Adult Health 2 Exam 2

What can LPNs not do?

- Assessment - Initial teaching - No central lines or blood transfusions

Nursing interventions with TPN?

- Bag should only hang 24 hours - Tubing/filter needs to be changes every 24 hours if lipids are in the bag, or 72 hours if there are no lipids - If TPN is completed before the new bag arrives, standard 5% dextrose solution should be hung

Causes of sinus bradycardia?

- Can be normal for some people (such as those who are very active like trained athletes) - Parasympathetic stimulation of the vagus nerve can also slow HR

S/S of decreased cardiac output?

- Decreased urine output - Lightheadedness - Fatigue

Patient teaching/interventions for myocarditis?

- Elevate HOB/tell the patient to sit up - Bed rest with restricted activity - Oxygen therapy

Nursing interventions for infective endocarditis?

- FIRST: obtain blood cultures - Give IV fluids and Tylenol for fever - Give antibiotics as ordered - Check peaks and troughs for antibiotics

Treatment for a-fib, what's the first line therapy and additional drug therapy?

- First line: rate control (metoprolol, beta blockers, digoxin, CCBs) - Then anticoagulation (Warfarin)

Treatment for DVT. How do the medications work?

- Heparin/lovenox is given initially because it works immediately to begin dissolving the clot and thinning the blood - Coumadin will be started/overlapped because it takes several days to begin preventing clots

Elevated level associated with liver cirrhosis? Treatment for it?

- High ammonia levels - Give lactulose to help them poop and remove ammonia from the body

Teaching for client with cirrhosis and ascites?

- High risk for bleeding due to decreased clotting factors - Teach to measure waist circumference and weight regularly - Follow a low sodium diet

What increases risk for cardiovascular conditions?

- Hypertension - High cholesterol (LDL) - Smoking (increases risk for aneurysm) - Collagen or connective tissue disorders

Nutrition for hepatitis health promotion?

- Increase protein, healthy fats, whole grains, and fruits and vegetables - Avoid alcohol

Labs/diagnostics associated with acute pancreatitis

- Increased amylase and lipase - Decreased serum calcium

Patient teaching for pancreatitis?

- Initially NPO to reduce pancreatic secretions - Avoid caffeinated beverages - No alcohol - Bland food (high carb) - Small, frequent meals - Monitor blood sugar if diabetes has developed

S/S of peripheral artery disease?

- Intermittent claudication - Dry, scaly, pale, or mottled skin - Cold or numb feet at rest - Loss of hair on the lower legs - Diminished or absent pedal, popliteal, or femoral pulses - Pain at rest aggravated by elevation

Nursing care for enteral nutrition/tube feeding?

- Keep at a 30-degree angle or higher when receiving feeding - Check residuals every 4-6 hours and before feeding starts - Stop feeding 30-60 minutes before any procedure where they may be laying down to prevent aspiration

S/S of chronic venous insufficiency?

- Leathery and brownish colored lower extremities - Eczema and itching - Edema - Increased skin temp in the ankle area - Pain

Self-care measures for patient with heart failure?

- Limit fluids - Limit sodium to less than 2 g per day - Monitor daily weight - Report cough if taking ACE inhibitors

Which individuals/ethnicities are at highest risk for developing heart failure?

- Males - African Americans - Those with family history - Advancing age

People/ethnicities at high risk for pancreatic cancer?

- Men - African Americans - Advancing age - Smokers - Diabetes - High fat diet - Family history

Nursing interventions for acute pancreatitis?

- Monitor blood sugar - Pain relief (demerol or morphine sulfate) - Give fluids (lactated ringers) - Keep NPO - Watch for seizures or muscle spasms due to hypocalcemia - Monitor for respiratory infections - Assess for leaks following pancreatectomy

Post op teaching for cholecystectomy-diet, pain control

- NPO until they can take water - Liquids and light foods for a few days (nutritious, low-fat diet) - Check blood sugar - Can walk to reduce abdominal pain from bloating - Increase water and fiber

Treatment for pericarditis pain?

- Oral ibuprofen (because the pain is caused by inflammation) - IV Toradol (another anti-inflammatory) - Bed rest with raised HOB

S/S of Crohn's?

- Pain - Diarrhea - Vomiting - Fever

S/S of pericarditis?

