A 37-year-old executive returns to your clinic for follow-up of recurrent upper abdominal pain. He initially presented 3 weeks ago, complaining of an increase in frequency and severity of burning epigastric pain, which he has experienced occasionally for more than 2 years. Now the pain occurs three or four times per
week, usually when he has an empty stomach, and it often awakens him at night. The pain usually is relieved within minutes by food or over-the-counter antacids, but then recurs within 2 to 3 hours. He admitted that stress at work had recently increased and that because of long working hours, he was drinking more caffeine
and eating a lot of take-out foods. His medical history and review of systems were otherwise unremarkable, and, other than the antacids, he takes no medications. His physical examination was normal, including stool guaiac that was negative for occult blood. You advised a change in diet and started him on a proton-pump
inhibitor. His symptoms resolved completely with the diet changes and daily use of the medication. Results of laboratory tests performed at his first visit show no anemia, but his serum Helicobacter pylori antibody test was positive.
What is your diagnosis?
What is your next step
Showing posts with label FREE. Show all posts
Showing posts with label FREE. Show all posts
Friday, May 23, 2014
Tuesday, May 20, 2014
Medical Surgical Nursing Case Study: Cardiovascular System 1
A 72-year-old man presents to the clinic complaining of several weeks of worsening exertional dyspnea. Previously, he had been able to work in his garden and mow the lawn, but now he feels short of breath after walking 100 feet. He does not have chest pain when he walks, although in the past he has experienced episodes of retrosternal chest pressure with strenuous exertion. Once recently he had felt lightheaded, as if he were about to faint while climbing a flight of stairs, but the symptom passed after he sat down. He has been having some difficulty sleeping at night and has to prop himself up with two pillows. Occasionally, he wakes up at night feeling quite short of breath, which is relieved within minutes by sitting upright and dangling his legs over the bed. His feet have become swollen, especially by the end of the day. He denies any significant medical history, takes no medications, and prides himself on the fact that he has not seen a doctor in years. He does not smoke or drink alcohol.
On physical examination, he is afebrile, with a heart rate of 86 bpm, blood pressure of 115/92 mm Hg, and respiratory rate of 16 breaths per minute. Examination of the head and neck reveals pink mucosa without pallor, a normal thyroid gland, and distended neck veins. Bibasilar inspiratory crackles are heard on examination. On cardiac examination, his heart rhythm is regular with a normal S1 and a second heart sound that splits during expiration, an S4 at the apex, a nondisplaced apical impulse, and a late-peaking systolic murmur at the right-upper sternal border that radiates to his carotids. The carotid upstrokes have diminished amplitude.
What is the most likely diagnosis?
What test would confirm the diagnosis?
Wednesday, April 23, 2014
Carbohydrates
Carbohydrates 1
Carbohydrates are made of carbon, hydrogen, and oxygen atoms. Many different monosaccharides, or simple sugars, can combine into polysaccharides, or complex carbohydrates. Even though they have a bad reputation among some diet plans, carbohydrates perform many essential functions for cells. In this chapter, I present the basic structure of carbohydrates and explain their importance to cells.
CH2O: Structure of Carbohydrates
In recent years, due to the comeback of the low- carb diet, carbohydrates have gotten a bad rap. Some people have started thinking that proteins are good, and carbohydrates are bad. However, the idea that carbohydrates aren’t good for you is overly simplified. After all, carbohydrates are an essential component of your cells. What can make a difference is the type of carbohydrates you eat. Carbohydrates are organic molecules composed of carbon, hydrogen, and oxygen. The two main types of carbohydrates are as follows:
Monosaccharides are also called simple sugars. (Most diets recommend that you avoid eating too much of this type of carbohydrate.) Glucose is a monosaccharide that is usually available to your cells.
Polysaccharides are also called complex carbohydrates. (Fiber is an example of a complex carbohydrate that is a recommended part of your daily nutrition.)
Keeping it simple: Monosaccharides
Monosaccharides, or simple sugars, are single sugars. (“Mono” means “one” and “sacchar” means sugar.) Many monosaccharides have the generic formula CH2O: For every one carbon atom they have, they have two hydrogen atoms and one oxygen atom. Two monosaccharides that may be familiar to you are glucose (see Figure 5-1A) and fructose (a sugar found in fruit and also in high-fructose corn syrup).
All monosaccharides have certain features in common:
A backbone of 3, 4, 5, 6, or 7 carbons. Sugars are categorized based on the number of carbons: In order of the numbers, they are called trioses, tetroses, pentoses, hexoses, and heptoses. For example, glucose is a hexose, or 6-carbon sugar.
Hydroxyl groups (–OH) attached to every carbon but one. The hydroxyl groups make sugars polar, which is why they dissolve easily in water.
One double-bonded oxygen attached to the carbon backbone. An oxygen double-bonded to a carbon is called a carbonyl group. If the carbonyl group is located at the end of a monosaccharide, the sugar is an aldose. If the carbonyl group is located within the carbon backbone, the sugar is a ketose. Glucose is an aldose because its carbonyl group is at the end of the carbon backbone.
Of the four groups of macromolecules (carbohydrates, proteins, nucleic acids, and lipids), carbohydrates have the greatest number of hydroxyl groups (–OH) attached to their carbon atoms. When you’re trying to distinguish between the four types of macromolecules, a structure with hydroxyl groups attached to almost every carbon is probably a carbohydrate.
Two monosaccharides can have the same numbers of carbon, hydrogen, and oxygen atoms and yet have very different properties. When two monosaccharides have the same atoms, but those atoms are arranged differently, the sugars are isomers of each other (“iso” means same). For example, if the hydroxyl group (–OH) and hydrogen atom (–H) attached to the fourth carbon from the top in glucose (see Figure 5-1A) were swapped with each other, the sugar would be converted to galactose. Glucose and galactose are almost identical, except for that one change in the arrangement of the atoms, and yet they behave very differently in cells.
The way the atoms are bonded together is very important in the structure and function of sugars. Isomers are made from exactly the same atoms, but their atoms are arranged differently.
In the watery environment of the cell, monosaccharides convert into ringshaped structures. A bond forms between two atoms in the backbone of the sugar, causing the sugar to bend around to form the ring. As an example, compare the linear structure of glucose shown in Figure 5-1A with the ring structure shown in Figure 5-1B.
Making it complex: Polysaccharides
Polysaccharides, or complex carbohydrates, are polymers (see Chapter 4) of monosaccharides. (“Poly” means many, and “sacchar” means sugar, so a polysaccharide is “many sugars” strung together.) To make polysaccharides, monosaccharides are joined together by condensation reactions (see Chapter 4). During condensation, a water molecule is removed as a bond is formed between an atom in the growing polysaccharide chain and an atom in
the monosaccharide that is being added to the chain (see Figure 5-1B). The bonds between monosaccharides are called glycosidic linkages.
Polysaccharides are classified based on the number of monosaccharides in the chain:
Disaccharides are chains of two monosaccharides. Sucrose (see Figure
5-1B), or table sugar, is a disaccharide that is probably very familiar to you. Another disaccharide you probably know about is lactose, the sugar
found in milk.
Oligosaccharides are short chains of monosaccharides (see Figure 5-1C). Oligosaccharides are part of receptors in the plasma membranes of your cells.
Polysaccharides are long chains of monosaccharides (see Figure 5-1D). Starch and cellulose, both shown in Figure 5-2, are two polysaccharides that you probably eat every day. Starch is found in bread, potatoes, rice, and pasta; cellulose is referred to as fiber in your diet.
Many cell types produce polysaccharides. Starch and cellulose, which are made by plants, are both polymers of glucose. Glycogen, made by animal cells, is also a polymer of glucose. Chitin, found in the shells of crustaceans and insects, is a polymer of a nitrogen-containing monosaccharide called N-acetylglucosamine. Peptidoglycan, the polysaccharide found in bacterial cell walls (see Chapter 2), is a polymer of two alternating monosaccharides, N-acetylglucosamine and N-acetylmuramic acid.
Polysaccharides can also be different based on how their monosaccharides are strung together. Starch, cellulose, and glycogen are all made entirely of glucose, yet they behave very differently in the body. Starch and glycogen are easily broken down in the human digestive system. Cellulose, or fiber, can’t be broken down at all by humans. Instead, it passes right through your digestive system and exits as part of your wastes.
The difference between starch, cellulose, and glycogen isn’t what they’re made of, but rather in the bonds between the glucose molecules:
The glucose molecules in starch are joined with a bond called a α–1,4–glycosidic linkage.
The glucose molecules in cellulose are joined with a β–1,4–glycosidic linkage.
At approximately every tenth glucose molecule, a branch is joined to the main backbone of glycogen by an α–1,6–glycosidic linkage. Thus, glycogen molecules are highly branched.
The reason humans can digest starch and glycogen, but not cellulose, is that human enzymes can break down some glycosidic linkages, but not others. Human enzymes break down α –1,4–glycosidic linkages and α –1,6–glycosidic linkages, but not β –1,4–glycosidic linkages. Together, starch, cellulose, and glycogen demonstrate how important different types of glycosidic linkages can be to polysaccharide structure and function.
The type of glycosidic linkage between monosaccharides is very important in determining structure and function of polysaccharides.
Functions of Carbohydrates
Carbohydrates are probably most famous for their role in providing energy to bodies (and, of course, cells), but they perform many other important functions for cells as well:
Carbohydrates are an important energy source for cells. The monosaccharide glucose is a rapidly used energy source for almost all cells on planet Earth. In addition, many cell types store matter and energy for later use in the form of polysaccharides. Plants, algae, and bacteria store energy in starch, and animals and bacteria store energy in glycogen.
Carbohydrates are important structural molecules for cells. Polysaccharides are the major components of the cell walls of plants, algae, fungi, and bacteria. The cell walls of plants and algae contain cellulose, the cell walls of fungi contain chitin, and the cell walls of bacteria contain peptidoglycan.
Carbohydrates are important markers of cellular identity. The surfaces of cells are marked with glycoproteins, molecules of protein that have an attached sugar. Different cells have different glycoproteins on their surface, marking the cells with their identity. In your body, liver cells are marked as liver cells, heart cells are marked as heart cells, nerve cells are marked as nerve cells, and so on.
Carbohydrates are important extracellular molecules. Polysaccharides are a major component of the sticky matrix that surrounds cells. They help bacteria stick to surfaces
Carbohydrates are made of carbon, hydrogen, and oxygen atoms. Many different monosaccharides, or simple sugars, can combine into polysaccharides, or complex carbohydrates. Even though they have a bad reputation among some diet plans, carbohydrates perform many essential functions for cells. In this chapter, I present the basic structure of carbohydrates and explain their importance to cells.
CH2O: Structure of Carbohydrates
In recent years, due to the comeback of the low- carb diet, carbohydrates have gotten a bad rap. Some people have started thinking that proteins are good, and carbohydrates are bad. However, the idea that carbohydrates aren’t good for you is overly simplified. After all, carbohydrates are an essential component of your cells. What can make a difference is the type of carbohydrates you eat. Carbohydrates are organic molecules composed of carbon, hydrogen, and oxygen. The two main types of carbohydrates are as follows:
Monosaccharides are also called simple sugars. (Most diets recommend that you avoid eating too much of this type of carbohydrate.) Glucose is a monosaccharide that is usually available to your cells.
Polysaccharides are also called complex carbohydrates. (Fiber is an example of a complex carbohydrate that is a recommended part of your daily nutrition.)
Keeping it simple: Monosaccharides
Monosaccharides, or simple sugars, are single sugars. (“Mono” means “one” and “sacchar” means sugar.) Many monosaccharides have the generic formula CH2O: For every one carbon atom they have, they have two hydrogen atoms and one oxygen atom. Two monosaccharides that may be familiar to you are glucose (see Figure 5-1A) and fructose (a sugar found in fruit and also in high-fructose corn syrup).
All monosaccharides have certain features in common:
A backbone of 3, 4, 5, 6, or 7 carbons. Sugars are categorized based on the number of carbons: In order of the numbers, they are called trioses, tetroses, pentoses, hexoses, and heptoses. For example, glucose is a hexose, or 6-carbon sugar.
Hydroxyl groups (–OH) attached to every carbon but one. The hydroxyl groups make sugars polar, which is why they dissolve easily in water.
One double-bonded oxygen attached to the carbon backbone. An oxygen double-bonded to a carbon is called a carbonyl group. If the carbonyl group is located at the end of a monosaccharide, the sugar is an aldose. If the carbonyl group is located within the carbon backbone, the sugar is a ketose. Glucose is an aldose because its carbonyl group is at the end of the carbon backbone.
Of the four groups of macromolecules (carbohydrates, proteins, nucleic acids, and lipids), carbohydrates have the greatest number of hydroxyl groups (–OH) attached to their carbon atoms. When you’re trying to distinguish between the four types of macromolecules, a structure with hydroxyl groups attached to almost every carbon is probably a carbohydrate.
Two monosaccharides can have the same numbers of carbon, hydrogen, and oxygen atoms and yet have very different properties. When two monosaccharides have the same atoms, but those atoms are arranged differently, the sugars are isomers of each other (“iso” means same). For example, if the hydroxyl group (–OH) and hydrogen atom (–H) attached to the fourth carbon from the top in glucose (see Figure 5-1A) were swapped with each other, the sugar would be converted to galactose. Glucose and galactose are almost identical, except for that one change in the arrangement of the atoms, and yet they behave very differently in cells.
The way the atoms are bonded together is very important in the structure and function of sugars. Isomers are made from exactly the same atoms, but their atoms are arranged differently.
In the watery environment of the cell, monosaccharides convert into ringshaped structures. A bond forms between two atoms in the backbone of the sugar, causing the sugar to bend around to form the ring. As an example, compare the linear structure of glucose shown in Figure 5-1A with the ring structure shown in Figure 5-1B.
