Mark Klimek NCLEX Review Questions

Primary dietary prescription for calcium nephrolithiasis (kidney stones) ? PG. 85

Low calcium diet

For client with nephrolithiasis the diet should be ___ ash

Acid

If kidney stone is calcium phosphate the diet must be low in ___ too

Phosphorus

Primary diet tx for uric acid nephrolithiasis is __ ____

Low purine

Client with uric acid nephrolithiasis should have a diet low in ____

Methionine

What is methionine?

Precursor of the amino acid cystine

2 foods high in methionine?

Eggs, milk

Clients with cystine nephrolithiasis should have an ____ ash diet

Alkaline

Inc. fluids over 3000 cc /day is more effective in treating renal calculi than ANY dietary modification, T/F?

True. Want to flush tract than worry about diet

What is the common name for Laryngotracheobronchitis - LTB

Croup

What is the typical temp elevation in croup?

Low grade, usually below 102, but can go up to 104.

Are ATBs helpful for croup? For epiglottits?

For croup, no. Epiglottitis, yes

Is croup viral or bacterial?

Viral

With which condition is croup most often confused?

Epiglottitis

Can croup be managed at home? Can epiglottitis be managed at home?

Yes. No, epiglottitis is a 911 emergency

Are sedatives used for kids with croup?

No, bc this would mask the signs of respiratory distress

What causes epiglottitis? A virus or bacteria?

H. influenza BACTERIA

What is the best tx for croup?

Cool moist air

What should never be done to a child with epiglottitis?

Never put anything in the child's mouth, ie, a tongue blade can lead to obstruction

What are the typical signs and symptoms of croup?

Barking cough, inspiratory stridor, labored resp. pattern

What 3 signs tell you that the child has epiglottitis instead of croup?

Muffled voice, drooling, increased fever

When is croup bad enough to be evaluated by a doc?

When retractions, and high pitched stridor are present

What lead level needs intervention?

50-60 micrograms/ dl

With which class of drugs will a child with lead poisoning be treated?

Chelating agents

What do chelating drugs do?

They increase the excretion of heavy metals

The most freq. cause of lead poisoning is...

Ingestion of lead-based paint chips

Name 3 common chelating agents for lead poisoning

EDTA, desferal, BAL in oil

S&S of lead poisoning

Drowsiness, clumsiness, ataxia, seizures, coma, resp. arrest

Sx of lead poisoning show up in the ____ system

Neuro

Leukemia is cancer of the ___ forming tissues

Blood

The type of cell that is most common and problematic in leukemia is ____

Immature WBC

In leukemia the RBC count is ...

Low, bc the bone marrow is going "wild" producing all those immature WBC - no energy or nutrients to make platelets

In leukemia, the platelet count is ...

Low, bc the bone marrow is going "wild" producing all those immature WBC - no energy or nutrients to make platelets

Bc the RBCs are low, the pt will exhibit ___ and ___

Pallor and fatigue

Bc of the immature WBCs, the pt is at risk for ___

Infection

Bc of low platelets, the pt is at risk for ___, ___, and ___

Bruising, ecchymosis, bleeding, petechiae

What causes lymph gland enlargement in leukemia?

All those small immature WBC clog the lymph system

Should you take a rectal temp on a child with leukemia?

No

Should you take an oral temp on a child with leukemia?

Yes, as long as they are over 4 years old, in remission, and have no sores in their mouth

Should the child with active leukemia use straws, forks, cups?

NO straws, NO forks, YES cups

RN's priority in tx a child with newly diagnosed leukemia is...

Dec. risk of infection

When the leukemia child's platelets and WBC's are low, his activities should be ...

Limited

When the platelet and WBCs are low the nurse should not insert a..

Suppository

Are IM injections and IV sticks permitted on a child with leukemia?

When labs are low IMs avoided and IVs limited; only done when absolutely necessary (to give chemo or measure blood counts)

Why are kids on chemo also on allopurinol

To prevent uric acid kidney stones (remember when chemo kills cancer cells, purines and uric acid build up and could cause kidney stones

Why do some kids with leukemia have joint pain?

The immature WBCs infiltrate the joint and cause inflammation

Why is a child with leukemia at risk for neuro sx due to ICP

The immature WBCs infiltrate the brain and cause inflammation

What is alopecia?

Hair loss

If the platelet count is low what drug should the child not take?

Aspirin

Is the alopecia from chemo permanent?

No. It will grow back. (Alopecia of radiation therapy is permanent bc the follicle is destroyed)

What does ANC mean?

Absolute Neutrophil Count

What is the ANC used for in leukemia?

If ANC <500, then pt will be on protective isolation

Which is used more commonly to decide if the pt should be on isolation: WBC or ANC

ANC is more reliable and valid

By the end of the 1st 6 months of life an infants birthweight should ____

Double

By the end of the first year of life an infants birthweight should ___

Triple

Ideal food for infants is ___

Breast milk

Breast milk contains substances that increase immunities T/F?

True

Bottle-fed infants dont bond well with their moms T/F?

False

The 1 nutrient that commercial formulas are typically low in is ___

Fe

Breast milk does not contain iron T/F?

False. However, it does not contain enough iron- so they should be fed iron fortified cereal starting at 6 months

At what age should the infant be fed cows/goats milk?

Not before 12 months

What is the major problem with feeding an infant skim milk?

They dont get enough calories and dont grow. Dehydration from excessive solute load and inability to concentrate urine

When should the infant be introduced to textured solid foods?

4-6 months

What is the first food that an infant should be introduced to?

Iron fortified rice cereal

When forced to eat, the preschool child will...

Rebel

Parents of preschool children should be taught that as long as the child eats ___ good nutritious meal per day, they should not make eating food an issue

One

Refusal to eat is common in preschoolers T/F?

True, but still offer a variety

Youngsters develop food preferences by..

Observing significant ppl in their environ

School-age kids grow at a slower rate than infants, toddlers, or adolescents T/F?

True

What dietary strategy is most appropriate for the industrious school-age child?

Wholesome snacks, bc they are often too busy too eat

Girls in adolescence need more calories than adolescent boys T/F?

False, boys need more cals

Adolescents should take vitamin supplements T/F? PG. 90

True

Mastitis and breast engorgement are more likely to occur in...

Primipara

Where does the organism that causes mastitis come from?

The INFANTS nose or mouth

Which organism most commonly causes mastitis

Staph

Prolonged intervals between breast-feeding (dec/inc) the incidence of mastitis

Increase

Cant too-tight bras lead to mastitis?

Yes, by preventing emptying of ducts

Mastitis usually occurs at least ___ days after delivery

10

When mastitis is present the breasts are ___, ____, and ____

Hard, swollen, warm

Mastitis is accompanied with a fever over ___

102

If mastitis is caused by an organism , what causes breast engorgement

Temporary increase in vascular & lymph supply to the breast in preparation for milk production

If mastitis occurs 1+ weeks after delivery, when does breast engorgement occur?

2-5 days after delivery

Does breast engorgement interfere with nursing?

Yes, the infant has a difficult time latching on

What class of drugs is used to treat mastitis?

ATBs

ATBs are used to treat breast engorgement (T/F)?

False

Application of (warm H2O compresses/ice packs) is the preferred tx for breast engorgement

Ice packs to dec swelling

The mother with mastitis should stop breast feeding (T/F)?

