Final Exam

Question 1

PACU/Recovery Room purpose

Answer 1

ongoing evaluation and stabilization of patients
anticipate, prevent and manage complications after surgery

Question 2

hand off report

Answer 2

two way verbal interaction
report between two health care professionals is required to communicate the patient’s condition and needs

Question 3

Assessments in PACU

Answer 3

history
initial assessment- LOC and awareness, Respiratory assessment, temp, pulse, resp, BP, O2 sat, examine surgical site for bleeding and drainage

Question 4

discharge from PACU

Answer 4

determined by health care team
criteria for discharge: stable VS, normal temp, no overt bleeding, return of swallow and gag reflux, ability to take liquids, adequate UO

Question 5

places people can be discharged to

Answer 5

hospital unit- ICU, telemetry, med surg
home

Question 6

respiratory complications of surgery

Answer 6

atelectasis
pneumonia
PE
laryngeal edema
ventilator dependence
pulmonary edema

Question 7

cardiovascular complications of surgery

Answer 7

HTN
hypotension
hypovolemic shock
dysrhythmias
VTE (venous thromboembolism)
DVT
heart failure

Question 8

General complications of surgery

Answer 8

sepsis
anemia
anaphylaxis
pressure ulcer
wound infection
wound dehiscence
wound evisceration
skin rashes or contact allergies

Question 9

gastrointestional complications of surgery

Answer 9

paralytic ileus
gastrointestinal ulcers and bleeding

Question 10

neuromuscular complications of surgery

Answer 10

hypothermia
hyperthermia
nerve damage/paralysis
joint contractures

Question 11

kidney/urinary complications from surgery

Answer 11

UTI
acute urinary retention
electrolyte imbalance
AKI
stone formation

Question 12

common reactions after surgery

Answer 12

postoperative n/v
decreased or no peristalsis for up to 24 hours
paralytic ileus
constipation

Question 13

Labs for after surgery

Answer 13

electrolytes
CBC
ABGs
Urinanalysis
Creatinine

Question 14

Priority patient problems after surgery

Answer 14

potential for hypoxemia
potential for wound infection and delayed healing
acute pain

Question 15

interventions to prevent hypoxemia

Answer 15

airway maintenance
monitor O2 sat/pulse ox
positioning
oxygen therapy
breathing exercises
movement/mobility

Question 16

preventions for wound infection and delayed healing

Answer 16

dressing changes
asses wound for infection
assess drains
drug therapy

Question 17

wound complications

Answer 17

dehiscence- partial or complete separation
evisceration- total separation of all wound layers and protrusion of internal organs

Question 18

managing pain

Answer 18

drug therapy
relaxation
distraction
massage
positioning

Question 19

patient teachings on discharge

Answer 19

prevention of infection
care and assessment of surgical wound
management of drains and catheters
nutrition therapy
pain management
drug therapy

Question 20

pre-operative

Answer 20

begins when the patient is scheduled for surgery and ends at the time of transfer to the surgical site

Question 21

post-operative

Answer 21

starts with completion of surgery and transfer of the patient to a specialized area of monitoring such as the PACU and may continue after discharge from the hospital until all activity restrictions have been lifted

Question 22

preoperative assessments

Answer 22

complete set of VS
focus on problem areas identified in patients history
s/s of infection
increased PT and INR
abnormal electrolytes
HCG test
psychosocial exam
lab test: UA, CBC, H/H, Clotting study, electrolyte, BUN, creatinine, ABGs
Imaging
ECG

Question 23

informed consent

Answer 23

implies that the patient has sufficient information to understand:
nature and reason for surgery
who will be preforming surgery and other ppl present
all available options and risks
risk associated with procedure and potential outcomes

Question 24

nurse’s responsibility in informed consent

Answer 24

that the consent form is signed, and you serve as a witness to the signature, not to the fact that patient is informed

Question 25

preoperative chart review

Answer 25

ensure all documentation, preoperative procedures, order are complete check consent forms

Question 26

preoperative patient preparation

Answer 26

 Hospital gown  Antiembolism stockings or pneumatic compression devices, if ordered  Give valuables to a family member or lock them in a safe place  ID band in place, bracelet indicating allergies, bracelet indicating type and screen was completed  Remove dentures (some facilities allow them in the OR)  Remove all prosthetic devices, hairpins, and clips  Remove hearing aids (some facilities allow them in the OR)  Per hospital policy, remove nail polish, artificial nails  Have the patient empty their bladder  After drug administration that can affect cognition or judgment, raise siderails, ensure call system is within easy reach of the patient, and the bed is in low position  Answer questions and offer reassurance as needed

Question 27

preoperative drugs

Answer 27

 Sedatives  Hypnotics  Anxiolytics  Opioid analgesics  Anticholinergic agents  Antibiotics  Specific – purpose drug  May be given “on call” or after the patient is transferred to the preoperative area

Question 28

Because of an unexpected emergency case, a patient scheduled for colon surgery at 8 AM has been rescheduled for 11 AM. What is the nurse’s best action related to preoperative prophylactic antibiotic administration according to the Surgical Care Improvement Project (SCIP) guidelines? 1. Administer the preoperative antibiotic at 7 AM as originally prescribed 2. Administer the antibiotic at the same time as the other prescribed preoperative drugs 3. Adjust the antibiotic administration time to be within 1 hour before the surgical incision 4. Hold the preoperative antibiotic until the patient is actually in the operating room and has been anesthetized

Answer 28

3

Question 29

A 75-year old patient is having an exploratory laparotomy tomorrow. The wife tells the nurse that at night the patient gets up and walks around his room. What priority action does the nurse take after hearing this information? 1. Notifies the provider 2. Develops a plan to keep the patient safe 3. Obtains an order for sleep medication 4. Tells the patient not to get out of bed at night

Answer 29

2

Question 30

The nurse is preparing the patient for surgery. Which common laboratory tests does the nurse anticipate to be ordered? (Select all that apply) 1. Total cholesterol 2. Urinalysis 3. Electrolyte levels 4. Uric acid 5. Clotting studies 6. Serum creatinine

Answer 30

2,3,5,6

Question 31

The nurse has given the ordered preoperative medications to the patient. What actions must the nurse take after administering these drugs? (Select all that apply) 1. Raise the side rails 2. Place the call light within the patient’s reach 3. Ask the patient to sign the consent form 4. Instruct the patient not to get out of bed 5. Place the bed in its lowest position

Answer 31

1,2,4,5

Question 32

The nurse is assessing a postoperative patient’s gastrointestinal system. What is the best indicator that peristaltic activity has resumed? 1. Presence of bowel sounds 2. Patient states he is hungry 3. Passing of flatus or stool 4. Presence of abdominal cramping

Answer 32

3

Question 33

What is the priority nursing assessment when a patient is admitted to the PACU? 1. Level of consciousness 2. Airway and gas exchange 3. Dressing and incision status 4. Vital signs and body temperature

Answer 33

2

Question 34

A patient who is 2 days postoperative for abdominal surgery states, “I coughed and heard something pop.” The nurse’s immediate assessment reveals an opened incision with a portion of large intestine protruding. Which statements apply to this clinical situation? (Select all that apply) 1. Dehiscence has occurred 2. This is an emergency situation 3. The wound must be kept moist with normal saline- soaked sterile dressings 4. This is an urgent situation 5. Evisceration has occurred

Answer 34

2,3,5

Question 35

Which are interventions for the medical-surgical nurse to use in preventing hypoxemia for the postoperative patient? (Select all that apply) 1. Monitor the patient’s oxygen saturation 2. Position the patient supine 3. Encourage the patient to cough and breathe deeply 4. Get the patient up ambulating as soon as possible 5. Instruct the patient to rest as much as possible

Answer 35

1,3,4

Question 36

1. You know that nursing care in PACU is multifaceted and involves: (select all that apply) A. Monitoring the patient's physiological status B. Intervening to ensure uneventful recovery from anesthesia and surgery C. Providing a safe environment for the patient experiencing limitations in physical, mental, and emotional function D. Preventing or promptly treating complications in the immediate post-anesthesia period E. Upholding the patient's rights to dignity, privacy, and confidentiality F. Utilizing high tech equipment so health care costs will be justified

Answer 36

ABCDE

Question 37

The nurse anesthetist gives you Mr. Potter's record, and prepares to give you a verbal report. You know that her verbal report should include: (Select all that apply) A. Mr. Potter's height and weight B. The name of the surgical procedure Mr. Potter had C. Mr. Potter's relevant health history D. Anesthetic agents and other drugs that were administered to Mr. Potter E. Mr. Potter's estimated blood loss during surgery F. Mr. Potter's religious preference G.Mr. Potter's fluid status and IV therapy

Answer 37

ABCDEG

Question 38

In providing care for Mr. Potter, your first step is to: A. Assess your patient B. Analyze patient data C. Plan care D. Intervene E. Evaluate care

Answer 38

A

Question 39

In PACU, many assessments and interventions are done simultaneously. However, the most critical, high-priority assessment to be done with Mr. Potter is his: A. Operative site B. Skin integrity C. Pulse D. Airway E. Blood Pressure

Answer 39

D

Question 40

Which TWO assessments are your next priorities? A. Operative site B. Skin color C. Skin integrity D. Pulse E. Blood pressure F. Orientation

Answer 40

DE

Question 41

Since Mr. Potter is a smoker, he has increased risk associated with surgery and anesthesia. You are aware that smoking can be responsible for which of the following in the immediate postoperative period? (Select all that apply) A. Dehydration B. Difficulty in clearing secretions C. Cardiac dysrhythmias D. Increased drowsiness

Answer 41

BC

Question 42

Why is it important to measure arterial oxygen saturation (SpO2) levels in PACU? A. Levels indicate how much oxygen is available for use by tissues B. Levels reflect the effectiveness of intraoperative sedation C. Levels reflect the ability to absorb medications from the bloodstream D. Levels reflect how much oxygen has been used by tissues

Answer 42

A

Question 43

Given Mr. Potter's SpO2 of 97%, what intervention is indicated? A. Continue to monitor SpO2 B. Increase oxygen to 100% C. Increase liter flow to 15 liters per minute D. Remove Mr. Potter from the ventilator

Answer 43

A

Question 44

You recognize that a number of conditions may be responsible for Mr. Potter's low body temperature. These include which of the following? (Select all that apply) A. Surgical wound infection B. The anesthetics Mr. Potter received C. The environmental temperature in the OR D. Mr. Potter's preoperative skin prep E. The common use of cooled irrigation solutions during surgery

Answer 44

BCD

Question 45

The opiate antagonist ____________ should be readily available in PACU should reversal of respiratory depression be necessary. A. atropine sulfate B. naloxone hydrochloride C. protamine sulfate D. aminophylline

Answer 45

B

Question 46

You assist Mr. Potter to a sitting position on the side of the PACU bed and allows him to dangle his feet for ten minutes. This will help prevent _____________ when Mr. Potter stands. A. Orthostatic hypotension B. Orthostatic hypertension C. Orthostatic paresis D. Orthostatic paralysis

Answer 46

A

Question 47

Before discharge, Mr. Potter is given instructions regarding the need to: (Select all that apply) A. Report an elevated temperature B. Monitor and protect his operative site C. Avoid strenuous activity D. Have a glass of wine at bedtime E. Continue deep breathing exercises F. Let someone else drive him home G. Continue ice packs at home

Answer 47

ABCEFG

Question 48

The nurse anesthetist reports that your patient is Mr. Potter, a 69-year-old man, who had a right inguinal hernia repair under general anesthesia. Mr. Potter smokes 1 1/2 packs of cigarettes per day and has a history of chronic bronchitis. He received no preoperative medication. During surgery, Mr. Potter received 900 mL of Lactated Ringer's intravenously. Estimated blood loss was 20 mL. A variety of general anesthetics were administered. Mr. Potter remains intubated with a 7.5 oral endotracheal (ET) tube because he is not fully awake. Continued intubation in PACU will allow for maintenance of a patent airway until Mr. Potter is in a more alert state and can breathe and expectorate secretions on his own.

