Remediation for Med-Surg

What drug may be prescribed to an alzheimers patient?

Donepezil (Aricept) * works by enhancing Acetylcholine function *Watch for tarry stools because may indicate GI bleeding, a serious side effect of this medication

Nursing intervention for client receiving Radioactive Iodine Therapy?

Drink plenty of fluids bc RAI is excreted through the kidneys. Shellfish allergy don't do RAI!

A client is returned to the surgical unit immediately after placement of a coronary artery stent that was accomplished via access through the femoral artery. What response should the nurse consider the priority when assessing this client?

Hematoma formation. Because the femoral artery is large, it has the potential for hematoma formation and hemorrhage after surgery. The client should not be in pain after this procedure. Although the leg used for circulatory access must be kept extended and immobile for several hours, this is not the priority. The ability to swallow is not affected because conscious sedation, not general anesthesia, is used.

What hematology studies will be monitored during anticoagulant therapy?

Hemoglobin Hematocrit Platelet count

What lab values besides glucose should be monitored in patient experiencing acute DKA?

Hemoglobin - may be altered due to hydration Calcium - Potassium - CRITICAL value to monitor bc insulin causes potassium to return to the cells resulting in hypokalemia BUN - dehydration can cause increased BUN so patient should be monitored for signs of renal insufficiency

Which nursing intervention should the nurse implement to help reduce the risk for abnormal bleeding during heparin therapy.

Maintain heparin of a continuous infusion pump

What data about the fluid in the water-seal chamber of a closed chest drainage system provide support for the nurse's conclusion that the system is functioning correctly?

Rises with inspiration and falls with expiration. During inspiration, negative pressure in the pleural space increases, causing fluid to rise in the chamber; during expiration, negative pressure in the pleural space decreases, causing fluid to drop in the chamber. If the system is closed to the atmosphere, as it should be, bubbles will not be present. If the system is closed to the atmosphere, as it should be, bubbles will not be present. Changes in intrapleural pressure cause fluid to rise on inspiration and fall on expiration (tidaling).

What does INR measure the effectiveness of?

Warfarin (Coumadin) therapy

Endocrine disorder resulting from overproduction of adrenocorticosteroids?

Cushing's syndrome

What is Somogyi's phenomenon?

rebound morning hyperglycemia after night time hypoglycemia. Often caused by too much insulin or the lack of an adequate bedtime snack

2. The nurse expects to see which manifestations of osteoarthritis in Mrs. Weil? (Select all)

-Joint pain -Swollen nodes of the joints -Asymmetrical involvement of the joints

To reflect a therapeutic level of warfarin (coumadin) the PT should be...?

1.5-2 times the control value in seconds and the INR should be 2-3

Would visual acuity of 60/20 or 20/60 indicate diabetic retinopathy?

20/60

The nurse is caring for the client post transsphenoidal hypophysectomy. In assessing the client it is noted that the client is exhibiting clear drainage from the nares. The nurse recalls this could indicate:

A cerebral spinal fluid leak from an opening to the brain

The nurse understands that which information is correct about osteoarthritis?

A noninflammatory condition involving formation of new joint tissue in response to cartilage destruction

What lab value would indicate that heparinization has been reached?

APTT 65 seconds, control 35 seconds *the APTT should be 1.5-2 times the control value in seconds

Endocrine disorder caused by adrenocortical insufficiency?

Addison's disease

What factors place someone as risk for a thyroid problem?

Age and gender Occurs most commonly at puberty, with pregnancy or in the 3-5th decades of life

A client who was in an automobile collision is now in hypovolemic shock. Why is it important for the nurse to take the client's vital signs frequently during the compensatory stage of shock?

Arteriolar constriction occurs. The early compensation of shock is cardiovascular and is reflected in changes in pulse, blood pressure, and pulse pressure; blood is shunted to vital organs, particularly the heart and brain. The cardiac workload will increase, not decrease, as the heart attempts to pump more blood to the vital organs. The heart compensates by increasing its contractility, which will increase, not decrease, the cardiac output. The sympathetic, not parasympathetic, nervous system is triggered to produce vasoconstriction.

A client with a history of severe intermittent claudication has a femoral-popliteal bypass graft. What is an appropriate postoperative nursing intervention on the day after surgery?

Assist the client with walking. Mobility reduces venous stasis and edema and enhances arterial perfusion and healing.

