Exam 1: NSG223/ NSG 223 (New 2024/ 2025 Update) Med Surg 2 Exam| Questions and Verified Answers| 100% Correct| Graded A- Herzing

Exam 1: NSG223/ NSG 223 (New 2024/ 2025
Update) Med Surg 2 Exam| Questions and
Verified Answers| 100% Correct| Graded AHerzing
QUESTION
What is the PR Interval
Answer:
The PR interval is measured from the beginning of the P wave to the beginning of the QRS
complex. It represents the time needed for sinus node stimulation, atrial depolarization, and
conduction through the AV node before ventricular depolarization
QUESTION
What is the ST Segment
Answer:
The ST segment, which represents early ventricular repolarization, lasts from the end of the QRS
complex to the beginning of the T wave.
QUESTION
QT Interval Time Frame
Answer:
The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm.
QUESTION
Complication of Long QT

Answer:
Many medications commonly given in the hospital can cause prolongation of the QT interval
(QTc), placing the patient at risk for a lethal ventricular dysrhythmia called torsades de pointes
QUESTION
What is the QT Interval
Answer:
represents the total time for ventricular depolarization and repolarization, is measured from the
beginning of the QRS complex to the end of the T wave
QUESTION
Procainamide Class, Use, and Adverse Effects
Answer:
•Functional Class: Antidysrhythmic
•Therapeutic USE: Life threatening atrial and ventricular arrythmias
•Side Effects: hypotension, headache, dizziness
•Adverse Effects: Heart block, cardiovascular collapse lupus like symptoms.
QUESTION
Amiodarone Class, Use, and Adverse Effects
Answer:
•Functional Class: Antidysrhythmic
•Therapeutic Use: Hemodynamically unstable ventricular tachycardia, SVT, Vfibnot controlled
by 1st line agents (Epinephrine)
•Side Effects: Hypotension, dizziness, fatigue, bradycardia
•Adverse Effects: Hepatotoxic, Pneumotoxic
Get baselines before giving
QUESTION

Heparin Class, Use, and Adverse Effects
Answer:
•Functional Class: Anticoagulant, Antithrombotic
•Therapeutic Use: Thrombosis prevention in MI, PE, open Heart Surgery, DVT
•Side Effects: rash, fever, hyperkalemia
•Adverse Effects: Hemorrhage, Thrombocytopenia, anaphylaxis
QUESTION
Heparin Nursing Conisderations, PTT Level, and Antidote
Answer:
•Nursing Considerations: Uses PTT to adjust dosing
•PTT level
•Normal 25-35 seconds
•Therapeutic on Heparin: 45-70 seconds
•Antidote: Protamine Sulfate: 1mg/100mg of Heparin
QUESTION
Nitroglycerin IV, Uses, Class, and Adverse effects
Answer:
•Functional Class: Antianginal, Coronary Vasodilator
•Therapeutic Use: Chronic Stable Angina, Heart Failure, acute MI
•Side Effects: headache flushing, dizziness, postural hypotension
•Adverse Effects: Vascular collapse
QUESTION
Nitroglycerin IV Nursing Considerations
Answer:
•Nursing Considerations:
•Careful observation of vital signs; can lower BP quickly.
•Titrate to relieve chest pain
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occurs as a result of inadequate ventilation, inadequate perfusion, or both. V./Q. imbalance
low level of cellular oxygen hypoxia
appears to be the main cause of hypoxia after thoracic or abdominal surgery and most types of respiratory failure. shunting
results when the amount of shunting exceeds 20% Severe hypoxia
Note: Alterations in perfusion may occur with a change in the pulmonary artery pressure, alveolar pressure, or gravity.
