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NUR 215 - Fundamentals > Exam 4 Study Guide: Q > Flashcards

Exam 4 Study Guide: Q Flashcards

1
Q

WHICH DIAGNOSTIC TEST/EXAM WOULD BEST MEASURE A CLIENT’S LEVEL OF HYPOXEMIA?
 CHEST X-RAY
 PULSE OXIMETER READING
 ARTERIAL BLOOD GAS (ABG) SAMPLING
 PEAK EXPIRATORY FLOW RATE

A

Arterial Blood Gas (ABG) Sampling

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2
Q
  • exchange of o2 and co2
  • takes place inside of the lungs
A

Respiration

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3
Q
  • movement of air in and out of lungs
  • what is counted when getting RR
A

Ventilation

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4
Q

T or F:
the term “Kussmaul” refers to a high-pitched, harsh, crowing inspiratory sound that occurs due to partial obstruction of the library

A

False:
- the term for this sound of respiratory distress is “stridor”
- Kussmaul respirations are slow and deep, seen in DKA

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5
Q
  • slow and deep
  • seen in DKA
A

Kussmaul Breathing Patterns

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6
Q
  • high-pitched
  • harsh
  • crowing inspiratory sound that occurs due to partial obstruction of t he larynx
A

Stridor

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7
Q

gradual increase in depth and respiration followed by decrease in depth and respiration and then apnea

A

Cheyne Stokes

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8
Q

what conditions are associated with the sputum color:
white/clear

A

viral
- usually with common cold

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9
Q

what conditions are associated with the sputum color:
yellow/green

A

bacterial

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10
Q

what conditions are associated with the sputum color:
black

A

smoke or dust inhalation

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11
Q

what conditions are associated with the sputum color:
rust

A
  • pneumonia
  • TB
  • Blood: hemoptysis
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12
Q

coughing up blood

A

hemoptysis

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13
Q

what conditions are associated with the sputum color:
pink and frothy

A

edema

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14
Q

what conditions are associated with the sputum with:
foul odor

A

bacterial infection

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15
Q

low blood oxygen level

A

hypoxemia

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16
Q

most direct way in which the level of oxygen in the blood can be measured

A

arterial blood gas sampling

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17
Q

A NURSE IS TEACHING HER CLIENT HOW TO OBTAIN A SPUTUM SPECIMEN. IN ORDER TO PROVIDE SAFE AND EFFECTIVE CARE, THE NURSE INSTRUCTS THE PATIENT THAT THE FOLLOWING ACTION WILL FACILITATE OBTAINING THE SPECIMEN?

 LIMITING FLUID INTAKE
 HAVING THE CLIENT TAKE DEEP BREATHS
 ASKING THE CLIENT TO SPIT INTO A COLLECTION
CONTAINER
 SUGGESTING TO THE CLIENT THAT THE SPECIMEN BE
OBTAINED AFTER EATING

A

having the client take deep breaths

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18
Q

Steps to obtain sputum specimen:

A

TO OBTAIN A SPUTUM SPECIMENT, THE CLIENT SHOULD:
 RINSE THE MOUTH TO REDUCE CONTAMINATION
 BREATHE DEEPLY
 THEN COUGH INTO A SPUTUM SPECIMEN CONTAINER
 THE CLIENT SHOULD BE ENCOURAGED TO COUGH AND
NOT SPIT TO OBTAIN SPUTUM
 SPUTUM CAN BE THINNED BY FLUIDS OR BY RESPIRATORY
TREATMENT SUCH AS INHALATION OF NEBULIZED
SALINE OR WATER
 THE OPTIMAL TIME TO OBTAIN A SPECIMEN IS ON ARISING
IN THE MORNING

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19
Q

IN CARING FOR A CLIENT WITH A TRACHEOSTOMY, THE NURSE WOULD GIVE PRIORITY TO THE NURSING DIAGNOSIS OF:
 RISK FOR INEFFECTIVE AIRWAY CLEARANCE
 ANXIETY RELATED TO SUCTIONING
 SOCIAL ISOLATION RELATED TO ALTERED BODY IMAGE
 IMPAIRED TISSUE INTEGRITY

A

risk for ineffective airway clearance

  • WHILE OTHER DIAGNOSES MAY BE APPLICABLE, MAINTAINING A PATENT AIRWAY BY TENDING TO EXCESSIVE SECRETIONS IS A PRIORITY. AIRWAY IS ALWAYS FIRST!!
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20
Q

What are the 3 types of artificial airways?

