Review Med Surg final exam(Samuel merit university)

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Med Surg final exam(Samuel merit university)

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Total Questions : 65

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Question 1:

Adlent has been diagnosed with hyperthyroidism. Which signs and symptoms may indicate thyroid storm, a complication of this disorder?

A. Hypotension, chills, thirst B. Lethargy, confusion, bradycardia C. Bradycardia, hypotension, low urine output D. Fever, tachycardia, tremors

Answer and Explanation

Choice C:

hoice D reason: Fever, tachycardia, and tremors are classic signs of a thyroid storm. A thyroid storm is a life-threatening condition characterized by an excessive amount of thyroid hormones, leading to hypermetabolic activity. This results in symptoms like a high fever, rapid heart rate (tachycardia), and tremors.

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Question 2:

Choose appropriate interventions to stabilize the patient with acute anemia. Select all that apply.

A. Fluid restrictions B. Iron supplements C. PRBC transfusion D. O2 therapy

Answer and Explanation

Choice A:

Fluid restrictions are not appropriate for stabilizing a patient with acute anemia. In fact, patients with anemia might require fluid resuscitation to maintain adequate blood volume and pressure. Restricting fluids could potentially worsen the patient's condition.

Choice B:

Iron supplements are necessary for patients with acute anemia, especially if the anemia is due to iron deficiency. Supplementation helps replenish iron stores in the body, aiding in the production of hemoglobin and red blood cells which are critical for carrying oxygen to tissues.

Choice C:

PRBC (Packed Red Blood Cells) transfusion is a common and effective intervention for acute anemia. It quickly increases the number of red blood cells in the patient's circulation, thereby improving oxygen delivery to tissues and alleviating symptoms of anemia such as fatigue and weakness.

Choice D:

O2 therapy, or oxygen therapy, is crucial for stabilizing patients with acute anemia. Anemia results in reduced oxygen-carrying capacity of the blood, and supplemental oxygen helps ensure that tissues receive sufficient oxygen. This intervention can be lifesaving in severe cases of anemia.

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Question 3:

A patient from a long-term care facility is admitted to the hospital with a sacral pressure injury. The base of the wound involves subcutaneous tissue. How should the nurse classify this pressure injury?

A. Stage 2 B. Stage 1 C. Stage 3 D. Stage 4

Answer and Explanation

Choice A:

Stage 2 pressure injuries involve partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, and moist, and may also present as an intact or ruptured serum-filled blister. Since the wound involves subcutaneous tissue, it exceeds the criteria for Stage 2.

Choice B:

Stage 1 pressure injuries are characterized by non-blanchable erythema of intact skin. While the skin is still intact, it may appear red and not lighten when pressed. Given the description of a wound involving subcutaneous tissue, Stage 1 is not appropriate.

Choice C:

Stage 3 pressure injuries involve full-thickness loss of skin, where adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible, but the depth of tissue damage varies by anatomical location. This aligns with the wound involving subcutaneous tissue.

Choice D:

Stage 4 pressure injuries involve full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone. While the wound described involves subcutaneous tissue, there is no mention of deeper tissue involvement, excluding Stage 4 classification.

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Question 4:

Vital Signs: BP 170/95 mmHg, HR 88 bpm, RR 18 breaths/min, SpO2 96% on room air.
Neurological Assessment: Right arm weakness (grade 2/5), right leg weakness (grade 3/5), expressive aphasia.
Cranial Nerves: Intact except for facial droop on the right side.
Heart Rate: Regular.
Skin: Warm and dry. No edema.
Abdomen: Soft, non-tender with active bowel sounds.
Urinary Output: Increased.

Laboratory Tests: CBC WBC 8,000/µL, Hemoglobin 14 g/dL, Platelets 150,000/µL.
CMP: Normal electrolytes, Creatinine 0.9 mg/dL, Glucose 150 mg/dL.

Neurologic Case Study

Patient Profile:

Age: 68 years.
Gender: Male.
Medical History: Hypertension, Type 2 Diabetes Mellitus.
Medications: Lisinopril, Metformin.
Allergies: None.

Chief Complaint: The patient presents to the emergency department (ED) with a sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Exhibits

What is a potential complication of the patient's condition?

