Final Exam Flashcards
Two patient teachings for external radiation?
-use mild soap
-avoid lotion containing alcohol
Client care for inpatient brachytherapy includes?
-flush the toilet 2-3 times
-limit visitors to 30 minutes, 6 feet apart.
Client receiving chemotherapy is at risk for _______________ due to myelosuppression.
-bleeding
-infection
What type of cancer causes the most deaths in the USA?
lung cancer
If a tumor suppressor gene tests positive…
The patient is at a higher risk of developing cancer.
A patient has lung cancer stage IV, this indicates
metastasis
What are 3 signs of cancer?
-hoarseness
-sore throat that does not heal
-unusual discharge
(not mood swings)
How can the RN assist with pain management in the patient with cancer?
proper assessment and relaxation therapy
What are negative aspects of biological aging?
-stress and obesity
Name 2 chronic illness?
COPD & HF
What are risk factors for cancer?
-smoking
-genetics
-radiation
Patient with microemboli and thrombocytopenia due to deficiency of ADAMTS13
-Thrombotic thrombocytopenia purpura (TTP)
Three symptoms of R. sided HF
peripheral edema, ascites, and JVD
Name three medications indicated for a myocardial infarction
-aspirin
-morphine
-nitroglycerin
(only-not furosemide)
What is radiofrequency catheter ablation?
-ablation of the area of conduction in the heart
Which patient is at risk for heparin induced thrombocytopenia?
patient receiving heparin for prophylactic treatment
What is your concern with patient with premature atrial contractions?
monitor cardiac rhythm
What causes immune thrombocytopenia purpura (ITP)
-a bacterial or viral infection
List common S/S of corticosteroids
-weight gain
-hypertension
-hyperglycemia
What should be include in teaching related to nitroglycerin?
-may cause severe headache
Patient teaching for thrombocytopenia?
do not blow your nose, gently dab
What causes orthopnea in a client with left sided heart failure?
-pulmonary edema
What are patient’s at risk for with atrial fibrillation?
-stroke patient
What is a risk factor for asthma?
-environmental allergies
A clinical manifestation of declining respiratory status?
-retraction of sternal muscles
First line treatment for bronchoconstriction in asthma is
beta-2 agonist (SABAs)
When teaching about PO prednisone side effects, what would the nurse include?
-decrease in immune system
In teaching your patient with COPD about MDI albuterol use include:
-breath in slowly & deeply for 5 seconds
Nursing interventions for patient who is short of breath
-raise the head of the bed
-oxygen
Test that measures lung function, specifically the amount and/or speed of air that can be inhaled and exhaled.
-spirometry
Alpha-1 antitrypsin deficiency can contribute to the development of COPD due to
-lack of protection to lung tissue during inflammation
A client with COPD develops peripheral edema and JVD. What complication of COPD may have developed?
-cor pulmonale
The RN hears continuous high-pitched squeaking sound due to bronchoconstriction. What is this called?
-wheezes
Side effects of bronchodilator (Albuterol)?
-tremors
A nurse is caring for a client receiving high flow oxygen
-it delivers a precise oxygen concentration
Client starts using fluticasone (RespiClick). Which of the following instructions should the nurse include
-“Rinse your mouth after each use.”
RN hears wheezing and dyspnea. The nurse interprets that these symptoms are related to what?
-narrowing of the airway
The number one cause of chronic obstructive pulmonary disease (COPD).
-Smoking
Why does a barrel chest occur in people with COPD
-lungs are chronically over-inflated with air
The primary purpose of pursed lip breathing is to:
-promote carbon dioxide elimination
What causes an autoimmune disease causing inflammation & destruction by entering the DNA of the cell?
-systemic lupus erythematosus
What are risk factors for Cholelithiasis?
-female
-oral contraceptives
-obesity
Which of the following are clinical manifestations of hypovolemic shock?
-tachycardia
What causes dark amber urine in the patient with cholelithiasis?
