Final Exam: NSG233/ NSG 233 (Latest 2023/ 2024 Update) Med Surg 3 Exam| Questions and Verified Answers| 100% Correct| Grade A- Herzing

Final Exam: NSG233/ NSG 233 (Latest 2023/
2024 Update) Med Surg 3 Exam| Questions
and Verified Answers| 100% Correct| Grade
A- Herzing
Q: Bite Priority
Answer:
Human bite: know what to do first with a human bite!
Animal: rabies prophylaxis
Snakebite: lie down, removing constrictive items, providing warmth, cleansing the wound,
covering the wound with a light sterile dressing, and immobilizing the injured body part below
the level of the heart.
CABs (Circulation, Airway Breathing)
NO: Ice, incision and suction, or a tourniquet
Tetanus and analgesia should be given as necessary.
Meds: FabAV or CroFAb: no limit on how much to give
S&S: necrosis, edema, ecchymosis
Tick: remove with tweezers, straight up pull, (try to get close to skin as possible)
S&S: bulls eye rash
Q: Poisoning in the house
Answer:
Carbon Monoxide: 100% O2 Atmospheric/hyperbaric chamber
Ingested Poison: ABC, Call poison control, try to describe what was ingested
Charcoal: most effective, Do not use if heavy metals were ingested. Corrosives: give water/milk
Cathartics: sorbitol: give w/ 1st dose of charcoal
syrup ipecac: Induces vomiting, only give to alert patients-and NO patients who ingested a
corrosive agent
Gastric emptying: intubate before lavage ( if -LOC/-gag reflex) with in 1 hour of ingestion.

Q: Overdose- multiply organ dysfunction syndrome
Answer:
Find out what Patient OD’d on. Give antidote if there is one
Treatment goals for a patient with a drug overdose are to support the respiratory and
cardiovascular functions, to enhance clearance of the agent, and to provide for safety of the
patient and staff.
Q: Abuse- interpersonal violence
Answer:
Priority: ask questions IN PRIVATE, separate from person who is abusive/neglectful
referral to shelter
adults are free to accept or refuse help
safety plans should be explored
Mandatory report: children and elderly abuse – only need to suspect abuse, do not need to prove
it
Q: PTSD- rape and stabbing
Answer:
Keep patient comfortable
Offer therapeutic communication -listen
Avoid triggers
**ask if patient plans to harm selfQ: Chest-Blunt trauma complications **
Answer:
Flail chest: paradoxical chest movement, hypoxemia, resp acidosis
Pulmonary contusion: abnormal accumulation of fluid,

lung sounds, cough, frank blood, mucus, chest pain, atelectasis, -BP, resp acidosis
Monitor: fluid intake, fluid replacement and pain
Managment: airway, O2, treat pain, bronchoscopy
Meds: morphine
Medical Management• ABC-oxygen, possible endotracheal intubation, ventilatory support•
Replace fluid volume• Restore negative intrapleural pressure if needed• Needle decompression•
Chest tube if needed• Hemothorax• Pneumothorax• Hemo-pneumothorax
Q: Crush injuries and trauma
Answer:
Hypovolemic shock
Spinal Cord Injury
Fractures
Acute Kidney Injury
Priority: ABC’s
SATA: Rhabdomyolysis: Triad: muscle cramps, muscle weakness, dark urine
Labs: CK levels, serum lactic acid levels
Compartment syndrome: elevate extremity, fasciotomy.
proper alignment of extremities, check peripheral pulses
Meds: pain, cephalosporins, penicillin
Q: Creatine Kinase (CK)
Answer:
Depend on age
30-200 men
30-170 women
Q: dissecting abdominal aneurysm
Answer:
medical emergency
get pdf at learnexams.com

Diffusing anger in the ED

Self safety is PRIORITY
gunfire- protect self
separate feuding individuals explains activities, eliminate triggers.

