NUR 204/ NUR204 Exam 3 (NEW 2026/ 2027 Update) Leadership and Management VERSION 2| Questions & Answers| Grade A| 100% Correct (Verified Solutions)- Fortis

1 …..DLDD NUR 204/ NUR204 Exam 3 (NEW 2026/ 2027 Update) Leadership and Management VERSION 2| Questions & Answers| Grade A| 100% Correct (Verified Solutions)- Fortis Q. What is micturition Answer urination Q. How much mL's of urine are expelled typically for adults Answer 250-450 mL Q. What is polyuria Answer excessive urination of 2.5 liters over 24 hours 2 Q. What causes polyuria Answer consumption of large amounts of fluids, diuretic meds, renal disease, sickle cell anemia, and diabetes Q. What is the significance of polyuria Answer can lead to dehydration which can cause fluid and electrolyte imbalances in the client Q. What is oliguria Answer producing less than 400 mL's of urine over the course of 24 hours Q. What causes oliguria Answer impaired renal blood flow, renal disease, decreased fluid intake, and hypovolemic shock 3 Q. What is anuria Answer lack of urine production less than 50 mL's in 24 hours Q. What is nocturia Answer increased urination at night Q. What is urgency in regards to the GU system Answer once you sensate, you need to go urinate immediately Q. What is dysuria Answer painful urination Q. What is hesitancy in regards to the GU system Answer patient knows they have to urinate but cannot start a stream 4 Q. What is enuresis Answer bed wetting Q. What are the two kinds of urinary incontinence Answer acute and chronic Q. What are some bladder irritants to avoid to promote normal urination Answer coffee, sodas, tea, and energy drinks Q. What color variant appears in urine when taking anticoagulants Answer red color 5 Q. What color variant appears in urine when taking diuretics Answer lightens to a pale yellow color Q. What color variant appears in urine when taking pyridium Answer orange to orange-red color Q. What color variant appears in urine when taking B-complex vitamins Answer bright yellow Q. What color variant appears in urine when taking levodopa and injectable iron compounds Answer brown or black color 6 Q. What is the normal pH range of urine Answer 4.6-8.0 Q. What does it mean if the urine is too acidic Answer client is at risk for kidney stones Q. What odes it mean if the urine is too alkaline Answer suggestive of infection Q. What is the normal range of specific gravity in urine Answer 1.010-1.025 7 What is the normal range for WBC in the the urine 0-4, or negative What does it mean if a patient is positive for WBCs in urine it can indicate that there is inflammation in the urinary tract or kidneys What is the normal test result for ketones in the urine negative What does it mean if a patient tests positive for ketones in the urine it can indicate for type 1 diabetes mellitius What is the normal test result for bilirubin in the urine negative What does it mean if a patient tests positive for bilirubin in the urine it can indicate liver or gallbladder dysfunction 8 What is the normal test result for glucose in the urine negative What does it mean if a patient tests positive for glucose in the urine it can indicate the presence of hemoglobin in the urine or myoglobin from muscle injury What is the normal test results for nitrites in the urine negative What does it mean if a patient tests positive for nitrites in the urine it can indicate that there is inflammation in the urinary tract or kidneys (coincides wit WBCs) What must occur when doing a 24 hour urine test on a patient all urine expelled from the patient the entire day must be stored in a large jug and packed with ice 9 What is very important about the 24 hour urine test no urine can be discarded, if it is, the 24 hour test must be restarted all over again What does a 24 hour urine test, test for creatinine clearance What is BUN blod urea nitrogen What does BUN affect in the urinary system identifies presence of renal problems What is the normal adult findings of BUN 10-20mg/dl 10 What is creatinine determinant of renal function, produced in relatively constant quantities by muscles What is the normal adult findings of creatinines females- 0.5-1.1 mg/dl and males- 0.6-1.2mg/dl What must occur before testing for creatinine preferably NPO for 8 hours before testing, avoid meat day before, and ensure adequate hydration What are other types of urine testin urinalysis (clean catch), urine culture (clean voided midstream), sterile, and residual urine What is urinary retention the bladder distends and client has feeling of bladder fullness 11 What causes urinary retention anesthesia, surgery, obstruction, childbirth, medications, kidney stones, STIs, What are some signs and symptoms of urinary retention pressure, discomfort, restlessness, diaphoresis, PVR 100cc what are some interventions you can do to stimulate reflex bladder for urinary retention applying a cold compress to abdomen and crede's method What causes urinary incontinence impaired ability to recognize bladder cues What diseases can cause urinary incontinence brain or spinal cord injuries, tumor, infection of CNS, demyelinating diseases (MS) What is functional urinary incontinence a state in which a usually continent person experiences incontinence because of a difficulty or inability