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Nursing school level 2 > Theory final exam > Flashcards

Theory final exam Flashcards

1
Q

PAD

A

peripheral arterial disease - partial or total occlusion of the artery

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2
Q

PAD can cause

A

tissue damage

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3
Q

most common cause of PAD

A

atherosclerosis

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4
Q

which part of the body is most commonly affected by PAD

A

lower extremities

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5
Q

PAD related to

A

cardiovascular and cerebrovascular disease

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6
Q

PAD occurs earlier in

A

pt with DM

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7
Q

hallmark of PAD

A

intermittent claudication

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8
Q

what increases pain with PAD

A

elevating the extremity or placing it in a horizontal position

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9
Q

Assessment of PAD

A

cold and pain with elevation
ruddy or cyanotic when placed in dependent position
prolonged cap refill
skin appears shiny, taut, and dry with no or little hair
bruit may be auscultated
muscle atrophy with prolonged ischemia

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10
Q

diagnostics with PAD

A

doppler ultrasound, ankle-brachial index, treadmill testing

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11
Q

ankle brachial index equation

A

ankle systolic/brachial systolic

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12
Q

normal ankle brachial index

A

1-1.3

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13
Q

management of PAD

A

reduce serum lipids, daily walking, stop smoking, healthy diet

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14
Q

pharmacologic therapy for PAD

A

hemorrheologic or antiplatelet agents, vasodilators, or antihyperlipidemics

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15
Q

pentoxifylline (trental)

A

increases flexibility of RBC and decreases blood viscosity

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16
Q

surgical intervention of PAD

A

revascularization, endarterectomy, endovascular surgery

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17
Q

arterial revascularization

A

arterial bypass and vascular grafting

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18
Q

endarterectomy

A

surgery to remove fatty deposits (plaque) that are narrowing the arteries in your neck

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19
Q

bypass graft

A

reroutes the blood flow around the stenosis or occlusion

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20
Q

femoral -popliteal graft

A

Surgical procedure of choice if atherosclerotic occlusion is below the inguinal ligament in the superficial femoral artery. grafts may be synthetic or autologous

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21
Q

post op disappearance of pulse

A

may indicate thrombotic occlusion of the graft—this is an emergency

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22
Q

post op PAD surgery

A

ABI not recommended, monitor pulse, color and temp, and cap refill

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23
Q

potential complications after PAD surgical repair

A

bleeding/hematoma and edema

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24
Q

severe edema, pain and decreased sensation can be indication of

A

compartment syndrome

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25
Q

PAD home care

A

avoid pressure on affected extremity, avoid vigorous massage of extremity, avoid exposure to cold, constrictive clothing, and crossing legs, stop smoking

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26
Q

nursing diagnoses of PAD

A

ineffective peripheral tissue perfusion, activity intolerance, and chronic pain

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27
Q

aneurysms risk factors

A

age, male gender, HTN, CAD, family history, high cholesterol, lower extremity PAD, stroke, smoking, obesity

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28
Q

most abdominal aortic aneurysms occur

A

below the renal arteries

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29
Q

aneurysms are usually

A

asymptomatic until dissection or rupture occurs

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30
Q

classification of abdominal aneurysms

A

supra-renal, juxta-renal, and intra-renal

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31
Q

aneurysm repair

A

open repair surgery - done under general anesthesia

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32
Q

open repair of aneurysm can be

A

trans peritoneal or retroperitoneal

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33
Q

most common complication of endovascular repair of aneurysm

A

endoleak

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34
Q

endoleak

A

leak inside the vessels that allows blood to pool up

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35
Q

what med do pt need after endovascular repair

A

home meds and beta blocker

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36
Q

chronic bronchitis s/s

A

blue bloater - hypoxia, increase rr, increase CO2, clubbing

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37
Q

emphysema s/s

A

pink puffer- purse lip breathing, barrel chest, thin, decreased CO2

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38
Q

diagnostic procedures for COPD

A

CXR, peak expiratory flow rate, pulmonary function test, pulse ox, ABGs, CBC, sputum culture

