Comprehensive Guide to Nursing Care for Older Adults, Exams of Nursing

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NR 255 Exam I|84 Questions with Answers 2023 White Blood Cells (WBCs) - CORRECT ANSWER normal range- 5-10 cells/mcL notes- very high=leukemia, low= poor immunity neutrophils (neutro) - CORRECT ANSWER normal range- 40-60% notes- elevated in bacterial and viral infections, low=neutropenia eosinophils (eosino) - CORRECT ANSWER normal range- 1-4% notes= elevated with allergic reaction, asthma, parasitic infection basophils (baso) - CORRECT ANSWER normal range- 0.5-1% notes- high amount seen in bone marrow issues like leukemia and lymphoma Hemoglobin (Hgb) - CORRECT ANSWER normal range- male= 14-16 g/dL, female= 12-14 g/dL notes-low=iron deficiency anemia or blood loss Hematocrit (Hct) - CORRECT ANSWER normal range- male= 41-50 vol%, female= 36-44 vol% notes- low=iron deficiency anemia or blood loss BUN - CORRECT ANSWER normal range- 7-20 mg/dL notes- high=impaired renal (kidney) function or dehydration, low= overhydration Creatinine - CORRECT ANSWER normal range- 0.8-1.2 mg/dL notes- high=impaired renal (kidney) function Sodium - CORRECT ANSWER normal range- 135-145 mEq/L notes- low=hyponatremia, high=hypernatremia, critical low < 120; critical high >160 Potassium - CORRECT ANSWER normal range- 3.5-5 mEq/L notes- low= hypokalemia, high= hyperkalemia, critical low <2.6; critical high >6.1 Albumin - CORRECT ANSWER normal range- 4-6 g/dL notes- helps determine liver or kidney disease, or if the body is not absorbing enough protein Glucose - CORRECT ANSWER normal range- 70-110 mg/dL notes- critical low < 40; critical high >450, normal fasting glucose 70-100 Perioperative phase - CORRECT ANSWER period of time from decision for surgery until patient is transferred into operating room pre-admission testing, admission to SC, In the holding area Intraoperative phase - CORRECT ANSWER period of time from when patient is transferred into operating room to admission to post-anesthesia care unit (PACU) · Maintenance of safety, physiologic monitoring, psychologic support Postoperative phase - CORRECT ANSWER period of time from when patient is admitted to PACU to follow-up evaluation in clinical setting or at home · Transfer of patient to PACU, post-op assessment, surgical unit, home or clinic AORN - CORRECT ANSWER -Association of Peri-Operative Registered Nurses Types of Anesthesia - CORRECT ANSWER 1. General- done when patient is totally unconscious 2. Regional- sedated or given anesthesia in certain area 3. Local- given for stiches 4. Conscious Sedation- twilight (colonoscopy and EGD) Penrose Drain - CORRECT ANSWER - Placed in the external aspect of the incision; drains directly on the dressing Jackson-Pratt and Hemovac Drain - CORRECT ANSWER - Self-contained drainage systems that drain wounds directly through a tube via gravity and vacuum. They are sutured in place with suture that seals the area when the drain is removed. Nurses must use sterile technique to empty the reservoir and record the amount and color of drainage every shift or more, as ordered how much drainage usually comes out in first 24 hrs - CORRECT ANSWER 200-800 mL Post-Operative Complications - CORRECT ANSWER 1. Respiratory System a. Atelectasis (complete respiratory failure) b. Pneumonia c. Hypoxemia d. PE 2. Circulatory System a. Hemorrhage b. Hypovolemic shock c. Thrombophlebitis d. Thrombus e. Embolism 3. GI a. Paralytic ileus b. Abdominal distension c. N & V 4. Urinary System a. Urinary retention b. UTI 5. Integumentary System a. Wound infection b. Wound dehiscence c. Wound evisceration d. Skin breakdown Surgical Environment - CORRECT ANSWER - Cool/basic design - NPSG's - Zones - Required OR attire Stages of Going Under General Anesthesia - CORRECT ANSWER 1. Stage 1: patient starts getting medication via IV; starts feeling dizzy 2. Stage 2: talk a lot, laugh a lot 3. Stage 3: patient is totally unconscious; intubated; patient has no response to pain 4. Stage 4 (NOT NORMAL): patient is too sedated; not coming out of anesthesia; vital signs are dropping Additional risks for gero patients undergoing surgery - CORRECT ANSWER -Fear -Complications/potential adverse effects/risks -Gero Stats -Biological Variations- Age-related changes S/S of malignant hyperthermia - CORRECT ANSWER -Severe muscle rigidity or spasms -Rapid, shallow breathing and problems with low oxygen and high carbon dioxide -Rapid heart rate -Abnormal heart rhythm -Dangerously high body temperature -Excessive sweating -Patchy, irregular skin color (mottled skin) S/S of hypothermia - CORRECT ANSWER -Shivering -Exhaustion or feeling very tired -Confusion -Fumbling hands -Memory