1. What is normal range forcholesterol, HDL, LDL

Less than 200, above 40,less than 130

2. What is the desired INR rangefor people taking warfarin

2.0-3.0

3. What is an indicator of cardiactamponade

Blood pressure is 10 MMHG or higher on expirationthen on inspiration

4. Patients scheduled for acoronary artery bypass graftshould not takeanticoagulants for at leastblank prior to the surgery toprevent excessive bleeding

A week

5. A patient is admitted with adiagnosis ofBradydysrhythmia. Whatassessment finding requiresimmediate intervention?

The patient reportsweakness and fatigue

6. Following insertion of apermanent pacemaker, apatient states they cannot getrid of these hiccups. Why isthis potentially a problem?

Hiccups may indicate thatthe pacemaker isstimulating the chest wallor diaphragm. This couldindicate a complicationsuch as lead wireperforation

7. Chapter 27 ...

8. What is the normal range forcreatine kinase? When areelevated levels first detectableafter myocardial injury andwhat is expected duration ofthe elevated levels?

30 to 170 units/L, 4 to 6hours, 3 days

9. What is the normal range fortroponin T? When are elevatedlevels first detectable aftermyocardial injury and what isexpected duration of theelevated levels?

Less than 0.2 ng/L, 3 to 5hours, 14 to 21 days

10. What is normal range fortroponin I? When are elevatedlevels first detectable aftermyocardial injury and what isexpected duration of theelevated levels?

Less than 0.03, threehours, 7 to 10 days

11. What is normal range formyoglobin? When are elevatedlevels first detectable aftermyocardial injury and what isexpected duration of theelevated levels?

Less than 90 mcg/L, twohours, 24 hours

12. While an echocardiogram is beingperformed what side should the patientlie on?

Left side andremain still

13. What are indications for anechocardiogram

CardiomyopathyHeart failureAnginaMyocardialinfarction

14. What are indications for stress test DysrhythmiasHFAnginaMI

15. What are two medications that areprescribed for pharmacological stresstest

DobutamineAdenosine

16. What do you instruct the patient to do 2to 4 hours before a stress test

Avoid tobacco,alcohol andcaffeine

17. Hemodynamic monitoring involvesspecial indwelling catheters thatprovide information about bloodvolume and perfusion, fluid status andhow well the heart is pumping. Arteriallines are placed in the radial (mostcommon), brachial or femoral artery.What should you Monitor for?

Monitorcirculation in thelimb with thearterial line.Such as capillaryrefill,temperature,color. Arteriallines are notused for IV fluidadministration

18. The pulmonary artery (PA) catheter isinserted into a large vein (internaljugular, femoral, subclavian, brachial)and threaded through the right atriaand ventricles into a branch of thepulmonary artery. PA catheters havemultiple lumens, ports and componentsthat allow for various hemodynamicmeasurements, blood sampling and

Infusion of IVfluids

ATI med surgStudy online at quizlet.com/_1f194r

19. What are thedifferent lumensused for?

20. What is theexpectedreference rangefor CVP (Centralvenous pressure)

1 to 8 MM HG

21. What is theexpectedreference rangefor pulmonaryartery systolic(PAS)

15 to 26

22. What is theexpected rangefor pulmonaryartery diastolic(PAD)

5 to 15

23. What is expectedrange forpulmonary arterywedge pressure(PAWP)?

4 to 12

24. What is theexpected rangefor cardiacoutput

4 to 7 L/minute

25. What is expectedrange for mixedvenous oxygensaturation

60% to 80%

26. When should anurse anticipatelowerhemodynamicvalues?

In older patients especially ifdehydration is a complication

27. What positionshould thepatient be in withhemodynamicmonitoring

Supine or Trendelenburg

28. What are postprocedurenursinginterventions forhemodynamicmonitoring

1. Obtain chest x-ray to confirm catheterplacement2. Continually monitor vitals3. Compare NIBP to arterial bloodpressure4. Observe and document waveforms.Report changes in waveforms to theprovider5. Document catheter placement eachshift and as needed6. Place the patient in supine positionprior to recording hemodynamic values (HOB can be elevated 15° to 30°)

29. What arecomplications ofhemodynamicmonitoring

30. What are nursingactionspreprocedurebefore anangiography

1. Patient is NPO for at least eight hoursbefore2. Assess for iodine/shellfish allergy3. Assess renal function4. Teach the client that the affected legmust remain straight after theprocedure5. The other normal stuff like ensureinformed consent blah blah

31. What are postprocedurenursinginterventions foran angiography

1. Assess vitals every 15 minutes for Onehour, every 30 minutes for one hour,every hour for four hours and thenevery four hours2. Assess the site for bleeding andhematoma with every vital sign check3. Maintain bed rest for 4 to 6 hours afterthe procedure4. Monitor urine output and administerIV fluids for hydration (contrast mediaacts as an osmotic diuretic)

32. How long dopatients receiveanticoagulationtherapy that havestent placement

6 to 8 weeks

33. What is cardiactamponade

Fluid accumulation in the pericardial sac

34. What aremanifestations ofcardiactamponade

hypotensionJVDMuffled heart soundsParadoxical pulse

35. What are nursingactions for cardiactamponade

1. Notify the provider immediately2. Administer IV fluids to combathypotension as prescribed3. Obtain a chest x-ray orechocardiogram to confirm diagnosis4. Prepare the client forpericardiocentesis

36. What isretroperitonealbleeding

Bleeding into the abdominal cavitybehind the peritoneum can occur due tofemoral artery puncture (after anangiography)

37. What are nursingactions forretroperitonealbleeding

1. Assess for flank pain and hypotension2. Notify the provider immediately3. Administer IV fluids and bloodproducts as prescribed

38. What are centralcatheter'sappropriate for

Any fluids due to rapid hemodilution inthe superior vena cava

39. What is postprocedure care fora PICC

40. What should youdo if there's anocclusion in theaccess device thatimpedes flow

1. Flush the line at least every 12 hours tomaintain patency (3 mL for peripheral &10 mL for central lines)2. Administer urokinase to lyseobstructions per facility protocol 3. Flush implanted port after every useand at least once a month whileimplanted

41. What are nursingactions for acatheterthrombosis/emboli

1. Flush the line per facility protocol2. Do not force fluid if resistance isencountered3. Use a 10 mL or larger syringe to avoidexcessive pressure

42. What is treatmentfor infiltration andextravasation

1. Remove using direct pressure withgauze sponge until bleeding stops2. Apply cool compress3. Elevation is optional4. Avoid starting a new IV site in the sameextremity

43. What are nursinginterventions toprevent an airembolism in a vascularaccess device

1. Leave central lines clamped whennot in use2. Have the patient hold breathwhile the tubing is changed3. If the patient has sudden SOB,place in Trendelenburg on left side,give oxygen and notify the provider

44. What are nursinginterventions toprevent accidentaldislodgment of acatheter

1. Cover the extremity site withstretch netting2. Wrap a washcloth folded intothirds around the arm beforeapplying a needed restraint3. When removing the dressing, pullfrom distal to proximal

45. Hemodynamicpressure lines shouldbe calibrated to readatmospheric pressureas blank.

Zero. Zero transducer to room air

46. What kind ofmedication would youuse for vasodilationsecondary to sepsis

Dopamine (vasopressors)

47. Chapter 28 ...

48. What aremedications/electricalmanagement forbradycardia

1. Atropine and isoproterenol(antiarrhythmic andbronchodilator) 2. Pacemaker

49. What aremedications/electricalmanagement for a fib,SVT or VT with pulse

1. Amiodarone, adenosine,verapamil (CCB)2. Synchronized cardioversion

50. What aremedications/electricalmanagement for VTwithout a pulse orventricular fibrillation

1. Amiodarone, lidocaine andepinephrine2. Defibrillation

51. What is cardioversion Delivery of a direct countershock tothe heart synchronized to the QRScomplex

52. What is defibrillation Delivery of an unsynchronized,direct countershock to the heart.Stops all electrical activity of theheart, allowing the SA node to takeover and reestablish a perfusingrhythm

53. What is held 48 hoursprior to electivecardioversion

Digoxin

54. What is indicative ofan MI

Chest pain and ST segmentdepression or elevation

55. Chapter 30 ...

56. What is anarthrectomy

Used to break up and remove plaqueswithin cardiac vessels

57. What is a stent Placement of a mesh wire device to holdan artery open and prevent restenosis

58. What is apercutaneoustransluminalcoronaryangioplasty

Involves inflating a balloon to dilate thearterial lumen and the adhering plaque,therefore widening the arterial lumen

59. What areindications for aPCI (angioplasty)

60. What arepreprocedurenursing actionsfor a PCI (besidesallergies,informedconsent, blahblah)

1. NPO at least eight hours if possible2. Assess renal function prior tointroduction of contrast dye3. Administer antiplatelet medications asprescribed

61. What are twomedications thatare administeredduring theintraprocedurefor PCI

Midazolam (Versed) and fentanyl

62. What is postprocedurenursing actionsafter a PCI

1. Assess vitals every 15 minutes for onehour, every 30 minutes for one hour,every hour for four hours and thenevery four hours.2. Assess the groin site at the sameintervals for bleeding and hematomaformation3. Assess for signs of thrombosis4. Maintain bed rest in a supine positionwith the leg straight for 4 to 6 hours ( orprescribed time)5. Monitor urine output

63. How long does aclient with a stentreplacementreceiveanticoagulationtherapy

6 to 8 weeks after

64. Perforation of an artery by thecatheter may cause blank

Cardiac tamponade

65. What are clinicalmanifestations of anaphylaxis

chillsFeverRashWheezingTachycardiaBradycardia

66. What are two medications thatmight be prescribed in theevent of anaphylaxis

Diphenhydramine orepinephrine

67. A coronary artery bypass graftis most effective when apatient has sufficientventricular function such as anEF greater then

40% to 50%

68. What are preproceduremedications for a CABG

1. Anxiolytics: lorazepamand diazepam2. Prophylactic antibiotics3. Anticholinergic such asscopolamine

69. What are some importantpreprocedure teachings for apatient that is going toundergo a CABG

1. Endotracheal tube andmechanical ventilator forairway management forseveral hours following thesurgery2. Inability to talk whileendotracheal tube is inplace3. Sternal incision andpossible leg incision4. 1 to 2 mediastinal chesttubes5. Indwelling urinarycatheter 6. Pacemaker wires7. Hemodynamicmonitoring devices

70. What are two medications thatare discontinued before aCABG

1. Diuretics 2 to 3 daysbefore surgery2. Aspirin and otheranticoagulants one weekbefore surgery

71. What are medications that areoften continued for CABG

Potassium supplementsAntidysrhythmic'sAntihypertensivesInsulin

72. Post procedure: what shouldyou do with the patient withintwo hours followingextubation

Dangle and turn the clientfrom side to side astolerated

73. What should youdo within 24hours after CABG

Assist the patient to a chair. Ambulatethe patient 25 to 100 feet by firstpostoperative day

74. How often shouldyou assessneurologicalstatus after CABG

Every 30 to 60 minutes until the clientawakens from anesthesia, then every 2to 4 hours or per facility policy

75. Monitor chesttube patency anddrainage. Measuredrainage at leastonce an hour.Volumeexceeding blankcould be a sign ofpossiblehemorrhage andshould bereported to thesurgeon

150 mL/hour

76. What kind ofmanifestations ofpain might anolder femalepatient showinstead of chestpain

Dyspnea, indigestion

77. What is a hearthealthy diet

Low-fat, low cholesterol, high-fiber, low-salt

78. What should thepatient's activitylevel be after aCABG

79. What canhypothermiacause

Vasoconstriction, metabolic acidosis andhypertension

80. What areindications ofcardiactamponade aftera CABG

1. Sudden decrease of chest tubedrainage following heavy drainage2. JVD with clear lung sounds3. Equal PAWP & CVP values

81. Treatment ofcardiactamponade aftera CABG involves

1. Volume expansion2. Emergency sternotomy(Pericardiocentesis is avoided becauseblood may have clotted)

82. What is maximumpotassiumadministrationrate IV

10 to 20 mEq/hour

83. How long shoulda patient remainNPO before aperipheral bypassgraft

Eight hours

84. What are twoclient educationpoints for aperipheral bypassgraft

1. Advise the patient not to cross legs2. Explain that pedal pulses will bechecked frequently

85. What are postprocedurenursinginterventions fora peripheralbypass graft

1. Assess vitals every 15 minutes for onehour and then every hour after the firsthour2. Administer anticoagulanttherapy/antiplatelet therapy3. Maintain bed rest for 18 to 24 hours.The leg should be kept straight duringthis time

