NURS 327 final

What is the difference between respiration and ventilation?

Respiration: exchange of gases Ventilation - bringing air in

Is Buck;s traction skin or skeletal?

Skin

How does Glucophage (metformin) work?

Slows the Release of sugar in the blood. Helps the boys respond better to insulin Reduce his glucose absorption

An x-ray of a trauma client reveals rib fractures in a client diagnosed with foil chest injury. Which intervention should the nurse include in the clients plan of care?

Suction the clients airway

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees.

In the surgery, when we verify the right pt, the right surgery on the right part of the body, what is this called?

Surgical time out

Morton neuroma is exhibited by which clinical manifestation

Swelling of the third lateral branch of the medial plantar nerve.

Which is not a guideline for avoiding hip dislocation after replacement surgery.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.

What is diffusion?

The movement of particles from an area of high concentration to an area of low concentration.

Some patient are given Enoxiparin 30mg SC prior to surgery. What is the reason for that?

To prevent a DVT

reasons for hypoglycemia

Too little food Medications Too much exercise

What is the cause of acute pancreatitis

Trypsin digest the pancreases

Your post op patient is nauseated. What is the first thing you should do?

Turn their head to the side

What type of diabetes is initially treated with diet and exercise?

Type 2

What is the difference between type one and type 2 diabetes?

Type one dose not produce insulin. While type 2 dose not respond to insulin.

The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure?

Up to 2 hours before surgery

Describe airborne precautions

Wear a mask that is an N95. The room is negative pressure so the air gets sucked in.

Why is it called a partial non-rebreather mask?

You are unable to inhale anything you exhale

What is the difference between colonization and infection

You have the bug in colonization. In infection the bug is present and the host gets sick.

When developing a teaching plan for a client scheduled for an amatory surgery with epidural anesthesia, which of the following would the nurse include?

You should experience a headache after this type of anesthesia

A nurse is planning discharge instructions for a client with osteomyelitis. What instruction should the nurse include in the discharge teaching?

You will receive IV antibiotics for 3 to 6 weeks

What is achlorhydria?

absence of hydrochloric acid in the gastric secretions

The trachea is __________ to the esophagus

anterior

morbid obesity

body mass index (BMI) of 40 or greater, which is generally 100 or more pounds over ideal body weight

Halux Valgus

bunion

Crohn's disease

chronic inflammation of the intestinal tract. Think cobble stones

When you inhale, the diaphragm

contracts

Xerostomia

dry mouth

How is Hepatitis A transmitted?

fecal-oral route

Describe droplet precautions

focuses on diseases that are transmitted by large droplets in the air that travel 3 to 6 feet from the patient. Precautions require wearing surgical masks. (ex. influenza). Private room.

The nurse is performing an assessment on an older adult patient and observes patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as?

kyphosis

What is eupnea?

normal breathing

Odynophagia

painful swallowing

The 3 p's in diabetes

polydipsia, polyuria, and polyphagia

Symptoms of hypoglycemia

tachycardia, excessive sweating (diaphoresis), light-headedness, visual disturbances

HHNS Vs DKA

· Diabetic ketoacidosis (DKA) is a condition of DKA=insulin deficiency resulting in acidemia due to altered metabolism. · Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is primarily a disorder of dehydration due to hyperglycemia

The physician schedules an elective surgical procedure for a patient who smoke cigarettes. When should the nurse recommend the client see smoking before surgical procedure to minimize risk associated with smoking cigarettes?

• 1 to 2 months

A client with emphysema informs the nurse, "The surgeon will be removing about 30% of my lung so that I will not be so short of breath and will have an improved quality of life." What surgery does the nurse understand the surgeon will perform?

• A lung volume reduction

Which statement describes paresthesia?

• Abnormal sensations

The nurse is caring for a client who has recurring cyanide us. Which consideration could the nurse suggest to best decrease the frequency of infection?

• Administer over-the-counter decongestant

A client is admitted with acute osteomyelitis that develops after an open fracture of the right femur. When planning the clients care the nurse her and anticipate which measure?

• Administering a large dose of IV antibiotics as ordered

During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?

• After menopause the bone density declines resulting in a gradual loss of height

A patient brought into the emergency department with carbon monoxide poisoning after escaping a house fire. What should the nurse monitor the patient for?

• Anemic hypoxemia

What is the most commonly prescribed treatment for the common cold?

• Anti-histamines

A client has undergone arthroscopy. After the procedure the site where the arthroscopy was inserted is covered by a bulky dressing. The clients entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy.

• Apply cold pack at insertion site

A client is scheduled to have an x-ray examination of the shoulder in which the synovial fluid will be aspirated and sent to laboratory for analysis. This will be followed by administration of a medium an x-ray. What procedure will the nurse prepare the client for?