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39
Q

FEV in COPD

A

low

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40
Q

pharmacologic management of COPD

A

bronchodilator, nebulizer inhalers (duoneb), corticosteroids, antibiotics, O2 therapy

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41
Q

surgical treatment of COPD

A

bullectomy, lung volume reduction surgery, lung transplantation

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42
Q

bullectomy

A

bullae are resected via thoracoscope

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43
Q

lung volume reduction surgery

A

procedure done via bronchoscope where a surgeon removes damaged parts of the lung to create more space for the lung to work better

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44
Q

single most important driver of ventilation

A

CO2 - supplemental oxygen may increase CO2 levels

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45
Q

most precise method of delivering exact amounts of O2

A

venturi mask

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46
Q

if COPD pt is in respiratory failure

A

begin high flow oxygen delivery regardless of history, obtain IV access, breathing techniques, and position

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47
Q

complications with COPD

A

resp. infections, heart failure, fluid retention, pneumothorax, pulmonary hypertension

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48
Q

open vs percutaneous tracheostomy procedure

A

open - performed in OR. percutaneous - usually performed at bedside in ICU

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49
Q

advantages of tracheostomy

A

decreases airway resistance, easier airway care, facilitates oral communication and speech, improves oral hygiene

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50
Q

outer cannula

A

fits into the stoma to keep it open

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51
Q

obturator

A

device that guides the outer cannula into the stoma during placement of the cannula

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52
Q

inner cannula

A

fits inside the outer cannula and can be removed for cleaning

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53
Q

what type of tube is used for patients who are ready for decannulation

A

cuff less tube with reusable or disposable inner cannula

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54
Q

if patient has metal tract tube they cannot get

A

an MRI

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55
Q

complications of trach

A

bleeding, infection, mucous plug, injury to laryngeal nerve, injury to esophagus, skin necrosis, false passage

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56
Q

what do you do is there is accidental decannulation

A

call rapid response, maintain an airway, and reinsert new tube if available

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57
Q

trach pt should always have

A

two tubes, one the size currently in the pt and one a size smaller

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58
Q

new trach tube care

A

do not change trach tape for at least 24 hr and physician will perform the first change 7 days after initial insertion

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59
Q

you need to bypass what when suctioning

A

bypass glottis to decrease cough reflex

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60
Q

what is lost when trach is in place

A

filtered, warm and humidifies air so the airway becomes drier and produces mucus scabs that can lead to infection, obstruction, and pneumonia

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61
Q

prevent crusting of trach through

A

proper humidification and hydration

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62
Q

what is used to wean the patient off the tracheostomy

A

decannulation cap

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63
Q

types of head and neck cancer

A

oral, salivary, laryngeal, nasopharyngeal, nasal cavity tumors

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64
Q

head and nick cancers are more common in

A

men than women

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65
Q

squamous cell carcinoma is more common in

A

smokers and drinkers

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66
Q

head and neck cancer risk factors

A

long periods of sun exposure, chewing tobacco, bad diet, breathing in chemical, genetic syndromes

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67
Q

leukoplakia is characterized by

A

irregular, smooth to thickened tissue on the tongue

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68
Q

erythoplakia is characterized by

A

smooth, velvety clinical presentation with a homogenous surface without ulceration

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69
Q

60-70% or oropharyngeal cancers are due to

A

HPV

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70
Q

clinical manifestations of head and neck cancer

A

ulcer or sore area in the head/neck, pain with chewing, trouble breathing, numb feeling in the mouth, unexplained loose tooth, persistent nose bleeds, constant sore throat, ear ringing, lump, pain

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71
Q

diagnosis of head/neck cancer

A

examination of mouth, throat, and neck, laryngoscopy, CT scan or MRI, PET scan

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72
Q

staging of head and neck cancer

A

TNM - tumor, number of nodes and location, and metastasis. stages 1-4

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73
Q

treatment options for oral cancer

A

surgery, radiation, or chemotherapy

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74
Q

transoral robotic surgery

A

removal of tumor during laryngeal cancer

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75
Q

total laryngectomy

A

open surgery to remove the entire larynx - stoma is created

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76
Q

radiation nursing care

A

adequate oral care because radiation causes dry mouth

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77
Q

nursing care of pt with trach stoma

A

wash stoma daily with moist cloth. clean edges with cotton swab dipped in mixture of hydrogen. remove inner cannula daily

