221 Final

Question 1

Most common symptom in early bladder cancer

Answer 1

Gross, painless hematuria (chronic or intermittent). Confirmed by BIOPSY.

Question 2

post op care for total laryngectomy

Answer 2

Monitor airway patency, VS, hemodynamic status, and comfrot level. Take VS hourly for first 24 hrs, and then every 2 hrs or according to agency policy until the patient is stable. Once off CCU monitor ever 4 hours.

Question 3

The patient tells the nurse, “ I have lost weight since going on Digoxin. The nurse should reply which of the following?

1. Hold your doses and see your doctor immediately
2. That is expected and is an action of the drug
3. This is a side effect and can have serious complications

Answer 3

It is expected that a patient will have weight loss from Digoxin. so 2.

Question 4

Major side effect of INH (tb drug)

Answer 4

B6 depletion

Question 5

When giving a diuretic what do you always check first?

Answer 5

BP!!!!!!!!!!!

Question 6

ATN manifestations

Answer 6

Fluid overload (S3, JVD), decrease urine output or not at all, hyperkalemia, cardiac dysrythmias (life threatening)-abnormally wide QRS complex

Question 7

K+ excess in oliguric phase

Answer 7

Cardiac muscle is inolerant or acute increase in K+, hyperkalemia creates an elevated T wave, hypokalemia creates and elevated U wave.

Question 8

How does Verapamil work?

Answer 8

Verapamil relaxes the smooth muscle of the heart

Question 9

Risk factors for pylenephritis

Answer 9

past medical Hx of chronic renal calculi (kidney stones)

Question 10

Ted Hose (for DVT)

Answer 10

• Promotes venous return
• make sure elastic band isnt too tight
• Apply before getting OUT OF BED

ICD’s are used to prevent DVT not for active DVT!

Question 11

Sickle Cell patho

Answer 11

When exposed to decreased O2 (being hig up in an airplane) – RBCs sickle, become rigid, fragile and sticky.

Question 12

‘what will you see with hypocalemia and hyperphosphatemia ?

Answer 12

Trousseau’s sign, cardiac arrhythmias, prolonged clotthing time (uremia shortens lifespan of plts, Ca+ important for clottinh factor cascade), fractures.

Question 13

AVF/AVG complications

Answer 13

Clotting/thrombosis, Steal syndrome: cold hands/fingers, numbness/tingling of giners, may resolve after 6 weeks.

Question 14

What are some signs and symptoms of DIGOXIN TOXICITY?

Answer 14

Halo’s in vision, Color changes in vision, Headache, Lethargy, Nausea, Diarrhea, Bradycardia, Dysrhythmia, Irritable.

Question 15

Lab values for ARF

Answer 15

K+ and phos increase, Ca+ and ph decrease Bun and creatinine increase

Question 16

Normal Bleeding time?

Answer 16

1-6 minutes

Question 17

Blood administration

Answer 17

Assess the clients lungs before and after, check for allergies, obtain a signed consent, 19 gauage or larger needle, isotonic solution(NS) in one and blood via the other spike, positively ID the donor blood and recipeient ( 2 RNs), check for storage lesions (old blood, temp of blood), takes 2-4 hours.

Question 18

intermittent claudication

Answer 18

arterial insufficiency, due to lactic acid accumulation build up in muscle, usually can feel it upon activity and subsides after 10 min

Question 19

Early s/s of diabetes

Answer 19

3 p’s polydipsia polyuria polyphagia. Classic sign is blurred vision, neuropathy also

Question 20

The client with chronic peripheral artery disease and claudication tells the nurse that burning pain often awkens him from sleep. What is the nurse’s interpretation of this change.

A. The client has inflow disease

B. The client ahs Outflow Disease.

C. The client’s disease is worsening.

D. The client’s disease is stable.

Answer 20

C. This is the worsening sign and symptom.

Question 21

(? from supplemental)

Beta blockers are ordered. The mechanism of action is

A. decrease heart rate, reduce myocardial oxygen demand

B. increased cardiac output, increased systemic vascular resistance

C.Stimulation of sympathetic nervous system

D. Alpha receptor stimulation producing vasoconstriction

Answer 21

A

Question 22

What is responsible for Coagulation of the blood?

Answer 22

Platelets

Question 23

Things that decrease preload

Answer 23

• Elevating HOB
• Nitrates (vasodialators)
• Morphine

Question 24

Nursing Responsibility for a Bone Marrow Biopsy

Answer 24

Get consent, Pre-emptive medication (Conscious sedation) Versed, & Morphine, Pressure dressing after (hold for 15 min) do frequent site checks, Assess the site for bleeding (underneath them) Possible Complications: Infections and bleeding

Question 25

EKG changes associated with coronary ischemia

Answer 25

T wave inversion and ST depression

Question 26

What does this EKG show?

Answer 26

Normal sinus Rhythm with a large PVC

Question 27

Acute interventions for ARF

Answer 27

I & O, daily weights, encourage cough and deep breathing, insentive spirometer

Question 28

S/S of Peripheral Artery Disease (PAD)

Answer 28

-withered calf muscle -hair loss -thick toe nails -shiny, tight skin -painful ulcers in the toe that are black and do NOT bleed. -Blood clots can form in some cases (STARVATION)

Question 29

List the following heart rhythms from most serious to least serious.

1. Normal Sinus Rhythm
2. PVC
3. A fib
4. V tach
5. V Fib

Answer 29

Vfib, V tach, PVC, A-fib, Normal sinus rhythm.

Question 30

accucheck coverage what type and why?

Answer 30

rapid or short acting b/c it’s easier to treat hypoglycemic rxn’s with these 2, go by sliding scale

Question 31

post op care for client after radical prostatectomy?

Answer 31

remain on bed rest, and nothing per rectum.

Question 32

What is this

Answer 32

V-Tach or Tombstone.

Question 33

Ventricular Fibrillation

Answer 33

No cardiac output;; patient is technically dead

Treatment: D-fib (shock) to try to get some kind of rhthym to work with

Question 34

Drug therapy for BPH

Answer 34

5a reductase inhibitors (Proscar) -decrease prostate size, decrease level of dihydrotestosterone, 6 months for relief of symptoms, supression of adrogens(hot flashes)
A-Adrenergic blockers = Tamsulosin (Flomax) - s/e: Hypotension, dizziness, fatigue (Priority nursing intervention is to assess for those s/e !

Question 35

What is the normal pTT or APTT (Activated partial thromboplastin time)

Answer 35

Normal (CONTROL) 30-45 seconds

Someone on Heparin (2x the control) or 60-90 seconds

Question 36

Intrarenal (ARF) results from conditions that cause direct damage to the renal tissue, some causes are:

Answer 36

Infection, Drugs (mutiple nephrotoxic antibotics: genotamcyin, all mycins), infiltrating tumors, IVP contrast, prolonged prerenal ischemia, nephrotoxic injury, acute glomerulonephritis, toxemia of pregnancy, malignant HTN, systemic lupus erthematosus, interstitial nephrtits, Acute Tubular Necrosis (ATN)

Question 37

if you believe someone is hypoglycemic but you don’t have an accucheck???

Answer 37

treat as hypoglycemic until proven otherwise, give 6-8 oz of regular pop for hypoglycemia, give hard candy 6-10 pieces, give a complex carb or cheese or protein

Question 38

Priority of care for hyperkalemia

Answer 38

Management! K+ (3.5-5.0), IV sodium bicarb to decrease blood ph, causing movement of K+ for the extracellular fluid into the cells in exchange for hydrogen ions.

Question 39

CHF causes

Answer 39

Arthersclerosis, HTN, MI

Question 40

Vascular Access sites for dialysis

Answer 40

Internal Arteriovenous Fistula (AVF)
-decreased complication rate, no dressing, allows freedom

Internal Arteriovenous Graft (AVG)
-decreased risk fo bleeding/clothing, no dressing, allows freedom

Question 41

What is the normal platelet count?

Answer 41

150000 to 400000

Question 42

c-reactive protein

Answer 42

shows up months before an MI, can possibly prevent an MI, lower # is better, measures the inflamm. Response

Question 43

Why would having a streptococcal sore throat be detrimental to someone with a hx of heart failurel?

Answer 43

because it leads to rheumatic fever, which can cause a heart murmur and endocarditis

Question 44

nutritonal therapy after stone removal

Answer 44

increase fluids to 3,000 ml/d

Question 45

tPA

Answer 45

-Clot buster

IMMEDIATELY stop tPA if: hematuria, gingival bleeding, blood oozing from IV, decreased LOC, nosebleed

Question 46

nephropathy is common in prolonged chronic diabetes, what is an early sign of nephropathy?

Answer 46

proteinuria

Question 47

A recent MI patient has admitted with chest pain, and nausea. Which is the priority? Emesis basin? Oxygen by cannula? Beta blocker? X-ray?

Answer 47

Oxygen

Question 48

What do Nitrates do?

Answer 48

Decrease pre and after load, which relieves chest pain.

Store in a cool area away from body and away from light,

sublingual, paste and spray are fast acting. Sublingual will cause tingling.

Nurse must wear gloves.

Question 49

Infections common with immunsupressive therapy

Answer 49

Cytomegalovirus(most troublesome, may result in graft loss and client deth)
Herpes virus-treat with acyclovir (Zovirax)

Question 50

(? from supplemental)

The pt with essential hypertension is started on procardia. The action of procardia includes:

A. Blocks stimulation of angiotension I to angiotension II

B. Inhibits beta 1 stimulation in the myocardium, decreasing heart rate

C. Produces vasodilation, decreasing afterload

D. Inhibits sympathetic nervous stimulation, decreasing cardiac output

Answer 50

C.

Question 51

Treatment for new MI?

Answer 51

Morphine, Oxyge, Nitrates, Asperin (ASA), Beta Blockers

MONAB

Question 52

If your urine sample comes back positive for streptococci, or is contaminated. What probably happened?

Answer 52

You touched the inside of the cup.

Question 53

Peritoneal dialysis-procedure

Answer 53

1-2 L dialysis instilled (gravity fill) over 10-20 minutes, fluid dwells, drains.

Aseptic technigue at all times !

Question 54

Patient on heparin in the hospital switching to coumadin

Answer 54

Patient cant go home on Heparin so placed on Coumadin

Coumadin takes a couple days to kick in

With both patient wont hemorrhage

Need to get INR regulated before taking off heparin

Coumadin is hard to regulate so always have vitamin K available

Question 55

To decrease Preload……

Answer 55

Administer Nitroglycerin, Morphine, Elevate HOB 45 degrees

Question 56

Post renal (outside of kidney)

Answer 56

sudden obstrution of urine flow due to enlarged prostate, kidney stones, bladder tumor or injury. BPH, STONES

Question 57

Insulin is? Made in? And produced by? Funtion?

Answer 57

a protein that is produced by the pancreas in the Islets of Langerhans, it is released and stabilizes blood glucose (lowers it)

Question 58

A client has had a recent MI. why is damage to the myocardium a problem for theis patient?

a. Damage to this area causes plaque to build up on the heart valves.
b. Damage to this layer can decrease the contractile force of the heart
c. Damage to this layer can lead to excessive cortisol and endorphin release.
d. Damage to this area causes striated heart muscle fibers to release damaging high defense lipoproteins.

Answer 58

b. Damage to this layer can decrease the contractile force of the heart

Question 59

Renal diet

Answer 59

low potassium diet, APPLES low protein, llow sodium (Toast, Applesauce, Greenbeans ) TARG

Question 60

Drugs contraindicated for someone of Coumadin

Answer 60

Aspirin, Nsaids, Motrin, Herbal Remedies or OTC (alot contain vitamin K which is antidote for coumadin)

Ex. of herbal remedies : Garlic, Ginger, Ginkgo, Ginseng &OMEGAS

Question 61

pt taking OHA says he wants to exercise and increase his meds what do we tell him?

