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AGACNP Exam > Common Problems in Acute Care > Flashcards

Common Problems in Acute Care Flashcards

1
Q

How long does acute pain last for?

A

Less than 6 months

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2
Q

Where is cutaneous pain located?

A

On the skin/surface of the body

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3
Q

Visceral pain originates where?

A

Internal organs

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4
Q

What is somatic pain?

A

Non-localized, from muscles, bone or soft tissue

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5
Q

What is the WHO’s ladder of pain management?

A

Starts with aspirin, Tylenol or an NSAID and builds thru three steps with heavier narcotics added, while keeping the original nonopioid

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6
Q

What type of pain are Fentanyl patches recommended for?

A

Breakthru cancer pain

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7
Q

Bisphosphonates should be used for management of what type of pain?

A

Metastatic bone pain management

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8
Q

Intact skin with nonblanchable redness is what stage pressure ulcer?

A

Stage 1

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9
Q

Partial thickness loss of skin with exposed dermis is what stage pressure ulcer?

A

Stage 2

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10
Q

Full thickness skin loss is what stage pressure ulcer?

A

Stage 3

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11
Q

Visible adipose tissue indicates what stage pressure ulcer?

A

Stage 3

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12
Q

Pressure ulcer with exposed tendon, ligament, cartilage or fascia is what stage?

A

Stage 4

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13
Q

Pt must maintain a good level of what to prevent pressure ulcer development?

A

Albumin

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14
Q

What is a normal albumin level?

A

3.5-5

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15
Q

What is a major complication of pressure ulcers?

A

Osteomyelitis

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16
Q

Fever is a body temp above what?

A

37

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17
Q

What induction agent can cause malignant hyperthermia?

A

Succinylcholine

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18
Q

Which electrolyte imbalance is an absolute contraindication for the use of succinylcholine?

A

Hyperkalemia

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19
Q

What are the two most commonly cultured organisms in the hospital?

A

Staph epi and staph aureus

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20
Q

Should you give Tylenol before cultures are drawn?

A

No

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21
Q

What might cause a postop fever?

A

Increased basal metabolic rate

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22
Q

A fever caused by what tends to “linger”?

A

A drug fever

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23
Q

If there is no indication of infection, what should be first line to treat postop fever?

A

Hydration and lung expansion

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24
Q

What are the three most common types of HA?

A

Tension, migraine, cluster

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25
Q

What is the treatment for a tension HA?

A

Over the counter analgesics and relaxation

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26
Q

What is a classic migraine?

A

Migraine w/aura

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27
Q

What is a common migraine?

A

Migraine w/o aura

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28
Q

Do most people with migraines get an aura?

A

No

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29
Q

What does a VDRL test rule out?

A

Syphilis

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30
Q

If someone has a migraine more than how many times per month, they are put on migraine prophylaxis?

A

2-3 times

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31
Q

What is the most common drug used for migraine tx?

A

Sumatriptan

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32
Q

Cluster HA usually affects what demographic?

A

Middle aged men

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33
Q

What type of pain does cluster HA cause?

A

Unilateral, periorbital

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34
Q

What type of HA may cause rhinorrhea and eye redness?

A

Cluster HA

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35
Q

How is cluster HA tx?

A

With 100% O2 with or without sumatriptan

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36
Q

What is normal phos?

A

3.5-5

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37
Q

What is normal K+?

A

3.5-5

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38
Q

Edema may be seen if albumin level drops below what?

A

Below 2.7

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39
Q

What is normal mag?

A

1.7-2.2

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40
Q

When would you use an enterostomal tube (ie PEG tube) for nutritional support?

A

When you can use the GI tract and the pt needs nutritional support for longer than 6 weeks

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41
Q

When would you use a nasoenteric tube?

A

When you can use the GI tract but pt needs nutritional support for less than 6 weeks

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42
Q

When is a duodenal tube used instead of an NG tube?

A

If pt is at risk for aspiration

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43
Q

When would a central line be used for parenteral nutrition?

A

If pt needs support for greater than 2 weeks

44
Q

What is refeeding syndrome?

A

Electrolyte imbalances that can occur once you start feeding a pt enterally who has not been fed in a while

45
Q

What is a major electrolyte imbalance seen in refeeding syndrome?

A

Hypophosphatemia

46
Q

Diarrhea is a major complication of what type of feeding?

A

Enteral

47
Q

What are three strategies to manage diarrhea that occurs during enteral feeding?

A

Change from bolus feedings to continuous, slow feeding rate, reduce concentration of formula

48
Q

What three things should be evaluated when looking at a pt with hyponatremia?

A

Urine sodium, serum os, clinical status

49
Q

What is a normal urine sodium?

A

10-20 mEq/L

50
Q

What is a normal serum os?

A

2 x the serum sodium

51
Q

What is a normal serum sodium?

A

135-145

52
Q

What is a normal serum os?

A

275-285

53
Q

A urine sodium greater than 20 suggests what?

A

A problem with the kidneys

54
Q

A urine sodium less than 20 suggests what?

