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NSG-3250 EXAM 1 (Adult Health) Questions and Answers (100% Correct Elaborations) Galen University
Typology: Exams
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Prof. goodluck 7/3/24 NURSING
Medical-surgical nursing a specialty area of practice that provides nursing services to patients from adolescence through the end- of-life in hospital medical-surgical units, clinics, ambulatory care units, urgent care centers, home health care agencies, and long-term care facilities Rehospitalization admission to the hospital within 30 days of a prior discharge from a hospitalization transitional care coordinated services and supports during the interval between preparing a patient to leave one setting and enter another A home health nurse is conducting an assessment of a client who may qualify for Medicare. Consequently, the nurse is utilizing the Outcome and Assessment Instrument Set (OASIS). When performing an assessment using this instrument, the nurse should assess what domain of the client's current status? Functional status Critical Care Nursing a specialty area of practice that provides nursing services to critically ill patients across the lifespan in acute care settings such as the hospital intensive unit; current practice settings have expanded to include virtual care and community settings
Rehabilitation nursing returning patients to optimal functionality through a holistic approach to care that is based on scientific evidence. Home health skilled nursing in a persons home community-based nursing promoting and maintaining the health of individuals and families, preventing and minimizing the progression of disease, and improving quality of life activities of daily living (ADLs) basic self-care tasks such as eating, bathing, toileting, walking, and dressing instrumental activities of daily living (IADLs) tasks necessary to conduct the business of daily life and also requiring some cognitive competence, such as telephoning, shopping, food preparation, housekeeping, and paying bills nurse navigator assist clients with transitions in different levels of care, such as from the hospital to a rehabilitation facility case manager ensure cost-effective care and to communicate with the medical insurance company
Medicare, Medicaid, and third party payers require documentation of the client's homebound status and the need for skilled professional nursing care When is discharge planning started? Upon admission preoperative phase period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table intraoperative phase period of time that begins with transfer of the patient to the operating room area and continues until the patient is admitted to the postanesthesia care unit postoperative phase period of time that begins with the admission of the patient to the postanesthesia care unit and ends after follow-up evaluation in the clinical setting or home perioperative phase period of time that constitutes the surgical experience; includes the preoperative, intraoperative, and postoperative phases of nursing care
ambulatory surgery includes outpatient, same-day, or short-stay surgery that does not require an overnight hospital stay Geriatric concerns with surgery Increased comorbidities Cardiac reserves are lower renal and hepatic functions are depressed GI activity is likely reduced Geriatric pre op considerations blood tests, EKG, and monitoring BP can help identify potential risks for cardiac related risks during surgery bariatric surgery complications Increased subQ tissue makes IV access difficult and delays wound healing Joint replacement failure Shallow respirations while laying supine emergency surgery surgery that must be performed immediately to save the person's life or a body organ little time for preparation diagnostic surgery determines or confirms a diagnosis
Ablative surgery To remove a diseased body part curative surgery cures; alleviates a problem informed consent an ethical principle that research participants be told enough to enable them to choose whether they wish to participate in a surgical procedure What distance should the nurse keep between their person and the sterile field? 1 foot If the patient is experiencing pre-hypothermia like symptoms during surgery, what can the nurse do? Warm the IV fluids to body temp Optimal nutrition is an essential factor in promoting healing and resisting infections and other surgical complications Any protein deficiency should be corrected before surgery to help provide adequate healing
If a patient reports of history of anorexia nervosa, the nurse should perform a _____________. Detailed analysis of the clients electrolyte levels. If the client is taking immunosuppressants after a transplant, what will the client be susceptible to? Infection Dentures, dental caries, or partial plates are important to let the ologist or CRNA know about because rotten teeth or prostheses can become dislodged and occlude the airways Drug or alcohol use/disuse before and after surgery can cause complications during surgery and or have complications with drug metabolism Heavy cigarette smoking intraoperative and post-op can cause atelecasis and hypoxia How long should a healthy patient stop smoking for before a surgery? Chronic patient? 2 days 3 - 4 weeks Before administering pre op drugs, what should be completed first
the informed consent form Respiratory, cardiovascular, hepatic and renal, endocrine, and immune systems should be assessed throughly especially if the patient has a chronic condition The purpose of being NPO before surgery is to prevent possible aspirations Preoperative skin preparation is to decrease bacteria without injuring the skin A patient with an active GI bleed that produces "coffee-ground" like emesis should anticipate surgery when? Without any delay What teaching should the nurse use when going over deep breathing post-op? The client should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs In order to there to be informed consent, the doctor must do what in the pre-op? explain the procedure and inform the client of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods
When is teaching most effective? before the surgery After preoperative medications are given, the patient should _____ in bed. stay. These meds can cause light-headedness or drowsiness When teaching patients about pre-op smoking cessation, the best thing to say is try and stop smoking entirely to reduce the changes of respiratory infections or pneumonia Most common complications during/after surgery VTE/ DTV Surgical site infections pulmonary complications/infections anesthesia reaction What happens before surgery? PAT assessment admission assessment risk of complication verify consent to treat confirm code status
education IV Pre-op meds surgical site marking comfort Educate the patient to discontinue _______ before surgery St. Johns wart due to its ability to interact with anesthesia Which arm do you not use for an IV placement? The side with a mastectomy. If bilateral, side with the least lymph nodes Purpose of bowel prep To decrease risk for contamination of the peritoneum Pt should lay flat in bed for ________ if spinal anesthesia is used to prevent a spinal headache 6 - 8 hours keep patient supine What should the PACU nurse do after a client got a epidural? Check vitals frequently. Laying in a flat position for an epidural is NOT necessary. For a spinal, it is.
