Packet Questions

Fluid and Electrolytes

1. What is fluid volume excess?

2. What is another term for fluid volume excess?

3. How can congestive heart failure cause hypervolemia (or fluid volume excess)?

4. How can renal failure cause fluid volume excess?

5. How can IV fluids with sodium induce hypervolemia?

6. Alka-Seltzer contains a lot of which electrolyte?

7. How can Alka-Seltzer cause hypervolemia?

8. Fleets enemas contain a lot of which electrolyte?

9. How can a fleet enema cause hypervolemia?

10. What is the normal action of aldosterone?

11. How can aldosterone cause hypervolemia?

12. What is the name of the disease a client can have that will induce hypervolemia due to too much aldosterone?

13. What hormone works the opposite of aldosterone?

14. How does ANP correct FVE?

15. What is the normal action of ADH, and what does ADH stand for?

16. How can ADH cause hypervolemia?

17. Where is ADH stored?

18. What will the effects be on the body if a client is producing too much ADH? What is the name of this disease?

19. What will the effects be on the body if the client does not have enough ADH? What

is the name of this disease?

20. What happens to the veins of the client who is hypervolemic?

21. Why does the hypervolemic client develop edema?

22. Define CVP. Where is CVP measured?

23. What is normal CVP?

24. If a client is hypervolemic, what will happen to the CVP?

25. If a client is hypovolemic, what will happen to the CVP?

26. If a client is hypervolemic, what are the lung sounds like and why?

27. Why does the client who is hypervolemic develop polyuria?

28. What happens to the blood pressure and pulse with hypervolemia? Explain why.

29. What happens to the weight in hypervolemia? Why?

30. What type of diet is prescribed for hypervolemic client? Explain why.

31. If a hypervolemic client is placed on a high-sodium diet, what would happen?

32. Why would you do a daily weight on the hypervolemic client?

33. Explain why diuretics are given to the hypervolemic client.

34. Lasix is a common diuretic. What is the major electrolyte imbalance that you are worried about with this drug?

35. What is the major electrolyte imbalance to watch for with thiazide diuretics?

36. Aldactone is a potassium-sparing diuretic. What is the major electrolyte imbalance you watch for with this drug?

37. How does bed rest cause diuresis?

38. Why is it so important to give IV fluids very slowly to the elderly?

2 Hurst Review Services

39. What is another name for fluid volume deficit?

40. Define fluid volume deficit.

41. How can GI losses affect your vascular space?

42. What is third spacing?

43. How can ascites induce hypovolemia?

44. How can burns induce hypovolemia?

45. Why will the diabetic client develop polyuria?

46. The person with polyuria will eventually develop what life threatening complication?

47. What three changes will you see in the urine output that will indicate the body is compensating?

48. How does hypovolemia affect the weight?

49. During hypovolemia, what happens to the blood pressure and pulse and why?

50. During hypovolemia, what happens to the CVP? Explain why.

51. During hypovolemia, what happens to the veins? Explain why.

52. Why do the extremities of a client who is hypovolemic become cool?

53. And what is going to happen to the urine specific gravity if a client is hypovolemic?

54. What is the treatment for mild fluid volume deficit?

55. What is the treatment for severe FVD?

56. What safety precautions are needed for the FVD client and why?

IV Fluids

57. How do isotonic solutions work?

58. Why is an isotonic solution contraindicated in a client with hypertension?

59. What complications do we worry about when administrating isotonic solutions?

60. How do hypotonic solutions work? Give examples.

61. When would a hypotonic solution be used?

62. Why would I worry about FVD in the client receiving a hypotonic solution?

63. How do hypertonic solutions work? Give an example.

64. When would a hypertonic solution be used?

65. Why would I worry about FVE in the client receiving a hypertonic solution?

Magnesium and Calcium:

Hypermagnesemia:

66. How do we get rid of excess magnesium from our body?

67. Renal failure can cause hypermagnesemia. Explain why.

68. Magnesium acts like a _______________________.

69. If a client has hypermagnesemia, what will happen to their DTR’s, muscle tone, respirations, and level of consciousness?

70. Could the client with hypermagnesemia have a life-threatening arrhythmia?

71. Why does the client who has hypermagnesemia develop flushing and warmth?

72. What effect will this flushing and warmth from hypermagnesemia have on the blood pressure?


73. Why would a client with hypermagnesemia require a ventilator?

74. Why would a client with hypermagnesemia be dialyzed?

75. Why is calcium gluconate given to someone who has hypermagnesemia?

Hypercalcemia:

76. Hyperparathyroidism can induce hypercalcemia. Explain how.

77. What is the normal action of parathormone?

78. How do thiazide diuretics cause hypercalcemia?

79. How does immobilization (bed rest) cause hypercalcemia?

80. If a client has too much calcium in the blood, what kind of muscle tone will the client have?

81. What will the client’s DTR’s be like?

82. How will it affect the client’s LOC, pulse, and respirations? Could the client have an arrhythmia?

83. Could the client have a kidney stone? Why?

84. Why is it so important to get the client walking or weight-bearing with hypercalcemia?

85. Why is it so important to increase fluids in hypercalcemia?

86. Calcium has an inverse relationship with what other electrolyte?

87. What do steroids do to your serum calcium level?

88. How does vitamin D help calcium?

89. What drug will return calcium to the bones? What disease is this drug used for?

Hypomagnesemia:

90. How can diarrhea induce hypomagnesemia?

91. Why are alcoholics prone to hypomagnesemia?

92. If you have a client with hypomagnesemia, what will the client’s muscles be like?

93. Could the client have a seizure?

94. Why do we worry about the client’s airway?

95. Why does the client with hypomagnesemia have a positive Chvostek’s and Trousseau’s, and what will happen to the DTR’s?

96. Could the client with hypomagnesemia have arrhythmias?

97. Describe the level of consciousness of the client with hypomagnesemia.

98. Would the client with hypomagnesemia have problems swallowing?

99. Why is it so important to check renal failure prior to giving IV magnesium?

100. Why are seizure precautions necessary when caring for a client with hypomagnesemia?

101. Why is it so important to discontinue the mag-sulfate infusion if a client begins to have flushing and sweating?

Hypocalcemia:

102. How does hypoparathyroidism affect the serum calcium levels?

103. How could a radical neck dissection/thyroidectomy affect the serum calcium level?


104. List symptoms of hypocalcemia and explain why the client has these symptoms.

105. Why do we give the hypocalcemic client vitamin D?

106. If a client has hyperphosphatemia, what other electrolyte imbalance will be present?

107. How will phosphate binders increase calcium levels?

108. Why do we give the hypocalcemic client calcium carbonate and calcium gluconate?

109. When you are giving someone IV calcium, what is the most important thing you need to remember to do? Explain why.

Sodium:

Hypernatremia:

110. If you have a client who is very dehydrated, what will happen to their serum sodium level? Explain why.

111. If you have a client who is dehydrated, what will happen to their H&H? Explain why.

112. Why does the client who is hypernatremic have dry sticky mucous membranes and why are they thirsty?

113. There is one organ in the body that really does not like it when sodium is out of balance. What is it?

114. Why is it so important when you are trying to lower someone’s serum sodium level that you dilute the client with IV fluid gradually?

