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4no51b Volume 1 CDC Study Questions

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What five things are medications used for?
To treat, cure, diagnose, or prevent disease, or to provide relief
What's a formulary?
A reference book or pamphlet that lists medications available at a specific health care facility. Also lists recommended dosages and special considerations
What term is used to describe a new drug before the drug becomes official?
Generic name
Why were drug standards developed?
To ensure product quality
Who is involved in selecting, obtaining, and storing different medicaions, as well as accounting for the safe dispensation of medications?
Pharmacists
What two essential patient history considerations must be obtained and documented before administiring a medication?
Current medications and allergies
What are the "Five Rights" of medication administration?
Right patient, Right medication, Right dose, Right route, right time
What's the first step in preparing medication?
Verify the medication order
What would you do if a patient refuses to take medication?
Try to find out why the patient is refusing the medication, report the situation promptly to the nurse or provider, and document the situation
What form do you use to report a medication error?
AF Form 765, Medical Treatment Facility Incident Statement
What are the four types of medication orders?
Stat, Single, Standing, and PRN
What are the six essential parts of a drug order?
Patients name, date order was written, drug name, drug dosage, method of administrating the drug and signature of provider
Who is responsible for documenting the administration of medication?
The individual who administers the medication
Why does the site of administration need to be documented when an injection is given?
To avoid duplicate injections at the same site
In order to avoid errors, what do many facilities use to copy a medication order?
A computer-generated product that lists all the medication orders that apply to a particular patient
What are the purposes of a palliative drug action?
Relieve symptoms of a disease without affecting the disease itself
What category of therapeutic drug effect has the purpose of replacing body fluids or substances?
Subsituitive
What do you call the process in which a medication is transported from the site of enty to the circulatory system?
Absorption
When an overdose of a drug occurs, what normally results?
Drug Toxicity
Name the two types of drug dependence.
Physical and Phsychological
What's the purpose of most drug therapy?
To maintain a constant level of a drug in the body in order to permit the therapeutic action to be achieved.
What factors influence the action that drugs have on the body?
Age, weight, sex, gentetic factors, psychological factors, ilness and disease, time of administration, and environment
Why are infants highly affected by drugs?
Infants have immature liver and kidney functions that result in a slower excretion of a drug
When patients don't believe a certain medication will help them, what factors are influencing them
Psychological factors
Why do oral medications taken before meals usualy act faster in the body?
Due to a low digestive system content
What's a PDR?
PDR stands for Physician's Desk Reference. It is a reference source containing the latest drug product information prepared by manufacturers.
What reference source is a collection of drug monographs kept current by periodic supplements prepared by pharmacists?
American Hospital Formulary Service
What reference is a combination of two official publications?
US Pharmacopia-National Formulary
Who ensures the local formulary is updated as needed?
Local facility pharmacy
When administering medication, what dangerous practice should you avoid?
Relying on your memory for drug information
What determines which category a drug is placed in?
The specific action of a drug
What type of preparition is described as one or more drugs dissolved in water?
An aqueous solution
Describe a capsule
A gelatinous container that holds drug in powder, liquid or oil form
What type of medication is used to induce sleep or dull the senses?
A hypnotic
What's an antiemetic used for?
Prevention of relief of nausea
What are the five general routes of medication administration?
Parenteral, oral, sublingual, buccal and topical
What's the first step to gake when preparing a medication for administration?
Verify the order
What should be done if a medication is to be administered on a date other than when it was ordered?
Document the fact
What are the four types of parenteral injection technique is administered to the skin's dermis layer?
Subcutaneous, intradermal, intramuscular, and intravenous
What are the two types of IV drug administration methods?
IV drip and IV push
What four factors may cause reduced muscle mass at a potential injection site?
Age, inactivity, malnutrition or disease process
What occurs within the barrel when the plunger of a syring is pulled back?
A vacuum is created and fluid is pulled into the barrel
Why are the quadriceps femoris sites preferred for pediatric patients?
