ATI med surg
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1.
What is normal range for
cholesterol, HDL, LDL
Less than 200, above 40,
less than 130
2.
What is the desired INR range
for people taking warfarin
2.0-3.0
3.
What is an indicator of cardiac
tamponade
Blood pressure is 10 MM
HG or higher on expiration
then on inspiration
4.
Patients scheduled for a
coronary artery bypass graft
should not take
anticoagulants for at least
blank prior to the surgery to
prevent excessive bleeding
A week
A patient is admitted with a
diagnosis of
Bradydysrhythmia. What
assessment finding requires
immediate intervention?
The patient reports
weakness and fatigue
6.
Following insertion of a
permanent pacemaker, a
patient states they cannot get
rid of these hiccups. Why is
this potentially a problem?
Hiccups may indicate that
the pacemaker is
stimulating the chest wall
or diaphragm. This could
indicate a complication
such as lead wire
perforation
7.
Chapter 27
...
8.
What is the normal range for
creatine kinase? When are
elevated levels first detectable
after myocardial injury and
what is expected duration of
the elevated levels?
30 to 170 units/L, 4 to 6
hours, 3 days
9.
What is the normal range for
troponin T? When are elevated
levels first detectable after
myocardial injury and what is
expected duration of the
elevated levels?
Less than 0.2 ng/L, 3 to 5
hours, 14 to 21 days
10.
What is normal range for
troponin I? When are elevated
levels first detectable after
myocardial injury and what is
expected duration of the
elevated levels?
Less than 0.03, three
hours, 7 to 10 days
11.
What is normal range for
myoglobin? When are elevated
levels first detectable after
myocardial injury and what is
expected duration of the
elevated levels?
Less than 90 mcg/L, two
hours, 24 hours
5.
12.
While an echocardiogram is being
performed what side should the patient
lie on?
Left side and
remain still
13.
What are indications for an
echocardiogram
Cardiomyopathy
Heart failure
Angina
Myocardial
infarction
14.
What are indications for stress test
Dysrhythmias
HF
Angina
MI
15.
What are two medications that are
prescribed for pharmacological stress
test
Dobutamine
Adenosine
16.
What do you instruct the patient to do 2
to 4 hours before a stress test
Avoid tobacco,
alcohol and
caffeine
17.
Hemodynamic monitoring involves
special indwelling catheters that
provide information about blood
volume and perfusion, fluid status and
how well the heart is pumping. Arterial
lines are placed in the radial (most
common), brachial or femoral artery.
What should you Monitor for?
Monitor
circulation in the
limb with the
arterial line.
Such as capillary
refill,
temperature,
color. Arterial
lines are not
used for IV fluid
administration
18.
The pulmonary artery (PA) catheter is
inserted into a large vein (internal
jugular, femoral, subclavian, brachial)
and threaded through the right atria
and ventricles into a branch of the
pulmonary artery. PA catheters have
multiple lumens, ports and components
that allow for various hemodynamic
measurements, blood sampling and
Infusion of IV
fluids
19.
What are the
different lumens
used for?
20.
What is the
expected
reference range
for CVP (Central
venous pressure)
1 to 8 MM HG
21.
What is the
expected
reference range
for pulmonary
artery systolic
(PAS)
15 to 26
22.
What is the
expected range
for pulmonary
artery diastolic
(PAD)
5 to 15
23.
What is expected
range for
pulmonary artery
wedge pressure
(PAWP)?
4 to 12
24.
What is the
expected range
for cardiac
output
4 to 7 L/minute
25.
What is expected
range for mixed
venous oxygen
saturation
60% to 80%
26.
When should a
nurse anticipate
lower
hemodynamic
values?
In older patients especially if
dehydration is a complication
27.
What position
should the
patient be in with
hemodynamic
monitoring
Supine or Trendelenburg
28.
What are post
procedure
nursing
interventions for
hemodynamic
monitoring
1. Obtain chest x-ray to confirm catheter
placement
2. Continually monitor vitals
3. Compare NIBP to arterial blood
pressure
4. Observe and document waveforms.
Report changes in waveforms to the
provider
5. Document catheter placement each
shift and as needed
6. Place the patient in supine position
prior to recording hemodynamic values (
HOB can be elevated 15° to 30°)
29.
What are
complications of
hemodynamic
monitoring
30.
What are nursing
actions
preprocedure
before an
angiography
1. Patient is NPO for at least eight hours
before
2. Assess for iodine/shellfish allergy
3. Assess renal function
4. Teach the client that the affected leg
must remain straight after the
procedure
5. The other normal stuff like ensure
informed consent blah blah
31.
What are post
procedure
nursing
interventions for
an angiography
1. Assess vitals every 15 minutes for One
hour, every 30 minutes for one hour,
every hour for four hours and then
every four hours
2. Assess the site for bleeding and
hematoma with every vital sign check
3. Maintain bed rest for 4 to 6 hours after
the procedure
4. Monitor urine output and administer
IV fluids for hydration (contrast media
acts as an osmotic diuretic)
32.
How long do
patients receive
anticoagulation
therapy that have
stent placement
6 to 8 weeks
33.
What is cardiac
tamponade
Fluid accumulation in the pericardial sac
34.
What are
manifestations of
cardiac
tamponade
hypotension
JVD
Muffled heart sounds
Paradoxical pulse
35.
What are nursing
actions for cardiac
tamponade
1. Notify the provider immediately
2. Administer IV fluids to combat
hypotension as prescribed
3. Obtain a chest x-ray or
echocardiogram to confirm diagnosis
4. Prepare the client for
pericardiocentesis
43.
What are nursing
interventions to
prevent an air
embolism in a vascular
access device
1. Leave central lines clamped when
not in use
2. Have the patient hold breath
while the tubing is changed
3. If the patient has sudden SOB,
place in Trendelenburg on left side,
give oxygen and notify the provider
36.
What is
retroperitoneal
bleeding
Bleeding into the abdominal cavity
behind the peritoneum can occur due to
femoral artery puncture (after an
angiography)
44.
37.
What are nursing
actions for
retroperitoneal
bleeding
1. Assess for flank pain and hypotension
2. Notify the provider immediately
3. Administer IV fluids and blood
products as prescribed
What are nursing
interventions to
prevent accidental
dislodgment of a
catheter
1. Cover the extremity site with
stretch netting
2. Wrap a washcloth folded into
thirds around the arm before
applying a needed restraint
3. When removing the dressing, pull
from distal to proximal
45.
Zero. Zero transducer to room air
38.
What are central
catheter's
appropriate for
Any fluids due to rapid hemodilution in
the superior vena cava
39.
What is post
procedure care for
a PICC
Hemodynamic
pressure lines should
be calibrated to read
atmospheric pressure
as blank.
46.
What kind of
medication would you
use for vasodilation
secondary to sepsis
Dopamine (vasopressors)
47.
Chapter 28
...
48.
What are
medications/electrical
management for
bradycardia
1. Atropine and isoproterenol
(antiarrhythmic and
bronchodilator)
2. Pacemaker
49.
What are
medications/electrical
management for a fib,
SVT or VT with pulse
1. Amiodarone, adenosine,
verapamil (CCB)
2. Synchronized cardioversion
50.
What are
medications/electrical
management for VT
without a pulse or
ventricular fibrillation
1. Amiodarone, lidocaine and
epinephrine
2. Defibrillation
51.
What is cardioversion
Delivery of a direct countershock to
the heart synchronized to the QRS
complex
52.
What is defibrillation
Delivery of an unsynchronized,
direct countershock to the heart.
Stops all electrical activity of the
heart, allowing the SA node to take
over and reestablish a perfusing
rhythm
53.
What is held 48 hours
prior to elective
cardioversion
Digoxin
54.
What is indicative of
an MI
Chest pain and ST segment
depression or elevation
55.
Chapter 30
...
40.
41.
42.
What should you
do if there's an
occlusion in the
access device that
impedes flow
1. Flush the line at least every 12 hours to
maintain patency (3 mL for peripheral &
10 mL for central lines)
2. Administer urokinase to lyse
obstructions per facility protocol
3. Flush implanted port after every use
and at least once a month while
implanted
What are nursing
actions for a
catheter
thrombosis/emboli
1. Flush the line per facility protocol
2. Do not force fluid if resistance is
encountered
3. Use a 10 mL or larger syringe to avoid
excessive pressure
What is treatment
for infiltration and
extravasation
1. Remove using direct pressure with
gauze sponge until bleeding stops
2. Apply cool compress
3. Elevation is optional
4. Avoid starting a new IV site in the same
extremity
56.
What is an
arthrectomy
Used to break up and remove plaques
within cardiac vessels
64.
Perforation of an artery by the
catheter may cause blank
Cardiac tamponade
57.
What is a stent
Placement of a mesh wire device to hold
an artery open and prevent restenosis
65.
What are clinical
manifestations of anaphylaxis
58.
What is a
percutaneous
transluminal
coronary
angioplasty
Involves inflating a balloon to dilate the
arterial lumen and the adhering plaque,
therefore widening the arterial lumen
chills
Fever
Rash
Wheezing
Tachycardia
Bradycardia
66.
What are two medications that
might be prescribed in the
event of anaphylaxis
Diphenhydramine or
epinephrine
67.
A coronary artery bypass graft
is most effective when a
patient has sufficient
ventricular function such as an
EF greater then
40% to 50%
68.
What are preprocedure
medications for a CABG
1. Anxiolytics: lorazepam
and diazepam
2. Prophylactic antibiotics
3. Anticholinergic such as
scopolamine
69.
What are some important
preprocedure teachings for a
patient that is going to
undergo a CABG
1. Endotracheal tube and
mechanical ventilator for
airway management for
several hours following the
surgery
2. Inability to talk while
endotracheal tube is in
place
3. Sternal incision and
possible leg incision
4. 1 to 2 mediastinal chest
tubes
5. Indwelling urinary
catheter
6. Pacemaker wires
7. Hemodynamic
monitoring devices
70.
What are two medications that
are discontinued before a
CABG
1. Diuretics 2 to 3 days
before surgery
2. Aspirin and other
anticoagulants one week
before surgery
71.
What are medications that are
often continued for CABG
Potassium supplements
Antidysrhythmic's
Antihypertensives
Insulin
72.
Post procedure: what should
you do with the patient within
two hours following
extubation
Dangle and turn the client
from side to side as
tolerated
59.
What are
indications for a
PCI (angioplasty)
What are
preprocedure
nursing actions
for a PCI (besides
allergies,
informed
consent, blah
blah)
1. NPO at least eight hours if possible
2. Assess renal function prior to
introduction of contrast dye
3. Administer antiplatelet medications as
prescribed
61.
What are two
medications that
are administered
during the
intraprocedure
for PCI
Midazolam (Versed) and fentanyl
62.
What is post
procedure
nursing actions
after a PCI
1. Assess vitals every 15 minutes for one
hour, every 30 minutes for one hour,
every hour for four hours and then
every four hours.
2. Assess the groin site at the same
intervals for bleeding and hematoma
formation
3. Assess for signs of thrombosis
4. Maintain bed rest in a supine position
with the leg straight for 4 to 6 hours ( or
prescribed time)
5. Monitor urine output
60.
63.
How long does a
client with a stent
replacement
receive
anticoagulation
therapy
6 to 8 weeks after
73.
What should you
do within 24
hours after CABG
Assist the patient to a chair. Ambulate
the patient 25 to 100 feet by first
postoperative day
74.
How often should
you assess
neurological
status after CABG
Every 30 to 60 minutes until the client
awakens from anesthesia, then every 2
to 4 hours or per facility policy
Monitor chest
tube patency and
drainage. Measure
drainage at least
once an hour.
Volume
exceeding blank
could be a sign of
possible
hemorrhage and
should be
reported to the
surgeon
150 mL/hour
What kind of
manifestations of
pain might an
older female
patient show
instead of chest
pain
Dyspnea, indigestion
77.
What is a heart
healthy diet
Low-fat, low cholesterol, high-fiber, lowsalt
78.
What should the
patient's activity
level be after a
CABG
75.
76.
79.
What can
hypothermia
cause
Vasoconstriction, metabolic acidosis and
hypertension
80.
What are
indications of
cardiac
tamponade after
a CABG
1. Sudden decrease of chest tube
drainage following heavy drainage
2. JVD with clear lung sounds
3. Equal PAWP & CVP values
Treatment of
cardiac
tamponade after
a CABG involves
1. Volume expansion
2. Emergency sternotomy
(Pericardiocentesis is avoided because
blood may have clotted)
81.
82.
What is maximum
potassium
administration
rate IV
10 to 20 mEq/hour
83.
