Med Surg 2 Exam 2

not-available-via-ai

Left-sided heart failure is characterized by the inability of the left side of the heart to effectively pump blood to the rest of the body. This can lead to systemic issues such as fluid retention, shortness of breath, and fatigue. It can also affect organs like the liver, causing liver congestion and dysfunction. On the other hand, right-sided heart failure occurs when the right side of the heart is unable to effectively pump blood to the lungs, leading to pulmonary issues such as fluid accumulation in the lungs, coughing, and difficulty breathing. Therefore, the given statement is incorrect.

There is no medical limitation on the number of times the sternum can be surgically opened. In fact, sternotomy (the surgical procedure of opening the sternum) is commonly performed in various cardiac surgeries such as bypass surgery or heart transplant. The sternum can be opened and closed multiple times if necessary for different surgical interventions. Therefore, the statement that the sternum can only be surgically opened three times is false.

Based on the given information, the patient is experiencing mental confusion, narrowing pulse pressure, noticeable weight gain, and has an enlarged left ventricle (LV) and enlarged left atrium (LA). These findings suggest left sided heart failure. In left sided heart failure, the left side of the heart is unable to effectively pump blood to the rest of the body, leading to symptoms such as fluid accumulation, weight gain, and decreased perfusion to the brain causing mental confusion. Therefore, the correct answer is Left Sided Heart Failure.

The values that would be interpreted as critical in this scenario are CK(CPK)- 48, CK-MB- 12%, and Troponin T-0.06. These values indicate elevated levels of creatine kinase (CK), CK-MB, and Troponin T, which are markers of cardiac muscle damage. Elevated levels of these markers suggest a possible myocardial infarction (heart attack) and require immediate attention and intervention.

The nurse would select the options of Smoking Cessation, Watch their Diet, and Lower Cholesterol when teaching a patient with atherosclerosis on how they can help themselves with the disease. Smoking cessation is important as smoking can worsen atherosclerosis. Watching their diet is crucial as a healthy diet can help manage the condition. Lowering cholesterol is essential as high cholesterol levels contribute to the development and progression of atherosclerosis.

Bilirubin is not the breakdown of complex amino acid chains. It is actually a yellow pigment that is formed when red blood cells break down. It is produced in the liver and then excreted in bile.

The correct answer is "It kills the targeted organism." Antibiotics are medications that are designed to kill or inhibit the growth of bacteria. Bactericidal antibiotics specifically kill the bacteria they target, while bacteriostatic antibiotics slow down the growth of bacteria. Antibiotics do not cause a heightened immune response or destroy mitochondria in the cell.

The nurse would use airborne precautions with a negative airflow room for a patient with measles. This is because measles is highly contagious and can spread through the air when an infected person coughs or sneezes. Airborne precautions involve wearing a mask and using a negative airflow room that helps prevent the airborne transmission of the virus to other patients and healthcare workers. Standard precautions, which include hand hygiene and wearing gloves, are also important but may not be sufficient to prevent the spread of measles. Contact precautions alone would not be enough as measles primarily spreads through respiratory droplets.

During a coronary artery bypass graft (CABG) surgery, the patient is fully heparinized to prevent blood clotting. Heparin is an anticoagulant medication that works by inhibiting the clotting factors in the blood. However, at the end of the surgery, it is important to reverse the effects of heparin to prevent excessive bleeding. Protamine sulfate is a medication that is used to reverse the anticoagulant effects of heparin. Therefore, the nurse should be ready with protamine sulfate for the surgeon towards the end of the surgery.

The nurse would consult the doctor for the patient with the lab values BNP-520 AST-200 ALT- 800 ESR-12 BILI- 7. These values indicate a significantly elevated BNP level, which is a marker for heart failure. The elevated AST and ALT levels suggest liver dysfunction, which can be a complication of heart failure. The elevated ESR may indicate inflammation, which can also be related to heart failure. The elevated bilirubin level may suggest liver dysfunction as well. Overall, these lab values indicate a worsening condition and require immediate attention from the doctor.

In the management of heart failure (HF), ACE inhibitors are considered the first line of pharmacologic defense. ACE inhibitors help to reduce the workload on the heart by dilating blood vessels and reducing fluid retention. They also help to improve cardiac function and decrease symptoms of HF. ARBs (angiotensin receptor blockers), digoxin, and beta blockers are also commonly used in the treatment of HF, but ACE inhibitors are typically the initial choice due to their proven efficacy and safety profile.

