Exam #2 review

Here is what I took away from the review session with Mrs. Semillo today.

There were a few things that she mentioned more than once or that she mentioned out of the blue.

- The majority of the questions will be about the assessment of and rationale for the cardiopulmonary system.
- When checking circulation, note 'mottled' skin (red/blue/purple blotches)
- When checking circulation, note the oral mucosa (tongue: shiny and beefy)
- Meds that can effect circulation are Coumadin (Warfarin) and Aspirin (most commonly)
- Do NOT use MRI if pt has metal, pacemaker, old lead based tatoo
- Do NOT do a CT if pt is allergic to iodine or shellfish
- If doing a bronchoscopy, check gag reflex (aspiration)
- If Left Ventricle enlarged, you may see edema or hear crackles (lung sounds)
- With apnea, crackles indicate secretions, fluid
- #4: Know that subjective is symptoms, objective is signs
Nurses treat signs/symptoms
Outcomes need to be specific and measureable (when, how much, how many, etc)
Be able to identify a good outcome statement
Be able to prioritize (ABC's, then safety)
Interventions need to address the signs and symptoms (the 'as manifested by')
- #5: Hypoxemia is measureable
The common diagnoses for oxygenation are:
- Ineffective tissue perfusion
- Impaired gas exchange
- Ineffective airway clearance
- #6: Know that you ask OPEN-ENDED questions.
- #10: If someone is having difficulty breathing, sit them up, use purse-lipped technique.
- When someone has a trach, air always needs to be humidified
- #11: Hyperoxygenate before suctioning (3-5 x's; 750mL (1 1/2 x's normal Tidal Volume (500mL))
- Check cannulas and masks for pressure sores

If anyone has anything else, please comment.

Oxygenation quiz

The following ten questions come from the book “Test Success” (Nugent/Vitale). See if you can answer them, then check for the answer key and rationales in the comments section of this post.

1. To prevent aspiration while administering physical hygiene to a patient receiving a nasogastric feeding tube, the nurse should:
a.) Lower the height of the bag
b.) Seek additional assistance
c.) Slow the rate of flow
d.) Shut off the feeding

2. A patient walking in the hall complains of sudden chest pain. The initial intervention by the nurse should be to:
a.) Take the patient's vital signs
b.) Perform a detailed pain assessment
c.) Walk the patient back to bed slowly
d.) Get a chair so the patient can sit and rest

3. When oxygen therapy via nasal cannula is ordered for a patient, the first action by the nurse is to:
a.) Post an “oxygen in use” sign on the door to the room
b.) Adjust the oxygen level before applying the cannula
c.) Explain the rules of fire safety and oxygen use
d.) Lubricate the nares with water-soluble jelly

4. To prevent aspiration after meals by a patient who has difficulty swallowing, the nurse should first:
a.) Position the patient in the low-Fowler's position
b.) Provide a pitcher of water at the bedside
c.) Encourage mouth care when necessary
d.) Inspect the mouth for pocketed food

5. What should the nurse do first when a patient chokes on food and is unable to speak?:
a.) Initiate the abdominal thrust maneuver
b.) Clap between the scapulae several times
c.) Instruct the patient to swallow forcefully
d.) Wait to see if the patient can cough up the obstruction

6. A patient with a history of chronic respiratory disease begins to have difficulty breathing. The adaptations that are the most serious would be:
a.) Orthostatic hypotension when rising and the need to sit in the orthopneic position.
b.) The need to sit in the orthopneic position and wheezing sounds on inspiration.
c.) Wheezing sounds on inspiration and mucus tinged with frank red streaks.
d.) Mucus tinged with frank red streaks and chest pain.

7. The adequacy of tissue oxygenation is most accurately measured by:
a.) Hematocrit values
b.) Hemoglobin levels
c.) Arterial blood gases
d.) Pulmonary function tests

8. The nurse assesses that the patient understands diaphragmatic breathing when the patient says, “I should:
a.) Feel my abdomen flatten on inspiration.”
b.) Raise my shoulders and chest when I breathe.”
c.) Hold my breath for 3 seconds at the height of inspiration.”
d.) Use my hands to put pressure against my abdomen when I inhale.”