False. The mother must keep breast feeding. (Offer unaffected breast first).

If the mother has an open abscess on her breast, she must not breastfeed (T/F)?

True

For breast engorgement, the non-breastfeeding mother should be told to express milk (T/F)

No, that would increase milk production and would make the problem worse (warm compresses or a warm shower to let milk "leak" is okay - Ice is best

What is the best tx for breast engorgement?

Breast feeding - it will balance supply and demand

What is mastoiditis?

Inflammation / infection of the mastoid process

What is the most common cause of mastoiditis?

Chronic otitis media

What are the 4 S&S of mastoiditis?

Drainage from ear, high fever, HA, and ear pain, tenderness over mastoid process

What unusual post-op complication can result from mastoidectomy?

Facial nerve paralysis d/t accidental damage during surgery

What should you do to assess for facial nerve paralysis post-mastoidectomy?

Have the patient smile and wrinkle forehead

What is the medical tx of mastoiditis?

Systemic ATBs

What is the surgery for mastoiditis called?

Simple or radical mastoidectomy

Will a simple mastoidectomy worsen hearing?

No, a radical mastoidectomy may

Should the nurse change the post-mastoidectomy dressing?

No, reinforce it. Physician changes first post-op dressing

What is a common side effect of mastoidectomy?

Dizziness (vertigo)

What is a major nursing diagnosis post-mastoidectomy ? PG 92

Safety

Define Menieres diease

An increase in endolymph in the inner ear causing severe vertigo

What's the famous triad of S&S in Meniere's?

Paroxysmal whirling vertigo - sensorineural hearing loss - tinnitus (ringing in the ears)

Does Meniere's occur more in men or women?

Women

What should the client do if they have an attack?

Bedrest

What safety measures should be followed with Meniere's?

Side rails up x4, ambulate only with assistance

What age group in Meniere's highest in?

40-60

What can prevent the attacks of Meniere's?

Avoid sudden movements

What electrolyte is given to ppl with Meniere's?

Ammonium chloride

What surgery is done for Meniere's?

Labyrinthectomy

What disease often follows labyrinthectomy?

Bell's palsy - facial paralysis, will go away in a few month

What is the activity order after labyrinthectomy?

Bed rest

When surgery is preformed for Meniere's, what are the consequences?

Hearing is totally lost in surgical ear

What should the client avoid after labyrinthectomy?

Sudden movements and increase Na foods

What type of diet is the client with Meniere's on?

Low salt

What two classes of drugs are given in Meniere's?

Antihistamines and diuretics (Diamox)

Meningitis is an inflammation of the ___ of the ___ and spinal ___

Linings, brain, cord

Meningitis can be caused by ___, ___, and ____.

Viruses, bacteria, and chemicals

The 4 most common organisms that cause meningitis are...

Pneumococcus, meningococcus, streptococcus, H. Influenza

Child with meningitis is most likely to be (lethargic, irritable) at first.

Irritable

What visual S&S will the pt with meningitis have?

Photophobia (over-sensitivity to light)

What is the most common musculo-skeletal S&S of meningitis?

Stiff neck - nuchal rigidity

Will the pt with meningitis have a HA?

Yes

Kernig's sign is positive when there is pain in the ___ when attempting to straighten the leg with the ___ flexed

Knee; hip

What type of vomiting is present in meningitis?

Projectile

What is the definitive diagnostic test for meningitis?

Lumbar puncture with culture of CSF

If the pt has meningitis, the CSF shows ___ pressure, ___ WBC, and ____ protein, ___ glucose

Inc., inc., inc., dec

On what type of isolation will the patient with meningitis be?

Contact and respiratory precaution

How long will the patient with meningitis be on these precautions?

Until they have been on an ATB for 48h

The room of a pt with meningitis should be ___ and ___

Dark and quiet

The client with meningitis can develop ___

Seizures

What is opisthotonos?

Arching of back (entire body) from hyperextension of the neck and ankles, d/t severe meningeal irritation

If a patient has opisthotonos, in what position would you place them?

Side-lying

Average duration of menstrual flow is ___. The normal range is ___ to ___ days.

5 days, 3-6

Average blood loss during menstruation is ____ cc

50-60 cc.

Name the two phases of the ovarian cycle

Follicular phase (first 14 days), luteal phase (second 14 days)

In the menstrual cycle, day 1 is the day on which...

Menstrual discharge begins

How long does an ovarian cycle last?

28d

How many days after ovulation does menstruation begin?

14 days

What hormones are active during the follicular phase?

FSH and Estrogen

What is the major function of the luteal phase of the ovarian cycle?

To develop and maintain the corpus luteum which produces progesterone to maintain pregnancy until placenta is est.

If an ovum is fertilized during the luteal phase what hormone will be secreted?

HCG (human chorionic gonadotropin)

During menstruation, the average daily loss of iron is ___ mg.

0.5 to 1.0 mg

What occurs during the follicular phase of the ovarian cycle?

It accomplishes maturation of the graafian follicle which results in ovulation

What type of environmental modification is best for a migraine?

Dark, quiet, environment

The long term tx of migraine focuses upon...

Assessing things that bring on stress and then planning to avoid them

What type of pain is typical of migraines?

Throbbing

Are migraines more or less common in men?

Less

Besides pain, ppl with migraines complain of what other S&S?

N&V, and visual disturbances

What are the processes occurring in migraines?

Reflex constriction then dilation of cerebral arteries

Where is the pain of migraines most likely located?

Temporal, supraorbital

Name a drug given to tx migraine?

Sansert (methsergide), Cafergot (prophylaxis: Imipramine)

Are migraine HAs usually unilateral or bilateral?

Unilateral

When Inderal is given in migraine headache, is it used to prevent or treat an attack?

To prevent. It does not treat

MS is a progressive ____ disease of the CNS.

Demyelinating

Myelin promotes ___, ___ ___ of nerve impulses.

Fast, smooth conduction

With demyelination the nerve impulses become ___ and ____.

Slow, uncoordinated

MS affects men more than women (T/F)

False, affects women more than men

What age group usually gets MS?

20-40

MS usually occurs in (hot/cool) climates

Cool

What is the 1st sign of MS?

Blurred or double vision

MS can lead to urinary incontinence (T/F)

True

MS can lead to impotence in males (T/F)

True

Patients with MS should be taught to walk with a ___ -___ gait

Wide-based

Why are Adrenocorticotropic Hormone (ACTH) and prednisone given during acute MS?

To dec. edema in the demyelination process

For acute exacerbations of MS ___ per IV is often used

ACTH (Corticotropin)

What drug can be given to treat urinary retention in MS?

Urecholine, Bethanocol

Will the muscles of MS clients be spastic or flaccid

Spastic

What 3 drugs can be given for muscle spasms?

Valium, Baclofen (Lioresal), Dantrium

Baclofen causes (constipation/ diarrhea)

Constipation

Dantrium causes (constipation/ diarrhea)

Diarrhea (Hint: the D's go together, Dantrium and Diarrhea)

Patients with MS should have (inc/restricted) fluids

Increased to dilute urine and reduce incidence of UTI

The diet of a patient with MS should be ___ -ash

Acid

What major sense is affected most in MS (besides vision)?

Tactile (touch) - they burn themselves easily

Which will bring on a MS exacerbation: over-heating or chilling?

