Ch19- EAQ, Fundamental HESI, Fundementals Nursing

Erythocyte sedimentation rate (ESR)

0-20 mm/h

Volume fraction (normal values)

0.37-0.52%

Creatinine (normal values)

0.5-1.2 mg/dL

International normalized ratios (INR)

0.8-1,1

Which action would the nurse perform when managing supplies required for a patient's minor procedure? 1 Keep some extra supplies handy. 2 Ensure that the supplies are outdated. 3 Unseal all the supplies for easy access. 4 Place the supplies away from the area of the procedure.

1

Which activity would the nurse include in a nursing plan for indirect care of a patient? 1 Manage the patient's environment. 2 Administer medication on time. 3 Change the intravenous solution when empty. 4 Counsel the patient about coping strategies.

1

Which implementation skill describes the nurse considering facts about nausea, the anatomy of the gastrointestinal tract, and the physical mechanisms for nausea and vomiting? 1 Cognitive 2 Interpersonal 3 Psychomotor 4 Consultative

1

Which level of prevention describes a nurse administering a vaccine to an infant? 1 Primary 2 Secondary 3 Tertiary 4 Rehabilitation

1

Which level of prevention describes a nurse conducting health awareness training programs at a community center? 1 Primary 2 Secondary 3 Tertiary 4 Indirect

1

Which action would the nurse take when the patient who is nothing by mouth (NPO) (no food or fluids allowed) develops an adverse reaction to a new intravenous (IV) drug? Select all that apply. One, some, or all responses may be correct. 1 Record the reaction. 2 Stop further administration of the drug. 3 Notify the health care provider. 4 Start oral medication. 5 Stop the medication and administer it again after the reaction subsides.

1,2,3

Which principle of care coordination would the nurse use to achieve a desired outcome for patients? Select all that apply. One, some, or all responses may be correct. 1 Organizational skills 2 Good time management 3 Appropriate use of resources 4 Providing the single best intervention 5 Avoiding prioritization of patient needs

1,2,3

Which action would the nurse perform when revising a nursing care plan? Select all that apply. One, some, or all responses may be correct. 1 Revise the nursing diagnoses. 2 Add new data with appropriate dates. 3 Maintain irrelevant nursing diagnoses. 4 Choose the method of evaluation for monitoring patient outcomes. 5 Continue the old, specific interventions for new nursing diagnoses.

1,2,4

Which action would the nurse take when administering a new, unfamiliar medication to a patient who cannot have food or fluids for 24 hours? Select all that apply. One, some, or all responses may be correct. 1 Ask the pharmacist for help. 2 Consult an experienced nurse for help regarding the drug. 3 Administer a different but similar drug. 4 Look up the medication in a drug book. 5 Request that the health care provider prescribe an oral medication.

1,2,4

Which factor would the nurse consider when making discharge plans for activities of daily living (ADLs)? Select all that apply. One, some, or all responses may be correct. 1 A paralyzed patient will need permanent assistance for ADLs. 2 Patients should be encouraged to participate in ADLs. 3 A patient with a fractured arm will need assistance writing checks. 4 Family members can be allowed to assist the patient, as needed. 5 Only a professional nurse can provide ADLs.

1,2,4

Which information accurately describes a physical care technique? Select all that apply. One, some, or all responses may be correct. 1 Staying organized while caring for the patient 2 Protecting oneself and the patient from injury 3 Ensuring that the patient has medical reports 4 Using proper hygienic infection control practices 5 Preparing a discharge summary and rehabilitation plan

1,2,4

Which intervention would be appropriate for a postoperative patient who is on bed rest and at risk of skin injuries after surgery? Select all that apply. One, some, or all responses may be correct. 1 Reposition the patient frequently. 2 Administer analgesics before turning. 3 Teach the patient about postoperative care. 4 Use pressure relief devices, if necessary. 5 Ambulate the patient.

1,2,4

Which nursing intervention is an example of direct care for a patient? Select all that apply. One, some, or all responses may be correct. 1 Administering medications 2 Inserting an intravenous (IV) line 3 Keeping the patient's room infection free 4 Counseling the patient about required care 5 Keeping all of the patient's paperwork updated

1,2,4

Which action would a student nurse take when asked to perform a procedure that the student nurse has been trained in but has not performed in the hospital? Select all that apply. One, some, or all responses may be correct. 1 Check the hospital's procedure manual to obtain more information. 2 Request the unit manager assign the procedure to another student nurse. 3 Ask an experienced nurse for supervision and guidance during the procedure. 4 Verbalize the steps of the procedure with an instructor before performing it. 5 Refuse to perform the procedure.

1,3,4

Which activity would the nurse perform when preparing for the implementation phase of the nursing process? Select all that apply. One, some, or all responses may be correct. 1 Reassessing the patient 2 Focusing on preventive measures 3 Organizing resources and care delivery 4 Counseling and motivating the patient 5 Reviewing and revising the existing nursing care plan

1,3,5

Which element is a chief component of the nursing process? Select all that apply. One, some, or all responses may be correct. 1 Diagnosis 2 Detection 3 Assessment 4 Identification 5 Implementation

1,3,5

Which activity is classified as an instrumental activity of daily living (IADL)? Select all that apply. One, some, or all responses may be correct. 1 Shopping 2 Getting magnetic resonance imaging (MRI) 3 Ambulating 4 House cleaning 5 Preparing meals

1,4,5

Which component is an element of the American Nurses Association (ANA) standards of practice and scope of nursing practice? Select all that apply. One, some, or all responses may be correct. 1 Describes what a nurse is licensed to perform 2 Is a definition of skills competencies for nurses 3 Sets standards for diagnosing diseases and disorders 4 Identifies the nature and intent of the ways nurses intervene for patients 5 Is an authoritative statement regarding the duties all nurses are expected to perform

1,4,5

Absolute neutrophil count (ANC)

1,500-8,000/mm3

Magneisum

1.5-2.0 mEq/L

Prothrombin Time (PT)

11-13.5 seconds

Sodium (normal values)

135-145 mEq/L

Platelets (normal values)

150,000-400,000/mm3

Atropine Conduction is slow, rate can be normal

1st degree av block

A home-health nurse provides palliative care for a patient in a community setting. The patient states, "The pain pills that I have been taking are not as effective as they used to be." After reviewing the patient's standing orders, which action does the nurse take? 1 Arranges for a hospital transfer 2 Increases the medication dosage 3 Schedules an office appointment 4 Contacts the health care provider for a new order

2

The nurse reviews potential interventions for a patient who is experiencing pain. When considering the administration of an analgesic, the nurse identifies that the medication may cause an adverse reaction, including increasing the patient's fall risk. The nurse is demonstrating which principle of critical judgment and decision-making? 1 Review the set of all possible nursing interventions for the patient's problem. 2 Review all possible consequences associated with each possible nursing action. 3 Judge the value of the consequences to the patient. 4 Determine the probability of all possible consequences.

