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77 Cards in this Set

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Post-operative swelling of the operative eye is minimized by (choose all that apply):
a. Keeping the head elevated
b. Using anti-inflammatory eye drops
c. Patching the operative eye for 24 hours
d. Putting pressure on the eye
e. All of the above
a. Keeping the head elevated
b. Using anti-inflammatory eye drops
c. Patching the operative eye for 24 hours
Oxygen was given by nasal cannula at 2 liters/min during surgery. This is most likely because:
a. Her pre-op O2 saturation was only 98%
b. The airflow helps relieve the claustrophobia of being under the surgical drapes.
c. It reduces post-op pain.
d. It keeps the sclera from drying out.
b. The airflow helps relieve the claustrophobia of being under the surgical drapes.
As nurse manager of an ophthalmic clinic you want to replace the current practice of having patients go to the hospital for a pre-op assessment and instead have them see one of your nurses in the clinic. Using Rose et al's research to provide the evidence for this practice change, you tell your supervisor that the nurse-led pre-op assessments in clinic were:
a. less expensive and often preferred by patients.
b. less expensive even though they were not preferred by patients.
c. more expensive but preferred by patients.
d. more expensive and not generally preferred by patients.
a. less expensive and often preferred by patients.
General feedback: To make a practice change, you need to present something that saves money and/or results in better care. This study reported that the change would both save money and be preferred (although patients were happy with either strategy). Note that the abstract does not describe who saw the patient in the hospital. The full article should describe this.
Morlet and Kelly (J Opthalmic Nurs Technol 1996 Mar-Apr;15(2):60-4) studied a technique of teaching self-administration of eye drops which involved steadying the hand and watching the dropper. They found that:
a. Patients over the age of 60 were unable to correctly administer the drops >80% of the time.
b. Although healthy volunteers could perform the technique easily, it was very difficult for patients post cataract surgery.
c. Those taught the technique did just as well with self-administration as their caregivers had done administering the drops to them.
d. Patients reported being fearful about self-administration and many dropped out of the study.
c. Those taught the technique did just as well with self-administration as their caregivers had done administering the drops to them.
Which of the following would increase the risk of bleeding during cataract surgery?
a. The patient takes aspirin daily for arthritis.
b. The INR is 1.
c. The patient holds perfectly still during the injection of the retrobulbar block.
d. The patient's pupil was dilated pre-operatively.
a. The patient takes aspirin daily for arthritis.
The patient has "Potential for pain related to tissue damage". The best expected outcome for this problem is:
a. Pt takes pain medicine around the clock.
b. Pt takes pain medicine as needed.
c. Eye tissue damage is minimized with good surgical technique.
d. Pt states pain is tolerable.
d. Pt states pain is tolerable.
Correct. This EO is specific, measurable, and it relates to the problem.
Which of the following describes phacoemulsification?
a. Lift a small piece of the central cornea off as a flap. Remove a small piece of the cornea. Replace the flap.
b. Make small slits like spokes in the cornea.
c. Break up the lens with sound waves and suction it out.
d. Reduce intraocular pressure by aspirating aqueous humor out of the anterior chamber with a small needle.
c. Break up the lens with sound waves and suction it out.
Correct. A replacement lens is then inserted.
Given the following objective, identify the "criterion." Following instruction from the nurse, the caregiver will demonstrate administration of eye drops with 100% accuracy.
a. the nurse
b. will demonstrate proper administration of eye drops
c. Following instruction from the nurse
d. 100% accuracy
d. 100% accuracy
Which of the following would result from hypotension?
a. Increased urine output.
b. Dilute appearing urine.
c. Elevated creatinine.
d. All of the above.
c. Elevated creatinine.
Correct. When blood pressure is low the kidneys are not perfused and renal failure can result.
The patient has a problem with bleeding and anemia. Which is the best expected outcome for this problem?
a. No bleeding.
b. Hct > 25%
c. Guiac negative stool.
d. All of the above.
b. Hct > 25%
A low hct but you will probably not do any better. Remember that the EO guides when you will do something about the problem. As long as her hct stays above 25 we will probably not transfuse her. Often MDs will write guidelines for the EO in th orders. You would see something like "Call MD if Hct<25".
