Adult Health Exam 3 Study Set

Glipizide works by

stimulating the pancreas to release insulin

Teach patient with HTN about what diet type?

the DASH diet

Metformin helps to control

the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver.

Rifampin can cause a non threating normal adverse effect of

turning body fluids to an orange/red color

Metformin also increases

your body's response to insulin

The nurse reviewed discharge instructions with the client newly diagnosed with diabetes type I about how to care for themselves if they have influenza. Which of the following statements by the client would indicate to the nurse that more teaching is required?

"I will need to increase my dose of insulin"

The nurse has taught a client newly diagnosed with Diabetes type I about preparing and administering prescribed dose of regular insulin and NPH insulin. Which of the following statements by the client would indicate to the nurse that more teaching is required? (Select all that Apply)

- I should use the same different body site every time I give myself an injection -I will use 0.5 ml syringes because the line marking should be easy to read

What is the DASH Diet?

- Low sodium intake - Carbs: 55-60% - Protein: 15-20% - Fat: 25-30%

The nurse is assessing the level of risk for complications of a client with pneumonia. Which of the following findings would indicate to the nurse the client will require admission to the hospital for treatment? (Select all that Apply)

-The client is A/O x 1 to self -The client has a BUN level of 24 -The client has a respiratory rate of 33 per minute

Normal Creatinine Lab Values

0.7-1.3

Stage 1 TB Treatment

1. 2 months 4 drugs (rifampin, isoniazid, ethambutol, pyrazinimide 2. Renders sputum noninfectious

Stage 2 TB Treatment

1. 4 months 2 drugs (rifampin isoniazid) 2. Eliminates intracellular persistent

CT scan precautions

1. Allergy to shell fish 2. Elevated BUN creatinine, (kidney disease) 3. BUN 10-20 creatinine 0.7-1.3 4. Used frequently to diagnose pulmonary emboli S/S would be increased SOB, chest pain, tachycardia

Nursing assessment for SOB

1. Ask a couple priority questions 2. Auscultate lung sounds all areas left to right (symmetry) 3. Have family/care giver present when doing DC teaching if possible

Diabetic complications

1. Can happen whether you have type 1 or type 2 2. Macrovascular complications 3. Microvascular complications 4. Need eye Dr. appointment soon after being diagnosed

Antihypertensives

1. Check blood pressure and apical HR prior to giving 2. Question patient about compliancy if return appointment shows no changes in BP after a medication was ordered 3. Avoid sudden postural changes, due to orthostatic hypotension 4. ACE inhibitors may cause angioedema (end in prils) this is a serious adverse life-threating affect 5. When checking a patients blood pressure, feet should be flat on the floor

Pleurisy

1. Chest pain with inspiration 2. Friction rub sound with auscultation

Treating pneumonia

1. Chest x-ray for diagnosis 2. Small frequent meals 3. Pneumonia vaccine

Asthma

1. Effective treatment? 02 stats elevate 2. With assessment, inspect patients breathing, is he/she using accessory muscles to breathe 3. Silent chest 4. Do not use anything with scent (perfumes, air fresheners) 5. Administer a Beta Adrenergic nebulizer to relax and open airways

Preventing aspiration pneumonia

1. Elevate HOB 2. Lateral position 3. Swallow studies if applicable 4. Thickened liquids 5. CVA patients most likely to get aspiration pneumonia

Cystic fibrosis

1. Genetic counseling for CF patients when fear having children is not the normal route for parents 2. Assess lungs, as this disease affects lungs mostly 3. Respiratory therapy (chest physiotherapy frequently (cupping) 4. Complications from lung issues, GI issues, liver

COPD

1. Improving air exchange ways aim of treatment 2. Some patients have chronic low self esteem 3. Tripod position to increase respiration effort 4. Home 02 use for improved prognosis and comfort 5. Teach to use pursed lip breathing, tripod position 6. Pao2 level should be at least 60%

Glucose monitoring

1. Let alcohol dry prior to getting blood 2. Wipe off first blood 3. Use side of finger or fat part of top of finger

Glycosylated hemoglobin (A1C)

