Podcast
Questions and Answers
Following an episode of metabolic alkalosis, a patient's EKG indicates a flattened T-wave and the presence of a U-wave. Which electrolyte imbalance correlates with these EKG findings?
Following an episode of metabolic alkalosis, a patient's EKG indicates a flattened T-wave and the presence of a U-wave. Which electrolyte imbalance correlates with these EKG findings?
- Hypokalemia (correct)
- Hyponatremia
- Hyperkalemia
- Hypercalcemia
A patient admitted for a suspected myocardial infarction (MI) has an initial troponin level of 1.2 ng/mL. Six hours later, a repeat troponin is 8.5 ng/mL. Considering these lab values, what is the priority nursing intervention?
A patient admitted for a suspected myocardial infarction (MI) has an initial troponin level of 1.2 ng/mL. Six hours later, a repeat troponin is 8.5 ng/mL. Considering these lab values, what is the priority nursing intervention?
- Initiating continuous EKG monitoring and preparing for potential cardiac catheterization. (correct)
- Administering a PRN antiemetic to prevent nausea.
- Encouraging oral fluid intake to maintain hydration.
- Administering a dose of prophylactic antibiotics as ordered
A patient receiving a blood transfusion suddenly develops fever, chills, and hypotension approximately 2 hours into the procedure. Which of the following transfusion reactions is the MOST likely cause, and what is the MOST appropriate initial nursing intervention?
A patient receiving a blood transfusion suddenly develops fever, chills, and hypotension approximately 2 hours into the procedure. Which of the following transfusion reactions is the MOST likely cause, and what is the MOST appropriate initial nursing intervention?
- Hemolytic transfusion reaction; slow the transfusion and administer normal saline.
- Allergic reaction; administer antihistamines and monitor.
- Transfusion-related acute lung injury (TRALI); administer diuretics and oxygen.
- Febrile non-hemolytic reaction; stop the transfusion and administer antipyretics. (correct)
A patient with end-stage renal disease refuses their scheduled hemodialysis appointment. After discussing the risks and benefits, the patient remains firm in their decision. Which of the following nursing actions is MOST appropriate?
A patient with end-stage renal disease refuses their scheduled hemodialysis appointment. After discussing the risks and benefits, the patient remains firm in their decision. Which of the following nursing actions is MOST appropriate?
A patient with chronic kidney disease presents with confusion and flank pain. Lab results reveal elevated BUN and creatinine levels, as well as hyperkalemia. Which assessment should the nurse prioritize?
A patient with chronic kidney disease presents with confusion and flank pain. Lab results reveal elevated BUN and creatinine levels, as well as hyperkalemia. Which assessment should the nurse prioritize?
A patient is scheduled for an intravenous pyelogram (IVP). The patient has a history of asthma and reports an allergy to shellfish. Which action should the nurse prioritize?
A patient is scheduled for an intravenous pyelogram (IVP). The patient has a history of asthma and reports an allergy to shellfish. Which action should the nurse prioritize?
Which finding is MOST indicative of acute rejection following a kidney transplant?
Which finding is MOST indicative of acute rejection following a kidney transplant?
A patient undergoing hemodialysis begins to complain of a severe headache, nausea, and confusion. The nurse suspects disequilibrium syndrome. Which of the following interventions is MOST appropriate initially?
A patient undergoing hemodialysis begins to complain of a severe headache, nausea, and confusion. The nurse suspects disequilibrium syndrome. Which of the following interventions is MOST appropriate initially?
A pregnant patient with preeclampsia is receiving magnesium sulfate. Which assessment finding warrants immediate notification of the healthcare provider?
A pregnant patient with preeclampsia is receiving magnesium sulfate. Which assessment finding warrants immediate notification of the healthcare provider?
A patient presents to the emergency department with severe abdominal pain and a positive pregnancy test. The patient reports light vaginal bleeding and shoulder pain. What condition is MOST likely occurring?
A patient presents to the emergency department with severe abdominal pain and a positive pregnancy test. The patient reports light vaginal bleeding and shoulder pain. What condition is MOST likely occurring?
Which modifiable risk factor has the MOST significant impact on reducing the incidence of both ischemic and hemorrhagic strokes?
Which modifiable risk factor has the MOST significant impact on reducing the incidence of both ischemic and hemorrhagic strokes?
A patient who experienced a stroke exhibits right-sided weakness, facial drooping, and difficulty speaking. Based on these symptoms, which area of the brain is MOST likely affected?
A patient who experienced a stroke exhibits right-sided weakness, facial drooping, and difficulty speaking. Based on these symptoms, which area of the brain is MOST likely affected?
A patient is actively seizing. Which of the following nursing actions should be implemented FIRST?
A patient is actively seizing. Which of the following nursing actions should be implemented FIRST?
A patient is admitted with suspected appendicitis. Which assessment finding is MOST concerning and warrants immediate notification of the healthcare provider?
