Mix 2 Flashcards
Which is appropriate for preop MRI
A. Shave grion & insert catheter
B. Remove metal containing objects from patient
C. NPO 6 hrs before test
D. Teach inhale techniques for administration of radioscope
B: Remove metal containing objects from patient
Mag levels are usually between ____ - _____
What will be the effects if Higher or Lower
1.8 - 2.6
Lower = Increase everything
Higher = Decrease everything
NCSBN, ID 5 processes in the test plan that are fundamental to the practice of nursing
Caring
Communication & Documentation
Nursing Process ADOPIE
(Assess, Diagnosis, Outcomes, Planning, Implantation, Evaluation)
Culture & Spirituality
Teaching & Learning
Client with cast complains of pain when arm is passively moved. Which should be the first nursing action?
A. Elevate arm
B. Document findings.
C. Additional analgesic pain relief
D. Assess arm for paresthesia & paralysis
Which disease process is the scenario associated with?
What would be the procedure to correct this problem?
D.
Compartment syndrome
fasciotomy relieves pressure
Surgeon makes incisions in the
Fascia (the tissue surrounding the muscles) to release the pressure and allow blood flow to return to normal
Client hospitalized for angina pectoris begins to experience chest pain.
Nurse gives Nitroglycerin, sublingual, but the pain is unrelieved.
What is the next nursing action?
A. Reposition client
B. Call clients family
C. Contact HCP
D. Administer another Nitroglycerin tab
D. Administer another Nitroglycerin tab
How do / can you administrator Nitroglycerin tabs in the hospital as a nurse to relieve chest pain.
Administer (# of pills) ( minutes part)
Up to
3 pills, 5 minutes apart
Which action is taken before a CT scan.
A. NPO minium of 3 hrs before test
B. Only 2 cigarettes morning of the test
C. Clear liquid breakfast
D. Take all routine medication on morning of the test
A.
The rest are alike because they all say “morning of test”
You can eliminate Like results
Difference between:
Veracity & Fidelity
Veracity = obligation to tell the truth
Fidelity = duty to do what one promised
What is a tort in the law
Civil wrong, other than breach in contract, in which allows an injured person to seek damages
FEMA
What is highest disaster level
Lowest
Highest = level 1
Lowest = level 3
Triage color management
Red
Yellow
Green
“Black”
Red: Need immediate help or death
Yellow need help within 30 min - 2 hr
Green can wait atleast 2 hrs
“Black” Dead or close to death
Medical attention cannot help them
Which is the most appropriate assignment for AP
A. Client requiring a colostomy
B. Client receiving continuous tube feedings
C. Client who requires urine specimen collection
D. Client with difficulties swallowing
C. Client who requires urine specimen collection
Best way for a nurse to handle an AP who is resistant to new policy changes.
A. Ignore the resistance
B. Exert coercion on the AP
C. Positive rewards system
D. Confront AP to encourage verbalization of feelings regarding the change.
D. Confront AP to encourage verbalization of feelings regarding the change.
While giving a bed bath an AP informs you that another patient has requested pain meds.
How do you best handle this?
A. Finish bedbath and administrator medication afterwards
B. Ask AP to find out last time pain meds were issued
C. Ask AP to tell client that they will receive their pain meds as soon as bedabth is complete
D. Cover client, raise side rails, inform patient that to you leave breafly to give meds.
Pain management is the priority proper
D. Cover client, raise side rails, inform patient that to you leave breafly to give meds.
Which is the priority for the nurse to assess first
A. Complaining of muscle aches, headaches, history of seizures
B. Client with twisted ankle
C. Minor laceration from a cooking accident
D. Chest pain after eating pizza with a spicy sauce
Chest pain after eating pizza with a spicy sauce
This system is used to express the combining activity of an electrolyte
mEq
1 mEq cation will always react with 1mEq of an anion
Generalized Edema, aka anasarca, is an excessive accumulation of fluid in the ______ space.
Causes: cardiac, renal, or liver failure
Interstitial
Most likely causes of
Hypertonic overhydration
Hypotonic overhydration
Hypertonic overhydration: Excessive Na consumption
Hypotonic overhydration: Water intoxication
Causes of
Hypertonic Dehydration
Hypotonic Dehydration
Hypertonic Dehydration: Excessive sweat, hyperventilation, ketoacidosis, prolonged fevers, Diarrhea, early-stage kidney disease, diabetes Insipidus
Hypotonic Dehydration: Chronic Illness, excessive hypotonic fluid replacement, kidney disease, chronic malnutrition
AKI, Chronic kidney disease, heart failure puts client at risk for…
(Fluid volume: Excess or Deficiency)
Excess
Increases secretions of Aldosterone, Cushings Syndrome, will have this affect _____ on the electrolyte _____
LOWER POTASSIUM <3.5
Which methods my K be given to a patient
IV (never Push) & Oral
Bananas, oranges, cantaloupes, honeydew, apricots, grapefruit (some dried fruits, such as prunes, raisins, and dates)
Cooked spinach.