Both will; but they tend to do better in cool weather (summer will always be a bad time for MS patients)

In Myasthenia Gravis (MG) there is a disturbance in transmission of impulses at the ___ ____.

Neuromuscular junction

The #1 sign of MG is ____ ____ ___

Severe muscle weakness

What is the unique adj. given to describe the early signs of MG?

The early signs (difficulty swallowing, visual problems) are referred to as BULBAR signs.

MG affects men more than women (T/F)

False, affects women more than men

When women get MG they are usually old or young?

Old

What neurotransmitter is problematic in MG?

Acetycholine

What class of drug is used to tx MG?

Anticholinesterases

What ending do anticholinesterases have?

-stigmine

Are anticholinesterases sympathetic or parasympathetic?

Parasympathetic

Anticholinesterases will have (sympathetic/cholinergic) side effects

Cholinergic (they will mimic the parasympathetic nervous system)

What surgery CAN be done for MG?

Thymectomy (removal of thymus)

The severe muscle weakness of MG gets better with exercises (T/F)

False, it is worse with activity

What will the facial appearance of a patient with MG look like?

Mask-like with a snarling smile (called a myasthenic smile)

If a patient has MG, what will be the results of the Tensilon Test?

The patient will show a dramatic sudden increase in muscle strength

Besides the Tensilon Test, what other diagnostic tests confirm a diagnosis of MG?

Electromylogram (EMG)

What is the most important thing to remember about giving Mestinon and other anticholinesterases?

They must be given EXACTLY ON TIME; at home, they might need to set an alarm

Do you give anticholinesterases with or without food?

With food, about 1/2 hour ac; giving ac helps strengthen muscles of swallowing

What type of diet should the pt with MG be on?

Soft

What equipment should be at the bedside of an MG patient?

Suction apparatus (for meals), Tracheostomy/ endotube (for ventilation)

Name the two types of crises that a MG pt can have

Cholinergic (too much Mestinon); Myasthenic (not enough Mestinon)

The #1 danger in Myasthenic and Cholinergic crisis is ___ ___.

Respiratory arrest

What words will the client use to describe the pain of an MI?

Crushing, heavy, squeezing, radiating to left arm, neck, jaw, shoulder

What is an MI?

Either a clot, spasm, or plaque, that blocks the coronary arteries causing loss of blood supply to the heart and myocardial cell death

What is the #1 S&S of an MI?

Severe chest pain unrelieved by rest and nitroglycerine

Males are more likely to get an MI than females (T/F)

True

Death d/t MI occurs within ___ hour of symptom onset in 50% of all patients

1

What pain medication is given for the pain of a MI (give three)?

Morphine, Demerol, Nitroglycerine

What is the reason for giving post MI patients ASA?

To prevent platelets from forming clots in the coronary arteries

Name a new drug with anti-platelet activity

Plavix

The 3 most common complications after MI are ___, ___, and ____.

Cardiogenic shock, arrhythmia, CHF

Give another name for an MI

Heart attack

What will the activity order be for the post-MI client?

Bed rest with bedside commode

What is the most common arrhythmia after an MI?

PVCs

What cardiac enzymes indicate an MI?

Elevated CPK, LDH, SGOT

What serum protein rises soonest after myocardial cell injury?

Troponin

Do people without cell damage have troponin in their blood?

No, troponin is only present when myocardial cells are damaged

How soon after cell damage does troponin increase?

As soon as 3 hours (can remain elevated for 7 days)

When will the client with an MI be allowed to engage in sexual activities after an MI?

6 weeks after discharge

Will fluid resuscitaion (administering large amounts of IV fluid) treat cardiogenic shock?

No, you must use cardiac drugs (giving IVs and blood will not help this kind of shock)

Will the client with an MI be nauseated?... diaphoretic?

Yes, Yes

What will the extremities of the client with an MI feel like?

Cold, clammy

What is the permanent EKG change seen post MI?

ST wave changes

Of CPK and LDH which rises earliest?

CPK

What drug will be used to treat PVCs of MI?

Lidocaine

Will the client with an MI need 100% O2 for their entire stay in the hospital?

No, just moderate flow (42% or 3-6L for first 48h)

Vegetables highest in Na are ___

Canned veggies

The fruit food that is highest in Na is ____

Tomato sauce

As a rule, fresh meats are ____ in Na

Low

As a rule, canned meats are ___ in Na

Very high

As a rule, smoked foods are ___ in Na

Very high

As a rule, fruits are ___ in Na

Low

As a rule, vegetables are ___ in Na

Low

As a rule, which are higher in sodium... vegetables or fruit?

Vegetables

As a rule, which are higher in sugars.. vegetables or fruits?

Fruits

As a rule, breads/cereals are ___ in Na

Moderately high

As a rule, processed meats and cheeses are ___ in Na

Very high

Margarine is much lower in Na than butter

False, it is the same

Salt substitutes contain Potassium (T/F)

True, so beware

An NG tube is inserted into the ____ via the ____.

Stomach, nares

You can feed a client through a NG tube (T/F)

True

When an NG tube is being used for decompression what is happening?

The stomach is being emptied of its contents by suction

NG tubes are used to pump the stomach of drug overdose clients (T/F)

True

What does gavage mean?

Feed a client with a tube

What does lavage mean?

To continuously irrigate the stomach via NG tube

When an NG tube is used to stop gastric hemorrhage, it is irrigated with ____

Iced tap water

How long do you irrigate an NG with iced tap water when the stomach is bleeding?

Until the irrigating solution comes back out clear

What is the maximum suction level used to decompress the GI tract via a NG?

25 mmHg

Why are salem sump tubes best suited for safe gastric suctioning?

Because they have vents that prevent damage to the gastric mucosa

When a NG tube is in for a long time it must be replaced every ___ to ___ weeks

2-3

People with a NG tube will breathe through their ___

Mouth (mouth care is important)

The best way that the nurse can check if the NG is in the stomach is...

To aspirate gastric contents; auscultating the gastric air bubble is the second best way

Before you put anything down the NG you must do what?

You must check the see if the NG placement is in the stomach

In what position should the client be when a NG is being inserted?

Sitting up with head slightly extended until the tube reaches the back of the throat then have them mildly flex the neck to push the tube in all the way

How do you determine how far to put an NG tube in?

Measure from the tip of the nose to the back of the ear then to the xiphoid process

In what position should the client be during a continuous NG tube feeding?

HOB must be elevated 30 degrees (semi-fowler's would be acceptable)

Is nephrotic syndrome a disease?

No, it is not a specific disease, it is a group of S&S that can result from many diseases

Is there any hematuria in nephrosis?

No, there is no hematuria in the -oses, but there is hematuria in the -itis's

What are the dietary modifications for nephrosis ?

High carbs, moderate proteins, low sodium

What is #1 nursing dx in nephrosis?

Alteration in fluid volume, excess

What are the 2 pathophysiologic processes in nephrotic syndrome?

Glomerular inflammation, loss of protein

What S&S are MOST common in nephrosis?

Generalized severe edema

What 2 classes of drugs are given for nephrosis?

Steroids, diuretics

Is bed rest common in treating nephrosis?

It is occasionally done, but not nearly as common as in acute glomerulo-nephritis, it is usually is most appropriate when edema is severe

In nephrotic syndrome, the BP will be most likely (hypotensive / hypertensive)

Hypertensive: remember in acute glomerulonephritis, the BP is hypertensive as well

In nephrotic syndrome, the urine is (frothy/very dark or tea-colored)?