to reach the toilet in time 12 What is reflex urinary incontinence involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached; specific to the client with a spinal cord injury What is stress urinary incontinence loss of urine related to increase in intra-abdominal pressure such as sneezing, laughing, or coughing What is continuous urinary incontinence ongoing, unpredictable loss of urine without bladder distention or awareness of bladder fullness What is urge urinary incontinence involuntary voiding related to an abrupt urge to void What is risk of urge urinary incontinence at risk for involuntary voiding related to an abrupt urge to void 13 what is overflow incontinence (previously called urinary incontinence) involuntary loss of urine associated with over-distention of the bladder what are some acute care setting interventions we can do for urinary incontinence frequent changes of sheets or bedding, prevent skin breakdown, and apple skin barrier creams or tropical agents what are some ongoing care interventions we can give for urinary incontinece bladder and pelvic floor training/exercises, pharmacologic treatment, prosthetic support, and surgical intervention as a last result what is a urinary tract infection (UTI) typically starts at urethra and spread upward to the bladder and can be found in both lower or upper tract what is kidney inflammation caused by a urinary tract infection pyelonephritis 14 Why are women more prone to UTIs shorter urethra than males what is the most common type of bacteria that cause UTIs E. coli what causes urinary tract infections HARD TO VOID what does the H in HARD TO VOID stand for hormone change; pregnancy, menopause, birth control what does the A in HARD TO VOID stand for antibiotics what does the R in HARD TO VOID stand for renal stones 15 what does the 1st D in HARD TO VOID stand for diabetes what does the T in HARD TO VOID stand for toiletries; excessive bubble baths, powders, perfumes what does the 1st O in HARD TO VOID stand for obstructions (BPH, strictures, stones) what does the V in HARD TO VOID stand for vesicoureteral reflux (VUR); most common in pediatric patients and is when urine from the bladder back flows into kidneys what does the 2nd O in HARD TO VOID stand for overextended bladder what does the I in HARD TO VOID stand for 16 indwelling catheters, invasive procedures, intercourse what does the 2nd D in HARD TO VOID stand for decreased immune system what are some signs and symptoms of a simple UTI dysuria, hesitancy, frequency, foul urine smell, subjective feeling of 'need to pee' what are some signs and symptoms of pyelonephritis fever, CVA tenderness, nausea, flank pain 'ill appearing' what are some nursing interventions for UTIs monitor kidney involvement, maintain fluids, warm sitz bath or heating pad, NSAIDS, and antibiotics per provider order what should you teach to patients about UTI take all antibiotics, wipe front to back, urinate after intercourse, avoid irritants 17 what are renal calculi stones formed mostly within the kidney but can form anywhere in the urinary system where there is a concentration of minerals when can stones be passed when there are less than 5 mm but is very painful when can stones be stuck within the urinary system greater than 5 mm what are the types of renal calculi oxalate, struvite, uric acid, cystiene what are some complications with renal calculi obstruction, hydroneprohrosis, kidney failure, infection what are some nursing interventions for renal calculi 18 proper hydration, pain management, and closely monitor IOs what is a stone lithotripsy using ultrasound shock waves to break the stones in smaller pieces What is percutaneous nephrolithotomy an invasive procedure only done when the stone is too large or can't use lithotripsy what are the different kinds of catheters foley, straight in/out cath, and suprapubic what is a foley catheter used for retention, surgery, critically ill patients what is a straight in/out cath used with obstruction and sterile sampling 19 what is a suprapubic catheter a long term catheter used for severe urinary retention to prevent skin breakdown, terminal illness, and pain what are some nursing care interventions when dealing with catheters make sure the catheter tubing does not get twisted or kinked, when in bed, the urine bag on the side of the bed what are some complications of indwelling catheters CAUTI, sepsis, infection, and truama what are some surgical options for problems with urinary elimination urinary diversion involving either the ileal conduit, kock pouch, cutaneous ureterostomy, and vesicostomy what are some possible complications with urinary diversion infection, renal calculi, distended bladder, changes in urinary pH, mucous plugs and ostomy clogs 20 what do crackles/rales sound like short discrete, classified as fine to coarse caused by air passing through what do crackles entail moisture what do rhonchi/gurgles sound like continuous low pitched rattling, most heard on inspiration what do rhonchi entail moisture what do wheezes sound like continuous high pitched whistling sound, most heard of expiration what do wheezes entail narrowing 21 what does stridor sound like high-pitched piercing sound heard most often on inspiration what does