Mark Klimek NCLEX Review - ABGs and Compensation

Questions and Answers

What are the 4 scenarios regarding water seal chamber and suction control?

Suction control, continuously: GOOD (correct)

Suction control, intermittent: BAD (correct)

Water seal chamber, intermittent: GOOD (correct)

Water seal chamber, continuously: GOOD

Congenital heart defects are either _ or no _.

TRouBLe

What is needed for congenital heart defects?

Murmur and echocardiogram

List the 4 defects of Tetralogy of Fallot.

Ventricular septal defect, pulmonary stenosis, overriding aorta, right ventricular hypertrophy Signup and view all the answers

Crutches, canes & walks are called: _ .

ambulatory assistive devices Signup and view all the answers

How do you measure crutch length?

2-3 finger widths below axillary to point lateral to and slightly in front of the foot, flex elbow 30°. Signup and view all the answers

What are the types of crutch gaits?

2 point Signup and view all the answers

What does 'even for even, odd for odd' mean?

Even gaits (2 & 4) when weight is evenly distributed. Signup and view all the answers

What is the use of strong and weak legs in relation to ambulatory devices?

Crutches: bad leg with crutches; Canes: on strong side, advance with weak side; Walkers: pick it up, set it down, and walk to it. Signup and view all the answers

What are Biological Agents in Category A?

STAPH B, Small Pox, Tularemia, Anthrax, Plague, Hemorrhagic illness, Botulism Signup and view all the answers

What are Biological Agents in Category B?

All others Signup and view all the answers

What are Biological Agents in Category C?

Nipah Virus, Hanta Virus Signup and view all the answers

When it comes to Biological Agents: Category is _, then Category , then Category .

A, the worst, B, C Signup and view all the answers

What is the transmission method for Small Pox?

Inhaled transmission/on airborne precautions. Signup and view all the answers

What are the treatment options for Tularemia?

Treat with streptomycin. Signup and view all the answers

What are the characteristics of Anthrax?

Spread by inhalation, looks like the flu, dies from respiratory failure. Signup and view all the answers

What are the symptoms associated with Plague?

Hemoptysis, hematemesis, hematochezia. Signup and view all the answers

What are the primary symptoms of Hemorrhagic illnesses?

Petechiae and ecchymoses. Signup and view all the answers

What are the major symptoms of Botulism?

Descending paralysis, fever, but is alert. Signup and view all the answers

What concept is related to ABGs (identifying & cause)?

ABGs Signup and view all the answers

Rule of the B's: If the __ and the _ are in the same direction then it is meta_

pH, Bicarb, Both, Bolic Signup and view all the answers

What distinguishes compensated from partially compensated?

In compensated, pH is within normal range; in partially compensated, pH is not normal. Signup and view all the answers

As the ___ goes, so goes _ except for _____

pH, my patient, potassium Signup and view all the answers

List some symptoms of 'Up' (alkalosis).

Hyperkalemia, Hypertension, Tachycardia, Tachypnea, Diarrhea, Seizures, Irritability, Spastic, Tetany, Borborygmi, Hyperreflexia Signup and view all the answers

List some symptoms of 'Down' (acid).

Hyperkalemia, Hypotension, Bradycardia, Bradypnea, Constipation, Coma, Arrest, Lethargic, Absent bowel sounds, Flaccid Signup and view all the answers

What is the only acid-base imbalance that causes Kussmaul respirations?

Metabolic Acidosis Signup and view all the answers

Causes of acid-base imbalances: First ask yourself, 'Is it _?' If yes, then it's _.

lung, respiratory Signup and view all the answers

Causes of acid-base imbalances: If it's not lung, then it's ___. If the patient has _ _ vomiting or suction, pick ___.

not lungs, prolonged gastric, alkalosis Signup and view all the answers

What is a HIGH pressure ventilator alarm triggered by?

increased resistance to air flow Signup and view all the answers

What is a LOW pressure ventilator alarm triggered by?

decreased resistance to air flow Signup and view all the answers

Respiratory alkalosis means ventilator settings may be too _. Respiratory acidosis means ventilator settings may be too _.

high, low Signup and view all the answers

What does 'extubate' mean?

Remove tube from Signup and view all the answers

Remember it's a PSYCH question if you are asked to Prioritize, don't forget ___________!

MASLOW Signup and view all the answers

The #1 problem in abuse is ________. What is the nursing action for denial with abuse?

Denial, confront the denial Signup and view all the answers

What are the 5 stages of grief?

denial, anger, bargaining, depression, acceptance Signup and view all the answers

What is the nursing action for denial with grief?

support the denial Signup and view all the answers

The #2 problem in abuse is _ & _.

Dependency, Codependency Signup and view all the answers

Define Dependency.

When the abuser gets the significant other to do things for them or make decisions for them. Signup and view all the answers

Define Codependency.

When the significant other derives positive self-esteem from doing things for or making decisions for the abuser. Signup and view all the answers

Dependency & Codependency treatment: Set _ and _ them.

limits, enforce Signup and view all the answers

Define manipulation and differentiate it from codependency.

When abuser gets the significant other to do harmful things to them. Signup and view all the answers

Wernicke's (Korsakoff's) Syndrome = _ induced by Vitamin _ deficiency.

Psychosis, B1 Signup and view all the answers

What are the characteristics of Wernicke's (Korsakoff's) Syndrome?

preventable, arrestable, irreversible Signup and view all the answers

What is the treatment for alcoholism using Antabuse (ReVia)?

Aversion Therapy Signup and view all the answers

What are some signs of Uppers?

Caffeine, Cocaine, Methamphetamines, PCP/LSD, ADHD Meds, Bath Salts Signup and view all the answers

What is the treatment for V Tach?

lidocaine and amiodarone Signup and view all the answers

Chest tube purpose is to reestablish _ in pleural space.

