Clinical 2

Question 0

What’s Cushing’s ? 4

Answer 0

1) high plasma cortisol
2) high Na, high blood volume & BP & Blood sugar
3) low potassium
4) moon face, buffalo hump, trunk obesity, mood swings, female masculinity

Question 1

What’s Addison’s disease ? 5

Answer 1

1) low plasma cortisol
2) low Na, dehydration,shock, low Bs
3) high potassium, arrhythmia,
4) pathological fractures, weight loss
5) diet: high protein, carb, & sodium, & low potassium

Question 2

What’s pneumonia tx with ? 4

Answer 2

1) mucolytics (mucomyst)
2) expectorants (robitussin)
3) bronchodilators (beta 2 agonists)
4) antibiotics (amoxicillin, bactrim)

Question 3

What’s ventricular septal defect? 4

Answer 3

1) abnormal opening between right and left ventricle
2) may vary in size from pinhole to no septum
3) characterized by loud murmur
4) May close spontaneously by age 3

Question 4

What’s Patent ductus arterious (PDA)?

3

Answer 4

1) Allows blood to be shunted from aorta to pulmonary artery causing blood to be reoxygenated in the lungs
2) Ax murmur, pulse pressure, tachycardia,
3) surgical intervention to divide vessels

Question 5

What’s coarctation of the aorta? 2

Answer 5

1) Narrowing of the aorta causing, increased BP & murmur

2) TX surgical

Question 6

What’s tetralogy of fallot ? 3

Answer 6

1) Four defects: ventricular septal defect, pulmonic stenosis, overriding aorta, right ventricular hyper trophy ( first three are congenital, fourth is aquired due to increased pressure with right ventricle
2) Cyanosis, clubbing of fingers, delayed physical growth.
3) children often squats or assumes chest knee position (cyanosis compensation)

Question 7

What’s left side heart failure? 4

Answer 7

1) pulmonary edema (tales, crackles)
2) cough with frothy, blood tinged
3) decreased renal function, (⬆️bun,albumin)
4) edema , weight gain, s3 gallop)

Question 8

What’s right side heart failure? 4

Answer 8

1) dependent edema (ankle,lower extremities)
2) jugular vein distention
3) liver enlargement & abd pain
4) anxiety, fear, depression.

Question 9

What’s heart failure treatment? 5

Answer 9

1) digitalis (digoxin): fundamental drug in HF TX
2) ace inhibitors (angiotensin converting) to dilate vessels: decrease after load
3) Diuretics- thiazides, loop diuretics
4) beta blockers
5) restrict sodium

Question 10

What’s Angina pectoris ? 4

Answer 10

1) pain down left arm
2) relived with rest or nitroglycerin
3) caused by coronary atherosclerosis
4) tx with stents, IV heparin, b blockers, c channel, nitro or sublingual nifedipine

Question 11

What’s Iron deficiency anemia ? 4

Answer 11

1) fatigue, glossitis ( inflammation of the tongue), spoon finger nails
2) most common type
3) caused by decreased dietary intake, blood loss due to ulcer,gastritis, menorrhagia (excessive menstrual bleeding)
4) TX IV dextran, oral supp with meals, take with ascorbic acid, use straw if liquids are used. STAINS

Question 12

What’s vitamin B 12 anemia & pernicious anemia ? 4

Answer 12

1) pallor, fatigue, RED tongue, paresthesia in hands and feet
2) pernicious anemia: gastric fails to secret intrinsic factor needed for b 12 absorption
3) DX by schilling test ( fast for 12 hrs; given small dose of radioactive b12 in water; 24 hr measure radioactive
4) give 25 to 100 mg of B 12,

Question 13

What’s sickle cell disease? 6

Answer 13

1) hemolytic anemia resulting from defective hemoglobin
2) promptly treat infection to prevent crisis
3) avoid high altitudes & temperature
4) folic acid given daily
5) analgesics for crisis morphine
6) enc fluids ( dehydration promotes crisis)

Question 14

What’s hemophilia? 4

Answer 14

1) prolonged bleeding problems
2) sex linked, transmitted to male by female carrier
3) factor VIII deficiency ( hemophilia a most common)
4) aspirin contra indicated

Question 15

What’s Alzheimer’s? 4

Answer 15

1) establish regular routine
2) color code objects & areas
3) cut food to small pieces
4) use night light

Question 16

What’s Hypothyroidism (myxedema)?