The patient has "Respiratory distress related to ascites, small bilat pleural effusions and history 60 pack-year smoker as evidenced by pt complaints of SOB and DOE and O2 saturation 88% on room air". The best expected outcome for this problem would be:
a. No respiratory distress
b. 20 pack-year smoker
c. denies SOB and DOE, O2 saturation >92% on room air
d. respiratory rate < 22
c. denies SOB and DOE, O2 saturation >92% on room air
The absence of the "as evidenced by" signs and symptoms is a good way to write a specific and measurable EO
The patient has "potential for thrombophlebitis". The best expected outcome for this problem is:
a. No calf pain on dorsiflexion of foot.
b. No calf swelling/redness/pain.
c. No sudden onset chest pain/SOB.
d. All of the above.
d. All of the above.
This is a tough one. Most venous thrombi are probably not detected. The MDs can order an ultrasound flow study but it is expensive and you have to figure out who to order it for. A good rule of thumb for ordering these tests is to ask yourself: "What would I do if the test were positive?" and the question "What would I do if the test were negative?". If your answers to these 2 questions are the same, don't order the test. If she turns out to have a thrombus, would you anticoagulate her with heparin? Consider her risk for bleeding problem.
Between 3/14 and 3/16, Mary's hematocrit increased from 24.0 to 30.3, most likely because:
a. The effects of chemotherapy on RBC development are waning off.
b. She received a blood transfusion.
c. She has recovered from the risk of bleeding from the chemotherapy.
d. She was dehydrated when the first hematocrit was drawn.
b. She received a blood transfusion.
Correct. This is a very rapid and significant increase in the hematocrit, which cannot be explained by nutritional factors.
Mary's elevated uric acid might be treated with:
a. Allopurinol
b. Kaexylate
c. Erythropoetin
d. Alternagel
a. Allopurinol
Correct. Allopurinol blocks an enzyme involved in metabolizing purines to uric acid. It is a drug used in the treatment of gout.
A normal platelet count is:
a. 5-10 thousand/dl
b. 50-70 thousand/dl
c. 150-300 thousand
d. None of the above.
c. 150-300 thousand
The renal failure has caused this patient to have restlessness of the limbs. She has difficulty sleeping because of her shortness of breath. You can give morphine in small doses to help this problem but you must be careful because morphine could easily make which of her other problems worse?
a. Hypotension
b. Respiratory distress
c. Elevated K+
d. All of the above
a. Hypotension
Which strategy is best to limit the muscle wasting seen in cancer cachexia?
a. Give high caloric intravenous nutrition supplemented with intravenous lipids.
b. Give an omega3 fatty acid , progesterone and an anabolic steroid with protein supplements.
c. Use elemental amino acids (rather than long protein chains) along with vitamin supplementation
d. Do weight bearing exercises along with a well-balanced diet.
b. Give an omega3 fatty acid , progesterone and an anabolic steroid with protein supplements.
General feedback: Cancer cachexia is very difficult to treat. There is a metabolic active breaking down of protein which is not responsive to increased intake. Our best options now include using a muscle building anabolic steroid (the kind an athlete might "abuse") such as oxandralone, a fish oil omega3 fatty acid (eicosapentaenoic acid) which blocks a protein destroying enzyme, and/or a progesterone such as megesterol. Of course, it helps when the patient has a good diet and when nausea and vomiting are controlled.
You hear in report that the patient has ascites. Which assessment finding is consistent with this?
a. She states it is easier to breathe supine on her left side.
b. BUN/Creatinine ratio > 20/1
c. Increased abdominal girth.
d. All of the above.
c. Increased abdominal girth.
A patient with lymphoma has the following labs:
Creatinine 2.9
BUN 45
Albumin 3.2
This patient's edema results from:
a. Failure of the kidneys to excrete water
b. Blockage of lymphatic drainage with fluid left behind in the interstitial space.
c. Decreased oncotic pressure.
d. All of the above.
Correct. Creatinine of 2.9 and BUN of 45 indicate renal renal failure. Knowing that she has lymphoma suggests a problem with lymphatic drainage. Her albumin level is low (3.2) which is consistent with low oncotic pressure holding fluid in the vessels.
The patient has a problem with bleeding and anemia. Which is the best expected outcome for this problem?
a. No bleeding.
b. Hct > 25%
c. Guiac negative stool.
d. All of the above.
d. All of the above.
It is not realistic to expect this patient to have no bleeding.
A patient with cancer who has received chemotherapy has the problem "Potential for infection". The best expected outcome for this problem in this patient is:
a. WBC < 15,000
b. No infection
c. Albumin > 3
d. T < 38.0
a. WBC < 15,000

