Final Exam Flashcards

Question

Malignant hyperthemia: what is it, signs and symptoms, who do you notify, treatment

Answer 1

**What is it:** an inherited disorder that can occur when exposed anesthetics **Signs and symptoms:** **1)** Tachycardia **2)** Decreased oxygen saturation **3)** Muscle rigidity of the jaw and/or chest **4)** Hypotension **5)** Elevated body temperature (late sign) **Notify:** Immediately notify surgeon and anasthesiologist **Treatment:** dantrolene sodium

Answer 2

**I:** Incentive spirometry 10x/hour every hour while awake **C:** Coughing and deep breathing Q1H while awake **O:** Oral care **U:** Understanding (by patient) **G:** Get up out of bed **H:** Head of bed at 30 degrees

Answer 3

**1)** Consume high protein meals **2)** Take vitamins A+C **3)** Take zinc

Answer 4

**1)** Call rapid response **2)** Have patient lay at 20 degree with knees bent **3)** Use a sterile dressing w/ saline to cover the organs **4)** Notify surgeon **- This is a medical emergency**

Answer 5

**4)** Assess the patient

Answer 6

**1)** Decrease the rate of the IV infusion.

Answer 7

**2)** Hypovolemia

Answer 8

**3)** Administer prescribed pain medication

Answer 9

**4)** Ambulate the patient as soon as tolerated

Answer 10

**3)** Client with a respiratory rate of 6 breaths/min

Answer 11

2) 80-100 mmHg

Answer 12

**1)** Infection control **2)** Smoking cessation **3)** Immunization

Answer 13

**1)** Incentive spirometry Q1H while awake **2)** Coughing and deep breathing Q1H (splinting) **3)** DVT prevention for PE -> sequential compression, early ambulation, anticoagulants

Answer 14

**1)** Q1H while awake

Answer 15

It is better to eat smaller, more frequent meals higher in calories and proteins

Answer 16

**1)** Before meals to open airways to maintain proper ventilation while eating

Answer 17

**2)** In high fowler's or tripod to promote airway patency and ventilation

Answer 18

**3)** Provide oral care as it removes plaque, build up, and moistens the tongue - The other two should be done before meals, but do not improve the taste of food

Answer 19

**False:** COPD does include emphysema and chronic bronchitis, not asthma

Answer 20

It is a destructive problems of lung elastic tissue of alveoli that reduces its ability to recoil after stretching leading to hyperinflation

Answer 21

It is a decrease in enzyme alpha 1 antitrypsin, which normally protects against protease enzymes, found in non-smokers as an inherited disorder - Lack of AAT allows proteases to harm elastic tissue of the alveoli

Answer 22

It is when cigarette smoking, air pollution, occupational exposure, or another respiratory tract infection in childhood triggers an inflammatory reaction promoting proteases to break down the elastin in alveoli

Answer 23

**1)** enzymes that eliminate particulates during breathing **2)** Cigarette smoke triggers high levels of proteases that damage the alveoli breaking down the elastin = less recoil causing collapsing and narrowing of the lungs reducing area for gas exchange

Answer 24

**1)** Hyperinflated lungs flatten the diaphragm, weakening it

Answer 25

**3)** Use of accessory muscles, air hunger sensation, uncoordinated breathing because inhalation starts before exhalation is complete

Answer 26

**2)** Respiratory acidosis and low SpO2

Answer 27

**1)** Increased mucus production, chronic cough, inflammation of bronchioles

Answer 28

Cigarette smoke is the main cause and other inhaled irritants can cause it leading to increased proteases, elastin breakdown = air trapping and reduced gas exchanged, cilia are also impaired harming cilial removal of mucus and fluid

Answer 29

Thick mucus and narrowed airways due to inflammation trap air

Answer 30

3) Increased mucus production allowing bacteria to proliferate

Answer 31

It is right-sided heart failure caused by chronic bronchitis and/or emphysema. Decreased blood flow d/t air trapping and stiff alveoli walls -> increases pressure -> narrowing long blood vessels -> increased heart workload against pressure -> right heart enlarges and thickens -> right-sided HF develops with venous backup

Answer 32

**1)** Quit smoking and vaping **2)** Avoid particulate matter (work exposure, hobby exposure, wear proper PPE)

Answer 33

2) Female, 65 years and older, history of cigarette smoking - not males, 65 years and older, sputum production is not a risk factor it is a symptom

Answer 34

- thin, loss of muscle mass in extremities - enlarged neck - slow moving - orthopnea (difficulty breathing while lying down) - accessory muscle use - RR 40-50 (emergency) - Sits forward in tripod position - Barrel chest (anterior and posterior chest are same size) - Delayed capillary refill - Finger clubbing - Dependent edema

Answer 35

**3)** Respiratory acidosis (you have poor O2 exchange and hypercapnia) and metabolic alkalosis because the body is chronically absorbing bicarbonate to compensate

Answer 36

**1)** Residual volume b/c of air trapping, more air is left over increasing residual volume significantly

Answer 37

**1) Maintaining airway and gas exchange** **2)** Weight loss d/t dyspnea (a lot of metabolic work to breathe hard) **3)** Fatigue d/t low O2 but high demand **4)** Infection risk - pneumonia

Answer 38

**1)** They induce bronchodilator by relaxing smooth muscle via activation of pulmonary beta-2 receptors **Education:** - Carry your inhaler at all times for life-saving moments - Know that it may cause your heart rate to go up along with systemic symptoms because it is non-specific - Take your SABA inhaler 5 minutes before other inhaled agents to improve their effects

Answer 39

**4)** Ipratropium - Tiotropium is the same medication class as ipratropium, cholinergic agonists, but tiotropium is a long-acting agent while ipratropium is a short-acting agent helpful for COPD exacerbations

Answer 40

- LABAs relax bronchial smooth muscle by activating pulmonary beta-2 receptors. - No, they cannot be used for acute COPD exacerbation, they have a slow onset **Medications:** - Salmeterol, indacterol, formoterol "-erols"

Answer 41

- They cause bronchodilation by inhibiting PSNS allowing SNS to dominate releasing epinephrine for pulmonary beta-2 receptor activation - They prevent bronchospasm and improve gas exhcange **Education:** - If a reliever (ipratropium), carry at all times - Shake inhaler well if it is a metered dose inhaler - Increase daily fluid intake d/t mouth dryness - Report blurred vision, headache, eye pain, nasuea, tremors, dryness as they are signs of an overdose **Medications:** aclidinium, ipratropium, tiotropium, umeclindium, "-iums"

Answer 42

- They help in COPD by disrupting inflammatory pathways reducing mucus production and relieving narrowed airways **Education:** - Use them daily even with no symptoms present because maximum effectiveness comes with 48-72 hour use - Perform good oral care because there is an increased risk of infection such as Candida - Rinse mouth after use to prevent Candida infection - It is not for symptomatic use **Medications:** fluticasone, beclomethasone, budesonide

Answer 43

- They work by thinning secretions **Education:** - Hepatotoxicity is possible **Medication:** - Acetylcystine

Answer 44

**4)** Q2H

Answer 45

**3)** Pursed lip breathing and diaphragmatic breathing - Tripod, high fowlers, and nostril flaring can help with oxygenation but are not breathing techniques

Answer 46

**4)** 88-92% - Placing them on oxygen at a rate higher to bring them up can knock out their drive to breathe. Their breathing drive becomes more about SpO2 levels than SpCO2 levels because of chronically lowered O2 and chronically high CO2. Thus, when they are over oxygenated, their body believes it does not need to breathe.

Answer 47

**1)** 2L/day to thin mucus

Answer 48

**1)** RR 40-50 **2)** O2 below 80-85% **3)** Cyanosis **4)** Altered mental status/confusion **5)** Accessory muscle use **6)** Wheezing/crackles

Answer 49

**3)** Tachycardia **4)** Pale Skin **6)** Confusio/irritability/restless 1 and 2 are signs of late hypoxia and 5 is a sign of chronic hypoxia

Answer 50

**1)** Confusion, irritability, restless **2)** Tachypnea (>20) **3)** Tachycardia **4)** Elevated BP **5)** Pale skin **6)** Intercostal retractions **7)** O2 <90%

Answer 51

**1)** Stupor **2)** Cyanosis **3)** Bradypnea (< 12RR) **4)** Bradycardia **5)** Hypotension **6)** Cardiac dysrhythmias

Answer 52

**1)** Nail clubbing **2)** Barrel chest **3)** Cyanosis **4)** Delayed capillary refill **5)** Pursed lip breathing

Answer 53

**1)** Eat high calorie, high protein meals **2)** Eat small frequent meals **3)** Non-gas producing foods **4)** Bronchodilator 30-min before eating to reduce difficulty eating

Answer 54

**2)** 10% - weight should be kept within 10% of ideal body weight

Answer 55

**1)** Dry mouth - Anticholinergics are very drying = dry mouth, reduced saliva production, dry eyes, constipation

Answer 56

**4)** Albuterol or ipratropium and then fluticasone - Albuteral and ipratropium are both relieving inhalers and the inhaled coriticosteroid should be continued

Answer 57

**True**, after inhaling slowly for 3-5 seconds, hold your breath for 10 seconds and then exhale

Answer 58

**1)** 1 minute for same inhaler and 5 minutes between different inhalers

Answer 59

**What is it:** it is a lung infection due to bacteria, viruses, or fungi causing inflammation and fluid build up in the airways **S/S:** fever, chills, malaise, loss of appetite, myalgia, cough (productive or not), dyspnea, increased RR, labored breathing, crackles, rhonchi, low O2 saturation **Dx:** increased WBC, sputum culture, chest x-ray, blood culture, ABG

Answer 60

**Priority:** impaired gas exhcange = improve **Interventions:** Increase HOB, early mobilization, O2 support, incentive spirometry, cough + deep breathing, bronchodilators

Answer 61

3) Ceftriaxone and Levofloxacin are two different broad spectrum antibiotic classes that can treat bacterial pneumonia infections

Answer 62

**1)** Ceftriaxone **- Class:** Cephalsoporin **- Side effects:** very safe overall, allergic reactions are main concern d/t cross-sensitivity to penicillin **- Teaching:** complete entire course **2)** Levofloxacin **- Class:** Fluroquinolone **- Side effects:** nausea, vomiting, swelling/rupture of tendon, c. diff and yeast infections **- Teaching:** take with food, avoid sun exposure, complete entire course

Answer 63

**1)** O2 will be maintained at 92% **2)** Free of infection with no fever and normal WBC **3)** Anxiety is at baseline

Answer 64

**1)** Sedentary lifestyle **2)** Smoking **3)** Stress **4)** Older adult **5)** High fat diet **6)** Diabetes

Answer 65

**Intermittent claudication:** is the classic leg pain characterized by burning and cramping with movement stoppoing upon rest Associated with peripheral artery disease (PAD)

Answer 66

**4)** It can cause blockages or full occlusions decreasing blood flow which causes cell death, gangrene, and necrosis

Answer 67

**1)** hair loss **2)** Dusky/pale/ashy skin **4)** Cold extremities **6)** Muscle atrophy - Puritis (itching) and petechiae (or small purple bruising) are not characteristic of PAD

Answer 68

**1)** Magnetic resonance angiography helps to assess blood flow in arteries **3)** Ankle-brachial index - assesses brachial and ankle BP and divides ankle/brachial

Answer 69

**1)** <.90 - ankle BP will be lower than brachial d/t occlusion

Answer 70

**1)** Atherosclerosis

Answer 71

**2)** Increase collateral circulation improving blood flow

Answer 72

**True:** both can reduce blood flow to the legs and feet

Answer 73

**1)** Keep yourself warm (warm house, wear socks, wear insulated shoes) - do not put warm items on skin d/t reduced sensation **2)** Prevent cold exposure b/c it causes vasoconstriction **3)** Complete abstinence from smoking and tabacco b/c it causes vasoconstriction **4)** Avoid caffeine d/t vasoconstriction

Answer 74

**3)** Aspirin and Clopidogrel can be used independently or dually for antiplatelet therapy

Answer 75

Grapefuit juice as it can reduce its effects

Answer 76

**4)** Cilostazol - Phosphodiesterase inhibitor helps with intermittent claudication, increase walking distance, and increase HDL levels

Answer 77

**Prolonged venous hypertension causing stretching of the veins and damaging valves** leading to backup and stasis of blood

Answer 78

**1)** Edema **2)** Stasis ulcers that are difficult to heal **3)** Stasis dermatitis **4)** Skin pigmentation changes (hyperpigmentation) **5)** Pedal pulses present **6)** ABI is normal

Answer 79

**1)** Compression stockings - Teds (for beds) for bedridden patients - Jobst (medical compression = need prescription) for ambulatory patients **2)** Elevate legs above heart for >30 minutes/day 3-4x

Answer 80

**PAD Ulcers** - Usually on toes, on top of or in between or lateral malleolus (ankle) - Well-defined edges - No bleeding - Deep **Venous Ulcers:** - Usually on medial malleolus (inside ankle) - Uneven ulcer edges - Granulation tissue - Superficial - Hard to heal

Answer 81

**1)** Hydrocolloid dressings placed with aspetic technique **2)** Gauze dressing moistened with zinc oxide (unna boot)

Answer 82

**1)** Reduced arterial flow/venous stasis (a-fib, immobility, venous insufficiency, prolonged sitting) **2)** Endothelial injury (smoking, trauma, hypertension, surgery) **3)** Hypercoagulability (sepsis, smoking, COVID-19)

Answer 83

**1)** Calf/groin pain **2)** Sudden onset of unilateral leg swelling **3)** Induration (hardening of skin) **4)** Warmth/redness **5)** Edema

Answer 84

Venous duplex ultrasonography to assess flow

Answer 85

Prevent complications of DVT (embolus -> PE, or increase in size) and anticoagulation

Answer 86

**1)** Gradual ambulation **2)** Bed rest and leg elevation **3)** Compression stockings **4)** warm, moist soaks

Answer 87

It takes 3-4 days before seeing therapeutic effect, thus warfarin and heparin must be used at the same time; heparin acts as a bridge for warfarin to start working

Answer 88

**4)** Protamine sulfate

Answer 89

**2)** Vitamin K

Answer 90

**4)** Idarocizumab

Answer 91

**1)** Andexanet alfa

Answer 92

They cause an extreme risk for clotting

Answer 93

**2)** INR and PT

Answer 94

**3)** If the therapeutic range of aPTT >100 seconds - This indicates the blood is taking too long to clot and they are at high risk of bleeding

Answer 95

**4)** PTT and aPTT

Answer 96

**1)** Q24H (1x/day) to monitor therapeutic range

Answer 97

6 hours after the initial dose and then after every dose given

Answer 98

**3)** 2-3 for treatment of DVT - 1.5-2 is for DVT prophylaxis

Answer 99

**1)** There are fewer drug interactions **2)** There is less frequent lab monitoring

Answer 100

**1)** Sudden bleeding of the gums or nose **2)** Petechiae or ecchymosis (bruising) **3)** Hematuria (blood in the urine) **4)** Abdominal pain **5)** Altered mental status **6)** Tachycardia **7)** Hypotension **8)** Tachypnea

Answer 101

**1)** S/S of bleeding and report any bleeding **2)** Do not use a straight razor, use an electric razor **3)** Do not abruptly stop medications **4)** Take at the same time each day

Answer 102

**1)** Air **2)** Fat **3)** Amniotic **4)** Cancer **5)** DVT clot (most common)

Answer 103

**1)** Hypoxemia (V/Q) mismatch **2)** Hypotension (left ventricle left with inadequate flow) **3)** Bleeding (due to anticoagulant therapy) **4)** Anxiety (related to hypoxemia and threat to life)

Answer 104

**1)** Sudden dyspnea **2)** Tachypnea **3)** Sharp, stabbing chest pain **4)** Feeling of impending doom **5)** Lightheaded **6)** Diaphoresis **7)** Cough **8)** Hemoptysis (bloody sputum)

Answer 105

**1)** Tachycardia **2)** Distended neck veins **3)** Crackles in lungs d/t edema **4)** Hypoxia **5)** Cyanosis **6)** Pulmonary hypertension **7)** Systemic hypotension

Answer 106

CTPA: Computed Tomography Pulmonary Angiography

Answer 107

**1)** D-dimer (clot breakdown) >250 ng/mL **2)** ABG (metbolic acidosis d/t lactic acid build up) **3)** Troponin (elevated) **4)** BNP (elevated)

Answer 108

**1)** Call rapid response team **2)** Administer supplemental O2 if below 90% **3)** Place in semi-fowler's position **4)** Obtain IV access **5)** Heparin bolus or use LMWH if HIT is a concern **6)** Alteplase if severe **7)** Assess cardiac and respiratory systems **8)** ABGs **9)** Vitals

Answer 109

Only if the patient is becoming unstable such as going into shock

Answer 110

**1)** Administer IV crystalloid fluids to restore plasma volume and prevent shock **2)** Monitor urine output **3)** Monitor mucus membranes and skin turgor **4)** Monitor s/s of heart failure **5)** Vasopressors if fluids are failing

Answer 111

**1)** Have reversal agents ready (Warfarin = vitamin K, heparin = protamine sulfate) **2)** Monitor for s/s of bleeding (hypotension, increased HR, abdominal distension/pain, sudden bleeding or bruising without cause, hematura, hemoccult stool) **3)** CBC/PLT labs

Answer 112

When the pleural cavity has less pressure than atmospheric causing air to leak into the chest from the lungs

Answer 113

When the pleural cavity has equal pressure to atmohspheric caused by a hole in the chest wall leaving the lungs open to the outside

Answer 114

A tension penumothorax is a type of closed pneumo when the pleural cavity pressure is greater than atmospheric. It is dangerous because air continues to build up in the chest cavity, but cannot exit because the punctured lung acts as a 1-way valve allowing air into the chest, but covers the hole during expiration so it cannot leave. The build up of air can place pressure on the heart and trachea deviating them.

