Med Surge - Test 1 P.9-17

Front 1

Topical med admin:

Because topical medications are applied locally to the skin and or mucous membranes, they affect only the tissues they are applied to: (true or false)

Back 1

false. system effects from topical agents can occur if the skin is thin, if the drug concentration is high, or if contact with the skin is prolonged

Front 2

Topical med admin:

the advantage of administering medications topically is that serious side effects fail to occur: (T or F)

Back 2

false. although the risk of serious side effects is generally low, they can occur

Front 3

Topical med admin:


there is less risk of injection with topically applied medications than with medications administered by injection (T or F)

Back 3

a. true. topical administration doesn’t puncture the skin and reduces the risk of infection that may occur with injections

Front 4

Injections: Maximum amount of drug that can be given for each route

ID

Back 4

ID: 0.3mL

Front 5

Injections: Maximum amount of drug that can be given for each route

IM

Back 5

IM: 3mL

Front 6

Injections: Maximum amount of drug that can be given for each route

SQ

Back 6

Sub-Q: 1mL

Front 7

Injected drugs act faster than oral medications and are utilized when clients are:

Back 7

•Vomiting
•Unable to swallow
•Restricted from taking oral fluids

Front 8

-Injected drugs act more quickly than oral medications because they reach the bloodstream either directly or by rapid absorption through the tissues. A risk for infection exists once a needle pierces the skin

TRUE OR FALSE

Back 8

TRUE

Front 9

-Parenteral drugs can be administered through four different routes:

•Subcutaneous (Sub-Q):
•Intramuscular (IM) :
•Intradermal (ID)
•Intravenous (IV) :

Back 9

•Subcutaneous (Sub-Q) injection: injection into tissues just below the dermis of the skin
•Intramuscular (IM) injection: injection into the body of a muscle
•Intradermal (ID) injection: injection into the dermis just under the epidermis
•Intravenous (IV) injection: injection into a vein

Front 10

-Each type of injection requires a certain set of skills to make certain that the medication reaches the proper location. Failure to inject a medication correctly can result in complications such as:

Back 10

•A drug response that is too rapid or too slow
•Nerve injury with associated pain
•Localized bleeding
•Tissue necrosis
•Sterile abscess

Front 11

-Add the time, date, and your initials to the vial you have opened. A multidose vial, properly labeled, can be used for up to ___days after opening. Swab the top of the opened or unopened vial with alcohol before piercing.

Back 11

30

Front 12

non–Luer-lok syringe VS Luer-lok syringe

what's the difference??

Back 12

A non–Luer-lok syringe uses a needle that slips onto the tip. A Luer-lok syringe uses a needle that twists onto the tip and locks into place.

Front 13

Measuring the correct dosage with a syringe:

The correct dosage is determined when...

Back 13

the middle ring touches the sides of the barrel. This portion of the plunger head is lined up with the dosage volume.

Front 14

-Needles are made of stainless steel and consist of three parts:

Back 14

the hub (which fits onto the syringe tip),

the shaft,

and the bevel (the slanted part at the tip of the needle).

Front 15

Needles
-what 2 parts of the needle need to maintain sterile?

Back 15

The shaft and bevel are the parts of the needle that must remain sterile.

Front 16

ID injection

-gauge
-depth
-mL

Back 16

26 to 27

Three eighths of an inch

0.1 to 0.3

Front 17

Sub-Q

-guage
-depth
-mL

Back 17

25-27

3/8-5/8 of an inch

0.1 to 1

Front 18

IM

-gauge
-depth
-mL

Back 18

22 to 27

5/8 to 3 inches

0.1 to 3

Front 19

The correct dosage is measured on a syringe:

Back 19

Where the head of the plunger touches the sides of the barrel of the syringe

Front 20

The maximum amount of medication you should give in one Sub-Q injection is:

Back 20

1mL

Front 21

You are preparing an IM injection from a liquid vial. You have selected a 25-gauge, 1.5-inch needle, but you are experiencing great difficulty withdrawing the fluid from the vial. You notice as you tip the vial up that the solution is very thick. What should you do?