Making it complex: Polysaccharides
Polysaccharides, or complex carbohydrates, are polymers (see Chapter 4) of monosaccharides. (“Poly” means many, and “sacchar” means sugar, so a polysaccharide is “many sugars” strung together.) To make polysaccharides, monosaccharides are joined together by condensation reactions (see Chapter 4). During condensation, a water molecule is removed as a bond is formed between an atom in the growing polysaccharide chain and an atom in
the monosaccharide that is being added to the chain (see Figure 5-1B). The bonds between monosaccharides are called glycosidic linkages.
Polysaccharides are classified based on the number of monosaccharides in the chain:
Disaccharides are chains of two monosaccharides. Sucrose (see Figure
5-1B), or table sugar, is a disaccharide that is probably very familiar to you. Another disaccharide you probably know about is lactose, the sugar
found in milk.
Oligosaccharides are short chains of monosaccharides (see Figure 5-1C). Oligosaccharides are part of receptors in the plasma membranes of your cells.
Polysaccharides are long chains of monosaccharides (see Figure 5-1D). Starch and cellulose, both shown in Figure 5-2, are two polysaccharides that you probably eat every day. Starch is found in bread, potatoes, rice, and pasta; cellulose is referred to as fiber in your diet.
Many cell types produce polysaccharides. Starch and cellulose, which are made by plants, are both polymers of glucose. Glycogen, made by animal cells, is also a polymer of glucose. Chitin, found in the shells of crustaceans and insects, is a polymer of a nitrogen-containing monosaccharide called N-acetylglucosamine. Peptidoglycan, the polysaccharide found in bacterial cell walls (see Chapter 2), is a polymer of two alternating monosaccharides, N-acetylglucosamine and N-acetylmuramic acid.
Polysaccharides can also be different based on how their monosaccharides are strung together. Starch, cellulose, and glycogen are all made entirely of glucose, yet they behave very differently in the body. Starch and glycogen are easily broken down in the human digestive system. Cellulose, or fiber, can’t be broken down at all by humans. Instead, it passes right through your digestive system and exits as part of your wastes.
The difference between starch, cellulose, and glycogen isn’t what they’re made of, but rather in the bonds between the glucose molecules:
The glucose molecules in starch are joined with a bond called a α–1,4–glycosidic linkage.
The glucose molecules in cellulose are joined with a β–1,4–glycosidic linkage.
At approximately every tenth glucose molecule, a branch is joined to the main backbone of glycogen by an α–1,6–glycosidic linkage. Thus, glycogen molecules are highly branched.
The reason humans can digest starch and glycogen, but not cellulose, is that human enzymes can break down some glycosidic linkages, but not others. Human enzymes break down α –1,4–glycosidic linkages and α –1,6–glycosidic linkages, but not β –1,4–glycosidic linkages. Together, starch, cellulose, and glycogen demonstrate how important different types of glycosidic linkages can be to polysaccharide structure and function.
The type of glycosidic linkage between monosaccharides is very important in determining structure and function of polysaccharides.
Functions of Carbohydrates
Carbohydrates are probably most famous for their role in providing energy to bodies (and, of course, cells), but they perform many other important functions for cells as well:
Carbohydrates are an important energy source for cells. The monosaccharide glucose is a rapidly used energy source for almost all cells on planet Earth. In addition, many cell types store matter and energy for later use in the form of polysaccharides. Plants, algae, and bacteria store energy in starch, and animals and bacteria store energy in glycogen.
Carbohydrates are important structural molecules for cells. Polysaccharides are the major components of the cell walls of plants, algae, fungi, and bacteria. The cell walls of plants and algae contain cellulose, the cell walls of fungi contain chitin, and the cell walls of bacteria contain peptidoglycan.
Carbohydrates are important markers of cellular identity. The surfaces of cells are marked with glycoproteins, molecules of protein that have an attached sugar. Different cells have different glycoproteins on their surface, marking the cells with their identity. In your body, liver cells are marked as liver cells, heart cells are marked as heart cells, nerve cells are marked as nerve cells, and so on.
Carbohydrates are important extracellular molecules. Polysaccharides are a major component of the sticky matrix that surrounds cells. They help bacteria stick to surfaces
Friday, March 14, 2014
Notes on Fluid and Electrolytes 3: FLUID VOLUME EXCESS
FLUID VOLUME EXCESS
A. Description
1. Fluid intake or fluid retention exceeds the fluid needs of the body.
2. Fluid volume excess also is called overhydration or fluid overload.
3. The goal of treatment is to restore fluid balance, correct electrolyte imbalances if present, and eliminate or control the underlying cause of the overload.
B. Types
1. Isotonic overhydration
a. Known as hypervolemia, isotonic overhydration results from excessive fluid in the extracellular fluid compartment.
b. Only the extracellular fluid compartment is expanded, and fluid does not shift between the extracellular and
intracellular compartments.
c. Isotonic overhydration causes circulatory overload and interstitial edema; when severe or when it occurs in a client with poor cardiac function, congestive heart
failure and pulmonary edema can result.
2. Hypertonic overhydration
a. Occurrence of hypertonic overhydration is rare and is caused by an excessive sodium intake.
b. Fluid is drawn from the intracellular fluid compartment; the extracellular fluid volume expands, and the intracellular fluid volume contracts.
3. Hypotonic overhydration
a. Hypotonic overhydration is known as water intoxication.
b. The excessive fluid moves into the intracellular space, and all body fluid compartments expand.
c. Electrolyte imbalances occur as a result of dilution.
C. Causes
1. Isotonic overhydration
a. Inadequately controlled IV therapy
b. Renal failure
c. Long-term corticosteroid therapy
2. Hypertonic overhydration
a. Excessive sodium ingestion
b. Rapid infusion of hypertonic saline
c. Excessive sodium bicarbonate therapy
3. Hypotonic overhydration
a. Early renal failure
b. Congestive heart failure
c. Syndrome of inappropriate antidiuretic hormone secretion
d. Inadequately controlled IV therapy
e. Replacement of isotonic fluid loss with hypotonic fluids
f. Irrigation of wounds and body cavities with hypotonic fluids
D. Assessment
1. Cardiovascular
a. Bounding, increased pulse rate
b. Elevated blood pressure
c. Distended neck and hand veins
d. Elevated central venous pressure
2. Respiratory
a. Increased respiratory rate (shallow respirations)
b. Dyspnea
c. Moist crackles on auscultation
3. Neuromuscular
a. Altered level of consciousness
b. Headache
c. Visual disturbances
d. Skeletal muscle weakness
e. Paresthesias
4. Integumentary
a. Pitting edema in dependent areas
b. Skin pale and cool to touch
5. Increased motility in the gastrointestinal tract
6. Isotonic overhydration results in liver enlargement and ascites.
7. Hypotonic overhydration results in the following:
a. Polyuria
b. Diarrhea
c. Nonpitting edema
d. Dysrhythmias
e. Projectile vomiting
8. Laboratory findings
a. Decreased serum osmolality
b. Decreased hematocrit
c. Decreased BUN level
d. Decreased serum sodium level
e. Decreased urine specific gravity
E. Interventions
1. Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and gastrointestinal status.
2. Prevent further fluid overload, and restore normal fluid balance.
3. Administer diuretics; osmotic diuretics typically are prescribed first to prevent severe electrolyte imbalances.
4. Restrict fluid and sodium intake.
5. Monitor intake and output and weight.
6. Monitor electrolyte values, and prepare to administer medication to treat an imbalance if present.
A. Description
1. Fluid intake or fluid retention exceeds the fluid needs of the body.
2. Fluid volume excess also is called overhydration or fluid overload.
3. The goal of treatment is to restore fluid balance, correct electrolyte imbalances if present, and eliminate or control the underlying cause of the overload.
B. Types
1. Isotonic overhydration
a. Known as hypervolemia, isotonic overhydration results from excessive fluid in the extracellular fluid compartment.
b. Only the extracellular fluid compartment is expanded, and fluid does not shift between the extracellular and
intracellular compartments.
c. Isotonic overhydration causes circulatory overload and interstitial edema; when severe or when it occurs in a client with poor cardiac function, congestive heart
failure and pulmonary edema can result.
2. Hypertonic overhydration
a. Occurrence of hypertonic overhydration is rare and is caused by an excessive sodium intake.
b. Fluid is drawn from the intracellular fluid compartment; the extracellular fluid volume expands, and the intracellular fluid volume contracts.
3. Hypotonic overhydration
a. Hypotonic overhydration is known as water intoxication.
b. The excessive fluid moves into the intracellular space, and all body fluid compartments expand.
c. Electrolyte imbalances occur as a result of dilution.
C. Causes
1. Isotonic overhydration
a. Inadequately controlled IV therapy
b. Renal failure
c. Long-term corticosteroid therapy
2. Hypertonic overhydration
a. Excessive sodium ingestion
b. Rapid infusion of hypertonic saline
c. Excessive sodium bicarbonate therapy
3. Hypotonic overhydration
a. Early renal failure
b. Congestive heart failure
c. Syndrome of inappropriate antidiuretic hormone secretion
d. Inadequately controlled IV therapy
e. Replacement of isotonic fluid loss with hypotonic fluids
f. Irrigation of wounds and body cavities with hypotonic fluids
D. Assessment
1. Cardiovascular
a. Bounding, increased pulse rate
b. Elevated blood pressure
c. Distended neck and hand veins
d. Elevated central venous pressure
2. Respiratory
a. Increased respiratory rate (shallow respirations)
b. Dyspnea
c. Moist crackles on auscultation
3. Neuromuscular
a. Altered level of consciousness
b. Headache
c. Visual disturbances
d. Skeletal muscle weakness
e. Paresthesias
4. Integumentary
a. Pitting edema in dependent areas
b. Skin pale and cool to touch
5. Increased motility in the gastrointestinal tract
6. Isotonic overhydration results in liver enlargement and ascites.
7. Hypotonic overhydration results in the following:
a. Polyuria
b. Diarrhea
c. Nonpitting edema
d. Dysrhythmias
e. Projectile vomiting
8. Laboratory findings
a. Decreased serum osmolality
b. Decreased hematocrit
c. Decreased BUN level
d. Decreased serum sodium level
e. Decreased urine specific gravity
E. Interventions
1. Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and gastrointestinal status.
2. Prevent further fluid overload, and restore normal fluid balance.
3. Administer diuretics; osmotic diuretics typically are prescribed first to prevent severe electrolyte imbalances.
4. Restrict fluid and sodium intake.
5. Monitor intake and output and weight.
6. Monitor electrolyte values, and prepare to administer medication to treat an imbalance if present.
Monday, March 3, 2014
Anatomy and Physiology Notes: Respiratory System
Primary functions of the respiratory system
1. Provides oxygen for metabolism in the tissues
2. Removes carbon dioxide, the waste product of metabolism
Secondary functions of the respiratory system
1. Facilitates sense of smell
2. Produces speech
3. Maintains acid-base balance
4. Maintains body water levels
5. Maintains heat balance
Upper respiratory tract
1. Nose: Humidifies, warms, and filters inspired air
2. Sinuses: Air-filled cavities within the hollow bones that surround the nasal passages and provide resonance during speech
3. Pharynx
a. Passageway for the respiratory and digestive tracts located behind
the oral and nasal cavities
b. Divided into the nasopharynx, oropharynx, and laryngopharynx
4. Larynx
a. Located above the trachea, just below the pharynx at the root of
the tongue; commonly called the voice box
b. Contains two pairs of vocal cords, the false and true cords
c. The opening between the true vocal cords is the glottis.
d. The glottis plays an important role in coughing, which is the most
fundamental defense mechanism of the lungs.
5. Epiglottis
a. Leaf-shaped elastic structure attached along one end to the top of
the larynx
b. Prevents food from entering the tracheobronchial tree by closing
over the glottis during swallowing
Lower respiratory tract
1. Trachea: Located in front of the esophagus; branches into the right
and left main stem bronchi at the carina
2. Main stem bronchi
a. Begin at the carina
b. The right bronchus is slightly wider, shorter, and more vertical than the left bronchus.
c. The mainstem bronchi divide into secondary or lobar bronchi that enter each of the five lobes of the lung.
d. The bronchi are lined with cilia, which propel mucus up and away from the lower airway to the trachea, where it can be expectorated or swallowed.
3. Bronchioles
a. Branch from the secondary bronchi and subdivide into the small terminal and respiratory bronchioles
b. The bronchioles contain no cartilage and depend on the elastic recoil of the lung for patency.
c. The terminal bronchioles contain no cilia and do not participate in gas exchange.
4. Alveolar ducts and alveoli
a. Acinus (plural acini) is a term used to indicate all structures distal to the terminal bronchiole.
b. Alveolar ducts branch from the respiratory bronchioles.
c. Alveolar sacs, which arise from the ducts, contain clusters of alveoli, which are the basic units of gas exchange.
d. Type II alveolar cells in the walls of the alveoli secrete surfactant, a phospholipid protein that reduces the surface tension in the alveoli; without surfactant, the alveoli would collapse.
5. Lungs
a. Located in the pleural cavity in the thorax
b. Extend from just above the clavicles to the diaphragm, the major muscle of inspiration
c. The right lung, which is larger than the left, is divided into three lobes, the upper, middle, and lower lobes.
d. The left lung, which is narrower than the right lung to accommodate the heart, is divided into two lobes.
e. The respiratory structures are innervated by the phrenic nerve, the vagus nerve, and the thoracic nerves.
f. The parietal pleura lines the inside of the thoracic cavity, including the upper surface of the diaphragm.
g. The visceral pleura covers the pulmonary surfaces.
h. A thin fluid layer, which is produced by the cells lining the pleura, lubricates the visceral pleura and the parietal pleura, allowing them to glide smoothly and painlessly during respiration.
i. Blood flows through the lungs via the pulmonary system and
the bronchial system.
