Exam 3 Review PowerPoint

Question 1

What should the nurse assess for in a patient who has bradycardia?

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Answer 1

HYPOXIA

Question 2

What is a potential cause of premature ventricular contractions (PVCs)?

Answer 2

Hyperkalemia (↑ potassium)

Question 3

Type 1 Diabetes
* What is the cause?
* What should the A1C of a patient with T1DM be?
* What are potential complications of T1DM?

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Answer 3

Cause: destruction & loss of beta cells (genetic)

A1C: less than 7%

Potential Complications:
* DKA
* Nephropathy - ↑ protein in urine
* Retinopathy - blindness
* Coronary Artery Disease (CAD)
* Stroke
* Peripheral Artery Disease (PAD)

Question 4

List the actions of insulin

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Answer 4

• Promotes glucose uptake
• Glucose is stored as glycogen
• Prevents fat & glycogen breakdown
• Inhibits gluconeogenesis
• ↑ protein synthesis

Question 5

List the onset, peak , & duration of Humulin R (regular) insulin.

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Answer 5

• Onset: 30 - 60 minutes
• Peak: 2-4 hours
• Duration: 6-8 hours

Question 6

List the onset, peak , & duration of Novalog (insulin aspart).

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Answer 6

• Onset: 5-15 minutes
• Peak: 1-2 hours
• Duration: 4-6 hours

Question 7

List the onset, peak , & duration of Lantus.

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Answer 7

• Onset: 2-4 hours
• Peak: flat
• Duration: 20-26 hours

Question 8

List the onset, peak , & duration of NPH insulin.

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Answer 8

• Onset: 2-4 hours
• Peak: 4-10 hours
• Duration: 10-16 hours

Question 9

Signs & Symptoms of Hypoglycemia

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Answer 9

• Hunger
• Anxiety
• **Tachycardia **(↑ HR)
• Headache
• Lightheadedness
• Confusion

Question 10

Treatment for hypoglycemia

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Answer 10

• Pt is awake & alert: 1/2 cup juice, then startch & protein
• Pt is unconscious: 1 amp of D50

Question 11

Signs & Symptoms of DKA vs. HHS

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Answer 11

DKA:
* pH under 7.3 (pH < 7.3)
* ↑ potassium
* glucose > 250 mg/dL

HHS:
* pH > 7.3
* serum osmo > 320 mOsm / kg
* glucose > 600 mg/dL

Question 12

Which electrolyte should be closely monitored with Syndrome of Inappropriate Antidiuretic Hormone (SIADH) and Diabetes Insipidus (DI)?

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Answer 12

Sodium

Question 13

What is the difference in syndrome of inappropriate antidiuretic hormone (SIADH) & diabetes insipidus (DI)?

Answer 13

SIADH: too much ADH (↑ ADH)

DI: lack of ADH (↓ ADH)

Question 14

What is SIADH? What happens to sodium & urine osmol? What is the treatment??

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Answer 14

SIADH = too much ADH

• ↑ ADH
• ↓ Na+
• ↑ urine osmol (concentrated urine)

Treatment: sodium replacement (hypertonic saline 3%)

Question 15

What is DI? What happens to sodium & urine osmol? What is the treatment??

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Answer 15

DI: lacking ADH

• ↓ ADH
• ↑ Na+
• ↓ urine osmol (diluted urine)

Treatment: fluid replacement (volume restoration) & Demopressin

Question 16

Signs & Symptoms of Cardiac (pericardial) Tamponade

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Answer 16

BECK’S TRIAD:
* + JVD
* Muffled heart sounds
* Pulsus paradoxus

• Dyspnea
• ↓ Diastolic filling
• ↓ stroke volume
• ↓ cardiac output

Question 17

S/S of tension pneumothorax

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Answer 17

• Trachea deviates to the OPPOSITE side
• hyperresonance is heard on the same side

Pneumothorax = collapsed lung

Question 18

Signs & Symptoms of Hemothorax

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Answer 18

• dyspnea (which can lead to tachypnea)
• Chest pain
• low BP (signs of shock)
• ↓ or absent breath sounds on injured side
• dullness to percussion on injured side

Question 19

Compartment Syndrome
* What is the hallmark sign?
* What is the treatment?
* What are the 5 P’s?

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Answer 19

• Hallmark sign = Unrelenting pain (pain out of proportion to injury)
• Tx = fasciotomy

5 P’s
* Pallor
* Paresthesia
* Proprioception
* Pain
* Pulse

Question 20

What is the earliest & most reliable symptom indicative of increased intracranial pressure (↑ ICP)?

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Answer 20

Change in LOC or mental status

Question 21

Symptoms & Treatment of Acute Renal Injury (ARI/AKI)

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Answer 21

S/S
* Oliguria (↓ urine output)
* hypocalcemia (& hyperkalemia due to ↓ GFR)
* ↑ BUN & Creatinine

Tx = ↓ sodium, potassium, & phosphorus intake(also ↓ protein intake)

Question 22

Which type of kidney injury causes acute tubular necrosis?

Answer 22

Intrinsic kidney injury

Question 23

Stages of Acute Tubular Necrosis

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Answer 23

Onset or Initiating Phase: hours to days; from precipitating event until tubular injury occurs

Oliguric / Anuric Phase: 5-16 days; necrotic tissue blocks urine & damages tubular wall

Diuretic Phase: 7-14 days; ↑ GFR & polyuria
* monitor for dehydration

Recovery / Convalescent Phase: renal tissue repair occurs, BUN & Creatinine return to normal

Question 24

What is the treatment for portal HTN & cirrhosis?

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Answer 24

TIPS procedure
* Transjugular Intrahepatic Portosystemic Shunt

Question 25

What are signs & symptoms of Fulminant Hepatic Failure (FHF)? What is the treatment?

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Answer 25

• Jaundice
• Ascites
• Confusion
• N/V
• Bleeding (↑ PT, aPTT, & INR; ↓ platelets)

Question 26

Signs & Symptoms of Fat Embolism Syndrome (FES).

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Answer 26

• Respiratory Failure
• Cerebral Dysfunction
• Skin petechiae (does not blanch)
• Symptoms occur within a few hours to 3-4 days
• Common after a long-bone fracture

Question 27

Primary vs. Secondary Multisystem Organ Dysfunction (MODS)

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Answer 27

Primary: Occurs as a result of an injury or diease that leads directly to organ dysfunction

Secondary: consequence of wisespread sustained systemic inflammation that indirectly leads to organ dysfunction

Question 28

Which IV solution most closely resembles the composition of plasma in the body?

Answer 28

Lactated Ringers