Final Exam Review

1. viral

The only way to treat ___1___ meningitis is to treat the symptoms such as dehydration, shock, and seizures

1. right lower quadrant 2. guarding 3. rebound tenderness

The pain associated with appendicitis can start in the epigastric/periumbilical area are and the progress to the __1__. The patient may shows signs of __2__ and __3__.

1. dull 2. gnawing 3. burning

The pain associated with gastric ulcers is usually described as a __1__, __2__ pain or a __3__ sensation in the midepigastrium of the back.

1. 100 2. 125 3. impaired fasting blood glucose (IFG)

The prediabetes range for fasting blood glucose is ___1___ mg/dL to ___2___ mg/dL. this is referred to as ___3___.

1. desmopressin

The prototype ADH hormone is __1__

Acarbose (Precose)

The prototype drug for alpha-glucosidase inhibitors

Canagliflozin (Invokana)

The prototype drug for sodium-glucose co-transporter 2 inhibitor (SGLT2)

Liraglutide (Victoza)

The prototype for GLP-1 Receptor agonist

1. similar

The symptoms and treatment of hiatal hernia are relatively __1__ to those of GERD

1. polyuria 2. polydipsia 3. polyphagia

The three main signs of type 1 diabetes are

1. dyspnea 2. fatigue 3. weakness 4. cough 5. palpitations

The three most common symptoms of mitral regurgitation are ___1___, ___2____, and ____3____. The patient may also have ___4___ (from pulmonary congestion) and ____5____.

1. fluid & electrolyte balance 2. pain management

The two big items for management of gallstones are __1__ and __2__.

1. Antidiuretic Hormone (aka vasopressin) 2. oxytocin

The two hormones the posterior pituitary releases

1. TSH (thyroid-stimulating hormone) 2. free T4 3. low

The two labs that are usually checked when looking for hypothyroidism or hyperthyroidism are __1__ and __2__. They have an inverse relationship, so when one level is high, the other is __3__.

1. resistance 2. secretion

The two main problems related to insulin in type 2 diabetics is insulin ___1___ and impaired insulin ___2___

dex suppression test

This is a test that is performed to check for Cushing's syndrome. Dexamethasone is administered, so the bodies normal response should be to decrease cortisol production. When the negative feedback loop is messed up due to the syndrome, the cortisol levels do not decrease even after administration of the dex.

1. total gastrectomy

This surgery removes the entire stomach and duodenum, lower portion of the esophagus, and supporting lymph nodes. The jejunum is then anastomosed to the remainder of the esophagus.

1. the elderly 2. IV drug users 3. prosthetic heart valves 4. cardiac devices 5. structural heart defects

Those at high risk for infective endocarditis include ___1___, ____2___, and people with ___3___, ___4____, and ___5____.

Skin fragile Truncal obesity Round face (moon face) Ecchymosis & Elevated BP Striae (purple) of extremities & abdomen Sugar high (hyperglycemia) Excessive body hair (hirsutism) Dorsocervical fat pad & Depression

To remember symptoms of Cushing's syndrome, remember the mnemonic "STRESSED"

1. fludrocortisone (Florinef) 2. sodium

To replace mineralocorticoids (aldosterone) longterm, the patient will be prescribed __1__. The patient needs to ensure they maintain adequate intake of __2__.

1. peptic

Too much cortisol can cause issues with __1__ ulcers

1. levothyroxine (Synthroid) 2. T4 thyroid hormone

Treatment for hypothyroidism is typically done through medication. The patient is prescribed __1__ which is a synthetic __2__.

1. autoimmune 2. beta 3. injectable insulin

Type 1 diabetes is a __1__ process where around 80% of __2__ have been destroyed at the time of diagnosis. It has a relatively rapid onset and the only treatment is __3__.

1. mucosal 2. submucosal 3. rectum 4. left side

Ulcerative colitis affects only the __1__ and __2__ layers of the entire length of the colon. It starts in the __3__ and works its way upward. Patient will often first present with pain on their __4__.

1. ketones 2. 240

Urine should be checked for __1__ in patients when their blood sugar rises above __2__ mg/dl

1.010-1.025

Urine specific gravity normal range

Medical nutrition therapy (MNT)

Use of specific nutritional therapies to treat an illness, injury, or condition.

3. Cluster A person with a cluster headache has pain on one side of the head, usually behind the eye, accompanied by nasal congestion, rhinorrhea (watery discharge from the nose), and tearing and redness of the eye. The pain is so severe that the person is not likely to lie still; rather he or she paces or thrashes about. The symptoms in the scenario do not describe a sinus headache.

While the nurse is making initial rounds after coming on shift, you find a client thrashing about in bed complaining of a severe headache. The client tells the nurse the pain is behind the right eye, which is red and tearing. What type of headache would the nurse suspect this client of having? 1. Migraine 2. Tension 3. Cluster 4. Sinus

1. bruit

You pay be able to auscultate a __1__ over the portal vein in a patient who has portal hypertension.

1. 1/8th inch

You want the pouching system to hug the stoma, but you don't want it to be touching. there should be about __1__ of space between the stoma and the system.

1. loperamide (Imodium) 2. alosetron (Lotronex) 3. dicyclomine (Bentyl)

__1__ and __2__ are used to control diarrhea in patients with irritable bowel syndrome. An anticholinergic/antispasmodic such as __3__ might be used. Antidepressants may also be used to manage depression and pain.

1. radiation 2. chemo

__1__ and __2__ can be used to reduce the size/growth of esophageal cancer/tumors. it may be used along with surgical resection.

1. Sulfonylureas 2. beta cells

__1__ are a class of drug that stimulates the production and release of insulin. It is used in type II diabetics and requires functioning __2__ to work.

1. pheochromocytoma 2. epinephrine 3. norepinephrine 4. blood pressure 5. heart rate 6. cardiac

__1__ is a tumor of the adrenal medulla which causes the excess of production of the catecholamines __2__ and __3__. This ramps up sympathetic body processes (fight or flight) such as increased __4__, __5__, and __6__ output.

1. education

__1__ is the biggest component of treatment of diabetes.

1. 75 2. colon resection 3. "cobblestone"

__1__% of patients with Crohn's disease may need surgery for complications. A __2__ can be performed to remove the diseased bowel, but recurrence is possible due to it be difficult to remove all of the diseased tissue due to it's __3__ nature

1. thyroid storm 2. tachycardia 3. hypertension

___1__ is a severe complication of hyperthyroidism. There are serious cardiac concerns due to __2__ and __3__.

1. myxedema coma

___1__ is a severe complication of hypothyroidism.

1. hyperglycemic hyperosmolar syndrome (HHS) 2. higher 3. comorbidities 4. rehydrating 5. IV insulin 6. potassium

___1__ is a variant of DKA that is seen in type 2 diabetics and the elderly. It has the same precipitating factors as DKA. Mortality is ___2__ due to ___3___. It is treated similarly to DKA by ___4___, giving ___5____, and watching ___6___ levels.

1. blood 2. urine

___1__ tests can be used to measure circulating serum level of hormones, and ___2___ tests can measure amount of hormones of hormone "end products" excreted from the body.

1. unstable 2. rest 3. nitroglycerin

___1___ angina has an unpredictable frequency and may or may not be relieved by ___2___ and/or ___3___

1. stable 2. rest 3. nitroglycerin

___1___ angina is predictable and is relieved by ___2___ and/or ___3___.

1. HgbA1c 2. 3 months

___1___ is a test that reads the percentage of hemoglobin with glucose attached in red blood cells, gives a snapshot of the patients blood glucose control over the past ___2___.

1. hypertensive crisis 2. organ failure

___1___ is an extreme elevation of blood pressure that puts the patient at risk for ___2___. it is an emergency that requires immediate and severe response.

1. self-monitored blood glucose

___1___ is an important way for type 1 and type 2 diabetics to manage their disease and ensure they are tracking their glucose levels.

1. infective endocarditis

___1___ is an inflammation of the inner layer of heart tissue as a result of an infectious microorganism, commonly develops in people with prosthetic heart valves, cardiac devices, or structural cardiac defects.

1. blood

___1___ is an irritant to brain tissue

1. encephalitis 2. herpes simplex virus

___1___ is inflammation of the brain tissue, most commonly caused by ___2___

1. pouch 2. bridge

a Loop colostomy is more difficult to __1__ than a normal colostomy. A plastic __2__ is placed underneath to help hold it in place until the incision heals.

1. cluster

a ___1___ headache can have 1-8 per day, each lasting 15 minutes to 3 hours. It is an excruciating pain behind the eyes, is medically treated with high flow oxygen administration

1. tension

a ___1___ headache is the most common type of headache, is bilateral, non-throbbing, and feels "band-like."

1. distal ileum 2. 6 3. B12 4. anemia

a bowel resection is a resection of the __1__. Diarrhea is common for __2__ weeks after the procedure. The patient will have decreased absorption of __3__, and decreased digestion of fat, protein, and glucose. __4__ is also common.

1. GI upset 2. diarrhea

a common side effect of biguanides (metformin) is ___1___ and ___2___.

hiatal hernia

a condition where the opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the lower portion of the thoracic cavity.

GERD (gastroesophageal reflux disease)

a fairly common disorder marked by backflow of gastric or duodenal contents into the esophagus that causes troublesome symptoms and/or mucosal injury to the esophagus

Ventilator-associated pneumonia (VAP)

a health care-acquired infection (HAI) that develops in a person requiring invasive mechanical ventilation (via endotracheal intubation or tracheotomy tube) for at least 48 hours

comatose

a level of consciousness consisting a state of unresponsiveness, even to stimuli. A person in a this state may lack a gag reflex or a pupillary response

Stuporous

a level of consciousness consisting of a level of impaired consciousness in which a person only minimally responds to painful stimulation, such as pinching the toe or shining a light in the eyes.

alert

a level of consciousness consisting of a patient is awake, aware, and responsive to stimuli.

Obtunded

a level of consciousness consisting of reduction in alertness with slow responses to stimuli, requiring repeated verbal stimulation to maintain attention, as well as having prolonged periods of sleep, and drowsiness between these periods.

lethargic

a level of consciousness described by severe drowsiness, listlessness, and apathy accompanied by reduced alertness. patient often needs a gentle touch or verbal stimulation to initiate a response

Urine osmolality

a measure of the solute concentration of urine, a more exact measurement of urine concentration than specific gravity

1. International normalized ratio (INR) 2. 2-3.5

a patient on warfarin therapy will have their ___1___ lab values measured to ensure they remain within the therapeutic range. In general, the therapeutic range for someone on warfarin therapy is ___2___ although it can vary slightly depending on circumstances.

1. tuned on their side. 2. very high

a patient who has been administered glucagon will most likely vomit, so they should be __1__ to prevent aspiration. Their blood sugar will most likely become __2__, but that is expected and will self correct in time.

focal seizure

abnormal electrical activity that occurs in one or more parts of one brain hemisphere; partial seizure

Hypertension

abnormally high blood pressure, systolic pressure is >130 OR diastolic >80

1. breakdown 2. absorption 3. carbohydrates 4. three times daily

acarbose works by slowing intestinal __1__ and __2__ of __3__. It is normally taken __4__.

diabetic ketoacidosis

acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat for energy (the byproduct of which is ketones)

1. blood pressure 2. slow 3. bounding

acute increases of ICP can cause an increase in ___1___ and a ___2___ ___3___ pulse

1. sulfasalazine (Azulfidine) 2. aspirin 3. sulfa drugs 4. mesalamine (Asacol)

aminosalicylates such as __1__ are used to help control ulcerative colitis. Patient does need to be screened for allergies to __2__ or __3__. Another medication in the class called __4__ is similar but has less side effects.

transsphenoidal hypophysectomy

an endoscopic procedure to remove a pituitary tumor where an incision is made through the sphenoid sinus (transsphenoidal) without disturbing brain tissue. basically going into the brain through the nose.

Ischemia

an inadequate blood supply to an organ or part of the body

1, inflammation

calcitonin salmon can be administered as a nasal spray, patients should be aware that is can cause __1__ of the nares.

1. vitamin D compound.

calcitriol is also called __1__

Hormones

chemical messengers that are manufactured by the endocrine glands, regulate organ functions by acting on distant chemical receptors at tissues

1. bile salts 2. stool 3. cholesterol

cholestyramine (Questran) works by binding __1__ in the intestines so that it they can be excreted through the __2__. The medication is normally used to for lowering __3__.

Epilepsy

chronic brain disorder characterized by recurrent seizure activity

1. NPO until symptoms subside 2. IV fluids prn 3. nutrition therapy 4. blood transfusion (if anemic) 5. Monitor I&O 6. monitor labs (CBC/coags) 7. abdominal assessment (distension, rigidity, pain) 8. pain management 9. reduce anxiety 10. Antacids, H2 blockers, PPI's 11. Patient education

collaborative management of gastritis (11 items)

1. quiet, cool, dark 2. anti-nausea

comfort measures that can provided for headaches include placing them in a ___1___ room and giving ___2___ medications.

Serum Osmolality

concentration of particles in blood

nephropathy

damage to the capillaries of the glomeruli, it is the most common cause of ESRD.

1. long-acting insulin 2. hypoglycemia

dawn phenomenon can be treated by switching the patient to __1__, but you have to be careful not to overtreat and create __2__

1. 4-8 2. low blood sugar

dawn phenomenon is hyperglycemia that occurs between __1__am without a preceding __2__. It is possibly due to altered counterregulatory hormone levels.

1. epilepsy 2. asthma 3. hyponatremia

desmopressin should be used cautiously in patients who have __1__, __2__, or __3__.

1. side 2. fetal

during a lumbar puncture, the patient is typically positioned on their ___1___ in a ___2__ position in order to spread out their vertebrae.

polyphagia

excessive hunger

polydipsia

excessive thirst

1. low glycemic index

foods that cause low to moderate fluctuations in blood glucose are considered to be ___1___

1. tonic-clonic seizure 2. 5

generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups. it can be more dangerous f lasts for more than ___1__ minutes

1. 1 minute 2. 15 minutes 3. 20 minutes

glucagon has an onset of __1__, a peak of __2__, and a duration of __3__.

1. shellfish 2. iodine

having an allergy to ___1___ or ____2___ can make you more susceptible to contrast dye, and may be a contraindication depending on the severity.

pyrosis

heartburn, is a radiating pain

levothyroxine should be taken 30-60 minutes before breakfast with water on an empty stomach.

how should levothyroxine be taken

the heart

hyperkalemia can cause problems with this organ

1. parathyroid hormone (PTH) 2. hypocalcemia

hypoparathyroidism is caused by an absence of __1__, which leads to __2__.

1. 126

if the fasting blood glucose level is ___1___ mg/dL or greater, it indicates diabetes

1. warfarin

levothyroxine increases the effects of the medication __1__

Community-acquired pneumonia (CAP)

occurs in the community setting or within the first 48 hours of hospitalization.

1. 90

pheochromocytoma is very rare and over __1__% of them are benign.

on an empty stomach 30 minutes before eating

propylthiouracil and methimazole should be taken how?

metformin

prototype biguanide

1. glucose levels

somatropin can cause hyperglycemia, so __1__ needs to be monitored.

