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Medical/Surgical > NU 454 Test IV > Flashcards

NU 454 Test IV Flashcards

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USMLE® Step 1 flashcards
1
Q

Shunts blood from portal circulation to superior/inferior vena cava

A

Ductus Venosus

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2
Q

Provides a passageway for most of the blood from the PA to the descending aorta (bypassing the lungs)

A

Ductus Arteriosus

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3
Q

Allows blood to be shunted from the RA to LA

A

Foramen Ovale

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4
Q

Direction of blood flow BEFORE birth

A

Right to Left

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5
Q

Direction of blood flow AFTER birth

A

Left to Right

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6
Q

Increased Pulmonary Blood Flow

A

ASD, VSD, PDA

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7
Q

Most common CHD

A

VSD

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8
Q

Systemic pressure in the LV is transferred to the R side of the heart. This increases pressure in the pulmonary vasculature, which increases pressure in the lungs reversing blood flow from R to L. (Reverse shunting)

A

Eisenmenger Syndrome

SE of VSD

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9
Q

Medication that attempts to close PDA

  • inhibits prostoglandins
  • vasoconstricts
  • IV for 3 doses
  • must be
A

Indomethacin (Indocin)

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10
Q

Drug that keeps PDA open

A

Prostaglandin E

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11
Q

Hypercyanotic spells are seen in what CHD

A

Tetralogy of Fallot

-“Tet Spells”

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12
Q

Obstructive Heart Defects

A

Pulmonary stenosis, aortic stenosis, coarction of the aorta

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13
Q

Blood pressure and O2 saturation are higher in the arms than legs in what CHD

A

Coarctation of the Aorta

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14
Q

Procedure to temporarily fix TGA by inflating a balloon and pulling it from LA to RA

A

Rashkind Procedure

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15
Q

Powerful vasodilator prostaglandin E

  • IV infusion
  • keeps PDA
  • monitor BP
  • SE: flushing, jitters, elevated temp, apnea
A

Alprostadil (Prostin VR Pediatric)

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16
Q

Do not give Digoxin if HR is less than?

A

100

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17
Q

Therapeutic Dig level

A

0.8-2.0 ng/mL

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18
Q

Post op hemorrhage in the infant

A

5-10 mL/kg/hr

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19
Q

Low Birth Weight

A

< 2500 g

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20
Q

Very Low Birth Weight

A

< 1500 g

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21
Q

Extremely Low Birth Weight

A

< 1000 g

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22
Q

Appropriate for Gestational Age (AGA)

A

10-90% on intrauterine growth curve

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23
Q

Small for Gestational Age (SGA)

A

< 10% on intrauterine growth curve

-Intrauterine growth retardation (IUGR)

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24
Q

Large for Gestational Age (LGA)

A

> 90% on intrauterine growth curve

gestational diabetic moms

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25
Q

< 37 Weeks

A

Preterm Infant

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26
Q

38-42 weeks

A

Full term infant

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27
Q

> 42 weeks

A

Post term infant

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28
Q

Death in utero 20 weeks before birth

A

Fetal death

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29
Q

Death in the first 27 days of life

A

Neonatal death

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30
Q

Death after 28 days of life

A

Postnatal death

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31
Q

Eyes are fused

A

< 24 weeks

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32
Q

AOP: the brain does not transmite message to lungs to take a breath

A

Central Apnea

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33
Q

AOP: the upper airway constricts or collapses

A

Obstructive Apnea

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34
Q

Ex. Aminophylline, Theophylline, Caffeine

  • CNS stimulants
  • Toxicity: tachycardia, vomiting, diuresis, irritability, dysrhythmias
A

Methylzanthines

-used to treat AOP

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35
Q

Poor feeding, apnea, tachypnea, pallor, tachycardia, murmur, decreased O2 sat

A

Anemia

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36
Q
  • Hematocrit > 65%
  • Blood too thick to adequately perfuse the body
  • S/S: lethargy, irritability, peripheral cyanosis, respiratory distress, hyperbilirubinemia, hypoglycemia
A

Polycythemia

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37
Q

RSV immune globulin used to treat bronchopulmonary dysplasia

A

Respigam

-given IV during RSV season (October-May)

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38
Q

JVD, cardiomegaly, loud systolic murmur, diastolic murmur, sustained dysrhythmias, clubbing, cyanosis, FATIGUE, chest pain, dyspnea on exertion, syncope on exertion, tachycardia (>120), irregular pulses

A

S/S of cardiovascular disorders in pregnancy

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39
Q

Anticoagulant SAFE in pregnancy

A

Heparin

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40
Q

Anticoagulant CONTRAINDICATED in pregnancy

A

Warfarin (Coumadin)

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41
Q

Normal pregnancy range for Hct

A

38-45%

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42
Q

Morphine
Demerol
Hemabate
NSAIDS

A

Do not use if have asthma and pregnancy!

