NR 324 Exam 1 Study Guide Questions with Answers, Exams of Nursing

Download NR 324 Exam 1 Study Guide Questions with Answers and more Exams Nursing in PDF only on Docsity! NR 324 Exam 1 Study Guide Questions with Answers *Make sure that you understand all of the terms you are studying, if you don’t know what a term means, look it up before you continue studying. Take your thinking a step further by asking yourself “why” as you are reviewing material you are studying. This will lead to understanding of the material versus memorization which will better help you answer application questions. Remember, this study guide does not mirror the exam and you are responsible for all course content; ensure that you have an understanding of concepts. That being said, if you complete and understand this study guide, you will be well prepared for the next exam. Chapter 17: Fluid, Electrolyte, and Acid-Base Imbalances 1. What are possible causes of hypervolemia? Excessive intake of fluids, abnormal retention of fluids (heart failure, renal failure), SIADH, Cushing’s. 2. What are the clinical manifestations of hypervolemia? Increased BP, bounding pulse Edema HA Polyuria Crackles, dyspnea 3. What are remarks that a patient might say if they are experiencing fluid volume overload? 4. What are the vital signs changes you’ll see with hypervolemia? BP, pulse, JVD distention, LOC 5. What are specific nursing assessments to assess for hypervolemia? 24-hour intake and output, assess cardio changes, Resp changes, LOC, PEERLA, daily weights, skin. 6. What is the treatment for these patients? Diet, fluid/sodium restriction, fluids, diuretics o What are the different types of diuretics? Loop diuretics: Furosemide – Lasix Thiazides: Hydrochlorothiazide Potassium sparing: Spiro lactone Quinzoline: metolazone o How would you educate your patient with each type? Loop diuretics cause the kidneys to increase flow of urine. This helps reduce the amount of water in your body and lower your blood pressure. Take this med in the morning. Thiazides reduce the amount of sodium and water in the body. Thiazides are the only type of diuretic that dilates (widens) the blood vessels, which also helps to lower blood pressure. Potassium-sparing used to reduce the amount of water in the body. Unlike the other diuretic medicines, these medicines do not cause your body to lose potassium. Do not increase the potassium you eat. 7. What are possible causes of hypovolemia? Fever, heatstroke, Diabetes insipidus, GI losses, Hemorrhage, dehydration 8. What are the clinical manifestations of hypovolemia? Poor skin turgor Lethargy Thirst, dry mucous membranes Decreased urine output, concentrated Increased respiratory rate Orthostatic hypotension 9. What are remarks that a patient might say if they are experiencing dehydration? 10. What are the vital signs changes you’ll see with hypervolemia? Decreased BP, Increased HR, Increased RR, flattened neck veins, thread pulse 11. What are specific nursing assessments to assess for hypovolemia? Skin turgor, skin (dry, breakdown), daily weights, intake and output 12. What is the treatment for these patients? Increase fluids 13. What are way’s to measure fluid volume status? Intake and output, daily weight 14. Which measurement is the best way to measure total body fluid gains/loss? Daily weight 15. What are lab value ranges, action in the body, clinical manifestation and treatments of the following: o Sodium (NA) : 135-145 Maintains the concentration and volume of ECF and influences water distribution. Where water goes sodium follows. Hypernatremia Manifestations: Restlessness, agitation twitching, seizures, coma Treatments: treat underlying cause, hypotonic solution (5% dextrose) Hyponatremia: Manifestation: Lethargy, confusion, decreased reflexes, seizures, and coma Treatments: treat underlying cause, fluid restriction, hypertonic saline in small amounts o Potassium (K): 3.5-5.0 HEART Regulates intracellular osmolality and promotes cellular growth. Neuromuscular and cardiac function are commonly affected. Hyperkalemia (renal failure, rapid TPN) Manifestations: irregular pulse, paresthesia, weakness, irritability Treatments: Kayexalate, IV insulin and glucose (pushes K+ into cells), Hemodialysis Hypokalemia (GI losses, diarrhea, vomiting, NG suction) Manifestations: muscles weakness, irregular pulse, fatigue, hyperglycemia Treatments: treat with oral or IV K+ (needs to be on pump and cannot exceed 10-20 mEq per hour 21. What are your nursing interventions related to care for these lines? Monitor for infection, systemic or local, vitals, measure at insertion site, flush/blood return MUST have both, pain assessment, listen bilateral lung sounds. Why do we do them? To assess for complications. 