Final Exam Flashcards
As a new nurse, what is the main priority?
Patient safety
If a patient’s BP drops from 140 to 80, as the nurse, what should you do?
Call the RRT team
What demonstrates patient autonomy?
Asking the patient if they have any questions prior to them signing consent
If your patient is part of the LGBTQ community, what would do as the nurse?
Don’t make assumptions!
If a patient had surgery two days ago but the doctor on-call is not who performed the surgery, and the patient is complaining of pain, as the nurse what would you first tell the doctor?
If the patient is allergic to any medications
Who can participate in quality improvement projects?
Everyone
If you move to a new city or state and are looking for a new physician or hospital to visit, what should you look for?
Accreditation
There is an older patient in the hospital for surgery. What would you include in your post-op assessment?
Any change in behavior
If you have a pre-op patient, as the nurse what is the most important thing to relay to the surgical team?
If the patient is taking any herbs or supplements
There are four people that need to be discharged on your floor. Who will require the most care after discharge?
Older adult patient with memory loss
Labs come back for a pre-op patient. What levels should the OR team be notified about specifically?
Potassium 2.9
Patient is experiencing pain after surgery and coughing even after pain meds have been administered, as the nurse, what should you tell the patient to do?
Splint the abdomen
A patient has an abdominal drain placed. What would be identified as recovery goals being met?
No redness around the area
A patient has been given sedatives prior to being taken to the OR room, but now the patient has to use the restroom. What would you do? A. Assist them to the restroom B. Tell them it is okay for them to go C. Insert a Foley catheter D. Give them a bedpan or urinal to use
D. Give bedpan or urinal
Your patient is in pre-op and you notice they have dry, brittle hair and nails, and poor skin turgor, what should you do?
Make sure the surgeon writes for a dietary consult after the surgery
Your patient is getting very anxious before their surgery, what is the best thing for the nurse to do?
Ask them to describe their feelings
You’ve been instructed to administer IV antibiotics to your pre-op patient but the patient stops you and asks if you can wait until closer to the surgery. What would you tell the patient?
Explain the rationale behind giving the antibiotics now versus later
A patient signed consent for MIS. As the nurse, what should you remind the surgeon?
That the patient only signed for MIS, nothing more
You walk into a room and noticed a frayed electrical cord. What do you do?
Get a new one
In the OR room, the surgeon puts on sterile gloves but then drops his hands below his waist, what should you tell the surgeon?
He just broke sterile field
When someone is receiving IV anesthesia, what post-anesthesia care is the best?
Hook them up to a monitor and monitor pulse ox
When bringing an older patient in the OR room, what action by the nurse is the most important for the patient?
Allowing them to keep their hearing aids on until the last minute
A circulating nurse needs to provide emotional support to her patient. What would be the best action?
Remain with the patient
You are the nurse in the PACU and have four patients to tend to. Who is the priority patient?
A. Blood pressure of 120/84
B. Pulse 58
C. Resp = 6
C. Respirations = 6
Patient’s O2 levels drop from 98 to 95. What should you do?
Assess for other signs of oxygenation
A patient is 10 hours post-op and is wearing anti-embolism stockings. The patient is complaining about them being too hot and itchy and wants you to take them off. What should you do?
Tell the patient that they are on to help prevent blood clots in the legs and they need to stay on for a few more hours
A patient just received spinal anesthesia. When you raised the head of the bed, the patient’s BP dropped. What should you do?
Lower the head of the bed
What is a priority PACU post-op assessment for patients?
Airway
Peripheral Arterial Disease (PAD)
Results from atherosclerosis that usually occurs in the arteries of the lower extremities and is characterized by inadequate flow of blood
How you help relieve leg pain in a patient who has PAD?
Place legs at rest in a dependent position but not above the heart
A nurse is collecting data from a client who has chronic PAD. Which of the following should the nurse expect to see?
