Adult Health Exam 1 Study Guide, Exams of Nursing

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Adult Health Exam 1 Study Guide 80 MC

questions verified solutions 2023-

1. After surgery your pt is at risk for pneumonia, what are some of the things you’re going to make them do? -get them walking/ambulate -incentive spirometer (coughing and deep breathing. Every 2 hrs) -turn frequently - cough (-supportive measures like humidified oxygen therapy for hypoxemia - mechanical ventilation for respiratory failure - a high calorie diet and adequate fluid intake - Interventions should include bed rest and - analgesic to relieve pleuritic chest pain) Way of using incentive spirometer: - Sit up straight on the bed or chair - Exhale fully - Seal your lips around the mouthpiece - Breath in slowly and deeply - Hold your breath for at least five seconds (make sure you check flow indicator in better or best position, slow down if lightheaded, practice before each meal, and before bed, practice at least 10 times within your session) 2. You have a pt going in for surgery and on anticoagulants what are some of the things you want to be aware of -be aware of pt nutrient status that can cause complicate w/ coagulation -any supplements that may interfere with meds -heparin/vit k, leafy greens - (Are they on any herbal medication? - Are they taking any supplement that can interfere with anticoagulate Medication? - Suppose patient is on heparin or coumadin (warfarin) and they are also taking Vitamin k rich food and fruits:

• Dried and Fresh Herbs
• Dark Green Leafy Vegetables
• Brussels Sprouts 3. What needs to be done before the pt signs the informed consent? -physician needs to explain procedure (otherwise you can’t get consent sign from patient) 4. What are complications of ibuprofen/NSAIDS? (Aspirin) -risk for bleeding
• with any NSAIDs, you always gonna have bleeding problems 5. What would be important to tell the medical staff? -any allergies such as a latex allergy
• if your patient is going for surgery and he/she has allergy on latex, due to the fact they will get problem while having surgery, thus you should be informed about that before proceeding for surgery because your patients might have allergy on catheter, nasal cannula, Adminocenofen...

6. At the conclusion of a surgical procedure, there is a radioactive wand that is passed over the wound to check if sponge is in the pt [at the conclusion of the surgical procedure (they actually have a wand)- pass the radial frequency wands scanner over the patient’s wound to check if the sponge is in the patient]
7. If pt is in the PACU or in the recovery room (both are same things) for 30 mins and they are groggy & sedated, VS little bit low what would be the 1 st^ thing to do to get their vital signs/respirations rate back up? -stimulate the pt. and try to wake them up before you notify the physician (the physician will most likely have the patient sign if they are still awake or have the next of kin sign it) -if you stimulate them they gonna moan, they gonna cough, they gonna take deep breath - -do not give them anything to drink right away because their gag reflex has not back yet 8. 2 identifiers

• name and date of birth

9. If you have spinal anesthesia, what position do you keep the pt in -Lateral position: patient usually lies on the side in a knee-chest position when administering the anesthetic agent. When finished the patient is positioned on his or her back. - flat (prone)? I think this is supine /: -if you raise that patient’s, he/she gonna have intracranial pressure, headache -after surgery, patient will lay flat in supine position Why does patient lay on side? Risk of aspiration 10. Some of the pts will not take all of their medication prior to surgery, how will they take it? (suppose a patient is on two different kinds of hypertensive -slowly and with sips of water 11. What would you expect to see in a pt who has lost a lot of blood in surgery - High pulse and respiration will be higher (to compensate HR and R goes up) - Low B/P - be aware of complications of blood loss after surgery 12. what/when is a time out? -before the surgery to make sure you have the right pt./procedure/documents/ everything has been filled out/ everything is completed/ etc. - go through the check list making sure everything is right 13. Preoperative assessment (select all) -pt.’s history -why they are having surgery -what are their current health problem -medication reconciliation- if they had any previous complications, Anesthesia while having Surgery -previous surgery -complications -assess vital signs -weight & height for proper med dosage -verify NPO status 14. If you’ve already sedated a pt. and consent has not been signed, what do you do? medication how would you take off that medication?) If patient was NPO medication, and that patient is going for surgery and you have to stop that

