MED SURG RN HESI EXIT EXAM 2024 Elaborated Questions And Correct Answers Graded A

MED SURG RN HESI EXIT EXAM 2024 Elaborated Questions And Correct Answers Graded A Monitor ABGs - PO2 > 80 mm Hg; PCO2 35-45 mm Hg; HCO3 21-28 mEq/L; pH 7.35-7.45 Chronic bronchitis - Airway destruction Chronic sputum with cough production on a daily basis for a minimum of 3 months in 2 consecutive years Reduced responsiveness of respiratory center to hypoxemia stimuli Precipitating factor: higher incidence in smokers "Blue bloaters" - generalized cyanosis of lips, mucous membranes, face, and nail beds Right-sided heart failure (distended neck veins, crackles) Lowest FiO2 possible to prevent CO2 retention Monitor for fluid overload Maintain PO2 between 55 and 60 Administer bronchodilators and anti-inflammatory agents Emphysema - Alveoli destruction Increased air trapping (increased AP diameter) Increased work, increased O2 consumption Precipitating factor: cigarette smoking "Pink puffers" Barrel chest, pursed-lip breathing, wheezing Lowest FiO2 possible to prevent CO2 retention Administer bronchodilators and anti-inflammatory agents Teach prolonged expiratory phase to clear trapped air Asthma - Unlike COPD, asthma is an intermittent disease with reversible airflow obstruction and wheezing COPD - Emphysema and chronic bronchitis Characterized by bronchospasm and dyspnea Compensation occurs over time in clients with chronic lung disease and ABGs are altered The amount of O2 in the blood decreased (hypoxemia) and the amount of CO2 in the blood increases (hypercapnia) causing chronic respiratory acidosis, which results in metabolic alkalosis as compensation Clients at risk for pneumonia - Altered LOC Depressed or absent gag and cough reflexes Susceptible to aspirating oropharyngeal secretions (alcoholics, anesthetized individuals) Brain injury Drug overdose Stroke victims Immunocompromised Adrenergics and sympathomimetics - Epinephrine; Albuterol (Proventil); Terbutaline (Brethine); Salmeterol (Serevent); Metaproterenol (Alupent); Levabuterol (Xopenex) Bronchodilation Adverse reactions: anxiety, increased HR, N/V, urinary retention Methylxanthine - Aminophylline (IV); Theophylline (PO) Bronchodilation Adverse reactions: hyperactivity, tachycardia, sleeplessness, cardiac dysrhythmias Monitor therapeutic range Crosses placenta Corticosteroids - Prednisone (PO); Solu-Medrol (IV); Budesonide (Pulmicort); Fluticasone (Flovent); Triamcinolone (Azmacort) Anti-inflammatory Encourage oral care after use Anticholinergics - Ipratropium (Atrovent); Tiotropium (Spiriva) Bronchodilator; control of rhinorrhea Adverse reactions: dry mouth, blurred visions, cough O2 delivery - O2 must be humidified if given at >4 L/min or delivered directly to the trachea Tuberculosis - Airborne precautions***** Symptoms: fever with night sweats, anorexia, weight loss, malaise, fatigue, cough, hemoptysis, dyspnea, pleuritic chest pain with inspiration, positive sputum culture, repeated upper respiratory infection Client may return to work after 3 negative sputum cultures Place client in respiratory isolation while hospitalized (mask for anyone entering room; private room; client wears mask if leaving room) Isoniazid (INH): metabolism primarily by liver and excretion by kidneys; increased phenytoin (Dilantin) levels Rifampin (Rifadin): used in conjugation with at least one other antitubercular agent; suppression of effect of birth control fills; orange body secretions; increases metabolism of digoxin and oral hypoglycemics Ethambutol: vision check before starting therapy and monthly thereafter Pyrazinamide Rifapentine Chest tubes - Used to remove or drain blood or air from the intrapleural space, to expand the lung after surgery, or to restore subatmospheric pressure to the thoracic cavity Keep all tubing coiled loosely below chest level Observe for air bubbling in the water seal chamber and fluctuations (tidaling) Do not strip or milk chest tubes Chest tubes are not clamped routinely. If the drainage system breaks, place the distal end of the chest tubing connection in a sterile water container at a 2-cm level as an emergency water seal If the chest tube is accidentally removed from the client, the nurse should cover with a dry sterile dressing Fluctuations (tidaling) in the fluid will occur if there is no external suction. These fluctuating movements are a good indicator that the system is intact; they should move upward with each inspiration and downward with each expiration. If fluctuations cease, check for kinked tubing, accumulation of fluid in the tubing, occlusions, or change in the client's position, because expanding lung tissue may be occluding the tube opening. When external suction is applied, the fluctuations cease. Ineffective breathing pattern - Inability of air sacs to fill and empty properly (emphysema, cystic fibrosis) Obstruction of the air passages (carcinoma, asthma, chronic bronchitis) Accumulation of fluid in the air sacs (pneumonia) Respiratory muscle fatigue (COPD, pneumonia) Daily urine output - 1 mL per kg per hour Total daily UO: 1,500-2,000 mL Acute renal failure (ARF)/ acute kidney injury (AKI) - Occurs when metabolites accumulate in the body and urinary output changes - may be reversible! Sodium and chloride are the primary extracellular ions; potassium and phosphate are the primary intracellular ions History of taking nephrotoxic drugs (salicylates, antibiotics, NSAIDs, ACE inhibitors, ARBs) Oliguric phase: increased BUN/creatinine; hyperkalemia; hyponatremia; acidosis; fluid overload; high urine specific gravity Diuretic phase: decreased fluid volume; hypokalemia; further hyponatremia; low urine specific gravity Monitor I&Os - give only enough fluids in oliguric phase to replace the losses (usually 400-500 mL/24 hr) Body weight is a good indicator of fluid retention and renal status***** Provide low protein, moderate fat, high carbohydrate diet Hyperkalemia - Dizziness, weakness, cardiac irregularities, muscle cramps, diarrhea, and nausea Sodium polystyrene (Kayexalate) may be prescribed if potassium is too high Hypokalemia - Dry mouth, thirst, weakness, drowsiness, lethargy, muscle aches, and tachycardia End stage renal disease (ESRD) - Progressive, irreversible damage to the nephrons and glomeruli, resulting in uremia Accumulation of waste products from protein metabolism is the primary cause of uremia - protein must be restricted in ESRD clients****** However, if protein intake is inadequate, a negative nitrogen balance occurs, causing muscle wasting Labs: azotemia; increased creatinine/BUN; decreased calcium (function of the kidney to reabsorb calcium); elevated phosphorus and magnesium (decreased calcium = increased phosphorus); anemia Provide a low protein, low sodium, low potassium, low phosphate, high calorie diet Administer phosphate binders with food because client is unable to excrete phosphates No magnesium-based antacids Monitor for fluid overload Admister erythropoietin (Epogen) to treat anemia (due to decreased production of erythropoietin in ESRD); do not shake vial (shaking may inactivate the glycoprotein) Beware of digoxin toxicity (excreted by the kidneys) Digoxin toxicity - N/V, anorexia, visual disturbances, restlessness, headache, cardiac dysrhythmias, pulse < 60 bpm 0.8 - 2.0 ng/mL Urinary tract infection - Consume oral fluids up to 3 L/day