Exam 2 Review Video & Practice Questions Flashcards
The physician has ordered a heparin bolus of 60 units/kg and a starting dose of 12 units/kg/hr for a patient. The patient weighs 176 pounds. What is the bolus dose for the patient?
4,800 units
1.) 176 lbs / 2.2 lbs = 80 kg
2.) 60 units x 80 kg = 4800 units
HEPARIN CALCULATIONS:
* How do you calculate a heparin bolus dose?
KNOW THIS - DR. T!!!!
1.) Convert lbs to kg
* 1 kg = 2.2 lbs
2.) Bolus dose (units/kg) X weight (kg) = units
EXAMPLE: Doctor orders Heparin bolus of 60 units/kg and a starting dose of 12/units/kg/hr. The patient is 176 pounds. What is the bolus dose?
1.) 176 lbs / 2.2 lbs = 80 kg
2.) 60 units/kg X 80 kg = 4,800 units
HEPARIN CALCULATIONS:
* How do you calculate mL of Heparin to give?
KNOW THIS!!! - Dr. T!!!!!
1.) Calculate units/mL of heparin in the vial
* Ex: 10,000 units / 10 mL = 1,000 units/mL
2.) Ordered amount / Amount on hand
EXAMPLE: Doctor orders a Heparin bolus of 60 units/kg and a starting dose of 12 units/kg/hr. The patient weighs 176 pounds. Now that you have determined the bolus dose based on the information above, the pharmacy has sent a 10,000 units / 10 mL vial of Heparin. How many mL of Heparin will you administer to the patient?
1.) 10,000 units / 10 mL = 1,000 units/mL
2.) Ordered / Amount on hand – 4,800 units / 1,000 units/mL = 4.8 mL
HEPARIN CALCULATIONS
* How do you calculate the Heparin infusion rate?
KNOW THIS!!! - Dr. T!!!
1.) Find the units / mL of Heparin that is on hand
2.) Calculate units per hour (multiply the patient’s weight (kg) by the starting dose (units / kg / hr))
3.) Find the mL per hour (Ordered / amount on hand)
EXAMPLE: A physician orders a Heparin bolus of 60 units/kg and a starting dose of 12 units/kg/hr. The patient weighs 176 pounds. The pharmacy delivers Heparin 25,000 units in 250 mL of D5W. What is the correct rate of infusion? (round to the nearest whole number)
Information we have from other calculations: 176 lbs / 2.2 lbs = 80 kg
1.) 25,000 units / 250 mL = 100 units/mL
2.) 80 kg x 12 units/kg/hr = 960 units/hr
3.) 960 units/hr / 100 units/mL = 9.6 mL/hr → nearest whole number = 10 mL/hr
Jane Harold, age 40, came to the ED with severe lower-left abdominal pain. The day before her admission, she felt nauseated & had abdominal distention, which she attributed to having no bowel movement for 4 days. Mrs. Harold has diverticulosis & stated that she only has a bowel movement twice a week. She often takes a laxative, which she had done the day before her ED visit. She had no results from the laxative, was still quiet nauseated, & had vomited one time. Her last menstrual period was 3 weeks ago. She is 165 cm tall and weighs 74 kg. She is currently lying on her back with her knees flexed. Her face is flushed, & she is quietly crying in obvious distress.
1.) What assessment findings will you prioritize as you begin to see Mrs. Harold?
2.) What laboratory studies would you like to see?
Jane Harold Clinical Reasoning Case – part 1
1.) Assessments to prioritize
* Vitals
* Abdominal Assessment
2.) Lab Studies to Obtain
* CBC: looks at WBC count to determine if there is an infectious process present
- BMP: shows electrolytes, as well as BUN & Creatinine to help determine Fluid Volume Deficit
- UA: LLQ pain can indicate kidney or urinary tract infection – UA helps us rule out kidney or UTI
- HCG: Used to rule out pregnancy or ectopic pregnancy
Jane Harold, age 40, came to the ED with severe lower-left abdominal pain. The day before her admission she felt nauseated & had abdominal distention, which she attributed to having no bowel movement for 4 days. Mrs. Harold has diverticulosis & stated that she only has a bowel movement twice a week. She often takes a laxative, which she had taken the day before her ED visit. SHe had no results from the laxative, was still quite nauseated, & had vomited once. Her last mentstrual period was 3 weeks ago. She is 165 cm tall & weighs 74 kg.
