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review 2 Flashcards

1
Q

pt with burn that has no blisters and only epidermis

A

first degree

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2
Q

what is second degree burn

A

partial thickness - moist, blisters, extends beyond epidermis

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3
Q

third degree burn

A

full thickness - dry, leathery , black pearly, dermis to underlying tissues, fat , muscle and or bone

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4
Q

parkland formula

A

fluid replacement for burns
4ml/kg x TBSA% burned during 24 hours
1/2 of fluid in 8 hours, remaining over 16 hours

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5
Q

tx to burn center criteria

A

partial thickness (2nd degree) >10% of TBSA
burn on face, hands, feet, genitalia, perineum, or major joints
3rd degree burns
electrical burn, including lightning
chemical burns
inhalation injury
burn with pt that has comorbidites making care complex
burn with trauma
burn children
burn that has special social, emotional or rehab needs

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6
Q

avulsion

A

bone fragments pulled off by attached ligaments and tendons

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7
Q

pt has headache, changes in vision and fever you note tenderness to temporal artery what do you suspect

A

giant cell arteritis

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8
Q

associated labs to giant cell arteritis

A

very high ESR
normal WBC
temporal artery biopsy postive in 85-95% cases

TX prednisone and referral

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9
Q

describe arteries in eye vs vein

A

arteries are brighter red and narrower than veins: A:V= 2:3 or 4:5

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10
Q

type 1 error

A

false positive; incorrectly rejecting the true null hypothesis

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11
Q

type 2 error

A

false negative ; failing to reject a null hypothesis which is false

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12
Q

national mandate to prevent VAP

A

HOB elevated

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13
Q

true or false ; there is pain in the eye associated with conjunctivitis

A

false

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14
Q

what is the minimal level of professional competence

A

credentialing

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15
Q

who oversees the licensure of the APRN

A

state BON

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16
Q

the ability of a test to correctly identify those with a disease

A

sensitivity

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17
Q

ability of a test to correctly identify those with out the disease (negative)

A

spcificty

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18
Q

null hypothesis

A

there is no significant relationship between the variables and the study. if the null hypothesis is rejected it means the results of the study are not due to chance

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19
Q

p <0/05 does what to null

A

rejects

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20
Q

p >0.05 does what to null

A

fails to reject the null

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21
Q

a pneumonia occurs 72 hours after endotracheal intubation- what is this and how do you treat

A

VAP
Vanco
Zosyn / cefepime / meropenem
Levofloxacin/ciprofloxacin

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22
Q

normal iop (intraocular pressure)

A

10 - 20 mm

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23
Q

tx for a pt with Addisons that is hypotensive

A

give D5NS

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24
Q

arcus senilis

A

blue/grey corneal ring in elderly due to hyperlipidemia ; permanent color change, no effect on vision

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25
Q

what changes would you make to vent if a pt has ARDS

A

decrease tidal volume (4-6ml/kg IBS instead of 6-8) with PEEP

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26
Q

management of open angle chronic glaucoma

A

prostaglandin analogs (latanoprost,bimatoprost,tafluprost… PROST)

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27
Q

tx for pt on vent if pulmonary shunting

A

increase PEEP

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28
Q

what lab is beneficial to assess prior to enteral feeding

A

pre-albumin

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29
Q

which population is at risk of angioedema with ACE inhibitor

A

African American

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30
Q

pt presents with suspected OD and has hyperkalemia, elevated LFTS and ph of 7.2 with normal C02 and low bicarb what do you suspect substance as overdose

A

ASA

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31
Q

what electrolyte disturbance should you monitor for with pt bone mets

A

hypercalcemia

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32
Q

s/s of hypercalcemia

A

muscle weakness
n/v
constipation
depression
anorexia

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33
Q

causes of pre-renal failure

A

impaired renal perfusion *(shock, dehydration, cardiac failure, burns, diarrhea, sepsis)

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34
Q

causes of intra-renal failure

A

nephrotoxic agents (ahminoglycosides -mycin drugs)
allergic disorders
mismatched blood tranfusion
damage to tubular portion of nephron- ATN