22. Be sure to understand which nursing diagnosis are priority over others. (A-B-C) Chapter 26: Nursing Assessment: Respiratory System 23. Describe the sound you would hear, where you would hear it, what could cause this sound, and treatments you would expect to have ordered: o Crackles: popping sounds on inspiration, heard in lungs, causes: HF, pulmonary edema, pneumonia, COPD. Treatments: stop fluids, start diuretics, fluid restriction (severe) and restrict sodium. o Wheezes: Continuous high-pitched squeaking or musical sound. Bronchial wall. Causes: asthma, anaphylaxis, COPD, airway obstruction. Treatments: Steroids (reduce inflammation), bronchodilators (open up). o Rhonchi: Continuous rumbling, snoring or rattling sound in large airways. Causes: COPD, cystic fibrosis, infection, pneumonia, smoker. Treatment: expectorant (mucinex), increase fluids, antibiotics, steroids or bronchodilator. o Pleural rub: coarse grating (sand paper). Inflamed pleural surfaces rubbing together. Causes: pleural effusion, pleurisy, pneumonia. Treatments: chest tube, antibiotic, diuretics and steroids. o Stridor: crowing sound of constant pitch. Partial obstruction of larynx or trachea. Causes: choking, epiglottitis, anaphylaxis. Treatment: epinephrine (Broncho dilates and vasoconstricts), Heimlich, steroids. 24. Explain how to perform the test, the normal findings, abnormal findings, when and why you would feel/hear abnormal findings: o Tactile fremitus: Place the palmar surface of the hands with hyperextended fingers against the patient’s chest. Ask patient to repeat the phrase “99” in a louder and deeper than normal voice. Normal: vibrations are normal. Abnormal: Increased vibrations. Causes: when the lungs become filled with fluid or is denser (pneumonia, lung tumors, thick bronchial secretions). Absent fremitus may be noted with pneumothorax or atelectasis. o Bronchophony: spoken or whispered “99” syllable more distinct than normal on auscultation. Normal: muffled. Abnormal: clear sounds. Causes: pneumonia o Egophony: Spoken “eeee” similar to “aaaa” on auscultation because of altered transmission of voice sounds. Normal: “eeee”. Abnormal: “aaaa”. Causes: pneumonia or pleural effusion. o Whispered pectoriloqy: patients whispers “1, 2, 3”. Normal: muffled. Abnormal: clear sounds. Causes: pneumonia. 25. Identify the following lab results & what specifically you are checking for when you are assessing them: o WBC: 5000-10,000. Infection o Hgb: 12-15. Amount of oxygen in the blood. Anemia or hemorrhage o Hct: 36-45. Amount of RBCs in one blood sample. Shock, hemorrhage, dehydration. o Platelets: 150-450. Thrombocytes in the blood. Promote coagulation. o BUN: 10-25. Evaluate kidney function. When the kidneys can’t get rid of urea. o Creatinine: 1.2-1.5. Evaluate the function of kidneys. 26. Explain nursing interventions you would perform if you have a client that has a high respiratory rate, dyspneic, and desaturation of the SPO2 levels. o How will you know if your patient is getting better after your interventions? Increase in SPO2, decrease RR 27. Explain the nursing management (assessments/interventions) for a patient receiving the following diagnostic tests: o CT scan: Evaluate BUN and creatinine to assess renal function. Assess allergies shellfish or iodine. Patient should be well hydrated before and after to excrete contrast. Warn patient that contrast injection may cause a feeling of being warm and flushed. o MRI: Evaluate BUN and creatinine to assess renal function. Contrast is not iodine based. Assess patient for claustrophobia, provide relaxation or other modes to cope. Patient must remove all metal. Patient with pacemakers and defib cannot have MRI. o Bronchoscopy: Instruct patient to be NPO status for 6-12 hr before the test. Give sedative if ordered. After procedure, keep patient NPO until gag reflex returns. Monitor for recovery for sedation. Blood-tinged mucous is not abnormal. If biopsy was done, monitor for hemorrhage and pneumothorax. o Lung