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ATI MED SURGE2010 > Med Surge > Flashcards

Med Surge Flashcards

1
Q

What lab finding do you expect in the initial 24 hours of a burn client?

A
  • HCT & HGB elevated due to loss of fluid volume
  • Na decreased due to third spacing
  • K increased due to cell destruction
  • Blood glucose increased due to stress
  • WBC increase
  • ABG metabolic acidosis
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2
Q

What lab findings do you expect within 48-72 hrs of a burn client?

A
  • Hgb & Hct decreased due to fluid shift
  • Na decreased due to renal loss
  • K decreased due to renal loss movement back to into cells
  • WBC decreased
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3
Q

Pt exhibit ventricular fibrillation what is the priority nursing intervention?

A

Defibrillation followed by CPR

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4
Q

Why is an arterial line insertion used?

A

Needed for continuous blood pressure monitoring and access to withdraw ABG sample and CBC.

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5
Q

What is a pulmonary artery catheter insertion is used for?

A

Inserted to measure cerebrovascular pressure, pulmonary artery pressure and CO. Used for the management of fluids and inotropic medications

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6
Q

What is the diagnostic procedure best to asses for ECG changes associated with MI and dysrhythmias?

A

ECG

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7
Q

What is the diagnostic procedure best used for cardiomegaly, cardiomyopathy, evaluation of cardiac contractility and function, PE, and pleural effusion?

A

Echocardiogram

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8
Q

What is the diagnostic procedure to diagnose cardiomegaly, pneumothorax, and evaluation of the lungs?

A

CT scan

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9
Q

Injection of photosensitizing agent that is absorbed by all the cells in the body, one to three days later when the agent remains in only the cancer cells, tumor is exposed to a specific wavelength of the light via an endoscope.

A

Photodynamic Therapy (PDT)

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10
Q

Patient using PDT, client educaiton

A
  • Instruct client to avoid sun exposure for 6 weeks

- Instruct the client to consume a liquid diet for several days until pain subside

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11
Q

Delivery of synchronized, direct countershock to heart; elective treatment for atrial dysrhythmias supraventricular tachycardia, ventricular tachycardia with pulse

A

Cardioversion

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12
Q

Delivery of unsynchronized, direct countershock to the heart. stops all electrical activity in the heart allowing the SA node to take over and re-establish a perfusing rhythm; tx for ventricular fibrilation or pulseless ventricular tachycardia

A

Defibrillation

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13
Q

Pre procedure for client prior to cardioversion

A

Anticoagulation therapy to prevent dislodgment of thrombi in blood stream

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14
Q

What is the priority nursing intervention for client receiving cardioversion

A

Obtain consent

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15
Q

What should the nurse do before cardioversion takes place?

A

Administer sedation as prescribed before cardioversion

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16
Q

Nursing procedure for cardioversion

A
  • Administer sedation
  • Administer prescribed antidysrhythmic -medication
  • Monitor the client in a lead that provides upright QRS wavelength
  • Perform CPR for cardiac asystole or pulsless rhythm
  • Monitor client for PE pr systemic emboli following cardioverison
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17
Q

Client education after cardioversion

A

Teach client and family how to assess pulse

Advise client to report palpitations or irregular heart beat

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18
Q

Client diagnosed with osteoporosis, client teaching on estrogen (Premarin).

A

Caution to clients with DVT, and encourage self breast exams

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19
Q

Client teaching on Raloxifene hydrochloride (Evista)

A

Monitor liver function tests

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20
Q

Client teaching on Calcium carbonate supplement

A

Give with food.

Monitor kidney stones

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21
Q

Client teaching on Alenodrate sodium (Fosamax), Ibandronate sodium (Boniva), Risedronate (Actonel)

A

Take with 6-8 oz of water early in am before eating

Remain upright for 30 min

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22
Q

Client teaching Vit D supplements

A

Watch for S&S of toxicity: nausea, constipation, kidney stone

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23
Q

Client education on Calcitonin

A

Can be taken IM/SC or nasally

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24
Q

Pt teaching with osteoporosis

A
  • Exposure to vit D (sunlight, fortified milk)
  • Encourage weight bearing exercise to improve strength
  • Reinforce use of safety measures and assistant device
  • Adequate amounts of protein, Mg, K and trace minerals
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25
Q

What are the clinical manifestations of a client with L-sided heart failure?

A

Dyspnea, othopnea, fatigue, S3 gallop, hypertrophy, pulmonary congestion,( dypnea, cough, bibsalar crackles), frothy sputum(blood tinged), altered mental status, oliguria

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26
Q

Client teaching about topical coritcoidsteroids to a client with contact dermatitis?

A

Topical corticosteroids triamcinolone acetonide apply but avoid face, folds, and take periodic medication vacations.

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27
Q

Pt teaching on coal tar

A
  • May stain skin and hair
  • May stimulate growth of skin cancer
  • Apply at night with gloves
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28
Q

What is medication for a client with contact dermatitis is contraindicated for pregnant client?

A

Tazarotene (Tazorac) caused birth defects

Methotrexate (Mexate)

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29
Q

What to monitor for client taking Methotrexate (Mexate)?

A

Monitor for fever, sore throat, bleeding, bruising, and fatigue.

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30
Q

Pt exhibits, vomiting, diarrhea, and is having a tap water enema is at risk for.

A

Hyponatremia

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31
Q

What are the clinical manifestations for a client with hyponatremia?

A

Hypothermia, tachycardia, rapid thready pulse, hypotension, head ache, confusion, lethargy, muscle weakness and fatigue

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32
Q

Pt with increased gastric motility. hyperactive bowel sounds, and abdominal cramping is at risk for.

A

Hyponatremia

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33
Q

Client with mOsm of less than 270 mOsm/L

A

Hyponatremia

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34
Q

Client with CHF and is hyponatremic what would you administer?

A

Loop diuretics

Ace inhibitors

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35
Q

A pt that has acute hyponatremia, what would the nurse administer?

A
  • Administer hypertonic oral and IV fluids

- Administer 3% NaCl slowly and monitor Na

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36
Q

What would you recommend a pt with hyponatremia in their diet?

A

Cheese, milk, and condiments

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37
Q

How do you restore normal ECF fluid volume?

A
  • Administer isotonic IV (0.9% NaCl)

- Administer lactated Ringers

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38
Q

What should you tell patient to report to provider who is hyponatremic?

A

Encourage client to report weight gain of 1-2 lbs in 24 hrs

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39
Q

What to monitor for pt who is hyponatremic

A

Monitor I&O and weight daily

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40
Q

What are the expected findings for a pt with an eye disorder?

A

Frequent headaches, eye strain, Blurred vision, poor judgement of depth, diplopia

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41
Q

The tendency to close or favor one eye and poor hand eye coordination may be objective findings for what type of patient?

A

A patient with an eye disorder

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42
Q

What is the nursing intervention for a client with an eye disorder?

