Fundamentals of Nursing: Elimination, Sensory Perception, Pharmacokinetics, Safe Medication Administration, and IV Therapy

Comprehensive practice flashcards in Question-and-Answer format covering ATI Fundamentals chapters on urinary elimination, sensory perception, pharmacokinetics, safe medication administration, and intravenous therapy.

How should a nurse instruct a client to perform pelvic floor (Kegel) exercises?

Tighten pelvic muscles for a count of $10$, relax slowly for a count of $10$, and repeat in sequences of $15$ in the lying-down, sitting, and standing positions $3\text{ to }4$ times per day.

What is the protocol for increasing voiding intervals during a bladder-retraining program?

Gradually increase urination intervals after no incontinence episodes for $3\text{ days}$, working toward the optimal interval of $4\text{ hr}$.

What post-void residual volume is required before removing an indwelling or suprapubic catheter?

A post-void residual of less than $50\text{ mL}$.

How do stress, urge, and overflow urinary incontinence differ in their etiology and clinical presentation?

Stress incontinence is the loss of small amounts of urine from increased abdominal pressure (laughing, sneezing, lifting) without detrusor contraction. Urge incontinence is the inability to stop urine flow long enough to reach the bathroom due to an overactive detrusor muscle. Overflow incontinence is urinary retention from bladder overdistention leading to frequent dribbling of small amounts of urine due to outlet obstruction or impaired detrusor muscle function.

What defines reflex incontinence versus functional incontinence?

Reflex incontinence is the involuntary loss of a moderate amount of urine without warning caused by hyperreflexia of the detrusor muscle (commonly from spinal cord dysfunction). Functional incontinence is urine loss caused by factors outside the urinary tract (cognitive, mobility, or environmental barriers) that prevent timely access to a toilet.

What key nursing considerations and client education points apply to the urinary tract analgesic phenazopyridine?

Phenazopyridine relieves bladder discomfort but does not treat infection; it is contraindicated in hepatic disorders and renal insufficiency; it turns urine orange; it should be taken with food; and the provider must be notified immediately if jaundice develops.

Why must a nurse screen for a history of glaucoma prior to administering urinary antispasmodics such as oxybutynin or dicyclomine?

Anticholinergic agents can cause pupillary dilation and impede drainage canals, increasing intraocular pressure.

How do specimen collection procedures differ among random urinalysis, clean-catch midstream, timed urine, and indwelling catheter collection?

Random urinalysis requires a non-sterile specimen. Clean-catch midstream requires cleansing the urethral meatus and collecting midstream voiding in a sterile cup. A timed urine specimen collects all voided urine over a specified time period (e.g., $24\text{ hr}$). A catheter specimen requires obtaining sterile urine directly from the catheter sampling port using aseptic technique.

What are the contrasting clinical manifestations of sensory deprivation versus sensory overload?

Sensory deprivation produces cognitive changes (decreased learning, disorientation), affective changes (restlessness, anxiety), and perceptual changes (decreased coordination, impaired color perception). Sensory overload results from excessive, sustained stimulation and manifests as racing thoughts, anxiety, and restlessness.

What specific nursing actions promote effective communication with a client who has aphasia?

Greet the client by name, allow only one person to speak at a time, speak clearly and slowly using short sentences and simple words without shouting, pause between statements, check comprehension, ask questions with simple answers, reinforce verbal statements with nonverbal cues, allow ample time for responses, and use communication aids such as picture charts.

To prevent accidental burns in clients with tactile sensation deficits, what is the recommended upper temperature limit for home water heaters?

An upper limit of $48.8^\circ\text{C}\ (120^\circ\text{F})$.

What is the expected intraocular pressure range measured by tonometry, and what condition does an elevated reading indicate?

The expected range is $10\text{ to }21\text{ mm Hg}$; elevated readings indicate glaucoma (especially angle-closure glaucoma).

How do testing distances and diagnostic thresholds compare between Snellen and Rosenbaum visual acuity charts?

The Snellen chart evaluates distance vision with the client positioned $6\text{ m}\ (20\text{ ft})$ away, where a denominator of $40$ or greater with corrective lenses indicates reduced acuity. The Rosenbaum chart evaluates near vision with the chart held $36\text{ cm}\ (14\text{ in})$ from the eyes.

What pathophysiological distinction differentiates cataracts from macular degeneration?

