160 Nursing Bullets: Medical-Surgical Nursing Reviewer

High-yield medical-surgical facts for NCLEX review, stripped to the concepts worth memorizing.

Nursing Bullets

1. Bone scan is done by injecting radioisotope per IV and then x-rays are taken.

2. To prevent edema at the site of a sprain, apply a cold compress for the first 24 hours.

3. To turn a client after a lumbar laminectomy, use the logrolling technique.

4. Carpal tunnel syndrome results from injury of the median nerve.

5. Massaging the back of the head is specifically important for the client with Crutchfield tongs.

6. A one-year-old child with a fracture of the left femur is placed in Bryant's traction. Both legs are elevated at a 90º angle because the child's weight is not enough for countertraction, so the entire body must be used.

7. Swing-through crutch gait is done by advancing both crutches together and moving both legs past the level of the crutches.

8. To prevent prosthesis displacement after a right total hip replacement for arthritis, place the patient with the right leg abducted.

9. Pain on non-use of joints, subcutaneous nodules, and elevated ESR are characteristic of rheumatoid arthritis.

10. Teaching for a patient with SLE should emphasize walking in shaded areas.

11. Otosclerosis is characterized by replacement of normal bone with spongy, highly vascularized bone.

12. A high-pitched voice is inappropriate for the client with hearing impairment.

13. Rinne's test compares air conduction with bone conduction.

14. Vertigo is the most characteristic sign of Meniere's disease.

15. A low-sodium diet is used for a client with Meniere's disease.

16. A client who had cataract surgery should be taught to call the MD for eye pain.

17. Risk for Injury takes priority for a client with Meniere's disease.

18. Irrigating the eye with sterile saline is the priority intervention when a foreign body protrudes from the eye.

19. Snellen's test assesses visual acuity.

20. Presbyopia is an eye disorder marked by lessening of the powers of accommodation.

21. The primary problem in cataract is blurring of vision.

22. The primary reason for iridectomy after cataract extraction is to prevent secondary glaucoma.

23. In acute glaucoma, obstruction of aqueous humor flow is caused by displacement of the iris.

24. Glaucoma is characterized by irreversible blindness.

25. Hyperopia is corrected by a convex lens.

26. Pterygium is caused primarily by exposure to dust.

27. A sterile chronic granulomatous inflammation of the meibomian gland is a chalazion.

28. The surgical procedure that removes the eyeball is enucleation.

29. Romberg's test is a test for balance or gait.

30. In a client with increased ICP showing decorticate posturing, observe for flexion of the elbows, extension of the knees, and plantar flexion of the feet.

31. The highest-priority nursing diagnosis for a client who becomes comatose after cerebral hemorrhage is Ineffective Airway Clearance.

32. The initial action for a client in the clonic phase of a tonic-clonic seizure is to obtain equipment for orotracheal suctioning.

33. The first intervention in a quadriplegic client experiencing autonomic dysreflexia is to elevate the head as high as possible.

34. After surgery for a brain tumor near the hypothalamus, assess for inability to regulate body temperature.

35. Post-myelography care (using metrizamide, Omnipaque) includes keeping the head elevated for at least 8 hours.

36. Homonymous hemianopsia describes a client who had a CVA and can see only the nasal visual field on one side and the temporal portion on the opposite side.

37. Ticlopidine may be prescribed to prevent thromboembolic CVA.

38. To maintain airway patency during a stroke in evolution, keep orotracheal suction available at all times.

39. For a client with CVA, the gag reflex must return before the client is fed.

40. Clear fluid draining from the nose of a client who had head trauma 3 hours ago may indicate a basilar skull fracture.

41. Gingival hyperplasia is an adverse effect of phenytoin (Dilantin) therapy.

42. Increased urine output best shows that mannitol is effective in a client with increased ICP.

43. A client with a C6 spinal injury would most likely have quadriplegia.

44. Falls are the leading cause of injury in elderly people.

45. To prepare a client for an EEG, shampoo the hair, exclude caffeine from the meal, and instruct the client to remain still during the procedure.

46. Primary prevention is true prevention: immunizations, weight control, smoking cessation.

47. Secondary prevention is early detection: purified protein derivative (PPD), breast self-examination, testicular self-examination, and chest x-ray.

48. Tertiary prevention is treatment to prevent long-term complications.

49. Seeing religious artifacts on a patient's nightstand, a culturally aware nurse asks the patient the meaning of the items.

50. A Mexican patient may request a curandero, or faith healer, who involves the family in healing.

51. In an infant, the normal hemoglobin value is 12 g/dl.

52. A patient is coming to terms with a chronic disease when he says something like "I'm never going to get any better," or exhibits hopelessness.

