NSG 119 Exam 2

Setting Priorities

Priorities should be based on the patient's immediate needs (perception of what is most important, anxiety level, and amount of time available), nursing diagnoses, and the goals and outcomes established for the patient.

Entrusting

Provides the patient with the opportunity to manage self-care

affective learning

Receiving, responding, valuing, organizing, and characterizing

A nurse is teaching an older-adult patient about post stroke seizures. What teaching method would be appropriate to use?

Short sessions during which the nurse provides the most important information at the beginning and end of the education session

Learning

Acquisition of new knowledge, behaviors and skills

Adult Learning

Adults tend to be self-directed learners; they often become dependent in new learning situations. The amount of information provided and the amount of time varies and readiness to learn.

Establish an environment that promotes learning: Factors that Affect Learning:

Age and developmental stage Motivation Readiness Active involvement Relevance Feedback Nonjudgmental support Repetition Timing Environment Emotions Physiological Events Culture Aspects Psychomotor ability Simple to complex learning

Interpret and evaluate laboratory values for changes that may have an affect on the client's response to medications, anesthesia, and surgery

Analysis of electrolytes CBC "Left-shift" (bandemia) Specimens for C&S ABGs Urine and renal laboratory tests Procedure-specific labs Glucose (diabetics) Serum amylase (pancreatic surgery

Patient Ed: Restoration of health:

As a nurse, you identify patient's willingness to learn and motivate interest in learning. Injured or ill patients need information and skills to help them regain or maintain their levels of health.

Identify the 6 ACCESS Model Components:

Assessment Communication Cultural Establishment Sensitivity Safety

Which drug would the nurse expect the primary health care provider to prescribe for a client to decrease blood pressure, decrease triglycerides, increase high-density lipoprotein cholesterol (HDL-C), and lower low-density lipoprotein cholesterol (LDL-C)? A. Advicor B. Caduet C. Vytorin D. Ezetimibe

B Amlodipine and atorvastatin are combined as Caduet to decrease blood pressure while de-creasing triglycerides (TGs), increasing HDL-C, and lowering LDL-C. Vytorin (ezetimibe and simvastatin) is a combination of a selective inhibitor of intestinal cholesterol and statin used to treat elevated cholesterol. Ezetimibe is in a class of medications called cholesterol-lowering medications. It works by preventing the absorption of cholesterol in the intestine. Advicor is a combination of niacin XR and lovastatin used to lower cholesterol and triglyceride (fat) levels in the blood.simvastatin, atorvastatin), which would successfully reduce total cholesterol in most clients when used for an extended

A hypertensive client with a large abdominal aortic aneurysm is having a surgical repair. What is the best category for this surgery? A. Urgent B. Emergent C. Radical D. Curative

B An emergent surgery requires immediate intervention because of life-threatening consequences. Examples include a gunshot or stab wound, severe bleeding, abdominal aortic aneurysm, compound fracture, and appendectomy that is ruptured or at risk of rupture. See Table 9.2 in your text

A client with appendicitis is to have an uncomplicated appendectomy performed. What is the best classification for this surgery? A. Elective B. Curative C. Diagnostic D. Minor

B Curative surgery is performed to resolve a health problem by repairing or removing the cause. Examples include removal of cancerous tumor and removal of gallbladder or appendix (as long as the appendix has not ruptured and the surgery is uncomplicated). See Table 9.1 in your text.

What is the best classification for the surgery when a female client has a biopsy of a nodule found in the right breast? A. Cosmetic B. Diagnostic C. Minor D. Palliative

B Diagnostic surgery is performed to determine the origin and cause of a disorder by taking a tissue sample with the intention of diagnosing (and staging, if applicable) a condition. Examples include breast biopsy after an abnormal finding on a mammogram and joint arthroscopy. See Table 9.1 in your text.

For which client would the nurse question the prescription of hydrochlorothiazide? A. Client with asthma B. Client with hypokalemia C. Client with hyperkalemia D. Client with chronic airway limitation

B Hydrochlorothiazide (HCTZ) is a thiazide di-uretic. The most frequent side effect associated with thiazide and loop diuretics is hypokalemia (low potassium level). Monitor serum potassium levels and assess for irregular pulse, dysrhythmias, and muscle weakness, which may indicate hypokalemia.

What is the nurse's best response when a pre-operative client speaks about fear of a reaction if blood is given during his or her surgery? A. "The likelihood that you will need a blood transfusion during your surgery is minimal, so do not worry about it." B. "You could donate some of your own blood, which is an autologous donation, a few weeks before your surgery." C. "With today's technology and procedures, it is very unlikely that you would have a reaction to donated blood." D. "The nursing staff follows very strict rules and procedures to prevent such an event from ever happening.

B When a client expresses fear of a blood transfusion reaction, a possible alternative is that the client can donate his or her own blood (autologous) a few weeks before the scheduled surgery. This procedure eliminates transfusion reactions and reduces the risk for acquiring bloodborne disease. A special tag is placed on the blood bag when an autologous blood donation has been made to ensure that clients receive only their own donated blood. Options A, C, and D do not respond to the client's stated fears.

What is the nurse's best response when a client asks about the difference between arteriosclerosis and atherosclerosis? A. Arteriosclerosis is the sudden blockage of an artery while atherosclerosis is formation of plaque in arteries. B. Atherosclerosis is forming plaques in arteries but arteriosclerosis is thickening of arterial walls associated with aging. C. Arteriosclerosis is hardening of arterial walls while atherosclerosis involves permanent localized dilation of arteries D. Atherosclerosis is thickening of arterial walls but arteriosclerosis is clot formation usually in the deep veins.

