Anatomy and Physiology Notes: Conduction System of the Heart

   Key Concepts

1. The electrical activity of cardiac cells is caused by the selective opening and closing of plasma membrane channels for sodium, potassium, and calcium ions.

2. Depolarization is achieved by the opening of sodium and calcium channels and the closing of potassium channels.

3. Repolarization is achieved by the opening of potassium channels and the closing of sodium and calcium

channels.

4. Pacemaker potentials are achieved by the opening of channels for sodium and calcium ions and the closing of channels for potassium ions.

5. Electrical activity is normally initiated in the sinoatrial (SA) node where pacemaker cells reach threshold first.

6. Electrical activity spreads across the atria, through the atrioventricular (AV) node, through the Purkinje system, and to ventricular muscle.

7. Norepinephrine increases pacemaker activity and the speed of action potential conduction.

8. Acetylcholine decreases pacemaker activity and the speed of action potential conduction.

9. Voltage differences between repolarized and depolarized regions of the heart are recorded by an electrocardiogram (ECG).

10. The ECG provides clinically useful information about rate, rhythm, pattern of depolarization, and mass of electrically active cardiac muscle.

Pathway

SA Node

|

Walls of the Atrium (Atrial Contraction)

|

AV Node

|

Delay in transmission

(To provide ample time for ventricular filling)

|

Bundle of His

|

Left and Right Bundle Branch

|

Purkinje Fibers

|

Ventricular Contraction

Notes on Fluid and Electrolytes 4 FLUID VOLUME DEFICIT

FLUID VOLUME DEFICIT

A. Description
1. Dehydration occurs when the fluid intake of the body is not sufficient to meet the fluid needs of the body.
2. The goal of treatment is to restore fluid volume, replace electrolytes as needed, and eliminate the cause of the fluid volume deficit.

B. Types of fluid volume deficits
1. Isotonic dehydration
a. Water and dissolved electrolytes are lost in equal proportions.
b. Known as hypovolemia, isotonic dehydration is the most common type of dehydration.
c. Isotonic dehydration results in decreased circulating blood volume and inadequate tissue perfusion.

2. Hypertonic dehydration
a. Water loss exceeds electrolyte loss.
b. The clinical problems that occur result from alterations in the concentrations of specific plasma electrolytes.
c. Fluid moves from the intracellular compartment into the plasma and interstitial fluid spaces, causing cellular dehydration and shrinkage.

3. Hypotonic dehydration
a. Electrolyte loss exceeds water loss.
b. The clinical problems that occur result from fluid shifts between compartments, causing a decrease in
plasma volume.
c. Fluid moves from the plasma and interstitial fluid spaces into the cells, causing a plasma volume deficit and causing the cells to swell.

C. Causes of fluid volume deficits
1. Isotonic dehydration
a. Inadequate intake of fluids and solutes
b. Fluid shifts between compartments
c. Excessive losses of isotonic body fluids

2. Hypertonic dehydration—conditions that increase fluid
loss, such as excessive perspiration, hyperventilation,
ketoacidosis, prolonged fevers, diarrhea, early-stage
renal failure, and diabetes insipidus

3. Hypotonic dehydration
a. Chronic illness
b. Excessive fluid replacement (hypotonic)
c. Renal failure
d. Chronic malnutrition

D. Assessment
1. Cardiovascular
a. Thready, increased pulse rate
b. Decreased blood pressure and orthostatic (postural) hypotension
c. Flat neck and hand veins in dependent positions
d. Diminished peripheral pulses

2. Respiratory: Increased rate and depth of respirations

3. Neuromuscular
a. Decreased central nervous system activity, from lethargy to coma
b. Fever

4. Renal
a. Decreased urinary output
b. Increased urinary specific gravity

5. Integumentary
a. Dry skin
b. Poor turgor, tenting present
c. Dry mouth

6. Gastrointestinal
a. Decreased motility and diminished bowel sounds
b. Constipation
c. Thirst
d. Decreased body weight

7. Hypotonic dehydration: skeletal muscle weakness

8. Hypertonic dehydration
a. Hyperactive deep tendon reflexes
b. Pitting edema

9. Laboratory findings
a. Increased serum osmolality
b. Increased hematocrit
c. Increased blood urea nitrogen (BUN) level
d. Increased serum sodium level

