My friends....

Please join me on Thursday, November 10th at 12 pm to help plan the welcome reception. There are alot of ideas floating around, and I have information to share. I know that some of you will be going away for your much deserved winter break, but I would still love to hear your imput!

We have invitations that need to be folded and little things that can be done at home to help us prepare if you are not one of the speak in public types :).

Also...a HUGE HUGE favour I need from each of you...I would like to prepare some sort of food for the new people coming in...is 5 dollars a piece feasable for each of you?

Thank you all so much!

Let us create a nice welcome for those coming in

-Christine :)

More for you future nurses,

Several people have requested a "Test Taking Statagies class", on how to read nursing test questions. I will be having a one class on Monday, November 7, 2005 9:00 - 10:00 am in L228. See you there.
Caralee

Dear SJDC Future Nurses,

We are in the process of evaluating new software for the computer lab and would like to get your input.

The online preview of Learning System, Nurse Logic, Dosage & Calculations, Pharmacology and Skill Building from Meds publishing has been set up. You have free access until December 1, 2005. Please follow the instructions on the attached student login document and use the following class activation code to access the exams.


7566fly680house669


You’ll first want to go to http://online.medspub.com/medsonline/sec-support.html and click “Check My Computer Settings.” That will walk you through six easy steps to make sure your computer is ready for Meds. Steps 2 and 3 even have places to click for FREE Internet Explorer and FlashPlayer upgrades if needed. Those two things are a must in order to run Meds online.

After you have reviewed the program, please send your comments to cbromme@deltacollege.edu

Identify was it easy to access and use?
Did it help you in your studies?

I look forward to your input.
Caralee

End of life care summary and free NCLEX questions...scroll down to the end of the article and click "take the test"End-of-Life Care - continuing education course for nurses, physical therapists, occupational therapists, paramedics, EMTs and...


:)

Does anybody know what's up with the "Question of the Week" on learningext.com ? It's been on the same question since 10/17 .... ?

Would you like your name/initials on your Delta Nursing jacket, sweatshirt, poloshirt?? I dont have a cost right now, but I need 25 items to place the order. If you sign up, and then if the price is not what you want to pay, then you can remove your name.... I just need an estimate of the #'s. Please send me an email : RDeYoung585@students.deltacollege.edu

I will post on the BLOG when I get the price :)

I was thinking white lettering, script style -- don't know if we have other options so if there is something different you would like, let me know & I'll find out

Does anyone have shelbas email?????
I have her hours that she is available and her phone number but not her email.
If someone could post that, it would be great.

Mike,

Hi there..please email me. I need to ask your help with a possible slide show presentation for the welcome reception...and your group's cultural thing was so good...please email me at rnstudychris@aol.com thanks so much!! :)

Everyone...there is a new shirt available from the SNA with the Delta ADN logo...Polo shirts! How fun! ;)Now available for $20.00 a piece in grey and navy blue.....guys I know you will like these, I suggested we get them..so y'all should buy one, so I dont look bad haha..Let me know if anyone wants one! :)

N2 Cancer drug considerations
Lilley: Pharmacology and the Nursing Process, 4th Edition
Multiple Choice Review Questions Chapter 46
1.
The term nadir refers to:
A. The average number of days it takes the bone marrow to recover from a dose of chemotherapy
B. The average number of days it takes for the chemotherapy to have its peak effect on the bone marrow
C. The patient's tolerance to the chemotherapy's bone marrow suppressant effect
D. The maximum dose for a chemotherapy agent in reference to bone marrow suppression

2.
General adverse effects of chemotherapy include which of the following? (choose all that apply)
A. Leukocytosis
B. Thrombocytopenia
C. Alopecia
D. Urinary retention

3.
Prednisone added to a chemotherapeutic regimen contributes to all of the following except:
A. Fluid retention and risk of infection
B. Increase in blood sugar
C. Sense of well-being and euphoria
D. Decrease in bleeding tendency

4.
Combinations of chemotherapeutic agents are frequently used for all of the following purposes except:
A. Preventing drug resistance
B. Providing a synergistic action
C. Decreasing cost of treatment
D. Decreasing the severity of adverse effects

5.
When a patient is receiving cyclophosphamide (Cytoxan), he or she should be advised to drink plenty of water/fluids to:
A. Prevent renal failure
B. Prevent hemorrhagic cystitis
C. Prevent liver dysfunction
D. Increase the red blood cell count

6.
The nurse would anticipate administering which of the following medications to patients receiving high-dose methotrexate?
A. bleomycin
B. cisplatin
C. leucovorin
D. dactinomycin

7.
Nausea and vomiting are frequent adverse effects associated with antineoplastic therapy. Patients who are experiencing this unpleasant effect should be advised:
A. To avoid eating any food during chemotherapy
B. That there is nothing that can be done for this effect and it will pass with time
C. To try to maintain hydration and nutrition, which are very important during treatment
D. To use antacids to relieve the irritation to the stomach, which should stop the nausea

8.
When teaching a patient receiving paclitaxel (Taxol), the nurse needs to prepare the patient for which of the following?
A. Weight gain
B. Vertigo
C. Arthralgias
D. Hypertension

9.
When assessing a patient for adverse effects related to cisplatin (Platinol), the nurse will monitor for which of the following? (choose all that apply)
A. Nephrotoxicity
B. Peripheral neuropathy
C. Hepatoxicity
D. Severe nausea/vomiting

10.
A major dose-limiting side effect of doxorubicin (Adriamycin) is:
A. Hemorrhagic cystitis
B. Cardiomyopathy
C. Hepatoxicity
D. Nephrotoxicity

11.
Which of the following laboratory results would cause the nurse to question administration of cyclophosphamide (Cytoxan)?
A. White blood cell count of 8000
B. Platelet count of 450,000
C. Hemoglobin of 15
D. Thrombocyte count of 8000

12.
The nurse would suspect which type of cancer in a patient receiving tamoxifen?
A. Lung cancer
B. Renal cancer
C. Breast cancer
D. Colon cancer

Hello everyone!!

Just a reminder for those that are interested...this Thursday at 10 am is the dimensional analysis review with Fern, then at 11 is the NCLEX review question session with Bonnie.

There are many sweatshirts available for those interested...they are 30 for pullovers and 35 for zip-up.

One more thing...I need speakers for the tea so far I have...

Christine Moles welcome and introduction

Mike speaking about PDA'S

Fazia will pass on the blog torch

Robyn will help with graduation letter

and Dan is making the invitations

Chuck will speak on the importance of sitting at the end of the row and speed reading (haha)


ANY ideas on speakers, handouts etc...Send em to my email rnstudychris@aol.com or talk to me on the break Thursday...later nurses to be

Congratulations Sarah Coots on the delivery of your first grandbaby!!!!!

Christine, If you haven't received any other offers, I would be happy to help you with invitations. I wasn't able to go to the reception so I missed out! Please email me at rdeyoung585@delta..... and we can exchange phone #'s or something if you want. Thanks for taking this on!

Complimentary and alternative medicine.
http://nccam.nih.gov/health/

Just thought I should say this...

To those that have decided that nursing is not the path for you...

We wish you all the best with your future endeavors. We offer our encouragement and honor your decsions to go on another path aside this one of nursing. Many of you had to make the very difficult decision to go another way, some feeling very sad for those of us remaining. Don't be sad for us, for this is the choice we have made. Let each of us rejoice in the bravery of one straying from the pack to lead another. You all will do tremendous things, we are proud of you, wish you all the happiness and health in the world.



(Ps..thanks Julie K...for opening my eyes, and being able to share with others :)

Check out this link to a former student, now RN
http://www.nursingstudio.net/
Her website is full of NCLEX RN questions and links to everything of interest to nursing students.

Hi everybody....A few things for you all..

1. Thank you Julie Kay. We are going to be able to use Locke 231 on Fridays as a quiet study room. The key word for this room is.....QUIET. So, if you are interested in coming in here...please be interested in being quiet haha. Thank you.

2. Beginning next Thursday, the 27th of October Bonnie has graciously offered her services to us as a tutor. She will be providing NCLEX questions that are relating to what we are learning about in N2. I have a request in with Julie Kay to be able to use the empty room on Locke 3 (I dont know the number, it is the one with the desks and supplies in it, the same place where Fern does her Monday meetings with us).

3. BONNIE...please send me an email with your email so that I dont have to keep asking you little things on this blog haha. Thank you...my email is rnstudychris@aol.com

Hi All,
I was just wondering what time the make up Math test is and where?
Thanks,
Tami

End-of-Life Care
http://www.criticalcareceu.com/courses/103/index_ccare.html
1.
More than 2.4 million people die each year in the United States. Of those:
a. Ninety percent die at home.
b. Less that 25% die at home.
c. Twenty percent die in hospitals.
d. Most die suddenly in an accident.

