Study Guide

Care of a patient with a DVT, never message, maintain bed rest, and always assess
calf circumference bilaterally.
Proper positioning of the patient on the OR bed. If upper and lower extremities are
allowed to dangle off the table this can cause nerve damage. The circulating
nurses responsibility is to be the advocate for the patient and correct positioning of
the patient is part of that responsibility.
Know lab values for Calcium, Magnesium, Sodium, Potassium, etc..
Know what complications are associated with increased or decreased lab values.
For instance, if a patients calcium level is 13.3, what should the nurse anticipate to
teach the patient about testing for? Increased calcium can be associated which
disorder?
What Abnormal Calcium Results Mean

Higher than normal levels may be due to a number of health conditions. Common causes
include:

Being on bed rest for a long time

Consuming too much calcium or vitamin D

HIV/AIDS

Hyperparathyroidism

Infections that cause granulomas such as tuberculosis and certain fungal and
mycobacterial infections

Metastatic bone tumor

Multiple myeloma

Osteomalacia

Overactive thyroid gland (hyperthyroidism) or too much thyroid hormone replacement

medication

Paget's disease

Sarcoidosis

Tumors producing a parathyroid hormone-like substance

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Use of certain medications such as lithium, tamoxifen, and thiazides

Lower than normal levels may be due to:

Disorders that affect absorption of nutrients from the intestines

Hypoparathyroidism

Kidney failure

Low blood level of albumin

Liver disease

Magnesium deficiency

Osteomalacia

Pancreatitis

Vitamin D deficiency

When diverticuli becomes inflamed the patient is at risk for peritonitis. A high
nursing priority in this case is to establish an IV line and to monitor this patients
vital signs.
A young woman complains of lower abdominal pain and vomiting. The nurse would
ask questions that are useful in determining the cause of the symptoms by having
the patient describe the pain.
Hepatic encephalopathy can be caused by increased ammonia levels so when a
patient presents with hepatic encephalopathy the RN can expect increased
ammonia lab values.
To properly prepare a patient who has severe ascites who is about to have a
paracentesis procedure the nurse would instruct the patient to empty their bladder,
position the patient on upright on the side of the bed, and verify that consents are
signed.
The nurse is caring for a patient with hypovolemia who is receiving fluid
replacement. The nurse knows that the patient is improving when the patient has a
good urinary output.
When teaching a newly diagnosed type 1 diabetes patient about their diet, it is
important to instruct the patient that they cannot eat whatever they want just

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because the cover the calories with enough insulin. It is important to teach them
about proper diet.
Know flu signs and symptoms. Such as when an elderly patient who has the flu
presents with crackles in the lungs the nurse should notify the health care provider
as this a adverse finding.
A patient with Hyperkalemia is at risk for irregular heart rhythms so the nurse must
ensure to monitor the cardiac rhythm and notify the physician of any problems.
It is important to plan interventions such as the promotion of ambulation, coughing,
deep breathing, and turning a postoperative patient. The outcomes with most likely
be met if the patient readily understands the rationale for these actions. Patients
are more likely to comply when they understand.
When a nurse is assessing for signs of complications from IV therapy, she would
look for redness, warmth, and swelling at the IV site which is known as phlebitis. If
an IV has infiltrated, the site may be pale, cool, swollen, and painful.
When a patient has cancer of the lung such as small cell carcinoma, the tumor cells
may cause SIADH. The nurse would assess for weight gain in the patient as a
manifestation of SIADH.
While transfusing blood, the nurse would watch for an elevation in body
temperature as this is a possible blood transfusion reaction. Stop the transfusion
and notify the physician. Keep the line open by infusing normal saline. The tubing
and remaining blood is sent to the lab for evaluation.
A beneficial medication in the treatment of a patient with adrenal insufficiency
would be hydrocortisone. Why?
A postoperative patient has a nursing diagnosis of ineffective airway clearance. The
nurse knows that the interventions have been effective when clear breath sounds
are auscultated.
An RN suspects that a patient has a duodenal ulcer because the patient reports
having a lot of pressure like pain in the mid-epigastric area that occurs 2 or 3 hours
after eating. The patient becomes diaphoretic and doubles over in pain during
assessment. The nurse notes a board-like abdomen and suspects the ulcer may
have perforated.
The nurse notices that a patient is becoming restless and agitated while regaining
consciousness after surgery. The oxygen saturation drops to 88%. The nurse
should encourage the patient to breathe deeply in order to open the alveoli.
Know Insulin!!!! Peak, onset action, etc. Long acting, immediate acting (rapid), etc.
The nurse needs to know that when giving Humalog (Lispro) before meals that the