E. Interventions
1. Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and gastrointestinal status.
2. Prevent further fluid losses and increase fluid compartment volumes to normal ranges.
3. Provide oral rehydration therapy if possible and intravenous (IV) fluid replacement if the dehydration is
severe; monitor intake and output.
4. Generally, isotonic dehydration is treated with isotonic fluid solutions, hypertonic dehydration with hypotonic fluid solutions, and hypotonic dehydration with hypertonic fluid solutions.
5. Administer medications as prescribed such as antidiarrheal, antimicrobial, antiemetic, and antipyretic
medications, to correct the cause and treat any symptoms.
6. Administer oxygen as prescribed.
7. Monitor electrolyte values and prepare to administer medication to treat an imbalance, if present.

Anatomy and Physiology Notes: Gastrointestinal-Hepatobillary System

This is an outlined lecture note on the Anatomy and Physiology of theGastrointestinal-Hepatobillary System. Some information are so compressed that some concepts are not explained 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 advanced concept in Pathophysiology and Medical Surgical Nursing.

Functions of the gastrointestinal system
- Process food substances.
- Absorb the products of digestion into the blood.
- Excrete unabsorbed materials.
- Provide an environment for microorganisms to synthesize nutrients, such as vitamin K.

 Mouth
- Contains the lips, cheeks, palate, tongue, teeth, salivary glands, muscles, and maxillary bones
- Saliva contains the amylase enzyme (ptyalin) that aids in digestion.

Esophagus
- Collapsible muscular tube about 10 inches long
- Carries food from the pharynx to the stomach


The stomach
- Contains the cardia, fundus, the body, and the pylorus
- Mucous glands are located in the mucosa and prevent autodigestion by providing an alkaline protective covering.
- The lower esophageal (cardiac) sphincter prevents reflux of gastric contents into the esophagus.
- The pyloric sphincter regulates the rate of stomach emptying into the small intestine.
- Hydrochloric acid kills microorganisms, breaks food into small particles, and provides a chemical environment that facilitates gastric enzyme activation.
- Pepsin is the chief coenzyme of gastric juice, which converts proteins into proteases and peptones.
- Intrinsic factor is necessary for the absorption of vitamin B12.
- Gastrin controls gastric acidity.

Small intestine
- The duodenum contains the openings of the bile and pancreatic ducts.
- The jejunum is about 8 feet long.
- The ileum is about 12 feet long.
- The small intestine terminates in the cecum.

Pancreatic intestinal juice enzymes
- Amylase digests starch to maltose.
- Maltase reduces maltose to monosaccharide glucose.
-  Lactase splits lactose into galactose and glucose.
- Sucrase reduces sucrose to fructose and glucose.
- Nucleases split nucleic acids to nucleotides.
-. Enterokinase activates trypsinogen to trypsin.


Large intestine
- About 5 feet long
- Absorbs water and eliminates wastes
- Intestinal bacteria play a vital role in the synthesis of some B vitamins and vitamin K.
- Colon: Includes the ascending, transverse, descending, and sigmoid colons and rectum
- The ileocecal valve prevents contents of the large intestine from entering the ileum.
- The anal sphincters control the anal canal.

Peritoneum: Lines the abdominal cavity and forms the mesentery that supports
the intestines and blood supply

Liver
-The largest gland in the body, weighing 3 to 4 lb.
-Contains Kupffer's cells, which remove bacteria in the portal venous blood
- Removes excess glucose and amino acids from the portal blood
- Synthesizes glucose, amino acids, and fats
- Aids in the digestion of fats, carbohydrates, and proteins
- Stores and filters blood (200 to 400 mL of blood stored)
- Stores vitamins A, D, and B and iron
- The liver secretes bile to emulsify fats (500 to 1000 mL of bile/day).
 Hepatic ducts
a. Deliver bile to the gallbladder via the cystic duct and to the
duodenum via the common bile duct.
b. The common bile duct opens into the duodenum, with the pancreatic duct at the ampulla of Vater.
c. The sphincter prevents the reflux of intestinal contents into the
common bile duct and pancreatic duct.

