UWORLD stuff

Question 1

malignant hyperthermia cause and s/s

Answer 1

• rare but life threatening inherited muscle abnormality that is triggered by specific, inhaled anesthetic agents and the depolarizing muscle relaxant succinylocholine used to induce general anethesia

Severe muscle rigidity or spasms.
Rapid, shallow breathing and problems with low oxygen and high carbon dioxide.
Rapid heart rate.
Irregular heart rhythm.
Dangerously high body temperature.
Excessive sweating.
Patchy, irregular skin color (mottled skin)

Question 2

cause of tumor lysis syndrome

Answer 2

Tumor lysis syndrome is caused by the massive release of intracellular ions such as potassium, phosphorus, and nucleic acids that have been metabolized to uric acid. The main organ responsible for the excretions of these substances is the kidney.

** allopurinal = med to decrease uric acid levels

Question 3

where to give immunizations for infant

Answer 3

anterolateral thigh with 1 in needle

** ventrogluteal area does not have enough muscle mass till at least age 3

Question 4

medications that cannot be combined

Answer 4

MAOIs (segeline) and SSRIs –> serotonin syndrome, NMS and hypertensive crisis

MAOIs need to be discontinued for at least 2 weeks before starting a new medication

Question 5

concerning assessment of neonate

Answer 5

**ptosis (Drooping of eyelid) could be indicative of paralysis of a cranial nerve

** remember that fluid heard in lungs should clear on its own with transition into real life, testes should decend by 6 months

Question 6

sickle cell anemia

Answer 6

at risk for dehydration

Question 7

hemophilia a

Answer 7

abnormal/inability to blood to clot

**not at risk for dehydration, no need for special diet

Question 8

concerns with “sulfa” drugs

Answer 8

dehydration

Question 9

IBD

Answer 9

common to have lower hemoglobin

common to have elevated c-reactive protein, ESR, and WBCs

• *black tarry stools require followup but not immediate priority
• *at risk for dehydration

Question 10

how often should a peripheral IV be changed

Answer 10

72-96 hours

Question 11

tachyarrhythmias intervention

Answer 11

cardioversion

Question 12

s/s of an asthma attack

Answer 12

rapid breathing
chest tightness
wheezing on expiratory
use of accessory muscles
cough from airway inflamation and increased mucus production
diminished breath sounds d/t hyperinflation

Question 13

IM injections

Answer 13

muscular area, 1 in to 1.5 inches for adults

Question 14

graves disease s/s

Answer 14

fever
excessive autonomic activity
AMS

*** condition occurs when the thyroid gland secretes excessive amount of hormone during stress, trauma, surgery, infection, etc

Question 15

botulism

Answer 15

life threatening condition with different causes… all stem from bacteria which could lead to paralysis

(from eating honey… young infants are unable to breakdown the bacteria in it)
–> improperly canned foods
early s/s –> can’t hold head up, constipation, diminished DTR, difficulty feeding

Question 16

breast engorgement treatment for woman who is exclusively using formula

Answer 16

cabbage leaves until they wilt
analgesic
ice packs for 15-20 mins every 3-4 hours

Question 17

EA/TEF

Answer 17

frothy saliva 
coughing 
choking 
drooling 
distended abdomen

Question 18

care of ascending colostomy

Answer 18

identify foods that are gassy/cause odor, avoid
clarify medications that are enteric coated with doctor
need sufficient fluid intake

Question 19

clozapine (clozaril)

Answer 19

atypical antipsychotic
at risk for agranulocytosis, cardiac disease (myocarditis) and seizures

**common side effects: weight gain, hypersalivation

Question 20

valsalva manuver

Answer 20

vagus nerve is stimulated
this slows down heart rate and decreases CO which could lead to cardiac complications
straining increases intra-abdominal and intrathoracic pressure and ICP
remember contraindicted in liver cirrhosis, eye surgery, heart disease, head injury, stroke, etc

Question 21

pts that should not use the valsalva manuver

Answer 21

vagus nerve is stimulated
this slows down heart rate and decreases CO which could lead to cardiac complications
straining increases intra-abdominal and intrathoracic pressure and ICP
remember contraindicted in liver cirrhosis, eye surgery, heart disease, head injury, stroke, etc

