NSG470 Exam #2

Anticholineric drugs

-Class of drugs used to treat Parkinson's disease -They help relieve the muscle weakness by blocking acetylcholine breakdown.

sickle cell anemia

a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape

X-linked dominant

a mode of genetic inheritance by which a dominant gene is carried on the X chromosome

PKU (phenylketonuria)

an autosomal recessive disorder that makes it impossible for babies to metabolize certain proteins

Neurofibromatosis

autosomal dominant disease characterized by numerous neurofibromas and by spots on the skin (>6 cafe au lait) and often by developmental abnormalities.

Mean Arterial Pressure (MAP)

diastolic pressure + 1/3 pulse pressure

Paracentesis

surgical puncture to remove fluid from the abdomen

seizure

An abnormal paroxysmal electrical discharge in the cerebral cortex manifested as an alteration in sensation, behavior, movement, perception, or consciousness

HMG-CoA Reductase Inhibitors (Statins)

-Class of drugs -Very powerful LDL reduction but at significant risk -Severe risk of liver toxicity, rhabdomyolysis -Many complaints of muscle pain (not necessarily rhabdomyolysis

Hepatitis C Virus (HCV)

-A blood-borne disease that is spread through contact with contaminated blood and other body fluids (most common!) -No vaccine available -Described as a silent epidemic because it can be present in the body for years and destroy the liver, before any symptoms appear -Blood, bodily fluids -Incubation period is less than 4 months -Alcohol and liver toxic drugs significantly speed up process of liver cell destruction

Down Syndrome

-A condition of mild to severe intellectual disability and associated physical disorders caused by an extra copy of chromosome 21 -This is caused by trisomy 21 (a nondisjunction)

Primary tumors

-A consequence of chronic liver disease. (infectious and/or cirrhosis) -Classified as hepatocellular carcinoma (HCC) Confirmed on biopsy -Symptoms mimic any type of liver disease There is no limit to treatment because if the cancer cannot be completely removed, the disease is usually fatal within 3 to 6 months.

X-linked

-A gene carried on the X chromosome. -If a male inherits an X-linked recessive trait from his mother, he expresses that trait because the Y from his father has no counteracting gene. -Females are more likely to be carriers of ____ traits but are less likely to express them.

dominant trait

-A genetic trait is considered dominant if it is expressed in a person who has only one copy of the gene associated with the trait. -This is an observable trait of an organism that can mask the recessive trait.

Tay-Sachs disease

-A human genetic disease caused by a recessive allele that leads to the accumulation of certain lipids in the brain. -Seizures, blindness, and degeneration of motor and mental performance usually become manifest a few months after birth.

Body Mass Index (BMI)

-A person's weight in kilograms divided by the square of height in meters. -Appears to be as strongly correlated with various metabolic and disease outcomes as other direct body fat measures.

Variant of uncertain significance (VUS)

-A term used to describe a change in the DNA sequence that does not have enough supporting evidence to be classified as either deleterious or benign. -Over time, a portion of the ____ will be reclassified as either benign or deleterious.

Aphasia

-Affects one quarter of stroke patients in various forms -Patient partly/completely loses ability to speak, read, write, or understand spoken word -Should have speech therapy consult -Encourage patient to use hand gestures to convey thoughts

portal hypertension

-An increase in the vascular pressure within a system of veins leading to and in the liver. -Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein that travels through the liver. -If the vessels in the liver are blocked due to liver damage (cirrosis), blood cannot flow properly through the liver. -As a result, high pressure in the portal system develops.

Pegasys (peginterferon alfa-2a)

-Anti-viral drug used to control Hepatitis C -Given as a monthly injection -Higher rate of serum negative effect in patients that receive this drug -Anti-virals by far treatment standard -Biggest issue with this drug is patient compliance and drug tolerance

Nimodipine (Nimotop)

-Antihypertensive drug (calcium channel blocker) -used to treat subarachnoid hemorrhage and/or delayed ischemic neurologic deficit (DIND) -Can reduce brain damage caused by bleeding from a burst blood vessel. -ORAL DRUG

autosomal recessive disorders

-Both parents are unaffected carriers -There is a 25% chance with each pregnancy for the child to be affected -All children of an affected individual will be carriers (unaffected)

contusion

-Bruising of brain tissue associated with hemorrhage and edema. -Causes bleeding and swelling inside of the brain around the area where the head was struck. -May occur with skull fractures or other blood clots such as a subdural or epidural hematoma. -When trauma is not the cause, the most common causes are chronic high blood pressure in older adults, bleeding disorders, or the use of medications that cause blood thinning

Penetrating

-Category of head injuries. -Most commonly related to gunshot or stab wounds -Most commonly caused by missile injures from - bullets

Ascites

-Causes include venous blood obstructions secondary to portal hypertension -Subsequent vasodilation and increased permeability leads to fluid accumulation -Then, the liver's inability to synthesize aldosterone leads to increased Sodium and water.

Catapress (Clonidine HCl)

-Central alpha agonist -Acts on CNS, exact mechanism is unknown -Moderate potency, well tolerated except in high risk populations (i.e. elderly) -Risk of confusion/sedation -Significant rebound HTN can occur -Can also be used for alcohol and opioid withdrawal

Dipeptidyl Peptase-4 (DPP-4) inhibitors Sitagliptin (Januvia) Vildagliptin (Galvus)

-Class of drugs -Increases and prolongs the action of incretin (hormone that increases insulin release). So, indirect way of stimulating islet cells. -Usually once daily dosing and effective Complications -Mild risk of hypoglycemia -Very mild side effects (GI, Headache, Upper Respiratory complications) -Weight neutral or some mild loss. Nursing indications: monitor kidney functions.

Calcium Channel Blockers

-Class of drugs -Inhibit calcium influx across cell membrane -Primary mechanism of action is that they dilate the peripheral arteries (vasodilation)

Non-convulsive SE (NCSE)

-Continuous or near continuous generalized electrical seizure activity without they typical tonic clonic physical motor manifestations -Presentations range from alterations in awareness with bizarre behaviors to mild confusion to coma

Tekturna (aliskiren)

-Direct Renin Inhibitor -Blocks the conversion of Angiotensinogen to -ACE-1 by blocking the activity of renin. -Minimal side effects, similar to ACE-I -Watch for hyperkalemia**

Beta Blockers

-Drug class -Has a high risk for orthostastic hypotension and bradycardia -Affect the SA Node which influences HR

Sulfonylureas - 1st and 2nd generation Glipizide (Glucotrol) Glyburide (Glucovance) Glimeperide (Amaryl)

-Drug used to manage glucose levels in Type II diabetics -Stimulates beta cells to produce more insulin. -Somewhat potent drug and can easily be used in combination with metformin. -Should be taken with meals 2x a day -May precipitate the need for insulin Complications -Risk of hypoglycemia -Sulfa allergy -Weight gain -Drug interactions (risk with NSAIDS), others.

X inactivation

-Early in embryonic development in females, one of the two X chromosomes is randomly and permanently inactivated in cells other than egg cells. -This phenomenon is called ______ or lyonization. -This ensures that females, like males, have one functional copy of the X chromosome in each body cell.

Autosomal Dominant

-Equal inheritance between males and females -50% chance of inheritance for each child of an affected individual

Generalized convulsive SE (GCSE)

-Generalized activity presents as tonic or clonic movement of extremities -Complete LOC -Frequently accompanied by incontinence and tongue biting

Glucagon-like peptide-1 receptor agonists (GLP-1 inhibitors) Exenatide (Byetta) Iraglutide (Victoza)

-Glucagon-like peptide-1 receptor agonists (GLP-1 inhibitors) -Both are injectable and mimic the action of incretin. -Promotes insulin release from pancreatic beta cells only in the presence of elevated glucose concentrations. -Similar benefits and complications as DPP-4 drugs

Angiotensin II Receptor Blockers (ARBs)

-Less side effects than ACE-I -Better efficacy (therapeutic response) -Same contraindications -Ongoing risk of hyperkalemia as well -Cancer causing agent used in production has lead to many drugs in this class being pulled off the market

HgA1C

-Measure of glucose control that is a result of glucose molecules attaching to hemoglobin for the life of the red blood cell. (90-120 days) -Normal 4-6% Target range for the diabetic under treatment is 7.0%

Hyperglycemic Hyperosmolar Syndrome (HHS)

-Metabolic disorder resulting from a relative insulin deficiency initiated by an illness that raises the insulin demand. -Persistent hyperglycemia then causes osmotic diuresis, losing water and electrolytes. -Body compensates to maintain osmotic equilibrium, shifting water from intracellular to the extracellular space. -The dehydration and resulting elevated serum sodium raises osmolality.

Liver hemangioma

-Most common liver tumor -More common in females Symptoms: -pain (thrombosis) -bleeding -platelet consumption -RUQ pain

Fragile X Syndrome (FXS)

-Most commonly inherited cause of intellectual disability -Occurs when a DNA series makes too many copies of itself and turns off a gene on the X chromosome -Long facial profile -More flexible joints -Softer skin -Significant developmental delays -ADHD -Autism spectrum -Aggressive behavior

Mucomyst (acetylcysteine)

-Mucalytic agent that protects the nephrons in the presence of IV contrast. -Patients on Metformin often take this. -For oral use and IV use. -Smells like rotten eggs. -Patient with renal disease has to drink a certain quantity before -testing that involves radiation or contrast.

Decompressive craniectomy (bone flap)

-Neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand. -Helps decreased elevated ICP

Subdural Hematoma (SDH)

-Occur when a blood clot forms underneath the skull and underneath the dura, but outside of the brain. -Can form from a tear in the veins that go from the brain to the dura, or from a cut on the brain itself. -They are sometimes, but not always, associated with a skull fracture.

epidural hematoma (EDH)

-Occurs when a blood clot forms underneath the skull, but on top of the dura, the tough covering that surrounds the brain. -Usually comes from a tear in an artery that runs just under the skull called the middle meningeal artery. -Usually associated with a skull fracture.

Informed Assent

-Participant's agreement to participate in the absence of full understanding. -Commonly applies to individuals who have not attained legal majority and/or capacity (minors, people with developmental or cognitive disabilities.

Diffuse Axonal Injury (DAI)

-Presence of diffuse damage to axons of cerebral hemispheres, corpus callosum, brain stem, or cerebellum -Often result in immediate and prolonged loss of consciousness

Non-alcoholic fatty liver disease (NAFLD)

-Related to obesity and metabolic syndrome -Can/will result in cirrhosis, cancer, liver failure, and death if untreated -Can be seen on imaging and some labs -Is reversible with diet and exercise -Statin drugs are contraindicated because they draw more lipoproteins to the liver causing more damage

Non-sulfonylurea Insulin Secretors Repaglinide (Prandin) Nateglinide (Starlix)

-Stimulates the pancreas to secrete insulin -No sulfa allergens -Has a much quicker action & shorter half-life -Less "common" drug-drug interactions (i.e. no d-d interactions with NSAIDS) Complications -Drug-drug interaction with most antibiotics -Hypoglycemia -Faster acting: eat immediately after each dose -Dosing is TID vs QD or BID.

Intracranial Pressure (ICP)

-The amount of pressure inside the skull. -Elevated pressure can be due to a tumor, an injury, or improper drainage of cerebrospinal fluid. -This pressure potentially restricts the flow of blood to the brain, depriving it of oxygen.

Cerebral Profusion Pressure (CPP) CPP = MAP - ICP

-The net pressure gradient causing cerebral blood flow to the brain. -It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic, and too much could raise intracranial pressure

Penetrance

-The percentage of individuals with a specific genotype who also express the expected phenotype. -Can vary in women with Fragile X syndrome.

