MED SURG 2 HESI REVIEW QUESTIONS (test knowledge of all the info you just studied

MED SURG 2 HESI REVIEW QUESTIONS (test knowledge of all the info you just studied List 4 common symptoms of pneumonia you might note on a physical exam tachypnea, fever w/ chills, productive cough, bronchial breath sounds 4 nursing interventions to assist client in coughing productively deep breathing, fluid intake increased to 3 L/day, use humidity to loosen secretions, suction airway to stimulate coughing what symptoms of pneumonia might you expect to see in an older client? confusion, lethargy, anorexia, rapid respiratory rate What should the O2 flow rate be for the client with COPD? 1-2 L per nasal cannula- too much eliminates their drive to breathe how do you prevent hypoxia during suctioning? deliver 100% O2 before and after suctioning during mechanical ventilation, what are 3 major nursing interventions? monitor respiratory status and secure connections, establish a communication mechanism with them, keep airway clear by coughing/suctioning physical findings you'd expect to see in a client with emphysema? barrel chest, dry/productive cough, decreased breath sounds, dyspnea, crackles in the lungs most common risk factor associated with lung cancer smoking describe preoperative nursing care for a client undergoing a laryngectomy involve family/client in the manipulation of tracheostomy equipment, plan communication method, refer to a speech pathologist, discuss rehab 5 nursing interventions after chest tube insertion maintain a dry occlusive dressing on the chest tube, keep all tubing connections tight and taped, monitor the patients clinical status, encourage the patient to breathe deeply periodically, monitor the fluid drainage and mark the time of measurement and the fluid level immediate action when a chest tube becomes disconnected from a bottle or suction apparatus? what if it's accidentally removed from client? place the end of the tube in sterile water container at 2 cm level, immediately reestablish the water-seal system and attach new drainage system as soon as possible, apply sterile dressing + notify PCP STAT what instructions should be given to client after radiation therapy? do NOT wash off lines, wear soft cotton garments, avoid use of powders/creams on radiation site what precautions are required for clients with TB when put on respiratory isolation? mask for anyone entering the room, private room, client must wear mask if leaving room 4 components of teaching for a patient with TB: cough into tissues and dispose into special bags, long term need for daily medication, good hand-washing technique, report symptoms of deterioration or blood in secretions differentiate between acute renal failure and chronic renal failure ARF= often reversible, abrupt deterioration of kidney function- CRF= irreversible, slow deterioration of kidney function characterized by increased BUN and creatinine, dialysis is eventually required During the oliguric phase of renal failure, protein should be severely restricted. What is the rationale for this restriction? toxic metabolites that accumulate in the blood are derived mainly from protein catabolism 2 nursing interventions for the client on hemodialysis do not take BP or perform venipunctures on the armwith A-V shunt, fistula, or graft - assess access site for thrill and bruit. highest priority nursing diagnosis for clients in any type of renal failure? risk for imbalanced fluid volume Why is a client in renal failure being given antacids? calcium and aluminum antacids bind phosphates and help to keep the phosphates from being absorbed into the bloodstream, thereby preventing rising phosphate levels, and must be taken with meals 4 essential elements of a teaching plan for clients with frequent UTI's fluid intake 3L/day, good hand washing, void q2-3h, take all prescribed meds, wear cotton undergarments what are the most important nursing interventions for clients with possible renal calculi? straining all urine is the most important- also strict I's and O's, analgesics PRN discharge instructions to be given to a client who has renal calculi? maintain fluid intake 3-4 L/day, follow up care, follow prescribed diet, avoid supine position after TURP, hematuria should subside by what postoperative day? the 4th day after urinary catheter is removed in the TURP client, what 3 priority nursing actions to be taken? strict I's and O's, observe for hematuria, inform client that burning and frequency may last for up to a week After kidney surgery, what are the primary assessments the nurse should make? respiratory status (breathing is guarded bc of pain), circulatory status (the kidney is very vascular and excessive bleeding can occur), pain assessment, urinary assessment (most importantly, assess urinary output) what diagnostic test is used to determine thyroid activity? T3 + T4 what condition results from all treatments for hyperthyroidism? hypothyroidism, requiring thyroid replacement 3 symptoms of hyperthyroidism and three symptoms of hypothyroidism HYPER: weight loss, heat intolerance, diarrhea - HYPO: fatigue, cold intolerance, weight gain 5 important teaching aspects for clients who are beginning corticosteroid therapy continue medication until weaning plan is begun by PCP; monitor serum potassium, glucose, and sodium frequently; weigh daily + report gain of more then 5lb/week, monitor BP and pulse, teach s/s of cushing's syndrome physical appearance of client's who are cushingoid moon face, obesity in the trunk, buffalo hump in back, muscle atrophy, thin skin which type of diabetes requires insulin replacement? Type 1 which type of diabetes does not require medication/insulin? Type 2 5 symptoms of hyperglycemia polydipsia, polyuria, polyphagia, weakness and weight loss 5 symptoms of hypoglycemia Hunger, lethargy, confusion, tremors or shakes, sweating necessary elements to include in teaching for a client newly diagnosed with diabetes how it is caused, management/treatment, meal planning, exercise program, insulin administration, sick-day management, s/s of hyper and hypoglycemia a client has purchased a 3 month supply of insulin, which bottles should be refrigerated? all of them except the insulin bottle they are currently using peak acting times of the following insulins: rapid-acting regular, intermediate-acting, long-acting 1-4h, 6-12h, peakless relationship between stress, exercise, bedtime snacking, and glucose balance in a diabetic patient stress/stress hormones usually increase glucose, also increasing the need for insulin; exercise can increase the chance for an insulin reaction so they should always have sugar snack available; a bedtime snack can prevent insulin reactions an insulin-dependent client is is complaining of a headache, slight nausea, and mild trembling, hands are cool and moist... what is this client most likely experiencing? hypoglycemia/insulin reaction 5 foot care interventions that should be taught to a new diabetic patient: check daily + report any breaks/sores/blisters, wear shoes that fit, never go barefoot or wear sandals, never personally remove corns or calluses, cut or file nails straight across, wash feet daily w/ mild soap and warm water How do clients experiencing angina describe that pain? squeezing, heavy, burning, radiating to left arm or shoulder, transient, or prolonged what would your teaching plan include for a client taking nitroglycerin? take at first sign of anginal pain, take no more than 3 five minutes apart, call 9-1-1 if there's no relief in 10 minutes