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ReMar Quick Facts
What must be done to determine clients baseline before starting the transfusion? - CORRECT ANSWER-Vital Signs For blood administration, what size IV is needed? - CORRECT ANSWER-18G w/ filter needle How many nurses confirm the unit of blood? - CORRECT ANSWER-Two How long after blood is removed from the banks refrigerator do you have to start it? - CORRECT ANSWER-30 minutes How long must you stay with the client after transfusion is started? - CORRECT ANSWER-15 minutes How many milliliters are in one unit of packed red blood cells - CORRECT ANSWER- About 250 mL Blood Administration: What are the signs of an adverse reaction? - CORRECT ANSWER-Restlessness, nausea, hives, SOB ,fever, chills, back pain Blood administration: What do you do if an adverse reaction occurs? - CORRECT ANSWER-Stop blood and run the normal saline that hangs with blood. Take vitals notify the physician and blood bank make sure urine and blood cultures are done What are the major complications of having an amputation performed? - CORRECT ANSWER-Infections, skin breakdown, phantom limb pain, joint contractures What is the positioning for care? AKA-(above the knee) amputation - CORRECT ANSWER-Elevate 1st 24hrs then prone position to prevent hip flexion What is the positioning for care? BKA-(below the knee) amputation - CORRECT ANSWER-Elevate foot of bed 1st 24hrs then prone position twice daily to prevent hip flexion Aneurysm - CORRECT ANSWER-Dilation formed at a weak point on the wall of an artery
Aneurysm: what sound would be heard on auscultation? - CORRECT ANSWER- Blowing bruit What are risk factors for aneurysm? - CORRECT ANSWER-Arteriosclerosis, infection ( syphillis), smoking, HTN Signs of a ruptured Aneurysm? - CORRECT ANSWER-Severe pain, N/V, tachycardia, decreased LOC, hypotension Aneurysm: client teaching - CORRECT ANSWER-Avoid straining, lifting, or exerting take, melds on schedule, Report severe back/ flank pain Appendicitis, commonly seen in what age range? - CORRECT ANSWER- 10 - 30 Classic sign of appendicitis? - CORRECT ANSWER-Acute Right Lower Abdominal Pain S/S of Appendicitis - CORRECT ANSWER-Loss of appetite, N/V, low grade temp. In appendicitis , localized tenderness is found in? - CORRECT ANSWER-McBurney's point Treatment for Appendicitis - CORRECT ANSWER-Immediate surgery to remove appendix, IV antibiotics, semi-fowlers position, NPO to rest gut How do precautions change w/AIDS? - CORRECT ANSWER-Pt. has low CD4 & is at risk for infection: - private room - reverse isolation RN wears gown, goggles, mask when direct contact w/ bodily fluids Causes of acute renal failure - CORRECT ANSWER-Infection, obstruction, shock 3 phases of Acute Renal Failure - CORRECT ANSWER-Oliguric, Diuretic, Recovery During the Oliguric phase what will you see? - CORRECT ANSWER-Low urine output, hyperkalemia, HTN, elevated BUN/creatinine, fluid overload, elevated Sodium & Potassium The diuretic phase is 2nd, what will you see? - CORRECT ANSWER-Urine output slowly returns, hypokalemia, hypotension, BUN/ creatinine decreases but still elevated What does recovery phase mean? - CORRECT ANSWER-Kidneys are recovering through a slow process, urine vl & BUN is normal What are nursing interventions for Acute Renal Failure? - CORRECT ANSWER-Daily weights, I&O's,treat the cause & diuretics
Signs of autonomic dysreflexia - CORRECT ANSWER-Increase in BP 40mm Hg, headache, bradycardia, Blurred vision, sweating Autonomic dysreflexia: what should be done during an episode? - CORRECT ANSWER-Place client in High-Fowlers, Check for bladder distention, Loosen restrictive clothing Autonomic dysreflexia: Treatment - CORRECT ANSWER-Removal of the stimuli, Pt. needs to void/ bowel movement Bell's Palsy affects which cranial nerve? - CORRECT ANSWER-Cranial nerve # What does the client with Bells Palsy suffer from? - CORRECT ANSWER-Temporary facial paralysis that affects chewing, eating, and closing their eyes Treatment for Bell's Palsy - CORRECT ANSWER-Wear eye patch @ night Use artificial tears Wear glasses to protect eyes *steroids to reduce edema Benign Prostatic Hyperplasia (BPH) - CORRECT ANSWER-Enlargement of the prostate gland Cause unknown Because the prostate blocks the urethra opening clients will feel and see what when they urinate? - CORRECT ANSWER-Straining to urinate Decreased stream Feeling like they have to go all the time Dribbling Who gets BPH? - CORRECT ANSWER-Men usually > What is the best way to assess for BPH? - CORRECT ANSWER-Rectal exam, will feel pea sized nodule What is the common surgical treatment for BPH? - CORRECT ANSWER-Transurethral resection of the Prostate (TURP) How is transurethral resection of the prostate (TURP) performed? - CORRECT ANSWER-Scope goes through the penis and removes parts of the prostate After a TURP procedure what is client at risk for? - CORRECT ANSWER-Bleeding; monitor for hemorrhage
