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Mark Klimek > Blue Book > Flashcards

Blue Book Flashcards

1
Q

Primary dietary prescription for calcium nephrolithiasis (kidney stones) ? PG. 85

A

Low calcium diet

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2
Q

For client with nephrolithiasis the diet should be ___ ash

A

Acid

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3
Q

If kidney stone is calcium phosphate the diet must be low in ___ too

A

Phosphorus

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4
Q

Primary diet tx for uric acid nephrolithiasis is __ ____

A

Low purine

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5
Q

Client with uric acid nephrolithiasis should have a diet low in ____

A

Methionine

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6
Q

What is methionine?

A

Precursor of the amino acid cystine

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7
Q

2 foods high in methionine?

A

Milk and eggs

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8
Q

Clients with cystine nephrolithiasis should have an ____ ash diet

A

Alkaline

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9
Q

Inc. fluids over 3000 cc /day is more effective in treating renal calculi than ANY dietary modification, T/F?

A

True. Want to flush tract than worry about diet

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10
Q

Acid-Ash diet

A

Meat, fish, eggs, and cereals are emphasized, with little fruit and vegetables and no milk or cheese.

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11
Q

What is the common name for Laryngotracheobronchitis - LTB

A

Croup

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12
Q

What is the typical temp elevation in croup?

A

Low grade, usually below 102, but can go up to 104.

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13
Q

Are ATBs helpful for croup? For epiglottits?

A

For croup, no. Epiglottitis, yes

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14
Q

Is croup viral or bacterial?

A

Viral

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15
Q

With which condition is croup most often confused?

A

Epiglottitis

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16
Q

Can croup be managed at home? Can epiglottitis be managed at home?

A

Yes. No, epiglottitis is a 911 emergency

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17
Q

Are sedatives used for kids with croup?

A

No, bc this would mask the signs of respiratory distress

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18
Q

What causes epiglottitis? A virus or bacteria?

A

H. influenza BACTERIA

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19
Q

What is the best tx for croup?

A

Cool moist air

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20
Q

What should never be done to a child with epiglottitis?

A

Never put anything in the child’s mouth, ie, a tongue blade can lead to obstruction

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21
Q

What are the typical signs and symptoms of croup?

A

Barking cough, inspiratory stridor, labored resp. pattern

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22
Q

What 3 signs tell you that the child has epiglottitis instead of croup?

A

Muffled voice, drooling, increased fever

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23
Q

When is croup bad enough to be evaluated by a doc?

A

When retractions, and high pitched stridor are present

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24
Q

What lead level needs intervention?

A

50-60 micrograms/ dl

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25
Q

With which class of drugs will a child with lead poisoning be treated?

A

Chelating agents

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26
Q

What do chelating drugs do?

A

They increase the excretion of heavy metals

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27
Q

The most freq. cause of lead poisoning is…

A

Ingestion of lead-based paint chips

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28
Q

Name 3 common chelating agents for lead poisoning

Eat Big Donuts

A

EDTA,

BAL in oil

desferal,

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29
Q

6 S&S of lead poisoning

Dumb Chicks Act Stupid Crazy

A

Drowsiness,

clumsiness,

ataxia-the loss of full control of bodily movements

seizures,

coma,

resp. arrest

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30
Q

Sx of lead poisoning show up in the ____ system

A

Neuro

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31
Q

Leukemia is cancer of the ___ forming tissues

A

Blood

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32
Q

The type of cell that is most common and problematic in leukemia is ____

A

Immature WBC

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33
Q

In leukemia, the platelet count is …

A

Low, bc the bone marrow is going “wild” producing all those immature WBC - no energy or nutrients to make platelets

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34
Q

Bc the RBCs are low, the pt will exhibit ___ and ___

A

Pallor and fatigue

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35
Q

Bc of the immature WBCs, the pt is at risk for ___

A

Infection

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36
Q

Bc of low platelets, the pt is at risk for ___, ___, ____and ___

A

Bruising, ecchymosis, bleeding, petechiae

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37
Q

What causes lymph gland enlargement in leukemia?

A

All those small immature WBC clog the lymph system

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38
Q

Should you take an oral temp on a child with leukemia?

A

Yes, as long as they are over 4 years old, in remission, and have no sores in their mouth

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39
Q

Should the child with active leukemia use straws, forks, cups?

A

NO straws, NO forks, YES cups

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40
Q

RN’s priority in tx a child with newly diagnosed leukemia is…

A

Dec. risk of infection

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41
Q

When the leukemia child’s platelets and WBC’s are low, his activities should be …

A

Limited

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42
Q

When the platelet and WBCs are low the nurse should not insert a..

A

Suppository

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43
Q

Are IM injections and IV sticks permitted on a child with leukemia?

A

When labs are low IMs avoided and IVs limited; only done when absolutely necessary (to give chemo or measure blood counts)

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44
Q

Why are kids on chemo also on allopurinol

A

To prevent uric acid kidney stones (remember when chemo kills cancer cells, purines and uric acid build up and could cause kidney stones

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45
Q

Why do some kids with leukemia have joint pain?

A

The immature WBCs infiltrate the joint and cause inflammation

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46
Q

Why is a child with leukemia at risk for neuro sx due to ICP?

A

The immature WBCs infiltrate the brain and cause inflammation

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47
Q

What is alopecia?

A

Hair loss

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48
Q

If the platelet count is low In leukemia what drug should the child not take?

A

Aspirin

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49
Q

Is the alopecia from chemo permanent?

A

No. It will grow back. (Alopecia of radiation therapy is permanent bc the follicle is destroyed)

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50
Q

What does ANC mean?

A

Absolute Neutrophil Count

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51
Q

What is the ANC used for in leukemia?

A

If ANC <500, then pt will be on protective isolation

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52
Q

Which is used more commonly to decide if the pt should be on isolation: WBC or ANC

A

ANC is more reliable and valid

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53
Q

By the end of the 1st 6 months of life an infants birthweight should ____

A

Double

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54
Q

Ideal food for infants is ___

A

Breast milk

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55
Q

Breast milk contains substances that increase immunities T/F?

A

T

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56
Q

Bottle-fed infants dont bond well with their moms T/F?

A

F

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57
Q

The 1 nutrient that commercial formulas are typically low in is ___

A

Fe

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58
Q

Breast milk does not contain iron T/F?

A

False. However, it does not contain enough iron- so they should be fed iron fortified cereal starting at 6 months

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59
Q

At what age should the infant be fed cows/goats milk?

A

Not before 12 months

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60
Q

What is the major problem with feeding an infant skim milk?

A

They dont get enough calories and dont grow. Dehydration from excessive solute load and inability to concentrate urine

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61
Q

When should the infant be introduced to textured solid foods?

A

4-6 months

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62
Q

What is the first food that an infant should be introduced to?

A

Iron fortified rice cereal

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63
Q

When forced to eat, the preschool child will…

A

Rebel

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64
Q

Parents of preschool children should be taught that as long as the child eats ___ good nutritious meal per day, they should not make eating food an issue

A

One

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65
Q

Refusal to eat is common in preschoolers T/F?

A

True, but still offer a variety

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66
Q

Youngsters develop food preferences by..

A

Observing significant ppl in their environ

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67
Q

School-age kids grow at a slower rate than infants, toddlers, or adolescents T/F?

A

True

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68
Q

What dietary strategy is most appropriate for the industrious school-age child?

A

Wholesome snacks, bc they are often too busy too eat

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69
Q

Girls in adolescence need more calories than adolescent boys T/F?

A

False, boys need more cals

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70
Q

Adolescents should take vitamin supplements T/F? PG. 90

A

T

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71
Q

Mastitis and breast engorgement are more likely to occur in…

A

Primipara

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72
Q

Where does the organism that causes mastitis come from?

A

The INFANTS nose or mouth

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73
Q

Which organism most commonly causes mastitis

A

Staph

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74
Q

Prolonged intervals between breast- feeding (dec/inc) the incidence of mastitis

A

Increase

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75
Q

Can too-tight bras lead to mastitis?