stridor entail narrowing what is pleural friction rub creaking, grating sound outside of respiratory tree caused by rubbing together of inflamed pleural surface what is absent or diminished breath sounds seen in pneumothorax, emphysema, surgically removed lung lobes, obstruction, atelectasis what lung sound is a medical emergency stridor 22 which sounds are caused by narrowed airways and what would you do to treat them, select all that apply A. wheeze B. crackles C. rhonchi D. stridor E. nebulizer or inhaler bronchodilator medication F. IV antibiotic to clear infection causing excess secretion G. IV or nebulizer steroids/anti-inflammatory meds A,D,E,G is wheezing upper or lower respiratory lower is stridor upper or lower respiratory upper what would you hear in someone with asthma and COPD wheezing 23 your 64 year old patient is 12 hours post op from CABG. when auscultating his lung sounds, the nurse hears normal breaths sounds in the upper lobes, but little passage in lower lobes. His VS are 125/88, RR 18 and shallow, spO2 96% on RA, HR 89. which nursing intervention would be best for this patient incentive spirometry x 10 breaths with good efforts what is inspiration an active process stimulated by chemical receptors in the aortha what is expiration a passive process what is pulmonary circulation moves blood to and from the alveolar capillary membranes for gas exchange what is oxygen transport Lungs and cardiovascular system 24 what is carbon dioxide transport diffuses into red blood cells and is hydrated into carbonic acid what is lung volumes tidal, residual, forced vital capacity (FVC); spirometry what is true about respiratory gas exchange the thickness of the alveolar capillary membrane affects the rate of diffusion what is the formula for oxygen transport oxygen transport = lungs + cardiovascular system what does hemoglobin carry oxygen and carbon dioxide what is anemia low hemoglobin, causing lower oxygen 25 what are some signs and symptoms of anemia fatigue, activity intolerance, shortness of breath, increased breathlessness, increase heart rate, pallor what is carbon monoxide toxicity Hgb binds with carbon monoxide, Hgb unavailable for oxygen transport where will you see pallor lower extremities and around the lips (know when you see pallor in darker complexions) why do we see increased heart rate with anemia not enough oxygen for hemoglobin so the heart works harder what is hypovolemia low blood volume 26 What is hypoxia deficiency in the amount of oxygen reaching the tissues what conditions cause hypovolemia shock and severe dehydration what is the result of hypovolemia hypoxia to bodys tissues what is the bodys response to hypovolemia peripheral vasoconstriction, increased HR, eventual decrease in BP to dangerously low level what is FiO2 fraction of inspired oxygen (defined by percentage of oxygen inhaled) what causes decreases in FiO2 obstruction, high altitudes, hypoventilations, and narcotic overdose 27 what happens when there is an increased metabolic rate increased oxygen demand when is an increased metabolic rate seen pregnancy, wound healing, and exercise what condition affect the chest wall movement obesity, too much weigh on the lungs so they cannot function properly what are some musculoskeletal abnormalities that affect the respiratory system abnormal structure of rib cage or vertebral column, trauma, neuromuscular diseases, and CNS alterations what are some influences of chronic lung diseases clubbing of the fingernails and barrel chest (over inflated) 28 what are some causes of acute hypoxia obstructed airway, pulmonary embolism, and impaired ventilation (asthma and pneumonia) what are some symptoms of acute hypoxia anxious, sitting up, increased RR, confusion, behavior changes, nasal flaring what are some causes of chronic hypoxia COPD, anemia, impaired ventilation (COPD), cardiac abnormalities what are some symptoms of chronic hypoxia fatigue, lethargy, clubbed fingers, barrel chest, SOA, PND, and orthopnea what is true about cyanosis cyanosis is a late sign, if your patient is turning blue, your patient is dying fast what are some signs and symptoms of an ineffective airway clearance ineffective or absent cough, gurgle sounds, inability to remove secretions (trach) 29 what is the defining characteristic of impaired gas exchange dyspnea on exertion what are some minor characteristics of impaired gas exchange three point positioning, pursed lip breathing, lethargy and fatigue, decreases oxygen sat, cyanosis what is aspiration state in which person is at risk for entry of secretions, solids, or fluids into the tracheobronchial passages What are the risk factors for aspiration LOC, depressed gag/cough reflex, impaired swallowing, stroke history what are some signs and symptoms for aspiration pain while swallowing, trouble starting to swallow, coughing or wheezing after eating, chest discomfort 30 what is activity intolerance insufficient physiological or psychological energy to endure or complete required or desired daily activities what are some defining respiratory characteristics of activity intolerance exertional dyspnea, excessively increased or decreased, rate, SOB what are some defining cardiac characteristics of activity intolerance pulses