6. Accessory muscles of respiration include the scalene muscles, which elevate the first two ribs, the sternocleidomastoid muscles, which raise the sternum, and the trapezius and pectoralis muscles, which fix
the shoulders.
Respiratpry Process
a. The diaphragm descends into the abdominal cavity during inspiration, causing negative pressure in the lungs.
b. The negative pressure draws air from the area of greater pressure, the atmosphere, into the area of lesser pressure, the lungs.
c. In the lungs, air passes through the terminal bronchioles into the alveoli to oxygenate the body tissues.
d. At the end of inspiration, the diaphragm and intercostal muscles relax and the lungs recoil.
e. As the lungs recoil, pressure within the lungs becomes higher than atmospheric pressure, causing the air, which now contains the cellular waste products carbon dioxide and water, to move from the alveoli in the lungs to the atmosphere.
f. Effective gas exchange depends on distribution of gas (ventilation) and blood (perfusion) in all portions of the lungs
Friday, February 28, 2014
Human Immunodeficiency Virus / Acquired immunodeficiency syndrome Lecture Notes
This is a Medical Surgical Nursing lecture note on AIDS/HIV in outlined format. Information and concepts are compressed to provide a quick review of the topic. Some information are so compressed that some concepts are not expounded in detail. If it is your first time to meet such information please refer to your textbook for further explanation of the concept. This review material requires a student to have a prior knowledge and good foundation of the subject matter for this only emphasizes important/ key information deemed important in understanding concepts in Pathophysiology and Medical Surgical Nursing.
Acquired immunodeficiency syndrome (AIDS)
High-risk groups
Heterosexual or homosexual contact with high-risk individuals
Intravenous drug abusers
Persons receiving blood products
Health care workers
Babies born to infected mothers
Assessment
Malaise, fever, anorexia, weight loss, influenza-like symptoms
Lymphadenopathy for at least 3 months
Leukopenia
Diarrhea
Fatigue
Night sweats
Presence of opportunistic infections
Protozoal infections (Pneumocystis jiroveci pneumonia, major source of mortality)
Neoplasms (Kaposi's sarcoma, purplish-red lesions of internal organs and skin, B-cell non-Hodgkin's lymphoma, cervical cancer)
Fungal infections (candidiasis, histoplasmosis)
Viral infections (cytomegalovirus, herpes simplex)
Bacterial infections
Interventions
1. Provide respiratory support.
2. Administer oxygen and respiratory treatments as prescribed.
3. Provide psychosocial support as needed.
4. Maintain fluid and electrolyte balance.
5. Monitor for signs of infection.
6. Prevent the spread of infection.
7. Initiate standard precautions.
8. Provide comfort as necessary.
9. Provide meticulous skin care.
10. Provide adequate nutritional support as prescribed.
Acquired immunodeficiency syndrome (AIDS)
- AIDS is a viral disease caused by human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy
- The syndrome is manifested clinically by opportunistic infection and unusual neoplasms.
- AIDS is considered a chronic illness.
- The disease has a long incubation period, sometimes 10 years or longer.
- Manifestations may not appear until late in the infection.
High-risk groups
Heterosexual or homosexual contact with high-risk individuals
Intravenous drug abusers
Persons receiving blood products
Health care workers
Babies born to infected mothers
Assessment
Malaise, fever, anorexia, weight loss, influenza-like symptoms
Lymphadenopathy for at least 3 months
Leukopenia
Diarrhea
Fatigue
Night sweats
Presence of opportunistic infections
Protozoal infections (Pneumocystis jiroveci pneumonia, major source of mortality)
Neoplasms (Kaposi's sarcoma, purplish-red lesions of internal organs and skin, B-cell non-Hodgkin's lymphoma, cervical cancer)
Fungal infections (candidiasis, histoplasmosis)
Viral infections (cytomegalovirus, herpes simplex)
Bacterial infections
Interventions
1. Provide respiratory support.
2. Administer oxygen and respiratory treatments as prescribed.
3. Provide psychosocial support as needed.
4. Maintain fluid and electrolyte balance.
5. Monitor for signs of infection.
6. Prevent the spread of infection.
7. Initiate standard precautions.
8. Provide comfort as necessary.
9. Provide meticulous skin care.
10. Provide adequate nutritional support as prescribed.
"Success is not final, failure is not fatal: it is the courage to continue that counts"
Tuesday, February 18, 2014
Pre-Board Exam Drill: Maternal Child and Community Health Nursing C
This is a 30 point Pre-Board Exam Drill on Maternal and Child Nursing and Community Health Nursing SET C.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1.When assessing a newborn diagnosed with ductus arteriosus, Nurse Melissa should expect that the child most likely would have an:
a. Loud, machinery-like murmur.
b. Bluish color to the lips.
c. Decreased BP reading in the upper extremities
d. Increased BP reading in the upper extremities.
2.The reason nurse May keeps the neonate in a neutral thermal environment is that when a newborn becomes too cool, the neonate requires:
a. Less oxygen, and the newborn’s metabolic rate increases.
b. More oxygen, and the newborn’s metabolic rate decreases.
c. More oxygen, and the newborn’s metabolic rate increases.
d. Less oxygen, and the newborn’s metabolic rate decreases.
3.Before adding potassium to an infant’s I.V. line, Nurse Ron must be sure to assess whether this infant has:
a. Stable blood pressure
b. Patant fontanelles
c. Moro’s reflex
d. Voided
4.Nurse Fe should know that the most common causative factor of dermatitis in infants and younger children is:
a. Baby oil
b. Baby lotion
c. Laundry detergent
d. Powder with cornstarch
5.During tube feeding, how far above an infant’s stomach should the nurse hold the syringe with formula?
a. 6 inches
b. 12 inches
c. 18 inches
d. 24 inches
6. In a mothers’ class, Nurse Lhynnete discussed childhood diseases such as chicken pox. Which of the following statements about chicken pox is correct?
a. The older one gets, the more susceptible he becomes to the complications of chicken pox.
b. A single attack of chicken pox will prevent future episodes, including conditions such as shingles.
c. To prevent an outbreak in the community, quarantine may be imposed by health authorities.
d. Chicken pox vaccine is best given when there is an impending outbreak in the community.
7.Barangay Wakwak had an outbreak of German measles. To prevent congenital rubella, what is the BEST advice that you can give to women in the first trimester of pregnancy in the barangay Wakwak?
a. Advice them on the signs of German measles.
b. Avoid crowded places, such as markets and movie houses.
c. Consult at the health center where rubella vaccine may be given.
d. Consult a physician who may give them rubella immunoglobulin.
8. May Anne a public health nurse knows that to determine possible sources of sexually transmitted infections, the BEST method that may be undertaken is:
a. Contact tracing
b. Community survey
c. Mass screening tests
d. Interview of suspects
9. Claudine, a 33-year old female client came for consultation at the health center with the chief complaint of fever for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the client noted yellowish discoloration of his sclera. History showed that he waded in flood waters about 2 weeks before the onset of symptoms. Based on her history, which disease condition will you suspect?
a. Hepatitis A
b. Hepatitis B
c. Tetanus
d. Leptospirosis
10. Ronie a 3-year old client was brought to the health center with the chief complaint of severe diarrhea and the passage of “rice water” stools. The client is most probably suffering from which condition?
a. Giardiasis
b. Cholera
c. Amebiasis
d. Dysentery
11.The most prevalent form of meningitis among children aged 2 months to 3 years is caused by which microorganism?
a. Hemophilus influenzae
b. Morbillivirus
c. Steptococcus pneumoniae
d. Neisseria meningitidis
12.The student nurse is aware that the pathognomonic sign of measles is Koplik’s spot and you may see Koplik’s spot by inspecting the:
a. Nasal mucosa
b. Buccal mucosa
c. Skin on the abdomen
d. Skin on neck
13.Angel was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the color of the nailbed that you pressed does not return within how many seconds?
a. 3 seconds
b. 6 seconds
c. 9 seconds
d. 10 seconds
14.In Integrated Management of Childhood Illness, the nurse is aware that the severe conditions generally require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require urgent referral to a hospital?
a. Mastoiditis
b. Severe dehydration
c. Severe pneumonia
d. Severe febrile disease
15.Myrna a public health nurse will conduct outreach immunization in a barangay Masay with a population of about 1500. The estimated number of infants in the barangay would be:
a. 45 infants
b. 50 infants
c. 55 infants
d. 65 infants
16.The community nurse is aware that the biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer?
a. DPT
b. Oral polio vaccine
c. Measles vaccine
d. MMR
17.It is the most effective way of controlling schistosomiasis in an endemic area?
a. Use of molluscicides
b. Building of foot bridges
c. Proper use of sanitary toilets
d. Use of protective footwear, such as rubber boots
18.Several clients is newly admitted and diagnosed with leprosy. Which of the following clients should be classified as a case of multibacillary leprosy?
a. 3 skin lesions, negative slit skin smear
b. 3 skin lesions, positive slit skin smear
c. 5 skin lesions, negative slit skin smear
d. 5 skin lesions, positive slit skin smear
19.Nurses are aware that diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of
leprosy?
a. Macular lesions
b. Inability to close eyelids
c. Thickened painful nerves
d. Sinking of the nosebridge
20. Perlita brought her 10 month old infant for consultation because of fever, started 4 days prior to consultation. In determining malaria risk, what will you do?
a. Perform a tourniquet test.
b. Ask where the family resides.
c. Get a specimen for blood smear.
d. Ask if the fever is present everyday.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1.When assessing a newborn diagnosed with ductus arteriosus, Nurse Melissa should expect that the child most likely would have an:
a. Loud, machinery-like murmur.
b. Bluish color to the lips.
c. Decreased BP reading in the upper extremities
d. Increased BP reading in the upper extremities.
2.The reason nurse May keeps the neonate in a neutral thermal environment is that when a newborn becomes too cool, the neonate requires:
a. Less oxygen, and the newborn’s metabolic rate increases.
b. More oxygen, and the newborn’s metabolic rate decreases.
c. More oxygen, and the newborn’s metabolic rate increases.
d. Less oxygen, and the newborn’s metabolic rate decreases.
3.Before adding potassium to an infant’s I.V. line, Nurse Ron must be sure to assess whether this infant has:
a. Stable blood pressure
b. Patant fontanelles
c. Moro’s reflex
d. Voided
4.Nurse Fe should know that the most common causative factor of dermatitis in infants and younger children is:
a. Baby oil
b. Baby lotion
c. Laundry detergent
d. Powder with cornstarch
5.During tube feeding, how far above an infant’s stomach should the nurse hold the syringe with formula?
a. 6 inches
b. 12 inches
c. 18 inches
d. 24 inches
6. In a mothers’ class, Nurse Lhynnete discussed childhood diseases such as chicken pox. Which of the following statements about chicken pox is correct?
a. The older one gets, the more susceptible he becomes to the complications of chicken pox.
b. A single attack of chicken pox will prevent future episodes, including conditions such as shingles.
c. To prevent an outbreak in the community, quarantine may be imposed by health authorities.
d. Chicken pox vaccine is best given when there is an impending outbreak in the community.
7.Barangay Wakwak had an outbreak of German measles. To prevent congenital rubella, what is the BEST advice that you can give to women in the first trimester of pregnancy in the barangay Wakwak?
a. Advice them on the signs of German measles.
b. Avoid crowded places, such as markets and movie houses.
c. Consult at the health center where rubella vaccine may be given.
d. Consult a physician who may give them rubella immunoglobulin.
8. May Anne a public health nurse knows that to determine possible sources of sexually transmitted infections, the BEST method that may be undertaken is:
a. Contact tracing
b. Community survey
c. Mass screening tests
d. Interview of suspects
9. Claudine, a 33-year old female client came for consultation at the health center with the chief complaint of fever for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the client noted yellowish discoloration of his sclera. History showed that he waded in flood waters about 2 weeks before the onset of symptoms. Based on her history, which disease condition will you suspect?
a. Hepatitis A
b. Hepatitis B
c. Tetanus
d. Leptospirosis
10. Ronie a 3-year old client was brought to the health center with the chief complaint of severe diarrhea and the passage of “rice water” stools. The client is most probably suffering from which condition?
a. Giardiasis
b. Cholera
c. Amebiasis
d. Dysentery
11.The most prevalent form of meningitis among children aged 2 months to 3 years is caused by which microorganism?
a. Hemophilus influenzae
b. Morbillivirus
c. Steptococcus pneumoniae
d. Neisseria meningitidis
12.The student nurse is aware that the pathognomonic sign of measles is Koplik’s spot and you may see Koplik’s spot by inspecting the:
a. Nasal mucosa
b. Buccal mucosa
c. Skin on the abdomen
d. Skin on neck
13.Angel was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the color of the nailbed that you pressed does not return within how many seconds?
a. 3 seconds
b. 6 seconds
c. 9 seconds
d. 10 seconds
14.In Integrated Management of Childhood Illness, the nurse is aware that the severe conditions generally require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require urgent referral to a hospital?
a. Mastoiditis
b. Severe dehydration
c. Severe pneumonia
d. Severe febrile disease
15.Myrna a public health nurse will conduct outreach immunization in a barangay Masay with a population of about 1500. The estimated number of infants in the barangay would be:
a. 45 infants
b. 50 infants
c. 55 infants
d. 65 infants
16.The community nurse is aware that the biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer?
a. DPT
b. Oral polio vaccine
c. Measles vaccine
d. MMR
17.It is the most effective way of controlling schistosomiasis in an endemic area?
a. Use of molluscicides
b. Building of foot bridges
c. Proper use of sanitary toilets
d. Use of protective footwear, such as rubber boots
18.Several clients is newly admitted and diagnosed with leprosy. Which of the following clients should be classified as a case of multibacillary leprosy?
a. 3 skin lesions, negative slit skin smear
b. 3 skin lesions, positive slit skin smear
c. 5 skin lesions, negative slit skin smear
d. 5 skin lesions, positive slit skin smear
19.Nurses are aware that diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of
leprosy?
a. Macular lesions
b. Inability to close eyelids
c. Thickened painful nerves
d. Sinking of the nosebridge
20. Perlita brought her 10 month old infant for consultation because of fever, started 4 days prior to consultation. In determining malaria risk, what will you do?
a. Perform a tourniquet test.
b. Ask where the family resides.
c. Get a specimen for blood smear.
d. Ask if the fever is present everyday.