A
  • nasopharyngeal tube
  • oropharyngeal tube
  • tracheostomy tube
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21
Q

artificial airway:
- nose
- protect airway

A

Nasopharyngeal Tube

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22
Q

artificial airway:
- mouth
- protect airway

A

Oropharyngeal Tube

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23
Q

artificial airway:
- trachea site
- patency with suctioning and oral care importance

A

Tracheostomy Tube

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24
Q

What are the categories of stress?

A

distress
eustress
developmental
situational
time
anticipatory
physiological
psychological

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25
Q

can threaten health

ex: financial worries

A

distress

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26
Q

good stress

ex: passionate kiss

A

eustress

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27
Q

predictable and associated with life stages

ex:
college graduation
external death of family member
excess heat
internal
disease
anxiety

A

developmental

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28
Q

random

ex: unpredictable (hurricane/accident)

A

situational

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29
Q

unable to meet demands (multiple demands)

ex: missed opportunity

A

time

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30
Q

worried about the future

ex: upcoming exam

A

anticipatory

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31
Q

affects the body

ex: structure/function (diseases, mobility problems)

A

physiological

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32
Q

arise from life events

ex:
work pressure
family arguments
stressors throughout the lifespan

A

psychological

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33
Q

THE HOSPITALIZED CLIENT STATES, “I NEED TO KNOW WHEN IM GOING TO BE DISCHARGED. IM SO UPSET AND WORRIED THAT IM MISSING WORK.” THE NURSE KNOWS

 THIS IS AN EXAMPLE OF:“EUSTRESS” AND NO
INTERVENTION IS NECESSARY.
 THIS IS AN EXAMPLE OF PSYCHOLOGICAL STRESS AND THE
CLIENT SHOULD BE PLACED ON ANTIDEPRESSANTS.
 THIS IS AN EXAMPLE OF DEVELOPMENTAL STRESS AND
THE CLIENT SHOULD TALK TO SOMEONE HIS OWN AGE.
 THIS IS AN EXAMPLE OF DISTRESS AND COULD AFFECT THE
CLIENTS HEALTH STATUS

A

THIS IS AN EXAMPLE OF DISTRESS AND COULD AFFECT THE CLIENTS HEALTH STATUS

  • THIS CLIENT’S STATEMENT INDICATES THAT HE IS
    EXPERIENCING DISTRESS
  • EVEN THOUGH IT COULD BE TERMED PSYCHOLOGICAL
    STRESS
  • IT WOULD BE INAPPROPRIATE TO SIMPLY PLACE THE CLIENT
    ON ANTIDEPRESSANT THERAPY WITHOUT GATHERING
    MORE DATA
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34
Q

T or F:
a client who is taking the drug atenolol (tenormin) may not exhibit the expected rise in blood pressure and pulse during the alarm stage of GAS (general adaptation s yndrome)

A

True:

  • atenolol is classified as a beta-blocking agent
  • by preventing epinephrine from binding to beta receptors, this drug would “mask” or lessen the cardiovascular response during the alarm stage
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35
Q

List 4 things to help a patient cope with stress

A

reflexology
massage
dance
sports
journal writing
aromatherapy
talk therapy
friends
chiropractic adjustments
touch therapy:
- - meditation
- - biofeedback
- - reiki
- - exercise
- - humor
- - art therapy
- - music
- - spirituality
- - acupuncture

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36
Q

What is “GAS”?

A

General Adaptation Syndrome

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37
Q

what are the stages of “GAS”?

A

alarm
resistance
exhaustion/recovery

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38
Q

What are psychological defense mechanisms?

A

avoidance
compensation
conversion
denial
displacement
dissociation
identification
intellectualization
minimization
projection
rationalization
reaction formation
regression
repression
restitution
sublimation

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39
Q

what are somatoform disorders?

A

physical symptoms with no known cause

  • if a person is confronted - leads to extreme anxiety ex-multiple personalities
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40
Q

what are 4 types of somotoform disorders?