Anticipation

-The signs and symptoms of some genetic conditions tend to become more severe and appear at an earlier age as the disorder is passed from one generation to the next. This phenomenon is called ________. -Most often seen with certain genetic disorders of the nervous system, such as Huntington disease, myotonic dystrophy, and fragile X syndrome. -Typically occurs with disorders that are caused by an unusual type of mutation called a trinucleotide repeat expansion.

Diastatic skull fractures

-These are fractures that occur along the suture lines in the skull. -In this type of fracture, the normal suture lines are widened. -These fractures are more often seen in newborns and older infants.

Linear Fracture (skull)

-This is the most common type of skull fracture. -There is a break in the bone, but it does not move the bone. -These patients may be observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. -Usually, no interventions are necessary.

basilar skull fracture

-This is the most serious type of skull fracture. -Involves a break in the bone at the base of the skull. -Patients with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. -They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. -These patients usually require close observation in the hospital.

Hepatitis B virus

-Transmission is primarily through blood -Can be transmitted in other bodily secretions but there is not as high of a viral load -Transferred in utero -Very long incubation period (up to 6 months) -Risk factors are associated to behaviors where exposure to blood is greatest (ie. health care workers)

Hepatitis A virus

-Transmitted oral-fecal route -Usually transmitted through infected food -Spreads quickly -Usually asymptomatic while virus is being spread -Most prople recover without issue -Flu-like symptoms -No jaundice usually -Easily prevented and vaccine is very effective

Hepatitis E virus

-Type of Hepatitis -Transmission is through oral-fecal route. -Seen in areas with poor water filtration and treatment. -Symptoms are more noticeable due to its abrupt and aggressive onset

Intermediate Acting Insulin (Humulin, Novolin)

-Type of Insulin -Onset: 1-2 hours -Peak: 6-12 hours

Short acting insulin (Regular)

-Type of Insulin -Onset: 30-60 minutes -Peak: 2-3 hours -Safe for IV

Long Acting Insulin (Insulin Glargine (Lantus))

-Type of Insulin -Onset: 60-70 minutes -Peak: 14-20 hrs DO NOT MIX

Depressed skull fractures

-Type of fracture may be seen with or without a cut in the scalp. -Part of the skull is actually sunken in from the trauma. -This type of skull fracture may require surgical intervention, depending on the severity, to help correct the deformity.

Hepatitis D virus

-Type of viral infection cause by a mutation -Infection with Hepatitis B is a precursor required to obtain this (blood borne) virus -Requires Hepatitis B antigens in order to replicate

genetic cross

-Used frequently in transmission genetics, involves the breeding of two selected individuals and the subsequent analysis of their offspring to try to understand how traits are passed from parents to offspring. -This is usually shown using a Punnett square.

esophageal varices

-Varicosities in the esophagus that develop as a result of elevated pressure in the portal system (portal hypertension) -Blood shifts and collateral circulation fills other veins, such as esophageal. -Extremely prone to rupture and severe hemorrhage will occur. -Very chronic condition -Mortality increases with each subsequent episode. (Mean mortality ~40% of patients)

Thiazolidinediones (TZD's) Pioglitizone (Actos) & rosiglitizone (Avandia)

-Very effective drug -Sensitizes body tissue to insulin -Comes with the option to pair with metformin, sulfonylurea -Rapid action with short half-life -Severe risk of edema, heart failure, MI, death. -Mild risk of hypoglycemia -Can increase lipids like metformin -Interferes with oral contraceptives "last ditch" effort before insulin

Niacin (B3)

-Water soluble B vitamin that improves all lipids -Not much liver involvement -Inhibits the mobilization of free fatty acids from peripheral adipose tissue to the liver which reduces the secretion of VLDL particles by the liver. -Because LDL is a product of VLDL degradation reducing VLDL will reduce LDL -Major side effect is flushing -Used as an adjunct with a statin

Spasticity

-When certain muscles are continuously contracting -Affects two thirds of stroke patients -Causes stiffness, tightness

A) 45 year-old African American attorney

1. Which individual is at greatest risk for developing hypertension? A) 45 year-old African American attorney B) 60 year-old Asian American shop owner C) 40 year-old Caucasian nurse D) 55 year-old Hispanic teacher

d. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

16. A client with type 2 diabetes mellitus has a blood glucose level higher than 600 mg/dL and is complaining of Polydipsia, polyuria, weight loss, and weakness. A nurse reviews the physician's documentation and would expect to note which of the following diagnosis? a. Hypoglycemia b. Pheochromocytoma c. Diabetic ketoacidosis (DKA) d. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

c. "The best time for me to exercise is mid-to late afternoon." A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak action times.

18. A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise? a. "The best time for me to exercise is after I eat" b. "The best time for me to exercise is after breakfast." c. "The best time for me to exercise is mid-to late afternoon." d. "The best time for me to exercise is after my morning snack."

a. Fluid volume deficient An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic dieresis leading to dehydration.

1A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The priority nursing diagnosis would be: a. Fluid volume deficient b. Family processes, dysfunctional c. Nutrition: less than body requirements, imbalanced d. Knowledge, deficient: disease process and treatment

a. Tremors

20. A nurse is caring for a client with type 1 diabetes mellitus. Which client complaint would alert the nurse to the presence of a possible hypoglycemic reaction? a. Tremors b. Anorexia c. Hot, dry skin d. Muscle cramps

c. Encourage the client to take 8 t0 12 oz of fluid every hours while awake

21. A nurse needs to maintain food and fluid intake to minimize the risk of dehydration in a client with diabetes mellitus who has gastroenteritis. The appropriate nursing intervention is to: a. Offer water only until the client is able to tolerate solid food b. Withhold all fluids until vomiting has ceased for at least 4 hours c. Encourage the client to take 8 - 12 oz of fluid every hours while awake d. Maintain a clear liquid diet for at least 5 days before advancing to solids to allow inflammation of the stomach and bowel to dissipate

C. "This test indicates how well my blood sugar has been controlled the past 6-8 weeks."

A 34-year-old man comes to the clinic for the results of a glycosylated hemoglobin assay (HbA1c). Which statement, if made by the client to the nurse, indicates an understanding of this procedure? A. "This test is performed by sticking my finger and measuring the results." B. "This test needs to be performed in the morning before I eat breakfast." C. "This test indicates how well my blood sugar has been controlled the past 6-8 weeks." D. "I must follow my diet carefully for several days before the test."

Primary Billiary Cholangitis

A 44 year old Caucasian female presents with the following symptoms: -pain in the upper right abdomen -fatigue -itchy skin -yellowing of the skin, or jaundice -swelling, or edema of the hands and feet -a buildup of fluid in the abdomen -dry mouth and eyes -weight loss These symptoms are common for which hepatic disease?

C. Tekturna (aliskeren)

A 48 year old AA male is presenting with Type 2 diabetes and HTN. Which of the following drugs would be most appropriate for the provider to prescribe the patient? A. Losartan B. Metroprolol C. Tekturna (aliskeren) D. Amlodipine

The number can indicate how quickly the virus is replicating. A higher number indicates that the virus is replicating quickly and a low number indicates that it is replicating slowly.

What does the Anti-HBxAG level indicate?

1. Ask the client about current lifestyle 2. Assess patient's compliance with diabetic medications 3. Recommend dietary and lifestyle changes 4. Educate patient on diet and lifestyle changes (less calories, more physical activity)

A Patient with Type 2 diabetes comes in with a BMI of 35. What would the nurse recommend next? (4)

a. orthostatic hypotension and confusion.

A client diagnosed with Parkinson's disease is prescribed to take levodopa. The nurse should instruct the client about possible side effects which include: a. orthostatic hypotension and confusion. b. acute hypertension and glycosuria. c. diarrhea. d. bradycardia

D. passive acquired immunity

A client exposed to hepatitis A is given a human immune globulin vaccine. The nurse explains this will provide: A. natural immunity. B. active acquired immunity. C. natural acquired immunity. D. passive acquired immunity.

c. diabetic nephropathy

A client has an elevated level of urinary microalbumin. The nurse understands this could be an indication of: A. Addison's disease B. pancreatitis C. diabetic nephropathy D. thyroid cancer

D) Decreased appetite Lasix causes a loss of potassium if a supplement is not taken. Signs and symptoms of hypokalemia include anorexia, fatigue, nausea, decreased GI motility,muscle weakness, dysrhythmias

A client has been taking furosemide (Lasix) for the past week. The nurse recognizes which finding may indicate the client is experiencing a negative side effect from the medication? A) Weight gain of 5 pounds B) Edema of the ankles C) Gastric irritability D) Decreased appetite

D. Give 6 ounces of orange juice to drink (An alert client with hypoglycemia should be given an immediate treatment of 15 grams of a rapid-acting sugar)

A client hospitalized with diabetic ketoacidosis calls the nurse and reports feeling hungry, shaky, and anxious. Which action by the nurse is most appropriate? A. Check the client's blood pressure and pulse B. Call the lab to draw blood for a glucose level. C. Administer 10 mg glucagon intramuscularly. D. Give 6 ounces of orange juice to drink.

c. Intravenous fluids containing 5% dextrose During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and 5% dextrose is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. NPH insulin is not used to treat DKA.

A client is admitted t a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intraveneous infusion of regular insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level in now 240 mg/dL. The nurse would next prepare to administer which of the following: a. Ampule of 5% dextrose b. NPH insulin subcutaneously c. Intravenous fluids containing 5% dextrose d. Phenytoin (Dilantin) for the prevention of seizure

b. icteric

A client is admitted with pain in the right upper quadrant, jaundice, and nausea, and is diagnosed with hepatitis C. The nurse recognizes the client is in which phase of hepatitis? a. preicteric or prodromal b. icteric c. posticteric d. terminal

c. Intravenous infusion of normal saline Rationale: The primary goal of treatment in hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency.

A client is brought to the emergency room in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. The nurse would immediately prepare to initiate which of the following anticipated physician's order? a. Endotracheal intubation b. 100 units of NPH insulin c. Intravenous infusion of normal saline d. Intravenous infusion of sodium bicarbonate

c. "The drugs inhibit cholesterol synthesis in the liver and may produce harmful effects."

A client is started on "statin" therapy for reduction of high cholesterol. When the client ask why he needs to have blood work done routinely to monitor his liver functions, the nurse explains: a. "The drugs have been known to cause hepatitis in some people." b. "All drugs are metabolized in the liver and it is just a safe practice." c. "The drugs inhibit cholesterol synthesis in the liver and may produce harmful effects." d. "It helps to monitor the response of the drug."

d. Systematically rotate insulin injections within one anatomic site

A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which of the following concepts? a. Always keep insulin vials refrigerated b. Ketones in the urine signify a need for less insulin c. Increase the amount of insulin before unusual exercise d. Systematically rotate insulin injections within one anatomic site

B. "You will drink a glucose solution and not eat anything for two hours.

A client scheduled to have a 2-hour glucose tolerance test asks the nurse what is involved in the test. The nurse explains: A. "You will have blood drawn two hours after eating a large meal. B. "You will drink a glucose solution and not eat anything for two hours. C. "After your breakfast meal, blood will be drawn every thirty minutes for two hours." D. "Blood is drawn two hours after eating a high carbohydrate meal."

