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NCLEX > Med-Surg > Flashcards

Med-Surg Flashcards

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1
Q

Addison Crisis

-manifestations-

A
  • Hypotension and tachycardia
  • Dehydration
  • Hyperkalemia and hyponatremia
  • Hypoglycemia
  • Fever
  • Weakness and confusion
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2
Q

Skin cancer screening

A-E

A

A - Asymmetry (eg, one half unlike the other)
B - Border irregularity (eg, notched or irregular edges)
C - Color changes and variation (eg, new blue or black pigmentation) (Option 1)
D - Diameter of 6 mm or larger (approximately the size of a pencil eraser)
E - Evolving (eg, changes in shape, size, and color)

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3
Q

Metabolic acidosis
(ex. of causes)
(5)

A

1) GI bicarbonate losses (eg, diarrhea)
2) Ketoacidosis (eg, diabetes, alcoholism, starvation)
3) Lactic acidosis (eg, sepsis, hypoperfusion)
4) Renal failure (eg, hemodialysis with inaccessible arteriovenous shunt)
5) Salicylate toxicity

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4
Q

Respiratory alkalosis

ex. of causes

A

Anxiety attack leading to hyperventilation

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5
Q

Metabolic alkalosis

ex. of causes

A

Excessive vomiting

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6
Q

Pertussis precautions

whooping cough

A

Droplet

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7
Q

Bell’s Palsy

A

facial paralysis, usually on one side

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8
Q

Respiratory acidosis

-treatment-

A

1) Positive pressure ventilation (Bi-PAP)
2) Meds to open airway
3) Mechanical ventilation

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9
Q

Chronic Kidney Disease

-allowable foods-

A

1) Apples
2) Pears
3) Grapes
4) Pineapple
5) Blackberries and blueberries
6) Plums

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10
Q

Treatment of Alcohol intoxication

A

Thiamine before or with IV glucose

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11
Q

Spleen

-function of organ-

A

Immune system

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12
Q

Hypertensive crisis

-BP level-

A

Systolic = >180

Diastolic = >120

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13
Q

Contraindicated medication with coronary artery disease

A

NSAIDs

ex. Ibuprofen, Naproxen

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14
Q

Antihypertensives (6)

A
  1. ACE inhibitors
  2. ARBS
  3. Calcium channel blockers
  4. Alpha adrenergic blockers
  5. Beta blockers
  6. Vasodilators
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15
Q

Cardiac Glycoside (med)

A

Digoxin

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16
Q

Cardiac Glycoside (def)

A

increase force and velocity of myocardial contractions to improve stroke volume and cardiac output and slow conduction rate to increase ventricular filling

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17
Q

Antianginal (def)

A

Nitroglycerin

use of nitrates, beta blockers, and calcium channel blockers to treat pain related to imbalances between myocardial O2 supply and demand

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18
Q

Risk with Propranolol

A

mask effect of hypoglycemia

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19
Q

Risk with Labetalol

A

Do no infuse in same IV with furosemide

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20
Q

Risk with ACE and ARBs

A

Hyperkalemia

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21
Q

Risk with loop diuretics

A

Hypokalemia

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22
Q

Transplants = (2)

A

1) Immunosuppression drugs

2) Risk of death from infection

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23
Q

Cardiac tamponade

A

Too much fluid collects in the pericardium (the sac around your heart). The fluid puts pressure on heart making it difficult for heart to pump. Cardiac tamponade can be life-threatening.

S/Sx

  • Chest pain
  • Shortness of breath
  • Pounding or racing heartbeat
  • Bulging veins in your neck, head, or temples
  • Weakness, lightheadedness, or fainting
  • Nausea or abdominal pain
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24
Q

Valsalva maneuver

-treats-

A

Supraventricular tachycardia

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25
Q

Intussusception

A

intestinal obstruction when a segment of the bowel folds (ie, telescopes) into another segment causing ischemia and leakage of blood and mucus

mostly occurs in children

assessment could show sausage-shaped abdominal mass

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26
Q

Duchenne muscular dystrophy

-pediatrics-

A

characterized by progressive replacement of muscle tissue with connective tissue.

Signs include Gower sign/maneuver (placing hands on the thighs to push up to stand), enlarged calves, walking on tiptoes, and frequent tripping/falling.

27
Q

Pyloric stenosis

1) Definition
2) S/Sx (3)

A

Overly thickened pyloric muscle (base of stomach before small intestines).

Causes postprandial projectile vomiting secondary to an obstruction at the gastric outlet.

