Med surg final study questions/ study guide

ascites treated w/ paracentesis

positioning upright

Chron's disease

inflammation of the small intestine

chronic renal failure causes

inflammation, artery obstruction, kidney stones, diabetes, high blood pressure

peritoneal dialysis (PD)

instillation into the peritoneal cavity

right sided heart failure most common cause

left sided hf

Left-sided HF results from

left ventricular dysfunction.

A nurse is caring for a client who has a traumatic brain injury. Which of the following findings should the nurse identify as an indication of increased intracranial pressure (ICP)?

restlessness

right sided heart failure occurs when

right ventricle fails to pump effectively

vt is indicative of

myocardial irritability

Cushing's syndrome symptoms

Obesity, wasted extremities, buffalo hump, acne, hirsutism, amenorrhea, proximal muscle weakness, striae, HTN

GERD prevention

-avoid large meals -avoid alcohol and smoking -eat sitting up -avoid recumbent position several hrs after meal -avoid bending for long periods -sleep with head elevated -lose weight if overweight

Gout chronic attacks Happens due to

-chronic elevated uric acid levels, -Joints become damaged, -Itching, skin peeling, -Uric acid kidney stones, -Tophi: white/yellowish growths found on helix of ear, fingers, elbows, toes

GERD nursing interventions

-monitor for any signs of respiratory distress or periods of apnea using a cardiac and/or apnea monitor -check vital signs -proper positioning -minimal handling after feedings -pacifier use reduces crying & encourages swallowing -minimize reflux -family education & support

Chron's disease symptoms

-rectal bleeding -loss of appetite -fatigue -fever -night sweats -cramping

Gout acute attack

-red, swollen tissue -often in big toes, ankles, fingers, wrists, knees, elbows -triggered by diet, injury, other stress -attacks often occur at night

Cushing Disease: diagnosis

1) 24 hour urine cortisol test 2) Increased ACTH 3) Imaging 4) Dexamethasone suppression test

SVT HR

151-220 BPM

Peptic Ulcer Disease

A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum

A nurse is admitting a client who has active tuberculosis to a room on a medical-surgical unit. Which of the following room assignments should the nurse make for the client?

A room with air exhaust directly to the outdoor environment

A nurse is reviewing the EKG strip of a client who has prolonged vomiting. Which of the following abnormalities on the client's EKG should the nurse interpret as a sign of hypokalemia?

Abnormally prominent U wave

A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome? (Select all that apply.)

Alopecia, Moon face, Purple striations, Buffalo hump

CAD symptoms

Angina, SOB, palpitations, tachycardia, nausea, sweating, tachycardia

A nurse is caring for an unconscious client who has a loss of the corneal reflex. Which of the following actions should the nurse take?

Apply lubricating eye drops.

Hemodialysis long term devices

Arteriovenous fistula or av graft

Anti-hypertensive Classifications Adrenergic Blockers:

BPH, give at hs to reduce orthostatic BP

A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.)

Blurred vision, Tachycardia, Moist, clammy skin

A nurse is caring for a client who has valvular heart disease and is at risk for developing left-sided heart failure. Which of the following manifestations should alert the nurse the client is developing this condition?

Breathlessness

Liver cirrhosis treatment

Cannot reverse process but can slow it. Treatment based on causative factors, implemented until symptoms cannot be controlled. Liver transplant may be needed to sustain life.

CAD diagnosed by

Cardiac catheterization (Not diagnosed in the ED)

nurse is caring for a client who is 5 hr postoperative following a transurethral resection of the prostate (TURP).The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. Which of the following actions should the nurse take first?

Check the tubing for kinks.

A nurse is assessing a client's cranial nerves as part of a neurological examination. Which of the following actions should the nurse take to assess cranial nerve III?

Checking the pupillary response to light

.A nurse is caring for a client who is unconscious and has a breathing pattern characterized by alternating periods of hyperventilation and apnea. The nurse should document that the client has which of the following respiratory alterations?

Cheyne-Stokes respirations

A nurse is providing teaching for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). The client asks about foods he should avoid eating. Which of the following foods should the nurse tell him to avoid

Chocolate

Addison's disease treatment

Chronic steroids (glucocorticoids)

A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?

Chvostek's sign

A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as a possible indication of venous insufficiency?

Cold and numb numbness distal to the fistula site

nurse is caring for a client who develops a ventricular fibrillation rhythm. The client is unresponsive, pulseless, and apneic. Which of the following actions is the nurse's priority?

Defibrillation

A nurse is planning care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include in the plan of care?

