Adult Health Exam #1
If the patient is seen using accessory muscle to breathe what do you do?
- Call the physician (when a patient uses their accessory muscles to breathe, this tells you they are not getting enough O2 and there is a build up of CO2)
Most dressing changes following surgery are ______
- Sterile
The PACU nurse should also prepare to administer _________ and facilitate ______
- administer the postoperative analgesic medication (you do not want your patient to be in severe pain) - facilitate early ambulation (**within 24 hours post op the patient SHOULD be moving!)
In the PACU, the nurse performs and documents __________, then checks __________
- baseline assessment (you want to make sure you are receiving a stable patient!) - check the surgical site (assess for any drainage or bleeding) (in addition make sure all drainage tubes and monitoring lines are connected and functioning)
- disruption of surgical incision or wound = ___________ - protrusion of wound contents = _________
- dehiscence - evisceration
Generally, hair is not removed preoperatively UNLESS the hair at or around the incision site is likely to interfere with the operation. - If hair is to be removed preoperatively, use _________
- electric clippers
Teach patients how to fix a state of hypoglycemia
- keep a simple sugar on them
To prevent a spinal headache the patient should be instructed to
- lay supine (flat) - give fluids
Patients temperature goes to 109 and patient becomes stiff, these are the signs of _________ and you should administer ________
- malignant hyperthermia - dantrolene
Patients with diabetes should be advised to not exercise within _________ of insulin injection or near its peak and to exercise ONLY when blood glucose is _________
- 1 hour - 80-250
Antibiotics are administered _________ to cut time
- 1 hour prior to cut time
After the initial assessment in the PACU, vital signs are monitored and patients general physical status is assessed and documented at least every _______
- 15 minutes
Regular (short-acting) insulin should be given _______ minutes before a meal
- 15 minutes
The pulse rate, blood pressure, and respiratory rate are recorded at least every ________ for the first _______ and every ______ for the next ________ The temperature is monitored every ______ for the first 24 hours
- 15 minutes for the first hour - 30 minutes for the next 2 hours - 4 hours for the first 24 hours
If a patient shows signs of hypoglycemia - give patient _______ Retest in _________ Provide ______
- 15g concentrated carbohydrate such as 2 or 3 glucose tablets, 1 tube glucose gel, 0.5 cup juice - Retest in 15 minutes - after initial treatment, follow with a snack including a starch and protein (ex: cheese and crackers, milk and crackers, half a sandwich)
hypoglycemia treatment:
- 15g concentrated carbohydrate such as 2 or 3 glucose tablets, 1 tube glucose gel, 0.5 cup juice - after initial treatment, follow with a snack including a starch and protein (ex: cheese and crackers, milk and crackers, half a sandwich)
The patient should be ambulating, sitting up, or doing some kind of movement within ________ after surgery
- 24 hours
When using an insulin pump, the needle or catheter is changed at least every _______
- 3 days
The patient is brought to the holding area or presurgical suite about ________ before the anesthetic is to be given
- 30 to 60 minutes
Carbohydrates: Fats: Protein:
- 50% to 60% - 30% - 10-20%
- Self care activities that the patient must accomplish each day to meet personal needs; they include personal hygiene/bathing, dressing/grooming, feeding, and toileting
- Activities of Daily Living (ADLs)
Rapid Acting Inhaled Insulin: - Examples - Onset = - Peak = - Duration =
- Afrezza - Onset = <15 min - Peak = ~50 minutes - Duration = 2-3 hours
Risk Factors for Type 2 Diabetes:
- Age - equal to or greater than 45 years - obesity - hypertension - history of gestational diabetes - Babies over 9 lbs - African Americans
Discussing home medications and pain medications are discussed with the patient when?
- BEFORE surgery (preoperatively) (MUST assess the patient's interest and willingness to use them)
If a patients BP is 89/43 what would you do?
- Bolus your patient - You need to give them fluids to raise the BP - Then notify the physician
If the patient has addition questions about the surgery, as a nurse you must:
- Contact the physician/surgeon
Medications that potentially affect the surgical experience
- Corticosteroids (thins the skin, slows healing time) - Diuretics (may cause respiratory depression) - Phenothiazines (may increase hypotensive action of anesthesia) - tranquilizers (may cause anxiety, tension, if withdrawn suddenly) - insulin - anticoagulants - anticonvulsant medications - thyroid medication - opioids - OTC herbals
If the blood glucose level cannot be read by the machine what should you do?
- Draw blood and send it to the lab
in older adults receiving oral medication, what is the biggest concern?
- Hypoglycemia (everything in the older adult slows down so medications stay in the body for longer periods of time)
- The complex skills needed for independent living, including meal preparation, grocery shipping, household management, finances, and transportation
- Instrumental Activities of Daily Living (IADLs)
refers to a localized reaction, occurring at the site of insulin injections - this may cause delayed absorption of insulin if you keep injecting at the same site
- Insulin lipodystrophy
With the rising cases of latex allergies, surgical cases should use
- Latex free gloves in anticipation of a possible allergy - if no allergy is present personnel can switch if desired
After injection of rapid acting insulin what should you as a nurse do?
- Make sure patient has a meal in front of them within 5 to 15 minutes after injection
Creatinine levels for males? Creatinine levels for females?
- Males = 0.6-1.2 - Females = 0.5-1.1
Normal Hgb levels in males? Normal Hgb levels in females?
- Males = 14-18 - Females = 12-16
Normal Hct levels in males? Normal Hct levels in females?
- Males = 42%-52% - Females = 37%-47%
Intermediate Acting Insulin - Examples: - Onset = - Peak = - Duration =
- NPH - onset = 2-4 hours - peak = 4-12 hours - duration = 16-20 hours
If a patient experiences an elevated BP, you should assess what?
- Pain level (pain causes a spike in BP)
Administer _____ prior to performing a dressing change
- Pain medication (ordered by the physician)
Characterized by the destruction of the pancreatic beta cells (no insulin is produced)
- Type I diabetes
4 main areas for insulin injection:
- abdomen (speed of absorption is greatest in the abdomen) - upper arm (posterior surface) - thigh (anterior surface) - hips
Metabolic syndrome
- abdominal obesity (>40 in men; >35in in women) - Hyperglycemia (FBS > or = to 100) - Hypertension (BP > or = 130/80) - Hyperlipidemia (Triglycerides > or = to 150; HDL <40 women; <50 men)
Signs and Symptoms of Hypoglycemia
- abnormally low blood glucose levels (falling less than 70) - sweating, tremors, tachycardia, palpitations, nervousness, hunger
Preoperative nursing interventions: - preparing the bowel - the goal of using an enema prior to surgery is to
- allow visualization of the surgical site and prevent trauma to the intestine or contamination of the peritoneum by fecal material
If a patient has a fractured femur and you give them a regional block what should the assessment include?
