Nursing 4 Exam I

first level of priority

emergent, immediate action required

ex: intercoastal retractions, labored breathing, pulslessness, sevree hypotension, crushing chest pain, suicidal ideations

second level of priority

urgent prompt action required

ex: high fever, cold extremities, decreasing level of conciousness, acute changes in lab values, increasing pain level

third level

nonurgent, action can wait

ex: decreased mobility, insomnia, lack of knowledge

the five rights of delegation

right task- is it appropriate to delegate

right circumstance- is the patient stable enough to delegate

right person- is this person trained to do the task

right direction/communication-clearly explain what needs to be done

right supervision- can i monitor the task and follow up on the patients response

RN vs LPN vs UAP scope of practice

LPN can continue something in the iv but cant start it

the three p’s of perfusion effect on bp and cardiac output

pump-contractility

pipes-afterload(the force the heart has to pump against), vasoconstriction/vasodilation

plasma-blood volume=preload

what is the first sign of poor perfusion

restlessness

arterial vasocontriction will what afterload and reduce what

will increase afterload and reduce cardiac output (blood flow out of the heart)

parasympathetic system signs

constricts pupils

stimulates saliva production

consticts bronchi

decreases hr and contractability

stimulates stomach, pancreas, and intestines

urination

promotes erection

sympathetic nervous system signs

dilates pupils

inhibits saliva porduction

dilates bronchi

increases hr and ocntractability\

stimulates epinephrine and norepinephrin release

stimulaes glucose release

inhibits stomach, pancreas, and intestines

inhiibits urination\

promotes ejactulation anf vaginal cotractions

a nurse is discussing the effect of medications autonomic nervous system. which is correct

anticholinergic medications will cause bronchodilation

patients with low cardiac output will receive what medication

dobutamine

b2 does what

bronchodilators

blocking b2 causes bronchoconstriction

beta blockers

htn, mi, hf, arrythmias

cholinergics vs anticholenergics

cholenergic: affect parsympathetic nervous system(resta sdn digest), salivation

anticholinergics: fight or flight, slows motiility, urinary retention

a pateitn with hypotension and tachycardia is dizzy what meds would they get

norepinephrine and fluid bolus

A nurse is providing education to a client recently prescribed oxybutynin. Which information would be appropriate?

use chewing gum to releive dry mouth

alpha does what o the arteries

vasoconstricts

A new nurse is monitoring a client with a norepinephrine infusion to maintain MAP > 65 mmHg via right forearm IV.  Which action by te new nurse would require correction by the preceptor? The new nurse

•A. decreases the infusion for a BP of 96/60 (72) mmHg.

•B. requests an order for phentolamine if the infusion infiltrates.

•C. recommends insertion of a central venous catheter for the infusion.

•D. stops the infusion for a heart rate of 58 bpm.

•D. stops the infusion for a heart rate of 58 bpm.

IV infiltration of vasopressor(norepinephrine, dopamine, phenylepinephrine)

can result in tissue necrosis due to lack of blood flow to area from vasoconstriction

notify HCP if this occurs

the tissue will need to be injected with phentolamine. alpha blocker will vasodilate blood vessels to restore blood to tissue

complete an incident report

•A nurse administers labetalol 20 mg IVP to a client with stroke symptoms who has a BP of 210/100 mm Hg at 1030. When should the nurse reassess the BP?

in 5 min, 1035

•A nurse administers diltiazem 0.25 IVP for a client with rapid atrial fibrillation at 146/min. When would the nurse anticipate a response in heart rate?

2 -5 min

•A nurse is providing pre-operative instructions to a client who is prescribed warfarin. When should the nurse instruct the client to stop taking warfarin?

5 days prior to surgery

what is the most potent diuretic

loop diuretic: furosemide

ace inhibitors and arbs

side effects- hypotension, hyperkalemia, angioedema

contarindicated: prgenancy, hyperkalemia

A- angioedema

C- cough

E-elevated K+

calcium channel blockers

nondihydroridines- diltiazem

dihydropyridines- amlodipine

also reduce the force of contraction, contraindicated in hf

A nurse is administering medications to a client with heart failure. It would be appropriate for the nurse to explain that

•A. carvedilol being used to increase the client’s heart rate.

•B. lisinopril is being used to dilate the blood vessels to improve cardiac output.

•C. hydrochlorothiazide is being used to increase the client’s blood pressure.

•D. amlodipine is recommended if your also have hypertension.

•B. lisinopril is being used to dilate the blood vessels to improve cardiac output.

what two class of drugs cause brwdycardia

beta blockers

special calcium channel blockers

A nurse is administering medications to a client. For each nursing intervention below, check to specify if the intervention is needed for the medication. Each nursing intervention may be indicated for more than one medication. 

A nurse is providing education to a client about their prescribed anticoagulant medication. For each instruction below, check to specify if the instruction is needed for the medication. Each instruction may be indicated for more than one medication. 

if a pateint has an inr of 1.8 and on warfarin what do you need to do. Inr(0.8-1.2), 2-3

needs more drug