General 2

Question 1

Three Indications for getting a peritoneal dialysis instead of a haemodialysis

Answer 1

Difficulty with vascular access
Unstable, infection, HTN, Anticoagulant
Patient is independent, can do treatments on their self

Question 2

Describe the procedure for peritoneal dialysis.

1st & Subsequent times

Answer 2

1st dialysate in (Warm it first) then drain

Subsequent times: Drain first then dialysate

Question 3

Preprocedure: Peritoneal dialysis

VS, Labs, BS
Dry weight (before dialysate)
________

Answer 3

Assess access point

Question 4

Difference between CAPD & APD peritoneal dialysis

Answer 4

CAPD = Daytime
4x - 5x
Gravity feed
Mobile

APD

Nighttime
Machine

Question 5

(Otitis externa/ media), also known as swimmer’s ear, is an inflammation of the outer ear and ear canal.

(Otitis externa/media) is an inflammation of the middle ear, which is located behind the eardrum

Answer 5

Otitis externa, also known as swimmer’s ear (bacteria / Fungus can grow in this fluid)

Otitis media is an inflammation of the middle ear

Question 6

FHR

Answer 6

Fetal heart rate
110 - 160

Question 7

Decelerations are….

Answer 7

temporary decreases in the fetal heart rate (FHR) that can occur during labor.

Three types:
Early, variable, and late.
Early = Normal

Late and variable = Concerning

Question 8

Early decelerations in FHR (abnormal/normal)

Late decelerations…

Causes

Answer 8

Early = normal

Fundal pressure, breech posistion, strong uterine contractions, vaginal examination, placement of internal monitoring equipment

Late = abnormal/ concerning

Hypoxemia due to uteroplacental insufficiency,

Occurs when the placenta doesn’t deliver enough nutrients to the fetus during pregnancy.

This can happen when the placenta doesn’t develop properly or is damaged, or when there’s insufficient blood flow to it.

Question 9

Early or late decelerations

Breech baby
Fetal Hypoxemia
Strong uterine contractions
Metabolic fetal acidemia
Uteroplacental insufficiency

Answer 9

Early decelerations = Normal
Breech baby
Strong uterine contractions

Late decelerations = Concerning
Fetal Hypoxemia
Metabolic fetal acidemia
Uteroplacental insufficiency

Question 10

During haemodialysis BP drops to 82/54

Nurse preforms the following intervention:

Reduce temperature of dialysate ( Warm fluid in veins causes vasodilation = low BP)

Adjusting rate of dialyzer flow

Place client in Trendelenburg posistion

Administration of: Fluid bolus, albumin, or Mannitol

These interventions don’t work to raise BP

Complete the following sentence:

The client is at Most risk for developing _____ due to ______

Conditions:

Hypoglycemia
Myocardial injury
Infectious disease
Fluid volume imbalance
Disequilibrium syndrome

Potential Causes:
Fluid shifts
DM
Pericardial disease
Frequent blood Transfusion
Rapid reduction of electrolytes

Answer 10

Most risk for developing myocardial injury due to pericardial disease

Question 11

Adverse SE

Increased Intercranial Pressure ICP
Neurotoxicity
Respiratory Despression
Othrostaic HTN
Constipation/ Emesis
Urinary retention

Choose:

Beta Blockers
Nsaids
Opiods

Answer 11

Opiods

Question 12

Myoclonus (sudden, involuntary muscle jerk, shake, or spasm.)

Hyperalgesia: increased sensitivity to pain and an extreme response to pain.

Delirium

Agitation

SE from Opiods

T or F

Answer 12

T

Question 13

Methylnaltrexone
Common brands: Relistor

Is….

When to use…

Answer 13

Gut motility stimulator
It can treat constipation caused by narcotic pain medications.

After other Anticonstipation measures taken.

