Interventions to prevent skin breakdown
Q2 turns, proper nutrition, water, food, consistent diaper changes if incontinent
Presbyopia
far sightedness that worsens with age
macular degeneration
the leading cause of visual deficits in the united states, it is the loss of vision in the central fields
cataracts
clouding of the lens of the eye, causes clouded vision
glaucoma
increased IOP leads to peripheral vision loss and blindness
diabetic retinopathy
complication of diabetes where the blood vessels in the retina become damaged
hyperopia
far sightedness that occurs when the light does not refract enough light, as a result images converge behind the retina
myopia
nearsightedness occurs when the eye over bends the light and images converge in front of the retina
miosis
pupillary constriction
mydrasis
pupillary dilation
eye changes related to aging
eyes sunken, sclera changes to more yellow/blue, cornea flattens which burns vision, muscle strength reduces and harder to look upward, pupil loses ability to dilate as much, harder discriminate between blue, green, and violet, tear production reduced
exophthalmos
protrusion of eye
endophthalmos
sunken in of the eye
ptosis
eye drooping
anisocoric
pupils different size
consensual response
constriction of the left pupil when light in shined in the right
anosmia
the complete loss of smell
presbycusis
age related hearing loss
antihistamines effect on the eye
dry it out and increase IOP
What can vitamin A deficiency cause?
dry eyes, blindness, keratomalacia
eye healthy diet
rich in fruit, red, orange, and dark green veggies (10 servings)
Prostaglandins agonist
Reduce IOP by dilating blood vessels in the trabecular mesh, which then collects and drains aqueous humor at a faster rate
Adrenergic agonists
reduce IOP by limiting the production of aqueous humor and by dilating the pupil, which improves the flow of the fluid to its absorption site
beta-adrenergic blockers
reduce IOP by limiting the production of aqueous humor and by dilating the pupil, which improves the flow of the fluid to its absorption site
Carbonic anhydrase inhibitors
Directly and strongly inhibit production of aqueous humor. They do not affect the flow or the absorption of the fluid.
Cholinergic agonists
reduce IOP by limiting the production of aqueous humor and by making more room between the iris and the lens, which improves fluid outflow
CT and eyes
shows bony structure around eyes and extraocular muscles
MRI and eyes
evaluate ocular nerves and assess for ocular tumors
radioisotope and eyes
locate lesion and tumors
ultrasonography
examines the orbit with high frequency sound waves
slit-lamp examination
magnifies the anterior eye structures
corneal staining
detects corneal trauma
Tonometry
tests IOP, needed yearly after 40
if testing at home teach patient measure at same time each day because they vary through out the day
fluorescein angiography
performed by physician or advanced practice nurse shows eye circulation using dye
electroretinography
graphs the retina’s response to light stimulation
useful in detecting blood vessel changes from either disease or drug use
keratoplasty
corneal transplant
Teaching:
oAntibiotics, pressure patch, and protective shield until patient returns to the surgeon
oTeach patient to lie on nonoperated side to reduce IOP
oDo not use an ice pack
What to do on a patient donating their cornea (after their death)
raise HOB 30 degrees, antibiotic eye drops, close eyes and put on small ice pack
corneal ulceration
-emergency!
-cornea has no separate blood supply and infections develop rapidly and can permanently damage vision
-homemade contact solution and large bottles that become contaminated large cause
-cornea will look hazy with an patchy area of ulceration
-treat with antibiotics and steroids every hour for the first 24 hours
trachoma
chronic conjunctivitis caused by chlamydia trachomatis. It scars the conjunctiva and is a common cause of preventable blindness worldwide
o Treated most commonly with oral azithromycin
normal IOP
10-20
CN II
optic nerve
corneal abrasion
- a scrape or scratch injury of the cornea
o Can lead to corneal infection which can lead to corneal ulcerations which is a deeper injury
cataract surgery
o Surgery- lens is extracted by phacoemulsification in which a probe is inserted and high frequency sound waves break up the cataract which are then suctioned out
o Post op care- antibiotics and steroids, wear dark glasses outdoors, expect to have eye itching and a blood shot appearance, but significant swelling or bruising is abnormal
o Best or final vision after surgery occurs in 4-6 weeks
what happens in glaucoma when IOP too high?
compress retina blood vessels
glaucoma primary causes
aging, hereditary, central retinal vein occlusion
Causes (associated):
diabetes mellitus, hypertension, severe myopia, retinal detachment
Causes (secondary):
: uveitis, iritis, neovascular disorders, trauma, ocular tumors, degenerative disease, eye surgery
o Primary open-angle glaucoma
is the most common kind, usually effects both eyes, and has no manifestations in its early stages. Outflow of aqueous humor through the chamber angle is reduced (22-32 tonometry reading)
o Primary angle-closure glaucoma
has a sudden onset and is an emergency (30> tonometry reading)
- Surgery management for glaucoma
- laser trabeculoplasty burns the trabecular meshwork, scarring it and causing the meshwork fibers to tighten. Tight fibers increase the size of the spaces between the fibers, improving outflow of aqueous humor and reducing IOP.
2.o Trabeculectomy is a surgical procedure that creates a new channel for fluid outflow.
-Both are ambulatory surgery procedures.
Keratononus
degeneration of corneal tissue resulting in an abnormal corneal shape
dry AMD
caused by gradual blocking of retinal capillaries allowing retina cells in the macula to become ischemic and necrotic
Central vision declines and patient described mild burning, eventually central vision is completely lost
Risks include hypertension, smoking, female, short stature, family history, long-term diet poor in carotene and vitamin E
No cure
Wet AMD
which is the growth of new blood vessels in the macula which are thin and leak blood and fluid
Can occur at any age, in one eye or both
Can lead to exudative macular degeneration which is sudden decrease in vision after detachment of pigment epithelium in the macula
Treated with laser therapy or ocular injections
Retinitis pigmentosa
- is a condition in which retinal nerve cells degenerate and the pigmented cells of the retina grow and move into the sensory areas of the retina, causing further degeneration
starts as night blindness but eventually total blindness
Lacerations
are caused by sharp objects and projectiles. The injury occurs most commonly to the eyelids and cornea, although any part of the eye can be lacerated.
o Initially the eye is closed and a small ice pack is applied to decrease bleeding. Minor lacerations of the eyelid can be sutured in an emergency department, an urgent care center, or an ophthalmologist’s office.
o A microscope is needed in the operating room if the patient has a laceration that involves the eyelid margin, affects the lacrimal system, involves a large area, or has jagged edges.
