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AC 2 Final Exam Flashcards

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1
Q

What are the ABCDEs of skin cancer?

A

Asymmetry
Border irregularity
Color
Diameter at least 1/4 in.
Evolution

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2
Q

What is an actinic keratoses?

A

Premalignant lesions
More common in men

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3
Q

What is a squamous cell carcinoma (SCC)?

A

Cancer of epidermis
Metastasis common
Can be related to chronic skin damage
Most common in people with darker skin
Looks scaly, slightly red

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4
Q

What is a basal cell carcinoma (BCC)?

A

Basal cell layer of epidermis
Metastasis rare
Genetic, chronic irritation
Starts as small fleshy bumps
Looks shiny, red, elevated

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5
Q

What’s a melanoma?

A

Pigmented cancer arising in melanin producing epidermal cells
Highly metastatic
Genetic, excessive UV exposure

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6
Q

What are the 4 types of skin cancer?

A

Actinic keratoses
Squamous cell carcinoma
Basal cell carcinoma
Melanoma

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7
Q

How is skin cancer/lesion treated?

A

Electrodesiccation and curettage (dig out)
Surgical excision (margins of 5 cm are best)
Mohs (for high risk or large BCC)
Cryosurgery (freezing area)

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8
Q

What kind of diagnostic study is done for scabies?

A

Scraping

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9
Q

How is contact dermatitis managed?

A

Obtain hx to identify causative agent
Avoidance therapy (once cause identified)
Steroid to suppress inflammation
Cool/moist dressings over topical steroids and increase absorption
No occlusive dressing with steroid

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10
Q

What is psoriasis?

A

A scaling disorder related to dermal inflammation
Abnormal growth of epidermal cells in the outer skin layers
Autoimmune rx, lifelong with exacerbation & remissions

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11
Q

What are the physical cues of scabies?

A

Shows up in folds, warm, moist areas
Pruritic
Blisters (small, red)
Can mimic contact dermatitis

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12
Q

Why is herpes zoster (singles) in eye a medical emergency?

A

It can lead to blindness

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13
Q

What are the characteristics of stage 1 pressure ulcer?

A

Redness that does not blanche when pressed
Reversible damage with the removal of pressure and shear force
Irregular erythema
Induration
Boggy or firm

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14
Q

What are the characteristics of stage 2 pressure ulcer?

A

Damage that includes epidermis, dermis, or both
Shallow ulcer, blister or abrasion

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15
Q

What are the characteristics of stage 3 pressure ulcer?

A

Injury to SubQ tissue
Goes to the underlying fascia, but not through
May have undermining
Deeper crater

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16
Q

What are the characteristics of stage 4 pressure ulcer?

A

Injury to the tissue that goes through the fascia
Includes structural visibility involvement: muscle, bone, tendon/ligament
May have osteomyelitis or septic arthritis

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17
Q

When is a pressure ulcer unstageable?

A

When unable to determine the depth of tissue damage due to necrotic tissue covering wound bed

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18
Q

How can you prevent pressure ulcers?

A

Frequent repositioning, avoid over sedation
Barrier cream if incontinent
Pressure reduction with mattresses/cushion
Assessment
Adequate nutrition & hydration (30-35kcal/kg, 1-1.5g/kg protein, 1mL/kcal fluid)

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19
Q

The Norton scale is used to

A

Identify risk of pressure ulcer
Less the number, higher the risk
Scale of 5 to 20

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20
Q

How is pressure ulcer treated?

A

Pain control
Keep what is wet wet and what is dry dry

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21
Q

What prophylactic treatment should be given to a patient who is on continuous opioid analgesic?

A

Treat constipation

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22
Q

Why can pain assessment in older adults be difficult?

A

Due to multiple chronic conditions
High incidence of cognitive impairment

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23
Q

How can you assess pain in cognitive impaired patients?

A

Baseline information (VS, agitation, ability to walk, stand, move, eating pattern, appetite, sleep pattern, elimination habits, etc.)
Talk with family or caregivers

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24
Q

What are some behavioral symptoms that indicates pain?

