Mark Klimek Blue Book (H's)

What information does the measurement of skin fold thickness yield?

The amount of body fat

In general, males have a higher risk of heart disease than females. (T/F)

True

Post-menopausal females have a lower risk of heart disease than males aged 25-40. (T/F)

False. They have a higher risk.

Family history of diabetes increases the risk fo heart disease. (T/F)

True

Family history of liver disease increases the risk of heart disease. (T/F)

False

Cigarette smoking increases the risk of heart disease. (T/F)

True

Oral contraceptives decrease the risk of heart disease. (T/F)

False, use increases the risk

Routine exercise decreases the risk of heart disease. (T/F)

True

What is done in a graft for hemodialysis?

A blood vessel is sutured between an artery and a vein.

What is done in an AV fistual?

A surgical anastomosis is made between the artery and a vein.

Does anything exit the skin in an AV fistula?

No

How long can an AV fistula be used?

Indefinitely

Who is the most likely to receive a graft for dialysis?

People with diabetes mellitus.

How often do clients with renal failure undergo dialysis?

3 times per week

Is hemodialysis short term or long term?

Both- but most short term dialysis is achieved by hemodialysis

How long does the average dialysis last?

4 to 6 hours

What are 3 ways to gain access to the circulation in hemodialysis?

AV shunt
AV fistula
AV graft

What is the most common site for an AV shunt?

Radial artery to radial vein

What should be avoided in the arm of the client with an AV shunt?

No venipuncture or blood pressure allowed in the arm with a shunt, graft or fistula.

What syndrome results when too much fluid is exchanged during hemodialysis too quickly?

Disequilibrium syndrome

What are the symptoms of disequilibrium syndrome?

Change in LOC
N/V
Headache
Twitching

Does anything exit the skin in an AV shunt?

Yes, the plastic tube that connects the artery and vein outside the arm

How long can AV shunt be used?

Just for a few weeks

Hemophilia is a ___________ disorder.

Bleeding

Hemophilia A is a deficiency of Factor # __________.

VIII

During an acute bleeding episode, you should apply________ for 15 minutes and apply________.

Pressure, ice

The inheritance patterns for hemophilia is:

Sex linked recessive

In hemophilia, the PTT is (up/down), the coagulation or clotting time is (up/down) and the platelet count is (up/down).

Up (increased or longer)
Up (increased or longer)
Neither (hemophilia does not affect platelets)

What does hemarthrosis mean?

Bleeding into the joints

During bleeding into the joints you should (mobilize/immobilize) the extremity.

Immobilize to prevent dislodging the clots that do form.

To treat hemarthrosis you should _______ the extremity above the __________.

Elevate, heart

What is the name of frozen factor VIII given to hemophiliacs?

Cryoprecipitate

Once you have stopped the bleeding into the joint, how long should the hemarthrosis patient wait before bearing weight or doing range of motion?

48 hours

What drug can you apply topically to stop bleeding?

Epinephrine, or topical fibrin foam

Which of these symptoms are NOT seen in hemophilia? Prolonged bleeding, petechiae, ecchymosis or hematoma?

Petechiae

Hepatitis is an _____, ______ disease of the _______.

Acute, inflammatory, liver

Hepatitis A,B,C and D are all (bacterial/viral) diseases.

Viral

An early sign of hepatitis A is ________.

Anorexia or fatigue

Early stage hepatitis often looks like the _______.

Flu

In later stages of hepatitis, the ______ turns dark.

Urine

What does pre-icteric mean?

The stage BEFORE the patient exhibits jaundice.

What is the icteric stage?

When the patient exhibits jaundice.

What skin symptoms do you see in hepatitis? (Give 2)

Pruritis (itching)
Jaundice (Both are due to bilirubin accumulation)

Which disease has more severe symptoms-- Hepatitis A or B?

Hepatitis B

Patients with hepatitis have an aversion to _________.

Cigarettes

In hepatitis the ________ are light colored.

Stools: remember the urine is dark and stools are light. (Bilirubin ends up in the skin and urine instead of the stool where it should have gone.)

What is the common name for Herpes Zoster?

Shingles

What type of rash occurs with shingles?

A vesicular rash over the pathway of a sensory nerve

How long does it take for shingles to heal?

30 days

Who is the most common subjective symptoms of shingles?

Pain, pain, Pain

What three drugs are given for shingles?

Acyclovir (anti-infective)
Tegretol (anticonvulsant--given to stabilize nerve cell membranes) Steroids (anti-inflammatory)

What other disease is related to shingles?

chickenpox

What organism causes shingles?

Varicella--herpes zoster

What is the #1 nursing diagnosis with shingles?

