SE5l, Medical-Surgical Review Curse PowerPoint

SE5l, Medical-Surgical Review curse PowerPoint.
pdf
Medical-Surgical Nursing
Certification Review
SE5l, Medical-Surgical Review curse PowerPoint.pdf
CMSRN Exam
Given four times a year

Spring (usually May)
Fall (usually October)
AMSN Annual Convention
(usually September)
Nursing 200x Symposium in the
Spring
AMSN Nursing Practice Roles
Helping Role 17% (32-36)

Teaching/coaching role 17% (32-36)
Diagnostic and Patient Monitoring Role
25% (38-42)
Administering and Monitoring
Therapeutic Intervention 25% (58-62)
AMSN Nursing Practice Roles
Effective Management of Rapidly

Changing Situations 10% (18-22)
Monitoring/Ensuring Quality Health
Care Practice 3% (4-7)
Organizational and Work-Role
Competencies 3% (4-7)
Distribution Patient Problem
GI 19% (36-40)
Pulmonary 19% (36-40)
Cardiovascular 15% (28-32)
Diabetes/Other endocrine 15% (28-32)
Distribution Patient Problem
Renal/GU-12%(22-29)
Musculoskeletal/Neuro 11%
(20-24)
Hematological / Immune /
Integumentary 9% (16-20)
Preparing for the Test

Medsurg Nursing Certification
Board Requirements CMSRN
credential
Minimum of 3,000 hours in Medsurg
nursing as a staff nurse, clinical nurse
specialist, clinical educator, faculty,
manager, or supervisor.
Practice in medical-surgical nursing

for at least two full years of the past
five years
Registered Nurse

Contacting Medical- Surgical
Nursing Certification Board
MSNCB Home Office
East Holly Avenue, Box 56, Pitman, NJ
08071-0056
Phone: 856-256-2323 or Toll free 866877-2676
Fax: 856-589-7463 (fax)
E-mail: msncb@ajj.com
http://www.medsurgnurse.org
9
Publications to review
Scope and Standards for MedicalSurgical Nursing Practice

ANA Code for Nurses
Human Rights Guidelines for Nurses in
Clinical and other Research
10
AMSN Core Curriculum for MedicalSurgical Nursing

Medical Surgical Nursing Review
Questions
Review Course
Examination Prep Guide
Your nursing experience
11
Test Taking Tips
Read questions all the way through

Eliminate obvious wrong answers
Take moment to relax occasionally
Have good reason to change answers
12
Stress Reduction
Review prior to exam, but dont cram

especially the night before (raises
stress levels making it more difficult)
Take time during the exam to take deep
breaths and relax.
You will have 4 hours to take the exam
which has 200 questions plenty of
time!
13
A patient begins to experience a severe GI

bleed. The plan of care to meet the
patients fluid needs should include, as a
priority, planning for which of the following?
A. Provision for skin care

B. Monitoring vital signs frequently
C. Decreasing PH of gastric fluids
D. Rapid infusion of IV blood and fluids
14
To prevent complications on the third day

after an uncomplicated acute MI, the nurse
would implement which action?
A. Monitor the patients ability to perform
activities of daily living without shortness
of breath
B. Accompany the patient ambulating for a
short distance at least each shift
C. Apply anti-embolic hose to the legs
D. Give the patient a nitroglycerin sublingual
to prevent chest pain before all out of bed
activities
15
A patient is having a seizure activity. What

should the nurse do during this activity?
A. Insert an oropharyngeal airway
B. Promote safety of body systems
C. Protect the patients head on a pillow
D. Observe the length and after effects of the
seizure
16
A patient in acute renal failure developed

acute pulmonary edema. Which of the
following interventions would be
inappropriate to include in the patients
care?
A. Administration of oxygen at 3 L/min per
nasal cannula
B. Administration of morphine and
Furosemide (Lasix)
C. Place the patient in high Fowlers position
D. Replace fluids with normal saline
17
Fluids and Electrolytes
18
Fluid
Intracellular
Body water
Extracellular
Body water
19
Electrolytes
Same electrolytes in
intracellular space as
in extracellular space
Always measure
extracellular space
20
Sodium
Necessary for protein synthesis