A

Tense body language
Sad facial expression
Fidgeting
Persistent verbalizations
Verbal outbursts
Wandering, tearful, delusions, hallucination

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25
Q

What kind of pain is easily controlled with short acting analgesics?

A

Acute pain

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26
Q

What kind of pain is associated with post-op, procedural, traumatic injuries?

A

Acute pain

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27
Q

PCA pump is used for this type of pain

A

Acute pain

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28
Q

What is the characteristic of chronic pain?

A

Persists at fluctuating intensity

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29
Q

What are some manifestations of chronic pain?

A

Depression
Eating, sleep disturbances
Impaired function

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30
Q

What kind of pain is opioids, NSAIDs less effective?

A

Neuropathic pain

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31
Q

How is chronic pain treated?

A

Basal pain meds + different therapies for pain spikes
Predictable spikes: short acting agent prior to event
Unpredictable spikes: have short acting readily available

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32
Q

According to the WHO analgesic ladder, what kind of pain meds can you give for mild pain (1-3/10)?

A

Aspirin
Acetaminophen
NSAIDs
Coanalgesics

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33
Q

According to the WHO analgesic ladder, what kind of pain meds can you give for moderate pain (4-6/10)?

A

Codeine
Hydrocodone
Oxycodone
Nonopioid analgesic
Coanalgesics

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34
Q

According to the WHO analgesic ladder, what kind of pain meds can you give for severe pain (7-10/10)?

A

Morphine
Oxycodone
Hydromorphone
Fentanyl
Nonopioid analgesics
Coanalgesics

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35
Q

What is the maximum mg of acetaminophen per day?

A

4000mg

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36
Q

Demerol (meperidine) can cause ____ in older adults

A

Tremors and seizures

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37
Q

What are some non-pharmacologic pain treatment?

A

Massage
Yoga
Music
Aromatherapy
Acupuncture
Hypnosis
Hot/cold packs

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38
Q

What are some examples of coanalgesics?

A

Antidepressants
Anticonvulsants
Corticosteroids
Etc

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39
Q

What are the 5 important elements of the WHO 3-step model of analgesic dosing?

A

By mouth
By the clock
By the ladder
For the individual
With attention to detail

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40
Q

What does hospice care do?

A

Management of pain and control of symptoms
At home or free standing hospice facility
Hospice pays for meds for comfort measures
Individualized plan of care

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41
Q

What is the eligibility for hospice care?

A

Prognosis of 6 months or less (however benefit is not limited to 6 months)

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42
Q

Hospice services include

A

Physician, nursing care
Medical appliances and supplies
Drugs for management and comfort
Homemaker and home health aide services
Short term inpatient and respite care
Counseling
Bereavement services

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43
Q

Can palliative care be part of hospice?

A

Yes

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44
Q

What is the difference between hospice and palliative care?

A

Similar; both focuses on comfort and symptom management.
Hospice is more of individual, while palliative cares patient and family as unit
Quality of life, not quantity

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45
Q

What are the 5 stages of dying according to Elisabeth Kubler-Ross?

A

Denial
Anger
Bargaining
Depression
Acceptance

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46
Q

What are the common symptoms at the end of life?

A

Dyspnea
Constipation
Fatigue
Anorexia and cachexia
Cough
N/V
Anxiety
Delirium

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47
Q

What medications are used to manage EOL dyspnea?

A

Opioids
Bronchodilators
Diuretics

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48
Q

What non-pharmacologic treatments are used to treat EOL dyspnea?

A

Humidified O2
Counseling
Pursed lip breathing
Energy conservation
Fans, HOB elevation
Music/massage

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49
Q

How is anorexia & cachexia treated during EOL?

A

Dietary consultation
Medications (appetite stimulant?)
Parenteral/enteral nutrition
Odor control
Counseling

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50
Q

How is stomatitis/dysphagia treated during EOL?

A

Social activity of eating
Treat infections, obstructions and reflux
Diet modifications
Benefit vs. burden of feeding tubes
Oral hygiene
Oral lubricants

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51
Q

How is EOL fatigue treated?

A

Meds (steroids, antidepressants, EPO, blood transfusion)
Nonpharm (rest, conserve energy, PT/OT)

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52
Q

How is EOL N/V managed?

