Exam 1 Summary Set Flashcards
1
Q
____ is the first-line treatment for OA
A
acetaminophen
2
Q
young to middle-aged women are at risk for ____
A
rheumatoid arthritis (RA)
3
Q
Sjogren syndrome is a manifestation of ____
A
RA
4
Q
____ is the drug treatment for RA
A
methotrexate
5
Q
methotrexate is contraindicated in ____
A
pregnant women
6
Q
the 4 stages of cancer development
A
(1) initiation
(2) promotion
(3) progression
(4) metastasis
7
Q
how similar the cancer cells look to the parent cell
A
grading
8
Q
determines the exact location of the cancer and whether metastasis has occurred
A
staging
9
Q
the 7 warning signs of cancer are CAUTION - what does it stand for?
A
C = changes in bowel and bladder habits
A = a sore threat
U = unusual bleeding or discharge
T = thickening / lump
I = indigestion / difficulty swallowing
O = obvious change in wart or mole
N = nagging cough
10
Q
drugs designed to target specific molecules or pathways involved in cancer growth
A
targeted therapy
11
Q
surgery and radiation are ____ types of therapy
A
localized
12
Q
chemo, hormonal, and targeted therapy are ____ types of therapy
A
systemic
13
Q
the priorities for neutropenic precautions are _____
A
(1) protect from infection
(2) educate family and friends on how to reduce risk of infection
14
Q
describe some of the care for someone with neutropenia
A
(1) HH
(2) private room
(3) clean room at least 1x per day
(4) VS q4h
(5) daily WBC checks
(6) no potted plants or flowers
15
Q
the most common location for metastasis of colorectal cancer is ___
A
the liver
16
Q
bleeding from the rectum
A
Hematochezia
17
Q
what is the definitive diagnostic test for CRC?
A
colonoscopy
18
Q
empty colostomy bag when it is ___ full
A
1/3 to 1/2
19
Q
what should you NOT put in a colostomy bag and why?
A
aspirin b/c risk of ulcers
20
Q
<____mL/hr urine output can lead to kidney damage
A
30
21
Q
what is the main difference between dehydration and fluid volume deficit?
A
dehydration is loss of water ONLY; FVD is loss of water and salt
22
Q
Na > 145 and increased osmolality are signs of what?
A
dehydration
23
Q
which solution do you use to treat dehydration?
A
isotonic (.9%) Na+ solution and extra water
24
Q
aldosterone function
A
increased water and Na reabsorption; increased K excretion
25
ADH function
water reabsorption
26
the best indicator of fluid overload is ___
weight gain
27
diphenoxylate hydrochloride is given to pts with gastroenteritis but should be withheld from ____
older adults b/c of drowsiness
28
metabolic acidosis and which electrolyte imbalance are linked?
hyperkalemia
29
Kussmaul respirations
Dysrhythmias
Decreased LOC
Decreased reflexes
What is this?
metabolic acidosis
30
what are the lab values for metabolic acidosis?
pH < 7.35
HCO3 < 23
31
massive blood transfusion is a risk factor for which acid-base imbalance?
metabolic alkalosis
32
positive Chvostek & positive Trousseau are seen in which conditions?
(1) Respiratory alkalosis
(2) hypocalcemia
(3) hypomagnesemia
33
during ____, you should re-breath expired air as a treatment option
respiratory alkalosis
34
which electrolyte imbalance can lead to cerebral edema?
hyponatremia
35
how does hyponatremia affect HR?
increases
36
what solution should you treat hyponatremia with?
hypertonic 3% normal saline
37
Cushing disease is a risk factor for which electrolyte imbalances?
hypernatremia
hypokalemia
hypocalcemia
38
inverted T wave and depressed ST segment are signs of which imbalance?
hypokalemia
39
peaked T wave and widened QRS segment are signs of which imbalance?
hyperkalemia
40
Ca gluconate can be used to treat ____
hyperkalemia and hypermagnesemia
41
one thing to have on standby with hypocalcemia is ____
emergency trach equipment
42
laxative misuse can lead to ____
hypomagnesemia
43
magnesium normal range
1.3-2.1 mEq/L
44
diagnosis for DM
A1C > 6.5% or
FBG > 126 mg/dL; or
2-hr GTT > 200 mg/dL; or
s/s hyperglycemia + random BG > 200 mg/dL
45
name 3 three key drugs (besides insulin) used to treat DM
(1) metformin (biguanide)
(2) GLP-1 agonist (semaglutide, ozempic)
(3) sulfonylureas (glipizide)
46
sulfonylureas work by...