Gallbladder
-Stores and concentrates bile and contracts to force bile into the duodenum during the digestion of fats
- The cystic duct joins the hepatic duct to form the common bile duct.
- The sphincter of Oddi is located at the entrance to the duodenum.
- The presence of fatty materials in the duodenum stimulates the liberation of cholecystokinin, which causes contraction of the gallbladder and relaxation of the sphincter of Oddi.

Pancreas
Exocrine gland
- Secretes sodium bicarbonate to neutralize the acidity of the stomach contents that enter the duodenum
-. Pancreatic juices contain enzymes for digesting carbohydrates, fats, and proteins.
Endocrine gland
- Secretes glucagon to raise blood glucose levels and secretes somatostatin to exert a hypoglycemic effect
- The islets of Langerhans secrete insulin.
- Insulin is secreted into the bloodstream and is important for carbohydrate metabolism.

“If at first you don't succeed, try, try again. Then quit. No use being a damn fool about it.”  -WC Fields

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)

•  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"

Notes on Fluid and Electrolyte 2: CONCEPTS OF FLUID AND ELECTROLYTE BALANCE

CONCEPTS OF FLUID AND ELECTROLYTE BALANCE

Ebook Version here

A. Electrolytes
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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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.

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

“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

Nursing Leader: Sanger and Breckinridge

This is a series of post regarding notable nursing leaders who have given many contribution to nursing and their influence uplifted the nursing profession.


Nursing Leaders
Florence Nightingale, Clara Barton, Lillian Wald, Lavinia Dock, Margaret Sanger, and Mary Breckinridge are among the leaders who have made notable contributions both to nursing's history and to women's history. These women were all politically astute pioneers. Their skills at influencing others and bringing about change remain models for political nurse activists today. Contemporary nursing leaders, such as Virginia Henderson, who created a modern worldwide definition of nursing, and Martha Rogers, a catalyst for theory  development.

Sanger (1879-1966)
Margaret Biggins Sanger, a public health nurse in New York, has had a lasting impact on women's health care. Imprisoned for opening the first birth control information clinic in America, she is considered the founder of Planned Parenthood. Her experience with the large number of unwanted pregnancies among the working poor was instrumental in addressing this problem.

Breckinridge (1881-1965)
After World War I, Mary Breckinridge, a notable pioneer nurse, established the Frontier Nursing Service (FNS). In 1918, she worked with the American Committee for Devastated France, distributing food, clothing, and supplies to rural villages and taking care of sick children. In 1921, Breckinridge returned to the United States with plans to provide health care to the people of rural America. In 1925, Breckinridge and two other nurses began the FNS in Leslie County, Kentucky. Within this organization, Breckinridge started one of the first midwifery training schools in the United States.

Nursing Leader: Mary Mahoney

This is a series of post regarding notable nursing leaders who have given many contribution to nursing and their influence uplifted the nursing profession.


Nursing Leaders
Florence Nightingale, Clara Barton, Lillian Wald, Lavinia Dock, Margaret Sanger, and Mary Breckinridge are among the leaders who have made notable contributions both to nursing's history and to women's history. These women were all politically astute pioneers. Their skills at influencing others and bringing about change remain models for political nurse activists today. Contemporary nursing leaders, such as Virginia Henderson, who created a modern worldwide definition of nursing, and Martha Rogers, a catalyst for theory  development


Mahoney (1845-1926)
Mary Mahoney  was the first African American professional nurse. She graduated from the New England Hospital for Women and Children in 1879. She constantly worked for the acceptance of African Americans in nursing and for the promotion of equal opportunities (Donahue, 1996, p. 271). The American Nurses Association (2006b) gives a Mary Mahoney Award biennially in recognition of significant contributions in
interracial relationships.

NCLEX-RN DRILL 1

Test your knowledge in nursing concepts. Improve our test taking skills. Develop your attitude in attacking board type questions. Answer this NCLEX-RN DRILL and review the rationale behind the correct answer.

