Exam 4: NSG223/ NSG 223 (Latest 2024/ 2025 Update) Med Surg 2 Exam| Guide Questions and Verified Answers| 100% Correct| Grade A- Herzing
Exam 4: NSG223/ NSG 223 (Latest 2024/
2025 Update) Med Surg 2 Exam| Guide
Questions and Verified Answers| 100%
Correct| Grade A- Herzing
Q: Loss of Proprioception
Answer:
Loss of proprioception: ability to perceive the position of your body in space
Q: Ischemic Stroke Symptoms
Answer:
Hemiplegia
Hemiparesis
Dysarthria
Apraxia
Dysphasia
Dysphagia
Aphasia: difficulty communicating
Expressive: Cannot answer, knows answer but cannot get it out
Receptive: Do not understand what you are saying
Global: Both
Loss of proprioception: ability to perceive the position of your body in space
Facial Droop
Q: Hemorrhagic Stroke Nursing Assessment
Answer:
CT
MRI to determine extent of damage
Under 40- Drug Screen
No Lumbar Puncture
Aneurysm Precautions: bed rest laying down, dim lights, SCD (leg squeezers), need them to turn
still, stool softeners
Environment: Quiet, head of bed 30 degrees
Bowel/Bladder
Lighting
Prevention
Bed Rest
Sedation
If INR high, use Vitamin K and plasma
Q: Hemorrhagic Pharmacological Treatment
Answer:
If caused by elevated INR due to Warfarin
Reverse INR with FFP and Vitamin K
If caused by NOACs: Idarucizumab (Praxbind) reverses dabigatran (Pradaxa)
Seizures: phenytoin (Dilantin) (more likely for seizures)
Anti-hypertensives (ACE favored)
Analgesics for pain
Acetaminophen for fever
Antidepressants
Q: Ischemic Pharmacological Treatment
Answer:
Anticoagulants: Warfarin INR Goal 2-3
NOACs: do not have to check INR or APTT often
Dabigatran (Pradaxa) (only one with reversal)
Apixaban (Eliquis) & Edoxaban (Savaysa) & Rivaroxaban (Xarelto)
Antiplatelet: Plavix & Aspirin
Statins: Helpful in reducing risk of ischemic stroke (even in those who do not need their
cholesterol decreased)
Antihypertensives: (ACE preferred with or without a diuretic)
Oxygen
THROMBOLYTICS (tPA, Alteplase)
Clot Buster- ISCHEMIC ONLY, symptoms started less than 3 hours ago.
Q: Cataract Discharge Teaching
Answer:
An eye shield is usually worn at night for the first week to avoid injury. The nurse also explains
that there should be minimal discomfort after surgery and educates the patient about taking a
mild analgesic agent, such as acetaminophen, as needed. Antibiotic, anti-inflammatory, and
corticosteroid eye drops or ointments are prescribed postoperatively. Patients prescribed antiinflammatory or corticosteroid eye drops are monitored for possible increases in IOP
Q: Macular Degeneration Patient Education
Answer:
Amsler grids are given to patients to use in their homes to monitor for a sudden onset or
distortion of vision. These may provide the earliest sign that macular degeneration is getting
worse. Patients should be encouraged to look at these grids, one eye at a time, several times each
week with glasses on if needed for corrected near vision. If there is a change in the way the grid
appears to the patient (e.g., if the lines or squares appear distorted or faded), the patient should
notify the ophthalmologist immediately and should arrange to be seen promptly
Q: Nursing Assessment of Cataracts
Answer:
Decreased visual acuity is directly proportionate to cataract density. The Snellen visual acuity
test, ophthalmoscopy, and slit-lamp biomicroscopic examination are used to establish the degree
of cataract formation. The degree of lens opacity does not always correlate with the patient’s
functional status. Some patients can perform normal activities despite clinically significant
cataracts. Others with less lens opacification have a disproportionate decrease in visual acuity;
hence, visual acuity is an imperfect measure of visual impairment.