B Arteriosclerosis is a thickening, or hardening, of the arterial wall which is often associated with aging. Atherosclerosis is a type of arterio-sclerosis that involves the formation of plaque within the arterial wall and is the leading contributor to coronary artery and cerebrovascular disease. A sudden blockage is an acute arterial occlusion. Permanent dilation of arteries occurs with an aneurysm. Clot formation in the deep veins is a deep vein thrombosis (DVT).

return demonstration

The chance to practice the skill

Which classification will a client having surgery, who also had a myocardial infarction (MI) 6 weeks ago, fit best based on the American Society of Anesthesiologists (ASA) system? A. ASA class I B. ASA class II C. ASA class III D. ASA class IV

D ASA Class IV clients have severe systemic dis-ease that is a constant threat to life. Examples include recent (less than 3 months) MI, CVA, TIA, or CAD/stents; ongoing cardiac ischemia or severe valve dysfunction; severe reduction of ejection fraction; sepsis; and DIC, ARD, or ESRD not undergoing regularly scheduled dialysis. See Table 9.4 in your text.

What is the nurse's priority action when inter-viewing a preoperative client who had a right hip replacement? A. Document this in the client's preoperative chart. B. Mark the right hip with an indelible pen. C. Use caution when positioning the client. D. Communicate this to the operative personnel.

D Communicate this information to operative personnel to ensure that electrocautery pads, which could cause an electrical burn, are not placed on or near the area of the prosthesis. Other areas to avoid when placing electrocautery pads include on or near bony prominences, pacemakers, scar tissue, hair, tattoos, weight-bearing surfaces, pressure points, and metal piercings.

What is the best classification for surgery when a client with Crohn's disease has a colostomy? A. Preventative B. Reconstructive C. Curative D. Palliative

D Palliative surgery is performed to increase the quality of life (often to reduce pain) while reducing stressors on the body; non-curative in nature. Examples include ileostomy creation, stent placement to alleviate obstruction, and thoracentesis to drain fluid to reduce pain. See Table 9.1 in your text.

What frequency of drug dosage therapy would the nurse advocate for an older client with hypertension who lives alone and is able to man-age his or her self-care? A. Four times a day B. Three times a day C. Twice a day D. Once a day

D Research shows that clients, especially older adults, are more compliant with and able to manage self-care when drug dosages are prescribed once a day. The more frequently doses are scheduled, the more likely a client will be unable to follow the treatment regimen and miss doses of the prescribed drugs

What priority teaching would the nurse pro-vide for a client who will be discharged with a prescription for atorvastatin? A. "Take over-the-counter ranitidine when you experience nausea or vomiting." B. "Go to the emergency department if you experience a nagging, nonproductive cough." C. "You can use acetaminophen if the drug causes mild to moderate headaches." D. "Immediately report any muscle cramping to your primary health care provider."

D Statins reduce cholesterol synthesis in the liver and increase clearance of LDL-C from the blood. Therefore, they are contraindicated in clients with active liver disease or during pregnancy because they can cause muscle myopathies and marked decreases in liver function. Statins also have the potential for interactions with other drugs, such as warfarin, cyclosporine, and selected antibiotics. They are discontinued if the client has muscle cramping or elevated liver enzyme levels.

Which condition would the nurse suspect when a client has these findings (BP 200/130 mm Hg; sudden headache, blurred vision, and dyspnea)? A. Sustained hypertension B. Primary hypertension C. Secondary hypertension D. Malignant hypertension

D Hypertensive crisis (or malignant hypertension) is a severe type of elevated BP that rapidly progresses and is considered a medical emergency. A person with this health problem usually has symptoms such as morning headaches, blurred vision, and dyspnea and/or symptoms of uremia (accumulation in the blood of substances ordinarily eliminated in the urine). Clients are often in their 30s, 40s, or 50s with their systolic BP greater than 200 mm Hg.

Participating

The nurse and patient set objectives and become involved in the learning process together

Which common laboratory tests does the nurse expect will be completed on a client prior to surgery? Select all that apply. A. Lipid profile B. Urinalysis C. Metabolic panel D. Clotting studies E. Complete blood count F. Fasting blood glucose

B, C, D, E Common preoperative laboratory tests include: urinalysis; blood type and screen; complete blood count (or hemoglobin and hematocrit); clotting studies (prothrombin time [PT], international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count); metabolic panel (including serum glucose, serum electrolytes, kidney function, liver function, and serum proteins); and pregnancy test for the female client

Briefly explain patient education in each phase of health care: Maintenance and promotion of health and illness

The nurse is a visible, competent resource for patients who want to improve their physical and psychological well-being. In the school, home clinic or workplace, nurses provide information and skills that allow patients to assume healthier behaviors.

Which techniques would the nurse use when performing an initial cardiovascular assessment on a middle-aged client? Select all that apply. A. Check blood pressure on the dominant arm. B. Palpate all of the major pulse sites. C. Auscultate bruits in the radial and brachial arteries. D. Palpate and compare temperature differences in the lower extremities. E. Check the client for orthostatic hypotension. F. Perform bilateral but separate palpation on the carotid arteries.

B, C, D, E, F Because of the high incidence of hypertension in clients with atherosclerosis, assess the blood pressure in both arms. Palpate pulses at all the major sites on the body and note any differences. Palpate each carotid artery separately to prevent blocking blood flow to the brain! Also feel for temperature differences in the lower extremities and check capillary filling. Pro-longed capillary filling (>3 seconds in young to middle-aged adults; >5 seconds in older adults) generally indicates poor circulation. Many clients with vascular disease have a bruit in the larger arteries, which can be heard with a stethoscope or Doppler probe. A bruit is a turbulent, swishing sound, which can be soft or loud in pitch. It is heard as a result of blood trying to pass through a narrowed artery. A bruit is considered abnormal, but it does not indicate the severity of disease. Bruits often occur in the carotid, aortic, femoral, and popliteal arteries. Orthostatic hypotension is checked because it is a frequent side effect of antihypertensive drugs.

