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Med-Surg ATI > 2013A M-S ATI > Flashcards

2013A M-S ATI Flashcards

1
Q

What position facilitates breathing?

A

orthopneic position, sitting up with arms resting over bed table

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2
Q

What is a hemolytic transfusion reaction?

A

When the RBCs given to a pt are destroyed by the pt’s immune system

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3
Q

What are signs of a hemolytic transfusion reaction?

A

low back pain, flank pain, apprehension

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4
Q

What does kussmaul respirations indicate?

A

hyperglycemia

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5
Q

Following mastectomy, how should pt treat the arm on side of surgery?

A

Elevate that arm on pillow to promote lymphatic drainage, HOB 30, and start arm exercises 24h after

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6
Q

What to do if pt has bee sting and is allergic?

A

Epi first! Then remove stinger, soapy water, apply ice, and get help.

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7
Q

What are s/s of hyperthermia?

A

anxiety, loss of muscle coordination, hot/dry skin. GIVE COOLING BLANKET AS FIRST ACTION. Eventually take blood sample for electrolytes and monitor output w/ urinary catheter.

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8
Q

What is gastric lavage?

A

Pumping of the stomach. A LARGE-BORE NG TUBE IS NEEDED. RN gives 200-300 ml of NS at a time. Pt then lies on left side to ↓ amt of NS leaving the stomach and not aspirate.

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9
Q

What is dumping syndrome?

A

Occurs after gastrectomy, where the undigested contents of your stomach move too rapidly into your small bowel. Common symptoms include abdominal cramps, nausea and diarrhea. PT SHOULD LIE SUPINE AFTER MEALS TO SLOW MVMT OF FOOD.

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10
Q

Pt teaching for new hearing aid?

A

Amplification of background noise takes some adjustment, biggest challenge. Start off wearing in intervals to get use to the noise, not continuously. Always have on lowest volume that still allows pt to hear.

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11
Q

Song for hypo- vs hyperglycemia?

A

Cool and clammy, give them candy. Hot and dry, the sugar is high!

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12
Q

s/s of hyperglycemia

A

Kussmaul respirations, ↑ UO, abdominal cramping

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13
Q

What do you do if pt has peripheral vascular dz and has low O2 Sat reading?

A

First move the pulse ox to a different location that has better blood flow to get an accurate reading. She could apply warm blanket for vasodilation but it is not the first action.

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14
Q

How does Metformin work?

A

decreases the amt of glucose produced in the liver and the tissue sensitivity to insulin. SHOULD TAKE WITH OR RIGHT AFTER MEALS. (May cause N/V when first taking.)

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15
Q

Levothyroxine (Synthroid) is given for hypothyroidism. What should the pt not take with it b/c it reduces the absorption?

A

should not be taken with calcium supplements.

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16
Q

Pt on TPN does not have the next feeding available. What should the nurse do?

A

Give 10% dextrose until next TPN is available. That way the pt is getting the glucose content comparable to TPN.

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17
Q

what is peritoneal dialysis?

A

a way to remove waste products from your blood when your kidneys can no longer do the job adequately. During peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) fill in for your kidneys, with the help of a fluid (dialysate) that flows into and out of the peritoneal space.

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18
Q

What do you do if the drainage from peritoneal dialysis is sluggish?

A

Turn pt on side, this may reposition the tubing and remove from the peritoneal wall.

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19
Q

What is an indication of a DVT?

A

unilateral swelling

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20
Q

What is Cholecystectomy?

A

removal of gall bladder.

Sanguineous drainage on dressing 2h post op is expected, as well as greenish-brown drainage from T-tube

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21
Q

What are expected findings of pancreatitis?

A

elevated WBC, generalized jaundice, N/V

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22
Q

What is paralytic ileus and significance to acute pancreatitis?

A

it is a pseudo-obstruction in the intestine that can be identified w/ absent bowel sounds and this finding should be highest priority.

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23
Q

What is a life-threatening adv effect of Mag sulfate?

A

respiratory paralysis. This is a CNS depressant.

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24
Q

What is the difference b/w a pacemaker in synchronous vs asynchronous mode?

A

Synchronous–discharges to maintain the programmed HR
Asynchronous–discharges at a continuous fixed rate

Pacing spikes should be seen before each QRS to indicate proper depolarization of the heart

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25
Q

What is Erythropoietin and why would it be given to someone w/ chronic kidney failure?

A

important glycoprotein hormone produced by the kidney that is critical for the formation of red blood cells by the bone

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26
Q

Pt teaching for effects of Erythropoietin (Epogen)?

A

Pt needs adequate iron stores, so may need to take iron supplements. This will help increase prod of blood cells and reduce need for a transfusion. Frequent blood tests are needed to monitor Hgb and evaluate effectiveness of tx.

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27
Q

Why is a pt cooled before CABG procedure?

A

to decrease metabolic needs. So the RN should assess pt temp afterwards b/c it can fall even after warming measures following OR.

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28
Q

What does the incentive spirometer prevent?

A

Atelectasis. The spirometer expands the lower lobes of the lungs. Assess effectiveness by clear breath sounds in the lung bases bilaterally.

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29
Q

What does a pt with hyperthyroidism and rising BP indicate?

A

High SBP, low DBP indicates pt at greatest risk for thyroid storm. LIfe-threatening and happens when your thyroid gland suddenly releases large amounts of thyroid hormone in a short period of time

30
Q

How long should a pt wait b/w puffs with an inhaler?

A

20 to 30 seconds

31
Q

Pt teaching for using an inhaler tx for asthma?

A

hold breath for 10 seconds, exhale w/ pursed lips, wait 20-30 sec b/w puffs, rinse mouth after use

32
Q

What drug are pts with hepatic encephalopathy given?