A

Yes, by preventing emptying of ducts

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76
Q

Mastitis usually occurs at least ___ days after delivery

A

10

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77
Q

When mastitis is present the breasts are ___, ____, and ____

A

Hard, swollen, warm

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78
Q

Mastitis is accompanied with a fever over

A

102

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79
Q

If mastitis is caused by an organism , what causes breast engorgement

A

Temporary increase in vascular & lymph supply to the breast in preparation for milk production

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80
Q

If mastitis occurs 1+ weeks after delivery, when does breast engorgement occur?

A

2-5 days after delivery

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81
Q

Does breast engorgement interfere with nursing?

A

Yes, the infant has a difficult time latching on

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82
Q

What class of drugs is used to treat mastitis?

A

ATBs

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83
Q

ATBs are used to treat breast engorgement (T/F)?

A

F

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84
Q

Which Application of (warm H2O compresses/ice packs) is the preferred tx for breast engorgement?

A

Ice packs to dec swelling

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85
Q

The mother with mastitis should stop breast feeding (T/F)?

A

False. The mother must keep breast feeding. (Offer unaffected breast first).

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86
Q

If the mother has an open abscess on her breast, she must not breastfeed (T/F)?

A

T

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87
Q

For breast engorgement, the non- breastfeeding mother should be told to express milk (T/F)

A

No, that would increase milk production and would make the problem worse (warm compresses or a warm shower to let milk “leak” is okay - Ice is best

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88
Q

What is the best tx for breast engorgement?

A

Breast feeding - it will balance supply and demand

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89
Q

What is mastoiditis?

A

Inflammation / infection of the mastoid process

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90
Q

What is the most common cause of mastoiditis?

A

Chronic otitis media

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91
Q

What are the 5 S&;S of mastoiditis?

A

Drainage from ear,

high fever,

HA, and

ear pain,

tenderness over mastoid process

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92
Q

What unusual post-op complication can result from mastoidectomy?

A

Facial nerve paralysis d/t accidental damage during surgerym

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93
Q

What should you do to assess for facial nerve paralysis post-mastoidectomy?

A

Have the patient smile and wrinkle forehead

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94
Q

What is the medical tx of mastoiditis?

A

Systemic ATBs

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95
Q

What is the surgery for mastoiditis called?

A

Simple or radical mastoidectomy

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96
Q

Will a simple mastoidectomy worsen hearing?

A

No, a radical mastoidectomy may

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97
Q

Should the nurse change the post- mastoidectomy dressing?

A

No, reinforce it. Physician changes first post-op dressing

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98
Q

What is a common side effect of mastoidectomy

A

Dizziness (vertigo)

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99
Q

What is a major nursing diagnosis post- mastoidectomy ? PG 92

A

Safety

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100
Q

Define Menieres diease

A

An increase in endolymph in the inner ear causing severe vertigo

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101
Q

What’s the famous triad of S&S in Meniere’s?

A

Paroxysmal whirling vertigo - sensorineural

hearing loss -

tinnitus (ringing in the ears)

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102
Q

Does Meniere’s occur more in men or women?

A

Women

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103
Q

What should the client do if they have an attack?

A

Bedrest

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104
Q

What safety measures should be followed with Meniere’s?

A

Side rails up x4, ambulate only with assistance

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105
Q

What age group in Meniere’s highest in?

A

40-60

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106
Q

What can prevent the attacks of Meniere’s?

A

Avoid sudden movements

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107
Q

What electrolyte is given to ppl with Meniere’s?

A

Ammonium chloride

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108
Q

What surgery is done for Meniere’s?

A

Labyrinthectomy

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109
Q

What disease often follows labyrinthectomy?

A

Bell’s palsy - facial paralysis, will go away in a few month

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110
Q

What is the activity order after labyrinthectomy?

A

Bedrest

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111
Q

When surgery is preformed for Meniere’s, what are the consequences?

A

Hearing is totally lost in surgical ear

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112
Q

What should the client avoid after labyrinthectomy?

A

Sudden movements and increase Na foods

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113
Q

What type of diet is the client with Meniere’s on?

A

Low sodium

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114
Q

What two classes of drugs are given in Meniere’s?

A

Antihistamines and diuretics (Diamox)

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115
Q

Meningitis is an inflammation of the ___ of the ___ and spinal ___

A

Linings, brain, cord

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116
Q

Meningitis can be caused by ___, ___, and ____.

A

Viruses, bacteria, and chemicals

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117
Q

The 4 most common organisms that cause meningitis are…

A

Pneumococcus, meningococcus, streptococcus, H. Influenza

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118
Q

Child with meningitis is most likely to be (lethargic or irritable) at first.

A

Irritable

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119
Q

What visual S&S will the pt with meningitis have?

A

Photophobia (over-sensitivity to light)

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120
Q

What is the most common musculo- skeletal S&S of meningitis?

A

Stiff neck - nuchal rigidity

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121
Q

Will the pt with meningitis have a HA?

A

Yes

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122
Q

Kernig’s sign is positive when there is pain in the ___ when attempting to straighten the leg with the ___ flexed

A

Knee; hip

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123
Q

What type of vomiting is present in meningitis?

A

Projectile

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124
Q

What is the definitive diagnostic test for meningitis?

A

Lumbar puncture with culture of CSF

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125
Q

If the pt has meningitis, the CSF shows ___ pressure, ___ WBC, and ____ protein, ___ glucose

A

Inc., inc., inc., dec

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126
Q

On what type of isolation will the patient with meningitis be?

A

Contact and respiratory precaution

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127
Q

How long will the patient with meningitis be on these precautions?

A

Until they have been on an ATB for 48h

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128
Q

The room of a pt with meningitis should be ___ and ___?

A

Dark and quiet

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129
Q

The client with meningitis can develop ?

A

Seizures

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130
Q

What is opisthotonos?

A

Arching of back (entire body) from hyperextension of the neck and ankles, d/t severe meningeal irritation

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131
Q

If a patient has opisthotonos, in what position would you place them?

A

Side lying

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132
Q

Average duration of menstrual flow is ___. The normal range is ___ to ___ days.

A

5 days, 3-6

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133
Q

Average blood loss during menstruation is ____ cc

A

50-60 cc.

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134
Q

Name the two phases of the ovarian cycle

A 
Follicular phase (first 14 days), 
luteal phase (second 14 days)
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135
Q

the menstrual cycle, day 1 is the day on which…

A

Menstrual discharge begins

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136
Q

How long does an ovarian cycle last?

A

28d

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137
Q

How many days after ovulation does menstruation begin?

A

14 days

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138
Q

What hormones are active during the follicular phase?

A

FSH and Estrogen

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139
Q

What is the major function of the luteal phase of the ovarian cycle?

A

To develop and maintain the corpus luteum which produces progesterone to maintain pregnancy until placenta is est.

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140
Q

If an ovum is fertilized during the luteal phase what hormone will be secreted?

A

HCG (human chorionic gonadotropin)

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141
Q

During menstruation, the average daily loss of iron is ___ mg.

A

0.5 to 1.0 mg

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142
Q

What occurs during the follicular phase of the ovarian cycle?

A

It accomplishes maturation of the graafian follicle which results in ovulation

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143
Q

What type of environmental modification is best for a migraine?

A

Dark, quiet, environment

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144
Q

The long term tx of migraine focuses upon…

A

Assessing things that bring on stress and then planning to avoid them

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145
Q

What type of pain is typical of migraines?

A

Throbbing

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146
Q

Are migraines more or less common in men?

A

Less

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147
Q

Besides pain, ppl with migraines complain of what other S&S?

A

N&V, and visual disturbances

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148
Q

What are the processes occurring in migraines?

A

Reflex constriction then dilation of cerebral arteries

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149
Q

Where is the pain of migraines most likely located?

A

Temporal, supraorbital

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150
Q

Name a drug given to tx migraine?

A

Sansert (methsergide) (met-i- sir-jide), Cafergot (prophylaxis: Imipramine) (I-mip-a-rine)

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151
Q

Are migraine HAs usually unilateral or bilateral?

A

Unilateral

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152
Q

When Inderal is given in migraine headache, is it used to prevent or treat an attack?

A

To prevent. It does not treat

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153
Q

MS is a progressive ____ disease of the CNS.