Which instructions would the nurse give a client for following dietary recommendations of the American College of Cardiology (ACC) and the American Heart Association (AHA)? Select all that apply. A. Consume a dietary pattern that emphasizes intake of lean protein. B. Consume low-fat dairy products, poultry, and fish. C. Lower sodium intake to no more than 2400 mg/day. D. Engage in aerobic physical activity six to seven times a week. E. Limit intake of sweets and red meats. F. Eat legumes, tropical vegetable oils (e.g., canola oil), and nuts.

B, C, E, F The ACC and AHA publish dietary recommendations for lowering LDL-C levels. These recommendations are based on the best current evidence from randomized controlled trials and includes consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; consume low-fat dairy products, poultry (without the skin), fish, legumes, non-tropical (e.g., canola) vegetable oils, and nuts; limit intake of sweets, sugar-sweetened bever-ages, and red meats; aim for a dietary pattern that includes 5% to 6% of calories from saturated fat; and limit trans fats.

When the nurse performs blood pressure screenings, which clients would be referred for further evaluation? Select all that apply. A. Diabetic client with blood pressure 118/76 mm Hg B. Client with heart disease and blood pressure 148/90 mm Hg C. Renal failure client with blood pressure of 180/90 mm Hg D. Client with no known health problems and blood pressure of 106/70 mm Hg E. Client with muscle cramping taking a statin drug with blood pressure 124/82 mm Hg F. COPD client with blood pressure 158/88 mm Hg

B, C, E, F The client with heart disease has stage 1 hyper-tension. The client with renal failure has very high blood pressure and stage 2 hypertension. The client taking the statin drug should be referred for a change in drug therapy because muscle cramps are a side effect of these drugs and this indicates that the client is not tolerating the statin. The client with COPD also has stage 2 hypertension (See Table 33.1). The diabetic client and the client with no known health problems both have normal blood pressure readings.

Which drugs usually taken daily by a client would the surgeon instruct the nurse to be sure to administer prior to surgery? Select all that apply. A. Daily multivitamin B. Anticonvulsant C. Stool softener D. Beta blocker E. Daily chewable aspirin F. Anticoagulant

B, D Drugs for cardiac disease, respiratory disease, seizures, and hypertension are commonly al-lowed with a sip of water before surgery. Some antihypertensive or antidepressant drugs are withheld on the day of surgery to reduce ad-verse effects on blood pressure during surgery. Usual drug schedules are individualized so the nurse would be sure to check with the surgeon regarding which drugs should be given and which should be held.

Which statements best describe the preoperative period when a client is being prepared for surgery? Select all that apply A. It begins when the client makes an appointment with a surgeon to discuss the need for surgery. B. It ends when the client is transferred to the surgical suite. C. It is a time during which a client's need for surgery is established. D. During this time, the client receives testing and education related to the impending surgery. E. It begins when the client is scheduled for surgery. F. It is a time when clients and families receive instruction for after discharge

B, D, E The preoperative period begins when the client is scheduled for surgery and ends at the time of transfer to the surgical suite. During this period, the client receives preparatory education, as well as testing to establish a baseline and correct any abnormalities.

Identify the nurse's responsibility in evaluating the outcomes of the teaching learning process

The nurse is legally responsible for providing accurate, timely, patient information that promotes continuity of care. Documentation of patient teaching supports quality improvement efforts and promotes third-party reimbursement.

Telling

The nurse outlines the task the patient will perform and gives explicit instructions.

Timing

Time the teaching for when a patient is most attentive, receptive, and alert and organize the activities to provide time for rest and teaching - learning interactions.

Creating an environment that promote learning:

Timing you can't go into the room rushing your patient. Ask the patient how much time can you devote to this learning. Turn your phone off to give your patient your undivided attention. Share personal experience as it relates to what you're teaching. Ask yourself is your patient ready to learn or motivated to learn. Have a plan ready to teach your patient.

physical capability

To learn psychomotor skills, the following physical characteristics are necessary: size, strength, coordination, and sensory acuity.

Atherosclerosis

Type of arteriosclerosis involving formation of plaque within arterial wall

Joint Commission suggestions:

Use plain language Use "teach back" and "show back" techniques Limit information to two or three important points Use drawings or models Clear communication and plain language is imperative when communicating with all clients Desire to learn Influences how much & fast a person learns Influenced by patients own recognition of need to learn Nurse assists by helping patient recognize need to learn

What are the priority nursing care concepts for clients with vascular problems? A. Perfusion and fluid balance B. Clotting and immunity C. Inflammation and perfusion D. Perfusion and clotting

D. The priority care concepts for clients with vascular problems are perfusion and clotting. Inflammation is an interrelated concept for these clients.

What would be the nurse's best action when a client reports dizziness when changing position from sitting to standing and a sudden dry cough after starting a prescription of captopril? A. Instruct the client to change positions slowly and take an over-the-counter cough syrup. B. Tell the client to take the drug at bedtime and use over-the-counter throat lozenges. C. Notify the primary health care provider immediately about these side effects. D. Teach the client to increase fluid intake to at least 3 L/day.

C Captopril is an angiotensin-converting enzyme inhibitor (ACEI). Antihypertensive drugs all have the potential to cause hypotension. However, the most common side effect of this group of drugs is a nagging, dry cough. The nurse should immediately notify the primary health care provider of this finding. Clients must also be taught to report this problem as soon as possible. If a cough develops, the drug is discontinued and the client is started on another drug therapy to control hypertension.