Answer 48

Mr. potter report… useful for practice questions

Question 49

PaO2 range

Answer 49

80-100 mmHg

Question 50

pH range

Answer 50

7.35-7.45

Question 51

PaCO2 range

Answer 51

35-45 mmHg

Question 52

HCO3 range

Answer 52

22-26 mEq/L

Question 53

transtracheal oxygen

Answer 53

oxygen delivered through a small flexible catheter that is places in the trachea through a small incision used for patients with long term O2 needs avoids irritation that nasal prongs cause typically require less O2 when delivered in this method

Question 54

tracheotomy

Answer 54

surgical incision into trachea for purpose of establishing an airway

Question 55

tracheostomy

Answer 55

stoma that results from tracheotomy may be temporary or permanent

Question 56

indications for a tracheostomy

Answer 56

stenosis of airway obstruction of airway laryngeal or neck trauma neck cancer extended need for mechanical ventilation

Question 57

complications of tracheostomy

Answer 57

dislodgment obstruction (mucus plugging) SQ emphysema skin breakdown (moisture and pressure) infection (lung infection) bleeding (from mucosal irritation)

Question 58

features of tracheostomy tubes

Answer 58

single lumen and dual lumen cuffed and un-cuffed reusable and disposable fenestrated and un-fenestrated

Question 59

nursing care with trachs

Answer 59

stoma care humification of airway suctioning ensure placement and patency monitor cuff pressures maintain extra trach and obturator at bedside frequent oral care aspiration precaution

Question 60

complications of trach suctioning

Answer 60

hypoxia tissue trauma infection vagal stimulation and bronchospasm cardiac dysrhythmias

Question 61

nutritional concerns with trachs

Answer 61

aspiration- inflated cuff can interfere with passage of food through the esophagus and weakened muscles elevate HOB 30 min after eating may need enteral feeding tube

Question 62

weaning from trach tubes

Answer 62

trials of cuff deflation gradual decrease in size of trach tube may change from cuffed to un-cuffed may change to fenestrated tube cap trach with speaking valve or trach button

Question 63

psychosocial considerations with trachs

Answer 63

communication support for patients and families become involved in self care activities

Question 64

ABG

Answer 64

most accurate, invasive, obtained by arterial blood draw

Question 65

A patient is receiving preoperative teaching for a partial laryngectomy and will have a tracheostomy. How does the nurse define a tracheostomy to the patient? – A. Opening in the trachea that enables breathing – B. Temporary procedure that will be reversed later – C. Technique using positive pressure to improve gas exchange – D. Procedure that holds the airway open

Answer 65

A

Question 66

A patient returns from the operating room after a tracheostomy placement. While assessing the patient which observations by the nurse warrant immediate notification to the provider? – A. Patient is alert but unable to speak – B. Small amount of bleeding present at incision – C. Skin is puffy at the neck area with a crackling sensation – D. Respirations are audible and noisy with increased respiratory rate

Answer 66

C

Question 67

To prevent accidental decannulation of a tracheostomy tube, what does the nurse do? – A. Obtain an order for continuous upper extremity restraints – B. Secure the tube in place using ties or fabric fasteners – C. Allow some flexibility in motion of the tube while coughing – D. Instruct the patient to hold the tube with a tissue while coughing

Answer 67

B

Question 68

A patient has a recent tracheostomy. What necessary equipment does the nurse ensure is kept at the bedside? (select all that apply) – A. Ambu bag – B. Pair of wire cutters – C. Oxygen tubing – D. Suction equipment – E. Tracheostomy tube with obturator

Answer 68

ACDE

Question 69

A nurse is educating a client who will be going home with a tracheostomy. When discussing suctioning frequency, what should be included in the education? – A. The tracheostomy should be suctioned every 4 hours – B. The tracheostomy should be suctioned when secretions can not be cleared and physical symptoms are present – C. The tracheostomy should only be suctioned in an emergency – D. The tracheostomy should only be suctioned at times when the home health nurse is available.

Answer 69

B

Question 70

A patient with a tracheostomy is unable to speak. He is not in acute distress, but is gesturing and trying to communicate with the nurse. Which nursing intervention is the best approach to the situation? – A. Rely on the family to interpret for the patient – B. Ask questions that can be answered with a yes or no – C. Obtain an immediate speech consult – D. Encourage the patient to rest rather than struggle with communication

Answer 70

B

Question 71

steps for trach suction

Answer 71

1. Assess the need for suctioning (routine unnecessary suctioning causes mucosal damage, bleeding, and bronchospasm). 2. Wash hands. Don protective eyewear. Maintain Standard Precautions. 3. Explain to the patient that sensations such as shortness of breath and coughing are to be expected but that any discomfort will be very brief. 4. Check the suction source. 5. Set up a sterile field. 6. Preoxygenate (hyperventilate) the patient with 100% oxygen for 3 ventilations prior to suction. 7. Quickly insert the suction catheter until resistance is met. Do not apply suction during insertion. 8. Withdraw the catheter 1 to 2 m, and begin to apply suction. Apply suction and use a twirling motion of the catheter during withdrawal. Never suction longer than 10 to 15 seconds. 9. Hyperoxygenate for 1 to 5 minutes or until the patient's baseline heart rate and oxygen saturation are within normal limits.

Question 72

Chronic airflow limitations (CAL)

Answer 72

asthma and COPD (chronic bronchitis and emphysema)

Question 73

Causes of Asthma

Answer 73

inflammation and hyper responsiveness of airways to common stimuli inflammation in the mucous membranes and hyper responsiveness constricts the bronchial smooth muscle intermittent if well controlled

Question 74

triggers of asthma

Answer 74

allergens cold air/poor air quality exercise respiratory illness/ URI general irritants microorganisms GERD

Question 75

diagnostics on asthma

Answer 75

ABG (hypoxemia or acidosis) PFTs

Question 76

treatment and nursing care for asthma

Answer 76

goal: control and prevent episodes, improve airflow, relieve symptoms medications: inhaled or systemic; preventative and rescue; bronchodilators and anti-inflammatory agents avoidance of triggers, inhalers and nebulizers, oxygen therapy if extreme

Question 77

status asthmaticus

Answer 77

severe and life threatening treatment: oxygen, IV fluids, potent systemic bronchodilation, IV steroids, epinephrine emergency intubation can develop pneumothorax and cardiac respiratory arrest absence of wheezing can indicate complete airway obstructions

Question 78

COPD causes

Answer 78

chronic exposure to irritants, commonly smoking. causes inflammation, congestion, mucosal edema and bronchospasm. only effects airways, not alveoli production of large amounts of thick mucus EMPHYSEMA

Question 79

Symptoms of COPD

Answer 79

dyspnea orthopnea cough with sputum production use of accessory muscles hypoxemia chronic acidosis weight loss fatigue barrel chest cyanosis clubbing of fingers anxiety

Question 80

diagnostics for COPD

Answer 80

ABG sputum sample CBC chest xray chest CT PFTs

Question 81

nursing care for COPD

Answer 81

attain or maintain gas exchange within the patient's baseline and control symptoms O2 therapy: O2 sat between 88-90 Hypoxic vasoconstriction with emphysema (blood shunting from unhealthy part of lung to healthy part... artificial O2 will mess up this process) Positioning; elevate the HOB, tripoding Cessation of smoking energy conservation breathing exercise nutritional counseling medications (bronchodilators, anti-inflammatories, mucolytic agents)

Question 82

COPD complications

Answer 82

hypoxemia acidosis respiratory infection cardiac failure cardiac dysrhythmias

Question 83

purpose of lung cancer chest tubes

Answer 83

collects air, fluid, or blood from the pleural space allows the lung to re-expand prevents air from re-entering the pleural space wet drainage system

Question 84

nursing care for lung cancer chest tubes

Answer 84

ensure dressing is tight and intact around tubing assess SOB and breath sounds check alignment of trachea Palpate for puffiness or crackling observe for signs of infection check to see if tube 'eyelets' (holes indicating dislodgment) are visible Keep drainage system lower than the level of the patient's chest asses for tidaling watch for tension pneumothorax and SQ emphysema

Question 85

lung cancer chest tube emergencies

Answer 85

tracheal deviation sudden onset or increased intensity of dyspnea O2 sat less than 90 Drainage greater than 70mL/hr eyelets on the chest tube chest tube falls out of patient's chest

Question 86

What are some most common types of pneumonia? (Select all that apply) A. community acquired B. hospital acquired C. ventilator associated D. healthcare associated E. dormant pneumonia

Answer 86

ABCD

Question 87

Which clinical manifestations would the nurse most likely see in a client diagnosed with pneumonia? (Select all that apply) A. Chest discomfort B. Dyspnea C. Fever D. Cough E. Myalgia F. Increased respiratory rate

Answer 87

ABCDEF

Question 88

Which diagnostic tests does the nurse initially expect to be ordered for the client with pneumonia? (Select all that apply) A. Pulse oximetry B. Arterial blood gases C. Chest X-ray D. Chest CT E. Sputum culture F. Complete Blood Count (CBC) G. Complete Metabolic Panel (CMP) H. Coagulation panel I. Pulmonary function test

Answer 88

ABCEF

Question 89

When caring for a client with pneumonia, which nursing intervention is the highest priority? A. Increase fluid intake B. Encourage deep breathing exercises and controlled coughing C. Ambulate as much as possible E. Maintain a nothing-by-mouth (NPO)

Answer 89

B

Question 90

What should the nurse include in discharge teaching for a client to prevent further pneumonia? (Select all that apply) A. Continue IV antibiotics B. Continue breathing exercises C. Healthy balanced diet D. Decrease fluid intake E. Avoid crowded public areas F. Annual flu vaccine G. Pneumococcal vaccine

Answer 90

BCEFG

Question 91

pneumonia

Answer 91

excess fluid in the lungs resulting from an inflammatory process inflammation triggered by many infectious organisms and inhalation of irritating agents develops when the immune system cannot overcome the invading organisms

Question 92

pneumonia types

Answer 92

community acquired CAP hospital acquired HAP health care associated HCAP ventilator associated VAP

Question 93

community acquired pneumonia CAP

Answer 93

acquired in community

Question 94

hospital acquired pneumonia HAP

Answer 94

diagnosis less than 48 hours after admission to hospital

Question 95

health care associated pneumonia HCAP

Answer 95

diagnosis greater than 48 hours after admission to a hospital and has had recent treatment at a health care facility (inpatient or outpatient)

Question 96

ventilator associated pneumonia VAP

Answer 96

diagnosis within 48-72 hours of intubation

Question 97

pneumonia risk factors

Answer 97

older adult not vaccinated for flu or pneumococcal Chronic health problems limited mobility uses tobacco or alcohol altered LOC aspiration poor nutritional status immunocompromised status mechanical ventilation

Question 98

pneumonia prevention

Answer 98

avoid risk factors annual influenza vaccine pneumococcal vaccine avoid crowded areas during flu season hand washing cough, turn, and move if you have impaired mobility Clean respiratory equipment avoid indoor pollutants stop smoking drink 3L of fluid each day as recommended with diet

Question 99

CM of pneumonia

Answer 99

increased RR or dyspnea hypoxemia cough purulent, blood tinged, or rust colored sputum fever with or without chills pleuritic chest discomfort acute confusion from hypoxia

Question 100

pneumonia lab results

Answer 100

sputum by gram stain, culture, and sensitivity testing CBC to assess elevated WBC blood culture ABGs serum lactate level procalcitonin BUN and electrolytes

Question 101

pneumonia imaging assessment

Answer 101

chest x ray pulse ox invasive tests: transtracheal aspiration, bronchoscopy, direct needle aspiration of the lung

Question 102

Priority nursing diagnosis for pneumonia

Answer 102

impaired gas exchange related to decrease diffusion at the alveolar- capillary membrane

Question 103

pneumonia nursing interventions

Answer 103

O2 therapy monitor pulse ox cough and deep breath every 2 hours incentive spirometry adequate hydration assess fluid status drug therapy

Question 104

diabetes definition

Answer 104

chronic metabolic disease resulting from either a deficiency in insulin secretion, resistance of insulin action at the cellular level or both resulting in hyperglycemia and inability to regulate blood glucose.

Question 105

what happens in the absence of insulin?

Answer 105

body breaks down other sources for energy (fats and proteins) counter-regulatory hormone levels are increased (glucagon, epinephrine, GH, and cortisol)

Question 106

why is insulin important?

