Exam 2: NSG123/ NSG 123 Med Surg 1 Exam (Latest 2024/ 2025 Update) | Questions and Verified Answers| 100% Correct| Grade A- Herzing
Exam 2: NSG123/ NSG 123 Med Surg 1
Exam (Latest 2024/ 2025 Update) | Questions
and Verified Answers| 100% Correct| Grade
A- Herzing
Q: a patient presents with symptoms of gallbladder disease, and the nurse should anticipate
what type of diagnosis test to be performed?
Answer:
abdominal Xray
Q: patient presents with symptoms of gallstones and jaundice, the nurse should anticipate what
type of diagnosis test to be performed
Answer:
ultrasonography
Q: when radiography is not conclusive, which option of diagnosis is run by for acute
cholecystitis blockage?
Answer:
cholescintigraphy
Q: endoscopy retrograde cholangiopancreatography (ERCP)
Answer:
permits direct visualization of structures of hepatobiliary system.
Q: Murphy’s sign
Answer:
Pain with palplation of gall bladder (seen with cholecystitis)
Q: how to treat a cholecystitis?
Answer:
requires hospitalization fasting periods at the hospital
fluid replacement – IV electrolytes antibiotics
pain relief medication
gallbladder stone removal ERCP
Q: Peritonitis symptoms
Answer:
sudden severe abdominal pain, rigid abdomen, shallow rapid respiration, tachycardia with weak
pulse, nausea and vomitting
Q: risk of peritonitis
Answer:
perforation or rupture of structure in GI tract from appendix, peptic ulcer, diverticulitis, bowel
obstruction)
traumatic injury ruptured ovarian cyst postoperative complication septic shock
Q: Laparoscopy Cholecystectomy
Answer:
removal of gallbladder through a small inci- sion. less risk, reduce long stay in hospital and
improvement on recovery
Q: nutritional therapy for post care of acute gallbladder inflammation
Answer:
low fat liquids
powdered supplements high in protein stirred into fats kind milk cooked fruits and veggies
avoid eggs, coffee, pork, fried foods, cheese, gas forming vegetables
Q: nonsurgical removal of gallstones
Answer:
Dissolving gallstones by infusion of a solvent MTBE into the gallbladder. There are several
routes, but laparoscopic chole- cystectomy is the standard for management.
Q: pre-op for gallbladder surgery
Answer:
chest x ray electrocardiogram
liver function test
vitamin K supplements if prothrombin is low
iv with glucose protein supplements to help prevent liver damage
Q: Laparoscopy Cholecystectomy
Answer:
minimal invasive removal of the gallbladder
Q: post op complications of laparoscopy Cholecystectomy
Answer:
loss of appetite, vomiting, pain, distention of the abdomen, fever
Q: choledocholithotomy
Answer:
incision into the common bile duct to remove a stone
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What is cholecystitis? inflammation of the gallbladder, which can be acute or chronic
symptoms of cholecystitis -Pain is always present and is located in RUQ or epigastrium; it may radiate to the right shoulder or scapula (BOAS SIGN)-n/v/anorexia
calculous cholecystitis chemical irritation and inflammation result from gallstones (cholelithiasis) that obstruct the cystic duct, gall bladder neck, or common bile duct
acalculous cholecystitis the inflammation of the gallbladder without associated gallstones
how acalculous cholecystitis occurs? after major surgical procedures, orthopedic surgeries, severe trauma, or burns.
Pigment stones and cholesterol stones? pigment stones are made by unconjugated bile pigment and cannot be dissolve, only surgerycholesterol stones account for 75% of the cases, made by bile oils and is insoluble in water.
cholesterol stones 3 times more in woman, older than 40, have obesity, formed in bile that is supersaturated w cholesterol; yellow in color; caused by obesity, DM, genetics, pregnancy & 4Fs
symptoms of gallstones Upper right abdominal pain, gas, bloating, nausea and vomiting
how do you diagnose cholelithiasis? ultrasound, or HIDA scan, magnetic resonance
symptoms of gallstones? Upper right abdominal pain, gas, bloating, nausea and vomiting
a patient presents with symptoms of gallbladder disease, and the nurse should anticipate what type of diagnosis test to be performed? abdominal Xray
patient presents with symptoms of gallstones and jaundice, the nurse should anticipate what type of diagnosis test to be performed ultrasonography
when radiography is not conclusive, which option of diagnosis is run by for acute cholecystitis blockage? cholescintigraphy
endoscopy retrograde cholangiopancreatography (ERCP) permits direct visualization of structures of hepatobiliary system.