- assess distal pulses and check for movement and sensation
If the patient does not cough effectively, ________, pneumonia, or other complications can occur
- atelectasis (collapse of the allveoli)
Hypotension can result from: - The most common cause is
- blood loss - hypoventilation - position changes - pooling of blood - side effects of medications and anesthetics - most common cause = loss of circulating volume through blood and plasma loss (if the blood loss exceeds 500mL, replacement is usually indicated!)
Sick day rules:
- check blood sugar - call physician - continue to take insulin and DM medications - Eat meals at regular times and drink 8-12 oz fluids every hour *(if BS is high choose sugar free; if low choose sugary)* - check urine ketones when BS is >240
The _________ (with the preoperative checklist and verification form) accompanies the patient to the OR with the ________ form attached, along with all ______ reports and ________
- completed medical record - surgical consent form attached - laboratory reports - nurses records
Diabetic Foot Care
- don't wear the same shoes 2 days in a row - shoes should be soft, like leather - NO sandals - wash feet with lukewarm water and soap - NO soaking - moisturize feet after bath but AVOID in between toes - Check for sores, blisters, etc. Cover any with dry, sterile dressing and CALL the physician - Cut toe nails straight across
Exercise recommendations in people with Diabetes:
- exercise 3 times each week with no more than 2 consecutive days without exercise
What is provided to the patient when preparing discharge?
- expected outcomes - immediate postoperative changes anticipated - prescriptions - nursing unit and/or surgeon's telephone number - follow-up care information
How to fix Somogyi Effect
- give patient a bedtime snack or decrease insulin dosage before bed
Very Long Acting Insulin - Examples: - Onset = - Peak = - Duration =
- glargine (lantus), detemir (levemir), glargine - Onset = 1-6 hours - Peak = continuous (no peak) - Duration = 24-36 hours *used for basal dose* *cannot be mixed with other insulins*
Criteria for the diagnosis of diabetes: - Causal plasma glucose concentrations = - Fasting glucose (no caloric intake for at least 8 hours) = - 2 hour postload glucose = - HbA1C =
- greater than or equal to 200 - greater than or equal to 126 - greater than or equal to 200 - less than 7%
Recommended Mean Arterial Pressure:
- greater than or equal to 65
During anesthesia, the patient's temperature may fall. Glucose metabolism is reduced, and as a result, metabolic acidosis may develop. - This condition is called _______, and is indicated by a core body temperature that is lower than normal. Values for this are ____
- hypothermia - 36.6C (98F or less)
Treatment for Dawn Phenomenon
- increase the insulin dose prior to bed
- Volatile liquid agents and gases - produce the effect as agents enter the blood through the pulmonary capillaries and act on cerebral centers to produce loss of consciousness and sensation - When administration is discontinued, the vapor or gas is eliminated through the lungs
- inhalation anesthesia
Biguanides (metformin)
- inhibits production of glucose by the liver - monitor kidney function! (BUN and Creatinine and GFR) - Stop 48 hours prior to and for 48 hours after the use of contrast
If a patient is found by a family member unresponsive at home and blood sugars are low what should they do?
- inject 1mg of glucagon
Two main problems related to insulin in type 2 diabetes:
- insulin resistance - impaired insulin secretion
Risk factor for Type 2 diabetes includes HDL levels of _________mg/dL or triglyceride levels of __________ mg/dL
- less than or equal to 35 - greater than or equal to 250
Rapid Acting Insulin: - 3 examples = - onset = - peak = - duration =
- lispro, aspart, glulisine - onset: 5-15 minutes - peak: 30-60 minutes - duration: 2-4 hours
One goal of preoperative nursing care is to educate the patient how to promote optimal _________ and resulting blood oxygenation after anesthesia. In addition, the nurse may also demonstrate how to use a/an _________, a device that provides measurement and feedback related to breathing effectiveness
- lung expansion - incentive spirometry
To ensure the correct site is being used: the surgical site is typically
- marked by the patient and the surgeon prior to the procedure
Instruct the patient to not use the exact same site for insulin injections:
- more than once in 2 to 3 weeks
The ______ witnesses the signature of informed consent; however it is the responsibility of the __________ to provide a clear and simple explanation of what the surgery will entail prior to the patient giving consent. This individual must also inform the patient of the benefits, alternatives, risks, and possible complications
- nurse - physician/surgeon
What interventions occur during the immediate preoperative
- patient changes into gown, mouth is inspected, jewelry is removed, valuables stored in a secure place - administer preanesthetic medications
In the PACU the nurse should assess:
- patients airway - respiratory function - cardiovascular function - skin color - level of consciousness - ability to respond to commands - Vital Signs - Surgical Site
Blood glucose testing is done at the _____ action time of the medication to evaluate the need for dosage adjustments
- peak
Classic clinical manifestations of diabetes and hyperglycemia include:
- polyuria - polydipsia - polyphagia
If a patient declines blood transfusions for religious reasons (such as Jehovah's Witnesses) this information needs to be clearly identified in the ________ period, documented and communicated to the appropriate personnel
- preoperative period
Consent is valid ONLY when signed before administering
- psychoactive medications/sedatives
When drawing up mixed insulin; you should:
- push air into the cloudy first then clear - draw up the clear first (regular insulin) and then draw up the cloudy (NPH)
How to splint a patient for deep breathing and coughing who has an incision in his abdomen?
- put the palms of both hands together, interlacing the fingers snugly
Short Acting Insulin - Examples = - Onset = - Peak = - Duration =
- regular (Humulin R) - onset = 30-60 minutes - Peak = 2-3 hours - Duration = 4-6 hours
Urinary retention interventions
- set up bladder training / voiding schedule
One goal of preoperative nursing care is to educate the patient how to promote optimal lung expansion and resulting blood oxygenation after anesthesia. The patient assumes a ________ position to enhance lung expansion. - The nurse then demonstrates how to take a deep, slow breath and how to exhale slowly. After practicing deep breathing several times, the patient is instructed to breathe deeply, exhale through the mouth, take a short breath, and cough deeply in the lungs
- sitting
Spinal headaches may occur after
- spinal anesthesia
If a thoracic or abdominal incision is anticipated, the nurse demonstrates how to:
- splint the incision to minimize pressure and control pain (splinting or placing the hands across the incision site acts as an effective support when coughing)
Second Generation Sulfonylureas (Glipizide, Glypuride, glimepiride)
- stimulate beta cells of the pancreas to secrete insulin - when taken with beta-blocking agents, may mask usual warning signs and symptoms
Patient is on narcotic, at risk for constipation, In the MAR what do you look for - if the patient is on a ____________ - patients on narcotics SHOULD be on stool softeners
- stool softener (patients on narcotics SHOULD be on stool softeners)
Risk Factors for Malignant Hyperthemia
- strong bulky muscles - history of muscle cramps or muscle weakness - history of unexplained temperature elevation - history of an unexplained death of a family member during surgery that was accompanied by a febrile response
What are the goals of promoting mobility postoperatively?