2.
In the United States, end-of-life care programs:
a. Are widely used in most states.
b. Are used for far more than the 60 days considered necessary to gain maximum benefit.
c. Are available in the vast majority of hospitals.
d. Have few nurses or physicians certified in palliative care.

3.
All of the following statements about hospice care are true except:
a. Drugs for symptom control and pain relief are not covered by the Medicare hospice benefit program.
b. Most Americans do not know that hospice care can be provided in the home.
c. The Medicare hospice benefit guarantees comprehensive high-quality care at little or no cost.
d. To access the hospice benefit, the client’s doctor must certify that the client likely has six months or less of life remaining.

4.
Palliative care:
a. Seeks to hasten death once a person has been declared terminal.
b. Seeks to improve the quality of life of dying clients.
c. Should not be used in conjunction with other therapies that prolong life.
d. Is not applicable in the early stages of an illness.

5.
Which of the following statements about hospice care is true?
a. It is a specific place or facility.
b. It is only for people with cancer.
c. Anyone diagnosed with terminal illness is eligible.
d. It is only for older people.

6.
The principle of double effect states:
a. The healthcare provider has a duty to protect life and to provide the means to end life.
b. Hastening death is acceptable if it is an unintended consequence of relieving suffering.
c. A healthcare worker is not required to intervene if a client attempts to take his or her own life. d. A client can refuse medical treatments but cannot refuse artificial nutrition or hydration.

7.
Studies of death trends in American hospitals show:
a. More blacks than whites die as hospital inpatients.
b. In 2000, whites and blacks died in the hospital in equal proportions.
c. Access to pain medications is better for blacks than for whites.
d. Poor communication is not a factor when deciding on end-of-life care options.

8.
Federal law requires hospitals to inform clients that they have the right to complete an advance directive.
a. True
b. False

9.
All of the following statements about do-not-attempt-resuscitation (DNAR) orders are true except:
a. It was formerly known as do-not-resuscitate orders.
b. DNAR orders are found in over 90% of medical charts.
c. The DNAR order should be readily available in the event of an emergency.
d. Withholding CPR does not equate with letting someone die.

10.
All of the following statements about artificial nutrition and hydration (ANH) are true except:
a. Many older clients choose to end their lives by refusing food and liquids.
b. Forgoing ANH is the same as “killing” or “starving” the client.
c. Nasogastric tube feedings can lead to such complications as pain, aspiration pneumonia, and epistaxis.
d. People who choose not to have ANH do not suffer from hunger or thirst.

11.
Which of the following is an urgent indication of the need to discuss end-of-life care?
a. Discussion of the prognosis.
b. Discussing treatment with low probability of success.
c. Discussing hopes and fears.
d. Inquiries about hospice or palliative care.

12.
Discussing death explicitly helps the client express fears and concerns about the dying process and allows the clinician to address them directly.
a. True
b. False

13.
Which of the following statements about pain is true?
a. It should not be considered as a vital sign.
b. Most people in nursing homes with advanced cancer receive effective treatment for pain.
c. When pain is relieved symptoms such as depression, diminished appetite, and impaired sleep may disappear.
d. Its symptoms are generally effectively managed by clinicians.

14.
The Joint Committee on Accreditation of Healthcare Organizations (JCAHO) requires that hospitals and other healthcare facilities regularly assess, monitor and manage pain in all clients.
a. True
b. False

15.
Which of the following statements about pain is false?
a. Pain perception varies from person to person.
b. Older adults may have a higher pain threshold than younger people or children.
c. A person’s perception of pain may be affected by cultural considerations.
d. The client’s preferences should not define the goal of pain management.

16.
Drowsiness frequently occurs at the beginning of opioid therapy, not only from drug action on the brain but also because the client has been sleep-deprived due to unrelieved pain.
a. True
b. False

17.
Shortness of breath is common among dying clients. All of the following approaches are used to treat this symptom except:
a. Inhaled corticosteroids.
b. Supplemental oxygen.
c. Anti-anxiety medications.
d. Low doses of morphine.

18.
Methods such as massage, physical therapy, acupuncture, and psychotherapy can be effective in the treatment of pain.
a. True
b. False

19.
One of the most common fears expressed by a person with a terminal illness is:
a. Fear of starvation.
b. Fear of disfigurement.
c. Fear of pain.
d. Fear of dying in the presence of family members.

20.
Depression during end-of-life care may be due to all of the following factors except:
a. A weak support system.
b. Persistent negative thinking regarding the diagnosis.
c. The need to spend time alone.
d. Increased dysfunction related to the illness.

21.
Although depression is highly treatable in most people, it cannot be treated effectively during end-of-life.
a. True
b. False

22.
Bereavement is:
a. The period of time, approximately 6 months, before a loved one’s death.
b. Being deprived of someone through death and the feeling of desolation that follows.
c. The process by which an individual is able to move through the stages of grief and emerge from the grieving process.
d. An exaggeration of the normal process of grieving, often resulting from multiple losses.

23.
All of the following caregiver problems are common except:
a. Families may face severe economic consequences.
b. Physical exhaustion, economic worries, and disrupted routines may lead to anxiety and depression.
c. Care for the loved one often takes priority over the caregiver’s own healthcare needs.
d. Hospice benefits provide mental health services for the caregiver.

24.
Which statement about end-of-life and cancer is true?
a. Chemotherapy and radiation treatments are usually stopped several months before death.
b. Treatment of cancer clients near death becomes gradually less aggressive.
c. Hospice is often being used to manage the death rather than palliate the disease.
d. Cancer clients are usually admitted to hospice care several months before death.

25.
Clients with Alzheimer’s disease are eligible for hospice care and account for more 30% of the annual hospice census.
a. True
b. False

26.
In people with severe cognitive impairment, artificial nutrition and hydration:
a. Can be withheld if the client’s wishes have been made clear in an advance directive.
b. Is given via feeding tube to more than 18% of those with severe cognitive impairment.
c. Is sometimes given because the nursing home receives special reimbursement.
d. All of the above

27.
The availability of HAART for the treatment of HIV/AIDS has eliminated the need to provide end-of-life care to HIV positive clients.
a. True
b. False

28.
A person living with advanced AIDS may have unique issues related to the disease including:
a. Stigmatization because of HIV/AIDS.
b. Lack of traditional support systems.
c. Bereavement from multiple losses.
d. All of the above

29.
Which of the following statements about dying children is true?
a. The majority of children with cancer receive palliative care.
b. It is sometimes difficult to predict whether a life-threatening illness will end in cure or death.
c. Children do not fear death as much as adults.
d. Children are prone to addiction from pain medications.

30.
The dying child and family members need to talk with one another about death.
a. True
b. False

31.
The possibility of dying raises issues for both the child and the family. These include:
a. Fear of a painful death.
b. Fear of dying alone.
c. Fear of not being present when the child dies.
d. All of the above

32.
Signs of imminent death include all of the following except:
a. Drowsiness.
b. Extremities becoming cool to the touch.
c. Rattling or gurgling breath sounds.
d. Increased ease in controlling pain.

33.
Post-mortem care should include all of the following except:
a. Remove all equipment and soiled linen from the bedside.
b. Avoid facial discoloration by placing the body in a supine position with a pillow under the head and shoulders.
c. Avoid upsetting the family by allowing only a short viewing of the body.
d. Attach identification tags to the ankle and wrist.

34.
All of the following statements about autopsies are true except:
a. Nationally, only about 5% of deaths undergo autopsy.
b. Clinical diagnoses, whether obtained from death certificates or hospital discharge data, contain major inaccuracies compared with autopsy diagnoses.
c. The healthcare system as a whole can benefit enormously from autopsy data.
d. Autopsies disfigure the body.

35.
Questions about organ donation are best discussed with the client in the context of advance directives.
a. True
b. False

36.
Which of the following statements about bereavement is false?
a. A family’s bereavement begins when their loved one is diagnosed with terminal illness.
b. Grief can cause somatic distress, guilt, and hostile reactions.
c. Grief can cause overwhelming fatigue.
d. It is best not to form new relationships while grieving.

Next Thursday at 11 am there is going to be a group study with Bonnie. It will be sort of like an NCLEX related question/answer session. I have requested the use of Locke 230(where the meetings with Fern are). If y'all are interested in coming...please look onto the blog and I will find out where the actual room is going to be. I have also asked Kim Thompson if there is a classroom that can be used for people who like quiet study in lieu of the throng of teenage love affairs going on under the desks in the library. :) Hope everyone is doing well in clinicals...on to nursing two :) PS...Thank you Bonnie for all your support

Christine M.,
I talked to Kim Thompson about getting a classroom to have a study group, Thurs at 1100 as you mentioned to me today. She will get it done and I will leave it up to you to verify it with her and get the word out to anyone interested if that is ok with you.
Since you all have study sessions and lectures already, I would like to bring in a bunch of NCLEX questions concerning your present subject and show you how you can study smarter, increase your comprehension and raise your test scores all at the same time.
The way I will show you is an alternative way of learning. If you are doing great already with traditional learning, keep doing what you are doing, but if you feel as if you are struggling and are not getting good scores despite reading all of the required material, then I can show you another way to learn.
Let me know. Tell me where and when, and I will be there.

