Med Surg Test 3 Flashcards
(112 cards)
1
Q
What 3 types of meningitis are there?
A
bacterial, viral, fungal
2
Q
Signs and symptoms of meningitis?
A
Neck pain, back pain, stiffness, photophobia
3
Q
What populations are at the highest risk for meningitis?
A
People living in close proximity; college dorms, military barracks, prisons, etc.
4
Q
What tests are done for meningitis?
A
lumbar puncture to look for increased WBCs
5
Q
What complication could a patient complain of after a lumbar puncture?
A
Headache (leaking cerebral spinal fluid)
6
Q
What would the doctor order for bacterial meningitis?
A
IV Antibiotics, typically going for 14-21 days
7
Q
what is ICP?
A
Inter-cranial pressure
8
Q
What are complications of meningitis?
A
ICP, seizures
9
Q
Top three concerns for a patient with meningitis?
A
Activity intolerance (spinal cord pain), ineffective coping, sensory deficits
10
Q
What are we assessing with meningitis?
A
Vitals, neuro, pain, headaches, lab results
(Watch for changes in these to see if there are further complications)
11
Q
What interventions would you do for a meningitis patient?
A
Low stimulation room, administer ordered antibiotics, admin IV fluids PRN, pain meds, HOB at 30 degrees
12
Q
What is TB?
A
A life-threatening respiratory infection
13
Q
What is important to assess with TB?
A
Respirations and lung sounds
14
Q
What precaution is a patient with TB put on?
A
Airborne (with negative pressure room)
15
Q
On the PPD an induration of 5mm or greater is considered positive in which populations?
A
HIV-infected, person with recent contact to a TB positive person, immunocompromised, people with fibrotic changes on chest X-ray consistent with previous TB
16
Q
Mr. Brown is positive for TB, what is his treatment?
A
Antibiotics (for 9-12 months)
17
Q
What is the PPE for airborne?
A
Gown, gloves, N-95 mask
18
Q
Complications of TB?
A
Respiratory failure, bronchopleural fistula, pleural effusions
19
Q
What will you assess on a patient with TB?
A
Lung sounds, vitals (esp O2 and fever), lab values, sputum
20
Q
What interventions will we take with a TB positive patient?
A
Continuous monitoring of oxygen, antibiotics, adequate nutrition
21
Q
MRSA is what type of precaution?
A
Contact
22
Q
What PPE for contact precautions?
A
Gown, gloves
23
Q
What is an antibiotic that can be used for MRSA?
A
Vancomycin
24
Q
What does the body use to fight off infection?
A
WBCs
25
What two major lymphocytes does the body use to fight infection?
B and T cells, B makes you have signs and symptoms and T attacks infection
26
B cells do what?
Mark and produce antibodies to infections
27
Which cells need to live with a host? (B or T cells)
T cells
28
Which organ levels are elevated if you have an autoimmune issue?
Liver and spleen
29
CBC with diff is breaking down which blood cells?
WBCs
30
What things would you want to know about your patient when presenting with infection?
Diet (eating enough protein, vitamin C), health history
31
What meds can affect your patient's immune system?
Steroids, chemo, antibiotics
32
A nurse is caring for a client who is post-op in skeletal traction. Which three things should the nurse suspect?
A. Slight pain at the insertion site
B. Serious drainage on the dressing
C. Movement of the pin
D. Elastic bandages secure around the traction ropes
E. Minimal edema around the pin
A, B, E
33
A nurse is assessing a client for a possible anaphylactic reaction. For which of the client findings should the nurse intervene first?
A. Urticaria (itching)
B. Stridor
C. Vomiting
D. Hypotension
B. Stridor
34
When removing PPE, should the nurse take off the eyewear or gown first?
Eyewear
35
Which is a contraindication of using aspirin?
A. History of gastric ulcers
B. Report or recent migraine
C. Glaucoma
A
36
True or False. You should cleanse a would with 0.9% sodium chloride saline before obtaining a culture for a wound drainage culture.
True - Remove any leftover ointments first
37
What will appear if a tuberculin skin test is positive?
An induration (hardened area, 10mm or larger)
38
When caring for an immobile patient, what should be the priority?