- Pericardial friction rub - Frequent sharp chest pain that is worse with deep inspiraton and when lying supine - Jugular vein distention

Hepatitis disease prevention and health promotion teaching

- Promote adequate nutrition and a well-balanced diet - Ensure adequate hand-washing to prevent fecal-oral transmission - Hep A and B vaccinations - Keep follow-ups for liver function testing

What are the signs and symptoms of worsening heart failure and CHF?

- Pulmonary congestions (cough, crackles and wheezes, blood-tinged sputum) - Severe SOB - Weight gain - Paroxysmal nocturnal dyspnea

What is a low sodium diet? What foods would you teach the patient to avoid?

- Restricted to 2 g per day - Processed foods should be avoided because they have lots of sodium

S/S of worsening endocarditis?

- Signs of infection (fever, chills, weakness) - New onset or worsening murmur - Splinter hemorrhages, Janeway lesions, Osler's nodes, or Roth spots - Petechiae

Patient teaching after laparoscopic cholecystectomy

- They will have 1-4 small puncture holes in the abdomen - Take showers not baths - Drink lots of water - May resume work in 1 week - Notify MD if fever greater than 101 persists 1-day post-surgery - May have bloating (walk around to pass gas)

Treatment for sinus bradycardia?

- Transcutaneous pacer pads - Atropine (blocks parasympathetic influence on the heart)

What is sclerotherapy? How is it performed?

- Treats varicose veins - Performed by inserting a needle of saline in the vein to decrease the size

What self-care teaching would you provide for patients with chronic venous insufficiency?

- Use stockings, velcro wrap, elastic tubular support bandages, etc. - Flex and extend the lower extremities if sitting or standing for long periods of time - Maintain glucose levels in diabetics - Diet high in protein, vitamin A and C, and zinc

Temporary pacemakers- What are they used for? Where and how are they placed?

- Used to treat bradydysrhythmias when the condition is temporary and when a permanent pacemaker is either not necessary or not immediately available - Attached to the epicardium during open-heart surgery

Cause of infective endocarditis?

- Usually the result of an infection elsewhere in the body (like strep or staph) - A preexisting heart disease (such as damaged valves due to rheumatic disease) - Or an abnormal immune reaction

Patient teaching/nursing interventions for mechanical valve replacement- how to prevent complications?

- Will need to be on anticoagulents - Will need lab monitoring if on lifelong Warfarin (PT/INR) - Make sure to teach about taking prophylactic antibiotics when having dental procedures because of the risk of infective endocarditis

2000 mL at 100 mL/hr, gtt is 10, how many gtt/min? Round to the nearest whole number

17 gtt/min

Nurse is administering 1000 mL of LR over 9 hours using macro drip tubing (12 gtt/mL). What is the drop rate (gtt/min)? Round to the nearest whole number

22 gtt/min

The healthcare provider has prescribed ertapenem 4 mg/kg/day in 2 divided doses. The client weighs 264 lb. How many mg/dose should the client receive?

240 mg

Your client is prescribed vancomycin 2 mg/kg/day divided in 4 doses. The client weighs 189 lb. How many mg/dose of the medication should the client receive? Round to the nearest whole number.

43 mg

Your client is ordered an IV drip at 4 mcg/kg/minute. The client weighs 246 lb. You have a bag of the medication that reads 150 mg/300 mL. How many mL/hour will you administer? Round to the nearest tenth.

53.7 mL/hour

Your medication order reads: give 1000 mg of gentamycin in 500 mL of normal saline over 90 minutes. Your gtt is 15. What is the gtt/min? Round to the nearest whole number.

83 gtt/min

The flu vaccine should be encouraged for individuals with what cardiac problems?

All cardiac problems! Select all options with heart problems

If your client develops sinus bradycardia, is hypotensive, and c/o feeling faint, what would be your first action?

Apply transcutaneous pacemaker pads (TCP is a temporary means of pacing a person's heart during an emergency to stabalize the patient until a more permanent means of pacing is achieved

Causes of sinus tachycardia?

Associated with physiological stressors: Exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, MI, HF, hyperthyroidism, anxiety, fear, too much caffeine

What is the most common cause of pancreatitis?

Autodigestion of the pancreas

Teaching for client with new pacemaker

Avoid lifting and ROM of the arm on the side of placement to avoid lead displacement, need to wait at least 2 weeks then get cleared by the MD

If a client is admitted with cirrhosis and vomiting, what do you need to assess?

