Show:
COPD
Asthma
Heart Failure
Medications
Hypertension
100
Your newly diagnosed COPD patient states: "I don't want to be on oxygen because I heard that stuff can be addicting!" What do you teach your patient about O2 and COPD?
O2 is NOT addicting but using too much O2 can cause your body to stop breathing. However, O2 use is safe during periods of SOB, in fact, research has shown that using it for 15 hours a day improves mental acuity and sleep
100
A patient with asthma is scheduled for a pulmonary function test. What are we going to tell the patient to do before coming in for the test?
What is withhold bronchodilators for 6-12 hours.
100
FACES is the acronym used to describe the most common clinical manifestations of HF. What does each letter stand for?
F = fatigue, A = activity intolerance/limitations, C = congestion/cough, E = edema, S = SOB
100
furosemide (Lasix) should be held (per the order) if the patient's potassium level is greater than or less than _____?
What is less than 3.5 K-sparing should be held if K is >5.0
100
The initial treatment for patients diagnosed with pre-hypertension
What is lifestyle modification (decrease salt <1500 mg/day (DASH diet), stop smoking, start walking, lose weight, decrease stress) Normal adults keep Na <2300mg/day
200
Which of the following physical assessment findings are normal for a client with advanced chronic obstructive pulmonary disease (COPD)? A. Increased anteroposterior chest diameter. B. Underdeveloped neck muscles. C. Collapsed neck veins. D. Increased chest excursions with respiration.
What is A: barrel chest Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. Overly developed, not underdeveloped, neck muscles are associated with COPD because of their increased use in the work of breathing. Distended, not collapsed, neck veins are associated with COPD as a symptom of the heart failure that the client may experience secondary to the increased workload on the heart to pump blood into the pulmonary vasculature. Diminished, not increased, chest excursion is associated with COPD.
200
Which of the following findings would most likely indicate the presence of a respiratory infection in a client with asthma? A. Cough productive of yellow sputum. B. Bilateral expiratory wheezing. C. Chest tightness. D. Respiratory rate of 30 breaths/ minute.
What is A: yellow sputum; the rest may be normal s/s of an asthmatic patient
200
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. What would the nurse anticipate when auscultating the client's breath sounds?
What are crackles.
200
A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the client for what beginning signs and symptoms of digoxin toxicity?
What is nausea, vomiting, visual disturbances
200
What would you tell a patient who asks: "What is the best way to get an accurate blood pressure reading?"
What is proper sized cuff, around bare arm w/ midline placed above brachial artery, place pt. arm at heart level; legs uncrossed, resting for ~five minutes remember: too small of cuff = false high, too large = false low
300
The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). pH 7.35; PC02 62; PO2 70; HCO3 34 The nurse should: A. Apply a 100% non-rebreather mask. B. Assess the vital signs. C. Reposition the client. D. Prepare for intubation.
What is B; always assess first! Clients with chronic COPD have CO2 retention and the respiratory drive is stimulated when the PO2 decreases. The heart rate, respiratory rate, and blood pressure should be evaluated to determine if the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. Oxygen supplementation, if indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation. Pt. is in respiratory acidosis
300
A client uses a metered-dose inhaler (MDI) to aid in management of his asthma. Which action by the client indicates to the nurse that he needs further instruction regarding its use? Select all that apply. A. Activation of the MDI is not coordinated with inspiration. B. The client inspires rapidly when using the MDI. C. The client holds his breath for 3 seconds after inhaling with the MDI. D. The client shakes the MDI after use. E. The client performs puffs in rapid succession.
What is all of them!! Utilization of an MDI requires coordination between activation and inspiration; deep breaths to ensure that medication is distributed into the lungs, holding the breath for 10 seconds or as long as possible to disperse the medication into the lungs, shaking up the medication in the MDI before use, and a sufficient amount of time between puffs to provide an adequate amount of inhalation medication.
300
A nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment component would elicit specific information regarding the client's left-sided heart function? A. Listening to lung sounds B. Assessing for peripheral and sacral edema C. Assessing for jugular vein distention D. Monitoring for hepatomegaly
What is A. Listening to lung sounds Remember: Left-sided failure backs up into the lungs, right-sided failure backs up into the body. Remember the pathway through the heart :)
300
A nurse is preparing for the admission of a client with heart failure who is being sent directly to the hospital from the physician's office. The nurse would plan on having which of the following medications readily available for use? A. Digoxin (Lanoxin) B. Verapamil (Calan) C. Propranolol (Inderal) D. Diltiazen (Cardizem)
What is Digoxin (Lanoxin). Dig is your best answer here because it is the medication of choice in treating HF; because of the positive inotropic effect --> increased contractility and slowed HR.
300
What two systems are involved in short-term control of blood pressure?
What is SNS and vascular endothelium. SNS acts in seconds to increases HR and cardiac contractility → vasoconstriction, renin release from kidneys --> increased BP by increasing CO and SVR; vascular endothelium vasoconstricts blood vessels long term control = renal system, hormones
400
How long should a patient with COPD wait after exercise before using a bronchodilator?
What is 5 minutes
400
How is omalizuman (Xolair) different from most other asthma medications?
What is subcutaneous injection every 2-4 weeks; very expensive; SE = anaphylaxis
400
When assessing a patient with orthopnea, an appropriate question would be ...?
What is "How many pillows relieves your orthopnea?"
400
What is the advantage of Advair Diskus? (what is it?!)
What is combined fluticasone and salmeterol (LABA + ICS) (anti-inflammatory + bronchodilator)
400
At what time of day is BP the highest?
What is in the morning
500
http://www.ocelco.com/store/pc/catalog/207-120gr_1328_detail.jpg This type of device is called a ________. It works by...
What is a flutter device. It loosens secretions through vibrations.
500
The _____________ nervous system is overactive in asthma. Why?
What is parasympathetic; when stimulated, it increases release of ACh (aceytocholine) → increased smooth muscle contraction and mucus
500
A client who had cardiac surgery 24 hours ago has a urine output averaging 20mL/hr for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL and the serum creatinine level is 2.2 mg/dL. Based on these findings, the nurse would anticipate that he client is at risk for which of the following? A) Hypovolemia B) Acute renal failure C) Glomerulonnephritis D) Urinary tract infection
What is B) Acute renal failure Patients who undergo cardiac surgery are at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Renal insult is signaled by decreased urine output and increased blood urea nitrogen and creatinine levels. The client may need medications to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis. No data in the question indicate the presence of hypovolemia, urinary tract infection, or glomerulonephritis.
500
What are you going to teach a patient who has a new prescription for sublingual nitroglycerin?
What is keep out of the light, only good for six months, should tingle
500
What is the formula for mean arterial blood pressure (MAP) and what does it tell us?
What is (SBP + 2 DBP)/3 tells us organ perfusion; >50 is good