ACHPN Exam 108 Questions with Verified Answers,100% CORRECT

ACHPN Exam 108 Questions with Verified Answers APRN begins to overly identify with pain and suffering of patients; skips lunch, trouble concentrating, nightmares A. depression B. compassion fatigue C. anxiety D. empathy - CORRECT ANSWER B. compassion fatigue Patient with chronic bowel disease has developed persistent diarrhea, treatment most indicated to treat is: A. loperamide B. codeine C. diphenoxylate D. methylcellulose - CORRECT ANSWER A. loperamide- indicated for nonspecific diarrhea but should be avoided if gross bloody stool or temp above 101 degrees or if C. diff expected. 4mg initially, then 2mg after each loose stool, NTE 16mg/day. When utilizing the SPIRIT pneumonic, as a spiritual assessment tool for a hospice patient, the first question to ask for "S" part is: A. does spirituality play a part in your personal life? B. restrictions that affect healthcare decisions? C. how does faith affect how you feel about death? D. do you have a normal religious affiliation? - CORRECT ANSWER D. Spiritual: formal religious affiliation? Personal: practices/beliefs, daily life? Integration: spiritual community Ritual: specific practices that affect healthcare Implication: aspects of care to keep in mind Terminal events: does faith affect feelings about death? Obese patient, diabetes; underwent surgery for bowel obstruction 6 days ago and has persistent N/V. Feels "popping" sensation at incision site-->intestinal evisceration. Initial response: A. administer opioid, no intervention B. semi-fowler's knees up, notify surgeon C. explain what is happening, ask for guidance D. supinate patient, cover with dry sterile gauze - CORRECT ANSWER B. INITIAL RESPONSE: notify surgeon Next- cover sterile soaked gauze, IV site, O2 76 year old female, generally good health, new pathologic fracture of proximal femur. pt states it occurred while walking- most likely cause: A. abuse B. multiple myeloma C. osteoporosis D. bone cyst - CORRECT ANSWER C. osteoporosis- DEXA scan gold standard; T-score -2 indicates osteoporosis When collaborating with patient and family on POC, it's important for them to understand: A. rights and responsibilities B. limitations C. organizations philosophy D. difference between goals and objectives - CORRECT ANSWER A. rights and responsibilities- ask them what goals and expectations are, what is important to them Native American patient, stage IV multiple myeloma, on hospice in extended care facility. Reportedly little pain AEB does not request medicine but does lay in fetal position and refuses food and fluids. APRN should advise nursing staff: A. pt probably comfortable without pain medication B. pt may avoid outward expressions of pain C. staff nurse should be more aware of pt needs D. pt probably prefers to suffer than take medications - CORRECT ANSWER B. pt may avoid outward expressions of pain, but his body language indicates otherwise Middle Eastern hospice pt, cared for at home by sisters and daughters. On exam, rows of circular slightly reddened areas up and down back. Most appropriate response: A. notify APS of abuse B. tell family hospice pts cannot receive cupping C. acknowledge use of cupping D. provide supportive care for pressure sores - CORRECT ANSWER C. acknowledge cupping- ancient form of healing that releases toxins Pt with progressive onset MS has chronic bladder dysfunction with spasms, frequency, incontinence. He takes ER oxybutynin. Which dietary restrictions should APRN advise? A. simple carbs B. citrus fruits C. apples and apple juice D. caffeine and alcohol - CORRECT ANSWER D. caffeine and alcohol are bladder irritants and promote diuresis Family reports patient has not attended mass in 50 years. Pt is nearing death but remains responsive and not requested priest. APRN should: A. assume pt will not want to see a priest B. ask priest on call to visit C. ask the patient if he/she wants to see a priest D. ask the family if priest should be called - CORRECT ANSWER C. ask the patient, never