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CNS Boards > CNS Boards Review > Flashcards

CNS Boards Review Flashcards

1
Q

This theory focuses on the quality of nurse-client interaction

A

Peplau - Interpersonal relations model of nursing - 1952

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2
Q

This theory centers on self care, self care deficity, and nursing systems

A

Orem - General Theory of nursing - 1959

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3
Q

This theory focuses on behavior of the patient, the nurses’ reaction to the pt’s behavior, and the nurses’ subsequent actions

A

Orlando - Nursing process theory - 1950s

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4
Q

This theory has concentric circles of variables including physiological, psychological, sociocultural, spiritual, and developmental and interventions should be primary, secondary and tertiary

A

Neuman - Total-person systems model of nursing - 1972

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5
Q

This theory considers those stress-related events that are turning points in a person’s life and can lead to dander or to opportunity.

A

Hoff - Crisis Theory of nursing

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6
Q

This theory considers cultural issues as central to providing care and promotes study of cultural differences in r/t people’s beliefs about illness, behavioral patterns and caring as well as nrsg behavior.

A

Leininger - Transcultural theory of nursing 1974

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7
Q

This theory views the individual holistically from the perspective of health, sickness, and behavior with a nrsg goal to promote health and prevent illness.

A

Watson - Philosophy of Human Caring

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8
Q

Stages of Clinical Competence for nurses

A

Novice, advanced beginner, competent, proficient, expert - Benner

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9
Q

This model is used to predict health behavior with the understanding that people take a health action to avoid negative consequences if the person expects that the negative outcomes can be avoided and that he is able to do the action

A

Health Belief Model

Threat. Benefit. Intervening Factors.

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10
Q

Nursing process steps

A

assessment, diagnosis, planning, implementation, evaluation

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11
Q

Goal HR % of cardiovascular conditioning after illness/injury

A

60-90% of max HR

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12
Q

70% of cases of nocturia are r/t what?

A

over production of urine at night - nocturia > 2x nightly is linked with depression - treated with desmopressin

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13
Q

Treatment for overactive bladder (drug class)

A

Anticholinergics - Detrol, Ditropan

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14
Q

How much fiber is recommended daily to prevent constipation?

A

20-35 grams per day

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15
Q

CAGE stands for what?

A

Cutting down, Annoyed by Criticism, Guilty feelings, Eye opener

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16
Q

Moderate drinking is considered how many drinks per day for males and females?

A

2 per day (14/wk) for men, 1 per day (11/wk)for women

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17
Q

How many stages of Alzheimer’s classification are there?

A

Seven 1. pre clinical, no evidence of impairment, 2. mild cognitive decline 3. ST memory loss 4. moderate cognitive decline 5. confusion 6. profound confusion 7. severe

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18
Q

Barthel Index of ADL’s assessment of older adults includes what?

A

feeding, mobility, personal grooming, toileting, urinary ctrl, fecal ctrl, stairs, ambulatory status, transferring, bathing

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19
Q

Instrumental ADLs (IADLs) are what?

A

Telephone use, shopping, food preparation, housekeeping, laundry, transportation, medication, and financial responsibility

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20
Q

Confusion Assessment Method for delirium includes what criteria?

A

fluctuating inattention, disorganized thinking, and altered LOC

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21
Q

What are the recommendations to prevent renal complications of DM?

A

annual urine albumin and Cr, reduce protein intake to 0.8-1.0/kg body weight per day in early CKD stages, nl glucose level

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22
Q

What are the screening recommendations to prevent retinal complications in diabetics?

A

yearly exams - treat with laser photocoagulation

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23
Q

What are the recommendations to prevent neuropathic complications of diabetes?

A

screen yearly with pinprick, vibration sensation, monofilament test - screen for autonomic neuropathy at 5 yrs for DM1 and at 2 for DM2 - ankle brachial index - CV autonomic neuropathy tachy >100 at rest and orthostatic hypotension

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24
Q

What are the recommendations to prevent CV complications in diabetics?

A

ctrl HTN (130/80), lipid management statin if LDL >100mg/dL, ASA daily

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25
Q

What is JNCs preHTN classification?

A

120-130/80-89

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26
Q

What is JNC stage 1 HTN?

A

140-159/90-99

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27
Q

What is JNC stage 2 HTN?

A

greater than or equal to 160/100

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28
Q

What are JNC recommendations for screening for HTN?

A

recheck 2 years if normal, annually for pre HTN, every 2 mos for stage 1, and every month for stage 2

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29
Q

At what age should cholesterol be checked every 5 years?

A

after age 20

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30
Q

What what age should screening be done for osteoporosis if risk factors are present?

A

age 60, otherwise age 65

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31
Q

What does the pneumonic ‘fractured’ stand for in osteoporosis risk?

A

Family/personal hx; Race (asians/Caucasians increased risk); Age and gender (F > 65 high risk), Chronic disease/meds (DM, hyperparathyroid, corticosteroids); Thin Bones/low wt; Under Active; Reduced estrogen (postmenopausal); Excessive ETOH/smoking (ETOH disrupts Ca balance & impairs Vit D metabolism); Diet (deficient in VitD/Ca)

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32
Q

What is normal DEXA scan range?

A

0-10 T score

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33
Q

What are the 6 signs of malignant melanoma?

A

Asymmetry, Border is irregular, Color is mottled, Diameter is >6mm, Elevation is almost always present, Enlargement or a h/o an increase in size (most important sign)

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34
Q

Which level of prevention is screening?