Cooked broccoli.
Potatoes.
Sweet potatoes.
Mushrooms.
Peas.
Cucumbers.
Are foods high in this electrolyte
K
What does sodium polystyrene sulfonate do?
Cation-exchange resin
Promotes the gut to absorb Na and excretion of K
IV calcium or
Insulin with glucose
Maybe given to a patient with Hyperkalemia to solve the problem
T or F
True
Diuretics can cause
Hypo/Hypernatremia
Hyponatremia
Where water goes Na flows
Caution
If client is taking Lithium monitor it’s level if patient is (hyponatremic / Hypernatremic)
Hyponatremic
Hyponatremia can cause diminished Lithium excretion, resulting in toxicity
Corticosteroids
Cushing syndrome
Kidney disease
Hyperaldosteronism
(Hyponatremia/Hypernatremia)
Hypernatremia
Aluminum hydroxide (increases / reduces) Phosphorus levels, causing (higher / lower) calcium levels
Reduces phosphate
Increases calcium
Seizure precautions for
Hypo/Hypercalcemia
Hypocalcemia
Why would you move a client with a calcium imbalance carefully?
They are at a risk for fractures
_____ is the antidote for magnesium OD
Calcium Gluconate
Fluid is found in 3 compartments
Intercellular ___%
Interstitial ____%
Intravascular ____%
Intercellular 70%
Interstitial 22%
Intravascular 6%
Increased serum osmolality
Increased hematocrit
Increased BUN (Blood urea nitrogen)
Increased serum sodium
Increased Urine specific gravity
(Dehydration / Fluid Overload)
Decreased serum
Decreased hematocrit
Decreased BUN (Blood urea nitrogen)
Decreased serum sodium
Decreased Urine specific gravity
(Dehydration/ Fluid Volume Overload)
Increased serum osmolality
Increased hematocrit
Increased BUN (Blood urea nitrogen)
Increased serum sodium
Increased Urine specific gravity
Dehydration
Decreased serum
Decreased hematocrit
Decreased BUN (Blood urea nitrogen)
Decreased serum sodium
Decreased Urine specific gravity
Fluid Volume Overload
Infusion rate of K
5 - 10 mEq/hr
Never >20
Client with Addisons disease, hyperuricemia, or tissue damage is at risk for…
Hypokalemia/ Hyperkalemia
Hyperkalemia
Client taking corticosteroids, Hyperaldosteronism, or Cushings syndrome is at risk for…
Hyponatremia/ Hypernatremia
Hypernatremia
Cushings also creates hypokalemia/ Hypernatremia
Normal serum phosphate levels are ______
What factors contribute to Hypophosphatemia /Hyperphosphatemia
3 - 4.5 mg/dL
Hypophosphatemia = Malnutrition/ Aluminum hydroxide or Magnesium-based antiacids
Hyperphosphatemia:
Renal insufficiency, hypoparathoidism,
tumor lysis syndrome
( metabolic emergency that can occur when cancer treatment kills large amounts of tumor cells, causing them to break apart and release their contents into the bloodstream.)
Difference between
Insensible Loss
&
Sensible Loss
(Hydration Related)
Insensible= Skin & Lungs (Can’t notice)
Sensible = Urine, wound drainage, GI tract loss
Cushings syndrome = hypo /Hyperkalemia
Addisons syndrome = hypo/ Hyperkalemia
Cushings syndrome = hypokalemia
Addisons syndrome = Hyperkalemia
The Oppsite is true for the Na values
During Acidosis the body moves H ions into the cell (to lower the pH)
To make room for the H in the cell the cell kicks K out.
This creates Hypokalemia/ Hyperkalemia
During Alkalosis the cells pump H into the bloood stream and this forces K back into the cells.
