NCLEX Review MedSurg Flashcards
What is the primary dysfunction of Cushing’s syndrome? Most often caused by what? What are the expected findings? Assessment findings? Medication? Client teaching?
too much cortisol, over secretion of hormones
injury to the pituitary
carcinoma
long-term corticosteroid use
fatigue
sleep disturbances
irritability
decreased libido
back and joint pain
decreased immune function
thin skin, bruising, petechiae
HTN
tachycardia
weight gain
irregular menses
dependant edema
moon face, truncal fat, buffalo hump, straie
muscle wasting
osteoporosis
hyperglycemia
hirsutism
red cheeks, acne
emotional lability
taper off corticosteroids
ketoconoszole (inhibits cortisol)
hydrocortisone
eat calcium, vit D, and potassium-rich foods
meticulous skincare
S/S of infection
monitor weight
What indications may appear if there is an allergy or hypersensitivity to an antibiotic such as penicillin? What is the nursing action?
urticaria
rash
hypotension
dyspnea
anaphylaxis
stop the administration and contact HCP
What areas are a priority when assessing a safety risk?
First look for airway obstructin, hypoxia, bleeding, infection, or injury
Next, what is the risk to the client, addressing the greatest risk first
What is the Rhomberg test? What is the sign it is looking for? If the sign is elicited, what is indicated? What is the Babinski sign? What does it indicate in someone older than 2 years?
standing, ankles and knees together, arms resting at the side. Observe the ability to maintain balance with eyes open and then with eyes closed
excessive swaying, unable to maintain balance
nerologic disturbance
stroke sole of foot and if toes fan and flex up it is an abnormal finding
CNS disorder involving the cortico spinal tract
What is nursing care for client with brain tumor?
maintain airway, monitor lung sounds
Monitor neurologic status–LOC, deficits, occurrence of seizures
Help with ambulation for safety
Seizure precautions
Administer meds
What is the expected pharmacological action of epoetin alfa (erythropoietin, darbepoetin)? Who can it help? Complications? How often should Hgb and Hct be monitored?
growth factors that act on bone marrow to increase production of RBCs
anemia related to CKD
chemotherapy
pre-surgery
anemia caused by zidovudine (for HIV)
HTN from elevated hematocrit
MI, stroke, seizure from rapid blood count rise
DVT
HA, body aches
1-2X week
What are complications of NSAIDs?
dyspepsia
abd. pain
heartburn
nausea
GI bleeding or perf d/d damage of gastric mucosa
What neuromuscular disorders can impair a person’s rate and depth of respiration?
MS
Guillain-Barre
spinal cord injuries
CVA
What can cause secondary HTN?
kidney disease
Cushing’s (too much glucocorticoids)
aldosteronism
pheochromocytoma (too much catecholamines)
brain tumor, encephalitis
medications
pregnancy
what happens in the aura stage of a migraine with an aura?
numbness and tingling of mouth, lips, face, or hands
acute confusion
visual disturbances: light flashes, bright spots
What is management for polycystic kidney disease?
meds (use NSAIDS cautiously)
non-pharm methods
apply dry heat to abd. or flank to reduce discomfort
low-sodium diet
increase fluid and fiber
control BP
What are seizure precautions?
rescue equipment at the bedside
bed at low position
side rails up and padded if unconscious
wheels locked
saline locked IV access
move things that could cause injury
assist with ambulation
turn on side with head slightly forward
loosen clothing
nothing in mouth!
What are generally contraindicated in the first 6-8 hours after a snake bite?
ice
tourniquets
heparin
corticosteroids
What are IV non-opiod anesthetic agents? IV opiod agents?
barbituates: phenobarbital sodium
benzodiazapines: the “lams”
propofol
ketamine
fentanyl
alfentanil, sufentanil
morphine
What is the prototype anti-parkinson medication? MOA? Therapuetic effect? AE? Nursing actions?
levodopa-carbidopa
dopamine synthesis and activating receptors (the carbidopa puts the brakes on the levidopa)
relief from bradykinesia, resting tremors, dyskinesia, and muscle rigidity
dose-dependant
N/V
drowsiness
OH
nightmares, hallucinations
dry mouth, blurred vision, mydriasis, urinary retention
constipation
administer with food
avoid administering with high-protein foods (delays absorption)
discolors urine
avoid CNS depressants like alcohol
chew gum
high fiber
increase fluid
fall risk
Best position after a liver biopsy?
right side lying to protect and prevent bleeding
What is an EMG? How is an EMG performed?
electromyography
determine the presence and cause of muscle weakness
at bedside
tech places thin needle in muscle
electrode attached to needles and an oscilloscope
records activity during muscle contractions
What type of pressure does a CPAP provide? Hoe is it effective?
