Editing Medical-Surgical Nursing – RN Flashcards

Flashcards at registered nurse depth for medical-surgical nursing. Cover the answer, state it aloud, then check. Focus on the reasoning, not just the fact.

== Cardiovascular ==

;Troponin timing after myocardial injury
:Begins to rise about 3 to 4 hours after injury, peaks around 12 to 24 hours, and stays elevated up to 10 to 14 days. A single early normal value does not rule out infarction, so serial levels are drawn.

;Why nitroglycerin is absolutely contraindicated with sildenafil or tadalafil
:Both are vasodilators. Combined within 24 to 48 hours they cause profound, refractory hypotension. Always ask about phosphodiesterase type 5 inhibitor use before giving nitrates.

;Earliest sign of decreased cardiac output the nurse can detect at the bedside
:Change in level of consciousness such as restlessness or confusion, with narrowing pulse pressure and urine output falling below about 30 mL per hour. Hypotension is a late finding.

;Distinguishing left-sided from right-sided heart failure
:Left-sided backs up into the lungs, producing crackles, orthopnea, paroxysmal nocturnal dyspnea, and an S3 gallop. Right-sided backs up systemically, producing jugular venous distention, peripheral and sacral edema, hepatomegaly, and ascites.

;Heart failure teaching point that most reduces readmission
:Daily morning weight after voiding, before breakfast, same scale and clothing, with a call to the provider for a gain of 2 to 3 pounds in a day or 5 pounds in a week.

;Signs of digoxin toxicity and the factor that potentiates it
:Anorexia, nausea, vomiting, yellow-green halos or blurred vision, confusion, bradycardia, and new dysrhythmias. Hypokalemia, often from loop diuretics, potentiates toxicity even at a therapeutic drug level of roughly 0.5 to 2.0 ng/mL.

;Why atrial fibrillation causes stroke and what that means for care
:Blood stagnates in the fibrillating atria and forms thrombi that embolize to the brain. Anticoagulation, not just rate control, is the priority intervention, and the nurse assesses apical and radial rates for a pulse deficit.

== Respiratory ==

;Meaning of a suddenly quiet chest in a patient with severe asthma
:Airflow has become so limited that no wheeze can be generated. It signals impending respiratory failure and requires immediate escalation, not reassurance.

;Oxygen target in advanced chronic obstructive pulmonary disease and the reason
:Roughly 88 to 92 percent. Excess oxygen worsens ventilation-perfusion matching and can blunt respiratory drive in chronic carbon dioxide retainers, but oxygen is never withheld from a hypoxemic patient.

;Continuous bubbling in the water seal chamber of a chest drainage system
:Indicates an air leak in the system. Assess the dressing, insertion site, connections, and tubing. Never clamp for a prolonged period, because that can create a tension pneumothorax, and never strip or milk the tubing.

;Tuberculosis medication adverse effects the nurse teaches
:Rifampin turns body fluids orange and reduces oral contraceptive effectiveness. Isoniazid is hepatotoxic and causes peripheral neuropathy, prevented with pyridoxine. Pyrazinamide is hepatotoxic and raises uric acid. Ethambutol causes optic neuritis, so any vision or color change is reported.

== Renal and Endocrine ==

;Most immediately lethal complication of acute kidney injury and the treatment sequence
:Hyperkalemia. Calcium gluconate stabilizes the myocardium but does not lower potassium. Insulin with dextrose, beta agonists, and bicarbonate shift potassium into cells. Binders and dialysis actually remove it.

;Why phosphate binders are given with meals in chronic kidney disease
:They bind dietary phosphorus in the gut so it is excreted in stool rather than absorbed. Given between meals they have no phosphorus to bind and are ineffective.

;Order of treatment in diabetic ketoacidosis
:Isotonic intravenous fluids first, then a regular insulin infusion, with continuous potassium monitoring. Withhold insulin and replace potassium first if the serum potassium is below about 3.3 mEq/L, and add dextrose to the fluids when glucose falls to roughly 200 to 250 mg/dL.

;How hyperosmolar hyperglycemic state differs from diabetic ketoacidosis
:It occurs in type 2 diabetes with glucose often above 600 mg/dL, profound dehydration, and altered mentation, but without significant ketosis or acidosis, because residual insulin is enough to suppress lipolysis. Fluid resuscitation is the mainstay.

