463Final_Randomized Flashcards
1
Q
- Instructions for Total Hip Anthroplasty
- What does caffeine do to pt high risk for osteoporosis
A
- raised toilet seat, do not adduct leg or flex more than 90 degrees, sit in chairs that have arms, avoid putting on socks and shoes for 8 weeks
- Increases calcium loss in urine, along w/ smoking ETOH, steroids.
2
Q
- How do you know an NG tube is in the wrong place?
- How do you measure the proper length of tube for NG
- Why do you elevate HOB to 30 degrees?
A
- trachea- presence of air escaping
- tip of nose to ear , xiphoid process to sternum.
- promote swallowing, aspiration
2
Q
- How to prevent cloggin of feeding tube
- If dobhofff or PEG becomes dislodged
- How often do you replace TPN tube and bag?
A
- crush meds, flush before and after, dilute viscous solutions, use liquid meds
- stop infusion, flush with saline/heparin, if unsuccssful, aspirate, follow protocol
- every 24 hours
3
Q
- PT treated for TB, when will no longer be contagious
- Most frequent early symptom of lung cancer?
- TB s/sx
A
- 2-3 weeks of med thearpy
- Cough, later- hoarseness
- Cough (yellow), chills, night sweats, dyspnea
3
Q
- Risk with a cast
- What is pt instructed to monitor with cast
- How do you achieve proper traction
A
- Skin integrity, don’t stick anything underneath
- pain, swelling, color, tingling, numbness, coolness or diminshed pulse. (notify HCP fo circulatory impairment)
- Weights need to be free-hanging, with knots away from pulleys.
4
Q
- Troponin T
- Myglobin
- CK-MB
A
- 0 - 5%
4
Q
- What is used to lubricate a trach catheter
- What is a trach plug
- what is it used for
A
- Saline
- decannulation of trach tube
- speech, not speaking valve.
4
Q
- How long should the nurse stay with the patient to ensure transfusion rx is NOt occuring?
- What is a standard isotonic solution
- Trach tube, suctioning, when to hyperoxygenate?
A
- 15 minutes
- Sodium Chloride (w/o dextrose)
- Before (step 1) and after
5
Q
- Skin assessment MS
- Neurologic asessment MS
- MSK MS
A
- pressure ulcers
- speech, nystagmus, ataxia, tremors, spasticity, decreased hearing
- muscle weakness, paresis, spasms, foot dragging, dyarthria
6
Q
- Priorities for fracture
A
- Hydration, respiratory, circulation, pain, hx of conditions/meds, prevention
7
Q
- If a chest tube for tension pneumo is no available, next best thing?
- Mantoux Test id aministered
- Where should head be positioned when trach is suctioned
A
- thoracentesis, removes air
- Intradermal, its the PPD
- the opposite from the bronchus being suctioned
7
Q
- What does sucralfate used for
- What is misoprostol used for
- prior to gastric surgery when should you notify HCP
A
- short term tx of ulcers. provides cytoprotection of esophagus, stomach and duodenum.
- prostaglandin to prevent gastric ulcers caused by NSAIDS.
- If NG tube is not functioning properly
8
Q
- Constant bubbling is it normal or abnormal?
- Prioritis if chest tube becomes disconnected?
A
- Abnormal, could be an air leak
- submerge tube in saline t create water seal, stay w/ pt, assess resp distress, HCP
8
Q
- Priority Action for blood transfusion reaction
A
- stop transfusion
- chang iv tubing, keep iv line open
- notify HCP
- stay with patient
- monitor vs ever 5 min
- prep ER meds
- obtain urine specimen
- return bag and tubing to blood bank
- document
9
Q
- Why is PN delivered at a constant rate of infusion
- how is hep A is spread fecal oral route,
- Full liquid diet includes..
A
- to prevent unstable glucose level
- do not share eating utensils
- milk, custards, veg/fruit juice, strained cereal, butter margarine cream
10
Q
- Calculating Dosage formula
- 1 oz, how manly mLs
- 1 tsp, how many mL?
- 1 tbsp
A
- Desire/Available x amount
- 30
- 5
- 15
10
Q
- Other Nursing Dx
- Does parkinsons have acute exacerbations?
- goal is to
A
- Impaired swallowing, impaired verbal communication
- no
- maintenance, independence, avoid contractures and falls, promote exercise
11
Q
- Right Brain Stroke damage affects what side
- Symptoms
A
- Left paralyzed
- Spatial deficits, denies problems, rapid performance, short attention span, impulsive safety problems, impaired judgment, impaired time concept
12
Q
- # 3 post op priority
- # 4 Post op priority
- # 5 Post op priority
A
- Incenstive Spirometer; risk for paralytic ileus- intestinal block, atelactasis
- I/Os, profusion of kidneys
- Early ambulation
13
Q
- osteoarthritis- stiffness or swelling?
- what is an early sign of compartment syndrome
- characteristics of paget’s disease
A
- stiffness
- inability of pain med to relieve pain (neurovascular assess)
- kyphosis and bowing of the legs
13
Q
- Large intestine obstruction is rapid or gradulal
- Small intestine vomiting?
- Large intestine vomiting
A
- gradual
- frequent and copious
- rare
14
Q
- If chest tube becomes dislodges?
- -orrhaphy means
- -ostomy means
A
- pinch skin together, apply occlusive sterile dressing, cover with 2 inch tape, call HCP!
- repair of suture
- creation of an opening
15
Q
- Stool type with Crohn’s
- Purpose of NG tube continuous suction pt w/ small bowel obstruction
- An antirheumatic drug irritant for pt w/ PUD
A
- Loose, watery
- remove gas/fluids from stomach & intestines
- Indocin
15
Q
- What does brudzinski’s, kernig’s sign represent
- Patient with right sided hemiglegia, what type of diet?