A

Increase amount of light in the room

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43
Q

What do you provide for a client with an eye disorder?

A

Magnifying lens and large print books and newspapers

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44
Q

Client education for a patient with eye disorder?

A

Wear protective sunglasses to protect the eyes

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45
Q

Client education for a patient with eye disorder?

A

Wash hands before and after eye medication

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46
Q

What foods do you want patient with eye disorder to incorporate in their diet?

A

Foods rich in antioxidants , such as green leafy vegetables

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47
Q

Client teaching to older clients to prevent eye disorders

A

Clients 40 years or older should have annual eye checks ups and measurements of IOP

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48
Q

To prevent injury for a client with eye disorder

A

Arrange the home to remove hazard, such as throw rugs

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49
Q

A pressure monitoring system comprised of catheter with infusion system, a transducer, and a monitor is used to display hemodynamic information.

A

Arterial Line

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50
Q

What are the components of a hemodynamic monitoring system?

A
  • Pressure transducer
  • Pressure tubing
  • Monitor
  • Pressure bag and flush device
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51
Q

Arterial lines are not used for

A

intravenous fluid infusion

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52
Q

Where are arterial lines placed?

A

Radial (most common), brachial, femoral artery

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53
Q

What should be assessed to verify the integrity of arterial waveform?

A

Blood Pressure readings

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54
Q

How do you monitor the circulation of limbs with arterial line?

A

Capillary refills, temperature, and color of the limbs

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55
Q

Permit of withdrawal of blood samples can be done through what?

A

Arterial line

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56
Q

Client presents with tachycardia, bounding pulse, hypertension, tachypnea, increased CVP is in what state?

A

Client is hypervolemic

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57
Q

Clinical manifestations of hypervolemia

A

Dyspnea, orthopnea, crackles, diminished breath sounds, edematus, and distended neck veins

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58
Q

Critical lab finding for pt with Hypervolemia

A
  • Hct decreased
  • Osmolarity decreased
  • Na WNL
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59
Q

A client who is respiratory alkalosis and chest xray reveals possible pulmonary congestion

A

Pt is at risk for hypervolemia

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60
Q

Causes of hypervolemia

A
  • Chronic stimulus to the kidney to conserver sodium and water
  • CHF, cirrhosis, increased glucocorticoids
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61
Q

Nursing implementations for a client who is hypervolemic?

A

Check ABGs, SaO2, and chest x ray

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62
Q

What position should a pt with hypervolemia be placed in

A

semi Fowler’s position

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63
Q

What do you want to monitor for a patient with hypervolemia?

A

Daily weight

I&O

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64
Q

What would you administer for a client with hypervolemia?

A

-Administer diuretics (osmotic, loop) as prescribed.

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65
Q

A client with hypervolemia should limit

A

fluid and sodium

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66
Q

What lung sounds would you expect for a client with hypervolemia?

A

crackles

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67
Q

What do you monitor and document for a pt with hypervolemia?

A

Presence of edema (pretibial, sacral, periorbital)

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68
Q

Client education for a patient with hypervolemia

A

-Encourage client to weigh themselves daily,and notify PC if 1 to 2 lb gain in 24 hrs

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69
Q

What diet should a patient with hypervolemia have?

A

-consume a low sodium diet, read food labels to check for sodium contents

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70
Q

What are the client outcomes for a patient with hypervolemia?

A
  • Client will maintain adequate oxygen level
  • Client will be free for anxiety
  • Client will be compliant with fluid restriction intake
  • Client will consume a low sodium diet
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71
Q

What are the causes for hypovolemia?

A

-Abnormal GI losses (vomiting, nasogastric sunctioning, diarrhea,) diaphoresis, diuretic therapy, DI, renal disease, adrenal insufficiency

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72
Q

Pt is hyperthermic, tachycardia, thready pulse, hypotension, orthostatic hypotension, decreased CVP is in what state?

A

Hypovolemic

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73
Q

Pt is dizzy, syncope, confused, and weak, and fatigued, what is the priority nursing intervention?

A

Administer supplemental oxygen

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74
Q

Pt exhibits increased osm greater than 300 mOsm/L, increased protein, BUN, electrolytes, and glucose. This patient is in what state?

A

Hypovolemic shock

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75
Q

What fluid replacements would you administer for a patient with hypovelmia?

A
  • Colloids (whole blood, packed RBCs, plasma, synthetic plasma expanders)
  • Crystalloids (Ringer’s lactate, normal saline)
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76
Q

What vasconstrictors would you administer to a pt with hypovolemia?

A

dopamine (Intropin)

norepinephrine (Levophed)

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77
Q

A patient with respiratory acidosis nursing priority intervention.

A

Oxygen therapy

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78
Q

A patient with respiratory alkalosis nursing priority intervention.

A

Oxygen therapy

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79
Q

A patient with metabolic acidosis and has DKA nursing priority intervention.

A

Administer insulin

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80
Q

A patient with metabolic acidosis and has GI disruption what is nursing priority intervention?

A

Administer antidiarrheal and provide rehydration

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81
Q

A patient with metabolic alkalosis and has GI loses what is nursing priority intervention?

A

Administer antiemetics and electrolyte replacements

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82
Q

Respiratory acidosis nursing care:

A
  • Oxygen therapy
  • Maintain patent airway
  • Positioning (enhance gas exchange)
  • Breathing techniques
  • Ventilatory support
  • Bronchodilators
  • Mucolytics
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83
Q

Respiratory alkalosis nursing care:

A
  • Oxygen therapy
  • anxiety reduction
  • rebreathing techniques
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84
Q

Pt exhibits tachycardia, tachypnea, shallow, rapid breathing, pale and is cyanotic is experiencing what acid base imbalance?

A

Respiratory Acidosis

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85
Q

Pt exhibits tachypnea, anxiety, tetany, tingling, and numbness has rapid deep respirations is experiencing what acid base imbalance?

A

Respiratory Alkalosis

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86
Q

What clinical manifestations does a client with metabolic acidosis exhibit?

A

Bradycardia, weak peripheral pulses, hypotension, tachypnea, muscle weakness, flaccid paralysis, fatigue, confusion, Kussmaul respirations.

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87
Q

A client with depressed skeletal muscles resulting in ineffective breathing is in what acid base imbalance state?

A

Metabolic alkalosis

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88
Q

pH 7.30 PaCO2 50 HCO3 24

A

Respiratory acidosis

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89
Q

pH 7.47 PaCO2 37 HCO3 21

A

Metabolic alkalosis

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90
Q

A patient with acid base imbalance is at risk for convulsion, coma, respiratory arrest. What is the priority nursing intervention?

A

Implement seizure precautions and perform management interventions in necessary .

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91
Q

Clinical manifestations for a client with hyponatremia

A

headache, tachycardia, confusion, muscle weakness, fatigue, decreased deep tendon reflexes, seizures

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92
Q

What should the nurse administer for a patient with hypernateremia?

