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Complex Med Surg Exam 1 with correct answers
Serves as guidelines for critical care nurses, establishes goals for patient care. - CORRECT ANSWERS ✔✔AACN Standards for Acute and Critical Care Nursing Practice What makes delirium different from dementia? - CORRECT ANSWERS ✔✔Delirium is fast onset, acute in nature, and there is usually a cause to it. True or False: Delirium is associated with low rates of mortality and morbidity? - CORRECT ANSWERS ✔✔False- it is associated with high rates of mortality and morbidity. 3 Types of Delirium and characteristics - CORRECT ANSWERS ✔✔Hyperactive- agitated, combative, disoriented Hypoactive- quiet delirium Mixed- fluctuating between hyperactive and hypoactive Risk factors for delirium - CORRECT ANSWERS ✔✔Older than 70, came from a nursing home, hx of substance abuse, renal or liver disease, central lines, physical restraints. Drug of choice for delirium - CORRECT ANSWERS ✔✔haloperidol Biggest risk for delirium patients - CORRECT ANSWERS ✔✔FALLS
ABCDE Bundle for Delirium - CORRECT ANSWERS ✔✔A-Awakening B- Breathing Coordination C- Choice of Sedation D- Delirium Monitoring E-Early mobility and exercise living will, advanced directive - CORRECT ANSWERS ✔✔A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes. Abandonment - CORRECT ANSWERS ✔✔-Severing professional relationship when patient is in need of care -Can even happen if you go to lunch and do not transfer care to another nurse Moral conflict - CORRECT ANSWERS ✔✔-Nurse not required to practice if situation violates moral or religious beliefs -Must transfer care to another nurse to avoid abandonment Witholding: not ________ Withdrawing: not _________ - CORRECT ANSWERS ✔✔Not initiating Weaning or removing True or false: family presence during codes is promoted - CORRECT ANSWERS ✔✔True!
Prostate cancer screening - CORRECT ANSWERS ✔✔-If you decide to be tested, you should get a PSA blood test with or without a rectal exam. How often you're tested will depend on your PSA level. -At age 50, men should ask doctors if they are at risk for developing prostate cancer. Where is blood produced? - CORRECT ANSWERS ✔✔bone marrow What makes up the majority of blood? - CORRECT ANSWERS ✔✔plasma What is hematopoiesis and where does it occur? - CORRECT ANSWERS ✔✔The process of replenishing blood cells Main site is in the bone marrow---makes stem cells which then differentiate into leukocytes, erythrocytes, and thrombocytes Function of the liver? - CORRECT ANSWERS ✔✔Filters and stores our blood supply. This is our reserve in case we lose a large amount of blood. What do lymph nodes do? - CORRECT ANSWERS ✔✔filter lymph and foreign matter What does the spleen do? - CORRECT ANSWERS ✔✔Produces lymphocytes, filters blood, and destroys erythrocytes when they are too old What do mature erythrocytes consist mostly of? - CORRECT ANSWERS ✔✔hemoglobin
What binds to hemoglobin? - CORRECT ANSWERS ✔✔Oxygen Lifespan of an erythrocyte is about ___ days. - CORRECT ANSWERS ✔✔ 120 Why will renal failure patients not have a normal erythrocyte lifespan? - CORRECT ANSWERS ✔✔Because of lack of erythropoietin that is produced in the kidneys. What can renal failure patients get in order to normalize erythrocyte cycles? - CORRECT ANSWERS ✔✔Epogen----synthetic erythropoietin Normal hemoglobin levels for men and women - CORRECT ANSWERS ✔✔Men: 14- Women: 12- What can an increase and decrease in hemoglobin indicate? - CORRECT ANSWERS ✔✔Increase: polycythemia, living in high altitudes, medications Decrease: bleeding, anemia, medications (antibiotics, aspirin). What is a hematocrit? - CORRECT ANSWERS ✔✔Percentage of hemoglobin in relationship to blood volume Normal hematocrit for males and females? - CORRECT ANSWERS ✔✔Males: 42-52% Females: 37-47%
True or false: The elderly are NOT more susceptible to myelosuppressive effects of medication - CORRECT ANSWERS ✔✔False, they are more susceptible. The drugs diminish the bone marrow and cause a decrease in blood cell formation. Which of the following situations would most likely prompt an increase in erythropoietin synthesis? A.A woman is admitted to the hospital with anemia (Hemoglobin down, stimulates erythropoietin production, erythrocyte production). B.A man with atrial fibrillation has begun taking anticoagulants to prevent a stroke. (thrombocytes) C.A child fractures his ulna and radius in a playground accident. D.A woman develops an infection in an arterial ulcer. (leukocytes) - CORRECT ANSWERS ✔✔A.A woman is admitted to the hospital with anemia (Hemoglobin down, stimulates erythropoietin production, erythrocyte production). What is anemia? - CORRECT ANSWERS ✔✔A decrease in the number of RBC. Can be caused by destruction of RBC, lack of production, or major loss of RBC. What type of anemias cause immature destruction of erythrocytes? And what is an example of this? - CORRECT ANSWERS ✔✔Hemolytic anemias Sickle cell Treatment options for anemia - CORRECT ANSWERS ✔✔Blood transfusion High protein diet RBC booster (Procrit or Epogen) Diet modification (folic acid deficiency anemia)