A
  • hypochondriasis
  • somatization
  • somatoform pain disorder
  • malingering
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41
Q

preoccupied with disease
they are ill or will become ill
can even imagine symptoms
have a fear they will become worse or become incurable

A

hypochondriasis

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42
Q

expressed in physical S/S
anxiety and emotional turmoil are expressed
loss of physical function
pain that changes frequently
symptoms that are exaggerated

A

somatization

43
Q

chronic pain
emotional pain that manifests physically
source of pain cannot be discovered or exaggerated

A

somatoform pain disorder

44
Q

conscious effort to escape mentally
calling in sick to work just because you dont want to go

A

malingering

45
Q

THE NURSE SHOULD ASSESS EVERY CLIENT TO DETERMINE IF STRESS REDUCTION INTERVENTIONS SHOULD BE PART OF THE PLAN OF CARE. THE RATIONALE FOR THIS ACTION IS THAT:

 THERE ARE MORE PERSONS EXPERIENCING MENTAL
ILLNESS NOW THAN IN THE PAST
 LIFE IS SO MUCH MORE STRESSFUL THAN IT HAS EVER
BEEN
 THE OCCURRENCE OF STRESS IN CLIENTS IS
UNPREDICTABLE
 CLIENTS OFTEN DEVELOP MALADAPTIVE COPING
STRATEGIES
 ALL OF THE ABOVE

A

All of the Above:

  • the nurse recognizes that all clients respond differently to healthcare interventions
  • therefore, it is important to assess every client’s level of stress to determine if interventions are required
46
Q

light sleep and slowing brain and body processes are associated with which stage of NREM sleep?

  • NREM I
  • NREM II
  • NREM III
  • REM
A

NREM II

  • these are characteristics of a person in stage II of NREM sleep
47
Q
  1. THE NURSE IS CARING FOR A HOSPITALIZED CLIENT WHO NORMALLY WORKS THE NIGHT SHIFT AT HIS JOB. THE CLIENT STATES, “I DON’T KNOW WHAT IS WRONG WITH ME. I HAVE BEEN NAPPING ALL DAY AND CANT SEEM TO THINK CLEARLY.” THE NURSES BEST RESPONSE IS:

 “YOU ARE SLEEP DEPRIVED, BUT THAT WILL RESOLVE IN A FEW DAYS”
 “YOU ARE EXPERIENCING HYPERSOMNIA, SO IT WILL BE IMPORTANT FOR YOU TO WALK IN THE HALL MORE OFTEN”
 “THERE HAS BEEN A DISRUPTION INF YOUR CIRCADIAN RHYTHM. WHAT CAN I DO TO HELP YOU SLEEP BETTER AT NIGHT?”
 “I WILL NOTIFY THE DOCTOR AND ASK HIM TO PRESCRIBE A HYPNOTIC MEDICATION TO HELP YOU SLEEP.”

A

“THERE HAS BEEN A DISRUPTION INF YOUR CIRCADIAN RHYTHM. WHAT CAN I DO TO HELP YOU SLEEP BETTER AT NIGHT?”

  • THE DATA SUGGEST THAT THE PATIENT IS USED TO BEING AWAKE AT NIGHT AND SLEEPING DURING THE DAY
  • THE HOSPITAL ROUTINE HAS DISRUPTED THIS NORMAL PATTERN
48
Q

for which sleep disorder would the nurse most likely need to include safety measures in the client’s plan of care?

snoring
enuresis
narcolepsy
hypersomnia

A

narcolepsy

  • can occur suddenly during the daytime hours when a person is involved in any type of activity
  • this could put the person at risk for harm depending on the activity, in which he or she is engaged
49
Q

nursing actions include providing oxygen at the ______________, that will correct the hypoxia.

A

Lowest Liter Flow

50
Q

what is the flow rate and FiO2 of the nasal canula?

A

1 - 6 L/min
delivers FiO2 24% - 44% per L
> 4 L/min humidify

51
Q

what is the flow rate and FiO2 of the simple mask?

A

6 - 12 L/min
delivers FiO2 35% - 50%
6 L causes rebreathing CO2

52
Q

what is the flow rate and FiO2 of the non-rebreather (NRB)?

A

10 - 15 L/min
delivers FiO2 80% - 95%
must keep bag inflated
elevate bed into high fowlers position
can get oxygen toxicity
- cant use longer than 24 hours

53
Q

what is the flow rate and FiO2 of the venturi mask?

A

4 - 12 L/min
delivers most precise FiO2 24 - 50% with attachments
best for patient with COPD or Chronic Lung Disease

54
Q

what is one way to prevent post-operative pneumonia?

A

us the incentive spirometer to promote maximum lung expansion

55
Q

what is Cheyne-Stokes respiratory pattern?

A
  • a respiratory pattern that progressively increases and then decreases in depth
  • followed by a period of apnea
56
Q

what are early signs of hypoxia?

A

tachypnea
tachycardia
hypertension
restlessness
accessory muscles usage
pale skin and mucous membranes
anxiety
confusion

57
Q

what are late signs of hypoxia?

A

stupor
cyanosis
bradypnea
bradycardia
hypotension
cardiac dysrhythmias
(extreme) restlessness

58
Q

what should be your first action when a patient is experiencing respiratory distress?

