Exam #1
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Lymphatic Vessels | Bring fluid from interstitial space back to blood vessels. Empty into the subclavian veins.
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| Spleen Functions | Produces antibodies, filters old RBCs, and destroys old RBCs
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| Splenectomy procedure and risk | Removal of the spleen which results in an increased risk for infection due to the removal of the immunity functions of the spleen.
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| Thrombocytes | Platelets with coagulation factors
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| Universal donor | O-; can donate to all blood types
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| Blood type A or B can donate to... | AB
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| Can Rh+ donate to Rh- | NO...Rh- cannot receive + blood.
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| Can Rh- donate to Rh+ | Yes.
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| Only IV fluid hung with blood products | Normal Saline
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| Time for s/s to appear for a reaction to donated blood products. | 15-20 minutes. RN must stay with pt during this time to verify no adverse reaction to blood.
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| S/S of blood transfusion reaction | Chills, Fever, SOB, Tachycardia, back pain, HA, chest pain, hypotension.
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| If s/s of hemolytic reaction occur when a patient is receiving blood transfusion... | STOP infusion immediately, notify physician and notify blood bank. Incident report may be needed, per agency policy.
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| Length of time a unit of blood can hang | 4 hrs. Must then discard. If greater duration is required or fluid overload occurs, may call blood bank and have unit split into smaller units.
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| Procedure when additional fluids are needed during blood transfusion. | RN will need to start another line. Additional fluids may NOT be piggybacked.
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| Pre-transfusion check | 2 RNs needed to positively identify patient and blood unit ID. Blood hung on pump.
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| IV gauge for blood transfusion | IV gauge 18-20
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| Liver function | Produces bile, Metabolizes, Synthesizes coagulation factors VII, IX, X, and prothrombin. Stores Vitamins and glycogen.
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| Lymph nodes to be concerned about | Greater than 1 cm, hard, and immobile.
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| Hematology diagnostic tests | Blood chemistry, Hematologic studies, Bone marrow aspiration/biopsy, Coagulation studies, Bone scan, Schilling test.
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| When use of radioisotopes during diagnostic test is required, RN needs to assess for what type of allergy. | Shellfish allergy
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| Hematocrit should be about __x greater than hemoglobin | 3x
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| HgB value when blood transfusion is usually required. | 9
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| Lovenox dosing is based on.. | Patient's weight
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| INR normal value | 1-2; patient's with cardiac issues may be 2.5-3.5
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| Platelet normal value | 150,000-400,000.
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| Increase in platelet value = | Blood clot, affects on the cardiac and respiratory system due to higher blood viscosity.
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| Decrease in platelet value = | Increased risk for bleeding
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| Primary blood dyscrasias | Problem with the blood...i.e sickle cell
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| Secondary blood dyscrasias | A cause other than defect in blood...i.e malnutrition, drugs, disease processes.
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| Sickle cell is more prevalent in... | African Americans
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| Sickle cell can cause | Clots which lead to hypoxia which leads to tissue necrosis.
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| Anemia | Result of decreased production, increased RBC destruction, or blood loss
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| Polycythemia | Results from hypoxia, erythropoietin, secreting tumors, kidney disease, genetic defects. Increases blood viscosity = clot.
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| Hypochromic Anemia | Iron or vitamin deficiency. Most common anemia.
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| Pernicious Anemia | Lack of intrinsic factor. Occurs with GI issues. TX: B12 shots monthly for the rest of their life.
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| Erythroblastosis Fetalis Anemia | Pregnant mother with Rh- blood, is exposed to baby's Rh+ blood. The mother produces antibodies and attacks fetus' blood. AKA hemolytic anemia
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| Secondary Anemia | Caused by bleeding, trauma, leukemia, cancer, kidney disease.
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| Anemias caused by genetic factors | Sickle Cell Anemia or Spheroidal
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| Aplastic Anemia | Caused by malfunctioning bone marrow.
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| Anemia is more prominent in... | Women then children, especially pregnant women.
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| High risk groups for anemia | Pregnant women, women, children, poor dietary intake, PUD, long term ASA use, colon cancer.
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| Signs and symptoms of anemia | Pallor, fatigue, weakness, dyspnea, brittle nails, pica, headache.
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| Iron supplements | Best on empty stomach, vitamin C increases absorption. SHOULD NOT be given with milk or antacid.
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| Vitamin that increases iron absorption | Vitamin C
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| Considerations when giving IV iron | Could have anaphylactic reaction. MUST do test dose first. Requires a separate IV site
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| Considerations when giving IM injection of iron | Deep IM injection using z-track. Change the needle and aspirate.