Question 22

ACE inhibitors

Answer 22

increase serum potassium, so always assess BP and K+ prior to administration

Question 23

SBFT

Answer 23

imaging study to assess the function of the small bowel
non-invasive
fast for 8 hours prior to administration
stools may be chalky for 72 hours

Question 24

complications of PEEP

Answer 24

barotrauma –> pneumothorax and subcutaneous emphysema … decreased venous return which can lead to hypotension

Question 25

raynaud phenomenon

Answer 25

vasospastic disorder resulting in an episodic vascular response related to cold temp or emotional stress s/s color change in appendages white in color from decreased perfusion followed by bluish-purple appearance d/t cyanosis numbness/coldness pt should immerse hands in warm watter may also be prescribed CCB avoid COLD water

Question 26

fifth disease "slapped face" or erythema infectiosum

Answer 26

viral illness caused by human parvovirus and affects mainly school aged children - spread thru resp secretions and period of communicability occurs before onset of symptoms - distinct red rash on cheeks *then spreads to extremities and a maculopapular rash develops then goes to proximal and distal surfaces* - malaise - joint pain - can take NSAIDS - typically recover within 7-10 days - once they develop symptoms THEY ARE NO LONGER INFECTIOUS .... ISOLATION NOT REQUIRED

Question 27

transplant pts

Answer 27

likely immunosuppressed by steroids and anti-rejection drugs - organ transplant clients will have blunted response to infection, such as a low-grade fever * *SYSTEMIC SYMPTOMS may indicate serious underlying infection** - may develop fulminant sepsis w/in a few hours if antibiotics are delayed * *IN PRIORITIZING PTS SYSTEMIC > LOCALIZED S/S**

Question 28

position for prolapsed cord

Answer 28

knee-chest position or trendelenburg **nurse can also use sterile, gloved hand to lift the presenting part off the cord** other --> o2 and IV fluids otherwise --> cord compression and impaired fetal oxygenation occurs emergency c-section ususally required unless vag birth is imminent and safe

Question 29

shoulder dystocia

Answer 29

mcroberts maneuver

Question 30

leopold maneuver

Answer 30

systematic approach to palpating the pregnant abdomen to identify fetal presentation

Question 31

Kawasaki disease

Answer 31

mucocutaneous lymph node syndrome - >/= 5 days of fever, bilateral nonexudative conjunctivitis, mucositis, cervical luymphadenopathy, rash and extremity swelling **CORONARY ARTERY ANEURYSMS are the most serious possible sequelae in untreated clients.. need EKG** **IVIG and aspirin therapy... parents cautioned about risk of reye syndrome... also teach CPR**

Question 32

scope of practice RN

Answer 32

``` clinical assessment intitial client education discharge education clinical judgement initiating blood transfusion ```

Question 33

scope of LPN/LVN

Answer 33

``` monitor RN findingd reinforce education routine procedures (cath insertion) most med administrations ostomy care tube patency & enteral feeding specific assessments (lung sounds, bowel, neuro checks) ```

Question 34

scope of UAP

Answer 34

``` activities of daily living hygiene linen change routine, stable VS documenting i/o positioning ```

Question 35

catatonic schizophrenia

Answer 35

immbolity, remaining mute, bizarre postures, extreme postures, extreme negativism, staring - unable to meet basic needs so at high risk for dehydration and malnutrition

Question 36

myelomeningocele

Answer 36

- occurs as result of neural tube failing to fuse properly during fetal development high risk for infection, priority is to cover the area with sterile moise dressing - at risk for hydrocephalus - place newborn in prone position, with face turned to side to prevent rupture

Question 37

therapeutic aPTT for heparin pt

Answer 37

between 46-70 seconds (1.5-2.0x baseline) **protamine is reversal agent for heparin**

Question 38

autonomic dysreflexia

Answer 38

occur in any individual with a spinal cord injury at or above T6 - leads to exaggerated sympathetic nervous system response resulting in uncontrolled hypertension - common triggers include bladder or rectum distension and pressure ulcers MANIFESTATIONS: acute onset of throbbing h/a, nausea, blurred vision; hypertension and bradycardia; diaphoresis and skin flushing above level of injury MED EMERGENCY --> need bladder cath to remove precipitating trigger

Question 39

GBS

Answer 39

acute immune-mediated polyneuropathy - ascending muscle paralysis - absence of reflexes - autonomic dysfunction is common (orthostatic hypotension, paralytic ileus, urinary retention, diaphoresis) - NM respiratory failure is the most life-threatening complication **monitor rate and depth of resp** GOLD STANDARD FOR ASSESSING EARLY VENTILATION FAILURE: measurement of serial bedside forced vital capacity (spirometry)

Question 40

active pulmonary TB

Answer 40

