NR 452 Simulation Questions and Answers, Quizzes of Nursing

Download NR 452 Simulation Questions and Answers and more Quizzes Nursing in PDF only on Docsity! NR 452 Simulation Questions with Answers. 1. What key priority assessment findings are usually seen in left-sided heart failure? How do these findings differ from right-sided heart failure? Left sided heart failure: the left side of the heart cannot pump the blood out of the heart so blood starts to back up into the lungs. Left-sided heart failure or left ventricular failure have different manifestations with right-sided heart failure. Pulmonary congestion occurs when the left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation. Pulmonary venous blood volume and pressure increase, forcing fluid from the pulmonary capillaries into the pulmonary tissues and alveoli, causing pulmonary interstitial edema and impaired gas exchange. Right-Sided Heart Failure When the right ventricle fails, congestion in the peripheral tissues and the viscera predominates. The right side of the heart cannot eject blood and cannot accommodate all the blood that normally returns to it from the venous circulation. Increased venous pressure leads to JVD and increased capillary hydrostatic pressure throughout the venous system. 2. Identify two common medication classes used to treat left-sided heart failure. What are two nursing considerations for each identified classification of medication? ACE Inhibitors and Beta-blockers (caution with asthmas, blood pressure, heart rate, hold less than 60), Digoxin can both be used. Nursing considerations when giving medications such as ACE Inhibitors nursing interventions are; • Take complete health history of patient. • Monitor blood pressure and pulse frequently to avoid initial dose hypotension. • Daily check the weight and fluid overload. • Check the s/s of angioedema (swelling of face and extremities) • Monitor BUN, serum potassium, creatinine, AST, ALT, serum bilirubin level • ACE inhibitors may cause false urine acetone level • Monitor kidney function • Hyperkalemia Secondly, nursing interventions when giving the patient a Beta Blocker; • Inquire patient’s complete health history including allergies, diabetes or any respiratory diseases • Monitor blood pressure and pulse prior administration of medicine. If blood pressure and pulse is not in normal range inform the health practitioner. • Observe daily intake an output of fluid. Check body weight. • If patient is on parenteral drug, then check blood pressure and pulse frequently. • Patient with respiratory disease specially with asthma or COPD should be closely monitored for sign and symptoms. 6. Identify four different classifications of antibiotics. What priority nursing considerations should you review when a patient is on an antibiotic? Aminoglycosides, penicillins and penicillinase-resistant drugs, sulfonamides, tetracyclines, and antimycobacterials. Nursing considerations for cephalosporins - take with food - adm liquid form to children, do not crush tablets - have vitamin K available for hypoprothrombinemia - avoid alcohol while taking medication and for 3 days after finishing course of medication - cross allergy with penicillins - monitor renal and hepatic function - monitor for thrombophlebitis Nursing considerations of penicillin - culture and sensitivity before treatment - monitor serum electrolytes and cardiac status if given IV - monitor and rotate injection sites, monitor for 20 min after IM - good mouth care - 1-2 hr ac or 2-3 hr pc => reduce gastric acid destruction - yogurt or buttermilk if diarrhea develops => loose, foul-smelling stool - instruct patient to take missed drugs as soon as possible, do not double dose - check cross-sensitivity with cephalosporins Nursing considerations of tetracyclines - Take 1 h before or 2-3 h after meals - GI upset => with food except milk or food high in calcium - Do not take with antacids, milk, iron preparations - note expiration date => highly nephrotoxic => I & O - protect from sunlight - monitor renal function - topical applications may stain clothing - use contraceptive method in addition to oral contraceptives - yellow of the teeth Amino Cispro – tendon rupture, oto toxicity 7. What impact do Advanced Directives have on the nursing care of the patient? What resources are available to assist with completion and adherence to a patient’s end of life wishes? The registered nurse is responsible and accountable for assessing educational needs in respect to advance directives and to insure that the clients and staff members have the sufficient knowledge to make sound and knowledgeable decisions relating to these important aspects of client care. This knowledge enables the clients to make knowledgeable decisions about their own advance directives and it enables other members of the nursing team to integrate the principles of advance directives into the care that they provide to their clients. The nurse can help the patient with resources to assist in adherence to the patient’s end of life in using the Association for Death Education counseling, Association of American Medical Colleges, The Education of Palliative and End-of-Life Care.