NUR-101 FUNDAMENTALS EXAM 3 STUDY GUIDE 2024 UPDATE, Exams of Nursing

Download NUR-101 FUNDAMENTALS EXAM 3 STUDY GUIDE 2024 UPDATE and more Exams Nursing in PDF only on Docsity! NUR-101 FUNDAMENTALS EXAM 3 STUDY GUIDE 2024 UPDATE There will be 105 questions on this exam. Multiple choice questions, a few select all. Topics to include Fluid and Electrolytes, Nutrition, and Perioperative. Hope this helps – J.Ware Fluid and Electrolytes – Chapter 39 • Comparisons of fluid volumes between adults and infants. Infants have less blood volume and less surface area. Infant = 70% Total body fluid Men= 60% Total body fluid Women = 50% Total body fluid • IV fluid infusion protocols – how long can fluids run – blood, dextrose 4 hours (500 ml), two nurses check blood, 14-24 gaugue, blood + 0.9 NS, VS every 15 mins, 25-50 ml first 15in • Fluid intake volumes can be easily assessed by measuring urinary function Should be excreting what one puts in • (hourly urine output). The less urine out is a sign that a person is not taking in enough oral fluid. This is considered dehydration (medical diagnosis) and fluid volume deficit in nursing diagnosis. IF the labs are decreased – hypokalemia – or increased - then the nursing diagnosis is fluid and electrolyte imbalance and considered dangerous. Pg 1484 30-50ml an hour • Remember that a medical diagnosis is made by performing a physical assessment, look at laboratory values, and look at diagnostic testing. • Know how much body fluid is lost through the GI tract normally? With severe diarrhea? pg 1473 2600ml, as much as taken in Severe diarrhea: • Extracellular volume is manifested by excess of vascular and interstitial fluid, such as heart failure – manifested by edema and orthopnea (shortness of breath) pg 1473 • Who (developmentally by age) is at greatest risk for fluid and electrolyte imbalance? Infants, because their kidney functioning has not matured. Older adults • What is an autologous transfusion? collection and reinfusion of the patient’s own red blood cells. Decreases the risk for complications from mismatched blood. Technique requires advanced planning (blood donated 5 weeks in advance) • Know the difference between extracellular, intracellular, intravascular, and interstitial fluids Extracellular: Fluids outside the cells; Intravascular (fluids within vascular space) and Interstitial (fluids within the tissue) Intracellular Fluids: within the cells • Which type of disease process would cause the patient to need the administration of total parenteral nutrition? Fluid electrolyte imblances, malnutrition. Is TPN hypertonic or hypotonic? Hypertonic. Is it peripheral vascular (enteral) or central vascular? Remember that this is all about adequate long -term weight gain AND the patient’s ability to intake oral food/drink and hold it down – severe conditions - so you can surely consider GI diseases and metabolic conditions that rob calories. Pg 1493 • Diuretic therapy – what is the nursing diagnosis used to teach patient to drink more fluids? Deficient fluid volume • What is the nursing diagnosis used when the drug in not potassium sparing and the potassium is decreased? • Which location of insertion site is assessed by the nurse for a central venous access device? subclavian vein (located beneath the collarbone) or into the internal jugular vein (located in the neck) • Know the terms: atelectasis, fluid volume deficit, myocardial infarction, fluid volume excess Atelectasis: destruction of alveoli Fluid volume deficit : Decreased intravascular, interstitial, and/or intracellular fluid. Fluid output more than fluid intake Myocardial infraction : death of cardiac tissue, heart attack Fluid volume excess : intravascular compartment occurs due to an increase in total body sodium content and a consequent increase in extracellular body water • How does a nurse change a peripheral venous access dressing? What are the steps cleansing, sterile or clean technique, drying….. Hashtag motion up and down then side to side with cotton swab spinal cord (such as spina bifida) and the brain (such as anencephaly). Should be taken during first trimester. • Differentiate between vitamins, proteins, carbohydrates, fats, minerals Vitamins: Used for metabolism Proteins: Growth, maintenance, repair of body tissues Carbs: Energy and fiber Fats: Energy and vitamins Minerals: biochemical reactions in the body • Which nutrients in food supply energy to the body? Pg 1196 Carbs, and fats, proteins (macronutrients) • Know adult (general average) normal and abnormal lab values for serum albumin, hemoglobin, hematocrit, creatinine, cholesterol, triglycerides, and BUN. You will be given some numbers for lab values and you will determine what is a value that indicates malnutrition, cardiac disease potential, Serum Albumin: 3.4-5.4 (low = malnutrition, liver disease or inflammatory disease) (high= dehydrated or rich protein diet) Hemoglobin: 12-17.5 (protein in red blood cells responsible for