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ATI med surg

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1.

What is normal range for


cholesterol, HDL, LDL

Less than 200, above 40,


less than 130

2.

What is the desired INR range


for people taking warfarin

2.0-3.0

3.

What is an indicator of cardiac


tamponade

Blood pressure is 10 MM
HG or higher on expiration
then on inspiration

4.

Patients scheduled for a


coronary artery bypass graft
should not take
anticoagulants for at least
blank prior to the surgery to
prevent excessive bleeding

A week

A patient is admitted with a


diagnosis of
Bradydysrhythmia. What
assessment finding requires
immediate intervention?

The patient reports


weakness and fatigue

6.

Following insertion of a
permanent pacemaker, a
patient states they cannot get
rid of these hiccups. Why is
this potentially a problem?

Hiccups may indicate that


the pacemaker is
stimulating the chest wall
or diaphragm. This could
indicate a complication
such as lead wire
perforation

7.

Chapter 27

...

8.

What is the normal range for


creatine kinase? When are
elevated levels first detectable
after myocardial injury and
what is expected duration of
the elevated levels?

30 to 170 units/L, 4 to 6
hours, 3 days

9.

What is the normal range for


troponin T? When are elevated
levels first detectable after
myocardial injury and what is
expected duration of the
elevated levels?

Less than 0.2 ng/L, 3 to 5


hours, 14 to 21 days

10.

What is normal range for


troponin I? When are elevated
levels first detectable after
myocardial injury and what is
expected duration of the
elevated levels?

Less than 0.03, three


hours, 7 to 10 days

11.

What is normal range for


myoglobin? When are elevated
levels first detectable after
myocardial injury and what is
expected duration of the
elevated levels?

Less than 90 mcg/L, two


hours, 24 hours

5.

12.

While an echocardiogram is being


performed what side should the patient
lie on?

Left side and


remain still

13.

What are indications for an


echocardiogram

Cardiomyopathy
Heart failure
Angina
Myocardial
infarction

14.

What are indications for stress test

Dysrhythmias
HF
Angina
MI

15.

What are two medications that are


prescribed for pharmacological stress
test

Dobutamine
Adenosine

16.

What do you instruct the patient to do 2


to 4 hours before a stress test

Avoid tobacco,
alcohol and
caffeine

17.

Hemodynamic monitoring involves


special indwelling catheters that
provide information about blood
volume and perfusion, fluid status and
how well the heart is pumping. Arterial
lines are placed in the radial (most
common), brachial or femoral artery.
What should you Monitor for?

Monitor
circulation in the
limb with the
arterial line.
Such as capillary
refill,
temperature,
color. Arterial
lines are not
used for IV fluid
administration

18.

The pulmonary artery (PA) catheter is


inserted into a large vein (internal
jugular, femoral, subclavian, brachial)
and threaded through the right atria
and ventricles into a branch of the
pulmonary artery. PA catheters have
multiple lumens, ports and components
that allow for various hemodynamic
measurements, blood sampling and

Infusion of IV
fluids

19.

What are the


different lumens
used for?

20.

What is the
expected
reference range
for CVP (Central
venous pressure)

1 to 8 MM HG

21.

What is the
expected
reference range
for pulmonary
artery systolic
(PAS)

15 to 26

22.

What is the
expected range
for pulmonary
artery diastolic
(PAD)

5 to 15

23.

What is expected
range for
pulmonary artery
wedge pressure
(PAWP)?

4 to 12

24.

What is the
expected range
for cardiac
output

4 to 7 L/minute

25.

What is expected
range for mixed
venous oxygen
saturation

60% to 80%

26.

When should a
nurse anticipate
lower
hemodynamic
values?

In older patients especially if


dehydration is a complication

27.

What position
should the
patient be in with
hemodynamic
monitoring

Supine or Trendelenburg

28.

What are post


procedure
nursing
interventions for
hemodynamic
monitoring

1. Obtain chest x-ray to confirm catheter


placement
2. Continually monitor vitals
3. Compare NIBP to arterial blood
pressure
4. Observe and document waveforms.
Report changes in waveforms to the
provider
5. Document catheter placement each
shift and as needed
6. Place the patient in supine position
prior to recording hemodynamic values (
HOB can be elevated 15 to 30)

29.

What are
complications of
hemodynamic
monitoring

30.

What are nursing


actions
preprocedure
before an
angiography

1. Patient is NPO for at least eight hours


before
2. Assess for iodine/shellfish allergy
3. Assess renal function
4. Teach the client that the affected leg
must remain straight after the
procedure
5. The other normal stuff like ensure
informed consent blah blah

31.

What are post


procedure
nursing
interventions for
an angiography

1. Assess vitals every 15 minutes for One


hour, every 30 minutes for one hour,
every hour for four hours and then
every four hours
2. Assess the site for bleeding and
hematoma with every vital sign check
3. Maintain bed rest for 4 to 6 hours after
the procedure
4. Monitor urine output and administer
IV fluids for hydration (contrast media
acts as an osmotic diuretic)

32.

How long do
patients receive
anticoagulation
therapy that have
stent placement

6 to 8 weeks

33.

What is cardiac
tamponade

Fluid accumulation in the pericardial sac

34.

What are
manifestations of
cardiac
tamponade

hypotension
JVD
Muffled heart sounds
Paradoxical pulse

35.

What are nursing


actions for cardiac
tamponade

1. Notify the provider immediately


2. Administer IV fluids to combat
hypotension as prescribed
3. Obtain a chest x-ray or
echocardiogram to confirm diagnosis
4. Prepare the client for
pericardiocentesis

43.

What are nursing


interventions to
prevent an air
embolism in a vascular
access device

1. Leave central lines clamped when


not in use
2. Have the patient hold breath
while the tubing is changed
3. If the patient has sudden SOB,
place in Trendelenburg on left side,
give oxygen and notify the provider

36.

What is
retroperitoneal
bleeding

Bleeding into the abdominal cavity


behind the peritoneum can occur due to
femoral artery puncture (after an
angiography)

44.

37.

What are nursing


actions for
retroperitoneal
bleeding

1. Assess for flank pain and hypotension


2. Notify the provider immediately
3. Administer IV fluids and blood
products as prescribed

What are nursing


interventions to
prevent accidental
dislodgment of a
catheter

1. Cover the extremity site with


stretch netting
2. Wrap a washcloth folded into
thirds around the arm before
applying a needed restraint
3. When removing the dressing, pull
from distal to proximal

45.

Zero. Zero transducer to room air

38.

What are central


catheter's
appropriate for

Any fluids due to rapid hemodilution in


the superior vena cava

39.

What is post
procedure care for
a PICC

Hemodynamic
pressure lines should
be calibrated to read
atmospheric pressure
as blank.

46.

What kind of
medication would you
use for vasodilation
secondary to sepsis

Dopamine (vasopressors)

47.

Chapter 28

...

48.

What are
medications/electrical
management for
bradycardia

1. Atropine and isoproterenol


(antiarrhythmic and
bronchodilator)
2. Pacemaker

49.

What are
medications/electrical
management for a fib,
SVT or VT with pulse

1. Amiodarone, adenosine,
verapamil (CCB)
2. Synchronized cardioversion

50.

What are
medications/electrical
management for VT
without a pulse or
ventricular fibrillation

1. Amiodarone, lidocaine and


epinephrine
2. Defibrillation

51.

What is cardioversion

Delivery of a direct countershock to


the heart synchronized to the QRS
complex

52.

What is defibrillation

Delivery of an unsynchronized,
direct countershock to the heart.
Stops all electrical activity of the
heart, allowing the SA node to take
over and reestablish a perfusing
rhythm

53.

What is held 48 hours


prior to elective
cardioversion

Digoxin

54.

What is indicative of
an MI

Chest pain and ST segment


depression or elevation

55.

Chapter 30

...

40.

41.

42.

What should you


do if there's an
occlusion in the
access device that
impedes flow

1. Flush the line at least every 12 hours to


maintain patency (3 mL for peripheral &
10 mL for central lines)
2. Administer urokinase to lyse
obstructions per facility protocol
3. Flush implanted port after every use
and at least once a month while
implanted

What are nursing


actions for a
catheter
thrombosis/emboli

1. Flush the line per facility protocol


2. Do not force fluid if resistance is
encountered
3. Use a 10 mL or larger syringe to avoid
excessive pressure

What is treatment
for infiltration and
extravasation

1. Remove using direct pressure with


gauze sponge until bleeding stops
2. Apply cool compress
3. Elevation is optional
4. Avoid starting a new IV site in the same
extremity

56.

What is an
arthrectomy

Used to break up and remove plaques


within cardiac vessels

64.

Perforation of an artery by the


catheter may cause blank

Cardiac tamponade

57.

What is a stent

Placement of a mesh wire device to hold


an artery open and prevent restenosis

65.

What are clinical


manifestations of anaphylaxis

58.

What is a
percutaneous
transluminal
coronary
angioplasty

Involves inflating a balloon to dilate the


arterial lumen and the adhering plaque,
therefore widening the arterial lumen

chills
Fever
Rash
Wheezing
Tachycardia
Bradycardia

66.

What are two medications that


might be prescribed in the
event of anaphylaxis

Diphenhydramine or
epinephrine

67.

A coronary artery bypass graft


is most effective when a
patient has sufficient
ventricular function such as an
EF greater then

40% to 50%

68.

What are preprocedure


medications for a CABG

1. Anxiolytics: lorazepam
and diazepam
2. Prophylactic antibiotics
3. Anticholinergic such as
scopolamine

69.

What are some important


preprocedure teachings for a
patient that is going to
undergo a CABG

1. Endotracheal tube and


mechanical ventilator for
airway management for
several hours following the
surgery
2. Inability to talk while
endotracheal tube is in
place
3. Sternal incision and
possible leg incision
4. 1 to 2 mediastinal chest
tubes
5. Indwelling urinary
catheter
6. Pacemaker wires
7. Hemodynamic
monitoring devices

70.

What are two medications that


are discontinued before a
CABG

1. Diuretics 2 to 3 days
before surgery
2. Aspirin and other
anticoagulants one week
before surgery

71.

What are medications that are


often continued for CABG

Potassium supplements
Antidysrhythmic's
Antihypertensives
Insulin

72.

Post procedure: what should


you do with the patient within
two hours following
extubation

Dangle and turn the client


from side to side as
tolerated

59.

What are
indications for a
PCI (angioplasty)

What are
preprocedure
nursing actions
for a PCI (besides
allergies,
informed
consent, blah
blah)

1. NPO at least eight hours if possible


2. Assess renal function prior to
introduction of contrast dye
3. Administer antiplatelet medications as
prescribed

61.

What are two


medications that
are administered
during the
intraprocedure
for PCI

Midazolam (Versed) and fentanyl

62.

What is post
procedure
nursing actions
after a PCI

1. Assess vitals every 15 minutes for one


hour, every 30 minutes for one hour,
every hour for four hours and then
every four hours.
2. Assess the groin site at the same
intervals for bleeding and hematoma
formation
3. Assess for signs of thrombosis
4. Maintain bed rest in a supine position
with the leg straight for 4 to 6 hours ( or
prescribed time)
5. Monitor urine output

60.

63.

How long does a


client with a stent
replacement
receive
anticoagulation
therapy

6 to 8 weeks after

73.

What should you


do within 24
hours after CABG

Assist the patient to a chair. Ambulate


the patient 25 to 100 feet by first
postoperative day

74.

How often should


you assess
neurological
status after CABG

Every 30 to 60 minutes until the client


awakens from anesthesia, then every 2
to 4 hours or per facility policy

Monitor chest
tube patency and
drainage. Measure
drainage at least
once an hour.
Volume
exceeding blank
could be a sign of
possible
hemorrhage and
should be
reported to the
surgeon

150 mL/hour

What kind of
manifestations of
pain might an
older female
patient show
instead of chest
pain

Dyspnea, indigestion

77.

What is a heart
healthy diet

Low-fat, low cholesterol, high-fiber, lowsalt

78.

What should the


patient's activity
level be after a
CABG

75.

76.

79.

What can
hypothermia
cause

Vasoconstriction, metabolic acidosis and


hypertension

80.

What are
indications of
cardiac
tamponade after
a CABG

1. Sudden decrease of chest tube


drainage following heavy drainage
2. JVD with clear lung sounds
3. Equal PAWP & CVP values

Treatment of
cardiac
tamponade after
a CABG involves

1. Volume expansion
2. Emergency sternotomy
(Pericardiocentesis is avoided because
blood may have clotted)

81.

82.

What is maximum
potassium
administration
rate IV

10 to 20 mEq/hour

83.