Before a TURP, what will all clients get? - CORRECT ANSWER-3way (lumen) Foley catheter What are the three lumens for in a 3way lumen Foley catheter? - CORRECT ANSWER- Inflating the ballon, inflow of solution, outflow of urine What will the Dr. order to be done afte a TURP? - CORRECT ANSWER-Continuous bladder irrigation (CBI) What is the goal of the bladder irrigation? ( after a TURP ) - CORRECT ANSWER- Reduce/prevent blood clot formation What type of fluid is used to irrigate the bladder? - CORRECT ANSWER-Isotonic sterile saline After a TURP , what do you want the urine to be? - CORRECT ANSWER-Light pink During a continuous bladder irrigation, what must the client be monitored for? - CORRECT ANSWER-Bladder distention Fluid overload/ hyponatremia Blood loss After a TURP, if bladder spasms occur give... - CORRECT ANSWER-B&O suppositories or Ditropan Best position for a pt. receiving a TURP, post-op? - CORRECT ANSWER-Lying flat, sitting up puts pressure on the bladder Discharge instructions after TURP - CORRECT ANSWER-Drinking 2-3L of fluids daily No lifting or straining If bright red clots call MD Do kegel exercises What must be received before a transfusion is started? - CORRECT ANSWER-Written consent What is the most common infection spread through blood transfusion? - CORRECT ANSWER-Hepatitis B In order to determine donor compatibility what must be done? - CORRECT ANSWER- Type and cross match Why must you run blood at a slow rate? - CORRECT ANSWER-Because running blood fast can cause fluid overload
What herbal medication is used to lower BP? - CORRECT ANSWER-Garlic What is the best diet for a hypertensive client? - CORRECT ANSWER-Low-sodium low fat, Abdominal cramps while breast-feeding is due to the release of? - CORRECT ANSWER-Prolactin & Oxytocin Buerger's disease (Thromboangiitis Obliterans) Disease is obstruction of blood vessels mainly where? - CORRECT ANSWER-Hands & Feet Buerger's Disease Clients presents w/ what symptoms? - CORRECT ANSWER-Pale, blue, cold hands and feet. May tingle or be painful Who is most at risk for Buergers disease? - CORRECT ANSWER-Males who smoke or chew tobacco What are treatment goals for Buergers disease - CORRECT ANSWER-No cure Teach to stop smoking, dress for weather , reduce life stressors What are two age groups most at risk to suffer a burn injury? - CORRECT ANSWER- Children and elderly What are the four types of burns? - CORRECT ANSWER-Chemical, electrical, thermal, radiation If the face or neck has been burned what is the nursing priority? - CORRECT ANSWER-Airway obstruction Burns: what is the best route for pain meds? - CORRECT ANSWER-IV What diet is appropriate for burn clients? - CORRECT ANSWER-High calorie high- protein What is a common electrolyte problem in clients with burns? - CORRECT ANSWER- Hypokalemia ; potassium released due to cell destruction Burns: What should you give before a dressing changes? - CORRECT ANSWER-Pain medication When the cancer cell travels from that you original location to a new place it is called? - CORRECT ANSWER-Metastasis
What acronym is used to describe the warning signs of cancer? - CORRECT ANSWER- C.A.U.T.I.O.N. What does C.A.U.T.I.O.N. stand for? - CORRECT ANSWER-Change in bowel or bladder Any sore that does not heal Unusual bleeding/ discharge Thickening in breast Indigestion Obvious change in wart Nagging cough or hoarseness What are two ways to describe a tumor? - CORRECT ANSWER-By grading or staging What is the difference between grading and staging - CORRECT ANSWER-Grading describes a tumor by the cells Staging describes the progression of a tumor by the clinical symptoms What are the three types of radiation treatment? - CORRECT ANSWER--External
- unsealed internal
- sealed internal What precautions must be taken for client receiving radiation treatment? - CORRECT ANSWER-Private room/ bathroom Limit visitors rotate nursing staff who provide care Place sign at door and bedside What is the most dangerous type of radiation? - CORRECT ANSWER-Sealed internal radiation because solid radio active implant is placed inside the tumor What additional precautions must be done for clients receiving sealed internal radiation?
