Advanced Med-Surg Proctored ATI
Review/151 Questions and Answers.
Arterial Blood Gas - -ABG's via arterial puncture or arterial line: allows the
most accurate method of assessing respiratory function.
-Steps for collecting ABG's - -a. Perform Allen test if no arterial line
b. sample is drawn into heparinized syringe
c. keep on ice and transport to laboratory immediately
d. document amount and method of oxygen delivered for accurate results
e. apply direct pressure to puncture site at least 5 min (longer for clients at
risk for bleeding)
-Bronchoscopy - -visualizes the larynx, trachea, bronchi; obtains tissue
biopsy; and removes foreign bodies.
-Steps for a bronchoscopy procedure - -a. obtain informed consent
b. maintains NPO 8 to 12 hr.
c. Provide local anesthetic throat spray
d. position upright
e. administers medications as prescribed, such as atropine (to reduce oral
secretions), sedation, and/or anti-anxiety.
f. label specimen
g. observe postprocedure
-gag reflex
-bleeding
-respiratory status, vital signs, and level of consciousness
-Mantoux test - -Positive test indicates exposure to tuberculosis. Diagnosis
must be confirmed with sputum culture for presence of acid-fast bacillus
(AFB).
-Mantoux test steps - -a. administer 0.1 mL of purified protein derivation
intradermal to upper half inner surface of forearm (insert needle bevel up)
b. Assess for reaction in 48 to 72 hr following injection; induration
(hardening) of 10 mm or greater is considered a positive test; 5 mm may be
considered significant if immunocompromised.
, -QuantiFERON-TB Gold test (QFT-GT) and T-SPOT.TB - -Identify the presence
of Mycobacterium tuberculosis infection by measuring the immune response
to the TB bacteria in whole blood.
-Thoracentesis - -Surgical perforation of the pleural space to obtain
specimen, to remove fluid or air, or to instill medication.
-Steps for Thoracentesis - -a. informed consent
b. educate client: remain still, feeling of pressure, positioning
c. position upright
d. monitor respiratory status and vital signs
e. label specimens
f. Document client response, amount, color and viscosity of fluid (maximum
amount of fluid to be removed at a time is 1L).
g. Chest tube at bedside
h. Obtain CXR before and after procedure
-Asthma - -Chronic inflammatory disorder of the airways resulting in
intermittent and reversible airflow obstruction of the bronchioles.
-Contributing factors of asthma - --Extrinsic: antigen-antibody reaction
triggered by food, medications, or inhaled substances
-Intrinsic: pathophysiological abnormalities within the respiratory tract
-Older clients: beta receptors are less responsive to agonist and trigger
bronchospasms.
-Manifestations of asthma - --Sudden, severe dyspnea with use of accessory
muscles
-sitting up, leaning forward
-diaphoresis and anxiety
-wheezing, gasping
-coughing
-cyanosis (late sign)
-barrel chest
-Diagnostic procedures for asthma - --ABGs
-sputum cultures
-pulmonary function tests
, -Nursing interventions for asthma - --remain with the client during the
attack
-position in high-fowler's
-assess lung sounds and pulse oximetry
-administer oxygen therapy
-maintain oxygen access
-Medications for athma - -Administer bronchodilators before anti-
inflammatory
1. Bronchodilators
-short-acting inhaled: albuterol; for rapid relief
-Methylxanthines: theophylline; monitor therapeutic range for toxicity.
2. Anti-inflammatory
-corticosteriods: fluticasone and prednisone
-Leukotriene antagonist: montelukast
3. Combination agents
-Ipratropium and albuterol (Combivent)
-Fluticasone and salmeterol (Advair)
-Therapeutic measures for asthma - --respiratory treatments
-oxygen administration
-Client Education for asthma - --avoidance of allergens and triggers
-proper use of inhaler and peak flow monitoring
-Status asthmaticus - -life-threatening episode of airway obstruction this is
often unresponsive to treatment
-Manifestations of status asthmaticus - --extreme wheezing
-labored breathing
-use of accessory muscles
-distended neck veins
-high risk for cardiac and/or respiratory arrest
-Nursing interventions for status asthmaticus - --place in high-fowler's
-prepare for emergency intubation
-administer oxygen, epinephrine, and systemic steroid as prescribed
-provide emotional support
Review/151 Questions and Answers.
