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Text Mode – Text version of the exam 1. During which stage of pressure ulcer development does the ulcer extend into the subcutaneous tissue? 2. During which stage of pressure ulcer development does the ulcer extend into the underlying structures, including the muscle and possibly the bone? 3. Which type of incontinence is associated with weakened perineal muscles that permit leakage of urine when intra-abdominal pressure is increased? 4. Ageism refers to 5. When assessing the older adult, the nurse anticipates increase in which of the follow components of respiratory status? 6. According to the classification of hypertension diagnosed in the older adult, hypertension that can be attributed to an underlying cause is termed 7. Which of the following terms refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? 8. Which of the following states is characterized by a decline in intellectual functioning? 9. When a person who has been taking opioids becomes less sensitive to their analgesic properties, that person is said to have developed a (an) 10. Prostaglandins are chemical substances thought to 11. Which of the following principles or guidelines accurately informs the nurse regarding placebos? 12. Regarding tolerance and addiction, the nurse understands that 13. The preferred route of administration of medication in the most acute care situations is which of the following routes? 14. Mu opioids have which of the following effects on respiratory rate: 15. Which of the following electrolytes is a major cation in body fluid? 16. Which of the following electrolytes is a major anion in body fluid? 17. Oncotic pressure refers to 18. Which of the following solutions is hypotonic? 19. The normal serum value for potassium is 20. In which type of shock does the patient experiences a mismatch of blood flow to the cells? 21. Which stage of shock is best described as that stage when the mechanisms that regulate blood pressure fail to sustain a systolic pressure above 90 mm Hg? 22. When the nurse observes that the patient’s systolic blood pressure is less than 80–90 mm Hg, respirations are rapid and shallow, heart rate is over 150 beats per minute, and urine output is less than 30 cc per hour, the nurse recognizes that the patient is demonstrating which stage of shock? 23. Which of the following vasoactive drugs used in treating shock results in reduced preload and afterload, reducing oxygen demand of the heart? 24. The nurse anticipates that the immunosuppressed patient is at greatest risk for which type of shock? 25. Which of the following colloids is expensive but rapidly expands plasma volume? 26. Which of the following terms refers to cells that lack normal cellular characteristics and differ in shape and organization with respect to their cells of origin? 27. Palliation refers to 28. During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? 29. The drug, Interleukin-2, is an example of which type of biologic response modifier? 30. Of the following terms, which is used to refer to the period of time during which mourning a loss takes place? 31. Which of the following “awareness contexts” is characterized by the patient, the family, and the health care professionals being aware that the patient is dying but all pretend otherwise? 32. For individuals known to be dying by virtue of age and/or diagnoses, which of the following signs indicate approaching death: 33. Which of the following terms best describes a living will? 34. A malignant tumor 35. Which of the following classes of antineoplastic agents is cell–cycle-specific? 36. Regarding the surgical patient, which of the following terms refers to the period of time that constitutes the surgical experience? 37. When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as 38. When a person with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the patient may show signs of alcohol withdrawal delirium during which time period? 39. Which of the following categories of medications may result in seizure activity if withdrawn suddenly? 40. When the patient is encouraged to concentrate on a pleasant experience or restful scene, the cognitive coping strategy being employed by the nurse is 41. According to the American Society of Anesthesiology Physical Status Classification System, a patient with severe systemic disease that is not incapacitating is noted to have physical status classification 42. Which stage of anesthesia is termed surgical anesthesia? 43. Fentanyl (Sublimaze) is categorized as which type of intravenous anesthetic agent? 44. Which of the following manifestations is often the earliest sign of malignant hyperthermia? 45. Which of the following terms is used to refer to protrusion of abdominal organs through the surgical incision? 46. When the method of wound healing is one in which wound edges are not surgically approximated and integumentary continuity is restored by granulations, the wound healing is termed 47. The nurse recognizes which of the following signs as typical of the patient in shock? 48. When the nurse observes that the postoperative patient demonstrates a constant low level of oxygen saturation, although the patient’s breathing appears normal, the nurse identifies that the patient may be suffering which type of hypoxemia? 49. When the surgeon performs an appendectomy, the nurse recognizes that the surgical category will be identified as 50. Which of the following terms is used to describe inability to breathe easily except in an upright position?Practice Mode
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Clinically, a deep crater with or without undermining of adjacent tissues is noted.
A stage IV pressure ulcer extends into the underlying structure, including the muscle and possibly the bone.
A stage II ulcer exhibits a break in the skin through the epidermis or dermis.
A stage I pressure ulcer is an area of nonblanchable erythema, tissue swelling, and congestion, and the patient complains of discomfort.