A patient is admitted with suspected appendicitis. Which assessment finding is MOST concerning and warrants immediate notification of the healthcare provider?
A patient with acute pancreatitis is NPO and receiving IV fluids. Which laboratory value would indicate the HIGHEST priority for intervention?
A patient with acute pancreatitis is NPO and receiving IV fluids. Which laboratory value would indicate the HIGHEST priority for intervention?
A patient with cirrhosis develops ascites. Which dietary modification is MOST important to include in the patient's education?
A patient with cirrhosis develops ascites. Which dietary modification is MOST important to include in the patient's education?
A patient is recovering from a laparoscopic cholecystectomy. What teaching point is MOST important to prevent complications?
A patient is recovering from a laparoscopic cholecystectomy. What teaching point is MOST important to prevent complications?
A patient with a history of gastric ulcers reports a sudden onset of severe abdominal pain, rigidity, and rebound tenderness. What is the MOST likely cause of these findings?
A patient with a history of gastric ulcers reports a sudden onset of severe abdominal pain, rigidity, and rebound tenderness. What is the MOST likely cause of these findings?
A post-operative patient has absent bowel sounds, abdominal distension, and reports not passing flatus. Which intervention is MOST appropriate for this patient?
A post-operative patient has absent bowel sounds, abdominal distension, and reports not passing flatus. Which intervention is MOST appropriate for this patient?
A 3-week-old infant presents with projectile vomiting after feeding, visible peristaltic waves across the abdomen, and an olive-shaped mass in the right upper quadrant. Which condition is MOST likely?
A 3-week-old infant presents with projectile vomiting after feeding, visible peristaltic waves across the abdomen, and an olive-shaped mass in the right upper quadrant. Which condition is MOST likely?
Which statement is MOST important for a patient with chronic gastritis to include in their self-care education?
Which statement is MOST important for a patient with chronic gastritis to include in their self-care education?
A patient presents with hematemesis that resembles 'coffee grounds'. What condition is MOST likely to be associated with this finding?
A patient presents with hematemesis that resembles 'coffee grounds'. What condition is MOST likely to be associated with this finding?
A patient one day post-thyroidectomy develops numbness and tingling around the mouth and in the fingers. Which laboratory value should the nurse prioritize reviewing?
A patient one day post-thyroidectomy develops numbness and tingling around the mouth and in the fingers. Which laboratory value should the nurse prioritize reviewing?
A patient in diabetic ketoacidosis (DKA) has a blood glucose level of 500 mg/dL and arterial pH of 7.2. What is the priority intervention?
A patient in diabetic ketoacidosis (DKA) has a blood glucose level of 500 mg/dL and arterial pH of 7.2. What is the priority intervention?
Which is the MOST appropriate post-operative positioning for an unconscious client with hypotension, while awaiting further orders?
Which is the MOST appropriate post-operative positioning for an unconscious client with hypotension, while awaiting further orders?
Which EKG change is expected with hyperkalemia and acidosis?
Which EKG change is expected with hyperkalemia and acidosis?
During an assessment of a client with AKI, the nurse notes CVA tenderness, hematuria, and dark urine. What would the nurse prioritize based on this assessment data?
During an assessment of a client with AKI, the nurse notes CVA tenderness, hematuria, and dark urine. What would the nurse prioritize based on this assessment data?
The healthcare provider prescribes an IVP for a client with a possible diagnosis of kidney stones. What information is MOST IMPORTANT to communicate to the provider BEFORE the test is performed?
The healthcare provider prescribes an IVP for a client with a possible diagnosis of kidney stones. What information is MOST IMPORTANT to communicate to the provider BEFORE the test is performed?
The nurse is caring for a client who had a kidney transplant. Which assessment requires IMMEDIATE intervention?
The nurse is caring for a client who had a kidney transplant. Which assessment requires IMMEDIATE intervention?
A client with severe uremia presents to the ED with a BUN of 60 mg/dL and a creatinine of 4.0 mg/dL and is scheduled for emergency hemodialysis. Which nursing intervention is the HIGHEST priority during dialysis?
A client with severe uremia presents to the ED with a BUN of 60 mg/dL and a creatinine of 4.0 mg/dL and is scheduled for emergency hemodialysis. Which nursing intervention is the HIGHEST priority during dialysis?
A nurse administering magnesium sulfate to a preeclamptic client is preparing for a seizure. Which medication should the nurse have readily available at the bedside?
A nurse administering magnesium sulfate to a preeclamptic client is preparing for a seizure. Which medication should the nurse have readily available at the bedside?
A G1P0 client at 8 weeks gestation presents to the ED with reports of severe abdominal pain and vaginal bleeding. What is the MOST IMPORTANT question to ask related to a possible ectopic pregnancy?
A G1P0 client at 8 weeks gestation presents to the ED with reports of severe abdominal pain and vaginal bleeding. What is the MOST IMPORTANT question to ask related to a possible ectopic pregnancy?
Which of the following is a modifiable risk factor for stroke?