triggering the release of insulin from the liver
47
lab values of DKA
BG > 300 mg/dL
Ketones positive
pH < 7.35
HCO3 < 15 mEq/L
elevated BUN / creatinine
48
lab values of HHS
BG > 600 mg/dL
No ketones
pH > 7.4
HCO3 > 20 mEq/L
elevated BUN / creatinine
Osmolarity > 320 mOsm/L
49
most common GI problem with DM is ___ d/t ___
constipation; peripheral neuropathy
50
older adults with DM are at higher risk of developing ____
dementia and nephropathy / kidney disease
51
myxedema coma can result from
hypothyroidism
52
name at least 3 s/s of myxedema coma
(1) respiratory failure
(2) hypotension
(3) hypothermia
(4) bradycardia
(5) reduced mental status
53
nursing considerations for levothyroxine
(1) administer 1hr before meals and other meds
(2) monitor TSH levels
54
___ is used to treat hyperthyroidism (medication)
methimazole
55
nursing considerations for methimazole
(1) monitor for liver toxicity
(2) contraindicated in pregnancy
(3) take with meals
56
name the pharmacologic treatment options for alzheimer's disease from least to most invasive
(1) donepezil
(2) memantine
(3) diazepam & haloperidol
57
___ and ___ are considered chemical restrains
diazepam and haloperidol
58
side effects of hydantoin are ____
headache and drowsiness
59
pharmacologic treatment for seizures is
(1) benzodiazepines
(2) hydantoin
60
nursing considerations with hydantoin
(1) don't use with warfarin d/t bleed risk
(2) can lead to gingival hyperplasia so oral care is important
61
the two types of benzodiazepines given for seizures are usually what?
Lorazepam, clorazepate
62
____ is given IV to manage status epilepticus
Lorazepam
63
clorazepate function
prevent seizures
64
what should you monitor for with use of benzodiazepines?
(1) hypotension
(2) respiratory depression
65
BEFAST acronym stands for...?
B - balance
E - eye or vision changes
F - facial drooping
A - arm weakness
S - speech changes
T - time of onset
66
key considerations with the administration of IV alteplase
(1) dosed by pt weight
(2) must be given within 3-4.5 hrs of onset of symptoms
(3) test blood glucose for hypoglycemia
(4) may need to administer antihypertensive drug first
(5) stop anticoagulants for 24 hrs after d/t bleed risk
67
the main priority for stroke patients is
to restore perfusion to the brain
68
ABCS of stroke prevention are
A - aspirin as appropriate
B - blood pressure management
C - cholesterol management
S - smoking cessation
69
2 key s/s of hemorrhagic stroke are
headache and intracranial pressure
70
the two types of manifestations of delirium are
hypoactive and hyperactive
71
hypoactive s/s of delirium include
apathetic, lethargic, unaware, withdrawn
72
hyperactive s/s of delirium include
agitation, restlessness, aggression
73
difficulty writing
agraphia
74
inability to perform simple commands
apraxia
75
loss of balance or coordination
ataxia
76
inability to recognize familiar objects by sight, hearing, or touch
agnosia
77
inability to speak or understanding language
aphasia
78
crepitus is
coarse grating of the joints
79
post-op PAC means
pharmacology, ambulation, and compression
80
post-op PAC is used to
avoid clotting
81
low-grade fever, weight loss, and symmetric, bilateral joint inflammation is what?
rheumatoid arthritis
82
respiratory complications of RA
(1) pleurisy
(2) pneumonitis
(3) pulmonary HTN
83
cardiac complications of RA
(1) myocarditis
(2) pericarditis
84
eye complications of RA
(1) iritis
(2) scleritis
85
what are the safety precautions for use of methotrexate?
(1) take med 1x weekly
(2) can cause mouth ulcers (self-resolve)
(3) can cause mild liver irritation
(4) contraindicated in pregnant women
(5) retinal damage
(6) decreased immunity
86
the three components inside the skull are
brain tissue, CSF, intravascular blood
87
the brain is dependent on which two systems (primarily)?
cardiac, respiratory
88
normal ICP is
7-15 mmHg
89
the first compensations in Intracranial Regulation will occur in the ___
CSF
90
what can cause ICR impairment?
(1) impaired perfusion of oxygenated blood
(2) compromised neurotransmission
(3) glucose regulation
(4) pathology of the brain (i.e., tumors, inflammation)
91
Name the 3 major consequences of ICR impairment
(1) cerebral edema
(2) increased intracranial pressure
(3) neuronal injury or death
92
Population risk factors for ICR impairment include
(1) older adults
(2) adolescent and YA
(3) children
(4) accidents - falls, assault, MVA
93
T/F: There is no screening test for ICP.
