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Spring 2015 Final Exams > NUR-345 Final Exam > Flashcards

NUR-345 Final Exam Flashcards

1
Q

What are the two types of megaloblastic anemias?

A

Cobalamin (Vitamin B12) deficiency and folic acid deficiency

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2
Q

What causes a cobalamin (Vitamin B12) deficiency?

A
  • dietary deficiency
  • intestinal malabsorption
  • chronic alcholism
  • a lack of intrinsic factor
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3
Q

How is cobalamin (Vitamin B12) deficiency treated?

A

Parenteral (IM injections [cyanocobalamin or hydroxocobalamin]) or intranasal (Nascobal, CaloMist) for life

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4
Q

How is folic acid deficiency treated?

A

1-5 mg/day PO

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5
Q

What is the normal aPTT time?

A

25-35 seconds

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6
Q

What is the normal PT time?

A

11-16 seconds

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7
Q

How is neutropenia diagnosed?

A

<1000 and <500 is LIFE threatening!

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8
Q

What is neutropenic isolation?

A
  • strict handwashing
  • private room w/ HEPA (reverse isolation)
  • no flowers or plants
  • no raw fruits or veggies
  • assess visitors prior to entry
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9
Q

What are the symptoms of Hodgkin’s lymphoma?

A

insidious onset w/ enlarged, movable, non-tender cervical/axillary/inguinal lymph nodes

other sx:

  • weight loss
  • fatigue
  • weakness
  • fever
  • chills
  • tachycardia
  • night sweats
  • generalized pruritis
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10
Q

What electrolyte should be monitored with multiple myeloma?

A

calcium d/t increased uptake by bone

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11
Q

What is the nursing management in a pt with MLL who has hypercalcemia?

A

high fluid intake; urine output monitoring to prevent kidney stone formation

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12
Q

What should the nurse do if abnormal VS (like increased temperature) are obtained before starting a blood transfusion?

A

call MD w/ abnormal VS

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13
Q

What is a febrile, nonhemolytic reaction?

A

the sensitization to donor WBCs, platelets, or plasma proteins

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14
Q

What are the clinical manifestations of a febrile, nonhemolytic reaction?

A

sudden chills and fever (rise in temp of > 1 degree C), HA, flushing, anxiety, vomiting, muscle pain

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15
Q

What is the nursing management for a febrile, nonhemolytic reaction?

A

give antipyretics as prescribed–avoid aspirin in thrombocytopenic pts and DO NOT RESTART transfusion unless ordered my MD

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16
Q

How do you prevent a febrile, nonhemolytic reaction?

A

consider leukocyte-poor blood products (filtered, washed, or frozen) for pts w/ a hx of two or more such reactions

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17
Q

What are the manifestations of left sided heart failure?

A
  • weakness
  • fatigue
  • increased HR
  • anxiety, depression
  • dyspnea
  • shallow respirations (32-40/min)
  • paroxysmal nocturnal dyspnea (reabsorption of fluid from dependent body areas, pt feels suffocated)
  • orthopnea, dry, hacking cough
  • nocturia
  • frothy, pink-tinged sputum
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18
Q

What are the manifestations of right sided heart failure?

A
  • fatigue
  • increased HR
  • anxiety, depression
  • dependent, bilateral edema w/ wt gain
  • ascites/anasarca
  • cachexia
  • RUQ pain
  • anorexia and GI bloating
  • nausea
  • dusky > brown > brawny skin coloration
  • lower extremity shiny w/ decrease hair growth
  • confusion
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19
Q

What are the symptoms of a DVT?

A
  • extremity pain
  • edema
  • increase in calf circumference
  • (+) Homan’s sign
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20
Q

What are the complications of a DVT?

A

pulmonary embolism

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21
Q

What is the nursing care given to a patient with a venous leg ulcer?

A
  • moist dressings
  • high protein diet
  • vit. A, vit. C, and zinc acid aid in wound healing
  • compression of the leg is essential to healing
  • elastic wraps
  • unna boot
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22
Q

What are the common SE of Lasix?

A
  • dehydration
  • hypocalcemia
  • hypocholoremia
  • hypokalemia
  • hypomagnesemia
  • hyponatremia
  • hypovolemia
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23
Q

What are the sx of hypocalcemia?