make assumptions When educating a patient or family about disease or treatment, the first step is to begin by assessing the patient's: A. emotional status B. knowledge base C. experience D. physical condition - CORRECT ANSWER B. knowledge base- first assess by asking "can you tell me what you know about your illness"? Indications that the spouse of a patient who died is suffering from traumatic grief include prolonged period (>60 days): A. expressing anger, bitterness, blame regarding the death B. decrying negative habits of deceased (smoking, drinking) C. focusing on occupational role D. talking frequently about the deceased - CORRECT ANSWER A. expressing anger, bitterness, blame regarding death --> also indications include avoiding talking about deceased, avoiding occupational/social roles, assuming some bad habits of the deceased A family member is concerned about the "death rattle" exhibited by a patient. When discussing administration of antimuscarinic agents such as glycopyrrolate, what possible adverse effects should be considered? A. increased sedation, delirium, xerostomia B. prolonged suffering, inability to communicate C. insomnia, depression, anxiety D. excessive sedation, respiratory depression, itching - CORRECT ANSWER A. increased sedation, delirium, xerostomia When conducting a review of the literature as part of evidence based research, the level of evidence that is based on a quasi-experimental study such as a matched case control study would be categorized as: A. level I B. level II C. level III D. level IV - CORRECT ANSWER C. Level III Level 1- meta analysis Level 2- well designed, may or may not be randomized Level 3- case control, quasi experimental study Level 4- comparative non-experimental Level 5- case reports without evidence A patient has osteomyelitis and an open draining wound in the proximal anterior thigh with copious amounts of purulent drainage. The wound has been requiring dressing changes 4-5 times per day. The effective method for managing the wound care is: A. apply alginate packing B. apply a pouch (such as a Hollister Wound Manager) C. utilize negative pressure wound therapy D. applying absorptive dressings with cellulose fibers - CORRECT ANSWER B. apply pouch such as hollister wound manager- change Q4-7 days A female patient who has undergone surgery, radiotherapy, and chemotherapy for breast cancer has lost her hair but states she cannot afford to buy a wig. Which organization can you refer to for financial assistance? A. songs of love foundation B. assoc of cancer online resources C. cancer care D. american cancer society - CORRECT ANSWER D. American Cancer Society According to the American Geriatrics Society Guideline for the Prevention of Falls in Older Persons, if a patient has had one fall in the previous year: A. the patient should be assessed for gait and balance B. no further assessment is needed C. a full assessment including vision, joint function, mental status, neuro status should be carried out D. refer to geriatric specialist - CORRECT ANSWER A. Assess for gait and balance including the Get up and Go Test. Only multiple falls should elicit a full assessment If a patient receiving abdominal radiation has 7-9 loose stools daily with severe cramping and some incontinence, according to the National Cancer Institute Scale of Severity of Diarrhea, the pts score would be: A. 1 B. 2 C. 3 D. 4 - CORRECT ANSWER C. 3 Score 0: normal stools Score 1: 2-3 above normal, no other sx Score 2: 4-6 above normal, nocturnal, abd cramps Score 3: 7-9 above normal, severe cramping/ incontinence Score 4: 10+ above normal, grossly bloody stools, need for parenteral support A palliative care patient with MS is increasingly immobile and spends most of the time in bed. Which of the following scores (range 6-23) on the Braden Scale is the breakpoint for risk of pressure ulcer? A. less than 8 B. less than 12 C. less than 16 D. less than 18 - CORRECT ANSWER C. Less than or equal to 16 Score of 23 indicates minimal risk and 6 indicates a