D. a consistent number of calories are needed each day

A client was diagnosed as having type 2 diabetes and was treated with diet and exercise. When assisting the client with diet planning, the nurse's instructions include: A. no substitutes can be made if using the food exchange plan. B. the greatest number of calories should be from the protein group. C. the meal plan can be disregarded if "dietetic"foods are used. D. a consistent number of calories are needed each day

d. Elevated blood glucose level and low plasma bicarbonate level In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an emergency room. Which finding would a nurse expect to note as confirming this diagnosis? a. Comatose state b. Decreased urine output c. Increased respirations and an increase in pH d. Elevated blood glucose level and low plasma bicarbonate level

d. maintain patency of the intravenous line

A client with coronary artery disease (CAD) is having frequent premature ventricular contractions (PVCs) and dysrhythmias. It is most important for the nurse to: a. administer PRN anti-anxiety medications. b. maintain client on complete bed rest. c. document the ECG rhythm hourly. d. maintain patency of the intravenous line

B. Pioglitazone (Actos)

A client with diabetes and coronary heart disease is being evaluated for treatment. In light of the heart condition, which medication option is more likely to be an issue? A. Metformin (Glucophage) B. Pioglitazone (Actos) C. Insulin D. Sitagliptin (Januvia)

b. Convey empathy, trust and respect toward the client

A client with diabetes mellitus demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The appropriate intervention to decrease the client's anxiety is to: a. Administer a sedative b. Convey empathy, trust and respect toward the client c. Ignore the signs and symptoms of anxiety so that they will soon disappear d. Make sure that the client knows all the correct medical terms to understand what is happening.

C. needs adjustment in diet and/or medication.

A client with type 1 diabetes mellitus has a glycosylated hemoglobin level of 8%. The nurse recognizes that this indicates the client: A. has not been taking his insulin B. is well controlled in his diet and insulin. C. needs adjustment in diet and/or medication. D. has a low hemoglobin level

A. "Measure your blood sugar and urinary ketones every two to four hours while you are sick."

A client with type 1 diabetes who has the flu calls the nurse asking what to do. The best advice by the nurse would be: A. "Measure your blood sugar and urinary ketones every two to four hours while you are sick." B. "You should not take any insulin until you are well again." C. "You should increase your insulin dose for five days, then return to the prescribed dose." D. "You should be hospitalized whenever you have the flu in case it affects your diabetes."

Metabolic Syndrome

A constellation of metabolic factors that directly increase the risk of atherosclerosis, heart disease, type II DM, and can all cause mortality.

Globoid Cell Leukodystrophy (Krabbe's disease)

A degenerative disorder that affects the nervous system. It is caused by the shortage (deficiency) of an enzyme called galactosylceramidase.

D. "Exercise increases the use of insulin in the body, so it requires less insulin.

A diabetic client asks the nurse why it is so important to exercise several times a week. Which of the following is the best response by the nurse? A. "Exercise helps to increase blood sugar levels, so the body needs less food." B. "Exercise helps reduce high ketone levels, so the body stays healthier." C. "Exercise brings down high sugar levels, so the body needs less food." D. "Exercise increases the use of insulin in the body, so it requires less insulin.

pedigree chart

A diagram that shows the occurrence of a genetic trait in several generations of a family.

Battle's sign

A discoloration (bruising) behind the ear over the mastoid process in the line of the posterior auricular artery. Often associated with a basilar skull fracture. -Patients may complain of hearing abnormalities (i.e. echoing) caused by the fluid pooling around the ear

Karyotype

A display of the chromosome pairs of a cell arranged by size and shape.

Aspartate Transaminase (AST) Alanine Transaminase (ALT) Gamma-glutamyltransferase (GGT) Ammonia Alkalin Phosphatase (ALP) Serum Albumin

A doctor orders some lab work for a patient with a history of hepatic disease. What liver function tests and other lab tests would the nurse expect the doctor to order?

d. Turner Syndrome (45, X)

A female presents with lymphedema in hands and feet, a short/Webbed neck, a low posterior hairline, short stature, and delayed physical development. Based on this information, the patient most likely has? a. Fragile-X syndrome b. Down syndrome c. Klinefelter syndrome d. Turner syndrome

De novo (new) mutation

A genetic alteration that is present for the first time in one family member as a result of a variant (or mutation) in a germ cell (egg or sperm) of one of the parents, or a variant that arises in the fertilized egg itself during early embryogenesis.

a. "I need to stop my insulin." When a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the physician. The client should monitor the blood glucose level every 3 to 4 hours.

A home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for 36 hours. Which additional statement by the client indicates a need for further teaching? a. "I need to stop my insulin." b. "I need to increase my fluid intake." c. "I need to monitor my blood glucose every 3 to 4 hours." d. "I need to call the physician because of these symptoms."

3, 4, 1, 2, 5, 6 1. Check the client's blood glucose level 2. Give the client ½ cup of fruit juice to drink 3. Take the client's vital signs 4. Retest the blood glucose level 5. Give the client a small snack of carbohydrate and protein 6. Document the client's complaint, actions taken, and outcome

A hospitalized client with type 1 diabetes mellitus received NPH and regular insulin 2 hours ago (at 7:30 am). The client calls the nurse and reports that he is feeling hungry, shaky, and weak. The client ate breakfast at 8 am and is due to eat lunch at noon. List in order of priority the actions that the nurse would take. (Number 1 is the first action.) ____ Take the client's vital signs ____ Retest the blood glucose level ____ Check the client's blood glucose level ____ Give the client ½ cup of fruit juice to drink ____ Give the client a small snack of carbohydrate and protein ____ Document the client's complaint, actions taken, and outcome

Albumin and total protein

A liver function test that measures a specific protein made by the liver. The body needs this protein to fight infections and to perform other functions. Lower-than-normal levels of _______ and ___________ might indicate liver damage or disease.

d. "The medication I'm taking help release the insulin I already make."

A nurse in interviewing a client with type 2 diabetes mellitus. Which statement by the client indicates an understanding of the treatment for this disorder? a. "I take oral insulin instead of shots." b. "By taking these medications, I am able to eat more." c. "When I become ill, I need to increase the number of pills I take." d. "The medication I'm taking help release the insulin I already make."

-Speech pathology consult -Swallowing function test -Monitor intake and output -May need enteral/parenteral nutrition supplementation

A nurse is assessing a post-stroke patient with dysphasia. What should be included in a post-stroke patient's plan of care?

c. Monitor blood glucose levels frequently

A nurse is assisting a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) to develop a plan to prevent a recurrence. Which of the following is most important to include in the plan of care? a. Test urine for ketone levels b. Eat six small meals per day c. Monitor blood glucose levels frequently d. Receive appropriate follow-up health care

d. Administer regular insulin intravenously

A nurse is caring for a client admitted to the emergency room with diabetic ketoacidosis(DKA) In the acute phase, the primary nursing action is to prepare to : a. Correct the acidosis b. Apply a monitor for an electrocardiogram c. Administer 5% dextrose intravenously d. Administer regular insulin intravenously

blood glucose

A nurse is caring for a patient who is having a seizure. The patient has no prior history of seizures. After stabilizing the patient, what should the nurse check?

Statins (HMG-CoA Reductase Inhibitors)

What drug class is the first line of treatment for dyslipidemias?

1. Prevent partial airway obstruction 2. Hypoventilation 3. Aspiration pneumonia 4. Atelectasis

A nurse is explaining to a nursing student the importance of regularly monitoring a post-stroke patient's airway and respiratory status. What 4 respiratory related complications that the nursing student should be aware of in a post-stroke patient?

a. Polyuria

A nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification? a. Polyuria b. Diaphoresis c. Hypertension d. Increased pulse rate

c. Apply a moisturizing lotion to dry feet but not between the toes

A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction is included in the plan? a. Soak feet in hot water b. Avoid using a mild soap on the feet c. Apply a moisturizing lotion to dry feet but not between the toes d. Always have a podiatrist cut you toenails; never cut them yourself

D. Genetic testing for a minor is not typically done for diseases/conditions where the onset of symptoms occurs in late adult-hood.

A nurse is providing care to a 16-year-old male patient at a routine doctor's visit. The patient's mother voices her concern about their family history of heart disease. She states that she wants her son to receive genetic testing. Which statement made by the nurse is the most appropriate: A. Your son is too young to get genetic testing. B. I will contact his provider. C. He can only receive genetic testing if he provides informed assent. D. Genetic testing for a minor is not typically done for diseases/conditions where the onset of symptoms occurs in late adult-hood.

a. Rotates sites for injection

A nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. The nurse would appropriately inquire whether the client: a. Rotates sites for injection b. Administers the insulin at a 45-degree angle c. Cleanses the skin with alcohol before each injection d. Aspirates for blood before injection into the subcutaneous tissue

c. Temperature

A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose of 120 mg/dL, temperature of 101 degrees F, pulse of 88 beats/min, respirations of 22 breaths/min. and blood pressure of 100/72 mm Hg. Which finding would be of most concern to the nurse? a. Pulse b. Respiration c. Temperature d. Blood pressure

d. "I will notify my physician if my blood glucose level is higher than 250mg/dL."

A nurse provides instructions to a client newly diagnosed with type 1 diabetes. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client states: a. "I will stop taking my insulin if I'm too sick to eat." b. "I will decrease my insulin dose during times of illness." c. "I will adjust my insulin dose according to the level of glucose in my urine." d. "I will notify my physician if my blood glucose level is higher than 250mg/dL."

b. Shakiness

A nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which of the following symptoms develops? a. Polyuria b. Shakiness c. Blurred vision d. Fruity breath odor

1. Review the patient's history, including past medical history. 2. Perform a physical exam. 3. Establish last known well time if not already done. 4. Perform a neurological exam to assess patient's status using the NIHSS.

A patient arrives to the emergency room presenting with facial drooping and slurred speech. Within 25 minutes of the patient's arrival, what 4 actions should take place?

A gallbladder issue (i.e. obstruction, gall stones)

A patient comes in with a chief complaint of right upper quadrant pain. What might the nurse expect their pain to be indicative of?

D. Taken statin before going to bed

A patient comes in with a complaint of leg pain since starting on statin. What should the nurse suggest that the patient do to alleviate the pain and increase compliance? A. Suggest applying ice or heat B. Take 200mg of Tylenol q4h C. Take 600mg Motrin q8h D. Taken statin before going to bed

An order for IV or subcutaneous insulin

A patient comes into the ED with an acute ischemic stroke. Blood tests taken indicate that the patient's serum glucose level is 250mg/dL. What order does the nurse expect to receive from the provider?

10 minutes

A patient exhibits signs and symptoms of a stroke whiIe at a grocery store and is rushed to the hospital in an ambulance. Immediate general assessment by a stroke team, emergency physician, or other experts as well as an order for an urgen CT scan should occur within what time frame after their initial arrival?

Stage 5 of Parkinson's disease

A patient experiencing the following symptoms is most likely in what stage of Parkinson's Disease? -Aggressive symptoms -Hallucinations and spasms -Complete invalidism -Patient is confined to bed or chair -Patient is unable to ambulate even with assistance -High order sensory association areas of the neocortex and prefrontal cortex affected

Stage 3 of Parkinson's disease

A patient experiencing the following symptoms is most likely in what stage of Parkinson's Disease? -Imbalance of the body and improper reflexes observed -Pronounced gait disturbances and moderate generalized disability -Postural disability with tendency to fall -Substantia nigra, amygdala and hippocampus are involved

Stage 4 Parkinson's

A patient experiencing the following symptoms is most likely in what stage of Parkinson's Disease? -Significant disability is observed -Personal assistance is required for simple task -Limited ambulation with assistance -Temporal mesocortex and allocortex are affected -Cognition and emotion are affected

Stage 2 of Parkinson's disease

A patient experiencing the following symptoms is most likely in what stage of Parkinson's Disease? -Moderate symptoms with facial modifications -Tremors on both sides of the body (bilateral) observed -Slow shuffling gait with decrease excursion of legs -Affects the intermediate reticular zone, lower raphe, coeruleus-complex

Stage 1 of Parkinson's disease

A patient experiencing the following symptoms is most likely in what stage of Parkinson's Disease? -Mild, non-severe symptoms -Tremors on one side and postural changes observed -Patient leads to the unaffected side -Affected arm is in a semi-flexed position -Blank face, unilateral movement -Affects the olfactory bulb and nuclei IX and X in the medulla

Since the Hepatitis C antibody test can remain positive in people after the infection has resolved and only shows that the person has developed Hepatitis C antibodies. A positive antibody test is followed by a hepatitis C RNA test. The Hep C RNA test detects genetic material of the virus and is a better determinant to see if the virus is actually present.