-Add diluent to the vial so the solution is easier to withdraw.
-Add more air to the vial.
-Change needles and use a 21-gauge, 1.5-inch needle.
-Change needles and use a 27-gauge, 1.5-inch needle.

Back 21

Change needles and use a 21-gauge, 1.5-inch needle.

Front 22

. As the needle gauge gets smaller, the diameter gets larger

true or false

Back 22

true

Front 23

Mrs. Jones, a 65-year-old, 110-kg client, is ready for her annual flu vaccine that is delivered intramuscularly. What size needle would you use to administer this IM injection to Mrs. Jones?

-26-gauge by three eighths of an inch needle
-26-gauge by five eighths of an inch needle
-26-gauge by 1-inch needle

Back 23

26-gauge by 1-inch needle

A 1-inch to 1.5-inch needle is used for IM injections.

Front 24

Lesson 3.3

-Injection sites should be free of infection, skin lesions, bony prominences, and large underlying muscles or nerves. Rotation of Sub-Q injection sites from one major site to another major site was once common practice for clients receiving insulin. The new human insulin is less likely to cause hypertrophy of tissues. Therefore clients can choose one anatomic area (e.g., the abdomen) and systematically rotate sites within that region. Once all potential sites within that area are used, you may move to another anatomic site (e.g., the thigh) or start the original rotation pattern over in the original anatomic area.

Back 24

:)

Front 25

Lesson 3.3

-The amount of adipose tissue on a client's body influences the choice of needle length and angle of needle insertion. A 25-gauge, one half to five eighths of an inch needle deposits medication into the Sub-Q tissue of a normal-size client. A child may require what size of a needle?

Back 25

one-half-inch needle

Front 26

Lesson 3.3
-what should you do for an obese client to find the correct needle length?


whati s the preferred needle length?

what is the angle of insertion??

Back 26

-For an obese client, you must pinch the tissue and use a needle long enough to insert through the fatty tissue at the base of the skin fold.

The preferred needle length is 1/2 the width of the skin fold.



For injection in an obese client, the angle of insertion should be 90 degrees.

Front 27

Lesson 3.3

-For thin or cachectic clients, you may need to pinch the skin and inject the Sub-Q medication at what angle?


what is the best site for injection on an extremely lean client?

Back 27

at a 45-degree angle.




The upper abdomen is the best site for injection for an extremely lean client.

Front 28

Because you must be able to penetrate deep muscle tissue with an IM injection, needles are longer.

what is the standard ______inch needle is used for the average adult.

Older adults, cachectic clients, and children require ___inch in length.


Obese clients may require ______inch inche needles.

Back 28

1.5

shorter needles of 0.5 to 1


obese: as long as 2 to 3

Front 29

IM injections can deliver larger volumes (up to 3 mL) of medication than can Sub-Q injections.


Older infants and children under the age of 2 years can receive up to how much medication via an IM injection.

Back 29

1 mL

Front 30

Three common sites are chosen for IM injections.

Each has certain advantages and disadvantages.
-the ventrogluteal site
-what is it preferred for?

Back 30

preferred injection site for infants (especially for administration of irritating solutions), and adults.

Front 31

Three common sites are chosen for IM injections.

Each has certain advantages and disadvantages.

which 2 sites are away from major nerves and blood vessels?

Back 31

ventrogluteal and vastus lateralis

Front 32

Three common sites are chosen for IM injections.

Each has certain advantages and disadvantages.

what is the preferred site for infants receiving immunizations and may also be used for toddlers, older children, and adults

Back 32

vastus lateralis

Front 33

Three common sites are chosen for IM injections.

Each has certain advantages and disadvantages

Deltoid is used for only small medication volumes such as:

Back 33

(0.5 to 1 mL) or when other sites are inaccessible.

