Med Surg 1 ATI
Atherosclerosis
"hardening of the arteries" begins as soft deposits of fat that harden with age
Goals of HIV
(1) monitoring HIV disease progression and immune function (2) initiating and monitoring antiretroviral therapy (ART) (3) preventing the development of opportunistic diseases (4) detecting and treating opportunistic diseases (5) managing symptoms (6) preventing or decreasing complications of treatment (7) preventing further transmission of HIV
what will a person look like if they are HYPERglycemic?
-3 P's: polyuria, polydipsia, polyphagia -dehydration -fatigue -fruity order to breath -Kussmaul breathing -weight loss -hunger -poor wound healing -Tachycardia -sunken eyes -abdominal pain
What type of drugs are prescribed for PAD?
-ACE inhibitors -Antiplatelet agents
Which racial or ethnic groups are at a higher risk for impaired glucose regulation?
-American Indians -Alaska Natives -African Americans -Hispanics/Latinos -Mexican Americans -Asians
What are the 2 drugs used for treatment of relapsing MS?
-Aubagio: immunomodulatory agent with anti-inflammatory properties -Gilenya: prevents lymphocytes from reaching the CNS and causing damage
HYPERvolemia manifestations
-BEST indicator is daily weight -peripheral edema -jugular venous distention -bounding pulse -increase BP -dyspnea, crackles -muscles spasms
HYPOphosphatemia manifestations
-CNS depression -muscle weakness/pain -respiratory and heart failure -rickets and osteomalacia -confusion
name some risk factors for a pulmonary embolism
-DVT (most common) -immobility or reduced mobility -surgery -history of DVT -obesity -smoking -HF -pregnancy -clotting disorder -Afib -fractured long bones
What are the primary drugs used to treat tonic-clonic and focal-onset seizures?
-Dilantin: teach oral care -Tegretol: watch for changes in behavior -Phenobarbital: causes drowsiness -Depakene: DO NOT crush
What are the diagnostic studies for CAD?
-ECG 12 lead (track the electrical activity of the heart) -Cardiac Catherization (to identify and localize CAD)
What can cause HYPOnatremia?
-GI losses: diarrhea, vomiting, fistulas, NG suction -renal losses: diuretics, adrenal insufficiency -skin losses: burns, wound drainage
HYPERphosphatemia manifestations
-HYPOcalcemia -numbness/tingling in mouth and extremities -muscle cramps -tetany -seizures -calcified deposition in soft tissue such as: joints, arteries, skin, kidneys and corneas
Name the modifiable risk factors for CAD
-High serum lipids -hypertension -tobacco use -physical inactivity -obesity
How should the nurse treat a superficial vein thrombosis?
-NSAIDS (Arixtra) -elevate extremity -compression stockings -mild exercise -warm compress
Drugs that restrict lipoprotein production for CAD
-Rosuvastatin (Crestor) -Simvastatin (Zocor)
What are some complications of seizures?
-SE -severe injury and death can result form trauma during a seizure -effects on lifestye
When is immediate medical care required for seizures?
-SE occurs -significant bodily harm occurs -first time seizure -lasting longer than 5 minutes
What are the drugs used most often to treat generalized-onset NONmotor and myoclonic seizures?
-Zarontin: take with food, causes drowsiness -Divalproex: blood levels -Klonopin
Diagnostic studies of seizures
-accurate, comprehensive description of seizures and health history** -EEG- MEG with an EEG -CBC, serum chemistries, liver and kidney function, US to rule out metabolic disorders -CT or MRI
What are some metabolic problems that may cause seizures?
-acidosis -electrolyte imbalances -HYPOglycemia -HYPOxemia -alcohol or barbiturate withdrawal -dehydration or water intoxication
Name some nonmelanoma skin cancers
-actinic keratosis -basal cell carcinoma -squamous cell carcinoma
What causes HYPERphosphatemia?
-acute kidney injury -chronic kidney disease -excess intake of phosphate or V D -hypoparathyroidism -renal failure -sickle cell anemia -hyperthermia
Name the nonmodifiable risk factors for CAD
-age -gender -ethnicity -family history -genetics
How should the nurse treat CF?
-aggressive CPT -antibiotics -O2 therapy -postural drainage with percussion and vibration -monitoring stools
What are some short acting bronchodilators used to treat COPD?
-albuterol (rapid acting or rescue inhaler) -Albuterol and atrovent
For a person with MS, what will their emotional manifestations look like?
-anger -depression -euphoria
Name some risk factors for pneumonia
-aspiration -inhalation of microbes -hematogenous spread
What are some antiplatelet drugs for PAD?
-aspirin -Clopidogrel (Plavix)
What can the nurse do while they are waiting for help to arrive when a trach becomes dislodged?
-assess ABCs -presence or absence of any respiratory distress -use a hemostat to spread the opening where the tube was displaced -insert the obturator in the replacement (spare) trach tube, lube tube with saline and insert the tube into the stoma -remove the obturator at once so air can flow through the tube -other option is to insert a suction cath to allow passage of air and serve as a guide for insertion
Psoriasis
-autoimmune disease -extremely rapid turnover of epidermal cells -no cure but control is possible
What are some other forms of drug therapy used to treat MS?
-muscle relaxants -CNS stimulants -anticholinergic -tricyclic antidepressants -selective potassium channel blockers -antiseizure drugs
How is the postictal phase of a tonic-clonic seizure characterized?
-muscle soreness -fatigue -may sleep for several hours -may not feel normal for hours or days -have no memory of seizure
What are the diagnostic tests for PD?
-no specific test exist -diagnosis is based on history and clinical features -requires presence of TRAP
Name the 2 categories of lung cancer
-non-small cell (NSCLC)= 80% -small cell (SCLC)= 20%
What are some serious complication of PAD?
-nonhealing arterial ulcers and gangrene -may result in amputation
How will the nurse treat a pt with HYPERnatremia?
-replace fluids orally or IV with ISOTONIC or HYPOTONIC fluids -make sure to decrease sodium levels gradually
The nurse is preparing a trach tube emergency replacement kit, what will be included in it?
-replacement tube of equal or smaller size at bedside -BVM -hemostats -lubrication -suction cath -obturator
Three VTE measures
1) early and progressive mobilization 2) compression stockings 3) SCD's
What is the infection process?
1) pathogen 2) susceptible host 3) reservoir 4) portals of exit from the reservoir 5) mode of transmission 6) portal of entry to the susceptible host
How is HIV progression monitored?
1. CD4+T counts 2. Viral load -lower viral load the less active the disease
Magnesium (Mg) levels
1.3-2.1 mEq/L
Sodium (Na) levels
136-145 mEq/L
Platelets
150,000 to 400,000
The cuff should not be inflated more than what?
20-25 cm H20
Bicarb (HCO3) levels
22-26 mEq/L
Phosphate (PO4) levels
3.0-4.5 mg/dL
What is the normal potassium level?
3.5 to 5
Potassium (K) levels
3.5-5.0 mEq/L
What is a normal output in an hour?
30 mL or 1 output every 8 hr
PaCO2 normal range
35-45 mm Hg
RBC
4.2 to 5.4 million/mm3
What are normal white blood cell count levels?
5,000 to 10,000 mm3
What is the normal range for WBC?
5,000-10,000
What is a normal A1C percentage?
6% or less
What is a prediabetic A1C percentage?
6-7%
What is the goal A1C for diabetic patients?
7%
pH range
7.35-7.45
What is a normal glucose range?
70-110 mg/dL
What is the normal glucose range?
74-106 mg/dL
Calcium (Ca) levels
9.0-10.5 mg/dL
Ramipril (Altace)
ACE inhibitor for PAD -decrease: cardiovascular morbidity and mortality -increase: peripheral blood flow, ABI, and walking distance
If a pt has pneumocystis jiroveci pneumonia what can you diagnose them with?
AIDS
pneumonia
Acute infection in the lung parenchyma
ABCDE rule
Asymmetry Border irregularity Color change Diameter >6 mm Evolving in appearance
What is a lab test the nurse could run to check for infection?
CBC with white blood cell with differential
name the target cells for HIV
CD4+T cells
The nurse is caring for a pt who is going to have a cardiac catherization done today. What should the nurse do postoperatively?
Compare post assessment with baseline, monitor catheter insertion site for hematoma, and bleeding, teach will need to lay flat and not bend affected leg for 2-6 hours depending on site closer, monitor ECG and for chest pain. Increase fluids to flush out dye and prevent dehydration
What is the most common diagnostic test for pulmonary embolism?
D-dimer: with blood draw
HYPOvolemia
ECF volume deficit
HYPERvolemia
ECF volume excess
HYPERvolemmia
ECF volume excess
T or F: we know what causes MS
FALSE
T or F: people with type 1 can take Metformin
FALSE: because they are insulin-dependent they can only receive insulin injections
How will a pt present if they have HIV?
FLULIKE SYMPTOMS -fever -swollen lymph nodes -sore throat -headache -malaise -nausea -muscle and join pain -diarrhea
T or F: symptoms for lung cancer appear early
False -will appear later in disease as it may be masked by chronic cough
FITT formula for CAD
Frequency Intensity Type Time
Drugs that are fibric acid derivatives for CAD
Gemfibrozil (Lopid) -increases bleeding with warfarin (coumadin)
HYPERnatremia
High sodium >145 mEq/L -elevated serum sodium occurring with inadequate water intake, excess water loss or sodium gain -cellular dehydration
What is the nurses primary concern if the trach becomes dislodged?
IMMEDIATELY call for help
Which organ regulates potassium? -liver -lungs -heart -kidneys
Kidneys
What is the primary treatment of PD?
Levodopa with Carbidopa
Is there a certain test that is used to diagnose MS?
NO -based on history, clinical manifestations, and results of certain diagnostic tests
What is a good way to treat pulmonary embolisms?
PREVENTION -compression devices -early ambulation -prophylactic anticoagulation GOAL: to prevent further thrombi
what is the most definitive diagnostic test for a pulmonary embolism?