Nonmusical, discontinuous popping sounds that occur during inspiration (while usually heard on inspiration, they may also be heard on expiration); may or may not be cleared by coughingSecondary to fluid in the airways or alveoli or to delayed opening of collapsed alveoli during inspirationAssociated with heart failure and pulmonary fibrosis crackles
Discontinuous popping sounds heard in early inspiration and throughout expiration; harsh, moist sound originating in the large bronchi; can be heard over any lung region; do not vary with body positionAssociated with obstructive pulmonary disease Coarse crackles
Soft, high-pitched, discontinuous popping sounds heard in mid to late inspiration; sounds like hair rubbing together; originates in the alveoli, especially in dependent areas; may vary with body positionAssociated with interstitial pneumonia, restrictive pulmonary disease (e.g., fibrosis); fine crackles in early inspiration are associated with bronchitis or pneumonia Fine crackles
Assessment of __________essential for the well-being of the patient who is acutely or critically ill respiratory status
Assessment of Respiratory Function in the Patient Who Is Acutely or Critically Ill The nurse must note changes in the patient’s vital signs and evidence of hemodynamic instability and report them to the primary provider, because they may indicate that the mechanical ventilation is ineffective or that the patient’s status has deteriorated.positioned with the head of bed elevated to prevent aspirationin patients with ARDS who are experiencing refractory hypoxemia, prone positioning is recommendedLethargy and somnolence may be signs of increasing carbon dioxide levels and should not be considered insignificant, even if the patient is receiving sedation or analgesic agents.Chest auscultation, percussion, and palpation are essential and routine parts of the evaluation of the patient who is critically ill, with or without mechanical ventilation.Failure to examine the dependent areas of the lungs can result in missing the findings associated with disorders such as atelectasis or pleural effusion.
is measured by having the patient take in a maximal breath and exhale fully through a spirometer. The normal value depends on the patient’s age, gender, body build, and weight. vital capacity
Nursing interventions (Bronchoscopy) Before the procedure, the nurse should verify that informed consent has been obtained. Food and fluids are withheld for 4 to 8 hours before the test to reduce the risk of aspiration when the cough reflex is blocked by anesthesia.The patient must remove dentures and other oral prosthesesSedation given to patients with respiratory insufficiency may precipitate respiratory arrest.general anesthesia may be used for rigid bronchoscopyAfter the procedure, the patient must take nothing by mouth until the cough reflex returnsThe patient is not discharged from the postanesthesia care unit (PACU) until adequate cough reflex and respiratory status are present
remain the most common treatment and are given for sneezing, pruritus, and rhinorrhea. Antihistamines
example of combination antihistamine/decongestant medications. Brompheniramine/pseudoephedrine
a mast cell stabilizer that inhibits the release of histamine and other chemicals, is also used in the treatment of rhinitis. Cromolyn
may be used for nasal obstruction. Oral decongestant
can act as a mild decongestant and can liquefy mucus to prevent crusting. saline nasal spray
can be given in each nostril two to three times per day for symptomatic relief of rhinorrhea. Two inhalations of intranasal ipratropium
may be used for severe congestion intranasal corticosteroids
may be used to relieve irritation, itching, and redness of the eyes. cromolyn ophthalmic solution 4%
Appropriate allergy treatments may include leukotriene modifiers and immunoglobulin E modifiers
Note: The choice of medications depends on the symptoms, adverse reactions, adherence factors, risk of drug interactions, and cost to the patient
is the most frequent viral infection in the general population Viral Rhinitis (Common Cold)
Viral Rhinitis (Common Cold) The term common cold often is used when referring to a URI that is self-limited and caused by a virus.The most common cold-causing viruses survive better when humidity is low, in the colder months of the year.Rhinoviruses are the most likely causative organisms.Despite popular belief, cold temperatures and exposure to cold rainy weather do not increase the incidence or severity of the common cold.
refers to an infectious, acute inflammation of the mucous membranes of the nasal cavity characterized by nasal congestion, rhinorrhea, sneezing, sore throat, and general malaise cold
Colds caused by rhinoviruses tend to occur in the early fall and spring
Nursing management The nurse monitors the patient’s vital signs, assists in the control of bleeding, and provides tissues and an emesis basin to allow the patient to expectorate any excess blood.The nurse continuously assesses the patient’s airway and breathing as well as vital signs. On rare occasions, a patient with significant hemorrhage requires IV infusions of crystalloid solutions (normal saline) as well as cardiac and pulse oximetry monitoring.
accounts for approximately half of all head and neck cancers. Cancer of the larynx
Cancer of the larynx Cancer of the larynx is most common in people older than 65 years and is four times more common in men!!!!!!!!!!!!Almost all malignant tumors of the larynx arise from the surface epithelium and are classified as squamous cell carcinoma.
