Exam5 Study Guide: Q Flashcards
time that medication has pharmacological effect
duration
range of therapeutic concentrations
therapeutic range
concentration that produces the desired effect
therapeutic level
effectiveness depends on concentration at intended site
i.e. nitrofurantoin for a UTI
concentration of active drug at target sites
the client has been on a low-protein diet. this will most likely affect which pharmacokinetic process?
- absorption
- excretion
- distribution
- metabolism
distribution
a low-protein diet may lead to an inadequate level of plasma proteins, which will affect availability of “free” drug
the nurse is having difficulty deciphering the medication prescription written by the provider.
what is the best strategy to clarify the information?
- ask the patient what medication the provider prescribed
- call the pharmacist and ask him or her to read the prescription
- ask the nurse who knows the provider’s handwriting to read the prescription
- call the provider and ask him or her to clarify the prescription
call the provider and ask him or her to clarify the prescription
all other answers increase the risk of a medication error
decrease response to the same dose of medication
tolerance
persons reliance on or need for a drug, leads to compulsive patterns of drug use where lifestyle centers on taking the drug
dependence
improper use of drugs, including alcohol, OTC medications, and prescription drugs
misuse
inappropriate intake of substance by amount, type, or situation, continuously or periodically
abuse
street drugs sold illegally or prescription drugs abused
illicit drugs
what are the 6 components of medication orders/prescriptions?
- client’s full name (some locales require address)
- date and time
- name of medication
- dosage size, frequency, number of doses
- route of administration
- printed name and signature of prescriber, including relevant credentials and legal registration identifier or DEA # (written prescriptions)
what should your assessment consist of before administering medications?
vitals
assess patient condition
your knowledge of medication
factors that affect drug metabolism
what should your assessment consist of during administering medications?
mental status
coordination
ability to self-administer drug
swallow (for oral meds)
what should your assessment consist of after administering medications?
effectiveness
side effects
signs of adverse reaction/toxicity
what should your physical assessment consist of when administering medications?
identify potential problems and need for adapting medication administration
what should your medications history consist of when administering medications?
allergy history
type of reaction
treatment
history of illness
attitude toward medication
learning needs
pregnancy/breast feeding
3 checks of medication administration:
when do you check the medication label against the medication administration record (MAR)?
before you pour
3 checks of medication administration:
when do you verify the label against the MAR?
after you pour
3 checks of medication administration:
when do you check the medication again?
at the bedside
what are the 6 rights of medication administration?
right drug
right dose
right time
right route
right patient
right documentation
T or F:
when administering a drug via a parenteral route, the drug would be absorbed fasted if given per the (IM) route?
False
absorption refers to the “movement” of the drug from the site of administration into the bloodstream.
therefore, the IV, parenteral route leads to “instant” absorption.
The nurse knows that the results of a fecal occult blood test can be inaccurate if:
- the client has had an excessive intake of red meat
- the female client is menstruating
- the client takes high doses of vitamin C
- all of the above
all of the above
the results of a fecal occult blood test can be inaccurate for any of the reasons given
Mrs. Addie is 70 years old.
while the nurse is gathering admission assessment data, the patient states, “i’ve taken a tbsp of milk of magnesia every day for 3 years”.
which nursing diagnosis is most appropriate for the nurse to use in her plan of care?
- diarrhea
- constipation
- risk of ineffective therapeutic regimen
- perceived constipation
perceived constipation
daily laxative, use by the patient might suggest that she perceives she is constipated, and the nurse would gather further assessment data related to the client’s bowel pattern. There is not enough data to infer actual constipation
you are caring for a patient with a colostomy.
in order to provide safe care you understand that when irrigating a colostomy, a proper fitting cone is needed to prevent:
- introducing air into the colon
- leaking the solution around the stoma
- administering the solution too rapidly
- introduction of bacteria from the stoma
leaking the solution around the stoma
a proper fitting cone prevents leakage of the solution around the stoma that may cause irritation and damage to the skin surrounding the stoma
the nurse is assisting the client in caring for her ostomy.
the client states, “oh, this is so disgusting. i’ll never be able to touch this thing.”
the nurse’s best response should be:
- im sure you will get used to taking care of it eventually
- yes, it is pretty messy, so i’ll take care of it for you today
- it sounds like you are really upset
- you sound very angry. should I call the chaplain for you?
it sounds like you are really upset
this statement reflects the principles of therapeutic communication
what are age-related GU changes that occur in older adults?