53. Most absorption of water occurs in the large intestine.

54. Most nutrients are absorbed in the small intestine.

55. When assessing eating habits, ask "What have you eaten in the last 24 hours?"

56. A vegan diet should include an abundant supply of fiber.

57. A hypotonic enema softens the feces, distends the colon, and stimulates peristalsis.

58. First-morning urine is the best sample to measure glucose, ketone, pH, and specific gravity.

59. To induce sleep, the first step is to minimize environmental stimuli.

60. Before moving a patient, assess the patient's physical abilities, ability to understand instructions, and the strength required to move the patient.

61. To lose 1 lb (0.5 kg) in 1 week, the patient must cut weekly intake by 3,500 calories (about 500 calories daily). To lose 2 lb (1 kg) in 1 week, cut weekly intake by 7,000 calories (about 1,000 calories daily).

62. To avoid shearing-force injury, a completely immobile patient is lifted on a sheet.

63. To insert a catheter from the nose through the trachea for suction, ask the patient to swallow.

64. Vitamin C is needed for collagen production.

65. Bananas, citrus fruits, and potatoes are good sources of potassium.

66. Good sources of magnesium include fish, nuts, and grains.

67. Beef, oysters, shrimp, scallops, spinach, beets, and greens are good sources of iron.

68. Nitrogen balance estimates the difference between intake and use of protein.

69. A Hindu patient is likely to request a vegetarian diet.

70. No pork or pork products are allowed in a Muslim diet.

71. In the "hot-cold" system used by some Mexican, Puerto Rican, and other Hispanic and Latino groups, most foods, beverages, herbs, and drugs are described as "cold."

72. Milk is high in sodium and low in iron.

73. Discrimination is preferential treatment of individuals of a particular group, usually discussed in a negative sense.

74. Increased gastric motility interferes with absorption of oral drugs.

75. When feeding an elderly patient, limit high-carbohydrate foods because of the risk of glucose intolerance.

76. When feeding an elderly patient, give essential foods first.

77. For a patient who follows Jewish custom, milk and meat should not be served at the same meal.

78. Only the patient can describe his pain accurately.

79. Cutaneous stimulation releases endorphins that block transmission of pain stimuli.

80. Patient-controlled analgesia (PCA) is a safe method to relieve acute pain from surgical incision, traumatic injury, labor and delivery, or cancer.

81. An Asian-American or European-American typically places distance between himself and others when communicating.

82. Active euthanasia is actively helping a person die.

83. Brain death is irreversible cessation of all brain function.

84. Passive euthanasia is stopping the therapy that sustains life.

85. Voluntary euthanasia is actively helping a patient die at the patient's request.

86. A back rub is an example of the gate-control theory of pain.

87. Pain threshold, or pain sensation, is the initial point at which a patient feels pain.

88. The difference between acute and chronic pain is duration.

89. Referred pain is felt at a site other than its origin.

90. Relieving pain with a back massage is consistent with the gate-control theory.

91. Pain seems more intense at night because the patient is not distracted by daily activities.

92. Older patients often do not report pain because of fear of treatment, lifestyle changes, or dependency.

93. Utilization review determines whether the care provided was appropriate and cost-effective.

94. A value cohort is a group of people who experienced an out-of-the-ordinary event that shaped their values.

95. A third-party payer is an insurance company.

96. Intrathecal injection administers a drug through the spine.

97. When a patient makes an emotionally charged statement, the nurse should respond to the emotion behind it rather than the literal words.

99-105. The steps of the trajectory-nursing model are:

• Step 1: Identify the trajectory phase
• Step 2: Identify the problems and establish goals
• Step 3: Establish a plan to meet the goals
• Step 4: Identify factors that facilitate or hinder goal attainment
• Step 5: Implement interventions
• Step 6: Evaluate the effectiveness of the interventions

106-107. Two goals of Healthy People 2010 are:

• Help individuals of all ages increase quality of life and years of optimal health
• Eliminate health disparities among different segments of the population

108. A community nurse acts as a patient's advocate by telling a malnourished patient to go to a meal program at a local park.

109. If a patient is not following his treatment plan, the nurse should first ask why.

110. When a patient is ill, family members must maintain communication about his health needs.

111. Ethnocentrism is the universal belief that one's way of life is superior to others'.

112. When communicating through an interpreter, the nurse should speak to the patient and the interpreter.

113. Prejudice is a hostile attitude toward individuals of a particular group.

114. The three phases of the therapeutic relationship are orientation, working, and termination.

115. Patients often show resistive and challenging behaviors in the orientation phase of the therapeutic relationship.

116. Abdominal assessment is performed in this order: inspection, auscultation, palpation, percussion.

117. When measuring blood pressure in a neonate, select a cuff no less than one-half and no more than two-thirds the length of the extremity used.

118. When giving a drug by Z-track, do not use the same needle used to draw the drug into the syringe, because it could stain the skin.

