Evolve HESI 1

Stages of Health Policy Process

(agenda setting) 1) policy formulation-identifying goals, problems, and potential solutions 2) policy adoption-authorized selection and specification of means to achieve goals, resolve problems, or both 3) policy implementation-adoption and occurs when the policy is put to use 4) policy evaluation-compares policy outcomes or effects with the intended or desired effects

Diabetic Ketoacidosis (DKA)

-Shortage of insulin resulting in hyperglycemia and production of ketones -a complication of diabetes that is caused by having too little insulin; also called hyperglycemia -A form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available.

Romberg test

-ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed -stand to the side of the client -expected finding: client should be able to stand with minimal swaying for at least 5 seconds

National Organ Transplant Act (NOTA)

-forbids the purchase or sale of organs -protects the donors estate from liability for injury or damage that results from the use of an organ

Max volume of an IM injection recommended for a newborn/infant?

0.5 mL

Max volume of an IM injection recommended for a preschool aged child?

1 ml

Nursing Diagnostic Process

1. Assessment of patient's health status 2. Validate data with other sources 3. Defining characteristics 4. Interpret and analyze meaning of data 5. Cluster data 6. Identify patient's needs 7. Formulate nursing diagnosis

Stages of Life (Erikson)

1. Trust v Mistrust 2. Autonomy v. Shame and Doubt 3. Initiative v. guilt 4. Industry v. inferiority 5. Identity v. role confusion 6. intimacy v isolation 7. Generativity v stagnation

steps of EBP process (0-6)

1. ask PICOT question 2. search and collect best/most relevant evidence 3. critically appraise evidence 4. integrate evidence w/ own clinical expertise and patient preferences and values in making a practice decision or change 5. evaluate outcomes of the change 6. disseminate outcomes of evidence-based change

Nursing Judgment- Critical thinking levels

1. basic critical thinking 2. complex critical thinking 3. commitment

In adolescents, the maximum length for insertion of an enema tube is ?

10 cm

In infants, the volume of solution required for an enema is:

150-250 mL warmed solution

Max volume of an IM injection recommended for school aged and older children?

2.0 mL with sufficient muscle mass

Normal RPM for adolescents and adults

20 rpm

Normal Potassium Level

3.5-5.0 mEq/L

Which RR would the nurse expect for a 2 year old/ toddler?

30 rpm (25-32 rpm)

Elisabeth Kubler-Ross five stages of grieving

5 stages of grief: 1. deny 2. anger 3. bargain 4. depressed 5. accept

In adolescents, the volume of solution required for an enema is:

500-750 mL

which blood glucose levels would the nurse identify as hypoglycemia?

72 - 108 in adults is normal less than 72 = hypoglycemia

The peak of NPH insulin is when?

8 to 12 hours after administration

Common law

A legal system based on custom and court rulings

Trans bronchial biopsy

A pulmonologist performs a diagnostic bronchoscopy with biopsy. The endoscope was introduced into the bronchus, and attachments were used to perforate the bronchial wall. Tissue was obtained and submitted to the pathologist, who identified it as "lung parenchyma." What type of biopsy was performed?

Conversion Disorder

A rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found.

temporal lobe

A region of the cerebral cortex responsible for hearing and language.

occipital lobe

A region of the cerebral cortex that processes visual information

Prescriptive Theory

A theory that gives specific directions on how an organizational form should best be created and managed. action oriented

induration

Act of hardening; a specific area of hardened tissue

Which gland secretes androgens, corticosteroids, and catecholamines?

Adrenal gland

HIV positive patients are protects by which act?

Americans with disabilities act

Autoantibodies

Antibodies produced by B cells that mistakenly attack and destroy "self" cells belonging to the patient; autoantibodies are the pathophysiologic agent of most autoimmune disorders

Which condition is contraindicated for Valerian?

Cardiac Disease

DKA s/s

D-ehydration K-etones in urine/blood, Kussmauls and K+ A-cidosis, Acetone breath, Anorexia d/t nausea

Which condition is contraindicated for St. John's Wort herbal therapy?

Dementia (St. John's Wort is used to treat anxiety) other contraindicated for st. johns: schizophrenia, bipolar depression, Alzheimer's

Kohlberg's Theory of Moral Development

Developing children progress through a predictable sequence of stages of moral reasoning (preconventional, conventional, postconventional).