A. Edema around the ankles and feet
B. Ulceration around the medial malleoli
C. Scaling eczema of the lower legs with stasis dermatitis
D. Pallor on elevation of the limbs and rubor when limbs are dependent
D. Pallor on elevation of the limbs and rubor when limbs are dependent
Sodium Levels
136 - 145
Potassium Levels
3.5 - 5.0
Calcium Levels
9.0 - 10.5
Magnesium Levels
1.3 - 2.1
Phosphorus Levels
3.5 - 4.5
Chloride Levels
98 - 106
ROME
Respiratory
Opposite
Metabolic
Equal
pH Range
7.35 - 7.45
Alkalosis >7.45
Acidosis <7.35
PaCO2 Range
45 - 35
Alkalosis <35
Acidosis >45
HCO3- Range
22 - 26
Alkalosis >26
Acidosis <22
Respiratory vs. Metabolic Factors
PaCO2 deals with respiratory
HCO3- deals with metabolic
What does it mean if ROME values are all within normal limits?
Homeostasis
Causes of Respiratory Acidosis
Respiratory depression from poisons Anesthetics Trauma Neurological diseases Inadequate chest expansion d/t muscle weakness Obesity Airway obstruction Asthma Some cancers Pulmonary edema
Causes of Respiratory Alkalosis
Hyperventilation d/t fear Anxiety Intracerebral trauma Excessive mechanical ventilation Hypoxemia from asphyxiation Shock Pneumonia
Causes of Metabolic Acidosis
Diabetic ketoacidosis Starvation Heavy exercise Fever Hypoxia Intoxication with ethanol or salicylates Kidney failure Liver failure Dehydration Diarrhea
Causes of Metabolic Alkalosis
TPN NG tube suctioning Prolonged vomiting Laxative abuse Diuretics
Ileostomy
A surgical opening into the ileum to drain stool
Colostomy
A surgical opening into the large intestine to drain stool
Describe a stoma that is ischemic
Bluish/purple in color
GERD
Gastric content and enzyme leakage back up into the esophagus.
Risk Factors of GERD
Obesity Older adults Sleep apnea NG tube Excessive ingestion of fatty foods, chocolate, or caffeine Pregnancy NSAIDs Stress
Antacids
Neutralize excess acidi
Types of Antacids
Mylanta
Maalox
Gaviscon
Histamine2 Receptor Antagonists
Reduce the secretion of acid
Types of H2 Receptors Antagonists
Zantac
Pepcid
Axid
Proton Pump Inhibitors (PPIs)
Protonix - pantoprazole
Prilosec - omeprazole
Nexium - esomeprazole
Prevacid - lansoprazole
Is it better to have a pill form or liquid form of antacids?
Liquid - it will coat the lining of the esophagus
Peptic Ulcer
An erosion of the mucosal lining of the stomach or duodenum
Causes of Peptic Ulcer Disease
H. pylori NSAIDs Corticosteroids Stress Alcohol
Most common treatment of Peptic Ulcers
2 antibiotics and a PPI
Gastritis
Inflammation of the stomach
Risk Factors of Gastritis
H. pylori E. coli Family hx Prolonged use of NSAIDs Caffeine Stress
Chronic vs. Acute Gastritis
Chronic gastritis is indicated by light, clay colored stools
Carafate
Mucosal barrier
Cholecystitis
Inflammation of the gallbladder
Cholelithiasis
Presence of stones in the gall bladder
Osteoporosis
Common chronic metabolic bone disorder resulting in low bone density
Occurs when the rate of bone resorption exceeds the rate of bone formation resulting in fragile bone tissue and subsequent fractures
Osteoarthritis (OA)
Cartilage destruction with bone spur growth at joint ends; degenerative
Localized inflammatory response
Occurs usually in people who are overweight
Symptoms of OA
Pain with activity that improves with rest
Heberden’s and Bouchard’s nodes
Rheumatoid Arthritis (RA)
Synovial membrane inflammation resulting in cartilage destruction and bone erosion; inflammatory
Can affect all joints
Occurs usually in people who are underweight
Can involve the lungs, heart, skin, and extra-articular
Symptoms of RA
Swelling, redness, warmth, pain at rest or after immobility (morning stiffness)
Swan neck and boutonniere deformities of hands
Medications to Help Treat OA
Tylenol and NSAIDs
Risk Factors for RA
Female gender (3:1) Age 20 - 50 Genetic predisposition Epstein-Barr virus Stress
Non-Medication Treatment Options for RA
Morning stiffness - hot shower
Pain in hands/fingers - heated paraffin wax
Edema/swelling - ice
TNM
Tumor - Node - Metastasis
X = unable to evaluate 0 = no evidence of... is = in situ = hasn't spread from original location 1-4 = size, extent, spread, number, etc.
