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Med Surg Final ATI

What rate do you set a nasal cannula at, and how much pure O2 is the patient getting? 1-6 L/min and 24-40% O2
What rate do you set a simple mask at, and how much pure O2 is the patient getting? 5-8 L/min and 40 - 60% O2
What rate do you set a non-rebreather mask at, and how much pure O2 is the Patient getting? 10-15 L/min and 80-95% O2
Which mask delivers the most accurate O2 concentration? Venturi Mask
What pressure is suction maxed out at and what is the max time you can suction at one time? 120 mmHg and 10-15 sec.
How much fluid can you suction at one time and why? 1L of fluid max to avoid cardio collapse
What size induration of the skin after a PPD indicates a positive TB test? Greater than 10mm
How many sputum tests are needed to show that the Pt is clean of TB? 2-3
What dilution should potassium be at when infusing? 40 to 80 mEq in 100 mL of IV solution
Which medications can be diluted in blood when transfusing blood? No medications can be added to blood products.
How many nurses should be checking the blood when transfusing and what are they looking for? 2 nurses check for gas bubbles, cloudiness or discoloration.
How large can varicose veins get before they are removed? 4mm
What does garlic do to the blood? It thins the blood.
What medication should be considered for A Fib and what electrical management is considered? Amioderone, and it manages the electrical synchronized cardioversion.
What medication should be considered for V tach and what electrical management is considered? Amioderone and defibrilation.
After defibrillating or cardioversion a patient, what stpes are taken by the nurse? Check vitals, airway patency, and obtain an ecg.
What medication should be considered for bradycardia and what electrical management is considered? Atropine and a pacemaker
What level of Human B-type natriuretic peptides (BNP) are considered mild, moderate and severe heart failure? mild = 300 and above. Moderate = 600 and above. Severe = 900 and above.
Concerning heart failure, what daily and weekly weight gains are bad? Daily - 2lb, weekly - 5lb
What level of BP is considered hypertension? 140/90 or greater
Chest pain and ST segment depression or elevation are signs of what specifically? MI
How can a nurse tell the difference between an MI and an angina attack? Pain unrelieved by rest, nitro and lasting more than 15 minutes
When a patient gets a liver biopsy, what is a common nursing intervention for resting? Lay on the biopsied side, in this case the right side?
What lab tests are you going to get after a suspected I or cardiac muscle injury? Myoglobin – Levels no longer evident after 24 hr ☐ Creatine kinase-MB – Levels no longer evident after 3 days ☐ Troponin I – Levels no longer evident after 7 days ☐ Troponin T – Levels no longer evident after 14 to 21 days
What are some indications for needing a pacemaker? Bradycardia, complete heart block, sick sinus syndrome, atrial and ventricular dysrhythmias.
How long does the battery in a pacemaker last? 10 years
What are some indications that the pacemaker may be stimulating the diaphragm? hiccups and muscle twitching
When should a patient take their pulse when they have a pacemaker? The same time every morning
Where is the tip of the PICC line end up? Superior vena cava
How long is a PICC line? 40 to 65 cm with single or multiple lumens
How ling can a PICC line stay in the Patient? 12 months
What allergies should be accessed before putting a contrast media in a patient? Shellfish and Iodine
Do you take Iron supplements with or without meals? With
What are some common signs of leukemia? Increased WBC, increased bleeding time, decreased HGB and hematocrit
What are some signs of a HT crisis and what is the main medication used? Also, what is the major reason for it? Reason - Patient does not follow the medication therapy regimen. Signs - Severe headache, BP over 240/120, epistaxis, blurred vision, dizziness, disorientation. medication - nitroprusside (Nipride), nicardipine (Cardene IV), and labetalol all IV.
What position do you put a patient in when the patient is undergoing shock? Trendelenberg position - feet higher than head.
what is the best indicator of pulmonary edema? orthopnea - difficulty breathing while laying flat
What is a max glasgow coma number, what needs to be monitored and what is a coma score? 15 = max, 8 needs to be monitored and 3 is a coma
What is a babinski's sign used for and what is it? When the sole of the foot is rubbed and the toes fan out. This is a sign of head or spinal trauma.
What is a normal ALT level and what disease affects this? Hepatitis. Normal = 8-20 units/liter
What can you not consume before getting an EEG? Caffiene - if consumed the r=test needs to be redone or an alternate test needs to be done
Which vertebrae are usually damaged when there is breathing trouble and the patient becomes quadriplegic. (Phrenic Nerve Damage) C3-C5
What is the most definitive test for bacterial meningitis? CSF (spinal tap)
What is Myopia a risk factor for what? Retinal detachment
What kind of diet does a patient need for pulmonary edema? Consume a diet low in sodium along with fluid restrictions and consult with the provider regarding diet specifications. ● Refrain from smoking.
What is paralytic ileus? When the bowel isn't moving
What are some priority GI assessments for hypokalemia? decreased motility, abdominal distention, constipation, paralytic ileus, nausea, vomiting, anorexia
What are some side effects of hypertension medications (ace inhibitors and beta blockers)? Clients who are taking antihypertensives should be instructed to change positions slowly, be careful when getting out of bed, driving, and climbing stairs until the medication’s effects are fully known
What is a big side effect of diuretics? Hypokalemia - muscle weakness, irregular pulse, and dehydration. Thiazide and loop diuretics can cause hypokalemia, and potassium-sparing diuretics can cause hyperkalemia.