Privacy Level

Environmental Factors between nurse and patient

SVT (supraventricular tachycardia)

Episodes of abnormally fast/racing heartbeat - 150 - 250 bpm

syncopal episode

Fainting; brief loss of consciousness caused by transiently inadequate blood flow to the brain.

Which body region is most at risk for pressure injury when the client is in side lying position?

Greater trochanter

hypercarbia

Increased carbon dioxide level in the bloodstream. -hypoventilation

Calcitonin (CT)

Inhibits the breakdown of bone; causes a decrease in blood calcium concentration

Which body region is most at risk for pressure injury when the client is in upright sitting position?

Ischial spine

Sclera and mucous membrane are assessed for what?

Jaundice

Where is best to assess for cyanosis?

Lips + nail beds

Medicare Part C

Medicare Advantage Plans: Available in select locations, managed- care option run by private companies, provides a few additional services, higher plan cost paid by all members, not just those in Medicare Part C

controlled substance issues for a particular nursing unit are the responsibility of the ________________

Nursing Unit Manager

Which condition is contraindicated for ginseng herbal therapy?

Pregnancy

Medicare Part D

Prescription drug coverage

Research Based Practice vs. EBP

RBP is based only on research studies. EBP is a problem solving approach to clinical practice, involves current best practice based on research findings, combines clinical expertise with client preference and values

disaster triage tag system

Red: Emergent (class I) Yellow: Can wait short time for care (class II) Green: Non-urgent or "walking wounded" (class III) Black: Expected to die/are dead (class IV)

level of caring

Relational Factors between nurse and patient

Which body region is most at risk for pressure injury when the client is in semi-fowlers position?

Sacrum

Zolipidem (Ambien)

Sedative/hypnotic; short use for INSOMNIA o Can cause daytime sleepiness o schedule 4 drug; risk for dependence o avoid ETOH, barbiturates, opioids and other CNS depressants when taking

Which condition is contraindicated for Bupropion?

Seizures

Which antidepressant medication is a selective monoamine oxidase-B inhibitor? a. Selegiline b. Phenelzine c. Isocarboxazid d. Tranylcypromine

Selegiline is a a selective monoamine oxidase-B inhibitor. The other medications are nonselective monoamine oxidase-A and B inhibitors.

Information exchange

Situational Factors between nurse and patient

Kohlberg's Theory of Moral Development Stages

Stage 1. Obedience and Punishment Orientation. Preconventional level; Morality based on consequences Stage 2. Instrumental relativist: there is more than one right view Stage 3. Good Interpersonal Relationships. Postconventional level; morality based on self-chosen principles Stage 4. Society Maintaining orientation. Have a conception of the function of laws for society as a whole Stage 5. Social Contract and Individual Rights. They begin to think about society in a very theoretical way, stepping back from their own society and considering the rights & values that a society ought to uphold. Stage 6: Universal Principles."theoretical stage"

Benners stages of clinical competence

Stage 1: Novice Stage 2: Advanced Beginner Stage 3: Competent Stage 4: Proficient Stage 5: Expert

punishment and obedience orientation

Stage 1: Rules are obeyed to avoid punishment ;no internalization of moral values

instrumental relativist stage

Stage 2 of pre-conventional morality based on concepts of reciprocity and sharing

Good Boy-Nice Girl Orientation

Stage 3: good behavior is doing what gets them approval form authority and peers

Society maintaining orientation

Stage 4. Individuals expand their focus from the relationship with others to societal concerns . Moral decisions taken 2 accounts aside all perspectives. Right behavior is doing one's duty, showing respect for authority, and maintaining the social order

Oxytocin (OT)

Stimulates contraction of the uterus and release of milk from breast.

total laryngectomy

Surgical removal of the entire larynx/hyoid bone/strap muscles and tracheal rings

cordectomy

Surgical removal of the vocal cords/ a vocal cord

PPD test

The test that can detect exposure to tuberculosis

Uniform Anatomical Gift Act (UAGA)

a law permitting a person of legal age and sound mind to give all or any part of his/her body to take effect upon his/her death or gives the right to another. = allows the client to donate organs

Joint Commission

a not-for-profit organization that evaluates and accredits different types of healthcare facilities

Adrenal glands

a pair of endocrine glands that sit just above the kidneys and secrete hormones (epinephrine and norepinephrine) that help arouse the body in times of stress.

