Exam 3 Flashcards
carcinogenesis
malignant transformation involving 3 step process of initiation, promotion, and progression
Initiation
carcinogen damages DNA by changing a specific gene
Promotion
process by which carcinogens are subsequently introduced
Progression
process by which tumors go from bad to worse
- neovascularization
- invasion
- metastasis
Proto-oncogenes
Turn on cell growth
Anti-oncogenes
Turn off cell growth
Hypertrophy
cell growth that causes tissue to increase in size by enlarging each cell
Hyperplasia
growth that causes tissue to increase in size by increasing the number of cells
Metaplasia
conversion from the normal pattern of differentiation if one type of cell into another type of cell not normal for that tissue
Dysplasia
an alteration in the shape, size, appearance, and distribution of cell
Anaplasia
disorganized, irregular cells that have no structure and have loss of differentiation; the result is almost always malignant
Neoplasia
new or continued cell growth not needed for normal development or replacement of dead and damaged tissues.
ANC levels that increase the risk for infection
1,500 risk for infection increases; 500 severe risk for infection
Nadir
lowest level of ANC after chemotherapy
Collaborative mgmt of sepsis and DIC
- prevention is best measure
- IV antibiotic therapy
- Anticoagulants
- cryoprecipitated clotting factors
Collaborative mgmt of SIADH
- fluid restriction
- increased sodium intake
- demeclocycline
- treating the underlying cancer
Signs and symptoms of superior vena cava syndrome
edema of face, Stoke’s sign, edema of arms and hands, dyspnea, erythema, cough, hoarseness
Antimetabolites
“imposter” metabolites used to fool cancer cells into using them for cellular reactions will impair division
Antitumor antibiotics
damage cell DNA and interrupt DNA and RNA synthesis
Alkylating agents
inhibit DNA and RNA synthesis, and therefore cell division, by tightly binding DNA strands together
Antimitotic agents
Interfere with the formation of microtubules necessary for mitosis, comes from vinca plant
Factors delaying wound healing
- Poor nutrition
- Tissue perfusion and oxygenation
- excessive wound drainage
- Diseases
- Age
- Medications
- Infection
Braden scores
- 12 or less is high risk for development of ulcer
- 18 at risk for ulcer
PUSH score
0 is healed; 17 not healed
Diabetes insipidus comes from where?
posterior pituitary gland
The nurse is conducting a staff in-service on childhood endocrine disorders. Diabetes insipidus is a disorder of:
posterior pituitary
The nurse is caring for a preschool child with suspected diabetes insipidus. Which clinical manifestation should the nurse expect to observe?
Polyuria and polydipsia
A nasal spray of desmopressin acetate (DDAVP) is used to treat which disorder?
Diabetes insipidus
Type 1 diabetes
Characterized by progressive destruction of beta cells, usually leading to an absolute insulin deficiency
Type 1 diabetes onset
peak onset between 11-13; childhood and adolescence
Hallmark signs of type 1 diabetes
weight loss, polydipsia, polyuria, polyphagia, weakness and fatigue, ketoacidosis
Preparing insulin
- air into intermediate
- air in regular
- draw up regular
- draw up intermediate
Rapid insulin onset, peak, and duration
Onset: 10-30 minutes
Peak: 30 minutes to 3 hours
Duration: 3-5 hours
Short acting insulin onset, peak, and duration
Onset: 30-60 minutes
Peak: 2-5 hours
Duration: 5-8 hours
Intermediate acting insulin onset, peak, and duration
Onset: 1-4 hours
Peak: 4-12 hours
Duration: 10-16
Long acting insulin onset, peak, duration
Onset: 2-4 hours
Peak: None
Duration: 24 hours
Type 2 diabetes characteristics
- Insulin resistance
- Pancreas decreased ability to produce insulin
- Inappropriate glucose production from liver
- Alteration in production of hormones and adipokines
- Individuals with metabolic syndrome at increased risk for type 2 diabetes
A1C normal level
less than or equal to 6.5%; greater than 7% is not good
Sulfonylureas
stimulates beta cells, increases number of insulin receptors, decreases amount of glucose produced by liver
Biguanides
decreases amount of glucose produced by liver, increases glucose used by muscles
Ex: metformin
Alpha-glucosidase inhibitors
inhibits CHO absorption in small intesting; starch blockers
Ex: Acarbose
Thiazolidinediones
decreaes insulin resistance, inhibits glucose production in liver
Ex: Actos
Meglitinides
stimulates short burst of insulin release from pancreas
Dipeptidyl peptidase (DDP)
slows the activation of incretin hormones
Parents of a toddler with hypopituitarism ask the nurse, “What can we expect with this condition?” The nurse should respond with which statement?
