Medical Surgical Nursing 5 Flashcards

Terms Definitions
Etiologic and morphologic classification for...

Malaria

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

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
3
4
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Often widely disseminated at time of diagnosis
non-Hodgkin's lymphoma
Choose the appropriate word(s) from the choices in parentheses to complete the sentence r/t classification and tx protocols for TB.When a person who is taking corticosteroids for rheumatoid arthritis has a positive PPD skin test, tx would inc
latent
True or False?

Pts with platelet deficiencies usually bleed from __SUPERFICIAL SITES__ while those with diminished clotting factors experience __DEEP OR INTERNAL__ bleeding.
True
Choose the appropriate word(s) from the choices in parentheses to complete the sentence r/t classification and tx protocols for TB.

When a person who is taking corticosteroids for rheumatoid arthritis has a positive PPD skin test, tx would include drugs
latent
When the nurse determines that the patient’s anxiety needs to be relieved before effective teaching can be implemented, the phase of the nursing process being used is A. assessment. B. diagnosis. C. planning. D. evaluation.
planning.
Characteristic of what transfusion reaction?

May be avoided by leukocyte reduction filters

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
2. febrile reaction
True or False?

An example of an intravascular extrinsic hemolytic anemia results from __BLOOD TRANSFUSION REACTIONS__.
True
The class of antibiotics most commonly used to treat a Category 1 CAP is __________ __________ __________.
advanced generation macrolides
The drug that minimizes bradycardia from vagal stimulation in the treatment of MI is:

a. beta-adrenergic blockers
b. IV morphine
c. stool softeners
d. IV amiodarone (Cordarone)
e. IV nitroglycerin
f. ACE inhibitors
c. stool softeners
The drug that is associated with decreased reinfarction and increased survival in the treatment of MI is:

a. beta-adrenergic blockers
b. IV morphine
c. stool softeners
d. IV amiodarone (Cordarone)
e. IV nitroglycerin
f. ACE inhibitors
a. beta-adrenergic blockers
True or False?

The nurse suspects heparin-induced thrombocytopenia and thrombosis syndrome when a pt receiving heparin requires __DECREASED__ heparin to maintain therapeutic activated thromboplastin times.
False

The nurse suspects heparin-induced thrombocytopenia and thrombosis syndrome when a pt receiving heparin requires INCREASED heparin to maintain therapeutic activated thromboplastin times.
Usual initial clinical manifestations of TB include:a. chest pain, hemoptysis, and weight lossb. fatigue, low grade fever, and night sweatsc. cough with purulent mucus and fever with chillsd. pleuritic pain, nonproductive cough, a
b. TB usually develops insidiously with fatigue, malaise, low-grade fevers, and night sweats. Chest pain and a productive cough may also occur, but hemoptysis is a late symptom.
Identify the class of drugs that are used to PREVENT THROMBOSIS OF PLAQUES:

a. nitrates
b. calcium channel blockers
c. antiplatelet agents
d. beta-adrenergic blockers

(can have more than one answer)
c. antiplatelet agents
What is the mechanism of pulmonary hypertension for the following condition:Neuromuscular disordersa. stiffening of pulmonary vasculatureb. obstruction of pulmonary blood flowc. pulmonary capillary/alveolar damage
d. local vasoconstriction and shunting
During assessment of a patient admitted to the hospital with an acute exacerbation of MS, the nurse would expect to find:a. tremors, dysphasia, and ptosisb. bowel and bladder incontinence and loss of memoryc. motor impairment, vis
c. Motor and sensory dysfunctions, including paresthesias as well as patchy blindness, blurred vision, and hearing loss, are the most common manifestions of MS. Bowel and bladder dysfunctions and ataxia also occur, but excessive involuntary movements, tremors, and memory loss are not seen in MS.
The nurse plans close monitoring for the patient who has undergone electrophysiologic testing because this test:

a. requires the use of dyes that irritate the myocardium
b. causes myocardial ischemia resulting in arrhythmias
c. induces arrhythmias that m
c. Electrophysiologic testing involves electrical stimulation to various areas of the atrium and ventricle to determine the inducibility of arrhythmias and frequently induces ventricular tachycardia or ventricular fibrillation. The patient may have "near-death" experiences and requires emotional support if this occurs.
An example of a metastatic infection that occurs as a complication of pneumococcal pneumonia is:a. pleurisyb. empyemac. meningitisd. pleural effusion
c. Pneumococcal meningitis is a metastatic complication of pneumococcal pneumonia, as well as infectious pericarditis, arthritis, or endocarditis. Pleurisy, empyema, and pleural effusion may also result from pneumococcal pneumonia, but these conditions are caused by local spread rather than a hematogenous route.
A nursing intervention that is indicated for the pt during a sickle cell crisis is:
a. frequent ambulation
b. applicaiton of antiembolism hose
c. restriction of sodium and oral fluids
d. administration of large doses of continuous narcotic analgesics
d. Because pain usually accompanies a sickle cell crisis and may last for 4-6 days, pain control is an important part of tx. Rest is indicated to reduce metabolic needs, and fluids and electrolytes are administered to reduce blood viscosity and maintain renal function. Although thrombosis does occur in capillaries, elastic stockings that primarily affect venous circulation are not indicated.
An example of a metastatic infection that occurs as a complication of pneumococcal pneumonia is:
a. pleurisy
b. empyema
c. meningitis
d. pleural effusion
c. Pneumococcal meningitis is a metastatic complication of pneumococcal pneumonia, as well as infectious pericarditis, arthritis, or endocarditis. Pleurisy, empyema, and pleural effusion may also result from pneumococcal pneumonia, but these conditions are caused by local spread rather than a hematogenous route.
The primary tx for cor pulmonale is directed toward:a. controlling arrhythmiasb. dilating the pulmonary arteriesc. strengthening the cardiac muscled. treating the underlying pulmonary condition
d. If possible, the primary management of cor pulmonale is treatment of the underlying pulmonary problem that caused the heart problem. Low-flow oxygen therapy will help prevent hypoxemia and hypercapnia that causes pulmonary vasoconstriction.
An observation of the patient made by the nurse that is most indicative of Parkinson's disease is:a. large and embellished handwritingb. a weakness of one leg resulting in a limping walkc. difficulty arising from a chair and begin
c. The bradykinesia of Parkinson's disease prevents automatic movements, and such activities as beginning to walk, rising from a chair, or even swallowing saliva cannot be executed unless they are consciously willed. Handwriting is affected by the tremor and results in the writing trailing off at the end of words. Specific limb weakness and muscle spasms are not characteristic of Parkinson's disease.
Angina pectoris, the pain, most likely occurs with myocardial ischemia as a result of:
a. death of myocardial tissue
b. arrhythmias caused by cellular irritability
c. lactic acid accumulation during anaerobic metabolism
d. elevated pressure in the ventric
c. When the coronary arteries are occluded, contractility ceases after several minutes, depriving the myocardial cells of glucose and oxygen for aerobic metabolism. Anaerobic metabolism begins and lactic acid accumulates, irritating myocardial nerve fibers that then transmit a pain message to the cardiac nerves and upper thoracic posterior roots.
A pt with acute myelogenous leukemia is to start chemo. During the induction stage of chemo, the nurse can expect the pt to:
a. experience mild side effects of the drugs
b. experience additive bone marrow suppression
c. receive high-dose treatment daily f
b. Induction therapy is aggressive tx with chemotherapeutic agents, which often causes the pt to become devastatingly ill and predisposed to complications because the bone marrow is even further suppressed by the drugs. Induction therapy is usually administered for 10 days and may be followed by intensification therapy that involves high-dose therapy for several months.
The anemia that follows acute blood loss is most frequently treated with __INCREASED DIETARY IRON INTAKE__.
False