A

secondary

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35
Q

Which model includes pre contemplation, contemplation, preparation, action, and maintenance?

A

Transtheoretical model (Prochaska & DiClemente)

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36
Q

Explain Systems Theory

A

See parts in r/t the whole

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37
Q

Which type of social support is the strongest?

A

emotional - as opposed to instrumental ($, time), information (advice, info), appraisal (feedback, affirmation)

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38
Q

Explain habituation as a stress reduction technique.

A

incorporate routine into daily activities during stressful situations

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39
Q

Explain time blocking as a stress reduction technique

A

set aside time to adapt to change and incorporate it into daily routine

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40
Q

Explain change avoidance as a stress reduction technique

A

avoid unnecessary change if able to during increased change times

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41
Q

What is the recommended cholesterol limit per day?

A

300mg/d

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42
Q

How many daily calories should be from carbs

A

carbs: 55-60%,

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43
Q

How much calcium is recommended daily?

A

600 IU/day up to age 70, then 800 IU/day

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44
Q

What does spirometry measure?

A

Forced Expiratory volume (FEV1) which is volume expelled in 1st second of Forced Vital Capacity (FVC) which is volume of air expelled forcefully after max inhalation -

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45
Q

What are Kubler-Ross’ 5 stages of grief?

A

Denial, Anger, Bargaining, Depression, Acceptance

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46
Q

What is the most common type of glaucoma?

A

chronic open angle (wide angle)

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47
Q

What does percussion over an organ sound like?

A

dull

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48
Q

What does percussion over a fluid filled area sound like?

A

flat

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49
Q

What does percussion over an air-filled area sound like?

A

resonant

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50
Q

What should nl bone conduction vs air conduction be in a Rinne test?

A

AC 2x> BC. Behind mastoid bone and then in front of ear

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51
Q

What does the Weber test measure?

A

Conductive loss (lateralize to affected ear), Sensorineural loss (lateralize to normal ear). On top of head.

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52
Q

Conductive hearing loss results in difficult hearing what sounds?

A

low tones and vowels

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53
Q

What tones does sensorineural hearing loss affect?

A

high tones, difficult with background noise

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54
Q

What are characteristic signs of breast cancer lumps?

A

single, non-tender, firm, ill defined margins

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55
Q

Which side has 3 lung lobes?

A

right

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56
Q

Which kind of breath sounds are normal?

A

Vesicular (low pitch, soft intensity)

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57
Q

What is a normal ankle brachial index?

A

1-1.4

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58
Q

What are Boutennier’s nodes a cardinal sign of?

A

Rheumatoid arthritis

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59
Q

The individual is viewed as a unitary energy source within the larger universe constantly interacting with the environment

A

Science of Unitary Human Beings - Rogers - 1980s

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60
Q

What are acrochordons?

A

Skin tags - benign, often found in older adults

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61
Q

What are lentigines?

A

Liver spots - benign, found in older adults

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62
Q

Why are actinic keratoses concerning?

A

They are precancerous lesions and should be examined carefully as they may become squamous cell or basal cell carcinoma. As opposed to seborrheic keratoses which are benign skin lesions.

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63
Q

JNC 8 recommended goat for treating those > 60 years

A

150/90

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64
Q

JNC 8 goal for treating HTN in those

A

140/90

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65
Q

A 10kg weight loss can result in what amount of reduced systolic bp? (#mmHg)

A

20mmHG

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66
Q

In HTN, what should the dietary sodium restriction be?

A

2,000 mg or 2grams. (CHF 2-3 grams)

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67
Q

Which heart medications reduce myocardial oxygen demand and induce coronary vasodilation?

A

Calcium Channel Blockers: Nifedipine, Verapamil, Diltiazem

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68
Q

Which heart sound is commonly heard in heart failure?

A

S3 gallop

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69
Q

Which class of heart medications are the mainstays of chronic HF management)

A

ACE inhibitors: Captopril, Enalapril, Lisinopril. Reduce afterload and prevent ventricular remodeling. Also BB

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70
Q

Virchow’s Triad (thrombophlebitis)

A

Vessel injury, venous stasis, hyper coagulation states

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71
Q

What is % of caucasian adults afflicted w/ HTN?

A

10-15%

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72
Q

Pharmacologic management of CHF includes 4 classes of agents:

A

1st line: ACE inhibitors (decrease afterload and prevent ventricular remodeling), then ARBs (inhibit RAAS) Diuretics (decrease preload), nitrates (decrease afterload), digoxin (contractility). BETA BLOCKERS

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73
Q

What does DMAIC stand for?

A

(define, measure, analyze, improve, control)

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74
Q

4 things that motivate employees the most include:

A

autonomy, salary, recognition, respect

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75
Q

Transtheoretical model describes stages of change. What are they?

A

pre contemplation, contemplation, preparation, action, and maintenance. There are 2 temporal dimensions to this process: distance of the behavior and duration of the behavior

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76
Q

This is the ratio of incidence of infection/disease among those who have been exposed compared to the incidence among those who have not been exposed:

A

Risk ratio. A risk ratio of 1.0 suggests the probability that those exposed will have higher rates. A risk ratio of 1.5 shows that the exposed group is 1.5 times more likely to become infection or diseased than the group not exposed. A lower number suggests exposure brings less risk of infection/disease.

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77
Q

This sampling occurs when there is an equal chance for any member of a group to be a part of the sample, allowing generalization of results

A

Probability sampling. Subtypes: cluster, multi-stage, simple random

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78
Q

What are the different types of non-probability sampling?