A nurse is caring for a client who sustained a transection of the spinal cord. The nurse continually monitors this client for what medical emergency?

Autonomic hyperreflexia. Autonomic hyperreflexia, an uninhibited and exaggerated response of the autonomic nervous system to stimulation, results in a blood pressure greater than 200 mm Hg systolic and 100 mm Hg diastolic; it is a medical emergency. Although a pressure ulcer can result from prolonged immobility, it is not an emergency. Although gastrointestinal atony can result from immobility and cause a fecal impaction, it is not a medical emergency. Although a urinary tract infection can result from stasis of urine or repeated catheterizations, it is not a medical emergency.

Refers to the agreement to respect the client's right to self-determine healthcare decisions?

Autonomy

Refers to the act of taking positive action to help others?

Beneficence *includes client advocacy

A 10-year-old child is admitted to the pediatric unit in vaso-occlusive sickle cell crisis. The nurse manager is planning to assign a room. Which child is the best roommate option for this client?

Child with thalassemia because not communicable

Which response should the nurse expect when assessing a client who is dehydrated? Select all that apply .

Confusion occurs because of a decrease in cerebral perfusion. The eyes appear sunken because of decreased intracellular and extracellular fluid associated with dehydration. The blood pressure will be decreased with dehydration because of hypovolemia. The pulse will be rapid and thready with dehydration; a bounding pulse is associated with fluid volume excess. Dependent edema may occur with fluid volume excess, not deficit.

What is nurse's priority action when caring for a child with acute laryngotracheobronchitis?

Continually assessing the respiratory status. Laryngeal spasms can occur abruptly; patency of the airway is ensured with constant assessments for signs of respiratory distress. Reducing fever, delivering humidified oxygen, and providing emotional support to the child are all important, but none is the priority.

The nurse is caring for a client that is admitted with the diagnosis of mild chronic heart failure. The nurse expects to hear what lung sounds?

Crackles Left-sided heart failure causes fluid accumulation in the capillary network of the lungs; fluid eventually enters alveolar spaces and causes crackling sounds at the end of inspiration. Stridor is not heard in chronic heart failure, but with tracheal constriction or obstruction. Wheezes are not heard with chronic heart failure, but with asthma. Friction rubs are not heard with chronic heart failure, but with pleurisy.

If APTT is 120 seconds, control 35 seconds what should the nurse do?

Decrease the rate of infusion. Current infusion rate could cause bleeding

A postoperative client is diagnosed as having atelectasis. Which nursing assessment supports this diagnosis?

Diminished breath sounds on auscultation. Atelectasis refers to the collapse of alveoli; breath sounds over the area are diminished. A productive cough most often is associated with inflammation or infection, not atelectasis. Clubbing of the fingertips is a late sign of chronic hypoxia related to prolonged obstructive lung disease. Crackles at the height of inhalation are not specific to atelectasis. Crackles are associated with fluid in the alveoli, which occurs with heart failure and pulmonary edema.

An 83-year-old client is diagnosed with left-sided congestive heart failure. Which assessment findings should the nurse expect to find on this client? Select all that apply .

Dyspnea, crackles, cool extremities. Left-sided heart failure causes impaired tissue perfusion, pulmonary congestion, and pulmonary edema, which also causes signs and symptoms such as crackles and dyspnea. Decreased cardiac output causes decreased blood flow to major body organs, especially the kidneys. Peripheral edema and jugular distention are signs of right sided congestive heart failure.

Which nursing interventions will reduce pain related to decreased venous flow? -Apply cold packs -Elevate the affected leg -Gently massage the affected leg Administer NSAIDS pRN for pain -Apply a warm compress

Elevate the affected leg to promote venous return and reduce swelling Apply a warm compress to promote return and reduce swelling

A nurse plans to teach the signs of rejection to a client who just had a transplanted kidney. What sign of rejection should the nurse include?

Elevated blood pressure. Hypertension results from hypervolemia because of failure of the new kidney. Weight gain will occur because of fluid retention with failure of a transplanted kidney. Body temperature will exceed 100° F if a kidney is rejected. Urine output will be decreased or absent, depending on the degree of failure.