Answer 115

**1)** Medical procedures **2)** Underlying conditions like COPD **3)** Chest trauma

Answer 116

**1)** Respiratory discomfort **2)** Chest pain **3)** Shortness of breath **4)** Tachypnea **5)** Assymetric lung expansion **6)** Decreased or absent lung sounds on affected side **7)** Tachycardia **8)** Hypotension **9)** Tracheal deviation **10)** Jugular vein distension **11)** Cyanosis

Answer 117

Chest x-ray

Answer 118

Air drain is placed high on the lung apex Fluid drain is placed low near the lung base

Answer 119

Because if fluid backs up from the system into the tube drainage can stop and cause another penumothorax or effusion

Answer 120

**1)** Q1H

Answer 121

**3)** 2cm so air does not go back into the patient

Answer 122

Mild-moderate bubbling indicates that air is passing through the chamber which is normal Excessive bubbling indicates a leak is present

Answer 123

**Tidaling:** the normal rise of water-seal chamber liquid by 2-4cm during inhalation and fall during exhalation **Absence of tidaling** can indicate that the lung is healed or there is an obstruction in the tube

Answer 124

**1)** Padded clamps **2)** Sterile gauze

Answer 125

SA node discharge rate of >100 BPM

Answer 126

**1)** Fever/infection **2)** Pain **3)** Anxiety/Fear **4)** Caffeine **5)** Hypovolemia

Answer 127

**1)** Palpitations **2)** Chest pain **3)** Dizziness **4)** SoB

Answer 128

Prolonged tachycardia decreases coronary perfusion time, decreases diastolic filling, and reduced coronary perfusion pressure = low O2 ouput with high O2 demand

Answer 129

**1)** Treat underlying cause **2)** Treat/mitigate fall risk

Answer 130

SA node discharges at **< 60BPM**

Answer 131

**1)** Vomiting **2)** Suctioning **3)** Valsava maneuvers (bearing down, gagging)

Answer 132

**1)** Diaphoresis **2)** Chest pain **3)** SoB **4)** Syncope **5)** Dizziness/confusion **6)** Hypotension

Answer 133

**False**, individuals who are stable with sinus bradycardia should not receive treatment, only patients who are symptomatic

Answer 134

**1)** Administer IV atropine **2)** Administer IV fluids **3)** Administer supplemental oxygen to bring above 90%

Answer 135

A pacemaker is needed in refractory bradycardia

Answer 136

It is an anticholingeric medication that blocks muscarinic receptors on the heart. Therefore, it inhibits the PSNS allowing the SNS to dominate **increasing HR** **Monitor:** HR, s/s such as blurred vision, dizziness, headache, urin retention, constipation (it's very drying)

Answer 137

Atria quiver while ventricles beat at a rapid rate in response to the impulses of the atria causing a decrease in cardiac output because of poor blood filling

Answer 138

**1)** Irregular apical pulse **2)** fatigue **3)** weakness **4)** SOB **5)** Palpitations **6)** Chest pain **7)** Anxiety

Answer 139

12-lead ECG diagnosis **1)** No clear p-wave **2)** Irregular R-R rhythm, wont be evenly spaced **3)** Varying HR

Answer 140

**1)** Hypertension **2)** CAD **3)** HF **4)** ACS

Answer 141

Preventing embolus formation

Answer 142

**1)** Diltiazem (calcium channel blocker) **2)** Metoprolol (beta-blockers) **3)** Digoxin (cardiac glycoside **4)** Warfarin **5)** Apixaban/rivaroxaban (direct oral anticoagulants)

Answer 143

**2)** Rate control

Answer 144

**What is it:** calcium channel blocker **Heart effect:** slows SA and AV conduction slowing heart rate **Monitor:** Hypotension, heart rate, s/s of HF **Educate:** Slow position changes d/t orthostatic hypotension

Answer 145

**What is it:** beta blocker **Heart effect:** slows ventricular response by decreasing catecholamines that stimulate beta receptors **Monitor:** heart rate and blood pressure, may cause bronchospasm **Educate:** Slow position changes d/t orthostatic hypotension

Answer 146

**What is it:** cardiac glycoside **Heart effect:** Increases heart **contractility,** slows AV conduction, decrease SNS activity, slows heart rate, **beneficial for HF with A. fib** **Monitor:** Assess apical pulse for 1 minute before giving, digoxin toxicity, potassium levels becuase it can cause hyperkalemia **Educate:** s/s of digoxin toxicity (fatigue, anorexia, blurred vision, mental status change)

Answer 147

**1)** Hypokalemia (this triggers toxicity and taking digoxin can also cause hyperkalemia as a separate issue) **2)** High digoxin doses

Answer 148

**What is it:** anticoagulant via vitamin K-depend clotting factor inhibition **Heart effect:** Thins blood to prevent clotting in the heart **Monitor:** INR, s/s of bleeding **Educate:** Avoid ginseng, ginger, ginko, and garlic which can interfere with medication, avoid or stay consistent with vitamin K, s/s of bleeding

Answer 149

**What is it:** Direct Oral Anticoagulants **Heart effect:** Thins blood to prevents clots in the heart **Monitor + Educate:** s/s of bleeding

Answer 150

**1)** Stroke, PE, DVT prevention **2)** Help to convert a-fib back to sinus rhythm

Answer 151

Hold if **below 60 HR** and contact provider

Answer 152

**1)** Irregular Pulse **2)** Fatigue **3)** Shortness of Breath **5)** Palpitations **6)** Hypotension

Answer 153

**3)** Preventing emboli formation **5)** Antiarrhythmic medications to prevent heart failure

Answer 154

**2)** Maintain a consistent vitamin K intake or avoid vitamin K foods

Answer 155

**1)** Administer vitamin K and prothrombin complex concentrate - Both help reverse the effects of Warfarin. While TXA can help prevent excessive bleeding, it does not target warfarin's action specifically

Answer 156

**V-tach:** repeitive firing of the ventricles d/t irritable ventricular foci with **3 or more consecutive premature ventricular contractions** **BPM:** 140-180

Answer 157

**1)** Wide QRS **2)** R-R interval is regular **3)** No visible p-waves **4)** Rapid BPM 140-180

Answer 158

**1)** Illicit drug use like cocaine and inhalants **2)** Ischemic heart disease **3)** Hyper/hypokalemia **4)** HF **5)** Alcohol use

Answer 159

**1)** Dizziness **2)** Angina **3)** SOB **4)** Palpitations

Answer 160

**1)** Call for help **2)** Attach ECG pads for 12 lead **3)** Give amiodarone (150mg) and help with cardioversion

Answer 161

**1)** Call 911/call for help/Rapid response **2)** Get defebrilator or delegate someone to get it **3)** Start CPR and continue it even while defibrilator is being set up

Answer 162

- It is when there are many irritable foci firing totaly disorganized - No ventricular contraction - **The ventricles quiver consuming a large amount of oxygen**

Answer 163

- There is no cardiac output, no pulse, no perfusion anywhere - It is rapdily fatal in 3-5 minutes

Answer 164

**1)** Acute MI **2)** HF **3)** Acidosis **4)** hyper/hypokalemia **5)** hypomagnesemia

Answer 165

**1)** Pulseless **2)** Apneic **3)** Unresponsive **4)** Pupils dilated and fixed

Answer 166

**1)** Call code/call 911 **2)** Start CPR **3)** Continue CPR and defibrilate as soon as possible

Answer 167

- No recognizable deflection - No discernable pattern, chaos

Answer 168

Absence of any ventricular rhythm; no electrical impulses anywhere, no perfusion

Answer 169

**1)** Severe hyperkalemia **2)** Acidosis **3)** MI **4)** HF

Answer 170

**1)** Call 911/call code **2)** Start CPR

Answer 171

**3)** Pulseless Ventricular Tachycardia **5)** Ventricular fibrilation

Answer 172

2-2.4 inches

Answer 173

Every 6-8 seconds

Answer 174

- 30 compression : 2 breaths - 100-120 compressions/minutes and 10-12 breaths/minute

Answer 175

**1)** Unstable angina **2)** STEMI **4)** NSTEMI

Answer 176

**1)** Familiar pattern **2)** Occurs with exertion **3)** Relieved at rest **4)** < 15 minutes **5)** Relieved by nitroglycerin

Answer 177

**1)** Pain intensity increases **2)** Attacks vary **3)** Occurs without exertion **4)** Is **not** relieved by rest **5)** >15 minutes **6)** Poorly relieved by nitroglycerin **7)** **may have ST changes** **8)** **NO** troponin changes

Answer 178

**1)** Chest pressure **2)** Discomfort **3)** SoB **4)** Nausea **5)** Pain/pressure/discomfort lasts longer than 30 minutes **6)** Pain relieved only by opioids **7)** Pain raidiates to jaw, arm, or back **8)** Occurs **w/o cause often in the morning**

Answer 179

**1)** SoB **2)** Pain between shoulder blades **3)** Fatigue **4)** Indigestion

Answer 180

**ECG:** ST elevation in 2 contiguous leads **Cause:** rupture of atheroslcerotic plaque leading to an emboli that **occludes 100%** of the coronary vessel **Tx:** percutaenous coronary intervention (PCI) - angioplasty w/ or w/o stent or fibrinolytic therapy if no PCI is available

Answer 181

**ECG:** ST depression and T wave inversion **Cause:** vasospasm, dissection, or narrowing/partial occlusion of the vessel by thrombus or atheroclserosis **Tx:** Administer 325mg of aspirin, administer clopidogrel if needed, administer beta blocker 1-2 hours after MI, ACE/ARB 24 hours after, statin for abnormal lipids

Answer 182

**3)** < 90 minutes - STEMIs can be rapidly fatal if the vessel if left occluded and must be treated within 90 minutes of arrival at the hospital

Answer 183

**3)** Delay taking the history and assess the patients symptoms with yes or no questions - You should stop taking a detailed history and do a brief assessment using yes or no questions. The other options are not correct in the current scenario, you should assess your patient first

Answer 184

**2)** Administer tissue plasminogen activator (TPA) also known as Alteplase within 30 minutes of a STEMI with no PCI available

Answer 185

**1)** < 10 minutes

Answer 186

**3)** Avoid NSAIDs, take tylenol - NSAIDs can contribute to bleeding so it is best to use Tylenol for pain management following an MI

Answer 187

**1)** Troponin **3)** Creatinine kinase

Answer 188

**What does it do:** it dilates the blood vessels allowing for blood to move past an occlusion during an MI or partial occlusion to relieve pain and restore flow **How many times can you give:** a total of 3 times 5 minutes between each dose HOLD IF SYSTOLIC BP IS **< 100 mmHG** **Contraindications:** low BP, taking any erectile dysfunction medications such as **sildenafil or any other "-afils"**

Answer 189

**4)** 3-5 months

Answer 190

If it burns when placed under the tongue

Answer 191

In an airtight container that blocks out sunlight

Answer 192

They should call 911 after taking 1 pill with no chest pain relief within 5 minutes

Answer 193

**Use:** used during MI if pain is not relieved by nitroglycerin **Monitor:** BP, RR (can cause respiratory depression), HR, and vomiting

Answer 194

Managing pain reduces metabolic activity reducing oxygen demand

Answer 195

If the patient is hypoxemia below 90% to bring their SpO2 up

Answer 196

**3)** Semi-fowlers - this helps with oxygenation and prevents too little blood from reaching the brain as in tripod or high fowler's - supine does not provide comfort and oxygen support

Answer 197

**3)** Climb 2 flights of stairs without symptoms

Answer 198

**1)** If they experience dyspnea **2)** If they begin to have angina **3)** Their target HR is exceeded, often 20BPM more than goal HR

Answer 199

**What:** It is an abnormally low amount of RBCs, Hgb concentration, or hematocrit **Problem:** diminishes O2 carrying capacity to tissue and organs

Answer 200

**2)** Iron-deficiency anemia

Answer 201

**1)** Fatigue **2)** Pallor **3)** Cold, cold sensitivity **4)** Extertional dyspnea **5)** Somnolence (sleepy/tired) **6)** Numbness/tingling **7)** Headache **8)** Smooth, bright red tongue (pernicious anemia)

Answer 202

**1)** Vitamin C

Answer 203

**Systolic:** < 120 mmHG AND **Diastolic:** < 80 mmHg

Answer 204

**Systolic:** 130-139 mmHG OR **Diastolic:** 80-89 mmHG

Answer 205

**1)** Physical inactivity **2)** Smoking **3)** Obesity **4)** Family history of hypertension **5)** 60 years or older **6)** Stress

Answer 206

**1)** Stroke **2)** MI **3)** PVD **4)** CKD

Answer 207

**1)** CKD (cause and complication) **2)** Pregnancy **3)** Oral contraceptives **4)** Cushing's

Answer 208

**1)** Blood pressure of >130 mmHg systolic or >80 mmHg **2)** Headaches **3)** Dizziness **4)** Flushing **5)** Often asymptomatic - "silent killer"

Answer 209

Loss of 20 mmHg systolic or 10 mmHg within three minutes after moving from a lying/sitting position to standing

Answer 210

**3)** < 1.5g of sodium per day

Answer 211

**1)** Reduce or stop smoking **3)** Abstain or decrease alcohol consumption **4)** Increase physical activity **6)** Modify their diet to a plan like the DASH diet **8)** Lose weight - They should also reduce their caloric intake, and increase their calcium, potassium, fiber, and low-fat intake

Answer 212

**1)** Make treatment occur 1x/day - It's best to make treatment 1x/day and if possible, only one type of medication to reduce the time spent thinking about their medication and negative side effects

Answer 213

**3)** Diuretics, Hydrochlorothiazide - Diuretics are the drug class of choice becuase they can quickly remove excess fluid and sodium reduce blood pressure - Hydrochlorothiazide is preferred over loop or potassium sparing becuase it is low cost, highly effective in uncomplicated hypertension, reduce calcium excretion reducing kidney stone risk, and is self-limiting thus in older adults reducing the risk of over diuresis

Answer 214

Greater than >180 mmHg systolic AND/OR >120 mmHg diastolic - This constitutes a medical emergency

Answer 215

**1)** Severe headache **2)** Blurred vision **3)** Dizzy **4)** Nose bleeding **5)** Uremia **6)** Anxiety

Answer 216

**1)** Place in semi-fowlers **2)** Administer O2 if they are becoming hypoxic to keep it above 90% **3)** Call rapid response/911

Answer 217

**What is it:** a thiazide dieuretic that removes water, sodium, and potassium from the body **Used:** #1 treatment for hypertension, and can be used in heartfailure during fluid volume overload, but loop diuretics are preferentially used **Monitoring:** - S/S hypokalemia (weakness, decreased reflexes, irregular pulse) - S/S dehydration - Glucose levels - Renal function (BUN and Creatinine) - Tinnitus (and other hearing problems but less common in thiazides than in loops) - Uric acid retention - may be harmful for those with gout **Education:** - Eat foods high in potassium - Rise slowly d/t orthostatic hypotension - Take in the morning to avoid nocturia - May affect blood glucose control - May cause decreased libido in males - Report tinnitus, changes in pulse, and any weakness

Answer 218

**1)** MI **2)** Hypertension **3)** CAD **4)** Valvular disease/dysfunction

Answer 219

When the heart cannot contract forcefully enough during systole to eject enough blood out, often leads to fluid back up into the atria and pulmonary system **Ejection fraction: < 40%**

Answer 220

When the ventricle cannot adequately relax during diastole preventing adquate blood filling for cardiac output. Ventricles become less compliant over time becuase you need more pressure to move the same amount of volume Ejection fraction is preserved becuase while you have less filling, you still push out an adequate amount keeping the proportion similar. **EJ: < 40%**

Answer 221

**1)** Poor activity tolerance = dyspnea and fatigue **2)** Daytime oliguria and nighttime nocturia **3)** Angina **4)** Confusion, dizziness **5)** Restless **6)** Pallor/ashen skin **7)** Tachycardia **8)** Weak pulses **9)** Cool extremities **10)** Pulmonary congestion/edema **11)** Orthopnea - will sleep upright and/or with a lot of pillows

Answer 222

**1)** Frothy, pink-tinged sputum **2)** Tachypnea **3)** Hacking cough **4)** Crackles near the base of the lungs **5)** Restless **6)** Pulmonary hypertension **7)** Systemic hypotension **8)** Oliguria

Answer 223

**1)** Place in high Fowler's position (if not hypotensive) **2)** Provide O2 to keep at 90% SpO2 **3)** Administer IV push furosemide over 1-2 minutes to treat edema and to avoid ototoxicity - Can also use nitroglycerin to reduce preload and afterload lessening fluid build up

Answer 224

**1)** Peripheral edema **2)** Ascietes **3)** Enlarged liver and spleen **4)** Neck vein distension **5)** Swollen hands/fingers **6)** Polyuria at night as fluid is mobilized **7)** Clothing and accessory do not fit well **8)** Weight gain (10-15 lbs) **9)** Anorexia **10)** Nausea