How long should
a patient remain
NPO before a
peripheral bypass
graft
Eight hours
84.
What are two
client education
points for a
peripheral bypass
graft
1. Advise the patient not to cross legs
2. Explain that pedal pulses will be
checked frequently
85.
What are post
procedure
nursing
interventions for
a peripheral
bypass graft
1. Assess vitals every 15 minutes for one
hour and then every hour after the first
hour
2. Administer anticoagulant
therapy/antiplatelet therapy
3. Maintain bed rest for 18 to 24 hours.
The leg should be kept straight during
this time
86.
What are teaching
points for foot
inspection and
care
87.
The graft may
occlude due to
reduced blood
flow and clot
formation. This
occurs primarily
in the first
24 hours post operative
88.
What kind of
procedure is used
for graft
occlusion
Thrombectomy or thrombolytic therapy
89.
What procedure
is used for
compartment
syndrome
Fasciotomy
90.
Chapter 35
...
91.
92.
What are physical assessment findings
for peripheral artery disease
What are nursing actions for
arteriography
1. Bruit over
femoral and aortic
artery's
2. Decreased
capillary refill of
toes
3. Decreased or
non-palpable
pulses
4. Loss hair on
lower calf, ankle
and foot
5. Dry, scaly,
mottled skin
6. Thick toenails
7. Cold/cyanotic
extremity
8. Pallor of
extremity with
elevation
9. Dependent
Rubor
10. Muscle atrophy
11. Ulcers and
possible gangrene
1. Observe for
bleeding and
hemorrhage
2. Palpate pedal
pulses to identify
possible occlusions
93.
How does a plethysmography
diagnose PAD
A decrease in
pulse pressure of
the lower
extremity indicates
a possible blockage
in the leg
94.
A Doppler probe is used to take
various blood pressure measurements
for comparison. In the absence of
peripheral arterial disease, pressures
in the lower extremities are
Higher than those
in the upper
extremities
95.
What is nursing
care for a patient
with PAD
1. Encourage collateral circulation
2. Avoid crossing legs
3. Avoid restrictive garments
4. Elevate the leg to reduce swelling, but
not to elevate them about the level of the
heart
5. Provide a warm environment
6. Avoid exposure to cold
7. Avoid stress, caffeine and nicotine and
anything that causes vasoconstriction
96.
What are
medications for
PAD
1. Antiplatelet medications - aspirin,
Plavix, trental
2. Statins - can relieve manifestations
associated with PAD such as intermittent
claudication
97.
What are two
surgical
procedures for
PAD
1. Percutaneous transluminal
angioplasty
2. Laser assisted angioplasty
98.
What are nursing
interventions for
these two
procedures
1. Observe for bleeding/vitals
2. Keep client on bed rest with limb
straight for 6 to 8 hours before
ambulation
3. Antiplatelet therapy for 1 to 3 months
99.
What is arterial
revascularization
surgery used for
Patients who have severe claudication
and/or limb pain at rest, or patients who
are at risk for losing a limb due to poor
arterial circulation
100.
What are nursing
actions for
arterial
revascularization
surgery
1. Maintain adequate circulation in the
repaired artery. The location of the pedal
or dorsalis pulse should be marked and
its strength compared with the
contralateral leg on a scheduled basis
using a Doppler
2. Assess color, temperature, sensation
and capillary refill compared with the
contralateral extremity on a scheduled
basis
3. Monitor BP!!!!
4. No bending of the hip and knee
101.
One
complication of
graft is
compartment
syndrome what
are
manifestations
of it
Tingling
Numbness
Worsening pain
Edema
Pain on passive movement
Unequal pulses
(prepare patient for Fasciotomy)
102.
What are risk
factors for
peripheral venous
disease
103.
Patients with
venous disease
most often
complain of limb
pain that feels
like
104.
What are signs of
DVT and
thrombophlebitis
105.
106.
What are signs of
Venous
insufficiency
What are clinical
manifestation of
varicose veins
1. Venus thromboembolism associated
with Virchow triad
2. Hip surgery, total knee replacement,
open prostate surgery
3. Heart failure
4. Immobility
5. Pregnancy
6. Oral contraceptives
7. Family history
109.
For varicose veins
Trendelenburg
test is used. What
are the nursing
actions for this
test
110.
What should you
encourage the
patient to do if
they have DVT or
thrombophlebitis
111.
What should you
teach the patient
to do if they have
venous
insufficiency
112.
What are
medications for
DVT and
thrombophlebitis
Anticoagulants
113.
How long does it
take for warfarin
to take affect
3 to 4 days
114.
DVT and
thrombophlebitis
both can use
thrombolytic
therapy. What are
the details of this
therapy?
115.
For varicose
veins,
sclerotherapy
may be
performed. What
are the details of
this therapy?
116.
What should the
nurse monitor for
postoperatively
after varicose
veins - vein
stripping
Aching pain and feeling of fullness or
heaviness in the legs after standing
1. Stasis dermatitis is a brown
discoloration on the ankles that extends
at the calf relative to the level of
insufficiency
2. Edema
3. Stasis ulcers ( typically found around
ankles)
1. Distended, superficial veins that are
visible just below the skin and are
torturous in nature
2. Patients often report muscle cramping
and aches, pain after sitting and pruritus
107.
What are
laboratory tests
for PVD
D dimer test measures fibrin
degradation products present in the
blood produced from fibrinolysis. A
positive test indicates that thrombus
formation has possibly occurred
108.
What are
diagnostic
procedures for
DVT and
thrombophlebitis
1. Venus duplex ultrasonography
2. Impedance plethysmography
3. If the above test are negative for a
DVT, but one is still suspected a
venogram, which uses contrast material
or MRI may be needed for accurate
diagnosis
1. Place the patient in the supine position
with legs elevated
2. When the patient sits up, the veins will
fill from the proximal and if varicosities
are present
117.
What are two
other surgical
interventions
that can be
performed for
varicose veins
118.
Venous stasis
ulcers often form
over the medial
malleolus.
Venous ulcers
are chronic, hard
to heal and often
recur. They can
lead to
amputation
and/or death.
What are nursing
interventions for
venous ulcers
119.
120.
121.
1. Endovenous laser treatment
2. Application of radiofrequency energy
What are patient
teachings for
patients that
have venous
ulcers (diet and
DVT prevention)
1. Recommend a diet high in zinc,
protein, iron and vitamins A & C
2. Instruct patient on the use of
compression stockings
A pulmonary
embolism occurs
when a
thrombus is
dislodged,
becomes an
embolus and
lodges into a
pulmonary
vessels. What are
manifestations
of a pulmonary
embolism's
1. Sudden onset of dyspnea, pleuritic
chest pain, restlessness and
apprehension, feelings of impending
doom, cough and hemoptysis
What are clinical
findings of a
pulmonary
embolism's
Tachypnea
Crackles
plural friction rub
Tachycardia
S3 or S4 heart sounds
Diaphoresis
Low-grade fever
Petechia over chest and axillae
Decreased arterial O2 sat
122.
What should you
do if you suspect
that a patient
has a pulmonary
embolism
1. Notify the health care provider
immediately, reassure the client, and
assist with position of comfort with the
head of the bed elevated.
2. Prepare for oxygen therapy and ABGs
while continuing to monitor and assess
the patient for other manifestations
123.
When should
Venus
compression
stockings be
removed
Before going to bed. Legs should be
elevated before the stockings are
reapplied
124.
Chapter 36
...
125.
What is
secondary
hypertension
caused by
Certain disease states or medications
126.
How does
hypertrophia of
the left ventricle
develop
As the heart pumps against resistance
caused by the hypertension
127.
What is the
maximum BMI a
person should
have in regards
to health
promotion and
disease
prevention for
hypertension
30
128.
What are risk
factors for
secondary
hypertension
129.
Blank, can occur
with verapamil
hydrochloride,
so encourage
intake of foods
that are high in
fiber
Constipation
130.
What kind of
juice should not
be taken with
CCB medications
Grapefruit juice
131.
What are two
side effects of
ARBs
Angioedema, hyperkalemia
132.
Aldosterone receptor
antagonists such as blank, block
aldosterone action. They
promote the retention of
potassium and excretion of
sodium and water
Eplerenone
142.
Monitor BP every 5 to 15 minutes and
assess neurological status and monitor
ECG
133.
What are Side effects of
aldosterone receptor
antagonists
Hypertriglyceridemia,
hyponatremia,
hyperkalemia
Before, during
and after
administration
of IV
antihypertensive
what should you
do
143.
Chapter 17
...
144.
What should you teach the
patient that is taking
aldosterone receptor
antagonists
No grapefruit juice or
St. John's wort. Do not
take salt substitutes
with potassium or foods
rich in potassium
How long should
a patient abstain
from smoking
before a
pulmonary
function test
6 to 8 hours prior to testing
134.
135.
What do central alpha
antagonist such as clonidine do
Reduce peripheral
vascular resistance and
decrease blood
pressure by inhibiting
the reuptake of
norepinephrine
145.
Four to six hours prior to testing
136.
What are side effects of central
alpha antagonist
Sedation, orthostatic
hypotension,
impotence
If a patient uses
inhalers how
long should they
withhold use
before a
pulmonary
function test
146.
What is PaO2
The partial pressure of oxygen
147.
What is SaO2
Percentage of oxygen bound to
hemoglobin as compared with the total
amount that can be possibly carried
148.
What is normal
bicarbonate
according to ATI
21 to 28
149.
What are
preprocedure
nursing actions
for an arterial
puncture
150.
What are
intraprocedural
nursing actions
while
performing an
arterial puncture
151.
What are
postprocedural
nursing actions
while
performing an
arterial puncture
152.
What are two
complications
from an arterial
puncture
137.
Alpha adrenergic antagonist,
such as blank, reduce blood
pressure by causing vasodilation
Prazosin
138.
When is prazosin given
Usually at Night and
Monitor BP for two
hours after initiation of
treatment
139.
140.
141.
What are dietary approaches to
stop hypertension
1. Diet high in fruits,
vegetables, and low-fat
dairy
2. Avoid foods high in
sodium and fat
3. Consume foods rich
in potassium, calcium
and magnesium
What are clinical manifestations
of a hypertensive crisis
1. Severe headache
2. Extremely high blood
pressure - greater than
240/120
3. Blurred vision,
dizziness and
disorientation
4. Epistaxis
What are two medications that
are given IV for a hypertensive
crisis
Nitroprusside
Nicardipine
Hematoma and air embolism
153.
What should you
do if the patient
has a hematoma
1. Observe the patient for changes in
temperature, swelling, color, loss of pulse
or pain
2. Notify the provider immediately if
symptoms persist
3. Apply pressure to the hematoma site
154.
What should you
do if a patient
exhibits
symptoms of an
air embolism
1. Place the patient on his left side in the
Trendelenburg position
2. Monitor the patient for a sudden onset
of SOB, decrease in SaO2, chest pain,
anxiety and air hunger
3. Notify the provider immediately if
symptoms occur, administer oxygen and
obtain ABGs
Why is a
bronchoscopy
performed
1. Visualization of abnormalities such as
tumors, inflammation and strictures
2. Biopsy
3. Removal of foreign bodies and
secretions
4. Treat post operative atelectasis
155.
156.
What is
preprocedure
nursing
interventions for
a bronchoscopy
157.
What are
intraprocedural
nursing
interventions for
a bronchoscopy
158.
What are post
procedure
nursing
interventions for
a bronchoscopy
The patient is not discharged from the
recovery room until adequate cough
reflex and respiratory effort are present
159.
What are three
complications
that can occur
from a
bronchoscopy
Laryngospasm, pneumothorax,
aspiration
160.
What are nursing
interventions for
Laryngospasm spasm
and what can decrease
the likelihood of
laryngeal edema
1. Monitor the patient for signs of
respiratory distress
2. Maintain a patent airway by
repositioning the patient or
inserting an oral/nasopharyngeal
airway as appropriate
3. Administer oxygen therapy to
the patient as prescribed.
Humidification can decrease the
likelihood of laryngeal edema
161.
What are nursing
interventions for a
pneumothorax
1. Assess patient's breath sounds
and O2 sat and obtain a follow-up
chest x-ray
162.
What are nursing
interventions for
aspiration
1. Prevent aspiration and the
patient by withholding oral fluids
or food until the gag reflex
returns
2. Perform suctioning as needed
163.
What is a thoracentesis
Performed to obtain specimens
for diagnostic evaluation, instill
medication into the plural space,
and remove fluid or air from the
plural space
164.