Fluid volume in extracellular spaces
21
Hyponatremia
Dilutional most common
Excessive fluid intake

Edema, confusion
Treatment decrease fluid intake
True
Fluid and sodium loss

Dry tissue
Treatment replace both sodium and
water
22
Hypernatremia
Most common, fluid loss without loss

of sodium
Dry tissue
Treatment replace fluids
Increased sodium with diet rare could

occur with full strength high protein
tube feeding
23
Potassium
Irritant at neuromuscular junction

Increased muscular irritability
24
Hyperkalemia
Causes cell wall destruction,

increased intake, renal failure
Symptoms irritable muscles
Treatment Kayexalate, calcium

gluconate, insulin
25
Hypokalemia
Increased loss of potassium

or increased fluid
Muscle
flaccidity
Treatment potassium supplements
IV
Oral
26
Calcium
Sedative at the neuro level

Necessary for coagulation
27
Hypercalcemia
Increased intake, hyperparathyroidism

Symptoms
Sedation
Treatment
Decrease calcium intake
28
Hypocalcemia
Decreased calcium intake, increased

phosphate levels, renal disease
Hyperactive deep tendon reflexes
Chvosteks
Trousseaus
Laryngospasm
29
Phosphate
Informal inverse relationship with

calcium
Symptoms may be opposite of
calcium (hypophosphatemia looks like
hypercalcemia, etc)
30
Magnesium
Hypermagnesemia
Usually poor renal excretion
Muscular depression
Hypomagnesemia
Hyperactive
deep tendon reflexes
31
Serum Osmolality
2(Na) + BUN/5 + glucose/20 = 275-295

mOsm/l
Quick and dirty 2(Na)
Higher the number, dryer the patient
32
IV Fluids
Hypertonic = above 295 mOsm/L
Isotonic = 275 295 mOsm/L
D5LR, D5NS
NS, LR
Hypotonic = below 275 mOsm/L

NS
33
A patient experiencing a sodium imbalance

must be assessed for which of the following
symptoms?
A. Changes in level of consciousness

B. Irritability of skeletal muscles
C. Depression of deep tendon reflexes
D. Evidence of acid-base imbalances
34
A patient who is severely dehydrated would

most likely be treated initially with which of the
following IV solutions?
A. Hypertonic
B. Isotonic
C. Hypotonic
D. Colloidal
35
Which of the following assessment data are

consistent with hypovolemia?
A. Increased pulse and a swollen tongue

B. Neck vein distention and dry skin
C. Weight loss and thirst
D. Increased blood pressure and a fever
36
Which of the following sets of signs and

symptoms would be exhibited by a patient with
a serum potassium of 6.8 mEq/L?
A. Bradycardia and constipation

B. Confusion and muscle cramps
C. Paralytic ileus and paresthesias
D. Diarrhea and spastic paralysis
37
38
Immune System
Leukocytes
A. Granulocytes
1. Neutrophils first line of
defense against bacteria
2. Eosinophils phagocytize
antigen-antibody complexes
3. Basophils- contain
histamine and heparin
39
Immune System
B. Nongranulocytes
1) Monocytes phagocytize
bacteria
2) Lymphocytes provide
immunity against foreign
invaders including transplants
C. Immune Response
1) Humoral B lymphocytes,
memory
2) Cellular T lymphocytes,
foreign invaders
40
Compromised
Immune System
Steroids
suppression of system
Chemotherapy
41
Acquired Immune
Deficiency Syndrome
In 2009
33.3 million people worldwide living
with AIDS
2.6 million new infections this year
Women and those 15-24 accounted for
50% of infections
Project that by 2012 100 million people
will be infected
42
Transmission of AIDS
Blood
Semen
Vaginal fluids
Breast milk
Transplacental ?
Transmitted even when asymptomatic
43
Pathophysiology
Retrovirus, part of the Lentivirius family

