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Level 2 > Complex Final Exam Old Info > Flashcards

Complex Final Exam Old Info Flashcards

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1
Q

What color is sputum production with pneumonia?

A

thick, yellow-green

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2
Q

When should you do a sputum culture and sensitivity with pneumonia?

A

before antibiotics

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3
Q

What will a chest x-ray show with pneumonia?

A

consolidation/fluid build-up

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4
Q

What might ABG’s show with pneumonia?

A

hypoxemia, PaO2 <80

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5
Q

What position should a patient with pneumonia be placed in?

A

high fowlers

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6
Q

What antibiotics can be used for pneumonia?

A

penicillins, cephalosporins

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7
Q

What color is sputum production with TB?

A

purulent, blood tinged

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8
Q

How long does a cough last to be dx with TB?

A

3+ weeks

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9
Q

What is the priority intervention for TB?

A

preventing infection transmission

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10
Q

What precautions are used for TB?

A

airborne

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11
Q

What type of room should a patient with TB be in?

A

negative airflow

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12
Q

How many negative sputum cultures are needed to determine that you do not have TB anymore?

A

3

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13
Q

How often should you get sputum cultures?

A

every 2-4 weeks

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14
Q

What tests should be done before starting TB meds?

A
  • liver
  • vision
  • hearing
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15
Q

What toxicity is common with all TB meds except ethambutol?

A

hepatotoxicity

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16
Q

What TB medication is neurotoxic, and what does this cause?

A
  • isoniazid (TB)
  • paresthesias of the hands/feet
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17
Q

What vitamin should you give for neurotoxicity?

A

B6

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18
Q

What happens to urine/secretions when taking rifampin (TB)?

A

turns orange

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19
Q

What TB med should vision changes be reported for?

A

ethambutol

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20
Q

Who can not be administered ethambutol?

A

patients <8 y/o

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21
Q

What is a normal PaO2 level?

A

80-100

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22
Q

What happens to the PaCO2 with respiratory acidosis?

A

increases, >45

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23
Q

What happens to the PaCO2 with respiratory alkalosis?

A

decreases, <35

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24
Q

What happens to the HCO3 with metabolic acidosis?

A

decreases, <22

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25
Q

What happens with HCO3 with metabolic alkalosis?

A

increases, >26

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26
Q

With asthma, what does silent chest indicate?

A

no lung sounds, obstruction

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27
Q

How can you tell an asthma attack is worsening?

A

unable to talk, cyanosis

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28
Q

What position should you place someone with asthma in?

A

high fowlers

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29
Q

What happens with emphysema?

A
  • loss of lung elasticity
  • CO2 retention
  • respiratory acidosis
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30
Q

What happens with chronic bronchitis?

A

inflammation of the bronchi and bronchioles

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31
Q

What are signs with COPD that the brain is not getting enough oxygen (<88%)?

A
  • confusion
  • disorientation
  • altered mental status
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32
Q

What color is sputum production with COPD?

A

rust colored

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33
Q

What position should you place someone with COPD in?

A

high fowlers

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34
Q

What breathing techniques should people with COPD do?

A
  • abdominal breathing
  • pursed-lip breathing
  • TCDB
  • incentive spirometer
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35
Q

What do respirations look like with COPD?

A

rapid, shallow, use of accessory muscles

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36
Q

Why should you increase calories with COPD?

A

there is increased work needed to breathe, so more calories are being burned

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37
Q

What type of meals should someone with COPD eat?

A

small and frequent with soft, easy-to-chew foods

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38
Q

What are the expected side effects of albuterol (COPD)?

A

tachycardia, tremors

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39
Q

What side effect of ipratropium (COPD) indicates toxicity?

A

palpitations

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40
Q

What is the therapeutic range of theophylline (COPD)?

A

10-20

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41
Q

In what order should you give meds for COPD?

A

B before C, bronchodilator before corticosteroid

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42
Q

What should you watch for with fluticasone and prednisone (COPD corticosteroids)?

A
  • infection (immunosuppressant)
  • black, tarry stools
  • hyperglycemia
  • weight gain
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43
Q

What diagnostic tests for HIV antibodies?

A

ELISA

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44
Q

What does the western blot tests do (HIV)?

A

confirms results after + ELISA test

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45
Q

What CD4 T lymphocyte level indicates severe HIV?