Which of the following is a modifiable risk factor for stroke?
The nurse is assessing a client who is suspected of having a stroke. Which of the assessment findings would indicate to the nurse that the client is having an ischemic rather than hemorrhagic stroke?
The nurse is assessing a client who is suspected of having a stroke. Which of the assessment findings would indicate to the nurse that the client is having an ischemic rather than hemorrhagic stroke?
A client begins to have a tonic clonic seizure while sitting in the chair. What is the nurses' FIRST action.
A client begins to have a tonic clonic seizure while sitting in the chair. What is the nurses' FIRST action.
The nurse is assessing a client who states, " My pain started in the middle of my stomach and has moved to the right lower quadrant." Along with this assessment, which action should the nurse take when assessing this client?
The nurse is assessing a client who states, " My pain started in the middle of my stomach and has moved to the right lower quadrant." Along with this assessment, which action should the nurse take when assessing this client?
The nurse just received orders on a new client admitted with acute pancreatitis. Which order should the nurse question?
The nurse just received orders on a new client admitted with acute pancreatitis. Which order should the nurse question?
The nurse is providing education to a client with ascites regarding the disease process. Which statements indicate the client understands the information?
The nurse is providing education to a client with ascites regarding the disease process. Which statements indicate the client understands the information?
Following an episode of prolonged vomiting, a patient exhibits a flattened T-wave and a prominent U-wave on their EKG. This MOST likely indicates which electrolyte imbalance?
Following an episode of prolonged vomiting, a patient exhibits a flattened T-wave and a prominent U-wave on their EKG. This MOST likely indicates which electrolyte imbalance?
A patient's troponin levels rise from 0.08 ng/mL to 6.3 ng/mL over a 6-hour period. Which pathological process is MOST consistent with this lab finding?
A patient's troponin levels rise from 0.08 ng/mL to 6.3 ng/mL over a 6-hour period. Which pathological process is MOST consistent with this lab finding?
During a blood transfusion, a patient develops acute respiratory distress and pulmonary edema. What type of reaction is MOST likely occurring?
During a blood transfusion, a patient develops acute respiratory distress and pulmonary edema. What type of reaction is MOST likely occurring?
A patient with end-stage renal disease has decided to stop hemodialysis. What is the MOST appropriate nursing intervention following this decision?
A patient with end-stage renal disease has decided to stop hemodialysis. What is the MOST appropriate nursing intervention following this decision?
A patient with chronic kidney disease exhibits confusion and flank pain. Lab results show elevated potassium and creatinine. Which ADDITIONAL assessment finding would warrant the MOST immediate intervention?
A patient with chronic kidney disease exhibits confusion and flank pain. Lab results show elevated potassium and creatinine. Which ADDITIONAL assessment finding would warrant the MOST immediate intervention?
A patient with a history of asthma and shellfish allergy is scheduled for an intravenous pyelogram (IVP). What is the MOST critical action the nurse should take?
A patient with a history of asthma and shellfish allergy is scheduled for an intravenous pyelogram (IVP). What is the MOST critical action the nurse should take?
A kidney transplant recipient presents with fever, graft tenderness, and decreased urine output. Which diagnostic finding is MOST indicative of acute rejection?
A kidney transplant recipient presents with fever, graft tenderness, and decreased urine output. Which diagnostic finding is MOST indicative of acute rejection?
A patient undergoing hemodialysis reports a severe headache, nausea, and confusion. Which intervention is MOST appropriate if disequilibrium syndrome is suspected?
A patient undergoing hemodialysis reports a severe headache, nausea, and confusion. Which intervention is MOST appropriate if disequilibrium syndrome is suspected?
A pregnant patient with preeclampsia is receiving magnesium sulfate. Which assessment finding is MOST indicative of magnesium toxicity and warrants immediate intervention?
A pregnant patient with preeclampsia is receiving magnesium sulfate. Which assessment finding is MOST indicative of magnesium toxicity and warrants immediate intervention?
A patient with severe abdominal pain and a positive pregnancy test reports light vaginal bleeding and shoulder pain. What additional assessment finding would STRONGLY suggest a ruptured ectopic pregnancy requiring immediate surgical intervention?
A patient with severe abdominal pain and a positive pregnancy test reports light vaginal bleeding and shoulder pain. What additional assessment finding would STRONGLY suggest a ruptured ectopic pregnancy requiring immediate surgical intervention?
Which modifiable risk factor is MOST crucial to address in order to minimize the likelihood of both ischemic and hemorrhagic strokes?
Which modifiable risk factor is MOST crucial to address in order to minimize the likelihood of both ischemic and hemorrhagic strokes?
A stroke patient exhibits left-sided weakness, spatial disorientation, and impulsive behavior. Which area of the brain is MOST likely affected?
A stroke patient exhibits left-sided weakness, spatial disorientation, and impulsive behavior. Which area of the brain is MOST likely affected?
