308-Test 1

A patient with chronic neck pain is seen in the pain clinic for follow-up. In order to evaluate whether the pain management is effective, which question is best for the nurse to ask?

"Does the pain keep you from doing things you enjoy?"

Which statement, if made by an older adult patient, would be of most concern to the nurse?

"I don't go on daily walks anymore since I had pneumonia 3 months ago."Inactivity and immobility lead rapidly to loss of function in older adults.

A patient scheduled for an elective hysterectomy tells the nurse, "I am afraid that I will die in surgery like my mother did!" Which response by the nurse is most appropriate?

"Tell me more about what happened to your mother."- bc you are concerned with malignant hyperthermia

what can make the nausea worse

- drinking liquids - eating fats - cup of hot tea between meals

what may make the stomach ph above 6

- meds given to prevent stress ulcers or reflux such as proton pump inhibitors or H2 receptor antagonists

what happens to the following systems if pain goes untreated

...

what is normal waist hip ratio

.8

how many faces are there

0-5

most common ADR of opioids

1 N&V 2 respiratory depression 3 sedation

Look for foods that have no more than ____ of fiber in a serving

1 gram

How long before insertion of IV do you need to apply EMLA

1 hour

how many people with flesh eating bacteria die and why

1 in 4 toxic shock and organ failure

how long do you follow this diet

1 month

First 2 days post op bariatric sx- can only have ___ fluid per day

1 ounce of fluid- then after 2 days you can have 2 ounces

when someone has C dif what can you use to clean the surfaces

1% bleach- this eliminates spores

what is the highest priority post op 1. Maintaining the patient's blood glucose within a normal range 2. Ensuring that the patient has an adequate dietary protein intake

1- glucose is more important

how many sounds will you hear when using doppler

1- initial systolic 2-reverse flow 3- small forward flow

1s space is where 2nd space 3rd space

1- intravascular 2- interstitial- edema 3- gets trapped in pleural, pericardial, peritoneal

"I do not really understand what the doctor said." Which action is best for the nurse to take? 1. Notify the surgeon that the informed consent process is not complete. 2. Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.

1- talk to surgeon directly

how many lumens does a PICC have

1-3

mild pain=

1-3

>500 solutions needing to be given centrally include

1. > 10% dextrose 2. 5% protein hydrosylate 3. high electrolytes

what can cause anaphylaxis

1. AB 2. latex 3. anesthesia

what are some risk factors for C dif

1. AB tx 2. drugs that decrease gastric acidity 3. renal failure 4. inflammatory bowel 5. CA 6. imunosupression 7. malnutrition 8. NG intubation 9. G tube 10. colonoscopu 11. prolonged hospital stay 12. ICU admission

Steps of EBP

1. Ask clinical question- PICOT 2. collect evidence 3. appraise and synthesize evidence 4. generate evidence- put it into practice 5. evaluate

high level of homocysteine shows high risks of what

1. CAD 2. PVD 3. stroke

what are the 6 inflammation markers

1. CRP 2. ESR 3. plasma viscocity 4. tumor necrosis factor 5. interleukin 6 6. omego 3 tissue concentration

where can transcellular fluid be

1. CSF 2. GI tract 3. lungs- pleural 4. joint- synnovial 5. abdomen- peritoneal

3 most common bacteria that cause UTI

1. E. Coli 2. Klebsiella Proteus 3. Psudomonas Serratia

2003 IOM Health Professions Education Report

1. EBP 2. QSEN 3. SBAR 4. NPSG- TJC

bad things of NSAIDS- 4

1. GI irriation- give gastric cytoprotection 2. makes you bleed- caution if taking anticoagulant 3. renal impairment- ensure adequate hydration and urine ouput 4. cardiovascular complications

when does pulsus alternans happen

1. HF 2. cardiac tymponade

What are the dangers of rapid fluid replacement

1. HF 2. diuresis 3. hypernatremia

What all regulates water balances

1. HPA- hypothalamus pituitary regulation 2. RAAS- kidney regulation 3. BNP- cardiac regulation 4. GI regulation- by absorption 5. insensible water loss- skin and lungs

what increases afterload

1. HTN 2. vasconstriction

Which actions will the nurse include in the surgical time-out procedure

1. Have the patient state name and date of birth. 2. Verify the patient identification band number. 3. Ask the patient to state the surgical procedure. 4. Confirm the hospital chart identification number.

Which procedures increase the risk of C Dif

1. NG intubation- takes out stomach acid 2. G tube 3. colonoscopy 4. mechanical ventilation

Which nursing actions will the nurse take to assess for possible malnutrition in an older adult patient (

1. Observe for depression. 2. Review laboratory results. 3. Assess teeth and oral mucosa. 4. Ask about transportation needs.

what is allowed in a clear liquid diet

1. Plain water 2. Fruit juices without pulp 3. Strained lemonade or fruit punch 4. Clear, fat-free broth (bouillon or consomme) 5. Clear sodas 6. Plain gelatin 7. Honey 8. Ice pops without bits of fruit or fruit pulp 9. Tea or coffee without milk or cream

Which systems cause an increased venous return and therfore increased CO

1. RAAS 2. SNS

what are some new emerging infections

1. SARS 2. Ebola 3. Bird flu 4. Hep C

Insulin is most quickly absorbed where then where then where

1. abdomen 2. arms 3. thighs 4. butt

where can 3rd spacing occur

1. abdomen- peritoneal 2. lungs- pleural 3. pericardial 4. brain 5. extremeties

pain classification

1. acute or chronic 2. intermittent or persisten 3. malignant or non malignant

when do eosinophils increase

1. allergies 2. skin inflammation 3. parasitic infection 4. bone marrow disorders

when a patient can not communicate- what order should you go in to figure out if in pain

1. always try self report 2. see if they have a dx that usually causes pain 3. look at their behavior 4. ask the family 5. check physiological responses- VS

what 2 other things does DM cause

1. amputations 2. blindness

what are 2 catastrophic events int eh OR

1. anaphylaxis 2. malignant hyperthermia

what causes a thrill

1. aneurysm 2. aortic regurgitation 3. AV fistula

name some adjuvants:

1. anticonvulsants- Gabapentin 2. tricyclic antidepressants- amitriptyline 3. corticosteroids- dexamethazone 4. muscle relaxants- Baclofen 5. Capsaicin- Zostrix 6. complementary medicine

what are some common vesicants

1. antineoplastics 2. antibiotics 3. contrast media 4. phenergan 5. dilantin 6. valium

what causes a systolic murmur (3)

1. aortic or pulmonic valve stenosis 2. mitral or tricuspid regurgitation 3. venticular septal defect

the most common complications of enteral feedings

1. aspiration 2. diarrhea 3. displaced tubes

what causes a bruit

1. atherosclerosis 2. PVD 3. aneurysm 4. fistula

which food allergies are related to latex allergies

1. bananas 2. avacados 3. eggs 4. potatoes 5. chestnuts 6. peaches

wht does the systemical inflammatory response syndrom score count

1. body temp <96.8 or > 100.4 2. heart rate > 90 3. resp rate > 20 4. WBC < 4000 or > 12,000

when do monocytes decrease

1. bone marrow disorders 2. leukemia

when is gastric decompression indicated

1. bowel obstruction 2. paralytic ileus 3. sx on stomach

The ____(4)____ do not have subcutaneous tissue and Category/Stage III and IV ulcers can be shallow.

1. bridge of nose 2. ear 3. occiput 4. malleolus

How does HBO help

1. causes constriction of vessels which reduces edema and ICP 2. helps defense mechanisms of WBC 3. forms CT 4. forms new blood vessels

2 things you need to do before angiography

1. check allergy to contract 2. dont eat or drink anythign 6-12 hours before

When would you do a stress tredmill test

1. chest pain symptoms 2. family history 3. abnormal rhythms 4. smoking 5. diabetes 6. high BP

who should use wong backer

1. children 2. cognitive ish 3. speak different language

what can you drink first 2 days after bariatric

1. clear broth 2. sugar free jello 3. crystal light 4. sugar free koolaid

Cool thing that you can do with a PermCath (tunneled phresis catheter)

1. collect stem cells 2. support patient during transplant episode

which CA causes inflammation-3

1. colon 2. breast 3. lung

nurses role in pain management

1. competency in pain assessment 2. use standard measurements 3. help dr titrate correctly (we assess titration) 4. educate

addiction aspects

1. compulsive use 2. loss of control 3. use despite harm

How can you prevent aspiration

1. confirm placement 2. Chest X ray is mandatory 3. residual volume every 4-6 hrs 4. HOB raised

Clinical manifestations of low NA

1. confused 2. lethargic 3. restless 4. HA 5. apprehension 6. nausea 7. abdominal pain 8. postural hypotension 9. muscle weakness

order for preparing narcotics

1. count 2. remove 3. med check 1 4. dosage calc 5. prepare meds 6. med check 2 7. go to bed 8. med check 3

NG intubations has many purposes:

1. decompress stomach- remove gas and fluid 2. lavage stomach to remove toxins 3. Dx probs with GI motility 4. treat obstruction 5. compress bleeding site 6. aspirate contents for analysis 7. to administer radiographic contrast media

intraluminal fluid sequestrations causes what 2 things

1. decreased blood volume 2. bloating

what are 3 possible causes of malabsorption syndrome

1. decreased enzymes- like in cystic fibrosis 2. drug interactions 3. reduced bowel surface area- colectomy

when do you not give hypertonic

1. dehydrated like with DKA 2. HF (fluid overload) 3. Renal failure

Isolating patients under contact precautions is associated with

1. depression 2. med errors 3. fewer visits from physician

Who is most at risk for getting MRSA

1. diabetics 2. malnourished 3. people with invasive devices 4. depressed immune function 5. corticosteroids 6. working with seafood

what can cause pulse def.

1. dysrhythmias 2. atrial fibrillation (flutter) 3. premature ventricular contraction

what else causes crackles

1. edema 2. bronchitis 3. HF 4. pneumonia

causes of bradycardia

1. electrolyte imbalance 2. problems with heart conduction system

which meds can cause obesity

1. estrogen 2. corticosteroids 3. antidepressants

What 4 factors determine wound treatment

1. etiology of wound 2. amoutn of exudate 3. frequency of dressing changes 4. cost

what symptoms are present with severe C dif

1. fever 2. nausea 3. dehydration

What does Group A strep cause

1. flesh eating bacteria 2. impetigo 3. strep throat

What do you give to tx UTI

1. fluoroquinalones (Cipro) 2. Nitrofurantoin (Macrobib) 3. Sulfanomides (Bactrim, Septra) 4. cranberry juice 5. Pyridium- helps with pain

sign of UTI

1. frequency, urgency, dribbling, dysuria 2. perineal itching 3. urethral discharge 4. cloudy and foul smalling urine 5. hematuria 6. lower back or abdominal discomfort 7. pyuria 8. fever 9. N&V

name 2 types of restrictive bariatric sx

1. gastric banding 2. sleeve

nurse pre stress test

1. get VS 2. get pre EKG 3. hold BB for 24 hours before 4. hold caffiene 24 hours before 5. dont smoke 3 hours before test

starvation pathophys.

1. glucose decreases so insulin decreases 2. use fat and muscle protein

after a mastectomy what should pt do

1. hand exercises as soon as she can 2. wait to shower until drain gone 3. wait to do water aerobics until 3-4 weeks 4. dont take BP or blood from bad side

top 3 leading causes of death

1. heart disease 2. Ca 3. stroke

what is the reason protein calarie malnutrition sometimes causes death

1. heart failure 2. lyte imblance 3. low body temp

If due to flesh eating bacteria- you go into shock, what will happen

1. heart failure 2. respiratory failure 3. renal failure

what can an echo tell you

1. heart size 2. appearance of valves 3. thickness of heart muscle 4. EF

what are some mechanical obstructions (this is different that ileus which is due to anesthesia and manipulation)

1. hernia 2. adhesiosn 3. intursuseption (bowel in bowel) 4. volvulus (twisted bowel) 5. feces

REnal failure lytes

1. hyperkalemia 2. hyperphosphatemia 3. hypocalcemia 4. hyponatremia- from dilution

5 things under metabollic syndrome

1. hyperlipidemia 2. HTN 3. DM 4. cardiovascular disease 5. obesity

dumping syndrome is the result of rapid gastric emptying. What 3 things does this rapid emptying cause?

1. hyperosmolar jejunal chyme 2. inapropriate gut horome release 3. rapid glucose absorption

what will increase preload

1. hypervolemia 2. regurgitation of the valves 3. MI 4. aortic stenosis

Complication of HBO

1. hypoglycemia if give insulin before because it increases metabolic rate 2. tumors thrive on O- dont give if CA

when do lymphocytes decrease

1. immune system disease like with lupus or HIV MOST IMPORTANT

use opioids cautiously in patients with ____

1. impaired ventilation 2. liver failure 3. renal failure 4. increased ICP

How does HBO help with healing

1. improves defense mechanism of WBC 2. strengthens antibacterial function of certain enzymes 3. increases fibroblast activity (forms CT) 4. links CT fibers 5. forms new blood vessels

consequences of unrelieved pain

1. increased catabolic demands 2. taxed cardiovascular system 3. anorexia 4. fever 5. poor healing 6. immobility 7. impaired immune responses 8. hyperglycemia 9. sleep depreviation 10. suicidal thoughts 11. depression and anxiety 12. develop into chronic pain

why not trendelenburg

1. increases risk for aspiration 2. impairs gas exchange 3. increases risk of retinal detachment 4. increases cerebral edema 5. decreases CO

which populations are at risk for undertreated pain

1. infants 2. children 3. OA 4. substance abusers 5. cognitive impairment

when do monocytes increase

1. infection 2. inflammation 3. CA

when do lymphocytes increase

1. infections 2. leukemia 3. bone marrow CA 4. radiation therapy

an exchange in peritoneal dialysis includes these 3 phases

1. inflow 2. dwell 3. drain

phases of primary intention wound healing and how long they last

1. initial- lasts 3-5 days- 2. granulation- lasts 5 days- 4 weeks 3. maturation and scar contraction- lasts 7 days to several months

what does the ECF consist of

1. interstitial 2. vascular- plasma 3. transcellular

what are you at risk for after doing gastric bypass

1. iron def.

what may you de def in after bariatic sx

1. iron- anemia- due to low intrinsic factor 2. Ca 3. Vit B12

what 3 things can a PCA pump do

1. keep you hydrated 2. deliver AB 3. relieve pain

when do basophils increase

1. leukemia 2. chronic inflammation 3. food allergies 4. radiation therapy

who is at risk for 3rd spacing

1. liver probs so make less protein 2. burns 3. trauma

what causes 3rd spacing- 2

1. loss of albumin- decreases oncotic pressure liver disease or malnutrition 2. damage to capillaries- damage of endothelial cells increases capillary permeability

The role of the RNFA (registered nurse first assistant)

1. making incisions 2. suturing 3. hemostasis

pre op for coronary Ca scan

1. med hx 2. BP 3. risk assessment 4. blood test (cholesterol level)

we said tricyclic antidepressants are good for neuropathic pain states such as, ____

1. migraines 2. low back pain 3. CA pain 4. fibromyalgia

what are some examples of chronic intermittent pain- 3

1. migraines 2. sickle cell anemia 3. inflammatory bowel disease exacerbation

mild C dif=

1. mild to mod. mucoid fowl smelling diarrhea 2. minimal lower abdominal cramps 3. mild tenderness

what should you not give with iron

1. milk 2. coffee 3. tea

what causes a diastolic murmur (3)

1. mitral or tricuspid stenosis 2. aortic or pulmonic regurgitation

what meds are put in PCA pumps

1. morphine 2. demerol 3. dilaudid

what 2 things can result in turbulent blood flow (a murmur)

