406 Midterm Flashcards
1
Q
Break up the presentation/question into parts (cues) to determine meaning (i.e. normal vs. abnormal). Identify cues.
A
Analyzing
2
Q
Cluster cues to determine meaning
A
Analyzing
3
Q
Generates hypotheses
A
Analyzing
4
Q
Use research based standards/rules to rule in or rule out hypothesis
A
Applying standards
5
Q
NDX defining characteristics, related factors and risk states; patho
A
Applying standards
6
Q
Making a judgment as to “fit”
A
Applying standards
7
Q
Look for differences and similarities
A
Discriminating
8
Q
Does this help confirm or disconfirm hypothesis
A
Discriminating
9
Q
Do you need Lab data? Further physical assessment?
A
Information seeking
10
Q
Draw conclusions
A
Logical reasoning
11
Q
If this then probably that
A
Logical reasoning
12
Q
Confirm or disconfirm DX
A
Logical reasoning
13
Q
Predict potential patient problems and envision a plan & desired outcomes .
A
Predicting
14
Q
How will this prob/plan affect patient safety? If I do this then….
A
Predicting
15
Q
How will you recognize this same concept/problem in other situations?
A
Transforming knowledge
16
Q
Are you confident in your reasoning abilities?
A
Confidence
17
Q
Have you considered the entire context of this problem? Age, co-morbidities, medication, etc
A
Contextual perspective
18
Q
Were you creative when you generated or restructured ideas? Did you think of alternatives?
A
Creativity
19
Q
Did you consider multiple possibilities? Did you get stuck on one train of thought?
A
Flexibility
20
Q
Were you eager to correctly interpret the situation/problem and did you use observation and thoughtful questioning to explore possibilities?
A
Inquisitiveness
21
Q
Did you use research-based process and research-based criteria to interpret the situation/problem?
A
Intellectual integrity
22
Q
Guessing without a basis for deriving meaning does not count
A
Intellectual integrity
23
Q
Did you recognize anything that seemed familiar from past experiences?
A
Intuition-pattern recognition
24
Q
Were you open to other possible interpretations of the situation/data?
A
Open-mindedness
25
Did you constantly reflect on your thinking, assumptions, and decisions to assure accurate interpretation of data
Reflection
26
QSEN: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care
Patient-centered Care
27
QSEN: Honor learning opportunities with patients who represent all aspects of human diversity
Patient-centered Care (attitude)
28
QSEN: Seek to understand one’s personally held attitudes about working with patients from different ethnic, cultural and social backgrounds
Patient-centered Care (attitude)
29
QSEN: Value cultural humility
Patient-centered Care (attitude)
30
QSEN: Respect the boundaries of therapeutic relationships
Patient-centered Care (skill)
31
QSEN: Integrate principles of effective communication with knowledge of quality and safety competencies
Patient-centered Care (knowledge)
32
QSEN: Value consensus
Patient-centered Care (attitude)
33
QSEN: the process of reflective practice
Patient-centered Care
34
QI definition: use
data to monitor the outcomes
35
QSEN: Assure ethical oversight
QI
36
QSEN: Explain common causes of variation in outcomes of care in the practice specialty
QI
37
QSEN: Appreciate how unwanted variation affects outcomes of care processes
QI
38
QSEN: differences between micro-system and macro-system change
QI
39
Informatics
Use information and technology to communicate, manage knowledge, mitigate error, and support decision making
40
What's wrong with this order: 10 mg morphine, IM, Q4h, prn for pain
the dose is too high
41
Acute cholecystitis: clear liquid diet; progress to low fat as tolerated
Wrong. Patient should be NPO until bowel sounds return
42
What's wrong with the order: O2 per protocol to maintain POX at 95%
not specific; need to know the rate and dose
43
Cholecystectomy for acute cholecystitis: before the dangle at the side of the bed
give pain medication
44
2 days post op, consideration for temperature
Normal for it to be elevated slightly at this point
45
What is the GI complication of morphine
constipation
46
what is the serious complication that a d-dimer test can rule out
PE
47
MI case: Yes or No: Basal metabolic panel
Yes
48
MI case: Yes or No: PT and PTT
Yes
49
MI case: Yes or No: bilirubin
No
50
MI case: Yes or No: Urinalysis
Yes (to assess kidney function)
51
MI case: Yes or No: Type and crossmatch for 2 units of packed RBCs
No
52
MI case: Yes or No: chest x ray on admission and in morning
Yes
53
MI case: besides pain management, why give morphine?