A

convenience, quota, and purpose

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79
Q

Authoritative statements by which the quality of practice, service or education can be judged.

A

Standards of practice

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80
Q

Selye’s General Adaptation Syndrome has (how many) phases:

A

3: alarm, resistance, exhaustion

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81
Q

this includes efforts to control the underlying cause or condition that results in disability

A

Primary prevention

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82
Q

This aims at preventing an existing illness or injury from progressing to long term disability

A

Secondary prevention

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83
Q

This refers to rehabilitation and special educational services to mitigate disability and improve function and participatory or social outcomes once disability has occured

A

Tertiary prevention

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84
Q

Maslow’s Hierarchy of Needs

A

Basic needs: food, shelter; Safety/Security: locks, lighting; Belonging: love, comfort, favorite surroundings; Trust: control over lifestyle, pain, choices; Self-esteem: status, pride, confidence; Self actualization: satisfying relationships, values, creativity, self direction.

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85
Q

Eric Erikson Pertinent Developmental States

A

Adolescent: Identity vs. Role Confusion; Young Adult: Intimacy vs. Isolation; Middle-age adult: Generativity vs. stagnation; Older Adult: integrity vs. Despair

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86
Q

Steps in a needs assessment

A
  1. Determine target population 2. Review or collect data (subjective/objective) 3. Conduct RCA to determine opportunities for improvement
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87
Q

SWOT

A

Strengths, Weaknesses, Opportunities and Threats

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88
Q

Closure of mitral valve

A

S1; ventricular systole [SIMS]

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89
Q

Closure of aortic/pumonic valves

A

S2, ventricular diastole [SZAPD}

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90
Q

The ability to understand a different culture and provide individualized, appropriate care

A

Cultural competence

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91
Q

Characteristics of delirium

A

Rapid onset, altered levels of consciousness, usually r/t a specific cause, usually reversible.

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92
Q

Characteristics of dementia

A

Gradual onset, clear consciousness, multiple cognitive impairments, memory impairments, disorientation, hallucinations, delusions,

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93
Q

What percent of dementia is due to Alzheimer’s disease?

A

60-80%

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94
Q

A diagnosis of dementia is based on:

A

Memory loss (both short and long term) plus one of the following: aphasia, apraxia, agnosia, disturbed executive function

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95
Q

Pharmacological Treatment for Early Dementia

A

Cholinestrerase Inhibitors: donepezil (Aricept).

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96
Q

Pharmacological Treatment for Middle-Late Dementia

A

Memantine (Namenda) (plus cholinesterease inhibitor)

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97
Q

Pharmacological Treatment for Delirium

A

Neuroleptics for hallucinations; haloperiodl or risperdone, benzos if induced by benzo withdrawl or alcohol

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98
Q

Hospital insurance covers acute hospital, limited nursing home care and/or home health care as well as hospice care for the terminally ill. No premiumPayed for by Social Security Taxes

A

Medicare A.

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99
Q

Medical insurance covers physicians, APRNs, lab work, PT & OT. Patients must pay an annual deductible in addition to monthly payments

A

Medicare B.

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100
Q

A prescription drug plan covers part of the costs of prescription drugs at participating pharmacies. IT is administered by private insurance companies, so monthly costs and benefits vary

A

Medicare D

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101
Q

A combined federal and state welfare program authorized by Title XIX of the Social Security Act to assist people with low income with payment for medical care. Eligibility and reimbursement guidelines vary by state.

A

Medicaid

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102
Q

A federal health insurance program for those who have Social Security or those who have bought in that provides payment to private healthcare providers but limits reimbursement.

A

Medicare

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103
Q

A HMO receives payment for services (vs. pay for service). A PCP serves as a gatekeeper to determine what other services the patient needs and patient must stay within HMO network.

A

Medicare managed Care

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104
Q

Health care program serving active military and their spouses/ dependents. All other insurances (including medicare) must pay before this kicks in

A

Tricare

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105
Q

Having a patient draw the face of a clock with all 12 numbers and the hands indicating a specific time is on which assessment tool?

A

Mini-Cog

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106
Q

Normal aging on the renal system

A

30-40% of nephrons are lost, kidney size decreases resulting in inability to concentrate urine. Filtration rate decreases. Excess potassium may be secreted.

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107
Q

Normal aging on the neurological system

A

Breaks in neural pathways interfere with sensory input (ex. full bladder).

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108
Q

Difficulty understanding and producing language in speaking, reading, and writing although patient may understand gestures and pictures/diagrams

A

Global aphasia

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109
Q

Clear understanding but difficulty producing language. Picture charts are helpful for the patient

A

Broca’s aphasia (expressive)

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110
Q

Difficulty understanding language but can understand gestures and are able to produce language, albeit sometimes incorrectly. May be able to write or use letter boards for communication.

A

Wernicke’s aphasia (receptive)

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111
Q

This type of incontinence is caused during events such as laughing, sneezing, coughing etc.

A

Stress incontinence

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112
Q

This type of incontinence is caused by overactive bladder

A

Urge incontinence

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113
Q

What are the 5 steps of CNS consultation (according to Norwood)

A

1.gaining entry 2. problem identification 3. action planning 4. evaluation 5. disengagement

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114
Q

This type of incontinence is caused by an inability to fully empty the bladder.

A

Overflow incontinence

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115
Q

This type of incontinence is caused by an inability to make it to the toilet in adequate time.