- to improve circulation, prevent venous stasis, and promote optimal respiratory function
If you enter a patients room, the patient is unconscious or cannot swallow and you check their sugar and it is 50 what do you do?
- treat them with dextrose (D50W) - then call the doctor
For informed consent, If the surgery is an emergency/a life-saving measure
- we do NOT need to obtain consent of the patient - You DO need two physicians to say this is a life-saving measure
To evaluate basal insulin and determine bolus insulin doses, testing is performed ________
0 before meals
International Normalized Ratio (INR)
0.9-1.2 seconds
BUN levels
10-20
Prothrombin Time (PT)
11-12.5 seconds
Normal RR
12-20
Normal BP
120/80
Sodium Levels
135-145
Partial thromboplastin time (PTT)
20-30 seconds
Potassium Levels
3.5-5
Activated partial thromboplastin time (APTT)
30-40 seconds
When the nurse is caring for a patient with type I diabetes, what clinical manifestation would be a priority to closely monitor? A. hypoglycemia B. hyponatremia C. ketonuria D. polyphagia
A hypoglycemia
A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A) Fasting plasma glucose greater than or equal to 126 mg/dL B) Random plasma glucose greater than 150 mg/dL C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D) Random plasma glucose greater than 126 mg/dL
A) Fasting plasma glucose greater than or equal to 126 mg/dL
The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurses most appropriate action? A) Teach the patient about actions to slow the progression of nephropathy. B) Ensure that the patient receives a comprehensive assessment of liver function. C) Determine whether the patient has been using expired insulin. D) Administer a fluid challenge and have the test repeated.
A) Teach the patient about actions to slow the progression of nephropathy.
The nurse is teaching a client about coughing and deep breathing techniques to prevent postoperative complications. Which statement is appropriate for the nurse to make to the client at this time as it relates to these techniques? A. "Use of an incentive spirometer will help prevent pneumonia" B. "Close monitoring of your oxygen saturation will detect hypoxemia." C. "Administration of intravenous fluids will prevent or treat fluid imbalance." D. "Early ambulation and administration of blood thinners will prevent pulmonary embolism."
A. "Use of an incentive spirometer will help prevent pneumonia"
The health care provider schedules an elective surgery for a patient who smokes cigarettes. When should the nurse recommend that the patient cease smoking before the surgical procedure to minimize risks? A. 4 to 8 weeks B. 3 to 4 months C. 2 weeks D. 3 weeks
A. 4 to 8 weeks
What is the blood glucose level goal of a diabetic patient who will be having a surgical procedure to ensure strict glycemic control? A. 80-110 B. 150-240 C. 250-300 D. 300-350
A. 80 to 110
The nurse is providing preoperative teaching to a client scheduled for hip replacement surgery in 1 month. During the preoperative teaching, the client gives the nurse a list of medications she takes, the dosage, and frequency. What intervention provides the client with the most accurate information? A. Instruct the client to stop taking St. John's wort at least 2 weeks prior to surgery due to its interaction with anesthetic agents. B. Instruct the client to continue taking ephedrine prior to surgery due to its beneficial effect on blood pressure. C. Instruct the client to discontinue Synthroid due to its effect on blood coagulation and the potential for heart dysrhythmias. D. Instruct the client to continue any herbal supplements unless otherwise instructed, and inform the client that these supplements have minimal effect on the surgical procedure.
A. Instruct the client to stop taking St. John's wort at least 2 weeks prior to surgery due to its interaction with anesthetic agents.
The nurse assesses an older adult patient who reports dimmed vision. What does this alert the nurse to include in the plan of care? A. a safe environment B. restrictions of the patient's unassisted mobility activities C. preparations for probable cataract extractions D. referral to an ophthalmologist
A. a safe environment
A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign? A. an open reduction of a fracture B. an insertion of an intravenous cath C. irrigation of the external ear canal D. urethral catheterization
A. an open reduction of a fracture
The nurse is performing the shift assessment of a postsurgical patient. The nurse finds his mental status, level of consciousness, speech, and orientation are intact and at baseline, but the patient tells you he is very anxious. What should the nurse do next? A) Assess the patients oxygen levels. B) Administer antianxiety medications. C) Page the patients the physician. D) Initiate a social work referral.
A. assess the patients oxygen levels
The perioperative nurse is providing care for a client who is recovering on the postsurgical unit following a transurethral prostate resection (TUPR). The client is reluctant to ambulate, citing the need to recover in bed. For what complication is the client most at risk? A. Atelectasis B. Anemia C. Dehydration D. Peripheral edema
A. atelectasis
A nurse is caring for a client newly diagnosed with type 1 diabetes. The nurse is educating the client about self-administration of insulin in the home setting. The nurse should teach the client to do what action? A. avoid using the same injection site more than once in 2 to 3 weeks B. Avoid mixing more than one type of insulin in a syringe. C. Cleanse the injection site thoroughly with alcohol prior to injecting. D. Inject at a 45-degree angle.
A. avoid using the same injection site more than once in 2 to 3 weeks
The OR nurse is participating in the appendectomy of a 20 year-old female patient who has a dangerously low body mass index. The nurse recognizes the patients consequent risk for hypothermia. What action should the nurse implement to prevent the development of hypothermia? A) Ensure that IV fluids are warmed to the patients body temperature. B) Transfuse packed red blood cells to increase oxygen carrying capacity. C) Place warmed bags of normal saline at strategic points around the patients body. D) Monitor the patients blood pressure and heart rate vigilantly
A. ensure that IV fluids are warmed to the patients body temperature
An adult patient has just been admitted to the PACU following abdominal surgery. As the patient begins to awaken, he is uncharacteristically restless. The nurse checks his skin and it is cold, moist, and pale. The nurse concerned the patient may be at risk for what? A) Hemorrhage and shock B) Aspiration C) Postoperative infection D) Hypertension and dysrhythmias
A. hemorrhage and shock
The perioperative nurse has completed the presurgical assessment of an 82-year-old female patient who is scheduled for a left total knee replacement. When planning this patients care, the nurse should address the consequences of the patients aging cardiovascular system. These include an increased risk of which of the following? A) Hypervolemia B) Hyponatremia C) Hyperkalemia D) Hyperphosphatemia
A. hypervolemia
The nurse is preparing an elderly client for a scheduled removal of orthopedic hardware, a procedure to be performed under general anesthetic. For which adverse effect should the nurse most closely monitor the client? A. Hypothermia B. Pulmonary edema C. Cerebral ischemia D. Arthritis
A. hypothermia
The nurse is monitoring the status of a postoperative client in the immediate postoperative period. The nurse would become most concerned with which sign that could indicate an evolving complication? A. increasing restlessness B. A pulse of 86 C. BP of 110/70 D. Hypoactive bowel sounds in all 4 quadrants
A. increasing restlessness
The nurse is creating the care plan for a client newly admitted to the rehabilitation unit. The client is an older adult who has had a stroke but who lived independently until this event. What is a goal that the nurse should include in this client's nursing care plan? A. Maintain joint mobility B. Refer to social services C. Help the client ambulate three times every day D. Perform passive range of motion with the client twice daily
A. maintain joint mobility
An OR nurse will be participating in the intraoperative phase of a patients kidney transplant. What action will the nurse prioritize in this aspect of nursing care? A) Monitoring the patients physiologic status B) Providing emotional support to family C) Maintaining the patients cognitive status D) Maintaining a clean environment
A. monitoring the patients physiologic status
A nurse is reviewing a surgeons prescription sheet for a preoperative client that states the client must be nothing by mouth (NPO) after midnight. The nurse should call the surgeon to clarify that which medication should be given to the client and not withheld? A. Prednisone B. Ferrous sulfate C. Cyclobenzaprine D. Conjugated estrogen
A. prednisone
The circulating nurse in an outpatient surgery center is assessing a client who is scheduled to receive moderate sedation. What principle should guide the care of a client receiving this form of anesthesia? A. The client must never be left unattended by the nurse. B. The client should begin a course of antiemetics the day before surgery. C. The client should be informed that he or she will remember most of the procedure. D. The client must be able to maintain their own airway.