-excretion of bilirubin through the urinary tract
Which of the following are risk factors for osteoarthritis?
-obesity and ligament injury
How is rheumatoid arthritis diagnosed?
-Anti-CCP
-rheumatoid factor
Which type of medication would inhibit tumor necrosis factor in rheumatoid arthritis?
Etanercept (Enbrel)
Older patients with RA may face difficulty due to
drug interactions & toxicity are a concern
What is the pathophysiology behind systemic lupus erythematosus?
-Autoantibodies against nucleic acids attacking DNA
Which medication would a patient with a GI bleed be treated with?
IV esomeprazole (Nexium)
A patient presents with right upper quadrant pain and right shoulder pain. Which of the following may be occurring?
cholelithiasis
Osteoarthritis is caused by?
-injury
-wear and tear
Patient teaching for lupus includes which of the following?
-staying out of the sun
What indicates a sudden GI bleed?
hematemesis
Immune thrombocytopenia is caused by
recent infection
What causes Bell’s Palsy?
-virus
Clinical manifestations of multiple sclerosis
-urinary complications
-vision changes
-numbness and tingling
Stable angina characteristics
-occurs with emotional upset
-is relieved by nitroglycerin and rest
Atrial flutter ECG reading
Sawtooth P waves
Patient with COPD uses albuterol to relax smooth muscle around the bronchioles to open up the airway. Side effects
tremors
Radiofrequency catheter ablation
destroys areas of conduction.
What should be done for an ST elevated MI?
needs percutaneous coronary intervention within 90 minutes
Which compensatory mechanism causes retention of sodium and water in heart failure?
renin angiotensin aldosterone activation
Side effects of prednisone use
-truncal obesity
-thin skin
-hyperglycemia
Diagnostic tests for heart failure
-Echocardiogram
-BNP
Clinical manifestations of digoxin toxicity
-blurred vision
-lack of appetite
What causes the signs and symptoms in Parkinson?
decreased dopamine
What medication would be started on a patient with Bell’s Palsy?
Corticosteroid
Patient’s with myasthenia gravis have
antibodies on the acetylcholine receptors
Chronic illness characteristics
-periods of stability and instability
-progressive
-permanent changes to physiology, results in irreversible changes
A client with Guillain Barre has paralysis that has ascended to abdomen, what is your greatest concern?
assessing patient work of breathing.
What does TRAP stand for in Parkinson’s disease?
tremor, rigidity, akinesia, postural instability
What are initial symptoms of amyotrophic lateral sclerosis?
dropping objects
Which of the following would be most concerning to the nurse when assessing a client with asthma?
accessory muscle use
A thyroidectomy is an intervention that is used to treat
hyperthyroidism
What clinical manifestation is seen in hyperthyroidism?
irritability
What clinical manifestation is common in hypothyroidism?
intolerance to cold
Which conditions can some patients have a goiter?
hyperthyroid (Graves’ disease and Hashimoto’s)
What autoimmune disease is associated with hyperthyroidism?
Graves Disease
Cushing’s syndrome is excess exposure to ….
corticosteroids (exposure to high levels of cortisol)
Which of the following is a clinical manifestation of Addison’s disease?
salt craving
What is a characteristic of myxedema?
-mask like effect
-prominent tongue
-facial and preorbital edema
Lab findings for Grave’s disease would include
-Decreased TSH
-Elevated T4
Beta blockers are given to a patient with hyperthyroidism to….
block effects of sympathetic nervous system
What lab results would the RN expect to see in Cushing’s?
-hypernatremia
-hypokalemia
Gradually discontinue corticosteroid therapy to prevent
adrenal insufficiency
Iatrogenic causes of Addison’s disease include
-chemotherapy
-anticoagulation therapy
The lab values the RN would expect in Addison’s include
-hyponatremia
-hyperkalemia
What is the most serious electrolyte disorder associated with kidney disease?
hyperkalemia
Why would a client with CKD be administered calcium gluconate?
to protect myocardium of heart
Which client would be at most risk for developing kidney disease?