Answer 61

Do NOT increase meds but eat more to prevent hypoglycemia

Question 62

The client becomes SOB and his lips are dusky. His ❤ rate is 120 and respiration are moist. The nurse administers O2 and places him in high fowlers mainly to: A. Increase BP B. prevent orthostatic hypotension C. Facilitate suctioning D. Decrease the preload

Answer 62

D. Decrease preload

Question 63

Azotemia is?

Answer 63

High levels of Nitrogenous waste products in urine. Kidneys are not filtering correctly.

Question 64

In order to diagnose HTN?

Answer 64

elevated BP readings must be present on at least 3 consequtive occasions during several weeks

Question 65

Blood pressure increases with age due to?

Answer 65

ARTERIOSCLEROSIS (hardening of the arteries) and loss of elasticity

Question 66

(? from supplemental)

Lasix 40mg is ordered for a pt in the ED. After administering lasix is important for the nurse to:

A. check the serum potassium level

B. Weigh the client

C. Measure the clients output

D. Take the clients BP

Answer 66

D (initially)

Question 67

Complications of Sickle cell crisis

Answer 67

Prone to infection r/t spleen fails to phagocytize foregin substances (pneumonia), chronic leg ulcers.

Question 68

proscar and flomax

Answer 68

given to BPH and kidney stones , vasodilator opens up allows stone to pass and also decreases prostate size, take at bedtime (flomax) causes erectile dysfunction

Question 69

Risk factors of getting Bladder cancer

Answer 69

Cigarette smoking (ewwy), exposure to dyes used in some rubbber and cable industries, pt with a PMH of chronic renal lithiasis (recurrent stones), chronic UTIs and chronic cystitis.

Question 70

Diabetes type 2 process and risk factors

Answer 70

Most prevalent type (90% of patients) pancreas can still secrete SOME insulin, this is called Peripheral Insulin Resistance Major risk factors: obesity and BMI >25.

Question 71

Erythropoietin (procrit)

Answer 71

Used in pts not responding to hydroxyurea, can be self administer at home ( teach self injections)

someone with leukemia cant take this.

Question 72

What blood chemistries should you check for in a urine sample?

Answer 72

BUN, Creatinine. These are expected in a client in suspected Cancer of pancreas. Run this test before chemo.

Question 73

A new MI patient comes in, what needs to be done?

Answer 73

Give morphine, o2, get iv access established.

Question 74

Nursing Diagnosis for HTN most common is?

Answer 74

Deficient knowledge related to management of disease process.

Question 75

Med that can cause ATN

Answer 75

aminoglycosides (mycins), amphotericin B (antifungal), Cisplatin (chemo), radioisotopic contract media (IVP dye)

Question 76

What is the action of Calcium channel blockers and what foods would you tell someone to avoid when on them,?

Answer 76

Cardizem (Diltiazem) relaxes smooth muscle, AVOID GRAPEFRUIT b/c your liver cant eliminate it and it builds up in the body

Question 77

(? from supplemental)

56 year old female is seen in the ED with C/O crushing chest pain radiating to her neck and shoulders . The admitting dx is MI. The following orders are noted: o2 4L nc, chest xray, blood work including triponin and myoglobin levels, EKG, and morphine sulfate 2mg IVP. What shoud the nurse do first?

A. Give morphine

B. Obtain 12 lead EKG

C. Order the chest xray

D. Call the lab obtain specimen

Answer 77

A

Question 78

Post-op for TURP

Answer 78

high potential for hemorrage, continous bladder irrigation (CBI) used to keep catheter from becoming occluded by blood clots, monitor Hgb and Hct, assess for hematuria in continous drainage bad, decrease irrigation rate of flow in clotting occurs, contact DR to udate any complications.

Question 79

If stone is present should fluids be increased to dilute?

Answer 79

No when stones are present, just hydrate do once stone is gone you can super hydrate to help keep new stones from forming.

Question 80

Hemodialysis complications

Answer 80

Hypotension (hold diuretics and antihypertensives), disequillbrium syndrome (causes nausea, confusion, restlessness, and headache, cerebral edema (confusions, alter LOC,jerking, headache), dialysis encephalopathy ( assess mental status and treat with aluminum-chelating agents)

Question 81

The final event of an MI is usually what?

Answer 81

Thrombosis

Question 82

Which of the following are true about brain natriuretic peptide (BNP) ? select all A. The test is useful in diagnosing CHF, B. The hormone has been shown to increase in response to ventricular volume expansion C. BNP is a marker of ventricular systolic and diastolic dysfunction D. The test is useful in diagnosing a MI

Answer 82

A, B, C

Question 83

Nutritional threrapy for CRF

Answer 83

Restrict protein (40gm/day)
low protein det is deficient in vitamins- replace water soluble vitamins lost in dialysis, all but ADEK (fat soluble)

Question 84

What is the T wave?

Answer 84

Ventricular relaxation or repolarization.

Question 85

Nursing interventions for pulmonary Edema

Answer 85

Adminster O2, place in semi-fowlers position, DONT cough and deep breath

Question 86

Someone is getting an IVP (Intravenous Pyelogram) what is of most concern before the procedure?

Answer 86

Check for iodine sensitivity (allergy) Shellfish, shrimp, seafood, etc.

Question 87

Glucophage (metformin)

Answer 87

Decreases hepatic glucose production

Question 88

drugs to give a pt with a PVC?

Answer 88

lidocaine or pronestyl

Question 89

What are some side effects of atenolol? Select all that apply 1. Anxiety 2. Fatigue 3. Constipation 4. Dyspnea

Answer 89

Fatigue and dyspnea

Question 90

Hematologic manifestions of CRF

Answer 90

Anemia r//t the decreased prodcution by the kidney of the hormone erythropoietin (decrease erythropoesis)

• teach self-injections of procrit (erythropoetin) SQ
• know ready to d/c when can properly give injection.

Question 91

Nursing interventions for sickle cell

Answer 91

Manage pain (PRIORITY), bedrest during exacerbation, increase fluids, IV fluids, O2, teach to avoid: overexertion, high altitudes(moutains), dehydration (drink at least 8-10 glasses of water daily.

Question 92

What does PVC stand for?

Answer 92

Premature Ventricular Contraction. The ventricle has cantracted before it can properly fill.

Question 93

Someone taking nephrotoxic drugs to treat a previous condition develops ARF (Acute renal failure) what stage is this?

Answer 93

Intrarenal stage

Question 94

What to do when pt has abdominal aortic aneuryms

Answer 94

• Report complaints of abdominal pain to Dr. immediatly!
• DO NOT PALPATE ABDOMEN!

Question 95

Urinary diversion pre-op management

Answer 95

Body image distubrance r/t change in body function

Question 96

Femoral Popliteal bypass for PAD

Answer 96

• improved blood flow beyond stenosis or occlusion
• monitor extremity q15min initially

*Assess pedal pulse q15min, complete neurovascular assessment

skin color changes (pallor) temp, cap refill, pp distal to operative site

avoid flextion of leg (no pillow)

Question 97

A patient has an mi and edema, which meds should you give.

Answer 97

Morphine Diuretics

Question 98

Anticoagulant therapy for treatment of DVT

Answer 98

-Pt placed on Heparin drip in the hospital -Patient cant go home on heparin so they’re placed on Coumadin or lovenox (LMWH) -Lovenox is given subQ, do not aspirate or massage, Leave air bubble! -Coumadin Therapy: administer same time each day, have blood drawn routinely to monitor serum electrolytes. -Pts on coumadin should wear a med-alert bracelet at all times, Report any bleeding -INR should be 2.0-3.0 on coumadin, if -Coumadin takes a couple days to have an affect so they need to be on Heparin IV for a couple days so theat the body can switch to coumadin.

Question 99

Care of client post thoracentesis

Answer 99

Monitor VS, check breath sounds for absent or redcued sounds on the affected side. Check for bleeding around puncture site. Assess for reaccumlation of fluid in the pleural space, subQ emphysema, infection, and tension phenumothorax. encourage to breath deeply to promote expansion of lungs.

Question 100

Management of pneumonia

Answer 100

Antibiotics, O2, analgesics, antipyretics, chest physiotherapy, rest, hydration, nutrition

Question 101

Nutrition for Anemic patients

Answer 101

Foods high in iron: red meat, spinach, raisins, green-leafy veggies, dried fruits.
Eat small frequent meals with snacks.

Question 102

Early signs of primary HTN (40% asymptomic ) A. End stage renal disease B. blindness C. Early morning headaches D. Loss of peripheral pulses and parathesias

Answer 102

C. Early morning headache. As well as unexplained fatigue and nocturia

Question 103

The most common symptom of early bladder cancer is?

Answer 103

Gross painless hematuria. Either chronic or intermittent.

Question 104

what to teach client when going for cystoscopy

Answer 104

They may experience burning and frequency for several hours after.

Pyridium may be used after to decrease bladder irritability.

Question 105

What does the nurse hope to accomplish by administering Bumex?

1. Reduce heart Arythmia
2. Stop chest pain
3. Reduce crackles and coughs in lung
4. Cause expansion of avioli

Answer 105

3. Reduce crackles and cough due to secretions in the lungs. Bumex or Bumetanide helps to reduce swelling and fluid retntion. Used to help in High BP.

Question 106

Nursing intervention post-nephrectomy

Answer 106

meaure urinary output every 1-2 hours to ensure that the remaining KK is functional

Question 107

tell pt w/ sickle cell to avoid ….

Answer 107

injury and high altitudes

Question 108

Before using IVP what does the nurse need to asses for?

Answer 108

Seafood allergies. SHRIMP

Question 109

someone with pernicious or iron def Anemia needs to take iron, how do they take it?

Answer 109

take iron on empty stomach so 1 hr b4 or 2 hours post meal can be taken with OJ , expect ur stools to be dark and tarry after not bright red

Question 110

major complications of a prostatectomy

Answer 110

erectile dysfunction and incontinence

Question 111

PAD Venous Symptoms (Gluttony)

Answer 111

Peripheral pulses- present but difficult to feel

Capillary Refill- less than 3 seconds

Edema- lower extremity edema

skin color- bronze, brown

texture- alligator, thick, hard

Temperature- warm

pruitis- frequently occurs

Nails will be thick for both arterial and venous

Question 112

People prone to getting DVT (venous insufficiency)

Answer 112

-immobile, *abdominal surgeries*, someone who doesnt change positions alot (truck driver, CRAB BOAT CAPTAINS ON THE BEARING SEA! LOL)

Question 113

For an acute MI with Pulmonary Edema what would you give?

Answer 113

diuretic and morphine

Question 114

Chronic Pyelonephritis s/s

Answer 114

fever, chills, flank pain, and dysuria

Question 115

The nurse initiated a teaching plan for Carol, Age 42, which is preparing for discharge following hospitalization for thrombophlebitis. She is to be discharged on Coumadin. Which statements indicate that teaching has been successful for discharge? (SATA) A. “I should increase my diet to include more salads to loose weight.” B. “I should wear a medic alert bracelet to indicate i am taking an Anticoagulant.” C. “I will need to have my blood draw regularly to monitor the effects of Coumadin.” D. “I will check with my physician before I begin or stop any medications” E. “I will begin an exercise program to facilitate circulation and decrease the chances of another DVT.”

Answer 115

B, C, D, E

Question 116

how is pneumothorax treated?

Answer 116

chest tube to water seal drainage.

Question 117

Points to remember for suctioning, when is not the easier kind that is already attached (like danielles pt)

Answer 117

Maintain surgial aspesis, mositen catheter, insert cath until patient coughs, dont suction while inserting, push in fast, pull out slow and hold suction down and let go while using a twist motion to pull out, do not suction for longer then 10 seconds, rinse cath between insertions. (am i referring to sex right now?!! moisten (lube), until they cough (she gags), go in fast, pull out slow, twist, clean off in between?? hahaahah im dirty)

Question 118

diabetes is a ______ rather than a _______

Answer 118

syndrome rather than a disease, it’s altered lipid distribution

Question 119

complications of diabetic neuropathy

Answer 119

delayed gastric emptying, infection, poor wound healing, hyperglycemia

Question 120

Calcium Channel Blockers are? How do they work?