3

Answer 16

1) low bmr, T3 & T4
2) cold sensitive, weight gain, alopecia, decreased perspiration
3) TX hormone replacement (synthroid,levothyroid)

Question 17

What’s Hyperthyroidism Grave’s 3 disease?

Answer 17

1) high T3 & T4, high titter anti thyroid
2) heat sensitivity
3) anti thyroid drugs (sski,methimazole,radiation)

Question 18

What’s Hypo parathyroid ? 5

Answer 18

1) Tetany, muscular irritability.
2) DX hypomagnesimia, low calcium, x-ray bones appear dense
3) phosphorus
4) TX calcium chloride or glauconite, calcitron (rocatrol) for hypocalcemia
5) observe for tetany

Question 19

What’s Hyperparathyroidism? 3

Answer 19

1) high calc, low phosphorus
2) renal calculi, pathological fractures, back & joint pain
3) prevent renal calculi with fluids & prevent fractures, monitor potassium

Question 20

What’s Cystitis ? 3

Answer 20

1) urgency & frequency, burning on urination, cloudy urine & odorous
2) TX enc fluids, cranberry juice, ABX (Septra), (pyridium) urinary tract analgesic
3) void every 2 to 3 hours

Question 21

What’s Pyelonephritis ? 3

Answer 21

1) inflammation of the kidney caused by bacteria infection
2) predisposing factors: UTI, urinary obstruction
3) usually caused by E.coli

Question 22

What’s Glomeruli nephritis ? 4

Answer 22

1) hematuria, urine dark colored, weight gained, lung rales, fluid overload
2) abd or flank pain
3) occurs 10 days after a skin or throat infections ( staphylococcus streptococcus)
4) Dialysis or plasma electrophoresis if renal failure develops (antibody removal)

Question 23

What’s Prostatic hypertrophy ? 6

Answer 23

1) hesitancy, weak urine stream
2) hematuria & retention
3) Benin hypertrophy, increase in size with age
4) prostate specific antigen (psa) normal is < 4 mg/ml increased in prostatitis
5) Meds: 5 alpha reductive agent & Alpha blocking agent
6) TURP - transurethral suprapubic resection (through bladder)

Question 24

What’s acute/chronic renal failure? 4

Answer 24

1) oliguria phase:, < 400 ml, high k+,Bun,creatinine, ca+,Na, anemia
2) Diuretic or recovery phase: urine output 5 L/day, high Bun, Na & K+ loss in urine
3) chronic: anemia,azotemia,fluid retention,
4) kayexalate for high potassium

Question 25

What’s Hemodialysis ? 4

Answer 25

1) blood shunted through dializer for 3-5 hrs/2-3 times day
2) check thrill & bruit q 8 h, don’t use for BP or blood specimens
3) check for hemorrhage & hepatitis
4) disequilibrium syndrome

Question 26

What’s Peritoneal dialysis ? 5

Answer 26

1) catheter in peritoneal cavity (tenckoff, gore tex)
2) peritoneum is dialyzing membrane
3) weigh before & after
4) if problems with out flow reposition supine or low fowlers , side to side
5) clean insertion site and apply sterile dressing

Question 27

What’s Chickenpox (varicella)? 4

Answer 27

1) isolation until all vesicles are crusted; communicable from 2 days before rash
2) avoid aspirin due to Reye’s syndrome use Tylenol
3) topical calamine lotion or baking soda baths
4) airborne and contact precautions

Question 28

What’s Pertussis (whooping cough)? 4

Answer 28

1) URI for 1-2 weeks
2) severe cough with high pitch “whooping” sound, specially at night
3) lasts 4-6 weeks
4) incubation usually 10 days

