UWorld Stuff

Question 1

Torsades de Pointes

Answer 1

usually caused by hypomagnesemia

first line treatment is IV mag and defib.

discontinue any meds that cause QT prolonging (such as Ziprasidone)

Question 2

Myopia

Answer 2

nearsightedness

can’t see far away

Question 3

Airborne precautions for

Answer 3

measles

TB

varicella

Question 4

GCS ranges

Answer 4

Head injury classification:Mild, GCS 13-15; moderate, GCS 9-12; severe, GCS ≤8.

Question 5

“permissive hypertension”

Answer 5

acute stroke pts requires “permissive hypertension” during first 24-48 hours for adequate perfusion through the damaged cerebral tissues.

However, the blood-brain barrier is no longer intact once the blood pressure is >220/120 mm Hg.

Therefore, “mild” lowering is required, usually to a systolic pressure that is not below 170 mm Hg.

Question 6

HYPO or HYPERnatremia when you dilute formula

Answer 6

hypo

Question 7

Post-Laparoscopic Cholecystectomy and right shoulder pain

Answer 7

referred pain

not heart attack

Question 8

Rationalization

Answer 8

Using excuses to explain away threatening circumstances

“I did poorly on the test because the questions were so tricky”

Question 9

Displacement

Answer 9

Transferring thoughts & feelings toward one person or object onto another person or object

A person who is angry with a boss comes home & yells at the spouse

Question 10

Regression

Answer 10

Returning to a previous level of development

Question 11

Introjection

Answer 11

Taking on the qualities or attitudes of others without thought or examination

A person may take on the political views of a famous, admired actor

Question 12

Reaction formation

Answer 12

Behaving in a manner or expressing a feeling opposite of one’s true feelings

A parent who is resentful of an “unplanned” child becomes overprotective of that child

Question 13

Repression

Answer 13

Keeping unacceptable thoughts or traumatic events buried in the unconscious

A person who was raped cannot recall the event

Question 14

Sublimation

Answer 14

Transforming unacceptable thoughts or needs into acceptable actions

A person may turn to boxing to deal with aggression

Question 15

What disease processes need droplet precautions?

Answer 15

Neisseria meningitidis (bacterial)
Haemophilus influenzae type B
Diphtheria
Mumps
Rubella
Pertussis
Group A Streptococcus (strep throat)
Viral influenza

Question 16

Contractions during first stage of labor

Answer 16

last 45-80 seconds
should not exceed 90 seconds

2-5 contractions every 10 min
should not occur more than every 2 minutes

intensity - 25-50 mmHg (should not exceed 80)

***If uterus is contracting for 90 seconds or longer, then uterine hypertonicity is occurring which is decreasing blood flow to the placenta and fetus.

Question 17

Babinski sign

Answer 17

plantar reflex

younger than 1 = toes fan out = reflex present

older than 1 = toes curl in (planter felxion) = reflex absent

Question 18

Parkinson’s

Answer 18

bradykinesia
muscle rigidity
resting tremor
shuffling gait
masked facial expression

Question 19

Histrionic Disorder

Answer 19

self-dramatizing

Attention-seeking, needs to be the center of attention

Overly friendly and seductive, attempts to keep others engaged

Demands immediate gratification and has little tolerance for frustration

Question 20

HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count)

Answer 20

form of preeclampsia

Symptoms may be nonspecific, such as right upper quadrant pain and nausea.

Question 21

Retinoblastoma

Answer 21

white pupil (leukocoria / cat’s eye reflex is one of the first signs

it’s an intraoccular malignancy of the retina.

other s/sx: absent red reflex, asymmetric or of a differing color in the affected eye, and fixed strabismus (constant deviation of one eye from the other).

