Exam 1: NSG123/ NSG 123 (Latest 2024/ 2025 Update) Med Surg 1| Guide with Questions and Verified Answers| 100% Correct- Herzing
Exam 1: NSG123/ NSG 123 (Latest 2024/
2025 Update) Med Surg 1| Guide with
Questions and Verified Answers| 100%
Correct- Herzing
Q: Incompetent Patient
Answer:
Legal definition: individual who is not autonomous and cannot give or withhold consent (e.g.,
individuals who are cognitively impaired, mentally ill, or neurologically incapacitated).
Q: Ethical Considerations with Consent
Answer:
non-English speaking patients, cognitive impairment, emergency surgery, language barriers etc.
Q: Reasons surgery may be delayed or postponed
Answer:
- Poor nutrition or hydration status
- Respiratory Infection (elective surgery)
- Infection
- Anesthetic Allergies
- Drugs & Alcohol
- Uncontrolled hypertension
- Medications such as diuretics, steroids, insulins, opioids, anticoagulants
Q: Perioperative Patient Teachings
Answer:
Discontinue smoking 30 days prior
Stop any OTC herbal medications 2 weeks prior
Stop aspirin or anticoagulant 7-10 days prior
Nothing by mouth
Q: What is done in the OR to maintain asepsis?
Answer:
All surgical supplies are sterilized
All personal wash and scrub hands and arms with antiseptic soap
Only those who have taken proper sanitary precautions can touch sterilized objects
Surgical team members wear long-sleeved, sterile gowns and gloves. Head and hair are covered
with a cap, and a mask
Q: Unrestricted Zone
Answer:
street clothes are allowed
Q: Semi-Restricted Zone
Answer:
where attire consists of scrub clothes and caps
Q: Restricted Zone
Answer:
where scrub clothes, shoe covers, caps, and masks are worn. The surgeons and other surgical
team members wear additional sterile clothing and protective devices during surgery.
Q: Circulating Nurse Role
Answer:
: the circulating nurse manages the OR and protects the patient’s safety and health by monitoring
the activities of the surgical team, checking the OR conditions, and continually assessing the
patient for signs of injury and implementing appropriate interventions. A foremost responsibility
includes verifying consent; if not obtained, surgery may not commence. The team is coordinated
by the circulating nurse, who ensures cleanliness, proper temperature, humidity, appropriate
lighting, safe function of equipment, and the availability of supplies and materials. circulating
nurse is responsible for ensuring that the second verification of the surgical procedure and site
takes place and is documented.
Q: Scrub Nurse/Surgical Tech Role
Answer:
performs the activities of the scrub role, including performing hand hygiene; setting up the
sterile equipment, tables and sterile field; preparing sutures, ligatures, and special equipment and
assisting the surgeon and the surgical assistants during the procedure by anticipating the
instruments and supplies that will be required, such as sponges, drains, and other equipment. As
the surgical incision is closed, the scrub person and the circulating nurse count all needles,
sponges, and instruments to be sure that they are accounted for and not retained as a foreign body
in the patient
Q: Registered Nurse First Assist Role
Answer:
Practices under direct supervision of the surgeon. RNFA responsibilities may include handling
tissue, providing exposure at the operative field, suturing, and maintaining hemostasis
Q: Prevention of Wound Dehiscence
Answer:
An abdominal binder can provide support and guard against dehiscence and may be used along
with the primary dressing, especially in patients with weak or pendulous abdominal walls or
when rupture of a wound has occurred.
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Pre-Operative Phase The preoperative phase begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room (OR) bed.
Intra-operative Phase: The intraoperative phase begins when the patient is transferred onto the OR bed and ends with admission to the PACU. Intraoperative nursing responsibilities involve acting as scrub nurse, circulating nurse, or registered nurse first assistant
Post-operative Phase: The postoperative phase begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home.
Patients who need special consideration during surgery 1. Older adults2. Obese patients 3. Patients with disabilities4. Patients undergoing emergency surgery5. Patients undergoing ambulatory surgery
Surgeon’s Role in Consent The surgeon must also inform the patient of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods.
Nurse’s Role in Consent Nurse witnesses consent being signed.The nurse clarifies the information provided, and if the patient requests additional information, the nurse notifies the physician. The nurse ascertains that the consent form has been signed before administering psychoactive premedication
What happens to a consent form once it is signed? The signed consent form is placed in a prominent place on the patient’s medical record and accompanies the patient to the OR.
Incompetent Patient Legal definition: individual who is not autonomous and cannot give or withhold consent (e.g., individuals who are cognitively impaired, mentally ill, or neurologically incapacitated).
