Exam 1 Summary Set Flashcards
____ is the first-line treatment for OA
acetaminophen
young to middle-aged women are at risk for ____
rheumatoid arthritis (RA)
Sjogren syndrome is a manifestation of ____
RA
____ is the drug treatment for RA
methotrexate
methotrexate is contraindicated in ____
pregnant women
the 4 stages of cancer development
(1) initiation
(2) promotion
(3) progression
(4) metastasis
how similar the cancer cells look to the parent cell
grading
determines the exact location of the cancer and whether metastasis has occurred
staging
the 7 warning signs of cancer are CAUTION - what does it stand for?
C = changes in bowel and bladder habits
A = a sore threat
U = unusual bleeding or discharge
T = thickening / lump
I = indigestion / difficulty swallowing
O = obvious change in wart or mole
N = nagging cough
drugs designed to target specific molecules or pathways involved in cancer growth
targeted therapy
surgery and radiation are ____ types of therapy
localized
chemo, hormonal, and targeted therapy are ____ types of therapy
systemic
the priorities for neutropenic precautions are _____
(1) protect from infection
(2) educate family and friends on how to reduce risk of infection
describe some of the care for someone with neutropenia
(1) HH
(2) private room
(3) clean room at least 1x per day
(4) VS q4h
(5) daily WBC checks
(6) no potted plants or flowers
the most common location for metastasis of colorectal cancer is ___
the liver
bleeding from the rectum
Hematochezia
what is the definitive diagnostic test for CRC?
colonoscopy
empty colostomy bag when it is ___ full
1/3 to 1/2
what should you NOT put in a colostomy bag and why?
aspirin b/c risk of ulcers
<____mL/hr urine output can lead to kidney damage
30
what is the main difference between dehydration and fluid volume deficit?
dehydration is loss of water ONLY; FVD is loss of water and salt
Na > 145 and increased osmolality are signs of what?
dehydration
which solution do you use to treat dehydration?
isotonic (.9%) Na+ solution and extra water
aldosterone function
increased water and Na reabsorption; increased K excretion
ADH function
water reabsorption
the best indicator of fluid overload is ___
weight gain
diphenoxylate hydrochloride is given to pts with gastroenteritis but should be withheld from ____
older adults b/c of drowsiness
metabolic acidosis and which electrolyte imbalance are linked?
hyperkalemia
Kussmaul respirations
Dysrhythmias
Decreased LOC
Decreased reflexes
What is this?
metabolic acidosis
what are the lab values for metabolic acidosis?
pH < 7.35
HCO3 < 23
massive blood transfusion is a risk factor for which acid-base imbalance?
metabolic alkalosis
positive Chvostek & positive Trousseau are seen in which conditions?
(1) Respiratory alkalosis
(2) hypocalcemia
(3) hypomagnesemia
during ____, you should re-breath expired air as a treatment option
respiratory alkalosis
which electrolyte imbalance can lead to cerebral edema?
hyponatremia
how does hyponatremia affect HR?
increases
what solution should you treat hyponatremia with?
hypertonic 3% normal saline
Cushing disease is a risk factor for which electrolyte imbalances?
hypernatremia
hypokalemia
hypocalcemia
inverted T wave and depressed ST segment are signs of which imbalance?
hypokalemia
peaked T wave and widened QRS segment are signs of which imbalance?