The nurse understands that a TIPS procedure, which stands for Transjugular Intrahepatic Portosystemic Shunt, is not a long term solution for portal hypertension. Instead, it is a temporary solution that helps to relieve symptoms and manage complications of portal hypertension. A TIPS procedure involves creating a shunt between the portal vein and hepatic vein to reduce pressure in the portal system. However, it may not be a permanent fix and may require further interventions or additional procedures in the future. Therefore, the statement is false.

The nurse would anticipate the patient to be experiencing an NSTEMI (Non-ST Elevation Myocardial Infarction). In an NSTEMI, there is partial blockage of a coronary artery, leading to reduced blood flow to the heart muscle. This can cause ischemia and damage to the heart, which is reflected in the EKG as a depressed or sunken ST segment. This is different from a STEMI (ST Elevation Myocardial Infarction), where there is complete blockage of a coronary artery and the ST segment is elevated. ACS (Acute Coronary Syndrome) is a broader term that encompasses both NSTEMI and STEMI. CHF (Congestive Heart Failure) is a separate condition involving the heart's inability to pump blood effectively.

The correct answer is that the patient is exhibiting left-sided HF and has pulmonary edema. Furosemide is a loop diuretic that works by inhibiting the reabsorption of sodium and chloride in the loop of Henle in the kidneys. This leads to increased urine production and ultimately helps to remove excess fluid from the body, including fluid that has accumulated in the lungs due to pulmonary edema. By reducing the fluid volume in the lungs, furosemide can help alleviate symptoms and improve respiratory function in patients with left-sided HF and pulmonary edema.

When a patient is on Warfarin, they should try to eliminate Vitamin K from their diet. Warfarin is an anticoagulant medication that works by inhibiting the activity of Vitamin K, which is necessary for blood clotting. By reducing Vitamin K intake, the patient can help maintain the effectiveness of the medication and prevent complications such as excessive bleeding.

The statement is false because right-sided heart failure does not typically cause acidosis. Acidosis is more commonly associated with left-sided heart failure, where the heart is unable to effectively pump oxygenated blood to the body, leading to a buildup of carbon dioxide and a decrease in pH. Right-sided heart failure, on the other hand, occurs when the right side of the heart is unable to effectively pump blood to the lungs for oxygenation. This can lead to fluid accumulation in the body, but it does not directly cause acidosis.

The nurse understands that there are immunizations available for hepatitis A and hepatitis B. These vaccines can help prevent the spread of these viral infections and protect individuals from developing hepatitis. The immunizations for hepatitis C are currently not available, so it is not included in the correct answer. The correct answer includes options A and B, indicating that there are immunizations for hepatitis A and hepatitis B.

During a coronary artery bypass graft (CABG) surgery, the patient is at the highest risk for hemorrhage. This is because the procedure involves manipulating and grafting blood vessels, which can lead to bleeding. Additionally, anticoagulant medications are often used during the surgery to prevent blood clots, which further increases the risk of hemorrhage. Therefore, the operating room nurse must closely monitor the patient for any signs of bleeding and take appropriate measures to control it if necessary.

Based on the given information that the patient is diagnosed with cirrhosis, the nurse can estimate that the patient has approximately 5 years remaining. Cirrhosis is a chronic and progressive condition characterized by irreversible scarring of the liver. The prognosis for cirrhosis varies depending on various factors such as the underlying cause, the extent of liver damage, and the patient's overall health. While cirrhosis is a serious condition, it is possible for patients to live for several years with proper management and treatment. Therefore, 5 years can be considered a reasonable estimate for the patient's remaining lifespan.

After a myocardial infarction (MI), a patient is typically advised to gradually increase their activity level. This is because during the first 48 hours after an MI, the patient is in the acute phase and needs to rest and recover. However, after 10 days, the patient's condition has stabilized, and they can start increasing their activity level under medical supervision. This allows the patient's body to gradually adapt and regain strength without putting excessive strain on the heart. Waiting for 10 days ensures that the patient has had enough time to heal and reduces the risk of complications.

