Med Surge Exam 1

Late Stage of death

- Dysphagia (difficulty breathing or not breathing at all) - mottling of skin (waxy)

HOPE

- Hope - What gives you a sense of hope, peace, or strength? What makes you feel stronger? - Organized - Do you have a religion you belong to? Is your religion important to you? - Personal spirituality and practices - What are your personal spiritual beliefs? What spiritual practices are most helpful for you? - Effects on medical care and end of life issues - Has your illness interfered with the ability to do things that give your life meaning and a sense of purpose? What spiritual practices should we know about when we care for you?

Early Stage of Death

- Loss of mobility - loss of desire to eat - increase in sleep 0 decrease cognitive behavior

informed consent

- Procedure to be performed with potential risks - Type of anesthesia being provided with risks - Any possible potential procedures that could take place during surgery - Postoperative plan of care and potential complications - Surgeons': responsibility to obtain consent; nurse verifies and witnesses consent

Respiratory Acidosis

- Respiratory pH <7.35 - PaO2 low - PaCO2 high - Serum bicarbonate variable: Usually normal in acute respiratory acidosis, Elevated in chronic respiratory acidosis due to kidney compensation - Respiratory function is impaired Reduced exchange of O2 and CO2 Retention of CO2 Respiratory depression Inadequate chest expansion Airway obstruction Reduced alveolar-capillary diffusion

Postoperative Assessment

- Skin color - safety when giving medication - ambulation - most common complication - education

Respite Care

- allowing to admit for care to give faimly a break at home

Middle stage of death

- decline in patient mental status - brief periods of awake times - pulling of their secretions; gurgling, moaning, deep breathing (death rattle)

Terminal Sedation

- legal in 11 states not meant to cause or quicken death, but to relieve sysmptoms until death occurs. - used when client have intolerable suffering not responding to other treatment - provides a prescription from the state and must be a citizen of that specific state.

Comfort care

- managing shortness of breath, pain, nausea, anxiety, constipation

It could take 1 to 14 days to go through all the stages of dying

. The nurse is teaching a client about the stages of dying. Which statement by the client indicates that learning has occurred? A. "It could take 1 to 14 days to go through all the stages of dying." B. "Going through the stages of dying could take 5 years or more." C. "It will take 3 weeks for the dying process to occur." D. "I will have to be in hospice care for 6 months."

what are magnesium levels?

1.5-2.5

what are sodium levels?

135-145

What are potassium levels?

3.5-5

what are glucose levels?

74-106

what are calcium levels?

9-11 mg/dL

Your health care provider may be able to give you free samples

A client is seeking treatment for a respiratory infection at a local clinic. During the visit, the client verbalizes concern about the cost of medication and the inability to pay for it. Which of the following responses should the nurse use? A. "Maybe you can borrow some money to get the medicine." B. "Antibiotics are seldom prescribed." C. "Your health care provider may be able to give you free samples." D. "Where did your money go this month?"

At Admission

A nurse at a community hospital is providing education for a client as part of the approach to care. At which of the following points of care should the nurse begin educating the client about their health issues and treatment? A. At admission B. At discharge C. During diagnosis D. During recovery

Establishing smoke-free restaurants

A nurse is assisting a community group to establish a disease prevention policy. Which of the following should the nurse recognize is an example of effective public health policy? A. Banning sugar from convenience stores B. Encouraging energy drinks after sports C. Requiring physical education through elementary school D. Establishing smoke-free restaurants

Clients who live 40 smiles from the city

A nurse is assisting with community needs analyses of four counties regarding physical access to quality health care. The nurse should focus on interventions for which of the following groups? A. Clients who live 40 miles from the city B. Clients who have a high school education C. Clients who have three or more children D. Clients who use public transportation

"Tell me what happened to make you feel that way"

A nurse is caring for a client in an acute care setting who states, "The nurses here have been awful to me." Which of the following statements by the nurse demonstrates professional communication with the client? A. "Tell me what happened to make you feel that way." B. "The provider can discharge you if you are not happy with your care." C. "The nurses are doing the best that they can." D. "This hospital does have some pretty bad nurses."

the nurse should begin full cardiopulmonary resuscitation CPR immediately

A nurse is caring for a client who has a full code status. The client has experienced cardiac arrest and has activity on the electroencephalogram. Which of the following nursing interventions should the nurse perform? A. Hold cardiopulmonary resuscitation (CPR) until orders are confirmed. B. The nurse should begin full cardiopulmonary resuscitation CPR immediately. C. Perform a head-to-toe assessment. D. Begin chest compressions but hold rescue breathing.