A. the client must never be left unattended by the nurse
The nurse is caring for an older adult client who is receiving rehabilitation following an ischemic stroke. A review of the client's electronic health record reveals that the client usually defers her self-care to family members or members of the care team. What should the nurse include as an initial goal when planning this client's subsequent care? A. The client will demonstrate independent self-care. B. The client's family will collaboratively manage the client's care. C. The nurse will delegate the client's care to a nursing assistant. D. The client will participate in a life skills program
A. the client will demonstrate independent self-care
A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the childs pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes? A) Type 1 diabetes B) Type 2 diabetes C) Noninsulin-dependent diabetes D) Prediabetes
A. type I diabetes
The nurse has just reassessed the condition of a post-operative client who was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which parameter most carefully during the next hour? A. urinary output of 20mL/hour B. Temperature of 37.6C(99.6F) C. Blood pressure of 100/70 D. Serous drainage on the surgical dressing
A. urinary output of 20mL/hour
The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the health care provider? A. when the patient's blood ammonia concentration reaches 180mg/dL B. when a lactate dehydrogenase concentration is 300 units C. when a serum albumin concentration is 5.0 D. When a serum globulin concentration is 2.8
A. when the patient's blood ammonia concentration reaches 180mg/dL
The nurse is performing a preoperative assessment on a patient going to surgery. The patient informs the nurse that he drinks approximately two bottles of wine each day and has for the last several years. What postoperative difficulties can the nurse anticipate for this patient? A) Alcohol withdrawal syndrome immediately following surgery B) Alcohol withdrawal syndrome 2 to 4 days after his last alcohol drink C) Alcohol withdrawal syndrome upon administration of general anesthesia D) Alcohol withdrawal syndrome 1 week after his last alcohol drink
B) Alcohol withdrawal syndrome 2 to 4 days after his last alcohol drink
The OR will be caring for a patient who will receive a transsacral block. For what patient would the use of a transsacral block be appropriate for pain control? A) A middle-aged man who is scheduled for a thoracotomy B) An older adult man who will undergo an inguinal hernia repair C) A 50-year-old woman who will be having a reduction mammoplasty D) A child who requires closed reduction of a right humerus fracture
B) An older adult man who will undergo an inguinal hernia repair
A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the most appropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes? A) Ask the patient to describe an optimally healthy meal. B) Ask the patient to keep a food diary and review it with the nurse. C) Ask the patients family what he typically eats. D) Ask the patient to describe a typical days food intake.
B) Ask the patient to keep a food diary and review it with the nurse
An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so important to this patient? A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. B) Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. C) Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes. D) Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.
B) Avoiding foot ulcers may mean the difference between institutionalization and continued independent living.
While the surgical patient is anesthetized, the scrub nurse hears a member of the surgical team make an inappropriate remark about the patients weight. How should the nurse best respond? A) Ignore the comment because the patient is unconscious. B) Discourage the colleague from making such comments. C) Report the comment immediately to a supervisor. D) Realize that humor is needed in the workplace.
B) Discourage the colleague from making such comments.
The nurse is preparing to change a patients abdominal dressing. The nurse recognizes the first step is to provide the patient with information regarding the procedure. Which of the following explanations should the nurse provide to the patient? A) The dressing change is often painful, and we will be giving you pain medication prior to the procedure so you do not have to worry. B) During the dressing change, I will provide privacy at a time of your choosing, it should not be painful, and you can look at the incision and help with the procedure if you want to. C) The dressing change should not be painful, but you can never be sure, and infection is always a concern. D) The best time for doing a dressing change is during lunch so we are not interrupted. I will provide privacy, and it should not be painful.
B) During the dressing change, I will provide privacy at a time of your choosing, it should not be painful, and you can look at the incision and help with the procedure if you want to.
A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase of treatment? A) Monitoring the patient for dysrhythmias B) Maintaining and monitoring the patients fluid balance C) Assessing the patients level of consciousness D) Assessing the patient for signs and symptoms of venous thromboembolism
B) Maintaining and monitoring the patients fluid balance
The nursing instructor is discussing the difference between ambulatory surgical centers and hospital- based surgical units. A student asks why some patients have surgery in the hospital and others are sent to ambulatory surgery centers. What is the instructors best response? A) Patients who go to ambulatory surgery centers are more independent than patients admitted to the hospital. B) Patients admitted to the hospital for surgery usually have multiple health needs. C) In most cases, only emergency and trauma patients are admitted to the hospital. D) Patients who have surgery in the hospital are those who need to have anesthesia administered
B) Patients admitted to the hospital for surgery usually have multiple health needs.
The nurse is caring for a patient who is postoperative day 2 following a colon resection. While turning him, wound dehiscence with evisceration occurs. What should be the nurses first response? A) Return the patient to his previous position and call the physician. B) Place saline-soaked sterile dressings on the wound. C) Assess the patients blood pressure and pulse. D) Pull the dehiscence closed using gloved hands
B) Place saline-soaked sterile dressings on the wound.
The nurse knows that elderly patients are at higher risk for complications and adverse outcomes during the intraoperative period. What is the best rationale for this phenomenon? A) The elderly patient has a more angular bone structure than a younger person. B) The elderly patient has reduced ability to adjust rapidly to emotional and physical stress. C) The elderly patient has impaired thermoregulatory mechanisms, which increase susceptibility to hyperthermia. D) The elderly patient has an impaired ability to decrease his or her metabolic rate
B) The elderly patient has reduced ability to adjust rapidly to emotional and physical stress.