1. narrowing of the valve (stenosis) when it should be open 2. regurgitation when should be closed

side effects of IV acetaminophen (Ofirmev)- 5

1. nausea and vomit 2. HA 3. insomnia 4. onstipation 5. pruritus

Name the 4 stages of pressure ulcers

1. nonblanchable erythema 2. partial thickness skin loss 3. full 4. full

top 5 gallop poll

1. nurses 2. pharmacists 3. teachers 4. dr 5. military

causes of infiltration

1. obstructed blood flow 2. obstructed fluid flow 3. mechanical- puncture vein 4. chemical- meds cause inflammation

the 6 P's of neurovascular assessment

1. pain 2. pallor 3. pulse 4. paresthesis 5. paralysis 6. poikilothermia

Manifestations of flesh eating bacteria

1. pain 2. swollen, hot red skin 3. hypotension 4 fever 5. dehydration 6, N&V

what kind of data do you need for a successful titration of pain meds

1. pain intensity 2. patient goal 3. adverse effect of med 4. measures of functionality 5. sleep 6. emotional state 7. impact of pain on patient quality of life

what should you do if client has dysphagia with oral feedings

1. palpate throat during swalloing 2. place in high fowlers (not semi fowlers) 3. inspect food packets in the mouth before feeding 4. rest 30 min before meal 5. flex head to chin down position(decr risk of aspiration)

titrating anelgesics should be based on:

1. patient goals 2. intensity 3. adverse drug effects 4. functionality 5. sleep 6. emotional state 7. caregivers report of pain impact on quality of life

what does the patient exercise to

1. peak heart rate (220-age) 2. peak exercise tolerance

what AB treat flesh eating bacteria

1. penicillin 2. clindamycin 3. erythromycin

Clinical manifestations of HA- MRSA

1. pneumonia 2. sepsis 3. wound infection

There are four basic types of enteral formula:

1. polymeric 2. modular 3. elemental 4. specialty

10 patient safety strategies ready for adoption

1. pre op checklist 2. bundles and checklists to prevent central line blood infections 3. reduce urinary cath. use 4. bundles to prevent ventilatory associated pneumonia 5. hand hygiene 6. do not use abbreviations 7. reduce pressure ulcers 8 barrier precautions to prevent HCA infections 9. use real time ultrasonography from central line placement 10. improve prophylaxis for venous thromboembolisms

Who is more likely to get UTI

1. pregnant 2. DM 3. stool incontinence 4. genetic

What are the 4 phases of general anesthesia

1. preinduction 2. induction 3. maintenance 4. emergence

What factors effect stroke volume

1. preload 2. afterload 3. myocardial contractility

post procedure of angioplasty

1. pressure over femoral artery 2. lay on back for several hours 3. check for bleeding or chest pain

Severe C dif

1. profuse watery diarrhea 2. abdominal distention and pain 3. fever 4. nausea 5. dehydrated

PQRST of pain

1. provokes- what causes it 2. quality 3. radiation/ region (where is it) 4. severity 5. time- when did it start

LPN can insert IV if state allows- but what can only the RN do

1. push meds 2. hang blood 3. give fluids and meds to critically ill patients

which medical conditions are risk factors for C dif

1. renal failure 2. inflammatory bowel disease 3. CA

problems with TPN

1. risk for infection 2. expensive

side effects of Opioids

1. sedation 2. mental confusion 3. N and V 4. constipation 5. urinary retention 6. pruritis 7. respiratory depression

complications that arise from UTI

1. septic shock 2. renal failure 3. urethral obstruction 4. pyelonephritis 5. urosepsis- sepsis caused by UTI

When do you avoid the isotonic fluid of LR- 2

1. severe liver disease- because liver can't metabolize lactate to bicarb and get acidosis 2. if pH is above 7.5

what is afterload affected by

1. size of ventricles 2. wall tension 3. BP

what can you drink after first 2 days- bariatric

1. skim milk 2, cream of wheat 3. sugar free vanilla pudding 4. sugar free vanilla yogurt

Physiological and psychological factors influencing functional status:

1. sleep 2. sensory impairment 3. mobility and balance 4. experience of loss 5. special consideration in OA

what do you need to do for patient before angioplasty

1. start IV 2. put on cardiac monitor 3. sedative 4. blood thinner

what are the 3 types of protein calarie mulnutrition

1. starvation related- primary 2. chronic disease related- secondary 3. acute disease related

how to manage stress

1. stress resistance 2. cognitive appraisal 3. effective coping

4 types of debridement

1. surgical 2. autolytic 3. enzymatic 4. negative pressure therapy- pulse vac 5. mechanical- wet to dry and irrigation

common symptoms of dumping syndrome

1. sweating 2. shaking 3. N and V 4. tachycardia 5. abdominal cramps 6. diarrhea

cardiovascular system is taxed leading to (4)

1. tachycardia 2. increased BP 3. increased myocardial O demand 4. hypercoagulation

angiotensinogen goes where- 3

1. tell the brain to release ADH (vasopressin) and also makes you thirsty 2. tells the adrenal cortex to release aldosterone 3. tells the blood vessels to constrict

what are some words that describe neuropathic pain

1. tingling 2. prickling 3. shooting 4. electric shock like 5. jabbing 6. squeezing 7. spasm 8. cold

pre op meds

1. valium 2. demerol 3. blood 4. AB 5. corticosteroids 6. atropine

name some opioids that contain acetaminophen

1. vicodin0 500 or 750 2. lortab- 500 3. percocet - 325

soft food diet- how tiny should food be

1/2 inch or smaller

About ____ people with chronic disease have one or more daily activity limitations

1/4

how much of your weight can you lose, without having side effects

10 %

how strong is methadone

10 times as potent as morphine

Anything ___% causes chemical phlebitits so you should not give it in a peripheral

10%

how long after giving IV antibiotic would a reactions occur

10-15 minutes- monitor closely

how much of diet is protein

10-30%

Mild to moderate temperature elevations (less than ____° F) do not harm the young adult patient and may benefit host defense mechanisms.

103-

If the intra-abdominal pressure is more than ___ mm Hg, suspect that the patient has intra-abdominal hypertension

12

how long can you hang lipid only emulsions

12 hours

what is preHTN

120-139

what % of population is OA

13%- increasing

stage 1 HTN

140-159

during first 2 days try to take only 1 tsp of fluid every

15 minutes

bolus intermittent feedings should be administered over ____-____ min

15-30 increase the volume of formula for the firs 4-6 hrs until full amount is achieved

Most adults produce between _______ mL of urine per day

1500-2000 ml

stage 2 HTN

160

Central PN Peripheral PN

1600 mOm/L- 20-50% glucose up to 20% glucose

Braden scale score < ____ means a pressure sore

18

size of catheter for blood or rapid rate stuff

18

Normal BMI

18.5-24.9

normal pre albumin

19-38

how many cups of milk can you have a day on low fiber diet

2

Assess IV site frequently and chart every ____

2 hours

Systemic inflammatory response syndrome score

2 or more= inflammation

AFter 2 days you can have ____ fluid a day

2 ounces of fluid

After abdominal surgery, a patient with protein calorie malnutrition is receiving parenteral nutrition (PN). Which is the best indicator that the patient is receiving adequate nutrition? 1. albumin 3.5 2. incision healing normally

2- the albumin is kinda low and does not reflect caloric intake

A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction and is complaining of anxiety and incisional pain. The patient's respiratory rate is 32 breaths/minute and the arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first? 1. Discontinue the nasogastric suction. 2. Give the patient the PRN IV morphine sulfate 4 mg. 3. Teach the patient how to take slow, deep breaths when anxious.

2- the breathing fast is due to pain- wont be able to breath slow until you fix the pain

how many lumens does a CVC have

2-4

normal prealbumin- the most sensitive indicator of protein def.

20

Size of IV cath for adult

20-22

Tell me about staph and noses

20-30% have staph in nose 2% have MRSA in nose

how much of dieat is fats

20-35%

Wound drainage should decrease and change in color from sanguineous to serosanguineous by the second postoperative day.

200 mL sanguineous fluid in the wound drain- on second post op day is bad

size of IV cath for children or elderly

22-24

How long can you use tubing for blood

24 hours

how long can you hang lipid containing solutions

24 hours

how long can you use tubing for lipids

24 hours

3rd spacing article says isotonic fluids range from _____-______

240-340

overweight

25-29.9

what is the number for hypotonic

250

normal serum transferrin

250-425

Level of prevention- for early detection

2nd

mammogram

2nd

As the nurse prepares a patient the morning of surgery, the patient refuses to remove a wedding ring, saying, "I have never taken it off since the day I was married." Which response by the nurse is best? 1. tape ring 2. make sign consent 3. suggest giving it to family to hold

3

what is a safe zone

3 ft can go in room without gowning

Exercise or stress testing- common protocol uses _____ stages at set speed and elevation of the tredmill belt

3 minute

A chronic condition is defined as being longer than

3 months

only ulcers of stage ____ will heal by scar formation

3 or 4

notionwide prevalance of ESB

3%

when does motility resume in the large intestines

3-5 days

the levels will rise how long after injury

3-6 hours

normal bands are

3-6%

The gastric pouch is limited to + or - _____ ml

30

Urine output < ___ and hour or ____ a day is concerning

30 500

atients should be reassessed_____ after receiving IV opioids for pain

30 min and reassess 1 hour after oral administration

pain assessment frequency- within ___ of parenteral med and within ___ of oral med

30 minutes 1 hour or whenever they have a change in pain

does the nuclear stress test take a long time

30 minutes and then return 2-4 hours later to do it at rest

what % of hospital patients have malnutrition

30-50%

plan to take ___-___ min to eat each meal

30-60

what is the number for an isotonic solution

300

FDA- combination drugs to conatin no more than ____ of acetominophen

325

what is the number for hypertonic

375

LA is teh ___ most obese state

3rd

systemic inflammatory response syndrome occurs as a result of

3rd spacing- fluid trapping- decreases circulation- hypoperfusion and ischemia- aneorobic metabolism then Na/K pump fails- so Na moves into cells- more swelling- cytokines cause even more cell damage and inflammtion- these cytokines may travel throughout body

a pain scale of ___ or more significantly interferes with function

4

infiltration of any blood or vesicant (extravasaion)- is a rating of

4

The risk for oversedation is greatest in the first _____ after transfer from the postanesthesia care unit.

4 hours

how long can you hang blood

4 hours

How do you give Vanc for C dif

4 times a day for 1- days- crushed for NG

get NG tube if feedings will last shorter than

4 weeks

how much can obesity shorten your life

4 years

An IV injection of an opioid should be injected over ____ min

4-5 min

mod pain=

4-6

toponin is released in response to injury how long after the injury

4-6 hrs

what is normal CO for adult at rest

4-8 L/ min

Bariatric sx is recommended for a BMI of

40 or 35 with a co morbidity such as HTN or DM

Losing more than ___% of weight can be fatal

40%

mortailty rate if get ESB (extended spectrum betalactamase)

42-100% mortality

how much of diet is carbs

45-65%

How long is the On Q pump good for

5 days- go home with it

after preparing the insulin- how long can you wait to give it

5 min

after bariatric sx- how many meals should you eat a day

5 small meals

A loss of more than ___% of usual body weight over 6 months is a critical indicator for further assessment

5%

normal WBC

5,000-10,000

1 in ___ americans smoke

5- 43 million

How long is the lock out interval on a PCA pump set for

5-6 mimutes

how many Americans suffer from persistent pain each year

50 mil- usually pain goes untreated

Call rapid response team if urine output is < ____ after 4 hours

50- but should make 30 ml an hour

The Infusion Nurses Society mandates that all fluids with a tonicity exceeding ____ mEq/L be infused through a central venous access device, where the more rapid blood flow of the superior vena cava quickly whisks the solution into the circulation and away from venous tissue.

500

hold feeding is residual volume is >

500

weight change of 1 lb is equal to how much fluid

500 ml 2.2 lb= 1 liter= 1 kg

how fast does the ball deflate

5ml/hr

NOLA is teh ___ most obese city

5th

Most facilities' policies require emptying bags a minimum of every ___ hours.

6

acute pain is less than ____

6 months

how long will you need to crush meds post bariatric sx

6 weeks

If patient does not void ____hours after removal it may be necessary to recatheterize

6-8

most patients urinate ___-____ hours after sx

6-8

what is normal stroke volume

60-70 ml- ejected each beat

what % of adults are overweight or obese

69%

Ultimately, the kidneys filter __ liters of fluid per hour, 99% of which is reabsorbed.

7

how long is a Huber needle good for

7 days- used to access implanted ports

HbA1c should be below ____

7%

severe pain=

7-10

how long can you use tubing for dextrose and AA

72 hours

how often should you change continuous infusion IV tubing

72-96 hours

Perform catheter care a minimum of every ___ hours, regardless of the type of catheter the patient has.

8- cleanse area and assess for leaks

Gallop honesty and ethics professions survery- ___% of americans put nurses first

80%

preHTN

80-89

how many calories should we consume if we want to lose weight

800-1000

SS is ___% of an OA income

90%

HTN stage 1

90-99

the client needs to have O sat of at least ___ on room air in order to be DC from PACU

92%

BMI > ___ th percentile is obese

95

what is plasma osmolarity with FVE

< 275

what is normal systolic pressure

<120

Underweight

<18.5

normal diastolic

<80

Call rapid response team is O2 sat is

<90% after supplementation

Call rapid response team is systolic blood pressure is

> 180 < 90

Call rapid response team if respirations are

> 28 < 8

what is plasma osmolarity in hypovolemia

> 295

HTN stage 2

>100

Call rapid response team if heart rate is

>140 <40

at what residual would you hold feedings

>200

A patient who has a small cell carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should notify the health care provider about which assessment finding?

A Na of 120 is more important than weight gain

A patient's blood pressure in the postanesthesia care unit (PACU) has dropped from an admission blood pressure of 140/86 to 102/60 with a pulse change of 70 to 96. SpO2 is 92% on 3 L of oxygen. In which order should the nurse take these actions? a. Increase the IV infusion rate. b. Assess the patient's dressing. c. Increase the oxygen flow rate. d. Check the patient's temperature.

A- to help wtih volume loss C B D

what happens to the ANS, HPA, and thyroid

ANS is supressed- HPA is activated- thyroid is supressed

The nurse reviews the medication orders for an older patient with arthritis in both hips who is complaining of level 3 (0 to 10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy?

Acetaminophen- Tylenol

Mechanical debridement with wet-to-dry dressings is painful, and patients should receive pain medications before the dressing change begins

Administer the ordered PRN hydrocodone (Lortab) 30 minutes before the dressing change.

The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action should the nurse take?

Administer the prescribed normal saline bolus and insulin.- you would not apply O2 bc may not be due to hypoxia

VasCath without a tunnel

Arrow cath- can be done a bed

who will you know if infected then

Ask about fatigue or feelings of malaise."just not feeling well."

The nurse plans to teach a patient and the caregiver how to manage high blood pressure (BP). Which action should the nurse take first?

Ask the patient and caregiver to select information from a list of high BP teaching topics.Because adults learn best when given information that they view as being needed immediately, asking the caregiver and patient to prioritize learning needs is likely to be the most successful approach

An older Asian patient, who is seen at the health clinic, is diagnosed with protein malnutrition. What priority action should the nurse include in the teaching plan?

Ask the patient to record the intake of all foods and beverages for a 3-day period. Assessment is the first step

why not use aleve (NSAID) or ASpirin

Aspirin and the NSAIDs are associated with a high incidence of gastrointestinal bleeding in older patients.

A family caregiver tells the home health nurse, "I feel like I can never get away to do anything for myself." Which action is best for the nurse to take?

Assist the caregiver in finding respite services.

estimates total body fat stores

BMI

useful as a measure of nutritional status that doesn't depend on body build or body fram

BMI- estimates total body fat stores

marker of choice for determining if dyspnea is due to respiratory or cardiac problem

BNP- b type natriuretic peptide

which meds should not be taking along with anesthesia and why

BP meds- may cause hypotensive crisus no Captopril (Capoten)

if an arm has a PICC line- what can you not do to that arm

BP or venipuncutre

what produces toxins A and B

C Dif

what is does extended use of AB cause What does taking a lot of AB cause Using AB without dr order

C Dif MRSA MRSA

Prolonged mechaical ventilation

C dif

nucleic acid amplication

C dif

who do you put on a non narcotic angalgesic

C dif

- Anaerobic spore forming bacillus

C diff

this is a protein made by the liver during acute inflammation.

C reactive protein- CRP

When is HBO treatment contraindicated

CA

red, swollen, painful pustules or boiles with pus or other drainage.