Cataracts involve progressive opacity of the lens that blocks the entry of light rays into the eye, whereas macular degeneration causes deterioration of the center of the retina, resulting in loss of central vision.

What therapeutic effects and adverse effects are associated with atropine ophthalmic solution?

Atropine ophthalmic drops produce mydriasis (pupillary dilation) and cycloplegia (ciliary muscle paralysis) for procedures. Adverse effects include photophobia, blurred vision, reduced accommodation, and potential anticholinergic systemic absorption effects (tachycardia, dry secretions).

What are the expected Rinne and Weber test results in conductive hearing loss versus sensorineural hearing loss?

In conductive hearing loss, the Rinne test demonstrates bone conduction equal to or greater than air conduction ($\text{AC} \le \text{BC}$), and the Weber test lateralizes to the affected ear. In sensorineural hearing loss, the Rinne test demonstrates air conduction greater than bone conduction ($\text{AC} > \text{BC}$) with reduced duration for both, and the Weber test lateralizes to the unaffected ear.

Where is the light reflex expected to appear during an otoscopic examination of a healthy tympanic membrane?

Visible from the center anteriorly at the $5\text{ o'clock}$ position in the right ear and at the $7\text{ o'clock}$ position in the left ear.

What post-surgical positioning and restrictions are required following a tympanoplasty or myringoplasty?

Position the client flat with the operative ear facing upward for $12\text{ hr}$, maintain sterile ear packing, avoid air travel, avoid forceful coughing or sneezing with the mouth closed, and cover the ear when washing hair to prevent water entry.

What clinical significance does a medication's therapeutic index (TI) carry regarding serum level monitoring?

The therapeutic index is the ratio of average lethal dose to average effective dose. Medications with a high TI have a wide margin of safety and do not require routine monitoring, whereas medications with a low TI have a narrow margin of safety and require close monitoring of peak and trough serum levels.

How many half-lives ($t_{1/2}$) are generally required for a medication to achieve a steady blood concentration?

It typically takes $4$ half-lives for medication intake to equal the rate of metabolism and elimination.

How do pharmacological agonists, antagonists, and partial agonists differ in their mechanisms of action?

An agonist binds to and activates normal receptor activity (e.g., morphine activating mu receptors). An antagonist binds to a receptor and prevents or blocks endogenous or exogenous activation (e.g., losartan blocking angiotensin II receptors). A partial agonist acts concurrently as an agonist at some receptors and an antagonist at others (e.g., nalbuphine acting as an agonist at kappa receptors and antagonist at mu receptors).

How should a nurse perform nasolacrimal occlusion when administering eye drops, and why?

Apply gentle pressure with a finger and clean tissue over the nasolacrimal duct for $30\text{ to }60\text{ seconds}$ after instillation to prevent the medication from draining into the systemic circulation.

How must the nurse manipulate the auricle when instilling ear drops in an adult versus a child under 3 years of age?

Pull the auricle upward and outward for adults; pull the auricle downward and backward for children younger than $3\text{ years}$ of age.

What are the correct instructions for inhaling and breath-holding when using a metered-dose inhaler (MDI) without a spacer?

Shake the inhaler $5\text{ to }6$ times, exhale, tilt the head back slightly, actuate the inhaler while taking a slow deep breath over $3\text{ to }5\text{ seconds}$, hold the breath for $10\text{ seconds}$, and slowly exhale through pursed lips.

What water flush volumes must be used before, between, and after administering medications through an enteral feeding tube?

Flush the tube with $15\text{ to }30\text{ mL}$ of warm water before and after each individual medication, and flush with a final $30\text{ to }60\text{ mL}$ of water following the last administered medication.

What needle gauge, needle length, insertion angle, and maximum volume are appropriate for an intradermal injection?

A $26\text{- to }27\text{-gauge}$ needle, $0.01\text{ to }0.1\text{ mL}$ volume, inserted bevel up at an angle of $10^\circ\text{ to }15^\circ$ until a small bleb appears.

What are the recommended maximum volumes, needle gauges, and sites for intramuscular (IM) injections in adults and infants?

Use a $22\text{- to }25\text{-gauge}$, $1\text{- to }1.5\text{-inch}$ needle at a $90^\circ$ angle. In adults, the ventrogluteal site accommodates up to $3\text{ mL}$, and the deltoid site accommodates $1\text{ to }2\text{ mL}$. In infants $1\text{ year}$ and younger, the vastus lateralis is recommended.

