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Perioperative
Respiratory
Fluid & Electrolyte Balance
Cardiac
Endocrine
100
This type of pain is highly resistant to relief, and an example is cancerous pain.
*What is Intractable Pain. Other types of pain include Acute - from temporary injury, disease, surgery; Chronic - persists for indefinite periods > 3 months; Cancerous vs Non-cancerous, Phantom, Radiating, and Referred pain.
100
A client is diagnosed with Gastroenteritis caused by the Salmonella organism. Name 3 manifestations of this disease process.
*What is N/V, diarrhea, abdominal distention, abdominal tenderness, fever, GI upset. Nursing Dx related to GI organisms causing for disease include: Altered Elimination, Electrolyte distrubance, FVD, Alteration in comfort, Altered Nutrition.
100
A client's lab values are as follows: Na+ 148, K+ 3.7, Ca+ 9.8, Mag 2.0. What electrolyte imbalance is present?
*What is hypernatremia. Hypernatremia is a loss of fluids either via hyperventilation, fever, diarrhea or other reason. Manifestations of hypernatremia include dry, sticky membranes, tongue red/swollen, dyspnea, hypotension, tachycardia, and in severe cases fatigue, restlessness, disorientation, and even coma.
100
What disease is classified by a decrease in bone density, "brittle bones", due to a loss of calcium out of the bone or inadequate nutritional intake of calcium?
What is Osteoporosis. Osteomalacia is classified by a deficiency in Vitamin D, causing for a lack of calcium absorption in the body. It is referred to as "soft bones" due to bone demineralization. Paget's disease consists of excessive osteoblastic (re-formed bone) and osteoclastic (breakdown)activity creating structurally disorganized and weakened bones.
100
When the thyroid gland does not produce enough thyroid hormone (due to illness, surgery, stress, obstruction, etc.), the pituitary gland detects this reduction in hormone and makes more TSH (releases/stimulates thyroid hormone production) to correct the problem. Blood test results of TSH > 5... What disorder is this?
What is hypothyroidism. In hyperthyroidism, there are high levels of thyroid hormone present, which results in an increased metabolism. The pituitary gland detects this excess and therefore reduces the amount of TSH, levels are therefore <1.
200
Give 1 example of an opioid analgesic, a non-opioid analgesic, an adjuvant analgesic, and a non-pharmacologic intervention for pain relief.
*What is Morphine, Codeine, Hydrocodone, Oxycodone, Hydromorphone, Meperidine, Fentanyl (all opioids); NSAIDs, Acetaminophen (non-opioids); Tricyclic antidepressants and anticonvulsants (adjuvants); relaxation techniques, repositioning, distraction, environmental considerations/changes, massage, cold/heat, etc. (non-pharm).
200
The 1st line of defense is important in preventing infection/illness. Name 3 of the body's first lines of defense.
*What is intact skin and mucous membranes, nasal passages - cilia, lungs - alveolar phagocytes, oral cavity - saliva, eyes - tears, GI tract - acidity and resident flora, vagina - acidity and resident flora, urethra - urine. 2nd line of defense involves the inflammatory process.
200
What are 2 priority nursing diagnoses for the client with fluid volume excess issues?
*What is ineffective breathing, impaired gas exchange, impaired skin integrity, and electrolyte imbalance. Nursing interventions include: assessing lung sounds, oxygen PRN, high-fowler's position, assess edema, daily weights, decrease IV fluids, limit fluids and Na+, diuretics as ordered, elevate legs, etc.)
200
Please give an example of how spiral and impacted fractures can occur.
What is (spiral) from twisting or abusive type of injury; (impacted) from great force or pressure like a MVA. Open fractures require surgical intervention to reduce fracture. Risk for infection is great with any type of open/compound fracture. Nursing interventions include: splinting, elevate, check 6 P's, immobilize, prevent DVTs, cast/skin care, prevent infection.
200
Name 4 manifestations noted in clients with Addison's disease.
What is bronze pigmentation of skin, changes in distribution of body hair, GI disturbances, weakness, hypoglycemia, postural hypotension, weight loss, fatigue, dehydration, in adrenal crisis there is vascular collapse (severe hypotension), and renal shut down (decrease in serum Na+ and increase in serum K+)
300
What are the 6 common pain indicators for a client who is cognitively impaired?
What is 1) facial expressions, 2) verbalizations or vocalizations, 3) body movements, 4) changes in interpersonal interactions, 5) changes in activity patterns or routines, 6) mental status changes. *Pain assessment includes self-report, search for cause, observe behaviors, family reporting, attempt an analgesic trial.
300
The nurse performs a detailed assessment of the client at risk for infection. Name one assessment of history, physical assessment, and laboratory assessment piece that is important in assessing for risk for infection.
*What is (history) pre-existing and current conditions, hx of infections, meds, stressors, nutritional status, immunizations, health and sexuality practices; (physical) VS, skin, lymph nodes, lungs, pain, discharge, hygiene, psychosocial; (Labs) CBC, ESR, cultures, antibody screening, auto-antibody screening, antigen screening.
300
The client has the following lab values: Na+ 137, K+ 6.0, Mag 2.0, Ca+ 10.0. What is a potential serious complication of this electrolyte problem?
*What is cardiac arrhythmias or cardiac arrest. Manifestations of hyperkalemia include slow and irreg pulse, hypotension, restlessness, irritability, weakness, paresthesias, V fib, peaked T waves (resting phase), widened QRS (ventricular conduction), increased GI motility, N/V, diarrhea, and hyperactive BS.
300
Name 4 nursing assessment findings in the client with Osteomyelitis of the plantar surface of the left foot.