A

200

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46
Q

What precautions should be used for HIV?

A

standard unless bodily fluids are involved

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47
Q

What is the priority intervention for HIV?

A

preventing secondary infection

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48
Q

What happens to blood, vomit, and feces with HIV?

A

they are contaminated

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49
Q

What happens to healthy tissue with lupus?

A

gets inflamed and destroyed

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50
Q

What immunological tests are done for lupus?

A
  • ANA
  • dsDNA
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51
Q

When lupus affects the bones, what happens to the CBC?

A

pancytopenia

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52
Q

When lupus affects the kidneys, what happens to the BUN/creatinine?

A

increased

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53
Q

What is Raynaud’s phenomenon (lupus)?

A

pallor and cyanosis of the fingers

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54
Q

What is the first sign of lupus?

A

morning stiffness

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55
Q

What type of rash do you get with lupus?

A

butterfly rash

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56
Q

What are the 4 “A” symptoms of lupus?

A
  • alopecia
  • anorexia
  • anemia
  • arthraligia
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57
Q

What part of the GI tract does UC affect?

A

the rectum and sigmoid colon

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58
Q

Where do you have pain with UC?

A

LLQ

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59
Q

How many diarrheas can you have a day with UC, and what can they consist of?

A
  • 15-20/day
  • blood, mucus, pus
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60
Q

What part of the GI tract does Chron’s affect?

A

the whole GI tract

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61
Q

How many diarrheas can you have a day with Chron’s, and what can they consist of?

A
  • 5/day
  • mucus, pus
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62
Q

Where do you have pain with Chron’s?

A

RLQ

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63
Q

What levels should you assess for UC/Chron’s?

A
  • albumin
  • K
  • Mg
  • Vitamin B12
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64
Q

What foods should you avoid with UC/Chron’s?

A
  • grains
  • fruits/veggies
  • seeds
  • beans
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65
Q

What nutritional intake should you increase with UC/Chron’s?

A

protein and calories

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66
Q

What nutritional intake should you decrease with UC/Chron’s?

A

fiber (diarrhea)

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67
Q

What medications can you take for UC/Chron’s?

A
  • sulfonamides
  • corticosteroids
  • immunosuppressants
  • immunomodulators
  • anti-diarrheals
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68
Q

What is cholelithiasis?

A

gallbladder stones

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69
Q

What is cholecystitis?

A

inflamed gallbladder

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70
Q

Where/how does the pain occur with gallbladder disease?

A

sharp, in RUQ, radiates to the right shoulder

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71
Q

What nutritional intake should you decrease with gallbladder disease?

A
  • fat (dairy, fried food, chocolate, nuts, gravies)
  • gas-forming foods (beans, cabbage, broccoli, cauliflower, coffee)
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72
Q

What nutritional intake should you increase with gallbladder disease?

A
  • fat-soluble vitamins (A, D, E, K)
  • bile salts (dark, leafy green veggies)
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73
Q

What does gonorrhea target?

A

male urethra, female cervix

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74
Q

What happens with urination in gonorrhea?

A
  • dysuria
  • pain w/ voiding
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75
Q

What symptoms are present in females with chlamydia?

A
  • painful intercourse/voiding
  • vaginal discharge
  • lower abdominal pain
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76
Q

What symptoms are present in males with chlamydia?

A

penile discharge

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77
Q

What are the manifestations of genital herpes?

A
  • pain, itching
  • small red bumps
  • white blisters
  • ulcers
  • scabs
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78
Q

What antibiotic is given for gonorrhea?

A

ceftriaxone IM

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79
Q

What antibiotics are given for chlamydia?

A

azithromycin or doxycycline

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80
Q

When can the patient resume sex after having chlamydia?

A
  • 7 days
  • after completion of meds
  • negative test
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81
Q

Does acyclovir cure genital herpes?

A

no, it just relieves symptoms and decreases transmission

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82
Q

Is BPH a precursor for prostate cancer?

A

NO

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83
Q

What happens to urination with BPH?

A
  • frequency
  • urgency
  • hesitancy
    -incontinence
  • incomplete emptying
  • post-void dribbling
  • nocturia
  • decreased force of the urinary system
  • straining with urination
  • hematuria
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84
Q

What does persistent urinary retention lead to with BPH?

A

frequent UTI’s

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85
Q

What is hydronephrosis (BPH)?