Answer 225

Edema is a poor measure because it take a lot of fluid retention before edema becomes apparent in heart failure **Weight** is a better measure. **Education:** - Take your weight daily - Take your weight at the same time each day - Take your weight, preferrably in the morning before you've eaten anything - Take your weight wearing the same clothing each time

Answer 226

2-3kg in one day 5-6kg in one week

Answer 227

**1)** BNP **2)** Troponin **3)** Creatinine **4)** BUN - Hematocrit is not elevated, it is often lowered to do fluid dilution - GFR is typically lowered which is why we see high creatinine and BUN d/t poor kidney filtration

Answer 228

**4)** **Echocardiogram**, can see valvular changes, pericardial effusion, chamber enlargement, vetricular hypertrophy, and most importantly, **ejection fraction**

Answer 229

DoC w/ no fluid volume overload are Angiotensin Converting Enzyme Inhibitors -> **ACEIs** DoC for HF with fluid volume overload are **diuretics, mainly loop such as furosemide**

Answer 230

**2)** Losartan, we would want to switch to an ARB if ACEIs do not work for the patient

Answer 231

**4)** Cough, is a side effect of ACEIs and patients should be switched to an ARB instead

Answer 232

**What do they do:** both suppress the RAAS which helps vasodilate vessels and increase sodium and water excretion decreasing afterload and improving stroke volume **Medications:** - ACEIs = -"april" -> lisinopril, clanapril, captopril - ARBs = "-artan" -> losartan, valsartan **Monitoring:** - Hold if patients PB < 100 mmHg systolic - S/S of hyperkalemia - Angioedema - If BP drops below 90 mmHg systolic elevate legs **Education:** - Rise slowly d/t orthostatic hypotension - Decrease potassium rich foods in your diet

Answer 233

**What do they do:** They block beta receptors on the heart reducing catecholamine (Epi, Nor epi, dopamine) stimulation thereby reducing heart rate and blood pressure. **Medications:** "-olol" -> atenolol, metoprolol **Monitoring:** - Heart rate, do not give if below 60 BPM - Blood pressure, do not give if below 100 mmHg systolic **Education:** - Rise slowly d/t orthostatic hypotension - May cause fatigue, weakness, depression, or sexual dysfunction - **Do not stop abruptly** - can cause severe rebound tachycardia - May mask hypoglycemic symptoms

Answer 234

**3)** Ibuprofen, it is a NSAID and they should be avoided as they can cause sodium and fluid retention

Answer 235

**Increased intraocular pressure** that compresses the nerves, vessels, and photoreceptors in the eye causing a loss of vision at the **periphery toward the center**

Answer 236

**Angle-closure glaucoma** as it causes complete and sudden vision loss d/t an obstruction of aqueous humor flow - **it is a medical emergency**

Answer 237

**1)** blurry vision **2)** halos around lights **3)** loss of peripheral vision **4)** poor dark vision **5)** anxiety and fear

Answer 238

Through routine eye exams using tonometry to detect high pressure in the eye > 32 mmHg

Answer 239

**3)** Place the knuckle or tip of your funger at the puncta to prevent eye drops from entering the tear duct - Punctal occlusion should be done to prevent eye drops from entering systemic circulation

Answer 240

**1)** Wash your hands before instilling eye drops **2)** Do not touch the dropper to the eye surface **3)** Wait 5-10 minutes betwen drops to prevent dilution **4)** Hold pressure on the tear duct by performing punctal occlusion **5)** Use your eye drops at the sime time each day **6)** Your eyes may become blurry, sting, or burn temporarily after eye drops

Answer 241

They help drain fluid from the eye

Answer 242

They reduce the amount of aqueous humor in the eye

Answer 243

To lower the pressure in the eyes

Answer 244

**1)** Knock to announce yourself when entering the patient's area **2)** Orient the patient to their room/environment **3)** Provide clock face times for food locations on their plate **4)** Do not move items or rearrange without their permission **5)** Talk in a normal voice **6)** Offer your arm when walking

Answer 245

**Sensorineural:** permanent hearing loss d/t damage to the cochlear hairs or auditory nerve **Causes:** prolonged exposure to loud noises (plane engines, lawn mowers, loud music), loop diuretics, other medications **S/S:** tinnitus, difficulty following conversations, hard to hear in loud environments

Answer 246

**Conductive:** temporary hearing loss d/t external ear conditions **Causes:** cerumen build up, infection, object obstructin canal **S/S:** obstruction, speaking softly, hearing better in one ear than the other

Answer 247

**1)** Wear hearing protection **2)** Receive annual hearing screens **3)** No q-tips **4)** Do not place anything bigger than your pinky into the ear **5)** Do not candle or engage in candling **6)** Take care of your hearing aid

Answer 248

**1)** Fall risk d/t dizziness, unsteady, and fatigue **2)** Home safety - visual indicators for alarms, phones, and doorbells

Answer 249

**1)** Ensure their hearing aids are in **2)** Make sure amplifier is working **3)** Use white boards **4)** Remove loud noises **5)** Face them so that they can lip read **6)** Speak in a low octave voice **7)** Teach back education **8)** Talk to them in a well-lit room

Answer 250

**1)** Clean only the mold (nothing electronic) with mild soap and water **2)** Place the hearing aid in the lowest setting

Answer 251

It is brief periods of **apnea lasting longer than 10 seconds** while asleep d/t the relaxation of neck muscles, soft palate, and tongue obstructing the airway while asleep causing intermittent hypoxia + impaired ventilation

Answer 252

**1)** Hypertension **2)** Cardiovascular diseases **3)** Stroke **4)** Insulin resistance **5)** Dementia

Answer 253

**1)** Fatigue **2)** Daytime sleepiness **3)** Headaches **4)** Waking up gasping **5)** Irritabiltiy **6)** Memory loss **7)** Overweight (cause + symptom) **8)** Snoring

Answer 254

More common in men Higher in those 60+ y/o

Answer 255

Improving gas exchange **1)** Changing sleeping positions **2)** Losing weight **3)** Continuous Positive Airway Pressure (CPAP)

Answer 256

CPAP provide continuous positive airway pressure, which means it continuous maintains a set pressure during inhalation and exhalation to keep the airway patent. Make sure to the mask has a good fit.

Answer 257

**2)** A 74-year-old male who smokes and has a fractured femur

Answer 258

**4)** The blood clot interferes with perfusion in the lungs.”

Answer 259

**2)** Cover the insertion site with sterile gauze

Answer 260

**1)** Reproducible leg pain with exercise

Answer 261

**2)** Warm skin with brisk capillary refill

Answer 262

1) Poor gas exchange from decreased alveolar surface area 2) Increased anteroposterior chest diameter from air-trapping 4) Hypercapnia from retained PaCO2 5) Respiratory acidosis with a low pH

Answer 263

**4)** Encouraging the client to drink 2 to 3 L of water daily

Answer 264

**3)** Albuterol (Proventil), an inhaled short-acting beta2-agonist (SABA)

Answer 265

**3)** Heart rate

Answer 266

**1)** Ventricular tachycardia

Answer 267

**2)** Shortness of breath

Answer 268

**3)** Blood presure 88/48 mmHg

Answer 269

1) Reduce moisture 2) Nutrition (vitamins A+C, zinc) 3) Reduce sun exposure (hats, long sleeves, sunscreen) 4) Burn prevention (turn down water heater)

Answer 270

1) No massaging area (friction and tears) 2) Hot water and soap (burns) 3) Cornstarch (promotes bacterial growth) 4) Briefs (holds moisture)

Answer 271

Stage 1: **nonblanchable** redness, **intact skin**, sensation changes Stage 2: partial-thickness skin loss, **dermis exposed, pink, moist, red** Stage 3: full-thickness skin loss,** fat visible**, slough/eschar possible, granulation tissue Stage 4: Full-thickness skin loss, **exposed, muscle, tendon, and bone** slough/eschar, tunneling, undermining Unstageable: obscured full-thickness skin loss by eschar/slough Suspected deep tissue injury: nonblanchable, deep red/maroon, skin intact or open

Answer 272

1) Immobility 2) Decreased sensation/perception 3) Poor nutrition 4) Diabetes or peripheral vascular disease 5) Moisture/incontinence

Answer 273

1) Monitor albumin and proterin serum 2) Good nutrition 3) Check perfusion 4) Turn Q2H

Answer 274

HoB should not be higher than 30 degrees

Answer 275

Serum albumin

Answer 276

1) Pain management 2) Dress wound 3) Relieve pressure

Answer 277

45 degrees (High Fowler's)

Answer 278

Inflammation of the joints

Answer 279

- Progressive deterioration and loss of articulating joint cartilage, bone, and connective tissue - Synovial fluid declines = decreased lubrication and nutrition - Associated with pain w/ mobility - Most common in older adults

Answer 280

1) Enzymes break down articular matrix eroding cartilage and bone 2) Inflammation sets in calcifying, thinning, and ulcerating tissue 3) Cartilage disintegrates causing it to float, creates crepitus (noises)

Answer 281

Grating sound in osteoarthritic joints d/t loosened bone and cartilage in the joint

Answer 282

1) Primary OA: age and genetics (mechanical weardown) 2) Secondary OA: joint injury, obesity

Answer 283

1) Manual occupations 2) Excessive use 3) Trauma 4) Joint disease 5) Athletics 6) Metabolic diseases 7) Blood disorders (hemophilia)

Answer 284

1) Men under 55 y/o 2) Women over 55 y/o 3) Veterans are 2x more likely to be diagnosed at age 40

Answer 285

Localized, unilateral

Answer 286

1) Avoid injury 2) Take breaks at work, especially if it is repetitive tasks 3) Proper nutrition to prevent obesity

Answer 287

1) Pain location and quality 2) Joint stiffness 3) Any swelling 4) Disruption of ADLs 5) Age, gender, work, veteran, weight

Answer 288

1) Stiffness w/ 30 minutes of no activity 2) Severe joint pain that worsens with activity 3) Crepitus 4) Nodules on hands

Answer 289

Pain is relieved by rest/sleep

Answer 290

1) MRI 2) Erythrocyte sedimentation rate (ESR) 3) X-ray

Answer 291

1) Pain management 2) Decreased mobility d/t pain and atrophy

Answer 292

1) NSAIDs like Diclofenac 1% cream = topical NSAID, 2 weeks before effective, avoid heat to area 2) Acetaminophen = 4000mg/day max, **use only 3000mg** d/t liver damage 3) Celecoxib = cox 2 inhibitor; watch out for edema, SOB, dark-tarry stool; not for those with hypertension, kidney disease, or cardio history 4) Corticosteroid injection = reduced inflammation (suppresses immune system, decrease bone density, increase blood sugar, weight gain) 5) Hyaluranic acid = increase lubrication

Answer 293

Kidney damage, GI bleed (dark-tarry stools), dehydration

Answer 294

1) Rest and exercise 2) Hot and cold packs 3) Aquatic exercises 4) Topical capsacin (modified substance P) 5) Glucosamine supplement (reduced inflammation) 6) Proper lifting and posture

Answer 295

1) Total join arthroplasty: total join replacement of all functional parts with a prosthesis (Ex: hip, knee, shoulder, ankle) 2) Contraindications: infection anywhere in the body, hypertension, uncontrolled diabetes, progressive inflammation

Answer 296

1) KEEP LEGS ABDUCTED 2) On surgery day, ambulate them 3) Night after surgery = weight bearing ambulation, 1 week later = full weight bearing 4) VTE prevention = heparin, ambulation 3x/day, heel push, leg extensions, knee pushes

Answer 297

1) Exercise after heat is applied 2) Exercise on good and bad days 3) Respect pain 4) Active exercise is best

Answer 298

1) A chronic, progressive, and systemic inflammatory autoimmune disease affecting primarily synovial joints; 2) Etiology: environment and genes, stress, infection, but affects women more d/t reproductive hormones 3) Characterized by exacerbations and remissions

Answer 299

2-3x more women than men; mainly white individuals

Answer 300

1) Early: joint inflammation, low-grade fever, fatigue, weakness, parathesias 2) Late: deformities join joint (swan neck, ulnar deviation), **morning stiffness that lasts longer than 30 minutes**, moderate-severe pain, fatigue, subcutaneous nodules, dry eyes/mouth/vagina

Answer 301

1) Pain 2) Decreased mobility 3) Decreased self-image

Answer 302

1) Rheumatic factor 2) HsCRP 3) Anti-CCP 4) Antinuclear antibody 5) Erythrocyte sedemendation rate

Answer 303

1) Total joint arthroplasty 2) NSAIDs 3) Disease-modifying antirheumatic drugs (methotrexate and hydroxychloroquine) 4) Biological response modifiers = inhibit inflammatory cytokines 5) Ice + heat application 6) Wax dips

Answer 304

1) DMARDs: they slow the progression of RA by reducing joint pain and inflammation. 2) Use: Earlier in the disease process = more effective

Answer 305

What is it: immunosuppressing drug that works by reducing pain and swelling Taken: once per week Length: Work best earlier in disease course, takes 4-6 weeks before seeing inflammation control Effects: Decrease in WBC or platelets d/t bone marrow suppression, elevated liver enzymes and serum creatinine. Lymph node tumor. Pneumonitis. Mouth sores. Dyspnea.

Answer 306

1) Increased infection risk = avoid large crowds and those who are ill 2) Avoid alcoholic beverages becuase of possible liver toxicity 3) Report adverse effects like mouth sores and acute dyspnea 4) Taking folic acid can help decrease side effects 5) Methotrexate use can cuase birth defects, therefore patients who can become pregnant should be on strict birth control. It must be stopped 3 months before pregnancy and cannot be used while breastfeeding.

Answer 307

1) What is it: It is an antimalarial drug that helps suppress the immune response to decrease joint and muscle pain. 2) Stage: Works best in mild RA 3) Side effects: Lightheadedness, stomach discomfort, headache 4) Contraindications: Do not use if present cardiac disease or dysrhythmias

Answer 308

1) Find alternatives for ADLs 2) Replace heavy cup lids and difficult handles 3) Long-handled brushes 4) Shoe horn 5) Handles + grip bars 6) OT consult

Answer 309

1) Antibodies (rhuematoic factors) attack healthy synovium causing inflammation 2) Inflammation and immunity factors cause cartilage damage alongside cytokine + WBC attraction 3) Synovium thickens, fluid accumulates in joints, bone fuses and calcifies

Answer 310

**1)** 50 + **2)** Male **3)** Genetic **4)** Toxin or chemical exposure **5)** Chronic use of antipsychotics

Answer 311

**1)** Bradykinesia: slowness of movements **2)** Akinesia: difficulty intiating movement **3)** Tremor (pill-rolling) **4)** Gait (Shuffling, festinating) **5)** Muscle rigidity **6)** Stooped posture **7)** Masklike expression **8)** ANS difficulties (swallowing, chewing, mood)

Answer 312

**1)** Administer meds **2)** Monitor intake (aspiration risk, nutrition) **3)** Sit upright while eating, smaller meals, thickened liquids **4)** OT consult **5)** Exercise **6)** Safe area/fall prevention

Answer 313

**1) Dopaminergic agents:** increase dopamine in BG (Cabidopa prevents levodopa from being broken down) **2) Dopamine agonists:** activate release of dopamine (Bromocriptine, ropinirole) - monitor for orthostatis hypotension **3) Anticholinergics:** block Ach controlling tremor and rigidity (Benztropine) - very drying - mouth, GI, GU

Answer 314

**1)** Aspiration pneumonia **2)** Altered cognition **3)** UTI **4)** Depression **5)** Skin breakdown

Answer 315

1) Initiates metabolic proceses (weight loss, tachycardia, increased RR) 2) Higher rates of infection d/t higher cortisol levels 3) Unrelieved pain can lead to pneumonia (shallow breathing) and hypercoagulation leading to MI/stroke. 4) Increased heart rate and blood pressure in acute pain 5) Impaired mobility

Answer 316

1) Nonopoids - mild to moderate nociceptive pain (NSAIDs, acetaminophen) 2) Opioids - moderate to severe pain (Oxycodone, hydrocodone, morphine) 3) Adjuvants - anticonvulsants/antidepressants for neuropathic pain

Answer 317

Nerve-related pain, monitor for sedation and suicidal ideation.