A patient actively seizing is experiencing a prolonged tonic-clonic seizure. After ensuring the patient's safety, which pharmacological intervention should the nurse anticipate being administered FIRST?
A patient actively seizing is experiencing a prolonged tonic-clonic seizure. After ensuring the patient's safety, which pharmacological intervention should the nurse anticipate being administered FIRST?
A patient being assessed for appendicitis reports sudden relief from severe abdominal pain. Which action is MOST critical for the nurse to take?
A patient being assessed for appendicitis reports sudden relief from severe abdominal pain. Which action is MOST critical for the nurse to take?
A patient with acute pancreatitis has amylase, lipase, and glucose levels trending upward. What additional laboratory result would MOST indicate a life-threatening complication requiring immediate intervention?
A patient with acute pancreatitis has amylase, lipase, and glucose levels trending upward. What additional laboratory result would MOST indicate a life-threatening complication requiring immediate intervention?
A patient with cirrhosis and ascites is being discharged. Which dietary instruction is MOST crucial to prevent further fluid accumulation?
A patient with cirrhosis and ascites is being discharged. Which dietary instruction is MOST crucial to prevent further fluid accumulation?
A patient recovering from a laparoscopic cholecystectomy asks about returning to normal activities. What teaching point is MOST important to prevent complications?
A patient recovering from a laparoscopic cholecystectomy asks about returning to normal activities. What teaching point is MOST important to prevent complications?
A patient with a history of gastric ulcers presents with sudden, severe abdominal pain, rigidity, and rebound tenderness. What other assessment finding would BEST support the suspicion of a perforated ulcer?
A patient with a history of gastric ulcers presents with sudden, severe abdominal pain, rigidity, and rebound tenderness. What other assessment finding would BEST support the suspicion of a perforated ulcer?
A post-operative patient has absent bowel sounds, abdominal distension, and reports not passing flatus. What is the MOST appropriate initial intervention?
A post-operative patient has absent bowel sounds, abdominal distension, and reports not passing flatus. What is the MOST appropriate initial intervention?
An infant presents with projectile vomiting after feeding, visible peristaltic waves, and an olive-shaped mass in the upper abdomen. Which electrolyte imbalance is MOST likely to be present?
An infant presents with projectile vomiting after feeding, visible peristaltic waves, and an olive-shaped mass in the upper abdomen. Which electrolyte imbalance is MOST likely to be present?
Which dietary modification is MOST important for a patient with chronic gastritis to include in their self-care education to minimize exacerbations of their condition?
Which dietary modification is MOST important for a patient with chronic gastritis to include in their self-care education to minimize exacerbations of their condition?
Which assessment finding MOST clearly differentiates upper GI bleeding from lower GI bleeding?
Which assessment finding MOST clearly differentiates upper GI bleeding from lower GI bleeding?
A patient one day post-thyroidectomy develops numbness and tingling around the mouth and in the fingers. In addition to assessing Chvostek's and Trousseau's signs, which electrolyte imbalance is the MOST likely cause of these symptoms?
A patient one day post-thyroidectomy develops numbness and tingling around the mouth and in the fingers. In addition to assessing Chvostek's and Trousseau's signs, which electrolyte imbalance is the MOST likely cause of these symptoms?
A patient in diabetic ketoacidosis (DKA) has a blood glucose level of 500 mg/dL and an arterial pH of 7.2. After initiating intravenous fluids, which intervention is the PRIORITY?
A patient in diabetic ketoacidosis (DKA) has a blood glucose level of 500 mg/dL and an arterial pH of 7.2. After initiating intravenous fluids, which intervention is the PRIORITY?
Which is the MOST appropriate post-operative position for an unconscious client with hypotension?
Which is the MOST appropriate post-operative position for an unconscious client with hypotension?
What EKG change is MOST indicative of hyperkalemia in a client with metabolic acidosis?
What EKG change is MOST indicative of hyperkalemia in a client with metabolic acidosis?
During an assessment of a client with acute kidney injury (AKI), the nurse identifies costovertebral angle (CVA) tenderness, hematuria, and dark urine. Which additional assessment would the nurse prioritize based on these findings to further evaluate kidney function?
During an assessment of a client with acute kidney injury (AKI), the nurse identifies costovertebral angle (CVA) tenderness, hematuria, and dark urine. Which additional assessment would the nurse prioritize based on these findings to further evaluate kidney function?
The healthcare provider prescribes an intravenous pyelogram (IVP) for a client with suspected kidney stones. What information is MOST IMPORTANT for the nurse to communicate to the provider BEFORE the test is performed?
The healthcare provider prescribes an intravenous pyelogram (IVP) for a client with suspected kidney stones. What information is MOST IMPORTANT for the nurse to communicate to the provider BEFORE the test is performed?
The nurse is caring for a client who had a kidney transplant. Which assessment finding requires the MOST immediate intervention?
The nurse is caring for a client who had a kidney transplant. Which assessment finding requires the MOST immediate intervention?
