Signs & Symptoms
What diagnostic S/S would you anticipate in a patient experiencing appendicitis? What S/S would you consider emergent?
Right lower quadrant pain
Sudden improvement in pain or the patients description of a "pop" feeling
A client has just had surgery for colon cancer. Which of the following disorders might the client develop?
A- Peritonitis
B- Diverticulitis
C- Partial Bowel Obstruction
D- Complete Bowel Obstruction
A- Peritonitis
A patient requires a high dose of a new antihypertensive medication because the new medication has a significant first-pass effect. What does this mean?
a. The medication must pass through the patient's bloodstream several times to generate a therapeutic effect.
b. The medication passes through the renal tubules and is excreted in large amounts.
c. The medication is extensively metabolized in the patient's liver.
d. The medication is ineffective following the first dose and increasingly effective with each subsequent dose..
C
Discuss the purpose behind the use of an IS.
- What does it prevent? Explain the patho behind your response.
- How often should a patient use it?
IS (Incentive Spirometer) is used post operatively to prevent atelectasis. Atelectasis is the complete or partial collapsing of the lung. It typically occurs postoperatively due to anesthesia and prolonged bed rest. Patients should be using their IS every 1-2 hours.
When placing an NG tube, what is needed prior to attaching the tube to suction?
X-ray results to confirm tube placement
Which of the following patients would you immediately call Rapid Response Team (RRT) for?
A - Patient with BP 140/87, R 12, P 67, 02 98%
B - Patient with BP 110/80, R 18, P 101, 02 96%
C - Patient with BP 118/90, R 24, P 130, 02 88%
C
A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following?
A- Metabolic acidosis with hyperkalemia
B- Metabolic acidosis with hypokalemia
C- Metabolic alkalosis with hyperkalemia
D- Metabolic alkalosis with hypokalemia
D- Metabolic alkalosis with hypokalemia
Which of the following is a reversal drug for opioids?
-Glucagon
-Naloxone
-Physostigmine
-Vitamin K
Naloxone
What interventions should be implemented for a patient on Metolazone? What should you monitor for?
- Daily weight, strict I&O, frequent respiratory assessment
Monitor for: Low potassium, sodium, and magnesium
Heparin- PTT & INR
Warfarin- PT & INR
A client with gastric cancer may exhibit which of the following symptoms?
A- Abdominal cramping
B- Constant hunger
C- Feeling full
D- Weight gain
C- Feeling full
Michael works as a triage nurse, and four clients arrive at the emergency department at the same time. List the order in which he will assess these clients from first to last.
A- 50 yr old female with moderate abdominal pain and occasional vomiting
B- Irritable infant with a fever, petechiae, and nuchal rigidity
C- 35 year old jogger with a twisted ankle, having a pedal pulse, and no deformity
D- ambulatory dazed 25 year old male with a bandaged head wound
1- Infant
2- head wound
3- abdominal pain and vomiting
4- twisted ankle
Rationale:
Infant- risk of meningitis
Head wound- TBI
Abdominal pain- potentially an infection, obstruction, etc
Ankle- minimal complications
When administering pain medications, patient safety is our biggest concern. Rank the following medications orders from highest to lowest concern for administering to your patient.
Tramadol PO 100 mg q 4-6 hrs
Fentanyl IV 100 mcg q 2 hrs
Dilaudid IV 2 mg q 2 hrs
Tylenol PO 350 mg q 4-6 hrs
1. Fentanyl IV
2. Dilaudid IV
3. Tramadol PO
4. Tylenol PO
A 15-year-old male client arrives at the emergency department. He is conscious, coherent, and ambulatory, but his shirt and pants are covered with blood. He and his hysterical friends are yelling and trying to explain that they were goofing around and he got poked in the abdomen with a stick. Which of the following comments require intervention?
A- The stick was really dirty and covered in mud
B- He pulled the stick out, just now, because it was hurting me
C- He's a diabetic so he needs attention right away
D- There was a lotto blood and we used three bandages
B
Rationale: Impaled objects could be providing tamponade effect and removal could cause sudden hemodynamic decompensation.
- Name the two liver enzyme labs
- What are the normal and abnormal levels?
- What does each enzyme reflect as to what's going on in the body?
ALT & AST are the two enzymes used to assess liver function.
ALT- normal < 50
- Measures liver damage
AST- normal < 45
- Measures liver health
Abnormal levels can reflect:
ALT- liver damage (ex. Cirrhosis, hepatitis, etc.)