- Meniere’s disease pt experiences
A
- menigitis, call HCP
- pureed, easy to swallow
- vertigo, place pillow either side of head
16
Q
- Symptoms of both MI and Angina
- Duration of pain for MI
- Duration of pain for Angina
A
- pressure in the chest, radiate to neck lower jaw, left arm/shoulder.
- more than 15 minutes
3.
17
Q
- What happens in cardiac tamponade
- Coumadin lab test effectiveness
- Heparin labs
A
- heart is compressed by fluid, decreased LV filling, pulsus paradoxus
- PT- prothrombin
- PTT (partial thromboplastin time)
18
Q
- Common affect of chronic bronchitis
- What encourages a COPD pt to breath
- Best way to determine hypoxic
A
- Rust blood tinged sputum
- high flow oxygen eliminates their drive to breathe
- ABG’s
18
Q
- What do H2 blockers do
- What do PPI’s do
- What do antacids do?
A
- promote ulcer healing -tidine
- reduce gastric acid secretion, healing, used in combo w/ antibiotics for H.pylori
- increase gastric pH
19
Q
- Actions for acute exacerbation of PUD with complications
A
- NPO
- NG suctioin
- IV PPI
- Bed rest
- Fluid replacement LR’s
- Blood transfusion
- Stomach lavage
20
Q
- Order of operation for post op assessment x8
- What do you assess in the airway?
A
- Airway, Breathing, Circ, Neuro, Gastro, GU, Surgical Site, Pain
- e tube, mask, oral/nasal airway
21
Q
- Before admitting a patient to OR, which forms must the nurse make sure are in the chart of all patients
- Circulating Nurse Role
- How can you enable patient to ambulate TCDB?
A
- Signed Consent, Hx/Physica, Preanesthesia assessment.
- coordination of surgical suite, documentation, electrical equiment, counting
21
Q
- What might you see in skin with parkinsons?
- Cardiovascular parkinsons
- GI Parkinsons
A
- sobrrhea, dandruff, ankle edema
- postural hypotension
- drooling
22
Q
- drugs that end in -agiline
- COMT inhibitors
- What should you assess in appearance with parkinsons?
A
- Monoamine Oxidase inhibitors, block break down of dopamine
- block break down of levodopa
- Mask liked face, slow monotone speech
22
Q
- Transfer technique for stroke patient
- What is a critical factor for stroke pt for discharge?
- When do pt have maximum recovery from rehab?
A
- Chair near pt’s strong arm, never lift from neck, ensure feet are flat on the ground when moving
- performing ADLs
- 1st year
23
Q
- S/Sx of dumping syndrome
- How to prevent dumping syndrome
- Early S/Sx of dumping syndrome
A
- weakness, ab discomfort, abnormal bowel evacuation, after meals, after surgery
- Limit fluids with meals
- Pallor, syncope
24
Q
- What is dysarthria
- Lowest possible score on Glasgow Coma
- Highest possible score?
A
- distsurbed muscular control of speech- pronunciation, articulation, phonation
- 3= deep coma or death
- 15, fully awake
24
Q
- How do you decrease workload of heart after MI
- What position for Heart Failure
A
- Aspirin, other meds, oxygen, angioplasty
- High Fowler’s
25
Q
- What does aspirin do?
- What does plavix do?
- What is a side effect of aspirin
A
- analgesia, reduce inflammation and fever by inhibiting prostaglandins, decrease platelet aggregation
- inhibits platelet aggregation by inhibit bind of ATP to receptors
- GI bleed, indigestion, nausea, anorexia
25
Q
- A CXR measures
- EKG measures
- Respiratory complications Post op
A
- pulmonary, enlarged heart
- Cardiac disease, dyrhythmias
- hypoxemia, pneumonia, atelectasis
26
Q
- Chest Tube major concern
- Standard Chest Tube is
- If a patient has a Tube feeding and a Ct scan scheduled, what action
A
- SubQ Emphysema at Insertion site
- -20cm H2O
- shuff off feeding 30-60 min before
26
Q
- Post Cardiac Cath, notify HCP if
- What if there is bleeding
- post op cardiac cath teaching
A
- dysrhythmias, cheest pain, numbness, tingling, cool extremeities
- apply pressure and call physician’
- no heavy lifting
27
Q
- Causes of exacerbation in MS
- Tx of flare ups
- General assessment of MS
A
- inflammation, stress
- steroids, focus on immobility, respiratory and UTI’s and pressure ulcers
- apathy, inattentiveness
27
Q
- What is a side effect of plavix
- what should nurse monitor with aspirin
- what should nurse monitor with plavix (clopidogrel)
A
- similar to aspirin
- don’t give to pt’s with asthma or allergies, hypersensitive
- monitor for signs of thrombocytic purpura. Bleeding time. Platelet count.
28
Q
- Manifestation of MS
- How to prevent sensory deprivation
- What is brudzinski’s sign
A
- Urinary retention, hyperreflexia of extremeities, ataxia, dec concentration
- asesss support sys for pt who is isolated
- flexing head and flexing hip and knee
28
Q
Priority Action ofr Dysrhythmias
A
- ABCs
- O2
- Baseline vitals, including O2 sat
- 12 lead EKG w/ continuous monitoring
- Rate/rhthm
- Identify
- Establish IV access
- Baseline labs
29
Q
- Why monitor weight with PN?
- What % of dextrose solution to avoid sclerosing of veins
- When will pt experience delayed gastric emptying?
A
- Hypervolemia risk
- no higher than 10%
- residual is greater than 150 mL
31
Q
- What concern might you have after a CABG
- pain in the lower extremities not relieved by rest indicates
- How can it be relieved?