Question 29

What’s Rubella? 3

Answer 29

1) contact precaution
2) droplet: maculopapular rash appears first on the face & then on rest of the body
3) symptoms subside first day after rash

Question 30

What’s Scarlet fever ? 3

Answer 30

1) high fever with vomiting chills, followed by enlarged tonsils covered with exudate
2) straw berry tongue
3) droplets spread, or contaminated group A beta hemolytics streptococci

Question 31

What’s Mononucleosis? 3

Answer 31

1) fever, enlarged lymph nodes sore throat, flulike symptoms
2) direct contact with oral secretion
3) TX is rest & good nutrition; strenuous exercise is to be avoided to prevent spleen rupture

Question 32

What’s Tuberculosis? 3

Answer 32

1) low grade fever, weight loss, night sweats
2) cough with occasional streaked with blood: chest tightness & dull aching chest
3) DX sputum smear for acid-fast bacilli

Question 33

What’s TX for Tuberculosis? 3

Answer 33

1) Isoniazid (INH) 6-9 mo therapy, > 35 not recommend because high hepatotoxic risk
2) regimen: Isoniazid, rifampin, ethambutol, streptomycin
3) Isolation for 2-4 weeks or 3 negative sputum

Question 34

What’s Hepatitis? 6

Answer 34

1) RUQ pain, clay colored stool, dark urine, salt accumulation under skin pruritus
2) elevated alt,sat,alp,bilirubin
3) antibodies to anti HAV
4) diet low in fat, high in calories and protein, no alcohol
5) vit K ( Aqua mephyton)
6) anti viral drugs interferon & lamivudine

Question 35

What’s Lyme disease ? 5

Answer 35

1) transmitted from tick bites
2) stage 1 rash develops at site of tick bite 2 to 30 days; ring develops, suggesting bull’s eye
3) stage 2 develops in 1-6 months if untreated, cardiac conduction defects
4) stage 3 arthralgias, enlarged or inflamed joints occur after 7 month after infection
5) TX: ABX 3-4 weeks doxycycline, azythromycin during stage 1, IV penicillin during later stages

Question 36

What’s Syphilis ? 6

Answer 36

1) stage 1 painless chancre disappears within 4 weeks
2) stage 2 copper colored rash on palms & soles, low grade fever
3) stage 3 cardiac & Cns dysfunction
4) transmission kissing, sexual contact, 10-90 days
5) TX penicillin G, pcn allergy - erythromycin, 10-15 days ceftriaxone & tetracyclines (non pregnant females)
6) reportable disease, abstinence until TX completed

Question 37

What’s gonorrhea ? 4

Answer 37

1) thick discharge from vagina or urethra
2) painful intercourse, dysuria
3) in males dysuria and yellow green discharge
4) IM Rocephin , 1 time & po doxycillin BID for 1 wk, penicillin

Question 38

What’s Chlamydia ? 3

Answer 38

1) Men- dysuria, women- thick discharge, yellow color discharges; painful menses
2) May cause sterility
3) treat with Azithromycin, doxycillin, erythromycin

Question 39

What’s the age appropriate preparation for health care procedure ? 4

Answer 39

1) toddler: simple explanation, allow choices, use distraction & typical fear is separation from parents
2) pre-school age: enc understanding by playing with puppets, dolls. Demonstrate equipment. Talk at eye level. Fears: separation with parents, ghosts, scary people.
3) School-age: allow questions, allow to handle equipment. Fears: dark, injury, being alone, death.
4) Adolescent: explain long term benefits. Accept regression, provide privacy. Fears: social competence, war, accidents, death.

Question 40

What’s incentive spirometer? 1

Answer 40

1) hold mouth piece in mouth, exhale normally, seal lips & inhale slowly & deeply, keep ball or cylinder elevated 2-3 seconds. Exhale & repeat.