Hi Guys!!! 2 things I wanted to address.

1) How did those of you do on that test today in skills lab? Can you say major brain fart????

2) Anyone know when Richard will be posting our final grades for N1?

Have a great week!
I have to honestly say I am so thankful to have made it this far!!!

Cher

Just curious, is anyone else having problems opening the math info file on docushare??? You know the one caralee posted on nursing 101.

Changing classes. Sorry that I was not able to get right back to some of you to answer questions this weekend, I felt so free after getting out of N4 that I signed up for 3, 12 hour shifts of nursing at LMH this weekend. Now I am ready to start mental health on Mon. The next 2 weeks, we have lecture on Mon 1230-1630. I can probably meet you before or after, let me know. My Tues-Wed clinicals do not start until Nov. 1st, so I am not sure if that means that I will be free all day on those days until it starts. I will let you know after my first day.
For the N2 class, the pharm book is really helpful for the pain, I have posted a bunch of stuff and links on our blog to help you too.
I am looking at a Davis pocket Nutrition guide called Nutri Notes, that I bought from the college bookstore, right now. Unfortunately these little books cost as much as a big textbook.I wish that I had this pocket book when I was in your class. It has all of the different kinds of diets and foods in it for all of the different medical conditions. It includes ethnic and culture foods, lists of foods that have all of those wanted or unwanted vitamins and minerals that Shelba loves to test you on. Check it out. I will also have it with me if you want to look at it.
Good luck, have fun, remember that common sense goes a long way. Take notes (hint, hint) Tape lectures. Check out practice tests from the nursing center online. Shelba writes for them, they are Lippencott. Their info is current and very helpful, you can also find a bunch of Nursing Made Incredibly Easy articles and tests there. I have the links posted in most of my practice tests in the test bank. Take tests right away after lecture to see what you need to focus in on the most with your studies.

When you do the skills lab and watch the cancer video, take kleenexes.

Skills Lab Drug Scenarios ???

For the drugs that we need to be familiar with, when it says "Normal dose and rate" do we need to know the norms for each therapeutic action of the drug?

For instance with Acetylsalicylic acid - it reduces fever and inflammation, and it's an analgesic...do we need to know the normal does for each of the three uses and for adult and child?

If anyone can shed some light here I would love it!

Thanks,
-Lisa

Newsletters Anyone?
These are some of the newsletters that are sent to me in my email. If you are interested, here are some links to check out their sites or sign up. You can find info for the current subjects that you are learning in N2 and beyond. They have lots of practice questions too. Good resourses.

Kaplan Nursing Newsletter
http://www.kaptest.com/repository/templates/Lev2InitDroplet.jhtml;jsessionid=ZHMFZUXW02YIDLA3AQJHBNVMDUCBG2HB?_lev2Parent=/www/KapTest/docs/repository/content/Nursing_Domestic&source=nurse_index

Heart Center Newsletter Online
http://heart.healthcentersonline.com/newsletter/heart/101105.html

Advance for Nurses newsletter and free magazine
http://nursing.advanceweb.com/newsletter.htm

Medscape Nurses
http://www.medscape.com/nurses-home

Nursing Center Newsletter
http://www.nursingcenter.com/home/index.asp

Nurse practitioner enews
http://www.nursingcenter.com//upload/static/403753/NP_Aug05.htm

Diabetes Health online newsletter
http://diabetes.healthcentersonline.com/newsletter/diabetes/081605.html

Cancer Health online newsletter
http://cancer.healthcentersonline.com/newsletter/cancer/071905.html

I have a question for the "PDA Users" of this group. I wasn't planning on getting a PDA for a while, but an opportunity came up to get a used one really cheap. It is a Palm 505. I could really use some help getting set up. Anyone with some simple directions of what and how to get started? And I really mean simple directions. I am not that pda literate. I would be glad to meet with you a few minutes before class on Thursday if that is easier. Thanks!
Tami C

Potassium Problem
A physician orders furosemide (Lasix) and spironolactone (Aldactone) for a patient. Prior to administering the medication, the nurse determines that the patient's potassium is 3.2 mEq/L. In addition to notifying the physician, the nurse should anticipate taking which of the following actions?
(1) Not administering the Lasix or Aldactone.
(2) Administering the Aldactone only.
(3) Administering the Lasix only.
(4) Administering the Lasix and Aldactone.

Hello Future Nurses,

For those of you taking the skills test on Monday, check out the Nursing 101 success folder on docushare for the important handouts. These handouts will assist you in the check- off process and what to study for on the math test. Let me know if you have any questions.

Caralee

A little fun link to start off your weekend...

Click on the link below...this took me FOREVER to find the difference between the two pics.

See how long it takes you!

Good luck...it's hard. Make sure your speakers are on...cause a song will start playing that might help you find the difference.

http://members.home.nl/saen/Special/Zoeken.swf

Calm Student-Nurse Jitters - Search Nursing Jobs & Careers at Monster.com

Congratulations on completion of N1!!!! Take a break watch a movie, do something unproductive. Feel better? Good!

We started N2 around the 22 of March 2005. We were a little slow posting at the beginning but we really picked up speed as we went along, until the grand finale of everyone pitching in with study guide helps at the end. If you want to see if there is anything in our blog that could help you, here is the link.
http://deltarnstudents.blogspot.com/
Start in the archives in March.

I will be having to change my tutor hours at the tutor center starting Monday because I am now in N5 which has a different schedule. Monday afternoons may still be ok. Tues and Wed late afternoons may be ok too.
We'll work it out. Call me if you want to make sure and schedule some extra study time. If you want to just talk through practice questions and rationale, I love that too!
(C) 329-1369
(H) 474-6339

Tips for NCLEX_RN
I found this at a student site in all nurses.comm.
http://allnurses.com/forums/showthread.php?t=100105
Tips for NCLEX_RN
Maslow's Hierarchy:
the main two to focus on are physiological needs and Safety & Security.
Physiological needs- food, water, oxygen, shelter, rest, sex, temperature, elimination
Safety & Security- Physical (what is threatening the pt.)
Psychological (knowledge and understanding,What to expect) look at your answer choices and eliminate all the psychological answer choices.
Physiological needs must be met first!Can you apply the ABC's (airway, breathing, circulation, cardiac). if an answer involves maintaining the airway, or breathing problems, it is the correct one. if the answer pertains to the cardiovascular system that would be correct. if the ABC's don't apply ask yourself what is the highest priority?this is your answer.
Ex:A pt is being treated for heart failure with diuretic therapy. which of the following best indicates to the nurse that the pts condition is improving?
1. pts weight has remained stable since admission.
2. pts systolic BP has decreased
3. there are fewer crackles heard when auscultating tthe pts lungs
4. pts urinary output is 1500cc's per day
The answer is #3(rationale: crackles are due to pulmonary edema and a decrease in crackles is a sign that pulmonary edema is decreasing.#1 pts weight should be decreasing,#2 is a distractor BP should decrease but may be due to other causes,#4 a distractor, pts urinary output is within normal limits
Look for hints in the wording of the question stem: most, first, best, initial essential, vital, immediate, highest, priority, indicate that you must establish priorities.
Further teaching is necessary: indicates the answer will contain incorrect info.
The phrase client understands the teaching indicates the answer will be correct information.
The phrase most accurate: indicates that more than one answer will sound good.
You may see expected words in an answer choice that is not correct.if you come across a question that you are unfamiliar with or you do not know what the question is asking you, read the answers to obtain clues, then try to reword the question using the clues.
Prioritization: who would the nurse see first? who should the nurse transfer from the unit during a disaster?the nurse would always see the patient who is least stable FIRST (condition may be life threatening, or moving pt may cause further harm), ABC's apply. the nurse would always transfer the patient who is most stable (condition is not life threatening and outcome is predictable).
PRIORITIZING USING ABC'S
Ex: The client with a diagnosis of cancer is receiving morphine sulfate 10 mg subcutaneously every 3-4 hours for pain. when preparing the plan of care for the client, the nurse includes which priority action?
1.monitor the clients temperature
2. monitor the urine output
3. encourage the client to cough and deep breath
4. encourage increased fluids
The correct answer is #3(rationale; use the abc's, morphine suppresses the respiratory reflex). PRIORITIZING USING MASLOW'S HIERARCHYEX:
The nurse is reviewing the plan of care for a pregnant client with a diagnosis of sickle cell anemia. which nursing diagnosis, if stated on the plan of care, would the nurse select as receiving the highest priority?
1. Anxiety
2. Ineffective individual coping
3. Altered Body Image
4. Fluid volume deficit
The correct answer is #4(rationale: the physiological needs come first!Options 1, 2 & 3 are eliminated because they are all phsychological and physiological needs are first! Always eliminate the psychological needs.
Nursing Process:Assessment & Implementation
The nurse should ALWAYS ASSESS first! then implementation. Implementation is done after assessment.
Ex: The nurse is teaching a client with diabetes mellitus about dietary measures to follow. The client expresses frustration in learning the dietary regimen. the nurse would initially:
1. Identify the cause of the frustration
2. continue with the dietary teaching
3. notify the physician
4. tell the client that the diet needs to be followed
the correct answer is #1 (rationale; The initial action is to identify the cause of the frustration,assessment is the first step,options 2,3 &4 are implementation steps of the nursing process.)