A
- sudden cessation of mediastinal c.t., HALLMARK sign of cardiac tamponade
- peripheral arterial disease (cold)
- placing in a dependent position
32
Q
- What is the purpose of a cardiac monitor
- Type of edema with cardiac failure is
- Antidote for heparin
A
- displays the patient’s heart rhythmn, to observe abnormalities
- dependent
- protamine sulfate
34
Q
- Hematocrit
- Hemoglobin
- Platelets
- PTT
A
- 45%
- 12 -15
- 150,000-400,000
- 9.5 - 11.8
34
Q
- How long does TIA last
- What is the difference between TIA and stroke
- Risk factors of stroke
A
- 1 hour to 24 hours, early warning sign
- no infarction, ischemia to brain, no brain damage, symptoms resolve
- HTN, exercise, diet, diabetes
35
Q
- Clincal manifestation of hemorrhagic stroke?
- S/Sx of stroke
- Pathophysiology of Stroke/TIA
A
- Same as ischemic stroke, sudden headache
- weakness paralysis of one side, numbness, sudden confusion, trouble speaking, slurred speech, vision problems, dizziness, loss of balance, difficulty swallowing
- Atherosclerosis
35
Q
- What is a total gastrectomy
- What is a vagotomy
- What is gastric resection
A
- removal of stomach w/ attachment of esophagus to jejunum
- division of the vagus nerve to eliminate vagal impulses that stimulate hydrochloric acid secretion in the stomach
- removal of lower half of stomach, includes vagotomy
35
Q
- Can you wear pouch inside underwear
- can you put tape to fix a leaking pouch
- what should you check before applying new wafer
A
- yes
- no
- skin is clean and dry
36
Q
- What will you notice in hands of parkinsons
- MSK parkinsons
- What will be your first nursing dx
A
- pill rolling
- rigid, bradykinesia, contractures, stooped posutre, shuffling gait
- Impaired physical mobility r/t rigidity, bradykinesia
37
Q
- Why should you NOT suction while advancing the catheter?
- How often should you auscultate breath sounds for an unconscious patient
- Why should you hyeroxygenate before, during, after for unconscious pt.
A
- cause mucosal trauam and aspiration
- Every 2 - 4 hours
- minimize cerebral hypoxia
38
Q
- Where is admin of blood take place and how many nurses?
A
- bedside, 2 nurses verify
40
Q
- Technique for preventing sensory overload on a patient
- What should nurse prevent in patient with intracranial pressure
- Major risk factor for developing CVA
A
- combine activities into one visit
- valsalva maneuver
- hypertension
40
Q
- Adult suction pressure
- How long should you wait between suction
- How long should suctioning take
A
- -80 to -120
- 30 sec
- 15 sec
41
Q
- Wernicke’s area affects
- Broca’s Area affects
A
- Senses and Speech, temporal lobe, AUDITORY center
- moral, emotions, reasoing, judgment, FRONTAL (Right Side Brain damage)
43
Q
- Duodenal ulcer is relieved by…
- What med is a risk factor for PUD
- Foods to AVOID with ulcerative colitis
A
- Food intake
- Taking ibuprofen (Motrin) for osteoarthritis
- dairy, beans, dried fruits, high fiber, nuts, raw fruits and veggies, seeds.
44
Q
- most important when applying new ileostomy bag
- Srugical unit after ileostomy, FIRST action
- Clear liquids
A
- fits snugly, to prevent fluid on the abdomen
- Measure output, assess
- minimal residual, relieve thirst/maintain f&E
45
Q
- What is the primary neurpathic condition of MS
- What would an MRI of the brain or sminap cord show with MS
- What would CSF show with MS
A
- autoimmune, activated by T cells.
- plaques, inflammation, atrophy, tissue breakdown
- increase in IgG, oligoclonal banding
46
Q
- Left brain stroke affects what side
- Symptoms
A
- Right Side paralyzed
- impaired speech/language, r/l discrimination, slow performance, cautious, aware of deficit, anxiety, depression, impaired comprehension r/t language math
47
Q
- Approximately how much drainage w/ c.t.?
- If you see continuous gentle bubbling in suction control chamber…
- Water seal chamber constant bubbling indicates (insp, exper)
A
- 50 mL expected
- normal finding (b/c not intermittent)
- Leak, call HCP– (intermittent bubbling is normal!)
49
Q
- What is a low residue diet
- what pt would have this type of diet?
- Cramping pain in the LLQ w/ irregular bowel function & diarrhea
A
- tender cooked meats, no fiber, or pulp in juices
- bowel inflammation, regional enteritis
- diverticulitits, increased pain w/ coughing bending lifting
49
Q
- What about NG tube prior to surgery
- Manifestation of peritonitis
- Dx for peritonitis
A
- do not touch, contact HCP if tube is not functioning
- pain over involved area, tenderness, rigidity, distention
- CBC,, electrolytes, xray, paracentesis culture, CT scan, peritoneoscopy
49
Q
- Ways to determine suction needs
- Open suction
- Closed suction
A
- O2, color, restless, breath sounds
- new sterile cather each suction
- suction is reusable
50
Q
- Small intestinte pain type (obstruction)
- Lg intestine paint type
- Bowel movement sm intestine obstruction
- Large intestine obstruction bowel movement
A
- Colicky, cramplike , intermittent
- low grade, cramping, ab pain
- feces for a short time
- absolute constipation
51
Q
- Early signs of Heart Failure
- Goals for a patient having an MI
- Endovascular repair for AAA
A
- chest/jaw pain, SOB, N/V. seating, heart burn, malaise
- decrease pain
- minimally invasive, sutureless aortic graft into the abdominal aorta.
52
Q
- S/Sx of Fat Embolism
- S/Sx of Compartment Syndrome
- Bone fracture
A
- ARDS, chest pain, tachypnea, cyanosis, tachycardia
- pain not relieved by pressure, numbness, tingling, pallor, paralysis, pulseless
- breaking a bone
53
Q
- When should GERD pt eat before bed
- HOB for sleeping
- When should they take PPI meds
A
- 3hr before
- 4-6 blocks, gravity fosters esophageal emptying. 30 degrees
- before first meal of the day
55
Q
- Characteristic of myasthenia gravis
- Why?