Fluid / Fiber
Senna - Stimulants
Docusate - Stool Softener
Lactulose or Sodium phosphate

Question 14

Which 5 interventions would the nurse include in the plan of care for a client to maintain good seal during NPWT

1. ID air leaks using stethoscope
2. Shave hair around would
3. Ensure periwound skin surface is dry
4. Avoid wrinkles when applying transparent film
5. Fill uneven skin surfaces with barrier skin product
6. Frame the periwound area with hydrocolloid dressing
7. Cut transparent film to extend 1/2 inch beyond wound perimeter
8. Use as many dressing layers as needed

Answer 14

1. ID air leaks using stethoscope
2. Ensure periwound skin surface is dry
3. Avoid wrinkles when applying transparent film
4. Fill uneven skin surfaces with barrier skin product
5. Frame the periwound area with hydrocolloid dressing
6. Cut transparent film to extend 1/2 inch beyond wound perimeter
7. Use as many dressing layers as needed for prevent air leaks.

Wrong:
2. Shave hair around would.
Use clippers not “shave”

7. Cut transparent film to extend 1/2 inch beyond wound perimeter

Transparent film should extend 1 or 2 “ beyond wound perimeter

8. Use as many dressing layers as needed for prevent air leaks.

1 or 2 layers only.
Multiple layers prevent moisture vapor transmission causing Maceration

Question 15

Which of the following would a nurse do to help a client with a Negative Self-Imag3

1. Set realistic goals for behavior modification
2. Reward client for practicing new behaviors
3. Provide positive regard for adaptive behavior only
4. Encourage the client to practice behavior modification
5. Help client ID Negative qualities & Experiences
6. Help client ID own behavior needing change
7. Reinforce self-worth with time and attention by giving one-on-one time

Answer 15

1. Set realistic goals for behavior modification
2. Reward client for practicing new behaviors
3. Encourage the client to practice behavior modification
4. Help client ID Negative qualities & Experiences
5. Help client ID own behavior needing change
6. Reinforce self-worth with time and attention by giving one-on-one time

Incorrect:

3. Provide positive regard for adaptive behavior (Social or practical competence to live in society)

Nurse will give unconditional positive regard & avoid reinforcement of Negative behaviors

5. Help client ID Negative qualities & Experiences

Instead, recognize positive qualities & accomplishments

Question 16

Conditioner where a client will need TPN (total parental nutrition) (4)

Answer 16

Highly Stressed Neurological States

Burns
Sepsis
Head Trauma
No able to digest / absorb foods

Question 17

TPN can’t be stopped Abruptly

If TPN bags is empty & another isn’t ready, what does the nurse do?

Answer 17

Infuse 10% glucose solution

Question 18

Risk factors for TPN are

Hypoglycemia or Hyperglycemia

Answer 18

Both

Be prepared to treat both conditions

Insulin & Glucagon ready

Question 19

DM patient feels: Hunger, irritated, shaky and weak

Which would the nurse suggest to help with these symptoms of hypoglycemia

6 saltine crackers
3 Graham crackers
120 mL of fruit juice
240 mL skim milk
6 - 10 hard candie
4 tbl honey
120 mL of diet soda
Decrease carb intake
Admin insulin on sliding scale base

Answer 19

6 saltine crackers
3 Graham crackers
120 mL of fruit juice
240 mL skim milk
6 - 10 hard candies

Wrong

4 tbl honey = Too Much, 1 tbl is needed

120 mL of diet soda
Decrease carb intake
Admin insulin on sliding scale base

Question 20

79 yr old client returned home from hospital for heart failure.

The client started walking 3x weekly but has stopped the routine due to being tired.

VS:

HR 68
RR 20
SpO² 92% RA
BP 112 / 68

COMPELETE THE SENTENCE

The nurse would 1. ___________ because 2. ___________

1. Advise the client to slow down on the exercise program

Inform the client to maintain the same exercise regimen

Instruct client to check ankel edema before exercising

The heart needs to contract efficiently, and exercise is one treatment measure to accomplish this.

