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AdultCare1-Cook > Final Exam (class review) > Flashcards

Final Exam (class review) Flashcards

1
Q

what does SIRS stand for?

A

systemic inflammatory response syndrome

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2
Q

what are 4 parts of the 1 hr sepsis bundle?

A

-drawing lactate and blood cultures
- administer broad spectrum ABX
- administering IV fluids
- giving vasopressors (if needed)

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3
Q

what may an increases lactate and increased bands indicate?
what are 2 other levels that may be effected?

A

sepsis
- abnormal WBC and rising procalcitonin (elevates in response to inflammatory cytokines)

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4
Q

what may redness around a surgical site indicate?

A

infection

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5
Q

what do pain, serous drainage and mild edema indicate around a surgical site?

A

normal findings of a surgical wound

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6
Q

what should the nurse ensure to do first before giving antibiotics to a patient with sepsis?

A

ensure blood cultures were drawn first

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7
Q

what does a urine output of 15 mL/hr indicate?

A

organ dysfunction (poor perfusion)

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8
Q

what is the MOST effective mechanism of prevention for prevention of infection spread?

A

hand hygiene

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9
Q

what are some risk factors for sepsis?

A
  • immunocompromised
  • central lines
    -malnutrition
  • invasive procedures
  • older than 80 yr
  • history of DM; cancer
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10
Q

what is a major modifiable risk factor for cardiovascular disease?

A

smoking

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11
Q

List 4 nonmodifiable risk factors for cardiovascular disease?

A

age, gender, ethnic origin and family hx

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12
Q

what does the P wave represent on an EKG?

A

atrial depolarization

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13
Q

which part of an EKG represents ventricular depolarization and atrial repolarization?

A

QRS wave

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14
Q

what does the T wave represent?

A

ventricular repolarization

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15
Q

what is a normal cholesterol level?

A

<200 mg/dL

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16
Q

Describe the correct sequence of electrical conduction throughout the heart.

A
  1. SA node
  2. AV node
  3. bundle of HIS
  4. purkinje fibers
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17
Q

what is a venous duplex ultrasound used to diagnose?

A

DVT

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18
Q

what are the parameters for monitoring PTT with IV heparin?

A
  • daily
  • 6 hr after initiation
  • 6 hr after any dose change
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19
Q

what is protamine sulfate the antidote for?

A

heparin

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20
Q

what is the antidote for warfarin?

A

vitamin K

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21
Q

what are some findings with DVT?

A
  • sudden onset of pain
  • warmth
  • edema
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22
Q

how can DVT be prevented?

A
  • early ambulation
  • leg exercises
  • adequate hydration
  • compression socks
  • SCDs
  • venous plexus foot pump
  • anticoagulants
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23
Q

what does an elevated troponin indicate?

A

cardiac cell damage

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24
Q

what are 3 treatment interventions for symptomatic bradycardia?

A

IV atropine, IV fluids, and oxygen

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25
Q

why should beta blockers not be given with bradycardia?

A

they cause bradycardia

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26
Q

what is a benefit of direct oral anticoagulants?
list some examples of these meds

A

no need for frequent lab monitoring
- dabigatran, rivaroxaban, apixaban, and edoxaban

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27
Q

what action should be taken for a client who has recently received benzocaine prior to a bronch and has developed persistent cyanosis?

A

notify the rapid response team (methemoglobinemia)

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28
Q

What medication can the nurse prepare for administration of if a patient has developed methemoglobinemia after receiving benzocaine?

A

IV methylene blue

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29
Q

how does a tension pneumothorax lead to decrease cardiac output?

A
  • air collects putting pressure on blood vessels, limiting blood return causing decreased filling of the heart
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30
Q

what is gold standard for chest tube placement?

A

chest x- ray

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31
Q

what should be assessed first in a person with chest trauma?

A

chest expansion

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32
Q

what is a finding that should require immediate follow-up following a lung biopsy?

A

absent breath sounds (may indicate pneumothorax)

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33
Q

what is expected for the water seal chamber of a chest tube drainage system?

A

tidaling (rise and fall of water - 2-4 in)

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34
Q

which chamber is expected to have intermittent bubbling?

A

water seal chamber

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35
Q

what type of chest wall movement is expected with flail chest?

A

paradoxical movement

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36
Q

what causes flail chest?

A

fractures of multiple ribs causing instability

  • during expiration thorax bulges out
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37
Q

why may hyperparathyroidism cause fractures?

A

elevation in PTH increases release of calcium and phosphate from bone into the blood, making the bone less dense

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38
Q

what does heat intolerance indicate in a patient who has graves disease?

A

an exacerbation

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39
Q

what happens to TSH with hypothyroidism?

A

elevation

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40
Q

what would happen to calcium levels with parathyroid hormone deficiency?

A

decreased serum calcium

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41
Q

what does PTH do to bone resorption?

A

increases it to increase serum calcium

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42
Q

what are expected findings of thyroid storm?

