Medical-Surgical Nursing Exam 4 Answer Key

Exam 4 1. If a patient comes out of surgery, you must watch for what? Airway 2. If a patient constantly keeps swallowing after surgery, what is that an indication of? Posterior bleeding. Open mouth and look with flashlight. 3. If a patient has surgery, they should be taking what medication for pain? Aspirin and NSAIDs (Ibuprofen, naproxen, diclofenac, indomethacin, celecoxib). Take Tylenol. 4. Classic symptoms of pleuritis? Sharp pain on inspiration! Friction rub, Shallow breathing 5. What to do to prevent secretion? Suction PRN, Chest physiotherapy (cupping up to move secretion upwards), deep cough, turn, reposition, incentive spirometer 10x and hour while awake. 6. Best way to assess a patient has learn to perform a task that you showed them? Have them demonstrate it back to you. 7. What to do when a patient comes back from bronchoscopy before they eat.? Check gag reflex. 8. Intervention for patient with laryngitis? Rest, humidified air, fluid, ASA in adult or Tylenol, Antibiotic if bacterial, Medication to control GERD, encourage patient to rest voice by not speaking, no whispering, communicate by writing, throat lozenges for comfort and avoid causative factors. 9. Medication patient CAN take for epistaxis? They can take Lasix, allergy medication, BP medication, NO ASA and NO NSAIDs. 10. Cystic Fibrosis? Increase mucus production. Increase fluid to thin out mucus, exercise. No BEDREST due to airway. 11. Cancer of the larynx assessment? Classic symptoms? Hoarse voice for a long period of time. Throat and ear pain. SOB and chronic cough, pain, dysphasia, airway obstruction. 12. Laryngectomy? Always assess airway first and airway clearance. Resp function, LS. 13. Complication of gonorrhea? Fitz Hugh syndrome (web in the liver), Sever flank pain 14. Syphilis? Stage 1-Spirocheteenters via skin or mucous membrane between 3-90 days. Papule develops at the site of entry sloughs of and leave a painless, red, ulcerated area called chancre which heals but the spirochete remains active in the infected individual and can be transmitted. Stage 2. Begins 2-8 weeks later, affect more generally= flulike symptoms, joint pain, hair loss, skin rashes, mouth sores, lymphadenopathy and condylomatous. growth in moist areas of the body. Stage 3. More severe if not treated for 10-20 years later= form gummas= tumors of rubbery consistency that can breakdown and ulcerate leaving holes in body tissues. May affect heart, circulatory system, NS. Can also affect newborn if mom is carrying spirochete leading to hepatosplenomegaly, bilirubin, RBCs, and birth defect. 15. Plastic sign and symptoms of trichomoniasis? Strawberry spot, frosty smell discharge. 16. You assess a patient of Spox 82. But patient is still talking, what would you do? Use different spox, lift head of bed, double check on yourself before you report to the doctor. 17. Breathing exercise for patients with COPD? Should not receive more than 2L of oxygen. 88-92. DIAPHRAGMATIC BREATHING. 18. Correct way to use an inhaler? 1. Gently squeeze the canister into the inhaler unit. Shake the inhaler and remove the cab. 2. Exhale 3. Place the inhaler mouthpiece in your mouth. 4. Press the canisters down to acuate a dose of medication, breathing slowly and deeply. Time the dose and breathe so the medication goes into the lungs and not your tongue. Hold breath for 5-10s. Repeat step 2-4. 19. Chest tubes?! Water seal chamber TIDALINGS OR FLUTUATE. Suction control chamber BUBBLES GENTLY. Do not pin chest tubes to lining and do not kin tubes. 20. After a patient has surgery, they need to cough and ambulate to prevent what? Atelectasis, Pulmonary embolism. 21. Nursing treatment for pharyngitis? Saltwater guggles, honey could help inflammation, antibiotics (penicillin.) Encourage fluids and rest. 22. Good lung down-if patient has problem breathing with their lungs, they lay down on their good lung which helps decrease shortness of breath. 23. Tuberculosis- Take your medication (Rifampin, Pyrazinamide, Ethambutol.) Strict adherence to antibiotic therapy, strict treatment regimen. 24. Medications use to treat trichomoniasis? Flagyl (metronidazole) Tinidazole (Tindamax) 25. Influenza- Droplet 26. When do we suction? PRN and when you hear gurgleing and crackles. 27. Inhale corticosteroids adverse effect? Oral thrush, hoarse or cocky voice, sore mout6hor throat. Rinse mouth after use. 28. Adverse effect of predisone? 29. If a chest tube gets disconnected? Put Vaseline on gauze and wrap it 3x 30. When is the best time to collect urine samples? Early in the morning 31. If a patient has general warts, what are they at risk or? HPV which can led to cervical cancer if left untreated. 32. Signs and symptoms in a patient with pneumothorax? Adminish or absent breath sounds on affected side. 33. What to do for a patient who has epistaxis? Position to sit in chair and lean forward slightly, Direct pressure 5-10mins, Apply silver nitrate. 34. Obtructive sleep apnea? Apnea during sleep. Patient is supine, throat muscles relax tongue falls back and obstruct the airway. Patient becomes hypoxic (drop of O2) brain says take a deep breath, loud, sudden inhalation. Can happen up to 10x an hour. 35. Listening to Breath sounds after giving asthma medication. Breath sounds should be clear, no SOB, spo2 above 95. 36. Things to avoid in Lung cancer? Stop smoking, Passive smoke, 3rd hand smoke. 37. Signs and symptoms of TB? Cough, blood-tinged sputum, night sweats fever, dyspnea, weight loss, chest pain. 38. What place patient at risk for pneumonia? Immobility, Diff. swallowing, Patients with aids, chemicals and VAP. 39. Intervention for patients who are post-Op? Position every 2 hours, incentive spirometer, ambulate, cough and rebreathe, assess surgery site.