Responsibilities for Informed Consent
Provider obtains it
Patient give it
Nurse witnesses it
A patient with a drain and dressing is being discharged. What is the priority message to remind the patient of?
Hand hygiene when working with the drain or dressing change to prevent infection
An older adult just come back from surgery. The family is concerned that he is taking longer to wake up than they figured. As the nurse, what would you tell them?
Older adults often take a longer amount of time to wake up from the anesthesia because it takes longer to process through their body
A nurse answers a call light in the post-op unit and the patient states that there is blood gushing from my incision. What should the nurse do?
Hand hygiene and put on gloves
A newly licensed nurse is changing the dressing around a Penrose drain. What action by the new nurse would need an intervention from the RN in charge?
Securing the safety pin to the sheets - would be considered a restraint
What is the most important function of inflammation and immunity?
To provide protection
A nurse is trying to prevent infection in an older adult. What would be the first thing they should do?
Assess vaccination records
Someone is newly dx with osteoarthritis. As the nurse, what medication should you educate the patient about?
Tylenol
A nurse is working in the orthopedic clinic today. What would be a contraindication of joint replacement?
Severe osteoporosis
During peri-op , what should the nurse do as wound infection prevention?
Administer antibiotics
A patient is being discharged to a short term rehab facility. What is the nurse’s number one priority?
Provide verbal hand-off to the facility
A nurse is working in a RA clinic and there are four patients. Which patient would you see first?
Patient with red, hot, and swollen wrists
A nurse identifies poor body image in a patient. After education, what would be a good indication that the education worked?
Patient went to a book club
Your patient has RA and has red, hot joints. What would be a non-medication treatment option that you could tell them about?
Ice
A patient comes in self-diagnosed with osteoarthritis. The patient has a low-grade fever and pain in the back of her knees. What should the nurse assess for?
Assess for baker’s cysts which could indicate RA
A patient has RA in her hands but wants to finish knitting a baby blanket. What would you suggest the patient to do?
Dip hands in heated paraffin wax
What are Heberden’s nodules?
Enlarged areas on the distal ends of the digits
What are Bouchard’s nodules?
Enlarged areas on the proximal area of the digits
What is one fact that is always true about cancer?
The tumor cell needs to develop own source of blood
Most common form of metastasis?
Bloodborne
If you are caring for a patient with peptic ulcer pain, what should you do?
Notify PCP immediately - could be perforation
If a patient is educated about H. pylori, what is the main concern when a patient is given an antibiotic?
Are they going to follow the drug regimen completely?
You walk into a room and see your patient on the floor vomiting blood. What is the first thing you would do?
Put on gloves
You have a patient with an NG tube inserted. What is comfort measure that you could delegate to a UAP?
Oral care
A patient has a newly placed ileostomy and has some concerns about going to prom. What would be the best action by the nurse?
See the ostomy nurse about dresses and different bags that the patient could wear
A patient with diverticulitis would eat what kind of diet?
Low fat, no seeds
Baked fish, carrots, juice
After teaching a patient about Humira, what would indicate that the patient needs additional teaching?
