NR 463_Final Exam Flashcards
1
Q
- Failure of the aortic valve to close completely allow blood to flow from?
- Patient teaching with infective endocarditis
- S/Sx of endocarditis?
A
- Aorta to left ventricle
- alway notify healthcare providers of this hx
- retinal/splinter hemorrhage, osler’s nodes, painless erythematous macules on the palms
2
Q
- What is a sign of decreased CO in pt w/ aortic valv regurg?
- How to differentiate pericarditis from other cardiopulmonary problems?
- Pericarditis complications
A
- SOB on minimial exertan & diastolic murmur
- Pericardial friction rub
- pulsus paradoxus, distant heart sounds, distenden jug veins, falling BP
3
Q
- Complications of thrombolytic therapy
- post-CABG limitations first 6 weeks
- Pt w/ PAD should NOT
A
- Tarry Stools
- no weight bearing
- elevate legs above heart, use heating pad, soak feet in hot water
4
Q
- S/Sx of dumping syndrome
- How to prevent dumping syndrome
- Early S/Sx of dumping syndrome
A
- weakness, ab discomfort, abnormal bowel evacuation, after meals, after surgery
- Limit fluids with meals
- Pallor, syncope
5
Q
- Duodenal ulcer is relieved by…
- What med is a risk factor for PUD
- Foods to AVOID with ulcerative colitis
A
- Food intake
- Taking ibuprofen (Motrin) for osteoarthritis
- dairy, beans, dried fruits, high fiber, nuts, raw fruits and veggies, seeds.
6
Q
- Stool type with Crohn’s
- Purpose of NG tube continuous suction pt w/ small bowel obstruction
- An antirheumatic drug irritant for pt w/ PUD
A
- Loose, watery
- remove gas/fluids from stomach & intestines
- Indocin
7
Q
- Risk factors for colorectral cancer
- Foods that increase risk for stomach cancer
- Signs of flail chest
A
- hx of ulcerative colitis or GI polyps
- smoked foods like bacon or ham
- Paradoxical chest movement
8
Q
- PT treated for TB, when will no longer be contagious
- Most frequent early symptom of lung cancer?
- TB s/sx
A
- 2-3 weeks of med thearpy
- Cough, later- hoarseness
- Cough (yellow), chills, night sweats, dyspnea
9
Q
- Concerning assessment Tension Pneumothorax
- Nurse instruction during removal of chest tube?
- Early signs of compartment syndrome
A
- dec CO, hyperresonance, tracheal deviation to opposite side, bradypnea
- exhale and bear down
- Numbness and tingling in the fingers
10
Q
- How long does a plaster take to dry
- How should cast extremity be positioned?
- Technique for drying cast
A
- 24-72 hours
- elevate to reduce edema
- Cool setting on hair dryer
11
Q
- Risk with a cast
- What is pt instructed to monitor with cast
- How do you achieve proper traction
A
- Skin integrity, don’t stick anything underneath
- pain, swelling, color, tingling, numbness, coolness or diminshed pulse. (notify HCP fo circulatory impairment)
- Weights need to be free-hanging, with knots away from pulleys.
12
Q
- HOB with traction
- Can the nurse remove or lift weights?
- What should you examine
A
- kept low for countertraction (30-40 degrees)
- no need Dr. Order
- temperature, peripheral pulses, skin breakdown, numbmness, increase in pain, ropes pulleys
13
Q
- Instructions for Total Hip Anthroplasty
- What does caffeine do to pt high risk for osteoporosis
A
- raised toilet seat, do not adduct leg or flex more than 90 degrees, sit in chairs that have arms, avoid putting on socks and shoes for 8 weeks
- Increases calcium loss in urine, along w/ smoking ETOH, steroids.
