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NUR 355: Med Surg I > Exam 4 Study Guide: Q > Flashcards

Exam 4 Study Guide: Q Flashcards

1
Q

causes of respiratory alkalosis

A

o anxiety induced hyperventilation
o poor oxygenation can induce hyperventilation

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2
Q

nursing interventions for a patient with respiratory alkalosis

A

o identify causes of anxiety

o rebreathing techniques (breathe into a paper bag or cupped hands) to retain CO2 and slow down breathing

o teach patient stress reduction

**non-rebreather mask is not a good option because the client should rebreathe some CO2

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3
Q

ABG values correlated with respiratory alkalosis

A

o PaCO2 < 35 mmHg
o pH > 7.45

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4
Q

S/S of respiratory acidosis

A

o high respiratory rate
o patient is acidic
o respiratory system is attempting to compensate by “blowing off” excess acid in the form of CO2

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5
Q

nursing priority of respiratory acidosis

A

o maintain patient’s airway

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6
Q

primary cause of respiratory acidosis

A

o primarily hypoventilation - which occurs with opioid overdose

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7
Q

which acid base disorder correlated with change in HCO3?

A

Metabolic acid base disorder correlate with changes in HCO3 (respiratory do not)

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8
Q

what ABG values are associated with metabolic acidosis?

A

o HCO3 < 22 mEq/L
o pH < 7.35
o normal PaCO2

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9
Q

causes of metabolic alkalosis??

A

o excessive oral ingestion of bicarbonate-based antacids
o vomiting and NGT suctioning
o Potassium wasting diuretics

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10
Q

ABG values indicate metabolic alkalosis

A

o pH . 7.45
o HCO3 > 26 mEq/L
o CO2 is normal

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11
Q

S/S of acute kidney injury (AKI)

A

o volume overload due to decreased urine output such as edema, JVD, SOB, hypertension, pulmonary edema and increased potassium

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12
Q

important interventions for a patient with CKD

A

o Monitor I&Os
o SPO2 > 93% and low protein diet
o monito lung sounds

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13
Q

what is the purpose of daily weights?

A

o weight is the best non-invasive indicator of fluid status

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14
Q

what is a good way to measure fluid retention?

A

1 L of H2O = 1kg
o a change in BWT is a good measure of excess fluid loss or retention
o patient education: clinical manifestations of hypervolemia such as edema

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15
Q

what diet should patients with fluid retention follow?

A

limit sodium and fluid intake

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16
Q

who is at risk for dehydration?

A

older adults

o less total body water than younger adults

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17
Q

what are important points with older patients at risk for dehydration

A

cognitively impaired

o and cannot obtain fluids independently or cannot make his or her need for fluids known
o causes poor cerebral perfusion and cerebral hypoxia, causing confusion
o increasing IVF rate would increase perfusion but rehydrating too rapidly with IVF can lead to cerebral edema
o watch for SOB when rehydrating rapidly, you may need to slow down the infusion and notify the physician

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18
Q

what should the nurse do when a patient has an elevated BUN with dehydration?

A

prepare to administer IV fluids

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19
Q

S/S of hypovolemia

A

o tachycardia
o hypotension
o concentrated urine
o flattened neck veins - could quickly lead to hypovolemic shock
o preventing injury - older adult with moderate dehydration may experience orthostatic hypotension, dangle on the bedside before ambulating

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20
Q

how is hypovolemia corrected

A

Isotonic Solutions (0.9% NS, LR)

o used for fluid volume deficit

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21
Q

hypervolemia interventions

A

o daily weights each morning before anything to eat or drink
o fluid restrictions
o monitor for edema
o edema in the lower extremities - elevate legs on a pillow or two

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22
Q

S/S of HYPERVOLEMIA

A

o tachycardia
o JVD
o edema
o crackles
o absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid overload and fluid balance in the patient’s body

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23
Q

S/S of HYPOCALCEMIA

A

o anxiety
o confusion
o irritability
o paresthesia
o positive chvostek/trousseau sign
o tetany
o twitching
o tremors
o focal numbness
o muscle spasms
o biliary colic
o dysphagia
o wheezing
o tingling around the mouth
o bronchospasms
o laryngospasms

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24
Q

causes of HYPOCALCEMIA

A

o chronic alcohol abuse is an etiology of hypocalcemia and hypomagnesemia

o parathyroid regulates calcium in the body and a thyroidectomy can affect the parathyroid increasing risk of hypocalcemia

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25
Q

who is at risk for HYPERMAGNESEMIA?

A

o patients taking excessive amounts of milk of magnesia

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26
Q

who is at risk for HYPOMAGNESEMIA?