Decrease the client's fluid intake.

most common heart failure

Left side (ventricular) failure

SVT S/S

Palpitations, hypotension, dyspnea-Hypotension Chest Pain. Fatigue and vertigo

What type of arthritis can go into remission

Rheumatoid Arthritis

Cholecystitis S/S

severe midepigastric or right upper quadrant pain radiating to back and referred to right scapula usually after meals fat intolerance flatulence indigestion diaphoresis n/v chills low grade fever possible jaundice clay-colored stools with common bile duct obstruction

Adrenergic inhibitors

sudden stoppage rebound syndrome ( catapres)

SVT

supraventricular tachycardia

Cushings Syndrome treatment?

surgery to remove tumor, drug or radiation therapy, total adrenalectomy

SIADH

syndrome of inappropriate antidiuretic hormone

Hep A causes

travel or meals in aread of poor senitation ingestion of contaminated water or food

Peritoneal Dialysis (when outflow is inadequate)

turn pt from side to side BEFORE checking for kinks in tubing

v fib s/s

unconscious, no heart sounds, peripheral pulses, BP. resp arrest. cyanosis. pupil dilation.

Rheumatoid Arthritis cause is

unknown

most common of all dysrhythmias

v-fib

QRS complex

ventricular depolarization and atrial repolarization

Vfib

ventricular fibrillation

T wave represents

ventricular repolarization (resting) It is a upward (positive) deflection

VT

ventricular tachycardia

Hemodiaylsis interventions

-Weigh client before and after procedure -Monitor BP -Maintain fluid restrictions

Osteoporosis Age range

-Women age 65 & older, -Men age 75 & older

Ulcerative Colitis Treatment

-change diet to avoid mechanical trauma -drugs to reduce inflammation

NSTEMI treatment

1. Nitrates = 1st line 2. Beta blockers 3. Antiplatelets: -Aspirin -Ticagrelor, prasugrel, or clopidogrel 4. Anticoagulants: -Low molecular weight heparins (Enoxaparin) -Fondaparaniux 5. Statins NO fibrinolytic therapy

Rheumatoid Arthritis s/s

1. Swan Neck fingers 2. Boutonniere Thumb 3. Usu affect PIP and MP (not in DIP) 4. Ulnar deviation of the fingers at the MCP joints

DKA Nursing Interventions

1. airway - suctioning PRN 2. I/O - Foley - monitoring glucose - telemetry - v/s - neuro checks - administeration of NA/bicarb - insulin - ABGs - Q1h accucheck - *potassium labs* if you get your labs back with hypoK, first put pt on telemetry

Normal GFR Range

125 mL/Minute: amount of filtrate produced by the kidney each minute to determine renal function.

Rheumatoid Arthritis age range

20-60

Normal EF

55-60%

n order to limit the infarct size the artery must be opened within

90 minutes of presentation

Chronic Renal Failure gfr rate

<60 mL/min for longer than 3 months (normal gfr 125 mL/Minute)

GERD risk factors

> Smoking, alcohol > Caffeine, chocolate, fatty foods > Pregnancy, obesity > Hiatal Hernia

Osteoarthritis risk factor

Age-40+,Repeated joint injuries,Strenuous jobs nursing,Overweight,Genetics

A nurse is caring for an older adult client who has rheumatoid arthritis (RA) and is taking aspirin 650 mg every 4hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication?

Erythrocyte sedimentation rate (ESR)

Liver cirrhosis S&S

Fatigue, decreased apetite, nausea, weakness, abdominal pain, spider angiomas, weight loss. Common complications include ascites, edema in LLs, jaundice, gall stones, increased itching, ecchymosis, bleeding, increased sensitivity to meds, accumulation of toxins in the brain, portal vein HTN, development of varices (stomach and esophagus), immune system dysfunction, encephalopathy, liver cancer.

A nurse is preparing to administer three liquid medications to a client who has an NG feeding tube with continuous enteral feedings. Which of the following actions should the nurse take

Flush the NG feeding tube with 30 mL of water immediately following medication administration

A nurse is caring for a client who has returned from the surgical suite following surgery for a fractured mandible. The client had intermaxillary fixation to repair and stabilize the fracture. Which of the following actions is the priority for the nurse to take?

Prevent aspiration.

Peptic Ulcer Disease Treatment

Proton-pump Inhibitors Antibiotics Endoscopy Surgery

A nurse is providing teaching to the family of a client who has Parkinson's disease. Which of the following information should the nurse include in the teaching?

Provide client supervision

A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranololhydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provide

The client has a history of bronchial asthma

a nurse is caring for four clients who have drainage tubes. Which of the following clients should the nurse recognize as being at risk for hypokalemia?

The client who has a nasogastric (NG) tube to suction

A nurse is caring for four hospitalized clients. Which of the following clients should the nurse identify as being at risk for fluid volume deficit?