Infects CD4 lymphocytes
Carries genetic information on RNA into
the cells DNA
CD4 cells, necessary to immune function,
decrease in numbers in acute phase
44
CD 4 Classification of AIDS
> 500 CD4 cells /micro L
Category I:
Category II: 200-400 CD4 cells/ micro L
Category III:
< 200 CD4 cells/ micro L
45
Clinical Classification of AIDS
Clinical Category A= asymptomatic or

have persistent generalized
lymphadenopathy or symptoms of primary
HIV infection
Clinical category B= symptoms of immune
deficiency not serious enough to be AIDS
defining
Clinical Category C= AIDS-defining illness
46
Treatment of AIDS
Prevention
Optimal treatment includes combination of
at least 3 drugs, often referred to as
HAART
Reverse transcriptase inhibitors
Protease inhibitors
Fusion inhibitors
47
Hematologic System
Erythrocytes: 120 day life span

Requires erythropoietin from kidneys
(80%) and liver (20%)
Thrombocytes: 7.5 day life span, 1/3
sequestered in spleen. Increased blood
platelet level following splenectomy
a. Clotting cascade
Extrinsic
Intrinsic
Enzymes
48
White blood cells

Neutrophils- first line of defense against
bacteria
Immature
cells are Bands
Eosinophils- break down antigen/antibody

complex
Basophils- work to keep blood flowing

through micro-vascular system
Monocytes-effective bacterial macrophage
49
Lymphocytes:
T-lymphocytes-react against foreign or
abnormal cells
B-lymphocytes- becomes antibodies when
exposed to something seen as a long term
threat
50
Assessment
History
Objective information
Physical
assessment
Diagnostic studies
51
Hematologic concerns
Anemia
Blood loss, Hemolytic
Sickle cell
Iron deficiency
Pernicious
Disseminated Intravascular coagulation
Hodgkins
52
Sam Andrew had just been diagnosed with

pernicious anemia following his gastric
resection. He asked how long he will need to
take the vitaminnB12. You tell him hell need to
continue:
A. Until his anemia is corrected
B. For the rest of his life
C. It depends on his physicians assessment of
him
D. Its different in everyone
53
A.
B.
C.
D.
Which of the following laboratory results

would be considered the most indicative of
DIC?
High platelet count
Elevated blood glucose
Increased bleeding times
Presence of fibrin degradation products
(FDP)
54
Cardiovascular system
55
Anatomy and Physiology

A. Heart: atria, ventricles, valves,
coronary circulation, cardiac,
conduction system
B. Cardiac Cycle: Systole, diastole
C. Peripheral vascular system:
Veins, arteries, arterioles, venioles,
capillaries
56
57
58
59
CO=HR
SV
Stroke
volume
Preload
Afterload
Contractility
Heart Rate
Impact of the ANS
60
Assessment:
Nursing History
Past medical
Diet
Medication
Pain
Edema
Other
61
Chest Pain
Description?
Location?
Does it radiate?
What causes it?
What causes it worse?
What makes it better?
62
Physical Assessment
Inspection
Edema, skin assessment, hair
growth
Palpation
Peripheral pulses, PMI
63
Heart sounds
Normal
S1
S2
Abnormal
S3 lub DUB dub
S4 lub dub DUB
Murmurs
Friction rub
64
Diagnostic studies
Cardiac enzymes & proteins

Troponins
CPK-MB, myoglobin, troponins
LDH
Doppler ultrasound
ECHO:TEE
Thallium imaging
Pericardial fluid analysis
65
Diagnostic procedures
Electrocardiogram
Electrophysiology
Echocardiography
Stress test
Doppler Ultrasound
Cardiac Catheterization
66
Acute Coronary Syndromes (ACS)

Sudden Death
Stable Angina
Coronary
Arterial
Thrombosis
Non-ST-Elevation
MI
STElevation MI
Sudden Death
67
ECG Changes Consistent with