S/Sx
1) Olive-shaped mass in epigastric area just to the right of the umbilicus.

2) Nonbilious emesis
3) Progressive dehydration

28
Q

Cancer warning signs

CAUTION

A
  • Change in bowel or bladder habits
  • A sore that does not heal
  • Unusual bleeding or discharge from a body orifice
  • Thickening or a lump in the breast or elsewhere
  • Indigestion or difficulty in swallowing that does not go away
  • Obvious change in a wart or mole
  • Nagging cough or hoarseness
29
Q

Fluid for burns

A

Lactated Ringers

30
Q

Pulmonary embolism

-risk factors and examples-

A

1) Venous stasis
2) Hypercoagulability of blood
3) Endothelial damage
4) Inactivity/immobility
- after C-section

31
Q

Seizure phases

A

1) Prodromal phase - period with warning signs that precede the seizure
2) Aural phase - period before the seizure when the client may experience visual or other sensory changes.
3) Ictal phase - period of active seizure activity
4) Postictal phase - period of recovery when client may experience confusion, or headache.

32
Q

Bacterial meningitis

1) Description
2) S/Sx in children

A

1) inflammation of the meninges in the brain and spinal cord caused by specific types of bacteria, including group B streptococcal, meningococcal, or pneumococcal pathogens.

2) S/Sx
- Fever or possible hypothermia
- Irritability
- Frequent seizures
- High-pitched cry
- Poor feeding and vomiting
- Nuchal rigidity
- Bulging fontanelles

33
Q

Amyotrophic lateral sclerosis

-Lou Gehrig disease-

A

Neurological motor neuron degeneration that leads to:

1) progressive muscle weakness
2) twitching and muscle spasms
3) difficulty swallowing
4) difficulty speaking
5) respiratory failure

There is no cure. Treatment focuses on symptom management.

34
Q

Concussion

-expected neurological changes-

A

1) brief loss of consciousness
2) retrograde amnesia
3) headache

Clients should be observed closely by family members and not participate in strenuous or athletic activities for 1–2 days.

35
Q

Hypomagnesemia

-S/Sx-

A

Often associated with alcohol abuse due to poor absorption, inadequate nutritional intake, and increased losses via the gastrointestinal and renal systems.

1) Ventricular arrhythmias (torsades de pointes): most serious priority
2) Neuromuscular excitability: tremors, hyperactive reflexes, positive Trousseau and Chvostek signs, and seizures.

36
Q

Hypercalcemia

-S/Sx-

A

1) Constipation and polyuria: Calcium has a diuretic effect

2) positive Trousseau and Chvostek signs

37
Q

Hypernatremia

-S/Sx-

A

Increased thirst with dry mucous membranes

38
Q

Hypokalemia

-S/Sx-

A

1) Serious complication is cardiac arrhythmias
2) Muscle weakness/paralysis
3) Soft, flabby muscles
4) Paralytic ileus: abdominal distension, decreased bowel sounds

39
Q

Trousseau sign - positive

A

Contraction of hand and fingers when BP cuff is inflated

40
Q

Chvostek signs - positive

A

Contraction of the muscle near lip when facial nerve, by ear, is tapped

41
Q

Eclampsia (HELLP)

-S/Sx-

A

Hemolysis

Elevated Liver enzymes

Low Platelets

42
Q

Manifestations of nephrotic syndrome (4)

A

1) Massive proteinuria – caused by increased glomerular permeability
2) Hypoalbuminemia – resulting from excess protein loss in the urine
3) Edema – specifically periorbital and peripheral edema and ascites; caused by low serum protein and albumin as fluid is pulled into interstitial spaces and body cavities
4) Hyperlipidemia – related to increased compensatory protein and lipid production by the liver

43
Q

Histrionic personality disorder (4)

A

1) Self-dramatizing, exaggerated or shallow emotional expression
2) Attention-seeking, needs to be the center of attention
3) Overly friendly and seductive, attempts to keep others engaged
4) Demands immediate gratification and has little tolerance for frustration

44
Q

Schizoid personality disorder

A

1) exhibit social detachment
2) inability to express emotion
3) do not enjoy close relationships and prefer to be aloof and isolated

45
Q

Antisocial personality disorder (3)

A

1) pattern of disregard for and violation of the rights of others
2) manipulate others for personal gain
3) lack empathy

46
Q

Major predisposing factors for the development of delirium in hospitalized clients (9)

A

1) Advanced age
2) Underlying neurodegenerative disease (stroke, dementia)
3) Polypharmacy
4) Coexisting medical conditions (eg, infection)
5) Acid-base/arterial blood gas imbalances (eg, acidosis, hypercarbia, hypoxemia)
6) Metabolic and electrolyte disturbances
7) Impaired mobility - early ambulation prevents delirium
8) Surgery (postoperative setting)
9) Untreated pain and inadequate analgesia

47
Q

Hyperosmolar hyperglycemic

A

a serious complication usually associated with type 2 diabetes.

