A nurse identifies that a patient needs FURTHER teaching on crohn's disease when she states:
" My Prednisone will have to be weaned down slowly."
"All layers of the bowel are effected increasing my risk for serious complications, so we need to treat flares seriously."
"I can't wait till i get my ileostomy and colectomy and i won't have to be sick anymore."
"I will have to have a yearly TB test and should not get a live vaccine while I am on the infliximab (Remicaid)."
A nurse would realize that which THREE Interventions would NOT be indicated in a patient with a diagnosis of uncomplicated C-Diff
Contact precautions & dedicating equipment
Fx hand hygiene with alcohol based hand rub
A patient with IBD has presented in the ER with multiple odd infections in the past 4 months. You expect the ER did a shitty job of taking a medical hx (and protecting this pt) and that the patient is on 1 or more of the following drugs THAT INCREASE THE RISK FOR INFECTION SPECIFICALLY?
The most appropriate diet for a nurse to teach a patient about who is in an acute diverticulitis episode that was just cleared to be advanced from NPO?
High protein for wound healing
The first nursing intervention for a patient postop from an uncomplicated colostomy the first time the nurse hears bowel sounds is for the nurse to?
measure abdominal girth
call the surgeon so he can place the order to advance the diet
assess the patient for cramping
change the perioperative pouch to a reusable pouch
Select for me the forms of Hepatitis that have vaccines, if you have not noticed these are also the forms of hepatitis that once you recover from them you are granted the gift of lifelong immunity.
Hep A: ( vowel transmits by bowel)
Hep B: (Body fluids: semen, blood and saliva)
Hep C: (Crack & Cock: Blood + Semen)
Due to the common and serious Side effect/ adverse effect of alpha Interferon (used to treat Hep C and Hep B chronic carriers) What medication would a nurse not be surprised to see also on her patient's med list who was on this drug?
A patient with cirrhosis is suffering from new hepatic encephalopathy due to digesting blood from bleeding hepatic varices. Which of the patients clinical manifestations are directly related to the encephalopathy
Serum ammonia: 111 mcg/dl
lethargy and confusion
In a patient with liver failure, the #1 thing to treat first would be?
ascites and low albumin
bleeding esophageal varices
poor glycogen storage and hypoglycemic events
Jaundice and elevated bilirubin
All of the following are appropriate nursing interventions for liver failure except?
Keeping scissors at the bedside and deflating the esophageal balloon of a Sengstaken Blakemore tube every 8-12 hours
Setting up nitroglycerin to be on standby when administering vasopressin (pitressin) to a patient with bleeding esophageal varices
Encouraging a pt. who is post TIPS procedure to use a warm back on back ord abdominal pain to reduce discomfort
Titrating lactulose (cephulac) to produce 3-4 loose stools a day
Infusing fresh frozen plasma before packed red cells
Encouragin the pt with ascites to rest in the semi-fowlers position
A pt. presents to the ER with epigastric pain that gets worse with eating. Temp: 38.0 C, WBC: 18; Amylase: 160; Lipase: 190 (elevated); ALT: 44 (High); AST: 45 (high); GGT: 34 (high). Upon entering the room you notice that her skin appears yellow and she has scratch marks over her arms and face. You will expect the testing to show that this patient has which condition?
Acute pancreatitis with biliary obstruction
The nurse realized there is a need for further pt teaching about a T-tube when the pt. states?
"I will let you know if the drainage stops and i feel pain and like I'm going to puke."
"I think i will just hang the drain bag from my IV pole when my wife and I walk in the hall."
"Someone should be in to empty the bag at least every 8 hours."
"The fluid should be bloody then turn green-brown."
Which diagnostic procedure can be a cause of pancreatitis?
In pancreatitis, electrolyte abnormalities may occur. Which of the following may occur?
2 large squares and 3 little squares across on EKG paper would be how much time?
Identify the following that apply to this image
Prolonged with Heart block
If prolonged there is a high risk for VTACH
Represents AV conduction time
This represents the depolarization of both ventricles (select all that apply)
Complete 3rd degree heart block
A student nurse is describing the rhythm she saw on the monitor to her instructor " His heart rate was like 165, seemed regular, i couldn't really see a p wave or count the PR interval, and the QRS was wide, it looked like little mountains, all in a row." The instructor's eyes go wide and she runs down the hall. Why does she scream for a code as she runs?
It is Ventricular Tachycardia
It is Asystole
It is Atrial fibrillation
It is ventricular fibrillation
Select all the instances (4) when it would not be appropriate to deliver a shock (Defibrillation of syncrohinized cardioversion respectively) to a patient
a patient in VTACH who is awake and alert
a patient in asystole found unresponsive in the parking lot
a patient found unresponsive in the cafeteria in V-fib
While doctor is placing an EJ line in patient's neck who is in VTACH and unresponsive
A pt in Aflutter who arrived at the ER and has been experiencing symptoms for the past 15 hours
A person in A-fib who arrived at the ER who is on no meds and has been having symptoms for 4 days.
You would expect a patient to be treated more aggressively for Premature ventricular contractions in all the following situations expect?
PVC falls on T wave
PVC's are multifocal
The teacher notes the students understood the lecture about the differences between Afib and Aflutter when they stated the following?
"Aflutter is more organized with contractions that originate from one place while Afib is much more irregular with quivers that originate from multiple atrial cells."
"Afib doesn't need to be treated with anticoagulants but aflutter does."
"Afib is less common, Aflutter is very common
"Aflutter requires defibrillation due to its organized pattern while Afib requires synchronized cardioversion to reset its irregular pattern."
