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CPNRE > Prep 2 > Flashcards

Prep 2 Flashcards

1
Q

where is S1 and S2 heard loudest when auscultating

A

S1 -first heart sound is loudest at the apex of the heart

S2 sounds or the second heart sounds are loudest at the base of the heart.

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2
Q

Lead II Placement

A

mnemonic:
salt, pepper and ketchup.
white lead should be placed in the right part of the chest while the black lead is in the left part of the chest. The red lead should be placed below the black lead as pictured below.

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3
Q

There are five Ps essential in conducting neurovascular assessment - what are they?

A

pain, pulse, pallor, paresthesia and paralysis.

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4
Q

define paresthesia

A

abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness) with no apparent physical cause

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5
Q

Uses for Antitussive

A

used to prevent or relieve a cough

-suppress cough reflex; usually dry or nonproductive cough

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6
Q

Uses for Expectorants

A

thin bronchial secretions

  • It does this by increasing the water content of the mucus, thinning it out, and making your cough more productive.
  • promotes secretion of sputum by the air passages, used especially to treat coughs
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7
Q

Uses for mucolytics

A

make the mucus less thick and sticky and easier to cough up.

- usually prescribed for people who have a long-term (chronic) cough. They work best if they are taken regularly.

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8
Q 
main contraindications (5) for Beta blockers
--mnemonic
A 
1- asthma
2-heart block
3-COPD
4-DM
5-hyperkalemia
(can remember by ABCDE-asthma, block, COPD, DM, Electrolyte)
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9
Q

what is Cholelithiasis

A

formation or presence of stones in the gallbladder. It’s classified according to what makes the stones

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10
Q

Risk factors for Cholelithiasis - 4 F’s

A

female, fertility (pregnant), fat, and being 40 years old and above

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11
Q

Right side of heart pumps to the _____ with oxygenated or deoxygenated blood?

A

lungs with deoxygenated blood

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12
Q

left side of heart pumps from the _____ to the ____ with oxygenated or deoxygenated blood?

A

pumps from the lungs to the body

oxygenated

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13
Q

what happens with Left sided HF?

A
  • Decrease blood to body
  • decreased pulses
  • decreased cardiac output (activity intolerance and signs of decreased tissue perfusion)
  • Pulmonary congestion
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14
Q

what happens with RIGHT sided HF?

A
  • back up/increased blood to body
  • decreased blood to lungs
  • congestion of peripheral tissues (liver and GI tract congestion)
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15
Q

will you see JVD and anorexia and complaints of GI distress in left or right sided HF?

A

RIGHT

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16
Q

cough w/ blood-tinged sputum, restlessness, rales, orthopnea are signs of left or right sided HF?

A

LEFT

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17
Q

Cor pulmonale refers to the enlargement or change in the structure and function of the

A

heart’s right ventricle. Its most common cause is the increased blood pressure in the arteries of the lungs or pulmonary hypertension.

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18
Q

cor pulmonale can also happen as a result of

A

COPD, cystic fibrosis, scleroderma, and obstructive sleep apnea.

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19
Q

Dumping syndrome relates to the group of symptoms that occur after _____. it particularly happens to pts who…

A

eating

-patients who have undergone surgeries to remove parts of or all of the stomach.

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20
Q

Nursing interventions for dumping syndrome (5)

A

1-Wait 30 minutes after meals to consume liquids
2-Lie down for 15-30 minutes after eating
3-consume high amount of proteins and complex carbs
4-Eat 5-6 small meals a day rather than 3 large meals
5- AVOID Foods that are very cold or hot increase gastric motility

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21
Q

BP, P, RR for ICP vs Shock

A 
ICP:
BP = increased
Pulse = Decreased
RR = Decreased
Shock:
BP = Decreased
Pulse = increased
RR = Increased
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22
Q

Tx for MI

A 
mnemonic = MOAN
Morphine
Oxygen
Aspirin
Nitrates
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23
Q

describe A. cardiac catheterization

A
  • Radiopaque catheter is passed through the femoral artery directly into the heart and large vessels.
  • Shows BP within heart; health care provider can examine the heart closely with the tip of the catheter to detect abnormalities; blood samples can be obtained to determine oxygen content.
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24
Q

Atrial Septal Defect (ASD) is caused by the Foramen ovale does not close after birth; involves an abnormal opening between..

A

between the right and left atria.

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25
Q

Ventricular Septal Defect (VSD) is caused by an opening between?
Signs and s?

A

right and left ventricles of the heart

-loud, harsh murmur combined with a systolic thrill

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26
Q

Atrial Septal Defect (ASD)/Ventricular Septal Defect (VSD) – both have Increased or decreased pulmonary blood flow and are associated with what disorders?