A

Lactulose to rid the body of ammonia through increased stool. Ammonia contributes to enlarged liver and can cause confusion. Rx can cause hypokalemia and dehydration, so monitor. LOC should be better.

33
Q

Can the nurse adjust the screws on external fixation device?

A

NOPE, only the provider.

34
Q

What kind of pain is associated w/ pancreatitis?

A

intense, piercing abdominal pain

35
Q

What kind of pain is associated with cholecystitis?

A

vague pain radiating to the right shoulder

36
Q

What would indicate peritonitis?

A

RIGID, BOARD-LIKE ABDOMEN
This is inflammation of the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.

37
Q

How might a pt with a detached retina describe their CC?

A

Sensation of a curtain being pulled over part of the visual field, and detachment is a sudden onset. NO PAIN.

38
Q

Weights for traction should be between what range?

A

5-10 lbs ( 2.3-4.5 kg)

39
Q

When should the nurse notify provider of a lot of chest tube drainage?

A

greater then 70 mL/hr

40
Q

Pt teaching for ileostomy?

A

Clean skin around stoma w/ mild soap and apply skin barrier before new pouch, and empty when 1/3 to 1/2 full. Avoid high-fiber foods b/c this only drains liquid stools.

41
Q

What position should pt be in for insertion of nontunneled percutaneous CVC?

A

trendelenburg position, decrease risk of air embolism

42
Q

How long are nontunneled percutaneous CVC left in?

A

3-4 weeks

43
Q

What electrolyte does salt substitutes contain?

A

Potassium! So heart failure pt taking K-sparing diuretic shouldn’t use salt substitutes.

44
Q

When administering a flush solution thru arterial line, what should nurse do?

A

infuse NS under pressure

45
Q

Iron should be taken on empty stomach. What should they eat more of though?

A

high-fiber foods b/c iron can cause constipation

46
Q

If a pt is not used to taking morphine on a regular basis, what may they experience?

A

increased N/V

47
Q

Post-op care for pt after radical mastectomy?

A

elevate arm on pillow to promote lymphatic fluid drainage, HOB at 30, exercise arm 24h after surgery

48
Q

What is the solution used with blood transfusion?

A

NS 0.9% sodium chloride

49
Q

Types of transfusion reactions?

A

Febrile (chills/fever), allergic (bronchospasm/urticaria), hemolytic (low back or flank pain/apprehension)

50
Q

When someone comes in w/ rash and redness spreading over body, what is first thing to ask?

A

What medications are you taking?

51
Q

What is portal hypertension?

A

Portal hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver). The increase in pressure is caused by a blockage in the blood flow through the liver.
Increased pressure in the portal vein causes large veins (varices) to develop across the esophagus and stomach to get around the blockage. The varices become fragile and can bleed easily.

52
Q

What is aspiration pneumonia?

A

Aspiration pneumonia occurs when food, saliva, liquids, or vomit is breathed into the lungs or airways leading to the lungs

53
Q

What is ALS?

A

Amyotrophic lateral sclerosis. A dz of the nerve cells in the brain and spinal cord that control voluntary muscle movement

54
Q

What is normal range of prealbumin?

A

Adults: 19.5-35.8 mg/dL

Below normal range indicates malnourishment or nutrient deficiencies.

55
Q

What % of total body weight loss indicates poor nutrition?

A

5% in 30 days or 10% in 6 months

56
Q

Normal creatinine levels? What would indicate issue with kidneys?

A

A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher than normal may indicate impaired renal function.

57
Q

what glucose level is indicative of DKA?

A

> 300 mg/dL

58
Q

What is given for conscious sedation?

A

sedative and anesthetic to blood pain

59
Q

Should Type 1 Diabetic still take insulin if unable to eat regular diet while sick?

A

YES. to prevent hyperglycemia
When you have a cold or flu, or if you have a fever for a day or two, your body needs sugar that it can use for energy to help fight the illness. If you’re feeling too sick to eat, your body will get its energy by releasing blood sugar from stored supplies in the liver, making your blood sugar level rise. That’s why you need to keep taking your insulin or diabetes medication when you’re sick to control your blood glucose levels even though you may not be eating or may be eating less than normal.

60
Q

When irrigating a wound, what should the nurse use?

A

30-60 mL syringe w/ a 19-gauge. This delivers right amt of pressure.

61
Q

Why would pt with L sided HF have oliguria during the day?

A

decreased blood flow to the kidneys

62
Q

Signs of R sided HF?

A

distended abdomen, JVD, dependent edema

63
Q

What is infiltration?

A

IV fluid leaks into surrounding tissue.

  • swelling
  • discomfort
  • burning
  • tightness
  • cool skin
  • blanching.
64
Q

Why are creatinine levels important to assess before Gentamiciin?

A

b/c it is nephrotoxic

65
Q

Right brain stroke s/s

A

Paralysis on the left side of the body
Vision problems
Quick, inquisitive behavioral style (impulsive)
Memory loss

66
Q

Left brain stroke s/s

A

Paralysis on the right side of the body
Speech/language problems
Slow, cautious behavioral style (anxiety about future, feelings of guilt, expressive aphasia)
Memory loss

67
Q

What should you always do before suctioning a pt?

A

preoxygenate for 30sec to 3min to prevent hypoxemia

68
Q

What does concentrated red urine w/ intermittent clots after TURP mean?

A

possible risk for hemorrhage

69
Q

What should a pt taking hormone replacement for menopause contact provider about?

A

If she has calf pain b/c it could be DVT, or intense h/a and numbness in arms may be CVA

70
Q

When Tensilon is given, how do you determine if cholinergic or MG crisis?

A

If pt has increased muscle weakness and twitching it it cholinergic crisis. It would improve with Myasthenic crisis.

Med-Surg ATI (3 decks)

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