EXAM REVIEW

1. Priority question
a. Look for pt at risk for dysrhythmias or airway issues or if you don’t treat them, they will
die
2. EKG
a. Fluid and electrolytes (hypokalemia and hyperkalemia)
b. Hyperkalemia- tall T wave
i. • Cardiac dysrhythmias
ii. • Cramping leg pain
iii. • Weak or paralyzed skeletal
iv. muscles
v. • Abdominal cramping or diarrhea

c. Hypokalemia- prominent U wave, shallow T wave, ST depression

i. • Cardiac most serious
• Skeletal muscle weakness (legs)
• Weakness of respiratory muscles
• Decreased GI motility
• Hyperglycemia
d. Where is P, QRS, T wave
e. Where to perform
f. How long do they take- EKG 15-20 mins while laying supine
g. Echocardiogram take 40-60 minutes
3. Chest tube drainage questions
a. NCLEX style question slide
i. 1st chamber- collection chamber
ii. 2nd water seal chamber (continuous bubbling not normal)
iii. 3rd suction control (bubbling normal)
b. Tidaling- reflect changes in pressure
c. -thoraxes
d. Hemothorax- accumulation of blood in the pleural space
e. Tension pneumothorax- pressure(air) has built up in the chest/pleural space and has
collapsed the lung and does not escape. Everything is pushed to the unaffected side
(mediastinal shift)
i. In respiratory distress, tachycardia, dyspnea
f. Pleural effusion- build up of excess fluid between the layers of the pleura
i. Chest pain, non productive cough, dyspnea, orthopnea
ii. Bacteria in pleural space causing inflammation
g. Emphysema
i. SOB, barrel chest, use of accessory muscles, clubbed nails (hypoxemia
h. Empyema
i. Pockets of pus inside a body cavity (large numbers of tubercular organisms in
pleural space)
ii. Diagnosed using a chest X-ray then ultrasound
4. ABG interpretation and values
a. Acidosis and alkalosis
b. Respiratory Acidosis
i. Neuro decline, headache, drowsy, respiratory rate decreases, BP decreases,
confusion
c. Respiratory Alkalosis
i. Tachypnea, Fast respiratory rate
d. Metabolic Acidosis
i. Kussmaul’s- deep labored hyperventilation, confused, cardiac changes
e. Metabolic Alkalosis- bradypnea, hypokalemia
f. Compensation?
5. Bronchoscopy and Thoracentesis
a. Bronchoscopy
i. What to give before (explain procedure, hyperextended position, check gag
reflex, not to drink anything
ii. Through the nose or mouth to the trachea to the bronchi, should be lying down
or seated
b. Thoracentesis- Check for bleeding, should be sitting with hands supine
i. Large bore needle, going into the pleural space to take out fluid or air.
ii. Upright with elbows on an overbed table with feet supported
6. Tuberculosis
a. What kind of isolation- airborne precautions (private room)?
b. What kind of room assignment- negative air flow pressure room
c. Medication for TB with side effects
i. Rifampin- orange urine
ii. Isoniazid- peripheral neuropathy and hepatotoxicity
iii. Pyrazinamide- increase in serum uric acid
iv. Ethambutol- blurred vision or color
v. Streptomycin- hearing loss
d. Teachings
e. Preventive measures
f. DOT (Direct observation therapy)- administer medications to TB patients daily during
isolation
g. Mantoux test- to determine if someone is infected with mycobacterium tb
h. Complete ABG as in structed
i. TST- positive if greater than 15mm
7. Further teaching
a. There is something wrong, look for choice where there is wrong information
8. Hypovolemia and Hypovolemic Shock
a. Fluid deficit
b. Increased temperature, rapid pulse, tachypnea, tachycardia, hypotension, flat neck
veins
c. Bleeding
d. Decreased co
 e. Decreased renal output (urinary)
9. Hypervolemia- bounding pulse, SOB, dyspnea, rales, crackles, edema, HTN, Semi- fowlers
10. Memorize lab values of electrolytes
a. Call dr if potassium is high or low. Correct immediately
11. Memorize lab values for respiratory and cardiac
a. Cholesterol values
b. CRP
c. Troponin
d. WBC, esoniphils
12. Tracheostomy
a. Assessment and intervention
b. How to provide care
13. Hypertension
a. Lifestyle modifications
b. Risk factors
c. Nonmodifiable risk factors
d. Medications decrease blood volume and lower pressure
14. Pneumonia symptoms- pleuritic chest pain and productive cough
15. Influenza vaccines
a. Who receives
b. Allergies
c. Teaching for respiratory infections
16. COPD- case study
a. Bronchodilators- before meals to relieve SOB
b. Corticosteroids- decrease inflammation
c. Never increase oxygen
d. #1 risk factor- cigarette smoking
17. Fluid volume O/D
a. Signs and symptoms
b. Signs and symptoms of electrolyte imbalances
c. Hypermagnesemia
18. MI and Angina
a. Nitroglycerin and aspirin side effects types (sublingual and transdermal
b. What happens if troponin I and T elevated
c. Angina- caused by anxiety and stress, there is an increase in Troponin 1, prep for EKG
i. Silent ischemia- absence of any subjective symptoms, diabetic neuropathy, can
be confirmed by a ECG.
ii. Prinzmetal’s variant- rare, occurs at rest, can eb seen in patients with a history
of migraines, raynaud’s phenomenon, heavy smoking
iii. Microvascular- syndrome X, chest pain occurs in the absence of significant CAD
19. Asthma signs and symptoms interventions
a. Cough, tachypnea, wheezing (no crackels), chest tightness
20. Emphysema
a. What kind of symptoms and nursing assessments
 b. Lung disease that causes damage to alveoli to weaken and collapse
c. Mainly in COPD, asthma, cigarette smoking, prolonged cough, wheezing, thick sputum,
in X-Ray, pulse ox can be below 80, incentive spirometer, CHECK ABG for respiratory
acidosis
d. Only thing about alveoli being destructed
i. Impaired gas exchange
ii. SOB, Cyanosis, Mental not alert and oriented
iii. How can you treat? Can be complication of a disease (treat the disease)
iv. On ventilator
21. PAD DVT
a. Elevate- DVT
b. Dangle- PAD
c. Risk factors
i. Tobacco use
ii. Chronic kidney disease
iii. Diabetes mellitus
iv. Hypertension
v. Hypercholesterolemia
22. Laryngectomy airway issues
a. Keep trach and suction set up
b. Ineffective airway clearance
c. Assess for airway clearance
23. First ppt one question from human anatomy and physiology
24. Cardiac Biomarkers (indicates myocardial infarction)
a. Troponin T
b. Troponin I- when elevated it is a reliable indicator of myocardial injury
c. Cardiac enzymes find out damage (Troponin)
25. PICC line CVAD
a. Who needs it
i. Bacterial Endocarditis
ii. They are used with patients who need vascular access for 1 week to 6 months
but can be in place for longer periods.
iii.
b. Nursing assessment

26. Dehydration
Who is at risk - feeding tube clients, pt w/gastroenteritis?

infant s/s: depressed fontanel = dehydrated vs. bulged = increased ICP

elderly s/s: skin tenting on hands & abdomen
27.