Answer 106

key that moves glucose into cells a decrease can cause hyperglycemia the cells don't get the glucose they need

Question 107

symptoms of DM

Answer 107

polyuria, polydipsia, polyphagia, metabolic acidosis, Kussmaul respirations, dehydration and electrolyte imbalance

Question 108

polyuria

Answer 108

frequent and excessive urination caused by osmotic diuresis secondary to excess glucose

Question 109

polydipsia

Answer 109

excessive thirst caused by dehydration

Question 110

polyphagia

Answer 110

excessive eating cause by cell starvation

Question 111

types of diabetes

Answer 111

type 1, type 2, gestational

Question 112

type 1 diabetes

Answer 112

no insulin is produces autoimmune disorder beta cells of the pancreas are destroyed by antibodies onset usually occurs less than 30 yo abrupt onset weight loss requires insulin could be viral in etiology

Question 113

Type 2 diabetes

Answer 113

reduction of the cells to respond to insulin and decreased secretion of insulin from beta cells onset usually occurs greater than 50 yo could have no symptoms or polydipsia, fatigue, blurred vision, vascular and neural comlications

Question 114

gestational diabetes

Answer 114

glucose intolerance during pregnancy

Question 115

Acute complications of DM

Answer 115

Diabetic Ketoacidosis Hyperglycemic- Hyperosmolar state Hypoglycemia all considered medical emergencies

Question 116

DKA

Answer 116

insulin deficiency and acidosis

Question 117

HHS

Answer 117

insulin deficiency and severe dehydration

Question 118

hypoglycemia

Answer 118

too much insulin or too little glucose

Question 119

What are chronic complications of DM caused by

Answer 119

changes in blood vessels in tissue and organs (poor tissue perfusion, cell damage and death) vascular changes result from: hyperglycemia thickening basement membranes and causing organ damage. hyperglycemia affects cell integrity

Question 120

What are the two types of chronic complications in DM

Answer 120

macro vascular microvascular

Question 121

Macrovascular examples

Answer 121

cardiovascular disease- MI cerebral vascular disease- stroke peripheral vascular disease- PAD/PVD pulmonary embolism- PE

Question 122

risk factors for macrovascular diseases

Answer 122

HTN obesity dyslipidemia sedentary lifestyle

Question 123

nursing implication for DM

Answer 123

decreasing modifiable risk factors

Question 124

microvascular examples

Answer 124

retinopathy neuropathy nephropathy

Question 125

retinopathy

Answer 125

caused by damage to the retinal vessels causing leaking and retinal hypoxia

Question 126

neuropathy

Answer 126

progressive deterioration of nerves loss in sensation or muscle weakness blood vessel changes that lead to nerve hypoxia can affect multiple body systems (extremities, GI, cardiac, urinary)

Question 127

nephropathy

Answer 127

change in kidney that decreases function and causes kidney failure chronic high blood glucose: causes leaking and hypoxia of nephrotic vessels increase in filtration of large particles, damaging kidneys further

Question 128

Fasting blood glucose range

Answer 128

70-100 above 126 on at least 2 occasions is diagnostic for DM

Question 129

Glucose tolerance test

Answer 129

less than 140

Question 130

Hemoglobin A1C

Answer 130

4-6% levels greater than 6.5% are diagnostic for DM

Question 131

Planning and Priorities for DM

Answer 131

injury related to hyperglycemia impaired wound healing injury related to diabetic neuropathy acute and chronic pain related to diabetic neuropathy injury related to retinopathy (reduced vision) potential for kidney disease potential l hypoglycemia potential DKA potential HHS

Question 132

expected outcome for DM

Answer 132

maintaining blood glucose in expected range and preventing acute and chronic complications of DM are the primary outcomes

Question 133

interventions for DM

Answer 133

proper nutrition- decrease alcohol, carb counting, watch saturated fats and cholesterol exercise- watch for injury blood glucose monitoring- accurate samples, clean technique, adequate supplies medications- DM T1 will require insulin, DM T2 may require medication

Question 134

ways to reduce risk for peripheral neuropathy by proper footcare

Answer 134

cleanse and inspect feet daily wear properly fitting shoes avoid walking with bare feet wear clean, dry socks daily trim toenails properly report non healing breaks in the skin of the feet

Question 135

s/s of neuropathy

Answer 135

tingling/numbness burning muscle cramps piercing or stabbing pain metatarsalgia (walking on marbles) allodynia (pain from normal non-painful stimuli) hyperalgesia (exaggerated pain response)

Question 136

reducing injury from impaired vision

Answer 136

regular eye exams appropriate eyewear reading aids adaptive devices for insulin administration/ BG monitoring

Question 137

reducing injury for diabetic nephropathy

Answer 137

control HTN control hyperlipidemia assess kidney function annually smoking cessation

Question 138

hypoglycemia features

Answer 138

skin is cool and clammy absent dehydration no change in respirations anxious, nervous, irritable mental status seizure and coma weakness, double vision, blurred vision, hunger tachycardia, palpitations glucose is less than 70 negative ketones

Question 139

hyperglycemia features

Answer 139

Skin is warm and moist Dehydration is present Kussmaul respirations- fruit odor Mental status varies No specific symptoms- acidosis and dehydration Glucose greater than 250 Positive ketones

Question 140

Laboratory findings for DKA

Answer 140

glucose greater than 300 variable osmolarity positive serum ketones pH less than 7.35 HCO3 less than 15 variable serum Na BUN greater than 30 Creatinine greater than 1.5 positive urine ketones

Question 141

Laboratory findings for HHS

Answer 141

glucose greater than 600 osmolarity greater than 320 negative serum ketones pH greater than 7.4 HCO3 greater than 20 normal or low serum Na elevated BUN and creatinine negative urine ketones

Question 142

60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. Is her condition consistent with hyperglycemia or hypoglycemia? Explain why...

Answer 142

Hypoglycemia especially because she received her insulin about an hour ago and has not replenished her glucose supply.

Question 143

60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. What is your first action? Explain why...

Answer 143

Check her blood glucose level immediately because the methods to increase her blood glucose level are dependent on how the current level is.

Question 144

60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. What is the most likely cause leading to this problem?

Answer 144

Clearly, there was a delay in eating after receiving the insulin. Moreover, it is possible because of her recent change to insulin, she was not aware of the necessity of eating soon after receiving insulin.

Question 145

60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. What should happen to prevent this from happening again in the future?

Answer 145

More education to the patient about the relationship between insulin and eating. The nurse should also evaluate the patient 20 min after administering short acting insulin.

Question 146

21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. O2 sat is 99, BP 110/60, pulse is 110/min, Resp. are 32/min, glucose 485 mg/dL . Should you apply oxygen at this time? Why or why not?

Answer 146

No. Applying oxygen would serve no useful purpose. His respiratory symptoms are a result of compensation for the metabolic acidosis.

Question 147

21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. What is going on with this patient?

Answer 147

DKA

Question 148

21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. What is the immediate intervention the Dr. would prescribe?

Answer 148

IV drip because SQ wont absorb fast enough and is inappropriate for emergency situations. patient could also get IV fluids to correct fluid deficit.

Question 149

21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. What is another acute complication of DM resulting from elevated glucose?

Answer 149

HHS

Question 150

how long is each segment of a monitor strip

Answer 150

6 second strip

Question 151

P wave

Answer 151

represents atrial depolarization (atrial contraction) present, consistent, configuration, one P wave before each QRS complex

Question 152

PR interval

Answer 152

represents the time required for atrial depolarization as well as impulse travel through the conduction system

Question 153

QRS complex

Answer 153

is measured from the beginning of the Q (or R) wave to the end if of the S wave (ventricular contraction)

Question 154

ST segment

Answer 154

represents early ventricular repolarization- ventricular returning to resting state. indication of MI

Question 155

QT interval

Answer 155

total time required for ventricular depolarization and repolarization

Question 156

Steps to ECG Rhythm Analysis

Answer 156

determine HR, Heart rhythm, analyze P waves, measure PR interval, QRS duration, examine the ST segment.

Question 157

normal PR interval duration

Answer 157

0.12- 0.20 and constant

Question 158

normal QRS duration

Answer 158

0.06-0.12 and constant

Question 159

Elevations in ST segment

Answer 159

may indicate myocardial infarction, pericarditis, hyperkalemia

Question 160

depression in ST segment

Answer 160

is associated with hypokalemia, myocardial infarction, ventricular hypertrophy.

Question 161

normal sinus rhythm

Answer 161

rate 60-100 bpm rhythm: atrial and ventricular rhythms are regular

Question 162

sinus arrhythmia (SA)

Answer 162

variant of normal sinus rhythm, results from changes in intrathoracic pressure during breathing, has all the characteristics if normal sinus rhythm except for its irregularity. The PP and RR intervals vary, with the difference between the shortest and the longest intervals being greater than 0.12 second

Question 163

Dysrhythmias

Answer 163

Any disorder of the heartbeat

Question 164

Tachydysrhythmias

Answer 164

Heart rate greater than 100 beats per minute

Question 165

Bradydysrhythmias

Answer 165

Heart rate less than 60 bpm

Question 166

Premature complexes

Answer 166

Early rhythm complexes; if they become more frequent, especially those that are ventricular, the patient may experience symptoms of decreased cardiac output.

Question 167

Repetitive rhythm complexes

Answer 167

Bigeminy, trigeminy, quadrigeminy

Question 168

Etiology for dsyrhythmias

Answer 168

May occur for many reasons. Can be classified by their site of origins in the heart (sinus, atrial, ventricular). Managed with antidysrhythmic drug therapy.

Question 169

Care of patients with dysrhythmias

Answer 169

Asses VS every 4 hours Monitor for cardiac dysrhythmias Evaluate and document patients response Encourage patient to notify nurse if chest pain occurs Asses for chest pain and respiratory difficulty Asses peripheral circulation Administer medication and monitor response Monitor lab values Monitor activity tolerance and schedule exercise/rest periods, avoid fatigue Promote stress reduction Offer spiritual support

Question 170

Atrial Dysrhythmia-Supra-ventricular Tachycardia

Answer 170

Rapid stimulation of atrial tissue occurs at rate of 100-280 bpm in adults. P waves may not be visible, because they are embedded in the preceding T wave.

Question 171

Atrial Fibrillation

Answer 171

Most common dysrhythmia. Associated with atrial fibrosis and loss of muscle mass. Common in heart disease such as HTN, heart failure, CAD. Many other risk factors. Cardiac output can decrease by as much as 20-30%

Question 172

Assessment for A Fib

Answer 172

Assess for fatigue, weakness, SOB, dizziness, anxiety, syncope, palpitations, chest discomfort or pain, hypotension. High risk for PE, VTE, stroke

Question 173

Drug Therapy for A fib

Answer 173

Calcium channel blocker, aminodarone, beta blockers, digoxin, anticoagulants, antiplatelet

Question 174

Other treatments for A fib

Answer 174

Cardio version, per cutaneous radio frequency catheter ablation, bi-ventricular pacing, surgical maze procedure

Question 175

Ventricular dysrhythmias

Answer 175

More life threatening than atrial dysrhythmias. Left ventricle pumps oxygenated blood throughout the body to perfume vital organs and other tissues. Most common or life threatening: PVC, VT, VF, VA

Question 176

Ventricular dysrhythmia- ventricular tachycardia

Answer 176

Also called v tach- repetitive firing of an irritable ventricular ectopic focus, usually 140-180 bpm or more.

Question 177

Stable VT

Answer 177

Treatment: oxygen amiodarone, lidocaine, or magnesium sulfate, elective cardio version radio frequency catheter ablation, implantable cardioverter debrillation. Oral antidysrhythmic agent: mexiletine or sotalol To prevent further occurrences.

Question 178

Unstable VT

Answer 178

Can cause cardiac arrest, unstable VT without a pulse is treated the same way as v fib. Assess patient’s airway, breathing, circulation, LOC, and oxygenation level

Question 179

Treatment for V Fib

Answer 179

Life threatening… no cardiac output or pulse, blood is no longer being pumped out of the heart and brain not receiving blood. May be the first manifestation of CAD. First priority: patient immediately. Continue high quality CPR, provide airway management, follow ACLS protocol.

Question 180

Ventricular dysrhythmia- ventricular fibrillation

Answer 180

Called v fib. Result of electrical chaos in ventricles

Question 181

Ventricular dysrhythmia-ventricular asystole

Answer 181

Called ventricular standstill- complete absence of any ventricular rhythm.

Question 182

Treatment for ventricular asystole

Answer 182

Full cardiac arrest- no cardiac output or perfusion to the rest of the body. Prognosis is poor. Manage airway. Administer CPR- compressions, airway, breathing. DO NOT DEFIBRILLATE… no electrical activity to shock. Follow ACLS protocols

Question 183

Patient teachings with dysrhythmias

Answer 183

Prevention, early, recognition, and management. Lifestyle, modifications, (avoid caffeinated beverages, stop, drinking, drink, alcohol in moderation, follow prescribe diet). Drug therapy instructions. Teach the patient and family how to take pulse and or blood pressure and report any changes. Keep follow up appointments. Provide oral and written instruction for pacemaker, ICDS, cardiac exercise programs, support groups as applicable.

Question 184

A client who had open abdominal surgery 4 hours ago reports feeling weak and dizzy. The client's current blood pressure has decreased to 98/50, and pulse rate is 120. What is the nurse's best action at this time? –A. Document the vital signs, and continue to monitor the client. –B. Remind the client to stay in bed if feeling weak and dizzy. –C. Call the health care provider immediately. –D. Increase the client's IV rate to restore fluid volume.

Answer 184

C

Question 185

A client in the telemetry unit is on a cardiac monitor. The monitor technician notices there are no ECG complexes and the alarm sounds. What is the first action by the nurse? –A. Begin CPR immediately. –B. Call the emergency response team. –C. Press the record button to get an ECG strip. –D. Assess the client and check lead placement

Answer 185

D

Question 186

Hypertension

Answer 186

most common health problem seen in primary settings. AHA 2017 guidelines above 130/80

Question 187

desired BP in 60 yo and older

Answer 187

below 150/90

Question 188

desired BP in younger than 60 yo

Answer 188

below 140/90

Question 189

desired BP in patients with DM and heart disease

Answer 189

below 130/90

Question 190

BP elevations...

Answer 190

results in damage to organs, causes thickening of the arterioles, as the blood vessels thicken, perfusion decreases and body organs are damaged

Question 191

HTN is a major risk for...