continuous positive airway pressure (inhalation and exhalation) with a leak-proof mask
acts as a splint to keep the upper airway and trachea open during sleep
What are expected findings with pulmonary edema? Nursing actions?
anxiety
inability to sleep
cough with pink, frothy sputum (key finding)
tachypnea, dyspnea or orthopnea
hypoxemia
cayanosis (later)
tachycardia
crackles
reduced UO
confusion, stupor
S3 heart sound (gallop)
increased pulmonary artery occlusion pressure
high fowlers
O2 high-flow
monitor VS q15min
Monitor I&O
monitor hemodynamic status
ABGs especially K+ with diuretics
maintain patent airway
What are manifestations of hyponatremia?
HA
Confusion
lethargy
muscle weakness
respiratory compromise
fatigue
decreased DTR
seizure
lightheadedness
increased GI motility
hyperactive bowel sounds
abd. cramping
nausea
What is acute glomerulonephritis? Ho long does it usually last? Common manfestations? Can it be caused by strep? Who is that most commonly seen in? Findings?
inflammation of the glomeruli that causes intravascular coagulation
1-2 weeks
oliguria
edema
HTN
circulatory congestion
hematuria
proteinuria
yes
kids 5-8 years old
coke colored urine
decreased UO, hematuria, proteinuria
irritability
anorexia
lethargy
discomfort
periorbital or facial edema
low-grade fever
HTN
vomiting
encephalopathy
genital swelling
How can a client reduced vertigo episodes?
restrict movement of the head
change positions slowly
avoid caffeine
dark and quiet spaces
use assistive devices
clutter-free
diuretic in reduce fluid in semicircular canals
space out intake of fluids throughout the day
decrease sodium intake
What is nephrotic syndrome? What does it lead to? Findings?
change in glomerular membrane which then allows albumin to pass into urine. Decreases the blood osmotic pressure because of albumin loss
proteinuria
hyperlipidemia
edema
frothy urine
weight gain
facial and periorbital edema that improves throught the day
ascites
edema of exremeties and genitalia
muehrcke line on fingernails (white lines)
pallor
anorexia
diarrhea, vomiting
irritabiltiy
lethargy
dyspnea
What is the nursing care for a sickle cell crisis? What is preferred meds for mild to mod pain? Severe?
promote rest to preserve oxygen consumption
O2 if hypoxia present
intense hydration therapy
monitor I&O
oral therapy
IV fluids and electrolyte replacement
caution with potassium
blood products
treat/prevent infection
comfort measure such as warm packs to joints
acetaminophen or ibuprofen
opioid analgesics
What ar the complications of sickle cell anemia? What can can they indicate?
severe pain
swollen joints, hands, feet
abd. pain
obstructive jaundice
visual disturbances
respiratory infections
osteomyelitis
murmurs
renal failure and enuresis
hepatomegaly (from excessive pooling)
splenomegaly (excessive pooling)
seizures
hypovolemia from reduced circulating blood, can lead to shock
What is the FLACC pain assessment model?
Asses behaviors of child from 2mos to 7 yrs
FACE
LEGS
ACTIVITY
CRY
CONSOLABILITY
What are complications of Reye syndrome? Risk factors? How does it present?
primarily affects liver and brain
causes liver dysfunction and cerebral edema
using aspirin to treat viral infection
typically follows viral infections such as influenza, gastroenteritis or varicella
lethargy
irritability
confusion
delirium
profuse vomiting
loss of consciousness
What is patent ductus arteriosus (PDA)? Result? Findings?
normal fetal circulation conduit between pulmonary artery and aorta fails to close
increased pulmonary blood flow with a left-to-right shunt
systolic murmur
wide pulse pressure
bounding pulse
HF
rales
can be asymptomatic
What is intussuseption? Who is it common in? Findings?
segment of bowel telescopes into distal segment causing venous obstruction
infants and children 3mos-6yrs
adb. pain
abd. sausage-shaped mass
stools mixed with blood an mucus that resembles currant jelly
vomiting
fever
distended abd.
What is the body’s response to low blood glucose? What are the manifestations of hypoglycemia? Later stage?
enacts “fight or flight” and releases epinephrine
tachycardia
pounding heart
diaphoresis
shaking
dizziness
pallor
HA
hunger or nausea
anxiety/irritability, difficulty concentrating
tingling of lips
blurred or tunnel vision
slurred speech
loss of consciousness
seizures
What would a c-reactive marker indicate?
inflammation, something going on with the inflammatory process. Indicates possible infection
What is another term for Meniere’s disease? S/S?
endolymphatic hydrops
hearing loss
vertigo
tinnitis
aural fullness
