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