Striae

stretch marks

1. eating a snack 2. intermediate insulin

the Somogyi effect can be managed by ___1___ at bedtime, as well as administering ___2__ at bedtime

1. pain relief 2. abortive

the primary goal for managing headaches is ___1___ and providing ___2___ therapy ASAP.

1. chemo 2. radiation 3. surgery

treatment for gastric cancer is multimodal and may include __1__, __2__, and __3__.

200-800 mOsm/kg

urine osmolality normal range

How would the nurse assess for a mediastinal shift?

-Deviation of trachea to one side of the body

What should the nurse include in discharge teaching for a patient who has had pneumonia?

-all medications should be taken as prescribed and courses of treatment should be fully completed -education on all medications and possible side effects -symptoms that require contacting provider (difficulty breathing, worsening cough, recurrent/worsening fever, medication intolerance) -importance of returning for follow up examination -importance of adequate nutrition, hydration, and rest

Who is at risk for developing asthma?

-smokers -exposure to second hand smoke or other environmental pollutants -family history of asthma -personal history of eczema or allergies -history of severe respiratory infections -obesity -premature birth

1. issues with speech

1 sign of left MCA stroke

Why would a patient need a chest tube?

1. Remove air/fluid from pleural space 2. Prevent air/fluid from returning to the pleural space 3. Restore negative pressure within the pleural space to re-expand the lung

1. sensitive to cold 2. lethargic 3. dry skin 4. dry/brittle hair 5. weight gain 6. constipation 7. decreased heart contractility 8. increased atherosclerosis 9. apathy 10. menstrual irregularity

10 clinical manifestation of hypothyroidism

1. jaundice 2. clay-colored stool 3. tea-colored urine 4. pruritus (itching) 5. anorexia 6. nausea/vomiting 7. fatigue 8. RUQ pain/heaviness (due to hepatomegaly) 9. elevated liver enzymes 10. Anemia 11. bleeding

11 clinical manifestations of hepatic dysfunction

1. neomycin 2. lactulose

2 medications are used to decrease the bacterial production of ammonia in the GI system. __1__ (be cautious because it is nephrotoxic) and __2__

1. retinopathy 2. nephropathy

2 microvascular complications of diabetes

1. propylthiouracil (PTU) 2. methimazole (Tapazole)

2 prototype antithyroid drugs

1. bad visual problems 2. neglect of left side of the body (not weak, just forget it is there)

2 signs of right MCA stroke

1. H. Pylori test 2. EGD (gold standard)

2 types of diagnostic tests used to diagnose gastric ulcer

1. EGD 2. barium swallow 3. esophageal manometry

3 diagnostic test used to diagnose GERD

1. flushing of face and hands 2. nausea/vomiting 3. urinary frequency 4. inflammation at injection site (if injected)

4 adverse effects of calcitonin salmon

1. radiation sickness 2. bone marrow depression 3. hypothyroidism 4. Pregnancy category X

4 adverse effects of radioactive iodine

1. osteoporosis 2. pagets disease 3. renal failure 4. malignancies

4 causes of hypercalcemia other than hyperparathyroidism

1. headache 2. vomiting 3. hypoglycemia 4. acute pancreatitis

4. adverse reactions of Januvia

1. polyuria (large amounts of dilute urine) 2. polydipsia (excessive thirst) 3. dehydration 3. hypernatremia

4. clinical manifestations of diabetes insipidus

1. GHRH - Growth Hormone releasing Hormone 2. TRH - thyroid releasing hormone 3. CRH - corticotropic releasing hormone 4. PRH - prolactin releasing hormone 5. Somastatin - growth hormone inhibiting factor

5 hormones that are produced and released by the hypothalamus

1. flushing 2. throbbing 3. headache 4. hypotension 5. tachycardia

5 main side effects of nitroglycerin

1. liver failure (cirrhosis) 2. hepatic encephalopathy 3. portal hypertension 4. esophageal varices 5. ascites

5 major complications of severe liver dysfunction

1. bleeding 2. dumping syndrome 3. bile reflux 4. gastric outlet obstruction 5. pernicious anemia

5 post surgical concerns after a partial or total gastrectomy.

1. fever that doesn't get better in 2 days 2. vomiting or diarrhea for more than 6 hours 3. large amounts of ketones in urine 4. blood sugar over 240 (if on insulin or oral meds) 5. symptoms of DKA or dehydration

5 reasons a diabetic patient should call provider

1. chocolate 2. citrus fruits 3. caffeine 4. fried/fatty foods 5. garlic/onions 6. mint 7. tomato based foods

7 foods that can trigger GERD

1. avoid certain food triggers 2. consume small meals 3. don't eat/drink <2 hours prior to lying down in bed 4. elevate HOB 5. lose weight if overweight 6. avoid tobacco 7. avoid medications that irritate the esophagus or delay gastric emptying time.

7 lifestyle modifications that can be made to manage GERD

1. water intoxication 2. tremors 3. sweating 4. vertigo 5. headache 6. abdominal cramps 7. nausea/vomiting 8. nasal irritation (with nasal administration)

8 adverse effects of desmopressin

1. bile reflux from duodenum 2. blockage by gallstones 3. alcohol intake 4. obesity/high lipids 5. hypercalcemia (causes trypsin to be converted faster) 6. ductal trauma (like from ERCP to remove gallstones) 7. pancreatic tumor 8. some medications

8 causes of pancreatitis

1. fatigue 2. pyrosis after eating 3. belching 4. sour taste 5. intolerance to spicy food 6. pernicious anemia (B12 deficiency) 7. anorexia 8. nausea/vomiting

8 clinical manifestations of chronic gastritis

1. hyperactive reflexes 2. positive Chvostek's sign 3. positive Trousseau's sign 4. hypotension 5. abdominal cramps 6. tetany 7. bone pain 8. fractures

8 clinical manifestations of hypocalcemia

1. exophthalmos 2. eye drops/ointment 3. eye patch

A big complication of hyperthyroidism is __1__, which is where the eyes bulge out of their sockets. It is important to protect the corneas, so the patient may need __2__, may need to wear an __3___, or may even need to have decompression surgery in severe cases.

1. multivitamin

A patient who has inflammatory bowel disease may need a supplemental __1__ due to malabsorption of fat soluble vitamins.

1. iron

A patient who has inflammatory bowel disease may need supplemental __1__ if anemia is present

1. B12

A patient who has inflammatory bowel disease may need supplemental __1__ if their ileum is inflamed or removed.

1. 200 2. 126 3. 200 4. 5.8

ADA criteria for diagnosis of diabetes include: 1. symptoms of polyuria/polydipsia plus random glucose concentration __1__ mg/dl for higher 2. fasting blood sugar greater than __2__ mg/dl 3. 2 hour postprandial or glucose tolerance test of greater than __3__ mg/dl. 4. A1c level __4__ % or higher

1. more efficient

Activity/exercise are important for diabetics because it makes the body ___1___ in using insulin

1. ok in moderation 2. dehydration 3. awareness

Alcoholic beverages are ____1___, but hydration is important because they are at an increased risk for ___2___. The effects of alcohol can also decrease ___3___ of signs/symptoms.

1. 5.5% 2. 6.4% 3. lifestyle changes

An A1c result of ___1___ to ____2___ indicates prediabetes and an increased risk. This is the point where it is important to start having a discussion about decreasing risk through ___3___.

1. secondary infection

Antibiotics are used in patients with inflammatory bowel diseases to treat for __1__.

1. surgery 2. fluids 3. antibiotics

Appendicitis is usually fixed with __1__, but the patient may choose to treat with __2__ and __3__ if it has not ruptured yet.

1. urinary tract infection 2. dehydrated

Because Invokana helps you excrete more sugar in your urine, it increases the risk of __1__. You can also become __2__ because you are pulling a lot of water out of the body along with the sugar.

1. higher

Because thyroid hormones (T3 & T4) stimulate the bodies metabolic processes, the more thyroid hormones you have have circulating, the __1__ the bodies metabolic rate is.

1. oxygen demand 2. heart rate 3. impulses 4. blood pressure 5. contractility

Beta-blockers reduce myocardial ___1___ by blocking beta-adrenergic sympathetic stimulation to the heart. The result is a reduction in ___2___, slowed conduction of ___3___ through the conduction system, decreased ___4___, and reduced myocardial ___5___.

1. chronic pulmonary diseases 2. lungs 3. bronchoconstriction

Beta-blockers that are non-selective are generally contraindicated in patient with significant ___1___, because they can stimulate beta receptors in the ___2___ causing ___3___.

1. bone resorption

Bisphosphonates slow or block __1__ to lower calcium levels.

1. vitamin D

Calcitonin salmon can be combined with __1__ because it helps the body absorb calcium.

1. laparoscopically 2. open

Cholecystectomy (removal of gallbladder) can be performed either __1__ or __2__.

1. asymptomatic 2. congestive heart failure

Chronic mitral regurgitation is often ___1___ whereas acute mitral regurgitation usually manifests as severe ___2____

1. 50 2. 45 3. 40

Colonoscopy should be performed every 10 years for everyone starting at age __1__, except for African Americans who should start at age __2__. If someone has 2 primary relatives who had colorectal cancer before age 60, then they should start screening at age __3__ and repeat every 5 years. Other option in this scenario is to start at the age the family member was diagnosed minus 10 years.

1. 3rd 2. leading 3. polyps 4. colonoscopy

Colorectal cancer is the __1__ most common cancer in both men and women, and is the __2__ cause of cancer death in the US. Most colorectal cancers form from adenomatous __3__, which is why early screening via __4__ is so important.

1. glucose 2. sodium 3. fluid volume

D5NS is infused in a patient with Addisonian crisis because it works to replace __1__, __2__, and __3__ all at the same time.

1. head trauma 2. brain tumor/resection 3. irradiation of pituitary gland 4. failure of renal tubes to respond to ADH 5. phenytoin (Dilantin) 6. lithium 7. electrolyte

Diabetes insipidus can be caused by a secondary disorder such as __1__, __2__, __3__, or __4__. It can also be secondary to certain medications such as __5__ or __6__. DI can also be caused by a __7__ imbalance.

1. metabolic acidosis 2. slowly 3. rapidly 4. 300-1000

Diabetic ketoacidosis (DKA) is a type of severe ___1___ which can lead to diabetic coma. It can develop ___2___ or ___3___, and blood sugars can range from ___4___.

1. 10

Diabetics should limit their amount of simple sugars (sucrose) to no more than ___1___% of total caloric intake.

1. serologic 2. endoscopic biopsies

Diagnosis of Celiacs disease is based of of __1__ tests and __2__

1. high fiber 2. 6-8 glasses

Dietary modifications are an important part of managing diverticulitis. The patient should switch to a __1__ diet after inflammation has subsided. They also need to increase their fluid intake to __2__ of water per day

1. food diaries.

Dietary plans for patients with inflammatory bowel disease will be highly individualized. The patient should keep a __1__ in order to identify which foods are "problem" foods.

1. colonoscopy 2. CT 3. X-ray

Diverticulitis is mainly diagnosed via imaging such as __1__, __2__, or __3__.

1. mortality rate

Esophageal cancer has a high __1__, particularly because seeking care is often delayed due to symptoms being bothersome but not severe enough.

1. Interferon 2. week

For post treatment exposure to hepatitis C, the main treatment is administration of __1__ IM 3 times per week, which decreases reproproduction of the virus. There is also a long acting form of this medication that only has to be given one time per __2__.

1. biliary colic 2. nausea 3. vomiting 4. fat

Gallstones can cause __1__, which is another way of saying gallbladder pain. When the cystic duct is blocked, bile flow is obstructed which can cause __2__ and __3__. A gallstone "attack" is often triggered by a high__4__ meal, because bile is necessary for digestion of __4__.

1. liver

Glucagon is stored in the __1__

1. goitrogens

Goiter can also be caused by __1__, which inhibit T4 production. __1__ can be found in foods such as cabbage, soybeans, spinach, peaches, and peas, as well as in medications such as glucocorticoids, lithium, and phenytoin.

1. bile 2. fibrosis/cirrhosis

Hepatic dysfunction can be caused by +obstruction of the liver biliary tract. + infection and inflammation which damages the liver and interrupts the flow of __1__ (aka cholestasis) + severe hepatocellular dysfunction resulting from __2__.

1. Cushing's disease

Hyperfunction of the adrenal glands can lead to the condition known as __1__

1. sodium 2. potassium 3. phosphate

Hyperglycemia causes low levels of these three electrolytes

1. 180 mmHg 2. 120 mmHg

Hypertensive crisis is defined by systolic BP greater than ___1___ OR diastolic BP greater than ___2___.

1. Addison's disease

Hypofunction of the adrenal glands can lead to the condition known as __1__

1. insulin 2. eating corretly

Hypoglycemia can be caused by taking too much ___1___ or by not ___2___ when taking ___1___

1. pituitary 2. hypothalamus

Hypothyroidism can also be cause by a malfunction of the __1__ or __2__, which causes not enough TSH to be released, which leads to not enough production of thyroid hormones (T3 & T4)

1) Hashimoto 2) Iodine deficiency

Hypothyroidism is due to defective hormone synthesis, and can be cause by factors such as __1__ disease (an autoimmune disorder), __2__ deficiency, or certain medications.

1. female

IBS is more common in the __1__ gender.

1. basal 2. bolus 3. glargine (Lantus/Basaglar) 4. aspart (Novolog) 5. lispro (Humalog)

If patients are carb counting, they will use a __1__ plus __2__ insulin regimen. The __1__ insulin will be insulin __3__ and the __2__ insulin will be __4__ or __5__.

1. low 2. high

In a patient with diabetes insipidus, urine osmolality and urine sodium is 1. (high/low), while serum osmolality and serum sodium are 2. (high/low)

1. increased

In general, hyperthyroidism causes 1(increased/decreased) metabolism.

1. fats

In type 1 diabetics, because no insulin is being produced, the body cannot get its energy from glucose and starts breaking down ___1___ to get energy.

1. ACTH 2. primary

Increased levels of __1__ can cause hyperpigmentation because ___1___ acts on the melanocytes in the skin. Hyperpigmentation is related more to __2__ adrenal insufficiency

dyspepsia

Indigestion; A mild discomfort in the upper belly or abdomen, belching or bloating

1. NG tube

It is important no to manipulate the __1__ post esophagectomy because you don't want to accidently rupture the sutures

1. NPO 2. hydrochloric acid 3. NG tube

It is very important that patients with pancreatitis be kept __1__, because the pancreas needs to rest and __2__ is a powerful stimulate for enzyme release. The patient may also need a __3__ to help decompress the stomach and control nausea. The patient should remain __1__ until they are pain free.

1. blood vessels 2. heart 3. kidneys 4. brain 5. eyes

Long term hypertension gradually damages __1___ throughout the body, particularly in target organs such as the ___2___, ____3____, ___4___, and ____5____.

1. 10

Metformin can be used in children __1__ years old and up

1. a low dose 2. increased weekly

Metformin should be started at __1__ and then __2__ in order to let the body acclimate to the GI effects.

1. kidney 2. liver

Metformin should be used cautiously in patients who have __1__ or __2__ disease.

