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NEW 2022 Working Update Solution FOR ATI MED SURG Final EXAM ALL Pracice Questions AND Answers
Pharmacology (NUR 3145)
Santa Fe College
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QUESTIONS AND ANSWERS 2022
What is normal range for troponin I? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels? - CORRECT ANSWER Less than 0, three hours, 7 to 10 days
What is normal range for myoglobin? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels? - CORRECT ANSWER Less than 90 mcg/L, two hours, 24 hours
While an echocardiogram is being performed what side should the patient lie on? - CORRECT ANSWER Left side and remain still
What are indications for an echocardiogram - CORRECT ANSWER Cardiomyopathy
Heart failure
Angina
Myocardial infarction
What are indications for stress test - CORRECT ANSWER Dysrhythmias
HF
Angina
MI
What are two medications that are prescribed for pharmacological stress test - CORRECT ANSWER Dobutamine
Adenosine
What do you instruct the patient to do 2 to 4 hours before a stress test - CORRECT ANSWER Avoid tobacco, alcohol and caffeine
Hemodynamic monitoring involves special indwelling catheters that provide information about blood volume and perfusion, fluid status and how well the heart is pumping. Arterial lines are placed in the radial (most common), brachial or femoral artery. What should you Monitor for? -
QUESTIONS AND ANSWERS 2022
CORRECT ANSWER Monitor circulation in the limb with the arterial line. Such as capillary refill, temperature, color. Arterial lines are not used for IV fluid administration
The pulmonary artery (PA) catheter is inserted into a large vein (internal jugular, femoral, subclavian, brachial) and threaded through the right atria and ventricles into a branch of the pulmonary artery. PA catheters have multiple lumens, ports and components that allow for various hemodynamic measurements, blood sampling and - CORRECT ANSWER Infusion of IV fluids
What are the different lumens used for? - CORRECT ANSWER
What is the expected reference range for CVP (Central venous pressure) - CORRECT ANSWER 1 to 8 MM HG
What is the expected reference range for pulmonary artery systolic (PAS) - CORRECT ANSWER 15 to 26
What is the expected range for pulmonary artery diastolic (PAD) - CORRECT ANSWER 5 to 15
What is expected range for pulmonary artery wedge pressure (PAWP)? - CORRECT ANSWER 4 to 12
What is the expected range for cardiac output - CORRECT ANSWER 4 to 7 L/minute
What is expected range for mixed venous oxygen saturation - CORRECT ANSWER 60% to 80%
When should a nurse anticipate lower hemodynamic values? - CORRECT ANSWER In older patients especially if dehydration is a complication
What position should the patient be in with hemodynamic monitoring - CORRECT ANSWER Supine or Trendelenburg
QUESTIONS AND ANSWERS 2022
JVD
Muffled heart sounds
Paradoxical pulse
What are nursing actions for cardiac tamponade - CORRECT ANSWER 1. Notify the provider immediately
Administer IV fluids to combat hypotension as prescribed
Obtain a chest x-ray or echocardiogram to confirm diagnosis
Prepare the client for pericardiocentesis
What is retroperitoneal bleeding - CORRECT ANSWER Bleeding into the abdominal cavity behind the peritoneum can occur due to femoral artery puncture (after an angiography)
What are nursing actions for retroperitoneal bleeding - CORRECT ANSWER 1. Assess for flank pain and hypotension
Notify the provider immediately
Administer IV fluids and blood products as prescribed
What are central catheter's appropriate for - CORRECT ANSWER Any fluids due to rapid hemodilution in the superior vena cava
What is post procedure care for a PICC - CORRECT ANSWER
What should you do if there's an occlusion in the access device that impedes flow - CORRECT ANSWER 1. Flush the line at least every 12 hours to maintain patency (3 mL for peripheral & 10 mL for central lines)
Administer urokinase to lyse obstructions per facility protocol
Flush implanted port after every use and at least once a month while implanted
