Answer Key to MS P1

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Answer Key

1. Answer: C

The priority nursing action for a patient arriving at the ED in distress is always assessment of vital signs. This indicates the extent of physical compromise and provides a baseline by which to plan further assessment and treatment. A thorough medical history, including onset of symptoms, will be necessary and it is likely that an electrocardiogram will be performed as well, but these are not the first priority. Similarly, chest exam with auscultation may offer useful information after vital signs are assessed.

2. Answer: C

It is always critical that patients being discharged from the hospital take prescribed medications as instructed. In the case of antibiotics, a full course must be completed even after symptoms have resolved to prevent incomplete eradication of the organism and recurrence of infection. The patient should resume normal activities as tolerated, as well as a nutritious diet. Continued use of the incentive spirometer after discharge will speed recovery and improve lung function.

3. Answer: C

When a family member is dying, it is most helpful for nursing staff to provide a culturally sensitive environment to the degree possible within the hospital routine. In the Vietnamese culture, it is important that the dying be surrounded by loved ones and not left alone. Traditional rituals and foods are thought to ease the transition to the next life. When possible, allowing the family privacy for this traditional behavior is best for them and the patient. Answers A, B, and D are incorrect because they create unnecessary conflict with the patient and family.

4. Answer: A

The charge nurse planning assignments must consider the skills of the staff and the needs of the patients. The labor and delivery nurse who is not experienced with the needs of cardiac patients should be assigned to those with the least acute needs. The patient who is one-week post-operative and nearing discharge is likely to require routine care. A new patient admitted with suspected MI and scheduled for angiography would require continuous assessment as well as coordination of care that is best carried out by experienced staff. The unstable patient requires staff that can immediately identify symptoms and respond appropriately. A post-operative patient also requires close monitoring and cardiac experience.

5. Answer: B

Glucagon is given to treat insulin overdose in an unresponsive patient. Following Glucagon administration, the patient should respond within 15-20 minutes at which time oral carbohydrates should be given. Glucagon reverses rather than enhances or prolongs the effects of insulin. Lipoatrophy refers to the effect of repeated insulin injections on subcutaneous fat.

6. Answer: D

One gel pad should be placed to the right of the sternum, just below the clavicle and the other just left of the precordium, as indicated by the anatomic location of the heart. To defibrillate, the paddles are placed over the pads. Options A, B, and C are not consistent with the position of the heart and are therefore incorrect responses.

7. Answer: D

All of the statements are true. The gurgles and clicks described in the question represent normal bowel sounds, which vary with the phase of digestion. Intestinal obstruction causes the sounds to intensify as the normal flow is blocked by the obstruction. The swishing and buzzing sound of turbulent blood flow may be heard in the abdomen in the presence of abdominal aortic aneurism, for example, and should always be considered abnormal.

8. Answer: A

Emergency treatment following a chemical splash to the eye includes immediate irrigation with normal saline. The irrigation should be continued for at least 10 minutes. Fluorescein drops are used to check for scratches on the cornea due to their fluorescent properties and are not part of the initial care of a chemical splash, nor is patching the eye. Following irrigation, visual acuity will be assessed.

9. Answer: D

Post-surgical nursing assessment after hip replacement should be principally concerned with the risk of neurovascular complications and the development of infection. A temperature of 101.8 F (38.7 C) postoperatively is higher than the low grade that is to be expected and should raise concern. Some pain during repositioning and following physical therapy is to be expected and can be managed with analgesics. A small amount of bloody drainage on the surgical dressing is a result of normal healing.

10. Answer: B

During a witnessed seizure, nursing actions should focus on securing the patient's safely and curtailing the seizure. Restraining the limbs is not indicated because strong muscle contractions could cause injury. A side-lying position with head flexed forward allows for drainage of secretions and prevents the tongue from falling back, blocking the airway. Rectal diazepam may be a treatment ordered by the physician, who should be notified of the seizure.

11. Answer: C

Emergency triage involves quick patient assessment to prioritize the need for further evaluation and care. Patients with trauma, chest pain, respiratory distress, or acute neurological changes are always classified number one priority. Though the patient with chest pain presented in the question recently ate a spicy meal and may be suffering from heartburn, he also may be having an acute myocardial infarction and require urgent attention. The patient with fever, headache and muscle aches (classic flu symptoms) should be classified as non-urgent. The patient with the foot injury may have sustained a sprain or fracture, and the limb should be x-rayed as soon as is practical, but the damage is unlikely to worsen if there is a delay. The child's chin laceration may need to be sutured but is also non-urgent.

12. Answer: C

Normal serum calcium is 8.5 - 10 mg/dL. The patient is hypocalcemic. Increased gastric motility, resulting in hyperactive (not hypoactive) bowel sounds, abdominal cramping and diarrhea is an indication of hypocalcemia. Numbness in hands and feet and muscle cramps are also signs of hypocalcemia. Positive Chvostek's sign refers to the sustained twitching of facial muscles following tapping in the area of the cheekbone and is a hallmark of hypocalcemia.

