Med-Surge Term 2

In the endocrine system, secreting cells send hormones to:

The blood

The control of hormonal secretion is usually part of a

Negative feedback

Hormone secreted by anterior pituitary gland, this hormone plays an important role in stimulating breast development necessary for production of milk and eventual lactation is:

Prolactin

The pituitary gland is really two gland. They are the:

Anterior and posterior

Antidiuretic hormone and oxytocin are stored and released by the:

Posterior pituitary gland

Corticoids are hormones secreted by the

Adrenal Cortex

The process stimulated by glucocorticoids that converts substance to glucose is called

gluconeogenesis

The part of the brain that plays a dominant role in the regulation of many body functions and called the master glands is

Pituitary gland

The portion of the adrenal gland that secretes the hormones epinephrine and norepinephrine is the

adrenal medulla

Insulin and glucagon's are antagonists because

insulin decreases blood glucose concentration; glucagon increases it

The body's internal clock thought to affect mood and sleep is supported by the

Pineal gland

This hormone secreted by the thyroid gland increases calcium storage in bone

Calcitonin

The nurse explains that the negative feedback inhibition controls hormone release by communication between

the pituitary and the target organ

which diagnostic test for diabetes mellitus provides a measure of glucose levels for the previous 8 to 12 week?

Glycosylated Hemoglobin (HbA1c)

To which diet should a patient with Cushing syndrome adhere

less sodium

In diabetes insipidus, a deficiency of which hormone causes clinical manifestations?

Antidiuretic hormone (ADH)

What is the postoperative position for a person who has had a thyroidectomy?

Semi-Fowler

What extra equipment should the nurse provide at the bedside of a new postoperative thyroidectomy patient?

Tracheotomy Tray

As the nurse is shaving a patient who is 2 days postoperative from a thyroidectomy, the patient has a spasm of the facial muscles. What should the nurse recognize this as?

Chvostek sign

What do the Chvostek sign and the Trousseau sign indicate?

Low levels of serum calcium

A patient has undergone tests that indicate a deficiency of the parathyroid hormone secretion. She should be informed of which potential complications?

Laryngeal spasms

What should the nurse include in provisions for the postoperative care of the patient who had a thyroidectomy?

A. assessing ability to speak by asking him or her to recite name and address every hourb. Maintain anatomic position of the head when moving a patientc. Doing voice check every 2 hoursd. checking for bleeding at the sides and the back of the head

The nurse would instruct a patient with hyperthyroidism (graves disease) to select which of the following nutritious foods of the increased metabolism related to the disease?

Lean meat, White bread, leafy green vegetables, supplemental vitamin D

Adrenocorticotropic hormone (ACTH) stimulates the adrenal glands to release adrenaline

Flase

Parathyroid hormone causes a decrease in blood calcium levels

False

Cortisol is an example of a mineralocorticoid

Flase

Glucagon causes a reduction of the blood glucose concentration

Flase

Pancreatic beta cells release insulin

True

The thyroid gland produces two hormones, thyroxine and TSH

False

A nurse is caring for a client who has just undergone thyroidectomy. Which technique is the best way for the nurse to assess the surgical site for bleeding

checking for moisture on the back of the dressing over the client's neck and shoulders

A client is found to have hypoparathyroidism. Which nutritional supplement does the nurse tell the client to take on a daily basis, reinforcing teaching to the client about measure to manage the disorder?

Calcium carbonate with Vitamin D

A nurse is following a plan of care for an older client with diabetic neuropathy of the lower extremities resulting from type 2 DM. Which problem does the nurse recognize as the highest priority for this client?

Increased risk for injury

Hypoglycemia signs and symptoms

Shakiness, Blurred vision, cold sweats, headache, increased pulse, and hunger

A nurse is studying the results of periodic serum laboratory studies in a client with diabetic ketoacidosis who is receiving an intravenous insulin infusion. Which finding should prompt the nurse to contact MD

Potassium 3.1 mEq/L

A nurse is providing information on the glycosylated hemoglobin assay (HgbA1C) and its purpose to a client with DM. The nurse reinforces information to the client that this blood test is performed for which reason?