2

Which action would the nurse take when the patient asks for a bedpan as the nurse is reassessing the patient? 1 Call the assistive personnel (AP) and ask him or her to bring a bedpan for the patient. 2 Assist the patient onto the bedpan. 3 Quickly finish the reassessment. 4 Reassure the patient that an AP will bring a bedpan soon.

2

Which action would the nurse take when unable to perform a complex intervention successfully? 1 Continue until the intervention is successfully completed. 2 Ask for assistance from an experienced nurse. 3 Tell the patient about the inability to perform it. 4 Compromise on the intervention to make it easier to perform.

2

Which activity would the nurse perform when implementing indirect care measures? 1 Positioning the patient correctly 2 Collecting and transporting labeled specimens 3 Administering vaccines 4 Teaching the patient about home care

2

Which direct care measure would the nurse be using when consulting with the dietitian and health care provider to determine the initial rate that will be prescribed for the tube feeding to lessen the chance of diarrhea? 1 Preventive 2 Controlling for an adverse reaction 3 Consulting 4 Counseling for nutritional needs

2

Which prevention level would describe a clinic nurse screening a patient for diabetes? 1 Primary 2 Secondary 3 Tertiary 4 Quaternary

2

Which priority action would the nurse take before administering a new drug? 1 Confer with a colleague before giving the medication. 2 Consult with a pharmacist to obtain knowledge about the medication. 3 Ask the patient about the medication. 4 Administer the medication as prescribed and on time.

2

Which information about standing orders is accurate? Select all that apply. One, some, or all responses may be correct. 1 They provide instructions from the unit manager about care in emergencies. 2 They are preprinted documents that contain orders for various clinical problems. 3 They provide legal protection to the nurse when caring for the patient. 4 They are signed by the licensed prescribing health care provider in charge at the time of implementation. 5 They are signed by the patient or the patient's relative before the treatment is started.

2,3,4

Bicarbonate (HCO3) (normal values)

22-26 mEq/L

Activated Partial Thromboplastin Time (aPTT)

25-40 seconds

When does implementation begin? 1 During the assessment phase 2 Immediately in some critical situations 3 After the care plan has been developed 4 After mutual goal setting between the nurse and patient

3

Which action does the nurse take right before implementing interventions? 1 Review the care plan. 2 Decide if the outcomes remain appropriate. 3 Reassess the patient. 4 Compare assessment findings to validate existing nursing diagnoses.

3

Which action indicates that the nurse is using physical care techniques? 1 Meeting the patient's expressed needs 2 Performing indirect care measure 3 Using safe patient-handling procedures 4 Providing a hand-off report

3

Which implementation skill describes a nurse explaining to the patient about inserting a feeding tube? 1 Cognitive 2 Technical 3 Interpersonal 4 Psychomotor

3

Which level of prevention describes the nurse working in collaboration with a physiotherapist to help aid the ambulatory functions of a patient who suffered a motor vehicle accident? 1 Primary 2 Secondary 3 Tertiary 4 Quaternary

3

Which method would the nurse use when teaching a patient about foot care? 1 Give instructions once in a loud voice. 2 Provide instructions, asking the patient to repeat the instructions at the end. 3 Repeat instructions as needed, having the patient do a return demonstration. 4 Present instructions to the family, having the family explain instructions to the patient.

3

Which response would the nurse make for a patient who expresses confusion about how to manage a leg wound after discharge? 1 Provide a written document that contains the necessary instructions. 2 Tell the patient that a relative will be taught how to take care of the wound. 3 Explain and demonstrate the necessary action to the patient. 4 Inform the patient that it will be explained later during discharge.

3

Albumin

3.5-5 g/dL

Potassium (normal values)

3.5-5.0 mEq/L

pCO2

35-45 mmHg

Which action would the nurse take when, right before starting the intravenous (IV) line, the patient needs to void (urinate)? 1 Sedate the patient. 2 Start the IV line immediately. 3 Insert a Foley catheter. 4 Assist the patient to the bathroom.

4

Which type of implementation skill is described when the nurse correctly administers an enema solution to a patient? 1 Interpersonal 2 Cognitive 3 Collaborative 4 Psychomotor

4

Which type of order describes a prewritten prescription in the intensive care unit (ICU) that states in case of a headache, acetaminophen is to be given to the patient? 1 Protocol 2 Intervention 3 Standard prescription 4 Standing order

4

Glycosylated Hemoglobin (HbA1C)

4% to 5.9% nondiabetics > 7% good nondiabetics control > 9% poor diabetes control

Which sequence would the nurse follow for making decisions about implementing interventions? 1. Judge the value of the consequences to the patient. 2. Determine the probability of possible consequences. 3. Review all possible consequences associated with each intervention. 4. Review all possible interventions for the patient.

4,3,2,1

Urine pH

4.5-8

Hematocrit (Ht) (normal values)

42-52% adult male 37-46% adult female

White Blood Cells (WBC) (normal values)

5,000-10,000/mm3

Blood Urea Nitrogen (BUN) (normal values)

6-20 mg/dL

pH (normal values)

7.35-7.45

Glucose, fasting

70-110 mg/dL

Calcium

8.5-10.5 mg/dL

pO2 (normal values)

80-100 mmHg

Urine Output

800-2,000 ml/day 0.5-1.0 ml/kg/h

SaO2

95-100%

Chloride

95-105

Critical WBC (normal values)

<2,000 or >40,000 /mm3

Cholesterol (total)

<200 mg/dL

Glucose, casual

<200 mg/dL

Glucose, critical levels

<40 mg/dL or >400 mg/dL

Sinus bradycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a slower than usual (≤60 beats/minute) rate. Sinus bradycardia is a slower than usual (≤60 beats/minute) heart rate.

A 66-year-old female client is having cardiac diagnostic tests to determine the cause of her symptoms. In her follow-up visit to the cardiologist, she is told that she has a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia did the tests reveal?

Spasms in atrial (many pwaves), blood pools-- tx with anticoagulant (warfarin), cardizem, digoxin & cardiovert if symptoms present

A fib

Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy. Explanation: Ketones (or ketone bodies) are byproducts of fat breakdown, and they accumulate in the blood and urine. Ketones in the urine signal a deficiency of insulin and control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy

A nurse is teaching a patient recovering from diabetic ketoacidosis (DKA) about management of "sick days." The patient asks the nurse why it is important to monitor the urine for ketones. Which of the following statements is the nurse's best response?

Heparin 20,000 units in 500 ml D5W at 50 ml/hour has been infusing for 5½ hours. How much heparin has the client received? A) 11,000 units. B) 13,000 units. C) 15,000 units. D) 17,000 units

A) 11,000 units

While instructing a male client's wife in the performance of passive range-of-motion exercises to his contracted shoulder, the nurse observes that she is holding his arm above and below the elbow. What nursing action should the nurse implement? A) Acknowledge that she is supporting the arm correctly. B) Encourage her to keep the joint covered to maintain warmth. C) Reinforce the need to grip directly under the joint for better support. D) Instruct her to grip directly over the joint for better motion.

