Capstone Exam #1

Creatinine

0.6-1.2

What to monitor in a patient who has possible renal insufficiency

BUN and Creatinine

How does Simvastatin (Zocor) affect liver enzymes?

Can cause elevation of AST/ALT, possible liver damage

A child comes in with a diagnosis of Rheumatic fever, what should the nurse ask the parent?

Has the child had a sore throat in the past 2-6 weeks?

Which foods would the nurse recommend for a patient who is post parathyroidectomy?

Patient needs to be taught to eat foods high in calcium such as dairy, collard greens, tofu, and yougurt

Heparin Labs

aPTT and platelet count

The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition?

- Potassium level of 3.0 mEq/L (3.0 mmol/L)

A client with diabetes mellitus has a glycosylated hemoglobin A1c level of 8%. On the basis of this test result, the nurse plans to teach the client about the need for which measure?

- Preventing and recognizing hyperglycemla

The nurse is caring for a client with Crohn's disease who has a calcium level of 8 mg/dL (2 mmol/L). Which patterns would the nurse watch for on the electrocardiogram? Select all that apply.

- Prolonged QT interval - Prolonged ST segment

The nurse reviews the electrolyte results of a client with chronic kidney disease and notes that the potassium level is 5.7 mEq/L. Which patterns would the nurse watch for on the cardiac monitor as a result of the laboratory value? Select all that apply.

- Tall peaked T waves - Widened QRS complexes

Which client is at risk for the development of a potassium level of 5.5 mEq/L (5.5 mmol/L)?

- The client who has sustained a traumatic burn

On review of the clients' medical records, the nurse determines that which client is at risk for fluid volume excess?

- The client with kidney disease and a 12-year history of diabetes mellitus

A client has been admitted to the hospital for gastroenteritis and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen (BUN) level drops to which value?

-15 mg/dl (5.4 mmol/L) *Drops to normal

The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply.

-Respirations that are increased in rate 28 -Respirations that are abnormally deep

The nurse is caring for a client who takes ibuprofen for pain. The nurse is gathering information on the pts. Medication history and determines it is necessary to contact the PHCP if the client is also taking which meds? SATA

-warfarin -glimepiride -amlodipine

Normal INR:

0.8-1.1

BUN

10-20 mg/dL

Normal PT time:

11-13.5 seconds

Hemoglobin

12-18 g/dL

Platelets

150,000-400,000

Fibrinogen

200-400 mg/dL

Normal aPTT

30-40 seconds

Hematocrit

37-52%

ALT normal range

4-36

WBC

5,000-10,000

AST normal range

8-33

Calcium

8.5-10.5 mg/dL

The nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is most likely at risk for a fluid volume deficit?

A client with an ileostomy

The nurse is caring fora client with heart failure. On assessment, the nurse notes that the client is dyspneic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present?

An increase in blood pressure and increased respirations

The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis?

Anti-streptolynsin O titer

Signs of hypovolemia

Anxiety/agitation, confusion, cool/clammy skin, decreased urine output, diaphoresis, general weakness, hypotension, low body temp, pallor, weak/thready pulse; tachypnea, tachycardia, unconsciousness.

The nurse is caring for a postoperative client who is receiving demand-dose hydromorphone via a patient-controlled analgesia (PCA) pump for pain control. The nurse enters the client's room and finds the client drowsy and records the following vital signs: temperature 97.2° F (36.2° C) orally, pulse 52 beats per minute, blood pressure 101/58 mm Hg, respiratory rat 11 breaths per minute, and SpO2 of 93% on 3 liters of oxygen via nasal cannula. Which action should the nurse take next?

Attempt to arouse the client

A client is admitted to the emergency department with chest pain that is consistent with myocardial infarction based on elevated troponin levels. Heart sounds are normal. The nurse should alert the primary health care provider because the vital sign changes and client assessment are most consistent with which complication? Refer to chart.

