Med Surg E4

Urine output of 20mL/2 hours Let's consider this patient had a foley catheter placed. Is there anything we need to do?

- check for kinks - occlusion r/t purulent drainage

when do we use NS or LR?

- dehydration and N/V/D - bolus or maintenance - acute kidney injury - hyponatremia - hypotension - sepsis - burns

Urine output of 20mL/2 hours What would decrease urine output indicate?

- renal/kidney failure - acute kidney injury

what IV fluid would you give a patient that is dehydrated?

1/2 NS

what fluid would you expect to be cautiously administered to a patient with fluid volume excess?

1/2 NS

what would we expect to use for DKA?

1/2 NS and D5W

what are treatments for hypernatremia?

1/2 NS or D5W, treat underlying cause

Urine output of 20mL/2 hours What is the normal urine output/hour?

30 mL/hr

what is the normal amount of residual urine expected?

50 mL post void

A nurse is providing dietary teaching for a client who has taken furosemide. The nurse should recommend which of the following foods as the best source of potassium? A. Bananas B. Cook carrots C. Cheddar cheese D. 2% milk

A. Bananas

A nurse is caring for a client who has metabolic alkalosis. For which of the following clinical manifestations should the nurse monitor? (SATA) A. Bicarbonate excess B. Kussmaul's respirations C. Flushing D. Circumoral paresthesia E. Lethargy

A. Bicarbonate excess D. Circumoral paresthesia

A nurse is reviewing a clients laboratory report of blood gas findings. HCO3 18, PaCO2 28. Which of the following pH Values and donitions should the nurse expect when interpreting these findings? A. Decreased pH and metabolic acidosis B. Decreased pH and respiratory acidosis C. Elevated pH and metabolic alkalosis D. Elevated pH and respiratory alkalosis

A. Decreased pH and metabolic acidosis

A nurse is preparing to administer potassium chloride (KCL) to a client who is receiving potassium diuretic therapy. The nurse reviews the clients serum potassium and it is 3.2. Which of the following actions should the nurse take? A. Give the ordered KCL as prescribed B. Omit the KCL dose and document that it was not given C. Hold the prescribed dose and notify the provider of the serum potassium level D. Call the lab to verify the clients results

A. Give the ordered KCL as prescribed

A nurse is admitting a client who has serum calcium level of 12.3, and initiates cardiac monitoring. Which of the following findings should the nurse expect during initial assessment? A. Lethargy B. Hyperactive deep tendon reflexes C. Prolonged st segment D. Hyperactive bowel sounds

A. Lethargy

A nurse is caring for a client who has the following arterial blood gas results: HCO3 18, PaCo2 28, pH 7.30. The nurse recognizes the client is experiencing which of the following acid base imbalances? A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis

A. Metabolic acidosis

A nurse is caring for a client whose arterial blood gas results show a pH of 7.3 and a PaCO2 of 50. The nurse should identify that the client is experiencing which of the following acid base imbalances? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis

A client is admitted to the emergency room with a respiratory rate of 7/min. Article blood gases (ABG) reveal the following values. Which of the following is an appropriate analysis of the ABGs? pH 7.22, PaCo2 68, Bicarbonate 26. A. Respiratory Acidosis B. Metabolic Acidosis C. Metabolic Alkalosis D. Respiratory Alkalosis

A. Respiratory Acidosis

A nurse is reviewing the arterial blood gas values for a client. The pH is 7.32, PaCO2 48, and HCO3 is 23. The nurse should recognize that these findings indicate or which of the following acid base balance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

A. Respiratory acidosis

A nurse is assessing a client who is taking chlorothiazide sodium. The nurse recognizes which of the following as manifestation of hypokalemia? A. Shallow respirations B. Hypertensive crisis C. Diarrhea D. hyperreflexia

A. Shallow respirations

A nurse is caring for a client who had a thyroidectomy and a serum calcium level of 7.6. Which of the following findings should the nurse expect? A. Tingling of the extremities B. Hypoactive deep tendon reflexes C. Shortened QT intervals D. Constipation

A. Tingling of the extremities

Which of the following are priorities? Select 2. A. Urine output of 20 mL/2 hrs B. Potassium of 4.7 C. Blood pressure of 104/68 D. Pulse of 98 E. Sodium of 160 F. Glucose of 82

