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ATI Medical Surgical Real Exam 255 Questions and Correct Answers
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A nurse is caring for client who is experiencing supraventricular tachycardia. Upon assessing the
client, the nurse observes the following findings: heart rate 200/min, blood pressure 78/40 mm
Hg, and respiratory rate 30/min. Which of the following actions should then nurse take?
A. Defibrillate the client's heart.
B. Perform synchronized cardioversion.
C. Begin cardiopulmonary resuscitation.
D. Administer lidocaine IV bolus.
Answer: B. Perform synchronized cardioversion.
The nurse should perform synchronized cardioversion for a client who has supraventricular
tachycardia.
What rhythms are shockable? (defibrillation)
Answer: ventricular fibrillation and pulseless ventricular tachycarida
What dysrhythmia are amiodarone and lidocaine indicated for?
Answer: ventricular arrhythmias
The nurse should initiate CPR for a client who what?
Answer: is pulseless or not breathing
A nurse is preparing a client who has supraventricular tachycardia for elective cardioversion.
Which of the following medications should the nurse instruct the client to withhold for 48 hr
prior to cardioversion?
A. Enoxaparin
B. Metformin
C. Diazepam
D. Digoxin
Answer: D. digoxin
Cardiac glycosides, such as digoxin, are withheld prior to cardioversion. These medications can
increase ventricular irritability and put the client at risk for ventricular fibrillation after the
synchronized countershock of cardioversion.
_______ are usually given prior to cardioversion to reduce anxiety and minimize discomfort with
the procedure.
Answer: Sedatives like diazepam
Metformin is held before what kind of procedures? Example? Why?
Answer: Ones that involve contrast dye like cardiac catheterization, in order to prevent kidney
damage.
__________ prevent blood clots that can be released into the circulatory system after
cardioversion.
Answer: Anticoagulants like enoxaparin
What kind of drugs are withheld prior to cardioversion?
Answer: cardiac glycosides like digoxin
exopthalmosis
Answer: condition produced by hyperthyroidism in which the eyeballs protrude beyond their
normal protective orbit because of swelling in the tissues behind them
entropion
Answer: the inversion of the edge of an eyelid
ectropion
Answer: the eversion of the edge of an eyelid
ptosis
Answer: drooping
A nurse is caring for a client who has emphysema and is receiving mechanical ventilation. The
client appears anxious and restless, and the high-pressure alarm is sounding. Which of the
following actions should the nurse take first?
A. Obtain ABGs.
B. Administer propofol to the client.
C. Instruct the client to allow the machine to breathe for them.
D. Disconnect the machine and manually ventilate the client.
Answer: C. Instruct the client to allow the machine to breathe for them.
When providing client care, the nurse should first use the least restrictive intervention. Therefore,
the first action the nurse should take is to provide verbal instructions and emotional support to
help the client relax and allow the ventilator to work. Clients can exhibit anxiety and restlessness
when trying to "fight the ventilator."
A nurse is caring for a client who has a potassium level of 3. Which of the following assessment
findings should the nurse expect?
A. Positive Trousseau's sign
B. 4+ deep tendon reflexes
C. Deep respirations
D. Hypoactive bowel sounds
Answer: D. Hypoactive bowel sounds
Deep tendon reflexes are used to monitor what electrolyte level?
Answer: magnesium
What kind of respirations occur with hypokalemia and why?
Answer: shallow respirations due to respiratory muscle weakness
Trosseau's sign evaluates for what electrolyte imbalances?
Answer: hypocalcelmia and hypomagnesemia
What is hypokalemia's effect on the GI system?
Answer: It decreases smooth muscle contraction leading to decreased peristalsis and hypoactive
bowel sounds.
Deep tendon reflexes in hypomagnesemia
Answer: increased e.g. 4+
Deep tendon reflexes in hypermagnesemia
Answer: decreased e.g. absent or 1+
What should be done if you are performing a cardiac assessment on a client and you hear a
murmur?
Answer: Listen with the client on their left side so it can be heard more clearly
A nurse is conducting an admission history for a client who is to undergo a CT scan with an IV
contrast agent. The nurse should identify that which of the following findings requires further
assessment?
A. History of asthma
B. Appendectomy 1 year ago
C. Penicillin allergy
D. Total knee arthroplasty 6 months ago
Answer: A. History of asthma
A client who has a history of asthma has a greater risk of reacting to the contrast dye used during
the procedure. Other conditions that can result in a reaction to contrast media include allergies to
foods, such as shellfish, eggs, milk, and chocolate.
What are conditions that may cause a reaction to contrast media? Patients with these conditions
require further screening before a procedure with IV contrast.
Answer: history of asthma and allergies to shellfish, eggs, milk, and chocolate
What drugs would warrant further screening for increased risk of renal damage in someone
getting a procedure with IV contrast?
