Nursing Info Pt.1
Use of only the shoulders is associated with
cervical spine injury.
review of symptoms
disabilities and limitations;hearing or vision loss,paralysis,stiffness,weakness, cognitive impairment; any current health deviations
After receiving a change-of-shift report, which patient will the nurse assess first?
septicemia who has intercostal and suprasternal retractions suggest the onset of ARDS, which will require rapid interventions such as administration of oxygen and use of positive pressure ventilation.
food and fluid restriction
1.clear liquids,water,clear tea,black coffee,carbonated beverages, and fruit juice without pulp---- min fasting period is 2 hours. 2. breast milk----min fasting period is 4 hours 3.non human milk,including infant formula----min fasting period is 6 hours 4.light meal,toast and clear liqiuid---min fasting period is 6 hours 5.reg or heavy meal,fried or fatty food,meat----min fasting period is 8 hours this is done to prevent the risk of vomiting and aspiration during or after anesthesia
The nurse is aware that a major difference between hodgkin's lymphoma and NHL is.. 1. Hodgkin's only occurs in young adults 2. Hodgkin's is characterized by the presence of Reed-Sternberg cells 3. NHL is characterized by the presence of Reed-Sternberg cells 4. NHL can only be treated with radiation
2. Hodgkin's is characterized by the presence of Reed-Sternberg cells
The ____ team consists of nurses who circulate, nurses who scrub, an RFNA, one or more surgeons, an anesthesiologist or a nurse anesthetist, and other technical personnel.
Surgical
The client diagnosed with myasthenia gravis is prescribed the cholinesterase inhibitor, neostigmine (Prostigmin). Which data indicate the medication is effective?
The client is able to feed self independently This medication promotes muscle contraction, which improves muscle strength, which, in turn, would allow the client to perform ADL's without assistance.
These four patients arrive in the emergency department after a motor vehicle crash. In which order should they be assessed? A 72 year old with palpitations and chest pain A 30 year old with a misaligned right leg with intact pulses A 22 year old with multiple fractures of the face and jaw A 45 year old complaining of 6/10 abdominal pain
The highest priority is to assess the 22-year-old patient for airway obstruction, which is the most life-threatening injury. The 72-year-old patient may have chest pain from cardiac ischemia and should be assessed and have diagnostic testing for this pain. The 45-year-old patient may have abdominal trauma or bleeding and should be seen next to assess circulatory status. The 30-year-old appears to have a possible fracture of the right leg and should be seen soon, but this patient has the least life-threatening injury.
Which information obtained by the nurse when caring for a patient who has cardiogenic shock is an indication that the patient may be developing multiple organ dysfunction syndrome (MODS)?
The patient's serum creatinine level is elevated The elevated serum creatinine level indicates that the patient has renal failure as well as heart failure
A patient is admitted to the hospital with a new diagnosis of Guillain Barre'. During the acute phase, the nurse recognizes that... The priority of care is to monitor the patient's vital capacity and ABG's Early treatment with steroids can suppress the immune response and prevent ascending nerve damage Voluntary motor neurons are damaged, but the autonomic nervous system is unaffected The most serious complication is demyelination of the cranial nerves
The priority of care is to monitor the patient's vital capacity and ABG's
Low cholesterol diet:
This diet is characterized by less than (<) 300 mg
PPN
peripheral paretneral nutrition, NOT central line but peripheral, for short term
What is chronic illness? examples
permanent change; causes/caused by irreversible alterations in normal anatomy/physiology; special patient ed for rehab; long period care/support. Heart disease, stroke, cancer, resp. disease, diabetes...
Rights
person is entitled to; legitimate expectation
What are the values of the dominant group?
personal space, time, respect, food/nutrition, family, gender, religion, $, language, housing (thinness, beauty, technology).
The ICU charge nurse will determine that teaching about hemodynamic monitoring for a new staff nurse has been effective when the new nurse...
positions the transducer line level with the phlebostatic axis
applied research?
practical research = directly influence/improve clinical practice. always useful
A single order is given one time. What is an example?
pre-op med
informed consent
pt must sign legal document called consent forms. it states the pt has been informed of procedure to be performed, the alternative treatments, and the risks involves and that the pt agrees to the procedure.this is responsibilty of the physicians but the nurse might witness it. always done before pt is given preoperative meds, it becomes part of patients record.
foods high in sodium
table salt, soy sauce, cured pork, most cheeses, cottage cheese, processed meat
A buccal medication is given as a _____ or _____, which is placed against the _____ _____ between the _____ and _____ near the molars.
tablet, lozenge. mucous membrane, cheek, gums.
Palliative Care
the active total care of patients whose disease is not responsive to curative treatment. Focus on controlling pain and other symptoms Reduce distress for patient and family Can start earlier than 6 mo prior to death
Why are IV fluids important for the child with increased respiratory rate?
the child is at risk for dehydration and acid/base imbalance
General systems theory?
theory for universal application
assessment
when non emergency surgery is scheduled, a thorough assessment is made that starts with the pts health history and physical examination.the Lpn often assists by collecting specific,relevant data, this assessment is usually performed before admission to the nursing care unit,lab studies,urine studies,blood grouping/crossmatching,chest radiography,pulmonary function test,and EKG. in many instances, these and other procedures are performed on an outpatient basis before admission
Caring for what type of patient requires the coordinated services of a large number of health care professionals to help patients stay healthy and prevent complications or injuries?
Disabled
Which of the following skin conditions is a common finding in patients with systemic lupus erythematosis (SLE)?
Discoid lesions Discoid lesions, vascular lesions, and a butterfly rash across the nose and cheeks are common skin manifestations.
A client arrives at the emergency department with severe chest pain and shortness of breath. The client is diaphoretic, pale, and weak. Suddenly, the client collapses and becomes unresponsive. What is the priority action by the nurse?
Initiate chest compressions before ventilations.
Radiation therapy is instituted for a client with Hodgkin's disease. After 1 week, the radiation site becomes red and irritated. Which statement indicates that the client treated the area appropriately at home?
"I applied nothing to the area; I just kept it dry."
A patient with hypotension and temperature elevation after doing yard work on a hot day arrives in the emergency department (ED). After the nurse has completed discharge teaching, which statement indicates that treatment has been effective?
"I should have sports drinks when exercising outside in the hot weather" Electrolyte solutions such as sports drinks help replace fluid and electrolytes lost when exercising in hot weather.
A client in a semiprivate room is diagnosed with pediculosis corpus. A nurse will initiate treatment after moving the client to another room. The client's roommate asks the nurse for information about the client. What should the nurse say?
"I'm sorry, but I can't share confidential information."
Which of the following client statements should the nurse evaluate as indicating the client's correct understanding of the causes of coronary artery disease (CAD)?
"The leading cause of CAD is atherosclerosis."
The family member of a client diagnosed with dissociative identity disorder (DID) asks a nurse if hypnotic therapy might help the client. How should the nurse respond?
"Yes, a client is often not consciously aware of alter personalities."
feminization of poverty?
# of female households at poverty level - unmarried mothers, divorce, abandonment, abortion
Tonsillitis
- inflammation of the tonsils - may be viral or bacterial - may be related to streptococcus infection
A child needs 150% of the usual calorie intake for normal growth and development.
...
Do not examine the throat of a child with epiglottitis because of the risk of completely obstructing the airway
...
In planning and providing nursing care, patent airway is always a priority of care, regardless of age
...
genontic nursery
..... care
If a subcutaneous injection is to be given at a 90 degree angle, you should choos a needle that is ___ inches in length.
1/2
If a subcutaneous injection is to be given at a 90 degree angle, you should choos a needle that is ____ inches in length.
1/2
BMI (body mass index): Obesity
30 or greater
At what age is visual acuity 20/20?
7
A terminally ill patient is admitted to the hospital. Which action should the nurse include in the initial plan of care? a. Determine the patient's wishes regarding end-of-life care. b. Emphasize the importance of addressing any family issues. c. Discuss the normal grief process with the patient and family. d. Encourage the patient to talk about any fears or unresolved issues.
A
What can cause fluid imbalance?
Age, gender, environment (heat and sweating etc), disease, trauma (crush injuries, burns), therapies (diuretics), GIT losses (gastro)
No some examples of physical abuse
Already hitting tying up
Psychosocial Manifestations
Altered decision making Anxiety Withdrawal Fear Helplessness Peacefulness Unusual communication
The nurse is developing a care management plan with a client who has been diagnosed with gastroesophageal reflux disease (GERD). What should the nurse should instruct the client to do? Select all that apply.
Avoid a diet high in fatty foods. Avoid beverages that contain caffeine. Avoid all alcoholic beverages.
The health care provider prescribes an infusion of heparin and daily PTT testing for a patient with a venours thromboembolism (VTE). Which of the following will nurse include in the plan of care?
Avoid giving any IM medications to prevent localized bleeding
Conjuctivitis that is normally unilateral is called?
Bacterial conjunctivitis
Viral conjunctivitis usually occurs _____.
Bilaterally
Which surgical therapy involves removal of the entire tumor along with a margin of normal tissue? Breast conservation surgery Axillary node dissection Modified radical mastectomy Primary radiation
Breast conservation surgery
List signs of neglect
Bruising bedsores what underclothes
Stacey is HIV positive and comes into the clinic with complaints of frequent drenching night sweats, diarrhea, headaches, and severe fatigue. Which laboratory finding do you expect to see? CD4+ T cell count of 800 cells/microliter and a decreased viral load. CD4+ T cell count of 700 cells/microliter and an increased viral load CD4+ T cell count of 300 cells/microliter and an increased viral load. CD4+ T cell count of 1200 cells/microliter and a decreased viral load.
CD4+ T cell count of 300 cells/microliter and an increased viral load.
What is the acronym for communication before a procedure?
CICAD. (CHECK the patient ID, INTRODUCE yourself, explain the procedure and gain CONSENT, ASSESS the client and confirm that the procedure is still appropriate, DESCRIBE what the patient can expect)
macrominerals
Calcium, Phosphorus, Sulfur, Sodium, Chloride, Potassium, Magnesium
A patient who has had severe chest pain for several hours is admitted with a diagnosis of acute myocardial infarction (AMI). Which of these ordered laboratory tests should the nurse monitor to help determine whether the patient has had an AMI?
Cardiac-specific troponin I or troponin T Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction (MI).
Age-related ____ that contribute to a decreased ability to clear drugs through the ____ and renal system place the older adult at risk for adverse drug effects.
Changes/liver
Which of the following is not considered a cauastive factor in the development of cardiomyopathy?
Chronic elevation in intracranial pressures
Which finding in a patient who is receiving interleukin-2 indicates a need for rapid action?
Crackles heard at the lower scapular border Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2; the patient may need oxygen and the nurse should rapidly notify the health care provider.
Complications of PEEP
Decreased blood pressure
What is nursing theory?
Developed to describe nursing; differentiates nursing from other fields
______ procedure involves the removal and study of tissue to make an accurate diagnosis.
Diagnostic
What process involves enzymes help break down food particles to their simplest form so that the nutrients can be absorbed by the body?
Digestive
A 58 year-old woman calls the health clinic when she has a moderate amount of vaginal bleeding 6 years after menopause. The nurse will anticipate teaching the patient about which of the following?
Endometrial biopsy A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis.
Because of the normal decline in metabolism and physical activity, _____ needs lessens with age.
Energy
Who determines whether drugs are prescription or not?
FDA
The official drug name is assigned by the _____. Most often it's the same as the _____ name.
FDA. generic.
T/F: During ancient times, nurses had glamorous roles
False
A patient with septic shock has a urine output of 20 ml / hr for the past 3 hours. The pulse rate is 120 bpm and the central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP) are low. Which orders given by the health care provider will the nurse question?
Give furosemide (Lasix) 40 mg IV Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock.
The organism usually responsible for epiglottitis is?
Haemophilus influenzae (H. influenzae, primarily type B)
HIPAA
Health Insurance Portability & Accountabiity Act
In the late 60s healthcare focus was aimed at the old adult because
Help more people live longer and live healthier lives
Report descrepancies in narcotic counts ____.
Immediately
Following surgery, a patient's central venous pressure (CVP) monitor indicates low pressures. Which action will the nurse anticipate taking?
Increase the IV fluid infusion rate A low CVP indicates hypovolemia and a need for an increase in the infusion rate.
During what stages of life do nutritional needs become greater?
Infancy, adolescence, pregnancy, lactation.
What is fowlers position?
It is a type of body position for a patient where the patient lies in bed with their hands by their sides and their upper body raised by the bed being lifted. (eg, flat is 0 degrees fowlers, whereas sitting upright is 90 degrees fowlers)
What are 2 types of nurses?
LPN & RN
Which of 2 nurses consisered founder of public Health nursing?
Lilian Wald
What 2 nurses opened up Henry Street Settlement?
Lilian Wald and Mary Brewster
Who was first trained nurse in US?
Linda Richards
Cardiogenic shock
Low blood flow
Who was first professor of nursing?
Mary Adelaide Nutting
Who was first African American nurse?
Mary Mahoney
A nurse is performing an assessment of a postpartum client two hours after birth, and notes heavy bleeding with large clots. What should be the nurse's initial action?
Massaging the fundus firmly
What is the nurse's priority action in caring for a client who has just had a liver biopsy?
Monitor vital signs
While waiting for cardiac transplantation, a patient with severe heart failure has a ventricular assist device implanted. When developing a plan of care, nursing actions should include which one of the following?
Monitoring the surgical incision for signs of infection
List examples of emotional abuse
Name-calling demoralizing
All _____ should be stored in a locked cabinet.
Narcotics
As an effective member of a multidiscipliary rehabilitation team, the ____ is a care planner, teacher, caregiver, counselor, coordinator and advocate.
Nurse
A 24 year-old patient is hospitalized with the onset of Guillain Barre syndrome. During the illness, the most essential assessment for the nurse to carry out is
Observing respiratory rate and effort The most serious complication of Guillain-Barré syndrome is respiratory failure, and the nurse should monitor respiratory function continuously.
A patient who is unconcious after a fall from a ladder is transported to the emergency room by family members. During the primary survey of the patient, the nurse should
Obtain a Glasgow Coma Scale score The Glasgow Coma Scale is included when assessing for disability during the primary survey
When the nurse is assessing a patient who is recovering from an episode of DKA, the patient reports feeling anxious, nervous, and sweaty. Which action should the nurse take next?
Obtain a glucose reading using a finger stick
A nurse who works in a community-based clinic is implementing primary prevention with the clients who use the clinic. What should the nurse include in primary prevention activities?
Obtaining a rubella titer on a woman who is planning to start a family
Public Agencies
Official or governmental agencies organized at the city, country, state, or national level. Usually funded by taxes along with reimbursement from insurance companies
How do we assess fluid balance?
On a fluid balance chart where all fluid input and output is recorded
Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most rapid action by the nurse? Oxygen saturation of 88% increase in apical pulse rate 1-kg weight gain decreases in urine output
Oxygen saturation of 88% A decrease in oxygen saturation to less than 92% indicates hypoxemia. The nurse should administer supplemental oxygen immediately to the patient.
Sickle cell treatments:
Oxygen, Pain meds, fluid
What allergy often runs in families?
PCN
The nurse at the clinic is interviewing a 61 year-old woman who is 5 feet 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years.She walks 5 miles on most days and has a glass of wine 2-3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk?
Pap testing Sunscreen use Mammography Colorectal screenin
Neglect
Passive form of abusing which caregivers failed to provide for the needs of a person under their care
What is race?
Physical characteristics; skin, body, face, hair
Which of the following levels of basic human needs is more basic?
Physiologic
Maslow's Hierarchy of Basic needs
Physiological - food, water, O2, ... Safety - shelter, security ... Love & Belonging - family, friends, love Self-esteem - feelings of indepdence Self- actualization - reaching full potential
Attitude
Pos/Neg feelings toward a subject
Political
Power
______ teaching should include surgical preparation; what to expect in the surgical suite and the PACU; what tubes, dressings, or equipment may be in place after surgery; and how patient participation can promote ______.
Preoperative/surgery
Voluntary Agencies
Prominent agencies in the delivery of home healthcare. Normally governed by a board of directors and funded by donations, endowments, and third party reimbursement
While caring for a patient with aortic stenosis, the nurse establishes a nursing diagnosis of acute pain related to decreased coronary blood flow. Which of the following is an appropriate intervention by the nurse related to this diagnosis?
Promote rest to decrease myocardial oxygen demand Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain.
_____ recognition and reporting of ADEs will prevent serious injury to patients.
Prompt
_____ are made of smaller units called amino acids.
Proteins
Which ocular or facial signs/symptoms would the nurse expect to find when assessing the client diagnosed with myasthenia gravis?
Ptosis and diplopia Ptosis is drooping of the eyelid, and diplopia is unilateral or bilateral blurred vision.
What legislation set the standards for the quality and purity of medications?
Pure Food and Drug Act 1906
2 methods of nursing research?
Quantatative & Qualitative
Changes in skin color that occur in response to cold
Raynaud's phenomenon
Finger pain associated with cold weather
Raynaud's phenomenon.
A nurse notes the following laboratory values for a client receiving chemotherapy: white blood cell count 6000/µL, red blood cell count (RBC) 3.7 million cells/cm3, hematocrit 35%, platelet count 80,000 mm3. Which order would the nurse question?
Rectal temperatures every 4 hours
Pulmonary artery wedge pressure
Reflects left ventricular end diastolic pressure.
What type of facility would be recommended for a patient who had a hip replacement I needed physical therapy
Rehab facility rehabilitation
What is the process of restoring an individual to the best possible health and functioning following a physical or mental impairment and the prevention of further disablity?
Rehabilitation
Respite Care
Relief for family caregivers
Cultural Diversity Factors
Religion Communication View of time Organization of the family Nutrition Death and dying Susceptiblity
A 78 year-old man has confusion and a temperature of 104 F. He is diabetic with purulent drainage from his right great toe. His assessment findings are BP 84/40, HR 110, RR 42 and shallow. His skin has changed from hot and moist to cool and moist. This patient's symptoms are most likely indicative of which of the following?
Septic shock The patient's blood pressure is low his heart rate is fast and his respirations are rapid. This indicates shock. He also has fever and known infection
Which laboratory result for a patient whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider?
Serum potassium 2.8 Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation; the health care provider will need to prescribe a potassium infusion to correct this abnormality.
Uses for Common Transplants
Skin grafts are frequently used with burn patients. Bone marrow donation is used with leukemias and other malignancies. Corneas are used to prevent or correct blindness.
A pressure ulcer demonstrating full-thickness skin loss involving damage to subcutaneous tissue extending down to, but not through, the underlying fascia, would be classified as?
Stage 3
What major organ is is normally emptied in 1 to 4 hours, dependign on the amount and kinds of foods eaten?
Stomach
Patients commonly _____ taking medications because of side effects such as anorexia, nausea, vomiting, dizziness, drowsiness, dry mouth, constipation, and diarrhea.
Stop
Which recommendation would be most helpful to suggest to a primigravid client at 37 weeks' gestation who has leg cramps?
Straighten the knee and flex the toes toward the chin.
The nurse is providing stress management education to a group of elderly women. Which of the following statements, if made by the nurse, would be an accurate description of the effect of stress on the cardiovascular system?
Stress causes increased sympathetic nervous system stimulation, which causes the heart rate to increase and blood vessels to constrict . The result is an increase in blood pressure
Which information will the nurse plan to include when teaching a 19 year-old to perform testicular self-examination
Testicular self-examination should be done in a warm area
Home Healthcare
The delivery of health-related services in the client's home
What is ageism
The disliking of aging and older people based on the belief
Grief
The lived experience in reaction to the loss.
Cardiac output
The volume of blood pumped by the heart in 1 minute
What is nitrogenous waste?
Urea, uric acid, creatinine.
Which of these findings is the best indicator that the fluid resuscitation for a patient with hypovolemic shock has been successful?
Urine output is 60 ml over the last hour Assessment of end organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful.
is nursing considered a profession?
Yes
stress
a state of agitation that renders the body out of balance
Age cohort
a term used by demographics to describe a group of people born with in this special specific period of time for example baby boomers
diagnostic test
a test used to determine a diagnosis or to determine the cause and nature of a pathological condition
What is an example of a generic name vs. a trade name?
acetaminophen vs. Tylenol
delirium
acute confused state that beings with disorientation can be from acute illness or environmental change can progress to changes in level of consciousness, irreversible brain damage, and death find and treat underlying cause
Functional age
an age that person is still functional according to age appropriateness
Cystic fibrosis
an autosomal recessive disease that causes dysfunction of the exocrine glands
what are concepts?
an idea. abstract impressions organized into symbols of reality
Asthma
an inflammatory reactive airway disease that is often chronic
Which is a priority assessment for the client in shock who is receiving an IV infusion of packed red blood cells and normal saline solution?
anaphylactic reaction
life-threatening allergic reaction
anaphylaxis
What is cultural conflict?
aware of diff - feel threatened - ridicule beliefs and traditions of others
What is knowledge?
awareness of the reality one acquires through learning/investigation
Following a generalized tonic-clonic seizure, the patient is tired and sleepy. The nurse should: a) suction the patient before allowing him to rest b) allow the patient to sleep as long as he feels sleepy c) stimulate the patient to increase his level of consciousness d) check the patient's level of consciousness every 15 minutes for an hour
b) allow the patient to sleep as long as he feels sleepy
Pathologic fractures may be indicative of
bone mets
When teaching a patient with a seizure disorder about the medication regimen, it is most important for the nurse to stress that: a) the patient should increase the dosage of the medication if stress is increased b) if gingival hypertrophy occurs the drug should be stopped and the health care provider notified c) stopping the medication abruptly may increase the intensity and frequency of seizures d) most over-the-counter and prescription drugs are safe to take with anticonvulsant drugs
c) stopping the medication abruptly may increase the intensity and frequency of seizures
crackles, chest pressure, and cool extremities are all consistent with the patient's diagnosis of
cardiogenic shock
How do you check to make sure you have the right client?
check ID bracelet, ask patient to state name or DOB
What should you do to a patient following a medication error?
check VS, do a head to toe assessment
What is the chemical name of a drug?
chemical and molecular structure name
Q-T interval represents
depolarization and repolarization of the entire conduction system.