A
  • anxiety, irritability
  • tetany, abdominal cramps
  • (+) Chvostek’s and Trousseau’s signs
  • convulsions, bone fracture
  • tingling, numbness
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24
Q

What is HbA1c?

A

shows the amount of glucose attached to hemoglobin molecules over RBC life span (approximately 120 days)

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25
Q

What is the normal value of HbA1c?

A

<7%

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26
Q

What does a normal HbA1c reduce?

A

the risk of retinopathy, nephropathy, and neuropathy associated with DM

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27
Q

What does HbA1c measure?

A

the amount of glycoslated hemoglobin as a percentage of total hemoglobin

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28
Q

What type of insulin is Novolog?

A

rapid-acting insulin

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29
Q

What type of insulin is NPH?

A

intermediate-acting

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30
Q

What is the onset, peak, and duration of Novolog?

A

Onset: 15 min

Peak: 60-90 min

Duration: 3-4 hours

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31
Q

What is the onset, peak, and duration of NPH?

A

Onset: 2-4 hours

Peak: 4-10 hours

Duration: 10-16 hours

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32
Q

What are the storage instructions for insulin?

A
  • Do not heat/freeze
  • In-use vials may be left at room temperature up to 4 weeks
  • Extra insulin should be refrigerated
  • Avoid exposure to direct sunlight
  • Insulin can be stored in a thermos or cooler to keep it cool (not frozen) if the patient is traveling in hot climates
  • Prefilled syringes are stable up to 1 week when stored in the refrigerator
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33
Q

When is a subtotal thyroidectomy indicated?

A
  • Ig goiter causing compression
  • Unresponsive to antithyroid meds
  • Thyroid cancer
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34
Q

What are the instructions prior to receiving a subtotal thyroidectomy?

A

anti-thyroid meds are taken 4-6 weeks prior to get to Euthryroid state

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35
Q

What are the possible complications of a subtotal thyroidectomy?

A
  • hypothyroidism
  • hypoparathyroidism
  • hypocalcemia (tetany)
  • hemorrhage
  • damage to laryngeal nerve
  • infection
  • thyrotoxic crisis
  • airway obstruction
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36
Q

What is a thyroid storm?

A

A life threating condition with a high mortality rate. It occurs when there is a large “dumping” of thyroid hormone into the system.

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37
Q

What are the manifestations of a Thyroid Storm?

A
  • increased BMR
  • fever
  • HTN
  • tachycardia
  • arrhythmia
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38
Q

What are the nursing responsibilities in caring for a patient experiencing a thyroid storm?

A
  • assess for the clinical manifestations
  • treat with tylenol
  • sponge bath
  • Inderal (propranolol)
  • IV fluids
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39
Q

What are the nursing responibilities for a patient post-subtotal thyroidectomy?

A
  • teach pt turning techniques to avoid stress on suture lines; have O2, suction, tracheostomy tray all in pt’s room post-op
  1. airway
  2. respiratory status
  3. laryngeal damage
  • assess q2h for VS, hemorrhage (feel behind neck), neck swelling, frequent swallowing, choking
  • keep pt in semi-fowler’s position with only a small pillow to avoid pillow to avoid neck flexion
  • assess for tetany (d/t accidental parathyroid removal): tingling, muscle twitching, Trousseau & Chvostek signs
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40
Q

What are the nursing responsibilities post-transphenoidal hypophysectomy?

A
  • HOB elevated 30 degrees
  • oral care q2h (no tooth brush) with floss/rinsing mouth (continue for 2 weeks)
  • assess nasal drainage for CSF –> if positive for glucose, there is a CSF leak
  • monitor and correct electrolytes and glucose levels
  • Monitor ECG
  • Protect from infection
  • assess for presence of halo sign (yellow on the edge and clear in the middle) as it indicates CSF
  • assess nuero conidtion every hour for the first 24 hours and then q4h
  • administer stool softeners to prevent straining
  • breathe through mouth
  • NO bending over/coughing/blowing nose/sneezing
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41
Q

What is the treatment for an Addison’s crisis?

A
  • IV hydrocortisone
  • IV replace fluid loss
  • reverse hyperkalemia (Kayexalate)
  • monitor BP
  • ECG
  • monitor VS closely
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42
Q

What is the treatment for Addison’s disease?

A
  • lifelong replacement of corticosteroids (Prednisone) and mineralcorticoids (Florinef)
  • Na+ replacement during excess heat
  • avoid using alcohol or caffeine
  • monitor sx for gastric bleeding or hypoglycemia
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43
Q

What is the normal value range for BUN?

