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MS Final Exam

Pts immune system not working very well highest priority is wash your hands
Older postop pt who has a wound infection, what finding on assessment first sign is confusion
What would a nurse do to stay protected against aids pt standard precautions
HIV pt assessing them how do you know how the disease has progressed to aids opportunistic infections; yeast infection, thrush (infections most people aren’t affected by)
Try to ambulate pt w/ anemia signs of an issue dyspnea on assertion. HR abnormal respiratory rate ↑ 20 abnormal HR ↑ 100
Pt has a lot of bruising ask pt if they are on aspirin
Planning care platelet count 30,000 mm plan of care Too low, so pt is at risk for bleeding
Nursing obtaining history for pt w/ iron deficiency anemia what would correlate w/ dx vegetarian who doesn’t eat red meat
Blood levels low take iron and folic acid; If wbc low take zinc and folic acid. C/B bone marrow not producing enough or autoimmune disease, AIDS, chemo ect. low platelet precautions: CB chemo r/f bleeding. Can get an infusion of platelets to increase.
Pt has thrombo cytopenia (↓ platelet count) low platelet count; what instructions to gv to pt on discharge; don’t use hard tooth brush electric razor avoid aspirin
Pt has excessive catecholamine release; adrenaline release, epinephrine, and norepinephrine causes sympathetic response ↑ hr and ↑ resp
Pt has hormone deficiency most important one to monitor Thyroid hormone
Pt has acromegaly abnormal growth hormone release. ↑ in feet, hands, and jaw; can expect soft tissue changes but not bone
Pt who SIADH what happens Retain fluid; delusional hyponatremia. HOLD fluids for pt
Pt has Spiro lactone- potassium sparing diuretic what should they avoid eating avoid K +
↑ dose corticoid steroids must be weaned off b/c adrenal gland needs to start producing hormones again
Dietary hyperthyroid ↑ calories, carbs, and proteins b/c body needs more of these to burn off due to ↑ energy level
Pt has subtotal thyroidectomy hypocalcemia; check w/ trousseau and chevosicks
Hypoglycemia give pt 4 oz juice; complex carb= if unable to swallow give glucagon (releases glucose from liver).
Pt 15 yr hx of DM; Pt can’t feel anything in feet check to mk sure tack not in foot ect
Pt DM visually impaired wants to know if daughter can draw up meds 3 weeks refrigerated w/ needles upright
Keto acidosis what to expect fruity breath; rapid and deep respirations
Pt on IV insulin for hyperglycemia monitor Potassium b/c insulin drives K into cells.
Assessing pt, nurse thinks pt could have respiratory acidosis what kind of pts at r/f hypo ventilating, COPD, asthma, and opioids (↓ O2 & ↑ CO2)
Pt getting discharged teach them r/f metabolic alkalosis taking antacids
Pt has COPD has cough low grade temp what info would be useful to have has sputum changed color (might be viral or not urgent)
Pt has asthma can’t get a deep breath in, decreased breath sounds and no wheezing check oxygen saturation.
When checking 4 pt’s w/ asthma which one you assess first HR is ↑ b/c pt could be in distress
Pt has frequent asthma attacks and severe arthritis pain Ask pt which meds they take b/c NSAIDS can trigger asthma
Pt being sent home on inhaled corticoid steroid meds nurse should teach pt rinse mouth out after, don’t use for rescue inhaler; used for long term
Pt w/ lung disease which symptoms would nurse know to intervene Check breathing, check hr, accessory muscles, or edema
Pt worried about catching flu tell pt to get flu shot
Pt has pneumonia wants to know how to get rid of sputum drink atleast 2L of water a day
Pt has nicotine patch and wants to smoke DON’T; can cause heart attack
Pt dizzy from supine to sitting orthostatic hypotension, what should nurse do? check bp
Cardiac Cath procedure what should the nurse check before the procedure Check for iodine or shellfish allergy b/c of contrast dye
Assessing pt in outpatient clinic how would you know if Left sided heart fail Crackles, winded easily, poor exercise tolerance
Admitting pt to pcu what might tell you the pt has right sided heart failure lower extremity edema
Pt prostatic valve replacement risk for getting blood clot
Pt has severe heart failure what position is best sit pt up w/ pillows under arm in high fowlers
Pt chart has order lovastatin what should you monitor for?= watch liver enzymes (statins metabolized in liver)
Pt new dx hypertension avoid sodium & canned foods
Pt w/ venous ulcer assessment findings brown discolorations
Pt has peripheral artery disease had percutaneous angioplasty monitor for bleeding or occlusion
Pt on warfarin pt says are you going to take me off heparin keep on cpl days b/c warfarin takes a couple of days to get to therapeutic levels.
Pt has suspected coronary disease what’s the difference between angina and MI angina relived w/ nitro/ rest
Lab test w/ chest pain Check Troponin 1
Pt has glaucoma what increases IOP that patient should avoid don’t bend over, don’t wear tight shirt or ties, don’t strain
Pt w/ macular degeneration where would you put the tv on side of the pt
Which med puts pt at ↑ risk for hearing loss Gentromyocin (antibiotics)
Pt has ruptured ear drum wants to know what to do now ear drum will prob heal by itself
Meniere’s Disease is an inner ear disorder and causes dizziness, vertigo, tinnitus; has a lot of vertigo stand up slowly, don’t bend over, ask for help: look up right answer; The vertigo may cause severe nausea and imbalance. Hearing loss may become permanent.