A patient has a positive Hepatitis antibody test. The provider also orders a hepatitis C RNA test. The patient asks the nurse why he needs both tests. What should the nurse include in her explanation to the patient?

-Poor diet -Sedentary lifestyle -Lack of physical activity

What factors contribute to the increase in obesity in the U.S.?

-Apply padded side rails -Ensure an immediate oxygen source and suction equipment available -Place patient in a side lying to facilitate drainage of secretions -Guide patient's movements to prevent injury- do NOT restrain patient -Head tilt/chin lift if necessary (protect airway) -Remove constrictive clothing

A patient is at risk for seizures. What are some precautions the nurse can take to ensure patient safety?

-Take Lopid with meals (2-3 times/day) because the drug binds to the foods you eat. -Expected side effects include nausea and stool changes.

A patient is prescribed a new drug Lopid to help manage their high cholesterol. What education should the nurse provide the patient with?

1. OLDCART symptoms 2. Ask patient what medications they are on 3. Explain that persistent cough is an expected side effect of ACE Inhibitors 4. Discuss finding an alternative medication with the patient and share information with the provider

A patient presents with a persistent cough at a follow-up visit at their doctor's office. What should the nurse do?

1. Vitals 2. Hypoxia 3. Increase intracranial pressure (ICP) 4. Seizures 5. Hypoglycemia

A patient receives Metoprolol to help control their hypertension before receiving tPA therapy. What 5 factors should the nurse monitor for in this patient?

A. "I am so happy I don't have to take those shots anymore now that the virus is no longer detected."

A patient with Hepatitis C is on Pegasys to help control the virus. Their most recent lab results indicate that they are seronegative. Which of the following statements indicates that the patient needs further teaching? A. "I am so happy I don't have to take those shots anymore now that the virus is no longer detected." B. "I should still use protection during intercourse to prevent spreading the virus to my wife." C. "I will still have to take my monthly shot."

Overweight

A patient with a BMI of 25-29.9 kg/m2 is considered to be _________?

Obese

A patient with a BMI of 30-34.5 kg/m2 is considered to be _________?

Severely Obese

A patient with a BMI of 35-39.9 kg/m2 is considered to be _________?

Underweight

A patient with a BMI of <18.5 kg/m2 is considered to be _________?

Morbidly Obese

A patient with a BMI of >40 kg/m2 is considered to be _________?

Pre-hypertensive

A patient with a BP reading of 120-139/80-89 is considered to be _______?

Non-Sulfonylurea Insulin Secretors have drug-drug interactions with antibiotics.

A patient with an infected foot wound is currently on a Non-Sulfonylurea Insulin Secretors (Starlix). What is a complication associated with the drug that may result in the patient having to discontinue its use?

D. Take baby aspirin

A patient with dyslipidemias complains of facial flushing after taking Niacin. What would the nurse recommend that the patient do to decrease the facial flushing. A. Drink more water B. Apply a cold compress to their face C. Discontinue use of drug D. Take baby aspirin

C. Hydrochlorothiazide (HCTZ)

A patient with impaired renal function is prescribed a diuretic to help get rid of fluid accumulation in the abdomen due to a hepatic disorder (ascites). Which order by the physician should the nurse question? A. Spironolactone B. Furosemide (Lasix) C. Hydrochlorothiazide (HCTZ)

A. Administer acetaminophen C. Apply cooling blankets to the patient

A post-stroke patient is hyperthermic. Which of the following nursing interventions would be most effective for regulating temperature: A. Administer acetaminophen B. Give the patient an ice bath C. Apply cooling blankets to the patient D. Request an order for IV N.S. 0.9%

Electrophoresis

A process where DNA fragments are separated according to size using electrical charges and a fluorescent dye

Ischemic Stroke

A stroke caused by a clot that blocks blood flow to an area.

Hemorrhagic

A stroke caused by when bleeding occurs inside the brain or around brain tissue.

tPA (tissue plasminogen activator) can thin the blood and therefore raise blood pressure even higher. If blood pressure continues to be uncontrolled, the patient could have damage to the arterial walls and/or hemorrhage.

A stroke patient fulfills all of the criteria for tPA therapy, but their blood pressure is 210/98. Why is tPA contraindicated in this patient?

Anticoagulants or anti platelet drugs should not be administered until a follow up CT scan at 24 hours does not show intracranial hemorrhage.

A stroke patient is receiving tPA therapy. How long should a nurse withhold anticoagulant or anti platelet treatment?

Surgical clipping

A surgical procedure performed to treat an aneurysm. If the aneurysm is intracranial, a craniotomy is performed, and afterwards an Elgiloy or titanium Sugita clip is affixed around the aneurysm's neck.

Glasgow Coma Scale (GCS) 3-8 represents severe TBI (10%) 9-12 moderate (10%) 13-15 mild (80%)

A tool used to evaluate altered mental status in a patient related to a head injury.

b. diabetic ketoacidosis

A type 1 diabetic was admitted to the emergency room with an elevated temperature and urinary tract infection. The findings were 3+ acetone in the urine and blood glucose of 654 mg/dL. The nurse recognizes the client is probably experiencing: A. hyperinsulinism b. diabetic ketoacidosis c. a Somogyi reaction. d. nonketotic hyperosmolar syndrome

Hispanic and African American males

What group of people are at the highest risk for hypertension?

Hepatitis A and Hepatitis B

What types of hepatitis are there vaccines for?

Diuretics

When a patient is on a volume enhancer (isotonic solution) going at a steady rate, what class of drugs is contraindicated in that patient?

X-linked recessive

Affected females -Each male child born to female carrier will have a 50% chance of being affected -Each female child will have a 50% chance of being an unaffected carrier Affected males -Each male child born to an male carrier will be unaffected -Each female child will be have a 100% chance of being affected

c. Polydipsia

After several diagnostic tests, a client is diagnosed with diabetes insipidus. A nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder? a. Fatigue b. Diarrhea c. Polydipsia d. Weight gain

status epilepticus

All adult patients whose seizures continue > 5 minutes or who have 2 or more seizures with incomplete recovery between them.

Increased Intracranial Pressure (ICP) as manifested by Cushing's Triad

An ED nurse is assessing a patient that suffered a head injury who presents with the following signs and symptoms: -Hypertension with widened pulse pressure -Bradycardia -Abnormal/irregular respiratory patterns What does the nurse suspect to be the source of the patient's symptoms?

b. hepatitis B vaccine and hepatitis B immune globulin (HBIG)

An LPN had a needle-stick injury and had not been immunized for hepatitis B. The infection control nurse advises the LPN to get which of the following treatments? a. evaluation of liver function tests in 10 days b. hepatitis B vaccine and hepatitis B immune globulin(HBIG) c. hepatitis B vaccine d. hepatitis B immune globulin(HBIG)

GINA (Genetic Information Nondiscrimination Act)

Act that prohibits covered employers from firing, refusing to hire, or otherwise discriminating against individuals on the basis of their genetic information, and from discriminating against employees and applicants on the basis of a family member's genetic information. (i.e. health insurance coverage costs)

X-linked dominant

Affected females -Each child will have a 50% chance of being affected* Affected males -Each male child will be unaffected -Each female child will have a 50% chance of being affected

Hemophilia

An X-linked recessive disorder in which blood fails to clot properly, leading to excessive bleeding if injured.

recessive allele

An allele that is hidden whenever the dominant allele is present

Allele

An alternative form of a gene.

Nondisjunction

An error in meiosis or mitosis in which members of a pair of homologous chromosomes or a pair of sister chromatids fail to separate properly from each other.

d. Gives a small continuous dose of regular insulin subcutaneously and the client can self- administer a bolus with an additional dose from the pump before each meal

An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump. a. Is timed to release programmed doses of regular or NPH insulin into the bloodstream while regularly monitoring blood glucose levels b. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels c. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream d. Gives a small continuous dose of regular insulin subcutaneously and the client can self- administer a bolus with an additional dose from the pump before each meal

concussion

An injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.

Human Genome Project (HGP)

An international collaborative effort to map and sequence the DNA of the entire human genome.

Genotype

An organism's genetic makeup, or allele combinations.

Valproic Acid (Depakote)

Anti seizure medication that can lead to elevated plasma ammonia.

1. Assess circulation, airway, breathing and evaluate vital signs. 2. Administer oxygen if patient is hypoxemic (less than 94% saturation). Consider oxygen if patient is not hypoxemic. 3. Establish IV access.Make sure that an IV has been 4. Take blood samples to measure blood count, coagulation studies, and blood glucose. Give IV insulin or dextrose if glucose is too high or too low. 4. Assess the patient using the NIH Stroke Scale (NIHSS). 5. Order a brain CT scan without contrast. 6. Obtain a 12-lead ECG and assess for arrhythmias.

As per the NINDS algorithm, what are 6 things that should be assessed/performed during the general assessment in the ED?

A) go get a blood pressure check within the next 48 to 72 hours

At a community health fair the blood pressure of a 62 year-old client is 160/96. The client states "My blood pressure is usually much lower." The nurse should tell the client to: A) go get a blood pressure check within the next 48 to 72 hours B) check blood pressure again in 2 months C) see the health care provider immediately D) visit the health care provider within 1 week for a BP check

subarachnoid hemorrhage

Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates.

a. Switch from whole milk to skim milk.

Blood work done to identify risk factors for coronary heart disease reveals a client has elevated cholesterol and low density lipid (LDL) levels. The nurse should make the following suggestions for changes in dietary habits: a. Switch from whole milk to skim milk. b. Eliminate all red meat from the diet. c. Eliminate all simple sugars from the diet. d. Avoid eating eggs or any foods prepared with eggs

a. rebleeding

When caring for a client who has had a subarachnoid hemorrhage, the nurse focuses nursing interventions on preventing: a. rebleeding. b. seizures. c. aphasia. d. meningitis.

D. 2-3 hours

When does regular insulin generally have peak action after application? Answers: A. 30-45 minutes B. 45-60 minutes C. 1-2 hours D. 2-3 hours

Marfan's syndrome (arachondactyly)

Connective tissue disorder caused by a defect in the fibrillin gene Signs and symptoms include: -Long and lanky body habitus -Myopia/ retinal dislocations (nearsightedness) -Mitral valve prolapse/aortic rupture -Hyperextensible joints -Pectus excavatum -Arachnodactyly

Nicardipine (Cardene)

Calcium channel blocker Used to treat chronic angina, HTN, and intracerebral hemorrhage Adverse Effects: Bradycardia, Hypotension

CPP = MAP - ICP MAP= SBP + 2(DBP)/3 MAP= 70 CPP= MAP-ICP CPP= 70 - 14 CPP= 56

Calculate the CPP of a patient whose BP is 106/52 and ICP is 14 mmg Hg.

