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NR 463- Exam 3 Flashcards

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1
Q
  1. How long should aspirin be discontinue prior to procedure
  2. What position should patient be with spinal anasthesia
  3. Name drug types during pre-op
A
  1. 2 weeks
  2. lie flat 6-8 hours
  3. anticholinergics, antidiabetics, antiemetics, benzos, antibiotics, b-blockers, histamines, opioids
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2
Q
  1. How long should patient be on clear liquids prior to procedure
  2. how long for breast milk pre procedure
  3. how long for non human mil pre procedure
  4. light meal?
  5. reg meal?
A
  1. 2 hrs
  2. 4hrs
  3. 6hrs
  4. 6hrs
  5. 8hrs
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3
Q
  1. Whan can anxiety to do patient outcome
  2. What are you evaluation pre-op
  3. What are psychoscoial concerns?
A
  1. impair cognitions, decision making and coping
  2. psychoscial cultural chart, id, consent. (not critical care setting). Lab results
  3. situational changes, concerns of unknown, body image, past experiences, knowledge deficit
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4
Q
  1. What does ABC/Pulse ox measure
  2. What does blood glucose measure
  3. what does BUN/Creatnine measure
A
  1. resp/metabolic function, ox status
  2. metabolic, diabetes mellitus
  3. renal function
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5
Q
  1. Respiratory Xray measures
  2. CBC measures
  3. EKG measures
A
  1. pulmonary disorders, cardiac enlargement
  2. Anemia, Immune Status, infection
  3. cardiac disease, dysrhythmias
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6
Q
  1. Electrolytes measure
  2. hCG measures
  3. Serum Albumin
  4. Urinalysis
A
  1. metabolic, renal, diuretic SE’s
  2. pregnancy
  3. nutrition
  4. renal, hydration, UTI
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7
Q
  1. What do you need to have ready for pre-op prep
  2. What do you need to inform patient regarding room temp
  3. What do you need to inform patient regarding bed in OR
A
  1. ID bands, allergies, phys exam, IV epidural, Informed consent (blood/procedure). Vitals, Surgical site marked, NPO since.., Voided/Cath time. Belongings
  2. OR will be cold
  3. Will be narrow
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8
Q
  1. Inform patient of what they will hear in OR
  2. What will you doo pre-procedure
  3. What should you tell the caregiver
A
  1. machines will be heard
  2. vitals, pain control, TCDB, IV lines, Anesthesia dmin, surg site marked.
  3. can sstay in preop holding area, will be able to see patient from recovery when awake, questions
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9
Q
  1. Rationale behind positioning during procedure
  2. What is the most common position during procedure?
  3. What is prone position used for during procedure?
A
  1. correct MSK alignment, pressure on extremities, thoracic excursion, prevent occlusion of arteries/veins, modesty, previous pains, aches.
  2. Supine- abdomen, heart or breast
  3. back surgery (laminectomy)
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10
Q
  1. How does anestesia affect vessels?
  2. Why is positioning important
  3. Checks/Assessment intra-op
A
  1. peripheral vessels to dilate
  2. affects where pooling of blood will occur
  3. LOC, skin integrity, mobility, emotional status/functional limitation, equip ready
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11
Q
  1. Intra/Op Implementation
  2. Where should provider stand during procedure
  3. What should a team member communicate during procedure
A
  1. Integrity of sterile field, Count, Position, prevent chem injury from prep solutions, safe use of electrical equip, safe med admin, changes in vitals, blood loss, urine output