yes, consent will be obtained from a legal proxy

A nurse is caring for a client who has end-stage lung cancer. The client has a decreased level of consciousness, extreme shortness of breath, and a respiratory rate of 40/min. The client's family member states to the nurse, "My sibling doesn't have any advance directives. Can they still receive palliative sedation?" Which of the following statements should the nurse include when speaking with the client's family? A. "Yes, consent will be obtained from a legal proxy." B. "No, consent should have been obtained before a change in the level of consciousness." C. "Consent is not required for palliative sedation to be administered." D. "The client's wish is not followed for palliative sedation."

Respite care is available for caregivers of terminally ill clients

A nurse is caring for a client who is receiving home hospice care. The family states, "We are exhausted. We do not want to admit our parent to a long-term care unit, but what alternatives do we have?" Which of the following statements should the nurse include when speaking to the family? A. "Respite care is available for caregivers of terminally ill clients." B. "I think you should admit your parent to the long-term care unit so your family can get some rest." C. "You can take them to the emergency room and get them admitted to the hospital for a while." D. "You can do this for a little longer. You should just rest when they rest."

Contact the chaplain

A nurse is caring for a client who practices Catholicism. The client has just received word from the physician that their condition is terminal and there is nothing else that can be added to their treatment plan. The client is visibly upset and requesting to speak with a priest and have their last rites administered. Which of the following interventions should the nurse perform? A. Notify the charge nurse. B. Pray with the family. C. Contact the chaplain. D. Complete discharge teaching.

An 87 year old client

A nurse is caring for a group of four clients. Which of the following clients would the nurse conclude is most at risk for developing Alzheimer's disease? A. A male client B. An 87-year-old client C. A client who smokes cigarettes D. A client with limited mobility

If the client is exposed to toxins or violence in their environment, their health environment, their health may be impacted

A nurse is collecting information from a client at a local clinic. The nurse should recognize that which of the following social determinants of health may affect this client's outcomes? A. If the client was born into poverty, health may be difficult to achieve. B. If the client is socially active, they will succeed in life. C. If the client is exposed to toxins or violence in their environment, their health may be impacted. D. Clients born to immigrant parents will be more successful because they may be bilingual.

Practicing Self care

A nurse is discussing burnout with their nursing team. Which of the following should be included as an effective strategy to prevent nurse burnout? A. Practicing self-care B. Avoiding calling out sick C. Completing mandatory overtime D. Using personal protective equipment

Occupation and work conditions

A nurse is discussing the impact of social determinants of health and their impact on the spread of communicable diseases and infections. Which of the following factors should the nurse identify as a social determinant that increases the risk of infection among individuals who are living at a lower income level? A. Comorbidities B. Citizenship status C. Occupation and work conditions D. Family history and genetic background

Report any workplace injuries to the manager

A nurse is discussing the importance of a healthy work environment with a newly graduated nurse. Which of the following statements by the experienced nurse should help the new nurse learn how to maintain a healthy work environment? A. "Report any workplace injuries to the manager." B. "All nurses will experience bullying at some point in their career." C. "Get another job if you don't feel supported." D. "You will learn to deal with the moral distress that comes with nursing."

Nurses are retiring faster than new nurses are being hired

A nurse is discussing the nursing shortage with another staff member. Which of the following should the nurse identify as a cause of the current nursing shortage? A. Nurses are retiring faster than new nurses are being hired. B. Clients are requiring more care than they did 10 years ago. C. The majority of nurses working at the bedside are young and inexperienced. D. Nursing schools don't have enough applicants.

Vaccines are recommended because most people do not have access to high quality vitamins

A nurse is managing a community vaccine clinic, and a client asks why so many vaccines are currently recommended by the Centers for Disease Control and Prevention. Which of the following is the best response for the nurse to use? A. "Vaccines are recommended for children so that adults will have immunity from illnesses." B. "Vaccines are recommended so that medicines such as antihypertensives will not be necessary." C. "Vaccines are recommended because they can prevent people from getting many serious diseases." D. "Vaccines are recommended because most people do not have access to high quality vitamins."

consulting with a physical therapist about care decisions

A nurse is planning care for a client with complex medical needs. Which of the following would be an example of interprofessional collaboration? A. Consulting with a physical therapist about care decisions. B. Including the client's family members in their care C. Involving the client in decision-making for their care. D. Working with another nurse to perform a wound dressing.

