Medical-Surgical Nursing in Canada

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Which intraoperative complication is a widespread activation of the clotting cascade that results in the formation of clots in small blood vessels throughout the body, which as it consumes clotting factors and platelets disrupts normal clotting and can result in severe bleeding from various sites?

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If detected, which catastrophic event in the OR will result in anesthesia and surgery being halted, 100% oxygen administered, and client will be treated with dantrolene sodium?

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Malignant hyperthermia is a rare inherited disease where hyper metabolism of skeletal muscle resulting in altered control of intracellular calcium can occur in response to exposure to succinylcholine, a general anesthesia, but may also be triggered by trauma, heat and stress. This results in hyperthermia with rigidity of skeletal muscles. It can result in cardiac arrest and death. What is/are the first sign(s) of this occurring?

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What is the most common cause of post-operative hypoxemia?

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Most common immediate post-op complication include:

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Which of the following are interventions to prevent deep vein thrombosis and pulmonary emboli?

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A transient cessation of bowel mobility that prevents effective passage of intestinal contents; typically resolves in 2-3 days with supportive treatment. Which condition is this?

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Small bowel obstruction that results when peristalsis stops; bowel lumen remains patent, but contents of intestine are not propelled forward, producing severe nausea and vomiting; may be caused by neurogenic or muscular impairment. Which condition is this?

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Meaghan, 26, should remain NPO after her abdominal surgery until

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If no catheter, the post-operative patient is expected to void __________ within 6-8 hours after surgery.

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Drainage from surgical wounds should change from sanguineous to serosanguineous to serous with progressively less output with surgical wound healing.

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Infants and the elderly are at a higher risk for fluid-related problems/imbalances.

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Potassium's normal range lab values are - mmol/L.

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Sodium's normal range lab values are - mmol/L.

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Normal arterial plasma pH is -

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In arterial blood gases, a normal range for PaCO2 is - mmHg.

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In arterial blood gases, a normal range for HCO3 is - mmol/L.

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When using arterial blood gases and pH to determine acid-base imbalances, remember the acronym ROME: respiratory opposite metabolic equal.

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Hypotonic solution results in cellular ( swelling, shrinking ).

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Hypertonic solution results in cellular ( shrinking, swelling ).

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Serum creatinine levels ( increase, decrease ) when renal function decreases.

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Sudden body weight change is an excellent indicator of overall fluid volume. One litre of water weighs ______.

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The average daily urine output is 1500 mL, or 1 mL/kg/hr.

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These are clinical presentations of fluid volume deficit, or hypovolemia:

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These are clinical presentations of fluid volume excess, or hypervolemia:

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( Hyponatremia, Hypokalemia, Hypernatremia, Hyperkalemia ) is a frequently overlooked cause of confusion in the elderly.

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Which electrolyte imbalance has the following clinical manifestations: fatigue, N/V, decreased bowel mobility; parenthesis, decreased reflexes, muscle weakness, leg cramps, polyuria; weak, irregular pulse; ECG changes; hyperglycemia.

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Which medication, in hyperkalemia, binds to potassium for excretion in feces?

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Chvostek's and Trousseau signs are used to detect hypocalcemia, which often presents with numbness and tingling in extremities and around the mouth, as well as hyper reflexes and muscle cramps. ( Chvostek's sign, Trousseau's sign ) is the twitching of the facial muscles in response to tapping over the area of the facial nerve. ( Trousseau's sign, Chvostek's sign ) is carpopedal spasm caused by inflating the blood-pressure cuff to a level above systolic pressure for 3 minutes.

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Metabolic acidosis is most commonly caused by renal failure. With acidosis, hyperkalemia may occur as potassium shifts out of the cell.

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Metabolic alkalosis is most commonly caused by severe vomiting or excessive gastric suction. Hypokalemia will produce alkalosis.

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Respiratory acidosis is always caused by a respiratory problem (hypoventilation) with inadequate excretion of CO2. Treatment is aimed at improving ventilation.

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Respiratory alkalosis is caused by hyperventilation.

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The RPN should not take blood pressures, nor should blood draws be done, on the extremity with the PICC line.

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Clinical manifestations of infiltration include swelling, pallor and coolness, and pain at insertion site. Treatment for the peripheral IV site complication of infiltration is to stop the infusion and discontinue the IV, then elevate the affected extremity.

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Extravasation, similar to infiltration but with an administration of a vesicant or irritant solution/medication into the surrounding tissues. Clinical manifestations are similar to infiltration, but blistering and necrosis of tissue can occur. Treatment for the peripheral IV site complication of extravasation is stopping the infusion and notifying the physician immediately, but leaving the IV cannula in place with warm or cold compresses based on the medication.

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Phlebitis, manifesting as pain, swelling and a reddened area around the insertion site or along the path of the vein is treated by discontinuing the IV and applying a warm moist compress.

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Thrombophlebitis is the presence of a clot plus inflammation. Manifests the same as phlebitis but client may experience immobility of the extremity because of pain, sluggish flow rate. Treatment is to discontinue the IV, initially apply cold compress followed by warm compress.

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Treatment for the peripheral IV site complication of a hematoma is to discontinue the IV, apply pressure with a sterile dressing and ice to prevent extension of the hematoma.

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Treatment for the peripheral IV site complication of an air embolism is clamping the cannula, placing the client on left hand side in Trendelenburg position, assessing vital signs, administering oxygen and notifying the physician.

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For blood product administration, a larger diameter cannula is needed, usually 18-20 gauge.

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For most IV therapy a 22 gauge catheter is sufficient.

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The RPN should monitor the client and IV site _______ for signs of systemic and local complications related to peripheral IV therapy.