Frothy. Remember in AGN, it is tea-colored

Is scrotal edema common in nephrosis?

Yes

What is done for scrotal edema? PG. 110

Elevate the scrotum on a scrotal sling and apply ice

Name the 3 sub-scales in the Glasgow coma scale (GCS)

Best eye opening (E), Best verbal response (V), and best motor response (M)

Whats max score on GCS?

15

What is the minimum score on the GCS?

3

A score equal to or below ____ on the GCS is considered coma

7

Pupillary reaction test cranial nerve ___

#3

A respiratory pattern in which there is alternation between apnea and hyperventilation is known as..

Cheyenne-Stokes

A value of 20/80 on visual acuity means that the patient can see at ___ feet what normal people see at ___ feet

20, 80

Babiniski's reflex is tested by stroking the ___

Bottom lateral surface of the foot

It is always pathologic if a Babinski is negative (T/F)

False, non-walking infants normally have a positive Babinski, walking infants, toddlers, and all other people should normally have a negative Babinski

When a Babinski is positive the ___ ___ ___ flexes and the other ___ fan out

Great toe dorsiflexes, toes

In decorticate posturing, the legs are ____ and the neck and arms are ___ and ___ rotated

extended, flexed, internally

In decerebrate posturing, the legs are ___ and the arms, neck and back are ____

Extended, extended (pronated)

A score of 4 for a reflex means that it is ____

Hyperactive

Cerebellar function is evaluated by testing for ____, ____, ____, ____ Pg. 110

Posture, gait, balance, coordination (ie Romberg's sign)

Assault

A threat or an attempt to make bodily contact with another person without that person's consent

Battery

An assault that is carried out

Common law

Law resulting from court division that is then followed when other cases involving similar circumstances arise

Malpractice

An act of negligence- commonly used when speaking of negligent acts committed by a person working in a certain profession, such as medicine or nursing

Ethics

A system that defines actions with respect to their being judged right or wrong

False imprisonment

Unjustifiable restraint or prevention of the movement of a person without proper consent

Misdemeanor

A wrong of less seriousness than a felony

Good Samaritan Law

Law that gives certain persons legal protection when giving aid to someone in an emergency

Felony

A wrong of serious nature

Negligence

Performing an act that a reasonable and comparable person under similar circumstances would not do, or failing to perform an act that a reasonable and comparable person under similar circumstances would do

Invasion of privacy

A wrongful act that violates the right of a person to be let alone

Liable

Being accountable, responsible, or answerable for an act

Libel

A written untruthful statement about a person that subjects him/her to ridicule or contempt

Slander

A spoken untruthful statement about a person that subjects him/him to ridicule or contempt

How could a nurse be convicted of assault?

If the client perceives that the nurse intends to do a procedure without consent or justification

How could a nurse be convicted of battery?

If the nurse willfully touched a client in any manner that is wrong in some way

Clients have a right to refuse nursing interventions (T/F)

True

If a nurse uses restraints to keep a client, who is a danger to himself, in bed, the nurse is likely to be convicted of false imprisonment (T/F)

False, you can detain/restrain a person against their will if they are: 1) a threat to self; 2) a threat to others

In order to legally sign as a witness to informed consent, the nurse must have been present when the physician and client discussed the procedure (T/F)

False. You are only witnessing that the patient was the one who signed the consent

It is NOT necessary for the nurse to determine if the client understands what the physician is said in order to witness an informed consent

True. You are only witnessing a signature

Can a patient legally sign an informed consent after they have received the premedication analgesic for a procedure?

No. The patient would be considered to be under the influence of a mind-altering drug. The consent would be invalid

Name 3 groups of ppl who cannot give legal consent

Minor, unconscious client (even under influence of CNS drugs), mentally ill

In an emergency situation, when client and family cannot give consent, consent is assumed and tx proceeds (T/F)

True

The legality of no code or slow code orders is well-est. in the courts

False- no definitive policy in the courts exists at this time- dealt with on a case-by-case basis

Anxiety-producing thoughts are called ____

Obsessions

Repetitive actions designed to reduce anxiety are called _____

Compulsions - such as washing hands over and over, dusting furniture 3 hour per day, refusing to turn your back to anyone

Which defense mechanism is most closely associated with OCD

Displacement

Should you allow an OCD person to perform their compulsive behavior?

Yes, give them time to do their ritual and try to set a limit and redirect

Should you ever make an OCD person stop their compulsive behavior?

No, they will become very anxious

Is the patient with OCD neurotic or psychotic?

Neurotic- they know reality

Should you confront the OCD patient with the absurdity of their behavior?

No, just say things like "You washed your hands for so long you must have been very anxious.

What should you do if an obsessive-complusive person is always late due to their rituals?

Get them started earlier - for ex. if they wash their hands for 1/2 hour before meals and are always late for breakfast, just get them started 1/2 hour earlier

What are the two typer of oral contraceptives?

Progestin only & combination progesterone and estrogen

How many days of the menstrual cycle do you take the progestin only pill?

All 28 days

How many days of the menstrual cycle do you take the combo pill?

You take it on days 5-24, but not on days 24-28 and 1-4 (8 days off)

How log before surgery must you d/c PO contraceptives

One week before surgery

If a woman forgets to take the pill one day, what should she do?

Take it as soon as she remembers it, and take next pill at regular time.

What if a woman forgets to take the pill for two days in a row? What should she do?

Take 2 pills a day for 2 days in a row and then resume normal schedule

What should a woman do if she forgets to take her pill for 3 days or more?

Throw away pack & start new pack same day. Use back-up contraceptive method for 7 days

If a woman doesn't stop oral contraceptives one week before surgery she is at risk for developing ___

Thrombophlebitis

People who smoke more than ___ cigs per day should not be on an oral contraceptive

15, bc if you smoke you have constriction of vessels and this potentates the chances that a woman on oral contraceptives will get thrombophlebitis

If a woman on oral contraceptives misses a period, should she still take pills?

Yes, however, if 2 missed periods occur, stop and have a pregnancy test.

Will breakthrough bleeding, N&V, and breast tenderness go away when a woman is on oral contraceptives?

Yes, after about 3-6 months of tx

Osteoarthritis is a ____ disease of the ___

Degenerative, joint

Osteoarthritis is most commonly caused by the wear and tear of life (T/F)

True

The most common symptom of osteoarthritis is ____ _____

Joint pain

What 2 joints are most commonly affected in osteoarthritis?

Knee and hip

To control the pain of osteoarthritis one should use heat or cold?

Heat

What 3 meds are used in osteoarthritis?

Aspirin, NSAIDs, steroids

What do you observe on the fingers of the client with osteoarthritis?

Heberden's nodes

Are Heberden's nodes painful?

Not in the beginning, can be later as swelling occurs

Are rest periods and ROM exercises appropriate in the care of osteoarthritis?

Yes, rest is probably the most effective thing they can do.

The pain of osteoarthritis is usually better or worse with rest? With activity?

Better with rest, worse with activity

What age group gets osteoarthritis?

60-80 years old

Osteoarthritis is more common in females (T/F)

False, it occurs in equal frequency

For cervical osteoarthritis the client should wear..

A cervical collar

What is arthroplasty?