Spiral CT scan -requires IV contrast media -allows visulation of the lungs
T or F: the keto diet helps control seizures
TRUE: the high-fat, low carb diet helps -ketones pass into the brain and replace glucose as an energy source
16 yr old normal vital signs
Temp: 97.5-98.6 Pulse: 55-85 RR: 12-18
10 yr old normal vital signs
Temp: 97.5-98.6 Pulse: 60-95 RR: 14-22
4 yr old normal vital signs
Temp: 97.5-98.6 Pulse: 66-110 RR: 20-25
2 yr old normal vital signs
Temp: 97.5-98.6 Pulse: 70-110 RR: 20-30
Newborn normal vital signs
Temp: 97.7-99.1 Pulse: 100-150 RR: 35-55
Generalized-onset MOTOR seizures
Tonic-clonic or grand mal -start over wide areas of both sides of the brain -most common generalized-onset motor seizure
PD TRAP
Tremor Rigidity Akinesia Postural instability
Can a person with MS go into remission?
YES, the myelin can regenerate and want them to stay in remission
diabetes mellitus
a chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization or both
Insulin
a hormone that is made by the B cells in the islets of Langerhans of the pancreas
What drugs are prescribed to pts with CAD?
a lipid-lowering drug therapy statins are recommended
What is a cardiovascular assessment finding for someone who is HYPOvolemic?
a weak, thready pulse
The nurse teaches a patient recently diagnosed with type 1 diabetes about insulin administration. Which statement by the patient requires an intervention by the nurse? a) "I will discard any insulin bottle that is cloudy in appearance." b) "The best injection site for insulin administration is in my abdomen." c) "I can wash the site with soap and water before insulin administration." d) "I may keep my insulin at room temperature (75° F) for up to 1 month."
a) "I will discard any insulin bottle that is cloudy in appearance."
The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes? a) A 48-yr-old woman with a hemoglobin A1C of 8.4% b) A 58-yr-old man with a fasting blood glucose of 111 mg/dL c) A 68-yr-old woman with a random plasma glucose of 190 mg/dL d) A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL
a) A 48-yr-old woman with a hemoglobin A1C of 8.4%
The nurse is assigned to care for a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in managing diabetes, what should be the nurse's initial intervention? a) Assess patient's perception of what it means to have diabetes. b) Ask the patient to write down current knowledge about diabetes. c) Set goals for the patient to actively participate in managing his diabetes. d) Assume responsibility for all of the patient's care to decrease stress level.
a) Assess patient's perception of what it means to have diabetes.
The nurse has been teaching a patient with diabetes how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? a) Chooses a puncture site in the center of the finger pad. b) Washes hands with soap and water to cleanse the site to be used. c) Warms the finger before puncturing the finger to obtain a drop of blood. d) Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.
a) Chooses a puncture site in the center of the finger pad.
The nurse is caring for a pt who is receiving antiretroviral therapy (ART) for treatment of AIDS. Which assessment BEST indicates that the pts condition is improving? a) Decreased viral load b) Increased drug resistance c) Decreased CD4+T cell count d) Increased aminotransferase levels
a) Decreased viral load
The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? a) Increased triglyceride levels b) Increased high-density lipoproteins (HDL) c)Decreased low-density lipoproteins (LDL) d) Decreased very-low-density lipoproteins (VLDL)
a) Increased triglyceride levels
A patient has human immunodeficiency virus (HIV) infection and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result? a) The patient has the virus but the infection is well controlled. b) The syndrome has been cured, and the patient can discontinue all medications. c) The patient will be prescribed lower doses of antiretroviral medications for 2 months. d) The patient is not taking antiretrovirals and needs to be taught the benefits of therapy.
a) The patient has the virus but the infection is well controlled. In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/μL or as undetectable. "Undetectable" indicates that the viral load is lower than the test is able to report. "Undetectable" indicates that the patient still has the virus, but the virus is well controlled.
Which oxygen mask provides consistent oxygen concentration? a) VM b) NRB c) PRM d) simple F
a) VM
A nurse in the ED is assessing a client for a closed pneumothorax and significant bruising of the left chest following a motor-vehicle crash. The client reports severe left chest pain on inspiration. The nurse should assess the client for which of the following manifestations of pneumothorax? a) absence of breath sounds b) expiratory wheezing c) inspiratory stridor d) rhonchi
a) absence of breath sounds A client who has pneumothorax experiences severely diminished or absent breath sounds on the affected side.
HYPERcalcemia will cause: a) acidosis b) alkalosis
a) acidosis
The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? a) cheese b) broccoli c) chicken d) oranges
a) cheese
A nurse in an urgent care clinical is collecting data from a client who reports exposure to anthrax. Which of the following finding is an indication of the prodromal stage of inhalation anthrax? a) dry cough b) rhinitis c) sore throat d) swollen lymph nodes
a) dry cough A dry cough is a clinical manifestation found in the prodromal stage of having inhalation anthrax. During this stage, it is difficult to distinguish from influenza or pneumonia because there is no sore throat or rhinitis.
A nurse is planning care for a client who has COPD and is malnourished. Which of the following recommendations to promote nutritional intake should the nurse include in the plan? a) eat high calorie foods first b) increase intake of water at meal times c) perform active range of motion exercises before meals d) keep saltine crackers nearby for snacking
a) eat high calorie foods first The client who has COPD often experiences early satiety. Therefore, the client should eat calorie-dense foods first.
The nurse is assessing a patient newly diagnosed with type 2 diabetes. Which symptom reported by the patient correlates with the diagnosis? a) excessive thirst b) gradual weight gain c) overwhelming fatigue d) recurrent blurred vision
a) excessive thirst
A nurse is assessing a client who has fluid overload from a cardiovascular disorder. which of the following manifestations should the nurse expect? (select all that apply) a) jugular vein distension b) moist crackles c) postural hypotension d) increased heart rate e) fever
a) jugular vein distension b) moist crackles d) increased heart rate The increase in venous pressure due to excessive circulating blood volume results in neck vein distension. This is an indicator of pulmonary edema that can quickly lead to death. Fluid volume excess, or hypervolemia, is an expansion of fluid volume in the extracellular fluid compartment. This results in increased heart rate and bounding pulses.
The nurse is called to the pts room by the pts spouse when the pt experiences a seizure. Upon finding the pt in a clonic reaction, what should the nurse do first? a) turn the pt to the side b) start O2 via mask at 6 L/min c) restrain the pts arms and legs to prevent injury d) record the time sequence of the pts movements and responses as they occur e) none of the above
a) turn the pt to the side
A nurse is providing discharge teaching to a client who has AIDS about preventing infection while at home. Which of the following instructions should the nurse include in the teaching? a) was your genitalia using an antimicrobial soap b) rinse your dishes with cold water c) clean your toothbrush once per month d) incorporate raw fruits and vegetables into your diet
a) was your genitalia using an antimicrobial soap
A nurse is teaching a client who has HIV about the early manifestations of AIDS. Which of the following statements should the nurse include in the teaching? a) you can expect a persistent fever and swollen glands b) you can expect an elevated white blood cell count c) you can expect an increase in blood pressure and edema d) you can expect weight gain
a) you can expect a persistent fever and swollen glands Clients who have AIDS can have persistent fever, swollen glands, diarrhea, weight loss, and fatigue. These manifestations indicate the onset of AIDS.
pulmonary edema
abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs complication of various lung and heart diseases
Akinesia
absence or loss of control of voluntary muscles movements
Phlebitis
acute inflammation of walls of veins in hand or arm
What medications are pts treated with if they have CF?
aerosol and nebulization of meds to dilate the airways and liquefy mucus and to facilitate clearance
pertussis
aka whooping cough highly contagious infection of the respiratory tract caused by gram-neg bac
What does a pulmonary embolism obstruct?
alveolar perfusion
Actinic keratosis
an irregularly shaped, flat, papule with indistinct borders and an overlying hard keratotic scale or horn
What drugs are used to treat seizures?
antiseizure drugs -stabilize nerve cell membranes and prevent spread of the epileptic discharge -1/3 of pts need a combo regimen for adequate control
The nurse teaches a patient with diabetes about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? a) "I plan to lose 25 pounds this year by following a high-protein diet." b) "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." c) "I should include more fiber in my diet than a person who does not have diabetes." d) "If I use an insulin pump, I will not need to limit foods with saturated fat in my diet."
b) "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."
The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the instructions if the patient makes what statement? a) "I should only walk barefoot in nice dry weather." b) "I should look at the condition of my feet every day." c) "I will need to cut back the number of times I shower per week." d) "My shoes should fit nice and tight because they will give me firm support."
b) "I should look at the condition of my feet every day."
