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nursing theory test deck Flashcards

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1
Q

Common Complications of SLE (9 points)

A
  1. Chest pain when taking a deep breath
  2. Fatigue
  3. Fever with no other cause
  4. General discomfort
  5. Hair loss
  6. Mouth sores
  7. Sensitivity to sunlight
  8. Butterfly rash
  9. Swollen lymph nodes
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2
Q

Preventing exacerbations of SLE: (5 Preventions) and (4 early symptoms)

A

Preventing SLE:

  1. Decreased Sun Exposure
  2. Adaquate Sleep
  3. Healthy Diet
  4. Exercise
  5. Decreased Stress

Early Symptoms of SLE:

  1. Increased Fatigue
  2. Fever
  3. Rash
  4. Headache
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3
Q

Can SLE patients get vaccinations?

A

Yes SLE pt’s can.

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4
Q

Enzyme immunoassay.

A

After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done.

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5
Q

Diagnosis of AIDS.(3 points)

A
  1. HIV 3 years ago
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6
Q

**Counseling mother infected with HIV re: care of infant **

A

Although infants of HIV-infected mothers always test positive for HIV antibodies, most infants are not infected with the virus.

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7
Q

Benefits of health promotion for clients with HIV

A

Improve the patient’s immune function,

Nursing Question: “Do you use any injectable drugs or have sexual activity with multiple partners?

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8
Q

Risks for infection with HIV (4 points)

A
  1. Workplace transmission: a needlestick with a needle and syringe used to draw blood.
  2. Community teaching most common method of transmission: sexual contact with an infected partner.
  3. Individual that uses drugs prevention:participate in a needle-exchange program.
  4. Developed Mycobacterium avium complex infection-Nursing intervention is maintain intact perineal skin.
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9
Q

What is assessed for in terms of determining the type of therapy for a client with HIV?

A

treatment is individualized based on CD4+ counts, the amount of virus in the blood, and the patient’s wishes.

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10
Q

Explain antiretroviral therapy

A

Medications: work in various ways to decrease viral replication in the blood. A patient who has been HIV positive for 5 years and has cytomegalovirus (CMV) retinitis, would need more teaching of what ART therapy is since, client who likely get it are in there early stage of HIV. Fat redistribution to the trunk, with wasting of the arms, legs, and face=a change in antiroviral therapy. To evaluate the effectiveness of ART viral load testing is done.

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11
Q

**What are the Early manifestations of HIV **

A

Persistent generalized lymphadenopathy is common in the early stage of chronic infection. Nursing action=Palpate the regional lymph nodes

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12
Q

Types of Diabetes: Type one & type two

A

Type one: Absolute insulin deficiency. Most common in children.Symptoms generally arise suddenly, e.g. weight loss.

Type two: Insulin resistance/impaired insulin secretion. Onset is generally around 35 years. Symptoms occur insidously e.g. weight gain.

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13
Q

Explaining family history and the risks of developing diabetes. (5 points)

A
  1. Genetic links, if the parents or other family members have diabetes
  2. Mother had gestation diabetes.
  3. A person diet, what they eat
  4. Exercise, how much a person is active
  5. There Fincial situation-economic factors
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14
Q

Manifestations of diabetes inspidous

A

The patient is confused and lethargic

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15
Q

Particular tests for assessing diabetes 6 points

A
  1. Monitor blood glucose
  2. A1c test
  3. Non-fasting lipid profile
  4. Urinalysis
  5. Eye screening
  6. Examine Legs for amytrophy, sensation, and reflexe
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16
Q

**What is the impact that exercise has on diabetic patients? (4 points) **

A
  1. improves insulin resistance
  2. Improves lipid profile
  3. lowers blood pressure
  4. protects against the development of type 2 diabetes
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17
Q

Explain why a diabetics nutrional needs are important?

A
  1. Eating Healthy=prevention/control of diabetes
  2. Eating right=weight loss quicker than exercising
  3. Diet=high nutrients, low fat, and moderate calories, carbohydrate intake monitored.
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18
Q

What is intensive insulin therapy?** **

A

Designed to control blood sugar levels. Requires close monitoring of blood sugar levels and frequent doses of insulin.

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19
Q

Impact of corticosteroids on diabetes

A

Corticosteriods make it difficult to control glucose levels.

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20
Q

**Teaching Capillary blood glucose monitoring (Six Steps) **

A
  1. Washes hands
  2. If difficult to get blood, warm hands or put arm down for 2min. New lancet each time.
  3. Use side of finger pad as there are less nerve endings.
  4. Alternative site not recommended after meal and pts with erratic blood glucose control.
  5. Puncture only deep enough to obtain large drop of blood. (Deep punctures cause bruising and pain)
  6. Lancets disposed in sharps container.
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21
Q

Priority treatment for DKA

A

Restoration of extraceullar fluid volume through intravenous administration.