1. 2

Oral antidiabetic agents are typically only used by type ___1___ diabetics.

1. dumping 2. pernicious anemia

Patients who have surgery for a gastric ulcer are at risk for _1__ and __2__.

1. fiber 2. metamucil

Patients with irritable bowel syndrome should add __1__ to their diet, but they need to be careful not to overdo it. __2__ is good to add because it helps bulk the stool up.

1. steatorrhea 2. floats

Patients with necrotizing pancreatitis have a problem with metabolizing fat, so lots of fat deposit show up in the stool, which is also called __1__. The poop __2__ due to the high fat content

1. IV antibiotics

Patients with necrotizing pancreatitis will be given __1__ due to the potential for infection

1. disturbed body

Patients with ostomies are at risk for __1__ image.

Health care-associated pneumonia (HCAP)

Pneumonia occurring in a nonhospitalized patient with extensive health care contact

Metanephrine

Product of epinephrine and norepinephrine metabolism

1. thyroid 2. high doses 3. low doses

Radioactive iodine is absorbed by the __1__ gland and destroys the __1__ cells. It can be used at __2__ doses to treat hyperthyroidism and thyroid cancer, and can be used at __3__ to do thyroid imaging studies.

1. other thyroid medications 2. bodily waste

Radioactive iodine should not be given in conjunction with __1__. Fluid intake should be increased and all __2__ should be disposed of according to protocol.

1. bleeding 2. airway 3. increase clotting. 4. vasopressin

Ruptured esophageal varices is a medical emergency, the __1__ must be stopped and the __2__ must be maintained. The patient will be given an IV fluid bolus and blood products, as well as Aquamephyton or Kcentra in order to __3__. The patient may also be given __4__, which is a potent vasoconstrictor, to try to control the __1__.

1. perfusion 2. necrosis 3. moist 4. beefy red

Stoma assessment is very important postoperatively because there is a risk for injury. Need to be watchful for a decrease in stoma __1__, or __2__ of the stoma. A healthy stoma should be __3__ and __4__.

1. comprehensive stroke center

Stroke patients who get their care from a ___1___ have better outcomes than those who do not.

1. growth hormone (GH) 2. thyroid stimulating hormone (TSH)

The 2 two hormones that we need to know that are released by the anterior pituitary.

1. rehydrate 2. correct electrolyte imbalance 3. correct acid/base imbalance

The 3 overall goals of treatment for DKA are

1. desmopressin (DDAVP) 2. intranasally 3. by mouth

The best initial way to treat diabetes insipidus is to replace the ADH with the drug __1__. It is normally given __2__ but must be given __3__ if the patient has had a pituitary resection. The patients lab values should start to come back to normal as the medication takes effect.

1. monitor blood sugar 2. amount of insulin

The best way to avoid diabetic ketoacidosis is to regularly __1__ and take the appropriate __2__.

1. pharmacologic

The first line treatment for hypertension is ___1___ therapy

1. handwashing/standard precautions 2. protective equipment 3. never re-cap used needles 4. screening for blood donors

4 ways to decrease transmission of Hep B, C, & D in healthcare settings

1. coughing 2. blinking 3. swallowing

Neuro patients often lose their reflexive protective measure such as ___1___, ___2___, and ___3___ so it is important to protect them from injury

1. cholesterol

Pregnancy can increase the risk for gallstones because the GI system slows down and there is an increase in __1__ intake.

1. lifestyle management 2. hypertension

Prevention is the best "treatment" for ischemic stroke through ___1___ and ___2___ control.

1. Glisson's capsule 2. right shoulder

__1__ is the covering of the liver. when there is pressure on it, like from hepatomegaly, it causes a lot of pain in the right upper quadrant that can also be referred up to the __2__.

1. pancreatitis 2. autodigestion 3. ischemia 4. necrosis

__1__ is inflammation of the pancreas. Acute pancreatitis involves __2__ of the pancreas, which is when pancreatic enzymes are prematurely activated and start eating away at the pancreatic tissue. This leads to edema and damage to the pancreatic tissue. Edema leads to __3__ and __4__ of the pancreatic tissue

1. CT scan

__1__ is the best method of diagnostic tool to use to diagnose pancreatitis

1. abdominal cavity

Peritonitis is defined as inflammation of the peritoneum, which is the serous membrane lining the __1__

1. abdominal X-ray

Peritonitis is mainly diagnosed via __1__ which will show free air or dilated loops of the bowels

1. anticonvulsant 2. seizure 3. 10-20

Phenytoin is a ___1___ medication commonly used for ____2___ disorders. It has a narrow therapeutic window of ___3___ mcg/mL

Hospital Acquired Pneumonia (HAP)

Pneumonia occurring ≥48 hours after hospital admission that did not appear to be incubating at the time of admission

1. Syndrome of inappropriate diuretic hormone (SIADH) 2. retention

__1__ is caused by an excess of ADH, which causes the body to withhold urine production, leading to fluid __2__ and decreased urine output.

1. calcitonin 2. resorption 3. calcium

__1__ is hormone that is produced by the thyroid gland to balance the effects of parathyroid hormone (PTH). It inhibits bone __2__, lowers serum __3__ levels, and increases excretion of __3__.

1. hepatitis 2. viral

__1__ is inflammation of the liver that can be caused by viruses, chemicals, toxins, or alcohol. __2__ __1__ is the most common blood born pathogen in the US.

1. airway 2. benzodiazepines 3. barbiturates

___1___ management is important in a patient with status epilepticus. The patient is first given IV ____2____, then later given ___3___.

1. triptans 2. hypertension 3. heart disease

___1___ medications are used to treat headache, they work by constricting blood flow so may not be a good idea in patients with ___2___ or ___3____.

1. surgical

____1___ management is often required in cases of hemorrhagic stroke in order to prevent further blood flow and worsening rupture.

sodium

excess or insufficient ____2___ is an electrolyte that can be the cause of seizures

1. water intoxication

excessive volume of water in the body leads to dilutional hyponatremia, which is also called __1__

1. 12 2. sugar

exercise can lower blood sugar for up to __1__ hours because the muscles start to pull in __2__ for fuel.

syncope

fainting or sudden loss of consciousness caused by lack of blood supply to the cerebrum

1. genetic

family history is very important in assessing for pheochromocytoma as there is a strong __1__ link.

1. high dose IV antibiotics 2. steroids

for bacterial meningitis, early administration of ___1___ and ___2___ is best treatment.

1. accidently 2.

for most patients with type 2 diabetes, their disease is discovered ___1___ during routine lab tests or examinations.

1. 1.2-1.5 mg/kg/day

for patients with hepatic encephalopathy, the recommended range for high biological protein is __1__.

1. acute 2. chronic 3. risk of bleeding 4. NSAIDS 5. aspirin

gastritis is a superficial inflammatory process. __1__ gastritis consists of transient inflammation causing edema and superficial erosion. __2__ gastritis consists of inflammation that leads to atrophy of gastric tissue. It can also be erosive or non-erosive. Erosive gastritis leads to an increased __3__, so the patient must be careful with __4__ or __5__.

1. 180

glucose starts spilling into the urine around __1__ mg/dl.

1. juice 2. peanut butter 3. milk

good sources of carbohydrates to use when blood sugar is dropping too low and is caught early by the patient include 4 ounces of ___1___, ___2___, or ___3___.

1. C 2. antiviral 3. prevention 4. infection 5. cirrhosis

hepatitis __1__ is the most common form of hepatitis. It has no vaccine but can now be cured with new __2__ medications such as simeprevir (Olysio) and sofosbuvir (Sovaldi). The most important focus is __3__ by reducing risk factors, as untreated hepatitis __1__ leads to chronic __4__ and __5__.

1. normal 2. LFTs 3. amylase 4. ultrasound of the gallbladder

labs are often __1__ in patients with gallstones. If the common bile duct is obstructed, they will have elevated __2__ and __3__. The diagnostic test of choice for diagnosing gallstones is __4__.

1. 60 2. see symptoms

in general, hypoglycemia is defined as blood sugar that is less than ___1___, but it can vary from person to person and is truly defined by when the patient begins to ___2___.

1. meals

in general, it is not a good idea to skip ___1___ when taking any medications for diabetes.

1. 4

in general, liquids are a better way to get carbohydrates when trying to correct for hypoglycemia. 15 grams of carbohydrates can be found in __1__ ounces of juice.

1. elevated liver enzymes (AST, ALT, ALP, LDH) 2. elevated bilirubin 3. elevated PT 4. decreased Vitamin K 5. decreased albumin 6. anemia

labs that should be monitored in hepatic dysfunction

1. low sodium 2. high potassium 3. low glucose 4. high WBC

lab values to check when assessing for Addison's disease would include 1. Sodium (high/low) 2. Potassium (high/low) 3. Glucose (high/low) 4. WBC (high/low)

hepatotoxicity

thiazolidinediones (pioglitazone) require careful monitoring because of the potential for ___1___.

1. kidneys 2. fluid 3. heart failure

thiazolidinediones (pioglitazone) sensitize the tissue to insulin, they act on the ___1___ to cause retention of sodium (and thus ___2___ retention), which is why it is contraindicated in patient with ___3___.

FAST Facial weakness Arm weakness Speech Time

this acronym is used to identify stroke

Preload

this is the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole when the volume of blood in the ventricle is at its highest point.

vagotomy

this surgical treatment for gastric ulcer consists of cutting part of the vagus nerve, which reduces the stimulus for gastric acid production.

Primary headaches

this type of headache has no identifiable underlying cause

secondary headache

this type of headache is a symptom of an underlying cause such as brain tumor, hemorrhagic stroke, or infection.

1. blood 2. body fluids 3. replacing fluids (blood transfusion or IV fluids)

to fix decreased preload in a patient, you need to increase the return of circulating blood which can be done by controlling the loss of ___1___ or ___2___ and by ___3___

1. dehydration 2. hypotension 3. UTI 4. genital fungal infection

4 side effects of Invokana

1. GI discomfort 2. Nausea/vomiting 3. heartburn 5. hypoglycemia

4 side effects with glyburide

What immediate intervention is needed if a chest tube becomes disconnected from the chest tube system device?

-A temporary water seal can be established by immersing the chest tube's open end in a bottle of sterile water

Describe the key points a nurse should emphasize when educating a patient about taking medications for TB.

-Adherence is of utmost importance! -Treatment will last for 6-12 months -multiple medications will most likely be prescribed -medications can cause nausea -medications should be taken on an empty stomach, ideally 1 hour before a meal -better to take near bedtime -risk for liver toxicity (NO ALCOHOL, monitor for jaundice and LFTs) -Rifampin has interactions with many other drugs that decrease the other drugs effectiveness. It will also turn body fluids orange and can stain. It is teratogenic so women should use 2nd form of BC -Isoniazid should be taken along with a multivitamin. Avoid foods high in tyramine (tuna, aged cheese, red wine, soy sauce)

What are the important nursing considerations when administering oxygen via a non-rebreather mask and explain rationales.

-Although it technically delivers 100% oxygen, there is no way to guarantee the patient is actually receiving the full amount (usually because of mask fitting) and thus is considered a low-flow system. -The bag must be inflated enough that it does not collapse upon inspiration, which would block oxygen from reaching the patient -monitor for skin breakdown and can cause patient to experience claustrophobia

What will the nurse assess to determine if there is an air leak in a patient with a wet suction (water seal system)?

-Continuous bubbling in the water seal chamber can indicate an air leak

Why would a patient with COPD develop right sided heart failure?

-Cor pulmonale (right sided heart failure) is a complication of emphysema that is caused by long -term high blood pressure in the pulmonary arteries. -High pressure in the pulmonary arteries increases pressure in the right ventricle, which leads to the back up of blood in the venous system, resulting in dependent edema, distended neck veins, or pain in the region of the liver.

What physical assessment findings would a patient with atelectasis exhibit?

-Fine crackles (rice crispies) starting the base of the lungs upon auscultation -minimal chest expansion -respiratory rate may be normal at first but will increase over time -dyspnea, cough, increased sputum production

In your own words, write a definition for asthma.

-Inflammation and constriction of the airways that decreases the effectiveness of breathing

What is a short acting Beta 2 agonist, when is it used, and what are the nursing considerations when administering?

-It is a "rescue" inhaler that causes bronchodilation in the lungs by relaxing smooth muscles. -it is used for quick relief of acute asthma symptoms, or for prevention of exercise induced bronchospasm -patient should be educated on proper use of inhaler and how to clean it. -possible side effects include tremors, tachycardia, chest pain, headache, insomnia, hyperactivity, and hypokalemia

How will nurse determine if a patient needs oxygen therapy?

-O2 saturation -ABG's -skin color changes (cyanosis) -change in mental status (decreased LOC or anxiety) -vital sign changes (increased heart rate and blood pressure) -tripod position -increased work of breathing, use of accessory muscles.

How will the nurse position a patient post op pneumonectomy? Explain the rationale for the positioning.

-Patient will lay on their operative side which allows the fluid remaining in the empty space to consolidate. This helps avoid a mediastinal shift of the other organs and structures of the chest.

What are the key pathophysiology mechanisms in a patient with COPD.

-Patients lungs are hyperinflated, they cannot expel enough air out of the lungs and thus retain too much CO2. -Chronic bronchitis is a common condition that contributes to COPD. It is characterized by inflammation, increased mucus production, and scarring of the inner lining of the bronchial airways -Emphysema is a common condition that contributes to COPD. It is characterized by destruction of the alveolar walls, which causes pockets of air to form in alveolar space (blebs), pockets of air in the parenchyma (bullae)

Why is it important for the nurse to avoid suction when inserting the suction catheter into the tracheostomy?

-To avoid causing trauma to the tissue

What is a peak flow meter and why is it helpful for patients with asthma?

-a device that measure how well air flow out of your lungs. -can alert a patient when asthma symptoms are worsening and indicate what treatment should be done -can help healthcare providers decide about treatment options -can help identify patterns in asthma symptoms to determine prevention strategies

What should the nurse consider when administering oxygen therapy to a patient with COPD.

-administration of too much oxygen in certain COPD patients can decrease their hypoxic drive, thus resulting in buildup of too much CO2. -It is important to monitor vitals and ABG's -Long term oxygen therapy is indicated for patients with very severe COPD

How would the nurse determine if a patient with COPD is worsening/developing acute respiratory failure?

-cognitive changes (behavioral changes, decreased LOC, memory impairment) -increasing dyspnea, tachycardia, and/or tachypnea which my indicate increasing hypoxemia and impending respiratory failure. -monitor pulse oximetry and ABG's

For whom is a thoracotomy indicated?

-diagnose lung or chest disease -remove cysts, tumors, cancerous tissue -patient with chronic lung disease (multiple types of surgery)

How will the nurse determine if a patient with pneumonia is improving? What will the nurse evaluate?

-fever starts to go down -more effective breathing pattern -decreased anxiety -clearer lung sounds (adventitious lung sounds should start to diminish)

Describe high priority interventions to prevent atelectasis in a patient who is post op surgical procedure?