A

the backflow of urine into the ureters and kidneys that can lead to kidney damage

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86
Q

What lab levels are increased with BPH?

A
  • WBC (systemic infection)
  • BUN/creatinine (kidney damage)
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87
Q

What lab levels are decreased with BPH?

A

RBC (hematuria)

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88
Q

What is the level for PreHTN?

A

120-129/<80

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89
Q

What is the level for stage 1 HTN?

A

130-139/80-89

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90
Q

What is the level for stage 2 HTN?

A

> /= 140 / >/= 90

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91
Q

What lab level should you monitor with diuretics (HTN/HF)?

A

potassium (K)

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92
Q

What are the side effects of ACE inhibitors (HTN/HF)?

A
  • angioedema
  • cough
  • elevated potassium
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93
Q

What should you watch for with beta blockers and ACE inhibitors (HTN/HF)?

A

redness, itching, rash

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94
Q

What should you monitor with beta blockers (HTN/HF)?

A

HR, SBP, glucose

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95
Q

What is the DASH diet for HTN?

A
  • decreased sodium
  • increased potassium and calcium
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96
Q

What foods are high in sodium?

A
  • canned soups/sauces
  • chips, pretzels
  • smoked meats
  • seasonings
  • tomato juice
  • processed foods
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97
Q

What fruits and veggies are rich in potassium?

A
  • apricots
  • bananas
  • tomatoes
  • potatoes
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98
Q

What does left-sided HF affect?

A

lungs

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99
Q

What does right-sided HF affect?

A

body

100
Q

What color is sputum production in LHF?

A

pink and frothy

101
Q

Which heart failure causes hepatomegaly and splenomegaly?

A

right

102
Q

Which heart failure causes SOB, cough, crackles, and wheezing?

A

left

103
Q

Which heart failure causes JVD and ascites?

A

right

104
Q

When should you report weight gain with HF?

A
  • 2 lbs/day
  • 5 lbs/week
105
Q

What position should you place someone with HF in?

A

high fowlers

106
Q

What does the B-type natriuretic peptide do?

A

confirms HF dx

107
Q

What do labs look like for LHF? (H&H, BUN/creatinine)

A
  • decreased H&H
  • increased BUN/creatinine
108
Q

What do labs look like for RHF? (H&H, albumin, total protein)

A
  • decreased H&H
  • decreased albumin
  • decreased total protein
109
Q

What nutritional intake should be decreased with HF?

A
  • sodium
  • saturated fats
110
Q

What nutrition intake should be increased with HF?

A

protein

111
Q

What must be assessed before administering digoxin?

A

apical HR, hold <60

112
Q

What can hypokalemia cause for digoxin?

A

toxicity

113
Q

What is the normal digoxin level?

A

0.8-2

114
Q

What are the signs of digoxin toxicity?

A
  • confusion
  • muscle weakness
  • loss of appetite (N/V)
  • fatigue
  • yellow-green halos
115
Q

What is the main cause of PAD?

A

smoking

116
Q

How can you promote vasodilation with PAD?

A

provide a warm environment and insulated socks

117
Q

What type of clothing should you wear for PAD?

A

non-restrictive

118
Q

How should the legs be with PAD?

A
  • not crossed
  • can elevate for short time (not above the heart)
  • dAngle
119
Q

Can heat be directly applied to the affected extremity with PAD?

A

no, because sensitivity is decreased

120
Q

Can the client be exposed to cold with PAD?

A

no

121
Q

What will happen over the involved blood vessel with a DVT?

A
  • warmth
  • edema
  • induration
  • redness
122
Q

Should you ambulate with a DVT?

A

NO

123
Q

How should the legs be with a DVT?

A
  • not crossed
  • elevated above the heart
124
Q

What type of compress should be used for a DVT?

A

warm, moist

125
Q

What is a normal d-dimer?

A
  • <500 ng/mL FEU
    OR
  • < 250 ng/mL DDU
126
Q

What does a venous duplex ultrasonography show for a DVT?

A

a picture of blood flow through the vessel

127
Q

Should you massage a DVT?

A

NO

128
Q

What do anticoagulants do for a DVT? (Heparin, Warfarin)

A

keep the clot from getting bigger and prevent the formation of new clots

129
Q

What does alteplase do, and what should you watch for (DVT)?