Answer 318

1) Low percent body weight as water 2) Decreased thirst response 3) Decreased kidney function

Answer 319

Loss of water w/o loss of sodium increasing osmolality and decreasing volume

Answer 320

Loss of both water and electrolytes equally decreasing volume

Answer 321

Too much isotonic fluid increasing volume

Answer 322

1) Lack of water intake 2) Lack of thirst response (coma, tube feeding w/o water) 3) GI losses (vomiting, diarrhea) 4) Diabetes insipidous (no ADH = large urine output) 5) Excessive sweating 6) Wound drainage

Answer 323

1) sudden weight loss (1kg (2.2lbs)/day =1L of water lost) 2) dry oral mucosa 3) Low BP 4) High HR 5) High RR 6) Flat veins 7) Oliguria (minimal urine output, dark, less than 500mL/day or 30mL/hour) 8) LOC 9) seizures **10) Na+ increased (>145)** 11) High sodium, high hematocrit, high BUN, high urine specific gravity, high creatinine

Answer 324

1) blood loss 2) GI losses (nausea, vomiting) 3) diuretic treatment 4) lack of aldosterone 5) Altered intake (impaired swallowing) 6) prolonged NPO 7) confusion

Answer 325

1) sudden weight loss 2) Low BP 3) High HR 4) Dry mucosa 5) Oliguria

Answer 326

There is no sodium loss in fluid volume deficit

Answer 327

Decreased tissue perfusion leading to low O2 to tissues, shock

Answer 328

Impaired tissue perfusion d/t edema (generalized, pulmonary edema) because capillaries are pushed farther away from cells

Answer 329

Na+ shifts fluid away from cells causing them to shrink leading to LOC, confusion, shock

Answer 330

Isotonic Na+ solution (sodium included to prevent seizures from rapid shifting) and extra water, fall prevention

Answer 331

Isotonic Na+ solution, monitor, fall prevention

Answer 332

1) Excess Na+ isotonic solutions 2) high oral intake of sodium and water 3) Oliguria (CKD) 4) Heart failure 5) IV overload

Answer 333

1) Sudden weight gain (1kg (2.2lbs)/day) 2) Edema 3) Bounding pulse 4) Dyspnea/SOB 5) Pulmonary edema 6) Distended veins 7) Increased RR and BP 8) decreased Hct, Hgb 9) pale, cool skin 10) lung crackles

Answer 334

1) Fluid/Na+ restriction 2) Elevate HOB 3) Administer O2 4) **Diuretics (Furosemide)** 5) Aquaretics 6) Dialysis

Answer 335

1) Type: It is a loop diuretic that removes water, sodium, and electrolytes (K+) 2) *Oral* onset is 60 minutes and duration is 8 hours; *IV* onset is 5 minutes and duration is 2 hours (rapid intervention) 3) Adverse effects: Ototoxicity (hearing damage), excess Na+/K+/water loss, hypotension 4) Teaching: Slow position changes and eat foods high in potassium or supplement

Answer 336

**1)** Output is greater than intake **2)** Output is less than intake **3)** Altered elecrolyte distribution (i.e., potassium moving into ECF and H+ moving into ICF during acidosis, calcitonin increasing ECF Ca2+ )

Answer 337

1) Skin: poor turgor, dry skin 2) Kidney: decreased GFR means less excretion and decreased concentrating capacity increasing water loss 3) Muscular: less muscle mass = less total body water 4) Neurologic: decreased thirst reflex = less fluid intake 5) Endocrine: adrenal atrophy = poor Na+ and K+ balance (low for both)

Answer 338

Obligatory urine output: The minimum output per day to remove toxic waste. Amount: 400-600mL/day

Answer 339

Insensible water loss: lost fluid b/c no mechanism controls it (Ex: salivation, perspiration, lung vapor, fistulas, drains, GI suction Amount: 500-1000mL/day

Answer 340

~2300mL/day

Answer 341

Stimulus: It is secreted by the adrenal cortex when Na+ ECF levels are low, renin signals release Function: Acts on the kidneys to prevent and Na+ and water excretion by increasing reabsorption

Answer 342

Stimulus: Secreted by the hypothalamus and stored in the PP for release when blood osmolarity is too high Function: Inserts aquaporins into the collecting ducts to reabsorb water

Answer 343

Stimulus: Released from the heart atria and ventricles in response to increased blood volume and blood pressure Function: Inhibits Na+ and water reabsorption at the kidneys (works in contract to aldosterone)

Answer 344

**Functions:** **1)** constricts ateries and veins to increase total peripheral resistance **2)** Constricts afferent arterioles to decrease GFR and urine output **3)** Stimulates aldosterone output to increase Na+ and water reabsorption

Answer 345

**Sodium:** 136-145 mEq/L **Potassium:** 3.5-5.0 mEq/L **Calcium:** 9.0-10.5 mg/dL **Magnesium:** 1.3-2.1 mEq/L **Osmolarity:** 270-300 mOsm

Answer 346

**Lab value:** <136mEq/L **Key issue:** decreased membrane excitability (need high ECF Na+ to excite) and **cellular swelling** **Causes:** prolonged diuresis, excessive water intake, kidney failure, GI fluid loss, burns **Sx:** *normal volume* = increased HR; *hypovolemic* = thready, weak pulse, rapid HR, hypertension; *hypervolemic* = rapid, bounding pulse, BP normal or elevated -> *cerebral changes (behavioral)* = **LoC, confusion, seizure**, headache -> *Neuromuscular* = weakness, hyporeflexia -> *Intestional* = increased GI motility, nausea, diarrhea **Nursing role:** monitor LoC, extremity strength/reflex, slow position changes, monitor patient's respons to therpy, prevent hypernatremia and fluid overload, **Tx:** IV saline (if deficit), reduce dieuretic dose, **increase Na+ intake**, **hypertonic solution if ECF is low osmolairty**, lithium for SIADH

Answer 347

**Lab value:** >145 mEq/L **Key issue:** increase tissue excitability (Na+ moves more easily into cells), **cells shrink and stop responding** **Causes:** kidney failure, hyperaldosteronemia, dehydration, excessive Na+ intake, IV fluids, steroids, diabetes insipidous **Sx:** *nervous* = altered mental status, **irritable, agitated**, short attention span; *skeletal muscle* = twiching, contractions, weakness + hyporeflexia in severe; *CV*= **edema**, decreased contractility; **other** = skin flushed and dry, thirsty **Nurse:** assess muscle strength with hand grip/arm flexion **Tx:** Restrict Na+ intake, **furosemide** diuretic, **isotonic saline w/ dextrose 5% in .45% sodium to correct imbalance without rapid shifting into cells**

Answer 348

**Lab value:** <3.5 mEq/L **Key issue:** decreased excitability causing nerve and musces cells to be less responsive **Causes:** diuretics (loop + thiazide), corticosteroids, high aldosterone, vomiting, diarrhea, alkalosis, hyperinsulinism **Sx:** respiratory = shallow, **weak respirations** ; skeletal muscle = hyporeflexia, weak grip; CV = weak, thready pulse, orthostatic hypotension; neuro = irritable, anxious, confused; GI = decreased peristalsis, N/V, constipation -> ECG Findings: **Prominent U-wave** , ST depression, inverted T wave **Nurse role:** **Ensure good urine output,** PO K+ with food d/t N/V, adequate gas exchange **(assess respiratory status and heart Q2H)**, prevent K+ admin injury **Tx:** K+ supplements, IV K+ (**DO NOT PUSH, DILUTE INSTEAD; 5-10 mEq/hour)**, self intake (bananas, citrus, raisins, meat), switch to potassium sparing diuretics like **Spironolactone**

Answer 349

HELL NO. It should be administed via IV infusion, diluted with saline, and administered slowly at 5-10mEq/hour. It cannot be given IM/SubQ.

Answer 350

Effer-K can be dissolved in liquid for PO admin

Answer 351

**Lab value:** >5.0 mEq/L **Key issue:** increases cell excitability causing less response to stimuli, **especially conduction to the heart** **Causes:** high K+ intake (supplements,** salt substitutes**), IV infusion, whole blood transfusions, acidosis, kidney failure, **potassium-sparing diuretics (Spironolactone), ACE Inhibitors (lisinopril - 'prils)** , acidosis **Sx:** *CV=* bradycardia, hypotension, ectopic beats, heart block, asystole, ventricular fibrilation; *neuromuscular=* twitching, **contracting/cramps**, **numbness/tingling of hands/feet/mouth**, weakness starting at extremities; *GI=* increased motility, diarrhea, hyperactive BS -> *ECG:* **Peaked T waves**, prolonged PR, wide QRS **Nurse role**: **assess for any cardiac complications** with continuous monitoring , decrease potassium intake, prevent falls, **Tx:** Patiromer/Kayexelate = bind K+ decreaseing GI absorption, low K+ foods, no supplements, **potassium-excreting diuretics (loop=furosemide or thiazide = hydrochlorothiazide)**; insulin w/ dextrose, dialysis

Answer 352

**Lab value:** <9.0 mg/dL **Key issue:** Inceased Na+ movement across excitable membranes when there is low Ca2+ = increased depolarization **Causes:** Decreased Ca2+ intake, lactose intolerance, malabsorption syndromes (Chron's/Celiac), low vitamin D intake, diarrhea, alkalosis, CKD, wound drainage, decreased parathyroid hormone **Sx:** *neuromuscular=* muscle twitching, **painful cramps/spasms in thigh/calf,** N/T of hands/feet/lips, **positive Troussea's sign, positive Chvostek** sign; *CV=* **weak respirations** weak, thready pulse, decreased HR and BP; *ECG=* **prolonged QT intervals** ; *GI=* increased bowel sounds, cramping, diarrhea; *skeletal=* osteoporosis **Nursing role:** **decrease environmental stimuli, have emergency trachestomy equipment on standby (d/t laryngospasm)**, careful lifting/moving d/t brittle bones, proper body mechanics **Tx:** Dietary (spinach, kale)/IV Ca2+ replacement, vitamin D

Answer 353

**Lab values:** >10.5 mg/dL **Key issue:** High Ca2+ causes excitable tissue to be less sensitive = cells needs a stronger stimulus to depolarize **Causes:** Excess Ca2+ intake, excess vitamin D intake, hyperparathyroidism, CKD, thiazide diuretics, immobiltiy **Sx:** *CV=* increased HR and BP in mild and decreased in severe, increased clotting in legs and pelvis, edema; *ECG=* short QT, wide T; *neuromuscular=* weakness, **hyporeflexia**, confusion; *GI=* constipation, decreased bowel sounds, vomiting, **excessive urination** **Nursing role:** **monitor cardiac function,** rehydration with normal saline **Tx:** Stop Ca2+ intake, use normal fluids, **phosphorus/calcitonin/biphosphonates/NSAIDs** to keep Ca2+ in bone, stop/change diuretics **(stop thiazide, start loop)**

Answer 354

**Lab value:** <1.3 mEq/L **Key issue:** Increased membrane excitability (magnesium at normal levels helps inhibit) - also **low Mg2+ means low K+ and Ca2+** **Causes:** decreased absorption of dietary Mg2+ (proton pump inhibitors - stop acid = no magnesium chelation, Celiacs/Chron's), Thiazide and loop diuretics, diarrhea **Sx:** CV= **tachycardia, hypertension**, dysrthymias (a. fib, v. fib, long QT); neuromuscular= **hyperreflexia**, N/T, irritability, **positive Troussea's, positive Chvostek, seizures;** GI = nasuea, constipation **Nursing Role:** **monitor cardiac activity,** assess DTR in IV Mg2+ replacement, seizure precuations **Tx:** discontinue diuretics (loop + thiazide), aminoglycosides, magnesium sulfate, IV therapy

Answer 355

**Lab value:** >2.1 mEq/L **Key issue:** high Mg2+ causes extreme inhibition and decreased depolarization **Causes:** mangesium-containing antacids/laxitives, IV replacement, CKD/kidney failure **Sx:** **CV = bradycardia, peripheral vasodilation, hypotension, cardiac arrest, respiratory depression**; ECG = wide QRS, prolonged PR; neuromuscular = **absent or reduced DTR**, muscle weakness **Nursing Role:** **monitor cardiac function**, monitor DTR **Tx:** calcium gluconate, stop all Mg2+ products, **loop (furosemide/lasix)**, Mg2+ free fluids

Answer 356

When the body has a physiological needs for more cells (Ex: more WBCs during infection) or after apoptosis

Answer 357

When cells go from immaturity to maturity for a specific function

Answer 358

It is what prevents cells from growing outside their territory. Cancer cells do not have contact inhibition.

Answer 359

Proto-oncogenes: regulate and promote cell growth Tumor supressor genes: regulat and suppress cell growth Cancer cells benefit becuase mutations will either inactive tumor suppressor genes or overactivate proto-oncogenes.

Answer 360

Abnormal cell growth which new tissues grow unregulated harming normal cell function

Answer 361

1) Initiaion: lose regulation, irreversible 2) Promotion: enhanced growth by endogenous hormones or other substances 3) Progression: increased growth and can be detected, **has own blood supply**

Answer 362

How similar cancer cells look like parent cells

Answer 363

How progressed is the cancer? Informes prognosis, tx, and options. Tumor-node metastasis (TNM): 1) Location 2) Size 3) Lymph spread 4) Spread to distant points

Answer 364

**Death:** Lung + Bronchus **Incidence:** Prostate (men), breast (women)

Answer 365

1) Carcinogen exposure = responsible for 90% of cancer 2) Genetics 3) Immunity (reduced immunity d/t **age**, infection, transplant, medications) - age is a risk because exposure accumulates

Answer 366

Cachexia: malnutrition and extreme body wasting caused by cancer becuase it steals nutrients that cells need

Answer 367

1) **Prophylactic:** tissue removal to prevent cancer (i.e. mastectomy) 2) **Diagnostic:** removal of all or part of lesion to test 3) **Curative:** remove all cancerous tissue, cure 4) **Debulking:** partial tumor removal to improve symptoms, improve other treatment, and increase survival time 5) **Palliative:** symptom relief and impove quality of life 6) **Reconstructive:** increase function and/or appearance

Answer 368

1) **Monotherapy:** single treatment modality used 2) **Combination:** two or more treatments used together 3) **Maintenance:** continued treatment to prevent cancer recurrence and progression 4) **Experimental:** clinical trials for a new treatment

Answer 369

Radiation therapy is using high-energy radiation to kill cancer cells for curative or palliative treatment. Effects are only seen in the target area.

Answer 370

1) Reduce time in field 2) Increase distance from field 3) Use shielding (lead apron/shield) 4) Use dosimeter

Answer 371

1) External beam: radiation is outside of patient, they are not radioactive (IMRT, stereotactic, radiosurgery) 2) Brachytherapy: internal radiation, object placed direct in contact with tumor or ingested giving a higher dose. Patient is only radioactive while the seed is still in

Answer 372

1) Radiation dermatitis: redness pigmentation, desquamation 2) systemic: fatigue, altered taste, bone marrow suppression 3) Fibrosis and scarring 4) Secondary malignancies 5) N/V 6) Photosensitive skin

Answer 373

Because their skin becomes photosenitive increasing sunburn risk. They should avoid sun during and 1 year after radiation is complete.

Answer 374

1) Wash area with mild soap and water 2) **No scrubbing** 3) Do **not** remove ink tattoo until radiation therapy is complete

Answer 375

The use of antineoplastic (chemo) or immunotherapy drugs to kill cancer and disrupt regulation of cancer cells. It kills both healthy and cancerous cells. Types: Chemo, immunotherapy, hormone (endocrine), and targeted therapy

Answer 376

Therapy that works to activate the immune system to attack cancer cells

Answer 377

Chemo used **before** surgery/radiation to debulk or shrink the tumor

Answer 378

Chemo used **after** radiation/surgery

Answer 379

No, but it can help increase survival time

Answer 380

The schedule must be followed to achieve the best dose in order for the best response

Answer 381

Vesicant: medication that is damaging to tissue on direct contact Assess IV site and stop infusion if s/s appear.

Answer 382

No, they should use a glove.

Answer 383

Do not double up, take the next dose when scheduled

Answer 384

1) Cardiac muscle damage 2) Decreased bone density 3) Anemia 4) Reduced immunity 5) Neutropenia 6) Thrombocytopenia 7) Reduced clotting 8) N/V 9) Mucositis 10) Alopecia

Answer 385

Bone marrow suppression d/t concern of reduced immunity

Answer 386

1. Handwashing or alcohol-based rubs before contact 2. Clean their room and bathroom 1x/day 3. Place patient in private room 4. Vitals Q4H 5. Monitor IV sites 6. Inspect mucus membranes and skin 7. Restrict sick visitors 8. Change wound dressings daily 9. Notify provider of any possible infection 10. Keep equipment in patients room 11. Monitor WBC daily 12. Avoid catheter use 13. Avoid potted plants/flowers in the room

Answer 387

1) Avoid crowds 2) no sharing toiletries 3) bathe daily 4) use antimicrobial soap 5) do not drink standing liquids 6) do not clean up after pets

Answer 388

Vomit inducing substance/agent

Answer 389

Before chemo is best but can also be given at first s/s

Answer 390

* Anticipatory: before receiving chemo, triggered by thoughts, sights, sounds * Acute: w/in 24 hours of receiving chemo (i.e. Decarbazine) * Delayed: after first 24 hours (Cisplatin) * Breakthrough: intermittent

Answer 391

Use: Treat nasuea and vomiting, antiemetic MoA: serotonin antagonist blocking the H-HT3 receptors in brain and GI. Route: Oral or IV When: 1-2 hours before chemo Side effects: headache, orthostatic hypotension, bradycardia, vertigo, constipation, porlonged QT interval

Answer 392

Use: Nasuea and vomiting, antiemetic MoA: dopamine (D2) antagonist in the brain Route: Oral Side effects: drowsiness, extrapyramidal reactions, difficulty cooling body

Answer 393

Mucositis: inflammation of the oral and GI mucosa Relieved: gentle flossing, non-alcoholic rinses, brush every 8 hours, drink 2L of water daily, avoid spicy and acidic food

Answer 394

Alopecia: hair loss Protection: use sunscreen and coverings

Answer 395

Hair regrowth begins ~1month after stopping chemotherapy

Answer 396

Decline in concentration and memory during chemo

Answer 397

It is peripheral neuropathy caused by damage to the nerves in extremities, especially lower extremities cuasing gait and balance issues, loss of sensation in hands and feet, orthostatic hypotension, erectile dysfunction, pain, constipation, and reduced taste

Answer 398

The time and energy one spends on everything cancer-related: treatment, managing care, driving, waiting, fatigue and side effects of treatment

Answer 399

Immunotherapy: medication used to activate the body's own immune system to detect and attack cancer cells. Sx: fatigue, rash, increased infection risk Preference: It may be preferred over chemo because there are less cytotoxic effects.