A) Acknowledge that she is supporting the arm correctly The wife is performing the passive ROM correctly, therefore the nurse should acknowledge this fact (A). The joint that is being exercised should be uncovered (B) while the rest of the body should remain covered for warmth and privacy. (C and D) do not provide adequate support to the joint while still allowing for joint movement

An obese male client discusses with the nurse his plans to begin a long-term weight loss regimen. In addition to dietary changes, he plans to begin an intensive aerobic exercise program 3 to 4 times a week and to take stress management classes. After praising the client for his decision, which instruction is most important for the nurse to provide? A) Be sure to have a complete physical examination before beginning your planned exercise program. B) Be careful that the exercise program doesn't simply add to your stress level, making you want to eat more. C) Increased exercise helps to reduce stress, so you may not need to spend money on a stress management class. D) Make sure to monitor your weight loss regularly to provide a sense of accomplishment and motivation.

A) Be sure to have a complete physical examination before beginning your planned exercise program The most important teaching is (A), so that the client will not begin a dangerous level of exercise when he is not sufficiently fit. This might result in chest pain, a heart attack, or stroke. (B, C, and D) are important instructions, but are of less priority than (A).

The nurse plans to obtain health assessment information from a primary source. Which option is a primary source for the completion of the health assessment? A) Client. B) Healthcare provider. C) A family member. D) Previous medical records

A) Client A primary source of information for a health assessment is the client (A). (B, C, and D) are considered secondary sources about the client's health history, but other details, such as subjective data, can only be provided directly from the client.

A client with chronic renal failure selects a scrambled egg for his breakfast. What action should the nurse take? A) Commend the client for selecting a high biologic value protein. B) Remind the client that protein in the diet should be avoided. C) Suggest that the client also select orange juice, to promote absorption. D) Encourage the client to attend classes on dietary management of CRF

A) Commend the client for selecting a high biologic value protein Foods such as eggs and milk (A) are high biologic proteins which are allowed because they are complete proteins and supply the essential amino acids that are necessary for growth and cell repair. Although a low-protein diet is followed (B), some protein is essential. Orange juice is rich in potassium, and should not be encouraged (C). The client has made a good diet choice, so (D) is not necessary

After completing an assessment and determining that a client has a problem, which action should the nurse perform next? A) Determine the etiology of the problem. B) Prioritize nursing care interventions. C) Plan appropriate interventions. D) Collaborate with the client to set goals.

A) Determine the etiology of the problem Before planning care, the nurse should determine the etiology, or cause, of the problem (A), because this will help determine (B, C, and D).

The nurse is using a genogram while conducting a client's health assessment and past medical history. What information should the genogram provide? A) Genetic and familial health disorders. B) Chronic health problems. C) Reason for seeking health care. D) Undetected disorders.

A) Genetic and familial health disorders A genogram that is used during the health assessment process identifies genetic and familial health disorders (A). It may not identify the client's chronic health problems (B), so it is not a reason to seek health care (C). A genogram is not a diagnostic tool to detect disorders (D), such as those based on pathological findings or DNA.

An adult male client with a history of hypertension tells the nurse that he is tired of taking antihypertensive medications and is going to try spiritual meditation instead. What should be the nurse's first response? A) It is important that you continue your medication while learning to meditate. B) Spiritual meditation requires a time commitment of 15 to 20 minutes daily. C) Obtain your healthcare provider's permission before starting meditation. D) Complementary therapy and western medicine can be effective for you.

A) It is important that you continue your medication while learning to meditate The prolonged practice of meditation may lead to a reduced need for antihypertensive medications. However, the medications must be continued (A) while the physiologic response to meditation is monitored. (B) is not as important as continuing the medication. The healthcare provider should be informed, but permission is not required to meditate (C). Although it is true that this complimentary therapy might be effective (D), it is essential that the client continue with antihypertensive medications until the effect of meditation can be measured

During the daily nursing assessment, a client begins to cry and states that the majority of family and friends have stopped calling and visiting. What action should the nurse take? A) Listen and show interest as the client expresses these feelings. B) Reinforce that this behavior means they were not true friends. C) Ask the healthcare provider for a psychiatric consult. D) Continue with the assessment and tell the client not to worry.

A) Listen and show interest as the client expresses these feelings When a client begins to cry and express feelings, a therapeutic nursing intervention is to listen and show interest as the client expresses feelings (A). (B) is not therapeutic option and the nurse does not know the dynamics of their relationships. (C) is not indicated at this time. (D) is non-therapeutic and offers false hope

A client who is 5' 5" tall and weighs 200 pounds is scheduled for surgery the next day. What question is most important for the nurse to include during the preoperative assessment? A) What is your daily calorie consumption? B) What vitamin and mineral supplements do you take? C) Do you feel that you are overweight? D) Will a clear liquid diet be okay after surgery?

A) What is your daily calorie consumption? Vitamin and mineral supplements (B) may impact medications used during the operative period. (A and C) are appropriate questions for long-term dietary counseling. The nature of the surgery and anesthesia will determine the need for a clear liquid diet (D), rather than the client's preference

Serum Potassium

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent arrhythmias?

used to treat ventricular fibrillation and unstable ventricular tachycardia

Amiodarone

Acls and cpr asap!

Asystole

Sawtooth Atrial rate 250-350 Ventricular rate is steady Cardioversion, cardizem (verapamil), amiodarone

Atrial flutter

Seconal 0.1 gram PRN at bedtime is prescribed to a client for rest. The scored tablets are labeled grain 1.5 per tablet. How many tablets should the nurse plan to administer? A) 0.5 tablet. B) 1 tablet. C) 1.5 tablets. D) 2 tablets.

B) 1 tablet 15 gr=1 Gm. Converting the prescribed dose of 0.1 grams to grains requires multiplying 0.1 × 15 = 1.5 grains. The tablets come in 1.5 grains, so the nurse should plan to administer 1 tablet (B).

The healthcare provider prescribes furosemide (Lasix) 15 mg IV stat. On hand is Lasix 20 mg/2 ml. How many milliliters should the nurse administer? A) 1 ml. B) 1.5 ml. C) 1.75 ml. D) 2 ml.

B) 1.5 ml

A client is to receive 10 mEq of KCl diluted in 250 ml of normal saline over 4 hours. At what rate should the nurse set the client's intravenous infusion pump? A) 13 ml/hour. B) 63 ml/hour. C) 80 ml/hour. D) 125 ml/hour

B) 63 ml/hour

A male client being discharged with a prescription for the bronchodilator theophylline tells the nurse that he understands he is to take three doses of the medication each day. Since, at the time of discharge, timed-release capsules are not available, which dosing schedule should the nurse advise the client to follow? A) 9 a.m., 1 p.m., and 5 p.m. B) 8 a.m., 4 p.m., and midnight. C) Before breakfast, before lunch and before dinner. D) With breakfast, with lunch, and with dinner.