Skeletal proportions are normal for age
A child with hypopituitarism is being started in growth hormone (GH) therapy. Nursing considerations should be based on which knowledge?
Replacement therapy requires daily subcutaneous injections
A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered?
At bedtime
An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse
understands that which occurs with acromegaly?
There is excess growth hormone (GH) after the closure of the epiphyseal plates
A child will start treatment for precocious puberty. The nurse recognizes that this will involve the injection of which synthetic medication?
Luteinizing hormone-releasing hormone
Hypophysectomy is done through what?
Transphenoidal surgery
Hypophysectomy is done for what?
anterior pituitary tumor
The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder?
Dry skin
A goiter is an enlargement or hypertrophy of which gland?
Thyroid
Exophthalmos (protruding eyeballs) may occur in children with:
Hyperthyroidism
The nurse is teaching the parents of a child who is receiving methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease). Which statement made by
the parent indicates a correct understanding of the teaching?
“If my child develops a sore throat and fever, I should contact the physician immediately.”
Which clinical manifestation may occur in the child who is receiving too much
methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease)?
Lethargy and somnolence
A child with hypoparathyroidism is receiving vitamin D therapy. The parents
should be advised to watch for which sign of vitamin D toxicity?
Weakness and lassitude
Glucocorticoids, mineralocorticoids, and sex steroids are secreted by the:
adrenal cortex
Chronic adrenocortical insufficiency is also referred to as:
Addison disease
A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of:
cortisone
The parents of a neonate with adrenogenital hyperplasia tell the nurse that they are afraid to have any more children. The nurse should explain which statement about
adrenogenital hyperplasia?
Genetic counseling is indicated
Which is characteristic of the immunemediated type 1 diabetes mellitus?
Age at onset is usually younger than 20 years
Which is considered a cardinal sign of diabetes mellitus?
Frequent urination
Hyperglycemia associated with diabetic ketoacidosis is defined as a blood
glucose measurement equal to or greater than _____ mg/dl.
200
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present?
Poor wound healing
A parent asks the nurse why selfmonitoring of blood glucose is being
recommended for her child with diabetes. The nurse should base the explanation on which knowledge?
Children are better able to manage the diabetes
The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which?
Ketonuria is suspected
The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. Which should the nurse explain about exercise in type 1 diabetes?
Extra snacks are needed before exercise
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapidreleasing sugar should be followed by:
complex carbohydrate and protein
The nurse is caring for an 8yearold child with type 1 diabetes. The nurse should teach the child to monitor for which manifestation of hypoglycemia?
Shaky feeling and dizziness
The nurse is caring for an 11yearold boy who has recently been diagnosed with diabetes. Which should be included in the teaching plan for daily injections?
He is old enough to give most of his own injections
The nurse is discussing with a child and family the various sites used for insulin
injections. Which site usually has the fastest rate of absorption?
Abdomen
To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence?
Need to be perfect and similar to peers
The nurse is implementing care for a schoolage child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the
nurse implement first?
Begin 0.9% saline solution intravenously as prescribed
The nurse should teach parents of a preschool child with type 1 diabetes that
which can raise the blood glucose level?
steroids
A nurse is reviewing the laboratory results on a schoolage child with
hypoparathyroidism. Which results are consistent with this condition?
Decreased serum calcium
Nursing care of a child diagnosed with a syndrome of inappropriate ADH should include which of the following? (Select all that apply.)
- weigh daily
- restrict fluids
The nurse should expect to assess which clinical manifestations in an adolescent with Cushing syndrome? (Select all that apply.)
- hyperglycemia
- cushingoid features
- susceptibility to infections
A nurse is planning care for a schoolage child with type 1 diabetes. Which insulin preparations are rapid and short acting? (Select all that apply.)
- NovoLog
- Novolin R
A nurse is planning interventions for a toddler with juvenile hypothyroidism.
Which interventions should the nurse plan to implement for this child? (Select all that
apply.)
- Moisturizer for dry skin
- Implementation of thyroxine therapy
The nurse is caring for a schoolage child with hyperthyroidism (Graves disease).
Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply.)