Answer 400

Immune-related adverse events: It is when the immune system stimulation affects healthy cells too causing systemic inflammation (hepatitis, pancreatitis, colitis, etc.) Tx: corticosteroids

Answer 401

Targeted therapy: The use of medications to block growth and spead by interfering with growth and regulatory pathways. For instance, blocking VEG-F acting directly on cancer cell Sx: GI disturbance, decreased immunity, skin rash, hypotension

Answer 402

The therapy will not work if the protein or mutation is not expressed.

Answer 403

Endocrine therapy: aromatase inhibitors, GRH analogs, antiandrogens, and antiestrogens to prevent cancer cells from receiving growth stimulation Sx: fatigue, orthalgia (joint pain), bone pain, hot flashes, sexual dysfunction, osteoporosis, thrombosis

Answer 404

Colorectal cancer

Answer 405

Found: Rectosigmoid area Metastasis: Most often spreads to the liver

Answer 406

1) 50 y/o 2) Genetic predisposition or family history 3) First degree relative = 2-3x risk 4) Familial adenomatous polyposis (FAP) = polyp have 100% chance of becoming cancerous 5) Inflammatory GI issues = Chron's, Ulcerative colitis 6) Personal factors (smoking, alcohol use, physical inactivity, high red meat intake)

Answer 407

Age: Beginning at age 45 Tests: stool-based testing, fecal-occult blood testing, multi-targeted stool DNA, colonoscopy, sigmoidoscopy

Answer 408

1) Increase fiber intake 2) Decrease fat intake 3) Increase vegetables 4) Reduce smoking and drinking

Answer 409

1) Rectal bleeding 2) Anemia 3) Change in stool consistency 4) Change in stool shape

Answer 410

Colonocopy: viewing entire large bowel

Answer 411

1) Rectal radiation 2) Palliative radiation 3) Adjuvant chemo 4) Bevacizumab: angiogenesis inhibitor, blocks VEG-F 5) Intrahepatic chemo: with 5-fluororacil for liver metastasis

Answer 412

1) Colon resection: removal of part of the colon and surrounding lymph nodes 2) Abdominoperineal resection: remove part of the sigmoid colon, rectum, and anus via abdominal + perineal incisions

Answer 413

1) Begins functioning 2-3 days post-op 2) Empty at 1/3-1/2 full 3) Avoid flatus foods 4) Cleans stoma before appliance 5) Should be pink, moist, and 1-3cm tall

Answer 414

1) NO straining 2) soak in sitz bath for 10-20 minutes 3-4x/day 3) analgesics 4) side-lying 5) avoid sittin for long periods and use foam pads 6) avoid using air rings and rubber donuts

Answer 415

1) older adults 2) Those with breathing dificiluties (COPD, asthma) 3) Kdiney failure 4) Diabetes melitus 5) Diarrhea (bicarb loss) 6) Pancreatitis (bicarb loss) 7) Fever 8) Heavy exercise

Answer 416

**Labs: ph less than 7.35;** PaO2 (80-100mmHg), PaC02 (35-40mmHg), **HCO3 (less than 15-20)** **Sx:** cardiac = tachy and increased CO early on, **hypotensive and brady later** with wide QRS complex; **CNS = depression of CNS function, lethargy, confusion**; neuromuscular = hyporeflexia, flaccid paralysis; respiratory = **Kussmal respirations**; integumentary = warm, flush, dry skin - cognitive changes may be first seen **Nurse role:** akways **assess CV system first d/t hyperkalemia risk** (H+ ions are exchanged into ICF for K+ into ECF) **Tx:** hydrate low and slow to avoid edema, bicarbonate, antidiarrheals, insulin for DKA

Answer 417

**Labs:** **pH less than 7.35**; PaO2 (less than 90mmHg); **PaCO2 (>50mmHg);** HCO3- (21-28+) **Sx:** CV= Tachy and high CO early, hypotension and bradycardia with wide QRS complex later on; CNS= depression of CNS w/ **lethargy and confusion**; neuromuscular= hyporeflexia; **integumentary= pale to cyanotic skin** **Nurse role**: always **assess CV system first d/t hyperkalemia risk,** monitor accessory muscle use, breath sounds, cyanosis, monitor lung sounds **Tx:** oxygenation = bronchodilators, antiinflammatories, mucolytics, O2 therapy, mechanical venitlation

Answer 418

**1) Increased bases**: Antacid use, blood transfusion, sodium barb, TPN **2) Decreased acids:** vomiting, NG suction, hypercortisolism, hyperaldosteronism, thiaizde diuretics

Answer 419

**1) Excess CO2 loss:** hyperventilation, mechanical ventilation, salicylate overuse (too much aspirin stimulating medulla), high altitude

Answer 420

1) Breathe into paper bag 2) Calm reassurance if hyperventalation is due to panic or fear 3) Supplemental O2 as needed

Answer 421

1) Administer fluids as prescribed 2) Administer electrolyte replacement if prescribed

Answer 422

Think of hypokalemia and hypocalcemia symptoms! **CNS:**diziness, agitation, confusion, hyporeflexia, N/T in hands/feet/mouth, positive Trousseau's and Chvostek signs **Neuromuscular:** cramps, twitches, "charlie horse", tetany **CV:** tachycardic, thready pulse, digoxin sensitivity **Respiratory:** hyperventilation (respiratory), decreased RR effort (metabolic)

Answer 423

1) Redhydrate w/ IV electrolytes 2) Stop suctioning 3) Stop loop/thiazide dieuretics 4) Antiemetics

Answer 424

**Acidosis:** hyperkalemia, hyporeflexia, muscle weakness/paralysis, **Alkalosis**: hypokalemia, hyperreflexia, muscle cramps/twitching

Answer 425

**1) What is it:** a hypermetabolic state related to increased T3 and T4 hormones **2) Labs:** High T3+T4, low TSH **3) Sx:** tachycardia, hypertension, hyperglycemia, warm, sweaty, heat intolerance, exopthalmos (bulging eyes), goiter (bulging of thyroid gland), irritable, nervous, fine/soft hair **4) Nursing interventions:** promote calm environment, encourage rest, I/O's and weight, monitor nutrition, decrease room temp, cool showers, report any 1 degree increases in temperature, montior for thyroid storm, monitor vitals, monitor mental status

Answer 426

It is a severe and life-threatening complication of hyperthyroidism where heart rate increase and temperature spikes dramatically, which may lead to coma and possibly death

Answer 427

No, you should not palpate goiter as it can lead to thyroid storm.

Answer 428

**1) What is it:** it is an drug that blocks iodine from binding in the thyroid gland reducing T3+T4 release **2) Used for:** It is used to treat hyperthyroidism **3) Monitor for:** liver toxicity, hypothyroidism **4) Patient education:** It can suppress your immune system and increase your risk for infection = avoid crowds and those who are ill; symptoms such as weight gain, cold intolerance, and slow heart rate may indicate hypothyroidism indicating the dose needs to be lowered; lastly, women who become pregnant should stop taking this drug and contact their provider d/t birth defect risks

Answer 429

**1) What is it:** inadequate thyroid hormone decrease metabolic system activity **2) Lab levels:** low T3+T4, high TSH **3) Sx:** Fatigue, excess sleeping (up to 16 hours and still feeling tired), cold intolerance, constipation, weight gain w/o calorie increase, pallor, brittle nails, depression, bradycardia, hypotension, hair loss, dry ksin, myxedema, hoarseness **4) Nursing interventions:** vital signs and **chest pain**, monitor weight, **monitor mental status changes**, increase activity slowly, avoid laxatives which may interfere with meds, hypothyroidsm decrease medication metabolism = be careful with meds becoming toxic, **monitor respiratory status,** increase room temp/extra blankets

Answer 430

**1) What is it:** it is a thyroid replacement medication becuase it acts as a T4 analog **2) Used for:** hypothyroidism **3) Monitor for:** chest pain, dyspnea, hyperthyroidism **4) Patient education:** take 1 hour before meals with water on an empty stomach; avoid taking iron, calcium, and antacids within 4 hours of taking levothyroxine as they decrease absorption; may increase insulin needs and other meds

Answer 431

**1) What is it:** excess adrenal hormones like cortisol, aldosterone, androgens, and estrogens **2) Sx:** weakness, fatigue, join pain, decreased libido, thin/fragile skin, increased HR and BP, weight gain, increased appetite, bone pain (fracture risk), hyperglycemia, extreme muscle wasting, truncal obesity, buffalo hump, moon face, hypernatremia, hypokalemia, hypocalcemia **3) Nursing actions:** I/O's and weight daily, hypervolemia s/s (edema, SoB, high BP/HR), safe environment d/t fracture risk, meticulous skin care, handwashing, antiseptic dressing changes

Answer 432

**1) What is it:** adrenal insufficiency lacking in cortisol and aldosterone creating a rapid and acute crisis **2) Sx:** salt craving, weight loss, hyperpigmentation of skin (bronzing), N/V, anorexia, low BP, hypovolemia, hyponatremia, hypoglycemia, hyperkalemia, hypercalcemia **3) Nursing role:** prevent circulatory shock, monitor fluids and electrolytes, saline infusions to restore volume, hydrocortisone IV bolus + continuous infusion, monitor and treat hyperkalemia, hypoglycemic management, safe environment

Answer 433

Priority is to assess for circulatory shock (low BP, LoC down)

Answer 434

74-106 mg/dL

Answer 435

**1) A1C:** greater than 6.5% OR **2) Fasting BG:** greater than 126 mg/dL OR **3) 2-hour GTT:** greater than 200 mg/dL OR **4) Random BG:** greater than 200 mg/dL WITH hyperglycemis symptoms

Answer 436

**1) Polyuria** = osmotic diuresis d/t high glucose **2) Polydipsia** = thirst d/t fluid loss and high osmolatiry **3) Polyphagia** = increased hunger as body struggles to use glucose **4) Fatigue** = d/t inadequate glucose utilization and energy production

Answer 437

150 minutes of aerobic exercise per week

Answer 438

**1) What is it:** autoimmune destruction of beta cells of pancreas creating a lack of insulin causing the body to be unable to move glucose into its cells (thinks it's starving) **2) Cause:** autoimmune **3) Risk factors:** family history, age (kids, teens, young adults) **4) Sx:** polyuria, polydipsia, polyphagia - abrupt onset of these **5) Tx:** lifelong insulin use

Answer 439

**1) What is it:** peripheral tissue insulin resistance with impaired insulin secretion d/t beta cell exhaustion **2) Cause:** unknown, genetic **3) Risk factors:** obesity, poor diet, physicaly inactivity, family history, medications, environment **4) Sx:** polydipsia, fatigue, blurred vision, dry/warm skin

Answer 440

**1) Sx of hypoglycemia:** weakness, fatigue, sweaty (clammy), tremulous/shaky, anxious, decreased/loss of consciousness, cold **2) Treatment:** **A.** If BG is less than 70 mg/dL, give 15g of **fast acting simple carbs**; if below 50 mg/dL give 30g of fast acting simple carbs. -> **if conscious:** 4oz juice/soda, tbsp of honey, 3-4 glucose tabs, 5 hard candies -> **if unconscious: nothing by mouth**, IM glucagon, IV dextrose **B.** After carbs given, recheck BG in 15 minutes. If still hypoglycemia, repeat simple carbs. **C.** Once BG is above 70 mg/dL and no s/s of hypoglycemia present, provide a snack of **complex carbs** **3) Nursing role:** obtain IV access, provide O2 (only if below 90%), no oral anything if they are unconscious/altered, recheck BG every 15 minutes, check neuro status

Answer 441

It is a hormone that prevents hypoglycemia by triggering the release of glucose from storage in liver and skeletal muscle. It has the opposite action of insulin.

Answer 442

**1)** IV/nasal glucagon **2)** They are turned on their side b/c it can induce vomiting **3)** Readminister if the patient is still unconscious after 10 minutes

Answer 443

**1)** Check insulin before administering (miscalculation) **2)** Keep regular timing of food intake **3)** Do not exercise while insulin is peaking **4)** Monitor exercise/activity as it can cause BG drop even hours later **5)** Do not exercise if ketones are present (indicates insulin is insufficient, raise BG above 100 mg/dL) **5)** Avoid alcohol - it inhibits liver glucose production causing hypoglycemia. If you want to drink, drink with meals.

Answer 444

**1) Eye + vision problems like retinopathy** d/t vessel blockage, leakage, and retinal hypoxia and edema increasing pressure in the eye. This causes glaucoma too. **2) Peripheral neuropathy causing burning, tingling, pain, loss of sensation** d/t hyperglycemia reducing O2 and nutrient delivery leading to nerve hypoxia and decreased transmission **3) Diabetic autonomic neuropathy** d/t hyperglycemia affecting the SNS and PSNS causing orthostatic hypotension, gastroporesis and constipation, N/V, heartburn, early satiety, and urinary urgency and incontinence **4) Diabetic nepropathy** d/t hyperglycemia and hypertension harming nephrons causing albuminuria and decreased GFR later on **5) Sexual dysfunction** such as ED, retrograde ejaculation, decreased lubrication, and painful intercourse **6) Cognitive dysfunction** d/t hyperglycemia harming neurons leading to atrophy

Answer 445

**1)** Biguinides (Metformin) **2)** GLP-1 agonist (semaglutide - Ozempic) **3)** Sulfonylureas (Glipizide, Glimepiride)

Answer 446

**1) Class:** Biguinides **2) MoA:** lowers blood glucose by inhibitng liver glucose production (also reduces intestinal absorption and increase insulin sensitivity) **3) Adverse effects:** do not take with alcohol (hypoglycemia and lactic acidosis risk); **hold 24 hours before contrast** and surgery (kidney damage risk); GI upset like **diarrhea (most common)** and N/V - take it with food to reduce GI discomfort

Answer 447

**1) Class:** GLP-1 agonists **2) MoA:** increase insulin secretion, decreases glucagon secretion, reduces appetite **3) Adverse effects:** pancreatitis (s/s abdominal pain, nausea)

Answer 448

**1) Class:** Sulfonylureas **2) MoA:** lowers BG by triggering release of insulin from beta cells (may also increase insulin sensitivity and decrease hepatic glucose production) **3) Adverse effects:** Can cause **hypoglycemia (take with meals)**, check with pharmacist before over the counter drug use d/t multiple interactions; **absolutely no drinking (hypoglycemia and disulfide-like reactions = severe vomiting)**

Answer 449

No, rapid, short/regular, and intermiediate (NPH) should never be mixed with long acting or premixed insulin formulations.

