Library of Congress Cataloging-in-Publication Data Lippincott's Review of Medical-Surgical Nursing Certification. AMSN founded the Medical-Surgical Nursing Certifi cation Board (MSNCB) to promote and implement a certification examination for medical-surgical nurses.
AMSN certifi cation eligibility criteria
If you take a paper-and-pencil exam, you will be notified of your results in a few weeks. If you take a computerized exam, you'll find out the results right away—which can be scary.
Parts of a test question
The nurse accepts the patient's decisions, even if they differ from the decisions the nurse would make. The nurse considers the educational, cultural and socio-economic background of the patient when planning and providing patient education.
Practice roles of the nurse
The nurse makes every effort to respect the patient's decisions and to communicate those wishes to other members of the health care team. Process evaluation examines the activities and behaviors of the health care provider such as the nurse.
Common legal concerns for nurses
Some states provide a statutory penalty against health care providers who violate the patient's right to confidentiality. Informed consent is the voluntary authorization by a patient to a caregiver to do something to the patient.
Reducing nursing liability
Advanced directives, such as living wills and durable powers of attorney for health care, maintain a patient's autonomy. The nurse promotes, advocates and strives to project the health, safety and rights of the patient.
Code of Ethics for Nurses
For most organs – such as the heart, liver, kidney and pancreas – the patient must be declared brain dead and physically kept alive until the organs are harvested. Option D is incorrect because it is the employer's responsibility to improve the safety and health of employees.
Stages of adult development
If the patient is female, age at menarche, age at menopause, and pregnancy history are considered. Visit the patient regularly and perform routine personal care activities while family members are present.
Dealing with death and dying
Inspection uses the senses of sight and smell to observe the patient, such as when a nurse observes a patient's gait or smells a fruity odor on a patient's breath. This is influenced by the nurse's interactional style (see Interactional Styles Affecting Therapeutic Communication, page 46).
Interaction styles affecting therapeutic communication
Nurses who communicate compassionately have poor boundaries and cannot clearly separate their own emotional responses from the patient's needs and desires. Nurse: Remains quietly with the patient but does not try to take away the patient's pain.
Therapeutic communication techniques for medical-surgical nursing
Option B is an example of confrontation, which draws attention to inconsistencies in what the patient is saying. Correct Answer: D The nurse allows the patient time to gather his thoughts by using silence.
Characteristics of acute and chronic wounds
A dynamic process that restores anatomical and functional integrity, wound healing operates on a continuum from injury to healing. The chart below describes the role of protein, calories, vitamins and minerals in wound healing.
The role of nutrition in wound healing
Hyperglycemia impairs the inflammatory response and collagen synthesis and causes leukocyte dysfunction, increasing the risk of infection. Medications, including anti-inflammatory drugs, anti-cancer drugs, anticoagulants and anti-prostaglandins, interfere with the normal healing process.
Norton scale
Reposition the patient - from back to side, to the opposite side, to the back - at least every 2 hours. When the patient is on his side, make sure he is not lying directly on the trochanter.
Skin tear without tissue loss
Treat the underlying disorder—for example, monitor blood glucose levels, administer insulin or an oral antidiabetic, and teach the patient with diabetes proper nutrition. Use pillows or foam wedges to prevent bony prominences from direct contact with the bed.
Skin tears with partial tissue loss
Identify patients at risk, including those with chronic diseases such as diabetes mellitus, and cardiovascular, renal and neurological diseases. Use a valid skin integrity risk assessment tool and a classification system such as Payne-Martin (see Payne-Martin Classification System for Skin Tears).
Skin tears with complete tissue loss
Identify risk factors that contribute to skin breakdown, including immobility, incontinence, nutritional deficiencies, and altered level of consciousness. This classification system improves documentation and allows for better tracking of care outcomes for patients with skin lacerations.
Payne-Martin classifi cation system for skin tears
Elevate the patient's heels off the bed or use a device that completely relieves pressure on the heels. If the patient is confined to a chair, take steps to reduce pressure on sensitive skin areas.
Comparing types of shock
The extracellular fluid (ECF) compartment includes water outside the cells; this compartment makes up 30% of total body water, or about 15 L of fluid (including 5 L of blood). Skin affects fluid movement through sweating (visible fluid loss) and evaporation.