- What could this lead to
A
- tiredness with slight exertion
- acetylcholine deficiency, difficult to stimulate muscular movement.
- weakness of respiratory muscles
56
Q
- Why would surgeon order prone position for amputee
- Intervention for amputee
A
- prevention of hip contractures (hardening of muscle)
- diabetes consult, long acting insulin, family coop for nutrition restriction, PT consult to increase activity/expend calories
57
Q
- What is a illeostomy
- How often do you change ostomy pouch
- When should you empty pouch
A
- opening to bring small intestine to surface of abdomen
- 3-7 days
- when 1/3 full. Assess outpus, odor, amount, color
58
Q
- Diet for patient with GERD/hiatal hernia
- What can caffeine, alvocol, smoking cause
- What should they do after eating
A
- Low fat, small frequent meals to prevent gastric distention
- increase in LES pressure
- DO NOT lie down for 2-3 hours, wear tight clothing, or bend over
60
Q
- How must a person be diagnosed with MS x3
- Early symptoms of MS
- End stage MS
A
- 2 inflammatory demyelinating lesions in CNS, attack occuring at diff times, rule out other dx
- blurred vision, thinking, balance/coordination, numbness, tingling
- Respiratory, SOB, secretions, pain, urinary retention, paralysis, nystagmus, dec hearing, hyperreflexia
61
Q
- What should physician order after removal of chest tube
- when checking to see of all connections of c.tube are secure what should you feel for?
- Prior to removal of chest tube, what to assess?
A
- pain med
- crepitus or empyema (air, gas under skin)
- RR, O2, Tachypnea, hypoxia, resp distress, lungs, pain
63
Q
- Onset of parkinsons
- Is it unilater or bilateral
- Classic signs of parkinsons
A
- Gradual
- can start on one side of the body
- tremors, rigidity, bradykinesia (tremor is the 1st sign)
63
Q
- Cause for Mitral Stenosis
- Cause for Mitral Regurg
- Cause for Aortic Stenosis
- Cause for aortic Regurg
A
- rheumatic fever, prego
- ischemia, infarcts
- calcification (aging)
- idiopathic, HTN
64
Q
- Peritonitis Pre op
- Peritonitis Post Op
- Small intestine obstruction is rapid or gradual?
A
- NPO, iv fluids, antibiotics, NG suction, analgesics, oxygen PRN,
- NPO, NG tube low intermittent suction, SemiFowler, IV fluids, parenteral nutrition, antibiotic, blood transfusion, sedative/opioids
- rapid
65
Q
- How long does a plaster take to dry
- How should cast extremity be positioned?
- Technique for drying cast
A
- 24-72 hours
- elevate to reduce edema
- Cool setting on hair dryer
65
Q
- What should you do for a homeless patient with TB
- Early symptoms of Lung Cancer
- Late symptoms
A
- encourage a shelter for a meal or nights rest to ensure therapy
- cough, chest pain, pneumonitis, dyspnea
- hoarseness, dysphagia
66
Q
- How often should nurse check NG tube?
- When do you know a colostomy is functioning?
- Name a complication with ileostomys?
A
- every 4 hours
- passing gas
- F &E imbalance
67
Q
- 3 Major complications of PUD
- What is the most lethal complications
- What is perforation
A
- Hemorrhage, perforation, gastric outlet obstruction
- Peforation, seen mostly in duodenal ulcrs
- spillage of gastric/duodenal contents in peritoneal space
69
Q
- Emergency MGMT for Stroke
A
- CT scan
- Ensure patent airway
- Stroke code
- remove dentures
- pulse oximetry
- IV access
- Remove clothing
- baseline tab tests,
- head in midline
- HOB 30 degrees
- Seizure precautions
- NPO
70
Q
- What happens to levodopa with Sinemet drug?
- How does MS develop, according to belief?
- 3 Pathological porcesses in MS
A
- converts to dopamine in the CNS, serves as a neuro transmitter. Relief fo tremors
- genetics, environmental exposure, infection
- Chronic inflammation, demyelination, gliosis (scarring) in the CNS.
72
Q
- After aortofemoral bypass what position should the client be placed in?
- How do analgesics help an MI
- What is a side effect of propanolol that could affect pt with asthma
A
- Full supine- hip remain straight to prevent bleeding
- reduces pain and preload, which reduces workload of the heart
- bronchospasms
74
Q
- What does the glasgow coma scale measure
- What is the NIHSS
- What is the procedure for NIH
A
- Motor, verbal, eye opening
- 15 item neurologic examination used to evaluate the effect of an acute attack
- rates pt’s ability to answer questions and perform activites.
75
Q
- What i bill roth 1
- What is billroth 2
- What is pyloroplasty
A
- partial gastrectomy with remaining to duodenum
- anastomosed to the jejunuum
- enlargment of the pylorous to prevent obstruction enhancing gastric emptying
76
Q
- Glucose
- BUN
- Creatnine
A
- 70-110
- 8-25
- 0.6 - 1.3
78
Q
- What is a potential hazard near oxygen tank
A
- nail polish, flammable
78
Q
- What does the nurst pay attention to during rehab stroke? x6
A
- Pt’s rehab potential
- phys status of body systems
- complication caused by stroke/chronic conditions
- pt’s cognitive status
- family resources/support
- expectations of the pt & caregover rt/t rehab program
80
Q
- Cerebellum affects
- Brainstem affects
A
- balance
- airway
81
Q
- Dopaminergic drugs
- anticholinergic drug
- antihistamine like benadryl have a…
A
- levodopa/carbidopa, converts to dopamine in basal ganglia
- benztropine- help balance cholinergic and dopaminergic activity
- anticholinergic effect
82
Q
- Recommended diet first 4-6 weeks with colostomy?