Answer: aminoglycosides, NSAIDs, metformin
Patients with what conditions have an increased risk for renal damage from a procedure with IV
contrast?
Answer: history of diabetes mellitus, renal impairment, or heart failure
A nurse is an ED is reviewing the provider's prescriptions for a client who sustained a rattlesnake
bite to the lower leg. Which of the following prescriptions should the nurse expect?
A. Apply ice to the clients puncture wounds
B. Initiate corticosteroid therapy for the client
C. Keep the client's leg above heart level
D. Administer an opioid analgesic to the client
Answer: D. Administer an opioid analgesic to the client
Expect an opioid analgesic to promote comfort in someone with a rattlesnake bite.
What critter should you apply ice to the bite of and why?
Answer: a black widow spider bite in order to reduce the action of the neurotoxin
If a patient gets bitten by a snack, what level should the extremity be maintained at?
Answer: at the level of the heart, not above or below it
What should the nurse plan to administer for a bee or wasp sting?
Answer: corticosteroids and antihistamines
A nurse is caring for a client who is 12 hr post op following a total hip arthroplasty. Which of the
following actions should the nurse take?
A. Maintain adduction of the client's legs.
B. Encourage range of motion of the hip up to a 120° angle.
C. Place a pillow between the client's legs.
D. Keep the client's hip internally rotated.
Answer: c. Place a pillow between the client's legs
Post-op total hip arthroplasty
-maintain ab/adduction of the client's legs?
-encourage ROM of the hip up to what angle?
-pillow?
-avoid ________ rotating the hips
Answer: -maintain AB-duction of the legs
-encourage ROM of the leg up to 90 degrees (do not flex the hip past 90 degrees)
-place a pillow between the legs
-avoid internally rotating the hips
A nurse is caring for a group of clients. The nurse should plan to make a referral to physical
therapy for which of the following clients?
a. A client who is receiving preoperative teaching for a right knee arthroplasty.
b. A client who states they will have difficulty obtaining a walker for home use.
c. A client who reports an increase in pain following a left hip arthroplasty.
d. A client who is having emotional difficulty accepting that they have a prosthetic leg.
Answer: a. A client who is receiving preoperative teaching for a right knee arthroplasty.
The nurse should make a referral to physical therapy for a client who is receiving Pre-operative
teaching for a knee arthroplasty so the client can begin understanding postoperative exercises
and physical restrictions.)
What should you contact if a client reports an increase in pain following a left hip arthroplasty?
Answer: the provider
Who should you contact if a client states they will have difficulty obtaining a walker for home
use?
Answer: a social worker
Who should you contact if a client is having emotional difficulty accepting that they have a
prosthetic leg?
Answer: The nurse should refer the client to a “counsellor” to assist with coping with the
adjustment to the need of a prosthetic leg.
A nurse in a provider's office is assessing a client who has migraine headaches and is taking
feverfew to prevent headaches. The nurse should identify that which of the following
medications interact with feverfew?
a. Metoprolol
b. Bupropion
c. Naproxen
d. Atorvastatin
Answer: c. Naproxen
Both naproxen and feverfew impair __________ and place the client at risk for ________.
Answer: platelet aggregation bleeding
feverfew + naproxen = bleeding
The nurse should recognize that the effort of atorvastatin is decreased by what herb?
Answer: St. John's Wort
atorvastatin + St. John's wort = ?
Answer: decreased effect of atorvastatin
A nurse is providing discharge teaching to a client who has heart failure and a new prescription
for a potassium-sparing diuretic. Which of the following information should the nurse include in
the teaching?
A. Try to walk at least three times per week for exercise.
B. To increase stamina, walk for 5 min after fatigue begins.
C. Take over-the-counter cough medicine for persistent cough.
D. Use a salt substitute to reduce sodium intake.
Answer: A. Try to walk at least 3 times a week for exercise.
The development of a regular exercise routine can improve outcomes in clients who have heart
failure.
Should someone with heart failure walk for 5 minutes after fatigue begins? Why or why not?
Answer: No, it can exacerbate the patient's heart failure and won't increase stamina.
Right or left hemispheric stroke symptom?
A. aphasia
B. visual spatial deficits/loss of depth perception
C. one-sided neglect/unawareness of affected side
D. left hemianopsia
E. right hemianopsia
F. impulsive
G. cautious
Answer: A. aphasia - left
B. visual spatial deficit - right
C. one-sided neglect - right
D. left hemianopsia - right
E. right hemianopsia - left
F. impulsive - right
G. cautious – left
A nurse is caring for a client who is experiencing supraventricular tachycardia. Upon assessing
the client, the nurse observes the following findings: heart rate 200/min, blood pressure 78/40
mm Hg, and respiratory rate 30/min. Which of the following actions should the nurse take?