Tip!: Practice doesn't make your perfect but practice makes you better

1 A client is being discharged and needs instructions on wound care.When planning to teach the client, the nurse should:
a. identify the client’s learning needs and learning ability.
b. identify the client’s learning needs and advise him what to do.
c. identify the client’s problems and make the appropriate referral.
d. provide pamphlets or videotapes for ongoing learning.

2 A client is requesting a second opinion. The nurse who supports and promotes the client’s rights is acting as the client’s:
a. teacher.
b. adviser.
c. supporter.
d. advocate.

3 The client tells the nurse she has been smoking one pack of cigarettes a day for the past 20 years. The nurse recognizes this is what part of the nursing process?
a. assessment
b. planning
c. implementation
d. evaluation

4 During the assessment step of the nursing process, the nurse collects subjective and objective data. The nurse uses the information to identify:
a. medical diagnoses.
b. actual or potential problems.
c. client’s response to illness.
d. need for community support groups.

5 The nurse performs daily, routine equipment checks to detect possible malfunction. This is part of the nurse’s role in the:
a. nursing process.
b. quality assurance plan.
c. care management.
d. assessment plan.

6 The nurse is developing a nursing diagnosis for a client who has pneumonia. The nurse recognizes
the diagnosis describes an actual or potential problem that:
a. the nurse can treat independently
b. the nurse can treat with a physician’s order.
c. requires physician’s intervention.
d. relates to the clients’ primary diagnosis.

7 After administering pain medication, the nurse returns to check the client’s level of comfort. This stage
of the nursing process is known as:
a. assessment.
b. planning.
c. implementation.
d. evaluation.

8 A client has lost 10 pounds related to nausea and vomiting. The nurse identifies an appropriate expected
outcome: The client will:
a. gain weight.
b. gain 2 pounds within 1 week.
c. not lose weight.
d. gain 10 pounds in 2 days.

9 A problem-solving process that requires empathy, knowledge, divergent thinking, discipline, and creativity is known as:
a. critical thinking.
b. nursing process.
c. framework for nurses.
d. care management.

10 At the end of the shift, the nurse is ready to leave but has not been relieved by the oncoming shift nurse. The nurse’s responsibility to provide care for clients is part of the nurse’s:
a. Code of Ethics.
b. nursing process.
c. critical thinking.
d. quality assurance.

“A thinker sees his own actions as experiments and questions--as attempts to find out something. Success and failure are for him answers above all.” - Nietzche

Pre-Board Exam Drill: Fundamentals of Nursing B

This is a 30 point Pre-Board Exam Drill on Fundamentals of 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. The nurse is inserting an indwelling urinary catheter. Which action is essential to decrease the complications associated with catheter insertion?
a. cleanse the female client using betadine-soaked 4x4’s, cleaning from the rectal area to the clitoris
b. utilizing a catheter that is slightly larger than the external urinary meatus
c. utilize clean technique
d. test the retention balloon prior to insertion

2. The nurse is caring for an adult client who is scheduled for an intravenous pyelogram (IVP). Which nursing intervention is essential?
a. encourage large amounts of fluids prior to the test
b. assess for any indications of allergies
c. administer a laxative
d. restrict fluids only in clients with marginal renal reserve or uncontrolled diabetes


3. The nurse is caring for a client who has a nasogastric tube attached to low wall suction. The suction is not working. Which is the nurse least likely to note when assessing the client?
a. client vomits
b. client has a distended abdomen
c. there is no nasogastric output in the last two hours
d. large amounts of nasogastric output


4. A client who has ascites is admitted to the hospital and will be undergoing a paracentesis. What should be included in the nursing care plan?
a. monitor client closely for evidence of vascular collapse
b. place client in Trendelenburg position for the procedure
c. encourage client to drink plenty of fluids to distend the bladder prior to the procedure
d. have client remain on bed rest for 24 hours following the procedure


