NUR 3219C Care Management
Fall 2019 Care ManagementIIII Exam 2 Study Guide
Exam 2 Study Guide
Fall 2019
1. Metabolic acidosis. The respiratory system compensates by increasing its activity
and blowing off excess carbon dioxide. pH (acid) 7.35- 7.45 (alkaline)
Metabolic acidosis occurs when: diabetic ketoacidosis
KUSSMAL deep rapid respirations
Starvation
Hypoxia, ischemia
Fevers
Seizures
Kidney failure, liver failure , pancreatitis, diabetes
Type 1 diabetes
Ingestion od acids ( aspirin: salicylate)
(Hyperpnea : increased rate and depth of breath)
The body produces excess amounts of acid (ketoacid or lactic acid) the kidneys cant
remove enough from the body the respiratory tries to compensate
Interventions drug therapy antidiarrheals insulin to treat DKA
2. Recognize early cardiovascular changes for a patient experiencing moderate acidosis.
Delayed electrical conduction (AV node conduction)
Ranges from bradycardia to heart block: electrical signals are blocked abnormal heart
rhythm (Normal heart 60-100)
Tall T waves: this suggests hyperkalemia
(hyperventilation) Widened QRS complex
Prolonged PR interval
Hypotension
Thready peripheral pulse
3. What are dietary actions that can cause metabolic alkalosis?
Alkalosis pH >7.45 Antacids Total parenteral nutrition excess bicarbonate/ citrate
4. What interventions are most important for patients with respiratory acidosis?
pH <7.35 Improving gas exchange
drug therapy: bronchodilators/ mucolytics/ anti inflammatory
oxygen therapy (keep at or above 90% oxygen sat)
pulmonary positioning & breathing
Mechanical ventilation
5. What is the best method to confirm proper placement of a central venous access device?
Chest X-ray (before solutions are infused)
They require confirmation of tip location at the caval-atrial junction (CAJ)
6. What activity can dislodge the PICC catheter or occlude the lumen?
Muscle contraction of the arm / physical activity/ heavy lifting
7. Discuss how compartment syndrome can lead to complications with a PICC line.
When increased tissue perfusion in a confined space causes decreased flow to the area
This study source was downloaded by 100000815611969 from CourseHero.com on 02-07-2023 22:55:02 GMT -06:00
https://www.coursehero.com/file/51715737/NUR-3219C-Care-Management-II-Exam-2-Study-Guide-Fall-2019docx/
, NUR 3219C Care Management
Fall 2019 Care ManagementIIII Exam 2 Study Guide
Exam 2 Study Guide
Fall 2019
8. What action should the nurse take when a PICC line insertion site is swollen?
Apply continuous heat, rest, and elevate the extremity. Remove catheter if this treatment
is unsuccessful.
9. Grade 3 phlebitis at an IV site is indicated by what assessment
findings? Pain at access site with erythema and / or edema
Streak formation
Palpable cord
10. What is the most appropriate size syringe to use when flushing a PICC
line? 10mL syringe
11. A patient has questions about complications regarding her surgery while signing the
consent form. How should the nurse respond?
Contact the surgeon and request that they see the patient for further clarification.
12. How should the nurse teach a patient to cough and deep breathe?
Discussion, demonstration with return demonstration and practice. Incentive spirometry
13. What should the patient be taught about pre-op cleansing at home?
One or two days prior shower with antiseptic solution
Clean well around surgical site
No shaving
14. Assessment and intervention of post op drain insertion site.
Assess for maintenance of suction/ empty drain / evaluate type and color of drainage /