A. Defibrillate the client's heart.
B. Perform synchronized cardioversion.
C. Begin cardiopulmonary resuscitation.
D. Administer lidocaine IV bolus.
Answer: B. perform synchronized cardioversion
A nurse is teaching a young adult client how to perform testicular self-exam.
-use one or both hands? examine at same time?
-roll each testicle how?
-perform when?
-how often?
Answer: -use both hands to examine one testicle at a time
-roll each testicle horizontally between the thumb and the fingers to feel for any deep lumps in
the center
-during or after warm bath/shower
-once a month
A nurse is assessing a client following the administration of magnesium sulfate 1 g IV bolus. For
which of the following adverse effects should the nurse monitor?
-reflexes?
-BP?
-breathing?
-cardiac
Answer: -depressed or absent reflexes
-decreased BP
-respiratory paralysis
-depressed cardiac function/heart block
Magnesium sulfate can be used to treat what cardiac conditions? What is an adverse cardiac
effect?
Answer: treats cardiac dysrhythmias such as torsades de pointes and refractory ventricular
fibrillation
AE: depressed cardiac function including heart block
A nurse is planning care to decrease psychosocial health issues for a client who is starting
dialysis treatments for chronic kidney disease. Which of the following interventions should the
nurse include in the plan?
A. Remind the client that dialysis treatments are not difficult to incorporate into daily life.
B. Inform the client that dialysis will result in a cure.
C. Tell the client that it is possible to return to similar previous levels of activity.
D. Begin health promotion teaching during the first dialysis treatment.
Answer: C. Tell the client that it is possible to return to similar previous levels of activity.
The nurse should help the client develop realistic goals and activities to have a productive life
Before starting dialysis, the nurse should inform the client of the difficulty of incorporating
dialysis into daily life to allow the client to develop realistic expectations.
Answer: True.
Dialysis is a cure for CKD.
Answer: False, it is a life-long management.
For a client starting dialysis, when should the nurse begin health and lifestyle teaching?
Answer: In the first weeks after starting the dialysis treatment once the client feels better
physically and emotionally.
effect of hypokalemia on EKG
Answer: -flatted T wave
-presence of U wave
effect of hypocalcemia on EKG
Answer: prolonged ST interval and prolonged QT interval
The nurse should review the client's (what lab value?) after the administration of FFP. What is
the desired effect of fresh frozen plasma on the lab value?
Answer: prothrombin time the desired effect is a decrease in prothrombin time
What blood product is rich in clotting factors?
Answer: Fresh frozen plasma. FFP is administered to treat acute clotting disorders. The desired
effect is a decrease in the prothrombin time.
The nurse should teach that the maximum effect of epoetin alfa will occur in how long?
Answer: 2-3 months
The client who has what condition will have a plethoric (dark, flushed) manifestation of the
facial skin and mucous membranes?
Answer: polycythemia vera
The client who has what type of anemia will have manifestation of glossitis (smooth, beefy-red
tongue) and weight loss?
Answer: pernicious anemia
The client who has what type of anemia will have manifestations of jaundice with an enlarged
liver and spleen?
Answer: sickle cell anemia
In aplastic anemia, what blood components are absent/reduced? What is this called? Is it sudden
or gradual?
Answer: All three major blood components (red blood cells, white blood cells, and platelets) are
reduced or absent, which is known as pancytopenia. Manifestations usually develop gradually.
cardiac tamponade findings
-BP
-special BP thing
-heart sounds
Answer: -hyoptension
-pulses paradoxus
-muffled heart sounds
What is pulses paradoxus?
Answer: When the systolic BP is at least 10 mmhg higher on expiration than on inspiration.
pericarditis findings
-HR
-EKG abnormality
-3 symptoms
-what relieves the chest pain
Answer: -tachycardia
-ST-T spiking (elevation)
-dyspnea, hiccups, nonproductive cough
-chest pain relieved by sitting upright or leaning forward
The nurse should increase the intake of food containing what for a client who has megaloblastic
anemia?
Answer: folic acid
Which adventitious breath sound? "high-pitched musical squeak on inspiration or expiration
through a narrow or obstructed airway."
Answer: wheezes
Which adventitious breath sound? "coarse, loud, low-pitched sounds during inspiration or
expiration. Coughing often clears the airway and stops the sound."
Answer: rhonchi
Which adventitious breath sound? "loud, dry, rubbing or grating sounds over the lower lateral
anterior chest surface during inspiration or expiration."
Answer: friction rub
A client who had a recent myocardial infarction is at risk for left-sided heart failure. ________
are breath sounds caused by movement of air through airways partially or intermittently
occluded with fluid and are associated with heart failure and frothy sputum. These sounds are
heard at the end of inspiration and are not cleared by coughing.