What are preprocedure
nursing interventions
for a Thoracentesis
1. Obtain preprocedure x-ray as
prescribed
2. Position the patient sitting
upright with his arms and
shoulders raised and supported
on pillows and/or on an overbed
table and with his feet and legs
well supported
3. Instructed patient to remain
absolutely still during the
procedure and not to cough or
talk unless instructed by the
primary care provider
165.
What are
intraprocedural
nursing interventions
for a thoracentesis
1. Monitor the patient's vitals, skin
color and O2 sat throughout the
procedure
2. Measure and record the
amount of fluid removed from the
patient's chest
(The amount of fluid removed is
limited to one L at a time to
prevent cardiovascular collapse)
3. Label and send specimens to
the Laboratory
166.
What are post procedure
nursing interventions for a
thoracentesis
1. Apply a dressing over the
puncture site and assess
dressing for
bleeding/drainage
2. Monitor vitals and
respiratory status hourly for
the first several hours after
3. Encourage the patient to
deep breathe to assist with
lung expansion
4. Obtain a chest x-ray (check
resolution of effusions, rule out
pneumothorax)
What are complications of
a thoracentesis
Mediastinal shift,
pneumothorax, bleeding,
infection
168.
What is a mediastinal shift
Shift of thoracic structures to
one side of the body (Monitor
VS, auscultate lungs for a
decrease in or absence of
breath sounds)
169.
What is a symptom of
pneumothorax
Diminished breath sounds
170.
What are indications of a
pneumothorax
1. Deviated trachea
2. Pain on the affected side
that worsens upon exhalation
3. Affected side does not move
in and out upon
inhalation/exhalation
4. Increased HR
5. Rapid shallow respirations
6. Nagging cough or feeling of
air hunger
167.
176.
What are
medications for
rhinitis
177.
What are holistic
or
complementary
therapies for
rhinitis
Echinacea, large doses of vitamin C and
zinc
178.
What is sinusitis
Inflammation of the mucous membranes
of one or more of the sinuses
179.
What is sinusitis
associated with
1. Deviated nasal septum
2. Occurs after rhinitis
3. Nasal polyps
4. Inhaled pollutants or cocaine
5. Facial trauma
6. Dental infections
7. Loss of immune function
180.
What are
symptoms of
sinusitis
Nasal congestion
Headache
Facial pressure/pain (worse when head
is tilted forwards)
Cough
Bloody/Purulent nasal drainage
Tenderness to palpitation
Low-grade fever
181.
What are
diagnostic tests
for sinusitis
1. CT scan or sinus x-rays
2. Endoscopic sinus cavity lavage or
surgery to relieve the obstruction and
promote drainage of secretions may be
done as a diagnostic procedure
171.
Chapter 20
...
172.
How long does it take for a
patient to exhibit
symptoms when exposed
to healthcare acquired
pneumonia
24 to 48 hours
182.
What are nursing
interventions for
sinusitis and
what should you
discourage
1. Encourage the use of steam, sinus
irrigation, nasal spray
2. Increase fluid and rest
3. Discourage air travel, swimming and
diving
173.
What is rhinitis
Inflammation of the nasal
mucosa
183.
174.
What is objective data for
rhinitis
1. Red, inflamed, swollen nasal
mucosa
2. Low-grade fever
What are
medications for
sinusitis
175.
What are nursing
interventions for rhinitis
1. Encourage rest, 8 to 10
hours a day and increase fluid
intake to at least 2000 mL/day
2. Encourage use of home
humidifier or breathing
steamy air
3. Proper disposal of tissues
and use of cough etiquette
1. phenylephrine: used to reduce
swelling of the mucosa
2. Patients should be encouraged to
begin OTC decongestant at the first
manifestation of sinusitis
3. Signs of rebound nasal congestion
may occur if decongestions are used for
more than 3 to 4 days
4. Amoxicillin if there is bacteria
5. NSAIDs, Tylenol, aspirin
184.
What is patient
education for
sinusitis and
what should the
patient report
1. Sinus irrigation and saline nasal
spray's are an effective alternative to
antibiotics for relieving nasal congestion
2. Contact the provider for
manifestations of a severe headache,
neck stiffness and high fever
(meningitis/encephalitis)
What are
complications of
sinusitis
Meningitis and encephalitis can occur if
pathogens enter the bloodstream from
the sinus cavity
186.
When are adults
contagious when
infected with the
flu
24 hours before manifestations develop
and up to five days after
187.
What are three
extra symptoms
of the avian flu
compared to the
flu
Severe diarrhea and cough, hypoxia
188.
What is nursing
care for
hospitalized
patients infected
with influenza
189.
What are
antivirals that
may be
prescribed for
treatment and
prevention of
the flu
1. Amantadine
2. Rimantadine
3. Ribavirin
What antivirals
may be
prescribed to
shorten the flu
1. Relenza
2. Tamiflu
191.
When should
patients begin
antiviral
medications
24 to 48 hours after the onset of
manifestations
192.
Vaccination for
the flu is
encourage for
everyone over six
months of age.
However highrisk patients
include
1. History of pneumonia
2. Chronic medical conditions
3. Over the age of 65
4. Pregnant women
5. Health care Providers
What is a
complication of
the flu
Pneumonia
185.
190.
193.
194.
What is the most common
manifestation of pneumonia in
older adults
Confusion
195.
How does the sputum look with
pneumonia
Purulent, blood tinged
or rust colored sputum
196.
Elevated wbc's are normally
elevated in pneumonia with the
exception of
May not be present in
older patients
197.
What are diagnostic procedures
for pneumonia
1. Chest x-ray will show
consolidation of lung
tissue
2. Pulse oximetry may
show less than expected
range
198.
What are nursing interventions
for pneumonia
1. Position the patient in
high Fowlers unless
contraindicated
2. Encourage coughing
or suctioning
3. Oxygen
therapy/breathing
treatments as
prescribed
4. Incentive spirometer
5. Structure activity to
include periods of rest
6. Encourage fluid intake
of 2 to 3 L/day
199.
It is important to obtain a
culture specimen before
antibiotic therapy. What are
two common antibiotics given
Penicillins and
cephalosporins
200.
What are nursing considerations
regarding medications for
pneumonia
1. Observe patients
taking cephalosporins
for frequent stools
2. Monitor her kidney
function, especially older
adults who are taking
penicillins and
cephalosporins
3. Take medication with
food. Some penicillins
should be taken one
hour before meals or
two hours after
201.
Bronchodilators are given to
reduce bronchospasms and
reduce irritation. What is a
short acting Beta two agonist
bronchodilator
Albuterol
202.
Anti-cholinergic
medications such as
blank, block the
parasympathetic
nervous system,
allowing for
increased
bronchodilation and
decreased
pulmonary
secretions
Ipratropium
203.
Methylxanthines
such as blank,
require close
monitoring of serum
medication levels
due to narrow
therapeutic range
Theophylline
204.
What are adverse
effects of
Theophylline
Nausea, tachycardia, diarrhea
205.
What should you
watch for in patients
taking albuterol
Tremors, tachycardia
206.
Observe for dry
mouth in patients
taking ipratropium
and monitor heart
rate. Adverse effects
include
Headache, blurred vision and
palpitations which may indicate toxicity
207.
What should you
encourage patients
to do while taking
ipratropium
Suck on hard candies to help moisten
dry mouth
Anti-inflammatories
such as
glucocorticosteroids
such as fluticasone
and prednisones are
prescribed to reduce
inflammation.
Monitor for
Immunosuppression, fluid retention,
hyperglycemia, hypokalemia and poor
wound healing, black/tarry stools
208.
209.
210.
What are other
nursing
considerations for
anti-inflammatories
What are
complications from
pneumonia
211.
What are manifestations of
atelectasis
1. Patient reports
SOB and exhibits
findings of
hypoxemia
2. Patient has
diminished/absent
breath sounds
over the affected
area
3. Chest x-ray
shows area of
density
212.
What are manifestations of acute
respiratory distress syndrome (ARDS)
1. Hypoxemia
persists despite
oxygen therapy
2. Patients dyspnea
worsens as bilateral
pulmonary edema
develops that is
non-cardiac related
3. Chest x-ray
shows an area of
density with a
"ground glass
"appearance
4. Blood gas
findings
demonstrate
hypercarbia even
though pulse
oximetry shows
decreased
saturation
213.
Patient with pulmonary tuberculosis
is being discharged with a
prescription for rifampin. The nurse
should plan to include which of the
following in the patient's discharge
teaching plan
Urine and other
secretions orange
in color
214.
A nurse is caring for a patient with
COPD. What assessment finding
should the nurse report to the
primary care provider regarding the
color of sputum
Productive cough
with green sputum
215.
What kind of diet should a patient
with COPD be on
High calorie and
protein
216.
Chapter 21
...
Atelectasis, bacteremia, acute respiratory
distress syndrome
217.
What are some things that may
trigger asthma attacks
1. Changes in
temperature and
humidity
2. Perfume
3. Air pollutants
4. Seasonal allergies
5. Stress
6. Medications (aspirin,
NSAIDs, beta blockers,
cholinergics)
7. enzymes in laundry
detergent
8. Sinusitis with post
nasal drip
9. Viral respiratory tract
infection
224.
What are some things that a nurse
should monitor when a patient is
using Theophylline
Monitor the
patient's serum
levels for toxicity.
Side effects will
include
tachycardia,
nausea and
diarrhea
225.
What are some things that a nurse
should monitor the patient for when
the patient is using albuterol
Tremors and
tachycardia
226.
What is something that a nurse
should monitor the patient for when
the patient is using Ipratropium
Dry mouth
227.
If a patient was showing symptoms of
ipratropium toxicity what would the
symptoms be?
Headache, blurred
vision or
palpitations
228.
What kind of asthma attack is
salmeterol used for
Is used to prevent
an asthma attack
and not at the
onset of an attack
229.
What are things that a nurse should
watch for when a patient is taking
corticosteroids, leukotriene
antagonist (singulair), mast cell
stabilizer (Cromolyn), or monoclonal
antibodies (omalizumab)
1. Decreased
immune function
2. Hyperglycemia
3. Black, tarry
stools
4. Fluid
retention/weight
gain (common)
5. Hypokalemia
with corticosteroids
such as
prednisone
When a patient has asthma
what temperature of water
should be used to eliminate
dust mites in bed linens?
Hot water
What is something that should
be encouraged as part of
asthma therapy for a patient
Regular exercise because
it promotes ventilation
and perfusion
220.
There are many risk factors for
asthma, most of them are
common sense. What are two
risk factors that you may not
think of?
1. GERD
2. The older patient is
more susceptible to
infection and therefore
they're at bigger risk for
complications
221.
What are some physical
assessment findings of asthma
1. Dyspnea
2. Anxiety or stress
3. Coughing
4. Wheezing
5. Mucus production
6. Use of accessory
muscles
7. Prolonged exhalation
8. Poor O2 sat
9. Barrel chest or
increased chest diameter
230.
How should prednisone be taken?
With food
231.
What is status asthmaticus
Life-threatening
episode of airway
obstruction that is
unresponsive to
common treatment
232.
What are symptoms of status
asthmaticus
1. Extreme
wheezing
2. Labored
breathing
3. Use of accessory
muscles
4. Distended neck
veins
5. Creates a risk for
cardiac/respiratory
arrest
218.
219.
222.
What diagnostic test is most
accurate for diagnosing asthma
and its severity?
Pulmonary function test
223.
What are some things that you
can do as a nurse to maximize
patient comfort in a patient
that has asthma
1. Hi Fowler's
2. Oxygen
3. Monitor cardiac rate
and rhythm for changes
during an acute attack
4. Initiate and maintain IV
access
5. Encourage prompt
medical attention for
infections and
appropriate vaccinations
233.
What are nursing interventions for
status asthmaticus
1. Prepare for
emergency
intubation
2. As prescribed,
administer oxygen,
bronchodilators,
epinephrine and
initiate systemic
steroid therapy
234.
Chapter 22
...
235.
What is emphysema characterized
by
Loss of lung
elasticity and
hyperinflation of
lung tissue
236.
What is a genetic risk for COPD
Alpha-1 antitrypsin
deficiency
237.
What are some physical assessment
findings of COPD
1. Barrel chest
2. Hyperresonance
on percussion
3. Thin extremities
and enlarged neck
muscles
4. Clubbing of
fingers and toes
5. Dependent
edema secondary
to right-sided heart
failure (increase in
pulmonary
pressure)
238.
Would hematocrit be low or high in
a patient that has COPD?
High due to low
oxygenation levels
239.
Does COPD increase or decrease
caloric demands
Increase because
work of breathing
has increased
240.