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43
Q

Safe to be used with myasthenia gravis pregnant women

A

Pitocin

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44
Q

DO NOT use in pregnant women with myasthenia gravis

A

Mag Sulfate

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45
Q

Early miscarriage

A

< 12 weeks

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46
Q

Late miscarriage

A

12-20 weeks

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47
Q

Viable fetus

A

20 weeks or 500 g

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48
Q

Bleeding and closed cervix

A

threatened miscarriage

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49
Q

Cervix is open, but products are not expelled

A

inevitable miscarriage

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50
Q

Fetus is lost, placenta is attached, and bleeding occurs

A

incomplete miscarriage

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51
Q

Fetus is outside of uterus with membranes

A

complete miscarriage

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52
Q

Fetus died and all products are in uterus with no cervical opening

A

missed miscarriage

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53
Q

Thirst, syncope, tachycardia, changed sensorium, hypotension, low UOP, agitated, restless, thready HR

A

S/S of shock

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54
Q

PAINLESS bleeding

A

placenta previa

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55
Q

PAINFUL hard rigid abdomen

A

abruptio placentae

-marginal or concealed (grades 1-3)

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56
Q

Uterus appears purplish and copper colored (echymotic)

A

couvelaire uterus

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57
Q

Cord begins to branch before it inserts into the placenta

A

valamentous insertion of the cord (vasa privea)

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58
Q

The cord is off to one side rather than centrally located

A

battledore insertion of the cord

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59
Q

Full placenta and small placenta

A

succenturiate placenta

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60
Q

Hypotension, nausea, warmth, flushing, muscle weakness, decreased reflexes (assess DTRs), slurred speech

A

Mag toxicity

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61
Q

Antidote for mag sulfate

A

calcium gluconate

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62
Q

Patterns NOT associated with uterine contractions

A

Episodic

EW = episodic without

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63
Q

Patterns that ARE associated with uterine contractions

A

Periodic

PC = periodic contractions

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64
Q

Tachycardia in the fetus most often indicates

A

Infection in the mother with fever

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65
Q

No late decels w/ uterine contractions in a 10 minute frame

A

Negative oxytocin challenge test

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66
Q

Repetitive decels w/ more than half of contractions in a 10 minute frame

A

Positive oxytocin challenge test

67
Q

MVUs > 400

A

Uterine tachysystole

68
Q

Apnea in infants

A

No breathing for > 15 seconds

69
Q

Nitrogen Washout

A

Administer 100% o2 for 6-12 hours – causes free air to be absorbed by the capillaries to body’s natural response
-contraindicated in premies (risk for ROP)

70
Q

Sudden hypotension, bradycardia, o2 sat that does not improve with oxygen administration

A

Infant pneumothorax

71
Q

Chest tube insertion location for infant pneumothorax

A

4th intercostal space; midclavicular line

72
Q

Dx of pneumothorax

A

Tranallumination of the chest (performed by nurse)

73
Q

Cytomegalovirus results in

A

Hearing disabilities in the infant

74
Q

IVIG

A

Tx of sepsis: Intravenous immunoglobulin therapy to enhance baby’s natural immune system

75
Q

Jittery, irritability, cyanosis, apnea, hypotonia, seizures

A

S/S of hypoglycemia in the infant

76
Q

D15 and D25 can only be administered through

A

A central line

77
Q

Hypoglycemia in an infant

A

< 40

78
Q

If blood glucose < 25

A

Give IV dextrose

79
Q

Nerve damage to one or both arms

A

Erb’s Palsy

80
Q

Perinatal Hypoxic-Ischemic Brain Injury

A

Stroke

81
Q

May be associated with neurologic damage, hypoglycemia, hypocalcemia
-Repetitive motions of both hands – check blood sugar