There is one opening in the schedule at the derm clinic, and four pts are seeking appointments today. Which pt will the nurse schedule for the available opening? a) 50 yr with skin redness after having a chemical peel 3 days ago b) 38 yr with a 7 mm nervs on the face that has recently become darker c) 62 yr with multiple small, soft, pedunculated papules in both axillary areas d) 42 yr with complaints of itching after using topical fluorouracil on the nose
b) 38 yr with a 7 mm nervs on the face that has recently become darker
Which patient with type 1 diabetes would be at the highest risk for developing hypoglycemic unawareness? a) A 58-yr-old patient with diabetic retinopathy b) A 73-yr-old patient who takes propranolol (Inderal) c) A 19-yr-old patient who is on the school track team d) A 24-yr-old patient with a hemoglobin A1C of 8.9%
b) A 73-yr-old patient who takes propranolol (Inderal)
The nurse informs the pts with a bacterial pneumonia that the MOST important factor in antibiotic treatment is: a) Antibiotics should have been used to prevent pneumonia b) All the supplied antibiotics should be taken even when symptoms have resolved c) Enough antibiotics for 2 days treatment should be reserved in case symptoms recur d) Pts should request antibiotics for upper respiratory infections to prevent development of spreptococcal-related diseases
b) All the supplied antibiotics should be taken even when symptoms have resolved
A nurse is teaching a client who has HIV about how the virus is transmitted. Which of the following statements should the nurse include the teaching? a) HIV can be transmitted as soon a person develops manifestations b) HIV can be transmitted to anyone who has contact with the infected blood c) HIV is transmitted through the respiratory route through droplets d) HIV is transmitted only during the active phase of the virus
b) HIV can be transmitted to anyone who has contact with the infected blood
A patient with diabetes is scheduled for a fasting blood glucose level at 8:00 AM. The nurse teaches the patient to only drink water after what time? a) 6:00 PM on the evening before the test b) Midnight before the test c) 4:00 AM on the day of the test d) 7:00 AM on the day of the test
b) Midnight before the test
Which oxygen mask provides the highest oxygen flow? a) VM b) NRB c) PRM d) simple FM
b) NRB
A patient is admitted with a diagnosis of cellulitis of the left leg and has been placed on antibiotics. Which laboratory result is the best indicator that the treatment is having a positive outcome for the patient? a) WBC of 2,900/μL b) WBC of 8,200/μL c) WBC of 12,700/μL d) WBC of 16,300/μL
b) WBC of 8,200/μL
HYPOcalcemia will cause.... a) acidosis b) alkalosis
b) alkalosis
A nurse was accidently stuck with a needle used on a pt who is infected with HIV. After reporting the incident, what care should this nurse receive first? a) personal protective equipment b) combination ART therapy c) counseling to report blood exposures d) a negative evaluation by the manager
b) combination ART therapy Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection.
A community health nurse is providing teaching about malignant melanoma to a group of clients. the nurse should inform the group that which of the following traits places a client at risk for developing malignant melanoma? a) brown eyes b) light skin c) black hair d) dark skin
b) light skin
A nurse is caring for a client who has a lesion on the back of his right hand. the client asks the nurse which type of skin cancer is the most serious. Which of the following responses by the nurse is appropriate? a) basal cell carcinomas b) melanomas c) actinic keratoses d) squamous cell carcinomas
b) melanomas Melanomas are malignant neoplasms with atypical melanocytes in both the epidermis, the dermis, and sometimes the subcutaneous cells. It is the most lethal type of skin cancer, often causing metastases in the bone, liver, lungs, spleen, the CNS, and lymph nodes.
A patient with diabetes who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? a) avoid sick people and wash hands b) obtain comprehensive dental care c) maintain hemoglobin A1C below 7% d) coughing and deep breathing with splinting
b) obtain comprehensive dental care
COPD pts are encouraged to modify their ADLs to conserve energy. They can do this by: a) running while doing ADLs b) sitting while doing ADLs c) laying down while doing ADLs d) playing cards while doing ADLs
b) sitting while doing ADLs
What can diabetes be the leading cause of? (select all that apply) a. lung cance rb. end-stage renal disease c. adult blindness d. chronic cough e. nontraumatic lower limb amputations
b. end-stage renal disease c. adult blindness e. nontraumatic lower limb amputations
how do you treat squamous cell carcinoma?
biopsy and treat
The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? a) A new onset of polycythemia b) Presence of mononucleosis-like symptoms c) A sharp decrease in the patient's CD4+ count d) A sudden increase in the patient's WBC count
c) A sharp decrease in the patient's CD4+ count A decrease in CD4+ count signals an exacerbation of the severity of HIV.
When planning care for a patient with dehydration related to nausea and vomiting, the nurse would anticipate which fluid shift to occur because of the fluid volume deficit? a) Fluid movement from the blood vessels into the cells b) Fluid movement from the interstitial space into the cells c) Fluid movement from the interstitial spaces into the plasma d) Fluid movement from the blood vessels into interstitial spaces
c) Fluid movement from the interstitial spaces into the plasma In dehydration, fluid is lost first from the blood vessels. To compensate, fluid moves out of the interstitial spaces into the blood vessels to restore circulating volume in that compartment.
What kind of breather are pediatrics? a) mouth b) chest c) nose d) ear
c) nose
A nurse is caring for a client who has HIV. Which of the following types of isolation should the nurse implement to prevent transmission of HIV? a) protective isolation b) droplet precautions c) standard precautions d) airborne precautions
c) standard precautions Standard precautions should be implemented with every client, to prevent the spread of infection transmitted by direct or indirect contact with infectious blood or body fluids. Because HIV is spread through blood and bodily fluids, standard precautions are appropriate.
a nurse is planning to instruct a client on how to perform pursed lip breathing. Which of the following should the nurse include in the plane of care? a) take quick breaths upon inhalation b) place your hand over your stomach c) take a deep breath in through your nose d) puff your cheeks upon exhalation
c) take a deep breath in through your nose -blow out twice as long as you breath in
The nurse should instruct their MS pt to minimize what?
caffeine intake
What should the nurse do if the seizure lasts longer than 5 minutes?
call for help and be timing the seizure
pulmonary hypertension
caused by constriction of pulmonary vessels in a response to alveolar hypoxia -leading to right side HF (cor pulmonal)
What is the first diagnostic test done for pts with suspected lung cancer?
chest x-ray
At what age are CF signs and symptoms first noticed?
childhood
parkinson's disease
chronic, progressive neurodegenerative disorder characterized by bradykinesia, rigidity, tremor at rest, and gait changes
multiple sclerosis
chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord
What is the most common risk factor for COPD?
cigarette smoking
What is the primary cause of COPD?
cigarette smoking
What is the most common cause of COPD?
cor pulmonale
Which statement made by a parent indicates an understanding about the management of a child with cellulitis on the arm? a) "I am supposed to continue the antibiotic until the redness and swelling disappear" b) "I have been putting ice on my son's arm to relieve the swelling" c) "I should call the doctor if the redness disappears" d) "I have been putting a warm soak on my son's arm every 4 hours"
d) "I have been putting a warm soak on my son's arm every 4 hours"
The nurse is teaching a patient with type 2 diabetes about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? a) "I will go running when my blood sugar is too high to lower it." b) "I will go fishing frequently and pack a healthy lunch with plenty of water." c) "I do not need to increase my exercise routine since I am on my feet all day at work." d) "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week."
d) "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week."
The nurse assesses small, firm, reddened raised lesions with flat, rough patches on a patient that are causing intense pruritus. What question should the nurse next ask the patient? a) "Have you started any new medications?" b) "Do you have a history of seasonal allergies?" c) "Have you had any lesions such as this before?" d) "Tell me about your activities the past 2 to 7 days."
d) "Tell me about your activities the past 2 to 7 days."
As the nurse you encourage your COPD pt to drink plenty of water. How much water should they drink daily? a) 3-5 L b) 9-10 L c) 0-1 L d) 2-3 L
d) 2-3 L to help thin secretions
What is the median life span of someone who has CF? a) 100 b) 86 c) 19 d) 41
d) 41
The nurse caring for a patient hospitalized with diabetes would look for which laboratory test result to obtain information on the patient's past glucose control? a) Prealbumin level b) Urine ketone level c) Fasting glucose level d) Glycosylated hemoglobin level
d) Glycosylated hemoglobin level
The nurse is teaching the residents of an independent living facility about preventing skin infections and infestations. What should be included in the teaching? a) Use cool compresses if an infection occurs. b) Oral antibiotics are needed for any skin changes. c) Antiviral agents will be needed to prevent outbreaks. d) Inspect skin for changes when bathing with mild soap.
d) Inspect skin for changes when bathing with mild soap.
A diagnosis of AIDS can be made for a pt with HIV with: a) A CD4+T cell count <500/uL b) A WBC count <3000/uL c) Development of oral candidiasis (thrush) d) Onset of Pneumocystis jiroveci pneumonia
d) Onset of Pneumocystis jiroveci pneumonia
Which nursing action would be of HIGHEST PRIORITY when suctioning a pt with a trach? a) auscultating lung sounds after suctioning is complete b) giving antianxiety meds 30 minutes before suctioning c) instilling 5 mL of normal saline into the trach tube before suctioning d) assess the pts oxygen saturation before, during and after suctioning
d) assess the pts oxygen saturation before, during and after suctioning
How can a pt with PAD decrease their ischemic pain?
dangling the legs or sleeping in a chair
How can one reduce the risk of RSV/bronchiolitis?
decontaminate surfaces
What is immunosuppressive therapy for MS?
drug therapy used to SLOW progression of disease -immunomodulators -adrenocorticotropic hormone
How will the nurse diagnose a superficial vein thrombosis?
duplex ultrasound
How can HIV be transmitted perinatally?
during pregnancy, delivery or breastfeeding
cor pulmonale
enlargement of the right ventricle caused by a primary disorder of the respiratory system
Why do CF pts appear malnourished?
enzymes do not reach the intestines to digest ingested nutrients
How often should you provide oral care to a pt who is NPO?
every 4 hr or as needed
How often should you clean a nondisposable inner cannula?
every shift
HYPERmagnesemia
excess of magnesium >2.1
HYPERkalemia
excessive potassium >5.0 *most common in renal failure
Exact cause of PD is unknown but..
interplay between environmental factors and genetics
Seborrheic keratosis
irregularly round or oval, often papules or plaques benign age spots
Chronic obstructive pulmonary disease (COPD)
is a preventable, treatable, but often progressive disease characterized by persistent airflow limitationassociated with an enhanced chronic inflammatory response in the airways and lungs, primarily caused by cigarette smoking
What is the best IV solution to give a pt who is in a volume deficit?
isotonic solutions such as: -normal solution -lactacted ringers -D5 for children
When the body cannot regulate immune responses, what can happen?
it allows for opportunistic diseases to develop
What is the primary organ for regulating fluid and electrolyte balance?
kidneys
HYPOglycemia
low blood sugar <70 mg/dL (severe <50)
HYPOnatremia
low sodium <136 mEq/L
What kind of skin cancer causes majority of skin cancer related deaths?