A. Auscultating breath sounds every 2 hours or less
B. Performing ROM exercises 2-3 times a day
C. Apply anti embolic stockings
A (Think ABCs and secretions for an immobile patient)
39
Which PPE should the nurse remove first; Gown, mask, or gloves
gloves (remove most contaminated to least contaminated)
40
Patient is 2 days Post op from an above the knee amputation. Which is an appropriate nursing intervention?
A. Elevate the foot of bed
B. Encourage client to sit up
C. Elevate residual limb with a pillow
D. Have the client lie prone every 3 hours for 20 minutes at a time
D
41
Which of these puts a patient at risk for wound dehiscence?
A. obesity
B. poor nutritional status
C. wound infection
D. altered mental status
E. pain medication administration
A, B, C
42
What type of wedge device is used for a patient with a hip arthroplasty?
abduction device
43
What is Russell's traction?
A type of skin traction that incorporates a sling under the knee and a rope with an overhead pulley
44
What vaccine should a college student receive?
Meningitis (meningococcal polysaccharide vaccine)
45
Should the nurse expel the air bubble in a pre-filled syringe of enoxaparin before administering?
No
46
Which can be suggested for use with OA to relieve discomfort? Heat, ice or both?
Both
47
Which dressing should be used on a stage 1 pressure injury?
Transparent dressing - to keep moisture and bacteria out, minimizing friction and sheet but still allowing oxygen
48
A serum albumin less than ____ indicates poor nutrition and can mean poor wound healing
3.5
49
What is orthopnea?
Shortness of breath while lying flat
50
The pathophysiology of ______ is that destruction of lung tissue occurs in the patient during granuloma formation.
Tuberculosis
51
The nurse would monitor for which potential adverse effect in a patient receiving antitubercular medication? Select all that apply.
A. Numbness of feet/hands
B. Jaundice
C. Hypertension
D. Abnormal bleeding
E. Vision changes
A, B
52
TB is classified into __ groups.
4 (latent, primary, primary-progressive, drug-resistant)
53
A calcified granuloma evident on chest x-ray is a classic sign of the type of TB termed _____ ______. The inactive bacilli remain dormant within the healed granuloma. Patients with LTBI have no symptoms, do not feel ill, and are not contagious. As long as the immune system remains intact, the bacilli remain in the healed tissue of the granuloma for the individual’s lifetime and do not progress to TB infection.
latent TB
54
Primary TB infection is often asymptomatic and is confirmed only by which two ways? (This person is not infectious.)
positive sputum cultures and positive skin test
55
What color sputum would you expect in a patient with TB?
rust colored (blood streaked)
56
What is the name of test used to determine if a person has TB?
Mantoux
57
What blood test can be used to confirm a Mantoux test?
QuantiFeron
58
Which classification of tuberculosis (TB) infection can be caused by primary or secondary spread?
Multidrug resistant TB
59
60
Which is the main cause of blood-tinged, rust-colored sputum in a patient suffering from tuberculosis (TB)?
A. The destruction of lung parenchyma tissue
B. The inflammatory process of lungs
C. Decreased pH and increased CO2
D. Tachypnea and tachycardia
A
61
The nurse documents an induration of 6 mm as positive for tuberculosis (TB) exposure. To which patient would this finding apply?
A. An HIV-infected person
B. Recent immigrant from foreign country
C. Person working in a healthcare setting
D. Person who has no risk factors for TB
A
62
The nurse is teaching about the epidemiology of tuberculosis (TB). Which statements confirm understanding? Select all that apply.
A. TB is present in foreign-born individuals
B. Low-socioeconomic groups are most affected
C. Most affected are 40-60 years old
D. About half the HIV-infected population in the US is affected
E. Individuals with AIDS are most prone to TB
A, B, E
63
What is DOT therapy?
When a patient takes their meds in front of or through video while a trained worker observes for adherence.
64
The nurse is assessing a patient with tuberculosis (TB). Which best describes the gas exchange in the patient?
A. Alteration in gas exchange; related to necrosis of the lung tissue
B. Alteration in comfort; pain related to pleurisy
C. Alteration in gas exchange; decreased related to impaired alveolar-capillary interface
A (Necrosis of lung tissue is related to NANDA in patient from TB, hence rust color sputum)
65
An induration of 10mm or greater is considered positive in which type of patients? (select all)
A. Recent immigrant from foreign country
B. Person with no known risk factors for TB
C. Healthcare worker
D. Children younger than 4
A, C, D
66
The nurse understands that the priority intervention with the patient with TB is which of the following?