Joint replacement

What is arthrodesis?

Joint fusion

What is otosclerosis?

Overgrowth of the spongy bone in the middle ear that doesn't allow the bones of the middle ear to vibrate

What will the client with otosclerosis complain of besides hearing loss?

Buzzing or ringing in the ears (tinnitus)

Do ppl have a loss of hearing with otosclerosis?

Yes

What is a corrective surgery for otosclerosis called?

Stapedectomy - removing the stapes bone and replacing it with a micro prosthesis

Should side rails be up after stapedectomy?

Yes, client may feel dizzy

What should the client avoid post- stapedectomy?

Coughing, sneezing, blowing nose, swimming, showers, flying

What warning should you give the client about getting up after stapedectomy?

Get up slowly

What should the client expect regarding hearing post-stapedectomy?

An initial decrease with the benefits of surgery noticeable in 6 weeks

What should the client do if he must sneeze?

Open his mouth, this de-pressurizes the middle ear

What type of hearing loss is associated with otosclerosis?

Conductive

Which sex has a higher incidence of otosclerosis?

Women

Do hearing aids help hearing in otosclerosis?

Yes

What will be the results of the Rinne test in otosclerosis?

Bone conduction will be better than air conduction

Is stapedectomy done under general or local anesthesia?

Local

If the client complains of dec. hearing after stapedectomy what would you say?

It is normal d/t edema. The hearing will start to improve within 6 weeks

Which side will the client be allowed to lie upon post-stapedectomy

Depends on MD: operative side promotes drainage, un-operative side prevents graft dislodgment. Dont make a big deal of position post-op

What 2 drugs are commonly given post-stapedectomy

Codeine/Demerol for pain, Dramamine for dizziness

Cysts on the ovaries are usually malignant (T/F)?

False, usually benign

What is the #1 reasons why MD's remove ovarian cysts?

Remove before they transform into malignant

Do small ovarian cysts cause S&S?

No, only large ones

Common signs of large ovarian cysts are..

Low back pain, pelvic pain, abnormal bleeding

What does torsion of an ovarian cyst mean?

Twisting of cyst with interruption of its blood supply

What is the big danger from torsion?

Necrosis and rupture of ovary

What other disorders resemble rupture of ovarian cysts?

Appendicitis, rupture of a fallopian tube pregnancy

What affect do oral contraceptives have on ovarian cysts?

They cause it to stop growing and decrease in size

What are the 3 most common signs of ovarian cyst rupture?

Pain, abd distention, abd rigidity

Compare signs of non-ruptured ovarian cysts with the signs of a ruptured ovarian cyst

Non-ruptured= low back pain, dull pelvic pain, abnormal uterine bleeding esp. with mensturation
Ruptured: acute pain, abd distention, and abd rigidity

After surgery to remove an ovarian cyst the woman can return to normal activities between ___ to ___ weeks

4-6 weeks

How soon after removal of an ovarian cyst can a woman resume sexual intercourse?

4-6 weeks

Should a woman douche after surgery to remove an ovarian cyst?

No, it is not good to douche on a regular basis, it destroys the natural protective vaginal flora

What does lightening mean?

When the fetal head descends into the pelvis

When does it occur in pregnancy?

2-3 weeks before birth for primipara

What is the most common positive effect of lightening?

After it occurs the woman can breathe much easier

Name the 2 earliest signs that a woman is likely in labor

Low back pain and show (blood-tinged mucous plug has passed)

What is the most RELIABLE or VALID indication that a woman is in labor?

The onset of regular contractions that result in progressive dilatation/effacement of the cervix

What are the 2 processes that occur to the cervix during labor?

Effacement and dilation

What is the meaning of cervical effacement?

The cervix thins

Into how many stages is labor and delivery divided?

4

What is accomplished during the first stage of L&D?

Full effacement and dilation

How long is the first stage of labor and delivery for a primagravida? For a multigravida?

12 hours, 6 hours

The cervix is fully dilated when it is ___ cm

10

The 2nd stage of L&B accomplishes..

Delivery of infant

The 2nd stage of L&D begins with ___ and ends with ___ of the ___

Full dilation, delivery, infant

The 2nd stage of labor and delivery lasts ___ hours for a primagravida and ___ hours for a multigravida

1.5, .5

The 3rd stage of L&D accomplishes...

Expulsion of the placenta

The 3rd stage of the L&D lasts...

Less than one hour

What occurs during the 4th stage of L&D?

Recovery

When does 4th stage of L&D end?

2 hours after expulsion of the placenta

What is the average blood loss during labor?

500 cc

When the terminology "the 3 phases of labor" is used, what does it mean?

If the statement refers to PHASES of labor, it means the 3-step process of latency, followed by active and transitional. (LAT order - just as its spelled in LATency)

Normal length of pregnancy is ____ to ____ days

240, 300

Pregnancy is divided into ____ trimesters

3

During the 1st trimester the woman experiences decreased or increased vaginal secretions?

Increased

When are urine pregnancy tests positive?

At the time of the first missed period

Pregnancy tests test for the presence of what hormone?

HCG (human chorionic gonadotropin hormone)

Urine and blood pregnancy tests are enough evidence to be certain of pregnancy (T/F)?

False, these tests only suggest pregnancy

What is Hegar's sign?

Uterine softening

What is Chadwick's sign?

Blue-tint to the cervix

The first trimester goes from week ___ to week __

1 - 13

The second trimester goes from week ___ to week ___

14-27

Which week can mother first feel the fetus move?

16th-20th week, (the end of the 4th month into the 5th month)

What is the word used to ID the feeling that the mother experiences when the fetus moves?

Quickening

The 3rd trimester goes from week ___ to week ___

28 - 40

In which trimester does the women most feel backache?

Third

Which trimester is the fetus most susceptible to effects of outside agents?

First

What is the name of the process in which outside agents cause birth defects in the fetus?

Teratogenesis

Which trimester is N&V most common?

First

Which trimester do Braxton-Hicks contractions begin?

Third

What are Braxton-Hicks?

Usually painless contractions that strengthen the uterus for labor

Which trimester does quickening occur?

2nd

Which trimester does venous congestion in the legs occur?

Third

Which trimester does linea nigra appear?

Second

What is linea nigra?

Single dark vertical line on the abdomen

Which trimester do striations occur?

Second

What are striations?

Horizontal pigmented lines on abd

What is chloasma?

Mask of pregnancy- pigmented area on face

Which trimester is constipation most common?

Third

In addition to the nares, where else should the nurse assess for skin irritation when nasal cannulae are in use?

Behind and on top of the ears

What are two signs of hypoxia?

Restlessness and tachycardia

What is the highest flow rate appropriate for nasal cannulae?

6 L/min

How often should the nares of a client with O2 by nasal cannulae be assessed for skin breakdown?

Q 6-8 hours

What is the maximal O2 flow rate for the client with COPD?

2 L/min

What are the signs of O2 toxicity?

Confusion, HA

What can happen if the client with COPD is given a high flow rate of O2

They may stop breathing

What is the problem with giving high flow rates of O2 by nasal cannulae?

Dries the mucous membranes

Can a client smoke in the room when the O2 is turned off?

No, the O2 delivery device must be removed from the wall or the tank out of the room before a client can smoke

When O2 is administered, it must be ...

Humidified

Masks deliver higher or lower concentrations of O2 than nasal cannulae?

