Medical Surgical Nursing 7 Flashcards

Terms Definitions
Etiologic and morphologic classification for...

Thalassemia

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

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

Affects all ages
non-Hodgkin's lymphoma
An appropriate nonopioid analgesic for mild pain is A. oxycodone. B. ibuprofen (Advil). C. lorazepam (Ativan). D. cyclobenzaprine (Flexeril).
ibuprofen (Advil).
True or False?

Thrombotic thrombocytopenic purpura is characterized by __DECREASED__ platelets, __DECREASED__ RBCs, and __DECREASED__ agglutination function of platelets.
False

Thrombotic thrombocytopenic purpura is characterized by DECREASED platelets, DECREASED RBCs, and INCREASED agglutination function of platelets.
Choose the appropriate word(s) from the choices in parentheses to complete the sentence r/t classification and tx protocols for TB.

Latent TB infection is treated with (INH / combination) therapy.
INH
The desirable level for TRIGLYCERIDES is _____.
<190 mg/dl
Increased incidence in atomic bomb survivors?

a. AML
b. ALL
c. CML
d. CLL
c. CML
When air in the intrapleural space progressively increases intrathoracic pressure because it cannot escape during expiration, a _____ _____ occurs.
tension pneumothorax
Characteristic of what transfusion reaction?

Destruction of donor RBCs

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
1. acute hemolytic reaction
Collapse of the lung due to accumulation of air in the intrapleural space caused by a sucking chest wound is a _____ _____.
open pneumothorax
The drug that relieves pain by decreasing O2 demand and increasing O2 supply 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
e. IV nitroglycerin
Linkages of NANDA nursing diagnoses, NOC patient outcomes, and NIC nursing interventions can be used to A. evaluate patient outcomes. B. provide guides for planning care. C. predict the results of nursing care. D. shorten written
provide guides for planning care.
True or False?

Staging of lymphomas is important to __PREDICT PROGNOSIS__.
False

Staging of lymphomas is important to DETERMINE TREATMENT.
What is the mechanism of pulmonary hypertension for the following condition:Pulmonary fibrosisa. stiffening of pulmonary vasculatureb. obstruction of pulmonary blood flowc. pulmonary capillary/alveolar damaged. l
a. stiffening of pulmonary vasculature
Nursing interventions for the pt with aplastic anemia are directed toward the prevention of the complications of:
a. fatigue and dyspnea
b. hemorrhage and infection
c. thromboemboli and gangrene
d. cardiac arrhythmias and heart failure
b. Hemorrhage from thrombocytopenia and infection from neutropenia are the greatest risks for the pt with aplastic anemia. The pt will experience fatigue from anemia, but bleeding and infection are the major causes of death in aplastic anemia.
Cardiac debrillation:

a. enhances repolarization and relaxation of ventricular myocardial cells
b. provides an electrical impulse that stimulates normal myocardial contractions
c. depolarizes the cells of the myocardium to allow the SA node to resume pac
c. The intent of defibrillation is to apply an electrical current to the heart that will depolarize the cells of the myocardium so that subsequent repolarization of the cells will allow the SA node to resume the role of pacemaker.
Initial antibiotic tx for pneumonia is usually based on:a. the severity of symptomsb. the presence of characteristic leukocytesc. Gram's stains and cultures of sputum specimensd. H&P exam and characteristic chest x-ray finding
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.
The nurse suspects stable angina rather than MI pain in the patient who reports chest pain:
a. is relieved by nitroglycerin
b. is a sensation of tightness or squeezing
c. does not radiate to the neck, back, or arms
d. is precipitated by physical or emotio
a. One of the primary differences between the pain of angina and the pain of an MI is that angina pain is usually relieved by rest or nitro, which reduces the oxygen demand of the heart, while MI pain is not. Both angina and MI pain can cause a pressure or squeezing sensation; may radiate to the neck, back, arms, fingers, and jaw; and may be precipitated by exertion.
The nurse explains to the pt with pernicious anemia that:
a. death can be prevented by cobalamin supplementation for the rest of the pt's life
b. the syptoms of the disease can be completely reversed with cobalamin (vit B12) therapy
c. bone marrow transpl
a. Without cobalamin replacement, individuals with pernicious anemia will die in 1 to 3 years, but the disease can be controlled with cobalamin supplements for life. Hematologic manifestations can be completely reveresed with therapy, but long-standing neuromuscular complications may not be reversed. Since pernicious anemia results from an inability to absorb cobalamin, dietary intake of the vitamin is not a treatment option, nor is a bone marrow transplant.
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
The use of computers to document nursing practice with nursing languages A. protects patient anonymity and confidentiality. B. establishes that high standards of care are met. C. assists in the evaluation of the effectiveness of nursin
assists in the evaluation of the effectiveness of nursing interventions
When teaching the patient with angina about taking nitroglycerin tablets, the nurse instructs the patient:

a. to take the tablet with a large amount of water so it will dissolve right away
b. to lie or sit down and place one tablet under the tongue when
b. A common complication of nitrates is dizziness caused by orthostatic hypotension, so the patient should sit or lie down and place the tablet under the tongue. The tablet should be allowed to dissolve under the tongue, and to prevent the tablet from being swallowed, water should not be taken with it. If the pain is not relieved, 2 more tablets may be taken at 5-minute intervals, but if the pain is present after 15 minutes and 3 tablets, the patient should seek medical attention.
To administer iron IM, the nurse should:
a. use a short, fine needle to avoid pain
b. massage the site after the injection to promote absorption
c. include 0.5 ml of air in the syringe to clear the iron from the needle
d. administer the injection in the v
c. Parenteral iron is very irritating and can stain the skin, so needles are changed between withdrawing and administering the medication; 0.5 ml of air is left in the syringe to completely clear the solution from the syringe during administration; it is administered Z-track in the large upper outer quad of the buttocks; and the site is not massaged after administration.
The nurse uses protective measures with pts at risk for lung abscesses based on the knowledge that lung abscesses occur most frequently in pts with:
a. lung tumors
b. altered consciousness
c. altered immune response
d. pulmonary infarct infections
b. The most common cause of lung abscesses is aspiration of oropharyngeal materials into the lung, especially when oral and dental hygiene are poor. Positioning to protect the airway and prevent aspiration in pts with altered consciousnes is an important measure.
In planning care for the pt with bronchiectasis, the nurse includes measures that will:a. relieve or reduce painb. prevent paroxysmal coughingc. prevent spread of the dx to othersd. promote drainage and removal of mucus
d. Mucus production is increased in bronchiectasis and collects in the dilated, pouched bronchi. A major goal of tx is to promote drainage and removal of the mucus, primarily through deep breathing, coughing, and postural drainage.
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 TBb. poor compliance with drug therapy in pts with TBc. the increased population of im
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.
A second 12-lead ECG performed on a patient 4 hours after the onset of chest pain reveals ST-segment elevation. The nurse recognizes that this finding indicates a:
a. transient ischemia typical of unstable angina
b. lack of permanent damage to myocardial
c. A differentiation is made between myocardial infarcts that have ST-segment elevations on ECG and those that do not. Chest pain that is accompanied by ST-segment elevations is associated with prolonged and complete coronary thrombosis and is treated with reperfusion therapy.
In teaching the pt with pernicious anemia about the disease, the nurse explains that it results from a lack of:
a. folic acid
b. intrinsic factor
c. extrinsic factor
d. cobalamine intake
b. Pernicious anemia is a type of cobalamin (vit B12) deficiency that results when parietal cells in the stomach fail to secrete enough intrinsic factor to absorb ingested cobalamin. Extrinsic factor IS cobalamin and may be a factor in some cobalamin deficiencies but not in pernicious anemia.
The primary tx for cor pulmonale is directed toward:
a. controlling arrhythmias
b. dilating the pulmonary arteries
c. strengthening the cardiac muscle
d. 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.
The patient's PR interval comprises six small boxes on the ECG graph. The nurse determines that this indicates:

a. a normal finding
b. a problem with ventricular depolarization
c. a distrubance in the repolarization of the atria
d. a problem with conduct
d. The normal PR interval is 0.12 to 0.20 seconds and reflects the time taken for the impulse to spread through the atria, AV node and bundle of His, the bundle branches, and Purkinje fibers. A PR interval of six small boxes is 0.24 seconds and indicates that the conduction of the impulse from the atria to the Purkinje fibers is delayed.
A pt is diagnosed with cancer of the lung after seeking medical tx for symptoms of SIADH. The nurse recognizes that the lung malignancy most commonly r/t this symptom:a. can be successfully treated with radiationb. metastasizes early and has
b. SIADH is one manifestation of paraneoplastic endocrine disturbance associated with small cell lung cancer. Small cell lung cancer is associated with cigarette smoking and has the poorest prognosis because of high malignancy and early spread. Surgical resection of squamous cell lung cancer and adenocarcinoma is possible if localized, and large cell tumors are somewhat radiosensitive. Adenocarcinoma is associated with lung scarring and chronic interstitial fibrosis.
To detect and treat the most common complication of MI, the nurse:
a. measures hourly urine output
b. ausculatates the chest for crackles
c. uses continuous cardiac monitoring
d. takes VS q2hr for the first 8 hours
c. The most common complication of MI is cardiac arrhythmias, especially ventricular arrhythmias that may be life-threatening. Continuous cardiac monitoring allows for identification and treatment of arrhythmias that may cause further deterioration of the cardiovascular status.
During discharge teaching with a pt with newly diagnosed sickle cell disease, the nurse teaches the pt to decrease the risk of a sickle cell crisis by:
a. limiting fluid intake
b. avoiding hot, humid weather
c. eliminating exercise from the lifestyle
d. s
d. The pt with sickle cell disease is particularly prone to infection, and infection can precipitate a sickle cell crisis. Pts should seek medical attention quickly to counteract URIs because pneumonia is the most common infection of the pt with sickle cell disease. Fluids should be increased to decrease blood viscosity, which may precipitate a crisis, and moderate activity is permitted.
A pt is diagnosed with cancer of the lung after seeking medical tx for symptoms of SIADH. The nurse recognizes that the lung malignancy most commonly r/t this symptom:
a. can be successfully treated with radiation
b. metastasizes early and has the poorest
b. SIADH is one manifestation of paraneoplastic endocrine disturbance associated with small cell lung cancer. Small cell lung cancer is associated with cigarette smoking and has the poorest prognosis because of high malignancy and early spread. Surgical resection of squamous cell lung cancer and adenocarcinoma is possible if localized, and large cell tumors are somewhat radiosensitive. Adenocarcinoma is associated with lung scarring and chronic interstitial fibrosis.
A 52-year-old man is admitted to the ER with severe chest pain. The nurse suspects an MI upon finding that the patient:
a. has pale, cool, clammy skin
b. reports nausea and vomited once at home
c. is anxious and has a feeling of impending doom
d. has had
d. The pain of an MI is usually severe, is usually unrelieved by nitro, rest, or position change, and usually lasts more than the 15 or 20 minutes typical of angina pain. All of the other symptoms may occur with angina as well as an MI.
A pt receiving chemo for breast cancer develops cryptococcoses and is treated with IV amphotericin B. The nurse monitors the pt for side effects of the amphotericin B with the knowledge that this pt is at risk for increased:
a. renal impairment
b. immunos
c. Apmhotericin B is a toxic drug with many side effects, including hypersensitivity reactions, fever, chills, malaise, nausea and vomiting, and abnormal renal function, but it does not commonly cause immunosuppression. The side effect that would most commonly intesify when a pt also receives chemotherapeutic agents would be the nausea and vomiting.
A pt diagnosed with Class 3 TB 1 week ago is admitted to the hospital with symptoms of chest pain and a possible MI. The nurse knows that:a. the pt has a TB infection without clinical evidence of the diseaseb. respiratory isolation may be req
b. A pt with class 3 TB has clinically active disease, and respiratory isolation is required for active disease until the pt has been on drug hterapy for at least 2 weeks or until smears are negative on 3 consecutive days. A TB infection without clinical evidence of TB is class 2, class 4 includes pts with a hx of TB but without current disease, and class 5 includes those suspected of having TB pending definite diagnosis.
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