Negative pressure Signup and view all the answers

Pneumothorax v.s. hemothorax: and , v.s. and .

air, apical (high), blood, basal (low) Signup and view all the answers

Study Notes

ABGs and Acid-Base Imbalances

ABGs (Arterial Blood Gases) help identify acid-base imbalances.
Rule of the B's: If pH and Bicarb move in the same direction, it indicates metabolic alkalosis or acidosis.
Compensated vs. Partially Compensated: Compensated has a normal pH, while partially compensated does not; check the compensating system for abnormalities.
As pH rises, potassium levels typically decrease, and vice versa, except in cases involving potassium levels.

Signs of Alkalosis and Acidosis

Signs of Alkalosis: Include hyperkalemia, hypertension, tachycardia, and seizures.
Signs of Acidosis: Include hyperkalemia, bradycardia, hypotension, and lethargy.
Metabolic alkalosis may arise from prolonged gastric vomiting, while respiratory issues can indicate acidosis or alkalosis depending on ventilation status.

Ventilator Alarms

High Pressure Alarms: Triggered by increased resistance; causes include kinked tubing, water in tubes, or mucus in airway.
Low Pressure Alarms: Triggered by decreased resistance; causes usually involve disconnections in tubing.
Respiratory alkalosis indicates overventilation, while respiratory acidosis indicates underventilation.

Substance Abuse and Psychological Concepts

The primary problem in substance abuse is denial; confront this by highlighting inconsistencies in statements and behaviors.
The five stages of grief: denial, anger, bargaining, depression, and acceptance (mnemonic: DAB-DA).
Dependency arises when the abuser relies on others, whereas codependency is the significant other's reliance on the abuser’s needs for self-esteem.

Nursing Actions for Substance Abuse

For dependency and codependency, set and enforce limits, and work on the codependent person's self-esteem.
Wernicke's Syndrome is induced by thiamine deficiency, characterized by psychosis with memory loss and confabulation.

Aminoglycosides

Aminoglycosides are potent antibiotics effective against serious infections, all end in "-mycin" but not all "-mycin" drugs are aminoglycosides.
Examples of aminoglycosides: Streptomycin, Gentamycin, Vancomycin; non-aminoglycoside mycins include Azithromycin and Erythromycin.
Toxic effects include ototoxicity (hearing) and nephrotoxicity (kidneys); monitor hearing, balance, and creatinine levels.

Heart Medications

Inotropic effects are related to heart strength; positive inotropes increase strength while negative inotropes decrease it.
Chronotropic effects are related to heart rate; positive chronotropes increase rate while negative decrease it.
Dromotropic effects concern the conductivity of the heart; positive enhances while negative inhibits conduction.
Calcium Channel Blockers and Beta Blockers generally exhibit negative inotropic, chronotropic, and dromotropic effects.

Arrhythmias

Various arrhythmias are distinguished by their depolarization patterns; lethal arrhythmias include asystole and ventricular fibrillation.
Treat PVCs with lidocaine and amiodarone, while V-Tach is treated similarly.

Chest Tubes and Complications

Chest tubes restore negative pressure in the pleural space to keep the lungs inflated.
Monitor for complications like drainage device breakage, where immediate action involves clamping and replacing the device, or tube dislodgment, which involves covering it with sterile gauze.

Congenital Heart Defects

Congenital defects are classified as "trouble" when they involve right-to-left shunting, cyanosis, or require surgical intervention.
Tetralogy of Fallot includes four defects: ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy.

Ambulatory Assistive Devices

Crutches, canes, and walkers are classified as ambulatory assistive devices; crutches should be measured with specific distal measurements and elbow flexion angles.
Different crutch gaits include 2-point, 3-point, 4-point, and swing-through, emphasizing the sequence of leg and crutch movements.### Gait Patterns
Even gaits (2 & 4) indicate weight is evenly distributed.
Two affected legs suggest mild impairment (faster), while four affected legs indicate severe impairment (slower movement).
For brace extremities or amputations, use a "swing through" method for mobility.

Crutch and Cane Usage

Crutches are used with the bad leg while supporting weight.
Canes should be used on the strong side and advanced with the weak side.
Walkers should be picked up, set down, and approached for walking; belongings must be placed to the side, not in front.

Biological Agents: Category A

Includes severe agents that pose the highest risk.
Key agents include:
- STAPH B
- Small Pox: transmitted through inhalation, airborne precautions required, fatal due to septicemia, rash starts around the mouth.
- Tularemia: causes chest symptoms, leads to respiratory failure, treated with streptomycin.
- Anthrax: spreads by inhalation and resembles flu symptoms; fatal due to respiratory failure, treated with supro, PCN, and streptomycin.
- Plague: transmitted via inhalation, characterized by 3 H's: hemoptysis, hematemesis, and hematochezia; fatal due to respiratory failure and DIC, treated with Doxycycline and Mycins.
- Hemorrhagic illnesses: presents with petechiae and ecchymoses, has a high fatality rate.
- Botulism: ingested toxin causing descending paralysis, fever while remaining alert, fatal due to respiratory arrest.

Biological Agents: Category B & C

Category B includes agents that pose lesser risks compared to Category A.
Category C comprises emerging pathogens, such as:
- Nipah Virus
- Hantavirus

Risk Severity of Biological Agents

Categories suggest severity:
- Category A: the worst
- Category B: lesser concern
- Category C: emerging threats

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Description

This quiz covers essential concepts related to arterial blood gases (ABGs) and the rules of compensation in the context of NCLEX exam preparation. It includes important definitions and key concepts that nurses must master to identify and interpret ABG results. Strengthen your understanding of these critical nursing topics with this focused review.