10. The nurse understands that which is a correct description of compartment syndrome?

Elevated pressure within a confined myofascial section compromises neurovascular function

A thallium scan is scheduled for a client who had a myocardial infarction. The nurse explains that the reason the scan has been prescribed is to:

Establishing the viability of myocardial muscle is a radionuclear study that determines viability of myocardial tissue; necrotic or scar tissue does not extract the thallium isotope. Monitoring the mitral and aortic valves and visualizing the ventricular systole and diastole is available from cardiac catheterization with angiography. A 12-lead ECG determines the adequacy of electrical conductivity.

Refers to loyalty, truthfulness and keeping a commitment to a client?

Fidelity

Which disease is the most common type of hyperthyroidism?

Graves disease. Cause over-secretion of thyroid hormones

Disorder of thyroid gland that causes chronic thyroiditis and eventually leads to hypothyroidism?

Hashimoto's diseases

What are signs of a blood transfusion reaction?

Headache, tachypnea, chills, hypotension and elevated temp. *stop blood transfusion and hang a new normal saline infusion

Administration route for heparin therapy for DVT and why?

IV - bolus dose and then continuous IV infusion

A client is returned to the surgical unit after an abdominal cholecystectomy. What is the main reason why the nurse should assess for clinical indicators of respiratory complications?

Incision is in clot proximity to the client's diaphragm. The location of the incision results in pain on inspiration or coughing. The subsequent reluctance to cough and deep breathe facilitates respiratory complications from retained secretions. Length of time required for surgery does not take a prolonged period. Bile does not impair inflammatory or immune responses. Cholelithiasis and cholecystitis generally are inflammatory, not infectious, processes.

A client is receiving dexamethasone (Decadron) to treat acute exacerbation of asthma. For what side effect should the nurse monitor the client?

Increased blood glucose. Dexamethasone increases gluconeogenesis, which may cause hyperglycemia. Hypokalemia, not hyperkalemia, is a side effect. Liver dysfunction is not a side effect. Hypertension, not hypotension, is a side effect.

Refers to equality and fairness?

Justice

What should diabetics know about drinking alcohol?

May induce hypoglycemia. Should only be done in moderation and with or shortly after meals

What physical assessment should the nurse perform to assist in the diagnosis of DVT?

Measure calf circumference bilaterally - provides data regarding affected leg and also gives a baseline

A nurse in the postanesthesia care unit identifies a progressive decrease in blood pressure in a client who had major abdominal surgery. What clinical finding supports the conclusion that the client is experiencing internal bleeding?

Oliguria A decreased blood volume leads to a decreased blood pressure and glomerular filtration; compensatory antidiuretic hormone (ADH) and aldosterone secretion cause sodium and water retention, resulting in decreased urine output . The respirations become rapid and shallow to compensate for decreased cellular oxygenation. The peripheral pulse rate may be rapid and thready, but it is the same rate as the apical rate. Hypokalemia, not hyperkalemia, occurs because as sodium is retained, potassium is excreted.

A client on a mechanical ventilator is receiving positive end-expiratory pressure (PEEP). The nurse understands that this treatment improves oxygenation primarily by:

Opening collapsed alveoli and keeping them open.

A nurse is administering high concentrations of oxygen to a 7-year-old child. What is the nurse's most important consideration concerning the oxygen?

Oxygen must be humidified before administration. Because of the drying nature of oxygen, it should be humidified before it is administered. The method of oxygen delivery and the amount are included in the health care provider's prescription. Oxygen is not combustible, but it supports fire. Oxygen is not warmed before administration; it is cool on administration.

A nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Which clinical finding supports the nurse's suspicion that the client is developing cor pulmonale?

Peripheral edema. Cor pulmonale is right ventricular failure caused by pulmonary congestion; edema results from increasing venous pressure. A productive cough is symptomatic of the original condition, COPD. Although twitching of the extremities may be caused by alterations in oxygen and hydrogen ion levels and their effects on the central nervous system, it is the sign of peripheral edema that directly indicates increasing venous pressure secondary to cor pulmonale. Although lethargy progressing to coma is caused by alterations in oxygen and hydrogen ion levels and their effects on the central nervous system, the sign of peripheral edema directly indicates increasing venous pressure secondary to cor pulmonale.

A client sustains a fracture of the head of the femur and the nurse is concerned about the client experiencing a fat embolus. The nurse should assess the client for which clinical indicator common to a fat pulmonary embolus?