A

Increased pulmonary blood flow; Associated with Down’s Syndrome and FASD

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27
Q

Tetralogy of Fallot has increased or decrease pulmonary blood flow?
What is the major characteristic feature of this type of congenital heart anomaly ?

A

decreased

  • Cyanosis
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28
Q

classic symptoms of type 1 Diabetes

A

three P’s:

polydipsia, polyuria, polyphagia, along with fatigue

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29
Q

• Prophylactic antibodies are given to children with

A

heart disease To prevent bacterial endocarditis

• Also given to those with a congenital defect for - Dental or other

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30
Q

Leukemia is caused by an abnormal…

A

increase of immature WBCs

  • They do not function normally because the cells are immature and do not function as healthy WBCs to fight infection; increase susceptibility to infection results
    • Unhealthy WBC take over production of RBCs which causes anemia
    • Decreased platelet production
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31
Q

what may be early objective symptoms of Leukemia

A

Petechia and purpura

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32
Q

Teachings for Leukemia

A
  • Infection prevention
  • Bleeding from decreased platelets
  • Fractures resulting from involvement of the bone marrow
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33
Q

what is hemophilia?

A

A congenital bleeding disorder in which the blood does not clot normally (x-linked recessive). Effects men more

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34
Q

what are the major goals when caring for a child with sickle cell disease:

A

a. Control pain.

b. Prevent dehydration, hypoxia, and infection

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35
Q

what is sickle cell anemia

A

inherited red blood cell disorder in which there aren’t enough healthy RBCs to carry oxygen throughout your body.

the red blood are shaped like sickles or crescent moons.

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36
Q

what are o Four major factors that might trigger a sickle cell crisis:

A

o Dehydration

b. Infection
c. Physical or emotional stress
d. Exposure to cold

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37
Q

what is Pyloric Stenosis

A

Narrowing) obstruction at the lower end of the stomach (pylorus)
—food cant reach bowel

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38
Q

what is Hirschsprung’s Disease - Aganglionic Megacolon (THINK BOWEL)

A

 Occurs when there is an absence or ganglionic innervation to the muscle of a segment of the bowel
• Normal peristalsis is affected
• Stool enters the affected part & stays there

39
Q

describe Care of Major Burns

A
  • Establish/maintain airway/emergency care – Focus on ABCs
  • IV- fluids, pain relief – massive shift of fluid into extracellular spaces and affects electrolyte levels
  • Pain relief, NG tube
  • Nutrition
  • Infection control
    o Nurse on sterile sheets/masks/gloves
    o Wound care- strict asepsis/debridement/grafts
  • q 1h urine output
40
Q

Addisons and Cushings disease = all about steroids - in relation to steroids, what is the difference? Appearance?

A

Addisons: Absent steroids - Steroids too low
–Small, weak, abnormal tan
Cushings - Cushion of steroids - too HIGH
–Big, Round, Hairy

41
Q

Addison disease signs and symptoms

- Remember to think LOW, except 2 HIGHS- Double Ps

A 
LOW:
BP
Weight
Temp
hair (alopecia)
mood (depression)
Energy (fatigue)
Sodium (below 135)
Glucose
HIGH:
Pigmentation (bronze )
Potassium (over 5.0)
42
Q

Cushings disease signs and symptoms

- Remember to think BIG

A 
BIG:
BP
Glucose, & Sodium
Belly "truncal obesity"
Face- moon face
Buffalo hump - Fat pad
Hair - Hirsutism
Stretch marks - purple striae
Red face - rosy cheeks
Infections "slow wound healing"
Risk for fractures and brittle bones
43
Q

TX for Addisons and cushings

A

Addisons: ADD some steroids “-sone”
- and IV maintenance therapy to bring BP up

Cushings: Control Causes
- Cut out tumor or Steroids (Slowly decrease)

44
Q

Respiratory acidosis Occurs when the CO2 is too ___ causing pH to be ___
-Causes?

A

Occurs when the CO2 is too high causing pH to be low (acidotic)
Causes:
• Hypoventilation, respiratory failure, pneumonia, pulmonary emboli, or long-standing COPD

45
Q

Metabolic acidosis
Occurs when HCO3- is __= pH ____
–Causes:

A

Metabolic acidosis
Occurs when HCO3- is low = pH fall below 7.35
 Causes:
• Anaerobic metabolism, lactic acidosis, diabetic ketoacidosis, anoxia, poisoning, overdose

46
Q

GERD therapeutic management

A

 Avoid high-fat foods, avoid milk products at night, avoid late night snacking
 Head of bed elevated to about 30 degrees
 Don’t lie down for 2-3 hours after eating
 Drug therapy may include:
• H2 receptor blockers
• Proton pump inhibitors
• Anatacids
• Sucralfate
• Prokinetic drugs

47
Q

Thyroid gland:

Endocrine gland that synthesizes and secretes thyroxine (T4) and triiodothyronine (T3), these hormones regulate…