-notify the physician (The doctor will most likely tell you to have the patient sign it if they are still awake if they completely sedated they will get the next of kin)

15. Things to do to prevent possible DVT (select all) - SCDS - TED Hose - Ambulate - Anticoagulants - (walk around, wear compression stockings, take anticoagulant medication) 16. What meds do you give to a pt. who is nauseated/vomiting Antiemetic ( ex: Zofran) 17. What do you monitor for a pt. on heparin? - Bleeding. Avoid vitamin K 18. Know difference between hypo/hyperkalemia, what causes each

• HYPOKALEMIA K<3.5 serum, Fatigue, anorexia, nausea, vomiting, dysrhythmias, muscle weakness and cramps, paresthesias, glucose intolerance, decreased muscle strength, DTRs Signs: Alkalosis, shallow respirations, irritability, confusion, drowsiness,weakness, fatigue, arrhythmias : Tachycardia, Irregular Rhythm and/or Bradycardia, lethargy, thready pulse, nausea, vomiting. Cause: loop diuretics -HYPERKALEMIA Serum potassium greater than 5.0 mEq/L Cause: usually treatment related, impaired renal function, hypoaldosteronism, tissue trauma, acidosis. Signs: Muscle twitching/ weakness, irritability & anxiety, decreased BP, ECG changes- tall peaked T waves, Dysrhythmias- Irregular Rhythm Bradycardia, abdominal cramping, diarrhea
• (potassium actually gonna affect GI system, Heart, lung, muscles of whole body - potassium conduct electricity in the body, it is crucial for heart function like contraction) 19. What would you see in a pt. with fluid volume deficit? s/s -low B/P, low electrolyte, rapid weight loss, decreased skin turgor, dehydration, rapid weak pulse, low cardiac output, concentrated urine, oliguria, increased temperature, cool clammy skin due to vasoconstriction, lassitude, thirst, nausea, muscle weakness, cramps.

20. Pt. with high potassium levels, what would you do? -monitor HR with ECG, -teach to avoid high-potassium foods (if you have to give medication give diuretic) 30. What food would you encourage a pt. with hypokalemia to eat? - Spinach, Bananas, oranges, tomatoes, soybeans, avocados, sweet potatoes, green leafy -(POTASSIUM- Potatoes, Oranges, Tomatoes, Avocados, Strawberries, Spinach, fIsh, mUshrooms, Mush-melons (Cantaloupe)- **THIS IS REVOLUTIONARY

31. What are 2 things that can lead to osteoporosis?** -decrease in calcium and vitamin D (vitamin D is needed to absorb calcium), alcohol use, estrogen low, smoking, sedentary life, corticosteroid use 32.We’ll be given 4 options and need to identity which one is health promotion a. Getting tests done i. Physical exam ii. Dental exam iii. TB screen iv. Blood pressure, cholesterol, glucose v. Eye exam, hearing exam vi. Colorectal screening vii. Mammogram, cervical cancer screening, Prostate-specific antigen test (PSA) b. Primary prevention: i. Immunization, nutrition, fitness, education c. Secondary prevention: i. Communicable disease screening ii. Early detection d. Tertiary prevention: i. Begins after injury or illness ii. Prevention of pressure ulcers iii. Promote independence e. Improve physical and psychological Well being f. Provide information and skills to patients to assume healthier behaviors

33. What do you do with a pt. who falls and has a fracture (I have a fracture and I feel like going to the bathroom what you gonna do before you go and get ambulance to get me?) -immobilize the fracture Signs & Symptoms of fracture : pain, edema, deformity, decline in function, muscle spasm, crepitation, ecchymosis/ contusion 34. What is crepitus? - a grating sound or sensation produced by friction between bone and cartilage. Common in arthritis. - A person with knee crepitus can usually feel the crunching or crackling sensation by placing a hand over the knee cap as the knee bends and straightens. 35. When are you at risk for osteomyelitis? - Extension of soft tissue infection - Direct bone contamination - Bloodborne spread from another site of infection - this typically occurs in area of bone that has been traumatized or has lowered resistance. 36. What is the “RICE method?” - Rest, Ice, Compression, and Elevation - It is nursing care for sprains and strains 37. What is orthostatic hypotension? -is a sudden decrease of B/P when the pt stand up (sign and symptom could be:

• Blurry vision
• Weakness
• Fainting (syncope)
• Confusion
• Nausea
• Feeling lightheaded or dizzy after standing up)

• (When you stand up, gravity causes blood to pool in your legs and abdomen. This decreases blood pressure because there's less blood circulating back to your heart) There are so many causes which lead to orthostatic hypotension:
• Dehydration. Fever, vomiting, not drinking enough fluids, severe diarrhea and strenuous exercise with excessive sweating can all lead to dehydration, which decreases blood volume. Mild dehydration can cause symptoms of orthostatic hypotension, such as weakness, dizziness and fatigue.
• Heart problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure. These conditions prevent your body from responding rapidly enough to pump more blood when standing up.
• Endocrine problems. Thyroid conditions, adrenal insufficiency (Addison's disease) and low blood sugar (hypoglycemia) can cause orthostatic hypotension, as can diabetes — which can damage the nerves that help send signals regulating blood pressure.
• Nervous system disorders. Some nervous system disorders, such as Parkinson's disease, multiple system atrophy, Lewy body dementia, pure autonomic failure and amyloidosis, can disrupt your body's normal blood pressure regulation system.
• After eating meals. Some people experience low blood pressure after eating meals (postprandial hypotension). This condition is more common in older adults. 38. What would you notice with a pt with hypokalemia and electrolyte imbalance? -notice of hypoglycemia (because lack of insulin also causes the breakdown of fat cells, with the release of ketones into the blood, turning the blood acidic (hence the term ketoacidosis). The acidosis and high glucose levels

in the blood work

together to cause fluid and potassium to move out of the cells into the blood circulation- this means if you have high glucose level in the blood you also gonna have high potassium, and with low glucose level -low potassium - these both go together)

39. What do you do with someone with sinusitis? -palpate the orbital area -“raccoon?” (around the eyes and nose) -go up and down 40. What do you educate a pt. with the flu to do? -wash your hands 41. Pt. who is SOB, she’ll give vital signs, sit up, if O2 saturation level is low, can you administer oxygen? - Yes! 42. Why do you use bronchodilators? - For people with asthma (to open up their airway passages) & COPD - Medication: Albuterol Inhaler 43. Risk factors leading to an asthma attack (not a select all) - Excessive amount of perfume, cigarette smoking,dust, animals, 44. How do you use an incentive spirometer? - Sit up in a chair or bed. Hold the incentive spirometer at eye level DG has - Slowly breath out (exhale) completely - Put the mouthpiece in your mouth and close your lips tightly around it. - Breathe in (inhale) slowly through your mouth as deeply as you can. As you inhale, you will see the piston rise 45. Math questions 10 questions- drop factor IV drop rate: Volume (ml)/ Time (min) * Drop factor ( gtts/ml)=Y ( flow rate in gtts/min) 46. Why do you teach a pt pursed lip breathing -to eliminate CO2 or bad air out of the lungs for those with COPD, and anybody with respiratory problems, for example (it improves ventilation, releases trapped air in the lungs, keeps the airways open longer and decreases the work of breathing, prolongs exhalation, improves breathing patterns, relieves SOB, causes relaxation)

47. What would you educate a pt with COPD on? -side effects of inhaler - tachycardia (main one) - anxiety and restless Know side effects of hypovolemia 48. Select all pertaining to tuberculosis- -signs/symptoms: progressive fatigue. Malaise, anorexia, weight loss, chronic cough (productive), night sweats, hemoptysis, pleuritic chest pain, low grade fever

