497 & 498 1st Midterm

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How is AIDS diagnosed?

When CD4 count less than 200 and must be diagnosed with one of these conditions: HIV Wasting Syndrome (recurrent bacterial pneumonia), Chronic herpes, Candida infections of the esophagus and lungs, Kaposi Sarcoma, Tuberculosis, and Brain infections

Venous Thrombosis

When a blood clot (thrombus) forms on the wall of a vein, this is accompanied by inflammation of the vein wall and some degree of obstructed venous blood flow

Complicated Hypertension

When prolonged hypertension causes damage to the walls of the vessels resulting in stiffness and hypertrophy of the vessels

Autoimmune diseases

When the body's own cells begin to identify other body cells as being foreign

Xenograft

When the tissue used for a transplant is from a different species

Allograft

When the tissue used for a transplant is from the same species; comes from either a living donor or a cadaver

Graft-vessel-host Disease (GVHD)

When the transplant rejects the body; occurs 7-30 days after the transplant; it is a frequent and potentially fatal complication of bone marrow transplants; if HLAs aren't closely matched, the transplant tissue recognizes the host cells as foreign and initiates a cell-mediated response

True Aneurysm

When the wall of the artery has at least one layer of cells intact; outpouching on either side of the vessel

Valvular Stenosis Disease

When valve orifices are restricted and cannot open fully; forward blood flow is impeded due to pressure gradient that is created across the open valve

Answer: 3) This is describing ventricular tachycardia (QRS is a giveaway), and the treatment for a stable patient is Amiodarone or cardioversion. If the patient were unstable, we'd go ahead and defibrillate.

Which of the following does the nursing student realize is the treatment for a stable patient presenting with QRS intervals above 0.12 seconds with a regular rhythm and a rate of 100-250 bpm? 1) Atropine 2) Defibrillation 3) Amiodarone 4) Adenosine

Answer: B - prolonged hiccups indicate pacemaker failure. Other signs and symptoms of pacemaker failure are dysrhythmias, dizziness, faintness, chest pain, shortness of breath, increase or decrease in apical rate.

Which of the following signs and symptoms indicate pacemaker failure? a) excessive thirst b) prolonged hiccups c) flushing of the skin d) increased urine output

Diagnostic Studies for RA

X-ray (baseline used for disease progression); rheumatoid factor (present in 80% of patients); elevated ESR and CRP (indicated inflammation); test synovial fluid for WBCs and possible MMP-3

Stage III RA - Severe

X-ray evidence of cartilage and bone destruction; joint deformity

Stage II RA - Moderate

X-ray evidence of osteoporosis; slight bone and cartilage destruction; no joint deformity

Diagnostics for Aortic Aneurysm

X-ray, echocardiogram, ultrasound, CAT scan (used in the initial phase of diagnosing), angiogram

Answer: D. A pulse would be assessed for first. Then the patient will be defibrillized and chest compressions will begin immediately.

You are the nurse working on the telemetry unit and you have finally gotten to sit down to work on some charting. Suddenly the heart monitors at the station start beeping. Patient in room 18 is showing this rhythm on the monitor. The medical team advances together into the room and finds them unconscious. What is priority action by the nurse? A) Prepare to administer adenosine to the patient B) Begin chest compressions C) Prepare for defibrillation D) Check for a pulse

Answer: B. With SVT (Supraventricular tachycardia), the first thing to do would be to instruct the pt. to perform the Valsalva maneuver by bearing down.

You, the nurse, note the following rhythm on the EKG monitor for a patient named billy. What is the first thing the nurse should do? a) Check for a pulse b) Tell Billy to try to poop c) Prepare to defibrillate billy d) Prepare to administer Amiodorone

hydroxychloroquine (Plaquenil)

a DMARD generally used for malaria but can also used to Lupus because of its antirheumatic/ immunosuppressive effect

sulfasalazine (Salazopyrin)

a DMARD used for the treatment of rheumatoid arthritis

Highly Active Antiretroviral drugs (HAARTs)

a combination of at least three medications (Antivirals and/or Antiretrovirals)

Antiviral drugs

a general term for the medications used to treat infections and viruses other than HIV

Systolic Heart Failure

a heart dysfunction effecting the heart's squeezing ability characterized by a decrease in the left ventricular ejection faction (EF) (how much blood is pumped out of the ventricle with each beat)

nevirapine (Viramune)

a non-nucleoside reverse transciptase inhibitor (NNRTI) used in combination with antiretrovirals to treat HIV; should not be administered in females with a CD4 count >250 or males with a CD4 count >400 due to the risk of severe life-threatening hepatotoxicity

zidovudine/AZT (Retrovir)

a nucleoside reverse transciptase inhibitor (NRTI) that helps to treat HIV; it is usually given in combination with Combivir and Trizivir; also helps to prevent the transmission of HIV from mother to child during pregnancy and childbirth; may cause bone marrow suppression

emtricitabine (Emtriva)

a nucleoside reverse transciptase inhibitor (NRTI) that when used with other antiretroviral agents is used for the treatment of HIV

tenofovir (Viread)

a nucleotide reverse transciptase inhibitor (NTRTI) that is also a prodrug used to treat HIV, chronic Hepatitis B; this drug is more resistant to virus mutations; prevents other medications from getting broken down in the GI tract; and helps the absorption of other protease inhibitors

indinavir sulfate (Crixivan)

a protease inhibitor (PI) used for the treatment of HIV; should be administered 1 hour before or 2 hours after a meal for optimal absorption

ritonavir (Norvir)

a protease inhibitor (PI) used for treatment of HIV generally administered with other antiretroviral; may cause pancreatitis, serious liver problems, and/or jaudice

Paroxysmal nocturnal dyspnea (PND)

a sudden onset of shortness of breath in the middle of the night

Protease Inhibitors (PIs)

act by inhibiting the protease retroviral enzyme. This enzyme promotes the breakup of chains of protein molecules at designated points, a process necessary for viral replication

Heart Failure

an abnormal condition involving impaired cardiac pumping/filling that results in the hearts inability to produce an adequate CO to meet metabolic needs

Cardiac Hypertrophy

an increase in the muscle mass and thickness of the cardiac wall in response to chronic dilation; results in poor contractility, higher O2 needs, poor coronary artery circulation, and risk for ventricular dysrhythmias

glatiramer acetate (Copaxone)

believed to somehow modify immune system processes that are associated with symptoms of MS; used for the reduction of relapse frequency in patients with relapsing-remitting MS

Reverse Transcriptase Inhibitors (RTIs = NRTIs, NNRTIs, and NTRTIs)

block the activity of the enzyme reverse transcriptase, which promotes the synthesis of new viral DNA molecules from the RNA genome of the parent virion

azathioprine (Imuran)

blocks the metabolism of purines, inhibiting the synthesis of T-cell DNA, RNA, and proteins, thereby blocking immune response; used in the prevention of organ rejection and treatment of rheumatoid arthritis

Mononuclear phagocytes

capture and present antigens to the lymphocytes

Aortic Valve Stenosis

caused by a nonrheumatic origin; results in an obstruction of flow from the left ventricle to the aorta during systole; causes left ventricular hypertrophy and increased myocardial O2 consumption related to increased myocardial mass; leads to decreased CO and pulmonary hypertension

Hypertrophic Cardiomyopathy

characterized by decreased compliance of the left ventricle and hypertrophy of the ventricular muscle mass; ability for the heart to relax becomes impaired leading to poor CO; septal hypertrophy mat obstruct left ventricle outflow

Restrictive Cardiomyopathy

characterized by rigid ventricular walls that impairs diastole filling; EF is normal due to contractility impairment (less goes in, less goes out); contractibility remains relatively normal

S+S of Right-Sided HF

congestion of peripheral tissue, dependent edema and ascites, liver congestion (signs of impaired liver function), GI congestion (anorexia, weight loss, GI distress), JVD

Lymphocytes

created in the bone marrow

The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the Critical Care Unit with acute decompensated heart failure with dyspnea at rest. The nurse anticipates the administration of which medication? A) atropine B) carvedilol C) lisinopril D) milrinone

d. milrinone

Goals of Anti-Retroviral Therapy (ART) & Highly Active Antiretroviral Therapy (HAART)

decrease the viral load of active infection in the blood, maintain or raise CD4 T-cell counts, delay development of HIV/AIDS-related symptoms, and to prevent transmission of HIV

fingolimod hydrochloride (Gilenya)

decreases the amount of lymphocytes available to the CNS; used for the reduction of relapse frequency in patients with relapsing-remitting MS

Antiretroviral drugs

drugs indicated specifically for the treatment of infections caused by HIV

Venous Stasis

dysfunctional vein valves that cause a change in unidirectional blood flow; caused by inactive extremity muscles

Manifestations of Hypertrophic Cardiomyopathy

exertional dyspnea, angina, fatigue, loud S4, syncope, sudden death

Manifestations of Mitral Valve Stenosis

exertional dyspnea, palpitations from A-fib, fatigue, accentuated S1, low-pitched diastolic murmur, hoarseness (pressure on the laryngeal nerve), hemoptysis, chest pain, seizures, stroke

Manifestations of Chronic HF

fatigue, dyspnea, PND, persistent dry cough, tachycardia, chest pain, restlessness ,confusion, edema, weight gain

Manifestations of Restrictive Cardiomyopathy

fatigue, exercise intolerance, dyspnea, S3+S4, mild hepatomegaly, JVD, mitral valve regurgitation murmur

enfuvirtide (Fuzeon)

fusion inhibitor that works outside the cell to block the HIV from entering the cell.

Diagnostics of HF

history + physical; chest x-ray; ECG; Cardiac enzymes (troponin; BNP - most important for HF); HR + BP; echocardiogram; stress testing; cardiac catheterization (angiogram) - for initial phase

Common Adverse Effects of Corticosteroids

hypertension, hypokalemia, hypernatremia, headache, vertigo, insomnia, growth suppression, hyperglycemia, petechiae, delayed wound healing, muscle weakness, osteoporosis, and weight gain

Causes of Systolic Heart Failure

impaired contractile function (ex. MI), increased afterload (ex. hypertension), cardiomyopathy, mechanical abnormalities (ex. valve disease)

Compensatory mechanisms to maintain CO

increased SNS activation (release of epinephrine and norepinephrine); increased release of Renin (increases BP + vasoconstriction); increased release of ADH (increased water retention); Cytokine release (systemic inflammatory response); enlargement of the heart chambers

Disease Modifying Antiarheumatic Drugs (DMARDs)

inhibit the movement of cells into an inflamed, damaged area, such as a joint. This prevents increased damage happening at the joint and decreases pain; often take several weeks for onset of action; can have more toxic adverse effects than NSAIDs

sirolimus (Rapamune)

inhibits T-cell activation by binding to an intracellular protein which prevents cellular proliferation; used for the prevention of organ rejection in kidney transplants

tacrolimus (Advagraf; Prograf)

inhibits T-cell synthesis; used for the prevention of organ rejection in liver, kidney, and heart transplants as well as for autoimmune diseases and severe psoriasis

ciclosporin (Sandimmune; Neoral; Cyclosporine)

inhibits the release of the cytokines; used for the prevention of rejection of bone marrow transplantation as well as rheumatoid arthritis and psoriasis; adheres to Styrofoam and cannot be given with St. John's Wort or grapefruit juice

Dilated Cardiomyopathy

most common type of Cardiomyopathy; when the heart chambers dilate and ventricular contraction is impaired; EF is significantly reduced; scarring and atrophy of myocardial cells is evident; atrial enlargement also occurs and blood becomes static in the ventricles

Class I HF

no limitations of physical activity; physical activity does not cause fatigue; palpitations; dyspnea

Tricuspid Valve Stenosis

occurs almost exclusively in patients with rheumatic mitral stenosis, IV drug users, or those treated with dopamine agonists; results in right atrial enlargement, increased systemic venous pressure, and severe JVD

Mitral Valve Regurgitation

occurs if there is damage to the heart wall that supports the valve resulting in its ability to close properly; caused by MI, rheumatic heart disease, mitral valve prolapse, or infective endocarditis

Manifestations of Acute Decompensated HF (ADHF)

orthopnea, dyspnea, tachypnea, use of accessory muscles, cyanosis, cool + clammy skin, cough w/ frothy blood-tinged sputum, breath sounds, tachycardia, hypotension or hypertension (depending on the stage)

Nursing Interventions for Rheumatoid Arthritis

pain management, nutritional therapy, maintenance of joint function, self care, care during joint replacement

Nursing Interventions for Juvenile Idiopathic Arthritis

pain management, promote general health, facilitate treatment compliance, encourage heat to joints and exercise, support child and their family through treatment

Nursing Interventions for AIDS

prevention, nutritional support, rest + exercise (balance), avoid exposure to infections, reposition if needed to minimize skin breakdown, provide emotional and spiritual support

mycophenolate mofetil (CellCept)

prevents proliferation of T-cells by inhibiting intracellular purine synthesis; used for the prevention of organ rejection in kidney, liver, and heart transplants