- A client is considered high risk for development of clots and thus a potential pulmonary embolism. Which of the following statements indicated a need for further teaching?This is a need for teaching: so probably something like “I can sit aroundand do nothing or I don’t need to move” 2. A client is being started on hydromorphone (Dilaudid) for abdominal pain. Which of the following need to be included in the patient education?Can’t find this answer: but something to do with either respiratory depression or chances of constipation with opioids- Cause ODD Spasms(where bile will leak out the pancreas3. The nurse is working in an urgent care clinic that has standardized treatment protocols for implementation by nursing staff. After reviewing the history, physical assessment,and vital signs for a 60-year-old patient as shown in the accompanying figure, which action should the nurse take first?Report the vision change to the health care provider4. The nurse is caring for a male patient who reports an urgent need to urinate but is unable to pass more than a few drops of urine on the toilet. Which is the priority assessment to be performed by the nurse?Bladder scan to determine the amount of urine in the bladder5. A client has a foreign body in the eye. What action by the nurse takes priority?Administering the ordered antibiotics6. The nurse understands that the patient with acute glomerulonephritis has had an immune complex response to which of the following?Group A beta-hemolytic Streptococcus
- A client is taking warfarin (Coumadin) and asks the nurse if taking St. John’s wort is acceptable. What response by the nurse is best?“No, it may interfere with the warfarin.”8. The nurse is caring for a client preparing to have a laparoscopic cholecystectomy in the morning. Which statementby the client indicates a need for further teaching?“I’m glad I won’t have to have an open cholecystectomy.” 9. A nurse assesses a client admitted to the cardiac unit. Which statement by the client alerts the nurse to the possibility of right-sided heart failure?“My shoes fit really tight lately.”10. A nurse witnesses a client begin to experience a tonic-clonic seizure and loss of consciousness. Which action should the nurse take?Turn the client’s head to the side11. The client’s health care provider has ordered gentamicin (Garamycin) 3 mg/kg/day in three divided doses. The client weighs 264 lb. The client will receive _ milligrams per dose of Garamycin.120 mg per dose12. A nurse is assessing a client with suspected cholecystitis.Where would the nurse expect the client’s pain to be located?Right, upper quadrant, radiating to the right scapula is characteristic ofcholecystitis13. The nurse is providing discharge teaching for a client whohas peptic ulcer disease caused by Helicobacter pylori infection. Which statement by the client indicates that additional teaching is needed?I will take my medication every day until my heartburn is gone14. A nurse cares for a client who has a family history of colon cancer. The client states, “My father and my brother had colon cancer. What is the chance that I will get cancer?” How should the nurse respond?”You should have a colonoscopy more frequently to identify abnormal polyps early.”15. A client with Crohn’s disease is recovering from a bowel resection. The nurse realizes which of the following may occur?
The patient will possibly have a recurrence in another portion of the bowel.16. A patient diagnosed with borderline personality disorder is hospitalized several times after self-inflicted lacerations. The patient remains impulsive. Which nursing diagnosis is the focus of this therapy?Risk for self-directed violence17. A nurse performs an assessment of pain discrimination onan older adult client. The client correctly identifies, with eyes closed, a sharp sensation on the right hand when touched witha pin. Which action should the nurse take next?Touch the pin on the same area of the left hand.18. A priority nursing intervention for a patient diagnosed with major depressive disorder is:Carefully and unobtrusively observe on the basis of assessed data, at varied intervals around the clock.19. A client does not understand why vision loss due to glaucoma is irreversible. What explanation by the nurse is best?”Because eye pressure was too high, the tissue died.”20. Which client is most at risk for the development of cholecystitis?45 year old lady with multiple kids and eats fast food21. The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client’s abdomen is tense and rigid. What actiontakes priority?Notify the health care provider immediately 22. Which documentation indicates that the treatment plan for a patient experiencing acute mania has been effective?“Converses with few interruptions; clothing matches; participates in activities.”23. Which medication should the nurse anticipate administrating for a client diagnosed with acute exacerbation of inflammatory bowel disease?Solumedrol - The nurse is caring for a 32-year-old woman diagnosed with schizophrenia. The woman tells the nurse, “The news on TV last night was all about me.” This is an example of what kind of thought content?Ideas of reference 25. A nurse plans care for a client with epilepsy who is admitted to the hospital. Which interventions should the nurseinclude in this client’s plan of care? (Select all that apply.)Have suction equipment at the bedside.Keep bed rails up at all times.Ensure that the client has IV access.26. A clinic nurse is reviewing the record of a client recently diagnosed with a cataract. Which of the following clinical manifestations associated with this disorder would the nurse expect to be documented in the client’s record?Painless progressive loss of vision27. What is a nurse’s legal responsibility if child abuse or neglect is suspected?Report the suspicion according to state regulations.28. A nurse assesses clients on a medical-surgical unit. Whichclient should the nurse identify as having the greatest risk for cardiovascular disease?A 45-year-old American Indian woman with diabetes mellitus29. A woman gave birth to a healthy newborn 1 month ago. The patient now reports she cannot cope and is unable to sleep or eat. She says, “I feel like a failure. This baby is the root of my problems.” The priority nursing diagnosis is:Risk for other-directed violence30. A client is being prepared for emergency surgery. The client’s medication list includes warfarin (Coumadin) 5 mg once a day. Which of the following test would the nurse anticipate to be ordered before surgery?PT mainly and INR31. After teaching a client newly diagnosed with epilepsy, thenurse assesses the client’s understanding. Which statement bythe client indicates a need for additional teaching?”If I am nauseated, I will not take my epilepsy medication.”
