Final Exam: NSG123/ NSG 123 (Latest 2024/ 2025 Update) Med Surg 1| Review with Questions and Verified Answers| 100% Correct- Herzing
Final Exam: NSG123/ NSG 123 (Latest 2024/
2025 Update) Med Surg 1| Review with
Questions and Verified Answers| 100%
Correct- Herzing
Q: Hypotonic Solutions
Answer:
0.45% Sodium Chloride
0.225% Saline
0.33% Saline
Q: Hypertonic Solutions
Answer:
3% Saline & 5% Saline
Q: Isotonic Solutions
Answer:
Normal Saline (0.9% Saline)
Lactated Ringer
5% Dextrose in Water
Q: Phlebitis Definition
Answer:
Phlebitis is characterized by a reddened, warm area around the insertion site or along the path of
the vein, pain or tenderness at the site or along the vein, and swelling
Q: Prevention of Phlebitis
Answer:
Phlebitis can be prevented by using aseptic technique during insertion, using the appropriate-size
cannula or needle for the vein, considering the composition of fluids and medications when
selecting a site, observing the site hourly for any complications, anchoring the cannula or needle
well, and changing the IV site according to agency policy and procedures.
Q: Patient Teaching for Fluid Volume Excess
Answer:
Daily weight
Report respiratory changes
Limit sodium & fluid
Q: What makes the blood more acidic or alkaline?
Answer:
The pH is the indicator
Q: What does compensation look like in metabolic acidosis?
Answer:
Lungs compensate, Respiratory Rate (should be hyperventilating)
Q: What does compensation look like in metabolic alkalosis?
Answer:
Lungs Compensate, Hypoventilation to increases
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Fluid Volume Deficit Lab & Vitals Increased BUN & CreatinineIncreased Hematocrit & HemoglobinIncreased Urine Specific GravityDecreased BPIncreased PulseIncreased Temp
Fluid Volume Excess Lab & Vitals Decreased Hematocrit, HemoglobinDecreased Urine Specific GravityIncreased BPIncreased RespirationsBounding Pulse
DMARD Methotrexate Monitor Prior to and during therapy, monitoring the CBC, renal function, and liver function is essential. Liver function tests help guide methotrexate dosage.
What disease is Methotrexate given for? RA
Diagnostic Test for RA Antibodies to cyclic citrullinated peptide (anti-CCP) have a specificity of approximately 95% at detecting RAThe ESR and CRP tend to be significantly elevated in the acute phases of RA and are therefore useful in monitoring active disease and disease progression.
In SLU Where is the butterfly rash located? Cheeks The most familiar skin manifestation (occurring in less than 50% of patients with SLE) is an acute cutaneous lesion consisting of a butterfly-shaped erythematous rash across the bridge of the nose and cheeks
Complication and Teaching of Corticosteriods for Long Term Osteoporosis, increase calcium and vitamin D
Gout Dietary Restrictions The nurse encourages the patient to restrict consumption of foods high in purines, especially organ meats, and to limit alcohol intake
Fluid Movement in Hypotonic Solutions WATER INTO CELLS. When the extracellular fluid has fewer solutes (osmolarity) than the fluid in the cells. Water will move from extracellular space into the cells.
Fluid Movement in Hypertonic Solutions WATER OUT OF CELLS When the extracellular fluid has more solutes (osmolarity) than within the cells, water flows out of the cells
Fluid Movement in Isotonic Solutions Both the extracellular and intracellular fluids have the same osmolarity, so there is no movement of water between them
Hypotonic Solutions 0.45% Sodium Chloride0.225% Saline0.33% Saline
Hypertonic Solutions 3% Saline & 5% Saline
Isotonic Solutions Normal Saline (0.9% Saline)Lactated Ringer5% Dextrose in Water
Phlebitis Definition Phlebitis is characterized by a reddened, warm area around the insertion site or along the path of the vein, pain or tenderness at the site or along the vein, and swelling
Prevention of Phlebitis Phlebitis can be prevented by using aseptic technique during insertion, using the appropriate-size cannula or needle for the vein, considering the composition of fluids and medications when selecting a site, observing the site hourly for any complications, anchoring the cannula or needle well, and changing the IV site according to agency policy and procedures.
Patient Teaching for Fluid Volume Excess Daily weightReport respiratory changesLimit sodium & fluid
What makes the blood more acidic or alkaline? The pH is the indicator
What does compensation look like in metabolic acidosis? Lungs compensate, Respiratory Rate (should be hyperventilating)
What does compensation look like in metabolic alkalosis? Lungs Compensate, Hypoventilation to increases
2 Major Buffer Systems Kidneys & Lungs The body’s major extracellular buffer system is the bicarbonate-carbonic acid buffer system, which is assessed when arterial blood gases are measured
What is the kidney’s role in regulating the pH? The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. In respiratory and metabolic alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance
Osteoporosis S/S The bones become progressively porous, brittle, and fragile. They fracture easily under stresses that would not break normal bone. This occurs most commonly as compression fractures of the thoracic and lumbar spine, hip fractures, and Colles fractures of the wrist. These fractures may be the first clinical manifestation of osteoporosis
Risk Factors for Osteoporosis Alcohol intake of 3 or more drinks dailyCurrent use of tobacco productsFamily historyHistory of bone fracture during adulthoodInactive or sedentary lifestyleInadequate calcium and vitamin D intakeLow body mass indexMalabsorption disorders (e.g., eating disorder, celiac disease, bariatric surgery)Men older than 60 years of ageWomen who are postmenopausalPrescribed corticosteroids (e.g., prednisone) for longer than 3 months
Diagnostic Test for Osteoporosis Osteoporosis is diagnosed by dual-energy x-ray absorptiometry (DEXA), which provides information about BMD at the spine and hip.
