AHN Study Guide Key answer

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Northwestern University *

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170

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Anatomy

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Apr 3, 2024

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CHAPTER 1 — INTRODUCTION TO ANATOMY AND PHYSIOLOGY Crossword Puzzle Figure Labeling: Planes of the Body 2. The sagittal plane runs lengthwise from the front to the back. A sagittal cut gives a right and a left portion of the body. A midsagittal cut gives two equal halves. The coronal (frontal) plane divides the body into a ventral (front) section and a dorsal (back) section. The transverse plane cuts the body horizontal to the sagittal and frontal planes, dividing the body into caudal and cranial portions. See Figure 1-2 for additional information. Table Activity 3. See Table 1-6 for additional information. One Body Part of Major System Major System Function Lungs Respiratory Exchange of carbon dioxide for oxygen; regulation of acid-base balance Blood vessels Cardiovascular Transportation of nutrition, water, oxygen, and wastes Brain Nervous Coordination of body’s activities; communication Stomach Digestive Mechanical and chemical breakdown of food; absorption of
nutrients Kidneys Urinary Clearing blood of waste products; water and electrolyte balance; acid-base balance Bones Skeletal Support; movement; storage of minerals; blood cell formation Voluntary muscles Muscular Movement; maintenance of posture; heat production Skin Integumentary Protection; regulation of body temperature; synthesis of chemicals; sense organ Thyroid gland Endocrine Production of hormones that affect metabolism Lymph nodes Lymphatic Protection Gonads Reproductive Production of sex cells Multiple Choice 4. Answer 4: Nursing documentation should include medical terminology and specific details that describe assessment findings, interventions, or evaluation. {Note to student: patient statements can be used in nursing documentation but should be placed in quotation marks.] 5. Answer 2: Nursing documentation is a legal record of care that was given to the patient. This note shows the patient had a position change every two hours. [Note to student: Based on the type of risks that the patient has, the nurse might also use additional interventions every 2 hours, for example: skin assessment, range-of motion, incentive spirometer, toileting, or oral fluids]. 6. Answer 3: Dorsal or posterior is towards the back of the body. The perineal area is inferior to the umbilicus. The front of the chest is the anterior surface. The face and top of the head are the superior to the rest of the body. 7. Answer 1: The dorsalis pedis pulse is on the top of the foot and it is the most distal pulse in the lower extremity. The popliteal is behind the knee (can be difficult to locate). The posterior tibial pulse is behind the medial malleolus (lateral ankle). The femoral pulse is in the groin area. 8. Answer 3: Medial is towards the midline. The sternum is in the middle of the chest. 9. Answer 4: The plasma membrane contains surface proteins that identify a cell as coming from one particular individual. Tissue typing is performed for compatibility to reduce the chances of rejection of a transplanted organ 10. Answer 1: A muscle cell cannot operate properly unless the intracellular Ca 2 + concentration is kept low during rest. 11. Answer 2: Hematopoietic disorders affect the blood cell – producing cells located in the red bone marrow; a decreased red blood count is anticipated. Potassium and glucose are electrolytes. Blood urea nitrogen reflects kidney function. 12. Answer 3: The spleen plays important role in the immune function. Loss of the spleen increases the patient's risk for developing infections. 13. Answer 3: The gallbladder is located just below the right ribs. The spleen is on the left side. The small intestine and cecum are located in the lower abdominopelvic cavity. 14. Answer 2: The urinary bladder is located in the hypogastric region. See Figure 1-4 for additional information. 15. Answer 1: The stomach is located in the epigastric region. See Figure 1-4 for additional information. 16. Answer 2: The appendix is located in the right lower quadrant. See Figure 1-5 for additional information. 17. Answer 4: Once diagnosed, patients are usually placed on “nothing by mouth” (NPO), but a patient who develops a small bowel obstruction at home will often seek health care because of vomiting and abdominal pain. A proximal obstruction is one that is closer to the beginning of the small intestine; therefore, the blockage is higher up in the system. Vomiting can occur whenever there is an intestinal obstruction; however, in a distal large intestinal obstruction, vomiting is less likely. If it develops, it usually occurs later and the emesis could have a fecal odor. 18. Answer 1: The epidermis or skin is composed of stratified squamous tissue. One of the main functions is to protect the body from infection. Bones are for strength and structure. Simple columnar tissue participates in the secretion of mucus. Adipose tissue provides insulation.