The client who has gastroenteritis and is febrile.

diverticulosis

abnormal outpouchings in the intestinal wall of the colon

P wave

atrial depolarization (contraction)

bruit

can be heard with a stethoscope

v-fib if not treated fast =

death

Hep C caused by

needle, blood contact

Gout S/S

warmth, pain, swelling in joint-usually the big toe, pain starts at night with red/purple skin around affected area, limited movement in the joint with scaling or peeling skin

AKI nursing interventions

§Eliminate or prevent cause §Decrease K+ •Kayexalate •IV glucose and insulin •Pulls K+ into the cells §Replace Ca+ §Decrease Phosphate

AKI diet Oliguiric phase

§Oliguiric phase •Low protein, high carb & restricted K+

Gout nursing interventions

• Force fluids to prevent formation of kidney stones. • Give and evaluate pain effectiveness using pain scale. • Observe for adverse effects of meds: bone marrow suppression, abdominal pain, vomiting.

unstable angina

•New in onset •Occurs at rest ••Increase in frequency, duration, or with less effort ••Pain lasting > 10 minutes ••Needs immediate treatment ••Symptoms in women often under-recognized

myocardial infarction

•Result of abrupt stoppage of blood flow through a coronary artery, causing irreversible myocardial cell death (necrosis)

CAD risk factors

•Risk Factors •Elevated serum lipids •Hypertension •Tobacco use •Physical inactivity •Obesity •Diabetes Mellitus •Substance abuse •Psychologic State

A nurse is caring for a client who has hypovolemic shock. Which of the following should the nurse recognize as an expected finding?

Oliguria

DI

pituitary glands poor ADH, High output High sodium

Most MIs occur in the setting of .

preexisting CAD. When a thrombus develops, blood flow to the heart muscle beyond the blockage stops, resulting in necrosis

chronic renal failure (CRF)

progressive condition in which the kidneys cannot filter certain waste products; also called chronic kidney failure

VT S&S

-Electrolyte imbalance -Digitalis toxicity -CHF

A nurse is caring for a client who reports heart palpitations. An ECG confirms the client is experiencing ventricular tachycardia (VT). The nurse should anticipate the need for taking which of the following actions?

Elective cardioversion

A nurse on a telemetry unit is caring for a client who has premature ventricular contractions (PVCs). While sitting in a chair, the client feeling reports feeling lightheaded. If the client is having PVCs, which of the following findings should the nurse expect when auscultating the client's apical pulse?

Irregular pulsations

Addisonian crisis

N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP

A nurse is assessing a client who has a sodium level of 116 mEq/L. Which of the following findings should the nurse expect?

Nausea and vomiting

STEMI

ST elevation myocardial infarction

diverticulitis/Diverticulosis

Symptoms: Low abdominal pain, cramping Diagnosis: Colonoscopy Treatment: Increase Fiber intake, antibiotics

Rheumatoid Arthritis

a chronic autoimmune disorder in which the joints and some organs of other body systems are attacked

A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortisolism?

Moon face

Anti-hypertensive Classifications: calcium channel blockers

Use in caution with heart failure

V Fib drugs

epinephrine, vasopressin

CAD modifiable risk factors

• Hypertension • Smoking • Sedentary lifestyle • Hyperlipidemia • Women: menopause without estrogen replacement/BCPs with smoking

chronic renal failure causes what labs

•Hyperkalemia, Hyponatremia, metabolic acidosis, anemia

Gout Diagnosis

-Serum uric acid- above 6 mg/dL (normal 2-6 mg/dl) -24-hour urine uric acid -Synovial fluid aspiration

Hep D transmission

co-infects w/ Hep B

DKA

diabetic ketoacidosis

GERD

gastroesophageal reflux disease

Anti-hypertensive Classifications ace

Nsaid reduce effectiveness, Cough, sudden anaphylaxis reaction

PUD

peptic ulcer disease

Postoperative Nursing Care

primary goal of the postoperative period is to stimulate circulation by encouraging movement and preventing stasis within the extremity.

CRF low

protein, sodium, potassium

hiatal hernia

protrusion of a part of the stomach upward through the opening in the diaphragm

A nurse is assessing an infant following a motor vehicle crash. Which of the following findings should the nurse monitor to identify increased intracranial pressure?

increased sleeping

SVT treatment

•IV adenosine (half-life 10 sec, asystole) -IV β-blockers -Calcium channel blockers (Amiodarone) •Synchronized cardioversion

aki diet Diuresis phase

•Low protein, high calorie & restricted fluids •Bedrest •Daily weights & I&Os •Dialysis if needed

aki diet diuresis phase

•Low protein, high calorie & restricted fluids •Bedrest •Daily weights & I&Os •Dialysis if needed

Left sided failure is caused by

•The inability of the left ventricle to: • 1. empty adequately during systole or • 2. fill adequately during • diastole

Chronic CAD

•When the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen, myocardial ischemia occurs.

Asystole

••No pulse, BP, RR ••Loss of consciousness ••No ventricular contraction

Ulcerative Colitis s/s

Weight loss, foul-smelling stools, recurrent bloody stools with MUCUS AND PUS, abd pain, urgency, and weakness.

Osteoarthritis s/s hands

- Enlarged finger joints , -Heberden's Node: distal interphalangeal joint, -Bouchard's Node: proximal interphalangeal joint

Osteoporosis nursing intervention safety

-Call light, non-slip socks, fall risk signs/bands, clutter free environment, no rugs, watch for pets,-Good body mechanics

A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer?