- A nurse is pregnant and preparing to administer medications to a client admitted for urinary tract infection associated with urinary retention. Which of his medications must be handled with gloves?Maybe Proscar – look up33. The nurse is providing health teaching to a group of mothers of school-aged children. Which statement by a motherindicates the need for additional instruction?“Both of my children have the same eye medication, which is a real bonus, because I only need to buy one bottle.”34. The physician orders furosemide (Lasix) 8 mg intravenously daily. The nurse furosemide (Lasix) 40 mg/4mL available, How much should the nurse administer?0.835. The nurse planning to assess the structure of a family. Which question should the nurse ask?“Who lives with you in this home?”36. Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important outcome related to the nursing diagnosis: Imbalanced nutrition: less than body requirements. Within 1 week, the patient will:gain 1 to 2 pounds.37. A nurse is caring for a client who weighs 220 pounds and is started on enoxaparin (Lovenox). The order is for 1 mg/kg SQ daily, not to exceed 90 mg. How much enoxaparin does the nurse anticipate administering?90 mg38. A patient’s care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating?Darting eyes, tilted head, mumbling to self39. The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to:Administer IV fluids.40. The physician orders digoxin (Lanoxin) 250 mcg every day. The nurse has digoxin (Lanoxin) 0.5 mg tablets on hand, Howmany tablet(s) should the nurse administer?0.5 tablet
- A client being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan toDiscontinue the patient’s oral food intake.42. A nurse reviews a client’s laboratory results. Which findings should alert the nurse to the possibility of atherosclerosis? (Select all that apply.)Total cholesterol: 280 mg/dLTriglycerides: 200 mg/dLLow-density lipoprotein cholesterol: 160 mg/dL43. A nurse reviews the chart of a client who has Crohn’s disease and a draining fistula. Which documentation should alert the nurse to urgently contact the provider for additional orders?Serum potassium of 2.6 mEq/L44. A client is ordered to receive aspirin after an acute heart attack. The nurse is evaluating use of this medication with other medications. The nurse is aware that aspirin can cause which drug interaction?Increased risk of bleeding with anticoagulants45. An older adult who is cognitively impaired is admitted to the hospital with pneumonia. Which signs and symptoms would the nurse expect to be exhibited by the patient?Increased confusion46. A nurse assesses clients on a medical-surgical unit. Whichclients should the nurse identify as at risk for secondary seizures? (Select all that apply.)A 26-year-old woman with a left temporal brain tumorA 38-year-old male client in an alcohol withdrawal programA 42-year-old football player with a traumatic brain injury47. A client calls the office complaining that the escitalopram (Lexapro) she was started on last week is not working to improve her mood. The nurse would provide which of the following instructions:It take a few weeks to work48. A nurse is assigned to care for a group of clients. On review of the clients medication administration records, the
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nurse determines that which medication would put a client at risk for hypokalemia?Lasix or any diuretic49. A nurse obtains a focused health history for a client who is scheduled for magnetic resonance angiography. Which priority question should the nurse ask before the test?”Do you have allergies to iodine or shellfish?”50. A client with Crohn’s disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?Fistulas can form between the bowel and bladder.51. A client is being interviewed for assessment related to erectile dysfunction. Which of the following medications are used to treat erectile dysfunction? (Select all that apply.)Tadalafil (Cialis): preferred due to being more naturalSildenafil (Viagra): pill – no alcohol or grapefruitVardenafil (Levitra): pill – no alcohol or grapefruitAlprostadil (Carverject): injectionPapaverine: vasodilator – injectionPhentolamine (Regitine) – injection 52. The nurse is seeing a patient who has been in the clinic eight times in the past 6 months for injuries from an abusive partner. The patient states, “I don’t see any way to get away from my partner, and I can’t keep going on like this.” What assessment question is most important for the nurse to ask?”Have you thought about hurting yourself or someone else?”53. A client’s intraocular pressure (IOP) is elevated. What action by the nurse is best?Plan to teach about drugs for glaucoma.54. The nurse is caring for a client with an acute attack of diverticulitis. Which intervention should the nurse be prepared to implement?IV fluids, pain, monitor for peritonitis watch for perf55. A client with ulcerative colitis has a come into the emergency department. Which finding is inconsistent with a diagnosis of ulcerative colitis?
Ulcerative colitis: character, amount consistency of stools; abdominal pain, cramping, blood, mucus (anything outside of these s/s is would be the correct answer… These are what ulcerative colitis is – the question is asking what ulcerative colitis is NOT)56. A nurse cares for a client who has advanced cardiac disease and states, “I am having trouble sleeping at night.” How should the nurse respond?”Use pillows to elevate your head and chest while you are sleeping.”57. A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse’s best response.“You’re laughing. Tell me what’s happening.”58. The nurse is assessing the client’s abdomen post bowel surgery. What is the best indicator of intestinal activity?Bowel sounds in all four quadrants – most likely59. Several children are seen in the emergency department for treatment of illnesses and injuries. Which finding would create a high index of suspicion for child abuse? The child who has:Bite marks60. A newly admitted patient diagnosed with schizophrenia says, “The voices are bothering me. They yell and tell me I’m bad. I have got to get away from them.” Select the nurse’s most helpful reply.“I’ll stay with you. Focus on what we are talking about, not the voices.”61. A nurse assesses a client who is recovering from an ileostomy placement. Which clinical manifestation should alert the nurse to urgently contact the health care provider?Pale and bluish stoma62. A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, “Do I have to keep taking this lithium even though my mood is stable now?” Select the nurse’s most appropriate response.“Taking the medication every day helps reduce the risk of a relapse.”63. A disheveled patient with severe depression and psychomotor retardation has not bathed for several days. The nurse should:Firmly and neutrally, assist the client to shower
- The physician orders pantoprazole (Protonix) 150mg intravenously. You receive pantoprazole 150mg in 250mL. Thetubing delivers 10gtts/min. What is the drip rate to infuse over 30 minutes?83 drops ?65. A client has a history of chronic infections of the kidney. What sign may implicate the client may have developed renal failure?Decreased GFR and oliguria (Normal GFR averages 125)66. The nurse assesses the patient and notes all of the following. Select all of the findings that indicate the systemic signs/symptoms of inflammation.Oral temperature 38.6° C/101.5° FWBC 20 cells/McL 109/L Patient reports, “I’m tired all the time. I haven’t felt like myself in days.”67. The nurse is caring for a client who is experiencing renal colic due to a kidney stone. Which of the following assessments requires immediate notification to the physician?Maybe hydronephrosis (Back up of urine into the kidneys)68. A patient diagnosed with schizophrenia has auditory hallucinations. The patient anxiously tells the nurse, “The voice is telling me to do things.” Select the nurse’s priority assessment question.“What is the voice telling you to do?”69. A nurse is volunteering at a 5K run event. Which of the following contestants would you monitor most carefully for hyponatremia?Not 100% sure but common causes of hyponatremia are: diuretic use, diarrhea, heart failure, liver disease, renal disease, and the syndrome of inappropriate ADH secretion (SIADH).70. The nurse is reviewing the lipid panel of a male client who has atherosclerosis. Which finding is most concerning?Triglycerides: 198 mg/dL71. A client who has been started on lisinopril (Prinivil) for hypertension is instructed to notify the physician if they experience which of the following symptoms?