Question 41

What’s hemorrhage in surgical complications? 3

Answer 41

1) low BP & high pulse,
2) cold, clammy skin.
3) replace blood volume

Question 42

What’s shock in surgical complications? 2

Answer 42

1) low BP & high pulse, cold clammy skin

2) tx cause and O2 & IV fluids

Question 43

What’s atelectasis & pneumonia in surgical complications? 2

Answer 43

1) cyanosis , cough, tachy, high temp, pain on affected side.
2) NC: suctioning, oxygen, antibiotics, cough and turn q 2hrs

Question 44

What’s Embolism in surgical complications? 3

Answer 44

1) dyspnea, pain, restlessness,
2) Abg- low O2, high Co2
3) NC: oxygen, anticoagulant heparin, IV fluids.

Question 45

What’s deep vein thrombosis in surgical complications? 2

Answer 45

1) positive homang’s sign.

2) NC: experienced 6-14 days post op. Heparin

Question 46

What’s paralytic ileus in surgical complications? 2

Answer 46

1) absent bowel sounds, no flatus, no stools

2) NC: nasogastric

Question 47

What’s blood test ranges? 6

Answer 47

1) RBC: adult 4.6-6.2 million. Child 3.2-5.2
2) WBC: Adult 5,000-10,000/mm3. Ch 5,000-13,000
3) hemoglobin: man 13-18. Ch 11-12.5
4) PTT: heparin 20-40 sec
5) PT: Coumadin 9-12
6) Platelets: 100,000-400,000

Question 48

What’s Lab tests ranges? 7

Answer 48

1) total cholesterol: optimal < 200 mg. borderline 200-239 mg/dl. High > 239
2) LDL opt < 139. Brdln 140-160. High >160
3) HDL men 35-70. Women 35-85 mg
4) creatinine adult: 0.6-1.5. Chld 0.4-1.2. Infant 0.3-0.6 mg/dl
5) CK- DX MI man 55-170 u/l. Women 30-135 u/l
6) Albumin protein malnutrition 3.5-5.5
7) BUN 7-18

Question 49

What’s lab tests liver? 2

Answer 49

1) liver enzymes- with damaged liver cells enzymes are released into blood stream. AST 10-40 units. ALT 5-35 u
2) Blood ammonia- liver converts ammonia to urea. With liver disease ammonia levels rise. Normal 15-40 mc

Question 50

What’s the suctioning procedure? 9

Answer 50

1) wear protective eyewear
2) hyper oxygenate before during and after suctioning-100% O2 for 3 min or 3 deep breaths
3) explain procedure ( potentially fear)
4) semi-fowlers position
5) lubricate catheter with sterile saline & insert without applying suctioning
6) advance cath as far as possible or until client coughs; don’t apply suctio
7) withdraw cath 1-2 cm, apply suction & withdraw cath with rotating motion for no more than 10 sec; wall suctioning set between 80-120 mmhg
8) repeat after pt has rested
9) hyper oxygenate for 1-5 min after suctioning endotracheal tube, then mouth is suctioned; provide mouth care

Question 51

What’s suctioning complications? 6

Answer 51

1) hypoxia 4) tissue trauma
2) bronchi spasm 5) cardiac disryth
3) vagal stimulation 6) infection

Question 52

What’s Tracheostomy care? 15

Answer 52

1) performed Q 8hrs prn
2) hyperoxygenate
3) suction tube
4) remove old dressing
5) open sterile trache tube kit
6) put on sterile gloves
7) remove inner cannula
8) clean with hydrogen peroxide if permanent inner cannula
9) rinse with sterile water dry & reinsert
10) clean stoma site with hydrogen peroxide & sterile water
11) change ties or velcro tracheostomy tube holder as needed: old ties must remain in place until new ties are secured tie on side of the neck: allow 2 fingers to be inserted under tie.
12) apply new sterile dressing: don’t cut gauze pads.
13) document site of tracheostomy type, quantity of secretion & pt tolerance
14) purpose of cuff- prevent aspiration of fluids ; inflated during continuous mechanical ventilation, during and after eating, during and 1 hr after a tube feeding, when pt may aspirate check Q 8 hrs
15) airway obstruction, tracheal necrosis, infection