What are nursing actions for a catheter thrombosis/emboli - CORRECT ANSWER 1. Flush the line per facility protocol
- Do not force fluid if resistance is encountered
QUESTIONS AND ANSWERS 2022
- Use a 10 mL or larger syringe to avoid excessive pressure
What is treatment for infiltration and extravasation - CORRECT ANSWER 1. Remove using direct pressure with gauze sponge until bleeding stops
Apply cool compress
Elevation is optional
Avoid starting a new IV site in the same extremity
What are nursing interventions to prevent an air embolism in a vascular access device - CORRECT ANSWER 1. Leave central lines clamped when not in use
Have the patient hold breath while the tubing is changed
If the patient has sudden SOB, place in Trendelenburg on left side, give oxygen and notify the provider
What are nursing interventions to prevent accidental dislodgment of a catheter - CORRECT ANSWER 1. Cover the extremity site with stretch netting
Wrap a washcloth folded into thirds around the arm before applying a needed restraint
When removing the dressing, pull from distal to proximal
Hemodynamic pressure lines should be calibrated to read atmospheric pressure as blank. - CORRECT ANSWER Zero. Zero transducer to room air
What kind of medication would you use for vasodilation secondary to sepsis - CORRECT ANSWER Dopamine (vasopressors)
Chapter 28 - CORRECT ANSWER
What are medications/electrical management for bradycardia - CORRECT ANSWER 1. Atropine and isoproterenol (antiarrhythmic and bronchodilator)
- Pacemaker
What are medications/electrical management for a fib, SVT or VT with pulse - CORRECT ANSWER 1. Amiodarone, adenosine, verapamil (CCB)
QUESTIONS AND ANSWERS 2022
Assess renal function prior to introduction of contrast dye
Administer antiplatelet medications as prescribed
What are two medications that are administered during the intraprocedure for PCI - CORRECT ANSWER Midazolam (Versed) and fentanyl
What is post procedure nursing actions after a PCI - CORRECT ANSWER 1. Assess vitals every 15 minutes for one hour, every 30 minutes for one hour, every hour for four hours and then every four hours.
Assess the groin site at the same intervals for bleeding and hematoma formation
Assess for signs of thrombosis
Maintain bed rest in a supine position with the leg straight for 4 to 6 hours ( or prescribed time)
Monitor urine output
How long does a client with a stent replacement receive anticoagulation therapy - CORRECT ANSWER 6 to 8 weeks after
Perforation of an artery by the catheter may cause blank - CORRECT ANSWER Cardiac tamponade
What are clinical manifestations of anaphylaxis - CORRECT ANSWER chills
Fever
Rash
Wheezing
Tachycardia
Bradycardia
What are two medications that might be prescribed in the event of anaphylaxis - CORRECT ANSWER Diphenhydramine or epinephrine
A coronary artery bypass graft is most effective when a patient has sufficient ventricular function such as an EF greater then - CORRECT ANSWER 40% to 50%
QUESTIONS AND ANSWERS 2022
What are preprocedure medications for a CABG - CORRECT ANSWER 1. Anxiolytics: lorazepam and diazepam
Prophylactic antibiotics
Anticholinergic such as scopolamine
What are some important preprocedure teachings for a patient that is going to undergo a CABG
- CORRECT ANSWER 1. Endotracheal tube and mechanical ventilator for airway management for several hours following the surgery
Inability to talk while endotracheal tube is in place
Sternal incision and possible leg incision
1 to 2 mediastinal chest tubes
Indwelling urinary catheter
Pacemaker wires
Hemodynamic monitoring devices
What are two medications that are discontinued before a CABG - CORRECT ANSWER 1. Diuretics 2 to 3 days before surgery
- Aspirin and other anticoagulants one week before surgery
What are medications that are often continued for CABG - CORRECT ANSWER Potassium supplements
Antidysrhythmic's
Antihypertensives
Insulin
Post procedure: what should you do with the patient within two hours following extubation - CORRECT ANSWER Dangle and turn the client from side to side as tolerated
What should you do within 24 hours after CABG - CORRECT ANSWER Assist the patient to a chair. Ambulate the patient 25 to 100 feet by first postoperative day