Patients that have COPD may need
blank of oxygen via nasal cannula or
up to blank via Venturi mask
2 to 4 L/min, 40%
241.
Patients who have chronically
increased PaCO2 levels usually
require blank of oxygen via nasal
cannula
1 to 2 L/min
242.
A positive expiratory pressure device
assist patients to remove airway
secretions. The patient inhales
deeply and exhales through the
device. While exhaling, a ball moves
causing
A vibration that
results in loosening
the clients
secretions
How often should a patient with
COPD do exercise conditioning
(walking until dyspnea occurs,
resting and then walking again)
20 minutes, 2 to 3
times weekly
243.
244.
How much fluids
should a patient
who has COPD
drink
2 to 3 L/day
245.
Most of the
medications for
COPD are the
same as asthma.
With the
exception of
Mucolytic's.
What are two
kinds of
mucolytic's?
Mucomyst, dornase alpha
246.
Chapter 23
...
247.
How long does it
take for the risk
of transmission
to decrease
regarding TB
2 to 3 weeks after anti-tuberculin
therapy
248.
A patient will
have a positive
intradermal TB
test within blank
weeks of
exposure to the
2 to 10
249.
How often
should patients
who live in highrisk areas be
screened for
tuberculosis
On a yearly basis
250.
What are risk
factors for TB
In addition, recent travel outside of the
US, substance use and health care
occupation
251.
What are
symptoms of TB
1. Persistent cough lasting longer than
three weeks
2. Purulent sputum, possibly blood
streaked
3. Fatigue and lethargy
4. Weight loss and anorexia
5. Night sweats
6. Low-grade fever in the afternoon
252.
When should the
Mantoux test to
be read
Within 48 to 72 hours
253.
What is a
positive
Mantoux test?
1. 10 mm or greater
2. 5 mm is considered positive for
immunocompromised patients
254.
What kind of diet should
a patient with TB be on?
Foods that are rich in protein,
iron and vitamin C
255.
How does isoniazid work
By preventing synthesis of
mycolic acid in the cell wall
268.
How often are sputum
samples needed during
tuberculosis therapy
Every 2 to 4 weeks to
monitor therapy
269.
What is miliary TB
Where the infection
invades the bloodstream
and can lead to MODS
256.
How should isoniazid be
taken
On an empty stomach
257.
What should you
monitor for any patient
that is taking isoniazid
Hepatotoxicity and
neurotoxicity, such as tingling of
the hands and feet (vitamin B6
is used to prevent
neurotoxicity)
270.
What are
symptoms/complications of
miliary TB
Headaches
Neck stiffness
Drowsiness
Pericarditis
271.
Chapter 56
...
272.
What is the only condition
that increases serum
creatinine levels
Kidney disease
273.
What is the purpose of a
VCUG
To detect whether urine
refluxes into ureters as an
x-ray is taken while the
patient is voiding
274.
What should you do as a
nurse after a patient has a
VCUG
1. Monitor the patient for
infection for the first 72
hours after
2. Encourage increased
fluid intake
3. Monitor urine output
275.
What are preprocedure
nursing interventions for a
patient that is going to have a
kidney biopsy
1. Review coagulation
studies
2. NPO for 4 to 6 hours
before
276.
What are post procedure
nursing interventions for a
patient that has had a kidney
biopsy
1. Monitor vitals
2. Assess dressings and
urinary output (hematuria)
3. Review HGB and HCT
values
4. Administer PRN pain
medication
258.
How does rifampin work
Inhibits DNA dependent RNA
polymerase activity
259.
What are side effects of
rifampin
1. Hepatotoxicity (they should
report yellowing of the skin,
pain or swelling of joints, loss of
appetite or malaise)
2. Orange color of urine and
other secretions
3. May interfere with oral
contraceptives
260.
What is a side effect of
pyrazinamide
Hepatotoxicity
261.
How should
pyrazinamide be
consumed?
Instruct the patient to drink a
glass of water with each dose
and increase fluids during the
day
How does ethambutol
work
By inhibiting protein synthesis
What are two things that
you need to obtain
before administering
ethambutol to a patient
1. Baseline visual acuity
2. Determine color
discrimination ability
262.
263.
(this medication should not be
given to children younger than
13 years of age)
264.
What is the most
important thing to teach
a patient that is on
ethambutol
To report vision changes
immediately
265.
What is streptomycin
sulfate
Aminoglycoside antibiotic that
potentiates the efficacy of
macrophages during
phagocytosis
266.
What kind of patients are
put on streptomycin
Those who have multi drugresistant TB because of this
medications high level of toxicity
267.
What are two side effects
of streptomycin
Ototoxicity
Renal function decline
277.
A cystography or
cystourethrography are used to
discover abnormalities of bladder
wall and/or a occlusions of ureter
or urethra. What are preprocedure nursing interventions
for these procedures?
1. NPO after midnight
2. Administer
laxative/enema for
bowel preparation the
night before the
procedure
278.
What position should a patient be
in for a cystography or
Cystourethrography
Lithotomy position
279.
What color urine may come out
after a cystography or
cystourethrography
Urine maybe pink
tinged
280.
What should you do if blood clots
are present or urine output is
decreased or absent after a
cystography or
Cystourethrography
Irrigate urinary
catheter with NS
What are a retrograde pyelogram,
Cystogram, or urethrogram used
for
To identify obstruction
or structural disorders
of the ureters and
renal pelvis of the
kidneys by instilling
contrast dye during a
cystoscopy
281.
282.
What is a renography used for
To assess renal
bloodflow and
estimate GFR after IV
injection of radioactive
material to produce a
scanned image of the
kidneys
283.
What should you assess frequently
during and after A renography if
captopril is given to change blood
flow to the kidneys
BP
284.
What is an excretory urography
used for
To detect obstruction,
assess for a
parenchymal mass,
and assess size of the
kidney. IV contrast
dye is used to
enhance images
285.
What are preprocedure nursing
interventions for a patient that is
having an excretory urography
1. Increased fluids the
day before the
procedure
2. Bowel prep
3. NPO after midnight
4. Hold Metformin for
24 hours before
procedure
286.
What are post procedure
nursing interventions for a
patient that has had an
excretory urography
1. Administer parenteral
fluid or encourage oral
fluids to flush dye
2. Diuretics may be
administered to increase
dye secretion
3. Follow up creatinine and
bun serum levels before
Metformin is resumed
287.
A nurse is reviewing a
patient's laboratory findings
for urinalysis. The findings
indicate the urine is positive
for leukoesterase and
nitrates. Which of is an
appropriate nursing action?
Obtain a clean catch urine
specimen for culture and
sensitivity because this
determines the antibiotic
that will be most effective
for treatment of the
urinary tract infection
288.
Why would a patient with a
history of asthma be at risk
for a complication when
undergoing excretory
urography?
A patient who has a history
of asthma has a higher risk
of having an asthma attack
as an allergic response to
the contrast dye used
during the procedure
289.
Chapter 57
...
290.
How do you estimate a
patient's amount of fluid
removed after dialysis
By comparing the patients
preprocedure weight to
the post procedure weight
291.
How long should invasive
procedures be avoided after
dialysis
4 to 6 hours due to the risk
of bleeding related to an
anticoagulant
292.
How do you check an AV
fistula or AV graft for patency
By checking for thrill or
bruit
293.
When should you contact the
provider after dialysis
1. If bleeding from the
insertion site last longer
than 30 minutes
2. Absence of thrill/bruit
3. Signs of infection
294.
What kind of diet should a
patient be on after dialysis
high folate, high protein
diet
295.
What is disequilibrium
syndrome
Caused by too rapid of a
decrease in BUN and
circulating fluid volume. It
may result in cerebral
edema and increased ICP
296.
What are signs/symptoms of
disequilibrium syndrome
nausea
Vomiting
Change in LOC
Seizures
Agitation
297.
298.
299.
300.
Blank, is a risk
factor for dialysis
disequilibrium and
hypotension due to
rapid changes in
fluid and
electrolyte status
Advanced age
What can a nurse
do to decrease the
risk of
disequilibrium
syndrome
1. Use a slow dialysis exchange rate,
especially for older adults and those
being treated with hemodialysis for
the first time
2. Administer
anticonvulsants/barbiturates if
needed
What is something
that a nurse should
do for a patient
experiencing
hypotension from
dialysis other than
administer IV fluids
Lower the head of the patient's bed
What is peritoneal
dialysis
Involves instillation of a hypertonic
solution into the peritoneal cavity. The
solution dwells in the peritoneal cavity
as ordered by the provider. Drain the
solution that includes the waste
products. The peritoneum serves as
the filtration membrane
301.
What color should
the dialysate
solution be
Clear, light yellow is expected
302.
How much should
the outflow be
compared to the
inflow
Expected to equal or exceed amount
of dialysate inflow (insufficient outflow
could mean infection)
If a fibrin clot has
formed in the
peritoneal dialysis
catheter what
should you do?
Carefully milk the catheter
304.
What are two
conditions caused
by dialysis
Hyperglycemia and hyperlipidemia
305.
Blank, is a common
cause of poor
inflow or outflow
Constipation
306.
What position
should a patient be
in during CCPD and
APD treatment
Supine with head slightly elevated
303.
307.
If medications are
held before dialysis
can they be
administered after it
is done
Yes, medications that can be partially
dialysed during the treatment
should be withheld. After the
treatment, the nurse should
administer the medication.
308.
Why should a
patient that is
experiencing
shortness of breath
not receive
peritoneal dialysis
Because they may not be able to
tolerate excessive fluids being
instilled into their abdomen
309.
Chapter 58
...
310.
What are patient
indications of endstage kidney disease
necessitating kidney
transplant
1. Anuria
2. Proteinuria
3. Marked azotemia
4. Severe electrolyte imbalance
5. Fluid volume excess conditions
(heart failure, pulmonary edema)
6. Uremic lung
311.
What are subjective
signs/symptoms of
end-stage kidney
disease
Anorexia
Fatigue
Paresthesia
SOB
Dry, itchy skin
Metallic taste
Muscle cramping
312.
What are object of
signs/symptoms of
end-stage kidney
disease
Decreased attention span, seizures,
tremor, HF, Edema, dyspnea,
hypertension, distended jugular
vein's, anemia, vomiting, pulmonary
edema, cardiac dysrhythmias, pallor,
dry itchy skin, bruising, halitosis and
diminished or dark colored urine
313.
What is
methylprednisone
sodium succinate
An anti-inflammatory and
immunosuppressant used to
decrease the immune system
response of inflammation and
rejection of donor kidney
314.
What is another
immunosuppressant
medication used to
prevent rejection of
the donor kidney
Cyclosporine
315.
A patient has had a
kidney transplant is
usually dialyzed
within blank of the
surgery
24 hours
316.
What are some
things you should
assess/monitor
the patient for
after a kidney
transplant
1. Vital signs every 15 minutes initially
and advance to every hour
2. Report urine output less than 30
mL/HR
3. Urine appearance and older should
be checked hourly (initially pink and
bloody)
4. Daily weights
5. Maintain continuous bladder
irrigation as prescribed (to prevent clots
from forming)
What diuretic is
preferred when
oliguria is present
after a kidney
transplant
Mannitol
What kind of diet
should a patient
be on after a
kidney transplant
Low-fat, high-fiber, increased protein,
low-sodium, avoid sugars or
carbohydrates
When taking
cyclosporine
what are two
things you need
to do
1. Magnesium supplements because it
reduces magnesium levels
2. Avoid grapefruit
320.
What is hyper
acute rejection
Rejection that occurs within 48 hours
after surgery caused by an anti-body
mediated response that causes small
blood clot to form in the transplanted
kidney
321.
What are
symptoms of a
hyper acute
rejection
Fever, hypertension, pain at the
transplant site
322.
What is
treatment for
hyper acute
rejection
Immediate removal of the donor kidney
323.
What is acute
rejection
Occurs one week to two years after
surgery. An antibody mediated
response causing vasculitis in the donor
kidney and cellular destruction starts
with inflammation that causes lysis of
the donor kidney
324.
What are
symptoms of an
acute rejection
Oliguria
Anuria
Low-grade fever
Hypertension
Tenderness over the transplanted
kidney
Lethargy
Azotemia
Fluid retention
317.
318.
319.
325.
What is
treatment for
acute rejection
Involves increased doses of
immunosuppressive medications
326.
What is chronic
rejection
Occurs gradually over months to years.
Blood vessel injury from overgrowth of
the smooth muscles of the blood vessels
causing fibrotic tissue to replace normal
tissue resulting in a nonfunctioning donor
kidney
327.