A

6-20 mg/dL

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44
Q

How is a UTI prevented?

A
  • complete entire antibiotic rx
  • maintain daily fluid intake of half their body weight in ounces (150 –> 75 oz/day)
  • good peri-care habits
  • empty bladder frequently/completely
  • urinate before/after intercourse
  • avoid bath salts, vaginal deodarant sprays, bubble baths, bath oils, hot tubs
  • fluids/foods to avoid d/t being potential bladder irritant: caffeine, alcohol, citrus juices, chocolate, highly spicey foods
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45
Q

What foods should be avoid in a pt with calcium oxalate kidney stone?

A
  • black tea
  • spinach
  • rhubarb
  • cocoa/chocolate
  • beets
  • pecans
  • peanuts
  • okra
  • wheat germ
  • lime peel
  • swiss chard
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46
Q

What foods should be avoid in a pt with a uric acid kidney stone?

A
  • organ meats
  • poultry
  • fish
  • sardines
  • red wine
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47
Q

What foods should be avoid in a pt with a calcium phosphate kidney stone?

A

high animal protein consumption

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48
Q

What foods should be avoid in a pt with a struvite stone (magnesium ammonium phosphate) kidney stone?

A
  • dairy
  • red & organ meats
  • whole grains
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49
Q

What are the risk factors for bladder cancer?

A
  • cigarrette smoking
  • chronic recurrent renal calculi
  • chronic lower UTI’s
  • long-term indwelling catheter
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50
Q

What are the symptoms of bladder cancer?

A

painless hematuria

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51
Q

When and where is a nephrostomy tube inserted?

A

directly into kidney d/t complete ureteral obstruction

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52
Q

What are the nursing repsonsibilities in a pt with a nephrostomy tube?

A
  • assess for kinking or compression
  • NEVER clamp tube
  • Possible Irrigation: STRICT sterile technique w/ NSS 5 mL @ a time
  • If more than 1 drainage tube, record output separately
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53
Q

What are the nursing responsibilities post-nephrostomy tube incision?

A
  • muscle aches from hyper-extension during surgery
  • respiratory status: IS, splinting, CDB
  • Abd. distention: bowel is manipulated during surgery –> decreased peristalsis –> NPO until BS return
  • early ambulation
  • daily weight
  • Urine output: check q1-2hr; total output should be at least 30-50 mL/hr; check color, consistency, mucus, blood, sediment
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54
Q

What are the complications of GERD?

A
  • esophagitis –> ulcerations –> scar tissue –> esophageal stricture –> dysphagia
  • Respiratory: sore throat, wheezing, coughing, dyspnea, hoarseness
  • disturbed sleep patterns
  • dental erosion
  • Barrett’s esophagus: pre-cancerous; change in type of cell to another; flat cells in esophagus change to columnar
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55
Q

What are the lifestyle modifications for GERD?

A
  • wt loss
  • no ASA/NSAIDs
  • HOB elevated
  • small frequent feedings
  • NO smoking
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56
Q

What is the nutritional therapy for GERD?

A
  • high protein
  • low fat
  • NO alcohol/spicy foods
  • NO milk @ HS –> leads to increase gastric secretions
  • avoid coffee, cola, wine
  • take fluids between meals
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57
Q

How is Pepcid classified?

A

H2 Histamine Receptor Blockers

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58
Q

What is the rx for chronic gastritis?

A
  • bland diet: 6 small meals
  • antacids: 1 & 3 hours AFTER
  • avoid alcohol, caffeine, ASA, smoking
  • antibiotics for H. pylori (PPI, Byaxin, vancomycin)
  • Proton Pump inhibitors
  • monitor for bleeding
  • tx for anemia
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59
Q

What are the symptoms of a gastric ulcer?

A
  • dyspepsia (heartburn, bloating, N/V, pain)
  • occurs 1-2 hours after meals
  • rare at NOC
  • worsens w/ food intake
  • H. pylori
  • NSAIDs, ASA, steroids, SSRIs
  • severe stress
  • smoking
  • wt loss
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60
Q

What are the symptoms of a duodenal ulcer?