A. Antibiotic admin
B. Initiation of isolation
C. TB test
D. Chest x-ray
B
67
Ineffective airway clearance, alteration in gas exchange related to necrosis of lung tissue, ineffective coping related to isolation and long-term therapy and alteration in comfort due to pain related to pleurisy are related to what disease?
tuberculosis
68
What are signs and symptoms of TB?
Rust colored sputum, wheezing, fever, night sweats, chills, weight loss and elevated WBCs
69
When wrapping an amputated limb with compression dressings which things should be done? (Select All)
A. Figure 8 technique
B. Wrap from distal to proximal
C. Keep wrapped 3-4 hours per day
D. If pain occurs, the wrapping is probably too tight
A, B, D (not C because it should be wrapped at all times unless bathing)
70
What signs and symptoms of an infection following a limb amputation should you educate the patient on?
Increased purulent drainage, redness, warmth, fever
71
A diabetic patient who had an elective below-the-knee amputation returns to the unit for IV antibiotic
care on postop day 3. Upon closer examination,
the nurse notices the patient has a pillow under the residual limb. What should the nurse do in this situation?
A. Leave the pillow in place to prevent dependent edema
B. Remove the pillow to prevent contractures
C. Remove the pillow to prevent VTE
D. Leave the pillow to promote circulation
B
72
Which statement by the patient indicates effective patient teaching has been done regarding phantom limb pain after an amputation?
A. “This pain means I may have intact nerves that are required for successful limb reattachment.”
B. “There is nothing that can be done for this pain—my foot is gone!”
C. “So do you think gabapentin might help with this pain?”
D. “I understand massage of the residual limb helps with this pain.”
C. The administration of antidepressant and anticonvulsant medications such as gabapentin has demonstrated effectiveness in treating phantom limb pain. It does not indicate intact nerves. It can be treated with medications. Touching the residual limb may increase the pain.
73
The nurse monitors for which clinical manifesta- tions in the patient diagnosed with osteoarthritis? (Select all that apply.)
A. Shortness of breath
B. Decreased range of motion of affected joint
C. Joint pain that improves with activity
D. Warmth and swelling of affected joints
E. Heberden’s nodes
B, D, E
OA does not cause lung disease as RA can. Decreased ROM is an expected finding in patients with OA. Joint pain due to OA typically gets worse with activity, not better, as it is in the case of RA. Warmth and swelling in affected joints is a common finding. Heberden’s nodes located over the distal phalanges are also a common finding in OA patients.
74
Total joint replacement therapy is most common for which musculoskeletal disorder?
A. Paget’s disease
B. Osteosarcoma
C. Osteoarthritis
D. Osteomyelitis
C
75
The nurse correlates diminished adaptive immune responses with which of the following? (Select all that apply.)
A. Decreased peripheral B cells
B. Decreased antibody response
C. Decreased peripheral T cells
D. Decreased phagocytic capacity
E. Decreased eosinophils
A, B, C
76
The nurse understands that immunity acquired by an infant through their mother is an example
of which type of immunity?
A. Cell-mediated immunity
B. Humoral-mediated immunity
C. Adaptive immunity
D. Passive immunity
D
77
The nurse assesses for which of the following laboratory results with a decreased humoral-mediated immune response? (Select all that apply.)
A. Decreased peripheral T cells
B. Decreased antibody response
C. Increased antibodies
D. Increased dendritic cells
E. Increased leukocytes
B - A decreased humoral immune response reflects decreased antibodies. T cells are a part of cellular immunity. Leukocytes are part of both innate and cellular immunity but an increase indicates an effective response. Dendritic cells link innate and adaptive immune response.
78
The nurse recognizes which patient to be at greatest risk for developing osteoarthritis?
A. A 70-year-old Black male patient
B. A 45-year-old White female patient
C. A 65-year-old Black female patient with obesity
D. A 30-year-old White male patient
C
Rationale: Advanced age, obesity, and female sex are all strong risk factors for developing OA.