The nurse recognizes that a post-op patient of a CABG (coronary artery bypass graft) requires a specific dose of dopamine. Among the options provided, the correct order of dopamine is 10mcg/kg/min. This dosage is likely appropriate for the patient's condition and will help maintain blood pressure and cardiac output after the surgery.

Helping the heart eject more blood from the ventricle is the best action to help a patient with systolic heart failure. In systolic heart failure, the heart is unable to effectively pump blood out of the ventricles, leading to a decrease in cardiac output. By assisting the heart in ejecting more blood, it can improve cardiac output and alleviate symptoms of heart failure. Helping the heart fill effectively may be important in diastolic heart failure, but in this case, the question specifies systolic heart failure.

The patient with a blood pressure of 169/100, heart rate of 87, ejection fraction of 32 from a recent ECHO, and shortness of breath is likely in heart failure. These symptoms indicate that the heart is not pumping effectively, as evidenced by the low ejection fraction and the presence of shortness of breath. The elevated blood pressure may be a compensatory mechanism to try to maintain adequate perfusion.

The statement suggests that limiting alcohol intake is the best way to prevent cirrhosis. However, this is not entirely accurate. While excessive alcohol consumption is a significant risk factor for cirrhosis, there are other causes as well, such as hepatitis infections and fatty liver disease. Therefore, the best form of prevention for cirrhosis is not solely limited to reducing alcohol intake, but also involves maintaining a healthy lifestyle, getting vaccinated against hepatitis, and managing other underlying conditions.

Based on the information provided, the patient is a 22-year-old UF student who has been experiencing chest pain for 25 minutes while playing Call of Duty. The intensity of the pain has not changed. This suggests that the patient is experiencing Prinzmetal angina, also known as variant angina. Prinzmetal angina is characterized by chest pain that occurs at rest, often during periods of emotional stress or physical exertion. The pain is caused by a spasm in the coronary arteries, leading to a temporary reduction in blood flow to the heart.

The correct answer is to deflate the balloon. A BLAKEMORE tube is a type of gastric tube that is used to control bleeding in patients with esophageal varices. The tube has two balloons - one in the esophagus and one in the stomach - that can be inflated to apply pressure and stop the bleeding. If the patient becomes cyanotic, it suggests that the balloon is obstructing the airway and preventing proper oxygenation. Therefore, the nurse's priority action should be to immediately deflate the balloon to ensure the patient's airway is clear and restore adequate oxygenation.

One hour after a myocardial infarction (MI), the patient is at risk for ventricular fibrillation (VFIB). VFIB is a life-threatening arrhythmia characterized by chaotic, disorganized electrical activity in the ventricles of the heart. It can lead to a loss of effective pumping action, causing cardiac arrest and sudden death. Prompt medical intervention, such as defibrillation, is necessary to restore a normal heart rhythm and prevent further complications.

The priority nursing action if a patient's chest tube has come out is to apply Vaseline STAT. This is because applying Vaseline to the area where the chest tube came out can create a temporary seal and prevent air from entering the pleural space, which could lead to a pneumothorax. This action helps to stabilize the patient's condition until further interventions can be implemented.

Esophageal varices are the most fatal complication of cirrhosis. Cirrhosis is a condition in which the liver becomes scarred and damaged, leading to various complications. Esophageal varices are enlarged veins in the lower part of the esophagus that can rupture and cause life-threatening bleeding. This is considered the most fatal complication because the bleeding can be severe and difficult to control, leading to significant morbidity and mortality. Ascites, splenomegaly, and other complications of cirrhosis can also be serious, but esophageal varices pose the highest risk of fatality. Brain cancer is not directly related to cirrhosis and is not a common complication.

The explanation provided in the correct answer accurately describes the body's natural compensation to heart failure. It states that a decrease in cardiac output (CO) stimulates the sympathetic nervous system (SNS) to release norepinephrine (NE), which leads to an increase in heart rate (HR), contractility, and vasoconstriction. Vasoconstriction increases venous return to the heart, increasing ventricle filling. However, the abundance of blood overfills the heart, causing myocardial tissue to atrophy. As a result, the hyperatrophied ventricle has decreased contractility and a decreased CO.

The nurse's response suggests that the patient's hospital stay will be at least 8 days, indicating that the patient will not be discharged before that time. The other options either provide a vague response (a couple of days) or contradict the information given (21 days).