BP, HR, and respirations

Where do you listen for a pericardial friction rub?

Best heard with the stethoscope diaphragm placed at the lower left sternal border of the chest, you can also have the patient hold their breath

If the patient comes in with severe pain from their gallbladder and suddenly the pain disappears, what do you need to do?

Call the MD immediately because their gallbladder has ruptured

Patient teaching about ACE inhibitors- what needs to be reported?

Cough

Pathophysiology of chronic venous insufficiency?

Damage to the veins results in backward blood flow, pooling of blood in the legs, and swelling

Signs and symptoms of worsening aortic stenosis?

Decreased CO will affect all organs: - Decreased LOC/syncope due to decreased blood flow to the brain - Kidneys will be affected as well

What do you need to educate patient's with heart failure to report to their MD?

Educate about the importance of daily weights: report weight gain of 3 lb over 2 days or 3-5 lb over 1 week

What can you tell patients with varicose veins to do to help with the pain?

Elevate the legs

Know transmission of all types of hepatitis

Hep A - contaminated food Hep B - sexual transmission Hep C - Blood (but not through blood transfusion) Hep E - fecal-oral

Treatment for infective endocarditis?

Identify the causative organism then give IV antibiotics

S/S of esophageal cancer?

If varices burst in the esophagus they will start coughing up blood (coughing up blood is always a concern, check on this patient first!)

Patient teaching for PAD?

Inform the patient that they should avoid using heating pads on their lower extremities because they do not have good sensation, so they are at high risk for burns

If someone has been exposed to Hep A, what should you advise them?

Make sure the others living in the household get the vaccination

The nurse is caring for a client with hepatic encephalopathy who has an ABG result of: pH 7.53, pO2 95 mmHg, pCO2 50 mmHg, HCO3 37 mEq/L. The nurse should interpret the ABG as what?

Metabolic alkalosis

Education for patients with a-fib?

Need to educate these patients that they will be started on coumadin (Warfarin) to prevent embolization of clots from the atria

Pathophysiology of peripheral artery disease?

PAD results from atherosclerosis (gradual thickening of the arterial wall) which results in progressive narrowing and degeneration of the arteries, this causes a decrease in blood flow to the distal extremities which can lead to tissue damage

Signs and symptoms of B1 (thiamine) deficiency?

Paresthesia - numbness and tingling (usually occurs with alcoholic cirrhosis)

What is an atrial flutter?

Regular atrial rhythm that is 200-350 bpm

Patient teaching for home parenteral nutrition?

Report fever, chills, N/V, or malaise

What are abdominal adhesions?

Scar-like tissue, build-up of tissue on the abdominal wall

Abnormal findings post-cholecystectomy?

Signs of infection: redness, swelling, bile-colored drainage/pus, severe abdominal pain, N/V, fever, chills (Fever 100 F or higher past 24 hours needs to be reported)

Which precautions are used for hepatitis?

Standard precautions (just gloves) should be used for bloodborne pathogens like hepatitis

What would be the issue with a heart failure patient taking cough medicine?

Taking cough medicine could hide the fact that their cough is a sign of worsening HF

If you have a patient complaining of SOB and cough, and they report they are taking cough medicine to control the cough, what do you need to educate them about?

The cough could be an indication of worsening heart failure

How do collagen disorders increase risk for cardiovascular conditions?

The tissues are weak so they are at greater risk for aneurysm and rupture

What causes syncope due to worsening aortic stenosis?

The valve is getting so narrow and tight that blood flow to the brain is restricted causing the patient to pass out

If a person's serological viral hepatitis is negative, what do you look for?

Think about other hepatitis causes such as OTC (NSAIDs)

If you have a patient whose heart monitor is showing 130 but they are apneic and you don't feel a pulse, what should you do?

Trust your hands, you need to do CPR

If you have a client who develops atrial flutter and c/o chest pain and SOB, what would be your first action?