Alteration in comfort: pain, #2 Impaired skin integrity

Hepatitis A

Enteric precautions
Fecal/oral route of transmission
Incubates 3 to 5 weeks
Vaccine available (Can give immune globulin after exposure)
HAsAg (this is what the blood test show) Hepatitis A surface Antigen

Hepatitis B

Watch those needles
HBsAg (this is what blood tests show) Hepatitis B surface antigen
HBIG - vaccine
Vaccination available, can give immune globulin after exposure
Transmitted by blood and body fluids
Incubates 5 to 35 weks

Hepatitis C

Watch those needles
Incubates 2 to 23 weeks
Transmitted by blood only
No vaccine, immune globulin doesn't work

Which types of client should have their toenails trimmed only by an MD?

Diabetics, peripheral vascular disease, very thick nails

Two purposes of bed bath are...

Cleanses the skin
Provides comfort

The typical hospital client (should/should not) wear their dentures.

Should

What type of movement should be used for cleansing eyes?

Inner to outer canthus

Before applying elastic hose the nurse should...

Elevate the clients legs for 3 to 5 minutes to decrease venous stasis

Clients on what class of drugs should use an elastic razor?

Anticoagulants (heparin/coumadin/lovenox)

When a client is unable to hold his dentures firmly in his mouth, the nurse should...

Leave them out

How often should mouth care be performed for those clients on oxygen?

Every 2 hours

Should lemon and glycerine swabs be used to cleanse the mouth?

No, they are not cleansing agents. They are used AFTER cleansing as a moistening agent

How should a client's toenails be trimmed?

Straight across

Are nurses permitted to give perineal care to clients of the opposite sex?

Yes, nurses are permitted to give perineal care to clients of the opposite sex.

Clients on what type of therapy must use a safety blade razor (non electric)?

Oxygen therapy, since an electric razor could cause sparks

How should a nurse carry soiled linen?

In a neat bundle held away from the body.

When giving a bed bath, on which body party should the nurse begin to work?

The eyes

Give three reasons for giving a back rub.

Comfort
Stimulate circulation and muscles
Relaxation

The greatest danger in placing water in the mouth of the unconscious patient during oral hygiene is...

Aspiration

When shaving a client, water used should be more (hot/cold) than bath water?

Hot

What does evening or hour of sleep (HS) care consist of?

Oral hygiene
Washing face/hands
Back rub
Tightening linens

What is dentifrice?

Agents which promote adherence of dentures to gums, ie, Polygrip

What is sordes?

Crusts on the tongue and gums due to improper oral hygiene

What action will facilitate the trimming of brittle toenails?

Soaking in warm water

Should the client roll the elastic stocking down to wash legs? Why or why not?

No, it can cause a constricting band around the ankle/foot.

Elastic stockings should be removed for the bath. (T/F)

True

When should a patient put on TED hose?

Before getting out of bed (before the swelling occurs).

Hyperemesis Gravidarum is ______ and ________ vomiting that persists into the _____ trimester.

Severe and prolonged; 2nd trimester (normal vomiting should be gone before 2nd trimester)

Give three possible causes of hyperemesis gravidarum.

Pancreatitis
Multiple pregnancies
Hydatidiform mole

Has hyperemesis gravidarum ever been associated with mixed feelings about pregnancy?

Yes, increased incidence of it in women who are ambivalent about pregnancy

What are the two most common complications of hyperemesis gravidarum?

Electrolyte imbalance (dehydration)
Starvation

What is the initial diet order for clients with hyperemesis gravidarum?

NPO

Why are doctors cautious in using antiemetics to treat hyperemesis gravidarum?

They don't want to harm the fetus

What are the instructions given to clients recovering from hyperemesis gravidarum in relation to mealtime?

Remain seated upright for 45 minutes after each meal

What is the biggest challenge in nursing care of the client with hyperemesis gravidarum?

Getting them to eat

Hypertension is an ________ or sustained elevation in the (systolic/diastolic) __________.

Intermittent, diastolic blood pressure

Hypertension is often fatal if untreated. (T/F)

True

Hypertension is more common in blacks or whites?

Blacks

Aging decreases the risk of hypertension. (T/F)

False, it increases the risk

Obesity increases the risk of hypertension. (T/F)

True

Oral contraceptives (increase/decrease/do not effect) the blood pressure.

Increase

What four organs does hypertension affect the most?

Brain (stroke)
Eyes (blindness)
Heart (MI)
Kidney (renal failure)

How many measurements must be made before you can say a person has hypertension?

At least three

What blood pressure is considered to be hypertension?

Anything greater than 140/90 mm Hg

Which pressure is most damaging, an increased (systolic/diastolic)?

