Milestone 2 Retake

Question 1

Diabetes Insipidus

causes

s/s: urine osmolarity, K, Na, urine soecific gravity (nml)

tx: med

testing

Answer 1

● Causes:
○ Insufficiency of ADH or loss of sensitivity in nephrons circulating ADH
○ Head Trauma, Brain Tumor, Brain Surgery, CNS Infection
● Signs/Symptoms:
○ Peeing non-stop, crystal clear, cannot have concentrated urine
○ Low urine osmolarity (concentration)
○ Serum Osmolality High
○ Hypokalemia & Hypernatremia
○ Polyuria & Polydipsia
○ 1.001-1.005 Urine Specific Gravity (normal for them)
● Treatment:
○ Desmopressin (replaces ADH)
● Testing:
○ Fluid Deprivation Test (withhold fluid for

Question 2

cushing’s syndrome

causes

s/s

Answer 2

● High Cortisol
● Causes:
○ Taking lifelong steroids (prednisone)
○ Pituitary Tumor (over production of ACTH by pituitary which stimulates adrenal
gland to produce Cortisol)
● Signs/Symptoms:
○ Moon Face & Buffalo Hump
○ Central Obesity (thin extremities)
○ Thin Fragile Skin, Easily Bruised, Abdominal Stretch Marks
○ Acne
○ Hirsutism
○ Hypertension & Hyperglycemia
○ Infertility

Question 3

Addison’s Disease & Blood Sugar

Answer 3

● Hypoglycemia

Question 4

Dialysis & Hypertension & Edema

purpose. of dialysis

Answer 4

● Acute or urgent dialysis is indicated when there is a high and increasing level of serum
potassium, fluid overload, or impending pulmonary edema, increasing acidosis,
pericarditis, and advanced uremia.

It may also be used to remove medications or toxins
(poisoning or medication overdose) from the blood

or for edema that does not respond
to other treatment, hepatic coma, hyperkalemia, hypercalcemia, hypertension, and
uremia.

Question 5

Chronic kidney disease & metabolic acidosis

Answer 5

● Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete
increased loads of acid. Decreased acid secretion results from the inability of
the kidney tubules to excrete ammonia (NH3−) and to reabsorb sodium
bicarbonate (HCO3−). There is also decreased excretion of phosphates and
other organic acids.

Question 6

Acute Renal Failure Priority

Answer 6

● Fluid & Electrolyte Imbalances

Question 7

What drug is used to treat ascites in cirrhosis?

Answer 7

● Spirolactone

Question 8

Acute Pancreatitis Symptoms

Answer 8

● Severe midepigastric pain. Pain is frequently acute in onset, occurring 24 to 48 hours
after a very heavy meal or alcohol ingestion, and it may be diffuse and difficult to
localize. It is generally more severe after meals and is unrelieved by antacids.

Question 9

ARDS Symptoms

Answer 9

● Initially, ARDS closely resembles severe pulmonary edema. The acute phase of ARDS is
marked by a rapid onset of severe dyspnea that usually occurs less than 72 hours after
the precipitating event. Arterial hypoxemia that does not respond to supplemental
oxygen is characteristic.

Question 10

Nonrebreather mask
Respiratory Acidosis

Answer 10

● pH less than 7.35 PaCo2 over 45
● Low pH and High CO2
● Chronic respiratory acidosis occurs with pulmonary diseases such as chronic
emphysema and bronchitis, obstructive sleep apnea, and obesity.

Question 11

Pulmonary Edema Action

Answer 11

● Clinical management of a patient with acute pulmonary edema due to left ventricular
failure is directed toward reducing volume overload, improving ventricular function, and
increasing oxygenation. These goals are accomplished through a combination of oxygen
and ventilatory support, IV medication, and nursing assessment and interventions.

Question 12

Assessment of Cardiomyopathy

Answer 12

● Vital signs
● Calculation of pulse pressure and identification of pulsus paradoxus
● Current weight and any weight gain or loss
● Detection by palpation of the point of maximal impulse, often shifted to the left
● Cardiac auscultation for a systolic murmur and S3 and S4 heart sounds
● Pulmonary auscultation for crackles
● Measurement of jugular vein distention
● Assessment of edema and its severity
● Improve cardiac output & peripheral blood flow
● Increase activity tolerance and improve gas exchange

Question 13

Hydrocephalus Treatment

Answer 13

● Hydrocephalus must be identified early. Treatment needs to be initiated in order to
prevent brain tissue damage that can result from the increased ICP that hydrocephalus
creates. Specific treatment will depend on the underlying etiology.