Fatigue management What are some foods high in folic acid - CORRECT ANSWERS ✔✔Beef, liver, peanut butter, beans, asparagus, broccoli Treatment for iron deficiency anemia - CORRECT ANSWERS ✔✔Iron supplementation What are some patient teaching points for giving oral iron supplements? - CORRECT ANSWERS ✔✔Monitor for allergic reactions Give with straw to prevent staining Causes skin irritation The symptom of "pica" would refer to which type of anemia? - CORRECT ANSWERS ✔✔Iron deficiency anemia---pica is the desire to eat non-food items What size IV would you use for someone about to receive a blood transfusion and what fluid would you hang? - CORRECT ANSWERS ✔✔18g or 16g (large bore needle) 0.9% sodium chloride Which fluid would you not use during blood transfusions and why? - CORRECT ANSWERS ✔✔D5W because the blood will clot True or false: It is safe to add medications to blood products - CORRECT ANSWERS ✔✔FALSE
Get first urine and first blood sample Initiate infusion of 0.9% sodium chloride Notify provider immediately True or false: the nurse should get a patients vital signs 1 hour after completion of a blood transfusion. - CORRECT ANSWERS ✔✔True, and usually 1 hour afterwards, then Q4 after that. What should you dispose blood products in? - CORRECT ANSWERS ✔✔Red biohazard bags When monitoring lab values during/after a blood transfusion, what are we specifically looking for? - CORRECT ANSWERS ✔✔The patients Hgb levels should rise by 1 with each unit transfused! So if they started out at 5, and received 3 units, they should be up to around 8 after all bags have transfused. If not, they are still bleeding somewhere. Characteristics of an acute hemolytic reaction during blood transfusion - CORRECT ANSWERS ✔✔Immediate onset May be mild or life threatening Chills, fever, low back pain, blood in urine, tachycardia, flushing, hypotension, chest tightening or pain, tachypnea, anxiety Characteristics of a febrile reaction to blood transfusion and how would you treat it? - CORRECT ANSWERS ✔✔30 minutes to 6 hours after transfusion Chills, fever, flushing, headache, anxiety Treat by using WBC filter, and administer antipyretics
Characteristics of mild allergic reaction to blood transfusion and how would you treat it? - CORRECT ANSWERS ✔✔During or up to 24 hours after transfusion Itching, uticaria (hives), flushing Administer antihistamines Normal leukocyte count is - CORRECT ANSWERS ✔✔5,000-10, What test do we use to get a neutrophil count? - CORRECT ANSWERS ✔✔CBC What test will tell us if a patients neutrophils are banded or segmented? - CORRECT ANSWERS ✔✔CBC with DIFFERENTIAL What is the difference between banded and segmented neutrophils? - CORRECT ANSWERS ✔✔Banded- New neutrophils Segmented- Mature neutrophils Which cell type will be increased during times of infection? - CORRECT ANSWERS ✔✔Banded neutrophils When will a patients neutrophil count be decreased? - CORRECT ANSWERS ✔✔Aplastic anemia, hepatitis, and pharmacological agents What does a shift to the left mean when considering neutrophil counts? - CORRECT ANSWERS ✔✔Increased number of bands- acute bacterial infection
What is the moderate risk range for ANC levels and what would we implement for these patients? - CORRECT ANSWERS ✔✔500- Start neutropenic precautions for patient Educate on reporting early signs of infection (fever, change in level of consciousness) What is the severe risk range for ANC levels and what would we implement for these patients? - CORRECT ANSWERS ✔✔Under 500 Neutropenic precautions Prevent infection Possibly administer neupogen Educate on reporting early signs of infection (fever, change in level of consciousness) Normal platelet count - CORRECT ANSWERS ✔✔150,000-400, When might a platelet count be elevated or low? - CORRECT ANSWERS ✔✔Elevated: malignancy or polycythemia vera Low: autoimmune disease, bone marrow suppression, increased consumption (continuous injury that needs clotting/healing), increased destruction, enlarged spleen). What is considered a low platelet count (thrombocytopenia)? - CORRECT ANSWERS ✔✔less than 150, What is considered critically low for platelet counts and what is the patient at risk for? - CORRECT ANSWERS ✔✔less than 30,