Which surgical approach does the nurse expect will be used for a client having an uncomplicated cholecystectomy at the same-day surgery clinic? A. Simple B. Open C. Minimally invasive D. Radical

C A minimally invasive approach to surgery is performed in a body cavity or body area through one or more endoscopes; it can correct problems, remove organs, take tissue for biopsy, re-route blood vessels and drainage systems; it is a fast-growing and ever-changing type of surgery. Examples include arthroscopy, tubal ligation, hysterectomy, lung lobectomy, coronary artery bypass (MIDCAB), and cholecystectomy. See Table 9.2 in your text. 61

Readiness to Learn

Demonstration of behaviors that patient is motivated to learn. Reflects a desire and willingness to learn Patient willingly participates in goal setting and decision making regarding care Nurse's role is to encourage development of readiness

Motivation to Learn:

Desire to learn Influences how much & fast a person learns Influenced by patients own recognition of need to learn Nurse assists by helping patient recognize need to learn

A preoperative client's vital signs before transport to the surgery holding area are: (BP 90/60 mm Hg, HR 110/minute, RR 24/minute, T 100.9oF [38.3oC]). What is the nurse's priority action? A. Administer acetaminophen with just a sip of water. B. Recheck the vital signs in 15 minutes. C. Call and notify the surgeon immediately. D. Instruct the client to cough and take deep breaths.

C This client's BP is low, HR is high, and oral temperature is elevated. These changes in vital signs may indicate that the client is at risk for an infection which must be treated before the client can have surgery. Options A, B, and D may be included in the care of this client, but at this time, the priority action is to notify the surgeon

motivation to learn

- behavior - health beliefs and sociocultural background - perception of severity and susceptibility of a health problem and the benefits and barriers to treatment - perceived ability to perform behaviors - desire to learn - attitudes about providers - learning style preference

Teaching environment

- distractions or persistent noise - comfort of the room - room facilities and available equipment

ability to learn

- physical strength, movement, dexterity and coordination - sensory deficits - reading level - developmental level - cognitive function - physical symptoms that interfere

Resources for learning

- willingness to have family members and others involved in the teaching plan - family members' perceptions and understanding of the illness and its implications - financial or material resources - teaching tools

Identify nursing diagnoses that indicate a need for education

-Decisional conflict -lack of knowledge (affective, cognitive, psychomotor) -impaired health maintenance -impaired health ability to mange diet/exercise regimen -self-care deficit

affective learning

-involves feelings, beliefs, and ideals -example: a client listens to the nurse explain life changes necessary to manage diabetes and then discusses feelings regarding the diagnosis

Which piece of equipment would the nurse recommend for a client to manage hypertension at home? A. Blood pressure monitoring device B. Stationary exercise bicycle C. Blood glucose monitoring device D. Kitchen food scale

. A The nurse would teach the client to obtain an ambulatory BP monitoring (ABPM) device for use at home so the pressure can be checked daily. The nurse would also evaluate the client's and family's ability to use this device accurately and instruct the client to keep a record of blood pressure readings and report very low or high readings to the primary health care provider.

An internal impulse that causes a person to take action is: 1. Anxiety 2. Motivation 3. Adaptation 4. Compliance

2. Motivation An internal impulse is a force acting on or within a person that causes the person to behave in a particular way

The nurse who works with pediatric patients who have diabetes. Which is the young age group to which the nurse can effectively teach psychomotor skills such as insulin administration? 1. Toddler 2. Preschool 3. School age 4. Adolescent

3. School Age Complicated skills such as learning to use syringe, require considerable practice but are developmentally appropriate for school age children.

Which of the following patients is most ready to begin a patient-teaching session? 1. Patient who is unwilling to accept that her back injury may result in permanent paralysis 2. Patient who is newly diagnosed with diabetes who is complaining that he was awake all night because of his noisy roommate 3. Patient with irritable bowel syndrome who has just returned from a morning of testing the gastrointestinal laboratory 4. Patient who had a heart attack 4 days ago now seems somewhat anxious about how this will affect his future

4. A mild level of anxiety motivates the learning, but a high level of anxiety prevents learning

Demonstration of the principles of body mechanics used when transferring patients from bed to chair would be classified under which domain of learning? 1. Social 2. Affective 3. Cognitive 4. Psychomotor

4. Psychomotor learning involves acquiring skills that integrate mental and muscular activity

Which of the following is an appropriately stated learning objective for Mr. Ryan, who is newly diagnosed with diabetes? 1. Mr. Ryan will understand diabetes. 2. Mr. Ryan will be taught self-administration of insulin by 5/2. 3. Mr. Ryan will know the signs and symptoms of low blood sugar by 5/5. 4. Mr. Ryan will perform blood glucose monitoring with the EZ Check Monitor by discharge.

4. the objective describes an appropriate and achievable skill that the patient can be expected to master within a realistic time frame.

After a client is prepared for surgery and before preoperative drugs are given and the client is transferred to surgery, which intervention can the nurse delegate to the assistive personnel (AP)? A. Assist the client to the bathroom to empty his or her bladder. B. Help the client to remove the hospital gown. C. Recheck the client's identity with another AP. D. Teach the client to use incentive spirometry.

A After the client is prepared for surgery and just before transport into the surgical suite, the nurse would ask the AP to assist the client to the bathroom to empty his or her bladder. This action prevents incontinence or overdistention and is a starting point for intake and output measurement. Most facilities have clients re-move their clothes and wear a hospital gown to surgery.

What would the nurse suspect when assessing an older preoperative client and finding brittle nails; dry, flaky skin; muscle wasting; and dry, sparse hair? A. Poor fluid and nutrition status B. Improper client care by the home care giver C. Expected physiological changes that occur with aging D. Depression of the client related to the aging process

A Indications of poor fluid or nutrition status include: brittle nails; muscle wasting; dry or flaky skin, decreased skin turgor, and hair changes (e.g., dull, sparse, dry); orthostatic (postural) hypotension; and decreased serum protein levels and abnormal serum electrolyte values.