ACS
68
Anti- ischemic Options

Nitrates
Dilate blood vessels; relaxes and expands

artery, increasing blood flow
Morphine
Pain relief, Dilate blood vessels; relaxes and

expands artery, including blood flow
Beta blockers
ACE inhibitors
Calcium blockers
Slows pumping action of the heart, reduce

oxygen requirements
Dilate blood vessels, prevent fluid retention, and
ease the workload of the heart
Dilate blood vessels and reduce vascular
smooth-muscle contraction
69
Antiplatelets and Antithrombin Agents
Salicylates: Aspirin
ADP-receptor inhibitors: Clopidogrel
Glycoprotein(GP) Iib-IIIa receptor antagonists
Heparin-unfractionated heparin (UFH)
Low- Molecular weight heparins (LMWH) with
UA/NSTEMI indications
Enoxaparin
Dalteparin
Direct- acting Antithrombins
Bivalirudin
Argatrobran
Lepirudin
70
CV Conditions
CHF
Diuretics,
ACE Inhibitors, Digitalis, Beta
Blockers
BNP- Brain Naturetic Peptide
Hypertension
Highest Risk: African American males in
southeast United States
Weight loss- diet management; exercise,
Diuretics, Ace inhibitors, Beta blockers,
Angiotensin 2 receptor blockers
71
CV conditions
Chronic Peripheral Circulatory Disease
Arterial(
PAD-peripheral arterial disease):

Thrombolytics, antiplatelet aggregates,
revascularization-stents, arterioplasty,
bypass grafting
Venous )PVD-peripheral venous disease):
elevation, wound prevention- assessmentmanagement, antiplatelet aggregates
DVT: Heparin, LMWH, warfarin, labs:
PT/PTT/INR, D-dimer: SVC filter
72
Which of the following complications would

likely to happen in a client receiving both a
calcium channel blocker and Lanoxin?
A.
B.
C.
D.
A change in the blood pressure

A decrease in the pulse rate
An increase in respiratory rate
Presence of a systolic murmur
73
You are caring for a patient post MI, who

suddenly develops bradycardia and
hypotension. What is the likely cause?
A.
B.
C.
D.
Anxiety reaction
Cardiogenic shock
Medication overdose
Pulmonary edema
74
Mr. Jones, just returning from a coronary

angiogram, develops bradycardia and a
narrowing pulse pressure. What is the
most likely cause?
A. Cardiac tamponade
B. Positional hypotension
C. Myocardial infarction
D. Anaphylactic shock
75
Which of the following antihypertensive

should be avoided in a person with
diabetes?
A.
B.
C.
D.
Calcium channel blockers

Beta Blockers
ACE inhibitors
Nitrates
76
Cancer
Uncontrolled growth of cells Due
to alteration in cells genes

Immune system fails to destroy
Etiologic factors
Chemicals
Radiation
Viruses
Host-related
factors (tobacco use etc)
77
Cancer Prevention
Age
Sex
Geographical
location
Racial or ethnic
origin
Familial tendency
Environmental
Lifestyle
Tobacco use
Diet
Alcohol
Occupational risks
Biological risks
Iatrogenic risks
Psychosocial
78
Cancer screening and early

Detection
Early detection-attempt to diagnose at

a curable stage
Secondary prevention- to identify and treat
before disease is symptomatic thus halting
the disease
Health promotion requires consumer
involvement
79
Therapeutic modalities
Surgery- for staging and treatment

Radiation-Side effects at site of radiation
Biologic therapy-alter host responses to
malignant cells
Chemotherapy- use of chemical agents
80
Sue Lynn, a 50 year old diagnosed with an

autoimmune disorder, asks what that
means. You tell her:
1.
2.
3.
4.
The bodys ability to fight off infections has been

lost
She is experiencing an increase in one white
cell line
Her immune system is attacking her own body
cells
It is a short lived event which will make her
susceptible to bruising
81
Which of the following sets of signs and

symptoms would be exhibited by a patient
with a serum potassium of 6.8 MEq/l?
A.
B.
C.
D.
Bradycardia and constipation

