QB 9 Flashcards
Obtaining informed consent is the responsibility of the health care provider, while the nurse’s role is to witness the client’s signature and ability to give consent.
TRUE OR FALSE
TRUE
Providing information about the procedure and obtaining a client’s informed consent is done by the health care provider who is doing the procedure. It does not fall within the nurse’s scope of practice.
Mentally ill clients do retain the right to refuse treatment until a court has determined that they are incompetent.
TRUE OR FALSE
TRUE
What does an emancipated minor mean and can they sign their own informed consents ?
This is a minor who has been given the right to make independent decisions prior to attaining the legal age of doing so.
Emancipated minors may sign their own informed consents.
Being apart from family is fear provoking, stressful, and produces anxiety for the school-aged child. Clinical manifestations associated with anxiety include ________________________________
agitation, restlessness, increased muscle tension, gastric symptoms, headache, nausea, and the inability to focus.
This is a serious complication that usually results from long bone fractures or fracture repair in which fat globules are released from the yellow bone marrow into the bloodstream within 12 to 48 hours after an injury. These may occlude major blood vessels.
Fat Embolism Syndrome
Petechiae are seen on the chest 50% to 60% of the time
When a large bone, such as the femur, is fractured, the risk for complications is high because the yellow bone marrow lies within the femur. Should this bone fracture, the bone marrow can be released into the bloodstream and develop into fat emboli.
What are manifestations of fat embolism syndrome ?
Fat embolism syndrome (FES) occurs when embolic fat macroglobules pass into the small vessels of the lung and other sites, producing endothelial damage and resulting in respiratory failure, cerebral dysfunction, and a petechial rash. FES is most commonly associated with trauma, long bone and pelvic fractures, and orthopedic surgery.
Clinical manifestations include pulmonary insufficiency, neurologic symptoms, anemia and thrombocytopenia, tachypnea, dyspnea, and tachycardia.
In addition, adult respiratory distress syndrome, irritability, confusion, and restlessness may progress to delirium or coma can occur. Petechiae appears on the trunk of the body, face, and in the axillary folds. The most effective approach to treatment of FES is prevention.
What is Disulfiram and what do we need to remember about it ?
It is a drug used to maintain sobriety.
Intake of any form of alcohol with disulfiram will cause a severe reaction, including flushed skin, pounding headache, tachycardia, chest pain, shortness of breath, blurred vision, and hypotension.
Disulfiram, an alcohol deterrent that is prescribed to help clients abstain from alcohol. All forms of alcohol ingestion, direct and indirect, should be avoided for this client. Serious adverse effects such as chest pain may occur if the client takes an unapproved OTC medication and the prescribed medication.
What symptoms would you see in fluid volume overload ?
elevated BP, rapid bounding pulses, dependent edema, moist crackles on auscultation, headache, pale and cool skin, rapid weight gain, dyspnea, jugular vein distention. urine specific gravity less than 1.01; increased central venous pressure; and decreased hemoglobin, hematocrit, and blood urea nitrogen because of hemodilution.
What symptoms would you see with fluid volume deficit?
increased, thready pulse, a decreased BP, postural hypotension, increased rate and depth of respirations, and poor skin turgor.
Decreased urinary output, thirst, and changes in sensorium.
________________–fluids such as dextrose 5% can cause volume overload and pulmonary edema more quickly than other IV fluids
What are risk factors that can predispose the client to fluid volume overload?
hypertonic
Risk factors for the development of fluid volume overload include history of congestive heart failure, renal failure, liver cirrhosis, and excessive ingestion of sodium. Administer a diuretic and restrict fluids as prescribed. Teach the client about a sodium-restricted diet. Obtain daily weights. Monitor breath sounds and vital signs. Elevate the head of bed if the client becomes dyspneic.
The nurse should encourage the client to engage in activities that dissipate anxiety and increase self-esteem.
TRUE OR FALSE
ABSOLUTELY TRUE
what to remember about Cocaine ?
what kind of drug is it ?
Cocaine is a short acting, highly addictive stimulant that produces an intense and rapid euphoric feeling. Common adverse effects include weight loss, risk for injury due to impaired judgment, fatigue, disturbed sleep cycle and patterns, irritability, and restlessness. Treatment may address symptoms caused by its use and withdrawal, such as hypertension, nausea and vomiting, dysphoria, agitation, and suicidal ideation. Involvement in physical activity and social activities may reduce the withdrawal symptoms and associated cravings.
The nurse in the outpatient clinic receives a phone call from an adolescent who states, “There is no reason to live. I am going to shoot myself.” Which response by the nurse is best?
- “Do you have access to a gun?”