"Try not to become a man of success, but rather try to become a man of value."
Friday, February 14, 2014
Pre-Board Exam Drill: Maternal Child and Community Health Nursing B
This is a 30 point Pre-Board Exam Drill on Maternal and Child Nursing and Community Health Nursing SET B.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1.According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement?
a. The community health nurse continuously develops himself personally and professionally.
b. Health education and community organizing are necessary in providing community health services.
c. Community health nursing is intended primarily for health promotion and prevention and treatment of disease.
d. The goal of community health nursing is to provide nursing services to people in their own places of residence.
2.Nurse Marie is aware that the disease declared through Presidential Proclamation No. 4 as a target for eradication in the Philippines is?
a. Poliomyelitis
b. Measles
c. Rabies
d. Neonatal tetanus
3. Nure Franciene knows that the step in community organizing that involves training of potential leaders in the community is:
a. Integration
b. Community organization
c. Community study
d. Core group formation
4. Nurse Anna a public health nurse takes an active role in community participation. What is the primary goal of community organizing?
a. To educate the people regarding community health problems
b. To mobilize the people to resolve community health problems
c. To maximize the community’s resources in dealing with health problems.
d. To maximize the community’s resources in dealing with health problems.
5.Tertiary prevention is needed in which stage of the natural history of disease?
a. Pre-pathogenesis
b. Pathogenesis
c. Prodromal
d. Terminal
6.The nurse is caring for a primigravid client in the labor and delivery area. Which condition would place the client at risk for disseminated intravascular coagulation (DIC)?
a. Intrauterine fetal death.
b. Placenta accreta.
c. Dysfunctional labor.
d. Premature rupture of the membranes.
7.A fullterm client is in labor. Nurse Betty is aware that the fetal heart rate would be:
a. 80 to 100 beats/minute
b. 100 to 120 beats/minute
c. 120 to 160 beats/minute
d. 160 to 180 beats/minute
8.The skin in the diaper area of a 7 month old infant is excoriated and red. Nurse Gretel should instruct the mother to:
a. Change the diaper more often.
b. Apply talc powder with diaper changes.
c. Wash the area vigorously with each diaper change.
d. Decrease the infant’s fluid intake to decrease saturating diapers.
9.Nurse Carlos knows that the common cardiac anomalies in children with Down Syndrome (tri-somy 21) is:
a. Atrial septal defect
b. Pulmonic stenosis
c. Ventricular septal defect
d. Endocardial cushion defect
10. Nurse Cristeta was diagnosed with severe preeclampsia is now receiving I.V. magnesium sulfate. The adverse effects associated with magnesium sulfate is:
a. Anemia
b. Decreased urine output
c. Hyperreflexia
d. Increased respiratory rate
11. Mrs. Pregy Der, a 23 year old client is having her menstrual period every 2 weeks that last for 1 week. This type of menstrual pattern is bets defined by:
a. Menorrhagia
b. Metrorrhagia
c. Dyspareunia
d. Amenorrhea
12. Mrs. Caby Nhet is admitted to the labor and delivery unit. The critical laboratory result for this client would be:
a. Oxygen saturation
b. Iron binding capacity
c. Blood typing
d. Serum Calcium
13.Nurse Dorothy is aware that the most common condition found during the second-trimester of pregnancy is:
a. Metabolic alkalosis
b. Respiratory acidosis
c. Mastitis
d. Physiologic anemia
14.Nurse Imo Gin is working in the triage area of an emergency department. She sees that several pediatric clients arrive simultaneously. The client who needs to be treated first is:
a. A crying 5 year old child with a laceration on his scalp.
b. A 4 year old child with a barking coughs and flushed appearance.
c. A 3 year old child with Down syndrome who is pale and asleep in
his mother’s arms.
d. A 2 year old infant with stridorous breath sounds, sitting up in his
mother’s arms and drooling.
15. Mrs. Calista in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of the following conditions is suspected?
a. Placenta previa
b. Abruptio placentae
c. Premature labor
d. Sexually transmitted disease
16.A young child named Louella is suspected of having pinworms. The community nurse collects a stool specimen to confirm the diagnosis. The nurse should schedule the collection of this specimen for:
a. Just before bedtime
b. After the child has been bathe
c. Any time during the day
d. Early in the morning
17.In doing a child’s admission assessment, Nurse Angelique should be alert to note which signs or symptoms of chronic lead poisoning?
a. Irritability and seizures
b. Dehydration and diarrhea
c. Bradycardia and hypotension
d. Petechiae and hematuria
18.To evaluate a woman’s understanding about the use of diaphragm for family planning, Nurse Trish asks her to explain how she will use the appliance. Which response indicates a need for further health teaching?
a. “I should check the diaphragm carefully for holes every time I use it”
b. “I may need a different size of diaphragm if I gain or lose weight more than 20 pounds”
c. “The diaphragm must be left in place for atleast 6 hours after intercourse”
d. “I really need to use the diaphragm and jelly most during the middle of my menstrual cycle”.
19.Hypoxia is a common complication of laryngotracheobronchitis. Nurse Oliver should frequently assess a child with laryngotracheobronchitis for:
a. Drooling
b. Muffled voice
c. Restlessness
d. Low-grade fever
20.How should Nurse Melanie Marquez guide a child who is blind to walk to the playroom?
a. Without touching the child, talk continuously as the child walks down the hall.
b. Walk one step ahead, with the child’s hand on the nurse’s elbow.
c. Walk slightly behind, gently guiding the child forward.
d. Walk next to the child, holding the child’s hand.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1.According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement?
a. The community health nurse continuously develops himself personally and professionally.
b. Health education and community organizing are necessary in providing community health services.
c. Community health nursing is intended primarily for health promotion and prevention and treatment of disease.
d. The goal of community health nursing is to provide nursing services to people in their own places of residence.
2.Nurse Marie is aware that the disease declared through Presidential Proclamation No. 4 as a target for eradication in the Philippines is?
a. Poliomyelitis
b. Measles
c. Rabies
d. Neonatal tetanus
3. Nure Franciene knows that the step in community organizing that involves training of potential leaders in the community is:
a. Integration
b. Community organization
c. Community study
d. Core group formation
4. Nurse Anna a public health nurse takes an active role in community participation. What is the primary goal of community organizing?
a. To educate the people regarding community health problems
b. To mobilize the people to resolve community health problems
c. To maximize the community’s resources in dealing with health problems.
d. To maximize the community’s resources in dealing with health problems.
5.Tertiary prevention is needed in which stage of the natural history of disease?
a. Pre-pathogenesis
b. Pathogenesis
c. Prodromal
d. Terminal
6.The nurse is caring for a primigravid client in the labor and delivery area. Which condition would place the client at risk for disseminated intravascular coagulation (DIC)?
a. Intrauterine fetal death.
b. Placenta accreta.
c. Dysfunctional labor.
d. Premature rupture of the membranes.
7.A fullterm client is in labor. Nurse Betty is aware that the fetal heart rate would be:
a. 80 to 100 beats/minute
b. 100 to 120 beats/minute
c. 120 to 160 beats/minute
d. 160 to 180 beats/minute
8.The skin in the diaper area of a 7 month old infant is excoriated and red. Nurse Gretel should instruct the mother to:
a. Change the diaper more often.
b. Apply talc powder with diaper changes.
c. Wash the area vigorously with each diaper change.
d. Decrease the infant’s fluid intake to decrease saturating diapers.
9.Nurse Carlos knows that the common cardiac anomalies in children with Down Syndrome (tri-somy 21) is:
a. Atrial septal defect
b. Pulmonic stenosis
c. Ventricular septal defect
d. Endocardial cushion defect
10. Nurse Cristeta was diagnosed with severe preeclampsia is now receiving I.V. magnesium sulfate. The adverse effects associated with magnesium sulfate is:
a. Anemia
b. Decreased urine output
c. Hyperreflexia
d. Increased respiratory rate
11. Mrs. Pregy Der, a 23 year old client is having her menstrual period every 2 weeks that last for 1 week. This type of menstrual pattern is bets defined by:
a. Menorrhagia
b. Metrorrhagia
c. Dyspareunia
d. Amenorrhea
12. Mrs. Caby Nhet is admitted to the labor and delivery unit. The critical laboratory result for this client would be:
a. Oxygen saturation
b. Iron binding capacity
c. Blood typing
d. Serum Calcium
13.Nurse Dorothy is aware that the most common condition found during the second-trimester of pregnancy is:
a. Metabolic alkalosis
b. Respiratory acidosis
c. Mastitis
d. Physiologic anemia
14.Nurse Imo Gin is working in the triage area of an emergency department. She sees that several pediatric clients arrive simultaneously. The client who needs to be treated first is:
a. A crying 5 year old child with a laceration on his scalp.
b. A 4 year old child with a barking coughs and flushed appearance.
c. A 3 year old child with Down syndrome who is pale and asleep in
his mother’s arms.
d. A 2 year old infant with stridorous breath sounds, sitting up in his
mother’s arms and drooling.
15. Mrs. Calista in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of the following conditions is suspected?
a. Placenta previa
b. Abruptio placentae
c. Premature labor
d. Sexually transmitted disease
16.A young child named Louella is suspected of having pinworms. The community nurse collects a stool specimen to confirm the diagnosis. The nurse should schedule the collection of this specimen for:
a. Just before bedtime
b. After the child has been bathe
c. Any time during the day
d. Early in the morning
17.In doing a child’s admission assessment, Nurse Angelique should be alert to note which signs or symptoms of chronic lead poisoning?
a. Irritability and seizures
b. Dehydration and diarrhea
c. Bradycardia and hypotension
d. Petechiae and hematuria
18.To evaluate a woman’s understanding about the use of diaphragm for family planning, Nurse Trish asks her to explain how she will use the appliance. Which response indicates a need for further health teaching?
a. “I should check the diaphragm carefully for holes every time I use it”
b. “I may need a different size of diaphragm if I gain or lose weight more than 20 pounds”
c. “The diaphragm must be left in place for atleast 6 hours after intercourse”
d. “I really need to use the diaphragm and jelly most during the middle of my menstrual cycle”.
19.Hypoxia is a common complication of laryngotracheobronchitis. Nurse Oliver should frequently assess a child with laryngotracheobronchitis for:
a. Drooling
b. Muffled voice
c. Restlessness
d. Low-grade fever
20.How should Nurse Melanie Marquez guide a child who is blind to walk to the playroom?
a. Without touching the child, talk continuously as the child walks down the hall.
b. Walk one step ahead, with the child’s hand on the nurse’s elbow.
c. Walk slightly behind, gently guiding the child forward.
d. Walk next to the child, holding the child’s hand.
“Failure is the condiment that gives success its flavor.” -Capote
Wednesday, February 12, 2014
Pre-Board Exam Drill: Maternal Child and Community Health Nursing A
This is a 30 point Pre-Board Exam Drill on Maternal and Child Nursing and Community Health Nursing SET A.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1. May arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. She also tells the nurse that a home pregnancy test was positive but she began to have mild cramps and is now having moderate vaginal bleeding. During the physical examination of the client, the nurse notes that May has a dilated cervix. The nurse determines that May is experiencing which type of abortion?
a. Inevitable
b. Incomplete
c. Threatened
d. Septic
2. Nurse Reese is reviewing the record of a pregnant client for her first prenatal visit. Which of the following data, if noted on the client’s record, would alert the nurse that the client is at risk for a spontaneous abortion?
a. Age 36 years
b. History of syphilis
c. History of genital herpes
d. History of diabetes mellitus
3. Nurse Hazel is preparing to care for a client who is newly admitted to the hospital with a possible diagnosis of ectopic pregnancy. Nurse Hazel develops a plan of care for the client and determines that which of the following nursing actions is the priority?
a. Monitoring weight
b. Assessing for edema
c. Monitoring apical pulse
d. Monitoring temperature
4. Nurse Oliver is teaching a diabetic pregnant client about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy require:
a. Decreased caloric intake
b. Increased caloric intake
c. Decreased Insulin
d. Increase Insulin
5. Nurse Michelle is assessing a 24 year old client with a diagnosis of hydatidiform mole. She is aware that one of the following is unassociated with this condition?
a. Excessive fetal activity.
b. Larger than normal uterus for gestational age.
c. Vaginal bleeding
d. Elevated levels of human chorionic gonadotropin.
6. A pregnant client is receiving magnesium sulfate for severe pregnancy induced hypertension (PIH). The clinical findings that would warrant use of the antidote , calcium gluconate is:
a. Urinary output 90 cc in 2 hours.
b. Absent patellar reflexes.
c. Rapid respiratory rate above 40/min.
d. Rapid rise in blood pressure.
7. During vaginal examination of Janah who is in labor, the presenting part is at station plus two. Nurse, correctly interprets it as:
a. Presenting part is 2 cm above the plane of the ischial spines.
b. Biparietal diameter is at the level of the ischial spines.
c. Presenting part in 2 cm below the plane of the ischial spines.
d. Biparietal diameter is 2 cm above the ischial spines.
8. A pregnant client is receiving oxytocin (Pitocin) for induction of labor. A condition that warrant the nurse in-charge to discontinue I.V. infusion of Pitocin is:
a. Contractions every 1 ½ minutes lasting 70-80 seconds.
b. Maternal temperature 101.2
c. Early decelerations in the fetal heart rate.
d. Fetal heart rate baseline 140-160 bpm.