A stage IV pressure ulcer extends into the underlying structure, including the muscle and possibly the bone.
A stage III ulcer extends into the subcutaneous tissue.
A stage II ulcer exhibits a break in the skin through the epidermis or dermis.
A stage I pressure ulcer is an area of nonblanchable erythema, tissue swelling, and congestion, and the patient complains of discomfort.
Stress incontinence may occur with coughing or sneezing.
Urge incontinence is involuntary elimination of urine associated with a strong perceived need to void.
Neurogenic incontinence is associated with a spinal cord lesion.
Functional incontinence refers to incontinence in patients with intact urinary physiology who experience mobility impairment, environmental barriers, or cognitive problems.
Individuals demonstrating ageism base their beliefs and attitudes about older people based upon chronological age without consideration of functional capacity.
Fear of aging and the inability of many to confront their own aging process may trigger ageist beliefs.
Age-related loss of memory occurs more with short-term and recent memory.
Benign senescent forgetfulness refers to the age-related loss of memory in the absence of a pathologic process.
As a result, patient experience fatigue and breathlessness with sustained activity.
The nurse anticipates decreased vital capacity.
The nurse anticipates decreased gas exchange and diffusing capacity resulting in impaired healing of tissues due to decreased oxygenation.
The nurse anticipates difficulty coughing up secretions due to decreased cough efficiency.
Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromacytoma).
Primary hypertension has no known underlying cause.
Essential hypertension has no known underlying cause.
Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).
Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects.
Presbycusis refers to age-related hearing loss.
Cataract is the development of opacity of the lens of the eye.
Glaucoma is a disease characterized by increased intraocular pressure.
Dementia is an acquired syndrome in which progressive deterioration in global intellectual abilities is of such severity that it interferes with the person’s customary occupational and social performance.
Depression is a mood disorder that disrupts quality of life.
Delirium is often called acute confusional state.
Delusion is a symptom of psychoses.
Tolerance is characterized by the need for increasing dose requirements to maintain the same level of pain relief.
Addiction refers to a behavioral pattern of substance use characterized by a compulsion to take the drug primarily to experience its psychic effects.
Dependence occurs when a patient who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued.
Balanced analgesia occurs when the patient is using more than one form of analgesia concurrently to obtain more pain relief with fewer side effects.
Prostaglandins are believed to increase sensitivity to pain receptors by enhancing the pain-provoking effect of bradykinin.
Endorphins and enkephalins reduce or inhibit transmission or perception of pain.
Endorphins and enkephalins reduce or inhibit transmission or perception of pain.
Morphine and other opioid medications inhibit the transmission of noxious stimuli by mimicking enkephalin and endorphin.
Perception of pain is highly individualized.
A placebo effect is a true physiologic response.
A placebo should never be used as a first line of treatment.
Reduction in pain as a response to placebo should never be interpreted as an indication that the person’s pain is not real.
Physical tolerance usually occurs in the absence of addiction.
Tolerance to opioids is common.
Addiction to opioids is rare.
Addiction is rare and should never be the primary concern for a patient in pain.
The IV route is the preferred parenteral route in most acute care situations because it is much more comfortable for the patient, and peak serum levels and pain relief occur more rapidly and reliably.
Epidural administration is used to control postoperative and chronic pain.
Subcutaneous administration results in slow absorption of medication.
Intramuscular administration of medication is absorbed more slowly than intravenously administered medication.
Mu opioids also cause bradycardia, hypothermia, and constipation.
Kappa opioids result in no change in respiratory rate.
Delta opioids result in stimulation of respiratory rate.
Neither mu, nor kappa, nor delta opoids depress respiratory rate as its only effect upon respiratory rate.
Potassium is a major cation that affects cardiac muscle functioning.
Chloride is an anion.
Bicarbonate is an anion.
Phosphate is an anion.
Chloride is a major anion found in extracellular fluid.
Potassium is a cation.
Sodium is a cation.
Calcium is a cation.
Oncotic pressure is a pulling pressure exerted by proteins, such as albumin.
Osmolality refers to the number of dissolved particles contained in a unit of fluid.
Osmotic diuresis occurs when the urine output increases due to excretion of substances such as glucose.
Osmotic pressure is the amount of pressure needed to stop the flow of water by osmosis.
Half-strength saline is hypotonic
Lactated Ringer’s is isotonic.
Normal saline (0.9% NaCl) is isotonic.
A solution that is 5% NaCl is hypertonic.
Serum potassium must be within normal limits to prevent cardiac dysrhythmias.
Normal serum sodium is 135-145 mEq/L.
Normal serum chloride is 96-106 mEq/L.