What are
symptoms of
chronic
rejection
Gradual return of azotemia
Fluid retention
Electrolyte imbalance
Fatigue
328.
What is
treatment for
chronic
rejection
Monitor kidney status, continue
immunosuppressive therapy until dialysis
is required
329.
What is acute
tubular necrosis
Caused by a delay in transplanting the
donor kidney after harvesting may result
in hypoxic injury of the donor kidney
330.
What are
symptoms/signs
of renal artery
stenosis
Hypertension
Bruit over artery anastomosis site
Decreased kidney function
Peripheral edema
331.
What is the
most common
cause of first
transplant year
morbidity and
mortality
Infection
332.
Chapter 60
...
333.
What are the
four phases of
acute kidney
injury
1. Onset: begins with the onset of the
event, ends when oliguria develops and
lasts for hours to days
2. Oliguria: begins with the kidney insult,
urine output is 100 to 400 mL/24 hour
with or without diuretics and lasts for 1 to
3 weeks
3. Diuresis: begins when the kidneys start
to recover, diuresis of a large amount of
fluid occurs and can last for 2 to 6 weeks
4. Recovery: continues until kidney
function is fully restored and can take up
to 12 months
334.
What is prerenal
acute kidney
injury
Occurs as a result of volume depletion
and prolonged reduction of blood flow to
the kidneys which leads to ischemia of the
nephrons
335.
What is treatment for prerenal
acute kidney injury
1. Administer IV fluid
if no fluid restrictions
2. Administer calcium
channel blocker to
prevent the
movement of calcium
into the kidney cells
and to increase GFR
3. Monitor I and O's
4. Monitor for
decreased cardiac
output
336.
Intrarenal acute kidney injury
occurs as a result of direct damage
to the kidney from lack of oxygen
(acute tubular necrosis). What are
causes of intrarenal acute kidney
injury
1. Physical injury
2. Hypoxic injury renal artery or vein
stenosis or
thrombosis
3. Chemical injury acute nephrotoxins
(antibiotics, NSAIDs,
contrast dye, heavy
metal, blood
transfusion reaction)
4. Immunologic injury
- infection, vasculitis,
acute
glomerulonephritis
337.
What are two complications of
intrarenal acute kidney injury
Heart failure or
pulmonary edema
338.
What are signs/symptoms of acute
intrarenal kidney injury
ECG dysrhythmias
(tall T waves)
Flank pain
N/V
Lethargy
Tremors
Confusion
Post renal acute kidney injury
occurs as a result of bilateral
obstruction of structures leaving
the kidney. What are causes
1. Stone, tumor,
bladder atony
2. Prostate
hyperplasia, urethral
stricture
3. Spinal cord disease
or injury
340.
How do laboratory values look in
post renal acute kidney injury
Gradually increases
in serum creatinine,
BUN, urine specific
gravity
341.
What is nutrition for post renal
acute kidney injury
Restrict potassium,
phosphate and
magnesium during
oliguric phase and
increase protein
339.
342.
What are the five stages of chronic
kidney disease
Stage one: minimal
kidney damage with
normal GFR (greater
than 90 ML/min)
Stage two: mild
kidney damage with
GFR 60 to 89 mL/min
Stage III: GFR 30 to
59 mL/min
Stage 4: GFR is 15 to
29 mL/min
Stage five: GFR less
than 15 mL/min
343.
How much fluids are patients with
chronic kidney disease encouraged
to drink
At least 3 L of water
daily
344.
If a patient has diabetes or
hypertension and chronic kidney
disease what should you encourage
them to come in for regarding
yearly tests
Yearly testing for
albumin in the urine
345.
What are some signs and symptoms
of chronic kidney failure
Fatigue
Lethargy
Involuntary
movement of the
legs
Depression
Intractable hiccups
346.
How do you serum electrolytes look
in chronic kidney disease
Decreased sodium
and calcium;
increased
potassium,
phosphorus and
magnesium
347.
Why is hemoglobin and hematocrit
decreased in chronic kidney disease
From anemia
secondary to the
loss of
erythropoietin
348.
What are complications of CKD
Electrolyte
imbalance
Dysrhythmias
Fluid overload
Hypertension
Metabolic acidosis
Secondary infection
Uremia
349.
What kind of diet should a patient
be on that has chronic kidney
disease
High in
carbohydrates and
moderate in fat
350.
What medications are
considered nephrotoxic
Aminoglycosides
Amphotericin b
NSAIDs
Ace inhibitors
Arbs
Contrast dye
351.
If a patient is on digoxin
when should you
administer it
After receiving dialysis
352.
Why is aluminum
hydroxide given to
patients with chronic
kidney disease
Taken with meals to bind
phosphate in food and stop
phosphate absorption (take two
hours before or after digoxin)
353.
What kind of diuretic
should be avoided in
patients that have end
stage kidney disease
Loop diuretics
354.
What kind of Antacids
should a patient with
kidney disease avoid
Those containing magnesium
355.
If a patient has a high
creatinine level what
should you assess for in
the urine
Blood
356.
Chapter 61
...
357.
Who is more at risk for
urosepsis women or
men
Aging women due to decreased
estrogen which promotes
atrophy of the urethral opening
towards the rectum
358.
What are subjective
signs/symptoms of a
urinary tract infection
1. Lower back/abdominal
discomfort
2. Urinary frequency/urgency
3. Nausea
4. Dysuria, cramping
5. Urinary retention
6. Perineal itching
7. Hematuria
8. Pyuria (greater than four wbc
in urine sample)
359.
What are objective
signs/symptoms of a
urinary tract infection
1. Fever
2. Vomiting
3. Voiding in small amounts
4. Nocturia
5. Urethral discharge
6. Cloudy/smelly urine
360.
What are older adult
clinical manifestations
of a UTI
1. Mental confusion
2. Incontinence
3. Loss of appetite
4. Nocturia and dyslexia
5. Signs of urosepsis
361.
What are signs of urosepsis
Hypotension
Tachycardia
Tachypnea
Fever
362.
If a patient has a urinary tract infection
what are some things you'd expect to
find in the urine
Bacteria,
sediment, WBCs,
RBCs, positive
leukocyte
esterase and
nitrates
363.
If a patient has a urinary tract infection
what are some things you can
encourage the patient to do to relieve
symptoms
1. Promote fluid
intake up to 3 L a
day
2. Encourage
urination every 3
to 4 hours
instead of
waiting until the
bladder is
completely full
3. Recommend
warm sitz Bath 2
to 3 times a day
to promote
comfort
364.
What are two medications that are
prescribed less frequently for UTIs
because the medicine is less effective
and tolerated
Penicillins and
cephalosporins
365.
If a sulfonamide is prescribed for a
patient with a UTI what should you ask
the patient about?
Allergy to sulfa
366.
What is a bladder analgesic that is used
to treat UTIs
Phenozopyridine
(take with food)
367.
When a patient has a UTI they are
encouraged to drink cranberry juice
because a compound in cranberries
may stop certain bacteria from
adhering to the mucosa of the urinary
tract. Patients who have blank should
avoid cranberry juice, which irritates
the bladder
Chronic cystitis
368.
369.
370.
371.
What are risk factors for pyelonephritis
1. Men over 65
who have
prostatitis and
hypertrophy
of the prostate
2. Chronic
urinary stone
disorders
3. Spinal cord
injury
4. Pregnancy
5. Bladder
tumors
6. Urine pH
increases
7. Chronic
illnesses (DM,
HTN)
Chills, nausea, malaise, fatigue,
burning/urgency/frequency with
urination are all subjective signs and
symptoms of pyelonephritis. What are
two more less obvious symptoms?
Colicky type
abdominal
pain and
costovertebral
tenderness
What are objective signs/symptoms of
pyelonephritis
Fever
Tachycardia
Tachypnea
Hypertension
Flank/back
pain
Vomiting
Nocturia
Asymptomatic
bacteremia
Inability to
concentrate
urine or
conserve
sodium
What are 4 lab values that will be
increased with pyelonephritis nephritis
C-reactive
protein, ESR,
Creatinine
and BUN
375.
Does a diet high in calcium
increase the risk for kidney Stones.
Since the majority of stones are
composed of calcium phosphate
or calcium oxalate
No not unless there is
a pre-existing
metabolic disorder or
renal tubular defect
376.
Who is more at risk for
urolithiasis? Males or females
There is an increased
incidence of
urolithiasis in males
377.
What are four things that
contribute to an environment
favorable for stone formation
Urinary stasis,
urinary retention,
immobilization and
dehydration
378.
What is something that you might
see in a urinalysis of a patient that
has a kidney stone
Crystals
379.
What does KUB stand for
X-ray of kidney,
ureters and bladder
380.
What are things that a nurse
should assess/monitor for any
patient that has kidney stones
1. Pain
2. I and O's
3. Urinary pH
4. Strain all urine
5. Encourage
ambulation to
promote passage of
the stone
381.
According to ATI what should
respiration rate be
12 to 20 breaths per
minute
382.
What are medications given for
kidney stones
Opioids, nSAIDs,
oxybutynin chloride
383.
What are side effects of oxybutynin
chloride
1. Increased
intraocular pressure
(Contraindicated if
there's a history of
glaucoma)
2. Dizziness
3. Dry mouth
4. Tachycardia
5. Urinary retention
384.
Antibiotics such as gentamicin and
cephalexin are used to treat UTIs.
Administer the medication with
food to decrease G.I. distress.
What else should you monitor for
Nephrotoxicity and
ototoxicity. Also
inform the patient
that urine may have a
foul odor related to
the antibiotic
372.
What are complications of chronic
pyelonephritis
Septic shock
Chronic
kidney disease
Hypertension
373.
Although penicillin antibiotics are rarely
used to treat urinary tract infections with
kidney infections this type of penicillin
may be used
Ampicillin
385.
What are two things that are
common after a patient has had
extracorporeal shockwave
lithotripsy
Bruising at the site
where the waves are
applied and
hematuria
374.
Chapter 62
...
386.
If a patient keeps having calcium
phosphate stones what kind of
diet should they be on
Limit intake of food
high in animal
protein, limit sodium,
reduce calcium
387.
What are medications
that are given for
calcium phosphate
stones
Thiazide diuretics,
Orthophosphates,
Sodium cellulose phosphate
388.
If a patient has calcium
oxalate stones what
should their diet be
Avoid: spinach, black tea,
rhubarb, cocoa, beats, pecans,
peanuts, okra, chocolate, wheat
germ, lime peel, Swiss chard and
limit sodium intake
389.
What are medications
for uric acid stones
Allopurinol, potassium or sodium
citrate or sodium bicarbonate
390.
What is hydronephrosis
When a stone has blocked a
portion of the urinary tract
causing the urine to back up into
the kidneys causing distention of
the kidney
391.
Chapter 83
...
392.
Which ethnicities is
diabetes more prevalent
in
African-American, American
Indians and Hispanics
393.
What are risk factors for
diabetes
Obesity
Hypertension
Inactivity
Hyperlipidemia
Cigarette smoking
Genetic history
Elevated CRP
Ethnic group
Women who have delivered
infants weighing more than 9
pounds
BMI greater than 24
394.
What are two things
that the patient can add
to their diet to decrease
the risk of developing
diabetes
Omega-3 fatty acids and fiber
395.
What are clinical
manifestations of
diabetes
Hyperglycemia (blood glucose
level usually greater than 250)
Polyuria
Polydipsia
Polyphagia
Fruity breath
Decreased LOC
Headache
N/V
Seizures leading to coma
396.
Diagnostic criteria for diabetes
include 2 findings (on separate
days) of one of the following
1. Manifestations of
diabetes plus casual
blood glucose
concentration greater
than 200
2. Fasting blood glucose
greater than 126
3. Two hour glucose
greater than 200 with an
oral glucose tolerance
test
397.
How long is a patient instructed
to not eat or drink (other than
water) before a fasting blood
glucose test
Eight hours
398.
How long should a patient fast
for before an oral glucose
tolerance test
10 to 12 hours
399.
What is normal hemoglobin A-1
C range
4 to 6%
400.
How often should the needle in
a continuous infusion pump be
changed
Every 2 to 3 days
401.
Are insulin pens used if more
than one insulin is given
anytime
No
402.
What kind of insulin is Humalog
and NovoLog
Rapid acting, onset is 10
to 30 minutes
403.
What kind of insulin is Humulin
N and detemir insulin
Intermediate acting,
administered for control
between meals and at
night
404.
What kind of insulin is glargine
Long acting,
administered once a day
because it dissipates
slowly over 24 hours
405.