14
Q
- Pre-Op Teaching
- Pre-op assessment data give should be strictly
- Activites performed by the scrub nurse
A
- Where she will be taken post op, DB,
- Objective
- prep instrument table, passing instruments, counting
15
Q
- Before admitting a patient to OR, which forms must the nurse make sure are in the chart of all patients
- Circulating Nurse Role
- How can you enable patient to ambulate TCDB?
A
- Signed Consent, Hx/Physica, Preanesthesia assessment.
- coordination of surgical suite, documentation, electrical equiment, counting
- pain meds
16
Q
- Post op pt has delirium, ABC’s are good. What first action
A
- check pre op assessment for previous delirium or dementia
17
Q
- Preop Fentanyl/Atropine is most likely used for
- Most critical Hx to know prior to surgery
- Timeout consists of..
A
- decreased asethetic required
- history of death during surgery
- verify id band, ask PT to state surgical procedure, Have PT state name & DOB, confirm Surgical site
18
Q
- If patient has a temp 100.4 post op, what is first action?
- What should you do with a trach before deflating the cuff
- What are possibilities with a trach
A
- use IS due to atelactasis risk (infection takes 48 hours)
- Suction
- not possible to speak, fenestrated if no aspiration risk, speaking trach may be considered.
19
Q
- Chest Tube major concern
- Standard Chest Tube is
- If a patient has a Tube feeding and a Ct scan scheduled, what action
A
- SubQ Emphysema at Insertion site
- -20cm H2O
- shuff off feeding 30-60 min before
20
Q
- 1 lb = ?? oz
- 1 lb = ?? kg
- Drop factor Formula
A
- 16 Oz
- 2.2 kg
- Volume/Time x Drop Factor = flow rate
21
Q
- Calculating Dosage formula
- 1 oz, how manly mLs
- 1 tsp, how many mL?
- 1 tbsp
A
- Desire/Available x amount
- 30
- 5
- 15
22
Q
- Calcium
- Magnesium
- WBC
A
- 8.6 - 10
- 1.6 - 2.6
- 4500-11,000
23
Q
- K
- Sodium
- Bicarb
A
- 3.5 - 5
- 135 - 145
- 22 -29
24
Q
- Hematocrit
- Hemoglobin
- Platelets
- PTT
A
- 45%
- 12 -15
- 150,000-400,000
- 9.5 - 11.8
25
Q
- Glucose
- BUN
- Creatnine
A
- 70-110
- 8-25
- 0.6 - 1.3
26
Q
- Chloride
- RBC
- Troponin I
A
- 98-110
- 4 - 6
- < 0.6 ng/mL
27
Q
- Troponin T
- Myglobin
- CK-MB
A
- < 0.1 - 0.2 ng/mL
- < 90mcg/L
- 0 - 5%
28
Q
- Intermittent claudication is
- SE of nitroglycerin
- Warfarin antagonist
A
- cramping in the legs induced by exercise, obstruction of the arteries
- dizziness, headache, hypotension
- Vitamin K
29
Q
- Purpose of Cornoary Artery Bypass Graft
- Femoral popliteal bypass, nurse is most concerned if pt is
- HF is
A
- insert graft, anastomosed distally & proximally to bypass obstruction
- Clammy- hypovolemic shock
- failure of muscle to pump sufficient blood to meet body’s metabolic demands
30
Q
- Characteristic signs of heart failure
- What should you check following cardiac catheterization
- Most important factor to maintain circulation
A
- tachycardia increased respirations
- extremeties for pulses (concern is trauma to vessels)
- blood volume
31
Q
- What major vital sign would be altered in an elderly patient?
- when should hydrochlorothiazide be taken
- Major symptom of HF while sleeping
A
- Temperature
- with breakfast, diuresis could occur if taken at bedtime
- orthopnea- inability to breath while lying flat
32
Q
- What is the purpose of a cardiac monitor
- Type of edema with cardiac failure is
- Antidote for heparin
A
- displays the patient’s heart rhythmn, to observe abnormalities
- dependent
- protamine sulfate
33
Q
- If pt with iron deficieny receives heparin, what are you most concerned about?
