Med/Surg 1
A patient with hyperthyroidism presents with irritability, tachycardia, and heat intolerance. Which nursing intervention is most appropriate?
A. Provide warm blankets and fluids
B. Encourage increased calorie intake
C. Limit stimulation and maintain a cool environment
D. Teach about levothyroxine administration
C. Limit stimulation and maintain a cool environment
What is the most common cause of rheumatic carditis?
A. Viral infection
B. Streptococcal infection
C. Fungal infection
D. Autoimmune disorder
B. Streptococcal infection
Most common cause of rheumatic carditis.
STI characterized by painless ulcerated lesions (chancres).
What is syphilis?
A patient develops sudden shortness of breath and absent breath sounds on the left side after chest tube removal. What is the nurse’s priority action?
A. Notify the charge nurse
B. Start an IV bolus STAT
C. Call RR and prepare for needle decompression
D. Reinsert the chest tube
C
Call rapid response and prepare for needle decompression
A patient post-hysterectomy reports increased (heavy) vaginal bleeding, sudden increase in pain, and abdominal distension. What should the nurse do first?
Notify the surgeon immediately
A patient with left-sided heart failure will likely exhibit which symptoms? (Select all that apply)
A. Dyspnea
B. Crackles in lungs
C. Peripheral edema
D. Orthopnea
E. Jugular vein distention
A. Dyspnea
B. Crackles in lungs
D. Orthopnea
Tip:
Think “L for Lungs” → Left-sided heart failure primarily produces pulmonary symptoms (dyspnea, crackles, orthopnea).
Think “R for Rest of body” → Right-sided heart failure produces systemic symptoms (JVD, peripheral edema, ascites).
CBC with Auto Differential, C-reactive protein, Temperature, purulent drainage, Foul smell
What are indicators of infection?
A serious condition where pressure builds up inside a muscle compartment, cutting off blood flow and oxygen to the muscles and nerves. May develop after a compound fracture of the tibia after a motorcycle accident. The leg is swollen and feels tense, pulses are faint, and the patient reports severe pain unrelieved by opioids. The nurse needs to notify the PCP and prepare for an emergency fasciotomy (surgical cut into fascia to relieve pressure).
What is compartment syndrome?
Most common regimen: Isoniazid (INH) and Rifampin taken for 6-9 months following a positive Mantoux test. Patient recently traveled from Egypt and is reporting fever with bloody sputum with cough.
May also include: Pyrazinamide, Ethambutol
What are treatments for diagnosed active TB?
A patient with chest pain and ST elevation is experiencing this condition.
What is an acute myocardial infarction (STEMI)?
A patient with atrial fibrillation has HR 150 and BP 80/50. What is the priority intervention?
A. Administer IV beta-blocker
B. Prepare for synchronized cardioversion
C. Give oral anticoagulant
D. Monitor vital signs
B. Unstable AF requires immediate cardioversion.
Inflammation of the protective membranes surrounding the brain and spinal cord. It can be caused by infections (bacterial, viral, fungal, or parasitic) or noninfectious conditions. Classic triad: Fever, severe headache, and stiff neck. College students living in dormitories are strongly recommended to be vaccinated against this disease, since close living quarters increase risk.
What is meningitis?
Numbness+Tingling around the mouth, Tetany, Seizure, Chvostek's sign, Trousseau's sign
What are signs and symptoms of hypocalcemia?
During an acute Multiple Sclerosis (MS) exacerbation, the patient is prescribed IV corticosteroids. What is the purpose of this therapy?
A. Cure the disease
B. Slow nerve damage permanently
C. Reduce inflammation and shorten the relapse
D. Prevent orange urine
C
IV corticosteroids (e.g., methylprednisolone) are the standard treatment during an acute MS exacerbation.
• Their purpose is to suppress the immune response and reduce inflammation in the central nervous system, which helps shorten the duration and severity of the relapse.
MS is a chronic autoimmune disease of the central nervous system in which the immune system attacks the protective covering of nerve fibers (myelin), disrupting communication between the brain and body.
• They do not cure MS (so A is incorrect).
• They do not permanently slow nerve damage—they only help with acute inflammation (so B is incorrect).
• Corticosteroids are not related to urine color changes (so D is incorrect).
A postoperative patient after partial gastrectomy complains of dizziness, palpitations, and abdominal cramping 20 minutes after eating. The nurse recognizes:
A. Dumping syndrome — instruct patient to lie down and avoid fluids with meals.
B. Anaphylaxis — prepare epinephrine.
C. Hypoglycemia — give orange juice.
D. Myocardial ischemia — obtain EKG.
A. Dumping syndrome occurs when food moves too quickly from the stomach into the small intestine, causing fluid shifts and vasomotor/GI symptoms.