115. If you have a client who is becoming dehydrated, what will begin to happen to their sodium level? And what should you do before the client becomes hypernatremic?

116. Why is it so important to ensure proper water replacement with tube feedings?

Hyponatremia:

117. If a client is hyponatremic, what is their blood like? Concentrated or dilute? Why?

118. How can D5W make someone’s serum sodium go down?

119. How can drinking too much water make your serum sodium go down?

120. When you have a hyponatremic client, it is important that you restrict water. Explain why.

121. What IV fluids are used to treat hyponatremia? What nursing alerts are necessary when administering these fluids?

Potassium:

Hyperkalemia:

122. What organs must be working properly to help maintain your normal potassium level in your blood?

123. How can renal failure cause hyperkalemia?

124. How can Aldactone cause hyperkalemia?

125. What are the major symptoms of hyperkalemia?

126. When a client with a potassium imbalance has an arrhythmia, they are very dangerous. Why? What type of arrhythmias will the client have?

127. When you have a hyperkalemic client, why do we dialyze them?

128. Why do we give the hyperkalemic client calcium gluconate?

129. Why do we give the hyperkalemic client glucose and insulin?

130. How does Kayexalate work?

131. When you give Kayexalate, you can expect the serum potassium level to go down; therefore, what will happen to the serum sodium level? Explain


Hypokalemia:

132. How can vomiting induce hypokalemic?

133. What are the S/S of hypokalemic?

134. Why is it so important that you monitor the digoxin client closely for hypokalemia or other electrolyte imbalances?

135. How does Aldactone help hypokalemia?

136. Why is it so important to asses urine output before starting IV potassium?

137. What are some foods high in potassium?

138. What is the major side effects of oral potassium supplements?

Acid Base

139. What are the major acid/base chemicals? Are they acids or bases? What organs control each chemical?

140. What does the pH tell you?

141. What organ does not like it when the pH is messed up?

142. In respiratory acidosis or alkalosis, what are the problem organs?

143. In respiratory acidosis or alkalosis, who is going to compensate?

144. In metabolic acidosis or alkalosis, what are the problem organs?

145. In metabolic acidosis or alkalosis, who is going to compensate?

146. When you think of the lungs, what chemical needs to pop into your mind?

147. When you think of the kidneys, what chemicals needs to pop into your mind?

148. Can CO2 be a chemical that makes you sick and be a chemical that makes you compensate?

149. Can bicarb and hydrogen be chemicals that make you sick and be chemicals that make you compensate?

150. What is the only way you can have a buildup of CO2 in your blood?

151. What is the only way to lower CO2 in the blood?

Respiratory Acidosis:

152. In respiratory acidosis, which organs are not working right? Who is going to compensate? How does the compensation work?

153. In respiratory acidosis, what has happened to the CO2 level in your blood? What caused the increase? Give examples.

154. In respiratory acidosis, how is the client breathing? And how does this affect the CO2 level in the blood?

155. What is going to happen to the bicarb level in respiratory acidosis?

156. Why does it do this?

157. When someone gets very acidotic, what happens to their level of consciousness?

158. When a client has a high CO2 level is their blood, what is going to happen to the oxygen level in their blood?

159. What are the early signs of hypoxia?

160. When you have a client in respiratory acidosis, what is the primary thing that has to be fixed? Explain some ways this can be fixed.


Respiratory Alkalosis:

161. When someone is in respiratory alkalosis, what organs are going to compensate? With what chemicals are they going to compensate? Explain the compensation.

162. When someone is in respiratory alkalosis, how do they have to be breathing?

163. How does their breathing cause alkalosis?

164. What has happened to the pH in respiratory alkalosis?

165. What is the bicarb level going to do in respiratory alkalosis?

166. When someone is hysterical, why can they go into respiratory alkalosis?

167. What is the immediate treatment for respiratory alkalosis?

168. If you have a client who is on the ventilator, and the respiratory rate is set too high, will the client go into respiratory acidosis or respiratory alkalosis? Explain why.

169. How will sedation affect respiratory alkalosis?

Metabolic Acidosis:

170. In metabolic acidosis, what are the problem organs? What chemicals are altered?

171. What happens to the pH and why?

172. Which organs are going to compensate? With what chemical will they compensate?

173. If you have a client who is in acidosis, do you want that client to retain CO2 to compensate, or do you want this client to lose more CO2?

174. CO2 is a what?

175. If you have a client in metabolic acidosis, what is going to happen to their respiratory rate and why?

176. How can a DKA client go into metabolic acidosis?

177. How can an anorexic or bulimic client go into metabolic acidosis?

178. What are ketones and how do they affect the blood?

179. How can diarrhea induce metabolic acidosis?

180. In any type of metabolic acidosis, what is going to happen to the serum potassium level? Therefore, what is the major electrolyte imbalance they will have, and what is the major side effect they will have?

Metabolic Alkalosis:

181. In metabolic alkalosis, which organ has the problem? Therefore, what chemicals are going to be altered?

182. In metabolic alkalosis, which organs are going to compensate? What chemical are they going to compensate with? Explain compensation.

183. How can vomiting or a NG tube suction induce metabolic alkalosis?

184. Explain why antacids can cause metabolic alkalosis.

185. Why do we have to worry about hypokalemia in the alkalotic client? What life threatening complication can occur?

186. Treatment for metabolic alkalosis is directed toward what?

Burns

187. If someone has been burned, fluid seeps out into the tissue, why?

188. When the fluid seeps into the tissue, what happened to the blood pressure and the pulse? Explain why.


189. Why does the cardiac output decrease when the fluid seeps out into the tissue?

190. During this phase (when the fluid is seeping into the tissue), is this client in a fluid volume deficit or fluid volume excess?

191. When a client is in a fluid volume deficit, why does their urine output decrease?

192. After a major burn, when fluid is seeping out into the tissue, why is it important that ADH and aldosterone are secreted?

193. What is the treatment for carbon monoxide poisoning? Explain why.

194. When a client has any type of upper body burns, why do we have to worry about the airway?

195. What are the s/s of airway injury in the burn client?

196. Explain the Rule of Nines.

197. Using the Parkland formula, what percent volume of fluid is given the 1st 8 hours, 2nd 8 hours, and 3rd 8 hours?

198. What measurement is the best to way evaluate fluid volume status in the burn client?

199. How will an IV with albumin help fight shock? What are the risks with albumin administration?

200. Explain the difference between the tetanus toxoid and the tetanus immune globulin.

201. What is the purpose of the escharotomy?

202. What electrolyte do we worry about with burns?

203. Why do clients with burns have to take Mylanta and Tagamet?

204. What is the purpose of measuring a gastric residual?

205. Why are multiple antibiotics when treating burns?

206. When a client has an electrical injury, they are at a high risk for what arrhythmia?

207. How long is the client at risk for life-threatening arrhythmias?

208. Why can a client with an electrical burn have kidney failure?

Oncology

209. At what age should yearly mammograms start?

210. Why do testicular exams need to be done monthly?

211. Explain nursing assignments for radiation clients.

212. When a client has a radiation implant, why do we put them on a low fiber diet?

213. Why does this client have a foley catheter?

214. Why do we want to keep the client with a radiation implant on bed rest?

215. When a client has a radiation implant, there is a chance it will become dislodged. What would you do?

216. Explain the nursing care for the markings that a client will have when they are receiving external radiation therapy.