Answer 450

**Rapid acting:** 10 minutes before because it is rapid acting **Short/regular acting:** 30 minutes before eating

Answer 451

**Rapid:** 10-30 min onset, .5-3hr peak, 3-6hr duration **Regular:** 30-60 min onset, 1-5hr peak, 6-10hr duration **Intermediate:** 1-2hr onset, 6-14hr peak, 16-24hr duration **Long:** 1-2hr onset, no peak, 12-24hr duration **Ultra-long:** 30-90min, no peak, 24hr duration

Answer 452

**1)** Only give subQ, preferrably in the abdomen 2cm away from umbilicus **2)** Refridgerate unopened insulin **3)** Keep insulin out of direct sunlight **4)** Keep opened insulin at room temperature, cold insulin hurts to administer **5)** Wash your hands before testing **6)** Inspect vials and pens before using, should not be clumpy and only NPH should be cloudy **7)** Do not reuse strips or lancets **8)** Use fingertips to test

Answer 453

**1)** Examine feet daily **2)** Use a mirror to examine sole of foot **3)** Inspect between toes **4) Do NOT** treat blister, sores, or infections at home (don't treat anything yourself) **5)** Do not wear sandals **6)** Wash feet with water and dry thoroughly **7)** Wear clean socky daily **8)** Trim nails straight across **9)** No moistureizer between toes **10)** Wear a different pair of shoes daily **11)** Do not go barefoot

Answer 454

**1)** Eat 25g of fiber daily **2)** Eat legumes, vegetables, fruits, whole grains, dairy in place of empty calories **3)** If drinking, men should drink 2 drinks and 1 for women, **drink with meals** **4)** 1 unit of rapid acting insulin for 15g of carbohydrates **5)** 10-15g of carbohydrates per hour of moderate to intense physical activity **6)** Limit trans fats, saturated fats, cholesterol **7)** Keep a routine eating schedule with a similar amount of food **8)** Registered dieticians can help create a personalized meal plan and provide education

Answer 455

**1)** Avoid intense exercise in retinopathy, autonomic neuropathy, and peripheral neuropathy **2)** Wear proper footwear and inspect feet daily for peripheral diabetes **3)** Regular exercise can help prevent T2DM by increasing insulin sensitivity, reducing body weight and glucose intolerance **4)** Warm up first with low intensity sessions and should have a cool down session too; both 5-10 minutes long **5)** 150 minutes of aerobic activity per week and avoid going longer than 2 days without any activity **6)** Do not exercise when urine ketones are high **7)** Check BG before, at intervals during, and after exercise **8)** BG shoud be above 100 mg/dL before exercise **9)** Do not exercise during insulin peaks

Answer 456

**1)** Monitor blood glucose every 2-4 hours **2)** Continue taking your insulin or other antidiabetics - **do not omit insulin during illness** **3)** Drink 8-12 ounces of sugar-free liquids every hour your awake, 2L daily **4)** Continue to eat meals at regular times **5)** Notify your health provider that you're ill **6)** Test your urine for ketones to ensure they're in range, especially if you're vomiting **7)** Call your provider if you expierience: persistent N/V, hypoglycemia, moderate-high ketones, fever (101.4+), sick for longer than 1-2 days

Answer 457

**1) What is it:** rapid onset, life-threatening complication of diabetes caused by severe hyperglycemia, ketosis, metabolic acidosis, and a lack of insulin **2) Diagnosis:** BG = greater than 300 mg/dL, pH = less than 7.35, elevated ketones, elevated BUN/creatinine, low bicarbonate (less than 15 mEq/L) **3) Most common in:** Type 1 diabetes **4) Pathology:** infection or insufficient insulin -> hyperglycemia -> osmotic diuresis -> glucose in urine, dehydration, and electrolyte imbalance **5) Causes:** infection, lack of insulin, stress **6) Sx:** urine ketosis, acetone/fruity breath, kussmal breathing, respiratory alkalosis, polydipsia, polyuria, polyphagia, N/V, dehydrated, high HR, hyperkalemia, abdominal pain **7) Tx:** IV fluids, IV insulin, electrolyte replacement, address underlying cause, supportive breathing

Answer 458

**1) what is it:** gradual onset which turns into a hyperglycemic emergency characterized by **profound dehydration,** hyperosmolatiry, but **no ketoacidosis** becuase insulin secretion is enough **2) Diagnosis:** BG = great than 600 mg/dL, serum osmolarity = greater than 320 mOsm, pH = greater than 7.4, higher bicarbonate (above 20), high BUN/creatinine **3) Most common in:** Type 2 diabetes **3) Causes:** infection, stress/illness, poor fluid intake **4) Sx:** hyperglycemia, polyuria, polydipsia, **dry mucus membranes**, high HR, hypotension, **neurologic symptoms like confusion and lethargy into coma** **5) Tx:** aggressive **rehydration (main priority)**, insulin therapy, electrolyte replacement, address underlying cause

Answer 459

Adequate perfusion related to fluid volume deficit d/t osmotic diuresis. Hyperkalemia may take priorty in DKA if there are cardiac problems

Answer 460

The adjustments in blood flow depending on metabolic needs of the brain or BP changes

Answer 461

**MKD:** The sum of all cranial volumes, brain, CSF, and BP should remain constant, but can adapt if one changes. **CSF is the first to change in order to compensate** becuase we don't want to alter blood flow

Answer 462

**1)** Older adults (degenerative conditions, falls) **2)** Young adults and adolescents (risky behavior, MVA) **3)** Children (falls)

Answer 463

**1) Level of consciousness** **2) Unexplained headaches** **3)** Other neuro s/s like N/T, dizziness, confusion, **vision changes** **4)** OLD CARTS (pain assessment)

Answer 464

Balancing ICP

Answer 465

**1)** Priority one is ongoing assessment **2)** Decrease ICP if high by having the HOB @30 degrees and proper head+neck alignment. **3) Pharmacotherapy:** **IV Mannitol** (osmotic diuretic) to pull fluid off, sedatives like **Propofol** to decrease metabolic demand **4) Surgical:** craniotomy, shunt, drain

Answer 466

**1) Restore perfusion to the brain** **2)** CT to determine stroke type and cause **3)** Neuro exam

Answer 467

**A:** Aspirin **B:** Blood pressure management **C:** Cholesterol management **S:** Smoking cessation

Answer 468

**1) What is it:** The occlusion or blockage of a cerebral or carotid artery by thrombus or emboli causing decreased or lack of perfusion **2) Onset:** gradual (thrombic), sudden (embolic) **3) Risk factors:** atheroscerolsis, emboli, hypertension, obesity, diabetes melitus, smoking, drug and alcohol abuse, oral contraceptive use **4) LoC:** awake **5) Seizure presence:** no seizures **6) Sx:** dysphasia, muscle weakness, facial drooping, difficulty with walking (gait, balance), slurred speech, headache, trouble seeing **7) Tx:** fibrinolytic (Alteplase - TPA), craniotomy, shunt

Answer 469

**1) What is it:** a fibrinolytic, tissue plasminogen activator, that converts plasminogen to plasmin to lyse fibrin and fibrinogen breaking down clots **2) Timeframe:** 3-4.5 hours (after 3 hours there are special requirements) **3) BP:** must be below 185/110 - if above, antihypertensives must be given first (IV Labetolol) **4) Checks before admin:** confirm **onset** and timeframe of symptoms, Blood glucose (hypoglycemia can mimic stroke symptoms), K+ levels (it can lower K+), check pH (acidosis), weight (dosing is by weight), pregnancy (harm to fetus), any surgery within the past 14 days **5) Checks after admin:** hold anticoagulants (no Heparin, aspirin, etc.) for 24 hours, monitor vitals, monitor BG to prevent stroke complications, consult hematology to increase PT and INR

Answer 470

What is it: The interruption of vessel integirty cuasing bleeding into the brain tissue or subarachnoid space Onset: abrupt, sudden Risk factors: hypertension, cochise and alcohol use, obesity, diabetes LoC: decreased Seizure: yes Sx: severe, unrelieving headache, blurry vision, seizure, decreased LoC, difficulty walking, dysphasia Tx: antihypertensive, craniotomy, shunt

Answer 471

**1) Symptom onset (when**) **2)** Abrupt or slow onset **3)** Any improvement **4)** Medications (blood thinner, antihypertensives, contraceptives) **5)** Social diet (food, alcohol, smoking) **6)** Drug use (cocaine especially)

Answer 472

CT imaging such as CTP (computerized tomography perfusion) and CTA (computerized tomography angiography)

Answer 473

**1)** They should remain NPO until swallowing can be assessed **2)** Help with ambulation, they are a fall risk d/t neuro status and blood thinners **3**) Thickened liquids to prevent aspiration **4)** High fowlers when eating **5)** No straws **6)** Electric razor not straight razor to prevent bleeding **7)** Have suction available for aspiration **8)** Discontinue combined birth control **9)** Oral care continues even if NPO **10)** Toileting Q2-3H

Answer 474

Approach from their unaffected side but start with their affected side.

Answer 475

**Left-sided damage:** right-sided paralysis, more cautious, apprehensive, anxious, needs encouragement, impaired speech **Right-sided damage:** left-sided paralysis and neglect, more impuslive, impaired judgement, tends to deny problems, short attention

Answer 476

**Tonic-clonic seizure:** a seizure lasting 2-5 minutes where there is a tonic phase and clonic phase. **Tonic:** muscle stiffness and loss of consciousness **Clonic:** rhythmic jerking of all extremities

Answer 477

**1) What is it:** seizure medication that decreases sodium and calcium influx thereby stabilizing cell membranes **2) Meds:** Phenytoin, Fosphenytoin **3) Education:** Headache and drowsiness when starting, provide regular oral care and checks becuase it **can cause gingival hyperplasia**, **never give warfarin and phenytoin at the same time**, give IV for status epilecticus by diluting in .9% NS

Answer 478

**1) What is it:** GABA agonist allowing Cl- ions in to inhibit neurons **2) Meds:** Lorazepam, clorazepate **3) Education:** most often given IV for status epilepticus, clorazepate helps prevent seizures, **monitor for respiratory depression and hypotension**

Answer 479

**1)** O2 and suction ready **2)** IV access on patient **3)** Side rails with pads up

Answer 480

**1)** Protect from injury **2)** Do not place anything in their mouth **3)** Turn sideways to maintain airway **4)** Remove any injurious objects **5)** Suction oral secretions lightly **6)** Do not restrain, instead guide them **7)** Loosen restrictive clothing **8)** Record beginning and end times of seizure **9)** Remove pillow, raise side rails

Answer 481

**1)** Take vitals **2)** Provide O2 if needed **3)** Check neurologic status **4)** Keep side lying **5)** Allow to rest **6)** Check mouth for blood d/t tongue/cheek bite

Answer 482

**1) What is it:** a medical emergency d/t prolonged seizure lasting longer than 5 minutes or repeated seizures over 30 minutes **2) Causes:** withdrawl from antiepileptic drugs, infection, acute alcohol withdrawal, TBI, cerebral edema, metabolic disturbances **3) Priority:** establish airway **4) Tx:** IV-push lorazepam/diazepam

Answer 483

**1) what is it:** acute, abrupt, fluctuating course of disorientation, inattentiveness, disorganized thinking, altered level of consciousness, and cognition changes **2) Types:** Hyperactive = restless, agitated, aggressive; Hypoactive = quiet, stares, lethargic, unaware, moves slowly/not alot; mixed = both **3) Risk factors:** mechanical ventilation, sedation, old adults, alcohol disorders, organ disorders, low 02, UTI, insomnia **4) Management/tx:** O2 therapy if low, treating underlying cause (i.e. UTI), calm voice, reorient patient, ambulate them, provide comfort object **5) Prevention:** adequate lighting, clock and calendar in room, promote proper sleep-wake cycle, avoid unecessary meds and interventions, address pain, cluster cares at night

Answer 484

Need to know their **baseline**

Answer 485

**1) What is it:** specific and progressive cognitive loss affecting functional domains **2) Risk factors:** female, older adults, down syndrome, TBI, smoking, depression, CVD, excess stress, PTSD **3) Diagnosis:** mini-mental state exam (MMSE) = lower score, worse dementia, MoCHA, clock drawing test, PET (amyloid plaques), MRI to r/o, CT for structural changes

Answer 486

**Early:** forgets names, misplaces items, less social, can do ADLs, unable to travel alone to new places **Moderate:** cannot handle finances well, disoriented to place and time, gets lost while driving, wandering **Severe:** agnosia, incapacitated, bedridden, cannot do ADLs, loss of mobility

Answer 487

**1)** remove keys **2)** lock doors **3)** remove dangerous objects (knives, oven/stove, guns) **4)** lower bed **5)** use bed/chair alarm **6)** grab bars **7)** motion activated lights **8)** keep room quiet with TV off unless requested **9)** To prevent wandering place them close to nurses tation, have frequent checks or a sitter **10)** Keep away from stairs/elevators **11)** Consider if lines/drains are needed or camouflage them **12)** Toilet every 2 hours

Answer 488

Reorient in early stages Redirect/validate in late stages

Answer 489

**1) What is it:** a cholinesterase inhibitor prevening cholinesterase from breaking down acetylcholine allowing more to remain in the synapse improving ADLs **2) Treats:** Alzheimer's disease **3) Monitor:** Decreased heart rate, diziness, and falls d/t bradycardia

Answer 490

**HIV:** a chronic and progressive immunodeficiency virus characterized by an attack on CD4 T cells leading to AIDS and death without treatment

Answer 491

**1)** Sharing needles **4)** Unprotected sex (especially anally or with semenal contact) **5)** Blood transfusions **6)** Breast milk **7)** Direct contact with bodily fluids **8)** Vaginal secretions

Answer 492

- Seminal fluid

Answer 493

**1) Acute infection:** generic viral flu-like symptoms including - Fever - Sore throat - Night sweats - Chills - Headache - Muscle ache **2) Latent or Chronic infection:** feels fine, **asymptomatic** **3) Acquired Immunodeficiency syndrome (AIDS):** Falling WBC count (< 200), individual expriences s/s of opportunistic infections that arise

Answer 494

**Window period:** It is the time frame in which there is a *high false negative rate* because seroconversion, or antibody production is not high enough to be detectable **Days:** 0-20 days

Answer 495

**2)** WBC (they are experiencing an infection) **4)** Viral load (they should have none without an infection, but they have HIV)

Answer 496

**1)** Lymphocyte count (decreased) **2)** CD4+ count (decreased) **3)** Viral load testing (stage 2, increasing) **4)** WBC (increased)

Answer 497

**1)** Candida (thrush) **2)** Herpes (cold sores or genital) **3)** Kaposi's sarcoma **4)** Pneumonia **5)** Lymphoma **6)** Cytomegalovirus **7)** Toxoplasmosis **8)** Recurrent UTIs

Answer 498

- Presence of HIV *AND* one or more of the two: **1)** < 200 CD4+ count **2)** Presence of opportunistic infections

Answer 499

**ART:** Antiretroviral therapy which prevents HIV from replication decreasing viral load **Combination therapy:** It is used to both decrease viral load and increase immunity, you need one medication for each.

Answer 500

- Abacavir - Biktarvy - Emtricitabine

Answer 501

**1)** Fatigue **2)** Weight loss **3)** Weight redistribution **4)** Diarrhea **5)** High cholesterol **6)** Mood changes **7)** Nasuea and vomiting **8)** Rash

Answer 502

- Eat frequent, calorie dense, high protein, small means - Take supplements like vitamins A + E - Eat easy to swallow foods

Answer 503

- Exercise regularly - Consider the tesamorelin injection (reduces excess fat) - Metformin for those with diabetes

Answer 504

- Reduce fatty, spicy, dairy, and high insoluble-fiber foods - OTC loperamide (antidiarrheal) - Increase fluid intake - Keep the perineal area dry

Answer 505

- Eat nutritious foods - Avoid smoking, caffeiene, alcohol, and napping - Stick to a sleep schedule - Relax before bed

Answer 506

- Regular exercise - Avoid smoking - Reduce fat intake - Increase omega-3 fatty acids

Answer 507

- Eat smaller, more frequent meals - Eat plain foods (crackers, rice) - Avoid fatty and spicy foods - Eat cold meals over hot - Consider antiemetic prescription

Answer 508

- ART therapy to prevent Kaposi's sarvoma - Keep weeping lesions dressed - Take analgesics - Keep skin dry - Take valcyclovir to reduce/prevent herpes lesions

Answer 509

- **Q4-6 weeks** for efficacy due to drug mutation or resistance (mainly when changing medications or starting new ones)

Answer 510

- Q4-6 months

Answer 511

**1)** Frequent handwashing **2)** Get tested for TB **3)** Receive yealy influenza vaccine **4)** Don't drink standing water **5)** Viral load testing Q4-6 months **6)** Take antivirals as ordered

Answer 512

**1)** Stopping ART therapy **2)** History of HIV **3)** Low CD4+ cell count

Answer 513

No, they are not allowed to refuse care unless they have found an appropriate replacement for care and their refusal is based on religious beliefs

Answer 514

**1)** Foscarnet sodium treats cytomegalovirus **2)** It should be placed on an infusion pump to administer because it needs to be infused slowly **3)** It is highly toxic to the kidneys thus serum creatinine levels need to be monitored

Answer 515

- It is preexposure prophylaxis to prevent HIV - 99% effective in reducing infection of HIV by sex

Answer 516

- Postexposure prophylaxis that is used after known or possible exposure to HIV - Must be **started within 72 hours (3 days)**

Answer 517

**4)** Chemiluminescent immunoassay is the initial lab test for HIV - Another test is done using Western Blot or point-of-care testing to confirm infection

Answer 518

**1)** Wash hands frequently **2)** Do not dig in the dirt, no houseplants **3)** Report any infections or low-grade fevers **4) Do not share any razors, toothbrushes, washcloths, toothpaste or deodarant** **5)** Replace toothbrushes after illness **6)** Do not eat undercooked or raw food **7)** Do not change pet litter boxes **8)** Avoid reptiles/turtles

Answer 519

**3)** Keep the head of the bed elevated

Answer 520

**1)** Flat **6)** Color varies from pink to dark violet or black

Answer 521

**2)** “I should use warm saline or water to rinse my mouth.”

Answer 522

It binds to ACE-2 receptors found in vascular endothelium

Answer 523

**1)** Lungs **2)** Liver **3)** Heart **4)** Brain **5)** Kidneys **6)** Intestines **7)** Pharynx

Answer 524

**1)** Vasoconstriction **2)** Inflammation **3)** Hypercoagulability **4)** Endothelial dysfunction **5)** Edema

Answer 525

**1)** Immunization **2)** Physical distancing **3)** Handwashing **4)** Face masks

Answer 526

2 weeks following the final dose of the primary series

Answer 527

- 6 months+

Answer 528

Monitor patients for 15 minutes after administration

Answer 529

**1)** 65+ years old **2)** Comorbidities (cancer, chronic kidney/liver/lung disease) **3)** Diabetes **4)** Heart conditions **5)** HIV **6)** Smoking

Answer 530

**1)** Cough **2)** Fever **3)** Chills **4)** SoB **5)** Muscle/body aches **6)** Loss of taste/smell **7)** Sore throat **8)** Nausea/vomiting

Answer 531

**1)** Trobule breathing **2)** Persistent chest pain/pressure **3)** New confusion **4)** Inability to stay awake **5)** Blue lips **6)** Tachypnea **7)** Hypoxemia **8)** Orthopnea (difficulty breathing while lying down) **9)** Edema **10)** Hemoptysis **11)** Increasing dyspnea or dyspnea at rest