A

Functional incontinence

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116
Q

The indirect provision of care through helping others’ implement change

A

Consultation

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117
Q

The capacity to perform based on knowledge

A

competence

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118
Q

Actual performance (of a skill)

A

competency

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119
Q

What are the three determinants of learning?

A

Learning needs, readiness to learn, and learning style

120
Q

What are the four categories of readiness to learn?

A

PEEK. Physical, emotional, experiential, knowledge

121
Q

What are the four learning styles?

A

VARK. Visual, Auditory, Reading/Writing, Kinesthetic

122
Q

What are the four components of the complex adaptive systems model?

A

Assessment, Diagnosis, Intervention, Evaluation

123
Q

What are the 5 steps of the planned change and innovation model?

A

Needs Assessment, Identify appropriate interventions to achieve outcomes, Analyze research evidence, Implement EBP, Evaluate (modify PRN)

124
Q

Lewin’s 3 step change theory

A
  1. Unfreezing of the existing situation 2. Movement 3. Refreezing.
125
Q

What are the 5 basic principles of motivational interviewing?

A
  1. Empathy 2. Argument Avoidance 3. Self-efficacy support 4. Resistance reframing 5. Discrepancy awareness
126
Q

What is OARS?

A

Used in Motivational Interviewing. Open-ended questions, Affirmations, Reflective Listening, Summaries. Helps individuals explore and resolve ambivalence

127
Q

Behavioral Theories in Teaching/Learning Theories have these characteristics

A

Behavior is learned, can be shaped. Faculty-led, tightly structured learning environment. Positive/Negative Reinforcement.

128
Q

Cognitive Theories in Teaching/learning Theories have these characteristics

A

Learning is individualized. Faculty relinquish some control thus students have active roles and responsibilities for learning.

129
Q

Humanism

A

Goal is self actualization (do what is best), learning can be formal or informal. Self evals.

130
Q

Malcolm Knowles Adult Learning Principles (6)

A

Autonomy, Life experience/knowledge, Goal-oriented learning, applicability, usefulness, respect

131
Q

What are the four types of evaluation?

A

Process, Content, Outcome, Impact

132
Q

The ability to decode instructions, charts and diagrams; analyze risks to benefits; and make decisions that lead to actions

A

Health Literacy (definition from NIH)

133
Q

A formal, time-limited arrangement (usually short term) that includes teaching, support, counseling, coaching, evaluation etc.

A

Precepting

134
Q

A formal or informal long term personal relationship btwn and experienced person and less experienced person that provides advice/support, wisdom, guidance and counseling for professional development.

A

Mentoring.

135
Q

8 ethical principles relevant to nursing practice

A

Autonomy, non-maleficence, beneficence, justice, veracity, fidelity, confidentiality, privacy

136
Q

Conduct (of professionals) that falls below professional standards of care or standard minimum knowledge/ability

A

Negligence

137
Q

Approximately how many Americans are believed to be below basic levels of literacy?

A

93 million

138
Q

Etiology/ Pathophysiology of CHF

A

(Positive Feedback Loop); Always secondary to something else. Weak/Thick, Less Compliant ventricles lead to reduced cardiac output which leads to decreased organ perfusion. This stimulates the RAAS

139
Q

What happens when the RAAS is triggered?

A

Alodterone is released which causes compensatory Na and H20 retention. Excess fluid leaks into interstitial tissue causing pedal edema and weight gain. Norepi is also released which causes compensatory tachycardia and vasoconstriction.

140
Q

Formula for Cardiac Output

A

CO=HR x SV

141
Q

NYHA CHF Classification

A

Class I: No limitations; Class II: slight limitation, ADL’s may product SOB, fatigue; Class III: marked limitation; Class IV: inability to carry out any activity without discomfort. SOB @ rest.

142
Q

An ABI under 1 is indicative of what?

A

PVD

143
Q

The pathogenesis of arrhythmias falls into 1 of these 3 categories:

A
  1. Enhanced or suppressed automaticity (heart cells are all pacemaker cells) 2. Trigger activity (depolarization) 3. Re-entry (most common)
144
Q

why are ACE inhibitors or ARBs used for treatment in an acute MI?

A

the prevent ventricular remodeling and decreased development of heart failure

145
Q

How many people in the U.S. have HTN?

A

1 in 5. 50 million people. More than 30% are undiagnosed. Murica.

146
Q

What is first line pharmacological treatment for Stage I HTN?

A

Thiazide diuretic (HCTZ). Use cautiously in those with hx of gout or significant hyponatremia. Avoid concomitant NSAID use.

147
Q

When should Beta Blockers be avoided?

A

Asthma, reactive airway disease, 2nd/3rd degree heart block. NSAIDs decrease effectiveness

148
Q

What is first line pharmacological treatment for Stage II HTN?

A

2 drug combination. Thiazide diuretic + ACEI or ARB

149
Q

Calf pain produced by passive dorsiflexion of the foot

A

Homan’s sign. Possibly indicative of VTE. Lacks sensitivity and specificity.

150
Q

What are the three etiological categories of Anemia?

A
  1. Decreased RBC production 2. Increased RBC destruction 3. Blood loss
151
Q

How is sickle cell anemia diagnosed?

A

Hemoglobin electrophoresis

152
Q

Clinical manifestations of anemia are usually the result of reduced oxygen carrying capacity and include

A

pallor, dizziness, fatigue, weakness, constipation, headaches, irritability. etc. When untreated, leads to compensatory mechanisms that manifest with tachycardia then resulting hemodynamic instability and organ failure.