weak, increased or decreased pulse, rhythm changes, pre-activity level within 3 mins, EKG changes what are some defining blood pressure characteristics of activity intolerance abnormal BP response, failure to increase with activity, increased diastolic pressure greater than 15 mm hg what are some respiratory concerns do they use oxygen at home, smoking cessation, and prevention 31 what are some health promotions for respiratory concerns vaccines (influenza, pneumococcal, and covid), healthy lifestyle, environmental pollutant interventions for respiratory concerns depends on the issue and patients history. Patients history is just as important as an assessment what are some nursing interventions for promoting oxygenation hydration, positioning, movement, pursed lip breathing, chest physiotherapy, oxygen, medications, suctioning what is the most invasive nursing intervention for promoting oxygenation suctioning, can cause hemorrhage from nicking an artery what are some types of medications that promote oxygenation PO, nebulizers, IV what are some types of suctioning 32 oral, nasal, deep where does the blood dump into the heart from the superior and inferior vena cava. this is also deoxygenated blood from the body below and above the heart right atrium where does blood flow to when it exits the atrium and what valve does it flow through to get there right ventricle through the tricuspid valve what vessel does the blood flow to from the right ventricle and what valve does it have to go through pulmonary artery through the pulmonic valve where does the newly oxygenated blood from the lungs enter the heart and what vessels carry blood from the lungs to the heart the vessels that carry oxygenated blood are the pulmonary veins and flow into the left atrium where does blood flow to after the left atrium and what valve does it go through 33 enters the left ventricle through the bicuspid/mitral valve what vessel does blood flow through after the left ventricle and what is the name of the valve it flows through enters the aorta through the aortic valve where is the blood flow altered when a patient has a tricuspid valve problem right atrium and right ventricle you are at the nursing station in the ICU and you see a patient running a V. tach and V. fib. they are not your patient but you look around and the nurse is not there. what do you do run to the bedside to assess the patient after discovering a pulseless patient and alerting EMS (call 911) or the code team (pull code lever in room)- what does quality CPR always start with quality chest compressions 34 you are a phone triage nurse for an adult internal medicine clinic. a 58 year old male patient who is home alone calls and states he took his blood pressure twice in a row and it is 188/120 with chest pain. what is the best nursing action assist the patient to call 911 what is the formula for cardiac output cardiac output = heart rate x stroke volume what is the formula for moderate tachycardia increased cardiac output = increased heart rate x decreased stroke volume what is the formula for severe tachycardia decreased cardiac output = increased heart rate x decreased stroke volume what is the formula for moderate bradycardia decreased cardiac output = decreased heart rate x increased stroke volume what is the formula for severe bradycardia decreased cardiac output = decreased heart rate x increased stroke volume 35 a patient has a condition of the left ventricle in which it does not pump as much blood as it should. this would cause a decreased _______ and decreased ______ decreased stroke volume, decreased cardiac output what are the three factors that impact stroke volume preload, afterload, and contractility what is preload a volume (amount of stretch of ventricle at the end of diastole, or before contraction); also known as end-diastolic volume what is afterload pressure in which the ventricle must push against to get blood into lungs/body true or false: a patient with tachycardia has improved filling and pumping quality in the heart false 36 a patient has uncontrolled hypertension. this results in increased _______ and decreased ________ increased afterload, decreased cardiac output what is ejection fraction the amount of blood pumped out of the left ventricle with each contraction what does ejection fraction indate EF is an indication of the effectiveness of the heart as a 'pump' what is the normal range of ejection fraction greater than 55% when do you typically see lower values of ejection fracture (under 40%) patients with congestive heart failure 37 you are a nurse who witnesses an adult collapse at a ballgame. after determining the victim is pulseless and not breathing you direct another to call 911. your next best action is to... begin chest compressions at a rate of at least 100 compressions per minute with little to no interruption which of the following contains 2 assessment findings the nurse would expect to see in patients with chronic hypoxia changes barrel chest and finger clubbing 3 multiple choice options what is ischemia a decrease in supply of oxygenated blood to the tissues what is necrosis no supply of oxygenated blood to the tissues resulting in localized tissue death what is angina pectoris chest pain related to inadequate