Answer 191

stroke, myocardial infarction, kidney failure, death

Question 192

Classifications of HTN

Answer 192

primary and secondary

Question 193

primary classification of HTN

Answer 193

most common type, not caused by an existing health problem: can develop when a patient has any one or more of the risk factors: family history, African American ethnicity, hyperlipidemia, smoking, older than 60 or postmenopausal, excessive sodium and caffeine intake, overweight/obesity, physical inactivity, excessive alcohol intake, low potassium, calcium or magnesium intake, excessive and continuous stress.

Question 194

secondary classification of HTN

Answer 194

results from specific diseases and some drugs. kidney disease is one of the most common causes of secondary HTN

Question 195

physical assessment/clinical manifestations of HTN

Answer 195

most people have no symptoms, some patients experience headaches, facial flushing (redness), dizziness, fainting, blood pressure screenings (take in both arms, two or more readings at a visit, use appropriate size cuff)

Question 196

orthostatic hypotension

Answer 196

decrease in BP with changes in position, 20 mmHg for systolic and or 10 mmHg for diastolic

Question 197

psychosocial considerations for HTN

Answer 197

assess for stressors that can worsen HTN

Question 198

Diagnostic assessment for HTN

Answer 198

no specific lab or x-rays are diagnostic of primary hypertension. secondary hypertension can be screened with labs specific to the underlying disease ex: kidney disease

Question 199

interventions for HTN

Answer 199

lifestyle changes, complementary and alternative therapies, drug therapy, avoid OTC medications (NSAIDS, decongestants)

Question 200

lifestyle changes for HTN

Answer 200

dietary sodium restriction to less than 2g per day, reduce weight, use alcohol sparingly, exercise 3-4 times a week for 40 min, use relaxation techniques to decrease stress, avoid tobacco and caffeine

Question 201

complementary and alternative therapies for HTN

Answer 201

biofeedback and meditation

Question 202

Drug therapies for HTN

Answer 202

diuretics, calcium channel blocker, angiotensin converting enzyme (ACE) inhibitor, angiotensin II recpetor blockers (ARBs), Aldosterone receptors antagonists, beta adrenergic blockers,

Question 203

Venous Thromboembolism VTE

Answer 203

includes deep vein thrombosis DVT and pulmonary embolism PE

Question 204

Risk factors for VTE

Answer 204

stasis of blood, vessel wall injury, altered blood coagulation VIRCHOW'S TRIAD

Question 205

VTE prevention

Answer 205

prevention is key to address this challenge in health care: patient education, leg exercises, early ambulation, adequate hydration, graduated compression stockings, intermittent pneumatic compression, such as SCDs, venous plexus foot pump, avoid oral contraceptive, anticoagulant therapy

Question 206

Unfractionated Heparin Therapy (UFH)

Answer 206

Baseline PT, aPTT, INR, CBC with platelet count antidote: protamine sulfate heparin-induced thrombocytopenia (HIT)- life threatening complication

Question 207

Low Molecular Weight Heparin (LMWH)

Answer 207

Preferred for prevention and treatment of VTE antidote: protamine sulfate May see an overlap of enoxaparin and warfarin given for treatment of DVT or PE

Question 208

Warfarin

Answer 208

given PO monitor PT and INR Assess for bleeding antidote: vitamin K teach patients to avoid foods with high concentrations of vitamin K

Question 209

It is shift change. The oncoming nurse enters the room and notices observable hematuria in Mrs. Adam’s urinary catheter. * What action should the nurse initiate first? –1. Obtain a stat aPTT –2. Stop the heparin infusion –3. Assess vital signs –4. Observe the surgical site for bleeding

Answer 209

2

Question 210

After consulting with the HCP, the nurse is to administer a heparin antagonist. * * Which medication will be administered? –1. Vitamin K –2. Protamine Sulfate –3. Enoxaparin (Lovenox) –4. Ticlopidine (Ticlid)

Answer 210

2

Question 211

To which nursing diagnosis should the nurse give the highest priority when planning care for Mrs. Adams? – 1. Pain related to decreased venous flow – 2. Risk for injury (bleeding) related to anticoagulant therapy – 3. Impaired physical mobility related to prescribed bedrest – 4. Knowledge deficit related to lack of discharge teaching

Answer 211

2

Question 212

Mrs. Adams is transitioned to warfarin by mouth. Mrs. Adams should receive additional teaching about foods * Which food should the nurse instruct Mrs. Adams to avoid? –1. Apple products –2. Red meats –3. Green leafy vegetables –4. Nuts

Answer 212

3

Question 213

heart failure statistics

Answer 213

leading cause of hospital admission for patients over 65. major cause of disability and death. Readmission an important quality measure in acute care. CMS core measure.

Question 214

heart failure

Answer 214

chronic inability of heart to work effectively as a pump. Heart not able to maintain adequate cardiac output to meet the metabolic needs of the body.

Question 215

types of heart failure

Answer 215

left sided right sided high output failure most heart failure of the left ventricle and progresses to failure of both ventricles.

Question 216

right sided heart failure

Answer 216

right ventricle can not empty effectively.

Question 217

causes of right sided heart failure

Answer 217

left ventricular failure right ventricular MI pulmonary HTN chronic ling disease

Question 218

symptoms of right sided heart failure

Answer 218

systemic congestion - JVD - enlarged liver and spleen - anorexia and nausea - dependent edema - distended abdomen - swollen hands and fingers - polyuria at night - weight gain - increased blood pressure from excess volume - decrease blood pressure from failure

Question 219

left sided heart failure

Answer 219

decreased tissue perfusion form poor cardiac output and pulmonary congestion.

Question 220

systolic heart failure

Answer 220

heart can not contract forcefully enough to eject adequate blood

Question 221

diastolic heart failure

Answer 221

ventricle can not relax adequately during diastole preventing adequate filling of blood

Question 222

causes of left sided heart failure

Answer 222

HTN CAD valvular disease

Question 223

symptoms of left sided heart failure

Answer 223

pulmonary congestion - hacking cough, worse at night - dyspnea - crackles/wheezes in lungs - pink, frothy sputum - tachypnea - S3/S4 gallop Decreased cardiac output - fatigue and weakness - oliguria during day/nocturia at night - angina - confusion and restlessness - dizziness - pallor and cool extremities - weak peripheral pulses - tachycardia

Question 224

high output heart failure

Answer 224

occurs when cardiac output remains normal or above normal but there are increased metabolic needs to hyperkinetic conditions

Question 225

causes of high output heart failure

Answer 225

septicemia high fever anemia hyperthyroidism **not as common as the other two types

Question 226

Cardiac compensatory mechanisms

Answer 226

when cardiac output is insufficient to meet the demands of the body, compensatory mechanisms work to improve cardiac output. eventually the heart can not keep up with the demands, then CM of HF occur.

Question 227

compensatory mechanism: sympathetic nervous system stimulation

Answer 227

increase HR and blood pressure

Question 228

compensatory mechanism: RAAS

Answer 228

causes vasoconstriction and retention of Na and water

Question 229

compensatory mechanism: other chemical responses

Answer 229

immune responses causes ventricular remodeling. endothelium causes vasoconstriction. vasopressin causes vasoconstriction

Question 230

compensatory mechanism: myocardial hypertrophy

Answer 230

thicken of heart walls to increase muscle mass lead to more forceful contractions

Question 231

electrolytes related to cardiac

Answer 231

abnormalities from complications of HF or side effects of drug therapy

Question 232

BUN and creatinine

Answer 232

inadequate perfusion of kidneys can result in impairment and elevated levels

Question 233

hemoglobin and hematocrit

Answer 233

could be low secondary to demodilution

Question 234

urinalysis

Answer 234

possible proteinuria and high specific gravity

Question 235

microalbuminuria

Answer 235

early indicator of decreased compliance of heart and occurs before the BNP rises

Question 236

ABGs

Answer 236

evaluates hypoxemia decrease in gas exchange secondary to fluid filled alveoli

Question 237

BNP

Answer 237

will be elevated and used for diagnosing HF BNP is produced and released by the ventricles when the patient is fluid overload natiuretic peptides are neurohormones that promote vasodilation and diuresis through sodium loss in the renal tubules patients with renal disease may also have elevated levels

Question 238

Cardiac imaging

Answer 238

chest xray echocardiography

Question 239

chest xray

Answer 239

cardiomegaly may be present

Question 240

echocardiography

Answer 240

best tool in diagnosing HF measures chamber size, EF and flow

Question 241

Cardiac priority problems

Answer 241

impaired gas exchange related to ventilation/perfusion imbalance. decreased cardiac output related to altered contractility, preload, and after load. fatigue related hypoxemia. potential for pulmonary edema.

Question 242

HF nursing interventions

Answer 242

oxygen (90% or greater) monitor respirations and lung sounds if dyspnea present, high fowlers position reposition, cough, deep breath every 2 hours drug therapy nutrition therapy fluid restriction weight daily monitor and record I&O provide periods of uninterrupted rest asses the patient's response to increased activity

Question 243

Cardiac drug therapy effect

Answer 243

to improve stroke volume- reduced after load, preload, but improve cardiac muscle contractility

Question 244

if dyspnea present, high fowlers position because...

Answer 244

maximize chest expansion and improve oxygenation

Question 245

reposition, cough, deep breath every 2 hours because...

Answer 245

improve oxygenation and prevent atelectasis

Question 246

nutrition therapy because...

Answer 246

goal to reduce sodium and water retention reduce sodium intake 2g/day

Question 247

fluid restriction limit...

Answer 247

range from 2 liters to 3 liters per day

Question 248

weigh daily because

Answer 248

most reliable indicator of fluid gain or loss. 1 kg of weight gin or loss equals 1 liter of retained or lost fluid

Question 249

Cardiac nonsurgical options

Answer 249

CPAP- improves sleep apnea and supports cardiac output and ejection fraction cardiac resynchronization therapy- uses a permanent pacemaker alone or in combination with implantable cardioverter-defibrillator gene therapy

Question 250

Cardiac surgical options

Answer 250

heart transplant ventricular assistive devices (VAD)- mechanical pump is implanted to work with patient's heart to improve function

Question 251

patient teaching for heart failure

Answer 251

diet: sodium restriction and fluid restriction activity schedule drug therapy discharge instructions resources and equipment needs decreases readmissions!!!

Question 252

HF symptoms to report to HCP

Answer 252

rapid weight gain (3 lb/week or 1-2 lb/night) decrease in exercise tolerance lasting 2-3 days cold symptoms lasting more than 3-5 days excessive awakening at night to urinate development of dyspnea or angina at rest or worsening angina increased swelling in feet, ankles or hands

Question 253

Bert is concerned and he is not sure what caused this problem? What prior medical history puts Bert at risk for heart failure(Select all that apply)? – 1. Hypertension – 2. Hypothyroidism – 3. GERD – 4. Aortic valve stenosis

Answer 253

1,4

Question 254

Which question will provide the nurse the best data about any additional risk factors for heart failure? (Select all that apply) 1. “Do you have any chronic lung disorders?” 2. “Have you ever had a heart attack?” 3. “Do you have varicose veins?” 4. “Have you ever had low blood pressure?”

Answer 254

1, 2

Question 255

When planning care for Bert the nurse anticipates what diagnostic procedure? – 1. Cardiac catheterization – 2. Echocardiogram – 3. Angiography – 4. Exercise electrocardiograpy

Answer 255

2

Question 256

Which assessment finding would indicate to the nurse that Bert is experiencing right-sided heart failure? 1. Dyspnea 2. Tachycardia 3. Edema 4. Fatigue

Answer 256

3

Question 257

The nurse prepares a dose of Digoxin (Lanoxin) 0.125 mg IV push. The drug is supplied 0.25 mg in 2 mL. How many mL should the nurse prepare to administer?