They don't contain nerves or blood vessels
What are the three disadvantages of the oral method of administering medication?
Possible unpleasant taste, potential for gastric irritation and a slower rate of absorption.
Ideally, in what position should you place a patient in order to administer an oral medication?
Sitting
Why is there a minimal loss of potency when a sublingual medication is administered?
The medication bypasses the liver
In what three general areas of the body are topical medications administered?
Skin surface, body cavities or body orifices
Why should you wear gloves when applying a dermatologic medication?
For infection control and to avoid having the medications affect you in some way
How often do you assess a patients vital signs when administering an inhalation?
Before, during and after therapy
In what part of the eye do you administer opthalmic medications?
Lower conjuctiva sac
How do you administer eardrops in a patient less than 3 years of age? In an adult?
For patients less than 3 years of age, gently pull the earlobe down to straighten the canal. For adults, pull the auricle up and back to straighten the canal
What term is used to define a fluid volume deficit?
Hypovolemia
What are the nine signs and symptoms of fluid volume deficit?
Poor skin turgor, concentrated urine which will result in a high specific gravity, oliguria, dry mucous membranes, weak and rapid pulse, orthostatic hypotension, a low central venous pressure (below 4cm of H2O), confusion, and restlessness
What are the four disease processes mentioned in the text that can cause a fluid volume excess?
CHF, renal failure, cirrhosis, and Cushing's syndrome
What's and electrolyte?
A chemical substance (ion) capable of carrying an electrical charge when it's in water
What are the eight symptoms associated with a sodium defecit?
Confusion, weakness, restlessness, hyperthermia, tachycardia, muscle twitching, adominal cramp: and in severe cases, convulsions and coma
What are the signs and symptoms associated with a sodium excess?
The signs and symptoms are similar to dehydration including: thirst, dry sticky mucus membranes, oliguria (scanty urine output), hyperthermia, dry tongue, and lethargy
What electrolyte deficit and excess can cause dysrhythmias leading to cardiac or respiratory arrest?
Potassium
Which electrolyte in excess amounts can cause fractures?
Calcium
What does the symbol "ph" refer to?
Percentage of hydrogen ions (atoms) present in a solution
What do you call a solution that has a high "pH"?
An alkaline solution.
What do you call imbalance in the metabolism of food or fluids that's usually associated with insulin deficiency?
Metabolic acidosis
Excessive gastric suctioning that removes too much hydrochloric acid can result in what type of acid-base imbalance?
Metabolic acidosis
An increase in carbonic acid in the body fluids associated with difficulty breathing can result in what type of acid-base balance?
Respiratory acidosis
What type of acid-base imbalance is associated with a patient hyperventilating?
Respiratory acidosis
What is the normal plasma pH?
7.34 to 7.45
What basic equipment do you need to initiate an IV?
A solution container, an administration set, and a needle
How high should the IV container be positioned?
Normally between 24 and 36 inches above the patient
What are the eight basic components of an administration set?
An insertion spike, drip chamber, plastic tubing, clamp, vent port, medication port, secondary port, and needle adapter
What prevents the mixing of primary and secondary infusions when a piggyback setup is used?
A back-check valve on the primary tubing
What system is used to mix medications with specified amounts of the intravenous solution?
An in-lime chamber system
What are the three basic types of intravenous needles?
Wing tipped, over-the-needle catheters and inside-the-needle catheters
What type of needle is commonly used to initiate an IV in the scalp of a pediatric patient?
Wing-tipped
What type of needle is most commonly used when the possibility of extravasation is possible?
Inside the needle catheter
When would a volumetric pump be used?
For intra-arterial infusions or deep central venous lines (cut-downs) and for patients who have multiple IV lines and whose condition is such that they could roll onto or otherwise obstruct the line
When are variable pressure volumetric pumps used?
when patients require critical volume or critical medication
What three factors determine the type of intravenous solution to be used?
The patients condition, fluid and electrolyte imbalance and purpose for the IV
What's tonicity?