217. List basic side effects of chemotherapy.

218. What is a vesicant?

219. What do you do if a vesicant infiltrates?


220. What is the danger of a vesicant infiltrating?

221. List 6 general ways to prevent infection in the client receiving chemotherapy

222. What is one of the major complications post-hysterectomy and why?

223. When a client has had an abdominal hysterectomy, what is the position to avoid? And explain why.

224. Explain the post op care for a client who has had a mastectomy.

225. Why is it so important that the mastectomy client elevate her arm on the affected side?

226. Why is it important that the client exercise the affected side after a mastectomy?

227. List discharge teaching precautions for the mastectomy client.

228. When a client has a bronchoscopy, they are NPO until what returns?

229. What are some complications of a bronchoscopy that you need to watch for?

230. Explain procedure to obtain a sputum specimen.

231. When a client has had a pneumonectomy, what is the nursing care as far as positioning and why?

232. Why does the client who has had a total laryngectomy need to have a tracheostomy?

233. Why does the client who had a total laryngectomy have to be positioned in the

Fowler’s position?

234. Why does the laryngectomy client need to have NG feedings?

235. Why is it important that the laryngectomy client have frequent mouth care?

236. Explain suctioning.

237. Why is ulcerative colitis and Crohn’s disease considered to be risk factors for colon cancer?

238. Explain, in your own words, an ileal conduit.

239. What is the major symptom of bladder cancer?

240. Why is it important that hourly outputs be monitored after a client has had an ileal conduit?

241. Is mucous in this urine normal?

242. Why is it important that the ileal conduit client change their appliance in the morning?

243. Explain the pathophysiology behind an enlarged prostate (benign prostatic hypertrophy).

244. What are the symptoms of BPH? Why do they get these symptoms?

245. What is the major lab work assessed when prostate cancer is suspected?

246. Why does the client not have an incision with a TURP?

247. What is the most common complication of a TURP?


248. When a client has had a TURP, why do they not have to worry about impotency and infertility?

249. Explain how a three-way catheter works and why the prostatectomy client has to have it.

250. How do Kegel exercises help prostatectomy clients?

251. Why is it important that the prostatectomy client avoid sitting, driving, strenuous exercise, and lifting?

252. Why does the prostatectomy client have to take Colace?

253. What is one of the major signs diagnostically of stomach cancer?

254. When a client has had a fresh GI surgery, such as gastrectomy, is it okay for the nurse to manipulate the NG tube?

255. What are the two major complications of gastrectomy?

256. What are the S/S of GI tract obstruction?

Endocrine

257. List the major symptoms of hyperthyroidism.

258. What is another name for hyperthyroidism?

259. Why does the client develop the symptoms of hyperthyroidism?

260. What happens to the workload of the heart in hyperthyroidism?

261. What do you have to have in your diet to make thyroid hormones?

262. Explain how the antithyroid drugs work.

263. Give examples of the antithyroid drugs:

264. Why do we give iodine compounds preoperatively?

265. Why do you have to give iodine compounds in milk or juice and use a straw?

266. Why does the hyperthyroid client have to be put on beta blockers? How does this help the client?

267. How does radioactive iodine work?

268. What is one of the major complications of radioactive iodine?

269. When a client has had a thyroidectomy, why is it so important for them to support their neck?

270. How do you want a thyroidectomy client to be positioned? Explain why.

271. Why do we check for bleeding behind the neck with a thyroidectomy client?

272. Why do we keep a trach set at the bedside with a thyroidectomy client?

273. How do you assess for recurrent laryngeal nerve damage in the thyroidectomy client?

274. Why do we have to assess for parathyroid removal in the thyroidectomy client?

275. How do you assess for parathyroid removal?

276. What is another name for hypothyroidism?

277. When someone is hypothyroid, what has happened to their thyroid hormone levels?

278. What are the S/S of hypothyroidism?

279. What is cretinism?


280. How do you treat hypothyroidism?

281. When a client has started on drug therapy for hypothyroidism, is it temporary or permanent?

282. When somebody is hyperparathyroid, what is the major electrolyte imbalance they have?

283. Why do you have to worry about the bones of a client with hyperparathyroidism?

284. Why does the hyperparathyroid client have kidney stones?

285. What is the major electrolyte imbalance a hypoparathyroid client will have?

286. What type of symptoms will this client exhibit?

287. Why does the hypoparathyroid client need a quiet environment?

288. Why does the hypoparathyroid client need a trach tray at the bedside?

289. Why is it important that the hypoparathyroid client have a diet that is limited in phosphorus?

290. Explain how Amphojel works for the hypoparathyroid client.

291. When a client has Pheochromocytoma, what is the major problem they have?

292. What happens to this client’s blood pressure and pulse?

293. What is the major diagnostic test for Pheochromocytoma? Explain.

294. What are the four major actions of glucocorticoids?

295. When you hear the word mineralocorticoids, what is the major word you need to think of?

296. How does aldosterone work?

297. What is another name for glucocorticoids, mineralocorticoids, or sex hormones?

298. Why do steroids drive your blood sugar up?

299. If a client is making too much aldosterone, what is going to happen to the vascular space? Explain why.

300. Explain briefly the basic pathophysiology of Addison’s disease.

301. What is the major electrolyte imbalance a client with Addison’s disease will have?

302. What are the S/S of hyperkalemia?

303. Could the Addison’s disease client also have a life-threatening arrhythmia? Is so, why?

304. Does the Addison’s disease client have too many steroids in their blood or not enough steroids in their blood?

305. Why does the Addison’s disease client have trouble with shock?

306. Why does the Addison’s disease client need more sodium in their diet?

307. Why is I&O such an important nursing intervention with the Addison’s disease client?

308. Is the Addison’s disease client in a fluid volume deficit or a fluid volume excess?


309. What happens to the Addison’s disease client’s blood pressure?

310. When a client has Cushing’s syndrome, explain briefly, in your own words, what The client will look like?

311. When a client has Cushing’s syndrome, do they have too many steroids or not enough steroids?

312. Why does the Cushing’s syndrome client experience the following?

a. Growth arrestb. Thin extremities and skinc. Increased risk for infectiond. Hyperglycemiae. Psychosis to depression (changes in mood)