A 
hypotonic IV fluids (0.45 NaCl)
isotonic IV (0.9% NaCl)
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93
Q

Client education for a client with hypernatremia?

A

Encourage water intake and discourage sodium intake

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94
Q

Monitor the client’s level of consciousness and ensure safety.

A

Seizure Precautions

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95
Q

What nursing intervention can decrease thirst?

A

Provide oral hygiene

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96
Q

What to report to PCP for a client with hypernatremia?

A

Inadequate renal output less than 30 ml/hr

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97
Q

For a client with acute hypernatremia complications include seizures, convulsions if not treated immediately. What is the priority nursing intervention?

A

Maintain open airway and monitor clients vital signs

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98
Q

What does the volume (low pressure) alarm indicate in a ventilator?

A

Low exhale volume due to disconnection, cuff leak, and or tube displacement.

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99
Q

What does pressure (High pressure) alarms indicate in a ventilator?

A

Excess secretion, client biting the tubing, kinks in the tubing, client coughing, pulmonary edema, bronchospasms, and pneumothorax

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100
Q

What does apnea alarms indicated in a ventilator?

A

Ventilator does not detect spontaneous respiration in preset time.

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101
Q

What pressure should the cuff pressure be kept to reduce the risk of tracheal necrosis?

A

20 mm Hg

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102
Q

A client speaking, air hissing, or decreasing Sa O2 may indicate what?

A

Air leak around the cuff. Inadequate cuff pressure can result in inadequate oxygenation and or accidental extubation.

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103
Q

Clients receiving mechanical ventilation may require sedation or paralytic agents to prevent competition between extrinsic and intrinsic breathing. What are types of sedatives to use?

A

propofol( Diprivan), diazepam (Valium), lorazepam (Ativan), midazolam (versed_ and haloperidol (Haldol)

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104
Q

How often do you reposition the oral endotracheal tube?

A

Q24H

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105
Q

How do you assess for adequate nutrition for mechanically ventilated patients?

A
  • Bowel movement q8h
  • Monitor bowel habits
  • Administer enteral or parental feedings as RX
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106
Q

A client with RR greater than 30, BP changes more than 20% baseline, and SaO2 less than 90%, elevated ST segments, shows signs of what?

A

Weaning intolerance

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107
Q

Following extubation what should you monitor the client for?

A

Respiratory distress, airway obstruction such as ineffective cough. dyspnea, and stridor

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108
Q

Older clients have decreased respiratory muscle strength and chest wall compliance which make them susceptible to what.

A

Aspiration, atelectasis, and pulmonary infection

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109
Q

A client who is on a mechanical ventilator has a risk of increased thoracic pressure which results in what?

A

Increased Positive Pressure

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110
Q

Monitor for tachycardia, hypotension, urine output less than or equal to 30 ml/hr, cool clammy extremities, decreased peripheral pulses and decreased LOC illustrates:

A

Hemodynamic compromise

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111
Q

How do you decrease risk of aspiration?

A

Elevated HOB 30-45 degrees

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112
Q

What are medications used to prevent ulcers in mechanically ventilated patients?

A

sucrafalate

Histamine 2 blockers

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113
Q

What is the flow rates of T-pieces?

A

10L/min

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114
Q

What device can be used for clients who have tracheostomies, laryngectomies, or ET?

A

T-piece

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115
Q

What is the disadvantages of T-pieces?

A

High humidifications require frequent monitoring

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116
Q

What is the priority nursing interventions for a T-piece?

A
  • Ensure that exhalation port is open and uncovered
  • Make sure that the T piece does not pull on the tracheostomy or ET tube
  • Ensure that the mist is evident during inspiration and expiration.
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117
Q

What are the signs and symptoms of hypoxemia?

A

SOB, anxiety, tachypnea, tachycardia, restlessness, pallor, cyanosis of the skin, or mucous membranes, adventitious breathe sounds, confusion

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118
Q

Client exhibits tachypnea, tachycardia, restlessness, pale skin, elevated BP, adventious lung sounds which is representative of early or late findings of hypoxemia?

A

Early findings

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119
Q

What are late findings of hypoxemia in a client?

A

Confusion and stupor, cyanotic skin and mucous membranes, bradypnea, bradycardia, hypotension, and cardiac dysrhythmias

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120
Q

What position should the client be to facilitate breathing and promotion of chest expansion?

A

semi-fowler’s position or fowler’s position

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121
Q

What are the S&S of hypercarbia?

A

Restlessness, hypertension, and headache

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122
Q

Which symptoms of respiratory depression should be notified to the PCP?

A

Decreased RR and Decreased LOC

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123
Q

What are the clinical manifestations for a pt experiencing oxygen toxicity?

A

Nonproductive cough, substernal pain, nasal stuffiness, nausea, vomiting, fatigue, headache, sore throat, and hypoventilation

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124
Q

What is the nursing priority with a pt exhibiting oxygen toxicity.

A

Use the lowest level of oxygen necessary to maintain and adequate SaO2.

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125
Q

What are the signs and symptoms of hypoxemia?

A

SOB, anxiety, tachypnea, tachycardia, restlessness, pallor, cyanosis of the skin, or mucous membranes, adventitious breathe sounds, confusion

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126
Q

Client exhibits tachypnea, tachycardia, restlessness, pale skin, elevated BP, adventious lung sounds which is representative of early or late findings of hypoxemia?

A

Early findings

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127
Q

Nursing actions for a client using oxygen therapy

A
  • Signs to alert others of a fire hazard
  • Know where the closest fire extinguisher is located
  • Educate clients/family about smoking due to O2 use
  • Have the client wear cotton gown, bc synthetic or wool fabrics can generate static electricity
  • Ensure that all electric devices (razors, hearing aids, radios) are working
  • Ensures electric machinery (monitors, suction machines) well grounded
  • Do not use volatile, flammable materials (etOH) near clients receiving O2)
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128
Q

What are the advantages of Positive-pressure ventilators?

A
  • Forced/enhanced lung expansion
  • Improved gas exchange (oxygenation)
  • Decreased work of breathing
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129
Q

How do you establish method of communication with a patient who is on a mechanical ventilation?

A
  • Asking yes/no questions
  • Providing writing materials
  • Using dry erase boards
  • Picture communication board, or lip reading
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130
Q

Which symptoms of respiratory depression should be notified to the PCP?

A

Decreased RR and Decreased LOC

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131
Q

What are the clinical manifestations for a pt experiencing oxygen toxicity?

A

Nonproductive cough, substernal pain, nasal stuffiness, nausea, vomiting, fatigue, headache, sore throat, and hypoventilation

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132
Q

What do you monitor and document in ventilators settings hourly?