An increased diastolic

When a doctor takes three different blood pressure readings at different times, how far apart must the measurements be made?

At least one week

Can hypertension be cured?

No, just treated

What class of drugs is used to first treat hypertension?

Diuretics

Name the two most common dietary prescriptions used to treat hypertension?

Calorie reduction for weight loss
Sodium restriction

What two non-dietary lifestyle changes are used commonly to treat hypertension?

Decreases stress
Increase activity

When you take the blood pressure of the client with hypertension you would measure _____- _______, with the client _____, _______ and _______.

Both arms; lying, sitting and standing

What do caffeine and smoking do to blood pressure?

Increase it

What is the #1 side effect of antihypertensives?

Orthostatic hypotension (means you feel weak when you rise to a standing position because your blood pressure falls)

Would vasodilators or vasoconstrictors treat hypertension?

Vasodilators (decreases resistance)

Would sympathetic stimulators or sympathetic blockers treat hypertension?

Sympathetic blockers (decrease cardiac output and decrease resistance)

In hypovolemic shock there is a ________ in the circulating __________ volume -- this _______ tissue perfusion with ________.

Decrease; blood; decreases; oxygen

What gauge catheter would you use to start an IV in hypovolemic shock?

16 or larger

What is the #1 cause of hypovolemic shock?

Acute blood loss

What happens to the blood pressure in hypovolemic shock?

It decreases

What happens to the pulse pressure in hypovolemic shock?

It narrows (becomes a smaller number)

How do you calculate the pulse pressure?

You subtract the diastolic from systolic

If J. Doe's blood pressure is 100/60, what is his pulse pressure?

40 (100-minus 60 equals 40)

What is the normal pulse pressure?

40 (+ or -10)

In hypovolemic shock the level of consciousness (LOC) is (increased/decreased).

Decreased

Which heart rate is associated with hypovolemic shock, bradycardia or tachycardia?

Tachycardia

In hypovolemic shock the output of urine will be less than _______cc per hour.

25 to 30 cc

The client's skin will be _____, ______, and ________.

Cool, pale, clammy (due to arterial constriction to shunt blood from skin to vital organs)

Which acid-base disorder is MOST commonly associated with hypovolemic shock?

Metabolic acidosis (due to lactic acid accumulation- no oxygen = anaerobic metabolism)

Of all the following, which one(s) increase in hypovolemic shock? Blood pressure, output, heart rate, pH, LOC, pulse pressure, respiratory rate

Only the heart rate and respiratory rate

What are the first two sings of hypovolemic shock?

Change in LOC and tachycardia

What is the #1 medical treatment of hypovolemic shock

Replace blood and fluids

What are mast trousers?

Pneumatic device placed around the legs and lower body that is inflated to force blood centrally

Do clients in hypovolemic shock have to have a Foley inserted?

Yes, to measure urine output (when output is >30 cc per hour the shock has resolved)

In what position would you place a client in suspected hypovolemic shock?

On back with arms and legs elevated

How often are vital signs measured in hypovolemic shock?

Every 15 minutes

If the blood pressure (systolic) falls below 80 mmHg, what would you do first in hypovolemic shock?

Increase the oxygen flow rate

What is a hysterectomy?

It is surgical removal of the uterus

How long must a woman wait before having intercourse after hysterectomy?

4 to 6 weeks

Is the woman likely to have a foley catheter in after a hysterectomy?

Yes

Are enemas common before a hysterectomy?

Yes

What would you do if the client complains of flank pain (back pain) after hysterectomy?

Call the MD, probably had a ureter tied off accidentally in surgery

What are 2 common psychological reactions to hysterectomy?

Grief, depression

What causes thrombophlebitis after hysterectomy?

Venous stasis in the abdomen (the woman was in the vaginal lithotomy position for hours)

What sign would indicate the presence of thrombophlebitis?

A hard, red swelling in the posterior calf

Should you assess for Homan's sign?

No. Homan's sign is no longer recommended as a test for thrombophlebitis because it can cause a clot to embolize

How long does the woman have to be off oral contraceptives before hysterectomy?

Oral contraceptives should be discontinued 3 to 4 weeks preoperatively.

How long should a woman wait before lifting heavy objects after a hysterectomy?

2 months

How long does a lady have to wait before driving after a hysterectomy?

3 to 4 weeks

If the client complains of abdominal gas after a hysterectomy, the best intervention is.....

Ambulation

What are two major complications of a hysterectomy besides hemorrhage?

Thrombus and pulmonary embolus Urinary retention

What body position should be avoided after hysterectomy? Why?

Knee flexion (because it increases the chance of thrombophlebitis)

When will bowel sounds return after a hysterectomy?

After 24 hours but before 72 hours