A

Demyelinating—cause the loss or destruction of myelin in (nerve tissue).

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154
Q

Myelin promotes ___, ___ ___ of nerve impulses.

A

Fast, smooth conduction

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155
Q

With demyelination the nerve impulses become ___ and ____.

A

Slow, uncoordinated

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156
Q

MS affects men more than women (T/F)

A

False, affects women more than men

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157
Q

What age group usually gets MS?

A

20-40

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158
Q

MS usually occurs in (hot/cool) climates

A

Cool

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159
Q

What is the 1st sign of MS?

A

Blurred or double vision

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160
Q

MS can lead to urinary incontinence (T/F)

A

True

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161
Q

MS can lead to impotence in males (T/F)

A

T

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162
Q

Patients with MS should be taught to walk with a ___ -___ gait

A

Wide-based

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163
Q

Why are Adrenocorticotropic Hormone (ACTH) and prednisone given during acute MS?

A

To dec. edema in the demyelination process

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164
Q

For acute exacerbations of MS ___ per IV is often used

A

ACTH (Corticotropin)

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165
Q

What drug can be given to treat urinary retention in MS?

A

Urecholine, Bethanocol

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166
Q

Will the muscles of MS clients be spastic or flaccid

A

Spastic

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167
Q

What 3 drugs can be given for muscle spasms?

A

Valium, Baclofen (Lioresal), Dantrium

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168
Q

Which does Baclofen causes (constipation/ diarrhea)

A

Constipation

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169
Q

Which does Dantrium causes (constipation/ diarrhea)

A

Diarrhea (Hint: the D’s go together, Dantrium and Diarrhea)

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170
Q

Patients with MS should have (inc/restricted) fluids

A

Increased to dilute urine and reduce incidence of UTI

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171
Q

The diet of a patient with MS should be ___ -ash

A

Acid

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172
Q

What major sense is affected most in MS (besides vision)?

A

Tactile (touch) - they burn themselves easily

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173
Q

Which will bring on a MS exacerbation: over-heating or chilling?

A

Both will; but they tend to do better in cool weather (summer will always be a bad time for MS patients)

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174
Q

In Myasthenia Gravis (MG) there is a disturbance in transmission of impulses at the ___ ____.

A

Neuromuscular junction

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175
Q

The #1 sign of MG is ____ ____ ___

A

Severe muscle weakness

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176
Q

What is the unique adj. given to describe the early signs of MG?

A

The early signs (difficulty swallowing, visual problems) are referred to as BULBAR signs.

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177
Q

MG affects men more than women (T/F)

A

False, affects women more than men

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178
Q

When women get MG they are usually old or young?

A

Old

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179
Q

What neurotransmitter is problematic in MG?

A

Acetylcholine

A seat a col line

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180
Q

What class of drug is used to tx MG?

A

Anticholinesterases

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181
Q

What ending do anticholinesterases have?

A

-stigmine

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182
Q

Are anticholinesterases sympathetic or parasympathetic?

A

parasympathetic

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183
Q

Anticholinesterases will have (sympathetic or cholinergic) side effects

A

Cholinergic (they will mimic the parasympathetic nervous system

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184
Q

What surgery CAN be done for MG?

A

Thymectomy (removal of thymus)

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185
Q

The severe muscle weakness of MG gets better with exercises (T/F)

A

False, it is worse with activity

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186
Q

What will the facial appearance of a patient with MG look like?

A

Mask-like with a snarling smile (called a myasthenic smile

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187
Q

If a patient has MG, what will be the results of the Tensilon Test?

A

The patient will show a dramatic sudden increase in muscle strength

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188
Q

Besides the Tensilon Test, what other diagnostic tests confirm a diagnosis of MG?

A

Electromylogram (EMG)

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189
Q

What is the most important thing to remember about giving Mestinon and other anticholinesterases?

A

They must be given EXACTLY ON TIME; at home, they might need to set an alarm

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190
Q

Do you give anticholinesterases with or without food?

A

With food, about 1/2 hour ac; giving ac helps strengthen muscles of swallowing

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191
Q

What type of diet should the pt with MG be on?

A

Soft

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192
Q

What equipment should be at the bedside of an MG patient?

A

Suction apparatus (for meals), Tracheostomy/ endotube (for ventilation)

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193
Q

Name the two types of crises that a MG pt can have

A

Cholinergic (too much Mestinon); Myasthenic (not enough Mestinon)

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194
Q

The #1 danger in Myasthenic and Cholinergic crisis is ___ ___.

A

Respiratory arrest

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195
Q

What words will the client use to describe the pain of an MI?

A

Crushing, heavy, squeezing, radiating to left arm, neck, jaw, shoulder

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196
Q

What is an MI?

A

Either a clot, spasm, or plaque, that blocks the coronary arteries causing loss of blood supply to the heart and myocardial cell death

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197
Q

What is the #1 S&;S of an MI?

A

Severe chest pain unrelieved by rest and nitroglycerine

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198
Q

Males are more likely to get an MI than females (T/F)

A

T

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199
Q

Due to MI occurs within _____ of symptom onset in 50% of all patients.

A

One hour

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200
Q

What pain medication is given for the pain of a MI (Give three).

A

Morphine, Demerol, Nitroglycerine

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201
Q

What is the reason for giving post MI patients ASA?

A

To prevent platelets from forming clots in the coronary arteries

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202
Q

Name a new drug with anti-platelet activity.

A

Plavix

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203
Q

The three most common complications after MI are ____ _____,_____, and _______

A

Cardiogenic shock, arrhythmia, CHF

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204
Q

In Abruptio Placenta, the placenta ____________ from the uterine wall ____________.

A

Separates, prematurely

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205
Q

Give another name for an MI.

A

Heart attack

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206
Q

What will the activity order

be for the post-MI client?

A

Bed rest with bedside commode

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207
Q

What is the most common arrhythmia after a MI?

A

Premature ventricular contractions (PVCs)

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208
Q

What cardiac enzymes indicate an MI?

A

Elevated CPK, LDH, SGOT

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209
Q

What serum protein rises soonest after myocardial cell injury?

A

Troponin

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210
Q

Do people without cell damage have troponin in their blood?

A

No it is only present when myocardial cells are damaged.

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211
Q

How soon after cell damage does troponin increase?

A

As soon as 3 hours (can remain elevated for 7 days)

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212
Q

When will the client with an MI be allowed to engage in sexual intercourse after an MI?

A

6 weeks after discharge.

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213
Q

Will fluid resuscitation (administering large amounts of IV fluid) treat cardiogenic shock?

A

No, you must use cardiac drugs (giving IVs and blood will not help this kind of shock)

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214
Q

Will the client with a MI be nauseated?…diaphoretic?

A

Yes and yes

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215
Q

What will the extremities of the client with a MI feel like?

A

Cold and clammy

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216
Q

What is the permanent EKG change seen post MI?

A

ST wave changes

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217
Q

Of CPK and LDH which rises earliest?

A

CPK

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218
Q

What drug will be used to treat PVCs of MI?

A

Lidocaine

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219
Q

Will the client with a MI need 100% O2 for their entire stay in the hospital?

A

No, just moderate flow (42% or 3 to 6 liters for first 48hours)

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220
Q

Clear liquid diet (UC or Crohn’s)

A

Ulcerative colitis diet

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221
Q

Bed rest (UC or Crohn’s)

A

UC

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222
Q 
Women mostly (UC or
Crohn's)
A

UC

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223
Q

One-layer ulceration’s with edema of bowel (UC or Crohn’s)

A

UC

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224
Q

Steroids (UC or Crohn’s)

A

Either

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225
Q

Steroids (UC or Crohn’s)

A

Either

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226
Q

I&O (UC or Crohn’s)

A

Either

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227
Q

Rectum & Sigmoid colon (UC or Crohn’s)

A

UC

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228
Q

Bloody diarrhea (UC or Crohn’s

A

UC

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229
Q

Young adults (UC or Crohn’s)

A

UC

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230
Q

Surgery with ileostomy (UC or Crohn’s)

A

Either

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231
Q

Ileostomy (UC or Crohn’s)

A

Either

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232
Q

Jewish clients (UC or Crohn’s)

A

Either

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233
Q

Lesion through all layers of the bowel (UC or Crohn’s)

A

Crohn’s

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234
Q

Terminal-distal-small intestine (UC or Crohn’s)

A

Crohn’s

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235
Q

Regional enteritis (UC or Crohn’s)

A

Crohn’s

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236
Q

Adults, up to 40 (UC or Crohn’s)

A

Crohn’s

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237
Q

Lesions form patches (UC or Crohn’s)

A

Crohn’s

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238
Q

Sulfa drugs (UC or Crohn’s)

A

Crohn’s

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239
Q

Granulomas (UC or Crohn’s)

A

Crohn’s—hint: “gran”ny Crohn

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240
Q

String sign” on barium enema (UC or Crohn’s)

A

Crohn’s

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241
Q

Diarrhea (UC or Crohn’s)

A

Crohn’s

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242
Q

Pain & cramping (UC or Crohn’s)

A

Crohn’s

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243
Q

Steroids (Prednisone) (UC or Crohn’s)

A

Either

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244
Q

The purpose of an upper GI is to detect ___________.