Wow!!! Hey guys...we did it!!! Nursing one? CHECK

The days go by quick, dont they? Before we know it we will be graduating! Anyone interested in planning a graduation trip? How about a cruise for all of us? ....if we could just get the staff to pay for it...haha good luck to everyone, we should be very proud! :)

Hello futurenurses!
Goodluck on your final! Wear bright colors to stim your brain, watch out for caffeine and carbs, but make sure you eat.
Sorry about bogging you guys down with a lot of questions that you don't need right now. I am studying for my final too and did not have enough time to thin them down for you. Just ignore the ones you don't need. These are just examples to show you all of the different directions that you might have to think.

Here is on more that might interest you. Very short.
http://deltarnstudents.blogspot.com/2005/04/test-fluids-and-electrolytes.html

Disorders of Fluid Volume, Osmolality, and Electrolytes
Price: Pathophysiology, 6th Edition
Study Questions Chapter 21

1.
ECF volume imbalances are characterized by:
A.Isotonic body fluid losses or gains
B.Relatively greater losses or gains of Na+ than that of water
C.Relatively greater losses or gains of water than that of Na+
D.None of the above

2.
Na+ ions account for what percentage of the osmotically active particles in the ECF?
A.5%
B.15%
C.20%
D.90%

3.
Which of the following effects would result from a decrease of the serum Na+ concentration below the normal range?
A.Shift of water from the ICF to the ECF, causing cell shrinkage
B.Shift of water from the ECF to the ICF, causing cell swelling
C.Shift of water and Na+ from the ECF to the interstitial fluid (ISF), causing edema
D.None of the above

4.
The most common condition that causes a fluid volume deficit is:
A.GI losses (e.g., vomiting, diarrhea) combined with inadequate fluid intake
B.Third-space losses
C.Osmotic diuresis
D.Aldosterone deficiency

5.
Rapid administration of IV fluids can result in pulmonary edema because:
A.Tissue hydrostatic pressure in the lung parenchyma increases
B.Colloid osmotic pressure in the pulmonary vessels increases
C.Hydrostatic pressure in the pulmonary vessels increases
D.Lymphatic clearance in the interstitium increases

6.
You are caring for Mr. Brown, a 75-year-old patient with congestive heart failure who is receiving IV fluids. You notice that he is becoming increasingly restless and short of breath. His blood pressure and respiratory rate are increasing, and he has a moist-sounding cough. You also note that he has neck vein distention up to the jaw angle in the sitting position. You hear medium rales (crackles) throughout both posterior lung fields. Mr. Brown's symptoms are probably caused by:
A.Decreased venous return to the right ventricle
B.Circulatory overload and pulmonary edema
C.Liver congestion from fluid reflux from the heart
D.Increased tissue hydrostatic pressure in the alveoli
E.Decreased hydrostatic pressure in the pulmonary capillaries

7.
The best nursing intervention for Mr. Brown (see question #6) would be:
A.Elevating the foot of the bed to aid venous return
B.Slowing down the IV to a keep open rate and notifying the physician
C.Continuing to monitor the vital signs
D.Encouraging the patient to cough and breathe deeply to improve alveolar ventilation

8.
The first emergency action in the treatment of severe acute pulmonary edema is:
A.Positioning the patient in high Fowler's position with the legs lowered to reduce hydrostatic pressure in the chest
B.Placing the patient in a supine position to aid venous return to the heart
C.Increasing the IV rate to increase the effective circulating volume
D.Applying rotating tourniquets

9.
Serum osmolality changes represent total body water changes provided that:
A.No solute is lost from the body
B.Only electrolytes are lost from the body
C.Cell membranes are impermeable to water
D.The serum osmolality is corrected for the urea concentration

10.
What is the estimated serum osmolality in a patient with a serum Na+ concentration of 140 mEq/L and serum glucose of 100 mg/dl?
A.280 mOsm/kg
B.140 mOsm/kg
C.100 mOsm/kg
D.240 mOsm/kg

11.
The osmolality of urine in a person with normal renal function:
A.Is only lowered to 100 mOsm/kg in water diuresis
B.May be lowered to less than 30 mOsm/kg in water diuresis
C.Is raised only to 900 mOsm/kg in fluid volume deficit
D.Is iso-osmotic with the plasma in an isotonic fluid volume deficit
E.Is iso-osmotic with the plasma in water diuresis

12.
A 65-year-old man with a 40-year history of heavy cigarette smoking and a recent diagnosis of oat cell carcinoma of the lung is admitted to the hospital with a 2-week history of progressive lethargy and headaches. Physical assessment is within normal limits except for the lethargy, headaches, and diminished deep tendon reflexes. Serum laboratory values reveal the following: Na+, 105 mEq/L; Cl-, 72 mEq/L; K+, 4 mEq/L; HCO-3, 23 mEq/L; plasma osmolality, 222 mOsm/kg. Urine laboratory values include the following: urine Na+, 78 mEq/L; urine osmolality, 804 mOsm/kg; specific gravity, 1.029. The most likely cause of this patient's problem is:
A.Diabetes insipidus (ADH deficiency)
B.Isotonic ECF volume excess
C.SIADH (ectopic source)
D.Hyperaldosteronism
E.Compulsive water drinking (psychogenic polydipsia)

13.
The direct cause of the patient's neurologic symptoms in question #12 is:
A.Brain cell shrinkage
B.Increased levels of circulating ADH
C.Decreased serum Na+ concentration
D.Brain cell swelling and increased intracranial pressure

14.
Which of the following is the best treatment for the patient in question #12?
A.Water restriction alone
B.Isotonic saline alone
C.Hypotonic saline
D.Hypertonic saline and water restriction

15.
When hypertonic (3% to 5%) saline is injected IV, which of the following will occur?
A.Water will be drawn out of the cells to the ECF compartment
B.Water will shift from the ECF compartment to the ICF compartment
C.The Na+ pump will maintain equilibrium
D.Urine output will decrease

16.
Which of the following conditions associated with hyponatremia causes plasma hyperosmolality rather than hypoosmolality?
A.Acute renal failure
B.SIADH
C.Uncontrolled diabetes mellitus
D.Diuretic excess

17.
Some iatrogenic causes of hypernatremia include
A.High-protein enteral tube feedings with insufficient water intake
B.Insufficient fluid provided for confused older adults
C.Prolonged use of artificial ventilator
D.Therapeutic abortion with hypertonic saline entry into circulation
E.All of the above

18.
Hypokalemia is associated with all of the following conditions except:
A.Protracted vomiting or diarrhea
B.Cushing's syndrome
C.Administration of IV glucose and regular insulin to correct diabetic ketoacidosis (DKA)
D.Mineralocorticoid deficiency in Addison's disease
E.Metabolic acidosis

19.
Hypokalemia associated with protracted vomiting is caused by:
A.Loss of K+ in vomitus
B.Loss of K+ in the urine
C.Lowering of serum K+ because of a shift into the cells
D.All of the above

20.
The most frequent cause of hypokalemia is likely:
A.Licorice ingestion
B.Diuretic drugs
C.Mg++ depletion
D.Primary hyperaldosteronism

21.
Clinical manifestations of hypokalemia include all of the following except:
A.Fatigue and generalized muscle weakness
B.Serum K+ < 3.5 mEq/L
C. Tall, peaked T waves
D. Decreased bowel sounds
E. Paresthesias

22.
Which statement about hypokalemia is false?
A.Diuretics, digitalis, and hypokalemia are a particularly dangerous combination.
B.Hypokalemia can be diagnosed on the basis of clinical signs and symptoms alone.
C.The rate of K+ administration should not exceed 20 mEq/hr when it is added to an IV line to correct hypokalemia.
D.Ingestion of citrus fruits and juices should be encouraged in persons on long-term diuretic therapy.

23.
Hyperkalemia can be treated by all of the following procedures except:
A.IV calcium gluconate
B.IV glucose and insulin
C.IV sodium bicarbonate
D.Oral or rectal ion exchange resin (Kayexalate)
E.IV acidic solution

24.
Which of the following statements best describes normal Ca++ homeostasis?
A.The rate of Ca++ absorption from the gut is equal to the urinary excretion of Ca++.
B.The rate of Ca++ reabsorption from the bone is equal to the amount of serum calcitonin.
C.The rate of Ca++ reabsorption by the renal tubules is equal to the rate of HPO=4 reabsorption by the renal tubules.

