med surg random

Ketorolac (Toradol)

*class*: nonsteroidal anti-inflammatory agents, nonopioid analgesics *Indication* pain *Action*: Pain relief due to prostaglandin inhibition *Nursing Considerations*: -may cause GI bleeding, Stevens-Johnson Syndrome, anaphylaxis, drowsiness - should not exceed 5 days of therapy - bleeding risk increased with garlic, ginger, and ginkgo - may decrease effectiveness of hypertensive medications and diuretics

owens vid 4 urien station https://www.youtube.com/watch?v=knXtfggsPjU

- sterility to avoid infction saline soluitonCBI - due to enlarged prostate of males and/or transurethral resection of prostate (terp) or other surgeries - post op has 3way foley (stay away from bulb hub!!) and 2 giant sterile water for irrigation w one clamped and other open (check to make sure bags on hand on unit or room so do not run dry bc BAD NURSING PRACTICE and can be painful and clot risk for pt), assess color through tubing and doc amount etc (if continuously bright red= reg flag so keep irrigation is wide open at bottom and at one bag, if clot or obstuction suspected call angry doc), expect to see fewer clot and light pink tinged blood as time passes meaning you can slow rate w lower clamp and open PRN for clots w movement, doc amount of bags/ fluid intake for irrigation and count drainage ( CNA can empty and doc amount but RN assesses color and clots) to calculate total I/O for day DOC UNDER IRRIGANT NOT INTAKE (((ex: 10000irrigrant in and 11000 total in bag= doc 1000 net

Your hydromorphone vial is 5mg/ml. How many ml will you draw up to administer 1mg?* 1) 0.4ml 2) 1ml 3) 0.2ml 4) 0.3ml

0.2ml

The injection site is located on the abdomen; at least Blank 1 Question 5 1 inch3 inches2 inches4 inches distance from the umbilicus?

2 inches away in lovehandles, pinched skin 90 degrees SC. alternating sides each time

owens vid 2 urine https://www.youtube.com/watch?v=5BnC3gjvCnw

24 hour collections - without foley void; discard first mornings void, doc times, lab chooses container, get pt to tell each void time, no flushing or leaving out. put in contain in basin of ice. can send to lab for testing if no interruptions - indwelling cath; new drainage bag in basin on ice w container. maintain ice for 24 hrs.

bladder irrigation https://www.youtube.com/watch?v=9wGZ7YjuaFA

3 channels; infusion of sterile solution to prevent clot, drainage of fluid to bag (middle hub for portable bag; clean w alc swab prior to changing), inflate balloon to hold cath base rate on color; darker= faster, lighter=slower bc bleeding less drainage should equal or slightly more than infusion intake (if not assess kinks or suspect clot that might need manual irrigation)

How fast will you infuse the ketorolac?* 1) 60mg per minute 2) 30 seconds per mg 3) 1-2 minutes is preferred 4) Each 15mg must be equally distributed over 5 minutes

3) 1-2 minutes is preferred

What is the rate of administration for hydromorphone IV push?* 1) A single dose over a maximum of 1 minute. 2) A single dose over a maximum of 30 seconds. 3) A single dose over a minimum of 2 - 3 minutes. 4) A single dose slammed because the client requested it.

3) A single dose over a minimum of 2 - 3 minutes.

What are two problems that might occur with a central venous access?

Catheter related bloodstream infections (CR-BSl's) are a complication that is why it is so important to make sure the dressing around the site is occlusive. If it isn't the dressing needs to be changed. Another complication is a possible pneumothorax upon insertion.

A nurse is caring for a client who has a chronic illness and has extreme thirst and urination. The nurse should identify these as manifestations of which of the following disorders? Addison's disease Central diabetes insipidus Polycystic ovarian syndrome Hypoparathyroidism

Central diabetes insipidus MY ANSWER The nurse should identify that manifestations of central diabetes insipidus include polydipsia (extreme thirst), and polyuria (increased urination).

1. What are two reasons that a physician might order for a patient to have a central venous access?

Central venous catheters are most commonly used for emergent or trauma situations, critical care, surgery or when long term IV therapy is indicated.

A nurse is caring for a client who has fluid volume deficit related to hemorrhage. The nurse should identify that the client is at increased risk for which of the following conditions? Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) Increased systolic pressure Cerebral hypoperfusion Metabolic alkalosis

Cerebral hypoperfusion Fluid volume deficit can result in decreased blood flow and oxygen and places the client at risk for decreased perfusion to the brain and other vital organs.

A nurse is completing a preassessment for a surgical client. The nurse asks the client whether they or anyone in their family has a history of complications from anesthesia. Which of the following assessment findings is most concerning? Malignant hyperthermia Venous thromboembolism (VTE) Frequent falls Sleep apnea

Malignant hyperthermia Because malignant hyperthermia is genetic and can be triggered by anesthesia, it would be appropriate for the nurse to ask whether the client or anyone in their family has experienced complications from anesthesia.

List two potential problems/complications that the nurse would monitor for in a patient with a CBI?