Answer 532

**1)** Preventing the spread to others **2)** Impaired oxygenation **3)** Preventing severity of symptoms

Answer 533

**1)** N95 **2)** Eye protection **3)** Isolation Gown **4)** Nonsterile gloves

Answer 534

**1)** Stay at home **2)** Wear a mask **3)** Use a separate bathroom **4)** Limit caregivers **5)** Do not share utensils, beddings, or dishes **6)** Clean used spaces

Answer 535

**1)** Reposition and ambulate (as tolerated) frequently **2)** Change to a stomach-lying (self-proning) position **3)** Cough and deep breath Q2H **4)** Increase fluid intake

Answer 536

**1)** Nucleic acid amplification test (NAAT)

Answer 537

- Chest x-ray for lung infiltrates

Answer 538

**Preferred drug:** Nirmatrelvir-Ritonavir **Indication:** mild to moderate COVID-19 at risk of pregression to severe infection **Side effects:** diarrhea + altered taste **Education:** take missed doses within 8 hours of time, if over 8 skip the dose

Answer 539

**False:** remdesivir is not the preferred drug, instead it is nirmatrelvir-ritonavir

Answer 540

**Indication:** hospitalized patients with COVID-19 or within 7 days for unhospitalized patients **Side effects:** hepatotoxicity + nausea **Monitoring:** - Hepatic panel - PT before each administration - Montior for hypersensitivity during and following administration

Answer 541

**1)** Viral **2)** Bacterial **3)** Fungal

Answer 542

An infcetion in the lungs that causes inflammation and thick fluid/exudate build up in the alveoli

Answer 543

**1)** Older adult **2)** No pneumococcal, COVID-19, or influenza vaccination **3) Reduced immunity** **4)** Tobacco/alcohol use

Answer 544

**1)** Older adult **2)** Chronic lung disease **3)** Altered LoC **4)** Recent aspiration **5)** Endotracheal/NG tube **6) Reduced immunity** - Steroid use, cancer pt., transplant, immunosuppresants **7)** Mechanical ventilation **8)** Reduced mobility **9)** Poor nutrition **10)** Drugs that increase gastric pH

Answer 545

Community acquired is more common

Answer 546

**1)** Fever **2)** Chills **3)** Malaise **4)** Loss of appetite **5)** Myalgias

Answer 547

**1)** Tachypnea **2)** Dyspnea **3)** Cough w/ or w/o sputum (bloody possible) **4)** Labored breathing **5)** Diminished lung sounds **6)** Crackles, rhonchi, wheeze **7)** Low O2 **8)** Diminished chest expansion **9)** Pleuritic chest pain on inspriation

Answer 548

**1)** WBC (elevated) **2)** Sputum **3)** Blood culture (sepsis) **4)** ABGs **5)** Electrolytes (hyponatremia) **6)** BUN/creatinine **7)** Check for lactate (sepsis)

Answer 549

Chest x-ray, especially for older adults

Answer 550

**1)** Vaccination (influenza, pneumococcal, COVID-19) **2)** Handwashing **3)** Avoid crowds and sick people **4)** Aspiration precautions **5)** 3L of fluids/day **6)** Avoid pollutants **7)** Enough sleep/rest

Answer 551

**1)** Pulmonary hygiene (incentive spirometry, CDB, ambulate) **2)** Hydration **3)** Oral care (2x/day)

Answer 552

**1)** HOB >30 **2)** Oral care **3)** Hand hygiene **4)** Sterile suctioning **5)** DVT prophyaxis **6)** Daily weaning assessment **7)** Stress ulcer prophylaxis

Answer 553

**1)** HOB high fowlers **2)** Early ambulation **3)** 2-3L/day **4)** Keep O2 above 90% **5)** Incentive spirometry **6)** CDB Q2H **7)** Bronchidilators

Answer 554

**1)** Bronchodilators **2)** CDB **3)** Incentive spirometry **4)** 2-3L/day **5)** IV steroids **6)** Expectorants

Answer 555

**1)** Obtain blood cultures **2)** Administer antiinfectives as prescribed **3)** Check vitals **4)** Maintain BP

Answer 556

**1)** Albuterol - **Action:** bronchodilate - **Side effects:** Tachycardia, tremors **2)** Steroids - methylprednisolone - **Action:** anti-inflammatory, prevents swelling - **Montior:** blood glucose - **Education:** do not stop abruptly

Answer 557

**Class:** cephalosporin antibiotic **Action:** broad spectrum **Teaching:** complete entire course **Side effects:** very safe -> allergic reaction + cross sensitivity with penicillins

Answer 558

**Class:** antibiotic, fluoroquinolone **Action:** broad spectrum **Teaching:** take with food, avoid sun exposure, complete entire course **Side effects:** tendon swelling/rupture, c. diff/yeast infection, nausea, vomiting

Answer 559

**1)** Within 4 hours

Answer 560

*At least two* of the following to diagnose: **1)** Temperature of above 100.4F (38C) or below 96.8F (36C) **2)** Heart rate above 90 **3)** Respiratory rate above 20 or PaCO2 below 32 **4)** WBC above 12,000 or below 4,000

Answer 561

**1)** SIRS criteria have been met **2)** Confirmed or suspected infection

Answer 562

**1)** Vasopressors to keep MAP above 65mmHg **AND** **2)** Serum lactate above 2mmol/L despite fluid resuscitation

Answer 563

Must have SIRS and sepsis AND meet MODS criteria: organ failure and poor clotting with uncontrolled bleeding in two or more organ system

Answer 564

**Warm:** (things are relatively normal) - Decrease in capillary refill - Decreased systemic vascular resistance - Normal to increased cardiac output - warm extremities **Cold:** - Decompensation leading to increased systemic vascular resistance to shunt blood to vital organs - Decreased cardiac output - Cold extremities - Delayed capillary refill

Answer 565

**True**: septic shock, also known as cold shock, is nearly irreversible once a patient is in this state due to multiple organ failure and rapid decline

Answer 566

**1) Patients with reduced immunity (chronic diseases) 2) Patients with lines (especially central lines), tubes, and drains** **3)** Large open wounds **4)** Invasive procedures **5)** Malnutrition **6)** 80+ y/o **7)** Diabetes **8)** CKD **9)** Hepatitis **10)** Blood soaked gauze staying in contact for a long period of time

Answer 567

**1)** Remove any lines, tubes, and drains **2)** Sterile technique for insertions **3)** Maintain mucus membranes and skin **4)** Sepsis screening and assessment to notice changes from baseline (use validated tools like MEWS, qSOFA) **5)** Wean from ventilator ASAP **6)** Take temperature 2x/day **7)** Educate family on s/s of infection

Answer 568

**Early:** normal to increased HR and BP, increased CO **Late:** low blood pressure and even more low during septic shock - cytokines keep blood vessels dilated, decreased CO, slow capillary refill **Disseminated intravascular coagulation (DIC):** widespread hypoxia and ischemia leads to poor clotting as clotting factors are used up for unnecessary clotting - Low platelets, high INR and aPTT

Answer 569

**1)** Increased respiratory rate (tachypnea) **2)** Low O2 saturation (hypoxia) **3)** ARDs

Answer 570

**1)** Restless **2)** Feels like something is wrong **3)** Confusion

Answer 571

**Early:** warm and no cyanosis **Late (septic shock):** cool, clammy, pale skin, mottling, cyanotic, petechia and ecchymosis can occur d/t DIC

Answer 572

**1)** Low urine output (worsening with shock) - If they have no reason to have oliguria, suspect shock **2)** Increased creatinine

Answer 573

**1)** Hyperglycemia, high blood glucose

Answer 574

**1)** Procalcitonin (high) **2)** Lactate (>2mmol/L, high) **3)** WBC (>12 or < 4, high or low with decreasing neutrophils) **4)** Bacteria in the blood **5)** Cultures **6)** Blood glucose (high) **7)** Late = Low hematocrit, hemoglobin, fibrinogen, and platelets d/t DIC

Answer 575

**1)** Early identification **2)** Widepsread infection **3)** Potential for MODs

Answer 576

**1)** Lactate levels **2)** Draw labs/cultures x2 before antibiotics so long as it doesn't delay antibiotics by 45min **3)** Administer broad spectrum antibiotics **4)** Rapid administration of 30mL/kg crystalloid fluids for hypotension or lactate >4mmol/L (especially within first 3 hours) **5)** Apply vasopressors if hypotensive during or after fluid resuscitation to maintain MAP >65 mmHg

Answer 577

**1)** Screening for early detection **2)** O2 therapy, possible mechanical vent **3)** Antibiotics within 1 hour (cultures before antibiotics) **4)** Insulin to manage blood glucose **(keep between 140-180)** **5)** Corticosteroids to manage adrenal insufficiencies **6)** Heparin therapy for clotting **7)** Blood replacement for poor clotting **(platelets first choice)** **8)** Bicarb if pH below 7.2 with AKI **9)** DVT prophylaxis within 72 hours

Answer 578

**True:** source control to find the infection must be done between 6-12 hours to eliminate the infection

Answer 579

**3)** >/= 0.5mL/Kg/Hr

Answer 580

**1) HOB 30 degrees** **2)** Oral care Q12H w/ antimicrobial rinse (mouth ulcer prophylaxis) **3)** Prevent aspiration **4)** Subglottic suctioning **5)** Pulmonary hygiene (turning, positioning, chest physiotherapy) **6)** Daily assessment for extubation (minimize sedation) **7)** Maintain cuff pressure (15-20mmHg) **8) Hand hygiene when caring for ET tube** **9)** Early ambulation **10)** DVT prophylaxis

Answer 581

**D:** dislodgement **O:** obstruction **P:** pneumothorax **E:** equipment

Answer 582

**1)** Maintain patent airway (assess Q2-4hrs) **2)** Turn Q2H and assess lung sounds after **3)** Assess vitals Q4H **4)** Empty tubing with mositure collection - do not let it go into the humidifier **5)** Include family when possible **6)** Moisten oral mucosa Q2-4H **7)** Move ET tube to opposite side of the mouth Q24H **8)** Teach patients to avoid valsava maneuvers d/t hypotension (monitor I/Os, weight, urine output) **9)** Keep TV low w/ moderate PEEP **10)** Avoid excessive carbs in patients with COPD b/c it increases CO2 production

Answer 583

**4)** 140-180

Answer 584

Platelets are the first choice

Answer 585

**1)** Fluid overload - third spacing for ascietes **2)** Possible hemorrhage d/t GI varices and portal hypertension **3)** Acute confusion d/t elevated ammonia and hepatic encephalopathy **4)** Pruritis

Answer 586

- Extensive and irreversible scarring of the liver from inflammation and fibrosis - Scarring and inflammation creates pressure on the liver further damaging the cells and vessels - Nodules form blocking bile ducts and impair blood flow - Liver shrinks and becomes hard

Answer 587

**1)** Viral hepatitis (hep C) **2)** Chronic alcoholism **3)** Chronic biliary obstruction

Answer 588

**1) Portal hypertension:** increased pressure in the portal vein backflowing to the spleen -> splenomegaly, platelet destruction, and **thrombocytopenia (often first sign)** - Backflows into esophageal veins - Flows into abdomen too **2) Ascietes:** fluid shift into the peritoneum from portal hypertension and hypoalbuminemia and esophageal varices (bleed risk) - Fluid into peritoneum also causes decreased albumin circulation - Massive ascietes can cause RAAS to activate causing more retention **3) Biliary obstruction:** cannot absorb vitamin K = bleeding risk and jaundice **4) Hepatic encephalopathy:** change in mental status, reverisble if caught early, d/t blood shunting from portal vein to central cirulation allowing unprocessed substances (ammonia) **5) Gastropathy:** slow gastric mucosal bleeding, chronic blood loss anemia **6) Hepatorenal syndrome:** sudden decrease in urine output, increased BUN + creatinine, increased urine osmolarity **7) Peritonitis:** bacteria from bowel reach the ascitic fluid causing infection **8) Hepatopulmonary syndrome:** excesscive asitic volume causing dyspnea d/t increased intraabdominal pressure limiting thoracic expansion + diaphragm function

Answer 589

**1)** Bright red emesis **2)** Melena (black tarry stool) **3)** Decreased level of consciosness **4)** Hypovolemia (**Tachycardia,** hypotension, high RR, low Hgb, low Hct, weak pulses, oliguria, cold)

Answer 590

**Early (vague and nonspecific)** **1)** Fatigue **2)** Weight changes **3)** Anorexia **4)** Vomiting **5)** Abdominal and liver pain **6)** Thrombocytopenia

Answer 591

**1)** GI bleed **2)** Jaundice **3)** Ascites **4)** Spontaneous bleeding **5)** Dry, itchy skin **6)** Icterus (jaundice of the eyes) **7)** Rashes **8)** Peripheral edema **9)** Weight gain **10)** Palmar erythema **11)** Purpuric lesions/petechiae **12) Asterixis:** hand flapping

Answer 592

**1) ALT (increased)** **2)** AST (increased) **3)** Bilirubin (increased) **4)** Albumin (decreased) **5)** Prolonged PT/INR **6)** Ammonia (increased) **7)** Thrombocytopenia (low platelets) **8)** Anemia (low Hgb, low Hct, low RBC) **9)** Hypokalemia (bleeding risk)

Answer 593

**1)** Abdominal x-ray **2)** CT/MRI **3)** Ultrasound (ascietes, hepato/splenomegaly)

Answer 594

**1)** Low salt diet **(1-2g)** **2)** Late stage IV vitamins like thiamine, folate, and a multivitamin **3)** Diuretics (daily weights, I/Os) **4)** Paracentsis if respiratory is impacted (have them void before the procedure, vitals and weight before and after) **5)** Auscultate lungs Q4-8H **6)** Transjugular intrahepatic portal system shunt (shunt to remove ascietes long term and controls bleeding)

Answer 595

**- Propranolol (beta-blocker):** helps prevent bleeding by reducing heart rate and hepatic venous pressure gradient **- Monitor:** blood pressure and heart rate (hypotension and bradycardia) - hold if SBP < 100 or HR is < 60 **- Side effects:** weakness, fatigue, bronchospasm **- Education:** rise slowly as it may cause orthostatic hypotension

Answer 596

**1)** Propranolol (beta-blocker) **2)** Vasoactive medications like *Octreotide acetate* (suppress gastrin, serotonin, and intestinal peptide decreasing GI blood flow) **3)** Endoscopy to find and stop the source - endoscopic variceal ligation (banding) to decrease flow **4)** Pure RBCs, FFP, platelets **5)** Emergency balloon tamponade **6)** Antibiotics to prevent infection which can cause bleeding

Answer 597

**- Lactulose:** reduces pH and increases osmotic pressure to draw in water to the intestines, and converts NH3 to NH4, which can be excreted, all of which help *reduce ammonia levels via stool* **- Goal:** 3 bowel movements per day **- Side effects:** bloating and cramping

Answer 598

**1)** Minimize hepatoxic medications and medications that are difficult for the liver to metabolize -> Opioids, sedatives, barbituates **2)** Administer lactulose to excrete ammonia **3)** Administer nonabsorbable antibiotics to destroy flora decreasing ammonia production -> Neomycin **4)** Moderate protein low fat diet for high ammonia

Answer 599

**1)** Moisturizers **2)** Cool compress **3)** Corticosteroid creams **4)** SSRIs

Answer 600

**1)** Acetaminophen **2)** NSAIDs **3)** Alcohol

Answer 601

Autodigestion of the pancreas by enzymes that activate prematurely before reaching the intestines

Answer 602

Inflammation of the pancreatic duct and obstruction increasing pressure and duct rupture leaading to enzyme release within the pancreas

Answer 603

**1) Alcohol consumption (primary risk factor)** **2)** Biliary tract disease (gallstones can obstruct) **3)** Hyperlipidemia, hyperparathyroidism, hypercalcemia **4)** Trauma **5)** GI surgery **6)** Kidney failure

Answer 604

**1)** Avoid excessive alcohol consumption **2)** Have a low-fat diet

Answer 605

**1)** Sudden, severe, knife-like or boring pain **2)** Pain is in LUQ or epigastric **3) Pain is worse when lying down** **4)** Pain relieved by fetal position or upright **5)** Nausea and vomiting **6)** Weight loss **7)** Ecchymosis on flanks and blue-gray periumbilical color **8)** Jaundice **9)** Hypoactive bowel sounds **10)** Ascietes **11)** Warm, moist, fruity breath (hyperglycemia)

Answer 606

**1) Amylase (increased)** **2)** WBC (increased) **3)** Platelets (decreased) **4)** ALT/AST (increased) **5)** Ca2+ and Mg2+ (decreased) **6)** Bilrubin (increased) **7)** Blood glucose (increased) **8)** ESR (increased)

Answer 607

**1) NPO until pain free (rest the pancreas)** **2)** Resume diet with bland, high protein, low fat, non-stimulant foods (no coffee) **3)** Small, frequent meals **4)** Side-lying, upright, fetal position, or leaning forward (lying down is more painful) **5)** No alcohol or smoking **6)** Antiemetics PRN (nasogastric decompression if bad) **7)** Limit stress **8)** Enteral or parenteral nutrition if severe

Answer 608

**1) Acute pain:** morphine or hydromorphone **2) Mild-moderate pain:** Ketorlac (NSAID) **3) Avoid:** meperidine b/c of seizure risk

Answer 609

**1) Cimetidine:** histamine receptor antagonist to decrease gastric acid secretion - Give 1 hour before or after antacid **2) Omeprazole:** proton pump inhibitor to decrease gastric acid secretion - Monitor for hypomagnesemia

Answer 610

**Pancrealipase (Creon):** aids with fat and protein digestion **- Side effects:** monitor for headaches, cough, dizziness, and sore throat **- Education:** - Take with meals and snacks - Capsule can be opened and sprinkled on non-protein food - *Drink with a full glass of water after taking* - Wipe lips and rinse mouth - Take after histamine/antacid

Answer 611

**Complication:** Hypovolemia d/t extreme fluid shifting from retroperitoneal loss of protein-rich fluids **Tx:** IV fluids and electrolytes

Answer 612

When the bowel is physically blockes by problems outside the intestines, in the bowel walls, or in the intestinal lumen

Answer 613

Known as paralytic ileus or just ileus, a nonmechanical obstruction does not involve a physicl obstruction, instead peristalsis is decreased or absent d/t neuromuscular disturbance causing slowed movement or backup of intestinal contents

Answer 614

It occurs becuase intestinal contents back up at or above the obstruction. The GI system tries to compensate by increasing peristalsis and increasing secretions, which worsens the block causing edema and capillary leakage into the abdomen d/t the high presure.