Q: Glaucoma Cholinergic Medications
Answer:
Cholinergic (Miotics) (Pilocarpine & Carbachol): Increase aqueous fluid outflow by contracting
the ciliary muscle and causing constriction of pupil and opening up meshwork. Side Effects:
Periorbital pain, blurry vision, difficulty seeing in dark. Implications: Caution patients about
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Modifiable Risk Factors of Stroke
Hypertension
Diabetes
Hyperlipidemia (low cholesterol diet & increase fiber)
Smoking
Obesity
Stress
Diet (bad-high fat, processed) & Exercise
Non-Modifiable Risk Factors of Stroke
Age (55+)
Gender (Male)
Race (African American & Hispanic)
Family History/Genetics
Stroke Nursing Assessment
CT Scan- Rapid! (25 min) (check renal function)
Neuro Assessment
Balance & Coordination
Speech
Hemiplegia & Hemiparesis Definitions
Hemiplegia (half of body paralyzed)
Hemiparesis (half of body weakness)
Dysarthria & Apraxia Definitions
Dysarthria (slurred speech)
Apraxia (substitutes wrong words)
Dysphasia & Dysphagia
Dysphasia (difficulty speaking)
Dysphagia (difficulty swallowing)
Aphasia: Expressive vs. Receptive
Aphasia: difficulty communicating
Expressive: Cannot answer, knows answer but cannot get it out
Receptive: Do not understand what you are saying
Global: Both
Loss of Proprioception
Loss of proprioception: ability to perceive the position of your body in space
Ischemic Stroke Symptoms
Hemiplegia
Hemiparesis
Dysarthria
Apraxia
Dysphasia
Dysphagia
Aphasia: difficulty communicating
Expressive: Cannot answer, knows answer but cannot get it out
Receptive: Do not understand what you are saying
Global: Both
Loss of proprioception: ability to perceive the position of your body in space
Facial Droop
Hemorrhagic Stroke Nursing Assessment
CT
MRI to determine extent of damage
Under 40- Drug Screen
No Lumbar Puncture
Aneurysm Precautions: bed rest laying down, dim lights, SCD (leg squeezers), need them to turn still, stool softeners
Environment: Quiet, head of bed 30 degrees
Bowel/Bladder
Lighting
Prevention
Bed Rest
Sedation
If INR high, use Vitamin K and plasma
Hemorrhagic Pharmacological Treatment
If caused by elevated INR due to Warfarin
Reverse INR with FFP and Vitamin K
If caused by NOACs: Idarucizumab (Praxbind) reverses dabigatran (Pradaxa)
Seizures: phenytoin (Dilantin) (more likely for seizures)
Anti-hypertensives (ACE favored)
Analgesics for pain
Acetaminophen for fever
Antidepressants
Ischemic Pharmacological Treatment
Anticoagulants: Warfarin INR Goal 2-3
NOACs: do not have to check INR or APTT often
Dabigatran (Pradaxa) (only one with reversal)
Apixaban (Eliquis) & Edoxaban (Savaysa) & Rivaroxaban (Xarelto)
Antiplatelet: Plavix & Aspirin
Statins: Helpful in reducing risk of ischemic stroke (even in those who do not need their cholesterol decreased)
Antihypertensives: (ACE preferred with or without a diuretic)
Oxygen
THROMBOLYTICS (tPA, Alteplase)
Clot Buster- ISCHEMIC ONLY, symptoms started less than 3 hours ago.
Cataract Discharge Teaching
An eye shield is usually worn at night for the first week to avoid injury. The nurse also explains that there should be minimal discomfort after surgery and educates the patient about taking a mild analgesic agent, such as acetaminophen, as needed. Antibiotic, anti-inflammatory, and corticosteroid eye drops or ointments are prescribed postoperatively. Patients prescribed anti-inflammatory or corticosteroid eye drops are monitored for possible increases in IOP
Macular Degeneration Patient Education
Amsler grids are given to patients to use in their homes to monitor for a sudden onset or distortion of vision. These may provide the earliest sign that macular degeneration is getting worse. Patients should be encouraged to look at these grids, one eye at a time, several times each week with glasses on if needed for corrected near vision. If there is a change in the way the grid appears to the patient (e.g., if the lines or squares appear distorted or faded), the patient should notify the ophthalmologist immediately and should arrange to be seen promptly
Nursing Assessment of Cataracts
Decreased visual acuity is directly proportionate to cataract density. The Snellen visual acuity test, ophthalmoscopy, and slit-lamp biomicroscopic examination are used to establish the degree of cataract formation. The degree of lens opacity does not always correlate with the patient’s functional status. Some patients can perform normal activities despite clinically significant cataracts. Others with less lens opacification have a disproportionate decrease in visual acuity; hence, visual acuity is an imperfect measure of visual impairment.