Ethical Considerations with Consent Non-English speaking patients, cognitive impairment, emergency surgery, language barriers, etc.
Reasons surgery may be delayed or postponed 1. Poor nutrition or hydration status2. Respiratory Infection (elective surgery)3. Infection4. Anesthetic Allergies5. Drugs & Alcohol6. Uncontrolled hypertension7. Medications such as diuretics, steroids, insulins, opioids, anticoagulants
Patient teachings prior to surgery Discontinue smoking 30 days priorStop any OTC or herbal medications 2 weeks priorStop aspirin or anticoagulants 7-10 days priorNPODeep breathing & coughingIncentive spirometryMobility & active body movementPain assessment
What is done in the OR to maintain asepsis? All surgical supplies are sterilizedAll personal wash and scrub hands and arms with antiseptic soapOnly those who have taken proper sanitary precautions can touch sterilized objectsSurgical team members wear long-sleeved, sterile gowns and gloves. Head and hair are covered with a cap, and a mask
Unrestricted Zone Street clothes are allowed
Semi-Restricted Zone Where attire consists of scrub clothes and caps
Restricted Zone Where scrub clothes, shoe covers, caps, and masks are worn. The surgeons and other surgical team members wear additional sterile clothing and protective devices during surgery.
Circulating Nurse Role The circulating nurse manages the OR and protects the patient’s safety and health by monitoring the activities of the surgical team, checking the OR conditions, and continually assessing the patient for signs of injury and implementing appropriate interventions. A foremost responsibility includes verifying consent. The team is coordinated by the circulating nurse, who ensures cleanliness, proper temperature, humidity, appropriate lighting, safe function of equipment, and the availability of supplies and materials. The circulating nurse is responsible for ensuring that the second verification of the surgical procedure and site takes place and is documented.
Scrub Nurse/Surgical Tech Role Performs the activities of the scrub role, including performing hand hygiene, setting up the sterile equipment, tables and sterile field, preparing sutures, ligatures, and special equipment, and assisting the surgeon and the surgical assistants during the procedure by anticipating the instruments and supplies that will be required, such as sponges, drains, and other equipment. As the surgical incision is closed, the scrub person and the circulating nurse count all needles, sponges, and instruments to be sure that they are accounted for and not retained as a foreign body in the patient
Registered Nurse First Assist Role Practices under direct supervision of the surgeon. RNFA responsibilities may include handling tissue, providing exposure at the operative field, suturing, and maintaining hemostasis
Prevention of Wound Dehiscence An abdominal binder can provide support and guard against dehiscence and may be used along with the primary dressing, especially in patients with weak or pendulous abdominal walls or when rupture of a wound has occurred.
Who is at risk for wound dehiscence? Older patientsAnemiaPoor nutritional statusObesityMalignancyDiabetesThe use of steroids
Pneumonia Symptoms Post-Op Chills and feverTachycardiaTachypneaCough may or may not be present and may or may not be productive
Hypoxemia Post Operately Subacute hypoxemia is a constant low level of oxygen saturation when breathing appears normal. Episodic hypoxemia develops suddenly, and the patient may be at risk for cerebral dysfunction, myocardial ischemia, and cardiac arrest.
Causes and S&S of Atelectasis Post-Op Atelectasis remains a risk for the patient who is not moving well or ambulating or who is not performing deep-breathing and coughing exercises or using an incentive spirometer. Signs and symptoms include decreased breath sounds over the affected area, crackles, and cough
General Anesthesia Administration Inhalation or IV. Patient is asleep
Regional Anesthesia Spinal, Epidural. The patient receiving regional anesthesia is awake and aware of their surroundings unless medications are given to produce mild sedation or to relieve anxiety. In regional anesthesia, an anesthetic agent is injected around nerves so that the region supplied by these nerves is anesthetized. The effect depends on the type of nerve involved.
Local Anesthesia Preferred!! Local anesthesia is the injection of a solution containing the anesthetic agent into the tissues at the planned incision site. Often it is combined with a local regional block by injecting around the nerves immediately supplying the area. It is given directly to the surgical field, and the circulating nurse observes and monitors the patient for possible side effects
Malignant Hyperthermia – What is it and what are the S&S? Malignant hyperthermia is a rare inherited muscle disorder that is chemically induced by anesthetic agents. Can appear up to 24 hours after anesthesia. The initial symptoms of malignant hyperthermia are often cardiovascular, respiratory, and abnormal musculoskeletal activity. Tachycardia and generalized muscle rigidity are an early sign. The rise in temperature is a late sign that develops rapidly; body temperature can increase 1°C to 2°C (2°F to 4°F) every 5 minutes. Stop anesthesia.