- kidney function decreases
- urgency and frequency is common
- loss of bladder elasticity and muscle tone leads to:
- nocturia and incomplete emptying
the female client states to the nurse, “im so distressed. it seems like every time i laugh hard, i wet myself”.
the nurse knows that this condition is known as:
- stress incontinence
- urge incontinence
- functional incontinence
- unconscious incontinence
stress incontinence
results from increased pressure within the abdominal cavity
there is 24-hur urine collection in process for a client.
the nursing assistive personnel (NAP) inadvertently empties one specimen into the toilet instead of the collection “hat”.
the nurse should:
- continue with the collection of urine until the 24-hr time period is finished
- make a note to the lab to inform them that one specimen was missed during the collection
- begin filling a new collection container and take both containers to the lab at the end of the collection period
- dispose of the urine already collected and begin an entirely new 24-hr collection
dispose of the urine already collected and begin an entirely new 24-hr collection
once one specimen is missed during a 24-hr urine collection, the results of the laboratory test will be inaccurate and the collection must be restarted
high or low potassium levels can cause what?
cardiac disturbances
an obese patient is admitted with a diagnosis of congestive heart failure.
the nursing history reveals:
- has diabetes
- smokes 2 packs/day
- noncompliant with diet, exercise, and medications
the student nurse assigned to the patient states, “let’s focus on making her compliant, which will save all the problems. otherwise, we cant help her”.
what is the most appropriate response?
- lets explore reasons for the non compliance
- this statement shows a bias against the patient
- lets discuss how you derived your priority of care
- what do you know about congestive heart failure?
lets discuss how you derived your priority of care
acceptable range for ph serum:
7.35 to 7.45
measured by arterial blood gases (ABGs)
what is considered an acidosis serum?
pH below 7.35
what is a respiratory cause of acidosis?
retention of CO2
what is a metabolic cause of acidosis?
loss of bicarbonate
what is considered an alkalosis serum?
pH above 7.45
what is a respiratory cause of alkalosis?
blowing off CO2
what is a metabolic cause of alkalosis?
increase in bicarbonate
on assessment of a patient with acute renal failure, the nurse finds the following:
- distended neck veins, cool and pale skin, and crackles in the lungs.
the nurse should suspect the patient is experiencing:
- hypocalcemia
- hypovolemia
- hypervolemia
- hypercalcemia
hypervolemia
this patient is showing signs of fluid overload.
other findings include elevated blood pressure, bounding pulse, and increased respirations due to increased intravascular volume.
what are the causes and symptoms of hypervolemia?
- excessive retention of sodium and water in the ECF
- fluid volume excess can result from excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart
- the retained sodium increases osmotic pressure and pulls fluid from the cells into the ECF
- BP is elevated, pulse is bound, and respirations are increased and shallow, distended neck veins, edema, skin is pale and cool.
- urine output becomes dilute, and volume increases.
- rapid weight gain.
- in severe fluid overload, the patient develops moist crackles in the lungs, dyspnea, and ascites (excess peritoneal fluid)
- orthopnea - difficulty breathing while laying flat Hemodilution causes BUN, hematocrit, and the specific gravity of the urine to decrease.
what are the causes of hypovolemia?
- loss of fluid and electrolytes
- decreased blood volume
- tachycardia
- low BP
- weak thready pulse
- furrowed tongue
- sunken eyes
- increased skin turgor
- tacky MM
- increased temperature (body can’t sweat)
- sudden weight loss 5 - 15%
- elevated BUN-to-creatinine ratio
- elevated HCT
what are the names of the electrolyte imbalances with sodium?
hyponatremia
hypernatremia
what are the names of the electrolyte imbalances with potassium?
hypokalemia
hyperkalemia
what are the names of the electrolyte imbalances with calcium?
hypocalcemia
hypercalcemia
what are the names of the electrolyte imbalances with magnesium?
hypomagnesemia
hypermagnesemia
what are the names of the electrolyte imbalances with phosphorous?
hypophosphatemia
hyperphosphatemia
the nurse is administering a blood transfusion to a patient in shock. after 30 min the patient spikes a fever and reports chest pain. her blood pressure falls suddenly and she becomes tachycardic.
what type of reaction is this patient experiencing?
- allergic
- febrile
- hemolytic
- circulatory overload
hemolytic
this patient is showing signs of a hemolytic reaction, which is destruction of red blood cells. this occurs when infusing incompatible blood (high antibody response). this complication is rare; but fatal
the student nurse has earned “A’s” in all of her prerequisite courses. For the first exam in a nursing course, she earns a “D” and now feels that she may not be smart enough to become a nurse.
what type of “loss” is the student experiencing?
- actual
- external
- physical
- perceived
perceived
the student’s perception of herself as “not smart” is internal. unless she chooses to share her grade with others, it cannot be seen. this is not a physical loss
what is the theorist Elisabeth Kubler-Ross known for?
five stages of grieving:
- denial
- anger
- bargaining
- depression
- acceptance
individuals may not experience every stage, or go in a linear order, may experience two or more stages simultaneously
a young woman’s fiance died in a car accident one month prior to their wedding day. since his death, she has become sexually promiscuous.
what type of grief, if any, is the woman displaying?