25.
Body processes affected by the concentration of Ca++ ion include:
A.Contraction of cardiac and skeletal muscle
B.Permeability of the cell membrane to Na+ and K+
C.Release of neurotransmitters at synaptic junctions
D.Excitability of nerve tissue
E.All of the above

26.
All of the following statements concerning 1,25(OH)2D3 are true except:
A.It is the most metabolically active form of vitamin D.
B.It acts in concert with PTH to increase osteoclastic bone activity.
C.It increases the absorption of Ca++ and HPO=4 from the gut.
D.PTH stimulates its final hydroxylation in the liver.

27.
The major effect of calcitonin is to:
A.Stimulate hydroxylation of cholecalciferol in the liver
B.Inhibit PTH secretion by the parathyroid glands
C.Inhibit osteoclastic bone activity
D.Stimulate hydroxylation of 25-cholecalciferol in the kidney

28.
Direct effects of PTH secretion on target organs include all of the following except:
A.Increased osteoclastic bone resorption of Ca++ and HPO=4
B.Increased renal tubular Ca++ reabsorption
C.Increased renal tubular HPO=4 reabsorption
D.Increased serum Ca++

29.
Which of the following forms of Ca++ is physiologically active (i.e., plays a role in muscle contraction, nerve conduction, and blood coagulation)?
A.Ionized Ca++
B.Calcium bound to albumin
C.Calcium bound to globulin
D.Calcium complexed with HPO=4

30.
To accurately assess the total serum calcium concentration in the laboratory report, the examiner must correlate the measurement with:
A.Serum Na+ level
B.Serum Cl- level
C.Serum albumin level
D.Serum K+ level

31.
The most common cause of hypoparathyroidism and hypocalcemia is:
A.Idiopathic
B.End-organ resistance
C.Surgical removal of the parathyroids
D.Postradiation therapy

32.
A postoperative complication that results from sudden increased skeletal absorption of Ca++ and HPO=4 from the blood is called:
A.Hungry bone syndrome
B.Hypercalcemic crisis
C.Thyroid crisis
D.Acromegaly

33.
Signs and symptoms of hypocalcemia are more likely to be manifested under conditions of:
A.Metabolic acidosis
B.Metabolic alkalosis
C.ECF volume deficit
D.Hyperphosphatemia

34.
To check for Trousseau's sign (indicating latent tetany), a blood pressure cuff is applied to the arm and inflated above systolic pressure for 3 to 5 minutes. A positive response would be:
A.Paresthesias of the fingers
B.Bounding pulses in the wrist following removal of the cuff
C.Spasm of the wrist and finger muscles
D.Hyperemia of the hand

35.
Spasm of the facial muscles induced by tapping the facial nerve in front of the ear (indicating latent tetany) is known as:
A.Chvostek's sign
B.Temporomandibular sign
C.Homans' sign
D.Brudzinski's sign

36.
The most common cause of hypercalcemia is:
A.Malignancies
B.Primary hyperparathyroidism
C.Vitamin D intoxication
D.Adrenal insufficiency

37.
Factors important in the development of humoral hypercalcemia of malignancy include all of the following except:
A.Transforming growth factors such as TGF-alpha
B.Parathyroid hormone-related peptide (PTHrP)
C.Lymphotoxin
D.Osteoclast deactivating factors
E.Interleukin-1

38.
ECG changes characteristic of hypercalcemia are:
A.Shortened PR interval
B.Shortened QT interval
C.Prolonged QT interval
D.Sinus tachycardia

39.
The treatment of hypercalcemia requires adequate:
A.Vitamin D intake
B.Treatment with thiazide diuretics
C.Protein intake
D.Hydration with saline followed by giving loop diuretics

40.
Asymptomatic patients with malignancy-related hypercalcemia (< 12 mg/dl) who are receiving antineoplastic treatment may only require:
A. Increased oral fluid intake
B. Restriction of dietary calcium
C. Limitation of weight-bearing activities
D. Liberal use of sedatives to ensure a good night's rest

41.
Gallium nitrate, used in the treatment of malignancy-related hypercalcemia, exerts a hypocalcemic effect by:
A.Stimulating an antitumor response
B.Reducing renal Na+ excretion
C.Blocking PTH-induced bone resorption of calcium
D.Enhancing the action of prostaglandin-synthesis inhibitors

42.
The most common cause contributing to hypomagnesemia is:
A.Alcohol abuse
B.Vitamin D intoxication
C.Administration of cisplatin
D.Hyperparathyroidism

43.
The effect of hypomagnesemia on the neuromuscular system is:
A.Decreased excitability
B.Increased excitability
C.Significant paralysis
D.Release of ATP from cells

44.
The most common cause of hypermagnesemia is:
A.Ingestion of magnesium-containing drugs by a patient with renal insufficiency or failure
B.Diabetic ketoacidosis (DKA)
C.Adrenal insufficiency
D.Hemodialysis using untreated (hard) water

45.
Which of the following drugs should the nurse have available for emergency use when Mg++ is administered IV?
A.Digoxin
B.Lidocaine
C.Potassium chloride
D.Calcium gluconate

46.
A 35-year-old male alcoholic was brought to the hospital in a comatose state after being discovered in an alley behind a tavern. The patient's skull was fractured. An indwelling catheter inserted into his bladder revealed a urine output of 175 ml/hr. Serum laboratory tests revealed the following: Na+, 170 mEq/L; Cl-, 132 mEq/L; K+, 4.0 mEq/L; serum glucose, 80 mg/dl; plasma osmolality, 345 mOsm/kg. The urine osmolality was 100 mOsm/kg. After administration of the vasopressin test, the urine output decreased to 90 ml/hr, and the osmolality increased to 270 mOsm/kg. His vital signs included the following: blood pressure 120/84 mm Hg; oral temperature, 99.6° F; pulse, 90 beats/min; respirations, 20 breaths/min. The probable cause of this patient's problem is:
A.Central diabetes insipidus
B.Nephrogenic diabetes insipidus
C.Osmotic diuresis
D.SIADH

47.
Which of the following statements are correct regarding the treatment of the fluid and electrolyte imbalance of the patient in question #46? (More than one answer may be correct.)
A.The primary goal is to lower the serum Na+ gradually to avoid causing cerebral edema.
B.A hypotonic IV solution (D5W or D5-0.2% NaCl) should be given.
C.Water restriction is the treatment of choice to decrease polyuria.
D.Chronic treatment consists of administering exogenous ADH.

48.
Third-space fluid loss: (More than one answer may be correct.)
A.Is manifested by rapid decrease in body weight
B.Is the accumulation of fluid in a non-ECF or non-ICF compartment, which is not easily exchangeable with the ECF
C.May reduce the effective circulating blood volume
D.Represents a distributional loss of fluids from the ECF

49.
Which of the following test results indicate an isotonic fluid volume deficit caused by extrarenal losses? (More than one answer may be correct.)
A.Serum Na+ 140 mEq/L
B.Hematocrit 55%
C.Urine specific gravity 1.038 (or 1200 mOsm/kg)
D.Urine Na+ < name="Q_080B04F036664FB8B7071DAE8D222F6C">50.

50.
Somatic compensatory responses to the rapid loss of a large amount of body fluid (e.g., sequestration in intestinal obstruction, bleeding) include: (More than one answer may be correct.)
A.Sympathetic activation and peripheral vasoconstriction
B.Diminished renal perfusion
C.Stimulation of the ADH mechanism, causing thirst and increased renal water reabsorption
D.Activation of the renin-angiotensin-aldosterone mechanism, causing increased renal Na+ (and water) reabsorption
E.Increased heart rate and contractility to restore cardiac output

51.
Which of the following situations presents a danger of circulatory overload (hypervolemia)? (More than one answer may be correct.)
A.Administration of a hypertonic IV solution
B.Congestive heart failure
C.Acute renal failure
D.Pyrexia lasting 4 days

52.
SIADH may be associated with: (More than one answer may be correct.)
A.Massive edema
B.CNS lesions and injuries
C.Postoperative conditions: cardiac surgery
D.Administration of oxytocin for labor induction
E.Administration of oral hypoglycemic agents

53.
Some causes of hyperkalemia include: (More than one answer may be correct.)
A.Poor venipuncture technique
B.Acute and chronic renal failure
C.Ingestion of salt substitutes in a person with renal insufficiency
D.Aldosterone deficiency
E.Tissue damage (e.g., surgery, burns)

54.
ECG changes suggesting hyperkalemia include: (More than one answer may be correct.)
A.High, peaked T waves
B.Prolonged PR interval
C.Depressed ST segment
D.Prolonged QRS intervals

