Nur112 Test 3 Set One

Front 1

What is Dr. Grutzner's first name?

Back 1

Ingeborg

Front 2

A nurse autoclaves infected surgical instruments. Which infection link is the nurse breaking?
Etiologic agent
Reservoir
Portal of Exit
Method of transmission
Portal of entry
Susceptible host

Back 2

Etiologic agent

Front 3

Nurses avoid contracting hepatitis C by making sure their skin is not punctured by a needle.
Etiologic agent
Reservoir
Portal of exit
Method of transmission
Portal of entry
Susceptible host

Back 3

Portal of Entry

Front 4

The nurse administers the chicken pox vaccine to a pediatric patient.
Etiologic agent
Reservoir
Portal of Exit
Method of transmission
Portal of entry
Susceptible host

Back 4

Host Susceptiblity

Front 5

A nurse bandages a wound infected with MRSA.
Etiologic agent
Reservoir
Portal of Exit
Method of transmission
Portal of entry
Susceptible host

Back 5

Portal of Exit

Front 6

A nurse places a mask over a patient's nose and mouth in the ER because the patient has tuberculosis.
Etiologic agent
Reservoir
Portal of exit
Method of transmission
Portal of entry
Susceptible host

Back 6

Portal of exit.

Front 7

A nurse protects the heels and elbows of a patient to prevent the breakdown of skin.
Etiologic agent
Reservoir
Portal of exit
Method of transmission
Portal of entry
Susceptible host

Back 7

Portal of entry

Front 8

Community health nurses promote a project to get rid of unnecessary standing water to reduce the mosquito population.
Etiologic agent
Reservoir
Portal of exit
Method of transmission
Portal of entry
Susceptible host

Back 8

Reservoir

Front 9

Home health nurses teach patients how to properly refrigerate food
Etiologic agent
Reservoir
Portal of exit
Method of transmission
Portal of entry
Susceptible host

Back 9

Reservoir. Refrigeration reduces the growth of microorganisms on food.

Front 10

A nurse "red bags" infectious material for disposal.
Etiologic agent
Reservoir
Portal of exit
Method of transmission
Portal of entry
Susceptible host

Back 10

Etiologic agent. Infectious material is destroyed.

Front 11

What are two causes of hernia?

Back 11

congenital weakness
undue pressure or strain

Front 12

What is the osmolality of Normal Saline?

Back 12

300 mmOL/L

Front 13

What are the signs of fluid overload?
(there are four answers)

Back 13

Crackles/rales
hypertension
bounding apical pulse
Jugular Vein Distension (JVD) late sign

Front 14

What are the signs of Hypovolemia? (4)

Back 14

Dry mucous membranes,
hypotension,
increased urine specific gravity,
increased H&H

Front 15

What tonicity is D5W...?
isotonic
hypotonic or
hypertonic

Back 15

hypotonic
because the dextrose gets metabolized really quickly - initially isotonic but turns hypotonic

Front 16

Which electrolyte does water follow?

Back 16

Salt - Sodium - Na

Front 17

viscera can be pushed into the cavity

Back 17

reducible hernia

Front 18

viscera is stuck in the cavity

Back 18

irreducible or incarcerated hernia

Front 19

blood supply cut off in hernia

Back 19

strangulated hernia

Front 20

five types of hernia

Back 20

inguinal,femoral,umbilical,incisional,hiatal

Front 21

lump or swelling while standing or straining is a sign

Back 21

hernia

Front 22

What tonicity is D10W?

Back 22

Hypertonic

Front 23

What tonicity is D5W?

Back 23

Isotonic

Front 24

T/F: hernia can be manipulated back into the cavity

Back 24

True

Front 25

What is the osmolality of Lactated Ringers? Is it Hypo, Hyper or Isotonic?

Back 25

280 mmol/L - Isotonic

Front 26

What happens to the cells when hypertonic solution is introduced?

Back 26

They shrinko. Draws fluid out of cells.

Front 27

T/F:Incarcerated hernia can be replaced back into cavity, ending the sharp,steady pain.

Back 27

False

Front 28

S/S of obstruction of the particular viscera - What type of hernia?