Answer 120

VND, Verapamil, Nifedipine (procardia), Diltiazem (Cardzem).

Relax the smooth muscle in the heart. Decrease contractility and conductivity of the heart which decreases the demand for O2

Side Effects are decreased BP, Bradycardia, Headache, Perpheral Edema, and abdominal discomfort.

Question 121

Hypertensive Crisis

Answer 121

• BP 250/120 - Headache -Chest pain **STOPPING BETA BLOCKERS ABRUPTLY CAN CAUSE A HYPERTENSIVE CRISIS!

Question 122

Surgical tx for bladder cancer

Answer 122

Radical cystectomy
-ileal conduit is created

Question 123

Person has Bladder CA, theyve undergone a cystectomy,What is created, and what is expected for the first 2 days?

Answer 123

an Illeal Conduit is created, and mucous shreds in the Urine is expected for the first 2 days

Question 124

Care of a client with HTN and

Answer 124

-Give Ace-Inhibitor because they do not cause CHF and they bring dowm the blood pressure.

Question 125

Drugs for Bradycardia and decreased BP are?

Answer 125

IDEA. Isoproterenol, Dopamine, Epinephrine, Atropine.

Question 126

PAD Arterial Symptoms (Starvation)

Answer 126

Peripheral Pulses- decreased or absent

Capillary Refill- more than 3 seconds

Edema- No edema present

Pain- rest pain in foot

Skin color- Rubor/pallor

Texture- thing, shiny, dry

temperature- cool to cooler

pruitis- rarely occurs (itching)

Question 127

Name some Calcium Channel blockers and what they do ……

Answer 127

Very nice drugs verapamil, nifederone, diltiazem

Question 128

if someone is bleeding, what will BP and

Answer 128

low BP high heart rate

Question 129

Sodium balance of oliguric phase

Answer 129

Low Na+!! Avoid excessive intake of sodium, damaged tubules can conserve Na+

Question 130

Which meds will prevent the extension of an mi? Select all thy apply 1. Nitro 2. Aspirin 3. Ace inhibitor 4. Beta blockers

Answer 130

Nitro and beta blockers

Question 131

Hyper tensive crisis is?

Answer 131

BP 250/120, Headache, chest pain.

Stopping Beta Blockers suddenly can cause it.

Question 132

early s/s of CKD

Answer 132

decrease urine output, uncontrolled diabetes, hypertension (???)

Question 133

what type of isolation are TB patients in?

Answer 133

airborne

Question 134

What are the signs of myocardial ischemia?

Answer 134

Chest pressure ( elephant on chest) Neck or jaw pain Shoulder pain (referred pain) Clammy skin. Sob Nausea and vomitting.

Question 135

Too little insulin, undiagnosed DM, stress, low Na, Low Ca, hyperglycemia metabolic acidosis

Answer 135

DKA Diabetic Ketoacidosis

Question 136

What needs to be done after a thoracentesis?

Answer 136

Chest x-ray: to rule out pneumothorax and mediastinal shift.

Question 137

anemia

Answer 137

low 02 in blood, stimulated by hypoxia

Question 138

HHS main complications, s/s & treatment

Answer 138

blood glucose above 500, dehydration, altered LOC, give .9 or .45 to replace fluids,

Question 139

irreversible neuropathy is a complication of which type of anemia?

Answer 139

Pernicious

Question 140

Preneal (ARF) before the kindey, causes consists of factors outside of kindey, some of them are:

Answer 140

Decreased renovascular blood flow = HTN, decreased urine output, BUN 70, creatinine >2.9, specific gravity >1.040
Hypovolemia
Decreased cardica output
Decreased peripheral vascular resistance

Question 141

To assist someone with cultual needs pertaining to diet?

Answer 141

ASSESS what they normally eat, and offer some alternatives, help them list some foods lowest in Na+ and cholesterol from foods they normally consume

Question 142

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for Digoxin, hydrochlorothiazide, and a potassium supplement. Appropriate instructions for the patient include?

a. avoid dietary sources of potassium because too much can cause digoxin toxicity
b. take the pulse rate daily and never take digoxin if the pulse is below 60 BPM
c. take the hydrochlorothiazide before bedtime to maximize activity level during the day.
d. notify the health care provider immediatelyif nausea or dificulty breathing occurs.

Answer 142

D. Digoxin toxicity is potentiated by HYPOkalemia.

Question 143

What is Angina Pectoris?

Answer 143

Acute pain located in chest, usually an imbalance between oxygen supply and demand

Question 144

What is most common with an MI? What is the final event of an MI?

Answer 144

Most common complication? pVC or dysrythmia Final event: Thrombus

Question 145

What to teach a client on contiuous ambulatory peritoneal dialysis (CAPD)

Answer 145

To report fever & chills, report nausea and muscle meakness (s/s Na+ & K+ depletion from dialysis)

Question 146

blood sugar of 100-126 mg/dl

Answer 146

prediabetes

Question 147

What is this?

Answer 147

Ventricular Fibrillation

Question 148

Prior to giving Digoxin,you monitor pt’s heart rate and it is 58

Answer 148

Hold the med recheck apical pulse in an hour and if it is 60 or higher administer the drug

Question 149

Earliest signs of HTN

Answer 149

Nocturia, early morning headache, fatigue

Question 150

When teaching a client when and how to take TB meds, tell them to:

Answer 150

they will take 4-5 meds for 6-9 months, and then 2-3 for another 3 months. stress importance of taking the medication for the whole time

Question 151

What is a normal Digoxin Level?

Answer 151

Dig levels should be 0.8 - 2.0

Question 152

Following an acute MI, a previously healthy 67 Y.O. patient develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about.

a. digitalis preperations, such as digoxin
b. Calcium channel blockers, such as diltiazem
c. B-Andrenergic agonists, such as dobutamine
d. Ace inhibitors, such as captopril

Answer 152

D. Ace inhibitors are recommended to prevent the development of heart failure in MI patients.

Question 153

what to watch for when pt is on Tamsulosin (Flomax)

Answer 153

Hypotension, dizziness, and fatigue

Question 154

What instructions should be given to a client who is about to begin treatment with an HMG-Coa reductase inhibitor such as simvastin?

A. This drug can cause constipation

B. Take this drug on an empty stomach

C. Report any muscle tenderness to your health care provider

D You may expierience flushing of the skin with this medication

Answer 154

C. This drug can cause myopathy.

Question 155

How do ACE Inhibitors (Prils) work?

Answer 155

Stops the Conversion angiotensin I to Angiotensin II by causing sodium and water to leave body and retains Potassium. Patients will become dehydrated.

Side effects are dizziness, Cough, Headache, Dehydration, GI Distress, Orthostatic HTN.

Question 156

(? from supplemental)

Which of the following statements are true concerning the administration of NTG paste per chest wall? (SATA)

A. Orthostatic Hypotension may occur

B. Withhold the drug for BP less than 100/60

C. Withhold the drug for the dx of stable angina or acute coronary syndrome

D. Place the NTG paste on the chest wall with each application

E. May be used in clients with acute chest pain especially with no IV access is available

Answer 156

A, B, D, E

Question 157

Normal Serum Creatinine levels are?

Answer 157

0.5 - 1.5 mg/dl

Question 158

early s/s of anemia:

Answer 158

fatigue pallor sob, tachycardia , CP, HgB decreased

Question 159

A client with HTN should avoid which of following foods ? A. Turkey B. chicken. C. Green leafy veggies D. Frozen foods

Answer 159

D frozen foods

Question 160

Clinical manifestations of BPH (benign prostatic hypertrophy)

Answer 160

Feeling of incomplete bladder emptying after urination, may not be noticed for a long while.

Question 161

Multiple myeloma

Answer 161

Slow insidious nature, causes mental changes, series of involuntary muscular contractions, Ca+ is lost from bone, high levels of protein-acute tubular necrosis, bone pain (get help turning patient, give norco, vicodin, loritab, give two tabs if pain is 8, see what they usually take)

Question 162

What to Assess when a patient has a chest tube?

Answer 162

Difficulty breathing, pulse ox, check trachea alignment (tension pneumothorax), assess pain, look for ‘eyelets’ visible on chest tube.

Question 163

What is the mager diagnostic finding for an MI?

Answer 163

Troponin will increase 4-6 hours from event. CPK MB will also be positive or increase

Question 164

Nursing diagnosis for Anemia

Answer 164

Ineffectivwe therapeutic regimen management r/t lack of knowledge of meds and nutrition AEB: asking about diet, meds and RX.

• Teach to take Fe+ before meals with Vit C
• inform client that Fe+ will cause dark stools and constipation
• avoid taking with hot coffee/tea
• take enteric coated

Question 165

During the oliguric phase of ARF, neurological s/s result from?

A.Hypokalemia
B. hyponatremia
C. Decreased H+ ions in the blood
D.Urea and creatinine buildup in the blood

Answer 165

D. Urea and creatinine build up in the blood.
Unexcreated urea and creatinine build up in the blood = toxic effects on the CNS = neurological effects (lethargy/confusion)

Question 166

A BP reading of 140/90 indicates:

Answer 166

Hypertension

Question 167

sickle cell crisis care?

Answer 167

02, manage pain, bed rest, fluids, antibx

Question 168

Assessment findings for sickle cell

Answer 168

Increased bilirubin (client scratches skin), DIB (SOB), pale mucous membranes, C/O painful swelling of hands and feet, CHF, hepatomegaly, pneumonia on x-ray

Question 169

Your patient (admitted for hypertension) asks for help in ordering their dinner. Which would you select?

1. Chicken Tenders.
2. Hot Dogs.
3. Chicken Stir fry.
4. Baked Turkey Breast.

Answer 169

Baked Turkey Breast. The rest of those items are either fried or high in Sodium.

Question 170

Hodgkin B symptoms

Answer 170

Worse prognonsis=fever, night sweats, weight loss

Question 171

Stones are reccurent in..

Answer 171

50% of patients, and more common in summer.

Question 172

*KNOW ST CHANGES ON EKG

Answer 172

ST depression- indicates ischemia

ST elevation- indicates injury

Question 173

hemodialysis nursing interventions

Answer 173

Assess BP, lung and heart sounds before and after, weigh beofre and after, hold meds that effect BP, hold meds that be dialyzed off (anitbiotics, water soluble vitamins). Ausculate for bruit, palpate for fistula.

Question 174

someone in DKA or HHS when to stop the insulin drip and hang d5w?

Answer 174

when BS drops below 250 from whatever it was at

Question 175

in hemodialysis hold which meds?

Answer 175

antihtn’s dig, diuretics anything that lowers BP and diuretics bc they’re already losing enough electrolytes due to the dialysis

Question 176

Coagulation cascade

Answer 176

Heparin acts on intrinsic factor. Coumadin acts on extrinsic factor

Question 177

Action of ACE INHIBITORS

Answer 177

-Prevents conversion of angiotensin I to angiotensin II S/E: Hypotension Dry/persistent tickling Persistent dry cough -Does NOT effect

Question 178

DKA

Answer 178

Lack of insulin, breakdown of ketones (ketonuria) fruity breath, Hypokalemia, BS ^300

Question 179

Nursing interventions for a patient with AVG, what to not to on the arm it is in?

Answer 179

DONT measure BP, draw blood, place an IV or adminster injections, lift heavy objects or compress arm (carry with oppsosite arm) Palpate for thill, or ausculate for bruit (swooshing sound)

Question 180

Most people in renal failure have what kind of HCO3 levels?

