NURS 327 final
What is the difference between respiration and ventilation?
Respiration: exchange of gases Ventilation - bringing air in
Is Buck;s traction skin or skeletal?
Skin
How does Glucophage (metformin) work?
Slows the Release of sugar in the blood. Helps the boys respond better to insulin Reduce his glucose absorption
An x-ray of a trauma client reveals rib fractures in a client diagnosed with foil chest injury. Which intervention should the nurse include in the clients plan of care?
Suction the clients airway
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?
Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees.
In the surgery, when we verify the right pt, the right surgery on the right part of the body, what is this called?
Surgical time out
Morton neuroma is exhibited by which clinical manifestation
Swelling of the third lateral branch of the medial plantar nerve.
Which is not a guideline for avoiding hip dislocation after replacement surgery.
The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.
What is diffusion?
The movement of particles from an area of high concentration to an area of low concentration.
Some patient are given Enoxiparin 30mg SC prior to surgery. What is the reason for that?
To prevent a DVT
reasons for hypoglycemia
Too little food Medications Too much exercise
What is the cause of acute pancreatitis
Trypsin digest the pancreases
Your post op patient is nauseated. What is the first thing you should do?
Turn their head to the side
What type of diabetes is initially treated with diet and exercise?
Type 2
What is the difference between type one and type 2 diabetes?
Type one dose not produce insulin. While type 2 dose not respond to insulin.
The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure?
Up to 2 hours before surgery
Describe airborne precautions
Wear a mask that is an N95. The room is negative pressure so the air gets sucked in.
Why is it called a partial non-rebreather mask?
You are unable to inhale anything you exhale
What is the difference between colonization and infection
You have the bug in colonization. In infection the bug is present and the host gets sick.
When developing a teaching plan for a client scheduled for an amatory surgery with epidural anesthesia, which of the following would the nurse include?
You should experience a headache after this type of anesthesia
A nurse is planning discharge instructions for a client with osteomyelitis. What instruction should the nurse include in the discharge teaching?
You will receive IV antibiotics for 3 to 6 weeks
What is achlorhydria?
absence of hydrochloric acid in the gastric secretions
The trachea is __________ to the esophagus
anterior
morbid obesity
body mass index (BMI) of 40 or greater, which is generally 100 or more pounds over ideal body weight
Halux Valgus
bunion
Crohn's disease
chronic inflammation of the intestinal tract. Think cobble stones
When you inhale, the diaphragm
contracts
Xerostomia
dry mouth
How is Hepatitis A transmitted?
fecal-oral route
Describe droplet precautions
focuses on diseases that are transmitted by large droplets in the air that travel 3 to 6 feet from the patient. Precautions require wearing surgical masks. (ex. influenza). Private room.
The nurse is performing an assessment on an older adult patient and observes patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as?
kyphosis
What is eupnea?
normal breathing
Odynophagia
painful swallowing
The 3 p's in diabetes
polydipsia, polyuria, and polyphagia
Symptoms of hypoglycemia
tachycardia, excessive sweating (diaphoresis), light-headedness, visual disturbances
HHNS Vs DKA
· Diabetic ketoacidosis (DKA) is a condition of DKA=insulin deficiency resulting in acidemia due to altered metabolism. · Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is primarily a disorder of dehydration due to hyperglycemia
The physician schedules an elective surgical procedure for a patient who smoke cigarettes. When should the nurse recommend the client see smoking before surgical procedure to minimize risk associated with smoking cigarettes?
• 1 to 2 months
A client with emphysema informs the nurse, "The surgeon will be removing about 30% of my lung so that I will not be so short of breath and will have an improved quality of life." What surgery does the nurse understand the surgeon will perform?
• A lung volume reduction
Which statement describes paresthesia?
• Abnormal sensations
The nurse is caring for a client who has recurring cyanide us. Which consideration could the nurse suggest to best decrease the frequency of infection?
• Administer over-the-counter decongestant
A client is admitted with acute osteomyelitis that develops after an open fracture of the right femur. When planning the clients care the nurse her and anticipate which measure?
• Administering a large dose of IV antibiotics as ordered
During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?
• After menopause the bone density declines resulting in a gradual loss of height
A patient brought into the emergency department with carbon monoxide poisoning after escaping a house fire. What should the nurse monitor the patient for?
• Anemic hypoxemia
What is the most commonly prescribed treatment for the common cold?
• Anti-histamines
A client has undergone arthroscopy. After the procedure the site where the arthroscopy was inserted is covered by a bulky dressing. The clients entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy.
• Apply cold pack at insertion site
A client is scheduled to have an x-ray examination of the shoulder in which the synovial fluid will be aspirated and sent to laboratory for analysis. This will be followed by administration of a medium an x-ray. What procedure will the nurse prepare the client for?