79
The nurse monitors for which clinical manifestations in the patient diagnosed with osteoarthritis? (Select all that apply.)
A. Pain that improves with activity
B. Joint pain
C. Joint swelling
D. Unsteady gait
E. Increased temperature
B, C, D
80
When comparing osteoarthritis to RA, the nurse recognizes which of the following statements to be true? (Select all that apply.)
A. Osteoarthritic pain tends to get worse with activity, but RA gets better with activity.
B. Both RA and osteoarthritis are autoimmune diseases.
C. Patients with RA are at risk for developing extra- articular manifestations such as eye inflammation and lung disease, whereas osteoarthritis affects only joints and surrounding structures.
D. Patients with osteoarthritis typically have morning stiffness lasting less than 30 minutes, whereas RA patients typically complain of morning stiffness lasting greater than 30 minutes.
E. Both RA and osteoarthritis affect joints in a symmetrical pattern.
A, C, D
81
What is the pharmacological therapy for mild to moderate osteoarthritis?
acetaminophen (Tylenol)
82
____ is a chronic, systemic, autoimmune inflammatory disease characterized by an inflammatory process that affects diarthrodial, or freely moving, joints, causing pain and swelling
Rheumatoid arthritis
83
If the circulating clot moves through the heart to the lungs, it can block an artery supplying blood to the lungs. This condition is called?
A Pulmonary embolism (PE)
84
A blood clot in a large vein, usually in the leg or pelvis?
DVT (deep vein thrombosis)
85
What are signs and symptoms of a DVT?
Pain, swelling, tenderness, discoloration, redness, warmth in the affected area
86
The nurse is caring for a patient on a heparin drip who was admitted for DVT 2 days ago. Which laboratory value is most important to report to the provider immediately?
A. A normal INR
B. An increased hematocrit
C. An increased platelet count
D. A normal APTT
D
87
A positive _____ result stratifies the patient into a high-risk category for DVT.
d-dimer
88
What are the 6 Ps of a neurovascular check?
Pain
Pallor
Parathesia
Pulse
Paralysis
Poikilothermia
89
What are the 5 Ws?
Wind
Water
Wonder drugs
Wound
Walking
90
What vitals would change if there was severe blood loss after a THR or TKR?
Elevated heart rate and lowering BP
91
This is a complication of a bone fracture and can be accompanied by red/purple petichiae
Fat embolism
92
This is a medical emergency where the area must be cut open to relieve pressure.
Compartment syndrome
93
What labs would you want to monitor after an amputation?
H&H for blood loss
WBCs for infection
94
What medication can be given for phantom pain; numbness, pins and needles, burning
Gabapentin
95
With a venoustasis ulcer of the leg would you elevate legs? (Y/N)
Yes
96
With an arterialstasis ulcer of the leg would you lower or elevate legs?
Lower
97
What are interventions for fractures?
Administer meds (pain, antibiotic and inflammatory), elevate, ice, give positive feedback and encouragement
98
What is the main cause of chronic wounds?
Circulatory impairment
99
What lab do we look at for heparin?
APTT
100
What medication not only prevents, but also treats DVTs and PE?
Enoxaparin
101
What lab do we look at for warfarin?
INR
102
What is angioedema?
Swelling of the face
103
Patient is post op day three, was A&O at start of shift but during rounds is confused, short of breath and has skin parlor. What lab would you check?
H&H
104
A 55 year old with a history if RA is prescribed this med that can cause weight gain and lower bone density.
Prednisone
105
This med helps anxiety and is also an antihistamine
Hydroxyzine
106
This med is used to treat MRSA; decreases fluid output, increases fluid retention, swelling and fatigue.
Vancomycin
107
Antibiotic for pneumonia, bacterial bronchitis, tendon problems and nerve damage.
Levofloxacin
108
In order to have an allergic reaction to something a person must be exposed to it at least once before for the body to produce _____
Antibodies
109
Local or systemic? Itchy eyes, sneezing, puritis, hives and welts
Local
110
What two things on an ABG shows gas exchange?
CO2 and O2
111
What are signs and symptoms of impaired liver function?
Jaundice, epigastric pain, triple As elevated, fatigue
112
What are three jobs of the liver?
To filter toxins, filter blood, filter protein