CA- MRSA

Which MRSA is increasing and which decreasing

CA- MRSA- increasing HA- MRSA- decreasing 28%

An increased level of CRP is a risk factor for

CAD- may prevent future cardiac events

Usually monitoring ____ if on parenteral nutrition

CBG and I&O

The sleeves of a sterile surgical gown are considered sterile only to 2 inches above the elbows, so touching the surgeon's upper arm would contaminate the nurse's gloves

CHANGE THE GLOVES

the amount of blood pumped by each ventricle in 1 minute

CO

What med conditions are likely to cause undernutrition

COPD and Inflammatory bowel disease

Releases or discharges patients from the postanesthesia care area.

CRNA

deals with clotting

Ca

hypo_____ is a complication of TPN

Ca

Pinpoint potential heart problems and get patients help before too late

Ca coronary scan

used for asymptomatic paitients to assess heart disease

Ca coronary scan

This patient with chronic malnutrition is likely to have a low serum albumin level, which will affect the total serum ___.

Ca- more accurate is the ionized ca level

which of these should be seen about first Arterial blood pH is 7.32. Serum calcium is 18 mg/dL. Serum potassium is 5.1 mEq/L. Arterial oxygen saturation is 91%.

Ca- very very high- watch for dysrhythmias

which adjuvant is an OTC ointment

Capsaicin (Zostrix)

After the nurse provides dietary instructions for a patient with diabetes, the patient can explain the information but fails to make the recommended dietary changes. How would the nurse evaluate the patient's situation?

Choosing not to follow the diet is the behavior that resulted from learning.

_______(vitamin B12) cannot be obtained from foods of plant origin, so the patient will be most at risk for signs of cobalamin deficiency, such as paresthesias, peripheral neuropathy, and anemia.

Cobalamin- B12

A patient with second-degree burns has been receiving hydromorphone through patient-controlled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. What action by the nurse is most appropriate?

Consult with the health care provider about using a different treatment protocol to control the patient's pain.

_______is specific to myocardial injury and infarction and increases 4 to 6 hours after the infarction occurs. It is often trended with troponin levels.But not the most important

Creatine Kinase

The kidneys also play a role in the production of erythropoietin (which contributes to red blood cell production) and in the activation of vitamin __.

D

Which Vit def. is a cardiac risk factor

D

Which Vit is important for Ca absoption

D

bag of TPN is finished and you dont have a new bag on unit- what should you give

D10 W- need to give sugar to prevent hypoglycemia

turns hypotonic after metabolism of dextrose

D5W

Rapid onset, glucose in urine, Kausmul's respirations, CBG< 400, and Type 1 DM

DKA

what are you at risk for if give insulin via IV

DKA- because could have occlusion, low battery, or low insulin in pump

Which type of DM can develop DKA and which can develop nonketotic hyperosmolar coma

DKA- type 1 nonketotic hyperosmolar coma- Type 2

What is the leading cause of kidney disease

DM

what is MG in charge of

DNA and protein synthesis ATP formation carb metabolism

small pouch on the lining of the intestines that becomes inflamed

Diverticulitis

Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fiber.

Drink fluids between meals but not with meals. The pregnant woman should not drink fluid in between meals bc she may get nauseated

hydrocolloid dressings such as ___ are used to treat yellow wounsd

DuoDerm

_____ and _____ produce ESB enzymes which makes ABs useless

E coli and Klebsiella pneumoniae

An echo measures EF- what is that

Ejection fraction- the % of end diastolic blood volume that is ejected during systole

contain predigested nutrients, making it easier for a partially dysfunctional gastrointestinal tract to absorb them. They provide 1 to 3 kcal/mL.

Elemental formulas

ND for high Na

Excess fluid volume- because water will want to follow the Na and RISK FOR INJURY FALLS- and keep in mind if you have a low NA (caused by excess water) you are at risk for FVD and hypovolemia because you want be able to retain the water

what does intestinal obstruction do to fluid

FVD- due to 3rd spacing

SOB is a sign of

FVE

what could be some complications of IV therapy- 4

FVE HTN coughing SOB

T or F- I.V. administration sets for continuous infusion can easily be temporarily disconnected for patients to shower, eat, or ambulate and then reconnected.

False- Interrupting a continuous infusion is not recommended.Doing so increases hub manipulation and tubing contamination, thus increasing the risk of bloodstream infection.

bacteriacidal

Fidaxomicin

How can you reduce the pain from injection- according to article

Firmly press site for 10 seconds before injection can stimulate nerve endings

Procedure is monitored using a _____

Fluoroscope- continuous X ray

aspiration risk is higher with NG tube- if it is too high you may do _____

G or J tube

When Ig__ is low you get bowel inflammation and diarrhea

G- antitoxin A

What organs in particular does obesity affect

GB disease and nonalchoholic fatty liver

what organ usually comes out with bariatric surgery

GB- when lose weight rapidly is a risk for stones

A patient has been admitted to the hospital for surgery and tells the nurse, "I do not feel comfortable leaving my children with my parents." Which action should the nurse take next?

Gather more data about the patient's feelings about the child-care arrangements.

A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which action by the nurse is best?

Give immediate-release morphine 30 mg orally.

closed valve tip catheter that requires no heparin flushes are clamping

Groshong

this is bacteriacidal for aneorobic bacteria- helps treat wounds

HBO

hypervolemia can lead to ____

HF

very stretched walls= high BNP=

HF

what complication do you need to watch for while on TPN

HHNK- hyperglycemic hyperosmolar nonketotic syndrome

OA may also need these vaccines

Herpes zoster or HBV

double or triple lumen central catheter- reduces the risk of infection because it tunneled- softer

Hickmann

- take home monitory to see how daily routine effect heart

Holter- ambulatory

A patient's 4 × 3-cm leg wound has a 0.4 cm black area in the center of the wound surrounded by yellow-green semiliquid material. Which dressing should the nurse apply to the wound?

Hydrocolloid dressing (DuoDerm)The wound requires debridement of the necrotic areas and absorption of the yellow-green slough. A hydrocolloid dressing such as DuoDerm would accomplish these goals.

The nurse reviews the medication administration record in order to choose the most appropriate pain medication for a patient with cancer who describes the pain as "deep, aching and at a level 8 on a 0 to 10 scale". Which medication should the nurse administer?

Hydromorphone (Dilaudid) IV- need something that works fast- patch, oral, or suppository would take too long

do you want moist or dry wound healing

I like my wounds moist

longest absorption of all parenteral

ID

why at risk for iron def. anemia

IF (intrinsic factor) is reduced

The __ route is least preferable because drug absorption can be erratic with the route and because of the risk of tissue damage from the injections.

IM

which route is discouraged

IM because causes pain and unreliable absorption- better to use IV

Do not remove central line if what is prolonged

INR and PTT

the standards for IV infusion as seen in the court of law

INS

who came up with the infiltration and extravasation scales

INS- infusion nurses society

Monitored anesthesia care (MAC)

IV sedatives, such as the benzodiazepines, are administered

A patient who smokes a pack of cigarettes per day tells the nurse, "I enjoy smoking and have no plans to quit." Which nursing diagnosis is most appropriate?

Ineffective health maintenance related to tobacco use

A patient's peripheral parenteral nutrition (PN) bag is nearly empty and a new PN bag has not arrived yet from the pharmacy. Which intervention is the priority?

Infuse 5% dextrose in water until the new PN bag is delivered from the pharmacy.- this prevent hypoglycemia- dont simply monitor glucose until new bag gets here- do something

LPN/LVN education and scope of practice include sterile dressing changes for stable patients.

Initial wound assessments, patient teaching, and evaluation for possible poor wound healing or infection should be done by the registered nurse (RN).- if newly admitted- you do it

who developed the first pain management standards in 2001

JACHO

maintains normal heart rhythm

K

when getting general anesthesia- you need to watch for low _____ level because it can cause dysrhythmias

K

which lyte gives you orthostatic hyoptension when low

K

a diet high in ____ helps control BP

K also unsalted nuts, seeds, legumes

which lytes are vesicants

K and Ca

both ____ adn _____ directly irritate nerve fibers

K and bradikinin

why is arrhythmia a possibility with FVE

K is low (diluted)

___ leaves the cell and ___ enters and generates an action potential

K leaves and Na enters

Orange juice is high in _____ and would be advisable to drink if the patient was _____

K- hypokalemic

always check ____ before giving digitalis and hold it ____

K- too low

the most often used electrolyte replacement

KCl

tx with statins regardless of what

LDL

difference between Levin tube and Salem sump tube

Levin- single lumen Salem sump- double lumen

An old infection that is persisting and changing

MDR (multiple drug resistant) TB

May need a ____ to see organ failure

MRI

Sed rate will tell you about which one

MRSA UTI

Diabetics are at risk for

MRSA and UTI

The hospital nurse implements a teaching plan to assist an older patient who lives alone to independently accomplish daily activities. How would the nurse best evaluate the patient's long-term response to the teaching?

Make a referral to the home health nursing department for home visits.

The nurse is completing the medication reconciliation form for a patient admitted with chronic cancer pain. Which medication is of most concern to the nurse?

Meperidine (Demerol) is contraindicated for chronic pain

what does a high MG do to heart, what does high K do to heart, what does high Na do to heart, what does high Ca do to heart

Mg (bradycardia, hypotension), K (bradycardia, arrhythmia), Na (decreases contractility), Ca (tachycardia, arrhythmia, HTN)

what lytes are effected by vomit and suctioning

Mg and K

contain single macronutrients (protein, glucose, polymers, lipids) and are not nutritionally complete. They deliver 3.8 to 4.0 kcal/mL and are used to supplement patients' nutritional needs.

Modular formulas

when hyperosmolar enteral feedings are given to quickly- what lab value is off

NA is low- places client at risk for dehydration

so what causes decreased Na

NG suctioning

client with small bowel obstruction- vomitting for past 24 hours- pain of 8- hard distended abdomen and no bowel sounds- what do you do first

NG tube to decompress bc greatest risk if fluid and lyte imbalance pain meds are not 1st

only fluid that can be given with blood

NS- iso

careful with ____ if have gastric ulcers or bleeding

NSAIDS

generates nerve impulses transmission of nerve impulses

Na K and Ca

what fluids would be good to give with NG suction

Na decreases with NG suction- dont want D5W you need lytes- give LR or something like 3% NS

acid base balance

Na, K

skeletal muscle contraction

Na, K, Ca, especially MG

What is Capsaicin Zostrix

OTC ointment- relieves pain by circulating and depleting supplies of P

What is IV acetaminophen

Ofirmev- infuse over 15 minutes

Non narcotic pain med delivery system- Lays the catheter in surgical site before closing wound

On Q pump= a type of PCA

what are ESBL resistant to

PCN and cephalosporins

what increases Ca and what decreases Ca- and phosphate is opposite

PTH increases- so hyperparathyoid= high Ca Calcitriol- decreases

what are some macrovascular complications of DM

PVD, CAD, CVA

do not give a chronic opioid user this drug- why

Pentazocine (Talwin)- it is an opioid agonsit/ antagonist and can cause withdrawal

VasCath with a tunnel

PermCath- OR

what is essential for the activation if B complex vitamins

Phosphorus and MG

larger- sturdier- dialysis catheters

Phresis- VasCath

"a tingling feeling around my mouth." Which assessment should the nurse complete immediately?

Presence of the Chvostek's sign

Red Yellow Black

Protect Cleanse- use absorbant dressing Debride

will turn urine orange

Pyridium

HF stimulates what regulatory system and why

RAAS- because decreased CO gets less blood to kidneys

which regulatory system is launched as a result of 3rd spacing

RAAS- due to decreased renal perfusion ADH also released

LPN- can provide sterile dressing change, apply topical antimicrobials, apply dressings or meds for debridement, collect data about wound appearance

RN- implement wound care for complex or new wounds

REDAP

Redness Edema Drainage Approximation Pain

RICE

Rest Immobilize and compress Cold and later heat Elevate

safest and most effect bariatric sx

Roux en Y gastric bypass

what do you need to monitor if on Q pump in use

S&S of local anesthetic toxicity

when is systole heard

S1- systole- S2

when is diastole heard

S1- systole- S2- diastole

be caused by the oscillation of blood back and forth between the walls of the ventricles initiated by blood rushing in from the atria

S3

left ventricular heart failure- excess fluid of left ventricle=

S3

ventricular gallop atrial gallop

S3 S4

SIADH vs DI (diabetes insipidus)

SIADH- increase ADH- hypervolemia DI- decrease ADH- pee more "without taste"- not losing sugar in urine

what causes increased myocardial contractility

SNS

how do you find CO

SVx BPM

usual causative agents of cellulitis

Staph aureus and Streptococci

If no topical or intradermal agent is used/prescribed, the nurse should 'confuse' the nerves at the selected site.

Stroke the antibacterial agent firmly on the skin several seconds before venipuncture; this may fatigue the nerves & diminish the amount of perception

NErve fibers release ____ which potentiates and spears the pain message

Sub P

The following medications are prescribed by the health care provider for a middle-aged patient who uses long-acting morphine (MS Contin) for chronic back pain, but still has ongoing pain. Which medication should the nurse question?

Talwin- cause withdrawal if someone chronically uses opioids because it is an agonist/ antagonist

A patient is diagnosed with heart failure after being admitted to the hospital for shortness of breath and fatigue. Which teaching strategy, if implemented by the nurse, is most likely to be effective?

Teach the patient at each meal about the amounts of sodium in various foods.

Which VS is important to assess

Temp

A newly admitted patient is diagnosed with hyponatremia. When making room assignments, the charge nurse should take which action?

The patient should be placed near the nurse's station if confused in order for the staff to closely monitor the patient.

The nurse considers a nursing diagnosis of ineffective health maintenance related to low motivation for a patient with diabetes. Which finding would the nurse most likely use to support this nursing diagnosis?

The patient states that dietary changes have not made any difference at all.- not motivated bc not working

how does the On Q pump work

The pump self deflates and as it deflates it baths the wound with narcan or marcan- numbing med similar to novacaine

Contraindication of SQ injections

Things that affect blood flow- Circulatory shock and occlusive vascular disease

relieves pain by circulating and depleting supplies of "P" a proein from pain neurons involved in pain transmission- initially causes pain and then relieves it

Topical capsaicin (Zostrix)

What tests can you do to see if low Ca

Troussea and Chvostek's- also good for low Mg

what type of infections do they cause

UTI, respiratory, and life threatening infections

Making sure that sx is done on the correct patient at the correct place

Universal protocol 01

A patient is transferred from the postanesthesia care unit (PACU) to the clinical unit. Which action by the nurse on the clinical unit should be performed first?

VS

the exceptions that should be given more than 1 hour before sx are _____ and ____

Vanc and Fluoroquinolones (Cipro, Levaquin)

What treats MRSA

Vanc and Linezolid

Tx for C dif

Vanc and metronidazol MRSA tx= Vanc and Linezolid Flesh eating tx= penicillin, erythromycin, clindomycin

which AB are vesicants

Vanc and nafcillin

preffered IM site for irritating or oily substance

Ventrogluteal

what should you give along with iron supplements

Vit C- helps absorption

JVD is an expected finding when a patient performs the Valsalva maneuver because right atrial pressure increases. JVD that persists when the patient is sitting at a 30- to 45-degree angle or greater is significant

When the patient is lying flat, the jugular veins are at the level of the right atrium, so JVD is a common (but not a clinically significant) finding.

