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CMSRN Med-Surg Exam Questions And Correct Answers
Possible Causes of Appendicitis - ANSWER bowel CA, infection. barium ingestion, fecalmass
Notable Symptoms of appendicitis - ANSWER RLQ abd pain, fever, tachycardia, N/V,Rovsing sign
Diagnostic tests for appendicitis - ANSWER elevated WBC's, abd U/S, CT scan Nursing Dx for appendicitis - ANSWER acute pain, risk for infection Nursing tx for appendicitis - ANSWER fowler's position, IV access, prep for sx, minimalpain medication prior to sx to avoid masking changes in pain
Med/Surg tx for appendicitis - ANSWER IV fluids, abx, possible NG tube, antiemetics,appendectomy
Watch for with Appendicitis - ANSWER sudden decrease in pain may indicate rupture;notify MD immediately
Diet for appendicitis - ANSWER NPO Contraindicated for appendicitis - ANSWER no heat applications over abdomen, no deeppalpation of RLQ
other Appendicitis - ANSWER Fatal if untreated; bowel perforation and sepsis can occurin less than 36 hours
possible Causes of Cholecystitis - ANSWER gallstones, bacterial infection Symptoms of Cholecystitis - ANSWER sharp RUQ abd pain; referred pain to R shoulder,N/v, positive Murphy's Sign
Dx tests for cholecystitis - ANSWER abd U/s, serum alk phos, lactate, AST/SGOT andbilirubin elevated
Nursing Dx for cholecystitis - ANSWER acute pain, risk for infection Nursing Tx for cholecystitis - ANSWER routine, IV access if dehydrated or sx necessary Medical Tx for cholecystitis - ANSWER analgesics, abx, anticholinergics, lithotripsy, abdlaparotomy/laparoscopy
Watch for ____ with cholecystitis - ANSWER jaundice Diet for cholecystitis - ANSWER low fat, NPO for sx Contraindicated in cholecystitis - ANSWER high fat diet Possible causes of liver cirrhosis - ANSWER alcohol, hepatitis, toxins, gallbladder dx,hemochromatosis, right sided HF
Notable symptoms of liver cirrhosis - ANSWER enlarged liver, N/V, diarrhea orconstipation, flatulence, dull abd pain, weight loss
Diagnostic tests for liver cirrhosis - ANSWER liver biopsy, liver function studies
Notable symptoms for diverticulitis - ANSWER fever, LLQ abd pain, N/V, ribbonlikestools
Dx tests for Diverticulitis/osis - ANSWER barium enema, colonoscopy Nursing Dx for Diverticulitis/osis - ANSWER Risk for constipation, Dysfunctional GImotility
Nursing Tx for Diverticulosis/itis - ANSWER educate about fiber, monitor forinfection/bleeding
Medical Tx for diverticulitis/osis - ANSWER analgesics, abx, stool softeners, cathartics,colon resection with temporary colonostomy
Watch for _____, _____, ____, and ____ in Diverticulosis/itis - ANSWER changes in stool,abdominal rigidity, high fever/chills, hypotension
Diet for Diverticulosis/itis - ANSWER HIGH-FIBER AFTER pain lessens Facts about Diverticulitis - ANSWER may be acute or chronic Possible Causes of GERD/Reflux-ANSWER alcohol, smoking, hernia, obesity,pregnancy, NG tube >4 days
Symptoms to note of GERD/Reflux-ANSWER burning epigastric pain, may radiate tochest and arms
Diagnostic tests for GERD/Reflux-ANSWER esophagoscopy, barium swallow, upper GIseries
Nursing Dx for GERD/Reflux-ANSWER Pain Nursing Tx for GERD/Reflux-ANSWER upright positioning after meals, elevate HOBduring sleep, educate on weight loss, alcohol and smoking cessation
Medical Tx for GERD/Reflux - ANSWER antacids, H2 receptor agonists, proton pumpinhibitors, cholinergics
Watch for ____ in GERD/Reflux - ANSWER symptoms of esophagitis Diet for GERD/Reflux - ANSWER small, frequent meals; avoid eating before bedtime;avoid trigger foods
Contraindicated in GERD/Reflux - ANSWER alcohol, smoking Possible Causes of PUD/Peptic Ulcers - ANSWER H. pylori infection, overuse of NSAIDsor aspirin, chemo, stress
Possible Causes of GI Bleeds - ANSWER PUD, CA, ulcerative colitis, esophagealvarices, diverticulosis/itis
Notable symptoms of GI Bleeds - ANSWER bloody or coffee-ground vomitus, black,maroon, or bloody stools
Diagnostic Tests for GI Bleeds - ANSWER colonoscopy, EGD Nursing Dx for GI Bleeds - ANSWER Risk for bleeding, Acute pain Nursing Tx for GI Bleeds - ANSWER two large bore IV access, frequent VS
Diet for Hepatitis - ANSWER high calorie, high carb, moderate protein and fat Contraindicated in Hepatitis - ANSWER acetaminophen, EToh Facts about Hepatitis - ANSWER Five major types (A-E), G is a new type similar to C; maybe acute or chronic
Possible Causes of Bowel Obstruction - ANSWER CA, infection, scars from ulceration Notable Symptoms of Bowel Obstruction - ANSWER abd pain and distension, N/V withfecal odor, high-pitched or absent bowel sounds, Jelly-like stools, diarrhea