Higher

How often should the nurse check the flow rate of the O2?

At least once per shift

O2 is an explosive (T/F)?

False, it does not explode- it supports combustion

What structures in the brain are most affected in Parkinson's

Basal ganglia

The neurotransmitter imbalance that causes Parkinson's is a ___ in _____ ______

Decrease, dopamine activity

What drugs can cause a Parkinson-like syndrome?

Haldol, major tranquilizers - drugs that end in "-azine

What is the classic motor manifestation of Parkinson's?

Pill-rolling and tremors

What type of rigidity is typical of Parkinson's?

Cogwheel - Cogwheel' rigidity is a combination of leadpipe rigidity and tremor which presents as a jerky resistance to passive movement as muscles tense and relax

Parkinson's patients move fast or slow?

Slow

What type of gait is seen in Parkinson's?

Shuffling slow gait

Patients with Parkinson's have ___ speech

Monotone

Patients with Parkinon's tend to have constipation or diarrhea?

Constipation

Name 4 drugs used to treat Parkinson's

Levodopa, Sinement, Symmetrol, Cogentin, Artane, Parlodel

In what type of chair should Parkinson's patients sit?

Firm, hard-backed

What time of day can be particularly dangerous for the Parkinson's patient?

Mealtime, d/t choking

When a patient is taking Levodopa he should have assistance getting out of bed because...

Of orthostatic hypotension

What vitamin should patients on Levodopa avoid?

B6, pyridoxine - Vitamin B6 reduces the effectiveness of levodopa

Levodopa should be given with or without food?

With food

What might Levodopa do to patients urine?

Make it very dark

The tremors of Parkinson's will get better or worse when they purposefully move or perform a task?

Better, they tremor more when not performing an action

The client on a PCA pump is less likely to have post-op complications than the client w/o a PCA pump (T/F)?

True, b/c the comfortable pt moves around more and is less likely to get thrombophlebitis, pulmonary embolus, fatigue, ileus and pneumonia

Clients with COPD are not good candidates for PCA pumps (T/F)?

True, d/t the effects of narcotics on central respiratory control

Name the 3 most common uses of PCA techniques

Post-op pain, cancer pain, sickle-cell crisis pain

PCA pumps allow a more constant level of serum drug than conventional analgesia (T/F)?

True

A major disadvantage of PCA pump is that the client can take too much medication (T/F)?

False. It is not possible for a client to OD d/t the lock-out feature

Clients on PCA pumps use more medication than those receiving IM injections (T/F)

False, they use less

A disadvantage of PCA pumps is that the client does not ambulate as early d/t the machine (T/F)

False, PCA clients ambulate earlier and they pull their machine with them

When d/c a PCA infusion it is acceptable to discard the drug cartridge (T/F)

False, the whole cartridge system must be returned to the pharmacy d/t federal narcotic control laws

Comfort range of relative humidity is...

30-60%

Which patients should be forbidden to smoke? Smoke alone?

Those with oxygen in the room, confused, sleepy, drugged patients

When applying restraints remember to...

Avoid bruising the skin, cutting off circulation, and accidental entangling

List ways to ensure privacy...

Use drapes and screens during care in semi-private rooms

Plastic pillow cases are _____ (disadvantage)

Hot and slippery

When using restraints with clients who object, dont forget about ____ ______

False imprisonment

Individuals who are ill are ____ sensitive to noise than individuals who are well

More

When you are not at the bedside the bed should always be...

In the lowest position

Can nurses be held liable for an accident resulting from a client not being told how to use the call light?

Yes

Dangers associated with drafts are...

Circulation of micro-organisms on air currents

The first thing a nurse should do when a client objects to side rails is...

Explain why they are being used

The comfort range of temperature is ...

68-74

Is having the client verbally ID himself considered adequate for safety?

No, only ID bands are acceptable

Bed side rails should be up for the following individuals...

Elderly clients, unconscious, babies, young children, restless, confused

The S&S of sensory overload and sensory deprivation are...

Fear, panic, depression, inability to concentrate, restlessness, agitation

If a family member asks to have the side rails down while they are in the room you should...

Remember that you are responsible for the client's safety - not his family, it might be unwise to permit this

Pillows are sterilized between uses (T/F)

False

What is the common name for pediculosis?

Lice

What is a common finding with pediculosis pubis?

Reddish-brown dust in the underwear

What common household solution is used to remove nits?

Vinegar. Nits are the eggs of lice that adhere to the hair shaft

What shampoo is used for lice?

Kwell

Where are head lice most commonly found?

At the back of the head and behind the ears

On what do lice feed?

Blood

After tx how long do you have to inspect for lice?

Inspect for 2 weeks to be sure that they are all gone

What is the most common symptom of lice?

Itching

What is the most dangerous toxicity of Kwell?

CNS toxicity

What is the typical of the lesions of pemphigus

Foul-smelling, blisters break easily, seen in the elderly, cause is unknown

What is the characteristic lesion of pemphigus?

Large vesicular bullae

What are bullae?

Large blisters

What chemical is added to the bath water of a client with pemphigus?

Potassium permanganate

What precaution must be taken with potassium permanganate?

Be careful that no undissolved crystals touch the client; it will burn the skin

What is the typical skin care of pemphigus?

Cool, wet dressings

What unusual nursing dx is high priority in pemphigus?

Alteration in F&E balances - Because you may have lost bodily fluids due to oozing of the sores, you may receive fluids through a vein (intravenously), as well as electrolytes � minerals such as sodium, potassium and calcium that maintain the balance of f

What are the top 3 nursing interventions in pemphigus?

Oral care, protection from infection, encouraging high fluid intake

What kinds of fluids will clients with pemphigus drink best?

Cold fluids

What drugs are most commonly used?

Steroids

Should steroids be given with meals?

Always

What is the #1 cause of death of pemphigus?

Overwhelming infection

Define pemphigus

An acute or chronic disease of adults, characterized by occurrence of successive crops of bullae that appear suddenly on apparently normal skin and disappear, leaving pigmented spots. It may be attended by itching and burning and constitutional disturbanc

Define peritoneal dialysis

The removal of wastes, electrolytes and fluids from the body using the peritoneum as a dialyzing membrane

When PD is being used the client must be on heparin (T/F)

False, you don't need to be heparinized for peritoneal, but you do need to be heparinized for hemodialysis

How long does one episode /course of PD last?

Could be 10 hours

With PD there is a high/low risk of peritonitis?
PG 125

High

When fluid accumulates in the abd during PD what problem does the client experience first?

Dyspnea- SOB or difficulty breathing, d/t the inability of the diaphragm to descend

What nutrient is lost in highest amounts during PD?

Protein

Can a client who had recent bowel surgery get PD?

No

Should a client who is having breathing problems receive PD?

No

What body surface must be punctured to administer PD?

The abd

The solution introduced into the peritoneum during PD is called...

Dialysate

Before allowing the dialysate to flow into the peritoneal cavity it must be ___ to ____ temperature

Warmed, body

Before PD it is important the client be...

Weighed, to assess water loss or gain

What force is used to introduce the dialysate into the peritoneum

Gravity only, no pumps

How fast does the dialysate usually flow into the peritoneum?

In 10 minutes

How long is the dialysate allowed to remain in the peritoneum before it is drained out?

15-30 minutes

How long does it usually take for the dialysate to drain out of the perineum?