What drug would the nurse expect to be pre-scribed for a client with hypertension and for whom lifestyle modifications have failed to control blood pressure? A. Thiazide diuretic B. Calcium channel blocker C. Angiotensin-converting enzyme inhibitor D. Beta blocker

A Thiazide (low-ceiling) diuretics, such as hydro-chlorothiazide, inhibit sodium, chloride, and water reabsorption in the distal tubules while promoting potassium, bicarbonate, and magnesium excretion. Because of the low cost and high effectiveness of thiazide-type diuretics, they are usually the drugs of choice for clients with uncomplicated hypertension.

Which action increases the effectiveness of an-giotensin II receptor blockers (ARBs) and an-giotensin-converting enzyme inhibitors (ACEIs) in controlling hypertension for Afri-can-American clients? A. The ARB or ACEI is given with a diuretic, beta blocker, or a calcium channel blocker. B. A much higher dose of ARB or ACEI is prescribed for an African-American client. C. The ARB or ACEI is combined with rigorous lifestyle modifications. D. Clients take the ARB or ACEI around the clock on an individualized schedule.

A ACEIs and ARBs are not as effective in African Americans unless they are taken with diuretics or another drug category such as a beta blocker or calcium channel blocker

Which is the most important priority for nurses when caring for a client preoperatively? A. Client safety B. Client diagnostic testing C. Client care documentation D. Client teaching

A While all of these concerns are important when caring for a preoperative client, the priority concern is client safety. This is true throughout the perioperative (before, during, and after) period to protect clients against mistakes.

Which lifestyle changes would the nurse teach a client to help control hypertension? Select all that apply. A. Weight reduction if overweight or obese. B. Implement a healthy diet such as the DASH diet. C. Decrease smoking and nicotine use. D. Use relaxation techniques to decrease stress. E. Restrict sodium by not adding salt at the table. F. Increase activity by use of a structured exercise program.

A, B, D, F The nurse would teach all clients about lifestyle changes to help control hypertension including: restrict dietary sodium according to ACC/AHA guidelines (not adding table salt is often not enough); reduce weight if overweight or obese; implement a heart-healthy diet, such as the DASH diet; increase physical activity with a structured exercise program; abstain or de-crease alcohol consumption (no more than one drink a day for women and two drinks a day for men); stop smoking and tobacco use; and use relaxation techniques to reduce stress

When the nurse is screening a preoperative client, which factors increase the risk for complications during the perioperative period? Select all that apply. A. Age 72 B. 35 pounds overweight C. Walks half a mile everyday D. History of hernia repair surgery E. Smokes half a pack of cigarettes per day F. Type 2 diabetes

A, B, E, F Table 9.3 in your text gives a long list of risk factors for complications during the perioperative period. Walking every day would not be a risk factor, nor would a history of hernia repair surgery.

Which postoperative interventions would the preoperative nurse typically teach a client to pre-vent complications following surgery? Select all that apply. A. Range-of-motion exercises B. Massaging of lower extremities C. Incision splinting D. Deep breathing exercises E. Use of incentive spirometry F. Taking pain drugs when experiencing severe pain

A, C, D, E An essential responsibility of the preoperative nurse is to teach clients about postoperative procedures that will prevent complications after surgery including respiratory procedures such as splinting the incision to cough and deep breath as well as incentive spirometry. Range-of-motion exercises are important to prevent loss of range or motion. Clients should be taught how to perform these exercises and given opportunities to practice. Massaging lower extremities would be avoided to prevent DVT. Clients should not wait to ask for pain medication until the pain is severe.

Which manifestations would the nurse expect for a client with a history of malignant hyper-thermia (MH)? Select all that apply. A. High body temperature B. Decreased serum calcium level C. Tachypnea D. Skin mottling E. Muscle rigidity of jaw and upper chest F. Increased serum potassium level

A, C, D, E, F With MH, serum calcium and potassium levels are increased. Symptoms include tachycardia, dysrhythmias, muscle rigidity of the jaw and upper chest, hypotension, tachypnea, skin mottling, cyanosis, and myoglobinuria (muscle proteins in the urine due to rhabdomyolysis).

A blind client is to have a surgical procedure. What is the nurse's best response when the client asks if he or she will be permitted to sign the consent form? A. "Yes, but you will need to make an X instead of signing your name." B. "No, but you can give instructions for a responsible adult to sign for you." C. "Yes, but your signature will need to be witnessed by two people." D. "No, but your next of kin can sign the informed consent for you."

C A blind client may sign his or her own consent form, which will need to be witnessed by two people. Clients who cannot write may sign with an X, which must be witnessed by two people, one of whom can be the nurse.

An older client is having a cataract removal surgery. What is the best category for this surgery? A. Urgent B. Emergent C. Elective D. Cosmetic

C An elective surgery is performed to correct a nonacute problem. Examples include cataract removal, hernia repair, hemorrhoidectomy, and total joint replacement. See Table 9.2 in your text.