- How do you know a pt has “accepted” colostomy?
- If a patient does not TCDB, what can it lead to
A
- Low fiber, (after-high carb, high protein)
- When they participate in the care.
- Pneumonia, retianed pulmonary secretions
83
Q
- Pneumothorax Sx
- Hemothorax Sx
- Tension Sx
A
- unequal expansion
- decreased Hgb, Shock
- Tracheal deviation, distended neck veins
84
Q
- Complications with Ulcerative colitis
- Complications with Crohn’s
A
- strictures, perforation due to toxic megacolon, CRC, surgery cures
- fistulas, strictures, anal abseccesses, perforation due to inflammation of entire bowel, increased incidence of Small intestine cancer
85
Q
- What do hematinics and vitmains do
- why are enteral feeding preferred over parenteral
- Why would NG tube be used
A
- correct iron deficiency, anemia and promote healing
- bacterial overgrowth when the gut is not being used.
- during exacerbation when can’t tolerate reg diet
86
Q
- Bubbbles upon initial insertion or when air is being removed is…
- Fluctuation of the level of water in the seal with inspiration and expiration is called?
- Normal or abnormal
A
- Normal
- tidaling
- Normal
87
Q
- What should you observe for with fluid volume deficit
- Another Nursing Dx related to Ostomy
- Goals
A
- dehydration, delayed cap refill
- Skin Integrity
- no signs of hypovolemia, maintain skin intact, demonstrate function of ostomy
89
Q
- Post NPO EGD procedure
- What is the purpose of a colonoscopy
A
- NPO until gag reflex returns, saline gargles for relief, check temp q15-30 min
- Used to detect inflammaotry bowel disease, polyps, tumors and diverticulosis. Polyps can be removed.
91
Q
- What is a sign of decreased CO in pt w/ aortic valv regurg?
- How to differentiate pericarditis from other cardiopulmonary problems?
- Pericarditis complications
A
- SOB on minimial exertan & diastolic murmur
- Pericardial friction rub
- pulsus paradoxus, distant heart sounds, distenden jug veins, falling BP
93
Q
- Chloride
- RBC
- Troponin I
A
- 98-110
- 4 - 6
3.
94
Q
- Most common symptom of duodenal ulcer
- Gas forming vegetables
- Appropriate amt of drainage post op
A
- abdominal pain 2-3 hours after eating, food relieve pain
- onions, broccoli, radishes, beans cabbage
- 50 mL
94
Q
- MI pt skin color
- Primary nursing DX for Acute Cornoary Syndrome
- Intervention
A
- clammy cool to touch
- Decreased cardiac output, AEB decrease in BP
- monitor rhthmn/rate and trends in BP, effective oxygen thearpy, Labs )troponin, CK-MB), also vital organs
95
Q
- What does a Cuffed (balloon) endo tube prevent?
- What does an inflated cuff prevent?
- What does a low pressure cuff do?
A
- Aspiration, ensures set tidal volume
- air passing to vocal cords, nose or mouth
- Reduce risk of pulmonary aspiration
97
Q
- What major vital sign would be altered in an elderly patient?
- when should hydrochlorothiazide be taken
- Major symptom of HF while sleeping
A
- Temperature
- with breakfast, diuresis could occur if taken at bedtime
- orthopnea- inability to breath while lying flat
98
Q
- How can you diagnose parkinsons
- Collaborative care for parkinsons included
- Drugs used for parkinsons
A
- positive response to antparkinson drugs, hx & physica, MRI, SE’s to haloperidol (psychotic drugs)
- antiparkinson drugs, deep brain stimulation, ablation surgery
- dopaminergics, dopamine agonists, anticholinergics, antihistamine, MOI, Catechol OMT
99
Q
- What do Immunosuppressants do for IBD
- Biologic and targeted therapy (immunomodulators)
- Antidiarrheals
A
- Suppress immune sys
- inhibit cytokine tumor necrosis
- decrease GI motility
100
Q
- How is TB not spread
- How is it spread
- What does airbone entail
A
- by hands, objects, brief exposure
- airborne
- cough, speak, sneeze, sings
101
Q
- What does CBC show for IBD
- What does elevated WBC show
- Tests that can be done to diagnose
A
- iron deficiency anemia from blood loss
- toxic megacolon or perforation
- Barium enema, transabdominal ultrasound, CT, MRI, colonoscopy, occult blood
103
Q
- Pre-Op Teaching
- Pre-op assessment data give should be strictly
- Activites performed by the scrub nurse
A
- Where she will be taken post op, DB,
- Objective
- prep instrument table, passing instruments, counting
104
Q
- How often do you change lipid tube
- Where is tpn stored?
- What to do S/Sx of air embolism
A
- every 12 hours
- fridge
- left trendlenburg position
105
Q
- What is annuloplasty
- What is it used for
- what is usually the result of tricuspid valve disease
A
- reconstruction of annulus, or leaking valve
- mitral, tricupsid regurgitation
- pulmonary HTN or Right ventricular dysfunction
106
Q
- Pneumothorax intervention
- Hemothorax intervention
- Tension Pneumothorax intervetion
A
- chest tube with flutter valve, drainage sys
- c.t.w/drain. Autotransfusion of collected blood. Tx hypovolemia
- needle compression followed by c.t. w/ drain
108
Q
- Intermittent claudication is
- SE of nitroglycerin
- Warfarin antagonist
A
- cramping in the legs induced by exercise, obstruction of the arteries
- dizziness, headache, hypotension
- Vitamin K
108
Q
- Pre procedure colonoscopy
- Post procedure colonoscopy
A
- flex scope inserted while pt in side llying position. Will be sedated.