10 minutes (10 minutes flow in, 30 minutes in abd cavity, 10 minutes out = total of 50 minutes)

If the dialysate does not drain out well, you would first...

Have them turn side to side

What color is the dialysate when it comes out?

Straw colored- clear

Should you raise the HOB to increase drainage of the dialysate?

Yes

How often do you measure vital signs during PD?

Q15min during the first cycle and qhour thereafter

Can a client on PD: Sit in a chair? Eat? Urinate? Defecate?

Yes to all

If too much fluid is removed during PD, the client will experience...

Decreased BP (hypotension)

If the client absorbs too much of the dialysate the client will experience...

Increased BP (circulatory overload)

If the client complains of dyspnea during PD you would first ___, then ____

Slow the flow, elevate HOB

Cloudy drainage in the dialysate most commonly means...

Peritonitis, (Not good, call MD)

What would you do if you noticed a small amount of blood come out in the first few bottles that were infused?

Nothing, this is normal; the blood is due to the initial puncture of the abd

What precautions are important in the care of the client receiving PD?

Safety, bc they get dizzy

Is it I&O important to record during PD?

Yes

How high should the diasylate bag be when its being infused?

Shoulder height

What factor do clients with pernicious anemia lack?

Intrinsic factor. It has no other name

What vitamin is not absorbed in a patient with pernicious anemia?

Vit B-12

What is another name for Vitamin B-12

Extrinsic factor

Why isn't Vitamin B-12 (extrinsic factor) absorbed in pernicious anemia?

Bc these patients lack intrinsic factor

What happens when patients with pernicious anemia don't absorb Vitamin B-12?

Their RBC's do not mature and they become seriously anemic

What other disease can be confused with pernicious anemia?

Angina pectoris

What are some classic and unique signs of pernicious anemia?

Beefy red tongue, numbness, and tingling of the hands, sores in the mouth, chest pain

What is the medical treatment for pernicious anemia?

IM injections of Vitamin B-12

How long must the client receive this medical treatment?

For the rest of their life

Can we cure pernicious anemia?

No, just treat the symptoms

What unique urine test is done to diagnose pernicious anemia?

The Schilling test

Is it okay to give B-12 orally to a client with pernicious anemia?

No, it will never be absorbed d/t a lack of intrinsic factor

What neurologic test do they do for this anemia?

The Romberg test (a test for balance); in normal people this test is negative, in the client with pernicious anemia this test becomes positive (A loss of balance is interpreted as a positive Romberg's test)

What is conservation? In what stage does it develop?

When the child realizes that number, weight, volume remain the same even when outward appearances change; Concrete Operational

What is the age range of formal operation thinking?

12-15

What is the sensori-motor stage of intellectual development?

It is the intellectual stage of children from birth to 2 years

What is the age range of concrete operational thinking?

7-11

What is the age range of pre-operational thinking?

3-6

What is the classic pattern in formal operational thinking?

Abstract reasoning

What is egocentricity? In what stage is it found?

The child views everything from his frame of reference, common in pre-operational thinking

In Placenta Previa the placenta is implanted ___ than it should be and lays over the ____ ____.

Lower, cervical os

What is the classic symptom of Placenta Previa?

Painless 3rd trimester bleeding (hint: Painless Placenta Previa)

In whom is Placenta Previa most likely to occur? Prima or multi

Multigravida's

What is meant when the physician/nurse use the terms total (complete) or partial (incomplete) in reference to placenta previa?

Total or complete: placenta covers whole cervical opening
Partial or incomplete: placenta covers only part of the cervical opening

What are 3 complications of placenta previa?

Shock, maternal death, fetal death

What is the best and safest way to confirm placenta previa?

Ultrasound

Should a woman with placenta previa be hospitalized?

Yes, always if bleeding

If a surgeon delays doing a C-section for placenta previa it is d/t: (reason for delay)

Immaturity of the fetus (they will want the child to mature)

As soon as placenta previa is diagnosed, most pregnancies will be terminated via C-section if the fetus is mature (T/F)

True

If a woman is admitted with active bleeding with Placenta Previa you should monitor fetal heart tones ____

Continuously via fetal monitor

It is not necessary to use electronic fetal monitoring when there is active bleeding in Placenta Previa (T/F)?

False, infant must always be monitored

Will a woman with active bleeding in Placenta Previa be given any systemic pain relief during labor?

No, they don't want to suppress the fetus

If you were told to start the IV on the woman admitted for Placenta Previa, what gauge need would you use?

18 gauge, or any other one large enough to administer blood

Pneumonia is an ____ in the ____ __ ____

Infection, alveoli of lungs

Which blood gas disorder is most common in pneumonia?

Respiratory alkalosis, bc the hyperventilation blows off more CO2, than the consolidation traps in the blood

What is polycythemia vera

A blood disease in which there is an increase in erythrocytes, leukocytes, and platelets

What is the typical complexion of a client with polycythemia vera?

Ruddy red, almost purple

What procedure is done to relieve S&S in polycythemia vera?

Phlebotomy

What is phlebotomy?

Drain off 200-500 cc of blood from body (opposite of transfusion)

What type of diet will ppl with polycythemia vera be on?

Low iron

What are the 3 signs of this disease?

HA, weakness, itching

Is hemoglobin inc. or dec. in this disease?

Increased

What oral problem will people with polycythemia vera have?

Bleeding mucous membranes

What organ will be enlarged in polycythemia vera?

The spleen, bc it is destroying the excessive RBCs

D/t enlarged destruction of RBCs seen in polycythemia vera what blood level will be increased?

Uric acid levels will be high (remember- uric acid levels are always high when cells are being destroyed as in hemolysis, chemotherapy or radiation therapy)

What drug is most commonly used in polycythemia vera?

Myleran (this is usually used for bone marrow cancer)

How often should the client cough and deep breath post-op

q2h

How often should the post-op patient turn?

q2h

How often should the pt use the incentive spirometer?

Q1-2H

How often should the nurse auscultate the lung sounds post-op?

Q4h

How often should the bedridden post-op patient do leg exercises?

Q2h

The post-op pt should void by ___ hours post-op or you must call the MD

6-8

Will the typical post-op client have lung sounds? Bowel sounds? Increased temp?

Lung-yes; bowel sounds- no; Low grade temp- yes

Unless contraindicated the pt should be out of bed no later than ___ hours post-op

24h

DVT is most common in what kinda surgery?

Low abd or pelvic

The most common complication of DVT is ____ ______

Pulmonary embolism

The best way to prevent thrombophlebitis is TED hose (T/F)

False, ambulation /exercise are the best way

What is a paralytic ileus?

Paralysis of the bowel d/t surgery (common- especially in abd surgery)

If a post-op pt complains of gas and cramping you should first ____ then ____

Assess then ambulate

The onset of post-op infection is on the ___ or ____ day post-op day

2nd or 3rd, never before that (remember elevated temperatures earlier than the 2nd post-op is NOT an infection)

Define dehiscence

Separation of the incisional edges

Define evisceration

Protrusion of abd contents through a dehiscence

What do you do for dehiscence?

Dec HOB (but not flat; can steri strip, then call MD

What do you do, in order, for evisceration?

Dec HOB (but not flat); cover with sterile gauze moistened with sterile saline, call MD

Pregnancy (dec/inc) the body's insulin requirements

Increases

Can pregnancy convert a non-diabetic woman into a diabetic?