Monitor the irrigation for a bright blood-red output or large clots. The doctor should be notified of the frank blood output, and the large clots if they continue despite opening up the irrigant. Make sure to monitor the catheter to be sure it is patent at all times.

vascular access line ID vid https://www.youtube.com/watch?v=VohuW5CFXhQ

short PIV - yellow 24 kids - blue 22 can run blood thru - pink 20 - green 18 - black 16 med PIV: -paralllel in vien long PIV aka midlines - PICC - double single or triple lumen -red lumen twice the size of other lumen so blood draws in that one PORTS - access w hubert needle to touch access under skin MENODIALYSIS (HD) lines - for nephrologist -pigtail for IV access and blood draws

owens vid 3 urine station https://www.youtube.com/watch?v=LBbUxhH3_4s

sterile specimen -indwelling cath; clamp, clean gloves, cleanse port w alc swab, side port/specimen collection port connect sterile laurel lock 10ml syringe (NOT TO BULB HUB), pull back to collect, unclamp, empty wihout touching cup and ready w lid faced up, label bag and send lab. ( new inserted cath can be collected from bag) straining urine (white funnel w filter) - instruct pt to inform when voiding, measure in grad cylinder, keep stones or findings in a cup for testing

Is Ketorolac compatible with D5NS?*

sure is

CVAD blood obtain

syringe to port then syringe to tube flush line push pause push pause

CVAD dressing change procedure

terile tech w mask clean chlohexadine label and doc

A patient with an epidural catheter precludes the patient from receiving Lovenox. Question 2Select one:TrueFalse

true

The alcohol should be dry on the skin prior to injecting the Lovenox. Question 4Select one:TrueFalse

true

A nurse is encouraging a client who has a chronic illness to exercise. Which of the following statements should the nurse make? "Exercising at least 30 minutes per day can help decrease your risk for developing metabolic syndrome." "Exercising 3 times per week can help decrease your risk for developing chronic obstructive pulmonary disease." "Exercising several times each day can help decrease your risk for developing asthma." "Exercising 60 minutes every other day can help decrease your risk fo

"Exercising at least 30 minutes per day can help decrease your risk for developing metabolic syndrome." The nurse should teach the client that exercise can improve the health of clients who have metabolic syndrome, high blood pressure, type 2 diabetes mellitus, depression, anxiety, many types of cancer, and arthritis.

A nurse is teaching a nursing student about hyperventilation and acid-base balance. Which of the following statements should the nurse include in the teaching? "Hyperventilation causes a buildup of bicarbonate, resulting in an acidotic state." "Hyperventilation causes an elimination of carbon dioxide that results in an alkalotic state." "Hyperventilation causes a buildup in carbon dioxide, resulting in an acidotic state." "Hyperventilation causes an elimination of bicarbonate that results in an

"Hyperventilation causes an elimination of carbon dioxide that results in an alkalotic state." MY ANSWER Hyperventilation eliminates excess carbon dioxide from the body, which decreases the amount of acid being produced, resulting in an alkalotic state.

A nurse is teaching a client who has alcohol use disorder about ways to stop drinking alcohol. Which of the following statements by the client indicates a need for further teaching? "I think I will volunteer at the local soup kitchen." "I can go with my friends to the bar and order a soda." "I am going to stop drinking alcohol for the month of January." "I don't think I drink a lot, but I will keep a diary of my drinking and see what I find.

"I can go with my friends to the bar and order a soda."

A nurse is providing discharge education to a client who has hypokalemia. Which statement by the client indicates to the nurse the client understands the teaching? "I will continue to take my laxatives as needed for my constipation." "I will go to my follow-up appointments." "I will eat foods, such as bananas, to maintain my potassium level." "I will report a new episode of muscle weakness to my provider."

"I will continue to take my laxatives as needed for my constipation." Chronic use of laxatives may cause hypokalemia; therefore, this statement by the client indicates the client requires additional teaching.

A nurse is reinforcing teaching to a student about fluid volume deficit related to vomiting and diarrhea. Which of the following statements should the nurse include in the teaching about the body's response to fluid volume deficit? "The body responds to fluid volume deficit by releasing antidiuretic hormone." "When fluid volume deficit is present, the body will inhibit the thirst center." "Vagal nerve inhibition occurs when the body has low fluid levels." "The body will block the release of vaso

"The body responds to fluid volume deficit by releasing antidiuretic hormone." MY ANSWER The nurse should teach the student that release of antidiuretic hormone (ADH) will stimulate the kidneys to retain water, thereby increasing vascular water volume.

Diltiazem (Cardizem)

*class*: Ca Channel Blocker (Bezothiazepine), antianginals, antiarrhythmics, antihypertensive *Indication*: hypertension, angina, SVT, a-fib, aflutter *Action*: inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodilatation and decreased blood pressure. *Nursing Considerations*: - contraindicated in 2nd and 3rd AV block - may cause arrhythmias, CHF, bradycardia, peripheral edema, gingival hyperplasia - increases digoxin levels - don't drink *grapefruit juice* - assess for signs of CHF - monitor EKG continuously - tell patient to change positions slowly - monitor serum potassium - instruct pt on how to take blood pressure

Ondansetron (Zofran)

Antiemetic. Side effects: headache, EPSs. Nursing interventions: administer tablets 30 min prior to chemotherapy and 1-2 hr before radiation.