-frequent turning-early mobilization -strategies to expand the lungs (deep breathing exercise, incentive spirometry) -strategies to manage secretions (directed cough, suctioning, nebulizer treatments, chest percussion and postural drainage) -HOB upright as much as tolerated

Dry suction water seal system

-has three chambers: a collection chamber, water seal chamber, and dry suction control regulator -suction is controlled by the regulator dial -is a quieter machine than wet seal system

Traditional water seal system

-has three chambers: a collection chamber, water seal chamber, and wet suction control chamber. -The amount of suction is determined by the water level in the control chamber

Why is it important to provide humidification for a postop laryngectomy patient?

-important to decrease risk of mucus plugs, decrease cough, and decrease crusting around stoma

List the main points concerning health promotion that you as the nurse should educate a patient with asthma.

-important to take medications as prescribed, adherence is key -difference between "rescue" meds and meds that control the asthma -recognizing signs that indicate asthma is worsening and what actions to take -how and when to seek medical attention -how to prevent symptoms and asthma attacks from happening -proper use of different types of inhaled medications

Describe high priority assessments for the patient who is to undergo a thoracotomy.

-major complications are atelectasis and pneumonia -important to get a baseline prior to surgery so you know what their "normal" is -CBC, Electrolytes, BUN, Creatinine, EKG -important to turn/cough/deep breath every 2 hours -incentive spirometry is important -educate patient on how to properly splint incision when coughing -monitor and maintain chest tube drainage system if applicable -HOB to 30-45 degrees, some surgeries have specific positioning for patient

What should the nurse monitor in a patient who is taking systemic corticosteroids?

-monitor weight -monitor BP -monitor blood glucose levels -monitor for signs of osteopenia/osteoporosis

What assessment findings would indicate obstruction of the airway in a tracheostomy patient and what are the primary interventions to decrease risk of obstruction?

-obvious signs of secretion -Adventitious lung sounds (most likely Ronchi which is course crackles in upper airway) -diminished or absent lung sounds -decrease in O2 sat, ABG's, and/or vital signs -change in respiratory rate or mental status

Dry suction with one way valve

-system has: a collection chamber, one way mechanical valve, and dry suction control chamber -Valve permits air and fluid to leave chest but prevents their movement back into the pleural space -Can be set up quickly (like in an emergency) and works even if knocked over -useful for patients who are ambulating or being transported

When is a tracheostomy indicated?

-to bypass upper airway obstruction (tumor, trauma) -To permit long-term use of mechanical ventilation (>2 weeks) -to prevent aspiration of oral or gastric secretions in unconscious or paralyzed patients by closing off the trachea from the esophagus -to replace an endotracheal tube -to decrease WOB

What assessment findings would the nurse be most concerned in a patient with asthma?

-wheezing and shortness of breath, especially if it persists after medications -fever, muscle aches, chest pain -sputum changes

What equipment is needed at the bedside for a patient with a new tracheostomy?

-working suction -A complete replacement trach kit in the proper size -an obturator -an ambu-bag -Oxygen

1. B12 2. folic acid 3. multivitamin 4. iron

4 supplements that patients with inflammatory bowels disease may need.

1. antacids (tums) 2. H2 blockers (famotidine) 3. Prokinetics (metoclopramide) 4. PPI's (omeprazole)

4 classes of meds that can be used to treat hiatal hernia

1. neuromuscular excitability 2. twitches 3. Chvostek's sign 4. Trousseau's sign

4 classic signs of hypocalcemia

1. pyrosis 2. acid regurgitation 3. dyspepsia 4. odynophagia

4 clinical manifestations of GERD

1. severe hyperglycemia 2. osmotic diuresis 3. severe dehydration 4. hyperosmolality (increased BUN)

4 clinical manifestations of HHS

1. visible/palpable strong pulsations at carotid or temporal arteries 2. dyspnea 3. fatigue 4. breathing difficulties

4 clinical manifestations of aortic regurgitation

Who is at high risk for developing TB?

1. -close contact with someone who has active TB -immunocompromised -people without adequate healthcare -preexisting medical conditions or special treatments -immigration from or recent travel to country with high prevalence of TB -living in overcrowded, substandard housing -being a healthcare worker performing high risk activities -drug or alcohol abuse

1. dry skin 2. poor skin turgor 3. tachycardia 4. fatigue

4 clinical manifestations of dehydration

1. drain pancreatic abscess 2. subtotal pancreatectomy 3. whipple 4. removal of biliary stones

4 surgical managements for pancreatitis

1. active bleeding 2. hematemesis (coffee grounds in emesis) 3. melena (dark, tarry stools) 4. hematochezia (bright red bloody stools)

4 clinical manifestations of erosive gastritis.

1. nocturnal heartburn 2. substernal pain 3. feeling of fullness 4. dysphagia

4 common clinical manifestations of hiatal hernia

1. enlarged spleen 2. tortuous epigastric vessels 3. hemorrhoids 4. esophageal varices

4 complications arising from portal hypertension

1. EGD (for biopsy and cytology) 2. barium x-ray of upper GI 3. CT scans 4. CBC for anemia

4 diagnostic tests used to diagnose gastric cancer

1. abdominal ultrasound 2. CT (best) 3. MRI 4. ERCP (for recurrent disease)

4 diagnostic tools used to diagnose pancreatitis

1. high fever 2. tachycardia 3. hypertension 4. CNS effects

4 symptoms of thyroid storm

1. osteoporosis 2. Pagets disease 3. hypercalcemia 4. multiple myeloma

4 therapeutic uses for anti-hypercalcemic agents

1. hypertension 2. hyperlipidemia 3. atherosclerosis 4. hypercoagulability 5. obesity 6. diabetes 7. smoking 8. drug abuse 9. alcohol abuse 10. atrial fibrillation

10 modifiable risk factors for stroke

1. compromised airway 2. esophageal leakage around the anastomosis 3. fluid & electrolyte imbalance 4. dumping syndrome

4 things to monitor for post esophagectomy

1. elevated amylase & lipase 2. elevated LFTs 3. elevated blood glucose 4. elevated WBC --------------------------------------- 1. low calcium (severe disease) 2. low HCT & HGB 3. low albumin 4. low PO2

4 elevated labs and 4 decreased labs seen in patients with pancreatitis

1. CEREBRAL EDEMA, headache, decreased LOC, SEIZURES, coma 2. decreased GI functions 3. weakness, muscle cramps, decreased DTR's 4. CRACKLES, edema

4 groups of clinical manifestation of SIADH

1. anticonvulsants 2. estrogen 3. sulfa drugs 4. thiazide diuretics

4 types of medications that can cause pancreatitis.

1. small frequent meals of non irritating food. 2. calorie dense supplements 3. weight management 4. I&O status

4 key items regarding nutritional support/therapy after gastrectomy

1. Anticholinergics 2. beta blockers 3. Bisphosphonates 4. calcium channel blockers

4 medication classes that can trigger GERD by irritating the esophagus or delaying gastric emptying time

1. paracentesis 2. albumin 3. diuretics 4. low sodium diet

4 methods of treatment for ascites

1. anticoagulant therapy (warfarin, xarelto, eliquis) 2. antiplatelet therapy (aspirin) 3. statin therapy 4. antihypertensive therapy

4 prevention methods started after a TIA or ischemic stroke (all pharmacologic)

1. autoimmune disease 2. adrenalectomy 3. TB 4. histoplasmosis

4 risk factors for Addison's disease

1. Colon rest 2. antibiotics 3. pain management 4. surgery (possibly)

4 ways that diverticulitis is managed.

1. hypothyroidism 2. agranulocytosis 3. liver damage / hepatitis

3 adverse effects of propylthiouracil and methimazole

1. CAD 2. TIA/stroke 3. Peripheral vascular disease

3 chronic macrovascular complications of diabetes mellitus

1. dysphagia 2. odynophagia 3. eventual esophageal obstruction

3 clinical manifestations of esophageal cancer

1. fever 2. petechial rash 3. nuchal rigidity (can't touch chin to chest)

3 clinical manifestations of meningitis

1. endoscopy w/ biopsy 2. CBC 3. Urea breath test (for H. Pylori)

3 diagnostic tests for gastritis

1. EGD 2. esophageal manometry 3. CT of chest

3 diagnostic tests use to screen for hiatal hernia

1. serum test 2. urea breath test 3. stool test

3 diagnostic tools used to test for H. Pylori

1. increase nutritional status 2. gain weight 3. enhanced healing

3 goals of using TPN

1. age over 55 2. male 3. african america

3 non-modifiable risk factors for stroke

1. bleeding 2. infection 3. decreased fluid volume

3 post-op complications with appendectomy

1. Hepatitis A vaccine (active immunity) 2. IM Ig (passive immunity) 3. reduce risk factors

3 prevention methods for hepatitis A

1. bleeding risk 2. obstruction 3. strangulation of hernia

3 risks of hiatal hernia

1. dizziness/drowsiness 2. gingival hyperplasia 3. multiple drug interactions

3 side effects of phenytoin

1. management of hypocalcemia 2. hypoparathyroidism 3. chronic renal dialysis

3 therapeutic uses of calcitriol

1. treatment of graves disease 2. achieve euthyroid state prior to thyroidectomy 3. treatment of thyroid storm

3 therapeutic uses of propylthiouracil and methimazole

1. tong term treatment of children with growth failure (such as Turner Syndrome) 2. AIDS wasting 3. GR deficiency in adults (hypopituitarism)

3 therapeutic uses of somatropin

1. migraine 2. tension headache 3, cluster headache

3 types of primary headaches

1. colon resection with permanent or temporary colostomy 2. colectomy with ileostomy 3. colonic J pouch

3 types of surgical management for colorectal cancer

1. vagotomy (sever part of the vagus nerve) 2. pyloroplasty (makes the pyloric sphincter smaller) 3. subtotal gastrectomy

3 types of surgical management for gastric ulcers

1. caucasian 2. female 3. genetics (1st degree relative with the disease) 4. chromosomal abnormalities (Down syndrome, turner syndrome, type 1 diabetes)

4 risk factors for Celiacs disease

1. genetic predisposition 2. lack of exercise 3. body fat distribution 4. desensitization of leptin receptors within the hypothalamus leading to hyperphagia

4 causes of insulin resistance

1. female 2. 60 or older 3. obesity 4. pregnancy

4 risk factors for hiatal hernia

1. aminosalicylates 2. corticosteroids 3. immunosuppressants 4. antibiotics

4 classes of medications used to manage inflammatory bowel disease (excluding anti-tumor necrosis factor) by maintaining remission

1. belching 2. gagging 3. vomiting 4. abdominal/chest pain 5. infection 6. bleeding

6 complications of a Nissen fundoplication

1. respiratory distress 2. pneumonia 3. aspiration 4. pressure ulcer 5. DVT 6. contractures

6 complications of neuro patients with altered level of consciousness, most of these have to do with immobility.

1. basilar skull fracture 2. maxillofacial surgery 3. facial trauma 4. coagulation abnormalities (risk for bleeding) 5. esophageal varices/diverticulum 6. S/P gastric bypass or other large gastric surgery

6 contraindications for feeding tubes

1. GI effects 2. CNS effects (weakness, headache, irritability) 3. muscle pain 4. bone pain 5. hypermagnesemia

5 adverse effects of calcitriol

1. development of antibodies 2. swelling/joint pain 3. HYPOTHYROIDISM 4. INSULIN RESISTANCE 5. hyperglycemia

5 adverse effects of somatropin

1. antacids (tums) 2. H2 blockers (famotidine) 3. Prokinetics (metoclopramide) 4. PPI's (omeprazole) 5. barrier agents (sucralfate)

5 classes of meds that can be used to treat GERD

1. epigastric pain 2. dyspepsia 3. anorexia 4. hiccups 5. nausea/vomiting

5 clinical manifestations of acute gastritis

1. nausea/vomiting 2. acute abdominal pain 3. pain at McBurney's point 4. rebound tenderness 5. low grade fever (possible)

5 clinical manifestations of appendicitis

1. abdominal pain/cramping (often after meals) 2. bloated feeling 3. flatulence 4. diarrhea/constipation 5. mucus in stool

5 clinical manifestations of irritable bowel syndrome

1. frequent small meals 2. avoid contrictive garments 3. remain upright for 1 hour after eating 4. elevate HOB 5. medications

5 conservative approaches for managing hiatal hernias

1. ultrasound 2. HIDA scan (nuclear medicine) 3. ERCP 4. magnetic resonance cholangiopancreatography (MRCP) 5. percutaneous transhepatic cholangiography.

5 diagnostic test that can be used to diagnose gallstones

1. consciousness and cognition 2. cranial nerves 3. motor system (muscle size/tone as well as strength, coordination, and balance) 4. sensory system (all senses) 5. Reflexes

5 different areas assessed when performing a neuro exam

1. Kussmaul respiration 2. hypocapnia 3. circulatory depression 4. paralytic ileus 5. hypoxia

5 effects of acidosis

1. acute onset like "thunderclap" 2. markedly elevated blood pressure 3. presence of rash or signs of infection 4. vomiting 5. head trauma

5 headache red flags

1. Isotonic NS bolus 2. blood products (PRBCs, FFP) 3. Aquamephyton or Kcentra 4. Vasopressin 5. Sclerotherapy

5 things a patient with ruptured esophageal varices may be given

1. new meds/ dose change 2. change in weight 3. change in diet/exercise 4. illness (or other times of increased stress) 5. exhibit signs of hypoglycemia or hyperglycemia

5 times when a patient should monitor their blood glucose more frequently.

1. travelling to developing countries 2. fecal-oral 3. tainted produce or shellfish 4. poor sanitation of food service 5. can be transmitted via blood or sexual contact for short time period

5 ways hepatitis A/E is transmitted

1. headache 2. nausea 3. diarrhea 4. initial increased bone pain 5. ESOPHAGEAL EROSION 6. femoral fractures (longterm use)

6 adverse effects of alendronate

1. allergic reaction 2. infection 3. reactivation of TB and Hepatitis 4. liver damage 5. bone marrow suppression 6. lymphoma

6 adverse effects of anti-tumor necrosis factor medications

1. nausea 2. vomiting 3. respiratory distress with hypersensitivity reaction 4. hypokalemia with overdose 5. hypertension or hypotension 6. headache

6 adverse effects of glucagon

1. crampy abdominal pain 2. nausea 3. alternate between diarrhea and constipation 4. abdominal distension 5. flatus 6. low grade fever

6 clinical manifestations of diverticulitis.

