Adult Health I- Test 1

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Medical-surgical Nursing
Chapters 13, 14, 16-18
Acid/base balance and perioperative care
updated 7 years ago by Boosh_75
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1

a. The surgeon obtains signed consent before sedation and/or surgery

b. The nurse clarifies facts and dispels myths about surgery

c. The nurse is not responsible for providing detailed information about the procedure.

Rules for informed consent

2

What requires that you provide a patient information about informed consent, dietary restrictions, specific preparation for surgery, exercises after surgery, and plans for pain management prior to surgery?

National Patient Safety Goals

3

The nurse should report any electrolyte ______________ or any other abnormal test results to the anesthesia team and surgeon before surgery.

Imbalance

4

______________ surgery relieves symptoms of a disease process, but does not cure it.

Palliative

5

____________ such as hydroxyzine are given preoperatively to help reduce irritability.

Sedatives

6

_______________ such as lorazepam are give preoperatively to help induce sleepiness.

Hypnotics

7

______________ such as Versed are given preoperatively to reduce anxiety.

Anxyolitics

8

__________________ such as morphine are used preoperatively for pain management.

Opioid analgesics

9

______________ agents are given preoperatively to help reduce nasal and oral secretions.

Antichiolinergic

10

______________________ are used preoperatively when procedures are long or stress ulcers are likely.

H2 histamine blockers

11

QSEN states that nurses must make sure that when they are prepping elderly patients with _______________ preoperatively that they have a bedside commode or are close to a restroom with safely rails.

Laxatives

12

The __________ nurse sets up the sterile field and anticipates the needs of the surgeons while maintaining the count of the instruments and irrigation fluids used throughout the procedure.

Scrub

13

Assessment data is done in the ______________ patient to look for stable vital signs, normal body temperature, no overt bleeding, return of gag, cough, and swallow reflexes, ability to take liquids, and adequate urine output prior to discharge.

Postoperative

14

The nurse should assess for type, location, and intensity before and after giving medication during what type of assessment?

Postoperative pain assessment

15

What promotes complete lung expansion and helps prevent pulmonary problems post surgery?

Incentive Spirometer

16

a. Cover area with sterile moist dressings

b. Call physician

c. Do not try to put organs back into cavity

d. Raise HOB 15-20o

e. Take and document VS

f. Provide support for patient

Nursing intervention for dehiscence/evisceration

17

A patient's ____________ behavior during postoperative assessment may be indicative of shock, cardiac problems, increased metabolic rate, or pain.

Restless

18

Sternum

Inner thigh

Forehead

Best practice for measuring skin turgor

19

Fluid intake/retention does not meet the body's fluid needs resulting in fluid volume deficit or _______________.

Dehydration

20

Elderly patients do not have good skin elasticity so ____________ on the back of the hand to assess for skin turgor is not best practice for assessing dehydration.

tenting

21

__________ rehydration is should be considered first when dealing with dehydration if the stomach and intestines are viable as it can be difficult to keep track of IV input and rate adjustments.

Oral

22

a. Patient history (what is causing symptoms?)

b. Cardiovascular (HR, decresased BP, weak pulse)

c. Respiratory (increased resp.)

d. Skin turgor

e. Neurological (altered mental status)

f. Renal (dark, concentrated urine, inc. specific gravity, output <500ml/day)

Assessment for Fluid Volume Deficit (FVD)

23

1 Liter of water =__________kg

1

24

A weight change of 1lb is equal to __________ mL.

500

25

Patients with dehydration should be monitored for _______________ hypertension.

Orthostatic

26

Normal range for potassium is __________mEq/L

3.5-5.0

27

____________ is an electrolyte that helps regulate protein synthesis and glucose use and storage.

Potassium

28

_________ potassium may be caused by the use of laxatives or diuretics.

Low

29

Nerve transmission, smooth, skeletal, and cardiac muscle contractibility are all affected by _______________.

Hypokalemia

30

a. Confusion

b. Respiratory depression

c. Ileus

d. Constipation

Symptoms of hypokalemia

31

A nurse should NEVER give potassium ____________.

IV push

32

Potassium levels must be normal before administering _____________ or there is a risk of drug toxicity.

Digoxin

33

____________ may be caused by renal failure or too much intake of salt substitutes.

Hyperkalemia

34

Drug therapy for hyperkalemia is ____________ in enema or NG form to bind up the potassium or insulin which drives the potassium back into the cell.

Kayexalate

35

Renal patients should decrease there intake of potassium rich _________ such as dried apricots, bananas, and beets as they tend to hold on it as their ability to excrete solutes declines.

Foods

36

____________ precautions should be taken in patients with low potassium as muscle weakness may cause their risk to elevate.

Fall

37

____________ develops with changes in normal hydrostatic pressure differences.

Edema

38

Diffusion is important in the transport of most ____________.

Electrolytes

39

Diffusion of glucose into cell membranes cannot happen with the assistance of __________.

Insulin

40

_____________ mechanism is an example of how osmosis helps maintain homeostasis.

Thirst

41

Normal body osmolarity valus is ___________ mOsm/L which is considered isotonic.

270-300

42

The minimum urine amount needed to excrete toxic waste products is __________ mL.

400-600

43

Water lost through skin, lungs, and stool is called ____________ water loss.

Insensible

44

Collaberative care for a patient with fluid overload includes assessing for pitting edema, decreased Hgb, and possibly putting them on diuretics and restricting their fluid and __________ intake.