oxygen supply (ischemia) 38 what is myocardial infarction (MI) related to necrosis (death) of the heart muscle what is congestive heart failure (CHF) the heart is inadequate as a pump, decreased cardiac output what is true about heart failure heart failure almost always starts at the left side of the heart (hypertension) what abbreviation is used for what causes heart failure FAILURE what does F in FAILURE stand for faculty heart valves what does A in FAILURE stand for arrhythmias: a-fib most common (very common in adults 65+ with HTN) 39 what does I in FAILURE stand for infarction (myocardial) what does L in FAILURE stand for lineage (congenital)/ family history what does U in FAILURE stand for uncontrolled hypertension what does R in FAILURE stand for recreational drug use (cocaine) or alcohol abuse what does E in FAILURE stand for envaders (instead of invaders) viruses or infections that attack the heart muscle describe left-sided heart failure 40 the left side of heart cannot pump blood out of the heart efficiency so blood starts to back-up in the lungs what is the most common kind of heart failure left sided what is true about left sided heart failure left sided heart failure is likely to lead to right sided heart failure is left sided heart failure systolic or diastolic is can be either systolic or diastolic what is right sided heart failure the right side of the heart cannot pump the 'used' blood it received from the body efficiently so it can't get the blood back to the lungs to get replenished with oxygen what does right sided heart failure cause in regards to the peripherals blood backed up in the peripherals (legs, hands, feet, abdomen) 41 what does right sided heart failure cause in general congestion of blood in the heart and this increases the pressure in the inferior vena cava what is true about right sided heart failure right sided heart failure is usually caused from left sided heart failure because of the increased fluid pressure backing up from the left side to the right what are some signs and symptoms of left sided heart failure dyspnea, orthopnea, rales (crackling), increased heart rate, weakness, weight gain what are some signs and symptoms of right sided heart failure edema, weight gain, lethargic, a-fib, nocturia what are some nursing interventions to improve cardiac output and reduce the work of the heart alternate rest and activity, high fowlers to semi-fowlers, avoid stimulant, manage fluid baalnce, increase oxygen supply 42 what are some nursing interventions that DO NOT improve cardiac output and reduce the work of the heart valsalva maneuver, causes vasovagal syncope a nurse is caring for a patient admitted with a diagnosis of left-sided heart failure. the patient reports shortness of breath and has crackles in both lung bases. VS B/P 110/78, HR 95, spO2 96% on RA. which nursing action should the nurse take first place the patient in high fowler's position 3 multiple choice options what is stenosis in regards to impaired valvular function leads to ventricle hypertrophy and heart failure what is regurgitation in regards to impaired valvular function backflow what is angina in regards to coronary arteries not enough oxygen to myocardium (chest pain) 43 what is myocardial infarction in regards to coronary arteries decrease in coronary blood flow, leading to ischemia leading to cellular death what do men feel when experiencing chest pain crushing, squeezing, or stabbing; its sided and radiates to back, arm, jaw what do women feel when experiencing chest pain angina, but may be fatigue, indigestion, shortness of breath, back pain what would vital signs look like in a patient with a hemorrhage normal BP, spO2 sats. tachycardia HR and tachypnea RR what would vital signs look like in a patient with COPD normal BP/HR, slighty increased RR. spO2 around 88% what would vital signs look like in a patient with asthma 44 increased RR and HR. slightly low spO2 around 90% what would vital signs look like in a patient with respiratory failure slow RR, low spO2, bradycardia what would vital signs look like in a patient with narcotic overdose every VS is significantly dropped what would vital signs look like in a patient with hypertension pretty high BP what does the S1 sound represent the closing of the tricuspid and bicuspid valve what does the S2 sound represent the closing of the pulmonic and aortic valve 45 what does the S3 sound represent (abnormal) Early diastolic gallop showing a left ventricular dysfunction what does the S4 sound represent (abnormal) pre systolic occurring in late diastole gallop what does a provider do in regards to pain management assessment of need and prescribing pain medications or alternative therapies what does pharmacy do in regards to pain management verification of safety profile of pain management and dispensing of medications what do nurses do in regards to pain management assess and eval, non-medicinal interventions, administer meds, monitoring, and accurate pyxis cart count what is nocioceptive pain damage to tissues 46 what is visceral pain injuries or damage to your internal organs and is poorly localized as pressure or aching what is somatic pain stimulation of the pain receptors in your tissues, rather than your internal