Nasogastric Feeding Tube Placement Verification

Are We Using Best Practice? An estimated 1.2 million nasogastric (NG) or orogastric (OG) tubes are placed annually in the United States.1 A one-day prevalence study of NG/OG post pyloric (PP) tubes documented 24 % of the infants and children in those 63 hospitals had one of those tubes.2 A conservative estimate of 1-3% of all NG/OG tubes placed are misplaced with the worst-case scenarios involving lung damage or death.3 Placement of these tubes is primarily done at the bedside using blind technique meaning the nurse cannot discern the path or final location of the tube tip during the procedure. Placement verification methods vary widely from use of evidence-based methods, such as a radiograph or pH measurement to non-evidence-based methods such as auscultation or aspiration of gastric contents for visual inspection.2,4 Best practice has been defined by two groups—one focusing on pediatric patients and one that is international in scope.4,5 The New Opportunities for Verification of

A nurse is preparing to administer intravenous gamma globulin therapy to a client. The client asks what the purpose of this medication is. The nurse should explain that the medication provides which of the following types of immunity? Natural passive immunity Artificial passive immunity Natural active immunity Artificial active immunity

Artificial passive immunity Artificial passive immunity occurs when a client is injected with antibodies from another person who has immunity to a disease.

A nurse is caring for a client who has fluid volume deficit (FVD). Which of the following manifestations may be consistent with this diagnosis? (Select all that apply.) Blood pressure 92/66 mm Hg Heart rate 128/min Lower extremity edema Urine output 100 mL in 4 hr Jugular vein distention

Blood pressure 92/66 mm Hg is correct. A client whose systolic blood pressure is less than 100mm Hg may indicate the presence of fluid volume deficit (FVD). Heart rate 128/min is correct. A client who has heart rate of 128/min may indicate the presence of fluid volume deficit. Lower extremity edema is incorrect. Lower extremity edema is a manifestation of fluid overload; however, BP 92/66, heart rate 128/min, urine output 100 mL in 4 hours may be manifestations consistent with FVD. Urine output 100 mL in 4 hr is correct. A decrease in urine output may indicate the presence of fluid volume deficit. Jugular vein distention is incorrect. Jugular vein distention is a manifestation of fluid volume excess, not fluid volume deficit.

A nurse is teaching a client how to perform deep breathing exercises postoperatively. Which of the following instructions should the nurse include in her demonstration? Breathe out through your nose for eight seconds. Hold your breath for more than ten seconds or for as long as you can. Breathe in through your nose for four seconds. Relax at the end for five seconds, then repeat five more times.

Breathe in through your nose for four seconds. MY ANSWER After sitting up in a chair or leaning back in the bed, you breathe in through your nose for four seconds.

A nurse is caring for 4 clients on a medical-surgical unit. Which of the following client findings increases the risk for hypercalcemia? (Select all that apply.) Clients who have prolonged immobilization Clients who have bone cancer Clients who are postoperative following a thyroidectomy Clients who have hyperparathyroidism Clients who have vitamin D deficiency

Clients who have prolonged immobilization is correct. Prolonged immobilization can result in hypercalcemia related to inhibition of parathyroid hormone release. Clients who have bone cancer is correct. Clients who have malignancies such as bone cancer may develop hypercalcemia due to bone breakdown. Clients who are postoperative following a thyroidectomy is incorrect. Clients who are postoperative following a thyroidectomy are at increased risk for hypocalcemia, not hypercalcemia, due to removal of the parathyroid gland. Clients who have hyperparathyroidism is correct. Clients who have hyperparathyroidism are at increased risk for hypercalcemia. Clients who have vitamin D deficiency is incorrect. Clients who have vitamin D deficiency are at increased risk for hypocalcemia, not hypercalcemia, due to inability of gastrointestinal tract to absorb calcium.

A nurse is obtaining a past medical history from a client who is chronically ill and has an immune disorder. The nurse should recognize that which of the following past medical conditions is likely linked to the client's unhealthy gut microbiome? Bell's palsy Colorectal cancer Diabetes mellitus Kidney stones

Colorectal cancer MY ANSWER Immunity activity increases in response to the gastrointestinal system taking in food to the gut microbiome.

A nurse is caring for a client who has liver cirrhosis. Which of the following should the nurse understand is causing the client's ascites? Decreased fluid volume Decreased blood flow to the kidneys Decreased serum sodium Decreased vascular resistance

Decreased blood flow to the kidneys The cirrhotic liver causes pressure on the blood vessels leading to increased vascular resistance and decreased blood flow to the kidneys. This decreased blood flow to the kidneys triggers the kidneys to retain water and sodium chloride, and results in ascites.

A nurse is caring for several clients on a medical-surgical unit. Which of the following client diagnoses places the client at risk for fluid volume excess (FVE)? (Select all that apply.) Diabetic ketoacidosis Heart failure Renal failure Diabetes insipidus End-stage liver disease Preeclampsia

Diabetic ketoacidosis is incorrect. Clients who have diabetic ketoacidosis are associated with fluid volume deficit (FVD) due to osmotic diuresis; however, clients with heart failure, renal failure, end stage liver disease, and preeclampsia are at risk for FVE. Heart failure is correct. Clients who have heart failure, end stage liver disease, renal failure, and preeclampsia are at risk for FVE. Renal failure is correct. Clients who have renal failure, heart failure, end stage liver disease, renal failure, and preeclampsia are at risk for FVE. Diabetes insipidus is incorrect. Clients who have diabetes insipidus are at risk for fluid volume deficit (FVD) due to excessive urination related to deficient antidiuretic hormone (ADH); however, clients with heart failure, renal failure end stage liver disease, and preeclampsia are at risk for FVE. End-stage liver disease is correct. Clients who have renal failure, heart failure, end-stage liver disease, and preeclampsia are at risk for FVE. Pre

A transplant nurse is providing care related to a client's kidney transplant. Which priority nursing action would be most likely to take place during the preoperative phase? Monitoring the client for signs of organ rejection Monitoring the client for signs of health care-associated infection Educating the client's caregivers about the transplant process Administering fluids and surgical wound care

Educating the client's caregivers about the transplant process MY ANSWER While educating the client and their caregivers about the transplant process is an ongoing process that will likely continue across multiple phases, it begins in the preoperative phase.