1. Measurement to check glycemic control over a 3 month period 2. Should be <6.5 to be considered good control

Percussing with pneumonia

1. Medium intensity pitch/duration 2. Dull sounding

Pertussis (adults)

1. Need to get vaccinated to avoid spread of infection 2. Can be fatal to infants and children 3. Presents with a whooping cough (hence the name)

Bronchoscopy care

1. Need to keep HOB elevated 30-45 degrees 2. 02 is needed prn 3. Keep NPO till gag reflex returns

Facility acquired pneumonia (nosocomial)

1. Nonintubated patient that begins 48 hours or longer after admission 2. Ventilator-associated pneumonia occurs more than 48 hours after endotracheal intubation

Diabetes and use of prednisone

1. Prednisone will increase blood glucose causing hyperglycemia, need to check blood sugar more frequently 2. May need increased insulin or start insulin if only on oral meds (type 2)

Pleural effusion

1. React if patient recently had a thoracentesis and now has diminished breath sounds 2. May mean a collapsed lung may have occurred

Tracheostomy care

1. Set up suction 2. Sterile gloves (one hand sterile, one hand clean) 3. Check catheter function 4. Hyperoxygenation of patient 5. Insert suction catheter without suction 6. Withdraw suction catheter with intermittent suction rotating the catheter

How do you diagnosis TB

1. Sputum culture for acid-fast bacillus (best way****) 2. Chest x-ray 3. TB skin test 4. Quantaferon blood test

Diabetic "sick day" routine

1. Sugar fluids only if vomiting 2. Small frequent meals 3. Eat soup or gelatin 6-8x's per day 4. Check urine for ketones 5. DO NOT INCREASE INSULIN DOSE

Insulin administration

1. Use unit syringes 2. Clear/cloudy, draw up regular first then NPH 3. Use 45 degree angle when giving SQ 4. Different body site to increase absorption

Rhinitis

1. Usually caused from seasonal allergies 2. Can be caused from occupational, environmental pollens, 3. Remove them from the allergen causing substance I.E. carpets, pet hair, house dust ETC. 4. Use PPE in occupational areas

Primary/essential hypertension

1. has no identifiable cause. 2. It is the most common type of hypertension, affecting 95% of hypertensive patients 3. it tends to be familial and is likely to be the consequence of an interaction between environmental and genetic factors. 4. Prevalence of essential hypertension increases with age

Secondary hypertension

1. is high blood pressure that's caused by another medical condition. 2. Secondary hypertension can be caused by conditions that affect your kidneys, arteries, heart or endocrine system. 3. People with secondary hypertension often have blood pressure that is more difficult to control with one or two medications. 4. there can be other symptoms related to the medical illness that is causing the

Ketoacidosis

1. ketones in urine 2. Hyperglycemia 3. Fruity breath 4. Tachycardia, cardiac arrhythmias 5. Cardiac monitor at times, if shows tachycardia, 6. Regular insulin IV 7. 0.9% saline IV

Community acquired pneumonia

1.Acute infection (no previous facility admission w/I 14 days 2.Decision to treat at home or hospital depends on Age, vital signs, mental status, presence of co-morbid conditions, current physiologic condition

Normal BUN Lab Values

10-20

Normal Sodium Lab Values

135-145

HCO3 normal range

22-26 mEq/L

Normal Potassium Lab Values

3.5-5.0

PaCO2 normal range

35-45 mm Hg

Normal White Blood Cells Count

5000-10000

The nurse is reviewing a care plan for a group of assigned patients. Which of the following clients should the nurse identify as having the highest risk for developing hyperglycemic syndrome?

55-year-old client with diabetes type II that has pneumonia

Normal Blood sugar levels

60-110 70-120

pH range

7.35-7.45

Normal 02 saturation is

90% and greater

Metformin precautions

Adequate kidney function (BUN Creatinine) due to it being excreted through the kidneys and can build up toxic levels

A nurse is caring for a client who is having an acute severe asthma attack. Which of the following actions would be priority for the nurse to take?

Administer a prescribed nebulizer beta adrenergic medication

The nurse is caring for a client who has a prescription for regular insulin to be administered before breakfast. The nurse notes that Breakfast trays are delivered at 8 am. After checking the client's glucose level at 7, which of the following actions should the nurse take?