Creating: Hypokalemia / Hyperkalemia
Hyperkalemia
Hypokalemia
Adminsiter ____ for tetany
Calcium Gluconate
______ is a medication usedto manage hypocalcemia, cardiac arrest, and cardiotoxicity due to hyperkalemia or hypermagnesemia
Calcium gluconate
A diet low in ____ will lessen the Acidosis in DKA
Protein
ABG
When _____ occurs the pH is within normal limits
But, the Co² & HCo³ will be out of normal limits
Full compensation
ABG
Type of disorder that occurs when both Metabolic & Respiratory are either Acidosis/ Alkalosis
Mixed disorder
Allen’s test
Apply pressure to ulnar and radial arteries simultaneously
Ask client to open & close fist
Release pressure from _____ while compressing the ____ artery
Assess color: Normal = color returns
Abnormal = Stay pallor
When is this preformed?
What action is taken immediately afterwards?
Release pressure from Ulnar while compressing the Radial artery
When is this preformed?
Before ABG blood draw
What action is taken immediately afterwards?
Apply pressure for 5 - 10 minutes
What values equal death in ABG
6.8 Acidosis
7.8 Alkalosis
Posistion of client for rectal temperature
Sims
Nasal or oral surgery
Jaws wired shut
NG tube in place
Risk for seizures
All have temperature taken how
Rectal
Apical pulse (Left side 5th intercostal space) is assessed for 1 full minute in patients with heart conditions before the administration of ___ or ____
Digoxin or Beta Blockers
Difference between systolic & disystolic pressure is callled
Pulse pressure
Helps to predict cardiovascular complications (Heart attack / stroke)
Normal 40 - 60
What is idiopathic pain?
Pain in which the source of pain cannot be identified
What is the TENS/PENS device used for
To deliver low electrical current to the skin in an attempt to block pain
NSAIDS (Aspirin/ Ibuprofen) Contradictions
Acetaminophen (Tylenol) Contradictions
NSAIDS (Aspirin/ Ibuprofen) Contradictions
Bleeding Risk, Oral antidiabetic meds, CCB (Dipine)
Acetaminophen (Tylenol) Contradictions
Acetaminophen: Liver & renal problems
Acetylcyseine
Function
Antidote to Acetaminophen
- How does physical trauma without bleeding affect potassium levels?
- How do burns affect K levels
- Hyperkalemia. The cells break open releasing K into the blood stream
- If the burn causes oozing / Fluid loss Hypokalemia. The K will leave the body along with the fluid
Elevated WBC & platelets will cause this condition of K
Hypokalemia/ Hyperkalemia
Hyperkalemia
See deck on Coagulation
Ed’s class 1355 or something
Affects of leafy green foods on Warfarin
Makes it less effective
Shortens the Pt time
____ is the main component of erythroctes and serves as the vehicle for transportation of oxygen & carbon dioxide
Hemoglobin
____ represent RBC % in blood and is an important measurement in the presence of anemia or polycythaemia
Hematocrit
COPD, High altitudes, polycythaemia
Decreased /Elevated Hemoglobin
Elevated hemoglobin
Dehydration, high altitudes, polycythaemia
Decreased/ Elevated hematocrit
Elevated
Anemia, hemorrhage
Affected hemoglobin levels how?
(Part of the RBC that transports oxygen)
Anemia, hemorrhage, bone marrow failure, leukemia, overhydration
Affect hematocrit how?
(the ratio of the volume of red blood cells to the total volume of blood)
Both lower level
Do clients take morning insulin/ oral antidiabetic medication before receiving a fast blood sugar test
How long do they fast before test
What are normal & abnormal values for this test
No
8 - 12 hrs
70 - 99 normal
100 - 125 pre-diabetic
125 + diabetes
Affects on BS
Addisons disease / Cushings
Hyperthyroidism/ Hypothyroidism
Addisons disease: Lower
Addison crisis
life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium.
Cushings: Higher
High level Cortisol makes Insulin Ineffective & produces more glucagon
Hyperthyroidism: Higher
Insulin resistance
Hypothyroidism: Lower
decrease in metabolism, which can lead to excess insulin in the body and low blood sugar episodes.