9. When do wheezing breath sounds occur?
a.) When fluid is in the lung
b.) When sitting in the orthopneic position
c.) When air moves through a narrowed airway
d.) When the pleural sack rubs against the lung surface

10. Which is most effective for maintaining a patent airway?
a.) Active coughing
b.) Incentive spirometry
c.) Nebulizer treatments
d.) Abdominal breathing

Gearing up for exam #2

1. Which of the following is the primary purpose of surfactant?
a. to propel sheets of mucus toward the upper airway
b. to warm inspired air
c. to produce watery mucus
d. to reduce surface tension of the fluid lining the alveoli

2. a pt who has difficulty breathing, increased respiratory and HR and pale skin with regions of cyanosis may be suffering from...
a. hyperventilation
b. hypoxia
c. perfusion
d. atelectasis

3. when inspecting a pt's chest to assess respiratory status, the nurse should be aware of which of the following normal findings?
a. the contour of the intercostal spaces should be rounded
b. the skin at the thorax should be cool and moist
c. the anteroposterior diameter should be greater than the transverse diameter
d. the chest should be slightly convex with no sternal depression

4. which of the following normal breath sounds should be heard over the rtrachea?
a. vesicular
b. bronchovesicluar
c. bronchial
d. tympanic

5. mr. paks has COPD. his nurse has taught him pursed-lip breathing, which helps him in which of the following ways?
a. increase CO2, which stimulates breathing
b. teaches him to porlong inspiration and shorten expiration
c. helps liquefy his scretions
d. decreases the amount of air trapping and resistance

6. when caring for a pt with a tracheotomy, the nurse should be aware of which of the following?
a. the wound around the tube and inner cannula should be cleaned at least every 24 hrs
b. the pt has no impairment of speaking function
c. a newly inserted tracheostomy tube requires no immediate attention
d. suctioning of the tracheostomy tube must be done using sterile technique

7. which of the following statements regarding nursing diagnoses is accurate?
a. nursing diagnoses remain the same for as long as the disease is present
b. nursing diagnoses are written to identify disease
c. nursing diagnoses are written to describe pt problems that nurses can treat
d. nursing diagnoses focus on identifying healthy responses to health and illness

8. which of the following would be an appropriate nursing diagnosis for a toddler who has been treated on 2 different occasions for lacerations and contusions due to the parents' negligence in providing a safe environment?
a. high risk for injury related to abusive parents
b. high risk for injury related to impaired home managment
c. child abuse related to unsafe home environment
d. high risk for injury related to unsafe home environment
e. high risk for parents to be hung by their toenails by the nurse (just seeing if you are paying attention)

9. which of the following actions would be performed during the planning step of the nursing process?
a. interpreting and analyzing pt data
b. establishing the database
c. identifying factors contributing to pt's success or failure
d. selecting nursing measures

10. which of the following is a correctly written goal for a pt who is scheduled to amb following hip surgery?
a. over the next 24 hr period, the pt will walk the length of the hallway assisted by the nurse
b. the nurse will help the pt amb the length of the hallway once a day
c. offer to help the pt walk the length of the hallway each day
d. pt will become mobile within a 24 hr period

11. mr. conner is a 48-yr-old pt with a new colostomy. which of the following pt goals is written correctly?
a. explain to mr. conner the proper care of the stoma by 3/29/08
b. mr conner will know how to care for his stoma by 3/29/08
c. mr conner will demonstrate proper care of stoma by 3/29/08
d. mr conner will be able to care for stoma and cope with psychological loss by 3/29/08

12. which nursing action is considered an independent (nurse initiated) action?
a. executing physician orders for a catheter
b. meeting with other healthcare professionals to discuss a pt
c. helping to allay a pt's fears about surgery
d. administering meds to a pt

13. your pt, who is presented with high bp, is put on a low salt diet and instructed to quit smoking. you find him in the cafeteria eating a cheeseburger and french fries. he tells you there is not way he can quit smoking what is your first objective when implementing care for this pt?
a. explain to the pt the effects of a high salt diet and smoking on bp
b. identify why the pt is not following the therapy
c. collaborate with other healthcare professionals about the pt's treatment
d. change the nursing care plan

14. which is the most important act of evaluation performed by the nurse?
a. evaluating the pt's goal/outcome achievement
b. " the plan of care
c. " the competence of nurse practitioners
d. " the types of healthcare services available to the pt

15. which should the nurse do when pt data indicate that the stated goals have not been achieved?
a. collect more data for the database
b. review each preceding step of the nursing process
c. implement a standardized plan of care
d. change the nursing orders