How long should


a patient remain
NPO before a
peripheral bypass
graft

Eight hours

84.

What are two


client education
points for a
peripheral bypass
graft

1. Advise the patient not to cross legs


2. Explain that pedal pulses will be
checked frequently

85.

What are post


procedure
nursing
interventions for
a peripheral
bypass graft

1. Assess vitals every 15 minutes for one


hour and then every hour after the first
hour
2. Administer anticoagulant
therapy/antiplatelet therapy
3. Maintain bed rest for 18 to 24 hours.
The leg should be kept straight during
this time

86.

What are teaching


points for foot
inspection and
care

87.

The graft may


occlude due to
reduced blood
flow and clot
formation. This
occurs primarily
in the first

24 hours post operative

88.

What kind of
procedure is used
for graft
occlusion

Thrombectomy or thrombolytic therapy

89.

What procedure
is used for
compartment
syndrome

Fasciotomy

90.

Chapter 35

...

91.

92.

What are physical assessment findings


for peripheral artery disease

What are nursing actions for


arteriography

1. Bruit over
femoral and aortic
artery's
2. Decreased
capillary refill of
toes
3. Decreased or
non-palpable
pulses
4. Loss hair on
lower calf, ankle
and foot
5. Dry, scaly,
mottled skin
6. Thick toenails
7. Cold/cyanotic
extremity
8. Pallor of
extremity with
elevation
9. Dependent
Rubor
10. Muscle atrophy
11. Ulcers and
possible gangrene
1. Observe for
bleeding and
hemorrhage
2. Palpate pedal
pulses to identify
possible occlusions

93.

How does a plethysmography


diagnose PAD

A decrease in
pulse pressure of
the lower
extremity indicates
a possible blockage
in the leg

94.

A Doppler probe is used to take


various blood pressure measurements
for comparison. In the absence of
peripheral arterial disease, pressures
in the lower extremities are

Higher than those


in the upper
extremities

95.

What is nursing
care for a patient
with PAD

1. Encourage collateral circulation


2. Avoid crossing legs
3. Avoid restrictive garments
4. Elevate the leg to reduce swelling, but
not to elevate them about the level of the
heart
5. Provide a warm environment
6. Avoid exposure to cold
7. Avoid stress, caffeine and nicotine and
anything that causes vasoconstriction

96.

What are
medications for
PAD

1. Antiplatelet medications - aspirin,


Plavix, trental
2. Statins - can relieve manifestations
associated with PAD such as intermittent
claudication

97.

What are two


surgical
procedures for
PAD

1. Percutaneous transluminal
angioplasty
2. Laser assisted angioplasty

98.

What are nursing


interventions for
these two
procedures

1. Observe for bleeding/vitals


2. Keep client on bed rest with limb
straight for 6 to 8 hours before
ambulation
3. Antiplatelet therapy for 1 to 3 months

99.

What is arterial
revascularization
surgery used for

Patients who have severe claudication


and/or limb pain at rest, or patients who
are at risk for losing a limb due to poor
arterial circulation

100.

What are nursing


actions for
arterial
revascularization
surgery

1. Maintain adequate circulation in the


repaired artery. The location of the pedal
or dorsalis pulse should be marked and
its strength compared with the
contralateral leg on a scheduled basis
using a Doppler
2. Assess color, temperature, sensation
and capillary refill compared with the
contralateral extremity on a scheduled
basis
3. Monitor BP!!!!
4. No bending of the hip and knee

101.

One
complication of
graft is
compartment
syndrome what
are
manifestations
of it

Tingling
Numbness
Worsening pain
Edema
Pain on passive movement
Unequal pulses
(prepare patient for Fasciotomy)

102.

What are risk


factors for
peripheral venous
disease

103.

Patients with
venous disease
most often
complain of limb
pain that feels
like

104.

What are signs of


DVT and
thrombophlebitis

105.

106.

What are signs of


Venous
insufficiency

What are clinical


manifestation of
varicose veins

1. Venus thromboembolism associated


with Virchow triad
2. Hip surgery, total knee replacement,
open prostate surgery
3. Heart failure
4. Immobility
5. Pregnancy
6. Oral contraceptives
7. Family history

109.

For varicose veins


Trendelenburg
test is used. What
are the nursing
actions for this
test

110.

What should you


encourage the
patient to do if
they have DVT or
thrombophlebitis

111.

What should you


teach the patient
to do if they have
venous
insufficiency

112.

What are
medications for
DVT and
thrombophlebitis

Anticoagulants

113.

How long does it


take for warfarin
to take affect

3 to 4 days

114.

DVT and
thrombophlebitis
both can use
thrombolytic
therapy. What are
the details of this
therapy?

115.

For varicose
veins,
sclerotherapy
may be
performed. What
are the details of
this therapy?

116.

What should the


nurse monitor for
postoperatively
after varicose
veins - vein
stripping

Aching pain and feeling of fullness or


heaviness in the legs after standing

1. Stasis dermatitis is a brown


discoloration on the ankles that extends
at the calf relative to the level of
insufficiency
2. Edema
3. Stasis ulcers ( typically found around
ankles)
1. Distended, superficial veins that are
visible just below the skin and are
torturous in nature
2. Patients often report muscle cramping
and aches, pain after sitting and pruritus

107.

What are
laboratory tests
for PVD

D dimer test measures fibrin


degradation products present in the
blood produced from fibrinolysis. A
positive test indicates that thrombus
formation has possibly occurred

108.

What are
diagnostic
procedures for
DVT and
thrombophlebitis

1. Venus duplex ultrasonography


2. Impedance plethysmography
3. If the above test are negative for a
DVT, but one is still suspected a
venogram, which uses contrast material
or MRI may be needed for accurate
diagnosis

1. Place the patient in the supine position


with legs elevated
2. When the patient sits up, the veins will
fill from the proximal and if varicosities
are present

117.

What are two


other surgical
interventions
that can be
performed for
varicose veins

118.

Venous stasis
ulcers often form
over the medial
malleolus.
Venous ulcers
are chronic, hard
to heal and often
recur. They can
lead to
amputation
and/or death.
What are nursing
interventions for
venous ulcers

119.

120.

121.

1. Endovenous laser treatment


2. Application of radiofrequency energy

What are patient


teachings for
patients that
have venous
ulcers (diet and
DVT prevention)

1. Recommend a diet high in zinc,


protein, iron and vitamins A & C
2. Instruct patient on the use of
compression stockings

A pulmonary
embolism occurs
when a
thrombus is
dislodged,
becomes an
embolus and
lodges into a
pulmonary
vessels. What are
manifestations
of a pulmonary
embolism's

1. Sudden onset of dyspnea, pleuritic


chest pain, restlessness and
apprehension, feelings of impending
doom, cough and hemoptysis

What are clinical


findings of a
pulmonary
embolism's

Tachypnea
Crackles
plural friction rub
Tachycardia
S3 or S4 heart sounds
Diaphoresis
Low-grade fever
Petechia over chest and axillae
Decreased arterial O2 sat

122.

What should you


do if you suspect
that a patient
has a pulmonary
embolism

1. Notify the health care provider


immediately, reassure the client, and
assist with position of comfort with the
head of the bed elevated.
2. Prepare for oxygen therapy and ABGs
while continuing to monitor and assess
the patient for other manifestations

123.

When should
Venus
compression
stockings be
removed

Before going to bed. Legs should be


elevated before the stockings are
reapplied

124.

Chapter 36

...

125.

What is
secondary
hypertension
caused by

Certain disease states or medications

126.

How does
hypertrophia of
the left ventricle
develop

As the heart pumps against resistance


caused by the hypertension

127.

What is the
maximum BMI a
person should
have in regards
to health
promotion and
disease
prevention for
hypertension

30

128.

What are risk


factors for
secondary
hypertension

129.

Blank, can occur


with verapamil
hydrochloride,
so encourage
intake of foods
that are high in
fiber

Constipation

130.

What kind of
juice should not
be taken with
CCB medications

Grapefruit juice

131.

What are two


side effects of
ARBs

Angioedema, hyperkalemia

132.

Aldosterone receptor
antagonists such as blank, block
aldosterone action. They
promote the retention of
potassium and excretion of
sodium and water

Eplerenone

142.

Monitor BP every 5 to 15 minutes and


assess neurological status and monitor
ECG

133.

What are Side effects of


aldosterone receptor
antagonists

Hypertriglyceridemia,
hyponatremia,
hyperkalemia

Before, during
and after
administration
of IV
antihypertensive
what should you
do

143.

Chapter 17

...

144.

What should you teach the


patient that is taking
aldosterone receptor
antagonists

No grapefruit juice or
St. John's wort. Do not
take salt substitutes
with potassium or foods
rich in potassium

How long should


a patient abstain
from smoking
before a
pulmonary
function test

6 to 8 hours prior to testing

134.

135.

What do central alpha


antagonist such as clonidine do

Reduce peripheral
vascular resistance and
decrease blood
pressure by inhibiting
the reuptake of
norepinephrine

145.

Four to six hours prior to testing

136.

What are side effects of central


alpha antagonist

Sedation, orthostatic
hypotension,
impotence

If a patient uses
inhalers how
long should they
withhold use
before a
pulmonary
function test

146.

What is PaO2

The partial pressure of oxygen

147.

What is SaO2

Percentage of oxygen bound to


hemoglobin as compared with the total
amount that can be possibly carried

148.

What is normal
bicarbonate
according to ATI

21 to 28

149.

What are
preprocedure
nursing actions
for an arterial
puncture

150.

What are
intraprocedural
nursing actions
while
performing an
arterial puncture

151.

What are
postprocedural
nursing actions
while
performing an
arterial puncture

152.

What are two


complications
from an arterial
puncture

137.

Alpha adrenergic antagonist,


such as blank, reduce blood
pressure by causing vasodilation

Prazosin

138.

When is prazosin given

Usually at Night and


Monitor BP for two
hours after initiation of
treatment

139.

140.

141.

What are dietary approaches to


stop hypertension

1. Diet high in fruits,


vegetables, and low-fat
dairy
2. Avoid foods high in
sodium and fat
3. Consume foods rich
in potassium, calcium
and magnesium

What are clinical manifestations


of a hypertensive crisis

1. Severe headache
2. Extremely high blood
pressure - greater than
240/120
3. Blurred vision,
dizziness and
disorientation
4. Epistaxis

What are two medications that


are given IV for a hypertensive
crisis

Nitroprusside
Nicardipine

Hematoma and air embolism

153.

What should you


do if the patient
has a hematoma

1. Observe the patient for changes in


temperature, swelling, color, loss of pulse
or pain
2. Notify the provider immediately if
symptoms persist
3. Apply pressure to the hematoma site

154.

What should you


do if a patient
exhibits
symptoms of an
air embolism

1. Place the patient on his left side in the


Trendelenburg position
2. Monitor the patient for a sudden onset
of SOB, decrease in SaO2, chest pain,
anxiety and air hunger
3. Notify the provider immediately if
symptoms occur, administer oxygen and
obtain ABGs

Why is a
bronchoscopy
performed

1. Visualization of abnormalities such as


tumors, inflammation and strictures
2. Biopsy
3. Removal of foreign bodies and
secretions
4. Treat post operative atelectasis

155.

156.

What is
preprocedure
nursing
interventions for
a bronchoscopy

157.

What are
intraprocedural
nursing
interventions for
a bronchoscopy

158.

What are post


procedure
nursing
interventions for
a bronchoscopy

The patient is not discharged from the


recovery room until adequate cough
reflex and respiratory effort are present
159.

What are three


complications
that can occur
from a
bronchoscopy

Laryngospasm, pneumothorax,
aspiration

160.

What are nursing


interventions for
Laryngospasm spasm
and what can decrease
the likelihood of
laryngeal edema

1. Monitor the patient for signs of


respiratory distress
2. Maintain a patent airway by
repositioning the patient or
inserting an oral/nasopharyngeal
airway as appropriate
3. Administer oxygen therapy to
the patient as prescribed.
Humidification can decrease the
likelihood of laryngeal edema

161.

What are nursing


interventions for a
pneumothorax

1. Assess patient's breath sounds


and O2 sat and obtain a follow-up
chest x-ray

162.

What are nursing


interventions for
aspiration

1. Prevent aspiration and the


patient by withholding oral fluids
or food until the gag reflex
returns
2. Perform suctioning as needed

163.

What is a thoracentesis

Performed to obtain specimens


for diagnostic evaluation, instill
medication into the plural space,
and remove fluid or air from the
plural space

164.