A

Ulcerations

245
Q

What 3 structures does an upper GI series visualize?

A

Esophagus, stomach, duodenum

246
Q

Does barium come in different flavors?

A

Yes

247
Q

What is the most uncomfortable aspect of an upper GI series?

A

Lying & turning on a hard, flat X-ray table

248
Q
  1. Is fasting required before an upper GI series?
A

Yes, usually NPO after midnight.

249
Q

How much barium is swallowed?

A

8oz

250
Q

Barium is ___________ in

consistency.

A

Chalky-bitter taste

251
Q

If an ulceration does not reduce by 50% on upper GI in 3

weeks of medication treatment then _________ is suspected.

A

Malignancy

252
Q

What are the 3 classic vital signs?

A

Temperature, pulse, respiration

253
Q

Measurement of vitals requires a doctors orders.

A

False

254
Q

The temperature of the extremities and skin is (higher/lower) than the core.

A

Lower

255
Q

List the 5 most common sites in which to measure the temperature.

A

Oral, axillary, rectal, tympanic, temporal

256
Q

The normal adult temperature via the oral route is..

A

96.8

257
Q

The normal rectal temperature is..

A

99.6

258
Q

The normal axillary temperature is

A

97.6

259
Q

Body temperature is (increased/decreased) with activity.

A

Increased

260
Q

With any oral temperature device, the meter must be

______ the ________, and the ______ must

A

under, tongue, mouth , closed

261
Q

If your client is 4 years old or younger, should you take an oral temperature?

A

No

262
Q

Can you measure an oral temperature on an unconscious patient?

A

No

263
Q

Can you measure an oral temperature on someone with an

NG tube in place?

A

No

264
Q

If the client is found smoking, eating or drinking when you

are about to take a temperature you should wait ______ (at least).

A

15 minuets

265
Q

Should you use the oral route for measuring temperature when a client has oxygen per nasal cannulae?

A

Yes

266
Q

People on seizure precaution should have their temperature measured by which route?

A

Any route except oral

267
Q

People with facial trauma should have their temperature measured by which route?

A

Any route except oral or tympanic

268
Q

Clients with rectal surgery, should have their temperatures measured by which route?

A

Any route except rectal

269
Q

People with heart blocks or conduction problems should not have their temperatures taken per _____. Why?

A

Rectum-vagal stimu lation causes more heart block.

270
Q

When using a glass thermometer it should remain in the

mouth for _______ minutes.

A

3-10

271
Q

When using a glass thermometer it should remain in the rectum for _______ minutes.

A

2-3

272
Q

When using a glass thermometer it should remain in the axilla for _______ minutes.

A

8-11

273
Q

In the normal adult, which is longer, inspiration or expiration?

A

Expiration

274
Q

What is the normal respiratory for an adult?

A

12-20

275
Q

What is the normal respiratory for an adult?

A

Any respiratory rate below 10 per minute.

276
Q

What is tachynpea?

A

Any respiratory rate about 24 per minute.

277
Q

Is it acceptable practice to count the number or respiration in 15 seconds and multiply by 4 to get the rate. (T/F)

A

Yes, if the respirations are regular.

278
Q

What is the pulse?

A

The surge of blood ejected from the left ventricle.

279
Q

What is the average pulse rate

for an adult?

A

72 per minute (60 to 100)

280
Q

What rate classifies as tachy in an adult?

A

A rate above 100 per minute

281
Q

What rate classifies as brady in an adult?

A

A rate below 60 per minute

282
Q

Will pain alone increase the pulse rate?

A

Yes, pain alone can increase the pulse rate?

283
Q

Which finger should never be used to determine a pulse?

A

The thumb

284
Q

What does it mean to measure an apical pulse?

A

To auscultate with a stethoscope over the chest to hear the heart rate.

285
Q

If a pulse is irregular how would you determine the rate?

A

Count one full minute

286
Q

If an apical/radial pulse is regular how would you determine

the rate?

A

Count for 30 seconds and multiply by 2.

287
Q

What is an apical-radial pulse?

A

When 2 nurses measure the apical rate simultaneously with the radial rate for
comp ar ison .

288
Q

How long must an apical-radial pulse be measured?

A

Always for 1 full minute

289
Q

How many nurses are needed to measure an apical-radial pulse?

A

Always two (it is never acceptable for one nurse to measure the apical pulse for a minute then measure the radial or a minute.)

290
Q

What is a voiding cystogram?

A

It is a series of X-rays taken as the person with a full bladder is asked to void.

The X-rays show any reflux of urine back up the ureters (a dye if injected prior to this)

291
Q

Does the client need to have a catheter

inserted for a voiding cystogram?

A

Yes

292
Q

Is the client sedated for the voiding

cystogram?

A

No

293
Q

Is the client NPO for the voiding

cystogram?

A

No, just clear liquid breakfast

294
Q

What problems does a voiding cystogram diagnose best?

A

Bladder filling problems, vesicoureteral reflux

295
Q

What precautions are necessary for

males during a voiding cystogram?

A

Shielding the testicles from the X- rays

296
Q

Is there a bowel evacuation prep for a voiding cystogram

A

No

297
Q

For what reason are Montgomery straps used?

A

Permit you to remove & replace dressings without using tape (protects the skin)

298
Q

Sutures in general are removed by the ___ day.

A

7th

299
Q

Leaving a wound open to air decease infection by eliminating what 3 environmental conditions?

A

Dark, warm, moist

300
Q

To remove tape always pull

(toward/away) from the wound.

A

Toward (this way you don’t put pressure/pull on the suture line.

301
Q

Define contusion.

A

Bruise (internal)

302
Q

Define debridement.

A

Removal of necrotic tissue from a wound.

303
Q

What is the purpose of a wound drain?

A

Remove secretions from the area so healing occurs.

304
Q

To prevent germs from getting into or out of a wound you should use what type of dressing?

A

An occlusive dressing

305
Q

What solution is put onto the skin to protect it from the irritating effects of the tape?

A

Tincture of benzoin

306
Q

Withwhatisa round closed in first intention?

A

Sutures or steri-strips, staples

307
Q

What is another name of second

intention?

A

Granulation

308
Q

When swabbing an incision you would start at the incision or 1 Inch away from the incision?

A

Start at the incision and move outward.

309
Q

After you remove soiled dressings and before you put on the sterile dressing you must….

A

Wash your hands and put on sterile gloves

310
Q

What is meant be the phrase “advance the drain 1 inch”?

A

You pull the drain out 1 inch.

311
Q

After advancing a Penrose drain you

(should/should not) cut off the excess drain?

A

Should

312
Q

When a dressing is saturated, germs

can enter the wound from the outside. (T/F)

A

True, by a process called capillary action .

313
Q

When is a bad time to change

dressings?

A

Mealtime

314
Q

Define laceration.

A

Cut

315
Q

Whatisthe#1 difference between sealed & unsealed radiation?

A

Both are internal forms of radiotherapy however, in sealed, a solid object is placed in a body cavity;

in unsealed a radioactive substance is injected in liquid form into a vein

316
Q

What are the 3 principles the
nurse uses to protect
self when caring for a client with a sealed radioactive implant?