Cariogenic Shock

A patient has just been diagnosed with hypertension and has been started on captopril (Capoten). Which information is important to include when teaching the patient about this medication?

Change position slowly to help prevent dizziness and falls.

Glomerulonephritis in a child S/SX:

Dark brown urine, foamy or bubbling urine, HTN, Fluid retention (Edema)

Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD), the patients arterial blood gas (ABG) results include a pH of 7.51, PaO2 of 82 mm Hg, PaCO2 of 26mm Hg, and HCO3 of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to:

Decrease the respiratory rate

The home health nurse is visiting a client for the first time. While assessing the client's medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first?

Determine whether there are medication duplications.

How does Imdur (Isosorbide Mononitrate) affect the heart?

Dilates blood vessels, can cause severely low BP, educate about sitting down before taking the medication

The nurse is providing discharge instructions to a client receiving trimethoprim-sulfamethoxazole (Bactrim). Which instruction should be included in the list ?

Drink 8 to 10 glasses of water per day

Celiac disease diet?

Gluten-free diet (no BROW: barley, rye, oat, and wheat).

A patient with pancytopenia has a bone marrow aspiration/biopsy from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?

Have the patient lie on the left side for 1 hour.

What additional signs would the nurse expect to note in a client with hyponatremia?

Hyperactive bowel sounds

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis?

I noticed his urine was the color of cola lately

A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective?

I will call for help when I need to get up to use the bathroom

Elevated Troponin and Cariogenic shock Vital Signs:

Increased HR Increased RR Decreased BP

Metabolic acidosis causes what symptom?

Increased respirations, Kussmaul respirations

An adult female client has a hemoglobin level of 10.8 g/dL (108 mmol/L). The nurse interprets that this result is most likely caused by which condition noted in the client's history?

Iron deficiency anemia

What medication will decrease potassium?

Lasix (Furosemide)

Normal A1C Level

Less than 5.7%, determines your blood sugar levels for the past 3 months

Signs of dehydration

Lightheadedness, dizziness, and hypotension

Nursing care to decrease sodium in diet

Low sodium food options, if hypernatremia is severe, dextrose IV will be given

What is the most common acid/base balance from diuretic use?

Metabolic alkalosis

Decreased potassium level can lead to what?

Muscle Cramps Heart Dysrhythmias

Warfarin (Coumadin) Labs

PT/INR

A pt. with a hx. Of upper gastrointestinal bleeding has a platelet count of 300,000mm3. The nurse should take which action after seeing the lab results?

Place the normal report in the pt. chart.

Before administration of captopril (Capoten) to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patients

Potassium

Function of parathyroid gland

Regulates calcium in blood, increases blood calcium level

What type of ABG would you expect in a COPD patient?

Respiratory acidosis *Decreased pH *Increased PaCO2 *Increased HCO3

Which acid-base imbalance is caused by hyperventilating?

Respiratory alkalosis (losing too much co2)

To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating:

Sardines and liver *Also chicken, red meats, scallops

A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider?

Serum potassium level 3.0 mEq/L after 1 week of therapy *Hyperkalemia increases risk for dysrhythmias and digoxin toxicity

Trimethoprim-sulfamethoxazole (Bactrim) is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy?

Sore throat

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which early sign of HF?

Tachycardia

Longer PT/INR time indicates:

The blood is taking too long to form a clot, initiate bleeding precautions

Nitrofurantoin is prescribed for a client with a UTI. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the clients complaints?

The client is experiencing a pulmonary reaction requiring cessation of the medication

On review of the clients medical records, the nurse determines that which client is at risk for fluid volume excess?

The client with kidney disease and a 12 year hx of diabetes mellitus

Medications for A fib:

Warfarin (Coumadin), Apixaban (Eliquis)

The best way to assess urine output in infants:

Weigh the diapers, monitor for decrease in urine output

Which question should the nurse ask the parents of a child suspected of having glomerulonephritis?

has the child had a sore throat or a throat infection in the last few weeks?