Diabetic on long term Vancomycin
Which of the following would be important to monitor in a client taking furosemide?
-daily weight
-Blood pressure
-potassium level
What is a major difference in polycystic kidney disease and chronic kidney disease?
PKD involves cysts on liver, heart, vessels
Which of the following would be clinical manifestations of glomerulonephritis?
-proteinuria
-periorbital edema
Which of the following lab values would be consistent in the diuretic phase of AKI?
-hypernatremia
-hypokalemia
The stage of CKD is based on what?
Glomerular filtration rate (GFR)
What can affect renal function?
hypertension
What medication removes potassium from the body?
Sodium polystyrene sulfonate (Kayexalate)
The RN recognizes the patient will have a decrease in urine output in the _____ phase of AKI.
oliguric
A patient may not be a candidate for kidney transplant if
they abuse alcohol
The RN recognizes the patient has a _________________ cause of AKI due to long term use of vancomycin.
intra renal
After TURP surgery, why do we do continuous bladder irrigation?
to prevent clotting
What factors influences the development of cataracts?
-long-term corticosteroid use or diuretic use
What are clinical manifestations of cataracts?
-decreased or blurred vision
What is the surgical therapy for cataracts?
Phacoemulsification
What is phacoemulsification?
Ultrasonic vibrations/ sound waves dissolve lens into fragments that are suctioned out and replaced with a new intraocular lens
Nursing management implementation consideration for involving significant visual impairment.
Patients are at risk for polypharmacy
What is the main diagnostic study for glaucoma?
IOP measurement (tonometry)
Drug therapy for chronic open-angle glaucoma (glaucoma) to keep IOP low is
Beta Blocker eyedrops (Timolol)
What are a side-effect of the beta blocker eyedrops timolol?
May cause burning and discomfort but must continue use for retention of vision
Acute angle-closure glaucoma is a medical emergency that requires what medication to low IOP immediately?
Miotics (pilocarpine)
What is the action of miotics (Pilocarpine)?
Decrease IOP by increasing drainage-> enhancing outflow
What surgery creates a new opening for drainage during acute angle-closure glaucoma?
Lasor iridotomy
Retinopathy is most common in what patients?
Patients with HTN or DM
What are risk factors for retinal detachment?
-age
-hypertension
-diabetic retinopathy
What is the surgical therapy used for retinal detachment?
Laser photocoagulation (small burns-> scar)
Aged-related macular degeneration (AMD) more severe type and characteristic
Wet (exudative), abnormal blood vessels develop
AMD clinical manifestations
dark spots in the central visual field (scotomas/blind spots)
What is the diagnostic study used to confirm AMD (age-related macular degeneration)
Amsler grid test
Hearing loss and deafness causes
-increase/impacted dry cerumen
-calcification of ossicles
-thick coarse hair in ear canal
What is the most preventable cause of hearing loss?
-noise (blasting loud music)
What is a nursing intervention used as verbal aids to communicate with a hearing-impaired person?
Speak normally and slowly
Elderly mistreatment (EM) defined
Intentional acts of omission or commission by a caregiver or “trusted other” resulting in harm/serious harm
EM occurrence and underreoprting
-in home, assisted-living, and institutions
-underreported by victims/ HCP
EM risk factors
-Physical or cognitive limitations
-Psychiatric disorders
-Alcohol misuse / drug abuse
-Lack of social support
-Living with many others
-Inadequate income
Elderly mistreatment types
-abandonment
-financial abuse
-neglect
-physical abuse
-psychologic abuse
-sexual abuse
-violation of personal rights
The most common side -effect of chemotherapy
myelosuppression (bone marrow suppression)
What is myelosuppression
-Born marrow activity is decreased, resulting in fewer RBCs, WBCs (neutropenia), and platelets (thrombocytopenia)
What risk factors increase with myelosuppression?