86. What are teachingpoints for footinspection andcare

87. The graft mayocclude due toreduced bloodflow and clotformation. Thisoccurs primarilyin the first

24 hours post operative

88. What kind ofprocedure is usedfor graftocclusion

Thrombectomy or thrombolytic therapy

89. What procedureis used forcompartmentsyndrome

Fasciotomy

90. Chapter 35 ...

91. What are physical assessment findingsfor peripheral artery disease

1. Bruit overfemoral and aorticartery's2. Decreasedcapillary refill oftoes3. Decreased ornon-palpablepulses4. Loss hair onlower calf, ankleand foot5. Dry, scaly,mottled skin6. Thick toenails7. Cold/cyanoticextremity8. Pallor ofextremity withelevation9. DependentRubor10. Muscle atrophy11. Ulcers andpossible gangrene

92. What are nursing actions forarteriography

1. Observe forbleeding andhemorrhage2. Palpate pedalpulses to identifypossible occlusions

93. How does a plethysmographydiagnose PAD

A decrease inpulse pressure ofthe lowerextremity indicatesa possible blockagein the leg

94. A Doppler probe is used to takevarious blood pressure measurementsfor comparison. In the absence ofperipheral arterial disease, pressuresin the lower extremities are

Higher than thosein the upperextremities

95. What is nursingcare for a patientwith PAD

1. Encourage collateral circulation2. Avoid crossing legs3. Avoid restrictive garments4. Elevate the leg to reduce swelling, butnot to elevate them about the level of theheart5. Provide a warm environment6. Avoid exposure to cold7. Avoid stress, caffeine and nicotine andanything that causes vasoconstriction

96. What aremedications forPAD

1. Antiplatelet medications - aspirin,Plavix, trental2. Statins - can relieve manifestationsassociated with PAD such as intermittentclaudication

97. What are twosurgicalprocedures forPAD

1. Percutaneous transluminalangioplasty 2. Laser assisted angioplasty

98. What are nursinginterventions forthese twoprocedures

1. Observe for bleeding/vitals2. Keep client on bed rest with limbstraight for 6 to 8 hours beforeambulation3. Antiplatelet therapy for 1 to 3 months

99. What is arterialrevascularizationsurgery used for

Patients who have severe claudicationand/or limb pain at rest, or patients whoare at risk for losing a limb due to poorarterial circulation

100. What are nursingactions forarterialrevascularizationsurgery

1. Maintain adequate circulation in therepaired artery. The location of the pedalor dorsalis pulse should be marked andits strength compared with thecontralateral leg on a scheduled basisusing a Doppler2. Assess color, temperature, sensationand capillary refill compared with thecontralateral extremity on a scheduledbasis3. Monitor BP!!!!4. No bending of the hip and knee

101. Onecomplication ofgraft iscompartmentsyndrome whataremanifestationsof it

TinglingNumbnessWorsening painEdema Pain on passive movementUnequal pulses(prepare patient for Fasciotomy)

102. What are riskfactors forperipheral venousdisease

1. Venus thromboembolism associatedwith Virchow triad2. Hip surgery, total knee replacement,open prostate surgery3. Heart failure4. Immobility5. Pregnancy6. Oral contraceptives7. Family history

103. Patients withvenous diseasemost oftencomplain of limbpain that feelslike

Aching pain and feeling of fullness orheaviness in the legs after standing

104. What are signs ofDVT andthrombophlebitis

105. What are signs ofVenousinsufficiency

1. Stasis dermatitis is a browndiscoloration on the ankles that extendsat the calf relative to the level ofinsufficiency2. Edema3. Stasis ulcers ( typically found aroundankles)

106. What are clinicalmanifestation ofvaricose veins

1. Distended, superficial veins that arevisible just below the skin and aretorturous in nature2. Patients often report muscle crampingand aches, pain after sitting and pruritus

107. What arelaboratory testsfor PVD

D dimer test measures fibrindegradation products present in theblood produced from fibrinolysis. Apositive test indicates that thrombusformation has possibly occurred

108. What arediagnosticprocedures forDVT andthrombophlebitis

1. Venus duplex ultrasonography2. Impedance plethysmography 3. If the above test are negative for aDVT, but one is still suspected avenogram, which uses contrast materialor MRI may be needed for accuratediagnosis

109. For varicose veinsTrendelenburgtest is used. Whatare the nursingactions for thistest

1. Place the patient in the supine positionwith legs elevated2. When the patient sits up, the veins willfill from the proximal and if varicositiesare present

110. What should youencourage thepatient to do ifthey have DVT orthrombophlebitis

111. What should youteach the patientto do if they havevenousinsufficiency

112. What aremedications forDVT andthrombophlebitis

Anticoagulants

113. How long does ittake for warfarinto take affect

3 to 4 days

114. DVT andthrombophlebitisboth can usethrombolytictherapy. What arethe details of thistherapy?

115. For varicoseveins,sclerotherapymay beperformed. Whatare the details ofthis therapy?

116. What should thenurse monitor forpostoperativelyafter varicoseveins - veinstripping

117. What are twoother surgicalinterventionsthat can beperformed forvaricose veins

1. Endovenous laser treatment2. Application of radiofrequency energy

118. Venous stasisulcers often formover the medialmalleolus.Venous ulcersare chronic, hardto heal and oftenrecur. They canlead toamputationand/or death.What are nursinginterventions forvenous ulcers

119. What are patientteachings forpatients thathave venousulcers (diet andDVT prevention)

1. Recommend a diet high in zinc,protein, iron and vitamins A & C2. Instruct patient on the use ofcompression stockings

120. A pulmonaryembolism occurswhen athrombus isdislodged,becomes anembolus andlodges into apulmonaryvessels. What aremanifestationsof a pulmonaryembolism's

1. Sudden onset of dyspnea, pleuriticchest pain, restlessness andapprehension, feelings of impendingdoom, cough and hemoptysis

121. What are clinicalfindings of apulmonaryembolism's

TachypneaCrackles plural friction rubTachycardiaS3 or S4 heart soundsDiaphoresisLow-grade feverPetechia over chest and axillaeDecreased arterial O2 sat

122. What should youdo if you suspectthat a patienthas a pulmonaryembolism

1. Notify the health care providerimmediately, reassure the client, andassist with position of comfort with thehead of the bed elevated.2. Prepare for oxygen therapy and ABGswhile continuing to monitor and assessthe patient for other manifestations

123. When shouldVenuscompressionstockings beremoved

Before going to bed. Legs should beelevated before the stockings arereapplied

124. Chapter 36 ...

125. What issecondaryhypertensioncaused by

Certain disease states or medications

126. How doeshypertrophia ofthe left ventricledevelop

As the heart pumps against resistancecaused by the hypertension

127. What is themaximum BMI aperson shouldhave in regardsto healthpromotion anddiseaseprevention forhypertension

30

128. What are riskfactors forsecondaryhypertension

129. Blank, can occurwith verapamilhydrochloride,so encourageintake of foodsthat are high infiber

Constipation

130. What kind ofjuice should notbe taken withCCB medications

Grapefruit juice

131. What are twoside effects ofARBs

Angioedema, hyperkalemia

132. Aldosterone receptorantagonists such as blank, blockaldosterone action. Theypromote the retention ofpotassium and excretion ofsodium and water

Eplerenone

133. What are Side effects ofaldosterone receptorantagonists

Hypertriglyceridemia,hyponatremia,hyperkalemia

134. What should you teach thepatient that is takingaldosterone receptorantagonists

No grapefruit juice orSt. John's wort. Do nottake salt substituteswith potassium or foodsrich in potassium

135. What do central alphaantagonist such as clonidine do

Reduce peripheralvascular resistance anddecrease bloodpressure by inhibitingthe reuptake ofnorepinephrine

136. What are side effects of centralalpha antagonist

Sedation, orthostatichypotension,impotence

137. Alpha adrenergic antagonist,such as blank, reduce bloodpressure by causing vasodilation

Prazosin

138. When is prazosin given Usually at Night andMonitor BP for twohours after initiation oftreatment

139. What are dietary approaches tostop hypertension

1. Diet high in fruits,vegetables, and low-fatdairy2. Avoid foods high insodium and fat3. Consume foods richin potassium, calciumand magnesium

140. What are clinical manifestationsof a hypertensive crisis

1. Severe headache2. Extremely high bloodpressure - greater than240/1203. Blurred vision,dizziness anddisorientation4. Epistaxis

141. What are two medications thatare given IV for a hypertensivecrisis

NitroprussideNicardipine

142. Before, duringand afteradministrationof IVantihypertensivewhat should youdo

Monitor BP every 5 to 15 minutes andassess neurological status and monitorECG

143. Chapter 17 ...

144. How long shoulda patient abstainfrom smokingbefore apulmonaryfunction test

6 to 8 hours prior to testing

145. If a patient usesinhalers howlong should theywithhold usebefore apulmonaryfunction test

Four to six hours prior to testing

146. What is PaO2 The partial pressure of oxygen

147. What is SaO2 Percentage of oxygen bound tohemoglobin as compared with the totalamount that can be possibly carried

148. What is normalbicarbonateaccording to ATI

21 to 28

149. What arepreprocedurenursing actionsfor an arterialpuncture

150. What areintraproceduralnursing actionswhileperforming anarterial puncture

151. What arepostproceduralnursing actionswhileperforming anarterial puncture

152. What are twocomplicationsfrom an arterialpuncture

Hematoma and air embolism

153. What should youdo if the patienthas a hematoma

1. Observe the patient for changes intemperature, swelling, color, loss of pulseor pain2. Notify the provider immediately ifsymptoms persist3. Apply pressure to the hematoma site

154. What should youdo if a patientexhibitssymptoms of anair embolism

1. Place the patient on his left side in theTrendelenburg position2. Monitor the patient for a sudden onsetof SOB, decrease in SaO2, chest pain,anxiety and air hunger3. Notify the provider immediately ifsymptoms occur, administer oxygen andobtain ABGs

155. Why is abronchoscopyperformed

1. Visualization of abnormalities such astumors, inflammation and strictures2. Biopsy3. Removal of foreign bodies andsecretions4. Treat post operative atelectasis

156. What ispreprocedurenursinginterventions fora bronchoscopy

157. What areintraproceduralnursinginterventions fora bronchoscopy

158. What are postprocedurenursinginterventions fora bronchoscopy

The patient is not discharged from therecovery room until adequate cough

reflex and respiratory effort are present

159. What are threecomplicationsthat can occurfrom abronchoscopy

Laryngospasm, pneumothorax,aspiration

160. What are nursinginterventions forLaryngospasm spasmand what can decreasethe likelihood oflaryngeal edema

1. Monitor the patient for signs ofrespiratory distress2. Maintain a patent airway byrepositioning the patient orinserting an oral/nasopharyngealairway as appropriate3. Administer oxygen therapy tothe patient as prescribed.Humidification can decrease thelikelihood of laryngeal edema

161. What are nursinginterventions for apneumothorax

1. Assess patient's breath soundsand O2 sat and obtain a follow-upchest x-ray

162. What are nursinginterventions foraspiration

1. Prevent aspiration and thepatient by withholding oral fluidsor food until the gag reflexreturns2. Perform suctioning as needed

163. What is a thoracentesis Performed to obtain specimensfor diagnostic evaluation, instillmedication into the plural space,and remove fluid or air from theplural space