Diagnosis of Diastolic HF

pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, and a normal EF (which eliminates the possibility of systolic HF)

Aortic Valve Regurgitation

regurgitation of blood flow from the ascending aorta back into the left ventricle resulting in volume overload; left ventricle initially compensates through dilation and hypertrophy; will lead to pulmonary hypertension and right ventricular failure

B-Type Natriuretic Peptide (BNP)

released in response to increased left ventricular pressure; causes systemic vasodilation which decreases preload and afterload

Atrial Natriuretic Peptide (ANP)

released in response to increases in atrial pressure and causes systemic vasodilation to decrease preload and afterload

Pulmonic Valve Stenosis

results in the backflow of blood from the right ventricle; almost always congenital; causes right ventricle hypertension and hypertrophy

Class II HF

slight limitation of physical activity; comfortable at rest; ordinary physical activity causes fatigue; palpitations; dyspnea

Symptoms of Venous Thromboembolism

tenderness to pressure over the involved vein, edema, may have mild-moderate pain, deep reddish color to area caused by venous congestion

Mitral Valve Stenosis

thickening and shortening of the mitral valves strictures that results in a chronic increase in left atrial pressure and volume; causes hypertrophy of pulmonary vessels; may be caused by infection or trauma that damages the valves of the heart

Manifestations of Mitral Valve Regurgitation

thread peripheral pulses, cool + clammy extremities, weakness, fatigue, palpitations, gradually progressive dyspnea

Class IV HF

unable to carry on any physical activity without discomfort; symptoms of HF at rest; if any physical activity is undertaken, discomfort increases

Methotrexate

usually used for cancer treatment but in small doses can be used as an immunosuppressant for juvenile idiopathic arthritis

Valvular Regurgitation Disease

when the valve leaflets do not close completely; results in the backflow of blood

Describe the 2 aspects of the viral infection (HIV)

1. All daughter cells will have infection 2. Infected cell will take over cell function to replicate more infected cells

What drugs are used to treat peripheral artery disease?

Antiplatelets (Aspirin, Clopidgrel/Plavix), Cilostazol (Pletal, reduces pain associated with claudication) Pentoxifylline (Trental, increases RBC flexibility so that the cells can squeeze through narrowed arteries)

T cytotoxic cells

Attack antigens on the cell membrane

What is mitral valve regurgitation?

Backflow of blood into the left atrium

What drugs are used to prevent organ transplantation? Monoclonal Antibodies or Polyclonal Antibodies

Basiliximab

How do we treat COPD? Inhaled Cortiocosteroids

Beclomethasone/Qvar, Budesonide/Pulmicort, Fluticasone/Flovent - Anti-inflammatory, increase responsiveness of smooth muscle to increase effect of beta adrenergic agonists

What are adverse effects of Dixogin?

Bradycardia, hypotension, headache, confusion, fatigue, colored vision, halo vision, anorexia, convulsions, nausea, vomiting, diarrhea

What are clinical manifestations of chronic venous insufficiency?

Brownish-leathery skin, edema, tissue oozing, venous leg ulcer

Symptoms of SLE

Butterfly rash on the face, weight loss, symmetric polyarthritis, increased bone density loss, discoid lesions (raised, scaly, circular lesions), pericarditis, nephritis (in 50% of patients), memory loss, anemia, and increased risk for infection

Provide examples for chemical pnuemoitis, hypersensitivity penumoitis, and occupational asthma

C - Nitrous oxide fumes H - Moldy hay O - Coal miners

A patient with active HIV has been taking zidovudine (Retrovir). Which potential adverse effect may limit the length of time this medication can be taken? A) Lactic acidosis B) Hepatomegaly C) Bone marrow suppression D) Fatigue

C) Bone marrow suppression Rationale: bone marrow suppression is when there is a decrease in the production of leukocytes, RBCs, and thrombocytes. These decreases can be detrimental for HIV patients

C) Bone marrow suppression Rationale: bone marrow suppression is when there is a decrease in the production of leukocytes, RBCs, and thrombocytes. These decreases can detrimental for HIV patients

To help a patient with severe COPD decide about the use of home oxygen, you inform him that its use may: A) Help prevent infection that lead to exacerbation of his COPD B) Facilitate coughing and deep breathing to remove his copious secretions C) Improve his exercise intolerance, well-being and prevent heart failure D) Prevent the bronchospasm associated with chronic bronchial inflammation

C) Improve his exercise intolerance, well-being, and prevent heart failure

The nurse reviews pursed-lip breathing with a patient newly diagnosed with COPD. The nurse reinforces that this technique with assist respiration by which of the following mechanisms? A) Loosening secretions so that they may be coughed up more easily B) Promoting maximal inhalation for better oxygenation of the lungs C) Preventing bronchial collapse and air trapping in the lungs during exhalation D) Increasing the respiratory rate and giving the patient control of respiratory patterns

C) Preventing bronchial collapse and air trapping in the lungs during exhalation Rationale: Pursed-lip breathing helps to create back-pressure in the lungs forcing the alveoli to stay open

Which action by the occupational health nurses at a manufacturing plant where there is potential exposure to inhaled dust will be most helpful in reducing incidence of lung disease? A) Teach about symptoms of lung disease B) monitor workers for shortness of breath C) Require the use of protective equipment D) Treat workers who inhale dust particles

C) Require the use of protective equipment Rationale: Teaching about symptoms, monitoring for symptoms, and treating workers who have inhaled dust are secondary interventions focused ensuring that the condition doesn't get worse. While requiring the use of protective equipment is a primary intervention focuses on prevent illness from happening in the first place

A patient's ABG results are as followed. You recognize that these findings indicate what? Ph=7.31 PaO2=68mmHg PaCO2=58mmHg HCO3=32mEq/L SaO2=85% A) Metabolic acidosis B) Hypoxemia C) Respiration acidosis D) Respiratory insufficiency

C) Respiratory acidosis

A patient who had a kidney transplant is receiving cyclosporine orally in maintenance doses. What action would decrease the potency of this medication? A) taking it with orange juice B) mixing it with chocolate milk C) using a Styrofoam container to administer it D) using a clear plastic container to administer it

C) using a Styrofoam container to administer it Rationale: Cyclosporin adheres to Styrofoam, therefore if the medication is given in a Styrofoam container it could prevent the patient from getting the full dose of the medication

A hospitalized patient has an order for Ketorolac (Toradol). The nurse notes that the order is only for 5 days. What is the reason for this? A. The patient's pain should subside by that time B. There are concerns about addication to the drug C. The medication can cause severe kidney and GI effects D. The medication loses effectiveness over time

A patient is being discharged on cyclosporine therapy. Which statement by the patient indicates that more teaching is needed? A. "I will take the cyclosporine tablet with water" B. "I will take the cyclosporine tablet with milk." C. "I will take the cyclosporine tablet with grapefruit juice" D. "I will take the cyclosporine tablet with apple juice"

A patient is receiving Digoxin 0.25mg/day as part of treatment for heart failure. The nurse assess the patient before administering medication. Which assessment finding would be of most concern? A. Apical heart rate of 62 bpm B. Ankle edema +1 bilaterally C. Serum potassium level of 2.9 D. Serum digoxin level of 0.8

A patient who had a kidney transplant is receiving cyclosporine orally in maintenance doses. What action would decrease the potency of this medication? A. Taking it with orange juice B. Taking it with orange juice C. Using a styrofoam container to administer it D. Mixing it with chocolate milk

A patient with a history of heart failure presents with emergency department with difficulty breathing, cough, and edema of the lower extremities. The nurse anticipates the administration of which type of medication? A. Positive chronotropic B. Negative chronotropic C. Positive inotropic D. Negative inotropic

The nurse notes an order for the patient to receive an IV dose of methlyprednisone prior to administration of basiliximab. The nurse understands the rationale for this therapy is: A. Decreased pain at infusion site B. Enhanced supression of the immune system C. Prevention of cytokine release syndrome

The nurse reviews pursed lip breathing with a patient newly diagnosed with COPD. The nurse reinforces that this technique will assist respiration by which of the following mechanisms? A. Loosening secretions so that they may be coughed up more easily B. Promoting maximal inhalation for better oxygenation of the lungs C. Preventing bronchial collapse and air trapping in the lungs during exhalation D. Increasing the respiratory rate and giving the patient control of respiratory patterns

The patient is prescribed an ACE inhibitor. The nurse understands the primary mechanism of action is? A. To inhibit catecholamine release B. To inhibit acetylcholine release C. To inhibit aldosterone release D. To prevent vagal stimulation

HIV Diagnostic studies

CD4 T-cell count; CD4 fraction; viral load (the amount of active virus in the blood stream); resistance tests; test for neutropenia (decreased neutrophils), thrombocytopenia (decreased platelets), and anemia (decreased RBCs); altered liver function tests

Late chronic HIV (AIDS)

CD4 count <200; possibility for malignancies, wasting, and dementia; high risk for opportunistic diseases such as pneumonia, cryptococcal meningitis, retinitis, Mycobacterium ovium complex, Kaposi's sarcoma, or influenza virus which could be fatal to the pt.

Early chronic HIV

CD4 count >500; viral load low in blood

Why do we use vasodilators to treat heart failure?

Can slow progression of ventricular dysfunction when started early, helps decrease hypertrophy of heart, increases venous capacity

What is important education when taking Isoniazid?

Causes tears and urine to turn red, encourage patients to not use contact lenses as the redness will stain the contacts, also interferes with oral contraception

What are adverse effects of ARBs?

Chest pain and hypoglycemia

What is COPD?

Chronic Obstructive Pulmonary Disease - Progressive disease that causes airflow limitations (air trapping) due to loss of elastic recoil, airflow obstruction due to mucus hypersecretion, mucosal edema, and bronchospasm, parenchyma are destroyed (areas were gas exchange occurs), bronchioles collapse (causing barrel-chest), blood vessels thicken, dysfunction of cilia, hyperinflation of lungs, gas exchange abnormalities (respiratory acidosis due to high PaCO2)

Rheumatoid Arthritis (RA)

Chronic inflammation of connective tissue, primarily in the synovial joints; included periods of remission and periods of flare-ups; presence of abnormal IgG combined with rheumatoid factors deposited in the joints results in the destruction of cartilage and parts of the bone

What is Sarcoidosis?

Chronic, multisystem granulomatous disease of unknown cause that affects primarily the lungs

Answer: 2) Cardioversion is used if the patient is unstable. Anticoagulants are used if the arrhythmia has stuck around for 48 hr +. Adenosine may be used with a narrow QRS and regular RR interval. I made up Altemose.

A nursing student is aware that which of the following is the treatment for unstable atrial flutter? 1) Adenosine (Adenocard) 6 mg rapid IVP. 2) Cardioversion with adjacent Heparin therapy 3) Defibrillation STAT followed by CPR. 4) Altemose 3 mg IVP over 1-2 seconds.

Human Immunodeficiency Virus (HIV)

A virus that infects and destroys CD4 cells which when infected only have a life span of 2 days as opposed to 100 days; has to be within the cell in order to duplicate and all daughter cells are infected as well; eventually leads to AIDS once the body can no longer regenerate CD4 cells fast enough to keep up with the cells that are dying; most often transmitted by blood/blood products, homosexual/heterosexual activity, or through maternal-infant transfer

Describe Human Immunodeficiency Virus (HIV)

A virus that infects the Helper T Cells of the immune system (specifically the Helper T Cells with CD4 receptors) creating an immunodeficiency

A 28-year-old woman who has MS asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? A) "MS symptoms may be worse after the pregnancy." B) "Women with MS frequently have premature labor." C) "Symptoms of MS are likely to become worse during pregnancy." D) "MS is associated with a slightly increased risk for congenital defects."

A) "MS symptoms may be worse after the pregnancy."

The nurse in the emergency department receives ABG results for four recently admitted patients with COPD. Which patient will require the most rapid action by the nurse? A) 20-year-old with pH = 7.28; PaCO2 = 60 mmHg; PaO2 = 58 mmHg B) 40-year- old with pH = 7.34; PaPO2 = 33 mmHg; PaO2 = 80 mmHg C) 64-year-old with pH = 7.31; PaCO2 = 58 mmHg; PaO2 = 64 mmHg D) 32-year-old with pH = 7.50; PaCO2 = 30 mmHg; PaO2 = 65 mmHg

A) 20-year-old with pH = 7.28; PaCO2 = 60 mmHg; PaO2 = 58 mmHg Rationale: Normal ranges for pH, PaCO2, and PaO2 are 7.35-7.45, 40-60 mmHg, and 80-100 mmHg respectively. Therefore the 20-year-old is the furthest out of the normal ranges

The diet that will ordered for a patient with severe COPD and respiratory acidosis to best meet their nutritional needs is a: A) High-calorie, high-protein diet B) Low-fat diet with six small feedings a day C) High-calorie, high-carbohydrate, bland diet D) Regular diet with extra fluids to be taken with meals

A) High-calorie, high-protein diet

Based on the following ABGs, select two interventions with the highest priority Ph=7.31 PaO2=68mmHg PaCO2=58mmHg HCO3=32mEq/L SaO2=85% A) Increase the oxygen rate to 4 L/min after getting MD order B) Assist the patient into a position of comfort C) Teach the patient to use relaxation techniques D) Encourage the patient to take deep breaths and cough, and use pursed-lip breathing

A) Increase the oxygen rate to 4 L/min after getting MD order And D) Encourage the patient to take deep breaths and cough, and use pursed-lip breathing

To evaluate the effectiveness of therapy for a patient with cor pulmonale, the nurse will monitor the patient for: A) Jugular vein distension B) Elevated temperature C) Clubbing of the fingers D) Complaints of chest pain

A) Jugular vein distension

Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment? A) Pulse oximetry reading of 94% B) Absence of wheezes or crackles C) Respiratory rate of 22 breats/minute D) Decreased use of accessory muscles

A) Pulse oximetry reading of 94%

How does rheumatoid arthritis develop?