infection, hemorrhage, overwhelming fatigue, anemia
chemotherapy side-effects
-fatigue
-Nausea, vomiting, mucositis, stomatitis, esophagitis, constipation, diarrhea, anorexia (cachexia), hepatotoxicity
-hyperuricemia
-cardiotoxicity, pericarditis, myocarditis
-reproductive problems, nephrotoxicity,
-myelosuppression
-“Chemo” brain
Radiation/ chemotherapy Skin reactions
-redness, hyperpigmentation, dry desquamation, wet desquamation, alopecia
radiation induced thrombocytopenia S/S
-petechiae
-bruising
-signs for bleeding (gums, nose, mouth, rectum, cuts-unstopped)
-spontaneous bleeding (Platelets < 20,000)
blood in bodily fluids
-any signs associated with stroke
Thrombotic Thrombocytopenia Purpura (TTP) S/S
-petechiae, then purpura, then ecchymosis
-stroke symptoms
-neurologic abnormalities
-fever (in the absence of infection)
-renal abnormalities (kidney injury)
-bleeding/ clotting simultaneously (med-emerg.)
Stable angina (duration of pain-few minutes, subside with precipitating factor, ECG-St segment depression/ T wave inversion)
-Intermittent chest pain that occurs over a long period with similar pattern of onset, duration, and intensity of symptoms
-Onset: physical exertion, stress, or emotional upset
-May deny pain; have pressure, heaviness, or discomfort in chest dyspnea or fatigue
-Demand ischemia, no infarct- normal ECG, no alterations in troponin
MI testing
Probable heart attack: Troponin I or T above 0.40 ng/mL (elevates troponins)
Primary risk factor for HF
hypertension
HF precipitating causes
Dysrhythmias, infections, pulmonary embolism
Left-sided HF
Most common form of HF
Results from inability of left ventricle to:
Empty adequately during systole
Fill adequately during diastole
COPD S/S
Chest breathing
Use of accessory and intercostal muscles
Inefficient breathing
May experience wheezing and chest tightness
Diminished breath sounds
O2 Sat 88-92% at baseline
Clinical Manifestations-COPD
-underweight (anorexia)
-barrel chest
-chronic fatigue
-paroxysmal coughing (rib fx.)
-Compensation (pursed-lip breathing, tripoding)
COPD Diagnostics connfirmation
Spirometry and FEV1/ FVC ratio (<70% or less than 0.70)
How to perform pursed lip breathing
1) relax neck/ shoulders
2) breath in through nose for 2 seconds, mouth closed
3) breath out for 4 seconds through pursed lips, if too long, breath out 2x as long as breathed in
Why does a person perform pursed lip breathing?
-prolongs exhalation
-prevents bronchiolar collapse and air trapping
GERD/ Asthma Treatment
-When taking medications for asthma- is can exacerbate GERD, so treat with medications for GERD…GERD may trigger bronchoconstriction and aspiration
-Reflux may trigger bronchoconstriction as well as cause aspiration
FEV1-asthma
(breathing out in 1 minute-is going to be the maximum speed of exhalation in 1 second)
Asthma Treatments
-SABA (Albuterol) use for symptoms are used to treat asthma
-Treat allergies with Cetirizine (Zyrtec), inflammation of the mucus membranes- prophylactic Tx
Asthma exacerbations S/S, life-threatening S/S
S/S exacerbations-hypoxia, hypercapnia, and acute respiratory failure (Status Asthmaticus)
Guillain-Barre S/S
-Acute, ascending, rapidly progressive, symmetric weakness of the limbs
-muscle flaccidity (muscle atrophy)
-paresthesia (tingling)
-diplopia
-facial weakness
-dysarthria
-dysphagia
-signs for resp. compromise
Guillain-Barre Tx.