To help predict the risk for the development of chronic complication of DM

A nurse is monitoring a client who has undergone subtotal thyroidectomy for signs of postoperative complication. Which finding would be a matter of concerns for the nurse as an indication of hypocalcemia?

The client complains of a tingling sensation around the mouth

A nurse is monitoring a client who was brought to the ER in an unresponsive state and is now being treated for hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which finding indicates to the nurse that fluid replacement is inadequate?

Level of consciousness remains unchanged

A client with DM calls the clinic nurse and reports that she has been vomiting during the night and now has diarrhea. Which question does the nurse make a priority of asking the client?

Have you tested your blood glucose?

A LVN is reinforcing information to a client who will be self-administering regular insulin about storage of the insulin. The nurse gives what information to the client?

The the vial in current use may be kept at room temperature for as long as 1 month without significant loss of activity

A client with a medical history of DM is found to have sarcoidosis, and oral prednisone is prescribed. The LVN reinforces instructions to the client about the medication gives which information?

closely monitor the blood glucose level

A nurse is performing an assessment of a client with suspected pheochromocytoma. Which clinical manifestation does the nurse expect to note?

A BP higher than the normal range

A nurse is monitoring a client with pheochromocytoma who is receiving an IV infusion of phentolamine. Which vital sign does the nurse monitor most closely during the infusion?

blood pressure

What is the best initial treatment for DM?

Diet

What instructions should a nurse give to a diabetic patient to prevent injury to the feet?

Avoid going barefoot and always wear shoes with soles

The nurse discovers the type 1 diabetic (IDDM) patient drowsy and tremulous, the skin is cool and moist, and the respirations are 32 and shallow. These are signs of:

Hypoglycemic reaction; give 6 oz of orange juice

A client is scheduled to undergo an upper gastrointestinal (GI) series, and the LVN reinforces instruction to the client about the test. Which statement by the client indicates a need for further instruction?

I need to drink citrate of magnesia the night before the test and give myself a fleet enema on the morning of the test.

An adult client with an ileostomy is admitted to the hospital with a diagnosis of isotonic dehydration. What findings does the nurse expect to note while assisting with data collection?

Skin tentingFlat neck veinsWeak peripheral pulses

The nurse clarifies that the end product of carbohydrate metabolism is absorbed and put into the blood stream by the

Villi of the small intestine

A male patient complains that he will never adjust to his colostomy. Which is the best action for the nurse in this situation

Encourage him to express his concern

In caring for a patient with gastric bleeding who has a nasogastric tube in place, the nurse should include in the plan of care to ensure that the NG tube is

Kept patent with irrigation

Which of the following should be included in the patient teaching of a patient with a peptic ulcer?

Eating 6 small meals a day

What is the most lethal complication of a peptic ulcer?

Perforation

Why are peptic ulcers a common problem of aging?

Because of overuse of NSAIDS

In designing a teaching plan to present to a group of older adults regarding the prevention of esophageal cancer, the nurse would include information about the significance of the following except

Reduction of consumption of citrus fruit

A 43-year-old male patient is scheduled to undergo a colonoscopy. In preparation for the examination the teaching provided should include point

Enemas or cathartics will be administered to reduce the residue in the bowel

A 50-year-old man vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factor for gastritis, the nurse will ask the patient about

Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

The nurse explains that ______, the chief enzyme of gastric juice, is activated by hydrochloric acid to begin digestion of protein.

Pepsin

Because bowel contents from an ileostomy are virtually liquid, what should the nurse include in the plan of care?