313. Is the Cushing’s syndrome client in a fluid volume deficit or excess?

314. Why does the Cushing’s syndrome client develop high blood pressure and heart failure?

315. When a client has Cushing’s syndrome, their serum potassium level goes down. Why?

316. Why does the Cushing’s syndrome client need more calcium in their diet?

317. Does the Cushing’s syndrome client need to be on a low-sodium diet or a high- sodium diet? Explain.

318. Why does the Cushing’s syndrome client have ketones and glucose in their urine?

319. Why does the Cushing’s syndrome client not have protein in their urine? Is it normal to have protein in the urine?

320. In the diabetic client, why does the glucose build up in their blood?

321. In the diabetic client, why does the body start breaking down protein and fat?

322. Anytime you break down fat, you are going to get production of what?

323. Ketones are what?

324. What is the major acid base imbalance the diabetic client can develop and explain why.

325. Why does the diabetic develop the following symptoms?

a. Polyuriab. Weight lossc. Polydypsiad. Polyphagia

326. Explain how oral hypoglycemic agents work and give examples.

327. Why will an oral hypoglycemic agent not work in a Type I diabetic?

328. Why does a Type II diabetic have problems with wounds that will not heal or repeated vaginal infections?

329. What is the common treatment for Type II diabetics?

330. In the treatment of a diabetic, why do we have to limit the protein in the diet?

331. Why are diabetics prone to coronary artery disease?

332. How can a high-fiber diet benefit a diabetic client?

333. When the diabetic client exercises, why do they have to worry about hypoglycemia and how can they prevent it?

334. Why is it important that a diabetic client exercise when their blood sugar is at its highest?

335. When you start giving a client insulin, what is going to happen to their blood sugar?

336. When you give a client insulin, why should the client not have ketones and glucose


in the urine?

337. How does the insulin dosage need to be adjusted for the diabetic client who has glucose and ketones in the urine?

338. What is the only type of insulin that can be given IV?

339. When insulin is at its peak, that means the insulin is working really hard; therefore, what is going to happen to the blood sugar at the peak time?

340. How can hypoglycemia be prevented?

341. Why is rotating injection sites important for the client on insulin?

342. What is going to happen to anybody’s blood sugar when they are sick or stressed?

343. When a diabetic client is sick, their blood sugar is going to go up; therefore, what do they need to do with the dose of their insulin?

344. What major complication can occur in a Type I diabetic when the blood sugar is uncontrolled?

345. What are some general S/S of hypoglycemia, and what is the immediate nursing action?

346. After giving a simple sugar to the hypoglycemic client, what would the nurse do next?

347. Why is hypoglycemia considered to be more dangerous than hyperglycemia?

348. If you walk into a diabetic client’s room and find the client unconscious, do you treat the client as hypoglycemic or hyperglycemic?

349. Why is it so important that a diabetic client eat regularly and take their insulin regularly?

350. Explain the basic pathophysiology behind diabetic ketoacidosis.

351. When a client has diabetic ketoacidosis, why is it important that we measure the

blood sugar and the potassium hourly?

352. When you give a client insulin, what do you expect it to do to the client’s blood sugar? Why?

353. When you give a client insulin, what do you expect it to do to the client’s serum potassium level? Explain why.

354. Why is it so important that we monitor the diabetic ketoacidotic client’s EKG so closely?

355. Why are we measuring hourly output on the diabetic ketoacidosis client?

356. When a client has oliguria and anuria, what do you really have to start worrying about and why?

357. Explain diabetic foot care thoroughly.

Cardiac

358. Describe preload and afterload.

359. What is cardiac output?

360. If your cardiac output is decreased, do you perfuse as well as you normally do?

361. What conditions can affect your cardiac output?

362. If you are taking care of a client with decreased cardiac output, what is going to happen to their level of consciousness?

363. Could they start complaining of chest pain?

364. Why does a client’s (whose cardiac output is low) skin feel cool and clammy?

365. When you are taking care of a client who has decreased cardiac output, why do they


get short of breath and have wet lung sounds?

366. When you are taking care of a client who has decreased cardiac output, why do their peripheral pulses diminish?

367. What is going to happen to urine output when you have a client who has decreased cardiac output?

368. When you have a client with decreased cardiac output, why does their blood pressure drop?

369. How will bradycardia affect cardiac output?

370. How can tachycardia (i.e., heart rare> 150) affect cardiac output?

371. When someone has had an MI, how can this affect cardiac output and why?

372. If my blood pressure is really high, how will this affect cardiac output and why?

373. Draw a picture of my square heart and include the lungs and the aorta and trace the normal blood flow through the heart.

374. What is angina?

375. Explain the pain a client has with angina.

376. Why is nitroglycerine given?

377. When you give somebody nitroglycerine, more ________________ is going to get to the heart muscle?

378. How do you teach a client to take their nitroglycerine?

379. Why should nitroglycerine burn?

380. What is common and expected side effect of nitroglycerine?

381. When you give somebody nitroglycerine, are they going to vasoconstrict or vasodilate? Therefore, what is going to happen to their blood pressure?

382. Why do clients with angina need beta blockers? List several examples.

383. What is the purpose of aspirin for the angina client?

384. Why do angina clients need calcium channel blockers? List several examples.

385. Why is it so important that the angina client avoid isometric exercise, overeating, caffeine, or any drugs that increase the heart rate and avoid cold weather?

386. Why is it so important that the angina client rest frequently?

387. Is it okay for a client with angina to take their nitroglycerine prophylactically?

388. Before they take their nitroglycerine, should the client sit down or stand up? Explain.

389. Why is it so important that you ask the client if they are allergic to iodine before they go for a heart catheterization?

390. Any time you have a client who is injected with iodine-based dye, what is the common complaint the client will have?

391. In post-cardiac catheterization, you have to watch the puncture site closely. What are we watching it for?

392. When a client has had a heart cath, you have a pertinent nursing assessment you need to do distal to the insertion site. Explain.

393. With a MI (myocardial infarction), why does the client have necrosis?


394. Will rest or nitroglycerine relieve MI pain?

395. Explain how MI pain feels.

396. Why does an MI client get cold, clammy, and their blood pressure drop?

397. Why does the MI client’s white count go up?

398. Why does their temperature go up?

399. Which biomarker would be appropriate if the client has delayed treatment post MI?

400. Is a negative myoglobin a goof thing or a bad thing?

401. When a client has had a MI, what is the drug of choice?

402. When a client is having a MI, what arrhythmia is a very high risk?

403. When a client goes into V-fib, what is the priority nursing action?

404. What antiarrhythmics or used when the V-Fib are resistant to defibrillation?

405. What drugs are used for chest pain when the MI client arrives to the ED?

406. How do thrombolytics work? Give me three examples of common thrombolytics.

407. What is the major complications of a thrombolytic?

408. Before you give a thrombolytic, you are supposed to get a good history. What did I tell you to focus on (what type of disease or illness)?

409. After someone has received a thrombolytic, why is it so important that we decrease puncture sites?

410. What is angioplasty and what is the major complication of angioplasty?

411. What is your natural pacemaker?

412. What do artificial pacemakers do?

413. Can the electrical part of your heart be working and the pumping mechanism not?

414. Explain the difference between a demand and a fixed-rate pacemaker.

415. You really need to get worried about a pacemaker malfunctioning when the rate of the pacemaker does what?

416. Why is it so important that we immobilize the arm on the affected side after pacemaker insertion?

417. Why does the pacemaker client need to check their pulse every day?

418. Why does the pacemaker client have to avoid microwaves and MRI’s?

419. If you increase preload, what do you do to the workload of the heart?

420. List some ways preload can be increased.

421. List some ways preload can be decreased.

422. Explain afterload in your own words.

423. If you increase afterload, what do you do to the cardiac output?

424. If cardiac output is decreasing, that means the blood is not moving forward. If blood is not moving forward, then it has got to go backwards, so therefore where is it going to wind up?