5. A patient underwent an exploratory laparotomy two days ago. The physician has just written an order for a soft diet. The nurse assessed the client and did not hear bowel sounds in any quadrant. What is the best nursing action?
a. follow the physician’s order and feed the client
b. cancel the physician’s order and make the client NPO
c. order clear liquids for the client
d. notify the physician that the client does not have bowel sounds at this time


6. Your patient is receiving O2 at 2 liters per nasal cannula. His roommate lights a cigarette and tosses the match catching the curtain on fire. What is the priority action for the nurse?
a. turn off the oxygen 
b. sound the fire alarm
c. try to extinguish the fire
d. remove the clients from the room


7. An 84-year-old male patient has been bedridden for two weeks. Which of the following complaints by the patient indicates to the nurse that he is developing a complication of immobility?
a. stiffness of the right ankle joint 
b. soreness of the gums
c. short term memory loss
d. decreased appetite

8. Which of the following nursing interventions indicate an understanding on the part of the nurse concerning proper care of pressure ulcers?
a. rub reddened skin to increase circulation
b. use a heat lamp 4 times a day to dry the wound surface
c. cleanse a non-infected pressure ulcer with isotonic saline
d. cleanse a non-infected pressure ulcer with povidone-iodine
ANSWER C: A noninfected pressure ulcer should be cleansed gently with a non-ionic cleanser such as isotonic saline to prevent disruption of healing.

9. A client has been placed in blood and body fluid isolation. The nurse is instructing auxiliary personnel in the correct procedures. Which statement by the nursing assistant indicates the best understanding of the correct protocol for blood and body fluid isolation?
a. masks should be worn with all client contact
b. gloves should be worn for contact with non-intact skin, mucous membranes or soiled items
c. isolation gowns are not needed
d. a private room is always indicated


10. A female client will have to change the dressing on her injured right leg twice a day. The dressing will be a sterile dressing, using 4x4’s, normal saline irrigant, and abdominal pads. Which statement best indicates that the patient understands the importance of maintaining asepsis?
a. “If I drop the 4x4’s on the floor, I can use them as long as they are not soiled.”
b. “If I drop the 4x4's on the floor, I can use them if I rinse them with sterile normal saline.”
c. “If I question the sterility of any dressing material, I should not use it.”
d. “I should put on my sterile gloves, then open the bottle of saline to soak the 4x4’s.”


11. Which of the following nursing interventions would the nurse perform prior to administering a tube feeding?
a. check for placement by aspirating for gastric contents with a syringe and test pH with Testape
b. advance the tube 3-5 inches prior to the feeding
c. instruct the client to swallow
d. instill 30 ml of sterile water into the tube


12. An adult client is being treated in the burn unit for partial and full-thickness burns of the left foot, ankle, and leg. Skin autographs are taken from the right thigh and a skin graft is performed. The nurse planning care for the client on return from the operating room includes which of the following nursing interventions?
a. change dressing on graft sites every shift
b. cover donor site with fine mesh gauze and expose to air
c. lubricate donor site with skin cream every shift
d. hydrotherapy to graft sites daily


13. The nurse is caring for a client who is being transfused for severe gastrointestinal bleeding. The nurse can decrease the danger of hypothermia by:
a. administering blood with normal saline
b. administering blood products through a central line
c. giving only packed cells
d. warming blood to body temperature before administering


14. The mother of a three-year-old child calls the clinic and states that her child has just swallowed an unknown amount of baby aspirin. What is the best initial action for the nurse to take?
a. call the physician
b. instruct the mother to bring the child to the emergency room as soon as possible
c. discuss with the mother observable changes for which she should watch the child
d. tell the mother to give ipecac to the child and then come to the emergency room


15. A 56-year-old is admitted to the burn unit with partial and full-thickness burns of both legs, which occurred when a charcoal grill tipped over on her. The burn area is edematous. Blister formation and a large amount of fluid exudate is noted. Urine output is 30 ml per hour, BP 90/60, and pulses 110. A primary nursing diagnosis during the initial 48-72 hours following the burn is:
a. body image disturbance related to disfiguring burns of both legs
b. high risk for infection related to skin breakdown
c. potential for ineffective airway clearance related to smoke inhalation
d. fluid volume deficit related to increased capillary permeability