What is the rationale for using the Z-track technique during intramuscular injections?

It seals the medication path to prevent irritating medications or solutions that stain tissue (such as iron preparations) from leaking into subcutaneous tissue.

How does the abuse potential and legal status differ across controlled substance schedules?

Schedule I medications have high abuse potential and no accepted medical use in the United States (e.g., heroin). Schedules II through V have legitimate medical applications, with each subsequent schedule having decreasing risk of misuse and physical/psychological dependence (e.g., Schedule II morphine has higher abuse potential than Schedule IV phenobarbital).

What operational timeframes define "stat" versus "now" medication prescriptions?

A "stat" prescription must be administered immediately and once only; a "now" prescription is administered once within $90\text{ min}$ of the nurse receiving the prescription.

What are the administration timeframes for time-critical versus non-time-critical medications?

Time-critical medications (e.g., antibiotics) must be administered within $30\text{ min}$ of their scheduled time. Non-time-critical medications prescribed once daily, weekly, or monthly can be administered within $2\text{ hr}$ of their scheduled time. Non-time-critical medications prescribed more than once daily (not exceeding every $4\text{ hr}$) can be administered within $1\text{ hr}$.

What protocols must a nurse execute when taking a telephone medication prescription?

Read back the client's name, medication name, dosage, time, frequency, and route; use phonetic spelling aids ("b as in boy") and pronounce numbers individually ("one, seven" for 17); have a second nurse listen on an extension or speaker when possible; enter the order into the medical record; and ensure the prescribing provider signs the prescription within the facility's required timeframe (usually within $24\text{ hr}$).

According to the ISMP error-prone abbreviations list, why are trailing zeros and omitted leading zeros dangerous?

A trailing zero (e.g., $1.0\text{ mg}$) can be misread as $10\text{ mg}$ if the decimal point is missed, while an omitted leading zero (e.g., $.5\text{ mg}$) can be misread as $5\text{ mg}$; nurses must write $1\text{ mg}$ and $0.5\text{ mg}$.

What is the priority sequence of actions a nurse must take immediately following a medication error?

First, assess the client immediately (including vital signs and clinical status); notify the provider and charge nurse or nursing supervisor; implement corrective therapies; and complete an incident report within $24\text{ hr}$ without documenting or referencing the report in the client's medical record.

What peripheral IV catheter gauges are designated for trauma, surgical interventions/blood transfusions, and routine infusions?

A $16\text{-gauge}$ catheter is used for trauma and rapid fluid volume; a $16\text{- to }20\text{-gauge}$ catheter is used for surgical procedures and rapid blood product administration; and a $20\text{- to }24\text{-gauge}$ catheter is used for routine infusions, older adults, and children.

At what angle and orientation should an IV catheter be inserted into the skin and vein?

Insert the catheter smooth and steady with the bevel facing up at an angle of $10^\circ\text{ to }30^\circ$.

What are the standard replacement intervals for continuous versus intermittent IV administration sets?

Continuous IV administration tubing sets should be replaced every $96\text{ hr}$, whereas intermittent infusion tubing sets should be replaced every $24\text{ hr}$.

How do the clinical manifestations and management of IV infiltration differ from those of phlebitis?

Infiltration manifests as pallor, localized swelling, coolness of surrounding skin, damp dressing, and slowed infusion rate; treat by stopping the infusion, removing the catheter, and elevating the extremity with warm or cold compresses. Phlebitis manifests as erythema, throbbing, warmth, tenderness, and a palpable cord along the vein; treat by immediately stopping the infusion, removing the catheter, elevating the limb, and applying warm compresses $3\text{ to }4$ times daily.

What are the signs of systemic IV fluid overload, and what immediate nursing actions should be taken?

Signs include distended neck veins, hypertension, tachycardia, dyspnea, bilateral basilar crackles, and peripheral edema. Immediate actions: slow or decrease the IV flow rate, notify the provider, elevate the head of the bed, monitor vital signs and oxygen saturation, and administer prescribed diuretics.

What clinical findings indicate an IV catheter embolus, and what is the nurse's immediate emergency intervention?

A missing catheter tip upon removal and severe local pain along the vein. The immediate emergency action is to apply a tourniquet high on the extremity to limit venous flow and prepare the client for radiologic or surgical retrieval without reinserting the stylet.