Question 53

What’s chest tube care? 3

Answer 53

1) enc cough & deep breath
2) drainage system must be maintained below the level of insertion. Without kinks in tubing
3) observe for fluctuations of fluid in water seal chamber; stops fluctuations when : lung rexpands, tubing is obstructed, loop hags below rest of tubing, suction is not working: gently milk tubing if agency allows

Question 54

What’s removal of chest tube care? 4

Answer 54

1) instruct the pt to do valsalva maneuver
2) chest tube is clamped and quickly removed by the physician
3) occlusive dressing is applied to the site.
4) complications: observe for constant bubbling in water chamber; indicates air leak in the drainage system

Question 55

What’s complications of chest tube indications? 3

Answer 55

1) observe for constant bubbling in the water-seal chamber; this indicates air leak in the drainage system
2) if the chest tube becomes dislodged, apply pressure over the insertion’s site with a dressing that is tended on one side to allow for the escape of air
3) if the tube becomes disconnected from the drainage system, cut the contaminated tip off the tubbing, insert a sterile connector and reattach to the drainage system; otherwise immerse the end of the chest tube in 2 cm of sterile water until the system can be re-stablished.

Question 56

What’s central venous pressure? 3

Answer 56

1) purpose; measurement of effective blood volume & efficiency of cardiac pumping
2) indicates ability of the right side of the heart to manage fluid over load

3) Normal reading: 3-12 cm water.
a) elevated > 12 hypervolemia or poor cardiac contractility
b) lowered< 3 hypovolemia

Question 57

What’s nasogastric tube? 4

Answer 57

1) Levin-single-lumen: stomach tube used for removal stomach contents or provide tube feedings
2) Salem sump- double lumen stomach tube; most frequently used tube for decompression with suction
3) sengstaken- blakemore- triple lumen gastric tube with inflatable esophagus balloon, stomach balloon, gastric suction lumen used for treatment of bleeding esophageal varices.
4) Keofeed/ pobhoff-soft silicone rubber, medium length tube used for long term feeding; takes 24 hrs to pass from stomach into intestines lay on right side to facilitate passage

Question 58

What’s Levin/Salem sump ? 6

Answer 58

1) insertion: measure distance from tip of nose to earlobe, plus distance from earlobe to bottom of xiphoid process.
2) mark distance with tape and lubricate end of lube with water soluble jelly
3) insert tube through the nose to the stomach
4) offer sips of water & advance the tube gently: bend the head forward (close the epiglottis, closing the trachea)
5) observe for respiratory distress, an indication that tube is misplaced in the lung; if in correctly, secure tube with hypoallergenic tape
6) verify placement : x-ray is only way sure to verify placement. Aspirate gastric contents observe color usually cloudy & green

Question 59

What’s verify placement of NG tube?3

Answer 59

1) x-ray is only sure way to verify placement
2) aspirate gastric content ; observe color -gastric aspirate usually cloudy & green but may also be off white, tan bloody, or brown

3) measure PH of aspirate
a) Gastric usually < 4
b) intestinal usually > 4
c) respiratory usually > 5.5

Question 60

What’s NG tube care? 2

Answer 60

1) check residual before intermittent feeding; Hold feeding if more than 100 ml.

2) instill 15-30 ml
a) before & after each dose of Meds and tube feedings
b) after checking residual & ph
C) Q 4-6 hrs with continuos feedings
d) when feeding is discontinued
e) give fluids at room temp. Change bag Q 24-72 hrs

Question 61

What’s EKG ? 4

Answer 61

1) P wave represent atrial activity
2) PR interval represent passage of the impulse through AV node
3) QRS complex represents ventricular activity
4) T wave repolarization of the ventricles
5) U wave may or may not be present
4) t wave represents re depolarization

Question 62

What’s Spinal cord injury? 9

Answer 62

1) C3 & above - inability to control muscles of breathing- unable to breath , life ventilator support essentials.
2) C4 - no upper extremity muscle function, minimal ventilator - unable to care for self, may self feed with powder devices
3) C5 neck movement, possible partial strength of shoulder & bicep- can drive electrical wheelchair
4) C6 muscle function c5 level; may use wheelchairs, self feed with device
5) C7 muscle function in c6 level- can dress , drive with hand control, wheelchair
6) T1-T4 good upper extremity muscle strength- some independence from wheelchair, long leg braces for standing exercises
7) T5-L2 balance difficulty- still requires wheelchair, limited ambulation with long leg braces & crutches
8) L3-L5 trunk pelvis muscle function intact- may use crutches or canes for ambulation
9) L5- S3 waddling gait- ambulation