Vitals:
* BP: 96/50 mmHg lying & 84/46 mmHG standing
* HR: 112 bpm lying & 128 bpm standing
* RR: 28 breaths per minute
* Temperature: 38.7 degrees C
Abdominal Assessment:
* Bowel sounds absent.
* Abdomen is slightly distended, firm, & rigid.
* Rebound tenderness over the LLQ, although entire abdomen is tender to light palpitation.
Other Assessment Findings:
* Lung sounds clear to auscultation (CTA)
* Respiratory Rate is shallow
Lab Studies
CBC:
* WBC = 19,000/mm
* Hbg = 12.6 g/dL
BMP:
* Na+ = 148 mmol/L
* K+ = 3.6 mmol/L
* Creatinine = 1.6 mg/dL
* BUN = 50 mg/dL
UA = normal
HCG = negative
What do you anticipate as the immediate treatment for Mrs. Harold?
Jane Harold Clinical Reasoning – Part 2
Concerned for PERITONITIS
* Peritonitis =inflammation of the abdominal wall lining / peritoneum
…
↑ WBC count
* normal WBC = 4,500 - 11,000/mm)
borderline low K+
* normal K+ = 3.5 - 5.0 mmol/L
↑ BUN
* normal BUN = 8 - 20 mg/dL
…
How to determine it’s PERITONITIS
* Hx of diverticulosis
* Local or diffuse abdominal pain, fever, ↑ WBCs, orthostatic BP changes, N/V, inability to have BM, ↑ HR
With PERITONITIS, movement through the GI tract slows down to try & contain the organism that’s causing the peritonitis
Jane Harold, age 40, came to the ED with severe lower-left abdominal pain. The day before her admission she felt nauseated & had abdominal distention, which she attributed to having no bowel movement for 4 days. Mrs. Harold has diverticulosis & stated that she only has a bowel movement twice a week. She often takes a laxative, which she had taken the day before her ED visit. SHe had no results from the laxative, was still quite nauseated, & had vomited once. Her last mentstrual period was 3 weeks ago. She is 165 cm tall & weighs 74 kg.
Vitals:
* BP: 96/50 mmHg lying & 84/46 mmHG standing
* HR: 112 bpm lying & 128 bpm standing
* RR: 28 breaths per minute
* Temperature: 38.7 degrees C
Abdominal Assessment:
* Bowel sounds absent.
* Abdomen is slightly distended, firm, & rigid.
* Rebound tenderness over the LLQ, although entire abdomen is tender to light palpitation.
Other Assessment Findings:
* Lung sounds clear to auscultation (CTA)
* Respiratory Rate is shallow
Lab Studies
CBC:
* WBC = 19,000/mm
* Hbg = 12.6 g/dL
BMP:
* Na+ = 148 mmol/L
* K+ = 3.6 mmol/L
* Creatinine = 1.6 mg/dL
* BUN = 50 mg/dL
UA = normal
HCG = negative
Based on these findings & the suspected diagnosis of peritonitis, what interventions should the nurse anticipate?
Jane Harold Clinical Reasoning – Part 3
Large bore IV
Isotonic Solution (Lactated Ringers)
* due to volume depletion
* Given at a high rate (100 - 150 mL/hr)
NG Tube
* to decompress stomach, relieve pain & nausea
- Foley (for accurate I & Os)
- Abdominal Ultrasound or FAST Exam
- Chest X-Ray or abdominal flat plate to look for free air
- morphine for pain (cautiously)
Antibiotics
A nurse is caring for a patient with constipation whose primary care provider has recommended senna (Senokot) for management of this condition. The nurse should provide which of the following education points?
a.) Limit your fluid intake temporarily so you do not get diarrhea.
b.) Avoid taking the drug on a long-term basis.
c.) Make sure to take a multivitamin with each dose.
d.) Take this on an empty stomach to ensure maximum effect.
b.) Avoid taking the drug on a long-term basis
Stool softeners should be avoided on a long-term basis. Methods to improve constipation include ↑ fiber intake, water, & mobility.
How do you calculate the RATE OF INFUSION
KNOW THIS!!!!!!!!!!!!!!!!!