The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address what topic during this dialogue? A) The need for frequent eye examinations for patients with diabetes B) The fact that patients with diabetes have an elevated risk of myocardial infarction C) The relationship between kidney function and blood glucose levels D) The need to monitor urine for the presence of albumin
B) The fact that patients with diabetes have an elevated risk of myocardial infarction
The PACU nurse is caring for a patient who has arrived from the OR. During the initial assessment, the nurse observes that the patients skin has become blue and dusky. The nurse looks, listens, and feels for breathing, and determines the patient is not breathing. What is the priority intervention? A) Check the patients oxygen saturation level, continue to monitor for apnea, and perform a focused assessment. B) Treat the possible airway obstruction by tilting the head back and pushing forward on the angle of the lower jaw. C) Assess the arterial pulses, and place the patient in the Trendelenburg position. D) Reintubate the patient
B) Treat the possible airway obstruction by tilting the head back and pushing forward on the angle of the lower jaw.
A diabetic patient calls the clinic complaining of having a flu bug. The nurse tells him to take his regular dose of insulin. What else should the nurse tell the patient? A) Make sure to stick to your normal diet. B) Try to eat small amounts of carbs, if possible. C) Ensure that you check your blood glucose every hour. D) For now, check your urine for ketones every 8 hours.
B) Try to eat small amounts of carbs, if possible.
A 77-year-old mans coronary artery bypass graft has been successful and discharge planning is underway. When planning the patients subsequent care, the nurse should know that the postoperative phase of perioperative nursing ends at what time? A) When the patient is returned to his room after surgery B) When a follow-up evaluation in the clinical or home setting is done C) When the patient is fully recovered from all effects of the surgery D) When the family becomes partly responsible for the patients care
B) When a follow-up evaluation in the clinical or home setting is done
The nurse is caring for a client who is scheduled for surgery to remove her brain tumor. The client is very apprehensive and keeps asking when she will get her preoperative medicine. The medicine is ordered to be given "On call to OR." This means A. as the client is transferred to the OR bed B. After being notified by the OR and before other preoperative preparations C. As soon as possible, in order to alleviate the anxiety D. when the porter arrives on the floor to take the patient to surgery
B. After being notified by the OR and before other preoperative preparations
The patients surgery is nearly finished and the surgeon has opted to use tissue adhesives to close the surgical wound. This requires the nurse to prioritize assessments related to what complication? A) Hypothermia B) Anaphylaxis C) Infection D) Malignant hyperthermia
B. Anaphalaxis
A client has completed the acute treatment phase of care following a stroke and the client will now begin rehabilitation. What should the nurse identify as the major goal of the rehabilitative process? A. To provide 24-hour, collaborative care for the client B. To restore the client's ability to function independently C. To minimize the client's time spent in acute care settings D. To promote rapport between caregivers and the client
B. To restore the client's ability to function independently
A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient? A) A sulfonylurea B) A biguanide C) A thiazolidinedione D) An alpha glucosidase inhibitor
B. a biguinaide
The nurse is creating the plan of care for a patient who is status postsurgery for reduction of a femur fracture. What is the most important short-term goal for this patient? A) Relief of pain B) Adequate respiratory function C) Resumption of activities of daily living (ADLs) D) Unimpaired wound healing
B. adequate respiratory function
The nurse is monitoring a presurgical patient for electrolyte imbalance. Which classification of medication may cause electrolyte imbalance? A. corticosteroid B. diuretics C. phenothiazines D. insulin
B. diuretics
The nurse admits a patient to the PACU with a blood pressure of 132/90 mm Hg and a pulse of 68 beats per minute. After 30 minutes, the patients blood pressure is 94/47 mm Hg, and the pulse is 110. The nurse documents that the patients skin is cold, moist, and pale. Of what is the patient showing signs? A) Hypothermia B) Hypovolemic shock C) Neurogenic shock D) Malignant hyperthermia
B. hypovolemic shock
The intraoperative nurse is implementing a care plan that addresses the surgical patients risk for vomiting. Interventions that address the potential for vomiting reduce the risk of what subsequent surgical complication? A) Impaired skin integrity B) Hypoxia C) Malignant hyperthermia D) Hypothermia
B. hypoxia
An OR nurse is teaching a nursing student about the principles of surgical asepsis as a requirement in the restricted zone of the operating suite. What personal protective equipment should the nurse wear at all times in the restricted zone of the OR? A) Reusable shoe covers B) Mask covering the nose and mouth C) Goggles D) Gloves
B. mask covering the nose and mouth
A client is on call to the OR for an aortobifemoral bypass and the nurse administers the prescribed preoperative medication. After administering a preoperative medication to the client, what should the nurse do? A. Encourage light ambulation. B. Place the bed in a low position with the side rails up. C. Tell the client that he will be asleep before he leaves for surgery. D. Take the client's vital signs every 15 minutes.
B. place the bed in a low position with the side rails up
The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? A. NPH B. regular C. lispro D. lantus
B. regular
The nurse is providing preoperative teaching to a client scheduled for surgery. The nurse is instructing the client on the use of deep breathing, coughing, and the use of incentive spirometry when the client states, "I don't know why you're focusing on my breathing. My surgery is on my hip, not my chest." What rationale for these instructions should the nurse provide? A. To prevent chronic obstructive pulmonary disease (COPD) B. To promote optimal lung expansion C. To enhance peripheral circulation D. To prevent pneumothorax
B. to promote optimal lung expansion
Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control? A) A patient who skips breakfast when his glucose reading is greater than 220 mg/dL B) A patient who never deviates from her prescribed dose of insulin C) A patient who adheres closely to a meal plan and meal schedule D) A patient who eliminates carbohydrates from his daily intake
C) A patient who adheres closely to a meal plan and meal schedule
A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient? A) Examine feet weekly for redness, blisters, and abrasions. B) Avoid the use of moisturizing lotions. C) Avoid hot-water bottles and heating pads. D) Dry feet vigorously after each bath
C) Avoid hot-water bottles and heating pads.
A patient is scheduled for surgery the next day and the different phases of the patients surgical experience will require input from members of numerous health disciplines. How should the patients care best be coordinated? A) By planning care using a surgical approach B) By identifying the professional with the most knowledge of the patient C) By implementing an interdisciplinary approach to care D) By using the nursing process to guide all aspects of care and treatment
C) By implementing an interdisciplinary approach to care
A 68-year-old patient is scheduled for a bilateral mastectomy. The OR nurse has come out to the holding area to meet the patient and quickly realizes that the patient is profoundly anxious. What is the most appropriate intervention for the nurse to apply? A) Reassure the patient that modern surgery is free of significant risks. B) Describe the surgery to the patient in as much detail as possible. C) Clearly explain any information that the patient seeks. D) Remind the patient that the anesthetic will render her unconscious.
C) Clearly explain any information that the patient seeks.
The nurse is doing a preoperative assessment of an 87-year-old man who is slated to have a right lung lobe resection to treat lung cancer. What underlying principle should guide the nurses preoperative assessment of an elderly patient? A) Elderly patients have a smaller lung capacity than younger patients. B) Elderly patients require higher medication doses than younger patients. C) Elderly patients have less physiologic reserve than younger patients. D) Elderly patients have more sophisticated coping skills than younger patients
C) Elderly patients have less physiologic reserve than younger patients.