1. avoid drying/alkaline soaps 2. lukewarm baths 3. lotion 4. wear loose clothing 5. soft bed linens 6. keep room cool

6 comfort measures to manage pruritus

1. numbness/weakness of face, arm, or leg, especially on one side of the body 2. change in mental status 3. trouble speaking or understanding speech 4. difficulty walking or balancing 5. sudden severe headache 6. visual field loss

6 common symptoms of ischemic stroke

1. Pain 2. Seizures 3. dizziness/vertigo 4. visual disturbances 5. muscle weakness 6. abnormal sensation

6 common symptoms of neurological disorders

1. descending or sigmoid colostomy 2. patient able & interested in learning how to irrigate 3. absence of stoma hernia or prolapse 4. preferred regular bowel habits prior to colostomy 5. encouraged for retracted stoma 6. must have running water (indoor plumbing)

6 criteria for a patient to use stoma irrigation

1. fat, protein, and carbohydrate metabolism 2. detoxification 3. bile production & excretion 4. storage of glycogen, vitamins, fatty acids, & albumin 5. ingestion of bacteria & red blood cells 6. Clotting (synthesizes prothrombin and fibrinogen)

6 functions of the liver

1. hypermetabolic state 2. burn injuries 3. diseases of malabsorption 4. unwilling/unable to take things orally 5. pre/post op nutrition 6. cancer

6 indications for using TPN

1. reduce stress 2. avoid trigger foods 3. add fiber (but not too much) 4. add bulking agent (metamucil) 5. take probiotics 6. medications

6 managements for irritable bowel syndrome

1. fluid & electrolyte balance 2. manage diarrhea 3. bowel rest 4. nutrition/supplementation 5. medication 6. surgery

6 managements for patients with inflammatory bowel disease

1. alcohol use 2. smoking 3. stress 4. overweight 5. poor diet 6. lack of exercise

6 modifiable risk factors of hypertension

1. alcohol use 2. tobacco Use 3. caffeine use 4. gastric infection 5. pregnancy 6. obesity

6 risk factors for GERD

1. people who received blood products prior to 1992 2. multiple sexual partners 3. IV/intranasal drug use 4. needle stick injuries 5. tattoos/piercings 6. sharing razors/toothbrushes

6 risk factors for hepatitis B, C, & D.

1. high fat diet 2. alcohol 3. smoking 4. carbonated beverages 5. caffeine 6. stress

6 risk factors for irritable bowel syndrome

1. sweating 2. shakiness 3. hangry 4. agitation 5. headache 6. tachycardia

6 symptoms of hypoglycemia

1. general weakness 2. muscle cramps 3. dry skin 4. bradycardia 5. weight gain 6. intolerance to cold

6 symptoms of hypothyroidism

1. lab results 2. patient response 3. daily weights 4. I&O 5. Blood glucose 6. infusion site for S/S of infection

6 things to monitor when infusing TPN

1. radiation 2. chemo 3. endoscopic procedure 4. photodynamic therapy 5. esophageal stent or dilation 6. esophagectomy

6 treatments for esophageal cancer

1. manage bleeding 2. high calorie, low fat diet 3. decrease GI bacterial production of ammonia 4. avoid constipation 5. correct fluid and electrolyte imbalance 6. safety (fall risk)

6 ways to manage hepatic encephalopathy

1. nausea/vomiting 2. polyuria 3. polydipsia 4. electrolyte imbalance (potassium, sodium, chloride, and phosphate) 5. dry, hot skin due to dehydration 6. altered LOC 7. fruity breath

7 clinical manifestations of DKA

1. diarrhea 2. rectal bleeding 3. cramping 4. weight loss 5. nutritional deficits 6. pain 7. dehydration

7 clinical manifestations of inflammatory bowel diseases

1. massive fluid shifts (loss of plasma proteins in retroperitoneal space) 2. vasodilation (inflammatory response) 3. hemorrhage (results from necrosis of blood vessels) 4. problems with insulin production due to damaged islet cells ---------------------------------------- these result in 1. severe hypotension 2. hypovolemia 3. decreased LOC, restlessness, agitation 4. Turner's sign 5. Cullen's sign

7 clinical manifestations of severe (aka necrotizing) pancreatitis

1. severe pitting edema 2. JVD 3. hepatomegaly 4. ascites 5. anorexia 6. dyspnea 7. fatigue

7 clinical signs of right sided heart valve failures

1. Chronic esophageal irritation 2. GERD 3. Alcohol 4. Smoking 5. Hot foods/drinks 6. Food high in nitrosamines 7. Poor oral hygiene

7 risk factors for esophageal cancer

1. H. Pylori infection 2. gastritis 3. smoking 4. obesity 5. Race (African American, Hispanic, Asian, Pacific Islander) 6. diet low in fruit and veggies 7. diet high in salts and meats

7 risk factors for gastric cancer

1. hypoglycemia 2. nausea 3. anorexia 4. diarrhea 5. pancreatitis 6. renal impairment 7. thyroid c-cell tumors

7 side effects of liraglutide

1. increased metabolism 2. tachycardia 3. weight loss 4. heat intolerance / increased body temp 5. anxiety/agitation 6. insomnia 7. exophthalmos

7 symptoms of hyperthyroidism

1. weight loss 2. fatigue 3. anemia 4. diarrhea 5. streathorrea 6. flatulence 7. abdominal distension 8. abdominal pain

8 clinical manifestations of Celiacs disease

1. polyuria 2. polydipsia 3. nocturia 4. dehydration 5. hypotension 6. Tachycardia 7. decreased urine specific gravity, urine osmo, and urine sodium 8. increased serum osmo and serum sodium

8 clinical manifestations of diabetes insipidus

1. severe abdominal pain (LUQ and may radiate) 2. tender/rock hard abdomen 3. Nausea and vomiting that does not relieve pain 4. dehydration 5. fever 6. tachycardia 7. grey, greasy, foul smelling stool (has deposits of fat) 8. possible jaundice (if there is obstruction of bile flow)

8 clinical manifestations of pancreatitis

1. fever 2. increased abdominal pain 3. hypoactive or absent bowel sounds 4. nausea/vomiting 5. rigid board-like abdomen 6. elevated WBC 7. tachycardia 8. hypotension

8 clinical manifestations of peritonitis (come on suddenly)

1. mouth decay 2. kidney disease 3. eye disease 4. nerve disease/damage 5. heart disease/attack 6. stroke 7. impotence (males) 8. UTI/yeast infection (females)

8 complication of uncontrolled diabetes

1. meticulous abdominal assessment 2. bowel rest and GI decompression (NG tube) 3. dressing changes 4. monitor drains for excessive blood or purulent output 5. IV antibiotics 6. monitor fluid and electrolyte balances 7. provide pain management 8. prevent complications of immobility (turn/cough/deep breathe)

8 managements of peritonitis

1. Jewish 2. caucasian 3. northern urban environments 4. pesticide exposure 5. food additives 6. tobacco use 7. radiation exposure 8. autoimmune disorders

8 risk factors for Crohn's disease

1. people who received blood products prior to 1992 2. multiple sexual partners 3. IV drug use 4. needle stick injuries 5. tattoos/piercings 6. sharing razors/toothbrushes 7. healthcare workers 8. mother-child transmission 9. close contact with known infected person

8 risk factors for Hep B infection

1. heat intolerance 2. diaphoresis 3. hyperactivity 4. tremors 5. thin, soft hair 6. warm, moist skin 7. muscle breakdown 8. amenorrhea (no menstrual cycle)

8 symptoms of hyperthyroidism

1. tremors 2. anxiety 3. HEADACHE 4. DIAPHORESIS 5. PALPITATIONS 6. blurred vision 7. flushing 8. tachycardia 9. hyperglycemia

8 symptoms of pheochromocytoma (remember SNS stimulation)

1. weight loss 2. weakness 3. anorexia 4. nausea 5. vomiting 6. abdominal pain/cramps 7. palpable mass 8. change in stool color/size/frequency 9. blood in stool

9 clinical manifestations of colorectal cancer.

1. vertigo 2. tachycardia 3. syncope 4. diarrhea 5. sweating 6. pallor 7. palpitations 8. nausea 9. vomiting (rare)

9 clinical manifestations of dumping syndrome

1. high fever 2. extreme tachycardia/palpitations 3. heart failure 4. severe weight loss 5. diarrhea 6. dehydration 7. abdominal pain 8. altered LOC 9. seizures

9 clinical manifestations of thyroid storm

1. lethargy 2. behavioral changes 3. hypertension 4. AV block 5. Nausea/Vomiting 6. constipation 7. muscle weakness 8. kidney stones 9. osteoporosis

9 manifestations of hypercalcemia

1. over age 65 2. family history 3. African American 4. Jewish 5. Irritable bowel disease 6. alcohol abuse 7. obesity 8. high amount of fat/protein in diet 9. low fiber in diet

9 risk factors for colorectal cancer

1. Family history 2. Obesity (HUGE risk factor) 3. Race/ethnicity (african american, hispanic american, asian american, native american, pacific islander) 4. Age (45+) 5. Previously identified impaired fasting glucose or impaired glucose tolerance 6. hypertension (130/80) 7. Low HDL and high triglyceride level 8. history of gestational diabetes or baby over 9 lbs 9. polycystic ovary syndrome

9 risk factors for diabetes

1. F&E balance 2. pain management 3. anticholinergic (aka antispasmodic) 4. diet management 5. NG tube for decompression due to severe N/V 6. meds to dissolve gallstones 7. endoscopic stone removal 8. lithotripsy 9. cholecystectomy (gallbladder removal)

9 types of management of gallstones

6.3 mg A person who weighs 154 lbs weighs 70 kg. To calculate dosage, multiply 70 × 0.9 mg/kg = 63 mg. The nurse gives 10% (6.3 mg) over 1 minute.

A 154-pound woman has been prescribed tPA (0.9 mg/kg) for an ischemic stroke. The nurse knows to give how many mg initially? 6.3 mg 7.5 mg 8.3 mg 10 mg

receptive aphasia (Wernicke's aphasia)

A condition in which a patient is unable to understand what is being said or what is written, and the words they say don't make any sense.

1. unequal response In increased ICP, the pupil response is unequal. One pupil responds more sluggishly than the other or becomes fixed and dilated.

A nurse is assessing a client who has been in a motor vehicle collision. The client directly and accurately answers questions. The nurse notes a contusion to the client's forehead; the client reports a headache. Assessing the client's pupils, what reaction would confirm increasing intracranial pressure? 1. unequal response 2. equal response 3. rapid response 4. constricted response

glucosuria

Abnormal presence of glucose in the urine resulting from the ingestion of large amounts of carbohydrate or from a metabolic disease, such as diabetes mellitus

1. primary

Addison's disease is also called __1__ adrenal insufficiency, because the adrenal glands themselves are the problem. They are not able to produce hormones due to some sort of damage.

1. stress 2. infection 3. trauma 4. sudden withdrawal of replacement hormones

Addisonian crisis can be triggered by these 4 things

1. choreiform movements Choreiform, described as uncontrollable writhing and twisting of the body, is a typical sign associated with Huntington's disease. The other signs are commonly seen in clients with Parkinson's disease.

A nurse is caring for client with late-stage Parkinson's disease. The client's plan of care includes a nursing diagnosis of "Potential for Injury." Which would not be included as a cause for this diagnosis? 1. choreiform movements 2. shuffling gait 3. uncontrolled movements 4. rigidity

1. pain control

Adequate __1__ is very important after a Nissen fundoplication because it is important for the patient to be able to turn, cough, and deep breathe.

1. Partial Thromboplastin Time (PTT)

A nurse will monitor ___1___ lab levels in a patient who is receiving heparin therapy.

1. Kangaroo 2. 24

A __1__ pump is used for tube feeding. The tubing needs to be changed every __2__ hours in order to decrease the risk of bacteria growth.

1. MRI 2. CT

A __1__ scan or __2__ scan of the adrenal glands and pituitary gland can help confirm Addison's disease

1. migraine

A ___1___ headache is unilateral, throbbing, can have nausea/vomiting, photophobia, can have an aura, and can last up to 72 hours.

1. MRI 2. longer

A ___1___ scan uses magnetic fields and can provide more detailed images. On the downside, it can take ___2___ longer than a CT scan

1. CT 2. quick

A ____1___ scan uses X-rays to scan "slices" of the body. It is typically a very ___2___ procedure.

multiple myeloma

malignant tumor of bone marrow cells that causes the breakdown of bone.

1. esophagogastroduodenoscopy (EGD) 2. 2-3 3. airway 4. gag reflex 5. swallowing

A __1__ is a procedure in which there is visual examination of the esophagus, stomach, and duodenum. The patient should have a follow up procedure every __2__ years. It is important to maintain the patients __3__ after the procedure, and the monitor for the return of their __4__ and ability to __5__.

1. colonic J pouch

A __1__ is a procedure where the entire colon and rectum is removed, an anal cavity is made and a temporary ileostomy is created. Once this surgery has healed, the ileostomy is reversed and the ileostomy is connected to the __1__.

1. Addisonian crisis 2. 24-48

A __1__ is an acute insufficiency of cortisol and aldosterone hormones. It is a life threatening condition and can develop in __2__ hours

1. goiter 2. obstruct the airway

A __1__ is an enlarged thyroid that can be seen in both hyper and hypothyroidism. The biggest complication a nurse needs to worry about in a patient with a __1__ is that it can __2__.

4. Compliance with the prescribed medication regimen The most common cause of status epilepticus is sudden withdraw of anticonvulsant therapy. The type of medication prescribed, the client's stress level, and weight change don't contribute to this condition.

A client is admitted to an acute care facility after an episode of status epilepticus. After the client is stabilized, which factor is most beneficial in determining the potential cause of the episode? 1. The type of anticonvulsant prescribed to manage the epileptic condition 2. Recent stress level 3. Recent weight gain and loss 4. Compliance with the prescribed medication regimen

2. Left-sided cerebrovascular accident (CVA) When the infarct is on the left side of the brain, the symptoms are likely to be on the right, and the speech is more likely to be involved. If the MRI reveals an infarct, TIA is no longer the diagnosis. There is not enough information to determine if the stroke is still evolving or is complete.

A client is admitted with weakness, expressive aphasia, and right hemianopia. The brain MRI reveals an infarct. The nurse understands these symptoms to be suggestive of which of the following findings? 1. Transient ischemic attack (TIA) 2. Left-sided cerebrovascular accident (CVA) 3. Right-sided cerebrovascular accident (CVA) 4. Completed Stroke

1. shivering in hypothermia can increase ICP. Care must be taken to avoid the development of hypothermia because hypothermia causes shivering. Shivering, in turn, can increase intracranial pressure.

A client is being treated for increased intracranial pressure (ICP). The nurse should ensure that the client does not develop hypothermia because: 1. shivering in hypothermia can increase ICP. 2. hypothermia is indicative of severe meningitis. 3. hypothermia is indicative of malaria. 4. hypothermia can cause death to the client.

1. vasodilation Hypotension and hypoxia lead to vasodilation, which contributes to increased ICP, compressing blood vessels and leading to cerebral ischemia. As ICP continues to rise, autoregulatory mechanisms can become compromised; hypotension and hypoxia lead to vasodilation, which contributes to increased ICP.

A client suffered a closed head injury in a motor vehicle collision, and an ICP monitor was inserted. In the occurrence of increased ICP, what physiologic function contributes to the increase in intracranial pressure? 1. vasodilation 2. vasoconstriction 3. hypertension 4. increased PaO

4. Elevated 30 degrees After supratentorial surgery, the nurse should elevate the client's head 30 degrees to promote venous outflow through the jugular veins

A client undergoes a craniotomy with supratentorial surgery to remove a brain tumor. On the first postoperative day, the nurse notes the absence of a bone flap at the operative site. How should the nurse position the client's head? 1. Flat 2. Turned onto the operative side 3. Elevated no more than 10 degrees 4. Elevated 30 degrees

2. "You must avoid coughing, sneezing, and blowing your nose." After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line.