153
Q

This type of anemia is the most common

A

Iron-deficiency. Affects 1 in 5 U.S. adults. Especially the elderly

154
Q

Anemia of chronic disease is most commons these types of diseases:

A

Cancers, Auto-immune diseases and chronic iflammatory conditions (RA, ESRD, SLE, Hepatitis, CHF)

155
Q

Pharmacogenetics

A

how genetics affects drug transport and metabolism

156
Q

Pharmacogenomics

A

Looks at genetic variations when developing a new drug

157
Q

Pharmcodynamics

A

Drug effect and mechanism of action (what a drug does to the body)

158
Q

Pharmacokinectics

A

Movement of the drug. Absorption, distribution, metabolism and elimination (what the body does to the drug)

159
Q

The most common cancer in the U.S is

A

breast cancer, followed by prostate and lung, then colorectal

160
Q

TNM Cancer staging

A

T: size of primary tumor N: lymph node involvement M: malignant/metastasis

161
Q

Which neurotransmitters are implicated in depression?

A

Serotonin and norepi and dopamine

162
Q

A diagnosis of depression is considered when

A

There is a change from previous (normal) functioning, for at least 2 weeks, with at least 5 key indicators (ex: anhedonia, weight loss/gain, fatigue, insomnia, etc).

163
Q

Common pharmacological interventions for depression include:

A

SSRIs, MAOIs, Tricylcic antidepressants

164
Q

Common pharmacological interventions for bipolar disorders include:

A

Mania: Mood stabilizers (lithium); Depression: Antidepressants; Psychotic: Antipsychotics

165
Q

Inflammatory condition of the parenchyma of the lung with abnormal alveolar fluid retention

A

Pneumonia

166
Q

If a patient has pneumonia, you would expect to find this upon auscultation and percussion:

A

Crackles; Dullness (maybe flat if very fluid filled)

167
Q

Inability of respiratory system to maintain normal state of gas exchange to meet cellular requirements

A

Respiratory Failure. Dyspnea is classic symptom.

168
Q

Airflow limitation that is not fully reversible, usually progressive and associated with inflammation

A

COPD (emphysema and/or chronic bronchitis)

169
Q

What is the most common cause of pneumonia?

A

Aspiration, then droplet inhalation

170
Q

Characteristics of emphysema

A

alveolar damage. Destruction or enlargement.

171
Q

Characteristics of chronic bronchitis

A

Inflammation. Increased mucous production. Chronic cough.

172
Q

What is a normal FEV1/FVC ratio?

A

75-80% All stages of COPD will less than 70%

173
Q

COPD staging by FEV1

A

Stage 1 (Mild): FEV1>80%; Stage 2 (Moderate): FEV1 btwn 50-80%; Stage 3 (Severe) FEV1 btwn 30-50%; Stage 4 (Very Severe) FEV1

174
Q

Airflow limitation as a result of inflammatory obstruction that is reversible either spontaneously or with treatment.

A

Asthma

175
Q

What does the acronym COPDER stand for?

A

Corticosteriods/Co-morbidities; Oxygen; Preventative steps (no smoking/vaccines); Dilators; Education/action plan; Rehab.

176
Q

What does the acronym AIRESMOG stand for?

A

R/t Asthma: Allergy/Adherence to therapy; Infection/Inflmmation; Rhinitis/sinusitis; Exercise; Smoking; Medications; Occupational exposure/OSA; Gerd.

177
Q

Examples of Metabolic Acidosis

A

DKA, diarrhea, renal failure, shock, heart failure

178
Q

Examples of Metabolic Alkalosis

A

K+ wasting diuretics, overuse of antacids, loss of gastric secretions, massive blood transfusions, corticosteroid therapy

179
Q

Examples of Respiratory Acidosis

A

(Not moving air well) COPD, Oversedation, Neuromuscular disease, CNS depression, pulmonary edema

180
Q

Examples of Respiratory Alkalosis

A

(Rapid breathing) Pain, anxiety, PE, pneumothorax, fever

181
Q

Risk factors for fluid and electrolyte disorders

A

age extremes, gender, body size, environmental temperature, diet, exercise, stress, heavy alcohol conconsumption, fever. (Decreased total body water in elderly and obese)

182
Q

Clinical picture of hyponatremia

A

Most are neurological and vary. Can progress from cognitive impairment, seizure activity, coma. Muscle weakness and cramping. Potential Rhabdomyolysis (leads to acute tubular necrosis)

183
Q

Clinical picture of hypernatermia

A

Non-specific. Neurological in nature

184
Q

Clinical picture of hypokalemia

A

signs of ileus, hypotension, arrhythmias, cardiac arrest, respiratory distress, lethargy, fasciculations or tetany, cushingoid appearance.

185
Q

Clinical picture of hyperkalemia

A

decreased cell excitability, peaked t waves, decreased HR, twitching, tingling, numbness, look for signs of renal failure and cardiac disturbances

186
Q

An adaptive response to severe volume depletion and hypotension with structurally intact nephrons

A

Prerenal acute kidney injury. Can lead to intrinsic AKI if not promptly corrected.

187
Q

Causes of AKI

A

Volume loss from GI, renal, burns, or internal/external hemorrhage. Decreased renal perfusion in heart failure or sepsis. Some medications in volume-depleted states: ACEIs, ARBs

188
Q

Acute tubular necrosis (ATN)

A

structural injury in the kidney, either ischemic of cytotoxic, patchy necrosis. Distal nephron death. May not be reversible and may progress to CRF or death.