A

clot buster, watch for bleeding

130
Q

What are some clinical manifestations of HYPERthyroidism?

A
  • heat intolerance
  • weight loss
  • diarrhea
  • tachycardia
131
Q

What are some clinical manifestations of HYPOthyroidism?

A
  • cold intolerance
  • weight gain
  • constipation
  • bradycardia
132
Q

Which thyroid deficiency includes exophthalmos and goiter?

A

HYPERthyroidism

133
Q

Which thyroid deficiency includes myxedema and what is it?

A
  • HYPOthyroidism
  • swollen face, hands, feet
134
Q

What happens in myxedema coma (HYPOthyroidism)?

A
  • hypotension
  • bradycardia
  • respiratory failure
  • hypothermia
  • hyponatremia
  • hypoglycemia
  • coma
135
Q

How often should you palpate the thyroid with HYPERthyroidism?

A

once per shift

136
Q

What medication should you not take with HYPERthyroidism due to an increase in T4?

A

aspirin

137
Q

What should you do to room temperature with HYPERthyroidism?

A

decrease (heat intolerance)

138
Q

What temperature change indicates a thyroid crisis?

A

an increase of 1 degree or more

139
Q

What medications should you avoid with HYPOthyroidism due to an increased risk of respiratory depression?

A

CNS depressants

140
Q

What should you do to room temperature with HYPOthyroidism?

A

increase (cold intolerance)

141
Q

What nutritional intake should be increased with HYPERthyroidism?

A

calories, protein

142
Q

What nutritional intake should be increased with HYPOthyroidism?

A

bulk, fiber

143
Q

What nutritional intake should be decreased with HYPOthyroidism?

A

calories

144
Q

What is a normal blood glucose level?

A

65-110

145
Q

What is a hyperglycemic blood glucose level?

A

> 250

146
Q

What are the 3 P’s of hyperglycemia?

A

polyuria, polydipsia, polyphagia

147
Q

What is the skin like with hyperglycemia?

A

hot, dry

148
Q

What is a hypoglycemic blood glucose level?

A

<70

149
Q

What is the skin like with hypoglycemia?

A

cold, clammy

150
Q

What are some manifestations of hypoglycemia?

A
  • shakiness
  • confusion
  • diaphoresis
  • tachycardia
151
Q

What is the reference range of HA1C?

A

4-6%

152
Q

What is the acceptable DM range of HA1C?

A

6.5-8%

153
Q

What is the target goal of HA1C?

A

7%

154
Q

What should patients with DM be able to do?

A
  • self-monitor blood glucose (SMBG)
  • self-administer insulin
155
Q

What part of the body should those with DM inspect daily?

A

feet

156
Q

Can people with DM massage their feet or put lotion between their toes?

A

NO

157
Q

How should those with DM cut their toenails?

A

straight across

158
Q

How should insulin be drawn up?

A

clear (short-acting) to cloudy (long-acting)

159
Q

How often should BG be taken on a sick day?

A

every 3-4 hours

160
Q

What should you drink every 30 minutes on s sick day (DM)?

A

4 oz sugar-free, noncaffeinated liquid

161
Q

How should you get your carbs on a sick day (DM)?

A

through soft foods 6-8 times/day

162
Q

At what BG level should you call the provider?

A

> 240

163
Q

At what body temperature should you call the provider (DM)?

A

> 101.5 for over 24 hrs with no response to tylenol

164
Q

What should you eat/ drink when experiencing hypoglycemia?

A

10-20g readily absorbable carbs
- 2-3 glucose tabs
- 4 oz juice
- 6-10 hard candies

165
Q

What nutritional intake should you decrease with DM?

A
  • saturated fats
  • trans fats
  • cholesterol
  • simple carbs (refined grains, sugar)
166
Q

What do omega-3 fatty acids do?

A

decrease cholesterol

167
Q

What are the onset, peak, and duration of rapid-acting insulin (lispro, apart)?

A

O: w/in 15 mins
P: 1-2 hours
D: 3-4 hours

168
Q

What are the onset, peak, and duration of short-acting insulin (regular)?

A
  • O: 30-60 mins
  • P: 2-4 hours
  • D: 5-7 hours
169
Q

What are the onset, peak, and duration of intermediate-acting insulin (NPH)?

A
  • O: 2-4 hours
  • P: 4-10 hours
  • D: 10-16 hours
170
Q

What are the onset, peak, and duration of long-acting insulin (glargine)?