The nurse is caring for a patient who is admitted to the ER with the diagnosis of acute appendicitis. The nurse notes during the assessment that the patients ribs and xiphoid process are prominent. The patient states she exercises two to three times daily and her mother indicates that she is being treated for anorexia nervosa. How should the nurse best follow up these assessment data? A) Inform the postoperative team about the patients risk for wound dehiscence. B) Evaluate the patients ability to manage her pain level. C) Facilitate a detailed analysis of the patients electrolyte levels. D) Instruct the patient on the need for a high-sodium diet to promote healing.
C) Facilitate a detailed analysis of the patients electrolyte levels.
A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what? A) I read that a pancreas transplant will provide a cure for my diabetes. B) I will take my oral antidiabetic agents when my morning blood sugar is high. C) I will make sure to follow the weight loss plan designed by the dietitian. D) I will make sure I call the diabetes educator when I have questions about my insulin
C) I will make sure to follow the weight loss plan designed by the dietitian.
As an intraoperative nurse, you know that the patients emotional state can influence the outcome of his or her surgical procedure. How would you best reinforce the patients ability to influence outcome? A) Teach the patient strategies for distraction. B) Pair the patient with another patient who has better coping strategies. C) Incorporate cultural and religious considerations, as appropriate. D) Give the patient antianxiety medication
C) Incorporate cultural and religious considerations, as appropriate.
The circulating nurse will be participating in a 78-year-old patients total hip replacement. Which of the following considerations should the nurse prioritize during the preparation of the patient in the OR? A) The patient should be placed in Trendelenburg position. B) The patient must be firmly restrained at all times. C) Pressure points should be assessed and well padded. D) The preoperative shave should be done by the circulating nurse.
C) Pressure points should be assessed and well padded.
The nurse is caring for a 78-year-old man who has had an outpatient cholecystectomy. The nurse is getting him up for his first walk postoperatively. To decrease the potential for orthostatic hypotension and consequent falls, what should the nurse have the patient do? A) Sit in a chair for 10 minutes prior to ambulating. B) Drink plenty of fluids to increase circulating blood volume. C) Stand upright for 2 to 3 minutes prior to ambulating. D) Perform range-of-motion exercises for each joint
C) Stand upright for 2 to 3 minutes prior to ambulating.
A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best response? A) Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years. B) The cause is not known for sure but it is thought to have something to do with ketoacidosis. C) The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years. D) Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels
C) The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years.
The dressing surrounding a mastectomy patients Jackson-Pratt drain has scant drainage on it. The nurse believes that the amount of drainage on the dressing may be increasing. How can the nurse best confirm this suspicion? A) Describe the appearance of the dressing in the electronic health record. B) Photograph the patients abdomen for later comparison using a smartphone. C) Trace the outline of the drainage on the dressing for future comparison. D) Remove and weigh the dressing, reapply it, and then repeat in 8 hours.
C) Trace the outline of the drainage on the dressing for future comparison.
The nurse is caring for a trauma victim in the ED who will require emergency surgery due to injuries. Before the patient leaves the ED for the OR, the patient goes into cardiac arrest. The nurse assists in the successful resuscitation and proceeds to release the patient to the OR staff. When can the ED nurse perform the preoperative assessment? A) When he or she has the opportunity to review the patients electronic health record B) When the patient arrives in the OR C) When assisting with the resuscitation D) Preoperative assessment is not necessary in this case
C) When assisting with the resuscitation
A preop client expresses anxiety to the nurse about upcoming surgery. Which response by the nurse is most likely to stimulate further discussion between the client and the nurse? A. "If it's any help, everyone is nervous before surgery." B. "I will be happy to explain the entire surgical procedure to you." C. "Can you share with me what you've been told about your surgery?" D. "Let me tell you about the care you'll receive after surgery and the amount of pain you can anticipate."
C. "Can you share with me what you've been told about your surgery?"
The nurse is preparing a client for surgery prior to her hysterectomy without oophorectomy. The nurse is witnessing the client's signature on a consent form. Which comment by the client would best indicate informed consent? A. "I know I'll be fine because the physician said he has done this procedure hundreds of times." B. "I know I'll have pain after the surgery but they'll do their best to keep it to a minimum." C. "The physician is going to remove my uterus and told me about the risk of bleeding." D. "Because the physician isn't taking my ovaries, I'll still be able to have children."
C. "The physician is going to remove my uterus and told me about the risk of bleeding."
Maintaining an aseptic environment in the OR is essential to patient safety and infection control. When moving around surgical areas, what distance must the nurse maintain from the sterile field? A) 2 feet B) 18 inches C) 1 foot D) 6 inches
C. 1 foot
A patient is having a surgical procedure takes aspirin 325mg daily for prevention of platelet aggregation. When should the patient stop taking the aspirin before surgery? A. 2 weeks B. 4 weeks C. 7 to 10 days D. 2 to 3 days
C. 7 to 10 days
A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? A. A combination of protein and carbohydrates, such as a small cup of yogurt B. Two teaspoons of sugar dissolved in a cup of apple juice C. Half a cup of juice followed by cheese and crackers D. Half a sandwich with a protein-based filling
C. Half a cup of juice followed by cheese and crackers
The nurse is creating a plan of care for a client scheduled for surgery. The nurse should include which activity in the nursing care plan for the client on the day of surgery? A. Avoid oral hygiene and rinsing with mouthwash. B. Verify that the client has not eaten for the last 24 hours. C. Have the client void immediately before going into surgery. D. Report immediately any slight increase in blood pressure or pulse.
C. Have the client void immediately before going into surgery
A client newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline should the nurse teach the clients at this class? A. Low fat generally indicates low sugar. B. Protein should constitute 30% to 40% of caloric intake. C. Most calories should be derived from carbohydrates. D. Animal fats should be eliminated from the diet.
C. Most calories should be derived from carbohydrates.
In anticipation of a client's scheduled surgery, the nurse is teaching her to perform deep breathing and coughing to use postoperatively. What action should the nurse teach the client? A. The client should take three deep breaths and cough hard three times, at least every 15 minutes for the immediately postoperative period. B. The client should take three deep breaths and exhale forcefully and then take a quick short breath and cough from deep in the lungs. C. The client should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs. D. The client should rapidly inhale, hold for 30 seconds or as long as possible, and exhale slowly.
