Medical Surgical Certification questions with complete solutions

Medical Surgical Certification What are the Kubler-Ross stages of grief? Correct Answer: denial, anger, bargaining, depression, acceptance Describe Lewin's change management model Correct Answer: Unfreeze, change ...

Medical Surgical Certification What are the Kubler-Ross stages of grief? Correct Answer: denial, anger, bargaining, depression, acceptance Describe Lewin's change management model Correct Answer: Unfreeze, change, refreeze What changes are necessary for someone taking Coumadin (warfarin)? Correct Answer: Low or moderate intake of green leafy vegetables, fish, liver or cauliflower. These foods are high in vitamin K and may decrease INR level ARBs Correct Answer: Example: losartan(Cozaar), valsartan (Diovan), olmesartan (Benicar). Used to lower BP. May cause hyperkalemia. Contraindicated: renal artery stenosis What is the therapeutic range for digoxin therapy? Correct Answer: 0.8-2.0 ng/ml (greater than 2 is toxic) What are S/S of hypertensive crisis? Correct Answer: Headache, vision changes, confusion, nose bleeds (epistaxis), chest/back/abd pain, dyspnea, urinary frequency or oliguria Describe left sided heart failure Correct Answer: Results in fluid backing up into the lungs (pulmonary edema). S/S of pulmonary edema is pink, frothy sputum Treatment for pulmonary edema Correct Answer: oxygen, bipap, lasix, morphine (vasodilates vessels), dobutamine (helps with cardiac output) How is the progression of heart failure monitored? Correct Answer: Left ventricular ejection fraction (LVEF) on an echocardiogram What is the max amount of time an order for restraint usage may be utilized? Correct Answer: 4 hours (adults) S/S of a basilar skull fracture Correct Answer: Battle Signs: bruising behind ears, CSF leaking from nose (clear/colorless/+ for glucose), raccoon eyes What is a serious complication of a basilar skull fracture? Correct Answer: ➤May lead to bacterial meningitis (antibiotics may be given prophylactically to prevent this) What are the classic S/S of an epidural hematoma? Correct Answer: Patient appears lucent and then presents with decreased LOC (Surgical Emergency) What is an epidural hematoma? Correct Answer: Collection of blood between the dura and the skull Why should you avoid HYPOtonic solutions with brain injuries? Correct Answer: They cause fluid shifts and may increase cerebral edema (ex.: 1/2NS) What type of solutions are okay to use with brain injuries? Correct Answer: Isotonic (09%NS) is preferred, HYPERtonic is okay Cushing's Triad Correct Answer: severe hypertension, widened pulse pressure, bradycardia, abdnormal respiration Cushing's triad indicates Correct Answer: Increased intracranial pressure (brain herniation) Risk factors for ischemic stroke Correct Answer: Tobacco, ETOH, illicit drug use, obesity, African-Americans, Age (>55), family history, hx of A-fib/CHF/MI Clinical findings of DKA Correct Answer: Hyperglycemia (glucose >250), blood pH is acidotic (<7.30), Bicarb: <15, high ketones in the urine or blood (ketonuria/ketonemia) S/S of DKA Correct Answer: lethargy, kussmauls (Deep/fast breathing, fruity breath), abdominal pain, N/V, postural hypotension HHS (Hyperglycemic Hyperosmolar State) Correct Answer: Occurs in type II diabetics, does not cause ketones, Hyperglycemia (>600). Results in Severe Dehydration. Pt has polydipsia, polyphagia, polyuria) What test is the best way to rule out organ rejection or hepatitis in a liver transplant? Correct Answer: liver biopsy What positive assessment finding would indicate cholecystitis? Correct Answer: Positive Murphy's sign What assessment finding is suggestive of paralytic ileus? Correct Answer: absent bowel sounds Describe labs on someone who has DIC? Correct Answer: Low platelets (<100,000), high PT/PTT (>15/>60-90) and high d-dimer (>2 mg/L) What is the most important DIC medical intervention? Correct Answer: Stop the clotting -IV heparin PCO2 normal ABG range Correct Answer: PCO2 = carbon dioxide, 35-45 mmHg Respiratory Alkalosis causes Correct Answer: Respiratory distress (blowing off too much CO2), restrictive lung diseases, anxiety w/ excessive respiratory rate What is asterixis? Correct Answer: hand tremor, this is a classic sign of liver failure. Asterixis may resemble a bird flapping its wings (found in stage 1-3 hepatic encephalopathy) What labs are affected in metabolic acidosis? Correct Answer: Low HCO3 (<22) and low PH (acidotic, <7.35) What are s/s of pancreatic hemorrhage? Correct Answer: Cullens sign (bruising around umbilicus) and Turner's sign (flank or back bruising) What are typical manifestations of diastolic heart failure? Correct Answer: shortness of