Diagnostic tests for bowel Obstruction - ANSWER abdominal x-rays, barium enema,endoscopy, colonoscopy
Nursing Dx for Bowel Obstruction - ANSWER Dysfuctional GI motility; Acute pain Nursing Tx for Bowel Obstruction - ANSWER measure abd girths, encourage deepbreathing, IV access, prep for sx
Medical tx for bowel obstruction - ANSWER analgesics, abx, NG tube, IV fluids,exploratory laparotomy, ileostomy or colonostomy if needed
Watch for ____, _____,______, or _____; ______ may indicate obstruction is resolving -ANSWER hypovolemic shock, sepsis, bowel rupture, peritonitis; passing of flatus
Diet for Bowel Obstruction - ANSWER NPO
Contraindicated in Bowel Obstruction - ANSWER abd heat packs for pain Facts about Bowel obstruction - ANSWER includes volvulus, intussusception,adhesions, and paralytic ileus; fatal if not treated
Possible causes of Acute/Chronic Pancreatitis - ANSWER alcohol, trauma, infection,medications, biliary tract obstruction
Notable Symptoms of Acute/Chronic Pancreatitis - ANSWER epigastric pain thatworsens after meals, may radiate to shoulder, back, flank, and chest; fever, N/V, fatty foul stools; Cullen's and Grey Turner's signs Diagnostic Tests for Acut/Chronic Pancreatitis - ANSWER elevated AST,SGOT, bilirubin,glucose, WBC's, amylase, and lipase; low Ca; ERCP
Nursing Dx for Acute/Chronic Pancreatitis - ANSWER Acute/Chronic pain; Risk forimbalanced nutrition: less than body requirements
Nursing Tx for Acute/Chronic Pancreatitis - ANSWER routine; encourage rest Medical Tx for Acute/Chronic Pancreatitis - ANSWER IV fluids, TPN, NG tube, analgesia,abx, insulin if indicated
Watch for ____ and ______ in Acute/Chronic Pancreatitis - ANSWER hypovolemic shock,Calcium deficiency
Diet in Acute/Chronic Pancreatitis - ANSWER NPO. then bland high protein, low fat smallfrequent meals; restrict caffeine
Contraindicated in Acute/Chronic Pancreatitis - ANSWER high fat diet
Diagnostic Tests for Crohn's Dx - ANSWER barium enema, proctosigmoidoscopy, smallbowel x-ray
Nursing Dx related to Crohn's Disease - ANSWER acute/chronic pain; Risk forimbalanced nutrition: less than body requirements, Risk for bleeding
Nursing Tx for Crohn's Disease - ANSWER routine; iv access; pain control Medical Tx for Crohn's Dx - ANSWER analgesia, NG tube, bowel resection;anticholinergics, antidiarrheals, sulfasalazine, corticosteroids, immunosuppresants
Watch for __, __ or ____ in Crohn's Dx - ANSWER ileus, bloody stools or vomitus Diet for Crohn's Dx - ANSWER NPO; restrict raw fruits and veggies, fatty, spicy foods;may require TPN
Contraindicated in Crohn's Dx - ANSWER avoid trigger foods Facts about Crohn's Dx - ANSWER also known as "regional enteritis"; lesions in bowelare discontinuous ("skip" lesions); most common in women ages 20-
Possible Causes of Ulcerative Colitis - ANSWER unknown, may be genetic orimmunological
Notable Symptoms of Ulcerative Colitis - ANSWER liquid stools with blood, pus, and/ormucus, LLQ crampy abd pain, fever, rectal bleeding, weight loss
Diagnostic tests for Ulcerative Colitis - ANSWER barium enema, rectal biopsy,sigmoidoscopy
Nursing Dx for Ulcerative Colitis - ANSWER acute/chronic pain; Risk for imbalancednutrition: less than body requirements; Risk for bleeding
Nursing Tx for Ulcerative Colitis - ANSWER routine; IV access; pain control Medical Tx for Ulcerative Colitis - ANSWER analgesia, NG tubel; bowel resection;anticholinergics, antidiarrheals, sulfasalazine, corticosteroids, immunosuppresants
Watch for __, ___ or ___; _____ in Ulcerative Colitis - ANSWER ileus, bloody stools orvomitus; bowel CA
Diet for Ulcerative Colitis - ANSWER NPO; limit raw fruits and Vegetables, fatty, spicyfoods; may need TPN
Contraindicated in Ulcerative Colitis - ANSWER triggering foods Facts about Ulcerative Colitis - ANSWER lesions in bowel are continuous and diffuse GI anatomy sequence - ANSWER Mouth-> pharynx -> hypopharyngeal sphincter ->esophagus-> cardiac/esophageal sphincter-> stomach -> pyloric sphincter-> duodenum-> jejunum-> ileum-> (appendix)-> cecum (connects to ileocecal pouch)->ascending colon-> hepatic flexure-> transverse colon-> left colic flexure-> descending colon-> sigmoid colon-> rectum-> anus Parotidm submandibular, and sublingual glands produce______ - ANSWER producesaliva
What are the crypts of Lieberkuhn? - ANSWER These crypts, found between the villi inthe small intestine, secreting an alkaline intestinal juice containing mucus and enzymes that contribute to the digestive and absorptive process.
