Marites A. Rosapapan, R.N.

The

process of MedicalSurgical Nursing is not limited to a disease or a body system. The focus is holistic in nature and demands a broad knowledge base that spans adult health

 Taking

report on patients (at the bedside) Setting early priorities based upon report and what u have observed at the bedside

 Providing

nutrition (insulin before and after checking blood glucose Observation of amount eaten, intake and output

 Monitoring

lab values (BUN/Creatinine, electrolytes) Medication Administration (vitals first)

 IV

Fluids ( adding, changing, correcting) Administering blood and blood products Working with tubes, IV line, NGT, ET, IFC (both insertion and removal)

It will blow up in your face!

COMPREHENSION
Study basic information. You need the KNOWLEDGE to answer questions.

Case Scenario tells you something Item Stem asks you something Identify four critical elements Eliminate incorrect options

Key words: unlock critical ideas Examples: initial early late immediate first best most likely least likely postoperative The Client: focus of the question Examples Person with the health problem Relative or friend Another client A staff member The Issue: specific problem or subject Examples: A medication or toxic effect a medical diagnosis Client response behavior Type of stem True response stem False response stem Comparison stem Priority stem

True response stem False response stem Unsafe At risk contraindicated Comparison stem Differentiating between 2 items Comparing Priority stem: best, initial, priority Maslows Hierarchy of Needs ABCs Critical Thinking

Distractors: assign a symbol (+) : appropriate (?) : not sure, maybe correct (-) : inappropriate Always go with what you know Eliminate at least 2 at first attempt

Select an appropriate nursing intervention. Select an appropriate nursing diagnosis for a given scenario. Select PRIORITY nursing diagnosis based on the data provided in the stem of the question
Most important First Best

POSITIVE ATTITUDE

I THINK I CAN . . . I KNOW I CAN.

PREPARE

If you fail to prepare, . . .

prepare to fail.

Basic knowledge of anatomy & physiology = will lead you to the signs & symptoms of the disease Apply the nursing process Consider SAFETY Remember MASLOWS HIERARCHY OF NEEDS

Other information needed: Laboratory Tests & Normal Values Diagnostic Procedures Management: Medical & Surgical

ANGINA MYOCARDIAL INFARCTION HTN PVD AAA THROMBOPHLEBITIS DYSRHYTHMIAS ENDOCARDITIS VALVULAR HEART DISEASE

A client with a mitral valve disease has presented to the clinic for further evaluation of the mitral valve. Which chamber of the heart will be affected if the mitral valve is narrowed?
a. b. c. d. Right atrium Left atrium Right ventricle Left ventricle

Which female client is most at risk for cardiovascular disease? a. A woman on hormone replacement therapy b. A woman who has never been pregnant
c. A woman with elevated HDL (highdensity lipoprotein) levels d. A woman with abdominal obesity

A client with history of previous myocardial infarction is admitted with heart failure. What statement made by this client would alert the nurse to suspect the occurrence of heart failure?

a. It is getting more difficult to climb the stairs to reach the bathroom. b. I think my dose of digoxin may need to be increased. c. I have trouble remembering things recently. d. I drink at least two full glasses of water a day.

A nurse is preparing a client to undergo cardiac catheterization. What specific assessment should the nurse make before the procedure?
a. Ascertain if the client will require sedation. b. Ascertain if the client is able to roll side to side. c. Ascertain if the client has a history of diabetes mellitus. d. Ascertain if the client has allergies to iodinecontaining substances.

a. When the clients heart rate reaches 140 beats per minute. b. When the grade of the treadmill incline reaches 10%. c. If the clients respiratory rate exceeds 36 breaths/minute. d. If the clients ECG indicates significant STsegment depression

a. Measure urinary output. b. Assess for shortness of breath. c. Assess pulse oximetry every hour. d. Measure blood pressure in the lying and sitting positions.

a. Assess the clients airway, breathing, and level of consciousness. b. Administer verapamil IV push. c. Defibrillate the client. d. Begin cardiopulmonary resuscitation.

PNEUMONIA CAL
COPD
EMPHYSEMA CHRONIC BRONCHITIS

ASTHMA

CANCER OF THE LARYNX TUBERCULOSIS LUNG CANCER

PARAMETER pH

LESS THAN Acidosis

NORMAL VALUE 7.35-(7.40)7.45

MORETHAN Alkalosis

pCO2 Alkalosis 35 45 Acidosis (Respiratory) Interpret the pH: (for the first and last name of the ABG) HCO3 Is it compensated or uncompensated Acidosis 22 26 Alkalosis (Metabolic) compensated; falls within the normal range 7.35 7.40 = acidosis 7.41 7. 45 = alkalosis uncompensated: falls outside the normal range Is it acidosis (less than 7.35) or alkalosis (more than 7.45) Determine if it is respiratory or metabolic: (for the middle name of the ABG) What matches the pH? Look at the colors in the chart Is it respiratory (pCO2 ) Is it metabolic (HCO3) USE OF ARROWS (ROME): Respiratory Opposite Metabolic Equal Examples: pH- 7.25 () 7.49 () pCO2 28 () 25 ()

Other examples: pH 7.58 pCO2 36 HCO3 34

1. 2. 3. 4.