The P wave represents
depolarization of the atria
Advanced Directive
document signed in advance of event occuring where resuscitation may be needed.
cognitive development
does not change appreciably, may take longer to respond and react
The wife of a client with alcohol dependency tells the nurse, "I am tired of making excuses for him to his boss and coworkers when he cannot make it into work. I believe him every time he says he is going to quit." The nurse recognizes the wife's statement as indicating which behavior?
enabling
A nurse is making a home visit to a pregnant client at 20 weeks' gestation who is a member of the local Hmong community. The nurse is assisting the client with meal planning to promote optimal nutrition during her pregnancy. Based on the nurse's understanding of the client's culture and food preferences, which foods would the nurse suggest? Select all that apply.
fish cheese eggs
geriatric syndromes
group of nursing diagnoses or syndromes risks increase with age examples are functional or cognitive impairment, impaired mobility
Adulthood
grow and develop thru life span susceptible to health disorders
The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome and will monitor the pt closely for what kind of electrolyte imbalance associated with this oncologic emergeny?
hyokalemia TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemo. This can rapidly lead to acute renal failure.
mild allergic reaction
hypersensitivity
What is lactase deficiency and lactose intolerance and in what race of people is this disorder found?
inability to digest lactose; AA and Hispanics
Metabolism is the _____ or breakdown of the medication.
inactivating
Otitis media
inflammatory disorder of the middle ear
Confidentiality
information abotained about a pts history, condition or treatment
Communication
information exchanged b/w individuals
Privileged Communication
information given to a professional person who is forbidden from disclosing information in court without consent of provider of information
aspiration
irritation of bronchial mucosa; decreased bronchial blood supply; pneumonia; ARDS (adult respiratory distress syndrome and worse than pneumonia); possible death.
disengagement theory
isolate themselves from society; perception that they withdraw themselves
Behavior
manner of conducting oneself
Health-illness continuum model of health and illness?
measure person's level of health. Health = constantly changing state w/ high level wellness and death on opposite ends. death-illness-normal-good health-high level wellness
energy
measured as kilocalories (cal.)
What is a standing order?
med on a routine basis
Standard of Care
medical treatment guidelines; specific or general
financing
meds are expensive
All _____ should be stored in a locked cabinet.
narcotics
The nurse monitors the patient receiving treatment for ADHF with the knowledge that marked hypotension is most likely to occur with the IV administration of which of the following? furosemide (Lasix) milrinone (Primacor) nitroglycerin (Tridil) nitroprusside (Nipride)
nitroprusside (Nipride)
What are the four types of med errors?
no error, error without harm, error with harm, error resulting in death
Nonverbal
non verbal expressions
A generic drug name is also called the _____ name. When is it assigned?
nonproprietary. when the drug is first manufactured.
cultural influences on healthcare include:
nontraditional methods of care; physiologic variations, reaction to pain, mental health, language/communication, orientation to sace and time; food and nutrition; family support; socioeconomic.
dress and grooming
on the morning of surgery provide a clean gown,instruct the pt to remove all undergarments unless agency policy dictates otherwise, jewelry should be remove, body piercing. document the disposition of jewelry and dentures, should not be left at bed side. braid or secure long hair,remove hairpins or clips,provide a cap,remove nail polish,acrylic nails consult with the anesthesiologist or preoperative nurse, atleast one acrylic nail is usually remove,make up including mascara is also remove.pt must have identification band on wrist,allergie bands,blood type band.
sun downing
once evening sets in, patient becomes confused or has a change in mood, wake up in the morning alert and oriented managed with behavioral interventions
What would be most helpful for a patient that is experiencing chills because of an infection?
provide a light blanket chills signify a rise in temp. For this reason the nurse should only use a light blanket to avoid overheating.
Primary Care Manager (gate keeper)
provider for routine medical care, monitors the quality care
What are the "six rights?"
right drug, dose, client, route, time, documentation
Scope of Practice
set of regulations and ethical considerations; what you are allowed to do
green leafy vegetables, nuts, legumes, seafood, whole grains, oranges, cocoa, and chocolate
sources of magnesium in the diet
A drug has a "target organ" when it has a _____ effect on one type of _____ _____.
specific, body tissue
Verbal
spoken or written; using words
pressure ulcer defined as a change in skin temp. tissue consistency, and/or sensation.
stage 1
MODS is defined as
the failure of two or more organ systems in an acutely ill patient such that hemostasis cannot be maintained without intervention.
termination
the spatial or temporal end of something; a limit or boundary
limitation
the state of being limited or restricted
QRS represents
ventricular depolarization
data?
verifiable info
Tort
violation of a civil law; wrong against individual
BMI Equation
weight (in kg) / [height] (m)]2
Which of the following is the mnemonic used to educate people about the warning signs of cancer?
CAUTION
Who founded American Red Cross?
Clara Barton
What health care workers help individuals and aggregates (groups) to improve health of the entire community?
Community health nurses
During the diagnosis and long-term management of a seizure disorder, the nurse recognizes that one of the major needs of the patient is assistance to: Manage the complicated drug regimen of seizure control Cope with the effects of negative social attitudes toward epilepsy Adjust to the very restricted lifestyle required by a diagnosis of epilepsy Learn to minimize the effect of the condition in order to obtain employment
Cope with the effects of negative social attitudes toward epilepsy
Self-neglect
The failure to provide for the self based on a lack of ability or lack of awareness or lack of economics
indication for suctioning in a mechanically ventilated patient?
The patient's respiratory rate is 32
the human leukocyte antigen
This is very important for kidney and bone marrow transplants and minimizing the HLA mismatch increases the survival rates for heart and lung transplants.
What are some alternative methods of nutrition if a patient cannot eat?
Total parenteral nutrition, IV therapy, enteral tube feeding (nasogastric tube, gastrostomy tubes)
_____ _____ develop after prolonged intake of a medication, when a medication accumulates in the blood because of impaired metabolism or excretion, or when too high a dose is given.
Toxic effects
Which of the following describes the triad of symptoms found in the patient with Parkinson's Disease?
Tremor, rigidity, bradykinesia
A client has been newly diagnosed with cancer and asks how severe the disease is. You correctly respond that the TNM staging test will be performed to give a more accurate prognosis. What does the TNM staging criteria evaluate?
Tumor size, nodal involvement, metastasis
The ED receives notification that a patient who has just been in an automobile accident is being transported to your facility with anticipated arrival in 1 minute. In preparation for the patient's arrival, the nurse will obtain... 5oo ml of 5% albumin Lactated Ringer's solution Two 14-guage IV catheters Dopamine (Intropin) infusion
Two 14-guage IV catheters
What is the best type of faeces according to the bristol stool chart?
Type 3 or 4.
What do DRGs do
Until the page set amount runs out
How long will make your covered extended care facility costs
Until the set amount runs out
To verify the correct placement of an endotracheal tube (ET) after insertion, the best initial action by the nurse is to...
Use an end-tidal CO2 monitor to check for placement in the trachea End-tidal CO2 monitors are currently recommended for rapid verification of ET placement. Auscultation for bilateral breath sounds and checking chest expansion also are used, but they are not as accurate as end-tidal CO2 monitoring. A chest x-ray confirms the placement but is done after the tube is secured.
The registered nurse (RN) is referred to a client's home when a husband and wife have been confirmed to have scabies. The family asks, "How will we get rid of this?" When instructing on the proper procedure to wash contaminated clothing and sheets, which nursing instruction is a priority?
Use hot water throughout wash cycle.
Economical
Usefulness & practically
______ are at risk for megaloblastic anemia if adequate _______ ___ is not added to the diet.
Vegetarians/vitamin B12
_____ is the largest component of the body and body tissues are essential to all life processes in the body.
Water
Unfortunately, although ADEs are sometimes immediately apparent, they often take ___ or ____ to develop.
Weeks/months
disability
a disabled state or condition; incapacity
What is the difference between a drug and a medication?
a drug may or may not have a therapeutic effect, a medication is used for its therapeutic effect
behavior
a person's total activity- actions or reactions, especially conduct that can be observed
Patients presenting to the ED with hypertensive crisis will most likely experience: a) Severe anxiety and Respiratory failure b) Changes in vision and Numbness or Weakness c) Nausea/Vomiting and Chest Pain d) B & C e) All of the above
Correct answer: D
Narcotics should be _____ frequently, during the opening of narcotic drawers, and/or shift change.
Counted
What must be taken into consideration when performing ADL's on a patient?
Culture, likes and dislikes, religion, age, ability, lifestyle
________ procedure is made to remove diseased tissue or to correct defects.
Curative
If not managed Cardiomyopathy may lead to all of the following complications except: Heart Failure Blood Clots DVTs Cardiac arrest and sudden death
DVTs
During an acute exacerbation of SLE, the patient is treated with corticosteroids. The nurse should expect the steroids to be tapered when serum lab results reveal.... Increased RBC Decreased ESR Decreased Anti-DNA Increased complement
Decreased Anti-DNA
When the charge nurse is evaluating the skills of a new RN, which action by the new nurse indicates the need for more education in the care of patients with shock?
Decreasing the room temperature to 68 F for a patient with neurogenic shock Patients with neurogenic shock may have poikilothermia. The room temperature should be kept warm to avoid hypothermia.
______ in activites of daily living is the best indicator of who will need nursing home placement.
Dependence
Abandonment
Dependent older adults are deserted by the person or persons as possible for the custody or care
events of metastasis
Detach from the primary tumor and enter the circulation Survive the turbulent ciculation and adhere to the capillary basement membrane Gain entrance into the organ parenchyma Respond to a favorable growth environment Undergo angiogenesis and proliferate
A hospital client has told the nurse that his religion involves the burning of incense and has asked permission to do so on the unit. The nurse is aware that this practice would violate the hospital's fire regulations. What is the nurse's best action?
Dialogue with the client about alternative rituals or the possibility of performing the ritual outdoors.
A 60 year old man arrives in the clinic complaining of shortness of breath and a pounding heartbeat. Even when lying down he cannot seem to catch his breath. He also complains of a persistent cough that gets worse when he is lying down. Upon examination you notice edema in his legs ankles and feet as well as pale skin. You suspect the doctor will make a diagnosis of: Primary Cardiomyopathy Dilated Cardiomyopathy Restrictive Cardiomyopathy Hypertrophic Cardiomyopathy
Dilated Cardiomyopathy
The nurse is teaching the parents of a child with sickle cell disease. To instruct them on how to prevent sickle cell crisis, she should include which instruction?
Drink at least 2 quarts (2.3 liters) of fluids per day.
A young adult is hospitalized after an accident that resulted in a complete transection of the spinal cord at the level of C7. The nurse informs the patient that after rehabilitation, the level of function that is most liely to occur is the ability to
Drive a vehicle with hand controls A patient with injury at the level of C7 to C8 may have the following rehabilitation potential: ability to transfer self to wheelchair; roll over and sit up in bed; push self on most surfaces; perform most self-care; use wheelchair independently; and drive a car with powered hand controls (in some patients);
Which advanced director will allow phone number to make healthcare decisions for the ill parents/family member
Durable power of attorney
The two main priorities in health promotion in the battle against HIV are
Early detection and disease prevention
Burns to which of the following areas poses a significant threat of infection?
Ears and nose
To maintain a positive nitrogen balance in a major burn, the patient must
Eat a high protein, low-fat, high carbohydrate diet Increase normal caloric intake by about 3 times
______ disorders are thought to be caused by multiple biologic, psychologic, sociocultural and spiritual factors.
Eating
What is involuntary turning inward of the eyes also common in neonates called?
Estropia
_______ procedure includes a more extensive procedure than a biopsy.
Exploratory
Hospital-Based Agencies
Extensions of the services provided at a hospital.
If the family of the deceased is unsure of the organ donation wishes of their family member, the nurse does not need to notify an organ donation team. a. True b. False
False
Life lease
Four large initial investment into central monthly rental service fees will the person to a couple guaranteed a right residence for life
What body system regulates neural control and the secrection of hormones?
Gastrointestinal
______ is the study of aging.
Gerontology
Liquid oral iron supplements have been prescribed for a child. What is the most important information for the nurse to provide to this child's parents?
Give the medicine via a dropper or through a straw
Baby boomers
Group of adults born after World War II
What is family?
Group of people who live together and are emotionally bonded
Transplant Rejection Occurs if the donor organ does not match the recipient's
HLA
What is the acronym for before a procedure in regards to hygeine?
HPI (wash HANDS, PPE, INFECTION control)
What is the minority group?
Have physical or cultural characteristics different from dominant group
Theoretical
Honor, courage and commitment
What drug route has the most rapid effect?
IV
Predicting which patients will have an idiosyncratic response is _______.
Impossible
Which of the following is the benefit of yoga as an alternative therapy in the treatment of Parkinson's Disease?
Improves balance and flexibility
The nurse would expect the following findings in a patient as a result of the physiologic effect of stress on the reticular formation.
Inability to sleep the night before starting self-injections of insulin
Shock is best defined as...
Inadequate tissue perfusion
Elder abuse
Inappropriate behavior responses of the older adult intentional unintentional physical psychological emotional financial mistreatment
Vital statistics
Including birth, age at death,death
Central venous pressure
Indirectly measures right ventricular end diastolic pressure. A measure of volume.
Assessment of the patient during the primary survey indicates that the patient has delayed capillary refill of the extremities and cannot explain the events prior to admission to the emergency department. The nurse should first: 1. Insert one or two large-bore IV catheters to start intravenous fluid resuscitation. 2. Continue the primary survey to complete it with a brief neurologic examination. 3. Apply leads for electrocardiogram (ECG) monitoring. 4. Initiate pulse oximetry.
Initiate pulse oximetry.
Medicare part A
Inpatient hospital care extended care in a skilled nursing facility home visiting nurses occupational speech physical therapy hospice services
What cosmetic care part a pay for
Inpatient hospital extended care skilled nursing facility follow up hospital send home health services visiting nurses and occupational speech therapy
You and your classmates are studying for an Adult Health II exam, when Jena asks Katie "What do you think the answer is to number 16?" Katie does not answer, but stares blankly at Jena. What do you think is going on?
Katie is having an atypical absence seizure An atypical absence seizure is characterized by a staring spell, peculiar behavior during the seizure, and confusion after the seizure.
In the hospital setting, the daughter of a man who is dying tells the nurse, "It is hard to just sit with my father for hours and not say or do anything." As the nurse responds to the daughter's statement, what issue is most important for the nurse to focus on during their discussion?
Know that being present with the person is important.
The body makes use the energy received through the food that is eaten, and the _____ portion of _____ expenditure occurs during rest to carry out the mechanical activities needed to sustain life processes.
Largest/energy
When assessing a patient's full-thickness burn injury during the emergent phase, the nurse would expect to find
Leathery, dry, hard skin Dry, waxy, white, leathery, or hard skin is characteristic of full-thickness burns in the emergent phase
To evaluate the effectiveness of IV methylprednisolone (Solu-medrol) given to a patient with a T4 spinal cord injury, which information is most important for the nurse to obtain?
Leg strength and sensation The purpose of methylprednisolone administration is to help preserve motor function and sensation. Therefore the nurse will assess this patient for lower extremity function.
Most biotransformation occurs in the _____, although the lungs, kidneys, blood, and intestines also play a role
Liver
a resident of a long-term care facility is refusing to eat what could this be a BB and T
Loss of independence
cultural congruent care?
Madeline Leininger - Care that fits the person's valued life patterns and set of meanings, which is generated from people themselves rather than by predetermined criteria
What is a basic need?
Maslow. Essential to emotional and physiologic health and survival of humans
The nurse is caring for a client with gestational trophoblastic disease (GTD). Which of the following interventions will the nurse include in the client's plan of care? Select all that apply.
Measure fundal height. Administer ondansetron IV.
Pulmonary vascular resistance
Measures resistance to entry of blood into the heart. Reflective of volume.
What is a major source of home health care funding?
Medicare
After a medication reaches its site of action, it becomes ______ into a less active or inactive form.
Metabolized
What are the characteristics of the typical caregiver for an aging family member
Mid aged child
Which of the following are probable clinical findings in a patient with an acute venous thromboembolism (VTE)? Mild to moderate calf pain and tenderness Grossly diminished or absent pedal pulses Unilateral edema and induration of the thigh Palpable cord along a superficial varicose vein
Mild to moderate calf pain and tenderness Unilateral edema and induration of the thigh
What are a plugged lacrimal duct, treatment involves massaging the tear duct every 4 hours while infant is awake; after 1 year lacrimal ducts that are still plugged may be surgically opened symptoms of?
Mimic conjuctivitis
most common form of valve disease in the United States?
Mitral valve prolapse
What residential care exists in these four levels: 1. domicilary care 2. sheltered housing 3. intermediate care 4. skilled care
Modern long-term
Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock?
Monitor breath sounds frequently Since pulmonary congestion and dyspnea are characteristics of cardiogenic shock, the nurse should assess the breath sounds frequently.
Who was Lavinia Dock?
Nursing leader and women's rights activist; instrumental in women's right to vote
nursing theorist developed health promotion model?
Pender
The ______ of the surgical experience are Preoperative, Intraoperative and Postoperative.
Phases
A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9. Which action prescribed by the HCP should the nurse take first? Infuse regular insulin@ 20 units / hr Place the patient on a cardiac monitor Administer IV potassium supplements Obtain urine glucose and ketone levels
Place the patient on a cardiac monitor
The primary organ of absorbtion is the ____ _____.
Small intestine
Name the most beneficial legislation
Social Security program or Medicare
the info communicated for a surgical pt should include:
-pt diagnosis -surgical procedure to be performed -relevant medical history -any medication given -blood administered -latest vs -any drains -iv access lines
What are the 5 parts of the Nursing Process?
1. Assessing; 2. Diagnosing; 3. Planning; 4. Implementing; 5. Evaluating
4 types of quant. research?
1. Descriptive - explore & describe events in real life 2. Correlation - examine type and degree of relationships b/w 2 + variables 3. Quasi experimental research - examine cause and effect relationships b/w selected variables. 4 experimental - examine cause and effect relationships b/w variables under highly controlled conditions.
Major areas of risk factors?
1. age; 2. genetic factors; 3. psyiologic factors; 4. health habits; 5. lifestyle; 6. environment
After receiving change-of-shift report, which of these patients should be seen first?
24 year-old who is receiving neck radiation and has blood oozing from the neck Since neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first.
BMI (body mass index): Overweight
25 - 29.9
What month are tracks an object through 180 degrees; regards own hand; begins visual motor coordination milestones for a neonate?
3
How many times should you check that you have the right drug? When?
3. once when you get the med, once when you take it out of the package, and then once again before you administer it
How many levels of TRICARE?
4
BMI (body mass index): Underweight
< 18.5
Physical abuse
Any action that causes physical pain or injury
An amniotomy is performed on a client in labor. What is the priority nursing intervention following this procedure?
Assess fetal heart tones
Age discrimination
Based solely on age
What should you checkbefore doing an enteral tube feed?
Before feeding, check the position of the tube and it's length.
A 21-year-old is dying after an automobile accident. The family members want to donate the patient's organs and ask the nurse how the decision about brain death is made. The nurse explains that the patient will be considered brain dead when a. the patient is flaccid and unresponsive. b. CPR is ineffective in restoring heartbeat. c. the patient is apneic and without brainstem reflexes. d. respiratory efforts cease and no apical pulse is audible.
C The diagnosis of brain death is based on irreversible loss of all brain functions, including brainstem functions that control respirations and brainstem reflexes.
What would be important environmental assessments for the home care nurse to explore with a client who is being discharged home?
Checking access to the home with a walker, access and safety measures in the bathroom, and access to food preparation in the kitchen, and ensuring safety in the sleeping environment
What would be appropriate nursing interventions to include in the plan of care for a patient with acute renal failure? A. Monitor intake and output B. Monitor for signs of infection C. Provide for adequate intake of calcium and vitamin D D. all of the above
D. all of the above
Type of Advanced Directives
DNR Living Wills Durable POA Any advanced directive requires a written doctors order
TRICARE
DOD managed care program
A patient with a large stomach tumor that is attached to the liver undergoes a debulking procedure. The nurse explains that the expected outcome of this surgery is
Decrease in tumor size to improve the effects of other interventions A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective.
A client receiving a continuous infusion of lidocaine for ventricular dysrhythmias states "I am so tired. Even my vision is blurry." What is the nurse's best action?
Decrease the lidocaine infusion rate.
Parasympathetic nerves simulate what?
Digestive activity
Where do individuals learn their health beliefs and values?
Family
For what do these 4 conditions have to be met for? 1. the physician has determined the need for home care and has made or authorized a plan for home care 2. the patient needs intermitted skilled nursing care or physical or speech-language therapy or continued occupational therapy 3. the patient is homebound 4. the agency providing the care is Medicare certified
Medicare
______ procedures classified by purpose are: 1. Diagnostic 2. Exploratory 3. Curative 4. Palliative 5. Cosmetic
Surgical
Emotional abuse
Verbal
Quantatative?
basic and applied research. aka NUMBERS
Why are non-prescription or OTC meds taken? What do they treat?
enhance personal health. treat common health problems (e.g. constipation)
A patient undergoing external radiation has developed a dry desquamation in the treatment area. Which patient statement indicates that the nurse's teaching about management of this reaction has been effective?
"I can buy some aloe vera gel to use on the area"
The nurse should be sure a prothrombin time (PT) and partial thromplastin time (PTT) have been determined before a tonsillectomy.
...
What month are alertness to light and visual stimulus 8-12 inches away, can follow an object 60 degrees horizontally and 30 degrees vertically; blings at an approaching object milestones for a neonate?
1
depression
16-30% of nursing home residents events, loss, chronic illness, pain suicide is common
A client with preeclampsia is prescribed magnesium sulfate to prevent seizure activity. The nurse is reviewing the results of the client's serum magnesium level and determines that the client's level is therapeutic based on which result?
6.8 mEq/L (3.4 mmol/L)
What drugs in particular can cause photosensitivity?
ATBs
A 23 year old female comes into the clinic for a routine exam. She relates that she does monthly self-breast exam, but notes that each month there are different areas of tenderness on each breast. What questions are most appropriate for the nurse to ask?
Are your periods regular or irregular? Do you check on the same date each month? Have you noticed any consistent areas of tenderness? Have you noticed any solid or immobile masses? Have you had any dimpling of the breast or drainage from the nipples?
Medicaid
Assistance may be available for that those older adults who meet certain financial native comments
Critical care nurses... A. Are formally trained to provide physical, emotional, and psychological care to patients and families B. Are knowledgeable members of a multidisciplinary team C. Must be certified to work independently at the bedside D. Can insert central venous access devices in ICU only.
B. Are knowledgeable members of a multidisciplinary team
What is the nurse's priority to regulate the temperature of a neonate?
Block radiant, convective, conductive, and evaporative losses
ambulatory
able to walk, or not confined to bed
identifying data
age,marital status
vital signs
all vitals
TRICARE Extra
care provided by civilian providers w/in authorized provider network retirees and family member eligible
What is excretion?
exit of the med from the body
Negligence
failure to act properly
prostheses
hearing aids,eyeglasses,contact lenses,dentures,artificial limbs,other devices
name some settings for nursing care:
homes, schools, hospitals, clinics
sample?
population studied
foods low in K+
raw unskinned apple, cooked oatmeal, corn flakes, egg, american cheese, white bread, asparagus, cucumber, corn, lettuce, and onions
After teaching a primigravid client at 24 weeks' gestation, who has received permission from the primary care provider to make a 6-hour automobile trip to visit her parents, about precautions to take during the trip, which client statement indicates the need for further teaching?
"I will sleep for 1 hour at the halfway point of the trip."
A nurse is planning the care for a client with a pressure ulcer. Which statements should the nurse include in the client's nursing care plan? Select all that apply.