health care proxy

a person chosen by another person to make medical decisions if the second person becomes unable to do so

incident report

a report of any event that is not consistent with the routine operation of the health care facility that results in or has the potential to result in harm to a patient, employee, or visitor

Negative Airflow Room

a room where airflow is controlled to prevent the air from circulating into the hallway or other rooms- clients with TB

which aspect of psychosocial development is commonly observed in adolescents?

a search for personal identitiy development of an ethical system

Scoliosis

abnormal lateral curvature of the spine

Quasi-intentional torts

act that lacks intent but involves volitional action such as defamation of character or invasion of privacy

which action would the nurse expect in the plan of care of a client scheduled for an adrenalectomy?

administer parenteral corticosteroids -steroid therapy is usually given IV or IM prep and continued during operation to prepare for the acute adrenal insufficiency that follows surgery

Ambivalent Marital relationship vs. loving marital relationship

ambivalent = the surviving spouse now has feelings of anger and guilt to resolve loving = fewer feelings of guilt, less complicated grieving process

amoxicillin treats infections, however it is not considered what?

an antidote

ischemia

an inadequate blood supply to an organ or part of the body, especially the heart muscles.

Corticosteroids

anti-inflammatory agents that treat skin inflammation, the steroid hormones produced by the adrenal cortex; A group of hormones, including cortisol, released by the adrenal glands at times of stress

Sulfonamides

antimicrobial agents

goal of case management

avoid fragmentation of care and control cost

EMG (electromyography)

best way to measure movement in a muscle, a measurement technique that records electrical activity of a muscle or group of muscles -can test strength of muscles

MRI can detect what?

brain edema, ischemia, infection, neoplasm and trauma - applies magnetic field to the brain

luteinizing hormone (LH)

causes ovulation; stimulates the secretion of progesterone by the corpus luteum; causes the secretion of testosterone in the testes

Simvastatin (Zocor)

cholesterol lowering

Multiple Sclerosis (MS)

chronic degenerative disease characterized by sclerotic patches along the brain and spinal cord; signs and symptoms fluctuate over the course of the disease; more common symptoms include fatigue, balance and coordination impairments, numbness, and vision problems destruction of the myelin sheath on neurons in the CNS and its replacement by plaques of sclerotic (hard) tissue

isocarboxazid overdose (MAO overdose)

circulatory collapse

Biographical Information

client age, occupation, and type of insurance

During the preparation stage what may happen?

client determines that the advantages of change outweigh the disadvantages

For the intensive care of cancer clients, for which employment position would the facility hire a nurse?

clinical nurse specialist : the clinical nurse specialist is an expert in a specific area of practice/setting, such as an intensive care unit.

Aspirin and warfarin both interfere with what?

coagulation

Thick mucous gland secretions, elevated sweat electrolytes, meconium ileus, and difficulty maintaining and gaining weight are associated with which autosomal recessive disorder?

cystic fibrosis

What is the expected response to a beta blocker

decreased heart rate -inhibit activity of the SNS and adrenergic hormones, which decreases the hr and workload of heart. Does not reduce anxiety or pain/analgesic. can reduce bp

Nurse Practice Acts

describe and define the legal boundaries of nursing practice within each state

S/S of diabetic coma?

dry mucous membranes, hot flushed skin, deep rapid respirations, acetone odor to breath, n/v, weakness

clients discharged with an infusion device should expect which kind of care services? Home care or outpatient therapy?

home care. outpatient therapy is not identified as a method for continuing antibiotic therapy with an infusion device.

Medicare part A

hospital insurance

Meconium ileus

impacted stool in the newborn

myringotomy

incision into the tympanic membrane/eardrum

Which age related effects occur in the older client?

increased autoantibodies

Somatostatin (SS)

inhibits secretion of growth hormone

Health care organizations that apply for Magnet status must demonstrate:

innovations in professional practice such as personnel policies and programs

Why is the conjunctiva assessed?

presence of pallor

which hormone is released from the anterior pituitary gland?

prolactin, growth hormone and luteinizing hormone

Which hormone has both inhibiting and releasing action?

prolactin, secreted by the hypothalamus

Regulatory Law

reflects decisions made by administrative bodies such as state boards of nursing

Somatotropin and gonadotropin are what?