- abdominal cramps, bowel is inflated during procedure, watch for rectal bleeding and perforation. Check vitals
110
Q
- MI is commonly known as
- Angina is commonly known as
- Causes of MI
A
- Heart Attack
- Chest pain with activity
- Blockage of blood supply to heart muscle
111
Q
- Why is an obturaror at the bed side
- What type of procedure is trach
- What do you clean the inner cannula with
A
- to facilitate reinsertion of trach if dislodged outer cannula
- sterile
- Clorhexidine, peroxide, full or 1/2 strength, or saline
112
Q
- Complication w/ TPN
- Why taper TPN?
- Why monitor temp with PN
A
- glucose, infection, fluid overload, embolism, electrolyte imbalance
- Avoid hypoglycemia
- Risk of infection
112
Q
- What is the priority goal of Acute Coronary syndrome
- Most common complication post MI
- Other complications..
A
- stable signs of cardiac output
- dysrhythmias
- HF, Papillary Muscle Dysfunction, Ventricular Aneurysm, Dressler, Pericarditis.
113
Q
- K
- Sodium
- Bicarb
A
- 3.5 - 5
- 135 - 145
- 22 -29
113
Q
- patient with trigeminal neuralgia diet
- when do parkinsons experience tremors
- Caffeine and EEG test
A
- hot foods can trigger pain episode, also too cold
- at rest, give activity to perform
- restrice caffeine 1-2 days prior (hot chocalate included)
114
Q
- Preop Fentanyl/Atropine is most likely used for
- Most critical Hx to know prior to surgery
- Timeout consists of..
A
- decreased asethetic required
- history of death during surgery
- verify id band, ask PT to state surgical procedure, Have PT state name & DOB, confirm Surgical site
115
Q
- Characteristic signs of heart failure
- What should you check following cardiac catheterization
- Most important factor to maintain circulation
A
- tachycardia increased respirations
- extremeties for pulses (concern is trauma to vessels)
- blood volume
116
Q
- Treatment for Stroke
- What makes them a candidate for tPA
A
- Antihypertensive, Antiplatelet, Carotid Endarterectomy, thrombolytics, coumadin, Rehab, MGMT of cerebral edema, seizure prevention, clot retrieval, stents
- not a hemorrhagic,
117
Q
- Pre transfusion
- How long can blood be left out of fridge
- how long does blood transfusion take
A
- need consent, baseline vs, if temp > 100 notify hcp
- 20-30 min
- 2 hours, risk for bacteria infection
118
Q
- What are absence seizures
- What can basilar skull fracture cause
- What does MS involve
A
- momentary loss of consciousness, “blank stare”
- leakage of CSF test positive for glucose
- cerebellum- balance
119
Q
- Assessment of dressing of amputee
- Risk factors
- Why should you inquire about tighter glucose control
A
- snug to prevent edema but not tight for circulation, edema, erythema, amount/drainage
- Diabetes, atherosclerosis,
- To facilitate wound healing
120
Q
- Priority Actions for Chest pain
A
- Assess, pain, HR, and BP
- Administer nitro tablet
- stay with pt
- reasses in 5 min
- admin another nitro tab if pain not relieved and bp is stable
- reassess in 5 min
- if third nitro tab does not relieve pain, contact HCP
121
Q
- Calcium
- Magnesium
- WBC
A
- 8.6 - 10
- 1.6 - 2.6
- 4500-11,000
122
Q
- Concerning assessment Tension Pneumothorax
- Nurse instruction during removal of chest tube?
- Early signs of compartment syndrome
A
- dec CO, hyperresonance, tracheal deviation to opposite side, bradypnea
- exhale and bear down
- Numbness and tingling in the fingers
123
Q
- What color upper GI bleed
- Lower GI bleed
- complication with inflammotry bowel disease
A
- dark tarry
- red
- joints, finger clubbing, erythema, mouth ulcers, conjuctivitis, gallstones, kidney stones, liver disease, osteoporosis, embolism
124
Q
- Nursing MGMT for Valvular disorders
- For a mechanical valve replament what is the med regiment
- What is a valvulotomy
A
- diagnose/tx strep infections, antibiotics for dental procedures
- lifetime anticoagulation, risk for endocarditis, click
- incision of a valve, open/bypass is preferred
126
Q
- When is emergency surgery performed for bowel obstructino
- Nursing Care for bowel obstruction
- Problems caused by NG tube for obstruction
A
- strangulation
- NPO status, NG tube for decompression, IV fluids NS or LR, potassium verify renal function and pain control
- Fluid volume deficit related to suctioning
127
Q
- Hypotension priority response?
A
- O2
- Inspect Incision
- IV fluid bolusdrug intervention/vasoconstrictors.
128
Q
- What should you ensure patient does NOT have s/sx of for lumbar puncture?
- What position should pt be in for lumbar puncture
- Aseptic or Sterile technique?
A
- ICP, risk of downward herniation from CSF removal
- lateral recumbent
- Aseptic
130
Q
- Causes of Angina
- Damage of MI
- Damage of Angina
A
- decrease i blood sypply to heart muscle
- heart irreversible
- no damage
131
Q
- Open repair AAA
- What protein is released post MI
- What protein is sensitive to MI inury
A
- make an aincision, both techniques have similar morbidity rate
- Troponin
- Myoglobin
132
Q
- HOB with traction
- Can the nurse remove or lift weights?
- What should you examine
A
- kept low for countertraction (30-40 degrees)
- no need Dr. Order
- temperature, peripheral pulses, skin breakdown, numbmness, increase in pain, ropes pulleys
133
Q
- What valvular disease should you NOT give Nitro
A
- Aortic Valve Stenosis, hypotension
135
Q
- Risk factors for CAD x7
A
- Hypertension, Lipids, Tobacco use, Sedentary, Stress, Obesity, Diabetes.