;Priorities in the first 24 hours after thyroidectomy
:Airway and hemorrhage. Keep a tracheostomy tray and suction at the bedside, check behind the neck and on the pillow for bleeding, support the head when repositioning, assess voice quality for laryngeal nerve injury, and watch for hypocalcemia from parathyroid injury.

;Findings of Addisonian crisis
:Profound hypotension and shock with hyponatremia, hyperkalemia, hypoglycemia, and hypovolemia, often triggered by stress, infection, or abrupt steroid withdrawal. Treatment is immediate intravenous fluids with sodium and glucose plus intravenous hydrocortisone.

== Neurologic and Musculoskeletal ==

;Earliest sign of increased intracranial pressure
:A change in level of consciousness, including restlessness, irritability, or confusion. Cushing triad, which is rising systolic pressure with widening pulse pressure, bradycardia, and irregular respirations, is a late sign of impending herniation.

;Nursing measures that lower intracranial pressure
:Head of bed about 30 degrees, head midline and neutral, avoid hip and neck flexion, prevent Valsalva, cluster care, keep suctioning brief with preoxygenation, control fever and pain, and give osmotic diuretics as ordered. Avoid hypotonic fluids.

;First diagnostic priority in suspected stroke and why
:Noncontrast computed tomography of the head, to distinguish ischemic from hemorrhagic stroke. Thrombolysis saves lives in ischemic stroke and is lethal in hemorrhagic stroke. Alteplase is given to eligible ischemic patients generally within 3 to 4.5 hours of last known well.

;Behavioral differences between right and left hemisphere stroke
:Left hemisphere stroke causes right-sided weakness, aphasia, and slow cautious behavior. Right hemisphere stroke causes left-sided weakness, unilateral neglect, impulsivity, and poor safety judgment, which makes falls a major risk.

;Emergency sequence for autonomic dysreflexia
:Sit the patient upright immediately, loosen constrictive clothing, then find and remove the noxious stimulus, most often a distended bladder or fecal impaction, and notify the provider. It occurs with injury at or above the sixth thoracic vertebra and can cause stroke or death.

;Earliest reliable indicator of compartment syndrome
:Pain out of proportion to the injury, unrelieved by opioids and worsened by passive stretch, with paresthesia. Pulselessness is a very late sign. Keep the extremity at heart level, never above, and notify the provider immediately.

== Perioperative, Shock, and Safety ==

;Nursing response to evisceration
:Cover the viscera with sterile gauze moistened with sterile normal saline, place the patient in low Fowler position with knees slightly bent, keep the patient nothing by mouth, monitor for shock, stay with the patient, and notify the surgeon immediately. Never attempt to reinsert the organs.

;Two shock types that do not present with cool clammy skin
:Neurogenic shock, which presents warm, dry, and bradycardic, and early septic shock, which presents warm and flushed with bounding pulses before progressing to the classic cold picture.

;Time-critical sepsis bundle elements
:Obtain blood cultures before antibiotics when it does not delay care, give broad-spectrum antibiotics within the first hour, give rapid crystalloid resuscitation, measure and remeasure lactate, and add vasopressors if hypotension persists after fluids.

;Parkland formula and its timing pitfall
:4 mL of lactated Ringer solution per kilogram per percent of total body surface area burned in the first 24 hours, with half given in the first 8 hours calculated from the time of injury, not from arrival, and the balance over the next 16 hours. Titrate to urine output of about 30 to 50 mL per hour.

;Actions when a transfusion reaction is suspected
:Stop the transfusion immediately, keep the line open with normal saline using new tubing, take vital signs, assess the patient, and notify the provider and blood bank. Acute hemolytic reaction presents with fever, chills, flank or low back pain, hypotension, and dark urine.

;Why rectal temperatures and suppositories are avoided in neutropenia and thrombocytopenia
:They cause mucosal trauma, which allows bacterial translocation into the bloodstream in neutropenia and causes bleeding in thrombocytopenia. Fever in a neutropenic patient is an emergency, because it may be the only sign of infection.

;Meaning of new confusion in a hospitalized older adult
:Delirium until proven otherwise, and it is a symptom of an underlying problem such as infection, hypoxia, medication effect, pain, urinary retention, or electrolyte imbalance. It is never dismissed as normal aging or assumed to be dementia.

[[Category:Medical-Surgical Nursing]]
[[Category:Registered Nurse (NCLEX-RN)]]
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