A
  • Rate, FiO2, and tidal volume
  • Mode of ventilation
  • Use of adjuncts (PEEP, CPAP)
  • Plateau or peak inspiratory pressure
  • Alarm settings
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133
Q

What do you monitor for a client with oxygen induced hypoventilation?

A

Monitor client’s RR and pattern, LOC, and SaO2

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134
Q

What type of mask should the nurse use for delivery of precise oxygen levels?

A

Venturi masks

135
Q

Nursing actions for a client using oxygen therapy

A

Signs to alert others of a fire hazard
Know where the closest fire extinguisher is located
Educate clients/family about smoking due to O2 use
Have the client wear cotton gown, bc synthetic or wool fabrics can generate static electricity
Ensure that all electric devices (razors, hearing aids, radios) are working
Ensures electric machinery (monitors, suction machines) well grounded
Do not use volatile, flammable materials (etOH) near clients receiving O2)

136
Q

How do you establish method of communication with a patient who is on a mechanical ventilation?

A

Asking yes/no questions
Providing writing materials
Using dry erase boards
Picture communication board, or lip reading

137
Q

What is the priority nursing intervention in a patient on a mechanical ventilator?

A

Maintain a patent airway

138
Q

What diet restrictions should a client with Crohn’s disease have?

A
  • Educate client to eat foods high in protein and calories, and low in fiber
  • Instruct client to avoid caffeine and alcohol, and take multivitamin that contains iron
139
Q

A client with a mild case of diverticulitis should be prescribed what by the health care provider?

A
  • Antibiotics
  • Analgesics
  • Antispasmodics
  • Rest
140
Q

What delivers an FiO2 of 24%-55% at flow rates of 2-10 L/ min via different sized adaptors?

A

Venturi Mask

141
Q

A client taking Sulfasalazine (Azulfidine) should be advised to

A
  • Take with food
  • Avoid sun exposure
  • Increase fluid intake
  • Urine and skin may appear yellow or brown
142
Q

What delivers an FiO2 of 80%-95% at flow rate of 10-15 L/min to keep the reservoir bag 2/3 full during inspiration and expiration?

A

Nonrebreather mask

143
Q

What adverse side effects should a client inform the PCP when taking Mesalamine (Asacol, Pentasa, Rowasa)?

A

Headache or GI problems, such as abdominal discomfort or diarrhea

144
Q

Clients taking Prednisone (Deta son) for Ulcerative colitis should report what to PCP?

A

Unexpected weight gain or other signs of fluid retention

145
Q

What diet restrictions should a client with Crohn’s disease have?

A

Educate client to eat foods high in protein and calories, and low in fiber
Instruct client to avoid caffeine and alcohol, and take multivitamin that contains iron

146
Q

A client with a mild case of diverticulitis should be prescribed what by the health care provider?

A

Antibiotics
Analgesics
Antispasmodics
Rest

147
Q

What type of diet is appropriate for a client with diverticulitis?

A

Limited to clear liquids initially but may progress to a high fiber, low fat diet.

148
Q

A client taking Sulfasalazine (Azulfidine) should be advised to

A

Take with food
Avoid sun exposure
Increase fluid intake
Urine and skin may appear yellow or brown

149
Q

A client taking Olsalzine (Dipentum) is intolerant to sulfaszlazine and should report what to the PCP?

A

Sore throat, rash, bruising, and or fever

150
Q

Clients taking Prednisone (Deta son) for Ulcerative colitis should report what to PCP?

A

Unexexpected weithg gain or other signs of fluid retention

151
Q

Client teaching for use of Budesonide (Entocort)?

A

Avoid crowds and other exposures to infectious disease

152
Q

A client with IBS taking Cyclosporine (Sandimmune) and methotrexate (Rheumatrex) should monitor for?

A

Bleeding, bruising, or infection

153
Q

Client education on levothyroxine (Synthroid)

A
  • Tx begins slowly and dosage is increased 2-3 weeks
  • Serum TSH labs will be drawn at sched times to ensure appropriate dosage
  • Monitor for and report signs and symptoms of hyperthyroidism ( irritability, tremors, tachycardia, and palpitations, heat intolerance)
  • Inform client that tx is lifelong requiring medical assessment of thyroid function
154
Q

Client with myxedema coma will exhibit:

A
  • Significantly depressed respirations
  • Decreased CO
  • Worsening cerebral hypoxia
  • Stupor
  • Hypothermia
  • Bradycardia
  • Hypotension
  • Hypoglycemia
  • Hyponatremia
155
Q

What do you observer the client for when taking Diphenoxylate hydrochloride and atropine (Lomotil)

A

Respiratory depression

156
Q

Decreased T3, Elevated TSH with primary, Decreased T4, Elevated cholesterol, CBC showing anemia are lab findings for?

A

Hypothyroidism

157
Q

What is the treatment of choice for a client with hypothyroidism?

A

Thyroid hormone replacement therapy levothyroxine (Synthroid)

158
Q

levothyroxine (Synthroid) effects of warfarin

A

It increases effects of warfarin (Coumadin) and can increase the need for insulin and digoxin (Lanoxin)

159
Q

Nursing Actions for preprocedure to a client receiving hemodialysis:

A
  • Assess patency of access site (presence of bruit, palpable thrill, distal pulses, and circulation
  • Avoid taking BP, administering injections, or venipunctures on arm with access site
  • Assess VS, lab values (BUN, creatine, electrolyte, Hct) weight
160
Q

Client with myxedema coma will exhibit:

A 
Significantly depressed respirations 
Decreased CO
Worsening cerebral hypoxia
Stupor
Hypothermia
Bradycardia
Hypotension
Hypoglycemia
Hyponatremia
161
Q

What is the priority nursing intervention to a client with myxedema coma?

A

Maintenance of airway patency with ventilatory support if necessary

162
Q

What is the client outcome for a client taking a Synthroid?

A

The client’s TSH will return to the expected reference range.

163
Q

What complication is the client at risk for using hemodialysis?

A

Clotting and infection of access site

164
Q

What is the priority nursing intervention for a client receiving hemodialysis?

A

Use surgical aseptic technique during cannulation

165
Q

Client education after dialysis procedure?

A
  • Avoid lifting heavy objects with access site arm
  • Avoid carrying objects that compress the extremity
  • Avoid sleeping on top to the extremity with access device
  • Perform hand exercises that promote fistula maturation
166
Q

What types of medications are witheld until after dialysis?

A

Medications that lower BP

167
Q

Client experiencing hypotension during dialysis, what is the priority nursing intervention?

A

Carefully replace fluid volume with transfusion of IV fluids or colloids as Rx. and then slow dialysis exchange rate then lower head of bed

FOR SEVER Hypotension: D/C dialysis

168
Q

A client with anemia who is receiving dialysis, nursing intervention:

A
  • Administer Rx med therapy (erythropoetin)
  • Monitor Hgb, and RBC levels
  • Monitor of hypotension and tachycardia
169
Q

After dialysis what would you expect a decrease in?

