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NRSE-3540 Adult Care 1 > Final Exam Review > Flashcards

Final Exam Review Flashcards

1
Q

what does the acronym SIRS stand for?

A

systemic inflammatory response syndrome

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2
Q

how does SIRS differ from sepsis

A

sepsis has to have a confirmed infection

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3
Q

What included in the sepsis one hour bundle?

A

-drawing lactate level and blood culture
-administering broad spectrum antibiotics
-administering IV fluids (for lactate 4 mol)
-giving vasopressor if needed (to maintain a MAP of 65)

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4
Q

What lab value is most indicative of sepsis?

A

increased lactate

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5
Q

What can be found around a surgical site that will indicate infection

A

redness

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6
Q

Is serous drainage from a surgical site expected?

A

yes

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7
Q

Before administering antibiotics for sepsis, we must ensure

A

blood cultures were drawn

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8
Q

A urinary output of 15 mL is indicative of what

A

organ dysfunction

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9
Q

What is the most effective way to stop the spread of infection

A

hand hygiene

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10
Q

What are risk factors for developing sepsis?

A

being above 80, DM, post surgery

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11
Q

What is an example of a modifiable risk factor for cardiovascular disease

A

smoking, diet, sedentary lifestyle, psychological variables (stress)

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12
Q

what does the P wave on an EKG represent

A

atrial depolarization

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13
Q

What does the QRS complex represent on an EKG

A

atrial repolarization and ventricle depolarization

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14
Q

What is a normal cholesterol level

A

less than 200

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15
Q

What is the correct sequence of atrial conduction through the heart

A

SA node, AV node, bundle of HIS, purkinje fibers

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16
Q

What is the preferred diagnostic test for DVT

A

venous duplex ultrasound

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17
Q

When should we monitor levels of IV unfractionated heparin

A

at least daily
6 hours after initiation
6 hours after any dosage changes

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18
Q

Assessment findings of DVT include

A

unilateral pain, warmth, redness, swelling

-has a sudden onset of pain

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19
Q

when calculating heart rate on a strip, we should determine there are how many large boxes (as in how many equal 6 seconds)

A

30 (or three tick marks at the top)

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20
Q

Normal sinus rhythm has a heart rate between

A

60-100

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21
Q

What is the normal value for the PR interval

A

0.12-0.2

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22
Q

What is the normal value for QRS interval

A

0.06-0.10

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23
Q

What is the normal value for the QT interval

A

less than 0.44 seconds

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24
Q

sinus bradycardia has a heart rate of

A

less than 60

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25
Q

What are prevention measures for DVT

A

early ambulation, SCDs, compression stockings, fluids, calf pump exercises, anticoagulant therapy

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26
Q

What lab is indicative of cardiac damage

A

troponin

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27
Q

What can be used for treatment of sinus bradycardia

A

IV atropine, oxygen, and IV fluids

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28
Q

What drugs are dabigatran, rivaroxaban, apixaban, and edoxaban

A

oral anticoagulatns

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29
Q

What is the benefit of using oral anticoagulants

A

allow for fixed doses without frequent lab monitoring

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30
Q

A patient was given benzocaine prior to bronchial surgery, the nurse knows the patient is at risk for?

A

methemoglobinemia

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31
Q

What is methemoglobinemia

A

when hemoglobin in the cell no longer works. leads to chocolate colored blood and decreased oxygenation

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32
Q

What is the antidote for methomeglobenemia

A

IV methylene blue

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33
Q

Should a rapid response be called for a patient with methomeglobinemia?

A

YES

oxygen and sitting them up will not help. crash cart has the antidote

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34
Q

What is a complication of tension pneumothorax

A

deceased cardiac output

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35
Q

Why does tension pneumothorax cause decreased cardiac output

A

when blood vessels in the lungs are collapsed there is not enough blood return to the heart. decreased heart filling –> decreased cardiac output

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36
Q

What is the best method to confirm placement of a chest tube

A

X-ray

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37
Q

When a patient presents to the ED with a chest trauma, what should the nurse address first?
-chest expansion
-capillary refill
-PERRLA
-orientation

A

chest expansion

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38
Q

What is the ABCDE method of treating emergency chest trauma s

A

airway, breathing, circulation, disability (LOC), exposure (removing clothes)

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39
Q

What does it mean to assess the airway in ABC

A

making sure it is patent and not closed

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40
Q

What does it mean to assess breathing in ABC

A

assessing breath sounds and chest expansion

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41
Q

What does it mean to assess circulation in ABC

A

check capillary refill

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42
Q

Following a lung biopsy, which assessment finding would require immediate follow-up?
increased temp
productive cough
incisional discomfort
absent breath sounds

A

absent breath sounds

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43
Q

What is tidaling?

A

when the water seal container of a chest tube rises and falls with inspiration and expiration

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44
Q

is tidaling a normal finding?

A

yes

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45
Q

is continuous bubbling in the water seal container considered a normal finding?

A

No, may indicate air leak

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46
Q

the absence of tidaling in the water seal container may represent

A

fully expanded lung, obstruction in the chest tube

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47
Q

Are we allowed to milk the tube of a chest tube?

A

no

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48
Q

What is flail chest

A

paradoxical chest wall movement

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49
Q

You are caring for a patient in respiratory distress, o2 sat 89%, RR 30. What is the best course of action?
apply oxygen
reposition
encourage IS use
notify provider

A

apply oxygen

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50
Q

Hyperparathyroidism can put the patient at risk for?