biopsy: Same as bronchoscopy. With TTNA, check breath sounds q4hr for 24 hr and report and resp distress. Check incision site for bleeding. A chest x-ray should be done after TTNA or Tran’s bronchial biopsy to check for pneumothorax. With VATS a chest tube may be in post procedure until lung has reexpanded. Monitor breath sounds to follow chest reexpansion. Encourage deep breathing for lung reinflation. Chapter 27: Nursing Management: Upper Respiratory Problems 28. What is epistaxis? Nosebleeds 29. What are possible causes of epistaxis? Low humidity, allergies, upper resp infection, sinusitis, trauma, foreign bodies, hypertension, chemical irritants, street drugs, overuse nasal sprays. 30. What are the treatments? 1. Keep patient quiet 2. Place patient in a sitting position, leaning slightly forward with head tilted forward 3. Apply direct pressure by pinching the entire soft lower portion of the nose against the nasal septum for 10-15 minutes. o Which one do you do first? #2 o Which treatments are more advanced if simple measures do not work? Applying vasoconstrictive agent, cauterization or anterior packing, silver nitrate. 31. What is allergic rhinitis? Reaction of the nasal mucosa to a specific allergen. 32. What is key in the treatment/prevention of allergic rhinitis? Identifying and avoiding triggers of allergic reactions. 33. What are the 2 different types of flu vaccines? Inactivated and live attenuated. o What types of patients should receive each kind? Inactivated: injection. Over 6 months of age, can be used in people at increased risk (chronic medical conditions, nursing homes, immunocompromised, pregnant women). Live attenuated: nasal spray. Healthy people 2-49. 34. Tracheostomy: a) What is it? Surgically created stoma (opening) in the trachea to establish an airway. b) What is the purpose of it? Used to bypass an upper airway obstruction, facilitate removal of secretion or permit long term mechanical ventilation. c) What are the steps of trach care and suction and why/how they are done? d) What is the purpose of the cuff? Used for risk of aspiration or in mechanical vents. e) How do you accurately measure the pressure in the cuff? Inflate the cuff with the minimum volume of air required to obtain an airway seal. Cuff inflation pressure should not exceed 20 mm Hg or 25 cm H2O in order to prevent tracheal necrosis. MOV and MLT or commonly used methods. f) What are possible complications of a tracheostomy? Airway obstruction, air leak, aspiration, bleeding, infection, tracheal necrosis, tube displacement, fistula formation. g) What are roles of the RN, LPN, and UAP involving trach care? Cleansing inner cannula, cleanse stoma, suctioning, monitor cuff pressure every 8 hours, do not change ties for 24 hours, monitor of resp depression, infection and teach patient self-care. 35. What are common causes of head and neck cancer? Tobacco use, alcohol consumption. 36. What are clinical manifestations of head and neck cancer? Hoarseness that lasts more than 2 weeks, feeling of lump in the throat or change in voice quality. Sore throat, ear pain, swelling ▪ What is the CURB-65 scale? It’s a test used as a supplement to clinical judgment to determine the severity of pneumonia and if patients need to be hospitalized. ▪ How long are symptoms expected for pneumonia? 2-3 weeks c) Lung Cancer: Arise from mutated epithelial cells, tumor development promoted by epidermal growth factor, Occur primarily in segmental bronchi and upper lobes. Primary lung cancers categorized into 2 sub types: non-small-cell lung cancer (80%) and small- cell lung cancer (20%). ▪ What are the different carcinogens that can cause lung cancer? Pollution Radon/radiation Asbestos Industrial agents Smoking Genetic factors Gender differences ▪ Describe clinical manifestations of lung cancer: Symptoms appear late in disease. May be masked by chronic cough Depend on type of primary lung cancer, location, and metastatic spread Pneumonitis Persistent cough with sputum (most common) Hemoptysis Dyspnea Wheezing Chest pain ▪ Distinguish the different types of lung cancer: ▪ Squamous cell carcinoma Slow growing Early symptoms ▪ Adenocarcinoma Moderate growing Most-common in non-smokers ▪ Large-cell carcinoma Rapid growing Highly metastatic ▪ Describe the TNM staging system: • T: denotes tumor size, location and degree of invasion • N: indicates regional