Main Causes of Dumping Syndrome
• Surgical causes (most common):
• Gastrectomy – removal of part or all of the stomach
• Bariatric surgery – gastric bypass (Roux-en-Y) or sleeve gastrectomy for weight loss
• Esophagectomy – removal of part or all of the esophagus
• Fundoplication – surgery for GERD/hiatal hernia where the stomach is wrapped around the esophagus
Nursing interventions:
• Small, frequent meals
• High-protein, moderate-fat, low-carbohydrate diet
• Avoid fluids with meals (drink between meals)
• Lie down after eating to slow gastric emptying
A 70-year-old patient with COPD is admitted with shortness of breath and thick sputum. ABG shows
pH 7.32, PaCO₂ 58 mmHg, HCO₃⁻ 28 mEq/L, PaO₂ 64 mmHg.
What type of acid-base imbalance does this represent?
Respiratory acidosis with partial metabolic compensation
Rationale: Low pH, high PaCO₂, elevated HCO₃⁻.
pH 7.32 → slightly acidotic (normal 7.35–7.45).
• PaCO₂ 58 mmHg → elevated (normal 35–45), indicating respiratory acidosis.
• HCO₃⁻ 28 mEq/L → slightly elevated (normal 22–26), showing the kidneys are compensating.
• PaO₂ 64 mmHg → hypoxemia (normal 80–100).
Interpretation:
This represents respiratory acidosis with partial metabolic compensation, consistent with chronic COPD exacerbation.
Study focus:
• COPD patients often retain CO₂ chronically, leading to compensated respiratory acidosis.
• In acute exacerbations, the pH drops further, showing decompensation.
• Always assess oxygenation (PaO₂) alongside acid-base status.
Complications of infective endocarditis:
A. Stroke
B. Pulmonary embolism
C. Heart failure
D. Kidney damage
E. Hypothyroidism
ABCD
A patient with a C5 spinal cord injury suddenly develops severe hypertension, a pounding headache, and flushed skin above the level of injury.
1. What condition is occurring?
2. What is the priority nursing action?
1. Autonomic dysreflexia-
a potentially life-threatening emergency that occurs in people with spinal cord injuries at or above the level of T6. It is caused by an exaggerated autonomic nervous system response to a noxious stimulus below the level of injury, leading to sudden severe hypertension, pounding headache, and other symptoms.
• Mechanism:
• The stimulus activates the sympathetic nervous system, causing widespread vasoconstriction below the injury.
• Normally, the parasympathetic system would counteract this, but signals cannot pass below the spinal lesion.
• Result: dangerously high blood pressure with vasodilation only above the injury.
• Risk: Can cause stroke, seizures, retinal hemorrhage, or death if untreated.
2. Immediately elevate the head of the bed to lower blood pressure and reduce intracranial pressure.
Which rhythm requires immediate defibrillation?
A. Atrial fibrillation
B. Ventricular tachycardia with pulse
C. Ventricular fibrillation
D. Sinus bradycardia
The rhythm that requires immediate defibrillation is:
C. Ventricular fibrillation
Explanation:
Ventricular fibrillation (VF):
• Chaotic, disorganized electrical activity in the ventricles.
• No effective cardiac output → patient is pulseless.
• Immediate defibrillation is the priority intervention to restore organized rhythm.
Atrial fibrillation (AFib):
• Irregular atrial rhythm, but patients usually have a pulse.
• Managed with rate/rhythm control or anticoagulation, not immediate defibrillation unless unstable and pulseless.
Ventricular tachycardia with a pulse (VT with pulse):
• If stable → treat with antiarrhythmics.
• If unstable but with a pulse → synchronized cardioversion, not defibrillation.
• If pulseless → treat like VF with immediate defibrillation.
Sinus bradycardia:
• Slow but organized rhythm.
• Managed with medications (e.g., atropine) or pacing if symptomatic, not defibrillation.
A patient with a traumatic brain injury has a Glasgow Coma Scale score of 7. The patient’s pupils are unequal, and systolic blood pressure is rising with bradycardia. Identify the likely life-threatening condition.
Answer: Increased intracranial pressure (ICP) with impending brain herniation.
Glasgow Coma Scale (GCS) of 7 → indicates severe brain injury.
• Unequal pupils → suggests compression of cranial nerve III (oculomotor nerve), often from brain shift/herniation.
• Rising systolic blood pressure with bradycardia → part of Cushing’s triad, a classic sign of increased ICP.
• Cushing’s triad = hypertension, bradycardia, irregular respirations.
• Together, these findings strongly suggest increased ICP progressing toward brain herniation.
Nursing Priority
• Immediate action: Notify provider/rapid response.
