Medical Surgical Nursing 3 Flashcards

Terms Definitions
Etiologic and morphologic classification for...

Aplastic anemia

1. decreased RBC production
2. blood loss
3. increased RBC destruction

4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Primary initial clinical manifestation is painless lymph node enlargement
Identify the pathophysiologic stage of pneumococcal pneumonia:Outpouring of fluid into alveoli that supports microorganism growth and spread
True or False?

Treatment of __HEMACHROMATOSIS__ involves weekly phlebotomy for 2 to 3 years.
Accumulation of lymphatic fluid in the pleural space due to a leak in the thoracic duct is known as _____.
Proliferation of immature lymphocytes in bone marrow?

a. AML
b. ALL
c. CML
d. CLL
b. ALL
CNS manifestations common?

a. AML
b. ALL
c. CML
d. CLL
b. ALL
Collapse of the lung due to accumulation of blood in the intrapleural space is a _____.
Most common leukemia of adults?

a. AML
b. ALL
c. CML
d. CLL
d. CLL
Only cure is bone marrow transplant?

a. AML
b. ALL
c. CML
d. CLL
c. CML
Accumulation of lymphatic fluid in the pleural space due to a leak in the thoracic duct is known as _____.
Which of the following words is most likely to be used to describe neuropathic pain? A. dull B. mild C. aching D. burning
85% of acute leukemia in adults?

a. AML
b. ALL
c. CML
d. CLL
a. AML
The usual treatment for a large pneumothorax or hemothorax of any cause is a _____ _____ connected to _____-_____ _____.
chest tubewater-seal drainage
True or False?

A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical exam of the pt is __ECCHYMOSIS__.

A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical exam of the pt is PETECHIAE.
The class of antibiotics most commonly used to treat a Category 1 CAP is __________ __________ __________.
advanced generation macrolides
During the initial pain assessment process, the nurse should A. assess critical sensory components. B. teach the patient about pain therapies. C. conduct a comprehensive pain assessment. D. provide appropriate treatment and evalu
conduct a comprehensive pain assessment.
What is the mechanism of pulmonary hypertension for the following condition:

Chronic Obstructive Pulmonary Disease (COPD)

a. stiffening of pulmonary vasculature
b. obstruction of pulmonary blood flow
c. pulmonary capillary/alveolar damage
d. local vasoc
c. pulmonary capillary/alveolar damage
An important nursing responsibility related to pain is to A. leave the patient alone to rest. B. help the patient appear to not be in pain. C. believe what the patient says about the pain. D. assume responsibility for eliminating
believe what the patient says about the pain
Choose the appropriate word(s) from the choices in parentheses to complete the sentence r/t classification and tx protocols for TB.

A pt who has HIV and clinical TB should receive combination drug therapy for a minimum of (9 / 12) months and (6 / 9) mont
9 months (minimum)