"Use pressure-reduction devices." "Reposition every 1 to 2 hours." "Teach the family how to care for the wound." "Clean the area around the ulcer with mild soap."
types of burn injury
, smoke and inhalation, electrical, cold inhalation, and ... (chemical).
Signs and symptoms of tonsillitis
- sore throat - fever - enlarged tonsils (may have purulent discharge on tonsils) - breathing may be obstructed (tonsils touching, called "kissing tonsils")
Of the following information provided by a patient, which would help differentiate a hemorrhagic stroke from a thrombotic stroke? A. Presence of motor weakness B. Sudden onset of severe headache C. History of hypertension D. Sensory disturbance
. Sudden onset of severe headache
Orbital cellulitis can also lead to ____ _____.
Bacterial meningitis
Which of the following is the earliest sign of increased ICP that the nurse can assess?
Decreased level of consciousness
After a 25 year-old patient has returned home following rehabilitation for a spinal cord injury, the home care nurse notes that the spouse is performing many of the activities that the patient had been managing independently during rehab. Which of the following is the most appropriate action?
Develop a plan to increase the patient's independence in consultation with the patient and the spouse The best action by the nurse will be to involve all the parties in developing an optimal plan of care. Because family members who will be assisting with the patient's ongoing care need to feel that their input is important
route by which chemotherapy is most frequently given?
IV
With _________ infusions, the peak concentration occurs quickly, but the serum level also begins to fall ______.
IV/immediately
Which of the following is characteristic of the cancer cell in the initiation phase?
Once initiated, mutation is irreversible
What are bacteria and is an uncommon complication of sinusitis symptoms of?
Periobital cellulitis
During the rehabilitative phase of wound injury, the contour of scarring can be controlled with
Pressure garments Pressure garments help keep scars flat and prevent elevation and enlargement above the original burn injury area.
_____ _____ are predictable and often unavoidable secondary effects produced at a usual therapeutic drug dose.
Side effects
What is health?
State of complete physical, mental and social well being; not merely the absence of disease
When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to
Stop the infusion if swelling is observed at the site Swelling at the site may indicate extravasation, and the IV should be stopped immediately.
A patient with venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why the two medications are necessary. Which of the following statements by the nurse is accurate?
The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation
Why is genetic counseling important for the cystic fibrosis family?
The disease is autosomal recessive in its genetic pattern
physiologic development
all organ systems undergo some degree of decline, body less efficient
Among the different classes of medications, ________ cause a high incidence of allergic reactions.
antibiotics
Which of these patients is most appropriate for the nurse to refer to hospice care? a. A 60-year-old with lymphoma whose children are unable to discuss issues related to dying b. A 72-year-old with chronic severe pain as a result of spinal arthritis and vertebral collapse c. A 28-year-old with AIDS-related dementia who needs palliative care and pain management d. A 56-year-old with advanced liver failure whose family members can no longer care for him or her at home
c Hospice is designed to provide palliative care such as symptom management and pain control for patients at the end of life.
extremities
color,hair distribution,lesions,deformities,range of motion,crepitus,pain,weakness
Which of these transplants is least likely to have transplant rejection? Liver Cornea Heart Kidney
cornea
Therelaxation phase of the cardiac cycle is called
diastole
How does gender affect drug action?
different amounts of fat and muscle. most research has been done in males. unexplained reactions often occur in women.
Therapeutic response
enough of a drug to produce the desired physiological response, but not enough to cause toxicity.
genontophobic
fear of aging
Urinary Sys
kidneys shrink and blood flow decrease bladder muscles weaken and size decreases
Advocate
pleads the case for another
Sepsis with hypotension is characteristic of
septic shock
macronutrients
supply energy and build tissue such as carbs, fats, proteins
What are the two types of drug interactions?
synergistic and antagonistic
Drug tolerance results in a diminished _____ _____. It is common with _____ medications and results in the patient needing...
therapeutic effect. pain. increasingly higher dose
It is important to know the exact _______ for which a medication is prescribed so you can properly _____ patients about a medication's intended effect and to accurately evaluate the medication's desired effect.
therapeutic effect/teach
A patient's trough level is drawn as a blood sample __ ______before administering the drug, and the peak level is drawn whenever the drug is expected to reach its peak _____.
30 minutes/concentration
A patient's cardiac rhythm is sinus bradycardia with a heart rate of 34 beats/minute. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit: 1. Palpitations. 2. Hypertension. 3. Warm, flushed skin. 4. Shortness of breath.
4. Shortness of breath.
A 40-year-old client with schizophrenia lives in a rooming house. At the weekly nursing clinic he reports creatures eating at his skin while scratching vigorously. Which intervention should be done first?
Assess the physical problems
The nurse notes that a patient's cardiac monitor shows that every other beat has no P wave and has a QRS complex with a wide and bizarre shape. How will she document this rhythm?
Bigeminal PVCs Bigeminal PVC's or ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking.
Maintaining a good diet can help middle-aged and older adults maintain a high level of function and reduce the risks of ______ disease.
Chronic
What is the main difference between home health care nursing and public health care nursing?
Direct care to patients
What is is the cornerstone of the healing process. To support and maintain life or fight disease, the body must be supplied with the proper nutrients?
Nutrition
The highest serum concentration (_____ concentration) of a medication usually occurs just before the body absorbs the ____ of the medication.
Peak/last
A client was admitted to the hospital 2 weeks ago following an ischemic stroke. Following the early introduction of stroke rehabilitation, he has seen significant improvements in both his medical status and activities of daily living (ADLs). This morning, however, his nurse notes that the client has been coughing since eating a minced and pureed breakfast. Auscultation of the chest reveals coarse crackles. Which of the following practitioners should the nurse liaise with to obtain a swallowing assessment?
Speech therapist.
A diabetic patient who is hospitalized tells the nurse, "I don't understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up". Which response by the nurse is appropriate?
Stressors such as illness cause the release of hormones that increase blood sugar The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels.
A patient is scheduled for an abdominal aortic aneurysm (AAA) repair. Which of the following events causes the nurse to suspect rupture of the aneurysm ?
The patient complains of sudden, severe back pain
_____ that affect surgical outcomes are age, nutritional status, fluid and electrolyte balance, medical diagnoses, drugs, and habits such as use of tobacco and alcohol.
Variables
What are the characteristics of elder abuse
Withdrawn bruises
instrument?
devices used to collect and record data. Rating scales, pencil/paper tests...
>100mg/day
macromineral need
<100mg/day
micromineral need
What is the most common site of drug metabolism? What are some less common sites?
the liver. kidneys, lungs, intestines.
A patient with a T1 spinal cord injury is admitted to the intensive care unit. The nurse will teach the family that
full function of the patient's arms will be retained The patient with a T1 injury can expect to retain full motor and sensory function of the arms.
fats/lipids
most calorie-dense nutrient, insoluble in water/blood. 95% are triglycerides, should be 20-35% of total calories
Normal pulse & respiratory rate for a child 10 to 16 years (adolescent)
pulse 60 - 90 respiratory 16 - 20
intended effect or action of a medication
therapeutic effect
Body language accts for _ of the message?
55%
Which client, diagnosed with pneumonia, is most likely to have community-acquired pneumonia?
A client newly admitted to a long-term care facility
Medicare part C optional for part A and B individuals
Allows medico Medicare benefits through private insurance companies that demonstrate cost-saving HMO PPO PS so PSFS or MSA
What is a dyadic family?
Couple chooses not to have kids
To decrease the risk for ventilator-associated pneumonia, which action will the nurse include in the plan of care for a patient who requires intubation and mechanical ventilation?
Elevate the head of the bed to 30-45 degrees
What is cultural imposition?
Everyone should conform to your belief system
Hospice Nursing
Focuses on care of patients who are dying or whose condition is not expected to improve. The goal is to promote comfort and quality of life
A nurse is caring for a client exhibiting mild contractions and a cervical dilation of 4 cm. Using an external fetal monitor, the nurse observes variable decelerations. Which action should the nurse take first?
Place the client on her left side
Which nursing assessment data would be given priority for a child with clinical findings related to tubercular meningitis?
Signs of increased intracranial pressure (ICP)
Disease-specific diet: Cardiac
The patient should eat a low-cholesterol diet
vitamin D
absorbs calcium, helps with bone development, and alleviates inflammation, control of cell growth; found in the sun, fortified milk, mushrooms, fortified cereals. oysters and fish
pharmokinetics
absorption - route of administration to systemic secretion, elderly delayed distribution - in circulation to receptor site/target, elderly poor circulation metabolism - transformed into metabolic, liver function with old age excretion - through urine, kidney function decreases with age
What are the four parts of pharmacokinetics?
absorption, distribution, metabolism, excretion
PRN orders are given _____ _____. They are given after doing a good _____.
as needed. assessment
teaching methods
depend on situation. some hospitals have group classes, books,pamphlets,audiotapes,videotapes,reading level may be above pts ability,or too many technical terms used.
abdomen
distention,scars,bowel sounds
What are some examples of drug with target organs?
diuretics--kidneys Digoxin--heart
general survey
emotional state,ability to communicate,response to directions
Environment
factors external to host make illness more/less likely; anything that influences health: physical, social, biologic &cultural
what risk factors cannot be changed?
family history of cancer, age, genetics..
How does SES affect drug action?
financially disadvantaged don't seek health care
A client is being admitted to the substance abuse unit for alcohol detoxification. As part of his intake interview, a nurse asks when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to peak:
in 1 to 2 days.
maladaptation
inability to adjust to a change in environment
Battery
injuring, wounding, or touching a pt in offensive manner
TRICARE Standard
military and civilian providers provide care retirees and family members most expensive TRICARE annual deductible and cost share treatment
What are the two groups that drugs are grouped into?
prescription and non-prescription (OTC)
Implied Consent
presumption that a pt would give consent if able
history and present illness
problem being treated surgically
The trade name is also called the _____ name. It's the _____ name made by a specific manufacturer.
proprietary . brand.
Normal pulse & respiratory rate for a child 1 to 11 months
pulse 100 - 150 respiratory 25 - 35
Integumentary Sys
skin becomes dry, thin, inelastic pigment changes occur
Patients commonly _____ taking medications because of side effects such as anorexia, nausea, vomiting, dizziness, drowsiness, dry mouth, constipation, and diarrhea.
stop
The contractile phase of the cardiac cycle is called
systole
Ethical Principles
civil, moral and natural; foundation based
Pairs of wide QRS complexes are described
couplets
assessment
critical evaluation of information; the first step in the nursing process
Indirect service Agencies
Examples: Pharmaceutical and infusion companies and suppliers of durable medical equipment
When prone positioning is used in the care of a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning has been effective?
The patient's PaO2 is 90 mm Hg and the SaO2 is 92% The purpose of prone positioning is to improve the patient's oxygenation as indicated by the PaO2 and SaO2.
the 6 rights of medication
1The right medication, 2The right dose, 3The right patient, 4The right route, 5The right time, 6The right documentation
What month are follows a person or object for 180 degrees from 6 feet away; smiles in response to a face; raises head 30 degrees from prone milestones for a neonate?
2
Middle and late childhood
7 to 11 dental and vision screening group activities feel valuable and important
Phone etiguette, _ of the time, it is how the phone is answered?
82%
What is a nursing diagnosis?
A list of symptoms and information (like vitals, nursing assessment etc)
A patient who experienced a near drowning accident ina local lake, but now is awake and breathing spontaneously, is admitted for observation. Which action will be most important for the nurse to make during this observation period?
Auscultate breath sounds Since pulmonary edema is a common complication after near drowning, the nurse should assess the breath sounds frequently.
A client with chest pain is prescribed intravenous nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip?
Blood pressure is 88/46 mm Hg.
A client, diagnosed with asthma, is experiencing an anaphylactic reaction to a medication. After administering initial emergency care, the nurse would:
administer bronchodilators.
MODS starts as systemic inflammatory response syndrome which can occur as a result of what? Mechanical tissue trauma Abscess formation Endotoxin release Global perfusion deficits All of the above
all
An allergic reaction is an _____-_____ reaction. The person likely needs _____ _____.
antigen-antibody. previous exposure
Infancy
birth to 18 months changes occur rapidly
vitamin K
blood clotting, given to babies (they are not born with this), found in bananas, dark green leafy vegetables, scallions, herbs
Accidental drug interactions are common in the _____.
elderly
What patients are at risk for low protein?
elderly, malnourished, large wounds, burns, infants
Qualitative?
gain insight by discovering meanings. aka WORDS
from GI tract through portal vein to liver
how are carbohydrates converted to glucose
Antagonistic drug interactions are common in...
people who take multiple medications
The point at which the lowest amount of drug is in the serum is the ______ concentration.
trough
Unilateral leg swelling, redness, and tenderness
venous thromboembolism (VTE)
vitamin A
vision and skin, have to have it for a good immune system, carrots, red and orange vegetables, liver, green leafy vegetables, sweet potatoes
sleep, aging, fasting
what decreases basal metabolism
The nurse is assigned to care for four clients. Which client should the nurse assess first?
A client admitted one hour ago with new-onset atrial fibrillation who is receiving IV diltiazem
What does the term age to refer to
The process of getting old
Low sodium diet:
This diet is characterized by 1-2 grams of salt
Ethics
customs or modes of conduct; what is right or wrong
What is cultural blindness?
ignoring differences and proceed as they do not exist
Antagonistic drug interactions in elderly called...
polypharmacy
Cost Share
portion of the cost of care pt must pay even if covered by insurance
Beneficiaries
ppl who are eligible for healthcare benefits
Normal pulse & respiratory rate for a newborn
pulse 100 - 200 respiratory 30 - 60
foods low in Ca++
raw broccoli, carrots, green beans, cottage cheese, spinach
What is a half life/level?
the amount of time the body needs to lower the body's drug serum level by half via metabolism and excretion
Clear liquid diet:
A clear liquid diet is a diet that consists of food and drinks that are clear, meaning you can see through them. Examples: clear juices, ices, hard candy, and gelatin
What are types of knowledge?
science, philosophy, process
The nurse is conducting a health assessment of an older adult. The client tells the nurse about cramping leg pain that occurs when walking for 15 minutes; the pain is relieved with rest. The lower extremities are slightly cool to touch and pedal pulses are palpable +1. The nurse should instruct the client to:
seek consultation from the health care provider (HCP).
psychosocial
self concept is relatively stable throughout adult life
A 46-year-old patient is told by his doctor that he has type 2 diabetes and will require treatment and lifelong changes in his lifestyle. The patient is very distressed but asks for information about the illness, visits the local office of the American Diabetes Association, and elicits help and suggestions from his family in planning lifestyle changes. The nurse recognizes that this patient's response to stress is mediated by the personal characteristic of: 1. Attitude. 2. Optimism. 3. Hardiness. 4. Sense of coherence.
4. Sense of coherence.
The mother of a two-year-old with epiglottitis states that she needs to pick up her older child from school. The two-year-old child begins to cry and appears more stridorous. What is the nurse's priority action?
Ask the mother if there's anyone else who can meet the older child
What is the function of urination?
Elimination of waste (nitrogenous, toxins, drugs) and homeostasis (water balance, acid base balance etc)
Which of the following is the major difference between benign and malignant tumor cells?
Malignant tumors are capable of invasion and metastasis
What was the Goldmark Report?
Survey of nursing education; needed financial support for university programs
A client has been admitted with severe burns. Lactated Ringer's has been ordered to infuse via a pump. Why is this solution being used?
To prevent signs of hypovolemic shock and restore circulation
deficient knowledge
pt teaching may be performed in the physicians office, the clinic,during pre admission workup,or after admission to the hospital. a cost saving trend is to admit pts very early in the morning on the day of surgery, in this case the burden of preoperative teaching rest heavily on the physician, the office nurse,the admission nurse,or the clinic nurse. teaching should include the pt and those who will be with the pt.tell pt and family what to expect,verbal instructions and written instructions
What is an acute illness? examles
rapid onset of symptoms, lasts only a short amt of time, often non life threatening. common cold, diarrhea; pneumonia; appendicitis.
foods with high K+
raw codfish, pink salmon, tuna fish, banana, cantaloupe, raisins, avocado, tomatoes, salt substitue
foods high in magnesium
raw spinach, avocado, almonds, sunflower and pumpkin seeds, MAALOX (antacid)
micronutrients
regulate body processes such as vitamins, minerals, and water
Intrinsic Values
related to maintenance of life food and water
toxic levels of morphine, an opioid, cause severe _________ and death.
respiratory depression
thorax
respiratory pattern and effort,breath sounds,apical pulse
A patient diagnosed with DVT develops hemoptysis, tachycardia, and hypoxemia. For which of the following diagnostic tests will the nurse prepare the patient? 1. Chest radiograph 2. Venous doppler US 3. Pulmonary angiogram 4. Ventilation-perfusion scan
1. Chest radiograph
What are the 5 functions of family?
1. Physical, 2. economic; 3. reproductive; 4. affective/coping; 5. socialization
Steps in quantitative research process?
1. state research problem 2. define purpose of study 3. review related literature 4. formulate hypothesis 5. select research design 6. select population and sample 7. collect data 8. analyze data 9. communicate findings and conclusions
After explaining to a multigravid client at 36 weeks' gestation who is diagnosed with severe hydramnios about the possible complications of this condition, which client statement indicates the need for further instruction?
"I can continue to work at my job at the automobile factory until labor starts."
A client is admitted for an exacerbation of irritable bowel syndrome who insists on being allowed to keep a head covering on at all times. The best response by the nurse is:
"Please help me to understand this practice."
What is an acceptable time to give a medication, according to OSU policy?
1 hour within scheduled time
Goals of End of Life Care
1) Provide comfort and supportive care during the dying process. 2) Improve the quality of the remaining life. 3) Help ensure a dignified death.
The most significant factor in long-term survival of a patient with sudden cardiac death is: 1. Absence of underlying heart disease. 2. Rapid institution of emergency services and procedures. 3. Performance of perfect technique in resuscitation procedures. 4. Maintenance of 50% of normal cardiac output during resuscitation efforts.
2. Rapid institution of emergency services and procedures.
What is the normal visual acuity range for neonates?
20/100 to 20/400
A patient's trough level is drawn as a blood sample ________ before administering the drug, and the peak level is drawn whenever the drug is expected to reach its peak _____.
30 minutes/concentration
Tone of voice accts for _ of the message?
38%
What month(s) are social smile; reaches for cube 12 inches away; notices a raisin 12 inches away; stares at own hand milestones for a neonate
4-5
Which of the following is the most common type of leukemia in older adults? 1. Acute myelocytic leukemia 2. Acute lymphocytic leukemia 3. Chronic myelocytic leukemia 4. Chronic lymphocytic leukemia
4. Chronic lymphocytic leukemia
Only _ of the message is based on the _ _?
7% words spoken
What month(s) are reaches and grasps an object; picks up a raisin by raking; transfers objects from hand to hand milestones for a neonate?
7-8
After the nurse has received change-of-shift report about the following four patients, which shold be assessed first?
A 46-year old patient who has a deep vein thrombosis and is complaining of sudden onset shortness of breath
Of the following patients, the nurse recognizes that the one with the highest risk for a stroke is which of the following?
A 70 year-old African American male with hypertension
After administering the prescribed medications, which of the following clients requires immediate intervention?
A client taking digoxin who has a morning potassium level of 3.0 mEq/L.
After receving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first?
A patient who is cool and clammy, with new-onset confusion and restlessness The patient who has "wet-cold" clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management.
The emergency department (ED) triage nurse is assessing four victimes of an automobile accident. Which patient has the highest priority for treatment?
A patient with a sucking chest wound Most immediate deaths from trauma occur because of problems with ventilation, so the patient with a sucking chest wound should be treated first.
Medicaid
A program sponsored jointly by the federal government and the states to provide services to people whose income is below a mandated level
What is nursing process?
A scientific problem solving method by which nurses can plan and provide care for patients
IV sodium nitroprusside (Nipride) is ordered for a patient with acute decompensated heart failure (ADHF). Which of the following findings would require the nurse to adjust the nitroprusside?
A systolic BP < 90 Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension.
What medication do blacks not respond well to?
ACEI
Gray Panthers
Aim is to safeguard increase health to the extent possible to provide comfort care to the extent necessary
TRICARE Prime
All active duty - auto enrolled Most care received from PCM PCM referrals required for specialty care
Which of the following are characteristics of Hypertrophic Cardiomyopathy? Massive ventricular hypertrophy Rapid, forceful contraction of the left ventricle Impaired relaxation (diastole) Obstruction to aortic outflow (not present in all patients) All of the above
All of the above
Shock is best defined as A) cardiovascular collapse B) loss of sympathetic tone C) inadequate tissue perfusion D) blood pressure less than 90 mm Hg systolic
Answer: C Shock occurs when body tissues are inadequately perfused.
A client admitted with acute pyelonephritis now reports having a severe migraine, but declines PRN analgesics. What should the nurse discuss with this client? (Select all that apply.)
Ask the client which migraine treatments are helpful when at home. Alternative therapies such as relaxation or music can help.
After unsuccessful CPR efforts, the nurse must prepare an Islamic client for the morgue. Which nursing action should the nurse take?
Asking the client's family if they want to perform the ritualistic washing
Sometimes a single medication has many therapeutic effects. For example, _____ relieves pain and reduces fever and tissue inflammation.
Aspirin
The nurse is assessing a laboring client. The client suddenly screams and exclaims, "My baby is coming." What is the priority action by the nurse?
Assess for crowning
A nurse is caring for a client that received a colostomy 2 days ago. Which is the priority intervention?
Assess the drainage from the stoma.
A female client with anorexia nervosa is receiving care from her family after successfully completing the refeeding stage of treatment. Which nursing intervention takes priority at this time?
Assisting the family to work on the issues of autonomy and separation
What is stereotyping?
Assume all members of a culture, ethnic group or race act alike
When preparing to rewarm a patient with hypothermia, the nurse will plan to
Attach a cardiac monitor Rewarming can produce dysrhythmias, so the patient should be monitored and treated if necessary.
A patient at the clinic says, "I have always taken an evening walk but lately the leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking though". The nurse should proceed with a focused assessment by doing which of the following?
Attempt to palpate the dorsalis pedis and posterior tibial pulses The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication.
Three days after a myocardial infarction (MI), the patient develops chest pain that increases while taking a deep breath and is relieved by leaning forward. Which action should the nurse take next?
Auscultate for a pericardial friction rub The patient's symptoms are consistent with the development of pericarditis, a possible complication of MI.
A patient tells the health care provider about experiencing cold, numb fingers when running in the winter and is diagnosed with Raynaud's phenomenon. The nurse will anticipate teaching the patient about diagnostic test for which of the following?
Autoimmune disorders Secondary Raynaud's phenomenon may occur in conjunction with autoimmune diseases such as rheumatoid arthritis, and patients should be screened for autoimmune disorders.
The nurse is caring for a client who has been newly diagnosed with systemic lupus erythematosus (SLE). Which information would be included in a teaching plan that focuses on home care? Select all that apply.
Avoid exposure to sunlight. Keep exercise to a minimal level. Avoid over-the-counter (OTC) medications unless approved by the physician. Take rest periods as needed.