hyperkalemia
Ca gluconate can be used to treat ____
hyperkalemia and hypermagnesemia
one thing to have on standby with hypocalcemia is ____
emergency trach equipment
laxative misuse can lead to ____
hypomagnesemia
magnesium normal range
1.3-2.1 mEq/L
diagnosis for DM
A1C > 6.5% or
FBG > 126 mg/dL; or
2-hr GTT > 200 mg/dL; or
s/s hyperglycemia + random BG > 200 mg/dL
name 3 three key drugs (besides insulin) used to treat DM
(1) metformin (biguanide)
(2) GLP-1 agonist (semaglutide, ozempic)
(3) sulfonylureas (glipizide)
sulfonylureas work by…
triggering the release of insulin from the liver
lab values of DKA
BG > 300 mg/dL
Ketones positive
pH < 7.35
HCO3 < 15 mEq/L
elevated BUN / creatinine
lab values of HHS
BG > 600 mg/dL
No ketones
pH > 7.4
HCO3 > 20 mEq/L
elevated BUN / creatinine
Osmolarity > 320 mOsm/L
most common GI problem with DM is ___ d/t ___
constipation; peripheral neuropathy
older adults with DM are at higher risk of developing ____
dementia and nephropathy / kidney disease
myxedema coma can result from
hypothyroidism
name at least 3 s/s of myxedema coma
(1) respiratory failure
(2) hypotension
(3) hypothermia
(4) bradycardia
(5) reduced mental status
nursing considerations for levothyroxine
(1) administer 1hr before meals and other meds
(2) monitor TSH levels
___ is used to treat hyperthyroidism (medication)
methimazole
nursing considerations for methimazole
(1) monitor for liver toxicity
(2) contraindicated in pregnancy
(3) take with meals
name the pharmacologic treatment options for alzheimer’s disease from least to most invasive
(1) donepezil
(2) memantine
(3) diazepam & haloperidol
___ and ___ are considered chemical restrains
diazepam and haloperidol
side effects of hydantoin are ____
headache and drowsiness
pharmacologic treatment for seizures is
(1) benzodiazepines
(2) hydantoin
nursing considerations with hydantoin
(1) don’t use with warfarin d/t bleed risk
(2) can lead to gingival hyperplasia so oral care is important
the two types of benzodiazepines given for seizures are usually what?
Lorazepam, clorazepate
____ is given IV to manage status epilepticus
Lorazepam
clorazepate function
prevent seizures
what should you monitor for with use of benzodiazepines?
(1) hypotension
(2) respiratory depression
BEFAST acronym stands for…?
B - balance
E - eye or vision changes
F - facial drooping
A - arm weakness
S - speech changes
T - time of onset
key considerations with the administration of IV alteplase
(1) dosed by pt weight
(2) must be given within 3-4.5 hrs of onset of symptoms
(3) test blood glucose for hypoglycemia
(4) may need to administer antihypertensive drug first
(5) stop anticoagulants for 24 hrs after d/t bleed risk
the main priority for stroke patients is
to restore perfusion to the brain
ABCS of stroke prevention are
A - aspirin as appropriate
B - blood pressure management
C - cholesterol management
S - smoking cessation
2 key s/s of hemorrhagic stroke are
headache and intracranial pressure
the two types of manifestations of delirium are
hypoactive and hyperactive
hypoactive s/s of delirium include
apathetic, lethargic, unaware, withdrawn
hyperactive s/s of delirium include
agitation, restlessness, aggression
difficulty writing
agraphia
inability to perform simple commands
apraxia
loss of balance or coordination
ataxia
inability to recognize familiar objects by sight, hearing, or touch
agnosia
inability to speak or understanding language
aphasia
crepitus is
coarse grating of the joints
post-op PAC means
pharmacology, ambulation, and compression
post-op PAC is used to
avoid clotting
low-grade fever, weight loss, and symmetric, bilateral joint inflammation is what?
rheumatoid arthritis
respiratory complications of RA
(1) pleurisy
(2) pneumonitis
(3) pulmonary HTN
cardiac complications of RA
(1) myocarditis
(2) pericarditis
eye complications of RA
(1) iritis
(2) scleritis
what are the safety precautions for use of methotrexate?
(1) take med 1x weekly
(2) can cause mouth ulcers (self-resolve)
(3) can cause mild liver irritation
(4) contraindicated in pregnant women
(5) retinal damage
(6) decreased immunity
the three components inside the skull are
brain tissue, CSF, intravascular blood
the brain is dependent on which two systems (primarily)?
cardiac, respiratory
normal ICP is
7-15 mmHg
the first compensations in Intracranial Regulation will occur in the ___
CSF
what can cause ICR impairment?
(1) impaired perfusion of oxygenated blood
(2) compromised neurotransmission
(3) glucose regulation
(4) pathology of the brain (i.e., tumors, inflammation)
Name the 3 major consequences of ICR impairment
(1) cerebral edema
(2) increased intracranial pressure
(3) neuronal injury or death
Population risk factors for ICR impairment include
(1) older adults
(2) adolescent and YA
(3) children
(4) accidents - falls, assault, MVA
T/F: There is no screening test for ICP.