-have intubation kit ready
-Plasmapheresis
-Psychosocial support
Guillain-Barre precipitating factors
-bacterial or viral infection
-surgery
-vaccinations
Myasthenia Gravis S/S
-Progressive, fluctuating weakness of skeletal muscles
-Especially muscles involved in repetitive movements (facial expressions, blinking, chewing, swallowing, breathing)
-Bilateral ptosis & diplopia
-Difficulty with speech, chewing and swallowing
-Facial immobility
-In worst cases, can affect respiratory muscles
No sensory loss (can still feel)
MG-Testing
Tensilon (endrophonium) Test, if reversed for 5 minutes confirms MG
Mg Tx, teaching
-aspiration precautions, b/c muscles -weak and moves upward.
What if it worsens?> Prepare for intubation and ventilation
If there is a crisis?> Encourage resting frequently throughout the day
-Anticholinesterase Agents,
-Corticosteroids
MS Tx/ Education
-Position in semi-fowlers
- for urinary tract (incontinence)-toilet schedule
-due to sensitivity (take walks in morning in evening)
-Self-catheterization if necessary
-High-fiber diet to relieve constipation
-Emotional adjustments
-Lifestyle changes
-Safety (fall risk, aspiration)
-Corticosteroids, Immunomodulators , IV Monoclonal antibodies
Amyotrophic Lateral Sclerosis (ALS) Patho
-Motor neurons in brainstem and spinal cord gradually degenerate
-Electrical and chemical messages from the brain do not reach muscle to activate them
ALS teachings
Facilitate communication (voice banking)
Reduce risk of aspiration
Assess respiratory status
Pain control due to muscle weakness
Provide support
Code Status? Hospice Referral?
Patient remains cognitively intact while wasting away.
Assist patient and family in management of disease and grieving
Parkinson Tx/why
-primary treatment, Levodopa with carbidopa (Sinemet), levodopa is a precursor to dopamine and can cross the blood-brain barrier, carbidopa inhibits an enzyme that breaks down levodopa before it reaches the brain
Systemic Lupus Erythematous (SLE)- medications
NSAIDs:
Used for pain and inflammation (e.g., ibuprofen, naproxen).
Antimalarials:
Hydroxychloroquine (Plaquenil): Helps manage fatigue, skin rashes, and joint pain.
Corticosteroids:
Prednisone: Reduces inflammation and suppresses the immune response; used for flares.
DMARDs (Disease-Modifying Antirheumatic Drugs):
Methotrexate: For severe cases, helps control the immune system.
Biologics:
Belimumab (Benlysta): Targets specific immune system components to reduce disease activity.
Immunosuppressants:
Azathioprine, Mycophenolate mofetil: Used for severe manifestations or organ involvement.
SLE Patient Edu
Triggers for Flares: Sun exposure, emotional stress, infection, certain medications, and surgery.
Drug Side Effects: Be aware of side effects and early signs of flare-ups.
Organ Health: Monitor for signs of kidney failure and damage to vital organs.
Pregnancy Complications: Increased risk of stillbirth and spontaneous abortion; methotrexate should be discontinued at least 3 months before pregnancy. Hydroxychloroquine is safe during pregnancy.
Support: Include supportive therapy, counseling, and family involvement.
R.A. causes
Autoimmune Disorder: Immune system attacks joint tissues.
Genetic Factors: Family history can increase risk.
Environmental Triggers: Smoking, infections, and certain exposures.
RA teachings
Symptoms: Joint pain, stiffness, swelling, fatigue.
Lifestyle Modifications: Balanced diet, regular exercise, weight management.
Importance of Adherence: Consistent medication use and follow-up appointments.
RA treatment
Medications:
NSAIDs: For pain relief (e.g., ibuprofen).
DMARDs: Slows disease progression (e.g., methotrexate).
Biologics: Target specific parts of the immune system (e.g., TNF inhibitors).
Corticosteroids: Reduce inflammation.
Graves Disease Interventions
Medications:
Antithyroid Drugs:
Methimazole or Propylthiouracil (PTU): Reduce thyroid hormone production.