• Arthrogram
A client has a fiberglass cast on the right arm. What action should the nurse include in the care plan?
• Assessing movement and sensation in the fingers of the right hand
A nurse is caring for a client place in traction to treat a fractured femur. Which nursing intervention has the highest priority?
• Assessing the extremity for neurovascular integrity
A group of students studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction?
• Bucks
Following a total Knee replacement, the surgeon orders a CMP device. The client asked was the purpose of this treatment. What is the best response by the nurse?
• CMP increase his range of motion to the joint
Which hormone inhibit bone reabsorption in calcium deposit in the bone?
• Calcitonin
Which medication directly inhibits osteoclast thereby reducing bone loss and increasing bone mass density?
• Calcitonin
Declined a ride to the emergency department reporting shortness of breath. She has 3+ pitting Edema below the knee, respiration rate of 36 breaths per minute, and hearing respirations. The nurse auscultate so long to do real course crackles, moist high pitch noncontinuous sounds that do not clear with coughing. The nurse will document this sound ask which type?
• Crackles
The nurse is asked to explain to the client the age related process contributed to Beaumont and osteoporosis. What is the nurses best response
• Decrease in estrogen
The nurse is conducting the admission assessment for a client who is to undergo an arthrogram. What is a priority question the nurse should ask?
• Do you have any allergies • Many contrast dye's contain iodine.
Which term refers to flexion deformity caused by slowly progressive contractor of the Palmer facia?
• Dupunytren contracture
A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain?
• Elevate the affected extremity and use cold compress
A client with a fractured ankle is having a fiberglass cast applied. The client is yelling my leg is burning take it off. What action by the nurse is most appropriate?
• Explain that the sensation being felt is normal and will not burn the client.
After a bone fracture, fibrocartilaginous callus formation occurs at the same time of which process?
• Fibroblast migration
The nurse reminder a client receiving mechanical ventilation for which of the following complications?
• Gastrointestinal hemorrhage
A client undergoes an arthroplasty and outpatient clinic. After the procedure the nurse provides discharge teaching. Which response by the client indicates a need for further teaching?
• I should use a heating pad this evening to reduce some pain in my knee • The client should not use heat during the first 24 hours after the procedure because it could increase swelling.
Which measurement may increase compliance for a client with COPD?
• Increased oxygen supply
A female client is at risk for developing osteoporosis. Which action reduce the clients risk?
• Initiating weight-bearing exercise routine
Which intervention should the nurse implement with a client who has undergone a hip replacement?
• Instruct the client to avoid internally rotating of the legs
A client has an exaggerated convex curvature of the thoracic spine. What is the condition called?
• Kyphosis
A client has had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis has dislocated?
• Left leg has rotated internally
The client presents with an exaggeration of the lumbar spine curvature. How does the nurse interpret this finding?
• Lordosis
Which area of the spinal column is subjected to the greatest mechanical stress and degenerative changes?
• Lower lumbar
It is important for the nurse to provide required information in appropriate explanation of diagnostic procedures to a client with respiratory disorder in order to?
• Manage decreased energy levels
During surgery the patient develops a rebound hypothermia. The circulating nurse will monitor the patient closely for which of the following?
• Metabolic acidosis
The nurse is providing instructions to a client who is being prepared for skeletal traction. Which statement by the client indicates the teaching was effective?
• Metal pins will go through my skin to the bone
The wife of a client is concerned because her husband is requiring increasing high doses of pain medication. She states he was in pain long before he got cancer because he broke his back about 20 years ago. For that problem though his pain medication wasn't raised. What would the nurses best response be
• Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the clients relief.
A bone GLA protein has been ordered. How will the nurse prepare this order?
• Obtain a blood specimen
Client factor was reduced by surgically exposing the bone and realigning it. What type of treatment does this nurse identify this as?
• Open reduction
An instructor is describing the process of bone development. Which of the following would be the instructor described as being responsible for the process of ossification?
• Osteoblast
The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation?
• PaCO2
A patient had hand surgery to correct dupunytren's contracture. What nursing intervention is a priority postoperatively?
• Performing hourly neurovascular assessments for the first 24 hours
The nurse is conducting a musculoskeletal assessment of a client in a nursing home. The client is unable to dorsiflex right foot or extend the toes. The nurse evaluates this finding as an injury to which nerve?
• Peroneal
Which of the following presents with an onset of heel pain with first step in the morning?
• Planters fasciitis
When assessing a client with infectious diarrhea, which of the following would be the nurses suspect that the client is experiencing severe dehydration?
• Rapid, thready pulse
Which action by the nurse is most appropriate when the client demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery?