425. What are the major symptoms of left-sided heart failure and explain why.


426. Why does a client with left-sided failure have restlessness and tachycardia?

427. Why does a client with left-sided failure have nocturnal dyspnea?

428. Why does the client with left-sided failure basically have pulmonary symptoms?

429. What are the major symptoms of right-sided failure?

430. When a client is in right-sided failure, is the blood backing up into the arterial system or the venous system?

431. What does a Swan Ganz catheter measure inside the heart?

432. What does this catheter measurement tell you?

433. What is an A-line?

434. What is an Allen’s test?

435. Why is it so important that the distal circulation be checked when a client has an A- line? Explain your checks that you are going to do (nursing assessment).

436. If an A-line is accidentally pulled out, what is the first thing that needs to be done?

437. When a client has an A-line, pressure has to be kept in the infusion bag. Why? What would happen if you didn’t keep the pressure on the infusion bag?

438. Why does the client in heart failure develop cardiomagaly?

439. Explain how digitalis works.

440. When you slow down someone’s heart rate, you give the ventricles more time to do what?

441. When your heart squeezes down with more force and strength and on more blood, what is going to happen to cardiac output? What is going to happen to kidney perfusion?

442. Any time you increase kidney perfusion, what is probably going to happen to urine output?

443. When you start giving a client Digoxin, should their cardiac output go up or down?

444. When you increase a client’s cardiac output, what is actually happening inside the heart?

445. When you increase a client’s cardiac output, should they appear better oxygenated or less oxygenated?

446. When you start giving somebody Dig, we expect their cardiac output to increase; therefore, what should happen to their:

a. Level of consciousness?b. Lung sounds?c. Urine output?d. Skin?e. Peripheral pulses?f. Blood pressure?

447. Why does a congestive heart failure client need Lasix?

448. When a client goes on a low-sodium diet and bed rest, what might happen to them?

449. Why do we give diuretics in the morning?

450. If a HF client notices their weight increasing, what could that put them at risk for?

451. What is pulmonary edema?

452. How does a client develop pulmonary edema?

453. What are the major S/S of pulmonary edema?


454. When does pulmonary edema usually occur and why?

455. Why is the client in pulmonary edema restless and anxious?

456. Why is it so important that we hurry up and decrease the circulating volume in the pulmonary edema client?

457. When a client is in pulmonary edema, why do we give them Digoxin?

458. When a client is in pulmonary edema, why do we give them morphine?

459. How much morphine do we give them?

460. When a client is in pulmonary edema, why is it important that you sit them up with their legs down?

461. What is intermittent claudication?

462. Explain how intermittent claudication develops.

463. When a client has an arterial problem, that means the oxygen/blood are having a hard time getting to the tissue, so therefore different S/S develop. Explain the S/S.

464. Could a client with an arterial problem develop ischemia and necrosis in the affected extremity? Explain.

465. How will angioplasty help an arterial problem?

466. Whether you are studying Buerger’s disease or Raynaud’s disease, what is the key word that I told you to remember?

467. In Buerger’s disease and Raynaud’s disease, there is significant vasoconstriction, What type of things bring on the vasoconstriction in Buerger’s and Raynaud’s disease?

468. Explain the nursing care for someone with Buerger’s disease and Raynaud’s disease.

469. What is the most important thing to teach your client about Buerger’s disease or Raynaud’s disease- to avoid the __________________?

470. Why do Buerger’s disease clients have to do such excellent foot care?

471. When a client has a venous disorder, are they having trouble with oxygenation of the affected extremity?

472. Do you elevate venous disorders or lower venous disorders (such as an affected extremity)?

473. Explain the pathophysiology behind a venous disorder.

474. Why does a client with a venous disorder need Heparin?

475. How do TED hose help venous disorders?

476. When taking care of a client with a venous disorder, do you use warm moist heat or cold wet packs?

477. With DVT prevention is the key. We _____________ and _______________ the client.

Psychiatric Nursing

478. Why is the client with depression irritable?

479. Why do we want to prevent isolation when a person is depressed?

480. Why as depression lifts does the suicide risk go up?

481. How do you respond to a client’s delusion of grandeur?

482. Why does the manic client like to dress seductively?

483. What is the reason a manic client likes to manipulate?


484. Why do you not want to argue with or try to reason with the manic client?

485. What is an example of inappropriate affect in the schizophrenia client?

486. How does the nurse respond to the schizophrenia client’s neologism?

487. What is the most important thing to remember with a suicidal client?

488. If you use restraints for a suicidal client what must you do?

489. What is most important in the treatment of paranoia?

490. Why does the highly anxious client need step-by-step instructions?

491. Why do we include time in the schedule for rituals with an obsessive compulsive disorder client?

492. Why does the alcoholic have trouble with losing their magnesium and potassium?

493. Why would you observe the bulimic client for one hour after they have eaten a meal?

494. Explain the reason follow up is the key to successful treatment of a phobia?

495. How can the client with panic attacks learn to stop the anxiety?

496. Why do you warn a hallucinating client before you touch them?

497. Why do you give atropine pre procedure for electro-convulsive therapy?

Renal

498. What is the major cause of glomerulonephritis?

499. When a client has glomerulonephritis, are they in a fluid volume deficit or a fluid volume excess?

500. When a client has glomerulonephritis. Why do they develop malaise and headache?

501. When a client has glomerulonephritis, why does their urine output go down?

502. When a client has glomerulonephritis, why does their BUN and creatinine go up?

503. When a client has glomerulonephritis, why do they get protein in the urine?

504. Explain CVA tenderness.

505. In glomerulonephritis, why does the blood pressure go up?

506. And what will happen to the urine specific gravity?

507. With any type of kidney disease, it is not uncommon for the BUN to be elevated; therefore, why do we limit the protein in the diet?

508. If you gave a client with any type of renal disease protein in their diet, what will happen to the BUN?

509. Why does the glomerulonephritis client need rest?

510. When determining fluid replacement for a renal disease client (glomerulonephritis), you always give them what they lost in a 24- hour period plus 500cc. What is the purpose of adding 500cc’s?


511. Once diuresis begins in glomerulonephritis, will the client be at risk for a fluid volume deficit or fluid volume excess?

512. When a client has nephrotic syndrome, what is the major element that is leaking out into their urine?

513. What will protein or albumin hold onto in the vascular space?

514. If a client does not have protein or albumin in their vascular space (blood), what is going to happen to all the fluid that is supposed to stay in their vascular system?

515. How does this affect the vascular space?

516. Therefore, will the nephrotic syndrome client (in the acute stages) be in a fluid volume deficit or fluid volume excess?