• Arthrogram

A client has a fiberglass cast on the right arm. What action should the nurse include in the care plan?

• Assessing movement and sensation in the fingers of the right hand

A nurse is caring for a client place in traction to treat a fractured femur. Which nursing intervention has the highest priority?

• Assessing the extremity for neurovascular integrity

A group of students studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction?

• Bucks

Following a total Knee replacement, the surgeon orders a CMP device. The client asked was the purpose of this treatment. What is the best response by the nurse?

• CMP increase his range of motion to the joint

Which hormone inhibit bone reabsorption in calcium deposit in the bone?

• Calcitonin

Which medication directly inhibits osteoclast thereby reducing bone loss and increasing bone mass density?

• Calcitonin

Declined a ride to the emergency department reporting shortness of breath. She has 3+ pitting Edema below the knee, respiration rate of 36 breaths per minute, and hearing respirations. The nurse auscultate so long to do real course crackles, moist high pitch noncontinuous sounds that do not clear with coughing. The nurse will document this sound ask which type?

• Crackles

The nurse is asked to explain to the client the age related process contributed to Beaumont and osteoporosis. What is the nurses best response

• Decrease in estrogen

The nurse is conducting the admission assessment for a client who is to undergo an arthrogram. What is a priority question the nurse should ask?

• Do you have any allergies • Many contrast dye's contain iodine.

Which term refers to flexion deformity caused by slowly progressive contractor of the Palmer facia?

• Dupunytren contracture

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain?

• Elevate the affected extremity and use cold compress

A client with a fractured ankle is having a fiberglass cast applied. The client is yelling my leg is burning take it off. What action by the nurse is most appropriate?

• Explain that the sensation being felt is normal and will not burn the client.

After a bone fracture, fibrocartilaginous callus formation occurs at the same time of which process?

• Fibroblast migration

The nurse reminder a client receiving mechanical ventilation for which of the following complications?

• Gastrointestinal hemorrhage

A client undergoes an arthroplasty and outpatient clinic. After the procedure the nurse provides discharge teaching. Which response by the client indicates a need for further teaching?

• I should use a heating pad this evening to reduce some pain in my knee • The client should not use heat during the first 24 hours after the procedure because it could increase swelling.

Which measurement may increase compliance for a client with COPD?

• Increased oxygen supply

A female client is at risk for developing osteoporosis. Which action reduce the clients risk?

• Initiating weight-bearing exercise routine

Which intervention should the nurse implement with a client who has undergone a hip replacement?

• Instruct the client to avoid internally rotating of the legs

A client has an exaggerated convex curvature of the thoracic spine. What is the condition called?

• Kyphosis

A client has had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis has dislocated?

• Left leg has rotated internally

The client presents with an exaggeration of the lumbar spine curvature. How does the nurse interpret this finding?

• Lordosis

Which area of the spinal column is subjected to the greatest mechanical stress and degenerative changes?

• Lower lumbar

It is important for the nurse to provide required information in appropriate explanation of diagnostic procedures to a client with respiratory disorder in order to?

• Manage decreased energy levels

During surgery the patient develops a rebound hypothermia. The circulating nurse will monitor the patient closely for which of the following?

• Metabolic acidosis

The nurse is providing instructions to a client who is being prepared for skeletal traction. Which statement by the client indicates the teaching was effective?

• Metal pins will go through my skin to the bone

The wife of a client is concerned because her husband is requiring increasing high doses of pain medication. She states he was in pain long before he got cancer because he broke his back about 20 years ago. For that problem though his pain medication wasn't raised. What would the nurses best response be

• Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the clients relief.

A bone GLA protein has been ordered. How will the nurse prepare this order?

• Obtain a blood specimen

Client factor was reduced by surgically exposing the bone and realigning it. What type of treatment does this nurse identify this as?

• Open reduction

An instructor is describing the process of bone development. Which of the following would be the instructor described as being responsible for the process of ossification?

• Osteoblast

The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation?

• PaCO2

A patient had hand surgery to correct dupunytren's contracture. What nursing intervention is a priority postoperatively?

• Performing hourly neurovascular assessments for the first 24 hours

The nurse is conducting a musculoskeletal assessment of a client in a nursing home. The client is unable to dorsiflex right foot or extend the toes. The nurse evaluates this finding as an injury to which nerve?

• Peroneal

Which of the following presents with an onset of heel pain with first step in the morning?

• Planters fasciitis

When assessing a client with infectious diarrhea, which of the following would be the nurses suspect that the client is experiencing severe dehydration?

• Rapid, thready pulse

Which action by the nurse is most appropriate when the client demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery?