Answer: crackles
Post-PTCA with stent placement, the nurse should plan to administer scheduled doses of what?
This maintains the patency of the client's coronary arteries following the PTCA by preventing
platelet aggregation and thrombus formation around the newly placed stent.
Answer: aspirin
Patients who receive numerous blood transfusions (eg a sickle cell patient) are at risk of what
electrolyte imbalances?
Answer: hyperkalemia - transfused blood relases more K because of hemolysis
hypocalcemia - the citrate in the transfused blood binds the calcium in blood so it's excreted
The client who has received several blood transfusions is at risk for development of
hemosiderosis, which is excess storage of _________ in the body. The excess can come from
overuse of supplements or from receiving frequent blood transfusions, as in sickle cell anemia.
Answer: iron
The nurse should instruct the client who has stomatitis to avoid the use of lemon-glycerine swabs
because they cause drying and irritation of the mucous membranes.
Answer: True
The nurse should instruct the client with stomatitis to rinse the mouth out with_______,
_______, or _________ solution every 2 to 3 hr to promote comfort and healing.
Answer: hydrogen peroxide solution, baking soda solution or warm saline
ABGs normal pH normal PaCO2 normal HCO3
Answer: pH 7.35-7.45
PaCO2 35-45
HCO3 22-26
How can you determine respiratory/metabolic acidosis/alkalosis?
Answer: First look at the pH. 7.45 = alkalosis.
Then look at CO2. If abnormal = respiratory. If CO2 normal and HCO3 abnormal = metabolic.
isoniazid for TB
-how long is it usually prescribed for?
-monitor what organ?
-take with or without food?
Answer: -usually 6 months to 2 years
-monitor liver function
-empty stomach (1 hour before or 2 hours after a meal)
The nurse should recognize that bladder spasms are an expected manifestation after a TURP and
are usually controlled by a smooth muscle relaxant such as _________.
Answer: oxybutynin
Is a strong urge to urinate normal after a TURP?
Answer: yes
Post-TURP, the nurse should report urine output that is bright red/viscous with clots or urine that
resembles ketchup to the provider because this is an indication of _________.
Answer: arterial bleeding
brachytherapy
-what position during treatment?
-avoid contact with people between treatments?
-treatment how often?
-is blood in urine expected?
Answer: -bed rest with limited movement (lie still in bed)
-no need to avoid contact with people between treatments
-treatment usually 1-2 times per week
-blood in urine not expected
- report to the provider
EEG special instructions
Answer: -eat regular meals beforehand
-shampoo hair thoroughly, no sprays or oils
-wake up at 2 or 3 am the morning of
post sigmoid colon resection with colostomy
-how will the stoma change in size?
-diet?
-what will the stools be like?
-when will colostomy begin to function?
Answer: -it will be large and edematous and shrink over 6-8 weeks
-quickly return to regular diet after surgery, unless patient wants to restrict foods that cause gas
or odor. no need to do soft foods
-the colostomy will begin to function 2-6 days after surgery. the first 2-6 days there may only be
mucus drainage
patient with encephalitis from West Nile virus
-what level of precautions?
-vital signs how often?
-neuro status how often?
-risk of what?
-bed position?
-surroundings?
Answer: -standard precautions
-vital signs q 2 hrs
-neuro status at least q 4 hrs
-risk of increased ICP:
-head of bed elevated 30-45 degrees
-dark room, low-stimulation environment to promote comfort and decrease agitation
patient with epistaxis
-what position
-apply what
-blow nose?
-when to try something else?
Answer: -sitting leaning forward
-apply ice pack or cold compress
-apply direct lateral pressure for 10 minutes. if that doesn't work, try nasal packing or other
interventions
-avoid blowing nose for 24 hrs afterward
patient on TPN
-if TPN is not available, give what fluid?
-change tubing how often?
-blood glucose checks how often?
-weights how often?
Answer: -give 10% dextrose in water or 20% dextrose in water
-change tubing every 24 hrs
-check blood glucose every 4 hrs
-daily weights
s/sx of increased intracranial pressure:
-BP
-HR
-other
Answer: -widened pulse pressure/increased systolic BP
-bradycardia
-pupil changes
-LOC changes
-nausea and vomiting
_________ is a deep, rapid respiratory pattern of hyperventilation that can occur in a client who
has diabetic ketoacidosis.
Answer: Kussmaul respirations
Kussmaul respirations is a deep, rapid respiratory pattern of hyperventilation that can occur in a
client who has what condition?
Answer: diabetic ketoacidosis
This is a breathing pattern of deep to shallow breaths, followed by periods of apnea.
Answer: Cheyne Stokes respirations
Cheyne-Stokes respirations can be the result of a drug overdose or __________ and can precede
death.