Question 63

What’s hypokalemia? 5

Answer 63

1) < 3.5
2) n&v, muscle weakness, dysthymia, increased sensitivity to digital
3) DX: cause- vomiting, gastric suctioning, diarrhea, diuretics,steroids
4) TX: oral supplement (dilute in juice to avoid gastric irritation)
5) diet : Bananas,raisins,apricots,oranges,potatoes,carrots, beans,celery

Question 64

What’s hyperkalemia? 4

Answer 64

1) >5.0
2) dysthymia,cardiac arrest,muscle weakness,paralysis,diarrhea
3) causes: renal failure, use of potassium supplements, burns,crushing injuries
4) TX: restrict k+, keyexalate- with sorbitol to avoid fecal impaction, in emergency calcium gluconate IV, sodium bicarbonate IV, regular insulin and dextrose shifts k+ into cells, diuretics, hemodialysis

Question 65

What’s hyponatremia ? 4

Answer 65

1) < 135
2) muscle cramps,ICP,confusion,muscular twitching,convulsions
3) causes: vomiting,diuretics, excessive dextrose & water iv’s,excessive water intake
4) TX oral administration of sodium rich foods- beef broth, tomatoe juice,IV lactated ringers or 0.9% naci, water restrictions

Question 66

What’s hypernatremia? 4

Answer 66

1) > 145
2) high temp,weakness,disorientation,thirst,hypotension,tachycardia
3) causes: hypertonic tube feeding without h2o supplements, diarrhea,diabetes insipidus, otc alka-seltzer, high h2o
4) IV administration of hypotonic solution 0.3%naci or 0.45% naci: dex in water decrease sodium in diet

Question 67

What’s hypocalcemia? 4

Answer 67

1) < 4.5
2) Cns becomes increasingly excitable,tetany,trousseaus sign: inflate BP cuff on upper arm to 20 mm above systolic pressure: carpal spasms within 2-5 min indicate tetany,chvostek’s sign,seizures
3) causes: pancreatitis,renal failure,steroids & loop diuretics, post thyroid surgery,low ca diet
4) TX: calcium gluconate & calcium chloride; give it with orange juice to maximize absorption,seizure precaution,calcium supplements,vit D,

Question 68

What’s hypercalcemia? 4

Answer 68

1) > 5.1
2) sedative fx on Cns,muscle weakness,lack of coordination, constipation,abd pain & distention,confusion,dysrythmia
3) causes: Hyperparathyroidism, excessive intake,immobility,carbonated antacid
4) TX: IV 0.45% naci or 0.9%, enc fluids, lasix, calcitonin to lower ca levels, mobilize pt, decrease ca diet, maintain acid urine, surgical intervention may be needed in Hyperparathyroidism

Question 69

What’s hypomagnesimia? 6

Answer 69

1) < 1.5
2) acts as a depressant , tremors, tetany, seizures, depression, confusion, dysphagia
3) causes: alcoholism, gi suction, diarrhea, abuse of diuretics or laxatives
4) TX: increase intake of dietary magnesium: green vegetables, nuts, banana, oranges, peanut butter, chocolate
5) keep self inflating breathing bag, monitor resp status
6) test ability to swallow po fluids/food because of dysphagia

Question 70

What’s hypermagnesimia ? 5

Answer 70

1) > 2.5
2) depresses the Cns, depresses cardiac impulse, hypotension, facial flushing, paralysis, shallow respirations
3) causes: renal failure, excessive magnesium intake, antacid
4) TX: stop po & IV magnesium, emergency support ventilation, IV calcium gluconate, hemodialysis, teach otc drugs ( malox has mg), monitor cardiac rythm,
5) have calcium prep available to antagonize cardiac depression