True
94
to decrease ICP, HOB at ___ to ___
30 degrees; help with neck and head alignment
95
____ can decrease ICP by reducing metabolic demand of the brain
Propofol
96
which type of diuretic can be used to decrease ICP?
osmotic - Mannitol
97
two surgical interventions for ICP are
(1) craniotomy
(2) shunt procedure
98
which stroke is r/t atherosclerotic buildup, dysrhythmias, and prolonged HTN?
ischemic
99
which stroke is r/t prolong HTN, aneurysm, and drug abuse?
hemorrhagic
100
why do you monitor urine output for acetaminophen use?
check renal function
101
common s/s of both metabolic and respiratory acidosis
Dysrhythmias
Decreased LOC
Confusion
Lethargy
102
common s/s of both metabolic and respiratory alkalosis
N/T in fingers, feet, face
Lightheaded
103
basal insulin can be covered by which type(s) of insulin?
NPH intermediate
Long-acting
Ultra-long-actin
104
name the adverse effects of metformin
(1) GI symptoms
(2) hypoglycemia
(3) avoid with alcohol b/c liver metabolizes both
105
hold ____ 24 hours before contrast and surgery
metformin
106
adverse effects of GLP-1 agonists are
pancreatitis - abdominal pain and nausea
107
key pt education for taking sulfonylureas
take with meals to avoid hypoglycemia
108
which types of insulin should NEVER be combined with others in the same syringe?
long-acting
109
administer rapid-acting insulin ___ minutes before eating
10
110
give rapid-acting insulin at least ___ apart because of ___
4 hours; 3-hour peak
111
NPH intermediate insulin lasts
16-24 hours
112
glargine is
long-acting insulin
113
detemir is
long-acting insulin
114
degludec is
ultra-long acting insulin
115
____ should be given 30m before eating
regular insulin
116
____ should be given 10m before eating
rapid insulin
117
what is the therapeutic range for phenytoin?
10-20 mcg/mL
118
phenytoin <10 is a risk for
seizures
119
phenytoin >20 is a risk for
drug toxicity
120
stage 1 pressure injury is
non-blanchable, redness
121
stage 2 pressure injury is
blistering, partial thickness
122
stage 3 pressure injury is
full-thickness - skin loss; subcutaneous fat / tissue, tunneling, eschar
123
stage 4 pressure injury is
full-thickness - skin and tissue; bone, tissue, ligaments, muscle; eschar, slough
124
GI impacts of immobility
constipation
125
respiratory impacts of immobility
atelectasis, hypostatic pneumonia
126
metabolic impacts of immobility
ca loss in bones, fluid imbalance
127
integumentary impacts of immobility
impaired skin integrity, pressure injuries,
128
MSK impacts of immobility
muscle atrophy, protein breakdown, joint contractions
129
cardiovascular impacts of immobility
clotting / pooling, orthostatic BP, cardiac muscle less effective
130
what medications are used to treat Cushing syndrome?
(1) ketoconazole - adrenal corticosteroid inhibitor
(2) mitotane - destruction of adrenocortical cells
131
the main causes of Cushing disease are
(1) tumor
(2) adrenal hyperplasia
(3) cancer of the lung, GI, or pancreas
132
what is the difference between Cushing disease and syndrome?
Disease is caused by endogenous sources; Syndrome is caused by exogenous sources of cortisol
133
the main causes of Cushing syndrome are
long-term therapeutic use of corticosteroids (ex: Asthma, chemo, allergies)
134
pts with Cushing's disease are at increased risk for which of the follow (SATA)
a. infection
b. peptic ulcer
c. renal calculi
d. bone fractures
e. dysphagia
A, B, D
135
what lab values will show up for someone with Cushing's disease? SATA
a. increased sodium
b. decreased potassium
c. increased calcium
d. increased blood glucose
e. decreased lymphocytes
A, B, D, E
136
which of the following findings in someone with Cushing syndrome is priority?
a. weight gain
b. fatigue
c. fragile skin
d. joint pain
A - weight gain b/c could signify fluid retention
137
Addison's disease is an insufficiency of
aldosterone and cortisol
138
causes of Addison's disease include...