I think the answer is “nagging cough” – look up to verify72. A nurse cares for a client who is experiencing status epilepticus. Which prescribed medication should the nurse prepare to administer?Lorazepam (Ativan)73. A client is being treated for deep vein thrombosis with IV heparin? Which of the following medications needs to be available on the unit in case of an extremely elevated partial thromboplastin time (PTT)?Protamine sulfate74. The nurse is caring for a client with type 1 diabetes. It is 0630 and the client’s blood sugar is 300 mg/dl. The physician has ordered 25 units of NPH insulin to be given at 0630 and sliding scale coverage. According to the sliding scale below, how much total insulin should be given at 0630?Blood Glucose Regular InsulinBelow 150 0 units150-200 2 units201 -250 4 units251-300 6 units31 units75. A nurse plans care for a client with Crohn’s disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this client’s plan of care?Skin protection 76. When a hyperactive patient experiencing acute mania is hospitalized, what initial nursing intervention is a priority?Set limits on patient behavior as necessary.77. A client came to the clinic with erectile dysfunction. Whatare some possible causes of this condition that the nurse coulddiscuss with the client during history taking? (Select all that apply.)Recent prostatectomyLong-term hypertensionDiabetes mellitusConsumption of beer each night - Which patient statement indicates that the nurse’s teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective?”I will need to use a sunscreen when I am outdoors.” (Also must take folic acid, the sulfa in the drug decreases its absorption)79. An emergency room nurse obtains the health history of a client. Which statement by the client should alert the nurse to the occurrence of heart failure?“I get short of breath when I climb stairs.”80. A nurse who is applying eyedrops to a client holds pressure against the corner of the eye nearest the nose after instilling the drops. The client asks what the nurse is doing. What response by the nurse is best?”This prevents systemic absorption.”81. The nurse is caring for a postoperative patient who underwent bowel resection surgery that morning. The nurse assesses the patient’s abdomen and notes that there are hypoactive bowel sounds. The patient is resting quietly without nausea or vomiting. What is the appropriate action of the nurse?Keep the patient NPO and document the findings in the chart.82. Mrs. J, a 57-year-old woman, walks into the emergency department with complaints of “not feeling well” and has an open wound on the bottom of her foot, but the patient states she was not aware of this. The nurse interprets this response asPathologic impairment of sensory responses83. A client is being discharged on warfarin (Coumadin) therapy. What discharge instructions is the nurse required to provide? (Select all that apply.)Dietary restrictions Follow-up laboratory monitoringPossible drug-drug interactionsReason to take medication84. The client is ordered Heparin 4,000 units subcutaneous twice a day. It is available in 5,000 units/ml. How much will thenurse administer for the morning dose?0.8
- A patient has progressive memory deficit associated with dementia. Which nursing intervention would best help the individual function in the environment?Assist the patient to perform simple tasks by giving step-by-step directions. 86. A 40-year-old patient presents to her provider for a yearly physical. The provider notes a family history of breast cancer in the patient’s mother. The provider schedules the patient for a mammogram. The nurse recognizes this as what level of prevention?Secondary 87. A client is undergoing hemodialysis treatments three times per week is to receive 50units/kilogram of Epoetin (Procrit) following each treatment. She weighs 110 pounds. The dose she should receive will be:250088. The nurse understands that the patient who has undergone a transurethral resection of the prostate (TURP) is at risk for developing which priority concern?Hemorrhage89. A patient has been resistant to treatment with antidepressant therapy. The care provider prescribes phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI) medication. What teaching is critical for the nurse to give the patient?No tyramine: No cheese or wine; avocados or chinese food (anything fermented)90. A nurse prepares a client with acute renal insufficiency for a cardiac catheterization. The provider prescribes 0.9% normal saline to infuse at 125 mL/hr for renal protection. The nurse obtains gravity tubing with a drip rate of 15 gtts/mL. At what rate (gtts/min) should the nurse infuse the fluids?3191. The nurse is to administer an infliximab (Remicade) infusion to a client who weighs 110 lb. The client is to receive 5mg/kg of the drug, which is available as a 100 mg/10 mL solution. The nurse will draw up _ milliliters of solution for the client’s infusion.25
- A patient experiencing acute mania has exhausted the staff members by noon. The patient has joked, manipulated, insulted, and fought all morning. Staff members are feeling defensive and fatigued. Which is the best action?Hold a staff meeting to discuss consistency and limit-setting approaches93. A client has been diagnosed with hyperlipidemia and is being started on simvastatin (Zocor). Which of the following laboratory value would the nurse anticipate being ordered before the medication regimen is begun.AST/ALT – liver tests I believe – look up94. A middle-aged client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year, asks what can be done to help prevent these infections. Which is the nurse’s best response?”Drink more water and empty your bladder every 2 to 3 hours during the day.”95. A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client’s blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg.What action by the nurse is most appropriate?Start a large-bore IV with normal saline.96. A nurse teaches a client who has a history of heart failure. Which statement should the nurse include in this client’s discharge teaching?“Weigh yourself daily while wearing the same amount of clothing”97. The nurse is caring for a patient with benign prostatic hypertrophy who states that he feels a constant urge to urinate but cannot pass more than 30 to 60 mL of urine into the toilet at a time. The nurse performs a bladder scan and finds that there are 1100 mL of urine in the patient’s bladder. What is the priority nursing diagnosis for this patient?Urinary retention r/t obstruction of urinary bladder outlet98. The nurse is caring for a client who just had an esophagogastroduodenoscopy (EGD) completed. The client