What are preprocedure


nursing interventions
for a Thoracentesis

1. Obtain preprocedure x-ray as


prescribed
2. Position the patient sitting
upright with his arms and
shoulders raised and supported
on pillows and/or on an overbed
table and with his feet and legs
well supported
3. Instructed patient to remain
absolutely still during the
procedure and not to cough or
talk unless instructed by the
primary care provider

165.

What are
intraprocedural
nursing interventions
for a thoracentesis

1. Monitor the patient's vitals, skin


color and O2 sat throughout the
procedure
2. Measure and record the
amount of fluid removed from the
patient's chest
(The amount of fluid removed is
limited to one L at a time to
prevent cardiovascular collapse)
3. Label and send specimens to
the Laboratory

166.

What are post procedure


nursing interventions for a
thoracentesis

1. Apply a dressing over the


puncture site and assess
dressing for
bleeding/drainage
2. Monitor vitals and
respiratory status hourly for
the first several hours after
3. Encourage the patient to
deep breathe to assist with
lung expansion
4. Obtain a chest x-ray (check
resolution of effusions, rule out
pneumothorax)

What are complications of


a thoracentesis

Mediastinal shift,
pneumothorax, bleeding,
infection

168.

What is a mediastinal shift

Shift of thoracic structures to


one side of the body (Monitor
VS, auscultate lungs for a
decrease in or absence of
breath sounds)

169.

What is a symptom of
pneumothorax

Diminished breath sounds

170.

What are indications of a


pneumothorax

1. Deviated trachea
2. Pain on the affected side
that worsens upon exhalation
3. Affected side does not move
in and out upon
inhalation/exhalation
4. Increased HR
5. Rapid shallow respirations
6. Nagging cough or feeling of
air hunger

167.

176.

What are
medications for
rhinitis

177.

What are holistic


or
complementary
therapies for
rhinitis

Echinacea, large doses of vitamin C and


zinc

178.

What is sinusitis

Inflammation of the mucous membranes


of one or more of the sinuses

179.

What is sinusitis
associated with

1. Deviated nasal septum


2. Occurs after rhinitis
3. Nasal polyps
4. Inhaled pollutants or cocaine
5. Facial trauma
6. Dental infections
7. Loss of immune function

180.

What are
symptoms of
sinusitis

Nasal congestion
Headache
Facial pressure/pain (worse when head
is tilted forwards)
Cough
Bloody/Purulent nasal drainage
Tenderness to palpitation
Low-grade fever

181.

What are
diagnostic tests
for sinusitis

1. CT scan or sinus x-rays


2. Endoscopic sinus cavity lavage or
surgery to relieve the obstruction and
promote drainage of secretions may be
done as a diagnostic procedure

171.

Chapter 20

...

172.

How long does it take for a


patient to exhibit
symptoms when exposed
to healthcare acquired
pneumonia

24 to 48 hours

182.

What are nursing


interventions for
sinusitis and
what should you
discourage

1. Encourage the use of steam, sinus


irrigation, nasal spray
2. Increase fluid and rest
3. Discourage air travel, swimming and
diving

173.

What is rhinitis

Inflammation of the nasal


mucosa

183.

174.

What is objective data for


rhinitis

1. Red, inflamed, swollen nasal


mucosa
2. Low-grade fever

What are
medications for
sinusitis

175.

What are nursing


interventions for rhinitis

1. Encourage rest, 8 to 10
hours a day and increase fluid
intake to at least 2000 mL/day
2. Encourage use of home
humidifier or breathing
steamy air
3. Proper disposal of tissues
and use of cough etiquette

1. phenylephrine: used to reduce


swelling of the mucosa
2. Patients should be encouraged to
begin OTC decongestant at the first
manifestation of sinusitis
3. Signs of rebound nasal congestion
may occur if decongestions are used for
more than 3 to 4 days
4. Amoxicillin if there is bacteria
5. NSAIDs, Tylenol, aspirin

184.

What is patient
education for
sinusitis and
what should the
patient report

1. Sinus irrigation and saline nasal


spray's are an effective alternative to
antibiotics for relieving nasal congestion
2. Contact the provider for
manifestations of a severe headache,
neck stiffness and high fever
(meningitis/encephalitis)

What are
complications of
sinusitis

Meningitis and encephalitis can occur if


pathogens enter the bloodstream from
the sinus cavity

186.

When are adults


contagious when
infected with the
flu

24 hours before manifestations develop


and up to five days after

187.

What are three


extra symptoms
of the avian flu
compared to the
flu

Severe diarrhea and cough, hypoxia

188.

What is nursing
care for
hospitalized
patients infected
with influenza

189.

What are
antivirals that
may be
prescribed for
treatment and
prevention of
the flu

1. Amantadine
2. Rimantadine
3. Ribavirin

What antivirals
may be
prescribed to
shorten the flu

1. Relenza
2. Tamiflu

191.

When should
patients begin
antiviral
medications

24 to 48 hours after the onset of


manifestations

192.

Vaccination for
the flu is
encourage for
everyone over six
months of age.
However highrisk patients
include

1. History of pneumonia
2. Chronic medical conditions
3. Over the age of 65
4. Pregnant women
5. Health care Providers

What is a
complication of
the flu

Pneumonia

185.

190.

193.

194.

What is the most common


manifestation of pneumonia in
older adults

Confusion

195.

How does the sputum look with


pneumonia

Purulent, blood tinged


or rust colored sputum

196.

Elevated wbc's are normally


elevated in pneumonia with the
exception of

May not be present in


older patients

197.

What are diagnostic procedures


for pneumonia

1. Chest x-ray will show


consolidation of lung
tissue
2. Pulse oximetry may
show less than expected
range

198.

What are nursing interventions


for pneumonia

1. Position the patient in


high Fowlers unless
contraindicated
2. Encourage coughing
or suctioning
3. Oxygen
therapy/breathing
treatments as
prescribed
4. Incentive spirometer
5. Structure activity to
include periods of rest
6. Encourage fluid intake
of 2 to 3 L/day

199.

It is important to obtain a
culture specimen before
antibiotic therapy. What are
two common antibiotics given

Penicillins and
cephalosporins

200.

What are nursing considerations


regarding medications for
pneumonia

1. Observe patients
taking cephalosporins
for frequent stools
2. Monitor her kidney
function, especially older
adults who are taking
penicillins and
cephalosporins
3. Take medication with
food. Some penicillins
should be taken one
hour before meals or
two hours after

201.

Bronchodilators are given to


reduce bronchospasms and
reduce irritation. What is a
short acting Beta two agonist
bronchodilator

Albuterol

202.

Anti-cholinergic
medications such as
blank, block the
parasympathetic
nervous system,
allowing for
increased
bronchodilation and
decreased
pulmonary
secretions

Ipratropium

203.

Methylxanthines
such as blank,
require close
monitoring of serum
medication levels
due to narrow
therapeutic range

Theophylline

204.

What are adverse


effects of
Theophylline

Nausea, tachycardia, diarrhea

205.

What should you


watch for in patients
taking albuterol

Tremors, tachycardia

206.

Observe for dry


mouth in patients
taking ipratropium
and monitor heart
rate. Adverse effects
include

Headache, blurred vision and


palpitations which may indicate toxicity

207.

What should you


encourage patients
to do while taking
ipratropium

Suck on hard candies to help moisten


dry mouth

Anti-inflammatories
such as
glucocorticosteroids
such as fluticasone
and prednisones are
prescribed to reduce
inflammation.
Monitor for

Immunosuppression, fluid retention,


hyperglycemia, hypokalemia and poor
wound healing, black/tarry stools

208.

209.

210.

What are other


nursing
considerations for
anti-inflammatories

What are
complications from
pneumonia

211.

What are manifestations of


atelectasis

1. Patient reports
SOB and exhibits
findings of
hypoxemia
2. Patient has
diminished/absent
breath sounds
over the affected
area
3. Chest x-ray
shows area of
density

212.

What are manifestations of acute


respiratory distress syndrome (ARDS)

1. Hypoxemia
persists despite
oxygen therapy
2. Patients dyspnea
worsens as bilateral
pulmonary edema
develops that is
non-cardiac related
3. Chest x-ray
shows an area of
density with a
"ground glass
"appearance
4. Blood gas
findings
demonstrate
hypercarbia even
though pulse
oximetry shows
decreased
saturation

213.

Patient with pulmonary tuberculosis


is being discharged with a
prescription for rifampin. The nurse
should plan to include which of the
following in the patient's discharge
teaching plan

Urine and other


secretions orange
in color

214.

A nurse is caring for a patient with


COPD. What assessment finding
should the nurse report to the
primary care provider regarding the
color of sputum

Productive cough
with green sputum

215.

What kind of diet should a patient


with COPD be on

High calorie and


protein

216.

Chapter 21

...

Atelectasis, bacteremia, acute respiratory


distress syndrome

217.

What are some things that may


trigger asthma attacks

1. Changes in
temperature and
humidity
2. Perfume
3. Air pollutants
4. Seasonal allergies
5. Stress
6. Medications (aspirin,
NSAIDs, beta blockers,
cholinergics)
7. enzymes in laundry
detergent
8. Sinusitis with post
nasal drip
9. Viral respiratory tract
infection

224.

What are some things that a nurse


should monitor when a patient is
using Theophylline

Monitor the
patient's serum
levels for toxicity.
Side effects will
include
tachycardia,
nausea and
diarrhea

225.

What are some things that a nurse


should monitor the patient for when
the patient is using albuterol

Tremors and
tachycardia

226.

What is something that a nurse


should monitor the patient for when
the patient is using Ipratropium

Dry mouth

227.

If a patient was showing symptoms of


ipratropium toxicity what would the
symptoms be?

Headache, blurred
vision or
palpitations

228.

What kind of asthma attack is


salmeterol used for

Is used to prevent
an asthma attack
and not at the
onset of an attack

229.

What are things that a nurse should


watch for when a patient is taking
corticosteroids, leukotriene
antagonist (singulair), mast cell
stabilizer (Cromolyn), or monoclonal
antibodies (omalizumab)

1. Decreased
immune function
2. Hyperglycemia
3. Black, tarry
stools
4. Fluid
retention/weight
gain (common)
5. Hypokalemia
with corticosteroids
such as
prednisone

When a patient has asthma


what temperature of water
should be used to eliminate
dust mites in bed linens?

Hot water

What is something that should


be encouraged as part of
asthma therapy for a patient

Regular exercise because


it promotes ventilation
and perfusion

220.

There are many risk factors for


asthma, most of them are
common sense. What are two
risk factors that you may not
think of?

1. GERD
2. The older patient is
more susceptible to
infection and therefore
they're at bigger risk for
complications

221.

What are some physical


assessment findings of asthma

1. Dyspnea
2. Anxiety or stress
3. Coughing
4. Wheezing
5. Mucus production
6. Use of accessory
muscles
7. Prolonged exhalation
8. Poor O2 sat
9. Barrel chest or
increased chest diameter

230.

How should prednisone be taken?

With food

231.

What is status asthmaticus

Life-threatening
episode of airway
obstruction that is
unresponsive to
common treatment

232.

What are symptoms of status


asthmaticus

1. Extreme
wheezing
2. Labored
breathing
3. Use of accessory
muscles
4. Distended neck
veins
5. Creates a risk for
cardiac/respiratory
arrest

218.

219.

222.

What diagnostic test is most


accurate for diagnosing asthma
and its severity?

Pulmonary function test

223.

What are some things that you


can do as a nurse to maximize
patient comfort in a patient
that has asthma

1. Hi Fowler's
2. Oxygen
3. Monitor cardiac rate
and rhythm for changes
during an acute attack
4. Initiate and maintain IV
access
5. Encourage prompt
medical attention for
infections and
appropriate vaccinations

233.

What are nursing interventions for


status asthmaticus

1. Prepare for
emergency
intubation
2. As prescribed,
administer oxygen,
bronchodilators,
epinephrine and
initiate systemic
steroid therapy

234.

Chapter 22

...

235.

What is emphysema characterized


by

Loss of lung
elasticity and
hyperinflation of
lung tissue

236.

What is a genetic risk for COPD

Alpha-1 antitrypsin
deficiency

237.

What are some physical assessment


findings of COPD

1. Barrel chest
2. Hyperresonance
on percussion
3. Thin extremities
and enlarged neck
muscles
4. Clubbing of
fingers and toes
5. Dependent
edema secondary
to right-sided heart
failure (increase in
pulmonary
pressure)

238.

Would hematocrit be low or high in


a patient that has COPD?

High due to low


oxygenation levels

239.

Does COPD increase or decrease


caloric demands

Increase because
work of breathing
has increased

240.