A transsacral block would provide anesthesia for the perineum and lower abdomen What is the first sign of malignant hyperthermia? tachycardia The role of a circulating nurse would be to document everything Which form of PPE is always required in the OR during surgery? A mask covering the mouth and nose Which position has the greatest chance of inducing nerve damage during surgery trendelenburg During the excitement phase of anesthesia, which intervention should the nurse perform? Patient safety Malignant hyperthermia A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs. High levels of calcium and potassium leading to acidosis and cardiac dysrthmyias Early signs include a rise in end total CO2 and decreased O2 sat with tachycardia
Dantrolene Drug of choice to treat malignant hyperthermia from reaction to anesthetics Care in post-op includes Resumption of motor and sensory function Oriented Stable VS Shows no evidence of hemorrhaging or other complications of surgery What should the first thing the PACU nurse assesses on a patient that just retuned from the OR Airway patency PACU nurse functions Protect ABCs Resp LOC, TRP, O2 sat, BP Examine surgical area Discharge Nursing interventions in PACU Controlling nausea and vomiting relieving pain and anxiety assess systems
indicators of hypovolemic shock, hemorrhage Nursing interventions for a client who has received anesthesia Place client on a pulse ox and cardiac monitor If the patients fail to ambulate, if they are cleared to, what is a possible complication atelectasis Steroids impair wound healing If a patient has type 1 DM going into a same day surgery, the nurse should _________ assess blood glucose levels regularly If the client signed a consent form but was recently diagnoses with alzheimers, who is legally responsible for signing the client What do you do if the client has not signed the consent form, but is being medicated for a surgery? Tell the physician Who should know if the patient has a latex allergy?
The anesthesiologist Will an older adult experience sedative effects over a longer or shorter period? Longer In PACU, an increased respiratory rate with the use of accessory muscles should_______ be reported immediately If a patient is having surgery in the lower abdomen, what is the client at risk for? Thrombophlebitis If a client has a cholecystectomy, what does the patient have at risk. Pneumonia. Because you cannot be taking big deep breaths Which cardiac medication is given before surgery? Beta blocker If any of the packing tape touches the patient during packing, what should you do? Remove all of that packing strip What medication can cause a risk of dehiscence corticosteroids
How long is a concert good for? 6 weeks Which lab is required to rule out infection before a total joint replacement? Urinalysis Which analgesic should be held if the patient has a history of liver failure? Tylenol Which lab panel should be checked to see if there is a risk of bleeding? CBC Patients on dialysis should have this lab checked before surgery? Potassium If a patient is on warfarin, what lab should be checked before surgery? INR/PT Which electrolytes are you monitoring when administering large amounts of insulin? Potassium
Pre-diabetes A condition in which a person's blood glucose levels are above normal but not high enough for a diagnosis of type 2 diabetes. Previous hyperglycemia Family history of diabetes type 1 diabetes mellitus diabetes in which no beta-cell production of insulin occurs and the patient is dependent on insulin for survival Ketosis prone when insulin absent type 2 diabetes Diabetes of a form that develops especially in adults and most often obese individuals and that is characterized by high blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production. Oral antidiabetic medications gestational diabetes a form of diabetes mellitus that occurs during some pregnancies. Macrosomia Placental hormones inhibit insulin action Osmotic diuresis When excessive glucose is excreted in the urine cuz the kidneys cannot filter all of the glucose, it is accompanied by excessive loss of fluids and electrolytes
Diabetic Ketoacidosis (DKA) deficiency of insulin and highly acidic ketone bodies are formed, and metabolic acidosis occurs metabolic syndrome A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes. Risk factors for diabetes overweight, poor diet, little daily exercise, close relative with diabetes, ethnicity( African American, latin, Native American) Best way to diagnose diabetes ***checking A1C (Typically over 6.4%) A1C is a 3 month average of your blood sugar Classic symptoms of diabetes polyuria, polydipsia (thirst), polyphagia (hunger) Long term effects of metabolic syndrome Atherosclerosis, ischemic heart disease, left ventricular heart hypertrophy, type 2 DM