13. Answer: A

A patient on nasogastric suction is at risk of metabolic alkalosis as a result of loss of hydrochloric acid in gastric fluid. Of the answers given, only answer A (pH 7.52, PCO2 54 mm Hg) represents alkalosis. Answer B is a normal blood gas. Answer C represents respiratory acidosis. Answer D is borderline normal with slightly low PCO2.

14. Answer: A

The effect of Coumadin is to inhibit clotting. The next step is to check the PT and INR to determine the patient's anticoagulation status and risk of bleeding. Vitamin K is an antidote to Coumadin and may be used in a patient who is at imminent risk of dangerous bleeding. Preparation for transfusion, as described in option C, is only indicated in the case of significant blood loss. If lab results indicate an anticoagulation level that would place the patient at risk of excessive bleeding, the surgeon may choose to delay surgery and discontinue the medication.

15. Answer: A and B

Normal hemoglobin in adults is 12 - 16 g/dL. Total cholesterol levels of 200 mg/dL or below are considered normal. Total serum protein of 7.0-g/dL and glycosylated hemoglobin A1c of 5.4% are both normal levels.

16. Answer: B

An IV site that is red, warm, painful and swollen indicates that phlebitis has developed and the line should be discontinued and restarted at another site. Pain on movement should be managed by maneuvers such as splinting the limb with an IV board or gently shifting the position of the catheter before making a decision to remove the line. An IV line that is running slowly may simply need flushing or repositioning. A hematoma at the site is likely a result of minor bleeding at the time of insertion and does not require discontinuation of the line.

17. Answer: D

Fluid overload occurs when then the fluid volume infused over a short period is too great for the vascular system, causing fluid leak into the lungs. Symptoms include dyspnea, rapid respirations, and discomfort as in the patient described. Febrile non-hemolytic reaction results in fever. Symptoms of allergic transfusion reaction would include flushing, itching, and a generalized rash. Acute hemolytic reaction may occur when a patient receives blood that is incompatible with his blood type. It is the most serious adverse transfusion reaction and can cause shock and death.

18. Answer: B, C, and D

Uterine contractions typically become stronger and occur more closely together following amniotomy. The FHR is assessed immediately after the procedure and followed closely to detect changes that may indicate cord compression. The procedure itself is painless and results in the quick expulsion of amniotic fluid. Following amniotomy, cervical checks are minimized because of the risk of infection

19. Answer: D

An infant discharged home with hyperbilirubinemia (newborn jaundice) should be placed in a sunny rather than dimly lit area with skin exposed to help process the bilirubin. Frequent feedings will help to metabolize the bilirubin. A recheck of the serum bilirubin and a physical exam within 72 hours will confirm that the level is falling and the infant is thriving and is well hydrated. Signs of dehydration, including decreased urine output and skin changes, indicate inadequate fluid intake and will worsen the hyperbilirubinemia.

20. Answer: A

All infants under 1 year of age weighing less than 20 lbs. should be placed in a rear-facing infant car seat secured properly in the back seat. Infant car seats should never be placed in the front passenger seat. Infants should always be placed in an approved car seat during travel, even on that first ride home from the hospital.

source: studyguidezone.con

STAR Home TV: Sign Seeker

STAR Home TV: Sign Seeker: "A short film presented by Nestle Philippines."

Sleep Deprived? SEX!

Disclaimer: Before you raise an eyebrow or two to the word S.E.X, let me explain why this blog is called Sleep Deprived? Sex!

It's 3am in the morning when I started typing this blog entry, I'm tired and kind of dozing off into my bed, then suddenly flashed a porn site - which I'm not allowed to mention here - swiped the sleepy head in me. This blog is supposed to be about my college friends and stuff; but then, what the heck, let me just talk about Sex and Girls.

1. Sex - more than just a need, but sex - for me - is the ultimate expression of love one can give to the other. But what is it with sex that people look for? Is it the thrill of having your naked bodies touch and sweep as you jive onto the rhythm of the night? Or the feeling of holding the person you love the most, running your fingers into her/his body? Or just the exchange of bodily fluids? From a scientific point of view, sex is a need, a basic human need. More so, during coital intercourse, the "love" hormone, or the "feel good hormone" - Endorphins are released into our bloodstream in massive amounts, like its cousins that naturally occurs in nature, "Morphine and Heroine", Endorphins are quite addicting, that's why some of us ar

e addicted going to the gym - because extrane

ous activities force endorphins into our circulation: gym and sex, tantamount. More so, fondling the breast and playing with the nipples - no pun intended okay? - stimulates the pituitary gland to secrete the hormone Oxytocin; this hormone, which is also released during breast feeding and social contact promotes maternal bonding. And, let's not forget the ever so famous testosterone, which a raging pubescent male has. This hormone is not only responsible for the secondary sexual characteristics (hair growth, deep voice, etc.) but also sexual drive and wanting. Sexual arousal and excitement is basically an interplay of between physiologic, psychosomatic and social reactions. Needless to say; sex is sex, and there is nothing better than sex, but sex alone.