malignant melanoma
Hemoglobin (Hgb)
men: 13.5- 17.5 women: 12.0- 16.0
Hematocrit (Hct)
men: 38.3- 48.6% women: 35.5- 44.9%
What is the average life expectancy after the onset of symptoms?
more than 25 years
Basal cell carcinoma
most common type of skin cancer least deadly
glucose tolerance test (GTT)
most sensitive measure of glucose metabolism -early detection of diabetes
cystic fibrosis (CF)
multisystem disease characterized by altered transport of sodium and chloride ions in and out of epithelial cells
The nurse is performing suction on a trach pt, what should they adjust the suction pressure to?
no greater than 125 mm Hg pressure with tubing occluded
Type 2 diabetes
non-insulin dependent diabetes
What is the first line of treatment for actinic keratosis?
non-surgical
Paresthesia
numbness or tingling in toes or feet
If a pt has COPD, what is their drive to breath?
oxygen *too much oxygen can remove their drive to breath
M. Acidosis
pH: <7.35 PaCO2: 35-45 HCO3: <22
R. Acidosis
pH: <7.35 PaCO2: >45 HCO3: 22-26
M. Alkalosis
pH: >7.45 PaCO2: 35-45 HCO3: >26
R. Alkalosis
pH: >7.45 PaCO2: <35 HCO3: 22-26
How does someone develop type 2 diabetes?
pancreas continues to produce its own insulin but either: -NOT enough insulin is produced -body does not use insulin effectively
Name the most common symptoms of lung cancer
persistent cough with sputum
What confirms PD?
positive response to antiparkinsonian drugs
what is the most commonly used airway clearance technique for CF pts?
postural drainage
during acute exacerbation phases of MS, pts are at risk for what?
pressure ulcers
Coronary Artery Disease (CAD)
profound effect on perfusion -negatively affects cardiac function
Why are corticosteroids used to treat acute exacerbations?
reduce edema and acute inflammation at the site of demyelination
Atherectomy
removal of obstructing plaque
human immunodeficiency virus (HIV)
retrovirus that causes immunosuppression making person more susceptible to infections
myoclonic seizure
rhythmic arm abduction leading to progressive arm elevation -lasts 10-60 seconds
A trach tube with an inflated cuff is used for what?
risk for aspiration or in mechanical ventilation
What does a basal cell carcinoma look like?
rolled, well-defined "pearly" boarders and central erosion
When a persons CD4+T cell count reaches <200 what will happen?
severe problems develop AIDS
How do most CF pts appear?
short, under-weight, and malnourished because of protein malabsorption
The eustachian tubes of a child should be...
shorter and wider
bradykinesia
slowness in the initiation and execution of movement
Name the most important risk factor for lung cancer?
smoking
What kind of shoes should a pt with PAD wear?
soft, roomy protective footwear avoid extremes of hot and cold (no heating pads)
What diagnostic test confirms COPD?
spirometry
NONmotor ATYPICAL absence seizures
staring spells with other manifestations such as: -eye blinking -jerking movements of the lips -lasts longer than 10 seconds -usually continue into adulthood
status epilepticus (SE)
state of continuous seizure activity or condition when seizures recur in rapid succession without return to consciousness between seizures -any seizure lasting longer than 5 minutes -can happen to any type of seizure
What is steatorrhea?
stools with undigested fats -bulky -oily -foul smelling
What is the biggest intervention a nurse could recommend to their pt who has COPD?
stop smoking
Testing for HIV is the only....
sure method of determining HIV infection
What is a tracheostomy?
surgically created stoma (opening) in the trachea to: -establish a patent airway -bypass an airway obstruction -facilitate secretion removal -permit long -term mechanical ventilation -facilitate weaning from mechanical ventilation
What is the MAIN diagnostic tool for CF?
sweat chloride test >60 mmol/L
What is removed after placement has been confirmed in a tracheostomy?
the ET tube, if it is present
Trachs are the most dangerous during when?
the first 5-7 days
How will a pt present if they have HYPOkalemia?
the most serious: cardiac dysrhythmias -skeletal muscle weakness in the legs -decreased GI motility -hyperglycemia -soft, flabby muscles -decreased reflexes -constipation -shallow respirations -irregular pulse
What organ(s) does type 1 diabetes deal with?
the pancreas
postictal phase
the recovery period after the seizure -they need a lot of rest
In CF what obstructs the ducts of the lungs, pancreas, and intestines?
thick, viscous secretions -mucus will fill up (plug) glands in these organs. trapping sodium and chloride ions
Squamous cell carcinoma
thin, scaly erythematous plaque with indistinct boarders has the potential to metastasize
who is at greatest risk for severe injury and death from trauma during a seizure?
those who lose consciousness
How can HIV be transmitted?
through contact with certain body fluids -blood -semen -vaginal secretions -breast milk
What is the goal of drug therapy for seizure pts?
to prevent seizures with minimal drug side effects
Seizure disorders
transient, uncontrolled electrical discharge of neurons in the brain, interrupting normal function -also know as epilepsy -4th most common neurologic disorder
What is often the first sign of PD?
tremors -initially minimal
T or F: COPD develops slowly
true
What is the BIGGEST distinction between type 1 and 2?
type 1 diabetes there is an absence of the persons own insulin
Which type is more prevalent?
type 2
People with family history of what type of diabetes and condition are at an increased risk for insulin resistance?
type 2 and obesity
what is the most common type of pneumonia?
viral pneumonia -not treated with antibiotics
HIGH plasma osmolality results in...
water deficit
LOW plasma osmolality results in...
water excess
What is a predictor and poor prognosis of COPD in some pts?
weight loss
name a characteristic of asthma
wheezing, coughing, hyperventilation and air trapping
aural phase
with a sensory warning that is similar each time a seizure occurs and is considered part of the seizure -can have a metal taste in mouth
prodromal phase
with sensations or behavior changes that precede a seizure by hours or days
How can a diabetic person change their diet?
-avoid excess caloric intake, sweet drinks -have a diet high in whole grains, fruits and veggies -low sodium intake to lower BP and decrease risk of CVD
What is the overall goal when treating a seizure pt?
-be free from injury during seizure -optimal mental and physical functioning while taking meds -satisfactory psychosocial functioning
What can cause seizures in 2-20 year olds?
-birth injuries -head traumas -infection -genetic factors
What are some screenings a nurse can do to detect diabetic complications?
-blood pressure -dental examinations -foot examinations -eye examinations
What will some of the first symptoms of MS be?
-blurred or double vision -red/green color distortion -blindness in one eye
Radiation therapy for lung cancer
-both NSCLC and SCLC -used in comb with other therapies -used as a primary therapy for those who wish not to have surgical therapy
Name some treatments for COPD
-breathing retraining: PLB and diaphragmatic -effective coughing: huff coughing -chest physiotherapy -vibration vest -encourage pt to drink 2-3 L of h20 daily
How will the nurse treat HYPOcalcemia?
-calcium or vitamin D supplements -breathing into a paper bag -treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis
If someone has HYPERkalemia, how would they present?
-cardiac dysrhythmias -cramping leg pain -weak or paralyzed skeletal muscles -abdominal cramping -diarrhea -loss of muscle tone -decreased reflexes -confusion -irregular pulse
What assessments do you need to do postoperatively to the gastrointestinal area?
-check for bowel sounds -NG: verify placement to suction or clamped -nausea
Name some airway clearance techniques
-chest psypho therapy -high frequency chest wall oscillation systems -postural drainage -PEP devices -breathing exercises
What should the nurse monitor if the pt has cor pulmonal?
-chest x-ray -BNP will be increased
Name the diagnostic studies for lung cancer
-chest x-ray -CT scan of brain, pelvis, abdomen -lung biopsy for definitive diagnosis -pleural fluid analysis -MRI -PET scan -bone scans
What are some diagnostic tests to determine a pulmonary embolism?
-chest x-ray -electrocardiogram -troponin levels -b type natriuretic peptide -D-Dimer -Spinal CT scan
What can rigidity elicit?
-complaint of soreness -feeling tired and achy -pain in the head, upper body, spine or legs
Why should the nurse be concerned about their MS pts bowel and bladder function?
-constipation -spastic bladder -flaccid bladder (not able to void)
What are some complications of COPD?
-cor pulmonale -exacerbation -acute respiratory failure -depression -anxiety
Name the 3 things that are used to secure the trach in place?
-cotton ties -trach tapes -velcro straps
How can a venous thromboembolism be diagnosed?
-d-dimer -duplex ultrasound
Nursing implementations for fluid imbalances
-daily weights -I and O -labs -cardiovascular care -level of consciousness -vital signs -respiratory care -pt safety -skin care
HYPOcalcemia is caused by what?
-decreased production of PTH -multiple blood transfusions -loop diuretics -chronic alcohol use -diarrhea -increased calcium loss
How can exercise help a pt with MS?
-decreases spasticity -increases coordination -retrains unaffected muscles to act for impaired ones
Name some effects on the lifestyle a person with seizures can experience
-depression -social stigma (still exists) -discrimination in employment and educational opportunities -driving (think Emily's boyfriend)
name 3 primary preventions for diabetes
-diet -exercise -weight control
What are some common sleep problems people with PD experience?
-difficulty staying asleep -restless sleep -nightmares -drowsiness during the day
Name the diagnostic studies for PAD
-doppler ultrasound -Ankle brachial index (ABI) -Angiography and magnetic resonance angiography -duplex imaging
What are some symptoms of cor pulmonal?
-dyspnea -crackles in bases of lungs -JVD -hepatomegaly -peripheral edema -weight gain
what are some clinical manifestations to look for in a pt who has a pulmonary embolism?
-dyspnea (most common 85%) -tachypnea -cough -chest pain -crackles -wheezing -fever -tachycardia
How will a venous thromboembolism present in a pt?
-edema -pain -tenderness with palpation -dilated superficial veins -sense of fullness -warm skin ->100.4 temp
How will the nurse treat a pt with HYPERkalemia?