What is bone pain, fever, swelling at site, erythema to site and surrounding skin, heat, drainage at site, circulation impaired to tissue and bone, loss of function or ROM of foot/toes, increased WBC, increased ESR, bacteremia (causing sepsis). Can be severe and difficulty to treat, may lead to amputation & death.
300
Diabetes Insipidus is a water metabolism problem caused by a deficiency of ADH. Think about the nursing assessment findings in clients with this pituitary gland disorder. Based on those assessment findings, what are 2 important nursing interventions for a client with Diabetes Insipidus?
What is DO NOT DEPRIVE FLUIDS as there is a risk for severe dehydration, IVF, low salt diet (due to hypernatremia), medications to stimulate the production of antidiuretic hormone. Opposite disorder is SIADH: water intoxication problem due to water retention - results in severe hyponatremia, lethargy, mental status changes, tachycardia & HTN from serum FVE.
400
You are caring for a 78 year old male client who is on a PCA with Morphine 1mg Q 10 min PRN for end stage bone cancer pain relief. During your assessment, you note a pain level of 5/10, Pox is 92% on 2L O2 per NC, Pulse is 56, and RR is 12. What is your priority action at this time?
*What is continue to monitor the client and document findings, as all VS are WNL at this time. Other objective pain assessment findings include: increased BP, P, RR, dilated pupils, sweating, restlessness, inability to concentrate, and apprehension.
400
Your 21 year old client comes to the ER reporting dyspnea, and tingling and swelling of the mouth and throat after getting stung by a bee while mowing the lawn. Name 2 interventions you would provide as this client's nurse.
*What is call the stat team, IV hydration (as ordered), IV access, VS, medications (epi), oxygen, positioning, reassurance, CPR if necessary. Causes of anaphylactic reactions include: insect stings, medication reactions, food allergies (peanuts, eggs, shellfish).
400
The nurse is providing teaching to a client regarding hypocalcemia. What client signs/symptoms/manifestations would be included in this teaching?
*What is NM changes (muscle twitching, muscle spasms, positive chvostek's and trousseau's signs), decreased cardiac contractility, decreased HR, hypotension, increased peristalsis, abdominal cramping and diarrhea.
400
A client is taken to the OR to have an ORIF of the left hip following a fall. What are 3 potential medical complications that the nurse can help prevent post-operatively, and what are the 3 necessary hip precautions?
What is (complications) - DVT, bleeding, swelling, atelectasis/PN, skin breakdown, urinary retention, delayed union or infection at site; (hip precautions) - avoid hip adduction - bringing leg back into center, avoid internal rotation, avoid hip flexion greater than 90 degrees.
400
Name 5 classic manifestations of hypoglycemia, and 5 classic manifestations of hyperglycemia.
What is (hypoglycemia) - shaking, tachycardia, sweating, anxiety, dizziness, hunger, impaired vision, wekaness, fatigue, HA, irritability; (hyperglycemia) - 3 P's, dry skin, blurred vision, drowsiness, nausea. Long term complications of poor glucose control (elevated hgbA1C) include ARF, CRF, CAD, peripheral neuropathy, decrease in circulation, risk for infection, diabetic and retinopathy/blindness.
500
A client has a DVT in the left leg and c/o 4/10 pain in that extremity. You have provided non-pharmacological pain relief measures such as distraction and relaxation/guided imagery techniques, but there has not been a reduction in pain level and the client states she is comfortable at a 2/10 pain level. Per the World Health Organization Analgesic Ladder, what type of medication should be given (and give example).
*What is a weak narcotic, non-narcotic, and/or adjuvant drug. (Many examples of each). Step 1: 1-3 pain rating; requires non-narcotic and/or adjuvant drug. Step 2: 4-6 pain rating; requries weak narcotic, non-narcotic, or adjuvant. Step 3: 7-10 pain rating; requires strong narcotic, non-narcotic, w/ or w/o adjuvant.
500
A client with SLE has had bloodwork drawn this morning. What results would be expected on the CBC, BUN, creatinine, U/A, and ANA (anti-nuclear antibody)?
*What is CBC - pancytopenia or low counts of WBCs, RBCs, or platelets, BUN and creatinine elevated as kidney function declines, U/A shows protein and RBCs, positive ANA - abnormal immune test showing presence of antibodies.
500
A client is assigned the nursing diagnosis of Fluid Volume Deficit. What is a related etiology? What are possible signs and symptoms of FVD?
*What is... INCREASE IN THE FOLLOWING: Hemoconcentration, urine specific gravity, HR, RR, thirst, H/H, BUN, Na+ (hypernatremia) DECREASE IN THE FOLLOWING: Mental status, bowel sounds, strength, mucous production, turgor, weight, temperature, tears, urine, intake, capillary refill, BP.
500
A female client has just undergone a below-knee amputation (BKA) on the right extremity due to complications of DM. Name 4 nursing interventions that are essential during the first few days post-operatively.
What is elevate stump for the first 24 hours, prevent contracture of the joint above amputation, discuss phantom limb pain, analgesics per orders, evaluate healing and possible infection at site, prevent infection, dressing changes as ordered, compression dressing (stump shrinker). Nursing implications include: prevent further loss of circulation, promote comfort, promote optimal level of mobility.
500
Differentiate between the diagnosis of DKA and HHNS.
What is (DKA) - >300 blood glucose, ketones present - metabolic acidosis, hypokalemia initially and then hyperkalemia with acidosis; (HHNS) - >600 blood glucose, no ketones present / no acidosis, hypokalemia present. Increased BUN/creat and Na+ with both problems.