A

fractures

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51
Q

Why does hyperparathyroidism increase risk for fractures?

A

causes calcium to leave the bone and enter the blood stream (hypercalcemia)

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52
Q

Grave’s disease is a type of autoimmune disorder that causes

A

hyperthyroidism

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53
Q

What are s/s of hyperthyroidism/ Grave’s

A

heat intolerance, weight loss, increased appetite, insomnia, tachycardia

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54
Q

If TSH is elevated, T3 and T4 are

A

decreased

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55
Q

If T3 and T4 are elevated, TSH is

A

decreased

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56
Q

Would TSH or T3 be elevated in hypothyroidism

A

TSH

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57
Q

a patient with parathyroid hormone deficiency would have increased or decreased calcium levels/

A

decreased

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58
Q

What is thyroid storm?

A

When patients with hyperthyroidism enter an acute attack causing release of too many hormones at once

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59
Q

What is the best indicator for thyroid storm

A

increase in fever

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60
Q

Most common causes of thyroid storm

A

trauma, infection, vigorous palpation of goiter

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61
Q

Will patients in thyroid storm be hyperthermic or hypothermic

A

hyperthermic

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62
Q

Following a thyroidectomy, it is important for the nurse to inspect

A

behind the clients neck

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63
Q

What is an important complication of thyroidectomy

A

hemorrhage

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64
Q

What are trousseaus and chvostek signs

A

indicators for hypocalcemia

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65
Q

How to test for chvostek sign

A

tap the face and see if there are spasms

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66
Q

How to test for trousseau’s sign

A

use a blood pressure cuff and see if the wrist curls

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67
Q

A positive trousseaus sign indicates

A

hypocalcemia

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68
Q

What is the most severe form of hypothyroidism

A

myxedema coma

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69
Q

Myxedema coma is precipitated by

A

stress

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70
Q

What are s/s of myxedema coma?

A

bradycardia, hypotension, respiratory failure

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71
Q

Following a thyroidectomy, it is important to monitor for?

A

airway patency

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72
Q

What can damage the airway following a thyroidectomy?

A

nerve damage, hypocalcemia induced tetany, edema

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73
Q

If a patient develops stridor after a thyroidectomy, the nurse knows this is caused by

A

swelling

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74
Q

Is stridor after a thyroidectomy an emergency?

A

yes! notify provider as soon as possible

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75
Q

If a patient develops stridor after a thyroidectomy, the nurse should

A

contact provider and prepare for intubation

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76
Q

A patient with hypothyroidism will be prescribed

A

levothyroxine

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77
Q

to prevent thyroid crisis in a patient with hyperthyroidism, the nurse can?

A

encourage rest, keep environment quiet, room away from nurses station, limit visitors, provide cooling blanket

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78
Q

What should you tell a patient regarding diabetes management and sick days?

A

take insulin as prescribed

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79
Q

How often should a patient with diabetes take their blood glucose while sick

A

q 2-4 hours (more than normal)

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80
Q

What should the blood glucose range be for a patient with diabetes in the hospital

A

140-180

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81
Q

Should a diabetes patient who is sick remain NPO?

A

No, this can cause hypoglycemia

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82
Q

If a patient with diabetes is alert and oriented, but a blood sugar of 60, what is the best action

A

administer 15 g of oral carbohydrates

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83
Q

If the blood sugar is 51-70, how many carb snacks should we give

A

15 g carb snacks

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84
Q

If the patient has a BG of <50 but is alert and oriented, how many carb snacks should we provide

A

30 g carb snack

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85
Q

What is the ideal target range for BG at home (for diabetes)

A

70-110

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86
Q

What are examples of a 15 g carb snack

A

4 sugar cubes, 4 tsp of sugar, 1 tbs honey/syrup, 120 mL fruit juice, 5 hard candies

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87
Q

If a patient is not awake or alert, has an IV site, and is hypoglycemic we should administer

A

IV dextrose

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88
Q

If a patient is not awake or alert, no longer has IV, and is hypoglycemic we should administer

A

IM glucagon

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89
Q

After administering IM glucagon, what is the next nursing action?

A

turn them on their side (glucagon causes them to throw up and we do not want them to aspirate)

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90
Q

what are signs of diabetes type 1

A

abrupt onset, increased thirst, hunger, weight loss, and urination

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91
Q

What are signs of diabetes type 2

A

frequently no symptoms, thirst, fatigue, blurry vision

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92
Q

In a patient with type 1 diabetes, what is a sign of hyperglycemia

A

confusion, polyuria, hunger, tachypnea

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93
Q

What are complications of a client with DKA and on IV insulin

A

hypokalemia, hypoglycemia

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94
Q

What is the onset of regular insulin

A

30 minutes

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95
Q

If given regular insulin, it is important that the patient eats within

A

30 minutes

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96
Q

We should tell those with type 2 diabetes that exercise

A

can have a hypoglycemic effect, so they may need less insulin

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97
Q

What are the places insulin can be administered?

A

back of arms, abdomen, thigh, buttocks

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98
Q

Insulin is given at a 90 degree angle unless

A

there is not enough subcutaneous tissue (then it is 45)

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99
Q

How often should someone with diabetes check their feet

A

daily

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100
Q

If someone with diabetes cannot see their feet, what can they do

A

have someone else look, use a mirror

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101
Q

How should a patient with diabetes wash their feet

A

with lukewarm water and soap. dry thoroughly

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102
Q

Are nurses allowed to cut the toenails of patient with diabetes

A

no (let podiatry do it)

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103
Q

Should a patient with diabetes go barefooted?