Back 28

strangulated hernia

Front 29

T/F hernia can disappear while supine

Back 29

True

Front 30

herniorrhaphy

Back 30

replaces contents of hernia back into cavity and closes the opening

Front 31

Hernia operation where tissue is reinforced with different types of mesh

Back 31

hernioplasty

Front 32

name 3 classes of medications for hernia management

Back 32

antacids, H2 receptor blockers, proton pump inhibitors

Front 33

four foods containing theobromine, which acts as a smooth muscle reactant and vasodilator

Back 33

coffee, tea, cola, chocolate

Front 34

2 guidelines for hernia management HS

Back 34

sleep w/ HOB elevated
no food 2-3 hours before bedtime

Front 35

4 guidelines regarding food management for hernias

Back 35

small, frequent meals
low fat, bland foods
no acid producing foods
no theobromine

Front 36

2 instructions for management of hernias after eating

Back 36

sit up after eatting
antacids 30cc w/in 1-3 hours after eating

Front 37

2 values that will rise if appendix perforates

Back 37

temp and leukocyte count

Front 38

name 3 antacids

Back 38

Mylanta, Maalox, Amphojel

Front 39

3 GI S/S of appendicitis

Back 39

anorexia, N, nonbilious V

Front 40

4 proton pump inhibitors

Back 40

Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole

Front 41

appindicitis: leukopenia or moderate leukocytosis?

Back 41

mod. leukocytosis (10-15,000)

Front 42

Name Four H2 Antagonists:
What do they do?
What condition are they prescribed for?

Back 42

histamine H2-receptor antagonist inhibit the production of acid in the stomach. - used in the treatment of heartburn and peptic ulcers
Cimetidine
Famotidine
Ranitidine
Nizatidine

Front 43

appendicitis pain higher or lower when mobile?

Back 43

pain on walking or jumping

Front 44

define appendicitis

Back 44

inflammation of the appendix

Front 45

position someone with appendicitis tends to assume

Back 45

lies on side with hips flexed

Front 46

2 common causes of appendix inflammation

Back 46

an obstruction or a mucosal ulceration

Front 47

four potential complications of appendicitis

Back 47

infection, thrombosis, necrosis, perforation

Front 48

where do the two lines (+) which define the four abdominal quadrants intersect?

Back 48

umbilicus +

Front 49

the quadrant where ileus occurs with appendicitis

Back 49

RLQ

Front 50

diffuse ileus is a sign of this

Back 50

perforated appendix

Front 51

2 common causes of appendix inflammation

Back 51

an obstruction or a mucosal ulceration

Front 52

3 S/S of hypovolemia-c'mon you can do it

Back 52

thirst, BP lower, weak thready pulse. Great!

Front 53

You admin. hypotonic IV. What do you monitor for?

Back 53

hypovolemia and cell edema -
ooooooooooooooooooooooooo

Front 54

TPN solutions are hypo,hyper, or iso- tonic

Back 54

hypertonic. Syruppy

Front 55

Hypertonic sol'ns move fluids which way

Back 55

into circulation. The cells shrink. eeeeeeeeeeeeeeee

Front 56

generally accepted time frame for changing IV site dressing

Back 56

72-96 hours

Front 57

used to cofirm central line placement

Back 57

chest x-ray

Front 58

do you need to wear a mask for a central line dressing change

Back 58

yes, you do

Front 59

how is flow rate of a pump measured

Back 59

ml/hr

Front 60

how is gravity flow measured

Back 60

gtts/min

Front 61

describe pain from widespread peritoneal inflammation- poorly localized, sharp local, or diffuse

Back 61

it's diffuse

Front 62

What are some factors (3) that increase the risk of cholecystitis?

Back 62

obesity (high calorie diets increase biliary secretion of cholesterol); being older than 40 and female; cycles of weight gain & loss.

Front 63

What BMI range is considered "overweight"?

Back 63

25-29.9

Front 64

Why does paralytic ileus occur after abdominal surgery?

Back 64

After abdominal surgery, peristalsis stops temporarily due to the depressive effects of anesthesia and the effects of manual mamipulation of internal organs during surgery

Front 65

What are signs/symptoms of gallbladder problems?

Back 65

N/V after eating fatty foods.
Flatulance after eating fatty foods.
Feeling of fullness after eating.

Front 66

Abdominal rigidity is a really bad sign after abdominal surgery,. Why?

