Unit 2 Flash cards
1
Q
What disease is caused by the obstruction in the common bile duct causing bile to back up or be inflammed?
A
Cholecystitis
2
Q
What are some clinical manifestations for cholecystitis?
A
Pain with movement lasting 4-6 hrs
N/v
Fever
Heart burn/ indigestion/ flatulence
Jaundice
Elevated pulse and rr
3
Q
What are some modifiable factors associated with cholecystitis?
A
Oral contraceptives (estrogen)
Obesity
Diabetes
Liquid protein diet
Rapid weight loss
4
Q
What are some non modifiable factors associated with cholecystitis?
A
Female
Fertile
Fair
5
Q
What are some diagnostic testing for cholecystitis?
A
WBC count
Bilirubin
Liver enzyme
Serum amylase
Lipase count
Ct, MRCP, HIDA scan, ULT
6
Q
What are the nursing priorities for a patient with cholecystitis?
A
Acute pain
Ineffective breathing
Risk for impaired skin integrity
7
Q
what are the therapeutic measures for cholecystitis?
A
Pain control
Laparoscopic or open cholecystectomy
LOW FAT DIET
Elevate hob
8
Q
What are some low fat diets for cholecystitis ?
A
Veggies, fruits , lean meats and fish, low fat dairy products
9
Q
How should a low fat diet patient cook their meats??
A
Grill, boil or steam without skin on poultry
10
Q
Hardened deposits w/in the fluid in the gallbladder are associated with what disease?
A
Cholethiasis
11
Q
What are some manifestations of Cholethiasis ?
A
RUQ pain radiating to shoulder
Pain beginning after a fatty meal lasting 1-3 hrs
Jaundice
Fever;N/v
12
Q
What are some teaching to recommend after cholecystectomy?
A
Low fat diet; avoid gassing forming foods
Report pain, fever, foul odor or jaundice
Resume activity gradually; avoid lifting for 4-6 weeks after sx
13
Q
The nurse recognizes which as factors for cholecystitis? SATA
A.Obesity
B.Male
C.Female
D.African American descent
E. European descent
A
A.Obesity
C.Female
E. European descent
14
Q
The nurse correlated which clinical manifestation with Cholecystitis ?
A. Retroperitoneal pain
B. Absence of bowel sounds
C. Diarrhea
D. RUQ pain
A
D. RUQ pain
15
Q
The inflammation of the glomeruli within the bowman’s capsule of the kidney triggered by an immunological mechanism is the sign of what disease?
A
Glomerulonephritis
16
Q
What is the etiological process in Glomerulonephritis?
A. Tubular necrosis caused by bacteria and antibody reactions
B. Deposition of immunological completes and complement along the GBM
C. Deposition of bacteria and immunological components within the loop of Henle
D. Destruction of proteolytic enzymes contained in the GBM
A
B. Deposition of immunological completes and complement along the GBM
17
Q
What are some clinical manifestation of Glomerulonephritis?
A
**Protein and blood in urine **
WBC ^
Edematous.
Decreased urine output
HTN
Elevated BUN/Creatinine
18
Q
What is the treatment option for Post streptococcal Glomerulonephritis?
A
Antibiotics mainly penicillin
19
Q
Other treatment options given for Glomerulonephritis other than antibiotics?
A
Diuretics/ other Hypertensives
Sodium/ fluid restriction- Edema
Plasmapheresis- to txt immune triggered inflammation
20
Q
If Glomerulonephritis is not treated in acute it can lead to what ?
A
Renal failure in weeks - months
21
Q
What are some nursing diagnosis for Glomerulonephritis?
A
Impaired urinary elimination
Ineffective therapeutic regimen management
22
Q
What are some teachings for the patient and or family related to Glomerulonephritis?
A
Overview the disease process- S/s associated with disease
Medication adherence
Dietary restrictions
Avoid infections
23
Q
Plaque within the lumen of the vessels causing obstruction to blood flow is known as what disease
A
Atherosclerosis
24
Q
What are some risk factors for developing atherosclerosis?
A
Cigarette smoking
High LDL
HTN
Diabetes
Obesity
Excessive alcohol consumption
25
What is the primary treatment for atherosclerosis?
Lipid lowering medications
26
What are other treatments for atherosclerosis?
Dietary modifications
Smoking cessation
HTN management
Anticoagulant medication
Reduce stress
27
What is a another form to treat atherosclerosis once manifestations have become irreversible?
PTCA (percutaneous transluminal coronary angioplasty) - stent
CABG (coronary artery bypass graft)
28
What are some cues to recognize in atherosclerosis in the coronary arteries?