dressing should be clean and dry /
15. Reglan increases gastric emptying and is useful for emergency surgery.
Given prior to surgery to dry up stomach secretions even if pt hasn’t been NPO (NO
vomiting)
16. Patient has had sedation and needs to urinate. What should be nurse do to facilitate
urination and prevent falls. Provide patient with a urinal/ bedpan/
17. How should the nurse assess the patient’s anxiety? Providing emotional support,
ongoing explanation of procedures, and including family give anti anxiety meds promote
sleep communication distraction teach family members
18. When should an antibiotic be timed to be given pre-operatively? Why is this timing
important? One hour prior to surgery so the levels of antibiotics are at their peak for
surgery. (then typically every 4 hours )
This study source was downloaded by 100000815611969 from CourseHero.com on 02-07-2023 22:55:02 GMT -06:00
https://www.coursehero.com/file/51715737/NUR-3219C-Care-Management-II-Exam-2-Study-Guide-Fall-2019docx/
Fall 2019 Care ManagementIIII Exam 2 Study Guide
Exam 2 Study Guide
Fall 2019
1. Metabolic acidosis. The respiratory system compensates by increasing its activity
and blowing off excess carbon dioxide. pH (acid) 7.35- 7.45 (alkaline)
Metabolic acidosis occurs when: diabetic ketoacidosis
KUSSMAL deep rapid respirations
Starvation
Hypoxia, ischemia
Fevers
Seizures
Kidney failure, liver failure , pancreatitis, diabetes
Type 1 diabetes
Ingestion od acids ( aspirin: salicylate)
(Hyperpnea : increased rate and depth of breath)
The body produces excess amounts of acid (ketoacid or lactic acid) the kidneys cant
remove enough from the body the respiratory tries to compensate
Interventions drug therapy antidiarrheals insulin to treat DKA
2. Recognize early cardiovascular changes for a patient experiencing moderate acidosis.
Delayed electrical conduction (AV node conduction)
Ranges from bradycardia to heart block: electrical signals are blocked abnormal heart
rhythm (Normal heart 60-100)
Tall T waves: this suggests hyperkalemia
(hyperventilation) Widened QRS complex
Prolonged PR interval
Hypotension
Thready peripheral pulse
3. What are dietary actions that can cause metabolic alkalosis?
Alkalosis pH >7.45 Antacids Total parenteral nutrition excess bicarbonate/ citrate
4. What interventions are most important for patients with respiratory acidosis?
pH <7.35 Improving gas exchange
drug therapy: bronchodilators/ mucolytics/ anti inflammatory
oxygen therapy (keep at or above 90% oxygen sat)
pulmonary positioning & breathing
Mechanical ventilation
5. What is the best method to confirm proper placement of a central venous access device?
Chest X-ray (before solutions are infused)
They require confirmation of tip location at the caval-atrial junction (CAJ)
6. What activity can dislodge the PICC catheter or occlude the lumen?
Muscle contraction of the arm / physical activity/ heavy lifting
7. Discuss how compartment syndrome can lead to complications with a PICC line.
When increased tissue perfusion in a confined space causes decreased flow to the area
This study source was downloaded by 100000815611969 from CourseHero.com on 02-07-2023 22:55:02 GMT -06:00
https://www.coursehero.com/file/51715737/NUR-3219C-Care-Management-II-Exam-2-Study-Guide-Fall-2019docx/
, NUR 3219C Care Management
Fall 2019 Care ManagementIIII Exam 2 Study Guide
Exam 2 Study Guide
Fall 2019
8. What action should the nurse take when a PICC line insertion site is swollen?
Apply continuous heat, rest, and elevate the extremity. Remove catheter if this treatment
is unsuccessful.
9. Grade 3 phlebitis at an IV site is indicated by what assessment
findings? Pain at access site with erythema and / or edema
Streak formation
Palpable cord
10. What is the most appropriate size syringe to use when flushing a PICC
line? 10mL syringe
11. A patient has questions about complications regarding her surgery while signing the
consent form. How should the nurse respond?
Contact the surgeon and request that they see the patient for further clarification.
12. How should the nurse teach a patient to cough and deep breathe?
Discussion, demonstration with return demonstration and practice. Incentive spirometry
13. What should the patient be taught about pre-op cleansing at home?
One or two days prior shower with antiseptic solution
Clean well around surgical site
No shaving
14. Assessment and intervention of post op drain insertion site.
Assess for maintenance of suction/ empty drain / evaluate type and color of drainage /
dressing should be clean and dry /
15. Reglan increases gastric emptying and is useful for emergency surgery.
Given prior to surgery to dry up stomach secretions even if pt hasn’t been NPO (NO
vomiting)
16. Patient has had sedation and needs to urinate. What should be nurse do to facilitate
urination and prevent falls. Provide patient with a urinal/ bedpan/
17. How should the nurse assess the patient’s anxiety? Providing emotional support,
ongoing explanation of procedures, and including family give anti anxiety meds promote
sleep communication distraction teach family members
18. When should an antibiotic be timed to be given pre-operatively? Why is this timing
important? One hour prior to surgery so the levels of antibiotics are at their peak for
surgery. (then typically every 4 hours )
This study source was downloaded by 100000815611969 from CourseHero.com on 02-07-2023 22:55:02 GMT -06:00
https://www.coursehero.com/file/51715737/NUR-3219C-Care-Management-II-Exam-2-Study-Guide-Fall-2019docx/
