203D Beth's Final

Question 1

Clinical manifestations of acromegaly

Answer 1

coarse facial features and a thick tongue (may occlude airway)

Question 2

transsphenoidal hypophysectomy for pituitary adenoma teaching

Answer 2

you will not be able to brush your teeth for several days after surgery

Question 3

Intervention for fluid volume excess r/t SIADH

Answer 3

maintain fluid restriction as ordered

Question 4

Nurse suspects DI upon finding

Answer 4

urine specific gravity 1.003 (low)

Question 5

Hyperparathyroid, Ca+ 14 (high), phos 1.7 (low). Include which nursing action?

Answer 5

Increase oral fluids

Question 6

Hypoparathyroid for 20 years, assess for?

Answer 6

Tetany

Question 7

Hypoparathyroid teaching, calcium levels altered because role of parathyroid is to?

Answer 7

stimulate bone resorption, increasing calcium when levels fall

Question 8

Assess for tetany by

Answer 8

tapping facial nerve proximal to ear

Question 9

SIADH assessment findings

Answer 9

ADH increased (urine volume decreased), serum osmolality decreased, urine sp. gr. increased

Question 10

34 yo female, constipation, cold all the time, can’t get anything done, hair falling out. What does she have?

Answer 10

Myxedema (severe hypothyroid)

Question 11

Post-op hypophysectomy, monitor for?

Answer 11

Hypopituitaryism

Question 12

Pt. with untreated hypothyroidism, nurse should question which order?

Answer 12

Sedatives

Question 13

Hyperthyroid symptoms

Answer 13

nervousness, irritability, tachycardia, heat intolerance

Question 14

Exophthalmos (bug eyes) nursing interventions

Answer 14

lubricating eye drops, instruct patient to blink often

Question 15

Hypothyroid pt. with new Synthroid prescribed, assess what?

Answer 15

blood pressure and heart rate

Question 16

Assessment findings for DI

Answer 16

ADH decreased (urine volume increased), serum osmolality increased, urine sp. gr. decreased

Question 17

Early manifestation associated with hypo-pituitary

Answer 17

headache, visual changes, loss of smell

Question 18

Parathyroidectomy complications

Answer 18

hematoma at surgical site, vocal cord paralysis, increased bleeding with coughing

Question 19

Thyroid storm s/sx

Answer 19

severe tachycardia, hyperthermia, agitation/delirium/psychosis

Question 20

Cushing’s patient teaching: dexamethasone test involves

Answer 20

administered dexamethasone orally at 11PM, take plasma cortisol at 8AM next morning

Question 21

Pheochromocytoma complains of sweating, palpitations, and HA. Nurse should assess what first?

Answer 21

blood pressure (hallmark sign is severe HTN)

Question 22

Pheochromocytoma patients have

Answer 22

excessive catecholamine

Question 23

Addison’s pt. should consult MD if they experience this side effect of Florinef

Answer 23

rapid weight gain and dependent edema

Question 24

Clinical manifestations of Addison’s include

Answer 24

hyper K, hyperpigmentation, decreased resistance to stress

Question 25

Addison's crisis priority

Answer 25

prevent shock

Question 26

Receiving too much glocucorticoid replacement s/sx

Answer 26

moon face

Question 27

SIADH, what should be reported to physician

Answer 27

serum sodium 112 and headache

Question 28

Vomiting for 2 days, unable to take glucocorticoids. Anticipate that the patient may

Answer 28

develop adrenal insufficiency

Question 29

Corticosteroid therapy teaching

Answer 29

don't stop taking abruptly, taper off dosages as prescribed

Question 30

To measure effectiveness of steroid therapy, cortisol levels should be measured when?

Answer 30

8AM and 4PM

Question 31

Cushing's syndrome assessment reveals truncal obesity, thin arms/legs, what is another expected assessment finding?

Answer 31

purple/red striae on abdomen

Question 32

Idiopathic Cushing's disease rationale

Answer 32

taking steroids for another disease process

Question 33

Teach pt with hyper-cortisol to avoid consuming what?

Answer 33

caffeine

Question 34

Why is IV hydrocortisone ordered prior to bilateral adrenalectomy?

Answer 34

to compensate for the sudden lack of hormones following surgery

Question 35

Priority assessment post-op bilateral adrenalectomy?

Answer 35

vital signs

Question 36

Bilateral adrenalectomy pt teaching

Answer 36

wear a medical alert bracelet or necklace at all times

Question 37

Assess this pt. first

Answer 37

72 yo pt. that just started taking levothyroxine, pulse irregular, 134

Question 38

Flexion of arms, wrists, and fingers in comatose pt. is called what?

Answer 38

decorticate posturing

Question 39

Increased ICP pt should not receive what?

Answer 39

enemas

Question 40

midline tongue cranial nerve

Answer 40

12

Question 41

GCS 7, include which interventions

Answer 41

decrease noxious stimuli, HOB 30-45*, monitor VS

Question 42

When physician obtains spinal fluid from lumbar puncture, the nurse should?

Answer 42

obtain FSBG for comaprison

Question 43

Early sign of increased ICP

Answer 43

change in LoC

Question 44

Nursing diagnosis of ineffective breathing/airway for?

Answer 44

loss of cough/gag reflexes

Question 45

Most significant observation to report when monitoring a pt with increased ICP is?

Answer 45

decreasing pulse, Cheynne-Stokes respirations, widening pulse pressure

Question 46

For increased ICP pt, elevating HoB and straight alignment positioning are effective because they?

Answer 46

promote venous drainage

Question 47

Pt with inserted ICP monitor, the nurse should intervene when?

Answer 47

intervene when CPP > 15

Question 48

Craniotomy family teaching, purpose of bone flap is to?