B) 8 a.m., 4 p.m., and midnight Theophylline should be administered on a regular around-the-clock schedule (B) to provide the best bronchodilating effect and reduce the potential for adverse effects. (A, C, and D) do not provide around-the-clock dosing. Food may alter absorption of the medication (D).

What is the most important reason for starting intravenous infusions in the upper extremities rather than the lower extremities of adults? A) It is more difficult to find a superficial vein in the feet and ankles. B) A decreased flow rate could result in the formation of a thrombosis. C) A cannulated extremity is more difficult to move when the leg or foot is used. D) Veins are located deep in the feet and ankles, resulting in a more painful procedure

B) A decreased flow rate could result in the formation of a thrombosis Venous return is usually better in the upper extremities. Cannulation of the veins in the lower extremities increases the risk of thrombus formation (B) which, if dislodged, could be life-threatening. Superficial veins are often very easy (A) to find in the feet and legs. Handling a leg or foot with an IV (C) is probably not any more difficult than handling an arm or hand. Even if the nurse did believe moving a cannulated leg was more difficult, this is not the most important reason for using the upper extremities. Pain (D) is not a consideration

The nurse is assessing the nutritional status of several clients. Which client has the greatest nutritional need for additional intake of protein? A) A college-age track runner with a sprained ankle. B) A lactating woman nursing her 3-day-old infant. C) A school-aged child with Type 2 diabetes. D) An elderly man being treated for a peptic ulcer.

B) A lactating woman nursing her 3-day-old infant A lactating woman (B) has the greatest need for additional protein intake. (A, C, and D) are all conditions that require protein, but do not have the increased metabolic protein demands of lactation

On admission, a client presents a signed living will that includes a Do Not Resuscitate (DNR) prescription. When the client stops breathing, the nurse performs cardiopulmonary resuscitation (CPR) and successfully revives the client. What legal issues could be brought against the nurse? A) Assault. B) Battery. C) Malpractice. D) False imprisonment.

B) Battery Civil laws protect individual rights and include intentional torts, such as assault (an intentional threat to engage in harmful contact with another) or battery (unwanted touching). Performing any procedure against the client's wishes can potentially poise a legal issue, such as battery (B), even if the procedure is of questionable benefit to the client. (A, C, and D) are not examples against the client's request

A client who is a Jehovah's Witness is admitted to the nursing unit. Which concern should the nurse have for planning care in terms of the client's beliefs? A) Autopsy of the body is prohibited. B) Blood transfusions are forbidden. C) Alcohol use in any form is not allowed. D) A vegetarian diet must be followed

B) Blood transfusions are forbidden Blood transfusions are forbidden (B) in the Jehovah's Witness religion. Judaism prohibits (A). Buddhism forbids the use of (C) and drugs. Many of these sects are vegetarian (D), but the direct impact on nursing care is (B).

The nurse is teaching a client proper use of an inhaler. When should the client administer the inhaler-delivered medication to demonstrate correct use of the inhaler? A) Immediately after exhalation. B) During the inhalation. C) At the end of three inhalations. D) Immediately after inhalation

B) During the inhalation The client should be instructed to deliver the medication during the last part of inhalation (B). After the medication is delivered, the client should remove the mouthpiece, keeping his/her lips closed and breath held for several seconds to allow for distribution of the medication. The client should not deliver the dose as stated in (A or D), and should deliver no more than two inhalations at a time (C).

An elderly male client who is unresponsive following a cerebral vascular accident (CVA) is receiving bolus enteral feedings though a gastrostomy tube. What is the best client position for administration of the bolus tube feedings? A) Prone. B) Fowler's. C) Sims'. D) Supine.

B) Fowler's The client should be positioned in a semi-sitting (Fowler's) (B) position during feeding to decrease the occurrence of aspiration. A gastrostomy tube, known as a PEG tube, due to placement by a percutaneous endoscopic gastrostomy procedure, is inserted directly into the stomach through an incision in the abdomen for long-term administration of nutrition and hydration in the debilitated client. In (A and/or C), the client is placed on the abdomen, an unsafe position for feeding. Placing the client in (D) increases the risk of aspiration

An elderly male client who suffered a cerebral vascular accident is receiving tube feedings via a gastrostomy tube. The nurse knows that the best position for this client during administration of the feedings is A) prone. B) Fowler's. C) Sims'. D) supine

B) Fowler's The client should be positioned in a semi-sitting (Fowler's) (B) position during feeding to decrease the occurrence of aspiration. A gastrostomy tube, known as a PEG tube, due to placement by a percutaneous endoscopic gastrostomy procedure, is inserted directly into the stomach through an incision in the abdomen for long-term administration of nutrition and hydration in the debilitated client. In (A and/or C), the client is placed on the abdomen, an unsafe position for feeding. Placing the client in (D) increases the risk of aspiration

A client is receiving a cephalosporin antibiotic IV and complains of pain and irritation at the infusion site. The nurse observes erythema, swelling, and a red streak along the vessel above the IV access site. Which action should the nurse take at this time? A) Administer the medication more rapidly using the same IV site. B) Initiate an alternate site for the IV infusion of the medication. C) Notify the healthcare provider before administering the next dose. D) Give the client a PRN dose of aspirin while the medication infuses

B) Initiate an alternate site for the IV infusion of the medication A cephalosporin antibiotic that is administered IV may cause vessel irritation. Rotating the infusion site minimizes the risk of thrombophlebitis, so an alternate infusion site should be initiated (B) before administering the next dose. Rapid administration (A) of intravenous cephalosporins can potentiate vessel irritation and increase the risk of thrombophlebitis. (C) is not necessary to initiate an alternative IV site. Although aspirin has antiinflammatory actions, (D) is not indicated

Three days following surgery, a male client observes his colostomy for the first time. He becomes quite upset and tells the nurse that it is much bigger than he expected. What is the best response by the nurse? A) Reassure the client that he will become accustomed to the stoma appearance in time. B) Instruct the client that the stoma will become smaller when the initial swelling diminishes. C) Offer to contact a member of the local ostomy support group to help him with his concerns. D) Encourage the client to handle the stoma equipment to gain confidence with the procedure

B) Instruct the client that the stoma will become smaller when the initial swelling diminishes Postoperative swelling causes enlargement of the stoma. The nurse can teach the client that the stoma will become smaller when the swelling is diminished (B). This will help reduce the client's anxiety and promote acceptance of the colostomy. (A) does not provide helpful teaching or support. (C) is a useful action, and may be taken after the nurse provides pertinent teaching. The client is not yet demonstrating readiness to learn colostomy care (D).