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78
Q

larytube or larybutton

A

help keep the stoma open during early stages

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79
Q

blom singer laryngectomy tube

A

maintains latency of the trach after laryngectomy

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80
Q

diagnostics for asthma

A

CXR, measuring oximetry, H&P, pulmonary function studies

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81
Q

asthma care

A

identify and avoid triggers, pt teaching, meds

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82
Q

care for severe asthma exacerbation

A

SaO2 monitoring, ABGs, B2-adrenergic agonist, inhaled anticholinergic agents, oxygen, corticosteroids, IV fluids

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83
Q

teaching of inhaler

A

use spacer, Short acting beta agonist, clean unit to eliminate bacterial growth

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84
Q

singular

A

Leukotriene Pathway Inhibitor-Montelukast Sodium

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85
Q

three phases of a perioperative patient and what is our focus in each phase

A

preoperative- teaching and education, intraoperative- safety and sterile, and postoperative- pain management and prevention of complications

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86
Q

3 requirements of informed consent

A

adequate disclosure of diagnosis, purpose, and risks of treatment, understanding and comprehension, and consent given voluntarily

87
Q

nurses role during informed consent

A

advocate, witness, appropriate person signs consent

88
Q

consent may not be signed by a patient after

A

they have received narcotics or sedatives

89
Q

living will vs durable power of attorney

A

living will - short period of time/more emergent. durable power of attorney - can have early in illness and covers longer period of time

90
Q

pre surgical screening tests

A

chest x-ray, electrocardiography, urinalysis, and labs

91
Q

presurgical labs

A

CBC, CMP, pregnancy test, PT/INR, PTT

92
Q

nursing interventions for psychological needs of surgical patients

A

establish relationship, allow patient to verbalize fears, be prepared to response to questions about surgery

93
Q

preoperative checklist

A

document diagnostic tests, document pre-op medication given, document VS, document safety data which includes 2 identifiers, jewelry removed, last void/meal, dentures removed, informed consent verified, patient allergies

94
Q

SCIP protocol

A

antibiotic given 1 hour before surgery, glucose level below 200, hair removal, urinary catheter, beta blocker, VTE (anticoagulation) prophylaxis, temp management ( want temp in OR normal)

95
Q

phases of general anesthesia

A

induction, maintenance, emergence

96
Q

anesthetic complications

A

anaphylactic reactions from anesthesia or latex and malignant hyperthermia

97
Q

malignant hyperthermia

A

problem with receptor on skeletal muscle causing major metabolic reaction. familial history important

98
Q

malignant hyperthermia signs and symptoms

A

lactic acidosis, muscle contracture, hyperthermia. is important to identify early

99
Q

malignant hyperthermia treatment

A

dantrolene - directly interferes with muscle contraction by inhibiting ion release from the sarcoplasmic reticulum

100
Q

nurses job in the OR

A

universal protocol “time out”, maintenance of sterile technique, patient monitoring, instrument and sponge count

101
Q

common postoperative complications with respiratory

A

most common is atelectasis, pulmonary edema, aspiration, bronchospasm, hypoventilation, airway obstruction, pneumonia, hypoxemia

102
Q

what measures can be taken to prevent SSI

A

prophylactic antibiotics, hair removal, glycemic control, maintaining drainage devices

103
Q

dipstick urinalysis with presence of nitrates

A

indicated bacteriuria

104
Q

dipstick urinalysis with blood

A

infection

105
Q

dipstick urinalysis with ketones

A

dehydrated or DM

106
Q

indications for catheter

A

acute urinary retention obstruction, Perioperative use in selected surgeries, Assist healing of perineal and sacral wounds in incontinent patients, Hospice/palliative/comfort care, Required immobilization from trauma or surgery, Chronic indwelling catheter on admission, Accurate measurement of urine output in critically ill patients in ICU