2. Girls - well, hold-on now howdy, how will you start the party without the guest of honor? Basically, guys can't live without their gals, and vice versa.

We coexist with each other, and we sustain each other. So girls, before saying any bitter comebacks to the phrase, "We need you as muc

h as you need us", hear me out first. How can you fornicate alone? Go on, why don't you try it? Hard, is it not? Well, actually, I'm not here to sound as macho as I can about girls and sex, my point is; is that, Girls are girls, and they need to be respected, they're not toys where we can lay waste all the time, nor to toy on their feelings. Think of it this way com padre, we only meet our once in a lifetime mademoiselle, once in a lifetime. What ever happened to chivalry ei? Always remember, never leave your house without rubbers .... I kid you. Well, kidding aside, respect begets respect, so as Love. So do nothing to harm your dear thumbelina, or else, you'll see the truth to the adage: "Hell hath no furry than a woman scorned".

Well, there you have it. My nonsense manifesto of sort, a product of a bewildered-sleep deprived bachelor.

Stay excellent dear reader and I hope to hear form you soon! Ciao!

P.S

Not every guy who's insomniac thinks about sex (don't worry girls).

EDU Downgrade

For the past century, the Philippines has long clamored for its universities and colleges to be top gunners in education in the Far East Asia. These institutions should be able to endow graduates with competence and global competitiveness. Graduate professionals who can have international recognition. From business and finance, to health and its allied sciences, the country is continuously proving its worth in these fields. However just recently, a report regarding the demand for Chinese and Indian workers at the west exposed that there number has considerably increased by tenfold compared to the last decade. Has our country’s education system lost its grandiose promise of a better tomorrow? Has the public school system’s current status and the huge decline of student enrollees around the country greatly affected the system?

My friend once said that struggle and strife comes before success, so one must climb the mountain’s top in order to go the distance. The quality of education provided by different schools may be questionable; however, the quality of students is of more concern as it has grown far worse.

I see many students indulging themselves in vices such as cigarette smoking and alcohol up to the extent that they have taken their studies for granted. A survey conducted by Trends MBL in 2007 revealed that 12% of the youth in Metro Manila and 20% in Mindanao admitted that they have tried prohibited drugs. Smoking is yet another poison corrupting our Filipino students and their health as well. Filipino students when asked if they have smoked in the past 30 days answered in the affirmative. The results revealed that 1 in every 15 students did.

Aside form these vices are the small number of students who enter college. Out of the 6 million students who entered high school in 2007, only 2.4 million or 60% enrolled in college. More so, the survival rate from 1^st year to 4^th year was only 63.88%, and completion rate was even lower – only 58.62%. On the other hand, college dropouts accounted for 73% of the Filipino college entrants (Where is our Filipino Youth Going: Rolando Cruz, The Feedback Vol. XXIII no 1).

Has the academic quality of students gone to the abyss? Learners always blame the school’s administration and their teachers - but whatever happened to the so-called “student factor.” Indeed, the teachers, the administration, and other non-teaching personnel of the school must go hand-in-hand and side-by-side if you will – when it comes to providing paramount quality of education – beyond classroom instruction, that is. However, students must do their equal share to realize the goal of education and that is beyond thoughts alone. Studying and trooping to the libraries is one great exercise not only for the brain cells but is also one preventive measure against satisfying impulsive desires. Great huh?

I have seen the majority of the student populace as mall rats and net savvy bloggers, spending all their time into marginal activities that will neither boost their academic standing nor their lives. All it gives is petty satisfaction. Seat with a book on your lap, instead of that FHM and a bottle of your favorite booze. Skip the bar hopping nights and the I’m-going to-get-so-drunk evenings – read Brunner instead. There is nothing wrong with these activities; however, spending too much time and effort on these things is quiet preposterous!

My mom’s age-old lessons of gratifying yourself with your books, indulging with the many lessons your teachers can impart to you, and learning form other people’s experiences as you make you own are until now unquestionable. Clearly, there is nothing wrong with night outs with your friends or a well deserved vacation at some remote island. It is ok to reward yourself once in a while especially after a hard day’s work though, as the theory of positive reinforcement suggests. But, let’s not forget the second part of the theory – punishment. Drop the stick that you’ll puff when you fail a quiz or spend all night studying for a quiz you need to make up for. Things should work this way – in balance and moderation.

I will not deny myself of the guilty pleasures I have, but I will not deny myself of a better future. Education is an avenue of life, it’s the great equalizer, rich and poor alike are provided the same opportunities – we are on the same playing field. Education benefits us by providing a chance to improve the general quality of life. I will not lament nor cry on the nights of bar and drinks some of my friends have asked me to, but I’ll grieve for the time they have wasted. Regret hits you in the end!

Listen to the numerous success stories of some of the rich and the famous. Now, our job is to study. After graduation? We have the rest of our lives’ to party. Definitely, struggle and strife comes before success, even in the dictionary