NUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS

NUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS What is thrombocytopenia? - low platelet count What are granulocytes? - neutrophils, eosinophils, basophils ( Big takeway is that they are WBC's) Teaching for Iron supplements - -Take on an empty stomach - Take 1-2 hours before meal - Can turn front teeth red Cancer - patient teaching regarding social interaction and precautions - - Wash hands - Wear a mask - Limit interaction too less than 30 minutes Difference between chemotherapy and radiation - - Chemotherapy spreads throughout the whole body and kills everything - Radiation is localized. What stage is HIV declared AIDS? - Stage 3 Normal vs AIDS CD4 Levels - When the CD4 count drops below 200, a person is diagnosed with AIDS. A normal range for CD4 cells is about 700-1,000 Define acquired immunity - An immunity that develops before birth and throughout the lifetime ofNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS the individual Digoxin (Lanoxin) - teaching, levels, and OD symptoms - - contact health care professional before taking medication if pulse rate is <60 or >100. - Watch levels normal 0.8-2.0 - Toxicity symptoms include nausea, vomiting, abdominal pain What is MCV? - mean corpuscular volume. There are three main types of corpuscles (blood cells) in your blood-red blood cells, white blood cells, and platelets. Normal MCV range - 80-100 MCV > 100 means what? - Macrocytic anemia. Common causes include; B12 deficiency, Folic acid deficiency, EtOH abuse, or liver disease What lab is tested to determine anemia? What are the normal M/F levels for anemia? - Hemoglobin Male <13 Female <12 MCV is between 80-100, what is your next step? If this test is greater than 1.3 what are you thinking? - Check creatinine. If creatinine > 1.3 you need a renal consult for CKD MCV is < 80 what is your next step? What do you do if these two tests come back low? - Iron studies: Ferritin (is a protein that contains iron and is the primary form of iron stored inside of cells) <15 ng/ml TSTAT ( you get this by dividing the serum iron level by the total iron-binding capacity. The total ironbinding capacity correlates with circulating transferrin, which is the major iron-binding protein in plasma.) < 20%NUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS LOW -NUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS * Give iron supplements (IV or PO) * Consider EPO is surgery anticipated * Treat cause if iron deficiency anemia is confirmed. Examples; GI blood loss, menorrhagia, pregnancy, insufficient intake. MCV > 100 what is your next step? - Assess for; B12 deficiency Folate dificiency EtoH abuse Liver disease Hypothyroidism MCV is 85 and the creatinine is 1.2. What is your next thought as a nurse? - is the reticulocyte (baby RBC without a nucleus) normal? MCV is 85, creatinine is 1.2, and the reticulocyte count is normal between 0.5-1.5%. What is your next thought as the nurse? What do you need too rule out? - Rule out blood loss Rule out hemolysis Iron Consider EPO MCV is 85, creatinine is 1.2, and the reticulocyte count is 0.2%. What are you evaluating for? How is this normally treated?- Anemia of a chronic disease * TSTAT <20 * Decrease in RBC lifespan *Treat underlying disease * Consider EPO/ironNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS *RBC transfusion PRN Neupogen (filgrastim) and Neulasta (pegfilgrastim) - Colony stimulating factor. Treats neutropenia (lack of certain WBC's) usually caused by cancer, bone marrow transplant , or chemo MCV between 80-100 what do you expect the patient too be given too stimulate the production of RBC's? - Epogen MCV > 100 is the RBC bigger or smaller? - Bigger If you have a GI bleed what are you anticipating as a nurse? H&H 6 and 17% - - blood transfusion MCV 73. Patient has iron deficiency anemia. What are you going to do? What does this patient look like? (symptoms) - Symptoms - fatigue - Pallor - tachycarda - pale mucus membrane How long does ferrous sulfate take too kick in? When should the patient expect too feel better? - 1 month Pancytopenia definition - Anemia, thrombocytopenia, leukopenia How do you care with a patient with Ebola? What is Ebola? - deadly virus human/animal. problem with blood clotting. If you got this patient how would you care for them. PRECAUTIONS - Droplet. Why? - Bleeding What is atelectasis? - collapse of the alveoli in the lungNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS prevents normal exchange of O2 and co2 hypoventilation occurs How do we prevent Atelectasis? - Deep breathing exercises and coughing after surgery What does atalectasis look like? - Decreased breath sounds in the region of atelectasis and possibly dullness to percussion and decreased chest excursion are detectable if the area of atelectasis is large. Foods high in iron - foods high in iron! fish, meat, liver, green leafy vegetables. What are bands and segs? - Bands are young neutrophils Segs are mature neutrophils ANC Below 500 neutropenic precautions - Would you expect a cancer patient too have pancytopenia? - Yes What is leukopenia? - low WBC count ...low platlets called - thrombocytopenia If your patient has thrombocytopenia, what lab values would you expect? - Normal: 150,000- 500,000 Below 150,000 thrombocytopenia Teaching for Thrombocytopenia - - watch for bleeding - No IM injectionsNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS - no straight razorNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS -be gentle with skin and mouth care - No ASA or NSAID - No EtOH Bone marrow transplant teaching - - Explain procedure - get consent form signed - Anti-anxiety medication - Skin numbed with local anesthetic - patient is on there side. Can lay on stomach.. - ask for pain meds What type of dressing is used for bone marrow biopsy? - Pressure dressing Post bone marrow biopsy how is the patient positioned? - On the affected side How would you pick up on bleeding post biopsy? (No outward signs) - - low BP - Tachycardia Teaching for chemo - Systemic throughout the whole body. signs of infection bleeding precautions hand hygiene nutritional requirements Teaching for radiation - - localizedNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS Never Let