Question 14

What is Hydrocephalus:

Answer 14

● CSF is formed primarily in the ventricular system by the choroid plexus. It flows because
of the pressure gradient that exists between the ventricular system and the venous
channels. CSF is absorbed primarily by the arachnoid villi. Hydrocephalus results when
there is an obstruction in the ventricular system or obliteration or malfunction of the
arachnoid villi.

Question 15

Febrile Seizure Teaching

Answer 15

● Provide parental support and education regarding febrile seizures. Reassure parents of
the benign nature of febrile seizures. Counsel parents on controlling fever, discuss how
to keep a child safe during a seizure, and provide instruction and demonstration in the
administration of rectal diazepam at the onset of a seizure (if applicable). Instruct
parents when to call their physician or nurse practitioner and when to take their child to
the emergency room. Reinforce that any recurrent seizure activity will require prompt
medical attention.

Question 16

SCFE Surgery

Answer 16

● Surgical intervention may include in situ pinning, in which a pin or screw is inserted
percutaneously into the femoral head to hold it in place. After in situ pinning, assist the
child with crutch walking. Teach the family that weight bearing is usually resumed about
a week after the surgery and that the pin will be removed later
Slipped femoral capital epiphysis (SCFE)
● SCFE is a condition in which the femoral head dislocates from the neck and shaft of the
femur at the level of the epiphyseal plate. The epiphysis slips downward and backward.
The left hip is more often affected
● In acute SCFE, the pain is usually sudden in onset and results in inability to bear weight.
Chronic SCFE may present with an insidious onset of pain and limp.
● Do not attempt to perform passive range of motion to determine the extent of limitation in
the child with SCFE; this may cause worsening of the condition.

Question 17

Nursing Management Muscular Dystrophy

Answer 17

● There is no cure for Duchenne muscular dystrophy. However, the use of corticosteroids
may slow the progression of the disease. Calcium supplements and vitamin D are
prescribed to prevent osteoporosis, and antidepressants may be helpful when
depression occurs related to the chronicity of the disease and/or as an effect of
corticosteroid use. Medications to decrease the workload of the heart, such as betablockers
and ACE inhibitors may be prescribed.
● Nursing focus on promoting mobility (Encourage at least minimal weight bearing in a
standing position to promote improved circulation, healthier bones, and a straight spine)
and cardiopulmonary function

Question 18

Muscular Dystrophy: What is it

Answer 18

● Muscular dystrophy refers to a group of inherited conditions that result in progressive
muscle weakness and wasting. The muscles affected are primarily the skeletal
(voluntary) muscles
● Duchenne muscular dystrophy, the most common neuromuscular disorder of childhood,
results in a shortened life expectancy.

Question 19

Hemophilia Safety

Answer 19

● The primary goal of managing hemophilia is to prevent bleeding. This is best
accomplished by instructing the child to avoid activities with a high potential for injury
(e.g., football, riding motorcycles, skateboarding). Instead, encourage the child to
participate in activities with the least amount of contact (e.g., swimming, running, tennis)

Question 20

First Sign Sickle Cell Crisis

Answer 20

● Sickling may be triggered by any stress or traumatic event, such as infection, fever,
dehydration, physical exertion, excessive cold exposure, or hypoxia
● Immediately report symmetric swelling of the hands and feet in the infant or toddler

Question 21

Diarrhea Diet

Answer 21

● Avoid fluids high in glucose, such as fruit juice, gelatin, and soda, which may worsen
diarrhea
● Chronic diarrhea is often a result of excessive intake of formula, water, or fruit juice, so
teach the parents about appropriate fluid intake
● Google:
● Here’s another bit of good advice from Mom for treating diarrhea - eat the BRAT diet:
bananas, rice (white), applesauce and toast. When your health is good, physicians
usually recommend whole-grain, high-fiber foods. But high-fiber foods could spell trouble
when you have diarrhea

Question 22

Intussusception

Answer 22

● Intussusception is a process that occurs when a proximal segment of bowel “telescopes”
into a more distal segment, causing edema, vascular compromise, and, ultimately,
partial or total bowel obstruction. A barium enema is successful at reducing a large
percentage of intussusception cases; other cases are reduced surgically.

Question 23

Symptoms of Pyloric Stenosis

Answer 23

● Forceful, non bilious vomiting, unrelated to feeding position
● Hunger soon after vomiting episode
● Weight loss due to vomiting
● Progressive dehydration with subsequent lethargy

Question 24

Complications of Tetralogy of Fallot

Answer 24

● From Google:
● Blood clots (which may be in the brain causing stroke)
● Infection in the lining of the heart and heart valves (bacterial endocarditis)
● Abnormal heart rhythms (arrhythmias)
● Heart failure.
● Death.