517. When a client has nephrotic syndrome, they develop total body edema, What is the proper term for total body edema?

518. When a client has nephrotic syndrome, it is not uncommon for them to be placed on prednisone. Why?

519. Does the nephrotic syndrome client need a high-sodium diet or a low-sodium diet? Explain why.

520. Does the nephrotic syndrome client need a high-protein diet or a low-protein diet? Explain why.

521. How can bradycardia cause renal failure?

522. How can hypovolemia cause renal failure?

523. How can shock cause renal failure?

524. How can decreased cardiac output cause renal failure?

525. How can glomerulonephritis, nephrotic syndrome, or diabetes cause renal failure?

526. How can a kidney stone cause renal failure?

527. How can ureteral swelling cause renal failure?

528. How can a tumor or an enlarged prostate cause renal failure?

529. When a client is in renal failure, why does their BUN and creatinine go up?

530. What happens to the specific gravity in renal failure?

531. Why can renal failure client become anemic?

532. Why does the renal failure client’s blood pressure go up?

533. Why is the renal failure client at risk for congestive heart failure?

534. Why does the renal failure client develop anorexia, nausea, and vomiting?

535. Why does the renal failure client develop an itching frost?

536. Why does the renal failure client have to worry about osteoporosis?

537. There are two phases of renal failure. The first phase is an oliguric phase, If a client is oliguric, what has happened to the urine output?

538. Why does the oliguric client go into a fluid volume excess?


539. Why does the oliguric client develop hyperkalemia?

540. The second phase of renal failure is called the diuretic phase. When a client is diuresing, what has happened to their urine output?

541. Why will a client who is diuresing go into a fluid volume deficit?

542. If a client goes into a fluid volume deficit, what will happen to their blood pressure?

543. What will happen to their heart rate? Explain why.

544. When a client is diuresing, their serum potassium level goes down (hypokalemia). Explain why.

545. If a client is allergic to Heparin, they cannot be hemodialyzed. Why?

546. Is hemodialysis done every day?

547. Does the client who is being hemodialyzed have to watch what they eat and drink in between treatment? Why?

548. Explain the basic nursing care for a circulatory access (A-V shunt, fistula, or graft).

549. Why can’t a client who has an alternate circulatory access device have blood pressures or venipunctures in that extremity?

550. Explain in your own words what peritoneal dialysis is.

551. When a client is having peritoneal dialysis, where is the fluid going into?

552. What would you do if you instilled 1,000 cc’s of fluid into the peritoneal dialysis client and only 700 cc’s came back?

553. What should the drainage of peritoneal dialysis look like?

554. What would be S/S of infection with peritoneal dialysis?

555. When a client has CAPD for their renal failure, why do they have to increase protein and fiber in their diet?

556. When a client has CAPD, why do they have a constant sweet taste and why do they have anorexia?

557. What are the major signs of kidney stones?

558. What is the number one thing you need to remember with kidney stones?

559. Why is the serum creatinine not affected by what we eat?

560. What type of specimen do you have to have to test a creatinine level on a client?

561. Is the BUN affected by what we eat?

Gastrointestinal

562. What are the two major functions of the pancreas?

563. What is the major cause of pancreatitis?

564. How can gallbladder disease cause pancreatitis?

565. List all of the symptoms of pancreatitis. (Explain WHY these occur)

a. Abdominal distention and ascites

b. Abdominal mass

c. Rigid board-like abdomen

d. Bruising

e. Fever

f. Jaundice


g. Hypotension

h. Serum lipase and amylase (up or down)?

566. Why do we give the pancreatitis client steroids?

567. Why do we give the pancreatitis client anti-cholinergic drugs?

568. Why do we give the pancreatitis client Tagamet and antacids?

569. Is it possible that a pancreatitis client might have to have insulin? Explain why.

570. What is a peritoneal lavage and how does the pancreatitis client benefit from this?

571. What are the dietary changes needed for the pancreatitis client?

572. What is cirrhosis?

573. When a client has cirrhosis, what happens to the blood pressure in their liver and what is the proper term for this?

574. Explain the S/S of cirrhosis and explain why the client develops each symptom.

575. Why does the cirrhosis client sometimes develop hepatic encephalopathy and coma?

576. Your client is going to have a liver biopsy. What clotting studies should be checked? Please explain why.

577. Why is it so important that vital signs be checked pre-liver biopsy?

578. How is a client positioned during a liver biopsy?

579. How is a client positioned post-liver biopsy? Explain why.

580. Why does the client have to exhale and hold while the primary healthcare provider is puncturing into the liver?

581. Why are worried about I & O and daily weights with the cirrhosis client?

582. Why is rest so important with a cirrhosis client?

583. Why are we worried about prevention of bleeding in the cirrhosis client?

584. Why do we measure the abdominal girth in the cirrhosis client and what will it tell us?

585. What is a paracentesis?

586. When a client is having a paracentesis, what position do you put them in?

587. Why is it so important that the paracentesis client void pre-procedure?

588. Why is it so important to monitor the vital signs pre- and post-paracentesis?

589. During a paracentesis, the client could be thrown into a fluid volume deficit or fluid volume excess?

590. Where is the first place a cirrhosis client might develop jaundice?

591. When jaundice gets to the skin, what is one of the major nursing diagnoses?

592. Why do you have to avoid narcotics in any liver client?

593. When a client has a liver disease, what should be done with protein in the diet?

594. Why does the liver client need a low-sodium diet?


595. What chemical builds up in the blood that makes a client go into a hepatic coma?

596. How did that chemical develop?

597. What are symptoms of a hepatic coma? Explain why the client develops these symptoms.

598. What is the major drug used in hepatic coma? Explain why.

599. If a client is in hepatic failure and eats protein, what is going to happen to the ammonia level in their blood? Explain why.

600. What are bleeding esophageal varices?

601. Why does a client develop bleeding esophageal varices?

602. Why is the oxygen important with a client who has bleeding esophageal varices?

603. Explain how Octreotide (Sandostatin) works.

604. What is one of the complications of giving Octreotide (Sandostatin)?

605. Why does the client with bleeding esophageal varices need a Sengstaken Blakemore tube?

606. What is the nursing care associated with a Sengstaken Blakemore tube?

607. Explain symptoms of peptic ulcers.

608. What is the pre-procedure care of a gastroscopy? Explain to your client what to expect if they are going to have a gastroscopy.

