MedSurg - Test 2 Flashcards
1
Q
What questions would you ask during a GI assessment?
A
Dietary practices, nutrition, oral health, weight changes, appetite changes, stool changes, pain
2
Q
What is a normal albumin?
A
3.7-5.1 (according to book)
3
Q
If an albumin level is less than 3.5 what does this indicate?
A
altered nutritional status
4
Q
What is a normal pre-albumin level?
A
12-42 mg/dL
5
Q
What social history questions could you ask regarding GI?
A
Do you smoke? Do you use perception or OTC drugs? Any recent international travel?
6
Q
What medical history could you asking regarding GI?
A
Do you have a Hx of GERD, anorexia, bulimia, IBS, diabetes?
7
Q
With a patient that has an ostomy what should be assessed and documented?
A
The 3 S’s - Skin, Stoma, Stool
8
Q
What bowel sounds can be an early indication of obstruction, diarrhea, or inflammatory bowel syndrome?
A
hyperactive
9
Q
What is the expected reference range of creatinine in an adult patient?
A
0.5-1.2 mg/dL
10
Q
What lab is associated with a patient taking warfarin?
A
INR (international normalized ratio)
11
Q
What is an INR lab used for?
A
To see how long it takes for blood to form a clot.
12
Q
What is the normal range for INR?
A
2-3
13
Q
What is the risk of a high INR?
A
Risk of bleeding
14
Q
What is oliguria?
A
Low urine output
15
Q
If a patient is in the oliguric phase of acute kidney injury. What finding should the nurse expect?
A
Hyperkalemia
16
Q
When administering a cleansing enema, how high should the nurse hold the container?
A
12 inches above the anus
17
Q
TURP ?
A
Transurethral resection of the prostate
18
Q
What do anticholinergic medications do?
A
Suppress bladder contractions and increase bladder capacity.
19
Q
A group of kidney diseases that cause inflammation and damage to the glomeruli?
A
Glomerulonephritis
20
Q
What recommendation should a nurse make for a patient that takes OTC calcium carbonate antacids?
A
Drink a glass of water after taking
21
Q
BPH?
A
Benign prostatic hyperplasia
22
Q
What is urolithiasis?
A
Kidney stones
23
Q
What is Interstitial cystitis?
A
Chronic, painful bladder issue
24
Q
For a patient with chronic glomerulonephritis, which lab value would they expect to be decreased? A. Potassium B. Phosphate C. Creatinine D. RBC
A
RBC
25
What is the minimum amount of urine output in one hour?
30mL
26
What is uremia?
A condition when the kidneys are not able to filter waste from the blood
27
What is oliguria?
Little urine output
28
What is hyperkalemia?
Abnormally high levels of potassium in the blood
29
What is an inflammation of the kidneys caused by a bacterial infection called?
Pyelonephritis
30
What medication should be held on a patient doing a CT with contrast?
Metphormin
31
What jobs do the kidneys have?
Filter blood and produce urine from the byproduct, balance electrolytes, balance water, balance acids, help regulate BP and vitamin D
32
What is the first sign something is wrong with the kidneys?
Urine output
33
When BUN and creatinine are BOTH elevated it is a sign of what?
Kidney damage (or kidney issue)
34
If a urine analysis is positive what test would be run next?
A urine culture and sensitivity
35
What meds are nephrotoxic?
NSAIDS and -mycins (example: vancomycin)
36
What is nocturia?
Frequent urination during the night
37
What is anuria?
Absence or near absence of urine (less than 100mL in a day)
38
What happens to the body when kidney function decreases?
Edema, ammonia breath, vascular issues, dry skin
39
When collecting a UA from a female what are the steps?
Wipe three times (outside, outside, inside), urinate, hold, urinate in cup
40
How does urine have to be stored when doing a 24 hours urine collection?
On ice
41
True or False - Females are at a great risk for UTIs.
True
42
What are there signs and symptoms of a UTI?
Frequency, irritation, odor, dark color, blood in urine, cloudy
43
What does a UA look for with urine?
Nitrates and WBCs
44
What can happen if a UTI goes untreated?
The bacteria can travel up the ureters potentially to the kidney causing kidney infection or even urosepsis
45
What are three problems kidney stones can cause?
blockage, pain, tissue damage
46
What are risk factors for kidney stones?