Glaucoma Cholinergic Medications
Cholinergic (Miotics) (Pilocarpine & Carbachol): Increase aqueous fluid outflow by contracting the ciliary muscle and causing constriction of pupil and opening up meshwork. Side Effects: Periorbital pain, blurry vision, difficulty seeing in dark. Implications: Caution patients about diminished vision in dim lit areas. Pilocarpine can be stored at room temp for up to 8 weeks, then should be discarded.
Glaucoma Beta Blockers
Beta-Blockers (Timolol Maleate): Decrease aqueous humor production. Side Effects: Systemic effects like bradycardia, exacerbation of pulmonary disease, and hypotension. Implications: Contraindicated in patients with asthma, COPD, heart block, bradycardia, heart failure, and education patients about punctual occlusion to limit systemic effects.
Glaucoma Alpha-Adrenergic Agonists
Alpha-Adrenergic Agonists (Apraclonidine & Brimonidine): Decrease aqueous humor production. Side Effects: Eye redness, dry mouth, and nasal passages. Implications: Education about punctual occlusion to limit systemic effects.
Glaucoma Caronic Anhydrase Inhibitors
Carbonic Anhydrase Inhibitors (Acetazolamide & Dorzolamide) Decrease aqueous humor production. Implications: Do not give to patients with sulfa allergies and monitor electrolyte levels.
Glaucoma Prostaglandin Analogics
Prostaglandin Analogics (Latanoprost & Bimatoprost): Increase uveoscleral outflow. Side Effects: Darkening of the iris, conjunctival redness, possible rash. Implications: Instruct patients to report any side effects
Glaucoma Laser Trabeculoplasty
In laser trabeculoplasty for glaucoma, a laser beam is applied to the inner surface of the trabecular meshwork to open the intratrabecular spaces and widen the canal of Schlemm, promoting outflow of aqueous humor and decreasing IOP.
Glaucoma Peripheral Iridotomy
Peripheral iridotomy for pupillary block glaucoma, an opening is made in the iris to eliminate the pupillary blockage
Glaucoma Filtering
Filtering procedures for glaucoma are used to create an opening or fistula in the trabecular meshwork to drain aqueous humor from the anterior chamber to the subconjunctival space into a bleb (fluid collection on the outside of the eye), thereby bypassing the usual drainage structures. This allows the aqueous humor to flow and exit by different routes (i.e., absorption by the conjunctival vessels or mixing with tears). Trabeculectomy is the standard filtering technique used to remove part of the trabecular meshwork
Glaucoma Drainage Implants/Shunts
Drainage implants or shunts are tubes implanted in the anterior chamber to shunt aqueous humor to the episcleral plate in the conjunctival space. Implants are used when failure has occurred with one or more trabeculectomies in which antifibrotic agents were used
Risk Factors for Glaucoma
African American race
Cardiovascular disease
Diabetes
Family history of glaucoma
Migraine syndromes
Nearsightedness (myopia)
Older age
Previous eye trauma
Prolonged use of topical or systemic corticosteroids
Thin cornea
General Nursing Guidelines for the Administration of Topical Ophthalmic Medications
Topical application is the most common route of administration for ophthalmic drugs, and correct administration is essential for optimal therapeutic effects.
Systemic absorption of eyedrops can be decreased by closing the eye and applying pressure over the tear duct (nasolacrimal occlusion) for 3 to 5 minutes after instillation.
When multiple eyedrops are required, there should be an interval of 5 to 10 minutes between drops because of limited eye capacity and rapid drainage into tear ducts.
Absorption of eye medications is increased in eye disorders associated with hyperemia and inflammation.
Many ophthalmic drugs are available as eyedrops (solutions or suspensions) and ointments. Ointments are administered less frequently than drops and often produce higher concentrations of drugs in target tissues. However, they also cause blurred vision, which limits their daytime use, at least for ambulatory patients. For some patients, drops may be used during waking hours and ointments at bedtime.
Topical ophthalmic medications should not be used after the expiration date; cloudy, discolored solutions should be discarded.
Topical eye medications contain a number of inactive ingredients, such as preservatives, buffers, tonicity drugs, antioxidants, and so on. Some contain sulfites, to which some people may have an allergic reaction.
Some eyedrops contain benzalkonium hydrochloride, a preservative, which is absorbed by soft contact lenses. The medications should not be applied while wearing soft contacts and should be instilled 15 minutes or longer before inserting soft contacts.
To increase safety and accuracy of ophthalmic drug therapy, the labels and caps of eye medications are color-coded.
