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NUR 242 Exam 4 study test guide with 100% complete solution
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NUR 242 Exam 4 study test guide with 100% complete solution
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NUR 242 Exam 4 study test guide with100% complete solution
Normal BP - ANS Systolic <120 / Diastolic <80
Pre-HTN - ANS Systolic =120-139 / Diastolic=80-89
Stage 1 HTN - ANS Systolic=140-159 / Diastolic=90-99
Stage 2 HTN - ANS Systolic=>160 / Diastolic=>100
Malignant HTN - ANS Extremely high BP >180/110
S/S of Malignant HTN - ANS initially asymptomatic, headache upon awakening, blurred
vision, dizziness, chest pain, difficult breathing, numbness in face and legs, tinnitus, flushed
face, epistaxis
HTN Crisis - ANS acute and life threatening; accelerated HTN requires ER treatment
because organ damage can occur quickly
Pharmacological interventions for HTN - ANS ACE Inhibitors, Diuretics, Calcium Channel
Blockers, ARBs, and Beta Blockers
What symptom should you report right away with ACE Inhibitors? - ANS Dry nagging
cough- discontinue immediately and teach about orthostatic HTN in elderly
What is an example of an ACE inhibitor drug? - ANS Lisinopril, Enalapril
What is an example of a Calcium Channel Blocker? - ANS Verapamil, Amlodopine
What is an example of an ARB? - ANS Losartan, Valsartan
What is an example of a Beta Blocker? - ANS Metoprolol, Atenolol
Pt. teaching for Raynauds disease - ANS Stop smoking, avoid cold and stress, wear warm
clothing, take vasodilators as prescribed
Pt. teaching for Burgers Disease - ANS Use vasodilators as prescribed, smoking cessation,
avoid injury to upper and lower extremities, can cause gangrene
, S/S of Peripheral Arterial Disease (PAD) - ANS Leg pain, burning, cramping muscle
discomfort when walking that stops at rest. As the disease persists the pt can walk shorter
distances
Post-OP Care for Femoral Artery Bypass graft? - ANS warmth, redness and edema are
expected. Monitor for possible occlusion and continuous aching pain (first sign of occlusion)
Throbbing pain is due to increased blood flow to the area.
Notify the physician immediately if they experience what S/S after a femoral artery graft? -
ANS Cold, pale, cyanotic skin or decreased pulse
Amputation complications: - ANS infection, phantom limb pain, flexion contractions
Amputation Post-OP care: - ANS -DO NOT elevate limb on pillow (can cause flexion
contractures)
-1st 24 hours elevate the foot of the bed to decrease edema then keep the bed flat
-24-48 hours- place the pt. in prone position to stretch muscles and prevent hip flexion
contractures
Pt with a DVT is at high risk for? - ANS PE
DVT S/S - ANS -calf/groin tenderness
-sudden unilateral swelling
-positive Homans sign
DVT Risk Factors - ANS -venous stasis from varicose veins
-heart failure
-immobility
-use of birth control
-ulcerative colitis
-prolonged bedrest
DVT interventions: - ANS -SCDs
-Compression hose
-Elevate extremities
-IV continuous Heparin
When a pt. is on IV continuous Heparin, what lab values do you monitor? - ANS aPTT
Values
What is the normal aPTT range? - ANS 30-40 seconds
1.5-3 times normal control levels
*Call the MD if >70 seconds*
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