A

Anticholinergics
Steroids
Benzodiazepines
Antinausea drugs (zofran, granisetron)

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53
Q

When should antinausea meds administered when managing EOL N/V?

A

Before symptoms occurs

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54
Q

How is EOL cough treated?

A

Chest PT
Humidification
Elevate HOB
Suction
Cough suppressants

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55
Q

How is EOL anxiety managed?

A

Antidepressants
Benzodiazepines

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56
Q

What are some s/s of death?

A

Dehydration
Decreased urine output
Cold & mottled extremities
VS changes
Respiratory congestion including respiratory bubbling
Changes in breathing patterns
Confusion
Decreased/lack of swallowing reflex

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57
Q

What are some psychological/spiritual symptoms of death?

A

Fear of abandonment, dying process, unknown
Nearing death awareness
Withdrawal from family, friends, cargivers

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58
Q

What is the nurses’ role in EOL?

A

Know your own feeling about death and EOL issues
Start discussion early
Make sure patient and family is communicating
Listen

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59
Q

What are some nursing cares at the end of life?

A

Pain/symptom relief
Skin integrity
Bowel/bladder care
Oral care, ice chips, eye care

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60
Q

What does possible melanoma look like?

A

Asymmetrical
Well-defined border
Color can be dark with fleck of other colors
Diameter more than 6-7mm
Can be elevated

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61
Q

How is Mohs done?

A

Local anesthesia
Cut some out, look in the microscope. If more cancer cells in the area, cut more. Repeat until cancer cell gone

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62
Q

What is the palliative care priority?

A

Pain management

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63
Q

Does RA cause pain with activity that improves with rest?

A

No. It’s quite the opposite

64
Q

Can a person with osteoporosis lose height?

A

Yes

65
Q

Prednisone long-term use can cause

A

Fractures

66
Q

What medication is given to RA patients when all the treatment fails?

A

Methotrexate

67
Q

What are some post-op knee replacement care?

A

Early ambulation - can be full weight bearing
Pain management
CPM (knee in neutral position)

68
Q

What medication is used to manage gout pain?

A

NSAIDs

69
Q

What supplements are needed for elderly?

A

Vitamin A, C, D
Calcium

70
Q

Why is community resources good for cancer patients and for grief support?

A

Let their feelings out without judgement, feeling validation, can get tips from other people who have been through a same/similar situation, trauma bond

71
Q

How is pernicious anemia managed?

A

B12 injection monthly then oral B12

72
Q

What’s included in low cholesterol diet?

A

More greens
Lean meat
Chicken, turkey, fish
Limit red, fatty meat

73
Q

What should you do when you are infusing T-PA but the patient starts getting confused?

A

Stop infusion
May be a sign of bleeding

74
Q

What education is needed for pt with PVD?

A

Good shoes
Skin care to prevent ulcers
Dry between toes
Foot care

75
Q

When can we give Alteplase (t-PA)?

A

Ischemic stroke
BP < 185/110
Within 4.5 hours of onset
No active bleeding

76
Q

What are some symptoms of cataract?

A

Painless, blurred vision
Decrease in ability to perceive color

77
Q

When can you expect for your vision to be improved after the cataract surgery?

A

On the day of surgery

78
Q

Can otitis media cause N/V?

A

Yes, because it’s affecting middle ear

79
Q

Can heating pad help with earache?

A

Yes

80
Q

Does cataract surgery require general anesthesia and an overnight hospital stay?

A

No; it’s just some eyedrops to numb and they do surgery. You are awake

81
Q

How long should you hold your breath after inhaling albuterol?

A

10 seconds

82
Q

What are some a/e of captopril when used the first time?

A

Orthostatic/postural hypotension
Hyperkalemia
Low BP

83
Q

What is the simple test used to immigrants at Ellis Island to check for heart failure?

A

Walking up the steps

84
Q

According to the Heart Failure Core Measure Set, what should be done for the patient with HF before discharge?

A

ACE inhibitors
Cardiac diet (no added salt, limit Na to 2g/day)
ECHO for EF

85
Q

What’s the purpose of Alzheimer’s meds?