Gout, diabetes, family history
47
What are signs and symptoms of kidney stones?
pain, decreased urine, sharp pain, waves of pain, nausea and vomiting, flank pain, blood in urine, distention
48
What two ways can you diagnose kidney stones?
CT scan or ultrasound
49
What is a lithotripsy?
A procedure that breaks up kidney stones
50
When would surgery be required for kidney stones?
If they haven't been passed in 4-6 weeks or are larger than 10mm
51
What medications are used for kidney stones?
Pain meds (morphone or hydramorphone), Anti-inflammatory (NSAIDS), muscle relaxer (tamsulosin), antiemetics if nausea and vomiting
52
What would you monitor in a patient with kidney stones?
Vitals, pH, passing of the stone with a strainer, output and color, CBC
53
How often would you cleanse the perineal area with a patient that has a catheter?
Once a shift
54
What do you document when placing a foley?
size and storage (example: 16FR 500CCs)
55
What factors contribute to urinary incontinence?
stress, age, trauma, urge, history or UTIs
56
What medication is giving for incontinence overflow?
tamsulosin
57
What is stress incontinence?
Urine leaks during physical activities, coughing, etc
58
What is reflex incontinence?
When the bladder muscle contracts on its own
59
Mixed incontinence is a combination of which two types?
Stress and urge
60
This lab is used to determine if a patient needs dialysis or not?
GFR
61
With GFR the ____ the number, the better.
higher
62
What is an IVP?
IV Pyelogram (xray imaging procedure that examines the bladder, urinary tract, kidneys, ureters with contrast)
63
What is it called with bacteria travels up the ureters causing inflammation?
Pyelonephritis
64
What happens to vitals when a patient is dehydrated?
BP is down, HR is up
65
What lab would be important to run on a patient you suspect of having pyelonephritis?
CBC to see WBC count for infection
66
What would you check before giving acetaminophen? (Tylenol)
Liver function
67
What three labs assess the liver?
ALT, AST, ALP
68
What three labs assess the kidneys?
BUN, Creatinine, GFR
69
What tests can be done to diagnose BPH?
Digital rectal exam, urine analysis, blood test for PSA
70
What does the lab 'PSA' stand for?
Prostate specific antigen
71
If a patient is still experiencing BPH symptoms after months of non surgical treatments what surgical treatment will they likely have?
TURP (transurethral resection of prostate)
72
What would you expect the urine in the urine collection bag to look like after a TURP?
Light pink (urine with a ting of blood)
73
Is a weak urine stream a sign of UTI or BPH?
BPH
74
Is urgency a sign of BPH or UTI?
Both
75
What is it called when stool moves too slowly through the large intestine?
constipation
76
What are complications of constipation?
STEMI/MI, hemorrhoids, impaction
77
What is loose, unformed, watery stool?
Diarrhea
78
What medication is used to slow intestinal peristalsis, is an opioid, taken oral for diarrhea?
Diphenoxylate
79
What test is done to see if a patient has C. diff?
EIA (enzyme immunoassay)
80
What antibiotic medication is given for patients with C. diff?
vancomycin
81
What is important to know about vancomycin?
It is renal toxic
82
What are signs and symptoms of appendicitis?
Pain in RLQ, pain at McBurney's point, Rovsing's sign (LLQ elicits pain in RLQ), elevated WBC
83
If a patient has signs and symptoms of appendicitis and WBCs are over 20 what would you suspect?
perforated or ruptured appendix
84
A ruptured appendix could lead to?
peritinitis
85
What is the most used way to diagnose appendicitis?
CT
86
What antibiotic medication would be used for a mild case of C diff?
Metronidazole
87
A surgically created opening in an organ is called?
ostomy
88
Most hernias can be diagnosed without imaging, but what imaging would be used to tell the difference between different types of hernias?
CT or MRI
89
How is an incisional hernia formed?
Forms in the area of a previous surgery
90
A patient with a hernia is encouraged to do what if they have to cough?
Splint with a pillow
91
What is a topical medication used for hemorrhoids?
nifedipine
92
What interventions can be used for hemorrhoids?
Cold packs, sitz bath, increasing fluid and fiber, using stool softners
93
A patient with hemorrhoids asks the nurse how to prevent worsening symptoms. Which response is most appropriate?
a) "Avoid sitting for long periods and straining during bowel movements."
b) "Increase your intake of spicy foods to stimulate bowel activity."
c) "Take an NSAID daily to reduce inflammation."
d) "Use a cold pack on the abdomen to shrink the hemorrhoids."