BRCA12

Gene that is a major contributor of inherited breast cancer, incorrect DNA repair

a. bradykinesia

When doing a physical assessment of a client, the nurse should expect to find which symptom related to a diagnosis of Parkinson's disease? a. bradykinesia b. dry skin c. polyuria d. elevated blood pressure

45 minutes

Interpretation of the CT scan should occur within ____ minutes of the initial emergency department arrival?

Technically, childbirth is the "cure" however, 40% of moms develop Type 2 DM within 10-20 years.

Is gestational diabetes curable?

Fasting AM and 2 hours postprandial (after meal).

When is the best time for a diabetic patient to check their blood glucose?

2.5 mg/dL

When the serum bilirubin exceeds ____ mg/dl, the nurse will see jaundice.

1. Gum line 2. Roof of mouth

Where might the nurse see signs of jaundice in an African American patient aside from their corneas and skin?

ventriculostomy

a catheter placed in one of the lateral ventricles of the brain to measure intracranial pressure and allow for drainage of fluid

a. frontal lobe

Family members are upset and frightened over a client's use of profane language and verbal abusive behavior. The nurse explains that the behavior is related to the location of the client's brain damage in the: a. frontal lobe. b. parietal lobe. c. occipital lobe. d. temporal lobe

Trisomy

a condition in which an extra copy of a chromosome is present in the cell nuclei, causing developmental abnormalities (i.e. Down Syndrome)

B. Somogyi effect

The nurse is caring for a client who has normal glucose levels at bedtime, hypoglycemia at 2am and hyperglycemia in the morning. What is this client likely experiencing? A. Dawn phenomenon B. Somogyi effect C. An insulin spike D. Excessive corticosteroids

Proband

First affected family member who seeks medical attention for a genetic disorder

Preimplantation genetic testing

Following in vitro fertilization, testing is performed on embryos to identify embryos with a particular genetic disorder.

1. Blood glucose very high (>600mg/dl) 2. Normal pH, normal bicarb 3. Ketones usually absent 4. Serum osmolality >350mOsm/L

What are some common presentations of hyperglycemic hyperosmolar syndrome (HHS)? (4)

1. Support patient's airway, breathing, and circulation. 2. Check blood glucose. 3. Watch for complications of stroke and fibrinolytic therapy. 4. Transfer patient to intensive care if indicated.

Describe the 4 steps of the stroke pathway for stroke patients being treated with tPA or stroke patients given aspirin.

dysphagia

Difficulty swallowing liquids or food

Dyslipidemias

Disorders of lipoprotein metabolism. They can manifest as one or more of the following: -Elevated total cholesterol -low-density lipoprotein cholesterol (LDL) -Elevated triglyceride levels -Decreased high-density lipoprotein cholesterol (HDL) level

No.

Do statins lower mortality rates?

b. Trisomy

Down syndrome involves what type of variation in chromosomal numbers? a. Monosomy b. Trisomy c. Polyploidy d. Euploidy

oral hypoglycemics

Drugs that decrease glucose levels by: -stimulating insulin production by beta cells of pancreas -increasing insulin sensitivity -decreasing hepatic glucose production

C) Force fluids and reassess blood pressure

During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood pressure has decreased from 145 to 110mm Hg and the heart rate has risen from 72 to 96 beats per minute and the client complains of periodic dizzy spells. The nurse instructs the client to: A) Increase fluids that are high in protein B) Restrict fluids C) Force fluids and reassess blood pressure D) Limit fluids to non-caffeine beverages

a. rise slowly when changing from sitting or lying positions.

During early treatment, the client with hypertension experienced postural hypotension. The nurse can minimize symptoms of this problem by instructing the client to: a. rise slowly when changing from sitting or lying positions. b. limit Na in the diet. c. increase fluid intake. d. lie down for 1 hour after taking antihypertensive medications

Hyperthermia

During the acute phase of stroke, _______ is associated with poor neurologic outcomes. treat with acetaminophen and cooling blankets

Homozygous

Having two identical alleles for a particular gene

c) Iron

Hemochromatosis is more common in northern Europeans than in Asians andAfricans. It is thought that the gene for this disorder gave a selective advantage during deficiencies in which of the following? a) Folic acid b) Oxygen c) Iron d) Sodium e) Potassium

Often, the patient diagnosed incidentally with little to no outward symptoms. (i.e. patient is diagnosed after lab testing for a routine surgery)

How are most patients with Type II Diabetes diagnosed?

1. Maternal screening during a pregnancy 2. New born screening on baby

How can a parent better anticipate and prepare for a child with a genetic disorder/disease?

1. Stimulate the pancreas to make insulin. 2. Increases insulin receptor sensitivity in the tissues 3. Decreases gluconeogenesis in the liver Work together to decrease the amount of circulating glucose in the blood.

How do oral hypoglycemics work?

3 out of 5

How many of the 5 defining criteria must a patient present to be diagnosed with metabolic syndrome?

Increased cardiac output and/or Increased peripheral resistance

Hypertension results from what two main factors?

D. Aspirin

If a patient is not a candidate for tPA (fibrinolytic) therapy, which of the following medications should be administered to the patient instead? A. Warfarin B. Heparin C. Tylenol D. Aspirin

1. Encourage patient to recheck BP in different environments (at home, at the pharmacy, etc.) 2. Educate patient on dietary modifications 3. Encourage patient to increase physical activity level 4. Promote smoking cessation 5. Educate patient on monitoring salt intake

If a patient's BP reading is high at a doctor's office visit, what is the standard course of treatment for that patient? (5)

b) Half-shaded square

If it is known that an individual male is a carrier of a genetic disease, which of the following shapes would be indicated on a pedigree? a) Fully-shaded square b) Half-shaded square c) Non-shaded square d) Fully-shaded circle e) Half-shaded circle f) Non-shaded circle

C) Bed wetting

In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school age child for evaluation? A) Polyphagia B) Dehydration C) Bed wetting D) Weight loss

A. High blood glucose damages capillaries

In educating a client about Type II Diabetes, what would be a proper explanation for poor wound healing? A. High blood glucose damages capillaries B. Swings in blood sugar prevent proper clotting C. The pancreas fails to secrete the proper chemicals D. Ketosis prevents proper healing

C. I should not go more than 3 days without washing my feet

In educating a client with diabetes, what response would reveal need for further education? A. I should avoid tights B. I should take good care of my toe nails C. I should not go more than 3 days without washing my feet D. I should avoid going barefoot and should wear clean socks

c. dietary management; exercise regimen; and stress reduction.

In management of a newly diagnosed, low-risk client with hypertension, the nurse understands that the initial treatment generally consists of: a. aggressive treatment with diuretics, beta blockers, and 1,000-calorie diet. b. restriction of fluid and sodium intake. c. dietary management; exercise regimen; and stress reduction. d. lifestyle modification and a diuretic medication

A. Alternating insulin injection sites

Insulin lipodystrophy should be treated in part by: A. Alternating insulin injection sites B. Balancing diet and snack routine C. Reduction of insulin dose D. Adding an oral glycemic medication

Alkaline Phosphatase (ALP)

Liver function test that measures an enzyme found in the liver, bile ducts and bone. Higher-than-normal levels of ___ may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases. Can also be used to indicate possible cancers.

aspartate transaminase (AST)

Liver function test that measures an enzyme in the liver that helps metabolize alanine, an amino acid. This enzyme normally present in blood at low levels. An increase in ___ levels may indicate liver damage/disease or muscle damage.

alanine transaminase (ALT)

Liver function test that measures an enzyme in the liver that helps your body metabolize protein. When the liver is damaged, this enzyme is released into the bloodstream and levels increase.

Sucralfate (Carafate)

Medication that helps reduce the complications after band ligation of esophageal varices.

25 minutes

Neurologic assessment by stroke team and CT scan should be performed within ___ minutes of a patient's arrival?

predictive testing

Offered usually to asymptomatic individuals to detect genetic conditions that occur later in life.

Focal injuries

Often associated with direct impact to head (i.e. hematomas, contusions)

Acarbose (Precose)

Oral hypoglycemic alpha glucosidase inhibitor Slows carbohydrate absorption and digestion Adverse Effects: -Can cause intestinal effects -risk for anemia (decreased iron absorption) -hepatotoxicity (long term use) Take w/ first bite of food (3x/day)

hyperglycemic

Patients with acute ischemic stroke who are __________ tend to have worse clinical outcomes.

twice

People with the metabolic syndrome are at _____ the risk for cardiovascular disease compared with those without the syndrome.

SBP-DBP

Pulse Pressure (PP) = ___ - ___

metabolic syndrome

Raises the risk for Type 2 diabetes by about 5-fold.

Onset: 5-15 minutes Peak: 45-90 minutes

Rapid Acting Insulin such as Lispro (Humalog) and Aspart (Novolog) have an onset of action of __-__ minutes and peak at __-__ minutes

cosanguineous

Related, of the same blood

carrier testing

Testing in an asymptomatic individual to identify carrier status for a genetic condition.

Newborn screening tests

Testing to identify a fetus with a genetic disease or condition and is usually initiated due to family history or maternal factors.

Antimitochondrial Antibodies Test (AMA)

The _____ test identifies elevated levels of antimitochondrial antibodies (AMA) in the blood.

rare autosomal recessive disorders

The biggest concern for a child born of incest is a _____.

B. there is decreased insulin production by the pancreas or cell resistance to the insulin produced.

The client asks the nurse to explain how type 1 diabetes differs from type 2. The nurse explains that with type 2 diabetes: A. the client depends entirely on an outside source of insulin. B. there is decreased insulin production by the pancreas or cell resistance to the insulin produced. C. there are insulin antibodies that destroy the beta cells in the pancreas. D. the liver destroys the C-peptide chain of proinsulin produced by the pancreas

D. it reduces irritation to the tissues and increases absorption

The client who is self-injecting insulin was advised by the nurse to rotate injection sites because: a. it reduces the danger of nerve damage and decreases absorption. b. insulin can reach all parts of the body and be used more efficiently. C. it reduces the chance of infection and increases absorption. D. it reduces irritation to the tissues and increases absorption

b. elevate the head of the bed 30 degrees (Elevation of 30 degrees promotes venous drainage)

The client with a head injury has multiple nursing needs. To promote venous drainage and alleviate pressure, the nurse should: a. encourage the client to cough. b. elevate the head of the bed 30 degrees. c. use oxygen at 2 L/min. d. monitor the temperature every 15 minutes

b. reduce serum ammonia levels

The client with cirrhosis is given lactulose (Cephulac), which causes diarrhea. The client asks the nurse why it is necessary to take this medication. The nurse explains that the medication will: a. prevent gastrointestinal bleeding. b. reduce serum ammonia levels. c. promote excess fluid loss. d. prevent constipation

c. empty the bladder

The client's ascites is severe and is causing difficulty breathing and shortness of breath. The nurse prepares the client for a paracentesis to remove excess fluid by instructing the client to: a. lie on the right side b. lie on the left side. c. empty the bladder. d. drink nothing by mouth 12 hours prior to the procedure.

1. Ruptured Aneurysm 2. Arteriovenous malformation (AVM) rupture

What are two primary causes of a subarachnoid hemorrhage?

3 hours

The door-to-admission time for a patient that presents with symptoms of a stroke should be less than ___ hours?

b. What is the client's capillary blood glucose level?"