A

Improve symptoms

86
Q

What is the main reason for fall in elderly?

A

Muscle weakness

87
Q

What diagnostic tool is used for COPD pt with cough?

A

Spirometry used over x-ray

88
Q

Does COPD every get better?

A

No.
They can only hope for improved QOL. Bronchodilators help with this goal

89
Q

Is there a vaccine for herpes zoster?

A

Yes; Recombinant zoster (shingles) vaccine

90
Q

Herpes zoster can cause some

A

Neuralgia

91
Q

What can pt with dermatitis put on their skin to prevent exacerbation from hot, dry, air/heat?

A

Emollients

92
Q

What diagnostic test is used to diagnose CLL?

A

Bone marrow aspiration

93
Q

What kind of therapy is used for CLL?

A

Targeted therapy
We don’t want to expose too much

94
Q

What are some causes of iron deficiency anemia?

A

Lack of iron consumption
Bleeding
Low hemoglobin

95
Q

How does A. fib compromise cardiac output?

A

Atrium don’t have time to fill, so ventricle can’t pump adequate blood throughout the body -> decreased perfusion

96
Q

What kind of food should you give to pt with Parkinson’s?

A

Soft, thickened food
No finger foods (too hard)

97
Q

What activity/movement can help Parkinson’s pt with ambulation?

A

Marching in place

98
Q

Why are deadbolts sometimes necessary in Alzheimer’s patients?

A

Safety risk

99
Q

An elderly woman was possible raped and comes to the ER. The nurse must call the poilice immediately

A

False.
Talk to manager first, follow the policy/facility protocol
If not, pt will lose in court

100
Q

Why do we not give prophylactic antibiotic to neutropenic patients?

A

Due to risk of antibiotic resistance

101
Q

What do you need to monitor in patients who is getting radiation therapy to sites containing bone marrow?

A

Infection; can lower WBC

102
Q

NSAIDs should be avoided in elderly due to risk of

A

Kidney impairment

103
Q

Can you give sublingual morphine to a dying patient who can’t swallow?

A

Yes
Sublingual does not require swallowing
Benefit vs. risk

104
Q

What kind of breathing is a sign of death?

A

Cheyne-Stokes

105
Q

Can fentanyl patches cause respiratory suppression/depression in elderly?

A

Yes

106
Q

What are the 4 cardinal symptoms of Parkinson’s?

A

Tremors
Postural instability
Bradykinesia
Muscle rigidity

107
Q

What is the priority assessment when someone presents to the ED with complaints of stroke?

A

Onset of time; when was the last time you were normal?
To see if we can start t-PA or not

108
Q

What is the main complication of A. fib?

A

Stroke r/t blood clot

109
Q

How do you treat scabies?

A

Permethrin cream

110
Q

What is the name of the rash caused by heat and skin/skin friction? Often occurs under the breast or in the axilla

A

Intertrigo (type of dermatitis)

111
Q

Adjunctive (additional) drugs used for pain include

A

Antidepressants, anticonvulsants, corticosteroids

112
Q

What are the signs of PVD?

A

Brown discoloration, redness, itching and burning

113
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma

114
Q

How do you know if tamsulosin is working?

A

Able to pass urine
Tamsulosin is for BPH

115
Q

What are some interventions for acute HF?

A

Fluid restriction
Diuretic
Monitor VS, edema
Low sodium diet

116
Q

What is the best COPD prevention?

A

Smoking cessation

117
Q

What is the most common cause of skin cancer?

A

Sun damage

118
Q

Other than ABCDEs of skin cancer, what are some more signs of skin cancer?

A

Open sore that doesn’t heal for 3 weeks
Spot/sore that burns, itches, stings, crusts or bleeds

119
Q

Which skin cancer metastasis easily/commonly?

A

Squamous cell carcinoma

120
Q

What skin condition is caused by contact with an irritant/allergen and results in cell-mediated immune reaction?

A

Contact dermatitis

121
Q

How is psoriasis treated?

A

Topical steroids
Topical tar
UV light

122
Q

How is shingles treated?

A

Antivirals
Pain management

123
Q

What does an elevated BNP indicate?