A nurse is providing education to a group of nursing students. Which of the following conditions should the nurse explain causes fluid to move from the interstitial compartment to the vascular compartment? Elevated serum sodium Decreased serum calcium Excess fluid volume Hypotension

Elevated serum sodium MY ANSWER Elevated serum sodium exerts osmotic pressure, which pulls fluid from the interstitial compartment into the vascular compartment. Sodium is the major cation found in the extracellular fluid. To achieve homeostasis, water will move from an area of low osmolality through a permeable membrane to an area of high osmolality.

A nurse is discussing pancreatic cancer with a newly licensed nurse. Which of the following hormones should the nurse identify as being the most likely to have altered secretion? Oxytocin Luteinizing hormone Glucagon Adrenocorticotrophic hormone

Glucagon MY ANSWER The pancreas secretes insulin and glucagon, so pancreatic cancer will disrupt the secretion of these hormones.

A nurse is preparing a client scheduled for right knee arthroplasty surgery. Which of the following interventions should be the priority for the nurse to address to ensure client safety? Provide client education regarding the surgical procedure. Have the surgeon mark the surgical site. Ensure the client showered the night before. Initiate the prescribed antibiotic upon admission to the hospital.

Have the surgeon mark the surgical site. When using the greatest risk priority framework, the nurse should identify that the greatest risk relates to the completion of a surgical procedure on the wrong site. A National Patient Safety Goal is to prevent mistakes in surgery, which includes preventing surgery on the wrong site. To help prevent this, the surgical site is marked preoperatively by the surgeon.

A nurse is caring for a client who has a recent diagnosis of type 2 diabetes mellitus. Which of the following topics should the nurse teach the client first? Hand hygiene Sexually transmitted infections Injury prevention Heart healthy diet

Heart healthy diet The nurse's priority should be to teach the client about a heart healthy diet. According to the American Heart Association, cardiovascular disease is the leading cause of death in clients who have type 2 diabetes mellitus.

A nurse is assessing a client who has polycystic ovarian syndrome. Which of the following findings should the nurse expect? Polyuria Exophthalmos Polydipsia Hirsutism

Hirsutism MY ANSWER The nurse should expect to see hirsutism, which is thick, dark hair on the face, neck, chest, thighs, lower back, or buttocks, in a client who has polycystic ovarian syndrome.

A nurse is planning care for a client who has sickle cell disease. Which of the following potential complications should the nurse expect?

HirsutismHirsutism is caused by an endocrine disorder. PsoriasisPsoriasis is a skin condition, unrelated to sickle cell disease. AsbestosisAsbestosis is a respiratory illness. Vision lossMY ANSWERWhen red blood cells form in a sickle shape, instead of a round shape, it can cause significant issues with red blood cells transiting the cardiovascular system, clogging the lungs, impairing vision, and creating pain for the client.

A nurse is caring for a client who reports recent unintended weight loss, feeling lethargic, and increased thirst. The client has frequent urination, which interferes with their daily activities. Which of the following alterations in endocrine function should the nurse suspect? Hypothyroidism Hypoglycemia Hyperthyroidism Hyperglycemia

Hyperglycemia Common manifestations of hyperglycemia include increased thirst, increased urine output, unintentional weight loss, and fatigue.

What would the nurse do if they were caring for a client receiving TPN and the pharmacy had failed to have another bag available?

If TPN is temporarily unavailable, star D5W or D10W according to your facility policy/protocol. If TPN is not on time or "behind", do not try to catch up by increasing the rate.

A nurse is planning discharge teaching for a client who has been treated for hypocalcemia. Which of the following symptoms should the nurse instruct the client to report to the provider? (Select all that apply.) Irregular heartbeat Anxiety Weakness Constipation Abdominal distention Numbness of fingertips

Irregular heartbeat is correct. Irregular heartbeat is a manifestation of hypocalcemia; therefore, the nurse should teach the client to report palpitations. Anxiety is correct. Anxiety is a manifestation of hypocalcemia; therefore, the nurse should teach the client to report anxiety. Weakness is incorrect. Weakness is a manifestation of hypocalcemia; therefore, the nurse should teach the client to report diarrhea. Constipation is incorrect. Constipation is a manifestation of hypercalcemia; however, irregular heartbeat, anxiety, diarrhea, and numbness of fingertips are manifestations of hypocalcemia. Abdominal distention is incorrect. Abdominal distention is a manifestation of hypercalcemia; however, irregular heartbeat, anxiety, diarrhea, and numbness of fingertips are manifestations of hypocalcemia. Numbness of fingertips is correct. Numbness of fingertips is a manifestation of hypocalcemia; therefore, the nurse should teach the client to report numbness of fingertips.