9. Calcium gluconate is being administered to a client with pregnancy induced hypertension (PIH). A nursing action that must be initiated as the plan of care throughout injection of the drug is:
a. Ventilator assistance
b. CVP readings
c. EKG tracings
d. Continuous CPR
10. A trial for vaginal delivery after an earlier caesareans, would likely to be given to a gravida, who had:
a. First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39 weeks pregnancy was positive.
b. First and second caesareans were for cephalopelvic disproportion.
c. First caesarean through a classic incision as a result of severe fetal distress.
d. First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation.
11.Nurse Ryan is aware that the best initial approach when trying to take a crying toddler’s temperature is:
a. Talk to the mother first and then to the toddler.
b. Bring extra help so it can be done quickly.
c. Encourage the mother to hold the child.
d. Ignore the crying and screaming.
12.Baby Tina a 3 month old infant just had a cleft lip and palate repair. What should the nurse do to prevent trauma to operative site?
a. Avoid touching the suture line, even when cleaning.
b. Place the baby in prone position.
c. Give the baby a pacifier.
d. Place the infant’s arms in soft elbow restraints.
13. Which action should nurse Marian include in the care plan for a 2 month old with heart failure?
a. Feed the infant when he cries.
b. Allow the infant to rest before feeding.
c. Bathe the infant and administer medications before feeding.
d. Weigh and bathe the infant before feeding.
14.Nurse Hazel is teaching a mother who plans to discontinue breast feeding after 5 months. The nurse should advise her to include which foods in her infant’s diet?
a. Skim milk and baby food.
b. Whole milk and baby food.
c. Iron-rich formula only.
d. Iron-rich formula and baby food.
15.Mommy Linda is playing with her infant, who is sitting securely alone on the floor of the clinic. The mother hides a toy behind her back and the infant looks for it. The nurse is aware that estimated age of the infant
would be:
a. 6 months
b. 4 months
c. 8 months
d. 10 months
16.Which of the following is the most prominent feature of public health nursing?
a. It involves providing home care to sick people who are not confined in the hospital.
b. Services are provided free of charge to people within the catchments area.
c. The public health nurse functions as part of a team providing a public health nursing services.
d. Public health nursing focuses on preventive, not curative, services.
17.When the nurse determines whether resources were maximized in implementing Ligtas Tigdas, she is evaluating
a. Effectiveness
b. Efficiency
c. Adequacy
d. Appropriateness
18.Vangie is a new B.S.N. graduate. She wants to become a Public Health Nurse. Where should she apply?
a. Department of Health
b. Provincial Health Office
c. Regional Health Office
d. Rural Health Unit
19.Tony is aware the Chairman of the Municipal Health Board is:
a. Mayor
b. Municipal Health Officer
c. Public Health Nurse
d. Any qualified physician
20.Myra is the public health nurse in a municipality with a total population of about 20,000. There are 3 rural health midwives among the RHU personnel. How many more midwife items will the RHU need?
a. 1
b. 2
c. 3
d. The RHU does not need any more midwife item.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1. May arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. She also tells the nurse that a home pregnancy test was positive but she began to have mild cramps and is now having moderate vaginal bleeding. During the physical examination of the client, the nurse notes that May has a dilated cervix. The nurse determines that May is experiencing which type of abortion?
a. Inevitable
b. Incomplete
c. Threatened
d. Septic
2. Nurse Reese is reviewing the record of a pregnant client for her first prenatal visit. Which of the following data, if noted on the client’s record, would alert the nurse that the client is at risk for a spontaneous abortion?
a. Age 36 years
b. History of syphilis
c. History of genital herpes
d. History of diabetes mellitus
3. Nurse Hazel is preparing to care for a client who is newly admitted to the hospital with a possible diagnosis of ectopic pregnancy. Nurse Hazel develops a plan of care for the client and determines that which of the following nursing actions is the priority?
a. Monitoring weight
b. Assessing for edema
c. Monitoring apical pulse
d. Monitoring temperature
4. Nurse Oliver is teaching a diabetic pregnant client about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy require:
a. Decreased caloric intake
b. Increased caloric intake
c. Decreased Insulin
d. Increase Insulin
5. Nurse Michelle is assessing a 24 year old client with a diagnosis of hydatidiform mole. She is aware that one of the following is unassociated with this condition?
a. Excessive fetal activity.
b. Larger than normal uterus for gestational age.
c. Vaginal bleeding
d. Elevated levels of human chorionic gonadotropin.
6. A pregnant client is receiving magnesium sulfate for severe pregnancy induced hypertension (PIH). The clinical findings that would warrant use of the antidote , calcium gluconate is:
a. Urinary output 90 cc in 2 hours.
b. Absent patellar reflexes.
c. Rapid respiratory rate above 40/min.
d. Rapid rise in blood pressure.
7. During vaginal examination of Janah who is in labor, the presenting part is at station plus two. Nurse, correctly interprets it as:
a. Presenting part is 2 cm above the plane of the ischial spines.
b. Biparietal diameter is at the level of the ischial spines.
c. Presenting part in 2 cm below the plane of the ischial spines.
d. Biparietal diameter is 2 cm above the ischial spines.
8. A pregnant client is receiving oxytocin (Pitocin) for induction of labor. A condition that warrant the nurse in-charge to discontinue I.V. infusion of Pitocin is:
a. Contractions every 1 ½ minutes lasting 70-80 seconds.
b. Maternal temperature 101.2
c. Early decelerations in the fetal heart rate.
d. Fetal heart rate baseline 140-160 bpm.
9. Calcium gluconate is being administered to a client with pregnancy induced hypertension (PIH). A nursing action that must be initiated as the plan of care throughout injection of the drug is:
a. Ventilator assistance
b. CVP readings
c. EKG tracings
d. Continuous CPR
10. A trial for vaginal delivery after an earlier caesareans, would likely to be given to a gravida, who had:
a. First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39 weeks pregnancy was positive.
b. First and second caesareans were for cephalopelvic disproportion.
c. First caesarean through a classic incision as a result of severe fetal distress.
d. First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation.
11.Nurse Ryan is aware that the best initial approach when trying to take a crying toddler’s temperature is:
a. Talk to the mother first and then to the toddler.
b. Bring extra help so it can be done quickly.
c. Encourage the mother to hold the child.
d. Ignore the crying and screaming.
12.Baby Tina a 3 month old infant just had a cleft lip and palate repair. What should the nurse do to prevent trauma to operative site?
a. Avoid touching the suture line, even when cleaning.
b. Place the baby in prone position.
c. Give the baby a pacifier.
d. Place the infant’s arms in soft elbow restraints.
13. Which action should nurse Marian include in the care plan for a 2 month old with heart failure?
a. Feed the infant when he cries.
b. Allow the infant to rest before feeding.
c. Bathe the infant and administer medications before feeding.
d. Weigh and bathe the infant before feeding.
14.Nurse Hazel is teaching a mother who plans to discontinue breast feeding after 5 months. The nurse should advise her to include which foods in her infant’s diet?
a. Skim milk and baby food.
b. Whole milk and baby food.
c. Iron-rich formula only.
d. Iron-rich formula and baby food.
15.Mommy Linda is playing with her infant, who is sitting securely alone on the floor of the clinic. The mother hides a toy behind her back and the infant looks for it. The nurse is aware that estimated age of the infant
would be:
a. 6 months
b. 4 months
c. 8 months
d. 10 months
16.Which of the following is the most prominent feature of public health nursing?
a. It involves providing home care to sick people who are not confined in the hospital.
b. Services are provided free of charge to people within the catchments area.
c. The public health nurse functions as part of a team providing a public health nursing services.
d. Public health nursing focuses on preventive, not curative, services.
17.When the nurse determines whether resources were maximized in implementing Ligtas Tigdas, she is evaluating
a. Effectiveness
b. Efficiency
c. Adequacy
d. Appropriateness
18.Vangie is a new B.S.N. graduate. She wants to become a Public Health Nurse. Where should she apply?
a. Department of Health
b. Provincial Health Office
c. Regional Health Office
d. Rural Health Unit
19.Tony is aware the Chairman of the Municipal Health Board is:
a. Mayor
b. Municipal Health Officer
c. Public Health Nurse
d. Any qualified physician
20.Myra is the public health nurse in a municipality with a total population of about 20,000. There are 3 rural health midwives among the RHU personnel. How many more midwife items will the RHU need?
a. 1
b. 2
c. 3
d. The RHU does not need any more midwife item.
"Dare to be"- Maraboli
Monday, February 3, 2014
Notes on Fluid and Electrolyte 2: CONCEPTS OF FLUID AND ELECTROLYTE BALANCE
CONCEPTS OF FLUID AND ELECTROLYTE BALANCE
1. Description: A substance that is dissolved in solution and ome of its molecules split or dissociate into electrically charged atoms or ions.
2. Measurement
a. The metric system is used to measure volumes of fluids—liters (L) or milliliters (mL).
b. The unit of measure that expresses the combining activity of an electrolyte is the milliequivalent (mEq).
c. One milliequivalent (1 mEq) of any cation will always react chemically with 1 mEq of an anion.
d. Milliequivalents provide information about the number of anions or cations available to combine with other anions or cations.
B. Body fluid compartments
1. Description
a. Fluid in each of the body compartments contains electrolytes.
b. Each compartment has a particular composition of electrolytes, which differs from that of other compartments.
c. To function normally, body cells must have fluids and electrolytes in the right compartments and in the right amounts.
d. Whenever an electrolyte moves out of a cell, another electrolyte moves in to take its place.
e. The numbers of cations and anions must be the same for homeostasis to exist.
f. Compartments are separated by semipermeable membranes.
2. Intravascular compartment: Refers to fluid inside a blood vessel
3. Intracellular compartment
a. The intracellular compartment refers to all fluid inside the cell.
b. Most bodily fluids are inside the cell.
4. The extracellular compartment is the fluid outside the cell.
a. The extracellular compartment includes the interstitial fluid, which is fluid between cells (sometimes called the third space), blood, lymph, bone, connective tissue, water, and transcellular fluid.
b. Transcellular fluid is the fluid in various parts of the body, such as peritoneal fluid, pleural fluid, cerebrospinal fluid, and synovial fluid.
C. Third-spacing
1. Third-spacing is the accumulation and sequestration of trapped extracellular fluid in an actual or potential body space as a result of disease or injury.
2. The trapped fluid represents a volume loss and is unavailable for normal physiological processes.
3. Fluid may be trapped in body spaces such as the pericardial, pleural, peritoneal, or joint cavities, the bowel, or the aabdomen, or within soft tissues after trauma or burns.
4. Assessing the intravascular fluid loss caused by third-spacing is difficult. The loss may not be reflected
in weight changes or intake and output records and may not become apparent until after organ malfunction occurs.
D. Edema
1. Edema is an excess accumulation of fluid in the interstitial space.
2. Localized edema occurs as a result of traumatic injury from accidents or surgery, local inflammatory processes, or burns.
3. Generalized edema, also called anasarca, is an excessive accumulation of fluid in the interstitial space throughout the body and occurs as a result of conditions such as cardiac, renal, or liver failure.
E. Body fluid
1. Description
a. Body fluids transport nutrients to the cells and carry waste products from the cells.
b. Total body fluid (intracellular and extracellular) amounts to about 60% of body weight in the adult,
55% in the older adult, and 80% in the infant.
c. Thus, infants and the older adult are at ahigher risk for fluid-related problems than younger adults; children have a greater proportion of body water than adults and the older adult has the least proportion of body water.
2. Constituents of body fluids
a. Body fluids consist of water and dissolved substances.
b. The largest single fluid constituent of the body is water.
c. Some substances, such as glucose, urea, and creatinine, do not dissociate in solution; that is, they do not separate from their complex forms into simpler substances when they are in solution.
d. Other substances do dissociate; for example, when sodium chloride is in a solution, it dissociates or
separates into two parts or elements.
F. Body fluid transport
1. Diffusion
a. Diffusion is the process whereby a solute (substance that is dissolved) may spread through a solution or solvent (solution in which the solute is dissolved).
b. Diffusion of a solute will spread the molecules from an area of higher concentration to an area of lower concentration.
c. A permeable membrane will allow substances to pass through it without restriction.
d. A selectively permeable membrane will allow some solutes to pass through without restriction but will prevent other solutes from passing freely.
e. Diffusion occurs within fluid compartments and from one compartment to another if the barrier
between the compartments is permeable to the diffusing substances.
2. Osmosis
a. Osmotic pressure is the force that draws the solvent from a less concentrated solute through a selectively permeable membrane into a more concentrated solute, thus tending to equalize the concentration of the solvent.
b. If a membrane is permeable to water but not to all the solutes present, the membrane is a selective or semipermeable membrane.
c. Osmosis is the movement of solvent molecules across a membrane in response to a concentration gradient, usually from a solution of lower to one of higher solute concentration.
d. When a more concentrated solution is on one side of a selectively permeable membrane and a less concentrated solution is on the other side, a pull called osmotic pressure draws the water through
the membrane to the more concentrated side or the side with more solute.
3. Filtration
a. Filtration is the movement of solutes and solvents by hydrostatic pressure.
b. The movement is from an area of higher pressure to an area of lower pressure.
4. Hydrostatic pressure
a. Hydrostatic pressure is the force exerted by the weight of a solution.
b. When a difference exists in the hydrostatic pressure on two sides of a membrane, water and diffusible solutes move out of the solution that has the higher hydrostatic pressure by the process of filtration.
c. At the arterial end of the capillary, the hydrostatic pressure is higher than the osmotic pressure; therefore, fluids and diffusible solutes move out of the capillary.
d. At the venous end, the osmotic pressure or pull is higher than the hydrostatic pressure, and fluids and some solutes move into the capillary.
e. The excess fluid and solutes remaining in the interstitial spaces are returned to the intravascular compartment by the lymph channels.