- chronic
- disenfranchised
- masked
- no grief
masked
the woman is expressing her grief through maladaptive behavior to mask her grief. there has only been a short period of time since her fiance’s death
the client is dying of cancer and can no longer swallow. the son states to the nurse, “you must give dad some water, he always drank a lot of water”. the nurse’s best response is
- “you sound very upset. tell me more about your dad”.
- “your father is dying from cancer and water will not stop this process”.
- “research shows that withholding oral fluids decreased edema”.
- “i will call the provider and get a prescription to insert a nasogastric tube for the water”.
“you sound very upset. tell me more about your dad”.
these are statements that will begin a therapeutic conversation and encourage the son to express his feelings about his father’s impending death.
options B and C close communication and do not reflect caring.
options D is incorrect and does not address the underlying concern
what are the 4 phases of pharmacokinetics?
absorption
distribution
metabolism
excretion
what should you do before administering insulin?
check BG
what is the abbreviation for a subcutaneous injection?
Sub-Q
not SQ
what should you do after making a medication error?
immediately assess patient vitals then report findings to the provider
what is a drug incompatibility?
- chemical deterioration of a drug when they are mixed
- solution should be discarded and will often change appearance or contain particles
what are important points when administering otic drops to a child?
pull pinna DOWN and BACK,
- do not let the bottle touch the ear
- have them lay on their side for 2 minutes after
- do not apply pressure to the tragus after
when would you collect peak and trough IV Vancomycin levels?
trough:
- 30 min prior to administration of next dose
- peak 2 hours after infusion
what is the function of the renal system?
regulation of fluid and electrolyte balance
what condition is an older adult at risk for after vomiting for 3 days?
hypovolemia
what are some symptoms of dehydration?
- furrows of tongue
- dry MM
- eyes will be sunken
- BP will decrease
- HR will increase
what level of urine output is cause for concern?
< 30mL/hr for 2+ hours-called oliguric
what is anuric?
no urine output
what are symptoms of hyperkalemia?
elevated potassium level can cause arrhythmias and cardiac arrest
usually seen in patients who miss dialysis
patients are usually given sodium polystyrene sulfonate
you check your morning labs and your patient’s potassium > 5.0.
you do your first check on the MAR, and you see them have potassium PO 20 mEq qday ordered.
what will you do?
do not administer potassium and notify the provider
what are symptoms of a UTI?
- urinary frequency
- urgency
- nocturia
- hematuria
- cloudy
- foul-smelling urine
- fever
- painful urination
- flank pain
- confusion or delirium in the older adult
- new onset incontinence
- elevated WBC
what is a normal appearance of a stoma?
red
shiny
moist
small amount of blood
what should you do if the stoma is purple?
notify surgeon
could indicate ischemia
what are important points of ostomy care?
- empty the ouch when it is 1/3 - 1/2 full
- leave 1/8 in space around the stoma
- flatulence is expected
- skin barrier wafer should not be changed daily or could lead to skin breakdown
how should you communicate with a patient who just had an ostomy?
therapeutically:
“i realize this is difficult for you. I am going to do your colostomy care now, and I need you to watch this time, so you can participate next time. this is something you will learn to do on your own”.
what should you do if the client experiences cramping during colostomy irrigation?
- flow is stopped 15-30 seconds and have client take deep breaths
- caused by an infusion that is too rapid or too much pressure
what position is used for enemas and rectal examinations?
Sim’s position:
client is on the left side with the right leg flexed forward
what is a potential complication of digital removal to treat a fecal impaction?
vagal nerve stimulation causing a decrease in heart rate and potential dysrhythmias
what are the 2 main sources of skin moisture that lead to maceration (softening of skin)?
- incontinence and fever are most common source of moisture
- incontinence is not an accepted use for a foley catheter
what are indications for an indwelling urinary catheter?
- hematuria, obstruction, urological surgeries, decubitus, strict I&Os, neurogenic bladder, and immobility
- a client who refused to get out of bed, one in the ICU, or with frequent incontinence don’t warrant a catheter
what is urge incontinence?
a sudden urge to urinate caused by the bladder contracting when it shouldn’t and urine leaks through the sphincter
what are some interventions for urge incontinence?
- client should restrict fluid intake in PM
- restrict/eliminate caffeine
- take diuretics in the AM
- total fluid intake 2-3L/day
- toileting schedule q2h
what is:
short-term incontinence that is expected to resolve spontaneously. Typically caused by urinary tract infection or medications, such as diuretics
transient incontinence
what is:
involuntary loss of urine when the bladder becomes distended;
it is commonly associated with fecal impaction, enlarged prostate, and neurological conditions
overflow incontinence
what are appropriate interventions for peri care?