Back 66

Abdominal rigidity could mean hemorrhage or leakage of bile into abdominal cavity; peritonitis

Front 67

What do gallstones do?

Back 67

They obstruct flow of bile through the cystic duct, causing bile to accumulate in and inflame the gallbladder

Front 68

After cholecystectomy, where can the referred pain be? What are some nursing actions that will help with the pain?

Back 68

After cholecystectomy, patient may have referred pain in the left shoulder caused by abdominal distention from retained CO2. Position the patient on left side, with right knee flexed; walking with help; heat for 12-20 min on right shoulder too,

Front 69

I am used to spread the organs in laproscopic surgery. I may cause shoulder pain.

Back 69

I am CO2

Front 70

the hernia that occurs at the site of a previous surgery

Back 70

incisional hernia

Front 71

The most frequent hernia that occurs mostly in males

Back 71

inguinal hernia

Front 72

the hernia that occurs mostly in females

Back 72

FEMorAL , of course

Front 73

From which of the following would you expect sharp, local pain? hernia, cholecystitis, appendicitis, pancreatitis

Back 73

NOT hernia- the one that was not like the others

Front 74

Define sprain and strain.

Back 74

Sprain: Injury to LIGAMENTS and supporting muscle around a joint.
Strain: pulled muscle. Injury to musculocutaneous unit. Strains are graded 1st, 2nd, 3rd degree.

Front 75

If a ligament tear of the knee joint is NOT repaired, what are some long-term consequences?

Back 75

- joint instability
- easily damaged meniscus
- arthritis

Front 76

Repair of torn knee ligaments occurs in 3-4 weeks, after acute inflammation phase. What happens post op?

Back 76

Patient must use CPM - continuous passive motion machine. Also give pain meds - bone pain is "bad"

Front 77

What is tendonitis? Give some signs and symptoms. What symptom will you NOT see with tendonitis?

Back 77

Tendonitis is Inflammation of a tendon from overuse or repetitive use. S/S are
- tenderness over the tendon
- pain with movement
- swelling of tendon and area
- will NOT see ecchymosis

Front 78

What is tennis elbow? (lateral epicondylitis) Describe cause, s/s and treatment.

Back 78

Cause: degeneration, irritation or tears of the tendon that attaches the elbow to the arm muscle that is used to move hand backwards (as in a backwards tennis swing) . This injury happens with repetitive motion of WRIST (not elbow).
S&S: pain grasping objects & extending wrist. Pain and inflammation at tendon attachment site (outside or lateral elbow).
Treatment: ice, rest, immoblize, physical therapy, steroid injections.

Front 79

What is golfer's elbow (medial epicondylitis)? Describe cause, S&S, treatment.

Back 79

Cause: damage to tendon that attaches muscle to inside of elbow. This muscle allows fingers to curl and hand to flex up.
S&S: inside (medial) elbow pain, inflammation, pain with flexing fingers, carrying heavy items
Tx: ice, rest, immobilation, steroids, physical therapy.

Front 80

Name four ways fractures can occur.

Back 80

1. direct blow to bone.
2. twisting/torsion
3. extreme muscle contraction
4. pathological - bone tissue crumbles.

Front 81

Name that fracture!
A fracture in which a fragment of bone has been pulled away by a tendon and its attachment.

Back 81

Avulsion

Front 82

Name that fracture!
A fracture in which bone has been splintered into several fragments.

Back 82

Comminuted

Front 83

Name that fracture!
A fracture in which bone has been compressed.

Back 83

duh. compression fracture. seen in vertebral fractures.

Front 84

Name that fracture!
A fracture in which fragments are driven inward.

Back 84

Depression fracture. seen frequently in fractures of skull and facial bones.

Front 85

Name that fracture!
A fracture through the epiphysis

Back 85

duh. epiphyseal fracture. but... can you spell that?

Front 86

Name that fracture!
A fracture in which one side of a bone is broken and the other side is bent.

Back 86

Greenstick. happens in kids a lot.

Front 87

Name that fracture!
A fracture in which a bone ligament is driven into another bone fragment.

Back 87

Impacted.

Front 88

Name that fracture!
A fracture occuring at an angle across the bone.

Back 88

Oblique fracture. it is less stable than a transverse fracture.

Front 89

Name that fracture!
A fracture in which damage also involves the skin or mucous membranes.