Answer: increased intracranial pressure
This is a pattern of breathing in which the chest wall contracts during inspiration and expands
during expiration. This can occur in a client who has sustained rib fractures.
Answer: flail chest aka paradoxical breathing
What are some risk factors for breast cancer?
Answer: obesity, alcohol use (dose dependent - 3+ drinks/week), oral contraceptive use, family
history/genetics, “over age 50”, nulliparity, early menarche, late menopause, hormone
replacement therapy, increased breast density, first pregnancy after age 30
post radical prostatectomy with indwelling urinary catheter
-shower/bath?
-change urinary drainage bag how often?
-use what to prevent constipation?
-bladder control?
Answer: -shower only for 2-3 weeks, no baths
-change bag and tubing once a week
-use stool softener (not suppositories) to prevent constipation
-do kegels to regain bladder control. may be incontinent for 1-2 years after surgery
discharged post-op mastectomy with Jackson Pratt drain
-empty tube how often?
-baths or showers?
-when will drain and stitches be removed?
-exercise?
Answer: -empty tubes and record drainage 2x a day
-bath only until tubes and stitches are removed; no showers
-drain and stitches usually removed at same time, within 7-10 dyas
-normal activity and nonstrenuous exercise permitted. more strenuous exercise once
tubes/stitches are removed
Confluent (gathered together), honey-colored, crusted lesions are typically associated with what?
Answer: impetigo
What causes genital herpes?
Answer: herpes simplex virus
Shingles is what kind of herpes/what kind of virus?
Answer: herpes zoster reactivation of a dormant varicella virus
What is a large, tender nodule located on a hair follicle?
Answer: a furuncle aka a bacterial infection on a follicle
Herpes zoster, or shingles, results from the reactivation of a dormant varicella virus. It is the
acute, unilateral inflammation of the dorsal root ganglion. The infection typically develops in
adults and produces localized vesicular lesions confined to a dermatome. Are the lesions bilateral
or unilateral? localized or not? nodular or not?
Answer: Shingles produces unilateral, localized, nodular skin lesions.
What is the leading cause of SLE exacerbations, especially the characteristic skin lesions and
butterfly rash
Answer: exposure to sunlight and artificial UV light
A temperature of 37.8° C is within the expected reference range and does not indicate the client
is developing an infection.
Answer: True
SLE skin lesion care
-wear protective clothing and hat outside
-clean, dry, and moisturize the skin with warm water and unscented lotion
-gently pat dry
-topical corticosteroid creams may be used (not antibacterial creams)
Answer: For individuals with Systemic Lupus Erythematosus (SLE) experiencing skin lesions,
it's essential to adopt specific skincare practices. When going outside, wear protective clothing
and a hat to shield your skin from UV rays, which can exacerbate lesions. Cleanse your skin
gently with warm water, avoiding hot water which can dry out the skin. Use unscented lotion to
moisturize, as scented products might irritate sensitive skin. After washing, gently pat your skin
dry with a soft towel instead of rubbing it. If necessary, topical corticosteroid creams can be
applied to reduce inflammation and manage lesions, but avoid using antibacterial creams unless
directed by a healthcare professional. Regularly moisturizing and protecting the skin from sun
exposure can help manage and prevent flare-ups of SLE-related skin lesions.
Antihistamines are used to treat vertigo, as in the treatment of Ménière's disease. However,
vertigo is not a manifestation of histamine release.
Answer: True
How does the release of histamine in an allergic reaction affect mucus secretion and the bronchi?
Answer: increased mucus secretion, bronchial constriction, bronchospasms
What labs should be monitored prior to a liver biopsy and why?
Answer: platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT).
Many people with liver disease have clotting defects and are at risk for bleeding/hemorrhage
from a liver biopsy. (Normally the liver cells use vitamin K to make prothrombin.)
The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit
manifestations of a _________ abdomen and severe pain in the abdomen or back that radiates to
the ________ shoulder. Vomiting of blood and shock (high HR + low BP) can occur if the
perforation causes hemorrhaging.
Answer: boardlike right
What are two procedures that could be used to visualize polyps in the colon?
Answer: a sigmoidoscopy or barium enema
What procedure is used to identify an obstruction in the biliary tract?
Answer: an ERCP
What is used to determine the presence of free air in the abdomen?
Answer: an x-ray or fluoroscopy
An EGD is used to visualize what areas with a lighted tube to detect a tumor, ulceration, or
obstruction?
Answer: esophagus, stomach, duodenum
The head of the bed should be elevated at least how many degrees (semi-Fowler's position) while
a tube feeding is administered. This position uses gravity to help the feeding move down through
the digestive system and lessens the possibility of regurgitation?
Answer: at least 30 degrees!!!
The hepatitis ___________ vaccine is recommended for those who travel, especially military
personnel. It is also recommended for other at-risk groups.