Nutritional def. that is a wound healing barrier- 4

Zinc, Vit. C, iron, and protein

Is it ok to use a magnet when have spinal cord stimulation

a daily magnet yes- but not an MRI or RF (microwave ablation)

A fluid imbalance will lead to ____

a lyte imbalance

what causes a major change in SVR (systemic vascular resistance)

a small change in the radius of arterioles

what will you feel rather than pain

a tingling sensation

is it better to have a warm or cold wound

a warm wound is a happy wound

spinal cord stimulation is similar to a pacemaker- place under the skin in the ____ or ____

abdomen or upper butt

what does the bloating cause

abdominal pain and diarrhea

what kind of wounds are on Q pumps common for

abdominal surgery and mastectomies

when do you need humidication

above 4L

what do you need for a yellow wound

absorbant dressing like hydrocoloid or hydrogel

health care professionals have the responsibility to _____

accept the subjective report of pain by the patient

hypovolemic shock leads to what kind of pH ish

acidosis

HTN

acute

anxiety

acute

diaphoresis

acute

dilated pupils

acute

increased respiratory rate

acute

tachycardia

acute

which type of pain has a protective nature

acute

of patient has 16% bands

acute bacterial infection

what kind of pain is acute ischemia

acute pain

PCAs are best for controlling what kind of pain

acute- this is why it wasnt working for the guy in the above example

your pt has high K- he is on KCl and lasix- what do you expect to need to do

administer IV fluids high is dextrose0 D50W and give insulin to deceases the K

how often should you change PICC dressings

after the first 24 hours and then weekly

so an increased BP increases the workload of the heart because it increases

afterload

the peripheral resistance against which the left ventricle must pump

afterload

the resistance the left ventricle must overcome to circulate blood

afterload

Water content varies with ___, ___ and ___

age gender body mass

NPSG 6

alarms

a negative protein- attracts Na which then attracts water

albumin

you poop out all of your ___ which causes ___

albumin- ascites

with negative pressure therapy, ____ may decreases

albumin- make sure albumin not too light before negative pressure wound therapy

what would cause a low Mg

alchoholism or starvation

So what causes breast and colorectal CA

alcohol and obesity

It is also important to remember that patients who are tolerant to or dependent on alcohol might need higher-than-usual doses of some medications.

alcoholic may need higher dose of pain meds

Hypomagnesemia is associated with ______

alcoholism

what kind of fluid ish does hypoaldosteronism cause

aldosterone usually retains water and Na- so if low you will excrete water and get hypovolemia

forms gel- for irregular shaped wounds- can handle severe exudate- good for pressure ulcers or infected wounds

alignates

A patient is scheduled for a cardiac angiogram. The nurse acknowledges that a crucial and relevant consideration before this procedure is to ask the patient for a history of:

allergy to iodine or seafood

how does rest help healing

allows the body to use its nutrients and oxygen for healing

these sympathetic cells that control blood vessels

alpha cells in the vascular smooth muscle

A

always disinfect every needleness connector

the only Antibiotics that do not cause C Dif

aminoglycosides like gentamycin and streptomycin

which type of obesity is linked to metabollic syndrome

android

inject a special dye so that the fluoroscope can take special images called _____

angiograms

during a cardiac catheterization, contrast medium is injected directly into coronary arteries- used to evaluate patency of arteries and collateral circulation- what is this called

angiography

______ opens blocked arteries and restores normal blood flow to your heart muscle

angioplasty

restores the flow of blood through coronary arteries that are narrow or clogged due to atherosclerosis

angioplasty

1/3 of diet from____ 2/3 of diet from ____

animal plant

if you have a high Mg, avoid the consumption of _____ which contain Mg

antacids

other names for ventrogluteal

anterior gluteal or gluteas medias

what is gabapentin

anticonvulsant

adjuvants for chronic neuropathic pain

antidepressants and anticonvulsants

most frequently affected valves by a murmur

aortic and mitral

which murmurs does diaphragm hear

aortic and mitral regurgitation

- This is when you hear a squirt during S1 because the aortic valve is hardened- so aortic is open during S1 when the AV valves are closing (making the sound)- and it is the sound of blood going through an open hard aortic valve

aortic stenosis murmur

what is pulse def.

apical higher than peripheral

Drug therapy for obesity- 2 different kinds

appetite suppressors- noradrenergic serotonergic nutrient absorption blocker- Orlistat (Xenical)

what happens in the initial phase

approximation migration of epithelial cells clot

are pain meds PRN or around teh clock most effective

around clock

A nurse would assess a patient for which clinical manifestation of hypokalemia?

arrythmia

so low K= bradycardia what would a high K cause

arrythmia- decrease membrane potential and causes tachyarrythmias

what would influence wave form

arterial disease

The most common cause of disability

arthritis

give an ex of disabling chronic pain

arthritis- can cause fatigue and depression

The best way to reduce the pain of an IV start is to be ____ when inserting the needle through the skin

assertive

nursing management- what do you need to do before feeding

assess bowel sounds

A postoperative patient has not voided for 8 hours after return to the clinical unit. Which action should the nurse take first?

assess for distension/ perform a bladder scan- then if distended help them get to bathroom

patients have the right to ____ and ____ of pain

assessment and management

how do you hold the doppler to the skin

at 45 degrees

how much solution do you use to flush CVC

at least 5 ml

how much solution do you use to flush PICC

at least 5 ml

use what size syringe when accessing central lines

at least a 10 ml

when would you need to use a soft toothbrush

at risk for bleeding bc taking heparin

if anorexia- weigh the client

at same time each day stay with client during and after meals assign privlidges based on weight gain

how do you treat vasovagal reaction

atropine (to increase heart rate and BP) and opioid

which test is most used to check catheter placement and is this ok

auscultating air bolus- whoosh test NOT OKAY

Which of the following matches to correct ration a.3 oz of lean beef, 2 oz of low-fat cheese, and a tomato slice b.3 oz of roasted pork, a cup of corn, and a cup of carrot sticks c.Cup of tossed salad and nonfat dressing topped with a chicken breast d.Half cup of tuna mixed with nonfat mayonnaise and a half cup of celery

b

The new nurse cleans the ulcer with a sterile dressing soaked in half-strength peroxide.

bad

sensitive to stretch or pressure within the arterial system

baroreceptors

Hallucinations are an adverse effect associated with the dissociative anesthetics such as ketamine.

be sure patient has a quiet room

A patient with a history of valve replacement is at risk for endocarditis associated with invasive procedures and may need antibiotic prophylaxis.

be sure to tell dr about valves

what are natural sources of fiber and proetin

beans

what do you instruct pt to do while you remove central line

bear down and do valsalva

Why should you not give LR if pH above 7.5

because the liver converts lactate to bicard

what has a lot of zinc in it and is good for wound healing

beef patty

An older adult patient presents with a broken arm and visible scattered bruises healing at different stages. Which action should the nurse take first?

before notifying someone of the abuse perform an assessment with the abuser not in the room

when does pre op care begin and end

begin- when schedule sx end- with transfer to surgical suit

manifestations of chronic pain are more likely to be ____ than physiological

behavioral

what are the best interventions for obesity

behavioral- but not good long term

What is MRSA resistant to

betalactams (penicillin, methacilin, omoxacillin, oxacillin)

when the patient identifies physiological responses that can control migrains and other pain

biofeedback-like measuring skin tension

name some diagnostic sxs

biopsy and bronchoscopy

how do tricyclic antidepressants work

block reuptake of serotonin and NE

orlistat (Xenical)

blocks absorption of fat soluble vitamines- not enough Vit K- may cause bruising

what does palmitic acid do

blocks insulin an leptin

what happens in HHNK

blood sugar is high but no acidosis because no ketones (which are they products of fat breakdown)- you pee more because body is trying to get rid of glucose in the urine (polyuria) and then you get dehydrated and osmolarity increases- lyte imbalance can lead to death and we are at risk for clots

FVD or FVE- tachycardia

both

Plasma leaks into the traumatized tissue and releases

bradikinin

what occurs with a vasovagal reaction

bradycardia hypotension loss of consciousness

what does high K do to heart

bradycardia, arrhythmia

short transient , moderate to severe pain that occurs beyond the pain treated by current analgesix- occurs rapidly

breakthrough pain- like getting morphine every 6 hours but in 2 hours will experience intense short pain- will have special orders for breakthrough pain

what are the 3 CA alcohol can cause

breat, liver, colorectal breast and colorectal are ols obesity

what happens to respirations when FVE

breath faster

what does pursed lip breathing do- it prevents

bronchiolar collapse and air trapping

An artery that is narrowed or has a bulging wall may create turbulent blood flow which created a buzzing or humming called a

bruit

turbulent blood flow

bruit

turbulent flow sound in peripheral artery- due to an arterial obstruction or aneurysm

bruit

what may the patient feel as the catheter is removed

burning

what can cause acute disease related protein calorie malnutrition- with marked inflammation

burns, trauma, infection, head injury

how does a penrose drain empty

by gravity (it is an open system) not by negative pressure

how can opioid toxicities and side effect be managed

by rotating to a different opioid

why does it do more dumping

bypassess pyloric sphincter

Which action will the nurse implement for a patient who arrives for a calcium-scoring CT scan? a. Insert an IV catheter. b.Administer oral sedative medications. c.Teach the patient about the procedure. d.Confirm that the patient has been fasting.

c- rapid procedure with little risks

major advantage of sump tube

can be used for continuous suction

All PN solutions are changed at 24 hours

cant let a bag hang for more than 24 hours- get a new one but keep the tubing (dextrose and AA)- for 72 hours------- change enteral feedings every 4

used to assess arterial flow to extremities

capillary fill time

what can you treat extended spectrum betalactamases with

carbapenems

looks at circulation and pressures in different chambers

cardiac catheterization

What is the priority assessment when you find a client with a low Mg

cardiac rhythm- because a low Mg can cause arrythmia

what does SIADH do

cause an excess ADH- so more water is retained- water intoxication

what does insulin do to K

causes it to go into the cells so decrease it

what do you do with granulation tissue

cauterize or cut it off to allow healing to proceed

explain the vascular responses of inflammation

cell injury= cell death= release of kinins, histamines, and prostoglandins= dilation= hyperemia= increase cap permeability= fluid exudate also cell injury= momentary consctriction

explain the cellular responses of inflammation

cell injury= chemotaxis=calls over leukocytes

inflammation of SQ tissue

cellulitis

the most frequent cause of health care-associated bloodstream infections.

central lines

TPN should be given through a

central vein- HAS to be on an IV pump neither of these happened on my patient

what happens if you reduce Na too quickly

cerebral edema

what can you do if tolerance develops (nl)

change drug

interventions goal for obesity

change eating behavior

how often do you change gauze dressings and how often do you change transparent dressings

change gauze dressings every 2 days change transparent after 3-7 days

A patient comes to the clinic complaining of frequent, watery stools for the last 2 days. Which action should the nurse take first?

check BP- perfusion and hypovolemia are biggest concerns

a pt of lasix says he feels weak in his legs- what do you do first

check lab results

change respiratory and heart rate in response to CO2 pressure (hypercapnia)- also to decreased pH or hypoxia

chemoreceptors

can see a large heart in HF or cardiomyopathy

chest X ray

use _____ if you have difficult time clearing secretions with expectorated sputum production > 25 ml per day

chest physiotherapy

Visible pulsation of the abdominal aorta is commonly observed in the epigastric area for thin individuals. The nurse should simply document the finding in the admission assessment.

chill

high fiber diets may improve ____ levels

cholesterol- may prevent hyperlipidemia

decreased level of functioning

chronic

depression

chronic

fatigue

chronic

flat affect

chronic

when do you use electrical stimulation (neuroaugmentation)

chronic back or complex regional pain syndrome

Mild to moderate inflammation

chronic disease related protein calarie malnutrition

Without the disease you would be healthy, but due to do disease your body needs more nutrients that you aren't getting

chronic disease related protein calorie malnutrition

leading cause of death and disability=

chronic diseases

what kind of pain usually uses spinal cord stimulation

chronic leg or back

extends beyond the period of healing from acute episodes

chronic pain- non cancer

when would you titrate up

chronic, severe CA pain

"I will assist in preparing the operating room for the patient."

circulating nurse- The circulating nurse performs activities in the unsterile field and is not scrubbed, gowned, or gloved

What is the role of teh RN in the OR

circulating nurse- patient advocate- watched for contamination

What do you need to assess after an angiography

circulation to the extremeties

what contraindicates IM injection

circulatory shock

how do you get bladder pressure

clamp catheter and insert and 18 gauge angiocath into sampling port

what would you do

clamp catheter and turn patient on side in trendelenburg

is inserting an NG tube aseptic or clean

clean

what kind of diet after bariatric

clear liquid

helps maintain adequate hydration, provides some important electrolytes, such as ___ and ____, and gives some energy at a time when a full diet isn't possible or recommended.

clear liquid diet- Na and K

what does huff coughing do

clears secretions conserves energy reduces fatigue

examples of contracutres

close to joints- burn patients

signs of chronic hypoxia

clubbing peripheral edema rt sided heart failure <87%

protein deficient diets like vegans because they lack

cobalamin

What does Vit C have to do with healing

collagen and capillaries

large, insoluble, stays in vasculture to increase oncotic pressure

colloid

how can we dx pseudomembranous colitis (severe C Dif)

colonoscopy- but dont do it

what is gastric bypass

combine restrictive/ malabsorptive Roux en Y

Which bariatric sx is shown to cure Type 2 DM

combined- restrictive and malab. Gastric bypass- Roux en Y

NPSG 2

communication with staff

An example is idiopathic pain, chronic pain that persists in the absence of a detectable cause. An example of idiopathic pain is ______

complex regional pain syndrome (usually an arm or leg)

with hypovolemia, is everything hemodiluted or hemoconcentrated

concentrated

The patient's statement that her last menstrual period was 8 weeks previously

concern for anesthesia bc may be preggers

Most catheterizations require sterile insertion except for ______ (which require medical asepsis)

condom

A nurse assesses a postoperative patient 2 days after chest surgery. What findings indicate that the patient requires better pain management

confusion poor cough effort shallow breathing elevated temp hyperglycemia

what is an early neuro change for FVE

confusion and headache

why does unrelieved pain cause hyperglycemia

constant stress reaction releases glucose

does fiber help relieve constipation or diarrhea

constipation- fiber makes you poop

how does smoking effect wound healing

constrict vessles- prevent blood flow

what does stimulation of alpha cells cause

constriction

RAAS ultimatley causes

constriction and fluid retention

what does HBO do to blood vessels

constricts them which decreases edema and ICP

what precautions do you use for AB resistant organsisms

contact precautions

What kind of isolation for MRSA and is this a reportable infection What kind of isolation is flesh eating

contact- and yes contact

how often should you change injections caps on central lines- continuous and intermittent

continous- every 72-96 intermittent- every 7 days

what can reduce the risk of aspiration

continuous feedings and placing it in the intestines

A sensation of warmth or flushing is common when the contrast material is injected, which can be anxiety-producing unless it has been discussed with the patient.

coronary angiography

small tube made of wire mesh that props open the artery after it has been treated

coronary stent- some pts get this after angioplasty

Walking into the hallway outside an operating room without the hair covered

corridors leading to OR are unrestricted- need hair coverings and surgical attire

name the adjuvant best for inflammation

corticosteroid- dexamethazone

Common clinical manifestations of inflammation and infection are frequently not present when patients receive immunosuppressive medications such as

corticosteroids

tx inflammation

corticosteroids (Dexamethazone)

____ are used for patients who have prostatic hyperplasia

coude

Impaired skin integrity usually goes with hypervolemia due to edema but also applies to hypovolemia because

could be from diarrhea

what is an adverse effect of O therapy

cracks int he oral mucosa

what could a cold formula cause

cramping and diarrhea

elevation is specific for cardiac injury or MI.

creatine kinase

clear-soluble, small, classified by tonicity

crystalloid

removing GB is a ___ sx

curative

removing a benign cyst is a

curative

How do you give Metronidazol for C dif

daily IV- 7-10 days

what do you treat malignant hyperthermia with and what does it do

dantrolene- slows metabolism, reduces muscle contraction, and resolves catabolic process

- Cover exposed end of IV tubing for intermittent infusions with a

dead end sterile cap

genitourinary

decrease

what happens to Ca if you have Crohn's a malabsorption problem

decrease Ca

what does a high Na do to the heart

decrease contractility

What does TPN do to phosphate

decrease it

what does corticoseroids do to K

decrease it

what does exercise do to blood sugar

decrease it

why would mental status change during 3rd spacing

decrease perfusion to brain

unrelieved pain-respiratory

decrease- but acute pain increases breathin?

a ____ in gastric acidity may cause C Dif

decrease- taking antacids

Loss of albumin or protein leads to _____ oncotic pressure. Fluid can now leak from the intravascular space into the interstitial space and stay there, causing edema.

decreased

following bowel sx, a patient has been getting NS IV at 100 ml/hr, has an NG tube with intermitten suction, adn is NPO- what is an assessment finding that would alert nurse to major fuid and lyte imb.