Petechiae on the chest and shoulders suggest fat emboli after fractures. The petechial rash occurs from occlusion of small dermal capillaries leading to extravasation of red blood cells. Unilateral chest pain, sudden onset of dyspnea, and impending sense of doom are not specific for just a fat embolus; these may occur with emboli of any origin, such as from thrombophlebitis.

The nurse notifies the charge nurse of the red, warm, and edematous left leg and prepares to place a call to the surgeon. Which action should the nurse take before leaving the client's room to call the surgeon?

Place the client on bedrest and elevate the left leg on a pillow

What are the classic manifestations of DM?

Polyuria (increased urinary output) Polyphagia (increased appetite) Polydipsia (Increased thirst)

Test to assess for hypocalcemia?

Positive Chvostek's sign. Done by tapping over the parotid gland and observing for a facial grimace such as lips twitching

A client in her 30th week of gestation is in preterm labor, and the practitioner prescribes betamethasone (Celestone). The client asks the nurse why she is being given this drug. As a basis for the response the nurse takes into consideration that it:

Promotes neonatal pulmonary maturity

A nurse is caring for a client with an infection caused by group A beta-hemolytic streptococci. The nurse should assess this client for responses associated with which illness?

Rheumatic fever

A 5-month-old child undergoes heart surgery to repair the defects associated with tetralogy of Fallot. Prevention of what behavior is a priority for the nurse after the surgery?

Straining at school. Forceful evacuation involves taking a deep breath, holding it, and straining (Valsalva maneuver). This increases intrathoracic pressure, which puts excessive strain on the heart sutures. Crying is not a problem after cardiac surgery; it may, in fact, help prevent respiratory complications. Coughing and deep breathing are essential for the prevention of postoperative respiratory complications. Activity is gradually increased.

The primary health care provider has prescribed a stat chest x-ray and electrocardiogram for an 85-year-old client with a history of congestive heart failure. The pulse oximeter has changed from 90% to 86% oxygen saturation. The nurse's immediate actions include which of the following? Select all that apply.

Tell a staff member to get the electrocardiogram machine. Notify the x-ray department that a chest x-ray must be done stat. Increase the supplemental oxygen without a prescription from 2 L nasal cannula to 4 L nasal cannula and notify the health care provider. Have a staff member notify the nursing supervisor of the change in client status.

Immediately after birth the newborn and mother were given the opportunity to bond. Now, on admission to the newborn nursery, it is noted that the infant has signs of respiratory distress, and transient tachypnea of the newborn is suspected. The nurse reviews the mother's obstetric history and takes the neonate's vital signs. In light of this information and the nursery routine, what is the most appropriate intervention by the nurse for this newborn?

The newborn should remain in the nursery under the overbed warmer for continued observation because tachypnea is present. Newborns with respiratory rates faster than 60 breaths/min should not be fed because there is a risk for aspiration. Bathing will stress the newborn further and should be avoided. This newborn should not leave the close observation of the newborn nursery.

Clot in vein that causes pain and swelling?

Thromobphlebitis

What is the mechanism that results in Kussmaul respirations?

To compensate for metabolic acidosis, the respirations are deep and rapid - the lungs are attempting to remove CO2

True or false. Being sick increases blood sugar.

True. Illness increases the risk for dehydration and hyperglycemia

After resection of a lower lobe of the lung, a client has excessive respiratory secretions. Which independent nursing action should the nurse implement?

Turning and positioning

Should insulin be stored in the refrigerator?

Unopened insulin should be but once opened it can be kept at room temp for up to 1 month. *administration of cold insulin can increase local injection site irritation and lipodystrophy

What are the 3 major factors involved in the development of a DVT and what are they referred to as?

Virchow's triad 1. Stasis of blood 2. Vessel wall injury 3. Altered blood coagulation

How will hyperglycemia be treated?

With continuous IV infusion containing regular insulin.