Question 25

Cystic Fibrosis Management

Answer 25

● Therapeutic management of cystic fibrosis is aimed toward minimizing pulmonary
complications, maximizing lung function, preventing infection, and facilitating growth.
● Provide CPT, use of the vest airway clearance system, use of the flutter-valve devise,
and/or positive expiratory pressure therapy in order to clear secretions and maintain
airway patency. For children with cystic fibrosis, CPT is a critical intervention.
● Administer pancreatic enzyme supplements (pancrelipase [Creon, Pancreaze, Zenpep])
must be administered with all meals and snacks to promote adequate digestion and
absorption of nutrients
● Prevent Infection

Question 26

Boggy Uterus Action

Answer 26

● Massage the boggy uterus to stimulate contractions and expression of any accumulated
blood clots while supporting the lower uterine segment

Question 27

Shoulder Dystocia Action

Answer 27

● McRoberts Manuver and Superpubic Pressure
● From Google:
● The technique is performed by flexing the mother’s thighs toward her shoulders while
she is lying on her back. No specific degree of elevation or flexion of the patient’s legs
has been defined for the McRoberts maneuver.
Umbilical Cord Prolapse Action
● Umbilical cord prolapse is a rare obstetric emergency that occurs when the cord
precedes the fetus out
● Typically, the examiner places a sterile gloved hand into the vagina and holds the
presenting part off the umbilical cord until delivery. Changing the woman’s position to a
modified Sims, Trendelenburg, or knee-chest position also helps relieve cord pressure.
Do not attempt to replace the cord in the uterus. Monitor FHR, maintain bed rest, and
administer oxygen if ordered.

Question 28

Placenta Abruption

Answer 28

● Separation of the placenta from the uterine wall
● Emergency measures include starting two large-bore IV lines with normal saline or
lactated Ringer’s solution to combat hypovolemia, obtaining blood specimens for
evaluating hemodynamic status values and for typing and cross-matching, and
frequently monitoring fetal and maternal well-being
● Classic manifestations of abruptio placentae include painful, dark-red vaginal bleeding
(port-wine color) because the bleeding comes from the clot that was formed behind the
placenta; “knife-like” abdominal pain; uterine tenderness; contractions; and decreased
fetal movement. Rapid assessment is essential to ensure prompt, effective interventions
to prevent maternal and fetal morbidity and mortality
● Depending on severity the women can be monitored through a vaginal birth but if it is a
risk they will do c-section

Question 29

Alcohol Withdrawal Timing

Answer 29

● Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction
of alcohol intake
● Alcohol withdrawal usually peaks on the second day and is over in about 5 days. This
can vary, however, and withdrawal may take 1 to 2 weeks.
Alcohol Withdrawl Medications
● Safe withdrawal is usually accomplished with the administration of benzodiazepines,
such as lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), to
suppress the withdrawal symptoms

Question 30

Alcohol Withdrawal Symptoms

Answer 30

● Symptoms include coarse hand tremors, sweating, elevated pulse and blood pressure,
insomnia, anxiety, and nausea or vomiting. Severe or untreated withdrawal may
progress to transient hallucinations, seizures, or delirium, called delirium tremens.

Question 31

Inflammatory Bowel Disease & Peritonitis

Answer 31

● From Google:
● Long-term inflammation and ulcers in the colon can weaken the intestinal wall. Over
time, these weaknesses may develop into a perforation. A perforation can allow bacteria
and other intestinal contents to leak out into the abdomen, causing a serious condition
called peritonitis.

Question 32

COPD Exacerbation Treatment

Answer 32

● When the patient arrives in an ED, the first line of treatment is supplemental oxygen
therapy and rapid assessment to determine if the exacerbation is life-threatening. A
short-acting inhaled bronchodilator may be used to assess response to treatment. Oral
or intravenous (IV) corticosteroids, in addition to bronchodilators, are recommended in
the hospital management of a COPD exacerbation. Antibiotics also benefit patients with
COPD because bacterial infections often follow viral infections.

Question 33

COPD Treatment

Answer 33

● Therapeutic strategies for the patient with COPD include promoting smoking cessation
as appropriate, prescribing medications that typically include bronchodilators and may
include corticosteroids, managing exacerbations, and providing supplemental oxygen
therapy as indicated

Question 34

COPD & Oxygen

Answer 34

● Long-term oxygen therapy (more than 15 hours per day) has also been shown to
improve quality of life, reduce pulmonary arterial pressure and dyspnea, and improve
survival. Long-term oxygen therapy is usually introduced in very severe COPD, and
indications generally include a PaO2 of 55 mm Hg or less or evidence of tissue hypoxia
and organ damage such as cor pulmonale, secondary polycythemia, edema from rightsided
heart failure, or impaired mental status.
● Although the hypoxic drive is often cited as a concern in administering supplemental
oxygen to patients with COPD, in actuality it is a very small part of the overall stimulus
driving the respiratory system