- CORRECT ANSWER-All body fluids are radioactive; use hazardous cleanup, wear gloves and gown If a client sealed internal implant falls out what should you do? - CORRECT ANSWER- Pick up with long handle put in lead container Chemotherapy works by destroying cell __________. - CORRECT ANSWER-Wall What are the side effects of chemotherapy? - CORRECT ANSWER-Nausea, anorexia, alopecia, sterility, decreased bone marrow and platelets
In Celiacs disease malabsorption of ________occurs? - CORRECT ANSWER-Fats Celiacs disease: Foods containing ________ must not be eaten. - CORRECT ANSWER-Gluten What foods contain gluten? - CORRECT ANSWER-B.R.O.W. ( barley, rye, oats, wheat) Celiacs disease: what does the clients abdomen feel like? - CORRECT ANSWER- Distended Celiacs disease: what does the clients stool look like? - CORRECT ANSWER-Smelly, pale, bulky expect lots of gas w/some diarrhea Define the term CVA - CORRECT ANSWER-Cerebrovascular accident; Reduction of cerebral blood flow and oxygen causing brain cell damage Three most common causes of CVA are _______? - CORRECT ANSWER-Embolism, Hemorrhage, Thrombus What is the difference between CVA and Transient Ischemic Attack (TIA)? - CORRECT ANSWER-TIA is a temporary period Neurological deficit. It has similar signs of a CVA but the symptoms will all resolve. What is agnosia? - CORRECT ANSWER-Inability to use an object correctly Expressive aphasia occurs when _________? - CORRECT ANSWER-Client cannot communicate properly. Can be expressive or receptive CVA: remember to place clients belongings on the ____________ side. - CORRECT ANSWER-Unaffected CVA: What are the nursing assessments? - CORRECT ANSWER-Monitor vital signs, neurochecks , watch for seizures, monitor for increased in intracranial pressure, check ability to swallow What complication of the eyes can a client with CVA have? - CORRECT ANSWER- Corneal abrasions b/c lacrimal glands will not produce secretions. What is the activity level for this CVA client? - CORRECT ANSWER-Strict bed rest How do you position the CVA client? - CORRECT ANSWER-Turn q 2hrs on unaffected side, 20 mins on affected side, make sure to elevate affected extremities
Why would a thrombolytic be given to the CVA client? - CORRECT ANSWER-To dissolve clots Do not give thrombolytic sir the cause is ___________? - CORRECT ANSWER- Hemorrhage What other medications may be prescribed to treat a CVA? - CORRECT ANSWER- Anti-hypertensive, Anti-coagulants(not for hemorrhage), Anti-convulsants Do anti-coagulants like Coumadin and aspirin dissolve clots? - CORRECT ANSWER- NO. They only thin the blood not dissolve clots. What are the 3 disorders that make up COPD? - CORRECT ANSWER-Asthma, Brochitis, Emphysema What are the S/S of COPD? - CORRECT ANSWER-SOB w/activity, wheezing, productive cough, cyanosis What would the ABG of a client w/ COPD show? - CORRECT ANSWER-Hypoxemia What does the chest of a COPD client look like? - CORRECT ANSWER-Barrel chest What would the fingers of a client with COPD look like? - CORRECT ANSWER-Clubbed Due to SOB w/activity clients may experience _____ _________ because of difficulty eating? - CORRECT ANSWER-Weight loss Why must you assess the amount of O2 to your COPD client receives? - CORRECT ANSWER-COPD'ers keep a high level of CO2 in their blood A client with with COPD should not receive O2by nasal cannula greater than _________. - CORRECT ANSWER-2 LPM To control SOB the _________ ________ __________________ technique should be taught. - CORRECT ANSWER-Pursed lip breathing Chronic renal failure is progressive and irreversible. True or False - CORRECT ANSWER-True What are possible causes of chronic renal failure? - CORRECT ANSWER- Hypertension, Diabetes Mellitus II, frequent infections, renal or urinary obstructions S/S of chronic renal failure - CORRECT ANSWER-Decreased urine output, hypertension, decreased urine specific gravity, fluid overload