119. Sites for intradermal injection include the inner arm, the upper chest, and the back under the scapula.

120. When judging whether an exam answer is correct, consider whether the action promotes autonomy (independence), safety, self-esteem, and a sense of belonging.

121. Veracity is truth and is essential to a therapeutic relationship between provider and patient.

122. Beneficence is the duty to do good. Patient care carries an obligation to do no harm and an equal obligation to assist the patient.

123. Nonmaleficence is the duty to do no harm.

123-128. Frye's ABCDE cascade prioritizes care by identifying the most important treatment concerns.

• A: Airway. Everything affecting a patent airway, including a foreign object, fluid from an upper respiratory infection, and edema from trauma or an allergic reaction.
• B: Breathing. Everything affecting the breathing pattern, including hyperventilation, hypoventilation, and abnormal patterns such as Korsakoff's, Biot's, or Cheyne-Stokes respiration.
• C: Circulation. Everything affecting circulation, including fluid and electrolyte disturbances and disease processes that affect cardiac output.
• D: Disease processes. If airway, breathing, and circulation are intact, evaluate disease processes, prioritizing the one posing the greatest immediate risk. For example, in a patient with terminal cancer and hypoglycemia, hypoglycemia is the more immediate concern.
• E: Everything else. Issues such as writing an incident report and completing the chart. This category is never the highest priority.

129. Rule utilitarianism is the "greatest good for the greatest number of people" theory.

130. Egalitarian theory holds that equal access to goods and services must be provided to the less fortunate by an affluent society.

131. Before teaching any procedure, assess the patient's current knowledge and willingness to learn.

132. Process recording is a method of evaluating one's communication effectiveness.

133. Whether the patient can perform a procedure (psychomotor domain) is a better indicator of effective teaching than whether the patient can state the steps (cognitive domain).

134. When communicating with a hearing-impaired patient, face him.

135. When a patient expresses concern about a health issue, assess the patient's level of knowledge before addressing it.

136. Passive range of motion maintains joint mobility. Resistive exercises increase muscle mass.

137. Isometric exercises are performed on an extremity that is in a cast.

138. Anything below the waist is unsterile; a sterile field becomes unsterile on contact with any unsterile item; a sterile field must be monitored continuously; and a border of 1" (2.5 cm) around a sterile field is unsterile.

139. A "shift to the left" is evident when immature cells (bands) in the blood increase to fight an infection.

140. A "shift to the right" is evident when mature cells in the blood increase, as in advanced liver disease and pernicious anemia.

141. Before giving preoperative medication, ensure an informed consent form has been signed and attached to the record.

142. A nurse should spend no more than 30 minutes per 8-hour shift caring for a patient with a radiation implant.

143. A nurse should not be assigned to more than one patient with a radiation implant.

144. Long-handled forceps and a lead-lined container should be available in the room of a patient with a radiation implant.

145. Patients with the same infection in strict isolation can usually share a room.

146. Diseases requiring strict isolation include chickenpox, diphtheria, and viral hemorrhagic fevers such as Marburg disease.

147-155. Erik Erikson's developmental stages are:

• Trust versus mistrust (birth to 18 months)
• Autonomy versus shame and doubt (18 months to age 3)
• Initiative versus guilt (ages 3 to 5)
• Industry versus inferiority (ages 5 to 12)
• Identity versus identity diffusion (ages 12 to 18)
• Intimacy versus isolation (ages 18 to 25)
• Generativity versus stagnation (ages 25 to 60)
• Ego integrity versus despair (older than age 60)

156. An appropriate intervention for the spouse of a patient with a serious incapacitating disease is to help mobilize a support system.

157. The most effective way to reduce a fever is to give an antipyretic, which lowers the temperature set point.

158-163. The Controlled Substances Act designated five schedules that classify controlled drugs by abuse potential.

• Schedule I drugs, such as heroin, have a high abuse potential and no currently accepted medical use in the United States.
• Schedule II drugs, such as morphine, opium, and meperidine (Demerol), have a high abuse potential but accepted medical uses. Use may lead to physical or psychological dependence.
• Schedule III drugs, such as paregoric and butabarbital (Butisol), have a lower abuse potential than Schedule I or II. Abuse may lead to moderate or low physical or psychological dependence, or both.
• Schedule IV drugs, such as chloral hydrate, have a low abuse potential compared with Schedule III.
• Schedule V drugs, such as cough syrups containing codeine, have the lowest abuse potential of the controlled substances.

164. During lumbar puncture, note the initial intracranial pressure and the color of the cerebrospinal fluid.

165. Cold packs are applied for the first 20 to 48 hours after an injury; then heat is applied. During cold application, the pack is applied for 20 minutes and removed for 10 to 15 minutes to prevent reflex dilation (rebound phenomenon) and frostbite injury.