NR 462 Exam 1

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tbemis
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203113
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NR 462 Exam 1
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2013-02-25 23:10:29
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Med Surg
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NR 462 exam 1
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  1. What does PQRST stand for?
    P- Provocative(aggravating)/ Palliative(alleviating)

    Q- Quality/Quantity

    R- Region/Radiation

    S-Severity

    T-Timing
  2. What is the definition of an acute illness?
    • A disruption in functional ability usually
    • characterized by a rapid onset, intense
    • manifestations, and a relatively short duration

      Reversible; < 3 months

      Eg: Upper respiratory tract infection, Flu, etc.
  3. What is the definition of a chronic illness?
    • A disruption in functional ability usually characterized by a gradual, insidious onset with
    • lifelong changes

      Irreversible; >3 months

      Eg: H/T, DM, Cancer, etc.
  4. What is the primary level of health promotion?
    To decrease the person’s vulnerability to disease(avoid the onset of disease); the promotion of health and the prevention of illness

     Parenting education, attention to personal hygiene, immunization, and avoidance of toxins
  5. What is the secondary level of health promotion?
    Early detection of disease (sign and symptom) to initiate early intervention

     Cervical screening, mammography, blood pressure monitoring and blood cholesterol checking
  6. What is the tertiary level of health promotion?
    - minimize its effects and to prevent further disability (rehabilitation after condition is stabilized)

     Restorative care, therapeutic interventions
  7. What does ILIKEME stand for?
    I=Identify client’s strength

    L=Listen to the client’s self-description

    I=Involve the client in decision making

    K=Keep goals realistic

    E=Encourage client to think positively

    • M=Maintain an environment conductive to
    • client self-expression

    • E=Explain to the client how to use positive
    • self-talk instead of negative self-talk
  8. What are is the nursing care focus with someone who has a chronic illness?
    Managing symptoms

      Avoiding complications: eye complications in person with DM

      Avoiding acute illness: pneumonia in a person with COPD

      Promoting health: exercise

      Maintaining functional status
  9. What are the physical changes when someone ages?
    Cardiovascular, Renal, Respiratory, Endocrine, GI, nervous system, sensory, reproductive, dermatologic,
  10. What are some strategies for teaching the elderly?
    • Slow pace of presentation of material
    •  Adjust time for learner condition and attention span
    •  Use repetition/reinforcement
    •  Avoid distractions; modify the teaching environment
    •  Large print, non-glare paper, use of color
    •  Difficulty seeing and difficulty with color perception
    •  Voice
    •  Difficulty hearing
    •  Involve family and significant
  11. What are normal lab values for Sodium?
    135-145
  12. What are normal lab values for Potassium?
    3.5-4.5
  13. What are normal values for CO2?
    35-45
  14. What are normal lab values for Magnesium?
    1.5-3.5
  15. What are normal values for HCO3?
    22-26
  16. With a patient who has pneumonia what purpose does bed rest serve?
    It reduces the cellular demand for oxygen
  17. A client with pneumonia has a temperature ranging between 101 and 102 and periods of diaphoresis. Based on this information  which of the following nursing interventions would be a priority?
    Provide fluid intake of 3L/day
  18. What signs and symptoms would a nurse expect to find when assessing a 79 year old client with pneumonia?
    Confusion and lethargy
  19. What would be an expected outcome for a problem with impaired gas exchange?
    Alert and oriented to person, place, time and events
  20. With a patient who has been diagnosed with community-acquired pneumonia which nursing intervention has the highest priority?
    Obtain a sputum specimen for culture and sensitivity
  21. What is the rational that supports multidrug treatment for clients with pneumonia?
    Multiple drugs reduce development of resistant strain of the bacteria
  22. What should a nurse assess for a patient who has pneumonia on O2 therapy to determine if they are hypoxic?
    Confusion
  23. When a client with aspiration pneumonia become dyspneic, begins to cough, and is turing blue while feeding them, which is the first action the nurse should take?
    Turn the client to the side
  24. Which kind of influenza vaccination would you give to a pregnant female?
    Inactivated
  25. What is pursed-lip breathing taught for to patients with emphysema?
    To promote carbon dioxide elimination
  26. Which findings would you expect on a client with COPD and an upper respiratory tract infection?
    Coarse crackles and rhonchi
  27. How can the nurse best assist a patient to stop smoking?
    Help the client to develop a plan to quit and suggest a formalized program available in the community
  28. What does a 60% FEV1/FVC ratio tell you?
    The client has obstructive lung disease
  29. What should a nurse implement to a client with COPD who is SOB?
    Pursed-lip breathing
  30. A 28 year old nonsmoker with a deficiency in the enzyme Alpa1-antitrypsin, what does this predispose the client to?
    Development of lobular emphysema
  31. What would be very concerning to a nurse caring for a patient with COPD?
    Rusty colored sputum
  32. What is the best way to determine someone's fluid balance?
    To weigh them
  33. What is the normal lab values for Ca?
    8.6-10.2 mg/dL
  34. What are normal lab values for Cl?
    96-106 mEq/L
  35. What are clinical manifestations of low Ca?
    tetany, circumoral numbness, paresthesias, hyperactive DTRs, Trousseau’s sign, Chovstek's sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, and anxiety
  36. What are clinical manifestations of hypomagnesia?
    Acts directly on myoneural junction, affecting muscular irritability and contractions
  37. What are clinical manifestations of hypermagnesia?
    flushing, lowered BP, nausea, vomiting, hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, and dysrhythmias
  38. What is Chvostek's sign?
    A contraction of facial muscles in response to a tap over the facial nerve in front of the ear (hypocalcemia)
  39. What is Trousseau's sign?
    Refers to carpal spasms induced by inflating a blood pressure cuff on the arm (hypocalcemia)
  40. What does high and low potassium levels do to a T wave?
    High- peaked