The nurse is caring for an immune compromised client with a fungal infection of the scalp. What recommendation should the nurse make to prevent future problems?
Avoid sharing combs and brushes.
A hospice patient is manifesting a decrease in all body system functions except for a heart rate of 124 and a respiratory rate of 28. The nurse explains to the family that these symptoms a. will continue to increase until death finally occurs. b. are a normal response before these functions decrease. c. indicate a reflex response to the slowing of other body systems. d. may be associated with an improvement in the patient's condition.
B An increase in heart and respiratory rate may occur before the slowing of these functions in the dying patient.
A patient with terminal cancer is at home with a morphine drip. He is showing signs of pain, however his respiration rate is 10. What should the hospice nurse do? A) Hold the morphine B) Give the morphine C) Call the doctor for a new pain medication since the morphine is not working
B) Give the morphine
Which of the following labs are important indicators of renal function to monitor in the client with acute renal failure (ARF)?
BUN & creatinine
A client, recovering from a spinal cord injury, has a great deal of spasticity. Which medication would the nurse anticipate to relieve spasticity?
Baclofen
What are edema of the eyelid, reddened conjunctiva and enlarged preauricular glands. itching/burning, mild photophobia common complaints in older children symptoms of?
Bacterial conjunctivitis
If the side effects are serious enough to outweigh the _____ of a medication's therapeutic action, the prescriber will likely _____ the medication.
Benefits/discontinue
How is PD diagnosed? Select all those that apply A. MRI B. CT scan C. history and clinical features D. Positive response to antiparkinsonian drugs
C. history and clinical features D. Positive response to antiparkinsonian drugs
What is the acronym used for getting ready for a procedure?
CERDCH (CHECK the order on the chart, gather the EQUIPMENT, REVIEW the steps of the procedure, DISCUSS the procedure with the superviser if needed, CONFIRM the correct protocols, wash your HANDS)
As a nurse in a neuro clinic, you are aware that the most recognized organism associated with the development of Guillain-Barre' Syndrome (GBS) is
Campylobacter jejuni
A medication's _____ _____ determines the organ of excretion. For example, gaseous and volatile compounds, such as alcohol and nitrous oxide, exit through the _____.
Chemical makeup/lungs
What is the process for showering a patient?
Clean to dirty / top to bottom
A patient has a nursing diagnosis of disturbed sensory perception related to sleep deprivation. Which action will the nurse include in the plan of care?
Cluster nursing activities so that the patient has uninterrupted rest periods.
What is a theory?
Composed of a group of concepts, describes pattern of reality
What are an inflammation of the conjunctiva, the clear membrane that lines the inside of the lid and sclera symptoms of?
Conjunctivitis
What is a priority for the nurse developing a plan with a client admitted to the hospital with an acute exacerbation of rheumatoid arthritis?
Continuing to work on a positive self image because joint deformities are common in this disease
_______ procedure is performed to correct serious defects that affects appearance.
Cosmetic
Geriatrics
Deals with the physiology of aging with the diagnosis and treatment of diseases affecting the aged
The nurse is caring for a patient who is receving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea . When evaluating the patient response to the medications, which of the following is the best indicator that the treatment has been effective?
Decreased dyspnea with the HOB at 30 degrees Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees.
If not managed, cardiomyopathy may lead to all of the following complications except...
Diabetes mellitus
A 60 year-old man arrives in the clinic complaining of shortness of breath, a pounding heartbeat, and dyspnea that is unrelieved even with rest. He complains of a persisten cough that gets worse when he lies down. Upon examination, you notice edema in his legs, ankles, and feet as well as pale skin. Which of the types of cardiomyopathy best fit the presentation of this patient?
Dilated cardiomyopathy
What do home health nurses do?
Direct Care Provider Client and Family Educator Client Advocator Care Coordinator
After a medication is absorbed, it is ______ to tissues and organs and finally to the site of drug action.
Distributed
What is a binuclear family?
Divorced parents assume joint custody of children
Who enforces the narcotic laws?
Drug Enforcement Agency
Anorexia nervosa, bulimia and binge eating disorder are _______ disorders that often begin in adolescence.
Eating
A patient with a possible pulmonary embolism complains of chest pain and upon assessment the nurse finds a heart rate of 142, BP 100/60, and respirations 42. The nurse's first action should be to...
Elevate the head of the bed to 45-60 degrees The patient has symptoms consistent with a pulmonary embolism. Elevating the head of the bed will improve ventilation and gas exchange.
During the re-warming of a patient's toes that have suffered deep frostbite, the nurse
Ensures that analgesics are administered Rewarming of frostbitten tissue is extremely painful, and analgesia should be administered throughout the process.
Mongoloid race includes what groups of people?
Epicanthic fold (almond shaped eyes); yellow brown skin; short stature and brachycephalic skull; East asian (but all over- Asia; America - indiansl divided into north asiatic, artic, south asiatic, far east and american)
Multiple Organ Dysfunction Syndrome (MODS) is diagnosed when an acutely ill patient is unable to maintain hemostasis without intervention. Which of the following must also be evident for this diagnosis to be made?
Failure of two or more organ systems
Direct Care Agencies
Focus on direct client interaction by providing skilled care, associates therapies and health services, home health aids, chore workers, and delivery of respite care
What was Henry Street Settlement?
Focused on health needs of NYC poor living in tenements
Tumor angiogenesis refers to
Formation of blood vessels within a tumor
______ is the biomedical science of old age and the application of knowledge related to the biologic, biomedical, behavioral, and social aspects of aging to the prevention, diagnosis, treatment, and care of older people.
Geriatrics
_______ nursing aims to increase healthy behaviors in the aged, minimize and compensate for health-related losses and impairments of aging, and facilitate the diagnosis, care, and treatment of disease in the aged.
Gerontological
A client at 24 weeks gestation comes to the clinic for a prenatal check-up and informs the nurse that she has been "seeing double." The nurse checks the urine and determines that there is 3+ proteinuria. What does the nurse determine is the potential priority problem?
Gestation hypertension
A patient with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations 32, and blood glucose of 246. Which of these prescribed interventions will the nurse implement first?
Give normal saline IV @ 500 ml / hr Because of the low systemic vascular resistance (SVR) associated with septic shock, fluid resuscitation is the initial therapy.
Reed-Sternberg cells are used in the identification of
Hodgkin's disease.
What major health care involves teaching patients and families to care for themselves so as to promote independent functioning?
Home health care
In medications exit through sweat glands, you provide ______ to reduce skin irritation.
Hygiene
Which is faster--IM or SQ?
IM
What is the leading cause of death in acute renal failure (ARF)?
Infection
Three types of Consent
Informed Expressed Implied
Which of the following types of strokes is not considered an ischemic stroke? Lacunar embolic Intracerebral hemorrhage thrombotic
Intracerebral hemorrhage
What are the three types of dehydration?
Isotonic (sodium loss is the same as water loss) Hypotonic (sodium loss is greater than water loss) Hypertonic (sodium loss is less than water loss)
Bioethics
Issues currently being debated Specifics ethical issues
What is the bristol chart?
It is the chart that stool is measured against (type, pattern etc)
What is a subculture or subgroup?
Large group of people who are members of even larger cultural group, but have certain ethnic, occupational or physical characteristics not common to larger group
While performing a cervical examination on a client in labor, a nurse's fingertips feel pulsating tissue. What is the most appropriate nursing intervention?
Leave the fingers in place and press the nurse call light
_____ are a major source of energy for muscle tissue, even when glucose is available.
Lipids
Care delivered in ____-____ _____ residential facility is based on three principles:1. promontion of independence 2. maintenance of function 3. maintenance of autonomy (freedom from external authority to make decisions about one's health and health care)
Long-term care
Systemic vascular resistance
Measures resistance to left ventricular ejection. Reflective of vasoconstriction or viscosity.
Patients (e.g., older adults and those with chronic disease) are at risk for ________ ______ if their organs that metabolize medications do not function correctly.
Medication toxicity
A client is admitted to the labor and delivery unit in labor with blood flowing down her legs. What would be the priority nursing intervention?
Monitor fetal heart tones
What is the dominant group?
Most ability to control values and sanctions of society
Fluids, vitamins, and minerals are absorbed through the intestinal _____.
Mucosa
A patient has a spinal cord injury at T4. Vital signs reveal a falling BP with bradycardia. The nurse recognizes that this patient is experiencing which of the following?
Neurogenic shock r/t maldistribution of blood flow
Which information about a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse?
New onset shortness of breath New onset dyspnea suggests a pulmonary embolus, which will require rapid actions such as oxygen administration and notification of the health care provider.
Regular diet:
No restrictions
What are some of the indicators of self-neglect and aging person
No weight gain tone clothes smell bad
Are race and ethnicity the same?
No, race = physical, etnicity = cultural
_____ measures to reduce patient anxiety and increase knowledge about the surgical experience may actually decreas complications.
Nursing
The nurse obtains vital signs for a patient admitted 2 days ago with gram (-) sepsis. His temperature is 101.2 F, BP 90/56, pulse 92, and respiratory rate 32. Which priority action should the nurse take next?
Obtain oxygen saturation using pulse oximetry The patient's increased respiratory rate in combination with the admission diagnosis of gram-negative sepsis indicates that acute respiratory distress syndrome (ARDS) may be developing. The nurse should check for hypoxemia, a hallmark of ARDS.
For the patients who cannot take ____ feedings, nutritional support may be provided through enteral tube feedings, or peripheral or central catheters.
Oral
Of all of the physiologic needs, which one is most essential?
Oxygen
Determination of whether an event is a stressor is based upon a person's...
Perception
A nurse and an LPN are working in the labor and birth unit. Of the activities that must be done immediately, which should the nurse assign to the LPN?
Perform a straight catheterization for protein analysis.
factors affect health and illness?
Personal biologic & psychological; sociocultural (age, gender, strength, self esteem, income)
Chronic myelogenous leukemia (CML) is characterized by a proliferation of abnormal WBC's and the presence of which of the following fenetic markers?
Philadelphia chromosome
A patient with ADHF presents with tachypnea, dyspnea, and an oxygen saturation of 88%. Which of the following is an appropriate priority nursing intervention for this patient?
Place the patient in high Fowler's position with feet dangling A high fowler's position increases the lung capacity reducing the patient's work of breathing, while dangling promotes venous pooling in the extremities to reduce return to the heart.
A patient with ADHF presents with tachypnea, dyspnea, and a sat of 88%. An appropriate priority nursing intervention for this patient is... Assist the patient to CT&DB Assess intake and output Encourage alternate periods of rest and activity Place the patient in high Fowler's with feet dangling.
Place the patient in high Fowler's with feet dangling.
Skilled care facility
Provide skilled nursing care regular basis
Categories of Values
Religious Theoretical Political Economical Aesthetic Social
The nurse is caring for a client who has been intubated. What is the nurse's priority intervention?
Reposition the endotracheal (ET) tube every 24 hours
A patient with a spinal cord injury has spinal shock. The nurse plans care for the patient based on the knowledge that
Resolution of spinal shock is manifested by spasticity, hyperreflexia, and reflex emptying of the bladder
Durable Medical Equipment
Reusable equipment eg; wheelchairs, walkers
Patient Bill of Rights
Right to be Informed Right to Choose Right to be Heard and Respected Right to Safety
__ is third fastest, injected into subcutaneous tissue, then absorbed slower than IM.
SQ
What is a person's attitude about aging mainly influenced by
Society beliefs culture
Health care providers must recognize myths about the older adult and aging that results in _____ and _____ against older people.
Stereotyping/discrimination
A client has a tracheostomy. Which nursing action would prevent complications of suctioning?
Sterility of suction catheter
Which of the following are causes of increased ICP?
Stroke and head trauma
Before _____, the patient or legal guardiean mus sign a legal ____ form. Consent form from the patient must be obtained ______ preoperative medications are given.
Surgery/consent/before
Dysphagia diet:
Take swallowing difficulties (dysphagia) into consideration and plan accordingly
defines cardiac index
The amount of blood pumped through the heart per minute adjusted for an individual's BMI
A nurse is caring for a client with a nursing diagnosis of fluid volume deficit related to impaired thirst mechanism. Which outcome would the nurse determine as most appropriate for this client?
The client's intake and output are balanced.
When rewarming a patient who arived in the emergency department (ED) with a temprature of 87 F, which assessment indicates that the nurse should discontinue the rewarming?
The core temperature is 94 F A core temperature of 89.6° F to 93.2° F (32° C to 34° C) indicates that sufficient rewarming has occurred.
DRGs
The hospital pays set amount based on the patient's admitting diagnosis
Gerontology
The study of all aspects of the aging process including the chemical psychological economic social problems of the elderly adults and the consequences of these problems for older adults and society
Burns caused by flame, flash, scald, or contact with a hot object are examples of which type of burn injury?
Thermal
A patient is admitted to the coronary care unit following a prolonged cardiac arrest and successful cardiopulmonary resuscitation. When reviewing the health care provider's admission orders, which of the following orders is it most important for the nurse to question?
Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours Traumatic or prolonged (>10 minutes) cardiopulmonary resuscitation is a relative contraindication for the administration of fibrinolytic therapy.
What do you do when you accomodate cultureal practices in healthcare? example
Whenever possible and when practice not harmful to health. Dietary preferences, prayer, attire
What is the most frequent response to elder abuse by the abuse older adults
Withdrawn
Advance Directives
Written statements of a person's wishes regarding medical care. Living wills, directives to physicians, durable power of attorney for health care, medical power of attorney
ident-a-band
a band, usually worn on a client's wrist, with the client's name and medical record number
The nurse is providing care for a diverse group of clients. The nurse should consider the possible role of cultural norms if which clients avoid eye contact during interactions with the nurse? Select all that apply.
a client who is Native American an older adult client who identifies as Japanese
procedure
a particular way of accomplishing a desired result
Mr. Jones comes into the Emergency Room with a blood pressure of 189/124. What is the first priority of the health care team? a) Reduce blood pressure b) Ensure adequate hydration c) Reduce his pain d) Admit him to the hospital
a) Reduce blood pressure
The nurse finds a patient in bed having a generalized tonic-clonic seizure. During the seizure activity, the nurse should: a) turn the patient to the side b) suction the patient and administer oxygen c) insert an oral airway into the patient's mouth d) restrain the patient's extremities to prevent soft tissue and bone injury
a) turn the patient to the side
basal metabolism
amount required to maintain cell/tissue function, fluctuates for many reasons such as pregnancy and sickness (it goes up when your sick)
Service
answer customer needs
The medication acts as an ____, which causes _______ to be produced. With repeated _________, the patient develops an allergic response to the drug, its chemical preservatives, or a metabolite.
antigen/antibodies/administration
How many therapeutic effects do drugs have?
at least one, but some drugs have more than one
How does height and weight affect drug action?
because standard doses are based on the ht/wt of the average adult
Skeletal Sys
bones lose strength joints become stiff
An average cardiac output at rest is: a) 3 litres b) 4 litres c) 5 litres d) 10 litres
c
Name the roles of a nurse:
caregiver, communicator, counselor, leader. researcher, advocate
full liquid diet
consists of both clear and opaque liquid foods with a smooth consistency, transitional, includes high calorie/protein supplements if full liquid for >3 days
The nurse is preparing to administer the last dose of ceftriaxone before discharge to a 1-year-old but finds the the IV has occluded. The nurse should:
contact the prescriber to request a prescription change.
Lotions and splinting are used to prevent
contractures
The pathophysiology of secondary injury is related to autodestruction of the
cord by hemorrhage, edema, and the presence of metabolites and norepinephrine, resulting in anoxia and infarction to the cord.
adherence
cost problem- cutting down med to save money save meds longer
foods low in magnesium
cottage cheese, juices, oranges, tomato soup
Crossmatching is done on donors to test for
cytotoxic antibodies, a panel of reactive antibodies (PRA) is done, high % indicates poor chance of finding a donor.
vitamins
does not provide energy, but are necessary for metabolism of carbs, proteins, and fats
Explain concept of gender roles
dominant gender in family makes decisions for others
The pathologic process of PD involves the degeneration of
dopamine producing neurons in the substantia nigra
interactions
drug-drug, food, disease
DMEe
durable medical equipment
Agent
environmental factor/stressor that must be present or absent for an illness to occur.
Maslow's hierarchy of basic human needs is useful when planning and implementing nursing care as it provides a structure for:
establishing priorities of care
height and weight
height and weight
Abandonment
initiates care, leave pt w/out turning over care to someone equal or higher medical training
Bradycardia is associated with
injuries above the T6 level.
minerals
inorganic elements found in all body fluids; provide structure and regulate body processes
A side effect is a not _____, and an adverse effect is one that is potentially _____.
intended, harmful
Topical medications have a _____ effect.
local
A 34-year-old multiparous client at 16 weeks' gestation who received regular prenatal care for all of her previous pregnancies tells the nurse that she has already felt the baby move. How does the nurse interpret this finding?
normal because multiparous clients can experience quickening between 14 and 20 weeks' gestation
A client receiving chemotherapy for cancer has an elevated serum creatinine level. The nurse should next:
notify the HCP.
List health problems following crusades:
overcrowding and related stress, poor ventiliation, poor heating and cooling, poor sanitation, poor water supply
What nutritional support should be provided for the child with cystic fibrosis?
pancreatic enzyme replacement, fat-soluble vitamins (A, D, E, K) and a moderate-to-low-carbohydrate, high protein, moderate-fat diet
signs of hypocalcemia
paresthesia, facial spasms, and muscle tremors.
potential
possible but not yet realized
evidence based practice?
problem solving approach to making clinical decisions using best evidence available.
Normal pulse & respiratory rate for a child 6 to 10 years (school age)
pulse 70 - 110 respiratory 18 - 22
Professional Values
reflection of personal values
What is extended family?
relatives in close proximity (aunts, uncles, grandparents, cousins...)
nursing research?
research improving care of people (clinical setting) & study of people & nursing profession
How do you develop cultural knowledge?
research, observation, inquire
What is illness?
response of a person to the disease; abnormal process in which person's level of functioning is changed when compared w/ a previous level.
Cardinal signs of respiratory distress in children
restlessness, increased respiratory rate, increased pulse rate, diaphoresis
How do you develop cultural awareness?
self examination, biases, feeling toward others
What is ethnicity?
sense of identification with a collective group (common heritage)
What is a toxic effect of a medication? What is an example?
serious side-effect which may be life-threatening. low HR with Digoxin
Religious
strenght of belief
Return of reflex activity signals
the end of spinal shock.
What are some factors affecting absorption?
the form of the medication, how recently a meal has been eaten, condition of the GI tract, blood supply to the area, local site condition
admit
the process of signing a client into the hospital
transition
the process or an instance of changing from one form, state, activity, or place to another
The single parent of a young teenager is being treated for complicated bronchitis at a small rural hospital. The mother does not live in the area and has a poor command of English. The facility is experiencing delays in accessing a translator. In considering whether to allow the teenager to translate medical information for his mother, the nurse should consider that:
these circumstances may allow the child to translate.
caring
thoughtful attentiveness accompanied by responsability
transfer
to convey or shift from one person or place to another
comfort
to ease physically; relieve, as of pain
Word "nurse" originated from the Latin word "nutix" which means?
to nourish
main function of albumin
to regulate colloidal osmotic pressure of blood (regulates blood pressure)
reconcile
to resolve discrepancies
Where are sublingual drugs taken?
under the tongue and dissolved
Chemical code
use of drugs for resuscitation without use of CPR
Swelling associated with prolonged standing
venous disease
10%
what signifies significant weight loss in 6 months
Primary age groups for the development of Hodgkin's lymphoma are
young adults and adults over 60.
A 35 year-old woman is diagnosed with HIV. The client asks about her chances for getting rid of the disease. Which of the following responses are accurate?
"Anti-viral combinations will help to manage the disease progression, but there is no cure for the disease"
A client comes to the physician's office for treatment of severe sunburn. The nurse takes this opportunity to discuss the importance of protecting the skin from the sun's damaging rays. Which instruction best prevents skin damage?
"Apply sunscreen even on overcast days."
A Japanese couple are experiencing labor. During the admission process, the husband tells the nurse that the wife will not receive any pain medication during the process. The husband then waits in the waiting room. As the birthing process continues, the nurse asks the wife if she needs pain medication. She declines the offer and reminds the nurse by saying, "My husband told you I cannot have any pain medicine." What is the nurse's best response to the client?
"I want to advocate for you and assist with the pain during this process."
A client in sickle cell crisis has been hospitalized during her pregnancy. After giving discharge instructions, the nurse determines the client needs further teaching when she makes which statement?
"I will need to take an iron supplement even if my laboratory values are normal."
A nurse is providing instruction to a 38-year-old male client undergoing treatment for anxiety and insomnia. The practitioner has prescribed lorazepam 1 mg/po/tid. The nurse determines that teaching has been effective when the client states:
"I'll avoid coffee."
A client reports to a physician's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education?
"If I notice tingling in my lips or mouth, gargling may help the symptoms."
A 25 year old female is diagnosed with systemic lupus erythematosis (SLE). Which of the following statements regarding the need for family planning indicates further need for instruction?
"Infertility rarely occurs" Infertility is a complication of SLE
The nurse is caring for a group of clients in an acute medicine setting. What statement by a client would most warrant a referral to spiritual care, with the client's permission?
"It feels like one round of bad news after another for me, like I am being punished."
A client has had sucralfate prescribed as treatment for peptic ulcer disease. Which statement indicates that the client understands how to take the medication?
"It is important that I take this drug on an empty stomach."
A client on vacation experiences severe allergy symptoms, headache, and sinusitis (without respiratory distress). This client adamantly declines any supportive medications when offered. The nurse questions the client and learns the client receives weekly acupuncture treatments for these symptoms. The nurse's best response is:
"Let us try this until you can have acupuncture."
A Muslim client is scheduled to be discharged in 2 days, but insists on fasting until after dark. The nurse anticipates which explanation from the client?
"My religion requires me to fast all day until sunset."
The client who experiences residual arm pain after a fall has been referred to an acupuncture treatment center. What is the nurse's best response to the client's question, "How is acupuncture supposed to help me?"
"Pain is relieved by releasing endorphins, which balance the flow of energy."
A client with chronic pain comes to the clinic for an evaluation. During the visit, the client asks the nurse about possibly using acupuncture for pain relief. Which response by the nurse would be most appropriate?
"Restoring the energy balance in your body could help with pain relief."
When performing discharge teaching for the patient following a mechanical valve replacement, the nurse determines that further instruction is needed when the patients says...
"The only risk I have during dental procedures is bleeding because of my anticoagulants" The greatest risk to a patient who has an artificial valve is the development of infective endocarditits with invasive medical or dental procedures.
A nurse is providing education to the family of a client scheduled for discharge. The client, who has severe cognitive impairments, is a recent quadriplegic. The family has questions about the need to perform range-of-motion of exercises with the client. What information should the teaching session include? Select all that apply.
"Use sheepskin pads in the bed and wheelchair." "Friction and shear increase a paralyzed client's risk of pressure ulcers."