5. Osmolality
a. Osmolality refers to the number of osmotically active particles/kilogram of water; it is the concentration of a solution.
b. In the body, osmotic pressure is measured in milliosmoles (mOsm).
c. The normal osmolality of plasma is 270 to 300 milliosmoles/kilogram (mOsm/kg) water.
G. Movement of body fluid
1. Description
a. Cell membranes separate the interstitial fluid from the intravascular fluid.
b. Cell membranes are selectively permeable; that is, the cell membrane and the capillary wall will allow water and some solutes free passage through them.
c. Several forces affect the movement of water and solutes through the walls of cells and capillaries.
d. The greater the number of particles within the cell, the more pressure exists to force the water through
the cell membrane.
e. If the body loses more electrolytes than fluids, as can happen in diarrhea, then the extracellular fluid will contain fewer electrolytes or less solute than the intracellular fluid.
f. Fluids and electrolytes must be kept in balance for health; when they remain out of balance, death can
occur.
2. Isotonic solutions
a. When the solutions on both sides of a selectively permeable membrane have established equilibrium or are equal in concentration, they are isotonic.
b. An example of an isotonic solution is 0.9% sodium chloride, which is referred to as isotonic saline solution or normal saline solution.
c. Isotonic solutions are isotonic to human cells, and thus very little osmosis occurs; isotonic solutions have the same osmolality as body fluids.
d. Other solutions that are isotonic are 5% dextrose in water, 5% dextrose in 0.225% saline, and Ringer's
lactate solution.
3. Hypotonic solutions
a. When a solution contains a lower concentration of salt or solute than another more concentrated solution, it is considered hypotonic.
b. A hypotonic solution has less salt or more water than an isotonic solution; these solutions have lower osmolality than body fluids.
c. 0.45% sodium chloride, 0.225% sodium chloride, and 0.33% sodium chloride are examples of hypotonic solutions.
d. Hypotonic solutions are hypotonic to the cells; therefore, osmosis would continue in an attempt to bring about balance or equality.
4. Hypertonic solutions
a. A solution that has a higher concentration of solutes than another less concentrated solution is hypertonic; these solutions have a higher osmolality than body fluids.
b. Hypertonic solutions include 3% sodium chloride, 5% sodium chloride, 10% dextrose in water, 5% dextrose in 0.9% sodium chloride, 5% dextrose in 0.45% sodium chloride, and 5% dextrose in Ringer's lactate solution.
c. Refer to Table 14-1 (Chap. 14) for a list of isotonic, hypotonic, and hypertonic solutions.
5. Osmotic pressure
a. The amount of osmotic pressure is determined by the concentration of solutes in solution.
b. When the solutions on each side of a selectively permeable membrane are equal in concentration, they are isotonic.
c. A hypotonic solution has less solute than an isotonic solution, whereas a hypertonic solution contains more solute.
d. A solvent will move from the less concentrated solute side to the more concentrated solute side to equalize concentration.
6. Active transport
a. If an ion is to move through a membrane from an area of lower concentration to an area of higher concentration, an active transport system is necessary.
b. An active transport system moves molecules or ions against concentration and osmotic pressure.
c. Metabolic processes in the cell supply the energy for active transport.
d. Substances that are transported actively through the cell membrane include ions of sodium, potassium, calcium, iron, and hydrogen, some of the sugars, and the amino acids.
H. Body fluid excretion
1. Description
a. Fluids leave the body by several routes, including the skin, lungs, gastrointestinal tract, and kidneys.
b. The kidneys excrete the largest quantity of fluid.
c. As long as all organs are functioning normally, the body is able to maintain balance in its fluid content.
2. Skin
a. Water is lost through the skin in the amount of about 400 mL/day.
b. The amount of water lost by perspiration varies according to the temperature of the environment and of the body, but the average amount of loss by perspiration alone is 100 mL/day.
c. Water lost through the skin is called insensible loss (the individual is unaware of losing that water).
3. Lungs
a. Water is lost from the lungs through expired air that is saturated with water vapor.
b. The amount of water lost from the lungs varies with the rate and the depth of respiration.
c. The average amount of water lost from the lungs is about 350 mL/day.
d. Water lost from the lungs is called insensible loss.
4. Gastrointestinal tract
a. Large quantities of water are secreted into the gastrointestinal tract, but almost all this fluid is reabsorbed.
b. A large volume of electrolyte-containing liquids moves into the gastrointestinal tract and then returns again into the extracellular fluid.
c. The average amount of water lost in the feces is 150 mL/day, equal to the amount of water gained through the oxidation of foods.
d. Severe diarrhea results in the loss of large quantities of fluids and electrolytes.
5. Kidneys
a. The kidneys play a major role in regulating fluid and electrolyte balance.
b. Normal kidneys can adjust the amount of water and electrolytes leaving the body.
c. The quantity of fluid excreted by the kidneys is determined by the amount of water ingested and the amount of waste and solutes excreted.
d. The usual urine output is about 1500 mL/day; however, this varies greatly depending on fluid intake, amount of perspiration, and other factors.
I. Body fluid replacement
1. Description: Water enters the body through three sources—orally ingested liquids, water in foods, and water formed by oxidation of foods.
2. Amounts
a. The average total amount of water taken into the body by all three sources is 2500 mL/day.
b. About 10 mL of water is released by the metabolism of each 100 calories of fat, carbohydrates, or proteins.
3. Electrolytes
a. Electrolytes are present in foods and liquids.
b. With a normal diet, an excess of essential electrolytes is
taken in and the unused electrolytes are excreted.
J. Maintaining fluid and electrolyte balance
1. Description
a. Homeostasis is a term that indicates the relative stability of the internal environment.
b. Concentration and composition of body fluids must be nearly constant.
c. In a client, when one of the substances is deficient, either fluids or electrolytes, the substance must be replaced normally by the intake of food and water or by therapy such as intravenous solutions and medications.
d. When the client has an excess of fluid or electrolytes, therapy is directed toward assisting the body to eliminate the excess.
2. The kidneys play a major role in controlling all types of balance in fluid and electrolytes.
3. The adrenal glands, through the secretion of aldosterone, also aid in controlling extracellular fluid volume by regulating the amount of sodium reabsorbed by the kidneys.
4. Antidiuretic hormone from the pituitary gland regulates the osmotic pressure of extracellular fluid by regulating the amount of water reabsorbed by the kidney.
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Sunday, February 2, 2014
Notes on Fluids and Electrolytes Part 1
This Notes on Fluids and Electrolytes (1) focus primarily on the assessment of a fluid and electrolyte imbalance, interventions, and evaluating the expected outcomes. Fluids and electrolytes constitute a content area that is sometimes complex and difficult to understand. The nurse must understand cell functions and properties and the concepts related to body fluids as outlined in this chapter. It focuses on the common fluid and electrolyte disturbances. As you review this content, focus on the Pyramid Points related to the causes, assessment findings, and related treatments. In any fluid or electrolyte imbalance, nursing interventions include monitoring significant laboratory results and monitoring the client's cardiovascular, respiratory, gastrointestinal, neuromuscular, renal, and central nervous system status. Integrated Processes addressed in this chapter are Caring, Communication and Documentation, Nursing Process, and Teaching/Learning.
Important Terms
calcium
A mineral element needed for the process of bone formation, coagulation of blood, excitation of cardiac and skeletal muscle, maintenance of muscle tone, conduction of neuromuscular impulses, and the synthesis and regulation of the endocrine and exocrine glands. The normal adult level is 8.6 to 10.0 mg/dL.
fluid volume deficit
Dehydration in which the fluid intake of the body is not sufficient to meet the fluid needs of the body.
fluid volume excess
Fluid intake or fluid retention that exceeds the fluid needs of the body. Also called overhydration or fluid overload.
homeostasis
The tendency of biological systems to maintain relatively constant conditions in the internal environment while continuously interacting with and adjusting to changes originating within or outside the system.
hypercalcemia
A serum calcium level that exceeds 10.0 mg/dL.
hyperkalemia
A serum potassium level that exceeds 5.1 mEq/L.
hypermagnesemia
A serum magnesium level that exceeds 2.6 mg/dL.
hypernatremia
A serum sodium level that exceeds 145 mEq/L.
hyperphosphatemia
A serum phosphorus level that exceeds 4.5 mg/dL.
hypocalcemia
A serum calcium level less than 8.6 mg/dL.
hypokalemia
A serum potassium level less than 3.5 mEq/L.
hypomagnesemia
A serum magnesium level less than 1.6 mg/dL.
hyponatremia
A serum sodium level less than 135 mEq/L.
hypophosphatemia
A serum phosphorus level less than 2.7 mg/dL.
magnesium
Concentrated in the bone, cartilage, and within the cell itself; required for the use of adenosine triphosphate (ATP) as a source of energy. It is necessary for the action of numerous enzyme systems such as carbohydrate metabolism, protein synthesis, nucleic acid synthesis, and contraction of muscular tissue. It
also regulates neuromuscular activity and the clotting mechanism. The normal adult level is 1.6 to 2.6 mg/dL.
potassium
A principle electrolyte of intracellular fluid and the primary buffer within the cell itself. It is needed for nerve conduction, muscle function, acid-base balance, and osmotic pressure. Along with calcium and magnesium, it controls
sodium
An abundant electrolyte that maintains osmotic pressure and acid-base balance and transmits nerve impulses. The normal adult level is 135 to 145 mEq/L.
Friday, January 31, 2014
Pre-Board Exam Drill: Fundamentals of Nursing D
This is a 30 point Pre-Board Exam Drill on Fundamentals of Nursing SET D.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1. Before administering a nasogastric feeding, the nurse aspirate the stomach contents and obtain 50 cc of residual. the next action is to:
a. discard aspirate and begin tube feeding
b. replace aspirate and begin tube feeding
c. discard aspirate and hold the tube feeding
d. replace aspirate and hold the tube feeding
2. You are assigned to a client with a central vein IV infusing hyperalimentation solution. The most important nursing intervention is:
a. preparing the next bottle of solution prior to use
b. maintaining the exact amount of solution administered hourly by adjusting the flow rate
c. checking urine specific gravity, sugar, and acetone every for hours
d. changing the IV filter and tubing with each bottle change
3. You have been assigned to a female patient who needs to have a sterile urine specimen sent to the laboratory for a culture and sensitivity. After inserting the catheter, you find that urine is not flowing. Your next action is to:
a. remove the catheter, check the meatus, and reinsert the catheter
b. obtain a new, larger sized catheter and insert it
c. reassess if the catheter is in the vagina; if so, remove it and reinsert into meatus
d. insert the catheter a little farther, wait a few seconds, and if urine does not flow, reassess placement
4. When the urine begins to flow through catheter, your next action is to:
a. inflate the catheter balloon with sterile water
b. place the catheter tip into the specimen container
c. connect the catheter into the drainage tubing
d. place the catheter tip into the urine collection receptacle
5. Following application of a leg cast, you will first check the toes for:
a. increase in temperature
b. change in color
c. edema
d. movement
96. The client is unable to feel you apply pressure on his toes and complains of tingling. These signs indicate:
a. pressure on a nerve
b. phantom pain syndrome
c. overmedication of an analgesic
d. improper alignment of the fracture
7. From your knowledge of the casting procedure, you understand that a wet cat should be:
a. placed on a firm surface for the first few hours
b. handled only with the palms of the hands
c. left alone to set for at least three hours
d. pelated to lessen chance of irritation to the client
8. During a retention catheter insertion or bladder irrigation, the nurse must use:
a. sterile equipment and wear sterile gloves
b. clean equipment and maintain surgical asepsis
c. sterile equipment and maintain medical asepsis
d. clean equipment and technique
9. Care for a client following a bronchoscopy will include:
a. withholding food and liquids until the gag reflex returns
b. providing throat irrigations every four hours
c. having the client refrain from talking for several days
d. suctioning frequently, as ordered
10. Reviewing the lab tests of a client scheduled for surgery, you find that the white blood cell count is 9800/mm3. The most appropriate intervention is to:
a. call the operating room and cancel the surgery
b. notify the surgeon immediately
c. take on action as your recognize that it is a normal value
d. call the lab and have the test repeated
11. If the client with psoriasis complains about pruritus, the nurse should suggest using:
a. drying soaps or agents
b. hot water when bathing
c. emollient lubricants
d. a towel to provide vigorous drying after bathing
12. You are supervising a student nurse giving an IM injection to a client with right hip arthroplasty. You will know the SN requires further instruction if she:
a. administers the injection in the left deltoid muscle
b. turns the client on her right hip to administer the injection
c. keeps the abduction pillow in place and turns the client 10 degrees to administer the injection on the unaffected side
d. administers the injection after turning the client to her left thigh, keeping the abduction pillow in place
13. You are assisting a client to choose a meal that follows his dietary orders of high calorie, high protein, decreased sodium, and low potassium. You will know the understands his dietary guidelines when he chooses:
a. crab, beets and spinach, baked potato, and milk
b. halibut, salad, rice, and instant coffee
c. sirloin steak, salad, baked potato with butter, and chocolate ice cream
d. salmon, rice, green beans, sourdough bread, coffee, and ice cream
14. The best rationale for introducing your-self to a blind client and telling him exactly what you are doing is that these actions:
a. illustrate the principle of open communication
b. decrease the client’s anxiety and fear of the unknown
c. are the accepted procedure for beginning a nurse-client relationship
d. encourage and utilize clear communication
15. Sitting down at the client’s bedside to talk with the client with convey a sense of:
a. sympathy
b. communication
c. empathy
d. encouragement
16. While assessing a client who has orders for a hot-water bottle, heating pad, or hot compress, the first sign of possible thermal injury is:
a. tingling sensation in the extremities c. edema
b. redness in the are d. pain
17. When charting the procedure for applying restraints to a client, you will include:
a. what the client says about the restraint
b. procedure for applying the restraint
c. physician’s orders regarding the restraint
d. condition of the extremity following application
18. To perform the skill “turning to the side-lying position,” you would lower the head of the bed, elevate bed to working height, move client to your side of the bed, and flex client’s knees. The next intervention, would be to:
a. roll the client on his side
b. reposition client
c. place one hand on client’s hip and other on shoulder
d. reposition client’s arms so they are not under his body
19. Your client insists on being discharged from the hospital against medical advice. From a legal standpoint, the most important nursing action is to:
a. notify the supervisor and hospital administration
b. determine exactly why the client wants to leave
c. put all appropriate forms in the client’s chart before he leaves the hospital
d. request that the client sign the against medical advice (AMA) form
20. You are moving the client from the bed to a chair. The first appropriate intervention is to:
a. dangle the client at his bedside
b. put nonslip shoes or slippers on client’s feet
c. rock the client and pivot
d. position client so that he is comfortable.