What is propranolol?

beta blocker used to decrease some of the unpleasant symptoms of hyperthyroidism like palpitations and nervousness

3. Which symptom should Mrs. Weil report immediately while taking a non-steroidal anti-inflammatory drug (NSAID)?

black, tarry stools

Which type of diabetes does HHNS typically affect?

primarily affects type 2 diabetics who are significantly dehydrated

Which medication is the antagonist for heparin?

protamine sulfate

What is administered to treat hypocalcemia?

calcium glutinate or calcium chloride via IV

What should client know about exercising?

controlled diabetes may result in hypoglycemia. Uncontrolled may result in hyperglycemia

Clinical manifestations of hypothyroidism?

fatigue, constipation, weight gain

What are some signs of hypoglycemia?

feeling shaky and sweaty. *could provide milk and grahm crackers disorientation, tremors, palpitations, lightheadedness, confusion, cool clammy skin, slurred speech and lethargy

Why is hypocalcemia life threatening for thyroidectomy patient?

hypocalcemia can cause seizures, cardiac dysthymia and laryngospasm. If laryngospasm occurs it can occlude airway and an emergency tracheostomy may need to be performed.

What vital signs indicate someone is in hypovolemic shock?

hypotension and tachycardia. Priority is maintaining circulation. 18 gauge angiocath and infuse normal saline is priority intervention. *normal saline is isotonic and increases vascular volume

Possible long term side effect of RAI?

hypothyroidism requiring lifelong thyroid hormones

What type of fluid replacement is needed to treat hyperglycemia?

includes fluid replacement to correct dehydration caused by the increases concentration of glucose in the blood. Isotonic fluids, such as normal saline, are used initially to treat dehydration

A blood donor whose blood type is O-negative is known as a "universal donor." What does the nurse consider about O-negative blood that accounts for this classification?

it does not have any antigens that can cause a reaction

What is the purpose of enoxaparin (Lovenox)?

it is a type of anticoagulant given to prevent venous blood clots

What is dumping syndrome?

it is the most common complication after gastric surgery. It is due to intestinal dilation, peristaltic stimulation and hypovolemia caused by undigested food in the proximal small intestine. There is no treatment, resolves with time

A nurse explains to the parents of a toddler with a diagnosis of tetralogy of Fallot that the aim of palliative surgery is to directly increase the blood flow to the:

lungs. By improving blood flow to the lungs, the surgery increases the oxygen content of the blood, thereby increasing oxygen to all body cells. Tetralogy of Fallot causes the obstruction of blood flow to the lungs, not the brain, heart or kidneys.

What is Hyperglycemic-hyperosmolar nonketotic syndrome (HHNS) caused by?

persistant hyperglycemia. Ketosis does not occur

What is a thyroid storm?

occurs in clients with untreated hyperthyroidism or who aren't treated preoperatively Signs include tachycardia, fever and altered mental state

What drugs put a patient at an increased risk for DVT development?

oral contraceptives

What is a glycosated Hgb test?

reflects average blood glucose levels over a period of approximately 120 days (the life of the average RBC). Glucose molecules attach to hemoglobin in the red blood cell. The longer the glucose in the blood is above normal, the higher the percentage of glycosated hemoglobin. Normal range is from 4-6% with levels over 8% indicating poor glycemic control.

4. When the nurse is teaching Susan about medications for osteoporosis, which instruction is most important, knowing that Susan takes alendronate (Fosamax), a biphosphonate?

remain upright (sitting or standing) for at least 30 mins after taking this medication because biphosphonates can cause erosion in the esophagus. lying down can cause regurgitation into the esophagus

What instruction should the nurse include when teaching Ms. Pool about the use of PTU (propylthiouracil)?

report the onset of a sore throat or fever to HCP is very important because agranulocytosis is the most serious side effect of antithyroid meds

What lab test should be scheduled with donepezil (Aricept)?

serum liver enzyme test because liver toxicity is a significant side effect of acetylcholinesterase inhibitors

The nurse is preparing to discharge a client who presented to the emergency room for an acute asthma attack. The nurse notes that upon discharge the health care provider has prescribed theophylline (Theo-Dur) 300 mg orally to be taken daily at 9:00 AM. The nurse should teach the client to take the medication:

take prescribed dose at prescribed time. Be careful to avoid overdose

For treatment of PUD, sucralfate (Carafate) is prescribed. What is the mechanism of action?

the medication adheres to the lining of the stomach

What is glucagon used for?

to INCREASE blood glucose

What is the diagnosis of diabetes based on?

two fasting blood glucose levels greater than 126 mg/dL

Which OTC meds should warfarin patients avoid?

tylenol - can increase effects of warfarin leading to an increased risk of bleeding

What diagnostics would be scheduled to determine DVT diagnosis?

venous ultrasound, venography and coagulation studies

Which medication is the antagonist for warfarin?

vitamin k