(1) autoimmune
(2) TB
(3) metastatic cancer
(4) radiation to the abdomen
139
acute adrenal insufficiency is a ____
medical emergency
140
factors that can lead to acute adrenal insufficiency
(1) sepsis
(2) trauma
(3) stress
(4) adrenal hemorrhage
(5) steroid withdrawal
141
Addison's disease leads to which electrolyte imbalances?
hyponatremia
hyperkalemia
hypercalcemia
142
the primary nursing priority for patients with acute adrenal insufficiency is
prevent circulatory shock
143
should glucocorticoids for Addison's be taken with or without food?
with
144
which of the following instructions should the nurse include for a pt taking hydrocortisone? SATA
a. Take the medication on an empty stomach
b. notify the provider of any illness or stress
c. report any manifestations of weakness or dizziness
d. do not discontinue the medication suddenly
e. eat a low-sodium diet
B, C, D
145
which solution should be used to treat acute adrenal insufficiency
0.9% NaCl
146
phenytoin side effects are ___ and ___
headache, drowsiness
147
what should you monitor for when someone is on phenytoin?
cardiac dysrhythmias; hypotension
148
phenytoin can lead to ___
gingival hyperplasia
149
use of GLP-1 agonists can lead to ____
pancreatitis
150
glipizide is a
sulfonylurea
151
ACE inhibitors can cause
hyperkalemia
152
when surfaces rub the skin and irritate or tear fragile epithelial tissue
friction
153
when the skin itself is stationary and the tissues below the skin shift or move
shearing forces
154
name at least 4 ways to reduce pressure / prevent pressure injury
(1) HOB at 30 degrees
(2) pts in chairs / wheelchairs to stand and march in place 5 steps/hr
(3) pressure-offloading devices
(4) special mattress
(5) turn at least q2h
154
what should you NOT use for pressure injury prevention?
donut-shaped pillows
155
to improve pressure tolerance, perform peri care ___
q2h
156
to assess darker skin and pressure injuries, you can ____
(1) moisten the skin
(2) compare healthy skin to injury for reference point
157
the purpose of ketoconazole is ____
to supplement radiation or surgery for Cushing
158
when taking Ketoconazole, monitor for indications of ___ toxicity
liver
159
Ketoconazole should be taken with or without food?
with
160
the purpose of mitotane is to ____
reduce the size of the adrenal carcinoma tumor
161
what is the expected nurse's order for a patient with DKA?
rapid IV infusion of 0.9% NaCl over the first hour
162
What should the patient do to prevent DKA?
a. drink 1000 mL of fluids/day
b. monitor blood glucose every 8 hr when ill
c. notify provider if BG > 250 mg/dL
d. report ketons in urine that continue after 48 hrs illness
C
163
____ is indicated for patients in late-stage AD
Memantine
164
donepezil monitoring parameters
HR and dizziness b/c can cause bradycardia
165
the 4 cardinal signs of Parkinson's disease are
(1) tremors
(2) bradykinesia
(3) muscle rigidity
(4) postural instability
166
the main medication for Parkinson's is
Levodopa
167
what are the 4 main complications / safety concerns with Parkinson's Disease?
(1) aspiration pneumonia
(2) altered cognition
(3) Infection (UTI, skin breakdown)
(4) depression
168
when implementing the rule of 15, what do you need to check first?
if the patient is safe to swallow
169
levothyroxine is used to treat
hypothyroidism
170
levothyroxine precautions and education
(1) take in the AM on an empty stomach
(2) increased heart rate
(3) monitor TSH levels
171
where can hemorrhagic stroke bleed into?
(1) subarachnoid space
(2) brain tissue
172
bleeding into the ____ can lead to seizures
brain tissue
173
right-sided damage leads to more ____ behavior
irritable and impulsive
174
left-sided damage leads to more ___ behavior
cautious
175
____-sided brain damage leads to more neglect
right
176
nursing interventions for aspiration risk
(1) NPO until assessment
(2) thickened liquids
(3) no straws
(4) high Fowler's / 90 degrees
(5) tuck chin when swallowing
177
always approach a stroke patient from their ____ side
unaffected
178
when you're doing rehab with a stroke patient, start with ____ side
affected
179
check pregnancy status before administering IV ____
alteplase
180
IV alteplase can cause which electrolyte imbalance?
hypokalemia
181
what is the #1 priority intervention for DKA and HHS?
adequate perfusion d/t osmotic diaphoresis
182
how long will it take Methotrexate to take effect / see improvements?