Confusion and muscle cramps
Paralytic ileus and paresthesia
Diarrhea and GI spasms
82
A patient on your unit has been diagnosed

with AIDS. He expresses concerns for
your safety during his am care. You would
state:
1. lets talk about what we can call body
substance isolation
2. Youre not bleeding so theres no risk
3. Its just part of my job, so I dont think
about it.
4. It is scary, but you deserve my care
83
Gastrointestinal system
84
History and subjective assessment
Past history of GI disorders, Surgery, allergy,

lactose intolerance
Pain: location and r/t eating (full or empty
stomach)
Condition of teeth, tongue, oral mucosa
Dysphagia, belching, indigestion/heart burn,
nausea, vomiting
Weight loss, anorexia
Bowel movement frequency: Diarrhea,
constipation, laxative or enema use, presence of
dark stools or frank blood
85
Objective Assessment
Inspection: Weight, spider angioma

on trunk, visible peristalsis, distention,
jaundice, icterus, ecchymosis or
petechiae
2. Auscultation: Bowel sounds
3. Palpation: Distention, as, cites,
hepatomegaly (firm ridge below the rib
cage.
86
Diagnostic Studies
Lab tests: Electrolytes, LFTs, fecal

studies, analysis of gastric secretions
2. Radiography: Barium swallow,
barium enema, ultrasound, ERCP,
endoscopy, arteriography,
colonoscopy, nuclear medicine
imaging, CT scan
87
Liver Disease
Cirrhosis- Hardening of the liver

Medical
treatment-paracentesis, Transjugular
intra-hepatic Porto-systemic shunting (TIPS),
organ transplant
Nursing interventions: Monitor for bleeding,
albumin, B vitamin levels, serum ammonia;
treat alcoholism (refer to rehab); teach
avoidance of hepatotoxic substances and use
of OTC meds; control ammonia related
encephalopathy-neomycin, lactulose, reduced
protein intake
88
Esophageal varices
Medical treatment- Banding, sclerosing,

esophageal balloon tamponade,
transfusion of RBCs and clotting factors
(FFP)
Nursing interventions: monitor VS, S&S of
bleeding, PT, PTT, platelets, refer to
treatment for alcoholism
89
Viral Hepatitis
Transmission
A-
Fecal-oral, contaminated food

B and C-Blood and body fluid
Medical treatment
Hepatitis
A- supportive treatment, antdiarrhea and anti ememitics

Hepatitis B gamma globulin, prevention with
hepatitis vaccine
90
Hepatitis C initial infection is rarely treated

due to flu-like symptoms. Chronic state is
treated with antiviral therapy(ribavirin,
interferon injections) treatment similar to
cirrhosis when fibrosis develops
Nursing interventions
Teach hand washing and safe food handling,
safe sex, and recommend hepatitis A and
B vaccines
Monitor LFTs
Provide symptom management
91
Bowel disease
Inflammatory bowel disease

Medical
treatment- corticosteroids, azulvidine,

surgery( Colectomy/Colostomy or ileostomy)
Nursing Interventions: monitor for S&S of
bleeding, test stools for occult blood, ostomy
care including diet teaching and address body
image
92
Irritable bowel syndrome
Conventional medical treatment-imodium for

diarrhea; tegaserod maleate (Zelnorm) for
constipation; Alosetron hydrochloride ( Lotronex)
for diarrhea if conventional therapy is not
effective
Nursing intervention: Teach avoidance of the
individuals triggers- large meals, wheat, rye,
barley, chocolate, milk products, alcohol, drinks
with caffeine; stress or emotional upsets. Teach
avoidance of overusing saline enemas and OTC
laxatives
93
Bowel Disease
Obstruction
Medical treatment- NG tube, NPO, surgery

Nursing interventions: Monitor bowel
sounds, IV fluids, TPN, prepare for
diagnostic studies and surgery, treat N&V
94
Colon Cancer
Medical Treatment- polypectomy, tumor

resection, colectomy/ostomy, chemo and
or radiation
Nursing Interventions: Bowel prep, ostomy
care, diet teaching, teach effects of chemo
and radiation
95
Pancreatitis
Acute: NPO, fluids, possibly TPN.

