Adult Health Exam 1

What is the primary surgical purpose of a biopsy or exploratory laparoscopy?

Diagnostic (to determine or confirm a diagnosis).

Which surgical category includes procedures like appendectomies that remove diseased tissue?

Curative or Ablative surgery.

What is the purpose of restorative or reconstructive surgery, such as a joint replacement?

To restore function to a body part.

A nerve block performed to relieve pain in a terminal patient without curing the disease is classified as _____ surgery.

Palliative

What are three clinical advantages of Minimally Invasive Surgery (MIS) compared to open surgery?

Less blood loss, smaller incisions, and faster recovery times.

During the preoperative assessment, what is the most critical information to collect regarding previous surgeries?

History of anesthesia reactions (e.g., Malignant Hyperthermia).

What is the normal laboratory range for serum Potassium (K)?

3.5-5.0 mEq/L

What is the significance of a serum Creatinine level outside the range of 0.6-1.2 mg/dL in a surgical patient?

It indicates impaired renal function.

What is the normal laboratory range for White Blood Cell (WBC) count?

5,000-10,000 mu L

Which laboratory test is specifically used to monitor the therapeutic level of Warfarin?

International Normalized Ratio (INR).

What is the nurse's primary responsibility regarding informed consent?

To witness the patient's signature and verify their understanding of the procedure.

Whose responsibility is it to explain the specific risks, benefits, and alternatives of a surgical procedure to the patient?

The surgeon.

Under what condition may the requirement for informed consent be overridden?

In a life-threatening emergency when the patient or legal guardian is unavailable.

Why are anticoagulants like Warfarin usually held several days before surgery?

To minimize the risk of excessive surgical bleeding.

Why are Beta-blockers (e.g., Metoprolol) typically continued on the day of surgery?

To prevent rebound hypertension and tachycardia.

What is the risk of continuing Metformin on the day of surgery if IV contrast is used?

Increased risk of lactic acidosis.

Which medication class is held pre-operatively due to both bleeding risk and potential renal impairment?

NSAIDs.

How long before surgery should herbal supplements typically be discontinued?

2 weeks.

What is the standard NPO duration for solid foods before surgery?

8 hours.

What size IV access is preferred for a preoperative patient to allow for rapid fluid or blood administration?

Large-bore peripheral IV.

Why is the older adult surgical patient at higher risk for postoperative delirium?

Decreased physiologic reserves and increased sensitivity to anesthesia/polypharmacy.

Which member of the OR team is responsible for maintaining the sterile field and passing instruments?

The Scrub Nurse or Surgical Technologist.

What is the primary role of the Circulating Nurse during a surgical procedure?

Coordinating the room, documenting, and monitoring patient safety from a non-sterile position.

What are the three essential components confirmed during a surgical 'TIME OUT'?

Correct patient, correct site/side, and correct procedure.

When should prophylactic antibiotics be administered relative to the surgical incision?

30-60 minutes before incision.

How does the OR team prevent 'retained items' at the end of a procedure?

By performing manual surgical counts of sponges, needles, and instruments.

What life-threatening complication is triggered by volatile anesthetic agents and Succinylcholine?

Malignant Hyperthermia (MH).

What is the specific pharmacologic treatment for Malignant Hyperthermia?

Dantrolene IV.

Which type of regional anesthesia involves an intrathecal injection at L3-L4 and carries a risk for 'spinal headaches'?

Spinal Anesthesia.

What is the priority assessment sequence for a patient arriving in the PACU?

Airway, Breathing, Circulation, Neuro, Pain, Wound.

Which scoring system is used to determine a patient's readiness for discharge from the PACU?

Aldrete Score.

An Aldrete score of at least _____ is typically required for PACU discharge.

8-9

What is the most effective nursing intervention for preventing postoperative atelectasis and pneumonia?

Early ambulation and frequent use of the incentive spirometer.

What are the clinical signs of internal hemorrhage following surgery?

Tachycardia, hypotension, and a distended/firm abdomen.

How should a nurse manage a surgical wound that has undergone dehiscence?

Cover with sterile saline-soaked gauze and notify the surgeon.

What is the emergency nursing action for an evisceration?

Cover organs with sterile saline-soaked gauze, keep patient supine, and notify the surgeon STAT.

List the five cardinal signs of inflammation.

Redness, Heat, Swelling, Pain, and Loss of Function.

What causes the 'redness' (rubor) associated with acute inflammation?

Vasodilation causing increased blood flow to the area.

In a WBC differential, what does a 'shift to the left' indicate?

An increase in immature neutrophils (bands), signifying a severe or systemic infection.

Which laboratory marker is more sensitive and rises more quickly in response to acute inflammation than the ESR?

C-reactive protein (CRP).

What does the RICE acronym stand for in the management of inflammation?

Rest, Ice, Compression, Elevation.

What is the maximum daily dose of Acetaminophen for an adult to avoid hepatotoxicity?

4 grams.

How does chronic pain typically differ from acute pain in terms of duration?

Chronic pain lasts longer than 3-6 months.

What type of pain is characterized as burning, shooting, or electric-shock-like?

Neuropathic pain.

Pain felt in the left arm during a Myocardial Infarction is an example of _____ pain.

Referred

According to the WHO Analgesic Ladder, what is the first-line treatment for mild pain?

Non-opioids (e.g., Acetaminophen or NSAIDs).

What is the priority assessment for a patient receiving IV opioids?

Respiratory rate and depth.

Which medication is the antagonist used to reverse opioid-induced respiratory depression?

Naloxone (Narcan).

