Perfusion
A patient with Heart Failure needs to monitor what in their diet
sodium
Name an educational point for at patient with cystic fibrosis
increase mobility, small high calorie meals, use of percussion therapy, adhere to medication regimen, seek early treatment for any signs of infection
What is the gold standard for diagnosing cancer
biopsy
Your patient starts to have neurological changes: confusion, blurry vision, change in speech. What diagnostic test can the nurse anticipate?
CT scan
Provide the proper steps of a blood transfusion
1) make sure there is an order for blood and verify a type and cross has been completed
2) ensure HCP has obtained consent
3) get pre-transfusion vitals
4) gather supplies
5) RN/RN verification of blood
6) prime tubing with NS
7) spike blood products
8) start transfusion
9) stay with patient for first 15 minutes of transfusion, then vitals
A patient is complaining of severe sternal chest pain that radiates to her back. Which lab is most indicative of a myocardial infarction?
Troponin
A 42y/o female admitted to hospital with hyperemesis. Has had frequent large amount of NG drainage (approx 1000mL’s) per shift. What can we anticipate her ABG to read?
Metabolic Alkalosis
Your breast cancer patient is reporting new back pain, what is the priority action of the nurse?
Assess the pain, then call the MD
What is the purpose of Baclofen?
A patient with a history of lung cancer presents with sudden confusion, decreased level of consciousness, and irregular respirations. Imaging reveals brain metastases and increased intracranial pressure. List 2 nursing interventions to help decrease intracranial pressure
Cluster care
Elevate HOB
Low sensitivity environment (turn off lights, tv, sounds)
Promote rest
Our patients with PAD should do what with their legs?
dangle them off the bed
Name 2 ways the nurse can assess an infant for respiratory distress
Retractions, nasal flaring, lethargy, decrease in intake
After a mastectomy, we avoid trauma to effected arm to avoid what?
Lymphedema
You are discharging a patient home with prednisone. What education will you provide them? (name 1)
Monitor blood sugar
Might cause change in appetite
Might cause bloating
Taper the dose
A patient with heart failure presents with pulmonary edema and shortness of breath. Explain how decreased cardiac perfusion leads to impaired gas exchange in the lungs.
Bonus 100 points: what do we expect their ABG to result?
Bonus bonus 100 points: An increase in fluid in the lungs leads to pulmonary hypertension. 1. What does pulmonary hypertension lead to? 2. What in-class exemplar is it correlated with?
Decreased cardiac output from the left ventricle → blood backs up into the left atrium and back into the lungs → fluid in alveoli → impaired O₂ exchange
Bonus: Respiratory Acidosis (decrease gas exchange leads to build up of CO2 in blood stream)
Bonus bonus: 1. Cor Pulmonale (right sided heart failure) 2. COPD
Name 3 nursing assessment findings for decreased cardiac output
decreased urine output
cap refill > 3 sec
low blood pressure
lethargy
tachycardia
weak pulses
confusion
Interpret this ABG:
pH: 7.26
PaCO2: 56
HCO3: 24
PaO2 67
O2sat 92
Uncompensated Respiratory Acidosis with hypoxemia
List 3 signs and symptoms a patient with a new diagnosis of ALL might present with?
signs of bleeding (bruises, bloody nose), sings of neutropenia (illness lasting longer than normal, joint pain, fever), signs of anemia (weakness, fatigue, pale)
Name 4 things involved in seizure precautions?
Set up suction
Have oxygen available
Turn patient on their side
Pad side rails
Remove any dangerous objects
Time the seizure
A patient with advanced ALL is experiencing tumor lysis syndrome after her first round of chemotherapy. She develops metabolic acidosis. Provide 2 nursing interventions to help this patient
Fluids!
To prevent uric acid build up, start her on allopurinol
Monitor I/O's
Your patient went to the cath lab to receive a PCI through his groin. What are some post operative considerations (name 3)
Report any new chest pain
lay flat/bedrest for 4-6 hours
assess the site for redness, bleeding, swelling
if signs of bleeding, apply pressure to site
complete a neurovascular assessment
Explain the ABG progression of a patient with untreated asthma exacerbation.
Starts in Respiratory Alkalosis while the patient is hyperventilating. Then moves into normal ABG while the patient becomes tired. Patient becomes more tired and air trapping increases leading to the patient becoming Respiratory Acidosis due to hypoventilation
Your patient has small cell lung cancer, which lab do we need to closely monitor?
Sodium
Name 3 educational points about Carbidopa/Levodopa
It takes 3-4 weeks to take effect
Report any signs of new involuntary movements to MD
It will reduce symptoms, not stop the progression
Avoid taking with protein rich foods
Prolonged use can result in "on/off" periods
Will take 3-4 times a day
A 65yo male presents to the ER with lethargy, weakness, and chest discomfort. He has a history of DM-II, HTN, liver cirrhosis, and GERD, no history of blood thinners. He is triaged and brought to a room. 1. The nurse should do this FIRST.
The patient's chest discomfort is described as being an irregularly irregular feeling. You assess his vitals: 112/78, 160p, 26RR, 95% on RA.
2. What rhythm can the nurse anticipate the patient being in?
3. Is the patient Stable or Unstable?
4. What medication should the nurse prepare?
You give the medication but it is unsuccessful. Recent vitals are: 109/76, 168p, 27RR, 95% on RA.
5. What is your next intervention?
First: obtain an EKG
Rhythm: A fib with RVR
Patient is stable
Medication: Diltiazem
Next intervention: prepare to administer amiodarone and consider cardioversion if medications unsuccessful