Patients that have COPD may need


blank of oxygen via nasal cannula or
up to blank via Venturi mask

2 to 4 L/min, 40%

241.

Patients who have chronically


increased PaCO2 levels usually
require blank of oxygen via nasal
cannula

1 to 2 L/min

242.

A positive expiratory pressure device


assist patients to remove airway
secretions. The patient inhales
deeply and exhales through the
device. While exhaling, a ball moves
causing

A vibration that
results in loosening
the clients
secretions

How often should a patient with


COPD do exercise conditioning
(walking until dyspnea occurs,
resting and then walking again)

20 minutes, 2 to 3
times weekly

243.

244.

How much fluids


should a patient
who has COPD
drink

2 to 3 L/day

245.

Most of the
medications for
COPD are the
same as asthma.
With the
exception of
Mucolytic's.
What are two
kinds of
mucolytic's?

Mucomyst, dornase alpha

246.

Chapter 23

...

247.

How long does it


take for the risk
of transmission
to decrease
regarding TB

2 to 3 weeks after anti-tuberculin


therapy

248.

A patient will
have a positive
intradermal TB
test within blank
weeks of
exposure to the

2 to 10

249.

How often
should patients
who live in highrisk areas be
screened for
tuberculosis

On a yearly basis

250.

What are risk


factors for TB

In addition, recent travel outside of the


US, substance use and health care
occupation
251.

What are
symptoms of TB

1. Persistent cough lasting longer than


three weeks
2. Purulent sputum, possibly blood
streaked
3. Fatigue and lethargy
4. Weight loss and anorexia
5. Night sweats
6. Low-grade fever in the afternoon

252.

When should the


Mantoux test to
be read

Within 48 to 72 hours

253.

What is a
positive
Mantoux test?

1. 10 mm or greater
2. 5 mm is considered positive for
immunocompromised patients

254.

What kind of diet should


a patient with TB be on?

Foods that are rich in protein,


iron and vitamin C

255.

How does isoniazid work

By preventing synthesis of
mycolic acid in the cell wall

268.

How often are sputum


samples needed during
tuberculosis therapy

Every 2 to 4 weeks to
monitor therapy

269.

What is miliary TB

Where the infection


invades the bloodstream
and can lead to MODS

256.

How should isoniazid be


taken

On an empty stomach

257.

What should you


monitor for any patient
that is taking isoniazid

Hepatotoxicity and
neurotoxicity, such as tingling of
the hands and feet (vitamin B6
is used to prevent
neurotoxicity)

270.

What are
symptoms/complications of
miliary TB

Headaches
Neck stiffness
Drowsiness
Pericarditis

271.

Chapter 56

...

272.

What is the only condition


that increases serum
creatinine levels

Kidney disease

273.

What is the purpose of a


VCUG

To detect whether urine


refluxes into ureters as an
x-ray is taken while the
patient is voiding

274.

What should you do as a


nurse after a patient has a
VCUG

1. Monitor the patient for


infection for the first 72
hours after
2. Encourage increased
fluid intake
3. Monitor urine output

275.

What are preprocedure


nursing interventions for a
patient that is going to have a
kidney biopsy

1. Review coagulation
studies
2. NPO for 4 to 6 hours
before

276.

What are post procedure


nursing interventions for a
patient that has had a kidney
biopsy

1. Monitor vitals
2. Assess dressings and
urinary output (hematuria)
3. Review HGB and HCT
values
4. Administer PRN pain
medication

258.

How does rifampin work

Inhibits DNA dependent RNA


polymerase activity

259.

What are side effects of


rifampin

1. Hepatotoxicity (they should


report yellowing of the skin,
pain or swelling of joints, loss of
appetite or malaise)
2. Orange color of urine and
other secretions
3. May interfere with oral
contraceptives

260.

What is a side effect of


pyrazinamide

Hepatotoxicity

261.

How should
pyrazinamide be
consumed?

Instruct the patient to drink a


glass of water with each dose
and increase fluids during the
day

How does ethambutol


work

By inhibiting protein synthesis

What are two things that


you need to obtain
before administering
ethambutol to a patient

1. Baseline visual acuity


2. Determine color
discrimination ability

262.

263.

(this medication should not be


given to children younger than
13 years of age)
264.

What is the most


important thing to teach
a patient that is on
ethambutol

To report vision changes


immediately

265.

What is streptomycin
sulfate

Aminoglycoside antibiotic that


potentiates the efficacy of
macrophages during
phagocytosis

266.

What kind of patients are


put on streptomycin

Those who have multi drugresistant TB because of this


medications high level of toxicity

267.

What are two side effects


of streptomycin

Ototoxicity
Renal function decline

277.

A cystography or
cystourethrography are used to
discover abnormalities of bladder
wall and/or a occlusions of ureter
or urethra. What are preprocedure nursing interventions
for these procedures?

1. NPO after midnight


2. Administer
laxative/enema for
bowel preparation the
night before the
procedure

278.

What position should a patient be


in for a cystography or
Cystourethrography

Lithotomy position

279.

What color urine may come out


after a cystography or
cystourethrography

Urine maybe pink


tinged

280.

What should you do if blood clots


are present or urine output is
decreased or absent after a
cystography or
Cystourethrography

Irrigate urinary
catheter with NS

What are a retrograde pyelogram,


Cystogram, or urethrogram used
for

To identify obstruction
or structural disorders
of the ureters and
renal pelvis of the
kidneys by instilling
contrast dye during a
cystoscopy

281.

282.

What is a renography used for

To assess renal
bloodflow and
estimate GFR after IV
injection of radioactive
material to produce a
scanned image of the
kidneys

283.

What should you assess frequently


during and after A renography if
captopril is given to change blood
flow to the kidneys

BP

284.

What is an excretory urography


used for

To detect obstruction,
assess for a
parenchymal mass,
and assess size of the
kidney. IV contrast
dye is used to
enhance images

285.

What are preprocedure nursing


interventions for a patient that is
having an excretory urography

1. Increased fluids the


day before the
procedure
2. Bowel prep
3. NPO after midnight
4. Hold Metformin for
24 hours before
procedure

286.

What are post procedure


nursing interventions for a
patient that has had an
excretory urography

1. Administer parenteral
fluid or encourage oral
fluids to flush dye
2. Diuretics may be
administered to increase
dye secretion
3. Follow up creatinine and
bun serum levels before
Metformin is resumed

287.

A nurse is reviewing a
patient's laboratory findings
for urinalysis. The findings
indicate the urine is positive
for leukoesterase and
nitrates. Which of is an
appropriate nursing action?

Obtain a clean catch urine


specimen for culture and
sensitivity because this
determines the antibiotic
that will be most effective
for treatment of the
urinary tract infection

288.

Why would a patient with a


history of asthma be at risk
for a complication when
undergoing excretory
urography?

A patient who has a history


of asthma has a higher risk
of having an asthma attack
as an allergic response to
the contrast dye used
during the procedure

289.

Chapter 57

...

290.

How do you estimate a


patient's amount of fluid
removed after dialysis

By comparing the patients


preprocedure weight to
the post procedure weight

291.

How long should invasive


procedures be avoided after
dialysis

4 to 6 hours due to the risk


of bleeding related to an
anticoagulant

292.

How do you check an AV


fistula or AV graft for patency

By checking for thrill or


bruit

293.

When should you contact the


provider after dialysis

1. If bleeding from the


insertion site last longer
than 30 minutes
2. Absence of thrill/bruit
3. Signs of infection

294.

What kind of diet should a


patient be on after dialysis

high folate, high protein


diet

295.

What is disequilibrium
syndrome

Caused by too rapid of a


decrease in BUN and
circulating fluid volume. It
may result in cerebral
edema and increased ICP

296.

What are signs/symptoms of


disequilibrium syndrome

nausea
Vomiting
Change in LOC
Seizures
Agitation

297.

298.

299.

300.

Blank, is a risk
factor for dialysis
disequilibrium and
hypotension due to
rapid changes in
fluid and
electrolyte status

Advanced age

What can a nurse


do to decrease the
risk of
disequilibrium
syndrome

1. Use a slow dialysis exchange rate,


especially for older adults and those
being treated with hemodialysis for
the first time
2. Administer
anticonvulsants/barbiturates if
needed

What is something
that a nurse should
do for a patient
experiencing
hypotension from
dialysis other than
administer IV fluids

Lower the head of the patient's bed

What is peritoneal
dialysis

Involves instillation of a hypertonic


solution into the peritoneal cavity. The
solution dwells in the peritoneal cavity
as ordered by the provider. Drain the
solution that includes the waste
products. The peritoneum serves as
the filtration membrane

301.

What color should


the dialysate
solution be

Clear, light yellow is expected

302.

How much should


the outflow be
compared to the
inflow

Expected to equal or exceed amount


of dialysate inflow (insufficient outflow
could mean infection)

If a fibrin clot has


formed in the
peritoneal dialysis
catheter what
should you do?

Carefully milk the catheter

304.

What are two


conditions caused
by dialysis

Hyperglycemia and hyperlipidemia

305.

Blank, is a common
cause of poor
inflow or outflow

Constipation

306.

What position
should a patient be
in during CCPD and
APD treatment

Supine with head slightly elevated

303.

307.

If medications are
held before dialysis
can they be
administered after it
is done

Yes, medications that can be partially


dialysed during the treatment
should be withheld. After the
treatment, the nurse should
administer the medication.

308.

Why should a
patient that is
experiencing
shortness of breath
not receive
peritoneal dialysis

Because they may not be able to


tolerate excessive fluids being
instilled into their abdomen

309.

Chapter 58

...

310.

What are patient


indications of endstage kidney disease
necessitating kidney
transplant

1. Anuria
2. Proteinuria
3. Marked azotemia
4. Severe electrolyte imbalance
5. Fluid volume excess conditions
(heart failure, pulmonary edema)
6. Uremic lung

311.

What are subjective


signs/symptoms of
end-stage kidney
disease

Anorexia
Fatigue
Paresthesia
SOB
Dry, itchy skin
Metallic taste
Muscle cramping

312.

What are object of


signs/symptoms of
end-stage kidney
disease

Decreased attention span, seizures,


tremor, HF, Edema, dyspnea,
hypertension, distended jugular
vein's, anemia, vomiting, pulmonary
edema, cardiac dysrhythmias, pallor,
dry itchy skin, bruising, halitosis and
diminished or dark colored urine

313.

What is
methylprednisone
sodium succinate

An anti-inflammatory and
immunosuppressant used to
decrease the immune system
response of inflammation and
rejection of donor kidney

314.

What is another
immunosuppressant
medication used to
prevent rejection of
the donor kidney

Cyclosporine

315.

A patient has had a


kidney transplant is
usually dialyzed
within blank of the
surgery

24 hours

316.

What are some


things you should
assess/monitor
the patient for
after a kidney
transplant

1. Vital signs every 15 minutes initially


and advance to every hour
2. Report urine output less than 30
mL/HR
3. Urine appearance and older should
be checked hourly (initially pink and
bloody)
4. Daily weights
5. Maintain continuous bladder
irrigation as prescribed (to prevent clots
from forming)

What diuretic is
preferred when
oliguria is present
after a kidney
transplant

Mannitol

What kind of diet


should a patient
be on after a
kidney transplant

Low-fat, high-fiber, increased protein,


low-sodium, avoid sugars or
carbohydrates

When taking
cyclosporine
what are two
things you need
to do

1. Magnesium supplements because it


reduces magnesium levels
2. Avoid grapefruit

320.

What is hyper
acute rejection

Rejection that occurs within 48 hours


after surgery caused by an anti-body
mediated response that causes small
blood clot to form in the transplanted
kidney

321.

What are
symptoms of a
hyper acute
rejection

Fever, hypertension, pain at the


transplant site

322.

What is
treatment for
hyper acute
rejection

Immediate removal of the donor kidney

323.

What is acute
rejection

Occurs one week to two years after


surgery. An antibody mediated
response causing vasculitis in the donor
kidney and cellular destruction starts
with inflammation that causes lysis of
the donor kidney

324.

What are
symptoms of an
acute rejection

Oliguria
Anuria
Low-grade fever
Hypertension
Tenderness over the transplanted
kidney
Lethargy
Azotemia
Fluid retention

317.

318.

319.

325.

What is
treatment for
acute rejection

Involves increased doses of


immunosuppressive medications

326.

What is chronic
rejection

Occurs gradually over months to years.


Blood vessel injury from overgrowth of
the smooth muscles of the blood vessels
causing fibrotic tissue to replace normal
tissue resulting in a nonfunctioning donor
kidney

327.