136
Q
- Purpose of Cornoary Artery Bypass Graft
- Femoral popliteal bypass, nurse is most concerned if pt is
- HF is
A
- insert graft, anastomosed distally & proximally to bypass obstruction
- Clammy- hypovolemic shock
- failure of muscle to pump sufficient blood to meet body’s metabolic demands
136
Q
- Most common Sx of diverticulitis
- What are diverticula
- Diverticulosis
A
- Pain in LLq (sigmoid colon), palapable mass, infection.
- Outpouches of the colon
- no symptoms typically.
137
Q
- What is the primary diagnoses for MS
- Name another nursing dx
- what is the purpose of a lumbar puncture?
A
- Impaired phys mobility r/t muscle weakness or paralysis
- impaired urinary elimination r/t sensorimotor deficits, knowledge deficit
- CSF is aspirated by needle insertion in L3-4, or L$-5 to assess CNS diseases
138
Q
- # 1 priority post op
- # 2 Priority post op
- What does TCDB prevent?
A
- Positioning, prevent skin break down, lateral recumbent until arousal, then semifowler
- Turn Cough Deep Breathe
- PE/FE, hypostatic pneumonia buildup of secretions
139
Q
- # 1 Intervention for stroke
- other ways of management
A
- CT scan immediately #1, standing order
- MIR, Cardiac Monitor (afib?), echo, carotid NIVA, lipid pane, Coag panel, Hgb A1c
140
Q
- How to assess tolerance of tube feeding?
- How oftern should gastric residual be checked
- When should you hold the feeding and notify HCP
A
- GRV, ab distention, N/V, diarrhea, constipation, delayed g. emptying, listen to lung osunds, monitor aspiration.
- 4 hours
- aspiration, GRV is > 500 ml, ab distention
141
Q
- Glascow coma scale of 7 or less indicates
- spinal cord injury T3, pounding headache and nasal congestion
- Parkinsons diet
A
- pt is comatose and eyes may stay open, preven corneal irritation
- bladder distention, foley cath for kinks
- thick liquids are easier to swallow
142
Q
- Cerebrum affects
- Basal Ganglia affects
- Diancephalon
A
- Cognition
- Motor control (parkinsons)
- ANS (breathing)
143
Q
- Goals of treatment for IBD
- What do 5 ASA do for IBD
- What does antimicrobes do for IBD
A
- rest bowel, control inflammation, combat infection, corect malnutrition, alleviate stree, provide sympotmatic relief, improve quality of life.
- decrease GI inflammation, through direct contac with bowel mucosa
- prevent secondary infection, decrease inflammation
144
Q
- What does heparin do
- Low molecular weight heparin
- Warfarin (Coumadin)
A
- prevents conversion of firbinogen to fibrin and prthrombin to thrombin
- bin to antithrombin III, enhancing its effect
- Interferes with hepatic synthesis of Vitamin K (alternative when aspirin or plavix can’t be used)
146
Q
- Can you adminster TPN on a gravity pump
- What can be added to a blood bag
A
- no must be at a constant rate in an infusion pump
- saline ONLY
147
Q
- Amputation grief/loss considerations
- What is an important assessment post amputation
- What is prone position
A
- explain procedure, simply, resources (children), case mgmt, chaplain
- Pain
- lying on stomach
149
Q
- Signs of Perforation
A
- guarding ab, increased fever/chills, pallor, ab distention, restless, tachycardia
150
Q
- 1 lb = ?? oz
- 1 lb = ?? kg
- Drop factor Formula
A
- 16 Oz
- 2.2 kg
- Volume/Time x Drop Factor = flow rate
151
Q
- What is homonymous hemianopsia
- Cause of this?
- MGMT of homonymous hemianopsia
A
- loss of vision in one side of visual field
- lesions in the contralateral occipital lobe
- arrange env’t within perceptual field
153
Q
- Priority teaching family for stroke
A
- Call 911 and get med help if someon has 1 of the following symptoms
- check the time to know when first symptom appeared
154
Q
- Nursing Dx for lung cancer
- Post op intervention for a thoractomoy
- Priority nursing interventions, thoractomy
A
- Ineffective airway clearnace, anxiety, impaired gas xchange, ineffective breathing pattern
- Chest tube
- respiratory, sputum, breath sounds, chest tube function. Pain, surgical site.
155
Q
- How does nitro work?
- What do you clean a stoma with
- increased pain after eating is a characteristic of
A
- dilate peripheral vessels, thereby decreaseing preload
- soap and water
- gastric ulcer, relieved by vomiting
156
Q
- Complications post op AAA
- What else should you check for
- What should you check post op peripheral arterial bypass
A
- Ischemia, dysrhythmia, infection, VTE, neurlogic complications
- graft patency(BP) and renal perfusion.]
- CMS checks
157
Q
- What assessment is important for most valvular syndromes
- What diagnostic is important for most valvular syndromes
- What does it measure
A
- peripheral arterial, hypotension, abnormal rhythmn
- Cardiac Cath, Angiogram
- pressure gradient across valvues, size of valve openings
159
Q
- Post op pt has delirium, ABC’s are good. What first action
A
- check pre op assessment for previous delirium or dementia
161
Q
- If pt with iron deficieny receives heparin, what are you most concerned about?
- Digitalis Toxicity S/Sx
- When administering dopamine IV drip how in what unit
A
- Bleeding
- N/V, anorexia, visual disturbances, bradycardia,
- kilograms
162
Q
- Complications of thrombolytic therapy
- post-CABG limitations first 6 weeks
- Pt w/ PAD should NOT
A
- Tarry Stools
- no weight bearing
- elevate legs above heart, use heating pad, soak feet in hot water
163
Q
- What diagnostic procedure for inflammed heart complications
- What is pericardial effusion
- What should you do for cardiac tamponade
A
- Echocardiogram- show’s vegetation
- fluid in the pericardium
- Pericardiocentesis STAT
164
Q
- Another very important nurisng dx
- What happens to their swallowing ability in parkinsons?
