final

Question 1

assessment priorities post op-3 phase

Answer 1

phase 1- airway, vitals, indicators of recovery every 15 min
phase 2- presurgery LOC returned, O2 sat at baseline, vitals stable
phase 3- vitals stable, surgical site bleeding

Question 2

central line bundle to reduce infection-9

Answer 2

use checklist, hand hygiene, maximal barrier precautions, sterile technique, min traffic in room, chlorhexide for skin disinfection, use preferred sites, post-placement care, remove ASAP

Question 3

hyponatremia nursing care-3

Answer 3

1. low Na and volume-normal saline
2. if severe low Na- hypertonic saline 3%
3. low Na and high volume (SIADH)- conivaptan or tolvaptan

Question 4

potassium infusion-3

Answer 4

1. max of 1/10ml, rate no faster than 5-10 hr (never more than 20)
2. large vein w high flow, no hands
3. check q 1 hr, stop w pain, burn, infiltration

Question 5

candida albicans (oral thrush) treatment-4

Answer 5

nystatin (mycostantin) oral suspension swish/swallow
ice pop troches
topical triamcinolone in benzocaine
oral dexamethasone

Question 6

pernicious anemia vitamin supplementation

Answer 6

B12

Question 7

Hep A risk factors-5

Answer 7

Spread most often by fecal oral route
Flu like infection that may go unrecognized
Oral anal or contaminated food or water
Shellfish or food handlers
Incubation period 15-20 days

Question 8

Hep B risk factors

Answer 8

Blood and fluid transmission
Sex, needles, transfusions (now screened after 1992), Hemodialysis
Immunosuppressed more likely to develop
Incubation period 25-180 days
Many people with Hep B do not exhibit sx. If they do they might have jaundice, fever, joint pain, anorexia, N/V, RUQ pain, dark urine with light stool
Most adults who get Hepatitis B are able to clear it from their bodies and develop immunity
Small amount people do not develop immunity but become carriers

Question 9

Hep C risk factors

Answer 9

Spread blood to blood
Blood or organ transplants received before 1992
Illicit drug use (highest incidence)
Unsanitary tattoos
Sharing intranasal cocaine equipment
Do not share razors, toothbrushes or pierced earrings
Average incubation period 7 weeks
May be asymptomatic for months or years after initial exposure
Acute infection not common
Most people DO NOT clear the virus and chronic infection develops

Question 10

ommon signs of elevated ammonia levels (hepatic encephalopathy) stage 1

Answer 10

subtle, may not be recognized immediately

• personality, behavior, emotional, thinking, concentration
• fatigue, slurred/slowed speech, sleep disturbances

Question 11

common signs of elevated ammonia levels (hepatic encephalopathy) stage 2

Answer 11

continuing mental changes

• confusion, disorientation to time, place, person
• asterixis (hand flapping)

Question 12

common signs of elevated ammonia levels (hepatic encephalopathy) stage 3

Answer 12

progressive deteriorentation

• marked mental confusion
• stuporous, drowsy but arousable
• abnormal ECG, muscle twitching, hyperreflexia
• asterixis

Question 13

common signs of elevated ammonia levels (hepatic encephalopathy) stage 4

Answer 13

unresponsive, obtunded, no asterixis

• positive babinski
• muscle rigidity
• fetor hepaticus-musty sweet liver breath
• seizures/death

Question 14

hepatic encephalopathy diet changes

Answer 14

moderate protein and fat and simple carbs

Question 15

chronic pancreatitis interventions

Answer 15

pain management
PERT- pancreatic enzymen replacement therapy prevents malnutrition, malabsorption, and excessive weight loss-don’t give w H2 blockers, don’t mix w protein, monitor uric acid levels
-need 4000-6000 calories a day
-high carb, high protein, low fat

Question 16

asthma management

Answer 16

• avoid environmental triggers, drugs (aspirin, NSAID, beta blockers), MSG
• use inhaler 30 min before exercise

Question 17

appendicitis assessment-3

Answer 17

abdominal pain followed by N/V
RLQ pain (McBurney's point)
rebound tenderness

Question 18

appendicitis treatment-5

Answer 18

Make NPO, IV fluids, semi-fowlers, opoids, antibiotics

Question 19

CAN- Cardiovascular autonomic neuropathy problems-6

Answer 19

left ventricular dysfunction, painless MI, exercise intolerance, orthostatic hypotension, syncope, GI problems

Question 20

VAP-vent acquired pneumonia) bundle-6

Answer 20

1. elevate HOB 30 degrees
2. daily sedation vacation and weaning assessment
3. DVT prophylaxis
4. oral care
5. stress ulcer prophylaxis
6. suctioning

Question 21

hospital acquired pneumonia

Answer 21

onset/diagnosis >48 hrs after admission to hosp

Question 22

pneumonia prevention-7

Answer 22

vaccine, avoid crowds, cough/turn/deep breathe if immobile, clean resp equipment, avoid indoor pollutants, don’t smoke, 3 liters fluid/day

Question 23

influenza A treatment-4

Answer 23

amantadine, rimantadine, zanamivir, oseltamivir

Question 24

GERD education-6

Answer 24

1. 4-6 small meals- eat slow, remain upright couple hrs
2. avoid fatty foods, caffiene, alcohol, tobacco
3. don’t eat before bed
4. elevate HOB
5. lose wt, loose clothes, bending/straining
6. chew antacids thoroughly follow w glass of water

Question 25

rolling/paraesophageal surgery education-4

Answer 25

1. soft diet for 1 week, no carb bev
2. anti-reflux meds for 1 month
3. don’t drive 1 week
4. walk daily, no heavy lift

Question 26

hepatic encephalopathy interventions-2

Answer 26

1. high carb, mod fat and protein

2. lactulose, lacitol

Question 27

indications for TPN and gastrostomy tube

Answer 27

prevent malnutrition

Question 28

paralytic ileus treatment-3

Answer 28

NG tube, normal saline, LR

Question 29

dumping syndrome interventions-4

Answer 29

have pt lie down, decrease amt of food and eliminate fluids w meals
-high protein and fat low/mod carb
acarbose, sandostatin

Question 30

cholecystits interventions-3

Answer 30

• withhold food/fluids if N/V
• ketorolac, extracorporeal shockwave lithotripsy
• cholesystectomy (assess O2 sats)