Your first action would be to apply oxygen via nasal cannula (This is the first step in the dysrhythmia protocol)

A nurse is preparing to administer medications to a client who is NPO receiving enteral feedings through an NG tube. Which of the following prescriptions should the nurse clarify with the provider? a) Aspirin EC 325 mg per NG tube daily b) Atorvastatin 40 mg per NG tube daily c) Propranolol 20 mg per NG tube daily d) Sucralfate 2 g oral suspension per NG tube BID

a) Aspirin EC 325 mg per NG tube daily (enteric-coated tablets should not be crushed so they cannot be administered via NG tube)

A nurse is reviewing the medical record of a client who has heart failure. Which of the following findings should the nurse expect? a) BNP of 200 b) Bradycardia c) Fluid restriction of 3 L per day d) 4 g sodium diet

a) BNP of 200 (client with HF will have an elevated BNP level of >100)

A nurse is caring for a client with cirrhosis. Which of the following medications can the nurse expect to administer to this client? Select all that apply a) Diuretic b) Beta-blocking agent c) Opioid analgesic d) Lactulose e) Sedative

a) Diuretic (liver cirrhosis impacts kidneys and filtration) b) Beta-blocking agent (for portal hypertension) d) Lactulose (to get rid of ammonia)

A nurse is providing discharge teaching to the partner of a client who has a new diagnosis of Hepatitis A. Which of the following instructions should the nurse include in the teaching? a) Encourage her to eat foods high in carbs b) Have her perform moderate exercise to restore her strength more quickly c) During the illness, she may take Tylenol for fever or discomfort d) The provider will prescribe medication to help her liver heal faster

a) Encourage her to eat foods high in carbs (diet should be high in carbs and calories with only moderate amounts of protein and fat, especially if nausea is present)

A nurse in a provider's office is assessing a client who has GERD. The nurse should expect the client to report which of the following manifestations? Select all that apply. a) Regurgitation b) Nausea c) Belching d) Heartburn e) Weight loss f) Abdominal pain

a) Regurgitation b) Nausea c) Belching d) Heartburn f) Abdominal pain (clients with GERD rarely experience unplanned weight loss)

Which of the following are signs and symptoms of worsening heart failure? Select all that apply. a) Weight gain of 6 pounds per week b) Worsening or new onset of cough c) Hypotension d) Increased SOB e) Confusion f) Increased urine output

a) Weight gain of 6 pounds per week b) Worsening or new onset of cough d) Increased SOB e) Confusion

A nurse is completing dietary teaching with a client who has heart failure and is prescribed a 2 g sodium diet. Which of the following statements by the client indicates an understanding of the teaching? a) I should use salt sparingly while cooking b) I can have yogurt as a dessert c) I should use baking soda when I bake d) I should use canned vegetables instead of frozen

b) I can have yogurt as a dessert

A nurse is caring for a client who has a PEG tube and is receiving intermittent feedings. Prior to initiating the feeding, which of the following actions should the nurse take first? a) Flush the tube with water b) Place the client in semi-fowler's position c) Cleanse the skin around the tube site d) Aspirate the tube for residual contents

b) Place the client in semi-fowler's position

A nurse is planning care for a client who has cholelithiasis. Which of the following interventions should the nurse include in the plan? a) Restrict the client's fluid intake b) Restrict the client's calcium intake c) Decrease the client's fat intake d) Decrease the client's potassium intake

c) Decrease the client's fat intake (to reduce the occurrence of biliary colic)

A nurse in a clinic is assessing the lower extremities and ankles of a client who has a history of peripheral artery disease. Which of the following findings should the nurse expect? a) Pitting edema b) Areas of reddish-brown pigmentation c) Dry, pale skin with minimal body hair d) Sunburned appearance with desquamation

c) Dry, pale skin with minimal body hair

A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse expect? a) Hepatomegaly b) Pitting peripheral edema c) Jugular vein distention d) Crackles in the lung bases

d) Crackles in the lung bases

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? a) Pain in the right upper quadrant radiating to the right shoulder b) Report of pain being worse when sitting upright c) Pain relieved with defecation d) Epigastric pain radiating to the left shoulder

d) Epigastric pain radiating to the left shoulder

A nurse is monitoring the lab results of a client who has end-stage liver failure. Which of the following results should the nurse expect? a) Decreased lactate dehydrogenase b) Increased serum albumin c) Decreased serum ammonia d) Increased prothrombin time

d) Increased prothrombin time (clients who have end-stage liver failure have an inadequate supply of clotting factors and increased prothrombin time; all other levels are backwards)