Front 34

Three common sites are chosen for IM injections.

Each has certain advantages and disadvantages

what is the recommended site for hepatitis B vaccine and rabies immune globulin and vaccine injections.

Back 34

deltoid

Front 35

5.4

when giving an IM injection, why do you have to use the z-track technique?

Back 35

Because IM needles pass through Sub-Q tissue before reaching a muscle, you will use a special technique for administering an IM injection to avoid irritation and injury to Sub-Q tissue.

Front 36

5.4

When correctly administered, the Z-track leaves what kind of mark?

Back 36

a zigzag path that seals the needle track, preventing the medication from escaping the muscle tissue.

Front 37

For narcotic overdose we can give…….

Back 37

NARCAN!! IVP

Front 38

Narcan is an opioiod agoinst or antagonist?

Back 38

An Opioid (Narcotic) antagonist

Front 39

Narcan
is given IVP
-what the dose?

Back 39

0.4mg – 2mg IVP

Front 40

Narcan is AKA: (2)

Back 40

Naloxone Hydrochloride

Front 41

Narcan
-Usually given IV SLOWLY! Too rapid administration results in

Back 41

nausea, vomiting, tremors, sweating, increased BP, & tachycardia.

Front 42

Narcan
-the nurse makes the assessment of when the pt has too much narcotic (s/s?)

Back 42

hypotension, low sao2, mentation state change, low RR

Front 43

Narcan
-which kind of patient should you be cautious with when administering this medication?

Back 43

someone who uses cocaine because you can induce a seizure in the pt

Front 44

Circulating nurse role
-Responsible for all of the activities within their assigned OR:

Back 44

-Set-up for the procedure
-Checks equipment
-Primary RN who communicates with the pt
-Positions patient on the OR table (scrub pts skin area to insert Foley catheters

Front 45

During the procedure circulating nurse:

Back 45

-Monitors traffic in the rm
-Assess urine and blood loss amts
-Communicates with surgeon, anesthesiologist
-Provides supplies, medications, blood products,
-sets up equipment, transports specimens
-Documents care, events, interventions

Front 46

Complications from General Anesthesia

Malignant hyperthermia: possible treatment with

Back 46

dantrolene sodium, a skeletal muscle relaxant

Front 47

Malignant hyperthermia
-what kind of response is it?


what is it triggered by?


where in the body is this occurring?

Back 47

a biochemical chain reaction response


“triggered” by commonly used general anesthetics and the paralyzing agent succinylcholine


within the skeletal muscles of susceptible individuals.

Front 48

Malignant hyperthermia
-who gets this?

Back 48

MH susceptibility is inherited with an autosomal dominant inheritance pattern

This means that children and siblings of a patient with MH susceptibility usually have a 50% chance of inheriting a gene defect for MH

Front 49

Malignant hyperthermia

The general signs of the MH crisis include

Back 49

tachycardia (increased body metabolism, muscle rigidity and/or fever that may exceed 110°F, and carbon dioxide builds up

Front 50

Malignant hyperthermia
-severe complications include:

Back 50

: cardiac arrest, brain damage (secondary to the build up and high temperature (105-110 causing cerebral tissue damage , internal bleeding or failure of other body systems.

Front 51

Malignant hyperthermia
-how does death occur?

Back 51

secondary cardiovascular collapse

Front 52

WHAT DRUGS TRIGGER MH?

Back 52

--The volatile gaseous inhalation anesthetics are MH triggers:

sevoflurane
desflurane
isoflurane
halothane
enflurane
methoxyflurane

Also, succinylcholine (Anectine), the depolarizing muscle relaxant


"flurane" inhaled general anesthesia

Front 53

-Malignant hyperthermia

susceptible persons have a mutation that results in the presence of abnormal proteins in the muscle cells of their body. Exposed to certain anesthetic agents, it causes an abnormal release of what inside the muscle cell.