A. Kidney failure B. Aspiration pneumonia C. Hypotension D. Heart failure

Answer and Explanation

Choice A:

Kidney failure is not a common immediate complication related to the patient's presentation of sudden right-sided weakness and difficulty speaking, which are indicative of a stroke. Although diabetes and hypertension can eventually lead to kidney issues, this is not an acute complication.

Choice B:

Aspiration pneumonia is a potential complication of the patient's condition, especially given the presence of expressive aphasia. Patients with neurological deficits, particularly those affecting speech and swallowing, are at higher risk of aspirating food or liquids into the lungs, leading to pneumonia.

Choice C:

Hypotension is not commonly a direct complication of a stroke, especially considering the patient's elevated blood pressure. Stroke patients often present with hypertension rather than hypotension.

Choice D:

Heart failure, while related to the patient's underlying conditions like hypertension and possibly diabetes, is not an immediate complication of the acute neurological event described. The focus should be more on the neurological and respiratory complications.

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Question 5:

Vital Signs: BP 170/95 mmHg, HR 88 bpm, RR 18 breaths/min, SpO2 96% on room air
Neurological Assessment: Right arm weakness (grade 2/5), right leg weakness (grade 3/5), expressive aphasia
Cranial Nerves: Intact except for facial droop on the right side
Heart Rate: Regular
Skin: Warm and dry, no edema
Abdomen: Soft, non-tender with active bowel sounds
Urinary Output: Increased

Laboratory Tests:
- CBC: WBC 8,000/µL, Hemoglobin 14 g/dL, Platelets 150,000/µL
- CMP: Normal electrolytes, Creatinine 0.9 mg/dL, Glucose 150 mg/dL
- Coagulation Profile: INR 1.0, aPTT 30 seconds
Head CT Scan:
- No evidence of hemorrhage
- Hypodense area located in the right middle cerebral artery (MCA)

Patient Profile:

Age: 68 years
Gender: Male
Medical History: Hypertension, Type 2 Diabetes Mellitus
Medications: Lisinopril, Metformin
Allergies: None

Chief Complaint: The patient presents to the emergency department (ED) with sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Exhibits

Choose three parameters the nurse should monitor to assess the patient's progress.

A. Respiratory status B. Liver enzymes C. Blood pressure D. Neurological status E. Potassium level

Answer and Explanation

Choice A:

Respiratory status is crucial to monitor because patients with acute neurological deficits, such as those seen in strokes, are at risk of respiratory compromise. This can be due to weakened respiratory muscles or aspiration, which could lead to pneumonia or other respiratory complications.

Choice B:

Monitoring liver enzymes is not directly related to the acute management of a stroke patient. Liver enzymes would be more relevant in cases where liver function or hepatic issues are suspected, but not for this specific scenario.

Choice C:

Blood pressure monitoring is vital, as hypertension is a significant risk factor for stroke. Maintaining appropriate blood pressure is essential to prevent further neurological damage and complications. Acute changes in blood pressure can indicate worsening or improvement of the patient's condition.

Choice D:

Neurological status should be continuously monitored to assess the progression of the patient's stroke symptoms. This includes checking for changes in level of consciousness, motor function, speech, and other neurological signs. Prompt detection of changes can guide immediate interventions.

Choice E:

Potassium level monitoring is not a primary focus in the acute management of stroke. While electrolyte balance is important, it is not as critical as respiratory status, blood pressure, and neurological status in this context.

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Question 6:

Vital Signs: BP 170/95 mmHg, HR 88 bpm, RR 18 breaths/min, SpO2 96% on room air
Neurological Assessment: Right arm weakness (grade 2/5), right leg weakness (grade 3/5), expressive aphasia
Cranial Nerves: Intact except for facial droop on the right side
Heart Rate: Regular
Skin: Warm and dry, no edema
Abdomen: Soft, non-tender with active bowel sounds
Urinary Output: Increased

Laboratory Tests:
- CBC: WBC 8,000/µL, Hemoglobin 14 g/dL
- CMP: Normal electrolytes, Creatinine 0.9 mg/dL, Glucose 150 mg/dL
- Coagulation Profile: INR 1.0, aPTT 30 seconds
Head CT Scan:
- No evidence of hemorrhage
- Hypodense area located in the right middle cerebral artery (MCA)

Patient Profile:

Age: 68 years
Gender: Male
Medical History: Hypertension, Type 2 Diabetes Mellitus
Medications: Lisinopril, Metformin
Allergies: None

Chief Complaint: The patient presents to the emergency department (ED) with sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Exhibits

Choose two actions the nurse should take to address the condition identified in the previous question.

