CPSS EXAM 1 2024/2025 WITH 100% ACCURATE SOLUTIONS, Exams of Nursing

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CPSS EXAM 1 2024/2025 WITH 100% ACCURATE SOLUTIONS Small bottle that contains the drug - Precise Answer ✔✔Ampule Diameter of the needle - Precise Answer ✔✔Gauge Enlarged base by which a hollow needle may be attached to a device (as a syringe) - Precise Answer ✔✔Hub Cylindrical container that holds liquids - Precise Answer ✔✔Barrel A small container, usually with a closure, used especially for liquids - Precise Answer ✔✔Vial What are the reasons to give an injection? - Precise Answer ✔✔- if drug is poorly absorbed or degraded by GI system - if pt is uncooperative, unconscious, unable to take PO - used when localized therapy is desired - preferred when rapid & predictable drug response is desired in ER situations What is the needle size used for blood withdrawal? - Precise Answer ✔✔18 g What is the needle size used for IM injections? - Precise Answer ✔✔22g What is the needle size used for SubQ injections? - Precise Answer ✔✔25-27g What needle size is used for ID injections? - Precise Answer ✔✔26-27g What type of injection has the fastest rate of absorption? - Precise Answer ✔✔IV > IM > SQ When are IM injections indicated? - Precise Answer ✔✔- drugs are not easily absorbed PO - when you want an intermediate rate of onset & duration of action - when parenteral delivery is necessary What are the 3 main sites of IM injections? - Precise Answer ✔✔- gluteal (upper outter quadrant) - deltoid (lateral & 3-4cm below the acromion) - vastus lateralis (antero-lateral, upper thigh) What are the C/I to ID injections? - Precise Answer ✔✔- dermatitis - cellulitis - previous positive TB test What are the most commonly used sites for ID injections? - Precise Answer ✔✔Ventral forearm (TB) & back (allergy testing) *Rabies vaccine given ID in deltoid What technique should be used when giving an ID injection? - Precise Answer ✔✔Move down 3-4 finger widths from the antecubital area Use 0.1ccs max Angle needle 10-15 degrees DO NOT ASPIRATE What are the absolute C/I for radial & brachial ABGs? - Precise Answer ✔✔- no pulse/collateral circulation - cellulitis - aneurysm at puncture site - AV fistula or graft above puncture site What are the relative C/I for radial & brachial ABGs? - Precise Answer ✔✔- chronic renal disease - arterial disease - bleeding disorders/ anticoagulant therapy What are the potential complications of ABGs? - Precise Answer ✔✔- hemorrhage - thrombosis - transient arterial spasm - nerve damage - infections What artery is MC used for arterial puncture? - Precise Answer ✔✔Radial artery Which artery runs along the lateral aspect of the volar forearm deep to the superficial fascia between the styloid process of the radius and the flexor carpi radialis tendon? - Precise Answer ✔✔Radial artery Which artery is used if the radial artery is unavailable? - Precise Answer ✔✔Brachial artery Which artery runs along the medial 1/3rd surface of the antecubital fossa and should be accessed above the antecubial crease? - Precise Answer ✔✔Brachial artery Which artery is used only if the radial and brachial are not possible? Usually indicated when the pt is severely volume depleted or in shock? - Precise Answer ✔✔Femoral artery Which artery lies midway between the ASIS and the pubic tubercle? - Precise Answer ✔✔Femoral artery What are C/I to using the femoral artery? - Precise Answer ✔✔- aortofemoral bypass graft - previous femoral artery surgery - leg ischemia - aneurysm of femoral artery What technique is used for femoral artery sampling? - Precise Answer ✔✔Enter at steeper angle of 60-90 degrees Apply pressure for longer b/c inc risk of hematoma What is considered a positive Allen's test? - Precise Answer ✔✔Color returns to hand within 15 seconds * over 6 seconds = delayed *over 15 seconds = abnormal What happens if too much heparin is left in the syringe? - Precise Answer ✔✔Lowers the PCO2, bicarb & pH due to dilution of specimen What is the technique for drawing ABGs? - Precise Answer ✔✔Hold syringe like a pencil Insert needle 45-60 degree angle *Obtain 2mL of arterial blood* Lactate is metabolized by the liver into? - Precise Answer ✔✔Bicarbonate - buffers the blood if acidosis is present Which type of fluid is indicated for massive hemorrhage and resuscitation? - Precise Answer ✔✔Lactated Ringer What is the ideal IV site in the hand? - Precise Answer ✔✔Dorsal metacarpal veins What is the ideal IV site in the forearm? - Precise Answer ✔✔Cephalic vein, Accessory Cephalic vein, & Median Cubital vein What is the rate of a micro/macro drip? - Precise Answer ✔✔Microdrip - 60 drops/mL *good for peds* Macrodrip- 10-15 drops/mL *good for routine/rapid delivery* What is the formula for calculating flow rates? - Precise Answer ✔✔(Volume mL) x (drip set) / (time in minutes) What are the complications of IV therapy? - Precise Answer ✔✔Localized: - bruise, cellulitis, infiltration, extravasation, phlebitis Systemic: - sepsis, PE, air embolism, catheter fragment embolism, These complications can happen at insertion of needle if both walls of the vein are penetrated or at a later date if catheter moves and penetrates walls? - Precise Answer ✔✔Infiltration or Extravasation (blistering) What areas should not be used for venipuncture? - Precise Answer ✔✔- scars from burns & surgery - UE on the side of previous mastectomy - hematoma - IV/ blood transfusions on same arm - cannula/fistula/heparin lock - edematous extremities What type of antiseptic is used for blood cultures? - Precise Answer ✔✔Povidone-iodine wipes What is the order of blood draw? - Precise Answer ✔✔1- blood culture tube (yellow black) 2- Non additive tube (red or STT) 3- coagulation tube (light blue) - NEVER DRAWN FIRST 4- Additive tubes (Heparin- Dark green; EDTA- lavender; oxalate/fluoride- light gray) What kind of symptoms should be avoided when performing a finger stick? - Precise Answer ✔✔Avoid puncturing a finger that is cold, cyanotic, swollen, scarred or covered with rash What can be done to prevent a hematoma? - Precise Answer ✔✔- puncture only top wall of vein - remove tourniquet before removing needle - use major superficial veins - apply pressure to site How many times must a sample be discarded before a specimen can be obtained for analysis using an indwelling catheter? - Precise Answer ✔✔Discard a sample at least 3 times the volume of the line before a specimen is obtained for analysis What causes hemoconcentration (increased concentration of larger molecules & formed elements in blood)? - Precise Answer ✔✔- prolonged tourniquet application (+2 mins) - massaging, squeezing, or probing site - long term IV therapy - sclerosed or occluded veins What effect may exercise have on pts blood sample? - Precise Answer ✔✔increases: - CK - AST What phase consists of formation of granulation tissue, epithelialization & contraction? - Precise Answer ✔✔Regeneration What phases consists of scar formation? - Precise Answer ✔✔Remodeling What groups are high risk for wound healing? - Precise Answer ✔✔Elderly Disabled Bedridden Head injuries Spinal injuries Nonblanchable erythema of INTACT skin? - Precise Answer ✔✔Stage 1 pressure ulcer PARTIAL thickness skin loss involving epidermis, dermis, or both layers; presents clinically as an abrasion, blister or shallow crater? - Precise Answer ✔✔Stage 2 pressure ulcer FULL thickness skin loss that extends down to, but not through, the underlying fascia; presents clinically as a deep crater with/without adjacent tissue? - Precise Answer ✔✔Stage 3 pressure ulcer FULL thickness skin loss with extensive destruction, tissue necrosis, or damage to MUSCLE, bone, or supporting structures - Precise Answer ✔✔Stage 4 pressure ulcers What is the Wagner Grading System for DM ulcers? - Precise Answer ✔✔1- superficial 2- ulcer extension 3- deep ulcer w/ abscess or osteomyelitis 4- gangrene to portion of forefoot 5- extensive gangrene of foot What are the different types of debridement? - Precise Answer ✔✔autolytic mechanical chemical surgical What are the different ways to mechanically debride a wound (remove devitalized tissue, bacteria & proteolytic enzymes, and senescent cells)? - Precise Answer ✔✔- pulse irrigation - vacuum assisted closure - sharp debridement What type of wound debridement is used to decrease fluid & bacterial burden, increase capillary ingrowth, and mechanically pull edges of wounds together? - Precise Answer ✔✔Vacuum assisted closure device What are the clinical indications for enzymatic debridement? - Precise Answer ✔✔- ideal for nonsurgical candidates or alternate care sites - break down eschar before sharp debridement - in conjunction with mechanical - infected wounds Most topical abx are compatible with enzymatic agents except? - Precise Answer ✔✔Silver dressings What are the indications for non debridement? - Precise Answer ✔✔- poor perfusion - pain control - exposed bone - hospice pts - dementia/unpredictable behavior - stable necrotic tissue - anticoagulant pt What are the final pathways to wound healing failure? - Precise Answer ✔✔- Infection - Hypoxia (edema, radiation, scarring) What type of topical dressing is used for activation of wound environment? - Precise Answer ✔✔Dynamic dressing - biological support (Apligraf) - remove nonvital tissue (Accuzyme) What activates endothelial cells & fibroblasts, stimulates vascular proliferation, migration, and new blood vessel formation & recruits smooth muscle cells and epricytes to stabilize newly formed vessels? - Precise Answer ✔✔Platelet derived growth factors (pdGF) What modulates