• Tx- TB medication, decreased activity, Resp Isolation until negative sputum, frequently outpatient treatment
• Dx- Tb skin test ( screening), Chest X-ray, Sputum Studies ( 3 specimens collected on 3 different days) 49. Proper use of an inhaler Shake the inhaler, breathe in slowly. Breathe in slowly for 3-5 seconds hold breath for 10 seconds to allow medicine to go deeply into lungs. 50. If pt. is complaining of hoarseness, what would be some questions that you would ask? (cracked voice, broken voice) -what do you do as an occupation -ie: teachers talk a lot and this may affect/lead to their symptoms 51. Would a pt. with bronchitis take more fluids and why? -take more water to thin the mucus making it easier to expel or cough 52. What bacteria causes osteomyelitis? Staphylococcus aureus (main one), proteus & pseudomonas spp.

Escherichia coli. (the most common-Staphylococcus

aureus)

53. Giving a pt. meds to take home, what would be some of the things to include in their education? - (i.e. antibiotics) take the full dose even if your symptoms resolve 54. Signs of compartment syndrome Leg swollen tight, pale, and dusky. Swollen muscle compresses blood vessels and nerve in leg through casts. Pallor and dusky

55. Signs of thrombus (PE) -SOB, chest pain, anxiety, fever, tachycardia; death occurs 1 hour after onset of symptoms 56. What’s a PE -obstruction of the pulmonary artery or one of its branches by a thrombus that originated somewhere in the venous system -what kinds of symptoms would you see? Signs of pulmonary emboli - chest pain, rapid pulse, shortness of breath 57. What does a CPM do? Mobilizes the extremity while the patient is resting (to move the knee after surgery) 58. What would be something you would do prophylactically for a pt going in for bone surgery? -give antibiotics -tetanus shot -clean the wound Post hip surgery -use of an abduction pillow to prevent pt from crossing legs/bending -wouldn’t want a pt to sit on a low toilet seat at home 59. If a pt. is in bed after surgery, where would you look if you suspect bleeding? -under the pt. and look at the linen to see if there’s any pooling of blood (patient is lying down in supine position and you can see his/her wound, but can’t see bleeding- you see underneath the patient, push or rotate or turn the patient little bit and see underneath them for bleeding) 60. Need to know about walking with crutches 3 point gait - 1. Place crutch forward · 2. Step with weaker leg · 3. Step with stronger leg 61. What would you hear with a pt. with atelectasis - Crackles and decreased breath sounds

62. Measures to prevent atelectasis ( a complete or partial collapse of a lung or lobe of a lung — develops when the tiny air sacs (alveoli) within the lung become deflated. It's a breathing (respiratory) complication after surgery ) -early ambulation, Incentive spirometer, mobilization 63. Appropriate problems associated with COPD (select all) -appetite decrease -activity levels decrease 64. Foods rich in Calcium -milk, dairy, cheese, broccoli, kale, sardines, almond, okra, orange, sesame, chinese cabbage, navy beans, tofu, common fig, rapini, spinach 65. Scans for a pt. with osteoporosis -Dexa scan- bone density scan 66. What do you educating a pt. with TB to do? - Adherence to treatment regimen: take medications on empty stomach or 1 hour before meals; Pts taking INH should avoid foods with tyramine and histamine; avoid alcohol because of high potential for hepatotoxic effects; drug resistance can occur if medication regimen is not followed - Hand hygiene, covering mouth and nose when coughing and sneezing - Mouth care - Proper disposal of tissues 67. What would you see in a pt. whose IV site has been infiltrated (select all) Inflammation at or near insertion site Swollen taut skin with pain blanching/coolness of skin around IV site damp/wet dressing slowed/ stopped infusion No backflow of blood into IV tubing on lowering solution container 68. Neurovascular status - 5 P’s assessment : pain, pallor, pulse, paresthesia, paralysis - - (the purpose of assessing 5 Ps- is to assess for adequate nerve function and blood circulation to the parts of the body in order to detect signs and symptoms of potential complication such as compartment syndrome) 0