C. The client should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs.
The OR nurse is providing care for a 25-year-old major trauma patient who has been involved in a motorcycle accident. The nurse should know that the patient is at increased risk for what complication of surgery? A) Respiratory depression B) Hypothermia C) Anesthesia awareness D) Moderate sedation
C. anethesia awareness
The nurse just received a postoperative patient from the PACU to the medicalsurgical unit. The patient is an 84-year-old woman who had surgery for a left hip replacement. Which of the following concerns should the nurse prioritize for this patient in the first few hours on the unit? A) Beginning early ambulation B) Maintaining clean dressings on the surgical site C) Close monitoring of neurologic status D) Resumption of normal oral intake
C. close monitoring of neurologic status
A patient will be undergoing a total hip arthroplasty later in the day and it is anticipated that the patient may require blood transfusion during surgery. How can the nurse best ensure the patients safety if a blood transfusion is required? A) Prime IV tubing with a unit of blood and keep it on hold. B) Check that the patients electrolyte levels have been assessed preoperatively. C) Ensure that the patient has had a current cross-match. D) Keep the blood on standby and warmed to body temperature
C. ensure that the patient has had a current cross-match
A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the bodys need for insulin? A) Adequate sleep B) Low stimulation C) Exercise D) Low-fat diet
C. exercise
A patient with uncontrolled diabetes is scheduled to have surgery. What chief life threatening hazard should the nurse monitor for? A. dehydration B. hypertension C. hypoglycemia D. Glucosuria
C. hypoglycemia
The nurse is caring for a postoperative client with a history of congestive heart failure and peptic ulcer disease. The client is highly reluctant to ambulate and will not drink fluids except for hot tea with her meals. The client's vital signs are slightly elevated and she has a nonproductive cough. The nurse auscultates crackles at the base of the lungs. What complication should the nurse first suspect? A. Pulmonary embolism B. Hypervolemia C. Hypostatic pulmonary congestion D. Malignant hyperthermia
C. hypostatic pulmonary congestion
The intraoperative nurse is transferring a patient from the OR to the PACU after replacement of the right knee. The patient is a 73-year-old woman. The nurse should prioritize which of the following actions? A) Keeping the patient sterile B) Keeping the patient restrained C) Keeping the patient warm D) Keeping the patient hydrated
C. keeping the patient warm
The nurse is caring for a patient with alcoholism. When should the nurse assess for symptoms of alcoholic withdrawal? A. Within the first 12 hours B. About 24 hours postoperatively C. On the second or third day D. 4 days after a surgical procedure
C. on the second or third day
A female client, 47 years old, visits the clinic because she has been experiencing stress incontinence when she sneezes or exercises vigorously. What is the best instruction the nurse can give the client? A. Keep a record of when the incontinence occurs B. Perform clean intermittent self-catheterization C. Perform Kegel exercises four to six times per day D. Wear a protective undergarment to address this age-related change
C. perform kegel exercises four to six times per day
The nurse is performing wound care on a postsurgical client. Which of the following practices violates the principles of surgical asepsis? A. Holding sterile objects above the level of the nurse's waist B. Considering a 1 inch (2.5 cm) edge around the sterile field as being contaminated C. Pouring solution onto a sterile field cloth D. Opening the outermost flap of a sterile package away from the body
C. pouring solution onto a sterile field cloth
The perioperative nurse is constantly assessing the surgical patient for signs and symptoms of complications of surgery. Which symptom should first signal to the nurse the possibility that the patient is developing malignant hyperthermia? A) Increased temperature B) Oliguria C) Tachycardia D) Hypotension
C. tachycardia
The nurse is checking the informed consent for a 17-year-old who has just been married and expecting her first child. She is scheduled for a cesarean section. She is still living with her parents and is on her parents health insurance. When obtaining informed consent for the cesarean section, who is legally responsible for signing? A) Her parents B) Her husband C) The patient D) The obstetrician
C. the patient
The nurse is caring for a patient after abdominal surgery in the PACU. The patients blood pressure has increased and the patient is restless. The patients oxygen saturation is 97%. What cause for this change in status should the nurse first suspect? A) The patient is hypothermic. B) The patient is in shock. C) The patient is in pain. D) The patient is hypoxic.
C. the patient is in pain
A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurses most plausible conclusion based on this assessment finding? A) The patient should withhold his next scheduled dose of insulin. B) The patient should promptly eat some protein and carbohydrates. C) The patients insulin levels are inadequate. D) The patient would benefit from a dose of metformin (Glucophage).
C. the patients inulin levels are inadequate
The nurse in the ED is caring for a man who has returned to the ED 4 days after receiving stitches for a knife wound on his hand. The wound is now infected, so the stitches were removed, and the wound is cleaned and packed with gauze. The ED doctor plans to have the man return tomorrow to remove the packing and resuture the wound. This client's wound will now heal by what means? A. Late intention B. Second intention C. Third intention D. First intention
C. third intention
A patient is admitted to the ED complaining of severe abdominal pain, stating that he has been vomiting coffee-ground like emesis. The patient is diagnosed with a perforated gastric ulcer and is informed that he needs surgery. When can the patient most likely anticipate that the surgery will be scheduled? A) Within 24 hours B) Within the next week C) Without delay because the bleed is emergent D) As soon as all the days elective surgeries have been completed
C. without delay because the bleed is emergent
If a patient comes in with any clinical manifestations of hyperglycemia - such as polyuria, polydipsia, and/or polyphagia you should:
Check blood sugar levels
A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe? A) The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase. B) Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it. C) The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin. D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down
D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down
A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest potential to reduce an individuals risk for developing diabetes? A) Have blood glucose levels checked annually. B) Stop using tobacco in any form. C) Undergo eye examinations regularly. D) Lose weight, if obese
D) Lose weight, if obese
The nurse admitting a patient who is insulin dependent to the same-day surgical suite for carpal tunnel surgery. How should this patients diagnosis of type 1 diabetes affect the care that the nurse plans? A) The nurse should administer a bolus of dextrose IV solution preoperatively. B) The nurse should keep the patient NPO for at least 8 hours preoperatively. C) The nurse should initiate a subcutaneous infusion of long-acting insulin. D) The nurse should assess the patients blood glucose levels vigilantly
D) The nurse should assess the patients blood glucose levels vigilantly
The nurse is conducting preoperative teaching with a client about the use of an incentive spirometer. The nurse should include which piece of information in discussion with the client? A. Inhale as rapidly as possible B. Keep a loose seal between the lips and the mouthpiece C. After maximum inspiration, hold the breath for 15 seconds and exhale D. The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees
D. The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees (Semi-Fowlers or High Fowlers) (the breath should be held for 5 seconds, NOT 15, before exhaling slowly)
A patient preparing for a surgical procedure is taking corticosteroids. What should the patient be monitored for? A. obsutrction B. infection C. hypoglycemia D. adrenal insufficiency
D. adrenal insufficiency
The recovery room nurse is admitting a client from the OR following the client's successful splenectomy. What is the first assessment that the nurse should perform on this newly admitted client? A. Heart rate and rhythm B. Skin integrity C. Core body temperature D. Airway patency
D. airway patency
An older adult client with type 2 diabetes is brought to the emergency department by his daughter. The client is found to have a blood glucose level of 600 mg/dL (33.3 mmol/L). The client's daughter reports that the client recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? A. Administration of antihypertensive medications B. Administering sodium bicarbonate intravenously C. Reversing acidosis by administering insulin D. Fluid and electrolyte replacement
D. fluid and electrolyte replacement
The nurse is creating the care plan for a 70-year-old obese patient who has been admitted to the postsurgical unit following a colon resection. This patients age and increased body mass index mean that she is at increased risk for what complication in the postoperative period? A) Hyperglycemia B) Azotemia C) Falls D) Infection
D. infection Like age, obesity increases the risk and severity of complications associated with surgery. During surgery, fatty tissues are especially susceptible to infection. In addition, obesity increases technical and mechanical problems related to surgery. Therefore, dehiscence (wound separation) and wound infections are more common
A 21-year-old patient is positioned on the OR bed prior to knee surgery to correct a sports-related injury. The anesthesiologist administers the appropriate anesthetic. The OR nurse should anticipate which of the following events as the teams next step in the care of this patient? A) Grounding B) Making the first incision C) Giving blood D) Intubating
D. intubating
A nurse is caring for a client following knee surgery that was performed under a spinal anesthetic. What intervention should the nurse implement to prevent a spinal headache? A. Have the client sit in a chair and perform deep breathing exercises. B. Ambulate the client as early as possible. C. Limit the client's fluid intake for the first 24 hours postoperatively. D. Keep the client positioned supine.