19. Answer 3: The mucous membranes are designed to trap microorganisms and dryness decreases that function. Poor oral hygiene contributes to respiratory infection, especially for patients who are bedridden. Patients who are in a coma are not given solid food. Dignity and preservation of the teeth are desirable for all patients. 20. Answer 3: The bursae are small cushionlike sacs that are found between joints; therefore, the nurse would assess the movement and discomfort of the major joints. Critical Thinking Activities Activity 1 21. Knowledge of how the body works helps the nurse to distinguish normal findings from abnormal findings. Knowledge of location and function of organs helps the nurse predict the involvement of underlying structures that are related to patients’ reports of pain and discomfort and design interventions that will enhance function or repair dysfunction. Knowledge of physiology at the cellular level helps the nurse implement interventions that keep the body in homeostasis. Activity 2 22. 2-cm ecchymosis noted on distal tip of first digit of right foot. Activity 3 23. Accuracy is an important par t of documentation; thus using the patient’s words in direct quotes is acceptable. In addition, assessment data should reflect the nurse’s ability to make and record professional observations. When the nurse’s records are reviewed by other health care prof essionals or by legal or financial consultants, use of correct terminology and accuracy reflect the quality of care. CHAPTER 2 — CARE OF THE SURGICAL PATIENT Table Activity 1. Assessment Normal Findings Frequency a. Vital signs Same as or close to preoperative q 15 minutes x 4, q 30 minutes x 4, q 60 minutes x 4, q 4 hours x 4, until assessments are within normal range b. Incision Dressing dry and intact; no drainage Every time vital signs are assessed c. Respiratory effort Breathing comfortably without dyspnea q 1-2 hours d. Pain Relieved by analgesics and nonpharmacologic methods Assess concurrently with vital signs e. Urinary function Voids at least 30 mL/hour Within 6-8 hours of surgery f. Neurovascular Extremities are warm, pulse present; skin color normal for patient q 2 hours g. Activity Muscle-strengthening exercises, sitting, dangling, and walking; gradual progression towards baseline Per health care provider's orders and patient’s ability h. Gastrointestinal function Flat abdominal area; bowel sounds audible in four quadrants q 2 hours
Matching 2. d 3. a 4. f 5. e 6. b 7. g 8. c 9. i 10. h Multiple Choice 11. Answer 2: Patients are generally encouraged to eat well-balanced diets, but protein foods are specific for building and repairing body tissues. 12. Answer 1: Phenytoin (Dilantin) is a antiseizure medication. Antiseizure and cardiac medications are sometimes given with a sip of water. The surgeon or anesthesiologist should be contacted if there is a query. Warfarin sodium (Coumadin), an anticoagulant, is usually discontinued several days before the surgery. Ranitidine (Zantac) is an antiulcer medication and may be given prophylactically in the post-surgical period. Acetaminophen (Tylenol) is used postoperatively for mild pain. 13. Answer 1, 2, 3, 5: Surgeon provides information regarding the actual surgical procedure, as well as the risks, benefits, and possible outcomes. Nurse is responsible for teaching about the other topics. 14. Answer 4: Abnormal potassium levels can cause cardiac dysrhythmias. All of the values are slightly above normal and should be reported. Normal ranges include: potassium 3.5 to 5.0   mEq/L; sodium 135 to 145   mEq/L; glucose 70 and 100   mg/dL; and blood urea nitrogen 10 to 20   mg/dL 15. Answer 3: Urinary catheters are frequently made of latex and swelling is one symptom of allergic response. Throat discomfort after nasogastric tube insertion is not uncommon. Hematoma after a venipuncture could be related to poor technique or failure to provide pressure at the site; however, the nurse would follow up to see if the patient is on any medication (e.g., warfarin) or had health problems (e.g., hemophilia) that would interfere with clotting. Dermabrasion is a surgical procedure of scraping away skin. 16. Answer 2: Complete physical assessment and history are always important; however, the assessments that are most relevant to the skin preparation, relate to skin impairment (e.g., infection, irritation, bruises, lesions) and skin allergies. Skin infections could be a source of wound infection. Bruises, irritation and lesions should be noted as pre- existing conditions of the surgical procedure. Skin allergies impact the type of solutions, medications and equipment that contacts the skin. Any abnormal assessment findings are recorded and reported to the surgeon. 17. Answer 4: An oral airway can be inserted to keep the airway open (keeps tongue from obstructing airway). Bag- valve-mask is used when patients are not breathing. Oral suctioning (also, side lying position or elevation of the head) decreases the likelihood of aspirating secretions. Oxygen is administered to maintain saturation, but the airway must be open for oxygen to pass into the lungs. 18. Answer 3: The nurse who does the preoperative care signs the list thereby taking responsibility for the care on the list. Medication, tasks completed by delegation and teaching are included in the care prior to surgery. 19. Answer 2: Standard practice in most facilities is to monitor vital signs and make general assessments using the “times 4” factor— every 15 minutes times 4 (for 4 times); every 30 minutes times 4; every hour times 4; then every 4 hours, until assessments are within expected ranges. 20. Answer 4: Post-operative patients are at risk for hypovolemic shock. Signs/symptoms include: hypotension, tachycardia, restlessness, apprehension, and cold, moist, pale, or cyanotic skin. Standard protocol in most facilities includes: (1) administer oxygen (2) raise legs above the level of the heart; (3) increase the rate of IV fluid; (4) notify anesthesiologist and surgeon; (5) medications as ordered; and (6) assess response to interventions. 21. Answer 4: In the induction phase, the patient is awake and the administration of anesthetic agents begins. The stage is completed when the patient loses consciousness, and endotracheal intubation is established and placement verified. 22. Answer 2: Anesthesia may be maintained through a combination of inhalation and IV medications. Emergence from anesthesia occurs when the procedure is completed and reversal agents are given.
