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signs and symptoms of hemorrhage

Decreased BP; increased pulse rate; increased respirations; restlessness; diaphoresis; cold, clammy skin

true

If acetylcholine is not inactivated; there is hyperstimulation of the nerve endings true or false

risk for septic shock

PICC line, long term foley catheter use

Asystole

absence of contractions of the heart

pneumothorax

accessory muscle use, chest pain, shortness of breath, absent or diminished breath sounds

Chvostek sign

*indicator of hypocalcemia* twitching of facial muscles elicited by tapping on facial nerve

mechanical valve replacement

-long lasting -will require anticoagulation long term

neurogenic shock

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries.

Assess peripheral pulses

If burns are on the thigh & knees; during the dressing change, what is a priority nursing action?

hemodynamic instability

What is the first systemic even after a burn?

carbon dioxide narcosis and hypoxemia

Using oxygen may result in the client developing

mitral stenosis treatment

anticoagulants

anthrax priority

assess respiratory status

chest tube

set to 20

beta adnergic blocker

A client is diagnosed with systolic heart failure. What medication should the nurse anticipate administering?

daily aspirin

A client who is at high-risk for a cerebrovascular accident has medication ordered to lower their cholesterol and to prophylactically anticoagulate them. What specific agent might be diagnosed for this client?

oxygen toxicity

A condition of excessive oxygen consumption resulting in cellular and tissue damage.

compartment syndrome

For a client in hypovolemic shock (after a postpartum bleed); what serious complication should the nurse monitor?

repolarization

Return of the cell to resting state, caused by reentry of potassium into the cell while sodium exits the cell.

Hypophosphatemia

TPN must be delivered slowly in order to prevent

Depolarization

The process during the action potential when sodium is rushing into the cell causing the interior to become more positive.

friction rub

What breath sounds are consistent with pericarditis?

Combination of hydralazine and isosorbide dinitrate

What combination of drugs should be used for systolic heart failure if ace inhibitors caused a reaction?

Insertion of an implantable cardioverter defibrillator

What intervention can assist with severe left ventricular dysfunction?

patient controlled analgesia

What is the best way to assist with managing uncontrolled pain in a burn injury?

Position the client in the prone, left lateral position

What is the most appropriate action if you suspect an air embolus?

atropine

What medication should be administered after exposure to a nerve agent?

mitral stenosis

What valve disorder corresponds with pulmonary venous hypertension?

assess the client's skin

When using restraints, you should frequently

What does specific gravity measure?

concentration of urine and fluid volume status

safety assessment

do you feel safe at home

decrease pulmonary embolism risk

early ambulation

first step in emergency care

establish open airway

NC O2

for a patient immediately post-op with SOB

venturi mask

for reliable & precise oxygen therapy

enteral nutrition

giving nutrients into the gastro-intestinal tract through a feeding tube

Cardiac Catheter

is usually done to assess how blocked or open a client's coronary arteries are.

pulmonary artery catheter

left ventricular preload

hemodyalisis

may increased the risk of hospital acquired endocarditis

suicide assessment

plan? means available to carry out plan? how lethal is plan? Can you control your behavior and refrain from acting on suicidal thoughts and impulses? SI is highest priority for nurse SI passive (thoughts with no intent to act) vs active (has plan and thoughts)

sympathetic reaction

stimulates the renin-angiotensin aldosterone system

should rise and fall with respirations

the water level in a chest tube

bubbling

what indicates a leak in the water seal chest tube

12 hour fast

what is the best time to do a lipid profile


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