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MedSurg > Final Exam: SG Material 2 > Flashcards

Final Exam: SG Material 2 Flashcards

1
Q

Intermediate Insulin

  • brand name
  • peak
  • duration
  • onset
  • what other insulin can it be administered with?
A
  • NPH
  • peak: 4-12 hrs
  • duration: 18-24 hrs
  • onset: 1-2 hrs
  • regular or rapid acting
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2
Q

Long-acting insulin

  • brand name
  • peak
  • duration
  • onset
  • when to administer subcutaneous injection?
A
  • Glargine
  • NO peak
  • duration: 24 hrs
  • onset: 1-2 hrs
  • administered at bedtime or early in the morning
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3
Q

Rapid-acting insulin

  • brand name
  • peak
  • duration
  • onset
  • when to have a meal?
A
  • Lispro
  • peak: 1-2 hrs
  • duration: 4-6 hrs
  • onset: 5-15 mins
  • should have food within 5-15 mins after administration
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4
Q

Short-acting insulin

  • brand name
  • peak
  • duration
  • onset
  • when to have a meal?
A
  • Regular
  • peak: 1.5 hrs
  • duration: 6-8 hrs
  • onset: 30 mins - 1 hr
  • should have a meal within 1 hr
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5
Q

What test is used to test adherence in diabetic patients?

A

Hemoglobin A1C (ideal: less than 7%)

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6
Q

S/S of hypoglycemia (4) “DISH”

A

diaphoresis, irritability, shakiness, hunger

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7
Q

DKA occurs in? Indicated by?

A

DM1; indicated by ketones in the urine

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8
Q

Hyperosmolar hypoglycemic (HHS) requires similar treatment to DKA including? (4)

A
  • normal saline
  • insulin drip
  • electrolyte monitor
  • check mental status
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9
Q

Types of angina? (2)

A

stable: stopping activity and rest can alleviate pain
unstable: cannot be relieved with nitroglycerin, has a possibility of turning into an MI (happens spontaneously)

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10
Q

Patient teaching for nitroglycerin (3)

A
  • vasodilator: take while sitting or standing to prevent dizziness (orthostatic hypotension)
  • max of 3 doses, one every 5 mins if pain does not subside after 3rd dose, call 911
  • take under the tongue, do not chew or swallow
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11
Q

Patient teaching for hypertension (2)

A
  • sodium restriction (2 g/day)

- teach the patient to self-record BP

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12
Q

Hypertension and diabetes are associated with what disease process?

A

Chronic kidney disease

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13
Q

Preventions for DVT? (4)

A
  • SCD device on AT ALL TIMES
  • compression stockings
  • ambulation
  • prophylactic blood thinners
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14
Q

Lab monitoring for warfarin/coumadin (anticoagulant) (2)

A
  • PT (normal = 10-13 seconds)

- INR (normal = 2-3)

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15
Q

Lab monitoring for heparin?

A

aPTT

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16
Q

If a patient’s control is 30 and their aPTT result is 45, is their dose within therapeutic levels? What does it mean if they are below range?

A

(find the range by x 1.5 and 2 to the control)
range = 45-60 = within therapeutic range

below range = subtherapeutic

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17
Q

DVT is most common in which patients?

A

Periop patients

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18
Q

RSHF systemic s/s? (4)

A
  • JVD
  • hepatomegaly
  • splenomegaly
  • peripheral edema
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19
Q

LSHF respiratory s/s (4)

A
  • dyspnea
  • SOB
  • crackles in lungs
  • feelings “drowning” at night (unable to breath when lying down flat)
20
Q

Medication treatment for CHF? (2)

A
  • Lasix

- Digoxin

21
Q

Patient teaching for digoxin (2)

A
  • assess apical pulse, hold if less than 60

- s/s of digitalis toxicity: visual halos, nausea, vomiting, diarrhea, headaches

22
Q

Patient teaching for Lasix (2)

A
  • assess electrolytes (esp potassium; normal = 3.5-5)

- assess BP (hold if hypotensive)

23
Q

Congestive heart failure can cause?