A

cellular metabolism and growth

48
Q

By 70 years of age the lens begins to thicken due to a clumping of proteins and yellow deposits called

A

nuclear stenosis or senile cataract

49
Q

Older adult – As the heart pumps against a stiffer aorta, the systolic pressure ____, leading to a ____ pulse pressure

A

the systolic pressure increases, leading to a widened pulse pressure

50
Q

o Measure calf circumference for symmetry, if measurement off by __cm, refer client for DVT assessment

A

1cm

51
Q

assessing for edema involves

A

o Palpate skin for edema starting from ankle and moving way up leg. If edema present, measure the distance of the edema from the knee

52
Q

Delivered healthy baby 2 hours ago. PN’s priority assessment of the mother

A

Location and tone of the uterus – hemorrhage is frequently caused by uterine atony and is major complication during recovery period

53
Q

Primary action of Digoxin

A

improve the strength of contraction and slow the heart

54
Q

Physician orders for patient with diverticulitis: full fluid diet, morphine, IV prn for pain. What order should PN question?

A

Full fluid diet – with diverticulitis the goal is to rest the bowel; the client should receive nothing by mouth because she has signs of perforation

55
Q

What should PN do first when providing preoperative teaching to patient?

A

Instruct client about deep breathing, coughing and use of the incentive spirometer
– will have impact on recovery because deep breathing and coughing promote optimal lung expansion and oxygenation after anesthesia

56
Q

65 year old patient has pneumonia. What can PN suggest to facilitate clearing of respiratory secretions?

A

Increasing fluids – helps aid the expectoration of secretions

57
Q

Patient had total hip replacement. PN notices patient unsteady with walker. What should PN do

A

Discuss observations with physiotherapist

58
Q

ready for discharge. PN is ready to remove her IV and notices that patient is lethargic and is no longer oriented to time and place. What should PN do first?

A

Maintain IV access

– by doing so, the PN can ensure proper circulation and emergency access for medication if it is required

59
Q

17 year old patient has been feeling weak and nauseous for the past 7 days. Blood work results are normal except elevated calcium level. Condition that might be causing his symptoms…

A

Hyperparathyroidism

– in hyperparathyroidism, the bones decalcify and renal calculi develop. Lab works demonstrates elevated serum calcium

60
Q

Thyroid disorders typically occur when the thyroid gland releases too many or too few hormones.
Imbalance of this kind can create disturbance in the functions that regulate how the body metabolizes

A

that regulate how the body metabolizes proteins, fats and carbohydrates as well as in how it ​uses energy, consumes oxygen and produces heat

61
Q

Parathyroid glands control the ____ levels in our blood, in our bones, and throughout our body. Parathyroid glands regulate the _____ by producing a hormone called ______

A 
Calcium x 2
Parathyroid Hormone (PTH).
62
Q

hyperparathyroidism causes what electrolyte imbalance?

A

Hypercalcemia

63
Q

Patient has new colostomy. She will not look at it and refuses to participate in self-care. How can PN best assist?

A

Provide client and opportunity to discuss her feelings about the colostomy

(i. Refer to wound and ostomy support team – this can be part of care plan, but client needs to be ready to participate

64
Q

normal temp

A

36-38

65
Q

newly diagnosed with type 2 diabetes and states that she feels weak. After BG reading at 3 mmol/L, what should the PN do?

A

Provide a carbohydrate and monitor BG levels in 15 minutes

– the hypoglycemia state needs to be corrected and monitored to prevent further hypoglycemic crisis. Carbohydrates will produce the quickest response

66
Q

Patient receiving blood transfusion via a Y blood tubing set-up. Client develops chills, flushed face, flanked pain and burning sensation along vein which blood is being transfused. After stopping the transfusion, what should PN do next?

A

Keep the vein open with normal saline using a new IV tubing and check vital signs

67
Q

what is Somatic Symptom Disorder (SSD), previously known as somatoform disorder,

A

is a mental illness that causes unexplained physical symptoms such as pain that are distressing or disrupt the client’s normal functioning

68
Q

what is the first treatment provided to a client with dyspnea due to pneumonia?
other treatments?

A

Administration of oxygen is the first treatment
(As an emergency action, the nurse can administer oxygen without waiting for an order from the physician)
- Bed rest
- increased fluid intake
- antibiotic administration
but they are not the first action of the nurse

69
Q

. Full thickness burns are characterized by

A

deep red, brown or black burned sites, dry injured surfaces, edema, tissue disruption with fat exposure, and minimal or no pain

70
Q

Deep full-thickness burns are characterized by burn injuries to the

A

burn injuries to the muscle and bone, absence of edema and blisters, and a black burned area.
-cause minimal or no pain because the nerve endings are completely damaged.

71
Q

rushed to the emergency department after he is found lying unconscious on the floor. Physical assessment reveals cherry-red skin, mucus membranes, and nails.
Based on this finding, which of the following is the most likely cause of Bryan’s medical condition?