Diabetic complication prevention retinopathy, nephropathy, and neuropathy Combining starchy foods with protein and fat slows absorption and glycemic response Normal A1C levels 4 - 6% Normal triglyceride levels below 150 Raw or whole foods tend to have _________ response than cooked, chopped, or pureed foods. lower Eating whole fruits rather than juices decreases glycemic index because of the fiber Nursing care for DM Avoid moisturizer in already moist areas trim nails straight across Dry feet well after washing do not soak
Inspect feet Wear well fitted shoes How to draw up Insulin: Nicole Richie RN: Air into NPH, then air into Regular, draw up regular then draw up NPH. Dawn phenomenon ***Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels. Admin of insulin at a later time in day will coordinate insulin peak with the hormone release. 3 am to 7am, blood glucose levels rise dramatically Result from nocturnal surges of sugar and growth hormone (type 1 DM) Somogyi effect nocturnal hypoglycemia rebound resulting in hyperglycemia at night Insulin lipodystrophy loss of subcutaneous fat and appears as slight dimpling or more serious pitting of subcutaneous fat; the use of human insulin helps prevent this complication Resulting from insulin injections in one localized area Glipizide, glyburide NURSING CONCIDERATION:
Check renal functions. Creatinine levels. Anything over 2 is concerning Stress can cause hyperglycemia Latent autoimmune diabetes in adults (LADA) also known as Type 1.5 diabetes, is a condition in which type 1 diabetes develops in adults progression of autoimmune beta cell destruction in the pancreas is slower than in types 1 and 2 A BMI over ______ is a risk factor for diabetes 26 Native americans are more at risk for Diabetes The age over _____ is a risk factor 45 Inability to satisfy hunger is _______ and is a S/S of ______ Dysphagia Diabetes
Do not ______ the finger before doing blood glucose check massage/ rub Do not advise pts to have foods _____________ on the glycemic index HIGH Check creatinine levels if pt is on _______ Metformin Glyburide Helps bodies insulin attach to the receptors Food should be administered around the _______________ of NPH insulin Onset peak NPH insulin long acting insulin First sign of severe hyperglycemia Rapid deep breath respirations (Kussmauls)
For symptoms of nausea and vomiting, the nurse should ask What their current blood sugar is Fruity breath diabetic ketoacidosis acetone in breath When the patient starts asking questions about what is appropriate for their DM management the patient is ready to learn Manifestation of hypoglycemia BG below 70 cold, clammy skin numbness of fingers, toes, mouth increased HR emotional changes HA nervousness, tremors faintness, dizziness unsteady gait, slurred speech hunger changes in vision seizures, coma ALWAYS treat the patient with _________ first over ______
HYPOglycemia hyperglycemia Gerontology diabetes concerns Hypoglycemia concerns cuz they live alone Decreased renal function may skip meals Macrovascular accelerated atherosclerotic changes, coronary artery disease, cerebrovascular disease, and peripheral vascular disease Microvascular diabetic retinopathy and nephropathy Neuropathic peripheral neuropathy, autonomic neuropathies, hypoglycemic unawareness, neuropathy, sexual dysfunction ways to diagnose diabetes A1C, fasting glucose, and GTT test A patient who has been taking a sulfonylurea antidiabetic medication will begin taking metformin (Glucophage). The nurse understands that this patient is at increased risk for which condition?
renal failure We have an expert-written solution to this problem! The intensive care nurse is caring for a client admitted in a hyperglycemic-hyperosmolar state. Which of these prescriptions made by the primary health care provider will the nurse question? 1 ampule Sodium Bicarbonate IV now Ketones in the urine indicates that there is a deficiency of insulin A random glucose test level should be at or under 200 A fasting glucose test level Should be at or under 126 Short acting insulin should be given ______ mins before meals? 15 Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin, and therefore require a functioning pancreas to be effective
Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas Alpha-glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level An important reminder to teach type 1 diabetics about "sick day rules" is to not eliminate insulin when nauseated or vomiting Which lab is indicated when metformin is given serum creatinine levels What time will the dawn phenomenon occur? 0500 - 0600 Should diabetics eat food higher on the glycemic index? YES