transporting oxygen; low oxygen levels = high hemo.) (low hemo = anemia) Hematocrit: 35-49 (percentage of RBC’s in blood. Low = anemia, High = polycythemia and dehydration) WBC= 4800-10800 RBC= 4.7-6.1 Creatinine: 0.6-1.2 (kidney function) Cholesterol: LDL less than 100, HDL = 60 or higher. Total = less than 200 Triglycerides: less than <150 BUN: 8-20 K= 3.5-5.0 Na= 135-145 Cl=97-107 • Pregnancy and nutritional teaching - should a pregnant woman eat more calories? YES, especially after the first 12 weeks, which is the first trimester. After that the fetus begins to grow significantly. During the trimesters, which ones require more calories? Pg 1211 Third Trimester (Extra 450 calroies) • What is the best recommended nutrition for an infant? Breastfeeding. Why should formula (bottle feeding) contain iron? Because the mother has iron stores in her body that she can pass through breast milk (for 5 months). Bottled formula must contain the same iron if infant is not breastfeeding. When can an infant begin to drink cow’s milk? 12 months. When can an infant begin to eat solid foods? (meaning pureed food like jarred Gerber, not really solid food like a hamburger!) at 6 months. Pg 1210 • Constipation is a nutritional concern – teaching to include to bulk up the stool with fiber and fluids (need both or the fiber becomes hard in the colon) • Oatmeal, whole wheat, fresh vegetables and fruits with peeling are best sources of fiber. Know differences between insoluble and soluble fiber. How does fiber affect cholesterol? Soluble fiber: attracts water and turns to gel during digestion. This slows digestion. Soluble fiber is found in oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables. Lower risk of heart disease. Insoluble fiber : found in foods such as wheat bran, vegetables, and whole grains. It adds bulk to the stool and appears to help food pass more quickly through the stomach and intestines. Fiber lower blood cholesterol is through its ability to reduce the amount of bile reabsorbed in the intestines • What are the differences between unsaturated fats, trans fat, saturated fat, and hydrogenated fats? Unsaturated: lower cholesterol (vegetables) Trans: When manufactures partially hydrogenate liquid oils to become more solid, raise cholesterol Saturated: Contain more hydrogen, raise cholesterol (animal fats) Hydrogenated: manufactured fats created during a process called hydrogenation whereby hydrogen units are added to polyunsaturated fatty acids to prevent them from becoming rancid and to keep them solid at room temperature. • How often should Vitamin C be ingested? What are the benefits of taking Vitamin C? 65-90 mg a day. It is necessary for the growth, development and repair of all body tissues. It's involved in many body functions, including formation of collagen, absorption of iron, the immune system, wound healing, and the maintenance of cartilage, bones, and teeth. • Identify the ordered steps for administering an intermittent NG feeding. • What nursing interventions can be implemented to stimulate appetite? Good oral hygiene, favorite foods, minimal environmental odors, small frequent meals, attractive food. • What factors increase BMR (basal metabolic rate) Growth, infections, fever, emotional tension, extreme environmental temperatures, elevated levels of certain hormones • How many calories should be eliminated each day in order to lose one pound of fat per week? One pound of fat = 3500 calories 500 calories more per day than you consume • What is included in a clear liquid diet? Full liquid diet? Regular diet? Pureed diet? Bland diet? Clear: liquids that leave little residue (clear fruit juices, gelatin, broth) Full liquid: clear liquids, liquid dairy products, all juices, pureed vegetables Pureed: clear and full liquids, pureed meats, fruits, scrambled eggs Bland: foods that are soft, not very spicy, and low in fiber (cooked canned frozen vegetables, bread, crackers, pasta) Regular: no restrictions • What carbohydrate helps improve glucose tolerance? • What is the route of administration for TPN? Through the veins (total parenteral nutrition) • What signs and symptoms would indicate protein-calorie malnutrition in a patient who is on prolonged NPO status? Poor weight gain. Slowing of linear growth. Behavioral changes -Irritability, apathy, decreased social responsiveness, anxiety, and attention deficits. • What are the three sources of energy? Fats, Carbs, proteins • Diet considerations for cardiac/vascular disease, renal disease, diabetes, cystic fibrosis – which type of fats should not be allowed in the diet? Which type of protein is suggested for the disease process? Carbs? Cardiac: Renal: Diabetes: Cystic fibrosis: • Calculate BMI - pg 1198 • Which nutritional factors increase metabolic rate? Which patient conditions burn calories and cause weight gain or loss? Pg 1521 Eating small frequent meals increase BMR Anorexia and bulimia nervosa = weight loss • Nurses responsibility