164. What are preprocedurenursing interventionsfor a Thoracentesis

1. Obtain preprocedure x-ray asprescribed2. Position the patient sittingupright with his arms andshoulders raised and supportedon pillows and/or on an overbedtable and with his feet and legswell supported3. Instructed patient to remainabsolutely still during theprocedure and not to cough ortalk unless instructed by theprimary care provider

165. What areintraproceduralnursing interventionsfor a thoracentesis

1. Monitor the patient's vitals, skincolor and O2 sat throughout theprocedure2. Measure and record theamount of fluid removed from thepatient's chest(The amount of fluid removed islimited to one L at a time toprevent cardiovascular collapse)3. Label and send specimens tothe Laboratory

166. What are post procedurenursing interventions for athoracentesis

1. Apply a dressing over thepuncture site and assessdressing forbleeding/drainage2. Monitor vitals andrespiratory status hourly forthe first several hours after3. Encourage the patient todeep breathe to assist withlung expansion4. Obtain a chest x-ray (checkresolution of effusions, rule outpneumothorax)

167. What are complications ofa thoracentesis

Mediastinal shift,pneumothorax, bleeding,infection

168. What is a mediastinal shift Shift of thoracic structures toone side of the body (MonitorVS, auscultate lungs for adecrease in or absence ofbreath sounds)

169. What is a symptom ofpneumothorax

Diminished breath sounds

170. What are indications of apneumothorax

1. Deviated trachea2. Pain on the affected sidethat worsens upon exhalation3. Affected side does not movein and out uponinhalation/exhalation4. Increased HR5. Rapid shallow respirations6. Nagging cough or feeling ofair hunger

171. Chapter 20 ...

172. How long does it take for apatient to exhibitsymptoms when exposedto healthcare acquiredpneumonia

24 to 48 hours

173. What is rhinitis Inflammation of the nasalmucosa

174. What is objective data forrhinitis

1. Red, inflamed, swollen nasalmucosa2. Low-grade fever

175. What are nursinginterventions for rhinitis

1. Encourage rest, 8 to 10hours a day and increase fluidintake to at least 2000 mL/day2. Encourage use of homehumidifier or breathingsteamy air3. Proper disposal of tissuesand use of cough etiquette

176. What aremedications forrhinitis

177. What are holisticorcomplementarytherapies forrhinitis

Echinacea, large doses of vitamin C andzinc

178. What is sinusitis Inflammation of the mucous membranesof one or more of the sinuses

179. What is sinusitisassociated with

1. Deviated nasal septum 2. Occurs after rhinitis3. Nasal polyps4. Inhaled pollutants or cocaine5. Facial trauma6. Dental infections7. Loss of immune function

180. What aresymptoms ofsinusitis

Nasal congestionHeadacheFacial pressure/pain (worse when headis tilted forwards)CoughBloody/Purulent nasal drainageTenderness to palpitationLow-grade fever

181. What arediagnostic testsfor sinusitis

1. CT scan or sinus x-rays2. Endoscopic sinus cavity lavage orsurgery to relieve the obstruction andpromote drainage of secretions may bedone as a diagnostic procedure

182. What are nursinginterventions forsinusitis andwhat should youdiscourage

1. Encourage the use of steam, sinusirrigation, nasal spray2. Increase fluid and rest3. Discourage air travel, swimming anddiving

183. What aremedications forsinusitis

1. phenylephrine: used to reduceswelling of the mucosa2. Patients should be encouraged tobegin OTC decongestant at the firstmanifestation of sinusitis3. Signs of rebound nasal congestionmay occur if decongestions are used formore than 3 to 4 days4. Amoxicillin if there is bacteria5. NSAIDs, Tylenol, aspirin

184. What is patienteducation forsinusitis andwhat should thepatient report

1. Sinus irrigation and saline nasalspray's are an effective alternative toantibiotics for relieving nasal congestion2. Contact the provider formanifestations of a severe headache,neck stiffness and high fever(meningitis/encephalitis)

185. What arecomplications ofsinusitis

Meningitis and encephalitis can occur ifpathogens enter the bloodstream fromthe sinus cavity

186. When are adultscontagious wheninfected with theflu

24 hours before manifestations developand up to five days after

187. What are threeextra symptomsof the avian flucompared to theflu

Severe diarrhea and cough, hypoxia

188. What is nursingcare forhospitalizedpatients infectedwith influenza

189. What areantivirals thatmay beprescribed fortreatment andprevention ofthe flu

1. Amantadine2. Rimantadine 3. Ribavirin

190. What antiviralsmay beprescribed toshorten the flu

1. Relenza 2. Tamiflu

191. When shouldpatients beginantiviralmedications

24 to 48 hours after the onset ofmanifestations

192. Vaccination forthe flu isencourage foreveryone over sixmonths of age.However high-risk patientsinclude

1. History of pneumonia2. Chronic medical conditions3. Over the age of 654. Pregnant women5. Health care Providers

193. What is acomplication ofthe flu

Pneumonia

194. What is the most commonmanifestation of pneumonia inolder adults

Confusion

195. How does the sputum look withpneumonia

Purulent, blood tingedor rust colored sputum

196. Elevated wbc's are normallyelevated in pneumonia with theexception of

May not be present inolder patients

197. What are diagnostic proceduresfor pneumonia

1. Chest x-ray will showconsolidation of lungtissue2. Pulse oximetry mayshow less than expectedrange

198. What are nursing interventionsfor pneumonia

1. Position the patient inhigh Fowlers unlesscontraindicated2. Encourage coughingor suctioning3. Oxygentherapy/breathingtreatments asprescribed4. Incentive spirometer 5. Structure activity toinclude periods of rest6. Encourage fluid intakeof 2 to 3 L/day

199. It is important to obtain aculture specimen beforeantibiotic therapy. What aretwo common antibiotics given

Penicillins andcephalosporins

200. What are nursing considerationsregarding medications forpneumonia

1. Observe patientstaking cephalosporinsfor frequent stools2. Monitor her kidneyfunction, especially olderadults who are takingpenicillins andcephalosporins3. Take medication withfood. Some penicillinsshould be taken onehour before meals ortwo hours after

201. Bronchodilators are given toreduce bronchospasms andreduce irritation. What is ashort acting Beta two agonistbronchodilator

Albuterol

202. Anti-cholinergicmedications such asblank, block theparasympatheticnervous system,allowing forincreasedbronchodilation anddecreasedpulmonarysecretions

Ipratropium

203. Methylxanthinessuch as blank,require closemonitoring of serummedication levelsdue to narrowtherapeutic range

Theophylline

204. What are adverseeffects ofTheophylline

Nausea, tachycardia, diarrhea

205. What should youwatch for in patientstaking albuterol

Tremors, tachycardia

206. Observe for drymouth in patientstaking ipratropiumand monitor heartrate. Adverse effectsinclude

Headache, blurred vision andpalpitations which may indicate toxicity

207. What should youencourage patientsto do while takingipratropium

Suck on hard candies to help moistendry mouth

208. Anti-inflammatoriessuch asglucocorticosteroidssuch as fluticasoneand prednisones areprescribed to reduceinflammation.Monitor for

Immunosuppression, fluid retention,hyperglycemia, hypokalemia and poorwound healing, black/tarry stools

209. What are othernursingconsiderations foranti-inflammatories

210. What arecomplications frompneumonia

Atelectasis, bacteremia, acute respiratorydistress syndrome

211. What are manifestations ofatelectasis

1. Patient reportsSOB and exhibitsfindings ofhypoxemia2. Patient hasdiminished/absentbreath soundsover the affectedarea3. Chest x-rayshows area ofdensity

212. What are manifestations of acuterespiratory distress syndrome (ARDS)

1. Hypoxemiapersists despiteoxygen therapy2. Patients dyspneaworsens as bilateralpulmonary edemadevelops that isnon-cardiac related3. Chest x-rayshows an area ofdensity with a"ground glass"appearance4. Blood gasfindingsdemonstratehypercarbia eventhough pulseoximetry showsdecreasedsaturation

213. Patient with pulmonary tuberculosisis being discharged with aprescription for rifampin. The nurseshould plan to include which of thefollowing in the patient's dischargeteaching plan

Urine and othersecretions orangein color

214. A nurse is caring for a patient withCOPD. What assessment findingshould the nurse report to theprimary care provider regarding thecolor of sputum

Productive coughwith green sputum

215. What kind of diet should a patientwith COPD be on

High calorie andprotein

216. Chapter 21 ...

217. What are some things that maytrigger asthma attacks

1. Changes intemperature andhumidity2. Perfume3. Air pollutants4. Seasonal allergies5. Stress6. Medications (aspirin,NSAIDs, beta blockers,cholinergics)7. enzymes in laundrydetergent8. Sinusitis with postnasal drip9. Viral respiratory tractinfection

218. When a patient has asthmawhat temperature of watershould be used to eliminatedust mites in bed linens?

Hot water

219. What is something that shouldbe encouraged as part ofasthma therapy for a patient

Regular exercise becauseit promotes ventilationand perfusion

220. There are many risk factors forasthma, most of them arecommon sense. What are tworisk factors that you may notthink of?

1. GERD2. The older patient ismore susceptible toinfection and thereforethey're at bigger risk forcomplications

221. What are some physicalassessment findings of asthma

1. Dyspnea2. Anxiety or stress3. Coughing4. Wheezing5. Mucus production6. Use of accessorymuscles7. Prolonged exhalation8. Poor O2 sat9. Barrel chest orincreased chest diameter

222. What diagnostic test is mostaccurate for diagnosing asthmaand its severity?

Pulmonary function test

223. What are some things that youcan do as a nurse to maximizepatient comfort in a patientthat has asthma

1. Hi Fowler's2. Oxygen3. Monitor cardiac rateand rhythm for changesduring an acute attack4. Initiate and maintain IVaccess5. Encourage promptmedical attention forinfections andappropriate vaccinations

224. What are some things that a nurseshould monitor when a patient isusing Theophylline

Monitor thepatient's serumlevels for toxicity.Side effects willincludetachycardia,nausea anddiarrhea

225. What are some things that a nurseshould monitor the patient for whenthe patient is using albuterol

Tremors andtachycardia

226. What is something that a nurseshould monitor the patient for whenthe patient is using Ipratropium

Dry mouth

227. If a patient was showing symptoms ofipratropium toxicity what would thesymptoms be?

Headache, blurredvision orpalpitations

228. What kind of asthma attack issalmeterol used for

Is used to preventan asthma attackand not at theonset of an attack

229. What are things that a nurse shouldwatch for when a patient is takingcorticosteroids, leukotrieneantagonist (singulair), mast cellstabilizer (Cromolyn), or monoclonalantibodies (omalizumab)

1. Decreasedimmune function2. Hyperglycemia3. Black, tarrystools4. Fluidretention/weightgain (common)5. Hypokalemiawith corticosteroidssuch asprednisone

230. How should prednisone be taken? With food

231. What is status asthmaticus Life-threateningepisode of airwayobstruction that isunresponsive tocommon treatment

232. What are symptoms of statusasthmaticus

1. Extremewheezing2. Laboredbreathing3. Use of accessorymuscles4. Distended neckveins5. Creates a risk forcardiac/respiratoryarrest

233. What are nursing interventions forstatus asthmaticus

1. Prepare foremergencyintubation2. As prescribed,administer oxygen,bronchodilators,epinephrine andinitiate systemicsteroid therapy

234. Chapter 22 ...

235. What is emphysema characterizedby

Loss of lungelasticity andhyperinflation oflung tissue

236. What is a genetic risk for COPD Alpha-1 antitrypsindeficiency

237. What are some physical assessmentfindings of COPD

1. Barrel chest2. Hyperresonanceon percussion3. Thin extremitiesand enlarged neckmuscles4. Clubbing offingers and toes5. Dependentedema secondaryto right-sided heartfailure (increase inpulmonarypressure)

238. Would hematocrit be low or high ina patient that has COPD?

High due to lowoxygenation levels

239. Does COPD increase or decreasecaloric demands

Increase becausework of breathinghas increased

240. Patients that have COPD may needblank of oxygen via nasal cannula orup to blank via Venturi mask

2 to 4 L/min, 40%

241. Patients who have chronicallyincreased PaCO2 levels usuallyrequire blank of oxygen via nasalcannula

1 to 2 L/min

242. A positive expiratory pressure deviceassist patients to remove airwaysecretions. The patient inhalesdeeply and exhales through thedevice. While exhaling, a ball movescausing

A vibration thatresults in looseningthe clientssecretions

243. How often should a patient withCOPD do exercise conditioning(walking until dyspnea occurs,resting and then walking again)

20 minutes, 2 to 3times weekly

244. How much fluidsshould a patientwho has COPDdrink

2 to 3 L/day

245. Most of themedications forCOPD are thesame as asthma.With theexception ofMucolytic's.What are twokinds ofmucolytic's?