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onset action is 15 minutes after administration and to ensure that meal trays will be
delivered before onset in order for the patient not to become hypoglycemic.
When a patient becomes hypoglycemic, know what treatment is appropriate. For
instance, if the patient is unconscious or you are unable to arouse them, dont give
them orange juice or peanut butter! You would give oral treatments only to patients
who are responsive. If they are unresponsive you would give them glucagon.
You need to know what to teach patients with diabetes who to manage sick days.
You would instruct them to continue taking their insulin and to monitor their blood
sugar frequently. Never tell them to stop taking their insulin.
Know the test for Diabetes. HbA1C, fasting blood sugar, etc. What are you testing
for and how is the test performed. For instance the HbA1C evaluates glucose
control for over the past 3 months. Fasting blood glucose or sugar means you fast
(nothing by mouth before the test). The glucose tolerance test, also known as the oral
glucose tolerance test, measures your body's response to sugar (glucose). Eating and
drinking normally in the days leading up to the test is encouraged, but dont eat 8 hours before
the test. This test is done in several steps the patient drinks about 8 ounces of a glucose
solution.
Know Diabetes, Type 1 and Type 2. Diabetes Insipidus. Diabetic Ketoacidosis, etc.
A patient who is exhibiting Diabetes Insipidus due to a posterior pituitary tumor
should be monitored for fluid volume deficit.
If you have a patient with Diabetes, you want to teach them about exercising, esp.
the fact they the need to be sure and monitor their blood glucose before, during,
and after exercising (like swimming, running, walking).
Know what diagnostic tests would be ordered for the different GI disorders. Know
what diagnostic tests would NOT be ordered or that you would question if you saw
ordered. For instance, why would you not give a barium enema to a patient with
acute diverticulitis? You could perforate the abscessed intestine.
Be sure to review prioritization. What patient would you assess first? Always assess
before doing.
Remember that when considering the highest priority initial action for a
postoperative patient; consider what type of procedure they had. Remember if it is
immediately following surgery, monitoring for infection is not a priority. Infection
takes time to develop. Remember ABCs and remember always to assess first. Vital
signs are a part of assessment.
What are the manifestations for obstructive jaundice?

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What are the manifestations of impending hepatic encephalopathy? And which
findings suggest involvement of the CNS?
What is Asterixis?
If a patient with a DVT suddenly becomes anxious, dyspneic, tachycardic, and has
chest pain, what do you suspect? What has happened to the thrombus? What do
you call a thrombus once it becomes mobile? Where can it travel to?
What can we teach a patient with alcohol related cirrhosis about how the disease
can possibly be reversed during the early stages?
How do you assess a patient with an acute onset of pain in the lower right quadrant
for appendicitis? What is the procedure to assess called?
A patient with hypokalemia would present with EKG (ECG) changes and hypoactive
bowel sounds. Why?
Know your ABGs!!!! Be able to interpret AGBs!!!!! Is it compensated or
uncompensated?
What would be the highest priority for a patient with hemorrhaging esophageal
varices?
What would you keep at bedside for a patient with a senstaken-Blakemore tube?
Remember if they begin having respiratory distress we wouldnt want clamp the
tube we would want to ?

Know about the legality of informed consents and when they are considered acceptable and not.
For instance, Telephone consent from the father of a 17 year old unconscious male, to perform
emergency surgery? Is this acceptable?
What acid base imbalance is related to hyperventilation?
What is the primary teaching goal for a patient who has just been diagnosed with Diabetes? What
should they watch for? What should they know the signs and symptoms for?
When a patient has a JP drain (Jackson Pratt) you never want to curl the tubing and tape to the
patient as it could accidently pull the drain out. You want to check the patency of the drain and
maintain aseptic technique when emptying the drain. Observe for the amount and type of drainage
and make sure to document.
Know Billroth I and Billroth II procedures. What type of procedure are they? What are they for?
What do we teach the patient? If a patient develops dumping syndrome after a Billroth II, teach the
patient to lie down for about 30 minutes after eating.
If you auscultate crackles in a patient who is 24 hours postoperative be sure to have them turn,
cough, and deep breathe. If a patient complains it hurts too much to cough and deep breathe, be

