NSG 250 Quiz #1 CNI College 2023 with complete solution

PCA; why is it used? - correct answerGet med when you need it, has ceiling and is controlled doses of pain med, small frequent doses ensures consistent plasma levels Less lag time between identified need and med delivery which increases sense of control and decreases amount of meds needed Morphine and hydromorphone (dilaudid) typical for PCA What to do if another person is pressing PCA - correct answeronly pt should be pressing PCA for meds to prevent overdose; if another person is pressing the button ask them to stop, then provide education about PCA pump and its purpose, that only pt should be pressing if needed What is the ideal BMI and waist inch circumference? - correct answerBMI 18%-24%, waist 30in for women, 34in for men What is most reliable indicator of existing pain of pt? - correct answerPain is whatever pt says it is; self report of pain, 0-10 scale; considered subjective data S/S of pain - correct answerincreased heart rate, blood pressure and respirations physiologic s/s are more prominent in acute pain Acute pain s/s - correct answeracute pain is protective, temporary, self-limiting, and resolves w/ tissue healing fight or flight responses; tachycardia, hypertension, anxiety, diaphoresis, muscle tension behavioral responses: grimacing, moaning, flinching, guarding Interventions include TX OF UNDERLYING PROBLEM Hep-A route of transmission - correct answerfecal-oral; third world countries w/ contaminated food/water Hep-A Risk Factors & best prevention - correct answeringestion of contaminated food/water (shellfish), and close personal contact w/ individual best prevention is HANDWASHING Hep-B Route of Transmission - correct answerblood/body fluids, perinatal, sexual contact, tattoos, shared needles Hep-B Plan of Care - correct answerDon't share needles Don't share commodes because they can come in contact w/ bodily fluids Bed rest because it will improve the condition of the liver by decreasing energy demands Hep-C Route of Transmission - correct answerblood and bodily fluids, sharing needles, history of HIV, body piercing or tattoo w/ infected equipment Hep-C Prevention - correct answerAvoid sharing needles, engage in safe sex Hep-C precaution for nurse - correct answerstandard precautions Fibromyalgia - correct answerchronic syndrome of widespread musculoskeletal pain, stiffness, fatigue, sleep disturbances, and difficulty concentrating different from other types of chronic pain because of trigger points Fibromyalgia cause - correct answercause is unknown, maintaining a healthy lifestyle best way to decrease risk Fibromyalgia Risk Factors - correct answermiddle-aged women (20-50), family hx, psychiatric d/o, IBS, RA Fibromyalgia Manifestations - correct answerwidespread pain and fatigue, pain is localized to 18 tender points/fibromyalgia spots in neck, spine, shoulders, hips, elbows, knees Fibromyalgia Dx Tests - correct answerwidespread pain index of 7 or more trigger points, a symptom severity score of 5 or more, presence of symptoms for at least 3 months What kind of exercise for fibromyalgia pt - correct answerAerobic exercise and strength training are two primary nonpharm Tx Ways to reduce pain for fibromyalgia/pain management - correct answerPts are usually lacking rest, get at least 8hrs of sleep; lack of sleep can cause flare ups Reduce stressors to prevent flare ups Lyrica is best pain reliever med Pain and comfort measures for chronic pain Synthroid (levothyroxine) - correct answerthyroid hormone of T4 and T3 that is used for the Tx of hypothyroidism; helps thyroid function normally (increases metabolism, protein synthesis, cardiac output, renal perfusion, O2, temp, etc.) Synthroid SE's - correct answerhyperthyroidism from overmedicating begin w/ low dose and gradually increase over several weeks, take on empty stomach report to provider if experiencing: anxiety, tachycardia, palpitations, altered appetite, abdominal cramps, heat intolerance, fever, diaphoresis, weight loss, menstrual irregularities Synthroid therapeutic response - correct answerdecreased TSH levels, T4 levels within expected range, absence of hypothyroidism clinical manifestations: depression, weight gain, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia Normal TSH and T4 levels - correct answerTSH 0.4-4.0 T4 4.6-12 Natural sources of Levothyroxin - correct answerSoy beans, soy sauce, olive oil, flaxseed oil, almonds, walnuts, water herb teas Total/Subthyroidectomy Management Postop - correct answerKeep pt in HIGH-FOWLER'S, support head & neck w/ pillows, AVOID NECK EXTENSION CHECK FOR LARYNGEAL NERVE DAMAGE by asking pt to speak as soon as awake from anesthesia, and Q2hr after check surgical dressing and back of neck for excessive bleeding; respiratory distress can occur from compression of trachea respiratory distress can occur due to edema, keep trach supplies available, cough, deep breathe, suction monitor for hypocalcemia; tingling of toes/mouth, muscle twitching, positive chvostek's & trousseu;s chronic pain - correct answerpain of varying severity, location, etiology lasting >6 mos. depression, irritability, impaired mobility/activity, sleep disturbance acute pain - correct answerpain of varying severity, location, etiology lasting <6 mos elevated BP, HR, N/V, sweating, rapid/shallow breathing, anxiety, decreased function of ADLs, crying grimacing, shielding Liver Cirrhosis/Risk Factors - correct answerend stage of chronic liver disease, progressive, irreversible, leads to liver failure alcoholic/laennec most common types; excess alcohol and injection drug use Liver Cirrhosis Manifestations - correct answerearly: enlarged, tender liver, dull aching pain in RUQ, wt loss, weakness, anorexia, diarrhea, constipation