What are two major complications of these types of nutritional therapies?

Less common but more serious complications are dislodgement or misplacement. A complication of enteral nutrition is refeeding syndrome when nutritional therapy is started on a patient in a starvation state and increases the risk for fluid and electrolyte imbalances.

A nurse is caring for a client who has hyponatremia. Which of the following manifestations of hyponatremia should the nurse identify as the priority for immediate intervention? Weakness Anorexia Lethargy Hyperactive reflexes

Lethargy Lethargy is a manifestation of alteration in neurologic status, which is the most serious manifestation of hyponatremia and requires immediate intervention.

A nurse is teaching a client who has hypercalcemia about medications that can increase calcium. Which of the following medications should the nurse include in the teaching? Montelukast Amlodipine Rivaroxaban Lithium

Lithium Tamoxifen, theophylline, thiazides, vitamin D, lithium, vitamin A are examples of medications that will increase calcium.

A nurse is caring for a client who has hypokalemia. Which of the following manifestations should the nurse expect? (Select all that apply.) Muscle cramps Flattening of T waves on a cardiac monitor Vomiting Hyperactive bowel sounds Diarrhea

Muscle craps is correct. The nurse should recognize muscle cramps, vomiting, and the flattening of T waves on a cardiac monitor are manifestations of hyperkalemia. Flattening of T waves on a cardiac monitor is correct. The nurse should recognize muscle cramps, vomiting, and the flattening of T waves on cardiac monitor are manifestations of hypokalemia. Vomiting is correct. The nurse should recognize muscle cramps, vomiting, and the flattening of T waves on cardiac monitor are manifestations of hypokalemia. Hyperactive bowel sounds is incorrect. The nurse should recognize hyperactive bowel sounds is a manifestation of hyperkalemia. Diarrhea is incorrect. The nurse should recognize that diarrhea is a manifestation of hyperkalemia.

A nurse is planning discharge education about diuretic therapy for a client who has heart failure. Which of the following should the nurse instruct the client to report to the provider? Palpitations, fainting, decreased sensation in the feet Confusion, muscle twitching, headache Muscle weakness, irritability, constipation Aching joints, abdominal distention, anorexia

Muscle weakness, irritability, constipation Diuretic therapy, other than potassium-sparing diuretics, can lead to hypokalemia. The client should report muscle weakness, fluttery heart, and constipation to the provider as these are all signs of hypokalemia.

If the ondansetron is compatible with heparin and NS, how fast will you administer the ondansetron?* 1) 2-5 minutes is preferred 2) 1 minute is preferred 3) 4mg over 15 seconds 4) Each 1mg over 2 minutes

Not many clinicians are aware that ondansetron 4 to 8 mg iv should be administered over 2 to 5 min[6] and certainly not as a bolus or in less than 30 s.

A nurse is teaching a client who has a chronic illness about the DASH diet. The nurse should recommend which of the following cooking oils? Coconut oil Palm oil Olive oil Butter

Olive oil MY ANSWER Vegetable oils are preferred on the DASH diet.

A nurse teaches a surgical client about breathing and relaxation exercises during the preoperative phase. Which of the following postoperative complications would breathing and relaxation exercises help? Pain Malnutrition Sleep apnea Frequent falls

Pain MY ANSWER Pain management includes breathing and relaxation methods in addition to medication. Because pain is a common and often immediate complication of surgery, pain management should begin during the preoperative phase.

What is the difference between parenteral and enteral nutrition?

Parenteral nutrition is IV therapy and uses PICC lines. Enteral nutrition is a system that uses tubes such as a PEG tubes.

Explain the difference between a port-a-cath (PAC), peripherally inserted central catheter (PICC) and central line. Be thorough; explain location and possible length of time these accesses can be utilized.

Placing the Port is a small surgical procedure and takes less than an hour. It is typically performed by an interventional radiologist under local anesthesia with conscious sedation. The procedure involves a small incision on the chest wall for the port pocket and 5mm incision in lower neck to enter the vein. The port is placed completely under the skin. One end of the catheter is inserted into the vein while the other end is connected to the portal, under the skin. The tip of the catheter lies in the superior vena cava, just above the heart. The port may remain as long as the physician deems necessary. For a PICC Line-Local ahesthetic is used to numb the area where the PICC will be placed. The PICC will be inserted into a vein just above the bend of your elbow and guided into a large vein in your arm or chest. Most patients feel little or no discomfort during this procedure. A PICC line may stay in anywhere from 5 days to months at a time. It is important for the dressing to be chang

A nurse is teaching a client who has cancer about enhancing their immune system. Which of the following recommendations should the nurse make? Practice coping skills Decrease exercise routine Increase the use of supplements in the diet Take vitamin C in large dosesati

Practice coping skills

A nurse advocates for bicycle paths in the community to promote safe exercise for clients and prevent chronic illness. This is an example of which of the following kinds of prevention? Primordial Primary Secondary Tertiary

Primordial MY ANSWER Primordial prevention reduces risk of illness for the entire population, such as advocating for bicycle paths in the community to promote exercise.