Not b. because it is not written in measurable terms.
The patient has "Respiratory distress related to ascites, small bilat pleural effusions and history 60 pack-year smoker as evidenced by pt complaints of SOB and DOE and O2 saturation 88% on room air". The best expected outcome for this problem would be:
a. No respiratory distress
b. 20 pack-year smoker
c. denies SOB and DOE, O2 saturation >92% on room air
d. respiratory rate < 22
c. denies SOB and DOE, O2 saturation >92% on room air
The absence of the "as evidenced by" signs and symptoms is a good way to write a specific and measurable EO
Elevated phosphate might be treated with:
a. Allopurinol
b. Kaexylate
c. Erythropoetin
d. Alternagel
d. Alternagel
Correct. Alternagel binds to phosphate in the gut so it is not absorbed. When a patient is eating a diet, the med should be given with meals so that it is present when there is phosphate in the gut.
A patient is to receive radiation therapy for colorectal cancer. Which strategy is most likely to prevent poor nutritional intake in the 3 months after treatment?
a. Give protein supplements
b. Do nutritional counseling
c. Allow the patient to eat ad lib
d. Provide a multivitamin
b. Do nutritional counseling
General feedback: Ravasco (2005) found that at the end of raditaion treatment, protein supplements and counseling both had higher intake dietary than did ad lib intake. Counseling positively influenced nutritional intake to a greater extent than protein supplements or ad lib intake at 3 months.
Which strategy is best to limit the oral ulcerations that may result from chemotherapy?
a. Keep the patient NPO for 24 hours after each chemo dose.
b. Let the patient suck on ice chips.
c. Have the patient use a mouthwash of lidocaine.
d. Brush teeth and tongue vigorously.
c. Have the patient use a mouthwash of lidocaine.
General feedback: Chemotherapy destroys rapidly dividing cells such as the oral mucosa as a side effect. Good oral care preceeding the chemo is important, but once the ulcers have developed it is too painful to brush gums vigourously. Lots of things have been tried and interestingly simple ice is one of the most effective. Still, results are not fabulous. If you assume 60% of patietns will get mucositis, you would need to treat 5 patients with ice chips to prevent 1 case of mucositis.
The patient has the problem "Hypotension related to decreased venous return". The best expected outcome for this problem would be:
a. SBP>90
b. SBP>120
c. Venous return improved.
d. Hypotension resolved.
a. SBP>90
A normal serum hematocrit is:
a. 5-10 thousand/dl
b. 25-35%
c. 15 gm/dl
d. 37-47%
e. None of the above.
d. 37-47%
Mary's hematocrit is less than 30. She is bleeding in part because her platelet count is less than 20,000. A reasonable expected outcome for the bleeding problem would be:
a. Guiac negative stool.
b. Hematocrit 45%.
c. No bright red bleeding in large amounts.
d. No IM injections
c. No bright red bleeding in large amounts.

