Nursing 201

Lab values

100

My RBCs are low (less than 4.2) and I don't feel very well. My HGB and HCT are 10 and 36. The doctor says that I'm not bleeding anywhere. What is probably my diagnosis?

Anemia

200

Which type of panel provides basic hematology data?

CBC

300

My HGB and HCT are very high. I have lots of medical issues like COPD, Diabetes, a cerebrovascular accident and a cardiac dysrhythmia. Which of these pathos will affect my levels?

What is COPD - HGB carries oxygen to cells and removes the CO2 from the cells. In COPD, there is not as much oxygen so the HGB holds onto more to compensate.

400

What is excreted entirely by kidneys direct measure of renal function.

Creatinine

500

What does ESR stand for and what does it monitor within the body?

erythrocyte sedimentation rate, inflammation

Prioritization

100

The nurse has finished receiving the morning change-of-shift report. Which client should the nurse assess first? 1. The client diagnosed with pneumonia who has bilateral crackles. 2. The client on strict bed rest who is complaining of calf pain. 3. The client who complains of low back pain when sitting in a chair. 4. The client who is upset because the food is cold all the time.

2. The client with calf pain could be experiencing deep vein thrombosis (DVT), a complication of immobility, which may be fatal if a pulmonary embolus occurs; therefore, this client should be assessed first.

200

A client's nursing diagnosis is Deficient Fluid Volume related to excessive fluid loss. Which action related to fluid management should be delegated to a nursing assistant? 1. Administer IV fluids as prescribed by the physician. 2. Provide straws and offer fluids between meals. 3. Develop plan for added fluid intake over 24 hours. 4. Teach family members to assist client with fluid intake.

2. The nursing assistant can reinforce additional fluid intake once it is part of the care plan. Administering IV fluids, developing plans, and teaching families require additional education and skills that are within the scope of practice fore the RN

400

An RN is preparing to make morning rounds, who should she see first? 1. a 54 yr old 4 hours post cardiac catherization who has mild discomfort at the site 2. A pt. newly diagnosed with diabetes who needs reinforcement teaching 3. A pt. who arrived 30 minutes ago from post anesthesia care unit 4. A pt. ready for discharge but will not be ready to leave for 2 hours 5. A pt. with pneumonia who has received 2 doses of IV antibiotics and has an oxygen saturation of 93%

3. The patient who just arrived from PACU. They are at greatest risk for becoming unstable

500

An RN arrives to work 15 minutes late. She is assigned 5 pts. and an admission on the way. Place in order of priority how the RN should complete the following ... 1. Listen to report 2. Check the EMAR 3. Check status of all pts. 4. Review AM lab results, including CBG

1,3,4,2 Listening to report allows the RN to learn the status of each pt., then she can check on them. AM labs will help to determine any subtle changes that may need interventions then lastly the EMAR

Medications

100

A client has an order to receive enoxaparin (Lovenox). The nurse administers this medication by which route?

What is subcutaneously. Lovenox is an anticoagulant.

200

The client has received a dose of dimenhydrinate (Dramamine). The nurse assesses for the effectiveness of the medication by asking the client about relief of what?

nausea and vomiting. Dimenhydrinate is used to treat motion sickness and the symptoms that accompany it such as dizziness, vertigo, nausea, and vomiting.

300

The physician prescribes meperidine hydrocholoride (Demerol), 40mg intramuscular stat, for a postoperative client in pain. The medication label states meperidine hydrochloride (Demerol), 50mg per 1 mL. How many milliliters will the nurse safely prepare to administer to the client?

What is 0.8mL. __(40)__x mL=mL per dose (available) _(50)___ x 1mL = 0.8mL

400

A client with diverticular disease is receiving psyllium hydrophillic mucilloid (Metamucil). The drug has been effective when the client tells the nurse that he: A. Passes stool without cramping B. No longer has diarrhea C. Is not as anxious as he once was D. Does not expel gas like he used to

A. Passes stool without cramping Rationale: Diverticular disease is treated with a high fiber diet and bulk laxatives such as Metamucil. Bulk laxatives and fiber decrease the intraluminal pressure and make it easier for stool to pass through the colon.