A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? 1. "You must lie flat for 24 hours after surgery." 2. "You must avoid coughing, sneezing, and blowing your nose." 3. "You must restrict your fluid intake." 4. "You must report ringing in your ears immediately."

3. Maintains a patent airway Maintenance of a patent airway is always a first priority. Loss of airway is a possible complication of increasing ICP, as well as aspiration from vomiting.

A client with a traumatic brain injury is showing early signs of increasing intracranial pressure (ICP). While planning care for this client, what would be the priority expected outcome? 1. Attains desired fluid balance 2. Displays no signs or symptoms of infection 3. Maintains a patent airway 4. Demonstrates optimal cerebral tissue perfusion

2. low. Normal cerebral perfusion pressure (CPP) is 70 to 100 mm Hg. A CPP of 40 mm Hg is low.

A client with increased intracranial pressure has a cerebral perfusion pressure (CPP) of 40 mm Hg. This CPP reading is considered 1. high. 2. low. 3. within normal limits. 4. inaccurate.

3. Restricting fluid intake and hydration Fluid restriction may be necessary if the client develops cerebral edema and hypervolemia from SIADH. Antipyretics are administered to clients who develop hyperthermia. In addition, it is important to maintain adequate hydration in such clients. A client with neurologic infection should be given tracheal suctioning and hyperoxygenation only when the respiratory distress develops.

A client with neurologic infection develops cerebral edema from syndrome of inappropriate antidiuretic hormone (SIADH). Which is an important nursing action for this client? 1. Maintaining adequate hydration 2. Administering prescribed antipyretics 3. Restricting fluid intake and hydration 4. Hyperoxygenation before and after tracheal suctioning

negative feedback loop

A feedback loop in which a system responds to a change by returning to its original state, or by decreasing the rate at which the change is occurring.

1. MI 2. atypical symptoms

A female patient with a history of CAD who is presenting with fatigue should be assessed for possible ___1___ because women can have ___2___.

1. ostomy 2. loose 3. barrier cream 4. kegel 5. pouchitis

A j-pouch allows a patient to live without an __1__. Because the colon is gone, the patient will always have __2__ stool several times per day, which is why application of a __3__ is important to prevent perianal skin irritation. The patient will have to perform __4__ exercises in order to prevent incontinence. There is a risk for __5__, which is an infection of the J-pouch that is treated with antibiotics and fluids.

1. emergency 2. temporary

A loop colostomy can depend upon the skill of the surgeon, but it is generally used in __1__ situations or when it is expected to be more __2__ because it is easier to put back together.

1. decompression 2. lavage 3. drainage 4. salem sump 5. aspiration

A nasogastric tube is a large bore tube that is used for __1__, __2__, and __3__. The most often used one is called a __4__. They should never be used for feeding due to increased risk of __5__. It is a dual lumen tube which has one tube dedicated to venting to atmosphere.

3 A score of 3 indicates severe impairment of neurologic function, brain death, or pharmacologic inhibition of the neurologic response. A score of 15 indicates that the patient is fully responsive

A nurse assesses the patient's LOC using the Glasgow Coma Scale. What score indicates severe impairment of neurologic function? 3 6 9 12

1. Bradycardia 2. Bradypnea 3. Hypertension At a certain point as intracranial pressure increases due to an injury, the brain's ability to autoregulate becomes ineffective and decompensation (ischemia and infarction) begins. When this occurs, the patient exhibits significant changes in mental status and vital signs. The bradycardia, hypertension, and bradypnea associated with this deterioration are known as Cushing's triad, which is a grave sign.

A nurse caring for a patient with head trauma will be monitoring the patient for Cushing's triad. What will the nurse recognize as the symptoms associated with Cushing's triad? Select all that apply. 1. Bradycardia 2. Bradypnea 3. Hypertension 4. Tachycardia 5. Pupillary constriction

PH = acidic so <7.35 PO2 = normal to high due to kussmaul respirations PCO2 = alkaline so <35 due to kussmaul respirations causing decreased CO2 HCO3 = acidic so <22

A patient with DKA will be expected to have the following ABG values PH=? PO2=? PCO2=? HCO3=?

1. expressive aphasia, defects in the right visual fields, problems with abstract thinking Expressive aphasia, defects in the right visual fields, and problems with abstract thinking are symptoms consistent with right-sided hemiplegia.

A nurse is providing care to a client who has had a stroke. Which symptoms are consistent with right-sided hemiplegia? 1. expressive aphasia, defects in the right visual fields, problems with abstract thinking 2. impulsive behavior, poor judgment, deficits in left visual fields 3. problems with abstract thinking, impairment of short-term memory, poor judgment 4. short retention of information, deficits in left visual fields, misjudgement of distances

3. "There is a strong familial tendency." Migraine headaches have a strong familial tendency. Migraines are primary headaches, not secondary headaches.

A nurse is providing education about migraine headaches to a community group. The cause of migraines has not been clearly demonstrated, but is related to vascular disturbances. A member of the group asks about familial tendencies. The nurse's correct reply will be which of the following? 1. "There is a very weak familial tendency." 2. "No familial tendency has been demonstrated." 3. "There is a strong familial tendency." 4. "Only secondary migraine headaches show a familial tendency."

4. 190 mm Hg/120 mm Hg Elevated blood pressure (systolic >185; diastolic >110 mm Hg) is a contraindication to tPA.

A nurse knows that, for a patient with an ischemic stroke, tPA is contraindicated if the blood pressure reading is: 1. 170 mm Hg/105 mm Hg 2. 175 mm Hg/100 mm Hg 3. 185 mm Hg/110 mm Hg 4. 190 mm Hg/120 mm Hg

3. Vasopressin Manipulation of the posterior pituitary gland during surgery may produce transient diabetes insipidus of several days' duration (Hickey, 2009). It is treated with vasopressin but occasionally persists.

A patient had a small pituitary adenoma removed by the transsphenoidal approach and has developed diabetes insipidus. What pharmacologic therapy will the nurse be administering to this patient to control symptoms? 1. Mannitol 2. Furosemide (Lasix) 3. Vasopressin 4. Phenobarbital

3. Diplopia. The initial manifestation of MG usually involves the ocular muscles. Diplopia (double vision) and ptosis (drooping of the eyelids) are common. The majority of patients also experience weakness of the muscles of the face and throat, generalized weakness, and weakness of the facial muscles.

A patient has been diagnosed with myasthenia gravis. The nurse documents the initial and most common manifestation of: 1. Dysphoria. 2. Facial muscle weakness. 3. Diplopia. 4. Generalized fatigue.

2. This is significant for poor neurologic outcomes. Hyperglycemia has been associated with poor neurologic outcomes in acute stroke and should be treated if the blood glucose is above 140 mg/dL

A patient having an acute stroke with no other significant medical disorders has a blood glucose level of 420 mg/dL. What significance does the hyperglycemia have for this patient? 1. The patient has new onset diabetes. 2. This is significant for poor neurologic outcomes. 3. The patient has developed diabetes insipidus due to the location of the stroke. 4. The patient has liver failure.

1. levothyroxine

A patient who has had a thyroidectomy will have to take __1__ for the rest of their lives.

1. infliximab (Remicade) 2. adalimumab (Humira) 3. anti-tumor necrosis factor

A patient who has inflammatory bowel disease may be started on biologic and targeted therapy medications such as __1__ or __2__. They are classified as __3__ medications.

1. folic acid

A patient who has inflammatory bowel disease may need supplemental __1__, especially if they are taking sulfasalazine

1. 7%

A patient who is effectively managing their diabetes should keep their A1c below ___1___

1. cortisol 2. insulin

A patient with Cushing's can have increased blood sugar due to increased __1__ level, which means they should have their blood sugar monitored and may need __2__ therapy.

1. fractures/injury 2. calcium 3. vitamin D

A patient with Cushing's is at an increased risk for __1__ due to being in an osteoporotic state due to altered calcium metabolism. The patient should also have supplemental __2__ and __3__.

1. weights 2. physcological

A patient with Cushing's should have daily __1__ measured due to fluid shifts. They may also need __2__ support due to physical changes.

1. rectal drainage

A patient with a new ostomy will initially have some __1__ because the body is clearing out residual left in the colon. This should subside over time.

1. bed rest 2. NPO 3. fiber 4. NG tube

A patient with diverticulitis needs to rest their colon. They should be put on __1__ which slows down peristalsis, they should be __2__ or liquid diet that is low in __3__, and they may need a __4__ if they are vomiting

1. NG tube 2. clear liquid

A postoperative patient with a new stoma will be treated similarly to any GI post op patient. They will probably need an __1__ for decompression until peristalsis returns. They will be started on a __2__ diet and advanced as tolerated.

1. low 2. high

A patient with hyperthyroidism will have 1.(high/low) TSH levels and 2.(high/low) TH (T3 & T4) levels.

1. LOC 2. hypoventilation 3. hypothermia 4. hypotension

A patient with myxedema coma will initially present with a decrease __1__, followed by __2__, __3__, and __4__ (3 H's). This will eventually progress to CV collapse and shock. the patient may also be hyponatremic.

1. acute renal failure

A patient with pancreatitis may develop __1__ due to decreased perfusion to the kidneys. The patient is very dehydrated and there is a lot of 3rd spacing happening.

1. D50W 2. glucagon 1mg 3. 911 4. 10

A patient with severe hypoglycemia is given ___1___ if they are in the hospital. If they are at home, they administer ___2__ and immediately call ___3___. ___2___ can be repeated in __4__ minutes if needed.

postictal state

A period following a seizure that lasts between 5 and 30 minutes; characterized by labored respirations and some degree of altered mental status.

Trousseau's sign

A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.

1. seizure

A sudden and large drop in blood sugar can induce a __1__.

1. CT scanner 2. tPA (tissue plasminogen activator)

A suspected stroke victim is quickly given IV access and thrown in a ___1___ to figure out if a stroke is ischemic or hemorrhagic before administering ___2___, because it will make hemorrhagic stroke worse.

1. radioactive iodine

A treatment for hyperthyroidism that is more commonly used in middle aged and elderly patients is administration of __1__.

1. CNS 2. level of conscious 3. coma 4. 45 5. asterixis 6. handwriting

Ammonia is a __1__ depressant, so when it builds up in the blood, it can decrease the __2__ and may lead to __3__. Ammonia is considered elevated when it is over __4__. two other signs of hepatic encephalopathy are __5__ and deterioration of __6__.

1. lymph nodes

Esophageal cancer has few symptoms until advanced stages of the disease, but it can spread early to __1__ and other adjacent structures

1. surgery

People who are admitted to the hospital, and especially those who have had ___1___ are at an increased risk for developing a VTE

1. B 2. D

People with hepatitis __1__ may or may not have hepatitis __2__, but people wit hepatitis __2__ always have hepatitis __1__.

1. peak

___1___ is the time of highest risk for hypoglycemia in relation to the administration of insulin for a diabetic.

1. African Americans 2. Alaskan Natives 3. male

Esophageal cancer may have a geographic/cultural component, as there is an increased incidence among __1__ and __2__. It is also more common in the __3__ gender.

1. gluten 2. wheat 3. beer 4. grains

Celiacs is a lifelong disease that a patient will have to manage through avoiding dietary __1__, which is found in many items such as __2__, __3__, and processed __4__.

1. Amphotericin

___1___ is very hard on the kidneys, so you must weigh the cos/benefit of using it.

1. blood 2. cells

DKA will cause overall potassium depletion, but potassium levels may "look" high initially because the dehydration causes potassium to shift into the ___1___. Once you start to rehydrate the patient and give insulin, potassium will be drawn back into the __2__, which will cause the potassium lab levels to drop.

1. carbonated beverages 2. swallowing

After a nissen fundoplication, it is important for patients to avoid drinking __1__. It is also common for the patient to have trouble __2__ immediately after surgery.

3. Performing a lumbar puncture The client's history and assessment suggest that he may have increased intracranial pressure (ICP). If this is the case, lumbar puncture shouldn't be done because it can quickly decompress the central nervous system, causing additional damage. After a head injury, barbiturates may be given to prevent seizures; mechanical ventilation may be required if breathing deteriorates; and elevating the head of the bed may be used to reduce ICP.

After striking his head on a tree while falling from a ladder, a client is admitted to the emergency department. He's unconscious and his pupils are nonreactive. Which intervention should the nurse question? 1. Giving him a barbiturate 2. Placing him on mechanical ventilation 3. Performing a lumbar puncture 4. Elevating the head of his bed

1. 1-2 2. nausea 3. vomiting

After the amount of drainage from the T-tube decreases, you can being clamping the tube for short periods of time. It will typically start for __1__ hours to see how the patient tolerates it. If they start to have __2__ or __3__, then you need to uncamp the tube and let it start draining again.

1. first thing in the morning 2. full glass of water 3. 30 4. remain upright

Alendronate should be taken __1__ with a __2__, __3__ minutes before eating. The patient needs to __4__ for 30 minutes after taking.

1. refrigerator 2. room temperature 3. discomfort

Although insulins can be stored in the ___1___, it is better to give the injection at ___2___ in order to lessen the level of ___3__ for the patient

1. anticoagulation therapy

Ambulation in a patient suspected of VTE is ok only after starting ___1___

1. 3-4 weeks

Ambulation is encouraged on the day of surgery, but heavy lifting should be restricted for __1__ after surgery

1. hormones

Glands are cells that produce and secrete __1__

Electroencephalogram (EEG)

An amplified recording of the waves of electrical activity that sweep across the brain's surface. These waves are measured by electrodes placed on the scalp.

1. 4-5 2. 500

An ileostomy bag must be emptied frequently, normally __1__ times per day. The initial amount early after the procedure will be around 1000-1800 ml daily, but this will decrease to round __2__ml daily after the body adjusts.

1. pharmacologic 2. glucocorticoids 3. mineralocorticoids

An important part of treating Addison's disease is through __1__ therapy because they have an insufficiency of __2__ and __3__ which needs to be replaced.

4. Brain tumor The incidence of brain tumor decreases with age. Headache and papilledema are less common symptoms of a brain tumor in the older adult. Symptoms of epilepsy include fits and spasms, while symptoms of trigeminal neuralgia would be pain in the jaws or facial muscles. Hypostatic pneumonia develops due to immobility or prolonged bed rest in older clients.

An older client complains of a constant headache. A physical examination shows papilledema. What may the symptoms indicate in this client? 1. Epilepsy 2. Trigeminal neuralgia 3. Hypostatic pneumonia 4. Brain tumor

1. 3

Appliance size will have to be adjusted for up to __1__ months after surgery, because there will be swelling that will go down and the stoma will settle into its permanent size and shape.

Infarct

Area of dead tissue after a lack of blood supply

1. increases 2. increases

As volume of blood 1. (increases/decreases), preload 2. (increases/decreases)

1. peritoneum 2. portal hypertension 3. albumin 4. aldosterone

Ascites is defined as fluid in the __1__, and it occurs mainly due to __2__ stemming from hepatic dysfunction. It is also affected by decreased __3__ which causes decreased oncotic pressure, and elevated levels of __4__, which cause retention of sodium.