Is fasting required before measuring A1c
No
Avoid (2) before measuring Serum Creatinine
Exercise 8 hrs
Red Meat 24 hrs
Below normal Values <0.8 in Serum Creatinine are seen in these types of diseases
Diseases with Decreases Muscle Mass
Muscular Dystrophy
Myasthenia gravis
BUN LEVEL
Burns, dehydration, GI bleeding, Fever/ Stress, renal disease, UTI
Decreased / ELEVATED
Fluid Overload, malnutrition, severe liver damage, syndrome of inappropriate antidiuretic hormone
Decreases / Elevated
Burns, dehydration, GI bleeding, Fever/ Stress, renal disease, UTI
ELEVATED
Fluid Overload, malnutrition, severe liver damage, syndrome of inappropriate antidiuretic hormone
Decreased
Stages of hypertension
Normal = less than 120/80
Elevated = Systolic ___ / Diastolic ___
Stage 1 = Systolic ___ / Diastolic ____
Stage 2 = Systolic ___/ Diastolic ____
Hypertensive Crisis = Systolic ___ / Diastolic ___
Elevated = Systolic 120 - 129/ Diastolic <80
Stage 1 = Systolic 130 - 139/ Diastolic 80 - 89
Stage 2 = Systolic 140 Min. / Diastolic 90 Min
Hypertensive Crisis = Systolic >180 / Diastolic >120
WBC range
5,000 - 10,000 Normal
What does above and below mean
Below immune suppression (AIDS) - Neutropenic precautions
Above Fighting infection
Normal platelets range
150,000 - 400,000
What does above and below signify
<150,000 bleeding risk
> 400,000 blood clot risk
Caring for a client on a opiod PCA pump. Client appears to be sleeping
Vital signs: HR: 52, BP: 101/ 58, RR: 11, SpO² 93% @ 3 L oxygen via nasal Cannula
What action should take place next
A. Document findings
B. Attempt to arouse client
C. Contact HCP
D. Check med history on pump
B. Attemp to arouse
If successful, the vitals may normalize.
When sleeping vitals decrease
Amenorrhea…
Absence of period
Longterm protien status can be determined by evaluating this protein…
Serum albumin
Limit Na intake to …
<2300 mg
This type of diet is used for clients with dsyphagia, surgery of head or neck, dental problems
Mechanical soft
This diet maybe used as a transition diet after full clear liquid.
Includes
Ice cream
Breakfast drinks
Fruit / veg juices
Foods that are liquid at body temperature
Full liquid diet
This diet is used as Initial feeding after Complete Bowel Rest
Feeding after Malnourishment
Bowel prep / Post op
Clear liquid diet
T or F
All foods are allowed on a Soft Diet
Liquid, chopped, or pureed foods are tolerated best
True
Which client would get a
High Fiber Diet (how many grams)
Low Fiber Diet
High Fiber Diet: Constipation, IBS (Alternating Diarrhea & Constipation), Asymptomatic diverticulitis
20 - 35
Low Fiber Diet IBS, partially obstructed intestines, gastroenteritis, Diarrhea
Who is the DASH Diet used for
What does it consist of…
Atherosclerosis, DM, Hyperlipidemia, hypertension, MI, Nephrotic syndrome/ renal failure
Normal healthy foods
Fat restricted diet is used in which clients…
Malabsorption disorder, pancreatitis, gallbladder disease, GERD
High calorie/ High protein diet
Used for…
Severe stress, burns, wounds,Cancer, AIDS, COPD, Respitory failure,
Type of diet for
DM, Hypo/Hyperglycemia, obesity
Carbohydrate-consistent diet
Type of client on a protein restricted diet
Renal disease/ end stage liver disease
Low-purinenl diet is indicated for..
Types of patients
Types of food to avoid
“Purine is a precursor for Uric Acid, which forms stones & crystals “
Gout: Inflammatory arthritis
Caused by a buildup of uric acid in the bloodstream, Forms needle-like crystals which Hurt
Kidney Stones
Elevated Uric Acid levels
Anchovie & similar small fish
Organ meats, gravies, wild game
High Iron Diet
Which type of patients…
Special consideration
Anemia
Concurrent intake of Vitamin C will enhance absorption
Pregnancy nutrition considerations
(4)
Increase:
Calcium (fetal bones)
Iron (Increase Blood Volume),
Folic Acid (DNA synthesis & RBC production)
60g protein
Breastfeeding considerations
Nutrition
Increase: Protein, calcium, Vitamins A,B,C
Addition 500 calories daily
Avoid alcohol, caffeine, drugs
Bouillon, carbonated beverages, gelatin, hard candy, lemonade, ice pops, regular & decaf coffee
Are this type of food
Clear liquid diet
Meats & Dairy products are high in these vitamins
B
Parathyroid hormone regulates calcium, magnesium, and phosphorus levels in the blood.
When PTH production is low, calcium levels in the blood ( drop / raise ), and phosphorus levels (drop / rise)
Low PTH = Low calcium
Low calcium = High phosphorus