Mucomyst, dornase alpha

246. Chapter 23 ...

247. How long does ittake for the riskof transmissionto decreaseregarding TB

2 to 3 weeks after anti-tuberculintherapy

248. A patient willhave a positiveintradermal TBtest within blankweeks ofexposure to the

2 to 10

249. How oftenshould patientswho live in high-risk areas bescreened fortuberculosis

On a yearly basis

250. What are riskfactors for TB

In addition, recent travel outside of theUS, substance use and health care

occupation

251. What aresymptoms of TB

1. Persistent cough lasting longer thanthree weeks2. Purulent sputum, possibly bloodstreaked3. Fatigue and lethargy 4. Weight loss and anorexia5. Night sweats6. Low-grade fever in the afternoon

252. When should theMantoux test tobe read

Within 48 to 72 hours

253. What is apositiveMantoux test?

1. 10 mm or greater2. 5 mm is considered positive forimmunocompromised patients

254. What kind of diet shoulda patient with TB be on?

Foods that are rich in protein,iron and vitamin C

255. How does isoniazid work By preventing synthesis ofmycolic acid in the cell wall

256. How should isoniazid betaken

On an empty stomach

257. What should youmonitor for any patientthat is taking isoniazid

Hepatotoxicity andneurotoxicity, such as tingling ofthe hands and feet (vitamin B6is used to preventneurotoxicity)

258. How does rifampin work Inhibits DNA dependent RNApolymerase activity

259. What are side effects ofrifampin

1. Hepatotoxicity (they shouldreport yellowing of the skin,pain or swelling of joints, loss ofappetite or malaise)2. Orange color of urine andother secretions3. May interfere with oralcontraceptives

260. What is a side effect ofpyrazinamide

Hepatotoxicity

261. How shouldpyrazinamide beconsumed?

Instruct the patient to drink aglass of water with each doseand increase fluids during theday

262. How does ethambutolwork

By inhibiting protein synthesis

263. What are two things thatyou need to obtainbefore administeringethambutol to a patient

1. Baseline visual acuity2. Determine colordiscrimination ability

(this medication should not begiven to children younger than13 years of age)

264. What is the mostimportant thing to teacha patient that is onethambutol

To report vision changesimmediately

265. What is streptomycinsulfate

Aminoglycoside antibiotic thatpotentiates the efficacy ofmacrophages duringphagocytosis

266. What kind of patients areput on streptomycin

Those who have multi drug-resistant TB because of thismedications high level of toxicity

267. What are two side effectsof streptomycin

OtotoxicityRenal function decline

268. How often are sputumsamples needed duringtuberculosis therapy

Every 2 to 4 weeks tomonitor therapy

269. What is miliary TB Where the infectioninvades the bloodstreamand can lead to MODS

270. What aresymptoms/complications ofmiliary TB

HeadachesNeck stiffnessDrowsinessPericarditis

271. Chapter 56 ...

272. What is the only conditionthat increases serumcreatinine levels

Kidney disease

273. What is the purpose of aVCUG

To detect whether urinerefluxes into ureters as anx-ray is taken while thepatient is voiding

274. What should you do as anurse after a patient has aVCUG

1. Monitor the patient forinfection for the first 72hours after2. Encourage increasedfluid intake3. Monitor urine output

275. What are preprocedurenursing interventions for apatient that is going to have akidney biopsy

1. Review coagulationstudies2. NPO for 4 to 6 hoursbefore

276. What are post procedurenursing interventions for apatient that has had a kidneybiopsy

1. Monitor vitals2. Assess dressings andurinary output (hematuria)3. Review HGB and HCTvalues4. Administer PRN painmedication

277. A cystography orcystourethrography are used todiscover abnormalities of bladderwall and/or a occlusions of ureteror urethra. What are pre-procedure nursing interventionsfor these procedures?

1. NPO after midnight2. Administerlaxative/enema forbowel preparation thenight before theprocedure

278. What position should a patient bein for a cystography orCystourethrography

Lithotomy position

279. What color urine may come outafter a cystography orcystourethrography

Urine maybe pinktinged

280. What should you do if blood clotsare present or urine output isdecreased or absent after acystography orCystourethrography

Irrigate urinarycatheter with NS

281. What are a retrograde pyelogram,Cystogram, or urethrogram usedfor

To identify obstructionor structural disordersof the ureters andrenal pelvis of thekidneys by instillingcontrast dye during acystoscopy

282. What is a renography used for To assess renalbloodflow andestimate GFR after IVinjection of radioactivematerial to produce ascanned image of thekidneys

283. What should you assess frequentlyduring and after A renography ifcaptopril is given to change bloodflow to the kidneys

BP

284. What is an excretory urographyused for

To detect obstruction,assess for aparenchymal mass,and assess size of thekidney. IV contrastdye is used toenhance images

285. What are preprocedure nursinginterventions for a patient that ishaving an excretory urography

1. Increased fluids theday before theprocedure2. Bowel prep3. NPO after midnight4. Hold Metformin for24 hours beforeprocedure

286. What are post procedurenursing interventions for apatient that has had anexcretory urography

1. Administer parenteralfluid or encourage oralfluids to flush dye2. Diuretics may beadministered to increasedye secretion3. Follow up creatinine andbun serum levels beforeMetformin is resumed

287. A nurse is reviewing apatient's laboratory findingsfor urinalysis. The findingsindicate the urine is positivefor leukoesterase andnitrates. Which of is anappropriate nursing action?

Obtain a clean catch urinespecimen for culture andsensitivity because thisdetermines the antibioticthat will be most effectivefor treatment of theurinary tract infection

288. Why would a patient with ahistory of asthma be at riskfor a complication whenundergoing excretoryurography?

A patient who has a historyof asthma has a higher riskof having an asthma attackas an allergic response tothe contrast dye usedduring the procedure

289. Chapter 57 ...

290. How do you estimate apatient's amount of fluidremoved after dialysis

By comparing the patientspreprocedure weight tothe post procedure weight

291. How long should invasiveprocedures be avoided afterdialysis

4 to 6 hours due to the riskof bleeding related to ananticoagulant

292. How do you check an AVfistula or AV graft for patency

By checking for thrill orbruit

293. When should you contact theprovider after dialysis

1. If bleeding from theinsertion site last longerthan 30 minutes2. Absence of thrill/bruit3. Signs of infection

294. What kind of diet should apatient be on after dialysis

high folate, high proteindiet

295. What is disequilibriumsyndrome

Caused by too rapid of adecrease in BUN andcirculating fluid volume. Itmay result in cerebraledema and increased ICP

296. What are signs/symptoms ofdisequilibrium syndrome

nauseaVomitingChange in LOCSeizuresAgitation

297. Blank, is a riskfactor for dialysisdisequilibrium andhypotension due torapid changes influid andelectrolyte status

Advanced age

298. What can a nursedo to decrease therisk ofdisequilibriumsyndrome

1. Use a slow dialysis exchange rate,especially for older adults and thosebeing treated with hemodialysis forthe first time2. Administeranticonvulsants/barbiturates ifneeded

299. What is somethingthat a nurse shoulddo for a patientexperiencinghypotension fromdialysis other thanadminister IV fluids

Lower the head of the patient's bed

300. What is peritonealdialysis

Involves instillation of a hypertonicsolution into the peritoneal cavity. Thesolution dwells in the peritoneal cavityas ordered by the provider. Drain thesolution that includes the wasteproducts. The peritoneum serves asthe filtration membrane

301. What color shouldthe dialysatesolution be

Clear, light yellow is expected

302. How much shouldthe outflow becompared to theinflow

Expected to equal or exceed amountof dialysate inflow (insufficient outflowcould mean infection)

303. If a fibrin clot hasformed in theperitoneal dialysiscatheter whatshould you do?

Carefully milk the catheter

304. What are twoconditions causedby dialysis

Hyperglycemia and hyperlipidemia

305. Blank, is a commoncause of poorinflow or outflow

Constipation

306. What positionshould a patient bein during CCPD andAPD treatment

Supine with head slightly elevated

307. If medications areheld before dialysiscan they beadministered after itis done

Yes, medications that can be partiallydialysed during the treatmentshould be withheld. After thetreatment, the nurse shouldadminister the medication.

308. Why should apatient that isexperiencingshortness of breathnot receiveperitoneal dialysis

Because they may not be able totolerate excessive fluids beinginstilled into their abdomen

309. Chapter 58 ...

310. What are patientindications of end-stage kidney diseasenecessitating kidneytransplant

1. Anuria2. Proteinuria3. Marked azotemia4. Severe electrolyte imbalance5. Fluid volume excess conditions(heart failure, pulmonary edema)6. Uremic lung

311. What are subjectivesigns/symptoms ofend-stage kidneydisease

AnorexiaFatigueParesthesia SOBDry, itchy skinMetallic tasteMuscle cramping

312. What are object ofsigns/symptoms ofend-stage kidneydisease

Decreased attention span, seizures,tremor, HF, Edema, dyspnea,hypertension, distended jugularvein's, anemia, vomiting, pulmonaryedema, cardiac dysrhythmias, pallor,dry itchy skin, bruising, halitosis anddiminished or dark colored urine

313. What ismethylprednisonesodium succinate

An anti-inflammatory andimmunosuppressant used todecrease the immune systemresponse of inflammation andrejection of donor kidney

314. What is anotherimmunosuppressantmedication used toprevent rejection ofthe donor kidney

Cyclosporine

315. A patient has had akidney transplant isusually dialyzedwithin blank of thesurgery

24 hours

316. What are somethings you shouldassess/monitorthe patient forafter a kidneytransplant

1. Vital signs every 15 minutes initiallyand advance to every hour2. Report urine output less than 30mL/HR3. Urine appearance and older shouldbe checked hourly (initially pink andbloody)4. Daily weights5. Maintain continuous bladderirrigation as prescribed (to prevent clotsfrom forming)

317. What diuretic ispreferred whenoliguria is presentafter a kidneytransplant

Mannitol

318. What kind of dietshould a patientbe on after akidney transplant

Low-fat, high-fiber, increased protein,low-sodium, avoid sugars orcarbohydrates

319. When takingcyclosporinewhat are twothings you needto do

1. Magnesium supplements because itreduces magnesium levels2. Avoid grapefruit

320. What is hyperacute rejection

Rejection that occurs within 48 hoursafter surgery caused by an anti-bodymediated response that causes smallblood clot to form in the transplantedkidney

321. What aresymptoms of ahyper acuterejection

Fever, hypertension, pain at thetransplant site

322. What istreatment forhyper acuterejection

Immediate removal of the donor kidney

323. What is acuterejection

Occurs one week to two years aftersurgery. An antibody mediatedresponse causing vasculitis in the donorkidney and cellular destruction startswith inflammation that causes lysis ofthe donor kidney

324. What aresymptoms of anacute rejection

Oliguria AnuriaLow-grade feverHypertensionTenderness over the transplantedkidneyLethargyAzotemia Fluid retention

325. What istreatment foracute rejection

Involves increased doses ofimmunosuppressive medications

326. What is chronicrejection

Occurs gradually over months to years.Blood vessel injury from overgrowth ofthe smooth muscles of the blood vesselscausing fibrotic tissue to replace normaltissue resulting in a nonfunctioning donorkidney