Answer 257

1 mL

Question 258

Prior to administration what assessment finding would prevent the nurse from administering lanoxin? 1. BP 99/68 2. Apical pulse 48 3. Respiratory rate 28 4. SpO2 89%

Answer 258

2

Question 259

Which assessment is most important for the nurse to perform prior to the administration of captopril(Capoten)? 1. Apical pulse 2. Blood pressure 3. Respiratory rate 4. Intake and output

Answer 259

2

Question 260

Which complaint by Bert would be of highest concern after adminstration of captopril? 1. Diarrhea 2. Itching in throat 3. Constant dry cough 4. Dizziness when standing

Answer 260

2

Question 261

When planning care for Bert what should be the priority nursing diagnosis? 1. Fluid volume deficit 2. Ineffective airway clearance 3. Altered nutrition, greater than needs 4. Impaired gas exchange

Answer 261

4

Question 262

Which intervention should be implemented based on the diagnosis of activity intolerance? 1. Provide 3 large meals daily 2. Provide all activities of daily living (ADLs) for the patient 3. Encourage frequent rest periods 4. Encourage regular aerobic exercise

Answer 262

3

Question 263

The nurse enters Bert’s room and finds him lying in bed in a supine position. His respiratory rate is 32 per minute and he states that his back hurts. Which action should the nurse implement first? 1. Notify the respiratory therapist 2. Assist Bert to turn on his side 3. Elevate the head of Bert’s bed 4. Offer Bert a back massage

Answer 263

3

Question 264

The nurse assesses that Bert is becoming increasingly confused and restless, and that he has developed a frothy, productive cough. His vital signs are temperature 98, P 148, R 36, BP 110/64. Which intervention should the nurse implement first? 1. Obtain an oxygen saturation level via pulse oximeter 2. Call the lab to obtain a stat serum potassium level 3. Collect a sputum specimen for culture and sensitivity 4. Initiate suctioning to remove lung secretions

Answer 264

1

Question 265

Bert’s condition worsens and he is transferred to ICU. What are the priorities of care at this time (Select all that apply) 1. Rapid acting diuretics 2. Nitroglycerin 3. Aggressive pulmonary therapy 4. Aggressive IVF replacement 5. Beta blockers

Answer 265

1,2,3

Question 266

Bert is now recovered and on a medical surgical unit preparing for discharge. What statement by Bert indicates to the nurse that further teaching is required? 1. “I must weigh myself once a month and watch for fluid retention” 2. “If my heart feels like it is racing I should call the doctor” 3. “I’ll need to consider my activities for the day and rest as needed” 4. “I’ll need periods of rest and should avoid activity after a meal”

Answer 266

1

Question 267

Six months later Bert is back on your unit recovering from an AVR (aortic valve replacement) with an artificial valve. What should be including in his discharge teaching (Select all that apply)? – 1. Weigh yourself daily – 2. Use electric razors for shaving – 3. Pre-medicate with antibiotics prior to invasive procedures – 4. Avoid heavy lifting for 3-6 months

Answer 267

2,3,4

Question 268

angina pectoris

Answer 268

chest pain caused by temporary imbalance between the coronary arteries' ability to supply oxygen and the cardiac muscle's demand for oxygen. ischemia that occurs is limited in duration and does not cause permanent damage. Two types: chronic stable angina and unstable angina

Question 269

chronic stable angina

Answer 269

chest discomfort that occurs with moderate to prolonged exertion in a pattern that is familiar to the patient. Frequency, duration, and intensity of symptoms remain the same over several months. Results in only slight limitation of activity and is usually associated with a fixed atherosclerotic plaque. Usually relieved by nitroglycerin or rest; managed with drug therapy.

Question 270

acute coronary syndrome

Answer 270

term used to describe patients who have either unstable angina or acute myocardial infarction. Atherosclerotic plaque in the coronary artery ruptures, resulting in platelet aggregation (clumping), thrombus (clot) formation and vasoconstriction. ACS classified into one of three categories according to the presence or absence of ST- segment elevation on the ECG and positive serum troponin markers: - STEMI: ST elevated MI (traditional manifestation) - NSTEMI: Non ST elevated MI (common in women) - unstable angina pectoris

Question 271

unstable angina pectoris

Answer 271

chest pain or discomfort that occurs at rest or with exertion and causes severe activity limitation. Pressure may last longer than 15 min. Poorly relieved by rest or nitroglycerin. May present with ST changes but do not have changes in troponin or creatine kinase levels. New onset angina variant Prinzmetal's angina Pre-infarction angina

Question 272

new onset angina

Answer 272

describes the patient who has his or her first angina symptoms, usually after exertion or other increased demands on the heart.

Question 273

variant Prinzmetal's angina

Answer 273

chest pain or discomfort resulting form coronary artery spasm and typically occurs after rest.

Question 274

pre-infarction angina

Answer 274

refers to chest pain that occurs in the days or weeks before an MI

Question 275

Myocardial Infarction (MI or AMI)

Answer 275

occurs when myocardial tissue is abruptly and severely deprived of oxygen. When blood flow is quickly reduced by 80% to 90%, ischemia develops. Ischemia can lead to injury and necrosis of myocardial tissue if blood flow is not restored. Evolves over a period of several hours. Extent of infarction depends on collateral circulation, anaerobic metabolism and workload demands. Physical changes do not occur in the heart until 6 hours after the infarction. Once infarction occurs, scare tissue permanently changes the size and shape of the entire left ventricle, called ventricular remodeling.

Question 276

NSTEMI

Answer 276

Non ST segment elevation myocardial infarction. ST and T-wave changes on ECG. Indicates myocardial ischemia. Cardiac enzymes may be initially normal but elevate over the next 3-12 hours.

Question 277

causes of a NSTEMI

Answer 277

coronary vasospasm, spontaneous dissection, sluggish blood flow due to narrowing of the coronary artery.

Question 278

STEMI

Answer 278

ST elevated myocardial infarction. ST elevation in two leads on a ECG. Indicates myocardial infarction/necrosis. Attributable to rupture of the fibrous atherosclerotic plaque leading to platelet aggregation and thrombus formation at the site of rupture. Thrombus causes an abrupt 100% occlusion to the coronary artery.

Question 279

CAD/ ACS Etiology

Answer 279

atherosclerosis is the primary factor in the development of CAD; non-modifiable and modifiable risk factors contribute to atherosclerosis

Question 280

CAD/ACS incidence

Answer 280

average age for first MI, 65.1 years in men, 72 for women, postmenopausal women have lower incidence than men, postmenopausal women in their 70s or older have an equal chance.

Question 281

CAD/ACS health promotion

Answer 281

control or alter modifiable risk factors for CAD

Question 282

Physical assessment of ACS

Answer 282

may complain of pain or pressure, assess according to onset, location, radiation, intensity, duration, precipitating factors, relieving factors. assess for associated symptoms such as NV, diaphoresis, dizziness, weakness, palpitations, SOB assess BP, HR, Cardiac rhythm, dysrhythmias; sinus tach with PVC frequently occur in the first few hours after an MI assess distal peripheral pulses and skin temp; poor cardiac output can be manifested by cool, diaphoretic skin and diminished or absent pulses. auscultate for S3 gallop which often indicates HF (complication of MI) assess resp rate and breath sounds, crackles and wheezes may indicate LSHF assess for presence of JVD and peripheral edema. Assess for fever, patient with MI may experience temperature elevation for several days, in response to myocardial necrosis, indicating the inflammatory response.

Question 283

key features of angina

Answer 283

substernal chest discomfort: radiating to the left arm, precipitated by exertion or stress (or rest in variant angina) relieved by nitroglycerin or rest, lasting less than 15 min.

Question 284

key features of MI

Answer 284

pain or discomfort: substernal chest pain/pressure radiating to the left arm, pain discomfort in jaw, back, shoulder, or abdomen, occurring without cause usually in the morning, relieved by opioids, lasting 30 min or more.

Question 285

frequent associated symptoms of MI

Answer 285

N/V, diaphoresis, dyspnea, feelings of fear and anxiety, dysrhythmias, fatigue, palpitations, epigastric distress, anxiety dizziness, disorientation/ acute confusion, feeling SOB

Question 286

ACS psychosocial assessment

Answer 286

denial is common

Question 287

ACS lab assessment

Answer 287

Troponin's- T&I criterion stnadard use today; can be elevated within 3-4 hours and may remain elevated for 10-14 days. CK-MB (creatine kinase MB)

Question 288

ACS imaging assessment

Answer 288

thallium scans, contrast enhanced cardiovascular magnetic resonance, echocardiogram, computed tomography coronary angiography

Question 289

Other tests performed for ACS

Answer 289

12 lead ECG, stress test, cardiac catheterization

Question 290

Interventions for ACS to manage acute pain

Answer 290

supplemental oxygen, drug therapy, semi fowler position, quiet, calm environment

Question 291

Interventions for ACS to improve cardiopulmonary tissue perfusion

Answer 291

restoration of perfusion to injured area limits amount od extension, improves left ventricular function. complete, sustained reperfusion of coronary arteries after an ACS has decreased mortality rates.

Question 292

Interventions for ACS to increase activity intolerance

Answer 292

phase 1: patients progress at their own rate to increase levels of activity phase 2: cardiac rehab (all patients with MI should be referred)

Question 293

Interventions for ACS to promote effective coping

Answer 293

denial, anger, depression

Question 294

other examples of intervention for ACS

Answer 294

identify and manage dysrhythmias monitor for and manage HF monitor for and manage recurrent symptoms and extension of injury

Question 295

Invasive corrections to resolve angina or prevent MI

Answer 295

percutaneous coronary intervention (PCI) coronary artery bypass graft (CABG)

Question 296

The patient states that the chest discomfort occurs with moderate to prolonged exertion. He describes the pain as being “about the same over the past several months and going away with nitroglycerin or rest.” Based on the patient’s description of symptoms, what does the nurse suspect in this patient? A. Chronic stable angina (CSA) B. Unstable angina C. Acute ST elevated MI D. Acute Non ST elevated MI

Answer 296

A

Question 297

A 71-year-old female presents to the ED via EMS with pain in her upper back and shoulders that started 2 hours ago. She has been experiencing nausea, dizziness, shortness of breath, and diaphoresis. She reports that she has had more frequent indigestion over the past week and has been unusually fatigued Which of the following is the most likely diagnosis at this time? a. Acute Myocardial Infarction b. Chronic Stable Angina c. Congestive Heart Failure d. Deep Vein Thrombosis

Answer 297

A

Question 298

Which early reaction is most common in patients with the chest discomfort associated with unstable angina or MI? A. Depression B. Anger C. Fear D. Denial

Answer 298

D

Question 299

The patient is admitted for acute MI, but the nurse notes that the traditional manifestation of ST elevation myocardial infarction (STEMI) is not occurring. What other evidence for acute MI does the nurse expect to find in this patient? (Select all that apply) A. Positive troponin markers B. Chronic stable angina C. Non-ST elevation MI (non-STEMI) on ECG D. Cardiac dysrhythmia E. Pulmonary embolus F. Jugular vein distension (JVD)

Answer 299

AC

Question 300

A thallium scan is scheduled for a client who had a myocardial infarction (MI). What should the nurse explain to the client regarding the reason the scan has been prescribed? A. That it will monitor the mitral and aortic valves B. That it establishes the viability of myocardial muscle C. That it can visualize the ventricular systole and diastole D. That it will determine the adequacy of electrical conductivity

Answer 300

B

Question 301

The patient is traveling to the hospital via EMS to be admitted with AMI. He begins c/o extreme fatigue, chest pain, and shortness of breath. BP 84/59, HR 94, RR 28 and shallow, pulse thready, skin pale and diaphoretic. These symptoms are associated with: A. Decreased lung capacity B. Increased cardiac muscle tone C. Decreased cardiac output D. Increased cardiac output

Answer 301

C

Question 302

The patient arrives to the hospital. Which of the following are appropriate interventions for managing an Acute Coronary Syndrome? (Select all that apply) A. Supplemental oxygen B. Nitroglycerin SL C. Morphine IV D. Aspirin PO E. Propranolol PO F. Nifedipine PO

Answer 302

ABCDE

Question 303

Which of the following is considered a treatment for acute myocardial infarction? (Select all that apply) A. Supplemental oxygen B. Morphine IV C. Aspirin PO D. Tissue plasminogen activator IV E. PCI (Percutaneous Coronary Intervention) F. PTCA (Percutaneous transluminal coronary angioplasty) G. CABG (Coronary Artery Bypass Graft)

Answer 303

DEFG

Question 304

The patient received thrombolytic therapy for treatment of acute MI. What are post administration nursing responsibilities for this treatment? (Select all that apply) A. Document the patient’s neurologic status B. Observe all IV sites for bleeding and patency C. Monitor white blood cell (WBC) count and differential D. Monitor clotting studies E. Monitor hemoglobin and hematocrit F. Test stools, urine, and emesis for occult blood G. Observe the sternal wound site

Answer 304

ABDEF

Question 305

Which of the following is an appropriate recommendation for a patient being discharged from the hospital following an ACS episode? (Select all that apply) A. You should utilize resources to help you quit smoking B. You should consume no more than 2 g of sodium in 24 hours C. You can return to your usual activities right away D. You will be checking your labs regularly E. You can stop your hypertension medication F. You should find ways to manage your stress

Answer 305

ABDF

Question 306

What are characteristics of chronic stable angina? (Select all that apply) A. Pain is precipitated by exertion or stress B. Pain occurs without cause, usually in the morning C. Pain is relieved only by opioids D. Pain is relieved by nitroglycerin and rest E. Nausea, diaphoresis, feelings of fear, and dyspnea may occur F. Pain lasts less than 15 minutes

Answer 306

ABDF

Question 307

Within 4 to 6 hours after a client has a myocardial infarction, the nurse expects which blood level to increase? A. Lactate dehydrogenase (LDH-1) B. Creatine kinase-MB band (CK-MB) C. Erythrocyte sedimentation rate (ESR) D. Serum aspartate aminotransferase (AST)

Answer 307

B

Question 308

A patient is admitted with AMI and c/o moderate chest discomfort. The nurse asks about which associated symptoms? (Select all that apply) A. Nausea B. Diarrhea C. Diaphoresis D. Dizziness E. Joint pain F. Shortness of breath

Answer 308

ACDF

Question 309

Which of the following are appropriate interventions for managing stable angina? (Select all that apply) A. Supplemental oxygen B. Nitroglycerin SL C. Morphine IV D. Aspirin PO E. Propranolol PO F. Nifedipine PO

Answer 309

BDEF

Question 310

A client is admitted to the hospital with the diagnosis of myocardial infarction. The nurse should monitor this client for which signs and symptoms associated with heart failure? (Select all that apply) A. Weight loss B. Unusual fatigue C. Dependent edema D. Nocturnal dyspnea E. Increased urinary output

Answer 310

BCD

Question 311

Four patients are admitted with an Acute MI. Which one of them is least likely to be developing a complication? A. Pt c/o of increasing chest pain after receiving Morphine IV B. Pt with c/o increased need for urination C. Pt with multiple multifocal PVCs on EKG D. Pt with decreased level of consciousness and thready pulse

Answer 311

B

Question 312

Upper GI series (Barium Swallow)

Answer 312

X-ray from mouth to duodenojejunal junctions with use of barium

Question 313

Small bowel follow through

Answer 313

Extension of the upper Gi x-ray with use of barium

Question 314

Barium enema

Answer 314

x-ray of large intestine with use of barium

Question 315

EGD- esophagogastroduodenoscopy

Answer 315

visual examination of the esophagus, stomach, duodenum with use of fiberoptic scope

Question 316

EGD- esophagogastroduodenoscopy preparation

Answer 316

NPO for 6-8 hours and avoid anticoagulants, aspirin, NSADIS several days before the procedure.

