NR224 Exam 2 Study Guide with Answers, Exams of Nursing

Download NR224 Exam 2 Study Guide with Answers and more Exams Nursing in PDF only on Docsity! NR224 EXAM 2 STUDY GUIDE WITH ANSWERS Nutrition: 1) Define basal metabolic rate & resting energy expenditure BMR is the energy needed at rest to maintain life- sustaining activities for a specific amount of time. REE is the amount of energy you need to consume over a 24- hour period for your body to maintain all of its internal working activities while at rest. a. When is weight maintained, lost, and gained? (give intake versus outputs for each) From the kilocalories of food we eat. If we meet the energy requirements, it won’t change; if we exceed, we gain; if we fail to meet, we lose. 2) Describe the following (what are they, why are they important, examples of each) a. Carbohydrates: composed of carbon, hydrogen, and oxygen. Main source of energy in the diet. Main source of fuel for the brain, skeletal muscles during exercise, erythrocyte and leukocyte production, and cell function of the renal medulla. Examples are sugars, vegetables, fruits, milk. b. Proteins: provide a source of energy that is essential for growth, maintenance, and repair of body tissue. i. What are the different types of protein? (dispensable, complete) Dispensable: the body can synthesize, examples are alanine, asparagine, and glutamic acid. Complete: ‘high- quality’ protein contains all essential amino acids in sufficient quantity to support growth and maintain nitrogen balance. Indispensable: body doesn’t synthesize so we need these to be provided in our diet, like histidine. ii. What type of nitrogen balance is essentials for healing, growth, vital organ function, etc.? How does protein affect this nitrogen balance? POSITIVE nitrogen balance is essential for that. Protein NR224 EXAM 2 STUDY GUIDE WITH ANSWERS provides energy but because its essential role is to promote growth, maintenance, and repair, a diet needs to provide adequate kilocalories from nonprotein sources. c. Fats Most calorie-dense nutrient, composing of triglycerides and fatty acids. i. How much fat is needed in the diet to prevent deficiency of linoleic acid? What is lineoleic acid? Above 10% of daily nutrition, anything below will be a deficiency. Linoleic acid is another type of unsaturated fatty acid that is important for metabolic processes. ii. Triglycerides: circulate in the blood and are composed of three fatty acids attached to a glycerol. iii. Monounsaturated fatty acids: One double bond. Foods like almonds, pecans, cashews. iv. Polyunsaturated fatty acids: fatty acid with two or more carbon double bonds. v. Unsaturated fatty acids: unequal number of hydrogen atoms are attached and the carbon atoms attach to one another with a double bond vi. Saturated fatty acids: each carbon in the chain has attached hydrogen atom. 1. What are AHA guidelines for daily saturated fat intake? 10%. d. Water: Makes up 60-70% of total body weight. i. Describe signs and symptoms of dehydration? Feeling very thirsty, dry mouth, less urination, dark-colored urine, dry skin, tired, dizzy. ii. How would you educate a client about dehydration? Teach importance of drinking 6-8 glasses of water a day. How hydration is important for wound healing, healthy ski, digestion, healthy kidneys, and electrolyte balance. e. Vitamins: organic substances present in small amounts in food that are essential to normal metabolism. i. Fat Soluble: A,D,E, and K. Stored in the fatty compartments of the body. Needed through dietary intake, besides D. ii. Water Soluble: C and B complex. Body doesn’t store these, so we need to provide in daily food intake. f. Minerals: inorganic elements essential to the body at catalysts in biochemical reactions. 3) Describe: a. Digestion: mechanical breakdown that results from chewing, churning, and mixing with fluid and chemical reactions with food reduces to its simplest form. b. Metabolism and storage of nutrients: all biochemical reactions within the cells of the body. It is stored in tissues, like adipose tissue. c. Absorption: small intestine, lined with villi, primary absorption site for nutrients. d. Elimination: chyme moves by peristaltic action through ileocecal valve into the large intestine where it becomes feces. 4) How is it best to assess cultural views of food preferences? Ask the patient if they have any restrictions. NR224 EXAM 2 STUDY GUIDE WITH ANSWERS 14) When would an OG be placed in a patient (not in your book, from class): Facial or nasal trauma 15) How do we confirm placement? Testing the pH level. a. What is the gold standard for confirming placement? An X-ray 16) What do we have to do with an NG tube before we administer feedings and/or medications? Confirmation of placement. 