Pre-Operative
What is the correct time to educate a patient on exercise that needs to be done after the procedure?
Before the procedure (or) asap (both are acceptable)
The intraoperative nurse can advocate for each patient by doing this
Maintaining:
physical and emotional comfort, privacy, rights, and dignity.
How many milliliters would the nurse document on the intake and output log as being infused on a 1-liter bag of normal saline if 600ml remained in the bag?
400ml
1000ml-600ml (in bag) = 400 were infused (intake)
This risk is associated with incorrect placement of graduated compression stockings.
Pain, ineffective therapy, or restriction. Page 853 (Quality/Safety Alert).
Name one modifiable risk factor for hypertension
High cholesterol levels, alcohol intake, smoking, drug intake, not adhering to prescribed medications
Will also accept:
Nutritional Intake, sedentary lifestyle, diabetes, CKD, obesity, stress, sleep apnea (Page 867)
Non-modifiable- race, gender, genetics
It is the pre-op period for a surgical procedure requiring general anesthesia. What is the maximum distance that your patient will be able to drive home immediately following the procedure?
Zero (or) none
Patients may not drive themselves home at all.
When your patient is using an incentive spirometer every 1-2 hours, how do you instruct them to breathe?
Exhale normally, inhale slowly and deeply without using the nose. When unable to inhale any longer, hold breath and count to 3.
***Remember minimum of every 2 hours***
You have an order for Acetaminophen 1000mg po once now. The pharmacy has 500mg tablets.
How many tables would you give your patient?
2 tablets
500mg x 2 = 1000mg
Your patient is scheduled for a cardiac catheterization. You explain the purpose of this procedure is to _____?
Assess the blockage or open the coronary arteries if needed (Page 681)
A patient has a single, elevated blood pressure of 145/90. When would the clinician confirm that they have hypertension?
If there are two or more readings of at least 140 systolic, 90 diastolic.
No medication will be prescribed for a single elevated blood pressure reading.
What therapeutic communication can the nurse use when greeting a patient prior to a procedure
What is (are)
Approach patient, initiate dialogue, introduce themselves, use good eye contact, use a tone of voice that is calming to decrease anxiety
One task that the operating room nurse is responsible for in the Operating Room
What is (are)
Verifying consent, coordinating the team, maintaining cleanliness, temperature/humidity, lightening, monitoring aseptic technique, restocking supplies, and documentation
The physician ordered 1/2 strength liquid tube feeding. The total volume is 100ml. How many milliliters of water would you need to mix with the formula?
Total Volume 100ml. One half is 50ml (formula) making the amount of water you should mix 50ml.
(Enteral Nutrition, page 226).
Your patient with cardiovascular disease is being tested for orthostatic hypotension. What changes must be seen in the measurements to indicate a positive result?
Sustained decrease of at least 20 mm Hg in systolic or 10 mm Hg in diastolic within 3 minutes of moving from a lying or sitting position over to a standing position.
*Watch those systolic AND diastolic numbers
Your patient has had blood pressure that has gradually increased over the past 2 years. After a careful physical assessment, no cause was identified. What type of hypertension is this?
Primary Hypertension aka Essential Hypertension
(Note)
Secondary DOES have an identifiable cause.
Your patient stated that they did not understand the surgical procedure informed consent. What can you do for the patient?
Call the physician back to review the procedure with the patient.
What is the primary priority in the immediate postoperative period?
Maintain patent airway
This maintains ventilation and prevents hypoxemia (low oxygen in blood) and hypercapnia (high carbon dioxide)
The NP (nurse practitioner) orders you to give the patient streptomycin 8mg/kg IM every 6 hours. How many mg do you give a patient per dose, that weighs 110 lbs?
400mg
110 lbs. divided by 2.2 = 50kg
50kg x 8mg = 400mg - Great Job!
Your patient came into the ED with cardiac symptoms following a heavy (fried chicken and greens) lunch with friends. You explain to the physician that you cannot collect the lipid profile yet. Please state the reason why.
For accurate results, a 12-hour fast is needed.
Know your blood chem, hematology, and coagulation studies (page 672 - such as Lipid Profile, Coagulation aPTT/INR levels, BNP, hs-CRP)
Your patient has been taking a blood pressure medication for 2 months and it has not improved. What is the highest potential cause of this?
Adherence to prescribed therapy
An estimated 50% of patients discontinue their medications within one year.
The patient is at a high risk for Deep Vein Thrombosis (DVT). What is recommended immediately post-op to reduce this risk?
Early Ambulation
Older adults are at a higher risk for complications like hypothermia (low temperature) due to their inability to adjust. What are some measures you can use to bring up their temperature?
Use a warm blanket, forced air warming blanket, and frequent position changes.
Thermoregulation - regulating temperature
Hypothermia (low temperature)
Hyperthermia (high temperature)
The physician ordered 600mg to be given over 75 minutes. The pharmacy has 600mg in 200ml What rate would you set the pump to? (ml/hr)
160ml/hr
75min divided by 60 minutes in an hour=1.25 hours. 200ml over 1.25 hours = 160
What is the Ankle-Brachial Index (ABI) Pressure used for and what number indicates an abnormal level?
Degree of stenosis (narrowing) of peripheral arteries. ABI of lower than 1.00 is abnormal. See the levels on chart 26-2, page 824.
When an older patient is prescribed a diuretic, what must be monitored carefully for safety?
They are at risk for fluid volume deficit (not enough)
Dehydration. It can cause confusion in the older population or put them at risk for blood clots. It can also contribute to risk for UTIs due to concentrated urine