Question 317

EGD- esophagogastroduodenoscopy procedure

Answer 317

moderate sedation and lasts about 20-30 minutes

Question 318

EGD- esophagogastroduodenoscopy post procedure

Answer 318

keep patient NPO until gag reflex returns, priority care includes preventing aspiration and assess for any bleeding or pain that could indicate perforation.

Question 319

ERCP- endoscopic retrograde cholangiopancreatography

Answer 319

visual and radiographic exam of liver, gallbladder, bile ducts, and pancreas. uses radiopaque dye, used to diagnose obstruction as well as treat obstructions

Question 320

ERCP- endoscopic retrograde cholangiopancreatography preparation

Answer 320

NPO for 6-8 hours and typically avoid anticoagulants as determined by provider

Question 321

ERCP- endoscopic retrograde cholangiopancreatography procedure

Answer 321

moderate sedation and lasts 30 minutes to 2 hours

Question 322

ERCP- endoscopic retrograde cholangiopancreatography post procedure

Answer 322

keep patient NPO until gaga reflex returns, priority care includes preventing aspiration and assess for any bleeding or pain that could indicate perforation. assess for gallbladder inflammation and pancreatitis, severe abd pain, n/v, fever and elevated lipase.

Question 323

small bowel endoscopy- enteroscopy

Answer 323

provides a visual view of the small intestine. used to evaluate and locate source of GI bleeding

Question 324

small bowel endoscopy- enteroscopy preparation

Answer 324

NPO except water for 8-10 hours then complete NPO for 2 hours before swallowing capsule

Question 325

small bowel endoscopy- enteroscopy procedure

Answer 325

sensors are placed on abdomen and patient wears a data recorder. patient swallows the capsule endoscope and can resume normal activity. patient may eat 4 hours after swallowing the capsule. procedure lasts 8 hours.

Question 326

small bowel endoscopy- enteroscopy post procedure

Answer 326

explain to the patient that the capsule endoscope is excreted naturally and will be seen in the stool.

Question 327

colonoscopy

Answer 327

endoscopic exam of the entire large intestine- can be used to visually diagnose, biopsy, and treat. baseline test should be done at age 50 and every 10 years

Question 328

colonoscopy preparation

Answer 328

clear liquids the day before, NPO 4-6 hours before, avoid aspirin, anticoagulants, and anti-platelet drugs several days before. adequate bowel cleansing is essential.

Question 329

colonoscopy procedure

Answer 329

moderate sedation and procedure last 30-60 minutes

Question 330

colonoscopy post procedure

Answer 330

observe for signs of perforation (severe pain) and hemorrhage, feelings of fullness and cramping are expected, fluids are permitted after the patient passes flatus to indicate that peristalsis has returned.

Question 331

acute gastritis definition

Answer 331

inflammation of gastric mucosa or submucosa after exposure to local irritants or other causes. complete regeneration and healing occur within a few days. if the stomach muscle is not involved, complete recovery usually occurs with not residual gastric inflammation. if the stomach muscle is affected, hemorrhage could occur.

Question 332

acute gastritis etiology

Answer 332

h. pylori and long term NSAID use (most common)

Question 333

chronic gastritis definition

Answer 333

chronic inflammation of the mucosal lining of the stomach- thinning and atrophy, loss of intrinsic factor, vitamin b 12 and results in pernicious anemia. decrease in acid of the stomach- increase in gastric cancer risk

Question 334

type a chronic gastritis

Answer 334

autoimmune

Question 335

type b chronic gastritis

Answer 335

h pylori infection is the most common cause

Question 336

atrophic chronic gastritis

Answer 336

caused by exposure to toxic substances in the workplace, h pylori infection, or autoimmune factors

Question 337

gastritis prevention

Answer 337

eat a well balances diet, avoid drinking excessive amounts of alcohol, avoid taking large amounts of NSAIDs, aspirin, avoid coffee and caffeine, manage stress, stop smoking

Question 338

acute gastritis CM

Answer 338

rapid onset of epigastric pain or discomfort** n/v, hematemesis, gastric hemorrhage, dyspepsia, anorexia

Question 339

chronic gastritis CM

Answer 339

vague report of epigastric pain that is relieved by food** anorexia, n/v, intolerance of fatty and spicy foods, pernicious anemia

Question 340

gastritis diagnostic test

Answer 340

biopsy via EGD is gold standard

Question 341

acute gastritis interventions

Answer 341

treated symptomatically and supportively because healing process is spontaneous

Question 342

chronic gastritis inteventions

Answer 342

varies with cause

Question 343

h2 receptor antagonists

Answer 343

cimetidine/pepsid- decrease gastric acid secretions by blocking histamine receptors in parietal cells

Question 344

mucosal barrier

Answer 344

sucralfate- binds with bile acids and pepsin to protect stomach mucosa, stimulates mucosal protection, may cause the stools to be discolored black

Question 345

antacids

Answer 345

sodium bicarbonate- increases pH of gastric contents by deactivating pepsin

Question 346

proton pump inhibitor

Answer 346

omeprazole- suppress gastric acid secretions

Question 347

vitamin B 12

Answer 347

prevention or treatment of pernicious anemia

Question 348

PUD- peptic ulcer disease definition

Answer 348

mucosal lesion of the stomach or duodenum- occurs when mucosal defenses become impaired and no longer protect the epithelium from the effects of the acid and pepsin

Question 349

PUD- peptic ulcer disease types

Answer 349

gastric, duodenal, stress

Question 350

PUD- peptic ulcer disease etiology

Answer 350

most gastric and duodenal ulcers are cause by H pylori infection or NSAIDs- harder to diagnose in older adults

Question 351

PUD- peptic ulcer disease complications

Answer 351

hemorrhage, perforation, pyloric obstruction, intractable disease

Question 352

PUD- peptic ulcer disease CM

Answer 352

dyspepsia (indigestion), epigastric tenderness, n/v

Question 353

PUD- peptic ulcer disease diagnostic testing

Answer 353

EGD

Question 354

PUD- peptic ulcer disease priority problems

Answer 354

acute or chronic pain and upper GI bleed

Question 355

PUD- peptic ulcer disease interventions

Answer 355

diet- bland foods, avoid snacks, alcohol, tobaccos, caffeine complimentary therapy: hypnosis, imagery, yoga, meditation

Question 356

prostaglandins analogs

Answer 356

stimulates mucosal protection and decrease gastric acid secretions, help resist mucosal injury in patients taking NSAIDs and or high dose corticosteroids

Question 357

PPI triple therapy

Answer 357

PPI and two antibiotics

Question 358

PPI quadruple therapy

Answer 358

PPI, two antibiotics, bismuth (pepto-bismol)

Question 359

small bowel obstruction CM

Answer 359

abdominal discomfort or pain, upper or epigastric abdominal distention, nausea and early, profuse vomiting, possible visible peristaltic waves in upper and middle abdomen, obstipation (no passage of stool), severe fluid and electrolyte imbalance

Question 360

small bowel obstruction imaging

Answer 360

abdominal CT scan

Question 361

small bowel obstruction interventions

Answer 361

NPO, nasogastric tube, Iv fluid replacement and maintenance, monitor pain and VS, exploratory laparotomy, assess for bowel sounds, flatus and stool indicating peristalsis returned.

Question 362

osteoporosis definition

Answer 362

chronic metabolic disease in which bone loss causes decreased density and possible fracture- deceased bone mass

Question 363

osteoporosis generalized types

Answer 363

primary: postmenopausal women- decreased estrogen men in their seventh or eight decade of life- decreasing levels of testosterone which builds bone Secondary: results from other medical conditions

Question 364

osteoporosis regional

Answer 364

occurs when a limb is immobilized related to a fracture, injury, or paralysis. immobility for longer than 8-12 weeks and result in this type of osteoporosis

Question 365

osteoporosis risk factors

Answer 365

older age in both genders and all races, parent history of osteoporosis (especially mothers), low trauma fracture after 50, chronic low calcium and vitamin D intake, smoking, high alcohol intake, estrogen or androgen deficiency.

Question 366

osteoporosis teaching prevention

Answer 366

build strong bones as a young person, decrease modifiable risk factors- sun exposure, include dietary calcium, limit carbonated beverages, exercise

Question 367

osteoporosis physical assessment

Answer 367

kyphosis, "getting shorter", pain and assess for fractures

Question 368

osteoporosis imaging

Answer 368

DEXA scan- measures bone mineral density, best tool for definitive diagnosis

Question 369

osteoporosis interventions

Answer 369

nutrition therapy- fruits and vegetables, low fat dairy and protein, increased fiber, moderation of alcohol and tobacco exercise- walk 30 min 3-5 times a week drug therapy- calcium/vitamin d, bisphosphonates, estrogen antagonists and agonists, calcitonin

Question 370

71 year old Caucasian female has been diagnosed with osteoporosis for 15 years. * Both her mother and sister had osteoporosis and her sister recently died after a hip fracture. * She has been on calcium and vitamin D supplements and risedronate (Actonel) on and off for 12 years. * According to her most recent DEXA scan (Dual x-ray absorptometry) she continues to lose bone density. * Last year she sustained a fracture of her humerus. What risk factors does this patient have for osteoporosis?

Answer 370

– Older age – Maternal history of osteoporosis – History of low trauma fracture after age of 50

Question 371

Other than fractures, what other signs and symptoms might the nurse expect when caring for this patient with osteoporosis?

Answer 371

Kyphosis – Reports of “getting shorter” – Pain – Assess for fractures (pain, swelling, misalignment)

Question 372

What diagnostic test is used to diagnose and monitor progression of osteoporosis?

Answer 372

DEXA scan- measure bone density

Question 373

Which statement by the patient regarding lifestyle changes indicates a need for further teaching? – A. “I will get rid of my scatter rugs” – B. “ I will cut back to 3 martinis a day” – C. “I will increase my calcium and vitamin D intake” – D. “I am going to walk every day”

Answer 373

B

Question 374

osteoarthritis definition

Answer 374

most common arthritis, major cause of disability among adults older than 60, also called degenerative joint disease, deterioration and loss cartilage in one or more joints

Question 375

osteoarthritis causes

Answer 375

combination of factors; aging, genetics, obesity, joint injury, occupation. females more commonly

Question 376

osteoarthritis physical assessment

Answer 376

unilateral, single joint, affects weight bearing joints, spines, and hands, non-systemic, pain and stiffness, Herbeden's nodes.

Question 377

osteoarthritis treatments

Answer 377

Tylenol, topical drug administration, NSAIDs, cortisone injections, muscle relaxants rest, exercise, heat or cold applicants, weight control surgery

Question 378

Total Joint Arthroplasty complications

Answer 378

dislocation, infection, VTE, bleeding, hypotension, neuromuscular compromise, scar tissue formation

Question 379

Total Joint Arthroplasty interventions

Answer 379

positioning, aseptic technique for wound care, monitor temp, use SCDs, teach leg exercises, encourage fluids, administer anticoagulant, do not massage legs, VS q4, check for 5 Ps, continuous passive motion machine

Question 380

Which patients are at risk for developing OA? (Select all that apply) – A. Obese, older woman living alone – B. Slender, non smoking middle aged man – C. Middle aged man with 25 years working in construction – D. Young woman with a family history of cancer – E. Middle aged adult with multiple knee surgeries from high school soccer

Answer 380

ACE

Question 381

Postoperative care of a total knee replacement may include which of the following? (Select all that apply) – A. Hot compress to incisional area – B. Continuous passive movement (CPM) used immediately or several days post op – C. Ice packs to incisional area – D. Check CMS (circulation, movement, sensation) – E. Maintaining abduction

Answer 381

BCD

Question 382

The nurse is preparing an educational session for nursing students on the orthopedic unit. Which three signs of hip dislocation would be included? (Select all that apply) – A. Increased pain – B. Hip flexing at 45 degrees – C. Shortening of affected leg – D. Leg rotation – E. Skin breakdown near the incision

Answer 382

ACD

Question 383

factors contributing to UTI

Answer 383

obstruction, stones, vesicoureteral reflux, DM, characteristics of urine, gender, age, sexual activity, recent use of antibiotics

Question 384

minimizing catheter related infections

Answer 384

good hygiene, insert for appropriate use only, assess for daily need, use sterile technique when inserting, select a small sized catheter, keep tubing and collection bags lower than the bladder, perform daily catheter care.