107
Q

diagnostic test of pyelonephritis

A

elevated WC with increase in bands, leukocytes and WBC in urine (pyuria), positive urine cultures, positive blood cultures in bacteremia

108
Q

ESRD

A

end-stage renal disease (ESRD)

109
Q

what is the third leading cause of ESRD in the US

A

glomerulonephritis

110
Q

causes of acute glomerulonephritis

A

streptococcal infections (strep throat) group A beta hemolytic strep, viral infection, impetigo, lupus, good pastures syndrome, Wegener’s disease

111
Q

therapeutic management of glomerulonephritis

A

focuses on symptomatic management - antibiotics, protein and fluid restriction, bedrest, monitors I&Os, plasmapheresis, dialysis

112
Q

plasmapheresis

A

removal of harmful antibodies from the plasma

113
Q

nephrotic syndrome

A

glomerulus becomes permeable to plasma protein

114
Q

management of nephrotic syndrome

A

corticosteroids, control of DM, sodium restrictions and diuretics to control edema, and sure primary disease

115
Q

Lithotripsy

A

most common treatment for kidney stones in the U.S. Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment

116
Q

percutaneous nephrolithotomy

A

minimally-invasive procedure to remove stones from the kidney by a small puncture wound through the skin

117
Q

pyelolithitomy

A

surgical incision of the renal pelvis of a kidney for removal of a kidney stone.

118
Q

renal calculi teaching

A

drink 2000-3000 mL of fluid daily, lower protein intake, limit soda, coffee, and tea, less than 2 g sodium per day, avoid sudden increase in temp, avoid oxalate/purine containing foods, strain all urine

119
Q

ileal conduit

A

a system of urinary drainage which a surgeon creates using the small intestine after removing the bladder

120
Q

Nephrostomy

A

a small tube inserted through the skin directly into a kidney. The nephrostomy tube drains urine from the kidney into an external drainage pouch. this is only temporary

121
Q

diagnostics for BPH

A

DRE and PSA test

122
Q

cystitis

A

bladder UTI

123
Q

urethritis

A

urethra UTI

124
Q

normal calcium levels

A

8.6-10.2

125
Q

normal potassium levels

A

3.5-5

126
Q

stomy bag needs to be changed

A

every 3-4 days

127
Q

leading causes of amputation

A

infection, PAD, diabetes, trauma

128
Q

Metacarpal

A

removal of the entire hand with the wrist still intact.

129
Q

nursing goals of pt with amputation

A

Support psychological and physiological adjustment
Alleviate pain
Prevent complications
Promote mobility and functional abilities
Provide information about surgical procedure and treatment needs

130
Q

_________ stump to decrease swelling

A

elevate

131
Q

instruct patient after amputation to lie in _______ as tolerated at least twice a day

A

prone position

132
Q

how to care for incision after arthroplasty

A

with soap and water

133
Q

clinical manifestation of hip fracture

A 
External rotation and shortening
Muscle spasm
Severe pain
Shock 
No weight!
No walking!
134
Q

complications of joint surgery

A

infection and DVT

135
Q

5 Ps

A

pain, paresthesia, pallor, paralysis, pulselessness

136
Q

oblique fracture

A

complete fractures that occur at a plane oblique to the long axis of the bone

137
Q

comminuted fracture

A

a break or splinter of the bone into more than two fragments.

138
Q

spiral fracture

A

is a type of complete fracture. It occurs due to a rotational, or twisting, force

139
Q

complications of fractures

A 
Compartment syndrome
Fat embolism
Deep vein thrombosis (DVT)
Complications of immobility
Complications of fracture healing
140
Q

patient may become _______ ; ________ with a fat embolism

A

tachycardia and hypotensive

141
Q

what do you need to do for compartment syndrome

A

Fasciotomy required to relieve pressure and Emergent surgery required to prevent loss of limb

142
Q

myositis ossificans

A

bone forms within the muscle, and this occurs at the site of the hematoma

143
Q

osteomyletitis

A

Inflammation of bone caused by infection, generally in the legs, arm, or spine.