-eliminate oral and parenteral K intake -increase elimination of K: diuretics, dialysis, *kayexalate -force K from ECF to ICF by IV insulin or sodium bicarb -administering calcium gluconate IV
What are 2 things that aggravate tremors?
-emotional stress -increased concentration
What are some long-term consequences of HYPERglycemia?
-end organ disease due to microvascular damage(damage to the blood vessels) -Hypertension (heart attack or stroke) -Cardiovascular disease
Antiparkinsonian drugs either...
-enhance or release supply of DA (dopaminergic) -block the effect of overactive cholinergic neurons
How will the nurse treat a pt who has HYPERcalcemia?
-excretion of Ca with loop diuretic -stop taking meds that cause HYPERcalcemia -low Ca diet -mobilization and increase weight-bearing activity -bisphosphonates (severe cases) -IM or SC calcitonin
HYPERcalcemia manifestations
-fatigue, lethargy, weakness, confusion -hallucinations -seizures, coma -cardiac dysrhythmias -bone pain, fractures -polyuria -dehydration -high BP -nausea, vomiting
What should the nurse expect to find when looking for the presence of infection in a pt?
-fever -swelling -chills -malaise -redness -drainage -pain
How would the nurse treat HYPOnatremia?
-fluid restriction is KEY -loop diuretics
What are the 3 classes of seizures?
-generalized onset -focal onset -unknown onset
How to treat HYPOkalemia
-give KCl supplements orally or IV -always dilute IV KCl -NEVER give KCl via IV push or a bolus -should never exceed 10 mEq/hr -use an infusion pump -invert IV bags containing KCl several times to ensure even distribution in the bag -consuming potassium rich foods -IV KCl must be given by infusion pump to ensure correct administration rate
What assessment do you need to do postoperatively neurologic?
-glasgow coma scale -orientation -sensory and motor status -pupil size and reaction
What counter regulatory hormones rise glucose levels?
-glucagon -cortisol
Name the counterregulatory hormones
-glucagon -epinephrine -cortisol -growth hormone
Name some diagnostic tests for diabetes
-glucose screening -assess antibodies to confirm type 1 diabetes -lipid analysis (low HDLs and high triglycerides can be an indicator of insulin resistance -microalbuminuria (kidney functioning)
How does a pt present with manifestations of MS?
-gradually -vague symptoms occur periodically over months or years -disease diagnosed long after onset of first symptoms -progressive deterioration in neurologic function
How will someone present if they have HYPOnatremia?
-headache -irritability -difficulty concentrating -dry mucous membranes -cold, clammy skin -confusion -vomiting -seizures, coma
Name two contributing factors for diabetes
-heart disease -stroke
What are some CF complications?
-hemoptysis (can be fatal) -pneumothorax (air entering the chest wall) -bone, sinus and liver disease
What causes HYPERcalcemia?
-hyperparathroidism (2/3rds) -malignancy (cancers) (this is not uncommon to see in cancer pts)
What can cause HYPERnatremia?
-hypertonic tube feedings without water supplements -near drowning in salt water -IV fluids
What causes high potassium levels?
-impaired renal excretion -shift from ICF to ECF -massive intake
Why should the nurse encourage their PAD pt to exercise?
-improves oxygen extraction in legs -increases survival rates
What are two short-term consequences of HYPERglycemia?
-inadequate glucose reaching the cells (bc of water deficit) -DEHYDRATION
HYPOcalcemia manifestations
-increase in nerve excitability -tremors -positive Trousseau's or Chvostek's sign -laryngeal stridor -dysphagia -tingling around the mouth or extremities -cardiac dysrhythmias -weakness, fatigue -depression, confusion -low BP -bronchial spasms
What causes HYPERmagnesemia?
-increased intake/ingestion of products containing magnesium when renal insufficiency or failure is preset -excess IV magnesium administration -renal failure -hypothyroidism -adrenal insufficiency -laxatives
Name some possible precipitating factors of MS
-infection -smoking -physical injury -emotional stress -excessive fatigue -pregnancy -poor state of health
Percutaneous transluminal angioplasty (PTA) for PAD
-insertion of a catheter through femoral artery -cylindrical balloon -inflated dilating the vessel by compressing atherosclerotic intimal lining -stent is placed
If a pt has PAD how might they present?
-intermittent claudication -paresthesia -reduced blood flow to limbs -pain at rest
ART can significantly slow HIV progression, but it...
-is complex -has side effects -does not work for everyone -is expensive
Postoperative care of a trach precautions
-keep a replacement tube of equal or smaller size at the bedside for emergency reinsertion -do not change trach tapes for at least 24 hrs after the surgical procedure -if needed: the HCP performs the first tube change usually no sooner than 7 days after the tracheostomy
What are the two proper positions you should put a pt in to prevent respiratory complications?
-lateral "recovery" position -supine position once they are conscious
How will someone present if they have HYPERmagnesemia?
-lethargy -nausea/vomiting -impaired reflexes -muscle paralysis -respiratory and cardiac arrest -urinary retention -flushed, warm skin -low pulse -low BP
How is a Tonic-Clonic seizure characterized?
-loss of consciousness and falling to the ground -body stiffens (tonic) with subsequent jerking of the extremities (clonic) -cyanosis, excessive salivation and tongue or cheek biting, incontinence
How will the nurse treat cor pulmonal?
-low flow O2 -diuretics if the pt developes left side HF
What are some drugs you can give to treat pulmonary embolisms?
-low molecular weight heparin -unfractionated iv heparin -warfarin (coumadin) -Alteplase (activase)
Chemotherapy for lung cancer
-main treatment for SCLC
What is the overall goals for pts with PD?
-maximize neurologic function -maintain independence in ADLs for as long as possible -optimize psychosocial well-being
What are the goals for a pt with MS?
-maximize neuromuscular function -maintain independence in ADL for as long as possible -manage fatigue -optimize psychosocial well-being -adjust to the illness -decrease factors that precipitate exacerbations
What are some early manifestations of CF?
-meconium ileus in newborns (stool stuck in the bowel) -acute or persistent respiratory symptoms -malnutrition -steatorrhea-large, protuberant abdomen -emaciated appearance of extremities
What are some precipitating factors of seizures?
-metabolic acidosis or alkalosis -HYPERkalemia -HYPOglycemia -dehydration -water intoxication
What do the beginning stages of PD look like?
-mild tremors -slight limp -decrease arm swing
NSCLC type: Adenocarcinoma
-moderate growing -accounts for 40% of lung cancers -most common type of lung cancer in the US -most common type of lung cancer in those who have not smoked -found in peripheral areas of lungs -often has no manifestations until widespread metastasis is present
What should the nurse monitor when giving their PD pt Levodopa with Carbidopa?
-monitor for signs of dyskinesia (impairment of voluntary movements) -monitor for light-headiness from hypotension -give on an empty stomach
Name some common manifestations of MS?
-motor problems -sensory problems -cerebellar problems -emotional problems
intermittent claudication
-muscle pain that is caused by a constant level of exercise -resolves within 10 minutes or less with rest -occurs early in disease
Risk factors or triggers for asthma
-nose and sinus problems -respiratory tract infections (major trigger) -allergens -cigarette smoke -air pollutants -occupational factors -exercise -GERD -genetics -psychological factors-- stress
For a person with MS, what will their sensory manifestations look like?
-numbness and tingling -pain -decreased hearing -vertigo and tinnitus -chronic neuropathic pain -Lhermitte's sign
For a person with MS, what will their cerebellar manifestations look like?
-nystagmus -ataxia -dysarthria -dysphagia -fatigue
what should the nurse do when a pt is having a seizure?
-observe and time -open and maintain airway -support the head -turn to the side -loosen constrictive clothing -ease to the floor -DO NOT restrain or place object near or in the mouth
PAD pain at rest
-occurs as PAD progresses -aggravated by limb elevation -from insufficient blood flow -more often at night -pain relief by gravity
Counterregulatory hormones do what?
-oppose effects of insulin -stimulate glucose productions and release by the liver -help maintain normal blood glucose levels
how to manage HYPOphosphatemia
-oral supplementation of dairy products or phosphate -ingestion of foods high in phosphorus -IV of sodium or potassium phosphate
Name some interventions the nurse can give to pts to prevent respiratory complications
-oxygen therapy -coughing and deep breathing -incentive spirometer -sustained maximal inspiration -change pt position every 1-2 hrs -early mobilization -pain management -adequate hydration -chest physiotherapy
What can the nurse do to help prevent any injuries to the pt during a seizure episode?
-pad the siderails -place bed in low position -keep suction equipment at bedside
How will phlebitis present in a pt?
-pain -tenderness -warmth -erythema -swelling -palpable cord usually resolves after catheter removal
How will a superficial vein thrombosis present in a pt?
-palpable, firm cordlike vein -tender -painful -itchy -reddended -warm
What organ(s) does type 2 diabetes deal with?
-pancreas -liver -adipose tissue -muscles
What are some interventions to prevent hypothermia and fever?
-passive or active warming -oxygen therapy -opioids -coughing and deep breathing
What should the nurse do if the trach is not older than a week and they cannot replace the tube?
-place the pt in the semi-fowlers position to decrease dyspnea -cover the stoma with a sterile dressing -provide ventilation with the BVM over the nose and mouth
what should the nurse teach a seizure to do to promote safety measures?
-practice good general health habits -help to identify events or situations that cause seizures and ways to avoid -to avoid excessive alcohol, fatigue, and loss of sleep -handle stress constructively
what are some corticosteroids used to treat COPD?
-prednisone or methylprednisolone (IV push) -Fluticasone (make sure to rinse mouth to prevent infections)
What are some risk factors for Superficial Vein Thrombosis?
-pregnancy -obesity -malignancy -recent fractures
How will the nurse care for someone with HYPERmagnesemia?
-prevent: restrict magnesium intake in high-risk pts -IV CaCl or calcium gluconate if symptomatic -Fluids and IV furosemide to promote urinary excretion -dialysis
What are the 4 phases of seizures?