Examination of a client complaining of itching on his right arm reveals a rash made up of multiple flat areas of redness ranging from pinpoint to 0.5 cm in diameter. How should the nurse record this finding? A) Multiple vesicular areas surrounded by redness, ranging in size from 1 mm to 0.5 cm. B) Localized red rash comprised of flat areas, pinpoint to 0.5 cm in diameter. C) Several areas of red, papular lesions from pinpoint to 0.5 cm in size. D) Localized petechial areas, ranging in size from pinpoint to 0.5 cm in diameter.

B) Localized red rash comprised of flat areas, pinpoint to 0.5 cm in diameter Macules are localized flat skin discolorations less than 1 cm in diameter. However, when recording such a finding the nurse should describe the appearance (B) rather than simply naming the condition. (A) identifies vesicles -- fluid filled blisters -- an incorrect description given the symptoms listed. (C) identifies papules -- solid elevated lesions, again not correctly identifying the symptoms. (D) identifies petechiae -- pinpoint red to purple skin discolorations that do not itch, again an incorrect identification

A young mother of three children complains of increased anxiety during her annual physical exam. What information should the nurse obtain first? A) Sexual activity patterns. B) Nutritional history. C) Leisure activities. D) Financial stressors

B) Nutritional history Caffeine, sugars, and alcohol can lead to increased levels of anxiety, so a nutritional history (C) should be obtained first so that health teaching can be initiated if indicated. (A and C) can be used for stress management. Though (D) can be a source of anxiety, a nutritional history should be obtained first

A female client with a nasogastric tube attached to low suction states that she is nauseated. The nurse assesses that there has been no drainage through the nasogastric tube in the last two hours. What action should the nurse take first? A) Irrigate the nasogastric tube with sterile normal saline. B) Reposition the client on her side. C) Advance the nasogastric tube an additional five centimeters. D) Administer an intravenous antiemetic prescribed for PRN use.

B) Reposition the client on her side The immediate priority is to determine if the tube is functioning correctly, which would then relieve the client's nausea. The least invasive intervention, (B), should be attempted first, followed by (A and C), unless either of these interventions is contraindicated. If these measures are unsuccessful, the client may require an antiemetic (D).

When assisting an 82-year-old client to ambulate, it is important for the nurse to realize that the center of gravity for an elderly person is the A) Arms. B) Upper torso. C) Head. D) Feet

B) Upper torso The center of gravity for adults is the hips. However, as the person grows older, a stooped posture is common because of the changes from osteoporosis and normal bone degeneration, and the knees, hips, and elbows flex. This stooped posture results in the upper torso (B) becoming the center of gravity for older persons. Although (A) is a part, or an extension of the upper torso, this is not the best and most complete answer.

In developing a plan of care for a client with dementia, the nurse should remember that confusion in the elderly A) is to be expected, and progresses with age. B) often follows relocation to new surroundings. C) is a result of irreversible brain pathology. D) can be prevented with adequate sleep

B) often follows relocation to new surroundings Relocation (B) often results in confusion among elderly clients--moving is stressful for anyone. (A) is a stereotypical judgment. Stress in the elderly often manifests itself as confusion, so (C) is wrong. Adequate sleep is not a prevention (D) for confusion

The healthcare provider prescribes 1,000 ml of Ringer's Lactate with 30 Units of Pitocin to run in over 4 hours for a client who has just delivered a 10 pound infant by cesarean section. The tubing has been changed to a 20 gtt/ml administration set. The nurse plans to set the flow rate at how many gtt/min? A) 42 gtt/min. B) 83 gtt/min. C) 125 gtt/min. D) 250 gtt/min

B. 83 gtt/min

The healthcare provider prescribes the diuretic metolazone (Zaroxolyn) 7.5 mg PO. Zaroxolyn is available in 5 mg tablets. How much should the nurse plan to administer? A) ½ tablet. B) 1 tablet. C) 1½ tablets. D) 2 tablets.

C) 1½ tablets

Which response by a client with a nursing diagnosis of Spiritual distress, indicates to the nurse that a desired outcome measure has been met? A) Expresses concern about the meaning and importance of life B) Remains angry at God for the continuation of the illness. C) Accepts that punishment from God is not related to illness. D) Refuses to participate in religious rituals that have no meaning.

C) Accepts that punishment from God is not related to illness Acceptance that she is not being punished by God indicates a desired outcome (C) for some degree of resolution of spiritual distress. (A, B, and D) do not support the concept of grief, loss, and cultural/spiritual acceptance.

During a physical assessment, a female client begins to cry. Which action is best for the nurse to take? A) Request another nurse to complete the physical assessment. B) Ask the client to stop crying and tell the nurse what is wrong. C) Acknowledge the client's distress and tell her it is all right to cry. D) Leave the room so that the client can be alone to cry in private.

C) Acknowledge the client's distress and tell her it is all right to cry Acknowledging the client's distress and giving the client the opportunity to verbalize her distress (C) is a supportive response. (A, B, and D) are not supportive and do not facilitate the client's expression of feelings

A hospitalized male client is receiving nasogastric tube feedings via a small-bore tube and a continuous pump infusion. He reports that he had a bad bout of severe coughing a few minutes ago, but feels fine now. What action is best for the nurse to take? A) Record the coughing incident. No further action is required at this time. B) Stop the feeding, explain to the family why it is being stopped, and notify the healthcare provider. C) After clearing the tube with 30 ml of air, check the pH of fluid withdrawn from the tube. D) Inject 30 ml of air into the tube while auscultating the epigastrium for gurgling.

C) After clearing the tube with 30 ml of air, check the pH of fluid withdrawn from the tube Coughing, vomiting, and suctioning can precipitate displacement of the tip of the small bore feeding tube upward into the esophagus, placing the client at increased risk for aspiration. Checking the sample of fluid withdrawn from the tube (after clearing the tube with 30 ml of air) for acidic (stomach) or alkaline (intestine) values is a more sensitive method for these tubes, and the nurse should assess tube placement in this way prior to taking any other action (C). (A and B) are not indicated. The auscultating method (D) has been found to be unreliable for small-bore feeding tubes.

During a visit to the outpatient clinic, the nurse assesses a client with severe osteoarthritis using a goniometer. Which finding should the nurse expect to measure? A) Adequate venous blood flow to the lower extremities. B) Estimated amount of body fat by an underarm skinfold. C) Degree of flexion and extension of the client's knee joint. D) Change in the circumference of the joint in centimeters

C) Degree of flexion and extension of the client's knee joint The goniometer is a two-piece ruler that is jointed in the middle with a protractor-type measuring device that is placed over a joint as the individual extends or flexes the joint to measure the degrees of flexion and extension on the protractor (C). A doppler is used to measure blood flow (A). Calipers are used to measure body fat (B). A tape measure is used to measure circumference of body parts (D).