21. The nurse answers the phone in the emergency room, a woman states that she has a nosebleed that has not stopped for the past two hours. The nurse tells her that she should come to the ER immediately but do which of the following first?
a. put pressure on the bridge of the nose for 5 to 30 minutes, applying an icepack and sit with the head forward
b. apply heat to the bridge of the nose and do not eat
c. sit with the head back and use a towel to blot blood drainage
d. when blood is felt in the nose, lightly blow the nose into a tissue
22. A male client has been diagnosed with chronic obstructive pulmonary disease (COPD) for the last 10 years. He continues to smoke 2 packs of cigarettes a day. He requires oxygen to perform his daily activities. Which of the following therapeutic management modalities is necessary?
a. low flow of oxygen is usually ordered
b. oxygen flow is adjusted to a higher level if shortness of breath occurs
c. petroleum jelly should be applied around the nares to prevent irritation
d. oxygen flow rate is not a concern since he will feel better if the rate is high
23. Mrs. X has been diagnosed with acute asthma. she has been admitted to the hospital and all of the following instructions to the nurse are correct, except:
a. the head of the bed should be in the high position to facilitate drainage and breathing
b. a cool and dry environment should be maintained
c. air conditioner filter should be changed often
d. oxygen should never be used as it could restrict airways more
24. A female patient has had a partial gastrectomy with a vagotomy and pyloroplasty today. She has a nasogastric tube in her nares connected to low intermittent suction. The nurse should take which of the following precautions?
a. do not irrigate or reposition the NG tube because the stomach sutures can be ruptured
b. always use wrist restraints to assure placement of NGT
c. the NG tube should not be taped to the nose
d. expect copious amount of bright red blood from the NG tube postoperatively
25. A man complains of cramping abdominal pain. He has been diagnosed with acute diverticulitis. What nursing interventions are likely to be ordered?
a. increase activity and regular diet as tolerated
b. advise bed rest, clear liquids and meperidine (Demerol), 50 mg IM every 3-4 hours as needed
c. use ice packs on the abdomen and place the client in the trendelenburg position
d. use a K-pad (a temperature controlled heating pad) on the abdomen and allow regular diet as tolerated
26. has been diagnosed with esophageal varices. The physician notes there is active bleeding and orders the nurse to insert NG tube. The nurse should do which of the following?
a. insert the NG tube immediately
b. question the order because a varix might be perforated during insertion
c. use copious amount of K-Y jelly to insert the NG tube
d. refuse the order because a varix might be perforated during insertion
27. A 30-year-old patient has been diagnosed with folic acid deficiency. The client asks the nurse which foods are high in folic acid, and the nurse correctly responds:
a. green leafy vegetables, organ meats, nuts and eggs
b. fresh shrimp and oysters
c. dried fruits and oatmeal
d. tofu and tuna
28. Which of the following is an example of pica?
a. a craving for sweets
b. a craving for laundry starch and ice
c. a craving for shellfish
d. craving for pickles
29. An 82-year-old woman living in a long-term care facility develops urinary incontinence. After ruling out the presence of urinary retention or a urinary tract infection (UTI), the nurse should:
a. establish a 3-hour prompted voiding schedule
b. insert a foley catheter or teach the client to self-catheterize
c. restrict her fluid intake to 1500 ml/day
d. use adult diapers and change them frequently
30. Client education for the individual with gout includes:
a. dietary instructions to limit meat, poultry, organ meats and alcohol
b. dietary instructions to limit complex carbohydrates such as flat bread, rice and pasta
c. instructions for proper cast care
d. signs and symptoms of compartment syndrome, a major complication
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1. Before administering a nasogastric feeding, the nurse aspirate the stomach contents and obtain 50 cc of residual. the next action is to:
a. discard aspirate and begin tube feeding
b. replace aspirate and begin tube feeding
c. discard aspirate and hold the tube feeding
d. replace aspirate and hold the tube feeding
2. You are assigned to a client with a central vein IV infusing hyperalimentation solution. The most important nursing intervention is:
a. preparing the next bottle of solution prior to use
b. maintaining the exact amount of solution administered hourly by adjusting the flow rate
c. checking urine specific gravity, sugar, and acetone every for hours
d. changing the IV filter and tubing with each bottle change
3. You have been assigned to a female patient who needs to have a sterile urine specimen sent to the laboratory for a culture and sensitivity. After inserting the catheter, you find that urine is not flowing. Your next action is to:
a. remove the catheter, check the meatus, and reinsert the catheter
b. obtain a new, larger sized catheter and insert it
c. reassess if the catheter is in the vagina; if so, remove it and reinsert into meatus
d. insert the catheter a little farther, wait a few seconds, and if urine does not flow, reassess placement
4. When the urine begins to flow through catheter, your next action is to:
a. inflate the catheter balloon with sterile water
b. place the catheter tip into the specimen container
c. connect the catheter into the drainage tubing
d. place the catheter tip into the urine collection receptacle
5. Following application of a leg cast, you will first check the toes for:
a. increase in temperature
b. change in color
c. edema
d. movement
96. The client is unable to feel you apply pressure on his toes and complains of tingling. These signs indicate:
a. pressure on a nerve
b. phantom pain syndrome
c. overmedication of an analgesic
d. improper alignment of the fracture
7. From your knowledge of the casting procedure, you understand that a wet cat should be:
a. placed on a firm surface for the first few hours
b. handled only with the palms of the hands
c. left alone to set for at least three hours
d. pelated to lessen chance of irritation to the client
8. During a retention catheter insertion or bladder irrigation, the nurse must use:
a. sterile equipment and wear sterile gloves
b. clean equipment and maintain surgical asepsis
c. sterile equipment and maintain medical asepsis
d. clean equipment and technique
9. Care for a client following a bronchoscopy will include:
a. withholding food and liquids until the gag reflex returns
b. providing throat irrigations every four hours
c. having the client refrain from talking for several days
d. suctioning frequently, as ordered
10. Reviewing the lab tests of a client scheduled for surgery, you find that the white blood cell count is 9800/mm3. The most appropriate intervention is to:
a. call the operating room and cancel the surgery
b. notify the surgeon immediately
c. take on action as your recognize that it is a normal value
d. call the lab and have the test repeated
11. If the client with psoriasis complains about pruritus, the nurse should suggest using:
a. drying soaps or agents
b. hot water when bathing
c. emollient lubricants
d. a towel to provide vigorous drying after bathing
12. You are supervising a student nurse giving an IM injection to a client with right hip arthroplasty. You will know the SN requires further instruction if she:
a. administers the injection in the left deltoid muscle
b. turns the client on her right hip to administer the injection
c. keeps the abduction pillow in place and turns the client 10 degrees to administer the injection on the unaffected side
d. administers the injection after turning the client to her left thigh, keeping the abduction pillow in place
13. You are assisting a client to choose a meal that follows his dietary orders of high calorie, high protein, decreased sodium, and low potassium. You will know the understands his dietary guidelines when he chooses:
a. crab, beets and spinach, baked potato, and milk
b. halibut, salad, rice, and instant coffee
c. sirloin steak, salad, baked potato with butter, and chocolate ice cream
d. salmon, rice, green beans, sourdough bread, coffee, and ice cream
14. The best rationale for introducing your-self to a blind client and telling him exactly what you are doing is that these actions:
a. illustrate the principle of open communication
b. decrease the client’s anxiety and fear of the unknown
c. are the accepted procedure for beginning a nurse-client relationship
d. encourage and utilize clear communication
15. Sitting down at the client’s bedside to talk with the client with convey a sense of:
a. sympathy
b. communication
c. empathy
d. encouragement
16. While assessing a client who has orders for a hot-water bottle, heating pad, or hot compress, the first sign of possible thermal injury is:
a. tingling sensation in the extremities c. edema
b. redness in the are d. pain
17. When charting the procedure for applying restraints to a client, you will include:
a. what the client says about the restraint
b. procedure for applying the restraint
c. physician’s orders regarding the restraint
d. condition of the extremity following application
18. To perform the skill “turning to the side-lying position,” you would lower the head of the bed, elevate bed to working height, move client to your side of the bed, and flex client’s knees. The next intervention, would be to:
a. roll the client on his side
b. reposition client
c. place one hand on client’s hip and other on shoulder
d. reposition client’s arms so they are not under his body
19. Your client insists on being discharged from the hospital against medical advice. From a legal standpoint, the most important nursing action is to:
a. notify the supervisor and hospital administration
b. determine exactly why the client wants to leave
c. put all appropriate forms in the client’s chart before he leaves the hospital
d. request that the client sign the against medical advice (AMA) form
20. You are moving the client from the bed to a chair. The first appropriate intervention is to:
a. dangle the client at his bedside
b. put nonslip shoes or slippers on client’s feet
c. rock the client and pivot
d. position client so that he is comfortable.
21. The nurse answers the phone in the emergency room, a woman states that she has a nosebleed that has not stopped for the past two hours. The nurse tells her that she should come to the ER immediately but do which of the following first?
a. put pressure on the bridge of the nose for 5 to 30 minutes, applying an icepack and sit with the head forward
b. apply heat to the bridge of the nose and do not eat
c. sit with the head back and use a towel to blot blood drainage
d. when blood is felt in the nose, lightly blow the nose into a tissue
22. A male client has been diagnosed with chronic obstructive pulmonary disease (COPD) for the last 10 years. He continues to smoke 2 packs of cigarettes a day. He requires oxygen to perform his daily activities. Which of the following therapeutic management modalities is necessary?
a. low flow of oxygen is usually ordered
b. oxygen flow is adjusted to a higher level if shortness of breath occurs
c. petroleum jelly should be applied around the nares to prevent irritation
d. oxygen flow rate is not a concern since he will feel better if the rate is high
23. Mrs. X has been diagnosed with acute asthma. she has been admitted to the hospital and all of the following instructions to the nurse are correct, except:
a. the head of the bed should be in the high position to facilitate drainage and breathing
b. a cool and dry environment should be maintained
c. air conditioner filter should be changed often
d. oxygen should never be used as it could restrict airways more
24. A female patient has had a partial gastrectomy with a vagotomy and pyloroplasty today. She has a nasogastric tube in her nares connected to low intermittent suction. The nurse should take which of the following precautions?
a. do not irrigate or reposition the NG tube because the stomach sutures can be ruptured
b. always use wrist restraints to assure placement of NGT
c. the NG tube should not be taped to the nose
d. expect copious amount of bright red blood from the NG tube postoperatively
25. A man complains of cramping abdominal pain. He has been diagnosed with acute diverticulitis. What nursing interventions are likely to be ordered?
a. increase activity and regular diet as tolerated
b. advise bed rest, clear liquids and meperidine (Demerol), 50 mg IM every 3-4 hours as needed
c. use ice packs on the abdomen and place the client in the trendelenburg position
d. use a K-pad (a temperature controlled heating pad) on the abdomen and allow regular diet as tolerated
26. has been diagnosed with esophageal varices. The physician notes there is active bleeding and orders the nurse to insert NG tube. The nurse should do which of the following?
a. insert the NG tube immediately
b. question the order because a varix might be perforated during insertion
c. use copious amount of K-Y jelly to insert the NG tube
d. refuse the order because a varix might be perforated during insertion
27. A 30-year-old patient has been diagnosed with folic acid deficiency. The client asks the nurse which foods are high in folic acid, and the nurse correctly responds:
a. green leafy vegetables, organ meats, nuts and eggs
b. fresh shrimp and oysters
c. dried fruits and oatmeal
d. tofu and tuna
28. Which of the following is an example of pica?
a. a craving for sweets
b. a craving for laundry starch and ice
c. a craving for shellfish
d. craving for pickles
29. An 82-year-old woman living in a long-term care facility develops urinary incontinence. After ruling out the presence of urinary retention or a urinary tract infection (UTI), the nurse should:
a. establish a 3-hour prompted voiding schedule
b. insert a foley catheter or teach the client to self-catheterize
c. restrict her fluid intake to 1500 ml/day
d. use adult diapers and change them frequently
30. Client education for the individual with gout includes:
a. dietary instructions to limit meat, poultry, organ meats and alcohol
b. dietary instructions to limit complex carbohydrates such as flat bread, rice and pasta
c. instructions for proper cast care
d. signs and symptoms of compartment syndrome, a major complication
“If A is a success in life, then A equals x plus y plus z. Work is x; y is play; and z is keeping your mouth shut” - A. Eistein
Wednesday, January 29, 2014
Pre-Board Exam Dill: Fundamentals of Nursing C
This is a 30 point Pre-Board Exam Drill on Fundamentals of Nursing SET C.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1. When a client responds to a crisis situation or an acute injury, the sympathetic nervous system will respond in which of the following ways?
a. it will increase blood flow to the abdominal organs
b. it will decrease blood flow to the vital organs
c. it will stimulate the adrenals to release epinephrine
2. During the clonic phase of a generalized seizure, you may expect to see:
a. pupil dilatation, tachycardia and muscle spasms
b. bladder incontinence, elevated blood pressure and diaphoresis
c. loss of consciousness, cessation of breathing and cyanosis
d. contracted throat muscles, hyperventilation and salivation
3. The physician orders ice for the scrotum of a client diagnosed with epididymitis. The nurse correctly assumes that:
a. ice slows circulation and decreases peripheral edema
b. ice should be applied in intervals, not continuously
c. ice is placed on the scrotum continuously until the physician orders otherwise
d. ice will not stop the pain, and it has a placebo effect
4. The best time for menstruating women to perform a breast self-examination is:
a. right before the menstrual period
b. during the menstrual period
c. a few days after the menstrual period
d. 14 days after the menstrual period
5. Which of the following procedures is most effective for preventing hemolytic blood transfusion reactions?
a. administer the blood through 5% dextrose in water (D5W)
b. administration of a steroid prior to the transfusion
c. careful identification of the client and the blood product
d. using a leukocyte-poor filter during the transfusion
6. A superficial partial-thickness burn should heal in:
a. one week c. six weeks
b. three weeks d. two months
Answer A: Healing of superficial partial-thickness burns usually occurs within a week.