-prodromal phase -aural phase -ictal phase -postictal phase
What are the two complications that can happen if a pt has a pulmonary embolism?
-pulmonary infarction -pulmonary hypertension
NSCLC type: large cell
-rapid growing -accounts for 10% of lung cancers -often arise in bronchi -is highly metastatic via lymphatics and blood
What are the risk factors for malignant melanoma?
-red or blond hair -light colored eyes -fair skin that freckles -chronic sun exposure -family history
The nurse is teaching their pt with CAD about nutrition. What should they include in the teaching?
-reduce saturated fats and cholesterol -increase complex cabs and fiber -reduce red meat, egg yolks, and whole milk -increase Omega-3 fatty acids
How will someone who has HYPOvolemia present?
-restlessness -drowsiness -dry mucous membranes -cold, clammy skin -decreased skin turgor -decreased urine output -tachycardia -weight loss -weakness/dizziness -seizures/coma -low BP when stand up
How to treat HYPERphosphatemia
-restrict food and fluids containing phosphorus (dairy) -oral phosphate -binding agents -volume expansion and forced diuresis with loop diuretics -correct any HYPOcalcemia
Name some ways that end-organ disease due to damage to the blood vessels can present
-retinopathy (leading to blindness) -nephropathy (damage to kidneys) -peripheral neuropathy (numbness or tingling to lower extremities)
What can cause seizures in 6 month olds?
-severe brain injury -infection -inborn errors with metabolize -congenital defects involving the CNS
What are two ways COPD can be treated?
-short acting bronchodilators -corticosteroids
What do the later stages of PD look like?
-shuffling -propulsive gait with arms flexed -loss of postural reflexes
NSCLC type: Squamous cell
-slow growing -accounts for 25-30% of lung cancers -centrally located -causes early symptoms of nonproductive cough -does not have a strong tendency to metastasize
How to counterregulatory hormones increase blood glucose levels?
-stimulating glucose production and release by the liver -decreasing the movement of glucose into the cells
Loss of automatic movement occur subconsciously and result in what classic characteristics of a person with PD?
-stooped posture -masked face -drooling -shuffling gait
What can cause seizures in 20-30 year olds?
-structural legions -trauma -brain tumors -vascular disease
How does someone develop type 1 diabetes?
-the body develops antibodies against insulin and/or pancreatic B cells that produce insulin -results in not enough insulin to survive -could also be a genetic link
If someone has reduced blood flow to a limb how will it present?
-thin, shiny and taut skin -low of hair -diminished or absent pedal, popliteal or femoral pulses -pallor of foot with leg elevation -thick toenails -cool skin -delayed cap refill
How will someone present if they have HYPERnatremia?
-thirst -*alteration in mental status: agitation, restlessness, confusion, lethargy -dry swollen tongue -sticky mucous membranes -weakness -muscle cramps
Name the risk factors for PAD
-tobacco use -chronic kidney disease -diabetes mellitus -hypertension -hypercholesterolemia
Surgical therapy for lung cancer
-treatment of choice for early stage non-small cell -includes pneumonectomy, lobectomy, segmental, or wedge resections -not indicated for SCLC
What will a person look like if they are HYPOglycemic?
-tremors -diaphoresis -weakness -HUNGAR -headache -irritability -seizure -tachycardia -slurred speech -pallor
Generalized-onset NONmotor seizures types:
-typical absence -atypical absence
Ankle Brachial Index (ABI)
-use hand-held doppler -compare systolic numbers -Normal: 0.91-1.30
Immunomodulators for MS
-used to help slow disease down -modify the disease progression and prevent relapse -Betaseron -Extavia -Copaxone
Targeted therapy for lung cancer
-uses drugs that block the growth of molecules involved in specific aspects of tumor growth -maybe less toxic than chemotherapy
Virchow's triad
-venous stasis -damage to endothelium -hypercoagulability of blood
SCLC
-very rapid growth -most malignant -early metastasis -associated endocrine disorders -chemotherapy and radiation -poor prognosis
Elements you should look for during a respiratory assessment examination
-vital signs: HR, RR, BP, temp, O2 sat -breathing effort -skin color -thorax -extremities -auscultation of lung sounds
What can COPD pts do to protect themselves from bacterial or viral infections?
-wash hands frequently -stay away from sick people
What should the nurse expect to find when looking for a C-diff infection in a pt?
-watery diarrhea -loss of appetite -nausea -abdominal pain
For a person with MS, what will their motor manifestations look like?
-weakness or paralysis of limbs, trunk, and head -spasticity of muscles -scanning speech -flexed elbow -bent wrist -pronated forearm -clenched fist -thumb in palm
What does regular activity help with if a pt has CAD?
-weight reduction -reduction of systolic BP -increase of HDL cholesterol
A pt has COPD. What are some physical exam findings the nurse will find?
-wheezes -crackles -use of accessory muscles -decreased breath sounds ( they are not very loud) -barrel chest -tripod position -cough -underweight with anorexia bc of inadequate calorie intake bc of breathing -chronic fatigue -pursed lip breathing -digital clubbing -muscle atrophy
How often should a person with CAD exercise?
30 minutes most days with weight training 2 days a week
The normal CD4+T cell range
800-1,200 cells/uL
Chloride (Cl) levels
98-106 mEq/L
HYPOmagnesemia
<1.3
HYPOphosphatemia is caused by...
<3.0 -malnourishment/malabsorption -diarrhea -use of phosphate -binding antacids -inadequate replacement during parenteral nutrition -chronic alcohol use -diabetic ketoacidosis -respiratory alkalosis
HYPOphosphatemia
<3.0 mg/dL
HYPOcalcemia
<9.0 mg/dL
HYPERcalcemia
>10.5 mg/dL
HYPERphosphatemia
>4.5 mg/dL
What is a not controlled A1C percentage?
>7%
After admitting a postoperative pt to the clinical unit, which assessment data require the MOST immediate attention? a) O2 sat of 85% b) respiratory rate of 13/min c) temp of 100.4 F d) BP of 90/60
a) O2 sat of 85%
Which drug of the restrict lipoprotein production drugs for CAD increases the risk for rhabdomyolysis? a) Simvastatin (Zocor) b) Rosuvastatin (Crestor)
a) Simvastatin (Zocor) when used with fibric acid derivatives (gemfibrozil (Lopid), niacin (Niaspan), or erythromycin
A patient has been diagnosed with human immunodeficiency virus (HIV) infection. What rationale for taking more than one antiretroviral medication should the nurse give to the patient to improve compliance? a) Viral replication will be inhibited. b) They will decrease CD4+ T-cell counts. c) It will prevent interaction with other drugs. d) More than one drug has a better chance of curing HIV.
a) Viral replication will be inhibited. The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases.
The nurse askes a pt further questions about the clinical manifestations of PAD. Which of the following would the nurse expect to find to have a diagnosis of PAD? (select all that apply) a) dependent rubor b) paresthesia c) constant, dull ache in calf of thigh d) rest pain at night e) pruritus of lower legs f) elevation pallor
a) dependent rubor b) paresthesia d) rest pain at night f) elevation pallor
The nurse is caring for an older patient who has been receiving antiretroviral therapy for HIV infection for many years. The nurse is aware that complications of long-term antiretroviral use can include: (Select all that apply.) a) osteoporosis. b) insulin resistance. c) cognitive problems. d) urinary incontinence. e) cardiovascular disease.
a) osteoporosis. b) insulin resistance. e) cardiovascular disease.
A nurse is caring for a client who is postoperative following vein ligation and stripping for varicose veins. Which of the following actions should the nurse take? a) position the client supine with his legs elevated when in bed b) encourage the client to ambulate for 15 minutes every hour while awake for the first 24 hr c) the client to sit with his legs dependent after ambulating d) instruct the client to wear knee-length socks for 2 weeks after surgery
a) position the client supine with his legs elevated when in bed should elevate the client's legs above his heart to promote venous return by gravity. During discharge teaching, the nurse should reinforce the importance of periodic positioning of the legs above the heart
A nurse is reviewing a client's repeat lab results 4 hr after administering fresh frozen plasma. Which of the following lab results should the nurse review? a) prothrombin time b) WBC count c) platelet count d) hematrocrite
a) prothrombin time
a nurse on a med surg unit is caring for a client who is postop following a hip replacement surgery. the client reports feeling apprehensive and restless. which of the following findings should the nurse recognize as an indication of pulmonary embolism? a) sudden onset of dyspnea b) tracheal deviation c) bradycardia d) difficulty swallowing
a) sudden onset of dyspnea Clinical manifestations of pulmonary embolism have a rapid onset. Dyspnea occurs due to reduced blood flow to the lungs.
A nurse is providing teaching to a client about pulmonary function tests. Which of the following tests measures that volume of air the lungs can hold at the end of maximum inhalation? a) total lung capacity b) vital lung capacity c) functional residual capacity d) residual volume
a) total lung capacity Pulmonary function tests are used to examine the effectiveness of the lungs and identify lung problems. Total lung capacity measures the amount of air the lungs can hold after maximum inhalation.
A nurse is providing discharge instructions to a client who is postoperative following a surgical excision of a basal cell carcinoma. Which of following findings should the nurse include as a indication of a potential malignancy of a mole? a) ulceration b) blanching of surrounding skin c) dimpling d) fading of color
a) ulceration Ulceration, bleeding, or exudation are indications of a mole's potential malignancy. Increasing size is also a warning sign. The nurse should emphasize the importance of lifetime follow-up evaluations and the proper techniques for self-examination of the skin every month.
focal awareness seizures
are conscious and alert but have unusual feelings or sensations that can take many forms -may hear, smell, taste, see or feel things that are not real
how much exercise should a diabetic person get each week?
at least 150 minutes with moderate resistance training 3 times a week
What is the leading cause of PAD?
atherosclerosis
What is the major cause of CAD?
atherosclerosis
The nurse is teaching a patient with type 2 diabetes how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? a) "Smokeless tobacco products decrease the risk of kidney damage." b) "I can help control my blood pressure by avoiding foods high in salt." c) "I should have yearly dilated eye examinations by an ophthalmologist." d) "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."
b) "I can help control my blood pressure by avoiding foods high in salt."