QUESTIONS AND ANSWERS 2022
- Explain that pedal pulses will be checked frequently
What are post procedure nursing interventions for a peripheral bypass graft - CORRECT ANSWER 1. Assess vitals every 15 minutes for one hour and then every hour after the first hour
Administer anticoagulant therapy/antiplatelet therapy
Maintain bed rest for 18 to 24 hours. The leg should be kept straight during this time
What are teaching points for foot inspection and care - CORRECT ANSWER
The graft may occlude due to reduced blood flow and clot formation. This occurs primarily in the first - CORRECT ANSWER 24 hours post operative
What kind of procedure is used for graft occlusion - CORRECT ANSWER Thrombectomy or thrombolytic therapy
What procedure is used for compartment syndrome - CORRECT ANSWER Fasciotomy
Chapter 35 - CORRECT ANSWER
What are physical assessment findings for peripheral artery disease - CORRECT ANSWER 1. Bruit over femoral and aortic artery's
Decreased capillary refill of toes
Decreased or non-palpable pulses
Loss hair on lower calf, ankle and foot
Dry, scaly, mottled skin
Thick toenails
Cold/cyanotic extremity
Pallor of extremity with elevation
Dependent Rubor
Muscle atrophy
Ulcers and possible gangrene
QUESTIONS AND ANSWERS 2022
What are nursing actions for arteriography - CORRECT ANSWER 1. Observe for bleeding and hemorrhage
- Palpate pedal pulses to identify possible occlusions
How does a plethysmography diagnose PAD - CORRECT ANSWER A decrease in pulse pressure of the lower extremity indicates a possible blockage in the leg
A Doppler probe is used to take various blood pressure measurements for comparison. In the absence of peripheral arterial disease, pressures in the lower extremities are - CORRECT ANSWER Higher than those in the upper extremities
What is nursing care for a patient with PAD - CORRECT ANSWER 1. Encourage collateral circulation
Avoid crossing legs
Avoid restrictive garments
Elevate the leg to reduce swelling, but not to elevate them about the level of the heart
Provide a warm environment
Avoid exposure to cold
Avoid stress, caffeine and nicotine and anything that causes vasoconstriction
What are medications for PAD - CORRECT ANSWER 1. Antiplatelet medications - aspirin, Plavix, trental
- Statins - can relieve manifestations associated with PAD such as intermittent claudication
What are two surgical procedures for PAD - CORRECT ANSWER 1. Percutaneous transluminal angioplasty
- Laser assisted angioplasty
What are nursing interventions for these two procedures - CORRECT ANSWER 1. Observe for bleeding/vitals
Keep client on bed rest with limb straight for 6 to 8 hours before ambulation
Antiplatelet therapy for 1 to 3 months
QUESTIONS AND ANSWERS 2022
Patients with venous disease most often complain of limb pain that feels like - CORRECT ANSWER Aching pain and feeling of fullness or heaviness in the legs after standing
What are signs of DVT and thrombophlebitis - CORRECT ANSWER
What are signs of Venous insufficiency - CORRECT ANSWER 1. Stasis dermatitis is a brown discoloration on the ankles that extends at the calf relative to the level of insufficiency
Edema
Stasis ulcers ( typically found around ankles)
What are clinical manifestation of varicose veins - CORRECT ANSWER 1. Distended, superficial veins that are visible just below the skin and are torturous in nature
- Patients often report muscle cramping and aches, pain after sitting and pruritus
What are laboratory tests for PVD - CORRECT ANSWER D dimer test measures fibrin degradation products present in the blood produced from fibrinolysis. A positive test indicates that thrombus formation has possibly occurred
What are diagnostic procedures for DVT and thrombophlebitis - CORRECT ANSWER 1. Venus duplex ultrasonography
Impedance plethysmography
If the above test are negative for a DVT, but one is still suspected a venogram, which uses contrast material or MRI may be needed for accurate diagnosis
For varicose veins Trendelenburg test is used. What are the nursing actions for this test - CORRECT ANSWER 1. Place the patient in the supine position with legs elevated