A

heat intolerance, tachycardia, sweating, insomnia

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43
Q

what condition is thyrotoxicosis common in?

A

graves disease

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44
Q

what may cause thyroid storm?

A

trauma, infection, palpation of goiter, overdose of levothyroxine

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45
Q

why should the nurse inspect behind a client’s neck after a thyroidectomy?

A

blood is dependant and hemorrhage is a potential complication

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46
Q

what signs may be seen with hypocalcemia?

A

trousseaus and chvosteks

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47
Q

what severe complication of hypothyroidism may cause bradycardia, hypotension, and respiratory failure?

A

myxedema coma

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48
Q

what is the priority to monitor post thyroidectomy?

A

airway patency

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49
Q

what are some ways that airway may be impaired following a thyroidectomy?

A
  • nerve damage
  • hypocalcemia induced tetany
  • and edema
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50
Q

what should the nurse do if they here stridor after a client has had a thyroidectomy?

A

contact provider and prepare for intubation

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51
Q

what should the nurse encourage a patient with hyperthyroidism to do to prevent thyroid crisis?

A

encourage them to rest
- keep environment quit/reduce stimuli
- dim lights
- limit visitors
- provide cool blankets

52
Q

what are some client education points the nurse should tell the diabetic patient regarding sick day management?

A
  • take insulin as prescribed
  • check glucose more often than normal (2-4 hr)
  • need to eat food (prevent hypoglycemia)
53
Q

what is a good intervention to implement for a client who is alert and oriented with a blood glucose of 60?

A

administer 15 g of oral carbohydrates

54
Q

when should IM glucagon be utilized?

A

if pt is unconscious/unable to swallow and does NOT have an IV

55
Q

what are 3 s/s of type 1 DM?

A

increased thirst, hunger, and urination

56
Q

what are some s/s of type 2 DM?

A

frequently no s/s, but may have thirst, fatigue and blurred vision

57
Q

what is a symptom of hyperglycemia in a patient with type 1 DM?

A

confusion
-polyuria, hunger, tachypnea

58
Q

what are 2 potential side effects a client may experience with IV insulin that is being given for treatment of DKA?

A

hypokalemia
hypoglycemia

59
Q

how can insulin administration potentially cause hypokalemia?

A

insulin forces potassium from the blood stream and into the cells

60
Q

what is the onset of regular insulin (short acting)?

A

30 mins - 1 hr

61
Q

when should a patient who has been given regular insulin eat?

A

about 30 mins after administration

62
Q

what should we teach type 2 DM pts about exercise?

A

exercise can cause hypoglycemia

63
Q

what angle should subQ insulin be given?

A

90 degrees (in anterior thigh, upper arm, buttocks and abdomen)

64
Q

what foot care instructions should be given to diabetic patients?

A
  • inspect feet daily (in between toes)
  • wash feet daily w/lukewarm water
  • dry feet thoroughly
  • don’t walk barefoot
65
Q

what are s/s of ureteral renal stones

A

n/v and severe pain
- pallor and clammy skin

66
Q

what is a potential cause for pyelonephritis?

A

reflux of urine from the bladder into the kidney

67
Q

what is the most common cause of pyelonephritis (what pathogen)?

A

e. coli

68
Q

what are expected findings with pyelonephritis?

A

flank pain, fever, chills, anorexia, and n/v

69
Q

why may dehydration lead to renal calculi?

A

causes hypercalcemia which can leaf to stone formation

70
Q

what should we teach a client with polycystic kidney disease?

A

check BP and weigh self daily

71
Q

what increases risk for cystitis within women?

A

urethral proximity to anus

72
Q

what dietary restriction should a client with uric acid calculi avoid?

A

purine foods (organ meats, poultry, fish, gravies, red wines and sardines)

73
Q

what is an expected finding of the urine following a cystoscopy?

A

pink-tinged urine is expected

74
Q

why should pt increase oral fluid intake following a cystoscopy?

A

to increase urine output and limit dysuria

75
Q

when should a patient start being NPO before a cystoscopy?

A

NPO at midnight the night before

76
Q

what position should be in for a cystoscopy?

A

lithotomy position

77
Q

what does an indwelling catheter increase the risk for?

A

UTI

78
Q

what are some things a nurse should do directly after a kidney biopsy?

A
  • promote bed rest
  • check for flank pain
  • monitor for hematuria
  • assess biopsy site
79
Q

what is the purpose of Buck’s traction?

A

relieve muscle spasms

80
Q

what is a trademark of fat embolism?

A

petechiae on chest
- also: hypoxemia, dyspnea, tachypnea, agitation, and headache

81
Q

what is it called when a broken bone ends jam together?

A

impacted

82
Q

what is a comminuted fracture?

A

when impact fragments bone into several pieces

83
Q

what is a transverse fracture?

A

break goes straight across bone shaft

84
Q

what is an oblique fracture?

A

occurs at an angle across the bone

85
Q

how can flexion contracture be prevented following an AKA (above the knee amputation)?