A
94
A nurse is educating a patient with diverticulitis about dietary management during an acute episode. Which instruction should be included?
a) "Eat a high-fiber diet to promote bowel regularity."
b) "Consume clear liquids and avoid solid foods until symptoms improve."
c) "Include nuts and seeds to prevent further inflammation."
d) "Avoid drinking water to reduce bowel irritation."
B
95
Scenario: A 45-year-old patient presents to the emergency department with a 2-day history of watery diarrhea (8–10 episodes/day), nausea, and weakness. Vital signs: BP 90/60 mmHg, HR 110 bpm, RR 20/min, Temp 100.2°F (37.9°C). Labs show potassium 3.0 mEq/L and sodium 130 mEq/L.
Select all that apply: Which interventions should the nurse prioritize for this patient?
a) Administer IV fluids
b) Encourage small sips of a sports drink
c) Monitor for cardiac arrhythmias
d) Provide a high-fiber meal
e) Assess skin turgor and mucous membranes
Answer: a, c, e
Rationale: IV fluids address dehydration and hypotension, cardiac monitoring is needed due to hypokalemia, and skin/mucous membrane assessment evaluates hydration status. High-fiber meals and oral sports drinks are inappropriate during acute diarrhea with severe electrolyte imbalances.
96
Scenario: A 60-year-old patient with a history of hypertension reports constipation for 5 days, bloating, and mild abdominal pain. The patient takes a calcium channel blocker and has a sedentary lifestyle. The nurse notes hard, dry stools on assessment.
Select all that apply: Which factors are likely contributing to the patient’s constipation?
a) Sedentary lifestyle
b) Calcium channel blocker medication
c) Excessive dietary fiber intake
d) Dehydration
e) High caffeine consumption
Answer: a, b, d
Rationale: Lack of activity, calcium channel blockers (which slow GI motility), and dehydration contribute to constipation. Excessive fiber or caffeine typically promotes bowel movements
97
Place the following nursing interventions in the correct order of priority.
A. Administer a prescribed laxative
B. Encourage ambulation
C. Increase fluid intake
D. Assess bowel sounds
D, C, B, A
98
This type of hernia cuts off blood supply, causing severe pain, nausea, and an irreducible mass—indicating a surgical emergency.
strangulated hernia
99
Which of the following is the priority nursing action when a patient’s ileostomy output suddenly stops?
a) Encourage the patient to drink more fluids
b) Assess for signs of bowel obstruction
c) Change the ostomy appliance
d) Apply a warm compress to the abdomen
B
100
Scenario: A 72-year-old male patient with benign prostatic hyperplasia (BPH) reports difficulty starting urination, dribbling, and a feeling of incomplete bladder emptying. He denies fever or flank pain. Vital signs: BP 140/90 mmHg, HR 76 bpm, RR 14/min, Temp 97.8°F (36.6°C). A bladder scan shows 450 mL of residual urine.
Select all that apply: Which findings in the scenario indicate urinary retention?
a) Difficulty initiating urination
b) Dribbling after voiding
c) Residual urine of 450 mL
d) Absence of fever
e) Feeling of incomplete emptying
A, B, C, E
101
What would you expect the abdomen to feel like on a patient with peritinitis?
Rigid
102
If diverticulitis is not treated what can occur?
Peritinitis which could then lead to sepsis
103
What are three risk factors for C. diff?
Over age 65, use of antimicrobials, immunosuppressed
104
What imaging technique is used to look for or at a hernia and uses a contrast in the abdomen?
herniography
105
What are nursing interventions for a patient with a hernia?
Clear liquid diet (to start), ice pack, pain meds, deep breathing
106
What procedure is used for hemorrhoids?
Rubber band ligation
107
What is an out pouching of intestinal wall that becomes inflamed?
Diverticulitis
108
A nurse is caring for a client with an NG tube set to low intermittent suction. Which action should the nurse take to ensure proper functioning?
a) Irrigate the tube with 50 mL of tap water every shift
b) Check for placement by auscultating air over the epigastrium
c) Clamp the tube during ambulation to prevent reflux
d) Position the client in a supine position during suction
B
109
A nurse is caring for a client with a suspected strangulated hernia. Which assessment finding is most concerning?
a) Fever and tachycardia
b) Mild discomfort at the hernia site
c) Soft, reducible bulge
d) Increased flatus
A
110
MED: Common GI antibiotic that can cause GI upset?