A. Urine output of 20 mL/2 hrs E. Sodium of 160

A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect? A. pH 7.25, HCO3 19, PaCO2 30 B. pH 7.30, HCO3 26, PaCO2 50 C. pH 7.50, HCO3 20, PaCO2 32 D. pH 7.55, HCO2 30, PaCO2 31

A. pH 7.25, HCO3 19, PaCO2 30

A nurse is reviewing the article blood gas (ABG) results of a client who the provider suspects has metabolic acidosis. Which of the following results should the nurse expect to see? A. pH below 7.35 B. HCO3 above 26 C. PaO2 below 70 mm Hg D. PaCO2 above 45 mm Hg

A. pH below 7.35

do OTC medications cure a UTI?

AZO is for s/s it will not cure infection

Arterial Blood Gas (ABG) When is this indicated?

Any respiratory related illness, acute respiratory distress, trauma, s/s respiratory fatigue

A nurse is caring for a female client in the emergency department who reports shortness of breath, and pain in the lung area. She states that she started taking birth control pill 3 weeks ago and that she smokes. Her heart rate is 110/min, RR 40/min, and blood rpressure is 140/80 mm Hg. Her arterial blood gases are pH 7.50, PaCo2 29, PaO2 60, HCO3 20, SaO2 82%. Which of the following is the priority intervention? A. Prepare for mechanical ventilation B. Administer oxygen via face mask C. Prepare to administer sedative D. Assess for indications of pulmonary embolism

B. Administer oxygen via face mask

A nurse is reviewing the laboratory values of a client who has respiratory acidosis. Which of the following findings should the nurse expect? A. HCO3 30 B. PaCO2 50 mm Hg C. pH 7.45 D. Potassium 3.3

B. PaCO2 50 mm Hg

A nurse is caring for a client who has an indwelling urinary catheter and notes blood-tinged urine in the catheter bag. The nurse recognizes this finding can be a manifestation of what?

Bladder cancer

A nurse is caring for a client who has hypernatremia and requires IV fluid therapy due to his NPO status. Which of the wallowing solutions should the nurse prepare to infuse for this client? A. Lactated Ringers B. Dextrose 5% in 0.9% sodium chloride C. 0.45% sodium chloride D. Dextrose 10% in water

C. 0.45% sodium chloride

A nurse is caring for a client who has a prescription for potassium chloride (KCL) 20 daily PO. The nurse reviews the clients most recent laboratory results and finds the clients potassium level is 5.2. Which of the following actions should the nurse take. A. Give the ordered KCL as prescribed B. Omit the KCL dose and document it was not given C. Call the prescribing physician and inform her of the clients serum potassium level results. D. Call the lab to verify the clients results

C. Call the prescribing physician and inform her of the clients serum potassium level results.

A nurse is in the emergency department is caring for a client who collapsed after playing football on a hot day. The nurse recognizes these findings are consistent with which of the wallowing conditions? Sodium 154 glucose 102 Potassium 3.6 BUN 18 Chloride 105 Creatinine 0.7 A. Renal failure B. Low protein diet C. Dehydration D. Syndrome of inappropriate antidiuretic hormone

C. Dehydration

breast cancer what are most common s/s?

dimpling, pain, lump/mass, discharge, inverted nipple, orange peel skin, flaking

Arterial Blood Gas (ABG) Who can collect?

respiratory therapist nurses can if they have been trained, same as lab tech

Review this information

Cholecystitis - Infection of the Gallbladder, most common in women who has recently given birth, caused by high fat diet, causes clay-colored stools can be a s/s chronic condition, whereas severe abdominal pain, fever, NVD can be s/s of acute condition. Best diagnostic tool is ERCP. Cholelithiasis refers to gallstones.

A nurse is teaching a client who has a urinary tract infection (UTI) and is taking ciprofloxacin. What education needs to be given, be specific.

Complete the full course of the antibiotic to avoid resistance

A nurse is caring for an older adult client who has a urinary tract infection (UTI). Which of the following manifestations should the nurse expect to identify as a finding specifically associated with this client?

Confusion

treatment for respiratory alkalosis

reverse overdose, reduce fever, decrease pain, O2, diuretics for pulmonary edema, calming techniques, adjust vent settings

Sodium of 160 What might the patient be exhibiting?