A
  • O: 3-4 hours
  • P: none
  • D: 24 hours
171
Q

Which insulins should you give before meals?

A
  • rapid (lispro, aspart)
  • short (regular)
172
Q

When should you give NPH insulin?

A

between meals, at night

173
Q

When should you give glargine?

A

once daily at the same time

174
Q

Metformin (T2D) can cause lactic acidosis. What are the symptoms of lactic acidosis?

A
  • myalgia
  • sluggishness
  • somnolence
  • hyperventilation
175
Q

When should glipizide (T2D) be administered?

A

before meals

176
Q

Why should you avoid alcohol with glipizide (T2D)?

A

disulfiram effect

177
Q

What should you monitor with repaglinide (T2D)?

A

fluid retention and liver function

178
Q

When should you take acarbose (T2D)?

A

with the first bite of each meal

179
Q

When should you take pramlintide (T2D)?

A

right before each meal (SQ)

180
Q

What are some foods that are high in calcium?

A
  • milk products
  • green veggies
  • fortified OJ and cereals
  • red and white beans
  • figs
  • broccoli
  • kale
  • grains
181
Q

What are some foods high in vitamin D?

A
  • fish
  • egg yolks
  • fortified milk and cereal
182
Q

How often should someone with osteoporosis get sun exposure?

A

for 5-30 minutes 2 times/week

183
Q

What does increased bilirubin cause in cirrhosis?

A

jaundice
- clay-colored stool
- dark urine
- yellow skin/sclera

184
Q

What does increased ammonia cause in cirrhosis?

A
  • hepatic encephalopathy: confusion
  • asterixis (hand flapping tremor)
185
Q

What does decreased albumin cause in cirrhosis?

A

ascites

186
Q

How do you treat ascites?

A

paracentesis (drain 1L at a time)

187
Q

What does portal vein HTN cause in cirrhosis?

A
  • splenomegaly
  • esophageal varices
188
Q

What does increased estrogen cause in cirrhosis?

A
  • palmar erythema
  • gynecomastia
  • spider angiomas
189
Q

When splenomegaly occurs, WBC and PLT get trapped. What does this cause an increased risk for?

A

infection and bleeding

190
Q

What labs do you need to look at before a liver biopsy, and why?

A
  • H&H, PT/INR
  • worried about hemorrhage/bleeding and coagulation
191
Q

How much should the bed be elevated for someone with cirrhosis?

A

30 degrees with feet elevated

192
Q

How should encephalopathy be treated in cirrhosis?

A

lactulose (excretes ammonia)

193
Q

What are diuretics used for in cirrhosis?

A

ascites

194
Q

What are beta blockers used for in cirrhosis?

A

portal vein HTN, varices, preventing bleeding

195
Q

What nutritional intake should be increased with cirrhosis?

A
  • protein (unless encephalopathy occurs)
  • calories
  • vitamin B, C, K supplements
196
Q

What precautions should be used for hepatitis?

A

standard unless bodily fluids are involved

197
Q

What are safe injection practices for hepatitis?

A
  • aseptic technique
  • sterile, single-use disposable needles/syringes
  • single dose vials
  • hand hygiene, PPE
198
Q

What are the symptoms of hepatitis during the prodromal phase?

A
  • flu-like
  • body pains
  • fatigue
  • decreased appetite
  • N/V
  • adbominal and joint pain
199
Q

What are the symptoms of hepatitis during the icteric phase?

A

jaundice
- dark urine
- clay-colored stool
- “i” yellowing

200
Q

What are the risk factors for hepatitis A?

A
  • ingestion of contaminated food/water/stool (SHELLFISH)
  • close contact with the infected person
201
Q

What are the risk factors for hepatitis B?

A
  • unprotected sex with an infected individual
  • infants born to infected mothers
202
Q

What are the risk factors for hepatitis C?

A
  • IV drug use
  • blood/blood products
  • organ transplants
  • contaminated needles
203
Q

Why was there such a high risk & prevalence of hepatitis C before 1992?

A

blood transfusions were unscreened before this time

204
Q

What nephrotoxic meds should you avoid with chronic kidney disease?

A

NSAIDS

205
Q

What should you teach a patient with CKD to monitor at home?

A

BP and weight

206
Q

What electrolyte consumption should be decreased with CKD?