Heat Stroke **

Priority action: *Lower body temperature; O2, fluids, cool towel, cool bath (NO ICE BATH) elevate feet
+HR, +temp, confusion, headache, anxiety, cramps, gooseflesh, HOT,DRY skin, NO sweating

Alcoholic- first assessment

CAGE: Cut, Annoyed, Guilty, Eye-opener.
Assess: psych, w/drawal.
Mgt: blood glucose, benzo, barbiturate, seizure precautions.
Let them sleep if calm-
not calm- benzo’s-
check on patient regularly for – LOC
Blood glucose range: 70-110

Non-fatal drowning **

Priority: manage hypoxia, acidosis and hypothermia > airway, oxygen
Management: CPR, core temp (rectal) rewarming procedures during CPR, trach/PEEP, O2
Risks: ARDS> hypoxia, hypercarbia and respiratory acidosis can occur
Hypothermia> metabolic acidosis
NGT> decompress stomach and prevent aspirating gastric contents.
Monitor: ECG, ICP, I/O
Labs: serum electrolytes
Highest risk: <5 yo, >85 yo
Freshwater: loss of surfactant- inability to expand lungs
Saltwater: pulmonary edema
Observe pt for 23 + hours

Serum Electrolytes

* Mg+ 1.5-2.5
* Phos 2.5-4.5
* K+ 3.5-5
* Ca 8.5-10.9
* Chl 95-105

Bite Priority

Human bite: know what to do first with a human bite!
Animal: rabies prophylaxis
Snakebite: lie down, removing constrictive items, providing warmth, cleansing the wound, covering the wound with a light sterile dressing, and immobilizing the injured body part below the level of the heart.
CABs (Circulation, Airway Breathing)
NO: Ice, incision and suction, or a tourniquet
Tetanus and analgesia should be given as necessary.
Meds: FabAV or CroFAb: no limit on how much to give
S&S: necrosis, edema, ecchymosis
Tick: remove with tweezers, straight up pull, (try to get close to skin as possible)
S&S: bulls eye rash

Poisoning in the house

Carbon Monoxide: 100% O2 Atmospheric/hyperbaric chamber
Ingested Poison: ABC, Call poison control, try to describe what was ingested
Charcoal: most effective, Do not use if heavy metals were ingested. Corrosives: give water/milk
Cathartics: sorbitol: give w/ 1st dose of charcoal
syrup ipecac: Induces vomiting, only give to alert patients-and NO patients who ingested a corrosive agent
Gastric emptying: intubate before lavage ( if -LOC/-gag reflex) with in 1 hour of ingestion.

Overdose- multiply organ dysfunction syndrome

Find out what Patient OD’d on. Give antidote if there is one
Treatment goals for a patient with a drug overdose are to support the respiratory and cardiovascular functions, to enhance clearance of the agent, and to provide for safety of the patient and staff.

Abuse- interpersonal violence

Priority: ask questions IN PRIVATE, separate from person who is abusive/neglectful
referral to shelter
adults are free to accept or refuse help
safety plans should be explored
Mandatory report: children and elderly abuse – only need to suspect abuse, do not need to prove it

PTSD- rape and stabbing

Keep patient comfortable
Offer therapeutic communication -listen
Avoid triggers
**ask if patient plans to harm self-

Chest-Blunt trauma complications **

Flail chest: paradoxical chest movement, hypoxemia, resp acidosis
Pulmonary contusion: abnormal accumulation of fluid,
– lung sounds, cough, frank blood, mucus, chest pain, atelectasis, -BP, resp acidosis
Monitor: fluid intake, fluid replacement and pain
Managment: airway, O2, treat pain, bronchoscopy
Meds: morphine
Medical Management• ABC-oxygen, possible endotracheal intubation, ventilatory support• Replace fluid volume• Restore negative intrapleural pressure if needed• Needle decompression• Chest tube if needed• Hemothorax• Pneumothorax• Hemo-pneumothorax