strong likelihood of developing pressure ulcers. A 68 year old patient has appeared depressed so APRN assesses using Geriatric Depression Scale which comprises 15 questions. How many "yes" answers are needed to indicate depression? A. 4 B. 6 C. 8 D. 12 - CORRECT ANSWER B. 6 yes answers indicate depression. Tool can be used with normal cognition and mild to moderate cognitive impairment. When conducting the H&P of a military veteran who served in Vietnam, which concern applies to this specific group of vets? A. PTSD B. Shrapnel injuries C. Substance abuse D. Agent Orange - CORRECT ANSWER D. Agent Orange- known teratogenic effects including leukemia and Hodgkins lymphoma, type 2 DM, ischemic heart disease, parkinson's, peripheral neuropathy. If a dying person tells you she has been seeing her mother who is deceased for many years, what is the appropriate response? A. Does seeing your mother comfort or frighten you? B. You're just dreaming C. I'm sure your mother is watching over you D. It's probably because of the medicine - CORRECT ANSWER A. Does seeing your mother comfort or frighten you? Which of the following unique needs may need to be addressed in the POC for homeless patients? A. fall and dysphagia precautions B. PTSD C. lice and malnutrition D. drug seeking behaviors - CORRECT ANSWER C. Lice and malnutrition Patient who completed a course of mantle radiation for Hodgkins disease 20 yrs ago has developed increasing weakness and SOB on exertion. Because of previous radiation, patient is especially at risk for: A. pancreatic CA B. breast and lung CA C. liver CA D. colon and rectal CA - CORRECT ANSWER B. breast and lung cancer- pts with Hodgkins have 17% risk of developing another malignancy including increased risk of leukemia with onset often within 4 years APRN started support group for pts with Parkinsons to help with coping and delay progression. APRN is facilitator, this type of preventive program is: A. primary B. secondary C. tertiary D. quaternary - CORRECT ANSWER C. Tertiary Primary- prevent disease occurrence (no smoking, seatbelts, vaccinations) Secondary- identify and reduce impact (screenings, BP) Tertiary- prevent/delay disease progression 17 yr old with AIDS and pneumonia is medically unstable and his parents have broached the topic of EOL decisions with him; pt refusing to discuss the issue stating he is "not going to commit suicide". APRN advises parents to: A. remain supportive and wait for pt readiness to discuss EOL B. explain difference between EOL decisions and suicide C. urge the pt to participate in some decision making D. tell the pt they will make the decisions for him - CORRECT ANSWER A. Remain supportive and wait for patient readiness to discuss EOL. 15 yr old pt with leukemia tells APRN that she wants to fill out a living will so her parents will not have to make EOL decisions for her. A document appropriate for adolescent patients: A. Five Wishes B. Voicing My Choices C. My Wishes D. Willmaker Plus - CORRECT ANSWER A. Voicing My Choices- 48 yr old with myasthenia gravis had been fairly stable but after a recent bout of gastroenteritis, pt experienced marked weakening of the muscles. Tachypnea, single breath count test result of 14 (normal 50) , SpO2 95%. This likely indicates: A. normal respiratory status for MG B. atelectasis C. pneumonia D. impending respiratory failure - CORRECT ANSWER D. Impending respiratory failure- An illness like gastroenteritis can trigger a myasthenia crisis which can severely impair respiratory function. O2 sat can remain normal until situation is critical. Hospice patient receiving PO morphine to control pain of pancreatic cancer reports little relief so ketamine was ordered in addition along with lorazepam once or twice daily. When ketamine is administered, the dose of the opioid should: A. be reduced by 25 to 50% B. remain unchanged C. be increased by 25% D. be increased by 50% - CORRECT ANSWER A. Be reduced by 25 to 50%- An initial test dose of 25mg is often given and then the dosage is titrated upward