• Record the observation

Which of the following is the final stage of fracture repair?

• Remodeling

The client is postoperative from a total knee arthroplasty and medication include lidocaine 5%. Past medical history includes a left mastectomy and herpes zoster following treatment with chemotherapy. The best nursing action is to:

• Remove the patch after 12 hours

A client has a nursing diagnostic of ineffective airway clearance related to excessive mucus production. The best short term goal is for the client to?

• Report decreased congestion

The nurse is caring for a patient with emphysema, understand the airflow limitations are not reversible. The end result of deterioration is.

• Respiratory acidosis.

A client is brought to the emergency department by softball team member who states that the client in another player ran into each other and the clients is experiencing severe pain in the right shoulder. What symptoms are they fractured clavicle does the nurse recognize?

• Right shoulder slopes downward and droops inward

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain?

• Sharpe and piercing

Are they visit the family healthcare provider, a client is diagnosed with bunions on the lateral side of the great toe at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

• Some bunions are congenital, others are caused by wearing shoes that are too short and or narrow.

The nurse is assessing a client for scoliosis. What will the nurse have the client due to perform the assessment.

• Stand behind the client asked the client to bend forward at the waist

Clients left leg is in a skeletal traction with a Tomas splint and Pearson attachment. Which intervention should the nurse include in the clients care plan?

• Teach client how to prevent problems caused by immobility

A client has been treated for migraine headaches for several months and has come to the clinic stating that he is getting no better. The nurse is talking with a client and here's an audible click when the client is moving his job. What does the nurse suspect may be happening?

• Temporomandibular disorder

Which statement is accurate regarding the care of plaster cast?

• The cast can be dented while it's damp.

Which statement by a staff nurse on the orthopedic floor indicates a need for further education?

• The client is receiving physical therapy twice per day so the client does not need to continue passive motion device

Which homeostatic mechanism would the body of a critically ill client used to maintain normal pH?

• The lungs eliminate carbonic acid by blowing off more CO2

A client is described of having pectus carinatum. What physical manifestations what does condition have?

• The sternum protrudes in the ribs are sloped backwards.

The nurse is providing instructions to a client following application of a fiberglass cast. Which statement by the client indicates further education is needed?

• Under no circumstance should I get my cast wet • The cash and I come in contact with other plastic because the reaction can occur

A mechanically ventilated client is receiving a combination of atracurium and opioid analgesic morphine. The nurse reminder the client for which potential complication?

• Venous thromboembolic

The older adult client asked the nurse how to best maintain strong bones. What is the yes nurses best response?

• Weight bearing exercise can strengthen bones

The nurse is caring for a client following a tonsillectomy and adenoidectomy. Two hours after the procedure, the client begins to vomit large amounts of dark blood at frequent intervals and is tachycardic and febrile. After notifying the surgeon, the nurse

• obtains a light, mirror, gauze, and curved hemostat

What is asterixis?

"flapping tremor"

Malignat hypothermia usually occurs within _________ of induction

1 to 24 hours

Short acting insulin will peak at what time?

1-3 hours

List 5 ways to keep an oxygen tank safe?

1. Do not smoke near it 2. Transport on the floor in the car 3. How to use the tank 4. Keep out of the sunlight 5. Keep 5 feet from the electric outlets BE IN A CARRIER

Gastritis is inflammation of the gastric mucosa. Name 3 of the most common causes of gastritis?

1. Feeding 2. H. Pylori 3. Smoking, alcohol, medications

List the 8 elements of standard precautions

1. Gloves 2. PPE 3. Sharps container 4. Safe handling of waste 5. Hand washing 6. Lining 7. Cling 8. Fluid resistant gowns

What are 8 strategies to prevent atelectasis?

1. I.S 2. Movement 3. Deep breathing 4. Coughing 5. Percussion 6. Turning the Pt 7. Encourage liquids 8. Pursued lip breathing

List the two main diseases that would have the patient placed in airborne precaution.

1. Measles 2. TB

Name the six links in the chain of infection

1. Portal of entry 2. Infectous agent 3. Resovoir 4. Portal of exit 5. Mode of transmission 6.Susceptible host

What are the three phases preoperative care. What are they?

1. Preoperative: Before the operation 2. Intraoprative: In the surgery 5. PostOp: After the surgery till last appointment

List the 5 main people on the surgical team

1. Surgeon 2. Anesthesiologist or nurse ansiatist 3. Scrub nurse 4. RN first assist 5. Circulating nurse

Health care workers should be immune to or be vaccinated against which 5 diseases?

1. T Dap 2. Chicken pox 3. MMR 4. Hep B 5. Flu

Name three anti-nausea medications

1. Zofran 2. Phengan 3. Compazine

What are the 6 P's of compartment syndrome?