Question 22

sunset eyes

Answer 22

sclera visible above the iris

indicates increased intracranial pressure

Question 23

Zika Virus

Answer 23

transmitted via mosquitoes, sexual contact, and infected bodily fluids

s/sx: low-grade fever, arthralgias, microcephaly, developmental dysfunction, encephalitis in babies born to zika-infected women

avoid travel in areas w Zika Virus

Question 24

Amyotrophic lateral sclerosis (ALS)

Answer 24

progressive loss of motor neurons in the brainstem and spinal cord.

no cure.

fatigue, progressive muscle weakness, twitching and muscle spasms, difficulty swallowing, difficulty speaking, and respiratory failure.

Most clients survive only 3-5 years after the diagnosis as there is no cure.

Neurons involved in swallowing and respiratory function are eventually impaired, leading to aspiration, respiratory failure, and death.

Question 25

Riluzole

Answer 25

Riluzole (Rilutek) is the only medication approved for ALS treatment.

it slows disease progression and prolong survival by 3-6 mo

Question 26

Broca aphasia

Answer 26

expressive aphasia

they can comprehend things but have difficulty speaking

Broca aphasia - comprehend speech but demonstrate speech difficulties. The speech pattern often consists of short, limited phrases that make sense but display great effort and frequent omission of smaller words (eg, “and,” “is,” “the”)

they are aware of their deficits and can become frustrated easily

Question 27

Wernicke aphasia

Answer 27

receptive or fluent aphasia

unaware of their speech impairment

inability to comprehend spoken / written word and have a long but meaningless speech pattern

Question 28

global aphasia

Answer 28

the inability to read, write, or understand speech. This is the most severe form of aphasia.

damage to lots of brain (think broca + wernicke)

Question 29

Cystic fibrosis

Answer 29

diet high in calories, protein, and fat

Question 30

Kawasaki Disease

Answer 30

inflammation of arterial walls / not contagious

Acute - sudden onset of high fever (doesn’t respond to antibiotics or antipyretics / irritable / swollen red feet and hands / swollen and cracked lips / strawberry tongue

Subacute - skin peels from hands and feet / irritable

Convalescent - symptoms disappear slowly / no longer irritable

Question 31

Kawasaki Disease Tx

Answer 31

IV gamma globulin and aspirin

** we’re not worried about Reye atm so aspirin is fine

coronary artery aneurysms are most serious problem, and we give aspirin to prevent

Question 32

Histoplasmosis

Answer 32

from bird/bat feces and contaminated soil

fungal spores inhaled

Opportunistic fungal infection.
Get it from bird or bat droppings.
Pts are either asymptomatic or have mild pneumonialike symptoms (fatigue, fever, dyspnea, cough)

Question 33

Thyrotoxicosis

Answer 33

thyroid storm - increase in thyroid hormone that results in hyper-metabolic state

usually happens after exacerbation of hyperthyroidism

treated with antithyroid medications and/or surgical removal of the thyroid (ie, thyroidectomy).
nurse caring for a client after thyroidectomy must closely monitor for and immediately report any clinical manifestations of thyrotoxicosis (eg, fever, anxiety, tachycardia), particularly in clients with hyperthyroidism.

After surgery, thyroid hormone levels can remain elevated for several days, and may even increase, from intraoperative thyroid gland manipulation. Without treatment, thyrotoxicosis can rapidly progress to lethal complications (eg, hyperthermia, malignant hypertension, ventricular tachycardia).

Question 34

Meds for Anaphylactic shock

Answer 34

Epinephrine, intramuscular –dilates bronchial smooth muscleand provides vasoconstriction.

Bronchodilator such as albuterol is administered to dilate the small airways and reverse bronchoconstriction

Antihistamine (diphenhydramine) is administered to modify the hypersensitivity reaction and relieve pruritus

Corticosteroids (methylprednisolone)administered to decrease airway inflammation and swelling associated with the allergic reaction

Question 35

Lactase Deficiency

Answer 35

Another word for Lactose intolerance.

*** Can still eat cheeseand yogurtas long as it doesn’t make them feel sick (both have low levels of lactose)

Milk and icecream have highest levels.

Take daily calcium and vitamin D supplement

Lactase enzyme supplement should be taken with meals containing dairy

Question 36

Sinusoidal FHR

Answer 36

Repetitive, wave-like fluctuations w absent variability (no response to contractions).