609. When a client has a gastroscopy, they have to be NPO until their gag reflex returns. Why?

610. What would be a major sign of perforation post-gastroscopy?

611. Why do we give the peptic ulcer client antacids? What type of antacids would be the best- liquid or tablet?

612. Why do we give the client with peptic ulcer disease H-2 receptor antagonist? List some examples.

613. Why do we give the peptic ulcer client Carafate?

614. Why is it important that the peptic ulcer client decrease stress?

615. Why is it important that the peptic ulcer client stop smoking?

616. Explain what you would teach a peptic ulcer client about diet.

617. What is the difference in a peptic ulcer and a duodenal ulcer?

618. What is a hiatal hernia?

619. What are the major symptoms of a hiatal hernia?

620. What are the major nursing interventions for a client who has a hiatal hernia?

621. What is dumping syndrome?


622. After what surgery does a client get dumping syndrome?

623. What are the symptoms of dumping syndrome?

624. What are the major nursing interventions for a client who has dumping syndrome?

625. What is the difference in ulcerative colitis and Crohn’s disease?

626. What are the symptoms of ulcerative colitis and Crohn’s disease?3

627. What is another name for Crohn’s disease?

628. You are taking care of a client who is going to have an upper GI. Explain what is going to happen to the client.

629. Your client is going to have a barium enema. What is the pre-procedure care?

630. How would you describe a barium enema to a client?

631. Why is it so important that the client have a bowel movement after a barium enema?

632. When a client has ulcerative colitis or Crohn’s disease, do they need a high-fiber or low-fiber diet? Why?

633. Why does the client with ulcerative colitis or Crohn’s need to avoid cold foods and smoking?

634. What is one of the major antibiotics given for ulcerative colitis and Crohn’s disease? How does this drug help?

635. Why does the client with ulcerative colitis or Crohn’s disease need steroids?

636. What is the surgical treatment for ulcerative colitis?

637. What is the surgical treatment for Crohn’s disease?

638. When a client has an ileostomy, what will the drainage be like?

639. Why should an ileostomy client need to avoid rough foods or high-fiber foods?

640. Why does the ileostomy client need Gatorade?

641. Why is the ileostomy client at risk for kidney stones?

642. When a client has an ileostomy, what electrolyte are they losing a lot of?

643. Explain the nursing care for a colostomy.

644. Why does a client develop appendicitis?

645. Explain the major symptoms of appendicitis?

646. Why do we avoid giving enema to a client who has appendicitis?

647. When a client has had any abdominal surgery, what is the position of choice and why?

648. What is another name for Hyperalimentation?

649. Why does a client who is receiving Hyperalimentation need a central line?

650. Why do we discontinue Hyperalimentation gradually?

651. Why is it so important that we monitor daily weight in the hyperal client?

652. The hyperal client may have to start taking insulin. Why?


653. When a client is on hyperal we check their urine every day. What are some things you should be checking it for?

654. Why is it so important that we not mix hyperal ahead of time?

655. Why does Hyperalimentation need to be in a pump?

656. Why is it so important that home TPN clients emphasize hand washing?

657. How should you position your client?

658. Where does the central line go?

659. If air gets into your central line, what is going to happen? What position should you place the client in?

660. After the central line has been inserted, we always get a chest x-ray. What two things are we checking for in this chest x-ray?

Neuro

661. When performing an assessment on the neuro client, what is most important?

662. What is the pulse pressure?

663. What happens to the pulse pressure with increased intracranial pressure?

664. If a neuro client complains of a headache, what would this mean?

665. Explain the doll’s eye reflex.

666. Explain the ice water calorics test.

667. Explain the Babinski and what is the difference for a child less than one year of age and anyone greater than one year of age.

668. When a client is having a CT of the head, is it okay for them to talk?

669. Can a CT scan be done with contrast medium (dye)?

670. What type of client cannot tolerate an MRI scan?

671. Explain everything that you would teach a client about an MRI.

672. What is cerebral angiography?

673. When a client is having cerebral angiography, what artery do they go through?

674. What other procedure did we use the femoral artery for?

675. Why is it so important that a client who is about to have cerebral angiography be well hydrated?

676. Why is it so important that we assess the peripheral pulses before cerebral angiography?

677. When a client is having a cerebral angiography, it is not uncommon for them to complain of a warmth in the face. Explain why.

678. Is it so important that you ask this client who is about to have cerebral angiography if they are allergic to something. What is it?


679. Explain the post-procedure care for the cerebral angiography client and explain why.

680. Why is it so important that we watch for an embolus after cerebral angiography? Explain what you would watch for specifically in your client.

681. What is an EEG?

682. What is the pre-procedure care for a client who is going to have an EEG?

683. If a client were about to have an EEG, what would you tell them about the procedure?

684. When a client is having a lumbar puncture, do we get into cerebrospinal fluid?

685. What are some reasons for doing a lumbar puncture?

686. How do you position a client for a lumbar puncture?

687. Why do you put them in this position?

688. What should cerebrospinal fluid look like?

689. What is the post-procedure care of a lumbar puncture? Explain why.

690. What is the most common complication of a lumbar puncture?

691. How is this complication treated?

692. What is a big complication of a lumbar puncture?

693. What is one of the most important things you need to remember with a scalp injury?

694. What is an open head injury?

695. What is a closed head injury?

696. With which fracture is the client most at risk for infection?

697. Explain S/S of a basal skull fracture.

698. When a client has a basal skull fracture, where is the fracture?

699. What is Battle’s sign?

700. What are raccoon eyes?

701. What is cerebrospinal rhinorrhea?

702. Explain the S/S of a concussion.

703. If a client has been diagnosed with a concussion, what things should you teach before they go home?

704. Is it okay for a concussion client to go home alone?

705. If a client has an epidural hematoma, explain the sequence of events that will occur and why the client has these changes.

706. What is the treatment for an epidural hematoma?

707. When a trauma client comes into the emergency room, why do we have to assume a C-spine injury is present?


708. Why is it so important to keep the body in perfect alignment after trauma?

709. How do you tell CSF from other drainage?

710. When you have a head injury client, why is it so important that we keep the environment quiet?

711. When you have a head injury client, why do we have to pad the side rails?

712. With a neuro client, why do we want to avoid narcotics?

713. What happens to intracranial pressure (ICP) when the client sits up and lies down?

714. What is posturing?

715. Explain the two different types of posturing.

716. When a client is posturing, what happens to their caloric needs?

717. Why are osmotic diuretics used in the treatment of intracranial pressure? Explain exactly how they work.

718. When a client is on an osmotic diuretic, they better have two organs that are working perfectly. What are they?

719. Why are clients with increased intracranial pressure given steroids?

720. How can hyperventilation decrease intracranial pressure?

721. What would happen to the intracranial pressure if the temperature were to exceed 100.4F?

722. When taking care of a head injury client with increased intracranial pressure, why is

it so important that you space your nursing interventions?

723. What is the purpose of a barbiturate induced coma?

724. Why is it so important to restrict the fluids in a head injury client?

725. What should you restrict the fluids to? (How many cc’s per day?)

726. If a client were to become bradycardic, what would happen to the cerebral perfusion? Explain why.

727. If a client were to develop an increased blood pressure, what will happen to cardiac output? Explain how this would affect cerebral perfusion.

728. What is a major risk when a client has an ICP monitoring device?

729. Why is it so important that we keep the connections tight on an ICP monitoring device and also why is it so important to keep the dressings dry?

Respiratory

730. What is the purpose of a thoracentesis?

731. When a client is having a thoracentesis, where is the fluid being removed from?

732. What is the pleural space?

733. When the pleural space fills with fluid, what happens to the lungs?

734. Any time you are pulling fluid from a client’s body (thoracentesis, paracentesis, foley catheter), you are putting the client at risk for going into a fluid volume deficit or fluid volume excess. Why?

735. There is a possibility with a thoracentesis that a pneumothorax could occur. Why?

736. What has happened when a client needs a chest tube?


737. Chest systems have a water seal. First of all, what is the purpose of the water seal and what would happen if there was not water seal?