500

The Rn is caring for a pt. with ascities, and the MD just ordered Spironolactone. When the pt. asks why this drug was percribed, what is the best response by the RN? 1. "It will help increase the level of protein in your blood" 2. "It will cause an increase in the amount of aldosterone your body produces" 3. "It is a diuretic but does not make the kidneys excrete potassium" 4. "It will help you excrete large amounts of ammonia"

3. This medication is a potassium sparring diuretic. It also inhibits NA reabsorption and prohibits aldosterone which in turn, conserve potassium

ABGs

100

A pt is in danger of respiratory arrest following the administration of an opioid analgesic. An arterial blood gas value is obtained. The nurse should expect the PaCO2 to be which value? 1. 30 mmHg 2. 40 mmHg 3. 45 mmHg 4. 50 mmHg

4. 50 mmHg - a pt about to go into respiratory arrest will have inefficient ventilation and will be retaining carbon dioxide, resulting in an increased PaCO2 value

200

A pt with massive pulmonary embolism will have an ABG analysis performed to determine the extent of hypoxia. Which acid-base disorder may be present? 1. metabolic acidosis 2. metabolic alkalosis 3. respiratory acidosis 4. respiratory alkalosis

4. respiratory alkalosis - pt with a massive pulmonary embolism has a larger region of lung tissue unavailable for perfusion, causing the pt to hyperventilate and blow off large amounts of carbon dioxide and resulting in respiratory alkalosis. Resp. Acidosis is listed in their book. Both answers accepted

300

pH 7.60 PaCO2 37 mm Hg HCO3 35 mEq/L

Metabolic Alkalosis

400

Common cause of respiratory alkalosis

Hyperventilation or anxiety

500

The RN is caring for a child with a history of severe diarrhea. Which notation about acid base imbalance would the nurse expect to find in the medical record? 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis

3. metabolic acidosis In severe diarrhea, excess bicarbonate is lost (base)

Misc.

100

The LPN cares for a client reporting nausea, vomiting, and continuous RLQ abdominal pain. What comfort measures can help relieve the abdominal discomfort until the MD assesses the client? 1. Give the client small sips of tea to promote relaxation 2. Apply a warm blanket to the abdomen 3. Encourage the client to assume a side-lying position with the knees drawn to the chest 4. Give the client a pillow to splint the abdomen

3. Encourage the client to assume a side-lying position with the knees drawn to the chest

200

The nurse notes that a client's intravenous (IV) site is cool, pale, and swollen, and the solution is not infusing. The nurse interprets that which complication has been experienced by the client?

Infiltration

300

An otherwise healthy 28-year-old woman has just been diagnosed with stage 1 hypertension. The patient is 5'6" tall and weighs 115 pounds. She says she has a glass of wine once or twice a week and eats "fast food" frequently because of her busy schedule. Which topic will you plan one including in the patient teaching plan? 1. Benefits and adverse effects for beta-blockers 2. Adverse effects of alcohol on blood pressure 3. Methods for decreasing dietary caloric intake 4. Low-sodium food choices when eating out.

4. Lifestyle management, including sodium reduction, is appropriate initial therapy for a patient with stage 1 hypertension and no cardiovascular disease or risk factors. Antihypertensive medications would not be prescribed unless lifestyle changes were attempted for several months with out a decrease in blood pressure. This patient's assessment data indicate that she is not overweight and does not drink excessive alcohol, so discussing changes in these risk factors would not be appropriate.

400

What systems can immobility affect?

Skeletal, muscular, renal, cardiac, nervous, GI, respiratory, and integumentary.

500

An older adult pts post op wound is still healing weeks after surgery. The pt. asks the RN why it is healing so slowly. Which factors should the RN identify that negatively affect healing in older adults. Select all that apply 1/ Vascular changes 2. Nutritional status 3. Decreased activity 4. Keloid formation 5. Nutrient absorption

1,2 and 5. Vascular changes (atherosclerosis) impair blood flow to the wound. Wound healing requires adequate protein and Vitamin C. Older adults may have difficulties chewing or lack of access to food sources that could hinder this. Decreased activity level with age does not affect wound healing. Keloid formation is an abnormal type of wound healing that is not specific to older adults