Metronidazole (flagyl)
111
MED: A urinary analgesic commonly used to relieve pain, burning, and discomfort associated with urinary tract infections (UTIs), often alongside antibiotics. It can change urine color to a reddish-orange hue, which is a well-known side effect.
Phenazopyridine
112
A nurse is preparing to administer bisacodyl to a client with constipation. Which instruction should the nurse provide to ensure safe use?
a) "Take this medication with a large meal to enhance absorption."
b) "Swallow the tablet whole and avoid crushing it."
c) "Expect immediate relief within 15 minutes of taking it."
d) "Mix the tablet with milk to reduce stomach upset."
B - Bisacodyl is a stimulant laxative with an enteric coating to prevent gastric irritation. Crushing it or mixing with milk (especially) can reduce effectiveness and increase side effects
113
A nurse is educating a client about docusate sodium for occasional constipation. Which statement by the client indicates understanding?
a) "This medication will cause a bowel movement within an hour."
b) "I should drink plenty of water while taking this medication."
c) "It’s normal to experience abdominal cramping with this drug."
d) "I can stop taking it as soon as I feel better."
B - Docusate sodium is a stool softener that works by drawing water into the stool, so hydration enhances its effect. It doesn’t act quickly (takes 12–72 hours) and typically doesn’t cause cramping.
114
True or False: Docusate sodium is contraindicated in clients with acute abdominal pain or bowel obstruction.
True - it can make the condition worse
115
A nurse is caring for a client receiving magnesium hydroxide for constipation. Which assessment finding should the nurse report immediately?
a) Loose, watery stools
b) Mild abdominal bloating
c) Heart rate of 55 bpm and confusion
d) Increased thirst after administration
C
116
Magnesium hydroxide functions as both a ______ and a ______
Laxative / antacid - It neutralizes stomach acid (antacid) and draws water into the intestines to relieve constipation (osmotic laxative).
117
A nurse is monitoring a client taking diphenoxylate with atropine for diarrhea. Which side effect should the nurse prioritize assessing for?
a) Increased bowel sounds
b) Drowsiness and dry mouth
c) Elevated blood pressure
d) Frequent loose stools
B
118
Why is diphenoxylate combined with atropine in its formulation?
Atropine is added to discourage abuse of diphenoxylate (a controlled substance) by causing unpleasant side effects (e.g., dry mouth, tachycardia) at high doses.
119
A nurse is preparing to administer polyethylene glycol (PEG) to a client for bowel preparation. Which action is most appropriate?
a) Administer the solution warm to improve taste
b) Instruct the client to drink the full dose quickly over 1–2 hours
c) Mix the solution with a carbonated beverage for palatability
d) Encourage the client to lie flat during administration
B
120
What broad spectrum antibiotic is contraindicated in a patient with a sulfa allergy?
bactrim
121
Which medication would need an INR?
Warfarin
122
What identifies parasites in stool?
Parasite and ovum culture
123
A nurse is educating a client prescribed metronidazole for a bacterial infection. Which instruction should the nurse include?
a) "Take this medication with a glass of wine to reduce nausea."
b) "Avoid alcohol during treatment and for 48 hours after."
c) "Expect your urine to turn bright red as a normal effect."
d) "Take it on an empty stomach for best absorption."
B
124
A radiographic test that uses X-rays to capture images of the esophagus while the patient swallows
Barium swallow
125
A nurse is caring for a client 4 hours after an appendectomy. Which assessment finding requires immediate intervention?
a) Pain level of 4/10 at the incision site
b) Absence of bowel sounds
c) Rigid, board-like abdomen
d) Temperature of 99.8°F (37.7°C)
C
126
Match the nursing actions to their purpose:
Actions: 1) Palpate the bladder, 2) Assist with ambulation, 3) Insert a straight catheter if ordered
Purposes: a) Relieve urinary retention, b) Assess for distension, c) Stimulate bladder emptying
1-b, 2-c, 3-a
127
A patient reports uncontrolled loss of urine. Which assessments made by the nurse are most relevant to designing a proper treatment plan for the patient? Select all that apply.
A. Fluid intake
B. Voiding history
C. Smoking history
D. Alcohol history
E. Reproductive history
B, D
128
True or False: An epidural given too early can prolong labor?
True
