NSG 233 EXAMS STUDY GUIDE
Exam 1
1) Fluid Management of hypovolemic Shock: lactated ringers
2) ED stabilize unconscious patient: jaw-thrust maneuver, 2 large bore IV and
oxygen.
3) Assessing wounds: make sure they had tetanus vaccination.
4) Triage patients: blue cant survive, black are already dead, green, yellow and
red may survive.
5) Crush injuries actions SATA question:
a. PLACE 2 LARGE-BORE 14-16 GAG FOR AGRESSIVE FLUID
b. TRANSFUSION OF O-NEG BLOOD
c. PROPER CERVICAL ALIGNMENT
d. 100 OXYGEN NON-REBREATHER
6) Positive inotropes are epinephrine, isoproterenol and dopamine. Negative
are diltiazem and metoprolol. Both improve the contractility of the heart.
7) Severe hypothermia put you at risk for bradycardia, ventricular fibrillation,
hypotension and asystole, so the nurse must monitor cardiac telemetry for
these dysrhythmias. A client with hyperthermia is at risk for rhabdomyolysis
and muscle cramps.
8) Tetanus prophylaxis is indicated for cases of severe frostbite, human bite
wounds, and other wounds, such as those sustained while gardening.
9) ED triaging: Priority is A woman of childbearing age who reports severe
pelvic and/or abdominal pain for several hours might be experiencing
ectopic pregnancy. Fracture, vomiting t3x in 6h and superficial burn are not
life threatening.
10)
Acute respiratory heart failure: priority is to treat underlying cause by
restoring adequate gas exchange in the lung.
11)
Left femur facture complication is fat emboli which may be fatal.
Clinical manifestations include cyanosis, dyspnea, tachycardia, chest pain,
tachypnea, apprehension, restlessness, confusion, petechiae, and
decreased PaO2.
12)
Emergency Surgery: risk for aspiration, auscultate lungs.
13)
The client having a laparoscopic choley can shower 24 to 48 hours
after the procedure and is usually discharged if there are no complications
the same day or day after the procedure
14)
Frostbite on the feet: Rewarming with water that is temperature
controlled between 98.6- and 104-degrees Fahrenheit. The client’s feet
should be elevated following rewarming to minimize edema. Rewarming of
frostbitten extremities is extremely painful, so intravenous analgesia is
indicated.
15)
Crush injuries: never insert an indwelling catheter for a client with
blood present in the urinary meatus because bleeding is a sign of tissue
trauma and placement of a catheter might cause further trauma.
16)
Unconscious patient is at risk for aspiration: insert nasogastric tube
to suction gastric contents (gastric decompression).
17)
Type 1 diabetic clients should be taught to avoid exercise when blood
glucose levels exceed 250 mg/dL and have ketosis in urine.
18)
closed lower extremity fracture that has just been realigned and
splinted by the physician. First assessment: palpate for a dorsalis pedis
pulse to assess arterial circulation.
19)
Assessing flail chest: On inspiration, the rib sections will pull inward
and then sections will bulge out on expiration. The mediastinal structures
will shift to the unaffected side with inspiration, and shift towards the
affected side on expiration.
20)
Drugs for pulmonary congestion and reports feelings of anxiety are
diuretic like furosemide and an anti-anxiety medication like lorazepam.
21)
Crush injuries assessment: subcutaneous emphysema is air that has
become trapped under the skin. It may be noted upon inspection or
palpation of the chest or neck after trauma that results in damage to the
larynx and/or trachea as air leaks from these structures.
22)
Care of patient with violent behavior SATA:
a. AVOID WORKING ALONE
b. AVOID BEING PHYSICALLY TRAPPED
c. MAKING ONESELF AWARE OF A STAFF LOUNGE.
23)
Prophylaxis treatment of stress ulcer: mucosal-protecting medication
like sucralfate or misoprostol and a PPI or antiulcer medication like
pantoprazole. Ranitidine, famotidine, and cimetidine are all H2 blockers
used to treat an actual ulcer, not for prophylaxis.
24)
Sleep disturbance: benzo like temazepam
25)
IPV assessment: Do you feel safe at home?
26)
Gallbladder disease diet: low fat diet, avoid fried foods.
27)
ED client who has choked on a piece of food and is unconscious.
Can’t intubate, suction or do abdominal thrust. Next thing is to insert
tracheotomy.
28)
NPH insulin peaks between 4 and 12 hours after administration
29)
Alert and having an acute asthma attack: administer bronchodilator
like albuterol and a corticosteroid to reduce inflammation like
methylprednisolone.
30)
Anthrax is effectively treated with antibiotics.
31)
Asymmetric chest wall movement is a sign of flail chest: assessment
is to palpate for thoracic crepitus
32)
Education: insulin pens are a great alternative for client’s with poor
vision because the client can hear the clicks of the pen as the dose is
selected. The dose is also much easier to see than the insulin syringe.