  2. Near patient
  3. patient’s status
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12
Q
  1. Intra-op Evaluation
  2. What does the clinic unit evaluate?
  3. What does the home unit evalute?
A
  1. response to intervention, ABCs, vitals, LOC. Safe med
  2. effecrtiveness of nursing care in OR. Patient’s satisfaction, psych status, discharge planning
  3. patient’s perception of surgery, cargiver’s
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13
Q
  1. Circulating nurse role
A
  1. prep rm, ensure equipment available, aseptic technique, mech/elec equipment, pt phys/emo status, info from chart, devices/lines, transferring, induction of anesthesia, view draping procedure, Time out. prep/label blood. Blood/urine outpus. Records meds used. Count. goes w/ pt to PACU. Hand off
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14
Q
  1. Scrube Nurse Role
A
  1. Hand/Arm scrub down. Gowns self and others. instrument table, organied equipment. Draping. Time out. Count of sponges, needles, instruments. Aseptic technique. Irrigation solutions used to cacl blood loss. Verifies meds used by surgeon
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15
Q
  1. What is always hooked up during intra op
  2. Complications during procedure
A
  1. EKG, BP cuff, Pulse Ox
  2. anaphylactic response, malignant hyperthermia, hemorrhage, cardiac arrest
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16
Q
  1. S/Sx of malignant hyperthermia
  2. What is the emergent drug therapy?
A
  1. Tachypnea, hypercarbia, dysrhythmia, hyperthermia with rigidity, altered ctrl of calcium
  2. Dantrolene
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17
Q
  1. Types of anestesia x4
  2. What types of agents are used for gen anestesia
  3. What does it require
A
  1. General, Regional, Monitored, Conscious
  2. inhalation
  3. Advanced airway MGMT, knocked out
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18
Q
  1. What does gen anestesia eliminate?
  2. Define regional anestesia
  3. How is local anestesia administered
A
  1. coughing, gagging, vomiting, SNS response
  2. loss of sensation at region of body, not loss of consciousness
  3. topically, infiltration, intraQ, subQ, nebulized
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19
Q
  1. What is conscious sedation used for?
  2. What are their capabilities?
A
  1. minor procedures
  2. can breathe without assistance, no impairment of airways.
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20
Q
  1. Respiratory complications post op
  2. Heart Complication
A
  1. atelectasis, pulmonary edema, hypoventilation, hypoxemia, pneumonia
  2. Hypotension
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21
Q
  1. Hypotension priority response?
A
  1. O2
  2. Inspect Incision
  3. IV fluid bolusdrug intervention/vasoconstrictors.
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22
Q
  1. PACU hypertension tx
  2. Actions for dysrhythmias?
  3. If a patient wakes up with thrashing/disoriented what should you suspect first?
A
  1. SNS depression, analgesics, voiding, correct respiratory probs, drug therapy
  2. Correct it directly.
  3. Hypoxia, then hypoxemia.
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23
Q
  1. What is the cause of delayed emergence?
  2. How do they resolve
A
  1. prolonged drug action?
  2. on their own
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24
Q
  1. Signs of pain when patient can’t tell you
  2. How can you intervene for pain
A
  1. diaphoresis, restless, change in vitals
  2. IV opioids using epi cath, PCA, or regional anesthetic blockade.
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25
Q
  1. What is passive warming (PACU)
  2. What is active warming (PaCU)
  3. Why do you need oxygen when a patient is cold?
  4. How can you treat shivering
A
  1. warm blankets, socks, limit skin exposure
  2. forced air, heated water mattress, humidified oxygen, warmed IV fluids
  3. increased demand caused by shivering.
  4. Opioids
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26
Q
  1. When can NPO status return
  2. What interventions are necessary when NPO
  3. What intervention for abdominal distention
A
  1. gag reflex or peristalsis
  2. IV iinfusions, oral care (particulary with NG tube)
  3. ambulation
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27
Q
  1. How do you assess peristalsis return?
  2. What position can help with gas?
  3. How long does it take for infections to appear
A
  1. are you passing gas?