144
Q

sanguineous vs serous-sanguineous vs serous

A

sanguineous- red discharge (bleeding)
serous-sanguineous- pink discharge
serous- white discharge

145
Q

CSM

A

C- color plus cap refil, pulse, and temp
S- sensation
M- ability to move

146
Q

Hgb A1C levels

A

should be below or equal to 6.5

147
Q

1 unit of insulin lowers blood glucose by about

A

50 mg/dL

148
Q

regular insulin onset, peak, and duration?

A

onset - 30 minutes
peak - 2-4 hours
duration 6-8 hours

149
Q

lispro

A

ultra short acting insulin that is given 15 minutes before meal and leak levels seen within 30 minutes

150
Q

Lantus

A

called insulin Glargine - given once daily. provides a continuous low level of insulin secretion and cannot be mixed with any other insulin

151
Q

most protocols define hypoglycemia as

A

below 70 mg/dl

152
Q

mild symptoms of hypoglycemia

A

hunger, weakness, diaphoresis, dizzy, anxiousness, impaired vision, headache, and pounding heart

153
Q

severe symptoms of hypoglycemia

A

mental status changes, coma, death, unconsciousness, seizures

154
Q

mild/moderate hypoglycemia is defined as

A

FSBG 41-69 with or without symptoms

155
Q

severe hypoglycemia is defined as

A

41-69 if patient has mental status change or is unconscious, or NPO or FSBG is 40 or less

156
Q

glucagon

A

important hormone in carbohydrate metabolism that is released by the pancreas. helps maintain the level of glucose by causing liver to release its stored glucose.

157
Q

what precaution should severe hypoglycemia patient be put on

A

seizure precautions

158
Q

diagnostic test for meningitis

A

nasopharyngeal swab, test for kerning’s and brundzinski’s sign, x-rays, gram strain, cultures

159
Q

brudzzinski’s sign

A

severe neck stiffness causes a patients hips and knees to flex when the neck is flexed during meningitis

160
Q

kerning’s sign

A

severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed 90 degrees

161
Q

bacterial meningitic labs

A

WBC- greater than 1000
protein - greater than 500
glucose - decreased

162
Q

viral meningitis

A

WBC- 25-500
protein 50-500
glucose- normal

163
Q

how do you rule out bacterial meningitis

A

lumbar puncture

164
Q

meningitis vs encephalitis

A

patient with meningitis may be uncomfortable, lethargic, or distracted while encephalitis causes alteration in brain function

165
Q

BP will be _____ during a hemorrhagic stroke

A

elevated

166
Q

right hemisphere

A

attention span, impulse control, movement of left side, drawing skills, remembering visual object, face recognition, left side awareness, measuring distance of objects to body

167
Q

left hemisphere

A

motor speech, expressive speech, movement of right side, emotion, math, writing, reading letters and numbers, recognizing objects, remembering written info

168
Q

FAST

A

facial drop, arm weakness, speech difficulty, time to call 911

169
Q

medications for seizures

A

Ativan if status epilepticus. tonic-clonic: dilantin, tegretol…

170
Q

Guillain-Barre syndrome

A

acute, rapidly progressing motor neuropathy involving segmental demyelination of the nerve roots in the spinal cord and medulla

171
Q

clinical manifestations of Guillain barre syndrome

A

paralysis that starts in lower extremities and ascends bilaterally, paralysis of respiratory muscles, difficulty swallowing and talking, facial flushing, hypotension

172
Q

stages of Guillain Barre syndrome

A

acute, plateau, and recovery

173
Q

treatment for Guillain Barre syndrome

A

respiratory support, corticosteroids, immunosuppressants, plasmapheresis

174
Q

most common upper GI problem

A

GERD

175
Q

most common cause of GERD

A

hiatal hernia

176
Q

clinical manifestations of GERD

A

heartburn, dyspepsia, regurgitation, non cardiac chest pain, some respiratory symptoms