738. When a client has chest tubes, hopefully the lungs will do what?

739. What critical numbers would you report related to oxygenation and drainage in a closed chest drainage system?

740. Why is the CDU kept below the level of the chest?

741. What do you do when:a. Tubing disconnects from chest tubeb. CDU falls over and water leaks outc. When is bubbling normal?d. When is bubbling a problem?

742. What would happen if the water seal in the chest system is broken?

743. What life threatening complication can occur if you clamp a test tube?

744. What is a hemothorax?

745. What is pneumothorax?

746. When blood or air or fluid accumulates in the pleural space, what is going to happen to the lung?

747. What should you do if a client presents with a penetrating object to the chest?

748. What is a tension pneumothorax?

749. With a mediastinal shift, what will happen to the trachea?

750. When a client has an open pneumothorax, you are supposed to put a piece of petroleum gauze over the area. How many sides are taped down? Why do we leave one side open?

751. When a client has a fractured sternum or ribs, why are the respirations so shallow?

What acid base imbalance will this put them at risk for?

752. With a fractured sternum or ribs, why do we give non-narcotic analgesics?

753. What is flail chest?

754. What is paradoxical chest wall movement?

755. Why does the client with flail chest develop paradoxical chest wall movement?

756. With a fractured sternum or ribs, why is the client put on a ventilator with PEEP?

757. What is PEEP?

758. What is CPAP?

759. What is the major difference between the two (PEEP and CPAP)?

760. How can dehydration promote an embolus?

761. How can venous stasis promote a pulmonary embolus?

762. When a client has a pulmonary embolus, why does their pulse go up?

763. When a client has a pulmonary embolus, describe their chest pain.

764. When a client has a pulmonary embolus, the blood pressure is going to go up into their lungs. What effect will that have on the right side of the heart?

765. With a pulmonary embolus, the client will have fever and their WBC count will go up. Why?

766. Why does the PO2 go down with a pulmonary embolus?


767. What type of line will be put into the client to monitor the right side of the heart?

768. How will Heparin help the client who has developed a pulmonary embolus?

Orthopedics

769. Why is it so important that fractures be immobilized as soon as possible?

770. What type of emboli do you worry about with a fracture?

771. What would you do if a client came in with an open fracture?

772. Explain a neurovascular check.

773. There are two parts to a neurovascular check.

a. What is the neuro component?b. What is the vascular component?

774. Give S/S of a fat embolus?

775. What is compartment syndrome?

776. If you suspect a compartment syndrome, what should you do first?

777. In your Student Book pages explained several different things under “Cast Care.” Such as ice packs should go on the sides. Go through those components under “Cast Care” and explain why we do all of those things.

a. Ice packs on sides

b. No indentations

c. Use palms for the first 24 hours.

d. Keep uncovered and dry.

e. Do not rest cast on hard surface or sharp edge.

f. Mark breakthrough bleeding circle area, date, and time site.

g. Cover cast close to the groin with plastic.

h. Neurovascular checks with the 5 Ps

i. Elevate

778. When a client with an orthopedic injury complains of pain, what is the first thing you should do?

779. What are some of the purpose of traction?

780. Weight on traction should hang freely. Explain why.

781. What is skin traction. Give examples.

782. What type of assessment is very important when a client has skin traction? Explain why.

783. What is skeletal traction? Explain. Give examples.

784. Explain how to do pin care.

785. When a client has a total hip replacement, there are some important things to remember about positioning.

a. Explain why you want neutral rotation.

b. Limit flexion.

c. Want extension.

d. Abduction

786. Discuss the general nursing care for someone with the continuous passive motion machine.

787. What are some good exercises for the total hip replacement client?

788. Why is it so important that the total hip replacement client avoid flexion?

789. Give examples of things a total hip replacement client should avoid specifically


related to flexion.

790. Why is it important that we keep a tourniquet at the bedside with amputation?

791. Why is elevation so important with an amputation (for the first 24 hours)?

792. What can we do in the amputation client to prevent hip and knee contractures?

793. What is phantom pain?

794. Describe the nursing care with someone with phantom pain

Maternity

795. List presumptive, probable, and positive signs of pregnancy.

796. When teaching a pregnant client about exercise what heart rate do you tell her not to get above when exercising? And why?

797. The client should be taught to be alert for what danger signs during pregnancy?

798. What signs of true labor would the nurse teach the client?

799. Why is an IV fluid bolus of 1000 ml NS or LR given prior to an epidural?

800. The nurse caring for a laboring client receiving Pitocin would discontinue the Pitocin if what occurred?

801. When you assess tachycardia in a postpartum client, what should you think?

802. What should the nurse do when palpating the postpartum client’s fundus that is boggy? And why?

803. The nurse teaching a group of pregnant clients about breast feeding would include what important points?

804. What assessments are scored with the Apgar and when is it done?

Complications of Maternity

805. What is the first sign of an ectopic pregnancy?

806. What are the two priorities in the treatment of Abruptio placenta?

807. List treatments for the client with Hyperemesis Gravidarum.

808. By definition, preeclampsia involves what assessment data?

809. Why do the face and hands of the preeclamptic client swell?

810. What are priority assessments for the client receiving magnesium sulfate?

811. The nurse caring for a client in preterm labor would observe for which side effects of Brethine?

812. Why is Betamethasone given to the mom in preterm labor?

813. Why is it important to check FHT’s when membranes rupture, either artificially or spontaneously?

814. When are pregnant clients routinely assessed for GBS risk factors?

Pediatrics

815. When assessing a pediatric client, what is the order of obtaining vital signs?a. Respirations-always count for 1 full minuteb. Heart rate- always count for 1 full minutec. Blood pressured. Temperature

816. The child with mild coup can be treated at home with steam (hot showers), cool mist humidifiers, and car rides with windows down. How does cool-temperature therapy help the child with mild croup?

817. Why is the child, post tonsillectomy, positioned on their side, or head of bed elevated, or prone?


818. Why would we want the child with Otitis Media to lie on the affected side?

819. Why is it so important to recognize signs and symptoms of RSV quickly?

820. Why is the child with Cystic Fibrosis at risk for hyponatremia?

821. Why do we need to feed the pediatric client with heart failure when they are well rested, when they wake up and are showing signs of hunger, and before they start crying?

822. Why should an infant with a cleft lip and palate be burped frequently?

823. Explain why babies with esophageal Atresia do not have meconium?

824. Treatment for the client with mononucleosis consist of rest, analgesics, and fluids. Why would we not want this client to participate in contract sports?

Management and Delegation

825. Why do you need to know med-surge core content first when delegating routine tasks to LPNs and nursing assistive personnel (NAPs)?

826. Why can NAPs only perform routine, simple, repetitive common activities on stable clients in uncomplicated situations?

827. Why types of assignment transfers both responsibility and accountability?

828. Why is the RN responsible for knowing the staff’s strengths and weaknesses in regards to delegation?

829. What should the RN do when a weakness is identified in a staff member?

830. Why can the LPN not do any form of evaluation?

831. Why should the RN assess the newly admitted client first?

Packet Questions

Documents

hurst review

icp monitoring

sengstaken

fluid volume

fluid volume

bleeding esophageal

basal skull

decreased