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Galen Advanced Medsurg Nur265 EXAM 1
questions with correct answers
AKI S/S - CORRECT ANSWERS โโ oliguria;decreased urine output; azotomia; fluid overload signs- crackles, edema, confusion, low spO2 (88), tachycardia; Map below 65 AKI in xray dx - CORRECT ANSWERS โโ infiltration (fluid in lungs) AKI ABG results may read - CORRECT ANSWERS โโ respiratory alkalosis (spao2 below 88%) example of pre renal AKI - CORRECT ANSWERS โโ dehydration, blood loss, decreased cardiac output, heart failure; infection; NG suction, sepsis, V/D Example of intra renal AKI - CORRECT ANSWERS โโ myoglobinuria,BPH, tubular necrosis, nephrotoxocity; acute polynephtiits, contrast Example of post renal AKI - CORRECT ANSWERS โโ bladder neck obstruction, bladder cancer; calculi; tumor
Duiretic phase (3rd phase) of AKI - CORRECT ANSWERS โโ Nurse should give 3L-6L per day; place Foley Asses I and O (output=1000-2000mL/day) replace fluids and monitor electrolyes dialysis may be required Best Lab indicator of Kindey function (AKI and CKD) - CORRECT ANSWERS โโ creatine (Normal 0.6-1.2) AKI increased 1-2 every 24-48hrs Normal urine output per hour - CORRECT ANSWERS โโ 30 mL/hr normal potassium levels - CORRECT ANSWERS โโ 3.5-5.0 mEq/L Normal Sodium levels - CORRECT ANSWERS โโ 135-145 mEq/L Diet for AKI patients - CORRECT ANSWERS โโ mod protein high carb Complication of AKI - CORRECT ANSWERS โโ Preicarditis Nephrotoxic agents include - CORRECT ANSWERS โโ contrast
treatment for chronic kidney disease - CORRECT ANSWERS โโ hemodialysis and peritoneal dialysis complication during hemodialysis - CORRECT ANSWERS โโ Disequilibruim syndrome S/S of disequilibium syndrome medical emergency tell hcp - CORRECT ANSWERS โโ headache restless confused N/V seizure fatigue complication of peritoneal dialysis - CORRECT ANSWERS โโ peritonitis (board like abdomen) hemodialysis contraindicated for - CORRECT ANSWERS โโ severe cardiac disease, vascular disease, bleeding disorders peritoneal dialysis contraindicated for - CORRECT ANSWERS โโ fibrosis, active inflammatory GI disease, diverticulitis, ascites, central obesity, peritoneal adhesions, recent abd surgery
Arteriovenous Fistula care - CORRECT ANSWERS โโ Do not sleep on arm feel thrill & hear bruit every 4 hours NO bp on av access arm no venipuncture on av access arm assess distal pulses patient undergoing hemodialysis - CORRECT ANSWERS โโ weight before and after assess meds (meds to be held) VS = HR, BP,RR,temp assess site, skin, LOC, electrolytes Caring for peritoneal dialysis patient - CORRECT ANSWERS โโ patient and nurse must be masked sterile gloves remove old dressing remove contaminated gloves use Aseptic technique (sterile field 2 4x4 gauze, 3 cotton swab w/ iodine sterile gloves circular motion use swabs clean (insertion site to abd) repeat 3x precut gauze over site tape only EDGES
- VS during 6, measure, document characteristics of drainage 7.Send specimen to lab
- remove cath & apply dressing
- bedrest
- weigh again (expected weight loss due to removal of fluid) Hepatic encephalopathy causes - CORRECT ANSWERS โโ cirrhosis, liver failure s/s of hepatic encephalopathy - CORRECT ANSWERS โโ high ammonia, LOC changes confusion, personality changes, mood changes late sign jaundice, bad breath or fruity breath, sleep and mood disturbance treatment of cirrhosis (least invasive) - CORRECT ANSWERS โโ Lactulose PO (have bedside commode nearby..expect alot of poop) treatment for cirrhosis - CORRECT ANSWERS โโ neomycins, flagyl (antibiotics) cathartics (inhibit ammonia production)
Acute/chronic pancreatitis causes - CORRECT ANSWERS โโ alcohol, gallstones, ESRP, hyperparathyroid, hyperlipedimia, hypercalcemia acute pancreatitis S/S - CORRECT ANSWERS โโ mid epigastric pain LUQ pain radiates to back juandice,fever turners sign (blue flanks) cullen sign (periumbilicus) hypotension acute panreatitis labs - CORRECT ANSWERS โโ elevated lipase low calcium low magnesium elevated WBC elevated bilirubin acute pancreatitis nursing interventions - CORRECT ANSWERS โโ NPO 24hrs iv hydration pain management hydromorphone NO Morphine may need insulin momentarily