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| Dietary sources of iron | Dark green leafy vegetables, Beans and peas, dried fruits, eggs, nuts, raisin, seafood, spinach, whole grain
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| Dietary sources of B12 | Eggs, meat, poultry, shellfish, milk and milk products.
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| Dietary sources of Folate | Fruits and vegetables.
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| Dilantin use related to folate | Dilantin (used for seizure control) does not allow patient to absorb folate.
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| Patients who may have trouble absorbing folate... | Pts using dilantin, ETOH, or hemodialysis.
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| Treatment for polycythemia vera | Removal of blood, IV fluids
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| Possible complications of polycythemia vera | Stroke, MI, embolism, infection (due to immature WBC), bleeding (platelets are immature), poor perfusion, stasis ulcers.
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| Hemophilia | Genetic disorder which could cause excessive bleeding.
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| Increase in WBC precursors with accumulation in bone marrow or lymph tissue is sign of... | Leukemia
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| Blasts | Immature WBCs
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| Decrease in WBCs | Neutropenia, lymphocytopenia
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| Increase or decrease in WBCs causes and increase in... | Risk for infection. (When WBCs increase rapidly there is decreased immune function due to immature cells)
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| Neutropenia | Decrease in neutrophils. Caused by cancer, immunosuppressive disease/therapy, HIV, Lupis
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| Leukopenia | Decrease in WBC
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| Increase in WBC is what kind of infection | Bacterial
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| Decrease in WBC is what kind of infection | Fungal or viral
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| Patients with leukopenia need to have what type of precautions | Reverse isolation: no kids, keep in room as much as possible, no sick visitors or staff, wash fruits and veggies thoroughly (cooked is best), monitor temp every 4 hours, mask gown when leaving room.
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| Precautions for radiation therapy site. | No soap or lotion can be applied to area. Wash with warm water only.
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| Signs and symptoms of leukemia | Fever or night sweats, frequent infections, feeling weak or tired, headache, bleeding/bruising, bone and/or joint pain, swollen lymph nodes, weight loss
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| Blood tests for leukemia | CBC, platelets and HCT/HgB. Bone marrow biopsy.
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| Side effects for chemo | Bruising, fatigue, infection, bleeding, hair loss, nausea, vomiting, diarrhea, anorexia
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| Monoclonal antibodies | Used for tx of CLL(Chronic lymphocytic leukemia. Binds to leukemia cells and enables immune system to kill cell.
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| Interferon | Slows growth of cells. Mostly used for GI/Colon cancer
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| Biological therapy side effects | Rash/swelling at injection site, anemia, flu like symptoms. Not as severe as with chemo/radiation.
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| Radiation and chemo must occur before ... | Bone Marrow Transplant
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| Radiation therapy side effects | Fatigue, redness, dryness, tenderness at the site of therapy.
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| If there is an order for wound care on a radiation site, the nurse needs to .... | Talk to the radiologist before performing wound care.
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| Side effects of Bone Marrow Transplant | Infection, bleeding, s/e from high doses of chemo and radiation (which must occur before BMT)
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| Hodgkin's lymphoma | Malignant.
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| Lymphatic cancer is usually... | Systemic
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| Lymphoma signs and symptoms | Fatigue, night sweats, temperature, swollen lymph nodes (greater than 1 cm, hard, and immobile).
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| PICC and central line dressing changes are... | STERILE
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| Thrombocytopenia | Deficient number of platelets
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| Teach pts with thrombocytopenia to avoid.. | ETOH, ASA, and NSAIDS
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| Symptoms of thrombocytopenia | Sudden onset of petechiae, malaise, fatigue, general weakness.
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| Epistaxis | Nose bleed
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| PICCS are usually used for about....weeks before changing. | 6 weeks. Keep clean, flush, and perform sterile dressing changes.
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| Ferrous sulfate and antacids must be taken at least __ hours apart. | 2 hours
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| Prior to surgery, any abnormal labs need to be reported to... | The surgeon/physician
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| Clinical signs of stress | Nausea, vomiting, diarrhea, increased pulse, increased respiratory rate, increased blood pressure, diaphoresis
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| Anxiety can impair... | Cognition, decision making, and coping skills. Pts will not learn while anxious.
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| Perhaps the strongest positive coping mechanism... | Hope
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| Pre-op assessment includes.. | Health history and physical. Ask about Medications, family history, allergies, past reactions to anesthesia, past surgeries, infections (especially airway), COPD, asthma, smoking history, skin integrity.