Answer 180

Low HCO3 because they are in metabolic acidosis. Normal levels are 20-30

Question 181

Client with left side ❤ failure is Gavin difficulty breathing due to excessive fluid. What would ABGs look like ? A. Ph 7.47. Co2 30, Hco3 25 B. Ph 7.33, Co2 50, Hco3 26 C. Ph 7.20, Co2 35, Hco3 17 D. Ph 7.56, Co2 19, Hco3 24

Answer 181

B. resp acidosis

Question 182

A patient with a non-ST segment elevation Myocardial infarction (NSTEMI) is recieving heparin. What is the purpose ofthe heparin?

a. Heparin wil dissolve the clot that is blocking flow to the heart.
b. Coronary artery plaque size and adherance are decreased with heparin
c. Heparin will prevent the development of clots in the coronary arteries.
d. Platelet aggregation is enhanced by IV heparin infusion

Answer 182

C

Question 183

Post Op Teaching for Abdominal Aortic Aneuryms

Answer 183

-They will be in the ICU. -Prophylactic (prevents) antibiotics should be taken prior to dentist for those who recieved synthetic graft. -Teach to palpate peripheral pulses to make sure blood is getting down. -Teach that sexual dysfunction may occur if hypogastric AA is interrupted (decreased blood flow to penis) -May need refferal to a Urologist for impotence.

Question 184

sickle cell anemia manifestations

Answer 184

SOB, pale mucous membranes, palpitations, swelling in extremities, jaundice

Question 185

Bactrim is taken for how long?

Answer 185

3 - 5 days. Taken on an empty stomach

Question 186

causes of pernicious anemia

Answer 186

gastric bypass which removes the parietal cells or aging due to atrophy of parietal cells (loss of parietal cell fx)

Question 187

common clinical manifestations (s/s) or Lung CA

Answer 187

productive cough, blood tinged sputum, chest pain (pressure on nerve endings), dyspnea, wheezing, [anorexia, fatigue, weight loss] - (late sings), hoarseness, reoccurring resp infections that wont seem to go away.

Question 188

The client with heart failure is prescribed to take enalapril, an ACE inhibitor. which of the following precautions should the nurse to teach this client regarding drug therapy?

1. Avoid salt substitutes
2. be sure to take this mediaction with food.
3. Avoid aspirin while on this medication
4. Do not take this mediaction if your pulse rate is below 74 BPM.

Answer 188

Ace inhibitors inhibit the excretion of potassium. so A

Question 189

What is happening when the P wave is seen?

Answer 189

The P wave is the electrical impulse of the Atrium contracting or depolarizing.

Question 190

Anaphylactic/severe allergic reactions to blood transfusions

Answer 190

Wheezing, cyanosis, cardiac arrest, initiate CPR if indicated, epinephrine SQ or IV as ordered, do not restart transfusion, Call Code !

Question 191

To assist the patient with CAD to make the appropriate dietary changes, which of these nursing interventions will be most effective.

a. Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible.
b. Provide the patient with a list of low sodium, low cholesterol foods that should be included in the diet.
c. Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary.
d. Empahasize the increased risk for cardiac problems unless the patient makes dietary changes

Answer 191

A

Question 192

A client with a diagnosed abdominal aortic aneurysm develops lower back pain radiating to the groin. what is the nurse’s interpretation of this information.

a. The aneurysm has become obstructed.
b. The aneurysm may be undergoing expansion.
c. The client is expieriencing inflammation of aneurysm
d. The client is expieriencing normal sensation associated with this condition.

Answer 192

B

Question 193

Low potassium diet for CRF

Answer 193

APPLES, pasta, bread, spinachm, cucumber, coffee, peaches, eggs and chicken.

Question 194

Long term complications of Uncontrolled Hypertension

Answer 194

Renal Failure( kidney) , Stroke ( brain), Vascular Disease,Blindness (eyes)

Question 195

What is Stable Angina?

Answer 195

Predictable, reversible, pain on exertion as a form of chest pain.

Question 196

Prerenal (Before kidney)

Answer 196

Factors Outside of kidneys Shock, or interruption of blood flow to the kidneys from severe injury or illness (hypotension) Decrease urinary output, BUN increase, creatinine increase, specific gravity increase

Question 197

Ileal conduit care

Answer 197

meticulous skin care arpound stoma (cover stoma with gauze when changing appliance to keep dry), make sure there is drainage in bad post op (may be mucus shreds). Stoma should be red/pink moist, not flushed, not painful

Question 198

Ejection fraction

Answer 198

Left ventricle - 45-65% Cardiac Cath decreases 20%

Question 199

Mr. Tilly has a history of Buergers disease which is getting progressively worse. he is admitted with a gangrenous lesion of his right small toe. which goal does the nurse recognize is more important for mr. tilly? A. stop smoking B. perform meticukous foot care C. maintain normal weight D. control serum lipid levels

Answer 199

A!

Question 200

the flow of urine output in a nephrostomy tube should be? What would we check for if decreased output ?

Answer 200

continuous check for kinks

Question 201

the only insulin that can be given IV?

Answer 201

regular insulin

Question 202

Treatment of sicke cell disease

Answer 202

Broad-spectrum antibotics, folic acid, exchance blood transfusions(in aplastic crisis), chelation therapy to decrease transfusion-induced iron overload, Oxygen.

Question 203

Intrarenal (direct damage to the renal tissue)

Answer 203

infection, Drugs (mycins), IVP contrast, toxemia of pregnency, malignat htn, ATN (causd by ischemia, neprotoxins, or pigments)

Question 204

What are the two main reasons to prescribe aspirin to a cardiac patient?

Answer 204

To reduce platelet aggregation, to decrease temp of inflamed tissues.

Question 205

tx for hypoglycemia

Answer 205

fast acting CHO, check glucose, if normal give complex CHO, then 50% dextrose

Question 206

Renal function can be checked with this? It is a better indictor than BUN.

Answer 206

Serum Creatinine. It is not influenced by protein and exercise.

Question 207

Adminstration of blood

Answer 207

Remain with patient for first 15 minutes or 50 ml of blood (reactions occur at this time), infuse at rate of no more than 2 ml/min, take no more than 4 hours to administer, may use blood warmer to avoid chills.

Question 208

When on coumadin what two tests should be monitored?

Answer 208

pT & INR

Normal pT is 12-15 seconds

Normal INR is 2-3 for someone on Coumadin; Target GOAL is 2.5; and 0.8-2.0 for normal people not receiving Coagulation

Question 209

Patho of Hodgkin’s disease

Answer 209

Presence of Reed-Sternberg cells in the biopsy speciem ( GIANT, MALIGNANT, MULTINUCLEATED LYMPHOTCYTE)

Question 210

AVF/AVG nursing interventions

Answer 210

Do not measure BP, draw blood, place an IV, or adminster injections in the extermity its in, do not life heavy objects or do anything that compresses extremity. Teach to carry stuff with opposite arm.

Question 211

Most important assessment following a cardiac Cath is: A. Peripheral pulses B. resp rate C. Measurements for ascites D. Complaints of fatigue

Answer 211

A. Peripheral pulses

Question 212

A patients dig levels is 1.2 and his k+ is at 4.2, do you give digoxin, LASIX or both? And why

Answer 212

Both. LASIX to reduce the potassium level, and digoxin to bring the dig level up.

Question 213

If a patient with intermittent claudication says burning wakes him up from sleep what do you suspect?

Answer 213

the disease is worsening

Question 214

Antibiotics used to treat pneumonia

Answer 214

Penicilin G, cephalosporins, (Keflin), aminoglycosides- garamycin, nebcin, vancomycin (nephrotoxic)

Question 215

why does a patient who has undergone Gastric bypass surgery develop anemia?

Answer 215

because they cant absorb Vitamin B12 (Cobalamin)

Question 216

Some chemotherapies are nephrotoxic. what needs to be monitored when patients are on chemo?

Answer 216

BUN, Creatanine, & Urine output

Question 217

A chemo pt is at risk for?

Answer 217

bleeding, infection, & anemia

Question 218

Nursing Diagnosis for PAD

Answer 218

1 Acute Pain

• Activity Intolerence

Question 219

A 36 YO patient who has a history of thromboangiitis obliterans (Buerger;s disease) is admitted to the hospital with a gangrenous lesion of the right small toe. When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient?

a. Cessation of smoking
b. Maintenance of apropriate weight
c. Control of serum lipid levels
d. demonstration of meticulous foot care.

Answer 219

A. Smoking cessation. Only complete abstinance of nicotine will help reduce the risk of amputation in clients with Buergers disease.

Question 220

Microangiopathy

Answer 220

specific to diabetes, complication involving the kidneys, eyes and loss of sensation

Question 221

Anemia with CRF

Answer 221

r/t the decreased production by the kidney of the hormone erythopoietin Teach self-injections of procrit

Question 222

Assessing the insertion site of chest tube

Answer 222

ensure dressing is tight and intact, check skin around insertion site for puffiness or crackling (could be subcutaneous emphysema) as well as for infection (redness, purulent drainage) or excessive bleeding.

Question 223

Manifestations of CRF

Answer 223

Decrease urinary output with Azotemia(increase in bun and creatinine), arrythmias from hyperkalemia, drug toxicity, renal osteodystrophy (pidgeon chest)- as GFR decreased, phos and Ca+ are impaired, hypocalemia and hyperphosphatemia (trousseau’s, cardiac arrthymias, prolonged clotting time, fracures), pH decreases.

Question 224

what do you want the pulse ox to be with a COPD pt and why?

Answer 224

around 90%, because they are CO2 retainers. only give O2 via NC, excessive 02 takes away their hypoxic drive to breathe

Question 225

A client with case of fever, chills, and left costovertebral pain should have what kind of test started?

Answer 225

Clean catch urine test.

Question 226

A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that further treatment of the patient will require

a. Iv Adenosine
b. Electric cardioversion
c. Insertion of an implantable cardioverter-defirbrillator.
d. anticoagulant therapy with warfarin (Coumadin)

Answer 226

D Fib that has lasted more than 48 hours requires anticoagulation.

Question 227

Schilling Test

Answer 227

Used to diagnosis Pernicious Anemia and malabosption syndromes, postitive for pernicious anemia when radioactive B12 is not found in the 1st 24 hr urine.

Question 228

Ways to administer Heparin and reasons for it

Answer 228

Given IV or Subq

-Prevents extension of a clot:: does not dissolve a clot (steptokinase tPa)

Monitor PTT.

*if ptt is below 55; administer bolus of heparin or increase the rate.

If ptt is above 90, turn off hep drip for an hour, ptt should return normal because heparin has a short half life

Question 229

Discharge teaching after a TURP (home care)

Answer 229

May need meds for ED, leg bag day, foley cath bag at night, avoid heavy lifting, oral fluids 2-3 quarts a day, refrain from intercourse and driving after surgery, contine annual rectal exams.

Question 230

Streptokinase is prescribed for a client with myocardial injury. The therapy should be stopped when client experiences: A. Relief of pain B. oozing of blood from IV site C. Sudden decrease in LOC D. An increase in HR and myocardial contractility

Answer 230

C. Sudden decreases in LOC could be a sign of brain bleed

Question 231

Patients taking Potassium Sparing diuretics such as Aldactone should be taugh what?

Answer 231

Teach paient to avoid k rich foods and monitor for hyper kalemia.

Question 232

Anemia may be related to

Answer 232

Decreased intake of iron, cobalamin, folic acid, and green leafy vegetables

Question 233

Who is prone for renal disorders?

Answer 233

Smokers, Textile workers, PAinters,

Question 234

Which findings are indictive of flid volume overload?

A. palpitations, weakness. leg cramps
B. Pericardial friction rub
C. Pleural friction rub, fever, DIB(SOB)
D. S3

Answer 234

D. S3

palpitations, weakness, leg cramps = electrolyte imblance
Pericardial friction rub = pericarditis
Pleural friction rub, fever, and DIB = uremic toxins inflame the visceral and parietal pleura of the lung

Question 235

What additional physical assesment parameter should be included in the examination of a client diagnoses with HTN?