16. While assessing the client with burns on the back and trunk, the nurse notes areas that are not painful, grayish–white in color, and leathery in appearance. The nurse documents that these burns are:
a. superficial burns 
b. superficial partial thickness burns
c. deep partial thickness burns
d. full thickness burns


17. An adult is scheduled for IVP. Before sending her to have the test the nurse should:
a. ask if she is allergic to barium
b. ask is she is allergic to shellfish
c. give her a full glass of water
d. instruct her not to urinate until after the test


18. An adult has received one unit of packed red blood cells after sustaining severe trauma to his legs with profuse bleeding. To evaluate whether the transfusion has been effective the nurse should:
a. take his blood pressure
b. auscultate lung sounds
c. check hemoglobin and hematocrit results
d. take his temperature


19. The nurse is administering tracheostomy care to an adult. Which of the following should be included in the procedure?
a. soaking the outer cannula with saline solution
b. performing the procedure utilizing medical asepsis
c. soaking the inner cannula in half-strength hydrogen peroxide solution
d. cutting a sterile gauze pad to place between the neck and the tracheostomy tube


20. Which of the following teaching should the nurse include when establishing a bowel-training regimen for a 62-year-old with chronic constipation?
a. avoid laxative
b. decrease exercise
c. increase the fiber content of your diet
d. increase fluid intake 4500-5000 ml


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

Pre-Board Exam Drill: Psychiatric Nursing C

This is a 30 point Pre-Board Exam Drill on Psychiatric 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. An inpatient psychiatric client suddenly becomes loud and visibly anxious. What's the best action for the nurse to take? 
a.)Summon help and escort the client to his room. 
b.)Face the client squarely and say, "You must be quiet." 
c.)Say, "Calm down; you're safe here." 
d.)Say, "Let's go talk in your room."


2. A voluntary client on an inpatient psychiatric unit has a history of auditory hallucinations and self-aggression. The nurse is talking with the client when the client suddenly jumps up and says, to no one in particular, "Get away from me." What's the nurse's best response? 
a.)Escort the client to his room. 
b.)Say, "I won't let them harm you." 
c.)Sit quietly until the client becomes calm.
d.)Ask, "Who are you talking to?"


3. A 35-year-old voluntary client suddenly begins yelling, throws a chair, and exhibits extreme agitation. Which of the following would be most important for the nurse to consider when planning an intervention? 
a.)Because the client is a voluntary admission, restraints can't be used. 
b.)The family must be called for permission to restrain the client.
c.)Restraint should be used as a last resort. 
d.)Restraint can't be initiated until the physician is called.


4. Before forcing a client to take a medication, the nurse should give priority to:
a.)the client's danger to self or others. 
b.)what the "voices" are saying to the client. 
c.)whether the client's admission was voluntary. 
d.)the client's insight into the illness.


5. A client was admitted to the hospital 2 days ago for disrupting a town meeting, shouting religious delusions, and fighting with police. The client now refuses to take prescribed haloperidol (Haldol), saying, "I don't want it." Which response by the nurse would be best? 
a.)"It will help you feel better." 
b.)"You must take it or get an injection." 
c.)"What are you afraid of?"
d.)"You sound concerned."


6. A client has been prescribed 75 mg of amitriptyline (Elavil) at bedtime and 15 mg of phenelzine (Nardil) three times per day. Which nursing action takes priority? 
a.)Teaching the client about the adverse effects
b.)Calling the physician and questioning the order 
c.)Instituting dietary restrictions 
d.)Taking baseline vital signs



7. A client on an inpatient psychiatric unit has been taking a tricyclic antidepressant without satisfactory results, so the physician changes to a monoamine oxidase (MAO) inhibitor. In evaluating the physician's order, the nurse must first be sure:
a.)adequate time has elapsed between discontinuing the first medication and beginning the second. 
b.)the MAO inhibitor is begun at the same dosage as the tricyclic antidepressant. 
c.)the client isn't suicidal. 
d.)the client isn't allergic to cheese.