Crush injuries and trauma

Hypovolemic shock
Spinal Cord Injury
Fractures
Acute Kidney Injury
Priority: ABC’s
SATA: Rhabdomyolysis: Triad: muscle cramps, muscle weakness, dark urine
Labs: CK levels, serum lactic acid levels
Compartment syndrome: elevate extremity, fasciotomy.
proper alignment of extremities, check peripheral pulses
Meds: pain, cephalosporins, penicillin

Creatine Kinase (CK)

Depend on age
30-200 men
30-170 women

dissecting abdominal aneurysm

medical emergency
-chest or back pain is cardinal sign;
-hypotension;
-tachycardia
Weak pulses
treat with surgery stents
History: high blood pressure
can cause cardiac tamponade/shock

dissection aneurysm

hemorrhage into the vessel wall with longitudinal tearing of the vessel wall to forma a blood-filled channel
Clinical manifestations: sudden onset of excruciating pain, described as TEARING or RIPPING

PVC (Premature Ventricular Contraction)

Irregular rhythm. No Pwave. Wide,bizarre QRS.
Common and harmless
palpations, chest pain, SOB
not frequent- no treatment needed
frequent- medication is needed- amiodarone

Hemorrhage -shock

Stop bleeding- pressure
Identify and treat the cause
-BP, +HR, cool clam skin, -H/H(Hgb -7 =Heaven),
Early: restless. Late: metabolic acidosis

Shock- fluid**

two large-gauge IV
LR or NS
Blood products for blood loss-give RBC, Platelets, plasma, RBC (+ O2)

Shock symptoms **

tachycardia
hypotension
cool/clammy skin
weak peripheral pulses
anxiety
decreased urinary output
low central venous pressure
increase in CO, heart rate
decrease stroke volume

Cardiogenic Shock S&S

heart pump fails
-BP
-Cardiac Output
+HR
narrow pulse pressure
S&S: Pain, angina, arrhythmias, fatigue
Correct the cause!
PRIORITY: O2, treat pain, fluids (monitored closely for overload)
Meds: dobutamine, Nitro, dopamine, vasodilator, diuretics, albuterol, quinidine. AE: photosensitivity, nausea, vomiting, CNS changes

Hypovolemic shock **

Reduction of intravascular volume by 15-30 %
Treat underlying cause
Fluid and blood replacement
LR/NS
Blood products: colloids
Vasoactive meds
O2
SS: pale, anxious
tachycardia
hypotension, narrowing pulse pressure
+RR
– Cardiac Out
-urine
Labs: H&H, lactate,
ABGS
Interventions:
Passive leg raise
NO Trendelenburg
Meds: insulin, anti D, antiemetics, vasopressors
first sign: patient bleeding* or loss of fluids
Causes: dehydration, ascites, edema
SPO2: forehead not finger!

Hemoglobin normal range

12-18

Hematocrit normal range

40%-50%

Lactate normal range

0.5-1 mmol/L

Mechanical ventilation Shock

Mechanical ventilation may be needed for patients who experience shock
If patient is unable to breath on their own.

Sepsis **

-BP
cold clam skin
delay cap refill
confusion
high/low temp
Mgt: lactate level, culture before antibiotics, antibiotics, crystalloid/lactate, vasopressor
Med: Vasoconstrictor
Culture- to identify
aseptic technique and Hand hygiene
Labs: BUN, CRP, creatinine, WBC, H&H, platelet
serum albumin, prealbumin (protein)
no Trendelenburg

Septic shock

Norepinephrine IV – increases BP (1st choice vasopressor)
IV corticosteroids 2nd choice
SS: -BP, +HR/RR,
Labs: WBC -4, +12
Management: GCS + 2 points SOFA= organ dys.
Blood- colloids
antibiotics w/ 1st hour (culture 1st) broad-spectrum antibiotic agents are started until culture and sensitivity reports are received
urine output
fluids (NS)
O2

