NUR 351 Fall 2024 Final Exam Study Guide PDF

NUR 351 Fall 2024 Final Exam - Blueprint/Study Guide Test Questions Blueprint - 100 questions total: Psych/Mental Health: 18 Pediatrics: 9 Medical-Surgical: 73 Week 3 - Foundations of Medical-Surgical Nursing & Week 4 - Health Promotion/Teaching...

NUR 351 Fall 2024 Final Exam - Blueprint/Study Guide Test Questions Blueprint - 100 questions total: Psych/Mental Health: 18 Pediatrics: 9 Medical-Surgical: 73 Week 3 - Foundations of Medical-Surgical Nursing & Week 4 - Health Promotion/Teaching/Learning (10 questions): What are the components of the SBAR method of communication & an example of what would be included: ○ S - situation; B - background; A - assessment; R - recommendation Identifying safety concerns & prioritizing patients at greatest risk for falls, infections, etc. (know why patients may be at greatest risk - ex. Impaired mobility or orthostatic hypotension can lead to falls) What are appropriate nursing interventions for a patient who is dying? (ex. Pain management - most common worry; symptom management - keep patient comfortable; environment control - calm/quiet/peaceful) Create a teaching plan for the patient preparing for discharge ○ Assessing a patient’s readiness to learn Identify barriers that may impact their readiness (ex. Acceptance of information, cognitive abilities, emotional state, motivation, asking questions, seeking more information, etc.) Ex. a patient ready to learn - shows motivation, asks questions, accepts the diagnosis/treatment plan, etc. Identify health beliefs (cultural, religious, etc.) that may influence learning or consenting to treatment ○ Evaluate the teaching-learning process (ex. Direct observation, return demonstration, teach back method, etc.)  Ex. Teaching-learning process may take place over several “sessions”; ideally, the nurse demonstrates first then has the patient return demonstrate; this method can be incorporated for any method especially if the patient is expected to use or perform at home (ex. Insulin syringe, inhaler, wound dressing, etc.) ○ Reinforce behaviors that assist with health promotion (ex. Self-monitoring for signs/symptoms of illness, taking medications as prescribed, eating a well-balanced diet, exercising, following up with appointments, etc.) ex: diabetes- BG Review the levels of prevention: Primary, secondary & tertiary ○ What does each level mean? Primary (designed to prevent or slow the onset of disease) Secondary (detects illness in an effort to treat in the early stages) Tertiary (focuses on stopping the disease from progressing & re-establish baseline) ○ What are examples of each level? Primary (ex. Eating healthy food, exercising, wearing sunscreen, obeying seat-belt laws, etc.), Secondary (ex. Mammogram) Tertiary (ex. Rehabilitation) Week 5 - Immunity & Perioperative Nursing (7 questions): Signs & symptoms of infection (non-specific cause) ○ Malaise, fatigue, warm/flushed skin, fever, elevated WBCs, tachycardia, purulent drainage, etc. Managing anaphylaxis (allergic reaction) ○ Signs of allergic reactions: wheezing (possibly stridor), pruritus (rash), urticaria (itching), etc. ○ IM Epinephrine will be administered to counteract the reaction (administer ASAP before airway becomes compromised) Mechanism of Action: Blood vessel constriction occurs - BP elevates & cardiac output improves  ○ Monitor patient’s airway in case angioedema occurs or throat swelling worsens (patient at risk for airway compromise when experiencing an allergic reaction) ○ Before giving any medication to a patient, ask about allergies! ○ Educate patient on preventing allergic reaction (once cause is identified) Caring for the postoperative patient ○ Assess for signs of infection at surgical site If a drain is present, assess insertion site (redness, warmth, edema, increased drainage, odor, etc. from site could indicate infection); assess drainage color & amount ○ Assess, monitor, & treat for pain Encourage pain medication before pain worsens; may use non-pharmacologic measures to provide comfort such as changing positions, using a support pillow, heat packs, guided imagery, music, massage, distraction, etc. ○ Assessing NG tube placement: auscultate bowel sounds by placing a stethoscope over the stomach region & instilling air into the NG tube. BEFORE doing so, turn off the suction so the noise does not interfere with your assessment Week 6 - Dysrhythmias & Hypertension (10 questions): Rhythm