177
Q

GERD is directly related to

A

esophagus cancer

178
Q

diagnostics for GERD

A

EGD - esophagogaatroduodenoscopy, esophagram barium swallow, physical, or biopsy

179
Q

treatment of GERD

A

medications: H2 receptor blockers, PPIs, cholinergic, antacids, motility enhancers

180
Q

surgical procedures for GERD

A

laparoscopic - Nissen and toupet fundoplications

181
Q

main causes of peptic ulcers

A

aspirin and NSAIDs

182
Q

mortality is higher in which ulcers

A

gastric ulcers

183
Q

gastric ulcer pain

A

burning gassy pain felt high in epigastric 1-2 hours after meal

184
Q

duodenal ulcer pain

A

burning crampy upper abdominal pain usually 2-5 hours post meal

185
Q

cholelithiasis

A

stones in the gallbladder

186
Q

cholecystitis

A

inflammation of the gallbladder can be from gallstones or biliary sludge

187
Q

cholelithiasis occurs when

A

the balance of cholesterol, bile salts, and calcium in solution are altered

188
Q

initial clinical manifestations of gallbladder disease

A

indigestion, right upper quadrant pain, acute pain, V/N

189
Q

total gallbladder obstruction clinical manifestations

A

jaundice, dark amber urine, clay color stools, pruritus, intolerance of fatty food

190
Q

if ultrasounds is negative for gallstone diagnostic what is usually next

A

HIDA scan - cholescintigraphy

191
Q

labs for gallstones

A

elevated WBC, elevated direct and indirect bilirubin, AST and ALT might be elevated

192
Q

medical treatment for gallstones

A

NPO, medications, gastric decompression with BG tube, ERCP, surgery

193
Q

ERCP

A

Endoscopic retrograde cholangio-pancreatography

194
Q

open cholecystectomy

A

removal of gallbladder through right subcostal incision and T-tube inserted into the common bile duct which allows bile to drain

195
Q

how can you increase comfort for pt with laprascopic

A

Sims position

196
Q

1 and #2 causes of pancreatitis

A 
#1 - gallbladder disease
#2 - alcohol
197
Q

clinical manifestations of acute pancreatitis

A

pain - epigastric and radiating to back left flank and shoulder, N/V, low grade fever, hypotension, tachycardia, jaundice, paralytic ileus, tetany

198
Q

tetany

A

involuntary contraction of muscles - hypocalcemia

199
Q

paralytic ileus

A

absent or decreased bowel sounds

200
Q

blood test for acute pancreatitis

A

amylase and lipase will be elevated, elevated glucose, low calcium, increase triglycerides

201
Q

position for comfort during pancreatitis

A

fetal, side-lying, HOB elevated, sitting up leaning forward

202
Q

acute appendicitis clinical manifestations

A

periumbilical abdominal pain followed by anorexia, n/v, low grade fever

203
Q

is a CT or MRI preferred with appendicitis

A

CT

204
Q

crohns lesions are most common in the

A

distal ileum

205
Q

ulcerative colitis happens in the

A

rectosigmoid colon and rectum - begins in the rectum

206
Q

ulcerative colitis

A

bloody stools, left lower quadrant pain, diarrhea, weight loss not as common as crohns

207
Q

crohns manifestations

A

diarrhea, abd pain, cramping, weight loss

208
Q

inflammatory bowel disease pt need to be supplemented with

A

iron and B 12

209
Q

avoid what foods with inflammatory bowel disease

A

lactose, high fat, cold foods and high fiber foods

210
Q

risk factors of colorectal cancer

A

history of IBD, DM, smoking, alcohol, obesity, consuming more than 7 servings a week of red meat, family history, and KRAS gene mutation

211
Q

clinical manifestations of colorectal cancer

A

iron deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits

212
Q

diverticulum is most common in

A

the sigmoid colon

213
Q

what antibiotic do pt with diverticulitis usually get

A

flagyl

Nursing school level 2 (15 decks)

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