23. Answer 3: Spinal anesthesia is often used for lower abdominal, pelvic, and lower extremity procedures; urologic procedures; or surgical obstetrics. 24. Answer 2: Local anesthesia is commonly used for minor surgical procedures, such as a biopsy of a superficial skin lesion. 25. Answer 4: Combinations of sedatives, tranquilizers, anesthetics, or anesthetic gases are commonly used for moderate sedation. The health care provider is frequently focused on the procedure and relies on the nurse to monitor the patient. Monitoring vital signs is necessary to detect adverse effects of the medication or the procedure. 26. Answer 3: Resuscitation equipment must be readily available in case the patient has respiratory depression or cardiac dysrhythmia. Recovery is rapid and relatively less risky than other types of anesthesia. The patient is not routinely intubated. 27. Answer 3: For Arab Americans, verbal consent often has more meaning than written consent because it is based on trust. The need for written consent should be fully explained. 28. Answer 1: Teaching 1 or 2 days before surgery is ideal because the patient’s anxiety is not too high. Teaching too far in advance would affect retention of the information. The teaching should not be delayed (or hastened) because of the nurse’s schedule. 29. Answer 3: Before bowel surgery, medication (neomycin, sulfonamides, erythromycin) may be given over a period of days to detoxify and sterilize the gastrointestinal tract. 30. Answer 2, 3, 4: Antihypertensives interact with anesthetic agents to cause bradycardia, hypotension, and impaired circulation. 31. Answer 1: Nonsteroidal antiinflammatory drugs inhibit platelet aggregation and may prolong bleeding, increasing susceptibility to postoperative bleeding. 32. Answer 2: In the immediate postoperative period, all patients are at risk for aspiration related to nausea and vomiting and will have impaired abilities to manage secretions. Elderly patients have additional problems related to age. 33. Answer 2, 4, 6: The unlicensed assistive personnel (UAP) can assist the patient to remove any personal clothing and don hospital attire and can also apply the antiembolic stockings. The UAP can assist the patient to move from the bed to the stretcher. Comparing data, checking IV sites and equipment, and ensuring that the postoperative list is completed are nursing responsibilities. 34. Answer 4: The patient may be feeling fear of the unknown or fear of cancer; long-term, she may be thinking about death, mutilation, or change of lifestyle. First address the feelings and then ask her to expand on her fears. Based on assessment findings, the other options might be used. 35. Answer 2: While all of these patients have the potential for adverse reactions and drug-drug interactions, the elderly patient with polypharmacy and chronic health conditions is the most vulnerable. 36. Answer 2: Smoking increases the risk for pneumonia and atelectasis; use of the incentive spirometer decreases the risk for respiratory complications. The patient’s reading on pulse oximeter is likely to be lower than normal or low - normal because of the smoking. Patient-controlled analgesia pump and call bell are also important, but less related to the issue of smoking. 37. Answer 4: “What...?” is an open -ended question. This allows the patient to seek information and the nurse can determine areas where the patient needs clarification. The other questions are closed-ended and do less to encourage the patient to speak. 38. Answer 4: If consent is obtained while the patient is under the influence of consciousness-altering substances (even if prescribed), the consent is not considered valid. The other information is also relevant, and the surgeon should be advised. 39. Answer 2: The unlicensed assistive personnel (UAP) can assist with oral care; however, the patient and the UAP should be instructed that fluids should not be swallowed. During nothing by mouth (NPO) status, patients usually are not given any fluid. The exception could be small sips of water to take certain medications. Some surgeons will allow the patient to have small hard candies, but sucking hard candies does stimulate peristalsis, so this is not standard practice for all patients who are NPO. UAPs are not responsible for checking IV fluids. 40. Answer 3: Coughing increases intracranial pressure; therefore, coughing is contraindicated for patients with intracranial surgery. 41. Answer 2: The nurse would check for distention first and then consider the other options.