7. The setting that is most suitable for the treatment of a client with a full thickness burn is:
a. admission to a burn unit
b. admission to a medical unit
c. treatment in an emergency room or ambulatory care setting
d. home health care
Answer A: Full-thickness burns usually require hospitalization in a burn unit with comprehensive care by a burn team. The age of a client and the body area involved determine the need for emergency attention.
8. A full thickness burn would appear:
a. red, as if client were sunburned
b. bright red and weeping fluid
c. mottled without weeping fluid
d. brown and leather-like
9. In a patient with full thickness burn of the face, the nurse must immediately address:
a. airway management and hypovolemic shock
b. moderate discomfort and minor fluid loss
c. pain management with intravenous morphine
d. wound care
10. A full thickness burn of the face should heal in:
a. one week c. six weeks
b. three weeks d. months
11. If the client with psoriasis complains about pruritus, the nurse should suggest using:
a. drying soaps or agents
b. hot water when bathing
c. emollient lubricants
d. a towel to provide vigorous drying after bathing
12. You are supervising a student nurse giving an IM injection to a client with right hip arthroplasty. You will know the SN requires further instruction if she:
a. administers the injection in the left deltoid muscle
b. turns the client on her right hip to administer the injection
c. keeps the abduction pillow in place and turns the client 10 degrees to administer the injection on the unaffected side
d. administers the injection after turning the client to her left thigh, keeping the abduction pillow in place
13. You are assisting a client to choose a meal that follows his dietary orders of high calorie, high protein, decreased sodium, and low potassium. You will know the understands his dietary guidelines when he chooses:
a. crab, beets and spinach, baked potato, and milk
b. halibut, salad, rice, and instant coffee
c. sirloin steak, salad, baked potato with butter, and chocolate ice cream
d. salmon, rice, green beans, sourdough bread, coffee, and ice cream
14. The best rationale for introducing your-self to a blind client and telling him exactly what you are doing is that these actions:
a. illustrate the principle of open communication
b. decrease the client’s anxiety and fear of the unknown
c. are the accepted procedure for beginning a nurse-client relationship
d. encourage and utilize clear communication
15. Sitting down at the client’s bedside to talk with the client with convey a sense of:
a. sympathy
b. communication
c. empathy
d. encouragement
16. While assessing a client who has orders for a hot-water bottle, heating pad, or hot compress, the first sign of possible thermal injury is:
a. tingling sensation in the extremities c. edema
b. redness in the are d. pain
17. When charting the procedure for applying restraints to a client, you will include:
a. what the client says about the restraint
b. procedure for applying the restraint
c. physician’s orders regarding the restraint
d. condition of the extremity following application
18. To perform the skill “turning to the side-lying position,” you would lower the head of the bed, elevate bed to working height, move client to your side of the bed, and flex client’s knees. The next intervention, would be to:
a. roll the client on his side
b. reposition client
c. place one hand on client’s hip and other on shoulder
d. reposition client’s arms so they are not under his body
19. Your client insists on being discharged from the hospital against medical advice. From a legal standpoint, the most important nursing action is to:
a. notify the supervisor and hospital administration
b. determine exactly why the client wants to leave
c. put all appropriate forms in the client’s chart before he leaves the hospital
d. request that the client sign the against medical advice (AMA) form
20. You are moving the client from the bed to a chair. The first appropriate intervention is to:
a. dangle the client at his bedside
b. put nonslip shoes or slippers on client’s feet
c. rock the client and pivot
d. position client so that he is comfortable.
21. The primary purpose of client education is to:
a. collect client data
b. determine readiness to learn
c. assess degree of compliance
d. increase client’s knowledge that will affect health status
22. Your initial instruction to a client on the use of crutches to move upstairs should be to:
a. start with crutches and the unaffected leg on the same level
b. start with crutches and the affected leg on the same level
c. place crutches on the step after the affected leg is moved up the stair
d. place crutches on the stair and then move the affected leg to the stair
23. When a client experiences a severe anaphylactic reaction to a medication, your initial action is to:
a. start an IV
b. assess vital signs
c. place the client in a supine position
d. prepare equipment for intubation
24. If a blood transfusion reaction occurs, the first intervention is to:
a. place the client in high-fowler’s position
b. call the physician
c. slow the rate of transfusion to “keep open” rate
d. shut off the transfusion
25. The correct action for instilling eye drops is to instill the drops:
a. at the outer canthus of the eye
b. over the conjunctiva
c. directly on the cornea
d. into the center of conjunctival sac
26. Assessing a client for hypovolemic shock, the sign that you would expect to note if this complication occurs is:
a. hypertension
b. cyanosis
c. oliguria
d. tachypnea
27. When evaluating the client’s understanding of a low potassium diet, you will know he understands if he tells you that he will avoid:
a. pasta
b. raw apples
c. dry cereal
d. french bread
28. Irrigating a nasogastric tube should be carried out using which one of the following protocols?
a. gently instill 20 cc normal saline and then withdraw solution
b. instill 30 cc sterile water and then withdraw solution
c. instill 30 cc sterile saline, forcefully if necessary, and allow fluid to flow into basin for return
d. gently instill 20 cc sterile water and then allow fluid to flow into basin for return
29. The morning of the second postoperative day, a female patient is to be ambulated. Your first intervention is to:
a. get her up in a chair
b. use a walker when getting her up
c. have her put minimal weight on the affected side
d. practice getting her out of bed by slightly flexing her lips
30. You are assigned a client who has just had a nasogastric tube inserted postoperatively. During your evaluation of his status, you will check for:
a. electrolyte imbalance
b. gastric distention
c. ulcerative colitis
d. infection
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1. When a client responds to a crisis situation or an acute injury, the sympathetic nervous system will respond in which of the following ways?
a. it will increase blood flow to the abdominal organs
b. it will decrease blood flow to the vital organs
c. it will stimulate the adrenals to release epinephrine
2. During the clonic phase of a generalized seizure, you may expect to see:
a. pupil dilatation, tachycardia and muscle spasms
b. bladder incontinence, elevated blood pressure and diaphoresis
c. loss of consciousness, cessation of breathing and cyanosis
d. contracted throat muscles, hyperventilation and salivation
3. The physician orders ice for the scrotum of a client diagnosed with epididymitis. The nurse correctly assumes that:
a. ice slows circulation and decreases peripheral edema
b. ice should be applied in intervals, not continuously
c. ice is placed on the scrotum continuously until the physician orders otherwise
d. ice will not stop the pain, and it has a placebo effect
4. The best time for menstruating women to perform a breast self-examination is:
a. right before the menstrual period
b. during the menstrual period
c. a few days after the menstrual period
d. 14 days after the menstrual period
5. Which of the following procedures is most effective for preventing hemolytic blood transfusion reactions?
a. administer the blood through 5% dextrose in water (D5W)
b. administration of a steroid prior to the transfusion
c. careful identification of the client and the blood product
d. using a leukocyte-poor filter during the transfusion
6. A superficial partial-thickness burn should heal in:
a. one week c. six weeks
b. three weeks d. two months
Answer A: Healing of superficial partial-thickness burns usually occurs within a week.
7. The setting that is most suitable for the treatment of a client with a full thickness burn is:
a. admission to a burn unit
b. admission to a medical unit
c. treatment in an emergency room or ambulatory care setting
d. home health care
Answer A: Full-thickness burns usually require hospitalization in a burn unit with comprehensive care by a burn team. The age of a client and the body area involved determine the need for emergency attention.
8. A full thickness burn would appear:
a. red, as if client were sunburned
b. bright red and weeping fluid
c. mottled without weeping fluid
d. brown and leather-like
9. In a patient with full thickness burn of the face, the nurse must immediately address:
a. airway management and hypovolemic shock
b. moderate discomfort and minor fluid loss
c. pain management with intravenous morphine
d. wound care
10. A full thickness burn of the face should heal in:
a. one week c. six weeks
b. three weeks d. months
11. If the client with psoriasis complains about pruritus, the nurse should suggest using:
a. drying soaps or agents
b. hot water when bathing
c. emollient lubricants
d. a towel to provide vigorous drying after bathing
12. You are supervising a student nurse giving an IM injection to a client with right hip arthroplasty. You will know the SN requires further instruction if she:
a. administers the injection in the left deltoid muscle
b. turns the client on her right hip to administer the injection
c. keeps the abduction pillow in place and turns the client 10 degrees to administer the injection on the unaffected side
d. administers the injection after turning the client to her left thigh, keeping the abduction pillow in place
13. You are assisting a client to choose a meal that follows his dietary orders of high calorie, high protein, decreased sodium, and low potassium. You will know the understands his dietary guidelines when he chooses:
a. crab, beets and spinach, baked potato, and milk
b. halibut, salad, rice, and instant coffee
c. sirloin steak, salad, baked potato with butter, and chocolate ice cream
d. salmon, rice, green beans, sourdough bread, coffee, and ice cream
14. The best rationale for introducing your-self to a blind client and telling him exactly what you are doing is that these actions:
a. illustrate the principle of open communication
b. decrease the client’s anxiety and fear of the unknown
c. are the accepted procedure for beginning a nurse-client relationship
d. encourage and utilize clear communication
15. Sitting down at the client’s bedside to talk with the client with convey a sense of:
a. sympathy
b. communication
c. empathy
d. encouragement
16. While assessing a client who has orders for a hot-water bottle, heating pad, or hot compress, the first sign of possible thermal injury is:
a. tingling sensation in the extremities c. edema
b. redness in the are d. pain
17. When charting the procedure for applying restraints to a client, you will include:
a. what the client says about the restraint
b. procedure for applying the restraint
c. physician’s orders regarding the restraint
d. condition of the extremity following application
18. To perform the skill “turning to the side-lying position,” you would lower the head of the bed, elevate bed to working height, move client to your side of the bed, and flex client’s knees. The next intervention, would be to:
a. roll the client on his side
b. reposition client
c. place one hand on client’s hip and other on shoulder
d. reposition client’s arms so they are not under his body
19. Your client insists on being discharged from the hospital against medical advice. From a legal standpoint, the most important nursing action is to:
a. notify the supervisor and hospital administration
b. determine exactly why the client wants to leave
c. put all appropriate forms in the client’s chart before he leaves the hospital
d. request that the client sign the against medical advice (AMA) form
20. You are moving the client from the bed to a chair. The first appropriate intervention is to:
a. dangle the client at his bedside
b. put nonslip shoes or slippers on client’s feet
c. rock the client and pivot
d. position client so that he is comfortable.
21. The primary purpose of client education is to:
a. collect client data
b. determine readiness to learn
c. assess degree of compliance
d. increase client’s knowledge that will affect health status
22. Your initial instruction to a client on the use of crutches to move upstairs should be to:
a. start with crutches and the unaffected leg on the same level
b. start with crutches and the affected leg on the same level
c. place crutches on the step after the affected leg is moved up the stair
d. place crutches on the stair and then move the affected leg to the stair
23. When a client experiences a severe anaphylactic reaction to a medication, your initial action is to:
a. start an IV
b. assess vital signs
c. place the client in a supine position
d. prepare equipment for intubation
24. If a blood transfusion reaction occurs, the first intervention is to:
a. place the client in high-fowler’s position
b. call the physician
c. slow the rate of transfusion to “keep open” rate
d. shut off the transfusion
25. The correct action for instilling eye drops is to instill the drops:
a. at the outer canthus of the eye
b. over the conjunctiva
c. directly on the cornea
d. into the center of conjunctival sac
26. Assessing a client for hypovolemic shock, the sign that you would expect to note if this complication occurs is:
a. hypertension
b. cyanosis
c. oliguria
d. tachypnea
27. When evaluating the client’s understanding of a low potassium diet, you will know he understands if he tells you that he will avoid:
a. pasta
b. raw apples
c. dry cereal
d. french bread
28. Irrigating a nasogastric tube should be carried out using which one of the following protocols?
a. gently instill 20 cc normal saline and then withdraw solution
b. instill 30 cc sterile water and then withdraw solution
c. instill 30 cc sterile saline, forcefully if necessary, and allow fluid to flow into basin for return
d. gently instill 20 cc sterile water and then allow fluid to flow into basin for return
29. The morning of the second postoperative day, a female patient is to be ambulated. Your first intervention is to:
a. get her up in a chair
b. use a walker when getting her up
c. have her put minimal weight on the affected side
d. practice getting her out of bed by slightly flexing her lips
30. You are assigned a client who has just had a nasogastric tube inserted postoperatively. During your evaluation of his status, you will check for:
a. electrolyte imbalance
b. gastric distention
c. ulcerative colitis
d. infection
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