Observing the drainage from a patient with a nasal fracture for this sign would indicate whether an accompanying skull fracture is present
What is halo sign? (test fluid for presence of glucose which is present in CSF)
100
The priority assessment component for patients with problems related to the upper airway
What is adequacy of oxygenation? (Ensure unobstructed airway passage)
100
The primary prevention for reducing risk of lung cancer
What is smoking cessation and/or avoidance of second hand smoke?
100
Exudate from a wound that is watery in consistency and light red in color
What is serosanguineous?
100
When there is an abnormally low level of neutrophils.
What is neutropenia?
Patients are at risk for infection and should have neutropenic precuations implemented.
200
Smoking, a short neck, enlarged tonsils, obesity, and a large uvula can put a patient at risk for this non-infectious upper respiratory condition
What is OSA (Obstructive Sleep Apnea)?
200
A blood sample that assesses/provides values for abnormal oxygenation, ventilation, acid-base status
What is ABG (Arterial Blood Gas)?
200
Chemotherapy drug dosage is based on total body surface area (TBSA). How would the nurse calculate this?
What is assessment of height and weight?
200
What type of drainage is associated with an infectious process being present?
What is Purulent?
200
Loss of hair associated with chemotherapy or radiation (localized hair loss)
What is alopecia
300
What does the water in the water seal chamber do when the chest tube system is functioning correctly?
What is bubbles gently and continuously?
Vigorous bubbling in the water seal chamber may indicate a leak in the chest tube and system
300
The duration of suctioning a tracheostomy
What is no more than 5-10 seconds?
It is important to avoid prolonged suction time in order to prevent hypoxia.
300
What does CINV stand for?
What is Chemotherapy Induced Nausea and Vomiting?
*Nursing Priority is to monitor for signs of dehydration and electrolyte imbalances
300
Removing dead or infected tissue to promote wound healing
What is debridement?
300
Removal of breast tissue for a patient with a familial history of breast cancer is considered with type of cancer surgery?
What is Prophylactic?
400
The nurse is caring for a patient with chronic bronchitis, and notes the following clinical findings: fatigue, dependent edema, distending neck veins, and cyanotic lips. What condition is the patient experiencing?
What is Cor Pulmonale?
400
Upon assessment, reduced breath sounds that may indicate obstruction
What is a Silent Chest?
400
The term for a patient receiving chemotherapy that suffers from dry mouth.
*Important to encourage regular dental visits because of increased risk for cavities
What is Xerostomia?
400
A skin tear falls into what staging of pressure ulcers?
What is Stage II?
Often will require applying a transparent film dressing such as a Tegaderm to prevent further breakdown, keep bacteria out, allow for visualization of the wound, and encourage appropriate moisture for encourage tissue regeneration.
400
Radiation that is delivered from a source outside of the patient
What is teletherapy?
Patients undergoing teletherapy are not considered radioactive whereas patients with brachytherapy may be radioactive for a period of time.
500
Difficulty breathing while lying flat
What is Orthopnea?
500
Encouraging a patient to breath in through the nose 1,2 and out through the mouth 1,2,3,4
What is pursed-lip breathing?
Helps with proper oxygenation in time of anxiety with patients having difficulty breathing (ex. COPD exacerbation)
500
A patient with cancer complains of facial swelling, recent epistaxis, and that today his shirt collar felt tighter. What complication is the nurse suspicious of?
What is Superior Vena Cava Syndrome
500
The second phase of the healing process of Full-Thickness Wounds
What is Inflammatory?
This phase follows the hemostasis phase (approx 4-6 days). Assess for the presence of the inflammatory process.
500
Tumors often increase metabolism which may lead to this condition of extreme body wasting and malnutrition
What is Cachexia?
Assess appetite and nutritional intake as a priority nursing intervention