A
  • burning/cramping, heartburn, bloating, nausea, feeling of fullness
  • 2-5 hours after meals
  • most sx occur @ NOC
  • food relieves pain
  • H. pylori
  • NSAIDs, ASA, alcohol use
  • severe stress
  • smoking
  • wt loss
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61
Q

What are the complications of peptic ulcer disease?

A
  • hemorrahge
  • perforation
  • gastric outlet obstruction
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62
Q

What are the sx of perforation d/t PUD?

A

Sudden, severe upper abd pain that spreads throughout abdomen and is not relieved by food/antacids

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63
Q

How is PUD diagnosed?

A
  • endoscopy w/ bx
  • urea breat test
  • other lab work
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64
Q

What medications treat PUD?

A
  • Histamine (H2) receptor blockers & PPi
  • Antibiotic therapy
  • Antacids –> Carafate before meals
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65
Q

What are the nursing responsibilties post-bilroth surgery?

A
  • I/O
  • NG w/ gentle NSS irrigations to maintain patency
  • frequent position changes
  • splinting for CDB
  • BS assess
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66
Q

What are the complications of surgery for PUD?

A
  • Dumping syndrome
  • Post-prandial hypoglycemia
  • Bile reflux gastritis
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67
Q

What is Dumping Syndrome?

A

Ig bolus of gastric chyme entering the smlal intestine w/ meals. Draws fluids into bowel –> results in decrease in plasma volume, bowel distention, increased intestinal transit –> diarrhea/cramping

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68
Q

What are the sx of dumping syndrome?

A

occurs within 30 minutes of eating. pt c/o weakness, sweating, palpitations, dizziness, abd crmaps, borborygmi (audible BS), need to defecate.

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69
Q

How is dumping syndrome prevented?

A
  • eat 6 small meals/day
  • DO NOT drink fluids w/ meals
  • fluids 30-45 min before/after meals
  • avoid concentrated sweeds
  • increase proteins/fats to meet energy needs and tissue repair, while decreasing carbohydrates post surgery
  • lay down/recline after eating to prevent rapid dumping of food into intestine by gravity pull
70
Q

What is post-prandial hypoglycemia?

A

occurs w/ dumping syndrome which increases insulin release which lowers BS (but food passes through GI too fast for complete absorption to occur)

71
Q

What is bile reflux gastritis?

A

associated w/ pylorus reconstruction –> leads to epigastric distress and is treated w/ Questran

72
Q

What are the sx of C. diff?

A
  • watery diarrhea
  • fevor
  • anorexia
  • nausea
  • abd. pain
73
Q

What antibiotics are given to treat C. diff.?

A

Flagyl and Vancomycin

74
Q

What is the nursing care for a pt w/ C. diff?

A
  • gloves/gown
  • NO sharing equipment
  • 10% bleach to kill
  • contact isolation
75
Q

What is the medical management of Crohn’s disease?

A

Goal:

  • rest bowel (NPO)
  • control inflammation
  • treat infection
  • correct malnutrition
  • alleviate stress
  • symptomatic relief
  • improve quality of life
76
Q

What are the surgical procedures available for a patient with inflammatory bowel disease?

A

Crohn’s diesease: structureplasty

Ulcerative colitis: prctocolectomy w/ ileoanal reservoir

77
Q

What are the risk factors for colorectal cancer?

A
  • family hx of colorectal cancer (first-degree relative)
  • personal hx of inflammatory bowel disease
  • personal hx of colorectal cancer
  • family or personal hx of adenomatous polyposis (FAP)
  • family or personal hx of hereditary nonpolyposis colorectal cancer (HNPCC) syndrome
  • obesity (BMI > 30 kg/m2)
  • red meat (>7 servings/week)
  • cigarette use
  • alcohol (>4 drinks/week)
78
Q

What are the manifestations of chronic hepatitis?

A
  • malaise
  • easy fatiguability
  • hepatomegaly
  • myalgias and/or arthralgias
  • elevated liver enymes (AST & ALT)
79
Q

What is the normal reference range for lipase?

A

0-160 units/L

80
Q

What is the normal reference range for amylase?

A

30-220 units/L

81
Q

What is the normal reference range for ALT?

A

4-36 international units

82
Q

What is the normal reference range for AST?

A

0-35 units/L

83
Q

What is the treatment for chronic hepatitis?

A
  • Goals: decrease viral load and decrease liver enzyme levels
  • antivirals (Interferon)–can cause leukemia
  • slow rate of disease progression: cirrhosis, liver failure, cancer
84
Q

How do you prevent viral hepatitis?