- use a moisture barrier
- keep them clean and dry
- check skin every 2 hours
- use warm not hot water to clean skin
what are important points of urinary catheter care?
- external 4in of the catheter should be cleaned every 8 hours
- insertion is a sterile procedure
- foleys are closed systems
frequent urination at night.
common in older adults d/t loss of bladder elasticity
nocturia
blood in the urine.
could indicated UTI or cancer
hematuria
tests for blood in the stool to screen for colorectal cancer
Guaiac Test
what should you do for a patient who reports lower abdominal discomfort and has been unable to urinate for a period of time?
- use bladder scanner to determine if the patient is retaining urine
- do not press on the bladder
normal lab values for sodium?
135 - 145 mEq/L
normal lab values for potassium?
3.5 - 5 mEq/L
normal lab values for magnesium?
1.3 - 2.1 mEq/L
normal lab values for BUN (blood urea nitrogen)?
10 - 20 mg/dL
normal lab values for creatinine in males?
0.6 - 1.2 mg/dL
normal lab values for creatinine in females?
0.5 - 1.1 mg/dL
what changes will you observe in the 24 hours before death?
- decreased level of consciousness
- cool extremities
- incontinence - usually urine
- mucous collecting in the airways
- hearing is last to go - continue talking to patient
when performing postmortem care can you remove any lines or tubes (IV, foley, etc.)?
not until it is determined the client is not a medial examiner case
what are the 5 steps of postmortem care?
- make sure the provider has certified the client’s death (or 2 RNs)
- verify the client’s organ and tissue donation status
- remove medical equipment from the client
- cleanse the body while adhering to body-fluid precautions
- attach identification tags to the body
what are coping strategies for nurses after the death of a patient?
- going to the client’s funeral
- writing to family
- debriefing sessions with co-workers
- stress management techniques - exercise
- music
- journaling
- pet therapy
- meditation
- talking to a therapist, etc.
to live with an incurable condition and focus on relief of physical manifestations such as pain
pallative
patients terminally ill with a life expectancy < 6 mos.
a cure/treatment is no longer sough, and the focus is on quality of life and supporting the client towards a peaceful death while managing pain and anxiety
hospice
what should the nurse remember when communicating about end-of-life care?
- do not give opinion or advice
- barrier to communication and takes focus away from patient/family
- encourage family support
- stage patient’s grief to provide education and support
- assist with reality of the situation
- encourage expression about thoughts on death
denial stage of grief?
difficulty believing diagnosis
anger stage of grief?
lashes out at people or things
bargaining stage of grief?
negotiate for more time or a cure
depression stage of grief?
overwhelmingly sad by inability to change the situation
acceptance stage of grief?
plan for the future and moving forward
how can sleep change during grief?
- sleep pattern changes can occur in normal grief
- sleeping excessively can be a sign of depression and this is a sign of maladaptive grief
choosing someone to make medical decisions for the patient if they were incapacitated
POA (power of attorney)
written or oral instructions stating a person’s wishes regarding his healthcare if he were incapacitated or unable to make that decision
advance directive
complicated grief that occurs when the person expresses the grief through other types of behaviors
masked grief
grieving with no signs of acceptance past 6 months, signs of potential depression
(i.e. not going out of the house along with feelings of guilt for the death of his wife)
complicated grief
what could the nurse say to a family when caring for a client who just expired?
- ask if they would like to be involved in postmortem care
- “would you like to help with bathing o your loved one?”
this would be the most therapeutic response in this situation. the nurse should not discuss her own experiences
in hospice care, what are some pharmacologic and nursing practices to keep patients comfortable?
- pharmacologic pain measures using both nonopioids and opioids
- practice with compassion, respect for the inherit dignity, worth, and unique attributes
- sit with the client, hold their hand, and assist patient/family to establish a sense of control to preserve dignity
when caring for a patient in hospice, should you keep the client in the same position to prevent upsetting them?
no
is not therapeutic and does not supply comfort
which medication order is correct?
-Llisinopril 0 mg PO qday
- Norco 5/325 mg PO PRN
- Hydromorphone .5 mg IV q2h
Lisinopril
- norco missing PRN reason
- hydro missing 0 in front of .5
what is the effect of vitamin K on Warfarin?
vitamin K decreases effectiveness of Warfarin, must limit greens like broccoli and spinach that are high in vitamin K
Phosphate Levels
2.5 - 4.5
Bicarbonate levels
22-26
Chloride levels
95-105
Calcium levels
8.5-10.5
