Medical Surgical Nursing 6 Flashcards

Terms Definitions
Etiologic and morphologic classification for...

Anemia of gastritis

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

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
2
4
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Over 90% cure rate in stage I disease
Hodgkin's disease
Mature-appearing, but functionally inactive lymphocytes?

a. AML
b. ALL
c. CML
d. CLL
d. CLL
Identify the pathophysiologic stage of pneumococcal pneumonia:Blood flow decreases and leukocytes and fibrin consolidate in affected lung tissue
gray hepatization
True or False:

Genetic counseling and family planning is indicated for couples when one of them has __THALASSEMIA__.
True
Multiple fractured ribs causing paradoxic chest movement is known as _____ _____.
flail chest
An example of distraction to provide pain relief is A. TENS. B. music. C. exercise. D. biofeedback
music.
Characteristic of what transfusion reaction?

May restart transfusion with antihistamine therapy in mild cases

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
3. allergic reaction
Choose the appropriate word(s) from the choices in parentheses to complete the sentence r/t classification and tx protocols for TB.

The minimum tx period for a pt with an active TB infection is (6 / 9) months.
6 months
Collapse of the lung due to accumulation of air in the intrapleural space caused by a sucking chest wound is a _____ _____.
open pneumothorax
The desirable level for LDL is _____.
<130 mg/dl
Collapse of the lung due to accumulation of air in the intrapleural space caused by an injury to the lungs from closed rib fractures is known as _____ _____.
closed pneumothorax
The drug that controls ventricular arrhythmias 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
d. IV amiodarone (Cordarone)
During a health-promotion program, the nurse teaches the participants that the best way to prevent lung cancer is to:a. stop smoking and avoid secondhand smokeb. have an annual chest x-ray after the age of 50c. wear masks when exposed t
a. Smoking is responsible for approximately 80%-90% of cases of lung cancer, and enough cannot be said about its contribution to lung cancer as well as many other diseases. To prevent lung cancer, avoid exposure to cigarette smoke. Chest x-rays and evaluation of cough are diagnostic means once cancer has already developed.
Identify the class of drugs that are used to DECREASE HEART RATE:

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

(can have more than one answer)
d. beta-adrenergic blockers
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 (
9 months (minimum)6 months (beyond culture conversion)
The desirable level for HDL is _____.

(men or women)
men >37 mg/dl

women >40 mg/dl
Initial treatment of asystole and pulseless electrical activity is:

a. CPR
b. defibrillation
c. administration of atropine
d. administration of epinephrine
a. During asystole or pulseless electrical activity, CPR must be initiated immediately to maintain minimal cardiac output and oxygenation, followed by intubation and administration of epinephrine and atropine. Defibrillation is not effective because the myocardial cells are in a state of depolarization.
One of the characteristic phathophysiologic responses to infection by the TB bacillus is:a. metastases of osteocytes from the bone to the lung where they calcify lung tissueb. necrotic abscesses formed from reactions of the TB bacilli with ly
d. The TB bacilli create a cellular immune response with development of an epithelioid granuloma that is surrounded by lymphocytes. The central portion of the granuloma undergoes necrosis characterized by a cheesy appearance and is named caseous necrosis and eventually heals with fibrosis and calcification.
True or False?

A major concern in hemolytic anemias is maintenance of __LIVER__ function.
False

A major concern in hemolytic anemias is maintenance of KIDNEY function.
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 HAP
b. diagnostic testing does not have to be used to identif
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 pt has chronic bronchitis. To prevent the development of an acute exacerbation of chronic bronchitis (AECB), the nurse teaches the pt to take provided antibiotics with the onset of:a. rhinitis and headacheb. diffuse rhnonchi and wheezing
c. Acute bronchitis is the greatest threat to those who have chronic bronchitis, and they often are provided with antibiotics to take at the first symptoms, which include fever, increased productive cough, and exertional dyspnea. Diffuse rhonchi and wheezing may be heard on auscultation but would not usually be noted by the pt. Pleuritic pain may also occur, but the cough is productive.
The nurse teaches the patient taking antiseizure drugs that the method most commonly used to meausre compliance and to monitor for toxicity is:a. monthly EEGsb. a daily seizure logc. urine testing for drug levelsd. blood tes
d. Serum levels of antiseiaure drugs are monitored regularly to maintain therapeutic levels of the drug.
When teaching an older adult with CAD how to manage the treatment program for angina, the nurse instructs the patient:

a. to sit for 3-5 minutes before standing when getting out of bed
b. to exercise only twice a week to avoid unnecessary strain on the h
a. Orthostatic hypotension may cause dizziness and falls in older adults taking antianginal agents that decrease preload, and they should be cautioned about changing positions slowly.
During the care of the pt with thrombocytopenia, the nurse:
a. takes frequent temps to assess for fever
b. maintains the pt on strict bed rest to prevent injury
c. monitors the pt for headaches, vertigo, or confusion
d. removes oral crusting and scabs wit
c. The major complication of thrombocytopenia is hemorrhage, and it may occur in any area of the body. Cerebral hemorrhage may be fatal, and evaluation of mental status for CNS alterations to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention, but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs.
What is the function of the SECOND CHAMBER in a three-chamber water-seal pleural drainage system?
Water-seal chamber allowing escape of air but preventing its reentry to collection chamber
Premature ventricular contractions are indicated by a rhythm pattern finding of:

a. a QRS complex of >0.12 seconds followed by a P wave
b. continuous wide QRS complexes with a ventricular rate of 160 beats/min
c. sawtooth P waves with no measurable PR
a. The PVC is an ectopic beat that causes a wide, distorted QRS complex, greater than 0.12 seconds, because the impulse is not conducted normally through the ventricles. Because it is premature, it precedes the P wave and the P wave may be hidden in the QRS complex, or the ventricular impulse may be conducted retrograde and the P wave may be seen following the PVC. Continuous wide QRS complexes with a rate between 110 and 250 are seen in ventricular tachycardia, while sawtoothed P waves are characteristic of atrial flutter.
When caring for the pt with a chest tube, the nurse questions the practice of:a. looping the drainage tubing on the bedb. clamping the chest tube momentarily to check for leaksc. having the pt cough and deep breathe q2hd. strippin
d. Although stripping or milking chest tubes to promote drainage is somewhat controversial, there is no indication to milk the tubes when there is no bloody drainage, as in a pneumothorax. Tubing should be looped in the bed without any dependent loops to promote drainage, and pts should cough and deep breathe at least q2h to aid in lung reexpansion. Clamping of chest tubes may cause a tension pneumothorax, but tubes may be clamped momentarily to check for leaks in the system.
A 58-year-old patient is in a cardiac rehab program. The nurse teaches the patient to stop exercising if:

a. the HR exceeds 150 beat/min
b. the patient develops pain or dyspnea
c. the respiratory rate increases to 30 breaths/min
d. the HR is 30 beats ove
b. Any activity or exercise that causes dyspnea and chest pain should be stopped in the patient with CAD. The training target for a healthy 58-year-old is 80% of maximum HR, or 132 beats/min, but in a patient with cardiac disease undergoing cardiac conditioning, the HR should not exceed 20 beats/min over the resting pulse rate.
Lab and diagnostic findings the nurse would expect in an anemic pt with chronic alcoholism include:
a. achlorhydria and macrocytic erythrocytes
b. decreased serum folate and increased MCHC
c. increased indirect bilirubin and increased reticulocytes
d. dec
b. A common cause of folic acid deficiency is chronic alcohol abuse. Lab results in folic acid deficiency include decreased serum folate levels and increased mean corpuscular hemoglobin concentration (MCHC) due to the large cell size. Achlorhydria and macrocytic RBCs are characteristic of pernicious anemia, and increased indirect bilirubin and increased reticulocytes are characteristic of thalassemia and sickle cell anemia.
A pt with advanced lung cancer refuses pain meds, saying "I deserve everything this cancer can give me." The nurse's best response to the pt is:
a. "Would you like to talk to a counselor?"
b. "Can you tell me what the pain means t
b. Before making any judgments about the pt's statement, it is important to explore what meaning he finds in the pain. It may be that he feels it is deserved punishment for smoking, but further information needs to be obtained from the pt. Immediate referral to a counselor negates the nurse's responsibility in helping the pt, and there is no indication that he is not dealing effectively with his feelings.
The nurse advises a 75 yr old man that to prevent pneumonia, he should:a. obtain the pneumococcal vaccine q5-6yrsb. obtain the pneumococcal vaccine and an annual influenza vaccinec. seek medical care and antibiotic therapy for all URIs
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 strategy used to prevent the development of tolerance to the effects of transdermal nitrates includes:

a. removing the patch during the night
b. changing the sites of the patch every day
c. using the patch only when chest pain occurs
d. applying the pa
a. The body has a tendency to develop tolerance not only to the side effects of nitrates but also to the antianginal effect. Providing a nitrate-free period of at least 8 hours within each 24-hour period for any route of administration is usually effective in preventing development of tolerance. Night is the best time to remove the patch unless the patient has nocturnal angina. Patches are designed for continuous nitrate therapy and should not be used on a prn basis. The sites should be changed daily to prevent skin irritation and alterations in absorption, but this does not affect tolerance.
A pt has a platelet count of 50,000 and is dx with immune thrombocytopenic purpura. The nurse would expect initial tx to include:
a. splenectomy
b. corticosteroids
c. administration of platelets
d. immunosuppresive therapy
b. Corticosteroids are used in intial tx of ITP because they suppress the phagocytic response of splenic macrophages, decreasing platelet destruction. They also depress autoimmune antibody formation and reduce capillary fragility and bleeding time. All of the other therapies may be used but only in pts who are unresponsive to corticosteroid therapy.
A pt with a lung mass found on chest x-ray is undergoing further testing. A definitive diagnosis of cancer of the lung may be made with:
a. CT scans
b. lung tomograms
c. pulmonary angiography
d. identification of malignant cells in sputum
d. Although chest x-rays, lung tomograms, CT scans, MRI, and PET can identify tumors and masses, exact diagnosis of a lung malignancy requires identification of malignant cells either in sputum specimens or biopsies. It is important to note that a negative sputum cytology does not rule out the possibility fo cancer, but positive findings can confirm it.
A pt with active TB does not have negative sputum cultures after 6 months of tx because she says she cannot remember to take the meds all the time. The best action by the nurse is to:a. schedule the pt to come to the clinic every day to take
d. The nurse should notify the public health department if drug compliance is questionable so that follow-up of pts can be made by directly observed tx (DOT) by a public health nurse or a responsible family member. A pt who cannot remember to take the meds usually will not remember to come to the clinic daily or will find it too inconvenient. Additional teaching, or support from others, is not usually effective for this type of pt.
A pt with active TB does not have negative sputum cultures after 6 months of tx because she says she cannot remember to take the meds all the time. The best action by the nurse is to:

a. schedule the pt to come to the clinic every day to take the medicat
d. The nurse should notify the public health department if drug compliance is questionable so that follow-up of pts can be made by directly observed tx (DOT) by a public health nurse or a responsible family member. A pt who cannot remember to take the meds usually will not remember to come to the clinic daily or will find it too inconvenient. Additional teaching, or support from others, is not usually effective for this type of pt.
A patient with an acute MI has a sinus tachycardia of 126 beats/min. The nurse recognizes that if this arrhythmia is not treated, the patient is likely to experience:

a. hypertension
b. escape rhythms
c. ventricular tachycardia
d. an increase in infarct
d. Although many factors may cause a sinus tachycardia, in the patient who has had an acute MI, a tachycardia increases myocardial oxygen need in a heart that already has impaired circulation and may lead to increasing angina and further ischemia and necrosis.
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