What are
symptoms of
chronic
rejection

Gradual return of azotemia


Fluid retention
Electrolyte imbalance
Fatigue

328.

What is
treatment for
chronic
rejection

Monitor kidney status, continue


immunosuppressive therapy until dialysis
is required

329.

What is acute
tubular necrosis

Caused by a delay in transplanting the


donor kidney after harvesting may result
in hypoxic injury of the donor kidney

330.

What are
symptoms/signs
of renal artery
stenosis

Hypertension
Bruit over artery anastomosis site
Decreased kidney function
Peripheral edema

331.

What is the
most common
cause of first
transplant year
morbidity and
mortality

Infection

332.

Chapter 60

...

333.

What are the


four phases of
acute kidney
injury

1. Onset: begins with the onset of the


event, ends when oliguria develops and
lasts for hours to days
2. Oliguria: begins with the kidney insult,
urine output is 100 to 400 mL/24 hour
with or without diuretics and lasts for 1 to
3 weeks
3. Diuresis: begins when the kidneys start
to recover, diuresis of a large amount of
fluid occurs and can last for 2 to 6 weeks
4. Recovery: continues until kidney
function is fully restored and can take up
to 12 months

334.

What is prerenal
acute kidney
injury

Occurs as a result of volume depletion


and prolonged reduction of blood flow to
the kidneys which leads to ischemia of the
nephrons

335.

What is treatment for prerenal


acute kidney injury

1. Administer IV fluid
if no fluid restrictions
2. Administer calcium
channel blocker to
prevent the
movement of calcium
into the kidney cells
and to increase GFR
3. Monitor I and O's
4. Monitor for
decreased cardiac
output

336.

Intrarenal acute kidney injury


occurs as a result of direct damage
to the kidney from lack of oxygen
(acute tubular necrosis). What are
causes of intrarenal acute kidney
injury

1. Physical injury
2. Hypoxic injury renal artery or vein
stenosis or
thrombosis
3. Chemical injury acute nephrotoxins
(antibiotics, NSAIDs,
contrast dye, heavy
metal, blood
transfusion reaction)
4. Immunologic injury
- infection, vasculitis,
acute
glomerulonephritis

337.

What are two complications of


intrarenal acute kidney injury

Heart failure or
pulmonary edema

338.

What are signs/symptoms of acute


intrarenal kidney injury

ECG dysrhythmias
(tall T waves)
Flank pain
N/V
Lethargy
Tremors
Confusion

Post renal acute kidney injury


occurs as a result of bilateral
obstruction of structures leaving
the kidney. What are causes

1. Stone, tumor,
bladder atony
2. Prostate
hyperplasia, urethral
stricture
3. Spinal cord disease
or injury

340.

How do laboratory values look in


post renal acute kidney injury

Gradually increases
in serum creatinine,
BUN, urine specific
gravity

341.

What is nutrition for post renal


acute kidney injury

Restrict potassium,
phosphate and
magnesium during
oliguric phase and
increase protein

339.

342.

What are the five stages of chronic


kidney disease

Stage one: minimal


kidney damage with
normal GFR (greater
than 90 ML/min)
Stage two: mild
kidney damage with
GFR 60 to 89 mL/min
Stage III: GFR 30 to
59 mL/min
Stage 4: GFR is 15 to
29 mL/min
Stage five: GFR less
than 15 mL/min

343.

How much fluids are patients with


chronic kidney disease encouraged
to drink

At least 3 L of water
daily

344.

If a patient has diabetes or


hypertension and chronic kidney
disease what should you encourage
them to come in for regarding
yearly tests

Yearly testing for


albumin in the urine

345.

What are some signs and symptoms


of chronic kidney failure

Fatigue
Lethargy
Involuntary
movement of the
legs
Depression
Intractable hiccups

346.

How do you serum electrolytes look


in chronic kidney disease

Decreased sodium
and calcium;
increased
potassium,
phosphorus and
magnesium

347.

Why is hemoglobin and hematocrit


decreased in chronic kidney disease

From anemia
secondary to the
loss of
erythropoietin

348.

What are complications of CKD

Electrolyte
imbalance
Dysrhythmias
Fluid overload
Hypertension
Metabolic acidosis
Secondary infection
Uremia

349.

What kind of diet should a patient


be on that has chronic kidney
disease

High in
carbohydrates and
moderate in fat

350.

What medications are


considered nephrotoxic

Aminoglycosides
Amphotericin b
NSAIDs
Ace inhibitors
Arbs
Contrast dye

351.

If a patient is on digoxin
when should you
administer it

After receiving dialysis

352.

Why is aluminum
hydroxide given to
patients with chronic
kidney disease

Taken with meals to bind


phosphate in food and stop
phosphate absorption (take two
hours before or after digoxin)

353.

What kind of diuretic


should be avoided in
patients that have end
stage kidney disease

Loop diuretics

354.

What kind of Antacids


should a patient with
kidney disease avoid

Those containing magnesium

355.

If a patient has a high


creatinine level what
should you assess for in
the urine

Blood

356.

Chapter 61

...

357.

Who is more at risk for


urosepsis women or
men

Aging women due to decreased


estrogen which promotes
atrophy of the urethral opening
towards the rectum

358.

What are subjective


signs/symptoms of a
urinary tract infection

1. Lower back/abdominal
discomfort
2. Urinary frequency/urgency
3. Nausea
4. Dysuria, cramping
5. Urinary retention
6. Perineal itching
7. Hematuria
8. Pyuria (greater than four wbc
in urine sample)

359.

What are objective


signs/symptoms of a
urinary tract infection

1. Fever
2. Vomiting
3. Voiding in small amounts
4. Nocturia
5. Urethral discharge
6. Cloudy/smelly urine

360.

What are older adult


clinical manifestations
of a UTI

1. Mental confusion
2. Incontinence
3. Loss of appetite
4. Nocturia and dyslexia
5. Signs of urosepsis

361.

What are signs of urosepsis

Hypotension
Tachycardia
Tachypnea
Fever

362.

If a patient has a urinary tract infection


what are some things you'd expect to
find in the urine

Bacteria,
sediment, WBCs,
RBCs, positive
leukocyte
esterase and
nitrates

363.

If a patient has a urinary tract infection


what are some things you can
encourage the patient to do to relieve
symptoms

1. Promote fluid
intake up to 3 L a
day
2. Encourage
urination every 3
to 4 hours
instead of
waiting until the
bladder is
completely full
3. Recommend
warm sitz Bath 2
to 3 times a day
to promote
comfort

364.

What are two medications that are


prescribed less frequently for UTIs
because the medicine is less effective
and tolerated

Penicillins and
cephalosporins

365.

If a sulfonamide is prescribed for a


patient with a UTI what should you ask
the patient about?

Allergy to sulfa

366.

What is a bladder analgesic that is used


to treat UTIs

Phenozopyridine
(take with food)

367.

When a patient has a UTI they are


encouraged to drink cranberry juice
because a compound in cranberries
may stop certain bacteria from
adhering to the mucosa of the urinary
tract. Patients who have blank should
avoid cranberry juice, which irritates
the bladder

Chronic cystitis

368.

369.

370.

371.

What are risk factors for pyelonephritis

1. Men over 65
who have
prostatitis and
hypertrophy
of the prostate
2. Chronic
urinary stone
disorders
3. Spinal cord
injury
4. Pregnancy
5. Bladder
tumors
6. Urine pH
increases
7. Chronic
illnesses (DM,
HTN)

Chills, nausea, malaise, fatigue,


burning/urgency/frequency with
urination are all subjective signs and
symptoms of pyelonephritis. What are
two more less obvious symptoms?

Colicky type
abdominal
pain and
costovertebral
tenderness

What are objective signs/symptoms of


pyelonephritis

Fever
Tachycardia
Tachypnea
Hypertension
Flank/back
pain
Vomiting
Nocturia
Asymptomatic
bacteremia
Inability to
concentrate
urine or
conserve
sodium

What are 4 lab values that will be


increased with pyelonephritis nephritis

C-reactive
protein, ESR,
Creatinine
and BUN

375.

Does a diet high in calcium


increase the risk for kidney Stones.
Since the majority of stones are
composed of calcium phosphate
or calcium oxalate

No not unless there is


a pre-existing
metabolic disorder or
renal tubular defect

376.

Who is more at risk for


urolithiasis? Males or females

There is an increased
incidence of
urolithiasis in males

377.

What are four things that


contribute to an environment
favorable for stone formation

Urinary stasis,
urinary retention,
immobilization and
dehydration

378.

What is something that you might


see in a urinalysis of a patient that
has a kidney stone

Crystals

379.

What does KUB stand for

X-ray of kidney,
ureters and bladder

380.

What are things that a nurse


should assess/monitor for any
patient that has kidney stones

1. Pain
2. I and O's
3. Urinary pH
4. Strain all urine
5. Encourage
ambulation to
promote passage of
the stone

381.

According to ATI what should


respiration rate be

12 to 20 breaths per
minute

382.

What are medications given for


kidney stones

Opioids, nSAIDs,
oxybutynin chloride

383.

What are side effects of oxybutynin


chloride

1. Increased
intraocular pressure
(Contraindicated if
there's a history of
glaucoma)
2. Dizziness
3. Dry mouth
4. Tachycardia
5. Urinary retention

384.

Antibiotics such as gentamicin and


cephalexin are used to treat UTIs.
Administer the medication with
food to decrease G.I. distress.
What else should you monitor for

Nephrotoxicity and
ototoxicity. Also
inform the patient
that urine may have a
foul odor related to
the antibiotic

372.

What are complications of chronic


pyelonephritis

Septic shock
Chronic
kidney disease
Hypertension

373.

Although penicillin antibiotics are rarely


used to treat urinary tract infections with
kidney infections this type of penicillin
may be used

Ampicillin

385.

What are two things that are


common after a patient has had
extracorporeal shockwave
lithotripsy

Bruising at the site


where the waves are
applied and
hematuria

374.

Chapter 62

...

386.

If a patient keeps having calcium


phosphate stones what kind of
diet should they be on

Limit intake of food


high in animal
protein, limit sodium,
reduce calcium

387.

What are medications


that are given for
calcium phosphate
stones

Thiazide diuretics,
Orthophosphates,
Sodium cellulose phosphate

388.

If a patient has calcium


oxalate stones what
should their diet be

Avoid: spinach, black tea,


rhubarb, cocoa, beats, pecans,
peanuts, okra, chocolate, wheat
germ, lime peel, Swiss chard and
limit sodium intake

389.

What are medications


for uric acid stones

Allopurinol, potassium or sodium


citrate or sodium bicarbonate

390.

What is hydronephrosis

When a stone has blocked a


portion of the urinary tract
causing the urine to back up into
the kidneys causing distention of
the kidney

391.

Chapter 83

...

392.

Which ethnicities is
diabetes more prevalent
in

African-American, American
Indians and Hispanics

393.

What are risk factors for


diabetes

Obesity
Hypertension
Inactivity
Hyperlipidemia
Cigarette smoking
Genetic history
Elevated CRP
Ethnic group
Women who have delivered
infants weighing more than 9
pounds
BMI greater than 24

394.

What are two things


that the patient can add
to their diet to decrease
the risk of developing
diabetes

Omega-3 fatty acids and fiber

395.

What are clinical


manifestations of
diabetes

Hyperglycemia (blood glucose


level usually greater than 250)
Polyuria
Polydipsia
Polyphagia
Fruity breath
Decreased LOC
Headache
N/V
Seizures leading to coma

396.

Diagnostic criteria for diabetes


include 2 findings (on separate
days) of one of the following

1. Manifestations of
diabetes plus casual
blood glucose
concentration greater
than 200
2. Fasting blood glucose
greater than 126
3. Two hour glucose
greater than 200 with an
oral glucose tolerance
test

397.

How long is a patient instructed


to not eat or drink (other than
water) before a fasting blood
glucose test

Eight hours

398.

How long should a patient fast


for before an oral glucose
tolerance test

10 to 12 hours

399.

What is normal hemoglobin A-1


C range

4 to 6%

400.

How often should the needle in


a continuous infusion pump be
changed

Every 2 to 3 days

401.

Are insulin pens used if more


than one insulin is given
anytime

No

402.

What kind of insulin is Humalog


and NovoLog

Rapid acting, onset is 10


to 30 minutes

403.

What kind of insulin is Humulin


N and detemir insulin

Intermediate acting,
administered for control
between meals and at
night

404.

What kind of insulin is glargine

Long acting,
administered once a day
because it dissipates
slowly over 24 hours

405.