An additional dose of the prescribed diuretic needs to be taken before exercising

Tolerance to increased activity needs to be built up and takes time

Answer 20

The nurse would 1.Advise the client to slow down on the exercise program because 2.Tolerance to increased activity needs to be built up and takes time

Question 21

The umbilical Cord is protruding through the vagina after a patient’s “water broke “

Tell which interventions will be
INDICATED or CONTRAINDICATED

1.Administer Oxygen

2.Notify HCP

3.Monitor FHR continuous

4. Increase rate flow of Oxytocin
5. Gently push the cord into the vagina towards the cervix

6.Posistion client with HOB @ 30°

7. Wrap cord in sterile towel saturated with warm normal saline
8. Glove the hands insert 2 fingers into the vagina and exert pressure against the presenting part.

Answer 21

1.Administer Oxygen

2.Notify HCP

3.Monitor FHR continuous

7. Wrap cord in sterile towel saturated with warm normal saline
8. Glove the hands insert 2 fingers into the vagina and exert pressure against the presenting part.

(This will relieve pressure on the cord)

Question 22

T or F

In Umbilic Cord Prolapse the nurse would put client in a semi fowler position and leave client to contact the HCP

Answer 22

F

Extreme Trendelenburg
Modified left-lateral
Knee- chest posistion

Stay with patient and summon help

Question 23

5 yr old with asthma attack
Brought to ED
wheezes bilateral
Retractions noted
SpO² 90% RA
HR 112
RR 24
BP 124 / 82

Which actions would the nurse take

1. Start IV line
2. Obtain ABG
3. Administer quick relief medicine
4. Assist child into left lateral posistion
5. Ask parents to wait in ED waiting room.
6. Oxygen nasal Cannula 2L/m
7. Place on continous cardiorespiratory & pulse Ox monitoring
8. Obtain blood specimens for electrolytes, CBC, renal function test

Answer 23

1. Start IV line
2. Obtain ABG
3. Administer quick relief medicine
4. Place on continous cardiorespiratory & pulse Ox monitoring
5. Obtain blood specimens for electrolytes, CBC, renal function test

Wrong:

Face Maks instead of Nasal Cannula (Cannula will dry out membranes)

Question 24

After applying pressure to hand with severed fingers

Why wouldn’t you check to see if bleeding has stopped after 10 minutes?

Answer 24

Checking could dislodge clot and make bleeding start again

Question 25

Fingers severed Which actions do you take. 1. Call 911 2. Elevate affected hand above the heart 3. Place fingers in waterproof bag 4. Check victim for A,B,C 5. Place waterproof bag with fingers on ice 6. Apply direct pressure to amputation site with layers of dry gauze. 7. Remove gauze after 10 minutes to check bleeding status 8. Ensure fingers are transported to hospital

Answer 25

1. Call 911 2. Elevate affected hand above the heart 3. Place fingers in waterproof bag 4. Check victim for A,B,C 6. Apply direct pressure to amputation site with layers of dry gauze. 8. Ensure fingers are transported to hospital Wrong: 5. Place waterproof bag with fingers on ice. PLACE THEM IN ICE WATER 1PART ICE & 3 PARTS WATER 7. Remove gauze after 10 minutes to check bleeding status DONT REMOVE GAUZE. THIS CAN DISLODGE THE BLOODCLOT THAT FORMED.

Question 26

Medication Safety To promote Medication Administration safety & prevent med errors, the nurse checks atleast (1.) _____ client ID, reads the medication lable at least (2.) ______ times, and documents medication administration (3.) ________ Option 1. 1,2,3,4 Option 2. 1,2,3,4 Option 3 As soon as medication is given Immediately before medications are given After medications are given and after leaving the room Before removing the medication from the system.