Murphy’s sign Pain with palplation of gall bladder (seen with cholecystitis)
how to treat a cholecystitis? requires hospitalization fasting periods at the hospital fluid replacement – IV electrolytes antibiotics pain relief medication gallbladder stone removal ERCP
Peritonitis symptoms sudden severe abdominal pain, rigid abdomen, shallow rapid respiration, tachycardia with weak pulse, nausea and vomitting
risk of peritonitis perforation or rupture of structure in GI tract from appendix, peptic ulcer, diverticulitis, bowel obstruction) traumatic injury ruptured ovarian cyst postoperative complicationseptic shock
Laparoscopy Cholecystectomy removal of gallbladder through a small incision. less risk, reduce long stay in hospital and improvement on recovery
nutritional therapy for post care of acute gallbladder inflammation low fat liquidspowdered supplements high in protein stirred into fats kind milkcooked fruits and veggies avoid eggs, coffee, pork, fried foods, cheese, gas forming vegetables
nonsurgical removal of gallstones Dissolving gallstones by infusion of a solvent MTBE into the gallbladder. There are several routes, but laparoscopic cholecystectomy is the standard for management.
pre-op for gallbladder surgery chest x rayelectrocardiogram liver function testvitamin K supplements if prothrombin is lowiv with glucose protein supplements to help prevent liver damage
Laparoscopy Cholecystectomy minimal invasive removal of the gallbladder
post op complications of laparoscopy Cholecystectomy loss of appetite, vomiting, pain, distention of the abdomen, fever
choledocholithotomy incision into the common bile duct to remove a stone
surgical cholecystostomy A cholecystostomy procedure performed by making an abdominal incision and opening the gallbladder, allowing drainage of bile and purulent material.
percutaneous transhepatic Uses ultrasound to guide a needle into the bile ducts so dye can be injected
which of the following are assessment and diagnosis tools for diagnosing gallstones? select all that apply retrograde pyelogramendoscopy retrograde cholangiopancreatographyuktrasonographyoral cholecystography all that ends with graphya,b and C
medications to be administrated before ERCP? anticholinergic agents, or glucagon, decreasing the duodenum peristaltic movement
nurse role.in the after care of ERCP? monitor respiratory and CNS depression, hypotension, overreaction and vomiting, administer medications, and position the pt. observe vital signs and ass3ssing for signs of perforation or infection.
Nursing Diagnosis for post operatory? *acute pain and discomfort *impaired gas exchange *impaired skin integrity *impared nutrition status* lack of knowledge about selfcare associated with incision.
nursing intervention for post operative low Fowler positionIV fluidsnasogastric suctionsoft diet after bowel sounds returnearly ambulation
which of the following is a nursing priority for patients who have undergone surgical removal of the gallbladder? select all that apply biliary drainagemaintain skin integrity relieving painmaintain current nutritional status a,b and c
after recovery from anesthesia, the patient who had gallbladder surgery is placed in which position? low Fowler position
Peptic Ulcer Disease A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum
Chronic gastric ulcer occurs usually on an empty stomach, occurs I’m a lesser curvature of the stomach
esophageal ulcer A lesion in the mucosal lining of the esophagus, refluz disease GERD
what is the main cause of of gastric ulcers nowdays? anxietyhigher rates of NSAID useH.pylori infections
blood type O are more susceptible to the development of peptic ulcer? True or false? true
gastric ulcers happens from normal or decreased levels of acid that can may result in the formation of peptic ulcers. true or false? true
ZES ulcers are described as aggressive and refractory
Zes ulcer ia suspect when? ulcer that is resistant to standard medical therapy, hypersecretion of gastric, gastrinomas.