Pt has migraines and is on beta blockers to help manage them teach pt monitor pulse
Pt has bacterial meningitis what to know who they came into contact w/; know if living in dorm, group home ect
Parkinson’s how would you help to prevent respiratory complications sitting pt up, limit exercise,
Daughter has Alzheimer’s want to know new med if going to make dementia better will only slow it down, but won’t make disease better won’t cure
Pt has Alzheimer’s is going home what are some safety things bracelet, geri-chair, distractions, door locks
ALS and MS difference ALS kills you respiratory; Pt can live a long time w/ MS
When assessing pt what to expect to find (ascending when getting worse)= Descending when pt is getting better.
Pt with Myasthenia Gravis take meds what do they need about eating and timing w/ meds Take meds 45-60 minutes before they eat. (increases muscle strength and helps w/ swallow)
Pt has a brain attack is a stroke causes embolic stroke dysrhythmias- atrial fib
Immune system want to know what antibodies do fight off infection… neutralize virus, mark bacteria to be destroyed by wbc, activate compliment system
Anterior pituitary hyperfunction what physical characteristics would you see protrusion of the jaw, deepens voice, enlarged hands/feel, cyphosis, sweating (diaphoresis)
Fml pt in ER what kind of symptoms that would say EKG fatigue when resting, indigestion, sob, bloated
Pt prescribed diuretic (loop) for control of htn teach diet high in K; fluid loss lowers bp so change positions slowly, causes confusion
Bacterial meningitis should be doing in plan of care wash hands, droplet ISO
Pt discharged who has epilepsy= fenotonin let pt know need to wear med alert bracelet, seizure diary, take meds at same time every day, avoid triggers
Pt w/ Parkinson what symptoms Pill rolling motion, shuffling gait, tremors, no facial expressions
Cataracts what would you expect to see Blurred vision, halo effect
Pneumonia temp resp 30 bp 130/76 hr 100 O2 stat 91% give Oxygen, get sputum culture, give antibiotics, give antipyretic for fever
Left sided HF s/s Dyspnea, orthopnea, nocurnal dyspnea, fatigue, displaced apical pulse, S3 heart sound (gallop), pulmonary congestion (dyspnea, cough, bibasilar crackles), frothy sputum, altered mental status, oliguria (decreased urine output).
Right sided HF s/s Jugular vein distention, ascending dependent edema, abdominal distention, ascites, fatigue, weakness, nausea and anorexia, polyuria at rest (nocturnal), liver enlargement (hepatomegaly) and tenderness, and weight gain
Pt has multiple sclerosis early onset what are the s/s Fatigue is the first symptom, sensitivity to temp, stiffness in extremities Flexor spasms esp at night, deep tendon reflexes, positive Babinski’s reflex, and absent abdominal reflexes.
Pt has status epilepticus what drug/drugs (seizure longer than 5 minutes) Diazepam (valium, lorazapama), Phenytoin (Dilantin)
Tonic seizure Tonic-clonic seizure= lasts 1-2 min, but not more than 5, alteration in vision, smell, or emotional feeling. Tonic Phase: Stiffening of muscles, loss of consciousness, cessation of breathing, dilated pupils, and development of cyanosis.
Clonic Phase Seizure Rhythmic jerking of extremities, irregular resp, biting of the cheek or tongue, bladder/bowel incontinence.
Postictal Phase May last for several hours; unconsciousness may last for 30 minutes. Pt awakens slowly and is usually confused and disoriented. PT often reports headache, fatigue, and muscle aches. Pt may not have memory of what happened just before the seizure.
Absence seizure Most common in children; loss of consciousness lasting a few seconds, blank staring, and automatisms (behaviors that pt are unaware of, such as lip-smacking or picking at clothes). Resumes baseline neuro function, with no apparent sequelae.
Partial or focal/local seizure Seizure activity begins in one cerebral hemisphere.
Complex partial seizure Have associated automatisms, loss of consciousness for several minutes, amnesia may occur immediately prior to and after the seizure.
Simple partial seizure Consciousness is maintained throughout. Activity may consist of unusual sensations, a sense of déjà vu, autonomic abnormalities (change in HR) unilateral abnormal extremity movements, and or offensive smell.
Unclassified or idiopathic Seizures Don’t fit into other categories. These types account for 50% of all seizure activities, and occur for no known reason.
Guillain-Barre syndrome is a disorder causing demyelination and axonal degeneration resulting in acute, ascending and progressive neuropathy, characterized by weakness, paranesthesia and hyporeflexia.
Client has lump in breast; tearful scheduling mammogram; what do you tell her? a. Explore feelings – reassure b. Unless there is a relative – it may be benign
Endometriosis patient – married and children – thinks she’s infertile a. Not always infertility
Age 20 – endometriosis s/s a. Pain with intercourse b. Pain while on period
Finasteride for 4 weeks – no reduction in symptoms what should you tell the patient? a. It can take up to months for results to be seen
Benign prostatic hyperplasia pt is having difficulty urinating what should you tell pt? a. Prostate is providing pressure on the urethra
Nurse doing an assessment there is a lesion – smooth integrated area a. Put on gloves
Syphilis precautions a. Gloves when touching skin
Pelvic inflammatory disease from gonorrhea – sterility cause? a. Could cause scaring in fallopian tubes b. Untreated for long time
Disease process – ectopic pregnancy cause Pelvic inflammatory disease
Bacterial meningitis – plan of care a. Plan to monitor for tachycardia b. Provide emesis basin c. Administer antipiuretic medication d. Skin assessment e. Elevate head of the bed d/t increased risk for ICP
Phenytoin – instructions a. Don’t drive until 6 months’ seizure free b. Medical alert bracelet c. Seizure frequency diary d. Avoid triggers e. Take medicine as prescribed
Prevention of resp complications in parkinson’s patient a. Head of bed 30 degrees or more to prevent aspiration
Created by: acacianero
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