Back 89

Open or (old term -compound) fracture.

Front 90

Name that fracture!
A fracture that remains contained with no disruption of skin integrity

Back 90

Simple

Front 91

Name that fracture!
A fracture that twists around the shaft of the bone.

Back 91

Spiral

Front 92

Name that fracture!
A fracture that results from repeated loading of bone and muscle.

Back 92

Stress fracture

Front 93

Name that fracture!
A fracture that is straight across the bone shaft.

Back 93

Transverse fracture

Front 94

Name three things a nurse can do to help people prevent musculoskeletal injuries.

Back 94

1. wear protective geat.
2. alternate - don't be repetitious in sports or work activities.
3. use proper body mechanics; ergonomics.

Front 95

What is the Harris and Salter classification system?

Back 95

Harris & Salter classified epiphyseal plate fractures in children.
- common fractures in children
- weakest part of growing bone
- divides fx into 5 categories. higher = worse prognosis + more complications.
and by the way,
physis = growth plate
epiphysis = small portion by growth plate.
metaphysis = part next to growth plate - extends down to older bone, which is called diaphysis.

Front 96

Describe a Salter Type I fracture.
What happens, how does it heal and what are the complications?

Back 96

Harris & Salter classified epiphyseal plate fractures in children.
- common fractures in children
- weakest part of growing bone
- divides fx into 5 categories. higher = worse prognosis + more complications.
1. involves only epiphyseal plate (physis); heals quick; complications rare; usually the result of shearing forces; widens the plate.

Front 97

Describe a Salter Type II fracture.
What happens, how does it heal and what are the complications?

Back 97

II. most common. both physis & metaphysis involved; corner of metaphysis separates; rarely produces complications.

Front 98

Describe a Salter Type III fracture.
What happens, how does it heal and what are the complications?

Back 98

III. physis & epiphysis itself; extends to joint surface - through epiphyseal plate to joint surface, damages articular surface/cartilage; requires early reduction;

Front 99

Describe a Salter Type IV fracture.
What happens, how does it heal and what are the complications?

Back 99

IV - fracture through metaphysis, through epiphysis and to the articular cartilage (the growing cartilage); extends to joint surface; growth disturbances and angular deformities common when healing.

Front 100

Describe Type V Salter fracture.

Back 100

V - rare; from crush injury- axial loading. HIGHEST incidence of angular deformities when healing because it crushes/fuses growth plate in one part of plate (growth stops) and not in another part of plate (growth continues)

Front 101

Cute Mneumonic for Slater Fractures

Back 101

S: separtion of physis I
A: above the metaphysis II
L: lower, below physis - the epiphysis III
T: through the epiphysis & physis to the epiphysis IV
E: everything is
R: ruined - type V

Front 102

What are the three phases of bone repair?

Back 102

1. reactive phase
2. reparative phase
3. remodeling phase

Front 103

What happens during the Reactive phase of bone healing?

Back 103

reactive phase: hematoma forms and inflammation.
Blood Deprived Dead Bone is removed by macrophages and osteoClasts
C = Catabolism - breakdown
my image: the Cat jumps Down

Front 104

What happens during the Reparative phase of bone healing?

Back 104

Reparative Phase
Fibrin network forms
Capillaries infiltrate and reinforce
Collagin fibers form granulation tissue
Cartilage forms
Calcium deposits begin to Calcify Cells
Collar of granulation tissue & periosteum surrounds each bone fragment.

Front 105

What happens during the Remodeling phase of bone healing?

Back 105

Calcium salts still being deposited
Excess callus & bone resorption begins
Bone strongest where muscle & weight bearing stress is greatest.
Healing confirmed by xray, use, regained motion.

Front 106

Define paresthesia

Back 106

paresthesia = burning, tingling sensations or numbness. Caused by pressure on nerves or circulatory impairment

Front 107

Define fasciculation

Back 107

fasciculation = involuntary twitching of muscle fiber groups

Front 108

How much calcium should we have each day?

Back 108

1000 - 1200 mg daily

Front 109

What are the 5-6 P's that you test for when caring for a patient that has a cast?

Back 109

Pain: location, duration, severity
Paresthesia: touch, pinch, tingling, numbness
Paralysis: mobility in first intact joint distal to injury
Pallor: color/temp, capillary refill
Pressure
Pulses: distal to injury, compare sides.