6 months (beyond culture conversion)
The classification of pneumonia as commuity-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP) is clinically useful because:a. atypical pneumonia syndrome is more likely to occur in HAPb. diagnostic testing does not have to be used
c. Pneumonia that onsets in the community is usually caused by different microorganisms than pneumonia that develops during hospitalization, and tx can be empirical -- based on observations and experience w/o knowing the exact cause. In at least half the cases of pneumonia, a causative organism cannot be identified from cultures, and tx is based in experience.
A patient with a tremor is evaluated for Parkinson's disease. The nurse explains to the patient that Parkinson's disease can be confirmed by:a. CT and MRI scans b. relief of symptoms with administration of dopaminergic agentsc. th
b. Although clinical manifestations are characteristic in Parkinson's disease, there are no lab or diagnostic tests specific for the condition. A diagnosis is made when there are at least two of the three signs of the classic triad, and it is confirmed with a positive response to antiparkinsonian medication. Essential tremors increase during voluntary movement, while the tremors of Parkinson's disease are more prominent at rest.
While taking nursing histories of patients, the nurse identifies that the patient with the hightest risk for coronary artery disease is the patient who is:
a. an African-American man, age 65, with obesity and a BP of 160/85
b. a Caucasian man, age 54, who
d. The Caucasian woman has one unmodibiable risk factor (age) and two major modifiable risk factors (HTN and physical inactivity). Her gender risk is as high as a man's because of her age. The Caucasian man has one unmodifiable risk factor (gender), one major modifiable risk factor (smoking), and one minor modifiable risk factor(stressful lifestyle). The African-American man has an unmodifiable risk factor (HTN), and one minor modifiable risk factor (obesity), but African-American men are at less risk for CAD than are Caucasians of the same age. The Asian woman has only one major modifiable risk factor (hyperlipidemia), and Asians in the United States have fewer MIs than do Caucasians.
The nurse should check for leaks in the chest tube and water-seal system when:a. there is constant bubbling of water in the suction-control chamberb. there is continuous bubbling from the tube in the water-seal chamberc. the water level
b. The water-seal chamber should bubble intermittently as air leaves the lung with exhalation in a spontaneously breathing pt, and continuous bubbling indicates a leak. The water in the suction-control chamber will bubble continuously, and the fluid in the tubing in the water-seal chamber fluctuates with the pt's breathing. Water in the suction-control chamber, and perhaps in the water-seal chamber, evaporates and may need to be replaced periodically.
A nurse believes that patients with the same type of tissue injury should have the same amount of pain. This statement reflects A. a belief that will contribute to appropriate pain management. B. an accurate statement about pain mechanisms a
the nurse’s lack of knowledge about pain mechanisms, which is likely to contribute to poor pain management.
During a routine health exam, a 48-year-old man is found to have a total cholesterol level of 224 mg/dl and an LDL level of 140. The nurse teaches the patient that a Step 1 dietary change should include:
a. use of skim or 1% milk
b. elimination of red mea
a. Step 1 dietary changes include decreased intake of saturated fat and cholesterol and the substitution of skim or 1% milk for whole milk.
A pt has a WBC of 2300/uL and a neutrophil percentage of 40%.

Does the pt have a leukopenia?

WBC below 5000/uL
The nurse prepares to administer IV GM-CSF (Leukine) to a pt with neutropenia resulting from chemo for non-Hodgkin's lymphoma. The nurse explains to the pt that this preparation:
a. can stimulate the production and function of neutrophils and monocytes
a. GM-CSF is a type of colony-stimulating factor that is a naturally produced protein which stimulates proliferation and differentiation of granulocytes and monocytes. It is used to hasten recovery from bone marrow depression after chemo or decrease bone marrow suppression associated with chemo administration. Monoclonal antibodies, such as rituximab and ibritumomab tiuxetan, as well as interferons may be used to destroy malignant cells of NHL.
Initial antibiotic tx for pneumonia is usually based on:
a. the severity of symptoms
b. the presence of characteristic leukocytes
c. Gram's stains and cultures of sputum specimens
d. H&P exam and characteristic chest x-ray findings
d. Prompt tx of pneumonia with appropriate antibiotics is important in treating bacterial and mycoplasma pneumonia, and antibiotics are often administered on the basis of the hx, physical exam, and a chest x-ray showing a typical pattern characteristic of a particular organism, without further testing. Sputum and blood cultures take 24 to 72 hours for results, and microorganisms often cannot be identified with either Gram stains or cultures. Whether the pneumonia is community-acquired or hospital acquired is more significant than severity of symptoms.
What is the function of the FIRST CHAMBER in a three-chamber water-seal pleural drainage system?
Collection of air and fluid from chest cavity with air vented to second chamber
The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by:a. MRI findingsb. T cell analysis of the bloodc. analysis of cerebrospinal fluidd. history and clinical manifestations
d. There is no specific diagnostic test for MS, and a diagnosis is made primarily by history and clinical manifestions. In later MS, CT and MRI may detect sclerotic plaques. Some patients have elevations of oligoclonal immunoglobulin G, lymphocytes, and monocytes in cerebrospinal fluid, but these findings do not establish a diagnosis of MS.
The strict vegetarian is at highest risk for the development of:
a. thalassemias
b. iron deficiency anemia
c. folic acid deficiency anemia
d. cobalamin deficiency anemia
d. Because red meats are the primary dietary source of cobalamin, a strict vegetarian is most at risk for cobalamin-deficiency anemia. Meats are also an important source of iron and folic acid, but whole grains, legumes, and green leafy vegetables also supply these nutrients. Thalassemia is not related to dietary deficiencies.
The nursing assessment of a pt with bronchiectasis is most likely to reveal a hx of:
a. chest trauma
b. childhood asthma
c. smoking or oral tobacco use
d. recurrent lower respiratory tract infections
d. Almost all forms of bronchiectasis are associated with bacterial infections that damage the bronchial walls. The incidence of bronchiectasis has decreased with use of measles and pertussis vaccines and better tx of lower respiratory tract infections.
A patient's rhythm strip indicates a normal HR and rhythm with normal P wave and QRS complex, but the P-R interval is 0.26 seconds. The most appropriate action by the nurse is to:

a. continue to assess the patient
b. administer atropine per protocol
c. p
a. A rhythm pattern that is normal except for a prolonged P-R interval is characteristic of a first-degree heart block. First-degree heart blocks are not treated but are observed for progression to higher degrees of heart block.
A patient has a nursing diagnosis of stress urinary incontinence related to overdistention between voidings. An appropriate nursing intervention for this patient related to this nursing diagnosis is to A. provide privacy for toileting. B. mo
C. teach the patient to void at 2-hour intervals.
Two risk factors for CAD that are considered to increase the workload of the heart and increase myocardial oxygen demand include:
a. HTN and elevated serum lipds
b. cigarette smoking and diabetes mellitus
c. cigarette smoking and physical inactivity
d. ty
d. Stress r/t a type A behavior pattern is associated with increased sympathetic nervous system stimulation, increasing HR and contractility and thus the workload of the heart. HTN also increases the workload of the heart by requiring more force to pump blood through the diseased arterial vasculature.
While receiving a unit of packed RBCs, the pt develops chills and a temp of 102.2F. The nurse:
a. notifies the physician and the blood bank
b. stops the transfusion and removes the IV catheter
c. adds a leukocyte reduction filter to the blood administrati
a. Chills and fever are symptoms of acute hemolytic or febrile transfusion reaction, and if these develop, the transfusion should be stopped, saline infused through the IV line, the physician and blood bank notified immediately, the ID tags rechecked, and VS and urine output monitored. Addition of a leukocyte reduction filter may prevent a febrile reaction but is not helpful once the reaction has occurred. Mild and transient allergic reactions indicated by itching and hives might permit restarting of the transfusion after treatment with antihistamines.
Following a thoracotomy, the pt has a nursing diagnosis of ineffective airway clearance r/t inability to cough secondary to pain and positioning. The best nursing intervention for this pt is to:
a. have the pt drink 16 oz of water before attempting to dee
d. A thoracotomy incision is large and involves cutting into bone, muscle, and cartilage, resulting in significant postop pain. The pt has difficulty deep breathing and coughing because of the pain, and the analgesics should be provided before attempting these activities. Water intake is important to liquefy secretions, but it is not indicated in this case, nor should a pt with chest trauma or surgery be place in Trendelenburg's position because it increases intrathoracic pressure.
A pt with a hemoglobin level of 7.8 g/dl has cardiac palpations, a heart rate of 102, and an increased reticulocyte count. At this severeity of anemia, the nurse would also expect the patient to manifest:
a. pallor
b. dyspnea
c. a smooth tongue
d. sensiti
b. The pt's Hb level indicates a moderate anemia, and at this severity, additional findings ususally include dyspnea and fatigue. Pallor, smooth tongue, and sensitivity to cold usually manifest in severe anemia when the Hb level is below 6 gm/dl.
A patient with heart disease has a sinus bradycardia of 48 beats/min. The nurse recognizes that the patient is at greatest risk for:

a. asystole
b. heart block
c. sinus arrest
d. ectopic premature beats
d. In the presence of heart disease, a slow SA impulse may allow for escape arrhythmias and premature beats that can lead to further arrhythmias and decreased cardiac output.
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