A

no

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104
Q

What are signs and symptoms of a ureteral stone

A

severe pain, nausea, vomiting, pallor, clammy skin

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105
Q

Pyelonephritis is

A

infection of the kidneys

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106
Q

Pyelonephritis can be caused by

A

reflux of urine from the bladder

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107
Q

What is the most common cause of UTI and pyelonephritis

A

e - coli infection

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108
Q

What are sx of pyelonephritis

A

flank pain, fever, chills, anorexia with or with out vomiitng

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109
Q

What is the most common cause of kidney stone

A

dehydration

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110
Q

what is a common complication of chronic kidney disease

A

anemia

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111
Q

For patients with polycystic kidney disease, it is important that they monitor their

A

blood pressure and daily weight

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112
Q

A woman is more at risk for cystitis because

A

their urethra is close to the rectum

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113
Q

a client with uric acid stones should decrease the intake of

A

purine

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114
Q

Examples of purine sources

A

organ meats, poultry, fish, red wines, sardines, and gravies

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115
Q

Is pink-tinged urine expected following a cystoscopy?

A

yes

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116
Q

Following a cystoscopy, the patient should report

A

dark red urine (indicate of bleeding)

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117
Q

Following cystoscopy, patients should increase fluid intake in order to

A

decrease dysuria

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118
Q

is a patient NPO before a cystoscopy?

A

yes, NPO at midnight

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119
Q

What is a normal WBC count level

A

5-10,000

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120
Q

what is a CAUTI

A

catheter associated urinary tract infection

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121
Q

A catheter should only be in place for

A

no longer than medically needed d

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122
Q

Following a kidney biopsy, the patient should be on

A

strict bedrest

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123
Q

Following a kidney biopsy, what may be indicative of bleeding

A

flank pain, hematuria, on the bed

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124
Q

What to do with a limb that has been cut off in the community

A

put in watertight sealed bag, place in ice water

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125
Q

If a limb is amputated in the community, the patient should hold the limb

A

above the heart if possible

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126
Q

What is the purpose of bucks’ traction

A

reduce muscle spasms

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127
Q

Special considerations for skeletal traction

A

frequent pin care to reduce infection

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128
Q

What is most indicative of fat embolism

A

petechiae on the chest

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129
Q

What are other s/s of fat embolism

A

hypoxemia, dyspnea, tachycardia, agitation, headache

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130
Q

What is an impacted bone fracture

A

when the ends are jammed together

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131
Q

What is a comminuted fracture

A

the impact fragments bone into several pieces

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132
Q

What causes flail chest

A

when 3 or more ribs are broken in 2 separate places

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133
Q

What is the biggest indicator of tension pneumothorax

A

tracheal deviation

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134
Q

A transverse fracture is a break that goes

A

straight across bone shaft

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135
Q

an oblique fracture is a break that goes

A

through the bone shaft at an angle

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136
Q

What can help prevent flexion contracture

A

lie prone every 3 h for at least 20-30 min

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137
Q

What surgery causes flexion contracture the most

A

total knee arthroplasty
above the knee amputation

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138
Q

How long do we elevate the limb following a total knee arthroplasty

A

only the first 24 hours

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139
Q

What should we always ensure in patients with bucks and skeletal traction

A

make sure they are free hanging and not on the bed

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140
Q

What assessments should be made by the nurse while in Bucks and skeletal traction

A

skin color, temperature, distal pulses, capillary refill, movement, and sensation

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141
Q

signs of compartment syndrome

A

6 P’s
-pulselessness
-paralysis
-paresthesia
-paleness
-pain greater than expected
-paralyzed

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142
Q

What is phantom limb pain

A

limb pain felt in an amputated body part

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143
Q

what medication is most appropriate for phantom limb pain

A

iv calcitonin

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144
Q

where does pain from carpals tunnel occur

A

thumb, first two fingers and palm

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145
Q

What test is done for carpal tunnel

A

Phalen’s test

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146
Q

What is the phalen’s test

A

flexion of the wrist assessing for paresthesia

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147
Q

What does RICE stand for

A

rest, ice, compression, elevation

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148
Q

What age does GERD mostly occur

A

middle aged and older adults

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149
Q

How to reduce the contributing factors of GERD

A

-eat small frequent meals
-remain upright after eating
-avoid triggering foods

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150
Q

What foods should be avoided in GERD

A

-spicy foods, tomatoes, citrus foods, caffeine, alcohol, carbonated beverages, chocolate

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151
Q

What medications can be used to treat GERD

A

PPI’s (-azole) antacids, H2 blockers (famotidine)

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152
Q

Symptoms of sliding hernia

A

GERD symptoms (dyspepsia, regurgitation, dysphagia, belching, chest pain)

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153
Q

Symptoms of rolling hernia

A

fullness after eating, breathlessness, feeling suffocated

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154
Q

Why is an NG tube placed after fundoplication

A

prevent wrap from becoming too tight around esophagus

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155
Q

Initial drainage from NG tube after fundoplication

A

dark brown with old blood

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156
Q

8 hours after fundoplication, NG tube drainage should appear

A

yellowish green

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157
Q

why is it important to ensure an NG tube is anchored properly after insertion

A

re-insertion could cause perforation

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158
Q

risk factors for developing esophageal tumors

A

smoking and obesity
-malnutrition, untreated GERD, alcohol

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159
Q

What is Barrett’s epithelium

A

-caused by GERD
-premalignant esophageal cells

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160
Q

Many ulcers in PUD are caused by

A

H. pylori

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161
Q

What drug would the nurse expect to be ordered in a patient with postoperative ileus