- Digitalis Toxicity S/Sx
- When administering dopamine IV drip how in what unit
A
- Bleeding
- N/V, anorexia, visual disturbances, bradycardia,
- kilograms
34
Q
- After aortofemoral bypass what position should the client be placed in?
- How do analgesics help an MI
- What is a side effect of propanolol that could affect pt with asthma
A
- Full supine- hip remain straight to prevent bleeding
- reduces pain and preload, which reduces workload of the heart
- bronchospasms
35
Q
- What concern might you have after a CABG
- pain in the lower extremities not relieved by rest indicates
- How can it be relieved?
A
- sudden cessation of mediastinal c.t., HALLMARK sign is cardiac tamponade
- peripheral arterial disease (cold)
- placing in a dependent position
36
Q
- How does nitro work?
- What do you clean a stoma with
- increased pain after eating is a characteristic of
A
- dilate peripheral vessels, thereby decreaseing preload
- soap and water
- gastric ulcer, relieved by vomiting
37
Q
- Most common symptom of duodenal ulcer
- Gas forming vegetables
- Appropriate amt of drainage post op
A
- abdominal pain 2-3 hours after eating, food relieve pain
- onions, broccoli, radishes, beans cabbage
- 50 mL
38
Q
- What is a low residue diet
- what pt would have this type of diet?
- Cramping pain in the LLQ w/ irregular bowel function & diarrhea
A
- tender cooked meats, no fiber, or pulp in juices
- bowel inflammation, regional enteritis
- diverticulitits, increased pain w/ coughing bending lifting
39
Q
- Why is PN delivered at a constant rate of infusion
- how is hep A is spread fecal oral route,
- Full liquid diet includes..
A
- to prevent unstable glucose level
- do not share eating utensils
- milk, custards, veg/fruit juice, strained cereal, butter margarine cream
40
Q
- most important when applying new ileostomy bag
- Srugical unit after ileostomy, FIRST action
- Clear liquids
A
- fits snugly, to prevent fluid on the abdomen
- Measure output, assess
- minimal residual, relieve thirst/maintain f&E
41
Q
- How do you always assess pain
- What can cause peritonitis
- S/Sx of Peritonitis
A
- Character and intensity
- ruptured appendix
- ab rigidity, dec bowel sounds, N/V,
42
Q
- Common affect of chronic bronchitis
- What discourages a COPD pt to breath
- Best way to determine hypoxic
A
- Rust blood tinged sputum
- high flow oxygen eliminates their drive to breathe
- ABG’s
43
Q
- Early sign of oxygen toxicity
- What is tension pneumothorax
- What urgent intervention is needed?
A
- non productive cough, nasal congestion, sore throat
- Air pressure lung, deviated trach
- Chest tube w/ suction drainage- converts to open pneumothorax
44
Q
- If a chest tube for tension pneumo is no available, next best thing?
- Mantoux Test id aministered
- Where should head be positioned when trach is suctioned
A
- thoracentesis, removes air
- Intradermal, its the PPD
- the opposite from the bronchus being suctioned
45
Q
- What is a potential hazard near oxygen tank
A
- nail polish, flammable
46
Q
- osteoarthritis- stiffness or swelling?
- what is an early sign of compartment syndrome
- characteristics of paget’s disease
A
- stiffness
- inability of pain med to relieve pain (neurovascular assess)
- kyphosis and bowing of the legs
47
Q
- Characteristic of myasthenia gravis
- Why?
- What could this lead to
A
- tiredness with slight exertion
- acetylcholine deficiency, difficult to stimulate muscular movement.