Most corticosteroids end in _____. - CORRECT ANSWER--ONE What are some examples of corticosteroids? - CORRECT ANSWER-Dexamethasone, Cortisone, Prednisone What are the primary functions of of corticosteroids? - CORRECT ANSWER-To decrease inflammation and hormone replacement What should you teach clients about stopping corticosteroids therapy? - CORRECT ANSWER-To gradually decrease use; don't stop abruptly What must be monitored while client is taking corticosteroids? - CORRECT ANSWER- Potassium level, glucose level, and I&Os Corticosteroids may cause symptoms of _____________ syndrome. - CORRECT ANSWER-Cushing's Corticosteroids will also delay __________ healing. - CORRECT ANSWER-Wound If the client is NPO for surgery should you still give the steroids? - CORRECT ANSWER-Yes , during surgery , stress and illness in the body increases the needs for corticosteroids. In all other situations do not take steroids on an empty stomach. Crohn's disease is an ______________ of the bowels. - CORRECT ANSWER- Inflammation Can Crohn's disease be cured w/ surgery? - CORRECT ANSWER-No, symptoms frequently reoccur Crohn's disease affects the digestive tract from the mouth to the anus? True or False - CORRECT ANSWER-True S/S of Crohn's disease - CORRECT ANSWER-Abdominal pain, diarrhea, weight loss Excessive diarrhea will cause what electrolyte imbalance? - CORRECT ANSWER- Hypokalemia Crohn's disease: What foods should be avoided and why? - CORRECT ANSWER-Dairy products and high fiber meals, which may worsen the diarrhea Crohn's disease can lead to what kind of cancer? - CORRECT ANSWER-Colon Crohn's disease: What are the treatment goals? - CORRECT ANSWER-Drugs and Nutrition to reduce inflammation
In cystic fibrosis the ____________ _______________ or exocrine glands are affected.
- CORRECT ANSWER-Mucous producing How does cystic fibrosis change mucous secretions abnormally? - CORRECT ANSWER-Mucous glands become thick and sticky which causes obstructions in the body What are the two systems most affected by cystic fibrosis? - CORRECT ANSWER- RESPIRATORY: mucous gets trapped in the lungs DIGESTIVE: mucous blocks the pancreas and digestive enzymes making absorbing nutrients very difficult What is the most accurate test for cystic fibrosis? - CORRECT ANSWER-Sweat test- the chloride level will be > 60 mEq/L What are other ways to diagnose cystic fibrosis? - CORRECT ANSWER-Chest x-Ray, stool analysis, pulmonary function tests How does poor absorption of fat in the digestive change the appearance of stool? - CORRECT ANSWER-Steatorrhea (Greasy, foul smelling, pale) ______________ ________________ are given with each meal to help with absorption of nutrients in clients with cystic fibrosis - CORRECT ANSWER-Pancreatic enzymes What is the most appropriate diet with cystic fibrosis? - CORRECT ANSWER-High calorie high protein ______________ ___________________ is a common technique used to clear thick mucous from the lungs. This is important to prevent respiratory infections. - CORRECT ANSWER-Postural drainage What should parents who already have a child's with cystic fibrosis do before having another child? - CORRECT ANSWER-They should get genetic counseling because cystic fibrosis is hereditary Which type of diabetes is mostly controlled by diet and exercise? - CORRECT ANSWER-Type 2 diabetes Mellitus Which type of diabetes will be controlled mostly by insulin? - CORRECT ANSWER- Type 1 diabetes Mellitus What should you teach diabetics about footcare? - CORRECT ANSWER-Have MD cut toe nails, cut toe nails straight across, inspe feet daily for sores, keep skin clean and dry