Answer: hep A
Hepatitis B immune globulin is given as part of the standard childhood immunizations. It can be
administered as early as birth, especially in infants born to hepatitis B surface antigen (HBsAg)
negative mothers. These infants should receive the second dose between ___________ and
__________ months of age.__________.
Answer: (first shot within 12 hrs of birth) second shot: between 1 and 4 months of age
A liver lobectomy is used for a client who has localized _________ of a lobe of the liver.
Answer: cancer
Endoscopic sclerotherapy is the injection of a sclerotherapy agent during endoscopy to target
__________ that are actively bleeding. This promotes thrombosis, which eventually leads to
sclerosis.
Answer: esophageal varices
Fulminant hepatic failure, most often caused by ________, is characterized by the development
of hepatic encephalopathy within weeks of the onset of disease in a client without prior evidence
of hepatic dysfunction. Mortality remains high, even with treatment modalities such as blood or
plasma exchanges, charcoal hemoperfusion, and corticosteroids. Consequently, ________ has
become the treatment of choice for these clients.
Answer: -viral hepatitis
-liver transplantation
A transjugular intrahepatic portal-systemic shunt is placed to treat esophageal varices through
placement of a stent into the portal vein. The stent serves as a shunt between the portal
circulation and the hepatic vein, thereby reducing _________.
Answer: portal hypertension
The ________ laboratory test is specific to the hepatobiliary system in which levels can be raised
by alcohol and hepatotoxic drugs. Therefore, it is useful for monitoring drug toxicity and
excessive alcohol use.
Answer: GGT = gamma-glutamyl transferase
The nurse should recognize that the client has the potential for the development of ___________
due to the sudden withdrawal of the TPN solution.
Answer: hypoglycemia
S/sx of hypoglycemia?
Answer: -In addition to diaphoresis, other potential manifestations of hypoglycemia can include
weakness, anxiety, confusion, and hunger.
-CHAWD
-confusion
-hunger
-anxiety
-weakness
-diaphoresis
What should the first oral feeling be after a gastric bypass? How much? What to avoid?
Answer: -clear liquid such as water or broth
-only 30 ml (1 oz) per feeding
-avoid sugar (can cause diarrhea) and carbonation (pressure can cause leak)
Bowel sounds in bowel perforation
Answer: absent
When a client has first-degree frostbite, the skin of the affected area looks ________ and
_________.
Answer: red and waxy
When a client has second-degree frostbite, the skin of the affected area has large _________
Answer: fluid-filled blisters
When a client has third-degree frostbite, the skin of the affected area has small blisters that are
_________ and the skin does not ________.
Answer: blood-filled doesn't blanch
When a client has fourth-degree frostbite, the skin of the affected area is ________.
-are there blisters?
are the muscle and bones affected?
Answer: -no blisters
-muscles and bones are affected
Which lesion is described: rough, dry, scale lesion
A. actinic keratosis
B. basal cell carcinoma
C. malignant melanoma
D. squamous cell carcinoma
Answer: A. actnic keratosis
Which lesion is described: pearly papule with ulcerated center
A. actinic keratosis
B. basal cell carcinoma
C. malignant melanoma
D. squamous cell carcinoma
Answer: B. basal cell carcinoma
Which lesion is described: irregularly shaped with blue tones
A. actinic keratosis
B. basal cell carcinoma
C. malignant melanoma
D. squamous cell carcinoma
Answer: C. malignant melanoma
Which lesion is described: firm nodule with crust
A. actinic keratosis
B. basal cell carcinoma
C. malignant melanoma
D. squamous cell carcinoma
Answer: D. squamous cell carcinoma
expected findings in resuscitation phase after major burn:
-hemoglobin
-hematocrit
-potassium
-albumin
-sodium
Answer: -hemoglobin elevated
-hematocrit elevated
-potassium elevated
-albumin decreased
-sodium decreased
With __________ intention, a clean wound is closed mechanically, leaving well-approximated
edges and minimal scarring. A surgical incision is an example of a wound that heals by
__________ intention.
Answer: primary
patient recently extubated. what are signs of tracheal stenosis? (a complication of extubation)
Answer: increased coughing, inability to cough up secretions, difficulty talking/breathing
Who should get the pneumococcal vaccine? How many shots is it? When can they repeat it if
they aren't sure if they got it?
Answer: -adults 65 and up
-one shot
-if their last shot was over five years ago and they're 65 now, they should get it
what does dantrolene treat? what organ is it toxic to?
Answer: -muscle spasticity (e.g. cerebral palsy, multiple sclerosis)
-malignant hyperthermia
-hepatotoxic
- contradincated in patients with liver disease
s/p radical mastectomy
-when to begin arm exercises?
-position of affected arm in bed?
-avoid what arm position when ambulating to prevent contractures?