Administer the insulin at 7:30

The nurse is admitting a client who has TB and a productive cough. Which of the following isolation precautions should the nurse implement?

Airborne

The unlicensed personnel reports to the nurse that the client with diabetes type II has a bedside glucose of 65. Which of the following should be a priority by the nurse?

Assess the clients LOC

Crackles

Bubbling sound (pneumonia)

The nurse is monitoring a client who is receiving moderate sedation. Which of the following would best indicate to the nurse the clients ventilatory effort?

Capnography

Pneumonia diagnosis

Chest x-ray

The nurse is caring for a client who is admitted with SOB, productive cough, and is suspected of having pneumonia, the nurse should understand that which of the following diagnostic test should be the priority for this client

Chest x-ray

The nurse is developing a care plan for a group of assigned clients. Which of the following clients should the nurse identify as having the highest risk of developing aspiration pneumonia?

Client who has had a cerebral vascular accident

The nurse is monitoring a client with right lower lobe pleural infusion who is post thoracentesis one hour ago. Which of the following requires immediate attention by the nurse?

Diminished breath sounds auscultated in the right base

The nurse is performing a respiratory assessment for a client with pneumonia. The nurse notes that the sound heard when percussing the lower lobes was medium intensity pitch and duration. The nurse should document the finding as the following?

Dull

The nurse is preparing to administer a dose of influenza vaccine to a client. Which of the following allergies documented in the client's medical record should indicate a contraindication to administering the medication?

Eggs

Community acquired pneumonia Treatment

Empiric antibiotic therapy

Nurse has taught a client with newly diagnosed hypertension about the DASH diet. Which of the following food choices by the client would indicate to the nurse that more teaching is required?

Hamburger and salad

The nurse is educating a client newly diagnosed with asthma about preventing asthma attacks. Which of the following statements by the client would require follow up by the nurse?

I will choose perfumes that are lightly scented

A nurse has taught a client with allergic rhinitis about managing symptoms. Which of the following statements by the client would indicate to the nurse that teaching was affective?

I will have carpets removed from the bedroom

The nurse has taught a client with type I diabetes about exercise and glucose control. Which of the following statements by the client would indicate to the nurse more teaching is required?

I will increase my daily exercise when ketones are present in my urine (RATIONAL: Don't want ketones in urine sign of ketoacidosis)

Bilateral basal crackles

Indicates pneumonia and requires immediate action especially the geriatric client

How do you treat epistasis?

Initiate pinching (applying pressure) nostrils for 10 mins

The home health nurse is reviewing the daily blood glucose levels of a client with type I diabetes who receives prescribed NPH insulin morning and evenings and Lispro sliding scale with meals. The nurse notes that the client experiences hyperglycemia daily around 6 am. Which of the following would be the best action by the nurse?

Instruct the client to check the blood glucose at 2 am and record the results for a week

Influenza

Joints may ache/hurt

COPD

Keep respirations at normal rate if possible, increased respirations cause heart to work harder increasing oxygen demand

Beta blockers end in

LOL

The nurse is caring for a client who is 2 hours post op from a tracheostomy. Which of the following would be a priority for the nurse to have at the bedside?

Manual resuscitation bag

A nurse is caring for a client with hypertension who recently started taking Lisinopril. Which of the following if reported by the client would require immediate follow up by the nurse?

My lips seem puffy (Rational: this would be a sign of angioedema)

What kind of special masks are required to prevent TB spread

N95 masks

The nurse is caring for a client with COPD who is receiving prescribed low flow oxygen at 2 L/min via cannula. Which of the following findings would indicate to the nurse that the treatment needs to be revised?

PaO2 level of 55 (Rational: Should be 60 or above)

CCB

Pine

The nurse is assessing a client with chest pain with inspiration. The nurse notices a friction rub when auscultating breath sounds. Which of the following should the nurse suspect the client is experiencing?

Pleurisy

ACE inhibitors end in

Pril

A nurse is caring for a client with diabetes type I who is experiencing nausea, vomiting, abdominal pain, Kussmual respirations and a fruity scented breath. Which of the following actions by the nurse should be a priority?