A

Decreases in BP, weight, and lab values

170
Q

What complications should the nurse assess for after dialysis?

A

Hypotension, clotting of vascular access, headache, muscle cramps, bleeding

171
Q

What is the preventative measure the nurse will use for a client with an bloodborne disease?

A

Use standard precautions

172
Q

A peritoneal dialysis (PD) is used for

A

A client requiring dialysis and are unable to tolerate anticoagulation, or have difficulty with vascular access

173
Q

Client experiencing hypotension during dialysis, what is the priority nursing intervention?

A

Carefully replace fluid volume with transfusion of IV fluids or colloids as Rx. and then slow dialysis exchange rate then lower head of bed
FOR SEVER Hypotension: D/C dialysis

174
Q

How long is continuously ambulatory peritoneal dialysis (CAPD) done?

A

7 days a week for 4 to 8 hrs

175
Q

What is the client teaching on a pt’s diet who is anemic and receiving hemodialysis?

A

Educate client to eat foods high in folate (beans, green veggies)

176
Q

A client who has frequent blood transfusions and frequent blood access due to hemodialysis are at risk for?

A

Transmission of blood borne disease such as HIV and hep B and hep C

177
Q

A peritoneal dialysis is used for

A

A client requiring dialysis and are unable to tolerate anticoagulation, or have difficulty with vascular access

178
Q

Signs of infection and complications for a client receiving PD?

A

Infection: fever, blood, cloudy, or frothy dialysate return; drainage at access site

Complications: respiratory distress, abdominal pain, insufficient blood flow, discolored outflow

179
Q

What is the priority nursing interventions for a client receiving PD?

A

Monitor client’s VS frequently during initial dialysis in a hospital setting

180
Q

What lab value will you be monitoring for a client during PD?

A

serum glucose level

181
Q

What will the nurse record while a client is receiving a PD?

A

Record the amount of inflow compared to outflow of dialysate

182
Q

Signs of infection and complications for a client receiving PD?

A

Infection: fever, blood, cloudy, or frothy dialysate return; drainage at access site
Complications: respiratory distress, abdominal pain, insufficient blood flow, discolored outflow

183
Q

How do you prevent reflux of a client receiving PD?

A

Keep the outflow bag lower than the client’s abdomen

184
Q

Post procedure for a client receiving PD, nursing actions:

A

Monitor weight, serum electrolytes, creatine, BUN, and blood glucose

185
Q

What to teach client for home care of access site (PD)?

A

Instruct the client and family how to perform peritoneal dialysis with home visits and support groups

186
Q

A client that is receiving PD may allow microorganisms into the peritoneum and cause what?

A

Peritonitis

187
Q

What is the nursing actions for a client at risk for peritonitis?

A

Maintain surgical asepsis during procedure

Monitor for infection: fever, purulent drainage, redness or swelling, and cloudy or discolored drained dialysate

188
Q

What should you educate the client about to prevent peritonitis?

A

Educate the client to use sterile asepsis during procedure

189
Q

What do you want to assess for in the access site to prevent infection?

A

Assess site for wetness from a leaking catheter

Purulent drainage, redness or swelling

190
Q

For protein loss in a client receiving PD what lab value do you want to monitor?

A

serum albumin

191
Q

What do you want to teach the client with protein loss during peritoneal dialysis?

A

Instruct client to follow recommended renal diet with an increase in dietary protein

192
Q

If the tubing is obstructed or twisted causing a decrease in flow what should the nurse do?

A
  • Reposition the client if inflow or outflow is inadequate
  • Milk tubing to break fibrin clots
  • Check tubing for kinks or closed clamps
  • Tell the client to avoid constipation by using stool softeners and consuming a diet high fiber
193
Q

What lab value will you monitor for if patient is at risk for hyperglycemia?

A

Glucose

194
Q

What would the nurse administer when hyperglycemia is suspected?

A

Administer insulin for glycemic control

195
Q

A client with hyperglycemia should be instructed to:

A

Instruct pt to check serum glucose

196
Q

A client with increased AST aspartate amniotransferase (5-40 u/L) and ALT alanine aminotransferase (8-20 u/L)

A

Elevated AST and ALT occurs with hepatitis or cirrhosis

197
Q

What is the function of dialysis?

A

Rids the body of excess fluids and electrolytes
Achieves acid base balance
Eliminates waste products
Restores internal homeostasis by osmosis , diffusion, and ultrafiltration

198
Q

What is disequilibrium syndrome?

A

DS is caused by too rapid a decrease in BUN and circulating fluid volume. It may cause cerebral edema and increased ICP

199
Q

What is the nursing intervention for a client experiencing disequilibrium syndrome (nausea, vomiting, change in LOC, seizures, and agitation)?

A

Use a slow dialysis exchange rate

Administer anticonvulsants/ barbiturates if needed

200
Q

A client with increased ALP alkaline phosphatase (42-128 u/L)

A

Elevated ALP indicates liver damage

201
Q

A client with elevated Amylase (56-90 IU/L), Lipase (0-110 u/L)

A

Elevated amylase and lipase indicate pancreatitis

202
Q

A client presents with GI bleeding and unexplained diarrhea and is positive for c.diff is indicative of an opportunistic infection. What is the client education for this pt?

A

Instruct client about proper collection of stool sampling using a card or a collection cup. The client may be instructed to restrictions before collecting ( red meat, anticoagulants)

203
Q

Client with decreased albumin ( 3.5-5.0 g/dL)

A

Decreased albumin indicate hepatic disease

204
Q

Client with elevated AFP Alpha fetoprotein ( <40 mcg/L) and Ammonia ( 15-110 mg/dL)

A

Elevated AFP and ammonia found in liver cancer

205
Q

What diagnostic procedure is used for visualization of the oropharynx, esophagus, stomach and duodenum?

A

Esophagogastroduodenoscopy

206
Q

What medications restrictions should the patient follow before having an endoscopy procedure?

A

NSAIDs, warfarin, aspirin

207
Q

Client presents with anemia secondary to bleeding, abdominal discomfort, and abdominal distention. What is the nursing action for this patient to have an endoscopy done?

A

Evaluate the client’s understanding of the procedure

208
Q

What do you want to ensure the client be prior to most endoscopic examinations?

A

Client needs to be NPO for 6-8 hrs prior to endoscopic examinations

209
Q

A client having a colonscopy should be in what position?

A

Left side with knees to chest

210
Q

What type of anesthesia should the pt receive before a colonoscopy?

A

Moderate sedation: midazolam (Versed) usually given with an opiate analgesic

211
Q

A client that may need laxatives such as bisacodyl (Dulcolax), clear liquid diet, NPO after midnight, will be having what procedure done?

A

Colonscopy

212
Q

What would monitor for after a colonoscopy procedure?

