NCSBN All System Points to Remember/Quiz
NCSBN Cardiovascular
Points to Remember
Cardiovascular disease is the leading cause of death among Americans.
Measure blood pressure correctly
o give client 5 minutes rest, with 2 to 3 minutes between checks
o take blood pressure while client is lying, sitting, and standing
o ask client if s/he has recently smoked, drank a beverage containing caffeine or
was emotionally upset; if s/he answers yes to any of the questions, repeat blood
pressure in 30 minutes
o use the correct size BP cuff
o ensure the client's arm is supported and does not have legs crossed
Rarely, the heart may lie on the right side instead of the left (this is called dextrocardia ).
Valves control the direction of the blood flow through the heart; flow is unidirectional.
When the atria contract, the atrioventricular valves swing open, allowing the blood to
flow down into the ventricles.
When the ventricles contract the valves snap shut preventing blood from flowing back up
into the atria; semilunar valves open allowing blood to eject during ventricular
contraction.
If the SA node fails to generate an impulse, the AV node takes over, generating a slower
rate. If the AV node fails to generate an impulse, the Bundle of His takes over, generating
an even slower rate. If the Bundle of His fails to generate an impulse, the Purkinje fibers
take over and generate an even slower rate.
More Points to Remember
Damaged areas of the heart may also stimulate contractions and produce arrhythmias.
Rapid, short-term control of blood pressure is achieved by cardiac and vascular reflexes
that are initiated by stretch receptors (baroreceptors) in the walls of the carotid sinus and
the aortic arch.
, Many clients with angina or who have experienced a heart attack benefit from
involvement in a structured cardiac rehabilitation program to assist clients to increase
their activity level in a monitored environment.
Current research suggests that cardiovascular changes once related aging can now be
attributed to lifestyle and personal habits.
The elderly are less able to physically adapt to stressful physical and emotional
conditions, because their hearts do three things less quickly:
o the myocardium contracts less easily
o the left ventricle ejects blood less quickly
o the heart is slower to conduct the impulse for a heartbeat
Because different enzymes are released into the blood at varying periods after a
myocardial infarction, it is important to evaluate enzyme levels in relation to the onset of
the physical symptoms, e.g., chest pain.
Clients who are in postoperative recovery, on bed rest, obese, taking hormonal
contraceptives or had knee or hip surgery should be monitored closely for the
development of thrombophlebitis.
NCSBN Respiratory
Points to Remember
Oxygen is essential for life; therefore a priority nursing action is to keep the airways open
and ease breathing effort.
COPD causes poor gas exchange in the lungs, leading to decreased oxygen levels and
increased carbon dioxide levels in the blood and shortness of breath.
Nursing interventions for clients with chronic lung disease should include pacing of
activities, because these clients have little reserve for exertion.
Treatment of COPD consists of cessation of smoking, medications to open the airways
and decrease inflammation, prevention of lung infections, oxygen supplementation, and
pulmonary rehabilitation, i.e., using diaphragmatic breathing and pursed-lip breathing,
proper use of respiratory equipment, and occupational or physical therapy.
Clients with asthma must understand the different types of inhalers and when to use each
type: some rescue inhalers are for acute dyspnea while other inhalers are for maintenance
or prevention.
, To maximize therapeutic effect of inhalers, the key is technique; teach clients the right
technique and observe how well they use the inhaler.
Points to Remember 2
A pulse oximeter reading is simply one element of an assessment; it is not the whole
picture. Arterial blood gases will give a more complete picture of oxygenation.
Cyanosis, a late finding, is determined by oxygenation and hemoglobin content.
Clients with anemia may be severely hypoxemic and never turn blue; they may appear
ashen. Remember to check nail beds and mucous membrane for changes; don't forget
different skin coloring affects the appearance of anemia.
Clients with polycythemia may be cyanotic with adequate tissue oxygenation.
The serious public health issue of pulmonary tuberculosis requires control and reporting
of any incidence and recent contacts that the client had so prophylactic therapy for two to
three months can be initiated.
Clients with pulmonary tuberculosis (TB) need intensive community follow up to ensure
that they continue with long term pharmacological treatment. Clients who stop therapy
too soon are a source for more deadly multi-drug resistant forms of pulmonary TB.
Points to Remember 3
If an alarm sounds on a ventilator, first assess the client. If the alarm continues to sound
and the client develops distress, disconnect the client from the ventilator, use a manual
resuscitation bag to ventilate with 100% oxygen, and page or call the respiratory therapist
or the rapid response team immediately.