327. What aresymptoms ofchronicrejection

Gradual return of azotemia Fluid retentionElectrolyte imbalanceFatigue

328. What istreatment forchronicrejection

Monitor kidney status, continueimmunosuppressive therapy until dialysisis required

329. What is acutetubular necrosis

Caused by a delay in transplanting thedonor kidney after harvesting may resultin hypoxic injury of the donor kidney

330. What aresymptoms/signsof renal arterystenosis

HypertensionBruit over artery anastomosis siteDecreased kidney functionPeripheral edema

331. What is themost commoncause of firsttransplant yearmorbidity andmortality

Infection

332. Chapter 60 ...

333. What are thefour phases ofacute kidneyinjury

1. Onset: begins with the onset of theevent, ends when oliguria develops andlasts for hours to days2. Oliguria: begins with the kidney insult,urine output is 100 to 400 mL/24 hourwith or without diuretics and lasts for 1 to3 weeks3. Diuresis: begins when the kidneys startto recover, diuresis of a large amount offluid occurs and can last for 2 to 6 weeks4. Recovery: continues until kidneyfunction is fully restored and can take upto 12 months

334. What is prerenalacute kidneyinjury

Occurs as a result of volume depletionand prolonged reduction of blood flow tothe kidneys which leads to ischemia of thenephrons

335. What is treatment for prerenalacute kidney injury

1. Administer IV fluidif no fluid restrictions2. Administer calciumchannel blocker toprevent themovement of calciuminto the kidney cellsand to increase GFR3. Monitor I and O's4. Monitor fordecreased cardiacoutput

336. Intrarenal acute kidney injuryoccurs as a result of direct damageto the kidney from lack of oxygen(acute tubular necrosis). What arecauses of intrarenal acute kidneyinjury

1. Physical injury2. Hypoxic injury -renal artery or veinstenosis orthrombosis3. Chemical injury -acute nephrotoxins(antibiotics, NSAIDs,contrast dye, heavymetal, bloodtransfusion reaction)4. Immunologic injury- infection, vasculitis,acuteglomerulonephritis

337. What are two complications ofintrarenal acute kidney injury

Heart failure orpulmonary edema

338. What are signs/symptoms of acuteintrarenal kidney injury

ECG dysrhythmias(tall T waves)Flank painN/VLethargy TremorsConfusion

339. Post renal acute kidney injuryoccurs as a result of bilateralobstruction of structures leavingthe kidney. What are causes

1. Stone, tumor,bladder atony 2. Prostatehyperplasia, urethralstricture 3. Spinal cord diseaseor injury

340. How do laboratory values look inpost renal acute kidney injury

Gradually increasesin serum creatinine,BUN, urine specificgravity

341. What is nutrition for post renalacute kidney injury

Restrict potassium,phosphate andmagnesium duringoliguric phase andincrease protein

342. What are the five stages of chronickidney disease

Stage one: minimalkidney damage withnormal GFR (greaterthan 90 ML/min)Stage two: mildkidney damage withGFR 60 to 89 mL/minStage III: GFR 30 to59 mL/minStage 4: GFR is 15 to29 mL/minStage five: GFR lessthan 15 mL/min

343. How much fluids are patients withchronic kidney disease encouragedto drink

At least 3 L of waterdaily

344. If a patient has diabetes orhypertension and chronic kidneydisease what should you encouragethem to come in for regardingyearly tests

Yearly testing foralbumin in the urine

345. What are some signs and symptomsof chronic kidney failure

FatigueLethargy Involuntarymovement of thelegsDepressionIntractable hiccups

346. How do you serum electrolytes lookin chronic kidney disease

Decreased sodiumand calcium;increasedpotassium,phosphorus andmagnesium

347. Why is hemoglobin and hematocritdecreased in chronic kidney disease

From anemiasecondary to theloss oferythropoietin

348. What are complications of CKD ElectrolyteimbalanceDysrhythmiasFluid overloadHypertensionMetabolic acidosisSecondary infectionUremia

349. What kind of diet should a patientbe on that has chronic kidneydisease

High incarbohydrates andmoderate in fat

350. What medications areconsidered nephrotoxic

AminoglycosidesAmphotericin bNSAIDsAce inhibitorsArbsContrast dye

351. If a patient is on digoxinwhen should youadminister it

After receiving dialysis

352. Why is aluminumhydroxide given topatients with chronickidney disease

Taken with meals to bindphosphate in food and stopphosphate absorption (take twohours before or after digoxin)

353. What kind of diureticshould be avoided inpatients that have endstage kidney disease

Loop diuretics

354. What kind of Antacidsshould a patient withkidney disease avoid

Those containing magnesium

355. If a patient has a highcreatinine level whatshould you assess for inthe urine

Blood

356. Chapter 61 ...

357. Who is more at risk forurosepsis women ormen

Aging women due to decreasedestrogen which promotesatrophy of the urethral openingtowards the rectum

358. What are subjectivesigns/symptoms of aurinary tract infection

1. Lower back/abdominaldiscomfort2. Urinary frequency/urgency3. Nausea4. Dysuria, cramping5. Urinary retention6. Perineal itching7. Hematuria8. Pyuria (greater than four wbcin urine sample)

359. What are objectivesigns/symptoms of aurinary tract infection

1. Fever2. Vomiting3. Voiding in small amounts4. Nocturia5. Urethral discharge6. Cloudy/smelly urine

360. What are older adultclinical manifestationsof a UTI

1. Mental confusion2. Incontinence3. Loss of appetite4. Nocturia and dyslexia5. Signs of urosepsis

361. What are signs of urosepsis HypotensionTachycardiaTachypneaFever

362. If a patient has a urinary tract infectionwhat are some things you'd expect tofind in the urine

Bacteria,sediment, WBCs,RBCs, positiveleukocyteesterase andnitrates

363. If a patient has a urinary tract infectionwhat are some things you canencourage the patient to do to relievesymptoms

1. Promote fluidintake up to 3 L aday2. Encourageurination every 3to 4 hoursinstead ofwaiting until thebladder iscompletely full3. Recommendwarm sitz Bath 2to 3 times a dayto promotecomfort

364. What are two medications that areprescribed less frequently for UTIsbecause the medicine is less effectiveand tolerated

Penicillins andcephalosporins

365. If a sulfonamide is prescribed for apatient with a UTI what should you askthe patient about?

Allergy to sulfa

366. What is a bladder analgesic that is usedto treat UTIs

Phenozopyridine(take with food)

367. When a patient has a UTI they areencouraged to drink cranberry juicebecause a compound in cranberriesmay stop certain bacteria fromadhering to the mucosa of the urinarytract. Patients who have blank shouldavoid cranberry juice, which irritatesthe bladder

Chronic cystitis

368. What are risk factors for pyelonephritis 1. Men over 65who haveprostatitis andhypertrophyof the prostate2. Chronicurinary stonedisorders3. Spinal cordinjury4. Pregnancy5. Bladdertumors6. Urine pHincreases7. Chronicillnesses (DM,HTN)

369. Chills, nausea, malaise, fatigue,burning/urgency/frequency withurination are all subjective signs andsymptoms of pyelonephritis. What aretwo more less obvious symptoms?

Colicky typeabdominalpain andcostovertebraltenderness

370. What are objective signs/symptoms ofpyelonephritis

FeverTachycardiaTachypnea HypertensionFlank/backpainVomitingNocturiaAsymptomaticbacteremiaInability toconcentrateurine orconservesodium

371. What are 4 lab values that will beincreased with pyelonephritis nephritis

C-reactiveprotein, ESR,Creatinineand BUN

372. What are complications of chronicpyelonephritis

Septic shockChronickidney diseaseHypertension

373. Although penicillin antibiotics are rarelyused to treat urinary tract infections withkidney infections this type of penicillinmay be used

Ampicillin

374. Chapter 62 ...

375. Does a diet high in calciumincrease the risk for kidney Stones.Since the majority of stones arecomposed of calcium phosphateor calcium oxalate

No not unless there isa pre-existingmetabolic disorder orrenal tubular defect

376. Who is more at risk forurolithiasis? Males or females

There is an increasedincidence ofurolithiasis in males

377. What are four things thatcontribute to an environmentfavorable for stone formation

Urinary stasis,urinary retention,immobilization anddehydration

378. What is something that you mightsee in a urinalysis of a patient thathas a kidney stone

Crystals

379. What does KUB stand for X-ray of kidney,ureters and bladder

380. What are things that a nurseshould assess/monitor for anypatient that has kidney stones

1. Pain2. I and O's3. Urinary pH4. Strain all urine5. Encourageambulation topromote passage ofthe stone

381. According to ATI what shouldrespiration rate be

12 to 20 breaths perminute

382. What are medications given forkidney stones

Opioids, nSAIDs,oxybutynin chloride

383. What are side effects of oxybutyninchloride

1. Increasedintraocular pressure(Contraindicated ifthere's a history ofglaucoma)2. Dizziness3. Dry mouth4. Tachycardia5. Urinary retention

384. Antibiotics such as gentamicin andcephalexin are used to treat UTIs.Administer the medication withfood to decrease G.I. distress.What else should you monitor for

Nephrotoxicity andototoxicity. Alsoinform the patientthat urine may have afoul odor related tothe antibiotic

385. What are two things that arecommon after a patient has hadextracorporeal shockwavelithotripsy

Bruising at the sitewhere the waves areapplied andhematuria

386. If a patient keeps having calciumphosphate stones what kind ofdiet should they be on

Limit intake of foodhigh in animalprotein, limit sodium,reduce calcium

387. What are medicationsthat are given forcalcium phosphatestones

Thiazide diuretics,Orthophosphates,Sodium cellulose phosphate

388. If a patient has calciumoxalate stones whatshould their diet be

Avoid: spinach, black tea,rhubarb, cocoa, beats, pecans,peanuts, okra, chocolate, wheatgerm, lime peel, Swiss chard andlimit sodium intake

389. What are medicationsfor uric acid stones

Allopurinol, potassium or sodiumcitrate or sodium bicarbonate

390. What is hydronephrosis When a stone has blocked aportion of the urinary tractcausing the urine to back up intothe kidneys causing distention ofthe kidney

391. Chapter 83 ...

392. Which ethnicities isdiabetes more prevalentin

African-American, AmericanIndians and Hispanics

393. What are risk factors fordiabetes

ObesityHypertensionInactivityHyperlipidemiaCigarette smokingGenetic historyElevated CRPEthnic groupWomen who have deliveredinfants weighing more than 9poundsBMI greater than 24

394. What are two thingsthat the patient can addto their diet to decreasethe risk of developingdiabetes

Omega-3 fatty acids and fiber

395. What are clinicalmanifestations ofdiabetes

Hyperglycemia (blood glucoselevel usually greater than 250)PolyuriaPolydipsiaPolyphagiaFruity breathDecreased LOCHeadacheN/VSeizures leading to coma

396. Diagnostic criteria for diabetesinclude 2 findings (on separatedays) of one of the following

1. Manifestations ofdiabetes plus casualblood glucoseconcentration greaterthan 2002. Fasting blood glucosegreater than 1263. Two hour glucosegreater than 200 with anoral glucose tolerancetest

397. How long is a patient instructedto not eat or drink (other thanwater) before a fasting bloodglucose test

Eight hours

398. How long should a patient fastfor before an oral glucosetolerance test

10 to 12 hours

399. What is normal hemoglobin A-1C range

4 to 6%

400. How often should the needle ina continuous infusion pump bechanged

Every 2 to 3 days

401. Are insulin pens used if morethan one insulin is givenanytime

No

402. What kind of insulin is Humalogand NovoLog

Rapid acting, onset is 10to 30 minutes

403. What kind of insulin is HumulinN and detemir insulin

Intermediate acting,administered for controlbetween meals and atnight

404. What kind of insulin is glargine Long acting,administered once a daybecause it dissipatesslowly over 24 hours

405. What are manifestations ofhypoglycemia

Mild shakinessMental confusionSweatingPalpitationsHeadacheLack of coordinationBlurred visionSeizuresComa