What angle does insulin go into the fat? 90 degrees
What are signs of hyperglycemia? hot dry skin and fruity breath
A client with visual problems due to diabetes should get eye exams how often? yearly
What are some client education points with propranolol? ☐ Advise the client to take the dose with meals to increase absorption. ☐ Teach the client to check apical pulse prior to each dosage. ☐ Advise the client to notify the health care provider of significant changes.
What are some signs of hepatitis B? Objective Data Physical Assessment Findings ■ Low grade fever ■ Right upper quadrant abdominal pain ■ Nausea and vomiting ■ Jaundice ■ Dark urine
Another name for hyperthyroidism? Graves disease
What are some lab results that show hyperthyroidism? Serum TSH test – Decreased in the presence of Graves’ disease ■ Free thyroxine index (FTI) and T3 – Elevated ■ Thyrotropin-releasing hormone (TRH) stimulation test – Failure of expected rise in TSH
What are some findings to report in an intestinal obstruction? hematocrit at 60%, urine specific gravity at 1.040, low potassium levels.The urine specific gravity and hematocrit findings indicate significant dehydration
Why is nasogastric decompression done, and what are the S/S? Nasogastric decompression is a procedure done for client’s who have an intestinal obstruction. Bowel sounds may be absent (paralytic ileus) or hyperactive and high pitched (obstruction)
What should the nurse monitor to avoid complications in a nasogastric decompression? Monitor the client for an increase in abdominal pain, abdominal rigidity,fever, tachycardia, and hypotension.
What are some good lab values for cushings disease? Excessive glucocorticoids can cause sodium and water retention. Reduced glucose metabolism may cause hyperglycemia. Hypocalcemia and hypokalemia are also consistent in a client who has Cushing’s disease. BUN and creatinine levels should not be elevated.
What is the greatest risk for someone with cushings disease and how should it be monitored? The greatest risk to a client who has Cushing’s disease is fluid retention, which can lead to hypertension and heart failure. The nurse should weigh the client daily, check extremities for peripheral edema, assess neck veins for distention. Breath sounds.
What is a positive kernigs sign and what will it tell you? Positive Kernig’s sign = resistance and pain with extension of the client’s leg from a flexed position. It could be a sign of meningitis.
What are some points in discharge teaching for a hysterectomy? Instruct the client about a diet that is high in protein and vitamin C for wound healing, high in iron if anemic. ■ Instruct the client to restrict activity (heavy lifting, strenuous activity, driving, stairs, sexual activity) for 4 to 6 weeks.
What are some points in discharge teaching for coronary bypass grafts? Teach signs of infection. Treat angina - nitro and rest, healthy diet, light PT, Sex is safe after light PT is symptom free. Report weight gain.
If a surgical wound comes open, what are the steps to take? Call for help, stay there, cover the wound with a sterile towel or dressing that is moistened with sterile saline, do not attempt to reinsert organs, monitor the client for shock.
What are signs of infection around a surgical site? An area of redness indicates the possibility of infection, and the client should notify the provider. Fever is also a sign of infection and should be reported to the provider. An antibiotic ointment may be prescribed to prevent infection.
what are signs of digoxin toxicity? fatigue, muscle weakness, confusion, and loss of appetite.
If you are replacing fluid (crystaloids) for a PE client, what is a complication of that? IV fluids can contribute to pulmonary hypertension for clients who have right-sided heart failure (cor pulmonale).
What are some lab tests for colorectal cancer? Fecal Occult Blood Test (FOBT) - 2 samples within 3 days. no meat, NSAIDs, and vitamin C. Carcinoembryonic Antigen (CEA) serum test – CEA levels are elevated in most individuals with CRC. Hct and Hgb decreased
What are some complications of Peptic Ulcer disease? Perforation/hemorrhage(rigid abdomen, tachycardia, pain in R shoulder, rebound tenderness), pernicious anemia, dumping syndrome
What are IBD diet considerations? High protein, high calories, low fiber, avoid caffeine and alcohol, take iron supplements, eat small frequent meals
Discuss how you monitor a chest tube system? To maintain the water seal, the chamber must be kept upright and below the chest tube insertion site at all times. The nurse should monitor the water level due to evaporation. The nurse should add fluid to maintain the 2 cm water seal level.
How will the outcome of hypothyroid treatment be evaluated? The TSH level.
What urine output should a patient have postoperatively? 30 mL/hr - less should be reported
What is a reportable JP drain amount? 2 times the amount previous
What is a reportable finding in the legs (possible DVT) post operatively? Erythematous swollen warm area on left calf; calf pain on dorsiflexion
What are some lab values showing renal failure (Nephrotic Syndrome)? Blood glucose, blood pressure, serum electrolytes (less NA & CA, more K, Ph, Mg), serum creatinine (increase), arterial blood gases, and urine output
What are some good Post-op pain medications? Opioid analgesics (morphine sulfate, fentanyl [Sublimaze], codeine)
What medication do you not give with accutane? prednisone
When receiving external radiation therapy, what kind of diet should the patient eat and why? No red meat - Radiation can cause dysgeusia, making foods such as red meat unpalatable.