-when to begin ambulating?
Answer: -begin arm exercises + ambulation on first postoperative day
-keep affected arm elevated in bed
-avoid flexed position when ambulating to prevent contractures
What is a drug used to treat diabetes inspidus? What is a sign of the adverse effect of water
intoxication that may occur?
Answer: desmopressin headache
What type of lesion is each of these skin conditions?
A. freckles or rubella rash
B. herpes simplex, poison ivy, chickenpox
C. allergic reaction
D. warts and elevated moles
Answer: A. macules
B. vesicles
C. wheal
D. papules
where should an estradiol patch be applied?
Answer: the abdomen/trunk (not breasts)
when are the Hib and PCV13 (pneumococcal congudate) vaccines given to children?
Answer: 2, 4, 6, and 12-15 months of age
When is the Hep B vaccine given?
Answer: Birth (within 12 hrs), 1-2 months, 6-18 months
When is inactivated poliovirus vaccine given?
Answer: 2 months, 4 months, 6-18 months, 4-6 years old
TPN
-weigh how often?
-check blood glucose how often?
-change tubing how often?
-apply new dressing to IV site how often?
-what type of access
Answer: -daily weight
-check blood glucose q4
-new dressing to IV site every 2-3 days per facility
change tubing once every 24 hrs
central line
signs of deep vein thrombosis
-what would you see/feel?
-sensation?
-pulses?
-temp?
-leg circumference?
Answer: -may see/feel a hardened vessel and prominent superficial veins
-pt will feel pain/tenderness
-pulses not affected (that's arterial)
-skin may be warm
-increased leg circumference/swelling
Match the type of radiation with its description:
a. brachytherapy
b. teletherapy
c. stereotactic body radiotherapy
-radioactive insertions or infusions into or near the tumor
-precise delivery of high-dose radiation after tumor imafging
-radiation to the tumor from an external source
Answer: a. brachytherapy - radiactive insertion/infusion into/near tumor
b. teletherapy - radiation from external source
c. stereotactic body radiotherapy - precise high-dose radiation after tumor imagingchl
Chlorpromazine (Thorazine)
Answer: -typical antipsychotic anticholingergic effects
-orthostatic hypotension
-sedation
Should children with HIV get vaccines?
Answer: yes, all of them! full dose, no delay, nothing special
#1 reason for death after MI
Answer: dysrhythmias
What is the effect of hypercalcemia and hypocalcemia on the QT interval?
Answer: hypercalcemia = shortened QT interval
hypocalcemia = prolonged QT interval
What is the effect of hyperkalemia and hypokalemia on an EKG?
Answer: hyperkalemia = widened QRS and peaked T waves
hypokalemia = flatted T wave and cardiac dysrhythmias
What are some signs of adrenal insufficiency, an adverse effect of long-term use of inhaled
corticosteroids like fluticasone?
Answer: anorexia, weakness, nausea, hypotension, hypoglycemia
what are expected findings in mild preeclampsia? what would signify a progression to severe
preeclampsia?
Answer: -proteinuria +2, elevated BUN (over 20), platelets 100
-history of tachycardia
-sodium 3 g/day
-fluid 2 L/day
Which of these is NOT an a common part of aging and thus is the most reliable indicator of a
hematologic disorder in an older adult?
-pallor
-jaundice
-poor cap refill
-absence of hair on legs
Answer: -absence of hair on legs
Which is the only statin okay to have with grapefruit?
Answer: pravastatin
giving an IV med via an implanted venous access port
-what type of needle?
-dressing?
-flush?
-do what before giving med?
Answer: -22-gauge non-coring needle
-no dressing needed
-flush with heparin at least once a month and after each use
- 5 ml 100 units/ml. this is called locking/deaccessing
-check for blood return
before transfusing packed RBCs, check that they are less than how old?
Answer: less than a week old
what are the expected pulse and breathing rates during an MI?
Answer: weak or absent pulse (d/t decreased cardiac output) tachypnea (d/t anxiety and pain)
A client without cognitive decline should be able to remember and repeat three objects how
much later? What type of memory is this?
Answer: -five minutes later
-new/immediate memory
giving two incompatible IV fluids
Answer: -clamp the first fluid at the clamp closest to the port
-always check patency by aspirating before giving an IV bolus
-always give IV bolus injection at port closest to the client
-flush line with 10 ml saline before and after administering 2nd solution
serious AE of linezolid
Answer: irreversible peripheral neuropathy and reversible optic neuropathy
what antidysrhythmic has the adverse effect of cinchonism (tinnitis, headache, vertigo, visual
disturbances)?
Answer: quinidine
adenosine (antidysthmic) adverse effects
Answer: dyspnea from bronchoconstriction (but short half life of only 10 seconds) transient
feeling of warmth and facial flushing
Pruritis is an AE of methotrexate
Answer: True
which antineoplastic can cause hallucinations?
