Med Surg I- ATI review

What are the s/s of Addisonian crisis?

fever, weight loss, weakness, fatigue, N/V, diarrhea, abdominal pain, dehydration

What will happen if SIADH is left untreated?

seizures and/or a coma

Client has systemic lupus erythematosus (SLE), what lab should give the nurse the best indication of the patient's kidney function?

serum creatinine

A nurse is admitting a client who has acute failure following MI. The nurse recognizes that which of the following prescriptions by the provider requires clarification? Morphine sulfate 2mg IV bolus Q2hr PRN pain Lab testing of serum potassium upon admission 0.9% normal saline IV at 50mL/hr continuous Bumetanide 1 mg IV bolus Q12hr

0.9% normal saline IV at 50mL/hr continuous **0.9% sodium chloride is isotonic and will not cause the fluid shift needed in this client to reduce circulatory overload. This prescription requires clarification. **

What can be a s/e after sudden removal of the tumor, stress, trauma, surgery, or dehydration in a Cushing's Patient?

Adrenal Crisis

Nurse is caring for a patient with valvular heart disease and is at an increased risk for left-sided heart failure, what symptom would indicate the heart failure is developing?

Breathlessness: manifestations of LS heart failure include crackles and wheezes and breathlessness

Peritoneal Dialysis teaching

Client should increase protein, follow renal diet, watch for s/s of infection, tube care and function, client should lay supine with head slightly elevated during dialysis, client should take essential minerals and vitamins with supplements

What are some complications of a stroke?

Dysphagia Aspiration Numbness or loss of functioning on one side of the body Aphasia

A patient with Type I DM has a blood glucose of 48. What should the nurse give him to eat?

Graham crackers, or simple sugar such as juice

A nurse is monitoring a client following a thoracentesis. The nurse should identify which of the following manifestations as a complication and contact the provider immediately? Serosanguineous drainage from the puncture site Discomfort at the puncture site Increased heart rate Decreased temperature

Increased HR **clients are at risk for developing pulmonary edema or cardiovascular distress due mediastinal content shift after the aspiration of a large amount of fluid from the client's pleural space. Therefore, the client may experience an increase in heart and respiratory rate, along with coughing with blood-tinged frothy sputum, and tightness in the chest. These findings require notification of the provider immediately. **

What symptoms would a patient with fluid overload have?

Increased HR, BP, RR **The nurse should expect the client who has fluid volume excess to have tachycardia and increased cardiac contractility, increased BP and bounding pulse and increased respiratory rate and moist crackles heard in the lungs in response to the excess fluid. **

What electrolyte labs are directly associated with Cushing's and will they be high or low?

K,Ca will be decreased Sodium/Glucose will be increased Patient is at risk for poor skin integrity

Components of an ECG

P Wave: atrial depolarization PR segment: electrical impulse PR Interval measures time of atrial depolarization QRS: ventricular depolarization (pulse) T: ventricular repolarization

What medications will a person with Addison's be on?

Patient will be on steroids

What nutrients should a client with CKD limit?

Phosphorus Protein Sodium **A client who has CKD should restrict protein intake to prevent uremia that can develop because of the kidneys inability to remove the waste products of protein; CKD is at risk for hyperphosphatemia due to a reduction in excretion of phosphorous by the kidneys; risk for hypernatremia, edema, and hypertension due to sodium retention. **

What are some post CABG (coronary artery bypass graft) complications?

Pulmonary: Atelectasis, Pneumonia, Pulmonary Edema Hypothermia Decreased CO Electrolyte disturbances Neurological deficits

Nurse is caring for a client who has an ABG results of 7.3 pH, PaCO2 of 50, what is the acid base imbalance?

Respiratory Acidosis

Client is 8 hours post op from a thyroidectomy, what position should the nurse place the client?

Semi-fowlers, neck in neutral position

What is SIADH?

Syndrome of Inappropriate ADH is a condition where fluid is retained as a result of an overproduction of vasopressin or antidiuretic hormone (ADH) from the posterior pituitary gland

What part of the ECG will hyperkalemia cause a change to?

T wave

What lab value will be elevated with hypothyroidism?

TSH

What would you expect the ABG values for a patient to be with CKD?

The patient will have metabolic acidosis Characterized by: low HCO3, a low pH and a low or normal PACO2.

Right sided heart failure

The right ventricle does not empty all the way and it causes build up in the venous system and peripheral edema.

What is the purpose of the TSH blood test?

To test the function of the thyroid and determine if it is normoactive, hypoactive, or hyperactive.