Major Goals for Surgical Patients Reduced anxietyAbsence of latex exposureAbsence of positioning injuriesAbsence of complicationsMaintenance of the patient’s dignity
Post-Op Assessment Vital signsPainRespiratory functionCardiovascular functionSkin colorLevel of consciousnessAbility to respond to commands
Adverse Effects of Rifampin GI upsetSkin rashesHepatotoxicityAcute renal failureHarmless red-orange discoloration of body fluids
What medication is given for prevention of TB for those exposed to a positive patient? Isoniazid
Plan of Care for TB Airway clearanceAdherence to the treatment regimenPromoting activity and nutritionPreventing transmission
What type of isolation precautions is TB? What is worn for PPE? Airborne Precautions – N95 or Respirator Mask, Gloves, Gown, & Negative Pressure Room
What test is done to confirm TB diagnosis? Sputum Culture
Risk Factors for TB Close contact with someone who has TBImmunocompromisedPeople with preexisting conditionsSubstance abusePeople who do not have access to proper medical careImmigrationHealthcare workersLiving is overcrowded areas
Community-acquired pneumonia (CAP) Pneumonia occurring in the community or ≤48 hours after hospital admission or institutionalization of patients who do not meet the criteria for health care-associated pneumonia (HCAP)
Hospital Acquired Pneumonia (HAP) Develops 48 hours or more after admission and does not appear to be incubating at the time of admission
Ventilator Acquired Pneumonia (VAP) The patient has been endotracheally intubated and has received mechanical ventilatory support for at least 48 hours. VAP is a complication in as many as 28% of patient who require mechanical ventilation
Health care-associated pneumonia (HCAP) Pneumonia occurring in a non-hospitalized patient with extensive health care contact with one or more of the following: acute care facility, nursing home, long-term care facility, chemotherapy, wound care, dialysis
What is found during percussion of the lungs in a patient with pneumonia? Dullness replaces resonance when fluid or solid tissue replaces air-containing lung tissues, such as occurs with pneumonia, pleural effusions, or tumors
Reason for Peak Flow Meter and what results mean Used to monitor severity of asthma. Peak flow meters measure the highest airflow during a forced expiration. The patient takes a deep breath and places lips around the mouthpiece, and then exhales hard and fast.Volume may be measured in color-coded zones: the green zone signifies 80% to 100% of personal best; yellow, 60% to 80%; and red, less than 60%. If peak flow falls below the red zone, the patient should take the appropriate actions prescribed by their primary provider.
S&S of Asthma CoughDyspneaWheezing
Patient Teaching to Prevent Asthma Attacks Patients with recurrent asthma should undergo tests to identify the substances that precipitate the symptoms. Patients are instructed to avoid the causative agents whenever possible.
Prevention of Respiratory Complications Post-Op Incentive SpirometryDeep BreathingCoughing
Teaching for patients taking corticosteroids It is important to instruct patients that oral and nasal inhalations are not interchangeable. In people with asthma who are taking an oral corticosteroid, it is necessary to reduce the oral dosage slowly (over weeks to months) when an inhaled corticosteroid is added.
Management of Asthma Exacerbation Quick-acting beta2-adrenergic agonist medications are first used for prompt relief of airflow obstruction. Systemic corticosteroids may be necessary to decrease airway inflammation in patients who fail to respond to inhaled beta-adrenergic medications. In some patients, oxygen supplementation may be required to relieve hypoxemia associated with moderate to severe exacerbations.
Steps for Metered-Dose Inhaler 1. Shake well immediately before each use.2. Remove the cap from the mouthpiece.3. Exhale to the end of a normal breath.4. With the inhaler in the upright position, place the mouthpiece just inside the mouth, and use the lips to form a tight seal or hold the mouthpiece approximately two finger widths from the open mouth.5. While pressing down on the inhaler, take a slow, deep breath for 3 to 5 seconds, hold the breath for approximately 10 seconds, and exhale slowly.6. Wait 3 to 5 minutes before taking a second inhalation of the drug.7. Rinse the mouth with water after each use.8. Rinse the mouthpiece and store the inhaler away from heat.9. If you have difficulty using an inhaler, ask your provider about a spacer device (a tube attached to the inhaler that makes it easier to use).
Status Asthmaticus Definition Rapid onset, severe, and persistent asthma that does not respond to conventional therapy
S&S Status Asthmaticus Labored breathingProlonged exhalationEngorged neck veinsWheezing
Appropriate Medication Regimen for COPD For grade I (mild) COPD, a short-acting bronchodilator may be prescribed.For grade II or III COPD, a short-acting bronchodilator and regular treatment with one or more long-acting bronchodilators may be used.For grade III or IV (severe or very severe) COPD, regular treatment with one or more bronchodilators and/or inhaled corticosteroids for repeated exacerbations.