    Low- flat
  41. What are the signs of low Na?
    CNS deterioration
  42. What are the signs for high Na?
    • Thirst
    • CNS deterioration
    • Increased interstitial fluid
  43. What is typical urine output?
    0.5 mL/kg/hr
  44. Which organs help to control acid base balance?
    Pulmonary and Renal
  45. What does ROME stand for?
    • R-Respiratory 
    • O-Opposite
    • M-Metabolic 
    • E-Equal
  46. What is the definition of compensated for ABGs?
    The pH is normal and the PCO2 and HCO3 are both abnormal
  47. What is the definition of uncompensated for ABGs?
    pH is abnormal along with the PCO2 and HCO3
  48. What is somatic pain?
    aching or throbbing, localized, arises from bone, joint, muscle, skin, or connective tissue
  49. What is visceral pain?
    tumor involvement or obstruction, arises from internal organs
  50. What are non-pharmacologic nursing interventions for managing pain?
    • Exercise
    •  PT, OT, stretching, strengthening
    •  Physical methods
    •  ice, heat, massage
    •  Chiropracty
    •  Acupuncture
    •  Transcutaneous electrical nerve stimulation (TENS)
    •  Alternative therapies (placebo response)
    •  relaxation, imagery
    •  Herbals
    •  Therapeutic touch, massage
    •  Cognitive-behavioral therapy (CBT)
  51. What is the placebo effect?
    • A physiologic response that results from an
    • expectation that a treatment will work
  52. What are the physiologic dimension of pain?
    • -Transduction
    • -Transmission
    • -Perception
    • -Modulation
  53. What are factors that influence the pain response?
    • Past experience: less tolerate pain, want pain
    • relief sooner ask for medication before next dose is due
    •   Anxiety
    •   Depression
    •   Culture: excessive crying and moaning
    •   Gender: women report greater than men
    •   Genetics
    •   Gerontologic considerations
    •   Expectations
  54. What is addiction?
    • is a chronic, neurobiologic disease characterized by:
    •  Impaired control over drug use
    •  Compulsive drug use
    •  Continued use despite harm
    •  Craving
  55. What is the mode of transmission for influenza?
    • Airborne Droplet- Airborne diseases are
    • contagious to approx. a 5 foot perimeter
  56. What is Hospital-acquired pneumonia?
    Occurring 48 hours or longer after admission and not incubating at time of hospitalization
  57. What is aspiration pneumonia?
    • Sequelae occurring from abnormal entry of
    • secretions into lower airway
  58. What are the types of COPD?
    Bronchitis (Blue bloater), Emphysema (pink puffer)
  59. What is the cause of Bronchitis?
    • Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucus may plug airways
    •   Alveoli become damaged and fibrosed, and alveolar macrophage function diminishes 
  60. -Tough to get air in
  61. What is the cause of Emphysema?
    • Decreased alveolar surface area causes an increase in “dead space” and impaired oxygen diffusion
    •   Reduction of the pulmonary capillary bed increases pulmonary vascular resistance and pulmonary artery pressures 

    -causes right sided heart failure

    -Pursed lip breathing (due to CO2 retention)
  62. What are the risk factors for COPD?
    • Tobacco smoke causes 80-90% of COPD
    • cases!
    •  Smoking damages the cleaning mechanism,
    • increase accumulation of mucus
    •   Passive smoking
    •   Occupational exposure
    •   Ambient air pollution
    •   Genetic abnormalities
    •      - Alpha1-antitrypsin deficiency
  63. What are the percentages for FEV1/FVC for COPD?
    FEV1/FVC<70%
  64. What are the primary clinical manifestations of someone with COPD?
    Three primary symptoms: chronic cough, sputum production, and dyspnea on exertion
  65. What is cor pulmonale?
    hypertrophy of the right side of the heart, with or without heart failure, resulting from pulmonary hypertension
  66. What is the criteria for a nurse to administer PRN medicine?
    —The Nurse will use subjective and objective data – Assessment and then document reason given and results from medication
  67. What are the six rights of medication administration?
    • 1.Right drug/medication
    • 2.Right patient
    • 3.Right dose
    • 4.Right route
    • 5.Right time
    • 6.Right documentation
  68. What is the correct needle length and gauge for IM injections?
    The standard length is 1.5 inches, gauge 21-25 

    in an obese patient you might need to use a 3 inch needle
  69. What is the correct needle length and gauge for a subcutaneous injection?
    Length- less than one inch (3/8 or 5/8), gauge is 25-27.

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