Decreased LOC, irritability

A nurse is assessing a preschooler who has a calcium level of 8.0. Which of the following findings should the nurse expect? A. Dry, sticky mucous membranes B. Polyuria C. Negative chvostek's sign D. Muscle tremors

D. Muscle tremors

A nurse is caring for a client who has a new prescription for a low sodium diet. The clients family has requested to bring in some of teh clients favorite foods. Which of the following food items should the nurse tell the family members to omit? A. Boiled rice B. Flat bread C. Broiled fish fillet D. Pickled vegetables

D. Pickled vegetables

A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values would the nurse expect this client to have? A. pH 7.49, HCO3 24, PaCO2 30 B. pH 7.49, HCO3 30, PaCO2 40 C. pH 7.26, HCO3 24, PaCO2 46 D. pH 7.26, HCO3 14, PaCO2 30

D. pH 7.26, HCO3 14, PaCO2 30

what IV fluid would you give to a patient with an elevated potassium?

D5 with insulin

what is the treatment for hyperkalemia?

D5 with insulin

what are treatments for hyperkalemia?

D50 with insulin, sodium bicarb, Ca gluconate, diuretics

Sodium of 160 What is the first line of action in treatment?

D5W/Mannitol

Sodium of 160 What may the common cause be?

DM insipidus

A nurse is assessing a client who reports frequent vomiting and diarrhea for the past 3 days. What should the nurse expect to observe on a physical exam?

Dehydration, poor skin turgor, flat neck veins, darker urine, decreased urine, low sodium or potassium

A nurse is reviewing the medical record of a client who has a potassium level of 3.0 mEq/L. List out possible causes?

Diabetic ketoacidosis, diarrhea, anorexia, sweating, excessive alcohol use, chronic kidney disease

cholecystitis how is this diagnosed?

ERCP DX, labs, CT

List the type of patient the nurse may identify as being at risk for fluid volume deficit?

Elderly, infants suffering insensible loss, hemorrhage

A nurse is teaching a group of teenage clients about the use of condoms for the prevention of sexually transmitted infections (STIs). What information does the nurse need to provide?

Female condoms can reduce transmission

A nurse is assessing a client who has a sodium level of 116 mEq/L. What findings should the nurse anticipate?

Hyponatremia, N/V, headache lethargy, coma

when would we expect to use hypertonic solutions?

severe hyponatremia and increased ICP

Which of the following is most critical, and why? Potassium 3.6, Sodium 126, Magnesium 1.3 or Glucose 130?

Sodium 126

what are the common medications used to treat erectile dysfunction?

sildenafil

can you give potassium as an IV push?

NEVER give potassium in IV push

what is the #1 risk factor for any type of cancer?

smoking

Which of the following are at risk for Respiratory Alkalosis? A patient with nausea/vomiting/diarrhea, a patient who is taking a diuretic or a patient who is suffering from Aspirin overdose.

Pt with aspirin alkalosis

A nurse is assessing an older adult client who is receiving IV therapy. What are the s/s the nurse should monitor for regarding risk of fluid volume excess?

Renal impairment, liver problems, heart diseases, fluid retention

A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor what lab value(s)?

Sodium values, hypernatremia

how do we properly treat UTIs?

UA sample, CX and sensitivity

what is the most common treatment for benign prostatic hyperplasia?

anticholinergics

what relaxes bladder muscles?

anticholinergics

the mechanism of action of an anticholinergic in treating BPH can be explained how?

anticholinergics help with urinary retention and relax the bladder muscles

treatment for respiratory acidosis?

bronchodilators, O2, ATB for infection, chest tube, intubations with ventilation, reverse sedation, tx heart failure

describe the type of urine you would expect with a patient with a UTI?

cloudy, purulent, odorous

what is key before we start treatment of UTIs?

collect urine properly before starting antibiotic therapy, educate

what is key after starting treatment of UTIs?

complete all antibiotic therapy, wipe from front to back, bubble bath

would you expect the patient who is suffering from pyelonephritis to have pain, if so, where?

costovertebral region

cholecystitis is this dangerous if left untreated?

death can occur relating to gangrene

what are s/s of hypernatremia?