loss -Slurred speech -Drowsiness What is surgical asepsis? - CORRECT ANSWER the absence of all microorganisms within any type of invasive procedure. Sterile technique is a set of specific practices and procedures performed to make equipment and areas free from all microorganisms and to maintain that sterility Anesthesia awareness - CORRECT ANSWER rare experience that occurs when surgical patients can recall their surroundings or an event - sometimes even pressure or pain -related to their surgery while they were under general anesthesia Common medications used for N&V (nausea and vomiting - CORRECT ANSWER - odansetron -metoclopramide -promethazine PACU nurse responsibilities - CORRECT ANSWER -view pertinent information, baseline assessment upon admission to unit -Assess airway, respirations, cardiovascular function, surgical site, function of CNS, IVs, all tubes and equipment -Reassess VS, patient status every 15 minutes or more frequently as needed -Transfer report, to another unit or discharge patient to home aldrete scoring - CORRECT ANSWER -We use the Aldrete score to assess the anesthesia recovery phases Post Prandial Hypotension - CORRECT ANSWER excessive decrease in blood pressure that occurs after a meal Isolated Systolic Hypertension (ISH) - CORRECT ANSWER - Most common form of high blood pressure in people older than age 65 - Happens when your diastolic blood pressure is less than 80 mm Hg and your systolic blood pressure is 130 mm Hg or higher - Cannot use antihypertensive because it will cause patient to "bottom-out" Changes in Respiratory System - CORRECT ANSWER - Decreased aerobic capacity - Decreased ciliary activity, decreased respiratory muscle strength - Most older adults have smoked - Preventive measures include deep breathing, incentive spirometry, hydration, coughing, etc. Changes in Integumentary System - CORRECT ANSWER - Lose subcutaneous fat and connective tissue - Skin less elastic, more dry and more fragile - Lack of fever - Reduced tolerance to temperature changes - Xerosis (dry skin) - Thinning and graying of hair - Preventive measures include layer clothing, use sunscreen, etc. Seborrheic Keratosis - CORRECT ANSWER · Benign · Found on upper back and face · Elevated, light brown, irregularly shaped Cherry Angiomas - CORRECT ANSWER · Hyperproliferation of capillaries · Most commonly occur in older adult · Benign · Can go away over time Single Lentigo (Age Spots) - CORRECT ANSWER · In sun exposed areas · Flat, occur on face, hands, forearms · Benign · Can be lasered off Melanoma - CORRECT ANSWER · Most dangerous form of skin cancer · Invades basement membrane and travels o Asymmetry o Boarder o Color o Diameter o Evolution Varicella Zoster- "Shingles" - CORRECT ANSWER - Viral infection that causes a painful rash - Most often seen around your waist - Caused by the same virus that causes chickenpox Changes in Reproductive System - CORRECT ANSWER - Sexuality; libido unchanged; less intense response Changes in Reproductive System FEMALE - CORRECT ANSWER · Supporting musculature of the reproductive organs weakens, increasing risk of uterine prolapse · Breast tissue diminishes Changes in Reproductive System MALE - CORRECT ANSWER · Prostate gland may enlarge · Sperm count and viscosity of seminal fluid decrease Changes in GI System - CORRECT ANSWER - Digestion declines - Decreased sense of smell - Decreased saliva (xerostomia) - Decreased GI motility, increased risk of constipation - Taste declines (dysgeusia) - Dysphagia - Tooth loss (edentulism) Changes in the Endocrine System - CORRECT ANSWER - Less insulin secreted - Decreased sensitivity to insulin Nutrition - CORRECT ANSWER - Slower metabolic rate - Less physically active - Lack of vitamin D, Calcium and B12 Sleep - CORRECT ANSWER - Increased complaints Obstructive Sleep Apnea (OSA) - CORRECT ANSWER - When the muscles of the oropharynx become relaxed and can block the trachea; patient stops breathing Changes in the Musculoskeletal System - CORRECT ANSWER - ADL's and IADL's are altered - Exercise - DJD (O/A) after 70 years of age Dorsal Kyphosis - CORRECT ANSWER - Curvature of the thoracic spine due to deterioration of the vertebrate Changes in the Nervous System - CORRECT ANSWER - ANS is decreasing Changes in GU System - CORRECT ANSWER - Male- benign prostatic hyperplasia (BPH) - Female- more prone to incontinence Changes in Vision - CORRECT ANSWER - Presbyopia- inability to see things in close range - Sensitivity to glare - Adjustment to changes in light - Increase in eye diseases - MD= primary cause of vision loss - Visual aides Changes in Hearing - CORRECT ANSWER - Presbycusis- inability to hear high- pitched tones - Cerumen build-up