189
Q

Caused by mechanical obstruction of the urinary collecting system

A

Postrenal acute kidney injury. Includes renal pelvis, ureters, bladder, urethra.

190
Q

Signs/Symptoms of ARF

A

can be asymptomatic. mental status changes, n/v, seizures, SOB, peripheral edema, pulmonary rales,

191
Q

Prerenal ARF

A

impaired flow (ACEI, NSAIDs), intravascular depletion, kidneys resorb Na, CHF, azotemia, trace-2+ urine protein; BUN to serum Creatinine ratio >20:1

192
Q

Intrinistic ARF

A

Impaired sodium resorption, 3-4+ urine protein. #1 cause of ATN due to structural kidney damage. hypoperfusion, cytotoxic agents, acute glomerular nephritis

193
Q

4 categories of Intrinsic ARF

A

tubular, glomerular, vascular, interstitial

194
Q

Postrenal ARF

A

obstruction. Stones, tumors, enlarged prostate.

195
Q

which diagnostics are best to detect postrenal ARF (obstruction)

A

renal ultrasound, CT. Avoid pyelogram (contrast dye)

196
Q

Which medications might be given for ARF?

A

Diuretics. Dopamine (increase CO and GFR), CaChB (minimize nephrotoxcity in ATN, prevents Ca from going into kidney cells); N-acetylcysteine (Mucomist) ( prevention of contrast medium nephrotoxicity)

197
Q

The gradual loss of kidney function, that, if not stabilized, will result in ESRD.

A

CRF. ESRD is fatal without dialysis or kidney transplant

198
Q

Common causes of CRF

A

irreversible ARF, DM, HTN, GU cancer, BPH, glomerulonephritis

199
Q

In ESRD, kidneys are functioning at what capacity?

A

Less than 15% of normal

200
Q

Sepsis continuum

A

infection + SIRS= sepsis (“simple”), then severe sepsis, then septic shock

201
Q

What is one of the most common causes of sepsis?

A

Urosepsis. 25% of all sepsis cases. E Coli is responsible for over 50% of cases.

202
Q

What are the two types of strokes?

A

hemorrhagic and ischemic

203
Q

Which type of stroke is most common?

A

ischemic (90%). emboli, thrombus (hypercoagulability or vessel abnormality)

204
Q

5 risk factors for stroke account for over 80% of risk

A

HTN (#1), smoking, Abdominal obesity, diet, physical inactivity

205
Q

Management of acute ischemic CVA

A

Emergent CT, angiography, TPA, Do not treat HTN aggressively or fast (can cause rebound hypotension),

206
Q

Exclusion criteria for TPA

A

Greater than 3 hours since symptom onset; neurological deficits improving; CT scan shows hemorrhage; PTT>15 seconds or INR > 1.5; severe hypo or hyperglycemia; thrombocytopenia; severe HTN, patient with recent hx of CVA or head trauma, recent hx of major surgery, patient with seizure at onset of CVA

207
Q

What is the proper administration of TPA?

A

10% of total dose (0.9mg/kg) given as bolus over 1 minute, then remainder infused over 1 hour. No additional anticoags x 24 hours

208
Q

What is used if TPA is contraindicated?

A

IV heparin drip and ASA

209
Q

Common clinical presentation for subacachnoid hemorrhage (SAH)?

A

worst headache of life, nuchal rigidity, n/v. Usually related to aneurysm rupture.

210
Q

What are the three stages of alcohol abuse treatment

A

Detoxification (can be a medical emergency), Rehabilitation, Maintence

211
Q

Degenerative Joint Disease is primarily a disease of

A

cartilage. Affects weight bearing joints. Degrading enzymes are increased resulting in degradation vs. remodeling seen in healthy cartilage.

212
Q

What are the 5 medically accepted treatments for obesity?

A

Diet modification, exercise, behavior modification, drug therapy (appetite suppressants), surgery (BMI>40)

213
Q

What components are part of metabolic syndrome?

A

HTN, hyperglycemia, truncal obesity, dyslipidemia (increased triglycerides, decreased HDL)

214
Q

Symptoms of hepatitis

A

nonspecific flu-like (malaise, body aches, fever, n/v, diarrhea, headache, loss of appetite,); dark urine, jaundice, hepatomegaly, splenomegaly.

215
Q

Viral liver infection lasting at least one month. Short incubation period (15-50days). Transmitted through fecal/oral route. Vaccine available.

A

Hepatitis A

216
Q

Viral liver infection that can be acute or chronic with an incubation period of 60-90 days (or longer). Transmitted parenterally, sexually, perinatally or with close household contact. Vaccine available.

A

Hepatitis B

217
Q

Viral liver infection causing inflammation. normally short incubation period (2 wks-6months) but can persist up to 20 years before onset of cirrhosis or hepatoma. Spread by direct blood contact, usually IV drug use. No vaccine.

A

Hepatitis C (responds aggressively to interferon; primary cause of liver cancer)

218
Q

Cranial Nerve #1

A

Olfactory

219
Q

Cranial Nerve #2

A

Optic

220
Q

Cranial Nerve #3

A

Oculomotor

221
Q

Cranial Nerve #4

A

Trochlear

222
Q

Cranial Nerve #5

A

Trigeminal

223
Q

Cranial Nerve #6

A

Abducens

224
Q

Cranial Nerve #7

A

Facial

225
Q

Cranial Nerve #8

A

Vestibulococlear

226
Q

Cranial Nerve #9

A

Glossopharyngeal

227
Q

Cranial Nerve #10

A

Vagus

228
Q

Cranial nerve #11

A

Spinal Accessory

229
Q

Cranial Nerve #12

A

Hypoglossal

230
Q

What is first line drug therapy for status epilepticus?