Answer 26

Nurse checks at least 2 client ID, reads medication lables at least 3 times and documents medication administration as soon as medications are given

Question 27

ACE Inhibitor Used for which diseases Examples/ Names: Cautions / SE

Answer 27

Diseases: HTN Coronary artery disease Heart failure Diabetes Certain chronic kidney diseases Heart attacks Scleroderma Names: (pril) Captopril, Cilazapril, Enalapril, Fosinopril Don't take when pregnant SE: ANGIOEDEMA / Dry Cough

Question 28

Amiodarone Common brands: Pacerone, Nexterone Type of medication Used to treat: SE: Avoid:

Answer 28

Antiarrhythmic Treats: Afib SE: Serious lung problems, liver problems, worsening irregular heart rate. Grapefruit juice

Question 29

How does Amiodarone help against Afib? Se

Answer 29

Vasodilation SE: Hypotension/ dizziness

Question 30

Beta Blockers: Examples / Names Treats: SE

Answer 30

(olol) Treats: High blood pressure Chest pain (angina) Abnormal heart rate (arrhythmia) Congestive heart failure Heart attacks SE: Dizzy,tired, hypotension

Question 31

Oxytocin has a SE of antidiuretic effect. This will cause (Dehydration/ Water Intoxication)

Answer 31

Water intoxication

Question 32

Uterine Rupture can happen with oxytocin. Give 3 symptoms of this outcome Give a risk for Uterine Rupture with Oxytocin use

Answer 32

Sudden pain between contractions Excessive vaginal bleeding Decelerations on fetal monitor Risk Factor = High Parity (numerous pregnancies)

Question 33

CORRECRT In dehydration what happens to K & Na levels

Answer 33

K = Down Na = Up

Question 34

Pacemaker Complications include: (3)

Answer 34

Pericardial effusion: Build up of fluid around heart. Not putting pressure on heart Cardiac Tamponade (Fluid collects in sac around heart. Puts Pressure on the heart and keeps it from filling properly. Drop in blood pressure that can be fatal) Diaphragmatic pacing Malposistioned pace maker effects the diaphragm by electrical impulses to stimulate the diaphragm to help people breathe

Question 35

The following are unexpected in a patient who just had a biventricular Pacemaker placed in right subclavian area. 1. Client reports pain at diaphragm level 2. Hiccups that last long than normal 3. Dressing is clean & dry 4. Client uses left ear for talking on cell phone 5. Client preforms right shoulder ROM exercise 6. Client avoids lifting more than 10 lb 7. Implantation site is clear and free of redness, swelling, drainage. 8. Muscle contractions are noted over the diaphragm that correspond to HR

Answer 35

1. Client reports pain at diaphragm level 2. Hiccups that last long than normal 5. Client preforms right shoulder ROM exercise (Avoid lifting arm overhead) 8. Muscle contractions are noted over the diaphragm that correspond to HR (Diaphragmatic pacing- bad positioning of pacemaker / lead is dislodged Correct: Talk on cell phone on oppsite side of which pacemaker is located. *Avoid electromagnetic fields & telecommunications transmitters

Question 36

65 yr Female First assessment Post Op (open reduction with internal fixation of the left hip) Mark the normal direct Post Op Findings RR 8 BPM SpO² 93% on 3/L min NC Lung sounds clear to ausculation bilaterally BP 90/ 56 HR 120 BPM Peripheral pulses 2+ bilaterally Drowsy, arousable and responsive to stimuli PERRLA Sensation in tact bilateral lower extremities Bowel sounds hypoactive x4 quad Urine output 20mL p/h Surgical dressing saturated with bright red blood No redness over pressure point No petechiae or rashes throughout skin

Answer 36

SpO² 93% on 3/L min NC Lung sounds clear to ausculation bilaterally (92 - 100 Normal postop) Peripheral pulses 2+ bilaterally Drowsy, arousable and responsive to stimuli PERRLA Sensation in tact bilateral lower extremities Bowel sounds hypoactive x4 quad No redness over pressure point No petechiae or rashes throughout skin ABNORMAL BP = >120/ 80 due to patient pain Tachycardia

Question 37

Describe Breech posistion (Describe Types)

Answer 37

Baby is born bottom end first. 3 types Frank breech: Buttocks are down, Legs are straight up near their head Complete breech: Buttocks are down, legs are bent at the knee, feet near their buttocks. Footling breech: One or both of the baby's feet are down