8. A client reports no improvement in mood since beginning a regimen of 15 mg of tranylcypromine (Parnate) twice per day 1 week ago. Which of the following is the best nursing action?
a.)Say to the client, "The medication may need up to 4 weeks to take effect." b.)Say to the client, "You should feel the effects any day now." 
c.)Consult with the physician about a dosage adjustment. 
d.)Consult with the physician about a change of medication.


9. A client who has been hospitalized with depression is about to be discharged with a prescription of phenelzine (Nardil). In planning for discharge, the nurse should have a teaching plan that emphasizes: 
a.)getting adequate rest. 
b.)avoiding smoking.
c.)avoiding red wine. 
d.)taking the drug with food or milk.


10. The physician prescribes a monoamine oxidase (MAO) inhibitor for a client. Which of the following nursing diagnostic categories would be most appropriate to focus on during client teaching?
a.)Risk for injury 
b.)Disturbed thought processes 
c.)Deficient fluid volume 
d.)Disturbed sleep pattern


11. A nurse is teaching clients in an outpatient clinic about monoamine oxidase (MAO) inhibitors. The nurse would best evaluate the clients' understanding of how their medications work by noting:
a.)food selections. 
b.)fluid intake. 
c.)potential for self-harm. 
d.)level of anxiety.


12. A hospitalized client taking 30 mg of tranylcypromine (Parnate) twice per day complains of a stiff neck and headache. Which action would be best for the nurse to take? 
a.)Note the complaints as usual adverse effects.
b.)Withhold the next dose of medication. 
c.)Administer an analgesic, as needed and as prescribed. 
d.)Help the client relax.


13. A client avoids leaving home to shop for groceries or complete other errands. At times the client feels "crazy" because of her fear. The client seeks out her neighbor, a nurse, for help. The nurse's assessment is phobic reaction. Which of the following statements about a phobia is true? 
a.)The condition is a persistent, intrusive image that seems senseless to the person.
b.)It's important not to force the person to face the phobic object or situation. c.)The phobic condition can be cured by hypnosis. 
d.)It's necessary to agree with the client's assessment that the phobia is silly.


14. A 76-year-old widowed mother of six is admitted to a long-term care facility with a diagnosis of organic mental disorder. Which of the following approaches would be most helpful for the nurse in meeting the client's needs? 
a.)Make sure the client completes tasks that she begins. 
b.)Maintain a gentle approach that doesn't set limits. 
c.)Give the client alternative choices in making decisions.
d.)Simplify the environment as much as possible.


15. Which of the following snacks would be best for a client with anorexia nervosa who requires a high-protein, high-calorie diet? 
a.)Chicken soup and crackers 
b.)Doughnut and orange juice
c.)Egg salad and peanuts 
d.)Cashews and strawberries


16. What's the most appropriate nursing diagnosis for a client exhibiting obsessive-compulsive behavior?
a.)Ineffective coping 
b.)Imbalanced nutrition: Less than body requirements 
c.)Imbalanced nutrition: More than body requirements 
d.)Interrupted family processes
.

17. A 28-year-old accountant is admitted to the neurologic unit after a sudden onset of blindness the day before an important project is due for her boss. After preliminary evaluation and testing yields no positive findings, the physician's initial reaction is that the client may be demonstrating which defense mechanism? 
a.)Repression 
b.)Transference 
c.)Reaction formation
d.)Conversion


18. A client with bipolar disorder, manic phase, who usually dresses conservatively, appears at breakfast with brightly colored cheeks, wearing a miniskirt, sheer blouse, and designer boots. Which of the following actions should the nurse take to deal with the client's attire?
a.)Redirect the client to her room and help her put on her more customary clothing. b.)Allow her the freedom to wear what she prefers for now. 
c.)Remind the client of the dress code and the consequences of violation. 
d.)Tell the client what to wear and advise her that she has lost the privilege of choosing her wardrobe.


19. What's the most effective intervention for handling a client with an antisocial personality? 
a.)Reason with the client.
b.)Set limits with the client. 
c.)Ignore the client. 
d.)Agree with the client.