Abnormal IgG antibodies bind with rheumatoid factor and get deposited on connective tissue of synovial joints. This causes an increase in inflammation and the abnormal combination destroy the cartilage between the joints which gets replaced with granulation tissue. This granulation tissue then eats away at the bone.

What is heart failure?

Abnormal condition involving the pumping or filling action of the heart. Results in inadequate cardiac output to meet metabolic needs

How do we treat COPD? Mucolytics

Acetylcysteine/Mucomist - used to reduce sputum viscosity to improve airway clearance, administer bronchodilator prior to administering Mucomist to ensure efficacy

What medications treat hypertension?

Adrenergic drugs - Beta Blockers (Metoprolol/Lopressor, Propanolol/Inderal), Doxasin, Clonidine/Catapres Angiotensin-converting enzyme (ACE) inhibitors - Catopril/Capoten, Enalapril/Vasotec, Ramipril/Altase Angiotensin II receptor blockers (ARBs) - Lostartan/Cozaar, Valsartan/Diovan Calcium channel blockers - Amilodipine/Norvasc, Verapimil/Isoptin Diuretics - Lasix/Fureosmide, Spironolactdone/Aldactone, Acetazolamide/Acetazolame, Hydrochlorothiazide, Urozide Vasodilators - Sodium Nitroprusside, Nitroglycerin Direct renin inhibitors

What are nursing considerations for immunosupressant therapy?

Adverse Effects - Opportunistic infections (monitor WBC count and vital signs) Cyclosporin adheres to Styrofoam - must mix in glass container Can cause hypertension, nephrotoxicity Monoclonal antibodies may cause flu-like symptoms due to release of interleukins (aching joints) St. John's Wart and Grapefruit juice should be avoided Avoid live vaccines (Measles Mumps Rubella vaccine, Varicella and Shingles vaccine, Yellow fever vaccine)

What are second line drugs to treat tuberculosis?

Amkiacin Sulphate, Levofloxacin hemihydrate, Moxifloxacin hydrochloride

What is an autoimmune disease?

An autoimmune disease is where the immune system attacks the body (auto meaning self)

Diagnostic Studies for SLE

Anti-smith antibodies (more specific for condition), Presence of Antinuclear Antibodies (ANA) (not diagnostic for just this condition); titre for anti-double stranded DNA antibodies; elevated ESR and CRP (used to monitor not diagnose); persistent proteinuria

Which information about a patient who has a recent history of TB indicates that the nurse can discontinue airborne isolation precautions? A) TB mediations have been taken for 6 months B) Chest X-ray shows no upper lobe infiltrates C) Mantoux testing shows an induration of 10mm D) Three sputum smears for acid-fast bacilli are negative

D) Three sputum smears for acid-fast bacilli are negative Rationale: it takes a minimum of three negative sputum smears to ensure that the patient no longer has active TB infection

A patient who has chronic heart failure tells the nurse, "I felt find when I went to bed, but I work up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment information as: A) Two-pillow orthopnea B) Pulsus alternans C) acute bilateral pleural effusion D) paroxysmal nocturnal dyspnea

Which of the following statements made by a patient with COPD indicates a need for further teaching regarding the use of an Ipratropium inhaler? A. "I should rinse my mouth following the two puffs to get rid of the bad taste" B. "I should wait at least one to two minutes between each puff of the inhaler" C. "Because this medication is not fast acting, I cannot use it in an emergency if my breathing gets worse" D. "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily"

What are clinical manifestations of chronic heart failure?

Fatigue, exercise intolerance, dyspnea, orthopnea (must sit up to breathe), paraoxysmal nocturnal dyspnea, tachycardia, tachypnea, chest pain, edema, restlessness, anxiety, cyanosis or pale/grey skin, crackles or wheezes, ascites, persistent dry cough, frothy-pink sputum (from pulmonary edema), nausea, vomiting, decreased oxygen saturation, confusion, JVD, heptamegaly, splenomegaly, decreased urine output (kidney failure), weak palpable pulses

What are clinical manifestations of restrictive cardiomyopathy?

Fatigue, exercise tolerance, dyspnea, angina, orthopnea, syncope, edema, ascites, hepatomegaly, jugular venous distention (JVD)

What are adverse effects of anti-retroviral drugs?

GI symptoms (nausea and vomiting), fatigue, lack of energy, osteoporosis, Protease Inhibitors -(hypertriglyceridemia, insulin resistance, lipodysyophy (fat deposition)), Ritonavir - (pancreatitis, serious liver problems, jaundice), Zidovudine - (bone marrow suppression)

What are clinical manifestations of tuberculosis?

Hemoptysis, fatigue, malaise, anorexia, cough, weight loss, low grade fevers, night sweats

How do we diagnose a valvular disease?

History and Physical, Echocardiogram, ECG, Lab studies (cardiac markers, BNP, liver and renal function), cardiac catheterization

How do we diagnosed SLE?

History and physical (for butterfly rash, photosensitivty, or oral ulcers), Presence of Anti-Nuclear antibodies and Anti-smith antibodies, Persistent proteinuria, Elevated ESR and CRP (not diagnostic but used to monitor progression of disease), Hemolytic abnormalities (Leukopenia, Thrombocytopenia, Anemia etc).

How do we diagnosed rheumatoid arthritis?

History and physical, X-rays (not diagnostic until later stages), Rheumatoid Factor (found in 80% of cases), Bone scans, Elevated ESR and CRP, Synovial Fluid (elevated WBCs and MMP-3 increase)

What is a superficial venous thrombosis?

Inflammation and clot formation at an IV site

What are the four goals of ART/HAART drug therapy?

Decrease viral load, Maintain or raise CD4 cell count, Delay the development of HIV/AIDs related symptoms and opportunistic diseases, and Prevent transmission

S+S of Left-Sided HF

Decreased CO, activity intolerance, signs of decreased tissue perfusion, pulmonary edema, cyanosis, signs of hypoxia, orthopnea, cough w/ frothy sputum, paroxysmal nocturnal dyspnea

What is bronchiectasis?

Destruction of the elastic and muscular bronchial wall via bacterial infection causing pockets of pus to develop within the bronchial walls causing long-term damage

Symptoms of Aortic Rupture

Diaphoresis, weakness, hypotension, tachycardia, abdominal, back, groin, or periumbilical pain, changes in LOC, pulsating abdominal mass, quality and character of peripheral pulses

What are examples of NSAIDs?

Diclofenac (Voltaren), Ibuprofen (Advil), Naproxen (Aleve), Aspirin (ASA), Ketoralac (Toradol),

What drugs are used to treat heart failure? Cardiac Glycosides

Digoxin - positive inotropic effect, changes electrical conductivity of the heart to slow the heart rate - increases stroke volume, allows for greater filling, negative chronotropic effect

False Aneurysm

Disruption of all layers of the arterial wall but bleeding is contained by other structures or blood clots

What is important education when taking Isoniazid?

Drug is metabolized in the liver and can cause liver toxicity. Important to call doctor if passing clay colored stools or dark colored urine as this is indicative of liver failure.

How do we diagnosed pericarditis?

ECG (will see widespread ST elevation), Echocardiogram, CT scan, MRI, Chest x-ray

Differentiate between early, intermediate, and late HIV infection

Early - Viral load is low, CD4 count is greater than 500 (normal count is 800-1000) Intermediate - Viral load rises, CD4 count 200-500, Active Infection - chronic fatigue, persistent fever, chronic diarrhea, severe night sweats, most common infection in this stage is Oral candida/Thrush (other infections include Oral Hairy Leukoplakia, Shingles, Persistant vaginal yeast infections, Herpes, and Kaposi's Sarcoma) Late - CD4 count less than 200, severe immunodeficiency - diagnosed as AIDS

What are clinical manifestations of cystic fibrosis?

Early - failure to grow, clubbing, persistent cough, tachypnea, large, frequent bowl movements (oily or greasy), large, protuberant abdomen with emaciated appearance of extremities Late - Exacerbations of ↑ cough, Weight loss, ↑ Sputum, ↓ In pulmonary function

What are clinical manifestations of head and neck cancer?

Early - painless growth, unilateral sore throat, ear pain, change in voice quality, lump in neck Late - increase in pain, decreased movement of tongue, difficulty swallowing, nerve neuropathies, leukoplakia (white patches on tongue), erythroplakia (red patches on tongue)

How do we diagnose myocarditis?

Echocardiogram, Endomyocardial Biopsy (most diagnostic), CT scan, MRI, ECG (dysrhythmias), Elevated CRP, ESR, and Troponin

What is cor pulmonale?

Enlargement of the right ventricle caused by secondary disease (most commonly COPD)

Differentiate between latent TB and active TB

Latent - Virus is encapsulated in lungs by the immune system, not causing active infection and is not capable of transmission Active - Virus is causing infection in body and is capable of transmission

Chronic Constrictive Pericarditis

Loss of elasticity of the pericardial sac due to fibrosis and scarring which impairs the ability of the atria and ventricles to stretch and fill with blood during diastole

What is chronic constrictive pericarditis?

Loss of elasticity of the pericardial sac due to scarring and the thickened pericardium encases the heart and impairs the ability of the atria and ventricles to stretch during diastole

Monoclonal Antibodies

Majority end in "-mab";

What is hypertrophic cardiomyopathy?

Massive ventricular hypertrophy that results in a rapid, forceful ventricular contraction and impaired relaxation and filling

How does cystic fibrosis affect the lungs?

Mucus sticks onto the luemen walls of the lungs and cause fibrosis (thickening) and chronic pulmonary disorder Progressive loss of lung tissue from inflammation and scarring - resultant chronic hypoxia leads to pulmonary hypertension and cor pulmonale

Differentiate between inotropic, chronotropic, and dromotropic

Inotropic - contractility Chronotropic - heart rate Dromotropic - conduction system

Chronic transplant rejection

Occurs 4 months to 3 years after the transplant; most likely antibody-mediated response but may also involve inflammatory damage to vessel endothelium; retransplant would be required

Acute transplant rejection

Occurs within days to months after the transplant; signs of inflammation and impaired organ function occurs; mediated by T-cytotoxic lymphocytes in response to HLA antigens

Drug Therapy for SLE

NSAIDS (anti-inflammatory response), corticosteroids (anti-inflammatory), immunosuppressive drugs (used as a final line of defence to stop the body from attacking itself)

How do we treat SLE?

NSAIDs (Advil/Ibuprofen, Aspirin) Hydroxyhloroquine (Plaquenil) - antibiotic for malaria Corticosteroids (Demexamethasone, Prednisone, Hydrocortisone) Immunosuppresive Drugs - last resort

What is aortic stenosis?

Narrowing of the aorta

What are clinical manifestations of dilated cardiomyopathy?

Poor exercise tolerance, Dyspnea, paroxysmal nocturnal dyspnea, orthopnea, Cough, abdominal bloating, anorexia, Dysrhythmias, Pulmonary crackles, hepatomegaly, jugular venous distention

What are anti-retroviral drugs? Integrase Inhibitors

Raltegravir

Answer: d) We cannot defibrillate asystole. A

The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? a) Administer atropine 0.5 mg b) Administer epinephrine c) Defibrillate with 360 joules d) Begin cardiopulmonary resuscitation (CPR)

Answer: A, B, and D. Adenosine is administered as a very quick IV push. The physician must be present in the room and the crash cart must be on hand. An ekg monitor should be in the room to monitor the effectiveness of the medication.

The nurse is preparing to administer adenosine to the patient with the following rhythm which is symptomatic. What should the nurse plan on having in the patient room? a) Physician b) Crash cart c) IV pump d) EKG monitor e) Lidocaine

Answer: A, C, D, and E. A cellphone should not be used near the pacemaker and it's best to keep the phone about half a foot away from the pacemaker. It is not necessary for the client to avoid using a microwave or other electrical devices. However, magnets should be kept away from the device. In order to prevent disruption of the leads after implantation (the most common complication), patients are often taught to limit activity on the affected side for awhile after implantation. Pulses are a good indicator of whether the pacemaker is supplying the body with enough cardiac output.