The relative concentration of dissolved substances in a solution as compared to the solution concentration withing the red blood cells
What type of patients should receive parenteral hyperalimentation?
Patients who have a gastrointestinal disorder
Why are hyperalimentation solutions administered through central veins?
To prevent damage and irritation to the small vessels
What condition should be treated with blood volume expanders?
Hemorrhagic shock
Where are medications usually added to the IV container?
In the pharmacy
What information should be included on the medication label that's placed on the side of the bottle/bag?
The name and strength of the medication that was added, as well as the date, time, and initials of the person wh
How do you "prime" the administration set?
Insert the spike into the appropriate opening and alow a small amount of solution to flow through the tubing to eliminate air bubles.
What information should be included on the label attached to the administration set?
The patient's name, room number, date, time and any medications that have been added.
What should you do if there are vistiors present when you're going to start an IV?
Ask them to step out of the room until the IV is in place.
What factors should you consider when selecting an IV injection site?
The type of solution, rate of infusion, age and condition of the patient, condition of the veins, duration of the therapy, and type of equipment used
Why is it sometimes difficult to initiate an IV on elderly patients?
They have fragile veins that collapse when punctured with a needle.
Where would you start an IV if it will be in place for a long time?
The most distal vein possible to preserve other sites for future use.
What three veins are preferred for IV sites in the hand and arm?
Metacarpal, cephalic, and basilic veins
What should you do before you begin actual contact procedures with the patient?
Don gloves
How tight should you make a tourniquet?
Tight enough to obstruct the venous flow but not the arterial flow.
Where should you insert the needle in relation to the vein you're trying to pentetrate?
About 1/2 inch below the planned entry site into the vein
What precaution should you take when applying tape to a dressing?
Don't wrap the tape completely around the arm
What factors determine whether you should immobilize an IV?
If it's in a precarious position, near a joint, or if the patient is fairly active
What information should be documented after the IV is initiated?
The date and time, location of site, type and size of needle, type of solution, rate of infusion, and any special equipment (EID) or tubing that was used.
What are the indications of a circulatory overload?
Cyanosis, dyspnea, coughing, blood-tinged sputum, edema, distended neck veins, weight gain, decreased urinary output, weak rapid pulse, and rapid shallow respirations
What five complications are associated with the IV therapy itself?
Alterations of the infusion rate, infiltration, phlebitis, infection and embolism
Why shouldn't you attempt to catch up if the infusion is behind schedule?
Such an action could cause a circulatory overload
What causes infiltrations?
When the needle becomes dislodged or penetrates the vein wall, and the IV solution flows into the tissues instead of through the vein
What condition may complicate phlebitis?
The formation of a clot along the vein
What causes embolism?
Air bubles or foreign particles (clots) in the veins
What's the normal rate for a KVO IV?
Between 10 and 50 cc/hour, with the amount infused at less than 500 cc.
What's a transfusion?
The intraveous administration of whole blood or blood products
How is plasma supplied?
In a 225 cc units as pooled, fresh frozen, or single-donor plasma
What is blood mixed with after it's collected from a donor?
An anticoagulant
What's the first step in the actual transfusion process?
Compatibility testing
Once a transfusion is initiated, how long should it run slowly?
For the first 15 to 30 minutes
Who specifies what diet a patient is to receive?
The patients physician
Match the diet description in column A with its name in column B
See 4-11
Define appetite
The desire for food or an agreeable attitude toward eating food
What physical sensations can cause a loss of appetite?
Pain, discomfort, and unpleasant sights, unpleasant sounds, or unpleasant odors
In what ways does culture affect the way a person eats?
Types of food, eating utensils and methods of preperation
What's the strongest force that affects a person's appetite?
Personal preference
On what form do you identify where the patient will eat?
AF Form 1094, Diet Order
How should you help to prepare a patient for mealtime?