A

Lorazepam

231
Q

Herbedens or Bouchards nodes are a signs of what?

A

Osteoarthritis

232
Q

An autoimmune catabolic disorder resulting in low or absent circulating insulin, elevated plasma glucagon levels and failure of pancreatic beta cells to respond to all insulin-secretory stimuli

A

Type 1 DM

233
Q

pathophysiology of DKA

A

dehydration due to insulin deficiency results in high blood glucose levels and ketone formation

234
Q

Common causes of DKA

A

infection, missed or inadequate insulin, MI, CVA, new diagnosis of DM

235
Q

Treatment for DKA

A

fluid replacement, IV insulin, potassium replacement

236
Q

Early morning rebound hyperglycemia due to nocturnal hypoglycemia

A

Somogyi effect. Need to adjust evening snacks or insulin dose.

237
Q

Hyperglycemia due to hepatic gluconeogenesis in early morning

A

Dawn phenomenon. Related to hormones. No bedtime snack or ensure high protein.

238
Q

Insulin resistance in target tissues, decreased insulin receptors and/or impairment of insulin secretion.

A

Type 2 DM

239
Q

What are DM screening recommendations?

A

Any age if obesity and additional risk factors are present otherwise age 45. If normal, repeat every 3 years.

240
Q

what percent of the U.S. population has DM?

A

9.3% [about 29.1 million people] (38% of patients admitted to the hospital have hyperglycemia

241
Q

What is the #1 cause of renal failure and blindness?

A

DM

242
Q

In which type of DM are insulin doses smaller?

A

Type 1 (patients are very sensitive. A little bit goes a long way)

243
Q

What medications are recommended for HTN in diabetics and why?

A

ACE/ARB (renal protective effects)

244
Q

When is metformin contraindicated?

A

Decreased kidney function, recent use of IV contrast, decreased liver function, age>80, infection, cardiopulmonary insufficiency, alcoholism, surgery

245
Q

What are the three categories of insulin and when are they given

A

basal: long acting; not eating. overnight/btwn meals
nutrition/bolus: covers carbd eaten during meals
correction/rescue: corrects a high level and brings back to goal

246
Q

What are the normal basal insulins?

A

NPH, Glargine, Detemir. NPH has peak effects. Others’ do not

247
Q

Graves disease, mulinodular goiters and follicular thyroid cancer are results of

A

hyperthyroidism. 60-80% of ppl with hyperthyroidism have graves disease

248
Q

Hashimoto’s thyroiditis and iodine deficiency are indicative of:

A

hypothyroidism

249
Q

a low TSH and high T4 is indicative of

A

hyperthyroidism

250
Q

a high TSH and a low t4 is indicative of

A

hypothyroidism

251
Q

S/Sx of hyperthyroidism

A

fast: tachycardia, palpitations, a fib, fine tremor, weight loss, sweating, fatigue, heat intolerance, diarrhea, bulging eyes, absence of menses.

252
Q

S/Sx of hypothyroidism

A

slow/sluggish: weight gain, feeling cold, dry hair, skin, nails, hair loss, constipation, bradycardia, hypotension, heavier/longer menses

253
Q

Treatment for hyperthyroidism includes

A

anti-thyroid medications (MMI, PTU [first choice in thyroid storm]), Radioactive iodine 131 (most common in U.S.), thyroidectomy. + symptom management (htn: beta blockers (or CCB if BB contraindicated)

254
Q

Treatment for hypothyroidism includes

A

levothyroxine (take in morning 60-90 minutes prior to breakfast)

255
Q

Inflammatory bowel disease that causes long lasting inflammation and ulcers (unknown cause)

A

ulcerative colitis

256
Q

inflammatory bowel disease that can spread deep into bowel tissue; cause unknown

A

Crohn’s

257
Q

Functional bowel disorder characterized by abdominal pain/discomfort and altered bowel habits. cause unknown

A

IBS

258
Q

Principles of consultation

A

initiated by the consultee, nonhierarchial and collaborative relationship exists, consultant recommends changes that may be accepted or rejected.

259
Q

Family caregiving statistics

A

> 65 million people (29%) of the U.S. population provide care. $375 billion/year is the estimated value of care. Average is at least 20 hours/week with 13% of family caregivers providing 40+ hours/week.

260
Q

Caregiver burnout

A

Decreased energy, constant illness (increase from previous, sometimes due to neglect of personal health), persistent exhaustion. Feels of being overwelmed, helplessness and hopelessness.

261
Q

Nursing Moral Distress

A

r/t unhealthy work environment. Know right thing to do but are prevented from doing it. Discrepancies btwn education and practice. ineffective communication. lack of teamwork, futile care, gap btwn managed care services and evidence based practice

262
Q

Six standards to a healthy work environment

A

communication, collaboration, shared decision making, adequate staffing, nurse recognition, administrative support

263
Q

This type of public health insurance provides publicly funded care to elders, regardless of income

A

Medicare

264
Q

This type of public health insurance provides care for eligible poor

A

Medicaid

265
Q

Goals of care are to rule out the underlying disease, restore homeostatis and return the patient to the peak of health (or as close as possible). Self-limiting conditions that are expected to respond to some form of medical intervention

A

Acute Illness

266
Q

Uncertainty in outcomes or treatment required. Affects multiple systems and conditions, changes a persons’ lifestyle and relationships within it. Requires ongoing adjustments and is over a long period of time.