The anemia that follows acute blood loss is most frequently treated with BLOOD TRANSFUSIONS OR IRON SUPPLEMENTS
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 chamber
b. there is continuous bubbling from the tube in the water-seal chamber
c. the water levels in the water-s
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.
The nursing assessment of a pt with bronchiectasis is most likely to reveal a hx of:a. chest traumab. childhood asthmac. smoking or oral tobacco used. 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, admitted to the hospital for evaluation of chest pain, has normal cardiac enzyme values 4 hours after the onset of pain. A noninvasive diagnostic test that can differentiate angina from other types of chest pain is a(n):
a. ECG
b. exercise stre
b. An exercise stress test will reveal ECG changes that indicate impaired coronary circulation when the oxygen demand of the heart is increased. A single ECG is not conclusive for CAD, and negative findings do not rule out CAD. Echocardiograms of various types may identify abnormalities of myocardial wall motion under stress but are indirect measures of CAD. Coronary angiography can detect narrowing of coronary arteries but is an invasive procedure.
A pt with hemophilia is hospitalized with acute knee pain and swelling. Nursing interventions for the pt include:
a. wrapping the knee with an elastic bandage
b. placing the pt on bed rest and applying ice to the joint
c. gently performing ROM exercises t
b. During an acute bleeding episode in a joint, it is important to totally rest the involved joint and slow bleeding with application of ice. Drugs that decrease platelet aggregation, such as aspirin or NSAIDS, should not be used for pain. As soon as bleeding stops, mobilization of the affected area is encouraged with ROM exercises and physical therapy.
The resurgence in TB due to emergence of multidrug-resistant strains of M. tuberculosis is primarily the result of:
a. a lack of effective means to dx TB
b. poor compliance with drug therapy in pts with TB
c. the increased population of immunosuppressed i
b. Drug-resistant strains of TB have developed becuase TB pts' compliance to drug therapy has been poor and there has been general decreased vigilance in monitoring and follow-up of TB tx. Antituberculous drugs are almost exclusively used for TB infectious. TB can be effectively diagnosed with sputum cultures. The incidence of TB is at epidemic proportions in pts with HIV, but this does not account for drug-resistant strains of TB.
When obtaining a health hx from the pt with suspected CAP, the nurse expects the pt to report:a. an insidious onsetb. a dry productive coughc. a recent loss of consciousnessd. an abrupt onset of fever and chills
d. CAP usually has an acute onset with fever, chills, productive cough with purulent or bloody sputum, and pleuritic chest pain. A recent loss of consiousness or altered consciousness is common in those pneumonias associated with aspiration, such as anaerobic bacterial pneumonias.
To reduce the risk for falls in the patient with Parkinson's disease, the nurse teaches the patient to:a. use an elevated toilet seatb. use a walker or cane for supportc. consciously lift the toes when steppingd. rock side t
c. The shuffling gait of Parkinson's disease causes the patient to be off balance and at risk for falling. Teaching the patient to use a wide stance with the fee apart, to lift the toes when walking, and to look ahead helps promote a more balanced gait. Use of an elevated toilet seat and rocking side to side will enable a patient to initiate movement. Canes and walkers are difficult for patients with Parkinson's disease to maneuver and may make the patient more prone to injury.
A pt has a WBC of 2300/uL and a neutrophil percentage of 40%.

Does the pt have neutropenia?
Yes

Neutrophils less than 1000 to 1500/uL
A pt is admitted to the hospital with fever, chills, productive cough with rusty sputum, and pleuritic chest pain. Pneumococcal pneumonia is suspected. An appropriate nursing diagnosis for the pt based on the systemic manifestations of pneumococcal pneumo
b. The pt with pneumococcal pneumonia is acutely ill with fever and the systemic manifestions of fever, such as chills, thirst, headache, and malaise. Interventions that monitor temp and aid in lowering body temp are appropriate. Diarrhea is not associated, nor is disorientation and confusion unless the pt is very hypoxemic. Pleuritic pain is a local manifestation of pneumococcal pneumonia, not a systemic manifestion.
A patient with no history of heart disease has a rhythm strip that shows an occasional distorted P wave followed by normal AV and ventricular conduction. The nurse questions the patient about:

a. the use of caffeine
b. the use of sedatives
c. any aerobic
a. A distorted P wave with normal conduction of the impulse through the ventricles is characteristic of a premature atrial contraction. This arrhythmia is frequently associated in a normal heart with emotional stress or the use of caffeine, tobacco, or alcohol. Aerobic conditioning and holding the breath during exertion (Valsalva's maneuver) often cause bradycardia. Sedatives rarely may slow heart rate.
The nurse advises a 75 yr old man that to prevent pneumonia, he should:
a. obtain the pneumococcal vaccine q5-6yrs
b. obtain the pneumococcal vaccine and an annual influenza vaccine
c. seek medical care and antibiotic therapy for all URIs
d. obtain the pn
b. The pneumococcal vaccine is good for a lifetime except for immunosuppressed pts, who should receive the vaccine q5-6yrs. The influenze virus undergoes minor changes each year, and the vaccine should be taken by those at risk for influenze and lower respiratory infections annually in the fall before exposure to the flu virus occurs. Antibiotic therapy is not appropriate for all URIs unless secondary bacterial infections develop
A patient with an acute MI is having multifocal PVCs and ventricular couplets. He is alert and has a BP of 118/78 with an irregular pulse of 86 beats/min. The most appropriate action by the nurse at this time is to:

a. continue to assess the patient
b. b
c. PVCs in a patient with an MI indicate significant ventricular irritability that may lead to ventricular tachycardia or ventricular fibrillation. Antiarrhythmics, such as lidocaine, may be used to control the arrhythmias. Valsalva's maneuver may be used to treat paroxysmal supraventricular tachycardia.
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