Urine Ouput Hint from Professor
if the question gives you the patients weight, then you calculate the minimum urine output 05.ml/kg/hr. If the question does NOT give you the patient’s weight, the minimum urine output is 30ml/hr.
Creatine Level
0.6-1.2
BUN Level
6-24
Na Level
135-145
K Level
3.5-5
WBC Level
4.5-11
4,500 – 11,000
Platelets Level
150-450
Glaucoma Symptoms
Assess blurry vision
Loss of peripheral vision and see halos
Aching in eyes/headaches
Glaucoma Risk Factors
diabetes, older age, migraine, runs in family
Trabeculectomy
laser to make hole in the mesh work
Timolol: Purpose, Contraindications, and Adverse Effects
The purpose of the administration of beta-adrenergic blocking drugs is to decrease the IOP
beta blocker,
Contraindications include asthma and chronic obstructive pulmonary disease, as well as heart failure, bradycardia, atrioventricular block, left ventricular dysfunction, and cardiogenic shock. Known hypersensitivity to timolol is also a contraindication. (do not give asthmatics or bradycardic patients)
The most common adverse effects associated with timolol are burning and stinging.
Ocular Disorder Patient Education
Wear sunglasses
Keep blood pressure down
Eye exams
Do not share eye makeup or medications
Treat symptoms with over the counter for 3 days then go to doctor
If they have multiple eye drops they must be given 5-10 min apart, pressure on lacrimal duct 3-5 min
Symptoms of Meningitis
Headache and fever are frequently the initial symptoms. Fever tends to remain high throughout the course of the illness. The headache is usually either steady or throbbing and very severe as a result of meningeal irritation
A stiff and painful neck (nuchal rigidity) can be an early sign, and any attempts at flexion of the head are difficult because of spasms in the muscles of the neck
Positive Kernig sign: When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended
Rash
Photophobia
Positive Brudzinski Sign
Meningitis Can Be
Bacterial, viral, fungal
What medications are given to meningitis patients?
Broad spectrum antibiotics
Dexamethasone: steroid to decrease inflammation, helps absorption of antibiotic
Give 15-20 min before IV antibiotics
What cannot be done in meningitis with increased ICP
Lumbar Puncture
Viral Meningitis Medications
Antipyretic
Pain Meds
Increase risk of seizures
Cooling Blanket
TIA Risk Factors
Same as stroke
LPN Delegation
Give meds
No care plans
No Education
No IV Push Meds
No IV sedation
Can do head to toe, but you look at info as RN
First Line Treatments of Cancer
Adjuvant treatment and symptom management
Continues education and support
Home Care
PT
Toxicity assessment and management
Second & Third Line Treatments Cancer
Increasing acuity, Increasing symptom experience, Changes in functional status and quality of life
Palliative care
Continued education and support
Home Care
Pt
Nutrition
Toxicity assessment and management
Hemorrhagic Stroke 2 Meds
Mannitol & Hypertonic Solution: 3% NS
Death & Dying Medications
Morphine
Ativan (no benzos with delirium)
Haldol if they cannot have benzo
Atropine eye drops that go sublingual
Scopolamine
Hospice Things to Know
Chey-Stokes Respiratory
Might get more energy right before death
Nutrition they might not want to eat as much, give them whatever they want but do not push too much
Make room free of odors
Give pain meds on schedule
Tool for Macular Degeneration
Amsler Grid
Alkalating Agents (Names)
Cisplatin, Oxaliplatin
Alkalating Agents (Mechanism of Action)
Bond with DNA, RNA and protein molecules leading to impaired DNA replication – resulting in cell death
Alykalating Agents What to Know
Hard on Kidneys (BUN, Creatinine, Creatinine Clearance & Electrolytes & I&O)
Nausea Vomiting, Hair Loss, Stomatitis
Neurotoxicity when exposed to cold environment and foods(hands & feet)
Nitrosoureas (Name)
Lomustine
Nitrosoureas (Mechanism of Action)
Same as alkylating agents; cross blood-brain barrier
Bond with DNA, RNA and protein molecules leading to impaired DNA replication – resulting in cell death
Nitrosoureas (What to know)
Can cause thrombocytopenia, nausea & vomiting
Hard on liver & kidney
Topoisomerase Inhibitors (Names)
Topotecan, Teniposide
Topoisomerase Inhibitors (Mechanism of Action)
Induce breaks in DNA strand by binding to enzyme topoisomerase, preventing cells from dividing
Topoisomerase Inhibitors (what to know)
Topotecan: Flu-Like
Bone marrow suppression (WBC, RBC, Platelets)
Antimetabolites (Names)
Hydroxyurea, Methotrexate,
5-Fluorouracil
Antimetabolites (Mechanism of Action)
Interferes with the biosynthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis
Antimetabolites (What to know)
Methotrexate: toxic to kidneys
Bone marrow suppression, nausea, vomiting, diarrhea
Antitumor Antibiotics (names)
Doxorubicin (Adriamycin)
Epirubicin
Antitumor Antibiotics (Mechanism of Action)
Interfere with DNA synthesis by binding DNA and preventing RNA synthesis
Antitumor Antibiotics (What to know)
Doxorubicin: Can cause red urine
Bone marrow suppression
Alopecia
Cardiac Toxicity
Miotic Spindle Inhibitors (names)
Vincristine, Paclitaxel
Miotic Spindle Inhibitors (MOA)
Arrest metaphase by inhibiting tubulin depolymerization
Miotic Spindle Inhibitors (side effects)
Bone marrow suppression
Stomatitis
Peripheral Neuropathy
Hormonal Agents & Cancer
Hormonal Agents
Estrogen, progestin, steroids, aromatase inhibitors.