(Volume / time to infuse) x 60
A 76-year-old post-op patient is admitted to the unit from the PACU following gallbladder removal. The physician ordered zantac 50 mg IVPB every 6 hours. The pharmacy sends zantac 50 mg in 50 mL of D5W to infuse over 30 minutes. What is the correct volume to be infused & rate of infusion?
VTBI = 50 mL
Rate = 100 mL
Rate = (Volume / Time to infuse) x 60
Rate = (50 mL / 30 min) x 60 = 100 mL
Vomiting results in which of the following acid-base disturbances?
a.) Metabolic alkalosis
b.) Metabolic acidosis
c.) Respiratory alkalosis
d.) Respiratory acidosis
a.) Metabolic alkalosis
… ↑ pH & ↑ HCO3
* pH < 7.45
* HCO3 < 26
Vomiting = loss of acid (HCl) from the stomach
* loss of potassium & chlorides
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?
a.) Hepatitis B is transmitted primarily by the oral-fecal route.
b.) Hepatitis A is frequently spread by sexual contact.
c.) Hepatitis C increases a person’s risk of liver cancer.
d.) Infection with Hepatitis G is similar to Hepatitis A.
c.) Hepatitis C increases a person’s risk of liver cancer.
Hep A = fecal-oral
Hep B = blood borne & sexual contact
A nurse educator is teaching a group of recent nursing graduates about their occupational risk for contracting Hepatitis B. What preventative measures should their educator promote? (Select all that apply)
a.) Immunization
b.) Use of standard precautions
c.) Consumption of a vitamin rich diet
d.) Annual vitamin K injections
e.) Annual vitamin B12 injections
a.) Immunization
b.) Use of standard precautions
A patient has been diagnosed with AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate for this patient?
a.) Position the patient in a high Fowler’s position whenever possible.
b.) Temporarily eliminate animal protein in the patient’s diet.
c.) Make sure the patient eats at least 2 servings of raw fruit a day.
d.) Obtain a stool culture to identify the possible pathogens.
d.) Obtain a stool culture to identify the possible pathogens
Scott Mitchell, age 44, recently arrived to the ED. The triage report staes he has been seen as outpatient 1 day ago because of epigastric pain after heavy EtOH consumption at a recent work party. He stated he had been hung over & nauseated for 48 hours & has had severe epigastric pain ever since. He has returned to the ED due to nausea, 2 episodes of vomiting “large amounts of dark brown liquid”, & complaints of severe weakness. He also experienced dizziness when he stood or sat up abruptly. Vital signs at 6 PM are as follows:
- BP: 96/60 lying & 84/50 standing
- HR: 102 beats per minute
- RR: 20 breaths per minute
- Temp: 37.9 C
1.) What is the priority problem?
2.) What diagnostics would assist you in confirming this diagnosis?
3.) What interventions should the nurse expect?
Scott Mitchell Clinical Reasoning Part 1
PRIORITY PROBLEMS:
* GI bleed (dark colored vomit)
* Gastritis (heavy EtOH use)
DIAGNOSTICS:
* CBC, BMP, Cross Type, PT, PTT, INR
* Large Bore IV w/ isotonic solution (due to fluid volume deficit)
* NPO
* Ultrasound or FAST Exam
* NG Tube
* EGD (MOST CRITICAL)
ISSUE = ACUTE GASTRITIS related to EtOH consumption
Key Signs & Symptoms:
* Heavy EtOH consumption
* Severe epigastric pain
* Nausea x48 hours
* 2 episodes of vomiting (large amounts of dark brown liquid)
* Weakness, dizziness
* Orthostatic Hypotension
* ↑ HR
* ↑ RR
For patients with uncomplicated hypertension & no specific indications for another medication, what is the initial medication?
a.) Thiazide diuretics
b.) Vasodilators
c.) Calcium Channel Blockers
d.) ACE Inhibitors
a.) Thiazide Diuretics
The nurse is preparing an education plan for a patient newly diagnosed with hypertension. What should be included in the education plan?