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22
Q

**Initial Treatment for HHNC (TWO POINTS) **

A
  1. Fluids and minerals through an IV—to replace substances you lost and improve your urine output.
  2. Insulin through an IV—to help control your blood glucose levels.
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23
Q

** Initial action in response to hypoglycemia **

A

Initial action=15-20 grams of carbohydrates

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24
Q

**Potential manifestations following glucagon administration (4 marks) **

A

If any of the following occur inform a doctor/nurse immediately, and inform your pharmasit if other manifestations present themselves.

  1. Nausea
  2. Vomiting
  3. Low blood sugar
  4. Allergies e.g. skin rash, breathing problems.
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25
Q

**A Manifestations of acromegaly **

A

“Do you have to wear larger shoes now?”

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26
Q

Teaching re: SIADH

A

“I need to shop for foods that are low in sodium and avoid adding salt to foods.”

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27
Q

** Health teaching regarding antithyroid medications for clients with Graves’ disease **

A
  1. Antithyroid medications may take several weeks to take effect.
  2. Reason:Normalize metabolism and decrease the size and vascularity of the gland.
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28
Q

**Complications following thyroidectomy **

A

The patient has increasing swelling of the neck.

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29
Q

Nursing intervention for corneal ulceration of client with Graves’ (1 point)

A

elevate the head of the patient’s bed to reduce periorbital fluid.

30
Q

** Health teaching re: management of newly diagnosed hypothyroidism **

A

provide written handouts of all instructions for continued reference as the patient improves.

31
Q

**Manifestations of Cushings’ syndrome **

A

purplish red streaks on the abdomen.

32
Q

Adrenal insufficiency desired outcome

A

decreasing serum potassium

33
Q

** Difference between benign and malignant tumours**

A

The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors never metastasize.

34
Q

DEFINTION: Cell differentiation

A

Your tumor cells look more like immature fetal cells than normal bowel cells.”

35
Q

Explain: Complete carcinogen

A
  1. A chemical that is able to induce cancer without inducing an agent that promotes tumor growth or development
36
Q

**What are the Benefits of promoting healthy lifestyle changes on cancer development **

A

dietary fat and obesity promote growth of many types of cancer, decreasing these risks decreases chances of getting cancer. Strawberry yogurt.

37
Q

Family history of cancer impact on screening

A

have the patient ask the doctor about specific tests for colon cancer

38
Q

**Use of needle biopsy (one point) **

A
  1. The biospy will help the doctor decide what treatment to use for my enlarged prostate.
39
Q

Debulking (cytoreductive surgery) procedure

A

Reduction of tumour bruden to enhance adjuvant therapy.

40
Q

**Nursing measures in preventing complications from external beam radiation: **

A

perform perianal care with sitz baths and meticulous cleaning.

41
Q

** Nursing interventions for clients experiencing fatigue as a result of external radiation therapy **

A

establish a time to take a short walk every day.

42
Q

Nursing management of nausea and vomiting as a reaction to chemotherapy treatment

A

administer prescribed antiemetics 1 hour before the treatments

43
Q

Complications of vesicant IV chemotherapeutic agents

A

stop the infusion if swelling is observed at the site.

44
Q

**Nutrition for iron-deficient anemia: **

A

Legumes and dried fruits are high in iron and low in fat and cholesterol therefore they would be given.

45
Q

**Pancytopenic period from transplanted marrow (one point) **

A

hospitalization will be required for several weeks after the hematopoietic stem cell transplant

46
Q

** End-of-life Breathing patterns (3 points) **

A
  1. Respirations vary from slow, rapid, shallow, and irregular.
  2. Breathe sounds are wet, and noisy
  3. Cheyne-Stokes respirations= abnormal breathing pattern with alternating periods of apnea and deep rapid breathing, seen in near death clients.
47
Q

** Role of hospice (five points) **

A
  1. Compassion
  2. Concern
  3. Support
  4. Client and family needs are the focus.
  5. Acute pain management
48
Q

** Withdrawal behaviours nearing the end of life (6 POINTS) **

A
  1. Withdrawing from care.
  2. Withdrawing from loved ones.
  3. Feelings of detachment from physical world.
  4. Less desire to talk
  5. Less reponsive to voice, touch.
  6. May not awaken.
49
Q

**Normal assessment findings of body system functions near death (6 points) **

A

Integumentary:Cyanosis, wax like skin.
Respiratory:Congestion, Cheyne stokes signs.
Urinary:incontinence, no urine output.
GI System:BM, Nausea, distension.
Musculoskeletal system:Jaw sagging, loss of gag reflex, difficult to speak and move.
Sensory: decreased pain and sensation, hearing & touch last to go.
Cardiac: decreased heart rate, and BP, and weak pulse. Delayed drug absorption.

50
Q

**Role of cobalamin for pernicious anemia **

A

Pernicious anemia prevents the absorption of vitamin B12, and the patient requires injections or intranasal administration of cobalamin to get required B12 in there system.

51
Q

** Nursing Interventions of Hemolytic Anemmia **

A

Nursing care for patients with anemia should alternate periods of rest and activity to maintain patient mobility without causing undue fatigue.

52
Q

Health teaching regarding oral iron supplements

A

It is normal for the stools to appear black when a patient is taking iron.

