MILESTONE 2 RETAKE 2024 QUESTIONS WITH COMPLETE SOLUTIONS GRADED A+

1. Continuous bladder irrigation: A three-way (lumen) irrigation is used to de- crease bleeding and to keep the bladder free from clots—one lumen is for inflating the balloon (30 mL); one lumen is for instillation (inflow); one lumen is for outflow. Continuous irrigation may be used with TURP. The amount of fluid recovered in the drainage bag must equal the amount of fluid instilled -- secondary hemorrhage may occur from overdistension 2. Urethritis: Common in postmenopausal women Low estrogen levels decrease moisture and secretions in the perineal area, predis- posing it to the development of infection Testing: STI, multiple dipstick, leukocyte esterase, nitrite testing, x-ray, CT, ultra- sonography, kidney scans 3. Renal Calculi Risk Factors: 1. Kidney diseases: Polycystic kidney disease, horseshoe kidneys, chronic strictures, and medullary sponge disease 2. IBD, ileostomy, bowel resection 3. Medications: Antacids, acetazolamide (Diamox), vitamin D, laxatives, and high doses of aspirin 4. Calculi pain: Requires immediate attention IV or IM opioids IV NSAIDs If pain increases, notify HCP 5. Imitrex contraindications: Ischemic heart disease St. John's wort 6. Seizures: Assessment · History, factors/precipitating events, alcohol, aura Planning and Goals · Prevention of injury, control seizures, psychosocial adjustment, understanding, absence of complications Nursing Interventions · Prevent injury, seizure precautions Reducing Fear of Seizures · Adhere to prescribed treatment, take on a regular basis, monitor for drug resistance Precipitating factors: · Emotional disturbances, new environmental stressors, onset of menstruation, fever, change in lifestyle routine, bright flickering lights, stress, alcohol Monitoring and Managing Potential Complications · Status epilepticus · Toxicity of meds 7. Hyperthyroidism signs/symptoms: Ophthalmopathy - exophthalmos (abnor- mal protrusion of one or both eyeballs), (not always reversible) Nervousness: Hyperexcitable, irritable, apprehensive, · cannot sit quietly, fine hand tremor Cardiac: palpitations, rapid pulse, A-fib (new onset in adults), fatigability, weakness Skin: tolerate heat poorly, perspire, flushed skin, dry skin, diffuse pruritus GI: · amenorrhea, changes in bowel function, increased appetite, weight loss 8. Exophthalmos-POC: Assessment: - Vision changes, trauma, visual acuity Treatments: - Antibiotic eyedrops if infection is the underlying cause - Antithyroid therapy (propylthiouracil, methimazole), if Graves' disease is the under- lying cause - Corticosteroids for optic neuropathy - Eye lubricants (artificial tears) - Surgery if vision is threatened General: - Cold/warm compresses (trauma) - Eye protection (sunglasses) Testing: - CT, MRI, ultrasonography 9. Sensory perception peripheral neuropathy: The heels are particularly suscep- tible to breakdown because of loss of sensation of pain and pressure associated with sensory neuropathy. The skin is assessed for dryness, cracks, breakdown, and redness, especially at pressure points and on the lower extremities. The patient is asked about symptoms of neuropathy, such as tingling and pain or numbness of the feet. Deep tendon reflexes are assessed. Teaching: Use a mirror to inspect feet daily. 10. Diabetes foot care: Feet should be cleaned, dried, lubricated with lotion (but not between the toes), and inspected frequently Supine position - alleviate pressure on the heels by elevating lower legs on a pillow, the heels positioned over the edge of pillow Seated in a chair - position feet so that no pressure on heels If ulcer on one foot - provide preventive care to the unaffected foot and special care to affected foot. 11. Preop labs: pH 7.35 - 7.45 pCO2