A. Place the patient in restraints for safety B. Insert an NGT C. Anticipate thrombolytic therapy for ischemic stroke D. Establish IV access with normal saline E. Place the patient in the prone position

Answer and Explanation

Choice A:

Placing the patient in restraints for safety is not typically necessary unless the patient is agitated or a danger to themselves or others. This action is not directly addressing the acute condition of a stroke.

Choice B:

Inserting an NGT (nasogastric tube) is not an immediate priority in the acute management of a stroke. This might be considered later if the patient has swallowing difficulties and needs nutritional support, but it is not a first-line intervention.

Choice C:

Anticipating thrombolytic therapy for ischemic stroke is appropriate, as timely administration of thrombolytics can dissolve the clot and improve blood flow to the affected brain area, potentially reducing the severity of the stroke.

Choice D:

Establishing IV access with normal saline is crucial for administering medications and maintaining hydration. It ensures that the patient can receive necessary interventions promptly.

Choice E:

Placing the patient in the prone position is not appropriate in the management of an acute stroke. The prone position is generally used in respiratory conditions to improve oxygenation but is not relevant to stroke management.

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Question 7:

Vital Signs: BP 170/95 mmHg, HR 88 bpm, RR 18 breaths/min, SpO2 96% on room air
Neurological Assessment: Right arm weakness (grade 2/5), right leg weakness (grade 3/5), expressive aphasia
Cranial Nerves: Intact except for facial droop on the right side
Heart Rate: Regular
Skin: Warm and dry, no edema
Abdomen: Soft, non-tender with active bowel sounds
Urinary Output: Increased

Laboratory Tests:
- CBC: WBC 8,000/µL, Hemoglobin 14 g/dL
- CMP: Normal electrolytes, Creatinine 0.9 mg/dL, Glucose 150 mg/dL
- Coagulation Profile: INR 1.0, aPTT 30 seconds
Head CT Scan:
- No evidence of hemorrhage
Head MRI:
- Platelets 150,000/µL
- Hypodense area located in the right middle cerebral artery (MCA) territory
- Diffusion-weighted imaging (DWI) reveals an area of restricted diffusion in the right hemisphere consistent with recent ischemia
- Perfusion imaging shows decreased cerebral perfusion in the right MCA territory

Patient Profile:

Age: 68 years
Gender: Male
Medical History: Hypertension, Type 2 Diabetes Mellitus
Medications: Lisinopril, Metformin
Allergies: None

Chief Complaint: The patient presents to the emergency department (ED) with sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Exhibits

Choose two actions the nurse should take to address the condition identified in the previous question.

Answer and Explanation

Choice A:

Choice B:

Choice C:

Choice D:

Establishing IV access with normal saline is crucial for administering medications and maintaining hydration. It ensures that the patient can receive necessary interventions promptly.

Choice E:

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Question 8:

Vital Signs: BP 170/95 mmHg, HR 88 bpm, RR 18 breaths/min, SpO2 96% on room air
Neurological Assessment: Right arm weakness (grade 2/5), right leg weakness (grade 3/5), expressive aphasia
Cranial Nerves: Intact except for facial droop on the right side
Heart Rate: Regular
Skin: Warm and dry, no edema
Abdomen: Soft, non-tender with active bowel sounds
Urinary Output: Increased

Laboratory Tests:
- CBC: WBC 8,000/µL, Hemoglobin 14 g/dL, Platelets 150,000/µL
- CMP: Normal electrolytes, Creatinine 0.9 mg/dL, Glucose 150 mg/dL

Neurologic Case Study

Patient Profile:

Age: 68 years
Gender: Male
Medical History: Hypertension, Type 2 Diabetes Mellitus
Medications: Lisinopril, Metformin
Allergies: None

Chief Complaint: The patient presents to the emergency department (ED) with sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Exhibits

Which condition is the patient most likely experiencing?

