Needle decompression would need to take place to allow the lung to inflate to improve respiratory effort in what pulmonary medical emergency
what is tension pneumothorax
What is a late sign of tension pneumothorax?
Your client will likely need what device placed? How do you know your client has an air leak with this device?
What is flail chest?
what is paradoxical motion?
Surgical stabilization is necessary when what has happened?
what is when the spinal cord is not properly aligned and/or bone fragments are present in the area.
This is due to increasing the risk of further injury in either case
Spinal Shock would be represented by what classic symptoms
Spinal injury can also lead to what other type of shock?
Calculate the GSC score
The client opens the eyes spontaneously, is confused, and withdrawals from pain. Which score does the nurse document for this client?
what is GSC score of 12
Assessment for anaphylactic reaction that a priority for an individual stung by a bee and would suggest possible airway compromise
what is facial swelling, wheezing, or shortness of breath
Drug that is administered to treat delirium that can occur at the end of life.
what is Haldol
what other drug can be given for end of life care because it provides sedation, relieves air hunger and those who are passing, and provides analgesia effectively.
Administration of furosemide (Lasix) IVP is highest in priority for nursing interventions in this pulmonary fluid emergency.
what is pulmonary edema
Respirations often sound how during the late stage of the physical and psychological changes that occur before death.
Cushing’s Triad, a finding suggesting increased intracranial pressure shows what
what is Hypertension, bradycardia and bradypnea (irregular respirations).
what is the earliest sign of IICP?
What medication could be used to help reduce IICP.
IICP can lead to what life threatening condition and what is a classic assessment?
A client is receiving a continuous heparin infusion running at 14 mL/h. The solution available is 250 mL containing 25,000 units of heparin. Calculate the dosage (units) of heparin the client is receiving per hour.
what is 1400 units/hour
MODS is an outcome of what pathophysiological response in the body leading to a cascade of organ failure.
what is Widespread systemic inflammation
client presenting with thermal-regulation issues would require what interventions (be specific for hyper and hypothermia)
what is cool saline, relocating to a cool environment (hyper)
(hypo) warming blanket, warm intravenous fluids to the client, increasing the temperature in the room Client must be at least 86°F/30°C for resuscitate efforts to be effective
which temp concern will be presented with ASA overdose?
Prior to suctioning a client’s your intubated client you should do this to prevent compensate during suctioning.
what is hyper-oxygenate with 100% O2
This finding is consistent with an endotracheal tube placed in one lung versus the other?
2 chronic conditions that have a high incident of Stroke
what is HTN and DM
What is the best diagnostic test to evaluate for a Stroke
A hypotensive client is receiving IV dopamine (700 mg/500mL). The client weighs 105 kg and is receiving 25 mL/hr. How many mcg/kg/min is the client receiving?
what is 5.6mcg/kg/min
this is the key determination in diagnosing whether the client is in shock, regardless of the type of shock.
what is inadequate tissue perfusion due to loss of circulating volume
Client recently diagnosed with acute myocardial infarction has an ejection fraction of 38% is at risk of what shock?
Autonomy is best described as what?
what is Supporting the client’s right to when making treatment decisions
These Pulmonary conditions caused by various disorders that directly or indirectly injure the lungs, can be part of MODS and can cause non-cardiac pulmonary edema
what is ARDS and ALI
A client in respiratory failure will have what signs/symptoms?
what is bradypnea, cyanosis and altered mental status.
Tachypnea and tachycardia are signs of respiratory distress, not failure
If this finding is present the fluid can be checked for a halo effect on tissue paper to confirm that it is cerebral spinal fluid.
what is Otorrhrea following a head injury; concerns for an skull fracture
Nursing considerations for this client?
The physician caring for the client should be notified in the client should be placed on bed rest for safety purposes.
what time of hematoma is diagnosed when blood is present in the space between the dura and outer surface of the skull.
neuro trauma can result in what endocrine disorder?
Your client is receiving an IV nitroglycerin gtt (100 mg/250mL). The nurse needs to set the volumetric pump at which rate (mL/hr) to deliver 20 mcg/min?
what is 3ml/hr
Your client presents with evidence of infection that is untreated and causing systemic symptoms. The client is most at risk for?
what is septic shock
In the client’s health record, what puts the nurse at the highest level of lawsuit and is a form of professional negligence.
what is documents incompletely
This "noise/sound" heard during inspiration suggest airway edema and the healthcare provider should be notified immediately.
what is a crowing noise
abortive agents used for seizures include what medications
what is diazepam and lorazepam (benzodiazepine);
It is common for a client to have what signs/symptoms in the postictal state.
High-dose barbiturates cause what kind of an effect due to the action.
A 50 kg hypertensive client is ordered to receive 1.0 mcg/kg/min of IV nitroprusside. The solution strength is 100mg/250mL NS. How many mL/hr will the nurse set the IV pump?
what is 75 ml/hr
trauma clients and clients with fever, decreased urinary output, nausea and vomiting are most at risk for what type of shock?
what is hypovolemic
Nurses are required to report what situations as they arrise?
what is health disease crisis, elder and child abuse (suspected)