lymph node invasion • M: represents presence/absence of distant metastases d) Tuberculosis: Tuberculosis is an infectious disease caused by mycobacterium tuberculosis involves lungs primarily but any organ can be infected. M. Tuberculosis is gram-positive (acid-fast bacillus). Spreads from person-person via airborne droplets (i.e breathing, talking, singing, sneezing, and coughing). Cannot be spread by touching, sharing food utensils, kissing, or any other types of physical content. Inhalation causes small particles to lodge in the bronchiole & alveolus Local inflammatory reaction occurs Hallmark of TB (ghon focus) developing into a granuloma Granuloma is a defense mechanism (walls of infection and attempts to prevent further spread). M. tuberculosis is aerophilic (oxygen loving) affinity for lungs. Can also spread via lymphatic system. Other organs TB favors for growth can be kidneys, epiphyses of the bone, cerebral cortex, and adrenal glands. Clinical manifestations: LTBI-asymptomatic, Pulmonary TB takes 2-3 weeks to develop symptoms, cough becomes frequent, increased fever, chills, pleuritic pain, productive cough, and adventurous breath sounds. High fever in the afternoon. Complications: military TB, Pleural TB, pneumonia. Tests: TB skin test, chest x-ray, interferon release assays. Treatment: active: 2 phases and is aggressive. Latent: treated for 6-9 months. Diagnosis: ineffective breathing pattern, ineffective airway clearance, noncompliance, ineffective self-health management. Promote health, prevent spread. ▪ What precautions are these patients placed on? Single-occupancy room with 6-12 airflow exchanges/hour, HEPA masks must be worn, airborne isolation. ▪ When can these precautions be removed? Can be considered adequately treated when the therapy regimen has been completed and there is evidence of negative cultures, clinical improvement and improvement on chest x-ray. ▪ How long are the treatments? 6-12 months. e) Pulmonary Embolism: Blockage of one or more pulmonary arteries by a thrombus, fat, air embolus, or tumor tissue, Emboli are mobile clots that generally do not stop moving until they become lodged at a narrow area in the circulatory system, In the lungs the emboli gets lodged in smaller blood vessels and obstructs perfusion of alveoli. ▪ Where is the occlusion located in the body? Pulmonary artery ▪ What are the clinical manifestations of a pulmonary embolism? Variable Dyspnea most common Tachypnea Cough Chest pain Hemoptysis Crackles Wheezing Fever Syncope Change in LOC ▪ What are the treatments? Anticoagulation-low molecular weight heparin, unfractionated IV heparin, warfarin. Fibrinolytic agents – tissue plasminogen activator (tPA), alteplase (activase). ▪ What are possible causes of a pulmonary embolism? DVT in the legs Immobility Surgery Smoking Oral contraceptives ▪ How as nurses do we prevent P.E.’s? Semi-fowlers position IV access Oxygen therapy Frequent labs Emotional support and reassurance Educate the patient 39. What is a pneumothorax? Air entering the pleural cavity 40. What are the clinical manifestations of a pneumothorax? Dyspnea, decreased movement of involved chest wall, diminished or absent breath sounds on the affected side, hyper resonance to percussion. o What clinical manifestation would you see if a patient is developing a tension pneumothorax? Cyanosis, air hunger, tracheal deviation away from affected side, neck distention, violent agitation. o Why is a tension pneumothorax dangerous? Medical emergency, patient can die from inadequate cardiac output or severe hypoxemia. 41. What are possible causes of a pneumothorax? Rupture of small blebs, laceration or puncture of lung, chest trauma, compression of the lung, injury to chest wall. o What is your immediate treatment of a stab wound until a chest tube can be inserted? o What are your priority assessments when you are caring for a patient with a chest wound? Chapter 29: Nursing Management: Obstructive Pulmonary Disease 42. Asthma: a. What is the pathophysiology? Chronic inflammatory disorder of the bronchial mucosa  bronchial hyper-responsiveness, airway constriction and airway obstruction. Exposure to antigen initiates innate & adaptive immune response involving dendritic cells, helper T cells, inflammatory cytokines, interleukins, B cells and eosinophils. b. What are possible triggers of asthma? Genetics Allergens