Tell me how you hope the medication will help you complete your recovery

A nurse is providing care for a beginning a pharmaceutical regimen as part of their postoperative treatment. Which of the following statements given by the nurse would support co-creation of care? A. "Tell me how you hope the medication will help you complete your recovery." B. "You could refuse to take the pills, but this would be against my recommendation." C. "If you have any questions, read the directions on the bottle." D. "It is difficult to explain what the medication is and how it works."

i would like to understand more about your cultural practices will tell you me more

A nurse is providing care to a client who has a terminal illness. The client informs the nurse that they will not be accepting any prolonged treatment for their terminal illness due to their cultural beliefs. Which of the following statements by the nurse is appropriate? A. "I would like to understand more about your cultural practices. Will you tell me more?" B. "I understand your request, but you could live much longer with more treatment." C. "I can't go along with your request. I have to follow the treatment plan. D. "I think you should wait a little while to make your decision."

be nonjudgemental in their health care practices

A nurse is providing culturally competent care to a client who is terminally ill. Which of the following should the nurse perform when providing care to clients with diverse backgrounds? A. Implement multiple specialty care providers. B. Be nonjudgmental in their health care practices. C. Instruct the client to complete all their treatments. D. Encourage the client to be placed in the nursing home.

i can make my health care wishes known through advance directives

A nurse is providing education about advance directives to a client who has end-stage liver failure. Which of the following statements by the client reflects an understanding of advance directives? A. "I can make my health care wishes known through advance directives." B. "My family has the right to override my health care decisions if I have advance directives in place." C. "My advance directives will be kept at my lawyer's office in the event they are needed." D. "The two types of advance directives documents are a living will and a power of attorney for finances."

30%

A nurse is providing education to a community group about social determinants of health. The nurse should teach the group that social determinants of health account for approximately what percentage of health outcomes? A. 10% B. 30% C. None D. 75%

The Ability to empathize

A nurse is taking a class on leadership in the nursing profession. Which of the following should the nurse identify as a quality of an effective nurse leader? A. The ability to empathize B. The ability to complete research C. A position of authority D. Rigidity in decision making

Collaboration among staff to complete tasks

A nurse is teaching a class to new staff members about the importance of a positive work environment. Which of the following could be used as an example of professional comportment? A. Collaboration among staff to complete tasks B. Staff members socializing at the nurse's station C. Completing all care tasks before the end of the shift D. Postponing documentation in the medical record

Clinical death can be restored by CPR

A nurse is teaching a client regarding the difference between brain death and clinical death. Which client statement indicates accurate understanding? A. "Brain death can be restored by CPR." B. "Clinical death can be restored by CPR." C. "Clinical death means that the client will be on a ventilator." D. "Clinical death can't be reversed."

FAST

A nurse is teaching a group of older adult clients at the senior center about chronic illnesses. Which of the following acronyms should the nurse teach to the clients to help them remember common manifestations of a stroke? A. TALK B. FLIP C. RACE D. FAST

identify and implement plans to improve health

A nurse is using Healthy People 2030 as a guideline for planning a community activity to promote client health and wellbeing. Which of the following statements should the nurse include as the main goal of the Healthy People 2030 project? A. Strive for 2,030 fewer deaths in the U.S. per year B. Identify and implement plans to improve health. C. Improve health across the world. D. Provide specific interventions to improve cardiac health.

Assessing the result

A nurse is using a new wound-closure technique that is supposed to increase the rate of healing and decrease scarring. The nurse documents the appearance of the client's wound at set intervals and compares the notes to documentation of a past client with a similar wound that was treated using an established technique. Which of the following steps of evidence-based practice is the nurse performing when they compare the techniques? A. Assessing the result B. Applying the evidence to clinical practice C. Analyzing the evidence D. Posing a question

Attending a professional Conference

A nurse leader is discussing possible continuing education opportunities with other staff members. Which of the following actions should the nurse leader recommend to maintain clinical competence? A. Attending a professional conference B. Joining a nurses union C. Discussing facility policies with coworkers D. Removing expired supplies from the storage area

Report the incident to a manager

A nurse overhears another nurse being harassed by a staff member. Which of the following actions by the nurse is an appropriate way to handle this situation? A. Report the incident to a manager. B. Avoid interacting with the staff member. C. Ask the charge nurse for a new client assignment. D. Tell the staff member that they may lose their job for harassment.