A

least invasive first

  • place in high fowlers (60 - 90*) which is more effective than semi fowlers, to promote lung expansion and maximize ventilation
59
Q

what should be your first action if a patients SpO2 is in the 70s?

A

sit them up in high fowlers
use a nonrebreather
notify the provider of the change

60
Q

what are symptoms for oxygen toxicity?

A

change in loc
restlessness
non-productive dry cough

61
Q

what is the treatment for oxygen toxicity?

A

lower FiO2 % while maintaining SpO2

62
Q

what is chest physiotherapy?

A

a set of techniques that loosen respiratory secretions and move them into the central airways where coughing and suctioning can remove them

63
Q

what are important points of home oxygen therapy?

A

 OXYGEN THERAPY SYSTEM SHOULD BE KEPT 6 – 10 FEET AWAY FROM A HEAT SOURCE
 NO SMOKING
 WOOL FABRIC CAN GENERATE STATIC ELECTRICITY
 TEACHING CLIENT ABOUT HOW TO USE/CHECK OXYGEN TANK AND REGULAR DELIVERY SERVICE
 THROW RUGS ARE A FALL HAZARD
 TUBING CAN BE DISTRACTING AND BE A HIGH FALL RISK
 CHECK EARS FOR SKIN BREAKDOWN
 DO NOT ADJUST OXYGEN WITHOUT CALLING PROVIDER
 CHECK THE EQUIPMENT DAILY
 OXYGEN SHOULD BE STORED VERTICALLY

64
Q

what will occur after smoking cessation?

A
  • reverse the negative effects of smoking
  • BP and HR decrease
  • cough, circulation and SOB will improve
65
Q

what vaccine is recommended for COPD patients?

A

pneumococcal vaccine

66
Q

what age related changes occur with the lungs?

A
  • less lung compliance
  • decreased immune response
  • less alveolar inflation
  • decreased elasticity
  • decreased ability to expand the lungs
67
Q
  • more responsibility and roles that are manageable
  • common for a student who must work and care for family
A

role overload

68
Q

frustration and anxiety when a person feels inadequate for assuming a role

A

role strain

69
Q

uncertainty about what is expected
- i.e. starting a new job

A

role ambiguity

70
Q

effective
- making healthy choices to reduce negative effects of stress

    • exercising to relieve tension, hobbies, seeking support or advice
A

adaptive coping

71
Q

ineffective
- doesnt promote adaptation

A

maladaptive coping

72
Q

what is unhealthful coping?

A

overeating
working too much
oversleeping
substance abuse

73
Q

what occurs in the alarm stage of “GAS”?

A

fight or flight
- bronchioles dilate to increase oxygen available to muscle, brain, and cardiac cells

    • peristalsis decreases
    • HR and contractility increase
    • increased blood flow to skeletal muscles
    • stimulation sympathetic nervous system (SNS)
74
Q

what occurs in the resistance stage of “GAS”?

A

body tries to stabilize with coping mechanisms

exhaustion occurs when coping is ineffective resulting in injury, illness, or death

when adaptation is successful
- - client enters recovery

75
Q

what occurs in the exhaustion stage of “GAS”?

A

if stress continues and adaptive mechanisms become ineffective, a person enters the final stage, exhaustion

76
Q

physiological responses that occurs in the exhaustion stage of “GAS”

A

vasodilation
decreased BP
increased HR and RR

77
Q

exhaustion usually ends in:

A

injury
illness
or death

78
Q

what responses occur with the LAS inflammatory response?

A

vascular response
cellular response
exudate formation and then healing
begins with a reflex response

79
Q

what are the risks of chronic stress?

A

decreased immune response
HTN
stroke
constipation
headaches
memory issues
depleted energy

80
Q

what changes occur in the body with the stress response?

A

reduces immune cells ability to differentiate between self and non-self

81
Q

stress weakens immune system leading to autoimmune illnesses such as:

A

rheumatoid arthritis
allergies
infection

also causes:
vasoconstriction
high blood glucose
cortisol levels

82
Q

what are psychosocial stressors?

A

external stressors that arise from:
- work
- family dynamics
- living situation
- social relationships
- financial strain

83
Q

what is the term for good healthy stress?

A

eustress

84
Q

what are situational stressors?

A

unpredictable and can include:
- automobile accident
- a natural disaster
- job conflict
- or an illness

85
Q

what is developmental stress?

A
  • arises from normal life changes
  • can be predicted at various stages of life
  • going to, losing a parent, having a baby or getting married
86
Q

what are examples of healthy coping mechanisms?