protease activity, keeps the growth factor active while bound, delivers growth factor back to wound over time & modifies hostile proteolytic environment of chronic wound? - Precise Answer ✔✔Oxidized Regenerated Cellulose (ORC)/ Collagen What type of debridement is used for a wound requiring debridement of fibrinous exudate, other necrotic material or slough? - Precise Answer ✔✔Enzymatic debridement *removes senescent fibroblasts - can't produce cytokines *removes necrotic tissue harboring bacteria Give an example of an enzymatic debridement application? - Precise Answer ✔✔Accuzyme *apply directly to the wound Panafil What type of dressing is used to decrease bioburden? - Precise Answer ✔✔Anti-infective dressings What type of dressing is indicated for venous ulcers or DM ulcers? - Precise Answer ✔✔Acticoat (nanocrystalline silver coating) Wound with clean granular base; how to treat? - Precise Answer ✔✔Protect & keep moist Ex- Hydrocolloid, Hydrogel, VAC device, secondary dressing, wet to damp saline Wound with crater; how to treat? - Precise Answer ✔✔Fill the space with uniform contact Ex- Hydrogel, Alginate, Foam, hydrocolloid, VAC device, wet to damp saline Wound with necrotic/non-viable tissue; how to treat? - Precise Answer ✔✔Debride and cleanse Ex- enzymatic dressing, hydrogel, calcium alginates, pulse irrigation, VAC device, hypertonic salts, wet to damp saline Wound with exudate; how to treat? - Precise Answer ✔✔Absorb and contain Ex- Alginate, foam, VAC device, wet to damp saline Wound with sinus, tunnel, undermining; how to treat? - Precise Answer ✔✔Prevent pre-mature closure, absorb exudate- treat with loose packing Ex- soak gauze w/ hydrogel; calcium alginate if high drainage, VAC device, wet to damp saline Wound with infection; how to treat? - Precise Answer ✔✔Decrease local bacterial count Ex- pulse irrigation, long acting abx, antimicrobial, VAC device, wet to damp saline Which type of sutures pass through tissue easier & resists bacteria? - Precise Answer ✔✔Monofilament strands Which type of sutures have greater strength and are easier handling and softer knots? - Precise Answer ✔✔Multifilament strands List the absorbable synthetic sutures - Precise Answer ✔✔Vicryl Monocryl compromised wound healing (steroids, CA pts, obesity, malnourished)? - Precise Answer ✔✔Panacryl What type of suture is used in areas such as the periocular area, lips, & other mucosal surfaces- loses strength when exposed to moisture? - Precise Answer ✔✔Silk What type of suture is used in abdominal wall closures? - Precise Answer ✔✔Steel What are the 2 types of needle points? - Precise Answer ✔✔Taper point - soft, easy to penetrate skin Cutting point- tough, hard to penetrate skin Skin suture used for face, fingers, cosmetics? - Precise Answer ✔✔6-0 prolene Skin suture used everywhere, including dorsal of hand? - Precise Answer ✔✔5-0 ethilon Skin suture NOT used on face - Precise Answer ✔✔4-0 ethilon Most common SC closure, face? - Precise Answer ✔✔5-0 Vicryl Strong SC suture? - Precise Answer ✔✔4-0 Vicryl or PDS II What suture is used for tight spaces? - Precise Answer ✔✔5-0 vicryl What suture is used for intranasal & intraoral? - Precise Answer ✔✔Intranasal - 5-0 chromic gut Intraoral - 4-0 chromic gut When should sutures be removed? - Precise Answer ✔✔Eyelids- 3 days Face- 5 days Scalp - 7-10 days Trunk- 7-12 days UE - 7-14 days LE - 10-21 days What happens if wound edge is inverted? - Precise Answer ✔✔Sunken scar will form What type of suture technique is most commonly used in skin closures? - Precise Answer ✔✔Simple suture (simple interrupted) *most basic suture technique What type of buried suture technique is the closest to the surface than other buried sutures? - Precise Answer ✔✔Intradermal suture *important to place knot on deep site of suture to prevent abscess formation What type of suture technique is continuous series of simple suture loops- knotted only at each end? - Precise Answer ✔✔Simple running suture (baseball stitch) *can be diagonal or perpendicular to skin What type of suture technique assures a slightly greater independence or integrity of each loop? - Precise Answer ✔✔Running locking suture What type of suture design adds an additional pass through the epidermis at a point close to wound edge on each site; strength determined by large pass while small pass is used to approximate edges? - Precise Answer ✔✔Vertical mattress Involves making two sets of needles pass through the wound both in the same tissue plane at adjacent points. When is it most commonly used? - Precise Answer ✔✔Horizontal mattress *classically used to secure seal around drain tube* What non suture wound closure method is used for scalp wounds b/c it causes minimal injury to hair follicles? Not for areas that bear weight? - Precise Answer ✔✔Staples