A
  • sodium
  • potassium
  • phosphorus
207
Q

What is the recommended daily protein before starting dialysis?

A

0.6-1.0g/kg/day

208
Q

What is the recommended daily protein intake after starting dialysis?

A

1.2-1.5g/kg/day

209
Q

For CKD, when should you give digoxin, and what should you do to the level?

A
  • give after dialysis
  • reduce the level
210
Q

For CKD, what does sodium polystyrene (kayexalate) do and what should you restrict?

A
  • increases the elimination of potassium
  • restrict sodium
211
Q

For CKD, what do calcium carbonate and vitamin D do, and when should you take them?

A
  • stop phosphate absorption
  • take with meals, 2 hrs away from meds
212
Q

In CKD, when can furosemide not be used?

A

END STAGE

213
Q

What is needed for hemodialysis?

A

vascular access

214
Q

What should the temperature of the dialysate be in hemodialysis? In peritoneal dialysis?

A
  • H: body temperature
  • P: warmed, but not microwaved
215
Q

For hemodialysis, what is disequilibrium syndrome?

A

a rapid decrease in BUN and circulating fluid volume

216
Q

What electrolyte consumption should be decreased with hemodialysis?

A
  • sodium
  • potassium
  • phosphorus
217
Q

What nutritional intake should be increased with hemodialysis?

A
  • calcium
  • protein
  • carbs
218
Q

When would you do peritoneal dialysis?

A
  • inability to tolerate anticoagulation
  • difficulty with vascular access
  • chronic diseases (DM, CHF, HTN)
219
Q

What would an infected dialysate return look like?

A

bloody, cloudy, frothy

220
Q

Peritonitis is a complication of peritoneal dialysis. What is peritonitis?

A

infection of the peritoneum

221
Q

What should you do if protein loss is noticed after peritoneal dialysis?

A

increase protein and monitor albumin

222
Q

Peritoneal dialysis can cause hyperglycemia and hyperlipidemia leading to HTN. What meds can be given?

A
  • insulin
  • anti-lipemics
  • anti-HTN
223
Q

How do you assess the thrill and bruit for an AV graft/fistula?

A
  • feel/palpate the thrill (vibration)
  • hear/auscultate the bruit (whooshing sound)
224
Q

How is sinus tachycardia described?

A

fast but regular

225
Q

What HR and BP show sinus tachycardia?

A

HR: >/= 150 bpm
BP: decreased, SBP <90

226
Q

What can be used at home to test for atrial fibrillation?

A

Holter monitor

227
Q

What medications can be used to treat sinus tachycardia?

A

ADENOSINE (restarts heart)
- beta-blockers: metoprolol
- CCB: verapamil, diltiazem
- pain meds
- antipyretics

228
Q

What are those with atrial fibrillation at a huge risk for?

A

CLOTS
- MI
- PE
- CVA
- DVT

229
Q

How is atrial fibrillation described?

A

rapid and disorganized

230
Q

What medications/interventions can be used to treat atrial fibrillation? (ABCDE)

A
  • anticoagulants
  • beta-blockers
  • cardiac ablation
  • digoxin
  • electro cardioversion
231
Q

What do anticoagulants do in A fib?

A

prevent clots, but have a high risk for bleeding

232
Q

What do beta blockers do in A fib?

A

slow HR

233
Q

What does cardiac ablation do in A fib?

A

burns erratic cells

234
Q

What does digoxin do in A fib?

A

slows and strengthens

235
Q

What is electro cardioversion for A fib?

A

a baby shock to reset the SA node

236
Q

What is the rate for A fib?

A

usually > 100

237
Q

What is the rhythm for A fib?

A

irregular

238
Q

Is there a P wave with A fib?

A

no

239
Q

Is there a PR interval with A fib?

A

no

240
Q

What does QRS look like in A fib?

A

normal

241
Q

What is the rate for A flutter?

A

75-150

242
Q

What is the rhythm for A flutter?

A

regular

243
Q

Is there a P wave with A flutter?

A

no

244
Q

Is there a PR interval with A flutter?

A

no

245
Q

What does the QRS look like in A flutter?

A

normal

246
Q

what medications can be given for atrial flutter?

A

AMIODARONE
- beta blockers

247
Q

What are you worried about with atrial flutter?

A

rate control

Level 2 (8 decks)

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