A client with severe uremia is scheduled for emergency hemodialysis. Which nursing intervention is the HIGHEST priority during dialysis to minimize the risk of complications associated with rapid fluid and electrolyte shifts?
A client with severe uremia is scheduled for emergency hemodialysis. Which nursing intervention is the HIGHEST priority during dialysis to minimize the risk of complications associated with rapid fluid and electrolyte shifts?
A 8 week gestation client presents to the ED with reports of abdominal pain and vaginal bleeding. What is the MOST IMPORTANT question to ask related to a possible ectopic pregnancy?
A 8 week gestation client presents to the ED with reports of abdominal pain and vaginal bleeding. What is the MOST IMPORTANT question to ask related to a possible ectopic pregnancy?
Which of the following is the MOST effective modifiable risk factor for reducing the incidence of stroke?
Which of the following is the MOST effective modifiable risk factor for reducing the incidence of stroke?
The nurse is assessing a client who is suspected of having a stroke. Which of the assessment findings MOST strongly indicates to the nurse that the client is having a hemorrhagic rather than an ischemic stroke?
The nurse is assessing a client who is suspected of having a stroke. Which of the assessment findings MOST strongly indicates to the nurse that the client is having a hemorrhagic rather than an ischemic stroke?
A client begins to have a tonic clonic seizure while sitting in a chair. What is the nurse’s FIRST action?
A client begins to have a tonic clonic seizure while sitting in a chair. What is the nurse’s FIRST action?
While assessing a client with suspected appendicitis, the nurse notes that the client states, “My pain initially started in the middle of my stomach and has now moved to the right lower quadrant.” Along with this assessment, which action should the nurse take next?
While assessing a client with suspected appendicitis, the nurse notes that the client states, “My pain initially started in the middle of my stomach and has now moved to the right lower quadrant.” Along with this assessment, which action should the nurse take next?
The nurse is providing education to a client with ascites regarding the disease process. Which statement made by the client indicates they understand the information?
The nurse is providing education to a client with ascites regarding the disease process. Which statement made by the client indicates they understand the information?
Following a thyroidectomy, a patient reports circumoral tingling and exhibits a positive Chvostek's sign. Which action should the nurse prioritize based on these findings?
Following a thyroidectomy, a patient reports circumoral tingling and exhibits a positive Chvostek's sign. Which action should the nurse prioritize based on these findings?
A patient undergoing hemodialysis develops significant hypotension despite fluid boluses. After ruling out cardiac causes and adjusting the ultrafiltration rate, What intervention should the nurse implement next?
A patient undergoing hemodialysis develops significant hypotension despite fluid boluses. After ruling out cardiac causes and adjusting the ultrafiltration rate, What intervention should the nurse implement next?
A patient with chronic cirrhosis and worsening ascites is prescribed spironolactone and furosemide. Which assessment finding would warrant immediate modification of the medication regimen?
A patient with chronic cirrhosis and worsening ascites is prescribed spironolactone and furosemide. Which assessment finding would warrant immediate modification of the medication regimen?
A patient with a history of atrial fibrillation is admitted with an acute ischemic stroke. The patient's blood pressure is 180/110 mmHg. After ruling out thrombolytic therapy due to the time since symptom onset, which intervention is MOST appropriate?
A patient with a history of atrial fibrillation is admitted with an acute ischemic stroke. The patient's blood pressure is 180/110 mmHg. After ruling out thrombolytic therapy due to the time since symptom onset, which intervention is MOST appropriate?
A pregnant patient at 30 weeks' gestation presents with severe preeclampsia and is receiving magnesium sulfate. The patient's respiratory rate is 10 breaths/min, deep tendon reflexes are absent, and urinary output has decreased significantly over the past hour. Which medication should the nurse prepare to administer?
A pregnant patient at 30 weeks' gestation presents with severe preeclampsia and is receiving magnesium sulfate. The patient's respiratory rate is 10 breaths/min, deep tendon reflexes are absent, and urinary output has decreased significantly over the past hour. Which medication should the nurse prepare to administer?
A patient admitted with acute pancreatitis develops severe hypocalcemia. Besides administering calcium gluconate, what other intervention is MOST important for the nurse to implement?
A patient admitted with acute pancreatitis develops severe hypocalcemia. Besides administering calcium gluconate, what other intervention is MOST important for the nurse to implement?
A client is admitted to the emergency department after experiencing a tonic-clonic seizure at home. Upon arrival, the client is drowsy and confused. Which nursing intervention is the priority?
A client is admitted to the emergency department after experiencing a tonic-clonic seizure at home. Upon arrival, the client is drowsy and confused. Which nursing intervention is the priority?
A nurse is providing discharge teaching for a client with chronic gastritis. Which statement by the client indicates the need for further education?
A nurse is providing discharge teaching for a client with chronic gastritis. Which statement by the client indicates the need for further education?
A client with late-stage cirrhosis is exhibiting signs of hepatic encephalopathy. Lactulose is prescribed. What assessment finding would indicate that the medication is having the desired therapeutic effect?