• Record the observation
Which of the following is the final stage of fracture repair?
• Remodeling
The client is postoperative from a total knee arthroplasty and medication include lidocaine 5%. Past medical history includes a left mastectomy and herpes zoster following treatment with chemotherapy. The best nursing action is to:
• Remove the patch after 12 hours
A client has a nursing diagnostic of ineffective airway clearance related to excessive mucus production. The best short term goal is for the client to?
• Report decreased congestion
The nurse is caring for a patient with emphysema, understand the airflow limitations are not reversible. The end result of deterioration is.
• Respiratory acidosis.
A client is brought to the emergency department by softball team member who states that the client in another player ran into each other and the clients is experiencing severe pain in the right shoulder. What symptoms are they fractured clavicle does the nurse recognize?
• Right shoulder slopes downward and droops inward
A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain?
• Sharpe and piercing
Are they visit the family healthcare provider, a client is diagnosed with bunions on the lateral side of the great toe at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?
• Some bunions are congenital, others are caused by wearing shoes that are too short and or narrow.
The nurse is assessing a client for scoliosis. What will the nurse have the client due to perform the assessment.
• Stand behind the client asked the client to bend forward at the waist
Clients left leg is in a skeletal traction with a Tomas splint and Pearson attachment. Which intervention should the nurse include in the clients care plan?
• Teach client how to prevent problems caused by immobility
A client has been treated for migraine headaches for several months and has come to the clinic stating that he is getting no better. The nurse is talking with a client and here's an audible click when the client is moving his job. What does the nurse suspect may be happening?
• Temporomandibular disorder
Which statement is accurate regarding the care of plaster cast?
• The cast can be dented while it's damp.
Which statement by a staff nurse on the orthopedic floor indicates a need for further education?
• The client is receiving physical therapy twice per day so the client does not need to continue passive motion device
Which homeostatic mechanism would the body of a critically ill client used to maintain normal pH?
• The lungs eliminate carbonic acid by blowing off more CO2
A client is described of having pectus carinatum. What physical manifestations what does condition have?
• The sternum protrudes in the ribs are sloped backwards.
The nurse is providing instructions to a client following application of a fiberglass cast. Which statement by the client indicates further education is needed?
• Under no circumstance should I get my cast wet • The cash and I come in contact with other plastic because the reaction can occur
A mechanically ventilated client is receiving a combination of atracurium and opioid analgesic morphine. The nurse reminder the client for which potential complication?
• Venous thromboembolic
The older adult client asked the nurse how to best maintain strong bones. What is the yes nurses best response?
• Weight bearing exercise can strengthen bones
The nurse is caring for a client following a tonsillectomy and adenoidectomy. Two hours after the procedure, the client begins to vomit large amounts of dark blood at frequent intervals and is tachycardic and febrile. After notifying the surgeon, the nurse
• obtains a light, mirror, gauze, and curved hemostat
What is asterixis?
"flapping tremor"
Malignat hypothermia usually occurs within _________ of induction
1 to 24 hours
Short acting insulin will peak at what time?
1-3 hours
List 5 ways to keep an oxygen tank safe?
1. Do not smoke near it 2. Transport on the floor in the car 3. How to use the tank 4. Keep out of the sunlight 5. Keep 5 feet from the electric outlets BE IN A CARRIER
Gastritis is inflammation of the gastric mucosa. Name 3 of the most common causes of gastritis?
1. Feeding 2. H. Pylori 3. Smoking, alcohol, medications
List the 8 elements of standard precautions
1. Gloves 2. PPE 3. Sharps container 4. Safe handling of waste 5. Hand washing 6. Lining 7. Cling 8. Fluid resistant gowns
What are 8 strategies to prevent atelectasis?
1. I.S 2. Movement 3. Deep breathing 4. Coughing 5. Percussion 6. Turning the Pt 7. Encourage liquids 8. Pursued lip breathing
List the two main diseases that would have the patient placed in airborne precaution.
1. Measles 2. TB
Name the six links in the chain of infection
1. Portal of entry 2. Infectous agent 3. Resovoir 4. Portal of exit 5. Mode of transmission 6.Susceptible host
What are the three phases preoperative care. What are they?
1. Preoperative: Before the operation 2. Intraoprative: In the surgery 5. PostOp: After the surgery till last appointment
List the 5 main people on the surgical team
1. Surgeon 2. Anesthesiologist or nurse ansiatist 3. Scrub nurse 4. RN first assist 5. Circulating nurse
Health care workers should be immune to or be vaccinated against which 5 diseases?
1. T Dap 2. Chicken pox 3. MMR 4. Hep B 5. Flu
Name three anti-nausea medications
1. Zofran 2. Phengan 3. Compazine
What are the 6 P's of compartment syndrome?