decreased LOC not weight gain

After bowel surgery a patient is receiving NS IV fluids at 100ml/hr, has an NG tube to low intermittent suction and is NPO. An assessment finding that would alert the nurse to a mayor fluid/electrolyte problem in this patient is:

decreased LOC- indicates low Na

neuro signs of FVD

decreased LOC- weak, dizzy, light headed

what is hypovolemia

decreased intravascular volume

why are you more at risk for infection when inadequate nutrition

decreased leukocytes and changes in phagocytosis

what happens to GI tact

decreased motility- constipation and risk for paralytic ileus

what happens when you use proteins to get energy

decreased oncotic pressure- edema, hypovolemia, dehydration

Explain how the RAAS system works

decreased renal blood flow causes renin to convert angiotensinogen to angio 1- angio 1 becomes angio 2 by angio converting enzyme- angio 2 then goes to 3 places

GI

decreases

FVE does what to Na

decreases it- like in CHF

What does high Ca do to GI what does low Ca do to GI

decreases motility like a low K increases motbility- diarrhea

how does immobilization help

decreases the tissue metabolic needs

what type of pain is arthritis

deep somatic

what type of pain is tendonitis

deep somatic

FVD or FVE- weak and dizzy

def.

what do you use hypotonic solutions for

dehydrated= expands cells GI fluid losses

why do you vomit easily after sx

delayed gastric emptying- this is normal- this is also the most common complaint

immune system

depressed

what is JETOX

device for wound cleaning and debridement- o Shoots water and O- together they break up and remove crustation that prevent healing- called pulse vac debridement

Preload is the volume of blood in the ventricles at the end of ____

diastole

what is contraindicated if having spinal cord stimulation

diathermy- when you generate electric current to help healing with heat

Intravascular-to-extravascular movement of fluid occurs through ____, which is controlled by hydrostatic and capillary plas- ma oncotic pressures.

diffusion

which 2 opioids are only used for severe pain

dilaudid and fentanyl

Chronic pain can be ____

disabling

what do you do if patient refuses narcotic

discard and have some witness

what are some signs that your pt developed an air embolism

dizzy dyspnea fatigue

Behavior modification programs focus on how and when the person eats and de- emphasize aspects such as calorie counting

dont calorie count but look at how and when you eat

What do you do if you feel resistance when inserting NG tube

dont force it- but apply gentle pressure and rotate towards opposite nostril

A temperature of 100.8° F in the first 48 hours is usually caused by atelectasis, and the nurse should have the patient cough and deep breathe.

dont need to notify dr- just do incentive spirometer

The nurse obtains a health history from a patient who is scheduled for elective hip surgery in 1 week. The patient reports use of garlic and ginkgo biloba. Which action by the nurse is most appropriate?

dont tell the patient to stop all herbs and supplements you should discuss this with the dr

for acute pain with opioid naive people--

dont use basal rate

people are moving away from wet to dry- this is not moist wound healing

dont use it

what location is the upper outer quadrant

dorsogluteal- superior gluteal artery and scieatic nerve

what should patient do when taking an aldosterone antagonist

drink apple juice instead of OJ- need to not take in a lot of K because you arent getting rid of it

explain enzymatic debridement

drugs applied topically to debride necrotic tissue- this process can be slow

when do you not debride eschar

dry, stable, necrotic heel or foot

Because the patient's assessment indicates physiologic stability, the most likely cause of the patient's agitation is emergence delirium, which will resolve as the patient wakes up more fully. The nurse should look for a cause such as bladder distention. Although hypoxemia is the most common cause, the patient's oxygen saturation is 96%. Emergence delirium is common in patients recovering from anesthesia, so there is no need to notify the ACP

dude might just need to tinkle

occurs when the undigested contents of your stomach move too rapidly into your small bowel

dumping syndrome

fentanyl

duragesic

tell me about nausea in preg- what can help

eat a carb before getting out of bed- like a dry cereal

looks at valves and blood flow

echocardiogram

Non invasive test that uses US to examine the hearts anatomy and function

echocardiogram- records sound waves that bounce off the heart

FVE can lead to

edema

____ and ____ indicate hypersensitivity to opioids

edema and wheezing

An older adult patient who is malnourished presents to the emergency department with a serum protein level of 5.2 g/dL. The nurse would expect which clinical manifestation?

edema- this is a low total protein 6.4-8.3

dont give flu vaccine if allergic to

eggs

is pain sensory or emotional

either

is the roux en Y open surgery or lap

either

neuroaugmentation=

electrical stimulation

which formula do you give to someone who has a dysfunctional GI tract

elemental- have predigested ingredients modular would require tract to absorb whole nutrients polymeric would require tract to absorb whole nutrients

if you suspect a DVT because leg is swolen, red, and edema- what do you do and what should you not do

elevate it massage it or ambulate (stay in bed)

Stress response during sx casues ____

elevated cortisol, ADH, and ACTH- in order to conserve fluids

The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan?

encourage fluids to prevent stones encourage moving to lower Ca

what does diaphragmic breathing do

encourages maximal inhalation decreases respiratory rate

opioids mimic ____ pain relieving chemicals that the body produces naturally

endorphins

Closed circuit television

enlarged printed documents

if insufficient intake- what is your first choise- TPN or enteral

enteral nutrition

what causes cellulitis

enzymes from bacteria

why is zinc important

epitheliazation

What does Vit A do

epithelization

How often should you flush a PICC

every 12 hours

How often do you change intermittent infusion IV tubing

every 24 hours

how often do you change dressing of suprapubic catheters

every 24 hours

How often should you check NG tube residual

every 4 hours

how often should you flush the NG tube

every 4 hours

How often should you assess a PICC

every 4-8 hours

how long can you use tubing for propofol

every 6-12 hours

how often should you clean area (nose) around NG tube

every 8 hours

Who should be on I&O

everyone on IVT

FVD or FVE- HA

excess

Which fluid problem would cause a gallop

excess

which fluid problem would cause organ failure

excess- also says FVD in random notes

FVD or FVE- lethargy

excess- too much to drink and now im tired

FVD or FVE- confused

excess- why am I so bloated

what do contractures result from

excessice fibrous tissue formation

essential treatment for pt with chronic pain especially musculoskeletal pain

exercise

a laporatomy is a ___ surgery

explorative

with CA pain, a ____ drug is often given for underlying pain and a ___ is used to treat breakthrough pain

extended release morphine- for underlying fast acting narcotic- breakthrough

ESB

extended spectrum beta lactamases

Which scale should you use for an OA who doesnt understand rating sclae

faces

what is the wong backer scale

faces

the Oucher pain scale

faces of real people with different ethnicities

what is a drug given with NSAIDS to prevent GI effects

famotidine

what is somogyi phenomenon

fasting hyperglycemia tht occur during the morning in response to hypoglycemia at night- prevent by lowering insulin dose before bed or giving a bed time snack

why would someone not tell you about pain

fatigued or want to be a good patient may deny pain because they dont want you to think they are getting worse or they dont want the injection

where do they insert the needle to get into the heart

femoral artery

when does motility resume in the small intestine

first 24 hours

when should you monitor respiratory depression

first 24 hours with opioid naive patients

what are some foods high in P

fish, beef, pork, nuts, grains

In which disease to the bacteria hide from the immune system

flesh eating bacteria

recent chicken pox is a risk factor for

flesh eating bacteria

vasodilation occurs with

fluid overload

how can you prevent constipation when on a low fiber diet

fluids- water, juice, and milk

polyurethan or silicone- can hold lots of exudate- good for new wounds

foams

indwelling curved tip for intermittent in and out

foley coude straight

Elisa test Galium scan MRI CT US

for C dif MRSA Flesh eating- organ failure C dif- toxic megacolon or UTI obstruction UTI- obstruction

Give colace (stool softener)

for anyone on opioids- Docusate Na

what is in a hypotonic fluid

free water and NaCl

What is in a hypertonic fluid

free water and calories and lytes

what is NOT in an isotonic fluid

free water or calories

also on a low fiber diet avoid ____ foods and go easy on _____

fried- spices

Why does JVD incease if hypervolemic

from increased preload

what is visceral pain

from organs- GI, GB

sources of K

fruits and veggies (bananas and oranges)

a low fiber diet limits the amount of ____, ____, ____and ___ you can eat- and occasionallyw it will limit ____

fruits, veggies, cereals, grains milk

would could happen if cellulitis goes untreated

gangrene- due to a cut off in blood flow

which sx causes the most dumping syndrome

gastri bypass- Roux en y- combined

looking at the aspirate color is good to distinguish between ____ and ____ but does not help to differ between _____ and _____

gastric and intestinal stomach and respiratory

Pt has NG tube on suction after Abdominal surgery- which of these is abnormal and should alter provider 1. gastric distention 2. absent bowel sounds 3. incision pain of 9 4. small blood in drainage

gastric distention- NG tube may not be patent absent bowel sounds are nl after sx pain is expected

poisoning or drug overdose for which swift removal of stomach contents is required

gastric lavage- irrigation

minimally invasive restrictive sx to lose weight

gastric sleeve

so evisceration happens- after butt saline soaked dressing- what do you do

get VS to check for shock

obese person wants to lose weight... what is firs think you should do

get a 24 hr diet recall

how does anemia effect wound healing

get less O

how do you measure abdominal edema

girth and bladder pressure Measure girth every 4-8 hours

how can you reduce diarrhea

give fiber

when in doubt if someone is in pain, what should you do

give the analgesic and then evaluate their response

supplemental feeding are high in ____ so you need to assess for _____

glucose= hyperglycemia

what foods do you avoid if you have celiac disease

gluten- dont eat bread pudding, bran muffin, or graham crackers

correct order for gloving and gowning surgeon

gown 1st gloves 2nd

proud flesh

granulation tissue

what is a good source of Ca- besides milk

green beans and brocilli

color of gastric aspirate

green or colorless with sediment

which obesity is a better prognosis which obesity is easier to treat

gynoid android

How much of your grain should be whole grains

half

how much of plate should be fruits and veggies

half

why re combination drugs good

have opioid sparing effect

is it good or bad to have heart light up

healthy parts light up because they absorbed die

dont give NSAIDS if just had _____ sx

heart

what are some cardio effects of NSAIDS

heart attack, stroke, HF

give an example of FVE

heart failure

you hear s3 with

heart failure

The nasogastric (NG) tube is removed on the second postoperative day, and the patient is placed on a clear liquid diet. Four hours later, the patient complains of sharp, cramping gas pains. What action by the nurse is the most appropriate?

help the pt ambulate- Ambulation encourages peristalsis and the passing of flatus

why is phosphorus important to cells

helps divide

problem with acetaminophen

hepatic toxicity if > 4g/24 hours for chronic doses or > 6g/24 hrs for acute doses not good for swelling- minimal anti inflammatory

tell me about CO2 narcosis

hgih CO2 is normally the stimulant to breath- but with COPD you have constant high CO2 so you breath when low O - still can give O, just start low

Obese leptin= undernutrition leptin=

high low

you hear s4 with

high BP- left ventricular hypertophy

what causes a prolonged PR interval and a a wide QRS complex

high K

Cushings

high Na

what kind of heart sounds does the diaphragm hear

high pitches s1-s2- murmurs- pericardial friction rub

what kinds of food should you eat if undernutrition

high protein and calorie

what is your diet high and low in post bariatric

high protein, low carb, low fat

what does distended jugular veins mean

high right atrial pressure- right sided heart failure

High levels have been linked

higher risks

what happens to BUN

higher- but not due to renal failure- due to dehydrations

Mast cells release ___ that produce local inflammation

histamine

amino acid made during protein catabolism

homocysteine

what can the EKG on the stress tredmill test tell you

how each chamber responds to activity

occlusive- forms a gel- supports debridement- moderate to severe dressing

hydrocolloid

good for a lot of exudate

hydrocolloids, foams, alignates

debrides and maintains a moist environemnt- minimal drainage and goof for necrotic tissue- need 2nd dressing

hydrogel

dilaudid

hydromorphone

dilaudid is for severe pain- generic

hydromorphone

used for hyponatremia

hyper

Tell me about low Mg reflexes GI breathing BP

hyperactive reflexes decreased bowel sounds shallow respirations increased BP

Loose stools are associated with _____.

hyperkalemia

Peaked T waves are a sign of _____

hyperkalemia

do not give if cells are dehydrated like with DKA

hypertonic

fixes edema

hypertonic

stabilized BP and increases urine output

hypertonic

used to fix lyte and acid base imbalances

hypertonic

what IV fluids do you give to someone with decreased oncotic pressure experiencing 3rd spacking

hypertonic or colloid fluids

what fluid do you give to restore hypovolemia

hypertonic, isotonic, D5W, plasma expanders

5% dextrose in .45% NS

hypertonic- also for D5NS (9%)

What kind of fluids do people normally get post op- why

hypertonic- to help restore blood volume, increase urine production, and reduce edema

excess collagen tissue, large, red, raised and raised confined to the wound

hypertrophic scars

what is the difference between hypervolemia and FVE

hypervolemia- in the vessels FVE- interstitial fluid

hypernatremia

hypo

too much of this fluid gives you cell edema or increased ICP

hypo

Fluids if DKA or hyperglycemia

hypo- but if HHNK give isotonic

way need to give O2 for both hyper and hypvolemia- explain

hypo- decreased perfusion hyper- pulmonary congestion

what happens to bowel sounds in FVD

hypoactive

______ can cause laryngeal stridor, which may lead to respiratory arrest.

hypocalcemia

What can HBO cause due to fast oxidative metabolism

hypoglycemia

what happens if a diabetic gets gasrtric stasis

hypoglycemia- peripheral neuropathy slows impulse transmission delaying food absorption

_____ increases the risk for digoxin toxicity, which can cause serious dysrhythmias

hypokalemia

what electrolyte ish do you get with paralytic ileus

hypokalemia

what happens to lytes with cirrhosis

hypokalemia- from compensatory hyperaldosteronism hypernatremia- "

_____ is the hallmark of refeeding syndrome

hypophosphatemia- dysrhythmias, resp arrest, neuro characterized by fluid retention and lytes imb.

what does the decreased blood volume cause

hypotension and tachycardia

tell me about temp changes up to 3 days post op

hypothermia- first 12 hours= anesthesia fever- first day= inflammation fever- after day 3= infection

post op are you at risk for hyper or hypothermia- why

hypothermia- from pain and decreased CNS function from anesthesia

do not give this fluid if at risk for 3rd spacing

hypotonic

what fluids do you give for high Na

hypotonic or D5W

Don't give if being treated for CVA, head trauma, or having neuro surgery

hypotonic- because may cause increased ICP

this type of solution is usually infused when someone gets dialysis

hypotonic- dialysis dehydrates you

what do the VS indicate with 3rd spacing

hypovelmia- high heart rate and decreased urine output yet looks like fluid excess because edema everywhere

decreased LOC and cognitive impairment would do what to fluid

hypovolemia

what does cirrhosis do to fluid

hypovolemia- from acites- 3rd spacing

Emergence delirium may be caused by a variety of factors. However, the nurse should first assess for ______.

hypoxemia

what are some NSAIDS

ibuprohone, advil, motrin

NPSG 1

identify patient

why would you not be able to do a lap procedure

if previous abdominal surgeries left adhesions

Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patient's ability to take in more nutrients

if they get fatigued when eating due to heart failure

how does being old effect wound healing

impaired circulation and decreased collagen

What do corticosteroids do to wound healing

impairs phagocytosis by WBC increase risk of infection bc inhibit WBC

This drum is surgically placed under the skin, just below the ____

implantable vascular access device clavicle

I

implement insertion, care, and maintenance bundles

what actions should the nurse plan to take if a client has a low Ca

implement seizure precautions

induction

important to secure airway

when do you give isotonic fluids for hypovolemia

in HHNK

Who is likely to get an order for urinary catheterization

in the ICU for GI bleeding because need precise measurements

what does the rapid glucose absorption cause

inappropriate insulin release and therefore late hypoglycemia

doing what can help prevent the risk of respiratory acidosis

incentive spirometer

what can you use for assessment of respiratory status

incentive spirometry

while lactating, after preg should you increase or decrease your calories

increase

what does low P do to blood

increase bleeding

pain cues in nonverbal patients- BP will _____ and HR will ____

increase by 15% increase by 15%

What does a high Ca do to blood

increase clotting- a a low Phosphorous causes bleeding

The home health nurse cares for an alert and oriented older adult patient with a history of dehydration. Which instructions should the nurse give to this patient related to fluid intake?