Normal total serum calcium is 8.5-10.5mg/dL.
Distributive or vasogenic shock results from displacement of blood volume, creating a relative hypovolemia.
Cardiogenic shock results from the failure of a heart as a pump.
In hypovolemic shock, there is a decrease in the intravascular volume.
In septic shock, overwhelming infection results in a relative hypovolemia.
In the progressive stage of shock, the mechanisms that regulate blood pressure can no longer compensate, and the mean arterial pressure falls below normal limits.
The refractory or irreversible stage of shock represents the point at which organ damage is so severe that the patient does not respond to treatment and cannot survive.
In the compensatory state, the patient’s blood pressure remains within normal limits due to vasoconstriction, increased heart rate, and increased contractility of the heart.
The refractory or irreversible stage of shock represents the point at which organ damage is so severe that the patient does not respond to treatment and cannot survive.
In compensatory shock, the patient’s blood pressure is normal, respirations are above 20, and heart rate is above 100 but below 150.
In progressive shock, the patient’s skin appears mottled and mentation demonstrates lethargy.
In refractory or irreversible shock, the patient requires complete mechanical and pharmacologic support.
In refractory or irreversible shock, the patient requires complete mechanical and pharmacologic support.
A disadvantage of nitroprusside is that it causes hypotension.
Dopamine improves contractility, increases stroke volume, and increases cardiac output.
Epinephrine improves contractility, increases stroke volume, and increases cardiac output.
Methoxamine increases blood pressure by vasoconstriction.
Septic shock is associated with immunosuppression, extremes of age, malnourishment, chronic illness, and invasive procedures.
Neurogenic shock is associated with spinal cord injury and anesthesia.
Cardiogenic shock is associated with disease of the heart.
Anaphylactic shock is associated with hypersensitivity reactions.
Albumin is a colloid that requires human donors, is limited in supply, and can cause congestive heart failure.
Dextran is a colloid, synthetic plasma expander that interferes with platelet aggregation and is not recommended for hemorrhagic shock.
Lactated ringers is a crystalloid, not a colloid.
Hypertonic saline is a crystalloid, not a colloid.
Usually, anaplastic cells are malignant.
Neoplasia refers to uncontrolled cell growth that follows no physiologic demand.
Dysplasia refers to bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same type of tissue.
Hyperplasia refers to an increase in the number of cells of a tissue, most often associated with a period of rapid body growth.
Palliation is the goal for care in terminal cancer patients.
Alopecia is the term that refers to hair loss.
Metastasis is the term that refers to the spread of cancer cells from the primary tumor to distant sites.
Nadir is the term that refers to the lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow.
During this third step, cells show a propensity to invade adjacent tissues and metastasize.
During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information even after long latency periods.
During this first step, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA.
No stage of cellular carcinogenesis is termed prolongation.
Other cytokines include interferon alfa and filgrastim.
Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab.
Retinoic acid is an example of a retinoid.
Antimetabolites are cell cycle-specific antineoplastic agents.
Bereavement is the period of time during which mourning a loss takes place.
Grief is the personal feelings that accompany an anticipated or actual loss
Mourning is the individual, family, group and cultural expressions of grief and associated behaviors
In mutual pretense awareness, the patient, the family and the health care professionals are aware that the patient is dying but all pretend otherwise.
In closed awareness, the patient is unaware of his terminality in a context where others are aware.
In suspected awareness, the patient suspects what others know and attempts to find it out.
In open awareness, all are aware that the patient is dying and are able to openly acknowledge that reality.
As the oxygen supply to the brain decreases, the patient may become restless.
As the body weakens, the patient will sleep more and begin to detach from the environment.
For many patients, refusal of food is an indication that they are ready to die.
Based upon decreased intake, urinary output generally decreases in amount and frequency.
The living will is a type of advance medical directive in which the individual of sound mind documents treatment preferences.
A proxy directive is the appointment and authorization of another individual to make medical decisions on behalf of the person who created anadvance directive when he/she is no loner able to speak for him/herself.
Health care power of attorney is a legal document that enables the signer to designate another individual to make health care decisions on his/her behalf when he/she is unable to do so.
A durable power of attorney for health care is a legal document that enables the signer to designate another individual to make health care decisions on his/her behalf when he/she is unable to do so.
By this mechanism, the tumor metastasizes to other areas of the body.
Cells of malignant tumors are undifferentiated.
Malignant tumors demonstrate variable rate of growth; however, the more anaplastic the tumor, the faster its growth.
A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.
Antimetabolites are cell–cycle-specific (S phase).
Antitumor antibiotics are cell-cycle nonspecific.