Provide a referral to a speciality service

A nurse treating an older adult client who has diabetes mellitus notices that the client walks with a limp, which has not been noted on their medical record. Which of the following actions should the nurse take to help the client? A. Provide a referral to a specialty service. B. Alert the other members of the interdisciplinary team (IDT). C. Provide the client with an assistive device, such as a walker or cane. D. Educate the client about community services, such as house cleaning.

Posing a question

A nurse wants to use evidence-based practice to provide safe and effective wound care for a client with a rare clotting disorder. Which of the following is the first step the nurse should take? A. Posing a question B. Analyzing the evidence C. Gathering the best evidence D. Applying evidence to clinical practice

Provide a list of local farmers markets to clients

A nurse works at a medical facility that serves an immigrant community in a low-income area. The clients have disproportionately high rates of obesity and heart disease. The area also has limited access to fresh produce in most neighborhood supermarkets. According to the World Health Organization, which of the following steps should the nurse take in addressing the social determinants of health for the clients? A. Provide a list of local farmers' markets to clients. B. Conduct a survey to determine client satisfaction. C. Establish treatment plans for clients. D. Research the influence of social determinants on health issues.

Advance Directive

A written document prepared by a competent person to specify what if any extraordinary actions he or she would want when no longer able to make decisions about personal health care. - PLAN - Prepare and be proactive - Living will and DPOA - Advise on code status and wishes - Not active if not on file

adopting a process improvement method

An urgent care facility has experienced a decline in client outcomes over the past 6 months. The staff has identified that the roles and responsibilities of team members are not always apparent, which can prevent the coordination of client care. Which of the following would help the medical facility address this issue? A. Adopting a process improvement method B. Identifying care partners for the facility's clients C. Collaborating with professional organizations D. Consulting the facility's human resources department

moderation sedation

Deeper sedation Client can maintain airway

DNI

Do not Intubate - no intubation - may do CPR or medication interventions

Non-malficence

Emphasizes the importance of preventing harm and ensuring the patients well-being.

Procurement Committee (CORE)

First step in organ donation

The nurse should facilitate contact between the clients surgical team, physical therapist, and primary care physician

Following surgery to repair a tear in a client's shoulder, the client is prescribed physical therapy. During physical therapy the client has an exacerbation of their chronic back pain which is treated by another provider. Which of the following interventions would be priority to ensure the client receives holistic care? A. The nurse should educate the client about the medication that will be required during the recovery process. B. The nurse should facilitate contact between the client's surgical team, physical therapist, and primary care physician. C. The nurse should educate the client about potential health-care-associated infections that could hinder the postoperative recovery. D. The nurse should note the surgical error that occurred during the initial procedure in the client's records.

avoid foods high in potassium (citrus fruits, legumes, whole-grain foods, lean meat, milk, eggs, cocoa, some cola beverages)

Foods to avoid with hyperkalemia

deep sedation

General anesthesia Client cannot be awakened easily

IPASSBATON

Introduction Patient Assessment Situation Safety Concerns Background Actions Timing Ownership Next

Alzheimers

May slow the progression of the stages of death

SBAR

Situation - what has been done Background - previous surgeries. treatments, and medication Assessment - vital signs, lung and bowel sounds Recommendation - what is needed

Increase delegation between nurses at different levels

The busy emergency department at a hospital has experienced a sharp increase in negative outcomes among clients with heart conditions in the past month. Which of the following actions should the nursing staff take to improve client outcomes? A. Increase the workload of high-risk tasks among registered nurses (RNs). B. Increase delegation between nurses at different levels. C. Decrease the workload of low-risk tasks among licensed practical nurses (LPNs). D. Decrease collaboration between nurses at different levels.

This is a normal cognitive change that is occuring

The nurse is educating the client's family about the changes occurring during the early stage of the dying process. The family member tells the nurse, "My parent is really confused at times." Which of the following is the nurse's best response? A. "This is a normal cognitive change that is occurring." B. "Your parent has their days and nights mixed up." C. "Your parent is suffering from sundowners." D. "Showing any emotion near death is always positive."

DNR

Third type of advanced directive that is signed by a physician or authorized by a primary health care provider which instructs that CPR not to be attempted in the event of Cardiac or Respiratory arrest.

minimal sedation

Typically, can respond to verbal commands Cognitive function and coordination may be impaired

Safety

What is the priority in perioperative care?