A

alvimopan

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162
Q

A small bowel obstruction is likely to cause severe electrolyte imbalances due to

A

profuse vomiting (can contain fecal matter)

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163
Q

Does a large bowel obstruction have major fluid and electrolyte imbalances

A

no , vomiting occurs much less

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164
Q

Key characteristic of large bowel obstruction

A

ribbon shaped stool

165
Q

Risk factors for colorectal cancer

A

FAP, > 50, genetics, family history, smoking, obesity

166
Q

What are biggest indicators for colorectal cancer

A

rectal bleeding, change in stool consistency, anemia

167
Q

Anemia in colorectal cancer is likely to cause e

A

fatigue

168
Q

ABD pain and fullness are signs of colorectal cancer? T or F

A

true

169
Q

Does colorectal cancer cause weight gain or weight loss

A

weight loss

170
Q

Patient education for FOBT

A

-no NSAIDs or anticoagulants 7 days before
-no red meat, aspirin, or vitamin C (350mg) 3 days before

171
Q

How many stool samples are needed for a FOBT

A

2-3

172
Q

FIT vs FOBT

A

FIT is not altered by medications or foods

173
Q

Best method for treating CRC

A

surgery to remove the tumor

174
Q

How should a healthy stoma appear

A

reddish pinks and moist (small bleeding expected first 6-8 wks)

175
Q

why is it important to remeasure the stoma q week for the first 6-8 weeks

A

stoma shrinks in size

176
Q

How long after colostomy should it begin functioning

A

2 - 3 days

177
Q

Stool from ascending, transverse, and descending colostomy

A

ascending: liquid
transverse: pasty
descending: more solid

178
Q

Initial cause of appendicitis includes

A

hard pieces of stool

179
Q

What is ulcerative colitis

A

edema and inflammation of the colon

180
Q

Where does ulcerative colitis occur

A

rectum and rectosigmoid colon

181
Q

Crohn’s disease occurs in

A

the entire GI tract (mouth to anus)

182
Q

Crohn’s disease contains ____ which are openings in body parts that shouldn’t be there

A

fistulas

183
Q

Signs of peritonitis include

A

ABD pain, ABD tenderness, ABD distention, rigid and boardlike, bowel sounds diminishing

184
Q

Where does appendicitis pain occur

A

RLQ

185
Q

Why are enemas and laxatives contraindicated in appendicitis

A

cause appendix to rupture, increasing risk for peritonitis

186
Q

What type of foods should those with diverticular disease avoid? Why?

A

seeds, nuts, corn, popcorn, figs
-these may block diverticulum and cause diverticulitis

187
Q

Priority nursing action for patient with gastroenteritis

A

fluid replacement
-could be IV fluids
-could be oral gatorade or pedialyte

188
Q

Rigid-board like abdomen, fever, tachycardia, fever, nausea, vomiting are signs and symptoms of

A

peritonitis

189
Q

What foods should be avoided in celiac’s disease

A

barley, rye, wheat

190
Q

Complication of ulcerative colitis includes

A

low hemoglobin and hematocrit (due to bloody stools)

191
Q

Which is not a s/s of crohns disease
-anemia
-weight gain
-diarrhea
-weight loss
-RLQ pain

A

weight gain

192
Q

Crohns disease diet

A

low in fiber, raw vegetables, and lactose

193
Q

Famotidine, used to treat PUD, should be taken

A

at night

194
Q

Sepsis in the older adult may present as

A

confusion, AMS, incontinence

195
Q

what is qSOFA

A

used in non-icu settings

-systolic < 100
-AMS
-tachypnea >22

196
Q

A qSOFA score of __ requires more testing

A

2

197
Q

a SOFA score of ___ indicates a greater risk of poor outcomes in the ICU

A

greater than 1

198
Q

What are symptoms of bradycardia

A

syncope, confused, CP, hypotensive

199
Q

Patients with bradycardia may require laxatives because

A

straining to defecate is a form of valsalva maneuver (which causes bradycardia)

200
Q

Those with sinus tachycardia are going to be at risk for

A

low cardiac output

201
Q

VTE’s risk factors include

A

virchow’s triad
-hypercoagulability (oral contraceptives)
-venous stasis (immobility)
-injury (prostate surgery/smoking)

202
Q

What is Homan’s sign? is it best practice

A

test used to assess for DVT in the calf, this is NOT USED

203
Q

Two diagnostics for VTE

A

venous duplex ultrasound, d-dimer

204
Q

LMWH patient education

A

-how to self administer injection
(enoxaparin)

205
Q

Heparin toxicity antidote

A

protamine sulfate

206
Q

Warfarin toxicity antidote

A

vitamin k

207
Q

patient teaching for warfarin

A

-eat consistent amounts of vitamin K

-electric razor, medical alert bracelet

208
Q

Unfractionated heparin adverse effect

A

fatal agranulocytosis (do not administer if platelets < 150,000)

