Review Med surg exam (Montgomery college)

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Med surg exam (Montgomery college)

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Total Questions : 38

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Question 1:

The nurse is assessing a patient who has received the first dose of chemotherapy for leukemia.
Which patient's clinical findings indicate to the nurse that the patient has developed tumor lysis syndrome (TLS)?

A. Facial swelling and jugular vein distension (JVD). B. Muscle weakness, confusion, polyuria, and polydipsia. C. Flank pain, elevated uric acid, and cardiac monitor reveals an abnormal rhythm. D. Elevated liver function tests, jaundice, and blistering skin rash.

Answer and Explanation

Choice A:

Facial swelling and jugular vein distension (JVD) are indicative of superior vena cava syndrome (SVCS), not tumor lysis syndrome (TLS). SVCS occurs when the superior vena cava, which carries blood from the head, neck, upper chest, and arms to the heart, is obstructed. This can lead to facial swelling, cyanosis, and distended neck veins due to increased venous pressure.

Choice B:

Muscle weakness, confusion, polyuria, and polydipsia are symptoms of hypercalcemia. Hypercalcemia is characterized by elevated levels of calcium in the blood, which can cause neuromuscular and cognitive symptoms, excessive urination, and increased thirst.

Choice C:

Tumor lysis syndrome (TLS) is characterized by rapid destruction of tumor cells, leading to elevated levels of uric acid, potassium, and phosphate. Symptoms include flank pain due to uric acid crystallization in the kidneys, and abnormal heart rhythms due to hyperkalemia.

Choice D:

Elevated liver function tests, jaundice, and blistering skin rash are symptoms of liver toxicity or hepatic dysfunction, possibly due to drug-induced liver injury. These symptoms are not related to tumor lysis syndrome (TLS).

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Question 2:

The nurse is caring for a patient with recurrent prostate cancer who is scheduled to begin treatment with immunotherapy medication.
During patient teaching, which statement by the patient will indicate a need for further teaching by the nurse?

A. "You will monitor me for flu-like symptoms during my immunotherapy infusions.” B. "I do not have to worry about losing my hair after this treatment.” C. "Immunotherapy uses my own immune system to help fight the cancer.” D. "This therapy will prevent me from getting hospital-acquired infections.”

Answer and Explanation

Choice A:

Monitoring for flu-like symptoms during immunotherapy infusions is crucial because these medications can cause cytokine release syndrome. Symptoms like fever, chills, fatigue, and muscle aches are common side effects of immunotherapy and require close monitoring to manage and mitigate adverse reactions.

Choice B:

Immunotherapy generally does not cause hair loss, unlike traditional chemotherapy. Hair loss occurs because chemotherapy targets rapidly dividing cells, including hair follicle cells. Immunotherapy works by enhancing the body's immune response to cancer cells without targeting hair follicles.

Choice C:

Immunotherapy leverages the patient's immune system to recognize and attack cancer cells. It enhances the body's natural defenses by boosting immune system activity or by counteracting signals produced by cancer cells that suppress immune responses.

Choice D:

Immunotherapy does not prevent hospital-acquired infections. While it strengthens the immune system against cancer, it does not provide general protection against pathogens causing nosocomial infections. Patients undergoing immunotherapy should still follow standard precautions to avoid infections.

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Question 3:

The nurse is preparing to administer vancomycin 15 mg/kg/day divided equally every 12 hours to a patient with neutropenic fever.

The patient weighs 198 lb. How many mg will the nurse administer with each dose? Round the answer to the nearest whole number.

Write numerical answer only - no units.

Answer and Explanation

Correct Answer: "675" mg/dose

Explanation

Step 1 is (198 ÷ 2.2) × 15 = 1350 mg/day.

Step 2 is 1350 ÷ 2 = 675 mg/dose.

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Question 4:

The nurse is evaluating a patient with hyperthyroidism who is taking propylthiouracil (PTU) 100 mg/day for maintenance therapy.
Which statement from the patient indicates the medication therapy is effective?

A. "I have lost weight since taking this medication.” B. "I perspire a lot throughout the entire day.” C. "I have excess energy throughout the day.” D. "I am able to sleep and rest at night.”

Answer and Explanation

Choice A:

Weight loss in a patient with hyperthyroidism typically occurs due to an increased metabolic rate. Propylthiouracil (PTU) is used to decrease thyroid hormone production. Effective treatment would stabilize metabolism and prevent further weight loss, but not necessarily result in weight gain.