What are manifestations of


hypoglycemia

Mild shakiness
Mental confusion
Sweating
Palpitations
Headache
Lack of coordination
Blurred vision
Seizures
Coma

406.

What are some preventative


measures to avoid
hypoglycemia

Avoid excess insulin,


exercise and alcohol
consumption on an
empty stomach

407.

Blood glucose increases approximately


blank over 30 minutes following
ingestion of blank grams of absorbable
carbohydrate

40 mg/DL, 10

408.

If a patient is unconscious or any able


to swallow how can you administer
glucagon to them

By SQ or IM and
repeat in 10
minutes is still
unconscious

409.

If the patient is in an acute care setting


the nurse should administer blank if IV
access is available and consciousness
should occur within 20 minutes

50% dextrose

410.

When a patient has a blood glucose


level greater than 250 mg/DL they
should restrict

Exercise

411.

What are two things you should


monitor for any patient taking
Metformin

G.I. effects and


lactic acidosis

412.

When should Metformin be


discontinued before anything with
contrast dye

48 hours

413.

What kind of supplements should a


patient be taking that is on Metformin

Vitamin B12 and


folic acid

414.

When should glipizide be taken

30 minutes
before meals

415.

What medication can mask


tachycardia typically seen during
hypoglycemia

Beta blockers

416.

Should diabetic patients use lotion


between the toes after they wash their
feet with mild soap and water

No

417.

When is the best time to perform nail


care

After a shower or
bath

418.

What kind of socks should diabetic


patients wear

Socks made of
cotton or wool

419.

How should a diabetic patient clean a


cut on their foot

With warm water


and mild soap,
gently dry and
apply a dry
dressing

420.

How often should a diabetic patient


monitor their blood glucose when
they're sick

Every 3 to 4
hours

421.

What is the recommended blood


pressure of a patient with diabetes

Less than 130/80

422.

How often should a diabetic patient


get eye and foot exams

Every year

423.

Chapter 84

...

424.

What is
hyperglycemic hyperosmolar
State

An acute, life-threatening condition


characterized by profound
hyperglycemia (above 600) osmolarity
that leads to dehydration and an
absence of ketosis

425.

What are risk


factors for HHS

1. Older adult who has residual insulin


secretion
2. Older adult who has an adequate
fluid intake
3. Older adults who have decreased
kidney function and are unable to
excrete excess of glucose into the urine
4. MI, cerebral vascular injury or sepsis
5. Infection/stress
6. Glucocorticoids, diuretics, Dilantin,
propranolol, CCB

426.

What are clinical


manifestations of
HHS

blurred vision
Headache
Weakness
Polyuria
Polydipsia
Orthostatic hypotension
Change in LOC
Seizures/myoclonic jerking
Reversible paralysis

427.

How does serum


osmolarity look in
HHS

Greater than 320 mOsm/L

428.

How does your pH


look in DKA

Less than 7.3

429.

What is the pH
look like in HHS

Greater than 7.4

430.

What kind of fluids


should be
administered to
patients with DKA
or HHS

Isotonic fluid's such as normal NS


followed with a hypotonic fluid (IV
bolus of insulin)

431.

What should you


do when serum
glucose levels
approach 250
mg/DL

Add glucose to IV fluids to minimize the


risk of cerebral Edema associated with
drastic changes in serum osmolarity
and prevent hypoglycemia

432.

What else should


you monitor a
patient for when
they are in a
diabetic crisis

Hyperkalemia and then hypokalemia


as potassium follows insulin into the
cells

433.

How often should an older adult


patient monitor blood glucose when
they are sick

Every 1 to 4 hours

434.

If a patient who has diabetes would


like to consume alcohol what should
you tell them

Consume
carbohydrates
while drinking
alcohol will help
prevent
hypoglycemia

445.

Blank and blank scans are


more sensitive to
detecting bone problems
than a bone scan. When is
in radionucleotide
injected before the scans

Gallium, Thallium, 4 to 6 hours

446.

During a bone scan does


the patient need to be
sedated

Only if they are unable to lie


still for 30 to 60 minutes

447.

Following the procedure


does the patient need to
take any special
radioactive precautions

No but the patient should be


encouraged to drink plenty of
fluids to increased excretion of
radioisotope

448.

What kind of scan is done


to estimate the density of
a patient's bone mass,
usually in the hip or spine,
and the presence/extent
of osteoporosis

DXA (dual x-ray


absorptiometry)

449.

Is contrast material used


with a DXA scan

No

450.

At what age might a


baseline DXA scan be
performed

40

451.

Why would an
electromyography (EMG)
and nerve conduction
studies be performed

To determine the presence


and cause of muscle weakness

435.

What is PTU

Medication given
to suppress the
thyroid hormone
and will allow for
weight gain

436.

When assessing a patient diagnosed


with diabetes insipidus, the nurse
should expect which of the following
laboratory findings

Increased
hematocrit due to
dehydration

437.

A nurse is monitoring a patient's


status 24 hours after a total
thyroidectomy. What kind of breath
sound would you immediately report
to the provider

Laryngeal stridor

How should the patient take their


medication if they are on thyroid
hormone replacement therapy

On an empty
stomach to
promote proper
absorption

439.

Chapter 68

...

440.

Why is an arthroscopy performed

To visualize the
internal structures
of a joint, most
commonly the
knee or shoulder
joints

452.

How is an EMG performed

Thin needles are placed in the


muscle under study and
attach it to an electrode, which
is attached to oscilloscope.
Electrical activity is recorded
during a muscle contraction

441.

When can an arthroscopy not be


performed

If there is an
infection or if the
patient is unable to
bend the joint at
least 40

453.

How is a nerve conduction


study performed

442.

How often should you assess the


patient's neurovascular status and
dressing after an arthroscopy

Every hour or per


hospital protocol

Flat electrodes are taped on


the skin. Low electrical
currents are sent through the
electrodes and muscle
response to the stimulus is
reported

454.

Anticoagulants or muscle
relaxants

How often should a patient ice and


elevate extremity after an
arthroscopy

Ice and elevation


should be applied
for 24 hours

What are two medications


that must be avoided
before receiving an EMG or
nerve conduction study

455.

Swelling or tenderness

Bone scans are done when a patient


entire skeletal system is to be
evaluated. A radionucleotide test
involves radioactive material
injected blank before scanning

2 to 3 hours

What are two things that


the patient should report
to the provider after
receiving an EMG or nerve
conduction study

438.

443.

444.

456.

What kind of pain


medication can be
used for patients after
an arthroscopy

Opioid

457.

How long does a DXA


scan last for

Several hours. The radionucleotide


substance is injected and must be
absorbed by the bone prior to the
procedure. The patient must wait
several hours after the injection
before the scan can be completed

458.

During an EMG what


should you ask the
patient to do for an
easier insertion of the
needle into the
muscle

To flex their muscles

459.

Chapter 69

...

460.

What is an
arthroplasty

The surgical removal of a diseased


joint due to osteoarthritis,
osteonecrosis, rheumatoid arthritis,
trauma or congenital anomalies and
replacing it with prosthetics or
artificial components made of Metal
and/or plastic

461.

What are
contraindications to
an arthroplasty

1. Recent or active infection


2. Arterial impairment to the
affected extremity
3. The patient's inability to follow the
post surgery regimen
4. A comorbid condition such as
uncontrolled diabetes or
hypertension, osteoporosis,
progressive inflammatory condition,
unstable cardiac/respiratory
conditions

462.

What should a
patient do to prepare
for arthroplasty the
night before the
surgery

1. Scrub the surgical site with a


prescribed anti-septic soap
2. Wear clean clothes and sleep on
clean linens

463.

What should a
patient do in the
morning to prepare
for an arthroplasty

1. Scrub at the surgical site with a


prescribed anti-septic soap
2. Take antihypertensive
medications as well as other
medications that the surgeon allows
with a sip of water

464.

Prosthetic
components may or
may not be cemented
in place. Components
that do not use
cement allow the
bone to grow into

The prosthesis to stabilize it

465.

If the components are not


cemented when should weightbearing occur

Weight bearing is
delayed several
weeks until the
femoral shaft has
grown into the
prosthesis

466.

A CPM machine may be prescribed


after surgery to promote motion in
the knee and

Prevent scar tissue


formation

467.

When is a CPM turned off

During meals

468.

What position of the patient should


you avoid after an arthroplasty

Positions of flexion of
the knee are limited
to avoid flexion
contractures. Avoid
knee gatch and
pillows placed
behind the knee

469.

How should you position small


blankets or pillows to keep heels
off the bed in efforts to avoid
pressure ulcers

Slightly above the


ankle area

470.

After an arthroplasty opioids as


well as a continuous peripheral
nerve block may be initiated for a
patient. What should you monitor
the patient for in regards to a
continuous peripheral nerve block

Monitor the patient


for systemic effects of
local anesthetic, such
as hypotension,
bradycardia,
restlessness or
seizure

471.

Ice or cold therapy may be applied


to reduce post operative swelling.
Monitor the patients neurovascular
status of the surgical extremity
every blank

2 to 4 hours
(movement,
sensation, color,
pulse, capillary refill
and compare with
the contralateral
extremity)

472.

After a patient has had a hip


arthroplasty what kind of range of
motion exercise should you
encourage

Plantar flexion,
dorsiflexion, and
circumduction to
prevent clot
formation

473.

Early ambulation after a hip


arthroplasty is important. How
should you transfer the patient out
of bed

From the unaffected


side into a chair or
wheelchair

474.

What should you apply to the


surgical site following ambulation

Ice

475.

476.

477.

What is patient
positioning after a
hip arthroplasty

Place the patient supine with the head


slightly elevated and the affected leg in
a neutral position. Place a pillow or
abduction device between the legs
when turning to the unaffected side.
The patient should not be turned to
the operative side, which could cause
hip dislocation

What are four do's


after an
arthroplasty

1. Use elevated seating/raised toilet


seat
2. Use straight chairs with arms
3. Use an abduction pillow, or a pillow,
if prescribed between the patients legs
while in bed
4. Externally rotate a patient's toes

What are four


don'ts after an
arthroplasty

1. Avoid flexion of hip greater than 90


2. Avoid low chairs
3. Do not cross a patients legs
4. Do not internally rotate a patient's
toes

After a knee
arthroplasty when
can a patient kneel
and deep knee
bend

Unfortunately those are limited


indefinitely

How often should


a patient clean
their incision after
a total hip
arthroplasty

Daily with soap and water

480.

Chapter 70

...

481.

Upper extremity
amputation's are
usually the result
of a traumatic
injury however
lower extremity
amputation's are
usually the result
of

Peripheral vascular disease as a result


of arteriosclerosis

482.

What are signs of


inadequate
peripheral
circulation

Edema
Reduced cap Refill time
Necrosis
Lack of hair distribution

483.

What is the ankle


brachial index

Measures difference between ankle


and brachial systolic pressures

484.

What is a closed
amputation

The most common technique used.


Skin flap is sutured over end of
residual limb, closing site

478.

479.

485.

What is open
amputation

This technique is used when an


active infection is present. Skin
flap is not sutured over end of
residual limb allowing for
drainage of infection. Skin flap is
closed at a later date

486.

When your palpating


the residual limb for
warmth what might
heat indicate

Infection

487.

What do patients often


describe the pain
associated with
phantom pain as

Deep and burning, cramping,


shooting or aching

488.

What are two classes of


medications that some
patients may feel relief
from phantom pain

Anti-spasmodic's and
antidepressants

489.

Other than medications


what are four
alternative treatments
for phantom limb pain

Massage, heat, biofeedback or


relaxation therapy

490.

What should you teach


a patient to do to
reduce phantom limb
pain and prepare the
limb for a prosthesis

To push the residual limb down


toward the bed while supported
on a soft pillow

491.

How should you


position that affected
extremity to promote
bloodflow/oxygenation

Dependent position

492.

What are three things


that you can do to assist
in shrinking the residual
limb for a prosthesis
fitting

1. Wrapping the stump, using


elastic bandages to prevent
restriction of blood flow and
decrease edema (figure 8)
2. Use a stump shrinker suck
3. Use an air splint inflated to
protect and shape the residual
limb

493.

What are four things


that a nurse could do to
prevent the patient
from developing flexion
contractures after an
amputation

1. Range of motion exercises and


proper positioning immediately
after surgery
2. Avoid elevating the stump on a
pillow after the first 24 hours
following surgery
3. Have the patient lie prone for
20 to 30 minutes several times a
day
4. Discourage prolonged sitting in
a chair

494.

Chapter 72

...

495.

496.

497.

498.

499.