Assist the patient with oral hygiene, assist the patient to the bathroom or bedpan, provide equipment to wash his or her hands, straighten the linen, and raise the head of the bed to a sitting position
When do you serve patients who require the most assistance?
Last
What method is used to explain the location of foods to a blind patient?
The clock method
What are five reasons for the use of a NG tube?
Diagnose a disorder, feed a patient, relieve distension, drain the stomach, or wash out the stomach
In what position do you place the patien for an NG insertion?
High Fowlers positon
What are the steps used to determine the length of tube needed to reach the stomach?
Place the end of the tube at the tip of the nose, extend it to the patient's earlobe and then down to the xiphoid process
How do you prevent entrance fo the NG tube into the trachea?
With the NG tube at the level of the nasopharynx, have the patient flex their head to their chest and begin to swallow as you pass the tube
During placement of the NG tube, what patient reactions will indicate the need for you to stop and remove the tube?
Gasping for air, coughing, or turning cyanotic
What are the four methods used for assuring proper NG tube placement
Aspiration of the stomach contents, osculating for air sounds with injection of 5 to 15ml of air into the stomach, assuring the patient can speak, and an X-ray to ensure placement
What term is used to denote tube feedings?
Gavage
Prior to eeding the patient via an NG tube, what's your first priority?
Ensuring proper placement fo the NG tube
At what temperature should the tube feeding solution be when you use it?
Room temperature
How many minutes will it take to properly administer a tube feeding?
10 to 20 minutes
Define the term lavage.
Introduction of a solution into the stomach through a tube and then siphoning the solution back out
Why are irrigations performed?
To improve or ensure patency of the NG tube
What are three reasons a catheterization is performed?
Relieve or prevent bladder distention, collect a sterile urine specimen, or empty the bladder before certain surgical procedures
What are two types of catheters you'll deal with
Straight and Foley
Why is it important to decompress the bladder slowly?
To prevent bladder damage, shock, chills, and fever
What type of technique is used when inserting a catheter?
Sterile aseptic
How far into the urethra is the catheter inserted for a female patient?
Two to three inches or until urine begins to flow
How far into the urethra is the straight catheter inserted for a male patient? How about an indwelling catheter?
Six to ten inches or until the urine begins to flow. To the catheter bifurcation
Why do you pnch the catheter tube prior to removing it?
To prevent air from entering the bladder
To prevent damaging the urethra, what must you remember to do when removing an indwelling catheter?
Deflate the balloon
What's the purpose of bladder irrigations?
To remove or wash out blood, pus, bacteria, or waste products following urinary surgery
What are two types of enemas?
Cleansing and retention
What are three reasons for the use of cleansing enemas?
Relieve constipation, preperation for surgery, and preperation for diagnostic procedures
In what position is the patient placed when administering an enema?
Left lateral recumbent or on his or her back
When giving a cleansing enema, how many minutes should the solution container be held above the rectum?
At least 5 minutes
What are retention enemas used for?
Treat diseases of rectum and lower colon, soften fecal material or soothe an irritated colon or rectum, and administer medication
What are two reasons for colostomy irrigations?
Establishing fecal control and keeping the patient clean
What's the most common reason for receiving a colostomy?
Cancer of the rectum
When giving a retention enema, how high should the solution container be held above the rectum?
18 inches
Match the subject in column A with its nrmal value in column B
See 5-23
c,b,a,d
What term means the patient has a low oxygen content in the arterial blood?
Hypoxemia
hypoventilation can cause what type of acid-base imbalance?
Respiratory acidosis
When do you listen to lung sounds when your're providing respiratory care?
Before and after respireatory treatments
Match the definition in colum A with the proper term in column B
See 5-23
b,c,a,d
Why should "No Smoking" signs be posted utside rooms where oxygen is in use?
Because oxygen supports combustion and makes things more flammable
What type of blanket must be used in areas where oxygen is in use?
Cotton
What safety precautions should you take if you're using a metal oxygen tank?
Ensure the fill date doesn't exceed 5 years and the tank is secured to keep it from falling over
What's the function of airways?