Question 35

COPD & Oxygen Goal

Answer 35

● The goal of supplemental oxygen therapy is to increase the baseline resting partial
pressure of arterial oxygen (PaO2) to at least 60 mm Hg at sea level and an arterial
oxygen saturation (SaO2) to at least 90%

Question 36

Ulcerative Colitis Diarrhea

Answer 36

● The nurse assists the patient in determining if there is a relationship between diarrhea
and certain foods, activities, or emotional stressors. Identifying precipitating factors, the
frequency of bowel movements, and the character, consistency, and amount of stool
passed is important. The nurse provides ready access to a bathroom, commode, or
bedpan and keeps the environment clean and odor-free. It is important to administer
antidiarrheal medications as prescribed. Loperamide may be prescribed 30 minutes
before meals (see previous discussion on interventions for diarrhea). The nurse should
record the frequency and consistency of stools after therapy is initiated.

Question 37

GERD Teachings

Answer 37

● Management begins with educating the patient to avoid situations that decrease lower
esophageal sphincter pressure or cause esophageal irritation. The patient is instructed
to eat a low-fat diet; avoid caffeine, tobacco, beer, milk, foods containing peppermint or
spearmint, and carbonated beverages; avoid eating or drinking 2 hours before bedtime;
maintain normal body weight; avoid tight-fitting clothes; and elevate the head of the bed
by at least 30 degrees

Question 38

Small Bowel Obstruction Actions

Answer 38

● Decompression of the bowel through an NG tube is necessary for all patients with small
bowel obstruction; this may be tried for up to 3 days for patients with partial obstructions;
resting the bowel in this manner can result in resolution of the obstruction. Nursing
management of the patient with a small bowel obstruction who does not require surgery
includes maintaining the function of the NG tube, assessing and measuring the NG
output, assessing for fluid and electrolyte imbalance, monitoring nutritional status, and
assessing for manifestations consistent with resolution (e.g., return of normal bowel
sounds, decreased abdominal distention, subjective improvement in abdominal pain and
tenderness, passage of flatus or stool). Maintaining fluid and electrolyte balance is a
priority area to monitor in the patient with a small bowel obstruction. The presence of the
NG tube in conjunction with the patient’s nothing-by-mouth (NPO) status places the
patient at significant risk of fluid imbalance. Thus, measures to promote fluid balance are
critically important.
● The nurse reports discrepancies in I&O, worsening of pain or abdominal distention, and
increased NG output. If the patient’s condition does not improve, the nurse prepares him
or her for surgery. Nursing care of the patient after surgical repair of a small bowel
obstruction is similar to that for other abdominal surgeries

Question 39

PUD & NG Tube

Answer 39

● In PUD, during surgery and postoperatively, the stomach contents are drained by means
of an NG tube. The nurse monitors fluid and electrolyte balance and assesses the
patient for localized infection or peritonitis (increased temperature, abdominal pain,
paralytic ileus, increased or absent bowel sounds, abdominal distention). Antibiotic
therapy is given as prescribed.

Question 40

Symptoms of Diverticulitis

Answer 40

● Most commonly, no problematic symptoms occur with diverticulosis. Some patients may
have mild signs and symptoms that include bowel irregularity with intervals of alternating
constipation and diarrhea, with nausea, anorexia, and bloating or abdominal distention.
With diverticulitis, up to 70% of patients report an acute onset of mild to severe pain in
the left lower quadrant. This may be accompanied by a change in bowel habits, most
typically constipation, with nausea, fever, and leukocytosis

Question 41

Diverticulitis Diet

Answer 41

● Rest, oral fluids, and analgesic medications are recommended. Initially, a clear liquid diet
is consumed until the inflammation subsides; then, a high-fiber, low-fat diet is
recommended.
● Stage 2-4 Diverticulitis on Hinchey Staging: Withholding oral intake, administering IV
fluids, and instituting nasogastric (NG) suctioning if vomiting or distention occurs are
used to rest the bowel

Question 42

Poor Perfusion/Low Cardiac Output HF Symptoms

Answer 42

● Decreased exercise tolerance
● Muscle wasting or weakness
● Anorexia or nausea
● Unexplained weight loss
● Lightheadedness or dizziness
● Unexplained confusion or altered mental status
● Resting tachycardia
● Daytime oliguria with recumbent nocturia
● Cool or vasoconstricted extremities
● Pallor or cyanosis

Question 43

Alcoholic Hepatitis Teaching

Answer 43

Alcoholic Hepatitis Teaching
● Stop drinking alcohol
● Sodium restriction