The nurse is providing discharge teaching to the client who has just received a pacemaker. Which of the following should the nurse include in the plan of care? SATA: A) Use your cell phone on the opposite side of your pacemaker B) You should avoid using a microwave from now on C) For the next week, it would be best to limit activity on the side with your new pacemaker D) You will need to inform airport security about your pacemaker before you fly anywhere E) It would be a good idea to check your pulse daily

Answer: C. Anemia can contribute to sinus tachycardia.

The nurse sees the following rhythm on the monitor. Which of the following lab values does the nurse identify as being most likely to have caused this dysrhythmia? a) K 3.0 b) Ca 10.5 c) Hgb 9 d) Magnesium 2.1

Differentiate between a true and false aneurysm

True - wall of artery forms the aneurysms and at least one layer of vessel is still intact (outpouching) False - aneurysm has burst (involving all three layers) but a clot has formed and bleeding is contained

Pulmonary Edema

When fluid moves from the vascular space into the interstitial space between the alveoli and the pulmonary capillaries then eventually from the interstitial space into the alveoli as condition worsens. This shift in fluid impairs the surface area of tissue that is able to undergo oxygen-CO2 exchange

Anti-Retroviral Therapy (ART)

administered to individuals with active HIV infection, health care workers who have had needle stick injuries, infected mothers prior to birth, and high risk infants

Manifestations of Aortic Valve Stenosis

angina, syncope (related to decreased blood flow to the brain), exertional dyspnea, normal S1, diminished or absent S2, prominent S4

Antimetabolite-Folic acid

antagonism/antirheumatic/immunosuppressant; inhibits lymphocyte multiplication which has an immunosuppressive effect; in low doses they are used for their immunosuppressant and anti-inflammatory properties

Nitric Oxide (NO)

causes vasodilation so the blood does not build up in the heart or lungs

Common Complications of HF

pleural effusion (extra fluid around the lungs); A-fib; increased risk of sudden cardiac death or ventricular tachycardia; severe hepatomegaly (enlargement of the liver)

Corticosteroids

reduce the release of interleukin-1 which decreases the permeability of capillaries and decreases the migration of WBCs; promote the breakdown of proteins, the production of glycogen, and the redistribution of fat; need to be tapered off of, not discontinued abruptly

Natural killer cells

Responsible for killing tumor and cancer cells

What drugs are used to prevent organ transplantation? Mammalian target of rapamycin (mTOR) inhibitors

Sirolimus (Rapamune®)

What is restrictive cardiomyopathy?

Stiffening of the ventricular muscles that impairs diastolic filling and stretch

How do we diagnose cystic fibrosis?

Sweat chloride test, duodenoscopy (for pancreas), amniocentesis, chorionic villia testing, genetic test, chest x-ray, pulmonary function tests, fecal analysis for fat

What are anti-retroviral drugs? Reverse Transcriptase Inhibitors (RTIs) - Nucleotide Reverse Transcriptase Inhibitors (NTRTIs)

Tenofovir (Viread)

Aortic Dissection

The creation of false lumen between the intima and media of the vessel walls, this separation of the two layers of the vessel is where blood begins to pool

Humoral Immunity

Antibody-mediated immunity produced by plasma cells in response to antigens; primary response occurs 4-8 days after initial exposure but is faster when the body is exposed to the same antigen a second time (1-3 days) and the response lasts longer due to the reaction and activation of memory cells

What is head and neck cancer?

Arises from mucosal surfaces and causes tumors of paranasal sinuses, oral cavity, nasopharynx, oropharynx, and larynx Disfigurement is severe

What is peripheral artery disease?

Atherosclerosis of the peripheral arteries that causing narrowing or stenosis that impedes blood flow to the area

What is dilated cardiomyopathy?

Atrial and ventricular chamber enlargement that impairs systolic ejection

Differentiate between autografts, allografts, and xenografts

Autografts - are from host (ex. skin grafts, bone marrow, or blood) Allografts - are from living or cadaver donors Xenografts - from other species (ex. pig heart valve)

A patient has an extremely severe infection with a Mycobacterium that is resistant to all but one antitubercular drug; however, the patient had an allergic reaction to that medication in the past. What does the nurse anticipate being ordered for this patient? A) A combination of antitubercular drugs will be chosen to fight the infection B) Drug and supportive care will be provided to help the patient tolerate the antitubercular therapy C) The patient will remain under isolation precautions until the cough clears D) There is nothing that can be done for this patient

B) Drug and supportive care will be provided to help the patient tolerate the antitubercular therapy

When caring for a patient with COPD, the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 14kg. Which of the following would be an appropriate intervention to add to the plan of care for this patient? A) Order fruits and vegetables to be offered between meals B) Order a high-calorie, high-protein diet with five-six small meals a day C) Treat the patient to use frozen microwave meals at home that can be microwaved D) Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet

B) Order a high-calorie, high-protein diet with five-six small meals a day

Which diagnostic test will the nurse plan to discuss with a 54-year-old patient with progressively increasing dyspnea who is being evaluated for a possible diagnosis of COPD? A) Eosinophil count B) Pulmonary function testing C) Echocardiogram D) Immunoglobulin E (IgE) levels

B) Pulmonary function test

When developing a plan of care for a hospitalized patient with moderate dementia, which intervention will the nurse include? A) Provide complete personal hygiene care for the patient B) Remind the patient frequently about being in the hospital C) Reposition the patient frequently to avoid skin breakdown D) Place suction at the bedside to decrease the risk of aspiration

B) Remind the patient frequently about being in the hospital

The nurse is taking a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC), Which information obtained by the nurse is most relevant? A) The patient reports using cocaine twice at the age of 16 B) The patient's 29-year-old brother has had a sudden cardiac arrest C) The patient has family history of CAD D) The patient has a history of a recent upper respiratory infection

B) The patient's 29-year-old brother has had a sudden cardiac arrest

During assessment of a 72-year-old with ankle swelling, the nurse notes JVD with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates: A) jugular vein atherosclerosis B) elevated right atrial pressure C) decreased fluid volume D) incompetent jugular vein valves

B) elevated right atrial pressure

A 40-year-old patient seen in the clinic has been newly diagnosed with RA. Which medication does the nurse anticipate being ordered for the patient? A) adalimumab B) methotrexate C) infliximab D) etanercept

B) methotrexate Rationale: methotrexate is an DMARD that inhibits lymphocyte multiplication which provides an anti-inflammatory effect

When teaching a patient with myasthenia gravis (MG) about management of the disease, the nurse advises the patient to: A) anticipate the need for weekly plasmapheresis treatments B) perform physically demanding activities in the morning C) do frequent weight-bearing exercise to prevent muscle atrophy D) protect the extremities from injury due to poor sensory perception

B) perform physically demanding activities in the morning

A patient is taking a B-blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the B-blocker for this patient is to do which of the following? A) increase urine output B) prevent stimulation of the heart by catecholamines C) increase the contractility of the heart muscle D) cause peripheral vasodilation

B) prevent stimulation of the heart by catecholamines

The nurse notes an order for the patient to receive an IV dose of methylprednisolone prior to administration of basiliximab. The nurse understands the rationale for this therapy is: A) decreased pain at infusion site B) prevention of cytokine release syndrome C) enhanced suppression of the immune system D) enhanced suppression of circulatory system

B) prevention of cytokine release syndrome Rationale: due to the fact that this patient is on basiliximab, it can be assumed that this patient is about to receive a organ transplant. basiliximab is an immunosuppressant used to prevent organ transplant rejection. Cytokines are responsible for recruiting cells to sites of trauma (such as the trauma caused by an organ transplant surgery) and elicits an immune response to the trauma. methylprednisolone is a corticosteroid that inhibits inflammatory cytokines therefore decreasing the body's inflammatory response to the transplant surgery

A patient receiving digoxin 0.25 mg/day as part of treatment for heart failure. The nurse assesses the patient before administering medication. Which assessment finding would be of most concern? A) Ankle edema +1 bilaterally B) serum potassium level of 2.9 mmol/L C) apical heart rate of 62 beats/min D) serum digoxin level of 0.8 ng/ml

B) serum potassium level of 2.9 mmol/L

B) the patient's 29-year-old brother has had a sudden cardiac arrest

A patient has an extremly severe infection with a Mycobacterium that is resistant to all but one anti-tuberculin drug. However, the patient had an allergic reaction to that medication in the past. What does the nurse anticipate being ordered for this patient? A. A combination of anti-tuberculin drugs will be chosen to fight the infection B. Drug and supportive care will be provided to help the patient tolerate anti-tuberculin therapy C. The patient will remain under isolation precautions until the cough clears D. There is nothing that can be done for this patient

A patient is taking a Beta Blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the Beta Blocker for this patient is to do which of the following? A. Increase urine output B. Prevent stimulation of the heart by catecholamines C. Increase the contractility of the heart muscle D. Cause peripheral vasodilation

The patient's wife is taking Rifampin to prevent her from developing a TB infection. Which statement by the wife indicates that further teaching is needed? A. "Because my oral contraceptives will not work while I am taking Rifampin, I will use another form of birth control" B. "I will take the medication for 1 week and then stop" C. "I will avoid prolonged exposure to the sun" D. "My urine may turn a reddish color when taking Rifampin"

When caring for a patient with COPD, the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 14kg. Which of the following would be an appropriate intervention to add to the plan of care for this patient? A. Order fruits and fruit juice to be offered between meals B. Order a high calorie, high protein diet with five or six meals a day C. Teach the patient to use frozen meals at home that can be microwaved D. Provide a high calorie, high carbohydrate nonirritating frequent feeding diet

When teaching a patient about signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for which of the following? A. Visual changes such as photophobia B. Flickering lights or halos around lights C. Dizziness when standing up D. Increased urine output

Which potential problem is of most concern for a patient recieivng immunosuppresant drugs? A. Orthostatic hypotension B. Increased suscpectibility to infections C. Neurotoxicity D. Confusion

What is tuberculosis?

Bacterial infection of the lungs, spread via airbone droplets

What are nursing management strategies for heart failure?

Baseline objective and subjective history and physical (including vital signs), assess apical pulse against radial pulse (to determine perfusion), daily weights, monitor for therapeutic effects (increase in activity tolerance, clear lung sounds, decreased edema, palpable pedal pulses, increased cap refill), monitor electrolytes, monitor renal and liver ezymes (creatinine, estimated GFR, BUN, AST, ALP, ASP), patient education (monitor weight daily - 1kg in 24hours or 2kg a week), monitor BP and HR prior to medication administration), monitor for signs of toxicity), nutritional therapy (sodium restriction)

Stage IV RA - Terminal

Bony anklyosis (occurs when the joints fuse together due to the loss of cartilage rending joints immobile)

A patient is being discharged on cyclosporine therapy. Which statement by the patient indicates that more teaching is needed? A) "I will take the cyclosporine with water." B) "I will take the cyclosporine with apple juice." C) "I will take the cyclosporine with grapefruit juice." D) "I will take the cyclosporine with milk."

C) "I will take the cyclosporine with grapefruit juice." Rationale: grapefruit and cyclosporine are broken down by the same enzyme. The presence of grapefruit therefore effects the breakdown of cyclosporine, increasing the amount of the medication available in the bloodstream by 20-200%. This can cause medication toxicity

When teaching the children of a patient who is being evaluated for Alzheimer's Disease (AD) about the disorder, the nurse explains that: A) The most important risk factor for AD is a family history of the disorder B) New drugs have been shown to reverse AD dramatically in some patients C) A diagnosis of AD can be made only when other causes of dementia have been ruled out D) The presence of brain atrophy detected by MRI confirms the diagnosis of AD in patients with dementia

C) A diagnosis of AD can be made only when other causes of dementia have been ruled out

A patient with amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? A) Observe for agitation and paranoia B) Give muscle relaxants as needed to reduce spasms C) Assist with active range of motion D) Use simple words and phrases to explain procedures

C) Assist with active range of motion

A patient has been receiving oxygen per nasal cannula while hospitalized for COPD. The patient asks the nurse whether oxygen use will be needed at home. Which of the following would be the most appropriate response by the nurse? A) "Oxygen will not be needed until or unless you are in the terminal stages of the disease." B) "Long-term home oxygen therapy should be used to prevent respiratory failure." C) "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." D) "Oxygen will be needed when your oxygen saturation drops to 88% and you have symptoms of hypoxia."