Evaluation and assessment of peristomal skin integrity

All the following are salivary glands except

Ptyalin and Submucosal

Digestion starts at the

Mouth

The stomach was prevented from autodigestion by

Mucin

GERD is caused by

weak cardiac sphincter

Which one is the strongest diagnostic test of peptic ulcer

BIOPSY

What is the end digestion product of protein

Amino Acid

The main function of large intestine is

Absorption of water

The function of gallbladder is

store and concentrate bile

Stool guaiac test is used to detect

blood

Stomatitis is an inflammation of the

Mouth

Lack of intrinsic factor in the stomach will cause

Vitamin B12 anemia (PA)

Projectile vomiting is a strong sign of

Pyloric Stenosis

Dumping syndrome will cause a serious life threatening

Hypoglycemia

A patient with mucositis is being treated with viscous lidocaine 2%. Which instruction should the nurse include in the patients teaching plan?

Avoid eating for 30 minutes after taking the medication

A patient has recently been diagnosed with xerostomia. Which medication does the nurse anticipate will be ordered for this patient?

Mouthkote (artificial saliva)

Which beverage should a patient diagnosed with canker sores avoid?

Orange juice

Which therapy does the nurse instruct a patient to use to prevent plaque formation?

Flossing between teeth

A patient with a gastric ulcer has been prescribed misoprostol (Cytotec). Which condition diagnosed in the patient would cause the nurse to question this order>

Pregnancy

A patient has been prescribed atropine for treatment of pylorospasm. Which condition of the patient would cause the nurse to question this order

Closed-angle glaucoma

Which basic principle does the nurse consider when scheduling the administration of drug used to treat patient with GERD or peptic ulcer disease (PUD)?

Individualized scheduling is required to avoid drug interactions.

Which change in the care plan is required when metoclopramide (Reglan) is ordered for a patient with DM?

Increase frequency of monitoring for hypoglycemia

Which patient prescribed metoclopramide (Reglan) should not receive this medication?

A 50-year-old with epilepsy

Which histamine-2 (H2) antagonist is only available for oral administraion?

Nizatidine (Axid)

Which principle guides care planning for a patient with recurrent nausea and vomiting?

Antiemetics are more effective when given before the onset of nausea

When does the nurse expect to administer antiemetics to a patient with chemotherapy-induced nausea and vomiting (CINV)?

Both before and after chemotherapy is given

The nurse is teaching a patient who has been prescribed dronabinol (Marinol) for emetogenic chemotherapy. Which statement by the patient indicates a correct understanding of the nurse's instructions?

I will have someone stay with me when I first start taking this drug

Which type of laxative is best for a patient who is confined to bed an who regularly needs a laxative?

Bulk forming

Which potential complication is associated with the continued use of saline cathartics?

Fluid and electrolyte imbalance

A systemically acting antidiarrheal drug is ordered for a patient who has diarrhea associated with poisoning. Which is the reason why the nurse should question this order?

Reducing GI motility will allow the condition to worsen

A patient has been prescribed a laxative. Which situation or symptom exhibited by the patient would be a cause for the nurse to question this order?

Abdominal Pain

Do not crush proton pump inhibitors (PPI) medications

True

All the following are causes of constipation excepts:

Excessive exercise

All the following are causes diarrhea except:

Hypothyroidism

The food which increases the level of ammonia in the body is

Proteins

The initial step in management of pancratitis is

NPO

Cholelithiasis means removal of stones from the gallbladder

False

No medication will be give with antacid

True

Sengstaken-Blakemore tube is used to stop lower gastrointestinal bleeding

False

Bulk-forming laxative (Metamucil) are not appropriate for

Heart Patient

Lubricant laxatives and opioid antagonists are appropriate for

Pregnant patient

A patient with a history of irritable bowel syndrome is prescribed psyllium (Metamucil). Which instruction does the nurse include in the patient's teaching plan?