A
  • hand washing
  • proper personal hygiene
  • environment sanitation
  • control and screening of food handlers
  • avoid sharing toothbrushes and razors
85
Q

What teaching should be provided to the patient?

A
  • avoid alcohol/ASA/NSAIDs
  • avoid spicy/rough foods
  • avoid straining with stool, coughing, sneezing, retching, and vomiting
  • good oral hygiene–soft toothbrush
  • small frequent meals–low Na+
  • strict I/O, daily weights, measure abd girth
86
Q

What are the complications of acute pancreatitis?

A
  • pulmonary effusion, atelectasis, pneumonia
  • hypotension
  • tetany (hypocalcemia)
87
Q

What does CAUTION stand for?

A

Change in bowel or bladder habits

A sore that does not heal

Unusual bleeding or discharge from any body orifice

Thickening or a lump in the breast or elsewhere

Indigestion or difficulty swallowing

Obvious change in a wart or mole

Nagging cough or hoarseness

88
Q

What are the SE of Isoniazid and Rifampin?

A

nonviral hepatitis

89
Q

When can isolation precautions be discontinued in a patient with TB?

A

When 3 sputum cultures have returned negative.

90
Q

What are the 3 chambers for a chest tube?

A

collection, water seal, suction chamber

91
Q

What is the collection chamber of a chest tube?

A

air/fluid from pt

92
Q

What is the water seal chamber of a chest tube?

A

2 cm H2O that acts as a 1 way valve preventing air backflow to pt

93
Q

What is the suction chamber of a chest tube?

A

H2O vented to atmosphere; fill w/ 20 cm H2O hooked to LCS to cause GENTLE bubbling

  • Bubbling in water seal chamber occurs during exhalation, coughing, sneezing. There should be normal tidaling observed.
94
Q

What is the nursing responsibilities for a pt with a chest tube?

A
  • assess/palpate around dressing to assess for air leakage
  • prepare pt for frequent chest x-ray
  • never clamp unless ordered
  • keep collection unit BELOW level of lungs
  • do not empy collection chamber and mark level for I/O
95
Q

What do you do if there is accidental removal of a chest tube?

A

Immediately apply occlusive dressing and if drainage tube become disconnected from chest tube, stick in sterile H2O or per agency policy

96
Q

What are the nursing responsibilities in a planned removal of a chest tube?

A
  • offer pain med to pt 30-60 min prior
  • suture removal kit for MD
  • pt is instructed to take break
  • exhale
  • hold breath and do valsalva
  • tube is pulled and occlusive dressin plased then DSD
  • monitor VS and respiratory status frequently
97
Q

What is transudate?

A

clear, pale yellow fluid that collects when there are fluid shifts in the body

98
Q

What is exudate?

A

results from increased capillary permeability d/t inflammation that causes a cloudy fluid w/ cells and proteins d/t malignancy or disease like TB

99
Q

What is the purpose of traction?

A
  • to prevent or reduce pain & muslce spasm
  • to immobilize
  • to reduce fx
  • to expand joint space
100
Q

What are the nursing responsibilities for a patient in traction?

A
  • maintain proper body alignment
  • assess pressure points every 2 hours
  • traction is to be maintained continuously
  • keep weights off floor and hanging freely
  • make sure ropes are in pulleys correctly
101
Q

What is compartment syndrome?

A

reduction of blood supply that can occur from too tight a cast or nonexpansive muscle fascia

102
Q

What are the symptoms of compartment syndrome?

A
  • sweeling and increase pressure press on & compromise function of bloody vessels, nerves, tendons
  • decreased movement
  • severe pain
  • loss of sensation
  • vascular compromise
  • alteration in 6 P’s–pain, pallor, pulse, parasthesia, paralysis, pressure
103
Q

What may be assessed in a pt post-op hip surgery?

A

severe pain, lump in buttock, limb shortening, external rotation as may indicate prosthesis dislocation and notify surgeon immediately!

104
Q

What care is given to a pt post-op amputation?

A

Wound drainage system

  • sterile technique for dressing changes
  • wound drainage system to minimize swelling

Flexion contractures

  • most common w/ hip flexion
  • avoid by not sitting in chair > 1 hour or keeping residual limb elevated after the 1st post-op day
  • if able, have pt lie prone 30 inches 3-4x/day

Phantom limb sensation

  • pt still feels amputated limb
  • subsides ‘some’ but often chronic
  • opioids, TENS
  • tx varies depending on degree of tolerability by pt. MEDICATE! pain is real.