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| Postoperative delirium can occur with... | Dehydration, hypothermia, and adjunctive medications.
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| Problems affecting the neck or lumbar spine need to be relayed to PCP because... | They can affect airway management and anesthesia delivery.
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| Patient's with diabetes mellitus are especially at risk for... | Hypo/hyperglycemia, ketosis, cardiovascular alterations, delayed wound healing, infection.
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| Assessment for pts with diabetes mellitus prior to surgery.. | Serum glucose tests morning of surgery (baseline). Clarify with physician if insulin should be taken.
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| Drugs to check with doctor before giving the morning of surgery. | Insulin, thyroid meds, steroids
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| Abruptly stopping replacement corticosteroids could cause... | Addisonian crisis
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| Given oral meds when pt is NPO | May take meds with sip of water. Document appropriately.
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| IF a pt is NPO, the RN needs to double check to see if there is an order for... | IV fluids. If not the RN needs to call the physician and see if one needs to be ordered.
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| Implications of obesity on surgical procedures. | Stresses cardiac and pulmonary systems, increased risk of wound dehiscence and infection, slower recovery from anesthesia (meds hide in the adipose tissue), slower wound healing.
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| Considerations for underweight pts | May need to provide extra padding to prevent pressure ulcers.
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| Legal preparations prior to surgery. | Informed consent, signature for blood transfusion, advance directives and power of attorney.
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| If MPOA is approving a procedure over the phone... | 2 RNs need to witness
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| Immediately prior to transportation to holding room for surgery, the nurse should have the patient....prior to medication administration. | VOID :)
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| All patients are urged to stop smoking .....weeks before surgery. | 4-6 weeks
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| Patients prone to latex allergies may also be allergic to... | Avocados, bananas, peaches. Have asthma or hay fever.
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| Pre-op labs and diagnostic tests | Blood studies (CBC, electrolytes, coagulation, blood type and match), UA, EKG, CXR
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| Pre-op teaching | Deep breathing, incentive spirometry, splint incision, turn, reposition (prevent atelectasis/pneumonia). Leg exercises and antiembolic SCDs.
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| Role of the Scrub Nurse | Provides the surgeon with required instruments, sponges, drains, and other equipment, anticipating what will be needed. Prepares sterile tables prior to surgery.
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| Holding area | Complete preoperative preparations
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| Circulating nurse | Manages/coordinates patient care in the OR, protects safety/health needs, ensures rights are protected (controlling cleanliness, temp, humidity, and lighting).
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| The circulating nurse and the scrub person are responsible for accounting for all..... | Sponges and instruments at the close of surgery.
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| One of the most significant potential hazards to the pt in the OR is... | Electricity (electric shock and burns)
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| Time out or procedural pause | Before surgery or a procedure, surgeon and nurses will verify correct patient, surgical site, informed consent, etc.
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| General anesthetic | Produces analgesia, relaxes muscles, results in a sleep-like state. Patient will be intubated.
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| Regional anesthetic | Produces decreased sensation and pain in selected body parts by way of nerve blocks, intrathecal blocks (in brain), or epidural blocks.
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| Local anesthetic | Depresses superficial peripheral nerves and blocks conduction of pain impulses from their site of origin.
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| IV Conscious Sedation | Diazepam/Valium, Midazolam/Versed. Usually need RN present constantly during conscious sedation.
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| Cardiac meds need to be Ok by..... prior to discontinuation for a procedure. | Cardiologist
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| Skin staples | Reduces tissue handling and accomplishes wound closure faster than suturing. Usually removed within the first week after surgery.
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| Malignant hyperthermia | Reaction to anesthesia. Ask pts prior to surgery if they have any family member who have experienced this. Without antidote, the pt dies.
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| S/S of malignant hyperthermia | Increased temperature, rigid muscles
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| PACU Care | One on one. Monitor pain, vitals, drains, cardiac monitor, take vitals every 15 mins and document.
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| Loud, irregular respirations may indicate....after surgery. | May indicate obstruction of the airway, possibly from emesis, accumulated secretions, or patient positioning that allows the tongue to fall to the back of the throat.
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| If respiratory rate in decreased or O2 sats are 90-92... | Raise HOB and encourage patient to take deep breaths.
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| Decreasing BP and increased pulse rate in the post-op patient may signify... | Hemorrhage or shock
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| Sinus Bradycardia | All intervals of PQRST wave normal, just slow pulse. Monitor V/S
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| Sinus Tachycardia | All intervals of PQRST wave normal, just fast pulse. Monitor V/S. Assess pt for cause.