A client who has been NPO for 3 days is receiving an infusion of D5W 0.45 normal saline (NS) with potassium chloride (KCl) 20 mEq at 83 ml/hour. The client's eight-hour urine output is 400 ml, blood urea nitrogen (BUN) is 15 mg/dl, lungs are clear bilaterally, serum glucose is 120 mg/dl, and the serum potassium is 3.7 mEq/L. Which action is most important for the nurse to implement? A) Notify healthcare provider and request to change the IV infusion to hypertonic D10W. B) Decrease in the infusion rate of the current IV and report to the healthcare provider. C) Document in the medical record that these normal findings are expected outcomes. D) Obtain potassium chloride 20 mEq in anticipation of a prescription to add to present IV.

C) Document in the medical record that these normal findings are expected outcomes The results are all within normal range.(C) No changes are needed. (A,B, and D)

Which assessment data would provide the most accurate determination of proper placement of a nasogastric tube? A) Aspirating gastric contents to assure a pH value of 4 or less. B) Hearing air pass in the stomach after injecting air into the tubing. C) Examining a chest x-ray obtained after the tubing was inserted. D) Checking the remaining length of tubing to ensure that the correct length was inserted.

C) Examining a chest x-ray obtained after the tubing was inserted Both (A and B) are methods used to determine proper placement of the NG tubing. However, the best indicator that the tubing is properly placed is (C). (D) is not an indicator of proper placement

A resident in a skilled nursing facility for short-term rehabilitation after a hip replacement tells the nurse, "I don't want any more blood taken for those useless tests." Which narrative documentation should the nurse enter in the client's medical record? A) Healthcare provider notified of failure to collect specimens for prescribed blood studies. B) Blood specimens not collected because client no longer wants blood tests performed. C) Healthcare provider notified of client's refusal to have blood specimens collected for testing. D) Client irritable, uncooperative, and refuses to have blood collected. Healthcare provider notified

C) Healthcare provider notified of client's refusal to have blood specimens collected for testing When a client refuses a treatment, the exact words of the client regarding the client's refusal of care should be documented in a narrative format (C). (A, B, and D) do not address the concepts of informatics and legal issues

The nurse is instructing a client with high cholesterol about diet and life style modification. What comment from the client indicates that the teaching has been effective? A) If I exercise at least two times weekly for one hour, I will lower my cholesterol. B) I need to avoid eating proteins, including red meat. C) I will limit my intake of beef to 4 ounces per week. D) My blood level of low density lipoproteins needs to increase.

C) I will limit my intake of beef to 4 ounces per week Limiting saturated fat from animal food sources to no more than 4 ounces per week (C) is an important diet modification for lowering cholesterol. To be effective in reducing cholesterol, the client should exercise 30 minutes per day, or at least 4 to 6 times per week (A). Red meat and all proteins do not need to be eliminated (B) to lower cholesterol, but should be restricted to lean cuts of red meat and smaller portions (2-ounce servings). The low density lipoproteins (D) need to decrease rather than increase

The nurse is caring for a client who is receiving 24-hour total parenteral nutrition (TPN) via a central line at 54 ml/hr. When initially assessing the client, the nurse notes that the TPN solution has run out and the next TPN solution is not available. What immediate action should the nurse take? A) Infuse normal saline at a keep vein open rate. B) Discontinue the IV and flush the port with heparin. C) Infuse 10 percent dextrose and water at 54 ml/hr D) Obtain a stat blood glucose level and notify the healthcare provider.

C) Infuse 10 percent dextrose and water at 54 ml/hr TPN is discontinued gradually to allow the client to adjust to decreased levels of glucose. Administering 10% dextrose in water at the prescribed rate (C) will keep the client from experiencing hypoglycemia until the next TPN solution is available. The client could experience a hypoglycemic reaction if the current level of glucose (A) is not maintained or if the TPN is discontinued abruptly (B). There is no reason to obtain a stat blood glucose level (D) and the healthcare provider cannot do anything about this situation

Which action is most important for the nurse to implement when donning sterile gloves? A) Maintain thumb at a ninety degree angle. B) Hold hands with fingers down while gloving. C) Keep gloved hands above the elbows. D) Put the glove on the dominant hand first.

C) Keep gloved hands above the elbows Gloved hands held below waist level are considered unsterile (C). (A and B) are not essential to maintaining asepsis. While it may be helpful to put the glove on the dominant hand first, it is not necessary to ensure asepsis (D).

When conducting an admission assessment, the nurse should ask the client about the use of complimentary healing practices. Which statement is accurate regarding the use of these practices? A) Complimentary healing practices interfere with the efficacy of the medical model of treatment. B) Conventional medications are likely to interact with folk remedies and cause adverse effects. C) Many complimentary healing practices can be used in conjunction with conventional practices. D) Conventional medical practices will ultimately replace the use of complimentary healing practices.

C) Many complimentary healing practices can be used in conjunction with conventional practices Conventional approaches to health care can be depersonalizing and often fail to take into consideration all aspects of an individual, including body, mind, and spirit. Often complimentary healing practices can be used in conjunction with conventional medical practices (C), rather than interfering (A) with conventional practices, causing adverse effects (B), or replacing conventional medical care (D).

The nurse assigns a UAP to obtain vital signs from a very anxious client. What instructions should the nurse give the UAP? A) Remain calm with the client and record abnormal results in the chart. B) Notify the medication nurse immediately if the pulse or blood pressure is low. C) Report the results of the vital signs to the nurse. D) Reassure the client that the vital signs are normal.

C) Report the results of the vital signs to the nurse. Interpretation of vital signs is the responsibility of the nurse, so the UAP should report vital sign measurements to the nurse (C). (A, B, and D) require the UAP to interpret the vital signs, which is beyond the scope of the UAP's authority

An unlicensed assistive personnel (UAP) places a client in a left lateral position prior to administering a soap suds enema. Which instruction should the nurse provide the UAP? A) Position the client on the right side of the bed in reverse Trendelenburg. B) Fill the enema container with 1000 ml of warm water and 5 ml of castile soap. C) Reposition in a Sim's position with the client's weight on the anterior ilium. D) Raise the side rails on both sides of the bed and elevate the bed to waist level.

C) Reposition in a Sim's position with the client's weight on the anterior ilium The left sided Sims' position allows the enema solution to follow the anatomical course of the intestines and allows the best overall results, so the UAP should reposition the client in the Sims' position, which distributes the client's weight to the anterior ilium (C). (A) is inaccurate. (B and D) should be implemented once the client is positioned

The nurse is evaluating client learning about a low-sodium diet. Selection of which meal would indicate to the nurse that this client understands the dietary restrictions? A) Tossed salad, low-sodium dressing, bacon and tomato sandwich. B) New England clam chowder, no-salt crackers, fresh fruit salad. C) Skim milk, turkey salad, roll, and vanilla ice cream. D) Macaroni and cheese, diet Coke, a slice of cherry pie.