A. Skin examination for telangiectasis.

B Otoscopic examinations of the inner ear

C. Fundusopic examination of the Retina

D. Neurologic of the cranial nerves.

Answer 235

Anser is C. HTN can effect the appearance of the retina

Question 236

Treatment for DKA

Answer 236

treat the cause, give insulin, hydrate, give d5w KVO, prevent rebound hypoglycemia, stabilize the acidosis (priority)

Question 237

Ventricular Tachycardia

Answer 237

TOMBSTONE

• Filling time is decreased b/c heart is beating so fast, oxygen demand is up while supply is down (supply oxygen to pt)
• Treatment: Check pulse, If there is a pulse cardiovert if not DFIB, lidocaine, pronestyl, amioderone

Can lead to VFIB which is BADDDDD!

Question 238

Hemodialysis

Answer 238

Method of choice when rapid changes are requred in a short amount of time.
-pt complains of fatigue and is sleeping (azotemia) - emergency situation, SEE PT FIRST !
ISNT sterile

Question 239

Types of stones

Answer 239

Calsium oxalate, calcium phosphate, struvite (acidify urine with cran juice), Uric acid (give allupurinol [prevents] ), crystine -genetic defect.

Question 240

Make sure to maintain what with peritoneal dialysis?

Answer 240

aseptic, sterile technique, can cause peritonitis if connections are contaminated.

Question 241

Client is admitted with acute CHF. Soon after client becomes restless and coughs up pink frothy sputum. The nurse would perform which of the following ?( select all ) A. Administer codeine as cough suppressant B. use corticosteroid inhaler C. Administer IV nitro and morphine sulphate D. Weigh client and measure abdominal girth E. Restrict fluids and administer lasix as order

Answer 241

C and E. as well as elevate HOB, give cardiac stimulate

Question 242

The risk for developing prerenal failure is greatest in pts with?

A.

B. Acute pyelonephritis

C. Acute glomerulonephritis

D. SLE

Answer 242

A.
Disorders that decrease cardiac outout (
Renal infections ( pyelonephritits and glomerulonephritis) and SLE = intrarenal failure

Question 243

When is a chest tube needed?

Answer 243

when air or fluid gets in the lungs. used to get lungs back to normal intrapleural pressure, allow lungs to reexpand

Question 244

What is Unstable Angina?

Answer 244

New onset, increased frequency and may occur while at risk. If patient goes 6 months without any treatment there is a chance the arteries will close (Infarct)

Question 245

A patient with Diabetes is admitted unresponsive to the ED. initial findings are Potassium 2.8, Sodium 138, Chloride 90, Glucose 628. Cardiac monitoring shows multifocal PVCs. The nurse understands that the patients PVCs are most likely caused by.

a. Hyperglycemia
b. Hypoxemia
c. Dehydration
d. Hypokalemia

Answer 245

D. Hypokalemia increases the risk for Ventricular dysrhythmias like PVCs. V tach, and V Fib. life threatening

Question 246

Which instruction should be included in the teaching plan for a client with a permanant pacemaker?

1. Baths are not permitted; Take only showers.
2. Report pulse rate lower than your pacemaker setting.
3. If you feel weak, apply pressure over your generator for 30 seconds.
4. Have your pacemaker turned off before having magnetic resonance imaging testing.

Answer 246

B. Report pulse rates lower than pacemaker setting. should be normally 70-72 bpm

Question 247

Peritoneal dialysis diet

Answer 247

Allowed more protein in the diet because urea and protein are lost in the peritoneal bath.

Question 248

Ibritumomab tiuxetan (Zevalin)

Answer 248

A monoclonal antibody that tagets the CD20 antigen on the B cell and B cell tumor, allowing delivery of radiation directly to the malignany cells. (mouse urine)

Question 249

Ileal conduit (urinary diversion)

Answer 249

Uretters are anastamosed to a segment of the ileum for urinary drainage.
Common to have mucous shreds in urine post op r/t attachment to bowel to maintain blood supply.
Make sure ther is drainage in thr bag post-op

Question 250

insulin’s and peaks

Answer 250

rapid (lispro, aspart)( eat immediately) onset 5-15 min PEAK 30-90 minShort acting: (regular, Humilin R) onset 30-60 peak 2-4 hrIntermediate- ( Humilin N, NPH Lente) onset 1-2 hr peak 4-12 hrLong acting (Lantus, glargine, determir, Ultralente) onset 2-4 hr NO PEAK FOR LANTUS!!

Question 251

Home care post op cystectomy (urinary diversion)

Answer 251

oral fluids 2-3 quarts a day, avoid heavy lifting ( >10lbs), refrain from driving or intercourse, continue annual rectal exams, use a leg bag during the day if sent home with catheter.

Question 252

peritoneal dialysis

Answer 252

more simple, but carries the risk of peritonitis
Sterile

Question 253

What is a side effect of Propranolol?

Answer 253

Bradycardia

Question 254

What effect does Tachycardia have on the body and heart?

Answer 254

Increased Cardiac Ouput which in turn causes a higher demand for O2.

Question 255

Client taking Lipitor, lopressor, and procardia is going home. What are some appropriate discharge instructions ?

Answer 255

Low sodium low CHO diet, orthostativ\c HTN,mild exrcise, Betas cant be stopped abruptly, monitor liver fx (light stool, light urine, skin color changes, RUQ tener, fatigue).

Question 256

To reduce risk of complications associated with TPA

Answer 256

Following clot lysis, heparin and aspirin are prescribed

Question 257

Renal osteodystrophy

Answer 257

realted to CRF, as the GFR decrease, phos and Ca+ balances are impaired – (hypocalemia)

Question 258

Nursing diagnosis for UTI

Answer 258

Acute pain r/t inflammation of mucosal tissue of urinary tract AEB: pain on urination, flank pain, suprapubic pain, lower back pain or bladder spasms.

Question 259

DKA type 1 or 2 ??HHS type 1 or 2??

Answer 259

DKA (diabetic ketoacidisis) type 1 HHS type 2

Question 260

Preventions of Sickle cell

Answer 260

Flu and pneumonia vaccines since they are at risk for injection and to help prevent crisis, avoid hypoxia ( high altitudes, dehydration)

Question 261

One of the clinical manifestations of Cystitis is?

Answer 261

Suprapubic pain. Relieved by voiding and frequency.

Question 262

What is an angiogram?

Answer 262

• Shoots die in artery to look at blockages of artery
• Assess color, temp of affected leg post procedure if pedal pulses become weak.
• keep leg extended for 2 hours post procedure.

Question 263

If the PQRST are all present and the beat is 60-100 BPM, What is it considered?

Answer 263

Normal Sinus Rhythm.

Question 264

Shiny Skin with decreased hair growth is a symptom of ARTERIAL PVD OR VENOUS PVD?

Answer 264

ARTERIAL PVD

Question 265

Antidote for Heparin

Answer 265

Protamine Sulfate

Question 266

A client is to begin taking hydrochlorothiazide for contorl of HTN. what instructions should be given to this client before beginning therapy?

A. You may develop a sower pulse rate

B. You may notice some swelling in your feet.

C. You may develop shortness of breath.

Your diet should include foods high in potassium

Answer 266

D. Hydrochlorothiazide causes potassium loss.

Question 267

Side effect of Atenolol?

Answer 267

Fatigue and Dyspnea

Question 268

How do Beta Blockers (olol’s) work?

Answer 268

Block the beta receptors in the heart, causing decreased heart rate, decreased force of contraction, decrease BP.

Side effects are

1. Bradycardia,
2. lethargy
3. CHF

Question 269

During the assessment of Mr. Harvey, he tells the nurse that for years he has taken an evening walk but lately even a short walk causes leg pain and muscle cramping. if he stops for a while, the pain goes away. the nurse recognizes this condition as: A. thrombophlebitis due to a blood clot in a peripheral vessel with resulting obstruction B. DVT due to chronic inflammation of the peripheral veins C. varicose veins due to chronic venous insufficiency with resultant ischemia D. intermittent claudication due to perpheral ischemia nad accumuation of metabolites in the tissues

Answer 269

D

Question 270

Strephtomycin (TB drug) is

Answer 270

nephrotoxic

Question 271

What expected outcome would indicate effective management of a clients HTN?

a. The client has not developed pedal edema.

B. There is no evidence of sexual dysfunction

C.There is no indication of target organ damage

D. The client’s blood pressure reading is stable at 148/94

Answer 271

C. This is sign that the HTN is properly being managed.

Question 272

Diagnostics for DVT are?

Answer 272

Blood Studies

Platelets, bleeding time, INR, PTT

If elevated this will mean underlying blood disease.

If decreased polycythemia which will increase heart workload and bllod pressure.

Question 273

While you have a UTI, you should avoid what kind of food or juice?

Answer 273

Citrus. It irritates the bladder.

Question 274

Right sided heart failure or Core pulmonale symptoms are?

Answer 274

• Fatigue
• Ascites
• increased Veinous pressure
• enlarged liver and spleen
• JVD
• Anorexia and complaints of GI Distress
• Weight gain and edema
• Oliguria

Question 275

Why is ASA used as a prophylactic?

Answer 275

It reduces Platelet aggregation. It may also reduce temp secondary to MI.

Question 276

Skin in an anemia patient will look like?

Answer 276

skin may be pale (decreased HGB), flushing (increased HGB), jaundice (excessive hemolysis) cyanosis (low HGB, High deoxyhemoglobin) Pruritis (hodgkins), leg ulcers (sickle cell), Petechia (low platelet or clotting factor), eccymosis, hematoma.

Question 277

What are the major actions of Digoxin?

Answer 277

Increases Cardiac output, promotes mild diuresis. Must be held if Pulse is below 60 bpm.

Question 278

Which statement made by a client would alert the nurse to the possibility of right sided heart failure?

1. I sleep with four pilows every night
2. My shoes fit really tight
3. I wake up coughing every night
4. I have trouble catching my breath

Answer 278

2. My shoes fit really tight.

This is an early sign of Edema and heart failure.

Question 279

What would someone with arterial insufficiency look like?

Answer 279

STARVATION: thin skin, dependent (redness/rubor) skin then it turns white, cool to touch, thick toenails, they do not bleed and do not have edema cap. refill is more than 3 seconds

Question 280

Prostate-specific antigen (PSA)

Answer 280

normal is 0-4, variations can be utilized to determine between BPH and prostate CA, baseline can be utilized to determine cancer Tx, PSA may be normal in some men with prostate CA

Question 281

S/S of Acute rejection of Kindey transplant

Answer 281

Swelling, tenderness at graft site

Question 282

What is the normal platelet count?

Answer 282

150,000-400,000

Question 283

Pain management for kindey stones

Answer 283

Load em up! opoid analgesics, tamsulosin (flomax) [vasodilates], keep adequately hydrated -overhydration=spams.

Question 284

What is the most common complaint of a male with BPH (Benign Prostatic Hyperplasia)

Answer 284

Frequent urination due to a feeling of incomplete bladder emptying

Question 285

How long do you have to stay on Antihypertensive meds? and what are common side effects?

Answer 285

Pt should know they will be on these meds for the rest of their life

Common s/e are fatigue and male sexual dysfunction

Question 286

Erythropeietin (EPO), procrit, Epogen

Answer 286

increases RBCs

Question 287

Fluid restriction for CRF

Answer 287

Restrict Na+ and fluids, includes all PO, IV
spread over 24 hrs, 550ml during the day, 300 afternoon, 200 at night.

Question 288

A patient is scheduled for a cardiac cath before the test, nurse tells the patient …..

Answer 288

a feeling of warmth may be experienced as the contrast material is injected into the catheter

Question 289

Which of thses items is high in Sodium, thus contraindicated for a HTN patient?

1. Apple Juice
2. Orange Juice
3. Strawberry Banana Smoothie
4. Tomato Juice

Answer 289

Tomato Juice is the highest in sodium of those listed.