Rapidly administering prescribed 0.9 normal saline IV fluids

A nurse is caring for a client with diabetic ketoacidosis who has a prescription for IV infusion of insulin. Which of the following insulins should the nurse anticipate administering to the patient?

Regular

Safe use of inhalers

Rescue inhalers (albuterol) should not be overused due to adverse effect of tachycardia causing increased cardiac 02 demand with less supply

The nurse is assessing a client who is admitted with an upper respiratory tract infection. Which of the following findings is an early indication of hypoxia?

Restlessness

The nurse is implementing nutritional interventions for a client with pneumonia. Which of the following should the nurse include in the plan of care for this client?

Small frequent meals (Rational: digestion take a significant amount of O2, which pneumonia patients do not have enough O2)

The nurse is collecting the health history from client who reports night sweats, hemoptysis, and a recent exposure to TB. Which of the following diagnostic tests should the nurse expect to be prescribed for this client to confirm the diagnosis of TB?

Sputum

The nurse is preparing to measure the blood pressure of a client with a history of hypertension. Which of the following actions should the nurse take

Tell the client to keep feet flat on the floor

What type of TB vaccine do Foreigners need to have?

The TB vaccine Bacilli Calmette Guerin (BCG)

Hemopneumothorax is

The accumulation of blood and air in the pleural space of the chest.

The nurse is monitoring a client who experiencing a hypertensive crisis and is receiving prescribed IV infusion of antihypertensive medication. Which of the following findings would indicate that the client is experiencing a complication?

The client appears lethargic

Hemopneumothorax diagnosis

The diagnosis must be made as soon as possible! Diagnosis through imaging studies such as: - including plain radiography - computed tomography - ultrasonography.

The nurse is educating a client with diabetes type II about newly prescribed Glypizide, Which of the following statements by the nurse best described the action of this drug?

This medication will stimulate your pancreas to increase insulin

Insulin pump

Used by patients to provide either constant doses of insulin or to provide bolus for elevated blood sugars post prandial

Wheezing

Whistling sound (asthma)

Metformin class is

biguanides.

If Pneumonia is accompanied with sepsis what is required

blood cultures

Aspiration pneumonia

can occur when a foreign substance, such as vomit, is inhaled into the lungs

What should you do if 02 saturation level falls without known reason

check placement

Facility acquired pneumonia Treatment

difficult due to multidrug-resistant organisms

TB is spread by

droplets, coughing, sneezing AIR-BORN

Hyperglycemia S/S

frequent urination deep rapid labored respirations thirst hunger dry mucous membranes weakness malaise rapid, weak pulse hypotension soft eyeballs

Blood sugar will increase with

infections

Type 2 if blood sugar less than 65, always assess

level of consciousness/loss of consciousness

Diltiazem can cause

muscle cramps and constipation (notify MD)

Hypoglycemia S/S

nausea nervousness irritability diaphoresis pale cool skin irritability normal/shallow respirations tachycardia and palpitations strange or unusual respirations slurred speech headache blurred vision decreasing loc seizures leading to coma change in emotional behavior difficulty thinking.

Epistasis is a

nose bleed

Bacterial pneumonia

often caused by Streptococcus pneumoniae is the only form of pneumonia that can be prevented through vaccination

Metabolic Alkalosis Values

pH: greater than 7.45 HCO3: greater than 26 PaCO2: if uncompensated normal if compensating greater than 45

Respiratory Alkalosis Values

pH: greater than 7.45 PaCO2: less than 35 HCO3: if uncompensated normal if compensating less than 22

metabolic acidosis values

pH: less than 7.35 HCO3: less than 22 PaCO2: if uncompensated normal if compensating less than 35

Respiratory Acidosis Values

pH: less than 7.35 PaCO2: greater than 45 HCO3: if uncompensated normal if compensating greater than 26

In hypertensive crises, treatment should be questioned if

patient becomes lethargic

Influenza Vaccine do not give if

patient is allergic to eggs

Hemopneumothorax s/s

patients present with symptoms: - of shock, - respiratory difficulties such as dyspnea.

Capnography monitors

patients ventilatory effect (sedated patients)

Hypoxia can cause

restlessness