Alkylating agents are cell-cycle nonspecific.
Nitrosureas are cell-cycle nonspecific.
Perioperative period includes the preoperative, intraoperative, and postoperative phases.
Preoperative phase is the period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table.
Intraoperataive phase is the period of time from when the patient is transferred to the operating room table to when he or she is admitted to the postanesthesia care unit.
Postoperative phase is the period of time that begins with the admission of the patient to the postanesthesia care unit and ends after a follow-up evaluation in the clinical setting or home.
Emergency surgery means that the patient requires immediate attention and the disorder may be life-threatening.
Urgent surgery means that the patient requires prompt attention within 24-30 hours.
Required surgery means that the patient needs to have surgery, and it should be planned within a few weeks or months.
Elective surgery means that there is an indication for surgery, but failure to have surgery will not be catastrophic.
Alcohol withdrawal delirium is associated with a significant mortality rate when it occurs postoperatively.
Onset of symptoms depends upon time of last consumption of alcohol.
Onset of symptoms depends upon time of last consumption of alcohol.
Twenty-four hours is too short a time frame to consider alcohol withdrawal delirium no longer a threat to a chronic alcoholic.
Abrupt withdrawal of tranquilizers may result in anxiety, tension, and even seizures if withdrawn suddenly.
Abrupt withdrawal of steroids may precipitate cardiovascular collapse.
Monoamine oxidase inhibitors increase the hypotensive effects of anesthetics.
Thiazide diuretics may cause excessive respiratory depression during anesthesia due to an associated electrolyte imbalance.
Imagery has proven effective for oncology patients.
Optimistic self-recitation is practiced when the patient is encouraged to recite optimistic thoughts such as “I know all will go well.”
Distraction is employed when the patient is encouraged to think of an enjoyable story or recite a favorite poem.
Classification P3 patients are those who have compensated heart failure, cirrhosis, or poorly controlled diabetes, for example.
Classification P4 patients have an incapacitating systemic disease that is a constant threat to life.
Classification P1 refers to a normal healthy patient
Classification P2 reflects a patient with mild systemic disease
With proper administration of the anesthetic, this stage may be maintained for hours.
Stage I is beginning anesthesia, as the patient breathes in the anesthetic mixture and experiences warmth, dizziness, and a feeling of detachment.
Stage II is the excitement stage, which may be characterized by struggling, singing, laughing, or crying.
Stage IV is a stage of medullary depression and is reached when too much anesthesia has been administered.
Fentanyl is 75-100 times more potent than morphine and has about 25% of the duration of morphine (IV).
Examples of tranquilizers include midazolam (Versed) and diazepam (Valium).
Opioids include morphine and meperidine hydrochloride (Demerol).
Ketamine is a dissociative agent.
Tachycardia is often the earliest sign of malignant hyperthermia.
Hypotension is a later sign of malignant hyperthermia.
The rise in temperature is actually a late sign that develops rapidly.
Scant urinary output is a later sign of malignant hyperthermia.
Evisceration is a surgical emergency.
A hernia is a weakness in the abdominal wall.
Dehiscence refers to partial or complete separation of wound edges.
Erythema refers to redness of tissue.
When wounds dehisce, they will be allowed to heal by secondary intention.
Primary or first intention healing is the method of healing in which wound edges are surgically approximated and integumentary continuity is restored without granulating.
Primary or first intention healing is the method of healing in which wound edges are surgically approximated and integumentary continuity is restored without granulating.
Third intention healing is a method of healing in which surgical approximation of wound edges is delayed and integumentary continuity is restored by bringing apposing granulations together.
Pulse increases as the body tries to compensate.
Pallor is an indicator of shock.
Skin is generally cool and moist in shock.
Usually, a low blood pressure and concentrated urine are observed in the patient in shock.
Supplemental oxygen may be indicated.
Hypoxic hypoxemia results from inadequate breathing.
Episodic hypoxemia develops suddenly, and the patient may be at risk for myocardial ischemia, cerebral dysfunction, and cardiac arrest.
Anemic hypoxemia results from blood loss during surgery.
Clean-contaminated cases are those with a potential, limited source for infection, the exposure to which, to a large extent, can be controlled.
Clean cases are those with no apparent source of potential infection.
Contaminated cases are those that contain an open and obvious source of potential infection.
A traumatic wound with foreign bodies, fecal contamination, or purulent drainage would be considered a dirty case.
Patients with orthopnea are placed in a high Fowler’s position to facilitate breathing.
Dyspnea refers to labored breathing or shortness of breath.
Hemoptysis refers to expectoration of blood from the respiratory tract.
Medical-Surgical Nursing Exam 12
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