- Hyperthermia
- Tachycardia
- Vomiting
The clinic nurse is reviewing hemoglobin A1c levels on several children with type 1 diabetes. Hemoglobin A1c levels of less than _____ % is a goal for children with type 1 diabetes. (Record your answer in a whole number.)
7
The nurse is taking care of a 7yearold child with a skin rash called a papule.
Which clinical finding should the nurse expect to assess with this type of skin rash?
A lesion that is elevated, palpable, firm and circumscribed; less than 1 cm in diameter
The nurse is teaching nursing students about childhood skin lesions. Which is an elevated, circumscribed skin lesion that is less than 1 cm in diameter and filled with serous
fluid?
Vesicle
The nurse is taking care of a 2yearold child with a macule skin lesion. Which clinical finding should the nurse expect to assess with this type of lesion?
Flat, brown mole less than 1 cm in diameter
A schoolage child falls on the playground and has a small laceration on the
forearm. The school nurse should do which to cleanse the wound?
Wash wound gently with mild soap and water for several minutes
A child steps on a nail and sustains a puncture wound of the foot. Which is the
most appropriate method for cleansing this wound?
Soak foot in warm water and soap
Which nursing consideration is important when caring for a child with impetigo
contagiosa?
Carefully wash hands and maintain cleanliness when caring for an infected child
The nurse is caring for a 5yearold child with impetigo contagiosa. The parents ask the nurse what will happen to their child’s skin after the infection has subsided and
healed. Which answer should the nurse give?
There will be no scarring
Cellulitis is often caused by:
Streptococcus or Staphylococcus organisms
The nurse is conducting a staff inservice on appearance of childhood skin conditions. Lymphangitis (“streaking”) is frequently seen in which condition?
Cellulitis
The nurse should expect to assess which causative agent in a child with warts?
Virus
The nurse should implement which prescribed treatment for a child with warts?
Local destruction
Herpes zoster is caused by the varicella virus and has an affinity for:
Posterior root ganglia and posterior horn of the spinal cord
The nurse is taking care of a 7yearold child with herpes simplex virus (type 1 or 2). Which prescribed medication should the nurse expect to be included in the treatment plan?
Oral antiviral agent
Tinea capitis (ringworm), frequently found in schoolchildren, is caused by a(n):
fungus
The nurse is caring for a schoolage child with a tinea capitis (ringworm)
infection. The nurse should expect that therapeutic management for this child includes:
administering oral griseofulvin
Parents tell the nurse that their child keeps scratching the areas where he has poison ivy. The nurse’s response should be based on which knowledge?
Scratching the lesions may cause them to become secondarily infected
The nurse is taking care of a child with scabies. Which primary clinical
manifestation should the nurse expect to assess with this disease?
Pruritus
Which is usually the only symptom of pediculosis capitis (head lice)?
Itching
The nurse is talking to the parents of a child with pediculosis capitis. Which
should the nurse include when explaining how to manage pediculosis capitis?
“You will need to remove nits with an extrafine tooth comb or tweezers.”
The management of a child who has just been stung by a bee or wasp should include the application of:
cool compress
A father calls the clinic nurse because his 2yearold child was bitten by a black widow spider. The nurse should advise which to the father?
Take child to emergency department
A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend:
keeping the child quiet and coming to the emergency department
Rocky Mountain spotted fever is caused by the bite of a:
tick
The school nurse is conducting a class for schoolage children on Lyme disease. Which is characteristic of Lyme disease?
caused by a spirochete that enters the skin through a tick bite
The nurse is examining 12monthold Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. This is most likely caused by:
Candida albicans
The nurse is teaching a class on preventing diaper rash in newborns to a group of new parents. Which statement made by a parent indicates a correct understanding of the teaching?
“If my infant’s buttocks become slightly red, I will expose the skin to air.”
Which prescribed treatment should the nurse plan to implement for a child with psoriasis?
Tar and exposure to sunlight and ultraviolet light
Atopic dermatitis (eczema) in the infant is:
associate with allergy with a hereditary tendency
Nursing care of the infant with atopic dermatitis focuses on:
preventing infection
Tretinoin (RetinA) is a topical agent commonly used to treat acne. Nursing
considerations with this drug should include:
explaining that medication should not be applied until at least 20 to 30 minutes after
washing.
When is isotretinoin (Accutane) indicated for the treatment of acne during adolescence?
The acne has not responded to other treatments
A child experiences frostbite of the fingers after prolonged exposure to the cold. Which intervention should the nurse implement first?