Medications you would expect to administer to a patient with Afib include
The most helpful thing a nurse can say to a patient who is experiencing panic induced by the administration of adenosine for supraventricular tachycardia is?
"You will be fine."
" Adenosine is a very safe drug it will be out of your system in no time."
"Lots of patients feel this way when they get this drug."
"I know it's frightening, the medication is making you feel this way. You are safe, this will last a short time. You are safe, I will stay right here with you."
A pt with third degree heart block had a pacemaker inserted. You know what he needs further teaching when he states?
"The whole microwave thing is just a myth."
"I really will miss flying to see my folks in california."
"I shouldnt raise my left arm above my shoulder till the doc says."
"I shouldn't have an MRI."
"I will carry my card and keep my bracelet on."
Select the findings in the patient's chart that match a diagnosis of Infective endocarditis (4)
2 blood cultures drawn 30 min apart from 2 diff sites
protein in the urine
aortic and mitral vale murmurs
pericardial friction rub
Chest xray: cardiomegaly
A patient with idiopathic pericarditis who is suffering from the complication of cardiac tamponade would be suffering with all of the following symptoms EXCEPT?
muffled heart sounds
restlessness & anxiety
Rheumatic heart disease can be prevented by?
placing patients on bedrest when troponin levels are elevated
screening all men over 50 for cardiomyopathy
vaccinating children against the Coxsackie A virus
early identification and tx of strep
A male college athlete died of sudden cardiac death, the newspaper says it was r/t cardiomyopathy. The student nurse realizes this type of cardiomyopathy was most likely?
Dilated: Total ventricular dilation and atrial englargement
hypertrophic: left ventricular hypertrophy w/o ventricular dilation
Restrictive: impaired diastolic filling
A patient with an aortic stenosis is receiving a biologic pig valve. He has been educated that it must be replaced every 10 years or so. What med therapy should he be educated about?
prophylactic antibiotics for dental procedures
beta blockers to decrease the heart's workload
digoxin to improve contractility
How would a nurse differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)?
GAD is acute, Panic d/o is chronic
Chest pain is common in GAD, while it doesn't happen often in panic d/o
Hyperventilating is a hallmark sign of GAD but doesn't happen often in panic d/o
Depersonalization is commonly seen in panic disorder and absent in GAD.
Which 3 treatments are most appropriate for a pt with Generalized anxiety disorder (GAD)?
Long-term treatment with diazepam (Valium)
Acute symptom control with citalopram (Celexa)
Long-term treatment with buspirone (BuSpar)
Acute symptom control with ziprasidone (Geodon)
Ongoing Cognitive Behavioral Therapy
Long-term Treatment with an SSRI
A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization?
The client will refrain from ritualistic behaviors during daylight hours.
The client will wake early enough to complete rituals prior to breakfast.
The client will participate in three unit activities by day 3.
The client will substitute a productive activity for rituals by day 1.
A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this client's symptoms? (Select all that apply, which is all but one.)
A. Encourage the client to recognize the signs of escalating anxiety.
B. Encourage the client to avoid any situation that causes stress.
C. Encourage the client to employ newly learned relaxation techniques.
D. Encourage the client to cognitively reframe thoughts about situations that generate anxiety.
E. Encourage the client to avoid caffeinated products.
A client who is a veteran of the Gulf War is being assessed by a nurse for post-traumatic stress disorder (PTSD). Which of the following client symptoms would support this diagnosis? (Select all that apply,)
A. The client has experienced symptoms of the disorder for 2 weeks.
B. The client fears a physical integrity threat to self.
C. The client feels detached and estranged from others.
D. The client experiences fear and helplessness.
E. The client is lethargic and somnolent.
A client diagnosed with social phobia has an outcome that states, "Client will voluntarily participate in group activities with peers by day 3." Which would be an appropriate intrapersonal intervention by the nurse to assist the client to achieve this outcome?
1. Offer PRN lorazepam (Ativan) 1 hour before group begins.
2. Attend group with client to assist in decreasing anxiety.
3. Encourage discussion about fears related to socialization.
4. Role-play scenarios that may occur in group to decrease anxiety.
A pt presents to the unit with the following symptoms. He must check to make sure that doors lock 10 times, he has thoughts about germs that invade his waking moments and he washes his hands every half hour with a home made vinegar based soap. Identify the obsession.
handwashing every hour with home made soap
checking doors locked 10 times
thoughts about germs
Identify the abnormal urinalysis result:
Color: amber yellow
Specific Gravity: 1.02
Specific Gravity: 1.02
Color: amber yellow
A pt. who had a cytoscopy calls the office urgently stating that it burns when she pees and that she must be hemorrhaging because her pee is pink. What do you say?
This is normal after a cytoscopy, drink adequate amounts of fluids and it should resolve in a day or two.
Please come in so we can get a IVP
We are going to send you to get a U/A at a lab right away
This is a sign of bleeding go to your local ER as soon as possible.
Part of the diagnosis for glomerulonephritis includes?
diagnosis by exclusion
Hx of strep
Hx of longterm diuretic use
Those with increased risk factors for urinary calculi include all EXCEPT?
Large protein intake
Excessive intake of tea or fruit juice
sedentary or immobility
cold climate, northeast
low fluid intake
heavy feeling in abdomen, htn, heamturia and UTI all are signs of
renal artery stenosis
Polycystic kidney disease
Normal results when assessing the urinary system include all but?
palpable right kidney
no CVA tenderness during fist percussion
no bruits over each CVA
skin turgor: instant recoil