Which nursing interventions promote a client's compliance with antihypertensive therapy? Select all that apply. A. Provide oral and written instructions related to all prescribed medications. B. Give the client a list of resources for finding additional information on prescribed drugs. C. Stress that suddenly stopping beta blockers can cause angina or heart attack. D. Suggest that the client have a home scale for weight monitoring. E. Advocate for medications that are taken three times a day for better BP control. F. Teach clients to report unpleasant side effects to the primary health care provider

A, C, D, F Health teaching is essential to help clients be-come successful in managing their BP. Pro-vide oral and written information about the indications, dosage, times of administration, side effects, and drug interactions for antihypertensives. Stress that medication must be taken as prescribed. Teach that suddenly stop-ping drugs such as beta blockers can result in angina (chest pain), myocardial infarction (MI), or rebound hypertension. Teach clients to obtain an ambulatory BP monitoring (ABPM) device and suggest having a scale in the home for weight monitoring. Remember that clients are more compliant with the plan of care when drugs are given once a day. In-struct clients to report unpleasant side effects of antihypertensive drugs so that another drug may be prescribed to minimize those side effects

Which factors would the nurse note as increasing the risk for atherosclerosis with an older African-American client? Select all that apply. A. 20-year history of type 2 diabetes B. Nutrition includes three to four diet sodas per day C. Sedentary lifestyle D. 25 pounds overweight E. Father with history of colon cancer F. Grandmother died after heart attack

A, C, D, F Risk factors for atherosclerosis include: low HDL-C, high LDL-C, increased triglycerides, genetic predisposition, diabetes mellitus, obesity, hypertension, sedentary lifestyle, smoking, stress, African American or Hispanic ethnicity, older adult, and diet high in saturated and trans fats, cholesterol, sodium, and sugar

Informed consent implies to the nurse that a client understands which of the following? Select all that apply. A. The nature and reason for the surgery B. The length of stay in the hospital C. Who will be performing the surgery D. Information about the surgeon's experience E. The risks associated with the surgical procedure and its potential outcomes F. The risks associated with the use of anesthesia

A, C, E, F Informed consent implies that the client has sufficient information to understand: the nature of and reason for surgery; who will be performing the surgery and whether others will be present during the procedure (e.g., students, vendors); all available treatment options, and the benefits and risks associated with each option; the risks associated with the surgical procedure and its potential outcomes; the risks associated with the use of anesthesia; and the risks, benefits, and alternatives to the use of blood or blood products during the procedure.

Which control systems play an important role in maintaining a client's blood pressure? Select all that apply. A. The arterial baroreceptor system B. Elevated lipid levels C. Regulation of body fluid volume D. Dietary saturated fats and sodium E. Vascular autoregulation F. The renin-angiotensin-aldosterone system

A, C, E, F Stabilizing mechanisms exist in the body to exert overall regulation of systemic arterial pressure and to prevent circulatory collapse. Four control systems play a major role in maintaining blood pressure: the arterial baroreceptor system, regulation of body fluid volume, the renin-angiotensin-aldosterone system, and vascular autoregulation. Some elevated lipid levels contribute to development of atherosclerosis and arterial disease. A diet high in saturated fats and sodium is a risk factor for development of atherosclerosis.

What are the advantages for clients whose surgery is accomplished in a same-day surgery center (outpatient surgery center)? Select all that apply. A. Cost-effective care B. Increased post surgery responsibility for client C. Decreased need for anesthesia D. High degree of client satisfaction E. Service-oriented processes F. Case manager to coordinate post discharge care

A, D, E, F Advantages of same-day (outpatient) surgery centers include cost-effective care, service-oriented processes, and a high degree of client satisfaction. A case manager is used to coordinate post-discharge care for the client to ensure follow-up treatments and avoid postoperative hospital admission. Anesthesia is still needed for most surgical procedures, and increased client responsibility after the procedure would likely be considered a disadvantage of this type of surgery.

Which are the most sensitive indicators of malignant hyperthermia that the nurse would monitor for in a client? Select all that apply. A. Rise in the end-tidal carbon dioxide level with a decrease in oxygen saturation B. Extremely high temperature C. Increased metabolic rate D. Hypotension E. Tachycardia F. Cyanosis

A, E The most sensitive indications of MH are an unexpected rise in the end-tidal carbon dioxide level with a decrease in oxygen saturation, and tachycardia. All of the other signs and symptoms are indications of MH but not the most sensitive. Extremely elevated temperature, as high as 111.2° F (44° C), is a late sign of MH.

How does the nurse best interpret a client's low-density lipoprotein cholesterol (LDL-C) value which is greater than 190 mg/dL and does not respond to dietary intervention? A. The client should have total cholesterol and LDL-C testing repeated during the next routine examination. B. The client should be instructed to exercise 6 to 7 days per week to help bring the LDL-C level over time. C. The client should be evaluated for secondary causes of hyperlipidemia and treated with statin therapy because of the high LDL-C level. D. The client should be followed every 6 months routinely to check lipid profiles and detect trends in the values.

C Increased low-density lipoprotein cholesterol (LDL-C) ("bad" cholesterol) levels and low high-density lipoprotein cholesterol (HDL-C) ("good" cholesterol) indicate that a person is at an increased risk for atherosclerosis. For clients with elevated total cholesterol and LDL-C levels that do not respond adequately to dietary intervention, the primary health care provider prescribes a cholesterol-lowering agent, most likely a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors or "statin" (e.g., lovastatin, period.

Which statement best describes the interprofessional collaborative roles of the nurse and surgeon when obtaining informed consent? A. The nurse is responsible for having the informed consent form on the chart for the surgeon to witness. B. The nurse may serve as a witness that the client has been informed by the surgeon before surgery is performed. C. The nurse may serve as witness to the client's signature after the surgeon has the consent form signed, but before preoperative sedation is given and surgery is performed. D. The nurse has no duties regarding the consent form if the client has signed the informed consent form for the surgeon, even if the client then asks additional questions about the surgery.