a.) Engage in regular aerobic physical activity, such as a brisk walk (at least 30 minutes per day most days of the week)
b.) Eliminate alcoholic beverages from the diet
c.) Reduce sodium intake to no more than 200 mmol/day
d.) Maintain a normal body weight with a BMI between 18 and 30 kg/m2
a.) Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week)
- EtOH can be consumed in moderation
- Sodium should be no more than 100 mmol/day
- BMI should be between 18.5 - 24.9 kg/m2
An 84-year-old male patient who is newly diagnosed with hypertension has just been started on a beta-blocker. Your nursing education for the patient should include which of the following?
a.) Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker.
b.) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage.
c.) Use of strategies to prevent falls from postural hypotension.
d.) Limiting exercise to avoid injury that can be caused by increased intracranial pressure.
c.) Use strategies to prevent falls from postural hypotension
The patient diagnosed with diabetes mellitus type 2 is scheduled for bowel resection in the morning. Which medication should the nurse question administering to the patient?
a.) ticlopidine (Ticlid) a platelet aggregate inhibitor
b.) ticarcillin (Timetin), an extended spectrum antibiotic
c.) pioglitazone (Actos), a thiazolidinedione
d.) bisacodyl (Ducolax), a cathartic laxative
a.) ticlopidine (Ticlid), a platelet aggregate
- **ticarcillin (Timentin) – **antibotic should be given before surgery, especially bowel surgery
- pioglitazone (Actos) – Type 2 diabetes drug which should sitll be given to the patient before surgery
- bisacodyl (Ducolax) – bowel needs to be empty prior to bowel surgery
NITROGLYCERIN CALCULATIONS:
* How to calculate rate in mL/hr
KNOW THIS!!!!!
1.) Convert mg to mcg
* ____ mg X 1,000 = mcg
2.) Ordered / On Hand
* multiply by 60 if rate has to be converted from minutes to hours
A doctor ordered nitroglycerin (50 mg in 250 mL D5W) to run at 15 mcg/min. What is the nitrogrlycerin rate in mL per hour?
1.) 50 mg x 1,000 = 50,000 mcg in 250 mL D5W
* 50,000 mcg in 250 mL D5W → 200 mcg/mL
2.) (15 mcg x 60 min) / 200 mcg/mL = 4.5 mL
A nurse is caring for an older patient who has been experiencing severe watery diarrhea. When reviewing the patient’s most recent lab tests, the nurse should prioritize which of the following?
a.) Creatinine level
b.) Potassium level
c.) WBC level
d.) Hemoglobin level
b.) Potassium
An older adult is newly diagnosed with primary hypertension & has just been started on a beta-blocker. The nurse’s health education should include which of the following?
a.) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage.
b.) Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker.
c.) Use of strategies to prevent falls stemming from postural hypotension.
d.) Limiting exercise to avoid injury that can be caused by increased intracranial pressure
c.) Use of strategies to prevent falls stemming from postural hypotension
The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic & beta-blocker. Which of the following should the nurse integrate into the management of the patient’s hypertension?
a.) Carefully assess for weight loss because of impaired kidney function resulting from normal aging.
b.) Ensure that th epatient receives a larger initial dose of antihypertensive medication due to impaired absorption.
c.) Recognize that an older patient is less likely to adhere to his or her medication regimen than a younger patient.
d.) Pay close attention to the hydration status because of increased sensitivity to extracellular volume depletion.
d.) Pay close attention to hydration status becasue of increased sensitivity to extracellular volume depletion.
The nurse is caring for a 72-year-old patient who is in cardiac rehabilitation following heart surgery. The patient has been walking on a regular basis for about a week & walks for 15 minutes 3 times a day. The patient states that he is having a cramp-like pain in the legs every time he walks and that the pain gets “better when I rest”. The patient’s care plan should address what problem?
a.) Acute pain related to intermittent claudication.
b.) Acute pain related to vasculitis.
c.) Decreased mobility related to venous insufficiency.
d.) Decreased mobility related to VTE.
a.) Acute pain related to intermittent claudication.
Intermittent claudication presents as a muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity & relieved by rest.
A nurse is caring for a patient who is post-op from a neck dissection. What would be the most appropriate action to enhance the patient’s appetite?
a.) Avoid offering food unless the patient initiates it.
b.) Encourage the family to bring in the patient’s favored foods.
c.) Limit visitors at meal time so that the patient is not distracted.
d.) Provide thorough oral care immediately after the patient eats.
b.) Encourage the family to bring in the patient’s favored foods.