What type of immunity is acquired through a vaccination?

Artificial Active Immunity.

Which type of immunity is provided to a newborn via breast milk?

Natural Passive Immunity.

Which specific immune cells are the primary targets of the Human Immunodeficiency Virus (HIV)?

CD4+ T helper cells.

Which immunoglobulin is the 'first responder' to an infection?

IgM

Where is the pain associated with appendicitis typically located once it migrates from the umbilicus?

Right Lower Quadrant (McBurney's Point).

What is Blumberg's sign in the context of an abdominal assessment?

Rebound tenderness (pain upon release of pressure).

Why are heating pads and enemas strictly contraindicated in patients with suspected appendicitis?

They increase the risk of appendix rupture/perforation.

What is the preferred postoperative position for a patient following an appendectomy for a ruptured appendix?

Semi-Fowler's (to contain drainage in the lower pelvis).

What is the primary pathophysiology of Osteoarthritis (OA)?

Progressive breakdown of articular cartilage and formation of osteophytes.

How does the timing of joint stiffness in Osteoarthritis compare to inflammatory arthritis?

In OA, morning stiffness typically lasts less than 30 minutes.

What are the classic bony nodules found on the distal interphalangeal joints in OA called?

Heberden's nodes.

What is the underlying metabolic cause of Gout?

Hyperuricemia (excessive uric acid in the blood).

Which joint is most commonly affected in an acute gout attack (Podagra)?

The great toe (first metatarsophalangeal joint).

Which medication is used specifically for an ACUTE gout attack to reduce inflammation?

Colchicine.

What is the mechanism of action for Allopurinol in chronic gout management?

It decreases the production of uric acid.

Dietary education for a gout patient includes avoiding high-_____ foods like organ meats and shellfish.

Purine

At what CD4+ T cell count is a patient officially diagnosed with AIDS?

Less than 200 cells.

What is the purpose of Pre-Exposure Prophylaxis (PrEP)?

To prevent HIV infection in high-risk, HIV-negative individuals.

What is the most common opportunistic infection in patients with AIDS?

Pneumocystis jiroveci pneumonia (PCP).

What is the significance of an 'undetectable' viral load in an HIV-positive patient on ART?

The virus is suppressed to a level that prevents transmission and disease progression.

A patient with AIDS presents with purple skin lesions; what is the most likely diagnosis?

Kaposi Sarcoma.

What does a V/Q mismatch indicate in respiratory physiology?

An imbalance between ventilation (airflow) and perfusion (blood flow) in the lungs.

What is the first-line treatment for Group A Strep Pharyngitis?

Penicillin (or Amoxicillin).

Which type of pneumonia is acquired 48 hours after hospital admission?

Hospital-Acquired Pneumonia (HAP).

What is a common clinical presentation of pneumonia in the elderly that differs from younger adults?

Confusion or altered mental status (often without fever).

Which isolation precaution is mandatory for a patient with active Tuberculosis?

Airborne Precautions (negative-pressure room and N95 mask).

What is the standard 'RIPE' treatment regimen for active TB?

Rifampin, Isoniazid, Pyrazinamide, and Ethambutol.

Which TB medication is associated with the harmless side effect of orange-colored body fluids?

Rifampin.

Why is Vitamin B6 (Pyridoxine) administered with Isoniazid (INH)?

To prevent peripheral neuropathy.

How is a 'positive' Tuberculin Skin Test (TST) measured?

By the diameter of induration (hardness) in millimeters, not redness.

What is the defining physiological characteristic of Asthma?

Reversible airway inflammation and bronchoconstriction.

Which medication is the 'rescue' inhaler of choice for an acute asthma attack?

Albuterol (Short-acting beta-agonist/SABA).

What is a crucial patient teaching point after using an Inhaled Corticosteroid (ICS)?

Rinse the mouth to prevent oral candidiasis (thrush).

In COPD, what is the typical target SpO2 range?

88-92%

What is the primary diagnostic criteria for COPD based on spirometry?

An FEV1/FVC ratio of less than 70%.

A patient with emphysema typically presents with a '_____ chest' due to air trapping.

Barrel

What breathing technique helps COPD patients prevent airway collapse during exhalation?

Pursed-lip breathing.

Before performing a radial artery puncture for an ABG, which test must be done to ensure collateral circulation?

Allen's Test.

What is the priority nursing action for a patient post-bronchoscopy?

Maintain NPO status until the gag reflex returns.

A patient is to receive 500 mL of 0.9 NS over 4 hours. What is the rate in mL/hr?

125 mL/hr

If a surgeon marks a surgical site, which phase of perioperative care is occurring?

Preoperative phase.

What is the most dangerous complication of appendicitis?

Peritonitis leading to sepsis.

What lab value represents the percentage of red blood cells in total blood volume?

Hematocrit (Hct).

Primary Intention Healing

Healing of a surgical incision where edges are closely approximated with sutures or staples.

Why is the 'psoas sign' checked in suspected appendicitis?

To identify irritation of the psoas muscle, suggesting a retrocecal appendix.

Which medication for chronic gout increases the EXCRETION of uric acid in the urine?

Probenecid.

What is the 'window period' in HIV infection?

The time (6 weeks to 3 months) between infection and when antibodies become detectable.

Which diagnostic test for TB is preferred for patients who have received the BCG vaccine?

IGRA (QuantiFERON blood test).

What complication is suspected if a post-thoracentesis patient develops sudden dyspnea and asymmetrical chest expansion?

Pneumothorax.

How do you calculate drops per minute (gtts/min)?

(Total Volume times Drop Factor) / Time in minutes