Furosemide

Asystole treatment

atropine and epinephrine (first) cpr(second)

nurse is caring for a client who recently had surgery for insertion of a permanent pacemaker. Which of the following prescriptions should the nurse clarify?

mri of the chest

Angina, or chest pain, is the clinical manifestation of

myocardial ischemia

vt commonly occurs w/

myocardial ischemia or infarction

A nurse is caring for a newborn who has respiratory depression. Which of the following medications should the nurse anticipate administering?

naloxone

The most common reason for angina to develop is

narrowing of one or more coronary arteries by atherosclerosis. This leads to insufficient blood flow to the heart muscle. For ischemia secondary to atherosclerotic plaque to occur, the artery is usually blocked (stenosis) 70% or more (50% or more for the left main coronary artery

Hypertensive crisis treatment

*IV ASAP* IV antihypertensive: Nipride, labetalol, nicardipine Monitor BP every 15 min during treatment Assess neurological status Assess ECG

A nurse is assessing a client who had a craniotomy and has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following manifestations should the nurse anticipate?

Oliguria

.A nurse is caring for a child who is postoperative following ventriculoperitoneal (VP) shunt placement. In which of the following positions should the nurse place the client?

On the unoperated side

Vascular disease PAD

Pain: Intermittent Claudication or rest pain in foot -Pulse: Absent, weak, unequal -Edema: None unless leg is constantly in dependent position -Temp: cool -Color: bluish, grey, elevated pallor & dependent rubor -Wounds: regular shape, toes, foot, heels and pressure points •-No hair growth, dry skin, thickened nails, skin shiny

A nurse is caring for a client who has had a spinal cord injury at the level of the T2-T3 vertebrae. When planning care, the nurse should anticipate which of the following types of disability?

Paraplegia

nurse is caring for a client who is postoperative following an open reduction and internal fixation of a fractured femur. Which of the following actions is the most important for the nurse to complete in the postoperative period?

Perform neurovascular checks of the extremities.

A nurse is caring for a client who was admitted with bleeding esophageal varices and has an esophagogastric balloon tamponade with a Sengstaken-Blakemore tube to control the bleeding. Which of the following actionsshould the nurse take?

Provide frequent oral and nares care.

A nurse is teaching self-management to a client who has hepatitis B. Which of the following Instructions should the nurse include in the teaching?

Rest frequently throughout the day.

a nurse is assessing a client who has a concussion from a sports injury. Which of the following manifestations should the nurse expect?

Sensitivity to light

A nurse in a clinic is reviewing the laboratory values of a client who has primary hypothyroidism. The nurse should anticipate an elevation of which of the following laboratory values?

Thyroid stimulating hormone (TSH)

diverticulosis s/s

pain, flatulence, difficulty in defecation

5 P's

pain, pallor, pulselessness, paresthesia, paralysis

Hep B causes

parenteral or muscous membrane exposure to infectious body fluids such as blood, serum, semne, and saliva esp. sexual contact or shared needles

PAD

peripheral arterial disease

Peritoneal dialysis high risk for

peritonitis

Addisonian crisis precipitated by

physical or emotional stress, sudden withdrawal of hormone.

CRF Signs and Symptoms

-The urge to urinate more frequently -Urine may be pale and foamy -Hypertension, also known as high blood pressure -Swelling of the legs -Poor appetite -Weight loss

peptic ulcer disease s/s

-upper abdominal pain (epigastric pain) -dyspepsia: heartburn, bloating

A nurse is caring for an adolescent client who has a newly applied fiberglass cast for a fractured tibia. Which of the following is the priority action for the nurse to take?

Perform a neurovascular assessment.

DKA s/s

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

Chron's disease treatment

-Sulfasalazine (azulfidine): decrease intestinal inflammation -Biologics -Corticosteroids -Anti inflammatory synthetic corticosteroid -Immunomodulators -Healthy diet -Folic Acid & B12 may be needed -Enteral feeding may be needed -Adequate fluid intake

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication?

"I feel nauseated and have no appetite."

A nurse is caring for a client who is taking naproxen following an exacerbation of rheumatoid arthritis. Which of the following statements by the client requires further discussion by the nurse?

"I've been taking an antacid to help with indigestion."

A nurse is teaching a client who is obese and has obstructive sleep apnea how to decrease the number of nightly apneic episodes. Which of the following client statements indicates an understanding of the teaching?

"If I could lose about 50 pounds, I might stop having so many apneic episodes."

A staff nurse is teaching a client who has Addison's disease about the disease process. The client asks the nurse what causes Addison's disease. Which of the following responses should the nurse make?

"It is caused by the lack of production of aldosterone by the adrenal gland."