- Why should they perform physical exercise
A
- Imbalanced nutrition less than body requirments r/t inablility to ingest food
- impaired, assess gag reflex
- to deter muscle atrophy and joint contractures
165
Q
- What does PPD stand for
- What indicates positive test
- Can you make diagnosis on chest xray for tb
A
- Purified protein derivative
- >10mm induration, only indicates exposure
- not on its own
167
Q
- Manifestation with colorectal cancer
- Surgery for CRC
- # 1 Nursing Dx for -Ostomy
A
- iron deficiency, rectal bleeding, ab pain and change in bowel habits, obstruction or perforation
- Laparoscopic colectomy, right hemicolectoomy, abdonminal resection
- Risk for fluid volume deficit
168
Q
- Purpose of an EGD
- Status of patient prior to procedure
A
- visualize mucosal lining of esophagus, stomach, and duodenum. Can see motility, inflammation, ulcerations, tomros, varices, or mallory weiss tears.
- 8 hrs NPO, local anestesia sprayed on throat, will be sedated
169
Q
- What is a pneumothorax
- What is a hemothorax
- Name 3 chest tube systems
A
- air/gas in the cavity btwn lungs and chest causing collapse
- pleural effusion, blood accumulates in pleural cavity
- collection, water seal, suction control chambers.
170
Q
- Why is a tracheostomy used?
- What can a trach do?
- Examples of tach being used
A
- artifical airway for longer than 10 -14 days, bypasses an obstructed upper airway, clean and remove secretions
- can deliver oxygen easer
- vocal cord paralysis, obstructive sleep apnea, foreign body obstruction
172
Q
- Risk factors for colorectral cancer
- Foods that increase risk for stomach cancer
- Signs of flail chest
A
- hx of ulcerative colitis or GI polyps
- smoked foods like bacon or ham
- Paradoxical chest movement
173
Q
- What sound indicates a need for suctioning?
- routine care of chest tube, make sure that….
- Where should drainage sys maintain w/ c.t.
A
- Rhonchi
- connection btwn c.tube & drainage sys is taped, occlusive dressing is maintated at insertion site
- below client’s chest
174
Q
- What is vavlulotomy used for
- what is valvuloplasty
- What is it used for
A
- mitral stenosis
- repair of torn leaflets, chordae tendinae, pap muscles
- mitra or tricuspid regurgitaiton
175
Q
- When is a cuffed tube used?
- Action before patient wants to eat with trach tube
- What could bleeding mean if longer than a few hours of trachostomy?
A
- Mechanical ventilation
- inflate cuff (if cuffed)
- rupture of a vessel call HCP, URGENT LIFE THREATENING
176
Q
- -otomy
- -plasty
- What is a colostomy
A
- cutting into or incision
- repair or reconstruction
- opening to bring colon to surface of ab
177
Q
- What hormone is released when ventricles are overworked?
- What hormone is released when atria is overworked
- Post op MGMT for AAA
A
- BNP, excessive stretch
- ANP
- continuous EKG, pulse ox,., chest tubes, pain meds, epidural or PCA
178
Q
- What position for post lumbar puncture?
- Assessment of fluid of lumbar puncture
- Complication of Lumbar puncture
A
- Prone for 4-8 hours, if not supine. Turn Side to Side.
- Clear, pressure 60-150, protein 15-45, glucose 50/75, minimal WBCs. No bacteria
- Spinal fluid leak (clear), severe headache
180
Q
- Diet for person with diverticular disease?
- Lifestyle changes with diverticular disease
- What else should they consider
A
- High fiber, stool softeners, clear liquid, bulk laxatives,
- weight reduction
- Bed rest, anticholinergics,
181
Q
- ACE inhibitors
- Beta blockers
- Thrombolytic agents
A
- prevent conversion of angiotensin I to angiotensin I result is vasodilation
- inhibit SNS of the heart, reduce rate, contractiility and BP, decrease afterload
- breaks up firbin meashwork in clots, only for ST elevation of MI
182
Q
- How do you always assess pain
- What can cause peritonitis
- S/Sx of Peritonitis
A
- Character and intensity
- ruptured appendix
- ab rigidity, dec bowel sounds, N/V,
183
Q
- Treatment MS
- Drug therapy
- TX for incontinence
A
- maximize neuromuscul ftn, adls, mgmt fatigue, psychosocial, reduce exacerbations
- Interferon, immunomodulators, immunosuppressants, steroids, relaxants,
- no smoking, weight loss, scheduled voiding, pelvic floor muscle, kegil exercises
184
Q
- Failure of the aortic valve to close completely allow blood to flow from?
- Patient teaching with infective endocarditis
- S/Sx of endocarditis?
A
- Aorta to left ventricle
- alway notify healthcare providers of this hx
- retinal/splinter hemorrhage, osler’s nodes, painless erythematous macules on the palms
185
Q
- If patient has a temp 100.4 post op, what is first action?
- What should you do with a trach before deflating the cuff
- What are possibilities with a trach
A
- use IS due to atelactasis risk (infection takes 48 hours)
- Cuff
- not possible to speak, fenestrated if no aspiration risk, speaking trach may be considered.
186
Q
- Early sign of oxygen toxicity
- What is tension pneumothorax
- What urgent intervention is needed?
A
- non productive cough, nasal congestion, sore throat
- Air pressure lung, deviated trach
- Chest tube w/ suction drainage- converts to open pneumothorax
187
Q
- Mitral Valve stenosis sx look like
- Sx
- Aortic Valve Stenosis, Sx
A
- HF
- SOB, Extertional dyspnea (for all valve issues)
- Angina, syncope, exertional dyspnea, LV failure