Sodium

45

Daily __________ for a patient with fluid overload is a very important part of the I/O assessment.

Weight

46

Normal sodium levels are __________ mmol/L.

136-145

47

____________ is vital for skeletal muscle and cardiac contraction, nerve impulse transmission, and normal osmolarity and volume of the ECF.

Sodium

48

Low _________ causes water to be drawn into the cells causing them to swell.

Sodium

49

______________ is caused by renal disease, fluid retention, CHF, liver disease, SIADH, watery diarrhea, excessive sweating, and diuretics.

Hyponatremia

50

_____________ for hyponatremia may include restriction of fluids or adding sodium if there is a large loss, and may even include a diuretic to get rid of excess water if it is diluting the sodium.

Treatment

51

High sodium draws water out of the cells and causes them to shrink with ____________.

Hypernatremia

52

a. Dehydration

b. Tachycardia

c. Weak pulse

d. Postural hypotension

e. Elevated hematocrit

Symptoms of hypernatremia

53

A low-sodium diet restricts sodium intake to <___________mg per day.

1500

54

Tapping on the trigeminal nerve and having the patient "wink" back at you is a ____________ sign, signalling hypocalcemia.

Chevostek

55

When using a blood pressure cuff on a patient and a neuromuscular flexion reaction of the hand and wrist is noted, this is ____________ sign and may indicate hypocalcemia.

Trousseau's

56

Normal calcium levels are between _____________mg/dL.

9.0-10.5

57

Absorption of ____________ requires the active form of vitamin D.

Calcium

58

The ____________ gland releases PTH which tells the bones to release some of the stored calcium.

Parathyroid

59

The thyroid gland releases ______________ to halt the release of calcium from the bones.

Thyrocalcitonin

60

A symptom of hypocalcemia may be painful ____________ spasms.

Muscle

61

Patient's with hypocalcemia are at risk for bone ___________ so special care should be taken when moving these patients, such as using a slide sheet or lift.

Fractures

62

Patients with ______________ are at risk for increased blood clots and decreased peristalsis.

Hypercalcemia

63

Drug therapy for hypercalcemia include IV NS to flush out the extra calcium, furosemide, calcium ___________ which help to bind the calcium together, calcitonin to drive the calcium back into the bone, phosphorus, biphosphonates, and prostaglandin synthesis inhibitors.

Chelators

64

There is a/an ____________ relationship between phosphorus and calcium.

Inverse

65

Normal phosphorus levels are between ____________ mg/dL.

3.0-4.5

66

____________ is found in bones and activates vitamins and enzymes assisting in cell growth and metabolism.

Phosphorus

67

________________ results in decreased energy metabolism and is usually found with imbalances of other electrolytes and body fluids.

Hypophosphatemia

68

Musculoskeletal changes such as ________________ (muscle breakdown) can be seen in hypophosphatemia.

Rhabdomyolysis

69

Problems caused by _________________ center on the hypocalcemia that results from the reciprocal relationship.

Hyperphosphatemia

70

The ________________ system can respond quickly to acid/base imbalance by hyper/hypo-ventilation, thus blowing off or conserving CO2.

Respiratory

71

The _____________ react slower to acid/base imbalance but the reaction has a stronger propensity for regulation and balance by moving bicarbonate and helping in the formation of acids and ammonium.

Kidneys

72

______________ is the body's attempt to correct blood pH changes.

Compensation

73

A pH of <6.9 or >7.8 is usually ___________.

Fatal

74

Hot, dry, rapidly breathing with looks of dehydration is a usual sign of a patient in ____________.

Acidosis

75

Decreased PaO2 with a rising PaCO2

Hallmark of respiratory acidosis

76

a. pH <7.35

b. Bicarbonate HCO3 <21 n=mEq/L

c. PaO2 normal or slightly decreased

d. Serum potassium high

Laboratory assessment for metabolic acidosis

77

a. pH <7.35

b. PaO2 low

c. PaCO2 high

d. Serum bicarbonate HCO3 variable

e. Serum potassium levels elevated (if acute)

f. Serum potassium levels normal or low (if renal compensation present)

Laboratory assessment for respiratory acidosis

78

Decreased PaO2 with rising PaCO2

Hallmark of respiratory acidosis

79

_______________ is caused by prolonged vomiting, excess cortisol, hyperaldosteronism, thiszide diuretics, and prolonged NG suction.

Metabolic alkalosis

80

a. Focus on improving ventilation and oxygenation

b. Drug therapy (bronchodilators, anti-inflammatories, mucolytics)

c. Oxygen therapy

d. Pulmonary hygiene

e. Ventilation support

f. Prevention of complications

Respiratory acidosis interventions

81

Hyperventalation brought on by anxiety, fear, improper vent settings, stimulation of central respiratory center due to fever, CNS lesion, or salicylates can cause ______________________.

Respiratory alkalosis

82

Look for hypocalcemia, hypokalemia, CNS changes (positive Chvostek's and Trousseau's signs, tetany, CV changes, and respiratory changes in a/an _____________ patient.

Alkalotic

83

Prevent further loss of hydrogen, potassium, calcium, and chloride ions, restore fluid balance, monitor changes, provide safety, modify or stop gastric suctioning, IV solutions with base, drugs that promote hydrogen ion excretion.

Alkalosis intervention

84

______________ respirations are the compensatory mechanism for the diabetic patient with metabolic acidosis.

Kussmaul