A client with late-stage cirrhosis is exhibiting signs of hepatic encephalopathy. Lactulose is prescribed. What assessment finding would indicate that the medication is having the desired therapeutic effect?
A 2-month-old infant is diagnosed with pyloric stenosis. What is the priority nursing diagnosis for this patient?
A 2-month-old infant is diagnosed with pyloric stenosis. What is the priority nursing diagnosis for this patient?
Flashcards
What does the P wave represent?
What does the P wave represent?
Electrical activity representing atrial depolarization.
What does the QRS complex represent?
What does the QRS complex represent?
Ventricular depolarization and atrial repolarization.
What does the T wave represent?
What does the T wave represent?
Ventricular repolarization.
Normal PR interval?
Normal PR interval?
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What does elevated troponin indicate?
What does elevated troponin indicate?
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Alkalosis signs/symptoms
Alkalosis signs/symptoms
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EKG changes in hyperkalemia (acidosis)
EKG changes in hyperkalemia (acidosis)
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EKG changes in hypokalemia (alkalosis)
EKG changes in hypokalemia (alkalosis)
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Hemolytic transfusion reaction symptoms
Hemolytic transfusion reaction symptoms
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Febrile non-hemolytic transfusion reaction symptoms
Febrile non-hemolytic transfusion reaction symptoms
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Allergic transfusion reaction symptoms
Allergic transfusion reaction symptoms
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TRALI (Transfusion-related acute lung injury) symptoms
TRALI (Transfusion-related acute lung injury) symptoms
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TACO (Transfusion-associated circulatory overload) symptoms
TACO (Transfusion-associated circulatory overload) symptoms
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Normal BUN level?
Normal BUN level?
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Normal serum creatinine?
Normal serum creatinine?
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Normal hemoglobin
Normal hemoglobin
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Normal potassium?
Normal potassium?
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What does CVA tenderness indicate?
What does CVA tenderness indicate?
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What is prerenal AKI?
What is prerenal AKI?
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What is intrarenal AKI?
What is intrarenal AKI?
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What is postrenal AKI?
What is postrenal AKI?
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What does GFR show
What does GFR show
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Creatinine testing
Creatinine testing
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What is a pyelogram?
What is a pyelogram?
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Pyelogram contraindications
Pyelogram contraindications
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Intravenous pyelogram (IVP)
Intravenous pyelogram (IVP)
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Retrograde pyelogram
Retrograde pyelogram
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Kidney transplant rejection signs
Kidney transplant rejection signs
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Disequilibrium Syndrome
Disequilibrium Syndrome
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Disequilibrium Syndrome symptoms
Disequilibrium Syndrome symptoms
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Disequilibrium Syndrome interventions
Disequilibrium Syndrome interventions
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Hypotension Intervention during Dialysis
Hypotension Intervention during Dialysis
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Magnesium Sulfate Use
Magnesium Sulfate Use
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Mag Sulfate Levels
Mag Sulfate Levels
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Hypermagnesemia symptoms
Hypermagnesemia symptoms
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Assessments for preeclampsia
Assessments for preeclampsia
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BURP (Mag Toxicity)
BURP (Mag Toxicity)
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Ectopic pregnancy
Ectopic pregnancy
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Ectopic pregnancy symptoms
Ectopic pregnancy symptoms
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Ischemic stroke symptoms
Ischemic stroke symptoms
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TX for ectopic pregnancy
TX for ectopic pregnancy
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Ischemic stroke risk factors
Ischemic stroke risk factors
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Hemorrhagic stroke risk factors
Hemorrhagic stroke risk factors
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Hemorrhagic stroke symptoms
Hemorrhagic stroke symptoms
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Seizure precautions
Seizure precautions
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Acute seizure interventions
Acute seizure interventions
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During a seizure
During a seizure
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Appendicitis symptoms
Appendicitis symptoms
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Indication of appendicitis perforation
Indication of appendicitis perforation
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Lab values in pancreatitis
Lab values in pancreatitis
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Study Notes
Cardiac: EKG Interpretation
- P wave signifies SA node firing, leading to atrial depolarization.
- QRS complex indicates ventricular depolarization, also includes atrial repolarization.
- T wave represents ventricular repolarization.
- U wave may indicate electrolyte imbalances (sodium, potassium, calcium) and is related to Purkinje fibers.
- PR interval should measure 0.12-0.20 seconds.
- QT interval represents ventricular depolarization and repolarization.
Cardiac: MI Labs & EKG Changes in Electrolyte Imbalances
- Troponin elevates when cardiac muscle has an imbalance between oxygen supply and demand, indicating myocardial tissue damage.
- Metabolic alkalosis (pH above 7.45) results from excess bicarbonate or acid loss.
- Causes of metabolic alkalosis include vomiting, diuretic use, antacid overuse, and the diuresis stage of CKD.
- EKG changes in hyperkalemia (acidosis) show peaked T-waves and widened QRS complexes.