Mix the drug with a full glass of water

What is the end digestion products of carbohydrates:

Simple Sugar

One of the function of the intestine is

Production of vitamin K

An adult client with an ileostomy is admitted to the hospital with a diagnosis of isotonic dehydration. All the following are findings the nurse expect to note while assisting with data collection except:

Moist oral mucous membranes

All the following are nursing intervention post operative hemorrhoidectomy patient except

Medicate the patient with suppository for pain

The nurse points out which of the following as an example of a nonmechanical bowel obstruction?

A paralytic ileus

Which of the following would be the most helpful nursing intervention to increase the comfort of patient with appendicitis?

Complete bed rest

Bowel sound assessment on a patient with an early obstruction who has distention, nausea, and visible peristaltic waves would be

Hyperactive

All of the following are activities should the home health nurse suggest to an elderly patient to a void constipation except

Frequent Antacid for heartburns

Due to frequent bouts of constipation, the nurse examines the bedfast nursing home resident for ulceration of the anus, called

Anal fissure

The nurse anticipates that the patient who has had a subtotal gastrectomy will need supplemental:

Vitamin B12 due to loss of the intrinsic factor

Early phases of mechanical obstruction: auscultation of the abdomen reveals loud, frequent, high-pitched sounds (hyperactive)

True

Strangulated hernia is considered an emergency situation

True

A patient, age 69, has emphysema. On assessment, the nurse notes the presence of a ''barrel chest" What does this pathology result from?

An increased anteroposterior diameter caused by overinflation of the alveoli

Identify the purposes of chest drainage:

Drains air, blood and fluid from pleural space

What is the appropriate nursing intervention for a patient, age 40, who is diagnosed with active TB

Place the patient in acid-fast bacillus (AFB) Isolation Precautions

How would the nurse examining a patient with pleurisy document a low-pitched grating lung sound?

Friction Rub

The young man who had a bronchoscopy 1 hour ago asks when he can eat. Which response would be most helpful?

When the gag reflex returns

The nurse caring for a patient who has a closed chest drainage system notes that there is fluctuation (tidaling) in the water seal chamber. What is the most appropriate nursing action based on this assessment?

Document the tidaling (the chest tube is patent)

How does pursed lip breathing assist patients with asthma during an attack?

IT opens bronchioles by backflow air pressure

Which patient assessment indicates the most severe respiratory distress?

Abdominal breathing SaO2 77%

A nurse is preparing for the admission of a client with pulmonary TB. Which action reflects the use of evidence-based practice in the care of the client?

Keeping the door to the clients room closed

What is the purpose of the cilia in respiratory system?

Sweep debris toward nasal cavity

When assessing the SaO2 with a pulse oximeter, the result was 85%. What is the nurse initial intervention?

Re-check saturation (SaO2) at different site

Which of the following are thrombocytopenic precautions?

Using an electric razor

A laboratory test has determined that a 59-year-old male undergoing chemotherapy for lung cancer has a platelet count of 100,00/mm3, hemoglobin of 15 g/dL, and hematocrit of 44%. Which intervention can be anticipated?

avoidance of aspirin or aspirin preparations

Which infection-control measures would the nurse implement for a client with WBC 300,000/mm?

Protective Isolation

A nurse is providing teaching to a client who has neutropenia. Which of the following information should the nurse include in the teaching?

Avoid crowds

What is the process by which certain cells engulf and digest microorganisms and cellular debris?

Phagocytosis

The nurse assessing a differential sees an increase in immature neutrophils (bands) and is aware that this indicates

an overwhelming bacterial infection

The nurse explains that in the event of an invasion of an allergen, the basophils release a strong vasodilator, which is

Histamine

What does the elevation in the eosinophil count to 10% indicate?

allergy

What would a nurse include in a teaching plan for a home health patient with a hemoglobin of 8.4 mg?

Alternating activity with rest periods

When instructing the patient taking an oral liquid iron preparation, what should the nurse include?

Information relative to taking preparation through a straw to prevent staining of teeth

When the 14-year-old African American boy comes into the emergency room in sickle cell crisis, what should be the primary focus of care?