The family of a bedridden client with type 2 diabetes mellitus and chronic renal failure calls a nurse to report the following symptoms: headache, Polydipsia, and increased lethargy. To determine a possible diagnosis, the nurse asks the family which most important questions? a. "What is the client's urine output?" b. "What is the client's capillary blood glucose level?" c. "Has there been any change in the dietary intake?" d. "Have you increased the amount of fluids provided?"

C. The child may be experiencing Somogyi phenomenon, which often occurs at night.

The father told the nurse that his 11-year-old child with type 1 diabetes has frequent nightmares and wakes up in the middle of the night. Which of the following is probably the cause of the nightmares? A. The child is experiencing anxiety related to the diabetes. B. The child's nightmares have nothing to do with the diabetes. C. The child may be experiencing Somogyi phenomenon, which often occurs at night. D. The child may be experiencing dawn phenomenon with blood sugar elevations

Hyperacute phase

The first 24 hours after stroke.

Acute phase

The first week after a stroke.

autosomal recessive

The following are caused by what type of traits/disorders? -Blue eyes -Attached ear lobes -Cystic Fibrosis -Sickle Cell Anemia -Krabbe syndrome

Blunt

The following are examples of what mechanism of head injury? -Acceleration-deceleration (coup and contrecoup) -Deformation -Rotation

Hypoglycemia

The following are signs and symptoms of ______: -Confusion -Headache -Irritability -Nausea -Sweating -Tremors -Hunger

Hyperglycemia

The following are signs and symptoms of ______: -Weakness -Syncope -Polydipsia -Polyuria -Blurred vision -Fruity breath

c. expressivity

The frequency of expression of an allele when it is present in the genotype of an individual is known as the? a. penetrance b. association c. expressivity d. homogeneity

B) Send him to the emergency room for evaluation

The home health nurse visits a male client to provide wound care and finds the client lethargic and confused. His wife states he fell down the stairs 2 hours ago. The nurse should A) Place a call to the client's health care provider for instructions B) Send him to the emergency room for evaluation C) Reassure the client's wife that the symptoms are transient D) Instruct the client's wife to call the doctor if his symptoms become worse

a. Have the client lie on the right side with the bed flat. The client is positioned on the right side, which allows client's own body weight to provide downward pressure against the liver and upward pressure from the mattress; this reduces chances of internal bleeding

The nurse assisted the physician with a needle biopsy of the liver. Following the procedure, which action should the nurse take? a. Have the client lie on the right side with the bed flat. b. Check the client's coagulation time. c. Elevate the head of the bed. d. Instruct the patient to avoid deep breathing to prevent liver pressure.

c. breathing is controlled by the respiratory center in the brain.

The nurse caring for a client who has sustained a head trauma closely monitors respirations because: a. the client will be lethargic and forget to breathe. b. the trauma may cause the client to be disoriented. c. breathing is controlled by the respiratory center in the brain. d. the client will be unable to cough and clear secretions

b. Secondary liver disease

The nurse correctly recognizes that a shared goal of early intervention for both hypothyroidism and phenylketonuria (PKU) is avoidance of which complication? a. Cognitive impairment b. Secondary liver disease c. Obesity d. Heart disease

C. "File your toenails straight across. Avoid using scissors."

The nurse instructs a client with type 2 diabetes on foot care. In addition to keeping the feet clean and dry, the nurse may also offer the following advice: A. "Wear nylon socks to keep your feet warm." B. "Walk on bare feet to promote circulation." C. "File your toenails straight across. Avoid using scissors." D. "Wear open-toe shoes to avoid pressure around toenails."

c. constriction of blood vessels.

The nurse instructs clients with hypertension to drink beverages with caffeine (coffee, tea, cola drinks) in moderation because caffeine causes: a. accumulation of plaque in blood vessels. b. hardening of the arteries. c. constriction of blood vessels. d. dilation of blood vessels

d. becomes drowsy or confused

The nurse instructs the client with a minor head injury to return to the emergency room if which of the following occur? a. increased appetite and fluid consumption b. slight headache that continues for 24 hours c. slight nausea for several hours after injury d. becomes drowsy or confused

b. Obtain a capillary blood glucose level and perform a focused assessment

The nurse is caring for a client who is 2 days postoperative following an abdominal hysterectomy. The client has a history of diabetes mellitus and has been receiving regular insulin according to capillary blood glucose testing four times a day. A carbohydrate-controlled diet has been prescribed but the client has been complaining of nausea and is not eating. On entering the client's room, the nurse finds the client to be confused and diaphoretic. Which action is appropriate at this time? a. Call a code to obtain needed assistance immediately b. Obtain a capillary blood glucose level and perform a focused assessment c. Stay with the client and ask the nursing assistant to call the physician for an order for intravenous 50% dextrose d. Ask the nursing assistant to stay with the client while obtaining 15 to 30 g of carbohydrate snack for the client to eat

C) Tall peaked T waves

The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq KCL in 1000 ml of 5% dextrose in water IV. Which of the following EKG patterns indicates to the nurse that the infusions should be discontinued? A) Narrowed QRS complex B) Shortened "PR" intervals C) Tall peaked T waves D) Prominent "U" waves

b. osmotic diuretics and corticosteroids

The nurse is caring for a client with a subdural hematoma. To reduce intracranial pressure (ICP), the nurse anticipates giving the following medications: a. loop diuretics and beta blockers b. osmotic diuretics and corticosteroids c. histamine 2 antagonists and antibiotics d. calcium channel blockers and anticonvulsants

C. Administer 10-15 grams of a carbohydrate

The nurse is caring for a patient whose blood glucose level is 55mg/dL. What is the likely nursing response? A. Administer a glucagon injection B. Give a small meal C. Administer 10-15 grams of a carbohydrate D. Give a small snack of high protein food

A) Decrease in level of consciousness

The nurse is performing a neurological assessment on a client post right CVA. Which finding, if observed by the nurse, would warrant immediate attention? A) Decrease in level of consciousness B) Loss of bladder control C) Altered sensation to stimuli D) Emotional lability

b. place a tablet under the tongue as soon as chest pain starts.

The nurse is teaching a client with angina about taking nitroglycerin (NTG) tablets. The nurse instructs the client to: a. take the tablet with a large glass of water. b. place a tablet under the tongue as soon as chest pain starts. c. call 911 if pain is not relieved after taking one pill. d. discard any tablets if produce a tingling sensation

a. receptive aphasia (Wernicke's aphasia)

The nurse recognizes that a client with an ischemic stroke in the temporal lobe may exhibit which of the following symptoms? a. receptive aphasia b. global aphasia c. personality changes d. mood swings

A. injecting 40 units air into the NPH, 10 units air into the regular, aspirate 10 units of regular, then aspirate 40 units NPH.

The physician orders 10 units regular and 40 units NPH insulin subcutaneously. The nurse prepares the injection by: A. injecting 40 units air into the NPH, 10 units air into the regular, aspirate 10 units of regular, then aspirate 40 units NPH. B. injecting air into the regular, air into the NPH, aspirating the NPH, then aspirating the regular. C. injecting air into the regular, aspirating 10 units regular, injecting air into the NPH, then aspirating 40 units NPH. D. aspirating 10 units regular, then aspirating 40 units NPH

HIPPA (Health Insurance Portability and Accountability Act)

The privacy of genetic information is covered under the _____ Act.

Prothrombin time (PTT)

The time it takes your blood to clot. Increased ______ may indicate liver damage but can also be elevated if you're taking certain blood-thinning drugs, such as warfarin.

a. penetrance

The varying degree to which a specific phenotype is displayed is called the? a. penetrance b. association c. expressivity d. homogeneity

Gene

This is a segment of DNA on the chromosome that is coded for a particular trait.

Codominance

This is a type of heredity where two dominant alleles are both fully expressed in a phenotype

cystic fibrosis

This is an autosomal recessive heredity disease that affects the respiratory and digestive systems.

Heterozygous

This is an organism that has two different alleles for the same genetic trait.

Chromosome

This is the structure in the cell nucleus that houses a cell's genetic information

Coup Contrecoup

Type of head injury As head is tossed back and forth, the brain impacts the front of the skull and then recoils to impact the back of the skull resulting in sheared tissue and crushed tissue in the front and back

Spironolcatone (Aldactone)

What diuretic is a potassium sparing agent that can also be used to treat MI and LVH?

c. Autosomal recessive

Upon completing a three generation pedigree in an affected male patient, it was noted by the nurse that his parents are both carriers for the disorder. What pattern of inheritance is most likely based on this information? No one else in his family is affected. a. Mitochondrial b. X-linked dominant c. Autosomal recessive d. Autosomal dominant

X-linked recessive

Upon completing a three generation pedigree in an affected male patient, it was noted by the nurse that one particular health condition is also seen in his sister and maternal grandmother. His parents are not affected. What pattern of inheritance is most likely based on this information? a. X-linked recessive b. X-linked dominant c. Autosomal recessive d. Autosomal dominant

Diagnostic Testing

Used to establish a diagnosis of a genetic disorder in an individual who is symptomatic or has had a positive screening test.

Labetolol (first line) Nifedipine Methyldopa

What 3 antihypertensive drugs are indicated for pregnant patients?

CAT Scan MRI CT Scan

What 3 tests are used to diagnose Parkinson's Disease?

1. How the test will be carried out (for example, a blood sample). 2. What the test results mean, including positive and negative results, and the potential for uninformative results or incorrect results such as false positives or false negatives. 3. Any physical or emotional risks associated with the test. 4. Whether the results can be used for research purposes.

What 4 main components must be explained and understood by the patient in order to receive an informed consent for genetic testing?

18.5-24.9 kg/m2

What BMI range is considered to be a healthy weight for the patient?

Crestor (rosuvastatin)

What HMG-CoA Reductase Inhibitor has a lower incidence of liver toxicity?

1. Levadopa 2. Carbidopa

What are 2 dopaminergic drugs used to treat Parkinson's Disease?

1. Pyridostigmine (Mestinon) 2. Neostigmine (Prostigmine) 3. Edrophonium Chloride (Tensilon)

What are 3 anticholinergic drugs used to treat Parkinson's Disease?

1. Renal disease 2. Vascular disease 3. Hyperaldosteronism

What are 3 diseases that can lead to secondary hypertension?

AST (10-40 U/ml) ALT (8-40 U/ml) GGT (0-30 (U/ml)

What are 3 primary liver function tests (LFTs)?

1. Minors 2. Other persons with limited capacity to consent (persons with disabilities) 3. Prisoners

What are 3 vulnerable populations at risk for invasion of privacy related to genetic test results?

1. Facial droop: Smile for me, show your teeth. 2. Arm drift: Close your eyes and hold out your arms in front of you for 10 seconds 3. Speech: Have the person say, "You can't teach an old dog new tricks" The Cincinnati Prehospital Stroke Scale

What are 3 ways a nurse can assess a patient for signs and symptoms of a stroke?

1. ROM exercises 2. Anti-spastic drugs: -Tizanidine (Zanaflex) -Baclofen (Lioresal) -Diazepam (Valium) -Dantrolene sodium (Dantrium) 3. Botox injection for focal spasticity

What are 3 ways to prevent and treat muscle contractions?

1. Benzodiazepines (first line) 2. Phenytoin 3. Barbiturates 4. Propofol

What are 4 categories of drugs used to treat seizures?

-Induce a negative sodium balance -Reduce dietary salt -Administer diuretics -Transjugular Intrahepatic Portosystemic Shunt

What are 4 effective interventions for getting rid of ascites fluid?

-Metabolizes glucose, proteins, fat -Stores vitamins, Fe, & B-complexes -Converts ammonia to a by-product -Begins the formation of bile

What are 4 functions of the liver?