Beta-Blockers:
Manage symptoms like rapid heart rate and anxiety.
Radioactive Iodine Therapy:
Destroys overactive thyroid tissue to reduce hormone production.
Surgery:
Thyroidectomy: Partial or complete removal of the thyroid gland for severe cases.
Regular Monitoring:
Frequent thyroid function tests to adjust treatment as needed.
Graves Disease teachings
Signs and Symptoms:
Educate on symptoms of hyperthyroidism (e.g., weight loss, anxiety, heat intolerance).
Medication Adherence:
Importance of taking medications as prescribed and understanding potential side effects.
Follow-Up Care:
Stress the need for regular follow-ups for monitoring thyroid levels and adjusting treatment.
Lifestyle Modifications:
Balanced diet, regular exercise, and stress management techniques.
Eye Care:
If experiencing eye problems (Graves’ ophthalmopathy), advise on protective measures and follow-up with an eye specialist.
(DMARD) Methotrexate Complications
bone marrow suppression and hepatotoxicity use ALT/ AST to monitor before and during treatment, infection, teratogenic
osteoarthritis diagnostic and types of nodes
*Heberden’s nodes are DISTAL
*Bouchard’s nodes are PROXIMAL
*Synovial fluid analysis helps distinguish between OA and other types of inflammatory arthritis
*X-rays
Detect joint space narrowing, bony sclerosis, osteophyte formation
Cholestasis Tx
GI bleed testing
Endoscopy (source), angioscopy (if endo cannot be done), labs (BUN increase due to blood absorption), typing/ cross matching, occult blood
S/S of hypothyroidism
cold intolerance, weight gain, fatigue, dry skin, thin hair, slowed body processes, impaired memory, puffy face, pallor, sweat decrease, low initiative
Hyperthyroidism S/S
increased metabolism, increased tissue sensitivity by SNS, goiter, exophthalmos, ophthalmopathy, diplopia
Addisonian Crisis Lab Diagnostics, S/S
-Hyponatremia, hypoglycemia, hyperkalemia
Addisonian Crisis S/S
-tachycardia, hypotension, hypovolemia, dehydration, fever, weakness, confusion, vomiting, diarrhea, pain, shock
Primary Lab for Cushing Disease
-potassium, hypokalemia
Cushing Disease S/S
-truncal obesity, buffalo hump, hirsutism, thin hair, bruised/thing skin, acne, petechia/ purpura, purple striae, HTN, hyperpigmentation, thin extremities, muscle wasting, gynecomastia
Glomerulonephritis cause/ treatment
an infection of tonsils, pharynx, or skin by nephrotoxic strains of group A beta-hemolytic streptococci; form antibodies to streptococcal antigen
-restrict Na and fluid intake, diuretics
CKD Complications
↑ Nitrogenous waste products
Electrolyte imbalances (Hyperkalemia)
Metabolic acidosis
Atrophy and demyelination of nerve fibers
infection
Uremia
Fluid retention
anemia
CVD
bone disorders
Hemodialysis complications
hypotension, hypovolemia, chest pain, seizures, nausea, vision changes, muscle cramps
Cholelithiasis Tx
cholecystectomy
Comorbidities/ Causes Associated with Renal impairment
-DM, HTN, CVD, COPD, Obesity, Anemia, Bone Disease
-Glomerulonephritis, AKI, PKI, Obstructive Uropathy, Medication/toxins, systemic disease
BPH S/S
-nocturia, dribbling (skin breakdown), frequency
Complications of TURP for BPH
excessive bleeding, hemorrhage
Common nephrotoxic drugs
NSAIDS
Antibiotics
Antiviral
Diuretics (furosemide)
chemo
lithium
Digoxin
PPI
opioids
Fistula Education
avoid sleeping on access site, applying pressure, or lifting heavy objects w/ side w/ AV fistula
Takes 2-3, 3 months to develop or mature for long term use