Understanding parenteral solutions
Educate the patient and family to prevent, recognize, and treat FVE Third-space fluid replacement. In the fluid accumulation phase, fluid shifts from the intravascular space to the interstitial space.
Understanding electrolyte imbalances
Educate patient and family on dietary measures to ensure adequate fluid and sodium intake. Assess the patient for signs and symptoms of hyperphosphatemia and hypocalcemia, including tetany and muscle twitching.
Understanding acid–base imbalances
Assess the patient for signs and symptoms of respiratory acidosis, especially respiratory, pulse, and neurologic changes. Measure the patient's height and weight and calculate their body mass index (see Calculating BMI and What BMI Values Mean, page 84).
Interpreting arterial blood gas levels
As many as 50% of medical-surgical patients suffer from moderate malnutrition; the risk of malnutrition increases with the duration of hospital admission. Other possible indicators of malnutrition include reduced total lymphocyte counts (less than 1,800 cells/mm3) and reduced response to skin tests for cell-mediated immunity.
Calculating BMI
Underlying disease processes, such as malabsorption syndromes, gastric or intestinal resections, pancreatic insufficiency, vomiting, and diarrhea, can interfere with nutrient intake and utilization (see Normal and Hypermetabolic Nutritional Requirements). An increased need for nutrients can occur with stress reactions, cancer, operations, infections, trauma and burns.
What BMI values mean
Muscle breakdown results in weakness and fatigue and increases the risk of multiple organ failure. Malnutrition risks for the medical-surgical patient. Clear liquid diets that minimize residue in the gastrointestinal tract can be used before or after the procedure.
Visceral proteins and their normal values
Low-residue diets are nutritionally adequate and are used to avoid irritation of the gastrointestinal tract and reduce faecal volume. Sodium- and fluid-restricted diets are used in patients with cardiovascular disease; the extent of the restriction depends on the patient's degree of functional impairment.
Normal and hypermetabolic nutritional requirements
Monitor for gastrointestinal complications, such as diarrhea, delayed gastric emptying, and constipation, as well as for complications such as hyperglycemia and fluid and electrolyte imbalance. Being overweight significantly increases the risk of diabetes, cardiovascular disease, certain types of cancer and other diseases, such as gynecological abnormalities, osteoarthritis and stress incontinence.
Complications of obesity
Assess the location of the pain and ask the patient to rate the pain using a pain scale. Although the nurse should document the patient's pain, option C, this is not the first action the nurse should take.
Auscultatory sequence
Then move to the pulmonary area, located in the second intercostal space at the left sternal border. Next, listen to Erb's point, located in the third intercostal space at the left sternal border.
Acute coronary syndromes
- Determine rhythm
- method of rhythm strip analysis
- Calculate rate
- Evaluate P waves
- Determine PR interval duration
- Determine QRS complex duration
- Evaluate T wave
- Determine QT interval duration
- Evaluate other components
To calculate the duration, count the number of small squares between the start and end of the QRS complex and multiply that number by 0.04 seconds. Count the number of small squares between the beginning of the QRS complex and the end of the T wave, where the T wave returns to baseline.
Cardiac arrhythmias
Educate the patient about the signs and symptoms of heart failure to report to the physician. Increase patient knowledge about the relationship between risk factors and the development of CAD.
Angina
The nurse's astute assessments and prompt interventions can impact the patient's experience and recovery from CABG. Inform the patient and family about the operation and the immediate postoperative period in the intensive care unit.
Nursing care of the cardiac surgical patient requiring CABG
Assess the patient for signs and symptoms of heart failure, such as dyspnea, tachycardia, tachypnea, crackles, jugular vein distension, edema, and weight gain. Inform the patient of signs and symptoms of endocarditis, which should be reported to the practitioner immediately.
Classifying blood pressure readings
If the patient is receiving a thrombolytic, heparin, or warfarin (Coumadin), monitor him for signs and symptoms of bleeding. Assess the patient for signs and symptoms of pulmonary embolism, such as crackles, dyspnea, tachypnea, hemoptysis, tachycardia, and chest pain.