Osteoarthritis signs n symptoms

- Pain, stiffness and tenderness in relation to activity and weather. - Limited ROM especially after rest. - Crepidus when joint moves - Numbness and tingling which indicate bone changes that interfere with nerves. - Enlarged finger joints Heberden's or Bouchard's nodes. - Raynaud's phenomenon of the hand - Shiny, taut skin with or without nodules

Addisonian crisis treatment

- administer steroid therapy - monitor IV infusion of 0.9% NaCL or D5w with NaCL - administer iv glucose or glucagon - administer insulin with dextrose - administer potassium binding and extreting resin - monitor Vital signs

Right sided heart failure s/s

--Peripheral and dependent edema (eg, sacrum, legs, hands), especially in the lower extremities --Jugular venous distension --Increased abdominal girth due to venous congestion of the gastrointestinal tract (eg, hepatomegaly, splenomegaly) and ascites. --Nausea and anorexia may also occur as a result of increased abdominal pressure and decreased gastrointestinal circulation

Rheumatoid Arthritis diagnostic

-ESR - Increased Erythrocyte Sedimentation Rate,-CRP = C-reactive protein (+ = inflammation in body)-Acute infections, any inflammatory condition, widespread cancer,-X-ray- show joint deterioration

Osteoarthritis nursing interventions

-Encourage pt to maintain ADLs -Assess for neurovascular impairment -Assess gait -Provide pt education

Gout causes

-High intake of Purines ,-High Fructose corn syrup ,-High amounts ETOH: ETOH & uric acid compete for filtration., -Kidney disease, -Medications: Aspirin, cyclosporine, diuretics, -Dehydration, -Overweight, -Physical stress (stress, sx)

Diverticulitis symptoms

-LLQ pain -Constipation/Diarrhea -N/V -Low grade fever -Palpable mass in LLQ

Addison's disease S/s

-Muscular weakness and fatigue -Dark pigmentation of skin -GI disturbances and anorexia

Vascular disease PVD

-Pain: dull, achy, constant -Pulse: positive pulses -Edema: Yes (blood pools) -Temp: warm -Color: stasis dermatitis (brown) -Wounds: irregular shape, lower leg & ankles •May or may not have hair •Skin thick, hardened

Rheumatoid Arthritis How to care for swollen & inflamed joints

-Rest: using splinting device -Heat - stiffness -Cold - pain/inflammation -Physical exercise - decreases fatigue, prevent joint contractions -ROM exercises -Low Impact aerobic exercises -Multidisciplinary - OT/PT -Assistive devices - SAFETY!

Osteoporosis Signs and Symptoms

-Rounding of upper back: Dowager's Hump, -Inches of height lost: 2-3 inches -Low back, neck, hip pain on palpation or activity

SIADH nursing interventions

These include: - Diuretics, usually lasix - Restrict fluid intake 800ml-1L a day - Monitor: Electrolytes, I&O, daily weight, neuro status - Never let them get up alone

A nurse is caring for a client following the surgical placement of a colostomy. Which of the following statements indicates the client understands the dietary teaching?

A nurse is caring for a client following the surgical placement of a colostomy. Which of the following statements indicates the client understands the dietary teaching?

A nurse is caring for a client who has Cushing's syndrome. Which of the following interventions should the nurse expect to perform? (Select all that apply.)

Assess blood glucose level, . Assess for neck vein distention, Weigh the client daily

A nurse is caring for a female client in the emergency department who reports shortness of breath and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her heart rate is 110/min, respiratory rate 40/min, and blood pressure 140/80 mm Hg. Her arterial blood gases are pH 7.50, PaCO2 29 mm Hg, PaO2 60 mm Hg, HCO3 20 mEq/L, and SaO2 86%. Which of the following is the priority nursing intervention?

Administer oxygen via face mask.

A nurse is planning care for a client who has quadriplegia. Which of the following actions should the nurse take to prevent a pulmonary embolism (PE)? (Select all that apply.)

Assess legs for redness,. Apply elastic compression stockings, Perform passive range of motion exercises.

A nurse is assessing a client's radial pulse and determines that the pulse is irregular. Which of the following actions should the nurse take?

Assess the apical pulse for a full minute

A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?

Asthma

A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis.Which of the following instructions should the nurse include in the teaching plan?

Avoid foods high in fat.

A nurse is caring for an older adult client who has had surgery for an intestinal obstruction and has an NG tube to wall suction. Which of the following interventions should the nurse include in the client's postoperative plan of care? (Select all that apply.)

Discontinue suction when assessing for peristalsis, Irrigate the NG tube with 0.9% sodium chloride irrigation solution., Place sequential compression devices on the bilateral lower extremities. Reposition the client from side to side every 2 hr.

A nurse in an emergency department is caring for a client who had a seizure and became unresponsive after stating she had a sudden, severe headache and vomiting. The client's vital signs are as follows: blood pressure of198/110 mm Hg, pulse of 82/min, respirations of 24/min, and a temperature of 38.2° C (100.8° F). Which of the following neurologic disorders should the nurse suspect?

Hemorrhagic stroke

.A nurse is assessing a client who has right ventricular failure. Which of the following findings should the nurse expect?