A nurse is caring for a client who has hypercalcemia related to hyperparathyroidism. Which of the following should the nurse identify as potential complications of hypercalcemia? (Select all that apply.) Renal calculi Seizures Tetany Bone pain Decreased blood clotting First-degree atrioventricular block

Renal calculi is correct. Hypercalcemia can result in complications such as renal calculi, first-degree atrioventricular block, and bone pain. Seizures is incorrect. Seizures are a complication of hypocalcemia, rather than hypercalcemia; however, hypercalcemia can result in complications such as renal calculi, first-degree atrioventricular block, and bone pain. Tetany is incorrect. The nurse should identify that hypocalcemia, rather than hypercalcemia, causes tetany; however, hypercalcemia can result in complications such as renal calculi, first-degree atrioventricular block, and bone pain. Bone pain is correct. The nurse should identify bone pain as a complication of hypercalcemia. Decreased blood clotting is incorrect. Decreased blood clotting is not a complication of hypercalcemia; however, hypercalcemia can result in complications such as renal calculi, first-degree atrioventricular block, and bone pain. First-degree atrioventricular block is correct. Hypercalcemia can result in co

A nurse administrator of a health care facility wants to initiate a campaign to promote healthy eating. Which of the following actions should the nurse promote as part of the campaign? Encourage staff to maintain a body mass index between 18.5 and 24.9. Organize a 5K race for the staff and their families. Request that only healthy food options be served in the cafeteria, vending machines, and restaurants on the facility campus. Set a goal of total pounds for staff to lose, and create a poster in

Request that only healthy food options be served in the cafeteria, vending machines, and restaurants on the facility campus.

A nurse is providing care for a client who has a new diagnosis of anxiety. The client's heart rate is 100/min, respiratory rate is 34/min, and the client reports numbness and tingling of the hands. Which of the following acid-base imbalances should the nurse suspect? Respiratory acidosis Metabolic alkalosis Metabolic acidosis Respiratory alkalosis

Respiratory alkalosis MY ANSWER The client is manifesting anxiety, rapid heart rate, rapid respiratory rate, and numbness and tingling of the hands, which are all manifestations of respiratory alkalosis.

A nurse is caring for a client who has hypernatremia and is receiving a rapid infusion of IV fluids. The nurse should monitor for which of the following manifiestations? Hypoactive reflexes Hypotension Decreased urine output Seizures

Seizures MY ANSWER The nurse should monitor for seizures in this client. Administering IV fluids too rapidly to correct hypernatremia can result in cerebral edema, which leads to seizures.

A nurse is educating a group of nursing students about laboratory values that reflect fluid volume excess. Which of the following laboratory values should the nurse include in the teaching? Serum osmolality 320 mOsm/kg Serum sodium 128 mEq/L Hgb 20 g/dL Hct 55%

Serum sodium 128 mEq/L The reference range for serum sodium is 136 to 145 mEq/L. Serum sodium 128 mEq/L deflects fluid volume excess due to the excess fluid diluting the sodium particles in the serum resulting in a decreased serum sodium.

A nurse is teaching a client who has chronic obstructive pulmonary disease (COPD) about interventions for shortness of breath. Which of the following should the nurse include in the teaching? Sit in a tripod position Lay in a prone position Use panting breaths with frequent pauses Use caution when taking sedatives

Sit in a tripod position MY ANSWER The nurse should include in the teaching for the client to assume a tripod position when experiencing shortness of breath.

A nurse transfers a client to the PACU postoperatively. During the hand-off report, the nurse states that, "Dr. Jones performed a bowel resection." Which of the following sections of the SBAR communication tool does this statement address? Assessment Situation Recommendation Background

Situation

thrombosis s/s

Slowed or stopped infusion. Inability to flush catheter. Aching or burning at the infusion site. Skin warm and red. Swelling and edema of extremity. Throbbing pain in the limb.

A school nurse is developing a poster to raise awareness about social justice, equity, and diversity and inclusion to reduce stigma toward students who have chronic illnesses. Which of the following domains of the social determinants of health does this address? Education access and quality Health care access and quality Social and community context Neighborhoods and built environments

Social and community context MY ANSWER Raising awareness about discrimination is part of the domain of social and community context because it involves relationships between people.

For the patient experiencing kidney stones, what is the rationale for straining the urine?

Strain the urine to monitor the passage of stone fragments. They may be tested to determine the cause of the stones (ie: uric acid or calcium oxalate).

A nurse is assisting a client who has a chronic illness obtain health insurance. Which of the following laws has improved the access to care for people who have disabilities? Social Security Fairness Act Title IX Health Insurance Portability and Accountability Act of 1996 The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act, passed in 2010, improves the access to care for people who have disabilities.

A nurse is teaching a client who has hyponatremia. Which of the following statements should the nurse include in the teaching? "You will need to restrict fluids to prevent hyponatremia from recurring." "You will need to have a brain natriuretic peptide drawn every 3 months." "You will need to be on a 2 grams sodium diet." "You will need to wear a Holter monitor for 3 days after discharge."

You will need to restrict fluids to prevent hyponatremia from recurring." The nurse should include this in the education. Clients may need to restrict fluids to prevent reoccurrence of hyponatremia.

A school nurse is creating an assembly promoting antibullying after a child who has a disability was stigmatized at school. The nurse is addressing which of the following domains of the social determinants of health? Education access and quality Social and community context Health care access and quality Neighborhood and built environment

ocial and community context MY ANSWER Clients who have chronic illnesses can face challenges like unsafe neighborhoods, bullying, and discrimination. This falls within the social and community context determinant of health.