1. Screen for liver infections, such as hepatitis 2. Monitor the progression of a disease, such as viral or alcoholic hepatitis, and determine how well a treatment is working 3. Measure the severity of a disease, particularly scarring of the liver (cirrhosis) 4. Monitor possible side effects of medications

What are 4 indications for liver function tests?

1. Large artery atherosclerosis 2. Cardio embolism 3. Small vessel occlusion 4. Strokes of other determined etiology

What are 4 major causes for an ischemic stroke?

1. Glyburide 2. Metformin (Glucophage) 3. Avandia 4. Actos

What are 4 types of oral hypoglycemics?

1. Preventing falls 2. Maintaining adequate nutrition 3. Staying active 4. Managing stress 5. Dealing with emotions and mood changes

What are 5 areas of concern for family caregivers caring for a post-stroke patient that should be addressed in the discharge plan of care?

1. Age (<60 or >60) 2. BP goal (<150/90 or <140/90) 3. Is the patient diabetic? 4. Does the patient have renal disease? 5. Ethnicity 6. Patient's response to drug and dose

What are 6 factors that determine the patient's individual treatment algorithm for hypertension?

-Increased sympathetic nervous system activity -Increased renal absorption of Na/Cl/H20 -Increased activity of the RAAS -Decreased vasodilation -Arteriosclerosis (caused by stress, poor diet, smoking) -Insulin resistance

What are 6 other factors that can contribute to hypertension?

1. Arrhythmia 2. Hyperglycemia 3. Coagulation 4. DVT 5. Level of consciousness 6. Pain

What are 6 things the nurse should monitor a post-stroke patient for?

-Pruritus -(Dependent) Edema -Bleeding -Vitamin deficiencies (iron, B12, B6, D1) -Glucose abnormalities (very, very high after a meal, very, very low while fasting) -Rash (spider angiomas due to portal HTN)

What are some come signs and symptoms that may indicate a hepatic disease or disorder? (6)

-Tremors or shaking in hands, arms, legs, jaw, and face -Pill rolling -Rigidity or stiffness of limbs and trunk (Akinesia) -Slowness of movement (Bradykinesia) -Difficulties with balance, speech, and coordination -Blank facial expression -Shuffling steps and gait -Restlessness

What are some common signs and symptoms of Parkinson's Disease?

1. Hypotension 2. Symptoms associated to hyperglycemia 3. Dehydration 4. Altered level of consciousness

What are some common signs and symptoms of hyperglycemic hyperosmolar syndrome (HHS)? (4)

1. Interfere with oral contraceptives 2. Can increase lipids 3. Severe risk of edema related to fluid retention 4. Mild risk of hypoglycemia

What are some complications associated with Pioglitizone (Actos) and rosiglitizone (Avandia)? (4)

-Pressure ulcers -Poor nutrition -Urinary incontinence -Bowel control -Increased risk of nosocomial infection -Cerebral edema -Increased intracranial pressure -Seizures -Hemorrhage -Increased fall risk

What are some complications in post stroke patients?

-Detection rate (IEx. Factor V Leiden (one mutation tested, Cystic Fibrosis carrier screening (~25 - >100 "common" mutations BRCA1/2 (sequencing entire gene and del/dup) -Technology and quality varies lab to lab - easy testing option not necessarily the best -Inconclusive rates -Reclassification criteria

What are some complications related to genetic testing results?

1. Early signs of large cerebral infarct, edema, hypodensity, mass effect, obliteration of sulci in more than one third of middle cerebral artery territory on CT scan 2. NIH Stroke Scale score greater than 22 3. Difficult-to-control hypertension (Systolic BP >220 or diastolic BP >120) 4. Age 85 or older (dependent on doctor) 5. History of arteriovenous malformation or aneurysm

What are some contraindications for tPA therapy? (5)

1. Liver impairment 2. Renal impairment 3. Patients with dyslipidemias 4. Patients receiving IV contrast 5. Patients that have made antibodies against metformin

What are some contraindications of Metformin?

1. Asthma/COPD 2. Heart Block 3. Patients with elevated lipids 4. Diabetic patients

What are some contraindications of beta blockers (4)?

-Surgery to remove hematoma -ICP monitoring and management -Ventriculostomy -BP management -Intubation

What are some emergency management/treatments for an intracerebral hemorrhage?

-Brown eyes -Polydactyly -Alpha-1 antitrypsin (iron overload) -Huntington disease -Marfan syndrome (connective tissue disorder) -Neurofibromatosis

What are some examples of autosomal dominant genes?

-Treat pain (morphine sulfate or fentanyl) -Regulate body temperature (normothermia) -Sedation (to prevent HTN) -Position the head midline and elevated 30-45 -Administer Mannitol (diuretic) to prevent hypervolemia -Decrease noxious stimuli (to prevent increasing ICP related to autonomic nervous system functions)

What are some first level approaches for managing elevated ICP? (6)

-Proactive management -Enhanced/ earlier screenings -Risk reduction (lifestyle, medicine, surgery) -Family planning (identifying recessive risks) -Personalized medicine

What are some implications for genetic testing in adults? (5)

-Relationships -Current age/age of death -Age of onset of symptoms -Age of diagnosis -Genetic testing performed/results

What are some important things to document and update in a family pedigree chart?

-Bedrest -Blood pressure monitoring and control (i.e. Nitroprusside, metoprolol to maintain SBP < 150) -Surgical clipping -endovascular coiling

What are some management and prevention interventions that should implemented to prevent a "rebleed" in a head trauma patient?

-Atrial fibrillation (related to poor medication compliance to treat existing disease i.e. hyperthyroidism) -Cardiac disease -Carotid disease -Cigarette smoking -Cocaine abuse -Diabetes mellitus -Heavy alcohol use -Dyslipidemia -Hypertension -Physical inactivity & obesity

What are some modifiable risk factors for an ischemic stroke?

-Barbiturates -Hypothermia (helps control brain swelling) -Controlled hyperventilation (oxygen perfusion) -Decompressive craniectomy

What are some more aggressive (second level) approaches for managing elevated ICP? (4)

-African-American ethnicity -Older than age 65 -Female gender -History of stroke, heart attack, or TIA -Sickle cell disease

What are some non-modifiable risk factors that increase a person's chance of having an ischemic stroke?

1. Assess renal function - most of the diuretics depend on normal healthy kidney function to work 2. ALWAYS look at potassium and renal labs prior to administration 3. Assess patient's hydration status (diuretics can cause dehydration and volume depletion)

What are some nursing indications to consider for a patient prescribed a diuretic? (3)

-Identifying medication that will treat symptoms without trial and error -Treating mental health conditions -Personalizing dosage/ frequency -Identifying metabolism (Slow vs. Rapid metabolizers)

What are some of the benefits of pharmacogenetics?

-Birth defects -Alcohol abuse -Chronic HBC and HCV infection -Hemochromatosis -Cirrhosis

What are some of the causes of liver cancer (hepatocellular carcinoma (HCC))?

-Loss of consciousness -Lucidity -Altered mental status

What are some of the classic signs that present with an epidural hematoma?

-Liver enlargement (observed via U/S and CT scan) -Will show liver nodules as well. -Portal hypertension -Ascites -Peritonitis -Greater infection risk -Esophageal varices -Edema -Mental changes

What are some of the clinical presentations of hepatic cirrhosis?

-Elevated BP on physical exam -Vascular damage -Enlargement of the optic disc and retinal damage evident during fundal exam -Angina -Increased BUN/Creatinine -Left Ventricular Hypertrophy

What are some of the clinical presentations of hypertension? (6)

If a CDT (carbohydrate deficient transferrin) test comes back positive, it indicates chronic alcohol behavior. Alcohol interferes with normal liver production of transferrin and the normal binding of carbohydrate side chains to the transferrin molecule.

What does a positive CDT test indicate?

-Interpretation (Positive, negative, inconclusive) -Communicating to patient the importance of cascade testing -Encourage having other relatives tested to determine inheritance and refining risks -Full disclosure of result -Explaining VUS and what it means -Following the clinic's VUS policy of recontacting patients

What are some of the clinician's responsibilities for a patient receiving genetic testing?

It can help identify common health conditions (diabetes, heart disease) and focused diseases/disorders (i.e. cancers, birth defects, etc.)

What are some of the purposes for using a pedigree chart?

-Medications (i.e. sedatives, pain medications, illicit drugs) -Preexisting dementia -Language barriers

What are some other factors that may alter a person's Glascow Coma Scale score?

-More nutritious school lunches -More scheduled time for physical activity -Weight loss and physical activity programs -Healthier lifestyle education

What are some preventative measures schools are taking to prevent childhood obesity?

-Blood -Saliva/ buccal -Skin biopsy -Fetal cells (free circulating, amniocytes, chorionic villi)

What are some types of samples that can be used for genetic testing?

portal hypertension

What are spider angiomas caused by?

1. Compensated- signs and symptoms present, but reports are vague. (i.e. unexplained nosebleeds, mild fever, vascular changes, skin changes) 2. Decompensated- symptoms worsen Jaundice, ascites, bleeding worsens

What are the 2 main presentations of hepatic biliary cirrhosis?

1. hypertension 2. bradycardia 3. irregular respirations (decreased)

What are the 3 classic signs of increased intracranial pressure? (Cushing's triad)

1. Alcoholic - scar tissue surrounds the portal areas 2. Post-necrotic - diffuse scarring 3. Biliary - scarring near biliary ducts

What are the 3 types of hepatic biliary cirrhosis?

1. Hemolytic (from increased RBC destruction) 2. Hepatocellular (damage to the liver hinders its ability to properly filter) 3. Obstructive (extra-hepatic obstructions caused by occlusion of the bile duct)

What are the 3 types of jaundice?

1. ACE inhibitors (ACE-I) 2. Angiotensin receptor blockers (ARB) 3. Thiazide diuretics 4. Calcium channel blockers (CCB)

What are the 4 initial drug classes of choice for hypertension?

1. Facial Droop 2. Arm Drift 3. Slurred speech/difficulty speaking

What are the 4 major signs a person may exhibit that indicate they are having a stroke?

1. Obtaining pertinent personal and family medical history information (genetic pedigree) 2. Risk assessment 3. Patient education 4. Patient counseling

What are the 4 primary components of genetic counseling?

1. Implement lifestyle modifications and set BP goal 2. Set BP goal, initiate BP-lowering medication based on algorithm 3. Reinforce lifestyle and adherence Titrate medications to maximum doses or consider adding another medication (ACEI, ARB, CCB, Thiazide) 4. Reinforce lifestyle and adherence Add a medication class not already selected (i.e. beta blocker, aldosterone antagonist, others) and titrate above medications to max 5. Reinforce lifestyle and adherence Titrate meds to maximum doses, add another med and/or refer to hypertension specialist

What are the 5 basic steps for the treatment algorithm of hypertension?

1. Abdominal Obesity 2. Elevated Triglycerides 3. Low HDL Cholesterol 4. Hypertension (Borderline Hypertension) 5. Fasting Hyperglycemia

What are the 5 defining criteria of metabolic syndrome?

1. Respect for patient autonomy 2. Non-maleficence 3. Beneficence 4. Justice 5. Veracity (truthfulness) 6. Cultural sensitivity 7. Non-directiveness

What are the 7 principles of genetic counseling?

Total Cholesterol: < 200 mg/dL LDL: < 100 mg/dL HDL: > 40 mg/dL Triglycerides < 150 mg/dL

What are the desirable cholesterol levels for the following: Total cholesterol LDL HDL Triglycerides

1. Linear skull fracture (most common) 2. Depressed skull fracture 3. Diastatic skull fractures 4. Basilar skull fracture

What are the four major types of skull fractures?