1. BUN 2. Creatinine

It is important to monitor ___1___ and ___2___ lab values in a patient taking metformin due to the increased risk of liver or kidney damage.

1. 3

Levothyroxine should be given __1__ hours between other medications

1. is not

MNT for a patient with diabetes 1. (is/is not) very different from the way that most people should be eating.

1. red blood cells 2. white blood cells 3. platelets

Because Radioactive iodine can cause bone marrow depression, it is important to monitor CBC labs, and in particular should be looking for decreases in __1__, __2__, and __3__.

1. Hepatitis B vaccine

Because hepatitis B co-exists with hepatitis D, the risk of contracting hepatitis D can be lowered by receiving the __1__.

1. bleeding 2. K 3. Aquamephyton

Because patients with acute hepatitis may have an increased PT and thus increased risk for __1__, they may need to increase their intake of vitamin __2__. The brand name for the commercially available product is __3__.

1. fiber 2. enemas

Because the GI system is slowed down for patients with hypothyroidism, it is important to try to avoid constipation by encouraging a diet high in __1__, and avoidance of __2__, because they can increase the body's parasympathetic state.

1. fat metabolism 2. fat absorption

Because the ileum is often involved in Crohn's disease, patients often have altered __1__ and __2___.

1. type 2

Because you cannot differentiate between type 1 and type 2 diabetes based on blood sugar levels, you need to check labs for natural insulin levels before giving insulin. __1__ will have higher natural levels of insulin

1. 100 2. reduce

Blood sugar should be at least __1__ mg/dl before exercising, and should be checked every hour and treated if it drops below that. If exercising directly after a meal, some people may need to 2. (reduce/increase) insulin dose.

1. 1/3rd 2. 4-6

It is important not to let the ostomy bag overfill before emptying. it is good to get on some type of schedule, like when the bag is __1__ full or on a timed basis, like every __2__ hours.

1. any other insulins

It is important not to mix long acting insulin with ___1___

1. 1st degree relative 2. down syndrome 3. Turners Syndrome 4. Type I diabetes

Celiacs disease has a genetic component and is more common if a person has a __1__ who also has the disease. There is also a risk in patients who have chromosomal abnormalities such as __2__ syndrome, __3__ syndrome, or __4__.

1. end 2. feces 3. mucus 4. reverse

Colostomies can be +single barreled, which is called an __1__ colostomy +double barreled, where __2__ comes out of the proximal opening and __3__ comes out of the distal opening. +Loop colostomy, which is very similar to double barreled but easier to __4__.

1. irrigation 2. a pouch 3. ileostomy 4. retracted

Colostomy __1__ is kind of like an enema for the stoma. The goals of this therapy is to provide modified continence and eliminate or reduce the need for __2__. It is important to remember that a __3__ can never be irrigated because you can rupture the small intestines. This is especially encouraged for patients with __4__ stomas because they are hard to pouch

1. timing 2. quantity

It is important that diabetics are more aware of the ___1___ and ___2___ of food in relation with their therapy and exercise regimen

1. free fatty acid 2. protein

Cortisol increases ___1___ production and increases breakdown of __2__.

1. glucocorticoid 2. glucose 3. stress 4. anti-inflammatory

Cortisol is a type of ___1___, which means that as cortisol increases in the body, so does the ___2___ level. It is released with increased levels of __3__ and has a ___4___ effect on the tissues.

1. ileum 2. cobblestone

Crohn's disease can involve both the small intestine and the colon, but is more commonly found in the distal __1__. It is said to have a __2__ appearance because it can have patches of disease mixed with patches of healthy tissue.

1 pituitary

Cushing disease and cushing syndrome show the same S/S and are managed the same, the main difference is whether it is Cushing's disease is specifically caused by a tumor of the __1__ causing increased production of ACTH.

1. chronic use of exogenous steroid medications

Cushing syndrome can be caused by an outside source such as __1__

1. tumor 2. cortex 3. Oat cell carcinoma

Cushing's syndrome can be caused by internal factors such as a pituitary __1__ which causes excess secretion of ACTH, an adrenal __1__, hyperplasia of the adrenal ___2___, or a certain lung cancer called ___3___ which actually produces more ACTH itself.

1. glucocorticoids (cortisol)

Cushing's syndrome is caused by a severe excess of __1__

1. every 15 minutes

It is important to constantly reassess hemorrhagic stroke patients, assessments often start out every ___1___, then titrate up in intervals.

1. bleeding 2. signs/symptoms 3. toothbrush 4. razor 5. contact sports

It is important to educate patients on anticoagulant therapy about their increased risk of ____1___, and which ___2___ to be on the lookout for. They should also be educated about using a soft ____3___ and an electric ____4___, as well as not to engage in ___5___.

1. rebound hypertension

It is important to educate patients on not abruptly stopping their blood pressure medications due to the risk of ___1____.

1. spikes 2. stressor 3. dehydration 4. insulin dose

DKA occurs when the blood sugar __1__, can happen regardless of food consumption. Usually due to some type of ___2___, but ___3___ and skipping ___4___ can increase risk.

1. glucose 2. fat 3. protein

Deficiency of insulin results in decreased ____1___ utilization, increased ___2___ mobilization, and increased ___3___ mobilization.

1. 50-60 2. 20-30 (GOOD fats) 3. 10-20

MNT for diabetics focuses on percentage of calories that come from complex carbs, lean proteins, and good fats. Carbohydrates= ___1___% Fat = ___2____% Protein = ___3___%

1. frequent 2. small 3. drink fluids 4. fat 5. protein 6. dry foods 7. carbs 8. lying down 9. antispasmodic (dicyclomine)

Dumping syndrome can be managed by +eating __1__ , __2__meals +__3__ between meals rather than with them +diet high in __4__, __5__, and __6__, and low in __7__ in order to increase digestion time and rebuild tissues +__8__ after meals in order to slow gastric motility +__9__ medications to slow gastric emptying

1. energy metabolism 2. early phase 3. spaced out

Fatigue is very common in patients recovering from acute hepatitis due to decreased __1__. The fatigue is usually worse in the __2__ of the recovery. Activity is not harmful, but needs to be __3__ in order to allow rest, which takes priority.

1. IM Ig 2. passive 3. 2

For a person who has not previously had the Hep A vaccine and is exposed, they can be administered __1__, which gives __2__ immunity for 3 months by providing antibodies. It must ideally be given within __3__ weeks of exposure, the earlier the better.

1. blood sugar 2. lifestyle changes alone

For a type 2 diabetic, it is necessary to use pharmacologic treatment when they are not able to control ___1___ through ___2___

1. glycogen 2. glucose 3. 24

Glucagon works by accelerating the breakdown of __1__ to __2__ in the liver to increase blood sugar. It can be given IV or IM. Once it has been mixed, it is good for __3__ hours if refrigerated.

1. Lower esophageal sphincter

GERD is primarily caused by relaxation of the __1__. This allows acidic contents to flow into an environment that is not intended to handle it.

1. poor 2. 29

Gastric cancer has very few or even zero symptoms in the early stages. It has a __1__ prognosis with a 5 year survival rate of __3__%.

1. older adult men

Gastric cancer is more common in __1__ (age/gender)

1. iodine

Goiter can be due to a deficiency of __1__, and is more commonly seen in countries that don't have enough in their diet. The body tries to compensate for the lack of __1__ by producing extra TSH, which causes the thyroid to enlarge over time.

1. 10-14 2. two antibiotics 3. a PPI 4. bismuth salt

H. Pylori is treated for __1__ days with a combination of __2__, a __3__, and __4__.

1. ammonia 2. urea

Hepatic encephalopathy is damage to the brain that occurs due to a buildup of __1__ in the bloodstream, because the dysfunctional liver is not able to do what it normally does, which is to convert __1__ into __2__.

1. developing countries 2. fecal-oral 3. produce

Hepatitis A & E are very similar to each other, though E is rare in the United States and is more prevalent in __1__, due to poor sanitation. They are considered enteric viruses which means they are primarily transmitted via the __2__ route. In the US, it is often due to contaminated __3__.

1. Recombivax-HB 2. active 3. 1 month 4. 6 months 5. deltoid

Hepatitis B has a vaccine __1__, which provides __2__ immunity. It should be given to anyone deemed at high risk. It is administered in a series of three doses. The initial dose, then a second dose repeated at __3__, then the third dose repeated at __4__. The optimal site of administration is the __5__ muscle, because it allows for increased concentration in the muscle, allowing the vaccine to work better.

1. blood 2. bodily fluids 3. 1 week

Hepatitis B, C, & D are all transmitted similarly via __1__ and __2__. These viruses can live for up to __3__ on surfaces.

1. developing 2. vaccine 3. exposure

Hepatitis E is much more rare, and is more commonly found in the __1__ world, in places such as Asia, Africa, India, and Mexico. There is no __2__ so the only way to prevent is to reduce risk of __3__.

1. women 2. men

Hiatal hernia occurs more often in __1__ than in __2__.

1. problems 2. roller coaster

High blood sugars with type I and Type II diabetics will still end up causing the same __1__ over time. __2__ blood sugars can also increase complications over time, perhaps more so than continually elevated blood sugars.

1. 100 2. 100 3. 5-10 4. 0.1

IV insulin comes in bags of __1__ units per __2__ ml, which makes it easier to calculate since it is a 1:1 ratio. An IV bolus is usually given in the ED and then the patient is infused at a rate of ___3___ units per hour or ___4___ units/kg/hour

1. common bile duct 2. ERCP

If a gallstone is stuck in the __1__, then this will first need to be removed via an __2__ procedure before the laparoscopic cholecystectomy can be performed to remove the gallbladder.

1. heparin drip 2. argatroban 3. warfarin

If a patient develops heparin induced thrombocytopenia (HIT, it is important to immediately stop ___1___, give ____2___ IV (which inhibits thrombin and acts as an anticoagulant), and start on ___3___ after platelet count recovers.

1. weight 2. diet 3. exercise

If a patient has changes in ___1___, ___2___, or ___3___, they should check their blood glucose because their metabolism may have changed , which could effect insulin utilization

1. removed

If a patient has significant gallbladder disease/stones, then the gallbladder will be __1__ in most cases.

1. kidney 2. BUN 3. creatinine kinase 4. peeing

If a patient is having a scan with contrast dye, it is important to assess ___1___ function because it can be hard on them. 2 labs that you would monitor would be ____2___ and ___3___. You also need to make sure the patient is ___4___properly because that is how the dye will be flushed out of the system.

1. 48 2. laparoscopically 3. open

If a patient is having an appendectomy, it should be performed within __1__ hours of onset of symptoms. The surgery is typically performed __2__ unless rupture is suspected, in which case the surgery is performed __3__.

1. glucagon 2. outer thigh

If a patient is hypoglycemic and unconscious, the treatment is to administer __1__. The safest place on the body to administer it is the __2__.

1. let tablet dissolve under the tongue, do not swallow 2. medication should be carried with the patient at all times, but due to its instability, should be carried securely in the original container (dark glass bottle) 3. supply should be renewed every 6 months due to instability of medication 4. can take 1 tablet every 5 minutes, but must call EMS if no relief after 3rd tablet. 5. sit down after taking to avoid hypotension and syncope 6. side effects of the medication

If a patient self administers nitroglycerin, it is important to educate them on these 6 things

1. slowly taper the dose down until they are back where they should be.

If a patient taking propylthiouracil and methimazole shows signs of hypothyroidism, you need to __1__

1. liver biopsy 2. PT/INR 3. vitamin K 4. FFP

In a __1__ procedure, a small slender core of tissue is removed from the liver with a needle. __2__ should be checked prior to the procedure, because the liver is highly vascular and there is an increased risk for hemorrhage. The procedure may need to be rescheduled and the patient may be given __3__ or __4__ to try to get clotting back up.

1. CT angiography 2. bleeding 3. peripheral pulses

In a ___1___ procedure, dye is injected directly into the arteries of the brain so the X-ray scan can see blood flow more clearly. There is a risk of ___2___ and it is important to assess ___3___ after the procedure.

1. concentrated 2. dilute

In a normal state, nIf serum osmolality is too __1__, pituitary releases ADH telling kidneys to reabsorb water therefore decreasing serum osmolality (serum concentration) and increasing circulating volume. Urine output would decrease. If serum osmolality is too __2__ the pituitary withholds ADH telling the kidneys to excrete water therefore increasing the serum osmo and decreasing the circulating volume. Urine output would increase.

1. hypoglycemia 2. hyperkalemia 3. hypotension

In a patient with Addison's disease, you want to monitor for __1__, __2__, and __3__.

1. high 2. low

In a patient with SIADH, urine osmolality and urine sodium is 1. (high/low), while serum osmolality and serum sodium are 2. (high/low)

1. stimuli 2. ICP 3. labs

In a patient with encephalitis, it is important to decrease ___1___, monitor for increased ___2___, and monitor ____3___ due to the "heavy hitter" medications used.

1. slowed down 2. constipation 3. weight gain

In general, body system are __1__ in hypothyroidism. The GI system is slowed down, which causes __2__ and __3__.

1. metabolism 2. temperature 3. oxygen

In general, hypothyroidism slows the bodies __1__, lowers body __2__, and decreases the body's __3__ consumption.

1. inhibited 2. increases

In normal physiologic state, hormone concentration is maintained through negative feedback. If hormone production increases, further production is __1__. If hormone production decreases, further production ___2___.

1. anabolic 2. muscle 3. protein 4. emaciated

Insulin is also an ___1___ hormone that is needed to rebuild ____2___ in the body. When there is an absolute deficiency of insulin, as seen in type 1 diabetics, we see increased ____3___ utilization and wasting, which can cause the patient to look ___4___ due to the breakdown of ___2___.

1. abdomen 2. umbilicus 3. hypertrophy

Insulin is best absorbed when it is injected in the __1__. If given in the abdomen, it should be injected 2 inches away from the __2__. It is important to rotate injection sites in order to prevent __3__.

1. acetaminophen 2. allopurinol 3. amoxicillin 4. erythromycin 5. sulfa drugs 6. INH (TB meds) 7. NSAIDs 8. immunosuppressives 9. lipid lowering meds 10. estrogen 11. antipsychotic meds

It is important to educate patients with hepatitis to avoid hepatotoxic medications such as (11 of them)

1. blood sugar

It is important to get a ___1___ on a suspected stroke patient to rule out diabetic ketoacidosis.

1. protein 2. ammonia

It is important to manage bleeding in patients with hepatic encephalopathy because blood is a __1__ and any bleeding in the GI system will increase buildup of __2__.

1. symtpoms

Intervention in patients with hypoglycemia depends mostly upon the severity of the ___1___

1. kidneys.

Invokana works by increasing the excretion of glucose through the __1__.

1. diagnosis of exclusion

Irritable bowel syndrome is discovered via a __1__, which means that you basically have to rule everything else out first.

1. blood sugar 2. cholesterol 3. blood pressure

It is important for diabetics to adhere to MNT because it helps to (among other things) keep ___1___, ____2___, and ___3___ under control.