Types of valvular heart disease
Correct Answer: B Warfarin is at therapeutic levels when the patient's PT is 1½ to 2 times the control. When caring for a patient with arterial occlusive disease, which of the following home health care instructions is most appropriate for the nurse to provide to the patient.
Types of anemia
If the patient is deficient in vitamin B12, educate him about long-term treatment with an oral or parenteral vitamin B12 supplement. Educate the patient and family about the diagnosis of Hodgkin's disease and its treatment.
Staging lymphomas
A patient with acute or chronic leukemia may report vague signs and symptoms such as fatigue, malaise, petechiae, night sweats, bone or joint pain, and weight loss. The following table compares the incidence and signs and symptoms of different types of leukemia.
Types of leukemia
Acute leukemia produces anemia, bleeding, and symptoms of infection such as sudden onset of high fever; hepatosplenomegaly and lymphadenopathy may also be present. Additional signs and symptoms depend on the organ or tissue involved - for example, central nervous system involvement can cause headache and vomiting.
Blood and plasma transfusion compatibility
For a blood or plasma transfusion to be safe, the patient and the donor must have compatible blood types. An immediate reaction may occur during the transfusion itself or several hours after the transfusion.
Guide to immediate transfusion reactions
Assess the patient for signs and symptoms of infection and bleeding, and take measures to prevent their occurrence. Note the color of the patient's skin, lips, mucous membranes and nail beds; look at nails for clubs.
Determining asthma’s severity
Teach the patient to use a pillow to splint incisions in the abdomen and chest during coughing exercises. Teach the patient techniques for effective coughing and deep breathing to prevent atelectasis and promote lung expansion.
Comparing types of chest trauma
Provide pillows and teach the patient to support and wrap the diseased segment to minimize pain and allow maximum lung expansion. Teach the patient how to cough effectively to help clear secretions and to use diaphragmatic and pursed-lip breathing.
Comparing chronic obstructive pulmonary diseases
PEEP
Correct Answer: B In mild persistent asthma, the patient's daytime asthma symptoms occur 3 to 6 days per week. In mild intermittent asthma (Option A), the patient's daytime symptoms occur no more than twice a week.
ARDS B. Asthma
Note the patient's appearance, mannerisms, posture, facial expression, care, emotions, speech, and tone of voice. The patient may develop anomia (inability to remember the name) and aphasia (impaired ability to communicate orally or in writing due to malfunctions of the brain center).
Stages of Alzheimer’s disease
Educate the patient and his family about the condition, including the signs and symptoms of complications. Inform the patient and his family about the disease process and treatment, and provide supportive care.
Types of head injury
Contusion Bruising of the brain; This can be a coup injury (bleeding and edema below the site of the injury) or a contrecoup injury (bleeding and edema opposite the site of the injury). Huntington's disease (also called Huntington's chorea, hereditary chorea, chronic progressive chorea, and adult chorea) is a degenerative disease of the brain that causes dementia.
Using the Glasgow Coma Scale
Encourage the patient to participate in physical therapy to maintain muscle strength and reduce spasms. Encourage the patient to eat a balanced diet to maintain the proper functioning of the immune system and prevent constipation.
Differentiating seizures
Paraplegia (paralysis of both legs) results from spinal cord injuries from T1 level down. Fissure Breakdown in the spinal cord Compression of the spinal cord by bleeding and edema, causing permanent damage.
Types of spinal cord injury
Spinal cord injury caused by displaced tissue compressing nerve roots and narrowing the spinal canal. Unstable fracture with bone displacement. Spinal cord injury, current quadriplegia and loss of respiratory function.
Mechanisms of spinal cord injury
Speak slowly and simply; the patient may not be able to understand rapid speech and may become confused. When a stroke occurs in the posterior cerebral arteries, paralysis is usually absent; however, the patient may experience:
Signs and symptoms of stroke
Irritation of CN III (option A), IV (option B), and VI (option D) can cause diplopia, impaired eye movement, ptosis, and unequal pupils. Correct Answer: C Mannitol promotes osmotic diuresis by increasing the pressure gradient, thereby pumping fluid from intracellular to intravascular spaces.