1. Loss of consciousness of < 30 minutes 2. Any loss of memory, confusion 3. Any alteration in mental status at time of accident 4. Observed signs of other neurological dysfunction

What are the inclusion criteria for mild traumatic brain injuries? (4)

-Obtain informed consent -Be prepared to counsel on the result of the test you ordered. (If you don't know - REFER!) -Update patient's family history every year and offer updated testing as it becomes available -Educate patient about re-referral testing

What are the nurse's responsibilities when caring for a patient that is receiving genetic testing? (4)

Pre-meal 105mg/dl or less Post-meal 130mg/dl or less

What are the pre-meal and post-meal treatment goal values for a patient with gestational diabetes?

1. Blunt 2. Penetrating

What are the two main mechanisms of injury for head traumas?

1. Ischemic (most common) 2. Hemorrhagic

What are the two major types of strokes?

1. Primary 2. Secondary (90% of HTN cases)

What are the two types of hypertension?

1. Duchenne Muscular Dystrophy 2. Hemophilia A 3. Color Blindness

What are three X-linked recessive disorders?

-Clonidine (Catapres) -Hydralazine -Minoxidil

What are three more potent drugs used to treat hypertension?

1. Pregnancy (Category C drug) 2. Renal Disease

What are two contraindications for ACE Inhibitors?

Triamterene (Dyazide) & Hydrochlorothiazide (Maxzide)

What are two drugs used synergistically to treat hypertension and reduce and to help maintain the patient's potassium levels?

1. Hyperkalemia 2. Angioedema Symptoms should be treated similarly to how you would treat allergy symptoms (i.e. Benadryl & Prednisone).

What are two major side effects of ACE Inhibitors? How should they be treated?

D. In HHNS, blood pH tends to drop

What is NOT true of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) compared to diabetic ketoacidosis (DKA)? A. HHNS is found mainly in Type II Diabetes B. Both have high levels of hyperglycemia C. Both typically are treated with insulin D. In HHNS, blood pH tends to drop

Patients with angle-closure glaucoma

What is a contraindication for Levadopa?

Increased risk of pre-eclampsia (HTN crisis)

What is a risk associated with gestational diabetes?

60-100 mmHg Pressure should be above 50mmHG or the patient could have irreversible neurological damage.

What is normal cerebral profusion pressure?

Non-contrast cranial CT scan

What is the "gold standard" for diagnosis of a patient with a head injury?

Primary Billiary Cholangitis (autoimmune)

What is the antimitochondrial antibodies test (AMA) used to help detect?

Rupture of the aortic arch

What is the biggest concern for patients with Marfan's syndrome?

The patient has three consecutive high BP readings in a row.

What is the general rule of thumb (wait period) before diagnosing a patient officially with hypertension?

intracranial hemorrhage

What is the main complication of IV tPA therapy for a stroke patient?

normal pressure is 5 to 15 mm Hg

What is the normal range for intracranial pressure (ICP)?

-Teach and helping them manage hypertension -Encouraging and assessing pharmaceutical agent compliance -Encouraging lifestyle modifications -Assessing treatment success -Educating patient about adverse effects/side effects of medications -Preventing adverse events -Maintaining a cost efficacious approach

What is the nurse's responsibility when caring for a patient with hypertension?

Anti-HBc (Core antibody, IgM) usually presents in the acute phase and indicates that the virus is actively destroying liver Anti-HBs (Surface antibody) can presents as 'positive' if the person developed antibodies from an immunization from a vaccine or if they were previously exposed to Hepatitis B and the infection has resolved.

What is the primary difference between Anti-HBc (Core antibody, IgM) and Anti-HBs (Surface antibody) in an antibody test?

Lowers total peripheral resistance

What is the primary mechanism of action for an Angiotensin Converting Enzyme Inhibitor (ACE-I)?

The build of of serum ammonia.

What is the primary reason patients experience mental changes that occur with hepatic cirrhosis?

Hormonal Changes. Pregnancy related hormones actually decrease glucose production directly, however, the increase in body fat, delayed gastric emptying, and increased appetite during the course of the pregnancy contribute to the development of a hyperglycemic state.

What is the root cause of gestational diabetes?

Systolic: 140-159 Diastolic: 90-99

What is the systolic range and diastolic range for a patient with Stage I Hypertension?

Systolic: >160 Diastolic: >100

What is the systolic range and diastolic range for a patient with Stage II Hypertension?

1. Age 18 years or older 2. Clinical diagnosis of ischemic stroke with measurable neurologic deficit 3. Clearly defined time of onset of stroke within 180 minutes 4. Systolic BP <220 or diastolic BP <120 5. No evidence of intracranial hemorrhage or mass on baseline CT 6. Neurology consult 7. If possible, informed consent

What is the tPA administration criteria? (7)

CDT (Carbohydrate deficiency test)

What lab test can be used to indicate a patient's chronic alcohol behavior?

5' Nucleotidase

What lab test is done to confirm primary biliary cirrhosis?

Blood serum potassium

What lab value should the nurse always check before administering spironolactone?

GGT (gamma glutamyl transferase)

What liver function test is the most sensitive test - levels show elevation the quickest after exposure to alcohol or liver toxic drugs?

1. Gender 2. Body Fat vs. Muscle 3. Ethnicity 4. Age (elderly have less muscle mass)

What other factors might contribute to a person's BMI?

< 200

What should a Type II diabetic's postprandial blood glucose be?

1. Fluid replacement (0.9 or 0.45 NS) 2. Insulin administration - usually IV 3. Rehydration itself can help correct elevated glucose, sodium levels. 4. Electrolyte correction, especially K+ (F.I.R.E.) When glucose lowers, IV insulin may continue with IV Dextrose.

What should the nurse consider when managing a patient with hyperglycemic hyperosmolar syndrome (HHS)?

liver functions. Statins can be liver toxic and therefore, serial liver function tests should be conducted.

What should you check regularly if a patient is on a statin?

d. Translocation

What term refers to the process where unequal crossing over or abnormal segregation of homologous chromosomes results in a chromosome having a missing segment? a. Deletion b. Duplication c. Inversion d. Translocation

-History and physical -CBC, chemistry, coagulation studies, cardiac biomarkers -ECG -CT scan of the head -MRI -Electroencephalogram -Echocardiography, angiography

What tests and results are used to diagnose a stroke? (7)

Anticholinergics and Dopaminergic drugs

What two drug classes are used to treat Parkinson's Disease?

Alcohol affects ALT and AST.

What two liver enzymes does alcohol primarily affect first?

Spironolactone (Aldactone)

What type of diuretic would be the most effective at removing ascites fluid and maintaining normal potassium levels?

Hepatitis B Hepatitis C Hepatitis D

What types of Hepatitis are considered to be chronic?

d) The recurrence risk for the disease usually increases more rapidly in remotely related individuals

Which of the following is NOT true of the criteria for recurrence risk which indicate that a trait shows multifactorial inheritance? a) The recurrent risk is higher if more than one family member is affected b) If the expression of the disease in the proband is more severe, the recurrence risk is higher c) The recurrence risk is higher if the proband is of the less commonly affected sex d) The recurrence risk for the disease usually increases more rapidly in remotely related individuals e) If the prevalence of the disease in a population is "f", the risk for offspring and sibling probands is approximately the square root of "f"

c) Phenylketonuria (PKU)

Which of the following presents with retardation and requires limiting intake of a particular amino acid? a) Classical galactosemia b) Von Gierke disease c) Phenylketonuria (PKU) d) Cystinuria disease (Medium-chain acyl- coenzyme A dehydrogenase (MCAD) disorder

D. They affect males and females equally

Which statement made by a parent indicates correct understanding of autosomal recessive genetic disorders? A. They affect males greater than females B. Affected males can only have carrier daughters C. An affected child will always have an affected parent D. They affect males and females equally

Genetically speaking, they have a more active RAAS that might lead to the HTN because they are retaining more salt & water.

Why are African American and Hispanic males more at risk for hypertension?

They will always produce enough insulin to prevent DKA.

Why are Type II Diabetic patients never at risk of developing DKA?

Beta blockers inhibit beta cells in the pancreas which inhibits their ability to produce insulin. Lack of insulin can lead to hyperglycemia.

Why are beta blockers contraindicated in diabetic patients?

They affect cholesterol synthesis which increases circulating cholesterol and can increase risk of atherosclerosis.

Why are beta blockers contraindicated in patients with elevated lipids?

They are safer and have less risk for infection.

Why are laproscopic sleeves preferred over an open bypass procedure for bariatric patients?

Metformin has no effect on insulin or insulin production. Therefore it also is contraindicated in Type I Diabetics.

Why are patients receiving Metformin therapy not at risk for hypoglycemia?

We see gout more often in the summer because there is a greater risk for dehydration (due to weather) and therefore volume depletion (via sweating) increases their risk of Gout.

Why are patients receiving diuretic therapy more at risk for gout, especially during the summer?

Impaired liver function and bile salt synthesis of Vitamin K leads to decreased absorption and Vitamin K deficiency. Vitamin K is necessary for the synthesis of multiple clotting factors.

Why does bleeding (thrombocytopenia) occur in in patients with significant liver disease?

There are not many "outward signs" and many patients don't even know they are infected.

Why does hepatitis spread so quickly?

To offset potential hyperkalemia caused by spironolactone and maintain electrolyte balance.

Why is Lasix given for a patient in conjunction with spironolactone?

Poor glucose control can lead to microvascular damage. This can be a contraindication for tPA treatment and increase the patient's risk of experiencing another stroke.

Why is glucose control an important factor for treating a person experiencing a stroke?

Bile retention due to an underlying disease causes a build up of bilirubin. Bilirubin build up in the skin can trigger mast cells to release histamine causing the pruritus.

Why is pruritus a common sign of a hepatic disorder/disease?

Since vitamin K synthesis and absorption is hindered by impaired hepatic function, there are very few clotting factors to help stop bleeding.

Why is there so much bleeding involved with esophageal varices?

Non-Sulfonylurea Insulin Secretors are safe for patients with sulfa allergies because they do not have sulfa in them like Glucotrol and other sulfonylurea insulin secretor drugs have.

Why would a patient with Type II diabetes be prescribed Prandin or Starlix instead of Glucotrol?

Primary Biliary Cirrhosis (PBC)

____ is caused by an immune system attack on the small bile ducts within the liver by antimitochondrial antibodies (AMAs). Damaged bile ducts cause scarring, which can lead to liver failure. This condition also brings an increased risk of liver cancer.

Blood pressure (CO x PVR = BP)

____ is the product of cardiac output multiplied by peripheral resistance.

L-lactate dehydrogenase (LD)

_____ is an enzyme found in the liver. Elevated levels may indicate liver damage but can be elevated in many other disorders.

Endovascular coiling

_____ is when a catheter is inserted into the femoral artery, up to aneurysm and then fine platinum filaments are inserted to block further flow of blood into the weakened artery.

p53 gene

_____ mutations are found in more than half of all human cancers

Lewy body dementia (LBD)

______ is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behavior, and mood. -One of the most common causes of dementia.

Aspiration pneumonia

______ is the most common cause of non-neurologic death post-stroke.

Gamma-glutamyltransferase (GGT)

_______ is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage.

Bilirubin

________ is a substance produced during the normal breakdown of red blood cells. It passes through the liver and is excreted in stool. Elevated levels might indicate liver damage/disease or certain types of anemia.

Cardiac output (CO=HR x BV)

________ is the product of heart rate multiplied by volume.