Chest pain
SHOB
Fatigue
29
What are some cues to recognize of atherosclerosis in the peripheral vascular system ?
Severe pain
Difficulty walking
30
What are some actions the nurse should take with a patient who is showing signs of atherosclerosis?
Assess BP in both arms
Palpate major pulse sites and note differences
Auscultate for bruits
Monitor labs
31
What is some teaching considerations for atherosclerosis?
Management of chronic disease
-diabetes, HTN
Adhere to medication regimen
Follow up with pcp
Lifestyle changes
- Low-fat, low-cholesterol diet
*B-complex vitamin supplements if no contraindication
*Smoking cessation
*Exercise plan
*Weight loss
*Reduce/Manage stress
32
A PATIENT WITH ATHEROSCLEROSIS ASKS WHY SMOKING CESSATION IS IMPORTANT. HOW SHOULD THE NURSE RESPOND TO THIS CLIENT?
1.Tobacco toxins increase your HDL-C.
2.Tobacco reduces the effects of cholesterol in the body.
3.Tobacco causes the BP to drop and changes the cells within the arteries.
4.Tobacco smoke speeds the growth of atherosclerosis in coronary arteries, the aorta, and the legs.
4
33
THE NURSE IS PREPARING TEACHING MATERIAL TO HELP A CLIENT WITH ATHEROSCLEROSIS MANAGE LIFESTYLE CHANGES. WHAT SHOULD THE NURSE EMPHASIZE IN THIS TEACHING?
1.You need to limit cigarette smoking.
2.You need to follow a low-fat, low-cholesterol diet.
3.You should consider adopting an active lifestyle.
4.You may have dizziness at times, which is expected
2
34
IN REVIEWING LAB DATA FOR A CLIENT, WHICH VALUES ARE CONSISTENT WITH A DIAGNOSIS OF ATHEROSCLEROSIS? SELECT ALL THAT APPLY
1.Decreased homocysteine levels.
2.HDL-C 30mg/dL
3.LDL-C 120 mg/dL
4.Triglycerides 175 mg/DL
5.HgbA1c 5%
2
3
4
35
Elevated lipid levels in the blood ?
hyperlipidemia
36
What are risk factors for hyperlipidemia?
Genetics
High fatty foods
Can start at an early age
37
What are some treatments for hyperlipidemia ?
Low fat , low cholesterol diet
Lipid lowering medications
Lifestyle changes
38
What are some cues to recognize with HTN ?
headache
Chest pain
Vision changes
SHOB
Renal dysfunction
Dizziness
Fatigue
Nosebleeds
39
How is HTN diagnosed ?
two or more elevated BP readings on more than two office visits
Renal test
Endocrine test
Metabolic test
40
What are some complications to HTN
systolic dysfunction
Dilated cardiomyopathy
Renal failure
Stroke
HTN crisis
41
What are some lifestyle changes for HTN
Dash diet
Moderate exercise
Stress reduction
Smoking cessation
42
Other teaching for htn
Adhere to medication
Monitor BP at home
S/s of target organ damage stroke
43
A PATIENT’S BLOOD PRESSURE IS 140/86 MM HG; HOWEVER, PREVIOUS MEASUREMENTS HAVE BEEN WITHIN NORMAL LIMITS. THE PATIENT DENIES ANY OTHER COMPLAINTS. WHICH INTERVENTION WOULD BE APPROPRIATE FOR THIS PATIENT?
*REFER CLIENT TO THE ED FOR TREATMENT.
*PREPARE TEACHING ON ANTIHYPERTENSIVE MEDICATIONS.
*SCHEDULE AN ADDITIONAL MEASUREMENT IN A FEW WEEKS.
*INSTRUCT ON THE EFFECTS OF HTN ON MAJOR BODY ORGANS.
SCHEDULE AN ADDITIONAL MEASUREMENT IN A FEW WEEKS.
44
THE NURSE PROVIDES EDUCATION TO A PATIENT WHO IS PRESCRIBED THE DASH DIET. WHICH PATIENT STATEMENT INDICATES A NEED FOR ADDITIONAL TEACHING?
*I WILL EAT FOUR SERVINGS OF FRUIT EACH DAY.
*I WILL EAT ONE SERVING OF NONFAT DAIRY EACH DAY.
*I WILL EAT FIVE SERVINGS OF VEGETABLES EACH DAY.
*I WILL EAT A T LEAST THREE WHOLE-GRAIN FOODS EACH DAY.
I WILL EAT A T LEAST THREE WHOLE-GRAIN FOODS EACH DAY.