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| Atrial Fibrillation | Atria contracting spontaneously, ventricles can contract normal part of the time. Atrial rate may appear to be 350-600 while ventricle rate is 100-160
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| 2 shock-able waves | V tach and V fib
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| Ventricular Fibrillation | DEADLY RHYTHM. Rapid uncoordinated firing of the ventricles. This rhythm does not generate a pulse. Interventions: Quickly check pulse, if no pulse, De-fibrillate immediately.
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| Before giving water or ice chips to post-op patient... | Assess for gag reflex.
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| When a pt is transferred from PACU to Med/Surg, assess condition every... | 15 minutes for the first hour, every 30 minutes for 2 hours, every hour for 4 hours, then every 4 hours as needed.
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| If bleeding is noticed on a post-op bandage... | Circle blood and time bandage, then recheck every 15 minutes.
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| Before discharge from an ambulatory surgical center, the patient should... | Be able to void and ambulate independently (or up to baseline), be alert and oriented, have minimal nausea and vomiting, have a person to accompany them home.
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| If pt has flatulence or risk of paralytic ileus, or DVT, it is best to... | Get pt up and walking. Best way to prevent these issues.
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| Nutrition for post-op | Diet with significant amounts of protein and vit A and C help rebuild tissues and promote wound healing. Adequate carbs and fat are also needed to avoid depleting protein stores.
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| Time at which patients should void post-op | Within 6-8 hours. Janice gets nervous around 4 hours w/o voiding.
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| Inadequate urinary output may indicate ... | Hypovolemia, hemorrhage, electrolyte imbalance, inadequate circulation, hypoxia, or impending shock.
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| Paralytic ileus | Very painful, usually responds to TX with an NG tube, bowel rest, and IV.
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| If PO meds are crushed and inserted into NG tube... | Need to turn off suction for 30-50 minutes.
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| Hemo-vac output measured every ... | 8-12 hours.
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| Programming of PCA pumps need to be verified by... | 2 RNs
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| Trust vs. Mistrust | Newborn or infant
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| Autonomy vs Shame and Doubt | Toddler
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| Initiative vs Guilt | Preschool
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| Industry vs Inferiority | School-age
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| Identity vs Role Confusion | Adolescence
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| Intimacy vs Isolation | Young adult
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| Generativity vs Stagnation | Middle-age
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| Ego integrity vs. Despair | Old age
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| IS should be done every... while awake | 10x every hour
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| Turn, cough, deep breathe should be done .... | Every hour
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| Obese patients tend to breathe poorly when..... increasing the risk of hypoventilation and post-op pulmonary complications | Supine
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| Antidote for malignant hyperthermia | Dantrolene sodium (Dantrium)
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| S/S of shock | Pallor, cool moist skin, rapid breathing, cyanosis, rapid or weak pulse, low BP and concentrated urine.
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| Drugs that turn urine red. | Anticoagulant
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| Drugs that turn urine orange or orange-red | Pyridium
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| Drugs that turn urine green or blue-green color | Elavil or B-complex vitamins
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| Injectable componds that can turn urine/stool black or black-brown. | Injectable iron
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| Reasons for irrigating the bladder | To instill medication and to flush out old blood and clots (post TURP, injury, or bladder surgery.
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| TURP | Transurethral resection of the prostate.
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| TURBT | Transurethral resection for bladder tumor.
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| Monitoring irrigation fluid in I&O. | Irrigation fluid is intake.
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| Areas to avoid placing leads for EKG | Avoid bony prominences and fatty areas.
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| Rhythm strip | 6 second strip that can be printed from a monitor normally in lead II
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| Precordial leads | V1-V6
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| Limb Leads | Leads I, II, III (White, black, and red)
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| Isoelectric line | Baseline on EKG
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| The normal running speed for EKG | 25mm/sec (Dr. may ask to increase speed if extreme tachycardia is present)
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| Artifact or wandering baseline occurs: | Look to see if patient is moving or jerking, if there is muscle tremors. If there is a loose cable or lead.
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| What position should a pt be in prior to EKG | Supine or semi-fowlers
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| When can magnets be placed over pace-maker for EKG. | Only place magnet over pacemaker with physician order and document. (also have emergency equipment ready)
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| Electrodes in good condition may be reused within... | 24 hours
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| The limb electrodes may be placed on... | Lower extremities or on rib cage (avoid bony prominences or fatty tissue)
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| Cardiac Alert System | Goal is to obtain 12 lead EKG within 5 minutes of admission to ED or per hospital policy. This is in place to increase door-to-ballon times and improved patient care.