A

Tremors

82
Q

NORMAL; may be associated with crying or stimulation, common in infants during first 4 days of life
-Can be stopped when touched

A

Jitteriness

83
Q

Therapeutic Phenobarbital

A

15-40 mcg/mL

84
Q

SE: respiratory depression, elevated LFTs with long term use, vomiting, and diarrhea

A

Phenobarbital

85
Q

Phenobarbital dosage

A

3-4 mg/kg/day (max 5 mg/kg/day)

86
Q

Promotes absorption of CSF

A

Acetazolamide (Diamox)

87
Q

Increases risk for Digoxin toxicity

A

Hypokalemia

88
Q

Decreases the effectiveness of Digoxin

A

Hyperkalemia

89
Q
  • Fever
  • Leukocytosis
  • Pericardial effusion
  • Friction rub
A

Postpericardotomy Syndrome

90
Q

Asymptomatic at normal levels of activity

A

Class I Heart Disease

91
Q

Symptomatic with ordinary activity

A

Class II Heart Disease

92
Q

Symptomatic with less than ordinary activity

A

Class III Heart Disease

93
Q

Symptomatic at rest

A

Class IV Heart Disease

94
Q

Hemodynamics peak in what week?

A

24 (second trimester)

95
Q

Tx for cardiac pregnant patients

A

-bed rest
-adequate nutrition
-prophylactic abx
-vacuum delivery w/ NO PUSHING
-anticoagulation therapy
(estrogen increases coagulation)

96
Q

Antidote for coagulation therapy

A

Vitamin K

97
Q

Spinach, leafy veggies, okra, black-eyed peas

A

Food high in Vitamin K

98
Q

Chills, fever, pain in back and abdomen, shock

A

Hemolytic crisis

99
Q

Carbs, bread, pasta, green/leafy veggies, spinach, kale

A

Foods high in folic acid

100
Q

Least amount of fluid in amniotic sack for proper cushioning

A

6cm

101
Q

ARDS is precipitated in pregnancy by:

A
  1. DIC
  2. PE
  3. Aspiration Pneumonia
102
Q

Avonex
Betaseron
Copaxone

A

MS drugs to be avoided during pregnancy

103
Q

Tx for Bell’s Palsy

A

Steroids and supportive therapy

104
Q

Number one cause of death in Systemic Lupus Erythematous patients

A

Infection

105
Q

Destroys any residual products of conception that might be left in the tube following a salpingotomy

A

Methotrexate (Trexall)

106
Q

The margins of the placenta will break away and bleeding occurs in amniotic fluid and out of the vagina

A

Marginal Abruptio Placentae

107
Q

The bleeding is centrally located, and the sides of the placenta are still sealed around it. No vaginal bleeding

A

Concealed Abruptio Placentae

108
Q

May or may not have vaginal bleeding, uterine tetany, no maternal/fetal distress

A

Grade I Concealed Abruptio Placentae

109
Q

Uterine tenderness and tetany, may or may not have vaginal bleeding, shock like s/s and fetal distress

A

Grade II Concealed Abruptio Placentae

110
Q

Severe board like tetany, fetal monitor is painful, fetus is dead and mother is in profound shock which can lead to DIC

A

Grade III Concealed Abruptio Placentae

111
Q

Psychosis syndrome resulting form necrosis of the pituitary d/t loss of blood volume

A

Sheehan Syndrome

112
Q

Small dark adherent clots on maternal side of placenta

A

0-minimal placentae abruptio

113
Q

10-20% detachment of placental surface; external bleeding < 100mL

A

1-mild placentae abruptio

114
Q

20-50% detachment, external bleeding 100-500mL; uterine tetany and tenderness

A

2-moderate placentae abruptio

115
Q

> 50% detachment, internal and external bleeding > 500mL; uterine tetany, maternal shock, risk of fetal death and maternal DIC

A

3-severe placentae abruptio

116
Q

15% blood loss
Normal pulse
Normal SBP
MAP 80-90

A

Class I PP hemorrhage

117
Q

20-25% blood loss
Pulse 100
Normal SBP
MAP 80-90

A

Class II PP hemorrhage

118
Q

30-35% blood loss
Pulse 120
SBP 70-80
MAP 50-70

A

Class III PP hemorrhage

119
Q

40% blood loss
Pulse 140
SBP 60
MAP 50

A

Class IV PP hemorrhage

120
Q

Placenta attaches to outside of the myometrium

A

Accrete

121
Q

Placenta invades into the myometrium

A

Increta

122
Q

Placenta goes all the way through the myometrium and can even enter abdominal cavity