A

Time, distance, shielding

317
Q

What is another name for external

radiation therapy?

A

Beam or X-rays

318
Q

Whatisthe difference

between external radiation treatment and internal radiation treatment?

A

In external the tumor is bombarded with x-rays & nothing is placed in the body; in internal there is some radioactive substance introduced into the body

319
Q

Of sealed internal, unsealed internal,

and external radiation treatment, which is MOST dangerous for the nurse?

A

Sealed internal, unsealed internal and external radiation treatment is of no danger to the nurse unless the nurse is in the radiation treatment room during the treatment.

320
Q

Should pregnant nurses care for

patient receiving sealed internal radiotherapy?

A

No

321
Q

Should pregnant nurses care for a

patient receiving unsealed internal radiotherapy?

A

Maybe, as long as they don’t contact body secretions.

322
Q

What skin products should

the patient receiving external radiotherapy AVOID?

A

No ointments with metals like zinc oxide, no talcum powder

323
Q

Describe the hygiene measures

the you teach the patient receiving external radiotherapy?

A

Use plain water only, no soaps, pat dry, can use cornstarch for itch

324
Q

What are the 8 major side effects

of radiotherapy?

A

Pruritis, erythema, burning, sloughing of skin, anorexia, nausea & vomiting, diarrhea, bone marrow depression

325
Q

When the patient is receiving radioactive iodine what precautions is/are most important?

A

Wear gloves while in possible contact with urine, special precautions taken to dispose of the urine.

326
Q

Rape is a crime of passion. (T/F)

A

False, it is a violent act

327
Q

Most rapes occur involving two

people of different races. (T/F)

A

False, usually the same race

328
Q

When must psychological care of the rape victim begin?

A

In the emergency room

329
Q

Immediately after

rape,awomanwho iscalmand composed is adjusting well. (T/F)

A

False, calmness & a composed attitude are SIGNS of Rape Trauma syndrome, (calm person is just as disorganized as the crying and upset lady)

330
Q

Scoliosis is a ______

curvature of the ______.

A

Lateral, spine

331
Q

Scoliosis is MOST common in the
_______ and
______ sections of the spinal column.

A

Thoracic and lumbar

332
Q

Scoliosis in the thoracic spine is
usually convex to the
(left/right).

A

Right

333
Q

Scoliosis in the lumbar spine is

usually convex to the (left/right).

A

Left (*Hint: curve Left in Lumbar)

334
Q

With which other two spine

deformities is scoliosis associated?

A

Kyphosis (humpback), Lordosis (swayback)

335
Q

What is Kyphosis?

A

Humpback in the thoracic area

336
Q

What is Lordosis?

A

Swayback in the lumbar region (Lumbar, Lordosis)

337
Q

What is the difference between structural and functional scoliosis?

A

Structural-you are born with; Functional-you get from bad posture

338
Q

What age group should be routinely screened for scoliosis?

A

Young teens

339
Q

What are the 3 subjective complaints of clients with scoliosis?

A

Back pain, dyspnea, fatigue

340
Q

What test/exam CONFIRMS the diagnosis of scoliosis?

A

X-rays of the spine

341
Q

What type of brace is most commonly used for scoliosis?

A

Milwaukee Brace

342
Q

Name 4 exercises used to treat mild scoliosis.

A

Heel lifts; sit-ups; hyperextension of the spine; breathing exercises

343
Q

What kind of treatment is done for severe

scoliosis?

A

Surgical fusion with rod insertion

344
Q

What type of cast is used post-operatively for scoliosis?

A

Risser cast

345
Q

What kind of rod is used to “fix” curvature?

A

Harrington Rod

346
Q

Scoliosis MOST commonly affects _____ _____

type of clients

A

Teenage female

347
Q

How many hours a day should the client wear a Milkwaukee brace?

A

23

348
Q

What solution should be used on the skin where the

brace rubs?

A

Tincture of benzoin or alcohol,no lotions of ointments- you want to toughen the skin not soften it

349
Q

Clients with a Milwaukee brace should avoid vigorous

exercise. (T/F)

A

True

350
Q

After corrective SURGERY for Scoliosis how is the client turned?

A

Log rolled (in a body cast)

351
Q

How often should the neurovascular status of the

extremities of a client in a Risser cast be measured? Fresh post- operatively?

A

Every 2 hours

352
Q

What is a common complication of a

client in a body cast (like a Risser cast)?

A

Cast syndrome

353
Q

What is cast syndrome?

A

Nausea, vomiting and abdominal distention that can result in intestinal obstruction

354
Q

What group of people get cast syndrome?

A

Anyone in a body cast

355
Q

Whatisthe treatment of for cast syndrome?

A

Removal of the cast, NG tube to decompress, NPO

356
Q

How would you, the nurse, assess for

developing cast syndrome?

A

Ask the client if they are experiencing any abdominal symptoms-keep track of bowel movements & passing flatus (if not having BMs or passing flatus, cast syndrome is suspected)

357
Q

What causes cast syndrome,

specifically in a Risser cast?

A

Hyperextension of the spine by a body cast: the hyperextension interrupts the nerve & blood supply to the gut

358
Q

The inheritance pattern of sickle-cell anemia is _____

_____.

A

Autosomal recessive

359
Q

What does heterozygous mean?

A

It means you only have 1 defective gene from 1 parent.

360
Q

People who are (hetero/homo) have sickle cell

trait.

A

Heterozygous

361
Q

What does homozygous mean?

A

It means you have the defective gene from both parents.

362
Q

People who are (hetero/homo)zygous have sickle cell disease.

A

Homozygous

363
Q

People with sickle cell TRAIT only carry the disease, they DO NOT have symptoms. (T/F)

A

True-usually it has occurred that in times of SEVERE stress, the TRAIT does cause some symptoms but not usually.

364
Q

What are the #1 and #2 causes of sickle

cell crisis?

A

Hypoxia, dehydration

365
Q

The most common type of crisis that

occurs is a ______-______ crisis.

A

Vaso-occlusive criss

366
Q

In vaso-occlusive crisis the vessels become

occluded with ______ ______.

A

Abnormal RBC’s

367
Q

The abnormal hemoglobin produced by people with sickle cell anemia is called Hgb ______.

A

Hgb S – it “sickles”

368
Q

What shape does Hgb S make the RBC’s?

A

Crescent-shaped

369
Q

What are the top 3 priorities in care of the client with sickle-cell crisis?

A

Oxygenation

Hydration

PAIN control

370
Q

What activity order will the client with sickle cell CRISIS have?

A

Bedrest

371
Q

Tylenol, Morphine, Demoral, Aspirin which is

NEVER given to a sickle-cell patient?

A

Aspirin-it can cause acidosis which makes the crisis and sickling worse

372
Q

At what age is death most likely in sickle cell anemia?

A

Young adult

373
Q

Sickle-cell anemia symptoms do not appear before

the age of ____ months due to the presence of _____ ______.

A

6 months , fetal hemoglobin

374
Q

Sickle cell anemia is most commonly seen in

blacks/whites

A

Blacks

375
Q

Should a child in sickle-cell crisis wear tight clothes?

A

No, it can occlude vessels even more.

376
Q

Spinal cord injuries are more common in males. (T/F)

A

True

377
Q

In what age range is spinal cord injury most common?

A

15-25

378
Q

The #1 goal in emergency treatment of spinal cord injury is…

A

Immobilization of the spine

379
Q

When halo traction is being used to immobilize the spinal cord the client is allowed to _______.

A

Ambulate

380
Q

When the patient with spinal cord injury is in tongs or

on a stryker frame or on a circoelectric bed they are on

A

Absolute bed rest

381
Q

The 2 most common surgeries used to treat a spinal cord injury are ____ and _____ _____.

A

Laminectomy and spinal fusion

382
Q

What is spinal shock?

A

It is a common occurrence in spinal cord injury in which the spinal cord swells above and below the level in injury

383
Q

When does spinal shock

occur?

A

Immediately or within 2 hours of injury

384
Q

How long does spinal shock

last?

A

5 days to 3 months

385
Q

When the spinal cordinjuryisat

level of _____ to _____ the patient will be a quadriplegic.