  2. On right side gas rises along transverse colon and aids release.
  3. 48 hours
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28
Q
  1. What is #1 assessment for hypovolemic shock?
  2. Proper technique for post op mobilization
  3. Manifestation of a patient’s tongue falling back
A
  1. Blood pressure
  2. slow changes in position, avoid ortho hypotension
  3. Snoring, use of accessory muscles, decreased air movement
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29
Q
  1. What are manifestation of a patient with retained secretions?
  2. Manifestations of laryngospasms
  3. Manifestation of atelactasis
A
  1. noisy respiration, coarse crackles
  2. inspiratory stridor
  3. dec breath sounds, dec O2
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30
Q
  1. Manifestation of pulmonary edema
  2. Manifestation of PE
  3. Manifestation of Aspiration
A
  1. dec O2, crackles, infiltrates on xray
  2. tachypnea, hypotension, bronchospasms
  3. unexplained tachypnea, bronchospasms dec O2, atelactasis, alveolar hemorrhage, respiratory failure
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31
Q
  1. Manifestation of bronchospasms
  2. Interventions for tongue
  3. Interventions for secretions in mouth
A
  1. Wheezing, dyspnea, tachypnea, dec O2
  2. head tilt, jaw thrust
  3. Suction, TCDV, IV, Chest therapy
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32
Q
  1. Interventions for Laryngosasm
  2. Interventions for Laryngeal edema
  3. Interventions for Atelactasis
A
  1. O2 therapy, positive pressure ventilate, IV muscle relaxant, lidocain, steroids
  2. O2, antihis, steroids, sedative, intubate
  3. humidified O2, DB, IS, early mobilization
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33
Q
  1. Pulmonary Edema interventions
  2. PE interventions
  3. Aspiration interventions
A
  1. O@, diuretics, fluid restriction
  2. O2, Cardiopulmonary support, anticoagulant
  3. O2, cardiac, antibiotics
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34
Q
  1. Order of operation for post op assessment x8
  2. What do you assess in the airway?
A
  1. Airway, Breathing, Circ, Neuro, Gastro, GU, Surgical Site, Pain
  2. e tube, mask, oral/nasal airway
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35
Q
  1. What do you assess for breathing?
  2. Circulatory assesment
  3. Neuro assessment
A
  1. Resper, Quality, listen, pulse ox, O2
  2. EKG, BP, Temp, Cap refill, color peripheral pulses
  3. LOC, orientation, sensory, motor, pupil size
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36
Q
  1. Gastro Assessment
  2. GU assessment
  3. Surgical Site Assessment
A
  1. N/V
  2. outpus, drains
  3. dressing, drainage
37
Q
  1. # 1 priority post op
  2. # 2 Priority post op
  3. What does TCDB prevent?
A
  1. Positioning, prevent skin break down, lateral recumbent until arousal, then semifowler
  2. Turn Cough Deep Breathe
  3. PE/FE, hypostatic pneumonia buildup of secretions
38
Q
  1. # 3 post op priority
  2. # 4 Post op priority
  3. # 5 Post op priority
A
  1. Incenstive Spirometer; risk for paralytic ileus- intestinal block, atelactasis
  2. I/Os, profusion of kidneys
  3. Early ambulation
39
Q
  1. How often do you take vitals post op?
  2. What are you monitoring in variance?
A
  1. every 2 minutes
  2. BP shouldn’t vary more than 20 %
40
Q
  1. Incision assessment
  2. Order of Operation if incision complication
A
  1. dehiscence, evisceration, should change from red pink to yellow. Apply moist dressing
  2. Moist dressing first, call doctor
41
Q
  1. Role with JP drain post op
  2. How much should you expect with NG tube contents?
  3. What colors should you expect with NG tube?
A
  1. measure amount and record
  2. less than 1500 mL /day
  3. pale, yellow- green
42
Q
  1. What would NG tube look like after GI surgery?
  2. What smell should you expect of NG tube
  3. Consistency of NG tube
A
  1. Bloody
  2. Sour
  3. Watery consistency
43
Q
  1. What type of drug is scopalamine
  2. What is it used for?
  3. Side Effects
A
  1. Antiemetic, Anticholinergic
  2. Motion sickness
  3. dry mouth, urinary retention, dec sweating, dilated pupils, Drowsy, blurred vision, tachycardia,