The nurse is caring for a client admitted to the emergency department after being found lying on the bathroom floor with several empty pill bottles around her. While waiting for a psychiatric consult, the nurse discovers that the client's boyfriend has recently broken up with her. Which response is most likely is to build and maintain a therapeutic relationship within the emergency department?
"What can I do to help while you are here?"
The nurse facilitating the medication management group consistently notices that a particular client positions himself on the perimeter of the group. In order to be culturally mindful about the origin of this behavior, what question would the nurse ask the client?
"Where will you be comfortable sitting and still remain a part of the group?"
Signs and symptoms of asthma
- airway becomes edematous - airway becomes congested with mucus - smooth muscles of bronchi and bronchioles constrict - air trapping occurs in the alveoli
Signs and symptoms of epiglottitis
- sudden onset - restlessness - high fever - sore throat, dysphagia - drooling - muffled voice - child assumes upright sitting position with chin out and tongue protruding ("tripod" position)
Signs and symptoms of cystic fibrosis
- tenacious mucus production obstructs vital structures - lung insufficiency (most critical problem) - pancreatic insufficiency - increased loss of sodium and chloride in sweat
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify: 1. Dysrhythmias resulting from hypokalemia. 2. Fluid overload resulting from aggressive fluid replacement. 3. The presence of hypovolemic shock related to osmotic diuresis. 4. Cardiovascular collapse resulting from the effects of excess glucose on cardiac cells.
1. Dysrhythmias resulting from hypokalemia.
What are the 4 stages of illness?
1. Experiencing symptoms: pain, rash, fever, bleeding, cough.. 2. Assuming the sick role: person knows sick, seeks validation from others. Gives up normal activities, may do nothing; may self treat.. 3. Assume a dependent role: pt accepts diagnosis and follows prescribed treatment plan, conform to opinions of others, assistance 4.Achieving recovery and rehab: home, hospital or mix; pt gives up dependent role and assumes normal activities
4 Concepts common in nursing theory?
1. Person/patient. (*most important) 2. environ. 3. health. 4. nursing
When planning a community education program related to prevention of the cancer with the highest death rates in both women and men, the nurse will stress the importance of: 1. Smoking cessation. 2. Screening with colonoscopy. 3. Regular examination of reproductive organs. 4. Use of sunscreen and protection from ultraviolet light.
1. Smoking cessation.
sections of a research journal?
1. abstract 2. intro 3. methods 4. results 5. discussion 6. references.
3 examples of physiological characteristics:
1. how body metabolizes food (lactose tolorance) or alcohol; skin reacts to sun (tan vs. brown vs burn); mentration of women; breast function...
qualitative research methods
1. phenomenology - person lived through experience 2. grounded theory - person describes own reality 3. ethnography - routed in anthropology 4. historical - people use facts to explain present day problems
What are Maslow's 5 Basic Human needs?
1. physiologic; 2. safety and security; 3. love & belonging; 4. self esteem; 5. self actualization
bowel cleansing purposes
1. reduce the risk of contamination from fecal matter during the operation. 2.helps prevent postoperative distention until normal bowel function returns 3.prevents constipation and strainning in the postoperative period,strainning can create pressure on the surgical wound, surgery may be canceled if bowel preparation is inadequate
4 factors affect cultural sensitivity:
1. stereotyping; 2. cultural imposition; 3. cultural blindness; 4. cultural conflict
What are 4 aims of nursing?
1. to promote health; 2. to prevent illness; 3. to restore health; 4. to facilitate coping with a disability or death
1-kg of weight gain indicates a gain of what?
1000 ml of body water
Adolescence
12 to 18 onset of puberty
What month(s) are stacks blocks; places a peg in a round hole; stands and walks milestones for a neonate?
12-14
Early childhood
18 months to 6 yrs growth process slows
BMI (body mass index): Normal
18.5 - 24.9
In what year was it founded?
1882
Century that Nightingale brought major reforms in nursing?
18th century
Agent-host-environmental model of health and illness?
1965. Leavall & Clark. Examining causes of disease in individual. Agent = environmental factor/stressor that must be present or absent for an illness to occur. Host= living organism capable of being infected/affected by an agent. Influenced by family history, age & health habits. Environment = factors external to host make illness more/less likely; anything that influences health: physical, social, biologic &cultural
What was the Lysaught Report?
1981, Challenge to liscensure (nursing too big, split into acute and distributive care)
What is a nuclear or traditional family?
2 parents (homo or hetero, married or committed relationship) + children, and allmembers in same house until children leave as young adults
A patient's arterial blood gas (ABG) results include pH 7.31, PaCO2 50 mm Hg, PaO2 51 mm Hg, and HCO3 24 mEq/L. Oxygen is administered at 2 L/min, and the patient is placed in high-Fowler's position. An hour later, the ABGs are repeated with results of pH 7.36, PaCO2 40 mm Hg, PaO2 60 mm Hg, and HCO3 24 mEq/L. It is most important for the nurse to take which of the following actions? 1. Increase the oxygen flow rate to 4 L/min. 2. Document the findings in the patient's record. 3. Reposition the patient in a semi-Fowler's position. 4. Prepare the patient for endotracheal intubation and mechanical ventilation.
2. Document the findings in the patient's record.
The pulmonary artery waveform of a patient with a pulmonary artery catheter is blunted. The nurse notifies the health care provider, recognizing that: 1. The balloon is overinflated. 2. The catheter may be occluded by a thrombus. 3. The catheter is wedged in a pulmonary capillary. 4. The catheter has migrated from the pulmonary artery to the right ventricle.
2. The catheter may be occluded by a thrombus.
By ages 2 to 3 most children have a visual acuity of?
20/50
When planning care for adult patients, the nurse concludes that which of the following oral intakes is adequate to meet daily fluid needs of a stable patient?
2000-3000 ml
A patient has a diagnosis of acute myocardial infarction, and his cardiac rhythm is sinus bradycardia with six to eight premature ventricular contractions (PVCs) per minute. The pattern that the nurse recognizes as the most characteristic of PVCs is: 1. An irregular rhythm. 2. An inverted T wave. 3. A wide, distorted QRS complex. 4. An increasingly long PR interval.
3. A wide, distorted QRS complex.
When assessing a patient with sepsis, which of the following findings would alert the nurse to the early onset of acute respiratory distress syndrome (ARDS)? 1. SpO2 of 80% 2. Use of accessory muscles of respiration 3. Fine, scattered crackles on auscultation of the chest 4. ABGs of pH 7.33, PaCO2 48 mm Hg, and PaO2 80 mm Hg
3. Fine, scattered crackles on auscultation of the chest
After 3 weeks of radiation therapy, a patient has lost 10 pounds and does not eat well because of mucositis. An appropriate nursing diagnosis for the patient is: 1. Risk for infection related to poor nutrition. 2. Ineffective self-health management related to refusal to eat. 3. Imbalanced nutrition: Less than body requirements related to oral inflammation and ulceration. 4. Ineffective health maintenance related to lack of knowledge of nutritional requirements during radiation therapy.
3. Imbalanced nutrition: Less than body requirements related to oral inflammation and ulceration.
Angina occurs with myocardial ischemia as a result of which of the following? 1. Death of myocardial tissue 2. Dysrhythmias caused by cellular irritability 3. Lactic acid accumulation during anaerobic metabolism 4. Elevated pressure in the ventricles and pulmonary vessels
3. Lactic acid accumulation during anaerobic metabolism
A patient with GBS asks whether he is going to die as the paralysis ascends toward his chest. What is the most appropriate response? 1. Patients who require ventilatory support almost always die 2. Death occurs when the nerve damage reaches the brain and meninges 3. Most patients with GBS make a complete recovery 4. Even if death can be prevented, residual paralysis is usually permanent
3. Most patients with GBS make a complete recovery
A patient is admitted to the coronary care unit following a cardiac arrest and successful cardiopulmonary resuscitation. When reviewing the health care provider's admission orders, which of the following orders is it most important for the nurse to question? 1. Oxygen at 4 L/min per nasal cannula 2. Morphine sulfate 2 mg IV every 10 minutes until the pain is relieved 3. Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours 4. IV nitroglycerin at 5 mcg/minute and increase 5 mcg/minute every 3 to 5 minutes
3. Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours
DIC is a disorder in which... 1. the coagulation pathway is genetically altered leading to thrombus formation in all major blood vessels 2. an underlying disease depletes hemolytic factors leading to thrombotic episodes 3. a disease process stimulates the coagulation cascade resulting in microthrombi, as well as depletion of clotting factors 4. An inherited predisposition of clotting deficiencies
3. a disease process stimulates the coagulation cascade resulting in microthrombi, as well as depletion of clotting factors
Nursing priorities such as excision and grafting, pain management, and nutritional therapy are included in which phase of burn care?
Acute phase
The nurse notes thick, white respiratory secretions from a patient who is receiving mechanical ventilation. Which intervention will be most effective is resolving this problem.
Add additional water to the patient's enteral feedings Because the patient's secretions are thick, better hydration is indicated.
2/10/2017 1100 56-year-old client presents with sudden onset of stroke-like symptoms that started 45 minutes prior to admission. Presenting National Institute of Health Stroke Scale (NIHSS) Score = 20. Head CT negative for blood. Past medical history includes hypertension treated with an ACE inhibitor. Alteplase 68 mg IV, given over one hour. At the end of the alteplase infusion, the nurse notes that the client's tongue was swollen. What is the nurse's priority action?
Administer antihistamines, intravenous corticosteroids, and or epinephrine
A patient who has been involved in a motor vehicle crash is admitted to the emergency room with cool, clammy skin, tachycardia, and hypotension. Which of the following interventions should the nurse implement first?
Administer oxygen @ 100% per non-rebreather mask The first priority in the initial management of shock is maintenance of the airway and ventilation. Cardiac monitoring, insertion of IV catheters, and obtaining blood for transfusions also should be rapidly accomplished, but only after actions to maximize oxygen delivery have been implemented.
A client receiving intravenous heparin has developed hematuria and petechiae. What is the nurse's best action?
Administer protamine sulfate
In planning community education for prevention of spinal cord injuries, the nurse targets which of the following groups?
Adolescent and young adult men Spinal cord injuries are highest in young adult men between the ages of 15 and 30 and those who are impulsive or risk takers in daily living.
What services of benefits are part of the Medicare part C
Advantage or child plans private insurance
_____ drug effects are unintended, undesirable, and often unpredictable.
Adverse
______ is an ongoing development process that begins at conception and ends at death.
Aging
Ativan, an antianxiety medication, when given to an older adult may cause _____ and ______.
Agitation/delirium
What does gerontology and compass
All aspects of aging process including clinical psychological economic sociological
Causes of Cardiomyopathy include which of the following? Long term high blood pressure Pregnancy Certain viral infections All of the above
All of the above
_______ ______ also are unpredictable responses to a medication. Exposure to an initial dose of a medication causes a patient to become sensitized _______.
Allergic reactions/immunologically
__________ also are unpredictable responses to a medication. Exposure to an initial dose of a medication causes a patient to become sensitized _______.
Allergic reactions/immunologically
Respite care
Allows the primary caregiver to have time away from the constant demands of caregiving decreasing stress and the risk of abuse
Heat stroke is characterized by which of the following? Altered mentation Temperature between 101 - 102.5 Perspiration Hot, dry, ashen skin Circulatory collapse
Altered mentation Hot, dry, ashen skin Circulatory collapse
A 78 year old man has confusion and temperature of 104 degrees. He is a diabetic with purulent drainage from his right great toe. His assessment findings are BP 84/40; heart rate 110; respiratory rate 42 and shallow. This patient's symptoms are most likely indicative of Sepsis Septic shock MODS Systemic inflammatory response syndrome
Answer: B The patient's blood pressure is low, his heart rate is fast, and his respirations are high. This indicates shock. He also has a fever and an infection. Sepsis with hypotension is characteristic of septic shock.
A patient has a spinal cord injury at T4. Vital signs include a falling BP with Bradycardia. The nurse recognizes that this patient is experiencing: a) Relative Hypervolemia b) Absolute hypovolemia c) Neurogenic shock from low blood flow d) Neurogenic shock from a maldistribution of blood flow
Answer: D Neurogenic shock is caused by a maldistribution of blood flow and can result from a spinal cord injury at T5 or above.
Among the different classes of medications, ________ cause a high incidence of allergic reactions.
Antibiotics
What kind of measure is given into the newborn's eyes soon after birth?
Antibiotics
A patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). Which finding by the nurse will help confirm a diagnosis of neurogenic shock?
Apical heart rate 48 BPM
Which of the following menu choices is an appropriate choice for the client with acute renal failure (ARF)?
Apple Citrus fruits, bananas, and baked potatoes are all high in potassium, which the patient with ARF is unable to clear.
A nurse and an unlicensed assistive personnel (UAP) are caring for four clients together on the telemetry unit. Which of the following nursing actions can safely be delegated to the UAP?
Applying electrodes in the correct position for ECG monitoring.
In planning care and patient teaching for a patient with venous insufficiency, the nurse recognizes that the most important intervention in controlling this condition is...
Applying graduated compression stockings (TEDS)
How much should your input and output of fluid be per day
Approx 2500mls. Input = 1500ml fluid ingestion, 750ml food intake, 250ml metabolism Output = 1500ml urine, 100ml faeces, 400ml perspiration, 300ml expressed air
A float nurse is assigned to a surgical unit. The nurse is receiving 2 clients from the post anesthesia care unit (PACU) at the same time. When delegating tasks to other PACU personnel who are not known to the nurse, which question would be most important to ask?
Are you comfortable in performing the tasks being assigned?
Personal space?
Area around person regarded as part of person
A client in home hospice care verbalizes to her caregiver that she wants to meet with her minister. The caregiver, who does not want the minister to visit or to interact with the minister because of her different values and beliefs, asks the home health nurse how to handle this situation. To prevent further disagreement between the client and caregiver, what is the best recommendation for the nurse to implement?
Arrange for an alternative caregiver to be available for the client when the minister visits.
A patient has ICP monitoring with an intraventricular catheter. Which of the following is a priority nurisng intervention for this patient?
Aseptic technique to prevent infection
In caring for the patient who was admitted 24 hours previously with a C5 spinal cord injury, which nursing action has the highest priority?
Assessment of respiratory rate and depth Edema around the area of injury may lead to damage above the C4 level, so the highest priority is assessment of the patient's respiratory function.
A patient who is very close to death is very restless and keeps repeating, "I am not ready to die." Which action is best for the nurse to take? a. Remind the patient that no one feels ready for death. b. Sit at the bedside and ask if there is anything the patient needs. c. Insist that family members remain at the bedside with the patient. d. Tell the patient that everything possible is being done to delay death.
B Staying at the bedside and listening allows the patient to discuss any unresolved issues or physical discomforts that should be addressed.
_____ nurses sign their names on the required form.
Both
A patient with metastatic CRC is scheduled for both chemotherapy and radiation. What patient teaching is appropriate for this patient? Chemotherapy can be used to cure CRC Radiation is routinely used following surgery Both chemotherapy and radiation can be used as palliative measures The patient should expect few if any side effects from chemotherapeutic agents
Both chemotherapy and radiation can be used as palliative measures
Which surgical therapy used in the treatment of breast cancer involves removal of the entire tumor along with a margin of normal tissue?
Breast conservation surgery
A client who is HIV +, comes into the clinic with complaints of severe fatigue, drenching night sweats, diarrhea, and headache -- which she describes as worsening manifestations of earlier symptoms. The physician indicates that the client is in the Intermediate Chronic phase of infection. Which laboratory results would the nurse anticipate in this phase?
CD4 + T cell count of 300 cells/microliter and a increased viral load
A nurse calls the unit manager to report that her purse has been stolen from the locked break room. The nurse says she thinks she knows which of the staff stole the purse. Which actions by the nurse manager would be appropriate? Select all that apply.
Call hospital security to initiate an investigation. Ask the nurse to document all the facts related to the missing purse. Alert nursing administration that a staff's purse has been stolen. Ask other staff to report any suspicious activity they may have observed.
basic pathophysiologic definition of cancer?
Cancer is an unchecked proliferation of cells
Most of the energy needed to move, perform activites, and live is consumed in the form of _____, which are converted primarily to glucose for immediate use by the body's cells.
Carbohydrates
Although ______ are the body's main source of food energy, ____ are the most concentrated source.
Carbohydrates/fats
What is the most important intervention for the nurse to implement while caring for a neonate with an omphalocele?
Carefully position and handle the omphalocele
What are 3 race classifications?
Caucasian, Negroid, Mongoloid
true regarding a cancer cells susceptibility to chemotherapy?
Cells with a high mitotic rate respond well to chemotherapy
Patients presenting to the Emergency department in hypertensive crisis will most likely experience
Changes in vision Nausea / vomiting and chest pain Numbness or weakness
A neonate is admitted to the nursery following a long and difficult labor. Admission vital signs are temperature 96.5° F (35.8° C), heart rate 168 beats/minute, and respiratory rate 64 breaths/minute. After placing the neonate under the radiant heater, the nurse should take which action?
Check the neonate's blood glucose level.
When caring for a patient with acute coronary syndrome who has returned to the ICU after having baloon angioplasty, the nurse obtains the following assessment information. Which one indicates the need for immediate intervention by the nurse?
Chest pain rated at 8/10 The patient's chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse.
When to notify Law Enforcement
Child, elderly, domestic abuse Violence and sexual assult Restraint situations Intoxicated ppl w/ injuries Mentally incompetent ppl w/ injuries
The rate and extent of distribution depends on _____ , cell membrane ______, and protein binding. When there is poor perfusion, as in the case of heart failure, this ____ medication distribution.
Circulation/permeability/alters
Burns to which of the following areas poses a significant threat for respiratory compromise?
Circumferential burns of chest & back
How do you care for a catheter insertion site?
Clean the area around the drainage tube twice daily, use soap and water, rinse well and dry, do not apply lotion or powder, check for inflammation or infection (swollen, red, irritated, tender)
Allergic conjunctivitis is characterized by iching, reddened eyes with watery discharge and the conjunctiva has what type of appearance?
Cobblestone
When preparing for an annual physical exam for a patient who is 50 years old, the nurse will plan to teach the patient about which of the following?
Colonoscopy At age 50, individuals with an average risk for colorectal cancer (CRC) should begin screening for CRC. Colonoscopy is the gold standard for CRC screening.
Assisted-living center
Combine privacy with you live able services private apartments purchase relented maybe serve meals in restaurants tell dining room and receive laundry and housekeeping
A client with a history of cocaine abuse is receiving intravenous therapy and exits the hospital "to visit a friend." The client returns to the nursing unit 1 hour later, agitated, aggressive, combative, and reporting "chest pain." Place the nurse's actions in priority order from first to last. All options must be used.
Contact the security department. Obtain an ECG. Obtain a urine sample. Initiate a referral to obtain drug rehabilitation counseling.
Proprietary Organizations
Corporate or privately owned businesses that aim to make a profit. Receive payment from insurance companies but also accept private pay clients
The nurse obtains the following data when caring for a patient who experienced an acute myocardial infarction (AMI) 2 days previously. Which information is most important to convey to the health care provider?
Crackles are auscultated bilateraly in the mid-lower lobes The crackles indicate that the patient may be developing heart failure, a possible complication of myocardial infarction (MI). The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme (ACE) inhibitors for the patient.
A nurse monitoring a client who has sustained a head injury would determine that the intracranial pressure is rising if which of the following vital signs trends is notied during the course of the work shift? A. increased pulse, irregular respiration, increased BP B. decreased pulse, irregular respiration, increased pulse pressure C. increased pulse, decreased respiration, increased pulse pressure D. increased temperature, decreased pulse, irregular respirations, increased bp
D. increased temperature, decreased pulse, irregular respirations, increased bp
The family members of a patient who has just been admitted to the intensive care unit following an accident with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first?
Describe the patient's injuries and the care that is being provided
The pathophysiologic process of Parkinson's Disease involves the degeneration of which of the following?
Dopamine producing neurons in the substantia nigra
A 25 year-old woman arrives at the clinic for a physical. She has sought preventive care sporadically but has refused a pap smear in the past stating that nobody else in her family has ever had a cancer. The client asks what risk factors are associated with cervical cancer. Which of the following is a correct response?
Early-age onset of sexual activity, multiple sexual partners, multiparity, long-term 'pill' use, cervical trauma, HPV infection, smoking, and being of African descent are all risk factors.
The nurse is admitting a hospital client who does not speak English and who is accompanied by the client's school-aged child. The client appears to be in pain, but the nurse is unable to assess the character or history of the client's pain. How should the nurse best communicate with the client?
Enlist the help of a hospital interpreter; ask the son to translate if none is readily available.
A patient with Hodgkin's lymphoma who is undergoing external radiation tells the nurse "I am so tired I can haredly get out of bed in the morning." An appropriate intervention for the nurse to plan is to
Establish a time to take a short walk almost every day Walking programs are used to keep the patient active without excessive fatigue.
What are keloids and in what race of people is this found?
Excess growth of scar tissue at site of healed injury. African American
The final aspect of pharmacokinetics is ______, the process of medications exiting the body through the lungs, exocrine glands, bowel, kidneys, and liver.
Excretion
The rule of nines is a guide for determining which of the following?
Extent of burn calculated as total body surface area (TBSA) The rule of nines is an assessment tool used for estimating the extent of total body surface area that has been affected by the burn injury.
What organization is responsible for maintaining the medication standards set by law?
FDA
T/F:During ancient times, nurses did not follow directions of doctors. They were autonomous.
False
A nurse from a surgical unit is asked to work on the pediatric unit during a staffing shortage. The surgical nurse has not worked in pediatrics for 10 years and is not familiar with the unit. The surgical nurse approaches the nurse manager and claims not to be competent to work on the pediatric unit. What should the nurse manager do?
Find another nurse to cover the unit and send the nurse back to the surgery unit.
Who was founder of modern nursing?
Florence Nightingale
A mother calls the health clinic and tells the nurse that she found her toddler with an open and empty bottle of acetaminophen. The mother asks the nurse what she should do. What is the nurse's priority intervention?
Give the mother instructions on how to call poison control
Medicare
Government program that provides healthcare funny folder adult and those with disabilities
A client is scheduled for amniocentesis. What priority intervention should the nurse implement?
Have the client void
The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? Myocardial infarction (MI) immunizations family history of endocarditis dentist visits
Have you been to the dentist lately?"
assessment of preoperative pts
Health History -identifying data -history of present illness -past medical history -review of symptoms -functional assessment Physical Examination -general survey -ht/wt -Vital signs -skin -thorax -abdomen -extremities -prostheses
_____ _____ workers must consider the way a disabled individual funciton within the family and the patient and family should be involved from the outset in determining the plan of care
Health care
What system has greatly increased the number and types of health care settings?
Health care system
A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol, 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located?
Heart
The nurse is teaching the parents of a child diagnosed with celiac disease? What is the nurse's priority goal?