``` - airborne precaution (N95, hand hygiene) clinical manifestations: - cough - night sweats - fever - hemoptysis - unintended weight loss - fatigue **negative pressure room** ```

Question 41

ectopic pregnancy

Answer 41

fertilized egg implants and begins to grow outside the uterine cavity - may report a positive pregnancy test - abdominal pain vaginal spotting/bleeding ** can result in hemorrhage if left untreated and hemodynamic compromise**

Question 42

reaction to MMRV vax

Answer 42

- within 5-12 days after 1st dose - low-grade fever, mild rash, swelling and erythema, irritability and restlessness - rare but fever after MMRV cax can lead to febrile seizures

Question 43

toxoplasmosis

Answer 43

parasitic infection... acquired from exposure to infected cat feces or ingestion of undercooked meat or soil contaminated fruits/veggies can cause serious fetal harm

Question 44

SE of statins

Answer 44

hepatotoxicity muscle aches **assess LFT prior to starting med

Question 45

manifestations of airway obstruction

Answer 45

snoring use of accessory muscles decr o2 saturations cyanosis **head tilt and chin lift is a maneuver used to open the airway**

Question 46

risk factors of postpartum hemorrhage + extras

Answer 46

risk factors: grand multiparity (ie >/ 5 births), intrauterine infection, prolonged labor, use of oxytocin during labor, and coagulopathy perineal pad that is saturated in 1 hour indicates heavy/excessive bleeding --> hemodynamic compromise ** assess fundal tone, lochia amount and VS and notify HCP IMMEDIATELY!**

Question 47

burn injuries

Answer 47

cause cellular destruction, capillary leaking and fluid shifts fluids are lost during the emergent phase (first 24-72 hours), resulting in hypovolemia and hyponatremia... blood is more viscous and incr hematocrit and hemoglobin values also releases potassium so hyperkalemia **tall, peaked T waves, shortened QT interval and cardiac arrhythmias**

Question 48

mature minors

Answer 48

adolescents 14-18, deemed able to understand treatment risks allowed to give independent consent to receive/refuse treatment for some conditions (STIs, family planning, drug and alcohol abuse, blood donation and mental health care)

Question 49

mild-to-moderate dementia

Answer 49

may need frequent reality reorientation to promote appropriate behaviors **advanced dementia --> reality orientation may not be effective and might lead to anxiety, inappropriate behaviors and aggression, then use validation therapy**

Question 50

cirrhosis

Answer 50

leads to elevated bilirubin, ammonia and coagulation studies (PT/INR and aPTT) hyponatremia and hypoalbuminemia are expected

Question 51

polycythemia vera

Answer 51

requires periodic therapeutic phlebotomy treatments to reduce RBC count + risk of blood clotting associated with increased blood viscosity ** this can also occur secondary in someone w chronic hypoxemia (such as COPD) ** sluggish blood means decr tissue perfusion

Question 52

thrombocytopenic purpura

Answer 52

autoimmune condition in which antibodies bind to and cause destruction of platelets increased risk for bleeding * *remember better to use electric razors, not safety razors** * * low impact activity**

Question 53

somatic symptom disorder

Answer 53

psychological disorder that develops from stress --> medically unexplainable physical symtpoms * *redirect somatic complaints to unrelated, neutral topics * * limit time spent discussing physical symptoms * * secondary gains --> factors that intensify symptoms and coping strategies

Question 54

IV narcotics *pregnancy

Answer 54

nalbuphine, butorphanol, meperidine give during the peak of contractions... can help decrease the sedation of the fetus and subsequent NB resp distress at birth less med passes the placental barrier

Question 55

autonomic dysfunction + causes

Answer 55

dysfunction of the nerves that regulate nonvoluntary body functions, HR, BP and sweating *also affects BR, digestion, sensation ** can be sudden and severe but also reversible... typically irreversible causes: uncontrolled diabetes, irregulat protein build up in organs (amyloidosis), autodimmune diseases, some meds (cancer drugs), viruses and bacteria (HIV, botulism, lyme) and some inherited disorders (hypothyrodism)