increase fluids if your mouth feels dry

what does an increased contractility do to SV

increase it

what does illness do to blood sugar

increase it

what does renal failure to do P

increase it

what does stress do to blood sugar

increase it

What does cancer do to calcium

increase it- therefore it decreases phosphate it decreases everything else

what does chemo do

increase p

what does a high Ca do to heart

increase rate and cause arrythmias- a high Na decreases heart contractility

tell me about peeing a Ca

increase urine output= high Ca renal failure- low Ca

Increased venous return= ____ CO

increased

increased myocardial contractility=____ CO

increased

so do not give D5W to patients at risk for

increased ICP- cerebral edema

What happens to breathing in decreased blood volume

increased rate- because you dont have good O transport

cardio

increases

endocrine

increases

metabolism

increases

what happens to respiratory rate when in pain

increases

What does Ca do to Calcium

increases it

what does being immobile do to Ca

increases it

what happens to hemaoticrit

increases- even if you have anemia > 55%

are used short-term and provide a closed drainage system for urine.

indwelling catheters

most common CVC complication

infection

when do eosinophils decrease

infection

color of infiltration vs extravasation

infiltration- blanched extravasation- red both are swollen and painful

CRP=

inflammation

______ is a key underlying factor in many diseases

inflammation

so what info does EF provide

info about the left ventricle during systole

what does stimulation of baroreceptors do

inhibits SNS and causes PSNS (dilation and decreased HR)

ot tongue is swollen and obstructing airway- what do you do first

insert nasal airway- not intubate first

Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass?

instructing patient to cough and deep breath

Why do diabetes patients have to receive insulin shots

insulin is inactivated when given by mouth

What would you teach first- insulin injectin or the importance of exercise

insulin- prioritize the main health problem also teach from simple to complec

PRN is best for people with ___ pain ATC is best for people with ____ pain Bolus is best for people with ____ pain

intermitten chronic breakthrough

reduces the risk of mucosal erosion

intermittent suction- most tubes do this except sump

3rd spacing is the shift of fluid into

interstitial space

FVE refers to increase fluid in the ____

interstitial space (edema)

what does hyperosmolar jejunal chyme cause

intraluminal fluid sequestration

which route needs a much smaller dose

intraspinal

you should stop stress test if EKG changes associated with coronary ischemia occur such as

inverted T wave ST segment depression

loss of fluid due to sx

iso

waiting for blood transfusion

iso

what fluid if lots of vomit or diarrhea

iso

do not give this is have HF, kidney disease, or HTN

iso or hyper

when giving this fluid monitor carefully for FVE

iso or hyper

5% albumin and hetastarch are ____ fluids

isotonic

this solution for hypotensive or hypovelmia

isotonic

what IV solution do you give for HHNK

isotonic

what kind of solutions is 5% dextrose in .225% NS

isotonic

Problem with Zostrix

it burns- dont get in eyes

what happen to Na if you take diuretics

it decreases

what happens to FiO2 if respiratory rate increases

it decreases

what happens to pain sensitivity as we age

it decreases

Starvation pathophys. As glucose decreases, what happen to insulin

it decreases and counter regulatory hormones increase

what happens to ventilation when you have an NG tube and why

it decreases because you usually breath through your mouth

what happens to CO

it decreases- less fluid in vessels

what happens to leptin

it decreases- to diminish the effects of starvation- leptin tells the brain you are full, that there is enough fat- when you are starving your leptin is decreased because you need to eat

When artrial BP increased what happens to afterload

it increases

what happens to insulin when on TPN

it increases because feeding are high in sugar

what does hypokalemia do to resting memrbane potential again

it increases it so you have increased duration of the action potential and refractory period which could lead to ventricular arrhythmia

What does hypervolemia do to CO

it increases it until the heart gets too big and then it decreases

how does increased contraction cause increased SV

it increases ventricular emptying

why is an infection a barrier to wound healing

it incresae tissue destruction

why would yogurt help C dif

it is a probiotic

so if fluid overload what happens to hematocrit

it is low

Tell me about the adult's capacity to learn

it is unchanged

milk does not contain fiber so why is it a no no

it may leave a residue in the digestive tract and because of your current medical condition temporarily contribute to discomfort or diarrhea.

why does bearing down help insert a catheter

it relaxes the external sphincter

In an unconscious postoperative patient, a likely cause of hypoxemia is airway obstruction by the tongue, and the first action is to clear the airway by maneuvers such as the ____ or____

jaw thrust or chin lift font elevate HOB unless awake

what do you do if pt on PCA sleep soundly, awakes to voice, and has 8 breaths per minute

just continue to monitor

so if patient has a temp of 101.8- what do you do

just continue to monitor- unless the patient is complaining of fever symptoms then you can give an antipyretic for comfort dont use cooling blanket or notify provider for a moderate temp

shivering and hypothermia are common post op

just cover with blankets

The nurse assesses a patient's surgical wound on the first postoperative day and notes redness and warmth around the incision. Which action by the nurse is most appropriate?

just document the assessment- indicators of the normal initial (inflammatory)

Keloids are not disabling or painful

keep in mind bc i thought they hurt

same thing as hypertrophic scar but greater protrusion beyond wound edges

keloid

what happens when you use fat to get energy

ketones accumulate- acid base issues

why does renal failure cause low Ca

kidney can not convert Vit D into calcitriol

what could be a sign that 3rd spacing is causing ischemia

lactate- a byproduct of anaerobic metabolism

post op, what position should patient's be in

lateral recovery - prevents aspiration

so alcohol lowers Mg- what increases Mg

laxatives

Pulses travel from stimulator to spine on ______

leads (thin insulated medical wires)

MRSA causes leukocytosis with shift to the

left

order of wound measurement

length x width x depth length- head to toe

what happens to fluid if colon is removed

less absorbed so dehydrated

this is why you get acscites with liver failure or malnutrition

less albumin so fluid leaks into peritoneum

advantage of implanted cath

less risk for infection because totally under skin

How much before sx should you give prophylactic AB

less than 1 hour before incision dont do this ahead of time

what is a normal BMI

less than 30

what does low K do to heart

lethal venticular arrythmias

what is a late neuro change for FVE

lethargy and coma

using pain adjuvants decrease the amount of opioid needed

like combination therapy- but adjuvants are not really an analgesic

Cognitive therapies affect the perception of pain

like hypnosis and imagery

Nonsteroidal antiinflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury.

like ibuprofen

what should you do if experiencing symptoms of diverticulitis?

limit fiber avoid encreased abdominal pressure- dont cough dont take laxatives

To prevent common complications of continuous feeding the nurse should

limit the time the formula hangs to 4 hours- if longer than 4-8 hours may get bacterial contamination

what does this low insulin level cause

lipolysis and ketonic production

interrupts the generation of nerve impulses by altering the flow of NA into nerve cells through cell membrane

local anesthecis - like EMLA cream

what is hydrocodone

lortab and vicodin

what kind of sounds does the bell hear

low s3-s4-murmurs

twitches and spasms are due to

low Ca- like charley horse

skeletal muscle weakness

low K

which lyte causes bradycardia and why

low K- increases membrane resting potential

what lytes are effected by pancreatitis

low Mg and ca- become trapped in necrotic tissue

muscle weakness

low NA

nausea and abdominal pain are signs of

low Na

pt geting hydrochlorothiazide- confused and lethargic

low Na

postural hypotension could be due to

low Na- ortho hypotension has to do with K

shallow respirations is a sign of

low P and K

CRP- low, mod, and high risks

low- <1 mod 1-3 high- > 3

what does kayexalate do

lowers K

leading cause of cancer death

lung Ca

A patient receives 3% NaCl solution for correction of hyponatremia. Which assessment is most important for the nurse to monitor for while the patient is receiving this infusion?

lung sounds- dont worry about urine output monitor for fluid excess= crackles

which leukocytes are in charge of immune response

lymphocytes

tell me about grehlin in obese people and where it is made

made in stomach- obese people make more- makes them more hungry

what does tube feedings do to pH

make it more alkaline

• Length of the small intestine is decreased so less food absorbed

malabsorptive

what is dontrolene for

malignant hyperthermia

hyperthermia with rigidity of skeletal muscles- response to aneshtesia- what happens to pH

malignant hyperthermia- genetic resp. acidosis- hypercapnia

pain meds should be titrated for the dose of ____ while miniting the adverse side effects

max effect

What happens to respirations with FVE

may be SOB if fluid in lungs increase respiratory rate

does chronic pain have a known cause

may be unidentified

why is it dangerous to DC TPN rapidly

may cause rebound hypoglycemia

what would elevated HR and BP after sx tell you

may need pain meds

what do we do if we know a procedure will cause pain

medicate before the procedure

secondary tx for metabollic syndrome

meds- no specific med for it but will usually give something for cholesterol and HTN, and also metformin (glucophase) is used to lower sugar

Weight fluctuations, use of corticosteroids, and draining or infected wounds all suggest that the patient may be at risk for malnutrition.

meet with dietecian

name an appetite stimulant

megace- a chemo drug

how many calories is a normal diet- men and women

men- 1500-1800 women- 1200- 1500

not indicated in long term tx of pain- will be bad to give this if renal failure bc metabolite will accumulate in the blood

meperidine (demerol)

NG suction can lead to what pH change

met. alkalosis- high bicarb

Also known as Syndrome X- insulin resistant syndrome

metabollic syndrome

what do you use if gastric mitility is slowed

metaclorpramide- or other antiemetics like compazine or droperidol

why is the patient breathing fast

metbaollic acidosis

opioid with antagonist activity that is useful in treating nociceptive and neuropathic pain

methadone

most common prescribed for C deif

metronidazole and vanc

The patient with arthritis may require special positioning to avoid injury and postoperative discomfort.

mhmm

What happen in the granulation phase

migration of fibroblasts secretion of collagen wound is very fragile

Foods high in phosphate include _______

milk and other dairy

Your patient has a catheter in and his still taking in a lot more than excreting- after checking for kinks what should you do next

milk the catheter

Need to listen to the heart with the bell at which 2 spaces

mitral and tricuspid

- This is when you hear a squirt during S1 because the mitral valve isn't closing all the way

mitral regurgitation insufficiency murmur

which murmurs does bell hear

mitral stenosis

what type of pain is vicodin used for and what is generic

moderate pain hydrocodone

which leukocytes are macrophages and do phagocytosis

monocytes

explain shift to the left

more bands (immature neutrophils) than segs when fighting off active infection indicates acute bacterial infection

explain shift to the right

more segs (mature neutrophils) viral infections

Does chronic pain make you more or less sensitive to other pain and stimuli

more sensitive

opioids are controlled drugs that contain natural or synthetic chemicals based on ____, the active component of opium

morphine

______ is more likely to cause a drop in blood pressure while _____ is more likely to cause respiratory depression than are other opioids.

morphine fentanyl

the client should be able to _____ in order to be DC from PACU

move all 4 extremeties on command

cardiac valves become thicker and stiffer from lipid build up, degeneration of collagen, and fibrosis

murmur

what abnormal can you find using echo

murmur

what do increased catabolic demands lead to (this happens with unrelieved pain)

muscle breakdown and weight loss

Which drug/s may be prescribed as an adjuvant to pain management after fx repair of femur

muscle relaxants

which adjuvant is best to relieve spasms from muscle pain- or like a broken femur

muscle relaxants like- Baclofen

tell me about what you expect to see if K is high: muscle GI Pulse BP

muscle weak increase GI motility decrease pulse decrease BP

rises in response to myocardial injury within 30 to 60 minutes

myoglobin

. Indicator of very early heart injury but does not necessarily mean MI.

myoglobin- low molecular weight heme protein found in cardiac and skeletal muscle

for opioid OD

nalocone (narcan) - give if severe respiratory depression from opioids

22-50% O

nasal canula (1-6L)

what are 3 signs of severe C diff that are not prevent in mild

nausea, fever, dehydrated

can I change the flow rate if it is not working

need an order

Physical dependence develops when a patient actually needs a drug to function. If the patient stops taking the drug abruptly, withdrawal symptoms follow

need opioid for back back

regional anesthesia=

nerve block

for severe pain that is unresponsive to everything else

neuroblative- destroy nerves- rhyzotomies

Each individual's pain experience depends on the interaction between that person's ______ and the _____.

neurological system and the environment

phantom pain is actually ____ pain

neuropathic

what type of pain is phantom pain

neuropathic

what type of pain is shingles (post hepatic)

neuropathic

what type of pain is complec regional pain syndrome

neuropathic pain

which pain does not serve a useful purpose

neuropathic pain

what are some microvascular complications of DM

neuropathy, nephropahty, retinopathy

What is a circumstance where a placebo should be used

never

Brown or wild rice

no

Can an LPN adjust flow rates of an IV

no

Can an LPN remove a nontunneled central catheter

no

Can you do a colonoscopy if have C dif

no

Cereal, cake, and breads with coconut, dried fruit, nuts, and other seeds

no

Do opioids hasten death

no

Dried beans, peas and lentils

no

Dried fruits and prune juice

no

Dry bread, toast, crackers, and cereal

no

Is an air embolism covered by medicare and medicaid

no

Is it ok to use tubing that has visible blood int eh male leur end

no

Popcorn

no

Raw fruit, including those with seeds, skin or membranes

no

Raw or undercooked vegetables, including corn

no

Seeds and nuts, and foods containing them

no

Whole-wheat or whole-grain breads, cereals and pasta

no

Yogurt or ice cream with coconut, nuts, and granola

no

berries

no

can you develop a tolerance or physical dependency to non opioids

no

can you have coffee, tea, and soda

no

chips

no

coconut

no

corn

no

does tolerance develop to constipation

no

is a grimace a reliable pain sign

no

is an angioplasty a major sx

no

is effective wound care how many time you change the dressing

no

is effective wound care what dresing you use

no

is it ok to take coumadin before sx

no

is it ok to use alcohol based cleansers to wash hands if C dif

no

is it ok to wear a watch in the OR

no

is tachycardia a reliable pain sign

no

peanut butter- on soft diet

no

popcorn

no

redness

no

should an obese person weigh themselves daily

no

should you clamp the JP drain when the client is ambulating

no

so when taking corticosteroids for a long time can you watch for infection by look at WBC

no

temp

no

will you see a change in VS with chronic pain

no

should you clamp a penrose drain

no NEVER- only clamp JP drain

Is it ok to give a patient a deltoid shot into the right arm if they are right side paralyzed

no this will affect absorption- need to be able to move..