C) Skim milk, turkey salad, roll, and vanilla ice cream Skim milk, turkey, bread, and ice cream (C), while containing some sodium, are considered low-sodium foods. Bacon (A), canned soups (B), especially those with seafood, hard cheeses, macaroni, and most diet drinks (D) are very high in sodium

A postoperative client will need to perform daily dressing changes after discharge. Which outcome statement best demonstrates the client's readiness to manage his wound care after discharge? The client A) asks relevant questions regarding the dressing change. B) states he will be able to complete the wound care regimen. C) demonstrates the wound care procedure correctly. D) has all the necessary supplies for wound care.

C) demonstrates the wound care procedure correctly A return demonstration of a procedure (C) provides an objective assessment of the client's ability to perform a task, while (A and B) are subjective measures. (D) is important, but is less of a priority prior to discharge than the nurse's assessment of the client's ability to complete the wound care

The nurse mixes 50 mg of Nipride in 250 ml of D5W and plans to administer the solution at a rate of 5 mcg/kg/min to a client weighing 182 pounds. Using a drip factor of 60 gtt/ml, how many drops per minute should the client receive? A) 31 gtt/min. B) 62 gtt/min. C) 93 gtt/min. D) 124 gtt/min

D) 124 gtt/min

A client with acute hemorrhagic anemia is to receive four units of packed RBCs (red blood cells) as rapidly as possible. Which intervention is most important for the nurse to implement? A) Obtain the pre-transfusion hemoglobin level. B) Prime the tubing and prepare a blood pump set-up. C) Monitor vital signs q15 minutes for the first hour. D) Ensure the accuracy of the blood type match.

D) Ensure the accuracy of the blood type match All interventions should be implemented prior to administering blood, but (D) has the highest priority. Any time blood is administered, the nurse should ensure the accuracy of the blood type match in order to prevent a possible hemolytic reaction

The nurse notices that the Hispanic parents of a toddler who returns from surgery offer the child only the broth that comes on the clear liquid tray. Other liquids, including gelatin, popsicles, and juices, remain untouched. What explanation is most appropriate for this behavior? A) The belief is held that the "evil eye" enters the child if anything cold is ingested. B) After surgery the child probably has refused all foods except broth. C) Eating broth strengthens the child's innate energy called "chi." D) Hot remedies restore balance after surgery, which is considered a "cold" condition.

D) Hot remedies restore balance after surgery, which is considered a "cold" condition Common parental practices and health beliefs among Hispanic, Chinese, Filipino, and Arab cultures classify diseases, areas of the body, and illnesses as "hot" or "cold" and must be balanced to maintain health and prevent illness. The perception that surgery is a "cold" condition implies that only "hot" remedies, such as soup, should be used to restore the healthy balance within the body, so (D) is the correct interpretation. (A, B, and C) are not correct interpretations of the noted behavior. "Chi" is a Chinese belief that an innate energy enters and leaves the body via certain locations and pathways and maintains health. The "evil eye," or "mal ojo," is believed by many cultures to be related to the balance of health and illness but is unrelated to dietary practice.

At the beginning of the shift, the nurse assesses a client who is admitted from the post-anesthesia care unit (PACU). When should the nurse document the client's findings? A) At the beginning, middle, and end of the shift. B) After client priorities are identified for the development of the nursing care plan. C) At the end of the shift so full attention can be given to the client's needs. D) Immediately after the assessments are completed

D) Immediately after the assessments are completed Documentation should occur immediately after any component of the nursing process, so assessments should be entered in the client's medical record as readily as findings are obtained (D). (A, B, and C) do not address the concepts of legal recommendations for information management and informatics.

The UAPs working on a chronic neuro unit ask the nurse to help them determine the safest way to transfer an elderly client with left-sided weakness from the bed to the chair. What method describes the correct transfer procedure for this client? A) Place the chair at a right angle to the bed on the client's left side before moving. B) Assist the client to a standing position, then place the right hand on the armrest. C) Have the client place the left foot next to the chair and pivot to the left before sitting. D) Move the chair parallel to the right side of the bed, and stand the client on the right foot

D) Move the chair parallel to the right side of the bed, and stand the client on the right foot (D) uses the client's stronger side, the right side, for weight-bearing during the transfer, and is the safest approach to take. (A, B, and C) are unsafe methods of transfer and include the use of poor body mechanics by the caregiver.

An elderly resident of a long-term care facility is no longer able to perform self-care and is becoming progressively weaker. The resident previously requested that no resuscitative efforts be performed, and the family requests hospice care. What action should the nurse implement first? A) Reaffirm the client's desire for no resuscitative efforts. B) Transfer the client to a hospice inpatient facility. C) Prepare the family for the client's impending death. D) Notify the healthcare provider of the family's request.

D) Notify the healthcare provider of the family's request The nurse should first communicate with the healthcare provider (D). Hospice care is provided for clients with a limited life expectancy, which must be identified by the healthcare provider. (A) is not necessary at this time. Once the healthcare provider supports the transfer to hospice care, the nurse can collaborate with the hospice staff and healthcare provider to determine when (B and C) should be implemented

An older client who is a resident in a long term care facility has been bedridden for a week. Which finding should the nurse identify as a client risk factor for pressure ulcers? A) Generalized dry skin. B) Localized dry skin on lower extremities. C) Red flush over entire skin surface. D) Rashes in the axillary, groin, and skin fold regions

D) Rashes in the axillary, groin, and skin fold regions Immobility, constant contact with bed clothing, and excessive heat and moisture in areas where air flow is limited contributes to bacterial and fungal growth, which increases the risk for rashes (D), skin breakdown, and the development of pressure ulcers. (A, B, and C) do not address the concepts of inflammation and tissue integrity

The nurse is performing nasotracheal suctioning. After suctioning the client's trachea for fifteen seconds, large amounts of thick yellow secretions return. What action should the nurse implement next? A) Encourage the client to cough to help loosen secretions. B) Advise the client to increase the intake of oral fluids. C) Rotate the suction catheter to obtain any remaining secretions. D) Re-oxygenate the client before attempting to suction again.

D) Re-oxygenate the client before attempting to suction again Suctioning should not be continued for longer than ten to fifteen seconds, since the client's oxygenation is compromised during this time (D). (A, B, and C) may be performed after the client is re-oxygenated and additional suctioning is performed.

A female client asks the nurse to find someone who can translate into her native language her concerns about a treatment. Which action should the nurse take? A) Explain that anyone who speaks her language can answer her questions. B) Provide a translator only in an emergency situation. C) Ask a family member or friend of the client to translate. D) Request and document the name of the certified translator.

D) Request and document the name of the certified translator A certified translator should be requested to ensure the exchanged information is reliable and unaltered. To adhere to legal requirements in some states, the name of the translator should be documented (D). Client information that is translated is private and protected under HIPAA rules, so (A) is not the best action. Although an emergency situation may require extenuating circumstances (B), a translator should be provided in most situations. Family members may skew information and not translate the exact information, so (C) is not preferred.