Insulin pumps use rapid-acting insulin. Fast acting insulins should be
injected into faster-absorbing sites. Potential challenges of insulin pumps is
the risk of infection at insertion site.
33)
Hypothermia interventions: alcohol consumption increases one’s risk
for hypothermia because it alters the body’s defenses against hypothermia.
34)
Nonfatal drowning: first action is to administer oxygen/airway
35)
A client who has ingested an excessive dose of aspirin (salicylic acid)
may develop severe acidosis. Hemodialysis can help to correct this
imbalance. Activated charcoal is used for several different types of
poisoning. It binds some harmful substances so they may be eliminated by
the gastrointestinal tract instead of being absorbed. However, activated
charcoal does not bind ethanol and would therefore not be helpful for a
client who has ethanol poisoning. Gastric lavage is an appropriate
treatment for a client with NSAID overdose. However, the nurse must
elevate the client’s head or place the client on the side during gastric lavage
to prevent aspiration. A cathartic agent is a medication that stimulates
gastrointestinal mobility and increases elimination. A cathartic agent may
be used to treat bleach poisoning. However, multiple doses must be
avoided to prevent potentially fatal electrolyte abnormalities.
36)
Heat exhaustion actions to lower core temperature SATA:
a. immerse the client in a cool water bath, not an ice bath to
prevent shivering
b. Covering the client with wet sheets causes evaporative
cooling
c. Positioning a fan so it is blowing on the client.
d. Ice packs applied to the client’s groin and axillae help to
steadily lower core temperature as well.
e. Having the client drink water would not be appropriate
since the client with heatstroke has altered mental status.
37)
Triaging in a mass casualty accident: clients’ physiologic stability ie.
whether the client is dying or has injuries that make death likely if not
addressed immediately. Resource utilization, ie. what kind of diagnostic
testing and personnel is required, is also weighed. Clients are not placed in
triage categories according to religion, age, or insurance status.
38)
Antivenom administration in ED:
a. remove a tick, the nurse should use tweezers to grasp the tick and
pull the tick’s body up and away from the skin with a steady
motion.
b. Tweezers should not be used to remove a bee stinger from a
client’s arm because tweezers might squeeze the stinger and
release more venom. Instead, bee stingers should be removed by
using a fingernail, knife, or needle in a scraping motion.
c. Rabies is not transmitted via human bite; it is transmitted via
animal bite. Therefore, rabies post-exposure prophylaxis is not
indicated for a client who was bitten by a person. Rabies postexposure prophylaxis is administered via intramuscular injection,
not through a peripheral venous access device.
39)
Tension pneumothorax is a priority in ED: assess for deviated
trachea.
40)
A simple or spontaneous pneumothorax will cause diminished breath
sounds, increased respiratory rate, chest pain, and dyspnea.
41)
Neurovascular assessment is always a priority assessment in hip
fracture.
42)
Lyme disease is caused by a tick bite, and ticks are prevalent in
wooded areas. Symptoms are flu-like symptoms and an erythematous
lesion on the flank.
43)
Priority in mass casualty drill.
a. The client is showing signs of decreased perfusion but is treatable
and if not treated immediately would have a life-threatening
complication.
b. The client with the laceration requires pressure on the laceration
to stop the active bleeding and is neurologically intact so this
client is not in immediate life-threatening danger.
c. The client with a traumatic amputation and cyanotic, indicating
that the client is not breathing, and would be considered not likely
to survive even with immediate interventions.
d. The client who is pregnant and crying does not display any signs
or symptoms of injury and does not require any immediate
intervention.
44)
Complications related to a chest trauma after a fall SATA: hypoxemia
from disruption of the airway; injury to the lung parenchyma, rib cage, and
respiratory musculature; massive hemorrhage; collapsed lung;
pneumothorax; hypovolemia from massive fluid loss from the great vessels,
cardiac rupture, or hemothorax; or cardiac failure from cardiac tamponade,
cardiac contusion, or increased intrathoracic pressure.
45)
Wound from human bite orders: The nurse should clarify the order
for rabies immune globulin because rabies is transmitted via saliva from the
bite of an infected animal, not from a human bite.
46)
Treatment of suspected Intimate Partner violence SATA:
a. The nurse should report the findings to the charge nurse
b. The nurse should attempt to interview the client alone
c. The nurse can provide information to the client about legal rights
and a safe house or escape plan.
d. Never ask the spouse if he caused the injuries or confront him.
e. The nurse cannot have the police arrest the spouse.
47)
Activated charcoal is administered through a nasogastric tube for
poisoning.
48)
It is appropriate to insert a urinary catheter in a client with
hyperthermia in order for the nurse to monitor the urine carefully for color
(tea-colored?), amount, pH, and myoglobin.