A

Precreta

123
Q

Gestational HTN/BP elevation after 20 weeks with proteinuria

A

Preeclampsia

124
Q

Preeclampsia with seizures not related to any other cause

A

Eclampsia

125
Q

BP elevation detected for the first time after 20 weeks WITHOUT proteinuria

A

Gestational HTN

126
Q

Gestational HTN w/ no s/s of preeclampsia at time of birth; resolves within 12 weeks after birth - retrospective dx

A

Transient HTN

127
Q

Chronic elevation of BP which was previously well controlled with new proteinuria

A

Preeclampsia superimposed or chronic hypertension

128
Q

Common complication of preeclampsia and HTN during pregnancy

A

Pulmonary edema

129
Q

Urine dipstick > 3g/L or 30mg/dL

A

Proteinuria

130
Q

BP: > 140/90
Edema: may or may not be seen
Dipstick: > 30mg/dL
UOP: < 30mL/hr

A

Mild Preeclampsia

131
Q 
BP: > 160/110
Edema: massive weight gain, swelling
Dipstick: >2gm/24hr
UOP: < 20mL/hr
Hyperreflexia: > 3+
Platelets: < 100,000
Epigastric pain
Blurred vision
N/V
IUGR
Late decelerations
A

Severe Preeclampsia

132
Q

Normal Hgb

A

12-16

133
Q

Normal Hct

A

38-45%

134
Q

Normal PT

Normal PTT

A

12-14 sec

60-70 sec

135
Q

Normal fibrinogen

A

200-400 mg/dL

136
Q

Fibrin split products and D-dimers are usually

A

absent

137
Q

Normal BUN

A

10-20 mg/dL

138
Q

Normal Creatinine

A

0.5-1.1

139
Q

Normal LDH
Normal AST
Normal ALT

A

45-90
4-20
3-21

140
Q

Creatinine clearance

A

80-125 mL/min

141
Q

Burr cells or schistocytes are usually

A

absent

142
Q

Uric acid

A

2-6.6

143
Q

Bilirubin

A

0.1-1

144
Q

Mom: Hypotension, nausea, warmth, flushing, muscle weakness, decreased reflexes, slurred speech, confusion

Fetus: tachycardia, hypoglycemia, hypocalcemia, hypermagnesemia

A

S/S of mag toxicity

145
Q

Changes in variability; fetal tachycardia or bradycardia

A

Episodic patterns

146
Q

Early and late decelerations

A

Periodic patterns

147
Q

Variables =

A

Cord compression

148
Q

Early =

A

Head compression

149
Q

Accelerations =

A

Okay

150
Q

Late decelerations =

A

Placental insufficiency

151
Q

Reactive non-stress test

A

2 accelerations of FHR > 15bpm lasting > 15sec in a 20 minute span

152
Q

Non-reactive non-stress test

A

FM and FHR do not meet criteria in 40 minutes; requires further evaluation

153
Q

Equivocal non-stress test

A

Fewer than 2 fetal movements occur in 20 minutes, accelerations are < 15 bpm, and FHR is abnormal (160)

154
Q

Inhibits prostoglandins to stop labor

A

Indomethacin (Indocin)

155
Q

Hypertonic uterine dysfunction in the latent phase; effacement and dilation < 4 cm

A

Primary Inertia

156
Q

Hypotonic contractions in the active phase; get to 4 cm and then stop

A

Secondary Inertia

157
Q

Treatment for Group B streptococcal infection

A

PCN

158
Q

Breastfeeding is contraindicated in which TORCH

A

HIV

159
Q

Chest pain, coughing, dyspnea, tachypnea

A

s/s of PE

160
Q

Drug not to be used in pregnant clients with HTN or cardiovascular disorders

A

Methergine

160
Q

Goal and prevention of mastitis

A

Continue to breast feed infant

161
Q

Therapeutic Mag level

A

4-8 mg/dL

162
Q

Maximum Pit dosage

A

20 U

Medical/Surgical (3 decks)

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