C) Preventing bronchial collapse and air trapping in the lungs during exhalation Rationale: Pursed-lip breathing helps to create back-pressure in the lungs forcing the alveoli to stay open

A patient with a diagnosis of TB will be taking isoniazid (INH) as part of the anti-TB therapy. When reviewing the patient's chart, the nurse finds documentation that the patient is a "slow acetylator". This means that: A) The patient should not take INH B) The patient will need to take a combination of anti-TB drugs for successful therapy C) The dosage of INH may need to be lower to prevent INH accumulation D) The dosage of INH may need to be higher because of the slow acetylation process

C) The dosage of INH may need to be lower to prevent INH accumulation

Four weeks after beginning antitubercular drug therapy on an outpatient basis, the patient reports still experiencing night sweats. What does the nurse identify as the main concern at this time? A) The patient is not taking the medication properly B) More time is needed to see a therapeutic effect C) The patient's infection may be resistant to the drug therapy ordered D) The patient may have contracted a different strain of TB

C) The patient's infection may be resistant to the drug therapy ordered

The health care provider in considering changing from ipratropium (Atrovent) inhaler to tiotropium (Spivira). What is the primary advantage of tiotropium? A) Tiotropium (Spivira) is a shorter acting and thus will work quicker than ipratropium (Atrovent) B) Tiotropium (Spivira) decreases the number of COPD exacerbations when compared with ipratropium (Atrovent) C) Tiotropium (Spivira) is a long-acting anticholinergic drug that does not cause tremors associated with ipratropium (Atrovent) D) Tiotropium (Spivira) can be used to treat both acute and chronic exacerbations of COPD unlike ipratropium (Atrovent)

C) Tiotropium (Spivira) is a long-acting anticholinergic drug that does not cause tremors associated with ipratropium (Atrovent)

A patient is receiving INH for the treatment of TB. Which vitamin does the nurse anticipate administering with the INH to prevent INH-precipitated peripheral neuropathies? A) Vitamin C B) Vitamin B12 C) Vitamin B6 D) Vitamin D

C) Vitamin B6

After receiving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first? A) a patient who is receiving IV nitroprusside (Nirpride) and has a BP of 100/56 B) a patient who had dizziness after receiving his first dose of captopril C) a patient who is cool and clammy, with new-onset confusion and restlessness D) a patient has crackles in both posterior lung bases and is receiving oxygen

C) a patient who is cool and clammy, with new-onset confusion and restlessness

C) a patient who is cool and clammy, with new-onset confusion and restlessness Rationale: of course all of the patients would be checked on eventually but the new onset of confusion and restlessness is evident of a tissue perfusion problem which makes them the highest priority of the four

The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient... A) tells the home care nurse that furosemide (Lasix) is taken daily at bedtime B) uses and additional pillow to sleep when feeling short of breath at night C) calls the clinic when their weight increases by 6 lbs in a weeks time D) takes an ASA 81mg whenever they have chest pain

C) calls the clinic when their weight increases by 6 lbs in a weeks time

When teaching a patient about the signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for which of the following? A) dizziness when standing up B) visual changes such as photophobia C) flickering lights or halos around lights D) increased urine output

C) flickering lights or halos around lights

Which potential problem is of most concern for a patient receiving immunosuppressant drugs? A) orthostatic hypotension B) neurotoxicity C) increased susceptibility to infections D) confusion

C) increased susceptibility to infections Rationale: When the immune system's functioning is compromised it increases the risk of the person being infected by a foreign source

A patient with a history of heart failure presents to the emergency department with difficulty breathing, cough, and edema of the lower extremities. The nurse anticipates the administration of which type of medication? A) Positive chronotrope B) Negative chronotrope C) Positive inotrope D) Negative inotrope

C) positive inotrope

During assessment of a patient who is receiving digoxin, which findings would indicate an increased possibility of toxicity? A) apical pulse rate of 62 beats/min B) digoxin level of 1.5 ng/mL C) serum potassium level of 2 mmol/L D) serum calcium level of 4.8 mmol/L

C) serum potassium level of 2 mmol/L

The nurse is administering medications. One patient has an order for aspirin 81mg PO daily, and another patient has an order for aspirin 650mg 4-6 times a day (max. 4g/day). The nurse understands that the indications for the 81mg of aspirin once daily is: A) pain management B) fever reduction C) thromboprevention D) treatment of osteoarthritis

C) thromboprevention Rationale: aspirin is prescribed for thromboprevention because of its antiplatelet properties at a lower dosage. At a high dosage, aspirin is used for its NSAID properties (anti-inflammatory and analgesic effects) that slow the degenerative disease process associated with arthritis

When a patient is experiencing a cluster headache, the nurse will plan to assess for: A) nuchal rigidity B) projectile vomiting C) unilateral eyelid swelling D) throbbing, bilateral facial pain

C) unilateral eyelid swelling Rationale: cluster headaches effect one side of the head; bilateral facial pain and nuchal (neck) rigidity are characteristics of a tension headache; and projectile vomiting is a characteristic of a migraine

A patient with active HIV has been taking Zidovudine/Retrovir. Which potential adverse effect may limit the length of time this medication can be taken? A. Lactic acidosis B. Bone marrow suppresion C. Heptamegaly D. Fatigue

Before administering methotrexate to a patient, what is most important for the nurse to assess? A. Allergy to eggs B. Congestive heart failure C. Latent tuberculosis D. Hypothyroidism

During assessment of a patient who is receiving digoxin, which findings would indicate an increased possibility of toxicity? A. Apical pulse rate of 62 bpm B. Digoxin level of 1.5 C. Serum potassium level of 2 D. Serum calcium of 4.8

Four weeks after beginning anti-tuberculin therapy on an outpatient basis, the patient reports still expereincing night sweats. What does the nurse identify as the main course at this time? A. The patient is not taking the medication properly B. More time is needed to see a therapeutic effect C. The patient's infection may be resistant to the drug therapy ordered D. The patient may have contracted a different strain of TB

C. Positive inotrope

Risk Factors of Heart Failure

CAD, hypertension, Diabetes, tobacco use, obesity, high cholesterol, infective endocarditis, valve disorders, prolonged volume overload, PE

What diagnostic tests are used to diagnose HIV/AIDS?

CD4 count (not as diagnostic), CD4 fraction (most diagnostic), Viral load Will also see abnormal lab values (Anemia, Neutropenia, Thrombocytopenia, Alteration in liver enzymes (ALT, ASP, ALP))

Intermediate chronic HIV

CD4 count 200-500; viral load rises, virus increases in the blood; chronic fatigue occurs; pt. commonly acquires oral candida (Thrush), shingles, oral hairy leukoplakia, persistent vaginal candida, herpes, other bacterial infections, or Kaposi's sarcoma (vascular cancer)

How do we diagnose an aneurysm?

CT scan, X-ray, Ultrasound, Echocardiogram,

What are adverse effects of Milirone?

Cardiac dysarthymias (patient must be on cardiac monitor during IV administration, only given IV), hypotension, angina, hypokalemia, rare - thrombocytopenia

Why do we use beta blockers to treat heart failure?

Cardioprotective, prevent catecholamine stimulation/prevent SNS mediated actions, reduces heart rates which allows heart to fill

What is diastolic heart failure?

Characterized by impaired filling and relaxation of the ventricles (will have an adequate ejection fraction)

What is systolic heart failure?

Characterized by impaired left ventricular ejection fraction of the heart (will be less than 60%-65%)

What is idiopathic pulmonary fibrosis?

Characterized by scar tissue in the connective tissue of the lungs are a result of inflammation or irritation Clinical Manifestations: Exertional dyspnea, non-productive cough, inspirational crackles with or without clubbing

How do we diagnose bronchiectasis?

Chest x-ray, CT, bronchoscopy, sputum culture

What is bronchopulmonary dysplasia?

Chronic lung disease in infants (premature before 28 weeks gestation and were mechanically ventilated), will cause long term lung disease Involves pulmonary immaturity, surfactant deficiency, barotrauma, inflammation, fluid overload

Answer: 3 Patients with atrial fibrillation are at incredibly high risk for clots, even with anticoagulation therapy. Shortness of breath could indicate a PE, and this should be immediately investigated by the nurse. The patient should be NPO for at least 4 hr. prior to the procedure related to anesthesia use, but this is not as urgent of a concern. The patient should also withhold Digoxin therapy for 48 hours to ensure that, once cardioverted, NSR returns.

A 26-year-old client with atrial fibrillation that has not responded to medication therapy has arrived at the hospital for an elective cardioversion. Which of the following patient statements most concerns the nurse? 1) "I can't wait to stop taking this Coumadin. I've been on this crap for weeks now." 2) "I'm starving. I haven't eaten anything in 3 hours." 3) "I feel really short of breath, can I lie down?" 4) "I haven't taken my Digoxin since 9 o'clock last night. Is that okay?"

Metabolic Syndrome

A collection of risk factors that increase an individual's chance of developing cardiovascular disease and diabetes mellitus; generally characterized by abdominal obesity and insulin resistance (the body is unable to use insulin properly)

Chronic Venous Insufficiency

A disorder of inadequate venous return over a prolonged period caused by increased pressure that distends the veins and results in incompetent valves of the lower extremities

What is cystic fibrosis?

A genetic mutation (recessive gene) that is passed down from both parents. It causes an increase in sodium and chloride secretion from endocrine glands in the lungs, pancreas, and sweat glands

Cardiomyopathy (CMP)

A group of disease that affect the structure and function of the myocardium; leads to cardiomegaly (enlargement of the heart) and HF; may be primary or secondary

What is cardiomyopathy?

A group of diseases that affects the structure and function of the myocardium (muscle)

Answer(s): 2, 3 The ATRIAL rate is 220-300 bpm. Ventricular is about 75-150. The rhythm is regular, with the P wave appearing as little flutter or a "saw tooth pattern". The PR interval is not measurable r/t this saw-tooth P wave. The QRS is normal.

A group of nursing students are discussing atrial flutter. These students recognize that which of the following are seen with atrial flutter? Select all that apply: 1) Ventricular rate of 220-300 bpm. 2) Regular rhythm 3) Saw-tooth pattern 4) Measurable PR interval 5) Long QRS interval

Answer(s): 2, 3, 4, 5 Diarrhea will not stimulate a vagal response, but vomiting can. Chronic constipation will cause a consistent vagal response. Digoxin, beta blockers, and calcium channel blockers can all contribute to first degree blocks. Relate this to bradycardia.

A group of nursing students are studying AV blocks and ask their instructor, "what causes a first-degree block?" The nursing instructor responds that which of the following can cause a first-degree block: Select all that apply 1) Diarrhea 2) Chronic constipation 3) Diltiazem 4) Digoxin 5) Metoprolol

Diastolic Heart Failure

A heart dysfunction effecting the heart's ability to relax caused by impaired ability of the ventricles to relax and fill during diastole

What is Severe Combined Immunodeficiency Disease (SCID)?

A juvenile disease where there is the absence of both cell mediated and humoral mediated immunity

Answer: 1) Although electrolytes are likely the culprit, the nurse first needs to first assess the patient. Then, the nurse should look in the patient's chart and evaluate or request an order for electrolyte levels. This may eventually need to be documented, but the nurse can be held liable for neglect if he/she does not assess the patient first. The physician may or may not need to be contacted.

A nurse on a CVT unit views the monitor and sees the patient in room 452 has just begun having occasional PVCs. Which action should the nurse take first? 1) Check on the patient 2) Check last magnesium and potassium levels 3) Document the occurrence and watch for further PVCs 4) Contact the physician

Answer: 2) Patients with a-fib are at risk for pulmonary and systemic emboli, and new onset of confusion may indicate a stroke in this patient. Patients with atrial flutter may feel more tired some days than others.

A nurse working on a CVT unit receives report from day shift. After receiving report, which patient should the nurse see first? 1) A 23-year-old professional tennis player with a HR of 47 bpm. 2) A 69-year-old male with atrial fibrillation who has new onset confusion. 3) A 72-year-old female with atrial flutter who reports feeling unusually tired today and yesterday. 4) A 33-year-old female with sinus tachycardia who is asking for her at-home Metoprolol.

Answer: B. Antiarrhythmic medications are prescribed with the use of an ICD in order to prevent the tachycardic (or other deadly arrhythmia) from occurring in the first place. This makes sure that the ICD is used only when absolutely necessary.

A patient with cardiomyopathy has been given an ICD. Which of the following medications would the nurse expect to see in the MAR for this patient? A) Warfarin B) Cardizem C) Nitroglycerin D) Digoxin

When caring for a patient who has Guillain-Barre syndrome, which assessment data obtained by the nurse will require the most immediate action? A) The patient has continuous drooling of saliva B) That patient's BP is 106/50 mmHg C) The patient's quadriceps and triceps reflexes are absent D) The patient complains of severe tingling pain in the feet

A) The patient has continuous drooling of saliva Rationale: If the patient is drooling, it means that the muscles of the neck are being affected which can be fatal if respiration is impeded

What are clinical manifestations of the active infection of HIV?

Flu-like symptoms - Fever, swollen lymph nodes, malaise, anorexia, joint and muscle pain, diarrhea, diffuse rash, sore throat

Dendritic cells

Found in the skin and mucous membranes; capture and kill pathogens at their site of entry

How do we diagnose heart failure?