A

Monitor for rectal bleeding
Encourage plenty of fluids
Monitor VS esp, respiratory status
Instruct client that there may be increased flatulence

213
Q

What position will the pt be lying during an EGD?

A

left side lying

214
Q

What type of sedation will the client with an EGD be administered?

A

Moderate sedation

topical anesthetic

215
Q

Preparation for this procedure includes NPO 6-8 hrs; removal of dentures

A

EGD

216
Q

When performing an EGD advise client to notify PCP when what occurs?

A

Notify PCP of bleeding, abdominal or chest pain, and any evidence of bleeding

217
Q

A client receiving a conscious sedation such as a topical anesthetic and initally semi prone with repositioning throughout the which procedure?

A

ERCP

218
Q

When performing EGD when can you give fluids?

A

When gag reflex returns

219
Q

How is a client receiving a sigmoidoscopy is positioned?

A

on left side

220
Q

What complications is a pt at risk for during moderate sedation?

A

Oversedation

221
Q

Difficulty arousing the client, poor respiratory effort, evidence of hypoxemia, tachycardia, and elevated or low BP indicate?

A

Oversedation

222
Q

What is the nurse’s priority intervention with a client who is oversedated?

A

Prepare to administer antidotes to the sedatives

Maintain an open airway
administer oxygen
and monitor VS

223
Q

Symptoms of hemorrhage

A

bleeding, cool, clammy skin, hypotension, tachycardia, dizziness, and tachypnea

224
Q

What labs should the nurse monitor after a hemorrhage?

A

Hgb and Hct

225
Q

What should the client report to the PCP after a hemorrhage occurs?

A

Report fever, pain, and bleeding

226
Q

After any procedure using moderate sedation that affects the gag reflex places the clients at risk for?

A

aspiration

227
Q

What is the nursing action for a client at risk for aspiration?

A

The client should be NPO until the gag reflex returns

228
Q

A client with potential diagnosis of gastric ulcers, peristaltic disorders, tumors, varices and intestinal enlargements may have what type of study done?

A

Gastrointestinal studies with barium

229
Q

Pre procedure Gastrointestinal study

A

Inform client about medications, food and fluid restrictions (NPO after midnight) and avoid smoking or chewing gum (increases peristalsis)

230
Q

When do you schedule barium enema studies?

A

Barium enema studies must be scheduled prior to upper gastrointestinal studies

231
Q

Client education before GI studies?

A

Tell the client to restrict food and fluids for bowel preparations

232
Q

What do you monitor after the GI study procedure?

A

Monitor elimination of contrast material and administer a laxative if Rx
Force fluids to promote elimination of contrast material

233
Q

Why are clients receiving chemotherapy immunocompromised?

A

Immunosupression is due to bone marrow suppression by cytotoxic medications

234
Q

What lab value do you want to monitor for a client who is immunocompromised?

A

WBC

235
Q

If a client’s WBC drops below 1,000 mm3 what precaution should be initiated?

A

Neutropenic Precautions

  • Place client in a private room
  • Place a mask on pt if he needs to be transported
  • Protect the client form possible sources of infection (plants, visitor restriction), water equipment changed daily
236
Q

What is a primary prevention that client, staff, and visitors can do to prevent spread of infection?

A

Perform frequent hand hygiene

237
Q

What colony stimulating factors stimulates WBC production?

A

filgrastim (Neupogen, Neulasta)

238
Q

Client education for a pt that is immunocompromised

A
  • Avoid crowds whil undergoing chemotherapy
  • Avoid eating fresh fruits and veggies
  • Avoid yard work, gardening or changing a pet’s litter box
  • Avoid fluids sitting at room temp for greater than 1 hr
  • Wash toothbrush daily in dishwasher or rinse with bleach
  • Report fever >37.8 C
239
Q

A client undergoing chemotherapy is experiencing vomiting, what should the nurse do first?

A

Give the client antiemetic medications at times that are appropriate, prior to tx, during tx, and after tx

240
Q

What would you administer to increase appetite for a client undergoing chemotherapy?

A

megestrol (Megace)

241
Q

How can you promote adequate nutritional intake to client undergoing chemotherapy?

A

Provide liquid supplements as needed, add protein powders to food or tube feedings

242
Q

What technique may be useful adjuncts to antiemetics?

A

Visual imagery and relaxation techniques

243
Q

How do you enhance the client’s appetite?

A

Perform mouth care prior to serving meals

244
Q

What type of diet is suggested for a client who is going through chemotherapy and has nausea and vomiting?

A

Encourage consumption of high protein, high calorie, nutrient dense foods and avoidance of low or empty calorie foods

245
Q

What would you suggest to a client with a metallic taste in the mouth?

A

Encourage use of plastic eating utensils, sucking on hard candy, and avoidance of red meats

246
Q

What is the nursing intervention for a client with alopecia?

A

Discuss the impact of alopecia on self image. Discuss options such as hat, turbans, and wigs to deal with hair loss

247
Q

After hair loss client education:

A

Client should protect the scalp form the sun and can cause diaper rash ointment/ cream itching

248
Q

Mucositis

A

also known as stomatitis is an inflammation of tissues in the mouth, such as the gums, tongue, roof and floor of the mouth, and inside the lips and cheeks.

249
Q

What is the nursing action for a client with mucositis?

A
  • Examine the client’s mouth several times a day
  • Document the location and sz of lesions
  • Avoid using glycerine-based mouthwashes or mouth swabs
  • Administer a topical anesthetic prior to meals
  • Discourage selection of salty, acidic, or spicy foods on the menu
  • Offer mouth care before and after each meal
250
Q

Client education for a client with mucositis

A
  • Encourage client to rinse mouth with a soln: half 0.9%NaCl and half peroxide at least 2 times a day
  • Brush teeth using soft bristles
  • Encourage consumption of soft foods (mashed potatoes, scrambled eggs, cooked cereal) or ice cream, bananas, milk shakes
251
Q

Anemia

A

Decreased number of circulating RBC

252
Q

Thrombocytopenia

A

Decreased number of circulating platelets

253
Q

Symptoms of Anemia

A

Fatigue, pallor, dizziness, and SOB

254
Q

Symptoms of Thrombocytopenia

A

Petechiae, ecchymosis, bleeding of the gums, nosebleed, occult or frank blood in stools, urine, vomit

255
Q

Nursing intervention for anemia induced fatigue

A

Schedule activities with rest periods in between and using energy saving measures (sitting during showering)

256
Q

What erythropoeitic medications should be administered to a client who is anemic?

A 
erythropoeitn alfa (Epogen)
ferrous sulfal (Feosol)
257
Q

How do you evaluate the effectiveness of the erythropoetitic medications?

A

Hgb to determine response to medications

258
Q

What medications should you administer to a client who is thrombopoietic?

A

oprelvekin (Interleukin 11, Neumega)

259
Q

What should you instruct the client who has anemia or thrombocytopenia?

