ibis final Flashcards
(112 cards)
1
Q
urine specific gravity lab value
A
1.010-1.030
2
Q
would a patient with fluid volume deficit have a high or low urine specific gravity?`
A
high
3
Q
safety measures for a patient with increased confusion?
A
place patient in room closest to nursing station
4
Q
magnesium normal lab values
A
1.3-2.1
5
Q
sodium normal lab values
A
135-145
6
Q
potassium normal lab values
A
3.5-5
7
Q
chrloride normal lab values
A
98-106
8
Q
BUN normal range
A
10-20
9
Q
what does a high BUN indicate
A
patient dehydrated
10
Q
Physiological findings of a pt with N/V/D
A
dehydration poor skin turgor fluid volume deficit flat neck veins tachycardia low BP (hypotension) electrolyte imbalance
11
Q
fluid volume deficit means?
A
dehydration
12
Q
Aspiration prevention for patient with NG tube?
A
30-45 degree bed elevation
flush
aspirate for gastric secretions (ph testing)
abdominal x-ray
13
Q
instructions for flushing meds down NG tube
A
15-30 ml
put meds once at a time
14
Q
explanation for why patient needs IV access even though they are drinking by mouth
A
for medications
for emergency access
15
Q
Who do you refer a patient with pain and crepitus out of Temporomandibular joint (TMJ?
A
oral surgeon
16
Q
signs of TMJ disorder
A
pain
popping
crepitus
17
Q
who is responsible to obtain patient informed consent?
A
the surgeon (person performing surgery)
18
Q
What tasks can you delegate to an AP for a post op patient
A
vitals
feeding
ambulation
19
Q
Can an AP change dressings
A
No
20
Q
Isolation precautions for airborne
A
N95 mask
TB
measles (rubeola)
varicella zoster
21
Q
what precautions are there for rubella?
A
droplet
22
Q
where do you put linen that has been soiled by feces
A
biohazard
23
Q
proper linen handling
A
dont put on floor dont double bag wrap inward or use a tie dont shake dont leave extra linen inside room
24
Q
what do you put at the foot of isolation patient bed
A
plastic bag
25
isolation patient will have their own?
linen disposal hamper
26
how to keep a sterile field
dont reach over
keep hands over elbows
open outwards
wash hands for 20 secs
27
Response for when family asks why you dont put restraints on patient who keeps pulling out IV
lowest form of restraints have to be used before
wrap IV site with acrylics
place IV in non-reachable area
try to resolve patient confusion if they are confused
28
what do you do before obtaining wound culture
irrigate site
29
difference between speaking to male patient and female patient
male patients are more direct
30
home safety for fall risk patient
```
bars in shower
non slip bathmat
no carpet
no clutter
night light
non slip rug
med alert
shower chair
```
31
nursing actions for patient with partial hearing issues
make sure hearing aid is working
speak to patient face to face
clean hearing aid w/ non alcohol wipes or damp cloth
32
what does cold therapy do
constricts (less blood circulation)
33
what does hot therapy do
dilates (more blood circulation)
34
clean under patient nail with
orange stick
35
can a CNA cut a patients nail?
no
36
who cuts diabetic patients nails
podiatrist
37
clear liquid diet includes
```
black coffee
jello
apple juice
orange juice
chicken broth
```
38
is sherbert included in a clear liquid diet?
no
39
what kind of liquid is apple sauce
full liquid
40
what do you ask a patient to do if they have adventitious lung sounds (abnormal)
cough (could be congestion)
41
interventions for patient with low o2 saturation
raise head of bed (opens up airways)
42
what is the limit of O2 COPD patient can receive?