A nurse is caring for several clients on a medical-surgical unit. Which of the following clients are at risk for hypernatremia? (Select all that apply.) The client who has diabetes insipidus The client who is receiving hypotonic IV fluids The client who has dementia The client who has gastroenteritis The client who has diabetic ketoacidosis

The client who has diabetes insipidus is correct. Clients who have diabetes insipidus are at increased risk for hypernatremia due to the loss of total body water. The client who is receiving hypotonic IV fluids is incorrect. Hyponatremia, not hypernatremia, can occur when excessive administration of IV fluids or ingestion of water results in an increase of total body water without an alteration in body sodium or extracellular fluid. The client who has dementia is correct. Clients who have physical impairments such as right-sided weakness, psychosocial conditions including dementia, or decreased thirst sensation are at risk for hypernatremia related to decreased fluid volume compared to level of serum sodium. The client who has gastroenteritis is correct. Clients who have gastroenteritis are at risk for hyponatremia, which occurs when total body fluid decreases more than total body sodium, and is associated with diuretics and gastrointestinal losses. The client who has diabetic ketoacid

For each assessment finding, click to specify if the assessment finding is a normal finding, an expected abnormal finding, or an unexpected abnormal finding in a client who is about to undergo surgery. Each finding may support more than one. Assessment Findings Normal Finding Expected Abnormal Unexpected Abnormal (report to provider) Positive hCG Extremity assessment Platelet count White blood cell count Temperature Pain level

The client's elevated white blood cell count (WBC), pain level, extremity assessment, and temperature are associated with the inflammatory process (cellulitis), with an abscess present that requires the incision and drainage in the first place. Therefore, these are expected findings, even though they are outside defined limits, so the surgeon would not need to be notified. The client's positive human chorionic gonadotropin (HCG) result (possible pregnancy) is an unexpected abnormal for a client about to have surgery, where the risk to the pregnancy is higher. Therefore, this needs to be reported to the surgeon in case the surgery needs to be delayed while further labs are obtained, and risk/benefits are determined. The client's platelet count is normal.

American Nursing Association

The code of ethics for nurses is composed and published by

The physician has ordered a smaller dose than your prefilled syringe contains. You need to expel some medication. The correct way to hold the syringe to expel the medication is which of the following?

The syringe should be held needle down.

Why would a patient diagnosed with benign prostate hypertrophy (BPH) return from surgery with a continuous bladder irrigation (CBI)?

To ensure continuous flow from the bladder because bleeding and blood clotting can occlude urine flow.

A public health nurse is preparing an educational activity for the community about risk factors for chronic illness. Which of the following health habits should the nurse include as the leading cause of preventable death in the United States? Lack of exercise Not getting vaccines Tobacco use Poor eating habits

Tobacco use The nurse should include that tobacco use is the leading cause of preventable death in the United States.

A nurse is preparing a client for a surgical appendectomy. The nurse identifies an appendectomy as which of the following types of surgical classification? Expedited Elective Emergent Urgent

Urgent Because the client has an inflamed appendix, the surgery needs to be performed within hours to ensure the safety of the client.

A nurse is caring for a client who has a serum potassium of 5.2 mEq/L. Which of the following findings from the client's medical history should the nurse identify as a potential contributor to the client's serum potassium level? IV insulin administration Heart failure Use of ACE inhibitors Nephrotic syndrome

Use of ACE inhibitors MY ANSWER The use of ACE inhibitors can contribute to hyperkalemia.

A nurse is assessing a client in the preoperative area. Which of the following preoperative finding(s) should the nurse relay to the surgeon immediately? Select all that apply. Platelet count Temperature Home medications taken recently Urinalysis results Serum potassium White blood cell count (WBC)

When prioritizing hypotheses, the nurse should identify that the client's platelet count and positive hCG result should be reported immediately to the provider. This client is at a higher risk for bleeding related to the low platelet count. The client may likely be pregnant as they have a positive hCG. Therefore, elective surgery should be postponed until a negative pregnancy test is confirmed or after the pregnancy has been completed.

A nurse is caring for a client who has heart failure (HF). The nurse should identify that which of the following laboratory values is indicative of heart failure? Hemoglobin (Hgb) 10.5 g/dL Serum potassium 5.2 mg/dL Brain natriuretic peptide (BNP) 210 pg/mL Creatinine 1.0 mg/dL

rain natriuretic peptide (BNP) 210 pg/mL The nurse should identify a BNP level above 100 pg/mL is indicative of heart failure.

homeostatsis gloassary

acid-base balance The body uses physiological adaptations to keep fluids closest to neutral pH (between 7.35 and 7.45) so that the body can function effectively. acidosis acidosis Condition where body fluids have too much acid, which is caused by too much acid produced or loss of bicarbonate. aldosterone Steroid hormone made by the adrenal cortex. alkalosis Condition where body fluids have too much base and is caused by too much bicarbonate in blood or loss of acid. anions Negatively charged ions. antidiuretic hormone (ADH) Hormone that regulates fluid volume in the body and is synthesized in the hypothalamus and secreted by the pituitary gland. anxiolytic Medication that is prescribed to treat anxiety disorders. arterial blood gases (ABGs) Test that measures the oxygen and carbon dioxide levels in blood and to determine acid-base balance. ascites Fluid collects within the peritoneal cavity as a result of liver disease or dysfunction. basic metabolic panel (BMP) Blood test that provide

A nurse is teaching a client about healthy versus unhealthy microbes. The nurse should identify that which of the following systems accounts for the most microbes in the body? Gastrointestinal tract Reproductive system Urinary system Respiratory system

astrointestinal tract MY ANSWER The nurse should include that the GI tract accounts for 80% of the microbial mass in the human body.