- “Why do you want to shoot yourself?”
- “Think about how this will affect your family.”
- “Share with me what happened to you today.”
1) CORRECT – The nurse should first ensure the client’s safety by determining if the client has a plan and the means to carry out the plan. (Unless it is about self harm, you normally eliminate a yes/no question in a therapeutic response question.)
2) INCORRECT – The nurse should avoid “why” questions as they can be interpreted as judgmental. The “why” is not relevant at this time. It is more important to determine if the client has the means to carry out the suicide.
3) INCORRECT – This places the focus on the family as opposed to the client. The priority is the client’s safety.
4) INCORRECT – The nurse should offer the client the security that the nurse is concerned about the client’s safety. This may be a relevant assessment, but first the nurse must ensure the client’s safety.
Think Like a Nurse: Clinical Decision-Making
Alzheimer disease is a progressive neurological disorder that results in functional and cognitive declines. Appropriate interventions include:
Determining the client’s ability to perform activities of daily living, social and physical support, work history, cognitive ability, memory, communication, and behavior changes.
Performing a health assessment and determining height and weight, orientation, executive functioning, and mental status.
Orienting frequently and providing verbal, written, and visual cues.
Implementing fall and safety precautions.
Maintaining consistent caregivers and routine.
Referring client, family or caregiver to social and support programs.
What should we remember about gastric cancer ?
one risk factor is the a history of gastric ulcers resulting from the bacteria H. pylorie
Early symptoms of gastric cancer tend to be vague, such as pain relieved by antacids. As the tumor grows, a client may experience a loss of appetite, indigestion, nausea and vomiting, a bloated feeling, weight loss, and pain just above the umbilicus
Most gastric cancers are adenocarcinomas, which can occur anywhere in the stomach. The cancer often spreads to the lymph nodes and metastasizes to the liver, pancreas, esophagus, and duodenum.
What are manifestations of pernicious anemia ?
It is caused by impaired uptake of Vitamin B12, due to a lack of intrinsic factor produced by the stomach lining.
Clinical manifestations include lethargy, tingling and numbness in hands and feet, constipation or diarrhea, and a bright red, smooth tongue. Numbness, tingling, weakness, lack of coordination, and clumsiness can all occur. Both sides of the body are usually affected, and the legs are typically more affected than the arms. A severe deficiency can result in more serious neurological symptoms, including severe weakness, spasms, paraplegia, impaired memory, personality changes, and fecal and urinary incontinence.
Having a vitamin B12 deficiency, particularly, has been shown to impair neurological development in infants breastfed by vegetarian or vegan mothers.
Generally, the efficacy of combined oral contraceptives is increased in clients taking enzyme-inducing anti-epileptic drugs, such as, phenytoin, phenobarbital, and carbamazepine
TRUE OR FALSE .
FALSE
The efficacy is diminished
The client and partner should be informed about using other methods of birth control, such as a condom, when taking these medications.
What happens in sickle cell disease ?
A severe hereditary form of anemia in which a mutated form of hemoglobin distorts the red blood cells into a crescent shape at low oxygen levels. It is most common among those of African descent.
This disease causes red blood cells to assume a sickle shape, which alters oxygen-carrying capacity and enhances the ability of the cells to become trapped in capillaries, causing pain. The sickling of the red blood cells enhances the lysis of circulating red blood cells. In response to red blood cell destruction, the body accelerates the process of creating new replacement cells, which are released into the bloodstream before maturity. Because of the disease process, the laboratory result most likely to validate the disease would be a high reticulocyte count.
Content Refresher
In sickle cell disease, the hemoglobin is shaped differently. Sickle hemoglobin has a curved shape (like a sickle) rather than the flat-disc shape of normal hemoglobin. The shape alters the properties of the cells, causing them to become more rigid and less flexible. As a result of this, the cells are more likely to hemolyze and cause blockages in the blood vessels, disrupting the flow of blood. When caring for a client diagnosed with sickle cell disease, the nurse needs to assess the client for anemia, dark urine, jaundice, swelling of hands and feet, stunted growth, and stroke. The client may report fatigue and painful hands and feet. With sickle cell disease, the nurse should promote optimal oxygenation, adequate rest periods, hydration, nutrition, and pain management.
The nurse overhears the supervisor reprimand the charge nurse for not discussing feelings with a client. Shortly after, a client asks the charge nurse for an extra blanket. The charge nurse angrily responds, “Get it yourself!” The nurse recognizes the charge nurse is displaying which defense mechanism?
- Compensation.
- Displacement.
- Conversion.
- Projection.
1) INCORRECT - Compensation is an attempt to overcome real or imagined shortcomings.