A

C1 to C8

386
Q

When the spinal cord injury is between _____
and
_____, there is permanent respiratory paralysis.

A

C1 and C4

387
Q

Can the patient with spinal cord injury at C7 level

have respiratory arrest?

A

Yes, because even thought his injury was below C4, spinal shock can lead to loss function above the level, however the will not be permanently ventilator dependent-he will breath on when once spinal shock goes away.

388
Q

Spinal cord injury in the
thoracic/lumbar regions result
in ___plegia.

A

Paraplegia

389
Q

Ifairway obstruction
occursatthe accident site and
you suspect spinal cord injury, what maneuver is used to open the airway?

A

Modified jaw thrust

390
Q

In spinal cord injury never

______ the neck.

A

I Move, hyperextend

391
Q

How should you change the position of the spinal cord

injury patient after he has an order to be up? Why?

A

Slowly, because of severe orthostatic hypotension (they use a tilt table)

392
Q
  1. For the patient with neurogenic bladder you should

straight catheterize every ____ hours.

A

6 hours

393
Q

The patient with spinal cord injury will have (flaccid/spastic) muscles.

A

Spastic

394
Q

Name 3 drugs used to treat spasms.

A

Valium

Baclofen

Dantrium

395
Q

What is automatic dysflexia or hyperreflexia?

A

A common complication of quadriplegics in response to a full bladder or bowel.

396
Q

What are the vital sign changes seen in autonomic dysreflexia?

A 
Sweating
Headache
Nausea &amp; vomiting
Gooseflesh
Severe HYPERtension
397
Q

What do you do first for the client experiencing autonomic dysreflexia?

A

Raise HOB

398
Q

What do you do second for the client experiencing autonomic dysreflexia?

A

Check the bladder, check the bowel

399
Q

Do you need to call the doctor for autonomic dysreflexia?

A

No, only call the doctor if draining the bladder & removing impaction does not work

400
Q

What is the #1 treatment for autonomic dysreflexia?

A

Drain the bladder, empty the bowel

401
Q

What is the purpose of restricting activity after spinal

tap?

A

To prevent headache due to CSF loss

402
Q

Should the client drink after a spinal tap?

A

Yes, encourage fluids to replace CSF

403
Q

Do you need an informed consent for a spinal tap?

A

Yes

404
Q

Should CSF contain blood?

A

No

405
Q

Does the client have to be

NPO before a spinal tap?

A

No

406
Q

What is the normal color of cerebrospinal fluid?

A

Clear, colorless

407
Q

Into what space is the needle
inserted during a spinal
tap?

A

Subarachnoid space

408
Q

Can the client turn side-to-side after a

spinal tap?

A

Yes

409
Q

In what position should the client

be during a spinal tap?

A

Lateral decubitus (on their side) position and knees to chest

410
Q

Identify the activity restriction

necessary after lumbar puncture?

A

Lie flat for 6 to 12 hours

411
Q

What are the 2 purposes of a

spinal tap?

A

To measure or relieve pressure and obtain a CSF sample

412
Q

Does the client have to be sedated

before a spinal tap?

A

No

413
Q

Antibiotic (Define)

A

A drug that destroys or inhibits growth of micro-organisms

414
Q

Asepsis (Define)

A

Absence of organisms causing disease

415
Q

Antiseptic (Define)

A

A substance used to destroy or inhibit the growth of pathogens but not necessarily their spores (in general SAFE TO USE ON PEOPLE)

416
Q

Disinfectant (Define)

A

A substance used to destroy pathogens but not necessarily their spores (in general not intended for use on persons)

417
Q

Bactericide (Define)

A

Substance capable of destroying micro-organisms but not necessarily their spores

418
Q

Bacteriostatic (Define)

A

Substance that prevents or inhibits the growth of micro-organisms

419
Q

Anaerobe (Define)

A

Micro-organisms that do not require free oxygen to live

420
Q

Aerobe (Define)

A

Micro-organisms requiring free oxygen to live

421
Q

Pathogen (Define)

A

Micro-organism that causes disease

422
Q

Clean technique

Define

A

Practices that help reduce the number & spread of micro-organisms (synonym for medical asepsis)

423
Q

Sterile (Define)

A

An item on which all micro-organism have been destroyed

424
Q

Coagulate (Define)

A

Process that thickens or congeals a substance

425
Q

Host (Define)

A

An animal or a person upon which or in which micro- organisms live.

426
Q

Portal of entry (Define)

A

Part of the body where organisms enter

427
Q

Contaminate (Define

A

To make something unclean or unsterile

428
Q

Surgical asepsis (Define)

A

Practices that render & keep objects & areas free from all micro-organisms (synonym for sterile techniques)

429
Q

Medical asepsis (Define)

A

Practices that help reduce the number & spread of micro- organisms (synonym for clean techniques).

430
Q

Spore (Define)

A

A cell produced by a micro- organism which develops into active micro-organisms under proper conditions.

431
Q

Which hand should hold the suction catheter?

Which
should hold the connecting tube?

A

The dominant, the non- dominant

432
Q

The nurse should use (medical/surgical)

asepsis during airway suction?

A

Surgical asepsis (sterile technique)

433
Q

What kind of lubricant should be used on the suction catheter?

A

Sterile water-soluble

434
Q

Should the suction be continuous or

intermittent?

A

Intermittent to prevent mucosal damage

435
Q

For how long should suction be applied

during any one entry of the catheter?

A

10 seconds

436
Q

How often should the nurse clear the tubing during suctioning?

A

After each pass/entry/removal

437
Q

Which way would you turn the client’s head to suction
the right mainstem bronchus?

The left mainstem bronchus?

A

To the left, to the right

438
Q

The best client position during airway suctioning is _______.

A

Semi-fowlers

439
Q

The suction should be delivered while

(inserting/removing) the catheter.

A

While removing the catheter

440
Q

What outcomes would indicate that suctioning was effective?

A

Clear even lung sounds, normal vital signs

441
Q

How often should the client’s airway be suctioned?

A

When it needs to be, for example moist lung sounds, tachycardia, restlessness (hypoxia), ineffective cough

442
Q

The unconscious client should assume what position

during suctioning?

A

Side-lying, facing nurse

443
Q

If not contraindicated, what action by the nurse, before suctioning, would most likely reduce hypoxia during suctioning?

A

Administer a few breaths at 100% oxygen before beginning.

444
Q

What solution should be used to clear the tubing

during suctioning?

A

Sterile saline

445
Q

With what size catheter should an adult’s airway be suctioned?

A

12 to 16 French

446
Q

How much suction should be used for an infant?

A

Less than 80 mm Hg

447
Q

How much suction should be used for a child?

A

80to100mmHg

448
Q

How much suction should be used for an adult?

A

120to150mmHg

449
Q

Doyouassessfor suicide potential
whenever a
patient makes any statement about wanting to die or kill self?

A

Yes, in fact whenever a patient makes a statement about wishing or wanting to die or kill self you must ALWAYS AND FIRST assess for suicide potential*-stop everything and assess for suicide patient (except CPR, of course

450
Q

Children are at _____ risk for suicide.

A

Low risk for suicide

451
Q 
Adolescents are (low/high) risk for
suicide.
A

High

452
Q

The use of pills makes the patient

(low/moderate/high) risk for suicide.

A

Moderate

453
Q

The patient who has NO definite plan is

(low/high) risk for suicide.

A

Low risk

454
Q

The use of _____, _______, and ______ to kill self,

make high risk suicide.

A

Guns, ropes, knives

455
Q

Who is at higher risk for suicide, a man or awoman?

A

Man

456
Q

Of: married, divorced, and

separated, which marital status is highest risk for suicide? Lowest risk of suicide?

A

Highest-separated then divorced Lowest-married

457
Q

The goal of action while the suicidal

patient is still off the phone is to get _______ person _______ the ______

A

Another person on the scene (it then immediately decreases risk) Remember: people who are alone are always high risk

458
Q

Once the patient is admitted for

attempted suicide should you ever discuss the attempt with them?

A

pt, focus on the present and future.