45
IN PROVIDING CARE TO A PATIENT WHO IS DIAGNOSED WITH HYPERTENSION, WHICH ASSESSMENT DATA ARE RISK FACTORS FOR THIS DISEASE PROCESS? SELECT ALL THAT APPLY.
*CURRENT AGE 45 YEARS OLD.
*BODY MASS INDEX OF 28 KG/M2
*HISTORY OF CIGARETTE SMOKING
*GFR 58 ML/MIN
*CONCURRENT DIAGNOSIS OF DIABETES MELLITUS
CURRENT AGE 45 YEARS OLD.
*BODY MASS INDEX OF 28 KG/M2
*HISTORY OF CIGARETTE SMOKING
*CONCURRENT DIAGNOSIS OF DIABETES MELLITUS
46
What does right heart failure affect in the patient?
Right sided rocks the body
47
What does left sided heart failure affect in the patient?
Left sided affects lungs
48
What are the clinical manifestations of right sided heart failure?
** think swelling**
Swelling of hands and feet
Weight gain
Edema (pitting)
Large neck veins (JVD)
Lethargy/fatigue
Irregular heart rate
Nocturia
Girth (ascities)
Hepatomegaly
Splenomegaly
49
What are some clinical manifestation of Left sided heart failure ?
*** Left hurt Lungs**
** Think left drowning**
Dyspnea
Rales ( Crackles)
Orthopnea
Weakness/fatigue
Nocturnal proxsymal Dyspnea
Increased HR
Nagging cough ( pink, frothy sputum)
Gaining weight (2-3 lbs a day)
Pallor
Weak pulses
Delayed capillary refill
50
what should the nurse prioritize in a patient with heart failure?
Impaired oxygen
Decreased cardiac output
Excess fluid volume
51
A nurse is performing an assessment on a patient who came in for weakness, upon assessment the nurse finds the patient has orthopnea, weak peripheral pulses , has gained weight and decreased urinary output, increased heart rate and a cough. The nurse consider the patient is showing signs of what
Left sided heart failure
52
What actions should the nurse take with heart failure ?
Oxygen therapy
Elevate hob
Administer medications
Fluid and sodium restrictions
53
What medications will the nurse administer for heart failure ?
Diuretics
Ace inhibitors
ARBS
Vasodilators
Beta blockers
Inotropic agents
54
What are complications of HF?
Pulmonary edema
Renal failure
55
A patient with heart failure is having a B-type natriuretic peptide (BNP) level drawn. The nurse correlates that the results of this diagnostic provide which data? What is the purpose of this laboratory test?
A.Measures ejection fraction.
B.Rule out ischemic event.
C.Differentiate right- from left-sided heart failure.
D.Measure over-stretching of the ventricles.
D
56
The nurse monitors for which clinical manifestation in a patient diagnosed with right-sided heart failure (HF)?
A.Fatigue
B.Shortness of breath
C.Crackles with auscultation
D.Edema in the lower extremities
D
57
In administering an angiotensin-converting enzyme inhibitor to a patient with heart failure, the nurse correlates its effectiveness to which mechanism of action? (21)
A.Reduced afterload
B.Decreased preload
C.Increased contractility
D.Controls SNS response to decreased cardiac output
A
58
The nurse plans care for a patient who is admitted to the hospital for newly diagnosed left-sided heart failure. Which is the priority nursing diagnosis when planning care for this patient?
A.Dyspnea at rest
B.Dry persistent cough
C.Weak peripheral pulses
D.Jugular vein distention
A
59
While planning care, the nurse identified interventions to reduce a patient’s risk for developing heart failure. Which assessment findings did the nurse use to make this clinical determination? Select all that apply.
A.Body mass index of 31.3
B.Smokes ½ pack per day of cigarettes
C.Employed at a textile factory
D.Blood pressure of 168/90 mmHg
E.Fasting glucose of 120 mg/dL
A
B
D
E
60
The nurse notes that a patient with heart failure (HF) has a normal ejection fraction (EF). What should this information indicate to the nurse? Select all that apply.
A.It is known as HF with preserved EF.
B.It is associated with older patients with obesity
C.It occurs in patients with diabetes mellitus and atrial fibrillation.
D.It is exacerbated with invasive procedures and dental examinations.
E.There is less blood in the ventricle to eject because of the impaired filling.
A
B
C
E
61
In providing care to a patient with an acute exacerbation of heart failure, the nurse prepares to administer prescribed medication that provide which actions? Select all that apply.
A.Decrease preload
B.Increase preload
C.Decrease afterload
D.Increase afterload
E.Increase contractility
A
C
E
62
What is unstable angina?
refers to chest pain that can occur at rest
63
What is stable angina ?