406. What are some preventativemeasures to avoidhypoglycemia

Avoid excess insulin,exercise and alcoholconsumption on anempty stomach

407. Blood glucose increases approximatelyblank over 30 minutes followingingestion of blank grams of absorbablecarbohydrate

40 mg/DL, 10

408. If a patient is unconscious or any ableto swallow how can you administerglucagon to them

By SQ or IM andrepeat in 10minutes is stillunconscious

409. If the patient is in an acute care settingthe nurse should administer blank if IVaccess is available and consciousnessshould occur within 20 minutes

50% dextrose

410. When a patient has a blood glucoselevel greater than 250 mg/DL theyshould restrict

Exercise

411. What are two things you shouldmonitor for any patient takingMetformin

G.I. effects andlactic acidosis

412. When should Metformin bediscontinued before anything withcontrast dye

48 hours

413. What kind of supplements should apatient be taking that is on Metformin

Vitamin B12 andfolic acid

414. When should glipizide be taken 30 minutesbefore meals

415. What medication can masktachycardia typically seen duringhypoglycemia

Beta blockers

416. Should diabetic patients use lotionbetween the toes after they wash theirfeet with mild soap and water

No

417. When is the best time to perform nailcare

After a shower orbath

418. What kind of socks should diabeticpatients wear

Socks made ofcotton or wool

419. How should a diabetic patient clean acut on their foot

With warm waterand mild soap,gently dry andapply a drydressing

420. How often should a diabetic patientmonitor their blood glucose whenthey're sick

Every 3 to 4hours

421. What is the recommended bloodpressure of a patient with diabetes

Less than 130/80

422. How often should a diabetic patientget eye and foot exams

Every year

423. Chapter 84 ...

424. What ishyperglycemic -hyperosmolarState

An acute, life-threatening conditioncharacterized by profoundhyperglycemia (above 600) osmolaritythat leads to dehydration and anabsence of ketosis

425. What are riskfactors for HHS

1. Older adult who has residual insulinsecretion2. Older adult who has an adequatefluid intake3. Older adults who have decreasedkidney function and are unable toexcrete excess of glucose into the urine4. MI, cerebral vascular injury or sepsis5. Infection/stress6. Glucocorticoids, diuretics, Dilantin,propranolol, CCB

426. What are clinicalmanifestations ofHHS

blurred visionHeadacheWeaknessPolyuriaPolydipsiaOrthostatic hypotensionChange in LOCSeizures/myoclonic jerkingReversible paralysis

427. How does serumosmolarity look inHHS

Greater than 320 mOsm/L

428. How does your pHlook in DKA

Less than 7.3

429. What is the pHlook like in HHS

Greater than 7.4

430. What kind of fluidsshould beadministered topatients with DKAor HHS

Isotonic fluid's such as normal NSfollowed with a hypotonic fluid (IVbolus of insulin)

431. What should youdo when serumglucose levelsapproach 250mg/DL

Add glucose to IV fluids to minimize therisk of cerebral Edema associated withdrastic changes in serum osmolarityand prevent hypoglycemia

432. What else shouldyou monitor apatient for whenthey are in adiabetic crisis

Hyperkalemia and then hypokalemiaas potassium follows insulin into thecells

433. How often should an older adultpatient monitor blood glucose whenthey are sick

Every 1 to 4 hours

434. If a patient who has diabetes wouldlike to consume alcohol what shouldyou tell them

Consumecarbohydrateswhile drinkingalcohol will helppreventhypoglycemia

435. What is PTU Medication givento suppress thethyroid hormoneand will allow forweight gain

436. When assessing a patient diagnosedwith diabetes insipidus, the nurseshould expect which of the followinglaboratory findings

Increasedhematocrit due todehydration

437. A nurse is monitoring a patient'sstatus 24 hours after a totalthyroidectomy. What kind of breathsound would you immediately reportto the provider

Laryngeal stridor

438. How should the patient take theirmedication if they are on thyroidhormone replacement therapy

On an emptystomach topromote properabsorption

439. Chapter 68 ...

440. Why is an arthroscopy performed To visualize theinternal structuresof a joint, mostcommonly theknee or shoulderjoints

441. When can an arthroscopy not beperformed

If there is aninfection or if thepatient is unable tobend the joint atleast 40°

442. How often should you assess thepatient's neurovascular status anddressing after an arthroscopy

Every hour or perhospital protocol

443. How often should a patient ice andelevate extremity after anarthroscopy

Ice and elevationshould be appliedfor 24 hours

444. Bone scans are done when a patiententire skeletal system is to beevaluated. A radionucleotide testinvolves radioactive materialinjected blank before scanning

2 to 3 hours

445. Blank and blank scans aremore sensitive todetecting bone problemsthan a bone scan. When isin radionucleotideinjected before the scans

Gallium, Thallium, 4 to 6 hours

446. During a bone scan doesthe patient need to besedated

Only if they are unable to liestill for 30 to 60 minutes

447. Following the proceduredoes the patient need totake any specialradioactive precautions

No but the patient should beencouraged to drink plenty offluids to increased excretion ofradioisotope

448. What kind of scan is doneto estimate the density ofa patient's bone mass,usually in the hip or spine,and the presence/extentof osteoporosis

DXA (dual x-rayabsorptiometry)

449. Is contrast material usedwith a DXA scan

No

450. At what age might abaseline DXA scan beperformed

40

451. Why would anelectromyography (EMG)and nerve conductionstudies be performed

To determine the presenceand cause of muscle weakness

452. How is an EMG performed Thin needles are placed in themuscle under study andattach it to an electrode, whichis attached to oscilloscope.Electrical activity is recordedduring a muscle contraction

453. How is a nerve conductionstudy performed

Flat electrodes are taped onthe skin. Low electricalcurrents are sent through theelectrodes and muscleresponse to the stimulus isreported

454. What are two medicationsthat must be avoidedbefore receiving an EMG ornerve conduction study

Anticoagulants or musclerelaxants

455. What are two things thatthe patient should reportto the provider afterreceiving an EMG or nerveconduction study

Swelling or tenderness

456. What kind of painmedication can beused for patients afteran arthroscopy

Opioid

457. How long does a DXAscan last for

Several hours. The radionucleotidesubstance is injected and must beabsorbed by the bone prior to theprocedure. The patient must waitseveral hours after the injectionbefore the scan can be completed

458. During an EMG whatshould you ask thepatient to do for aneasier insertion of theneedle into themuscle

To flex their muscles

459. Chapter 69 ...

460. What is anarthroplasty

The surgical removal of a diseasedjoint due to osteoarthritis,osteonecrosis, rheumatoid arthritis,trauma or congenital anomalies andreplacing it with prosthetics orartificial components made of Metaland/or plastic

461. What arecontraindications toan arthroplasty

1. Recent or active infection2. Arterial impairment to theaffected extremity3. The patient's inability to follow thepost surgery regimen4. A comorbid condition such asuncontrolled diabetes orhypertension, osteoporosis,progressive inflammatory condition,unstable cardiac/respiratoryconditions

462. What should apatient do to preparefor arthroplasty thenight before thesurgery

1. Scrub the surgical site with aprescribed anti-septic soap2. Wear clean clothes and sleep onclean linens

463. What should apatient do in themorning to preparefor an arthroplasty

1. Scrub at the surgical site with aprescribed anti-septic soap2. Take antihypertensivemedications as well as othermedications that the surgeon allowswith a sip of water

464. Prostheticcomponents may ormay not be cementedin place. Componentsthat do not usecement allow thebone to grow into

The prosthesis to stabilize it

465. If the components are notcemented when should weight-bearing occur

Weight bearing isdelayed severalweeks until thefemoral shaft hasgrown into theprosthesis

466. A CPM machine may be prescribedafter surgery to promote motion inthe knee and

Prevent scar tissueformation

467. When is a CPM turned off During meals

468. What position of the patient shouldyou avoid after an arthroplasty

Positions of flexion ofthe knee are limitedto avoid flexioncontractures. Avoidknee gatch andpillows placedbehind the knee

469. How should you position smallblankets or pillows to keep heelsoff the bed in efforts to avoidpressure ulcers

Slightly above theankle area

470. After an arthroplasty opioids aswell as a continuous peripheralnerve block may be initiated for apatient. What should you monitorthe patient for in regards to acontinuous peripheral nerve block

Monitor the patientfor systemic effects oflocal anesthetic, suchas hypotension,bradycardia,restlessness orseizure

471. Ice or cold therapy may be appliedto reduce post operative swelling.Monitor the patients neurovascularstatus of the surgical extremityevery blank

2 to 4 hours(movement,sensation, color,pulse, capillary refilland compare withthe contralateralextremity)

472. After a patient has had a hiparthroplasty what kind of range ofmotion exercise should youencourage

Plantar flexion,dorsiflexion, andcircumduction toprevent clotformation

473. Early ambulation after a hiparthroplasty is important. Howshould you transfer the patient outof bed

From the unaffectedside into a chair orwheelchair

474. What should you apply to thesurgical site following ambulation

Ice

475. What is patientpositioning after ahip arthroplasty

Place the patient supine with the headslightly elevated and the affected leg ina neutral position. Place a pillow orabduction device between the legswhen turning to the unaffected side.The patient should not be turned tothe operative side, which could causehip dislocation

476. What are four do'safter anarthroplasty

1. Use elevated seating/raised toiletseat2. Use straight chairs with arms3. Use an abduction pillow, or a pillow,if prescribed between the patients legswhile in bed4. Externally rotate a patient's toes

477. What are fourdon'ts after anarthroplasty

1. Avoid flexion of hip greater than 90°2. Avoid low chairs3. Do not cross a patients legs4. Do not internally rotate a patient'stoes

478. After a kneearthroplasty whencan a patient kneeland deep kneebend

Unfortunately those are limitedindefinitely

479. How often shoulda patient cleantheir incision aftera total hiparthroplasty

Daily with soap and water

480. Chapter 70 ...

481. Upper extremityamputation's areusually the resultof a traumaticinjury howeverlower extremityamputation's areusually the resultof

Peripheral vascular disease as a resultof arteriosclerosis

482. What are signs ofinadequateperipheralcirculation

EdemaReduced cap Refill timeNecrosisLack of hair distribution

483. What is the anklebrachial index

Measures difference between ankleand brachial systolic pressures

484. What is a closedamputation

The most common technique used.Skin flap is sutured over end ofresidual limb, closing site

485. What is openamputation

This technique is used when anactive infection is present. Skinflap is not sutured over end ofresidual limb allowing fordrainage of infection. Skin flap isclosed at a later date

486. When your palpatingthe residual limb forwarmth what mightheat indicate

Infection

487. What do patients oftendescribe the painassociated withphantom pain as

Deep and burning, cramping,shooting or aching

488. What are two classes ofmedications that somepatients may feel relieffrom phantom pain

Anti-spasmodic's andantidepressants

489. Other than medicationswhat are fouralternative treatmentsfor phantom limb pain

Massage, heat, biofeedback orrelaxation therapy

490. What should you teacha patient to do toreduce phantom limbpain and prepare thelimb for a prosthesis

To push the residual limb downtoward the bed while supportedon a soft pillow

491. How should youposition that affectedextremity to promotebloodflow/oxygenation

Dependent position

492. What are three thingsthat you can do to assistin shrinking the residuallimb for a prosthesisfitting

1. Wrapping the stump, usingelastic bandages to preventrestriction of blood flow anddecrease edema (figure 8)2. Use a stump shrinker suck3. Use an air splint inflated toprotect and shape the residuallimb

493. What are four thingsthat a nurse could do toprevent the patientfrom developing flexioncontractures after anamputation

1. Range of motion exercises andproper positioning immediatelyafter surgery2. Avoid elevating the stump on apillow after the first 24 hoursfollowing surgery3. Have the patient lie prone for20 to 30 minutes several times aday4. Discourage prolonged sitting ina chair

494. Chapter 72 ...

495. At what age does theremodeling of bone stopoccurring at equal rates(osteoblastic versusosteoclastic activity)

30

496. What is the grading scale foropen fractures

Grade 1: minimal skindamageGrade 2: damage includesskin and muscle contusionbut without extensive softtissue injuryGrade 3: damage isexcessive to skin, muscles,nerves and blood vessels

497. What is a comminutedfracture

Has multiple fracture linessplitting the bone intomultiple pieces

498. What is the most commonfracture found in children

Greenstick: Fractureoccurring on one side butdoes not extend completelythrough the bone

499. What are the three biggestrisk factors for osteoporosis

1. Excessiveexercising/weight loss fromdieting and malnutrition2. Women who do not useestrogen replacementtherapy after menopause3. Patients on long-termcorticosteroid therapy

500. What are five physicalassessment findings of afracture

Crepitus, deformity, musclespasms, edema, ecchymosis

501. What position should a limbbe in after a fracture

Elevated above the heartand apply ice

502. How often shouldneurovascular checks beperformed when a patienthas a fracture

Every hour for the first 24hours and then every 1 to4 hours after

503. What is a closed reduction When a pulling force(traction) is appliedmanually to realign thedisplaced fractured bonefragments

504. What is an openreduction/internal fixation

When a surgical incision ismade and the bone ismanually aligned and keptin place with plates andscrews

505. What is more effective thansplints or immobilizersbecause they cannot beremoved by the patient

Casts

506. What is a spica cast A portion of the trunk and oneor two extremities

507. How should you handlea plaster cast until it isdry? It can take up to 24to 72 hours to dry

With the palms, not fingertips

508. Look at skin traction,bucks traction andbalanced suspensionskeletal traction

...