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sure to explain the benefits and what happens to the lungs post-op and why activity is important.
Medicate the patient with prescribed PRNs to help reduce the pain and encourage deep breathing.
Look over Therapeutic communication. Open ended questions.
What is a blood cortisol test and what instructions would the nurse give the patient?
When a patient returns to recovery from surgery very sedated why would the nurse place the patient
on their side?
You have a patient with a stroke who is unconscious and unresponsive to stimuli and you know that
they have a history of GERD you want to be sure to protect the patient from aspiration which could
lead to aspiration pneumonia.
What do you want to teach a diabetic patient about foot care?
What is the correct format for a written outcome? Remember, you must be able to measure the
outcome. Who is the outcome for? What are you going to keep them from doing or help them to do?
What is the time frame? i.e. by end of shift, by end of day, by discharge, etc. How will you know it
was effective?
A nursing diagnosis that would be appropriate for a patient with a weak and non-productive cough
could be ineffective airway clearance because the patient is unable to move mucus if he has a weak
effort. What are some interventions that would be appropriate for this nursing diagnosis?
Auscultation of clear breathe sounds would prove that interventions for a patient with fluid volume
overload have been successful. What interventions would you expect for the patient with excessive
fluid volume?
Effective therapeutic communication is essential especially with a patient that has been newly
diagnosed with esophageal cancer. Statements that thinking about dying only makes you feel worse
just diminishes the patients feelings and is non-therapeutic.
In providing discharge teaching to a patient that just had a barium study an important instruction is to
tell the patient to increase their fluid intake in order to help flush the system of the barium.
When inserting an NG tube it is important to ask the patient to swallow to help facilitate easy passage
of the tube. Giving the patient small sips of water will help encourage the patient to swallow
When drawing blood for a culture or ABG analysis from a patient who is on anticoagulant therapy an
important intervention is to hold pressure to the puncture site for at least 5-10 minutes to ensure the
patient does not continue to bleed.
If a patient is about to undergo surgery the patient states, Im not sure I understand what the doctor
said, it is important to call the surgeon and inform him that the consent process is not complete since
the patient states he doesnt understand. Be sure not hold pre-op medications until the consent
process is completed. If you give pre-op medications before the consent is signed, the consent is not
legal.
You must have written physicians orders before irrigating an NG tube, instilling medications through
the NG tube, or to discontinue the NG tube. What is the gold standard for ensuring proper placement
of an NG tube?

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Know side effects of medications such as albuterol can cause an increase in the heart rate.
Its important to restrict the patient with hyponatremia intake of oral free water. What is the rationale
for this intervention?
If a patient is receiving IV fluid such as normal saline, notify the physician immediately if crackles are
heard while auscultating the lungs.
Atelectasis is an adverse complication after surgery. What are the signs and symptoms of atelectasis
that the nurse might see in a post-op patient?
A nurse instructs a patient with pneumonia splint the chest when coughing to promote airway
clearance as the pain felt by the patient with pneumonia can prevent the patient from effective
coughing and clearing the airway of mucus.
Daily weights of a patient with hypovolemia would be the most accurate assessment the nurse could
make especially if the patient has multiple draining wounds.
A patient with hyperparathyroidism that has a high urine calcium level should encourage the patient to
drink 3000-4000 ml of fluid daily. What is the rationale for this?
If the nurse notes an order that states, NG tube to continuous suction, she should call the physician
and question the order. Why do you not want the suction set to continuous?
Instructing a patient with COPD on positioning that better promotes airway clearance is important.
Sitting the patient on the side of the bed and having them lean slightly forward on the tray table is an
optimal position.
It is common for a patient with pancreatitis to receive orders for blood glucose assessment every 6
hours with a sliding scale protocol for insulin administration. Depending on the blood glucose, the
administer insulin based on the sliding scale.
If a patient receives NPH insulin at bedtime it is important to provide a bedtime snack. If the patient
refuses the snack the nurse should watch for signs and symptoms of hypoglycemia.
Know delegation! What can you delegate and to whom? Unlicensed personnel cannot assess. They
can take vitals, measure input/output, etc.
Be sure to practice dosage calculation especially infusion rates.
Which diagnostic tests would be of most value when evaluating a patient for acute pancreatitis?
When assessing a patient with a goiter possibly due to hyperthyroidism what assessment technique
would you not do?
What is the best way to control diabetes? Compliance with diet, exercise, and medication is key.
Providing a calorie and high protein diet in six small meals a day is an appropriate intervention for a
patient with a nursing diagnosis of imbalanced nutrition.
Drugs that are likely to be prescribed for the COPD patient are Corticosteroids and beta adrenergic
agonists.

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Classic signs of COPD are cough, dyspnea, and heavy mucous production.
What are side effects of long term glucocorticoids?
What is a pleurodesis?