Question 385

UTI CM that may occur in the older adult

Answer 385

increasing mental confusion or frequent unexplained falls, sudden onset of incontinence or worsening incontinence, loss of appetite, nocturia, dysuria,

Question 386

cystitis prevention

Answer 386

drink 2-3 L per day, get sleep and rest, stay away from spermicides, women should clean peri-area front to back, empty bladder before and after intercourse, do not delay urination, notify provider if s/s of UTI develop, nutritional supplements to reduce the risk of developing UTI

Question 387

cystitis lab assessment

Answer 387

Urinalysis

Question 388

cystitis diagnostic assessment

Answer 388

Pelvic US or CT, voiding cystiurethrography, cystoscopy

Question 389

cystitis interventions

Answer 389

antiseptics, antibiotics, analgesics, antispasmodics, maintain adequate fluid intake, avoid fluids or food that will irritate bladder, comfort measures

Question 390

urolithiasis definition

Answer 390

presence of stones in urinary tract

Question 391

urolithiasis etiology

Answer 391

unknown, 90% have metabolic risk factors

Question 392

urolithiasis risk factors

Answer 392

family history, over weight, diet, history of urinary tract infections

Question 393

urolithiasis CM

Answer 393

severe pain, hematuria, n/v, pallor, diaphoresis, frequency, dysuria, flank pain, most intense pain when stone is moving, oliguria

Question 394

urolithiasis diagnostic assessment

Answer 394

KUB, x-ray, CT, US

Question 395

urolithiasis interventions

Answer 395

IV opioids, NSAIDs, spasmolytic drugs, tamsulosin to relax urethra, strain urine, antibiotics, assess for infection, monitor nutrition, high intake of fluids 3L, accurate I&Os, walk as often as possible, shock wave lithotripsy surgery.

Question 396

solid cancer

Answer 396

develop from specific tissues

Question 397

hematologic cancer

Answer 397

develop from blood cell forming tissues

Question 398

untreated cancers can cause

Answer 398

reduced immunity and blood producing functions, altered Gi structure and function, motor and sensory deficits, reduced gas exchange

Question 399

purpose of cancer management

Answer 399

prolong surivival time or improve quality of life

Question 400

cancer therapy includes

Answer 400

surgery, radiation, chemo, hormonal therapy, photodynamic therapy, immunotherapy, molecular targeted therapy, gene therapy.

Question 401

prophylactic surgery

Answer 401

removes at-risk tissue to prevent cancer development

Question 402

diagnostic surgery

Answer 402

removal of all or part of a suspected lesion for examination and testing.

Question 403

curative surgery

Answer 403

removes all cancer tissue

Question 404

cancer surgery post op

Answer 404

same physical needs as other patients, emotional and spiritual support, expression of concerns, help patient accept changes in appearance and function, support group resources, PT/OT planning for discharge

Question 405

purpose of radiation therapy

Answer 405

destroy cancer cells and have minimal damaging effects on the surrounding normal cells.

Question 406

teletherapy

Answer 406

radiation delivered from a source outside the patient, delivered in small doses on a daily basis for a set time period, patient is not radioactive.

Question 407

bracytherapy

Answer 407

radiation source is within the patient, sealed or unsealed, patient emits radiation for a period of time and is a potential hazard to others.

Question 408

sealed brachytherapy

Answer 408

patient emits radiation when implant is in place

Question 409

unsealed brachytherapy

Answer 409

patient body fluids are radioactive and must be handled according to guidelines.

Question 410

radiation side effects

Answer 410

skin changes, hair loss, altered taste, fatigue, inflammation of tissue lead to tissue fibrosis and scarring

Question 411

radiation therapy precautions

Answer 411

private room and bathroom, signage on doors, keep door closed, wear film badges, no pregnant nurses or nurse trying to conceive should care for this patient, no one under 16 should visit this patient, limit visitors, never touch radiation source with bare hands, keep dressings and linens in the patients rooms.

Question 412

chemotherapy purpose

Answer 412

used to cure and increase survival time and acts by damaging DNA and interferes with cell division. used along with other therapies.

Question 413

chemo administration

Answer 413

usually given every 3-4 weeks for a certain number of times. Typically given IV, monitor for extravasation, requires additional education and teachings to administer, wear PPE

Question 414

chemo side effects

Answer 414

anemia, neutropenia, thrombocytopenia, n/v, mucositis, alopecia, skin changes, anxiety, sleep disturbance, altered bowel elimination, psychosocial issues.

Question 415

anemia

Answer 415

decreased RBCs and hemoglobin

Question 416

neutropenia

Answer 416

decreased WBCs leading to immunosuppression

Question 417

thrombocytopenia

Answer 417

decreased number of platelets

Question 418

chemo interventions- neutropenia

Answer 418

avoid infection since bone marrow function is suppressed, encourage patient. to report signs of infection , strict hand washing, aseptic technique, avoid crowds and sick people, monitor CBC, administer filgrastim as needed.

Question 419

chemo interventions- anemia

Answer 419

monitor for symptoms of anemia, administer erythrocyte stimulating agents to improve, blood transfusion is common.

Question 420

chemo interventions- thrombocytopenia

Answer 420

monitor for bleeding and bruising, transfusion of platelets, administer growth factor, prevent injury

Question 421

chemo interventions- other

Answer 421

give antiemetics, frequent mouth assessment, soft bristle toothbrush, reassure that hair loss is temporary, give coping resources, avoid alcohol, drugs, and activities that increase head injury, avoid injury and protect feet, wear well fitting shoes, inspect feet daily, avoid rugs (Chemotherapy induced peripheral neuropathy)

Question 422

anemia can result from

Answer 422

dietary problems, genetic disorders, bone marrow disease, excessive bleeding, GI bleed.

Question 423

anemia key features

Answer 423

pallor, cool to touch, tachycardia, orthostatic hypotension, dyspnea on exertion, fatigue and somnolence

Question 424

iron deficiency anemia- causes

Answer 424

blood loss, poor GI absorption of iron, poor iron intake

Question 425

iron deficiency anemia- labs

Answer 425

hbg/hct and RBC decreased, ferritin decreased

Question 426

iron deficiency anemia- CM

Answer 426

weakness and pallor, fatigue, reduced exercise tolerance, fissures at the corners of the mouth

Question 427

iron deficiency anemia- interventions

Answer 427

increase oral intake of iron in food, oral iron supplements, give IV or IM iron for severe cases

Question 428

vitamin B12 anemia- causes

Answer 428

vegan diets or lacking dairy, Gi disorders, pernicious anemia secondary to gastritis

Question 429

vitamin B12 anemia- CM

Answer 429

pallor, jaundice, glossitis (beefy red tongue), fatigue, weight loss, paresthesias, poor balance

Question 430

vitamin B12 anemia- interventions

Answer 430

increase intake of foods rich in vitamin B12, vitamin supplements if anemia is severe, for pernicious anemia- administer B12 injections weekly and then monthly for the rest of their lives

Question 431

folic acid deficiency anemia- causes

Answer 431

poor nutrition, malabsorption, drugs- develops slowly

Question 432

folic acid deficiency anemia- CM

Answer 432

similar to those of vitamin B 12 deficiency anemia- does not affect nerve function

Question 433

folic acid deficiency anemia- treatment

Answer 433

diet rich in foods containing folic acid and vitamin b12, folic acid replacement

Question 434

aplastic anemia- definition

Answer 434

deficiency of circulating RBCs because of failure of the bone marrow to produce these cells pancytopenia (loss of all bone marrow parts)

Question 435

aplastic anemia- causes

Answer 435

long term exposure to toxic agents, drugs, ionizing radiation, viral infection

Question 436

aplastic anemia- treatment

Answer 436

assess for bone marrow failure, close monitoring of CBC, infection prevention, bleeding precaution, blood transfusion, immunosuppressive medications, splenectomy (could be destroying RBCs)

Question 437

hemolytic anemia- definition

Answer 437

results from an autoimmune process that causes excessive destruction of RBCs

Question 438

hemolytic anemia- causes

Answer 438

autoimmune, trauma, viral infection, exposure to chemical or drug

Question 439

hemolytic anemia-interventions

Answer 439

immunosuppressive therapy, plasma exchanges, splenectomy,

Question 440

Which statement about hematologic changes associated with aging is true? A. The older adult has increased blood volume B. The older adult has increased levels of plasma proteins C. Platelet counts decrease with age D. Antibody levels and responses are lower and slower in older adults

Answer 440

D

Question 441

The patient reports a history of splenectomy. Based on this information, what is the nurse most likely to assess for? A. Signs of bleeding B. Signs of infection C. Digestive problems D. Jaundice of the skin

Answer 441

B

Question 442

An experienced nurse is supervising a new graduate who is assessing a patient with a suspected hematologic problem. The experienced nurse would intervene if the new nurse performed which action? A. Auscultated the heart for abnormal heart sounds or irregular rhythm B. Palpated the abdomen to attempt to locate an enlarged spleen C. Assessed joints for swelling or pain D. Assessed the skin for petechiae and ecchymoses

Answer 442

B

Question 443

Question When assessing the patient with darker skin for pallor and cyanosis, which area would the nurse examine? A. Chest and abdomen B. General appearance of face C. Fingertips and toes D. Oral mucous membranes

Answer 443

D

Question 444

Question Which of the following interventions should the nurse implement for bleeding precautions? (SATA) A. Assess skin and mucous membranes B. Inspect stool and urine C. Measure abdominal girth D. Offer soft bristle tooth brush E. Offer to shave patient with razor F. Monitor lab values

Answer 444

ABCDF

Question 445

Question All of the following is true about bone marrow aspiration, EXCEPT: A. It is performed to evaluate patient’s blood cells and hematologic status B. It is performed in OR C. Biopsy could be obtained D. It could provide a differential diagnosis

Answer 445

B

Question 446

The nurse understands that anemia is a reduction in the number of which of the following? (Select all that apply) A. WBCs B. RBCs C. Platelets D. Hemoglobin E. Hematocrit F. Neutrophills

Answer 446

BDE

Question 447

What is the most common manifestation of anemia? A. Fatigue B. Long bone pain C. Weight gain D. Loss of appetite E. Headache

Answer 447

A

Question 448

What are integumentary manifestations of anemia? (SATA) A. Flashed cheeks B. Cyanosis C. Pallor D. Cool skin E. Intolerance of cold F. Dry flaky skin

Answer 448

CDE

Question 449

What are CV manifestations of anemia? (SATA) A. Tachycardia B. Bradycardia C. Hypertension D. Orthostatic hypotension E. Systemic edema

Answer 449

AD

Question 450

What are respiratory manifestations of anemia? (SATA) A. Dyspnea on exertion B. Orthopnea C. Decreased SaO2 D. Nagging cough E. Decreased breath sounds F. Tachypnea

Answer 450

ACF

Question 451

What are neurologic manifestations of anemia? (SATA) A. Neuropathy B. Somnolence C. Fatigue D. Headache E. Confusion F. Delirium

Answer 451

BCDE

Question 452

Question The nurse is caring for four patients. Which of these patients has the most common risk factor for anemia? A. Patient on vegan diet B. Patient with history of exposure to radiation C. Patient with lower GI bleed D. Patient with anorexia

Answer 452

C

Question 453

Which of the following are risk factors for pernicious anemia? A. Infections and chemotherapy B. Sickle cell disease C. Gastric resection and small bowel resection D. Blood loss and poor iron absorption

Answer 453

C

Question 454

Which of the following is treatment for folic acid deficiency anemia? (SATA) A. Blood products transfusion B. Cyanocobalamin injections IM C. Iron supplements IV D. Epoetin alfa injections SQ E. Folic acid tablets PO F. Lentil, spinach and broccoli G. Salmon, cantaloupe and eggs

Answer 454

EF

Question 455

A deficiency in RBC, WBC and platelets? – A. Aplastic anemia – B. Pancytopenia – C. Neutropenia – D. Thrombocytopenia

Answer 455

B

Question 456

Question * An unidentified male trauma client requires an emergent transfusion. What is the correct transfusion option for packed RBC? – A. Type AB-negative, uncrossmatched blood – B. Type AB-positive, uncrossmatched blood – C. Type O-negative, uncrossmatched blood – D. Type O-positive, uncrossmatched blood

Answer 456

C

Question 457

Question * When preparing to administer RBCs, the nurse notes that lactated Ringer solution is hanging on the IV pole. Which substance should be used to flush the line before hanging the blood? – A. Lactated Ringer solution – B. Normal saline – C. Heparin by infusion pump – D. Prophylactic antibiotics

Answer 457

B

Question 458

A nurse is preparing to administer a blood transfusion. What action is most important? – A. Correctly identifying client using two identifiers – B. Hanging blood product with lactated Ringers – C. Staying with the client for the entire transfusion – D. Keeping blood product refrigerated

Answer 458

A

Question 459

When a client undergoing a blood transfusion complains of flank pain and a sense of doom, which adverse reactions should be suspected? – A. A hemolytic transfusion reaction – B. Bacterial contamination of the blood – C. An allergic transfusion reaction – D. TACO

Answer 459

A

Question 460

If a client develops a skin rash, edema, and wheezing during a blood transfusion, what should the nurse do? – A. Discard the blood bag and tubing. – B. Decrease the rate of the transfusion. – C. Stop the transfusion immediately. – D. Reassess the client in 10 minutes.