After a bariatric surgery, what is the max food amount that a patient can eat? 1 cup / 8 oz after the patient has been cleared to eat. (30 mL liquid for first couple meals only) also - 2 servings of protein a day at least.
What is the normal range for serum creatinine and what does it indicate? 0.6 to 1.2 mg/dL - indicates renal function
What is the normal range for BUN and what does it indicate? 10 to 20 mg/dL - indicates renal function
What is the normal range for 24 hr Urine Creatinine Clearance and what does it indicate? 80 - 140 mL/min - indicates reduced renal blood flow.
What is the normal phosphate level? 3.5 to 4.5 mg/dL
What is the normal sodium level? 136 to 145 mEq/L
What is the normal potassium level? 3.5 to 5.0 mEq/L
What is the normal chloride level? 98 to 106 mEq/L
What is the normal calcium level? 9.0 to 10.5 mg/dL
What is the normal Mg level? 1.3 to 2.1 mEq/L
What are some good signs of left sided heart failure? Dyspnea, orthopnea (shortness of breath while lying down), S3 heart sound (gallop), Pulmonary congestion (dyspnea, cough, bibasilar crackles)
What is a good example of an emergency situation when considering esophageal issues? Esophageal Varicies that are actively bleeding is a medical emergency.
What is extravasation? unintentional infiltration of a vesicant medication that causes tissue damage.
How do you apply a 12 lead ECG? Attaching one electrode to each of the client’s extremities by applying electrodes to flat surfaces above the wrists and ankles and the other six electrodes to the chest, avoiding chest hair.
What position is the patient in when getting a 12 lead ECG read and what should the nurse monitor? supine. Monitor the client for signs and symptoms of dysrhythmia (chest pain, decreased level of consciousness, and shortness of breath) and hypoxia.
After taking nitroglycerin for heart pain, how many doses can the Pt take, how spaced apart and at what point does the Pt call 911? 3 doses - if pain is unrelieved after the first dose, call 911 (5min) and space them 5 minutes apart
What is a serious side effect of an inhaled anesthetic and what is the emergency treatment? Malignant hyperthermia is a life-threatening risk of inhalation anesthesia. Prompt administration of 100% oxygen, dantrolene (skeletal muscle relaxant), and a cooling blanket is vital for survival
Name some ototoxic medications? Gentamicin, lasix, nsaids, cisplatin (chemo med)
What is a common side effect for lupron (Prostate cancer medication) Hot flashes
What is a normal range for serum albumin? 3.1 - 4.3 g/dL
What aldrete score allows the patient to be discharged from the PACU? 8-10, but ABC is most important
What is a good PaO2 level? 80-100
What is a good PaCO2 level? 35-45
What is a good HCO3 level? 22-26
What is a good specific gravity level? 1.005 - 1.030
What is a good digoxin level? 0.5 - 2.0 ng/mL
pH 7.28 PaCO2 56 mm Hg HCO3- 25 mEq/L SaO2 89% - what is this? Respiratory acidosis
pH 7.28 PaCO2 43 mm Hg HCO3- 18 mEq/L SaO2 96% - What is this? Metabolic Acidosis
pH 7.50 PaCO2 36 mm Hg HCO3- 27 mEq/L SaO2 97% - What is this? Metabolic alkalosis
pH 7.48 PaCO2 33 mm Hg HCO3- 24 mEq/L SaO2 96% - What is this? Respiratory alkalosis
What diseases constitute a droplet precaution? Influenza type B, pertussis, plague, strep pneumonia
What diseases constitute a contact precaution? C Diff, herpes simplex, impetigo
What diseases constitute an airborne precaution? Measles, varicella, TB
After cataract surgery, how soon will normal vision return? After 4-6 weeks
What kind of antacids should cipro not be taken with? Any antacid containing aluminum
What are treatments for Syndrome of inappropriate antidiuretic hormone (SIADH) Treatment of SIADH consists of fluid restriction, administration of oral demeclocycline (Declomycin), and treatment of hyponatremia.
What three drugs can cause drug induced lupus? Procainamide, hydralizine and isoniazids
What class of drugs reduces the size of the prostate? 5 alpha reductase inhibitors (finasteride)
SLE (lupus) has what kind of rash? Butterfly across the nose
What is a good red blood cell amount? Females: 4.2 to 5.4 million/uL Males: 4.7 to 6.1 million/uL
What is a good WBC count? 5,000 - 10,000
What is a good platelet count? 150,000 - 400,000
What test and what is the normal range for it will be ordered for hemophilia? aPTT - 1.5 to 2 times normal range of 30 to 40 seconds (desired range for anticoagulation)
What is a good hgb level? Females: 12 to 16 g/dL Males: 14 to 18 g/dL
Which test measures vitamin B12 absorption with and without intrinsic factor. It is used to differentiate between malabsorption and pernicious anemia. Schilling test
Created by: joekosch