Help the parents and child follow the prescribed dietary restrictions
A patient is receiving intravesical bladder chemotherapy. For which of the following will the nurse monitor?
Hematuria The adverse effects of intravesical chemotherapy are confined to the bladder.
A 21 year-old female presents to the clinic with generalized fatigue and night sweats along with the presence of a painless, movable lump in the axillary area. What will the nurse anticipate testing for?
Hodgkin's lymphoma cervical, axillary, and inguinal areas.
An infant in the newborn nursery goes into cardiac arrest and needs to be resuscitated. The resuscitation cart was not restocked properly by the nurses on the unit after an earlier arrest, and critical supplies are missing. The baby sustains brain damage as a result of delays in obtaining needed supplies. How does the nurse manager address this situation?
Hold the nurses responsible because hospital procedure was not followed.
during Middle ages, which secular groups formed?
Hospital brothers of St. Anthony (care for those w/St. Anthony's fire disease); Misericordia in Italy (provide transport services for ill); Alexian Brothers (care for bubonic plague victims)
When teaching a patient with HIV regarding transmission of the virus to others, what comment would indicate need for further education?
I will isolate tissues that I use from my family. HIV is not spread casually
__ is second fastest, injected into muscle then absorbed into the bloodstream.
IM
What are the nursing organizations?
INO: International nursing organization. ANA:American Nurses Assoc.(Public education, clinical nursing standards, lobbying) NLN: National League for Nursing. (Fosters the development and improvement of all nursing services and nursing education.) AACN: American Association of Colleges in Nursing.(establish quality educational standards.) NSNA: National Student Nurses Assoc. Specialty Practive and Special Interest.
What should you always keep in mind during a nursing procedure?
ITD. Promote client independance and involvement, assess client tolerance to the procedure, ensure privacy and dignity. ITD.
__ is fastest, directly into the blood stream.
IV
Medicare part B optional
If you sent customary and usually physician rates after deductible and blitz transportation physical speech occupational therapy home health services medical supplies and equipment outpatient surgery and blood transfusions
An alert and oriented client comes to the emergency department after hitting his head in a motor vehicle accident. What should the nurse do first?
Immobilize the client's head and neck
actions when caring for a trauma patient with a suspected spinal cord injury who is admitted to the emergency department?
Immoblize the patient's head, neck, and spine Administer 02 using a non-rebreather mask Monitor cardiac rhythm and blood pressure Infuse normal saline at 150 ml / hr Tranfer the patient to radiology for spinal CT
Some antihypertensive medications cause _______ in male patients.
Impotence
Which of the following occurs as a result of "counterpulsation" during intraortic baloon pump (IABP) use?
Improved blood flow to the coronoary arteries
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for cancer of the colon. Which information about the patient is most indicative of the need for a change in therapy?
Increase in CEA An increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified.
When caring for a critically ill patient who is being mechanically ventilated, the nurse will monitor for which of the following clinical manifestations of MODS?
Increased BUN / Cr levels Clinical manifestation of MODS include symptoms of respiratory distress, signs and symptoms of decreased renal perfusion, decreased serum albumin and prealbumin, decrased GI motility, acute neurologic changes, myocardial dysfunction, DIC, and changes in glucose metabolism.
The initial cause of hypovolemia during the emergent phase of burn injury is
Increased capillary permeability Although all the above selections could contribute to hypovolemia in the burn patient, the initial and most pronounced effect is caused by fluid shifts out of the blood vessels as a result of increased capillary permeability.
Which housing option for the older adult office privacy of an apartment with a restaurant style meals and some medical personnel care services
Independent or assisted living inpatient hospital care extended care
An initial incomplete spinal cord injury often results in complete cord damage because of which of the following post-injury processes?
Infarction and necrosis of the cord caused by edema, hemorrhage, and metabolites
complications of a radial arterial line?
Infection, Bleeding, Peripheral neurologic deficit, Thrombus formation
Living will
Informs a physician that the individual wishes to die naturally if he or she develops a helminthiases an injury that cannot be cured
A diabetic patient is admitted with ketoacidosis and the health care provider writes the following orders. Which order should the nurse implement first?
Infuse 1 liter normal saline per hour The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids.
A patient with a possible disseminated intravascular coagulation (DIC) arrives in the Energency Department (ED) with a blood pressure 82/40, temperature 102 F, and severe back pain. Which of these physician orders will the nurse implement first?
Infuse normal saline 500 ml over 30 minutes The patient's blood pressure indicates hypovolemia caused by blood loss and should be addressed immediately to improve perfusion to vital organs.
A patient with shock of unknown etiology whose hemodynamic monitoring reveals BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure (PAWP) has the following collaborative interventions prescribed. Which intervention will the nurse question?
Infuse normal saline @ 250 ml / hr The patient's elevated pulmonary artery wedge pressure indicates volume excess. A normal saline infusion at 250 mL/hr will exacerbate this. The other actions are appropriate for the patient.
A diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made for a patient with type 2 diabetes who is brought to the emergency room in an unresponsive state. The nurse will anticipate the need to do which of the following priority actions?
Insert a large-bore IV catheter HHS is initially treated with large volumes of IV fluids to correct hypovolemia.
You must know if a drug is excreted through the ______, because the administration of laxatives or enemas increases ______, accelerates excretion, and thus lessens the time for drug effects.
Intestines/peristalsis
Two types of Values
Intrinsic Extrinsic
What is IV therapy feeding?
Introduction of mainly hydration into a peripheral vein. this methods requires additional nutritional support if used for more than a few days.q
microminerals
Iron, Zinc, Manganese, Chromium, Copper, Selenium, Fluoride, Iodine, trace elements: arsenic, boron, nickel, silicon, etc.
A client presents with blistering wounds caused by an unknown chemical agent. How should the nurse intervene?
Irrigate the wounds with water.
A hospice nurse who has become very close to a terminally ill patient and family is present in the home when the patient dies and feels saddened and tearful as the family members begin to cry. Which action should the nurse take at this time? a. Contact a grief counselor as soon as possible. b. Cry along with the patient's family members. c. Leave the home as quickly as possible to allow the family to grieve privately. d. Consider whether working in hospice is desirable since patient losses are common.
It is appropriate for the nurse to cry and express sadness in other ways when a patient dies, and the family is likely to feel that this is therapeutic
The physician just informs you that Paige's enzyme immunoassay is positive for HIV and that you need to draw another blood sample. She looks confused and says, "I already had that done." What do you tell her? You have tested positive for HIV but we need to run another test to be certain. We are unsure of the other blood sample so we need another to do the Western Blot blood test. It is common to do more than one blood tests to confirm HIV.
It is common to do more than one blood tests to confirm HIV.
When developing a teaching plan for a patient newly diagnosed with peripheral artery disease, which information should the nurse include?
It is important for you to stop smoking cigarettes Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD.
What is total parenteral nutrition (TPN)
It is the admistration of complete nutritional requirements, for when the patients digestive tract cannot absorb nutrients and hydration. The nutrients are administered directly into the blood via a LARGE vein (eg, subclavian) through a catheter.
What is ADPIE (definition and the acronym)
It is the process for basic nursing care. Assess, diagnose, plan, implement and evaluate
Define patient advocacy
It is where a nurse speaks on behalf of the patient, protecting their interests and ensuring that their needs and desires are considered.
A patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, and coolness in the left leg. The nurse should notify the health care provider and follow-up with which of the following actions?
Keep the patient on bedrest The patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until circulation can be restored.
The emergency department (ED) nurse receives report about a patient with full-thickness burns to 24% of the body. Which IV fluid will the nurse anticipate infusing
Lactated Ringers Fluid replacement is accomplished using crystalloid solutions such as Lactated Ringer's and colloids such as albumin. Albumin, however is usually reserved until after 12-24 hours post-burn when capillary permeability returns to normal or near normal.
Advanced directives
Legally recognize written document test specify the types of care and treatment desires when that individual cannot speak for himself or herself example : do not reccessitate DNR, mechanical ventilation or fresh nutrietion and hydration
When the nurse is caring for a patient on the first post-operative day after an abdominal aortic aneurysm (AAA) repair, which assessment finding is most important to communicate to the health care provider?
Loose, bloody stools may indicate intestinal ischemia or infarction and should be reported immediately because the patient may need an emergency bowel resection.
A school-age child, with a diagnosis of epilepsy, is admitted to the pediatric unit of a local hospital for evaluation of his anticonvulsant medications. As the nurse enters the child's room, the child begins to have a seizure. What is the priority nursing action?
Loosen any restrictive clothing
Hypovolemic shock
Low blood flow
A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a pneumothorax. Which action will the nurse acticipate?
Lower the positive end-expiratory pressure (PEEP) Because barotrauma is associated with high airway pressures, the level of PEEP should be decreased.
Prescription meds are taken under the supervision of an _____ or _____ _____ _____.
MD, advanced practice nurse
A laboring client in the latent stage of labor begins reporting pain in the epigastric area, blurred vision, and a headache. Which medication would the nurse anticipate for these symptoms?
Magnesium sulfate
Anaphylactic shock
Maldistribution of blood
Neurogenic shock
Maldistribution of blood
Septic shock
Maldistribution of blood
When the ventilator alarm sounds, the nurse finds the patient lying in bed holding the endotracheal tube (ET). Which action should the nurse take first?
Manually ventilate the patient with 100% oxygen The nurse should ensure maximal patient oxygenation by manually ventilating with a bag-valve-mask system. Offering reassurance to the patient, notifying the health care provider about the need to reinsert the tube, and activating the rapid response team also are appropriate after the nurse has stabilized the patient's oxygenation.
A 4-month-old infant has been carried into the emergency department after falling off his parents' bed and hitting his head on the floor. What should the nurse do next?
Move the family to an area where an assessment can be completed and call for a physician.
While working in the outpatient clinic, the nurse notes that the medical record states that a patient has intermittent claudication. Which of these statements by the patient would be supportive of that information?
My legs cramp whenever I walk more than a block Cramping that is precipitated by a consistent level of exercise is descriptive of intermittent claudication.
When caring for the patient with a pulmonary artery pressure catheter, the nurse notices that the waveform indicates that the catheter is in a wedged position. Which action should the nurse take?
Notify the health care provider When the catheter is in the wedge position, blood flow past the catheter is obstructed, placing the patient at risk for pulmonary infarction. A health care provider or specially trained nurse should be called to reposition the catheter.
The patient with septicemia develops a new onset of prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take?
Notify the patient's physician The patient's new onset of bleeding and diagnosis of sepsis suggest that disseminated intravascular coagulation (DIC) may have developed, which will require collaborative actions such as diagnostic testing, blood product administration, and heparin administration
What is involuntary rapid eye movements common in neonates called?
Nystagmus
During the primary assessment of a trauma victim, the nurse determines that the patient has an unobstructed airway. Which action should the nurse take next?
Observe the patient's respiratory effort Even with a patent airway, patients can have other problems that compromise ventilation, so the next action is to assess the patient's breathing.
A patient has 25% TBSA burned from a car fire. His wounds have been debrided and convered with a silver-impregnated dressing (Silvadene). The nurse's priority intervention for wound care would be to
Observe the wound for signs of infection during dressing changes
A nurse is working with an unlicensed assistive personnel (UAP). Which clients should the nurse assign to the UAP? Select all that apply.
Older adult client who had hip replacement surgery and needs to walk in the hall with a walker. Adult client who had a hysterectomy 3 days ago and requires vital sign checks every 4 hours.
What is a therapeutic relationship?
One that resides in the helpfulness zone (not impersonal (under involved) or familiar (over involved)
What are conjunctivitis in an infant under 30 days of age which is usually acquired from the mother during vaginal birth symptoms of?
Opthalmia neonatorum
Which of these infections, seen in the intermediate chronic infection phase, is an indicator of HIV disease progression? Candidiasis, Shingles Kaposi sarcoma Oral hairy leukoplakia
Oral hairy leukoplakia
Which assessment information is most important for the nurse to make in order to evaluate whether treatment for the patient with anaphylactic shock has been effective?
Oxygen saturation Because the airway edema that is associated with anaphylaxis can affect airway and breathing, the oxygen saturation is the most critical assessment.
The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider? Oxygen saturation has dropped to 89% even with the administration of 100% O2 per non-rebreather mask blood-tinged sputum and scattered crackles continued temperature elevation
Oxygen saturation has dropped to 89% even with the administration of 100% O2 per non-rebreather mask
purpose of positive end-expiratory pressure of a patient with ARDS
PEEP prevents the lung air sacs from collapsing during exhalation By preventing alveolar collapse during expiration, PEEP improves gas exchange and oxygenation.
__ is slowest, swallowed by the patient, then goes through the stomach, then the first pass effect, then absorbed by the Digestive tract.
PO
To determine whether there is a delay in impulse conduction through the atria, the nurse will measure
PR interval
What is the acronym for getting the environment ready before a procedure?
PRAAP. (provide PRIVACY, RAISE the bed, ADJUST the lighting and ARRANGE supplies, put the patient in the correct POSITION)
A 57 year old woman comes to the clinic for her yearly mammogram. Upon the clinical breast exam, the nurse notes persistent lesions on the nipple and areola with a palpable mass. Upon questioning, the client admits that her nipples have been itching and burning with occasional bloody discharge. What type of malignant breast cancer will the nurse anticipate being identified?
Paget's disease
A nurse is caring for a woman who has COPD and renal failure. She goes to dialysis three times a week and is thought to live for 1-2 more years. To which department would be best for the patient to be referred? a. Hospice b. Orthopedics c. Palliative d. ICU
Palliative
_______ procedure relieves symptoms or improves function without correcting the basic problem.
Palliative
Six P's
Pallor Pain Parasthesia Poikilothermia Pulselessness Paralysis (late sign)
Which of these nursing actions for a patient with Guillain-Barre' is appropriate for the nurse to delegate to an experinced nursing assistant? Administration of tube feedings administration of ordered medications, assessment are skills PROM
Passive range of motion to the extremities q 8H
A nurse is developing a care plan for a client with disseminated intravascular coagulation (DIC). Which nursing intervention should the nurse include?
Place a pressure-reducing mattress on the client's bed.
A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9. Which action prescribed by the health care provider should the nurse take first? cardiac monitor admin insulin urine glu ketone lvl
Place the patient on a cardiac monitor Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring. Since potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium.
Medicare part D
Prescription drug coverage starting 2006 voluntary plan for part A and b members
3 levels of preventive care
Primary - weight loss, diet, exercise, drugs, seatbelts, safe sex, parenting... Secondary - screenings, PAP smears, mamogram, family counseling Tertiary - medication, med therapy, surgical treatment, rehab, job training
In this type of Cardiomyopathy the etiology of the disease is unknown. In this case the heart muscle is the only portion of the heart involved, and other cardiac structures are unaffected. Primary Cardiomyopathy Secondary Cardiomyopathy Dilated Cardiomyopathy Hypertrophic cardiomyopathy
Primary Cardiomyopathy
Number in sequence the events that occur in disseminated intravascular coagulation (DIC). Activation of fibrinolytic system Fibrinogen converted to fibrin Release of fibrin split products Widespread fibrin and platelet deposition in capillaries and arterioles Inhibition of normal clotting Production of intravascular thrombin Depletion of platelets and coagulation factors Uncompensated hemmorrhage
Production of intravascular thrombin Fibrinogen converted to fibrin Widespread fibrin and platelet deposition in capillaries and arterioles Depletion of platelets and coagulation factors Activation of fibrinolytic system Release of fibrin split products Inhibition of normal clotting Uncompensated hemmorrhage
The nurse performing an assessment with a patient who has chronic peripheral artery disease of the legs and an ulcer on the left great toe would expect to find which of the following?
Prolonged capillary refill in all the toes Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery.
A young woman is admitted for surgical treatment of genital lesions. What should the nurse identify as an important part of care for this client?
Provide a chaperone or assistant in her care whenever possible.
A burn patient has a nursing diagnosis of impaired physical mobility related to a limited range of motion (ROM) secondary to pain. An appropriate nursing intervention for this person is to
Provide analgesic medications before physical activity and exercise The limited range of motion in this situation is related to the patient's inability or reluctance to exercise the joints because of pain, and the appropriate intervention is to help conrol the pain so that exercises can be performed. The patient is probably never without some pain, and although exercises and enlisting the help of the physical therapist are important, neither of these interventions addresses the cause.
After preoperative medications are given, the patient should _____ in bed.
Remain
The initial intervention in the management of a burn of any type is to
Remove the patient from the burn source and stop the burning process The first intervention is to remove the source and stop the burning process. Airway maintenance would be second, then establishing IV access, followed by assessing for other injuries.
When patients have reduced ____ function, they are at risk for medication toxicity.
Renal
The nurse is reviewing the lab report for a client in hospice care with breast cancer and brain metastasis. According to the information in the chart, what should the nurse do next?
Report the elevated calcium level immediately.
A nurse administers incorrect medication to a client. After assessing the client, and completing an incident report, which is the priority action by the nurse?
Report the incident to risk management
A nurse suspects an infant may have a tracheoesophageal fistula or esophageal atresia. What is the most important intervention by the nurse?
Report the suspicion to the health care provider
Financial abuse
Resources of an older person or stolen misused by a person from the older adult trusts
In which of the following systems are the symptoms of early MODS most evident?
Respiratory The respiratory system is the first to show signs because the direct effect on the pulmonary vasculature, fluid moves from the pulmonary vasculature and into the pulmonary interstitial spaces
Toxic levels of morphine, an opioid, cause severe _____ ______ and death.
Respiratory depression
The warning signs of a stroke include all of the following except...
Respiratory distress
What are the functions of sleep?
Restoration therapy (proteins are rebuilt and energy is replenished), preservation and protection, learning and memory consolidation
health belief model?
Rosenstock. What people percieve to be true about themselves in relation to their health. Modify factors for health: demographics, sociopsychological and structural variables. 3 components of individual perception of disease threat: 1. perceived susceptibility to a disease; 2. perceived seriousness of disease; 3. perceived benefits of action.
What should progress notes contain?
SOAP - subjective data (what the patient states), objective data (what you have measured), assessment (the nursing diagnosis, plan (the nursing care plan).
Which EKG change is most important for the nurse to convey to the health care provider when caring for a patient with chest pain?
ST segment elevation The patient is likely to be experiencing an ST-segment-elevation myocardial infarction (STEMI) and immediate therapy with percutaneous coronary intervention (PCI) or fibrinolytic medications is indicated to minimize the amount of myocardial damage.
A client has been diagnosed with dementia related to chronic and heavy alcohol consumption. In a family meeting with the client, discharge plans are being discussed. Which points should the nurse share with the family and client? Select all that apply.
Safety alarms on the doors will keep the client from wandering off. As the need for supervision increases, it may be necessary for the client to be placed in an extended-care facility.
A client presents at the health care provider's office with gray-brown burrows with epidermal curved ridges and follicular papules of the skin. The health care provider diagnoses scabies. Which teaching points would a nurse review with the client? Select all that apply.
Scabies is transmitted by close person-to-person contact or contact with infected linens and clothing. Severe itching of the affected areas, especially at night, is a common finding. All of the client's linens and clothing should immediately be washed in hot water.
A client with chronic back pain is admitted to the medical-surgical floor and is receiving multiple pain medications and an antidepressant for pain control. The physician's orders include a physical therapy consult for ambulation and back strengthening, magnetic resonance imaging (MRI) of the lumbar spine, and a computed tomography (CT) scan of the abdomen. How should the nurse schedule therapy and diagnostic tests?
Schedule the MRI of the lumbar spine first, then the physical therapy consult, and then the CT scan.
If you give only part of a premeasured dose of a controlled substance, a ____ nurse witnesses' disposal of the unused portion.
Second
Physical Manifestations
Sensory changes Circulatory and Respiratory Changes Loss of Muscle Tone Brain Death
Skilled Services
Services that must be performed or supervised by a licensed healthcare profession
What is culture?
Shared system of beliefs, values and behavioral expectations that provides social structure for daily living.
________ are predictable and often unavoidable secondary effects produced at a usual therapeutic drug dose.
Side effects
The nurse is ambulating a client. The client experiences chest pain after ambulating 50 feet. What is the nurse's priority intervention?
Sit the client down
What is the science of nursing?
Skilled application of knowledge to help others reach max health and quality of life
When caring for a patient who has septic shock, which assessment finding is most important for the nurse to report to the health care provider?
Skin cool & clammy Since patients in the early stage of septic shock have warm and dry skin, the patient's cool and clammy skin indicates that shock is progressing.
When the nurse is assessing a patient who is receiving nitroprusside (Nipride) infusion to treat cardiogenic shock, which finding indicates that the medication is effective?
Skin is warm, pink, and dry Warm, pink, and dry skin indicates that perfusion to tissues is improved.
A client with heart failure has been receiving an I.V. infusion at 125 ml/hour. Now the client is short of breath and the nurse notes bilateral crackles, jugular vein distention, and tachycardia. What should the nurse do first?
Slow the I.V. infusion.
A female client with a 30 pack year smoking history arives at the clinic for a physical. She admits a chronic cough over several years that has become more productive. You notice that her gait is unsteady, Which of the following diagnoses would you anticipate?
Small cell CA Small cell CA quickly metastasizes to the bone and brain.
Transplanting Partial Organs
Some organs such as the liver, lung lobes, or intestinal segments may be transplanted allowing a living donor and the recipient to both function using the organ.
What are high-technology interventions (the provisions of intravennous therapy and ventilator), hospice services, pediatric care, and mental health care for?
Specialty home care services
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection?
Stage 3 pressure ulcer on the left heel
Premature ventricular contractions (PVC's) occur while the nurse is suctioning the endotracheal tube. Which action by the nurse is best?
Stop and ventilate the patient with 100% oxygen Dysrhythmias during suctioning may indicate hypoxemia or sympathetic nervous system stimulation, and the nurse should stop suctioning and ventilate the patient with 100% oxygen.
To reduce the risk of laryngeal cancer in employees in a factory that uses respiratory irritants, what instructions should the nurse give the employees? Select all that apply.
Stop smoking. Limit alcohol use.
When teaching a patient with a seizure disorder about his medication regimen, which of the following priniciples is most important for the nurse to stress?
Stopping the medication abruptly may increase the frequency of seizures
What will the family's emotional response between aging love want attempts to cope with this metastability's and increase Harrimans
Stress overwhelmed
stroke volume?
Stroke volume (SV) + cardiac output / heart rate.
What two types of data can documentation contain?
Subjective (symptoms - are felt) and Objective (signs - can be measured)
When educating a female client recently diagnosed with systemic lupus erythematosis (SLE) about the triggers of the disease, the nurse is correct in stating that the most significant environmental triggers are
Sun exposure and sunburn
Which of the following types of injury is least likely to result in a full-thickness burn?
Sunburn
To determine the effectiveness of medications that a patient has received to reduce afterload, which hemodynamic parameter will the nurse monitor?
Systemic vascular resistance (SVR) Systemic vascular resistance reflects the resistance to ventricular ejection, or afterload.
A patient with paraplegia resulting from a t10 spinal cord injury has a neurogenic bladder. Which action will the nurse include in the plan of care?