History and Physical, ECG, Chest x-ray, Lab studies (e.g. Cardiac enzymes (Troponin and CK-MB), BNP - amount of stretch is considered normal or abnormal related to patient's age), Hemodynamic assessment (vitals), Echocardiogram (evaluating ejection fraction), Stress testing, Cardiac catheterization, Angiogram

Differentiate between humoral mediated immunity and cell mediated immunity

Humoral - immune system response is initiated by antibodies such as IgG which is the antibody responsible for primary immune response to foreign antigen, fights foreign bodies that are outside of cells Cell - immune system response is initiated by T cell antigen recognition via antigen presentation on macrophages and natural killer cells, fights foreign bodies that are inside cells

What are Disease Modifying Antirheumatic Drugs?

Hydroxychlororoquine (Plaquenil) Sulfasalazine (Salazopyrin) Gold Prepartions/Injections Methotrexate (immunosuppresant)

Differentiate between hyperacute, acute, chronic, and graft-versus-host rejection

Hyperacute - Humoral Rejection - Rejects organ/tissue immediately after transplantation Acute - Most common and treatable - Days to months after transplantation Chronic - Antibody Mediated Rejection - Occurs months to years after transplantation, typically irreversible Graft-versus-Host - Where graft rejects host (backwards reaction), occurs in immunodeficient patients, typically irreversible

Main types of Cytokines

Interleukins, interferons, Tumor-necrosis factor, Colony-stimulating factor, and erythropoietin's

Symptoms of PAD

Intermittent claudication (ischemic muscle pain during exercise, subsides within 10 minutes of stopping activity), parathesia, thin shiny hair/hair loss, diminished or absent pulses, elevation pallor or dependent rubour

B-lymphocyte

Involved in the humoral response; antibody related

Systemic Lupus Erythematosus (SLE)

Involves the production of a large variety of autoantibodies against normal body components such as nucleic acids, erythrocytes, coagulation proteins, lymphocytes, and platelets which when deposited in the body's connective tissue can trigger an inflammatory response leading to local tissue damage

How do we treat COPD? Anticholinergics

Ipratropium/Atrovent, Tiotropium Bromide/Sprivia - Indirectly cause airway relaxation and dilation, help reduce secretions in COPD patients

What is systemic lupus erythematosus?

Is a widespread systemic autoimmune tissue (immune system attacks healthy organs)

Tissue matching

Is not needed for the transplant of vascular tissue (ex. Skin, corneas, bone, and heart valves), but is important to find tissues with the closest HLA type of the donor and the recipient to maximize organ acceptance and minimize rejection

What are clinical manifestations of rheumatoid arthritis?

Joint pain, stiffness, limited range of motion, warmth/inflammation of joints, rheumatoid nodules on joints, Sjogren's Syndrome (burning and dry eyes), Felty's Syndrome (inflammatory eye disorders, enlarged spleen, blood disorders)

IgG

Largest component of total immune globulins; found in plasma and interstitial fluid; the only immunoglobulin that can cross the placenta

How do we diagnosed head and neck cancer?

Laryngoscopy, nasopharyngoscope, CT, MRI, PET scan (will determine spreading of cancer)

Describe left sided heart failure

Left ventricular failure that causes backup of blood into the left atrium and pulmonary veins resulting in pulmonary congestion and pulmonary edema

How do we treat cystic fibrosis?

Lungs: Bronchodilators Deoxyribonuclease (Mucolytic Agent) - Dornase Alpha (Pulmonyme - inhalation/nebulized Corticosteroids - Every other day to prevent stunting of development, cataract formation, and blood glucose intolerance Antibiotics as needed - Ciproflaxin, Cephalexin, Tobramycin aerosolized (more common in patients with CF than others GI: Administration of pancreatic enzyme replacement medication

Vaccines not to be given to people with immunodeficiency's

MMRV, varicella, yellow fever, and shingles vaccines

Which of the following statements made by a patient with COPD indicates a need for further teaching regarding the use of an ipratropium inhaler? A) "I should rinse my mouth following the two puffs to get rid of the bad taste." B) "I should wait at least one to two minutes between each puff of the inhaler." C) "Because this medication is not fast acting, I cannot use it in an emergency if my breathing gets worse." D) "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."

D) "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily." Rationale: ipratropium is medication prescribed to prevent wheezing and shortness of breath associated with COPD, it is not a fast-acting medication which means it would not help for immediate relief of shortness of breath

The patient's wife is taking rifampin to prevent her from developing a tuberculosis infection. Which statement by the wife indicates that further teaching is needed? A. "Because my oral contraceptives will not work while I am taking rifampin, I will use another form of birth control." B. "I will take the medication for one week and then stop." C. "I will avoid prolonged exposure to the sun." D. "My urine may turn a reddish color when taking rifampin."

Correct answer: B Rationale: Antitubercular therapy is taken for long periods of time, often 24 months. Although this patient does not have an active infection at this time and is taking the rifampin to prevent an infection, the nurse should further investigate the length of time the medication is ordered. All other statements are true.

A patient has an extremely severe infection with a Mycobacterium that is resistant to all but one antitubercular drug; however, the patient has had an allergic reaction to that drug in the past. What does the nurse anticipate as being ordered for this patient? A. A combination of anti tubercular drugs will be chosen to fight the infection. B. The patient will receive the drug and supportive care to help him tolerate the anti tubercular therapy. C. The patient will remain on isolation precautions until his cough clears. D. There is nothing that can be done with this patient.

Correct answer: B Rationale: It must be recognized that the urgency of treating a potentially fatal infection may have to be balanced against any prevailing contraindications. In extreme cases, patients are sometimes given a drug to which they have some degree of allergy with supportive care that enables them at least to tolerate the medication. Examples of such supportive care are treatment with antipyretics (e.g., acetaminophen), antihistamines (e.g., diphenhydramine), or even corticosteroids (e.g., prednisone, methylprednisolone).

Four weeks after beginning antitubercular drug therapy on an outpatient basis, the patient reports that he still experiences night sweats. What does the nurse identify as the main concern at this time? A.He is not taking his medication properly. B.More time is needed to see a therapeutic response. C.His infection may be resistant to the drug therapy ordered. D.He may have contracted a different strain of tuberculosis (TB).

Correct answer: C Rationale: The nurse should not jump to conclusions that the patient is not taking his medication properly. An improvement should start to occur within 2 weeks of starting drug therapy, but this may not occur if the patient's TB is not sensitive to the prescribed drugs. An evaluation of the drug therapy will be needed.

A patient is receiving isoniazid (INH) for the treatment of tuberculosis. Which vitamin does the nurse anticipate administering with the INH to prevent isoniazid-precipitated peripheral neuropathies? A.Vitamin C B.Vitamin B12 C.Vitamin D D.Vitamin B6

Correct answer: D Rationale: Pyridoxine (vitamin B6) may be indicated to prevent isoniazid-precipitated peripheral neuropathies and numbness, tingling, or burning of the extremities.

The patient's wife is taking rifampin to prevent her from developing a TB infection. Which statement by the wife indicates that further teaching is needed? A) "Because my oral contraceptives will not work while I am taking rifampin, I will use another form of birth control." B) "I will avoid prolonged exposure to the sun." C) "My urine may turn a reddish color when I'm taking rifampin." D) "I will take the medication for 1 week and then stop."

D) "I will take the medication for 1 week and then stop."

D) "Oxygen will be needed when your oxygen saturation drops to 88% and you have symptoms of hypoxia."

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? A) Arterial blood gases (ABGs) B) Serum creatine kinase (CK) C) 12-lead electrocardiogram (ECG) D) B-type natriuretic peptide (BNP)

D) B-type natriuretic peptide (BNP)

Before discharge, the nurse discusses activity levels with a 61-year-old patient with COPD and pneumonia. Which of the following exercise goals is most appropriate once the patient is fully recovered from this episode of illness? A) Slightly increase activity over the current level B) Swim for 10 minutes/day, gradually increasing to 30 minutes/day C) Limit exercise to activities of daily living to conserve energy D) Walk for 20 minutes/day, keeping the pulse rate less than 130 beats/min

D) Walk for 20 minutes/day, keeping the pulse rate less than 130 beats/min

When caring for a patient with a mitral valve stenosis, it is most important that the nurse assess for... A) peripheral edema B) diastolic murmur C) right upper quadrant tenderness D) complaints of shortness of breath

D) complaints of shortness of breath Rationale: mitral valve stenosis results in a fluid backup into the lungs related to the impairment/inability of blood to pass through the mitral valve; peripheral edema may also occur but it would not manifest until well after the shortness of breath started

An 82-year-old patient has been taking ibuprofen (Motrin) 200mg TID as treatment for arthritis. The patient has had no other health problems. What is the most important for the nurse to monitor while the patient in on this therapy? A) blood sugar B) hearing C) liver function studies D) kidney function studies

D) kidney function studies Rationale: ibuprofen is an NSAID which inhibits prostaglandins. Prostaglandins are responsible for dilating blood vessels leading to the kidneys. Absence of the prostaglandins can therefore lead to kidney ischemia and cause acute kidney injury

Before administrating methotrexate to a patient, what is most important for the nurse to assess? A) allergy to eggs B) hypothyroidism C) congestive heart failure D) latent tuberculosis

D) latent tuberculosis Rationale: methotrexate is a DMARDS which acts by inhibiting lymphocyte multiplication which along with an anti-inflammatory response, has an immunosuppressant effect.

D) milrinone

D) paroxysmal nocturnal dyspnea Rationale: paroxysmal = "sudden intensification of symptoms" nocturnal = "active at night" dyspnea = "difficulty breathing"

A patient in seen in the health clinic with symptoms of a stooped posture, shuffling gait, and pill rolling-type tremor. The nurse will anticipate teaching their patient about: A) Oral corticosteroids B) antiparkinsonian drugs C) the purpose of electroencephalogram (EEG) D) preparation for an MRI

D) preparation for an MRI

The nurse is assessing a patient who is receiving a milrinone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving IV milrinone? A) tachycardia B) bradycardia C) atrial fibrillation D) ventricular dysrhythmia

D) ventricular dysrhythmia

A patient has been receiving oxygen per nasal cannula while hospitalized with COPD. The patient asks the nurse whether the oxygen use will be needed at home. Which of the following would be the most appropriate response by the nurse? A. "Long term home oxygen therapy should be used to prevent respiratory failure" B. "Oxygen will not be needed until or unless you are in the terminal stages of this disease" C. "Long term home oxygen therapy should be used to prevent heart problems related to COPD" D. "Oxygen will be needed when your oxygen saturation drops to 88% and you have symptoms of hypoxia"

A patient is receiving INH for the treatment of TB. Which vitamin does the nurse anticipate administering with the INH to prevent INH-precipitated peripheral neuropathies? A. Vitamin C B. Vitamin B12 C. Vitamin D D. Vitamin B6

An 82 year old patient has been taking Ibuprofen/Motrin 3200mg divided three times daily as treatment for arthritis. The patient has had no other health problems. What is most important for the nurse to monitor while the patient is on this therapy? A. Blood sugar B. Liver function studies C. Hearing D. Kidney function studies

Before discharge, the nurse discusses activity levels with a 61 year old patient with COPD and pneumonia. Which of the following exercise goals is most appropriate once the patient is fully recovered from this episode of illness? A. Slightly increase acitivity over the current level B. Swim for 10 mins a day, gradually increasing to 30 mins a day C. Limit exercise to activities of daily living to conserve energy D. Walk for 20 min a day, keeping the pulse rate less than 130 bpm

The nurse is administering medciations. One patient has an order for aspirin 81mg by mouth daily, and another patietn has an order for aspirin 650mg Q4-6 times daily. The nurse understands that the indication for the 81mg of aspirin once daily is: A. Pain management B. Fever reduction C. Treatment of osteoarthritis D. Thrombprevention

The nurse is assessing a patient who is receiving a milirone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving IV milirone? A. Tachycardia B. Bradycardia C. Atrial fibrillation D. Ventricular dysrthymias

The patient is discharged home and returns to the ER 4 days later. The patient is admitted to critical care with acute decompensated heart failure with dyspnea at rest. The nurse anticipates the administration of which medication? A. Atropine B. Carvedilol C. Lisinopril D. Milirone

etanercept (Enbrel)

DMARD used on patients with juvenile idiopathic arthritis who are not receptive to methotrexate

adalimumab (Humira) & infliximab (Remicade)

DMARDs that inhibit the body's tumor necrosis factor resulting in reduction of inflammation and altering the body's immune response in treatment of rheumatoid arthritis

Drug Therapy for Rheumatoid Arthritis

DMARDs, corticosteroids, NSAIDS

What is a venous thromboembolism?

DVT or PE

How do we treat rheumatoid arthritis?

Disease Modifying Antiartheumatic Drugs (DMARDS) (prevent immune system breakdown of joint) Corticosteroids (Dexamethasone, Prednisone, Belcomethasone) NSAIDS (Advil/Ibuprofen, Aspirin) Biological or targeted therapy - Adalimumab (Humara), Infliximab (Remicade)

How do we treat pulmonary hypertension?