Yes

What name is given to diabetes that is brought on by pregnancy?

Gestational diabetes

Diabetes with pregnancy is (more/less) common as the woman ages

More

What is the #1 cause of infant illnesses when the mother has diabetes?

Hypoglycemia

When is infant hypoglycemia most likely to occur during L&D?

In the hours immediately following delivery

Hormones of pregnancy work against insulin (T/F)

True

A sign of gestational diabetes is excessive weight (loss/gain)

Weight gain

(Obese/ very thin) women are most likely to become diabetic during pregnancy

Obese

In gestational diabetes the client experiences a (dec/inc) in thirst

Increase (polydipsia)

In gestational diabetes the client experiences a (dec/inc) in urine output

Increase (polyuria)

Gestational diabetes is ass w/ (htn/hypotension)

Htn

Gestational diabetes is ass w/ what OB history?

Prev. large baby (over 9lb.), unexplained stillbirth, miscarriage, congenital anomalies

Women who have gestational diabetes tend to deliver infants who are (small/large)

Large for gestational age

Gestational diabetics tend to get ____ infections

Monilial (yeast) infections

What test confirms the diagnoses of gestational diabetes?

3 hr glucose tolerance test A blood sample will be collected when you arrive. This is your fasting blood glucose value. It provides a baseline for comparing other glucose values.
You will be asked to drink a sweet liquid containing a measured amount of gl

What are the 2 main tx methods in gestational diabetes?

Diet, insulin

How often should a woman visit the doctor prenatally if diabetes is present?

Twice a month, then once per week in the 3rd trimester

How many lbs/week is the diabetic allowed to gain the 2nd and 3rd trimesters?

1 lb a week (same as non-diabetic)

Is severe carbs restriction required in gestational diabetes?

No, it could lead to ketosis

Of protein, fat, and carbs, which ones (percent wise) inc in the diet of gestational diabetes?

Protein, fat

When is insulin used in tx of gestational diabetes?

When dietary control does not keep the blood sugar within normal limits

If insulin is used, the dose is the same in all 3 trimesters (T/F)

False, it varies

Oral hypoglycemics should never be used during pregnancy (T/F)

True, they cause birth defects (teratogenic)

When should a diabetic be delivered?

Btwn 37-39 weeks

What IV solution is used during labor for the diabetic

D5W

The mothers insulin requirements will (fall/rise) markedly after delivery

Fall

During pregnancy what complication is most dangerous for the fetus of a diabetic?

Ketosis

If ketosis is a big problem for the baby during pregnancy what is the big problem after delivery?

Hypoglycemia

Why is hypoglycemia such a dangerous problem?

Brain cells die w/t glucose, brain damage

(Multi/prima) gravida clients are most likely to get PIH

Primagravida

Which age group(s) are most likely to experience PIH?

Pts under 18 or over 35

When does pre-eclampsia usually begin in pregnancy (wk)?

After 20 weeks

Name the 3 symptoms of PIH

Hypertension, weight gain (edema), proteinuria

If pre-eclampsia is mild will the woman be hospitalized?

No, just rest at home

What is the best position for the client with severe pre-eclampsia?

Left-side lying

What is the dietary order for the woman with severe pre-eclampsia?

Low salt, high protein

Are diuretics used for woman with pre-eclampsia?

Yes

When a woman is hospitalized for severe pre-eclampsia the nurse should test the...

#1- reflexes, the urine for protein

When pre-eclampsia gets worse the deep tendon reflexes will be (hypo/hyper)- reflexia

Hyper-reflexia

Pre-eclampsia makes the neuromuscular system more or less irritable?

More

What vision problem do women with pre-eclampsia have?

Blurred vision

What type of precautions will be in effect for a woman with severe pre-eclampsia?

Seizure precautions

Name 5 things included in seizure precautions

Suction machine in room, O2 in room, padded rails upx4, must stay on unit, ambulation with supervision only, no more than 1 pillow

When is pre-eclampsia called eclampsia?

Once convulsions have occurred

In eclamptic patients what ominous sign almost always precedes a seizure?

Severe epigastric pain

What are the 3 major tx objectives in eclampsia?

Dec BP, control convulsions, diuresis

The urine output of the eclamptic client will (inc./dec.)

Decrease

How would you palpate the uterus to see if eclamptic woman was having contractions

Place the hand flat on the abd over the fundus with the fingers apart and press lightly

Premature rupture of membranes (PROM) is a ____ break in the amniotic sac ___ the ____ of the contractions

Spontaneous, before, onset

Usually labor starts within ____ hours of rupture of membranes

24

What is the danger with PROM?

Infection

How would you tell if the woman with PROM had an infection?

Maternal fever, fetal tachy, foul smelling discharge

To test for amniotic fluid the nurse should check the ___ of the fluid

pH

Amniotic fluid is (acidic/alkaline)

Alkaline

Being alkaline means having a (high/low) pH?

High

Amniotic fluid turns nitrazine paper deep ____

Blue

When PROM occurs, the age of the fetus must be determined. The best way to assess lung maturity is to check the ____ ratio

L/S (lecithin/sphingomyelin)

An L/S ratio greater than ___ indicates lung maturity

2.0

If labor does not begin within ___ hours after PROM, labor will likely be induced

24

If PROM occurs before viability, what is the typical management?

Termination of pregnancy

If PROM occurs after viability but before 36 weeks, what is the typical management?

Hospitalize, watch for infection, try to gain time for the infant to mature

If there are any signs of infection after PROM, what must occur immediately?

Delivery of fetus

PROM always occurs in a gush of fluid (T/F)?

False

The woman must avoid sexual intercourse if PROM has occurred (T/F)

True

What is self-disclosure?

When the nurse tells the patient personal information about self

Is it always bad for the nurse to self-disclose?

No, you can self-disclose as long as you do it cautiously and you are 100% sure it is therapeutic

If the nurse uses self-disclosure it should be ____ and the conversation should be...

Short, quickly re-focused back on the patient

Insight means the ability of the pt to ____ his own problems

Understand

During what phase should the nurse examine his/her own feelings

Pre-interaction phase

Flight of ideas is when the patient changes topics of conversation ____

Rapidly

The basis for a therapeutic nurse/patient relationship begins with the ___, self-____ and ____ _____

Nurses, awareness, self-understanding

What are the steps of the nurse/patient therapeutic relationship?

Pre-interaction phase, orientation phase, working phase, termination phase

Should the nurse self-disclose if the patient asks the nurse to?

No, not unless it is specifically therapeutic

The nurse should introduce information about the end of the nurse/patient relationship during the ____ phase

Orientation

Termination phase begins in the ____ phase

Orientation

Pulmonary edema is accumulation of ___ in the lung

Fluid

Pulmonary edema is a common complication of ___ disorders

Cardiovascular

Pulmonary edema usually results from _____ ____ failure

Left ventricular

What force causes pulmonary edema in left ventricular failure?

Increased hydrostatic pressure in the pulmonary capillaries

Can letting IVs run in too fast cause pulmonary edema?

Yes, in the client with poor cardiovascular function

What are the 4 classic signs of pulmonary edema?

Dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, coughing

What is meant by dyspnea on exertion?

Sudden episodes of difficulty breathing

What is meant by orthopnea?

SOB when lying flat