Midterm Content

Question 1

What is the nurse’s role in obtaining consent?

Answer 1

Ask patient to sign and act as witness. Notify physician if patient doesn’t have information.

Question 2

What 2 consents must be given?

Answer 2

Written and voluntary informed consent

Question 3

How can patients present with vulnerability/anxiety?

Answer 3

repetitive questions, withdrawn, avoiding communication

Question 4

How can the nurse address a vulnerable patient?

Answer 4

Empathy, listen well, psychosocial assessment

Question 5

The use of pre op checklists is significant. Why?

Answer 5

Greatly reduces morbidity and mortality

Question 6

By how much are deaths decreased when the WHO checklist is used?

Answer 6

Up to one third

Question 7

Pre op nursing care

Answer 7

NPO, pre op scrub, prep bowel, fluid status, assessments, medications, patient education

Question 8

Maintaining a patent airway in the PACU prevents

Answer 8

hypoxia and hypercapnia

Question 9

When do respiratory complications occur post op?

Answer 9

w/i 48 hrs

Question 10

most common respiratory complication post op

Answer 10

atelectasis. collapsed alveoli, X Ray confirmed

Question 11

Pneumonia will present with

Answer 11

productive cough, dyspnea, crackles

Question 12

PE will present with

Answer 12

dyspnea, pleuritic pain, fever, hemoptysis

Question 13

What causes respiratory complications postoperatively? (6)

Answer 13

Pre existing conditions, anaesthetics, O2/trach tubes, aspiration, immobility, narcotics

Question 14

How can respiratory complications be prevented? (4)

Answer 14

pre op teaching, post op assessment, adequate hydration, encouraging ambulation

Question 15

Who (3) are most at risk for CV problems post op?

Answer 15

Elderly and those w cardiac hx

Question 16

Thrombophlebitis/embolism happens when? Why? Mnfts?

Answer 16

POD 7-10.

Dehydration, pre rest, decreased circulation

Homan’s sign, calf pain

Question 17

When will an MI most likely occur post op?

Answer 17

48 hrs PO.

Question 18

Tx for blood loss

Answer 18

stop bleeding, plasma expanders, albumin, fluids, transfusion, coag factors

Question 19

When does inflammation peak post op?

Answer 19

12. up to 48 hrs.

Question 20

How long are I&Os monitored for?

Answer 20

x 48 hrs

Question 21

Why do we want to resume a normal diet ASAP? What must be in place?

Answer 21

promotes GI fx, assists wound healing.

BS and soft abdomen

Question 22

Vomiting is preceded by

Answer 22

Nausea

Question 23

5 Types of diarrhea

Answer 23

Secretory, osmotic, exudative, inflammatory, dysentry

Question 24

Complications from diarrhea

Answer 24

cardiac dysrhythmias, low urine output, muscle weakness

Question 25

Nursing care for those w diarrhea

Answer 25

assess and monitor, GI assessment, encourage bed rest, push fluids, bland foods, antidiarrheals, IV fluid therapy PRN

Question 26

Vomiting complications

Answer 26

fluid electrolyte imbalance, aspiration, increased ICP, wt. loss, Mallory-Weiss tear, dentition issues

Question 27

Hyperemesis Gravidarum is ... | Due to...

Answer 27

severe debilitating nausea and vomiting in early pregnancy . Increased levels of HCG

Question 28

Hyperemesis Gravidarum usually is in what trimester?

Answer 28

First

Question 29

What is the safest antiemetic drug to use during pregnancy?

Answer 29

Dimenhydrinate

Question 30

What is the most effective antiemetic to use during pregnancy? What are the issues with it?

Answer 30

Ondansetron. Not in a safe pregnancy category but benefit may outweigh the risk.

Question 31

What % of weight loss occurs to classify Hyperemesis Gravidarum?

Answer 31

>5%

Question 32

When is sx indicated in PUD?

Answer 32

Intractable ulcers, hemorrhaging, perforation, obstruction

Question 33

What is used to treat NSAID induced ulcers?

Answer 33

H2RA (eg. Ranitidine)

Question 34

Non pharmacological interventions for PUD?

Answer 34

Decrease stress, rest, smoking cessation, diet modification

Question 35

Another name for Crohns is

Answer 35

Regional enteritis

Question 36

Where does pain occur in regional enteritis (Crohns)?

Answer 36

right lower quadrant and periumbilical

Question 37

Age that regional enteritis usually occurs

Answer 37

adolesence

Question 38

Where is pain found in ulcerative colitis?

Answer 38

left lower quadrant, rebound tenderness

Question 39

Complications of regional enteritis (6)

Answer 39

``` obstruction fluid electrolyte imbalance malnutrition fistula/abcess formation retinitis/irititis/erythema nodosum depression ```

Question 40

What would fluid and electrolyte imbalance in IBD present with?

Answer 40

narrowing pulse pressure decreased urine output tachycardia

Question 41

Why would metabolic acidosis occur in Regional enteritis?

Answer 41

Loss of HCO3 (buffer) due to diarrhea would decrease ph

Question 42

How does regional enteritis lead to third spacing?

Answer 42

Not absorbing enough nutrients to form albumin = decreased OP = fluid shift = 3rd spacing

Question 43

Ulcerative colitis complications (6)

Answer 43

``` toxic megacolon perforation bleeding depression pyelonephritis/nephrolithiasis malignant neoplasms ```

Question 44

Common presentations of IBD

Answer 44

diarrhea, abdominal pain, low grade fever, anorexia, joint disorders, skin lesions, ocular disorders

Question 45

Complications of hyperemesis gravadarum

Answer 45

elevated urine-specific gravity, ketonuria, hypokale- mia, hypochloremic metabolic alkalosis, and ketosis

Question 46

What potential side effects for fetus in HEG? How do we prevent this?

Answer 46

Wernicke's encephalopathy. IV Thiamine

Question 47

Amount of anaesthetic to produce anaesthesia is what in elderly

Answer 47

Lower

Question 48

why is there more potent action in elderly for anaesthesia

Answer 48

less plasma proteins | lower met/excretion rate

Question 49

Why are elderly at risk for hypothermia when receiving an anaesthetic

Answer 49

impaired ability to increase metabolic rate and thermoregulate

Question 50

What is a side effect of Metoclopramide? When not to give?

Answer 50

Increases gastric emptying. When a patient doesn't have BS/is fresh post op/NPO

Question 51

What NTs released in CTZ stimulation? | What drugs work on these NTs?

Answer 51

Dopamine and serotonin | Onsansetron, metoclopramide, procholorperazine

Question 52

Major side effect of dimenhydrinate?

Answer 52

Drowsiness

Question 53

What nausea pathway is innervated in HG?

Answer 53

CTZ

Question 54

What NT does dimenhydrinate block

Answer 54

histamine

Question 55

What NT does scopolamine block

Answer 55

Ach

Question 56

What NT does metoclopramide block

Answer 56

dopamine

Question 57

What NT does ondansetron block

Answer 57

serotonin

Question 58

What NT does prochlorperazine block

Answer 58

dopamine

Question 59

What 3 drugs work on the CTZ

Answer 59

metoclopramide, ondansetron, prochlorperazine

Question 60

What 2 drugs work viscerally

Answer 60

metoclopramide and ondansetron

Question 61

What 2 drugs work at higher CNS/Vestibular

Answer 61

dimenhydrinate and scopolamine

Question 62

Toxic mega colon is a complication of

Answer 62

Ulcerative colitis