At what age does the


remodeling of bone stop
occurring at equal rates
(osteoblastic versus
osteoclastic activity)

30

What is the grading scale for


open fractures

Grade 1: minimal skin


damage
Grade 2: damage includes
skin and muscle contusion
but without extensive soft
tissue injury
Grade 3: damage is
excessive to skin, muscles,
nerves and blood vessels

What is a comminuted
fracture
What is the most common
fracture found in children

What are the three biggest


risk factors for osteoporosis

Has multiple fracture lines


splitting the bone into
multiple pieces
Greenstick: Fracture
occurring on one side but
does not extend completely
through the bone
1. Excessive
exercising/weight loss from
dieting and malnutrition
2. Women who do not use
estrogen replacement
therapy after menopause
3. Patients on long-term
corticosteroid therapy

500.

What are five physical


assessment findings of a
fracture

Crepitus, deformity, muscle


spasms, edema, ecchymosis

501.

What position should a limb


be in after a fracture

Elevated above the heart


and apply ice

502.

How often should


neurovascular checks be
performed when a patient
has a fracture

Every hour for the first 24


hours and then every 1 to
4 hours after

503.

What is a closed reduction

When a pulling force


(traction) is applied
manually to realign the
displaced fractured bone
fragments

504.

505.

What is an open
reduction/internal fixation

When a surgical incision is


made and the bone is
manually aligned and kept
in place with plates and
screws

What is more effective than


splints or immobilizers
because they cannot be
removed by the patient

Casts

506.

What is a spica cast

A portion of the trunk and one


or two extremities

507.

How should you handle


a plaster cast until it is
dry? It can take up to 24
to 72 hours to dry

With the palms, not fingertips

508.

Look at skin traction,


bucks traction and
balanced suspension
skeletal traction

...

509.

How often should you


insure that pulley ropes
are free of knots, fraying,
loosening and improper
positioning

Every 8 to 12 hours

510.

What are two things you


can do to treat muscle
spasms if it is prescribed

Heat, massage

511.

What is a normal
standard pin care
protocol (if the patient
has pins in place)

1. Pin care is provided usually


once a shift, 1 to 2 times a day
2. Chlorhexidine is usually used
and only one cotton tipped
swabs per a pin to avoid crosscontamination

512.

What is external fixation

Involves fracture immobilization


using percutaneous pins and
wires that are attached to a rigid
external frame

513.

What are advantages to


external fixation

1. Immediate fracture
stabilization
2. Minimal blood loss occurring
in comparison with internal
fixation
3. Allows for early mobilization
and ambulation
4. Permitting wound care with
open fractures

514.

What is a disadvantage
to external fixation

Risk of pin site infection leading


to osteomyelitis

515.

What is open reduction


and internal fixation

Refers to visualization of a
fracture through an incision in
the skin and internal fixation
with plates, screws, pins, rods
and prosthetics as needed

516.

How often should you


inspect bony
prominences with an
open reduction and
internal fixation

Every shift and ensure heels are


off the bed at all times

517.

What are the six p's


associated with
compartment syndrome

Pain, paralysis, paresthesia,


pallor, pulselessness and
poikilothermia

518.

Who is at greatest risk for


developing a fat
embolism

Adults between the age of 70


and 80

519.

Fat embolism's usually


occur within blank
hours following a long
bone fracture or with
total joint arthroplasty

48

What are clinical


manifestations of a fat
embolism

Dyspnea
Chest pain
Decreased O2 sat
Decreased LOC
Respiratory distress
Tachycardia
Tachypnea
Fever
Cutaneous petechiae (late sign)

520.

521.

522.

523.

524.

What is treatment for a


fat embolism

1. Maintain the patient on


bedrest
2. Oxygen for respiratory
compromise
3. Corticosteroids for cerebral
edema
4. Vasopressors and fluid
replacement for shock
5. Pain and anti-anxiety
medications as needed

What is the most


common complication
following trauma,
surgery or disability
related to immobility

DVT

What are ways to prevent


DVT

1. Encourage early ambulation


2. Apply antiembolism stockings
3. Administer anticoagulants
4. Encourage intake of fluids to
prevent hemoconcentration
5. Instruct the patient to rotate
feet at the ankles and perform
other lower extremity exercises
as permitted by the particular
immobilization device

What is treatment for


osteomyelitis

1. Long course of IV and oral


antibiotic therapy (3 months)
2. Surgical debridement
3. Hyperbaric oxygen treatment
4. Surgically implanted antibiotic
beads
5. Amputation

525.

If a wound from osteomyelitis is


left open to heal, standard
precautions are adequate and
blank technique can be used
during dressing changes

Clean

526.

What is avascular necrosis

Bloodflow is disrupted
to the fracture site and
the resulting ischemia
leads to tissue/bone
necrosis

527.

Who is at greater risk for


developing avascular necrosis

Patients receiving longterm corticosteroid


therapy

528.

A nurse is completing an
assessment of a patient who had
an external fixation device
applied two hours ago for a
fracture of the left tibia and
fibula. What are four things that
the nurse might find that would
indicate compartment
syndrome?

1. Intense pain when


the left foot is passively
moved
2. Hard, swollen muscle
in the left leg
3. Burning and tingling
of the distal left foot
4. Minimal pain relief
following a second dose
of opioid medication

529.

A nurse in the emergency


department is planning care for
a patient who has a right hip
fracture. What kind of
immobilization device should
the nurse anticipate in the plan
of care?

Bucks traction because


it is a temporary
immobilization device
applied to diminish
muscle spasms and
immobilize the affected
extremity until surgery
is performed

530.

Chapter 77

...

531.

The posterior pituitary gland


secretes the hormone blank
which causes the kidneys to
reabsorb water

ADH (vasopressin)

532.

A deficiency of ADH causes

Diabetes insipidus,
which is characterized
by the excretion of a
large quantity of diluted
urine

533.

Excessive secretion of ADH


causes

Syndrome of
inappropriate
antidiuretic hormone.
In SIADH, the kidneys
retain water, urine
becomes concentrated,
urinary output
decreases and
extracellular fluid
volume is increased

534.

535.

536.

537.

538.

539.

540.

541.

542.

543.

544.

What is the water deprivation test

Measures the
kidneys ability to
concentrate urine in
light of an increased
plasma osmolality
and a low plasma
vasopressin level.

The water deprivation test is


performed for patients who have a
diagnosis of diabetes insipidus. It
should only be conducted if the
patient's baseline serum sodium
level is blank and The osmolality of
the urine is below blank

Within the expected


range, 300

What is a positive result for


diabetes insipidus with the water
deprivation test

The kidneys are


unable to
concentrate urine
despite increased
plasma osmolality

What are preprocedure nursing


actions for the water deprivation
test

1. No
smoking/caffeine or
alcohol prior to test
2. Withhold fluids for
8 to 12 hours
3. Obtain IV access

What position is the patient in


during the test

Recumbent position
for 30 minutes
however The patient
may sit or stand
during voiding.

What is a complication of the


water deprivation test

Dehydration

What is Cushing's disease


(Hypercortisolism)

Hyper functioning of
the adrenal cortex
and an excessive
production of cortisol

What is Addison's disease

Hypo functioning of
the adrenal cortex
and a consequent
lack of adequate
amounts of serum
cortisol

What is a diagnostic test they can


use to determine if a patient has
Cushing's disease

Dexamethasone
suppression test

What is a positive result for


Cushing's disease after doing the
dexamethasone test

There is no decrease
in the production of
ACTH and cortisol

Disorders of the adrenal medulla


may cause

Hypersecretion of
catecholamines
(pheochromocytoma)

545.

The vanillylmandelic acid test is


used to diagnose
pheochromocytoma. How does
this test work

VMA testing is a 24
hour urine collection
for VMA, a breakdown
product of
catecholamines

546.

What is the expected range for


VMA in a 24-hour period

2 to 7 mg

547.

What is a positive result for the


VMA test that indicates
pheochromocytoma

Elevated levels

548.

What kind of food and


medications may be restricted 2 to
3 days before the test

Caffeine, vanilla,
bananas, chocolate,
aspirin and
Antihypertensive
medications

549.

A clonidine suppression test is


where the patients plasma
catecholamine levels are taken
prior to and three hours after
administration of clonidine. What
is a positive result for
pheochromocytoma

The clonidine has no


effect and no
decrease in blood
pressure

550.

What is normal reference range for


fasting blood glucose

Less than 110 mg/dL

551.

How long does the patient need to


abstain from food or fluids other
than water before a fasting blood
glucose test

Eight hours

552.

What is a normal reference range


for the oral glucose tolerance test

Less than 140

553.

How long does a patient need to


fast before the oral glucose
tolerance test

10 to 12 hours

554.

How often are blood samples


taken during the oral glucose
tolerance test

Every 30 minutes for


two hours

555.

What is normal range for HBA1C,


what level indicates pre-diabetes
and what level indicates diabetes

Normal: 5% or less
Pre-diabetes: 5.7% to
6.4%
Diabetes: 6.5% or
higher

556.

What is normal range for T3

70 to 205

557.

What is normal range for T4

4 to 12 mcg/dL

558.

Chapter 78

...

559.

What are risk factors for diabetes


insipidus

1. Head
injury/tumor/infection
(meningitis,
encephalitis)
2. Lithium

560.

What are signs/symptoms of


diabetes insipidus

Polyuria
Polydipsia
Nocturia
Fatigue
And other symptoms of
dehydration

561.

How is the urine chemistry in


diabetes insipidus (PH, sodium,
potassium, specific gravity,
osmolality)

Everything is decreased,
think dilute

562.

How is the serum chemistry in


diabetes insipidus

Think concentrated
everything is increased

563.

What would a
radioimmunoassay show you

Decreased ADH

564.

What kind of drink would a


patient with diabetes insipidus
went to avoid

Anything with caffeine

565.

What should be done daily with


the patient that has diabetes
insipidus

Daily weight

566.

What is an anticonvulsant that


stimulates the release of ADH

Tegretol

567.

What are three side effects of


Tegretol

Dizziness, drowsiness,
thrombocytopenia

568.

What are symptoms of


thrombocytopenia

Sore throat, fever,


bleeding

569.

Should Tegretol be taken with


or without food

With food

570.

Who should vasopressin be


given cautiously to

Patients who have


coronary artery disease
because it can cause
vasoconstriction

What are four teaching points to


a patient that has diabetes
insipidus

1. Weigh daily
2. Eat a diet high in fiber
3. Wear a medical alert
wristband
4. Monitor fluid intake

571.

572.

What are risk factors for


syndrome of inappropriate
antidiuretic hormone

Malignant tumors
Increased intrathoracic
pressure (PPV)
Meningitis
Cardiovascular accident
Medications
Trauma
Pain
Stress
Diuretics due to
increased sodium losses

573.

Early manifestations of SIADH


include

Headache
Anorexia
Muscle cramps
Weakness
Weight gain

574.

As a serum sodium level decreases


in SIADH, the patient begins to
experience personality changes,
hostility, sluggish deep tendon
reflexes and

Nausea, vomiting,
diarrhea and oliguria

575.

Later manifestations of SIADH


include

Confusion
Lethargy
Cheyne-stokes
respirations
Seizures
Coma
Death

576.

What are manifestations of fluid


volume excess

Tachycardia
Possible hypertension
Crackles in the lungs
Distended neck veins
Taut skin

577.

What is urine chemistry in SIADH

Think concentrated

578.

What is blood chemistry in SIADH

Think dilute

579.

What should oral fluids be


restricted to any patient that has
SIADH

500 to 1000 mL/day

580.

What is Demeclocycline

Tetracycline
derivative. Used for
SIADH

581.

With patients taking


demeclocycline monitor for
indications of a yeast infection in
the mouth. What can you do to
decrease the likelihood of this
happening?

Have the patient rinse


their toothbrush with
a diluted bleach
solution and increase
consumption of
yogurt

582.

How does lithium work in SIADH

Blocks the renal


response to ADH

583.

What are signs of lithium toxicity

Nausea, diarrhea,
tremors ataxia

584.

Should lithium be taken with or


without food

With food

585.

During treatment for SIADH if a


patient is receiving hypertonic
saline or loop diuretics how often
should their serum sodium level
be monitored

Every 2 to 4 hours

586.

Chapter 79

...

587.

588.

589.

What do the hormones T3


and T4 do

They affect all body systems


by regulating overall body
metabolism, energy
production, fluid and
electrolyte balance and
controlling tissue use of fats,
proteins and carbohydrates

What is the most common


cause of hyperthyroidism

Graves disease. Autoimmune


antibodies result in
hypersecretion of thyroid
hormones

What are two other causes


of hyperthyroidism

Toxic nodular goiter: caused


by overproduction of thyroid
hormone due to the presence
of thyroid nodules
Exogenous hyperthyroidism:
caused by excessive dosage of
thyroid hormone

596.