Bind to hormone receptor sites that alter cellular growth.
Lethal Tumor Dose
Dose that will eradicate 95% of the tumor and preserve normal tissue
Stages of Grief (Kubler-Ross)
Denial
Anger
Bargaining
Depression
Acceptance
Advanced Directive
Written documents that allow the individual of sound mind to document preferences regarding end-of-life care that should be followed when the signer is terminally ill and unable to verbally communicate their wishes. The documents are generally completed in advance of serious illness but may be completed after a diagnosis of serious illness if the signer is still of sound mind. The most common types are the durable power of attorney for health care and the living will.
Palliative Care
Palliative: Holistic care of patients whose disease is not responsive to curative treatment. ‘Symptom Management’
Palliative Care & Hospice Setting:
Hospital
Skilled Nursing Facilities and Assisted Living Facilities
Home
Inpatient Hospice Center
Palliative & Hospice
Bridge between cure-oriented treatment and the needs of terminally ill patients and their families for comprehensive care in the final years, months, or weeks of life
Optimize quality of life by anticipating, preventing, and treating suffering
ALL symptoms: physical, psychosocial, spiritual
Offered concurrently with or independent of curative or life-prolonging care
Goal: improve patient’s and family’s quality of life
All hospice care is palliative care, but not all palliative care is hospice care
What to know about teaching for internal radiation
No pregnant people or children in the room
Visitors have max of 30 min per day in the room
Radioactive sign on door with door closed
Stay 6 feet away from patient
Wear a device that measures radiation
Cancer Surgical Treatments
Biopsy: Obtain a sample to perform pathology on. May also take sample of nearby lymph nodes. Help determine if tumor is malignant and grade/stage of the tumor
Surgical removal of the entire cancer remains the ideal and most frequently used treatment method
Prophylactic Surgery: HIGH RISK patients. Ex: Breast CA with BRCA1 or BRCA2 genes. Colectomy, mastectomy, oophorectomy (examples)
Palliative Surgery: Surgical cure not possible. Goal is to relive symptoms and make patient as comfortable as possible
Reconstructive Surgery: Attempt to improve function or obtain a more desirable cosmetic effect. Ex: After mastectomy
Mammogram
Age 45-54: annual
Age 55 and up: every other year
Pap smear
Age 21-29: every 3 years
Age 30-65: every 5 years
Age 66 and up: NA unless past abnormal results
Colorectal Screen
Starting at AGE 45!
Colonoscopy every 10 years (if normal and low risk)
Lung Screening
CT scan if over age 55 and 30+ pack/year smoking history
Prostate Screening
Age 50: Every other year (if under 2.5)
Primary Cancer Prevention
Use of immunization to reduce risk of cancer. Ex: HPV and HBV vaccines
Secondary Cancer Prevention
Screening and early detection activities. Ex: Colonoscopy, PSA, CBC
Tertiary Cancer Prevention
Monitoring for and preventing recurrence of primary cancer and screening for development of second malignancies in cancer survivors. Ex: CT every 3 months, then 6 months, then yearly, etc
Cancer Prevention 2 things
150 minutes of exercise of week
1 alcoholic drink a day