Not a. {Guiac negative stool} because it is unlikely you will achieve this with a platelet count this low.
Long term use of oxycontin is associated with:
a. orthostatic dizziness
b. agitation
c. constipation
d. all of the above
c. constipation
The incidence of constipation in long term opioid use is 100%.
To conserve the patients blood and utilize resources appropriately, few routine labs were being sent. Which of the following alerted the nurse to the fact that a chemistry panel should be sent to assess for hypokalemia?
a. Pre-op K 4.1
b. Pre-op constipation
c. Post-op diuresis
d. None of the above are associated with hypokalemia
c. Post-op diuresis
Post-operatively, a patient is hypotensive. Which of the following is a good way to keep her blood pressure up?
a. Administer dopamine to stimulate the heart and constrict the blood vessels.
b. Administer normal saline intravenous fluids
c. Do not allow her up out of bed.
d. Any of the above.
b and c
Mrs Weet has "Alteration in gas exchange related to RML pneumonitis". Data which supports this diagnosis includes:
a. Vesicular breath sounds in lung periphery
b. Cough productive of yellow sputum.
c. Tetracycline allergy
d. All of the above.
b. Cough productive of yellow sputum.
Which of the following could contribute to renal dysfunction?
a. Receiving cisplatin in the presence of poor kidney function
b. Totalling output separately for the Foley and for the nephrostomy tube
c. Administering IV fluids and dopamine to keep BP >90/50
d. Receiving oxycontin for pain
a. Receiving cisplatin in the presence of poor kidney function
Cisplatin is nephrotoxic. It is contraindicated in pre-existing renal insufficiency. Patients receiving this drug will be well hydrated before and after therapy so they have a large urine output. This helps flush toxic compounds out before they can damage the kidney.
The Agency for Health Care Policy and Research uses the World Health Organization's "Ladder" approach to pain management. Which best describes this ladder?
a. Get pain assessment data first from the patient, then from caregivers, then from health professionals.
b. First try acetaminophen or a NSAID. Keep this and add an opioid if ineffective. Increase the opioid dose or use a more potent one if ineffective.
c. Use several different kinds of opioids whenever possible.
d. Pain medicines should be given only as needed to avoid toxicities.
b. First try acetaminophen or a NSAID. Keep this and add an opioid if ineffective. Increase the opioid dose or use a more potent one if ineffective.
Factors which are likely to contribute to fatigue in a patient include:
a. Hct 29
b. Depression
c. Lack of sleep
d. All of the above
d. All of the above
12 hours after surgery, your patient's blood pressure fell to 70/40. You suspect fluid volume deficit. What other data would support your tenative diagnosis?
a. Bradycardia, zero cc's of urine from the nephrostomy tube.
b. Tachycardia, <30cc/hr total urine output
c. Na+ 130, urine concentrated
d. Postoperative hematocrit 30
b. Tachycardia, <30cc/hr total urine output
Mrs Weet is allergic to plastic, rubber and latex. You may be able to order a cloth BP cuff from Central Supply but delivery will take a while. You are concerned about her BP and want to check it right away. The best way to do this is:
a. Use a plastic cuff and just live with the rash.
b. Give diphenhydramine (BENADRYL) before you check her BP.
c. Palpate the blood pressure instead of auscultating it
d. Place a thin layer of cloth or gauze between the BP cuff and her skin.
d. Place a thin layer of cloth or gauze between the BP cuff and her skin.
The Agency for Health Care Policy and Research makes which recommendations about treatment of cancer pain?
a. Pain can often be lessened with bedrest and having others do basic care (ADLs) for the patient.
b. Psychosocial interventions can generally substitute for pharmacological therapy if started early.
c. For severe pain, meperidine (DEMEROL) intramuscularly is the drug of choice.
d. Cutaneous stimulation (massage, heat or cold) sometimes increases pain briefly before relief occurs.
d. Cutaneous stimulation (massage, heat or cold) sometimes increases pain briefly before relief occurs.
On the day before discharge a patient has her Foley catheter removed. She has pain when attempting to void and it is difficult to get the flow started. Which would represent a good first choice in how to manage this pain?
a. Give her a container of warm water to pour over her perineum as she tries to urinate.
b. Administer ativan prior to each void.
c. Ask the MD for an antibiotic order
d. Reinsert the Foley.
a. Give her a container of warm water to pour over her perineum as she tries to urinate.
Warm water can relax perineal muscles allowing urine to flow.
Which of the following pre-op labs is consistent with risk of bleeding during surgery?
a. INR 1.03
b. PTT 24.6
c. Platelets 258,000
d. None of the above
d. None of the above
A patient has "Alteration in gas exchange". Treatment orders would most likely include:
a. O2 12 liters nasal prongs
b. Increase O2 to keep satuation less than 94%
c. Erythromycin 500mg IV q 6 hours
d. None of the above
d. None of the above
A patient has renal dysfunction on admission. This is evidenced by:

a. K 4.1
b. BUN 15
c. creatinine 1.4
d. Na 139
c. creatinine 1.4
Managing fatigue in Mrs Weet could involve which interventions?
a. Keep awake during the day by withholding pain medicine so she can sleep better at night.
b. Serzone
Depression is often associated with fatigue. Serzone is used to treat depression.
c. Maintain hematocrit by returning "discard" blood when drawing labs from IV catheter.
d. All of the above
b. Serzone
Depression is often associated with fatigue. Serzone is used to treat depression.
When Mr T arrives in the ER, you are alerted to the possibility of digitalis toxicity by which finding?
a. History of vomiting
b. EKG show atrial fibrillation. (No "p" waves, just a "quivering" baseline with irregular transmission down to the ventricles to give you a "qrs".)
c. Bright yellow visual disturbances.
d. BP 147/63
c. Bright yellow visual disturbances.
Correct, yellow or blurred vision is classic for dig toxicity. The vomiting and disorientation are adverse reactions to dig which are dose dependant, meaning they are more likely with higher doses. They help put the whole picture together but there are lots of other causes of vomiting and disorientation.
It surprises you that a patient's heart failure is not being managed at home with:
a. a thiazide diuretic
b. a beta blocker and/or ace inhibitor
c. a nitrate
d. a cardioglycoside
b. a beta blocker and/or ace inhibitor
General feedback: Beta blockers and angiotensin converting enzyme inhibitors have recently been found to extend lifespan in CHF and are the first line of therapy. A pt should probably be placed on a drug such as benazepril or captopril but the dose would have to be reduced because his kidneys are not functioning too well. Zaroxylyn is a thiazide diuretic. Isosorbide is a nitrate. Digoxin is a cardioglycoside.
Obstructive
Uropathy
Anatomic changes in the urinary system caused by obstruction. May be relieved or partially alleviated by correction of the obstruction, although permanent impairments occur if a complete or partial obstruction persists over a period of weeks to months, or longer.
Causes of UPPER urinary tract obstruction
Stricture, congenital compression of the calyx, stones (calculi). Compression from an aberrant vessel, tumor or abdominal inflammation and scarring (retroperitoneal fibrosis). Ureteral blockage from a malignancy of the renal pelvis ureter, bladder, or prostate.
Calculi
Urinary Stones- masses of crystals, protein, or other substances that are a common cause of urinary tract obstruction in adults.

Risk factors: Male, first one <50 yrs, inadequate consumption of water, inactivity.
Causes of LOWER urinary tract obstruction
Benign or malignant prostate enlargement in men. Urethral stricture. Incoordination between the detrusor muscle and urethral sphincter (vesicosphincter dyssynergia), or severe pelvic organ prolapse in a woman.
Renal colic
Moderate to severe pain often originating in the flank and radiating to the groin. Usually indicates obstruction of the renal pelvis or proximal ureter.
Cystinuria
Genetic disorder of amino acid metabolism. Leads to excretion of large volumes of cystine in the urine and when pH falls below 5.5, increased risk of cystine stone formation.
Bladder neck dyssynergia
Occurs when the smooth muscle of the urethrovesical junction fails to funnel during micturition, thereby obstructing the bladder outlet. Typically occurs in men.
Prostate enlargement
CAUSES
Acute inflammation- caused by acute bacterial prostatitis (leads to inflammation and enlargement, which restrict the urethral outflow tract).

BPH- nodular enlargement of the glandular elements fo the prostate; produces obstruction when it reduces the lumen of the proximal prostatic urethra.