WBC normal range

5,000-10,000

Sepsis Drug abuse

sharing of needles can cause sepsis due to infection

sepsis interventions

prevent infection: aseptic technique after careful hand hygiene
IV lines, arterial and venous puncture sites, surgical incisions, traumatic wounds, and urinary catheters must be monitored for signs of infection
First sign: confusion with or without agitation along with an increased respiratory rate
Labs: platelets, bilirubin, serum creatinine, urine output, serum levels of antibiotic agents, procalcitonin, CRP, BUN, creatinine, WBC count, hemoglobin, hematocrit, platelet levels, coagulation studies) and reports changes to the primary provider.
Glasgow Coma Scale (GCS)
MAP
Obtain specimen prior to giving antibiotics
hyperthermia: acetaminophen or applying a hypothermia blanket
IV fluids and meds

Gastric bypass-MODS

hrly urine output, monitor + pulse.
SS: Lung: dyspnea, resp fail.
Hypermetabolic: +glycemia, +lactic acid, +BUN, -skeletal muscle mass.
Hepatic: +bilirubin/liver test.
Renal: +creatinine, anuria.
Hematologic: immunocompromise, +bleed. Neuro: unresponsive, coma
Invasive procedures can introduce microorganisms inside the body that could lead to sepsis

Septic shock medication

Fluid therapy alone is not effective give vasopressors
norepinephrine or dopamine = MAP of 65 mm Hg or higher.
Adequate fluid therapy is necessary for maximal pressor (increased blood pressure) effect.
Acidosis decreases the effectiveness of the drug.

MODS hypotension

Hypotension is a common complication of MODS
Decreased blood flow and O2 delivery to tissues

Septic shock dopamine

do not give dopamine until fluids are replaced-
If fluid therapy alone is not effective, give vasopressor

Head injury (tree)

Assess Loss of consciousness
Maintain airway

ICP monitoring

maintaining adequate oxygenation
elevating head of the bed
seizure prevention
fluid and electrolyte maintenance
nutritional support
management of pain and anxiety
ensure adequate oxygenation and protect the airway.

restlessness (without apparent cause), confusion, or increasing drowsiness, has neurologic significance

ICP hazards

Vomiting with out nausea
no lumbar puncture
Cushing Triad: + BP, widen PP, – HR (bradypnea)

Closed head injury ICP

Concussion.
Mild: brief LOC
Major: coup-contrecoup, expressive aphasia and vision problems

Increased ICP treatment

mannitol – decreases ICP, give IV
restrict fluids
drain CSF
control fever
maintain systemic BP and O2
reduce metabolic demands
No cluster care, dim lights,\

Traumatic brain injury- ICP

normal ICP– 0-15 (if above 20 then interventions are done) i.e. mannitol. need a MAP greater than 50

SCI- intermediate intervention

Immobilize neck
stabilize patient
do not rotate or extend
maintain alignment

SCI assessment

Monitor respirations and breathing pattern
Lung sounds and cough
Monitor for changes in motor or sensory function; report immediately
Assess for spinal shock
Monitor for bladder retention or distention, gastric dilation, and ileus
Temperature; potential hyperthermia

spinal shock

complete but temporary loss of motor, sensory, reflex, and autonomic function immediately after injury- lasts less than 48hrs- weeks

s/s: flaccid, bradycardia, hypotension, paralytic ileus

Autonomic dysreflexia S&S **

*Pounding headache
cool and pale below the injury
redness and flushing above
High BP
low HR
High RR
diaphoresis
goose bumps (pyloric erections)
Correct the Cause!
Elevate HOB
*scan bladder-empty bladder(distended bladder is the cause)
remove constricting clothing
*occurs after spinal shock has resolved

Auto. Dysreflexia document **

Document S&S
Interventions taken
Time seizure started
what triggered the episode

Spinal Cord injury

Cervical: cant move (quad)
Lumbar: legs (para)
Thoracic: trunk

DIC

Triggers: sepsis, trauma, shock, abruptio placentae, toxin, malignancy.
1st sign; bleeding gums.
+D-dimer
+ Pt/PTT
Low fibrinogen/- platelet
give Heparin