Complete removal of the larynx can provide a cure in most advanced laryngeal cancers, when the tumor extends beyond the vocal cords, or for cancer that recurs or persists after radiation therapy total laryngectomy
total laryngectomy A total laryngectomy results in permanent loss of the voice and a change in the airway, requiring a permanent tracheostomyLaryngectomy tubes are similar in appearance to tracheostomy tubes; however, a laryngectomy tube can be distinguished from a tracheostomy tube because the patient is unable to speak or breathe when the laryngectomy tube is occluded.
prevents the aspiration of food and fluid into the lower respiratory tract. tracheal stoma
The third technique of alaryngeal speech is tracheoesophageal puncture
tracheoesophageal puncture This technique is the most widely used because the speech associated with it most resembles normal speech (the sound produced is a combination of esophageal speech and voice), and it is easily achieved either during the initial surgery to treat the tumor or at a later datevalve is placed in the tracheal stoma to divert air into the esophagus and out the mouth.A speech therapist teaches the patient how to produce sounds
Assesment of a patient undergoing laryngectomy The health history focuses on the following symptoms: hoarseness, sore throat, dyspnea, dysphagia, and pain or burning in the throat.The physical assessment includes a thorough head and neck examination with an emphasis on the patient’s a preoperative evaluation by the speech therapist is essential.because alcohol abuse is a risk factor for cancer of the larynx, the patient’s pattern of alcohol intake must be assessed.
medical managment (pleurisy) The objectives of treatment are to discover the underlying condition causing the pleurisy and to relieve the pain. At the same time, the patient must be monitored for signs and symptoms of pleural effusion, such as shortness of breath, pain, assumption of a position that decreases pain, and decreased chest wall excursion.Prescribed analgesic agents and topical applications of heat or cold provide symptomatic relief. A may provide pain relief while allowing the patient to take deep breaths and cough more effectively. If the pain is severe, an intercostal nerve block may be required
Review chart 19-12
Criteria for Weaning Careful assessment is required to determine whether the patient is ready to be removed from mechanical ventilation. If the patient is stable and showing signs of improvement or reversal of the disease or condition that caused the need for mechanical ventilation, weaning indices should be assessed Stable vital signs and arterial blood gases are also important predictors of successful weaning. Once readiness has been determined, the nurse records baseline measurements of weaning indices to monitor progress.
Assessment and Diagnostic Findings (ARDS) On physical examination, intercostal retractions and crackles may be present as the fluid begins to leak into the alveolar interstitial space. Common diagnostic tests performed in patients with potential ARDS include plasma brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery catheterization. The BNP level is helpful in distinguishing ARDS from cardiogenic pulmonary edema. Transthoracic echocardiography may be used if the BNP is not conclusive.
The primary focus in the management of ARDS includes identification and treatment of the underlying condition.
Medical management of ARDS This supportive therapy almost always includes ET intubation and mechanical ventilation.Supplemental oxygen is used as the patient begins the initial spiral of hypoxemiaThe concentration of oxygen and ventilator settings and modes are determined by arterial blood gas analysis, pulse oximetry, and bedside pulmonary function testing.Providing ventilatory PEEP support is a critical part of the treatment of ARDS. PEEP usually improves oxygenation, but it does not influence the natural history of the syndromeAdditional supportive treatments may include prone positioning, sedation, paralysis, and nutritional support
characterized by elevated pulmonary arterial pressure greater than 25 mm Hg at rest and greater than 30 mm Hg with exercise and secondary right heart ventricular failure Pulmonary hypertension (PH)
PH It may be suspected in a patient with dyspnea with exertion without other clinical manifestations.
“a general term given to any lung disease caused by dusts that are breathed in and then deposited deep in the lungs causing damageis usually considered an occupational lung disease, and includes asbestosis, silicosis and coal workers’ pneumoconiosis, also known as “”Black Lung Disease””” Pneumoconiosis
the number one work-related illness in the United States based on its frequency, severity, and preventability Occupational lung disease
OCCUPATIONAL LUNG DISEASE: PNEUMOCONIOSES (review book) Many people with early pneumoconiosis are asymptomatic, but advanced disease often is accompanied by disability and premature death.