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Total parenteral nutrition tubing should be changed every 24 hours.

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IV line tubing should be changed no more frequently than at a _______ hour interval, but at least every 7 days or immediately if contamination occurs.

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You are caring for a 72-year-old female who underwent a hysterectomy, salpingo-oopherectomy, and bilateral pelvic lymph node dissection (LND). She is post-op day 2. You received handover this morning and the night nurse told you that the patient has had a low urine output. During your assessment, you notice that her extremities are cold, her BP is low, her HR is high, and she seems restless. You suspect that the patient may be experiencing...

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Signs & symptoms of ______________ shock include narrowing pulse pressure, tachypnea, hypotension, decreased urinary output, weak & thready pulse, hypoactive or absent bowel sounds, decreased cerebral perfusion (anxiety, confusion) and skin hypoperfusion (pale, cool, clammy).

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Signs & symptoms of ____________ shock include narrowing pulse pressure, tachycardia, tachypnea with crackles, hypotension and peripheral hypoperfusion.

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Signs & symptoms of ____________ shock include hypotension, bradycardia, skin dry with poikilothermia, temperature and dysregulation (risk for hypothermia).

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Signs & symptoms of ____________ shock include wheezing, stridor, flushing, pruritus, urticaria, respiratory distress and circulatory failure, sense of impending doom, chest pain, and swelling of the lips and tongue.

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Septic shock manifests with tachypnea/hyperventilation, temperature dysregulation, decreased urine output, altered neurological status, GI dysfunction, and respiratory failure is common.

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Normal pulse pressure is 30-40 mmHg.

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A modified Trendelenburg position (head elevated, feet elevated 30 degrees) is recommended for hypovolemic shock to promote venous return and increases circulating blood volume.

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Blood is infused within 30 mins of pickup from blood bank and over 6 hours with Y-tubing.

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Blood transfusion is recommended when Hgb is below 70 g/L.

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Plasma is infused immediately after thawed, as rapidly as tolerated over 30-60 mins and is compatible for all with "O" type or own ABO group.

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Blood should be infused slowly to start, no greater than 2 mL/min for first 15 minutes as most reactions occur within first 50 mL of administration.

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________ reaction usually occurs when blood is transfused too quickly, presents with hypertension, bounding pulse, distended jugular veins, dyspnea, and restlessness/confusion. Nursing management is to stop transfusion, administer diuretics, apply O2 as needed and restart infusion slowly as directed.

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____________ reaction in blood transfusion typically occurs within 2 hours of infusion and usually resolves within 24-72 hours. Manifests as hypoxia and bilateral pulmonary edema. Nursing management is to stop the transfusion, provide O2, and mechanical ventilation is required in 75% of cases.

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Which of the following should the RPN teach the patient to avoid 72 hours prior to a fecal occult blood test?

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Post procedural education for a barium enema includes teaching the patient that bowel movements should change from chalky white/gray progressively to normal colour.

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Ileostomy pouch should be emptied when _____ full.

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Ostomy appliances should be changed ever 5-7 days and should be early in the morning before breakfast or 2-4 hrs after a meal.

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Patients receiving enteral feedings should have HOB elevated 30-45 degrees during meal and for at least 30 mins afterwards to prevent risk of aspiration

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Autonomic dysreflexia occurs in persons with an injury above T6. Symptoms include: severe pounding headache, sudden increase in blood pressure, profuse diaphoresis above level of injury, bradycardia.

Med-Surg

Medical-Surgical Nursing in Canada

Medical-Surgical Nursing in Canada

Which intraoperative complication is a widespread activation of the clotting cascade that results in the formation of clots in small blood vessels throughout the body, which as it consumes clotting factors and platelets disrupts normal clotting and can result in severe bleeding from various sites?

If detected, which catastrophic event in the OR will result in anesthesia and surgery being halted, 100% oxygen administered, and client will be treated with dantrolene sodium?

What is the most common cause of post-operative hypoxemia?

Most common immediate post-op complication include:

Which of the following are interventions to prevent deep vein thrombosis and pulmonary emboli?

A transient cessation of bowel mobility that prevents effective passage of intestinal contents; typically resolves in 2-3 days with supportive treatment. Which condition is this?

Small bowel obstruction that results when peristalsis stops; bowel lumen remains patent, but contents of intestine are not propelled forward, producing severe nausea and vomiting; may be caused by neurogenic or muscular impairment. Which condition is this?

Meaghan, 26, should remain NPO after her abdominal surgery until

If no catheter, the post-operative patient is expected to void __________ within 6-8 hours after surgery.

Drainage from surgical wounds should change from sanguineous to serosanguineous to serous with progressively less output with surgical wound healing.

Infants and the elderly are at a higher risk for fluid-related problems/imbalances.

Potassium's normal range lab values are - mmol/L.

Sodium's normal range lab values are - mmol/L.

Normal arterial plasma pH is -

In arterial blood gases, a normal range for PaCO2 is - mmHg.

In arterial blood gases, a normal range for HCO3 is - mmol/L.

When using arterial blood gases and pH to determine acid-base imbalances, remember the acronym ROME: respiratory opposite metabolic equal.

Hypotonic solution results in cellular swelling shrinking( swelling, shrinking ).

Hypotonic solution results in cellular ( swelling, shrinking ).

Hypertonic solution results in cellular ( shrinking, swelling ).

Serum creatinine levels ( increase, decrease ) when renal function decreases.

( Hyponatremia, Hypokalemia, Hypernatremia, Hyperkalemia ) is a frequently overlooked cause of confusion in the elderly.