Front 110

CMST is like the 5P's - it's a newer "term". What does CMST remind you to check in a person with a cast?

Back 110

C: color
M: motion
S: Sensation
T: Temperature

Front 111

What is the tonicity of plasma (serum)?
What is considered hypotonic tonicity?
What is considered hypertonic?

Back 111

Plasma is 300 mOsm/L
Hypotonic is < 250
Hyper is > 375

Front 112

Why is tonicity important? What creates tonicity in fluids?

Back 112

Tonicity will dictate in which direction the fluid moves - into which of the three compartments. Tonicity moves fluids. It is created by the electrolytes.

Front 113

Is there a relationship between tonicity and ADH (anti diuretic hormone)?

Back 113

you bet your sweet bippy! A change of as little as 10 points in tonicity can stimulate/inhibit ADH production.

Front 114

Isotonic solutions expand the ECF & are used for replacement therapy. You must monitor for fluid overload. What are four signs of fluid overload?

Back 114

Fluid overload:
- jugular vein displacement: distention
- increased BP
- bounding pulse
- rales/crackles

Front 115

What are the components of Ringer's Lactate?

Back 115

One litre of lactated Ringer's solution contains:
130 mEq of sodium ion = 130 mmol/L
109 mEq of chloride ion = 109 mmol/L
28 mEq of lactate = 28 mmol/L
4 mEq of potassium ion = 4 mmol/L
3 mEq of calcium ion = 1.5 mmol/L

Front 116

So what's the deal with D5W? Isotonic, hypotonic or hypertonic?
What is it (rarely) used for?

Back 116

D5W tonicity is 252 mOsm/L
- initially isotonic; glucose metabolizes quickly; turns hypotonic.
- used to supply water (replace cellular fluid)
- and correct increased serum
osmolality.

Front 117

Wait! D5W stands for 5% Dextrose in Water!!! I'm gonna get fat!!!
True or False and why?

Back 117

D5W is only a minor source of calories. 170 cal/liter.

Front 118

0.45 NaCl is another hypotonic solution. What will you monitor for when giving hypotonic solutions? (5)

Back 118

hypotonic
- decreased BP, Increased pulse
- pulse weak and thready
- thirsty
- decreased urine output (<30ml/hour over 24 hours)
- dark, concentrated, amber urine.

Front 119

Hypertonic solutions, such as 3% NaCl - what do they do and what should you monitor for?

Back 119

Hypertonic solutions move fluids back INTO circulation
- dangerous; rarely used in crystalloids form - but TPN (total parenteral nutrition) IS used.
- monitor for circulatory overload (same as isotonic: bounding pulse, distended neck veins (JVD), increased BP; crackles/rales

Front 120

Compare and Contrast angiocatheters and butterfly needles. When is each used appropriately?

Back 120

Angiocatheters
- soft, pliable, move with person
- less risk of infiltration
Butterfly Needle
- rigid, tiny gauge, more risk of infiltration
- used in pediatrics to access foot and scalp veins
- used by lab to draw blood.

Front 121

What are nursing responsibilities in managing IV therapy?
(I didn't get to type her whole slide so this info is off the web.)

Back 121

- Verify the doctor’s order
- Know the type, amount and indication of IV therapy.
- Practice strict asepsis.
- Inform client and explain purpose of therapy.
- PRIME IV tubing to expel air. This will prevent air embolism.
- Clean the insertion site of IV needle from center to the periphery with alcoholized cotton swab.
- Shave area of needle insertion if hairy.
- Change IV tubing every 72 hours to prevent contamination.
- Change/alter needle insertion site every 72 hours to prevent thrombophlebitis.
- Regulate IV every 15-20 minutes to ensure administration of proper volume of IV fluid as ordered.
- Observe for potential complications.

Front 122

Complications of IV Therapy
Infiltration
Describe it and what the nursing action is...

Back 122

Infiltration
- arm swollen; tight name tag
Nursing
- Warm towel and elevate arm to enhance circulation and reabsorbtion of infiltrated fluid.(or Cool Compress)
Restart iv in unaffected arm.
Contact MD for further treatment orders.
Questions for MD would include:
Is IV rate too high?
Need for pain medication?
Document incident.