- weakness of respiratory muscles
48
Q
- What are absence seizures
- What can basilar skull fracture cause
- What does MS involve
A
- momentary loss of consciousness, “blank stare”
- leakage of CSF test positive for glucose
- cerebellum- balance
49
Q
- Manifestation of MS
- How to prevent sensory deprivation
- What is brudzinski’s sign
A
- Urinary retention, hyperreflexia of extremeities, ataxia, dec concentration
- asesss support sys for pt who is isolated
- flexing head and flexing hip and knee
50
Q
- What does brudzinski’s, kernig’s sign represent
- Patient with right sided hemiglegia, what type of diet?
- Meniere’s disease pt experiences
A
- menigitis, call HCP
- pureed, easy to swallow
- vertigo, place pillow either side of head
51
Q
- Technique for preventing sensory overload on a patient
- What should nurse prevent in patient with intracranial pressure
- Major risk factor for developing CVA
A
- combine activities into one visit
- valsalva maneuver
- hypertension
52
Q
- Glascow coma scale of 7 or less indicates
- spinal cord injury T3, pounding headache and nasal congestion
- Parkinsons diet
A
- pt is comatose and eyes may stay open, preven corneal irritation
- bladder distention, foley cath for kinks
- thick liquids are easier to swallow
53
Q
- patient with trigeminal neuralgia diet
- when do parkinsons experience tremors
- Caffeine and EEG test
A
- hot foods can trigger pain episode, also too cold
- at rest, give activity to perform
- restrice caffeine 1-2 days prior (hot chocalate included)
54
Q
- Onset of parkinsons
- Is it unilater or bilateral
- Classic signs of parkinsons
A
- Gradual
- can start on one side of the body
- tremors, rigidity, bradykinesia (tremor is the 1st sign)
55
Q
- How can you diagnose parkinsons
- Collaborative care for parkinsons included
- Drugs used for parkinsons
A
- positive response to antparkinson drugs, hx & physica, MRI, SE’s to haloperidol (psychotic drugs)
- antiparkinson drugs, deep brain stimulation, ablation surgery
- dopaminergics, dopamine agonists, anticholinergics, antihistamine, MOI, Catechol OMT
56
Q
- Dopaminergic drugs
- anticholinergic drug
- antihistamine like benadryl have a…
A
- levodopa/carbidopa, converts to dopamine in basal ganglia
- benztropine- help balance cholinergic and dopaminergic activity
- anticholinergic effect
57
Q
- drugs that end in -agiline
- COMT inhibitors
- What should you assess in appearance with parkinsons?
A
- Monoamine Oxidase inhibitors, block break down of dopamine
- block break down of levodopa
- Mask liked face, slow monotone speech
58
Q
- What might you see in skin with parkinsons?
- Cardiovascular parkinsons
- GI Parkinsons
A
- sobrrhea, dandruff, ankle edema
- postural hypotension
- drooling
59
Q
- What will you notice in hands of parkinsons
- MSK parkinsons
- What will be your first nursing dx
A
- pill rolling
- rigid, bradykinesia, contractures, stooped posutre, shuffling gait
- Impaired physical mobility r/t rigidity, bradykinesia
60
Q
- Another very important nurisng dx
- What happens to their swallowing ability in parkinsons?
- Why should they perform physical exercise
A
- Imbalanced nutrition less than body requirments r/t inablility to ingest food
- impaired, assess gag reflex
- to deter muscle atrophy and joint contractures
61
Q
- Other Nursing Dx
- Does parkinsons have acute exacerbations?
- goal is to
A
- Impaired swallowing, impaired verbal communication
- no
- maintenance, independence, avoid contractures and falls, promote exercise
62
Q
- What happens to levodopa with Sinemet drug?
- How does MS develop, according to belief?
- 3 Pathological porcesses in MS
A
- converts to dopamine in the CNS, serves as a neuro transmitter. Relief fo tremors
- genetics, environmental exposure, infection
- Chronic inflammation, demyelination, gliosis (scarring) in the CNS.