A
  • lie prone every 3hr for 20 - 30 mins
  • avoid prolonged sitting
  • avoid elevating residual limb for prolonged periods
86
Q

what interventions should be performed with Buck’s traction?

A
  • ensure weights are free hanging
  • monitor peripheral pulses
  • examine skin under traction splint
  • assess skin temp
87
Q

what are signs that may indicate compartment syndrome following a surgical repair of an open fracture?

A

absent pulse
- pain, pallor, paresthesia, paralysis

88
Q

what medication can be given for phantom limb pain?

A

IV calcitonin (infusions the week after amputation)

89
Q

what are the symptoms of carpel tunnel syndrome?

A

thumb, index, middle and half of ring finger

90
Q

what does RICE stand for? when is it used?

A
  • rest
  • ice
  • compression
  • elevation
  • injuries
91
Q

who does GERD occur most in?

A

middle age and older

92
Q

what are GERD interventions?

A
  • 4-6 small meals/day
  • remain upright 1 -2 hr after meals
  • avoid spicy, alcohol, caffeine, citrus, carbonation
93
Q

what 3 med types are used for GERD?

A

PPIs, H2 blocker, antacids

94
Q

what are the goals for medication treatment of GERD?

A
  • inhibit gastric acid secretion
  • accelerate gastric emptying
  • protect mucosa
95
Q

what are 2 s/s of rolling hernia?

A

breathlessness and feeling of suffocation after eating

96
Q

what type of hiatal hernia causes GERD?

A

sliding
- heartburn, chest pain, dysphagia, and belching

97
Q

what are 2 risk factors for the development of esophageal tumors?

A

smoking and obesity
- also: malnutrition, intreated GERD, and excessive alcohol

98
Q

what is the purpose of NG tube placement after a nissen fundoplication?

A

to prevent fundoplication wrap from becoming too tight around the esophagus

99
Q

what causes barretts epithelium?

A

body substitutes normal squamous cell epithelium of the esophagus with columnar epithelium as a compensation for GERD

100
Q

what causes many peptic ulcers?

A

h. pylori

101
Q

what drug would the nurse expect for a client who has a postoperative ileus?

A

alvimopan (increases GI motility)

102
Q

how may a pt with a small bowel obstruction present?

A
  • profuse vomiting
  • fluid and electrolyte imbalances
103
Q

what are some characteristics of a large bowel obstruction?

A
  • slow development
  • shape of stool altered
  • minimal n/v
104
Q

what are 3 risks for colorectal cancer?

A

> 50, hx of crohns, smoker

105
Q

what are the 3 most common signs of colorectal cancer?

A

rectal bleeding, anemia, and change in stool consistency/shape

-also: fatigue, ABD fullness, uninentional weight loss

106
Q

what may cause a false positive for a FOBT?

A

NSAIDS, vitamin C and red meat

107
Q

what should be avoided for 48 hr before an FOBT?

A

aspirin, Vitamin C, and red meat

108
Q

how long should anti-inflammatory meds be discontinued before an FOBT?

A

7 days

109
Q

what is the best means of ensuring removal of colorectal cancer?

A

surgical removal of tumor with margins free of disease

110
Q

how should a healthy stoma appear?

A

reddish pink and moist

111
Q

when should a colostomy begin to function properly?

A

2 -3 days

112
Q

how is stool expected to be with a colostomy in the ascending colon?

A

liquidy

113
Q

an ostomy in which part of the colon is expected to be pasty?

A

transverse colon

114
Q

what may cause appendicitis initially?

A

hard pieces of stool

115
Q

what does ulcerative colitis cause in the colon?

A

edema and inflammation

116
Q

which GI condition are fistulas common in?

A

crohns disease
- fistula = abnormal connection btwn 2 organs

117
Q

what are 3 s/s of peritonitis?

A
118
Q

where is pain likely to be felt w/appendicitis?

A

RLQ

119
Q

why are enemas and laxatives contraindicated with appendicitis?

A

increases risk of rupture that could lead to peritonitis or sepsis

120
Q

what types of foods should be avoided with diverticular disease?

A

seeds, nuts, corn, popcorn, figs and tomatoes

121
Q

what is a priority concern for a pt with gastroenteritis?

A

fluid replacement (Gatorade and pedialyte)

122
Q

what may diminishing bowel sounds, tachycardia, rigid, board-like abdomen, fever and tachycardia indicate?

A

peritonitis

123
Q

can a person with celiac eat rice?

A

yes (gluten free) but cannot eat barley, rye, or wheat

124
Q

why may ulcerative colitis lead to low H&H?

A

bloody stools

125
Q

what are 3 s/s of crohn’s disease?

A

anemia, diarrhea, and weight loss

126
Q

what is a good food choice for a client with crohns?

A

chicken and rice

127
Q

when should famotidine be taken?

A

bedtime

AdultCare1-Cook (8 decks)

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