Question 290

Treatment of renal osteodystrophy

Answer 290

Calcium acetate (PhosLo) Lowers phosphate
 -to reat defective done development due to decreased serum Ca+

Question 291

A client with a history of myocardial inarction calls the clinic to report the onset of a cough that is troublesome only at night. What action should the nurse take at this time?

1. Instruct the client to come in to the clinic for evaluation
2. Instruct the client to increase fluid intake during waking hours
3. Instruct the client to use and over the counter cough suppressant before going to bed.
4. instruct the client to use two pillows to facillitate drainage of postnasal secretions

Answer 291

A. Instruct the client to come to the clinic for evaluation

Nocturnal cough is an early indicator of Heart failure.

Question 292

Signs and symptoms of a Hypertensive crisis

Answer 292

BP 250/120, Headache, Chest Pain

Question 293

Nursing diagnosis for an acute renal failure client that is vomiting

Answer 293

fluid volume deficit?, fluid and electrolyte imbalance? not sure on this one couldnt find and answer.

Question 294

The client is in atrial Fibrillation following cardiac surgery. Which of the following assesment parameters should the nurse monitor for complications associated with dysrhytmias.

a. measure urinary output
b. assess the shortness of breath
c. asses pulse oximetry every hour
d. Measure blood pressure in the lying and sitting positions

Answer 294

B. Assess for shortness of breath. Possible PE

Question 295

Complications of Anemia

Answer 295

Erythrocyte (RBC) disorders lead to hypoxia
Hypoxia accounts for and is the underlying cause of the s/s of anemia:
-DIB
-palpitations
-confusion and tachycardia in severe cases

Question 296

Calcium phosphate dietry suggestion

Answer 296

Diet high in Ca+ may actually lower the risk by decreasing urinary excretion of oxalate (a commone factor in many stones)

Question 297

Tx for diabetic client

Answer 297

self monitor glucose, exercise, lose weight (type 2) stop smoking, control HTN No alcohol, ADA diet w/ even exchanges 1 carb=15 grams of fat, type 1’s decrease insulin have a snack b4 exercise. And have several small carb snacks to prev hypoglycemia during exercise, wear proper footwear, get eyes checked annually

Question 298

New patient labs have revealed that the patient using heparin, has had his PTT time double. What will the nurse do? 1. Hold the next dose. 2. Notify the doctor. 3. Continue to observe and administer prescribed dose. 4. Adjust dose to profuse more quickly.

Answer 298

Continue to observe. Therapeutic doses of heparin will double PTT times.

Question 299

Hemoglobin A1c (glycosilated hemoglobin test) & normal ranges

Answer 299

Tests BS for 90-120 daysin a non-diabetic 4-6%, in a diabetic 7%

Question 300

What would help someone build collateral circulation for intermittent claudication?

Answer 300

walk/exercise

Question 301

disorder of carbs, proteins and fats?

Answer 301

Diabetes Mellitus

Question 302

Intermittent Claudication

Answer 302

• Pain with exercise/ walking
• goes away within 10-15 minutes
• due to peripheral ischemias and lactic acis (metabolite) accumulation tissues.

If patites states burning pain wakes him, the disease is worsening.

Control cholesterol, stop smoking (vasodialates)

Question 303

Iron deficiency Anemia (malabsorption)

Answer 303

Gastric surgery may remove or bypass duodenum, Vit B12 isnt absorbed due to decreased intrinsic factor (cant take B12 oral, must be IM)

Question 304

BNP (Brain Natriatic Peptide)

Answer 304

BNP is NOT an indicator of MI.

-BNP norm levels 0-100

less than 100 indicates repiratory problem or no problem

more than 100 indicates heart failure

Question 305

Lifestyle factors related to kindey stones

Answer 305

prolonged bedrest, prolonged hospitalization, immobility, sedentary occupation.

Question 306

(? from supplemental)

The client is a 55 yr old female, admitted with history of MI, valvular disorder, and CHF. The pt presents with weight gain, ascites, heart rate of 104, crackles, complaints of fatigue. The pt complains of chest pain that is radiating down the left arm and the triponin is elevated.What is developing? (SATA)

A. Pulmonary Embolism

B. Left sided heart failure

C. Right sided heart failure

D. Biventrical failure

E. MI

F.Unstable Angina

Answer 306

D, E

Question 307

normal ppl get PVCs why? And is it dangerous to us?

Answer 307

taking stimulants: coffee, cocaine, hypoxia, fever heart failure, MI, CAD, smoking, it’s only dangerous to an ischemic heart

Question 308

Drugs to give to someone in HTN crisis

Answer 308

Labetalol, Nadolol (Combined alpha a and B adrenergic blockers

Question 309

Sever Anemia symptoms

Answer 309

HgB irritation of oral mucosa, impaired thought processess, tachycardia, chest pain, blurred vision, pallor, depression, theres more but only the bold ones were highlighted.

Question 310

s/s of hyperglycemia

Answer 310

thirst, dry mucous membranes, poor skin turgor, polyuria fruity breath, fatigue tachycardia kussmauls

Question 311

teach diabetic client to avoid what and why?

Answer 311

injury because of slow wound healing

Question 312

AVG complications

Answer 312

Clotting/thrombosis, infections, steal sydrome= cold hand/fingers, numbness/tingling of fingers (my resolve after 6 weeks)

Question 313

With TB drugs you should watch for jaundince, yellow skin because these drugs are

Answer 313

liver toxic

Question 314

Common side effects of rifampin (TB drug)

Answer 314

turns saliva, tears and urine orange

Question 315

Orange urine sample is usually?

Answer 315

Pyridium. given for urinary pain. burning and urgency.

Question 316

What does this EKG show?

Answer 316

A-FIB

most common dysrhythmia!

Question 317

Discharge Teaching with someone on Coumadin?

Answer 317

• Take med at the same time every day (usually 2pm-5pm)
• Use soft toothbrush, electric shaving
• Routine lab follow up

–Dont eat Vitamin K (antidote)

• Wear med alert bracelet
• Stop taking it prior to medical procedure
• Ask Dr. before taking any drugs including OTC

Question 318

all diabetics get this for lunch…

Answer 318

1/2 turkey sandwich and glass of milk for a snack (not breast milk)

Question 319

pt is HHS you can tell they’re getting better when ….

Answer 319

urine output returns to normal, ^LOC

Question 320

Which intervention does the nurse plan for a client who is recieving a Continuous IV heparin infusion? A. have vitamin K available in case the client bleeds from the action of Heparin B. teach the client to give subcutaneou heparin injections for long term home therapy C. maintain strict bedrest to prevent accidental trauma D. notify the physician if PTT value is greater than 180 seconds.

Answer 320

D!!! Normal PTT 30-45, therapeautic is double…. 180 is wayyyy tooo highhhhhh

Question 321

What client should be aware of post-transplant

Answer 321

They will be on immunosuppressants for the rest of their life!!

Question 322

Client is to begin taking Bactrim for a UTI, how to tell him to take it?

Answer 322

With a full glass of H20, on an empty stomach which is an hour before or 2 hours after a meal. Oh and be sure to take the full prescription to get rid of the UTI ya nasty filthball

Question 323

Hematologic disorders of oliguric phase of ARF

Answer 323

Anemia due to impaired erythropoietin production, WBC alteration- infection is the major cause of death with ARF, encourage cough and deep breathing to prevent pneumonia.

Question 324

Acute blood transfusion reactions

Answer 324

Antibodies in the recipient’s serum react with anitgens on the donors RBCs
-casued by ABO-incompatible blood tye (adminstering to wrong patient)

Question 325

INR values should be?

Answer 325

2-3 whiole on medication and target is 2.5.

Unmedicated target is 1

Question 326

Most common EARLY complaint of Bladder Cancer?

Answer 326

Gross painless hematuria

Question 327

Diabetes type one

Answer 327

insulin dependent diabetes occurs earlier in life, beta cells are destroyed, may follow exposure to a virus, need to take insulin not OHA’s only OHA they can take is Glucophage linked with genetics, autoimmune, results are metabolic acidosis

Question 328

SE of antihypertensive medications

Answer 328

Beta Blockers- wheezing, bronchospasms, fatigue, hypotension, bradycardia, CHF

Ace Inhibitors- Hyperkalemia, hypotension, dry hacking cough, dehydration

Calcium Channel Blockers- hypotension, bradycardia

Question 329

Sickle cell crisis

Answer 329

Severe. S/S= pain first ( aching and swelling in joints of hands and feet - priority nursing intervention is to adminster dilaudid IVP during crisis, get blood cultures for temp > 101.0 = infection!

Question 330

If there is no fluccuations in a water seal chamber, what does this mean?

Answer 330

That the drainage system is blocked or the lung has reexpanded.

Question 331

s/s of hypoglycemia

Answer 331

low blood glucose under 70, confusion, irritability, diaphorsis, tremors, hunger headache weakness , visual disturbances (can mimic alcohol intoxication)

Question 332

Most critical assesment of a client with PVD

Answer 332

Pedal Pulses

Question 333

Mr. Gatlin has recieved intravenous heparin therapy for six days for treatment of DVT. The physician now orders warfarin (coumadin) without discontinuing the heparin. Mr Gatlin questions the nurse about the use of both medications. The nurses best response is? A. I will check with your doctor about this. you could be at risk for bleeding. B because you are allowed more activity now, the heparin is metabolized faster and needs to be supplemented with coumadin C. because of the potential for pulmonary embolism, it is important for you to have additional anticoagulants D. it takes several days for the coumadin to take effect, so we need to keep you on the heparin for a few more days.

Answer 333

D!

Question 334

What to do for blood transfusion reactions

Answer 334

Stop the infusion immediately (clamp everything off and get another IV), maintain NS IV line (seperate line), monitor vitals and urine output, recheck ID tags and numbers, notify blood bank immediately, send blood bag, tubing and UA to blood bank.

Question 335

Neupogen

Answer 335

Increases WBCs

Question 336

Renal diet for hemodiaylsis

Answer 336

low protein, low Na+ ( Toast, Applecause, Rice, Greenbeans ) TARG? lol

Question 337

Etiology and patho of stones

Answer 337

Crystals, when in concentrated form, untie to form stones. Keeping urine dilute and free-flowing prevents this!

Question 338

If patient does not want to go home on Coumadin.. an alternative would be..

Answer 338

Lovenox SubQ

Nurse would teach pt that shot is in abdomen, no aspirating, or massage. Keep air bubble

Question 339

A patient admits to the ER with chest pain that radiates to the shoulder. What should the nurse do first?

1. X-ray
2. Call lab to take samples for analysis
3. Hook up 12 lead
4. Morphine, O2, Nitrates, ASA

Answer 339

4. MONA

If you relieve the chest pain you relieve the ischemia.

Question 340

Nutritional therapy ARF

Answer 340

Decrease protein intake 1.2 to 1.3 g/kg

Question 341

Urinary tract calculi (nephrolithiasis)

Answer 341

Post-renal disease, Tx for UTI cause by pseudomonas predisposes client to renal calculi further down the road.

Question 342

what to tell a pt before going to cystoscopy?

Answer 342

They may experience some buring on urination & urinary frequency for several hours post cystoscopy. Tx with pyridium

Question 343

First thing people complain of with aortic aneurysm?

Answer 343

Excruciating Headache (cerebral)

pain (abdominal)

Thoracic Aneurysm- its high up so people mistake it as chest pain.

PROGNOSIS: DEATH

Question 344

Diuretics are?

Answer 344

Given with morphine in situation of MI and Pulomanary Edma. Usually LAsix to reduce pulmonary crackles and coughs as well as BNP level.

Question 345

if u have a pre-op NPO client that’s diabetic how to administer insulin therapy?

Answer 345

hold the long acting and dep. on BS give short acting

Question 346

Polycythemia- manifestations and major problems.