- When the patient sits up, the veins will fill from the proximal and if varicosities are present
What should you encourage the patient to do if they have DVT or thrombophlebitis - CORRECT ANSWER
What should you teach the patient to do if they have venous insufficiency - CORRECT ANSWER
QUESTIONS AND ANSWERS 2022
What are medications for DVT and thrombophlebitis - CORRECT ANSWER Anticoagulants
How long does it take for warfarin to take affect - CORRECT ANSWER 3 to 4 days
DVT and thrombophlebitis both can use thrombolytic therapy. What are the details of this therapy? - CORRECT ANSWER
For varicose veins, sclerotherapy may be performed. What are the details of this therapy? - CORRECT ANSWER
What should the nurse monitor for postoperatively after varicose veins - vein stripping - CORRECT ANSWER
What are two other surgical interventions that can be performed for varicose veins - CORRECT ANSWER 1. Endovenous laser treatment
- Application of radiofrequency energy
Venous stasis ulcers often form over the medial malleolus. Venous ulcers are chronic, hard to heal and often recur. They can lead to amputation and/or death. What are nursing interventions for venous ulcers - CORRECT ANSWER
What are patient teachings for patients that have venous ulcers (diet and DVT prevention) - CORRECT ANSWER 1. Recommend a diet high in zinc, protein, iron and vitamins A & C
- Instruct patient on the use of compression stockings
A pulmonary embolism occurs when a thrombus is dislodged, becomes an embolus and lodges into a pulmonary vessels. What are manifestations of a pulmonary embolism's - CORRECT ANSWER 1. Sudden onset of dyspnea, pleuritic chest pain, restlessness and apprehension, feelings of impending doom, cough and hemoptysis
What are clinical findings of a pulmonary embolism's - CORRECT ANSWER Tachypnea
Crackles
plural friction rub
Tachycardia
QUESTIONS AND ANSWERS 2022
What are two side effects of ARBs - CORRECT ANSWER Angioedema, hyperkalemia
Aldosterone receptor antagonists such as blank, block aldosterone action. They promote the retention of potassium and excretion of sodium and water - CORRECT ANSWER Eplerenone
What are Side effects of aldosterone receptor antagonists - CORRECT ANSWER Hypertriglyceridemia, hyponatremia, hyperkalemia
What should you teach the patient that is taking aldosterone receptor antagonists - CORRECT ANSWER No grapefruit juice or St. John's wort. Do not take salt substitutes with potassium or foods rich in potassium
What do central alpha antagonist such as clonidine do - CORRECT ANSWER Reduce peripheral vascular resistance and decrease blood pressure by inhibiting the reuptake of norepinephrine
What are side effects of central alpha antagonist - CORRECT ANSWER Sedation, orthostatic hypotension, impotence
Alpha adrenergic antagonist, such as blank, reduce blood pressure by causing vasodilation - CORRECT ANSWER Prazosin
When is prazosin given - CORRECT ANSWER Usually at Night and Monitor BP for two hours after initiation of treatment
What are dietary approaches to stop hypertension - CORRECT ANSWER 1. Diet high in fruits, vegetables, and low-fat dairy
Avoid foods high in sodium and fat
Consume foods rich in potassium, calcium and magnesium
What are clinical manifestations of a hypertensive crisis - CORRECT ANSWER 1. Severe headache
- Extremely high blood pressure - greater than 240/
QUESTIONS AND ANSWERS 2022
Blurred vision, dizziness and disorientation
Epistaxis
What are two medications that are given IV for a hypertensive crisis - CORRECT ANSWER Nitroprusside
Nicardipine
Before, during and after administration of IV antihypertensive what should you do - CORRECT ANSWER Monitor BP every 5 to 15 minutes and assess neurological status and monitor ECG
Chapter 17 - CORRECT ANSWER
How long should a patient abstain from smoking before a pulmonary function test - CORRECT ANSWER 6 to 8 hours prior to testing
If a patient uses inhalers how long should they withhold use before a pulmonary function test - CORRECT ANSWER Four to six hours prior to testing