A

o chronic alcohol abuse

o caused by malnutrition, alcohol abuse, vomiting, diarrhea, laxative abuse, and dehydration

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27
Q

may cause dysrhythmias

A

potassium > 5.0

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28
Q

S/S of HYPERKALEMIA

A

o generalized weakness
o muscle cramps
o paresthesia to weakness
o ECG changes (abnormal rhythms, widened QRS complex)
o bradycardia
o sinus arrest
o heart blocks
o ventricular dysrhythmias

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29
Q

treatment of HYPERKALEMIA

A

o must be treated immediately to reduce the extracellular potassium level

o insulin: enhances potassium movement into the cells to decrease both serum potassium and glucose levels and therefore should be administered with DEXTROSE to prevent hypoglycemia

o dialysis may also be needed (not the first prescription the nurse should implement

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30
Q

causes of HYPOKALEMIA

A

o many diuretics

  • especially loop and thiazide diuretics, increase the excretion of hydrogen ions, leading to excess acid loss through the renal system. this situation is an acid deficit of metabolic origin. monitor for metabolic alkalosis
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31
Q

S/S of HYPERNATREMIA

A

o disorientation
o hallucinations
o agitation
o restlessness
o neuromuscular irritability
o confusion
o seizures
o lethargy
o tachycardia
o dry mucous membranes
o skin flushed
o agitation
o thirst

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32
Q

causes of HYPERNATREMIA

A

o cushing’s syndrome
o hyperaldosteronism
o patient’s taking corticosteroids are at risk for hypernatremia
o dehydration can increase risk of hypernatremia

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33
Q

what should you education patients with hypernatremia

A

o drink at least 8 glasses of water/day
o administration of sodium bicarbonate for metabolic acidosis

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34
Q

what is one cause of HYPONATREMIA?

A

o hyperglycemia with glucosuria can cause sodium loss causing hyponatremia

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35
Q

hypnotic fluids important points

A

o hypnotic fluids (0.45% NS)

o may cause hypotension to worsen if given to patients with low BP

o hypotonic IV fluid, such as 0.45% NS shifts fluid out of the vessels and into the cells - because of fluid shift, hypotension may be worsened

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36
Q

what should you do if a provider orders 0.45% NS for a serum osmolality > 300 mOsm/kg

A

o causes fluid to move from the intravascular space into both the intracellular and interstitial spaces
o physicians tend to miss this so if you see this, question the order and remind the physician this ight not be the best choice for rehydration

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37
Q

a procedure to closely examine your cervix, vagina, and vulva for signs of disease.
allows direct visualization of the bladder wall and urethra

o dr may recommend this if your pap test result is abnormal

A

cystoscopy

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38
Q

what is cystoscopy used for

A

o to diagnose, monitor and treat conditions affecting the bladder and urethra

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39
Q

reveals the size and anatomy of the kidney, ureters, and bladder (KUB), as well as any tumors, cysts, calculi, and obstructions within the urinary tract

A

IV Urography

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40
Q

what is the first symptoms of polycystic kidney disease

A

o hypertension

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41
Q

infection and inflammation of the kidney, pelvis, calyces, and medulla

A

pyelonephritis

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42
Q

what is the drug phenazopyridine used for

A

o an antispasmodic agent that is used to treat bladder spasms caused by UTIs
o this is taken as needed and is not used to TREAT UTIs

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43
Q

S/S of bladder cancer

A

o painless hematuria
o dysuria

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44
Q

risk of bladder cancer

A

smoking

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45
Q

what controls the menstrual cycle

A

o hormonal secretions of FSH and LH from the anterior pituitary
o and the release of estrogen and progesterone from the ovaries

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46
Q

which testicle hangs lower?

A

left testicle

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47
Q

what are the tiny skin folds called

A

the scrotal wall has tiny skin folds called RUGAE

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48
Q

what is used to treat hot flashes associated with menopause

A

black cohosh

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49
Q

BPH interventions

A

o alpha blockers (act on the alpha receptors in the prostate, causing the smooth muscles of the prostate to relax)

o anticholinergic meds (meds prescribed to relax bladder smooth muscle in patients with overactive bladder)

o 5-alpha reductase inhibitors (prevent testosterone from being converted to dihydrotestosterone DHT, which causes enlarged tissues to shrink, thus reducing obstruction of the urethra)

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50
Q

HPV important points

A

o common STI of the anogenital tract
o evidence revealing its role in cancers of the cervix, vulva, vagina, anus, penis, and some head and neck cancers

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51
Q

genital herpes important points

A

o tingling or an abnormal sensation before presence of the vesicle
o ulcer is a prodromal sign for genital herpes
o prodromal symptoms may occur before the appearance of the blister, indicating the beginning of an outbreak