organs. well localized and can be felt superficial or deep what is neuropathic pain damage to or dysfunction of your nervous system resulting from misfiring pain signals. feels like shocking or burning what is tolerance in regards to pain management occurs after repeated exposure to an opioid analgesic in the long term what is physical dependance in regards to pain management withdrawal symptoms if drug was abruptly stopped such as agitation, insomnia, diarrhea, diaphoretic, and tachycardic 47 what is psychological dependance in regards to pain management overwhelming involvement with obtaining and using a drug to get high (drug seeking behavior) how would you treat pain in older adult patients opioid drugs can be used but must begin at 50-75% of the normal dose what abbreviation is used to assess pain in patient COLDERR what does C in COLDERR stand for character (sensation) what does O in COLDERR stand for onset 48 what does L in COLDERR stand for location what does D in COLDERR stand for duration what does E in COLDERR stand for exacerbation what does 1st R in COLDERR stand for relief what does 2nd R in COLDERR stand for radiation what are some non-pharmacology pain management nursing interventions positioning, distraction, massage, TENS unit, aqua therapy 49 what are some collaboration pain management nursing intervention music therapy, pet therapy, art therapy, PT/OT for ambulation what are some non-opioids to use for mild-moderate pain acetaminophen (Tylenol), ibuprofen (Motrin), and skeletal muscle relaxers what are adjuvant analgesics medications combined with analgesics to help relieve pain what are some examples of adjuvant analgesics anticonvulsants, antidepressants, corticosteroids, local anesthetics what are opioids (narcotics) designed for moderate to severe pain and acts on the central nervous system what are some commonly prescribed opioids/narcotics morphine, codeine, oxycodone, hydromorphone 50 what are some common side effect of opioids/narcotics pruritis, urinary retention, n/v, constipation what are some major side effects of opioids decreased LOC, respiratory depression (decreased RR) what is respiratory depression less than 12 respirations per minute in adults what are some indications to administer Narcan respiratory arrest in the setting of opiates, hypoxemia, and bradypnea what is a patient controlled analgesia (PCA) a drug delivery system that allows patients to administer pain meds when they want them without the risk of OD 51 what are the two kinds of PCA intravenous and epidural what is the epidural catheter placement inserted between the spinal vertbrae and dura mater to allow diffusion of analgesic true or false- the best judge of existence and severity of pain is physician or nurse false true or false- visible signs always accompany pain and can be used to verify its existence and severity false true or false- clients who are knowledgable about opioid analgesics are 'drug seekers' false true or false- addiction occurs with prolonged use of morphine or its deprivatives 52 true true or false- very young or very old people do not have as much pain false true or false- pain is a part of aging false true or false- a person who is asleep is not in pain false provider, nurse, or pharmacist? give medication to patients nurse provider, nurse, or pharmacist? order medications based on lab/diagnostic results provider 53 provider, nurse, or pharmacist? verifies ordered medications is a safe dose to administer pharmacist provider, nurse, or pharmacist? verifies ordered medications is appropriate for the diagnosis pharmacist provider, nurse, or pharmacist? assesses pain before administering ordered pain medication nurse provider, nurse, or pharmacist? suggests providers orders for non-pharmacological treatments that require a provider order nurse provider, nurse, or pharmacist? monitors patients for side effects of pain medications nurse 54 provider, nurse, or pharmacist? communicates side effect findings to provider nurse provider, nurse, or pharmacist? calls pharmacists to ask about medication administration question nurse provider, nurse, or pharmacist? increases ordered dose of pain medications when needed provider provider, nurse, or pharmacist? orders PT consult to help treat pain provider provider, nurse, or pharmacist? takes medications out of pyxis cart nurse provider, nurse, or pharmacist? ensures accurate disposal of partial dose narcotic medication vials/tablets/suspensions with a second clinician witness 55 nurse what type of pain is described as electric, jolting, burning, numbness, or tingling neuropathic what are some acute side effects of pain. select all that apply A. low motivation to cough or ambulate B. increased HR C. normal HR D. elevated temperature E. constipation F. diarrhea A,B,D your 72 year old male patient is exhibiting, irritability, insomnia, and signs of depression. what should you assess the patient for numerical pain rating 56 you are caring for patient who is in the end of life care for stage 4 cancer which has had for two years. what do you anticipate to find on his assessment normal HR, BP, and RR a 52 year old male presents to the ED with left arm pain. there is no history of injury. his VS are HR 110, BP 168/99, temp 98.7, spO2 