disorientation, hallucinations, agitations, restlessness, confusion, SZ, tachycardia, flushing, thirst

do we need to take any additional precautions when caring for a patient suffering from dehydration? if so, what?

elderly patients, hydration

cholecystitis what are the common causes?

fatty diet, post-pregnancy, female

would you be more concerned about a patient with BLE +1 pitting edema or a patient with flattened neck veins?

flattened neck veins may be due to decrease fluid to circulate

what are treatments for hyponatremia?

fluid restriction, 3% NS, oral sodium replacement, loop diuretics

what are s/s hyponatremia?

headache, lethargy, SZ, nausea, vomiting, coma

what is the purpose of estrogen therapy?

hormone replacement after menopause or total hysterectomy

what electrolyte imbalance would you anticipate with a patient with a SBO (small bowel obstruction) who has an NG tube placed?

hypokalemia

what are some of the common side effects of these oral medications for erectile dysfunction?

hypotension, prolonged erection

what is the most sensitive patient population to fluid imbalance?

infants

how can the nurse prevent CAUTI?

keeping it clean and sterile technique, use only when necessary

what would you expect to see in a patient's labs who is suffering from dehydration?

low sodium, potassium, BUN, creatinine, urine specific gravity, urine osmolality

pH 7.30, pCO2 36, HCO3 21

metabolic acidosis cause: DM, shock, renal failure

pH 7.50, pCO2 36, HCO3 31

metabolic alkalosis cause: sodium bicarb, tums, NG tube, prolonged NVD

pH 7.36, pCO2 37, and HCO3 25

normal

what are the steps in testicular self exam?

one testis at a time

what are treatments for hypokalemia?

oral intake, supplements, IV replacements

A nurse is reviewing the arterial blood gas (ABG) results of a client who the provider suspects has metabolic acidosis. Which of the following results should the nurse expect to see?

pH less than 7.35 and HCO3 more than 26

Arterial Blood Gas (ABG) What is a normal ABG?

pH: 7.35 - 7.45 PaCO2: 35 - 45 HCO3: 22 - 26

Are there any special considerations when caring for a patient with an STI, to include sharing of information and/or access to medical records? If so, explain

patient education, notify their sexual partners, report to local health department, access their medical records for history, share information with parents if minor

would you question an order for IV fluids on a patient in fluid volume excess?

potentially, IV should not be used, think about mL/hr as well, one liter or ongoing order

what does this color urine indicate?

pyridium medication for UTI can cause this, it will stain underwear educate patient

cholecystitis how is this treated?

removal of GB and/or diet modifications

pH 7.30, pCO2 48, HCO3 24

respiratory acidosis cause: respiratory depression, COPD, PNA, drugs, CNS trauma

pH 7.59, pCO2 18, and HCO3 25

respiratory alkalosis cause: hyperventilation, emotions, pain

treatment for metabolic acidosis

sodium bicarb IV, IV fluids, rapid acting insulin, antidiarrheals, dialysis, ventilation

treatment for metabolic alkalosis

stop potassium wasting diuretics, stop NG is possible, treat NVD

what medication(s) for acne can affect a fetus?

tazorac (tazarotene)

what are care/considerations when caring for a patient with blunt trauma to the testicles?

therapeutic communication, administer pain medication if available, embarrassed and guarded depending on age

what nursing interventions as appropriate for a patient suffering from respiratory alkalosis?

therapeutic environment, decrease stimuli, breathing techniques

when would you expect to see estrogen replacement therapy ordered?

total hysterectomy, ovary removal, ovary trauma, post-menopausal

what medications can cause metabolic alkalosis?

tums

what does a bladder scan indicate?

urinary retention, measuring post void if retention is expected

what are s/s of hyperkalemia?

weakness, cramps, paresthesia to weakness, widened QRS complex, brady, sinus arrest, heart blocks

what are s/s of hypokalemia?

weakness, lethargy, generalized weakness, ECG changes, ST depression, PVCs, nausea, vomiting, constipation, cramping

what age should women being having mammograms? does family history of breast ca impact this?

women start at the age 40 and get annual checks at age 45. family history does affect frequency

can the wrong type of fluid be harmful, if so why?

yes because it can pull fluid in and out of cells, depending on their diagnosis

do you suspect erectile dysfunction to be a difficult topic to discuss, why?

yes due to pride, society, age, gender and race