Prostate CA- encroaches the proximal urethra in men c advanced stage malignancies.
Urethral
Stricture
Narrowing of the lumen of the urethra. Occurs when infection, injury, or surgical manipulation produces a scar that reduces the caliber of the urethra. Occurs mostly in men; rare in women.
Pelvic organ prolapse
Occurs in women. Causes bladder outlet obstruction when the cystocele ( ) descends below the level of the urethral outlet.
Neurogenic
bladder
dysfunction
Causes urinary incontinence (UI). Associated with bladder outlet obstruction. Neurologic lesions of the brain, spinal cord, or peripheral nervous system cause neurogenic bladder dysfunction. Lesions in the brain produce neurogenic detrusor overactivity and cause urge UI. But still the brain stem micturition center remains intact and detrusor and sphinctor function remain coordinated.
Pessary
Rubber or silicone device designed to compensate for vaginal wall prolapse; may be inserted to mechanicallly reverse severe pelvic organ (bladder, uterus, or rectum) prolapse. Intravaginal hormone replacement therapy is critical to the long-term success of a pessary.
Oblique - a fracture which goes at an angle to the axis

Comminuted - one in which the bone is splintered into several pieces

Spiral - a fracture which runs around the axis of the bone

Compound - a fracture (also called open) which breaks the skin
What types of fractures are these?
Greenstick - an incomplete fracture in which the bone bends

Transverse - a fracture that goes across the bone's axis

Simple - a fracture which does not break the skin
What types of fractures are these?
A SIMPLE fracture involves a single fracture line through a bone.

A COMMINUTED fracture is one in which the bone has been fractured into two or more fragments.

An OPEN fracture is one in which the fractured bone penetrates the skin.
What types of fractures are these?
Closed or simple fracture. The bone is broken, but the skin is not lacerated.

Open or compound fracture. The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound.

Transverse fracture. The fracture is at right angles to the long axis of the bone.

Greenstick fracture. Fracture on one side of the bone, causing a bend on the other side of the bone.

Comminuted fracture. A fracture that results in three or more bone fragments.
What types of fractures are these?
Depressed Fracture
Depressed Fracture: usually occurs in flat bones during falls. Ex: skull.
Greenstick Fracture
Greenstick Fracture: incomplete breaks in bones that have not completely ossified. Most common in children when their bones are still soft. One side remains intact, while the other side has cracked from the bend. The term comes from the way a green twig bends but does not completely break.
Impact Fracture
Impact Fracture: this is when a long bone, e.g. the femur, received an impact on its long axis. The bone tissue becomes compressed into its self. This injury requires traction by trained personnel.
Longitudinal Fracture
Longitudinal Fracture: when a long bone breaks along its length. Ex: snapping a pencil in half.
Oblique Fracture
Oblique Fracture: occurs during violent twisting, usually when one end is planted on the ground and the other end twists, also called a spiral fracture.
Serrated Bone
Serrated Bone: when the two ends of a broken bone are rubbing against each other. This usually causes severe damage to blood vessels and nerves caught between the two broken ends.
Transverse Fracture
Transverse Fracture: this occurs in a straight line along a long bone.
Comminuted Fracture
Comminuted Fracture: this is when there are 3 or more fragments at the fracture site. Usually surgical intervention is required.
Contrecoup
Contrecoup: an injury on the side opposite to the impacted area. Very common with head injuries.
Avulsion Fracture
Avulsion Fracture: when a ligament pulls so hard on the part of the bone it is attached to that a small bone fragment breaks off.
Stress Fracture
Stress Fracture: usually happens with repeated stress, overuse, improper use, or returning to play before an injury has heeled properly.
Dislocation
A dislocation is when a joint, such as a knee, ankle, or shoulder, is not in the proper position.
Sprain
A sprain is when the connecting tissues of a joint have been torn.
Spiral Fracture
Spiral Fracture: occurs during violent twisting, usually when one end is planted on the ground and the other end twists, also called an oblique fracture.
Closed/Simple Fracture
Closed/Simple Fracture: A closed fracture is a broken bone that does not break the overlying skin. The tissue beneath the skin may be damaged.
Open/Compound Fracture
Open/Compound Fracture: a broken bone that breaks (pierces) the overlying skin.