Answer 346

Thick blood, enhanced blood viscosity and volume, congestion of organs and tissues and splenomegaly.
Manifestations- headache, dizziness, vertigo- all due to HTN secondary to hyperviscosity and hypervolemia (fluid volume overload)
Major problems- thrombosis(stroke), institute active or passive leg exercises and ambulate to prevent DVT.

Question 347

Which is the appropriate question to as a 52 y/o male with post renal failure

A. Do you have and heart problems?

B. Do you have an enlarged prostate?

C. Do you have high blood pressure?

D. Have you recently had a diagnostic exam that utlized dye?

Answer 347

B. Do you have an enlarged prostate?

Post renal failure results from obstruction of urine from the kindey
Ask about disorders that can lead to obstruction (renal calculi, blood clots, tumors)
Heart problems = prerenal failure
HTN & dye reactions = intrarenal failure

Question 348

What is a side effect a nurse should monitor for when administering Lipid Lowering Agents?

Answer 348

Hepatoxicity

Question 349

Diuretic phase (big urine)

Answer 349

Gradual increase in urine output to 1-3 liters a day, may reach 3-5 liters (>400 ml/hr), nephrons are still not fully functional, monitor for Na+, K+ levelrs for dehyradtion.

Question 350

What to report with a lithotripsy

Answer 350

WBCs >14,000

Question 351

Diagnostics of a DVT

Answer 351

Platelet count, bleeding time, INR, APTT if these are elevated, the patient has an underlying blood disease, if they are decreased, the person has in increase in RBC or polycythemia, increased workload of the heart, increased BP,

Question 352

What would someone with venous insufficiency look like?

Answer 352

Brawny(Brown) thick skin, warm to touch, normal OR thick toenails, these are the bleeders, these people are in glutany they feel a dull aching pain with heaviness and have lower extremity edema, cap refill less than 3 seconds

Question 353

Coplications of hypertension?

Answer 353

Target organs are Heart, Brain, Eyes, Kidney, and veins.

You know treatment is successful when target organs show no indicators of damage.

Question 354

What is the antidote for Coumadin?

What should be done after administration of antidote and why?

Answer 354

Vitamin K

Monitor the INR because coumadin has a long half life.

Question 355

Moderate symptoms of Anemia

Answer 355

HgB 6-10, same symptoms as mild but at rest, dyspnea on exertion, pallor

Question 356

Risk factors for primary hyper tension are?

Answer 356

Age (50% in people over 60), Alcohol, Smoking, Diabetes, elevated serum lipids (cholesterol) Excessive dietary sodium.

Question 357

for oral anti diabetics check which labs? Specifically for glucophage check which labs?

Answer 357

liver fx tests for OA’s (OHA’s) they r metabolized by the liver, and renal fx (BUN & Creatinine) for GLUCOPHAGE it is rapidly excreted by the kidneys

Question 358

When administering a blood tranfusion, person develops a blood transfusion rxn, what does the nurse do?

Answer 358

STOP the transfusion, get another line with normal saline, call doc!

Question 359

How do you give lovenox

Answer 359

Abdomen shot, sub q with no aspiration.

Question 360

Major complications of Abdominal Aortic Aneurysm

Answer 360

• if it ruptures patient probably will CROAK if they dont make it to the hospital stat. (within 2 min) -If pt is experiencing pain in abdomen DO NOT PALPATE! -Rupture is indicated buy shock symptoms and pains

Question 361

What is the main difference between an MI and Ischemia?

Answer 361

Ishcemia can be reversed

Question 362

What does the P wave on an EKG mean?

Answer 362

Depolarization of the atria.

Question 363

(? from supplemental)

The pt is started on medication Verapimil. The action of the drug is to:

A. Decrease serum cholesterol level

B. Produce smooth muscle relaxation and decrease BP and Heart rate

C. Increase SA and AV node conduction

D. Decrease the preload and it adjunct to nitroglycerin

E. increase coronary artery circulation

Answer 363

B.

Question 364

Drug Therapy for Antiplatelet Agents

Answer 364

• Aspirin
• Trental (most effective)
• Ticlopidine (Ticlid)
• Plavix- prevents platelet aggregation

Question 365

Anemia questions for patients

Answer 365

Age of menarche, clotting, cramping, and amount of bleeding.

Question 366

Elevated BP without an indentifiable cause (IDIOPATHIC)

Answer 366

Primary (Essential HTN)

Question 367

If NPO in the hospital and has hyperglycemia?

Answer 367

give small amount of aspart, lispro, regular, cover w/ accucheck

Question 368

What test is a better indicator of renal fx (BUN or CREATININE)? and why?

Answer 368

Creatinine, and because urea levels are influenced by infections and fluid intake. Normal levels are 0.5-1.5!

Question 369

A patient on muliple pain meds, what would you watch for?

Answer 369

drug toxcity, hypotension, so do liver and nephro tests (bun creatinine), as well as montior BP and HR

Question 370

What to watch for when patient is on hemodialysis?

Answer 370

disequillbrium syndrome = confusions, nasuea, restlessness, and headache, b/c hemodialysis is excreting too rapidly

Question 371

Normal platelet life is?

Answer 371

9-10 days

Question 372

What is atherosclerosis?

Answer 372

Plaque in the artery. Narrowing vessel. Altered lipid metabolism. Can lead to mi

Question 373

In the diuretic phase of ARF, which of the following is true?

A.Urine output decreases
B. Glomerular filtration of blood stops
C. THe body retains K+ and Na+
D. The renal tubules cant concentrate urine

Answer 373

D. The renal tubules can’t concentrate urine.
During the diuretic phase, the urine output increases, the glomeruli filter the blood and the body excretes (rather then retains) K+ and Na+

Question 374

Left sided heart failure Symptoms are?

Answer 374

• Restless and confusion
• Elevated Bp
• Orthopnia
• Dyspnea on exertion
• Hypoxia
• Pulmonary congestion, cough, wheezing
• Blood tinged sputum
• cyanosis and palor
• dysrhythmia

Question 375

we never mix what insulin and why?

Answer 375

Lantus because its too alkaline (pH is too high)

Question 376

The client with tachycardia is expieriencing all of the following clinical manifestations. Which one alertsthe nurse to the need for immediate intervention.

1. Chest Pain
2. Increased urine output
3. Mild orthostatic pressure
4. ECG tracing with P wave touching the T wave.

Answer 376

1. Chest Pain

The chest pain is a sign the Tachy may be increasing the coronary workload.

Question 377

Most threatening complication of ATN? and WHY

Answer 377

Hyperkalemia (K+ above 5) and because this causes Cardiac arrythmias and this is serious

Question 378

Most common nsg diagnosis of renal calculi (Kidney stones)

Answer 378

Pain related to irritation of the stone

Question 379

Femoral Popliteal BYpass Post op

Answer 379

-Monitor extremity q15 min initially, then hourly. -Assess pedal pulses q 15 min until stable. -Complete a neurovascular assessment… {Skin color changes (pallor), teemp, cap refill, pp distal to the operative site, sensation and movement} Avoid flexion of the leg NO PILLOW! -Monitor vitals IF CLIENT IS DIABETIC GOING FOR SURGERY DO YOU GIVE INSULIN? -give rapid acting insulin or get dr. order IF CLIENT HAS COPD GOING FOR SURGERY, LAY THEM FLAT BUT GIVE THEM OXYGEN,

Question 380

Raynauds Disease

Answer 380

• Vasospasms of the arterioles and arteries of the upper and lower extremities -Vasospasms causes CONSTRICTION of the cutaneous vessels. -CARDIZEM (calcium channel blocker) is given to vasodilate. -Attacks are intermittent and occur with exposure to cold or stress, caffeine or smoking. -Affects fingers, toes, ears, and cheeks (color changes- white blue red) Primarily in women 15-40 yrs old. -associated with autoimmune disorder (rheumatoid arthritis, scleroderma, systemic lupus) -occupation related trauma (typists, pianists, those who use Hand held vibrating equipment) WINK WINK 8===================D - - -

Question 381

Mild symptoms of Anemia

Answer 381

Hgb 10-14, palpitations, dyspnea, diaphoresis

Question 382

An ounce contains how many mLs?

Answer 382

30 ml !

Question 383

What does the QRS wave indicate?

Answer 383

This is the ventricular contraction or depolarization

Question 384

BUN level is normally?

Answer 384

10-30 mg/dl

Question 385

The nurse is performing an assessment with a client who has Chronic Arterial Insufficiency and she would expect to find? A. edema around the ankles and the feet B. ulceration aroung the inner aspect of the ankle C. scaling eczema of the lower extremities with stasis dermatitis D. Pallor on elevation of the limb, rubor when the limb is dependent

Answer 385

D.

Question 386

In assesing the client with an aortic aneurysm before surgery, a nurse notes that the client’s systolic BP has increased by 30 mm Hg compared with the reading from 1 hour ago. What is the Nurse’s best first action?

a. Measure abdominal girth

B. Ausculatation of the abdomen

C. Increase the IV Rate.

D. Measure blood pressure in both arms

Answer 386

A. A sudden increase in BP or HTN can cause enlargement or rupture of the Aneurysm. Bleeding out into the trunk.

Question 387

Megaloblastic (pernicious) Anemia

Answer 387

Chronic condition r/t impaired DNA synthesis, deficiency of folic acid and/or cobalamin (B12), may cause degenerative changes in the nervous system AEB: numbness and tingling in extermities.

Question 388

(? from supplemental)

A client with CHF is hospitalized with severe dyspnea and a hacking cough. She has pitting edema in both ankles and her vital signs are 170/100, P 110, RR 28. The nurse recognizes that the clients symptoms indicate

A. Venous Return to the heart is impaired causing a decrease in cardiac output

B. There is impaired emptying of both right and left ventricles

C. the right side of the heart is failing to pump enough blood to the lungs to provide systemic oxygenation

D. the myocardium is ischemic

Answer 388

B.

Question 389

What is the best condtion to guage JVD?

1. Bed Flat
2. Head of Bed at 90 degrees
3. Head of bed at 45 degrees
4. Head of Bed at 30 degrees

Answer 389

The best option is to have the head of bed at 45 degrees.

Question 390

Heparin drip

Answer 390

• continuous IV monitor, watch for signs of bleeding (hematuria, bloody stools, increased HR, Acts on intrinsic pathway. -Antidote is protamine sulfate

Question 391

Which statement made by a client would alert the nurse to the presence of edema?

1. I seldom sleep soundly at night
2. My shoes seem to be fitting tighter
3. I seem to feel more anxious lately
4. I drink at least two full glasses of water a day

Answer 391

2. My shoes are fitting tired. This is a sign of EDEMA

Question 392

Urinary diversion post op managment

Answer 392

Meticulous skin care around stoma.

Question 393

APTT levels should be?

Answer 393

Normal 30-45 Heparing is 60 - 90 or 2x

Question 394

A Nurse notes that the PR interval on a client’s ecg tracing is 0.14 seconds. What action should the nurse take?

a. Call the health care provider immediately.
b. Administer epinephrine immediately.
c. Apply Oxygen via nasal Cannula
d. Document the finding as the only action

Answer 394

Answer is D

PR interval normally ranges from 0.12 to 0.20

Question 395

Delayed hemolytic reactions

Answer 395

Occurs 2-14 days after transfusion or as early as 3 days and as late as several months.

Question 396

What symptoms are consistant with a Venous disease?

Answer 396

Edema, Aches, Heaviness. This is due to a lack of return of blood to the heart.

Question 397

Assessment finding common with a long standing venous (gluttony) disorder?

Answer 397

• Peripheral Edema
• Bronze skin
• Warm skin
• Dilated varicose veins
• aching/heaviness

Question 398

(? from supplemental)

Pt is admitted with chest pain and a positive triponin. Dr orders the following medications. Which meds should be given immediatly? (SATA)

A. Beta Blockers

B. NTG paste 1 inch to the chest wall

C. Digitalis

D. Hep lock and PRN nitroglycerin drip to control pain

E Verapimil

Answer 398

A, B, D

Question 399

(? from supplemental)

Perry is digitalized with digoxin IVP. which of the following observations indicates effectiveness of digoxin?