interpretation: Review the rhythm strips from Week 6 content: ○ Sinus Rhythms: Strip interpretation: Sinus rhythms: P, QRS, T are visible (brady HR 100); normal sinus rhythm HR 60-100 Treatment: Sinus bradycardia - avoid valsalva maneuver; if symptomatic may give Atropine; treat underlying cause; possibly need a pacemaker (temporary or permanent) Sinus tachycardia - treat underlying cause; if symptomatic may give calcium-channel blockers or beta blockers ○ Atrial Rhythms:  Strip interpretation: Atrial Fibrillation (A Fib): QRS visible then ‘fibs’ in between each visible QRS Treatment: Medications to control rate & rhythm; at risk for stroke - will have anticoagulant ordered & possibly antiplatelet medication ordered; may need cardioversion or ablation ○ Ventricular Rhythms: considered a lethal arrhythmia; check for pulse! Will defibrillate & perform CPR with this rhythm especially if patient has no pulse (remember: UNSTABLE gets the CABLE) Strip interpretation: Ventricular tachycardia (V Tach) - visible QRS, wide in appearance, looks like upside down V’s Ventricular fibrillation (V Fib) - ‘fibs’, no visible QRS Treatment: V Tach - treat underlying cause (treat electrolytes); if pulse present, instruct patient to perform Valsalva maneuver, administer antiarrhythmic (ex. Amiodarone), may need to perform synchronized cardioversion; if no pulse - CPR & defibrillation V Fib -Immediate CPR & defibrillation; treat underlying cause; ensure room safety BEFORE pressing the defibrillation button (ex. “I am clear, you are clear, we are all clear”) Hypertension education - limit intake of sodium, lifestyle/diet changes, stop smoking, exercise, watch fluid intake, importance of controlling modifiable risk factors, take medications as prescribed, etc. ○ Anti-hypertensive therapy may include diuretics. Monitor potassium levels; Furosemide = low potassium; Spironolactone = high potassium Week 7 - Myocardial Infarction (7 questions): What are the presenting symptoms with an MI? ○ Chest pain, neck/jaw/shoulder pain, fatigue, shortness of breath, abdominal pain, women may show vague symptoms, etc. What should be included when educating a patient about angina? ○ Explaining stable vs. unstable  ○ Balance rest & activity, smoking cessation, nitroglycerin usage (teach to keep it readily available - how to use, when to use, etc.) Understand the rationale for a cardiac catheterization ○ Diagnostic tool to determine cause of coronary artery disease - can be used to remove plaque or thrombus that is blocking the artery, can be used to insert stents into the artery/blood vessel to maintain patency after blockage is removed ○ Discharge teaching for the patient after a cardiac catheterization Monitor for signs/symptoms of infection at insertion site as wound heals (ex. Pain, warmth, swelling of extremity) Understand the rationale for performing a Percutaneous Transluminal Coronary Angioplasty (PTCA) ○ The PTCA is the intervention used to remove the blockage, by inserting a balloon-tipped catheter through an artery into the occluded coronary vessel & then inflating to open the artery (stents may have to be left in place to maintain the vessel’s patency) & restoring the blood flow. Review modifiable and nonmodifiable risk factors for CAD ○ What should be included when educating a patient at risk for CAD? Reduce modifiable risk factors (ex. Reduce stress, smoking cessation, healthy diet, weight management, exercise, etc.) Medications commonly prescribed to patients post-MI to help decrease cardiac workload ○ Beta blockers (ex. Metoprolol) to inhibit the sympathetic nervous system response ○ ACE inhibitors (ex. Lisinopril or Captopril) to reduce blood pressure Caution as medication can cause dizziness, hypotension & orthostatic hypotension — prevent falls! ○ Nitrates (ex. Nitroglycerin) to cause vasodilation which leads to decreased systemic vascular resistance What is the purpose of cardiac rehabilitation?  ○ To assist patient in returning to optimal state of health/wellness; individualized; post-operative strength building Week 8 - Neuro/Stroke (7 questions): Completing a neuro assessment & considerations of the elderly patient (some expected neuro changes that occur as we age, might mimic or mask stroke symptoms - Review “Age Related Changes in Geriatric Patients” in Week 8’s Content Slides from In-Class Session) ○ Slower response time; give clear/simple instructions/directions; allow time to process the instructions; weakness can be normal aging process; etc. Cranial nerve deficits (IX, X, XI, & XII): Dysphagia (risk for aspiration) Cranial nerve deficits (VIII): Ataxia (risk for falls - impaired gait) Cranial nerve deficits (II): Visual impairment (risk for falls, may have visual field loss) Patients with cerebellum damage are at risk for falls Caring for the stroke patient ○ Aphasia - difficulty speaking Encourage patient to communicate as able, demonstrate patience as patient will feel frustrated, create strategies to enhance & improve communication; assist patient with dignity (ex. Speech therapy offers techniques.) ○ Ataxia - balance/gait disturbance Fall prevention, educate on fall precautions, use a gait belt, patient may need other assistive devices to ambulate safely, etc. ○ Dysphagia - difficulty swallowing Aspiration risk, teach & follow aspiration precautions (HOB elevated, limit distractions while eating, small/frequent meals, rest between bites, crush meds - as applicable, thicken liquids - as applicable, etc.) Verapamil: calcium-channel blocker prescribed for hypertension ○ Caution as medication can cause hypotension, bradycardia, dizziness Week 10 - Overview of the Adult Respiratory System (Med-Surg content) & Week 11 - Pneumonia, Influenza, Pneumothorax, Hemothorax (11 questions): Smoking is a major risk factor for respiratory illnesses Elderly patients at risk for respiratory illness related to chest wall compliance/weakening due to osteoporosis & kyphosis Review nursing care before/after bronchoscopy ○ Bronchoscopy - direct visualization of respiratory tract; provides means to analyze tissues, & biopsy for specimens Due to invasive nature of this test & sedation required for the test, patient should be NPO for at least 8 hours prior After procedure, patient should remain NPO until gag reflex has returned, is alert, & sedation has worn off Nurse will monitor for hypoxia & bleeding during the recovery phase/post procedure; also monitor for subcutaneous crepitus around face & neck which could indicate bronchial or tracheal perforation & formation of air leaks from airway or lungs that accumulate under the skin Review Sputum Culture Collection & Instructions: ○ Sputum Analysis - checks for microorganisms and/or abnormal cell growth Collected by patient expectorating into a specimen cup or if intubated can be collected through suctioning Instruct patient to rinse mouth before giving sample as this will decrease the risk of contamination with normal mouth flora. Once specimen is collected, send to lab immediately as microorganisms can grow if left sitting out Lung infection is possible if sputum is greenish, has a foul order, & if patient has cough and fever present Assessing the patient requiring an oxygen delivery device ○ Assess respiratory status & response to oxygen Low flow devices: nasal cannula & face masks  High flow devices: Venturi mask Diagnostic test for Pneumonia: ○ CT scan - consolidation present = areas of infection What are the risk factors for pneumonia? ○ Elderly, long-term care residence, smoking, chronic respiratory diseases, immune system dysfunction, HIV/AIDs, prolonged immobility,aspiration, decreased gag/cough reflex Types of pneumonia & risk factors ○ Community-acquired: elderly, smoker ○ Hospital-acquired: currently admitted in the hospital & accompanied by the following risk factors - recent antibiotic therapy, immunosuppressive therapy, chronic disease, or treated within a healthcare facility ○ Healthcare-associated: recently discharged from the hospital or recently had a significant exposure to a healthcare setting Treatment for pneumonia ○ Thin secretions (increase fluid intake) ○ If antibiotics prescribed, ensure full completion of course ○ Bronchodilators, supplemental oxygen therapy as needed Chest tube - Rationale ○ Allows for the expulsion of air and/or fluid while allowing the lung to re-expand ○ Restores negative intrapleural pressure ○ Improves gas exchange ○ Inserted into the pleural space b/w the parietal and visceral pleura Week 12 - Fluid & Electrolyte balance, Acid-Base, Acute renal failure (7 questions):  Electrolyte Imbalances - Important to treat the cause; Brain sensitive to sodium & heart sensitive to potassium - will see this in the clinical symptoms ○ Hyperkalemia (Potassium >5.3) Risk for arrhythmias (need to be on a cardiac monitor) ○ Hypokalemia (Potassium 145) Risk for brain herniation if corrected too quickly Assess neuro status ○ Hyponatremia (Sodium