C It is the surgeon's responsibility to provide a complete explanation of the planned surgical procedure and to have the consent form signed before sedation is given and before surgery is performed. The perioperative nurse is not re-sponsible for providing detailed information about the surgical procedure. The nurse's role is to clarify facts that have been presented by the surgeon and dispel myths that the client or caregiver may have about the surgical experience. The nurse must verify that the consent form is signed, dated, and timed, and he or she may serve as a witness to the signature, not to the adequacy of the client's understanding (which is the surgeon's responsibility).

What is the nurse's best explanation to a client for use of low-dose niacin to decrease LDL-C and very-low-density lipoprotein (VLDL) cholesterol levels? A. It will prevent muscle myopathies. B. It works well to prevent elevated blood pressure. C. It helps reduce side effects of flushing and feeling too warm. D. It will help prevent the undesirable side effect of hypokalemia

C Low doses of niacin are recommended because many clients experience flushing and a very warm feeling all over with higher doses. Higher doses can also result in an elevation of hepatic enzymes. In statin-intolerant clients, niacin can be useful to help lower LDL cholesterol levels in combination with other drugs

What is the most appropriate category of surgery for a client who can barely ambulate with a walker at home, who is having a left total knee replacement? A. Urgent B. Palliative C. Reconstructive D. Simple

C Reconstructive surgery is performed on abnormal or damaged body structures to improve functional ability. Examples include hip and knee replacements. See Table 9.1 in your text.

self-efficacy

a person's perceived ability to successfully complete a task

Describe the inter-professional care for primary hypertension, including drug therapy and lifestyle modifications

Hypertensive crisis is a term used to indicate either a hypertensive urgency or emergency. This is determined by the degree of target organ disease and how quickly the BP must be lowered. Hypertensive urgency develops over days to weeks. The BP is severely elevated but there is no clinical evidence of target organ disease.Hypertensive urgencies usually do not require IV medications but can be managed with oral agents.If a patient with hypertensive urgency is not hospitalized, outpatient follow-up should be arranged within 24 hours.Hypertensive emergencies require hospitalization with intensive care monitoring and the IV administration of antihypertensive drugs, including vasodilators, adrenergic inhibitors, the ACE inhibitor enalaprilat, and the calcium channel blocker clevidipine (Cleviprex). Drugs are titrated based on MAP.Regular, ongoing assessment (e.g., ECG monitoring, vital signs, urinary output, level of consciousness, visual changes) is essential to evaluate the patient with severe hypertension

Goals and Outcomes

Identify what a patient needs to achieve to gain a better understanding of the information provided and better manage their illness.

Teaching

Imparting knowledge through a series of directed activites

Assess the elements of each factors. Learning Needs:

Information of skills needed by the patient to preform self-care and to understand the implications of a health problem Patient's experiences that influence the willingness and the need to learn Information that the family members require to support the patient's needs

psychomotor learning

Integration of mental and muscular activity, ranging from perception to origination

· Select appropriate nursing interventions to manage potential problem during the postoperative period.

Intervention for hypoxemia: Highest incidence occurs on 2nd postoperative day Interventions Airway maintenance Monitor (Spo2) Semi-Fowler's position Oxygen therapy, breathing exercises Mobilization as soon as possible Preventing Wound Infection Nursing assessment of surgical area is critical Dressings—First change usually done by surgeon Drains—Provide exit route for air, blood, bile; help prevent deep infections, abscess formation during healing Interventions Drug therapy, irrigation to treat wound infection Débridement Surgical management required for wound opening Managing Pain: Drug therapy Complementary and integrative health Positioning Massage Relaxation/diversion techniques

Learning in children

Learning in children depends on the child's maturation; intellectual growth moves from the concrete to the abstract as the child matures. Information presented to children need to be understandable and based on the child's developmental stage.

Identify the factors that affect readiness to learn

Loss of Health (grieving process) Health Status Attentional Set

One-on-one instruction

Most common method of instruction

Developmental capability

Need to know a patient's level of knowledge and intellectual skills before beginning a teaching plan.

Coping with impaired functions

New knowledge and skills are often necessary for patients to continue ADLs and learn to cope with permanent health alterations.

Determine appropriate patient learning level

Nurses need to assess all factors that influence content, ability to learn, and resources available Review factors affecting learning Nursing History Include health beliefs, culture, economics, support system, learning style Physical Exam General survey provides useful clues for education needs Motivation Everyone has different learning styles. Psychology- hx of anxiety and depression, being in a stage of denial or grief- patients will pushback a lot Health literacy- Can my patient move through the process with printed or written material? Physically- dexterity Learning Needs- readiness, language skills, learning type Age- too young- they will need a parent, cognitive level Think about socioeconomic status and physical factors. Can the patient afford what you are telling them to purchase? Can the patient physically do what you are teaching them?

Organizing teaching material

Organize teaching material into a logical sequence progressing from simple to complex ideas.

Domains of Learning

cognitive, affective, psychomotor

Learning Objective

describes what the learner will be able to do after successful instruction

Group instruction

economical way to teach a number of patients at one time

Motivation

internal state that helps arouse, direct, and sustain human behavior

cognitive learning

knowledge, comprehension, application, analysis, synthesis, evaluation

Fluid and electrolytes Complications Post Surgery

o Acid base imbalance o Electrolyte imbalance o Fluid deficit o Fluid overload

Respiratory Complications Post Surgery

o Airway obstruction o Aspiration o Atelectasis o Bronchospasm o Hypoventilation o Hypoxemia o Pneumonia o Pulmonary Edema o Pulmonary Embolus

Integumentary Complications Post Surgery

o Dehiscence o Hematoma o Infection

Gastrointestnal Complications Post- Surgery

o Delayed gastric emptying o Distention and flatulence o Hiccups o Nausea and vomiting o Postoperative ileus