What is PaO2 - CORRECT ANSWER The partial pressure of oxygen
What is SaO2 - CORRECT ANSWER Percentage of oxygen bound to hemoglobin as compared with the total amount that can be possibly carried
What is normal bicarbonate according to ATI - CORRECT ANSWER 21 to 28
What are preprocedure nursing actions for an arterial puncture - CORRECT ANSWER
What are intraprocedural nursing actions while performing an arterial puncture - CORRECT ANSWER
What are postprocedural nursing actions while performing an arterial puncture - CORRECT ANSWER
QUESTIONS AND ANSWERS 2022
What are nursing interventions for Laryngospasm spasm and what can decrease the likelihood of laryngeal edema - CORRECT ANSWER 1. Monitor the patient for signs of respiratory distress
Maintain a patent airway by repositioning the patient or inserting an oral/nasopharyngeal airway as appropriate
Administer oxygen therapy to the patient as prescribed. Humidification can decrease the likelihood of laryngeal edema
What are nursing interventions for a pneumothorax - CORRECT ANSWER 1. Assess patient's breath sounds and O2 sat and obtain a follow-up chest x-ray
What are nursing interventions for aspiration - CORRECT ANSWER 1. Prevent aspiration and the patient by withholding oral fluids or food until the gag reflex returns
- Perform suctioning as needed
What is a thoracentesis - CORRECT ANSWER Performed to obtain specimens for diagnostic evaluation, instill medication into the plural space, and remove fluid or air from the plural space
What are preprocedure nursing interventions for a Thoracentesis - CORRECT ANSWER 1. Obtain preprocedure x-ray as prescribed
Position the patient sitting upright with his arms and shoulders raised and supported on pillows and/or on an overbed table and with his feet and legs well supported
Instructed patient to remain absolutely still during the procedure and not to cough or talk unless instructed by the primary care provider
What are intraprocedural nursing interventions for a thoracentesis - CORRECT ANSWER 1. Monitor the patient's vitals, skin color and O2 sat throughout the procedure
- Measure and record the amount of fluid removed from the patient's chest
(The amount of fluid removed is limited to one L at a time to prevent cardiovascular collapse)
- Label and send specimens to the Laboratory
What are post procedure nursing interventions for a thoracentesis - CORRECT ANSWER 1. Apply a dressing over the puncture site and assess dressing for bleeding/drainage
- Monitor vitals and respiratory status hourly for the first several hours after
QUESTIONS AND ANSWERS 2022
Encourage the patient to deep breathe to assist with lung expansion
Obtain a chest x-ray (check resolution of effusions, rule out pneumothorax)
What are complications of a thoracentesis - CORRECT ANSWER Mediastinal shift, pneumothorax, bleeding, infection
What is a mediastinal shift - CORRECT ANSWER Shift of thoracic structures to one side of the body (Monitor VS, auscultate lungs for a decrease in or absence of breath sounds)
What is a symptom of pneumothorax - CORRECT ANSWER Diminished breath sounds
What are indications of a pneumothorax - CORRECT ANSWER 1. Deviated trachea
Pain on the affected side that worsens upon exhalation
Affected side does not move in and out upon inhalation/exhalation
Increased HR
Rapid shallow respirations
Nagging cough or feeling of air hunger
Chapter 20 - CORRECT ANSWER
How long does it take for a patient to exhibit symptoms when exposed to healthcare acquired pneumonia - CORRECT ANSWER 24 to 48 hours
What is rhinitis - CORRECT ANSWER Inflammation of the nasal mucosa
What is objective data for rhinitis - CORRECT ANSWER 1. Red, inflamed, swollen nasal mucosa
- Low-grade fever
What are nursing interventions for rhinitis - CORRECT ANSWER 1. Encourage rest, 8 to 10 hours a day and increase fluid intake to at least 2000 mL/day
- Encourage use of home humidifier or breathing steamy air
NEW 2022 Working Update Solution FOR ATI MED SURG Final EXAM ALL Pracice Questions AND Answers
Course: Pharmacology (NUR 3145)
University: Santa Fe College
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