If the high pressure alarm sounds on the ventilator, the nurse should check for some type
of obstruction or occlusion of the airway: mucous plugs, biting of the tube by the client,
the tube has slipped into right main stem bronchus, or increased secretions.
Smoking cessation is critical to reduce the risk and severity of lung disease.
Second-hand smoke enhances the risk of children to develop asthma or other chronic
lung diseases.
The best approach to pulmonary embolus is prevention; use compression stockings
(TEDS), along with sequential compression devices (SCDs), range of motion exercises
(passive or active), and repositioning, to help prevent clots in the deep veins.
, When caring for a client who just had a chest tube inserted, validate that there's no leak
from the lung. Only when there is no leak should an occlusive dressing be applied.
Gentle tidaling is expected in the water seal chamber of a chest tube; continuous bubbling
indicates an air leak and requires immediate intervention.
NCSBN Neurological
Points to Remember
Peripheral nerves can regenerate whereas nerves in the spinal cord do not regenerate.
Cranial nerves can have either motor or sensory functions or both motor and sensory
functions.
In multiple sclerosis, early changes tend to be in vision and motor sensation; late changes
tend to be in cognition and bowel control.
During a seizure, do not force anything into the client's mouth or attempt to suction the
mouth.
Tremors associated with Parkinson's disease occur at rest; they disappear when the client
reaches for something.
Alzheimer's victims should not be concurrently treated with donepezil (Aricept) and the
antidepressant paroxetine (Paxil). Donepezil increases acetylcholine in the brain and
paroxetine works by decreasing acetylcholine levels in the brain.
The client with myasthenia gravis will have more severe muscle weakness in the evening
due to the fact that muscles weaken with activity - described as progressive muscle
weakness - and clients usually regain strength with rest.
When caring for a comatose client, remember that the hearing is the last sense to be lost.
A major problem often associated with a left-sided brain infarction (CVA) is an alteration
in communication.
Clients with CVAs are at a greater risk for aspiration; evaluate to determine if dysphagia
is present.
Changes in a client's respirations (rate, rhythm and depth) are more sensitive indicators of
increases in intracranial pressure than blood pressure and pulse.
After a CVA, clients often have a loss of memory, emotional lability and a decreased
attention span.
NCSBN Cardiovascular
Points to Remember
Cardiovascular disease is the leading cause of death among Americans.
Measure blood pressure correctly
o give client 5 minutes rest, with 2 to 3 minutes between checks
o take blood pressure while client is lying, sitting, and standing
o ask client if s/he has recently smoked, drank a beverage containing caffeine or
was emotionally upset; if s/he answers yes to any of the questions, repeat blood
pressure in 30 minutes
o use the correct size BP cuff
o ensure the client's arm is supported and does not have legs crossed
Rarely, the heart may lie on the right side instead of the left (this is called dextrocardia ).
Valves control the direction of the blood flow through the heart; flow is unidirectional.
When the atria contract, the atrioventricular valves swing open, allowing the blood to
flow down into the ventricles.
When the ventricles contract the valves snap shut preventing blood from flowing back up
into the atria; semilunar valves open allowing blood to eject during ventricular
contraction.
If the SA node fails to generate an impulse, the AV node takes over, generating a slower
rate. If the AV node fails to generate an impulse, the Bundle of His takes over, generating
an even slower rate. If the Bundle of His fails to generate an impulse, the Purkinje fibers
take over and generate an even slower rate.
More Points to Remember
Damaged areas of the heart may also stimulate contractions and produce arrhythmias.
Rapid, short-term control of blood pressure is achieved by cardiac and vascular reflexes
that are initiated by stretch receptors (baroreceptors) in the walls of the carotid sinus and
the aortic arch.
, Many clients with angina or who have experienced a heart attack benefit from
involvement in a structured cardiac rehabilitation program to assist clients to increase
their activity level in a monitored environment.
Current research suggests that cardiovascular changes once related aging can now be
attributed to lifestyle and personal habits.
The elderly are less able to physically adapt to stressful physical and emotional
conditions, because their hearts do three things less quickly:
o the myocardium contracts less easily
o the left ventricle ejects blood less quickly
o the heart is slower to conduct the impulse for a heartbeat
Because different enzymes are released into the blood at varying periods after a
myocardial infarction, it is important to evaluate enzyme levels in relation to the onset of
the physical symptoms, e.g., chest pain.