until relief of pain is achieved. If PO or SL, doses may be taken 3-4 times daily. Continuous infusions are often used for SC or IV dosing. Hospice pt asking for overdose to cause her death because she is tired of suffering. Most appropriate response: A. It's illegal to give overdoses B. You don't really mean that C. Let's work together to better control your pain D. You should talk to your doctor about that - CORRECT ANSWER C. Let's work together to better control your pain 26 yr old male with no advance directive suffered a TBI and is in a vegetative state on life support. Pts mother, sister, best friend and fiancee are present. Which person can legally make the decision to withdraw life support? A. Friend B. Sister C. Mother D. Fiancee - CORRECT ANSWER C. Mother- If he was married, spouse, adult children, parents, then siblings. The principle of the double effect refers to the idea that: A. drugs may not be used to control pain if they hasten death B. drugs may be used to control pain even if they hasten death C. drugs should not be administered in order to hasten death D. drugs can be administered in order to hasten death - CORRECT ANSWER B. Drugs may be used to control pain even if they hasten death, as the intent is not to hasten death but to relieve suffering. Pt with ALS is no longer able to breathe independently and has elected to be extubated, understanding that this will lead to death. In addition to an opioid to relieve dyspnea, which other medication is usually administered? A. benzodiazepine B. antipsychotic C. SSRI D. atypical antipsychotic - CORRECT ANSWER A. Benzodiazepine to relieve anxiety. Pt with ESLD has made the decision to VSED to hasten death, and the pts family is supportive of this decision. Which action should the APRN take? A. notify APS B. provide supportive care C. advise the pt that VSED is an act of suicide D. discontinue services to the pt - CORRECT ANSWER B. Provide supportive care. 50 yr old pt receiving chemo complains her biggest problem is managing her home and family while dealing with fatigue. Which of the following referrals would most benefit the pt? A. nutritionist B. PT C. psychologist D. OT - CORRECT ANSWER D. Occupational therapist may be able to assist with strategies to manage fatigue while still being able to care for her family. APRN notes a team member usually prefers to work alone and makes excuses for not delegating more of his workload. The team member frequently takes overtime shifts when the unit is shorthanded but is increasingly short tempered and c/o fatigue and headaches. The team member is likely to experience: A. burnout B. advancement C. ostracism D. injury - CORRECT ANSWER A. Burnout When educating an 80 yr old pt about self care and pain control, the teaching strategy most useful is to: A. review study skills B. allow ample time for learning and practicing C. utilize role-playing D. utilize problem-centered learning - CORRECT ANSWER B. Allow ample time for learning and practicing. Also spending time getting to know the patient, eliminating non-essential info, remain patient and supportive, provide written materials. APRN has accepted a position in a different hospital and is in the "being" stage of role transition after 6 months. This stage is characterized as: A. emotional lability and recognition of limitations B. acceptance of the new role C. increase in knowledge and self-doubt D. limited problem solving skills - CORRECT ANSWER C. Being stage Doing (3-4 mo)- transition shock with emotional lability and self doubt. problem solving limited. Being (4-5 mo)- transition crisis, knowledge increases along with self-doubt; stress but increased awareness, feeling unprepared for clinical situations Knowing (3-4 mo)- acceptance of the new role and recovering from some of the problems and stresses of earlier stages A pt with COPD is recovering from PNA and has spent much of the day in bed with curtains drawn and appears to have been crying. The most appropriate response is: A. you seem upset B. why are you crying