Choice B:

Excessive sweating (perspiration) is a common symptom of hyperthyroidism due to an overactive thyroid gland. PTU aims to reduce thyroid hormone levels. Effective treatment should lead to a decrease in sweating as the metabolic rate normalizes.

Choice C:

Excess energy and hyperactivity are signs of untreated or inadequately treated hyperthyroidism. PTU reduces the production of thyroid hormones, and effective treatment should alleviate symptoms of excessive energy, resulting in more balanced energy levels.

Choice D:

Improved sleep and rest at night indicate effective management of hyperthyroidism. Reduced thyroid hormone levels from PTU help alleviate symptoms such as anxiety, restlessness, and insomnia, allowing the patient to achieve better sleep quality. .

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Question 5:

The nurse is caring for a patient who was treated for Addisonian crisis.
What clinical change indicates to the nurse that the prescribed therapy was effective?

A. Increase of 25 mmHg in the patient's systolic blood pressure. B. An increase in the serum potassium level from 3.5 to 5.6 mEq/dL. C. Patient complains of headache and is showing signs of restlessness. D. The patient has normal temperature with pallor to the skin.

Answer and Explanation

Choice A:

An increase in systolic blood pressure by 25 mmHg indicates a positive response to therapy for Addisonian crisis. Addisonian crisis involves severe hypotension due to low levels of cortisol and aldosterone, which regulate blood pressure. Cortisol replacement therapy helps to increase blood pressure by enhancing the responsiveness of blood vessels to catecholamines and promoting sodium and water retention. This improvement is critical for stabilizing the patient and restoring hemodynamic balance.

Choice B:

An increase in serum potassium level from 3.5 to 5.6 mEq/dL suggests hyperkalemia, which is a sign of worsening condition, not improvement. Addisonian crisis is characterized by hyperkalemia due to aldosterone deficiency, which impairs potassium excretion. Effective treatment would normalize potassium levels rather than increase them.

Choice C:

Complaints of headache and signs of restlessness may indicate adverse effects or complications, rather than therapeutic efficacy. These symptoms could result from inadequate or excessive dosing of corticosteroids or other underlying issues. Monitoring patient response and adjusting treatment is essential.

Choice D:

Normal temperature with pallor to the skin does not indicate effective therapy for Addisonian crisis. Pallor may reflect ongoing hypoperfusion or anemia. The absence of fever is not a definitive marker of therapeutic success. Key indicators include hemodynamic stability and normalized electrolytes.

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Question 6:

The nurse is caring for a patient with myxedema coma who has an order for levothyroxine intravenous bolus.

The order reads levothyroxine 0.5 mg intravenous bolus at a rate of 100 mcg/min.

The nurse will administer the medication over how many minutes? Fill in the blank with the numerical value only.

Answer and Explanation

Correct Answer: "5" minutes

Explanation

The correct answer is 5.

Step 1 is 0.5 mg × 1000 mcg ÷ 1 mg = 500 mcg.

Step 2 is 500 mcg ÷ 100 mcg/min = 5 min.

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Question 7:

The nurse is caring for a patient with hyperparathyroidism.
Upon assessment, the nurse notes polyuria, polydipsia, nausea, and vomiting and the following lab values: Potassium: 130 mg/dL. Calcium: 4.7 mg/dL. Phosphorus: 13.1 mg/dL. Magnesium: 25 mg/dL. Which of the following medications is recommended for this patient?

A. Regular insulin 10 units subcutaneous. B. Chlorothiazide 750 mg intravenous. C. Calcitonin 300 international units subcutaneous. D. Calcitriol 0.75 mcg orally.

Answer and Explanation

Choice A:

Regular insulin 10 units subcutaneous is used to lower blood glucose levels in hyperkalemia. While insulin can help shift potassium into cells, it is not indicated for hypercalcemia or hyperparathyroidism. Regular insulin would not address the elevated calcium levels in this patient.

Choice B:

Chlorothiazide 750 mg intravenous is a diuretic that can increase calcium reabsorption in the kidneys, potentially worsening hypercalcemia. It is contraindicated in hyperparathyroidism because it can exacerbate the high calcium levels and associated symptoms.

Choice C:

Calcitonin 300 international units subcutaneous is the correct choice for this patient. Calcitonin inhibits osteoclast activity, reducing bone resorption and lowering serum calcium levels. It provides rapid but short-term control of hypercalcemia, which is crucial for managing acute symptoms of hyperparathyroidism.