Neuro Complications post-surgery

o Delirium o Fever o Hypothermia o Pain o Post-Operative cognitive dysfunction

Cardiovascular Complications Post Surgery:

o Dysrhythmias o Hemorrhage o Hypertension o Hypotension o Superficial thrombophlebitis o Venous thrombophlebitis

Urinary Complications Post Surgery:

o Infection o Retention

Explain the physiological processes of perfusion and the population at risk.

o Perfusion refers to the flow of blood through arteries and capillaries, delivering nutrients and oxygen to cells and removing cellular waste products o Central Perfusion: Force of blood movement generated by cardiac output Requires adequate cardiac function, blood pressure, and blood volume Cardiac output (CO) = Stroke volume X Heart rate o Tissue or local perfusion Volume of blood that flows to target tissue Requires patent vessels, adequate hydrostatic pressure, and capillary permeability Impaired perfusion can potentially occur among all individuals, regardless of age, gender, race, or socioeconomic status. The populations at greatest risk are: • Middle-aged and older adults • Men • African Americans

Select appropriate strategies for the prevention of primary hypertension.

o Smoking and nicotine cessation o Diet o Exercise o Weight control

Role-play

people play themselves or someone else

psychomotor learning

pertaining to motor effects of cerebral or psychic activity

Analogies

supplement verbal instruction with familiar images that make complex information more real and understandable

cognitive learning

the acquisition of mental information, whether by observing events, by watching others, or through language

Simulation

the nurse poses a pertinent problem or situation for patients to solve, which provides an opportunity to identify mistakes

Explain the nursing process and the teaching process differ. The nursing process requires:

the nursing process requires assessment of all sources to date to determine a patient's total health care needs.

teaching process

the teaching process focuses on the patient's learning needs and willingness and capabilities to learn

Reinforcement

using a stimulus that increase the probability for a response

Labs needed before surgery:

§ Check LOC § Assist patient to bathroom - use bedpan § Assist patient with ADL § Use incentive spirometer to clear lungs of secretions and prevent pneumonia § Safety-siderails, fallmats, non-slip socks § Urinate § Patient needs have a bowel movement § Check drains and pouches § Check vital signs after every 15-30 minutes after surgery for the first 2hours § Make sure

Describe cultural and ethnic variations with blood pressure assessment

· African Americans-Hypertension prevalent and deadly; higher prevalence of salt sensitivity, stress-induced vasoconstriction and slower natriuresis, observed in blacks compared with whites, Chinese and Hispanic. differences in social and cultural influences such as health behaviors, access to health care, and environmental exposures that may all affect blood pressure

Practice implementing different methods of teaching and learning

· Cognitive · Psychomotor · Affective

Explain the pathophysiologic mechanisms associated with primary hypertension.

· Primary hypertension o Also called essential or idiopathic hypertension o Elevated BP without an identified cause o 90% to 95% of all cases o Exact cause unknown but several contributing factors • Water and sodium retention • Only 1 in 3 people who consume high sodium diet develop hypertension • The effect of sodium on BP has a strong genetic component • Stress and increased SNS activity • Causes increased vasoconstriction • ↑ HR • ↑ Renin release • Increased workload on the heart

Explain the clinical manifestations and complications of hypertension.

· Silent killer" · Symptoms of severe hypertension o Fatigue o Dizziness o Palpitations o Angina o Dyspnea

Older people Pre-op

• Greater incidence of chronic illness (e.g., hypertension, diabetes) • Greater incidence of malnutrition and dehydration • More allergies • An increased number of abnormal laboratory values (anemia, low albumin level) • Increased incidence of impaired self-care abilities • Inadequate or absent support systems • Decreased ability to withstand the stress of surgery and anesthesia • Increased risk for cardiopulmonary complications after surgery • Risk for a change in mental status when admitted (e.g., related to unfamiliar surroundings, change in routine, drugs) • Increased risk for falls and resultant injury • Mobility changes that affect recovery efforts

Demonstrate the role of the nurse in educating the pre-and post op patient

• Patient education occurs in pre-op • Think about the different learning domains • The nurse collects health data • Assess readiness • You want to make sure the patient tells you about any herbal supplements, ginger, garlic, ginko baloba, fish oil all can affect coagulation • Anxiety can impair cognition • You will use incentive spirometer • You will get baseline data: CBC, Lytes, BUN, Creatinine, A1C, Coagulation PTT and INR, type and screening, vitals, Blood glucose • Special religious or cultural beliefs- like being a Jehovah witness • All jewelry, makeup, nail polish is removed • Ask if the patient takes any aspirin or anti-platelet medication • Does this patient use any medication • Make sure you have your client's height and weight • Document the patient's allergies • A doctor will decide when the patient will go NPO • The nurse needs to make sure that the patient has an IV access line. • Make sure that the surgical consent form has been obtained. • History and physical needs to be complete and placed in the chart. • Some patients need to be cleared prior to surgery. Ensure the patient has received the necessary • The doctor may order the following labs: Lytes, BUN, Creatinine, A1C, Coagulation PTT and INR, type and screening (72 hours within the surgery to ensure the hospital has the blood on hand) • Women will have to have a pregnancy test - urine and serum blood test • Doctors may request that the patient • Make sure all the aids ( hearing aids, jewelry, etc are placed somewhere safe and sent with the patient.) • General consent- make sure that it was complete. • My role and responsibility as a nurse: • You have to knowledge of the procedure • The minute the patient says, "I don't understand", call the surgeon • Assess the patient's stress level • You walk them through the surgical process • Explain what the room will feel like • Possible complications are on the consent form • Think about goals during this time • Go back to the patient education term- health promotion, prevention, long term sustainability, meeting the clients where they are, teach the client about the incentive spirometer, receive a teach back during this time

arteriosclerosis

• Thickening or hardening of arterial wall • Often associated with aging