Answer 460

C

Question 461

Red Blood Cell/ Packed Red Blood Cells Transfusion

Answer 461

replace lost blood or anemia, ABO Rh factors, Infuse over 2-4 hours, use filtered pump tubing

Question 462

Platelet transfusion

Answer 462

to treat thrombocytopenia or active bleeding, pooled from multiple donors so the blood type doesn't matter, use specific tubing, infuse over 15-30 min

Question 463

Plasma transfusion

Answer 463

to treat deficiency in plasma coagulation factors, must be ABO compatible, infuse over 15-30 min, use y set tubing.

Question 464

Granulocyte (WBC) transfusion

Answer 464

used with sepsis or neutropenic infection, rare, more at risk for transfusion reactions (WBC surfaces have many antigens), usually requires closer monitoring, infuse over 1 hour

Question 465

Pre Transfusion protocol

Answer 465

assess labs, verify order with another RN, ensure IV access, assess vitals, obtain blood product from blood bank and administer asap, safety check (ID, MRN, expiration, ABO, Rh) and inspect blood for discoloration, gas bubbles, cloudiness

Question 466

During transfusion protocol

Answer 466

VS before starting. and 30 minutes after starting, use appropriate tubing, stay with patients for 30 min, assess for hyperkalemia.

Question 467

Blood transfusion complications

Answer 467

febrile transfusion reaction, hemolytic transfusion reaction, allergic reaction, bacterial transfusion reaction, transfusion-associated circulatory overload, transfusion related graft v. host disease, acute pain transfusion reaction

Question 468

febrile transfusion reaction

Answer 468

signs: fever, chills, tachycardia, hypotension and tachypnea occurs when a patient has has multiple transfusions and develop WBC, antibiotics prevention: give leukocyte reduced blood or single donor blood; use of WBC filters when administering blood products

Question 469

hemolytic transfusion reaction

Answer 469

signs: chills, fever, apprehension, HA, chest pain, low back pain, tachycardia, tachypnea, hypotension, sense of impending doom occurs when there is a blood type or Rh incompatibility- antigen antibody complexes form and destroy cells and cause inflammatory response prevention: ensure that all blood products are typed and cross matched, adhere to all safety checks prior to administration

Question 470

allergic reaction blood transfusion

Answer 470

signs: urticaria, itching, bronchospasm, anaphylaxis usually seen in patients with other allergies- immediately or within 24 hours prevention: give leukocyte reduced blood

Question 471

bacterial transfusion reaction

Answer 471

signs: tachycardia, hypotension, fever, chills caused by contaminated blood and onset is rapid.

Question 472

transfusion associated circulatory overload (TACO)

Answer 472

hypertension, bounding pulses, JVD, dyspnea, restlessness and confusion occurs when blood product is infused too quickly prevention: infuse blood products slowly, diuretics, monitor I&O

Question 473

transfusion related graft v. host disease

Answer 473

thrombocytopenia, anorexia, n&v, weight loss, infection occurs in immunocompromised patient and occurs within 1-2 weeks prevention: administered irradiated blood products that destroy t cells and cytokine

Question 474

acute pain transfusion reaction

Answer 474

signs: severe chest pain, back pain, joint pain, hypertension, anxiety and redness of head and neck rare and occurs during or immediately after transfusion treatment: control symptoms

Question 475

nursing interventions for blood transfusion complications

Answer 475

stop the infusion (don't flush tubing and put anymore blood into the patient) take down all blood tubing and save with all labels, oxygen, diphenhydramine, iv fluids for shock, antibiotics, antipyretics for fever, meperidine for rigors

Question 476

bone marrow

Answer 476

responsible for blood formation, first produces blood stem cells (stem cells can become whatever type of blood cell the body needs), also has a role in immune responses, located in flat bones and ends of long bones

Question 477

plasma

Answer 477

extracellular fluid with plasma proteins- albumin, globulins, fibrinogen

Question 478

RBCs

Answer 478

largest portion of blood, produce hemoglobin which carries oxygen and carbon dioxide, iron is important component of hemoglobin

Question 479

WBCs

Answer 479

role in inflammation and infection protection

Question 480

platelets

Answer 480

smallest blood cells, stick to injured vessel walls and aggregate to assist clotting, stored in spleen

Question 481

spleen- accessory organ of blood formation

Answer 481

destroys old or imperfect RBCs, breaks down the hemoglobin, stores platelets, antibody production and filters antigens

Question 482

liver- accessory organ of blood formation

Answer 482

produces prothrombin and other clotting factors, assists in the forming of vitamin K in the intestine, stores blood cells, stores iron in the form of ferritin

Question 483

hematologic changes with aging

Answer 483

decreased blood volume, lower levels of plasma proteins, bone marrow produces less blood cells, hemoglobin levels i men and women fall after middle age, immune response changes (weaker, lower and slower, WBC count lower)

Question 484

hematological assessment

Answer 484

patient history (age, gender, liver function, immunologic or hematologic disorders, drug use) nutrition status environmental exposure family history and genetic risk (sickle cells or hemophilia) current health problems (lymph node swelling, easy bruising or bleeding, common symptoms of hemo disease)

Question 485

hematologic skin assessment

Answer 485

inspect skin and mucous membranes for pallor nail beds for pallor and cyanosis petechiae and ecchymoses

Question 486

hematologic head and neck assessment

Answer 486

inspect and palpate all lymph node areas

Question 487

hematologic respiratory assessment

Answer 487

assess respirations and dyspnea on exertion/rest fatigue orthopnea

Question 488

hematologic cardiovascular assessment

Answer 488

assess pulses BP abnormal heart sounds irregular rhythms

Question 489

hematologic kidney and urinary assessment

Answer 489

assess urine for hematuria

Question 490

hematologic musculoskeletal assessment

Answer 490

rib or sternal tenderness may occur with leukemia assess range of joint motion document pain and joint swelling

Question 491

hematologic abdominal assessment

Answer 491

evaluate spleen stool psecimen to check for occult blood testing

Question 492

hematologic CNS assessment

Answer 492

neurologic checks and checks of cognitive function

Question 493

RBC count

Answer 493

4.2-6.1

Question 494

Hgb count

Answer 494

12-18 g/dL

Question 495

Hct count

Answer 495

37%-52%

Question 496

WBC count

Answer 496

5,000-10,000

Question 497

platelet count

Answer 497

150,000-400,000

Question 498

Prothrombin time

Answer 498

11-12.5 seconds

Question 499

iron count

Answer 499

60-180 mcg/dL

Question 500

ferritin count

Answer 500

10-300 ng/mL

Question 501

total iron binding capacity

Answer 501

250-460 mg/dL

Question 502

Bone marrow aspiration and biopsy

Answer 502

Evaluates hematologic status Specifically for a possible problem in blood cell production or maturation Invasive procedure Aspiration – cells and fluids are suctioned from the bone marrow Biopsy – solid tissue and cells are obtained by coring out an area of bone marrow with a large-bore needle Informed consent needed

Question 503

Bone marrow aspiration and biopsy preparation

Answer 503

Preparation: – Provide information and emotional support – Explain the procedure * Local anesthetic is used and may feel stinging or burning sensation * Mild tranquilizer or a rapid-acting sedative could be used * Expect a heavy sensation of pressure and pushing while the needle is being inserted – Positioning * Usually use the iliac crest * Patient should be placed in the prone or side- lying position

Question 504

Bone marrow aspiration and biopsy post operative procedure

Answer 504

Post procedure care: – Hold pressure briefly to site – Cover the site with a dressing after bleeding is controlled – Give mild analgesic for discomfort – Apply ice bag to the needle site to limit bruising – Observe site every 2 hours for 24 hours for signs of bleeding, bruising, and infection – Advise the patient to avoid contact sports or any activity that might result in trauma to the site for 48 hours

Question 505

What is cancer?

Answer 505

* Mutation of cells – Rapid growth – Can migrate or metastasize easily * Solid tumors or hematologic (blood) * Classified by type of tissue originating from or primary site * Cellular aspects of the cancer are also important to consider * Staging done at diagnosis – TNM system (tumor; node; metastasis)

Question 506

division

Answer 506

uncontrolled cell division

Question 507

growth

Answer 507

formation of a lump (tumor) or large numbers of abnormal white cells in the blood

Question 508

mutation

Answer 508

changes to how the cell is viewed by the immune system

Question 509

spread

Answer 509

ability to move within the body and survive in another part

Question 510

cancer prevention

Answer 510

* Don’t smoke * Avoid exposure to know carcinogens – Ex. UV light, asbestos * Eat a healthy diet – Fruits and vegetables, limit alcohol; low fat * Be physically active * Vaccinate against or early detection of to prevent cancer causing infections – Ex. Hepatits B; Human Papilloma virus (HPV); H.Pylori * Have the right genes – Certain genes have been isolated ****Sometimes there is no predisposing factor

Question 511

cancer surigcal treatment

Answer 511

Can be prophylactic, diagnostic, or curative * 30 % survival rate with surgery alone * Post op care – All traditional post op physical care – Need to address emotional and spiritual needs

Question 512

cancer raditaion therpay

Answer 512

* Destroys cancer cells but will also affect surrounding tissue * Typically given daily for a designated period of time * Can be external (teletherapy) or implanted (brachytherapy) * For external radiation patients will have markings for course of therapy * Side effects: – Fatigue – Hair loss – Skin changes * Skin care is very important – Altered taste – Inflammation and scarring of surrounding tissue

Question 513

cancer chemotherapy

Answer 513

Cytotoxic agents * Used to cure and/or increase survival time * Typically given IV but can also be PO * Administration requires special education – **Infiltration of the medication can be a serious complication (see next slide) * Adhere to all “chemo precautions” – Special handling of medications (IV or PO) – Special handling of all bodily fluids

Question 514

cancer chemotherapy AE

Answer 514

Side Effects caused by the damage of normal cells as well cancer cells – Anemia – Neutropenia – Thrombocytopenia – Nausea and vomiting – Mucositis – Hair loss – Skin changes – Chemo induced peripheral neuropathy – Altered bowel elimination – Anxiety – Sleep disturbances – Changes in cognition – Psychosocial concerns

Question 515

AB+

Answer 515

Antigen: A and B Antibody: None Compatible RBCs: All ABO and Rh groups Compatible Plasma: AB

Question 516

AB-

Answer 516

Antigen: A and B Antibody: None Compatible RBCs: O-, AB-, A-, B- Compatible Plasma: AB

Question 517

B+

Answer 517

Antigen: B Antibody: Anti A Compatible RBCs: B+, B-, O+, O- Compatible Plasma: B, AB

Question 518

B-

Answer 518

Antigen: B Antibody: Anti A Compatible RBCs: B-, O- Compatible Plasma: B, AB

Question 519

A+

Answer 519

Antigen: A Antibody: Anti B Compatible RBCs: O-, A-, A+,O+ Compatible Plasma: A, AB

Question 520

A-

Answer 520

Antigen: A Antibody: Anti B Compatible RBCs: O-, A- Compatible Plasma: A, AB

Question 521

O+

Answer 521

Antigen: NO A or B Antibody: Anti A and B Compatible RBCs: O-, O+ Compatible Plasma: O, A, B, AB

Question 522

O-

Answer 522

Antigen: NO A or B Antibody: Anti A and B Compatible RBCs: O-, O+ Compatible Plasma: O, A, B, AB

Question 523

15 gtts

Answer 523

1 mL

Question 524

1 tsp

Answer 524

5 mL

Question 525

1tbsp

Answer 525

15 mL

Question 526

1 oz

Answer 526

30 mL

Question 527

1 c

Answer 527

240 mL

Question 528

1 pint

Answer 528

500 mL

Question 529

1 quart

Answer 529

1000mL

Question 530

1 kg

Answer 530

2.2 lbs

Question 531

1 kg

Answer 531

1000 gm

Question 532

1 gm

Answer 532

1000 mg

Question 533

1mg

Answer 533

1000 mcg

Question 534

1L

Answer 534

1000 mL

Question 535

1 mL

Answer 535

1 cc