Increases cardiac perfusion (by decreasing O2 demand)
54
primary MI NDX
Alteration in cardiac tissue perfusion r/t myocardial ischemia secondary to coronary artery occlusion
55
MI NDX: Fear
Fear and anxiety related to impending doom secondary to MI
56
MI NDX: Activity
Activity intolerance related to decreased cardiac reserve
57
MI NDX: knowledge
Deficient knowledge related to lack of information
58
PT range
11 to 14
59
PTT range
25 to 35
60
INR range
0.8 to 1.2
61
hemoglobin range
about 12 to about 17
62
hematocrit range
about 35 to about 50
63
Lantus
long acting insulin
64
What time of day should Lantus (long acting insulin) be taken
bedtime
65
Onset of lantus (long acting insulin)
5 hours
66
Duration of lantus (long acting insulin)
24 hours
67
Hypoglycemic patient with DM: NDX:
Alteration in tissue perfusion r/t inadequate supply of glucose in the brain
68
Cold weather can be a precipitating factor in
angina
69
MI case: Yes or No: CBC
Yes
70
MI case: Yes or No: electroencephalogram
No
71
Patient has cigarettes at hospital
ask family to take them home
72
MI: decreasing chest pain also decreases ___
anxiety
73
MI: patient is instructed not to ___ ___
bear down
74
MI: patient is not allowed to g___________ by themselves
go to the bathroom
75
MONA
morphine, oxygen, nitroglycerine, aspirin
76
nitro has a _____ effect
vasodilation
77
action of aspirin in MI:
antiplatelet
78
MI: morphine reduces __load
preload
79
MI: don’t give morphine if rr is below
10
80
MI: check pt ___ min after giving morphine
30
81
MI: give morphine over ____ min
4 to 5
82
MI: no ____, bed pan with assistance
commode
83
MI: put them on __ __
bed rest
84
MI: give __ __ for HTN
ace inhibitor
85
eject fraction
normal is 50 to 70. It's the amount shot from left vent.
86
CVA case: first order to be carried out
administer O2
87
CVA case: Contraindicated for fibrinolytic therapy? taking warfarin and has INR of 2.4
Contra
88
CVA case: Contraindicated for fibrinolytic therapy? Major surgery in last 14 days
Contra
89
CVA case: Contraindicated for fibrinolytic therapy? Systolic BP 150
Not contra
90
CVA case: Contraindicated for fibrinolytic therapy? Platelet less than 100,000
Contra
91
CVA case: Contraindicated for fibrinolytic therapy? Blood sugar less than 50
Contra
92
CVA case: Contraindicated for fibrinolytic therapy? H/o MI 1 year ago
Contra
93
CVA case: The patient had a thrombolytic infusion. How long should you wait before giving anticoagulant or antiplatelet meds?
24 hours
94
How does a statin benefit a CVA patient
- Prevents narrowing of vessels
| - Prevents platelet aggregation
95
CVA case: modified barium swallow study is to r/o
aspiration
96
CVA case: Non contrast CT should be done within __ __ and read within 45 minutes
25 min
97
CVA case: you must give the thrombolytic within
3 hours
98
How long does it typically take for bowel sounds to return
24 to 48 hours
99
Hypoglycemia/DM case: the main dx could be
acute confusion
100
Hypoglycemia/DM case: Give 4 ounces of juice of
soda (not diet soda)
101
Hypoglycemia/DM case: Give 8 ounces of
milk
102
Hypoglycemia/DM case: give 7
life savers
103
Hypoglycemia/DM case: 1 tablespoon of
sugar
104
Hypoglycemia/DM case: 3
glucose tablets
105
Hypoglycemia/DM case: 2 tablespoons of
raisins
106
Hypoglycemia/DM case: A safety precaution
seizure precautions
107
Hypoglycemia/DM case: offer sugar followed by
carb and protein
108
DVT activity level instructions
bed rest, but permitted to move about the bed
109
DVT patient should be on bed rest, position legs
elevated but don't put pillows under the knees
110
Where in the hospital is an MI patient given thrombolytics
the ED (don't wait until they get transferred)
111
Can nurses give morphine by IVP
only if they certified
112
Pt has an anaphylactic reaction, treat with
epinephrine and benedryl
113
Morphine's half life is approx
2 hours
114
Morphine's onset
5 min (IV), 15 min (IM), 20 min (PO)
115
Need to be careful giving morphine to an asthma patient because
they already have resp issues
116
Patient has h/o seizures; morphine will
worsen it
117
morphine dose for older adults
should be smaller
118
Morphine can prolong
labor
119
Morphine can show up in
breast milk
120
Breathing pattern of morphine OD
cheynne stokes
121
DM patient: nervousness and tachycardia are signs of
hypOglycemia
122
dose of an IM glucagon
1 to 2 mg
123
Glucagon revives the patient rapidly, but they will be
confused
124
regular insulin peaks around
2 to 3 hours
125
Lantus doesn't have a very distinct
peak (even though the other card says 5 hours)
126
What about cookies and ice cream for a hypo glycemic?
not the best because high fat foods slow down absorption
127
CT skill that includes following hospital policies
Applying Standards
128
A1C is not used for
children
129
A healthy BMI is below
30
130
In which part of SPAR do you put the Vitals
Assessment
131
What is the criteria for removing an NG tube
when nothing else is coming out in the suction
132
Pt has been NPO and needs oral care: one option is
glycerin swabs
133
Hallmark sign of atelectasis
diminished breath sounds
134
Warfarin: therapeutic INR is
2.5
135
A fib can lead to thrombus formation because
the blood is stagnant