A
  • Use an electric razor instead of a razor blade when shaving
  • Use soft bristled toothbrush
  • Blow nose only when necessary
  • Wear shoes when ambulating
  • Avoid the use of NSAIDs
260
Q

Upon receiving a client, the nurse should immediately perform full body assessment giving priority to:

A

Airway, breathing, and circulation

261
Q

What to do if wound dehiscence or evisceration occurs?

A
  • Call for help
  • Stay with the client
  • Cover the wound with sterile towel or dressing that is moist with sterile saline
  • Monitor the client for shock
  • Notify health care immediately
262
Q

A client with incision and drain sites should be monitored for:

A

redness, excessive tenderness, and purulent drainage

263
Q

What to instruct client after a CABG?

A
  • Avoid strenuous exercise
  • Immediately report bleeding from insertion site, chest pain SOB, changes in color or temp of the extremity
  • Restrict lifting (<10 lbs) for the prescribed period of time
264
Q

What to lifestyle changes to instruct client to follow after CABG?

A
  • Manage weight
  • Consume a low fat/ low cholesterol diet
  • Exercise regularly
  • Stop smoking
  • Decrease etoh intake
265
Q

What are signs of complications in a client under hemodialysis?

A

Hypotension, clotting of vascular access, headache, muscle cramps, bleeding

266
Q

What to instruct a client who will be having a hysterectomy before procedure?

A

Maintain NPP

Ensure that informed consent was obtained

267
Q

After a hysterectomy client should be monitored for vaginal bleeding. What is excess bleeding?

A

Excess bleeding is more than one saturated pad in 4 hr

268
Q

After hysterectomy, monitor the client’s VS

A

VS: fever and hypotension

269
Q

After hysterectomy, monitor the clients breath sounds

A

Risk of atelactisis

Turn, cough and deep breath, encourage the use of IS and ambulation

270
Q

After hysterectomy, monitor bowel sounds

A

Client at risk for paralytic ileus

271
Q

After hysterectomy, monitor the clients urine output

A

Call PCP if less than 30 ml/hr

272
Q

After hysterectomy, provide IV fluid and electrolyte replacement

A

Until bowel sounds reture

273
Q

After hysterectomy, monitor client’s incision site

A

At risk for infection, look at integrity, and risk of dehiscence

274
Q

After hysterectomy, monitor client for signs of thrombophlebtitis

A

warmth, tenderness, and edema will be presesnt

275
Q

Take thromboembolism precautions

A

ie: sequential compression devices, ambulation

276
Q

Client education after hysterectomy

A

-Instruct the client about a well balanced diet that is high in protein and vit C and high in iron

277
Q

Psychological reaction to a hysterectomy; nursing action

A
  • Encourage the client to discuss positive aspects of life
  • Understand that occasional sadness in the client is normal, but persistent sadness indicates need for counseling assistance
278
Q

What is a positive Kernig’s sign?

A

Resistance and pain with extension of the client’s leg from a flexed position

279
Q

What are findings including in compartment syndrome?

A
  • Increased pain unrelieved with elevation
  • Intense pain when passively moved
  • Paresthesia or numbness
  • Color of tissue is pale (pallor)
280
Q

What are clinical manifestations of a fat embolism?

A
  • Decreased mental acuity
  • Respiratory distress
  • Tachycardia
  • Tachypnea
  • Fever
  • Cutaneous petechia (found in the neck, chest, upper arms, and abdomen)
281
Q

What are S&S of osteomyelitis?

A
  • Bone pain that is worst with movement
  • Erythemia and edema
  • Fever
  • Leukocytosis
282
Q

Nursing Care for PE (pulmonary embolism)

A
  • Administer oxygen
  • Initiate and maintain IV access
  • Administer anticoagulants
  • Provide emotional support and comfort to control client anxiety
  • Monitor changes of LOC
283
Q

Client education for treatment and prevention of PE:

A
  • Promote smoking cessation
  • Encourage the client to avoid long periods of immobility
  • Encourage physical activity such as walking
  • Encourage the client to avoid crossing legs
284
Q

What lab findings is indicative of Cushing disease?

A

Elevated plasma cortisol level in the absence of acute illness or stress

285
Q

Cushing’s disease lab findings:

A

Hypersecretion of ACTH by anterior pituitary

  • K and Ca decreased
  • Glucose increased
  • Na increased
  • Lymphocytes decreased
286
Q

Nursing Actions for Phantom Limb Pain

A
  • Recognize the pain is real and manage accordingly

- Described as deep, burning, cramping, shooting or aching

287
Q

How do you prevent flexion contractures?

A
  • ROM exercises and proper positioning
  • Avoid elevating the stump on a pillow after the first 24 hours
  • Have the client lie prone several times a day
  • Discourage prolonged sitting
288
Q

What type of medications do you treat phantom limb with?

A

Beta blockers such as propranolol (inderal) and antiepileptics such as gabapentin (Neurontin)

289
Q

Complications of intestinal obstruction include dehydration and electrolyte imbalance. What should you notify to PCP?

A

Hct, BUN, orthostatic vital signs, urine ouput, and specific gravity
(Assessment of hydration)

290
Q

Monitor client for fluid and electrolyte imbalance in a client with a nasogastric decompression procedure.

A

Metabolic acidosis: low obstruction

Metabolic alkalosis: high obstruction

291
Q

What are the laboratory findings for a client with Graves?

A

TSH decreased
FTI and T3 elevated
Thyrotropin releasing hormone (TRH) stimulation test: failure of expected rise in TSH

292
Q

What are the signs of digoxin toxicity?

A

Fatigue, muscle weakness, confusion, and loss of appetite

293
Q

Client education for pt self administering digoxin:

A

Count pulse fro 1 min before taking meds. 60-100
Take digoxin at same time ea day
Do not take with antacids
Check digoxin and potassium levels regularly

294
Q

LAB VALUES EXPECTED REF

A 
Na 136-145
K 3.5-5.0
Cl 98-106
Ca 9.0-10.5
Mg 1.3-2.1
Ph 3.5-4.5
295
Q

How do you position a pt before a thoracentesis?

A

Position the client sitting upright with his arms and shoulders raised and supported on pillows and or on an overbed table and with his feet and legs well supported

296
Q

Results for a Mantoux test shows and induration (palpable, raised, hardened area) of 10 mm or greater in diameter

A

Positive skin test for TB

297
Q

An induration of 5 mm is considered what in the Mantoux test?

A

Positive test for immunocompromised clients

298
Q

After a liver biopsy how should the client position themselves?

A

Instruct client to lie on affected side after the biopsy in order for hemostasis to occur

299
Q

Clinical manifestations of Hep B

A

Headache, fatigue, arthalgia and myalgia, pruritus, low grade fever, RUQ pain, nausea, vomiting, jaundice, dark urine

300
Q

What is pain?