Choice D:

Calcitriol 0.75 mcg orally is an active form of vitamin D that increases calcium absorption in the gut. It is used to manage hypocalcemia, not hypercalcemia. Administering calcitriol would further elevate the already high calcium levels, worsening the patient's condition.

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Question 8:

The nurse is caring for a patient with lymphoma who is receiving chemotherapy.
The patient's laboratory results are below.
What interventions will the nurse implement related to these results? ANC (Absolute neutrophil count): 2400/mm³. Hemoglobin: 8.4 g/dL. Hematocrit: 25.9%. Platelets: 6,000/mm³.

A. Implement neutropenic precautions and administer broad-spectrum antibiotics. B. Implement contact isolation precautions and administer intravenous prednisone. C. Implement bleeding precautions and administer platelet transfusion. D. Implement bedrest and administer packed red blood cell transfusion.

Answer and Explanation

Choice A:

Neutropenic precautions and broad-spectrum antibiotics are indicated for patients with neutropenia to prevent infections. However, the patient's ANC is within the normal range (2400/mm³), so these measures are not necessary. This choice does not address the low hemoglobin and platelet count.

Choice B:

Contact isolation precautions and intravenous prednisone are not relevant to the patient's current condition. Prednisone is an immunosuppressive corticosteroid used for inflammatory and autoimmune conditions, but it does not address the patient's anemia or thrombocytopenia.

Choice C:

C is most critical for immediate bleeding risk management. .

Choice D:

Bedrest and packed red blood cell transfusion address the patient's anemia (hemoglobin 8.4 g/dL, hematocrit 25.9%). While these interventions are necessary to improve oxygen-carrying capacity, they do not address the critical issue of thrombocytopenia. Combining interventions C and D would be ideal for comprehensive care, but based on the question,

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Question 9:

The nurse is providing discharge teaching to a patient diagnosed with Cushing's syndrome.
What statement made by the patient will demonstrate their understanding of the discharge instructions?

A. "If I feel stressed, I will increase my dose of corticosteroids to cope with my mood swings.” B. "I have to decide whether or not I want to have surgery to remove the tumor on my thyroid gland.” C. "My teammates will be happy that I can begin playing football again.” D. "I will stay away from people with infections and call my healthcare provider if I develop a fever.” .

Answer and Explanation

Choice A:

Increasing the dose of corticosteroids without consulting a healthcare provider can be dangerous as it can cause serious side effects like immunosuppression, weight gain, and high blood pressure. Patients with Cushing's syndrome already have excess corticosteroids and should avoid additional doses.

Choice B:

This statement is incorrect as Cushing's syndrome is not related to a thyroid gland tumor. The treatment for Cushing's syndrome often involves removing a tumor from the adrenal gland or pituitary gland, not the thyroid.

Choice C:

Resuming physically intense activities like football should be discussed with a healthcare provider. Patients with Cushing's syndrome may have muscle weakness, osteoporosis, and other health issues that could be exacerbated by high-impact sports.

Choice D:

Patients with Cushing's syndrome have a weakened immune system due to high corticosteroid levels. Avoiding infections and promptly reporting any signs of illness, like fever, is crucial for their health.

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Question 10:

The nurse is caring for a patient who has been in remission from breast cancer for five years.
What intervention will the nurse include as a component of survivorship care for this patient?

A. Schedule the patient for annual prophylactic radiation therapy to the affected breast. B. Educate the patient about the need for routine mammography screening. C. Coordinate with the hospice team to complete the patient's advanced directives. D. Teach the patient that they no longer need survivorship care after five years of remission.

Answer and Explanation

Choice A:

Routine prophylactic radiation therapy is not recommended for breast cancer survivors as it can lead to additional health issues such as secondary cancers and tissue damage. It is not a standard survivorship care practice.

Choice B:

Regular mammography screenings are crucial for early detection of breast cancer recurrence or new primary breast cancers. It is a standard component of survivorship care.

Choice C:

Coordinating with hospice care is more relevant for end-of-life care rather than survivorship care. Survivorship care focuses on maintaining health and monitoring for recurrence, not on palliative care planning.

Choice D:

Survivorship care is important throughout a patient's life, not just the first five years after remission. Continuous monitoring and health promotion are essential to detect any late effects of cancer treatment and maintain overall health.

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Med surg exam (Montgomery college)

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