Wrapping residual limb

  • fosters shaping and molding for eventual prosthesis
  • taken off and reapplied several times per day
105
Q

What are the nursing responsibilities for a pt post-op amputation?

A
  • inspect residual limb daily for signs of irritation and s/sx of infection
  • d/c prosthesis if irritation develops
  • wash limb thoroughly; rinse and pat dry, keep exposed to air for 20 minutes after washing
  • no lotions/alcohols/powders/oils unless rx by MD
  • residual limb sock: change daily and wash in mild soap and lay flat to dry
  • pain management
  • ROM daily of upper/lower
  • do not elevate the residual limb on pillow
  • lay prone if possible 3-4x/day
106
Q

How is lyme disease prevented?

A
  • avoid walking through tall grass and low brush
  • mow grass
  • move woodpiles and bird feeders away form house
  • wear long pants or tightly woven nylon tights
  • tuck pants into boots or long socks, wear long sleeved shirt and closed shoes when hiking
  • check for ticks
  • spray insect repellent containing DEET
107
Q

How do you treat systemic erythamatous lupus?

A
  • NSAIDs
  • anti-malarials
  • immunosupressive drugs
  • corticosteroids
108
Q

What is the nursing responsibilities in a pt with lymphedema following a mastectomy?

A
  • teach nonrestrictive clothing
  • NO venipunctures/injections in affected arm
  • NO BP in affected arm
  • do not keep arm in dependent position
  • compression dressing/sleeves
  • massaging
  • compression bandages
  • intermittent pneumatic compression sleeve
  • ROM
  • elevation
109
Q

What needs to be assessed in a patient receiving radiation?

A

careful assessment of skin

110
Q

What are the symptoms of a tension headache?

A
  • no prodrome, no N/V
  • possible light and sound sensitivity
  • bilateral location
  • constant/dull/band-like
111
Q

What are the symptoms of a migraine?

A
  • recurring
  • uni-/bi- lateral
  • family hx increases risk
  • may/may not have precipitating events–stress, foods, smells, fatigue
  • often there is a prodrome
  • “steady/throbbing”
112
Q

What are common food triggers of a migraine?

A

chocolate, cheese, oranges, tomatoes, onions, MSG, aspartame, alcohol, vinegar, caffeine, nicotine, nitrites

113
Q

What are the symptoms of a cluster headache?

A
  • sharp/stabbing pain around eye
  • uniterlateral edema, tearing, ptosis
  • attacks occur in clusters: same time each day, same season of year. usually at night
114
Q

What is the treatment of a cluster headache?

A

100% O2 @ 6-8L as it causes casoconstriction & increases serotonin in CNS

115
Q

What is decorticate?

A

internal rotation & adduction of arms w/ flexion of elbows, wrists, and fingers

116
Q

What is decerebrate?

A

arms are stiffly extended and adducted and hyperpronated as well as hyperextension of the legs w/ plantar flexion of feet

117
Q

What information should the nurse be aware of when giving anti-seizure medicaitons?

A
  • Common SE: diplopia, drowsiness, sluggishness, gingival hyperplasia (Dilantin)
  • no abrupt withdrawal
  • weaning under MD guidance after have been seizure free for a period of time and have normal EEG
118
Q

What are the nursing responsibilities during a seizure?

A
  • initiate seizure precautions
  • airway–do not restrain and ease to floor if in chair
  • protect from injury (head), turn to side, nothing in mouth, loosen restrictive clothing
  • note start, progression, areas of body involved
  • timing
  • post-ictal: stay with pt, orient, O2 prn, suction prn, LOC
  • teach: meds, medic alert bracelet, avoid alcohol/fatigue, proper nutrition
119
Q

How is seizure activity charted?

A
  • precipitating factors: identify & eliminate/reduce
  • how long dideach phase last? what occurred in each phase?
  • which body part affected 1st progression
  • LOC, tongue biting, stiffening/jerking, total lack of muscle tone
  • dilated pupils, excessive slaivation, altered breathing, cyanosis, flushing, diaphoresis, incontinence, posturing (decorticate/decerebrate)
  • post-ictal state (VS, pupils, memory, etc.)
120
Q

How is trigeminal neuralgia treated?