Postoperative Management Careful positioning of the patient is important. After pneumonectomy, 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. The patient with a lobectomy may be turned to either side, and a patient with a segmental resection usually is not turned onto the operative side unless the surgeon prescribes this position
Medical managemnet Tension Pneumothorax The goal of treatment is to evacuate the air or blood from the pleural space.A small chest tube (28 Fr) is inserted near the this space is used because it is the thinnest part of the chest wall, minimizes the danger of contacting the thoracic nerve, and leaves a less visible scarIf an excessive amount of blood enters the chest tube in a relatively short period, an autotransfusion may be needed
involves taking the patient’s own blood that has been drained from the chest, filtering it, and then transfusing it back into the vascular system. autotransfusion
impaired oxygen and carbon dioxide exchange results from destruction of the walls of overdistended alveoli. a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli emphysema
lung area where no gas exchange can occur dead space
increased carbon dioxide tension in arterial blood hypercapnia
one of the complications of emphysema, is right-sided heart failure brought on by long-term high blood pressure in the pulmonary arteries. cor pulmonale
there is destruction of the respiratory bronchiole, alveolar duct, and alveolus. panlobular (panacinar) emphysema
athologic changes take place mainly in the center of the secondary lobule, preserving the peripheral portions of the acinuscentral cyanosis ,respiratory failure and peripheral edema. centrilobular (centroacinar) form
an increase in red blood cells polycythemia
he most important environmental risk factor for COPD worldwide is cigarette smoking
used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FVC). results are expressed as an absolute volume and as a percentage of the predicted value using appropriate normal values for gender, age, and height.is also used to determine reversibility of obstruction after the use of bronchodilators Spirometry
the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means. The mask is constructed in a way that allows a constant flow of room air blended with a fixed flow of oxygen. It is used primarily for patients with COPD because it can accurately provide appropriate levels of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive. The Venturi mask
Characteristic symptoms of bronchiectasis include chronic cough the production of purulent sputum in copious amounts. hemoptysis. Clubbing of the fingerrepeated episodes of pulmonary infection.
a heterogeneous disease, usually characterized by chronic airway inflammation asthma
Asthma causes airway hyperresponsiveness, mucosal edema, and mucus productionsymptoms: cough, chest tightness, wheezing, and dyspneaAlthough asthma is the most common chronic disease of childhood, it can occur at any age.Smokers are at higher risk for having asthma-COPD overlapUnlike other obstructive lung diseases, asthma is largely reversible, either spontaneously or with treatmenAllergy is the strongest predisposing factor for asthma
efers to asthma induced by exposure in the work environment to dusts, vapors, or fumes, with or without a preexisting diagnosis of asthma occupational asthma
prevention of asthma Knowledge is the key to quality asthma care. Evaluation of impairment and risk are primary methods that help ensure control.
measure the highest airflow during a forced expiration peak flow meters
Peak flow monitoring Daily peak flow monitoring is recommended for patients who meet one or more of the following criteria: have moderate or severe persistent asthma, have poor perception of changes in airflow or worsening symptoms, have unexplained response to environmental or occupational exposures, or at the discretion of the clinician and patienthelps measure asthma severity and, when added to symptom monitoring, indicates the current degree of asthma control.
Cystic Fibrosis pathophysiolyg CF is caused by mutations or dysfunction in the protein cystic fibrosis transmembrane conductance regulator (CFTR), which normally transports chloride ions across epithelial cell membranes.characterized by thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as well as increased salt content in sweat gland secretionThe hallmark pathology of CF is bronchial mucus plugging, inflammation, and eventual bronchiectasis. Commonly, the bronchiectasis begins in the upper lobes and progresses to involve all lobes.
Read medcail management (644)
heart hollow, muscular organ located in the center of the thorax, where it occupies the space between the lungs (mediastinum) and rests on the diaphragm.pumps blood to the tissues, supplying them with oxygen and other nutrients.The inner layer, or endocardium, consists of endothelial tissue and lines the inside of the heart and valves. The middle layer, or myocardium, is made up of muscle fibers and is responsible for the pumping action. The exterior layer of the heart is called the epicardium.
During the relaxation phase, all four chambers relax simultaneously, which allows the ventricles to fill in preparation for contraction. is commonly referred to as the period of ventricular filling. Diastole
refers to the events in the heart during contraction of the atria and the ventricles. Systole
, the pulsation created during normal ventricular contraction apical pulse also known as PMI (point of maximal impulse)
Note: In the normal heart, the PMI is located at the intersection of the midclavicular line of the left chest wall and the fifth intercostal space
the middle, muscular layer of the atrial and ventricular walls. It is composed of specialized cells called myocytes, which form an interconnected network of muscle fibers. myocardium
Pulse pressure The difference between the systolic and the diastolic pressures
A normal pulse pressure is 40 mmHg
narrow pulse pressure e.g., BP of 92/74 mm Hg and pulse pressure of 18 mm Hgoccurs when there is vasoconstriction that is compensating for a low stroke volume and ejection velocity
A wide pulse pressure e.g., BP of 88/38 mm Hg and pulse pressure of 50 mm Hg) is associated with conditions that elevate the stroke volume (anxiety, exercise, bradycardia), or cause vasodilation (fever, septic shock).
useful for prompt diagnosis of HF in settings such as the ED Brain (B-Type) Natriuretic Peptide
Elevations in BNP can occur from a number of other conditions such as pulmonary embolus, MI, and ventricular hypertrophy.A BNP level greater than 100 pg/mL is suggestive of HF.