Monitor glucose, acid balance, K, Ca,
Serum Co2, and amylase, lipase. Pain
management, I7O monitoring; be alert for
signs of hemorrhage, renal and respiratory
failure
Chronic: Pancreatic enzymes, teach low
fat diet, pain management
96
Peptic Ulcer disease
Causes: Helicobter pylori has been found

to be the cause in most ulcers, 50% of the
population is colonized
NASAIDS are another significant factor for
gastric and duodenal ulcers in individuals
over 60
Corticosteroids cause erosion of gastric
mucosa
97
Interventions:
Assess
VS for signs of blood loss, assess

emesis for coffee ground appearance, and
test stools for occult blood
During acute bleeding-NG tube, NPO, IV
fluids, Monitor Hgb & Hct, RBC transfusions
may be necessary
Teach patient bland diet and medication
regimen
98
Antibiotics
Histamine 2 blockers
proton pump inhibitors
Barrier medications
99
Peritonitis
Nursing assessment
Monitor VS, WBCs, assess pain level,
assess firmness of the abdomen(rebound
tenderness)
Treatment:
Antibiotics(
intraperitoneal in peritoneal
dialysis patient)
Pain management
Antiemetics PRN
100
Mrs. Stone, 68, is on your unit with

ascites, as a complication of her liver
cancer. Her potassium level is elevated
and would most likely be related to:
A. Hypomagnesemia
B. Increased ammonia levels
C. Decreased albumin levels
D. Poor lymphatic system
101
A client with advanced cirrhosis is

admitted to your unit from the E.D.
Which of the following orders should
you question?
A. Phenobarbital 100 mg HS
B. Neomycin sulfate 300 mg
Q6 x 4 doses
C. Low protein diet
D. Serum ammonia levels daily
102
Jerry Thomas, 22, is being treated with

dexamethasone (Decadron) for an
acute head injury caused by a skiing
accident. He is also receiving ranitidine
(Zantac) because of dexamethasones
propensity to:
A. Increase peristalsis
B. Erode gastric mucosa
C. Decrease secretions
D. Irritate mucous membranes
103
Nutrition
Essential for adequate functioning of all
body systems
Calculating nutrition intake is based on kcalKilocalories

Carbohydrates 4 Kcal/gram
Protein
4 Kcal/gram
Fat
9 Kcal/gram
Enteral feeding is preferred over parenteral
feeding because it is important to maintaining a
functioning GI tract
104

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SE5l, Medical-Surgical Review curse PowerPoint.

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Given four times a year

SE5l, Medical-Surgical Review curse PowerPoint.pdf

AMSN Nursing Practice Roles

Helping Role 17% (32-36)

SE5l, Medical-Surgical Review curse PowerPoint.pdf

AMSN Nursing Practice Roles

Effective Management of Rapidly

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Distribution Patient Problem

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Distribution Patient Problem

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Preparing for the Test

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Practice in medical-surgical nursing

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Preparing for the Test

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Scope and Standards for MedicalSurgical Nursing Practice

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Preparing for the Test

AMSN Core Curriculum for MedicalSurgical Nursing

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Test Taking Tips

Read questions all the way through

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Review prior to exam, but dont cram

SE5l, Medical-Surgical Review curse PowerPoint.pdf

A patient begins to experience a severe GI

A. Provision for skin care

SE5l, Medical-Surgical Review curse PowerPoint.pdf

To prevent complications on the third day

SE5l, Medical-Surgical Review curse PowerPoint.pdf

A patient is having a seizure activity. What

SE5l, Medical-Surgical Review curse PowerPoint.pdf

A patient in acute renal failure developed

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Fluids and Electrolytes

SE5l, Medical-Surgical Review curse PowerPoint.pdf

SE5l, Medical-Surgical Review curse PowerPoint.pdf

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Necessary for protein synthesis

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Dilutional most common

Excessive fluid intake

Fluid and sodium loss

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Most common, fluid loss without loss

Increased sodium with diet rare could

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Irritant at neuromuscular junction

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Causes cell wall destruction,

Symptoms irritable muscles

Treatment Kayexalate, calcium

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Increased loss of potassium

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Sedative at the neuro level

SE5l, Medical-Surgical Review curse PowerPoint.pdf

Increased intake, hyperparathyroidism

Decrease calcium intake