Arterial Blood Gas - -ABG's via arterial puncture or arterial line: allows the
most accurate method of assessing respiratory function.
-Steps for collecting ABG's - -a. Perform Allen test if no arterial line
b. sample is drawn into heparinized syringe
c. keep on ice and transport to laboratory immediately
d. document amount and method of oxygen delivered for accurate results
e. apply direct pressure to puncture site at least 5 min (longer for clients at
risk for bleeding)
-Bronchoscopy - -visualizes the larynx, trachea, bronchi; obtains tissue
biopsy; and removes foreign bodies.
-Steps for a bronchoscopy procedure - -a. obtain informed consent
b. maintains NPO 8 to 12 hr.
c. Provide local anesthetic throat spray
d. position upright
e. administers medications as prescribed, such as atropine (to reduce oral
secretions), sedation, and/or anti-anxiety.
f. label specimen
g. observe postprocedure
-gag reflex
-bleeding
-respiratory status, vital signs, and level of consciousness
-Mantoux test - -Positive test indicates exposure to tuberculosis. Diagnosis
must be confirmed with sputum culture for presence of acid-fast bacillus
(AFB).
-Mantoux test steps - -a. administer 0.1 mL of purified protein derivation
intradermal to upper half inner surface of forearm (insert needle bevel up)
b. Assess for reaction in 48 to 72 hr following injection; induration
(hardening) of 10 mm or greater is considered a positive test; 5 mm may be
considered significant if immunocompromised.
, -QuantiFERON-TB Gold test (QFT-GT) and T-SPOT.TB - -Identify the presence
of Mycobacterium tuberculosis infection by measuring the immune response
to the TB bacteria in whole blood.
-Thoracentesis - -Surgical perforation of the pleural space to obtain
specimen, to remove fluid or air, or to instill medication.
-Steps for Thoracentesis - -a. informed consent
b. educate client: remain still, feeling of pressure, positioning
c. position upright
d. monitor respiratory status and vital signs
e. label specimens
f. Document client response, amount, color and viscosity of fluid (maximum
amount of fluid to be removed at a time is 1L).
g. Chest tube at bedside
h. Obtain CXR before and after procedure
-Asthma - -Chronic inflammatory disorder of the airways resulting in
intermittent and reversible airflow obstruction of the bronchioles.
-Contributing factors of asthma - --Extrinsic: antigen-antibody reaction
triggered by food, medications, or inhaled substances
-Intrinsic: pathophysiological abnormalities within the respiratory tract
-Older clients: beta receptors are less responsive to agonist and trigger
bronchospasms.
-Manifestations of asthma - --Sudden, severe dyspnea with use of accessory
muscles
-sitting up, leaning forward
-diaphoresis and anxiety
-wheezing, gasping
-coughing
-cyanosis (late sign)
-barrel chest
-Diagnostic procedures for asthma - --ABGs
-sputum cultures
-pulmonary function tests
, -Nursing interventions for asthma - --remain with the client during the
attack
-position in high-fowler's
-assess lung sounds and pulse oximetry
-administer oxygen therapy
-maintain oxygen access
-Medications for athma - -Administer bronchodilators before anti-
inflammatory
1. Bronchodilators
-short-acting inhaled: albuterol; for rapid relief
-Methylxanthines: theophylline; monitor therapeutic range for toxicity.
2. Anti-inflammatory
-corticosteriods: fluticasone and prednisone
-Leukotriene antagonist: montelukast
3. Combination agents
-Ipratropium and albuterol (Combivent)
-Fluticasone and salmeterol (Advair)
-Therapeutic measures for asthma - --respiratory treatments
-oxygen administration
-Client Education for asthma - --avoidance of allergens and triggers
-proper use of inhaler and peak flow monitoring
-Status asthmaticus - -life-threatening episode of airway obstruction this is
often unresponsive to treatment
-Manifestations of status asthmaticus - --extreme wheezing
-labored breathing
-use of accessory muscles
-distended neck veins
-high risk for cardiac and/or respiratory arrest
-Nursing interventions for status asthmaticus - --place in high-fowler's
-prepare for emergency intubation
-administer oxygen, epinephrine, and systemic steroid as prescribed
-provide emotional support