2) CORRECT— The charge nurse is displacing feelings of anger at the supervisor onto the client who is less threatening.
3) INCORRECT - Anxiety is repressed and converted into physical symptoms in conversion syndrome.
4) INCORRECT - Projection is the act of attributing one’s feelings, impulses, thoughts, or wishes to others.
Displacement is the unconscious transfer of an intense emotion from its original object to another one.
What to remember about the herbal supplement black cohosh ?
It may increase the hypotensive effect of antihypertensives
When used in the management of menopausal symptoms, black cohosh may cause hypotension when used in combination with antihypertensive drugs.
Criteria for hypertension
Criteria for Stage 1 hypertension include systolic blood pressure (SBP) of 130 to 139 mm Hg or diastolic blood pressure (DBP) of 80 to 89 mm Hg. Stage 2 hypertension criteria include SBP of 140 mm Hg or greater or DBP of 90 mm Hg or greater. Blood pressure is considered elevated if SBP is between 120 and 129 mm Hg and DBP less than 80 mm Hg.
What to remember about Lyme disease ……………….
what test is available for Lyme Disease
The test should be run in 4 to 6 weeks after the tick bite occurs, regardless of symptoms. It takes 1 to 2 months after the tick bites to get a reliable result because of the antibody formation process.
Lyme disease is a condition caused by the bite of a tick infected with Borrelia burgdorferi. When ticks bite humans, they transmit the bacterium, which can result in a chronic inflammatory process and multisystem disease. Assess the client’s skin around the area of the tick bite, observing for the presence of a bull’s-eye rash. Question the client about the presence of a headache, neck stiffness, muscle pain, fever, and chills. Educate the client about prevention: avoid tick infested areas, use insect repellent, wear protective clothing in high-risk areas, and treat pets. If a tick is found, remove it carefully with tweezers, wash the area with soap and water, and apply antiseptic. If flu-like symptoms or a bull’s-eye rash develops, notify the health care provider.
The nurse is aware that clients with a previous history of transfusion reactions are at higher risk for adverse transfusion reactions.
TRUE OR FALSE
TRUE
What is a transfusion-related acute lung injury (TRALI) ?
The reaction of anti-leukocyte antibodies between donor and recipient leads to TRALI. Leukocyte-reduced RBCs reduces the risk of TRALI recurrence.
Transfusion-related acute lung injury (TRALI), the leading cause of transfusion-related death, arises during or within 6 hours of a transfusion. The nurse observes for signs and symptoms of TRALI, including fever, chills, hypotension, tachypnea, frothy sputum, dyspnea, hypoxia, respiratory failure, and noncardiogenic pulmonary edema. Obtain blood samples for arterial blood gas analysis and human leukocyte antigen (HLA) or antileukocyte antibodies, as ordered. Obtain an emergent chest x-ray, administer supplemental oxygen, and administer corticosteroids, as prescribed. Diuretics will provide no benefit for the client with TRALI.
What is leukoreduction in relevance to blood transfusions ?
What can it help prevent ?
Leukoreduction is a process in which the white blood cells are intentionally reduced in red blood cells (RBCs) to diminish the risk of adverse reactions. The nurse knows this is typically requested when transfusing a client with a known history of transfusion reaction.
fluid in the lungs decreases the ability of the lungs to exchange oxygen and carbon dioxide.
TRUE OR FALSE
TRUE
extra fluid accumulating in the lungs can restrict oxygenation and hinder tissue perfusion. This can be seen in heart failure.
What to remember about dissassociative disorders ?
Dissociative disorders are characterized by either a sudden or gradual disruption in the integrative functions of identity, memory, or consciousness. The disruption may be transient or become a well established pattern. The development of a dissociative disorder is often associated with exposure to a traumatic event.
Dissociative disorder involves a lack of connection among cognitive processes like identity and memory. The client might report memory loss, co-morbid processes such as depression, or a separation from emotions. Sometimes this disorder is the result of post-traumatic stress disorder or other mental conditions. Medications and therapies can provide relief and prevent adverse outcomes like suicide.
What stage of psychosocial development is the toddler in ?
Psychosocial development theory states that a toddler must master autonomy or experience shame and doubt. Psychosocial development is fostered for the toddler by providing:
opportunities for socialization.
emotional support.
positive reinforcement for good behavior.
two selections when a choice needs to be made.
Other methods of fostering the toddlers psychosocial development include the use of distraction when unsafe or unwanted behaviors are exhibited; keeping routines simple and consistent; setting reasonable limits; giving simple rationales; and following through on discipline. Advise parents to maintain open communication with other caregivers so that consistency in child rearing can be maintained.