The nurse understands that a normal result for coagulation studies includes a PT (Prothrombin Time) of 12 seconds, an INR (International Normalized Ratio) of 1 second, and a PTT (Partial Thromboplastin Time) of 30 seconds. These values indicate that the blood is clotting within the expected range, suggesting normal coagulation function.

UFHealth would be in the "Response" stage during Hurricane Irma. The response stage is when the organization takes immediate actions to address the impact of the disaster. In this stage, UFHealth would activate emergency plans, mobilize resources, and provide medical assistance to those affected by the hurricane. This stage involves coordinating with other emergency response agencies and ensuring the safety and well-being of patients, staff, and the community.

Hepatitis B and C are both types of hepatitis that can become chronic. Chronic hepatitis refers to an ongoing inflammation of the liver that lasts for more than six months. Hepatitis B and C can lead to long-term liver damage, liver cirrhosis, and even liver cancer if left untreated. It is important to diagnose and manage chronic hepatitis B and C to prevent further complications and protect liver health.

When blood pools into the thoracic cavity due to trauma, a chest tube is typically placed in the low anterior chest. This location allows for effective drainage of the blood and helps to prevent complications such as hemothorax or tension pneumothorax. Placing the chest tube in the low anterior chest also allows for easier access and monitoring by healthcare providers. The other options (low lateral chest, low posterior chest, high lateral chest) are not the preferred locations for chest tube placement in this scenario.

The reason a PFT (Pulmonary Function Test) is ordered for a patient going down for a CABG (Coronary Artery Bypass Graft) is to determine if the patient will be able to be extubated post-op. This test helps assess the patient's lung function and capacity, which is crucial for successful extubation and ensuring adequate oxygenation after surgery. By evaluating the patient's respiratory status, the medical team can make informed decisions regarding extubation and post-operative care.

The nurse best understands the risks of Heart Failure when she explains CAD and advancing age as primary risk factors. CAD, or coronary artery disease, is a condition where the arteries that supply blood to the heart become narrowed or blocked, leading to a reduced blood flow to the heart muscle. This can increase the risk of heart failure. Advancing age is also a primary risk factor for heart failure as the heart muscles tend to weaken and become less efficient with age. Therefore, both CAD and advancing age are important factors to consider when discussing the risks of heart failure.

The patient is presenting with left-sided heart failure. This can be inferred from the symptoms mentioned in the report. The crackles in the bases of the lungs indicate pulmonary congestion, which is a common finding in left-sided heart failure. The prolonged cap refill time suggests poor perfusion, which can occur due to reduced cardiac output in left-sided heart failure. The patient's diaphoresis and recent weight gain are also consistent with fluid retention, another characteristic of left-sided heart failure. The normal heart rate and blood pressure do not rule out left-sided heart failure as they can vary depending on the severity of the condition.

The correct answer is Morphine, Nitroglycerin, and Diuretics. Left-sided heart failure can lead to fluid accumulation in the lungs, causing pulmonary edema. Morphine is commonly used to relieve anxiety and reduce the work of breathing in patients with pulmonary edema. Nitroglycerin helps to dilate blood vessels and reduce the workload on the heart. Diuretics are prescribed to help eliminate excess fluid from the body and reduce fluid buildup in the lungs. Aspirin and TPA (tissue plasminogen activator) are not typically used in the treatment of pulmonary edema. Phosphodiesterase inhibitors, such as milrinone, may be used in some cases, but they are not listed as options in this question.

The correct answer is High Risk for Bleeding, GI Disorders, and Altered mental status.


- High Risk for Bleeding is appropriate because fibrinolytic therapies can increase the risk of bleeding in patients.
- GI Disorders is appropriate because fibrinolytic therapies can cause gastrointestinal side effects such as nausea, vomiting, or abdominal pain.
- Altered mental status is appropriate because fibrinolytic therapies can affect the central nervous system and cause confusion or other changes in mental status.

These nursing diagnoses are relevant and important considerations for a patient receiving fibrinolytic therapies for their STEMI.

The physician has ordered dopamine at a rate of 5 mcg/kg/min. The concentration of dopamine in the solution is 2 g in 250 mL of 0.9% NS. The patient's weight is 80 kg. To calculate the rate at which the IV pump should be programmed, we need to determine the total dose of dopamine needed per hour.