Hepatomegaly

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis?

Nausea and vomiting

A nurse is reviewing the laboratory test results from a client who has prerenal acute kidney injury (AKI). Which of the following electrolyte imbalances should the nurse expect?

Hyperkalemia

A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect

Hyperpigmentation

Diverticulitis Treatment

I.V. antibiotics- diverticulitis, Avoid NSAIDs (↑ risk of bleeding), Opioids for severe pain, Stool softeners and bulk forming meds given to decrease aggravation to bowel, Metamucil and Citrucel (fiber)

DKA treatment

IV at high flow rate (200hr.) with insulin R (it doesnt matter what solution its in)

Cholecystitis Treatment

IV hydration, administration of antibiotics, and pain control with meperidine or morphine

Heart failure signs and symptoms

Impaired myocardial funcion - tachycardia, gallop, cardiomegaly, decreased peripheral pulses, mottled extremities, Pumonary Congestion - tachypnea, retractions, grunting, nasal flaring, cough, cyanosis, othropnea, hepatomegaly, edema, distended neck and peripheral veins, Systemic venous congestion- decreased urine output, failure to thrive, decreased exercise tolerance

While performing an admission assessment for a client, the nurse notes that the client has varicose veins with ulcerations and lower extremity edema with a report of a feeling of heaviness. Which of the following nursing diagnoses should the nurse identify as being the priority in the client's care?

Impaired tissue perfusion

A nurse is caring for a client who is receiving total parenteral nutrition via a peripherally inserted central catheter(PICC). When assessing the client, the nurse notes swelling of the client's arm above the PICC insertion site.Which of the following actions should the nurse take first?

Measure the circumference of both upper arms.

SIADH treatment

Mild (asymptomatic with sodium 120-130 meq/L) = Fluid restriction Moderate (asymptomatic with sodium 110-120 meq/L) = Loop diuretic + normal saline 0.9% saline Severe (symptomatic) = hypertonic saline 3% saline

NSTEMI

Non ST segment elevation MI; a heart attack that is not diagnosed on the EKG but is diagnosed by an elevated troponin on blood test

A nurse is caring for a client who has chronic kidney disease (CKD) and states she has heartburn. The provider prescribes aluminum hydroxide. The client asks, "Why can't I just take the antacid magaldrate my husband has at home?" The nurse explains to the client that aluminum hydroxide is the preferred antacid because it lowers which of the following?

Serum phosphorus levels

A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings? (Select all that apply).

Slurred speech, Bone pain, Pruritus

A nurse is discussing good food choices with a client who is recovering from an exacerbation of inflammatory bowel disease and is to start a low-lactose diet. Which of the following foods is the best choice for the client?

Soy milk

A nurse in the emergency department is caring for a client who reports chest pressure and shortness of breath.Which of the following laboratory tests should the nurse anticipate the provider to prescribe

Troponin I

A nurse is in a client's room when the client begins having a tonic-clonic seizure. Which of the following actions should the nurse take first?

Turn the client's head to the side.

post renal failure

Urine can't get out of the kidney -Enlarged prostate -kidney stone-tumors -ureteral obstruction -edematous stomas (ileal conduit)

A nurse is teaching a client who has acute kidney injury about the oliguric phase. Which of the following information should the nurse include in the teaching?

Urine output is less than 400 mL per 24 hr

A nurse is caring for a client who has Addison's disease and is at risk for Addisonian crisis. Which of the following actions should the nurse take?

Weigh the client daily.

CRF MEDS:

Zaroxyln(Diuretic)-give 20-30 minutes before Lasix(Bumix). Procit & Epogyn- 3x/wk after dialysis, may take 2-6 weeks for hematocrit to increase, Nephro caps & B12 helpful with anemia.

A nurse is caring for a client who has expressive aphasia following a cerebrovascular accident (CVA). Which of the following parameters should the nurse use first in order to assess the client's pain level?

a self-report pain rating scale

A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of following values?

amylase

Supraventricular Tachycardia (SVT)

an abnormal heart rhythm arising from aberrant electrical activity in the heart; originates at or above the AV node

A client who has a history of myocardial infarction (MI) is prescribed aspirin 325 mg. The nurse recognizes that the aspirin is given due to which of the following actions of the medication?

antiplatelet aggregate

Blood vessel disorder of narrowing or obstruction of one or more coronary arteries as a result of

atherosclerosis

peripheral arterial disease (PAD)

blockage of arteries carrying blood to the legs, arms, kidneys and other organs

Anti-hypertensive Classifications non-c blockers

bronchospasm

thrill

can be felt by palpating the fistula

Cushing's syndrome

caused by prolonged exposure to high levels of cortisol

CAD

coronary artery disease

SIADH s/s

decreased loc (cerebral edema/increased icp) seizures coma sodium less than 120

V-fib treatment

defibrillation (cpr, acls)

intrarenal failure

direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply

GERD treatment

eating small frequent meals; elevate head when sleeping; antacids;