What are manifestations of
hypoglycemia
Mild shakiness
Mental confusion
Sweating
Palpitations
Headache
Lack of coordination
Blurred vision
Seizures
Coma
406.
What are some preventative
measures to avoid
hypoglycemia
Avoid excess insulin,
exercise and alcohol
consumption on an
empty stomach
407.
Blood glucose increases approximately
blank over 30 minutes following
ingestion of blank grams of absorbable
carbohydrate
40 mg/DL, 10
408.
If a patient is unconscious or any able
to swallow how can you administer
glucagon to them
By SQ or IM and
repeat in 10
minutes is still
unconscious
409.
If the patient is in an acute care setting
the nurse should administer blank if IV
access is available and consciousness
should occur within 20 minutes
50% dextrose
410.
When a patient has a blood glucose
level greater than 250 mg/DL they
should restrict
Exercise
411.
What are two things you should
monitor for any patient taking
Metformin
G.I. effects and
lactic acidosis
412.
When should Metformin be
discontinued before anything with
contrast dye
48 hours
413.
What kind of supplements should a
patient be taking that is on Metformin
Vitamin B12 and
folic acid
414.
When should glipizide be taken
30 minutes
before meals
415.
What medication can mask
tachycardia typically seen during
hypoglycemia
Beta blockers
416.
Should diabetic patients use lotion
between the toes after they wash their
feet with mild soap and water
No
417.
When is the best time to perform nail
care
After a shower or
bath
418.
What kind of socks should diabetic
patients wear
Socks made of
cotton or wool
419.
How should a diabetic patient clean a
cut on their foot
With warm water
and mild soap,
gently dry and
apply a dry
dressing
420.
How often should a diabetic patient
monitor their blood glucose when
they're sick
Every 3 to 4
hours
421.
What is the recommended blood
pressure of a patient with diabetes
Less than 130/80
422.
How often should a diabetic patient
get eye and foot exams
Every year
423.
Chapter 84
...
424.
What is
hyperglycemic hyperosmolar
State
An acute, life-threatening condition
characterized by profound
hyperglycemia (above 600) osmolarity
that leads to dehydration and an
absence of ketosis
425.
What are risk
factors for HHS
1. Older adult who has residual insulin
secretion
2. Older adult who has an adequate
fluid intake
3. Older adults who have decreased
kidney function and are unable to
excrete excess of glucose into the urine
4. MI, cerebral vascular injury or sepsis
5. Infection/stress
6. Glucocorticoids, diuretics, Dilantin,
propranolol, CCB
426.
What are clinical
manifestations of
HHS
blurred vision
Headache
Weakness
Polyuria
Polydipsia
Orthostatic hypotension
Change in LOC
Seizures/myoclonic jerking
Reversible paralysis
427.
How does serum
osmolarity look in
HHS
Greater than 320 mOsm/L
428.
How does your pH
look in DKA
Less than 7.3
429.
What is the pH
look like in HHS
Greater than 7.4
430.
What kind of fluids
should be
administered to
patients with DKA
or HHS
Isotonic fluid's such as normal NS
followed with a hypotonic fluid (IV
bolus of insulin)
431.
What should you
do when serum
glucose levels
approach 250
mg/DL
Add glucose to IV fluids to minimize the
risk of cerebral Edema associated with
drastic changes in serum osmolarity
and prevent hypoglycemia
432.
What else should
you monitor a
patient for when
they are in a
diabetic crisis
Hyperkalemia and then hypokalemia
as potassium follows insulin into the
cells
433.
How often should an older adult
patient monitor blood glucose when
they are sick
Every 1 to 4 hours
434.
If a patient who has diabetes would
like to consume alcohol what should
you tell them
Consume
carbohydrates
while drinking
alcohol will help
prevent
hypoglycemia
445.
Blank and blank scans are
more sensitive to
detecting bone problems
than a bone scan. When is
in radionucleotide
injected before the scans
Gallium, Thallium, 4 to 6 hours
446.
During a bone scan does
the patient need to be
sedated
Only if they are unable to lie
still for 30 to 60 minutes
447.
Following the procedure
does the patient need to
take any special
radioactive precautions
No but the patient should be
encouraged to drink plenty of
fluids to increased excretion of
radioisotope
448.
What kind of scan is done
to estimate the density of
a patient's bone mass,
usually in the hip or spine,
and the presence/extent
of osteoporosis
DXA (dual x-ray
absorptiometry)
449.
Is contrast material used
with a DXA scan
No
450.
At what age might a
baseline DXA scan be
performed
40
451.
Why would an
electromyography (EMG)
and nerve conduction
studies be performed
To determine the presence
and cause of muscle weakness
435.
What is PTU
Medication given
to suppress the
thyroid hormone
and will allow for
weight gain
436.
When assessing a patient diagnosed
with diabetes insipidus, the nurse
should expect which of the following
laboratory findings
Increased
hematocrit due to
dehydration
437.
A nurse is monitoring a patient's
status 24 hours after a total
thyroidectomy. What kind of breath
sound would you immediately report
to the provider
Laryngeal stridor
How should the patient take their
medication if they are on thyroid
hormone replacement therapy
On an empty
stomach to
promote proper
absorption
439.
Chapter 68
...
440.
Why is an arthroscopy performed
To visualize the
internal structures
of a joint, most
commonly the
knee or shoulder
joints
452.
How is an EMG performed
Thin needles are placed in the
muscle under study and
attach it to an electrode, which
is attached to oscilloscope.
Electrical activity is recorded
during a muscle contraction
441.
When can an arthroscopy not be
performed
If there is an
infection or if the
patient is unable to
bend the joint at
least 40°
453.
How is a nerve conduction
study performed
442.
How often should you assess the
patient's neurovascular status and
dressing after an arthroscopy
Every hour or per
hospital protocol
Flat electrodes are taped on
the skin. Low electrical
currents are sent through the
electrodes and muscle
response to the stimulus is
reported
454.
Anticoagulants or muscle
relaxants
How often should a patient ice and
elevate extremity after an
arthroscopy
Ice and elevation
should be applied
for 24 hours
What are two medications
that must be avoided
before receiving an EMG or
nerve conduction study
455.
Swelling or tenderness
Bone scans are done when a patient
entire skeletal system is to be
evaluated. A radionucleotide test
involves radioactive material
injected blank before scanning
2 to 3 hours
What are two things that
the patient should report
to the provider after
receiving an EMG or nerve
conduction study
438.
443.
444.
456.
What kind of pain
medication can be
used for patients after
an arthroscopy
Opioid
457.
How long does a DXA
scan last for
Several hours. The radionucleotide
substance is injected and must be
absorbed by the bone prior to the
procedure. The patient must wait
several hours after the injection
before the scan can be completed
458.
During an EMG what
should you ask the
patient to do for an
easier insertion of the
needle into the
muscle
To flex their muscles
459.
Chapter 69
...
460.
What is an
arthroplasty
The surgical removal of a diseased
joint due to osteoarthritis,
osteonecrosis, rheumatoid arthritis,
trauma or congenital anomalies and
replacing it with prosthetics or
artificial components made of Metal
and/or plastic
461.
What are
contraindications to
an arthroplasty
1. Recent or active infection
2. Arterial impairment to the
affected extremity
3. The patient's inability to follow the
post surgery regimen
4. A comorbid condition such as
uncontrolled diabetes or
hypertension, osteoporosis,
progressive inflammatory condition,
unstable cardiac/respiratory
conditions
462.
What should a
patient do to prepare
for arthroplasty the
night before the
surgery
1. Scrub the surgical site with a
prescribed anti-septic soap
2. Wear clean clothes and sleep on
clean linens
463.
What should a
patient do in the
morning to prepare
for an arthroplasty
1. Scrub at the surgical site with a
prescribed anti-septic soap
2. Take antihypertensive
medications as well as other
medications that the surgeon allows
with a sip of water
464.
Prosthetic
components may or
may not be cemented
in place. Components
that do not use
cement allow the
bone to grow into
The prosthesis to stabilize it
465.
If the components are not
cemented when should weightbearing occur
Weight bearing is
delayed several
weeks until the
femoral shaft has
grown into the
prosthesis
466.
A CPM machine may be prescribed
after surgery to promote motion in
the knee and
Prevent scar tissue
formation
467.
When is a CPM turned off
During meals
468.
What position of the patient should
you avoid after an arthroplasty
Positions of flexion of
the knee are limited
to avoid flexion
contractures. Avoid
knee gatch and
pillows placed
behind the knee
469.
How should you position small
blankets or pillows to keep heels
off the bed in efforts to avoid
pressure ulcers
Slightly above the
ankle area
470.
After an arthroplasty opioids as
well as a continuous peripheral
nerve block may be initiated for a
patient. What should you monitor
the patient for in regards to a
continuous peripheral nerve block
Monitor the patient
for systemic effects of
local anesthetic, such
as hypotension,
bradycardia,
restlessness or
seizure
471.
Ice or cold therapy may be applied
to reduce post operative swelling.
Monitor the patients neurovascular
status of the surgical extremity
every blank
2 to 4 hours
(movement,
sensation, color,
pulse, capillary refill
and compare with
the contralateral
extremity)
472.
After a patient has had a hip
arthroplasty what kind of range of
motion exercise should you
encourage
Plantar flexion,
dorsiflexion, and
circumduction to
prevent clot
formation
473.
Early ambulation after a hip
arthroplasty is important. How
should you transfer the patient out
of bed
From the unaffected
side into a chair or
wheelchair
474.
What should you apply to the
surgical site following ambulation
Ice
475.
476.
477.
What is patient
positioning after a
hip arthroplasty
Place the patient supine with the head
slightly elevated and the affected leg in
a neutral position. Place a pillow or
abduction device between the legs
when turning to the unaffected side.
The patient should not be turned to
the operative side, which could cause
hip dislocation
What are four do's
after an
arthroplasty
1. Use elevated seating/raised toilet
seat
2. Use straight chairs with arms
3. Use an abduction pillow, or a pillow,
if prescribed between the patients legs
while in bed
4. Externally rotate a patient's toes
What are four
don'ts after an
arthroplasty
1. Avoid flexion of hip greater than 90°
2. Avoid low chairs
3. Do not cross a patients legs
4. Do not internally rotate a patient's
toes
After a knee
arthroplasty when
can a patient kneel
and deep knee
bend
Unfortunately those are limited
indefinitely
How often should
a patient clean
their incision after
a total hip
arthroplasty
Daily with soap and water
480.
Chapter 70
...
481.
Upper extremity
amputation's are
usually the result
of a traumatic
injury however
lower extremity
amputation's are
usually the result
of
Peripheral vascular disease as a result
of arteriosclerosis
482.
What are signs of
inadequate
peripheral
circulation
Edema
Reduced cap Refill time
Necrosis
Lack of hair distribution
483.
What is the ankle
brachial index
Measures difference between ankle
and brachial systolic pressures
484.
What is a closed
amputation
The most common technique used.
Skin flap is sutured over end of
residual limb, closing site
478.
479.
485.
What is open
amputation
This technique is used when an
active infection is present. Skin
flap is not sutured over end of
residual limb allowing for
drainage of infection. Skin flap is
closed at a later date
486.
When your palpating
the residual limb for
warmth what might
heat indicate
Infection
487.
What do patients often
describe the pain
associated with
phantom pain as
Deep and burning, cramping,
shooting or aching
488.
What are two classes of
medications that some
patients may feel relief
from phantom pain
Anti-spasmodic's and
antidepressants
489.
Other than medications
what are four
alternative treatments
for phantom limb pain
Massage, heat, biofeedback or
relaxation therapy
490.
What should you teach
a patient to do to
reduce phantom limb
pain and prepare the
limb for a prosthesis
To push the residual limb down
toward the bed while supported
on a soft pillow
491.
How should you
position that affected
extremity to promote
bloodflow/oxygenation
Dependent position
492.
What are three things
that you can do to assist
in shrinking the residual
limb for a prosthesis
fitting
1. Wrapping the stump, using
elastic bandages to prevent
restriction of blood flow and
decrease edema (figure 8)
2. Use a stump shrinker suck
3. Use an air splint inflated to
protect and shape the residual
limb
493.
What are four things
that a nurse could do to
prevent the patient
from developing flexion
contractures after an
amputation
1. Range of motion exercises and
proper positioning immediately
after surgery
2. Avoid elevating the stump on a
pillow after the first 24 hours
following surgery
3. Have the patient lie prone for
20 to 30 minutes several times a
day
4. Discourage prolonged sitting in
a chair
494.
Chapter 72
...
495.
496.
497.
498.
499.