Chest pain or discomfort that is associated with physical activity. Typically linked to fixed plaque formations and is predictable
Resolves with rest
64
Which type of angina is most concerning ?
Unstable angina
65
What chest pain is caused by coronary arterial spasm can occur at rest and in clusters (normally at night) ?
Variant angina (prinzmetals)
66
Why is unstable angina treated as an emergency ?
may not be relived with rest or meds and is precursor to MI
67
What are some medications to treat angina ?
Anticoagulants
- aspirin, heparin
Vasodilators
- nitroglycerin
Supplemental oxygen
Pain medication
- morphine
Lipid lowering meds
Ace inhibitor
Beta-blockers
68
What are some surgical therapies for angina?
PTCA
CABG
69
A male patient shows up to the ed presenting with symptoms of crushing substernal chest pain that radiates to the left arm and neck happening after exertion. The nurse can suspect the patient is showing sign of what ?
angina
70
A female patient comes in and complains of fatigue, heartburn and shortness of breath the nurse can assume the patient is presenting signs of what?
angina
71
A diabetic patient comes in with SHOB, weakness and the feeling of feeling unwell. The nurse suspects the patient is showing signs of what ?
angina
72
What are the nurses priorities related to angina?
Oxygen
Prevent or minimize MI
Provide information about angina
Support client
73
What is the priority action relating to a patient who came in with angina ?
OXYGEN
74
During an assessment, a patient describes experiencing chest pain with exercise that disappears with rest. The nurse correlates this finding with which health problem?
A. Stable angina
B. Variant angina
C. Unstable angina
D.Prinzmetal’s angina
A. Stable angina
75
The nurse is evaluating teaching provided to a patient with coronary artery disease. Which patient statement indicates that additional teaching is required?
A.I will adhere to my smoking cessation plan.
B.I am to reduce my daily intake of saturated fat.
C.I can take up to three doses of NTG, 15 minutes apart.
D. I am to follow the exercise plan for 30 minutes, 5 days per week.
C
76
The nurse is preparing teaching for a patient being treated for coronary artery disease. What dietary information should the nurse emphasize?
Restrict carbohydrate intake.
Limit calorie intake to less than 1000 mg/day.
Reduce saturated fat and sodium intake.
Limit fluid intake.
Reduce saturated fat and sodium intake.
77
In administering oxygen
2 L via nasal cannula to a
patient experiencing
angina, what does the
nurse explain as being
the primary purpose of
the oxygen?
A. Promotes vessel dilation.
B. Prevents clot formation.
C. Supports myocardial oxygen demand.
D. Decreases respiratory complications.
C. Supports myocardial oxygen demand.
78
Blood clot in a large vein usually in the leg or pelvis categorized as a vascular disorder is called what
DVT
79
Based on Virchow’s Triad. Which patient is at risk for developing a DVT?
25 y.o. with a UTI
40 y.o. paralyzed below the waist
35 y.o broken wrist
50 y.o. having colonoscopy
40 y.o. paralyzed below the waist
80
What diagnostic test is used to determine DVT ?
D-Dimer
UlT
81
What does a positive D-diMer indicate ?
elevated levels in the blood and likely to have a clot
82
What are some preventative measures for DVT?
Ambulating
VTE prophylaxis
- compression socks
- SCD’s
Low molecular weight heparin
-heparin
- Enoxaparin
83
A patient c/o pain, swelling and tenderness in his lower leg, after assessing the nurse notes discoloration and redness with warmth at touch. The patient states pain when dorsiflexion is done on the foot. The nurse can predict the patient is experiencing …..
DVT
84
In admitting a patient with a vascular disorder, the nurse correlates which clinical manifestation to femoral vein thrombosis?
A.Calf pain
B. Tenderness in the foot
C. Thigh swelling to the knee
D. Entire leg swollen and painfull
C. Thigh swelling to the knee
85
Which statement by the client discharged on warfarin (Coumadin) indicates the need for further teaching?
A. I can take acetaminophen for pain
B. I need to limit intake of leafy vegetables
C. It is ok if I see a little blood in my stool
D. I need to take the medication at the same time every day
C. It is ok if I see a little blood in my stool
86
In reviewing healthcare provider admission orders for a client admitted for treatment of a DVT of the left lower leg, which order should the nurse questions?
A.Compression stockings on both legs
B. Sequential compression device on both legs
C. Elevate the left leg 10-20 degrees above the heart
D. Encourage fluid intake
B. Sequential compression device on both legs
87
The nurse correlates which pathophysiological process to Virchow’s triad. Select all that apply.