S/S of Hypercalcemia Hypercalcemia produces adverse effects in several body systems.GI effects include anorexia, nausea, vomiting, abdominal pain, and constipation.Central nervous system effects are apathy, poor memory, depression, drowsiness, and disorientation.Cardiac effects include dysrhythmias, and an electrocardiogram (ECG) shows a prolonged QT interval and an inverted T wave.Weakness and decreased tone in skeletal and smooth muscles, dysphagia, polyuria, and polydipsia may also occur.
Alendronate (Fosamax) Teaching It is always necessary to take the drug with a full glass of water, not juice or coffee, at least 30 minutes before breakfast and before taking other drugs. The person must remain upright (either with the head elevated 90 degrees if in bed, sitting upright in a chair, or standing) for at least 30 minutes after administration.
Alendronate (Fosamax) Action and Disease Inhibits calcium resorption from the bone. Treats hypercalcemia and osteoporosis
Clinical Manifestation of RA The initial clinical manifestations of RA include symmetric joint pain and morning joint stiffness lasting longer than 1 hourSymmetric joint pain, swelling, stiffness, warmth, erythema, and lack of function are classic symptoms. Skin Nodules & AnemiaPalpation of the joints reveals spongy or boggy tissue.Often, fluid can be aspirated from the inflamed joint.Characteristically, the pattern of joint involvement begins in the small joints of the hands, wrists, and feet.Deformities of the hands (e.g., ulnar deviation and swan neck deformity) and feet are common in RAThe onset of symptoms is usually acute. Symptoms are usually bilateral and symmetric
What triggers stiffness and joint pain in RA? Stiffness and Joint Pain worse in morning lasting longer than an hour
Exercise for Osteoarthritis Exercise, especially in the form of cardiovascular aerobic exercise and lower extremity strength training, has been found to prevent OA progression and decrease symptoms of OAExercises such as walking should be begun in moderation and increased gradually.v
Exercise for Osteoporosis Weight-bearing exercise, walking, hikingResistance and impact exercises are most beneficial in developing and maintaining bone massThe best exercises are weight-bearing exercises that force an individual to work against gravity.These exercises include walking, hiking, weight training, stair climbing, tennis, and dancing.Walking is preferred to high-impact aerobics or running, both of which may put too much stress on the bones and may cause stress fractures.
What is the therapeutic response we expect when giving NSAIDs for RA Decreased pain and increased ROM
Goal of treatment in RA The goal of treatment at all phases of the RA disease process is to decrease joint pain and swelling, achieve clinical remission, decrease the likelihood of joint deformity, and minimize disability.
Goal of DMARD therapy in RA The goal of using DMARD therapy is preventing inflammation and joint damage.
Goal of treatment of SLE The goals of treatment include preventing progressive loss of organ function, reducing the likelihood of acute disease, minimizing disease-related disabilities, and preventing complications from therapy.
List of Medications for SLE: Belimumab (Benlysta)Corticosteroidshydroxychloroquine (Plaquenil)NSAIDSImmunosuppressive Agents (cyclophosphamide, azathioprine, mycophenolic acid (Myfortic), and methotrexate)
Corticosteroids in SLE Corticosteroids are another medication used topically for cutaneous manifestations, in low oral doses for minor disease activity, and in high doses for major disease activity
Hydroxychloroquine (Plaquenil) in SLE An antimalarial medication approved by the FDA, hydroxychloroquine (Plaquenil), is effective for managing cutaneous, musculoskeletal, and mild systemic features of SLE.
NSAIDs in SLE The NSAIDs used for minor clinical manifestations are often used in conjunction with corticosteroids in an effort to minimize corticosteroid requirements.
Immunosuppressive Agents in SLE Immunosuppressive agents (alkylating agents and purine analogues) are used because of their effect on overall immune function. hese medications are generally reserved for patients who have serious forms of SLE that have not responded to conservative therapies. Examples include cyclophosphamide, azathioprine, mycophenolic acid (Myfortic), and methotrexate
How to decrease bleeding risk in SLE The nurse should ensure that older adults taking ibuprofen on a long-term basis are evaluated for GI blood loss, renal dysfunction, edema, hypertension, and drug-drug or drug-drug disease interactions. A gastroprotective agent is recommended for patients at risk for upper GI bleeding.