A. increased ventricular rate

B. Decreased urine output

C. Serum potassium of 3

D. Weight Loss

Answer 399

D

Question 400

What is this?

Answer 400

PVC

Question 401

Nutrirional therapy before stone removal

Answer 401

Avoid forcing fluids ( Does Not facilitate stone passage, may exacerbate colic.

Question 402

Nutritional Therapy diet for HTN?

Answer 402

Low sodium diets, No processed foods, restrict fats and cholesterol.

Question 403

When should you suction a patient?

Answer 403

when respirations sounds moist, unable to expecctorate secretions, (remember how danielles pts sounded)

Question 404

What do Vasodialators do?

Answer 404

Decrease preload and afterload

Question 405

Someone with severe anemia will present with what?

Answer 405

confusion and tachycardia

Question 406

The client is discharged on beta blocking agents following an MI. Which of the following instructions are correct for this collect ? (Select all) A. Report abnormal fatigue B. An early sing of CHF is unexplained cough C. Weigh daily D. The medicatiojn may be discontinued if wheezing develops

Answer 406

A, b, c, d

Question 407

A client is SOB when he attempts to lie down at night to sleep. He has been sleeping in a recliner. The nurse should suspect: A. Lymphatic pneumonia B. MI C. R vent heart failure D. L side ❤ failure

Answer 407

D. L side ❤ failure

Question 408

Care of client with renal calculi (kindey stones)

Answer 408

LOAD EM UP! opoid analgesics, Tamsulosin (Flomax)-vasodilates, keep adequately hydrated (overhydration -spams)

Question 409

EKG changes for a heart attack are?

Answer 409

Deep Q waves mean damaged tissues for 4-6 weeks. ST segment will become elevated. T wave may become inverted, You will also see dysrhythmia, an increase temp and an increase in WBC

Question 410

When you have chest pain at home what should you do?

Answer 410

Take nitro 1 time, if no relief call doctor. You can take up to 3 times every five minutes. No more than 3 doses.

Question 411

How would you know that a loop diuretic is working in someone with CHF

Answer 411

decreased crackles in the lungs

Question 412

PT Time should be what

Answer 412

Coumadin level should be 12-15.

Question 413

cool and clammy what am I?Warm & dry what am I?

Answer 413

need some candy(low bs) Sugar high (hyperglycemia)

Question 414

For which client would drug therapy with lovastatin be contraindicated?

1. The client with Diabetes
2. The client with peptic ulcer disease
3. The client with rheumatoid arthritis
4. The client with cirrhosis of the liver

Answer 414

D. Statins elevate LDL and cholesterol.

Question 415

Someone has nephrolithiasis (Kidney stones) what stage is this in ARF?

Answer 415

postrenal

Question 416

Postrenal (ARF) involve mechancial obstruction of urinary outflow, some causes are:

Answer 416

Benign prostatic hypertrophy (BPH), bladder cancer, calculi formation (nephrolithiasis), neurmuscular disorders, prostate cancer, spinal cord disease, trauma, adhesions from surgery.

Question 417

care of pt on insulin pump

Answer 417

tight glucose control, continuous sub-q infusion of insulin, site infections can occur, wash hands and skin, rotate sites q 2-3 days , make sure pt. knows s/s of hyper/hypo glycemia

Question 418

What is arteriosclerosis? And what are contributing factors that are non modifiable

Answer 418

Hardening of the artery a loss of elasticity. Non modifiable is age, genetics, gender, menopause, and race.

Question 419

Why is resting good if a patient is having symptoms of a heart attack?

Answer 419

Because the coronary circulation can keep up with the demand of the body.

Question 420

PVCS

Answer 420

PVCS will have wide and bizarre QRS!

-Give antirhymatic (Pronestyl, Lidocaine, Rhythmol, Amerodione (this drug is not used often because it causes Irreversible Pulmonary Fibrosis)

Question 421

Biggest SE of Atenolol (Tenormin) BETA BLOCKER

Answer 421

Fatigue and Dyspnea

Question 422

Pt comes to ER and is complaining of calf pain with rapid ambulation r/t a lactic acid accumulation in muscle tissue

Answer 422

Intermittent Claudication

Question 423

If pt is admitted with a DVT and is complaining of shortness of breath..

Answer 423

• This patient is PRIORITY!
• Elevate HOB, give O2 and suspect a PE (Pulmonary Embolism)

Question 424

What Would pitting edema be indicative of?

Answer 424

Right sided heart failure

Question 425

A Cardiac Alarm has gone off. What should be done first?

1. Check the leads on the machine.
2. Administer morphine (MONAB)
3. Check Patient vitals
4. Administer O2

Answer 425

Check patient first.

Question 426

diabetic footcare

Answer 426

test water, use mild soaps, pat dry, assess for breakdown, cut toenails straight, wear properly fitting shoes at all times NEVER go barefoot

Question 427

Which of the folllowing drugs are used to prevent the extension of an MI? Slect all that apply

1. NSAIDS
2. Beta Blockers
3. ASA
4. Nitrates

Answer 427

2, 3, 4

Question 428

Bactrim must be administered how?

Answer 428

On an empty stomach. 1 hour before or two hours after a meal. With a full glass of water.

Question 429

Someone in DKA first you do what?

Answer 429

Correct the acidosis normal saline (.9) and 02

Question 430

Cardiovascular assesment questions are?

Answer 430

Ask about chest pain, SOB, Alcohol use, anemia, Rheumatic fever, Streptococcyl sore throat (Fever) stroke, HTN, Thrmoboflabytis, Edema (pitting is a sign of Right sided Heart Failure) Assess Respiratory status.

Question 431

If you stop a Beta Blocker abruptly

Answer 431

A Hypertensive Crisis can happen

Question 432

Ppl at risk for DVT!

Answer 432

-Surgical patients -Obesity -Prolonged Bed Rest -Over the road truck drivers that dont take a break -Gynecologic -Gastric Surgery -History of estrogen use -Crab Boat Captains on the Bearing Sea !!!!!!!

Question 433

Calf tenderness would be indicitive of?

Answer 433

DVT

Question 434

In ARF - Kussmauls respirations occur due to the body trying to?

A. Decrease the blood pH
B. Exhale excess CO2
C. Increase H+ ion excretion
D. Increase the CO2 level

Answer 434

B. Exhale the excess CO2

This prcess beings when damged tubules prevent the syntheis of ammonia. The H+ accumulates in the blood since it can’t combine with ammonia. This decrease the blood pH. At first the body compensates by combing the H+ with bicarbs. This forms carbonic acis, which breaks down into water and CO2.

Question 435

Oliguric phase of ARF

Answer 435

decrease production of urine ( remember 30 ml/hr is normal), Azotemia (increase accumulation or urea and creatinine), fluid retention (JVD, bounding pluse, pitting edema, S3)

Question 436

What to teach a client with cystitis before discharge?

Answer 436

Avoid bath, wipe front to back, increase fluids 3L/day, empty bldder every 2-4 hours while awak.

Question 437

Nursing interventions for ATN

Answer 437

diet: increase CHO, decrease protein, decrease Na+, decrease K+
Fluid restrictions, kayexalate to decrease K+ levels (hyperkalemia is life-threatening)

Question 438

MI (Myocardial Infarction) sudden onset?

Answer 438

Crushing or squeezing of chest not relieved by nitro.

May radiate to jaw, neck, back, or shoulder.

Dyspnea, decreased BP, Extreme weakness, Increased HR

Dyaphoresis.

Question 439

What are Streptokinase, and TPA?

Answer 439

These are clot busting agents. Do not give to patients who are pregnant, had cerebral anneurisms, or immunosuppressed. Asses for bleeding, bruising and oozing from IV site. If LOC changes withold med. Discontinue of decrease in HGB or dark stool which suggest GI Bleed. or if pt shows s/s of bleeding ex inc. HR dec. BP

Question 440

A patient has admitted with a Bi-ventricular failure, what will the nurse notice?

Answer 440

Dyspnea, JVD, edema

Question 441

A patient is scheduled for a cardiac catheterization with coronary angiopathy. Before the test, the nurse informs the patient that…

a. A catheter will be inserted into a vein in the arm or leg and advanced to the heart.
b. ECG monitoring will be required for 24 hours following the test to detect any dysrhythmia
c. a feeling of warmth may be expierienced as the contrast material is injected into the catheter.
d. it will be important to lie completely still during the coronary angiopathy procedure.

Answer 441

C. The iodine being inserted will be a warm feeling.

Question 442

Dehydration can lead to?

Answer 442

UTI, Calculi, Renal failure.

Question 443

Immunosuppressive therapy drugs used:

Answer 443

Cyclosporine, corticosteriods, antibodies.

Question 444

Cardiac Cath

Answer 444

• Can be done many times
• It is an arterial stick, pt will have sandbag for 4-6 hours, lay flat for 4-6 hours
• DO NEUROVASCULAR ASSESSMENT (color, temp, movement, numbness & tingling)

check pedal pulses

Question 445

Atrial Fibrillation

Answer 445

• Most common dysrhythmia
• Normal QRS, irregular P (quivering)

Cardiac Output is decreased and blood clots can form since blood is pooling in atrium.

Place on Heparin first then Coumadin

Pacemaker is not in SA mode so the AV node is selectively letting impulses through.

Question 446

What to give a client underdoing hemodialysis that helps increase Ca+, and decrease Phosphorous?

Answer 446

PhosLO( Renegel)

Question 447

What would be the most definitive method, or cardiac test

Answer 447

PTCA or Cardiac Catheterization

Question 448

treatment for HHS

Answer 448

treat cause, hydrate, give insulin , requires MORE fluid replacement than DKA, no acidosis present

Question 449

Pulmonary Embolism

Answer 449

-blockage of pulmonary artery by a thrombus

Manifestations: sudden change in mental status, appear drowsy

**WHEN PRIORITIZING SEE THIS PATIENT FIRST

Question 450

What exercise should a nurse instruct a patient to do if pt c/o incontinence?

Answer 450

Kegel excercises (it’ll help their sex life too)

Question 451

Nursing interventions when caring for pneumonia client, Tell client to:

Answer 451

cough and deep breath, encourage fluids, elevate head of bed, promote ROM, suction (if needed)

Question 452

normal urine color for post op bladder surgery

Answer 452

Pink during 1st several days (should not be bright red)

Question 453

Most critical Assessment finding in a client with Arterial PVD?

Answer 453

Absent pulses

Question 454

Clinical manifestations of kindey stones

Answer 454

Abdominal flank** pain (severe) r/t stone irritation, **hematura & renal colic, nausea and vomiting, mild shock (when passing stone)

Question 455

PTT findings R/T heparin drip

Answer 455

-PTT -Therapeutic level is 2 times the contol! Normal is 30-45 seconds Therapeutic level is 60-90. If the PTT is not within the therapeautic level, anticipate adjusting the flow rate of the Heparin per protocol.

Question 456

What is an expected finding upon assessment of someone with interstitial cystitis?

Answer 456

Suprapubic pain relieved by voiding (PEEIN’ their little hearts out)

Question 457

care of a client with a nephrostomy tube?

Answer 457

should have 30 mL /hr, never flush it, empty when it’s 1/3 full, give adequate fluids

Question 458

A potassium level >6 can lead to what?

Answer 458

MM Weakness & cardiac arrythmias. Normal levels are 3.5-5.0

Question 459

Diet for a client on peritoneal dialysis

Answer 459

More protein is allowed in diet because urea and protein are lots in the peritoneal bath.

Question 460

Acute Tubular Necrosis (ATN)

Answer 460

Intrarenal, Results when tubular cells do not get enough oxygen (ischemic ATN). These tubules are very metabolically active, they are very dependent on the oxygen that supplies the tubular cells.