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NUR 198 EXAM 2-QUESTIONS WITH
VERIFIED SOLUTIONS | 2026 UPDATE
An older adult comes in with new onset of confusion. What should you do first? Labs, to check for UTI or pneumonia. tolerance the diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect dependence A state in which there is a compulsive or chronic need, as for a drug first symptom of acidosis hyperventilation, increased RR action of 3% sodium hyperosmolar agent used in patients with severe hyponatremic encephalopathy, traumatic brain injury, and cerebral edema pain scales numeric rating scale: numbers visual analog scale: faces categorical scale: words, numbers, colors, locations on the body nonverbal cues of pain
Decreased activity, grimacing, frowning, crying, moaning, and irritability. Priority assessment in the PACU breathing, circulation, and respiratory adequacy ABCs: airway, breathing, circulation malignant hyperthermia a severe reaction to certain drugs used for anesthesia malignant hyperthermia symptoms dangerously high body temperature, rigid muscles or spasms, a rapid heart rate tachycardia, tachypnea, high fever medications that can cause malignant hyperthermia anesthesia drugs: halothane sevoflurane desflurane succinylcholine malignant hyperthermia treatment dantrolene by limiting the activation of calcium receptor appropriate medications for low-moderate pain
- Acute
- Fluctuating state of confusion
- Onset: fast
- Duration: hours to less than 1 month
- Causes: multiple, such as surgery, infection (sepsis, stoke, UTI's), drugs
- Management: remove or treat the cause
- Nursing interventions: reorient the client to reality; provide a safe environment possible causes of delirium ○ Dehydration ○ Electrolyte imbalance/ emotional stress ○ Lung, liver, heart, kidney, brain disorders ○ Infection (sepsis, stroke, UTI's) ○ Rx Drugs ○ Immobility ○ Untreated pain, unfamiliar environment ○ Metabolic disorders if delirium is left untreated what are possible outcomes changes in level of consciousness, irreversible brain damage, and sometimes death what assessments are performed on patients when they are in a state of acute confusion with alterations in attention and cognition? (delirium is suspected) CAM, confusion assessment method
healthcare team's primary goals for delirium patients § Improve oxygen § Reorient the client to reality; provide a safe environment § Supporting cognitive function § Reducing anxiety and agitation § Improve communication dementia
- Chronic
- Loss of short-term memory, thinking (cognitive), and behavior, causing reduced ability to perform ADL's
- Progressive cognitive decline
- Onset: slow
- Duration: months to years
- Causes: unknown, possibly familial, chemical
- Management: treat signs and symptoms
- Nursing interventions: reorientation is not effective in late stages; use validation therapy (acknowledge client's feelings and do not argue); provide safe environment Non-Alzheimer's disorders degenerative, vascular (can be from strokes), neoplastic, demyelinating, infectious, inflammatory, toxic, metabolic, and psychiatric disorders what disease process accounts for 70% of dementia?
ceftriaxone indications
- Suspected meningococcal septicemia
- Severe sepsis (consult only) bacterial infections Aging changes alters the drug pharmacokinetics and dynamics absorption, metabolism, distribution, excretion BEERS criteria A list of medications that are generally considered inappropriate when given to elderly people
- Increased sensitivity to medications such as sedatives, analgesics and anti-cholinergic drugs nursing implications for medications in the older adult ○ Need adjustment of dosage due to age; start low, go slow ○ Assess knowledge of medications and use ○ Review need for medication, coordination of prescriber ○ Factors that affect compliance ○ Keep medication regimen as simple as possible ○ Strategies to improve compliance recommendations for older adults to track medications with polypharmacy medications list medication organizer set a routine or reminder tools
keep medications in a visible location record side effects or concerns common acid/base imbalance with COPD patients
- elevated PaCO2 levels
- decreased pH
- kidneys attempt to compensate
- clinical manifestations: dyspnea, respiratory distress, confusion, respiratory failure major side effects of opioids respiratory depression, constipation, sedation, decreased LOC how to administer opioid medications through IV slowly side effects of pre-op benzodiazepines sedation, respiratory depression, hypotension, dizziness, impaired coordination, memory impairment, paradoxical effects (agitation, aggression) Benzodiazepines drugs that lower anxiety and reduce stress enhances GABA ABG arterial blood gas
metabolic alkalosis
- excess of bicarbonate (HCO3-) in the blood, leading to an increase in blood pH
- Alkalosis can affect the levels of ionized calcium in the blood, leading to hypocalcemia (low levels of calcium) physiological changes in older adults Cardiovascular System: Reduced elasticity of blood vessels. Increased risk of hypertension. Decreased cardiac output. Slower heart rate at rest. Respiratory System: Decreased lung elasticity and vital capacity. Reduced respiratory muscle strength. Increased susceptibility to respiratory infections. Musculoskeletal System: Loss of muscle mass (sarcopenia). Decreased bone density (osteoporosis). Joint stiffness and reduced flexibility. Nervous System:
Slower nerve conduction. Decline in cognitive function, memory, and reaction time. Changes in sleep patterns. Increased confusion with physical illness. Gastrointestinal System: Slower digestion and reduced absorption of nutrients. Decreased gastric acid secretion. Increased risk of constipation. Renal System: Decline in renal function and filtration rate. Reduced ability to concentrate urine. Increased vulnerability to dehydration. Integumentary System: Thinning and dryness of the skin. Decreased elasticity. Slower wound healing. Endocrine System: Changes in hormonal levels (e.g., menopause in females, andropause in males).