Back 53

calcium

-the release of calcium causes what?

Results in a sustained muscle contraction & the abnormal increase in energy utilization and heat production.

---The muscle cells eventually run out of energy, and die and they release?????

Large amounts of K+ are released into the bloodstream ----> heart rhythm abnormalities

Front 54

Malignant hyperthermia

The muscle pigment myoglobin is also released which affects what?

Back 54

and may be toxic to the kidney. (it occludes the kidney and it can’t perform its function and the pt goes into kidney failure)

Front 55

Malignant hyperthermia

-if left untreated, what can result?

Back 55

cardiac arrest, kidney failure, blood coagulation problems, internal hemorrhage, brain injury, liver failure, and may be fatal.

Front 56

Left lower quadrant

Back 56

-sigmoid colon
-descending colon
-bladder if distended
-ovary
-uterus if enlarged
-left spermatic cord
-left ureters
-testicles
-fallopian tube
-rectum
-small intestine

Front 57

left upper quadrant

Back 57

-tip of liver
-spleen
-stomach
-left kidney and adrenal gland
-pancreas
-portions of transverse and descending colon
-diaphragm
-piece of pancreas
-small intestine

Front 58

right lower quadrant

Back 58

-appendix
-cecum
-ascending colon
-bladder if distended
-ovary
-uterus if enlarged
-right spermatic cord
-right ureters
-large intestine
-fallopian tube
-prostate
-testicles

Front 59

right upper quadrant

Back 59

-liver
-duodenum
-right kidney and adrenal gland
-portions of ascending and transverse colon
-gall bladder
-diaphragm
-small intestine
-stomach

Front 60

what type of physical and emotional signs would the nurse see for a child in pain


toddlers (1-3)

*4 things*

Back 60

crying
rocking
not wanting to be touched
behavior changes (limited vocabulary)

Front 61

what type of physical and emotional signs would the nurse see for a child in pain

preschoolers (3-5)

*3 things*

Back 61

gritting teetth
covering painful areas w/ hands
unusual behavior

Front 62

if less than ___mL of medication is given, it should be filuted in how much NS or sterile water so the medication passes through the dead spaces

Back 62

1mL








5-10mL

Front 63

when the electrolyte K+ is administered, the maximum infusion rate is what

Back 63

10mEq per hour

Front 64

a danger of continuous IV infusions is that fluids may infuse too rapidly, causing circulatory fluid overload.

-how should the nurse assess fluid balance?

Back 64

assess skin hydration and tugor, body ewight, pulse, and BP before initating the infusion and during the infusion

Front 65

why is it recommended to add medications to new IV fluid containers whenever possible?

Back 65

to be able to deteremine the exact concentration of the medication in the IV solution

Front 66

if IV medications are administered too quickly, what may the client experience?

Back 66

adverse reactions

Front 67

when administering potent medications, what does the nurse assess before, during, and after infusion?

Back 67

vital signs

Front 68

adminstration of what kind of drugs by the IV route increases the risk of phelbitis?

Back 68

hyperosmolar

Front 69

insulin

the "lin" in the trade names of regular and N (NPH) insulin identifies their:

Back 69

recombinant DNA origin

Front 70

insulin

the "log" in several of the analog insulins defines their:

Back 70

chemically alterened DNA structure

Front 71

client situation and method of IV administration (Piggyback infusion, injection of bolus of medication, large volume infusion)

malnourished client with potassium depletion

Back 71

large volume infusion

Front 72

client situation and method of IV administration (Piggyback infusion, injection of bolus of medication, large volume infusion)

NPO client with a saline lock requesting pain medication

Back 72

injection of bolus through medication

Front 73

client situation and method of IV administration (Piggyback infusion, injection of bolus of medication, large volume infusion)

client requiring IV antibiotics

Back 73

piggyback infusion

Front 74

3 mL syrings are calibrated in ______

Back 74

tenths

Front 75

insulin

TB syringes are calibrated in ______

Back 75

hundredths

Front 76

the 1st long line calibrated on all strings is ________

Back 76

0

Front 77

preop teaching for 6-11 year old VS a toddler

Back 77

6-11 use medical play with real equipment

toddlers do medical play with dolls (but not their own dolls)

Front 78

reasons for surgery

diagnostic
-performed to determine what?