44
Q
  1. In a sterile field what is considered sterile?
  2. How do microbes travel
  3. Where do microbes harbor
A
  1. chest to table elvel and 2 inches above elbow. table tops only
  2. airborne particles enter w/ excessive air movements
  3. hair, skin respiraotry tract
45
Q
  1. What does a time out consist of?
  2. Discharge PACU to clinical unit
A
  1. Introduce each other, check right patiient, why here, allergies, position, estimated blood loss. Concerns. Plans Ted Hose. Essential supplies. Type of Procedure
  2. report, where caregiver is waiting, OP and Post Anesthetic period
46
Q
  1. Receiver of patient on clinical unit
A
  1. transfer to stretcher, to bed. Protect IV lines, wound drains, dressing and traction. compare vitals signs with report provided. assessment, Post op orders
47
Q
  1. Checks for ambulatory surgery?
  2. When should you not use Oxygen for porst op surgery
A
  1. All pacu crit met, no iv opiod drugs for 30 min, min n/v, voided, able to ambulate, written instructions understood
  2. tongue falls back, retained ssecretions
48
Q
  1. Why is a tracheostomy used?
  2. What can a trach do?
  3. Examples of tach being used
A
  1. artifical airway for longer than 10 -14 days, bypasses an obstructed upper airway, clean and remove secretions
  2. can deliver oxygen easer
  3. vocal cord paralysis, obstructive sleep apnea, foreign body obstruction
49
Q
  1. What does a Cuffed (balloon) endo tube prevent?
  2. What does an inflated cuff prevent?
  3. What does a low pressure cuff do?
A
  1. Aspiration, ensures set tidal volume
  2. air passing to vocal cords, nose or mouth
  3. Reduce risk of pulmonary aspiration
50
Q
  1. Why is an obturaror at the bed side
  2. What type of procedure is trach
  3. What do you clean the inner cannula with
A
  1. to facilitate reinsertion of trach if dislodged outer cannula
  2. sterile
  3. Clorhexidine, peroxide, full or 1/2 strength, or saline
51
Q
  1. Adult suction pressure
  2. How long should you wait between suction
  3. How long should suctioning take
A
  1. -80 to -120
  2. 30 sec
  3. 15 sec
52
Q
  1. Ways to determine suction needs
  2. Open suction
  3. Closed suction
A
  1. O2, color, restless, breath sounds
  2. new sterile cather each suction
  3. suction is reusable
53
Q
  1. What is used to lubricate a trach catheter
  2. What is a trach plug
  3. what is it used for
A
  1. Saline
  2. decannulation of trach tube
  3. speech, not speaking valve.
54
Q
  1. What is a pneumothorax
  2. What is a hemothorax
  3. Name 3 chest tube systems
A
  1. air/gas in the cavity btwn lungs and chest causing collapse
  2. pleural effusion, blood accumulates in pleural cavity
  3. collection, water seal, suction control chambers.
55
Q
  1. What should physician order after removal of chest tube
  2. when checking to see of all connections of c.tube are secure what should you feel for?
  3. Prior to removal of chest tube, what to assess?
A
  1. pain med
  2. crepitus or empyema (air, gas under skin)
  3. RR, O2, Tachypnea, hypoxia, resp distress, lungs, pain
56
Q
  1. Bubbbles upon initial insertion or when air is being removed is…
  2. Fluctuation of the level of water in the seal with inspiration and expiration is called?
  3. Normal or abnormal
A
  1. Normal
  2. tidaling
  3. Normal
57
Q
  1. Constant bubbling is it normal or abnormal?
  2. Prioritis if chest tube becomes disconnected?
A
  1. Abnormal, could be an air leak
  2. submerge tube in saline t create water seal, stay w/ pt, assess resp distress, HCP
58
Q
  1. If chest tube becomes dislodges?
  2. -orrhaphy means
  3. -ostomy means
A
  1. pinch skin together, apply occlusive sterile dressing, cover with 2 inch tape, call HCP!