With this condition, clients are able to produce enough insulin to prevent diabetic ketoacidosis but not enough to prevent extreme hyperglycemia, osmotic diuresis, and extracellular fluid deficit.

Some insulin is produced, blood glucose rises slowly and symptoms may not be recognized until hyperglycemia is extreme, often >600 mg/dL (33.3 mmol/L).

This eventually causes neurological manifestations such as blurry vision, lethargy, obtundation, and progression to coma.

Because some insulin is present, symptoms associated with ketones and acidosis, such as Kussmaul respirations (hyperventilation) and abdominal pain, are typically absent.

48
Q

Kussmaul respirations

A

deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis but also kidney failure.

It is a form of hyperventilation

49
Q

ABG results for over-sedation, sleep apnea, anesthesia, drug overdose, progressive neuromuscular disease, chronic obstructive pulmonary disease, and excessive alcohol ingestion with use of benzodiazepine alprazolam

A

Respiratory acidosis

Respiratory depression, leading to alveolar hypoventilation secondary to carbon dioxide retention, and respiratory acidosis.

Therefore, clients should be advised not to take multiple substances that increase the risk of respiratory depression (eg, opioids, benzodiazepines, alcohol, sedating antihistamines).

50
Q

ABG results for diarrhea, ketoacidosis, lactic acidosis, and renal failure

A

Metabolic acidosis

due to loss of bicarbonate or retention of acids; the lungs would compensate by hyperventilating.

51
Q

ABG results for vomiting, gastrointestinal suction, and administration of alkali (ie, sodium bicarbonate)

A

Metabolic alkalosis

lungs would compensate by hypoventilating.

52
Q

ABG results for hypoxia, anxiety, and pain

A

Respiratory alkalosis

due to alveolar hyperventilation (rapid breathing).

53
Q

Refeeding syndrome (PPM)

A

Potentially lethal complication of nutritional replenishment in significantly malnourished clients and can occur with oral, enteral, or parenteral feedings.

After a period of starvation, carbohydrate-rich nutrition (glucose) stimulates insulin production along with a shift of electrolytes from the blood into tissue cells for anabolism. The key signs of refeeding syndrome are rapid declines in phosphorous, potassium, and/or magnesium (mnemonic PPM). Other findings may include fluid overload, sodium retention, hyperglycemia, and thiamine deficiency.

54
Q

Compensation for metabolic acidosis

A

Respiratory alkalosis is the body’s natural compensation for metabolic acidosis. It is achieved by blowing more CO2 off from the system through rapid breathing.

55
Q

Meningococcal meningitis interventions

A

1) Droplet isolation precautions
2) Seizure precautions
3) Reduced stimulus environment
4) Bed rest with the head of the bed elevated between 10-30 degrees.

56
Q

Ventricular septal defect

-heart sound-

A

harsh systolic murmur is heard

Ventricular septal defect is an opening between the ventricles of the heart. Ventricular septal defect is an acyanotic defect.

57
Q

Mitral stenosis and aortic regurgitation

-heart sound-

A

Diastolic murmur is heard in mitral stenosis and aortic regurgitation

58
Q

Pulmonic stenosis

-heart sound-

A

Systolic ejection murmur is heard in pulmonic stenosis. Right ventricular hypertrophy will develop if this defect is not repaired. In adults, systolic ejection murmur is usually due to aortic stenosis.

59
Q

Patent ductus arteriosus

-heart sound-

A

If the ductus arteriosus remains open, blood will shunt from the aorta to the pulmonary arteries. The child will be acyanotic but will have a machine-like murmur heard on both systole and diastole.

60
Q

Breakdown of RBC creates…

A

Bilirubin

61
Q

EKG for Hyperkalemia

A

ST elevation

62
Q

Hypernatremia

-S/Sx (3)-

A

1) Swollen, dry tongue (red/beefy)
2) Nausea, vomiting
3) Increased muscle tone

63
Q

Acute asthma attack (AIM)

-meds-

A

1) Albuterol
2) Ipratropium
3) Methel-predniso-lone

64
Q

Meds not to mix with asthma (2)

A

1) Beta blockers

2) NSAIDs

NCLEX (6 decks)

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