Answer: asparaginase
cisplatin can cause what AE
Answer: tinnitus/ototoxicity
hand and foot syndrome as an AE of what antineoplastic?
Answer: capecitabine
expected reference range for aPPT? what to do if giving heparin and aPPT prolonged?
Answer: -expected: 60-80 seconds
-prolonged: slow down the rate, contact provide, monitor for bleeding
-Addison's diet
-sodium
-carbs
-protein
potassium
Answer: -high sodium
-high carb
-high protein
-low potassium
match the lobe of the brain with its function/area of cognition
-frontal
-temporal
-occipital
-limbic
a. vision
b. understanding speech (receptive)
c. expressing speech (expressive)
d. memory and learning
Answer: frontal = verbal expression of thoughtrs
temporal = understanding speech (receptive)
occipital = vision
limbic = memory and learning
What other asthma med cannot be used with theophylline because it could lead to theophyilline
toxicity?
Answer: leukotriene receptor antagonists (eg zafirlukast)
which med is used to test for adrenal insufficiency? what result indicates adrenal insufficiency?
Answer: cosyntropin - synthetic ACTH no elevated in cortisol levels → adrenal insufficiency
which med is used to test for cushing's? what result indicated cushing's?
Answer: dexamethasone
little/no suppression of cortisol production → Cushings
sulfasalazine
-type of drug?
-used to treat?
-monitor what/serious AE?
Answer: -DMARD
-rheumatoid arthritis
-monitor CBC
- can cause bone marrow suppression
a frontal headache indicates what fluid imbalance?
Answer: fluid overload
Acute confusion is a symptom of MI in adults 65+
Answer: True
excess progestin effect on
-mood
-weight
-menstrual cycle
-skin
Answer: -depression
-weight gain
-regularity (deficiency = amenorrhea)
-acne
primary hypothyroidism
-T3/T4
-TSH
Answer: T3/T4 = decreased
TSH = increased
The presence of _____ after thrombolytic therapy after an acute MI indicates reperfusion of the
coronary arteries
Answer: ventricular dysrhythmias
Q waves indicate what
Answer: infarction
herb used to treat menopausal symptoms like hot flashes
Answer: black cohosh
dietary supplement for constipation and to decrease cholesterol
Answer: flaxseed
gingko bilboa improves blood flow and can reduce pain r/t what
Answer: peripheral arterial disease
phenytoin adverse effects
-BP
-HR
-GI
-cardiac
Answer: -hypotension (if given too quickly)
-bradycardia (if givent too quickly)
-GI upset (just for oral phenytoin; prevent by giving with food)
-cardiac dysrhythmias
- will need to be on cardiac monitoring
phenytoin, phenySLOWIN, phenyLOWIN cefotetan can affect what, resulting in bleeding and
epitaxis?
Answer: vitamin K levels
well-controlled diabetes:
-HA1C
-fasting blood glucose
-postprandial BG
-casual BG
Answer: -HA1C <7%
-fasting BG <110
-postprandrial BG <160
-casual BG 90)
herbs that increase risk of bleeding
Answer: -feverfew
-echinacea
-garglic
-ginger
-ginkgko
long-term use of glucocorticoids can cause
Answer: -osteoporosis/stress fractures
-weight gain
-hypertension
-restless, irritable, agitated, anxious
which cranial nerve is assessed: ask patient to smell coffee
Answer: CN I - olfactory nerve
which cranial nerve is assessed: open mouth and say ahhhhh
Answer: -CN X
- vagus nerve (its motor function)
-palate and uvula should move upward in response also assess voice for hoarseness
which cranial nerve is assessed: raise eyebrows
Answer: CN VII - facial nerve
which cranial nerve is assessed: using a tongue blade to provoke gag reflex
Answer: CN IX - glossopharyngeal
symptom of prodomal stage of inhaling anthrax
Answer: sore throat
PICC line use what size syringe to flush when to flush and with what access it for blood
sampling? cleanse site with what?
how long can it be in place?
Answer: -10 ml syringe
-flush with 10 ml sterile NS before/after med admin
-flush with heparin at least once a day when not in use
-yes access for blood sampling (4 French lumen or larger)
-cleanse site with chlorhexidine
-can remain in place for months or years
what is blumberg's sign?
Answer: rebound tenderness
is it expected for a patient to have a positive blumberg's sign in cholecystitis?
Answer: yes
-unstable angina
-how long does it last?
-relieved by nitro?
-relieved by rest?
does physical exertion cause it?
Answer: -at least 15 minutes
-not relieved/barely relieved by nitro
-not relieved by rest
-can happen with physical exertion or at rest
what condition does tolvaptan treat?
Answer: SIADH