Rapid rewarming of the fingers by placing in warm water
Which best describes a fullthickness (thirddegree) burn?
Destruction of all layers of skin evident with extension into subcutaneous tissue
A child is admitted with extensive burns. The nurse notes that there are burns on the child’s lips and singed nasal hairs. The nurse should suspect that the child has a(n):
inhalation injury
Which explains physiologically the edema formation that occurs with burns?
Increased capillary permeability
The most immediate threat to life in children with thermal injuries is:
shock
After the acute stage and during the healing process, the primary complication from burn injury is:
infection
An adolescent girl is cooking on a gas stove when her bathrobe catches fire. Her
father smothers the flames with a rug and calls an ambulance. She has sustained major burns over much of her body. Which is important in her immediate care?
Remove her burned clothing and jewelry
A young child has sustained a minor burn to the foot. Which is recommended for treatment of a minor burn?
Cleanse the wound with a mild soap and tepid water
A toddler sustains a minor burn on the hand from hot coffee. Which is the first
action the nurse should recommend in treating this burn?
Hold burned area under cool running water
A parent of a child with major burns asks the nurse why a highcalorie and highprotein diet is prescribed. Which response should the nurse make?
The diet will avoid protein breakdown
Fentanyl and midazolam (Versed) are given before débridement of a child’s burn wounds. Which is the rationale for administration of these medications?
Provide pain relief
Nitrous oxide is being administered to a child with extensive burn injuries. Which is the purpose of this medication?
Provide anesthesia
Hydrotherapy is required to treat a child with extensive partialthickness burn wounds. Which is the primary purpose of hydrotherapy?
Debride the wounds
A child with extensive burns requires débridement. The nurse should anticipate which priority goal related to this procedure?
Reduce pain
Biologic dressings are applied to a child with partialthickness burns of both legs. Which nursing intervention should be implemented?
Observing wounds for signs of infection
Which is one of the first signs of overwhelming sepsis in a child with burn injuries?
Disorientation
Which is an effective strategy to reduce the stress of burn dressing procedures?
Give child as many choices as possible
Which is an important consideration for the nurse when changing dressings and
applying topical medication to a child’s abdomen and leg burns?
Wash hands and forearms before and after dressing change
The family of a 4monthold infant will be vacationing at the beach. Which
should the nurse teach the family about exposure of the infant to the sun?
Keep the infant in total shade at all times
A nurse is teaching a parent of an infant about treatment of seborrhea dermatitis (cradle cap). Which should the nurse include in the instructions?
Shampoo every day with an antiseborrheic shampoo
The nurse is teaching parents of toddlers about animal safety. Which should be included in the teaching session?
Teach your toddler not to disturb an animal that is eating
A school nurse assesses a case of tinea capitis (ringworm) on a 6yearold child.
Which figure depicts the characteristic lesion of tinea capitis?
picture with the scalp
Where do the lesions of atopic dermatitis (eczema) most commonly occur in the
infant? (Select all that apply.)
- cheeks
- extensor surfuces of arms and legs
- trunk
- scalp
The nurse is talking to a parent of an infant with severe atopic dermatitis
(eczema) . Which response(s) should the nurse reinforce with the parent? (Select all that
apply. )
- “You will need to keep your infant’s skin well hydrated by using a mild soap in the bath.”
- “You will need to prevent your baby from scratching the area by using a mild antihistamine.”
- “You should apply an emollient to the skin immediately after a bath.”
Which should the nurse include when teaching parents about preventing
childhood burn injuries? (Select all that apply.)
- keep hot liquids out of reach
- baby proof electrical outlets
- test water temperature before placing your child in the tub bath
The community health nurse is teaching parents about prevention of the spread and reoccurrence of pediculosis (head lice). Which should the nurse include in the teaching session? (Select all that apply.)
- Dryclean nonwashable items
- Boil combs and brushes for 10 minutes
- Discourage sharing of personal items
A nurse is caring for a 5-year old child with a major burn. The health care provider has written a prescription to notify the health care provider if urine output falls to or below 2 ml/kg/hr. The child weighs 55 lb. The nurse should notify the health care provider if the milliliters of urine output is at or below _____ for an hour. (Record your answer in a whole number.)
50
Top male cancer
Prostate Lung and bronchus Colin and rectum Urinary bladder Melanoma of the skin
Top 5 female cancers
Breast Lung and Bronchus Colon and rectum Uterine corpus Thyroid