A
  • antiseizure meds
  • analgesics & opioids
  • nerve blocks
  • surgical
  • glycerol rhizotomy
121
Q

How is trigeminal neuralgia managed?

A
  • avoid temperature extremes
  • do not neglect orla hygiene–soft toothbrush and assess oral cavity
  • soft diet w/ lukewarm foods
122
Q

What are the symptoms of neurogenic shock?

A
  • hypotension
  • bradycardia
  • usually w/ cervical or high thoracic injury
  • d/t loss of sympathetic NS innervation causing vasodilation
123
Q

Why is an ERCP used?

A
  • provides direct visualization of a body structure through a lighted fiberoptic instrument
  • pancreatic, hepatic, and common biliary ducts
  • evaluates juandice patients and pts w/ unexplained upper abdominal pain
  • can diagnosis obstruction and provide characteristics of the lesions visualized
124
Q

What should be assessed in a pt prior to receiving an abd CT scan?

A
  • allergy to iodine
  • claustrophobia
  • NPO for 4 hours
125
Q

What should be encouraged following an abd. CT scan?

A

drinking plenty of fluids

126
Q

How often should a pt have a colonoscopy?

A

every 10 years

127
Q

What medication should be withheld prior to receiving a pulmonary function test?

A

no inhaled bronchodialators for @ least 6 hours prior to procedure

128
Q

What should be done prior to a parencentesis?

A
  • explain the procedure
  • does not need to fast
  • written consent
  • urinate
  • labs
  • baseline VS w/ abd girth
  • positioning
129
Q

Who should accompany a pt to a knee arthroscopy?

A

someone over 18 who can drive them home and be with them for at least 24 hours

130
Q

What post-op care should be provided to a pt following a knee artheroplasty?

A
  • sterile dressing
  • wound should be clean and dry
  • ice and elevate for first 24-28 hours
  • pain and anti-nausea meds prn
131
Q

What should a MD be notified following a knee atheroplasty?

A
  • swelling, tingling, pain or numbness in the toes that is not relieved after elevation above hear for 1 hour
  • drainage that is foul smelling, green or yellow, or new presence of drainage
132
Q

What patient care should be given following a thoracentesis?

A
  • site is covered by bandage
  • check VS and s/sx of hypoxia, pneumothorax, hemotysis
  • check lung sounds
  • turn pt on unaffected side for 1 hour
  • normal activity can resume after 1 hour
  • encourage CDB
  • send specimens to lab
133
Q

What are some complications of a thoracentesis?

A
  • pneumothorax
  • intraplural bleeding
  • hemoptysis
  • reflex bradycardia
  • hypotension
  • pulmonary edema
  • emphysema d/t infection
134
Q

What is another name for a lung scan?

A

V/Q scan

135
Q

Why is a lung scan used?

A
  • dx of pulmonary embolism
  • identifies defects in blood perfusion
136
Q

What is done after a bronchoscopy?

A
  • NPO until gag reflex returns (about 2 hours)
  • check sputum for bleeding
  • signs of impared respirations or laryngospasm
  • post-bronchoscopy fever
  • warm saline gargles and/or lozenges for sore throat
137
Q

What are complications of a broncjoscopy?

A
  • fever
  • bronchospasm
  • hemorrhage
  • hypoxemia
  • pneumothorax
  • infection
  • laryngospasm
  • aspiration
  • cardiac arrest
138
Q

Why is a MRI better than a CT?

A
  • better contrast
  • no obscuring bone artifacts
  • shows blood flow
  • observe more planes
139
Q

What is done after an EEG?`

A

remove electrode paste with acetone and have pt shampoo hair

140
Q

What is the pt prep for a PET scan?

A
  • explain it
  • fast 4 hours before test
  • no alcohol, caffeine, or tobacco for 24 hrs before test
  • no sedatives
  • void before test
  • should not experience any discomfort
141
Q

How long does it take for BRCA 1/BRCA 2 results to available?

A

several weeks

142
Q

What are the limitations to a mammogram?

A

it is not a definitive diagnosis for breast cancer

143
Q

What pt care is given post-lumbar puncture?

A
  • hold dressing with adhesive at puncture site
  • prone position with pillow under abdomen
  • rehydrate with fluids using a straw
  • remain in reclining position for up to 12 hours–no elevation of head
144
Q

What should be taught to a pt prior to a cardiac stress test?