Answer 48

accommodate for post-op brain swelling

Question 49

Post-op craniotomy pt, which action by the inexperienced nurse requires the charge nurse to intervene?

Answer 49

the staff nurse suctions pt. every 2 hours (may increase ICP)

Question 50

sub-arachnoid hemorrhage, nursing diagnosis of pain related to

Answer 50

blood causing irritation to the meninges

Question 51

Glasgow Coma Scale

Answer 51

``` Eye: Verbal: 4. spontaneous 5. oriented 3. speech 4. confused 2. pain 3. inappropriate 1. none 2. incomprehensible 1. none Motor: 6. obeys 5. localizes 4. withdrawals 3. flexion 2. extension 1. none ```

Question 52

Left frontal lobe tumor expected findings

Answer 52

personality and judgement changes

Question 53

Most malignant type of brain tumor

Answer 53

glioblastoma multiforme

Question 54

Most accurate way to measure compliance and monitor toxicity

Answer 54

blood tests for levels

Question 55

Flashing lights, spots, numbness/tingling in the arms are examples of?

Answer 55

aura experiences

Question 56

Effective seizure teaching when father states:

Answer 56

stay with the child during and after the seizure

Question 57

CNA trying to insert an oral airway lol

Answer 57

is this really a question? stop that SHIT!

Question 58

Status epilecticus pt precautions

Answer 58

placing oxygen and suction equipment at the bedside

Question 59

MVA pt w/ open femur fracture, given Vanco in OR, Cr/BUN now high, what type of renal injury is this?

Answer 59

intra-renal

Question 60

Pt has BP 100/42, ICP 24, CPP indicates?

Answer 60

MAP - ICP = CPP, impaired blood flow to the brain

Question 61

MRI pre-procedure questions

Answer 61

metal in the body?

Question 62

Spinal fusion teaching plan, discuss what?

Answer 62

pt typically experiences more pain at the donor site than the fusion site

Question 63

Classic assessment for meningitis is called?

Answer 63

Brudzinski's sign: severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed

Question 64

Report this finding immediately in meningitis pt

Answer 64

BP 80/42

Question 65

exploding HA, photophobia, N/V

Answer 65

subarachnoid hemorrhage

Question 66

Risk for hemorrhagic stroke

Answer 66

HTN, BP 220/110

Question 67

Most frequent cause of stroke in pt with atherosclerosis

Answer 67

thrombus

Question 68

Right visual field deficit, during rehab phase, nurse should?

Answer 68

stay with pt, draw attention to food on right side of tray

Question 69

Appropriate action when assessing therapeutic effect of heparin drip (PTT low)

Answer 69

continue infusion and notify physician

Question 70

hyperparathyroidism can result in this renal disorder

Answer 70

increased Ca results in renal calculi

Question 71

Polycystic kidney disease, question which order?

Answer 71

Lovenox 60mg

Question 72

Possible cervical SCI action

Answer 72

immobilize and align the head/spine

Question 73

S2-S4 stab wound, lower motor neuron lesion, pt will experience

Answer 73

flaccid bladder

Question 74

T4 SCI, which activity indicates effective learning

Answer 74

check for bladder distension frequently

Question 75

Auscultate abdomen because pts with SCI often develop?

Answer 75

paralytic ileus

Question 76

T2 SCI, throbbing HA, nauseated

Answer 76

check BP (may be autonomic dysreflexia)

Question 77

Pt with ileoconduit, mucous in urine

Answer 77

normal for this pt

Question 78

Teach to empty ileoconduit frequently to prevent what?

Answer 78

separation of the appliance from the skin

Question 79

Nephrectomy tube placement order

Answer 79

1. call physician if tube dislodged 2. VS 3. bleeding 4. assure the tube in unobstructed 5. I/O

Question 80

Neurogenic bladder major complication

Answer 80

infection

Question 81

Corticoids regulate a lot of stuff EXCEPT potassium, T/F?

Answer 81

False

Question 82

New bladder CA diagnosis discharge education

Answer 82

smoking is the highest risk factor

Question 83

Hemodialysis access site assessment complications SATA

Answer 83

local bleeding, thrombus, yellow/green fluid normal: thrill, some numbeness/tingling d/t reduced blood flow to extremities

Question 84

Impaired renal perfusion, secondary HTN results from

Answer 84

increased RAAS production

Question 85

Urinary system disorder, frequent use of what nephrotoxic drugs?

Answer 85

frequent use of NSAIDs

Question 86

Hx renal calculi hospitalization highest priority?

Answer 86

pain from stone

Question 87

UA high protein indicates

Answer 87

damage to glomerulus

Question 88

Cr. clearance test

Answer 88

obtain supplies for and instruct patient about 24hr urine collection

Question 89

24hr urine collection missed sample

Answer 89

start over

Question 90

Pre-renal kidney injury causes

Answer 90

hypovolemia and cardiac pump failure

Question 91

Root cause of glomerulonephritis

Answer 91

group A strep throat infection

Question 92

High UO (oliguric) with acute renal failure

Answer 92

control of fluids

Question 93

N/V 5 days, BP low, BUN/Cr high, what caused acute renal failure?

Answer 93

pre-renal dehydration

Question 94

Assess patency of fistula

Answer 94

auscultate for bruit

Question 95

During inflow phase of peritoneal dialysis, pt reports abdominal cramping, nurse should?

Answer 95

decrease rate of dialysate

Question 96

Manage phosphate levels in renal pt by?

Answer 96

taking phosphate binding medication with all meals

Question 97

Prevent peritonitis by?

Answer 97

maintaining aseptic technique throughout procedure

Question 98

Spouse wants to divorce, nursing diagnosis?

Answer 98

altered family processes

Question 99

Post-op renal transplant management

Answer 99

hourly UO, protective isolation, aseptic technique (all of the above)