gastrodupdenostomy creation of an opening between the stomach and the duodenum
antrectomy excision of the antrum (of the stomach)
gastrojejunostomy creation of an opening between the stomach and the jejunum
Truncal vagotomy transection of vagus nerve trunks; must provide drainage procedure for stomach because it will not relax status post
vagotomy surgical transection of the fibers of the vagus nerve
Selective vagotomy Severs vagal innervation to the stomach but maintains innervation to the rest of the abdominal organs.
pyloroplasty surgical repair of the pyloric sphincter
gastrojejunostomy creation of an artificial opening between the stomach and jejunum
signs and symptoms of perforation of the stomach severe upper abdominal painvomiting collapseextremely tender and rigid abdomen hypotension and tachycardia
pharmacology management for peptic ulcer h2 Blockers and proton pump inhibitors
Histamine 2 Receptor Antagonists block the production of stomach acid, famotidine and cimetidine
Histamine 2 Receptor Antagonists “Ranitidine and Famotidine””If you take this medication, you will feel better when you ‘dine'””Used for duodenal and gastric ulcers as well as GERD and Zollinger-Ellison syndrome (increased gastric juices) by blocking H2 receptors in the stomach which reduces gastric acid secretionSide effects: increases risk of bacterial colonization in stomach because of reduced pH. Advis patient not to over eat, reduce stress, stop smoking, avoid aspirin and NSAIDs”
Cimetidine dose 200 mg BID PRN
H2RAs adverse effects headache, diarrhea, constipation, dizziness, drowsiness
Omeprazole: Pharmacokinetics -excretion via urine, metanbolism via hepatic,
appendicitis inflammation of the appendix
appendicitis nursing care • Patient is to remain NPO• Intravenous fluids • Semi-fowler’s position• Analgesics • No laxatives or enemas • No heat • Prepare to CT
peritonitis inflammation of the peritoneum
Primary peritonitis very unusual. due to a blood borne pathogen entering the peritoneal cavity.
Secondary peritonitis most common. due to any sort of bowel perforation.
terciary peritonitis occurs as a result of a superinfection in a patient who is immunocompromised
treatment for peritonitis Fluids and antibiotics IV broad spectrum
which peritonitis is also called spontaneous bacterial peritonitis? primary infection
Diverticulitis inflammation of a diverticulum
what drugs are contraindicated for appendicitis and peritonitis? laxatives and cathartics
How to manage GERD Avoid triggers-decrease high fat foods (they stay in the gut longer)-eat high protein, low fat-take fluids between rather than with meals to avoid over stretching the stomach, eat small frequent meals-avoid milk products at night, -avoid late night snaking and meals-Avoid foods that decrease LES pressure-Eliminate alcohol-Stop smoking-avoid lying down/laying flat 2-3 hours after eating-avoid tight clothing-Elevate HOB 30 degrees or 4-6 inch blocks-take PPI med before first meal of the day-chew gum-do weight reduction therapy
antacids should not be taken with what medication h2 receptors antagonist
antacids should be taken one and 3hrs after meals, and H2 antagonist should né taken once a day at bedtime, true or false true
Maalox, Mylanta medication what labs a nurse should be considered to check before? magnesium levels
Histamine 2 Receptor Antagonists “Ranitidine and Famotidine””If you take this medication, you will feel better when you ‘dine'””Used for duodenal and gastric ulcers as well as GERD and Zollinger-Ellison syndrome (increased gastric juices) by blocking H2 receptors in the stomach which reduces gastric acid secretionSide effects: increases risk of bacterial colonization in stomach because of reduced pH. Advis patient not to over eat, reduce stress, stop smoking, avoid aspirin and NSAIDs”
Omeprazole proton pump inhibitor
BMI >30 obese
BMI 25-29.9 overweight
diabetes type 2 is more likely to increase by 10 fold by What condition? obesity
GERD positioning Left side, hob 30 degrees (at home can be on bricks)
weight loss medications alone could manage weight? no, it must be adjunct with lifestyle modifications
medication for obesity benzphetamine
Benzphetamine medication works by stimulating the release of norepinephrine and dopamine, ir can supresse appetite
non-surgical intervention for obesity intragastric Ballon therapy
endoscopic placement of saline filled ballon, how long a patient can have this weight management 3 to 6 months
weight management that involves endoscopy placement of salinefilled ballon or a saline filled dual ballon in the stomach. intragastric ballon therapy
how the intragastric ballon therapy works this procedure increases the feeling of satiety and decreased gastric emptying
weight management surgical intervention gastric bypassgastric bandingsleeve gastrectomy biliopancreatic diversion w duodenal switch
After bariatric surgery, what post-op surgery care a pt should consider dietary guidelines, protein, and fiber should be consumed in each meal, eat slowly, chew food thoroughly, and fluids should be consumed every 30 minutes before meals and 30 to 60 min after meals.