Teach the patient how to self-catheterize at regular intervals Because the patient's bladder is spastic and will empty in response to overstretching of the bladder wall, the most appropriate method is to avoid incontinence by emptying the bladder at regular intervals through intermittent catheterization.
A patient who has fibromyalgia tells the nurse, "My life feels very chaotic and out of my control. I will not be able to manage if anything else happens". Which response should the nurse make initially?
Tell me more about how your life has been recently The nurse's initial strategy should be further assessment of the stressors in the patient's life.
What is The right medication, The right dose, The right patient, The right route, The right time, The right documentation?
The 6 rights of medication
A patient with a hisotry of a T2 spinal cord innjury tells the nurse, "I feel awful today. My head is throbbing and I feel sick to my stomach". Which action should the nurse perform first?
The BP should be assessed immediately in a patient with an injury at the T6 level or higher who complains of a headache to determine whether autonomic dysreflexia is occurring.
A patient with respiratory failure has hemodynamic monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 10cm H2O. Which information indicates that a change in the ventilator settings may be required?
The arterial line shows a blood pressure of 90/46 The hypotension indicates that the high intrathoracic pressure caused by the PEEP may be decreasing venous return and cardiac output (CO).
Which statement by a patient who is scheduled for a needle biopsy or the prostate indicates the nurse's teaching about the purpose of the biopsy has been effective?
The biopsy will help decide the treatment for my enlarged prostate" A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed.
When reviewing the chart for a patient with cervical cancer, the nurse notes the cancer is stages as Tis (in-situ), N0, M0. The nurse will teach the patient that
The cancer is localized to the cervix Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time.
A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD?
The client has a history of diverticulitis.
The client is being evaluated to rule out myasthenia gravis and being administered the Tensilon (edrophonium chloride) test. Which response to the test indicates the client has myasthenia gravis?
The client shows a marked improvement in muscle strength lasts approximately 5 minutes when Tensilon is injected.
A nurse is assigned with an ancillary staff member to care for a group of cardiac clients. Which client should the nurse address first?
The client who suffered an acute myocardial infarction (MI) who is complaining of constipation.
The nurse is attending a family meeting where a recent immigrant's treatment plan is being discussed. The client is a retired English teacher and defers to the oldest son when the care team asks the client questions. How should the nurse best interpret the client's action?
The client's action may reflect cultural and familial norms.
A client on the adolescent psychiatric unit was admitted with a diagnosis of body dysmorphic disorder. The client has not been able to attend school or his/her part-time work over the past year as a result of certain body obsessions. Recently, the client shaved the hair all over his/her body, claiming, "It is all growing weird." What component of therapy would be most important for the nurse to apply to this client?
The client's body image is real to the client.
A 62-year-old client who has smoked 2 packs of cigarettes per day for the last 10 years is admitted with a diagnosis of lung cancer. She reports having "no appetite" and exhibits symptoms of anorexia. The client is 5 feet, 8 inches (173 cm) tall and weighs 112 lb (50.8 kg). The client is now scheduled for a left lung lobectomy. The nurse should include which factor when planning to prevent postoperative pulmonary complications?
The client's weight relative to her height is low.
Which assessment information obtained by the nurse when caring for a patient receiving mechanical ventilation indicates a need for suctioning?
The increase in respiratory rate indicates that the patient may have decreased airway clearance and requires suctioning. Suctioning is done when patient assessment data indicate that it is needed, not on a scheduled basis.
Which assessment data obtained by the nurse when caring for a patient with a left radial arterial line indicates a need for the nurse to take action?
The left hand is cooler than the right The change in temperature of the left hand suggests that blood flow to the left hand is impaired
During the secondary survey of a trauma patient in the emergency deartment (ED), it is important that the nurse obtain details of the incident primarily because
The mechanism of injury can indicate specific injuries Specific injuries are associated with specific types of accidents and events surrounding an incident, and details of the incident along with the trajectory of penetrating injuries are important in identifying and treating the injury.
During post-op teaching with a patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient on which of the following?
The need for frequent laboratory blood testing Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to prevent clotting on the valve; this will require frequent international normalized ratio (INR) testing.
Chronological age
The number of years a person has lived
gerontics
The nursing care the service provided to older adults
After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective?
The patient exercises indoors during the winter months Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm, rather than hot, water to warm the hands. Pseudoephedrine is a vasoconstrictor and should be avoided. There is no reason to avoid taking aspirin and NSAIDs with Raynaud's phenomenon.
Which information obtained by the nurse when assessing a patient admitted with mitral valve regurgitation should be communicated to the health care provider immediately?
The patient has crackles audible to the lung apices Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics.
Which assessment finding by the nurse caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicate that the PEEP may need to be decreased?
The patient has subcutaneous emphysema The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP.
A patient who has severe pain associated with terminal liver cancer is being cared for at home by his family members. Which finding by the nurse indicates that teaching regarding pain management has been effective
The patient takes opioids around the clock on a regular schedule with additional doses when breakthrough pain occurs For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain.
A patient arrives at the Emergency department after checking her BP on the HyVee automatic BP machine. The reading was 200/110 and this is confirmed by a similar reading at the ED. What further information is needed to differentiate between a hypertensive emergency and hypertensive urgency?
The presence of acute symptoms related to hypertension
What is the first system to show signs of dysfunction? Cardiovascular Respiratory Renal Gastrointestinal
The respiratory system is the first to show signs because the direct effect on the pulmonary vasculature, fluid moves from the pulmonary vasculature and into the pulmonary interstitial spaces
Why might some tests be falsely positive or falsely negative? The tests were administered wrong The tests were contaminated The window period All of the above
The window period
It is important to know the exact _______ ______ for which a medication is prescribed so you can properly _____ patients about a medication's intended effect and to accurately evaluate the medication's desired effect.
Therapeutic effect/teach
_______ _______ is enough of a drug to produce the desired physiological response, but not enogh to cause toxicity.
Therapeutic response
A client asks why the chemotherapeutic drugs he has read about online are classified as cell-cycle specific and cell-cycle non-specific. What is the best explanation of these types of chemotherapy?
They are used to describe the cycle of cell activity at which they will have the greatest impact
Pureed diet:
This diet includes clear liquid diet, full liquid diet, and pureed meats and fruits
Mechanical soft diet:
This diet includes clear liquid diet, full liquid diet, pureed meats and fruits, and diced or ground foods
Diabetic diet:
This diet is a balanced diet
A young man comes into for a routine physical and mentions to his doctor that he has noticed his breasts have progressively become larger. After ruling out any malignancies, the best response of the doctor would be to tell the young man... This is the result of excess fibrous tissue This is called Gynecomastia and is result of the disturbance of the normal ratio of active androgen to estrogen in plasma or within the breast itself. A common breast problem in men. The enlarged breast may last years and will have a high risk for becoming malignant in the near future.
This is called Gynecomastia and is result of the disturbance of the normal ratio of active androgen to estrogen in plasma or within the breast itself. A common breast problem in men.
What criteria of the living will must be met before the document can go into effect
To physicians must agree in writing that the necessary criteria are met
_____ develop after prolonged intake of a medication, when a medication accumulates in the blood because of impaired metabolism or excretion, or when too high a dose is given.
Toxic effects
What are sources of knowledge?
Traditional, authoritative, scientific
Durable power of attorney for healthcare
Transfers the authority to make healthcare decisions to another person called the healthcare agent
The point at which the lowest amount of drug is in the serum is the ______ concentration.
Trough
Which assessment finding for a patient who is on the surgical unit after a radical abdominal hysterectomy related to ovarian CA is most important to report to the health care provider?
Urine output of 80 ml in the first 8 hours after surgery decreased urine output indicates possible low blood volume and further assessment is needed to assess for possible internal bleeding.
An 88 year old female presents to the emergency department (ED) with nausea & vomiting. VS reveal BP 86/56; AP 118; T 102.2 F. A diagnosis of heat stroke is identified. You are aware that all forms of heat stress occur when thermoregulatory mechanisms are unable to compensate for exposure to increased ambient temperatures. Which of the following are 'thermoregulatory mechanisms' involved in the occurrence of heat stress.
Vasodilation, sweating, and increased respirations
_____ and _____ are micronutrients; they are needed in small amounts for good health.
Vitamins/minerals
Which physical assessment data would alert the nurse to a possible mild toxic reaction in a client receiving lithium?
Vomiting and diarrhea
What are the steps to follow after a procedure?
WHILHDA. Dispose of waste, wash hands, inform the client how the procedure went, lower bed, wash hands, document the procedure, report abnomalities.
The nurse positions the patient with ear, face, and neck burns
Without pillows Patients with ear burns are not allowed to use pillows because of the danger of the burned ear sticking to the pillowcase, and patients with neck burns are not allowed to use pillows because contractures to the neck can occur.
The nurse is caring for a client with peripheral artery disease who has just returned from having a percutaneous transluminal balloon angioplasty. Which finding requires immediate attention from the nurse?
a change in the intensity of the pulse from the baseline
What is a Black Box Warning indicative of?
a medication that causes serious side effects
volunteer
a person who performs or gives his or her services of his or her own ree will
client care plan
a plan for care of a specific client or one designed espeically for one client
What would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy?
a salt water rinse will not cause further irritation to oral tissue that is fragile because of mucositis from chemo.
adaptation
ability to adjust to a change in environmnt
Skills
ability to do something well
Distribution begins with the _____ of the medication in the circulation and ends with...
absorption, arrival of the medication at the site of action
What three parts of PK are altered in the elderly?
absorption, metabolism, excretion
What part of PK does impaired GI functioning affect? Heart failure? Liver or renal disease?
absorption. impaired distribution. metabolism and excretion.
A synergistic drug interaction can be _____ or _____. What are examples of each.
accidental or planned. accidental--drinking alcohol. planned--tylenol given with opioids.
A primigravid client visits the clinic for a routine examination at 35 weeks' gestation. The client's blood pressure is near the baseline of 120/74 mm Hg with no proteinuria or evidence of facial edema. The client asks the nurse, "What should I take if I get an occasional headache after looking at my computer at work all day?" The nurse instructs the client that she can occasionally take which over-the-counter medication?
acetaminophen
TRICARE Prime Remote
active duty service members live 50 miles/ 1hr from MTF no claims to file PCM referrals required for specialty care
Effective Communication Skills
active listening interpreting nonverbal skills obtaining feedback focusing adjusting your style
past medical history
acute and chronic conditions,previous hospitalizations and surgeries,allergies,recent and current medications(include recreational and herbal medications)
The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. What would be a good way to increase the patient's nutritional intake?
adding items high in protein and/or calories like peanut butter, skim milk powder, cheese, honey, or brown sugar.
Adaptation theory?
adjustment of living matter to other living things and environment
decreased drug absorption with milk
adverse effects of trtracyclines, cipro concerning food
Ativan, an antianxiety medication, when given to an older adult may cause ___________.
agitation and delirium(idiosyncratic reaction)
Informed Consent
agreement by a client to accept a course of treatment; provided by physician
Supportive cares for DIC may include which of the following? Heparin Fibrinogen Cryoprecipitate Drotrocogin alpha Fresh Frozen Plasma (FFP)
all
Which of these factors affects the chances of a successful organ transplant? Select all that apply. Cross matching Time and transport Human leukocyte antigen Immunosuppressive therapy
all
There is a relationship between food and drug allergies. What's an example?
allergic to shellfish, no iodine-based dyes
What should the RN know about administering meds to geriatric patients?
allow sufficient time, offer small amounts of liquids before and after to increase absorption. 1-2 pills at a time
When planning the care of a patient with dehydration, the nurse would instruct the unlicensed to report what?
an output of less than 20 ml per 2 hours
Deductible
annual amount pt must pay for care b4 insurance
carbohydrates
are converted to glucose, primary source of energy, primarily from plant sources except for lactose
Sometimes a single medication has many therapeutic effects. For example, _____ relieves pain and reduces fever and tissue inflammation.
aspirin
A parent asks the nurse if medications can cause Reye syndrome. The nurse's most appropriate response is that Reye syndrome has been connected to:
aspirin.
A charge nurse is making assignments for a team that includes two registered nurses (RNs) and one unlicensed assistive personnel (UAP). One client requires a nurse to perform several complex procedures. The charge nurse should:
assign fewer clients to the RN managing this client's care.
The nurse teaches a client who has recently been diagnosed with hypertension about following a low-calorie, low-fat, low-sodium diet. Which menu selection would best meet the client's needs?
baked chicken, an apple, and a slice of white bread
1cal/kg/hr
basal metabolic rate (BMR) equation
Aesthetic
beauty, harmony, & form
the preoperative phase
begins when a decision is made to perform surgical procedure and ends when the pt enters the operating room, during this phase the goals of nursing care are to inform the pt of what to expect,reduce pt anxiety,and decrease the risk of complications during and after surgery.
What is ethnocentrism?
belief that one's ideas, beliefs, and practice are superior
risk
benefit outweighing risk
If the side effects are serious enough to outweigh the _____ of a medication's therapeutic action, the prescriber will likely _____ the medication.
benefits/discontinue
Absorption in the movement of drug molecules from the point of entry in the body into the _____ _____.
blood stream
What sorts of things can affect distribution?
blood supply at the tissue, vasoconstriction or vasodilation
What are two physiological barriers in the body to distribution?
blood-brain barrier and the placental barrier
A patient admitted to the hospital following a generalized tonic-clonic seizure asks the nurse what caused the seizure. The best response by the nurse is: a)"So many factors can cause epilepsy that it is impossible to say what caused your seizure." b)"Epilepsy is an inherited disorder. Does anyone else in your family have a seizure disorder?" c)"In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity." d)"Scar tissue in the brain alters the chemical balance, creating uncontrolled electrical discharges."
c)"In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity."
What is nursing?
care of others; profession focus' on holistic person receiving healthcare services and provides unique contribution to prevention of illness and mainenance of health
independent variable?
cause or condition manipulated/identified to determine relationship of dependent variable
What is relationship between drugs and food?
certain foods can trigger drug-food interactions
Loss of respiratory function occurs with
cervical spine injuries
A medication's _____ determines the organ of excretion. For example, gaseous and volatile compounds, such as alcohol and nitrous oxide, exit through the _____.
chemical makeup/lungs
The rate and extent of distribution depends on _____ , cell membrane ______, and protein binding. When there is poor perfusion, as in the case of heart failure, this ____ medication distribution.
circulation/permeability/alters
What does "no error" mean?
circumstances would have led to an error
skin
color,lesions,brusises,warmth,turgor,moisture
patient's presentation is consistent with dissecting thoracic aneurysm
complaining of "tearing" chest pain
Prenatal
conception to birth (39 wks)
narcotics should be _____ frequently, during the opening of narcotic drawers, and/or shift change.
counted
The most effective health care strategies are? a) Health promotion and Detection b) Detection and Prevention c) Limit disability and Detection d)) Health promotion and Prevention
d)) Health promotion and Prevention
Generalized seizures differ from partial seizures in that: a)Partial seizure are confined to one side of the brain and remain focal in nature b)Generalized seizures result in loss of consciousness while partial seizures do not. c)Generalized seizures result in temporary residual deficits during the postictal phase. d)Generalized seizures have no warning because the entire brain is affected at the onset.
d)Generalized seizures have no warning because the entire brain is affected at the onset.
The nurse is performing an admission assessment of a new client. When assessing potential cultural influences on the client's care, the nurse should address what domains? Select all that apply.
decision-making processes nutrition communication expressions of pain
The right heart delivers (oxygenated, deoxygenated) blood to the (pulmonary circulation, systemic circulation).
deoxygenated, pulmonary circulation
P-R interval represents
depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibers.
treatment of burns is related to the severity of the injury. Severity is measured by:
depth of burn, location of burn, percent of TBSA involved, and patient risk factors
anxiety interventions
determine presense and level of anxiety, the contributing factors,and the need for interventions.determine pts previous experience if any with hospitalization and surgery. if pt seems excessively nervous or fearful about surgery,report this behavior to the surgeon or anesthesia personnel.
DRG
diagnosis-related group. A system to classify all types of clients to determine how much Medicare pays the hospital, since client within each category are similar clinically and are expected to use the same level of hospital resources
A client has a history of heart failure and has been prescribed furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of:
digoxin toxicity.
After a medication is absorbed, it is ______ to tissues and organs and finally to the site of drug action.
distributed
Neurogenic shock is a type of
distributive shock and can result from a spinal cord injury at T5 or above.
What is chewing/swallowing difficulties called?
dysphagia
A patient is getting ready to discharge after a hypertensive crisis. For the nursing staff, what is important for them to teach the patient? a) Educate on medications to control blood pressure b) Educate on low sodium diet c) Set up patient with resources d) Explain about hypertensive crisis and warning signs e) All of the above
e) All of the above
Why is it pertinent to control blood pressure during a hypertensive emergency? a) To decrease possibility of intracranial hemorrhage caused by swelling of the brain b) To decrease possibility of heart attack and heart failure c) It decreases impaired blood flow to other important organs, like the kidneys d) To prevent damage to the retina e) All of the above
e) All of the above
food low in phosphorus
eggs, raisins, white bread
erikson
ego integrity versus despair and disgusts; life review good/bad-life (not always true)
The nurse is caring for a client with esophageal varices. The nurse should discuss which laboratory report finding with the health care provider (HCP)?
elevated PT/INR
high level wellness model?
encourages nurse to care for total peron; involves functioning to one's max potential while maintaining balance and purposeful direction. Wellness= active state, oriented toward max potential of individual, regardelss of health. Process of being, belonging, becoming, and befitting.
research?
examine carefully or search again; scientific inquiry = process using observable and verifiable info
What is deductive reasoning
examining a general idea, then considering specific actions/ideas
The final aspect of pharmacokinetics is ______, the process of medications exiting the body through the lungs, exocrine glands, bowel, kidneys, and liver.
excretion
Hospice
exists to provide support and care for persons in the last phases of incurable diseases so that they might live as fully as comfortably as possible.
What are the physical assessment findings for a child with asthma?
expiratory wheezing , rales, tight cough, and signs of altered blood gases
What is culture shock?
feelings person experiences when placed in a diff culture
The plateau is a serum concentration or level of a drug that has been reached and sustained with a series of _____ _____. When a plateau is reached, the patient should have _____ _____.
fixed doses, optimal results
In spinal shock, the entire cord below the level of the lesion fails to function, resulting in
flaccid paralysis and hypomotility of most processes without any reflex activity.
The Credé method is more appropriate for a bladder that is
flaccid, such as occurs with a reflexic neurogenic bladder.
hemoglobin level, PAWP, and MAP are useful in determining the effects of
fluid administration
pureed
foods of a smooth, soft "mashed potato" consistency that requires no chewing, usually blenderized
vitamin C
found in oranges, fruits, potatoes, red and green chili peppers, guava, herbs and dark leafy vegetables
Values
freely chosen; enduring beliefs, or attitudes about the worth of a person
A client discusses with the nurse the possibility of using alternative therapies for management of hypertension and diabetes. Which is an expected alternative therapy used by the client?
ginseng
The client with hepatitis A is experiencing fatigue, weakness, and a general feeling of malaise. The client tires rapidly during morning care. The most appropriate goal for this client is to:
gradually increase activity tolerance.
Authorized Provider Network
group of civilian providers authorized to deliver care to military beneiciaries
Controlled substances are those which are _____-forming, have a potential for _____ and those which affect _____ or _____.
habit, abuse, mind or behavior
A charge nurse is completing client assignments on a neurologic unit. One full-time nurse from the unit, two floating nurses, and one agency nurse are present for the shift. The charge nurse should assign the unit's full-time nurse to care for the client who:
had a craniotomy 24 hours earlier for a brain hemorrhage.
A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day. Several months later he reports having insomnia, shakiness, sweating, and one seizure. The nurse should first ask the client if he:
has stopped taking the clonazepam suddenly.
therapeutic
having healing or curative powers
Children with chronic otitis media are at risk for developing what problem?
hearing loss
A group of nurses are working to develop a program to address risk reduction strategies for major causes of mortality in the community. The community is made up largely of African Americans. To ensure that the program addresses the health needs of this population, the group would develop strategies focusing on which condition as the priority?
heart disease
Cardiovascular Sys
heart muscle weakens arteries narrow and become less elastic
Heat stress is an umbrella term for many heat-related emergencies including
heat syncope, heat edema, heat cramps, heat exhaustion, and heat stroke.
Infants have immature _____, _____ and _____ systems. They also have a lack of _____ for proper _____ _____.
hepatic, renal and GI. enzymes, drug metabolism
What is a loading dose? What are some common meds that need it?
high than average dose to achieve a therapeutic effect. dilantin, digoxin, azithromax
housing options
home sharing, home modifications, accessory apartments, elderly cottage, senior retirement, assisted living, board and care homes, nursing homes (some can be a devastation)
mechanical soft
household tools and machines are used to make foods easier to swallow and chew; does not restrict fat, fiber, spices or seasonings; appropriate for recovering head/neck/oral surgery, or dysphagia; not as "blenderized" as pureed
Positive Values
how something should be
Negative Values
how something should not be
Social
human interactions, kindness, sympathy & unselfishness
en medications exit through sweat glands, you provide ______ to reduce skin irritation.
hygiene
Avoidance of sun is necessary for 1 year to prevent
hyperpigmentation and sunburn injury to healed burn areas
What are the hallmark signs of TLS
hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.
Neurogenic shock is characterized by
hypotension and bradycardia.
Medications often cause unpredictable effects such as an _______ _______, in which a patient _______or _______to a medication or has a reaction different from normal.
idiosyncratic reaction/overreacts/underreacts
A stat order should be implemented _____.
immediately
When should you chart meds that you gave?
immediately
report discrepancies in narcotic counts _______.
immediately.
Patients are at increased risk for infection and malignancies while on
immunosuppressive.
Predicting which patients will have an idiosyncratic response is _______.
impossible
some antihypertensive medications cause _______ in male patients.
impotence(side effect)
nutritional status
improving albumin levels often coincide with overall improvement
The client has had a gastric resection, and is having difficulty clearing the airway of mucus. The nurse should determine if the client has:
incisional pain.
What is a cohabitating family?
individuals living together (unmarried adults), group marriages
What ages can experience altered drug actions?
infants, elderly
The nurse is assessing a middle-aged client with cancer who has lost 1 lb (0.5 kg) in 4 weeks. The client is taking ondansetron for nausea and now has a temperature of 101° F (38.3° C). The fever is indicative of:
infection.
skin preparation
intended to reduce the number or organism near the incision site. the process usually includes scrubbing and removing hair from a wide marging around the planned surgical site, is ordered by the physician or procedure manual.shaving causes tiny nicks that shelter organisms, therefore shaving is often delayed until shortly before surgery to allow less time for organisms to multiply.