17) Describe parenteral nutrition (PN): Form of specialized nutrition support provided intravenously. a. Why does the dressing change have to be sterile for CVC? To prevent or treat metabolic complications. b. What’s the difference between PN that can be given peripherally versus through a CVC? PN is more calorically dense than peripheral solutions, so it’s usually temporary, but if it’s greater than 10% dextrose, it requires a CVC instead. c. What are possible complications of PN? Pneumothorax from a puncture in the tube or metabolic complications like hypercapnia, hypoglycemia, hyperglycemia. Electrolyte and mineral imbalances can occur too. d. What are nursing assessments you would complete for a patient on PN? Assess the insertion site for signs of infection, assess for hyperglycemia. e. What if the PN bag ran dry before tapering, what’s the next step? Give then 10-15g of carbs i. Why must it be tapered? To prevent hyperglycemia. f. What does PN do to glucose levels? Increases glucose levels and can go hyperglycemic. 18) Describe nutritional changes that would be essential for a patient with each of these diagnoses: a. GI Disorders i. Peptic Ulcer: avoid caffeine, spicy foods, aspirin, NSAIDS, small meals ii. Crohn’s/Ulcerative Colitis: increase in fiber, fat reduction, avoid large meals, avoid lactose iii. Celiac: gluten free diet iv. Short Bowel Syndrome: lifetime EN or PN v. Diverticulitis: high fiber, no seeds b. Diabetes: carbohydrate consistency and monitoring, saturated fat less than 7%, cholesterol intake less than 200mg/L, and protein intake 15-20% of diet. c. Cardiovascular: balance caloric intake and exercise, eat fruits, vegetables, complex carbs, fish twice a week, limit foods and beverages high in sugar and salt, and limit trans- saturated fats to less than 1% d. Cancer: maximize fluid and nutrient intake; encourage small, frequent meals and snacks that are easy to digest. e. HIV/AIDS: maximize calories and nutrients, encourage small, frequent, nutrient-dense meals with fluid in between. NR224 EXAM 2 STUDY GUIDE WITH ANSWERS CH40: Oxygenation 1. What is atelectasis and how do we prevent it? A collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide. To prevent it, you can do deep breathing exercises, coughing, stop smoking, and ensuring positive airway pressure. 2. Respiratory wise, what are you looking for/at when observing a patient? Observe their chest wall movement for retraction and use of accessory muscles, observe their breathing pattern and assess for paradoxical breathing or asynchronous breathing. 3. What are the 6 P’s of dyspnea? Pulmonary bronchial constriction; Pneumothorax; Pump failure; Pneumonia; Pulmonary embolus; Possible foreign body 4. If a patient has a pulse ox of 89% we do not immediately place on oxygen, what would we do instead? Position the patient upright, then recheck. 5. What is orthopnea? An abnormal condition in which a patient has shortness of breath when lying down. 6. If a client is experience orthopnea while lying flat in bed, what intervention can we recommend to improve their condition short term? Have them use multiple pillows when reclining to breathe easier or sits leaning forward with arms elevated. 7. What are the clinical signs and symptoms of hypoxia? Apprehension, restlessness, inability to concentrate, decreased level of consciousness, dizziness, and behavioral changes. 8. What is the first sign of hypoxia that you will observe in a patient? The patient will not be able to lie flat, appear fatigued and agitated. 9. What clinical manifestations of hypoxia are found late stages? Cyanosis, which is a blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries. 10. What do you do if you get an abnormal pulse ox reading that does not match your physical assessment? a. Example: a SPO2 reading of 76% for a client who’s breathing is unlabored at a rate of 12 without evidence of hypoxia There could be compression by the probe; AV fistula present; vascular impingement, or elevation with respect to the heart. 11. Who should receive a flu vaccine? Older adults. 12. Who should receive the pneumonia vaccine? Older Asian American adults. 13. What are the different oxygen devices? What liters per minute do they require? Which ones are used for oxygen support, which ones are used for oxygen and ventilation support? 14. What is the purpose of percussion? Detects the presence of abnormal fluid in the lungs, and determines diaphragmatic excursion. 15. What is the importance of an incentive spirometer? Encourages voluntary deep breathing by providing visual feedback to patients about inspiratory volume. a. How do we use it? Patient holds the device and takes a deep breath, and they can see a bellow that rises to a predetermined volume by an inhaled breath. 16. Why is it important (respiratory focus) for patients to: a. Stay hydrated: severe dehydration can cause extracellular fluid loss and reduced circulating blood volume, and can cause a decrease in circulating blood volume and a decrease in stroke volume. NR224 EXAM 2 STUDY GUIDE WITH ANSWERS b. Cough & deep breathe a protective reflex to clear the trachea, bronchi, and lungs of irritants and secretions. It reduces secondary to respiratory muscle weakness, putting a patient at risk for retention of pulmonary secretions.