A

Pain is whatever the person experiencing it says it is and it exists whenever the person says it does

301
Q

Client education on Oxycodone

A
  • Use medication as directed
  • Prevent constipation with diet changes and stool softeners
  • Be aware that nausea may subside within a few days
302
Q

Hormonal contraceptives

A

May be decrease symptoms of PMS and PMDD

May be initial tx for endometriosis

303
Q

Leuporlide (Lupron)

A

Can cause birth defects so a reliable form of contraception is advised
May cause decease in libido and increase risk of osteoporosis

304
Q

Hormone replacement therapy (HRT)

A 
Should not be taken during pregnancy 
Smoking
Hx of Cancer (breast, uterus) 
Abnormal vaginal bleeding
Embolism
Stroke
Heart disease
HTN
305
Q

Clients with stent placement will receive anticoagulation therapy 6-8 weeks. Client instructions:

A

Take the medication at the same time each day
Have regular lab tests to determine therapuetic level
Avoid activities that could cause bleeding (use a soft toothbrush, wear shoes when out of bed)

306
Q

Medication Administration : IV

A
  • Apply a clean tourniquet or BP cuff 4-6 in above the proposed insertion site
  • Untie the tourniquet, cleanse the area at the site in a circular motion inward to outward
  • Remove the cover from catheter, grasp the plastic hub
  • Retie the tourniquet
  • Anchor the vein below the site of insertion
  • Pull the skin taut and hold it
  • Insert the the catheter maintaining a 10-30 angle. flashback of blood
  • Lower the hub of the catheter close to the skin
  • Advance the catheter into the vein
  • Stabilize the IV catheter
  • Apply pressure 1 1/4 inch above the insertion site
  • Remove the needle and activate safety device.
  • Dispose of used equipment
  • Document
307
Q

Medication to control HTN; Thiazide diuretics such as hydrochlorothiazide (Hydrodiuril) side effects

A

Monitor for hypokalemia watch for muscle weakness, irregular pulse and dehydration

308
Q

Calcium channel blocker, verapamil hydrochloride (Calan) dilitiazem (Cardizem)

A

Monitor for hypotension

309
Q

ACE inhibitor S/E

A

Monitor for hypotension

310
Q

Beta blockers such as metoprolol (Lopressor) and atenolol (Tenormin) adverse S/E

A

These medications can mask hypoglycemia in clients who have DM

311
Q

Central alpha agonists such as clonidine (Catapres) S/E

A

S/E include sedation, orthostatic hypotension,and impotence

312
Q

Alpha adrenergic antagonists such as prazosin (Minipress) S/E

A

S/E include postural hypotension

313
Q

What is the therapeutic effects of Furosemide (Lasix)?

A

Diuretics are used to decrease preload. Promote fluid excretion

314
Q

Propranolol (Inderal)

A

Beta adrenergic blocker- Treats sympathetic nervous system nervous system effects (tachycardia, palipations)

315
Q

What to do if there is a shortage of TPN solution?

A

Keep dextrose 10% in water at the bed side in case solution is unexpectedly ruined or a new bag is not available.

316
Q

Nursing Actions for fluid overload in a client receiving hyperosmotic solution

A
  • Assess the client’s lung sounds for crackles
  • Monitor clients daily weights and I&O
  • Use a controlled infusion pump to administer TPN at a prescribed rate
  • Gradually increase the flow rate until prescribed infusion rate is achieved
317
Q

Client on TPN monitor BS

A

Check cap glucose every 4-6 hrs for the first 24 hrs.

Need supplemental insulin until pancreas can increase its endogenous production of insulin

318
Q

A client with hypokalemia

A

Report abnormal findings to the PCP
Replace K
Encourage foods hight in K (avocados, broccoli, dairy products, dried fruits, cantaloup, bananas)

319
Q

IV K supplement

A

Never IV bolus=cardiac arrest

Max: 5-10 mEq/hr

320
Q

Client with hypokalemia (what to monitor)

A

Monitor for adequate urine output
Monitor clients receiving digoxin (Lanoxin) hypokalemia increased digoxin toxicity
Monitor Bowel sounds, and abdominal distention
Monitor kidney f(x) (BUN, creatine, GFR)
Monitor Mg, Ca, Phosphorus

321
Q

ECG for client with hypokalemia

A

PVC, bradycardia, blocks, v tachy, inverted T waves and ST depression

322
Q

Client with DM who has impaired vision and blindness

A

Encourage yearly eye exams to ensure the health of the eyes and to protect vision
Encourage management of Blood glucose levels

323
Q 
Insulin lispro (Humalog)
Rapid acting
A

Onset: less than 15 min
Peak: 0.5-1 hr
Duration:3-4 hr

324
Q 
Regular Insulin (Humulin R)
Short acting
A

Onset: 0.5-1 hr
Peak: 2-3 hr
Duration:5-7 hr

325
Q 
NPH insulin (Humulin N)
intermediate acting
A

Onset: 1-2 hr
Peak: 4-12 hr
Duration: 18-24 hr

326
Q 
insulin glargine (Lantus)
Long acting
A

Onset: 1 hr
Peak: none
Duration: 10.4-24 hr

327
Q

A nurse is instructing a person who had a left CVA and right lower extremity hemiparesis to use a quad cane. Which of the following is the most appropriate gait sequence?

A

Place the cane in the patient’s left upper extremity, encourage cane, then right lower extremity, then left upper extremity gait sequence.

328
Q

What are the dietary guidelines for bariatric surgery?

A

Provide 6 small meals a day when the client can resume intake. Observe for signs of dumping syndrome (cramps, diarrhea, tachycardia, dizziness, and fatigue). The client’s first feeding may only consist of 30 mL of liquid.

329
Q

What type of diet should a patient with heart failure have?

A

Low sodium diet and fluid restrictions

330
Q

Nontunneled percutaneous central catheter

A

Indications – Administration of blood, long-term administration of chemotherapeutic agents, antibiotics, and total parenteral nutrition
Insertion location – Subclavian vein, jugular vein; tip in the distal third of the superior vena cava

331
Q

Peripherally inserted central catheter

A

Indications – Administration of blood, long-term administration of chemotherapeutic agents, antibiotics, and total parenteral nutrition
Insertion location – Basilic or cephalic vein at least one finger’s breadth below or above the antecubital fossa; the catheter should be advanced until the tip is positioned in the lower one-third of the superior vena cava.

332
Q

angina

A

Precipitated by exertion or stress
Relieved by rest or nitroglycerin
Symptoms last < 15 min
Not associated with nausea, epigastric distress, dyspnea, anxiety, diaphoresis

333
Q

MI

A

Can occur without cause, often in the morning after rest
Relieved only by opioids
Symptoms last > 30 min
Associated with nausea, epigastric distress, dyspnea, anxiety, diaphoresis

ATI MED SURGE2010 (1 decks)

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