An Arab-American woman, who is a devout traditional Muslim, lives with her married son's family, which includes several adult children and their children. What is the best plan to obtain consent for surgery for this client? A) Obtain an interpreter to explain the procedure to the client. B) Encourage the client to make her own decision regarding surgery. C) Ask the family members to provide an interpretation of the surgeon's explanation to the client. D) Tell the surgeon that the son will decide after explanation of the proposed surgery is provided.

D) Tell the surgeon that the son will decide after explanation of the proposed surgery is provided Traditional Muslim women live in a patriarchal family where decisions are made by men. Most likely, the son will make the decision for his mother, so (D) provides the surgeon with culturally sensitive information. (A) may be necessary if a language barrier exists, but the son is the patriarch in the client's family at this time. It is culturally insensitive to encourage the woman to go against her religious and cultural worldview, as in (B). Family members are more likely to misinterpret medical information, but the son should be the primary decision-maker for his mother (C).

Which nutritional assessment data should the nurse collect to best reflect total muscle mass in an adolescent? A) Height in inches or centimeters. B) Weight in kilograms or pounds. C) Triceps skin fold thickness. D) Upper arm circumference.

D) Upper arm circumference Upper arm circumference (D) is an indirect measure of muscle mass. (A and B) do not distinguish between fat (adipose) and muscularity. (C) is a measure of body fat.

A male client tells the nurse that he does not know where he is or what year it is. What data should the nurse document that is most accurate? A) demonstrates loss of remote memory. B) exhibits expressive dysphasia. C) has a diminished attention span. D) is disoriented to place and time.

D) is disoriented to place and time The client is exhibiting disorientation (D). (A) refers to memory of the distant past. The client is able to express himself without difficulty (B), and does not demonstrate a diminished attention span (C).

Symptoms + BG >=200ml/dl at any time w/o regard to meal 2hr post-load glucose >200 (oral gluc test) fasting >126

Diagnostic Criteria

The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours Humalog is a rapid-acting insulin. NPH is an intermediate-acting insulin. A short-acting insulin is Humulin-R. An example of a long-acting insulin is Glargine (Lantus)

Duration of Insulin is:

subset of type 2 due to hormone release from placenta resist insulin 2nd & 3rd Trimester, give glucose challenge, dx if over 126

Gestational Diabetes

Hypoglycemia

Glucagon is used primarily to treat a patient with

Complete Blood Count (CBC)

Hematocrit (Ht) Volume fraction Hemoglobin (Hbg) Critical WBC White Blood Cells (WBC) Platelets

Lente, NPH Onset: 2-4 hrs Duration: 16-20 hours Peak: 4-12 hours

Intermediate

used to treat ventricular ectopy, ventricular tachycardia, and ventricular fibrillation

Lidocaine

Ultra Lente, Glargine (LANTUS) Onset: 1 hr Duration: 24 hrs NO PEAK

Long Acting

When to use? Morphine, O2, nitroglycerin, aspirin

MONA

Larger vessel damage

Macroangiopathy

clots build up, accelorates athro sclerosis, which can lead to myocardial infarction

Macrovascualr Angiopathy

Hemoglobin (Hbg) (normal values)

Male: 14-18 g/dL Female: 12-16 g/dL

Central Obesity, in a prothrombotic state (prone to clots), proinflammatory state, dyslipidemia, elevated BP 135/85 These people WILL get heart disease & diabetes

Metabolic Syndrome

Disease in blood vessels, in SMALLER (eyes, diabetic retinapothy)

Microangiopathy

blood seeps & protein leaks out, leads to blindness (diabetic retinapothy)

Microvascualr Angiopathy

Once digested, 100% of carbohydrates are converted to glucose. However, approximately 40% of protein foods are also converted to glucose, but this has minimal effect on blood glucose levels

Once digested, what percentage of carbohydrates is converted to glucose

The P wave depicts atrial depolarization, or spread of the electrical impulse from the sinoatrial node through the atria.

P Wave

"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." Explanation: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers

P-R interval

The PR interval represents spread of the impulse through the interatrial and internodal fibers, atrioventricular node, bundle of His, and Purkinje fibers.

PR Interval

Coagulates

Prothrombin Time (PT) Activated Partial Thromboplastin Time (aPTT) International normalized ratios (INR)

QRS always widened Treat with lidocaine Irregular rythm Can lead to vtach or vfib

Pvc

The QRS complex represents ventricular depolarization.

QRS Complex

Onset: 10-15 m Duration:2-4 hours Peak:1 hours Lispro (Humalog), Aspart, Apidra Give with breakfast

Rapid Acting

Regular(Humalin), Semilente Onset: 1-1.5 hr Duration: 4-6 hours Peak: 2-3 hours

Short Acting

Heart isnt beating fast enough to circulate O2, atropine

Sinus brady

Chemistry

Sodium Potassium Blood Urea Nitrogen (BUN) Creatinine Glucose, fasting Glucose, casual Glucose, critical levels Glycosylated Hemoglobin (HbA1C) Cholesterol (total)

Vagus stimulate, adenisone, cardiovert Narrow QRS

Svt

The T wave depicts the relative refractory period, representing ventricular repolarization

T Wave

Desmopressin Why?

The nurse is caring for a client with diabetes insipidus. The nurse should anticipate the administration of:

Serum Digoxin level

Therapeutic 0.5-2 ng/mL Toxicity > 2 ng/mL

Serum Lithium Level

Therapeutic 0.8-1.2 mEq/L Toxicity > 1.5 mEq/L

Serum Phenytoin level

Therapeutic: 10-20 ug/mL Toxicity: >20 ug/mL

Treat: Sulfonurea (Increase insulin) + biguanide (incr. isnulin sensitivity), diet & exercise

Type 2

TX: insulin, meal spacing

Type I

Rate is verrrry fast Defib, acls, amiodarone

Vfib

Hr is 150-250 no p wave (cant determine atrial rate) No Pulse: defibrillator, amiodarone, cpr, acls Pulse: cardiovert/amioderano

Vtach

0.24 seconds Explanation: In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block.

Which PR interval presents a first-degree heart block?

Immediate bystander CPR Explanation: The treatment of choice for v-fib is immediate bystander cardiopulmonary resuscitation (CPR), defibrillation as soon as possible, and activation of emergency services

Which of the following is the treatment of choice for ventricular fibrillation

Immediate defibrillation Explanation: Defibrillation is used during pulseless ventricular tachycardia, ventricular fibrillation, and asystole (cardiac arrest) when no identifiable R wave is present.

You enter your client's room and find him pulseless and unresponsive. What would be the treatment of choice for this client?

used to treat symptomatic bradycardia

atropine

Early morning hyperglycemia resulting from increased growth hormone circulation

dawn phenomenon

Blood alcohol level

legal intoxication 0.10%

Arterial Blood Gasses (ABGs)

pH pO2 pCO2 SaO2 Bicarbonate (HCO3)

Impaired glucose tolerance 140-199 impaired fasting glucose 110-126 screen at 40 is FHx present encourage weightloss

pre-diabetes