Orlistat (Xenical) inhibits fat absorption and should be taken with fat soluble vitamins.
causes of constipation medications – opioid chronic laxatives weaknessimmobility or lack of exercise fatiguediet
what os constipation less than 3 bowel movements per weekabdominal distention, pain, and bloading
how to diagnose finding of constipation? history and physical examMRIdefecographybarium enema, stool testing
hemorrhoids swollen, twisted, varicose veins in the rectal region
Stool Softeners docusate sodium (Colace)
Laxatives medications or foods given to stimulate bowel movements
Laxatives action speed up or improve the movement of intestinal content when movement becomes slow or sluggish with constipation
Valsalva maneuver forcible exhalation against a closed glottis, resulting in increased intrathoracic pressure
Valsalva maneuver can drop arterial pressure and cause what possible consequences? orthostatisis, dizziness, and syncope
What is diarrhea? frequent watery stools, more than 3 times a day w altered consistency
infections associated with diarrhea c. difficile
Clostridium difficile Oral metronidazole; if refractory, oral vancomycingram-posititive anaerobic organism
if a patient is constipated, what should a nurse should be teaching? stop holding stool in urgentdon’t syncope, go to the bathroom after each meal to develop normal bowel movements *not to use laxatives every day
any pt in antibiotics the possibility of an unexplained diarrhea C. Difficile
if you are assessing a pt with excessive diarrhea l, what would be your first assessment? electrolytes/labs
pt with a history of constipation, anal fissure, what medication we would consider? chronic issues or hemorrhoids (no Metamucil) stool bulker colase stool Softeners
Bismuth Salicylate Pepto Bismol, over the counter medication
traveling to another country, you got diarrhea, antibacterial, and antiviral medication you should take? bismuth salt
small bowel obstruction Physical blockage of the small intestines
diagnosis and assessment of small bowel movements abdominal x-ray and CT scan finding adhesions
adhesions internal scar tissue between tissues or organs
nurse must assess for fluid and electrolyte imbalance, labs, skin turgor, weak treaty pulse, capillary refill less than 2, significantly fluid loss small bowel obstruction
clinical manifestations of large bowel obstruction symptoms develop and progress relatively slowlyshape of stool is altered as it passes the obstructionblood loss in stoolweaknessweight lossanorexiaeventually, the abdomen becomes markedly distened
small bowel obstruction patien, what would be priorities? fluid and electrolytes
purpose of put in a NG tube to a small bowel obstruction decompress the abdomen
Large bowel obstruction Large amounts of distention, Patient does not have any vomiting or stooling.
Large bowel obstruction manifestation abdomen becomes markedly distended, loops of large bowel become visibly outlined, crampy severe abdominal pain.