C. please tell me what is bothering you D. i'm sure everything will be ok - CORRECT ANSWER A. You seem upset- this is the most empathetic response, recognizes feelings without prying. Allows pt time to respond. When the APRN(sender) is talking (transmission) and giving information (message) to a patient (recipient), communication is most dependent on the: A. situation B. sender C. message D. recipient - CORRECT ANSWER D. Recipient must be motivated to receive the message and must have no barrier like hearing impairment or emotional upset that interferes with the transmission. Ability to comprehend then depends on many complex factors. barrier to effective communication: A. nervous and speaks high pitch B. cheerful voice C. rubs hands together when speaking D. leans toward patient when speaking - CORRECT ANSWER communication style includes "I" statements and asks for opinions such as "How do you feel about that?" is: A. passive B. aggressive C. neutral D. assertive - CORRECT ANSWER rifampin - CORRECT ANSWER alleviates pruritus in liver disease- also could use dronabinol, UVB therapy, naloxone initial treatment for chronic mild to moderate osteoarthritis - CORRECT ANSWER acetaminophen 4g/day; avoid NSAIDs if possible only for severe pain; intraarticular injections for refractory cases opioid induced constipation - CORRECT ANSWER combo stimulant and stool softener; avoid bulk laxatives if poor fluid intake signs/sx of intestinal obstruction from cancerous lesion at duodenum - CORRECT ANSWER copious amounts of undigested food emesis, splashing sounds in LUQ, generally absence of pain or distension pleurX catheter drain limit at home - CORRECT ANSWER 2000cc consideration of lymphadema s/p mastectomy - CORRECT ANSWER infection control (most common complication)- examine arm often, avoid lab draws, tight clothing pressure ulcer dressing overview - CORRECT ANSWER Hydrogel- good for small drainage, NOT large amounts etoh clearance - CORRECT ANSWER 20mg/dL per hour Ex. 70kg patient with BAC 140mg/dL would take approx 7 hours to metabolize alcohol NYHA classification - CORRECT ANSWER I- essentially asymptomatic during normal activity, good prognosis II- sx w/some exertion, usually absent at rest, good prognosis III- obvious limitations, discomfort on any exertion, fair prognosis IV- sx at rest, poor Peripheral atertial disease presentation - CORRECT ANSWER pain range intermittent to severe constant, pedal pulses generally weak or absent, foot may be rubor on dependency and pale on elevation; skin pale, shiny, cool, edema usually absent or minimal assessing perfusion of LE - CORRECT ANSWER venous occlusion greater than 20 seconds ABI scoring - CORRECT ANSWER > 1.3- abnormally high 1-1.1 normal, asymptomatic <0.95 narrowing of 1+ leg blood vessels <0.8 moderate, intermittent claudication < 0.6 to 0.8- borderline perfusion 0.5-0.75 severe disease, ischemia <0.5 pain, even at rest, limb threatened 0.25 critical limb-threatening condition cancer associated constipation Senna protocol - CORRECT ANSWER Day 1- 2 tabs QHS Day 2- 2 tabs BID Day 3- 3-4 tabs BID or TID Day 4- if no BM rule out impaction, bisacodyl TID; if not impacted give lactulose, mag citrate, bisacodyl supp, or enema hospital acquired pneumonia considerations - CORRECT ANSWER must not be present on admission and must occur 48 hrs or more after admission 3 basic types of failures in an organization - CORRECT ANSWER 1. skill based- ex intended mistakenly using the wrong piece of equipment 2. rules based- incorrectly applies a rule 3. knowledge based- inadequate knowledge Medicare documentation guidelines - CORRECT ANSWER Problem focused- CC, brief HPI, 1-3 elements Expanded PF- CC, brief HPI, problem pertinent ROS Detailed- CC, extended HPI (>4 elements), extended ROS, pertinent PFSH comprehensive- CC, extended HPI, complete ROS, complete PFSH hospice eligibility for stroke patient - CORRECT ANSWER PPS less than 40%, poor nutritional status/inability to maintain adequate PO AEB: - loss of 10%+ weight in past 6 months - serum albumin less than 2.5 - history of pulmonary aspiration continuous O2 for COPD patient - CORRECT ANSWER PaO2 and O2 sat reach <50 or O2 sat <85% at rest; if other s/sx like cor pulmonale, peripheral edema, pulm HTN or hematocrit greather than 56% may also need O2 Metronidazole gel - CORRECT ANSWER may help control infection and decrease odor of severe lesions- hydrogen peroxide could hurt, Dakins has strong odor BP/HTN - CORRECT ANSWER Normal <120/80 Pre-HTN 120-130/80-89 Stage I- 140-159/90-99 Stage 2- >160/100 Protein-calorie malnutrition - CORRECT ANSWER results from inadequate intake of both protein and calories- gradual weight loss with intact visceral protein but loss of skeletal muscle mass- sx include decreased basal metabolism lack of SQ fat, tissue turgor, bradycardia, hypothermia Protein requirements for wound healing - CORRECT ANSWER 1.25-2 g/kg daily Glasgow Coma Scale - CORRECT ANSWER 3-8 coma <8 severe head injury 9-12 moderate head injury 13-15 mild head injury Problem based assessment for chief complaint - CORRECT ANSWER thorough hx, prioritize list, combo physical/psychosocial 5 elements of pain assessment - CORRECT ANSWER 1. words/descriptions 2. intensity 0-10 3. location 4. duration 5. aggravating/alleviating CHEOPS - CORRECT ANSWER pediatric, age 1-7 pain scale; crying/facial expression/verbalization/torso movement/LE movement/point to area >4= pain QOL scale - CORRECT ANSWER several categories of perception of QOL; avg normal 90, score 16-112; higher score = better QOL anticholinergics (scopolamine td) - CORRECT ANSWER ICP induced nausea, GI obstruction, excess GI secretions antihistamines (diphenhydramine) - CORRECT ANSWER ICP induced nausea, vestibular, GI obstruction benzos/antiemetic - CORRECT ANSWER general and anxiety induced nausea butyrophenones (haldol) - CORRECT ANSWER mechanical and opioid induced nausea cannibinoids - CORRECT ANSWER chemo induced nausea 5 HT-3 receptor antagonists (ondansetron) - CORRECT ANSWER chemo, radiation, post op nausea octreotide - CORRECT ANSWER GI obstruction phenothiazines (prochlorperazine) - CORRECT ANSWER general nausea prokinetic agents (metoclopramide) - CORRECT ANSWER - Used for gastroparesis (when the stomach moves slowly or not at all), GERD (short-term), post-op n/v, opioid- chemo- radiation-induced nausea - Stimulates gastric motility without increasing secretions - AEs: extrapyramidal symptoms - Contraindications: pts taking anticholinergic meds, CNS depressants steroids (dexamethasone) - CORRECT ANSWER frequently used with other antiemetics to potentiate their effects Steps to opioid conversion - CORRECT ANSWER 1. determine 24 hour dose 2. calculate equianalgesic dose 3. decrease dose of new med by 25-50% initially if sx controlled 4. increase 100-125% OR rotate opioids if sx NOT controlled adverse effects of radiation - CORRECT ANSWER fatigue, local skin irritation, burns, hair loss, GI upset, dysuria, depressed immune system, anemia "cancer diets" - CORRECT ANSWER idea- some foods "feed" cancer; basic concepts: avoid refined carb and milk avoid fatty, fast, processed avoid etoh, caffeine, nicotine, chemicals avoid meats avoid overcooking utilize organic when able raw foods encouraged radiation induced nausea - CORRECT ANSWER ondansetron 30 min prior to treatment tumor lysis syndrome - CORRECT ANSWER Chemotherapy can cause massive destruction of cells leading the creation of uric acid which can be toxic to the kidneys leading to Acute Tubular Necrosis. TNM staging of HCC - CORRECT ANSWER T= primary tumor N= regional lymph node M= distant mets X= cannot assess 0= not evident 1-4= increasing size, number, extent Example: stage IIIB, T3, N1, M0= solitary tumor with vascular invasion, regional lymph node mets, no distant mets xerostomia - CORRECT ANSWER decreased saliva production and dry mouth; Tx=pilocarpine, ADRs increased sweating, nausea, flushing, cramping good mouth care most important substituted judgement - CORRECT ANSWER form of surrogate decision making where the surrogate attempts