releasing hormones, not inhibiting

Diltiazem Hydrochloride (Cardizem (CD), Cartia, Dilacor, Dilt-XR, Tiazac)

slows down heart rate

Medicare Part B

supplemental medical insurance

which conclusion would the nurse suggest after identifying 12 mm of induration at the site of a clients tuberculin purified protein derivative test? (PPD)

the result indicates a need for further tests and a chest x ray; More than 10 mm is a positive test result

Why is nitroglycerin administered to the patient with chest pain?

to promote coronary vasodilation

Which is true about the effect of grief and loss in toddlers? School aged children?

toddlers express a sense of change in sleeping -cannot understand loss or death, but express the sense of absence with changes in eating/sleeping patterns or fussiness school aged children understand the permanence but not the causes of the death/loss

Changes in what enzymes indicate damage to heart tissue? (Why are cardiac enzymes viewed in blood draws for patients with chest pain?)

troponin, creatine kinase, and myoglobin

how often should a joint commission health care facility test the emergency preparedness plan?

twice a year

PET (positron emission tomography)

uses a radioactive tracer to produce images of activity in the CNS. Functional, not structural /scan a visual display of brain activity that detects where a radioactive form of glucose goes while the brain performs a given task

Intentional tort

willful act that violates another's rights - includes assault, battery and false imprisonment

Radiography

x-ray imaging used to detect a condition or anomaly - can see presence of organs, measure them, detect obstructions

which fine motor skills may be observed in an 8 to 10 month old infant?

-using pincer grasp well -picking up small objects -showing hand preference

when compared to their non hispanic white counterparts, which factors contribute to the health disparities among the older adult hispanic population?

-value differences -language barrier -lack of health care facility -inadequate health insurance

Korotkoff sounds

a series of five sounds (four sounds followed by an absence of sound) heard during the auscultatory determination of blood pressure and produced by sudden distention of the artery because of the proximally placed pneumatic cuff series of sounds that correspond to changes in blood flow through an artery as pressure is released

Secondary acute care includes what?

emergency care, acute medical surgical care, radiological procedures for acute problems ex: preparing a client for a CT scan after repeated cerebral attacks

Psychophysiological Factors between nurse and patient

emotional status, growth and development

mediastinoscopy

endoscopic visual examination of the mediastinum - a suprasternal incision is made for inspection/ biopsy of lymph nodes visual examination of the mediastinal structures, including the heart, trachea, esophagus, bronchus, thymus, and lymph nodes

Goiter

enlargement of the thyroid gland commonly seen with graves disease

ethical doctrine of autonomy

ensures the patient the right to refuse medical treatment

Lordosis

excessive inward curvature of the lumbar part of the spine

Kyphosis

excessive outward curvature of the thoracic spine that causes hunching of the back

Which age related effects DECREASE in the older client?

expression of IL-2 receptors, delayed hypersensitivity reaction, and primary/secondary antibody responses

first generation antipsychotics may cause

extrapyramidal side effects

Medicare is a _______________ funded program. Medicaid and State children's health insurance are ___________________ programs

federal ; state

Which feature according to Benner is observed in the nurse at the 'proficient' level

focuses on managing care rather than managing skills, more than 2 or 3 years of experience in the same clinical position

The Mental Health Parity Act

forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits

Patient Self Determination Act

health care association must provide written info to clients about their rights under state law to make decisions have the right to refuse tx or formulate advance directives

NIC simple physiological domain

interventions to manage restricted body movements

NIC behavioral domain

interventions to promote comfort using psychosocial domain

NIC complex physiological domain

interventions to restore tissue integrity, optimize neurological functions, provide care before/during/after surgery

frontal lobe function

involved in motor function: problem solving, memory, judgment, impulse control

Unintentional Tort

involves negligence or malpractice

Why is aspirin prescribed for RA?

it is anti-inflammatory - rheumatoid arthritis

nephrogenic diabetes insipidus

kidneys do not respond to ADH

The nurses error of failure to validate the data is categorized as what?

labeling

cardiac ischemia

lack of blood flow and oxygen to the heart muscle

Which medication may lead to bruxism?

levomilnacipran

what is the etiological factor of nephrogenic DI?

lithium is the most common cause of acquired nephrogenic DI- a medication used to treat bipolar disorder. long term use damages cells of the kidneys

Enoxaparin and Dalteparin are both what?

low molecular weight heparins

Androgens

male sex hormones

The nurse administrator has experience in what?

managing the care provided to clients within a health care agency

Second generation antipsychotics may cause:

metabolic side effects such as diabetes and dyslipiemia clozapine is more effective than others

cerebral palsy (CP)

motor disorder caused by damage to the brain

preferred care organizations PCO

narrow down the list of hospitals, pcp, and health care providers available to the member.