509. How often should youinsure that pulley ropesare free of knots, fraying,loosening and improperpositioning

Every 8 to 12 hours

510. What are two things youcan do to treat musclespasms if it is prescribed

Heat, massage

511. What is a normalstandard pin careprotocol (if the patienthas pins in place)

1. Pin care is provided usuallyonce a shift, 1 to 2 times a day2. Chlorhexidine is usually usedand only one cotton tippedswabs per a pin to avoid cross-contamination

512. What is external fixation Involves fracture immobilizationusing percutaneous pins andwires that are attached to a rigidexternal frame

513. What are advantages toexternal fixation

1. Immediate fracturestabilization2. Minimal blood loss occurringin comparison with internalfixation3. Allows for early mobilizationand ambulation4. Permitting wound care withopen fractures

514. What is a disadvantageto external fixation

Risk of pin site infection leadingto osteomyelitis

515. What is open reductionand internal fixation

Refers to visualization of afracture through an incision inthe skin and internal fixationwith plates, screws, pins, rodsand prosthetics as needed

516. How often should youinspect bonyprominences with anopen reduction andinternal fixation

Every shift and ensure heels areoff the bed at all times

517. What are the six p'sassociated withcompartment syndrome

Pain, paralysis, paresthesia,pallor, pulselessness andpoikilothermia

518. Who is at greatest risk fordeveloping a fatembolism

Adults between the age of 70and 80

519. Fat embolism's usuallyoccur within blankhours following a longbone fracture or withtotal joint arthroplasty

48

520. What are clinicalmanifestations of a fatembolism

DyspneaChest painDecreased O2 satDecreased LOCRespiratory distressTachycardiaTachypneaFeverCutaneous petechiae (late sign)

521. What is treatment for afat embolism

1. Maintain the patient onbedrest2. Oxygen for respiratorycompromise3. Corticosteroids for cerebraledema4. Vasopressors and fluidreplacement for shock5. Pain and anti-anxietymedications as needed

522. What is the mostcommon complicationfollowing trauma,surgery or disabilityrelated to immobility

DVT

523. What are ways to preventDVT

1. Encourage early ambulation2. Apply antiembolism stockings3. Administer anticoagulants4. Encourage intake of fluids toprevent hemoconcentration5. Instruct the patient to rotatefeet at the ankles and performother lower extremity exercisesas permitted by the particularimmobilization device

524. What is treatment forosteomyelitis

1. Long course of IV and oralantibiotic therapy (3 months)2. Surgical debridement3. Hyperbaric oxygen treatment4. Surgically implanted antibioticbeads5. Amputation

525. If a wound from osteomyelitis isleft open to heal, standardprecautions are adequate andblank technique can be usedduring dressing changes

Clean

526. What is avascular necrosis Bloodflow is disruptedto the fracture site andthe resulting ischemialeads to tissue/bonenecrosis

527. Who is at greater risk fordeveloping avascular necrosis

Patients receiving long-term corticosteroidtherapy

528. A nurse is completing anassessment of a patient who hadan external fixation deviceapplied two hours ago for afracture of the left tibia andfibula. What are four things thatthe nurse might find that wouldindicate compartmentsyndrome?

1. Intense pain whenthe left foot is passivelymoved2. Hard, swollen musclein the left leg3. Burning and tinglingof the distal left foot4. Minimal pain relieffollowing a second doseof opioid medication

529. A nurse in the emergencydepartment is planning care fora patient who has a right hipfracture. What kind ofimmobilization device shouldthe nurse anticipate in the planof care?

Bucks traction becauseit is a temporaryimmobilization deviceapplied to diminishmuscle spasms andimmobilize the affectedextremity until surgeryis performed

530. Chapter 77 ...

531. The posterior pituitary glandsecretes the hormone blankwhich causes the kidneys toreabsorb water

ADH (vasopressin)

532. A deficiency of ADH causes Diabetes insipidus,which is characterizedby the excretion of alarge quantity of dilutedurine

533. Excessive secretion of ADHcauses

Syndrome ofinappropriateantidiuretic hormone.In SIADH, the kidneysretain water, urinebecomes concentrated,urinary outputdecreases andextracellular fluidvolume is increased

534. What is the water deprivation test Measures thekidneys ability toconcentrate urine inlight of an increasedplasma osmolalityand a low plasmavasopressin level.

535. The water deprivation test isperformed for patients who have adiagnosis of diabetes insipidus. Itshould only be conducted if thepatient's baseline serum sodiumlevel is blank and The osmolality ofthe urine is below blank

Within the expectedrange, 300

536. What is a positive result fordiabetes insipidus with the waterdeprivation test

The kidneys areunable toconcentrate urinedespite increasedplasma osmolality

537. What are preprocedure nursingactions for the water deprivationtest

1. Nosmoking/caffeine oralcohol prior to test2. Withhold fluids for8 to 12 hours3. Obtain IV access

538. What position is the patient induring the test

Recumbent positionfor 30 minuteshowever The patientmay sit or standduring voiding.

539. What is a complication of thewater deprivation test

Dehydration

540. What is Cushing's disease(Hypercortisolism)

Hyper functioning ofthe adrenal cortexand an excessiveproduction of cortisol

541. What is Addison's disease Hypo functioning ofthe adrenal cortexand a consequentlack of adequateamounts of serumcortisol

542. What is a diagnostic test they canuse to determine if a patient hasCushing's disease

Dexamethasonesuppression test

543. What is a positive result forCushing's disease after doing thedexamethasone test

There is no decreasein the production ofACTH and cortisol

544. Disorders of the adrenal medullamay cause

Hypersecretion ofcatecholamines(pheochromocytoma)

545. The vanillylmandelic acid test isused to diagnosepheochromocytoma. How doesthis test work

VMA testing is a 24hour urine collectionfor VMA, a breakdownproduct ofcatecholamines

546. What is the expected range forVMA in a 24-hour period

2 to 7 mg

547. What is a positive result for theVMA test that indicatespheochromocytoma

Elevated levels

548. What kind of food andmedications may be restricted 2 to3 days before the test

Caffeine, vanilla,bananas, chocolate,aspirin andAntihypertensivemedications

549. A clonidine suppression test iswhere the patients plasmacatecholamine levels are takenprior to and three hours afteradministration of clonidine. Whatis a positive result forpheochromocytoma

The clonidine has noeffect and nodecrease in bloodpressure

550. What is normal reference range forfasting blood glucose

Less than 110 mg/dL

551. How long does the patient need toabstain from food or fluids otherthan water before a fasting bloodglucose test

Eight hours

552. What is a normal reference rangefor the oral glucose tolerance test

Less than 140

553. How long does a patient need tofast before the oral glucosetolerance test

10 to 12 hours

554. How often are blood samplestaken during the oral glucosetolerance test

Every 30 minutes fortwo hours

555. What is normal range for HBA1C,what level indicates pre-diabetesand what level indicates diabetes

Normal: 5% or lessPre-diabetes: 5.7% to6.4%Diabetes: 6.5% orhigher

556. What is normal range for T3 70 to 205

557. What is normal range for T4 4 to 12 mcg/dL

558. Chapter 78 ...

559. What are risk factors for diabetesinsipidus

1. Headinjury/tumor/infection(meningitis,encephalitis)2. Lithium

560. What are signs/symptoms ofdiabetes insipidus

PolyuriaPolydipsiaNocturiaFatigueAnd other symptoms ofdehydration

561. How is the urine chemistry indiabetes insipidus (PH, sodium,potassium, specific gravity,osmolality)

Everything is decreased,think dilute

562. How is the serum chemistry indiabetes insipidus

Think concentratedeverything is increased

563. What would aradioimmunoassay show you

Decreased ADH

564. What kind of drink would apatient with diabetes insipiduswent to avoid

Anything with caffeine

565. What should be done daily withthe patient that has diabetesinsipidus

Daily weight

566. What is an anticonvulsant thatstimulates the release of ADH

Tegretol

567. What are three side effects ofTegretol

Dizziness, drowsiness,thrombocytopenia

568. What are symptoms ofthrombocytopenia

Sore throat, fever,bleeding

569. Should Tegretol be taken withor without food

With food

570. Who should vasopressin begiven cautiously to

Patients who havecoronary artery diseasebecause it can causevasoconstriction

571. What are four teaching points toa patient that has diabetesinsipidus

1. Weigh daily2. Eat a diet high in fiber3. Wear a medical alertwristband 4. Monitor fluid intake

572. What are risk factors forsyndrome of inappropriateantidiuretic hormone

Malignant tumorsIncreased intrathoracicpressure (PPV)MeningitisCardiovascular accidentMedicationsTraumaPainStressDiuretics due toincreased sodium losses

573. Early manifestations of SIADHinclude

HeadacheAnorexiaMuscle crampsWeaknessWeight gain

574. As a serum sodium level decreasesin SIADH, the patient begins toexperience personality changes,hostility, sluggish deep tendonreflexes and

Nausea, vomiting,diarrhea and oliguria

575. Later manifestations of SIADHinclude

ConfusionLethargy Cheyne-stokesrespirationsSeizuresComaDeath

576. What are manifestations of fluidvolume excess

TachycardiaPossible hypertensionCrackles in the lungsDistended neck veinsTaut skin

577. What is urine chemistry in SIADH Think concentrated

578. What is blood chemistry in SIADH Think dilute

579. What should oral fluids berestricted to any patient that hasSIADH

500 to 1000 mL/day

580. What is Demeclocycline Tetracyclinederivative. Used forSIADH

581. With patients takingdemeclocycline monitor forindications of a yeast infection inthe mouth. What can you do todecrease the likelihood of thishappening?

Have the patient rinsetheir toothbrush witha diluted bleachsolution and increaseconsumption ofyogurt

582. How does lithium work in SIADH Blocks the renalresponse to ADH

583. What are signs of lithium toxicity Nausea, diarrhea,tremors ataxia

584. Should lithium be taken with orwithout food

With food

585. During treatment for SIADH if apatient is receiving hypertonicsaline or loop diuretics how oftenshould their serum sodium levelbe monitored

Every 2 to 4 hours

586. Chapter 79 ...

587. What do the hormones T3and T4 do

They affect all body systemsby regulating overall bodymetabolism, energyproduction, fluid andelectrolyte balance andcontrolling tissue use of fats,proteins and carbohydrates

588. What is the most commoncause of hyperthyroidism

Graves disease. Autoimmuneantibodies result inhypersecretion of thyroidhormones

589. What are two other causesof hyperthyroidism

Toxic nodular goiter: causedby overproduction of thyroidhormone due to the presenceof thyroid nodulesExogenous hyperthyroidism:caused by excessive dosage ofthyroid hormone

590. What are some clinicalmanifestations ofhyperthyroidism otherthan ones you wouldalready think of such asinsomnia, tachycardia,irritability and so on

1. Menstrual irregularities(Amenorrhea/decreasedmenstrual flow)2. Libido is initially increasedand then followed by adecrease3. Exophthalmos (Gravesdisease only)4. Vision changes5. Bruit over the thyroid gland

591. If someone was given thethyrotropin-releasinghormone stimulation test,what would be a positiveresult for hyperthyroidism

Failure of expected rise in TSH

592. In the radioiodine uptakeand thyroid scan test,iodine is administeredorally 24 hours prior to thetest, and then it ismeasured. What is apositive result?