ageism
- a bias that discriminates, stigmatizes, and disadvantages older adults based solely on their chronologic age
- fear of aging
- negative images in society
- feelings of increased
- burden on family Sodium (Na) salty sodium regulate fluid balance, blood pressure, and nerve transmission salt lives in the brain potassium (K) keeping potassium maintaining proper heart and muscle function potassium lives in the heart Calcium (Ca) calming calcium involved in muscle contraction and nerve transmission. It helps regulate heart rate and blood clotting. calcium lives in the muscle Magnesium (Mg)
might magnesium muscle and nerve function, blood glucose control, and bone health magnesium lives in the reflexes chloride (Cl) chloride in cells maintain fluid balance and is an essential component of stomach acid (HCl) phosphate (PO4) phosphate in the bones crucial for bone and teeth formation and is involved in energy metabolism chronic disease noncommunicable disease, medical or health problem with associated symptoms or disabilities think disease processes chronic illness human experience of living with chronic disease MCC, persons experience/perception examples of chronic disease arthritis, HTN, Lyme, lupus, diabetes, heart disease characteristics of chronic illness § Continuous adaptation and accommodation § Therapeutic regimens, treatment § Affects the entire family
§ Die the way they want to (if they don't want to take meds) § Dying at home Nursing Process ○ Identify specific problems, trajectory phase ○ Establish, prioritize goals ○ Plan of action to achieve desired outcomes ○ Interventions focus: § Regimens to control symptoms, avoid complications § Psychosocial issues affect quality of life ○ Evaluate outcomes, reassess problems (ADPIE) Nurses primary goals prevention of chronic disease: immunizations, vaccines, seatbelts, treatment management of care: screenings, blood sugar checks avoid complications: health promotion, health screenings, treatment hypotonic solution out of vessel into cells swell 0.45% NS,0.25 NS isotonic solution
stays where I put in, stays the same 0.9 NS, D5W, Lr hypertonic solution enter vessel out of cells shrink 3% NS, D10, D5.9/0.45, D50, albumin colloid A mixture containing small, undissolved particles that do not settle out. crystalloid a substance that, when dissolved, forms a true solution rather than a colloid and is able to pass through a semipermeable membrane tonicity The ability of a solution surrounding a cell to cause that cell to gain or lose water. diffusion Movement of molecules from an area of higher concentration to an area of lower concentration. osmosis Diffusion of water through a selectively permeable membrane osmolality the concentration of solutes in body fluids
□ Fistula drainage □ Gastric suctioning measuring intake and output ○ 1 oz = 30 mL ○ 8 oz = 1 cup ○ 1 cup = 240 mL ○ Measuring using calibrated container ○ Measure at eye level ○ If you see a meniscus, measure at the bottom of the meniscus excessive fluids results in what fluid volume overload, electrolyte changes, and organ dysfunction insufficient fluids results in what dehydration, electrolyte changes, and organ dysfunction fluid volume disturbances hypovolemia and hypervolemia hypovolemia causes and treatment ○ Causes: § Abnormal fluid losses - Vomiting, diarrhea, sweating, GI suctioning § Decreased intake - Nausea, anorexia, lack of access to fluids § Third-space fluid shifts - Due to burns, ascites § Additional causes - Diabetes insipidus, adrenal insufficiency, hemorrhage
○ treatment: § oral route § IV fluids: isotonic, hypotonic, hypertonic § assess I&O, vitals, LOC, breath sounds hypervolemia causes and treatment ○ Causes: § Excess oral fluids or IV fluids § Heart disease and renal disease are known risks for developing fluid volume excess. (peripheral edema and pulmonary edema) § Can result in hemodilution of cells and electrolytes in blood if hypotonic solution ○ treatment: § reduce salt and fluid intake § I&O, daily weights, assess lung sounds, edema § monitor responses to diuretics and parenteral fluids § fluid restrictions § dialysis § promote rest sodium imbalances hyponatremia and hypernatremia hyponatremia causes and treatment ○ causes: § excessive fluid intake