Normal RPM for infants and newborns

newborns = 40 rpm infants = 50 rpm

Which gland secretes calcitonin?

parathyroid gland

Clozapine is used for what and poses a risk for what?

o antipsychotic medication o risk for development of agranulocytosis, especially when combined with SSRI (such as prozac) o monitor WBC

What do neuroleptics do?

o it blocks dopamine o treats schizophrenia, does not treat Parkinson's o increases serotonin at post synaptic sites

How will the nurse evaluate the effectiveness of the training after teaching a family member how to administer SQ enoxaparin sodium?

observing the family member administering enoxaparin sodium to the client.

During the action stage what may happen?

old habits my get in the way of new health behaviors

Naloxone (Narcan)

opiate antagonist, reverses opioid induced resiratory depression

Which response identified by the nurse is unrelated to an extrapyramidal tract effect?

opisthotonos, oculogyric crisis, akathisia are all examples. Hypertension is unrelated. Extrapyramidal tracts: Originate in the brainstem, carrying motor fibres to the spinal cord. They are responsible for the unconscious, reflexive or responsive control of musculature, eg muscle tone, balance, posture and locomotion.

which hormone is released from the posterior pituitary gland? (acts on the uterus and mammary glands)

oxytocin

Which gland secretes melatonin?

pineal gland- also regulates circadian rhythms/reproductive and puberty

Which is a secondary cause of adrenal insufficiency aka Addisons disease?

pituitary tumors are secondary causes primary causes are hemorrhage, tuberculosis and metastatic cancer

Transtheoretical model of health behavior

pre contemplation, contemplation, preparation, action, maintenance (maintenance occurs 6 months after the change has been ongoing indefinitely)

which relationship reflects the relationship of naloxone to morphine sulfate?

protamine sulfate to heparin -protamine is the antidote for heparin overdose -naloxone will reverse opioid effects and overdose

HIPAA

protects individuals from losing health insurance when changing jobs by providing portability

Americans with Disabilities Act (ADA)

protects people with physical or mental disabilities against discrimination and ensures that they get fair opportunities and services in the social and professional spheres

Managed Care Organizations MCOs

provide comprehensive preventive and tx services to a specific group of voluntarily enrolled people

NIC taxonomy

provides a standardization to help nurses select suitable interventions for patients' problems

Cystometrography (CMG)

provides information bladder capacity, pressure and voiding reflexes

Older adult with recent memory loss can benefit from what?

providing electronic devices that give alerts

Which characteristics are major attributes of a health care organization?

public trust, unique purpose, and specialized workforce

Which action should the nurse take when administering ear drops to a 4 year old?

pull the auricle up and out

Private Indemnity Health Insurance

purchased as a group policy by an employer for its employees or by the individuals themselves ex: Blue cross blue shield

tomography

radiographic image of a selected slice of tissue

parietal lobe function

somatic sensory processing

Restraints are not used for what?

staff inconvenience

Catecholamines (epinephrine and norepinephrine)

stimulates by sympathetic NS; increases heart rate, blood pressure, blood glucose levels and dilates lung passageways

renal arteriography

study used to determine renal blood vessel size and abnormalities

Goitrogens

substances that interfere with the function of the thyroid gland/disrupt production of hormones ex: sulfonamide

tracheostomy

surgical creation of an opening into the trachea through the neck to establish an airway

adrenalectomy

surgical removal of one or both adrenal glands -diet must have ample protein and K+ -24 hr urine specimen is unnecessary - you cannot withhold the corticosteroids/ medications for this surgery

hypophysectomy

surgical removal of the pituitary gland

Medicare A

takes care of medical, surgical, and psychiatric costs

The nurse practitioner has experience in what?

taking care of clients in an outpatient, ambulatory care, or community care setting.

Roy Adaptation Model

the Roy adaptation model views the client as an adaptive system. the need for nursing care occurs when the client cannot adapt to internal and external environmental demands.

Semi-Fowler's Position

the head of the bed is raised 30 degrees; or the head of the bed is raised 30 degrees and the knee portion is raised 15 degrees

informed consent requires that ?

the responsible person must understand the procedure