for cholecystitis. A. Obesity B. Rapid weight gain C. Decreased blood triglyceride level D. Male sex

Which of the following labs would be expected in a patient who is suspected to have cholelithiasis? A. blood amylase 80 units/L B. WBC 9,000 C. Direct bilirubin 2.1 D. Alkaline phosphates 25 units/L

A nurse is preparing a presentation for a group of newly licensed nurses on cholecystectomy and extracorporeal shockwave lithotripsy. Sort the findings the right procedure: cholecystectomy or lithotripsy A. Remove of the gallbladder B. Non-invasive procedure C. Minimally invasive procedure D. Delivery of shockwaves to a stone E. Usually requires a 24 hour hospital stay F. Removal of stones

Cholecystectomy: A, C, E, F Lithotripsy: B, D

A nurse is completing preoperative teaching for a client who is scheduled for a laparoscopic cholecystectomy. Which of the following should be included in the teaching? A. The scope will be passed through your rectum B. You might have shoulder pain after surgery C. You will have a Jackson-Pratt drain in place after surgery D. You should limit how often you walk for 1-2 weeks

B. Shoulder pain is expected post-op due to free air that is introduced into the abdomen during laparoscopic surgery

True of False: A patient with GERD should be taught not to eat within 3 hours of going to bed.

True

A nurse is caring for a client with abnormal upper GI bleed. After inserting an NG tube, what type of drainage would you expect to see?

coffee-ground drainage

Which macro (macros are carbs, proteins, fats) should a type 1 diabetic limit?

carbs

What is the onset time of regular insulin?

30-60 minutes

True or False: A patient taking NPH insulin should eat a snack 8 hours after taking the medication.

True, clients should check blood glucose 8-10 hours after taking NPH, if hypoglycemic eat a snack of 15g carbs and recheck in 15 minutes.

True or False: The nurse should instruct the client to leave the insulin she is currently using at room temperature to minimize painful injections.

True

Pancrelipase is a combination of pancreatic enzymes used to increase digestion of fats, carbohydrates and proteins. The client should expect a reduction of _____ in stools.

Fat

Which method would the nurse identify as a possible means to evaluate glycemic control in the patient diagnosed with diabetes? Select all that apply. A. patient-initiated home glucose monitoring B. Random single fasting blood glucose level C. Continuous blood glucose monitoring devices D. Lab testing of HgbA1c levels E. Patient report of monthly low glucose symptoms

A, C, D

An arterial pH of less than ___ may be indicative of diabetic ketoacidosis.

A serum bicarbonate level of less than ___ may be a sign of ketoacidosis

Which clinical manifestations are most likely to be seen in a patient with type 1 diabetes mellitus? Select all that apply. A. fatigue B. weight gain C. excessive thirst D. decreased appetite E. increased urine output

A, C, E

If a patient is very thin they should receive an insulin injection with the needle inserted at a ___ angle.

45 if thin 90 for normal size person

Which of these is a sign of diabetic ketoacidosis? Select all A. Neurological changes B. Hot to touch C. Nausea and vomiting D. Urinary incontinence E. Weekend alcohol ingestion

A, B, C, D E is not correct bc it would cause hypoglycemia

The nurse monitors for which findings in the patient with hyperthyroidism? (Select all that apply.) A. Weight loss B. Cold intolerance C. Constipation D. Tachycardia E. Exophthalmos

A, D, E

Following thyroid surgery, the nurse frequently assesses the patient’s ability to speak in order to monitor for which complication? A. Parathyroid injury B. Hypocalcemia C. Laryngeal nerve injury D. Hypercalcemia

The nurse monitors for which complication in the patient with hyperparathyroidism? A. Renal stones B. Seizures C. Laryngospasm D. Hypertension

The nurse provides education to a patient who has a hiatal hernia and experiences GERD after eating. Which activity should the nurse instruct this patient to avoid? A. Lying flat after meals B. Eating small, frequent meals that are not spicy C. Sleeping with the HOB elevated 30 degrees D. Taking ranitidine on an empty stomach

The nurse has requested a dietary consult for a patient with GERD. What statements provide useful dietary information for this patient to manage the GERD symptoms? (Select all that apply.) A. Maintain an ideal body weight. B. Avoid spicy foods. C. Avoid fatty foods. D. A glass of wine after dinner will help you relax. E. A cup of peppermint will help improve digestion.