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| Normal Sinus Rhythm | Normal rate, normal rhythm
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| Arrhythmia | Abnormal heart rhythm
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| How to determine heart rate from 6 sec strip | Count R waves and multiply by ten. i.e. 4 waves x 10 = 40.
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| Bradycardia | HR less than 60
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| Tachycardia | HR more than 90
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| Atrial Fibrillation. | Heart is quivering. Fast irregular activity can cause blood clots and stroke. May require medication.
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| Ventricular Fibrillation | Lethal. Requires immediate defibrillation
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| Asystole | AKA Flatline. No rhythm and no pulse=legally dead.
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| MI on EKG | Diagnosed by ST elevation and/or reciprocal changes.
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| Myocardial ischemia on EKG | Flipped T waves. May be caused by lack of O2 to heart or previous MI.
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| Pulse-less Electrical Activity (PEA) | Perform CPR. Electrical activity is occurring but no heart beat.
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| Purpose of a chest tube | To expand the lung to normal negative intrathoracic pressure.
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| Pneumothorax (pneumo) | Pressure builds in pleural space = shrinks lung.
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| Two types of pneumothorax | Open (sucking chest wound) and Closed.
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| Which is more dangerous, and open or closed pneumothoroax? | Closed. It allows pressure to build and will eventually cause a tension pneumothorax.
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| Hemothorax | Blood in pleural space.
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| Pleural effusion | Transudate (clear fluid from CHF or renal and liver failure), Exudate (from TB or pneumonia) or Empyema (pus) in pleural space.
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| Tension Pneumothorax | EMERGENCY. Causes rapid cardiovascular collapse from pressure on the heart.
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| S/S of Tension Pneumothorax | Decreased BP, Increased Pulse, JVD, Deviated trachea
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| S/S of Pneumothorax | Shallow respirations, decreased breath sounds, anxiety, SOB, Decreased O2 sats.
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| Tx for Tension Pneumothorax | Needle Decompression using a large bore IV catheter. After decompression it will be a sucking wound and will need a chest tube.
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| Thoracostomy Procedure | Insertion of chest tube and drainage system. Drainage system does not need to be sterile but the chest tube does.
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| Always keep the chest tube ....the level of the pt. | Below the pt. Drainage system works on gravity.
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| Chest tubes need to be.... after placement. | verified with CXR
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| What should you do if a chest tube gets pulled out on accident. | Immediately apply a Vaseline gauze. It should be taped to the bed.
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| CDI | Clean, dry, intact.
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| Order to obtain blood samples | Blood cultures are always first. Then Blue, Red, Green, Purple, Grey.
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| Diagnostic tests for Lavender Tube | CBC, Blood counts, blood sugar
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| Diagnostic tests for Light Blue | Coagulation studies (PT, PTT, INR)
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| Diagnostic tests for Green top | Ammonia, troponin, iSTAT
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| Diagnostic tests for Gray top | Alcohol levels
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| Diagnostic tests for Red top | CMP (chemistry)
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| Gray tops are drawn after what type of prep is used.. | Betadine (NOT Alcohol or Chloraprep. They contain alcohol which may interfere with alcohol levels in blood)
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| Gray top tubes are kept....after blood is drawn. | On the person that performed the phlebotomy (in their pocket)
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| Arterial blood gas (ABG) procedure. | Must immediately go on ice, hold manual pressure for at least 5 minutes, and should be hand delivered to the lab.
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| Lab specimens that go on ice | Ammonia (green), lactate or lactic acid (green), ionized calcium (green), ABG (syringe)
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| If patient has a vagal reaction when drawing blood.... | Stop draw, call for help, lower HOB, and Check airway.
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| Purpose of NGT | Lavage stomach, assess for GI bleed, Decompress stomach.
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| Check continuous tube feedings every... | 4-6 hours.
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| Prodrugs | Drugs that are designed so that their 1st metabolite is the active form of the drug. If this drug is given IM or IV it will take longer to get a therapeutic effect.
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| Drug half-life | Time in which half of original dose is removed. It takes about 5 half-lives to remove a drug.
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| Additive effect | Similar drugs and response
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| Antagonistic effect | Less effective than each alone
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| Synergistic effect | Greater effect than each alone
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| Teratogenic | Causes Fetal deformities
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| Mutagenic | Mutates DNA
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| Carcinogenic | Predisposes PT to cancer
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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