459
Q

-pathy

A

Disease, suffering

460
Q

-penia

A

Lack, deficiency of

461
Q

-sect

A

To cut

462
Q

-plast

A

Plastic surgery on a specified part

463
Q

-sclerosis

A

Hardening of a tissue by: inflammation, deposition of mineral salt; an infiltration of connective tissue fibers

464
Q

-centesis

A

A perforation or puncture

465
Q

-genic

A

Produce, originate, become

466
Q

-emia

A

Blood

467
Q

-otomy

A

Butting

468
Q

-pexy

A

Fixation of something

469
Q

-atresia

A

Condition of occlusion

470
Q

-desis

A

Binding, fusing

471
Q

-cele

A

Combining form meaning a tumor or swelling or a cavity

472
Q

-cis

A

Cut, kill

473
Q

-rhapy; -rrhapy

A

Joining in a seam, suturatio

474
Q

-scope; -scopy

A

Instrument for observation

475
Q

-osis

A

Indicates condition, process

476
Q

-oma

A

Tu mor

477
Q

-ostomy

A

Surgical opening

478
Q

-stasis

A

Stoppage

479
Q

-itis

A

I n flammation

480
Q

-ology

A

Study of; knowledge, science

481
Q

-lysis

A

Breaking down

482
Q

-ectomy

A

Surgical removal of

483
Q

-tripsy

A

Crushing of something by a surgical instrument

484
Q

-ase

A

Used in naming enzymes

485
Q

-gram; -graphy

A

Write; record

486
Q

Syphilis first infects the

A

Mucous membranes

487
Q

What are the stages of syphilis?

A

Primary, secondary, latent, late

488
Q

Syphilis is a fatal disease if untreated. (T/F)

A

True

489
Q

What organism causes syphilis?

A

Treponema palladium

490
Q

What is the lesion like in primary syphilis?

A

The chancre (pronounced shanker)

491
Q

The chancres of syphilis are

painful/painless

A

Painless

492
Q

Chancres disappear without treatment. (T/F)

A

True

493
Q

Late syphilis attacks which 3 body organs?

A

Liver, heart, brain

494
Q

What test CONFIRMS the presence of

syphilis?

A

Dark-field illumination of the treponema palladium

495
Q

What is the treatment of choice for syphilis?

A

Pencillin

496
Q

Why is penicillin administered with
Procaine?
With Probenecid?

A

Procaine makes the shot less painful; Probenecid blocks the excretion of penicillin

497
Q

Whatisthemost common sign of

neurosyphillis?

A

Ataxia (gait problems)

498
Q

What does TENS stand for? Hey

A

Transcutaneous electrical nerve stimu lator

499
Q

. Is it an invasive procedure?

A

No, the skin in never broken.

500
Q

Can TENS be used for acute or chronic pain?

A

Both

501
Q

TENS use is based upon the _______ _______ of pain relief.

A

Gate control

502
Q

TENS electrodes stimulate (Large/small) diameter fibers.

A

Large-this is the basis of gate control theory.

503
Q

TENS electrodes are placed into the ..

A

Skin

504
Q

Can TENS units be placed over an incision to

decrease incisional pain?

A

Never

505
Q

Patient with what other mechanic device in use cannot use

TENS?

A

Cardiac pacemaker

506
Q

How often should the patient be taught to change the TENS electrodes?

A

Every day

507
Q

How is a dorsal-column stimulator different than a TENS

unit?

A

Dorsal column stimulation electrodes are surgically implanted by the spinal cord; the patient has to undergo a laminectomy to place the DCS electr od es.

508
Q

In what group of clients is thoracentesis

contraindicated?

A

Uncooperative, bleeding disorders

509
Q

. What instruction is most important to give the client undergoing thoracentesis?

A

Don’t move or cough

510
Q

What is thoracentesis?

A

The pleural space is entered by puncture & fluid is drained by gravity into bottles-allows the lungs rto re-expand

511
Q

If a client has a cough, what should be done before

thoracentesis?

A

Give him a cough suppressant.

512
Q

Does thoracentesis require a signed

informed consent?

A

Yes, it invades a body cavity.

513
Q

Describe the position the client should assume during a thoracentesis?

A

Upright with arms & shoulders elevated, slighting leaning forward

514
Q

What is exopthalmos?

A

Bulging outward eyes

515
Q

To care for a patient with

exopthalmos the patient should wear _____ _____ and use _________ ________.

A

Dark sunglasses, artificial tears

516
Q

Radioactive iodine is given to hyperthyroid patients because it _______ ______ plus decreases production of ________ _______.

A

Destroys tissue, thyroid hormone

517
Q

The #1 problem with using Propylthiouracil is ____.

A

Agranulocytosis

518
Q

What do you teach to all patients on drugs which have granulocytosis as a side effect?

A

Report any sore throat immediately

519
Q

Lugols solution decreases the _________ of the thyroid gland.

A

Vascu lar ity

520
Q

Lugols solution should be given _____a ______ to prevent staining of the teeth.

A

Through a straw

521
Q

SSKI should be given with _____ ______ to decrease the

________

A

Fruit juices; bitter taste (SSKI-super saturated sollution of potassium iodide)

522
Q

Patients with either hypo or hyper thyroid can go into thyroid storm. (T/F)

A

True

523
Q

Give another name for thyroid storm

A

Thyrotoxicosis, thyroid crisis

524
Q

In thyrotoxicosis, the temperature ______; the heart rate ______ and the patient becomes __________.

A

Increases (106);
increases;
deliriou s/comatose

525
Q

What is the first thing a nurse does when thyroid storm occurs?

A

Give oxygen

526
Q

What is the 2nd thing a nurse does when thyroid crisis occurs?

A

Call MD, can pack in ice or use hypothermia blanket

527
Q

What are the side effects of thyroid replacement drugs?

A

Tachycardia, palpitations and other signs seen in hyperthyroidism

528
Q

Why is Lugols solution given pre- operatively thyroidectomy?

A

To decrease the vascularity of the gland & minimize blood loss

529
Q

After thyroidectomy you check for wound hemorrhage by…

A

Slipping your hand under the neck and shoulders.

530
Q

The #1 complication of thyroidectomy in the first 8 to 12 hours is __________.

A

Hemorrhage-or maybe airway

531
Q

When moving the fresh post- operative thyroidectomy patient you must take care to never _____

A

Move the neck

532
Q

Post-operatively thyroidectomy patients will have sand bags on either side of the ______.

A

Neck

533
Q

Why do you assess the post-operative

thyroidectomy patient’s voice for hoarseness periodically?

A

Because during surgery the surgeon may have nicked the recurrent laryngeal nerve. (This nerve is tested on the state boards!)

534
Q

Will the post-operative thyroidectomy patient be allowed to talk?

A

He is on the voice rest unless you are assessing his voice

535
Q

What positions should the post-operative

thyroidectomy patient be?

A

Semi-fowlers with neck supported in midline

536
Q

What3piecesof equipment must be in the room with thyroid storm?

A

Suction, tracheotomy set, oxygen

537
Q

What calcium imbalance is common in the post-op thyroidectomy patient?

A

Hypocalcemia-due to accidental removal of the parathyroids.

538
Q

When is hypocalcemia most likely to occur after thyroidectomy? Why?

A

The 2nd and 3rd post operative day-because it takes awhile for the level to drop.

539
Q

Hypocalcemia will cause (tetany/severe muscle weakness).

A

Tetany

540
Q

What drug is used to treat decreased

calcium?

A

Calcium gluconate

541
Q

What is Chvostek’s sign?

A

A sign of hypocalcemia, it is when you tap the cheek, the patient puffs out the cheeks. (CHvostek and CHeeks)

542
Q

What is Trousseau’s sign?

A

It is a sign or hypocalcemia-it is when you get a carpopedal spasm of the hand when you apply a blood pressure cuff to the lower arm.

543
Q

What is the earliest sign of hypocalcemia?

A

Tremors/tingling

544
Q

Should you palpate the thyroid of the

hyperthyroid patient after ectomy?

A

No, it the could send them into thyroid storm

545
Q

Can dental work send a hyperthyroid client into thyroid storm?

A

Yes, any stress can.

546
Q
  1. Give another name for TPN.
A

Hyperalimentation

547
Q

Hyperalimentation contains

hypertonic ___, ____ acids, ______, ______, and _____.