What is the medication that can


be administered one hour after
anti-thyroid medication and is
only used for short term

Iodine solutions (mixed


with juice, use a straw
and take the food)

597.

How does radioactive iodine


therapy work

It is taken up by the
thyroid and destroys
some of the hormone
producing cells

598.

How long after radioactive


iodine therapy does a patient
need to stay away from infants
and small children and avoid
becoming pregnant

2 to 4 days and avoid


becoming pregnant for
six months following
therapy

599.

What are four other precautions


that a patient needs to take after
radioactive iodine therapy

1. Do not use the same


toilet as others for two
weeks and flush the
toilet three times after
use
2. Take a laxative for 2 to
3 days after treatment
3. Wear clothing that is
washable and wash
clothes separate from
others
4. Do not share a
toothbrush and use
disposable food service
items such as paper
plates

600.

What should a patient receive 10


to 14 days before a
thyroidectomy to reduce gland
size and prevent excess bleeding

Iodine

601.

After a thyroidectomy what


position should the patient be in

Hi Fowler's and avoid


neck extension

602.

After thyroidectomy how do you


check for laryngeal nerve
damage

By asking the patient to


speak as soon as they
awake from the
anesthesia and every
two hours there after

590.

What are some clinical


manifestations of
hyperthyroidism other
than ones you would
already think of such as
insomnia, tachycardia,
irritability and so on

1. Menstrual irregularities
(Amenorrhea/decreased
menstrual flow)
2. Libido is initially increased
and then followed by a
decrease
3. Exophthalmos (Graves
disease only)
4. Vision changes
5. Bruit over the thyroid gland

591.

If someone was given the


thyrotropin-releasing
hormone stimulation test,
what would be a positive
result for hyperthyroidism

Failure of expected rise in TSH

In the radioiodine uptake


and thyroid scan test,
iodine is administered
orally 24 hours prior to the
test, and then it is
measured. What is a
positive result?

An elevated uptake

593.

One week prior to the


radioiodine uptake test
what should patients
avoid regarding food

Anything that contains iodine

603.

If the parathyroid gland gets


damaged during a
thyroidectomy what will the
patient be needing

Calcium supplements

594.

Thionamides such as blank


and blank are used to
inhibit the production of
thyroid hormone

Methimazole, propylthiouracil

604.

What is usually given after a


thyroidectomy to reduce
postoperative edema

Prednisone

What are side effects of


thionamides

Hypothyroidism
Leukopenia
Thrombocytopenia
Hepatotoxicity

605.

595.

How much drainage should you


expect in the first 24 hours after
a thyroidectomy

50 mL (after the first 24


hours there should only
be scant drainage)

592.

606.

Thyroid storm/crisis results from a


sudden surge of large amounts of
thyroid hormones into the blood
stream, causing an even greater
increase in body metabolism.
Precipitating factors include

Infection
Trauma
Emotional stress
Diabetic ketoacidosis
Digitalis toxicity
Thyroidectomy

607.

What are clinical manifestations of


a thyroid storm/crisis

Hyperthermia
Hypertension
Delirium
Vomiting
Abdominal pain
Hyperglycemia
Tachydysrhythmias
Dyspnea

608.

If a patient is having a thyroid


storm you can administer
propylthiouracil to prevent further
release of thyroid hormones. You
can then administer iodine one
hour after. Why not give it before

Because if it is given
before it can
exacerbate
manifestations in
susceptible clients

609.

What are two things to look for as


an indicator of hypocalcemia

Chvosteks and
trousseau sign

610.

A nurse in a providers office is


reviewing the health record of a
patient who is being evaluated for
graves disease. What is an expected
laboratory finding for this patient?

Decrease in TSH
because the
pituitary gland
decreases the
production of TSH
when thyroid
hormone levels are
elevated

611.

Chapter 80

...

612.

What are risk factors for


hypothyroidism

1. Women between
the ages of 30 to 60
2. Lithium and
amiodarone
3. In adequate
intake of iodine

613.

What are some early findings of


hypothyroidism

Fatigue/lethargy
Intolerance to cold
Constipation
Weight gain
Pale skin
Thin, brittle nails
Depression
Thinning hair
Joint and/or muscle
pain

614.

What are late manifestations of


hypothyroidism

Bradycardia
Hypotension
Dysrhythmias
Slow thought
process/speech
Hypoventilation
Thickening of the
skin
Dry flaky skin
Swelling in face,
hands and feet
Decrease acuity of
taste and smell
Horse, raspy
speech
Abnormal
menstrual periods

615.

What kind of diet should a patient


with hypothyroidism be on

Low-calorie, high
bulk diet and
encourage activity
to prevent
constipation and
promote weight loss

616.

What is the medication of choice for


thyroid hormone replacement
therapy

Synthroid

617.

What are three medications that


Synthroid increases the effects of

Coumadin
Insulin (need for it)
Digoxin

618.

What type of medications decrease


the absorption of Synthroid

PPI's and H2
antagonist

619.

When should Synthroid be taken

1 to 2 hours before
breakfast

620.

What is a severe complication of


hypothyroidism

Myxedema

621.

A nurse any providers office is


reviewing the laboratory findings of
a patient who's being evaluated for
primary hypothyroidism. What is
expected a laboratory finding for
this patient?

Hematocrit 34%
which indicates
anemia, which is an
expected result for
patient who has
hypothyroidism

622.

What kind of laxative can a patient


not take when they are on Synthroid

Fiber laxatives
because it
interferes with
absorption

623.

Chapter 81

...

624.

What are causes of


Cushing's syndrome

Organ transplant
Chemotherapy
Autoimmune diseases (rheumatoid
arthritis)
Asthma
Long-term use of glucocorticoids

625.

What are some


signs/symptoms of
Cushing's disease

Weakness/fatigue
Back/joint pain
Decreased immune system
Bruising/petechiae
Hypertension
Tachycardia
Gastric ulcers
Weight gain
Hypervolemia
Hirsutism

What are expected


findings in
laboratory test
associated with
Cushing's disease

ATCH: increased
Cortisol: increased
Serum K/Ca: decrease
Serum glucose: I
Serum sodium: I
Lymphocytes: D

627.

Chapter 82

...

628.

What is Addison's
disease

An adrenocortical insufficiency. The


production of mineralocorticoids and
glucocorticoids is diminished resulting
in decreased aldosterone and cortisol

629.

What are some risk


factors for
Addison's disease

Autoimmune dysfunction
TB
Cancer
Adrenalectomy
Sepsis
Trauma
Steroid withdrawal

What are some


clinical
manifestations of
Addison's disease

Weight loss
Craving for salt
Hyperpigmentation
Severe hypotension
Dehydration
Hyponatremia
Hyperkalemia
Hypoglycemia
Hypercalcemia

626.

630.

631.

What would
laboratory values
be in a patient that
has Addison's
disease

632.

Hydrocortisone,
prednisone and
cortisone are all
glucocorticoids used
for Addison's disease.
How should this
medication be taken?

With food

633.

What is a potential
adverse side effects of
the mineralocorticoid
fludrocortisone

Hypertension and dosage may


need to be increased during
periods of stress or illness (One the
patient to expect mild peripheral
Edema)

634.

What is addisonian
crisis

An acute adrenal insufficiency


occurs when there is an acute
drop in adrenocorticoids due to
sudden discontinuation of
glucocorticoid medications or
when induced by severe trauma,
infection or stress

635.

What is treatment for


addisonian crisis

1. Administer insulin to move


potassium into the cell
2. Administer calcium and
kayexalate to counteract the
effects of hyperkalemia
3. Establish an IV line and initiate a
rapid infusion of NS
4. Loop or thiazide diuretics are
used to manage hyperkalemia
5. Administer hydrocortisone as
replacement therapy

636.

In the presence of
primary adrenal
insufficiency, plasma
cortisol levels blank in
response to the
administration of
ACTH

Do not rise

637.

Chapter 3

...

638.

What is the best


possible score for the
Glasgow coma scale

15

639.

What do the other


possible scores for the
Glasgow coma scale
indicate

1. Less than eight: associated with


severe head injury and coma
2. 9 to 12: indicate a moderate
head injury
3. Greater than 13: reflect minor
head injury

640.

What are the three


things that the
Glasgow coma scale
uses to determine the
score

Eye-opening, verbal and motor


response

Bun/creatinine: I
Serum glucose: D
Serum cortisol: D

641.

What is the
positioning for
a lumbar
puncture

Either the cannonball position or have the


patient stretch over and over bed table if
sitting is preferred

642.

Chapter 5

...

643.

What kind of
meningitis is
common
among
patients who
have AIDS

Fungal

What is the
haemophilus
influenza type
B vaccine

A vaccine for infants against bacterial


meningitis

What is
pneumococcal
polysaccharide
vaccine

For adults 65 years and older who have


not been previously vaccinated nor have
history of the disease (for adults or
immunocompromise, have a chronic
disease, who smoke cigarettes or live in a
long-term care facility)

What is the
meningococcal
vaccine

For adolescence to receive prior to living in


a residential setting in college and for those
in the military

What are risk


factors for viral
meningitis?
Also there's no
vaccine against
viral

Mumps, measles, herpes and west Nile


virus

What are some


subjective
signs of
meningitis

Excruciating, constant headache


Nuchal rigidity
Photophobia

649.

What are some


objective
physical
assessment
findings of
meningitis

Fever and chills


N/V
Altered LOC
Positive Kernig's sign
Positive Brudzinski's sign
Hyperactive deep tendon reflexes
Tachycardia
Seizures
Red macular rash
Restlessness/irritability

650.

What is the
most definitive
diagnostic
procedure for
meningitis

CSF analysis

644.

645.

646.

647.

648.

651.

What results from the


CSF analysis and lab
values would be
indicative of
meningitis

1. Appearance of CSF: cloudy


(bacterial) or clear (viral)
2. Elevated WBC
3. Elevated protein
4. Decreased glucose (bacterial)
5. Elevated CSF pressure

652.

What kind of
precautions is a
patient with
meningitis placed on

Isolation/droplet precautions, which


requires a private room

653.

What position should


a patient with
meningitis be in, in
bed

Head of bed elevated 30

654.

Chapter 6

...

655.

What is a myoclonic
seizure

A brief jerking or stiffening of the


extremities which may be
symmetrical or asymmetrical

656.

What is an atonic
seizure

Characterized by a few seconds in


which muscle tone is lost. The
seizure is followed by a period of
confusion

657.

What is one antielliptic drug

Phenytoin (decreases effectiveness


of oral contraceptives)

658.

What is a medication
that should not be
given with phenytoin

Warfarin

659.

What is a vagal nerve


stimulator

A device implanted into the left


chest wall and connected to an
electrode placed on the left vagus
nerve

660.

How does a vagal


nerve stimulator
work

It is programmed to administer
intermittent stimulation of the brain
via stimulation of the vagal nerve, at
a rate specific to the patients needs

661.

In addition to routine stimulation,


the patient may initiate vagal nerve
stimulation by holding a blank over
the implantable device, at the onset
of seizure activity. This either aborts
the seizure or lessons it's severity

Magnet

662.

What is status epilepticus


characterized by

A prolonged seizure
activity occurring
over a 30 minute
time frame

663.

Chapter 7

...

664.

Parkinson's disease is a progressively


debilitating disease that grossly
affects motor function. It is
characterized by four primary
symptoms which are

Tremor, muscle
rigidity,
Bradykinesia and
postural instability
(dopamine is
decreased)

665.

How's your patience Parkinson's eat


their food

1. Provide smaller,
more frequent
meals
2. Add commercial
thickener to thicken
food
3. Patients should
be weighed at least
weekly

666.

Medications such as blank, are


converted to dopamine in the brain,
increasing dopamine levels in the
basal ganglia

Levodopa

667.

Dopaminergics May be combined


with blank, to decrease peripheral
metabolism of levodopa requiring a
smaller dose to make the same
amount available to the brain. Side
effects are subsequently less

Carbidopa

668.

What is stereotactic pallidotomy

Destruction of a
small portion of the
brain within the
Globus pallidus
through the use of
brain imaging and
electrical stimulation

669.

Any patient that receives deep brain


stimulation should be monitored
for what afterwards

Infection, brain
hemorrhage,
neurological
impairment or
stroke like
symptoms

670.

What are two complications of


Parkinson's disease

Aspiration
pneumonia and
altered cognition
such as dementia

671.

Chapter 10

...