A
  • fast 2-4 hours before
  • avoid alcohol, tobacco, and caffeine
  • wear comfortable shoes and clothing
  • verbalize any symptoms
  • takes about 45 minutes
145
Q

What is done before a cardiac stress test?

A
  • informed consent
  • pretest EKG
  • baseline VS
  • apply and secure EKG electrodes
146
Q

What is done after a coronary angiogram?

A
  • assess circulation
  • check pulses, color, and sensation in extremity every 15 min for 1 hour
  • assess hypotension/HTN, abnormal HR, dysrhythmia, and signs of pulmonary emboli
147
Q

What should be done after a bone marrow biopsy?

A
  • apply pressure at puncture site
  • bandage/ice packs
  • assess for signs of shock, hemorrhage, & infection
  • bed rest 30-60 min after test
  • tenderness @ site for several days
  • mild analgesic
148
Q

Why is a venous doppler used?

A

evaluate pt’s circulation and blood flow, patency of veins, and looks for DVT, arteriosclerosis, venous insufficiency, and blood clots

149
Q

What is the purpose of a hyperbaric chamber in a pt with a wound that won’t heal?

A

It increases the amount of O2 that the blood can carry which then temporarily restores normal levels of blood gases and tissue funciton to promote healing and fight infection.

150
Q

How is a creatinine clearance test performed?

A

urine collected for 24 hours

151
Q

What needs to be taught in a pt receiving a creatinine clearance test?

A
  • little risk with blood draw
  • void and discard first urine specimen
  • show where to store urine
  • keep urine refrigerated
  • post the hours
  • no toilet paper
  • collect last specimen at end of 24 hours
  • take to lab
152
Q

What is important to assess for a pt before receiving a pyelography?

A

shellfish/idodine allergy

153
Q

What is contraindicated in a pt receiving a pyleography?

A
  • shellfish allergies
  • iodine allergies
  • renal insufficiencies
  • multiple myeloma
  • pregnancy
154
Q

What is an oral glucose tolerance test?

A

measure the body’s ability to use glucose, the body’s main source of energy

155
Q

When is OGTT used?

A

to dx gestational diabetes, prediabetes, and diabetes

156
Q

What pre-op care is given to a patient for an esophagogastroduodenoscopy?

A
  • explain procedure
  • NPO for 8 hours
  • may be mildly uncomfortable
  • throat is anesthetized to depress gag reflex
  • pt sedated during procedure
  • will not speak during test
157
Q

What is the urea breath test?

A

used to detect H. pylori and if the bacteria is present, urea is converted to CO2 which is delivered from the stomach to lung and then exhaled

158
Q

What are the side effects of a barium enema?

A
  • white stools
  • may cause constipation –> increase fluids
159
Q

What is the care given post-myelogram?

A
  • encourage fluid intake
  • voids within 8 hours post procedure
  • administer meds as prescribed
  • remain lying for hours after with HOB elevated
  • resume diet if there is no N/V
160
Q

What are the benefits of peak flow monitoring?

A
  • helps determine what makes asthma worse or better
  • whether treatment is working
  • when to add/stop medications
161
Q

What lab test/s would the nurse anticipate being drawn on a pt scheduled for a liver biopsy?

A
  • PT/INR
  • aPTT
162
Q

What is the normal RBC range?

A

M: 4.2-5.4 x 106/uL

F: 3.6-5.0 x 106/uL

163
Q

What is the normal Hct?

A

M: 40-50%

F: 37-47%

164
Q

What is the normal Hb?

A

M: 14.0-16.5 g/dL

F: 12.0-15.0 g/dL

165
Q

What is the normal platelet count?

A

150-400 x 106/uL

166
Q

What is the normal WBC count?

A

4.8-10.8 x 106/uL

167
Q

What is the normal bicarbonate?

A

24-31 mEq/L

168
Q

What is the normal calcium level?

A

8.5-10.5 mg/dL

169
Q

What is the normal chloride level?

A

98-106 mEq/L

170
Q

What is the normal magnesium level?

A

1.3-2.1 mg/dL

171
Q

What is the normal potassium level?

A

3.5-5.0 mEq/L

172
Q

What is the normal sodium level?

A

135-145 mEq/L

Spring 2015 Final Exams (3 decks)

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