Diuretic Therapy (will relieve dyspnea and reduces right ventricular volume), Anticoagulant therapy, Vasodilators (Caclium Channel Blockers - Nifedipine/Adalat, Dilitiazem/Cardizem, dilates pulmonary vessels to reduce pulmonary pressure) Prostacyclin (promotes pulmonary vasodilation and prevents platelet adhesion to prevent clot formation in lungs) - Iloprost/Ventavis - aerosolized, Bosentan/Tracleer - PO

What are adverse effects of Anticholinergics?

Dry mouth, dry throat, urinary retention, heart palpitations

What are adverse effects of ACE Inhibitors?

Dry non-productive cough, angioedema, hyperkalemia

Secondary Hypertension

Hypertension caused by another condition; the other condition must be treated first in order to treat the hypertension; can be caused by renal disease, endocrine disorders, neurological disorders, sleep apnea, medications, or pregnancy

What are adverse effects of corticosteroids?

Hypertension, electrolyte imbalances, nervousness, insomnia, hyperglycemia, peptic ulcers, increased risk of infection, weight gain

What are environmental lung diseases?

Environmental or occupational lung disease result from inhaled dust or chemicals (ex. Asbestos, Hanta virus (from mouse droppings)) Damage causes fibrosis of the lungs

How does cystic fibrosis affect the pancreas?

Excess mucus block the ducts which stop the release of vital digestive enzymes Fat, protein, and fat soluble vitamins are malabsorbed - results in steatorrhea (large, fatty, greasy clay colored stools due to indigestion of nutrients) Can also lead to the development of diabetes

What are clinical manifestations of hypertrophic cardiomyopathy?

Exertional dyspnea, Angina, Fatigue, Dysrhythmias, Syncope

Antibodies

Immune globulins produced by lymphocytes in response to antigens

Cell-mediated Immunity

Immune response initiated through specific antigen recognition by T-cells; involves T-lymphocytes, macrophages, and natural killer cells; provides immunity against pathogens within cells, fungal infections, contact hypersensitivity reactions, tumor immunity, and is responsible for the rejection of transplanted tissues

What is biological response modifying therapy?

Immunostimulant Therapy - Interferon - IFN beta-1a (Avonex) - IFN beta 1b - (Betaseron) - Interleukin - Aldesleukin (Proleukin) - Monoclonal Antibodies - Tocilizumab (Actemra) - Not to be given to patients with altered immune function such as RA or SlE

Acute HIV symptoms

Fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle & joint pain, diarrhea, and/or diffuse rash; occurs about 2-4 weeks after infection is acquired; lasts for only 1-2 weeks

How do we treat tuberculosis?

First line Drugs - Isoniazid (INH) - Primary Drug (antibiotic specifically for tuberculin bacteria), Ethambutomal Hydrochloride (EMB), Pyrazinomide (PZA), Rifampin (RMP)

Hyperacute transplant rejection

Occurs within minutes-hours to 2-3 days after the transplant; pre-existing antibodies to donor ABO or HLA antigens

How does cystic fibrosis affect the other organs?

Osteopenia or osteoporosis are common - lack of protein also causes weight and development problems Can also develop biliary cirrhosis and chronic cholestasis (biliary duct/tract damage), GERD, DIOS (similar to paralytic ileus, can cause bowel obstruction), gallstones, and constipation Reproductive system altered - males are usually sterile, females have delayed menarche and may be unable to become pregnant

What is an aneurysm?

Outpouching or dilation of the arterial wall. Emboli can line outpouching so there is significant risk of throwing a clot.

Aortic Aneurysm

Outpouching or dilation of the arterial wall; 75% of these occur in the abdomen region below the branching of the renal arteries (when it is known as an AAA)

Class III HF

Marked limitations of physical activity; comfortable at rest; less than ordinary physical activity causes fatigue; palpitations; dyspnea

T-lymphocyte

Migrate to the thymus; responsible for the immune response involving fungi and intracellular viruses; make up 70-80% of lymphocytes

What drugs are used to treat heart failure? Phosphodiesterase Inhibitors

Milirone - inhibits the enzyme phosphodiesterase positive inotropic response (increases contractility), vasodilation, increases calcium to improve myocardial contractility

What is the most common type of heart failure?

Mixed heart failure (systolic and diastolic), will have poor ejection fractions and will have dilated or stiffened ventricles that will impair filling

Symptoms of Juvenile RA

Morning stiffness, joint tenderness, limping, fever, rash, weight loss, fatigue, eye redness and pain (possible loss of vision)

What drugs are used to prevent organ transplantation? Antimetabolites

Mycophenolate mofetil (CellCept®) and Azathioprine (Imuran, prevents kidney rejection and treats rheumatoid arthritis)

What are clinical manifestations of bronchiectasis?

Persistent, productive cough often stimulated with positional changes, exertional dyspnea, fatigue, weight loss

What drugs are used to prevent organ transplantation? Glucocortioids

Prednisone and Methylprednisolone

What is the most important factor to consider when treating diastolic heart failure?

Preload (amount of blood returning to the heart before ejection) must be maintained to ensure filling and maintain cardiac output. (DO NOT USE NITRO OR VASOPRESSORS AS THIS WILL DECREASE THE PRELOAD)

Why do we use NSAIDs to treat autoimmune diseases?

Prostaglandins cause inflammation - NSAIDS block the prostaglandins to stop the inflammatory response

How do we diagnose COPD?

Pulmonary Function Tests: Spirometry post-bronchodilator medication (will determine mild, moderate, severe, or very severe, will evaluate FEV and FVC), Chest x-ray, History and physical, Walk Test (dyspnea scale), ABGs (low PaO2, elevated PaCO2, low pH, elevated Bicarbonate to try and compensate)

Describe right sided heart failure

Right ventricular failure that causes backup of blood into the right atria and into venous systemic circulation resulting in JVD, heptamegaly, splenomegaly, vascular congestion of GI tract, and periperhal edema

What is metabolic syndrome?

Risk factors that increase a patient's risk of developing heart failure Two most important risk factors are: Obesity and insulin resistance

How do we treat COPD? Phosphodiesterase Type 4 Inhibitor

Roflumilast/Daxas/Daliresp - Reduce coughing and excess mucus and increases levels of cAMP

What compensatory mechanism is activated to maintain cardiac output? SNS

SNS releases cathecholimines to increase heart rate, increase contractility, and causes peripheral vasocontrisction Will be detrimental over time as the increased heart rate and contractility will cause an increase in myocardial oxygen demand and heart workload

Cytokines

Soluble factors secreted by WBCs and a variety of other cells in the body that act as messengers throughout the body; instruct cells to alter their proliferation, differentiation, secretion, or activity as needed

What are the two types of valvular heart disease?

Stenosis (narrowing) or Regurgitation

Antigens

Substances the body recognizes as foreign that elicit an immune response; all body cells have receptors on them that help to identify antigens

What are clinical manifestations of an aortic dissection?

Sudden, severe chest pain, back pain radiating to neck or shoulders, "tearing or ripping" pain, pain increases with each heartbeat, weakened or absent pulses

What are adverse effects of Bronchodilators?

Tachycardia, tremors, palpitations, headache, hypokalemia (potassium is going from extracellular to intracellular), hyperglycemia - Monitor patient's blood pressure and heart rate (if patient is on beta blocker) as it is an antagonist of beta adrenergic agonists

How do we diagnose venous thromboemobolism?

PTT, INR, D-dimer, Platelet count, Ultrasound, CT scan, MRI

Diagnostics for Venous Thromboembolisms

PTT, INR, Hct, platelets, D-dimer (a fragment of fibrin formed as a result of clot breakdown), computed tomography venography, magnetic resonance venography

Symptoms of RA

Pain, stiffness, limited movement, inflammation, rheumatoid nodules, swan-neck deformities, Sjogren's syndrome (extremely dry eyes), Felty's syndrome (enlarged lymph nodes, inflammatory eye problems, and blood gysgracia), Raynaud's phenomenon (blue fingers and toes)

What are clinical manifestations of peripheral artery disease?

Pale, cool extremities, cnyanosis, intermittent claudication (pain in muscles when exercising), Increased rest pain (pain is worsened when lying down, is relieved when sitting), Elevation pallor (when legs are raised, skin whitens, when legs are lowered, skin reddens), Paraesthisia, Thin, shiny, skin, Hair loss, Diminished or absent pulses

Answer: B. This finding would be expected upon administration of adenosine. The rhythm should then begin again in some other rhythm, hopefully normal sinus rhythm. It would be important to document the exact time of this change and continue to monitor the change back to NSR. If this change does not occur, or if another rhythm is produced, appropriate action would then be taken based on the result.

The nurse has just administered adenosine via IV push and sees the following rhythm on the monitor. What is the nurse's priority intervention? a) Apply conductive gel and defibrillate the patient b) Document the findings and continue to monitor c) Administer another mg of the medication d) Begin chest compressions

What drugs are used to prevent organ transplantation? Calcineurin inhibitors (↓ IL-2 and 4)

Tacrolimus and Cyclosporine (prevents graft rejection)

Differentiate between the clinical manifestations of a thoracic, abdominal, and aortic aneurysm

Thoracic - Often asymptomatic, most common manifestation - deep diffuse chest pain, pain may extend to interscapular area Abdominal - Often asymptomatic, back or abdominal pain, may observe pulsatile mass, blue toe syndrome (due to throwing a clot), patchy mottling of feet and toes with presence of palpable pedal pulses may auscultate bruie, tachycardia, hypotensive, diaphoretic Aortic - Angina, hoarseness, decreased venous return, JVD

How do we assess and monitor for signs of aneurysm rupture?

Thorough history and physical exam, Diaphoresis, weakness, hypotension, tachycardia, abdominal, back, groin or periumbilical pain, change in level of consciousness, pulsating abdominal mass, quality and character of peripheral pulses

What are clinical manifestations of mitral valve regurgitation?

Thready peripheral pulses, cool, clammy extremities, weakness, fatigue, palpitations, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema

Autograft

Transplant of material from the patient's own body; common for skin, bone marrow, or blood; Known as an "isograft" if tissue comes from an identical twin of the patient

What are adverse effects of Xanthine Derviates?

Tremors, nervousness, gastroesophageal reflux, hyperglycemia, Avoid administering to patients with severe heart dysrthymias as drug may induce dysrthymias

What are clinical manifestations of aortic stenosis?

Triad reflects LV failure: Angina, Syncope, Exertional dyspnea, will auscultate systolic heart murmur, pulmonary hypertension

Juvenile Idiopathic Arthritis (Juvenile RA)

Umbrella term for arthritis in people under the age of 16; has no specific diagnostics; NSAIDS used for treatment

What are clinical manifestations of COPD?

Underweight, chronic fatigue, dyspnea, barrel-chest, use of accessory and intercostal muscles, pursed lip breathing, non-productive cough, bluish-red color of skin (polycythemia - increase in red blood cell production to try and compensate for decreased O2 circulation), prolonged expiration, decreased air entry, wheezes

What are clinical manifestations of venous thromboembolism?

Unilateral leg edema, pain, redness, paresthesia, Positive Homan's Sign (when patient raises leg and dorsiflexes their leg (raises toes/foot to head) and experiences pain in calf)

What organs do tuberculosis affect?

Upper lobes of lungs, kidneys (mimic renal failure), bones (presents with bone pain with no injury), cerebral cortext (meningitis), adrenal cortext (cortisol or aldosterone problems)

How does Dixogin toxicity present?

Very narrow therapeutic window and hyperkalemia can increase Dixogin levels, Toxicity symptoms - Headache, confusion, colored vision, halo vision, anorexia

A patient with a diagnosis of TB will be taking Isoniazid as part of anti-tuberculin therapy. When reviewing the patient's chart, the nurse finds the documentation that the patient is a slow acetylator. This means that: A. The dosage of INH may need to be lower to prevent INH accumulation B. The dosage of INH may need to be higher because of the slow acetylation process C. The patient should not take INH D. The patient will need to take a combination of anti-TB drugs for successful therapy

Normal CD4 cell range

800-1200 cells/L

What are two consequences of the compensatory mechanisms?

Dilation - Atria and ventricles become enlarged and is adaptive but will be ineffective over time to maintain cardiac output (will not be able to pump as effectively) Hypertrophy - Myocardial muscles become enlarged and result in poor contracility, increased oxygen demands, and poor ejection fraction

IgM

Responsible for primary immune response

How do we diagnose tuberculosis?