A

Glucose, amino acids, water, minerals, vitamins

548
Q

TPN can be safely given via a central

line. (T/F)

A

Yes, this is the preferred route.

549
Q

TPN can be safely infusedviaa

peripheral IV line. (T/F)

A

It can, but only for a very short period (48 to 72 hours maximum).

550
Q

If a TPN solution is running too slow
and is 2 hours behind
can you increase the rate 20%. (T/F)

A

No, never ever speed up the rate.

551
Q

If a TPN infusion runsintoofastit

creates a ____ osmolar imbalance.

A

Hyperosmolar-because of all the solu tes

552
Q

It is okay however toslowtherate

down if the client leaves the unit. (T/F)

A

False, never slow the rate down-it could cause hypoglycemia.

553
Q

What tests must the nurse perform

every 6 hours when apatientison TPN?

A

1 accu check, #2 urine glu cose/aceton e

554
Q

IV lipid emulsions can be given

central or peripheral. (T/F)

A

True

555
Q

Be certain to shake a lipid emulsion

before admininstration. (T/F)

A

False, never shake it, shaking damages the molecules.

556
Q

Into which port of a peripheral IV line can a lipid infusion be piggybacked?

A

The port closest to the insertion catheter site. More recently, lipids are included in the hyperalimentation bag & there is no separate administration of the lipids

557
Q

What is meant by tracheo-

esophageal malformation?

A

These are a group of congenital birth defects in which the esophagus and trachea are malformed.

558
Q

What are the 3 most common tracheo-esophageal malformations?

A

1) Esophageal atresia-EA,
2) tracheo-esophageal fistula-TEF
3) tracheo- esophageal fistula with esophageal astresia- TEF w/EA

559
Q

What is the defect called esophageal fistula?

A

An opening between the esophagus & trachea but the esophagus is connected to the stomach & trachea is connected to the lungs.

560
Q

Of: tracheo-esophageal fistula, esophageal atresia, and tracheo-esopheal astresia with fistula, which is the most common?

A

Tracheo-esophageal fistula with esophageal astresia

561
Q

Name-a blind end esophagus: the trachea is connected to the lungs.

A

Simple esophageal atresia

562
Q

Name-the trachea is connected to the lungs, the esophagus is connected to the stomach, but there is a hole connecting the trachea and the esophagus.

A

Tracheo-esophageal fistu la

563
Q

Name-a blind end esophagus, the trachea is connected to the lungs, and the trachea and esophagus are joined.

A

Tracheo-esophageal fistula with esophageal astresia

564
Q

. If an infant has tracheo- esophageal fistula with esophageal
atresia, what 3 signs will show up at first feeding?

A

Three C’s-coughing, choking, cyanosis

565
Q

In an infant chokes, coughs, or gets cyanotic during the first feeding what should the nurse do to ASSESS for tracheo-esophageal fistula with espophageal atresia?

A

Attempt to gently pass a catheter into the esophagus if you meet resistance STOP, there most probably is esophageal atresia.

566
Q

How is the diagnosis of tracheo-esophageal fistula with esophageal atresia confirmed?

A

X-ray with barium

567
Q

Prior to surgery for repair of tracheo-esophageal fistula with esophageal atresia, how is the infant fed?

A

They are NPO but fed by G-tube (gastronomy)

568
Q

Does a tracheo-esophageal fistula with esophageal atresia have to be repaired immediately?

A

No-can be maintained with G-tube feedings and suctioning until are old enough & stable enough to tolerate surgery.

569
Q

The #1 problem for infants with un-repaired tracheo- esophageal fistula with esophageal atresia is..

A

Aspiration, secondary problem in malnutrition.

570
Q

How do you meet the oral sucking needs of an infant with with un-repaired tracheo-esophageal fistula with esophageal atresia?

A

Use pacifiers, even though they don’t take anything orally, they should still be encouraged to suck.

571
Q

How should an infant with tracheo-esophageal fistula with esophageal atresia be positioned?

A

HOB up 30 degrees.

572
Q

Should you suction the blind esophageal pouch of esophageal atresia?

A

Yes, PRN, otherwise they may aspirate mucous

573
Q

What is the common cleaning solution used during tracheostomy care?

A

Hydrogen peroxide

574
Q

Cut the old trach ties (before/after) you have secured the new ties in place.

A

After

575
Q

Is it acceptable to scrub the inside of the tracheostomy cannula with a brush during tracheostomy care?

A

Yes, it is desirable

576
Q

What are the 2 major reasons for performing tracheostomy care?

A

To keep the airway patent, to keep the stoma site clean (decrease infection)

577
Q

Tie the ends of the trach ties in a (bow knot/double knot).

A

Only a double knot

578
Q

Trach care is performed by (clean/sterile) technique.

A

Sterile

579
Q

What must you do before performing trach care (besides wash your hands)?

A

Suction the airway

580
Q

A properly snug set of trach ties allows _______ finger(s) to be placed between the neck and ties.

A

One

581
Q

Both hands must be kept sterile throughout the entire trach care procedure. (T/F)

A

False, only the dominant hand remains sterile

582
Q

When trach suctioning and care is performed by the client at home, sterile technique must be followed. (T/F)

A

False, clean technique is adequate

583
Q

What is another name for trigeminial neuralgia?

A

Tic douloureux

584
Q

Which cranial nerve is affected by trigeminial neuralgia?

A

Cranial nerve 5

585
Q

What is the #1 symptom of trigeminial neuralgia?

A

Episodic, severe one- sided facial pain

586
Q

What drug treats trigeminial neuralgia?

A

Tegretol

587
Q

What triggers attacks of trigeminal neuralgia?

A

Breezes, cold or hot food s/flu id s, tooth brushing, chewing, touching the face, talking

588
Q

Is surgery done for trigeminal neuralgia?

A

Yes, nerve avulsion (destroying the nerve)

589
Q

What environmental modifications are necessary in care of the patient with trigeminial neuralgia?

A

Prevent drafts or temperature extreme.

590
Q

What dietary modifications are necessary in the care of a patient with trigeminal neuralgia?

A

Lukewarm, small frequent semi-solid food s

591
Q

After surgery for trigeminial neuralgia, the patient’s affected eye will be ______ and the patient should chew food on the _________ side.

A

Protected; unaffected

592
Q

What organism causes pulmonary TB?

A

Mycobacterium tuberculosis

593
Q

The mode of transmission of the mycobacterium

tubercuolsis organism is by _____ _____.

A

Droplet nuclei

594
Q

What living conditions predispose you to TB?

A

Crowded, poorly ventilated

595
Q

The incubation period of tuberculosis is…

A

4to8weeks

596
Q

What is the typical lung lesion in TB called?

A

A tubercle

597
Q

In TB, the appetite is ____; the client _______ weight and the temperature ________ in the _______

A

Decreased, loses, elevates, afternoon

598
Q

In TB, the appetite is ____; the client _______ weight and the temperature ________ in the _________.

A

Decreased, loses, elevates, afternoon

599
Q

What is a Mantoux test?

A

An intradermal skin test to screen for TB-called PPD

600
Q

When should a Mantoux test be read?

A

48 to 72 hours after test injection

601
Q

What qualifies as a positive Mantoux?

A

More than 10 mm induration (hardness), remember redness has nothing to do with the test being positive

602
Q

Name three drugs given to treat TB.

A

Isoniazid, Rifampin, Ethambutol

603
Q

How often and when during the day should Isoniazid,

Rifampin, and Ethambutol be given?

A

Every day, all together

604
Q

What is the #1 side effect of Isoniazid?

A

Peripheral neuritis-take B6 to prevent

605
Q

After how many weeks of drug therapy is the client considered NO LONGER contagious?

A

2to4weeks

606
Q

What isolation techniques are required for TB?

A

N-95 masks

607
Q

What test is most diagnostic for TB?

A

Sputum for acid-fact bacilla

608
Q

What does the sputum look like in TB?

A

Purulent (pus) or hemoptysis (blood)

609
Q

When should you obtain a sputum specimen for acid fast bacilli TB?

A

Early AM

Mark Klimek (14 decks)

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