Aluminum overuse may lead to - ANSWER low Ca/osteoporosis Sucralfate (Carafate) - ANSWER provides a barrier over ulcers and GI mucosaAdminister other PO meds at least 2 hours prior Antacids can be within 30 min Anti-emetics (OTC: Pepto-Bismol, other Bismuth preps; Rx: dolasetron, ondansetron,granisetron, aprepitatn, metoclopramide) - ANSWER don't use with long QT syndrome on ECG; correct low K+ and Mg++ levels prior to use; monitor for extrapyramidal sideeffects (involuntary movements)
Murphy's Sign - ANSWER painful inspiration from severe abd pain; from gallbladder pain Mallory-Weiss syndrome - ANSWER esophageal tears; from alcoholism orcoughing/vomiting
Grey-Turner's Sign-ANSWER flank bruising; associated w/ acute pancreatitis Cullen's sign-ANSWER periumbilical ecchymosis (bruising); associated w/ acutepancreatitis
Chvostek's Sign-ANSWER tap cheek, facial muscle twitch; indicates hypocalcemia Trousseau's Sign-ANSWER hand spasm after BP cuff >SBP for 3 min (hypocalcemia) Zollinger-Ellison Syndrome-ANSWER gastrinomas cause excess stomach acidproduction which leads to peptic ulcers (PUD) Curling's Ulcer-ANSWER GI ulcer associated w/ burn trauma Cushing's Ulcer-ANSWER GI ulcer associated with head trauma
Rovsing's Sign-ANSWER RLQ pain w/LLQ palpation; associated with appendicitis Psoas Sign-ANSWER RLQ pain on R thigh extension; associated with appendicitis Obtruator sign-ANSWER RLQ pain on internal rotation of the flexed right thigh Kehr's sign-ANSWER L shoulder pain from splenic rupture or other GI organ damagethat irritates the diaphragm
Shigella - ANSWER bacterial; fever, abd cramps, voluminous watery diarrhea, bloodymucoid stools, tenesmus; tx with trimethoprim/sulfamethoxazole
Salmonella - ANSWER bacterial; N/V, diarrhea w/o blood/mucus, fever, abd cramps; w/in48h of ingestions; self-resolving, support w/ IV fluids and abx as needed
Rotavirus - ANSWER viral, very contagious; adults very rarely affected; diarrhea severe,vomiting, low grade fever, and dehydration; vaccine available
Cholera - ANSWER bacterial; copious watery diarrheam vomiting, dehydration,electrolyte imbalances; seafood most likely cause in developed world; rehydrate with lactated Ringer's IV solution; can treat with abx; vaccine exists Typhoid - ANSWER bacterial, related to salmonella; bloody nose, abd pain, fever,bradycardia, abd distension RLQ, diarrhea; can be treated with ciprofloxacin, ceftriaxone, and cefixime as well as amoxicillin; vaccine exists Possible Prerenal Causes of Acute Renal Failure - ANSWER HF, burns Possible Intrarenal Causes of ARF/AKD - ANSWER nephrotoxic substances,glomerulonephritis, trauma
Diagnostic Tests for chronic renal failure (CRF/CKD) - ANSWER serum electrolytes,metabolic panels, BUN/creatinine, renal biopsy
Nursing Dx for CRF/CKD - ANSWER risk for imbalanced fluid volume, Risk for electrolyteimbalance
Nursing Tx for chronic renal failure (CRF/CKD) - ANSWER education regarding diet,self-care, infection control, pulmonary toilet, refer pt to National Kidney Foundation; teach s/s to report Medical Tx for CRF/CKD - ANSWER diet and fluid therapy, dialysis, kidney transplant,vitamin B/C/folic acid/iron/zinc/CA supplements
Watch for ___, ____, _____, ____, _____, ____, _____, _____, ______ in CRF/CKD - ANSWERhyperkalemia, hypocalcemia, HTN, cardiac arrythmias, HF, PNA, bleeding, depression, altered LOC Diet for CRF/CKD - ANSWER strict low protein (around 50G/day); fluid and NA/K+restrictions sometimes
Facts about CRF/CKD - ANSWER 4 stages: reduced renal reserve, renal insufficiency,renal failure, end-stage renal dx (ESRD)