2 L (they retain CO2)
43
patient with cardiac issues should be instructed not to do what when defecating
straining
44
what is the issue with a patient straining during defecation
can cause cardiac syncope (passing out)
| stimulates cranial nerve 10
45
why dont you let cardiac patients go to the bathroom by themselves
morphine they were given for pain can cause constipation which could cause them to strain while defecating
46
what do you give patient with constipation
stool softeners
47
use a gait belt if patient is
unbalanced
| weak
48
what should you assess before ambulating a patient
if they can bear weight
49
aspiration precaution for patient at home
sit up in chair (fowlers position)
50
what to assess when patient is immobile for long period of time to see if theyre ready to ambulate
able to move all extremities
51
what do you remove first
gloves (most dirty)
52
first thing you put on
gloves
53
next step if patient is still pulling out IV
put on mittens
54
restraint process
get order within 24 hrs
easy tie knot
dont tie to side rails
55
how often do you assess a restrained patient
every 2 hrs
56
what do you assess when assessing restrained patient
circulation
ROM (remove restraints & perform ROM exercises)
if they need to use bathroom
57
what is your priority assessment for a patient in vest restraints
respiration
58
priority assessment for patient in mittens
skin integrity
| circulation
59
how do you prevent patients nails from digging into their palms when in mittens
place towel or cotton in hands
60
where do you document a telephone order
in patients chart
61
what do you do with left over medication
throw away
62
how to prevent skin breakdown in immobile patient
barrier cream
clean & check often
reposition every 2 hrs
63
best solution to use when inserting IV into patient
chlorhexidine
64
phlebitits is
blood vessel inflammation
65
signs of phlebitis
warmth
burning sensation
redness
tenderness
66
what is infiltration
medication leaking into tissue
67
infiltration makes skin
cold
swollen
discolored
68
physiological changes in old people
```
lower metabolic rate
increased pain threshold
decreased cardiac output
decreased gastric motility
decreased skin turgor
```
69
first thing to do when removing NG tube
check order
70
recommendation for patient with circulation issues, cold feet and trouble sleeping
put on socks
71
is suction input or output
output
72
proper way to put anti embolic stockings on
```
no wrinkles (preserve skin integrity)
make sure theyre not too tight
```
73
where to put padding on restraints
over bony prominences
74
patients that are at risk for aspiration
```
NG tube pts
dysphagia pts
throat cancer pts (head and neck)
stroke pts
post op pts on general anesthesia
```
75
low sodium/fat/cholesterol patients cant have
```
packaged food (high sodium)
cheese (high fat and sodium)
red meat
dairy products (cant have low fat milk either)
chicken skin
animal products (high cholesterol)
```
76
high calcium food
salmon (high in calcium)
milk
oranges
citrus products
77
TUMS are also called
calcium carbonate antacid
78
what do calcium carbonate antacids cause
constipation
79
antacids
milk of magnesia
| aluminum hydroxide
80
what does milk of magnesia cause
diarrhea
81
what does aluminum hydroxide cause
constipation
82
what do you give for constipation
fluids and fiber
83
where do you test skin turgor on young patients
on hand
84
where do test skin turgor on old patients
on collar bone
85
vitamin d production gets triggered by
the sun
86
foods high in vitamin c
oranges
cabbage
green pepper
strawberries
87
you risk breaching EHR & EMR confidentiality when
some else documents for you
you give your password out
leave computer open
going into chart you arent assigned to
88
patient statements are
subjective
89
is vomiting subjective or objective
objective (you see i.t)
90
is nausea objective or subjective
subjective
91
what do you do first after collecting a stool sample
send to lab immediately
92
patient needs to be catheterized if
```
incontinent
immobile
going to surgery
urinary retention
open perineal wound
residual urine (unable to empty bladder even after urinating)
```
93
wipe from front to back to prevent
ecoli contamination
94
first step if patient hasnt urinated after catheter is removed
assess with bladder scan
95
normal gastric secretion ph
1-3
96
can you use gastric tube if ph is near range (ex. ph of 4)
yes
97
proper action for patient with cleansing enema
sims position
bag 12-18 in (30-45 cm)
hold solution to help gravity flow
insert 2 in to anus (lubricate tip)
98
orthodox jewish patient diet
kosher
meat and dairy eaten hrs from each other
no pork
99
islamic patient diet
no pork
100
what kind of liquid is grape juice
clear liquid
101
sublingal medication for patient that has NG tube what do you do?
place under patients tongue (always give med how i.ts supposed to be given)
102
education for patient who has difficulty swallowing or stroke
soft foods
nectar liquids
sit up to eat and lean forward
103
pulses locations
1. temporal
2. carotid
3. brachial
4. radial
5. apical/pmi/mitral
6. femoral
7. popliteal
8. dorsalis pedis
9. posterior tibial
104
what to do if patient has irregular heart beat
assess for full minute
105
why dont you assess both carotid pulses at same time
could drop BP
106
steps if patient has infiltration
```
assess
stop infusion
remove IV
put sterile dressing
elevate extremity (fluid gets reabsorbed)
apply warm (if fresh)
apply cold (after 24 hrs)
```
107
during BP reading patients arm should be
at level of heart
108
instructions for patient getting BP reading
no talking
keep legs uncrossed
keep feet flat
sit upright
109
what gender is more likely to have scoliosis
female
110
should incident reports be put in patients chart?
no
111
fall risk patient care plan should include
in reach call bell
lowered bed position
fall mats
112
what to do if ambulating patient and they begin to fall
help patient slide down or help fall against wall with gait belt