Are americans healthier than other countries

no- 26 nations have lower infant mortality rates

Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.?

no- Administering a dose of morphine when the patient already has severe pain will not address the problem.

can give NG tube if have pancreatitis

no- NPO

is tenting a good indicatory of dehydration (hypovolemia)

no- OA have decreased elasticity

can you take narcotics for C diff pain- why

no- because narcotics increase risk of getting megacolon

Can give NG tube if have paralytic ileus

no- because no GI motility can put in if going to do suction though

would being mobile help increaase Ca

no- being mobile decreases Ca

IV potassium chloride (KCl) 60 mEq- do you have to give via a central line

no- but you do need to give 10 mEq/ hr

IF NG tube- do you have to give continuous feedings via infusion pump and do you have to flush after checking residual

no- can be intermittent yes- must flush

can you use providone iodine to clean ulcers

no- cytotoxic- also can not use hydrogen peroxide or Na hypochlorate (Dakins)- damages new epithelization and delays healing

is constipation a complication of TPN

no- diarrhea is

is it good to catheterize for functional incontinence

no- do scheduled toileting

should you withhold opioids on the basis of respiratory concerns

no- dont hold- very unlikely

carrots, broccoli, cauliflower, and celery

no- especially if raw

is cool skin over an instertion site a complication

no- even though it may be a symptom of infiltration

would you cut a gauze and put it around drain

no- gauze may stick in wound- use foam

does pain interfere with rehab goals

no- give meds before therapy

should you worry about side effect of opioids at the end of life

no- give them the drugs

are there definitive measurements to assess pain

no- have pt describe pain in their own words

bagels, French bread, and sourdough bread

no- have tough crust

will placing a pillow under knees prevent thrombus

no- increase change

does the pain have to come from actual tissue damage

no- it can be potential damage

is it ok to use adhesive tape to keep a condom cath in place

no- it does not expand when penis changes sizes

The family member dries the wound using a hair dryer set on a low setting.- is that good

no- keep wound moist

Is it cool to assess pain in a nonverbal patient by looking at VS

no- look for behavioral changes

is it ok to do the bubble test

no- may be in respiratory tract but not bubble becuase of respiratory secretions

can you use wet to dry on granulating wounds

no- may damage it

are sedation and confusion frequent side effect of opioid patients

no- mild sedation and confusion are common with inititation of therapeutic opioid doses- these effects are transient

Is this a complete order NS KVO

no- needs rate- even though usually 20 ml/hr

A patient who has a surgical incision with pink, approximated edges- can wet to dry be used

no- not for approximated surgical incisions

A patient who has a full-thickness burn filled with dry, black material- can wet to dry be used

no- only for minimal eschar

is it good to catheterize for urge incontinence

no- pelvic exercises, meds, bladder training

is respiratory depression a common concern

no- rarely occurs if titrated

is respiratory depression often cited as a factor that limits use of opioids

no- rarely seen in long term opioid therapy- more seen in opioid naive patients and is only short lived

should you tell the patient that inserting the IV will hurt

no- say there will be some discomfort that will go away after in place

Cooked fruit with skin and seeds

no- seeds and skin are no bueno

is a post op urine output of 20 ml/hr normal

no- should be 30

is a warm sensation when voiding normal

no- sign for UTI

is a temp of 97.7 abnormal post op

no- slightly low post op is nl

pineapple and mango

no- these are stringy

are diuretics a good tx for increased fluid volume

no- they also remove lytes

can you have sherbert on a clear liquid diet

no- this is part of the full liquid diet

will it help relieve pain to Soak the old dressings with sterile saline 30 minutes before removing them.

no- this will cancel out the debridement

bacon, sausage, hot dogs

no- tough meat

can ibuprofen help with RA

no- wait- ATI says yes

pain from somatic or visceral structures

nociceptive

what are the 2 main categories of pain

nociceptive and neuropathic

step 1- for mild pain

non opioid with or without adjuvant

what are celebrex and toradol

non opioids use celebrex for period pain, arthritis

___ are given for mild pain

non opioids- NSAIDS, acetaminophen, aspirin

if patient can not use numerical use=

non, moderate, or severe

impregnated with saline or petroleum- for minor wound or second dressing- minimally absorbant

nonadherent

why should you not use nonadherent in the example

nonadherent can not absorb the exudate and it can not help with the debridement

complications of chronic illness usually occur due to

noncompliance

what labs measure pain

none

pre op for echo

none- even continue taking meds

60-100% O

nonrebreather (6-15 L)

used to deliver high flow rates and high concentrations of oxygen

nonrebreather mask- valve does not allow you to inspire room air

what type of catheter is instered during an emergency or trauma situations

nontunneled central catheter

Corn and peas- in soft diet

nope

apples and pears

nope

do you need to manipulate foreskin when applying condom cath

nope

will the patient feel tugging as catheter is removed

nope

do all patients have the sam threshold and tolerance

nope- all different

in COPD you get dyspnea and increased respiratory rate- so should you use abdominal breathing or pursed lip breathing

not abdominal- even though it decreases rate, it increases dyspnea pursed lip is easier

does measuring the residual help prevent aspiration

not according to article

why does LOC decrease when dehydrated

not enough O to brain

if the pain does not have an identifiable cause is it psych pain

not necesarrily

can you listen at apical and feel peripheral at same time

not really- get 2nd person

what position should you place your patient in if they are hypotensive

not trendelenburg like they used to just elevate their feet

A patient with renal failure has been taking aluminum hydroxide/ magnesium hydroxide suspension (Maalox) at home for indigestion. The patient arrives for outpatient hemodialysis and is unresponsive to questions and has decreased deep tendon reflexes. Which action should the dialysis nurse take first?

notify the provider do not review the Mg level on the chart

compare resting heart to exercised heart

nuclear stress test

Who teaches the patient about diet

nurses- not enough dieteciens

GB cancer

obesity

Imb between energy expenditure and energy intake

obesity

endometrial Ca

obesity

what is the most common nutritional problem

obesity

kidney CA

obesity and smoking

when is the ventrogluteal contraindicated

obvious scarring or deformity

most common PICC complication

occlusion and phlebitis

color of tracheobronchial aspirate

off white to tan

continuous infusion of a local anesthetic into the wound's adjacent tissue

on Q pump

When do you never use wet to dry mechanical debridement

on a clean gradulating pressure ulcer

does an echo take a long time

only 1 hour

does C dif produce a systemic sign like MRSA

only the severe C dif

when can you disconnect continuous infusion

only to change tubing

do not let your family push PCA button while you are sleeping

only you push

what is tramadol (Ultram)

opioid

step 3- moderate to severe

opioid with or without a non opiod with adjuvant

step 2- mild to moderate

opioid with or without nonopioid and an adjuvant

transduction transmission perception modulation

opioids good for transmission perception- relax modulation- antidepressants

best route

oral

The goal is to go from PCA to____

oral pain meds

opioids reach peak plasma concentration: oral, SQ or IM, IV

oral= 90 min SQ or IM- 30- min IV- 6 min

Who said that the goal of nursing is to render the patient or members of the family capable of meeting the patient's self care needs

orem (Theory of self care)

what do you need to monitor if patient is on patient controlled epidural analgesia pump

orthostatic hypotension

severe infection of bone, bone marrow, and surrounding tissue

osteomylitis- can be bacterial or fungal

When is weight loss recommended

over 25

Obese BMI

over 30

mobidly obese

over 40

+2 pitting edema would mean what for fluid

overload

lowest intensity of pain stimulus that is perceived as pain

pain threshold

amount of pain a person is willing or able to tolerate

pain tolerance

what type of surgery is a colostomy

palliative

where should you never start an IV

palm side of wrist

name 3 signs of hypoglycemia

palpitations sweating anxiety

This is mediated by the vagus nerve

parasympathetic effect on heart

information about ________ is more useful in evaluating effectiveness.

patient function

what kind of fluid ish does hyperglycemia cause

pee a lot so hypovolemia

PRSP

penicillin resistant strep pneumoniae

what is different about a jackson pratt and penrose drain

penrose is not negative pressure

opioids alter ___ and ___ response to pain

perception of and emotional response to pain

check coagulation status before

peripheral arteriography and venography

nose or ear blue tent

peripheral cyanosis

What is PPN

peripheral parenteral nutrition- given through PICC line

what causes poor prognosis in both inflammatory and malignant disease

persistent inflammation

expected physiological response manifested by withdrawal syndrome when blood levels of drug are abruptly decreased

physical dependence

____ and____ signs of pain are not reliable

physiological and behavioral

S&S of acute pain or chronic pain

pick one

where should you put the PCA button

pin it to gown- if left on table, may fall out of reach

A patient with HF has tachypnea, dyspnea, and O2 saty 85%- what do you do

place in high fowlers

what can a malpositioned tube cause

pneumothorax aspiration sepsis

PPSV 23

pneumovax

deliver 1 to 2 kcal/mL and require that patients can absorb whole nutrients. They include milk-based blenderized foods and commercially prepared whole-nutrient formulas.

polymeric formulas

what does diarrhea, laxatives, and enemas do to pH

poop out bicarb- so met. acidosis

4 sites you can use the doppler on

popliteal femoral posterior tibial dorsalis pedis

Names of implantable vascular access devices

port A cath PasPort

drug class for heart failure that improves contractility and myocardial oxygen consumption

positive inotropes

PCA pumps are usually used for __ and ___ pain

post op or cancer

when would you titrate down

post up

where does ADH come from where does ACTH come from- this releases aldosterone

posterior pit anterior pit

order of chest physiotherapy

postural drainage percussion vibration

most sensitive indicator of protein def. (half life of 2 days)

pre albumin

More and more C Dif is occurring in which population

pregnant women

end diastolic pressure=

preload

the volume of blood in the ventricles at the end of diastole, before the next contraction

preload

this determines the amount of stretch placed on myocardial fibers

preload

NPSG 7

prevent infection- wash hands

I SAVe the line is for

preventing catheter related blood stream infections

NPSG 15

preventing suicide

what is a major concern post op

prevention of infection

What is the most important thing to remember with wound care

prevention- aseptic tech. hand washing

PPSV 13

prevnar-Immunocompromised conditions

level of prevention- to reduce risks

primary

weight loss

primary

The nurse recognizes that an expected therapeutic outcome of a medication prescribed to decrease a patient's after-load is to:

promote vasodilation- vasodilation decreases after-load by decreasing peripheral resistance to the heart pushing blood out of the heart

Cell memebrane generate ____ which sensitizes nerve ending and constitute a primary source of pain in the periphery

prostoglandins

most common type of malnutrition

protein calorie

if low transferrin eat more

protein- not iron

which drugs decrease gastric acidity and therefore put you at risk for C dif

proton pump inhibitors and H2 receptor blockers

a syndrome of poorly or under treated pain-

pseudo addiction- asks for drug and you assume addicted

when the disease becomes serious it is called

pseudomonos colitits

when a patient wants to take a drug for reasons other than its intended therapeutic effect

psych dependence- like meth to stay awaek

a complex neurobiologic condition characterized by a drive to obtain and take substances for other than the prescribed therapeutic value

psychological dependence or addication

pain has physical, ____, ___, and ___ components

psychological, social, and spiritual

Why do you have a risk of AI with FVE

pulmonary congestion

what is a client at risk for after total knee replacement

pulmonary embolism- watch for chest pain or SOB

Pulse deficit is a difference between simultaneously obtained apical and radial pulses. It indicates that there may be a cardiac dysrhythmia that would best be detected with ECG monitoring

pulse def= EKG

does this procedure take a long time and are there any risks

quick and few risks

the best indicator of fluid losses or gain

rapid changes in weight

A patient has an open surgical wound on the abdomen that contains deep pink granulation tissue. How would the nurse document this wound?

red wound

How does negative pressure help wound healing

reduces bacteria- encourages blood flow

why elevate

reduces edema and inflammation

Pressure rises in the abdomen due to third spacing and does what to preload and afterload

reduces preload increases afterload

n example is the pain a patient with gall bladder disease feels under the right shoulder blade.

referred pain

Eating certain foods makes dumping syndrome more likely. For example

refined sugars- because they rapidly absorb water from the body

always injected- involves a central nerve or groups of nerves that innervate a site remote to the point of injection

regional anesthesia- also called block

which insulin can be given via IV

regular short acting insulin

opioid + nonopioid= opioid sparing effect

relief with decreased opioid dose so fewer opioid side effect

what is baclofen good for

relieving spasms associated with muscle pain

What happen in the maturation phase

remodeling of collage scar gets stronger

what happens in the gastric sleev sx

remove 3/4 stomach

Which fluid prob RC acute renal failure RC heart failure

renal failure= hypovolemia heart failure- hypervolemia

most common pressure ulcer complication

reoccurance

lost cells being replaced by conective tissue

repair- results in scar- more common then regenration

what do you use an isotonic solution for

replacing ECF losses

abdominal distention can then cause impaired

respiratory function

The patient's ______ is the highest priority of care while using PCA medication

respiratory rate

neuro changes of high Na- neuro changes of low Na-

restless, seizure, coma confusion, lethargy, HA (due to brain swelling)

Both aldosterone and ADH help restore BP by

retaining water and Na

What does ADH do

retains water and also causes constriction (hince called vasopressin)

what happens to urinary production when in pain

retention

_____ are most commonly used postoperatively because they have multiple lumens to allow for the drainage of urine, irrigation of the bladder, and instillation of medications into the bladder.

retention catheters

Once catheter in- dr removes guide wire and pushes catheter into the _________

right coronary artery

what does your body temp do when you are dehydrated

rises- get a fever- because blood usually cools you off so fever can cause hypovolemia and hypovolemia can cause fever

what types of cooking should you avoid- this type of cooking makes food tough

roasting, grilling, broiling

kentucky tennessee

s3 s4

most common place for pressure sores

sacrum and heels

preferred tube for gastric decompression

salem NG tube- also called gastric sump tube

how can you correct the acidosis

saline bolus to prevent hypovolemia

S

scrupulous hand hygiene

granulation tissue normally heals by

secondary intention- leave open- large scar

wound left open to heal by generation of tissue from edges inward and bottom up

secondary intention- pressure ulcer

if Na gets too high it can cause

seizures

belief in ones ability to take action

self efficacy- important for the adoption of new behaviors

explain autolytic debridement

semiocclusive or occlusive dressing to soften dry schar

dry uninfected wounds- polyurethane

semipermeable transparent

The nurse is caring for a patient with diabetes who had abdominal surgery 3 days ago. Which finding is most important for the nurse to report to the health care provider? Temp of 101 or seperation of wound edges by 1 cm

seperation of wound edges 3 days after sx- dehisence

when do neutrophils decrease (neutropenia)

serious infection or with meds chemo

Platelets release ____ which contribute to the pain signal

serotonin

if blind and meal time

serve entire meal at once to promote autonomy- not one food at a time

what determines how well a wound will heal

shape and location

a client is scheduled for a diagnostic procedure to rule of CV disease, pre procedure history would include asking about allergies to

shellfish or iodine

if pain comes and go's (intermitten) give a ____ drug

short acting

Crackles and diminished breath sounds

signs of fluid volume overload

if new dx of celiac- tell parents to increase intake of _____

simple carbs dont eat fiber, dairy, or high fat

40-60% O

simple face mask (6-12 L)

used for patients who require a moderate flow rate for a short period of time.

simple face mask- high flow rate to prevent rebreathing CO2

UP 2 UP 3

site mark time out

what are somatic pain

skin, CT, muscle bone

what respiratory problems can obesity cause

sleep apnea and hypoventilation syndrome

how should you remove a urinary catheter

slow and steady

what does unrelieved pain do to the GI system

slows down motility

Splinter hemorrhages

small red to black streaks under fingernails- infective endocarditis

when following this diet, what will happen to your bowel movements

smaller and fewer

used for bio weapons

smallpox and anthrax

acute myeloid leukemia

smoking

bladder Ca

smoking

cervical CA

smoking

larynx Ca

smoking

mouth CA

smoking

stomach Ca

smoking

throat Ca

smoking

esophageal CA

smoking and obesity

pancreatic CA

smoking and obesity

what should you tell patients to avoid doing before Ca test

smoking or caffeine 4 hours before

Treat the cause 1st

so i guess if diarrhea- fix that before giving IV fluids

Chemotherapy is an immunosuppressant. Even a low fever in an immunosuppressed patient is a sign of serious infection and should be treated immediately with cultures and rapid initiation of antibiotic therapy.

so if fever 102- assess first and immediatley

What is this and who came up with it- people guide their lives by beliefs of personal eficacy. A person's belief in his ability to cope with and manage a situation.

social cog theory- perceieved self efficacy- Bandura

who has the highest risk for FVD

someone who has impaired consciousness- can not feel thirst

will attach wires and patches to get heart beat

sonography

1 to 2 kcal/mL and are designed to meet specific nutritional needs related to specific illnesses, such as liver failure, pulmonary disease, diabetes, or HIV infection.

specialty formulas

intermitten high fever accompanied by shaking chills and sweating suggests

speticemia

a fever from a wound infection of aerobic organisms

spikes int he afternoon or evening

avoid eating ____ if have high Mg

spinach

shiny or dry shallow ulcer without slough or bruising.

stage 2

preinduction

start IV- confirm AB prophylaxis Periop nurse- completes assessment, checks consent, and preforms time out