spontaneous bleeding- mucous membranes, after needle sticks, nose bleeds, bruising What is considered a fatal hemorrhage level for platelet counts and what is the treatment for this patient? - CORRECT ANSWERS ✔✔less than 10, fresh frozen plasma What are some things to consider when a patient is on thrombocytopenic precautions? - CORRECT ANSWERS ✔✔pad side rails, FALL RISK, soft tooth brush, only electric razor, limit the number of needle sticks, BP cuff accidentally left on can cause bleeding-may use manual BP, hypertension can cause hemorrhagic stroke (ACE inhibitor, Beta blocker, Nitroglycerin) What would thrombocytopenia look like in a patient? - CORRECT ANSWERS ✔✔tachycardia, hypotension, bruising easy, nose bleeds, petechiae, possible organ failure Nursing considerations when giving a platelet transfusion - CORRECT ANSWERS ✔✔-look at single donor products first: less chance of adverse reaction -infuse over 30 minutes to an hour -febrile and allergic reactions may become more common Examples of procoagulant medications - CORRECT ANSWERS ✔✔Vasopressin (enhances vasoconstriction) Somatostatin (enhance clot formation) Aminocaproic acid (prevents fibrinolysis)
What is the most common reason people have DIC? - CORRECT ANSWERS ✔✔Septic shock What lab values would indicate DIC? - CORRECT ANSWERS ✔✔Platelet- decreased PT- Prolonged PTT- Prolonged Thrombin time- prolonged D-Dimer- increased What is therapeutic apheresis? - CORRECT ANSWERS ✔✔•Blood is taken from the patient and passed through a centrifuge to remove a specific component What is therapeutic phlebotomy? - CORRECT ANSWERS ✔✔Removal of a certain amount of blood under controlled conditions What does incidence mean when referring to a disease--mainly cancer? - CORRECT ANSWERS ✔✔What are someone's chances of getting it Mortality rate - CORRECT ANSWERS ✔✔chances of dying Survival rate - CORRECT ANSWERS ✔✔proportion of patients alive at some point after their initial diagnosis of cancer Why does cancer occur mostly in those older than 65? - CORRECT ANSWERS ✔✔Because they are exposed to things that cause cancer for longer
What type of cancer is the leading cause of cancer related deaths in men and women? - CORRECT ANSWERS ✔✔lung What types of cancers have the estimated most incidence rates in men and women? - CORRECT ANSWERS ✔✔Men- prostate Women- breast What are some examples of carcinogens? - CORRECT ANSWERS ✔✔Smoke, air pollutants, viruses and bacteria (HPV), UV light, genetics, fats, alcohol, nitrates, What is the largest contributor towards cancer related to carcinogens? - CORRECT ANSWERS ✔✔SMOKING! What are the characteristics of malignant cells? - CORRECT ANSWERS ✔✔1. Abnormal rate of growth
- Able to metastasize
- Able to cause cell death If you have an alteration in __________, your cells may no longer have programmed death, and you may have worse prognosis. - CORRECT ANSWERS ✔✔TP True or False: When a patient is on chemo, it can either be cell cycle specific or non-specific. - CORRECT ANSWERS ✔✔True
-Indigestion -Obvious changes in warts or moles -Nagging cough Example of primary prevention? - CORRECT ANSWERS ✔✔Telling everyone not to smoke (for a large population or group). What is secondary prevention? - CORRECT ANSWERS ✔✔Prevention related to detection and screening for a certain group: Example: HPV vaccination for women of a certain age. Tertiary prevention example - CORRECT ANSWERS ✔✔There has already been a problem and we are preventing it from getting worse ex: adjusting antihypertension meds What is TNM staging? - CORRECT ANSWERS ✔✔size of TUMOR spread to lymph NODES? has it METASTASIZED? What is the difference between differentiated and undifferentiated cells? Which is more dangerous? - CORRECT ANSWERS ✔✔Differentiated-has same cellular characteristics as organ it originates in. Undifferentiated- no longer has same cellular components of organ or system it is in, THIS IS MORE DANGEROUS!
Difference between a simple and radical procedure for cancer removal? - CORRECT ANSWERS ✔✔Simple usually removes the tumor, tissue and skin but not lymph nodes Radical usually removes everything including the lymph nodes! Examples of primary surgery for cancer patient - CORRECT ANSWERS ✔✔removing the entire tumor. ex: removing malignant melanoma with margins Includes simple and radical procedures Examples of prophylactic surgery for cancer patients - CORRECT ANSWERS ✔✔mastectomy if someone has breast cancer gene, polyp removal for colorectal cancer Examples of palliative surgery for cancer patients - CORRECT ANSWERS ✔✔Making spinal tumors smaller to make patient more comfortable. (radiation to shrink) True or false: radiation therapy may be internal or external - CORRECT ANSWERS ✔✔True What does radiation therapy do to cancer cells? - CORRECT ANSWERS ✔✔Disrupts malignant cells DNA What does nursing care focus on when caring for a patient with radiation therapy? - CORRECT ANSWERS ✔✔patient education, care for skin and mucosa, and general well being.