To prevent obstruction of the upper airway and allow passage of air and oxygen to the lungs
What will happen if an oropharyngeal airway is used on a conscious or semiconscious patient?
May cause vomiting or spasms of the vocal cord
What factors determine the method of oxygen administration the physician will select?
The patient's condition, the immediate situation, the available equipment, and whether the patient can tolerate the specific type of equipment necessary for ts administration
For what type of patient is an oxygen tent used?
Patients who are very sick, restless, or uncooperative
How is the concentration of oxygen monitored within the oxygen tent?
With an oxygen analyzer
What type of mask is used to administer inspired oxygen concentrations of 60-90%?
Nonrbreathing mask
What type of mask is used when the patient needs low concentrations of oxygen, 24 to 40 percent?
venturi mask
When is a continuous positive airway pressure mask used?
When other attempts in increase the patient's PaOx have failed, but prior to intubation
What's the purpose of the pocket mask?
To supply supplemental oxygen during mouth-to-mouth ventilatin plus reduces the possibility of contamination of the health care provider
How is the pocket mask placed on the patient's face?
Apply the mask so the apex is over the bridge of the patient's nose and the base is in the groove between the lower lip and the chin; grasp the patient's mandible with the first three fingers of each hand; and place your thumbs over the dome of the mask.
What concentration of oxygen can be elivered with the bag-valve-mask system?
90 percent
How often should you ventilate the patient when you're using the bag-valve-mask system?
Every 5 seconds
What triggers the flow restricted oxygen powered ventilatin device?
Patient inspiration or external controls
What wil happen if th ehumidifier is too full when you're using a nasal cannula?
The bubbling water may overflow into the gauges
How often are oxygen humidifiers changed?
At least every 48 hours
Why should suctioning be limited to 15 seconds
May induce hypoxia and respiratory problems
Who is normally responsible for inserting endotracheal tubes?
A doctor or anesthetist
Match the terms for special nursing procedures in column B with the appropriate statements about them in column A
See 5-25
d,a,c,b,d,b,b
Why is a trachestomy usually performed?
As an emergency measure when there's obstruction of the upper air passages.
Why do you suction a trachestomy prior to changing the dressing?
To help maintain a clean area longer
How often should trachestomy care be performed?
Every 8 hours, or as often as the pysician orders it
Define exertional dyspnea?
Difficulty breathin on exertion, which is relieved by rest
What are palpitations?
Unusual or irregular heart beats felt by the patient
What's one cause of cariogenic syncope?
A fall in cardiac output
What's the cause of cyanosis?
A reduced amount of hemoglobin in the blood
What can cause diminished pulses?
Arteriosclerosis
Where is the best anatmical location to hear heart sounds?
Apex of the heart
During auscultation of hear sounds, what does the S1 sund represent?
Closure of the mitral and tricuspid valves
What's the purpose of taking an apical-radial pulse?
To compare the pulse rate at the apex of the heart with that at the radial artery
Why do you need two people to take an apical-radial pulse?
One listens over the apex of the heart while the other counts th epulse rate of the radial artery
What's the purpose of defibrillation
To terminate ventricular tachacardia or v-fib
What should you do if defibrillation is unsuccesful?
Continue CPR until the physician decides whether or not to defibrillate
What is telemetry?
Electronic monitoring of the heart rhythm over airwaves
What's the normal arterial mean pressure?
70 to 90 mm HG
What prevents blood from backing up into the tubing of an arterial line?
A pressure bag
What type of information can a CVP provide to a physician?
Venous blood volume, assesment of right sided heart failure, and determination of hear infarctins
Name four possible insertin sites for a CVP line?
Brachial, femoral, subclaven, or jugular veins
Why is the patient taught to perform the "Valsalva maneuer" prior to insertin of a CVP line?
To decrease the chance of air embolism
What's the normal CVP range?
5 to 12 cm H20
What's the normal range for the PCWP?
8 to 1