A, B, C

A nurse working in an endoscopy clinic is screening patients for the risk of developing Barrett’s esopha- gus. The nurse should consider which patient at greatest risk? A. The patient with a 20-year history of alcohol abuse B. The patient with a 30-pack-per-year smoking history C. The patient who ingested lye as a child and is now 47 years old D. The patient who has had untreated GERD for 30 years

Which patient statement indicates effective teaching related to acute gastritis? A. “I will eat a diet rich in milk and cream to decrease the secretion of hydrochloric acid.” B. “I need to avoid using aspirin or nonsteroidal medications for routine pain relief.” C. “I will need to return for yearly upper endoscopy examinations.” D. “I will need to fully cook all meat, poultry, and egg products.”

The nurse identifies which nursing diagnosis as the highest priority for the patient admitted with PUD and possible perforation? A. Acute pain B. Ineffective health maintenance C. Nausea D. Impaired tissue integrity (GI)

The nurse assesses for which clinical manifestation in the patient with cholecystitis? A. Murphy’s sign B. Trousseau’s sign C. Cullen’s sign D. Grey Turner’s sign

The nurse admitting a patient with acute pancreatitis correlates this disease process with which etiology? A. Inflammation secondary to toxic substances B. Abuse of alcohol C. Destruction of the pancreas by viruses D. Digestion of the pancreas by enzymes

The nurse documents glucose in the urine as which finding? A. Polyuria B. Glucosuria C. Hyperglycemia D. Hyperosmolarity

What is measured by the HbgA1c test? A. Amount of glucagon stored in the liver B. Specific insulin levels in blood plasma C. Levels of hemoglobin after physical activity D. Average blood glucose concentration over time

Which are considered clinical manifestations of type 2 diabetes? (Select all that apply.) A. Decreased appetite B. Poor wound healing C. Fatigue D. Hyperactivity E. Visual disturbances

B, C, E

In a diabetic patient, numbness, tingling, and pain in the hands and feet are all symptoms of which complication? A. Autonomic neuropathy B. Hyperosmolar hyperglycemic syndrome C. Diabetic peripheral neuropathy D. Diabetic ketoacidosis

The nurse recognizes the action of insulin is to: A. Transport glucose to the cell B. Metabolize glucose within the cell C. Transport glucose to the liver for storage D. Transport glucose across the cell membrane

If a patient has hyperthyroidism their T3 and T4 will likely be ____ (high/low) and their TSH will be ____ (high/low)

high, low

What are three causes of hypoglycemia?

exercise, alcohol, insulin peak times

What are the 3 Ps when referring to clinical manifestations caused by hyperglycemia of Type I diabetes?

Polyuria, polydipsia, polyphagia

What is polydipsia?

escessive thirst

What is the cause of Type 1 diabetes mellitus?

The pancreas produces little to no insulin

Remember this rhyme about Type 1 diabetes...

Type 1 we have none, can give to our son (have no insulin, is often genetic)

What is the cause of type II diabetes?

The body becomes resistant to insulin or doesn't produce enough to maintain normal glucose levels

Remember this rhyme for Type II

Type II It's on you, Cells are through. It's usually a 'you' problem due to diet and exercise, cells are no longer responding to insulin

What are 4 risk factors for Type II diabetes? Think BBOL (like bowl)

B- blood pressure high B - blood glucose high O - obesity L - lipids, high cholesterol

Fill in the blanks... Risk factors for Type II diabetes include a BMI greater than ___, HgbA1c greater than ____.

BMI 26 or higher, HgbA1c over 6.5%

If a fasting blood glucose is over ____, it is interpreted as diabetes mellitus.

126

A random blood glucose level over ____ accompanied by classic signs and symptoms of hyperglycemia is diagnosed as diabetes mellitus.

200