True
to decrease ICP, HOB at ___ to ___
30 degrees; help with neck and head alignment
____ can decrease ICP by reducing metabolic demand of the brain
Propofol
which type of diuretic can be used to decrease ICP?
osmotic - Mannitol
two surgical interventions for ICP are
(1) craniotomy
(2) shunt procedure
which stroke is r/t atherosclerotic buildup, dysrhythmias, and prolonged HTN?
ischemic
which stroke is r/t prolong HTN, aneurysm, and drug abuse?
hemorrhagic
why do you monitor urine output for acetaminophen use?
check renal function
common s/s of both metabolic and respiratory acidosis
Dysrhythmias
Decreased LOC
Confusion
Lethargy
common s/s of both metabolic and respiratory alkalosis
N/T in fingers, feet, face
Lightheaded
basal insulin can be covered by which type(s) of insulin?
NPH intermediate
Long-acting
Ultra-long-actin
name the adverse effects of metformin
(1) GI symptoms
(2) hypoglycemia
(3) avoid with alcohol b/c liver metabolizes both
hold ____ 24 hours before contrast and surgery
metformin
adverse effects of GLP-1 agonists are
pancreatitis - abdominal pain and nausea
key pt education for taking sulfonylureas
take with meals to avoid hypoglycemia
which types of insulin should NEVER be combined with others in the same syringe?
long-acting
administer rapid-acting insulin ___ minutes before eating
10
give rapid-acting insulin at least ___ apart because of ___
4 hours; 3-hour peak
NPH intermediate insulin lasts
16-24 hours
glargine is
long-acting insulin
detemir is
long-acting insulin
degludec is
ultra-long acting insulin
____ should be given 30m before eating
regular insulin
____ should be given 10m before eating
rapid insulin
what is the therapeutic range for phenytoin?
10-20 mcg/mL
phenytoin <10 is a risk for
seizures
phenytoin >20 is a risk for
drug toxicity
stage 1 pressure injury is
non-blanchable, redness
stage 2 pressure injury is
blistering, partial thickness
stage 3 pressure injury is
full-thickness - skin loss; subcutaneous fat / tissue, tunneling, eschar
stage 4 pressure injury is
full-thickness - skin and tissue; bone, tissue, ligaments, muscle; eschar, slough
GI impacts of immobility
constipation
respiratory impacts of immobility
atelectasis, hypostatic pneumonia
metabolic impacts of immobility
ca loss in bones, fluid imbalance
integumentary impacts of immobility
impaired skin integrity, pressure injuries,
MSK impacts of immobility
muscle atrophy, protein breakdown, joint contractions
cardiovascular impacts of immobility
clotting / pooling, orthostatic BP, cardiac muscle less effective
what medications are used to treat Cushing syndrome?
(1) ketoconazole - adrenal corticosteroid inhibitor
(2) mitotane - destruction of adrenocortical cells
the main causes of Cushing disease are
(1) tumor
(2) adrenal hyperplasia
(3) cancer of the lung, GI, or pancreas
what is the difference between Cushing disease and syndrome?
Disease is caused by endogenous sources; Syndrome is caused by exogenous sources of cortisol
the main causes of Cushing syndrome are
long-term therapeutic use of corticosteroids (ex: Asthma, chemo, allergies)
pts with Cushing’s disease are at increased risk for which of the follow (SATA)
a. infection
b. peptic ulcer
c. renal calculi
d. bone fractures
e. dysphagia
A, B, D
what lab values will show up for someone with Cushing’s disease? SATA
a. increased sodium
b. decreased potassium
c. increased calcium
d. increased blood glucose
e. decreased lymphocytes
A, B, D, E
which of the following findings in someone with Cushing syndrome is priority?
a. weight gain
b. fatigue
c. fragile skin
d. joint pain
A - weight gain b/c could signify fluid retention
Addison’s disease is an insufficiency of
aldosterone and cortisol
causes of Addison’s disease include…
(1) autoimmune
(2) TB
(3) metastatic cancer
(4) radiation to the abdomen
acute adrenal insufficiency is a ____
medical emergency
factors that can lead to acute adrenal insufficiency
(1) sepsis
(2) trauma
(3) stress
(4) adrenal hemorrhage
(5) steroid withdrawal
Addison’s disease leads to which electrolyte imbalances?
