Exam 1
A patient comes into the E.D complaining of new onset chest pain that started after shoveling snow in the yard. The patient does not have any previous history of chest pain and is rating the pain a 9/10 stating “it feels like an elephant is sitting on my chest.” A 12-lead continuous ECG was completed and showed ST elevation. How long does the nurse have to get the patient to the cardiac catheterization laboratory in order to get the occlusion resolved?
90 min
Pain differences in duodenal versus gastric ulcers
Duodenal: midepigastric, 2-3hrs post meal, food may decrease pain
Gastric: pain with meals or within 30 min of eating, epigastric
A nurse is admitting a patient with APSGN. What s/s are they most likely to present with?
Anasarca, HTN, hematuria, proteinuria, decreased GFR
A patient was admitted to the unit with a T6 spinal injury and has been diagnosed with spinal shock. The patient begins complaining of a headache rated 8/10. What is the nurses priority action?
Take the BP then raise HOB and notify provider
A 50 yo man comes into the ED with chest pain. Which assessment regarding the chest pain is most important to ask?
Duration (cardiac damage becomes irreversible after how many minutes?)
What does it mean if an ECG shows ST elevation?
There is a total occlusion and the patient is having a MI
A 62 yo patient arrives at the ED presenting with a rigid, board like abdomen, severe upper ABD pain, shallow respirations, weak but rapid HR, and diminished bowel sounds. What are the nurses priority actions?
A client presents in the ED with weakness, muscle cramps, and N/V 36 hours after beginning chemotherapy. The physican prescribes allopurinol. As the nurse, you know this drug is used to treat and prevent?
Tumor lysis syndrome
A patient presents to the HIV clinic with questions about his diagnosis. The client is worried about the progression of the disease and would like to know how AIDs is diagnosed. As the nurse, how would you respond?
HIV diagnosis with 1 of the following:
CD4 count <200
Opportunistic infection (PCP pneumonia, TB, Thrush)
Wasting syndrome (loss of 10% body mass)
Report bloody stools or emesis
List differences between PAD and PVD (pulses, pain, skin/hair, edema, ulcers)
Arterial: diminshed pulses, pain upon elevation , no hair on lower legs, elevation pallor/dependent rubor, no edema, painless, round ulcers with minimal drainage.
Venous: pulses present but difficult to palpate due to edema, hair may be present or absent; painful, irregularly shaped, ulcers with lots of drainage,
Your patient is prescribed lactulose. As a nurse you are aware that this drug is used for what condition? What are you going to monitor?
Hepatic Encephalopathy
Monitor bowel sounds (must be present before administration); LOC, asterixis, amonia levels (15-60), stools (2-4 soft stools/day)
A client on your unit has an AV fistula for hemodialysis MWF. How is patency assessed and how often?
Palpating a thrill, hearing a bruit, every 8 hours
A patient presents to the ER with anorexia, flu-like symptoms, dark urine, and clay colored stools. The patient is diagnosed with hepatitis A. The patient is concerned about where they got this infection. As the nurse, what would you tell this patient about transmission of this infection?
It is spread through the fecal-oral route. Typically spread through contaminated food, poor hand hygiene, unsanitary food preparation.
What are the two main risks of long term immunosuppressive therapy?
A 50 yo patient's heart monitor begins showing ventricular tachycardia. What does this look like and what is the nurses priority action?
Mcdonals sign
Vtach with pulse: antidysrythmic (amiodarone) or cardioversison
Vtach w/o pulse: CPR and rapid defibrillation
A client is prescribed pancrealipase. The nurse understands this drug works best when given at what time?
Filgastrim is prescribed to a patient recieving chemotherapy. As the nurse you know this drug is prescribed to...
stimulate production of neutrophils to prevent neutropenia caused by chemo
A patient with HIV has been prescribed ARTs. The patient questions the nurse on what these drugs do and why it is important to stick to the drug regimen. How should the nurse respond?
ARTs delay disease progression by decreasing viral load of HIV. Adherence prevents drug resistance, delays disease progression into AIDs, prevents opportunistic infections, and reduces risk of transmisison to others.
Why are multiple immunosuppressive agents used to prevent organ rejection?
Treatment for atrial flutter/A-Fib
Beta Blockers- Slows does not convert
CCB- slows, does not convert
Amiodarone- converts
Anticoagulants- prevents thrombi formation (blood stasis in atria)
TEE- electrocardioversion; shocks heart back into rhythm.
Explain the lab alterations that will occur in Cirrhosis. Which are high/low?
Low: Albumin, Platelets
A 68 yo male has just returned to the unit after a TURP. Nursing management for this patient should include? Discharge teaching?
Oral and IV fluids (D5W), Oxygen, morphine, bed rest, DVT prophylaxis (SCDs, antiplatelets)
A patient is admitted to the unit with a history of a kidney transplant 4 years ago and multiple accounts of acute rejection. They are now diagnosed with chronic rejection. As the nurse, you know treatment for this patient will include?
Symptom management, there is no treatment