An elevated uptake

593. One week prior to theradioiodine uptake testwhat should patientsavoid regarding food

Anything that contains iodine

594. Thionamides such as blankand blank are used toinhibit the production ofthyroid hormone

Methimazole, propylthiouracil

595. What are side effects ofthionamides

HypothyroidismLeukopeniaThrombocytopeniaHepatotoxicity

596. What is the medication that canbe administered one hour afteranti-thyroid medication and isonly used for short term

Iodine solutions (mixedwith juice, use a strawand take the food)

597. How does radioactive iodinetherapy work

It is taken up by thethyroid and destroyssome of the hormoneproducing cells

598. How long after radioactiveiodine therapy does a patientneed to stay away from infantsand small children and avoidbecoming pregnant

2 to 4 days and avoidbecoming pregnant forsix months followingtherapy

599. What are four other precautionsthat a patient needs to take afterradioactive iodine therapy

1. Do not use the sametoilet as others for twoweeks and flush thetoilet three times afteruse2. Take a laxative for 2 to3 days after treatment3. Wear clothing that iswashable and washclothes separate fromothers4. Do not share atoothbrush and usedisposable food serviceitems such as paperplates

600. What should a patient receive 10to 14 days before athyroidectomy to reduce glandsize and prevent excess bleeding

Iodine

601. After a thyroidectomy whatposition should the patient be in

Hi Fowler's and avoidneck extension

602. After thyroidectomy how do youcheck for laryngeal nervedamage

By asking the patient tospeak as soon as theyawake from theanesthesia and everytwo hours there after

603. If the parathyroid gland getsdamaged during athyroidectomy what will thepatient be needing

Calcium supplements

604. What is usually given after athyroidectomy to reducepostoperative edema

Prednisone

605. How much drainage should youexpect in the first 24 hours aftera thyroidectomy

50 mL (after the first 24hours there should onlybe scant drainage)

606. Thyroid storm/crisis results from asudden surge of large amounts ofthyroid hormones into the bloodstream, causing an even greaterincrease in body metabolism.Precipitating factors include

InfectionTraumaEmotional stressDiabetic ketoacidosisDigitalis toxicityThyroidectomy

607. What are clinical manifestations ofa thyroid storm/crisis

HyperthermiaHypertensionDeliriumVomitingAbdominal painHyperglycemiaTachydysrhythmiasDyspnea

608. If a patient is having a thyroidstorm you can administerpropylthiouracil to prevent furtherrelease of thyroid hormones. Youcan then administer iodine onehour after. Why not give it before

Because if it is givenbefore it canexacerbatemanifestations insusceptible clients

609. What are two things to look for asan indicator of hypocalcemia

Chvosteks andtrousseau sign

610. A nurse in a providers office isreviewing the health record of apatient who is being evaluated forgraves disease. What is an expectedlaboratory finding for this patient?

Decrease in TSHbecause thepituitary glanddecreases theproduction of TSHwhen thyroidhormone levels areelevated

611. Chapter 80 ...

612. What are risk factors forhypothyroidism

1. Women betweenthe ages of 30 to 602. Lithium andamiodarone3. In adequateintake of iodine

613. What are some early findings ofhypothyroidism

Fatigue/lethargyIntolerance to coldConstipationWeight gainPale skinThin, brittle nailsDepressionThinning hairJoint and/or musclepain

614. What are late manifestations ofhypothyroidism

BradycardiaHypotensionDysrhythmiasSlow thoughtprocess/speechHypoventilationThickening of theskinDry flaky skinSwelling in face,hands and feetDecrease acuity oftaste and smellHorse, raspyspeechAbnormalmenstrual periods

615. What kind of diet should a patientwith hypothyroidism be on

Low-calorie, highbulk diet andencourage activityto preventconstipation andpromote weight loss

616. What is the medication of choice forthyroid hormone replacementtherapy

Synthroid

617. What are three medications thatSynthroid increases the effects of

CoumadinInsulin (need for it)Digoxin

618. What type of medications decreasethe absorption of Synthroid

PPI's and H2antagonist

619. When should Synthroid be taken 1 to 2 hours beforebreakfast

620. What is a severe complication ofhypothyroidism

Myxedema

621. A nurse any providers office isreviewing the laboratory findings ofa patient who's being evaluated forprimary hypothyroidism. What isexpected a laboratory finding forthis patient?

Hematocrit 34%which indicatesanemia, which is anexpected result forpatient who hashypothyroidism

622. What kind of laxative can a patientnot take when they are on Synthroid

Fiber laxativesbecause itinterferes withabsorption

623. Chapter 81 ...

624. What are causes ofCushing's syndrome

Organ transplantChemotherapyAutoimmune diseases (rheumatoidarthritis)AsthmaLong-term use of glucocorticoids

625. What are somesigns/symptoms ofCushing's disease

Weakness/fatigueBack/joint painDecreased immune systemBruising/petechiaeHypertensionTachycardiaGastric ulcersWeight gainHypervolemiaHirsutism

626. What are expectedfindings inlaboratory testassociated withCushing's disease

ATCH: increased Cortisol: increasedSerum K/Ca: decreaseSerum glucose: ISerum sodium: ILymphocytes: D

627. Chapter 82 ...

628. What is Addison'sdisease

An adrenocortical insufficiency. Theproduction of mineralocorticoids andglucocorticoids is diminished resultingin decreased aldosterone and cortisol

629. What are some riskfactors forAddison's disease

Autoimmune dysfunctionTBCancerAdrenalectomySepsisTraumaSteroid withdrawal

630. What are someclinicalmanifestations ofAddison's disease

Weight lossCraving for saltHyperpigmentationSevere hypotensionDehydrationHyponatremiaHyperkalemiaHypoglycemiaHypercalcemia

631. What wouldlaboratory valuesbe in a patient thathas Addison'sdisease

Bun/creatinine: ISerum glucose: DSerum cortisol: D

632. Hydrocortisone,prednisone andcortisone are allglucocorticoids usedfor Addison's disease.How should thismedication be taken?

With food

633. What is a potentialadverse side effects ofthe mineralocorticoidfludrocortisone

Hypertension and dosage mayneed to be increased duringperiods of stress or illness (One thepatient to expect mild peripheralEdema)

634. What is addisoniancrisis

An acute adrenal insufficiencyoccurs when there is an acutedrop in adrenocorticoids due tosudden discontinuation ofglucocorticoid medications orwhen induced by severe trauma,infection or stress

635. What is treatment foraddisonian crisis

1. Administer insulin to movepotassium into the cell2. Administer calcium andkayexalate to counteract theeffects of hyperkalemia3. Establish an IV line and initiate arapid infusion of NS4. Loop or thiazide diuretics areused to manage hyperkalemia5. Administer hydrocortisone asreplacement therapy

636. In the presence ofprimary adrenalinsufficiency, plasmacortisol levels blank inresponse to theadministration ofACTH

Do not rise

637. Chapter 3 ...

638. What is the bestpossible score for theGlasgow coma scale

15

639. What do the otherpossible scores for theGlasgow coma scaleindicate

1. Less than eight: associated withsevere head injury and coma2. 9 to 12: indicate a moderatehead injury3. Greater than 13: reflect minorhead injury

640. What are the threethings that theGlasgow coma scaleuses to determine thescore

Eye-opening, verbal and motorresponse

641. What is thepositioning fora lumbarpuncture

Either the cannonball position or have thepatient stretch over and over bed table ifsitting is preferred

642. Chapter 5 ...

643. What kind ofmeningitis iscommonamongpatients whohave AIDS

Fungal

644. What is thehaemophilusinfluenza typeB vaccine

A vaccine for infants against bacterialmeningitis

645. What ispneumococcalpolysaccharidevaccine

For adults 65 years and older who havenot been previously vaccinated nor havehistory of the disease (for adults orimmunocompromise, have a chronicdisease, who smoke cigarettes or live in along-term care facility)

646. What is themeningococcalvaccine

For adolescence to receive prior to living ina residential setting in college and for thosein the military

647. What are riskfactors for viralmeningitis?Also there's novaccine againstviral

Mumps, measles, herpes and west Nilevirus

648. What are somesubjectivesigns ofmeningitis

Excruciating, constant headacheNuchal rigidity Photophobia

649. What are someobjectivephysicalassessmentfindings ofmeningitis

Fever and chillsN/VAltered LOCPositive Kernig's signPositive Brudzinski's signHyperactive deep tendon reflexesTachycardiaSeizuresRed macular rashRestlessness/irritability

650. What is themost definitivediagnosticprocedure formeningitis

CSF analysis

651. What results from theCSF analysis and labvalues would beindicative ofmeningitis

1. Appearance of CSF: cloudy(bacterial) or clear (viral)2. Elevated WBC3. Elevated protein4. Decreased glucose (bacterial)5. Elevated CSF pressure

652. What kind ofprecautions is apatient withmeningitis placed on

Isolation/droplet precautions, whichrequires a private room

653. What position shoulda patient withmeningitis be in, inbed

Head of bed elevated 30°

654. Chapter 6 ...

655. What is a myoclonicseizure

A brief jerking or stiffening of theextremities which may besymmetrical or asymmetrical

656. What is an atonicseizure

Characterized by a few seconds inwhich muscle tone is lost. Theseizure is followed by a period ofconfusion

657. What is one anti-elliptic drug

Phenytoin (decreases effectivenessof oral contraceptives)

658. What is a medicationthat should not begiven with phenytoin

Warfarin

659. What is a vagal nervestimulator

A device implanted into the leftchest wall and connected to anelectrode placed on the left vagusnerve

660. How does a vagalnerve stimulatorwork

It is programmed to administerintermittent stimulation of the brainvia stimulation of the vagal nerve, ata rate specific to the patients needs

661. In addition to routine stimulation,the patient may initiate vagal nervestimulation by holding a blank overthe implantable device, at the onsetof seizure activity. This either abortsthe seizure or lessons it's severity

Magnet

662. What is status epilepticuscharacterized by

A prolonged seizureactivity occurringover a 30 minutetime frame

663. Chapter 7 ...

664. Parkinson's disease is a progressivelydebilitating disease that grosslyaffects motor function. It ischaracterized by four primarysymptoms which are

Tremor, musclerigidity,Bradykinesia andpostural instability(dopamine isdecreased)

665. How's your patience Parkinson's eattheir food

1. Provide smaller,more frequentmeals2. Add commercialthickener to thickenfood3. Patients shouldbe weighed at leastweekly

666. Medications such as blank, areconverted to dopamine in the brain,increasing dopamine levels in thebasal ganglia

Levodopa

667. Dopaminergics May be combinedwith blank, to decrease peripheralmetabolism of levodopa requiring asmaller dose to make the sameamount available to the brain. Sideeffects are subsequently less

Carbidopa

668. What is stereotactic pallidotomy Destruction of asmall portion of thebrain within theGlobus pallidusthrough the use ofbrain imaging andelectrical stimulation

669. Any patient that receives deep brainstimulation should be monitoredfor what afterwards

Infection, brainhemorrhage,neurologicalimpairment orstroke likesymptoms

670. What are two complications ofParkinson's disease

Aspirationpneumonia andaltered cognitionsuch as dementia

671. Chapter 10 ...