63
Q
- What is the primary neurpathic condition of MS
- What would an MRI of the brain or sminap cord show with MS
- What would CSF show with MS
A
- autoimmune, activated by T cells.
- plaques, inflammation, atrophy, tissue breakdown
- increase in IgG, oligoclonal banding
64
Q
- How must a person be diagnosed with MS x3
- Early symptoms of MS
- End stage MS
A
- 2 inflammatory demyelinating lesions in CNS, attack occuring at diff times, rule out other dx
- blurred vision, thinking, balance/coordination, numbness, tingling
- Respiratory, SOB, secretions, pain, urinary retention, paralysis, nystagmus, dec hearing, hyperreflexia
65
Q
- Treatment MS
- Drug therapy
- TX for incontinence
A
- maximize neuromuscul ftn, adls, mgmt fatigue, psychosocial, reduce exacerbations
- Interferon, immunomodulators, immunosuppressants, steroids, relaxants,
- no smoking, weight loss, scheduled voiding, pelvic floor muscle, kegil exercises
66
Q
- Causes of exacerbation in MS
- Tx of flare ups
- General assessment of MS
A
- inflammation, stress
- steroids, focus on immobility, respiratory and UTI’s and pressure ulcers
- apathy, inattentiveness
67
Q
- Skin assessment MS
- Neurologic asessment MS
- MSK MS
A
- pressure ulcers
- speech, nystagmus, ataxia, tremors, spasticity, decreased hearing
- muscle weakness, paresis, spasms, foot dragging, dyarthria
68
Q
- What is the primary diagnoses for MS
- Name another nursing dx
- what is the purpose of a lumbar puncture?
A
- Impaired phys mobility r/t muscle weakness or paralysis
- impaired urinary elimination r/t sensorimotor deficits, knowledge deficit
- CSF is aspirated by needle insertion in L3-4, or L$-5 to assess CNS diseases
69
Q
- What should you ensure patient does NOT have s/sx of for lumbar puncture?
- What position should pt be in for lumbar puncture
- Aseptic or Sterile technique?
A
- ICP, risk of downward herniation from CSF removal
- lateral recumbent
- Aseptic
70
Q
- What position for post lumbar puncture?
- Assessment of fluid of lumbar puncture
- Complication of Lumbar puncture
A
- Prone for 4-8 hours, if not supine. Turn Side to Side.
- Clear, pressure 60-150, protein 15-45, glucose 50/75, minimal WBCs. No bacteria
- Spinal fluid leak (clear), severe headache
71
Q
- Clincal manifestation of hemorrhagic stroke?
- S/Sx of stroke
- Pathophysiology of Stroke/TIA
A
- Same as ischemic stroke, sudden headache
- weakness paralysis of one side, numbness, sudden confusion, trouble speaking, slurred speech, vision problems, dizziness, loss of balance, difficulty swallowing
- Atherosclerosis
72
Q
- How long does TIA last
- What is the difference between TIA and stroke
- Risk factors of stroke
A
- 1 hour to 24 hours, early warning sign
- no infarction, ischemia to brain, no brain damage, symptoms resolve
- HTN, exercise, diet, diabetes
73
Q
- # 1 Intervention for stroke
- other ways of management
A
- CT scan immediately #1, standing order
- MIR, Cardiac Monitor (afib?), echo, carotid NIVA, lipid pane, Coag panel, Hgb A1c
74
Q
- Treatment for Stroke
- What makes them a candidate for tPA
A
- Antihypertensive, Antiplatelet, Carotid Endarterectomy, thrombolytics, coumadin, Rehab, MGMT of cerebral edema, seizure prevention, clot retrieval, stents
- not a hemorrhagic, < 3 hours
75
Q
- Cerebrum affects
- Basal Ganglia affects
- Diancephalon
A
- Cognition
- Motor control (parkinsons)
- ANS (breathing)
76
Q
- Cerebellum affects
- Brainstem affects
A
- balance
- airway