95% on RA and he is diaphoretic. what do you anticipate as your first nursing response (assume you have the orders) 12 lead EKG you are seeing a patient in the clinic for a back injury they sustained while lifting a heavy box at work. the patient describes that pain as an extreme tightness in their back and they have difficulty bending over. the numerical pain rating is 6/10. what pain intervention do you as a nurse anticipate needing to giving teaching about muscle relaxer a client with a 5/10 back pain associated with a dance injury sustained two days ago. she states she started taking ibuprofen 600mg every 6 hours as directed, but it was not effective. so now she has been taking the same medication 1000mg every 4 hours. what do you anticipate in this patients care assessing the patients serum BUN and creatinine 57 you are a medsurge nurse caring for a patient who is 2 days post op ileostomy placement. he had a IB PCA but it discontinued 8 hours ago. he has not had any pain medication since then and awake in 10/10 pain. what medication do you anticipate giving, and when will you assess its effectiveness IV morphine; 30 minutes a patient presents in the ED in 10/10 pain from sickle cell anemia crisis. this is an illness that is present from birth, and require severe pain treatment during exacerbations that average 5 times per year. what do you anticipate in this patient's care assessing the patients typical IV morphine dose and administering it IV which of the following symptoms is most commonly associated with left sided heart failure crackles 3 multiple choice options the best method of oxygen administration for client with COPD uses venti mask due to the controlled amount of oxygen delivered 3 multiple choice options 58 which of the following terms describes the force the ventricles must pump against to circulate blood from the heart to the body/lungs afterload 3 multiple choice options a nurse is teaching that patient with mitral valve problems about the valves in the heart. starting on the right side of the heart, describe the sequence of the blood flow through these valves 1. mitral 2. aortic 3. tricuspid 4. pulmonic 3,4,1,2 3 multiple choice options a client has developed atrial fibrillation with a ventricular rate of 150 beats per minute. A nurse assess the client for hypotension and dizziness 59 a patient is recovering form surgery. the patient is restless, heart rate is 120 bpm and blood pressure is 70/53, skin is cool/clammy. what is the next best nursing action notify the provider a nurse teaches a patient about atelectasis. which statement by the patient indicates an understand of actelectasis it is important to do breathing exercises 1-2 hours to prevent atelectasis 3 multiple choice options a client with COPD exacerbation is experiencing tachycardia. the nurses understanding of the physiological basis for this symptom is explained by which of the following statements the heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension 3 multiple choice options it is important that the nurse be knowledgable about cardiac output in order to evaluate blood flow to peripheral tissues which sites are used to administer intradermal injections? inner forearm, lateral upper arm, scapular area 60 which action is required when using the Z track method for IM admin? changing needles between drawing up the medication and admin it which route of medication administration is the fastest onset of action IV which statements are appropriate for the nurse to make to a patient who is about to receive pain meds by IVP "you will feel the effects quickly" "let me know if your arm hurts or swells" "the medication is being injected into your bloodstream" which actions apply to the administration of an intradermal injection monitoring the skin for a wheal inserting the needle into the skin with the bevel up applying outward traction to the skin around the site 61 a diagram of which injection site would be the most helpful when teaching a patient how to use an EpiPen? vastus lateralis which action by the nurse ensures patient safety when administering an IM injection rotating injection sites to prevent hypertrophy of tissue when preparing an IM injection, what can the nurse do to reduce the patients risk for infection clean the injection site with an alcohol swab what can the nurse do to minimize the patient's risk for injury when delivering an IM injection pull back on the plunger after inserting the needle which site is the most commonly used for IM injections ventrogluteal 62 which action by the nurse helps to ensure that the medication is delivered into the muscle when administering an IM injection? aspirating for blood return before injecting the medication the nurse is preparing an IV med for an infant. The RN needs a precise medication measurement and plans to use tuberculin syringe. What is the capacity of this syringe? 1 mL a patient is receiving IV fluids and develops tenderness, warmth, erythema, and pain at the site. which condition would the nurse suspect? phlebitis a diabetic patient has been changed from oral antidiabetic drugs to insulin. which info would help the patient ensure correct self administration of insulin? insulin is given as a subQ injection insulin is absorbed more quickly in the abd the recommended sites of injection include the upper arm, thigh, abd, butt the nurse needs to admin an injection to a patient. which precaution would the nurse take to prevent infection during injection administration? 