CVAD

central venous access device; admin of IV fluids, blood products, meds. on superierior or inferior vena cava. jugular, subclavian, or brachial, or femoral vein implants. placement confirmed w xray unless under fluoroscopy. benefits for chronic diseases or long term IV therapy needs; parenteral nutririon, chemo, blood

Nursing Practice Act (NPA)

defines the scope of nursing practice within the state

A nurse is planning care for a client who has a serum potassium level of 2.0 mEq/L. Which of the following prescriptions should the nurse anticipate including in the plan of care? Administer dextrose 5% in 0.45% sodium chloride with 40 mEq/L potassium chloride Initiate Insulin therapy Monitor for nephrolithiasis Administer an IV infusion of 0.9% sodium chloride with potassium chloride

dminister an IV infusion of 0.9% sodium chloride with potassium chloride MY ANSWER A client who has severe hyponatremia will require IV potassium chloride replacement at 10 to 20 mEq/hr.

A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD). The client's respiratory rate is 8/min and shallow with an oxygen saturation of 80%. Which of the following acid-base imbalances is the client most likely experiencing? Metabolic alkalosis Respiratory acidosis Metabolic acidosis Respiratory alkalosis

espiratory acidosis Respiratory acidosis occurs in clients who have problems due to respiratory mechanics or lung disease, such as COPD, where carbon dioxide builds up in the circulation due to hypoventilation.

The person performing the Lovenox injection must expel the air bubble in the prefilled syringe prior to administering the medication. Question 3Select one:TrueFalse

false

enternal lab vid https://www.youtube.com/watch?v=VhkOTl7J9cY

feedings to meet metabolic needs internal: absorbed via GI - NG tube; measure nose to ear then ear to xphoid process (aorund 60), have pt swallowing water during process (pick appropriate size for client-- 18 or 16 french etc), tape to nose and monitor sliding - dobhof tube(can float to duodenum w radiologist, can have wire or no wire for stability) check placement w Xray and keep wire in place until tube is in correct plae (do not place wire back in tube if out of place), smaller than NG (12 french), can give meds thourhg (crushed and disolved well and flush prior and after(check hospita policy on mixing meds at once or one at a time w flushing btwn ((flushes count as intake))), smaller= higher risk of occlusion -G tubes; an be put in w interventional radiology or OR. precut gauze to avoid irritation -J tubes; put in in OR !!always check for placement w xray and/or ph of gastric content intitially (airbubbles not best practice!!) and w measurements thereafter, and listen for air

collab session 1: professionalism

good SBAR questions critical thinking clinical judgement state model

What if your client had D5 0.45 NS infusing? Is ketorolac compatible?*

no

patricia banner

novice to expert nursing theorist based on the focus of care

owen cath vid 1 https://www.youtube.com/watch?v=OEvHLYvzs8s

types of caths: - red robin/ straight cath/ in and out; without pigtail - indwelling cath; yellow w pigtail for 10ml of sterile slaine (sizes/ 16 french, 18 french on hub) - three way cath; CBI DO NOT test balloon for infaltion prior to insertion green cath holder sticks to leg strict I and O's always good practice ! film cath/speciment cath: short cath w firm tube collector good for females-young children and older adults unisex intermitted cath; longer specimen gathers in bag urometer; typically in ICU/CCU to measure ml per hour, empty into back bag ON the HOUR each hour; home discharge w foley; portable leg bag- do not sleep in, loose clothing, changing bags; gloves, empty bag if needed, towel under, trashcan near, kink tub and alc swab hub, plug in wihtout touching inside or around hub, psuch twist firmly. record amount color smell times educate specimen sample from small child -wee/u bag; boys/girls, not for sterile specimen, for urine analysis, adhesion placed

A nurse is caring for a client who is chronically ill and has decreased mobility. Which of the following body systems should the nurse identify as the greatest risk of complication associated with bone demineralization? Gastrointestinal system Endocrine system Urinary system Respiratory system

urinary system; Clients who are chronically ill and immobile can develop renal calculi from bone demineralization and urinary tract infections due to incomplete bladder emptying.

Your client's Heparin and NS has been discontinued, and has new orders for LR at 100ml/hr and hydromorphone 1mg IV x 1. Is hydromorphone compatible with LR?* 1) Yes, they are compatible together. 2) No, they are not compatible together.

yes

Your client has NS infusing and a heparin drip has been Y'd into the NS. The physician has entered an order for ondansetron 4mg IV x 1. Is ondansetron compatible with the heparin and NS?* 1) Yes, both heparin and NS are listed as compatible under ondansetron. 2) No, Heparin is not listed as compatible. 3) No, NS is not listed as compatible. 4) I don't know how to find the compatibility.

yes NS and heparin are compatible w zofran

Pneumothorax S/S

↓or absent breath sounds Hyperresonance Dyspnea ↑HR Pain Anxiety ↑RR with respiratory alkalosis