Skin Testing (Mantoux), Chest x-ray (not completely diagnostic), Sputum Culture (take 3 consecutive sputum cultures on separate days), QuantiFERON-TB (rapid results but does not replace results from sputum cultures)

What are anti-retroviral drugs? Reverse Transcriptase Inhibitors (RTIs) - Nucleoside Reverese Transcriptase Inhibtors (NRTIs)

*Zidovudine (AZT, ZDV) and Emtricitabine (Emtrival)

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The most appropriate intervention by the nurse for this complaint is to... A) position the patient in Fowler's position, leaning forward on the overbed table B) remind the patient to ask for opioid pain medication every 4 hours C) teach the patient to take deep, slow respirations to control the pain D) force fluids to 3000 mL/day to decrease fever and inflammation

A) position the patient in Fowler's position, leaning forward over the overbed table Rationale: patients often feel better when leaning forward as it alleviates some of the pressure from the chest wall no longer pressing on the pericardium; patients with pericarditis would not be given opioids to minimize the pain, they would most likely be given NSAIDS to help with the inflammation as well as the pain; encouraging the patient to take deep breaths would worsen the pain for them, they prefer to take quick, shallow breaths to lessen the pain; and increasing fluid would not effect their pain level

The nurse is administering an IV infusion of a phosphodiesterase inhibitor to a patient with heart failure. The nurse will evaluate the patient for which therapeutic effects? (Select all that apply) A) Positive inotropic effects B) vasodilation C) decreased heart rate D) increased BP E) positive chronotropic effects

A) positive inotropic effect B) vasodilation & E) positive chronotropic effects

A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5 days. What is the reason for this? A) The medication can cause severe kidney and GI effects B) There are concerns about addiction to the drug C) The patient's pain should subside by that time D) the medication loses its effectiveness over time

A) the medication can cause severe kidney and GI effects Rationale: Toradol is an NSAID that inhibits prostaglandins which are responsible for dilating blood vessels leading to the kidneys. Absence of the prostaglandins can therefore lead to kidney ischemia and cause acute kidney injury. Toradol also has anticoagulant properties which can cause GI bleeding if there is any pre-existing ulcer or nick in the GI tract.

Which assessment information obtained by the nurse for a patient with aortic stenosis would be the most important to report to the heart care provider? A) The patient complains of chest pain associated with ambulation B) A thrill is palpable at the 2nd intercostal space, right sternal border C) a loud systolic murmur is audible along the right sternal border D) the point of maximum impulse (PMI) is at the left midclavicular line

A) the patient complains of chest pain associated with ambulation Rationale: the other answers would be expected findings associated with aortic stenosis while chest pain during ambulation may indicate worsening of the condition

The patient is prescribed an ACE inhibitor. The nurse understands the primary mechanism by which ACE inhibitors exert their therapeutic effect in a patient in heart failure is: A) to inhibit aldosterone secretion B) to inhibit acetylcholine release C) to inhibit catecholamine release D) to prevent vagal stimulation

A) to inhibit aldosterone secretion

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which information best supports this diagnosis? A) Weak, nonproductive cough effort B) respiratory rate of 28 breaths/minute C) Large amounts of greenish sputum D) Resting pulse oximetry (SpO2) of 85%

A) weak, nonproductive cough

The nurse is teaching a patient about the inhaler Advair (salmeterol and fluticasone). Which statements by the patient indicates a correct understanding of this medication? Select all that apply A) "I will rinse my mouth with water after each does" B) "This medication is taken twice a day, every 12 hours" C) "I need to use this inhaler whenever I feel short of breath, but make sure it's not less than 4 hours between doses." D) "I will call my doctor if I notice white patches inside my mouth." E) "I can take this inhaler if I get short of breath while exercising."

A, B, D Rationale: Advair is a long-lasting medication used to prevent bronchospasms that is to be taken on a daily basis. It is not intended for quick relief of shortness of breath. Also, fluticasone is a corticosteroid which increases the chances of having thrush grow on the tongue which can be prevented by rinsing the mouth after administration

The nurse is administering an IV infusion of a phosphodiesterase inhibitor to a patient with heart failure. The nurse will evaluate the patient for which therapeutic effect? SATA A. Positive inotropic effect B. Vasodilation C. Decreased heart rate D. Increased blood pressure E. Positive chronotropic effect

A, B, and E

A patient receiving ipratropium and albuterol (DuoNeb) in his nebulizer treatments. Identify the common side effects that might occur as a result of inhaled B-adrenergic agonists. Select all that apply A) BP changes B) Cataracts C) Dyspnea D) Headache E) Nausea F) Nervousness G) Oral thrush H) Palpitations I) Tachycardia J) Tremors

A, C, D, F, J

The nurse is teaching a patient about the inhaler Advair (Salmeterol and Fluticasone). Which statements by the patient indicate a correct understanding of this medication? SATA A. "I will rinse my mouth with water after each dose" B. "I need to use this inhaler whenever I feel short of breath but make sure its not less than 4 hours between doses" C. "This medication is taken twice a day, every 12 hours" D. "I can take this inhaler if I get short of breath while exercising" E "I will call my doctor if I notice white patches inside my mouth"

A, C, and E

A 40 year old patient seen in the clinic has been newly diagnosed with RA. Which medication does the nurse anticipate being ordered for the patient? A. Methotrexate B. Adalimumab C. Infliximab D. Etanercept

What are counterregulatory mechanisms that oppose the compensatory mechanisms?

ANP, BNP, and Nitric oxide are released in response to atrial and ventricle stretching and cause arterial and venous dilation which results in a decrease in preload and afterload

How do we treat HIV/AIDS?

ART (anti-retroviral therapy, used to slow down the progression of HIV) or HAART therapy (highly active anti-retroviral therapy, a combination of at least 3 anti-retroviral medications)

How do we treat COPD? Bronchodilators

Bronchodilators - Short acting (SABA) - Salbutomal/Ventolin, Terbutaline sulphate/Bricanyl Long acting (LABA) - Salmeterol/Servent, Formoteral/Foradil/Oxeze LABA with Glucocorticoid steroid - Budesonide/Formoterol (Symbicort), Fluticasone/Salmeterol (Advair)

Why do we use diuretics to treat heart failure?

Controls aldosterone levels to reduce sodium and water retention to prevent edema

How do we treat acute decompensated heart failure?

Decrease intravascular volume - Loop diuretics - Lasix/Furosemide Decrease venous return (preload) - High Fowler's position (decreases amount of blood returning to heart, will also increase thoracic cavity to assist with breathing), IV Nitroglycerin (vasodilator, increase perfusion to heart, vasodilation shifts fluid away from heart and lungs) Decrease afterload - IV Sodium Nitroprusside (vasodilators, decreases preload and afterload, will only be used with systolic pressure greater than 100), Morphine (vasodilator, will also help reduce anxiety) Improve gas exchange and oxygenation - O2, Non-invasive ventilator support (BiPAP) Improve cardiac function - Inotropic therapy Dixogin (improves contractility), monitoring Reduce anxiety - Sedatives - Valium, Morphine

Severe Combined Immunodeficiency Disease (SCID)

Defect characterized by the absence of both humoral and cell-mediated immunity; history of recurrent severe infections from infancy; lack of lymphocyte response to antigens, absence of plasma cells in bone marrow

What are clinical manifestations of SLE?

Dermatological - Butterfly rash, alopecia, ulcers in mouth Renal - Nephritis, hematuria, protenuria Cardiovascular - Dysrythmias, chronic pericarditis, endocarditis Musckoskeletal - Joint pain and stiffness (in AM), arthritis) Neurological - Cognitive dysfunction, seizures, memory deficiets Hematological - Antibodes against certain blood components (anemia, thrombocytopenia, neutropenia) Increased risk of infection

Describe progression of HIV Disease

The virus begins destroying CD4 cells and the infected cells die within 2 days. Initially, the bone marrow and thymus are able to replace the loss of the CD4 cells but over time, the loss is too great for the bone marrow and thymus to compensate for. This results in the development of AIDS.

What is chronic venous insufficiency?

Incompetent venous valves in the lower extremities. Will develop leg ulcers due to impaired blood flow if not treated.

What are anti-retroviral drugs? Protease Inhibitors (PIs)

Indinavir Sulfate (Crixivan), *Ritonavir (Norvir) (new medication with less side effects and has an increased resistance to viral replications or mutations)

What is rheumatoid arthritis?

Inflammation and degeneration of connective tissue in synovial joints

What is endo or myocarditis?

Inflammation of the myocardium that causes cell death. Severity of necrosis will display a variant of symptoms

Myocarditis

Inflammation of the myocardium; causes cardiac cells to die which then activates the body's inflammatory response; symptoms depend on how much of the heart has died

Pericarditis

Inflammation of the pericardium caused by infection, trauma, cancer, acute MI, TB, or prolonged untreated syphilis; Tissue damage is triggered by an inflammatory response, resulting in increased capillary permeability which allows plasma proteins to escape into the pericardial space

What is pericarditis?

Inflammation of the pericardium caused by infection, trauma, cardiac surgery, post MI etc.

What are anti-retroviral drugs? Reverse Transcriptase Inhibitors (RTIs) - Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Nevirapine (Viramune)

Primary Hypertension

No definite cause; risk factors include genes, fluid retention, altered renin mechanism, stress, hyperinsulinemia, and obesity

Stage I RA - Early

No destructive indications

Why do we use ACE Inhibitors and ARBS to treat heart failure?

Prevent sodium and water absorption, causes dieresis which reduces preload and afterload, decreases cardiac workload

Differentiate between primary and secondary pulmonary hypertension

Primary - high pulmonary arterial pressures caused by unknown origins Secondary - occurs when primary disease causes a chronic increase in pulmonary pressure (most commonly caused by COPD)

Differentiate between primary, secondary, complicated, and pediatric hypertension

Primary - hypertension is idiopathic (unknown cause) Secondary - hypertension is caused by a disease or treatment (such as corticosteroid use or pregnancy induced) Complicated - hypertension has begun to cause organ damage resulting in coronary artery disease, heart failure, kidney disease/failure, liver disease/failure, cerebrovascular disease, peripheral vascular disease etc. Pediatric - Most common is secondary hypertension but recently primary is becoming more common due to pediatric obesity

What compensatory mechanism is activated to maintain cardiac output? Neurohormonal

Renin-angiotensin-aldosterone system and ADH is secreted causing endothelin stimulation which leads to hypertrophy and causes systemic inflammatory response causing cardiac wasting, muscle wasting and fatigue.

IgE

Responsible for allergic reactions; found in plasma and interstitial fluid

T helper cells (CD4) & T suppressor cells

Responsible for cell-mediated immunity

Symptoms of Pericarditis

Sharp stabbing pleuritic chest pain that worsens with deep breathing and subsides when leaning forward, shortness of breath, rapid shallow breathing, pericardial friction rub, and fever

What are clinical manifestations of pericarditis?

Sharp, pleuritic chest pain, dyspnea, shallow breathing (to relieve pain), pain worsens when lying down, pain is relieved when sitting up, pericardial friction rub can be heard

What are clinical manifestations of chronic constrictive pericarditis?

Shortness of breath, dyspnea, edema, extreme fatigue, JVD, anorexia (symptoms mimic heart failure symptoms)

What are the clinical manifestations of pulmonary hypertension?

Shortness of breath, exertional dyspnea, paraoxysmal nocturnal dyspnea,fatigue, pink-frothy sputum, chest pain, near-syncope

How do we treat COPD? Xanthine Derivates

Theophylline, Aminophylline IV - increases levels of cAMP, smooth muscle relaxation, bronchodilation, and increased airflow

What is an aortic dissection?

The inner wall of the aorta breaks open but the outer wall does not. Bleeding occurs between this space.

Answer: A. Following defibrillation, CPR is immediately initiated if a perfusable rhythm is not initiated. The client may need to be shocked again, but chest compressions must begin first.

The patient who has recently been experiencing runs of ventricular tachycardia suddenly loses consciousness. The patient is defibrillated, and the rate returns as the following. What should the nurse do first? A) Begin compressions B) Shock the client again immediately C) Prepare for intubation D) Administer adenosine

Answer: B. Atrial flutter places the client at high risk for development of clot formation in the atria. Because the client is stable at this time, cardioversion or adenosine would not be performed at this time. Before cardioversion can occur in a patient, anticoagulant therapy should be begun at least 48 hours beforehand if possible.

The patient with a history of hypertension and diabetes has the following rhythm strip. The patient's vitals are as follows: BP 145/89, HR 90, SpO2 95%, RR 19. Which of the following does the nurse expect to do at this time? a) Prepare the client for cardioversion STAT b) Begin administering anticoagulants c) Grab the crash cart for administration of adenosine d) Teach the client about possibility of pacemaker installation

Peripheral Arterial Disease (PAD)

Thickening of the artery walls that can impede blood flow to the affected area; risk factors include smoking, obesity, immobility, hypertension, Diabetes, and high cholesterol

Manifestations of Aortic Valve Regurgitation

sudden weakness, severe dyspnea, chest pain, hypotension, "water-hammer" pulse (strong quick beat that collapses immediately), soft or absent S1, presence of S3 + S4, high-pitched diastolic murmur, Austin-Flint murmur, orthopnea, PND

Antirheumatoid arthritis drugs

suppress specific types of inflammation associated with rheumatoid arthritis; they are more powerful than NSAIDs for their anti-inflammatory and analgesic effects and they also slow the degenerative disease process of arthritis

basilixamab (Simulect)

suppresses T-cell activity by blocking the binding of the cytokine mediators; used for the prevention of organ rejection in kidney transplatations

497 & 498 1st Midterm

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