Monkeys Eat Bananas - neutrophils, lymphocytes, monocytes, eosinophils, basophils Elevated monocytes indicate - bacterial infection neutrophils elevated - bacterial infection Too many bands means? - Bad infection. WBC's are not maturing. What does a shift to the left mean? - Presence of bands Immature WBCs) or stabs (immature neutrophils) indicates serious infection What are the common side effects of chemo and radiation? - - Hair loss - Nausea - Vomiting - Fatigue Neutropenic precautions - Isolation procedures to protect an immunocompromised patient from infections ANC means - Absolute Neutrophil count What do you wear for neutropenic precautions? - - WASH YO HANDS ****** - mask -gloves -gown IF IT ASKS WHAT IS MOST IMPORTANT YOU WASH YO HANDSNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS ANC below 500 - Neutropenic precautions Passive immunity - Immunity conferred by transferring antibodies from an individual who is immune to a pathogen to another individual. Mom to babay active immunity - Developed by the persons own body after exposure to an antigen. Precautions with the HIV patient - Standard precautions How is HIV spread? - sex, sharing needles with infected people, contaminated blood, mother to fetus Is AIDS your biggest concern from a needle stick? - Nope. Hepatitis is a bitch. How long does it take for AIDS to show up? - 2-3 weeks bone marrow biopsy - other teaching - explain procedure too patient. Expect some swelling. Patient does not need an IV. Ebola signs and symptoms - within a few days, high fever, headache, muscle pain, fatigue, diarrhea What symptoms would you expect at stage 0 of HIV? - negative or indeterminate HIV test results near the time of diagnosis. Fever, fatigue, nausea, headache, lymph node. FLU LIKE SYMPTOMS Give the ranges for the following electrolytes; K+ MagNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS NaNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS INR - K+ 3.5-5.0 Mag 1.4-2.1 Na 135-145 INR: normal <1.1 On warfarin 2.0-3.0 Your patient is undergoing a bone biopsy and exhibits evidence of decreased pain tolerance. What can you do to decrease the patients discomfort?- add more lidocane Make sure you know PRN pain med options (like morphine) Emergent - Performed immediately to save a clients life, limb or organ Required - Surgery which needs to be done in order to retain quality of life. Can wait weeks. Example; thyroid disorder, cataracts Urget - Can wait 24 hours. Elective surgery - surgery that is recommended but can be omitted or delayed without catastrophe. Vagina repair optional surgery - Surgery that is not critical to survival or function. What medications need to be held 7-10 days prior to surgery? - - Anticoagulants -Antiparticles - Herbal supplements What type of food allergy indicates latex allergy? (there are 4) - - BananaNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS - Kiwi - Avocado - Nuts (ALEXIS :P) Why is a person NPO prior to surgery? - Aspiration Do you give BP medications before surgery? - Yes in the AM with a sip of water When is the pre-operative checklist started? - During pre-admission testing (phone call) What perioperative complications will the physician worry about if someone has a BMI of 28? - Healthy 18.5- >25 Increased infection risk Wound separation (dehiscence) Cardiac complications leading to hypoventilation Why do we ask about motion sickness prior to surgery? - Last stage of anesthesia is nausea. Those with motion sickness will need to be pretreated with medication so not too aspirate When is consent obtained prior to surgery? Who gets it? - Admission pre-op area. The doctor, however, it is witnessed by the nurse. Order: preadmission testing (phone call)--> day of "admission preop" What is on the consent form? - Risk, alternatives, benefits When is the site of surgery marked? Who does this? - in the admission preop. Marked by theNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS nurse and the patient. Verified by the nurseNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS What solution of choice is hung for non-diabetic patients - lactated ringers What IV solution do you anticipate will be hung for the peri op patietn - lactated ringer D5W if the patient is diabetic NS if there are live concerns What preoperative complication is Dantralene sodium prescribed for? - Malignant hyperthermia What is the most common post surgical complication? - Myocardial infarction (MI) What is the most common post op day 3 infection? - UTI What are the W's of preoperative complications and teaching? - Wind (PNA 1-3 days post op), water (UTI usually occurs between days 1-3) wound (days 5-30), walking (prevents DVT), waves (monitor ECG for 24 hours) A post of temp of 105 can be normal due to body response from surgery Temp from 99-100 is a sign of atalecasisis Which comes first allergy check or consent? - Allergy check How long before surgery are prophilactic antibiotics given? - 1 hour prior too cut time How does the nurse keep the patient safe during surgery? - - Skin precautions - supply count - keeps traffic in and out of room -maintains sterile fieldNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS How does the nurse keep the patient safe post surgery? - - monitor vitals signs (every 15 min for first 4 hours) - give back hearing aids - put up side rails - monitor surgical sites for infection - encourage them too get up and walk Explain Time-Out - circulating nurse - Right patient -Right site - 3x Reversal agent for benzodiazepines - Flumazenil (Romazicon) Reversal agent for narcotics - Narcan (naloxone) regional anesthesia - Temporary interruption of nerve conduction, is produced by injecting an anesthetic solution near the nerves to be blocked. For a patient in the PACU, what would you doo if the O2 stats start dropping? - Wake them up Check vitals What we will do for atalectasis? - Fever, increased HR and BP Breathing exercises IS Get movingNUR 172 FINAL EXAM 2024/25 ACTUAL QUESTIONS WITH VERIFIED SOLUTIONS aPTT levels - anything over 105 you should question Normal WBC levels - 5,000-10,000 viral set point - amount of virus present in the blood after the initial burst of viremia and the immune response that follows MI tests - troponin CK-MB Total CK EKG, labs, Echo, cardiac cath