A

Ventricular stretch
Usually with FVO

124
Q

What are some signs of FVO?

A

Edema, SOB, crackles, tachycardia

125
Q

What are some signs of right sided HF?

A

Ascites
Edema
JVD

126
Q

When does palliative care begin?

A

When someone has a terminal diagnosis

127
Q

What are the 7 factors of geriatric syndrome?

A

Immobility
Falls
Constipation
Urinary incontinence
Delirium
Polypharmacy
Frailty

128
Q

What indicates high risk of fall during TUG test?

A

If patient takes 12 seconds or more

129
Q

Where does nutrition assessment start?

A

Mouth

130
Q

What is the most difficult symptom in BPH?

A

Nocturia

131
Q

What BPH medication decreases usable testosterone/decrease production to reduce prostate size?

A

Finasteride

132
Q

What OTC supplement/med is commonly used in BPH?

A

Saw palmetto

133
Q

What should you do if there’s increased bleeding after TURP?

A

Increase fluid through cath to flush out & stop bleeding

134
Q

How does Parkinson’s progress?

A

Unilateral, pill rolling tremor -> bilateral tremor, mask like face -> postural instability -> akinesia -> completely dependent

135
Q

How is Parkinson’s diagnosed?

A

By exclusion

136
Q

What’s the big s/e of Levodopa?

A

Orthostatic hypotension

137
Q

Thrombolic stroke is caused by

A

Atherosclerosis

138
Q

What type of stroke occurs frequently during activity?

A

Hemmorhagic

139
Q

What’s the most important nursing care for post-op endarterectomy of TIA?

A

Maintain BP (BP too high -> rupture)
Bleeding (enlarged neck, deviated trachea, respiratory distress)

140
Q

What’s the FAST assessment?

A

Facial drooping
Arm weakness
Speech difficulty
Time to call 911

141
Q

What’s the ABCS of heart health to prevent stroke?

A

Aspirin when appropriate
BP control
Cholesterol management
Smoking cessation

142
Q

What is the nursing care priority for HF patient?

A

Fluid volume management
Monitor urine output, BP/HR, LOC, temp of extremities

143
Q

L. sided HF is treated with

A

ACE inhibitors
ARBs

144
Q

Concerning weight change in HF

A

+ >2lbs overnight
+ >5lbs from goal weight
- > 5lbs from goal weight

145
Q

When is chemical cardioversion used?

A

When pt hemodynamically stable
Adenosine 6/12 mg

146
Q

When is electrical cardioversion used?

A

When pt hemodynamically unstable
When we can’t use chemical (upcoming ablation)
Synchronized to deliver electrical current on the R wave

147
Q

What is Sick Sinus Syndrome?

A

Dysfunctional SA node to HR fluctuates from bradycardia to tachycardia and vice versa

148
Q

What are the physical assessment findings of PAD?

A

Cool temp
Absent hair growth
Ulcer on lower leg
Intermittent claudication
Muscle atrophy

149
Q

Where’s the PVD ulcer usually located?

A

Foot; upper foot ulceration

150
Q

In which venous condition would you NOT elevate lower extremities?

A

Arterial; away from the body

151
Q

A patient is on ACE inhibitor, Beta blocker, and diuretic. You notice pt’s HR and BP are low. What medications will you hold?

A

Hold ACE inhibitor and Beta blocker
But give diuretic

152
Q

Chronic bronchitis (blue bloaters) s/s

A

Overweight
Cyanotic
Elevated Hgb
Peripheral edema
Rhonchi and wheezing

153
Q

Emphysema (pink puffers) s/s

A

Older and thin
Severe dyspnea
Quiet chest (not much air movement)
Hyperinflation & flatten diaphragms in CXR due to trapped air

154
Q

DEXA scan is used to diagnose

A

Osteoporosis

155
Q

What are the B symptoms?

A

Fevers
Night sweats
Unintentional weight loss
Infections

156
Q

What’s a big thing in multiple myeloma?

A

Bone pain

157
Q

How is multiple myeloma diagnosed using blood test?

A

C: elevated calcium
R: renal insufficiency
A: anemia
B: bone lesion

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