7.44 52 32

7.36 47 28

7.30 70 26

uncompensated metabolic alkalosis Compensated metabolic alkalosis Compensated respiratory acidosis Uncompensated respiratory acidosis

Which nursing intervention in the preparation for or implementation of tracheal suctioning prevents tissue damage? a. Monitoring oxygen saturation while suctioning. b. Applying suction only as the catheter is removed. c. Hyperoxygenating the client before starting the procedure. d. Selecting the largest catheter that fits into the tracheal lumen.

Which assessment finding indicates to you that the ties are properly secured after you have changed the tracheostomy ties?
You can fit two fingers between the ties and the neck. The ties are fitted snugly. The ties hang loosely around the clients neck. The tracheal tube moves slightly with each respiratory cycle.

The client has had several episodes of laryngitis following an upper respiratory infection. Which statement by the client indicates the need for clarification regarding the causes and treatment of acute laryngitis?
I knew I would get laryngitis this time because I cheered for hours at the ball game. At the first hint of laryngitis, I whisper instead of talking in my regular voice. I suck on throat lozenges to keep my mouth and throat from getting so dry. When laryngitis starts, I quit smoking until all symptoms are gone.

A home care nurse is visiting a client with chronic bronchitis who states that he feels more short of breath than usual. Which pulmonary assessment finding alerts the nurse to the possibility of pneumonia in this client?

Pulse oximetry reading of 92% Shallow respirations of 32 per minute. Percussion is dull in the left lower lobe. Wheezes are audible over the right and left bronchi.

RHEUMATOID ARTHRITIS LUPUS ERYTHEMATOSUS DJD OSTEOPOROSIS FRACTURE JOINT REPLACEMENT

Which of the following best explains the development of a fat embolism as a complication of a bone fracture?
The bone is rich in blood and platelet activity is easily activated. Flat bones contain additional amounts of lipoprotein that initiate the lipid cascade. The marrow contains fat cells that can be dislodged during injury. Open fractures tear tissue as the bone exits the skin and this tissue enters the bloodstream as an embolism.

The nurse is caring for a client with a fractured femur. What factor in the clients history may impede healing of the fracture?
A sedentary lifestyle A history of smoking Oral contraceptive use Peripheral vascular disease

HYPER/HYPOTHYROIDISM ADDISON DISEASE DIABETES MELLITUS

What action should the nurse teach the diabetic client as the most beneficial in delaying the onset of microvascular and macrovascular complicaations?
Controlling hyperglycemia Preventing hypoglycemia Restricting fluid intake Preventing ketosis

Which statement made by a client whom the nurse is teaching how to self-inject insulin reflects a need for clarification of injection site selection and rotation?
The abdominal site is best because it is closest to the pancreas. I can reach my thigh the best, so I will use different areas of the same thigh. By rotating the sits within one area, my chances of having tissue increases or decreases is less. If I change injection sites from the thigh to the arm, the rate of absorption will be different.

What is the physiologic basis for the polyuria manifested by individuals with untreated Diabetes mellitus?
Inadequate secretion of antidiuretic hormone Early stage renal failure causing a loss of urine concentrating capacity Chronic stimulation of detrusor muscle by the ketone bodies in the urine Hyperosmolarity of the extracellular fluids secondary to hyperglycemia

The client who has diabetes is prescribed to take insulin glargine once daily and regular insulin four times daily. The first dose of regular insulin occurs at the same time of day as the insulin glargine dose. How should the nurse teach the client to take these two medications? Draw up and inject the insulin glargine first and then draw up the inject the dose of regular insulin. Draw up and inject the insulin glargine first, wait 1 hour, and then draw up and inject the dose of regular insulin. First draw up the dose of regular insulin, and then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together.

Acute Renal Failure Urinary Tract Infection Benign Prostatic Hyperplasia

HIATAL HERNIA GERD INFLAMMATORY BOWEL DISEASE INTESTINAL OBSTRUCTION COLORECTAL CANCER CIRRHOSIS HEPATITIS PANCREATITIS CHOLECYSTITIS/CHOLELITHIASIS

ALTERED STATE OF CONSCIOUSNESS BRAIN INJURY SPINAL CORD INJURY MS MYASTHENIA GRAVIS CVA

ANEMIA LEUKEMIA HODGKIN DISEASE