A. Hypoglycemia B. Hemorrhagic stroke C. Ischemic stroke D. Multiple sclerosis

Answer and Explanation

Choice A:

Hypoglycemia typically presents with symptoms such as sweating, trembling, hunger, confusion, and in severe cases, loss of consciousness. The patient's symptoms of sudden right-sided weakness and difficulty speaking are more consistent with a neurological event rather than low blood sugar levels.

Choice B:

Hemorrhagic stroke involves bleeding within the brain. Although it can present with similar symptoms to ischemic stroke, the diagnostic tests indicate no evidence of hemorrhage. This makes a hemorrhagic stroke less likely.

Choice C:

Ischemic stroke occurs when a blood clot blocks a blood vessel in the brain, leading to reduced blood flow and oxygen to a part of the brain. The patient's symptoms of sudden right-sided weakness and expressive aphasia are classic signs of an ischemic stroke, and the absence of hemorrhage on the head CT scan supports this diagnosis.

Choice D:

Multiple sclerosis (MS) is a chronic, progressive disease that affects the central nervous system. It usually presents with episodic neurological symptoms rather than the sudden onset seen in this patient. MS symptoms develop over time and can vary widely, whereas the patient's acute presentation is more indicative of a stroke.

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Question 9:

A patient admitted with acute renal failure asks for pain medication for a headache described as five out of ten on the pain scale. The nurse checks the MAR and sees that the only pain medication ordered is Ibuprofen. Which of the following actions should the nurse take first to ensure patient safety?

A. Inform the patient that the pain medication is contraindicated and offer to dim the room lights. B. Monitor the patient closely after administering the ibuprofen for pain. C. Consult the healthcare provider about ordering a different pain medication. D. Administer the ibuprofen as ordered since ibuprofen is used to treat headaches.

Answer and Explanation

Choice A:

Informing the patient that the pain medication is contraindicated and offering to dim the room lights addresses the immediate concern but does not provide an effective solution for pain management. While it's important to inform the patient, alternative pain relief should be pursued.

Choice B:

Monitoring the patient closely after administering ibuprofen for pain does not ensure patient safety, especially since ibuprofen can worsen kidney function in patients with acute renal failure. Administering ibuprofen is contraindicated in this case.

Choice C:

Consulting the healthcare provider about ordering a different pain medication is the safest first step. This ensures that the patient receives an appropriate pain reliever that does not further compromise their renal function. The healthcare provider can prescribe a medication that is safe for patients with acute renal failure.

Choice D:

Administering ibuprofen as ordered since it is used to treat headaches is not appropriate in this scenario. Ibuprofen is nephrotoxic and can worsen renal function in patients with acute renal failure, making it unsafe to administer.

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Question 10:

A high blood level of which substance causes hepatic coma?

A. Bilirubin B. Calcium C. Ammonia D. Sodium

Answer and Explanation

Choice A:

While elevated bilirubin levels can indicate liver dysfunction and lead to jaundice, they are not the primary cause of hepatic coma. Bilirubin is a byproduct of red blood cell breakdown and its accumulation can cause yellowing of the skin and eyes.

Choice B:

Calcium levels, whether high or low, can affect neuromuscular function and cardiac health, but they are not directly associated with causing hepatic coma. Hypercalcemia or hypocalcemia can present with various symptoms, but not typically with hepatic coma.

Choice C:

Elevated ammonia levels are directly associated with hepatic coma. In patients with severe liver dysfunction, the liver cannot efficiently convert ammonia (a byproduct of protein metabolism) into urea for excretion. The accumulation of ammonia in the blood can cross the blood-brain barrier and lead to encephalopathy, resulting in confusion, altered mental status, and potentially hepatic coma.

Choice D:

Sodium levels can affect neurological function, particularly with conditions like hypernatremia or hyponatremia. However, these imbalances are not the primary cause of hepatic coma. The direct link to hepatic coma is through elevated ammonia levels.

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Med Surg final exam(Samuel merit university)

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