A

LOC changes due to oxygenation and perfusion deficiency

24
Q

Diet for patients with kidney failure?

A
  • low sodium and low potassium renal diet
25
Q

End-stage renal disease can cause issues in?

A

mental status / changes in LOC

26
Q

Which dietary selection should lead the nurse to conclude that the dietary teaching is successful for a patient on a low-sodium diet?

A

Baked chicken, white rice, apple juice

27
Q

When should we anticipate the HCP ordering an anticoagulant?

A

To decrease or prevent clotting (eg: DVT)

28
Q

If a clot breaks in the left leg, where is it most likely to travel to?

A

To the lungs

29
Q

If a clot forms in the atrium from atrial defibrillation, it is most likely to travel to which organ?

A

The brain

30
Q

Antiplatelet vs anticoagulant

A

Antiplatelet: keeps platelets from sticking together (eg: aspirin, clopidogrel)
Anticoagulant: works on the coagulation cascade (eg: warfarin, heparin)

31
Q

Common side effect of aspirin?

A

GI bleed

32
Q

What is the onset of warfarin?

A

3-4 days (risk for DVT enlargement)

33
Q

What are the two types of heparin?

A

Unfractionated and LMW

Low-molecular-weight: Lovenox, can be used as a preventative measure for patients who are immobile for long periods of time; has a FASTER onset

34
Q

Heparin is measured in?

A

units

35
Q

A nursing student who is preparing to care for a postop patient with DVT asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct?

A

Warfarin has a delayed 3-4 day onset

36
Q

A 50 yr old female patient asks the nurse about taking aspirin to prevent heart disease. The patient does not have a hx of MI. Her cholesterol and BP are normal and she does not smoke. What will the nurse tell the patient?

A

There is most likely no protective benefit for patients of her age

37
Q

A patient who is taking clopidogrel (Plavix) calls the nurse to report black, tarry stools and coffee-ground emesis. the nurse will tell the patient to?

A

Continue taking the clopidogrel until talking to the provider

38
Q

A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient?

A

Anticoagulants (eg: heparin, abciximab (ReoPro); antiplatelets would not be strong enough

39
Q

A postop patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication?

A

Warmth to the touch, swelling are indications of DVT. Will anticipate administering an anticoagulant like enoxaparin (lovenox)

40
Q

A patient who is taking warfarin (coumadin) has just vomited blood. The nurse notifies the provider who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer?

A

Vitamin K (antidote for warfarin)

41
Q

A patient is receiving heparin post-op to prevent DVT. The nurse notes that the patient has a BP of 90/50, HR of 98. The patient’s most recent aPTT is greater than 90 seconds. The nurse reports lumbar pain. What should the nurse request to put an order for?

A

Protamine sulfate (antidote for heparin)

normal aPTT = 60-80 seconds

42
Q

Which vital sign should be taken for a patient with a gastroesophageal balloon in place?

A

Respiratory rate

43
Q

Aldosterone regulates? (2)

A
  • fluid volume

- sodium

44
Q

RAAS

A

renin aldosterone angiotensin system

45
Q

Describe the steps of RAAS in response to low BP (5)

A
  1. low BP is sensed by baroreceptors
  2. kidneys release renin
  3. renin secretes aldosterone
  4. aldosterone secretes angiotensin 1
  5. angiotensin-converting enzyme converts angiotensin 1 to 2 (potent vasodilator, culprit for increasing BP)
46
Q

ACE inhibitors end in? Effects?

A

-pril; decreases BP

47
Q

Patient teaching for ACE inhibitor medications? (3)

A
  • change positions slowly when sitting to standing (orthostatic hypotension)
  • should take the first dose when sitting down (can have first dose hypotension)
  • ACE non-prod cough can cause patient to stop adherence to medication

MedSurg (16 decks)

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