tells the nurse that her mouth is very dry after the procedure. What is the nurse’s first action?Check the client’s gag reflex99. A nurse receives report for a client who has CHF who is complaining of nausea and vomiting. The vital signs are T 98.5,pulse 54, respirations 18, and blood pressure 111/68. The nurse asks the physician for an order to obtain which of the following labs.Not sure: maybe BMP to look at electrolytes but these are common labs for CHF – CBC, urinalysis, electrolytes, blood urea nitrogen (BUN), creatinine, transaminases.100. How will the nurse assess for flank tenderness in a patient with suspected pyelonephritis?Strike a flat hand covering the costovertebral angle (CVA).EXAM 1:-Maslow: food and elimination -Doing assessments on a patient: vision blurry over past years- cataracts-Functioning adult: How would nurse assist in the house: easy directions-I’m seeing holes in vison- Macular Degeneration (this is a loss of central vision)-Dilated patient teaching: constipation: 1 daily stool softener-Decreased sensation for bath: concerned about burns-Old lady – not feeling well with an open wound on foot that she can’t feel: decreased sensationsGlaucoma: Pressure build up in chambers; blocked chamber systemAssociated with cardiovascular disease and diabetes mellitus Decrease BP medicationsEye medication for lifeUnilateral damage; edges of vision disappear – only peripheral leftOpen vs. closed glaucoma: closed is an emergency-Cataract: Blurred vision and common increasing with ageCloudy lens (UV rays and age); build-up of opaque Gray trimCure/treatment: surgically removed to replace lensNo pain
Post op: no strenuous activityMedications to dilate eyes prior to surgery -Tonometry: measures intraocular pressure10-21 mm Hgtest for glaucomagetting worse – glaucoma – need stronger medications or need to use medications already prescribed-Snellen Test:RN/LPN20/60 vision: means that the patient can read at 20 feet what a patient with perfect vision could read at 60 feet-Macular degeneration: loss of central vision-Myopia (nearsighted): light falls in front of retina; causing far away objects to be blurry-Hyperopia (farsightedness): distant objects are seen more clearly than up close-Presbyopia: age related decline of sight caused by aging of lens-Astigmatism: misshaped cornea-Exophthalmos: symptom of Grave’s disease; bulging eyes (Hyperthyroidism)-Retinal detachment: floaters20/200: legal blindness-Timolol treats primary open angel glaucoma: decreases production of aqueous humor; beta blocker – risk for decrease in heart rate and orthostatic hypotension; can affect blood sugar (monitor diabetic); hold pressure to innercanthus upon administration-Timolol and propranolol: only 2 FDA approved for headache-Latanoprost: changes color of eye-Bimatoprost: eyelashes grow thick -WHO definition of health: The state of complete physical, mental and social well-being-Health promotion model: encouraging health-promoting behaviors-Stroke lifestyle factors: fast food, physical inactivity and tobacco use-Presbycusis: progressive hearing disorder in older adults-Activities that weaken hearing: woodworking, target shooting and listening to loud music-Visual impairment: remove clutter from floor, keep all flooring in good repair,pain the edges of steps, use low pile carpeting in home, adequate lighting-Corneal staining for eye injuries: to see if there is a corneal abrasion -No MRI if eye injury has metal object in eye
-Confrontation test: having the patient looking directly at your eye or nose and testing each quadrant in the patient’s visual field by having them count the number of fingers that you are showing-Peripheral neuropathy: burning, stinging and numbnessEXAM 2:-Pediatric emergency room: mother talking about how a child is too much for her and she’s not sleeping or eating and can’t do anything right and blames the kid- risk for harm to other people-OCD: internal, repetitive thoughts-Manic phase: can’t think right – keep everything simple-Behavioral problems with dementia: repetitive behaviors, confusion in the evening (sundowners), verbal/physical outbursts (from frustrations)-Teach caregiver of patient with dementia: keep medications and chemicals locked, prove enjoyable activities, provide calendars and clocks in room; do NOT change routines-Auditory hallucinations: what would you expect to find: patient is going to belooking around, talking to self, squinting eyes trying to focus on what’s not you-Bipolar- Patient taking maintenance medications- Patient asking the nurse: I’m feeling better, do I stop taking medication? No we have to tapper to prevent relapses of your disorder-Who lives with you? Family structure question-Mentally challenged: nurse feeding into the patient and giving in: conduct meeting of minds and come to conclusion to be on same page with the wholeteam.-Expected for bipolar disorder (Select all that apply) 4 answers- hyperactivity , low depression, suicidal, homicidal-Know what OCD behaviors are: “What is not a behavior of OCD? – Is the question. (This is a negative answer) OCD people are: rigid, inflexible, very particular-Bipolar disorder: immediate action needed if nonstop physical activities and poor nutrition -An old confused female patient with a Urinary Tract Infection (UTI): delirium-Patient with schizophrenia says – High heat. Last time here. Did you get a coat?: Associative looseness (Looseness of association refers to jumbled thoughts incoherently expressed to the listener. Neologisms are newly coined words. Ideas of reference are a type of delusion. Thought broadcasting is the belief that others can hear ones thoughts)