late: portal hypertension (causes ascites, peripheral edema, anemia, low WBC?PLT), bleeding, ascites, gynecomastia, infertility, jaundice, neuro changes Advanced Cirrhosis: what is the function of the liver? - correct answerproduces bile and vitamin k for clotting; if cirrhosis, pt will not clot, so pt is prone to bleeding, causing petechiae, anemia; LIVER PRODUCES CLOTTING FACTORS Cirrhosis Pharm Management - correct answerLasix because liver is enlarged and has fluid accumulation between liver and peritoneal space (ascites), so Lasix removes excess fluid Lactulose decreases ammonia levels by excretion thru BM Cirrhosis diet should be low in what - correct answerLOW SODIUM IS PRIORITY because it will cause fluid build up low fat, no fried food, low protein Cirrhosis Diagnostic tests - correct answerLFT: elevated billirubin, albumin, ammonia Prolonged prothrombin time hypokalemia, hypernatremia Liver Disease - correct answerdisrupted liver cell function, impaired bilirubin conversion and excretion leading to jaundice and disrupted blood flow thru liver causing portal hypertension can lead to cirrhosis Ginko Biloba - correct answerImproves memory and promotes comfort by reducing restlessness Which hormone gets elevated if pt has hypothyroidism - correct answerTSH because it's negative feedback, so when there's not enough T3 and T4, TSH increases (secretes) to create more T3 and T4 to reach normal hormone levels Hypothyroidism/Risk factors - correct answerinsufficient delivery of TSH RF: women >50, hx of thyroidectomy, radiation of neck Hypothyroidism Manifestations - correct answerWEIGHT GAIN, COLD INTOLERANCE, LACK OF ENERGY, slow onset, goiter, fluid retention w/ edema, decreased appetite, constipation, dry skin, dyspnea, pallor, hoarsness, muscle stiffness, bradycardia, decreased taste & smell, sparse eyebrows, menstrual disturbances, blank expression, thick tongue Myxedema coma - correct answerlife-threatening, triggered by acute illness/trauma, hypothyoidism hypothermia, shallow edema around eyes and extremities, cardio collapse, hyponatrema, hypoglycemia MAINTAIN PATENT AIRWAY, F/E balance, cardio status, VS Hypothyroidism Nursing Care - correct answerSynthroid (levothyroxine) tx of choice Surgery if goiter is large enough to cause resp probs Avoid being cold, balance activity w/ rest periods encourage 2,000mL fluid/day and high fiber to prevent constipation Hyperthyroidism/Risk Factors - correct answercaused by excessive delivery of TSH RF: women, genetic factors, excessive use of iodine, 20-40yrs old What does the thyroid gland produce - correct answerthree hormones: T4 (thyroxine), T3 (triodothyroxine), and T4 (thyrocalcitonin) T3/T4 secretion regulated by anterior pituitary gland thru negative feedback system T3/T4 effect all body systems by regulating metabolism, energy production, controlling tissue use of fats, proteins, carbs Hyperthyroidism Manifestations - correct answerINCREASED APPETITE, HEAT INTOLERANCE, WEIGHT LOSS, INSOMNIA, tachycardia, palpitations, bulging eyes, enlarged thyroid flushed, clubbed fingers, tremors, amenorrhea, hypermotile bowels, diarrhea, hair loss, fine hair, warm skin, frequent mood changes Grave's Disease - correct answerautoimmune disorder; often underlying cause of hyperthyroidism, same s/s Thyroid storm/thyroid crisis - correct answerlife-threatening, usually a pt w/ grave's disease who experienced a stressor (infection, trauma) S/S: hyperthermia, tachycardia, HTN, abd pain, agitation, restlessness, psychosis, seizures, confusion Tx: cooling or induce shivering, replace fluids/electrolytes/glucose, relieve resp. distress, stabilize cardio function Hyperthyroidism Nursing Considerations - correct answerPharm therapy takes several weeks for meds to take effect (7 weeks) thyroidectomy: removal or all or part of gland. pt in semi fowler's postop, AVOID EXTENSION OF NECK balance activity w/ rest weigh daily and monitor albumin diet high carb/protein, 6 small meals a day Hyperthyroidism ideal environment - correct answerdecreased stimuli, because bodies are overactive so create a cool/calming effect environment Cushing's Disease - correct answerover secretion of adrenal cortex, caused by long term use of glucocorticoids to treat RA, asthma, etc Cushing's Disease Manifestations - correct answerWEAKNESS, FATIGUE, SLEEP DISTURBANCES, BUFFALO HUMP, MOON FACE, WEIGHT GAIN, RED CHEEKS, STRIAE hirsitism,dependent edema, altered emotional state, thin fragile skin, petechiae, HTN, tachycardia, irregular menses, shock state: decresed BP, increased HR, increased resp. Cushing's Disease Nursing indications - correct answermonitor I&O, daily weight, maintain safe environment to minimize risk of pathological fx and skin trauma labs: hypokalemia, hypocalcemia, hyperglycemia, hypernatremia Addison's Disease - correct answeradrenocortical insufficiency caused by damage or dysfunction or adrenal cortex Adison's Disease Manifestations - correct answerweight loss, salt craving, hyperpigmentation, weakness, fatigue, N/V, dizziness, ortho hyptension, dehydration, hyponatremia, hyperkalemia, hypoglycemia, hypercalcemia Addison's Disease Nursing Indications - correct answerprevent falls, tx hypoglycemia,/hyperkalemia- administer KAYEXALATE, insulin, calcium, glucose, sodium bicarb, hydrocortisone, AVOID ETOH and CAFFEINE Acute Adrenal Insufficiency (Addisonian Crisis) - correct answeracute drop of adrenocorticoids due to sudden d/c of glucocorticoid meds when induced by severe trauma, infection or stress; EMERGENCY Addisinian Crisis Nursing Indications - correct answerAdminister insulin to move potassium into cell, administer calcium to counteract effects of hyperkalemia, or loop/thiazide diuretics, rapid infusion 0.9% NaCl