55.
Hyperkalemia that reaches critical levels (> 7 to 8 mEq/L) presents a distinct danger of: (More than one answer may be correct.)
A.Cardiac dysrhythmias
B.Cardiac arrest
C.Hypertensive crisis
D.Hypovolemic shock
E.Increased cardiac contractility

56.
Hypocalcemia may be treated by giving: (More than one answer may be correct.)
A.Calcitonin
B.Calcium gluconate
C.Vitamin D
D.Diphosphonates
E.Plicamycin (Mithracin)

57.
In primary hyperparathyroidism: (More than one answer may be correct.)
A.Serum levels of PTH are always greater than it is in patients with hypercalcemia caused by vitamin D3 intoxication
B.An adenoma of one or more of the parathyroid glands is often the cause of the PTH hypersecretion
C.A generalized loss of bone mineralization may be evident on x-ray examination

58.
Which of the following signs or symptoms would the nurse most likely observe when assessing for hypophosphatemia? (More than one answer may be correct.)
A.Irritability, apprehension
B.Paresthesias
C.Diarrhea
D.Hypertension

Acid-Base Disorders
Price: Pathophysiology, 6th Edition
Study Questions Chapter 22

1.
Acid-base balance in the human body is maintained by controlling the concentration of:
A.Blood
B.Hydrogen ions
C.Carbon dioxide
D.Oxygen

2.
An acid can best be explained as:
A.An anion
B.A cation
C.A chemical that is able to donate a H+ ion
D.A chemical that combines with a hydrogen ion to form an acid

3.
The normal pH of the blood serum indicates that the serum is:
A.Neutral
B.Slightly acid
C.Slightly alkaline
D.None of the above

4.
Normally the pH of human blood serum is:
A.7.38 to 7.42
B.7.31 to 7.42
C.7.35 to 7.48
D.7.35 to 7.55

5.
The normal [H+] of the blood is:
A.16 mEq/L
B.35 mEq/L
C.40 mEq/L
D.63 mEq/L

6.
The Henderson-Hasselbalch equation reveals that maintaining a normal pH requires that the ratio of base bicarbonate to carbonic acid must be:
A.20:1
B.1:20
C.2:20
D.30:2

7.
Three body systems act to maintain the blood pH near 7.4 and defend against large deviations. Choose the series below that lists these three systems in order, from the fastest acting to the slowest acting.
A.Kidneys, lungs, blood buffers
B.Blood buffers, lungs, kidneys
C.Blood buffers, kidneys, lungs
D.Lungs, blood buffers, kidneys

8.
The lowest limit of blood pH at which a person can live more than a few minutes is approximately:
A.6.0
B.6.8
C.7.2
D.7.3

9.
The first step in the assessment of the acid-base status is:
A.Review the clinical history for disease processes that might lead to an acid-base disturbance
B.Examine the PaCO2
C.Examine at the laboratory report of the base excess because it always leads to the right conclusion about acid-base disturbances
D.Calculate the anion gap

10.
The rapid or prolonged administration of normal saline may cause:
A.Metabolic alkalosis
B.Metabolic (Cl-) acidosis
C.Dehydration
D.Hypoventilation

11.
Diarrhea from a colostomy will cause metabolic acidosis. The primary reason that this acid-base imbalance occurs is a:
A.Primary HCO-3 deficit
B.Primary HCO-3 excess
C.Primary H2CO3 excess
D.Primary H2CO3 deficit

12.
The primary defect in respiratory acidosis is:
A.Primary HCO-3 deficit
B.Primary HCO-3 excess
C.Primary H2CO3 excess
D.Primary H2CO3 deficit

13.
A person who has a condition in which the production of endogenous organic acids (e.g., diabetic ketoacidosis) is increased above the normal level will develop:
A.Respiratory acidosis
B.Respiratory alkalosis
C.Metabolic alkalosis
D.Normal anion gap metabolic acidosis
E.High anion gap metabolic acidosis

14.
A not uncommon method of providing a feeling of euphoria, often expressed as "being high," is to deliberately hyperventilate. Hyperventilation causes an acid-base imbalance called:
A.Respiratory acidosis
B.Respiratory alkalosis
C.Metabolic acidosis
D.Metabolic alkalosis

15.
Indiscriminate administration of oxygen can be deadly for the patient with COPD (chronic bronchitis and emphysema). Which of the following sequences describes the progression of adverse effects? 1. Hypoventilation 2. Depression of the respiratory center 3. CO2 retention 4. CO2 narcosis (coma)
A.1 → 2 → 3 → 4
B.2 → 1 → 3 → 4
C.3 → 4 → 2 → 1
D.4 → 3 → 1 → 2

16.
To reduce the risk of metabolic alkalosis, nasogastric suction tubes should be irrigated with:
A.Tap water
B.Normal saline

17.
A 31-year-old man was admitted to the hospital in a coma with a diagnosis of brain tumor. A tracheostomy was performed on the day of admission and pressure-controlled mechanical ventilation given continuously. His temperature has ranged between 102° and 103.4° F. On the fifth day after admission, you note that he has carpopedal spasms of the hands when you check his blood pressure. Which of the following statements best explains this phenomenon?
A.The patient's elevated temperature has induced a neuromuscular irritability and a febrile convulsion is imminent.
B.Serum pH has decreased because of respiratory acidosis produced by hypoventilation. The decreased pH in turn caused irritability of the nervous system.
C.Serum pH has increased because of respiratory alkalosis produced by hyperventilation. The alkalosis directly stimulates the nervous system and also causes a decrease in ionized serum Ca++. Consequently, hyperirritability of the nervous system occurred.
D.Total serum calcium has decreased because of the patient's immobility and its consequent loss in the urine.

18.
The IV fluid of choice to treat a patient with metabolic alkalosis and a fluid volume deficit secondary to vomiting over several days is:
A.Lactated Ringer's solution (metabolized to HCO-3)
B.D5W
C.Normal saline
D.Normal saline with added KCl

19.
A 60-year-old widow has been in the hospital for several days for a complete medical checkup. She is worried that she may have cancer, although all tests have been negative. Her physician has diagnosed her case as an anxiety reaction following the death of her husband (from cancer). In the middle of the night, she calls the nurse into her room and complains of muscle cramps in her feet and a prickling sensation in her fingers and toes. The nurse notes that she sighs frequently. Her hands are cold and clammy to the touch and she has a slight tremor. The probable difficulty is:
A.Respiratory alkalosis
B.Respiratory acidosis
C.Metabolic acidosis
D.Metabolic alkalosis

20.
Intervention(s) that might help relieve the symptoms of the patient in question #19 include: (More than one answer may be correct.)
A.Offering her the antacid of her choice
B.Elevating the head of her bed to improve ventilation
C.Having her breathe into a paper bag
D.Offering her reassurance and allowing her to discuss her fears

21.
The clues to a mixed acid-base disturbance are: (More than one answer may be correct.)
A.Undercompensation or overcompensation of a primary acid-base disorder
B.Failure to balance the expected compensation formula
C.The change in the anion gap does not equal the change in the HCO-3
D.A large anion gap

22.
Which of the following are classified as blood buffers? (More than one answer may be correct.)
A.Bicarbonate-carbonic acid system
B.Hemoglobin
C.Phosphate
D.Protein

23.
Factors that contribute to the maintenance of metabolic alkalosis include: (More than one answer may be correct.)
A.K+ depletion
B.Na+ excess
C.Cl- depletion
D.Fluid volume deficit and secondary hyperaldosteronism

24.
Cl--responsive metabolic alkalosis is caused most often by vomiting or diuretics, and urine Cl- is less than 10 mEq/L.
True False

25.
HCO-3 and Cl- have a direct relationship: when HCO-3 increases Cl- also increase.
True False

26.
The basic cause of respiratory acidosis is hyperventilation.
True False

27.
Laboratory values alone are usually sufficient to recognize acid-base disturbances.
True False

28.
Kussmaul breathing in a patient with metabolic acidosis indicates that the lungs are attempting to compensate for the disturbance.
True False

29.
Match the cause(s) of acid-base disturbance with the type of primary acid-base disturbance.
1.High anion gap metabolic acidosis
2.Respiratory alkalosis
3.Chronic respiratory acidosis
4.Acute respiratory acidosis
5.Hyperchloremic metabolic acidosis
6.Metabolic alkalosis

1 2 3 4 5 6
A.Diarrhea

1 2 3 4 5 6
B.Renal failure; Uncontrolled diabetes; Starvation; Salicylate poisoning

1 2 3 4 5 6
C.Nasogastric suction or vomiting; Loop or thiazide diuretic; Secondary hyperaldosteronism

1 2 3 4 5 6
D.Laryngospasm

1 2 3 4 5 6
E.COPD

1 2 3 4 5 6
F.Emotional stress; Mechanical ventilation

30.
Match the likely cause(s) of mixed acid-base disturbance with the type of mixed acid-base disturbance.
1.Metabolic acidosis and respiratory alkalosis
2.Acute-on-chronic respiratory acidosis
3.Metabolic acidosis and respiratory acidosis
4.Metabolic alkalosis and respiratory acidosis
5.Metabolic alkalosis and respiratory alkalosis

1 2 3 4 5
A.Cardiopulmonary arrest

1 2 3 4 5
B.Hyperventilating chronic heart failure patient treated with diuretics; COPD patient placed on mechanical ventilator

1 2 3 4 5
C.Salicylate intoxication

1 2 3 4 5
D.COPD patient receiving nasogastric suction

1 2 3 4 5
E.COPD patient who develops pneumonia

Fluid and Electrolyte Balance and Assessment
Price: Pathophysiology, 6th Edition
Study Questions Chapter 20

1.
The percentage of body water in proportion to body weight is influenced by many factors. Which of the following is true?
A.In proportion to body weight, the water content of the body decreases with age.
B.The body of a fat person contains more water than that of a thin person.
C.In proportion to body weight, an infant will have less water than has an older adult.
D.Gender has no bearing on the amount of water in proportion to body weight.