Angina is caused by

either an increased demand for oxygen or a decreased supply of oxygen

A STEMI is an

emergency situation

osteoporosis prevention

encourage the women to participate in weight-bearing activities; sun exposure-ok with precautions; this will increase the absorption of vitamin D (important for bones); vitamin E-no relationship to bone density or prevention of osteoporosis

heart failure (HF)

failure of the heart to supply an adequate amount of blood to tissues and organs

Cushing disease results from an excess of

glucocorticoids

Either producing too much uric acid or not excreting it normally through kidneys is a sign of

gout

CAD may be asymptomatic or

have chest pain, palpitations, dyspnea, syncope, cough, excessive fatigue

V fib causes

hyperkalemia, hypomagnesmia, electrocution, CAD, & MI

Cholecystitis

inflammation of the gallbladder

gouty arthritis (gout)

inflammation of the joints, present in gout; usually caused by uric acid crystals

liver cirrhosis end stage marked by

neuro changes

Diverticulosis Treatment

no reason to treat until inflammation occurs; should avoid laxatives, -eliminate segmental spasm -High fiber diet

A STEMI caused by an

occlusive thrombus creates ST-elevation in the ECG leads facing the area of infarction

Addison's disease

occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone

Left Sided Failure S&S

orthopnea, cough, adventitious breath sounds, dyspnea on exertion

Osteoarthritis risk factors

over 40, reparative injury, overweight, genetics, one limbed

ekg wave forms must have

p waves to be normal

A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?

pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg

A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values would the nurse expect this client to have?

pH 7.26, HCO3 14, PaCO2 30

A nurse is caring for a client who is experiencing severe nausea and vomiting after a course of chemotherapy. The nurse should monitor the client for which of the following clinical manifestations?

Metabolic alkalosis

A nurse is caring for a client 4 hr postoperative following a kidney biopsy. Which of the following interventions should the nurse take? (Select all that apply).

Monitor for hematuria, Check for flank pain.

myocardial infarction s/s

-Preexisting CAD -Initially, ↑ HR and BP, then ↓ BP (secondary to ↓ in CO) -Crackles -Most common complication -Present in 80% to 90% of MI patients -Ischemia, electrolyte imbalances, or SNS stimulation

nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of the following glycosylated hemoglobin (HbA1c) values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels?

6.3%

A nurse on a telemetry unit is caring for a client who has unstable angina and is reporting chest pain with a severity of 6 on a 0 to 10 scale. The nurse administers 1 sublingual nitroglycerin tablet. After 5 min, the client states that his chest pain is now a severity of 2. Which of the following actions should the nurse take?

Administer another nitroglycerin tablet

A nurse in an emergency department is caring for a client who has a sucking chest wound resulting from a gunshot. The client has a blood pressure of 100/60 mm Hg, a weak pulse rate of 118/min, and a respiratory rate of 40/min. Which of the following actions should the nurse take?

Administer oxygen via nasal cannula.

A nurse in an emergency department is caring for a client who is bleeding profusely from a deep laceration on his left lower forearm. After observing standard precautions, which of the following actions should the nurse perform first?

Apply direct pressure over the wound

A nurse is caring for a client who has a cardiopulmonary arrest. The nurse anticipates the emergency response team will administer which of the following medications if the client's restored rhythm is symptomatic bradycardia?

Atropine

A nurse is caring for a client who has an elevated potassium level and is on a cardiac monitor. The nurse is aware that hyperkalemia may be associated with changes to the T-wave. On the graphic, point and click on the area of the electrocardiogram (ECG) that represents the T-wave. (Selectable areas, or "Hot Spots," can be found by moving your cursor over the artwork until the cursor changes appearance, usually into a hand.

BOX ON THE FAR RIGHT. This is the T-wave. The ECG waveform of a client who has hyperkalemia will have a tall, peaked T wave. It is usually seen when the potassium level is 6 mEq/L or higher

A nurse is caring for a client who has ulcerative colitis and is teaching the client about the common link with Crohn's disease. Which of the following information should the nurse include?

Both are inflammatory

.A nurse is preparing a community health program for adults at risk for cardiovascular disease. Which of the following should the nurse include as a modifiable risk factor?

Cigarette smoking

A nurse is assessing for cyanosis in a client who has dark skin. Which of the following sites should the nurse examine to identify cyanosis in this client?

Conjunctivae

A nurse is caring for a client who has sustained a traumatic brain injury. The nurse should monitor the client for which of the following manifestations of increased intracranial pressure?

Decreased level of consciousness

A nurse is caring for a client who has pericarditis and reports feeling a new onset of palpitations and shortness of Which of the following assessments should indicate to the nurse that the client may have developed atrial fibrillation?

Different apical and radial pulses.

A nurse is caring for a client who has infective endocarditis. Which of the following manifestations is the priority for the nurse to monitor for?

Dyspnea

A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? (Select all that apply.)