20. A client on the nursing unit, charged with child abuse, doesn't speak to the staff when approached. Which response by the nurse would be best? 
a.)"If you need me, I'll be in the nurses' station." 
b.)"You need to come to grips with what has happened." 
c.)"Not speaking to the staff won't help your situation."
d.)"Admission to a psychiatric unit can be very difficult."


21. After refusing to eat for 4 days, a 17-year-old college freshman is referred to the inpatient eating disorders unit of a general hospital. Her affect is flat, her eyes downcast, and her long blonde hair dull and limp. Her clothes hang loosely on her body, and she appears sullen and frightened. Her weight on admission is 89 lb (40.4 kg); her normal weight is 114 lb (52 kg). Which of the following assessments would best enable the nurse to develop a specific nursing diagnosis? 
a.)Family history, including genograms 
b.)Psychiatric history, including all hospital admissions 
c.)Cardiac and respiratory history
d.)Weight loss history and general condition of skin, hair, and nails


22. A client is admitted for a suspected eating disorder. Which of the following statements would indicate that the client may be suffering from anorexia nervosa? a.)"I've gained 3 pounds in the last month." 
b.)"I eat loads of spinach and yellow vegetables each day."
c.)"I'm a perfectionist, and I work hard to get A's." 
d.)"I binge frequently in the morning and feel fat."


23. Which of the following nursing interventions would be included in the care of a client with anorexia nervosa as therapy progresses? 
a.)Let the client eat alone to avoid embarrassment. 
b.)Weigh the client once a week in the same clothing.
c.)Monitor the client for self-destructive tendencies. 
d.)Praise the client for "looking better," and remind the client that she isn't "too fat."


24. A client with a personality disorder exhibits manipulative behavior. Care planning for this client should include: 
a.)freedom to do as the client chooses when behavior improves. 
b.)limitations per unit rules without restrictions for broken rules. 
c.)reasonable expectations with varying limits.
d.)verbal reinforcement when the client functions within established limits.


25. A 40-year-old woman is brought to the hospital by her husband, who states that she has refused to eat or get out of bed for 2 days. The woman says that she's tired all the time and doesn't feel up to going to work. Her admitting diagnosis is major depression. Which question would be most appropriate for the admitting nurse to ask? 
a.)"What has been troubling you?" 
b.)"Why do you dislike yourself?"
c.)"How do you feel about your life?" 
d.)"What can we do to help?"

26. A 24-year-old secretary is transferred to your psychiatric unit. Her husband says that she has been overeating and that she vomits soon after she eats. Her weight stays about the same, at 96 lb (44 kg). In planning care for the client, the nurse should anticipate which medical diagnosis? 
a.)Anorexia nervosa
b.)Bulimia 
c.)Klein-Levin syndrome 
d.)Dysthymia


27. For a client with bulimia, which assessment is least important in the care plan? a.)Observe the client after eating for 1 hour. 
b.)Note the client's intake. 
c.)Note changes in appetite.
d.)Note changes in respiratory rate.


28. A client with personality disorder gets along poorly with the immediate family. The client's manipulative behavior most likely shows a failure to develop: 
a.)intimate relationships.
b.)trust. 
c.)industry. 
d.)feelings of guilt.


29. A 32-year-old client is admitted to the unit. She states, "I'm a well-known, wealthy designer," and begins to order the nurses to prepare her bath while she orders her tray and telephones her colleagues. Her husband states that she's too busy to eat and sleep and is losing weight. Her admitting diagnosis is bipolar disorder, manic phase. For which of the following events should the nurse plan?
a.)Erratic and unpredictable behavior if challenged 
b.)Boredom and the need for minute-to-minute activities 
c.)Rapid mood changes from elation to depression 
d.)One-to-one treatment to occupy the client's time


30. A 32-year-old lawyer is admitted to the neurologic unit with a sudden onset of blindness the night before an important case is scheduled to go to trial. Tests reveal no physical findings. Which of the following is the best assessment of the client's anxiety? a.)It's diffuse and free floating. 
b.)It's consciously experienced.
c.)It's localized and relieved by the blindness. 
d.)It's projected onto the environment.