breath, tachypnea and pulmonary congestion Friction rub is associated with what condition? Correct Answer: pericarditis or restrictive heart disease What lab is indicative of the degree of heart failure a person is exhibiting? Correct Answer: BNP (Brain natriuretic peptide): this hormone regulates BP and fluid volume levels. >51.2 is mild and >1000 pg/mL is severe Centriacinar emphysema Correct Answer: occurs in UPPER half of lung. Caused by long-term Cigarette smoking, occurs in older people >50) Troponin I Correct Answer: Elevation indicates an MI. >1.4 mcg/L. This lab stays elevated x14 days after a heart attack Digoxin toxicity Correct Answer: >2.0 n.g/mL. S/S: yellow/green halos in visual fields. Treatment: Digibind Cirrhosis leads to ______ which = increased risk for _________ Correct Answer: Portal HTN....increased risk for varices What is contraindicated in chronic ETOH cirrhosis patients? Correct Answer: NG tubes..due to risk of varices Multiple myeloma S/S Correct Answer: Increased calcium (calcium is pushed out of the bones), bone pain, bones become fragile and lead to fractures Assessment findings most consistent with peripheral vascular disease include Correct Answer: brown pigmentation on ankles from iron deposits leaking from venous stasis, warm legs, venous ulcers, pain with resting, distal edema Assessment findings consistent with Peripheral Artery disease Correct Answer: pain with ambulation, distal/digit ulcers and absent pulses Reversal agent for heparin Correct Answer: protamine sulfate Basophils Correct Answer: A granulocyte responsible for anaphylactic reactions Shift to the left Correct Answer: elevated bands (immature neutrophils) >10%. This occurs with infection /inflammation How would you recognize a leak in a chest tube system? Correct Answer: bubbling in water seal chamber. (don't confuse this with tidaling, the rise and fall with breath is normal) Virchow's Triad Correct Answer: Venous stasis, vessel wall damage, hypercoaguable state (cancer/dehydration). These place a person at a high risk of developing a pulmonary embolus The S1 sound represents the closure of the Correct Answer: Closure of mitral/tricuspid valves (start of systole/squeeze) "LUB" sound PaO2 normal ABG values Correct Answer: >60 mmHg Adenocarcinoma Correct Answer: type of lung cancer, occurs mostly in women, causes lots of mucous Describe neutrophils Correct Answer: 90% of granulocytes. Neutrophils fight infection and respond to inflammation What are the recommendations for BP in someone less than 50? Correct Answer: Less than 140/90 What are the recommendations for BP in someone 60+? Correct Answer: Less than 150/90 How long should you fast before cholesterol testing? Correct Answer: at least 8 hours or more What is a normal range for LDL cholesterol? Correct Answer: <160 mg/dL What is a normal range for HDL cholesterol? Correct Answer: >40 mg/dL What is a normal level for total cholesterol? Correct Answer: <200 mg/dL What is a normal level for triglycerides? Correct Answer: <150 mg/dL "An S3 heart sound can be normal in which people?" Correct Answer: young people and athletes An S3 heart sound is often associated with? Correct Answer: heart failure (when heard in the older adult) What is the definition of cardiac output? Correct Answer: the amount of blood pumped by the heart in one minute Acute lymphocytic leukemia (ALL) Correct Answer: dx age 2-4, s/s: anemia, bleeding, infection, elevated WBC, joint/bone pain. The most common form of childhood leukemia. Overproduction of lymphocytes Protonix Correct Answer: Management of GI bleeds. Begins with a bolus and then gtt S/S of peritoneal irritation Correct Answer: rigid abdomen, absent bowel sounds, tenderness/guarding of abdomen, severe focal pain, N/V What are causes of peritoneal irritation Correct Answer: appendicitis, cholecystitis, pancreatitis, obstruction, perforated viscous, inflammatory bowel disease What drugs increase the risk of pancreatitis? Correct Answer: corticosteroids, cyclosporine, sulfonamides, estrogens DKA treatment Correct Answer: 1. fluids (NS, D5 1/2NS) 2. Replace K (drops with insulin) 3. Monitor phosphorous 4. Insulin drip ACE inhibitor's mechanism of action Correct Answer: produce vasodilation by inhibiting the formation of angiotensin II. How to beta blockers work Correct Answer: Beta blockers decrease the sympathetic nervous system's response (aka desensitizes nerve receptors on blood vessels) to decreased cardiac output resulting in less constriction in the blood vessels, which ultimately lowers blood pressure What is a normal troponin level? Correct Answer: <0.4 ng/mL. This level may take up to 4 hours to increase and stays elevated post injury 10+ days