no fat soluable meds, avoid caffeine, alcohol, spicy food, Treatment for sinus bradycardia - CORRECT ANSWERS โโ Atropine sulfate Treatment for A fib - CORRECT ANSWERS โโ w/ pulse= 180 joules cardio version without pulse=CPR defibrillation Atrial flutter (EKG appearance) treatment - CORRECT ANSWERS โโ looks like sharp saw teeth cardioversion (must have pulse) ventricular fibrillation (EKG appearance) treatment - CORRECT ANSWERS โโ looks like tombstones defibrilate 360 joules med epinephrine/ amiodarone PVC (EKG appearance) - CORRECT ANSWERS โโ wide and bizarre "DIP" if run of this .....can be vtach let Dr. Know asap Pulmonary Edema - CORRECT ANSWERS โโ Medical emergency
dx xray = infiltration LV fails to eject blood meaning pressure in lungs "White lungs" S/S of pulmonary edema - CORRECT ANSWERS โโ crackles @ base, SOB, Dyspnea @rest skin cold clammy reduced urine output, lethargy confusion, disoriented Severe S/S productive frothy bood tinge sputum Nursing interventions for Pulmonary edema - CORRECT ANSWERS โโ high Fowler give 02 ( simple mask or non-rebreather) remove fluid ( diuretics, thoracentesis,) fluid restriction Valvular heart disease education to patient - CORRECT ANSWERS โโ Notify HCP and dentist of heart valve antibiotic prophylaxis before and after procedures (oral /resp ) clean all wound w/ antibiotic ointment
if chest tube drainage more than ........mL report to hcp - CORRECT ANSWERS โโ 150mL complication after treatment of cardiac tamponade - CORRECT ANSWERS โโ Stroke Blood was pooling now moving= clots may travel Define dilated cardiomyopathy - CORRECT ANSWERS โโ chronic disorder no cure chambers of heart large/ weak pump = decreased cardiac output causes of dilated cardiomyopathy - CORRECT ANSWERS โโ alcohol cocaine infection dilated cardiomyopathy is usually dx in what age group - CORRECT ANSWERS โโ 40 year old s/s of dilated cardiomyopathy - CORRECT ANSWERS โโ fatigue dyspnea s3, s4 gallop jvd crackles
weakness Like Left side heart failure Treatment of dilated cardiomyopathy - CORRECT ANSWERS โโ like heart failure treatment duiretics vasodilators heart transplant (if not done in 5 years patient will die) dilated myocardiopathy dx anticipate - CORRECT ANSWERS โโ counseling grieving define endocarditis - CORRECT ANSWERS โโ inflammation of the inner lining of the heart Endocarditis is caused by - CORRECT ANSWERS โโ staphylococus aureus, streptoccoci viridians (untreated strep, needles, dental procedures) S/S of endocardititis - CORRECT ANSWERS โโ pain w/ deep breathing, fever, anorexia murmurs, upper body petechiae
low urine output dyphasia chest pain radiates to left side treat meds for pericarditis - CORRECT ANSWERS โโ Nsaids, NO aspirin acute coronary syndrome S/S - CORRECT ANSWERS โโ unstable angina, acute myocardial infarction cause of acute coronary syndrome - CORRECT ANSWERS โโ atherosclerosis define Unstable angina - CORRECT ANSWERS โโ chest pain at rest ; more than 15mins not relieved by nitroglycerin Nitrate teaching - CORRECT ANSWERS โโ 3 dose 5mins apart (total15mins); take while seated; after 1st dose call 911 NO "fils' Sildenafil within 24-48hrs of giving nitrate Define myocardial infarction - CORRECT ANSWERS โโ MI heart muscle infarct (die) ST elevation T inversion
intervention needed right away Dx for myocardial infartion - CORRECT ANSWERS โโ Troponin elevated (over 0.5) EKG= ST elevation s/s of myocardial infarction - CORRECT ANSWERS โโ pain radiates to jaw, left arm, shoulder N/V, diaphoresis heartburn SOB chest pain Treatment for MI - CORRECT ANSWERS โโ 1. 1st 10 mins of chest pain EKG (12 lead)
- o2= SPO@ greater than 90%
- aspirin 1st 24hrs
- nitro 5, morphine iv 6, beta blocker take to cath lab or give thrombolytic "ASE" Sign of reperfusion after MI treatment - CORRECT ANSWERS โโ urine output normal 30mL/hr
Prosthetic mechanical heart valve teaching - CORRECT ANSWERS โโ good for 20 years coagulation meds for life click sound Prosthetic biological heart valve teaching - CORRECT ANSWERS โโ good for 10 years prophy antibiotics before procedures no click sound