Back 78

the origin and acuse of a disorder or the cell type for cancer

Front 79

reasons for surgery

example is breast biopsy, exploratory laparotomy

Back 79

diagnostic

Front 80

reasons for surgery

curative
-performed to resolve what

Back 80

a health problem by repairing or removing the cause

Front 81

reasons for surgery

examples are cholecystectomy, appendectomy, hysterectomy

Back 81

curative

Front 82

reasons for surgery

restorative
-perforemd to do what

Back 82

improve a patietn's functional ability

Front 83

reasons for surgery

examples are total knee replacement, finger reimplantation

Back 83

restorative

Front 84

reasons for surgery

palliative
-performed to do what

Back 84

relieve symptosm of a disease process, but does not cure

Front 85

reasons for surgery

examples are colostomy, nerve root resection, eleostomy

Back 85

palliative

Front 86

reasons for surgery

cosmetic
-performed for what reason

Back 86

to alter or enhance physical apperance

Front 87

reasons for surgery

exampels are liposuction, revision of scars, rhinoplasty

Back 87

cosmetic

Front 88

reasons for surgery

-gallstones

Back 88

curative

Front 89

reasons for surgery

-appendectomy

Back 89

curative

Front 90

reasons for surgery

-hip replacement

Back 90

restorative

Front 91

reasons for surgery

-valve replacement

Back 91

restorative

Front 92

urgency of surgery (elective, urgent, or emergent)

planned for coorection of a nonacute problem

Back 92

election

Front 93

urgency of surgery (elective, urgent, or emergent)

example is hernia repair

Back 93

election

Front 94

urgency of surgery (elective, urgent, or emergent)


example is cataract removal

Back 94

elective

Front 95

urgency of surgery (elective, urgent, or emergent)

hemorrhoidectomy

Back 95

elective

Front 96

urgency of surgery (elective, urgent, or emergent)

total joint replacement

Back 96

elective

Front 97

urgency of surgery (elective, urgent, or emergent)

requires prompt intervention

Back 97

urgent

Front 98

urgency of surgery (elective, urgent, or emergent)

may be life threatening if treatment is delayed more than 24-48 hours

Back 98

urgent

Front 99

urgency of surgery (elective, urgent, or emergent)

example is intestinal or bladder obstruction

Back 99

urgent

Front 100

urgency of surgery (elective, urgent, or emergent)

kidney stones

Back 100

urgent

Front 101

urgency of surgery (elective, urgent, or emergent)

bone fracture

Back 101

urgent

Front 102

urgency of surgery (elective, urgent, or emergent)

requires immediate intervention because of the life threatening consequences

Back 102

emergent

Front 103

urgency of surgery (elective, urgent, or emergent)

gunshot or stab wound

Back 103

emergent

Front 104

urgency of surgery (elective, urgent, or emergent)

severe bleeding

Back 104

emergent

Front 105

urgency of surgery (elective, urgent, or emergent)


compound fracture

Back 105

emergent

Front 106

urgency of surgery (elective, urgent, or emergent)


abdominal aneurysm

Back 106

emergent

Front 107

urgency of surgery (elective, urgent, or emergent)

appendectomy

Back 107

emergent

Front 108

urgency of surgery (elective, urgent, or emergent)

interruption with oxygen

Back 108

emergent

Front 109

age groups

medical play using real equipment

Back 109

school age 6-11

Front 110

age groups

medical play using real medical equipment with doll

Back 110

preschool 3-5

Front 111

age groups

medical play with dolls (not childs)

Back 111

toddler 1-3