D. keep the client positioned supine
The nurse is planning rehabilitation activities for a client who is working toward discharge back into the community. During a care conference, the team has identified a need to focus on the client's instrumental activities of daily living (IADLs). When planning the client's subsequent care, the nurse should focus particularly on which of the following? A. Dressing B. Bathing C. Feeding D. Meal preparation
D. meal preparation
The PACU nurse is caring for a male client who had a hernia repair. The client's blood pressure is now 164/92 mm Hg; he has no history of hypertension prior to surgery and his preoperative blood pressure was 112/68 mm Hg. The nurse should assess for what potential causes of hypertension following surgery? A. Dysrhythmias, blood loss, and hyperthermia B. Electrolyte imbalances and neurologic changes C. A parasympathetic reaction and low blood volumes D. Pain, hypoxia, or bladder distention
D. pain, hypoxia, or bladder distension
The nurse is caring for a hospice patient who is scheduled for a surgical procedure to reduce the size of his spinal tumor in an effort to relieve his pain. The nurse should plan this patient care with the knowledge that his surgical procedure is classified as which of the following? A) Diagnostic B) Laparoscopic C) Curative D) Palliative
D. palliative
The nurse is caring for a patient who is scheduled to have a needle biopsy of the pleura. The patient has had a consultation with the anesthesiologist and a conduction block will be used. Which local conduction block can be used to block the nerves leading to the chest? A) Transsacral block B) Brachial plexus block C) Peudental block D) Paravertebral block
D. paravertebral block
As a perioperative nurse, you know that the National Patient Safety Goals have the potential to improve patient outcomes in a wide variety of health care settings. Which of these Goals has the most direct relevance to the OR? A) Improve safety related to medication use B) Reduce the risk of patient harm resulting from falls C) Reduce the incidence of health care-associated infections D) Reduce the risk of fires
D. reduce the risk of fires
A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? A. make sure that the patient is aware that quantity of foods will be limited B. ensure that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found C. determine whether the patient is on insulin or taking oral antidiabetic medication D. review the patients diet history to identify eating habits, and lifestyle and cultural eating patterns
D. review the patients diet history to identify eating habits, and lifestyle and cultural eating patterns
In Type 2 diabetes, there is enough insulin present to prevent the breakdown of fat and the accompanying production of ketone bodies. Therefore ______ does not typically occur
DKA
- relatively normal blood glucose until about 3AM, when the levels begin to rise causing morning hyperglycemia
Dawn Phenomenon
Patient under this type of anesthesia are not arousable, not even to painful stimuli, they lose the ability to maintain ventilatory function and require assisstance in maintaining a patent airway
General anesthesia
What is a toxic effect of glucagon?
Hypokalemia
The patient should be instructed to take the pain medication as frequently as prescribed during the ________ postoperative period for pain relief
Initial
if disruption of wound occurs lay the patient in the ______ position
Low fowlers position
After surgery the patient is taken to the ______ to ensure safe emergence from anesthesia
PACU
Normal glucose levels at bedtime, a decrease around 2-3AM resulting in hypoglycemia levels, and a subsequent increase caused by the production of counterregulatory hormones - rebound hyperglycemia due to hypoglycemia from bedtime insulin A person who takes insulin doesn't eat a regular bedtime snack, and the person's blood sugar level drops during the night.The person's body responds to the low blood sugar by releasing hormones that raise the blood sugar level.
Somogyi effect
The purpose of witholding food and fluid before surgery is to prevent:
aspiration
Discharge planning begins
day of admission
How do we fix metabolic syndrome?
diet and exercise
In Type I diabetes, glucose derived from food cannot be stored in the liver but instead remains in the bloodstream and contributes to post-prandial (after meals) __________
hyperglycemia
Older adults are at higher risk for
hypothermia
Exercise _______ blood glucose levels
lowers
If it is a telephone consent we need
2 nurses
Teach the patient that _________ to treat HTN may mask the typical symptoms of hypoglycemia
Beta-Blockers
A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what? A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours. B) If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day C) I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea. D) I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine.
A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours.
Normal Platelet count
Both males and females = 150-400mm^3
A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of insulin can be stored at room temperature before it goes bad. What would be the nurses best answer? A) If you are going to use up the vial within 1 month it can be kept at room temperature. B) If a vial of insulin will be used up within 21 days, it may be kept at room temperature. C) If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature. D) If a vial of insulin will be used up within 1 week, it may be kept at room temperature
A) If you are going to use up the vial within 1 month it can be kept at room temperature.
Normal WBC Count
Both males and females = 5-10mm^3
A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is likely to have minimal contact with the health care system. In order to ensure that the patient maintains adequate blood sugar control over the long term, the nurse should recommend which of the following? A) Participation in a support group for persons with diabetes B) Regular consultation of websites that address diabetes management C) Weekly telephone check-ins with an endocrinologist D) Participation in clinical trials relating to antihyperglycemics
A) Participation in a support group for persons with diabetes
Normal HR
60-100
A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the ADAs recommendations include? A) 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein B) 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein C) 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein
D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein
The nursing instructor is talking with a group of medicalsurgical students about deep vein thrombosis (DVT). A student asks what factors contribute to the formation of a DVT. What would be the instructors best response? A) There is a genetic link in the formation of deep vein thrombi. B) Hypervolemia is often present in patients who go on to develop deep vein thrombi. C) No known factors contribute to the formation of deep vein thrombi; they just occur. D) Dehydration is a contributory factor to the formation of deep vein thrombi.
D) Dehydration is a contributory factor to the formation of deep vein thrombi.
The first dressing change postoperatively is typically performed by
The surgeon