Use of Diaphragmatic Breathing in COPD Reduces the respiratory rateIncreases alveolar ventilationSometimes helps expel as much air as possible during expiration
Ways to manage COPD Symptoms Breathing exercises (pursed lip breathing)Activity PacingExerciseOxygenPalliative Care
COPD Surgical Options Bullectomy: bullous emphysema, removal of airspaces that do not contribute to ventilationLung Volume ReductionLung Transplant
Risk factors to avoid for patient already diagnosed with COPD SmokingEnvironmental Pollution
Physcial Assessment Findings in COPD Chronic coughSputum productionDyspnea
What population may require alpha1-antitrypsin testing for COPD? This deficiency predisposes young people to rapid development of lobular emphysema, even in the absence of smoking. Among Caucasians, alpha1-antitrypsin deficiency is one of the most common genetically linked lethal diseases. COPD may also result from gene-environment interactions
PCV13 Recommendations Prevnar 13 is recommended for all adults 65 years of age or older as well as adults 19 years or older with conditions that weaken the immune system, such as HIV infection, organ transplantation, leukemia, lymphoma, and severe kidney disease
PPSV23 Recommendations Pneumovax is a newer vaccine and protects against 23 types of pneumococcal bacteria. It is recommended for all adults 65 years of age or older and for those adults 19 through 64 years of age who smoke cigarettes or who have asthma
Pneumococcal Vaccination Recommendations People at high risk for serious morbidity or mortality from a chronic condition
Pneumococcal Vaccination Contraindications Acute febrile illnessImmunosuppressive drug therapyImmunodeficiency states such as congenital immunodeficiency or active HIV diseaseHematologic cancers (leukemia or lymphoma) or generalized malignancyPregnancy
Treatment plan for patients with CAP Administration of the appropriate antibiotic as determined by the results of a culture and sensitivity
When is a patient ready for discharge with CAP? As soon as patients are clinically stable, have no medical problems, and have a safe environment for continued care.Clinical stability is defined as temperature less than or equal to 37.8°C (100°F), heart rate less than or equal to 100 bpm, respiratory rate less than or equal to 24 breaths/min, systolic blood pressure greater than or equal to 90 mm Hg, and oxygen saturation greater than or equal to 90%, with ability to maintain oral intake and normal (baseline) mental status.
When should pneumonia patients be switched to oral antibiotics? When they are hemodynamically stable, are improving clinically, are able to take medications/fluids by mouth, and have a normally functioning gastrointestinal tract
When do we position pneumonia patients laying on their left side? Right lower, lateral lobe pneumonia should be positioned in the left side-lying position to perform postural drainage of the right lung.
When do we position pneumonia patients in the prone position? A prone position would be appropriate for lower lobes, superior segments that are affected posteriorly.
When do we position pneumonia patients in the high Fowlers position? A Fowler’s or high-Fowler’s position, anteriorly or posteriorly, would be appropriate to drain the upper lobes of the lungs.
How to prevent pneumonia in the elderly VaccinationEarly diagnosis
Nursing Diagnoses for Pneumonia Ineffective Airway ClearanceFatigue and Activity IntoleranceRisk for Fluid Volume DeficitImbalanced NutritionKnowledge Deficit
Nursing Interventions for Pneumonia AntibioticsHumidified oxygenCoughingChest physiotherapyIncentive spirometryNutrition & Hydration
Nursing goals for pneumonia Improved airway patencyIncreased activityMaintenance of proper fluid volumeMaintenance of adequate nutritionUnderstanding of the treatment protocol and preventive measuresAbsence of complications
What diagnostic tests are done for pneumonia? 1. Blood cultures2. Sputum samples3. Chest x-ray (radiograph)4. Bronchoscopy5. Thoracentesis
Assessment Findings Pneumonia: CoughingSputumFeverImbalanced ABGsCrackles in lungsDullness on percussionIncreased WBCsUse of accessory muscles
Patients at risk for aspiration pneumonia Anyone with decreased level of consciousness such as:Head injurySeizuresAnesthesiaStroke
What causes aspiration pneumonia? Abnormal material, such as food, liquid, or bacteria, from the mouth or stomach enter the trachea and lungs
Pneumonia definition Pneumonia arises from normal flora present in patients whose resistance has been altered or from aspiration of flora present in the oropharynx. Patients often have an acute or chronic underlying disease that impairs host defenses.