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52
Q

S/S of Chlamydia in females

A

o dysuria
o dyspareunia (painful sexual intercourse)
o lower abdominal pain
o vaginal discharge
o cervical tenderness
o rectal d/c

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53
Q

gonorrhea risk factors

A

o age (particularly younger than 25 years old)
o low socioeconomic status
o multiple sexual partners
o hx of STIs including pelvic inflammatory disease (PID)
o M sex with M
o unmarried status

54
Q

syphilis PRIMARY clinical manifestations

A

genital ulcer and chancre

55
Q

syphilis SECONDARY clinical manifestations

A

o skin rash
o mucous patches
o fever
o hepatitis
o arthritis

56
Q

syphilis TERTIARY clinical manifestations

A

o cardiovascular and aortic regurgitation

57
Q

AKI clinical manifestations

A

o HTN from fluid overload
o edema
o JVD
o crackles
o pulmonary edema
o oliguria
o SOB (think airway/breathing)

58
Q

how can you reduce the risk of pulmonary edema in AKI

A

monitor I&O
- balance them

59
Q

when a patient comes in with potassium of 8, which medication order do you anticipate first

A

o insulin and dextrose

60
Q

are you concerned about BG 146?

A

o slightly, unless they just ate

usually don’t treat till > 150

61
Q

are you concerned about K of 6.7

A

yes, can cause arrhythmias

62
Q

what is a good indicator fluid balance is maintained

A

o no crackles
o clear lung sounds
o no adventitious sounds

63
Q

are you concerned about calcium level of 17

A

yes

64
Q

which food is high in sodium?

o fresh fruit
o broccoli
o potatoes
o brown rice
o beans
o mac & cheese

A

mac and cheese

65
Q

are you going to see patients with creatinine > 2 soon

A

yes

66
Q

patient getting 167ml/hr and develops SOB and crackles, what do you do

A

stop infusion and call the Dr

67
Q

what do you monitor for in a patient with metabolic acidosis

A

o decreased HR
o cardiac system

68
Q

why is a patient with respiratory acidosis tachypneic

A

o excess CO2 buildup in body, trying to lower level

69
Q

what is the appearance of syphilis cancres

A

o Cancre - silver oral ulcers

70
Q

what STI increases the risk of cervical cancer

A

HPV

71
Q

what is the MOA of flomax for BPH

A

o anticholinergic that relaxes bladder muscles
o alpha adrenergic blocking property relax smooth muscle for prostate

72
Q

which patient should you see first?

o WBC 9k
o sodium 137
o BG at 146
o potassium 6.8

A

potassium 6.8

73
Q

which findings indicates fluid balance in a CK patient?

o decreased calcium levels
o increased phosphorus levels
o edema in legs
o clear lung sounds

A

clear lung sounds

74
Q

in a patient with lower extremity edema, what should you do?

A

o document the pitting edema
o elevate lower limbs

75
Q

what is a priority to monitor with metabolic acidosis

A

cardiac rate and rhythm

76
Q

what can you monitor in a patient with CKD to reduce the risk of pulmonary edema

A

I&O

77
Q

what can you assess to see if there has been an improvement in pulmonary edema

A

o lung sounds (want no adventitious lung sounds and no crackles)

78
Q

who is at the highest risk for dehydration

A

o homeless
o elderly
o cognitive impairment (dementia & alzheimers)

79
Q

what are important discharge education points for a patient with fluid volume excess

A

o weigh themselves daily
o fluid restrictions
o monitor for peripheral edema (elevate lower limbs if noted)

80
Q

what causes hypocalcemia and hypomagnesemia

A

alcohol abuse

81
Q

S/S of HYPOCALCEMIA

A

o tremors
o anxiety
o confusion
o irritability
o positive chvostek/trousseau sign
o bronchospasm
o facial tremor/twitching

82
Q

what condition could put a patient into respiratory alkalosis and what should you instruct the patient to do

A

o anxiety - hyperventilation

o have clients breath into paper bag or cupped hands

83
Q

what can put a patient into respiratory acidosis

A

opioid OD - hypoventilation

84
Q

what is hyperkalemia?

A

elevated potassium

85
Q

what meds are given for critically high potassium levels

A

insulin and dextrose

86
Q

what medication is given to treat hypokalemia

A

potassium (usually 20 - 40 mEq)

87
Q

what causes hypernatremia

A

dehydration

88
Q

what is an important patient education point for hypernatremia

A

o low salt diet
o drink 8 glasses of water/day

89
Q

a patient just had a partial thyroidectomy and has facial twitching and irritability, what is wrong?

A

hypocalcemia

90
Q

why would a dehydrated patient be confused?