Dyspnea, Barrel chest, Clubbing of the fingers

.A nurse is caring for an older adult client who has left-sided heart failure. Which of the following assessment findings should the nurse expect?

Frothy sputum

A nurse on a medical-surgical unit is caring for four clients who are 24 to 36 hr postoperative. Which of the following surgical procedures places the client at risk for deep-vein thrombosis?

Hip arthroplasty

A nurse in the emergency department is monitoring a client who has a cervical spinal cord injury from a fall. The nurse should monitor the client for which of the following complications? (Select all that apply.)

Hypotension, Absence of bowel sounds, Weakened gag reflex

A nurse is caring for a client who is experiencing Cushing's Triad following a subdural hematoma. Which of the following medications should the nurse plan to administer?

Mannitol 25%

A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect? (Select all that apply.)

Increased heart rate, Increased blood pressure, Increased respiratory rate

A nurse in the ICU is caring for a client who has heart failure and is receiving a dobutamine drip. The nurse should identify that which of the following findings indicates that the medication is effective?

Increased urine output

A nurse is caring for a client who has peripheral arterial disease (PAD). Which of the following symptoms should the nurse expect to find in the early stage of the disease?

Intermittent claudication

A nurse in the emergency department is caring for a client who has a compression fracture of a spinal vertebra. During transport to the facility, the client was medicated with intravenous morphine. On arrival, the neurosurgeon determined urgent surgical intervention is indicated for the fracture. Staff members have been unable to reach the client's family. Which of the following actions should the nurse anticipate the neurosurgeon taking?

Invoking implied consent

A nurse is assessing a client who has atrial fibrillation. Which of the following pulse characteristics should the nurse expect?

Irregular

A nurse is conducting a primary survey of a client who has sustained life-threatening injuries due to a motor-vehicle crash. Identify the sequence of actions the nurse should take. (Move the actions into the box on the right, placing them in the selected order of performance. Use all the steps.)

Open the airway using a jaw-thrust maneuver., Determine effectiveness of ventilator efforts., Establish IV access., Perform a Glasgow Coma Scale assessment., Remove clothing for a thorough assessment.

A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the nurse anticipate?

Pantoprazole 80 mg IV bolus twice daily

A nurse is caring for a client who receives furosemide to treat heart failure. Which of the following laboratory values should the nurse monitor for this client due to this medication?

Potassium

A nurse is reviewing the laboratory results of a client who takes furosemide. Which of the following results should the nurse identify as the priority finding?

Potassium 2.9 mEq/L

A nurse is interpreting a client's ECG strip. Which of the following components of the ECG should the nurse examine to determine the time it takes for ventricular depolarization and repolarization?

QT interval

.A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the following interventions should the nurse plan to implement to decrease the client's ammonia level

Reduce the client's intake of protein.

A nurse is caring for a client who has a serum potassium level of 5.5 mEq/L. The provider prescribes polystyrene sulfonate. If this medication is effective, the nurse should expect which of the following changes on the client's ECG

Reduction of T-wave amplitude

A client is admitted to the emergency room with a respiratory rate of 7/min. Arterial blood gases (ABG) reveal the following values. Which of the following is an appropriate analysis of the ABGs? pH 7.22 PaCO2 68 mm Hg Base excess -2 PaO2 78 mm Hg Saturation 80% Bicarbonate 26 mEq/L

Respiratory acidosis

A nurse is caring for a client who is being admitted for an acute exacerbation of ulcerative colitis. Which of the following actions should the nurse take first?

Review the client's electrolyte values.

Hypertensive crisis symptoms

SBP >180 ~Headache (insufficient blood/oxygen to brain) ~Visual problems (insufficient blood supply to optic nerve) ~Alteration of consciousness ~Seizure ~Angina pectoris ~SOB (fluid overload) ~Edema/swelling

.A nurse is monitoring an older adult female client who had a myocardial infarction (MI) for the development of an acute kidney injury. Which of the following findings should the nurse identify as indicating an increased risk of acute kidney injury (AKI)?

Serum creatinine 1.8 mg/dL

A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first?

Stop the infusion

A nurse is assessing a client who sustained a basal skull fracture and notes a thin stream of clear drainage coming from the client's right nostril. Which of the following actions should the nurse take first?

Test the drainage for glucose

.A nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension, and has a BMI of 26. Which of the following goals should the nurse include?

The client will walk for 30 min 5 days a week.

A nurse is caring for a client who has a T-4 spinal cord injury. Which of the following client findings should the nurse identify as an indication the client is at risk for experiencing autonomic dysreflexia?

The client's bladder becomes distended.

A nurse is auscultating a client's heart sounds and hears an extra heart sound before what should be considered the first heart sound S1. The nurse should document this finding as which of the following heart sounds?

The fourth heart sound (S4)

MAP =

arterial pressure Keep 60-65 mm/hg ( SBP+2DBP) divide by 3

A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following should the nurse identify as an associated risk factor?

family history