- EKG changes in hypokalemia (alkalosis) show flattened T-waves, U waves, and ST depression.
Cardiac: Blood Transfusion Reactions
- Febrile non-hemolytic transfusion reaction involves WBC incompatibility, causing fever, chills, anxiety, and tachypnea, usually 1-6 hours post-transfusion. Leukocyte-reduced RBCs can help prevent this.
- Hemolytic transfusion reaction involves incompatible blood products, causing fever, chills, hypotension, hemolysis, renal damage, dark urine, and flank pain, usually within 24 hours post-transfusion.
- Allergic transfusion reaction involves allergens in the blood product, causing hives, itching, or even anaphylaxis, occurring minutes after transfusion begins.
- Transfusion-related acute lung injury (TRALI) occurs when donor plasma reacts with lung tissue, leading to acute respiratory distress and pulmonary edema, possibly hours to days post-transfusion.
- Transfusion-associated circulatory overload (TACO) results from too much blood volume, causing acute pulmonary edema and requiring a slowed transfusion rate, possibly hours after transfusion.
Renal: Kidney Failure Assessment
- Normal BUN levels are 10-20 mg/dL.
- Normal serum creatinine levels are 0.5-1.3 mg/dL, varying by gender and age.
- Normal hemoglobin levels are 12-18 g/dL, varying by gender.
- Normal potassium levels are 3.5-5.0 mEq/L.
- Costovertebral Angle (CVA) tenderness indicates possible kidney inflammation or infection, such as pyelonephritis.
- Clinical signs include hematuria, proteinuria, and dark urine.
- Identify kidney dysfunction from abdominal pain, urinary changes, and CVA tenderness.
- Monitoring lab markers such as BUN and serum creatinine assesses renal function.
- Patient education includes maintaining hydration, following dietary restrictions, and adhering to prescribed medications to promote kidney health.
- Prerenal issues affect GFR by reducing blood flow, intrarenal issues directly damage renal tissue, and postrenal issues involve obstruction.
- Kidney failure has three phases: initial insult, maintenance (oliguria and diuresis), and recovery.
Renal: Kidney Failure Labs, Findings, and EKG
- GFR is the best lab to test improved function of filtration.
- Creatinine is the best lab to test for damage.
- Kidney dysfunction causes abdominal pain (flank region from renal calculi or infection) and confusion (electrolyte imbalances, uremic encephalopathy).
- Common AKI signs include azotemia, elevated creatinine, fluid retention, SOB, N/V, low urine output, electrolyte imbalances, and low GFR.
- EKG changes in acidosis (hyperkalemia) include peaked T-waves and widened QRS complexes.
- Metabolic acidosis is most common in kidney failure.
Renal: Pyelogram
- Pyelogram is an X-ray of the urinary tract, used to diagnose kidney stones, cysts, UTIs, tumors, blockages, and enlarged prostate.
- Contraindications include pregnancy, allergies to contrast dyes or iodine, kidney failure, and severe dehydration.
- Patient education includes fasting, laxatives, pregnancy considerations, removing jewelry/metal, contrast injection sensations, the X-ray process, and duration.
- Intravenous Pyelogram (IVP) involves injecting contrast dye into a vein. Assesses size and shape of kidneys, ureters, and bladder.
- Contraindications for IVP include decreased renal function due to the nephrotoxic nature of the contrast media. Prepare patient with cathartic or enema the night before, and assess for iodine sensitivity.
- Retrograde pyelogram involves injecting contrast dye directly into the ureters via a catheter, usually during a cystoscopy.
- May be done if an IVP does not visualize the urinary tract or has decreased renal function.
- Complications are the same as cystoscopy (burning on urination, pink tinged urine, and urinary frequency are all expected)
Renal: Post Kidney Transplant & Hemodialysis
- Post-kidney transplant organ rejection signs include fever, hypertension, pain at the transplant site, and decreased urine output.
- Disequilibrium syndrome, a hemodialysis complication, occurs when solutes are removed from the blood too quickly, causing cerebral edema.
- Risk factors for disequilibrium syndrome include first-time hemodialysis, severe uremia, rapid fluid removal, long dialysis intervals, and pre-existing neurological conditions.
- Symptoms of disequilibrium syndrome include headache, confusion, restlessness, dizziness, seizures, nausea, vomiting, muscle cramps, hypertension, and bradycardia.
- Interventions for disequilibrium syndrome involve slowing or stopping dialysis, administering hypertonic saline or mannitol, monitoring for seizures, and providing oxygen therapy.
- Hypotension during hemodialysis involves rapid fluid depletion. Slowing the dialysis exchange rate is a key intervention.
OB: Mag Sulfate
- Administration of magnesium sulfate includes a loading dose followed by a maintenance dose to prevent seizures (eclampsia) and promote vasodilation.
- Close monitoring of magnesium levels is important to prevent toxicity, with preeclampsia therapeutic levels at 4.8-8.4 mEq/L.