The normal CVP is 2 to 6 mm Hg
Note: A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. There are many problems that can cause an elevated CVP, but the most common problem is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (less than 2 mm Hg) indicates reduced right ventricular preload, which is most often from hypovolemia. Dehydration, excessive blood loss, vomiting or diarrhea, and overdiuresis can result in hypovolemia and a low CVP.
also referred to as adrenergic fibers) are attached to the heart and arteries as well as several other areas in the body. Sympathetic nerve fibers
increased heart rate chronotropy
increased AV conduction dromotropy
increased force of myocardial contraction inotropy
Influences on Heart Rate and Contractility The heart rate is influenced by the autonomic nervous system, which consists of sympathetic and parasympathetic fibers.The decreased sympathetic stimulation results in dilation of arteries, thereby lowering blood pressure.Increased sympathetic stimulation (e.g., caused by exercise, anxiety, fever, or administration of catecholamines such as dopamine, aminophylline, or dobutamine) may increase the incidence of arrhythmias.Decreased sympathetic stimulation (e.g., with rest, anxiety reduction methods such as therapeutic communication or meditation, or administration of beta-adrenergic blocking agents) may decrease the incidence of arrhythmias.
P wave represents atrial depolarization
QRS complex represents ventricular depolarization
T wave represents ventricular repolarization (when the cells regain a negative charge; also called the resting state).
U wave is thought to represent repolarization of the Purkinje fibers;
The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization.
The ST segment, which represents early ventricular repolarization,
The QT interval, which represents the total time for ventricular depolarization and repolarization,
The TP interval is measured from the end of the T wave to the beginning of the next P wave—an isoelectric period . When no electrical activity is detected, the line on the graph remains flat; this is called the isoelectric line.
The PP interval is used to determine atrial rate and rhythm.
an open heart surgical procedure for refractory atrial fibrillation. maze procedure
Maze and Mini-Maze Procedures Because the procedure requires significant time and cardiopulmonary bypass, its use is reserved only for those patients undergoing cardiac surgery for another reasonSome patients may need a permanent pacemaker after this surgery because of subsequent injury to the SA node.
This surgery eliminates the need for opening the sternum, heart-lung bypass, and the use of cardioplegiaThis results in a shorter recovery time and a lower risk of infection mini-maze
is used in emergency situations as the treatment of choice for ventricular fibrillation and pulseless VT Defibrillation
the most common cause of abrupt loss of cardiac function and sudden cardiac death. Defibrillation is not used for patients who are conscious or have a pulse. The energy setting for the pulseless VT
Is given after initial unsuccessful defibrillation to make it easier to convert the arrhythmia to a normal rhythm with the next defibrillationThis medication may also increase cerebral and coronary artery blood flow epinephrine
Nursing management (Implantable Cardioverter Defibrillator) After a permanent electronic device (pacemaker or ICD) is inserted, the patient’s heart rate and rhythm are monitored by ECGpacemaker malfunction is detected by examining the pacemaker spike and its relationship to the surrounding ECG complexes.If the patient has an ICD implanted and develops VT or ventricular fibrillation, the ECG should be recorded to note the time between the onset of the arrhythmia and the onset of the device’s shock or antitachycardia pacing.he incision site where the generator was implanted is observed for bleeding, hematoma formation, or infectionA chest x-ray is usually taken after the procedure and prior to discharge to document the position of leads in addition to ensuring that the procedure did not cause a pneumothorax.
These agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of myocardial contraction (negative inotropic effect)These effects decrease the workload of the heartalso increase myocardial oxygen supply by dilating the smooth muscle wall of the coronary arterioles; they decrease myocardial oxygen demand by reducing systemic arterial pressure and the workload of the left ventricle Calcium Channel Blocking Agents
in addition to their use to treat angina, they are commonly prescribed for hypertension. Calcium Channel Blocking Agents
note: Hypotension may occur after the administration of any of the calcium channel blockers, particularly when administered IV. Other side effects may include atrioventricular block, bradycardia, and constipation.
provides information that assists in ruling out or diagnosing an acute MIIt should be obtained within 10 minutes from the time a patient reports pain or arrives in the EDthe location, evolution, and resolution of an MI can be identified and monitored. The 12-lead ECG