-What assessment question is most important to ask pertaining to spouse abuse- suicide-Kids giving away things: assess for suicidal thoughts-Patient with bulimia: (Select all that apply): swollen parotid glands, teeth rotting, knuckles with callus (Russel’s sign), normal weight-Patient taking Lithium: watch creatinine and TSH; therapeutic level 0.6-1.2-Limbic system is the emotional brain-Delirium: rapid, altered conscious, impaired memory-Agnosia: gave banana instead of ID-Dementia: use confabulation – making up stories-ECT (electroconvulsive therapy – used in patients with severe depression and bi-polar that do not respond to medications): NPO for 16-24 hours prior to procedure-Clozapine: schizophrenia medication – watch WBC – Agranulocytosis (severely low WBC count, mostly neutrophils)-OCD: rigidness and inflexibility; over exaggeration; and very particular; GiveSSRI for long term treatment, benzo to relieve current anxiety (short term only) – cannot be used for long term-Negative schizophrenia symptoms: taken away, short attention span, limitedability to communicate, anhedonia (unkept) -Narcissistic: all about one’s self-Borderline personality disorder: manipulation, splitting, risk for self-harm, fear of abandonment -Valium: benzo-Haldol: antipsychotic-Bulimia patient with dental deterioration: emesis (vomit) produced during purging is acidic and corrodes the tooth enamel -Russell’s sign: scratches on backs of knuckles – indicates bulimia -Alzheimer’s diseases diagnostic workup: rule out other causes of symptoms first-Manic patient is monopolizing group conversation: thank patient for their input but inform client that others need a chance to contribute (therapeutic communication)-Depression: give structured programs at activities-Agoraphobia: fear of going outside-Social phobia: intense anxiety or fear of being judged, negatively evaluated or rejected in a social performance situation -Claustrophobia: fear of enclosed spaces-Hypochondriasis: always sick
-Always asks if a client is thinking of hurting themselves and always ask openended questions-Symptoms that require immediate action: physical over comfort (Maslow’s)-Dementia: sun downing-Delirium: acute, reversible and sudden onset; causes: metabolic imbalances,infection (UTI in elderly), head trauma or severe pain-Electroconvulsive Therapy (ECT): before procedure need blood draw for labs and ECG-Antisocial personality disorder: disregards rights of others-Schizophrenia symptoms:-Positive: delusions, hallucinations, looseness of thoughts, promiscuinity, racing thoughts, extra inappropriate body movements-Negative: limited ability to communicate, short attention span, apathy(lack of emotion), poor/nonexistent social functioning-Risk for self-harm is always a priority diagnosis-Broca’s aphasia (expressive aphasia) after CVA (stroke): problems that the patient will exhibit – inability to answer questions, to express simple ideas and to name common objects-Equilibrium alterations: will experience nausea and vomiting – keep basin within easy reach; low lights to decrease symptoms and enhance patient comfort. Patient needs to look forward while walking, change positions slowlyand ride in front seat of car-Benzodiazepines: (Valium, Ativan, Xanax, Klonopin) Very habit forming and addictive; can go through withdrawal – may need to wean off meds – can cause high blood pressure and anxiety when withdrawing-SSRI: first line of defense – takes 3-4 weeks to work – do not stop suddenlyEXAM 3:- Kidney stones- prevention: increase water intake drink 3L of water-Witness patient hit the floor and the note the start of seizure- patient safety-roll to side-Patient in an accident: lost a lot of blood; blood pressure is in tanking (crashing): What kind of injury would kidney have? Prerenal injury-Continuous Bladder Irrigation (CBI) going, TURP performed earlier: 4000 mL has been infused, output is 4500, document the 500 as urine output. Do themath and that will be right answer-Topamax: do not crush; drink 6-8 glasses of water; may cause drowsiness donot use in pregnancy-Depakote: monitor LFT
-Keppra: monitor liver enzymes and kidney function-Day post op if ileostomy: 1-3 days- report if stoma is not moist and pink-Prostate post care plan: make sure patient knows side effects of LH-RH medications: normal side effects: impotence (erectile dysfunction), hot flashes, increase tenderness in breast tissue (gynecomastia) and decreased libido -Complicated grief: “I’m very busy with my normal ADLs and don’t have time to think about it” this is delayed grief -Greif reactions over 6 months – chronic grief; behavior of the grieving person interferes with normal functioning – masked griefs; grieving person unable to perform ADLs – exaggerated grief-Terminally ill patient due to chronic respiratory illness: provide comfort, preserve dignity and quality of life, prove social support for family members; do NOT discuss euthanasia and do not provide economic support to family members-Relaxation therapy: reduces pain and anxiety; improves scores on anxiety and stress scales; promotes sleep and used to treat nausea and vomiting -Breast cancer increased incidence in family: increase your screenings-Pyridium: urine turns orange tell patient this to relieve anxiety when it happens: relaxes the bladder – it relieves the feeling of needing to urinate very often; this medication relieves pain from urinary tract infections and other urinary problems; Remind patients that this drug will not treat an infection, only the symptoms because these drugs have no antibacterial activity; Teach patients to take the drug with or immediately after a meal to reduce the risk for GI upset.-Ileostomy/colostomy: Electrolytes are going to be low-What are the manifestations of AKI – due to nephrotic syndrome?Not all patients with AKI experience oliguria. IMMUNITY and inflammatory causes of AKI may allow proteins to enter the glomerulus, and these proteins can hold fluid in the filtrate, causing a polyuria (excess urine output) that disrupts FLUID AND ELECTROLYTE BALANCE. During AKI with high-volume urine output, hypovolemia and electrolyte loss are the main problems. The patient in the diuretic phase of AKI needs a plan of care that focuses on fluid and electrolyte replacement and monitoring. Onset of polyuria can signal the start of recovery from AKI.( I don’t know if this is right. I couldn’t find anything on it. Let me know if you do)-Acute epilepsy/seizure activity: Ativan-Patient died: how do you take care of dead body: with respect -Ditropan: relaxes the smooth muscle of the bladder-Process of digestion where most does it happen- small intestine-Prostate cancer testing: PSA test (Prostate-specific antigen) and DRE (digitalrectal exam) at 50 years old -ALWAYS take seizure medications