Clients who are in postoperative recovery, on bed rest, obese, taking hormonal
contraceptives or had knee or hip surgery should be monitored closely for the
development of thrombophlebitis.
NCSBN Respiratory
Points to Remember
Oxygen is essential for life; therefore a priority nursing action is to keep the airways open
and ease breathing effort.
COPD causes poor gas exchange in the lungs, leading to decreased oxygen levels and
increased carbon dioxide levels in the blood and shortness of breath.
Nursing interventions for clients with chronic lung disease should include pacing of
activities, because these clients have little reserve for exertion.
Treatment of COPD consists of cessation of smoking, medications to open the airways
and decrease inflammation, prevention of lung infections, oxygen supplementation, and
pulmonary rehabilitation, i.e., using diaphragmatic breathing and pursed-lip breathing,
proper use of respiratory equipment, and occupational or physical therapy.
Clients with asthma must understand the different types of inhalers and when to use each
type: some rescue inhalers are for acute dyspnea while other inhalers are for maintenance
or prevention.
, To maximize therapeutic effect of inhalers, the key is technique; teach clients the right
technique and observe how well they use the inhaler.
Points to Remember 2
A pulse oximeter reading is simply one element of an assessment; it is not the whole
picture. Arterial blood gases will give a more complete picture of oxygenation.
Cyanosis, a late finding, is determined by oxygenation and hemoglobin content.
Clients with anemia may be severely hypoxemic and never turn blue; they may appear
ashen. Remember to check nail beds and mucous membrane for changes; don't forget
different skin coloring affects the appearance of anemia.
Clients with polycythemia may be cyanotic with adequate tissue oxygenation.
The serious public health issue of pulmonary tuberculosis requires control and reporting
of any incidence and recent contacts that the client had so prophylactic therapy for two to
three months can be initiated.
Clients with pulmonary tuberculosis (TB) need intensive community follow up to ensure
that they continue with long term pharmacological treatment. Clients who stop therapy
too soon are a source for more deadly multi-drug resistant forms of pulmonary TB.
Points to Remember 3
If an alarm sounds on a ventilator, first assess the client. If the alarm continues to sound
and the client develops distress, disconnect the client from the ventilator, use a manual
resuscitation bag to ventilate with 100% oxygen, and page or call the respiratory therapist
or the rapid response team immediately.
If the high pressure alarm sounds on the ventilator, the nurse should check for some type
of obstruction or occlusion of the airway: mucous plugs, biting of the tube by the client,
the tube has slipped into right main stem bronchus, or increased secretions.
Smoking cessation is critical to reduce the risk and severity of lung disease.
Second-hand smoke enhances the risk of children to develop asthma or other chronic
lung diseases.
The best approach to pulmonary embolus is prevention; use compression stockings
(TEDS), along with sequential compression devices (SCDs), range of motion exercises
(passive or active), and repositioning, to help prevent clots in the deep veins.
, When caring for a client who just had a chest tube inserted, validate that there's no leak
from the lung. Only when there is no leak should an occlusive dressing be applied.
Gentle tidaling is expected in the water seal chamber of a chest tube; continuous bubbling
indicates an air leak and requires immediate intervention.
NCSBN Neurological
Points to Remember
Peripheral nerves can regenerate whereas nerves in the spinal cord do not regenerate.
Cranial nerves can have either motor or sensory functions or both motor and sensory
functions.
In multiple sclerosis, early changes tend to be in vision and motor sensation; late changes
tend to be in cognition and bowel control.
During a seizure, do not force anything into the client's mouth or attempt to suction the
mouth.
Tremors associated with Parkinson's disease occur at rest; they disappear when the client
reaches for something.
Alzheimer's victims should not be concurrently treated with donepezil (Aricept) and the
antidepressant paroxetine (Paxil). Donepezil increases acetylcholine in the brain and
paroxetine works by decreasing acetylcholine levels in the brain.
The client with myasthenia gravis will have more severe muscle weakness in the evening
due to the fact that muscles weaken with activity - described as progressive muscle
weakness - and clients usually regain strength with rest.
When caring for a comatose client, remember that the hearing is the last sense to be lost.
A major problem often associated with a left-sided brain infarction (CVA) is an alteration
in communication.
Clients with CVAs are at a greater risk for aspiration; evaluate to determine if dysphagia
is present.
Changes in a client's respirations (rate, rhythm and depth) are more sensitive indicators of
increases in intracranial pressure than blood pressure and pulse.
After a CVA, clients often have a loss of memory, emotional lability and a decreased
attention span.