Enteral medications are related to the _____. What are some possible ways this can be given?
intestines. nasogastric, gastrostomy (PEG), or jeugenostomy tube
You must know if a drug is excreted through the ______, because the administration of laxatives or enemas increases ______, accelerates excretion, and thus lessens the time for drug effects.
intestines/peristalsis
What are the four possible ways for a parenteral drug to be given?
intradermal, subcutaneous, intramuscular, intravenous
With _________ infusions, the peak concentration occurs quickly, but the serum level also begins to fall ______.
intravenous (IV)/immediately
preparation of the digestive tract
it depends on type of anesthesia and surgery,for surgery of the abdomen or digestive tract laxatives and enemas are generally given to empty the bowel.they sometimes must empty the bowel at home at home before being admitted to the hospital.
What organs are responsible for excreting most drugs? What does this mean for the patient?
kidneys. they need to be well-hydrated
What should you teach geriatric patients about their medications?
know pills by name, NOT color
When patients have better _____, they are more compliant with their medications.
knowledge
What should the RN know about administering meds to children?
less than 5 years old and they may have difficulty swallowing. crush medication
The nurse is caring for a patient with metastatic bone cancer. What are the clinical manifestations that would alert the nurse to the possibility of hypercalcemia?
lethargy, headache, weakness, muscle flaccidity, heart block, anorexia, N&V
Most biotransformation occurs in the _____, although the lungs, kidneys, blood, and intestines also play a role.
liver
_____ functioning decreases with age. This can lead to an increased risk of drug toxicity.
liver
Host
living organism capable of being infected/affected by an agent. Influenced by family history, age & health habits.
A client in a long-term nursing care facility who decides to be placed on hospice care expresses to the nurse, "I have outlived my family and friends; I have lost hope and there is no need for me to continue on." What underlying client concerns would the nurse first address with this client?
loneliness and feelings of isolation
quality of life
look at desired outcome vs actual side effects of med, important to reassure that the benefit of med outweighs the side effect
foods high in Ca++
low fat yogurt, Tums EX, skim milk, rhubarb, tofu
Besides the kidneys, what other organs are involved in medication excretion?
lungs (alcohol-based meds), sweat glands, mammary glands, GI tract (medications in bile)
clear liquid diet
made up of liquids clear at room/body temperature, maintain vital body fluids, salts, and minerals but is not adequate in calories and nutrients, often only transitional
havighurst
major tasks are maintenance of social contacts and relationships, social theory
which of the following nursing interventions in most appropriate when caring for a patient with dehydration?
measuring weight is the most reliable means of detecting changes in fluid balance. Weight loss would indicate restoration of fluid vlm.
What is the physiological change caused by a medication that results in the body's response to the medication?
mechanism of action
Patients (e.g., older adults and those with chronic disease) are at risk for ________ if their organs that metabolize medications do not function correctly.
medication toxicity
safety
medications, falls, environment, toileting schedules, john hopkins fall risk assessment prevention is key
The Benedictine Order was the entry of _____ into nursing
men
Endometrial ablation and balloon therapy are used to treat
menorrhagia
Expressed Consent
mentally competent adult; legal age to make rational decision in regards to medical well being
After a medication reaches its site of action, it becomes ______ into a less active or inactive form.
metabolized
What is cultural assimilation/ acculturation?
minority values replaced by values of dominant culture
A systolic murmur and palpable thrill would be expected in a patient with
mitral regurgitation
Medical Ethics
moral standards of conduct; accepted by professionall medical organizations
preoperative checklist
most agencies have a preoperative checklist that must be completed and signed before the pt leaves the unit.check to be sure that all lab,radiology,reports are with the chart. that jewelry,prostheses, and nail polish,have been removed,that the pt has voided,that premeds has been given,that vs has been recorded,and consent form signed.SBAR is frequently used.
What is the relationship between blood proteins and medications? What about in a patient with low proteins?
most meds are bound to albumin. the med is inactive when bound to protein. only the unbound med exerts a therapeutic effect. low albumin-->increased circulation of the med, patient will receive a lower dose and have more side effects.
Respiratory Sys
muscles become weaker and less elastic difficulty breathing may occur
Who was Harriet Tubman?
nurse and abolitionist, active in underground during civil war
home care assistance
nursing care given in the clinet's home
dietary factors concerning alcoholics
nutrient deficiency (esp. vitamin B), impaired storage, increased catabolism and excretion
functional assessment
occupation,roles,responsibilities,diet and fluid intake,exercise,tobacco and alcohol use, sources of stress and support,coping strategies,expectations of surgery
common myths of ageism
old age beings at 65 most older adults are in nursing homes older adults are sick and mental deterioration occurs not interested in sex do not care how they look and are lonely bladder problems are a problem of again do not deserve aggressive treatment for illness
kohlberg
older adults have completed their moral development and most are at conventional level depression is not always related to aging individuative relfective level, demonstrate faith and trust in greater pwoer self transcendence is a later life characteristic
cholesterol
only in animal products, essential nutrient, coats brain/nerve cells for protection
What are the four main routes of medication administration?
oral, parenteral, topical, inhalation
Developmental theory?
orderly and predictable growth and development, Eric Ericsson and Maslow
Immunosuppressive therapy is used to prevent
organ rejection while at the same time maintaining sufficient immunity in the recipient.
Extrinsic Values
originate outside the individual; not neccessary for life holism, humanism
If you give only ____ of a premeasured dose of a controlled substance, a ____ nurse witnesses' disposal of the unused portion. ____ nurses sign their names on the required form.
part/second/Both
culture of poverty?
passed down from generation - older, migrant workers, welfare...
What is disease?
pathologic change in the structure or function of the body or mind
What eight things are included in a prescription?
patient name, medication name, dose, route, frequency, amount to be dispensed, number of refills, physician signature
Listen
pay attention
highest concentration of med in blood VS lowest concentration of med in blood
peak vs. trough
The highest serum concentration (_____ concentration) of a medication usually occurs just before the body absorbs the ____ of the medication.
peak/last
What does cultural diversity include?
people of varying cultures, racial and ethnic origin; sexual orientation, lifestyle, ethnicity, religion; language; physical size; gender; age; disability
human dimensions affect health & illness (physical, emotional, intellectual, environ, sociocultural, spiritual)
physical - genetics, age, developmental level, race, gender emotional - how mind affects body function and responds to body conditions intellectual - cognitive abilities, educational background and past experiences environ _ housing, sanitation, climate, pollution, of air, food and water sociocultural - econ level, lifestyle, family culture spiritual - beliefs and values
In caring for a patient who had a spinal cord injury 21 days ago and has a weak cough with loose-sounds secretions, the initial intervention by the nurse should be to
place the hands on the epigastric area and push upward when the patient coughs Since the cough effort is poor, the initial action should be to use assisted coughing techniques to improve the ability to mobilize secretions.
Value Clarification
process in which an individual develops his own values set; Can I accept this or live with this?
reporting an error
professional responsibility to report, document the incident (event report), report to nurse manager and physician, do NOT put in chart
goal of nursing cara
promote independent function support individual strengths prevent complications of illness secure a safe and comfortable environment promote return to health
parenteral nutrition
promotes tissue, wound, and bowel healing and is a highly concentrated/hypertonic solution
To help prevent hip flexion deformities associated with rheumatoid arthritis, the nurse should help the client assume which position in bed several times a day?
prone
Medical History
pts medical history is an account of events of a pts life concerning their emotional, mental, and physical health
When monitoring the effectiveness of treatment for a patient with left ventricular failure, the most important information for the nurse to obtain is...
pulmonary artery wedge pressure (PAWP) PAWP reflects left ventricular end diastolic pressure (or left ventricular preload). Because the patient in left ventricular failure will have a high PAWP, a decrease in this value will be the best indicator of patient improvement. The other values would also provide useful information, but the most definitive measurement of improvement is a drop in PAWP.
basic research?
pure/lab research, not always useful
trans fats/hydrogenated liquid fat
raises serum cholesterol, man made
What is sickle cell anemia and in what race is it found?
red blood cells form crescent shape, deliver less Oxygen; AA
Deep partial thickness burns in the emergent phase are
red, shiny, and have blisters
enteral nutrition/feedings
reduced risk of sepsis, maintains intestinal function; continuous vs. intermittent; water is not received unless specifically given
When patients have reduced renal function, they are at risk for medication toxicity.
renal
When assessing a patient admitted with N&V what would support the diagnosis of fluid vlm deficit?
restlessness This is an early sign that dehydration is left untreated, cerebral signs could progress to confusion and later coma.
List seven signs of respiratory distress in a pediatric client.
restlessness, tachycardia, tachypnea, diaphoresis, flaring nostrils, retractions, and grunting
Describe the purpose of bronchodilators.
reverse bronchospasm
What is inductive reasoning?
reverse process - building from specific ideas/actions to conclusions about general ideas
What r effects on family?
role change, stress, economic probs, decreased social interaction, anxiety, fear, avoidance, blame
hydrogen
saturation of fat is base on the amount of what
What local site conditions might affect how fast a medication is absorbed?
scarring, bruising, edema
Epiglottitis
severe, life-threatening infection of the epiglottis
common problems older adults may experience (spices)
sleep disorders, problems with eating or feeding/poor nutrition, incontinence (BM or bladder), confusion/cognition, evidence of falls, skin breakdown
dementia
slow decline in cognitive function, subtle onset, maintain function they have and safety, decreased abilities to perform ADLs
A 29-year-old woman is concerned about her personal risk factors for malignant melanoma. She is upset because her 49-year-old sister was recently diagnosed with the disease. After gathering information about the client's history of sun exposure, the nurse's best response would be to explain that:
some melanomas have a familial component and she should seek medical advice.
What is a risk factor?
something that increases a person's chances for illness and injury.
variable?
something that varies and diff values measured
Pressure ulcer in which are partial-thickness
stage 2
pressure ulcer involving extensive destruction of surrounding and supporting structures.
stage 4
What are the four types of drug orders?
standing orders, PRN orders, single order, stat order
preparation for surgery
starts before or shortly after admissiion
What should you document about an error?
state factual information, who was notified, follow-up actions
hypothesis?
statement of relationships b/w DV & IV that researcher expects to find
Moral Principals
statements about broad, general philosophic concepts; autonomy and justice
The grandmother of an Asian client with a diagnosis of Zika virus is distressed and tells the nurse, "My granddaughter must be served cold foods because she has a hot illness and we must get her body in balance." When the nurse consults the dietitian, what foods would be suggested for inclusion in the client's daily meals? Select all that apply.
steamed fish green vegetables citrus fruits
A cerclage procedure is performed on a client at 20 weeks' gestation who is diagnosed with cervical incompetence. When preparing the discharge teaching plan, the nurse should expect to instruct the client to monitor herself for which problem?
symptoms of infection
Managed Care
sys managing the delivery of health care
albumin
the main protein in plasma, binds water, cations, fatty acids, hormones, bilirubin and drugs
End of life care
the period of time during which an individual copes with declining health from a terminal illness or from the frailties associated with advanced age even if death is not clearly imminent.
While admitting a client to the alcohol treatment program, the nurse asks the client how long she has been drinking, how much she has been drinking, and when she had her last drink. The client replies that she has been drinking about a liter of vodka a day for the past week and her last drink was about an hour ago. This information helps the nurse to determine which factor?
the severity of withdrawal symptoms
empathy
the vicarious experience of another's situation
verbalize
to express in words (written or spoken)
discharge
to let go, as in discharging a client from the hospital
polypharmacy
too many meds at once, anyone over 5 meds decrease adherence to med schedule increase changes in adverse effects and bad interactions
TPN
total parenteral nutrition, NOT peripheral line but central, for long term
Personal Values
traced to culture, society, institutions, marriage, family and personality
What is a blended family?
traditional but bringing in children from other relationship
soft diet
transition from liquids to a regular diet,eases chewing/swallowing difficulties from dental surgery, weakness, chemo; high fiber, gas forming, fried, greasy foods may be restricted to ease digestion
communication
transmission of knowledge, information, or messages to another person
Heart valves ensure the forward flow of blood through the heart. True or False
true
What are the two types of medication distribution?
unit dose system, computer-controlled dispensing (pyxis)
An idiosyncratic drug reaction is an _____ response, listed as "_____."
unpredictable, rare
What position does the child with epiglottitis assume?
upright, sitting with chin out and tongue protruding ("tripod" position)
A nurse is caring for a client with severe burns and receiving fluid resuscitation. Which finding indicates that the client is responding to the fluid resuscitation?
urine output of 30 mL/h
A client at risk for lung cancer asks about the reason for having a computed tomography (CT) scan as part of the initial exam. What is the nurse's best response? "A CT scan is:
useful for distinguishing small differences in tissue density and detecting nodal involvement."
preoperative medications
usually ordered to be given shortly before the pt is transported to surgery or when pt is in a holding area. may include opioids,antiemetic,anticholinergic drug (decreade secretions).must be given at time they are ordered because they interact with the anesthetic agent,ask pt to void immediately before the preoperative medication is given,medication will cause drowsiness and dry mouth. raise the side rails, call bell within reach,instruct the pt to remain in bed.
dependent variable?
variable studied, determined as a result of study
unsaturated fats
vegetable fats, oil, nuts, avocado, and fish, liquid at room temp, lowers cholesterol
Tortuous veins on the legs
venous insufficiency
Cardiac output is the amount of blood ejected by the (atrium, ventricle) over (1 heart beat, 1 minute).
ventricle, 1 minute
Courtesy
voluntary expression or respect; going above and beyond
Unfortunately, although ADEs are sometimes immediately apparent, they often take ___ or ____ to develop.
weeks/months
green leafy vegetables
what should not be eaten with coumadin and vitamin K antagonist
5%
what signifies significant weight loss in 1 month
1-2%
what signifies significant weight loss in 1 week
7.5%
what signifies significant weight loss in 3 months
A synergistic drug interaction is what?
where one drug enhances the effect of another
An antagonistic drug interaction is what?
where one drug negates the effect of another
foods high in phosphorus
white, canned, tunafish, beef liver, fresh pork, low fat yogurt, whole milk, skim milk
In providing discharge teaching for the client after a modified radical mastectomy, the nurse should instruct the client to avoid:
working in her rose garden.
Cooperation
working with other ppl; improve efficiency
Code of Ethics
written statement describing ideal behavior of a particular group
Can some risk factors be modified?examples
yes, quitting smoking, lifestyle changes
Tachycardia that is a response of the SNS to the pain of ischemia is detrimental because not only does it increase oxygen demand, it also... 1. Decreases CO 2. Causes reflex hypotension 3. May lead to ventricular dysrhythmias 4. Impairs perfusion of the coronary arteries
4. Impairs perfusion of the coronary arteries
Which of the following best describes the pathophysiology of SLE? 1. Circulating immune complexes formed from IgG 2. T-cell reaction that leads to the destruction of the deep dermal layer 3. Immunologic dysfunction leading to chronic inflammation of cartilage and muscles 4. The production of a variety of antibodies directed against the compnents of the cell nucleus
4. The production of a variety of antibodies directed against the compnents of the cell nucleus
By what month is the auditory nerve function mature in the infant?
5
A client receiving chemotherapy for metastatic colon cancer is admitted to the hospital because of prolonged vomiting. Assessment findings include irregular pulse of 120 bpm, blood pressure 88/48 mm Hg, respiratory rate of 14 breaths/min, serum potassium of 2.9 mEq/L (2.9 mmol/L), and arterial blood gas—pH 7.46, PCO2 45 mm Hg (6.0 kPA), PO2 95 mm Hg (12.6 kPa), bicarbonate level 29 mEq/L (29 mmol/L). The nurse should implement which prescription first?
5% Dextrose in 0.45% normal saline with KCl 40 mEq/L at 125 mL/h
If a subcutaneous injection is to be given at a 45 degree angle, you should choos a needle that is ____ inches in length.
5/8
If a subcutaneous injection is to be given at a 45 degree angle, you should choose a needle that is ___ inches in length.
5/8
What month(s) are pokes at holes in a peg board; well-developed pincer grasp; crawls; uncovers toy at seeing it hidden milestones for a neonate?
8-9
. As the nurse admits a patient with severe heart failure to the hospital, the patient tells the nurse, "If my heart or breathing stop, I do not want to be resuscitated." Which action is best for the nurse to take? a. Ask if these wishes have been discussed with the health care provider. b. Place a "Do Not Resuscitate" (DNR) notation in the patient's care plan. c. Inform the patient that a notarized advance directive must be included in the record or resuscitation must be performed. d. Advise the patient to designate a person to make health care decisions when the patient is not able to make them independently.
A A health care provider's order should be written describing the actions that the nurses should take if the patient requires CPR, but the primary right to decide belongs to the patient or family. The nurse should document the patient's request but does not have the authority to place the DNR order in the care plan. A notarized advance directive is not needed to establish the patient's wishes. The patient may need a durable power of attorney for health care (or the equivalent), but this does not address the patient's current concern with possible resuscitation.
The spouse of a patient with terminal lung cancer visits daily and cheerfully talks with the patient about vacation plans for the next year. When the nurse asks about any concerns, the spouse says, "I'm busy at work, but otherwise things are fine." An appropriate nursing diagnosis is a. ineffective coping related to lack of grieving. b. anxiety related to complicated grieving process. c. caregiver role strain related to feeling overwhelmed. d. hopelessness related to knowledge deficit about cancer.
A The wife's behavior and statements indicate the absence of anticipatory grieving, which may lead to impaired adjustment as the patient progresses toward death.
In assessing the emergency patient's health history during the secondary survey, the use a which of the following mnemonics can help guide the interview?
A - allergies M - medication history P - past history / pregnant L - last meal E - events os the illness or injury
A charge nurse is developing the client care assignments for the shift. Which client is most appropriately assigned to a licensed practical nurse (LPN)?
A client who experienced a cerebral vascular accident and has a do-not-resuscitate (DNR)
The team on an antepartum unit consists of two registered nurses (RN), one licensed vocational nurse (LVN), and one nursing assistant. Which one of the following conditions would be appropriate to assign the LVN?
A client with gestational hypertension
A patient has been newly diagnosed with Restrictive Cardiomyopathy. The patient is very anxious and asks you what Restrictive Cardiomyopathy is exactly. Your best response would be: A disease where the heart muscle becomes rigid and less elastic, meaning the heart can't properly expand and fill with blood between heart beats. A disease where the heart muscle becomes abnormally thick. This thickened heart muscle can make it harder for the heart to pump blood. A condition where inflammation of the pericardial sac that is characterized by fibrin deposition and thickening of the pericardium occurs.
A disease where the heart muscle becomes rigid and less elastic, meaning the heart can't properly expand and fill with blood between heart beats.
Medicare
A federally funded healthcare system designed to provide health coverage for persons who are older than 65 years, disabled, or diagnosed with end renal disease
What is a conceptual framework or model?
A group of concepts that follows understandable pattern
The warning signs of a stroke include all of the following EXCEPT.... A. Sudden respiratory distress B. Sudden weakness C. Sudden severe headache D. Loss of vision
A. Sudden respiratory distress
Which senior citizen politician Aschinger abuses volunteers of August to advance the interests of the older adults
AARP American Association of Retired Persons
What is the acronym for all nursing process?
ADPIE (assess, diagnose, plan, implement and evaluate)
When caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient which of the following?
About the purpose of outpatient Holter monitoring Holter monitoring is used to determine whether the patient is experiencing dysrhythmias such as ventricular tachycardia during normal daily activities. SCD is likely to recur.
A 46 year old is diagnosed with thromboangiitis obliterans (Buerger's disease). When planning expected outcomes for the patient, which outcome has the highest priority?
Absolute cessation of nicotine use is needed to reduce the risk for amputation in patients with Buerger's disease.
_____ is the passage of medication molecules into the blood from the site of administration.
Absorption
Seizures may be precipitated in which of the following disturbances or imbalances? Acidosis Electrolyte imbalances Alkalosis Dehydration
Acidosis - not alkalosis, along with electrolyte imbalances, hypoxia, alcohol and barbiturate withdrawal, dehydration, and water intoxication can all precipitate seizure activity.
fat soluble vitamins
(A, D, E, K) absorbed with fat into lymphatic circulation, excess stored in liver/adipose tissue, are received from dietary intake except for D
Signs and symptoms of otitis media
- fever, pain, infant may pull at ear - enlarged lymph nodes - discharge from ear (if drum is ruptured) - upper respiratory symptoms - vomiting, diarrhea
Signs and symptoms of bronchiolitis
- history of upper respiratory symptoms - irritable, distressed infant - paroxysmal coughing - poor eating - nasal congestion - nasal flaring - prolonged expiratory phase of respiration - wheezing; rales can be ausculated - deteriorating condition that is often indicated by shallow, rapid respirations
What usually causes bronchiolitis and how is it transmitted?
Caused by respiratory syncytial virus (RSV) and is found to be readily transmitted by close contact with hospital personnel, families and other children
Disease-specific diet: Diabetic
The patient should eat a balanced diet and avoid sugar in excess
Disease-specific diet: Renal
The patient should eat foods with low amounts of phosphorus, sodium, and potassium
High fiber diet:
This diet consists of whole grains, raw and dried fruits
Full liquid diet:
This diet includes clear liquid diet, dairy, and pureed vegetables
Soft/low residue diet:
This is a low-fiber diet (easy to digest)
Objective data definition
This is data that is measurable such as vitals, appearance of skin, a person's affect, skin turgor, lung sounds, bowel sounds, etc
Subjective data definition
This is data that the patient is reporting to you. Pain IS subjective because it cannot be measured
Bronchiolitis
a viral infection of the brochioles characterized by thick secretions
water soluble vitamins
absorbed directly through the intestinal wall and are not stored, C and B complex
saturated fats
animal fats (butter, cheese, lard, etc), solid at room temp, raise cholesterol
Why is it very important to treat tonsillitis if related to streptococcus?
because of the risk of developing glomerulonephritis or rheumatic heart disease
protein
building blocks of body tissue in maintenance, growth, and repair; 10-20% of daily caloric needs; physiologically and financially expensive
What is the most common postoperative complication following a tonsillectomy? Describe the signs and symptoms of the condition.
hemorrhage; frequent swallowing, vomiting fresh blood, and clearing throat
basal metabolic rate (BMR)
increased with growth, fever, infection, stress
vitamin B
kick starts your metabolism, gives you energy have to help it to make red blood cells, found in dark leafy vegetables
signs or manifestations of low albumin
liver disease, burns, malnutrition, often presents with edema and third spacing
Describe the care of a child in a mist tent.
monitor child's temperature, keep tent edges tucked in, keep clothing dry, assess child's respiratory status, look at child inside tent
vitamins
organic compounds needed in small amounts, fresh foods have higher amounts, essential nutrients
Normal pulse & respiratory rate for a child 3 t0 5 years (preschooler)
pulse 80 - 120 respiratory 20 - 25
Normal pulse & respiratory rate for a child 1 to 3 years (toddler)
pulse 80 - 130 respiratory 20 - 30
vitamin E
skin, hair, and nails burn patients, heart patients (heart disease), age related eye damage, cancer; found in green leafy vegetables and nuts especially sunflower seeds
foods with low sodium
whole wheat bread, white bread, whole milk, chicken (light meat), plain baked potato, fresh vegetables EXCEPT for tomatos