Suggests severe fetal anemia.

Question 37

Neurogenic Shock

Answer 37

distributive (vasodilatory) shock.

Bradycardia, massive vasodilation (hypotension), pooling of blood in veins, skin will be warm and dry due to vasodilation, poikilothermia (impaired thermoregulation / late sign)

Question 38

Systemic inflammatory response syndrome (SIRS)

Answer 38

vasodilation and capillary leakage, leading to hypotension and impaired end-organ perfusion

SIRS may occur in response to trauma, tissue ischemia, infection (ie, sepsis), and shock and can rapidly progress to hemodynamic instability, respiratory failure, and multi-organ dysfunction.

fever or hypothermia, tachycardia, leukocytosis or leukopenia, tachypnea

** sudden high fever and PaCO2 of 30 = SIRS

Question 39

Hemophilia

Answer 39

bleeding disorder caused by deficiency in coagulation proteins.

Treatment - replace missing clotting factor and teach injury prevention.

Factor VIII first, then CT scan to check for intracranial bleed.

Headache? Think intracranial bleed.

No aspirin. No contact sports. Need to wear medical alert bracelet.

Regular Diet.

Question 40

Tiotropium

Answer 40

inhaled steroid for COPD. You put the capsule in device and press a button and it pokes a hole into the capsule to let out powder that you then inhale into your lungs.

Should not be used as a rescue drug.

Should rinse your mouth out afterwards (its a steroid).

Does not reduce inflammation but causes bronchodilation.

Question 41

Ziprasidone hydrochloride (Geodon)

Answer 41

typical antipsychotic drug that is used for acute bipolar mania, acute psychosis, and agitation. Its use carries a risk for QT prolongation leading to torsade de pointes.

client should be placed on a cardiac monitor.

monitored for hypotension and seizures,

Question 42

Clomiphene

Answer 42

first-line treatment for infertility for women and works by stimulating ovulation.

Taken orally for 5 days early in the menstrual cycle (eg, beginning on days 3-5 of menses). Ovulation typically occurs 5-9 days after completing the medication.

Therefore, client needs to understand the importance of engaging in frequent sexual intercourse (every other day for 1 week) 5 days after completing the medication for the best chance of successful conception.

Question 43

Bumetanide

Answer 43

loop diuretic.

Question 44

Rifapentine

Answer 44

TB drug (antitubercular agent) used w other agents (isoniazid) in combination therapy for active and latent TB

reduce the efficacy of oral contraceptives

may cause red-orange-colored body secretions, which is an expected finding. Dentures and contact lenses may be permanently stained.

taken with meals

Hepatotoxicity may occur; therefore, liver function tests are required at least every month. Signs and symptoms of hepatitis include jaundice of the eyes and skin, fatigue, weakness, nausea, and anorexia.

Question 45

Atorvastatin

Answer 45

lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease.

serious adverse effect of statins, including atorvastatin and rosuvastatin (Crestor), is myopathy with ongoing generalized muscle aches and weakness.

A client who develops muscle aches while on a statin drug should call the HCP who will then obtain a blood sample to assess the creatine kinase (CK) level. If myopathy is present, CK will be significantly elevated (≥10x normal), and the drug will then be discontinued.

Question 46

Clozapine

Answer 46

An atypical antipsychotic medication.

can cause agranulocytosis

Used to treat schizophrenia that’s not respondingto standard treatment.

A client must have a WBC count of ≥3500/mm3 (3.5 × 109/L) and an absolute neutrophil count (ANC) of ≥2000/mm3 (2 × 109/L) before starting clozapine, so it is critical to obtain a baseline complete blood count and ANC.

Clients should also contact the health care provider immediately if they develop fever or sore throat, which can indicate infection due to neutropenia.

Question 47

Trismus

Answer 47

(inability to open the mouth due to a tonic contraction of the muscles used for chewing) may indicate a more serious complication of tonsillitis, a peritonsillar or retropharyngeal abscess (collection of pus).