A pregnant woman with asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The pt states "I am very nervous about making my baby sick." which info will the nurse include when teaching the pt? a) The antiretroviral medications used to treat HIV infections are teratogenic b) Most infants born to HIV-positive mother are not infected with the virus c) Because it is an early stage of HIV infection, the infant will not contract HIV d) Her newborn will be born with HIV unless he uses ART therapy
b) Most infants born to HIV-positive mother are not infected with the virus
A nurse on a medical unit is caring for a client who aspirated gastric contents prior to admission. The nurse administers 100% oxygen by nonrebreather mask after the client reports severe dyspnea. Which of the following findings is a clinical manifestation of acute respiratory distress syndrome (ARDS)? a) tympanic temp 100.4 F b) PaO2 50 mm Hg c) Rhonchi d) hypopnea
b) PaO2 50 mm Hg The client who has manifestations of ARDS has a low PaO2 level even with the administration of oxygen. Hypoxemia after treatment with oxygen is a manifestation of ARDS.
Name the two drugs for intermittent claudication (select 2): a) Clopidogrel (Plavix) b) Pentoxifylline (Trental) c) Cilostazol (Pletal) d) Gemfibrozil (Lopid)
b) Pentoxifylline (Trental) c) Cilostazol (Pletal)
Which drug is the most potent of the restrict lipoprotein production drugs for CAD? a) Simvastatin (Zocor) b) Rosuvastatin (Crestor)
b) Rosuvastatin (Crestor)
A nurse is providing instructions about pursed-lip breathing for a client who has COPD with emphysema. The nurse should explain that this breathing technique accomplishes which of the following? a) increases oxygen intake b) promotes carbon dioxide elimination c) uses the intercostal muscles d) strengthens the diaphragm
b) promotes carbon dioxide elimination The client who has COPD with emphysema should use pursed-lip breathing when experiencing dyspnea. This is one of the simplest ways to control dyspnea. It slows the client's pace of breathing, making each breath more effective. Pursed-lip breathing releases trapped air in the lungs and prolongs exhalation to slow the breathing rate. This improved breathing pattern moves carbon dioxide out of the lungs more efficiently.
A nurse is caring for an older client who has chronic obstructive pulmonary disease with pneumonia. The nurse should monitor the client for which of the following acid-base imbalances? a) respiratory alkalosis b) respiratory acidosis c) metabolic alkalosis d) metabolic acidosis
b) respiratory acidosis Respiratory acidosis is a common complication of COPD. This complication occurs because clients who have COPD are unable to exhale carbon dioxide due to a loss of elastic recoil in the lungs.
A nurse is developing a teaching plan for a client about preventing acute asthma attacks. Which of the following points should the nurse plan to discuss first? a) how to eliminate environmental triggers that precipitate attacks b) the client's perception of the disease process and what might have triggered past attacks c) the client's medication regimen d) manifestations of respiratory infections
b) the client's perception of the disease process and what might have triggered past attacks The nurse should apply the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing the client will provide the nurse with knowledge to make an appropriate decision. Therefore, the first step the nurse should take is to assess the client's current knowledge.
A nurse is teaching about daily chest physiotherapy with a client who has cystic fibrosis. The nurse should instruct the client that which of the following is the purpose of the treatments? a) to encourage deep breaths b) to mobilize secretion's in the airways c) to dilate the bronchioles d) to simulate the cough reflex
b) to mobilize secretion's in the airways The purpose of chest physiotherapy is to loosen the client's secretions and promote drainage of secretions from the lungs. Chest physiotherapy includes percussion, vibration, and promotion of drainage by gravity.
COPD exacerbations are commonly caused by what?
bacterial or viral infections
Why is nutritional therapy important in COPD pts?
bc they are not eating enough because of breathing -supplemental O2 during meals may be helpful -high calorie, high protein diets is recommended -increase fluids to thin secretions
Focal-onset seizures
begin in specific region of cortex in ONE hemisphere of the brain -manifestations are based on function of area of brain involved
pulmonary embolism (PE)
blockage of 1 or more pulmonary arteries by a thrombus, fat or air embolus or tumor tissue most commonly affects lower lobes
What is a cardiovascular assessment finding for someone who is HYPERvolemic?
bounding pulse
NONmotor TYPICAL absence seizures
brief staring spells that lasts less than 10 seconds -can resemble daydreaming -usually occurs only in children and rarely beyond adolescence -may stop as child matures or into another type
How can a pt prevent end-organ disease consequences?
by keeping glucose levels under control
A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? a) "The baby will be infected with HIV." b) "Having a cesarean section will keep your baby from having HIV." c) "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." d) "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."
c) "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection."
A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? a) "With type 2 diabetes, the body of the pancreas becomes inflamed." b) "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." c) "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." d) "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."
c) "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."
The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? a) 8:40 PM to 9:00 PM b) 9:00 PM to 11:30 PM c) 10:30 PM to 1:30 AM d) 12:30 AM to 8:30 AM
c) 10:30 PM to 1:30 AM
How long should a COPD pt walk each day at least? a) 5 hrs b) 10 minutes c) 15-20 minutes d) 45-55 minutes
c) 15-20 minutes
The nurse is caring for someone who has HYPERcalcemia. How much should they drink daily to properly excrete it? a) 1,000-2,000 mL b) 40,000-60,000 mL c) 3,000-4,000 mL d) 2,500-3,5000 mL
c) 3,000-4,000 mL
What elevation should a PD pt keep the head of bed to to prevent aspiration? a) 50 b) 80 c) 30 d) 0
c) 30 degrees
If a pt has PAD, what should their BMI be at? a) >35 b) 20 c) <25 d) <15
c) <25
A patient is admitted to the emergency department (ED) with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing actions will help identify the need for further assessment of the cause of this patient's manifestations if the nurse suspects the patient is at risk for HIV infection? (Select all that apply.) a) Assessment of lung sounds b) Reviewing living conditions c) Assessment of sexual behavior d) Assessment of drug and syringe use e) Evaluating for exposure to an ill person
c) Assessment of sexual behavior d) Assessment of drug and syringe use
A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise the patient to take? a) Eat a piece of pizza. b) Drink some diet pop. c) Eat 15 g of simple carbohydrates. d) Take an extra dose of rapid-acting insulin.
c) Eat 15 g of simple carbohydrates.
a nurse is providing discharge teaching to a client who has COPD and a new prescription for albuterol. Which of the following statement by the client indicates an understanding of the teaching? a) this med can increase my blood sugar levels b) this med can decrease my immune response c) I can have an increase in my HR while taking this med d) I can mouth sores while taking this med
c) I can have an increase in my HR while taking this med
The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a patient with human immunodeficiency virus (HIV). What laboratory study result indicates the medications are effective? a) Increased viral load b) Decreased neutrophil count c) Increased CD4+ T-cell count d) Decreased white blood cell count
c) Increased CD4+ T-cell count Antiretroviral therapy is effective if the HIV viral load is decreased, and the CD4+ T-cell count is increased.
A nurse is teaching a client who has AIDS about the transmission of Pneumocystis jiroveci pneumonia. Which of the following information should the nurse include in the teaching? a) PCP is sexually transmitted from person to person b) you were most likely exposed to a contaminated surface, such as a drinking glass c) PCP results from an impaired immune system d) you may have contracted PCP from a family pet
c) PCP results from an impaired immune system The nurse should explain that the organism that causes PCP exists as part of the normal flora of the lungs and develops into a fungus. It becomes an aggressive pathogen when the immune system is compromised and the infection results from an impaired immune system.
The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to explain how this medication works? a) Increases insulin production from the pancreas. b) Slows the absorption of carbohydrate in the small intestine. c) Reduces glucose production by the liver and enhances insulin sensitivity. d) Increases insulin release from the pancreas and inhibits glucagon secretion.
c) Reduces glucose production by the liver and enhances insulin sensitivity.
A heterosexual patient is concerned that they may contract human immunodeficiency virus (HIV) from a bisexual partner. What should the nurse include when teaching about preexposure prophylaxis? (Select all that apply.) a) Take fluconazole (Diflucan). b) Take amphotericin B (Fungizone). c) Use condoms for risk-reducing sexual relations. d) Take emtricitabine and tenofovir (Truvada) regularly. e) Have regular HIV testing for herself and her husband.
c) Use condoms for risk-reducing sexual relations. d) Take emtricitabine and tenofovir (Truvada) regularly. e) Have regular HIV testing for herself and her husband.
Which information will the nurse include when teaching an older pt about skin care? a) Dry the skin thoroughly before applying lotions b) Bathe and wash hair daily with soap and shampoo c) Use warm water and a moisturizing soap with bathing d) Use antibacterial soaps when bathing to avoid infection
c) Use warm water and a moisturizing soap with bathing
The nurse is caring for a pt who is going to have a cardiac catherization done today. What should the nurse do preoperatively? a) give the pt a shower b) order them a cheese burger c) asses of allergies to contrast dye, obtain neurovascular assessment, and vital signs d) obtain vital signs
c) asses of allergies to contrast dye, obtain neurovascular assessment, and vital signs
A nurse is teaching a group of young adults client about health promoting techniques to reduce the risk of skin cancer. Which of the following instructions should the nurse include? a) apply a broad spectrum sunscreen 5 minutes before sun expose b) wear a sun visor instead of a hat when outside in the sun c) avoid exposure to the midday sun d) use a tanning booth instead of sunbathing outdoors
c) avoid exposure to the midday sun The nurse should instruct clients to avoid skin exposure to the sun, especially during the midday hours of 1000 to 1600 because sun rays are the strongest at that time.