1.) Pain (present on passive movement and out of proportion to injury) 2.) Paresthesias (numbness, tingling, decreased sensation) 3.) Pallor (or cyanosis) 4.) Parythermia 5.) Paralysis (late, ominous sign) 6.) Pulselessness (very late, ominous sign)

What is the minimum daily fluid intake daily?

1.5 L

Normal blood sodium

135-145

Humalog (insulin lispro) onset

15 mins or less

The renal glucose threshold

180-200. Point to where the kidney can't handle the glucose anymore

HCO3 levels

22-26

normal potassium

3.5-5

blood CO2 levels

35-45

What % Oxygen will be delivered with a simple face mask

40-50%

At what amount of blood loss should you be concerned?

500 ML

What is the normal glucose level

60-120 mg?dL

Blood pH

7.35-7.45

Normal calcium levels

8.5-10.5 mg/dL

What is the earliest indicator of shock?

A change in the LOC

Absence of peristalsis in the lower esophagus is called what?

Achalasia

Client presents to the ED after being in a boating accident about three hours ago. Now the client reports having headache, fatigue, and feeling like he can't breathe enough. The nurse notes that the client is restless into cardiac with an elevated blood pressure. This client may be an early stages of what respiratory problem?

Acute respiratory failure

pancreatic secretions are _______? Why?

Alkaline. To cancel out HCL

Droplet precautions are for what 2 diseases?

All meningitis and all influenza Pertusis, Diptheria, Mumps, All Meningitis

Glycosalated Hemoglobin

Allows you to see a patients history for the last 3 months. How much glucose is carried by the Hem.

Refers to closure or collapse of alveoli

Atelectasis

Why doesn't micronase work with pt with type 1 diabetes

Because there is no insulin to produce

What dose lipase do?

Break down fats

What dose tripsyn do

Breakdown protein

You walk onto the unit and discover all the alcohol based hand rubs are gone. The most likely reason for this is what?

C. Diff

What type of pt do you use a ventri mask with

COPD Most accurate

Where can peptic ulcers occur?

Can be in esophagus, stomach duodem

Adenocarcinoma is defined as

Cancer that starts in the mucous producing cells

What laxative should be used by cardiac patients to avoid straining?

Colace

The elasticity of the lungs and throat is called?

Compliance

If edition determines that the client has been exposed to someone with TV. The nurse expect the physician to order what treatment?

Daily doses of isoniazid, 300 mg for 6 months to 1 year

Diabetes control depends on three factors. What are they?

Diet Exercise Medications

Describe contact precautions

Door can be open. You need a gown and booties. You can wear a mask and goggles but they are not necessary.

describe surgical asepsis

Everything is sterile

Symptoms of DKA (diabetic ketoacidosis)

Fruity smell your breath Dehydration Hyperglycemia Acidosis

Which of the following factors increases blood urea nitrogen

Gastrointestinal bleeding

If you're not sure if you're patient is hypo or hyper glycemic what should you do?

Give them sugar

Which is better Soap and water Or Alcohol based hand rub

Hand washing is better overall. Hand rub can be used up to 5 times, in between rooms, and when hands are not visible soiled.

Describe the simplest maneuver to mange the pts airway in the post op setting

Head tilt and chin lift

Protrusion of the intestines through an opening in the muscle.

Hernia

Too much carbon dioxide in the blood is also known as

Hypercapnia

What is the difference between hypoxia and hypoxemia

Hypoxemia:low oxygen content in the blood leads to -> Hypoxia: inadequate oxygenation to the tissues and cells symptoms: decreased pulse ox, tachypnea*, confusion*, restlessness*, dyspnea, use of accessory muscles, cyanosis decreased LOC

Which is a benefit of a CMP device when applied after knee surgery?

It promotes healing by increasing circulation and movement of the new joint

What is a LMA

Laryngeal Mask Airway used fmost frequently during anesthesia Inflatable mask positioned directly over the opening into the trachea (hypopharynx) Indicated for short term intubation or facial or nasal injuries. Or and Emergency Dept , EMTs

What is the medication lactulose used for

Lower ammonia levels

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority?

Maintaining traction continuously to ensure its effectiveness

And instructor is describing the process of bone development. Which of the following would be the instructor describe as being responsible for the process of bone ossification?

Osteoblast

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period?

Osteomyelitis

carina of trachea

Point at which the trachea divides into bronchi

A 10-year-old boy who was brought to the emergency room after a skiing accident is diagnosed with a fracture of the distal end of the femur. Why is this type of fracture significant?

Potential growth problems may result from the damage to the epiphyseal plate.