  2. repair of suture
  3. creation of an opening
59
Q
  1. -otomy
  2. -plasty
  3. What is a colostomy
A
  1. cutting into or incision
  2. repair or reconstruction
  3. opening to bring colon to surface of ab
60
Q
  1. What is a illeostomy
  2. How often do you change ostomy pouch
  3. When should you empty pouch
A
  1. opening to bring small intestine to surface of abdomen
  2. 3-7 days
  3. when 1/3 full. Assess outpus, odor, amount, color
61
Q
  1. Can you wear pouch inside underwear
  2. can you put tape to fix a leaking pouch
  3. what should you check before applying new wafer
A
  1. yes
  2. no
  3. skin is clean and dry
62
Q
  1. How do you know an NG tube is in the wrong place?
  2. How do you measure the proper length of tube for NG
  3. Why do you elevate HOB to 30 degrees?
A
  1. trachea- presence of air escaping
  2. tip of nose to ear , xiphoid process to sternum.
  3. promote swallowing, aspiration
63
Q
  1. How to assess tolerance of tube feeding?
  2. How oftern should gastric residual be checked
  3. When should you hold the feeding and notify HCP
A
  1. GRV, ab distention, N/V, diarrhea, constipation, delayed g. emptying, listen to lung osunds, monitor aspiration.
  2. 4 hours
  3. aspiration, GRV is > 500 ml, ab distention
64
Q
  1. How to prevent cloggin of feeding tube
  2. If dobhofff or PEG becomes dislodged
  3. How often do you replace TPN tube and bag?
A
  1. crush meds, flush before and after, dilute viscous solutions, use liquid meds
  2. stop infusion, flush with saline/heparin, if unsuccssful, aspirate, follow protocol
  3. every 24 hours
65
Q
  1. How often do you change lipid tube
  2. Where is tpn stored?
  3. What to do S/Sx of air embolism
A
  1. every 12 hours
  2. fridge
  3. left trendlenburg position
66
Q
  1. Can you adminster TPN on a gravity pump
  2. What can be added to a blood bag
A
  1. no must be at a constant rate in an infusion pump
  2. saline ONLY
67
Q
  1. Priority Action for blood transfusion reaction
A
  • stop transfusion
  • chang iv tubing, keep iv line open
  • notify HCP
  • stay with patient
  • monitor vs ever 5 min
  • prep ER meds
  • obtain urine specimen
  • return bag and tubing to blood bank
  • document
68
Q
  1. Pre transfusion
  2. How long can blood be left out of fridge
  3. how long does blood transfusion take
A
  1. need consent, baseline vs, if temp > 100 notify hcp
  2. 20-30 min
  3. 2 hours, risk for bacteria infection
69
Q
  1. Where is admin of blood take place and how many nurses?
A
  1. bedside, 2 nurses verify
70
Q
  1. 1 lb = ?? oz
  2. 1 lb = ?? kg
  3. Drop factor Formula
A
  1. 16 Oz
  2. 2.2 kg
  3. Volume/Time x Drop Factor = flow rate
71
Q
  1. Calculating Dosage formula
  2. 1 oz, how manly mLs
  3. 1 tsp, how many mL?