NG Aspiration to decompress abdominal wall management of large bowel obstruction
nurse intervention for large bowel obstruction monitor for
different between small bowel obstruction and large bowel obstruction notable visible abdominal distention at the wall, in the large bowel obstruction
if you see a nurse flushing the NG tube with 50ml of saline, what you should do? stop and educate the nurse it should be 30ml
if a pt require long term tube feeding, what is the best option
a pt is unable to feed, what would be the option parental nutrition
complication of TPN with hypoglycemia, if a nurse ran out of the bag what she sould do? give dextrose IV to avoid hypoglycemia
total parenteral nutrition (TPN) nutrient-complete solution given directly into bloodstream when person cannot eat by mouth
the iv lines used for parental nutrition cannot be used for other purposes? not, nurse should add another peripheral line
adverse reaction of TPN attributed to the hyoertonicity dehydration hypotension tachycardia nausea and vomiting diarrhea
difference between chrons disease and colitis? chrons disease can be in all gi system, colitis mostly in the colon
Chron’s disease test best way to diagnose CT scan
ulcerative colitis diagnostic The best way is to get a diagnosis is with a colonoscopy
patient should monitor food in their plane of care for release symptoms of? Ulcerative colitis
what the aspect to see a pt with chron’s disease low weight
Gallbladder disease cholelithiasis-gallstonesS&S- abdominal pain, jaundice, heart burn, food intolerance
gallbladder manifestation pain, tenderness, rigidity of upper right abdomen may radiate right shoulder
RUQ pain following meals with fried or fatty food? gallbladder
Murphy’s sign Pain with palplation of gall bladder (seen with cholecystitis)
H.pylori positive test indicates pt also has what IBD? peptic ulcer
nursing recommendations for peptic ulcers avoid food too hot, over stimulate acids, to cold to avoid cramps, no use of NSAIDs medication, alcohol, avoid coffee even decaffeinated coffee.
What is sucralfate? Forms protective coat over ulcer, causes constipation
pt comes back from surgery removal of gallbladder, complains from abdominal pain and shoulder, what would be the best action for the nurse post op care? get the pt to walk and ambulates to expelled the CO2 gas used during surgery, causing the pain.
laparoscopic cholecystectomy post surgery patient care heating pad 20min encourage pt to ambulate, assess bowel movements, and manage nausea.
how to diagnose large bowel obstruction? CT scan with visible outline of loops of large bowel obstruction.
pancreatitis symptoms upper abdominal pain, swollen and tender abdomen, nausea, vomiting, fever, increased heart rate, weight loss, and diabetes.
Chenodiol (chenodeoxycholic acid) treatment of gallstones Increases production of bile acidsMost successful in women with low cholesterol levels
TPN assessment glucose every 4 to 6 hours
post-operative care after gallstones removal? assess pt for obstruction, jaundice, signs of infection, and leaking, report to the doctor immediately
post-op teaching for patients after gallbladder surgery shower not to bathesmall serousanguineous fluid drains initial 24hrsempty drainage bag every 8 hourspt may return to work after 1 weekavoid heavy lifting
small bowel obstruction surgery, pt be prone to form? adhesions
Loperamide (Imodium) side effects torsades de pointes, other ventricular arrhythmias, cardiac arrest, drowsiness, nausea, vomiting
Lomotil (diphenoxylate/atropine) Antidiarrheal slow smooth muscle
Chenodiol Decreases cholesterol gallstone by inhibiting HMG-CoA reductase (decrease cholesterol synthesis), by decreasing intestinal reabsorp of cholesterol, & inhibiting secretion of cholesterol into bile
priority for small bowel obstruction fluid electrolytes
prep pt for appendicitis surgery, what should be the nurse priority keep pt NPO
symptoms for peritonitis pain, tenderness, RIGID ABDOMINAL MUSCLES, fever, nausea, and vomiting.
nurse interventions for peritonitis broad spectrum antibiotics keep pt IV fluidsanalgesic medicationantiemetic medication
Diverticulitis moderate pain LLQ
type of medications for GERD? antacids- mylanta, tumsproton pump inhibitors – omeprazolehistamine Blockers – famotidine