At what age does the
remodeling of bone stop
occurring at equal rates
(osteoblastic versus
osteoclastic activity)
30
What is the grading scale for
open fractures
Grade 1: minimal skin
damage
Grade 2: damage includes
skin and muscle contusion
but without extensive soft
tissue injury
Grade 3: damage is
excessive to skin, muscles,
nerves and blood vessels
What is a comminuted
fracture
What is the most common
fracture found in children
What are the three biggest
risk factors for osteoporosis
Has multiple fracture lines
splitting the bone into
multiple pieces
Greenstick: Fracture
occurring on one side but
does not extend completely
through the bone
1. Excessive
exercising/weight loss from
dieting and malnutrition
2. Women who do not use
estrogen replacement
therapy after menopause
3. Patients on long-term
corticosteroid therapy
500.
What are five physical
assessment findings of a
fracture
Crepitus, deformity, muscle
spasms, edema, ecchymosis
501.
What position should a limb
be in after a fracture
Elevated above the heart
and apply ice
502.
How often should
neurovascular checks be
performed when a patient
has a fracture
Every hour for the first 24
hours and then every 1 to
4 hours after
503.
What is a closed reduction
When a pulling force
(traction) is applied
manually to realign the
displaced fractured bone
fragments
504.
505.
What is an open
reduction/internal fixation
When a surgical incision is
made and the bone is
manually aligned and kept
in place with plates and
screws
What is more effective than
splints or immobilizers
because they cannot be
removed by the patient
Casts
506.
What is a spica cast
A portion of the trunk and one
or two extremities
507.
How should you handle
a plaster cast until it is
dry? It can take up to 24
to 72 hours to dry
With the palms, not fingertips
508.
Look at skin traction,
bucks traction and
balanced suspension
skeletal traction
...
509.
How often should you
insure that pulley ropes
are free of knots, fraying,
loosening and improper
positioning
Every 8 to 12 hours
510.
What are two things you
can do to treat muscle
spasms if it is prescribed
Heat, massage
511.
What is a normal
standard pin care
protocol (if the patient
has pins in place)
1. Pin care is provided usually
once a shift, 1 to 2 times a day
2. Chlorhexidine is usually used
and only one cotton tipped
swabs per a pin to avoid crosscontamination
512.
What is external fixation
Involves fracture immobilization
using percutaneous pins and
wires that are attached to a rigid
external frame
513.
What are advantages to
external fixation
1. Immediate fracture
stabilization
2. Minimal blood loss occurring
in comparison with internal
fixation
3. Allows for early mobilization
and ambulation
4. Permitting wound care with
open fractures
514.
What is a disadvantage
to external fixation
Risk of pin site infection leading
to osteomyelitis
515.
What is open reduction
and internal fixation
Refers to visualization of a
fracture through an incision in
the skin and internal fixation
with plates, screws, pins, rods
and prosthetics as needed
516.
How often should you
inspect bony
prominences with an
open reduction and
internal fixation
Every shift and ensure heels are
off the bed at all times
517.
What are the six p's
associated with
compartment syndrome
Pain, paralysis, paresthesia,
pallor, pulselessness and
poikilothermia
518.
Who is at greatest risk for
developing a fat
embolism
Adults between the age of 70
and 80
519.
Fat embolism's usually
occur within blank
hours following a long
bone fracture or with
total joint arthroplasty
48
What are clinical
manifestations of a fat
embolism
Dyspnea
Chest pain
Decreased O2 sat
Decreased LOC
Respiratory distress
Tachycardia
Tachypnea
Fever
Cutaneous petechiae (late sign)
520.
521.
522.
523.
524.
What is treatment for a
fat embolism
1. Maintain the patient on
bedrest
2. Oxygen for respiratory
compromise
3. Corticosteroids for cerebral
edema
4. Vasopressors and fluid
replacement for shock
5. Pain and anti-anxiety
medications as needed
What is the most
common complication
following trauma,
surgery or disability
related to immobility
DVT
What are ways to prevent
DVT
1. Encourage early ambulation
2. Apply antiembolism stockings
3. Administer anticoagulants
4. Encourage intake of fluids to
prevent hemoconcentration
5. Instruct the patient to rotate
feet at the ankles and perform
other lower extremity exercises
as permitted by the particular
immobilization device
What is treatment for
osteomyelitis
1. Long course of IV and oral
antibiotic therapy (3 months)
2. Surgical debridement
3. Hyperbaric oxygen treatment
4. Surgically implanted antibiotic
beads
5. Amputation
525.
If a wound from osteomyelitis is
left open to heal, standard
precautions are adequate and
blank technique can be used
during dressing changes
Clean
526.
What is avascular necrosis
Bloodflow is disrupted
to the fracture site and
the resulting ischemia
leads to tissue/bone
necrosis
527.
Who is at greater risk for
developing avascular necrosis
Patients receiving longterm corticosteroid
therapy
528.
A nurse is completing an
assessment of a patient who had
an external fixation device
applied two hours ago for a
fracture of the left tibia and
fibula. What are four things that
the nurse might find that would
indicate compartment
syndrome?
1. Intense pain when
the left foot is passively
moved
2. Hard, swollen muscle
in the left leg
3. Burning and tingling
of the distal left foot
4. Minimal pain relief
following a second dose
of opioid medication
529.
A nurse in the emergency
department is planning care for
a patient who has a right hip
fracture. What kind of
immobilization device should
the nurse anticipate in the plan
of care?
Bucks traction because
it is a temporary
immobilization device
applied to diminish
muscle spasms and
immobilize the affected
extremity until surgery
is performed
530.
Chapter 77
...
531.
The posterior pituitary gland
secretes the hormone blank
which causes the kidneys to
reabsorb water
ADH (vasopressin)
532.
A deficiency of ADH causes
Diabetes insipidus,
which is characterized
by the excretion of a
large quantity of diluted
urine
533.
Excessive secretion of ADH
causes
Syndrome of
inappropriate
antidiuretic hormone.
In SIADH, the kidneys
retain water, urine
becomes concentrated,
urinary output
decreases and
extracellular fluid
volume is increased
534.
535.
536.
537.
538.
539.
540.
541.
542.
543.
544.
What is the water deprivation test
Measures the
kidneys ability to
concentrate urine in
light of an increased
plasma osmolality
and a low plasma
vasopressin level.
The water deprivation test is
performed for patients who have a
diagnosis of diabetes insipidus. It
should only be conducted if the
patient's baseline serum sodium
level is blank and The osmolality of
the urine is below blank
Within the expected
range, 300
What is a positive result for
diabetes insipidus with the water
deprivation test
The kidneys are
unable to
concentrate urine
despite increased
plasma osmolality
What are preprocedure nursing
actions for the water deprivation
test
1. No
smoking/caffeine or
alcohol prior to test
2. Withhold fluids for
8 to 12 hours
3. Obtain IV access
What position is the patient in
during the test
Recumbent position
for 30 minutes
however The patient
may sit or stand
during voiding.
What is a complication of the
water deprivation test
Dehydration
What is Cushing's disease
(Hypercortisolism)
Hyper functioning of
the adrenal cortex
and an excessive
production of cortisol
What is Addison's disease
Hypo functioning of
the adrenal cortex
and a consequent
lack of adequate
amounts of serum
cortisol
What is a diagnostic test they can
use to determine if a patient has
Cushing's disease
Dexamethasone
suppression test
What is a positive result for
Cushing's disease after doing the
dexamethasone test
There is no decrease
in the production of
ACTH and cortisol
Disorders of the adrenal medulla
may cause
Hypersecretion of
catecholamines
(pheochromocytoma)
545.
The vanillylmandelic acid test is
used to diagnose
pheochromocytoma. How does
this test work
VMA testing is a 24
hour urine collection
for VMA, a breakdown
product of
catecholamines
546.
What is the expected range for
VMA in a 24-hour period
2 to 7 mg
547.
What is a positive result for the
VMA test that indicates
pheochromocytoma
Elevated levels
548.
What kind of food and
medications may be restricted 2 to
3 days before the test
Caffeine, vanilla,
bananas, chocolate,
aspirin and
Antihypertensive
medications
549.
A clonidine suppression test is
where the patients plasma
catecholamine levels are taken
prior to and three hours after
administration of clonidine. What
is a positive result for
pheochromocytoma
The clonidine has no
effect and no
decrease in blood
pressure
550.
What is normal reference range for
fasting blood glucose
Less than 110 mg/dL
551.
How long does the patient need to
abstain from food or fluids other
than water before a fasting blood
glucose test
Eight hours
552.
What is a normal reference range
for the oral glucose tolerance test
Less than 140
553.
How long does a patient need to
fast before the oral glucose
tolerance test
10 to 12 hours
554.
How often are blood samples
taken during the oral glucose
tolerance test
Every 30 minutes for
two hours
555.
What is normal range for HBA1C,
what level indicates pre-diabetes
and what level indicates diabetes
Normal: 5% or less
Pre-diabetes: 5.7% to
6.4%
Diabetes: 6.5% or
higher
556.
What is normal range for T3
70 to 205
557.
What is normal range for T4
4 to 12 mcg/dL
558.
Chapter 78
...
559.
What are risk factors for diabetes
insipidus
1. Head
injury/tumor/infection
(meningitis,
encephalitis)
2. Lithium
560.
What are signs/symptoms of
diabetes insipidus
Polyuria
Polydipsia
Nocturia
Fatigue
And other symptoms of
dehydration
561.
How is the urine chemistry in
diabetes insipidus (PH, sodium,
potassium, specific gravity,
osmolality)
Everything is decreased,
think dilute
562.
How is the serum chemistry in
diabetes insipidus
Think concentrated
everything is increased
563.
What would a
radioimmunoassay show you
Decreased ADH
564.
What kind of drink would a
patient with diabetes insipidus
went to avoid
Anything with caffeine
565.
What should be done daily with
the patient that has diabetes
insipidus
Daily weight
566.
What is an anticonvulsant that
stimulates the release of ADH
Tegretol
567.
What are three side effects of
Tegretol
Dizziness, drowsiness,
thrombocytopenia
568.
What are symptoms of
thrombocytopenia
Sore throat, fever,
bleeding
569.
Should Tegretol be taken with
or without food
With food
570.
Who should vasopressin be
given cautiously to
Patients who have
coronary artery disease
because it can cause
vasoconstriction
What are four teaching points to
a patient that has diabetes
insipidus
1. Weigh daily
2. Eat a diet high in fiber
3. Wear a medical alert
wristband
4. Monitor fluid intake
571.
572.
What are risk factors for
syndrome of inappropriate
antidiuretic hormone
Malignant tumors
Increased intrathoracic
pressure (PPV)
Meningitis
Cardiovascular accident
Medications
Trauma
Pain
Stress
Diuretics due to
increased sodium losses
573.
Early manifestations of SIADH
include
Headache
Anorexia
Muscle cramps
Weakness
Weight gain
574.
As a serum sodium level decreases
in SIADH, the patient begins to
experience personality changes,
hostility, sluggish deep tendon
reflexes and
Nausea, vomiting,
diarrhea and oliguria
575.
Later manifestations of SIADH
include
Confusion
Lethargy
Cheyne-stokes
respirations
Seizures
Coma
Death
576.
What are manifestations of fluid
volume excess
Tachycardia
Possible hypertension
Crackles in the lungs
Distended neck veins
Taut skin
577.
What is urine chemistry in SIADH
Think concentrated
578.
What is blood chemistry in SIADH
Think dilute
579.
What should oral fluids be
restricted to any patient that has
SIADH
500 to 1000 mL/day
580.
What is Demeclocycline
Tetracycline
derivative. Used for
SIADH
581.
With patients taking
demeclocycline monitor for
indications of a yeast infection in
the mouth. What can you do to
decrease the likelihood of this
happening?
Have the patient rinse
their toothbrush with
a diluted bleach
solution and increase
consumption of
yogurt
582.
How does lithium work in SIADH
Blocks the renal
response to ADH
583.
What are signs of lithium toxicity
Nausea, diarrhea,
tremors ataxia
584.
Should lithium be taken with or
without food
With food
585.
During treatment for SIADH if a
patient is receiving hypertonic
saline or loop diuretics how often
should their serum sodium level
be monitored
Every 2 to 4 hours
586.
Chapter 79
...
587.
588.
589.
What do the hormones T3
and T4 do
They affect all body systems
by regulating overall body
metabolism, energy
production, fluid and
electrolyte balance and
controlling tissue use of fats,
proteins and carbohydrates
What is the most common
cause of hyperthyroidism
Graves disease. Autoimmune
antibodies result in
hypersecretion of thyroid
hormones
What are two other causes
of hyperthyroidism
Toxic nodular goiter: caused
by overproduction of thyroid
hormone due to the presence
of thyroid nodules
Exogenous hyperthyroidism:
caused by excessive dosage of
thyroid hormone
596.