First, we calculate the total dose of dopamine needed per minute by multiplying the patient's weight (80 kg) by the ordered dose (5 mcg/kg/min). This gives us 400 mcg/min.

Next, we need to convert the concentration of dopamine in the solution from grams to milligrams. Since 1 g is equal to 1000 mg, the concentration is 2000 mg in 250 mL of solution.

To find the dose of dopamine per mL of solution, we divide the total dose (400 mcg) by the total volume of solution (250 mL). This gives us 1.6 mcg/mL.

Finally, to find the rate at which the IV pump should be programmed, we divide the total dose per hour (400 mcg/min) by the dose per mL of solution (1.6 mcg/mL). This gives us 250 mL/hr, which is equivalent to 3 mL/hr.

Diabetic retinopathy occurs when high blood sugar levels damage the blood vessels in the retina, the light-sensitive tissue at the back of the eye. This damage can lead to vision impairment and even blindness. Regular eye exams and proper management of blood sugar levels are crucial for preventing and treating diabetic retinopathy.

Late stage cirrhosis is characterized by severe liver damage and dysfunction. Ascites, or the accumulation of fluid in the abdominal cavity, is a common manifestation of late stage cirrhosis. Anemia may occur due to decreased production of red blood cells by the damaged liver. Peripheral edema, or swelling of the extremities, can occur due to fluid retention. Spider angiomas, or small dilated blood vessels near the skin's surface, may also be present in late stage cirrhosis. Fever, anorexia, and hepatomegaly (enlarged liver) are not typically associated with late stage cirrhosis.

Cirrhosis is a chronic liver disease characterized by the progressive destruction of liver cells and the formation of scar tissue. Early manifestations of cirrhosis can include fever, anorexia (loss of appetite), and hepatomegaly (enlarged liver). These symptoms may be present before more advanced signs such as ascites (accumulation of fluid in the abdomen), anemia, peripheral edema (swelling in the extremities), and spider angiomas (spider-like blood vessels on the skin) occur.

After the patient has had a mechanical valve placed, they will require anticoagulants for life. This is because mechanical valves have a higher risk of blood clot formation compared to natural valves. Anticoagulants help prevent the formation of blood clots by inhibiting the clotting factors in the blood. By taking anticoagulants, the patient can reduce the risk of complications such as stroke or valve blockage caused by blood clots. Therefore, it is anticipated that the patient will be sent home with anticoagulants as a lifelong treatment.

The nurse knows that the patient with Cirrhosis will have reduced bile production, which impairs the patient's ability to absorb lipids and fat-soluble vitamins. This deficiency in nutrient absorption can lead to various complications, including an increased risk for bleeding. Therefore, the primary nursing diagnosis for this particular deficiency would be "Risk for bleeding."

Based on the given protocol, the pump rate is adjusted based on the patient's PTT value. If the PTT is less than 35, the rate is increased by 4 units per kilogram per hour. If the PTT is between 35 and 45, the rate is increased by 2 units per kilogram per hour. If the PTT is between 45 and 60, the rate is increased by 2 units per kilogram per hour. If the PTT is between 60 and 80, there is no change in the rate. If the PTT is between 80 and 90, the rate is decreased by 2 units per kilogram per hour. Since the most recent PTT value is 45, the rate will be increased by 2 units per kilogram per hour. Therefore, the new pump rate will be 21.5 or 22 mls/hr.

A patient presenting with stroke-like symptoms should receive a CT scan right away. This is because a CT scan can quickly identify any bleeding or blockages in the brain, which are common causes of stroke. By obtaining a CT scan, healthcare professionals can determine the appropriate course of treatment for the patient, such as administering medication to dissolve a blood clot or performing surgery to remove a blockage. The CT scan provides crucial information that helps guide the immediate management of the patient's condition.

The flapping or tremoring hand motion is a sign of hepatic encephalopathy, which is directly related to the body's increase in ammonia due to the body's ineffective processing of protein. Hepatic encephalopathy is a condition that occurs when the liver is unable to remove toxins, such as ammonia, from the blood. Ammonia is a byproduct of protein metabolism, and when it builds up in the body, it can affect the brain and nervous system, leading to symptoms such as hand tremors. Therefore, the presence of flapping or tremoring hand motion suggests that the patient may be experiencing hepatic encephalopathy, which is directly related to the body's increase in ammonia due to ineffective processing of protein.