209
Q

What chest injury is mostly cause by rapid deceleration event like MVA

A

pulmonary contusion

210
Q

Pulmonary contusion causes hemorrhage to occur between the alveoli, resulting in

A

decreased breath sounds, decreased gas exchange, hypoxemia

211
Q

If laying patients with pulmonary contusion on their side, they should be placed

A

good lung down

212
Q

What is flail chest

A

3 or more fractures ribs occurring in 2 or more places

213
Q

Flail chest increases patient risk for

A

paradoxical chest wall movement, tachycardia, cyanosis, hypotension,

214
Q

What is the hallmark symptom of tension pneumothorax

A

tracheal deviation to unaffected side, absent breath sounds, respiratory distress

215
Q

Can patients smoke or use a bronchodilator before pulmonary function test

A

No smoking 6-8 h, no bronchodilator 4-6 h

216
Q

symptoms of pneumothorax, pleural effusion, and hemothorax

A

asymmetrical chest wall expansion, diminished breath sounds

217
Q

What are the most important nursing consideration for thoracentesis

A

-patient must stay completely still
-monitor for pneumothorax post procedure

218
Q

How much fluid is allowed to be taken during thoracentesis

A

1,000 mL

219
Q

What is the name for crackles felt underneath the skin during pneumothorax

A

subcutaneous emphysema/ crepitus

220
Q

After bronchoscopy, the patient must be NPO until

A

the gag reflex is returned

221
Q

After lung biopsy, it is important to obtain an x-ray to assess for

A

presence of pneumothorax formation

222
Q

What are the two types of NPPV

A

CPAP and BiPAP

223
Q

CPAP vs BiPAP

A

BiPAP has two levels: different for inspiration and expiration
CPAP maintains one level throughout

224
Q

How much water must be kept in the water seal container of the chest tube

A

2 cm

225
Q

What are the only reasons we can clamp a chest tube

A

-checking for air leak
-changing the tubing
-removing

226
Q

What should we do if the chest tube is pulled out

A

place tube in two inches of sterile water, clamp with hemostats, cover site with sterile gauze

227
Q

During transport, the chest drainage system should remain

A

upright and below the level of the chest

228
Q

If output for a chest tube is greater than ___ , contact provider

A

70

229
Q

Most patients with type 2 diabetes have this comorbidity

A

metabolic syndrome

230
Q

Metabolic syndrome includes

A

abdominal obesity (35 or 40 in), hyperglycemia (fasting > 100), hypertension (systolic 140, diastolic 90), hyperlipidemia (triglycerides 150 or more)

231
Q

Other risk factors for diabetes type 2

A

family hx, AA/hispanic/Pacific Islander, high birth weight babies, PCOS

232
Q

A1C level for diabetes

A

6.5 or greater

233
Q

Patients with diabetes should maintain an A1C of

A

7.0 or below

234
Q

Patients with diabetes should avoid these foods

A

empty calories (candy and soda), trans and saturated fats, high alcohol consumption

235
Q

After exercise, why should diabetics check glucose more frequently

A

they may need decreased insulin doses

236
Q

Exercise education for patients with diabetes

A

-neuropathy: be cautious of activities that can cause falls
-retinopathy: no raising BP due to risk of hemorrhage or retina detachment

237
Q

What would inhibit a person with diabetes from exercising

A

blood glucose not within 100-250, ketones in the urine

238
Q

What is the most common oral anti diabetic medication

A

metformin

239
Q

Metformin will decrease the blood levels of

A

folic acid and vitamin B

240
Q

Basal and bolus insulin doses

A

basal: set dose
bolus: short acting and taken at meal times

241
Q

When should a sick patients with diabetes notify their provider

A

-ketones in urine 24 h
-glucose > 250
after 2 treatments
-hypoglycemia

242
Q

Hallmarks of DKA (seen in type 1)

A

-BG >300
-fruity breath
-Kussmauls (deep and rapid)
-ketones in urine
-metabolic acidosis

243
Q

Hallmarks of HHS (seen in type 2

A

-bg > 600
-frequent urination, dehydration

244
Q

why are BUN and creatinine elevated in DKA and HHS

A

-dehydration

245
Q

should patients with diabetes ever go barefoot

A

no

246
Q

How to prevent diabetic retinopathy, nephropathy and neuropathy

A

-maintain glucose levels within normal limits

247
Q

Diabetic nephropathy disease progression can be slowed by

A

ACEs(-pril) and ARBS (-sartan)

248
Q

What endocrine gland is the master gland

A

pituitary gland

249
Q

Hypopituitarism, caused by decreased growth hormone, can lead to

A

decreased bone density and increased risk of fractures

250
Q

Hallmark symptoms of acromegaly

A

enlarged face hands and feet
coarse facial features
vision and voice changes
enlarged organs

251
Q

how to test for acromegaly

A

growth hormone supression test

-oral glucose given, if GH doesn’t change = acromegaly

252
Q

Acromegaly is treated with dopamine agonists, bomocriptine mesylate and cabergoline, what adverse reactions can these cause

A

chest pain, dizziness, watery nasal drainage = CSF leak

253
Q

After hypophysectomy, we should monitor patients for

A

-nucchal rigidity and headache = meningitis
-watery nasal drainage and increased swallowing (halo sign or glucose present) = CSF leak

254
Q

treatment for CSF leak

A

bedrest

255
Q

Pt education for hypophysectomy

A

no bending at waist, no coughing/sneezing/blowing nose/ brushing teeth

256
Q

Most important thing to monitor in patients with hyperthyroidism

A

increase in temperature (could indicate progression to thyroid storm)

257
Q

symptom specific to grave’s disease

A

exopthalamus

258
Q

Hyperthyroidism is treated with methimazole and propylthiouracil, what are patient teaching points for these medications

A

-they suppress immune system so avoid large crowds, monitor for infection

259
Q

Patient teaching for radioactive iodine

A

-sit while urinating
-flush 2-3 tiems
-avoid contact with pregnant and children one week
-do not share utensil

260
Q

Following a thyroidectomy, a patient experiences tingling in the mouth/toes/fingers, what should the nurse prepare to administer?