1.) Pain (present on passive movement and out of proportion to injury) 2.) Paresthesias (numbness, tingling, decreased sensation) 3.) Pallor (or cyanosis) 4.) Parythermia 5.) Paralysis (late, ominous sign) 6.) Pulselessness (very late, ominous sign)
What is the minimum daily fluid intake daily?
1.5 L
Normal blood sodium
135-145
Humalog (insulin lispro) onset
15 mins or less
The renal glucose threshold
180-200. Point to where the kidney can't handle the glucose anymore
HCO3 levels
22-26
normal potassium
3.5-5
blood CO2 levels
35-45
What % Oxygen will be delivered with a simple face mask
40-50%
At what amount of blood loss should you be concerned?
500 ML
What is the normal glucose level
60-120 mg?dL
Blood pH
7.35-7.45
Normal calcium levels
8.5-10.5 mg/dL
What is the earliest indicator of shock?
A change in the LOC
Absence of peristalsis in the lower esophagus is called what?
Achalasia
Client presents to the ED after being in a boating accident about three hours ago. Now the client reports having headache, fatigue, and feeling like he can't breathe enough. The nurse notes that the client is restless into cardiac with an elevated blood pressure. This client may be an early stages of what respiratory problem?
Acute respiratory failure
pancreatic secretions are _______? Why?
Alkaline. To cancel out HCL
Droplet precautions are for what 2 diseases?
All meningitis and all influenza Pertusis, Diptheria, Mumps, All Meningitis
Glycosalated Hemoglobin
Allows you to see a patients history for the last 3 months. How much glucose is carried by the Hem.
Refers to closure or collapse of alveoli
Atelectasis
Why doesn't micronase work with pt with type 1 diabetes
Because there is no insulin to produce
What dose lipase do?
Break down fats
What dose tripsyn do
Breakdown protein
You walk onto the unit and discover all the alcohol based hand rubs are gone. The most likely reason for this is what?
C. Diff
What type of pt do you use a ventri mask with
COPD Most accurate
Where can peptic ulcers occur?
Can be in esophagus, stomach duodem
Adenocarcinoma is defined as
Cancer that starts in the mucous producing cells
What laxative should be used by cardiac patients to avoid straining?
Colace
The elasticity of the lungs and throat is called?
Compliance
If edition determines that the client has been exposed to someone with TV. The nurse expect the physician to order what treatment?
Daily doses of isoniazid, 300 mg for 6 months to 1 year
Diabetes control depends on three factors. What are they?
Diet Exercise Medications
Describe contact precautions
Door can be open. You need a gown and booties. You can wear a mask and goggles but they are not necessary.
describe surgical asepsis
Everything is sterile
Symptoms of DKA (diabetic ketoacidosis)
Fruity smell your breath Dehydration Hyperglycemia Acidosis
Which of the following factors increases blood urea nitrogen
Gastrointestinal bleeding
If you're not sure if you're patient is hypo or hyper glycemic what should you do?
Give them sugar
Which is better Soap and water Or Alcohol based hand rub
Hand washing is better overall. Hand rub can be used up to 5 times, in between rooms, and when hands are not visible soiled.
Describe the simplest maneuver to mange the pts airway in the post op setting
Head tilt and chin lift
Protrusion of the intestines through an opening in the muscle.
Hernia
Too much carbon dioxide in the blood is also known as
Hypercapnia
What is the difference between hypoxia and hypoxemia
Hypoxemia:low oxygen content in the blood leads to -> Hypoxia: inadequate oxygenation to the tissues and cells symptoms: decreased pulse ox, tachypnea*, confusion*, restlessness*, dyspnea, use of accessory muscles, cyanosis decreased LOC
Which is a benefit of a CMP device when applied after knee surgery?
It promotes healing by increasing circulation and movement of the new joint
What is a LMA
Laryngeal Mask Airway used fmost frequently during anesthesia Inflatable mask positioned directly over the opening into the trachea (hypopharynx) Indicated for short term intubation or facial or nasal injuries. Or and Emergency Dept , EMTs
What is the medication lactulose used for
Lower ammonia levels
After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority?
Maintaining traction continuously to ensure its effectiveness
And instructor is describing the process of bone development. Which of the following would be the instructor describe as being responsible for the process of bone ossification?
Osteoblast
A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period?
Osteomyelitis
carina of trachea
Point at which the trachea divides into bronchi
A 10-year-old boy who was brought to the emergency room after a skiing accident is diagnosed with a fracture of the distal end of the femur. Why is this type of fracture significant?
Potential growth problems may result from the damage to the epiphyseal plate.