• Supportive measures: Elevate head of bed ~30°, maintain airway/oxygenation, avoid hypotonic fluids, monitor neuro status closely.
• Definitive treatment: Surgical intervention (e.g., craniectomy) may be required to relieve pressure.
A 25-year-old with type 1 diabetes presents with Kussmaul respirations, fruity breath odor, and blood glucose of 450 mg/dL.
List two immediate nursing interventions.
The priority nursing interventions for diabetic ketoacidosis (DKA) are rapid fluid resuscitation, IV insulin therapy, close electrolyte monitoring and replacement (especially potassium), and continuous assessment of vital signs, neurological status, and acid-base balance.
Detailed Breakdown for Study and Practice
1. Fluid Resuscitation
• Immediate IV fluids (0.9% normal saline) to correct severe dehydration and restore tissue perfusion.
• Patients may lose 10–15% of body weight in fluid due to osmotic diuresis.
• Monitor intake and output strictly to avoid overhydration, especially in those with renal or cardiac disease.
2. Insulin Therapy
• IV regular insulin infusion is the cornerstone of treatment.
• Goal: reduce blood glucose gradually to <200 mg/dL while correcting acidosis.
• Insulin should not be started until potassium is ≥3.3 mEq/L to avoid life-threatening hypokalemia.
3. Electrolyte Management
• Potassium monitoring and replacement is critical.
• Insulin drives potassium into cells, risking severe hypokalemia.
• Replace potassium as ordered to maintain 4.0–5.0 mEq/L.
• Monitor sodium, bicarbonate, and anion gap to track resolution of acidosis.
4. Acid-Base Balance
• Frequent ABG checks to monitor pH and bicarbonate.
• Sodium bicarbonate is rarely used, reserved for severe acidosis (pH <6.9).
• Watch for cerebral edema, especially in children, if acidosis is corrected too rapidly.
5. Infection Control
• Identify and treat precipitating causes such as pneumonia or urinary tract infection.
• Cultures and empiric antibiotics may be required.
6. Continuous Monitoring
• Vital signs: monitor for tachycardia, hypotension, tachypnea, Kussmaul respirations.
• Neurological status: assess for confusion, lethargy, or cerebral edema.
• Glucose checks: hourly point-of-care testing until stable.
7. Patient Education (Post-Stabilization)
• Reinforce sick-day rules: never skip insulin, monitor ketones when glucose >250 mg/dL.
• Recognition of early DKA symptoms (polyuria, polydipsia, fruity breath, abdominal pain).
• Review insulin administration techniques and adherence strategies.
Study Tips:
• Memorize the sequence: fluids → insulin → electrolytes.
• Know critical lab values: glucose >250 mg/dL, pH <7.3, bicarbonate <15 mEq/L, ketones present.
• Practice ABG interpretation: DKA = metabolic acidosis with high anion gap.
• Focus on safety priorities: airway, circulation, and preventing hypokalemia.
Pancreatitis management includes: Select All that Apply
⬜ NPO status
⬜ Pain control
⬜ Alcohol intake in moderation
⬜ IV fluids
⬜ High-fat diet
Correct: NPO status, Pain control, IV fluids
Rationale: Pancreatitis managed with bowel rest, fluids, analgesia. Antibiotics only if infection present; high-fat diet contraindicated.
Which signs indicate a tension pneumothorax in a trauma patient? (Select all that apply)
A. Tracheal deviation
B. Hypotension
C. Distended neck veins
D. Bradycardia
E. Absent breath sounds on one side
ABCE
A. Tracheal deviation
B. Hypotension
C. Distended neck veins
E. Absent breath sounds on one side
What is the correct use of an epinephrine auto-injector during an anaphylactic reaction?
A. Inject into the forearm
B. Inject into the outer thigh
C. Inject into the abdomen
D. Inject into the buttocks
B. Inject into the outer thigh
A postoperative client recovering from a femur fracture repair suddenly develops shortness of breath, anxiety, and chest pain. The nurse notes tachypnea, tachycardia and SpO₂ 84%.
What is the priority nursing action?
___________________________
Administer oxygen and call Rapid Response
Rationale: Sudden dyspnea, chest pain, hypoxemia after fracture = PE or Fat embolism
Regardless of whether it’s FES or PE, the priority nursing action is the same:
• Administer high-flow oxygen immediately to correct hypoxemia.
• Then notify the provider, anticipate diagnostics (ABGs, imaging), and prepare for advanced interventions (anticoagulation for PE, ventilatory support for FES).
Teaching tip:
If a case study emphasizes long bone fracture repair, fat embolism syndrome is the most testable answer.
If the stem emphasizes immobility, DVT risk, or clot formation, pulmonary embolism is more likely.