A

IV calcium gluconate
(pt has hypocalcemia)

261
Q

expected lab values with hypoparathyroidism

A

decreased PTH, calcium and magnesium
increased phosphorus

262
Q

expected lab values with hyperparathyroidism

A

increased PTH, calcium, and magnesium
decreased phosphorus

263
Q

Hyperparathyroidism increases clients risk of

A

hypercalcemia –> kidney stones, fractures

264
Q

What is lugol’s solution

A

treatment for hyperthyroidism (drink through straw 10-14 days before surgery)

265
Q

if serum calcium levels increase, PTH

A

decreases

266
Q

if serum calcium levels decrease, PTH

A

increases

267
Q

Calcitonin use

A

decrease calcium levels

268
Q

Decreased levels of estrogen put the female client at risk for

A

osteoporosis

269
Q

Kyphosis puts the patient at risk for

A

falls

270
Q

common cause of osteomyelitis

A

animal bites, open fractures

271
Q

Post-operative osteomyelitis can result from surgically implanted fixation devices. what pathogen causes this

A

MRSA

272
Q

What medications treat MRSA

A

iv vancomycin, dabtomycin, linezold

273
Q

ABX therapy for osteomyelitis may be longterm and often requires placement of

A

PICC lines

(6 weeks iv abx, then 4-6 wks oral)

274
Q

Hyperbaric oxygen therapy can be used to

A

promote wound healing in pts with osteomyelitis

275
Q

complete vs incomplete fractures

A

complete is entire width of the bone

276
Q

closed vs open/compund fractures

A

open/compund protrudes out of the skin

277
Q

Simple vs comminuted fractures

A

comminuted can have multiple fracture lines

278
Q

Displaced vs non displaced fractured

A

displaced the bone fragments do not stay in alignment

279
Q

Compression fractures are usually seen in the ___ and are most common in what population?

A

spine ; older adult

280
Q

Pathologic/spontaneous fractures are caused by

A

osteoporosis

281
Q

oblique fractures

A

break at an angle

282
Q

complications of fractures

A

DVT, fat embolism, compartment syndrome, infection

283
Q

What is the earliest sign of compartment syndrome

A

paresthesia

284
Q

What is the treatment for compartment syndrome

A

fasciotomy

285
Q

Chronic complication of fractures

A

avascular necrosis , chronic pain

286
Q

Why should NSAIDs be avoided in patients with a fracture

A

delay bone healing

287
Q

What is open reduction vs closed reduction

A

open reduction is surgically resetting, closed reduction is pulling the bones back into alignment

288
Q

Plaster casts are used less often because

A

-they take 24 hours to dry
(smell musty while drying as well)

289
Q

Fiberglass casts are more utilized because

A

-they weigh less
-dry much faster

290
Q

If someone has a wound under their cast, or still have severe swelling, what may the provider do

A

cut a window in the cast or cut the top to allow for swelling

291
Q

Patient education for casts

A

-report any tingling, cold digits, paralysis (may indicate compartment syndrome)
-do not stick things in cast

292
Q

Skeletal traction requires what to prevent infection

A

frequent pin care

293
Q

What to do if an amputaiton happens in the community

A

-assess ABC
-sterile dry gauze
-apply pressure and elevate above heart
-do not remove gauze

294
Q

Treamtent for Phantom limb pain

A

-iv calcitonin
-tens unit
-gabapentin (nerve pain)
-beta blockers (dull burning)

295
Q

How long do we elevate the stump after amputation

A

24 hours only

296
Q

Complications of amputation

A

-neuroma
-flexion contractures

297
Q

how to prevent flexion contracture

A

-do not elevate after 24 h
-ROM exercises
-turning
-lying prone
-firm patress

298
Q

Why do we do the figure 8 dressing after amputation

A

compress bottom of stump to shape it for prosthesis

299
Q

treamment for carpal tunnel

A

-wear brac
-NSAIDs
-surgery

300
Q

Treatment for sprain

A

RICE

301
Q

Hallmarkers for cystitis infection on a UA

A

-leukocyte estrerase, nitrites, WBC, RBC, casts

302
Q

Creatinine cannot be altered by other disease processes other than kidney dysfunction. T or F

A

true (why creatinine is the best indicator of kidney dysfunction)

303
Q

Education for 24 hour urine

A

-begin after your first void
-keep on ice
-get every single drop

304
Q

the bacteria that causes UTI and pyelonephritis

A

e-coli

305
Q

IF patient hasn’t voided in 6h, the nurse should

A

obtain bladder scanner

306
Q

a kidney ultrasound requires ____ ml of fluid before examination

A

500-1000

307
Q

What is a KUB

A

x-ray of kidneys, ureters, and bladder

308
Q

Which kidney diagnostic test measures for GFR

A

renal scan

309
Q

Is pink-tinged urine after cystoscopy an expected finding?