2.
In disease conditions whereby extracellular fluid is lost, which is the first fluid compartment to be depleted?
A.The interstitial fluid
B.The intravascular fluid
C.The intracellular fluid
D.None of the above

3.
The intracellular fluid volume of a 25-year-old woman weighing 120 lb (TBW = 50% of weight) would be approximately:
A.60 L
B.48 L
C.24 L
D.20 L

4.
The 24-hour maintenance fluid requirements for an average-sized adult are approximately:
A.600 ml
B.1000 ml
C.1500 ml
D.2500 ml

5.
A milliequivalent is a unit of:
A.Weight
B.Chemical activity
C.Osmotic concentration

6.
Serum electrolyte concentrations are preferably reported in terms of:
A.mm Hg
B.mg/dl
C.mg%
D.mmol/L
E.mEq/L

7.
The law of body electroneutrality states that:
A.The absolute numbers of cations and anions in the body must be equal.
B.The sum of the positive and negative charges (measured in mEq) in any particular body compartment and in the body as a whole must be equal.
C.The intravascular protein molecules must be neutral and cannot carry a positive or negative charge.
D.Positively charged Na+ ions must always be coupled with negatively charged Cl- ions.

8.
Which of the following statements about Na+ is not true?
A.It aids in maintaining total body water balance.
B.It aids in maintaining plasma osmotic concentration.
C.It is the chief ECF cation.
D.Renal excretion of Na+ is regulated primarily by ADH.

9.
The plasma osmolality is primarily determined by:
A.The plasma sodium concentration
B.The total ECF sodium stores
C.The plasma potassium concentration
D.The TBW

10.
The pressure exerted by serum protein in holding fluid within the intravascular compartment is
known as:
A.Hydrostatic pressure
B.Osmotic pressure
C.Ultrafiltration pressure
D.Colloid osmotic pressure

11.
Two fluid compartments containing nondiffusible solutes are separated by a semipermeable membrane. The osmotic concentration of compartment A is 300 mOsm and that of compartment B is 800 mOsm. Net movement of water will be:
A.From compartment A to compartment B
B.From compartment B to compartment A
C.Equal in both directions
D.None of the above

12.
What would be the minimal volume of obligatory urine output in a patient with renal insufficiency who must excrete 600 mOsm of solute when the maximal renal concentrating ability is 400 mOsm/L?
A.400 ml
B.600 ml
C.1500 ml
D.2000 ml

13.
Aldosterone is important in controlling the volume of the ECF because it controls:
A.Protein metabolism
B.Na+ (and water) reabsorption
C.K+ reabsorption
D.All of the above

14.
The organs that play the largest role in maintaining fluid and electrolyte balance in the body as a whole are the:
A.Adrenal glands
B.Parathyroid glands
C.Kidneys
D.Lungs

15.
The choice intravenous solution for the purpose of reducing cerebral edema would be:
A.Hypertonic (3% saline)
B.Isotonic (0.9% saline)
C.Hypotonic (D5W)

16.
A urine specific gravity measurement of 1.010 indicates that the estimated osmolality is approximately:
A.100 mOsm
B.300 mOsm
C.600 mOsm
D.1200 mOsm

17.
Which of the following statements about intracellular fluid is true? (More than one answer may be correct.)
A.It is approximately equal to 40% of the body weight.
B.It has a lower osmotic concentration than does the extracellular fluid.
C.It has a higher concentration of organic ions than does the extracellular fluid.
D.It is approximately equal to 5% of body weight.

18.
The Na-K-activated-ATPase system (Na-K pump) located in the cell membrane helps maintain the electrochemical gradient across the cell membrane by: (More than one answer may be correct.)
A.Actively moving water out of cells
B.Actively transporting sodium out of cells
C.Osmotically moving potassium into cells
D.Actively transporting potassium into cells

19.
Which of the following changes would stimulate the release of ADH? (More than one answer may be correct.)
A.An increase in the plasma osmolality of 1% to 2%
B.A decrease in the plasma volume by at least 5% to 10%
C.Hyponatremia
D.Hypernatremia
E.The stress of surgery

20.
Extracellular fluid characteristically contains: (More than one answer may be correct.)
A.80 mEq of Cl-/L
B.140 mEq of Na+/L
C.4 mEq of K+/L
D.5 mEq of Ca++/L

21.
Which of the following signs and symptoms would indicate an ECF volume deficit? (More than one answer may be correct.)
A.Rales and rhonchi heard over posterior lung fields
B.Blood pressure 130/80 mm Hg, lying position; 104/76 mm Hg, sitting position
C.Flat neck veins in the lying position
D.Oliguria (small amount of concentrated urine)

Pain, Fluid and Electrolyte Misc.
http://www.nursingceu.com/courses/105/index_nceu.html

1.When doing a rapid ABC assessment, which statement is false?
a. The airway is patent when speech is clear and no noise is associated with breathing.
b.Breathing is effective when the skin color is pale and the capillary refill is greater than 2 seconds.
c.If breathing is not effective, consider administering oxygen and placing an assistive device.
d. Circulation is effective when the radial pulse is present and the skin is warm and dry.

2.
When using the mnemonic PQRST to help develop a history, the letter R represents which of the following?
a.Rate
b.Region and radiation
c.Rhythm
d.Respirations

4.
Which of the following statements is false about the patient's chief complaint?
a.It is always the first words out of the patient's mouth.
b. It is a direct quote.
c. It is usually three words or less.
d. It is the main symptom that prompted the patient to seek medical attention.

5.
Which of the following statements is false when trying to develop a method to evaluate a patient's level of pain?
a. One method is to use the words mild, moderate, or severe.
b.One method is to use the scale 0 to 10.
c.The meaning of 10 is not the same for all nurses or all patients.
d.Patients always exaggerate numbers when using the 0-10 scale to make sure they are believed and receive pain medication.

6.
Which of the following statements is false about beta receptors found in the autonomic nervous system (ANS)?
a.Beta receptors are sites in the ANS where inhibitory responses occur when adrenergic hormones such as norepinephrine and epinephrine are released.
b.Activation of the beta receptors causes relaxation of the bronchial muscles, an increase in the heart rate, and an increase in the force of cardiac contractions.
c.Beta-blocking agents oppose the excitatory effects of norepinephrine.
d.Beta-blocking agents cause vasodilatation, decreased inotropic effect, and positive chronotropic affect.

7.
A serum K >5.5 mmol/L is defined as:
a. Hypocalcemia
b.Hyperkalemia
c.Hypokalemia
d.Hypernatremia

8.
A serum sodium of <135 mmol/L is defined as:
a. Hypercalcemia
b. Hyperkalemia
c.Hyponatremia
d. Hypernatremia

9.
Isotonic intravenous fluids are used frequently in the emergency room. Which of the following fluids are considered isotonic?
a. D5 1/2NS and D5LR
b. Ringer's and NS
c. D 1/4 W and 1/2NS
d. D5W and D5NS

PostOp test
Here is the link to read the article or get the rationale.
http://www.nursingceu.com/courses/105/index_nceu.html
I have deleted a bunch of the Qs because it's way more than you need to know right now. If you want to see the whole test, use the link.


3.
Planning for the post anesthesia period begins:
a. During the preoperative period.
b. During the intraoperative period.
c. Immediately postoperatively.
d. When HMO cost savers learn of the planned procedure.

4.
Early admission cases are:
a. First come, first serve surgeries.
b. Individuals who line up before the doors officially open to the medical complex.
c. Clients who will undergo a planned outpatient procedure.
d. Clients who, due to the seriousness of their procedure, will require admission for a prolonged stay.