Staring of IV fluids

Which patient statement from a 15-year-old girl with thrombocytopenia would require more assessment to report to the charge nurse?

I have this really weird Coke-colored urine.

The universal donor has which blood type?

O Rh negative

Which mandatory practice is the most effective and significant nursing practice to prevent the spread of infection?

Strict and frequent handwashing by all people having contact with the patient

The nurse is aware that the patient with fluids overload like (heart failure or renal failure) will receive which blood transfusion?

Packed blood cells (RBC)

The universal recipient has which blood type?

AB Rh positive

What is the name of the blood test by which we check the blood level for Warfarin (Coumadin) medication?

PT, INR

Protamine Sulfate is antidote drug for

Heparin

All the following are accessory blood forming organs except

Pancreas

A client's arterial blood gases (ABGs) are analyzed: pH 7.49, Paco2 31 mm Hg, Pao2 97 mm Hg, HCO3 22 mEq/L. Which acid-base disturbance does the nurse identify from these results?

Respiratory Alkalosis

A nurse monitors the chest tube drainage system of a client who has undergone surgery and the nurse notes the presence of continuous bubbling in the chamber. On the basis of this finding, the nurse would first check which item?

The chest tube connection sites

A nurse is providing care to a client with a closed chest tube drainage system. When the nurse assists the client in turning onto his side, the chest tube is accidentally dislodged from the insertion site. The nurse immediately take which action?

Apply pressure over the chest tube insertion site

The patient's chest x-ray showed presence of solid BLACK area on the right side. Which means presence of?

Pneumothorax

How would the nurse examining a patient with pleurisy document a low-pitched grating lung sound?

Friction rub

Dianne, M is 91 years old was presented to ER with shortness of breath, tachypnea, and tachycardia, history of COPD. Her ABG reports were pH 7.41, PaCO2 44, SaO2 55, HCO3 23. Interpret Dianne's ABG

Normal ABG with hypoxia

A nurse is preparing for the admission of client who has suspected active TB. Which of the following precautions should the nurse plan to implement to safely care for this client?

Place the client in a private room with a special ventilation system

Which of the following medication is considered from first line TB medication?

Isoniazid (INH)

What is the drug of choice to be given in case of status asthmaticus?

Adrenaline

Antihistamines agents and antileukotriene agents are the same respiratory drug classifcations

False

Diphenhydramine (Benadryl) is one of the Antileukotriene agents

False

In which situation might surgery be delayed?

The patient is still taking anticoagulants

A patient is on postoperative day 2 after a nephrectomy. What is the most effective way to increase her peristalsis?

Ambulation

The removal of a nondiseased appendix during a hysterectomy is classified as

Minor, elective, ablative

Which statement made by a patient during a preoperative assessment would be significant to report to the charge nurse and surgeon?

I have been taking an herbal product of feverfew for my migraines.

The patient is brough into PACU still unconscious. What should the nurse do first when the nurse assesses blood pressure of 90/42?

Assess the surgery site

The nurse anticipates that the patient will be give ________ anesthesia because of the left hand abscess.

Local

The nurse acting as a circulating nurse has a responsibility for

Observing for breaks in sterile technique

All the following are early signs of hemorrhage except

Hypotension

The nurse received the patient from the postanesthesia care unit (PACU) after had done removal of the appendix. What is the name of the procedure the patient had?

Appendectomy

The nurse will do all the following immediately after receiving the patient from the postanesthesia care unit (PACU) except

Assess the patient's chart for post-operative orders

The scale the nurse use for pain assessment is PQRST. What S is representing?

Severity

All the following are advantages of conscious sedation except

Induce amnesia

Obtaining the patient's surgical informed consent is responsibility of the

Physician

The following are nursing interventions used to prevent post-operative complications except

Inserting NG tube

The surgical procedure used to examine or remove stone from the kidney is

Nephroscopy