A

yes

310
Q

Patient education before and after cystoscopy

A

-npo, bowel prep before
-increase fluids after

311
Q

a voiding cystourethrography uses contrast dye to assess for

A

back flow of urine to the kidneys (takes x-ray during voids)

312
Q

After kidney biopsy, the pt must remain on strict bedrest ofr

A

2-6 hours

313
Q

Why is it important to monitor BP in someone receiving kidney bipsy

A

HTN increases risk of bleeding, complication of kidney biopsy is hemorrhage

314
Q

Sx of UTI

A

-cloudy/foul smelling urine
-frequency, urgency, burning while peeing
-pain with urination
-abdomen pain (from bladder spasms)

315
Q

number one way to prevent CAUTI

A

hand hygien

316
Q

Sx of pyelonephritis

A

-chills, fever, CVA tenderness, flank pain, nausea, vomiitng

317
Q

Complications of chronic pyelonephritis

A

-increase BUN and creatinine
-hyperkalemia
-hyponatremia

318
Q

acute glomerulonephritis is commonly caused by

A

strep infection

319
Q

Chronic glomerulonephritis symptoms

A

-HTN, fatigue, protein and blood in urine, edema, electrolyte imbalances, decreased GFR

320
Q

ABX used to treat UTI, pyelonephritis, glomerulonephritis

A

trimethoprim, trimethoprim/sulfamethoxazole, nitrofurantoin

321
Q

urinary analgesic used for UTI

A

phenazopyridine (will turn urine orange or red)

322
Q

Most common cause of renal calculi

A

dehydration

323
Q

symptoms of kidney stones

A

severe, sudden pain, flank pain, abdomen pain, urinary frequency, nausea, vomiting
-cholicky pain: comes and goes

324
Q

Patient education for lithotripsy

A

strain urine after

325
Q

Nursing interventions for nephrostomy tube

A

-drain 4-5 times a day
-change bag 3 times week
-avoid bathing, swimming pools, and hot tubs

326
Q

priority for polycystic kidney ydiseae

A

maintaining hypertension

327
Q

sx of PKD

A

-distended abdomen, abd pain, HTN, constipation,headaches, foul odor = infection, edema

328
Q

Why should we use NSAIDs cautiously in PKD?

A

reduce blood flow to kidney y

329
Q

Patients with PKD should limit

A

aspirin, protein and sodium

330
Q

pts with glomerulonephritis should restrict?

A

-sodium, water, potassium, and protein

331
Q

elevated amylase and lipase can indicate

A

acute pancreatitis

332
Q

Frequent vomiting causes what acid-base imbalance

A

alkalosis

333
Q

Frequent diarrhea causes what acid base imbalance

A

acidoss

334
Q

What is an acute ABD series

A

x-ray of the client’s chest, abdomen while supine, abdomen while sitting

335
Q

Pre and post nursing interventions for EGD and ERCP

A

pre: no NSAIDs/anticoagulants for one week, NPO
post: assess gag reflex

336
Q

Severe adverse reaction of colonoscopy

A

bowel perforation –> abdominal guarding and tenderness

337
Q

Clients may eat a soft diet a few days prior, avoid NSAIDs, take colase, and must do bowel prep for colonoscopy. T or F

A

true

338
Q

What diagnostic test is most accurate for GERD

A

pH monitoring (monitors pH level for 24-48 hours)

339
Q

Is volvulus risk low for sliding or rolling (paraesophageal) hiatal hernia

A

sliding

340
Q

What surgery can be done to treat hiatal hernia

A

Nissen fundoplication

341
Q

Pre and post nursing interventions for LNF

A

-pre: stop smoking, lose weight
-monitor NG and chest tube, eat soft diet, continue anti-reflux meds for one month

342
Q

Pre interventions for esophagectomy

A

-stop smoking 2-4 weeks before
-do pulmonary strengthening

343
Q

Why is respiratory care so important with esophagectomy

A

they are on ventilation first 16-24 h after procedure

344
Q

Are we allowed to irrigate NG tube after esophagectomy

A

NO

345
Q

Post surgical complications for esophagectomy

A

-cardiovascular (hypotension)
-wound management (prevent anastomosis)
-NG tube (no irrigation or oral care important)
-nutriton (J tube until no anastomotic leak is confirmed)

346
Q

Causes of acute gastritis

A

alcohol, caffeine, coffee

347
Q

Chronic cause of gastritis

A

h . pylori

348
Q

Will acute or chronic gastritis include symptoms of pain, dyspepsia, hematemesis, and melena?

A

acute

349
Q

Chronic gastritis does not produce symptoms until

A

ulceration occurs –> leading to N/V and pain

350
Q

Chronic gastritis leads to deficiency in what vitamin?

A

b12

351
Q

Gastritis can be treated with mucosal protectant medications such as

A

sucralfate and carolfate

352
Q

Symptoms of peptic ulcer disease

A

epigastric tenderness and pain, dyspepsia

353
Q

Ulceration of an ulcer in PUD can lead to

A

peritonitis (rigid boardlike abdomen and fever)

354
Q

What are the three types of ulcers in PUD

A

stress, gastric, duodenal

355
Q

Stress ulcers are more likely to cause

A

bleeding

356
Q

What type of peptic ulcer occurs 30-60 min after food, is rarely worsened by food ingestion, and has hematemesis?