6.
Standards for PACU care require that a post anesthesia care unit or an equivalent area be provided to whom?
a. Clients in good standing with local healthcare allocation agencies.
b. Pre-admit clients only.
c. Clients warranting further treatment and follow-up.
d. All who receive anesthesia care.

7.
Accepted standards for PACU care mandate that a client's condition while in the PACU be evaluated how frequently?
a. On admission, at five minutes, 15 minutes, and every 30 minutes thereafter
b. Continually
c. As individual condition warrants
d. Every 15 minutes

8.
Who is responsible for the discharge of the client from the post anesthesia care unit?
a. The charge nurse
b. The client
c. A physician
d. The HMO doorkeeper

12.
Which function is not one of the three essential functions listed for decreasing the postoperative complication rate?
a. Management of client airway
b. Review of planned cost coverage measures
c. Measurement and recording of vital signs
d. Report from anesthesiologist to the PACU nurse assuming care

15.
Clients in the PACU are under the primary care of:
a. The primary physician
b. The surgeon
c. The anesthesiologist
d. The nursing staff

16.
The overall incidence of postoperative nausea and vomiting (PONV) varies between:
a. 1% and 5% of postoperative clients
b. 5% and 10% of postoperative clients
c. 10% and 20% of postoperative clients
d. 20% and 30% of postoperative clients

17.
What is nausea?
a. The uncomfortable sensation of an impending episode of vomiting
b. The prodromal symptom of gastric eversion
c. An unfortunate result of lacto-lipid-carbohydrate overdose
d. Inevitable as a postoperative complication

19.
Those clients with a history of PONV are best treated:
a. By deferring the procedure in favor of other therapies.
b. By withholding anesthesia during the operation.
c. By both prophylactic and intra-operative treatment.
d. By utilizing the frequent gastric emptying techniques.

22.
Aspiration correlates closely with the presence of which of the following complications?
a. Pulmonary shunting
b. Hypoxemia and hyperventilation
c. Reactive airway disease
d. Vomiting and high gastric content volumes

23.
What is hypoxemia?
a. An excess of carbon dioxide in the blood
b. The condition of having a below-normal oxygen content
c. Always a call for induced ventilation
d. An oxygen saturation less then 94% by pulse oximetry

25.
What is pulmonary embolism?
a. A sequela (problem) of obesity
b. The sudden lodgment of material in a pulmonary artery with obstruction of the blood supply
c. The inhalation of any foreign material into the lungs
d. A result of allergic reactions to drugs, blood or blood products

26.
Hoarseness and sore throat occur in roughly how many intubated clients?
a. One-tenth
b. One-fifth
c. One -quarter
d. One-third

27.
In order to assess for respiratory insufficiency, it is important to:
a. Listen for breathe sounds.
b. Check respiration rates.
c. Observe depth and ease of breathing.
d. All of the above.

28.
Which of the following is not one of the four key events used to identify cardiovascular problems in the PACU?
a. Hypercapnia
b. Hypertension
c. Hypotension
d. Bradycardia

30.
What is hypotension?
a. A normal part of the healing process.
b. Common among northern Europeans.
c. A vasoconstrictive event related to stimulation of the vascular bed.
d. An abnormally low systolic blood pressure as compared to baseline.

31.
New-onset hypotension in the PACU is almost always a sign of:
a. An unwanted medication interaction.
b. Hypovolemia.
c. Blood loss.
d. All of the above.

32.
Vasopressors are agents that:
a. Augment coronary and cerebral blood flow associated with shock.
b. Stimulate renal vascularity.
c. Stimulate the beta 2 and alpha 7 receptors to promote vasoconstriction.
d. Reduce water reabsorption in the distal renal tubular epithelium.

33.
Common cause for tachycardias seen in the PACU includes all of the following except:
a. Pain
b. Hypovolemia
c. Hypoxia
d. Hypothermia

34.
In the immediate postoperative period, hypoxia may provoke which cardiovascular response?
a. Initial bradycardia
b. Wandering atrial pacemaker syndrome
c. Tachycardia
d. Sinus arrhythmia

35.
Bradycardia is a heart rate:
a. Greater then 100 bpm.
b. Less then 60 bpm.
c. Less then 30 bpm.
d. Greater then 60 bpm.

37.
Which of the following is not a complication of fluid and electrolyte imbalance?
a. Hyperthermia
b. Hyponatremia
c. Hypocalcemia
d. Hypermagnesemia

38.
Treatment for hypermagnesemia includes all of the following except:
a. Discontinuation of exogenous sources
b. Support of cardiorespiratory function
c. Intravenous calcium administration
d. Diuresis with furosemide

40.
What is one serious misconception concerning the use of narcotics in the immediate post anesthesia environment?
a. They increase respiratory depth and effort.
b. They interfere with the Cox 2 cycle.
c. Dosage must be kept small and infrequent to avoid addiction.
d. It is an effective means to resolve hypotension.

42.
What is the best time to plan analgesia for the PACU?
a. Prior to anesthesia
b. During induction
c. Intraoperatively
d. In the PACU

43.
What is the purpose of a PCA device?
a. To give the anesthesiologist greater control over medication delivery
b. To allow staffing to be decreased postoperatively
c. To include the facility pain-management team in postoperative care
d. To allow the client to self-administer analgesics in a safe manner

44.
Excessively low body temperature is known as:
a. Hyperkalemia
b. Hypokalemia
c. Hypothermia
d. Hyperthermia

45.
What is malignant hyperthermia?
a. A malaria based disorder
b. An autosomal-dominant inherited disorder
c. A toxemia of unknown origin
d. A frequent sequela(problem) of surgery

47.
What role do operating room procedures play in PACU temperature complications?
a. Clients are frequently recovered within the surgical suite to facilitate speedy discharge.
b. Laminar-flow ventilation promotes thermoregulation.
c. Prevention is the most important aspect of treatment.
d. No role. This is a trick question.

50.
What is the cause of diabetes insipidus?
a. Excessive plasma glucose levels
b. Underproduction of antidiuretic hormone
c. Increased plasma osmolarity
d. Hypernatremia

52.
Thyroid storm is characterized by:
a. The abrupt onset of symptoms of hyperthyroidism.
b. Bradycardia.
c. Hypoxemia.
d. Blood glucose levels in excess of 700 mg/dL.

HEY! THE ATI TEST RESULTS ARE IN! Go to ATItesting.com , at the top click on "students" and sign in :)

SKILLS LAB QUESTION...

For those of you that have done the injections...did you also do the scenarios? What did those entail? Where they over anything we have learned so we need to be ready to perform any skill?

Thanks,
-Lisa

This is a link my sister sent me about holes in the heart and strokes. Very informative. Debbie
http://www.scai.org/pr.aspx?PAGE_ID=2845

Hi All,
N4 is not having lecture on Tues. so I will be at the tutor center at 0800 on Tues. for anyone that wants to get practice in for your final or just practice tests alone or with a study buddy. I will bring a bunch of NCLEX practice books and laptop for fluids and electrolytes practice and be available for extra help with tutoring for same subject. I will be there until 1200, unless someone needs me at another time. I will also be there on Monday after my lecture ends (at 1045) until Fernisa's study session at 1700. If you want to make sure that I will be there for you, you can call my cell 329-1369 to confirm, or the tutor center at 954-5542.
Look at Richard's post and do just exactly that for right now. It helps to understand why things are moving and causing signs and symptoms rather than just memorizing stuff, but if that's all you have time for now, it's better than nothing.

Nifty Anatomy Website...

http://www.innerbody.com/htm/body.html

check this out...great review tool for basic anatomy of the body.

-Lisa

NEED PRACTICE?

I will go to the tutor center Shima 217, tomorrow, this Wednesday 10/5/05, as soon as I get out of my clinical at SJGH. I will hopefully make it there by 1600 (my cell 329-1369). The center stays open late on Wed. I will bring over 50 real blood gas papers so that you can see what they look like and practice interpreting. These are a piece of cake. In less than 10 minutes you can have these down pat and pick the right answer with confidence every time. Don't get so hung up on these that you lose time studying the other stuff.
What you really need to understand are the signs and symptoms of acidosis and alkalosis. What do you expect to see? Why? What is going on? Why? What can you and should you do about it as a nurse? What is the MOST important thing to do first? What can happen if something is not done? What is our body trying to do to compensate? What is so important about those electrolytes? What do they do? Does it really matter if they shift in or out of the cells a little bit? Learn the normal blood levels for the major electrolytes. This is where flash cards might come in handy.
I will bring all kinds of tutorial sheets and practice questions so we can discuss the answers together.
Check out your Fundamental's CD on the fluid and electrolyte tutorial if you haven't already.

The Cultural projects were really fun today! Thanks everybody! I have to admit, when we started gearing up for it, I had a not-so-cooperative attitude about it, but I thought today was really interesting. Thanks again for everybody's participation and work!