Cardiac Tamponade- PEA

Medical emergency-collection of fluid around the heart
Pressure on the heart prevents proper function
confusion
SOB
restlessness
decrease cardiac output
drop in BP
no oxygen to brain and vital organs
causes pulseless electrical activity

Abdominal Aortic Aneurysm tests

Pulsatile mass in the middle or upper abdomen
Palpable during routine physical
may hear systolic bruit over mass
Duplex, ultrasonography, CTA
Small aneurysm: ultrasonography q 6 mon monitor until big enough for surgery
Do palpate

AAA post op

Lie supine for 6 hours
HOB 45 degrees after 2 hours
use bedpan/urinal
BEDREST
Vitals and doppler assessment of peripheral pulses q 15 min
Assess for bleeding, pulsation, swelling, pain and hematoma formation
Temp: Q 4 hours
after 6 hours, roll side to side, ambulate with assistance to bathroom
*NOTIFY HCP: pt constantly coughing, sneezing or has a BP > 180

dysrhythmias and calcium

Low calcium levels lead to:
ventricular dysrhythmias, Prolonged QT, cardiac arrest. Ca= less than 8
Remember – changes in potassium and calcium and cause dysrhythmias

Calcium levels

8.5-10.5

IV-mL/hr lidocaine

know your dosage calculations.

Asystole treatment

CPR
**epinephrine and atropine
No defib

Endotracheal Tube(ETT) -assessment

Evaluate:
physiologic status
coping w/mechanical ventilation
vital signs,
respiratory rate
breath sounds
hypoxia
+ breath sounds :suction HOB 30 degrees or higher mechanical ventilator settings
endotracheal tube position
neurologic status and effectiveness of coping comfort level and communication
weaning requires adequate nutrition

Thoracotomy water seal functionality

Set at 20 cm
more water= more suction
intermittent bubbling in water seal chamber is normal
continuous bubbling = air leak
water-seal chamber has a one-way valve or water seal that prevents air from moving back into the chest when the patient inhales.

Chest tube- deep breathing **

Encourage coughing and deep breathing
Use of incentive spirometer
assist w/ repositioning and ambulation
Breathing techniques: diaphragmatic and purse-lip breathing Q 2 hours

Chest tube transport **

ensure tube remains in place
drainage system remains below level of patients chest
prevents air or fluid from entering the chest cavity
no need to clamp during transport

Pneumothorax – action

Pneumothorax is a collapsed lung
In the postoperative patient, pneumothorax is often accompanied by hemothorax
increasing shortness of breath, tachycardia, increased respiratory rate, and increasing respiratory distress
needle aspiration, chest tube insertion, nonsurgical repair or surgery.

Pneumonectomy- chest tube

NO chest tube needed after this procedure
a patient is usually turned every hour from the back to the operative side and should not be completely turned to the unoperated side.
This allows the fluid left in the space to consolidate and prevents the remaining lung and the heart from shifting (mediastinal shift) toward the operative side

Subcutaneous emphysema explanation **

*Crepitus
Air trapped under the skin in the chest area (need to know!)

Esophageal cancer- aspiration **

low Fowler
Later in a Fowler position, prevent reflux of gastric secretions.
Complication is aspiration pneumonia.
incentive spirometry, sitting up in a chair, nebulizer treatments.
*Chest physiotherapy is avoided
Maintain NPO status and parenteral or enteral support is warranted
After each meal, the patient remains upright for at least 2 hours to allow the food to move through the GI tract.