A

gastric

357
Q

what type of peptic ulcer causes hyper secretion, is relieved by food, has melena, and occurs 1.5 hours after a meal?

A

duodenal

358
Q

Most common complications of ulcer

A

perforation, pyloric obstruction, bleeding

359
Q

What is the urease breath test?

A

-test for h.pylori, can be used to diagnose peptic ulcer disease and gastritis

360
Q

What antibiotics can be used to treat H.pylori

A

clarimycin and amoxicillin

361
Q

Early symptoms of gastric cancer

A

dyspepsia, abdominal discomfort, epigastric and back pain

362
Q

Late symptoms of gastric cancer

A

N/V, weight loss, iron deficiency anemia

363
Q

Largest complication of gastrectomy

A

dumping syndrome

364
Q

patient education on how to prevent dumping syndrome

A

avoid fluids with meals, eat high protein-high fat low carb diet, small and frequent meals

365
Q

Early sx of dumping syndrome

A

vertigo, achy, syncope, pallor, diaphoresis, desire to lay down

366
Q

Late sx of dumping syndrome

A

sx of hypoglycemia: dizziness, diaphoresis, confusion, palpitation

367
Q

Causes of mechanical obstruction

A

tumors, scarring, adhesions, volvulus

368
Q

Causes of non-mechanical obstruciton

A

decreased peristaltic functions

369
Q

Complications of small and large bowel obstruction

A

hypovolemia, acid-base imbalances, sepsis

370
Q

Why do we insert an NG tube for obstruction

A

decompression

371
Q

CRC signs and symptoms can vary based on

A

location

372
Q

symptoms of right sided CRC

A

weight loss

373
Q

symptoms of transverse colon CRC

A

dark red blood, abdominal pain, using BR more often

374
Q

Rectosigmoid colon cancer

A

-change in stool, blood

375
Q

After a colon resection, what may the patient have

A

temporary or permanent colostomy

376
Q

timeline for abdominoperineal resection

A

wound may drain for 1-2 months, complete healing does not occur for 6-8 months

377
Q

IBS diagnostic

A

hydrogen breath test

378
Q

IBS - c medications

A

psyllium hydrophilic muciloid, linaclotide

379
Q

IBS- d medications

A

loperamide antidiarrheal, psyllium, alosetron (used cautiously in women)

380
Q

A hernia is caused by

A

weakness in abdominal wall

381
Q

strangulated hernia is caused by

A

coming through bowel wall and twisting

382
Q

s/s of hemorrhoids

A

bright red blood, itching, swollen/distended veins

383
Q

untreated peritonitis can lead to

A

sepsis

384
Q

If our patient has knees flexed in a fetal position and pain relief, this is an identifier for

A

peritonitis

385
Q

Peritonitis can cause elevated ____ and ____ due to

A

BUN and creatinine ; hypovolemia

386
Q

After abx solution is irrigated into client with peritonitis, this is the priority nursing actions

A

keep them sat up to keep drains draining properly

387
Q

Order of symptoms for appendicitis

A

abdominal pain –> nausea vomiting

388
Q

What is McBurney’s point

A

where the pain of appendicitis localizes to

389
Q

Can we give a client with appendicitis laxatives or enemas

A

NO, increases risk of rupturing

390
Q

Order of symptoms for gastroenteritis

A

nausea / vomiting –> abdominal pain –> diarrhea

391
Q

Patients with gastroenteritis are very at risk for this electrolyte imbalance due to excessive diarrhea

A

hypokalemia

392
Q

Antidiarrheals should be used sparingly in gastroenteritis because

A

lomotil is habit forming, may cause toxic megacolon

393
Q

What disease produces 10-20 liquid, bloody stools a day

A

ulcerative colitis

394
Q

Why can patients with ulcerative colitis develop anemia

A

chronic bleeding from ulcers

395
Q

Which disease process causes 5-6 loose, non bloody, steatorrhea stools

A

crohns disease

396
Q

Other than abdominal pain, will ulcerative colitis cause any physical assessment abnormalities

A

no

397
Q

Albumin, hemoglobin, and hematocrit are increased or decreased in ulcerative ecolitis

A

decreased

398
Q

What diagnostic can be used for ulcerative colitis

A

MRE

399
Q

What is an MRE diagnostic test

A

NPO 4-6 hours before, glucagon subcutaenous injection administered, allows for bowel to tbe seen

400
Q

Diagnostic test to show ulcerative colitis vs crohn’s

A

contrast via barium enema

401
Q

Medications for ulcerative colitis and crohns disease

A

aminosalicylate: sulfasalazine, mesalamine
Glucocorticoids: prednisone
Antidiarrheals: loperamide (Immodium), diphenoxylate hydrochloride, atropine sulfate (Lomotil)
Immunomodulators: adalimumab

402
Q

Client educations for adalimumab

A

avoid large crowds / infected people

403
Q

What foods should a client with ulcerative colitis avoid

A

corn, pepper, carbonation, smoking, nuts

404
Q

Two common problems for Crohn’s disease

A

malabsorption, fustila formation

405
Q

Folic acid and b12 will be high or low in crohns disease

A

low –> pernicious anemia

406
Q

Why is nutritions os important with crohns disease

A

-heals promote healing of fistulas

407
Q

can we give enemas to people with diverticulitis

A

no (may cause perforation and peritontonitis)

408
Q
A

NRSE-3540 Adult Care 1 (5 decks)

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