  4. 1 tbsp
A
  1. Desire/Available x amount
  2. 30
  3. 5
  4. 15
72
Q
  1. Calcium
  2. Magnesium
A
  1. 8.6 - 10
  2. 1.6 - 2.6
73
Q
  1. K
  2. Sodium
  3. Bicarb
A
  1. 3.5 - 5
  2. 135 - 145
  3. 22 -29
74
Q
  1. Hematocrit
  2. Hemoglobin
  3. Platelets
  4. PTT
A
  1. 45%
  2. 12 -15
  3. 150,000-400,000
  4. 9.5 - 11.8
75
Q
  1. How long should the nurse stay with the patient to ensure transfusion rx is NOt occuring?
  2. What is a standard isotonic solution
  3. Trach tube, suctioning, when to hyperoxygenate?
A
  1. 15 minutes
  2. Sodium Chloride (w/o dextrose)
  3. Before (step 1) and after
76
Q
  1. Why should you NOT suction while advancing the catheter?
  2. How often should you auscultate breath sounds for an unconscious patient
  3. Why should you hyeroxygenate before, during, after for unconscious pt.
A
  1. cause mucosal trauam and aspiration
  2. Every 2 - 4 hours
  3. minimize cerebral hypoxia
77
Q
  1. When is a cuffed tube used?
  2. Action before patient wants to eat with trach tube
  3. What could bleeding mean if longer than a few hours of trachostomy?
A
  1. Mechanical ventilation
  2. inflate cuff (if cuffed)
  3. rupture of a vessel call HCP, URGENT LIFE THREATENING
78
Q
  1. What sound indicates a need for suctioning?
  2. routine care of chest tube, make sure that….
  3. Where should drainage sys maintain w/ c.t.
A
  1. Rhonchi
  2. connection btwn c.tube & drainage sys is taped, occlusive dressing is maintated at insertion site
  3. below client’s chest
79
Q
  1. Approximately how much drainage w/ c.t.?
  2. If you see continuous gentle bubbling in suction control chamber…
  3. Water seal chamber constant bubbling indicates (insp, exper)
A
  1. 50 mL expected
  2. normal finding (b/c not intermittent)
  3. Leak, call HCP– (intermittent bubbling is normal!)
80
Q
  1. Complication w/ TPN
  2. Why taper TPN?
  3. Why monitor temp with PN
A
  1. glucose, infection, fluid overload, embolism, electrolyte imbalance
  2. Avoid hypoglycemia
  3. Risk of infection
81
Q
  1. Why monitor weight with PN?
  2. What % of dextrose solution to avoid sclerosing of veins
  3. When will pt experience delayed gastric emptying?
A
  1. Hypervolemia risk
  2. no higher than 10%
  3. residual is greater than 150 mL
82
Q
  1. How often should nurse check NG tube?
  2. When do you know a colostomy is functioning?
  3. Name a complication with ileostomys?
A
  1. every 4 hours
  2. passing gas
  3. F &E imbalance
83
Q
  1. Recommended diet first 4-6 weeks with colostomy?
  2. How do you know a pt has “accepted” colostomy?
  3. If a patient does not TCDB, what can it lead to
A
  1. Low fiber, (after-high carb, high protein)
  2. When they participate in the care.
  3. Pneumonia, retianed pulmonary secretions
84
Q
  1. Pre-op, what do you want to ensure that the patient has done?
  2. Post op assessment checks, scheduled
  3. How should nurse approach a patient in extreme agitation?
A
  1. Voided
  2. every 15 min first hour, every 30 min for 2 hours, every hour first 4 hours
  3. speak and move slowly toward client
85
Q
  1. Best results with IS
  2. Incision infection signs
  3. Prior to surgery which med should not be withheld
A
  1. HOB 45-90 degrees, hold breath for 5 sec before exhaling (inflate alveoli)
  2. warm, red, hard, purulent, tender
  3. steroid
86
Q
  1. What should you do if a pt has an allergy to latex
  2. What tape is recommended to prevent skin breakdown w/ frequent dressing changes
  3. When can NG tube be removed
A
  1. apply cloth barrier to BP cuff
  2. Mongtomery straps
  3. When you hear bowel sounds, (absent could mean paralytic ileus)
87
Q
  1. To thoroughly assess the client for postoperative bleeding what is the primary nursing action?
  2. Why is post op ambulation important
  3. When are Deep breathing exercises done?
A
  1. Assess for external or most likely signs of of bleeding first
  2. calcium will go back into the bone
  3. Pre-op, not in post op discharge teaching
88
Q
  1. When receiving pt on surgical unit, next step after airway check..
  2. What is the minimum urinary output for an adult?
  3. primary purpose of jackson-pratt
A
  1. Compare vital signs
  2. 30 mL/hr
  3. evacuation of fluid/blood from surgical wound

Nursing school pt 3 (13 decks)

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