42. Answer 3: Slowing of the respiratory rate suggests that the level of anesthesia is causing respiratory paralysis; the patient may require resuscitation. A decrease in blood pressure is also serious because of possible vasodilation. Loss of sensation and decreased movement of the lower extremities are expected. 43. Answer 3: The nurse would assess the extremity for the new report of discomfort. Based on assessment findings, the nurse could consider the other options. (Postoperatively, the patient could have an emboli or a deep vein thrombus. Positioning on the operating table could put pressure on tissues or nerves. Patient could also have a problem that is not directly related to surgery; for example, bursitis.) 44. Answer 1: The patient is instructed to get up and void before getting the medication because it causes most people to get drowsy. Urinary retention is also a common complication after surgery. The surgeon should mark the site and obtain consent. Most preoperative checklists require noting that the site has been marked and that the consent form is signed. All laboratory tests are usually completed at this point. 45. Answer 1, 2, 4, 6: The unlicensed assistive personnel (UAP) can obtain most of the equipment but is not responsible for checking the function of pumps or suction equipment. The nurse should ensure that these items are functional, as they are likely to be needed when the patient arrives 46. Answer 4: The patient must have stable vital signs before he/she is transferred to the nursing unit. If the order for transfer has been written, the postanesthesia care unit nurse would be responsible for informing the anesthesiologist about the unstable vital signs. Nausea, vomiting, a sore throat, and wound pain are expected. 47. Answer 1: First the nurse would check the patient. If there are no obvious signs or symptoms of shock, then the nurse would instruct the unlicensed assistive personnel (UAP) to take and report BP and pulse to determine a trend. A lower-than-baseline blood pressure is not uncommon after surgery. 48. Answer 4: The scrub nurse performs actions that require sterile handling. The circulating nurse is considered nonsterile and can perform tasks that require asepsis. He/she helps the scrub nurse and surgeons maintain sterility. 49. Answer 3: The ambulatory surgery patient is released to home, so the patient must be alert and pain, nausea, and vomiting must be controlled. The patient is not allowed to drive himself home and family’s willingness to assume responsibility does not absolve the nurse from making de cisions about the patient’s safety. 50. Answer 3: Any of these findings warrant further investigation; however, for diabetic patients, there is an increased susceptibility for infection and poor wound healing. Impaired communication can be a problem for patients who have had a cerebrovascular accident. Bloody emesis could be related to esophageal varices. Hypoventilation is a problem for patients with preexisting respiratory disorders. Critical Thinking Activities Activity 1 51 Latex allergy occurs in three ways: (1) as irritant contact dermatitis, (2) as type IV allergic reactions, and (3) as type I allergic reactions. The irritant reaction, which is most commonly seen, is a nonallergic reaction and results in itchy, dry, and irritated hands. The type IV allergic reaction to latex is a cell-mediated response to the chemical irritants found in latex products. The true latex allergy is the type I allergic reaction, and it occurs shortly after exposure to the proteins in latex rubber. The type I reaction is an immunoglobulin E – mediated systemic reaction that occurs when latex proteins are touched, inhaled, or ingested Factors influencing: Person's susceptibility and the route, duration, and frequency of latex exposure Risk factors: History of anaphylactic reaction of unknown cause during a medical or surgical procedure, multiple surgical procedures, food allergies (specifically kiwi, bananas, avocados, chestnuts), a job with daily exposure to latex, history of reactions to latex; history of allergies and asthma Methods of prevention: Screen prior to admission, provide a latex-free environment, communication to all members of the health care team, clearly marking the chart Activity 2 52. See Box 2-3. Activity 3 53. Older patients have higher morbidity and mortality rates than younger patients. Older individuals often have chronic conditions and polypharmacy that increases the risk for complications. Recovery can be affected by the level of mental functioning, individual coping abilities, and the availability of
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