A

Chronic Illness

267
Q

The ability to perform specific daily living tasks which are normally expected of an individual within a social environement

A

Functional Capacity. Assessed by ADL; IADL

268
Q

Considerations with gerontological pharmacokinetics: Absorption

A

Slows. Increased gastric pH, slower emptying.

269
Q

Considerations with gerontological pharmacokinetics: Distribution

A

Altered. Decreased total water. Increased body fat, Decreased cardiac output, consider protein status

270
Q

Considerations with gerontological pharmacokinetics :Metabolism

A

Decrease in liver size and blood flow to liver. Increases half life of some drugs

271
Q

Considerations with gerontological pharmacokinetics: Elimination

A

Declining renal function necessitates lower doses

272
Q

Considerations with gerontological pharmacodynatics

A

Central nervous system changes (receptor sensitivity, receptor sites) can result in increased side effects and behavioral changes. decrease in baroreceptor function can lead to orthostatic hypotension, increased risk of hypoglycemia in DM.

273
Q

Anticholinergics agents

A

Cumulative effects including urinary retention, dry mouth, dry eyes, constipation, sedation, confusion, hallucinations. Results from antihistamines, antidepressants, antipsychotics, cimetidine/ranitidine, antispasmodics, antidiarrheals, antiemetics, and anti-Parkinson’s drugs.

274
Q

Food/Drug Interactions: ACE inhibitors

A

Avoid potassium supplements & poassium-rich foods

275
Q

Food/Drug Interactions: Anticoagulants

A

Avoid foods high in Vitamin K (broccoli, spinach, burssel sprouts, cauliflower, kale)

276
Q

Common causes of hypernatremia

A

renal disease, diabetes insipidus, dehydration. Treatment includes treating underlying cause + IV fluid replacement

277
Q

Common causes of hypokalemia

A

diarrhea, vomiting, gastric suctioning. potassium replacement

278
Q

Common causes of hyperkalemia

A

renal disease, adrenal insufficiency, metabolic acidosis, dehydration. May be induced by NSAIDs and potassium sparing diuretics. Tx: underlying cause + one of the following: calcium gluconate, sodium bicarbonate, insulin and hypertonic dextrose

279
Q

Common causes of hypocalcemia

A

hypoparathyroidism, pancreatitis, renal failure, inadequate Vit D intake. S/Sx: tetany, tingling, seizures. Replace calcium and Vit. D

280
Q

Common causes of hypercalemia

A

Acidosis, kidney disease, hyperparathyroidsim. prolonged immobilization. S/Sx: muscle weakness, nausea, vomiting, cardiac issues (including arrest). Tx with loop diuretics and Iv fluids

281
Q

Rapidly progressing dementia causing memory impairments, behavioral changes and loss of coordination. Caused by a prion disease

A

Creutzfeldt-Jakob Disease

282
Q

A cognitive and functional decline similar to Alzheimer’s but symptoms fluctuate frequently. May involve visual hallucinations, muscle rigidity, and tremors

A

Dementia with Lewy bodies

283
Q

Symptoms similar to Alzheimer’s disease but memory loss may be less pronounced

A

Vascular dementia

284
Q

Opacity of the lens of the eye(s) that interferes with vision. Slow progression. Very common in older adults

A

Cataracts. Tx: surgery

285
Q

Group of eye conditions characterized by damage to the optic nerve and vision impairment. Involves an increase of intraocular pressure from inadequate drainage of aqueous fluid. S/Sx: blurred vision, halos around lights, lack of focus, headache

A

Glaucoma. Tx: topical beta blockers, miotics, potential surgery.

286
Q

Systolic CHF is characterized by

A

low EF, hypotension, S3. most common. Ventricles don’t squeeze well. Usually accompanied by valvular regurgitation

287
Q

Diastolic CHF is characterized by

A

normal EF, ventricles don’t relax well.

288
Q

What is the diagnostic test that will differentiate btwn systolic and diastolic CHF?

A

Echocardiogram

289
Q

S/Sx of CHF

A

SOB, periph edema, weakness, dizziness, arrhythmias, crackles, elevated JVP, S3

290
Q

What heart medication should be avoided in diastolic dysfunction?

A

Digoxin. Dig promotes contractility but in diastolic heart failure, relaxation (not contraction) is the issue, BB, CCB and nitrates are ok

291
Q

Examples of “rate control” A Fib medications include

A

CCB, BB, Digoxin, (+ AV node ablation)

292
Q

Examples of “rhythm control” A Fib medications include

A

anti-Arrhythmics (amniodorone), + ablation/ MAZE

293
Q

What are the components of the CHADSII score?

A

CHF +1; HTN+1; Age>75 +1; DM+1; Stroke hx +2. Score 0-6. 0: no tx; maybe aspirin; 1: aspirin, maybe warfarin; 2+: warfarin.

294
Q

Cushing triad

A

Htn, increased pulse pressure, bradycardia. Late sign of brain stem dysfunction

295
Q

4 clincal signs of Parkinsons disease

A

Tremor, muscle rigidity, dyskinesia, postural instability

CNS Boards (3 decks)

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