A

exercise
journaling
yoga
meditation
spending time with family
eating a balanced healthy diet
doing a hobby
taking vacation days or mental health days

87
Q

what physiological changes occur during relaxation?

A
  • decrease in BP, HR, RR, and oxygen consumption
  • meditation is proven to promote wellness and relaxation
88
Q

what are 3 NREM stages?

A

NREM I
NREM II
NREM III

89
Q

What occurs during NREM I?

A

light theta
- transition between wake and sleep
- lasts about 5 - 10 minutes
- light sleep
- - - can be awakened easily
- relaxed but aware of surroundings

90
Q

What occurs during NREM II?

A

50% sleep
- body temperature drops and HR slows
- brain begins to produce sleep spindles
- lasts approximately 20 minutes

91
Q

What occurs during NREM III?

A

deep
- delta 20 - 25% of sleep
- muscles relax
- PARASYMPATHETIC nervous system predominates BP and RR drop
- deepest sleep occurs
- - - difficult to rouse
- - - if awakened may be confused
- some dreams occur but dreams are less vivid
- very important for healing, growth, and tissues renewal

92
Q

what occurs during the REM stage of sleep?

A

dreams 20 - 25% of sleep
- brain becomes more active
- body becomes relaxed and immobilized
- dreams occur
- eyes more rapidly
- essential for mental and emotional restoration
- metabolism, temp, HR, and BP increase
- less restful than NREM sleep
- apnea may occur

93
Q

what biorhythm or biological clock influences wake and sleep time?

A

circadian rhythm
- 24 hours biological clock

94
Q

where is biorhythm or biological clock regulated?

A

regulated in the hypothalamus

95
Q

how does nicotine impact sleep?

A
  • nicotine causes more difficulty falling asleep and more easily aroused
  • temporary sleep disturbances occur during the withdrawal period
96
Q

what is the cause and symptoms of obstructive sleep apnea?

A
  • due to structures in the mouth and throat that relax during sleep and occlude the upper airway
      • could be the adipose tissue
  • causes snores, snorts, grunts, or thrashes during sleep
97
Q

what is insomnia?

A

most common sleep disorder
- the ability to get an adequate amount of sleep and to feel rested

98
Q

what are important sleep interventions?

A
  • dont eat before bed
    • carbohydrates can cause increase and then a rapid drop in BG
        • result in waking up
  • avoiding alcohol while taking benzodiazepines
  • progressive muscle relaxation and consistent sleep/walk times promote healthy sleep habits
99
Q

what can the nurse do to promote sleep?

A
  • multiple naps during the day can cause the client to be more awake at night
      • coordinate to plan all procedures
      • or testing to be done while awake
  • keep door closed to reduce outside noise
  • carbohydrates such as crackers, cereal, or bread should be avoided
      • boost blood glucose levels which can wake the client
100
Q

what is the impact of chronic sleep loss?

A

obesity
depression
hypertension
diabetes mellitus
heart attack
stroke
myocardial infarction
infections
possibly cancer
inability to concentrate
poor judgment
moodness
irritability
increased risk for accidents

101
Q

what is sleep diary?

A
  • specific information about sleep-wakefulness patterns usually over 14 days
  • allows identification of trends and associates specific behaviors interfering with sleep
102
Q

what are nursing actions to create a restful environment and promote comfort?

A
  • linens tight on the bottom and loose on the top to allow movement
  • keep linens and gown dry and free of irritants
  • close their door
  • turn down the lights
  • organize their procedures around their sleep time
  • control the temperature of the room
  • provide good ventilation
  • good body alighment
  • back rub
  • guided imagery
  • music therapy
  • use earplugs
  • warm bed bath or shower
103
Q

what are important aspects of personal sleep hygiene?

A
  • establish bedtime routine
  • regular sleep pattern
  • create comfortable environment
  • not exercising within 2 hours of sleep
  • not drinking alcohol at least 4 hours prior to sleep
  • do not use nicotine or caffeine
  • dont depend on sleeping aids
104
Q

what can a nurse do when working night shift to make it easier on the body?

A
  • plan rest days in between consecutive workdays
  • engage in conversation with others, not just listen and nod
  • do something that requires physical action periodically
      • even if it means just getting up and moving around
  • take frequent breaks (i.e. every 1 - 2 hours) during the night shift
  • dont take caffeine when you dont need it to stay awake, avoid caffeine at the end of your shift before sleep
  • practice good sleep hygiene measures during your off hours

NUR 215 - Fundamentals (4 decks)

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