hyponatremia
hyperkalemia
hypercalcemia
the primary nursing priority for patients with acute adrenal insufficiency is
prevent circulatory shock
should glucocorticoids for Addison’s be taken with or without food?
with
which of the following instructions should the nurse include for a pt taking hydrocortisone? SATA
a. Take the medication on an empty stomach
b. notify the provider of any illness or stress
c. report any manifestations of weakness or dizziness
d. do not discontinue the medication suddenly
e. eat a low-sodium diet
B, C, D
which solution should be used to treat acute adrenal insufficiency
0.9% NaCl
phenytoin side effects are ___ and ___
headache, drowsiness
what should you monitor for when someone is on phenytoin?
cardiac dysrhythmias; hypotension
phenytoin can lead to ___
gingival hyperplasia
use of GLP-1 agonists can lead to ____
pancreatitis
glipizide is a
sulfonylurea
ACE inhibitors can cause
hyperkalemia
when surfaces rub the skin and irritate or tear fragile epithelial tissue
friction
when the skin itself is stationary and the tissues below the skin shift or move
shearing forces
name at least 4 ways to reduce pressure / prevent pressure injury
(1) HOB at 30 degrees
(2) pts in chairs / wheelchairs to stand and march in place 5 steps/hr
(3) pressure-offloading devices
(4) special mattress
(5) turn at least q2h
what should you NOT use for pressure injury prevention?
donut-shaped pillows
to improve pressure tolerance, perform peri care ___
q2h
to assess darker skin and pressure injuries, you can ____
(1) moisten the skin
(2) compare healthy skin to injury for reference point
the purpose of ketoconazole is ____
to supplement radiation or surgery for Cushing
when taking Ketoconazole, monitor for indications of ___ toxicity
liver
Ketoconazole should be taken with or without food?
with
the purpose of mitotane is to ____
reduce the size of the adrenal carcinoma tumor
what is the expected nurse’s order for a patient with DKA?
rapid IV infusion of 0.9% NaCl over the first hour
What should the patient do to prevent DKA?
a. drink 1000 mL of fluids/day
b. monitor blood glucose every 8 hr when ill
c. notify provider if BG > 250 mg/dL
d. report ketons in urine that continue after 48 hrs illness
C
____ is indicated for patients in late-stage AD
Memantine
donepezil monitoring parameters
HR and dizziness b/c can cause bradycardia
the 4 cardinal signs of Parkinson’s disease are
(1) tremors
(2) bradykinesia
(3) muscle rigidity
(4) postural instability
the main medication for Parkinson’s is
Levodopa
what are the 4 main complications / safety concerns with Parkinson’s Disease?
(1) aspiration pneumonia
(2) altered cognition
(3) Infection (UTI, skin breakdown)
(4) depression
when implementing the rule of 15, what do you need to check first?
if the patient is safe to swallow
levothyroxine is used to treat
hypothyroidism
levothyroxine precautions and education
(1) take in the AM on an empty stomach
(2) increased heart rate
(3) monitor TSH levels
where can hemorrhagic stroke bleed into?
(1) subarachnoid space
(2) brain tissue
bleeding into the ____ can lead to seizures
brain tissue
right-sided damage leads to more ____ behavior
irritable and impulsive
left-sided damage leads to more ___ behavior
cautious
____-sided brain damage leads to more neglect
right
nursing interventions for aspiration risk
(1) NPO until assessment
(2) thickened liquids
(3) no straws
(4) high Fowler’s / 90 degrees
(5) tuck chin when swallowing
always approach a stroke patient from their ____ side
unaffected
when you’re doing rehab with a stroke patient, start with ____ side
affected
check pregnancy status before administering IV ____
alteplase
IV alteplase can cause which electrolyte imbalance?
hypokalemia
what is the #1 priority intervention for DKA and HHS?
adequate perfusion d/t osmotic diaphoresis
how long will it take Methotrexate to take effect / see improvements?