When should clients take diuretics? - CORRECT ANSWER-In the AM Why should clients take diuretics in the AM? - CORRECT ANSWER-If take in the evening clients will be going to the bathroom all night Diuretics: What should clients be monitored for? - CORRECT ANSWER-Dehydration, low potassium, hyponatremia, weight changes Loop and thiazide diuretics inhibit what electrolytes? - CORRECT ANSWER-Potassium, sodium, chloride Furosemide (Lasix) is a ________ diuretic. - CORRECT ANSWER-Loop Thiazide diuretics are contraindicated in clients allergic to? - CORRECT ANSWER- Sulfa drugs _____________ is an osmotic diuretic used to reduce ICP. - CORRECT ANSWER- Mannitol (Osmitrol) Because Mannitol decreases ICP it can also be used to treat _________. - CORRECT ANSWER-Glaucoma Mannitol crystallizes at room temperature, you will need a __________ needle to draw it up. - CORRECT ANSWER-Filter Spironolactone (Aldactone) is a ___________ sparing diuretic. - CORRECT ANSWER- Potassium Because Spironolactone helps the body retain potassium the client is at risk for? - CORRECT ANSWER-Hyperkalemia If your client's K+ is 3.0 and Lasix and Spironolactone are both ordered, how would you proceed? - CORRECT ANSWER-Only give the Spironolactone, the potassium is low and the Lasix will only create more K+ loss In order to accurately measure urine output a patient may be given a ___________ ___________. - CORRECT ANSWER-Indwelling (foley) catheter What is the epiglottis and what does it do? - CORRECT ANSWER-It is a lap of skin that is at the base of the tongue it opens and closes during breathing What is the cause of epiglottis? - CORRECT ANSWER-Haemophilus influenza ( bacteria)
What is the usual age of children who get epiglottis? - CORRECT ANSWER- 2 - 5 years old What are the signs of epiglottis? - CORRECT ANSWER-3D's DROOLING, DYSPHAGIA, DYSPHONIA( no voice) What will the child look like during an episode of of epiglottis? - CORRECT ANSWER- Sitting upright, tongue protruding drooling, shallow rapid breathing Can epiglottis be treated home? - CORRECT ANSWER-No child must go to hospital immediately When assessing the airway, can you use a tongue depressor or tongue blade? - CORRECT ANSWER-No never put anything in the mouth to assess If child cannot breathe what might be done? - CORRECT ANSWER-Intubation What medication will be given to treat epiglottis? - CORRECT ANSWER-Antibiotic therapy How can epiglottis be avoided? - CORRECT ANSWER-By getting the H. Influenzae vaccine What is the treatment for genital herpes? - CORRECT ANSWER-Acycovir Genital Herpes: If lesions are present in a pregnant woman how would you deliver the baby's? - CORRECT ANSWER-C-section What is the vision like with glaucoma? - CORRECT ANSWER-Blurry, tunnel vision, halos around light This condition can be chronic or acute due to - CORRECT ANSWER-Increased intraocular pressure ____________ is the most simple painless procedure used to measure intraocular pressure. - CORRECT ANSWER-Tonometry What are the two types of glaucoma? - CORRECT ANSWER-Open angle or closed angle Which type of glaucoma is painful? - CORRECT ANSWER-Closed angle is painful and most common Give this class of drug to constrict the pupil and let aqueous humor flow? - CORRECT ANSWER-Miotics
Incentive spirometers is a method of ________ ______ which helps maximin lung inflation. - CORRECT ANSWER-Deep breathing Incentive spirometry: Instruct the client to place ______ tightly around mouth piece. - CORRECT ANSWER- Lips Incentive spirometry is used after surgery to prevent __________. - CORRECT ANSWER-Atelectasis What is the normal intracranial pressure range? - CORRECT ANSWER- 5 - 15 mm Hg What are the common causes of ICP? - CORRECT ANSWER-Trauma, hemorrhage, edema, tumors ICP: Assess _________ ___________ ___________. - CORRECT ANSWER-Level of conscious, it'll decreases as ICP decreases Earliest sign of ICP? - CORRECT ANSWER-Decreased level of consciousness What are the signs of epiglottis? - CORRECT ANSWER- Why would a thrombolytic be given to the CVA client? - CORRECT ANSWER-