The nurse should educate the care partner on the protocols for administering the client's pain medication

Which of the following actions by a nurse facilitates a care partner's active role as a member of the collaboration team for a client receiving palliative care as part of the chemotherapy process? A. The nurse should ask the care partner to recommend the therapeutics to prescribe for the client. B. The nurse should ask the care partner to organize coordination among the other members of the team. C. The nurse should educate the care partner on the protocols for administering the client's pain medication. D. The nurse should ask the care partner to serve as a nursing assistant during the administration of chemotherapy

Active pursuit of wellness

Which of the following should the nurse include in an educational session about wellness, as the key aspect of achieving wellness? A. Achieving physical strength B. Absence of genetic abnormalities C. Having no risk factors D. Active pursuit of wellness

What HCO3 is alkalosis?

above 26

what HCO3 is acidosis?

below 22

What pH is acidosis?

below 7.35

DNR

do not resuscitate - No CPR - No resuscitation - No intubation - Usually reserved

What PaCo2 is alkalosis?

less than 35

What PaCo2 is acidosis?

more than 45

what pH is is alkalosis?

more than 7.45

Metabolic Acidosis

pH <7.35 HCO3 <22 PaCo2 normal Pao2 normal Higher respiratory rate Hyperkalemia - muscle twitching - weakness - arrhythmias Confusion

Metabolic Alkalosis

pH > 7.45 HCO3 >26 Too many antacids Diuretics Excess vomiting Hyperaldosteronism Lower respiratory rate Lower potassium - dysrhythmias - muscle cramps/ weakness - vomiting - tetany - tremors - EKG changes

respiratory alkalosis

pH >7.45 CO2 <35 Hyperventilation Tachypnea Higher temp Aspirin toxicity Higher heart rate Confusion and tiredness Tetany EKG changes Positive Chvostek sign - rebreather into a paper bag

Autonomy

patient is not capable of self-determination, you are ethically obligated to protect him or her as an advocate within the professional scope of practice, according to ANA.

Beneficence

promotes positive action to help others, encourages the nurse to do good for the patient.

Social justice

refers to equality and fairness, all patients should be treated equally and fairly regardless of age, gender identity, sexual orientation, religion, race, ethnicity, or education.

Fidelity

refers to the agreement that nurses will keep their obligations or promise to the patient to follow through with care.

Veracity

related principle in which the nurse is obligated to tell the truth to the best of his or hers knowledge. if you are not truthful with a patient his or hers respect will diminish and your credibility as a health care professional will be damaged.

- issues absorbing calcium from the GI tract - too much calcium leaving the body from excretion - kidney disease - diuretics - diarrhea - drainage from wounds

risk factors for hypocalemia

Living weill

second part of advanced directive, which identifies what one would or would not want if he or she were near death. Treatments that are discussed include: CPR, Artificial Ventilation, and Artificial nutrition or hydration.

CATS GO NUMB - convulsions/seizures - Arrhythmias - Tetany - Spasms and strider GO NUMB - Numbness in fingers, face, limbs - positive trousseaus sign - positive chcostek Sign

symptoms of hypocalcemia

- weak muscles and less contraction - slower reflexes Slowing of GI system (constipation) - lower BP - Nausea, vomiting, bloating - EKG changes

symptoms of hypokalemia

Insufficient magnesium intake - malnutrition/vomiting/diarrhea - malabsorption syndrome - celiac and Crohn's disease Increased magnesium excretion - diuretics or chronic alcoholism Intracellular movement of magnesium - hyperglycemia and insulin administration - sepsis

what are risk factors for hypomagnesemia

hypotension, nausea, vomiting, facial flushing, retention of urine, ileus, depression, and lethargy before progressing to muscle weakness, difficulty breathing, extreme hypotension, irregular heartbeat, and cardiac arrest

what are symptoms of magnesium toxicity

Hypertension and hypotension Decreased circulation

what are the age-related risks for cardiovascular system?

Impaired cognitive function Delayed reactions Sensory deficits

what are the age-related risks for neurological system?

Shortness of breath Decreased oxygenation of blood Decreased lung elasticity

what are the age-related risks for respiratory system?

- Decreased subcutaneous fat - Dry, fragile skin leading to slower healing.

what are the age-related risks for the integumentary system?

Inflamed joints leading to swelling and discomfort Arthritic joints

what are the age-related risks for the musculoskeletal system

Decreased kidney function Decreased ability to excrete waste Incontinence

what are the age-related risks for the renal and urinary system?

5 mL = 1 teaspoon

what is mL to teaspoons

urinating a lot

why are sodium levels high during dehydration?