Patient Teaching for SLE Apply sunscreenAvoid cloudy areaSensitive of sun
Clinical Manifestations of SLE Joint symptoms, with arthralgias, arthritis (synovitis), or both, occur in more than 90% of patients with SLE and are commonly the earliest manifestation of the disease processJoint swelling, tenderness, and pain on movement are also common. Frequently, these are accompanied by morning stiffness.Systemic symptoms include fever, malaise, weight loss, and anorexia.PericarditisButterfly Rash
IV Fluid for Hypovolemic Fluid Loss Normal SalineIf fluid losses are acute or severe, the IV route is required. Isotonic electrolyte solutions (e.g., lactated Ringer solution, 0.9% sodium chloride) are frequently the first-line choice to treat the hypotensive patient with FVD because they expand plasma volume
What IV Fluid should not be given to someone with diabetes? Dextrose 5%
Osteoarthritis Risk Factors Risk factors for the disease and its progression include older age, female gender, and obesity. In addition, certain occupations (e.g., those requiring laborious tasks); engaging in sport activities; and a history of previous injuries, muscle weakness, genetic predisposition, and certain diseases can also place patients at risk for joint destruction. The most prominent modifiable risk factor for OA is obesity
Clinical Manifestations of Osteoarthritis The main clinical manifestations of OA are pain, stiffness, and functional impairment. The joint pain is usually aggravated by movement or exercise and relieved by rest. If morning stiffness is present, it is usually brief, lasting less than 30 minutes. The onset is routinely insidious, progressing over multiple years.On physical examination, the affected joint may be enlarged with a decreased range of motion
What should be taken with calcium to improve absorption? Vitamin D
Gout Medications Short Term Acute attacks are managed with colchicine (Colcrys) (oral or parenteral), an NSAID such as indomethacin (Indocin), or a corticosteroid
Gout Medications Long Term Once the acute attack has subsided, uric acid lowering therapy should be considered. Xanthine oxidase inhibitors, such as allopurinol (Zyloprim) and febuxostat (Uloric), are the agents of choice. Uricosuric agents, such as probenecid (Benemid), may be indicated in patients with frequent acute attacks. Corticosteroids may be given to patients who have no response to other therapy.Colchicine (Colcrys), the prototype agent for the treatment and prevention of gout, is the most commonly administered antigout medicationSeveral uricosuric agents are used to reduce serum uric acid levels. Allopurinol (Zyloprim), a xanthine oxidase inhibitor, is the prototype uricosuric drug
When would you do surgery in osteoarthritis In moderate to severe OA, when pain is severe or because of loss of function, surgical intervention may be used. The procedures most commonly used are osteotomy (to alter the distribution of weight within the joint) and arthroplasty
First line management of osteoarthritis Exercise, especially in the form of cardiovascular aerobic exercise and lower extremity strength training, has been found to prevent OA progression and decrease symptoms of OA. Along with exercise, weight loss, which in turn decreases excess load on the joint, can also be extremely beneficial. Occupational and physical therapy can help the patient adopt self-management strategies
Diet Teaching Gout Severe dietary restriction is not necessary; however, the nurse encourages the patient to restrict consumption of foods high in purines, especially organ meats, and to limit alcohol intake. Maintenance of normal body weight should be encouraged. In an acute episode of gouty arthritis, pain management with prescribed medications is essential, along with avoidance of factors that increase pain and inflammation, such as trauma, stress, and alcohol.
Exercise in RA For moderate, erosive RA, a formal program with occupational and physical therapy is prescribed to educate the patient about principles of pacing activities, work simplification, range of motion, and muscle-strengthening exercises. The patient is encouraged to participate actively in the management program.
ABG Ranges pH: 7.35 to 7.45CO2: 45-35HCO3: 22-26
What medications are taken for osteoarthritis? NSAIDS (aspirin okay)Meloxicam (Mobic)
Medications taken for SLE Belimumab (Benlysta)CorticosteroidsHydroxychloroquine (Plaquenil)NSAIDSImmunosuppressants
Teaching for SLE Screen for Osteoporosis due to long term corticosteroidsIncrease calcium and vitamin DTake medications as prescribedStop smokingBecause sun and ultraviolet light exposure can increase disease activity or cause an exacerbation, patients should be instructed to avoid exposure or to protect themselves with sunscreen and clothing.
Azathioprine (Azasan, Imuran) in RA Azathioprine (Azasan, Imuran) is occasionally part of a maintenance immunosuppressive regimen Health care providers use azathioprine after organ transplant in children, as well as treatment of psoriasis, psoriatic arthritis, systemic lupus erythematosus, immune thrombocytopenia, inflammatory bowel disease, and other inflammatory disorders, but safety data are limited
Side Effects of Azathioprine (Imuran) Adverse effects of azathioprine include bone marrow suppression with neutropenia, thrombocytopenia, and anemia; hepatotoxicity with increased risk of posttransplant venoocclusive liver disease; GI upset, nausea, vomiting, and diarrhea; fever and muscle aches; and skin rash. It is necessary to obtain baseline liver function tests and a pregnancy test prior to therapyPatient Teaching