A nurse in the ED is assessing an older client who has community-acquired pneumonia. Which of the following findings should the nurse expect? Unequal pupils Hypertension Tympany upon chest percussion Confusion

confusion (sign of hypoxia)

A nurse suspects anaphylaxis when caring for a client following the initial administration of an oral antibiotic. Which of the following should be the nurse's priority intervention? Insert an IV line Count the respiratory rate Administer oxygen Prepare equipment for intubation

count respiratory rate

What are s/s of SIADH?

disorientation, headache, vomiting, muscle weakness, decreased LOC, irritability, loss of thirst, and weight gain

What should the nurse instruction be when a COPD patient states that they can feel the congestion but are not able to clear their lungs?

tell them to drink 2-3 L of fluid per day **Maintaining hydration through the consumption of adequate fluids will help liquefy thick secretions and facilitate their expectoration. **

ABG Normal Values

pH 7.35-7.45 HCO3 21-28 mEq/L PaCO2 35-45 mm Hg

What happens physiologically in a patient with Addison's?

production of mineralocorticoids and glucocorticoids is diminished, resulting in decreased aldosterone and cortisol (Patient should avoid physical and emotional stress due to the body's inability to release hormones at a necessary level to handle stressful stimuli)

What are signs and symptoms of cushing's disease?

weakness, fatigue, sleep disturbances, joint pain, irritability, depression

A nurse is caring for a client whose ABG results show a pH of 7.3 and a PaCO2 of 50mmHg. The nurse should identify that the client is experiencing which of the following acid-base imbalances?

Respiratory acidosis **With uncompensated respiratory acidosis, the pH is less than 7.35 and the PaCO2 is greater than 45mmHg. **

A nurse is prioritizing client care after receiving change-of-shift report. Which of the following clients should the nurse plan to see first? A client who is scheduled for an abd x-ray and is awaiting transport A client who has a prescription for discharge A client who received oral pain medication 30 min ago A client who told an AP he is short of breath

A client who told an AP he is short of breath

What are pharmaceutical interventions for hypovolemic shock?

Admin vasopressor, fluid resuscitation, Steroids

A client comes in and states she is SOB and started taking birth control a few weeks ago and she smokes. Her RR is at 40, her HR is at 110, ABG is: pH 7.5, PaCO2 29, pAO2 60, HCO3 20, and an SAO2 86%, what is the nurses next action?

Administer O2 via face mask

What are some clinical manifestations of PVD?

Bruit over femoral and aortic arteries Decreased cap refill time of toes (greater than 3 seconds) Loss of hair on distal lower extremities dry,scaly, mottled skin Ulcers and possible gang green of toes

S/S of peripheral vascular disease

Burning, cramping and pain in legs while exercising Numbness or burning in feet (primarily when in bed) Pain that is relieved by placing legs at rest in a dependent position

Medications for heart failure

Diuretics Ace Inhibitors (-pril) Calcium Channel Blockers: Diltiazen, Nifedipine (afterload reducing) Digoxin (blurred vision, anorexia main ADR), hold if HR is less than 60, Beta Blockers (-olol's) Monitor BP and Pulse (ortho hypotension)

A nurse on a med-surg unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client?

Increased anteroposterior diameter of the chest **the nurse should anticipate an increased anteroposterior diameter of the chest (barrel chest) because of chronic hyperinflation of the lungs. **

What electrolyte labs will be affected by Addison's?

Increased- K and Ca, BUN/Creatinine Decreased- Sodium, Cortisol, Glucose

What are some nursing interventions for CABG (coronary artery bypass graft) recovery?

Maintain patent airway and adequate ventilation Encourage the client to splint the incision while deep breathing and coughing Continually monitor the client's heart rate and rhythm Educate patient on s/s of infection

The nurse administered too much insulin after misreading the blood glucose, what is the nurses priority action?

Monitor the client for s/s of hypoglycemia

How would you educate client to treat angina at home?

Nitro (take at 5 min intervals for unrelieved CP- up to 3, call 911 after 1st NITRO if pain is unrelieved), Morphine in hosptial (monitor RR)

Nurse is caring for a female client who reports increase in bruising, what lab value can the nurse expect?

Platelets at 100,000 (normal range 150,000-400,000)

A client has a ventricular pacemaker, which part of the ECG will the pacemaker spike before?

QRS wave

What kind of insulin would you give a patient in DKA?

Regular insulin because it is short acting

Normal Electrolyte values

Sodium: 136 to 145 mEq/L Calcium: 9.0 to 10.5 mg/dL Potassium: 3.5 to 5.0 mEq/L Magnesium: 1.3 to 2.1 mEq/L Chloride: 98 to 106 mEq/L Phosphorus: 3.0 to 4.5 mg/dL

Left sided heart failure

The failure causes decreased cardiac output causing poor perfusion and elevated pulmonary venous pressure.

What part of the ECG would indicate hypokalemia?

abnormally prominent U wave

What are some causes of hypovolemic shock?

fluid loss from diarrhea, sweating, vomiting, trauma

How do you treat SIADH?

fluid restriction, administration of oral conivaptan (vasopressin antagonist), and treatment of hyponatremia

How will Acute Kidney Injury alter electrolytes?

hyperkalemia, hyperphosphatemia, hypocalcemia, irregular sodium (increased/decreased), metabolic acidosis

What are s/s of an adrenal crisis?

hypotension, hypoglycemia, hyperkalemia, abdominal pain, weakness, and weight loss

A nurse is providing teaching to a client about interventions to reduce the risk of developing cardiovascular disease. Which of the following statements by the client should indicate to the nurse the need for further teaching? A weight loss program can decrease my LDL cholesterol level Exercising regularly will increase HDL Adding foods containing omega-3 fatty acids to my diet can lower my risk Increasing my intake of foods containing trans-fatty acids can lower my risk

increase amounts of trans-fatty acid in diet