to establish what decision the patient would have made if that patient were competent to do so Peplau's four levels of anxiety - CORRECT ANSWER Mild: seldom a problem Moderate: perceptual field diminishes Severe: perceptual field is so diminished that concentration centers on one detail only or on many extraneous details Panic: the most intense state Types of Grief - CORRECT ANSWER Uncomplicated- ability to move toward acceptance of the loss Complicated- severe in longevity, affects daily function -Chronic- disbelief the loss is real -Masked- physical sx or other negative behaviors out of character -Delayed- feelings postponed Disenfranchised- minimized significance by others (ie coworker, pet, ex spouse) Anticipatory- starts at dx, pre-death often interventional analgesia - CORRECT ANSWER epidural- efficacy affected by catheter placement and med choice intrathecal- single injection can last 24 hrs, pump 6 months nerve block- intractable/severe pain LVAD discontinuation considerations - CORRECT ANSWER pt usually sedated to reduce the perception of dyspnea associated with abrupt reduction in cardiac output- in most cases pt will die within minutes neutropenia - CORRECT ANSWER disease or treatment cause, increased risk for infection 1000- high risk, 500- severe risk neutropenia + fever= broad spec abx, risk for fungal superinfection avoid fresh flowers, unpeeled fruits, HEPA filter mask, body/oral hygiene critical SVC syndrome - CORRECT ANSWER blockage like tumor or thrombosis reduces blood flow sx- edema, headache, dizziness, cough, flush, venous distension tx- steroids, diuretics nociceptive (somatic, visceral) - CORRECT ANSWER usually localized resolves over time "aching, throbbing" tx- opioids, adjuvants, steroids neuropathic - CORRECT ANSWER primary lesion in CNS (diabetes, cancer, trauma) chronic "burning, stabbing" tx- antidepressants, anticonvulsants, nerve blocks dyspnea - CORRECT ANSWER already on MSO4= increase morphine by 2.5mg to relieve sob opioid naive= 5mg PO Q4H O2 2-4LPM raise HOB fan in face cough/secretions - CORRECT ANSWER tx depends on underlying cause antitussives productive- O2, suction, mucolytic opioid, codeine anticholinergic repositioning bowel obstruction - CORRECT ANSWER partial or inoperable= dex for sx mgmt paralytic ileus= NG tube surgical only for complete obstruction Mucositis - CORRECT ANSWER Mucosal inflammation due to a disease process/ADR of chemo or radiation s/sx occur within 10 days of treatment- oral inflammation, intestinal, rectal tx= abx, antifungals, omeprazole, analgesics, topical, steroids common lab values (Na, K, Ca, PO, Mg) - CORRECT ANSWER Na 135-145 K 3.5-5.5 Ca 8.2-10.2 Phos 2.4-4.5 Mg 1.6-2.6 asthenia/fatigue - CORRECT ANSWER determine cause, alleviating/aggravating factors tx= stimulant meds, if depression SSRI, treat anemia, rest ABG- pH 7.26 CO2 57 O2 53 HCO3 22 O2 sat 84% - CORRECT ANSWER respiratory acidosis- PaCO2 increases, PaO2 decreases acute sudden change in consciousness, language disturbance, disorientation, confusion, visual hallucinations; s/sx fluctant post major surgery in 72 year old - CORRECT ANSWER delirium- treatment = trazadone, lorazepam, or haldol Wernick's encephalopathy - CORRECT ANSWER in pts with chronic etoch/amphetamines triad of eye pain, confusion, ataxia w ambulation treatment= IVF, thiamine Ethical Principles - CORRECT ANSWER Autonomy Beneficence Nonmaleficence Justice Fidelity Veracity medications usually discontinued a few days before death - CORRECT ANSWER antihypertensives, diuretics, hormones, abx, hypoglycemic agents, antidysrhythmics, laxatives compression stocking classes - CORRECT ANSWER I- 20-30 mmHg, support for varicose veins II- 30-40, used to prevent venous ulcers III- 40-50, used for treatment of refractory venous ulcers to control lymphadema IV- 50-60, use to treat severe lymphedema defense mechanisms - CORRECT ANSWER suppression- trying to forget (conscious) repression- forgetting (unconscious) sublimation- redirecting feelings/impulses denial- refusing to believe