What is the medication that can
be administered one hour after
anti-thyroid medication and is
only used for short term
Iodine solutions (mixed
with juice, use a straw
and take the food)
597.
How does radioactive iodine
therapy work
It is taken up by the
thyroid and destroys
some of the hormone
producing cells
598.
How long after radioactive
iodine therapy does a patient
need to stay away from infants
and small children and avoid
becoming pregnant
2 to 4 days and avoid
becoming pregnant for
six months following
therapy
599.
What are four other precautions
that a patient needs to take after
radioactive iodine therapy
1. Do not use the same
toilet as others for two
weeks and flush the
toilet three times after
use
2. Take a laxative for 2 to
3 days after treatment
3. Wear clothing that is
washable and wash
clothes separate from
others
4. Do not share a
toothbrush and use
disposable food service
items such as paper
plates
600.
What should a patient receive 10
to 14 days before a
thyroidectomy to reduce gland
size and prevent excess bleeding
Iodine
601.
After a thyroidectomy what
position should the patient be in
Hi Fowler's and avoid
neck extension
602.
After thyroidectomy how do you
check for laryngeal nerve
damage
By asking the patient to
speak as soon as they
awake from the
anesthesia and every
two hours there after
590.
What are some clinical
manifestations of
hyperthyroidism other
than ones you would
already think of such as
insomnia, tachycardia,
irritability and so on
1. Menstrual irregularities
(Amenorrhea/decreased
menstrual flow)
2. Libido is initially increased
and then followed by a
decrease
3. Exophthalmos (Graves
disease only)
4. Vision changes
5. Bruit over the thyroid gland
591.
If someone was given the
thyrotropin-releasing
hormone stimulation test,
what would be a positive
result for hyperthyroidism
Failure of expected rise in TSH
In the radioiodine uptake
and thyroid scan test,
iodine is administered
orally 24 hours prior to the
test, and then it is
measured. What is a
positive result?
An elevated uptake
593.
One week prior to the
radioiodine uptake test
what should patients
avoid regarding food
Anything that contains iodine
603.
If the parathyroid gland gets
damaged during a
thyroidectomy what will the
patient be needing
Calcium supplements
594.
Thionamides such as blank
and blank are used to
inhibit the production of
thyroid hormone
Methimazole, propylthiouracil
604.
What is usually given after a
thyroidectomy to reduce
postoperative edema
Prednisone
What are side effects of
thionamides
Hypothyroidism
Leukopenia
Thrombocytopenia
Hepatotoxicity
605.
595.
How much drainage should you
expect in the first 24 hours after
a thyroidectomy
50 mL (after the first 24
hours there should only
be scant drainage)
592.
606.
Thyroid storm/crisis results from a
sudden surge of large amounts of
thyroid hormones into the blood
stream, causing an even greater
increase in body metabolism.
Precipitating factors include
Infection
Trauma
Emotional stress
Diabetic ketoacidosis
Digitalis toxicity
Thyroidectomy
607.
What are clinical manifestations of
a thyroid storm/crisis
Hyperthermia
Hypertension
Delirium
Vomiting
Abdominal pain
Hyperglycemia
Tachydysrhythmias
Dyspnea
608.
If a patient is having a thyroid
storm you can administer
propylthiouracil to prevent further
release of thyroid hormones. You
can then administer iodine one
hour after. Why not give it before
Because if it is given
before it can
exacerbate
manifestations in
susceptible clients
609.
What are two things to look for as
an indicator of hypocalcemia
Chvosteks and
trousseau sign
610.
A nurse in a providers office is
reviewing the health record of a
patient who is being evaluated for
graves disease. What is an expected
laboratory finding for this patient?
Decrease in TSH
because the
pituitary gland
decreases the
production of TSH
when thyroid
hormone levels are
elevated
611.
Chapter 80
...
612.
What are risk factors for
hypothyroidism
1. Women between
the ages of 30 to 60
2. Lithium and
amiodarone
3. In adequate
intake of iodine
613.
What are some early findings of
hypothyroidism
Fatigue/lethargy
Intolerance to cold
Constipation
Weight gain
Pale skin
Thin, brittle nails
Depression
Thinning hair
Joint and/or muscle
pain
614.
What are late manifestations of
hypothyroidism
Bradycardia
Hypotension
Dysrhythmias
Slow thought
process/speech
Hypoventilation
Thickening of the
skin
Dry flaky skin
Swelling in face,
hands and feet
Decrease acuity of
taste and smell
Horse, raspy
speech
Abnormal
menstrual periods
615.
What kind of diet should a patient
with hypothyroidism be on
Low-calorie, high
bulk diet and
encourage activity
to prevent
constipation and
promote weight loss
616.
What is the medication of choice for
thyroid hormone replacement
therapy
Synthroid
617.
What are three medications that
Synthroid increases the effects of
Coumadin
Insulin (need for it)
Digoxin
618.
What type of medications decrease
the absorption of Synthroid
PPI's and H2
antagonist
619.
When should Synthroid be taken
1 to 2 hours before
breakfast
620.
What is a severe complication of
hypothyroidism
Myxedema
621.
A nurse any providers office is
reviewing the laboratory findings of
a patient who's being evaluated for
primary hypothyroidism. What is
expected a laboratory finding for
this patient?
Hematocrit 34%
which indicates
anemia, which is an
expected result for
patient who has
hypothyroidism
622.
What kind of laxative can a patient
not take when they are on Synthroid
Fiber laxatives
because it
interferes with
absorption
623.
Chapter 81
...
624.
What are causes of
Cushing's syndrome
Organ transplant
Chemotherapy
Autoimmune diseases (rheumatoid
arthritis)
Asthma
Long-term use of glucocorticoids
625.
What are some
signs/symptoms of
Cushing's disease
Weakness/fatigue
Back/joint pain
Decreased immune system
Bruising/petechiae
Hypertension
Tachycardia
Gastric ulcers
Weight gain
Hypervolemia
Hirsutism
What are expected
findings in
laboratory test
associated with
Cushing's disease
ATCH: increased
Cortisol: increased
Serum K/Ca: decrease
Serum glucose: I
Serum sodium: I
Lymphocytes: D
627.
Chapter 82
...
628.
What is Addison's
disease
An adrenocortical insufficiency. The
production of mineralocorticoids and
glucocorticoids is diminished resulting
in decreased aldosterone and cortisol
629.
What are some risk
factors for
Addison's disease
Autoimmune dysfunction
TB
Cancer
Adrenalectomy
Sepsis
Trauma
Steroid withdrawal
What are some
clinical
manifestations of
Addison's disease
Weight loss
Craving for salt
Hyperpigmentation
Severe hypotension
Dehydration
Hyponatremia
Hyperkalemia
Hypoglycemia
Hypercalcemia
626.
630.
631.
What would
laboratory values
be in a patient that
has Addison's
disease
632.
Hydrocortisone,
prednisone and
cortisone are all
glucocorticoids used
for Addison's disease.
How should this
medication be taken?
With food
633.
What is a potential
adverse side effects of
the mineralocorticoid
fludrocortisone
Hypertension and dosage may
need to be increased during
periods of stress or illness (One the
patient to expect mild peripheral
Edema)
634.
What is addisonian
crisis
An acute adrenal insufficiency
occurs when there is an acute
drop in adrenocorticoids due to
sudden discontinuation of
glucocorticoid medications or
when induced by severe trauma,
infection or stress
635.
What is treatment for
addisonian crisis
1. Administer insulin to move
potassium into the cell
2. Administer calcium and
kayexalate to counteract the
effects of hyperkalemia
3. Establish an IV line and initiate a
rapid infusion of NS
4. Loop or thiazide diuretics are
used to manage hyperkalemia
5. Administer hydrocortisone as
replacement therapy
636.
In the presence of
primary adrenal
insufficiency, plasma
cortisol levels blank in
response to the
administration of
ACTH
Do not rise
637.
Chapter 3
...
638.
What is the best
possible score for the
Glasgow coma scale
15
639.
What do the other
possible scores for the
Glasgow coma scale
indicate
1. Less than eight: associated with
severe head injury and coma
2. 9 to 12: indicate a moderate
head injury
3. Greater than 13: reflect minor
head injury
640.
What are the three
things that the
Glasgow coma scale
uses to determine the
score
Eye-opening, verbal and motor
response
Bun/creatinine: I
Serum glucose: D
Serum cortisol: D
641.
What is the
positioning for
a lumbar
puncture
Either the cannonball position or have the
patient stretch over and over bed table if
sitting is preferred
642.
Chapter 5
...
643.
What kind of
meningitis is
common
among
patients who
have AIDS
Fungal
What is the
haemophilus
influenza type
B vaccine
A vaccine for infants against bacterial
meningitis
What is
pneumococcal
polysaccharide
vaccine
For adults 65 years and older who have
not been previously vaccinated nor have
history of the disease (for adults or
immunocompromise, have a chronic
disease, who smoke cigarettes or live in a
long-term care facility)
What is the
meningococcal
vaccine
For adolescence to receive prior to living in
a residential setting in college and for those
in the military
What are risk
factors for viral
meningitis?
Also there's no
vaccine against
viral
Mumps, measles, herpes and west Nile
virus
What are some
subjective
signs of
meningitis
Excruciating, constant headache
Nuchal rigidity
Photophobia
649.
What are some
objective
physical
assessment
findings of
meningitis
Fever and chills
N/V
Altered LOC
Positive Kernig's sign
Positive Brudzinski's sign
Hyperactive deep tendon reflexes
Tachycardia
Seizures
Red macular rash
Restlessness/irritability
650.
What is the
most definitive
diagnostic
procedure for
meningitis
CSF analysis
644.
645.
646.
647.
648.
651.
What results from the
CSF analysis and lab
values would be
indicative of
meningitis
1. Appearance of CSF: cloudy
(bacterial) or clear (viral)
2. Elevated WBC
3. Elevated protein
4. Decreased glucose (bacterial)
5. Elevated CSF pressure
652.
What kind of
precautions is a
patient with
meningitis placed on
Isolation/droplet precautions, which
requires a private room
653.
What position should
a patient with
meningitis be in, in
bed
Head of bed elevated 30°
654.
Chapter 6
...
655.
What is a myoclonic
seizure
A brief jerking or stiffening of the
extremities which may be
symmetrical or asymmetrical
656.
What is an atonic
seizure
Characterized by a few seconds in
which muscle tone is lost. The
seizure is followed by a period of
confusion
657.
What is one antielliptic drug
Phenytoin (decreases effectiveness
of oral contraceptives)
658.
What is a medication
that should not be
given with phenytoin
Warfarin
659.
What is a vagal nerve
stimulator
A device implanted into the left
chest wall and connected to an
electrode placed on the left vagus
nerve
660.
How does a vagal
nerve stimulator
work
It is programmed to administer
intermittent stimulation of the brain
via stimulation of the vagal nerve, at
a rate specific to the patients needs
661.
In addition to routine stimulation,
the patient may initiate vagal nerve
stimulation by holding a blank over
the implantable device, at the onset
of seizure activity. This either aborts
the seizure or lessons it's severity
Magnet
662.
What is status epilepticus
characterized by
A prolonged seizure
activity occurring
over a 30 minute
time frame
663.
Chapter 7
...
664.
Parkinson's disease is a progressively
debilitating disease that grossly
affects motor function. It is
characterized by four primary
symptoms which are
Tremor, muscle
rigidity,
Bradykinesia and
postural instability
(dopamine is
decreased)
665.
How's your patience Parkinson's eat
their food
1. Provide smaller,
more frequent
meals
2. Add commercial
thickener to thicken
food
3. Patients should
be weighed at least
weekly
666.
Medications such as blank, are
converted to dopamine in the brain,
increasing dopamine levels in the
basal ganglia
Levodopa
667.
Dopaminergics May be combined
with blank, to decrease peripheral
metabolism of levodopa requiring a
smaller dose to make the same
amount available to the brain. Side
effects are subsequently less
Carbidopa
668.
What is stereotactic pallidotomy
Destruction of a
small portion of the
brain within the
Globus pallidus
through the use of
brain imaging and
electrical stimulation
669.
Any patient that receives deep brain
stimulation should be monitored
for what afterwards
Infection, brain
hemorrhage,
neurological
impairment or
stroke like
symptoms
670.
What are two complications of
Parkinson's disease
Aspiration
pneumonia and
altered cognition
such as dementia
671.
Chapter 10
...