AST- liver damage or damage/inflammation somewhere in the body (ex. pancreatitis)
The nurse is preparing to teach a client about the prescribed spironolactone (Aldactone) to monitor for adverse effects of the drug. The nurse should instruct the client about which adverse effects? Select all that apply.
A- Confusion
B- Fatigue
C- Hypertension
D- Leg cramps
E- Weakness
F- Urinary retention
A- Confusion
B- Fatigue
E- Weakness
= potassium SPARING (hyperkalemia s/s)
A client with C7 quadriplegia is flushed and anxious and complains of a pounding headache. Which of the following symptoms would also be anticipated?
A- Decreased urine output or oliguria
B- Hypertension and bradycardia
C- Respiratory depression
D- Symptoms of shock
B- Hypertension and bradycardia
Rationale: Hypertension, bradycardia, anxiety, blurred vision, and flushing occur with autonomic dysreflexia due to uninhibited sympathetic nervous system discharge
A 16-year-old child is brought to the emergency department by his mother with a complaint that the child just experienced a tonic-clonic seizure. On arrival in the emergency department, no apparent seizures were occurring. The mother states that her son is taking medication for the seizure disorder. The nurse plans care, knowing that which of the following medications are used for long-term control of tonic-clonic seizures? Select all that apply.
A- DiazepamB- Alprazolam
C- Gabapentin
D- Ethosuximide
E- Carbamazepine
F- Methylphenidate
C, D, & E
A client enters the emergency department confused, twitching, and having seizures. His family states he recently was placed on corticosteroids for arthritis and was feeling better and exercising daily. On data collection, he has flushed skin, dry mucous membranes, an elevated temperature, and poor skin turgor. His serum sodium level is 172 mEq/L. Choose the interventions that the health care provider would likely prescribe. Select all that apply.
A- Monitor I & O
B- Monitor vitals
C- Low sodium diet
D- Monitor electrolytes
E- Increase oral water intake
F- Administer sodium replacements
A, B, C, D, & E
What does GFR measure? What disease process do we utilize this lab for?
Give the values for each stages
GFR (Glomerular Filtration Rate) measures how well the kidneys are filtering blood. When evaluating for CDK (Chronic Kidney Disease) we look to the GFR for staging.
Stages include:
Stage 1 - > 90
Stage 2 - 60 - 89
Stage 3 - 30 - 59
Stage 4 - 15 - 29
Stage 5 - < 15
Describe S/S of Right sided Heart Failure and Left sided Heart Failure
Left: pulmonary congestion, tachycardia, tachypnea,
Right: Peripheral edema, JVD, ascites,
A nurse assesses a client who has episodes of autonomic dysreflexia. Which of the following conditions can cause autonomic dysreflexia?
A- Headache
B- Lumbar spinal chord injury
C- Neurogenic shock
D- Noxious stimuli
D- Noxious stimuli
Rationale: Noxious stimuli (ex. full bladder, fecal impaction, or decubitus ulcer) cause autonomic dysreflexia. Uncoordinated autonomic response that may result in life-threatening hypertensive episode
A 33-year-old patient with a history of seizures and medication compliance of phenytoin (Dilantin) and carbamazepine (Tegretol) is brought to the ED by the MS personnel for repetitive seizure activity that started 45 minutes prior to arrival. You anticipate that the physician will order which drug for status epilepticus?
A- Phenytoin and Carbamazepine PO
B- Carbamazepine IV
C- Magnesium Sulfate IV
D- Lorazepam IV
D- Lorazepam IV (Ativan)
Rationale: rapid onset
A- PO not prefered
B- No IV form
C- For pregnancies
A client in a one-car rollover presents with multiple injuries. Prioritize the interventions that must be initiated for this patient.
A- Use the chin lift organ thrust method to open airway
B- Remove the patients clothing
C- Give supplemental oxygen per mask
D- Insert a foley catheter is not contraindicated
E- Obtain a full set of vital signs
F- Secure/start 2 large bore IV's with normal saline
G- Assess for spontaneous respirations
1. Assess for spontaneous respirations
2. Use chin lift
3. Supplemental oxygen
4. Secure 2 IV's
5. Vitals
6. Remove clothes
7. Foley catheter
When evaluating a patients echocardiogram, we see results for an EF test. What does EF measure? What disease process do we utilize these results for?
Give values for each stage.
Ejection Fraction (EF) is a component of an echocardiogram used to measure how much blood is being pumped out of the hearts left ventricle with each beat. We use this to diagnose the severity of left sided heart failure.
Normal: 50 - 70 %
Mild: 41 - 49 %
Worsening: < 40 %