A

lack of cerebral perfusion

91
Q

what do you need to administer to a patient with lack of cerebral perfusion

A

IV fluids

92
Q

a dehydrated patient is getting IVF 150mL/hr and has SOB,
you hear crackles, what do you do?

A

o stop infusion and call the dr

  • fluid overload/pulmonary edema
93
Q

S/S of dehydration/hypovolemia

A

o flattened neck veins
o hypotension
o tachycardia
o concentrated dark yellow urine

94
Q

what fluids will you give patients with hypovolemia (dehydration)

A

isotonic 0.9% NS or LR

95
Q

are flattened neck veins high priority? if so, why

A

yes
o worry about brain perfusion

96
Q

are you concerned about patient with creatinine of 2?

A

yes
o kidney function is around 50%

97
Q

normal Hct

A

37 - 50%ish

98
Q

what is the priority in patients with respiratory alkalosis and respiratory acidosis

A

maintain airway

99
Q

is skin tenting a S/S of hypervolemia?

A

no

o hypertension
o JVD
o edema
o tachycardia
o crackles

100
Q

is skin tenting a S/S of HYPOVOLEMIA

A

yes

101
Q

what acid-base imbalance can be caused by potassium wasting diuretic? what are other causes of this condition

A

metabolic alkalosis

  • vomiting
  • NG suctioning
102
Q

what are education points for a patient with mild dehydration

A

o avoid caffeine
o consume non-caffeinated beverages

103
Q

what could cause a BUN in the 30s, and what should you give this patient?

A

fasting and dehydration

  • give IV fluids
104
Q

what is a hypotonic solution

A

0.45% NS

105
Q

what happens if hypotonic solution is given to a dehydrated patient

A

fluid shifts into cells

o will drop BP further

106
Q

what condition causes hyponatremia

A

hypoglycemia with glucosuria

107
Q

hypernatremia is caused by what conditions

A

Cushing’s & hyperaldosteronism

108
Q

what are causes of hypomagnesemia

A

o chronic alcohol abuse
o laxative abuse
o malnutrition
o dehydration

109
Q

what heart rate would you expect in a hypovolemic patient

A

o tachycardia

  • trying to compensate for hypotension
110
Q

what should you give to a patient who has a serum osmolality level > 300

A

hypotonic IVF
0.45% NS

111
Q

what should you do when a patient receiving a blood transfusion develops abdominal pain, back pain, face flushing, and SOB

A

o stop transfusion
o take vitals
o call the Dr

112
Q

what procedure would be performed to remove a kidney stone

A

cystoscopy

113
Q

what is the first symptom of polycystic kidney disease

A

HTN

114
Q

what are patient education points with Phenazopyridine (pyridium)

A

o treat bladder spasms with a UTI but does not cure UTI (need abx)
o urine will look orange

115
Q

what is the number 1 risk factor of bladder cancer?

A

smoking

116
Q

what is the early S/S of bladder cancer

A

painless blood in the urine

117
Q

pap smears screen for which type of cancer

A

cervical cancer

118
Q

a patient comes in with vaginal discharge, itching, and dysuria.
what should you find out

A

o color of the discharge

119
Q

what 4 hormones control the menstrual cycle

A

o FSH
o LH
o Estrogen
o Progesterone

120
Q

when performing an assess on an adult client’s scrotum,
what are normal and abnormal findings

A

Normal Findings:
o left testicle lower than right, rugae, skin darker

Abnormal Findings:
o no erythema or swelling

121
Q

what is the best response by a nurse when a young adolescent client comes in with severe menstrual cramps

A
  • this is normal and they should become less severe as you get older
122
Q

what is the MOA of an alpha adrenergic blocking medication for BPH

A

o relaxes the smooth muscle of the prostate

123
Q

what is the MOA of an ANTICHOLINERGIC medication for BPH

A

o relaxes the bladder muscle

124
Q

which STI increases the risk of cervical and penile cancer

A

HPV

125
Q

what is a prodromal S/S of genital herpes (before vesicles appear)

A

tingling and abnormal sensation

126
Q

what are S/S of a female with chlamydia

A

o painful urination
o painful intercourse
o lower abdominal pain
o cervical tenderness

127
Q

what are risks for gonorrhea

A

o Hx of STIs
o multiple partners

128
Q

when giving Lasix to patient with AKI,
what electrolyte imbalance are we concerned about

A

o Hypokalemia

  • can put the patient into metabolic alkalosis
129
Q

the normal range for the bicarbonate HCO3

A

22 - 26

130
Q

the metabolic parameter of the arterial blood gas set is

A

HCO3

131
Q

the respiratory parameter of the arterial blood gas set is

A

PaCO2

NUR 355: Med Surg I (6 decks)

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