Esophageal varices repair

Priority: airway.
NO: NGT, strain.
Tx: Bblockers, balloon tamponade, shunt, TIPS

Liver failure

irreversible damage to liver
liver transplant is only solution
jaundice
abdominal pain
confusion
swelling in legs/abdomen +ammonia/bilirubin/PT/PTT/ALT/AST. -albumin/Ca/platelets

Hepatic failure- ascites **

Increased abdominal girth.
short of breath
striae and distended veins may be visible over the abdominal wall.
Umbilical hernias also occur frequently in those patients with cirrhosis.
Fluid and electrolyte imbalances are common.
sodium restriction
Spironolactone, K sparing
paracentesis- remove fluid

Ileal conduit post op complications

Complications:
bowel sluggishness
erectile dysfunction
infection
blood loss
Empty collect device freq (when 1/3 full), drink 2L daily, skin care, beefy red stoma, wash water, dry skin around, give cranberry/vit C.
An ileal conduit is a type of surgical procedure that puts in place a system to mimic the work of the bladder

Burns assess

depth, extent of injury, location and cause
monitor for signs of infection +K, peak T-waves, -Na, +H/H(+18, +54%).

Burns electrical

ECG monitoring
Labs: serum creatinine kinase levels
disconnect source before move pt.
Entrance/exit.
**Continue ECG (know this!) , tetanus, monitor temp, indwell cath, 4 mL fluids.
3/4th degree: Myoglobin=red urine, muscle damage. Glycosuria(release liver glycogen response stress).

Burns- partial thickness

2nd degree burn
entire dermis, some dermis
painful w/blisters
heals in 2-3 weeks
cool with water
sterile non adhesive dressing
OTC pain meds
watch for infection
silver sulfadiazine

Burns- Full Thickness

3rd degree burn
Epidermis and dermis and some underlying tissue
pale, white, red, brown, charred color
lacks sensation= no pain
leathery appearance
silver sulfadiazine
grafting
debridement

Burns- fluid replacement

2 X kg X Burn %
Half 1st 8hrs, second half 16 hours

LR, NS, blood
daily wgt

Burns- agitation

Treatment of anxiety with benzodiazepines may be used along with opioids.

HIV skin lesions

Kaposi’s sarcoma
malignant tumor of the blood vessels associated with AIDS Brown/pink/purple lesions. Men +risk. Lead to organ failure. May spread through sexual contact

HIV CD4 count- pathology **

strongest predictor of subsequent disease progression and survival. Used to help check immune system with HIV.HIV attacks and destroys CD4 cells
ART : increase in CD4+
-200 AIDS

Aids- dementia

*HIV encephalopathy
Progressive decline in cognitive, behavioral and motor functions
chronic confusion
Early manifestations include memory deficits, headache, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia.
Later stages include global cognitive impairments, delay in verbal responses, a vacant stare, spastic paraparesis, hyperreflexia, psychosis, hallucinations, tremor, incontinence, seizures, mutism, and death.
treatment: antiviral therapy

Aids Gas exchange

Risk for PCP (Ppneumonia) cause inflammation and damage to the lungs.
difficult for oxygen to enter the blood stream and the removal of CO2
can lead to resp. failure
treatment: oxygen therapy and mechanical ventilation support
S&S: chest tightness, SOB, cough, dyspnea, +HR, fever, hypoxemia, cyanosis
Med: trimethoprim/sulfamethoxazole – prevent pneumonia- can stop when CD4 count + over 200

HIV (candidiasis)

First sign that HIV is progressing to a more severe stage
White, Plaque lesions easily scrapped off with tongue depressor.
women can also have this as a vaginal discharge that comes and goes.(burning and itching)
Education*

IV mg/kg

know your math

Gastric cancer-NGT

patients have difficulty swallowing
NGT to provide nutrition and hydration

Colon cancer- intestinal polyps

Colorectal cancer develops slowly from polyps in the colon or rectum and if identified early, can be removed before undergoing malignant transformation

Colon cancer tumor marker

CEA: tumor marker assess presence of colorectal cancer.
Other tests: contrast CT scans of the abdomen, pelvis, and chest, to screen for extent of the tumor and any metastases.