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35
Q

s/s of meth OD

A

mydriasis (dilated pupils)
hyperthermia
hallucinations

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36
Q

recommended testing for HIV

A

1-HIV 1/2 antigen/antibody combination immunoassay ; if postive procedure to HIV 1/HIV 22 antibody differentiation immunoassay

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37
Q

tx for prevention of pneumocystis pneumonia

A

bactrim

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38
Q

pt presents with butterfly rash, fever and weight loss what labs do you order to confirm diagnosis

A

Systemic Lupus Erythematous (SLE)

ANA ( + in 95% of patients)
antiphospholipid antibodies
CBC = anemia, leukopenia and thrombocytopenia

39
Q

Single best predictor of functional impairment after discharge

A

cognitive function

40
Q

Mnemonic for type of cranial nerve

A

s-some
s-say
m-marry
m-money
b-but
m-my
b-brother
s-says
b-big
b-bra
-m-matter
m-most

41
Q

mini mental mnemonic

A

O-orientation
r- recognition
a- attention
r-recall
l- language
2- identify 2 objects
3- follow 3 step commond
r-reading
w-writing
d-drawing

score: Max 30 , 24-30 no cognitive impairment
18-23 mild impairment, 0-17 severe impairment

42
Q

what is homonymous hemianopia

A

half vision

43
Q

do you want the family in the room while doing mini mental

A

no

44
Q

when do you do carotid endarterectomy

A

symptomatic with 50-90% stenosis
asymptomatic with >70-99%

45
Q

when is fibrinolytic therapy indicated in CVA

A

preferably <3-4.5 hours from onset of s/s

46
Q

initial therapy tx of seizure

A

5-20 minutes

IM midazolam
IV lorazepam- may repeat once
IV diazepam - may repeat once

47
Q

second therapy tx of seizure

A

20-40 minutes

IV fosphenytoin
IV valproic acid
IV levetiracetam

if not AV IV phenobarbital

48
Q

3rd therapy tx of seizure

A

40-60 minutes

repeat second line OR
anesthetic doses

49
Q

what is the reduction of the number of acetylcholine receptor sites

A

Myasthenia gravis

50
Q

what is MS

A

multiple sclerosis
body immune system attacks myelin

51
Q

woman presents with ptosis, dysarthria and extreme weakness what do you test for to confirm suspected dx

A

antibodies to acetylcholine receptors - MG

52
Q

pt has slightly elevated protein in CSF with numbness and tingling in a limb that progresses to all limbs - what is the dx

A

multiple sclerosis

53
Q

first test to order for MS

A

MRI before LP

54
Q

tx for MG

A

anti cholinesterase drugs-prostigmin
immunosuppressives
plasmapheresis
vent support during crisis

55
Q

mtg for MS

A

antispasmodics
interferon therapy
immunosuppressive therapy
plasmapheresis

56
Q

what is GBS

A

Guillain barre syndrome
progressive symmetrical ascending paralysis - usually preceded by suspected viral infection with fever 1-3 weeks before

57
Q

kernels sign

A

pain and spasms of hamstring muscles - s/s of meningitis

58
Q

you suspect meningitis what test do you perform with neck

A

Brudzinski sign
legs flex at both hips and knees in response to flexion of the head and neck to chest

59
Q

CSF findings with meningitis

A

elevated pressure
decreased glucose
elevated protein
presence of WBC

60
Q

MTG of meningitis

A

<=50 - Vanco plus ceftriaxone

> =50 vancomycine plus ampicillin plus ceftriaxone

61
Q

pt has a wreck and has decreased LOC upon arrival to ED is awake and alert then loses consciousness again - what do you suspect