4-6 weeks
183
the two nursing interventions for addisonian crisis are
(1) IV bolus of hydrocortisone
(2) monitor for s/s hyperkalemia
184
no polyphagia in ___
HHS
185
most common cause of DKA and HHS is ___
infection
186
SIADH can cause what?
hyponatremia (dilution)
187
s/s of both respiratory and metabolic acidosis
(1) Lethargy
(2) Confusion
(3) Decreased LOC
(4) Hyperkalemia
(5) Dysrhythmias
188
s/s of both respiratory and metabolic alkalosis
(1) Numbness and tingling
(2) Lightheadedness
189
Labs for Dehydration
(1) Increased osmolality (concentration)
(2) Increased Na
(3) Increased urine specific gravity
(4) Increased Hct
(5) Increased BUN
190
Labs for ECV deficit
(1) Increased urine specific gravity
(2) Increased Hct
(3) Increased BUN
191
attention, perception, pattern recognition are examples of
basic cognition
192
comprehension, problem-solving, decision-making, reasoning, and meta-cognition are examples of
higher-order cognition
193
name 3 age-related changes in cognition (as you get older)
(1) decrease in size and weight of brain
(2) decrease in the number of neurons
(3) slower neural responses
194
cognitive impairment is indicative of ____
underlying disease
195
reduction of cognitive function that does NOT interfere with functional ability
cognitive impairment
196
only a single area of cognitive functioning
focal cognitive disorders
197
what is a major predictor of cognitive decline?
slower walking speed / gait
198
Folic acid deficiency, DM, and metabolic syndrome are all linked to ___
higher risk of cognitive impairment
199
which cognitive functioning test screens for delirium?
CAM
200
which cognitive functioning test(s) screens for dementia and cognitive impairment
MMSE, MoCA
201
which cognitive assessment tool is more challenging - MMSE or MoCA?
MMSE
202
Syndrome of neurocognitive symptoms that impair cognitive capacity; leads to deficits in perception, functioning, and social relatedness
psychosis
203
name at least 3 causes of delirium
(1) infection
(2) hypoxia
(3) acute illness
(4) lack of sleep
(5) dehydration
(6) electrolyte imbalances
204
____ is the most frequent complication of hospitalization in the elderly
delirium
205
tight endothelial layer that restricts neurotoxic substances describes the ___
blood-brain barrier
206
the skull calcifies at age ___
12
207
which of the following are diagnostic testing tools for ICR impairment? SATA
a. CT and MRI
b. x-ray
c. EEG
d. physical exam
e. brain biopsy
f. lumbar puncture
g. electrode stimulation
A, B, C, E, F
208
____ surgery is performed if there is expansion of the brain tissue
craniotomy
209
___ surgery is performed if there is an embolus / thrombus in the brain
shunt
210
increased prevalence of ____ is NOT a normal part of aging
chronic pain
211
sudden onset of pain related to a certain injury
acute pain
212
pain lasting more than 3 months and may last for years
chronic pain
213
aching, cramping, and throbbing are types of ____ pain
nociceptive
214
burning, sharp, and shooting are types of ____ pain
neuropathic
215
which pain scale has the images of faces?
Wong-Baker
216
what is the gold standard for pain assessment?
patient reports their pain
217
which adjuvant pharmacologic methods can be used to treat pain?
anticonvulsants, antidepressants
218
when implementing non-pharmacological pain management options, ___ is the main priority.
Safety
219
increase in the number of cells
proliferation
220
under normal conditions, there is an equilibrium of cell proliferation and ___
cell death
221
what regulates proliferation?
intracellular signals
222
cancer cells lose ___ and ____, leading to overgrowth
contact inhibition; intracellular signaling
223
cells progress from immaturity to maturity
differentiation
224
poorly differentiated cells are what grade of cancer cell?
grade 3
225
____ regulate and promote cell growth
proto-oncogenes
226
____ regulate and suppress cell growth
tumor suppressor genes
227
the 5 treatment goals for cancer are
(1) prophylactic
(2) curative
(3) adjuvant
(4) neoadjuvant
(5) palliative
228
name the considerations and risks of Chemotherapy (8)
(1) extravasation
(2) bone marrow suppression
(3) N/V - CINV
(4) mucositis
(5) alopecia
(6) cognitive changes
(7) peripheral neuropathy
(8) time toxicity
229
____ occur when the stimulation of the immune system affects health cells
immune-related adverse events (irAEs)
230
which of the following can result from immune-related adverse events (irAEs)?
a. colitis
b. hypertension
c. kidney injury
d. anaphylaxis
A
231
bone pain, hot flashes, and sexual dysfunction are side effects of ___
hormonal therapy
232
radiation delivered from a source outside of the body
external beam
233
radiation sources that comes into direct, continuous contact with tumor for a specific amt of time
brachytherapy
234
what should you give for severe hypoglycemia?
Glucagon IM
Dextrose IV solution
235
you can use beta blockers in which endocrine d/o?
graves disease
236