63 clean the skin with an antiseptic swab avoid touching the needle with the contaminated area which type of syringe and needle would the nurse select to perform a tuberculin test in a patient suspected of TB 1mL, 1/4-5/8 for intradermal injection a patient is receiving an IVP med. As the nurse is administering the med, the patients IV site becomes swollen. which action would the nurse take first? stop admin of med and follow facility's policy this is an example of infiltration when teaching a patient about self admin of insulin, which instruction would the nurse give the patient regarding preparation of insulin? roll the cloudy insulin vial between the palms of hands prepare the regular insulin first and then draw up the NPH insulin admin both insulins before meal which information would the nurse inform the patient about subQ admin? the injection site should not be near any bony prominences or large nerves 64 med is injected into the connective tissue below the dermis which site does the nurse recommend to the patient for self admin of insulin abd, lateral aspects of upper arm, and thighs, scapular area, and upper ventrodorsal gluteal area IM injection for a 6 month old infant in which site vastus lateralis muscle IM injection for adults and adolescents ventrogluteal which precaution would the nurse follow when admin subQ injection? inject med slowly pinch skin with nondominant hand which sites can be used for an IM injection deltoid, vastus lateralis, and ventrogluteal 65 which complications of subQ injections would the nurse monitor for? pain, sterile abcess, and hypertrophy of skin 1 tbspn = ? mL 15 mL 1 tbspn = ? tsp 3 tsp what action would the nurse take when patient questions the medication they are about to be administered and say "I don't remember my medication looking like that" withhold the med and verify the med prescriptions by the health care provider after accidental admin of medication at the wrong time, what is the nurses first priority? assess the pt 66 which factor influences absorption? route of admin solubility blood flow to the site of admin a pt develops sudden onset of bronchiolar constriction, edema of pharynx, and SOB. which type of reaction is the pt experiencing? anaphylaxis the nurse plans to admin a med that can give immediate relief to a patient. which parameter of the drug will the nurse check for to find if the drug will give immediate relief to the patient? onset of action the nurse would compare the label of the medication container with the MAR during which circumstance? when performing any dosage calculation when preparing the med when returning the med to its storage place 67 a patient develops buccal irritation following admin of buccal med for 3 days. which nursing instruction may have prevented this? rotating the site the nurse would assist the patient into which position before admin of nasal med tilt the head back slightly have the pt lie supine with head tilted backward which vitals sign does the nurse delegate to the UAP for frequent monitoring respirations which intervention does the nurse implement while admin medications to older adult patients admin med slowly allow time for slower swallowing of meds a nurse is admin an eye med that removes secretions and cleanses the eye. which type of ophthalmic med is the nurse admin? eye irrigation 68 otic meds can be admin to a patient using which form of delivery? eardrops irrigations which regulatory agency is responsible for ensuring medications undergo vigorous testing before they are made available to the public food and drug administration (FDA) the nurse observes that a patient has a rash, itchy skin, inflammation, and swelling of the nasal passages, and raised skin eruptions after IV admin. which type of drug effect is the pt experiencing? allergic reaction Continuous enteral feedings require which nursing actions use 15-45 mL or facility policy for flushing the tubing flush the tubing with at least 15 mL of water before and after feeding 69 which action will the nurse take to admin a sustained release capsule to a new patient who insists that he cannot swallow pills contact the health care provider which nursing diagnosis is a priority for meeting the patients immediate needs after a nurse has identified a number of nursing diagnoses following an initial assessment pain associated with oral ulcers which could affect nutritional intake which nutrient helps with tissue repair protein what is the first action after placement of an NG tube x ray to confirm placement of tube which sign in a patient who is on enteral feedings would indicate adverse effects of formula N/V/D 70 which conditions would be an indication for enteral nutrition difficulty chewing cannot swallow anorexia nervosa which complications would the nurse be aware of when caring for a patient with dysphagia aspiration pneumonia dehydration decreased nutritional status weight loss which advantage does enteral feeding have over parenteral feeding maintains intestinal function and integrity