Posisble Causes of Glomerulonephritis - ANSWER strep infection, impetigo, Berger's dx Notable Symptoms of Glomperulonephritis - ANSWER dyspnea, edema, HTN, fatigue,hematuria, proteinuria
Diagnositc Tests for Glomerulonephritis - ANSWER Urinalysis, 24 hour urine, renalbiopsy
Nursing Dx for Glomerulonephritis - ANSWER Risk for imbalanced fluid volume, Risk forelectrolyte imbalance
Nursing Tx for Glomerulonephritis - ANSWER bed rest, teaching about diet, dialysis,infection risk, what to report
Medical Tx for Glomerulonephritis - ANSWER treat underlying condition, abx,antihypertensives, diuretics, dialysis; kidney transplant for chronic condition
Watch for ____, _____, ______ in Gloperulonephritis - ANSWER High K, High, Na, fluidoverload
Diet for Glomerulonephritis - ANSWER high calorie, low protein, low Na, low K, fluidrestriction
Glomerulonephritis Facts - ANSWER can be acute or chronic leads to renal failure Possible Causes of C diff - ANSWER prolonged abx use, nosocomial infectiontransmission, immunocompromise from HIV, chemo
Symptoms of Note about C Diff - ANSWER watery diarrhea, distintive odor, fever,anorexia, N/V, abd pain
Diagnostic Tests available for C diff - ANSWER liquid only stool culture, enzymeimmunoassay EIA, PCR assay
Nursing Dx for C diff - ANSWER diarrhea, risk for deficient fluid volume, bowelincontinence
Nursing Tx for c diff - ANSWER soap/water hand washing only, private room with
Watch for ____ in Nephrotic Syndrome - ANSWER significant changes in weight oredema
Nephrotic Syndrome Diet - ANSWER high protein, low Na, low cholesterol Contraindicated in Nephrotic Syndrome - ANSWER low K+ diet unless lab levels dictateotherwise
Neurogenic Bladder possible Causes - ANSWER CA, herpes zoster, spinal cord traumaor dx, cerebral disorder, acute infection
Neurogenic Bladder Symptoms to Note - ANSWER incontinence, distended bladder, s/sof UTI or kidney stones diagnostic tests for neurogenic bladder - ANSWER cystourethrography Nursing Ds for Neurogenic Bladder - ANSWER imparied urinary elimination, Functionalurinary incontinence
Nursing Tx for Neurogenic Bladder - ANSWER use/teach bladder eliminationtechniques; Valsalva, foley catheter, self catheterization, Crede's maneuver; avoid bed rest if possible Medical Tx for Neurogenic Bladder - ANSWER terazosin, doxazosinmphenoxybenzamine, transuretheral resection of the bladder neck; consult enterostomal therapist Watch for ______ or _____ in Neurogenic Bladder - ANSWER development of kidneystones or infection
Neurogenic bladder Diet - ANSWER based on underlying condition; no underlying
condition listed Neurogenic Bladder contraindicated - ANSWER fluid restriction Neurogenic Bladder facts - ANSWER spastic if upper motor neuron lesion, flaccid iflower motor neuron lesion
POssible causes of Urinary calculi (kidney stones) - ANSWER infection, urine retention,dehydration, sedentary lifestyle
Symptoms of Urinary calculi - ANSWER none for small non-obstruction stones; severedeep flank pain; hematuria; stones in ureter cause severe colicky lumbar pain; N/V
Diagnostic Tests for Urinary Calculi - ANSWER urinalysis, KUB X rays; 24 hour urinetests
Nursing Dx for Urinary Calculi - ANSWER Acute pain, nausea, impaired urinaryelimination
Nursing Tx for Urinary Calculi - ANSWER pain management, encourage fluid intake to3L/day, IV access, warm moist packs
Medical tx for Urinary Calculi - ANSWER opioids, antispasmodics, antiemetics, IV fluids,lithotripsy
Watch for ____, ____, ____ in Urinary Calculi - ANSWER heamaturia, UTI, hydronephrosis Diet for Urinary Calculi - ANSWER depends on type of Calculi (Ca, phosphate, uric acid,struvite, cystine, or oxalate)