A

A problem other than the kidneys

55
Q

What is isotonic hyponatremia caused by?

A

Extreme hyperlipidemia

56
Q

What is the tx for isotonic hyponatremia?

A

Cut down on fat

57
Q

Dehydration will cause what type of hypotonic hyponatremia? What will urine Na+ be?

A

Hypovolemic hyponatremia. Na+ will be less than 10

58
Q

What does hypovolemic hyponatremia with a urine Na+ >20 suggest?

A

That the kidneys cannot conserve sodium

59
Q

What is the most common cause of hypovolemic hyponatremia with urine Na+ >20?

A

Diuretic therapy

60
Q

What type of hyponatremia requires water restriction?

A

Hypervolemic, hypotonic

61
Q

What is the most common cause of hypertonic hyponatremia?

A

Hyperglycemia (usually from HHNK)

62
Q

What is serum os in hypertonic hyponatremia?

A

Above 290

63
Q

When would you give 3% NS in hyponatremia?

A

If CNS sx are present

64
Q

Hypernatremia is usually caused by what?

A

Excess water loss

65
Q

What kind of acid base imbalance can cause hypokalemia?

A

Alkalosis

66
Q

Hypokalemia can lead to what EKG changes?

A

Broad T waves and prominent U waves

67
Q

How should you manage hypokalemia with a K+ > 2.5 with no EKG changes?

A

Oral replacement

68
Q

Which other electrolyte abnormality can impair K+ correction?

A

Magnesium

69
Q

What class of drug can cause hyperkalemia?

A

Hyperkalemia

70
Q

How to emergently manage hyperkalemia?

A

10 units of insulin and 1 amp D50

71
Q

What is a normal total calcium level?

A

8.5-10.5mg/dl

72
Q

What is a normal ionized calcium level?

A

4.5-5.5 mg/dl

73
Q

Which calcium measure does not vary with the albumin level?

A

Ionized CA

74
Q

Hypocalcemia does what to deep tendon reflexes?

A

Increases them

75
Q

Which electrolyte imbalance causes prolonged QT?

A

Hypocalcemia

76
Q

What is the tx for acute hypocalcemia?

A

IV calcium gluconate

77
Q

What is the most common tx for hypercalcemia in the acute setting?

A

Calcitonin

78
Q

Respiratory acidosis will have a pH of what and CO2 of what?

A

pH < 7.35 and pCO2 > 45

79
Q

Myoclonus with asterixis is a sign of which acid base imbalance?

A

Respiratory acidosis

80
Q

What should you do for a vented pt with respiratory acidosis?

A

Increase the vent rate

81
Q

Respiratory alkalosis is caused by what?

A

Hyperventilation

82
Q

What will pH and CO2 be in respiratory alkalosis?

A

pH > 7.5 and pCO2 < 35

83
Q

Is bicarb low or high in metabolic acidosis?

A

Low

84
Q

What is the formula for anion gap?

A

[Na + K] - [HCO3 + Cl]

85
Q

What is a normal anion gap?

A

7-17

86
Q

What are three major causes of increased anion gap acidosis?

A

DKA, alcoholic ketoacidosis, lactic acidosis

87
Q

Renal tubular acidosis causes what type of metabolic acidosis?

A

Non-anion gap acidosis

88
Q

What is normal bicarb?

A

22-26

89
Q

What drug may be used to treat metabolic alkalosis?

A

Acetazolamide

90
Q

Bite wounds in what location should be left open to heal?

A

Hands and lower extremities

91
Q

Any wound greater than how many hours old should be left open to heal?

A

Greater than 6 hours old

92
Q

For human and animal bites, how long should pt be on a course of abx?

A

3 to 7 days

93
Q

Abx should cover what two types of organisms for animal and human bites?

A

Staphylococci and anaerobes

94
Q

Which organism is the most common cause of acute otitis media?

A

S. pneumoniae

95
Q

S. pneumoniae is the most common pathogen causing which 5 infections?

A

Otitis media, sinusitis, bronchitis, meningitis, CAP

96
Q

Endocarditis is most commonly caused by which organism?

A

S. aureus

97
Q

What are signs of an immediate transplanted organ rejection?

A

Immediate failure of the organ + flu-like syndrome

98
Q

What is the first thing to do if you think pt is rejecting an organ?

A

Immediate biopsy of the organ

99
Q

What type of therapy is used in antirejection regimens?

A

Triple therapy

100
Q

What are the components of triple therapy for antirejection regimen?

A

Corticosteroid + antimetabolite + calcineurin inhibitor or mTOR inhibitor

101
Q

Shingrix is indicated for adults over what age?

A

Over age 50

102
Q

Actinic keratoses are premalignant to what type of skin CA?

A

Squamous cell carcinoma

103
Q

What is the most common skin CA?

A

Basal cell carcinoma

104
Q

Body temp must be what to be declared brain dead?

A

37C or above

105
Q

What is a normal PaO2?

A

75-100

106
Q

What is a normal PaCO2?

A

35-45

AGACNP Exam (14 decks)

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