-Screening for colon cancer: colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, Computed tomography (CT) colonography every 5 years (probably a select all – make sure the years are correct on the test before you choose them, they could easily change them to trip us up) -Assess blood in the stool with colon cancer: emergency -Trajectory of disease: physical functioning-Lumbar puncture (spinal tap): NPO after midnight and 3 people to hold child down (probably a select all)-Allopurinol (treats kidney stones): breaks secondary hyperoxaluria (too much of a substance called oxalate in the urine)-Proscar: decreases DHT lab (testosterone) -Pyridium therapy: increased need to urinate will be relieved (urine color changes are normal)-Prostate cancer: test PSA and phosphate-Early sign of prostate cancer: increased PSA, weak urine streams and urine frequency-BPH: drink a lot of water and give Proscar (decreases DHT and shrinks prostate)-Palliative care: Alzheimer’s, COPD, sickle cell anemia, and end stage liver disease (probably a select all)-Patient taking Flomax: assist client out of bed – decreased BP-Colon cancer: increase fiber (beans) – look up high fiber foods in case it is a select all-Proscar: don’t give to pregnant patient -Gentamycin: immediate attention if buzzing of ears-Prostate cancer: eat high fiber-Seizures: take medications daily and on time-EEG: wash hair and patient does not have to fast-Hospice: just make the patient comfortable, no colonoscopy/procedures -Status epilepticus: kidney damage can occur – muscle catabolism -Dilantin: gingival hyperplasia – rinse mouth to prevent gum overgrowth-Seizure: risk of bleeding from injury-BPH: decrease BP and increased HR is a sign of hemorrhage -AKI: expected: hypertension; can’t filter: urine retention; hydronephrosis-AKI diuretic phase: prevent loss of electrolytes-Calcium stones: avoid green, leafy vegetables (spinach, kale, collards)-Uric acid stones: avoid anchovies, red meat, alcohol-Scopolamine/Atropine (Anticholerginic): side effect – dry mouth – give prior to surgery
-Avodart: decreases obstructive of outflow of urine through the urethra; shrinks prostate-Dilantin: cannot be mixed with D5W; cannot be given with antacids; can cause gingivitis; need good oral care – floss and brush; monitor for toxicity 10-20 is normal-Status epilepticus: seizure more than 5 minutes or series of seizures: give Ativan-Seizure precautions: never put anything in patient’s mouth, padded side rails, have suction available and oxygen-Post-op appendectomy with anxiety causing more pain: administer anxiety medications to reduce pain-Pain in lower legs: venous of peripheral vascular disease-Hormone therapy for prostate cancer: goal of treatment: to limit the amountof circulating androgens; Prostate cancer is fed by testosterone; Proscar: don’t let pregnant women handle it or sperm; Proscar may cause feminization of male patients – voice changes and decreased libido-TURP for BPH: blood pressure 90/50 and 130 HR indicates hypovolemia and shock – hemorrhage -TURP: minor clots are fine; lots of clots with burgundy blood – not good-AKI diuretic phase: can lose up to 10 L of fluid, urine would be very dilute/not concentrated. So very low specific gravity of urine – goal is to prevent loss of electrolytes – if electrolytes get imbalanced cardiac (potassium) and seizure (sodium) risks.-Teaching for epilepsy • Drug therapy information:• Name, dosage, time of administration• Actions to take if side effects occur• Importance of taking drug as prescribed and not missing a dose• What to do if a dose is missed or cannot be taken• Importance of having blood drawn for therapeutic or toxic levels as requested by the health care provider• Do not take any medication, including over-the-counter drugs, withoutasking your health care provider.• Wear a medical alert bracelet or necklace or carry an identification card indicating epilepsy.• Follow up with your neurologist, physician, or other health care provider as directed.• Be sure that a family member or significant other knows how to help you in the event of a seizure and knows when your health care provider or emergency medical services should be called.
- Investigate and follow state laws concerning driving and operating machinery.• Avoid alcohol and excessive fatigueMODULE 6:-Nephrotic syndrome: “Michelin man”; puffy face, arms and body – decrease serum albumin levels; if remove albumin from blood, fluid shifts into cells- -albumin helps with medications dispersing through body, would healing and fluid shifts. Liver produces albumin – liver issue causes decreased albumin – can lead to ascites because of shifts of fluid-Chron’s disease: effectiveness of treatment of infusion of Remicade – check the frequency and consistency of bowel movements-Viagra: treatment for pulmonary hypertension and erectile dysfunction-Chron’s has periods of remission and exacerbation; no cure; can affect different areas of bowels-AKI with proteinuria – Intrarenal – Protein and RBC are saved in the glomerulus, so protein in urine show that glomeruli are missing up – so intrarenal issue-If patient complaining of inflammation of skin: what would be assessment findings: fever, rash, sweating, malaise/ fatigue/tired, elevated Erythrocyte Sedimentation Rate (ESR) Normal rate is 15-20 (This lab value is also referred to as the “sed rate”)-Know organ placement: gallbladder RUQ and stomach LUQ: further teaching question-Pyelonephritis: doctor already has given diagnosis: What does the nurse assess for: fever, chills, CVA (stroke), objective data -touch, feel, and see things she gathered for herself.-Chron’s disease: stool/liquids draining all over ileostomy: skin care is priority-Patient has a stomach ulcer getting worse over several days: Blood pressureis 110/60: What doctor orders should nurse carry out: ortho hypotension, falls risk, iv fluids-Chron’s: signs of infection: ugly urine fistula from bowel to bladder-Diverticulitis diet: no high fiber when it is inflamed-Peptic Ulcer Disease: To treat H. Pylori: Clarithromycin, Prilosec and Amoxicillin-Chron’s disease bowel resection: I will have a colostomy-Potassium (K) of 4.9 is high but still normal (range is 3.5-5) hyperkalemia is 5.1 and higher; Calcium (Ca) of 12 is high hypercalcemia (normal range is 8.5-10.5)
-Steroid: Solumedrol (methylprednisolone): monitor for pulse is wrong (This isgoing to be a negative answer) – Know everything there is to know about thismedication; the answer to this question will NOT be “monitor for pulse”-Nephrotic syndrome: protein dumping: nephrotic treatment this is a select all that apply question: know everything about this-Management varies, depending on which process is causing the disorder (identified bykidney biopsy). Excess IMMUNITY may improve with suppressive therapy using steroidsand cytotoxic or immunosuppressive agents. Angiotensin-converting enzyme inhibitors(ACEIs) can decrease protein loss in the urine, and cholesterol-lowering drugs can improve blood lipid levels. Heparin may reduce vascular defects and improve kidney function. Diet changes are often prescribed. If the glomerular filtration rate (GFR) is normal, dietary intake of proteins is needed. If the GFR is decreased, protein intake must be decreased. Mild diuretics and sodium restriction may be needed to control edema and hypertension. Assess the patient’s hydration status because vascular dehydration is common. If plasma volume is depleted, kidney problems worsen. Acute kidney injury (AKI) may be avoided if adequate blood flow to the kidney is maintained.