All patients with known cardiac disease should be treated with

statins

what is something to know about methadone

stays in the body a long time- dont give extra dose too soon

don't hear reverse flow and you have a change in shape

stenosis

a dressing change with a penrose drain should be changes using _______ technique

sterile

what does stimulation of chemoreceptors do

stimulate vasomotor center to increase BP

off white or tan fluid is usually from the

stomach

what is pulsus alternans

strength varies but normal rhythm

Explain how the HPA system works

stress causes the hypothalamus to release corticotropic releasing factor which goes to anterior pit. and causes the release of ACTH which goes to the adrenal gland and releases the mineralcorticoid aldosterone which conserves Na and water and excretes K

how does obesity affect urination

stress incontinence- increases intraabdominal pressure- pee when lifting stuff

A radioactive tracer is given through IV which attaches to muscle cells in the heart so that they show up on imaging

stress test- nuclear scan- will give med via IV to work heart

Hypovolemia causes this kind of response

stress- andrenergic- constriction

what does it do once released

stretches heart to allow more fluid to pump increases urine output- Na and water excretion

airway obsrutction causes this sound

stridor

the amount of blood ejected from the ventricle with each heartbeat

stroke volume

early sign of O toxicity

substernal chest pain

why are diabetics at risk for UTI

sugar in the urine

client in HF getting lasix- has decreased bowel sounds and general muscle weakness- what should we do

suggest using K sparing diuretics

what position will you put the client in if evisceration

supine- hips and knees bent

the force opposing the movement of blood

systemic or peripheral vascular resistance

New bright-red drainage may indicate hemorrhage, and the nurse should initially assess the patient's vital signs for ____ and _____

tachycardia and hypotension

what do you want to patient to do while you withdraw the tube

take a deep breath and hold it- this closes the glottis and reduces risk of aspiration

if on corticosteroids for a long time- what do you need to do before sx

take a higher dose- adrenal insufficiency from long use needs extra dose to prevent Addisonian crisis

what do you do once fully deflated

take off tape and just pull catheter out

A patient who is using a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which action should the nurse take first?

take off the patch- Naloxone administration in a patient who has been chronically using opioids can precipitate withdrawal and would not be the first action.

does the angioplasty take a long time

takes between 30 min-3 hours

rehab

tertiary

contaminated wounds heal by

tertiary- delayed closure

delayed primary closure - will eventually suture it up

tertiary- wound may be contaminated

Who gets TDAP and what is it

tetnus, diptheria, pertussis adults over 65- one time booster in 10 years

Why is GERD common in obese people

the abdomen elevates the diaphragm

Which insulin do you put air in first

the cloudy one- NPH insulin (intermediate or long acting) because you want to withdraw the clear short acting insulin first

why do they keep the surgical suite cold

the decrease the risk of infection it does NOT decrease the amount of O needed

is simple face mask or nonrebreather a low flow

the nonrebreather is low flow

Which patient is most likely to need long-term nursing care management?

the one with chronic conditions like osteoarthritis or obesity

When using a nonrebreather mask, do not allow the reservoir bag to deflate. If it does deflate

the patient is likely to breathe in large amounts of exhaled carbon dioxide.

inflammation will occur with all cell injury unless_____

the pt is neutropenic- low WBC

What else can you not reuse when flushing a catheter

the same syringe

how does this reduce pain

the signals from the neurotransmitter reach the brain before the pain

what is the s2 sound

the sound of the SL valves closing (aortica and pulmonic) during diastole

what is the s1 sound

the sound of the the AV valves (tricuspid and mitral) closing as blood is pushed out of ventricles (systole)

where does BNP come from

the ventricles

What happens to cardiac workload is the afterload increases

the work increases

what would you check in an OA to see if FVD

their tongue- see if dry

what happens to bile and pancreatic enzymes

there are none

what happens to lytes in hypovolemia

they are higher

what happens to liver enzymes with malnutrition

they increase because of liver damage

how do NSAIDS work

they inhibit cyclo- oxygenase- the enzyme that converts arachidonic acid to prostoglandins

A disadvantage of leg bags is that __________

they must be changed more often

most unreliable is the physiological responses

they often stabilize quickly. Thus, pain can continue in the absence of vital-sign changes.

tell me about leptin in obese people

they produce high levels- but the brain is resistant to its action so they never feel full

What happens to Na and K levels with 3rd spacing

they rise

what happens to Hct and Hemoglobin

they rise

what happens to BUN and creatinine

they rise- hemoconcentration

Rapid inflation and deflation of the balloon pushes the vessel wall out and reestablishes blood flow- may feel chest pain

this is how the angioplasty helps

good adjuvant for burning leg pain

this is neuropathic pain- so a tricyclic antidepressant like Amitriptyline (Elavil)

maintenance

this is when he sx is performed

the point at which a person perceives pain.

threshold

vibration of vessel or chest wall

thrill

adjusting the dose or administration interval for safety and effectiveness

titration- can go up or down

why immobilize

to decrease the metabollic need

why do they need a diet high in protein

to help them heal

why do they need a diet low in fat

to prevent dumping syndrome

if a pt presents with Somogyi, his dr may advise him to take a bed time snack or decrease is insulin right before bed- why

to prevent hypoglycemia while he sleeps

o Central Cyanosis- bluish tinge in central areas such as

tongue conjunctiva inner surface of lips

client recovering from spinal anesthesia- what sensation will return first

touch then pain, warmth, and cold

tell me about normeperidine

toxic to CNS and causes seizures

how will you get pictures of teh heart

transducer

The process of creating an action potential is known as

transduction

_______dressings are used for red wounds or approximated surgical incisions.

transparent filk

adjucant for neurpathic pain

tricyclic antidepressants (Amitriptyline)

start to elevate 4 to 6 hours after myocardial injury and are highly specific to myocardium. They are the preferred diagnostic marker for myocardial infarction

troponin

the marker of choice to dx MI.

troponin- more acurate

what does it indicate if you have a larger waist hip ratio

truncul fat and increased complications

if you tried an NSAID and it didn't work, what do you do next

try another NSAID

Always collect specimens from the catheter's _____

tubing never get a sample from the collection bag

how often should you assess a catheter for intermittent infusions

twice a day

other names for acetaminophen

tylenol or excedrin

what is secondary protein cal malnutrition

undernutrition from alteration in absoprtion, digestion, or metabolism

what is primary protein cal malnutrition

undernutrition from poor eating habits

what is a good indicator of CO

urinary output

what is a key indicator of fluid status

urine specific gravity nl= 1.010-1.025

NPSG 3

use medicine safely - Take extra care with patients who take medicines to thin their blood.

consideration for a substance abuser

use single dose opioid because a mixed opioid agonist antagonist may cause withdrawal

what does the inappropriate gut hormone release cause

vasomotor and GI symptoms

sudden dizziness or fainting that can be triggered by pain, fright, or trauma

vasovagul reaction

what location do you use if child is less than 7 months

vastus lateralis

V

vein preservation

what will result due to an increased afterload due to HTN

venticular hypertophy- heart gets bigger because has to work harder to get blood out

what else should you monitor with 3rd spacing

ventilation- make sure O saturation >97%

what does the article say is the safest site and under what conditions

ventrogluteal- if greater than 1 ml for a child older than 7 months

commonly used for patients who have COPD.

venturi- because CO2 build up is minimal and specific conc.

what type of pain is a surgical incision

visceral

what stimulates the receptors

volume overload

vomit and gastric suctioning does what to pH

vomit out HCL- so you get met. alkalosis

how does acute pancreatitis effect fluid

vomit significanlty

how can you work around these problems in pH

wait 1 hour after meds or feeding to check pH

The patient's ____, ____, and _____ can indicate that he has metabolic syndrome

wait circumference HDL- not all triglycerides FPB

what do you do if patient complains of pain so you go get meds but when you come back they are sleeping

wake them up and give them the med

Exercise should be done daily for 30 minutes to an hour.

walk 40 min 7 days a week is great

what can you do to prevent thromboembolism post op

walk and turn

Possible complications of inhalation anesthetics include coughing, laryngospasm, and increased secretions.

watch for laryngospasms

color of pleural aspirate

watery or straw colored

watery vs mucoid diarrhea

watery= severe C diff mucoid= mild

if patient does not have adequate pain relief and there are no side effects present

we need to ask dr to titrate up

The most serious adverse effect of the neuromuscular blocking agents is weakness of the respiratory muscles, which can lead to postoperative hypoxemia.

weak respirations= hypoxemia

how often should you check weight for nutrition status

weekly- only check daily for fluid

ISBAR- what is A

what you think the problem is

when is natriuretic peptide secreted

when blood volume is increased

When is BNP high

when diastolic pressure increases with heart failure

when does pruritus occur

when given intrathecally

when should you use reverse isolation precautions (protective)

when pt has depressed immune function or neutropenia

emergence

when surgical procedure is done- reversal agents include anticholinsterases like neostigmine- opioid antagonistsand benzo antagonists

when does O toxicity occur

when the FiO2 is above 50% for 24-48 hours

when will a patient require home O2

when they have < 90% O2 sat 48 hours before DC

why would beginning at mitral be good

when you need to turn your pt to hear apical pulse

after having gastric bypass surgery- how should you start each meal

with a protein

when do neutrophils increase

with bacterial infection and inflammation RA, lupus, and vasculitis

when and how do you remove hair that interferes with sx

with clippers right before- not a razor

are there more older men or women living alone

women

what can you use for a cognitive or language barrier

wong baker pain FACES- ask patient to chose the face that best describes pain

What is REDAP for

wound care R- redness E- edema D- drainage A- aproximation P- pain

what is effective wound care

wound management

How does an action potential develop- the traumatized tissue in the periphery release biochemicals that stimulate afferent nerve fibers and allow movement of the pain impulse into the CNS

yea

lateral recovery position until gain consciousness and then supine with head up

yea

The tube feeding should be shut off 30 to 60 minutes before any procedure requiring the patient to lie flat.

yea- if getting feeding HOB must be up at 45

A review of the medical record, interviews with the patient and caregiver, and written information by the patient are all included in a comprehensive geriatric assessment.

yeah

ACCORDING TO THE CDC (2009) ASPIRATION IS NOT REQUIRED FOR IM

yeah

can you have hard candy on a clear liquid dieat

yeah- stupid

how often should OA get flu shot

yearly

color of intestinal aspirate

yellow, clear, or cloudy

A patient who has a wound with purulent drainage and dry brown areas- can you use wet to dry

yes

Applesauce or canned fruit

yes

Are crisis situations a good teaching opportunity

yes

Breads, muffins, pancakes, or waffles moistened with syrup, jelly, margarine or butter

yes

Butter, margarine, oils and salad dressings without seeds

yes

Can C dif cause sepsis

yes

Can an LPN monitory Iv sites for infection

yes

Cheese- in soft diet

yes

Does Alzhiemers cause inflammation

yes

Enriched white bread or rolls without seeds

yes

Fruit and vegetable juice with little or no pulp, fruit-flavored drinks and flavored waters

yes

Fruit cobbler with soft breading or crumb mixture

yes

Gelatin dessert with soft canned fruit

yes

IS HIV resistant

yes

If i hav to change IV site- do I have to get new tubing

yes

Is HBV resistant

yes

Is it ok to give these fluid vai PICC

yes

Macaroni, pasta, noodles, or rice

yes

Milk and foods made from milk, such as yogurt, pudding, ice cream, cheeses and sour cream

yes

Moist dry or cooked cereal

yes

Moist, tender meat, fish, or poultry that is ground or chopped into small pieces

yes

Most canned or cooked fruits without skins, seeds or membranes

yes

Poached, scrambled, or cooked eggs

yes

Refined cereals such as Cream of Wheat

yes

Soups with small soft pieces of vegetables and meat

yes

Tender meat, poultry and fish

yes

The family member places contaminated dressings in a plastic grocery bag.- is that good

yes

The new nurse uses a hydrocolloid dressing (DuoDerm) to cover the ulcer. Is this ok to do for a stage 2 pressure ulcer

yes

Tofu

yes

White rice, plain white pasta, noodles and macaroni

yes

are patients with a history of drug abuse at higher risk of abuse

yes

bananas, peaches, or melon

yes

can C dif cause a paralytic ileus

yes

can NG tubes treat obstruction

yes

can antihistamines be used as a pain adjuvant

yes

can obesity cause gout

yes

can someone sleep in the prescene of pain

yes

can you have gelatin on a clear liquid diet

yes

crackers

yes

do you need a Rx for spinal cord stimulation

yes

does a PICC need an infusion pump

yes

does asthma cause inflammation

yes

does pain cause clots

yes

eggs

yes

is a Deep red and moist wound bed expected

yes

is a clinician's barrier- belief that pain is a natural cause of aging

yes

is a clinician's barrier- the belief that pain is part of illness

yes

is a clinician's barrier- withholding pain meds until a cause it found

yes

is a cobblestone appearance expected with wound healing

yes

is codeine an opioid

yes

is drainage from JP drain of 30 ml/hr normal

yes

is high BP a part of metabollic syndrome

yes

is it ok to fold your hands 2 inches about your wait in OR

yes

is it ok to take digoxin before sx

yes

is it ok to take lasix before sx

yes

is it ok to take prednisone before se

yes

is it ok to use a phone when have spinal cord stimulation

yes

is there pain with keloids

yes

is titration a collaborative effort

yes

is withdrawing from interaction with others a sign of pain

yes

plain yogurt

yes

should you open sterile dressing packages before putting on sterile gloves

yes

tofu

yes

will good control of DM prevent wound infection

yes

would you need O therapy if you patient had tachypnea and a O2 sat of 94%

yes

Does MRSA reoccur Does flesh eating bacteria reoccur

yes no

Can i have the following in a soft diet

yes or no

so if allowed or not for a low fiber diet

yes or no

should you leave a space between the tip of the penis and the condom catheter

yes- 1-2 inches- prevents irritation and allows full drainage

does tolerance to itching pruritis occur

yes- after a few days- but may use antihistamine or bendadryl

is changing a dressing around an IV a risk for bacteria

yes- any catheter manipulation

is 200 mL sanguineous fluid in the wound drain worse than crackles in all lungs

yes- atelectasis is common post op just cough and deep breath

is atelectasis an complication of having an NG tube

yes- breathing through mouth

are contractures necesary for healing

yes- but may become abnormal

do people develop tolerance to sedation and confusion

yes- but not to constipation

is polyuria a complication of TPN

yes- but oliguria is not

T or F- draining the infection will help with MRSA

yes- but only dr can do this- you do not- can make infection worse by driving bacteria deeper into skin

If I use someones towel, will I be at risk for MRSA

yes- can be on personal care items

can you get MRSa on a bruise can you get flesh eating bacteria on a bruise

yes- do not have to have skin breakdown yes-usually starts from minor injury- but need skin breakdown or immunodef.

are tolerance and physical dependence nl physiological responses

yes- does not mean addiction

is a paralytic ileus a normal complication

yes- due to anesthesia- this is why theya re NPO until bowel sounds return

Are OA UTI assymptomatic

yes- except for a change in mental status

when getting blood specimen from central line- do you discard some

yes- first 5 ml

do you need to turn off infusion before getting blood from a central catheter

yes- for 1-5 minutes

does diabetes effect wound healing

yes- it decreases collagen synthesis

Canned or well-cooked vegetables without seeds, hulls or skins

yes- like cooked potatoes or carrots

does acute pain have a known cause

yes- like illness or sx, postop pain, labor, trauma, fracture, infection

can COPD cause malnutrition

yes- may chose to breath over eat

can someone laugh, talk, and walk if pain

yes- may make the pain bearable

is there a risk for infections when doing spinal cord stimulation

yes- need sx to place under skin

is 13,000 to high for WBC

yes- normal is 5,000-10,000

is a bad count of 11% too high

yes- normally 3-6% bands

is measuring the capnography a good way to determine placement

yes- of high CO2 then tube is probably in respiratory tract

can malnutrition be both excess and not enough food

yes- overweight or underweight

would diuretics be a good tx for high Na

yes- pee it out

are opioid safe

yes- rarely cause clinical addiction if taken as directed

is this statement made by a patient a sign that he has def. knowledge about pain management- " ill wait to take the potent med when i'll need them most. If i take them now, they won't be effective later on"

yes- that statement is incorrect

Should a child with MRSA go to school

yes- the only reason they would not is if drainage wound could not be covered

is it good to ask the family if they think she is in pain

yes- their assessment in usually good

creamy peanut butter- low fiber diet

yes- up to 2 T

if you dont have enough cobalamin what happens

you get anemic

The increase in WBC count with the increased bands (shift to the left) indicates that the patient probably has a bacterial infection, and the nurse should obtain wound cultures.

you would also monitor wound- but you need to get that culture

name a malabsorptive sx

• Bilio- pancreatic diversion