A client is admitted to the emergency department following a motorcycle crash. The nurse notes a crackling sensation upon palpation on the right side of the client's chest. After notifying the provider, the nurse should document this finding as which of the following? a) friction rub b) crackles c) crepitus d) tactile fremitus
c) crepitus Crepitus, also called subcutaneous emphysema, is a coarse crackling sensation that the nurse can feel when palpating the skin surface over the client's chest. Crepitus indicates an air leak into the subcutaneous tissue, which is often a clinical manifestation of a pneumothorax.
How often should a diabetic person check their feet? a) every 3 hours b) every 9 months c) every day d) never, they have the healthy feet
c) every day
Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of COPD? a) acute respiratory failure b) secondary respiration infection c) fluid volume excess resulting in right-side heart failure d) pulmonary edema caused by left-side heart failure
c) fluid volume excess resulting in right-side heart failure -cor pulmonal
Betaseron has been prescribed for a pt who has been diagnosed with relapsing-remitting multiple sclerosis. which statement, if made by the pt indicates that additional teaching is needed? A) I must rotate injection sites with each dose b) i should report depression or suicidal thoughts c) i will reduce my sodium intake to prevent edema d) it is important to avoid direct sunlight and use sunscreen e) none of the above
c) i will reduce my sodium intake to prevent edema
What is the classic symptom of PAD? a) leg pain b) right arm pain c) intermittent claudication d) MI
c) intermittent claudication
A nurse is caring of a client who has HIV. The client asks the nurse, "should I tell my partner that I am HIV positive?" Which of the following statements should the nurse give? a) that is your decision b) I would if I were you c) it sounds like you are unsure what to say to your partner d) your provider is required by law to notify your partner
c) it sounds like you are unsure what to say to your partner
A patient, admitted with diabetes, has a glucose level of 580 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? a) central apnea b) hypoventilation c) kussmaul respirations d) cheyne-stokes respirations
c) kussmaul respirations
A nurse in a provider's office is assessing a client who states he was recently exposed to tuberculosis. Which of the following findings is a clinical manifestation of pulmonary tuberculosis? a) pericardia friction rub b) weight gain c) night sweats d) cyanosis of the fingertips
c) night sweats Night sweats and fevers are clinical manifestations of tuberculosis.
A nurse is preparing to assist a provider to withdraw arterial blood from a client's radial artery for measurement of ABG. Which of the following actions should the nurse plan to take? a) hyperventilate the client with 100% oxygen prior to obtaining the specimen b) apply ice to the site after obtaining the specimen c) perform an Allen's test prior to obtaining the specimen d) release pressure applied to the puncture site 1 min after the needle is withdrawn
c) perform an Allen's test prior to obtaining the specimen The nurse should ensure that circulation to the hand is adequate from the ulnar artery in case the radial artery is injured from the blood draw. The most common site for withdrawal of arterial blood gases is the radial artery.
A patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? a) Cough, diarrhea, headaches, blurred vision, muscle fatigue b) Night sweats, fatigue, fever, and persistent generalized lymphadenopathy c) Oropharyngeal candidiasis or thrush, vaginal candida infection, or oral or genital herpes d) Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea
d) Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure.
A nurse is providing preoperative teaching to a client who is to undergo a pneumonectomy. The client states, "I am afraid it will hurt to cough after the surgery." Which of the following statements by the nurse is appropriate? a) after the surgeon removes the lung, you will not need to cough b) I'll make sure you get a cough suppressant to keep you from straining the incision when you cough c) don't worry. you will have a pump that delivers pain medication as you need it, so you will have very little pain d) I will show you how to split your incision while coughing
d) I will show you how to split your incision while coughing The client who had a pneumonectomy should cough to clear secretions from the remaining lung. The nurse should show the client how to splint her incision to reduce pain when coughing.
The nurse is teaching a newly diagnosed 34-year-old male about his HIV infection. Which statement by the pt would indicate the pt needs additional education? a) I will need to take my HIV meds daily for the rest of my life b) Although I only take one pill, it has multiple medications combined into a single tab c) I should notify my HIV provider if I get fevers that do not go away with Tylenol or Aspirin d) Once my viral load is undetectable, I don't have to worry about taking my meds every day
d) Once my viral load is undetectable, I don't have to worry about taking my meds every day
A 70 kg postoperative pt has an average urine output of 25 mL/hr during the first 8 hours. The PRIORITY nursing interventions giving this assessment would be... a) notify the surgeon and expect obtaining blood work to evaluate renal function b) perform a straight cath to measure the amount of urine in the bladder c) continue to monitor the pt bc this is a normal finding during this time period d) evaluate the pts fluid volume status since surgery and obtain a bladder ultrasound
d) evaluate the pts fluid volume status since surgery and obtain a bladder ultrasound
A nurse is assessing a client who has a lesion on his skin. Which of the following findings is a clinical manifestation of malignant melanoma? a) rough, dry, scaly lesion b) firm nodule with crust c) pearly papule with ulcerated center d) irregular shaped lesion with blue tones
d) irregular shaped lesion with blue tones Malignant melanomas are irregularly shaped and can be blue, red, or white in tone. They often occur on the client's upper back and lower legs.
A nurse is providing discharge teaching to a client who is postop following a rhinoplasty. Which of the following instructions should the nurse include? a) apply warm compresses to the face b) take aspirin 650 milligrams by mouth for mild pain c) close your mouth when sneezing d) lie on your back with your head elevated 30 degrees when resting
d) lie on your back with your head elevated 30 degrees when resting The nurse should instruct the client to rest in the semi-Fowler's position to prevent aspiration of nasal secretions.
Antiseizure drugs have a... a) short half life b) never dissolve c) should be crushed d) long half life
d) long half life
What should the nurse do post surgery for a peripheral artery bypass if the peripheral pulses cannot be found? a) find them with the doppler b) have another nurse try to find them c) rub the pts feet to warm them d) notify the HCP immediately
d) notify the HCP immediately
A nurse is preparing a client for a thoracentesis. Which of the following positions should the nurse place the client? a) lying flat on the affected side b) prone with the arms raised over the head c) supine with the head of bed elevated d) sitting while leaning forward over the bedside table
d) sitting while leaning forward over the bedside table When preparing a client for a thoracentesis, the nurse should have the client sit on the edge of the bed and lean forward over the bedside table because this position maximizes the space between the client's ribs and allows for aspiration of accumulated fluid and air.
A nurse is planning care for a client who has been admitted for treatment of a malignant melanoma of the upper leg without metastasis. the nurse should plan to prepare the client for which of the following procedures? a) curettage b) external radiation therapy c) regional chemotherapy d) surgical excision
d) surgical excision The therapeutic approach to malignant melanoma depends on the level of invasion and the depth of the lesion. Surgical excision is the treatment of choice for small, superficial lesions. Deeper lesions require wide local excision, followed by skin grafting.
A nurse is caring for a client who has a tracheostomy with an inflated cuff in place. Which of the following findings indicated that the nurse should suction the client's airway secretions? a) the client is unable to speak b) the client's airway secretions were last suctioned 2 hr ago c) the client coughs and expectorates a large mucous plug d) the nurse auscultates coarse crackles in the lung field
d) the nurse auscultates coarse crackles in the lung field The nurse should auscultate coarse crackles or rhonchi, identify a moist cough, hear or see secretions in the tracheostomy tube, and then suction the client's airway secretions.
A nurse is preparing to administer cisplatin IV to a client who has lung cancer. The nurse should identify that which of the following findings is an adverse effect to this medication? a) hallucinations b) pruitus c) hand and foot syndrome d) tinnitus
d) tinnitus An adverse effect of cisplatin is ototoxicity, which can cause tinnitus.
What can lead to significant fluid and electrolyte loss?
diarrhea and vomiting
For a person with MS, what will their cognitive manifestations look like?
difficulty with: -short-term memory -attention -info processing -planning -visual perception -word finding
Glycosylated hemoglobin test (A1C)
estimates glucose average over 3 months
What 2 vaccines should someone with COPD get?
flu and pneumococcal vaccine
ictal phase
form first symptoms to the end of seizure activity
Venous Thrombosis
formation of thrombus in association with inflammation of vein either superficial or deep (DVT)
What is the first sign of CF in adults?
frequent cough that becomes persistent and produces sputum
At what age can a person develop type 1 diabetes?
generally affect people under 40 but can occur at any age now
What two populations are at a greater risk for fluid and electrolyte imbalances?
geriatric and pediatrics
Blood glucose test
gives the patient the current blood glucose reading
focal impaired awareness seizures
have a loss of consciousness or a change in awareness, producing a dreamlike state -may do things can be dangerous or embarrassing -no memory of activities
Why is humidification important in trach care?
helps keep secretions thing and decrease formation of mucous plugs
asthma
heterogenous disease characterized by bronchial hyperreactivity with reversible expiratory airflow imitation
HYPERglycemia
high blood sugar >140 mg/dL not fasting >100 mg/dL fasting (severe >180)
Counterregulatory hormones
hormones that INCREASE blood glucose levels
When a persons CD4+T cell count drops to <500 cells/uL, what will happen?
immune problems begin
A pt has a low white blood cell count
immunocompromised
When do cortisol levels tend to be the highest?
in the morning
Rigidity
increased resistance to passive motion when limbs are moved through their ROM
What two age categories are at a higher risk for impaired glucose regulation?
infants and older adults
A pt has a elevated white blood cell count
infection
Acne vulgaris
inflammatory disorder of sebaceous glands causing noninflammatory lesions open and closed comedones
What drugs are used to treat status epilepticus?
initially, rapid-acting IV of Ativan or Valium
Low HDLs and high triglycerides can be an indicator for what?
insulin resistance
Type 1 diabetes
insulin-dependent
Peripheral Artery Disease (PAD)
progressive narrowing and degeneration of arteries of upper and lower extremities
Name the MOST common mode of transmission of HIV.
unprotected sex with an HIV-infected partner