53
Q

Collaborative problem for idiopathic aplastic anemia (hint: Pancytopenia is a medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets. )

A

Potential complication: hemorrhage

54
Q

**Crisis for sickle cell anemia **

A

Tissue hypoxia caused by small blood vessel occlusion.

55
Q

** Reason for jaundice in hemolytic anemia: (one point) **

A

Jaundice is caused by the elevation of bilirubin level associated with RBC hemolysis.

56
Q

**Highest priority nursing action during blood transfusion reaction (one point) **

A

Disconnect the transfusion and infuse normal saline.

57
Q

Injury concerns for client with immune thrombocytopenic purpura

A

Induced neutropenia and has a temperature of 100.8° F.

58
Q

**Collaborative care for sepsis-induced DIC **

A

Treatment of the acute sepsis is essential to resolving the DIC and will be the major focus of collaborative care. Treatment of the infectious process with IV antibiotics.

59
Q

Most common sources of infection for clients with neutropenia:

A

The earliest sign of infection in a neutropenic patient is an elevation in temperature. Check the temperature q4hr.

60
Q

**Post-operative intervention for rhinoplasty (five points) **

A
  1. After surgery, nasal packing may be inserted to apply pressure and prevent bleeding or septal hematoma formation.
  2. Nasal septal splints (small pieces of plastic or Silastic) may be inserted to help prevent scar tissue
    formation between the surgical site and lateral nasal wall.
    3.An external plastic splint is moulded to the new shape of the nose and placed on the nose.
    4.Adhesive-strip skin closures are placed to hold the skin against the septal cartilage.
    5.Typically, nasal packing is removed the day after surgery, and the splint is removed in 3 to 5 days.
61
Q

**Health teaching regarding management of allergic rhinitis (7 points) **

A

Avoid the following:

  1. house dust
  2. dust mites
  3. avoid allergens
  4. mold spores
  5. pollens
  6. pet allergies
  7. smoke
62
Q

**Concerns regarding decongestant sprays: (2 points) **

A
  1. The client using nasal inhalers needs careful instructions about proper use (Fig. 28–2).
  2. Nasal decongestant sprays can cause a rebound effect from prolonged use.
63
Q

**Priority clients to access influenza immunization (five points) **

A
  1. Older adults (65+)
  2. Young Children (23m-6yrs)
  3. Individuals with chronic conditions
  4. Pregnant women
  5. Health Care workers
64
Q

**Complications of influenza (four points) **

A
  1. Bronchitis
  2. Ear Infections
  3. Worstening=congestive heart failure
  4. Bacterial Chest infection causing intopnemonia.
65
Q

**Nasal packing complications (6 points) **

A
  1. Removal of the packing dislodges healing tissue and causes the nose to bleed again.
  2. Nasal packing can cause a lack of oxygen in those who have difficulty breathing through their mouths.
  3. Nasal packing can lead to a drop in the blood oxygen content and an increase in blood carbon dioxide levels causing respiratory and cardiac complications.
  4. Airway obstruction and asphyxiation can occur if the nasal packing slips back into the airway, particularly during sleep.
  5. Complications may occur if a pack compresses the Eustachian tube, causing ear problems.
  6. Uncommon Infections in the nose, sinus or middle ear after nasal packing insertion leading to septic shock.
66
Q

**Health teaching regarding nasal inhaler: (4 points) **

A
  1. Advise client of adverse reactions.
  2. Advise that use of some preparationsis contraindicated for clients with cardiovascular disease, hypertension, diabetes, glaucoma, prostate hyperplasia, hepatic and renal disease.
  3. Teach client that these drugs should not be used for more than 3 days or more than three to four times a day.
  4. Longer use increases risk of rebound vasodilatation, which can increase congestion.
67
Q

**Management of xerostomia (2 points) **

A
  1. Pilocarpine hydrochloride (Salagen) can be effective in increasing saliva production and should be started before the initiation of radiation therapy and continued for 90 days.
  2. Symptom relief can also be obtained by increasing fluid intake, chewing sugarless gum or sugarless candy,using nonalcoholic mouth rinses (baking soda or glycerin solutions),and using artificial saliva.
68
Q

Risk factors in the development of laryngeal cancer (4POINTS)

A
  1. Drinking alcohol
  2. Smoking
  3. HPV infection
  4. Family history.
69
Q

**Interventions for restoring communication following a total laryngectomy: (3 points) **

A
  1. Non-surgical restoration of speech following total laryngectomy consists of primarily two methods – electrolarynx and oesophageal speech
  2. Neck placement devices
  3. Intraoral placement devices.
70
Q

** Post-operative positioning of client for total laryngectomy and radical neck dissection (1 point) **

A

1.Elevate the head of the bed. The upright position promotes effective ventilation of the lungs, and reduces edema and swelling of the neck.

71
Q

**Health teaching regarding stoma care for client who has received a total laryngectomy (3 points) **

A
  1. Go to follow up appointments.
  2. Blood tests should be done to check thyroid function.
  3. Report any new symptoms after to doctor right away.

Nursing theory tests (1 decks)

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