4-6 weeks
the two nursing interventions for addisonian crisis are
(1) IV bolus of hydrocortisone
(2) monitor for s/s hyperkalemia
no polyphagia in ___
HHS
most common cause of DKA and HHS is ___
infection
SIADH can cause what?
hyponatremia (dilution)
s/s of both respiratory and metabolic acidosis
(1) Lethargy
(2) Confusion
(3) Decreased LOC
(4) Hyperkalemia
(5) Dysrhythmias
s/s of both respiratory and metabolic alkalosis
(1) Numbness and tingling
(2) Lightheadedness
Labs for Dehydration
(1) Increased osmolality (concentration)
(2) Increased Na
(3) Increased urine specific gravity
(4) Increased Hct
(5) Increased BUN
Labs for ECV deficit
(1) Increased urine specific gravity
(2) Increased Hct
(3) Increased BUN
attention, perception, pattern recognition are examples of
basic cognition
comprehension, problem-solving, decision-making, reasoning, and meta-cognition are examples of
higher-order cognition
name 3 age-related changes in cognition (as you get older)
(1) decrease in size and weight of brain
(2) decrease in the number of neurons
(3) slower neural responses
cognitive impairment is indicative of ____
underlying disease
reduction of cognitive function that does NOT interfere with functional ability
cognitive impairment
only a single area of cognitive functioning
focal cognitive disorders
what is a major predictor of cognitive decline?
slower walking speed / gait
Folic acid deficiency, DM, and metabolic syndrome are all linked to ___
higher risk of cognitive impairment
which cognitive functioning test screens for delirium?
CAM
which cognitive functioning test(s) screens for dementia and cognitive impairment
MMSE, MoCA
which cognitive assessment tool is more challenging - MMSE or MoCA?
MMSE
Syndrome of neurocognitive symptoms that impair cognitive capacity; leads to deficits in perception, functioning, and social relatedness
psychosis
name at least 3 causes of delirium
(1) infection
(2) hypoxia
(3) acute illness
(4) lack of sleep
(5) dehydration
(6) electrolyte imbalances
____ is the most frequent complication of hospitalization in the elderly
delirium
tight endothelial layer that restricts neurotoxic substances describes the ___
blood-brain barrier
the skull calcifies at age ___
12
which of the following are diagnostic testing tools for ICR impairment? SATA
a. CT and MRI
b. x-ray
c. EEG
d. physical exam
e. brain biopsy
f. lumbar puncture
g. electrode stimulation
A, B, C, E, F
____ surgery is performed if there is expansion of the brain tissue
craniotomy
___ surgery is performed if there is an embolus / thrombus in the brain
shunt
increased prevalence of ____ is NOT a normal part of aging
chronic pain
sudden onset of pain related to a certain injury
acute pain
pain lasting more than 3 months and may last for years
chronic pain
aching, cramping, and throbbing are types of ____ pain
nociceptive
burning, sharp, and shooting are types of ____ pain
neuropathic
which pain scale has the images of faces?
Wong-Baker
what is the gold standard for pain assessment?
patient reports their pain
which adjuvant pharmacologic methods can be used to treat pain?
anticonvulsants, antidepressants
when implementing non-pharmacological pain management options, ___ is the main priority.
Safety
increase in the number of cells
proliferation
under normal conditions, there is an equilibrium of cell proliferation and ___
cell death
what regulates proliferation?
intracellular signals
cancer cells lose ___ and ____, leading to overgrowth
contact inhibition; intracellular signaling
cells progress from immaturity to maturity
differentiation
poorly differentiated cells are what grade of cancer cell?
grade 3
____ regulate and promote cell growth
proto-oncogenes
____ regulate and suppress cell growth
tumor suppressor genes
the 5 treatment goals for cancer are
(1) prophylactic
(2) curative
(3) adjuvant
(4) neoadjuvant
(5) palliative
name the considerations and risks of Chemotherapy (8)
(1) extravasation
(2) bone marrow suppression
(3) N/V - CINV
(4) mucositis
(5) alopecia
(6) cognitive changes
(7) peripheral neuropathy
(8) time toxicity
____ occur when the stimulation of the immune system affects health cells
immune-related adverse events (irAEs)
which of the following can result from immune-related adverse events (irAEs)?
a. colitis
b. hypertension
c. kidney injury
d. anaphylaxis
A
bone pain, hot flashes, and sexual dysfunction are side effects of ___
hormonal therapy
radiation delivered from a source outside of the body
external beam
radiation sources that comes into direct, continuous contact with tumor for a specific amt of time
brachytherapy
what should you give for severe hypoglycemia?
Glucagon IM
Dextrose IV solution
you can use beta blockers in which endocrine d/o?
graves disease