in PACU to include nursing assessment and witnessing the signature. • Who obtains the patient signature? Who describes the risks of the surgery to the patient? The Doctor • What does the nurse do if the patient states that he does not want to be saved if he has a cardiac arrest during surgery? Discuss and document the exact wishes of the patient and family members before surgery. DNR • What discharge teaching is included for the patient who has just had an outpatient surgical procedure? • What is the proper technique for teaching a patient to cough and deep breathe? Patient in semi-fowlers (neck and shoulders supported) Patient places hands over the rib cage (to feel it rise and fall) Exhale gently and completely Inhale through the nose gently and completely Hold the breath for 3-5 seconds and mentally count 1 one thousand, etc. Exhale as completely as possible through mouth (pursed lips) Repeat 3 times This should be done every 1-2 hour while patent is awake for the first 24 hours after surgery • What is an advantage of having an epidural anesthesia for a cesarean section? Pain relief, while having little of the sedating side effects that limit the use of the intravenous pain medications. Relief can be achieved, optimally without losing the ability to control movement in any part of the body, also patient is awake. • Pain management – when to have patients request pain meds? How is pain measured? What does PRN mean? Can a nurse give a PRN med anytime or is it on a time scale just like routine meds? Pg 867 Ask for meds before pain becomes severe. pain scale. PRN = as needed. There is a time scale, every 2-4 hours the PRN medication can be given. • Identify the term conscious sedation. How would the patient act with the sedation? Conscious sedation is a combination of medicines through IV to help you relax (a sedative) and to block pain (an anesthetic) during a medical procedure. Mood is altered, may not be able to speak, loopy, loss of some memory (amnesia) Identify the teaching methods when working with a patient who needs leg exercise instructions. Prevention of venous stasis. Leg exercises and turning every 2 hours Assist with ambulation (begins in the evening, increases as tolerated) blood pressure, pulse, and respiratory rates are used to monitor tolerance Compression stockings, compression devices, Anticoagulant drugs Measure bilateral calf and thigh circumference daily Assess for leg swelling tenderness or palpable venous cord Place pillows under the legs, do not impede venous return so do not raise knee portion of bed • What are the risks of abdominal surgery for the obese patient? What are the nursing diagnoses for obesity and surgical risks? Risk for infection, medication may not perform as expected. Renal elimination rates of certain drugs are increased, reducing the effectiveness of these drugs. Patient is at great risk for skin breakdown due to the poor vascular supply of adipose tissue. • What do these surgical terms mean? diagnostic, ablative, palliative, reconstructive Diagnostic: confirm diagnosis Ablative: removal diseased part Palliative: make patient comfortable, reduce relieve intensity of illness Reconstructive: Restore • How do nurses assist patients dealing with nausea complications after surgery? Avoid large amounts of fluids or food at one time, nothing after being NPO Administer prescribed meds (antiemetics) Provide oral hygiene, as needed Maintain clean environment Avoid use of a straw Avoid strong smelling food Assess for possible allergy to meds (antibiotics or analgesics) Maintain bowel elimination • What is the primary focus in the assessment during the immediate post operative recovery period? Vitals, color and temp of skin, LOC, IV fluids, Surgical site, other tubes, comfort, position and safety Check on patient every 15 minutes until stable, then every 1 hour, then to every 2 hours for the first 24 hours then every 4 hours after. • Know the surgical terms and give examples: urgent, elective, emergency, emergent Urgent: done within a reasonable amount of time (24-48 hrs) to preserve health (appendicitis) Elective: Preplanned, pts choice (total knee replacements) Emergency: done immediately to preserve life or a body function (intracranial bleeding) • Why is cross-matching an important procedure before major surgery? Cross Matching is a procedure performed prior to a blood transfusion to determine whether donor blood is compatible (or incompatible) with recipient blood. • What should the nurse do if a lab result returns with an abnormal result? Notify Provider. • What should the nurse do if there is no informed consent on the chart? Go get one, or no surgery. • What are the guidelines for elimination needs after surgery? Pg. 880 • What medications are affiliated with thrombophlebitis? Anti-inflammatory agents, anticoagulants (prevent), analgesics • An ABG lab level PaCO2 is abnormal. What type of disease does this imply with a medical diagnosis? COPD