-Patient states, “I have issues going on in my region below the belt; I’ve gotten therapy for it: pelvis and hip hurting: get an x-ray-Patient with jaundice: asks nurse, why skin is itchy: Bile salts accumulate in the skin and cause the itching-Chron’s disease resection: concerns: morning labs pre albumin is going to low and B12 low due to malabsorption-Nurse is doing assessment: common characteristics of abusive parents: poor coping skills-H. Pylori- patient teaching: 2 antibiotics and 1 PPI: Although numerous drugs have been evaluated for the treatment of H. pylori infection, no single agent has been used successfully against the organism. A common drug regimen for H. pylori infection is PPI–triple therapy, which includes a proton pump inhibitor (PPI) such as lansoprazole (Prevacid) plus two antibiotics such as metronidazole (Flagyl, Novonidazol) and tetracycline (Ala-Tet, Panmycin, Nu-Tetra) or clarithromycin (Biaxin, Biaxin XL) and amoxicillin (Amoxil) for 10 to 14 days. monitoring. Onset of polyuria can signal the start of recovery from AKI.( I don’t know if this is right. I couldn’t find anything on it. Let me know ifyou do)-Peptic Ulcer Disease patient with sharp abdominal pain, tense and rigid: firstthing you do: call the doctor; If perforation into the peritoneal cavity is present, the patient typically has a rigid, board like abdomen accompanied by rebound tenderness and pain is peritonitis.-Causes of erectile dysfunction: (Select all that apply): Recent prostatectomy,long-term hypertension, diabetes mellitus, consumption of beer at night- What can impair Viagra from working: alcohol – Instruct patients taking PDE-5 inhibitors to abstain from alcohol before sexual intercourse because it may impair the ability to have an erection.-Cholecystitis: RUQ pain, radiates to right scapula and shoulder; Risk factors: 4 F’s and a D: Female, fat, fertile, 40 and diabetes-Cholecystitis: stains, t tube
-Know gallbladder labs and treatment-Problems in your bile ducts, gallbladder or liver can raise: bilirubin in blood -High amylase: indicates a pancreatic disorder/problem-Liver: lab work – AST, ALT -Increased fat: gallbladder issues-Cholecystitis: chronic – light color stool, dark urine-Murphy sign: used to differentiate pain in RUQ; refers to a maneuver during a physical examination as part of the abdominal examination-Peptic ulcer: rigid, board like abdomen-Risk for peptic ulcer: NSAIDs (risk for bleeding)-Sulfasalazine: take on a full stomach-Colorectal cancer risk factors: personal history of ulcerative colitis and gastrointestinal polyps; need high fiber and low fat diet; don’t worry about distant relatives only immediate relatives-Prostate cancer: test PSA and limit amount of circulating androgens-Biomass: changes in breasts-Pyelonephritis: risk for diabetes mellitus is present – give antibiotics and increase fluids-Infliximab: effective treatment: check frequency and consistency of bowel movements-Sucralfate (Carafate): (coats stomach) take one hour before meals and at bedtime; do not use in pregnancy-Common complaint in pyelonephritis: costovertebral region pain (where ribs come to an end posteriorly)-2 Antibiotic and proton pump inhibitor for H. Pylori-Colon cancer: risk with ulcerative colitis -Gallbladder under liver in RUQ-Post-op infection about 48 hours: temp may go up slightly post-op but not from infection-Kock pouch (formed by terminal ileum): embedded under the skin a reservoir that needs to be tapped (a nipple under the skin) to drain it; no ostomy on outside. “I will need to drain the pouch regularly with a catheter” (internal ileostomy, use catheter to drain stool)-Increased Peptic Ulcer Disease risk: NSAIDs use, alcohol, caffeine, stress, African American, H. Pylori (treated with strong antibiotics – Levaquin and Flagyl)-Azulfidine/Sulfasalazine: (used to treat ulcerative colitis): causes photosensitivity advise patient to wear sunscreen and limit sun exposure. Take with meals – can cause constipation; can cause harmless discoloration of the urine
Answer “Avoid exposure to sunlight while taking this medication.”-AKI due to glomerulonephritis – expected manifestations – hypertension-Pyelonephritis (infection of pelvis and kidney): risk factor is diabetes-Peptic ulcer medication regimen: Biaxin, Nexium and Amoxicillin – “These medications will kill the bacteria and stop acid production”-Post-op prostatectomy: Which complication requires priority assessment of patient: hemorrhage-Medications to eradicate H. Pylori: antibiotics, proton pump inhibitor, bismuth (protects and smooths)-Patient at highest risk for developing colon cancer: 32 year old female with a12 year history of ulcerative colitis – years of inflammation can cause cellularchanges which can lead to cancer-58 year old patient being discharged after ostomy surgery for colon cancer: needs a registered nurse within 6 months experience on the surgical unit; patient will need teaching and an experienced nurse can do that-With Carafate or Bismuth (both coat and soothe stomach): don’t take antacid within one hour because negates the purpose of them; -Chron’s medications to expect: 4 options (Select all that apply) Azathioprine (Azasan, Imuran)Mercaptopurine (Purinethol).Vedolizumab (Entyvio)Infliximab (Inflectra, Remicade, Remsima)Adalimumab (Humira), Natalizumab (Tysabri), Certolizumab pegol, (Cimzia)Vedolizumab (Entyvio)Drugs used to manage Crohn’s disease (CD) are similar to those used in the treatment of ulcerative colitis (UC). For mild-to-moderate disease, 5-ASA drugs may be effective, (see the Colitis section).Common drug therapy for UC includes amino salicylates, glucocorticoids, antidiarrheal drugs, andimmunomodulators. Teach patients about side effects and adverse drug events (ADEs) and when tocall their health care provider.The amino salicylates are drugs commonly used to treat mild-to-moderate UC and/or maintainremission. Several amino salicylic acid compounds are available. These drugs, also called 5-ASAs, arethought to have an anti-inflammatory effect on the lining of the intestine by inhibiting prostaglandinsand are usually effective in 2 to 4 weeks.Sulfasalazine (Azulfidine, Azulfidine EN-tabs), the first amino salicylate approved for UC, is metabolizedby the intestinal bacteria into 5-ASA, which delivers the beneficial effects of the drug, and sulfapyridine, which is responsible for unwanted side effects. Teach patients to take a folic acid supplement,because sulfa decreases its absorption.