Answer 615

**Alkalosis:** high in the small intestine (vomiting stomach acid and NG suction) **Acidosis:** End of small intestine or in the large intestines (loss of bicarbonate)

Answer 616

**3)** **ileum** of the small intestine because it is the **smallest, most narrow** location

Answer 617

**1) Adhesions** (scar tissue from surgery or pathology) **2)** Benign or malignant **tumors** **3)** Appendicitis complications **4) Fecal impaction** (older adults) **5)** Strictures d/t Chron's inflammation and radiation therapy **6) Intussusception:** one piece of bowel folds or telescopes into another segment overlapping **7) Volvulus:** twisting of the intestine **8)** Fibrosis d/t endometriosis

Answer 618

**1) Handling of intestines during surgery** **2)** Peritonitis d/t leakage of colon contents irritating and inflamming the GI **3)** Intestinal ischemia d/t arterial or venous thrombosis or embolus decreasing blood flow to or in mesenteric vessels **4)** Hypokalemia can predispose patients to ileus

Answer 619

**1)** Bowel surgery **2)** Intestinal tumors/cancer **3)** Older adults **4)** Constipation **5)** Family history of colorectal cancer

Answer 620

**1)** 2-3L fluid/day **2)** Regular exercise **3)** High fiber diet **4)** Stool softener PRN (docusate) **5)** Bulk forming medication (miralax) **6)** Early detection/screening for colorectal cancer

Answer 621

Keep patient NPO and call a provider

Answer 622

**1)** Midabdominal pain/cramping (Straingulation pain is persistent and localized) **2)** Vomiting, profuse if proximal SI obstruction **3)** Vomitus with bile and mucus, orange-brown, foul d/t bacteria **4) Obstipation:** no passage of stool **5)** No flatus **6)** Diarrhea in partial obstruction **7)** Metabolic alkalosis **8)** Upper abdominal distension

Answer 623

**1)** Mild, intermittent, colicky pain **2)** Lower abdominal distension **3) Obstipation:** no passage of stool **4)** Ribbon-like stool if partial **5)** Blood in stool **6) Borborygmi:** high-pitched bowel sounds associated with cramping in early obstruction **7)** Absent bowel sounds during late stages **8)** Metabolic acidosis

Answer 624

**1) Constant, diffuse pain** **2)** Abdominal distension **3)** Pain d/t ischemia is severe and constant **4)** Early decreased bowel sounds and absent later **5)** Vomiting gastric contents and bile is frequent, **rarely has foul odor like SI mechanical obstruction** **6)** Obstipation may be present

Answer 625

**1)** Severe pain that goes away **2)** Fever **3)** Tachycardia **4)** Hypotension **5)** Abominal rigidity Report immediately

Answer 626

**No definitive labs** but: **1)** High hemoglobin, hematocrit, and BUN d/t dehydration **2) Hyponatremia, Hypokalemia, Hypochloremia** **3)** Increased amylase

Answer 627

**1) Abdominal CT** **2)** Abomdinal x-ray **3)** Ultrasound (find probable cause) **4)** Endoscopy (definitive cause)

Answer 628

**1)** Keep NPO **2)** Insert nasogastric tube for decompression -> low continuous suction - Monitor proper output and placement Q4H **3)** IV fluids and electrolyte replacements (mainly sodium and potassium) for all obstructions **4)** Frequent oral care **5)** Pain control -> place in semi-fowlers and use analgesics with caution

Answer 629

**2)** X-ray is the gold standard - It's also important try and aspirate some gastric contents to verify location

Answer 630

**1)** Complete obstructions: surgical management **2)** Exploratory open laparotomy or laproscopic surgery (closed) - Colostomy or even colon resection - NGT tube inserted until GI motility returns and can withstand some intake

Answer 631

An **ileostomy is more irritating to the skin** than a colostomy becuase stool is more watery and less formed d/t it's placement in the small intestine

Answer 632

**1)** At ileum (bypasses entire large intestine) **2)** Located in RLQ **3)** Initial output can be up to 2L/day **4)** Stool: green, odorless, loose **5)** Diet: low-residue **6)** Watch for enteric coated medications

Answer 633

**1)** In the large intestine either right or left **2)** RLQ or LLQ **3) Stool:** more formed if lower (LLQ), higher is more liquid (RLQ) **4) Diet:** Regular

Answer 634

**1)** red/pink **2)** Moist **3)** Protrudes 1-3cm

Answer 635

- Edematous - Small bleeding is expected - Stool should come in 2-5 days

Answer 636

**1)** Dark red, purple, black **2)** Dry **3)** Ischemic **4)** Heavy bleeding = immediately report to surgeon

Answer 637

**1)** Redenned **2)** Moist **3)** itchy **4)** Impaired skin integrity

Answer 638

**1)** Cleanse the peristomal area with mild soap and water (no alcohol) **2)** Dry the area before applying a new bag **3)** Enure a good, secure fit for the bag **4)** The ostomy bag barrier should be cut 1/8 inch

Answer 639

- Any locations that are higher up in the GI system (ileostomies and higher colostomies)

Answer 640

**1)** Stringy vegetables **2)** Popcorn **3)** Fresh tomatoes

Answer 641

**1)** Broccoli, **2)** Cabbage, **3)** Corn, **4)** Fish

Answer 642

2+ infections within 6 months or 3+ in a year

Answer 643

**Uncomplicated:** no anatomical or functional abnormality of the urinary tract that makes the risk for infection or treatment failure higher **Complicated:** the presence of an anatomical or functional abormality that increases infection risk or treatment failure (i.e. pregnancy, male sex, obstruction, diabetes, CKD, etc.)

Answer 644

Bacterial presence in the urine or urinary tract but with **NO symptoms**

Answer 645

**1) Reduced immunity** **2) Female sex** - Short urethra - Urethral opening closer to anus **- Hormonal changes such as menopause and low estrogen** - Pregnancy **3)** Male sex - Prostate enlargement creating stasis - Loss of prostate proteins with age **4)** Stones (calculi = obstruction, surface irritation) **5)** Diabetes (glucose for bacterial and neuropathy = flaccid bladder) **6)** Concentrated urine **7)** Recent antibiotic use **8) Sexual intercourse** **9) Indwelling foley**

Answer 646

Sexual intercourse

Answer 647

**1)** Fever **2)** Flank pain **3)** Chills/rigors **4)** Malaise **5)** Costovertebral angle tenderness **6)** Pelvic pain in women or perineal pain in men

Answer 648

**1)** E. coli (80% of infections) **2)** Candida **3)** Enterococcus (less common) **4)** Klebsiella (less common)

Answer 649

**1)** Chemical exposure **2)** Radiation therapy **3)** Immunity issues like SLE (lupus)

Answer 650

**Interstitial cystitis:** chronic inflammation of the *entire* urinary tract (bladder, urethra, muscles) that is related to genetic and immunity dysfunction, **NOT infection** **S/S:** **1)** Pain with bladder filling and/or voiding **2)** Increased urinary frequency **3)** Increased urinary urgency **4)** Nocturia **5)** Suprapubic and/or pelvic pain

Answer 651

**1) Inreased urinary frequency** **2) Increased urinary urgency** **3) Dysuria (Burning while voiding)** **4)** Suprapubic pain **5)** Nocturia **6)** Urinary incontinence **7)** Urinary retention **8)** Hematuria **9)** Pyuria (WBC in urine) **10)** Bacteriuria **11)** Feeling of incomplete bladder emptying

Answer 652

**1) Change in mental status - confusion** **2)** Dysuria **3)** Urinary incontinence **4)** Nocturia **5)** Urgency **6)** Decreased well-being

Answer 653

**1)** Increased HR **2)** Low BP **3)** Increased RR

Answer 654

**1)** Urinalysis - Positive leukocyte esterase and nitrate is sensitive - Presence of WBCs (pyuria), RBCs, and casts **2)** Culture (determine bacteria) **3)** Cystoscopy (for recurrent UTIs and interstitial cystitis) **4)** CT

Answer 655

**1)** Use sterile technique when inserting catheters **2)** Hand hygiene **3)** Only use if necessary - Perioperative PRN - Acute retention/obstruction - Measurement of urine during critical illness or injury - Palliative - Wound healing d/t incontinence **4)** Routine hygiene to clean periurethral area not antiseptic **5)** Assess need for catheter daily

Answer 656

**1)** Drink 2-3L fluids/daily **2)** Good hand hygiene **3)** Good sleep, rest, and nutrition for immune health **4)** Avoid spermicides **5)** Do not delay urination (Don't hold it) **6)** Women should clean perineum and empty bladder before and after sexual intercourse **7)** Wipe from front to back only **8)** Men should clean perineum before intercourse

Answer 657

**Fluconazole** is the drug of choice for Candida infections because it is an antifungal

Answer 658

**Class:** antispasmodic/urinary analgesic **Action:** decreased bladder spasms, promotes bladder emptying, and provides pain relief (it does **NOT** treat the infection) **Side effects:** turns tears and urine orange to red that may stain clothing **Education:** Take with food

Answer 659

**1)** Complete full course **2)** Avoid sun exposure d/t sensitivity **3)** Report any diarrhea or allergic reaction symptoms

Answer 660

**1)** Warm sitz bath 3x/day for 20 minutes **2)** Increase fluid intake to atleast 1.5L **3)** Drink cranberry juice is it can reduce bacteral ability to adhere to cells - avoid in intersitial cystitis **4)** Avoid spices, soy products, and tomato products to reduce irritation and pain

Answer 661

**Hemodialysis:** is the processes of a machine filtering the blood to remove excess fluid, eletrolytes, and waste **Indication:** when medications, diet, and fluid restrictions are no longer effective leading to uremic symptoms and fluid and electrolyte imbalances

Answer 662

**1) Short-term:** HD catheter **2) Long-term:** Arterial-venous fistula - Takes up to 4 months to mature, 50% do not make it to maturity

Answer 663

They may dialyze off if given before and the patient loses out on whatever benefit it was supposed to give.

Answer 664

**1)** Do not carry heavy objects on the extremity **2)** Do not sleep on or compress the extremity **3)** Monitor for bleeding after dialysis (apply pressure) **4)** Assess function and perfusion Q4H -> Bruit, thrills, distal pulse, capillary refill **5)** No blood pressure taken on affected arm **6)** No blood draws or IVs on affected arm

Answer 665

**Complicaiton:** peritonitis **Prevention:** Sterile insertion and technique when assessing catheter **Clody and opaque effluent:** obtain a culture for labs

Answer 666

0.5mL/kg/hr or 1-3L/day

Answer 667

< 30mL/hr or < 500mL/day

Answer 668

A rapid reduction in kidney function causing an inability to maintain proper fluid and electrolyte balance and acid-base balance

Answer 669

**1)** Decreased perfuion to kidneys - Dehydration - Embolus or thrombus at renal arteries - Sepsis or shock - Myocardial infarction **2)** Damage to kidney tissue - Nephrotoxic medications (aspirin, NSAIDs like ibuprofen and naproxen) - CT contrast - Antibiotics (vancomycin, gentamicin) - Diabetes - Hypertension **3)** Obstruction of urinary output - Kidney stones - Pyelonephritis - Prostate cancer

Answer 670

**1)** Color **2)** Clarity **3)** Amount **4)** Odor **5)** Frequency < 30mL/hr for 2 hours or < 0.5mL/kg/hr = report

Answer 671

**1)** Low blood pressure, MAP < 65 **2)** High HR **3)** Weak peripheral pulses **4)** Decreased cognition

Answer 672

**1)** Increased creatinine **2)** Increased BUN **3)** High serum osmolality and urine specific gravity **4)** High K+ (metabolic acidosis - low bicarb) **5)** Low GFR **6)** High Phosphate **7)** Low calcium

Answer 673

**1)** CT **2)** Ultrasound **3)** Kidney biopsy during severe issues

Answer 674

**1)** Drink 2-3L of fluid/day **2)** Maintain a normal blood pressure **3)** Reduce nephrotoxic medications **4)** Monitor kidney function and increase fluids during contrast administration (**STOP** medformin 24 hours before contrast) **5)** Redose medications as needed to prevent kidney injury

Answer 675

**1)** To treat symptomatic uremia (decrease in cognition) **2)** High K+ levels, >6.5 **3)** Severe metabolic acidosis < 7.1 pH **4)** Fluid overload

Answer 676

Progressive, irreversible, damage to the kidneys altering elimnation that has lasted longer than 3 months

Answer 677

**1+2)** Often asymptomatic, risk factor reduction; GFR >90 **3)** Some symptoms, strategies to slow progression like ACE inhibitors; GFR 60-89 **4)** Manage complication, dialysis preparation; GFR 30-59 **5)** ESKD - dialysis or kidney transplant necessary; GFR < 30

Answer 678

**1) Kidney:** fluid overload (crackles, edema, bounding pulse) **2) Metabolic:** Hperkalemia (K+ high); metabolic acidosis (decreased acid secretion), hyperphosphatemia (high phosphate), hypocalcemia (low Ca2+) **3) Cardiac:** hypertension, hyperlipidemia, heart failure, pericarditis **4) Hematologic:** anemia (bleeding or bruising risk) **5) Immunity:** infection risk **6) GI:** N/V, anorexia **7) Cognitive:** changing cognition with advanced disease

Answer 679

**Uremia:** azotemia, or the build up of nitrogenous waste in the blood, that causes symptoms **S/S:** **1)** Metallic taste in the mouth **2)** Anorexia **3)** Nausea **4)** Vomiting **5)** Muscle cramps

Answer 680

**1)** Acute kidney injury **2)** Hypertension **3)** Diabetes

Answer 681

**1) Neuologic:** *lethargy and fatigue*, seizures, coma, upper extremity weakness **2) Cardiovascular:** hypertension, fluid overload **3) Respiratory:** metabolic acidosis causing tachypnea and Kussmal respirations to compsenate **4) Hematologic:** anemia (bruising, bleeding), decreased WBC **5) GI:** anorexia, nausea, vomiting, metallic taste, foul breath **6) GU:** late stage oliguria and anuria **7) Skin:** pruritis, dry skin, yellow/pallor or darkening **8) Musculoskeletal:** weakness, bone pain, fracture **9) Psychosocial:** depression, fatigue, sexual dysfunction

Answer 682

**1) Urinalysis:** early protein, glucose, RBCs, WBCs, and low urine specific gravity **2)** Early hyponatremia **3)** Late hypernatremia (Worsens hypertension and fluid retention); hyperkalemia = dysrhythmias; **4)** Reduced acid secretion = metabolic acidosis **5)** hyperphosphatemia **6)** Hypocalcemia **7)** High BUN and Creatinine **8)** Low GFR

Answer 683

**1)** Dieurtics **2)** Hemodialysis 3/week 3-4 hours or peritoneal dialysis in ESRD **3)** Fluid status assessment = daily weights, I/O's, fluid overload S/S **4)** Fluid restriction **5)** Monitor electrolytes **6) Medications:** phosphate binders, multivitamins

Answer 684

**1)** Control hypertension by using diuretics (thiaizde), Ca2+ channel blockers, ACEIs, beta blockers **2)** Monitor HF S/S

Answer 685

**1)** Consult a registered dietician **2)** Restrict protein early on d/t difficulty metabolising and excreting it (more is allowed for hemodialysis patients) **3)** Restrict sodium, potassium, and phosphorus **4)** Fluid restrictions **5)** Multivitamins, phosphate binders **6)** Give Ca2+ with vitamin D and iron

Answer 686

**Medication:** calcium acetate **Action:** prevents absorption of dietary phosporus **Education:** - Take with meals - Do not take within 2 hours of other medications - Take after dialysis - Monitor phosphorus and calcium levels **Side effects: constipation**, weakness, pulse irregularity

Answer 687

**Medication:** Cinacalcet **Action:** Reduces parathyroid hormone to maintain blood levels of Ca2+ and phosphorus **Side effects:** diarrhea, muscle pain

Answer 688

**Medication:** erythropoetin alfa **Action:** Prevents or corrects anemia **Monitor:** high hemoglobin (too high is > 10-11) because it increased blood viscosity **Side effects:** chest pain, high blood pressure, weight gain, swelling, hives

Final Exam Flashcards

(726 cards)