A

expanding hematoma - epidural bleed

62
Q

Cushings triad

A

wide pulse pressure
decreased RR
decreased HR

63
Q

s/s of left middle cerebral artery infarct

A

aphasia

64
Q

pathology of parkinsons disease

A

imbalance between ACH and dopamine

65
Q

what is rationale of administering nimodipine

A

calcium channel blocker
counters vasospasm s/p CVA

66
Q

how to treat cerebral vasospasm

A

MAP maintained at 110-130
intravascular volume expansion and HTN therapy to increase CPP

67
Q

pt does not loose consciousness, has shaking in right hand and hallucinations
what is your dx

A

partial seizure

68
Q

difference in partial and complex partial seizure

A

complex partial has impaired level of consciousness following seizure

69
Q

complication of c4 injury or above

A

respiratory compromise

70
Q

what kind of bleed is characterized by a lucid interval

A

epidural hematoma

71
Q

CCP

A

MAP - ICP

CCP in the 70s
ICP <20

72
Q

what is autonomic dysreflexia

A

emergency clinical condition
T4-T6
exaggerated autonomic response to a stimulus - bladder/bowel distention, hot/cold stimulus, restrictive clothing

s/s :
diaphoresis and flushing above level of injury
chills and severe vasoconstriction below level of injury
HTN
bradycardia

TX - stimulus removal and HTN

73
Q

Brown sequard syndrome

A

damage to one half of spinal cord
s/s :
ipsilateral upper motor neuron paralysis and loss of proprioception
contralateral loss of pain/temp

tx: MRI and steroids

74
Q

cauda equina syndrome

A

compression of nerve root at end of spinal cord

s/s:
numbness in lower legs, feet or “saddle”region

TX: MRI, steroids , emergency sx

75
Q

What complication may occur with T6 or above injury

A

neurogenic shock - loss of vasomotor tone inducing massive vasodilation

tx: fluids, vasopressors

76
Q

mtg of parkinsons

A

carbidopa-levodopa (sinemet)increase dioanube

dopamine agonists
a. Pramipexole
b. ropinirole
c. rotigotine

MAO-B -prevent breakdown of dopamine

a. selegiline
b. rasagiline
c.safinamide

77
Q

what happens during S2 heart sound

A

aortic and pulmonic vlavles are closed - mitral and tricuspid are open

78
Q

what happens during S1 heart sound

A

tricuspid and mitral valves are closed, aortic and pulmonic are open

79
Q

what type of dementia is associated with parkinsons

A

Lewy body dementia

80
Q

agnosia

A

inability to recognize an object

81
Q

apraxia

A

inability to perform a previously learned task

82
Q

medication mtg of Alzheimer

A

donepezil - all stages
galantamine - mild to moderate
rivastigmine -mild to moderate

memantine (NMDA) moderate to severe

83
Q

what do you use to screen for alcohol usage

A

C- have you ever felt need to cut down
A- have people annoyed you by criticizing your drinking
G- every felt guilty about drinking
E- have you ever had a drink first hinge in am (eye opener)

2 or more further assessment

84
Q

Hyper resonance of chest

A

In asthma and COPD
Represents air trapping

85
Q

Sound over bone

A

Dullness

86
Q

Sound over gas air trapping

A

Tympene

87
Q

Normal sound of chest

A

Resenance

88
Q

Chest X-ray of asthma

A

Hyperinflation

89
Q

QSEN initiative

A

Quality and safety education for nurses
6 key competencies
Patient centered care
Teamwork and collaboration
EBP
Quality improvement
Safety
Informatics

90
Q

Step approach for asthma

A
  1. SABA- Albuterol, levalbuteral
  2. ICS- budesonide, fluticasone,triamcinolone
  3. LABA- salmeterol,formeterol
  4. Medium dose ICS + LABA
  5. High dose ICS + LABA
91
Q

Inpatient mtg of asthma

A

Low O2
Inhaled SABA via MDI or nebulizer
Systemic glucocorticoid
Mag sulfate for those not responding to above

92
Q

What is a posit e TB for HIV? For immigrant? For normal population

A

5mm
10 mm
15mm

93
Q

TB medication regimen

A

RIPE

Rifampin, isoniazid, pyrazinamode and ethambutol

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