A. Vasodilation
B. Stasis of blood flow
C. Hypercoaguability
D. Leukocytosis
E. Endothelial injury
B. Stasis of blood flow
C. Hypercoaguability
E. Endothelial injury
88
A patient who is on IV heparin complains of sudden SHOB, low oxygen sat, sharp chest pain, tachycardia, hypotension , sweating, hemoptysis, feeling of impending doom. The nurse should suspect what and proceed with what interventions ?
clot has moved and blocks the pulmonary artery
Interventions:
High Fowler
Oxygen
Initiate bleeding precautions
Limit foods high on vitamin K
89
Clouding of the eyes crystalline lens is what?
cataract
90
What are some risk factors for cataracts ?
common after 60 y.o
Exposure to UV light
Family hx
Race and ethnicity
- African Americans
- Hispanic ethnicity
Diabetes
Obesity
HTN
Smoking / alcohol use
Lead exposure
91
What are some actions the nurse should take with a patient who has cataracts?
Implement safety measures
Administer pre op/post op eye drops
Elevate HOB
Maintain eye patch
Administer stool softeners
92
Eye is struck with finger, fist, solid objects causing internal eye damage from sudden compression is known as what?
Blunt trauma
93
Eye is pierced by sharp object, knife or metal fragment is known as ?
Penetrating trauma
94
Bleeding in front of eye between cornea and iris is known as what?
Hyphemia
95
Sudden loss of vision , sudden onset pain , flashing lights can be signs of what ?
detached retina
96
CaptoPRIL
Enalapril
Fosinopril
Lisinopril
Are all what?
ACE Inhibitors
97
What are some side effects of ace inhibitors ?
A-angioedema
C- Cough dry
E- elevated K+
98
What are ace inhibitors used for?
HTN
HF
99
What is the use for nitroglycerin?
Angina
Preventing angina
Acute coronary syndrome
100
What is the action of nitroglycerin ?
decrease blood pressure
Dilates vessels
Decrease vascular resistance
101
What are some common side effects of nitroglycerin
Headache
Hypotension
Hot flushing of face
think 3 H’s
102
What is the correct way to take nitroglycerin
1 sublingual tab every 5 mins up to 3 doses. If unresolved by third dose call 911
103
what medication class is Digoxin ?
Cardiac glycosides
104
What is the therapeutic range for digoxin?
0.8-2.0
105
What is digoxin lanoxin used for?
HF
Cardiogenic shock
Antiarrythmic
-A Fib
106
What are signs of toxicity with digoxin ?
GI symptoms - n/v, diarrhea
Visual symptoms - blurred vision, yellow/green vision , halo effect around dark object
Neurological symptoms- headache,drowsiness, confusion, disorientation.
107
What are the causes of toxicity in digoxin ?
Think DIG
Decreased potassium
Injured kidney
GFR decreased (elderly )
108
What is the antidote for digoxin ?
Digbind
109
Acebutolol
Metropolol
Propranolol
Nadolol
Are all what?
Beta - Blockers
110
What are beta blockers used for ?
HTN
stable angina
Chronic HF
Dysrhythmias
111
What are some side effects of beta blockers?
bradycardia
Heart blocks
Breathing problems
Bad for heart failure patient in an acute setting
Blood sugar making (hypoglycemia)
Blood pressure lowered (hypotension)
Think all b’s
112
What are beta blockers actions?
decrease resistance
Decrease workload
Decrease cardiac output
113
Atrovastatin
Fluvastatin
Lovastatin
Pitavastatin
Simvastatin
Rosuvastatin
Are all what
Lipid lowering agents
114
What is lipid lowering agents used for ?
Hyperlipidemia
Prevent CAD
Stabilizes fatty plaques in clients w/CAD.
115
What are some side effects of Lipid lowering agents?
headache
N/v
Dizziness
Constipation
Cramping
ABD pain
Hyperglycemia
116
What is an adverse side effect of lipid lowering agents ?
Rhabdomyolisis - muscle damage and can lead to kidney damage
117
What is warfarin/ Coumadin used for ?
decrease clotting factors
118
What is the therapeutic range for warfarin ?
INR 2-3
119
If a patient is on warfarin and taking antibiotics at the same time it can increase what ?
increase the risk for bleeding.
120
What is the use for heparin?
Inhibits formation of fibrin clots.
121
Is heparin used short or long term?
Short term
122
What do you want to monitor if a patient is on Heparin?
Platelet count
Normal: 150000,-450000
123
What is the therapeutic range for aPPT if a patient is on heparin ?
APTTT: 47-70 SECONDS
124
What is the antidote or heparin ?
Protamine Sulfate
125
What is the antidote for warfarin/Coumadin
Vitamin K