A

most likely demonstrating a sign of carbon monoxide poisoning. Cherry-red skin, mucus membranes, and nails indicate that the client has been exposed to high levels of carbon monoxide

72
Q

35 weeks’ gestation comes to the emergency department complaining of severe abdominal pain. Moderate dark vaginal bleeding is noted. Physical assessment findings - increased uterine tone with orthostatic changes in the blood pressure. External fetal monitor reveals fetal distress. Based on these initial findings, the client is most likely diagnosed with which of the following conditions?

A

client is most likely diagnosed with abruptio placenta

73
Q

antidote for magnesium sulfate toxicity?

A

Calcium gluconate is the antagonist or antidote for magnesium sulfate.

74
Q

what is Chadwicks sign?

A

bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow. It can be observed as early as 6 to 8 weeks after conception, and its presence is an early sign of pregnancy.

75
Q

what is Goodell’s sign ?
indicates?
seen approx?

A

is the softening of the cervix.

indication of pregnancy; approx 4 weeks gestation

76
Q

what is Hegar’s sign ?

Occurs approx when

A

softening and thinning of the lower segment of the uterus. It occurs at about 6 weeks of pregnancy

77
Q

What separates the atria from the ventricles

A

tricuspid valve and bicuspid valve

78
Q

Client rushed to ED after demonstrating signs of acute MI. History reveals chest pain has not been resolved by sublingual nitroglycerin. client is started on tissue plasminogen activator by infusion. The nurse caring for the client frequently assesses which of the following parameters?

A

nurse assesses for the client’s pulse rate.

-Tissue plasminogen activator dissolves existing clots, increasing the client’s risk for excessive bleeding. Internal hemorrhage increases the pulse rate and decreases the blood pressure

79
Q

________ is manifested with join pain that diminishes after rest. Joint symptoms intensify after activity.

A

Osteoarthritis

80
Q

A client on furosemide therapy has an increased risk for _____

A

hypokalemia

81
Q

risk of developing digoxin toxicity increases with

A

hypokalemia

82
Q

________ is manifested by vaginal itching and burning and vaginal discharge with a cottage-cheese-like appearance

A

Candidiasis

-Candidiasis occurs when the vaginal environment is altered. Antibiotics and corticosteroids decrease the host’s defenses.

83
Q

Isometric exercises are the most recommended exercises to

A

regain or maintain muscle strength

-. This group of exercises is encouraged forclients with casts or bone/muscle tractions.

84
Q

Anaerobic exercises involve

A

quick bursts of energy and are performed at maximum effort for a short time.
-Anaerobic means ‘without air’ and refers to the body producing energy without oxygen

85
Q

___ exercise promotes cardiovascular strengthening and overall body fitness.

A

Aerobic

The term Aerobic actually means “with oxygen,” which means that breathing controls the amount of oxygen that can make it to the muscles to help them burn fuel and move.

86
Q

_____ exercises involve activities that contract the muscles and facilitate active movements of the joints. This type of exercise increases muscle tone, strength, and mass

A

Isotonic

87
Q

history of CHF, complains of SOB. He cannot tolerate lying flat on the bed. Physical examination reveals accumulation of fluid in the left lung. Thoracentesis is ordered. The client must be placed in which of the following positions during the procedure?

A

lateral position, lying on the unaffected side with the head of bed elevated to 45degrees.

The client may also choose to sit on the edge of the bed and lean over the bedside table with the feet supported on a stool.

88
Q

Why is it dangerous for alcoholics to suddenly stop drinking?

A

cardiac failure
-alcohol withdrawal dilirium (DTs) may lead to death caused by hyperthermia, peripheral vascular collapse, cardiac failure

89
Q

culture specimens can be inaccurate if taken after ____

A

antibiotics

90
Q

erythripoietin therapy - tx associated with what disorders?

A

anemia w/ kidney failure/renal disease

91
Q

Erythropoietin (EPO) is a _____ produced by the ____.

A

Erythropoietin (EPO) is a hormone produced by the kidney.

92
Q

Primary functions of Erythropoietin

A

1- Promote the development of red blood cells.

2- Initiate the synthesis of hemoglobin, the molecule within red blood cells that transports oxygen

93
Q

what kind of diet for cirrhosis patient

A

low-protein diet

-cirrhosis interferes with livers ability to eliminate ammonia. Protein is converted to ammonia-pt requires a low-protein diet

94
Q

What is the biggest concern for a patient post-op?
A. Absent bowl sounds
B Pain
C. U/O less than 30ml/Hr

A

C.

absent bowl sounds and pain from incision site=normal postop; u/o <30ml/hr =most concern. May indicate inadequate perfusion of kidneys, or urinary retention

CPNRE (9 decks)

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