- Hypermagnesemia leads to muscle flaccid paralysis, respiratory depression, hypotension, bradycardia, and lethargy.
- Regular assessments include monitoring blood pressure, signs and symptoms (headache, vision changes, epigastric pain), heart rate, oxygenation, lung sounds, reflexes. Also edema and intake and output..
- Watch for signs of magnesium toxicity using the BURP acronym: Blood pressure decrease, Urine output decrease, Respiratory rate decrease, Patellar reflex absent.
- Symptoms of preeclampsia include blood pressure 140/90 mmHg, proteinuria indicating renal dysfunction, headache, blurred vision, and possible seizures.
OB: Ectopic Pregnancy
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, often in the fallopian tube.
- Assessment findings include a positive pregnancy test, unilateral abdominal pain, vaginal bleeding, lightheadedness, vital sign changes, and shoulder pain.
- Treatment options include medication (methotrexate) or surgery (laparoscopy or laparotomy).
NEURO: Stroke Risk Factors
- Modifiable risk factors for ischemic stroke include high blood pressure, atherosclerosis, diabetes, smoking, high cholesterol, atrial fibrillation, heart disease, and obesity.
- Modifiable risk factors for hemorrhagic stroke include high blood pressure, blood clotting disorders, illicit drug use, and use of anticoagulant medications.
- Non-modifiable risk factors include family history.
NEURO: Stroke Symptoms
- Hemorrhagic stroke symptoms: severe headache, nausea, vomiting, altered consciousness, weakness, seizures, visual disturbances, and slurred speech.
- Ischemic stroke symptoms: weakness, slurred speech, confusion, visual disturbances, severe headache, trouble with coordination, and dizziness.
NEURO: Seizure Interventions
- Seizure precautions involve bed safety (firm mattress), padded side rails, clearing the environment, soft head protection, and supervision.
- During a seizure interventions: maintain airway, provide oxygen, establish IV access, monitor EEG and vital signs, and evaluate ABGs.
- Administer benzodiazepines (diazepam or lorazepam) as first-line medications.
- Long-acting antiepileptic drugs (AEDs) help prevent seizure recurrence.
- Continuous monitoring of vital signs, oxygen levels, and neurological status.
- During a seizure, protect the client from injury, position them side-lying to prevent aspiration, and document the seizure length.
- Do not restrain the client or place anything in their mouth.
Metabolic: Appendicitis
- Symptoms include abdominal pain (starting near the umbilicus and moving to the RLQ), nausea/vomiting, fever, and loss of appetite.
- Murphy’s sign is positive when pain decreases with pressure on the RLQ but increases upon release.
- McBurney’s point is located in the RLQ where the appendix is located.
- Perforation is indicated by a sudden decrease in abdominal pain, but pain returns.
- With a perforated appendix, abdomen progression distends and temperature will elevate 38.8° C to 39.4° C (102° to 103° F).
- Rovsing's sign shows tenderness in the RLQ regardless of palpation location.
Metabolic: Pancreatitis
- Labs: Elevated pancreatic enzymes such as amylase and lipase. Amylase should be elevated during acute pancreatitis within 12-24 hours and will remain elevated for 2-3 days, elevated WBC, decreased calcium and magnesium levels.
- Reduced calcium levels due to saponification, leading to hypocalcemia symptoms like tetany and positive Trousseau’s/Chvostek’s signs.
- Diet: Decrease fatty foods.
- With a history of pancreatitis or cholecystitis, avoid fatty foods and alcohol.
Metabolic: Ascites & Cirrhosis
- Ascites results from fluid retention due to low albumin levels.
- Patient education for ascites includes decreasing fluid, sodium, and fat intake.
- Cirrhosis is irreversible liver damage with collagen infiltration.
Metabolic: GI, Thyroid, & DKA
- Pyloric stenosis presents with projectile vomiting and failure to thrive.
- Intussusception presents with severe abdominal pain, "Red Current Jelly" stools, vomiting, and a palpable mass.
- Hirschsprung's Disease presents with delayed meconium passage, abdominal distension, constipation, and poor growth.
- Gastritis teaching: Avoid alcohol and NSAIDs, drink milk as a snack, and increase exercise.
- Upper GI bleeding presents as hematemesis or tarry stools, while lower GI bleeding presents as bright red stools.
- Thyroid surgery complications include parathyroid gland damage, leading to hypocalcemia.
- Complications of Post surgical client positioning: pillow placement, DVT development, hypotension/shock.
Other: Post Surgical Client Positioning
- Positioning is vital for respiratory function and circulation of Post-surgical patients.
- For responsive clients, elevate the head of the bed to semi-Fowler’s position to promote chest expansion.
- Maintain an unresponsive or unconscious client in the lateral position to reduce aspiration risk.
- Avoid placing a pillow under the knees to prevent impaired venous return and DVT risk.
- Elevate the legs while lowering the head of the bed in cases of hypotension or shock.
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