If they stated they should take it with breakfast
A patient had their gall bladder removed. What would indicate the patient understood the teaching about gall bladder removal?
Decrease fatty foods in their diet
Patient is experiencing pain the shoulder blades after laparoscopic surgery. What do they need to do?
Ambulate
Patient needs to stick to a low-fat diet. What foods would indicate the patient understands?
Roast chicken breast, baked potatoes with chives, and OJ
A patient with a PCA button wakes up in pain. What should you tell them?
Push the button
Which patient is the most at risk for bacterial cystitis?
Female patient not taking estrogen
A nurse has a post-menopausal patient that has experienced 2 UTIs in the last six months. What would the nurse tell the patient?
Low estrogen can cause an increased risk for UTIs
True or False: Infection is always accompanied by inflammation.
False; Inflammation can occur without infection
Five Cardinal Manifestations of Inflammation
Warmth Redness Swelling Pain Decreased function
Serosanguineous Exudate
Blood-tinged amber fluid consisting of serum and red blood cells
Suspected Deep Tissue Injury
Intact skin appears purple or maroon
Blood-filled blisters may be present
Stage I Pressure Ulcer
Intact skin; area, usually over a bony prominence, is red and does not blanch with external pressure
Stage II Pressure Ulcer
Skin is not intact
Partial-thickness skin loss of the epidermis or dermis
Ulcer is superficial and may be characterized as an abrasion, a blister (open or fluid-filled), or a shallow crater
Bruising is not present
Stage III Pressure Ulcer
Skin loss is full thickness
SC tissues may be damaged or necrotic
Damaged extends down to but not through the underlying fascia; bone, tendon, and muscle are not exposed
Undermining and tunneling may or may not be present
Stage IV Pressure Ulcer
Skin loss is full thickness with exposed or palpable muscle, tendon, or bone
Often includes undermining or tunneling
Sinus tracts may develop
Slough and eschar are often present on at least part of the wound
Unstageable Pressure Ulcer
Skin loss is full-thickness and the base is completely covered with slough or eschar obscuring the true depth of the wound
What causes cholecystitis?
Fatty diet, high cholesterol
Affects American Indians and Mexicans the most
What are some signs and symptoms of cholecystits?
Pain in the right abdomen that radiates to the upper right shoulder
Who are the most likely people to have pain in their gallbladder?
Female
Forty
Fat
Fertile
Cholecystectomy
Removal of the gallbladder
After they remove the gallbladder laparoscopically, do they usually still have gallbladder pain afterwards?
No, they will just have post op pain
If they cannot get it done laparoscopically, what is another way they can remove the gallbladder?
Cholecystectomy
If someone went for a doctor’s visit and they lost 40 or 60 pounds from their last visit. What would the nurse ask them?
If the weight loss was intentional
Which type of malnutrition lacks calories?
Marasmus
Which type of malnutrition lacks protein?
Kwashiorkor
If a nurse is giving an NG bolus tube feeding every 4 hours, what would the nurse do before and after each feeding.
Before: check placement of the tube before feeding
After: Auscultate lung sounds
If a patient is transferred to the bariatric clinic after they had bypass surgery and they start saying, “I did not know it would be this hard to live like this…”, what is the best for the nurse to do?
The nurse should find out if they have a support system at home.
Assess their coping skills.
Get them into a support group.
If you delegate feeding to a CNA, what directions should you give them?
Nice, quite, relaxed atmosphere Hot food - hot Cold food - cold Urinals/bedpans off the bedside table Patient should have glasses, dentures, utensils, and hearing aids
If you are giving someone Maalox, what is the most important teaching the nurse should do with the patient?
Notify the provider if you have diarrhea
What intervention would be helpful for an incontinent patient?
Bladder training program
How should the nurse react if the patient is embarrassed to be incontinent?
The nurse should strategize with the patient about their lifestyle, use of pads, Kegel exercises, and a bladder program