1. hyperkalemic 2. diluted in water or juice 3. straw

It is important to remember that if a patient is __1__, we need to fix that before we administer potassium iodide. Potassium iodide also needs to be __2__ before administration and drunk through a __3__ because it is a harsh compound that can cause tooth breakdown and esophageal/duodenal ulcers.

1. rupture

It is ok to apply ice to abdomen for appendicitis pain, but you do not want to add heat because it increases the risk of __1__

1. cardiac 2. respiratory

It is very important to assess __1__ system and __2__ system in a patient who is having thyroid storm

1. reassess

It is very important to get a baseline in neuro, and then constantly ___1___.

1. rapid 2. 1-4 3. 10

Januvia is given orally. It has a __1__ onset, peaks in __2__ hours, and has a duration of __3__ hours

1. insulin 2. glucagon 3. GI

Januvia works by increasing the amount of __1__ released, decreasing the amount of __2__ released, and slows __3__ absorption.

1. T4

Levothyroxine is a synthetic salt form of __1__ which is used to replace what the body can no longer produce.

1. myxedema coma

Levothyroxine is used in the treatment of hypothyroidism and is used for emergency treatment of __1__.

1. alert 2. lethargic 3. obtunded 4. stuporous 5. comatose

List the 5 levels of consciousness

1. MI 2. morphine 3. oxygen 4. nitroglycerine 5. aspirin 6. beta-blocker

MONA therapy is the initial treatment for suspected ____1____ and stands for _____2___, ___3___, ___4___, and ____5___. If a dysrhythmia occurs, a ___6___ should also be given.

1. tumor 2. exogenous steroids

Medical management of Cushing's will depend on the cause, but generally must get rid of the causative factor to correct. Typically will try to remove __1__ if that is the cause, or taper __2__ if that is the cause.

NIHSS

National Institutes of Health Stroke Scale

1. calories 2. fat 3. protein

Nutrition is important for patients with hepatic encephalopathy. We want them to have high __1__ and low __2__. You don't want to restrict __3__, but you need to monitor for tolerance by monitoring ammonia level and LOC.

rheumatic endocarditis

Occurs most often in school-age children after group A beta-hemolytic streptococcal pharyngitis; need to promptly recognize and treat "strep" throat to prevent rheumatic fever, which leads to this.

1. clear liquid 2. low fat 3. alcohol 4. caffeine 5. nicotine 6. pancreatic enzymes

Once a patient with pancreatitis has become free from pain, PO nutrition can be started with a __1__ diet. The next step is to advance to a low __2__ diet. The patient must avoid __3__, __4__, and __5__. The patient may have to have supplemental __6__ if the there has been severe pancreatic damage.

1. bile

One of the biggest jobs of the liver is the production and excretion of __1__, which is responsible for the breakdown of fat in the digestive system.

1. symmetry 2. equal

One of the biggest physical things we look at when assessing for neuro problems is ___1___, on the normal body right should be ___2___ to left.

1. fluid volume imbalance 2. isotonic 3. albumin 4. 0.5-1 ml/kg/hr

One of the biggest problems that patients with pancreatitis have is __1__. The patient will have nausea and vomiting that is managed by keeping them NPO and placing an NG tube. You give __2__ fluids and __3__, in order to help pull fluid back into the intravascular space. You want to monitor electrolyte levels and I&O. The goal for urine output is __4__.

1. chronic 2. 3-6

One of the main complications of viral hepatitis is that it leads to __1__ hepatitis, which is defined as hepatitis that lasts longer than __2__ months.

1. jaundice 2. bilirubin

One of the major clinical manifestations of liver disease is __1__, which is caused by the accumulation of bile pigments (aka __2__) in the blood.

1. rapid acting 2. short acting

Only ___1___ and ___2___ can be infused through an IV pump

onset: 1 hour duration: 24 hours

Onset and duration of glyburide

1. bowel prep 2. clear liquid diet 3. sedatives 4. heart rate 5. blood pressure

PAtients who are having a colonoscopy will need to have a __1__ in order to clear everything out of their system so the camera can see clearly. The patient will be switched to __2__ at some point the day before the procedure. It is important to monitor for respiratory issues because the patient will have been given __3__, as well as monitoring for signs of bleeding/rupture such as changes in __4__ and __5__.

1. low dose 2. metabolic 3. oxygen 4. MI

Patient being started on levothyroxine who also have heart disease should be started with a __1__. This patient has been in a slow cardiovascular state for some time, and the increase in T4 can cause increased __2__ and __3__ needs of the heart too quickly. This can cause the patient to potentially have an __4__.

1. T tube 2. common bile duct 3. edema

Patient may have a __1__ placed in the biliary tract post operatively after gallbladder surgery in order to allow bile to flow freely. The device is sutured into the __2__, and attaches to an external bag to collect the bile. It is placed to ensure post operative __3__ doesn't cause blockage of the biliary system while the area is healing.

1. anticoagulants 2. thrombus 3. follow up appointments

Patient should be aware that although a mechanical heart valve is more durable and will last longer, it will require lifetime ___1___ due to a high risk of ___2___. The patient will also have to have frequent ____3___ to check labs

1. low to high fowler's

Patient should be positioned in a __1__ position post esophagectomy in order to help expand their airway and prevent reflux.

1. aspirin 2. antacids 3. calcium containing products 4. iron 5. vitamins

Patient taking alendronate should avoid taking __1__ as it increases the risk of bleeding. They should also avoid taking it at the same time as __2__, __3__, __4__, or other __5__ due to interference with absorption.

1. seafood

Patient who have allergies to __1__ should not use calcitonin salmon.

1. eating 2. defecating

Patient with irritable bowel syndrome often experience abdominal pain and cramping after __1__. They may experience symptoms relief after __2__.

1. aspiration 2. vomiting

Patients being administered glucagon should be placed on their side to prevent ___1___, because it can rapidly cause ___2___

1. 240

Patients can use a urine dipstick to check for the presence of ketones, and should do so whenever their blood sugar is greater than ___1___ mm/dL

1. sedated 2. metal objects

Patients getting an MRI may need to be ___1___ because they will be within the close confines of the machine for 30-120 minutes. Care must also be taken to be sure no ___2___ are anywhere within the magnetic zone.

1. wound & ostomy care 2. ostomy 3. partner 4. family

Patients having an ostomy placed are likely to have psychosocial concerns because it is a major lifestyle change. The patient should meet with a __1__ nurse as well as someone who lives with an __2__. It is also important to include the patient's __3__ or __4__ in these discussions

1. IV thyroxine 2. glucose 3. corticosteroids 4. sedatives

Patients in myxedema coma will be on life support. They will be administered __1__, __2__, and __3__. It is important to alter dosages of __4__ because it can cause further slowing of the body's already low basal metabolic rate.

1. coffee 2. tea 3. chocolate 4. alcohol 5. bananas 6. smoking 7. exercise 8. straining

Patients need to be educated on avoiding things that stimulate the sympathetic nervous system prior to catecholamine test. They should avoid foods such as __1__, __2__, __3__, __4__, and __5__. The patient should also avoid activities that increase SNS stimulation such as __6__, __7__, and __8__.

1. 45 2. 3

Patients should begin regular screening for diabetes once they reach the age of ___1___ and repeat the screening every ___2___ year(s).

1. "sick days" 2. BS 3. ketones 4. 10-15 5. 30 minutes

Patients should have a plan that they follow on ___1___. This should include knowing when to call the provider, frequent monitoring of ___2___ and __3__, eating ___4__ grams of carbs every 1-2 hours and drinking fluids every ___5___.

1. anticoagulants 2. digoxin

Patients taking levothyroxine may need to decrease dose of __1__ due to an increased risk for bleeding. Levothyroxine can also decrease __2__ levels.

1. iodinated contrast dyes

Patients taking metformin are at an increased risk for acute kidney injury and lactic acidosis with the use of ___1___, which is why they need to be screened before any type of diagnostic procedure that uses ___1___.

1. mechanical 2. complications

Patients who have a ___1___ valve need to be aware that the procedure requires more extensive surgery and thus has higher risk of ___2___.

mask symptoms of hypoglycemia

Patients who have diabetes and are taking beta-blockers need to be educated to check their blood sugar regularly because beta-blockers ___1___.

1. bowel prep 2. antibiotics

Patients will need to have a __1__ before any type of bowel surgery in order to reduce the risk of bacterial infection. They may also be started on __2__ prophylactically.

1. protein 2. carbs 3. sodium 4. fluid

Patients with Addison's disease should consume a diet high in __1__, __2__, and maintain adequate levels of __3__ and __4__ intake.

1. hydrocortisone 2. dexamethasone

Patients with Addison's disease should have an emergency kit with __1__ or __2__.

1. medical alert bracelet 2. stress 3. strenuous exercise

Patients with Addison's disease should wear a __1__ and avoid __2__, illness, and __3__.

1. elevate 2. heart 3. cross their legs 4. dependent

Patients with PAD should ___1___ their feet but not above the level of their ___2___. They should also be careful not to ____3___ or place in a ___4___ position for long periods of time.

1. cold 2. dress warmly 3. vasoconstriction 4. emotional stress

Patients with Raynaud's should be cautioned to avoid ____1___ environments or ___2___ if they cannot, because it causes increased ___3___ which can aggravate the disease. Raynaud's can also be aggravated by increased ___4___.

1. mechanical 2. artificial surfaces promote clotting and adhesion of platelets

Patients with ____1____ valve replacement require lifetime anticoagulant therapy because ____2____

1. CLABSI 2. 7 days 3. heparin 4. caps

Patients with a central line are at high risk for __1__. The dressing needs to be changed every __2__ unless it is soiled or no longer occlusive. The line needs to be flushed with __3__ before and after every use, and daily if not being used. __4__ on the hub at the end of the line need to be maintained according to institution policy.

1. bland 2. soft

Patients with esophageal varices need to be "kind" to heir esophagus in order to reduce risk of hemorhage. They should avoid foods that hurt the esophagus and stick with foods that are __1__ and __2__.

1. low fiber 2. bland 3. NSAIDS 4. aspirin

Patients with gastric ulcer should be educated to follow a __1__ and __2__ diet, as well as avoid medications such as __3__ and __4__ due to increased risk for gastric bleeding.

1. alanine transaminase (ALT) 2. alkaline phosphatase (ALP) 3. lactate dehydrogenase (LDH)

Patients with hepatic dysfunction will have elevated liver enzymes such as __1__, __2__, and __3__.

1. abdominal pressure 2. upwards

Patients with hiatal hernias should avoid constrictive clothing because it can increase __1__ and can push the hernia __2__.

1. frequent, small 2. caffeine 3. alcohol 4. spicy foods 5. protein 6. calorie

Patients with hyperthyroidism should be encouraged to consumer __1__ meals and replace fluids. They should avoid things that stimulate the GI system such as __2__, __3__, and __4__. We want to push a high __5__, high __6__ diet with lots of supplemental vitamins

1. lactose intolerance

Patients with inflammatory bowel disease should be evaluated for __1__, because it can the mimic the symptoms and make them worse.

1. smoke

Patients with inflammatory bowel diseases should not __1__, because it increases GI motility

1. high fat

Patients with inflammatory bowels disease should reduce __1__ foods in their diet, especially if a portion of their ileum is removed.

1. esophagitis 2. Barretts esophagus 3. esophageal cancer

Prolonged esophageal reflux can cause these 3 things

1. protein 2. urine

Proteinuria can be checked with a urine dipstick and indicates increased levels of ___1___ in the ___2___, can be indicative of uncontrolled blood sugar

Gylburide (DiaBeta)

Prototype 2nd generation sulfonylurea

1. beta-blockers 2. thyroid hormone

Radioactive iodine treatment can cause a surge in thyroid hormone, so the patient may need to temporarily take __1__ to counteract the surge. There will most likely be a deficiency of __2__ after this treatment, and the patient will have to start taking __2__ replacement medications.

1. Humalog (lispro) 2. Novolog (aspart)

Rapid acting insulins include ___1___ and ___2___

1. Humalog (LISPRO) 2. Novolog (ASPART) 3. Apidra (GLULISINE)

Rapid acting insulins include ___1___, ___2___, and __3__.

1. malignant tumors 2. head trauma 3. brain surgery 4. infection

SIADH is most often caused by __1__ that release ADH, __2__, __3__, or __4__.

1. sodium 2. intracellular fluid (ICF)

SIADH is the most common cause of low serum __1__, because it all tries to move to the __2__.

1. genetics 2. structural 3. metabolic 4. unknown

Seizures may be due to ___1___, ___2___ or ___3___ abnormalities, or it may be entirely ___4___.

1. doxazosin 2. nifedipine 3. propranolol

Short term management of pheochromocytoma is primarily focused on controlling hypertension through the use of an alpha blocker such as __1__ and/or calcium channel blocker such as __2__. A beta blocker such as __3__ may be used to control heart rate.

1. cardiovascular 2. LDL 3. triglycerides 4. HDL 5. viscous

Significant __1__ disease is associated with diabetes, and it can cause an increase in __2__ and __3__ levels, as well as a decrease in __4__ levels. The osmotic diuresis of diabetes also causes the blood to become more __5__, which hinders flow.

1. septic shock

Signs of __1__ include fever, tachycardia, narrowing pulse pressure, increased white count, increased lactic acid (>4)

1. epinephrine 2. check blood sugar 3. target blood sugar 4. beta-blockers

Some patients have a condition called hypoglycemic unawareness, which is caused by a blunted __1__ response and causes them to not get the early signs of hypoglycemia. This person is at very high risk and needs to be educated to __2__ more often and keep a higher ___3___. They should also avoid taking ___4___ because they will mask the sympathetic nervous response (i.e. symptoms) even more.

1. hypoglycemia 2. sulfa

Sulfonylureas (such as glipizide and glyburide) stimulate beta cells to make insulin, it is important to remember that they can cause ___1__ faster than other medications, and are contraindicated in patients with a ___2___ allergy

1. fatigued 2. 4 months

Supportive care is very important in the acute phase of viral hepatitis, as the patient will be very __1__ for the first 2-3 weeks. Full recovery from acute hepatitis can take as long as __ __2__.

1. total 2. subtotal

Surgical management for gastric cancer can either be a __1__ gastrectomy or a __2__ gastrectomy.

1. slow 2. central line 3. hypertonic 4. precipitates

TPN is given through a pump, and must be given in a __1__ and controlled manner. It must be given through a __2__, because the solutions are __3__ and can irritate peripheral veins. A __4__ must be in place to keep precipitates out of the body.

1. hypothalamus 2. hormones 3. inhibiting

The __1__ is a coordinating center for internal and external stimuli. It also regulates body functions such as thirst, hunger, BP, respiration, and emotions. It also produces and secretes stimulating __2__ and __3__ factors.

1. parathyroid gland

The __1__ is embedded on the posterior surface of the lobes of the thyroid gland.

1. Honeymoon period

The __1__ refers to when someone is first diagnosed and insulin starts getting put into the body, some of the insulin cells start working again,but it only lasts for a finite period of time

1. A1c

The __1__ test gives you an overall picture of glucose control, but it is not the whole picture. It is possible for a patient to be within the normal range of the test but still be having extreme hyperglycemic events.

1. Somogyi 2. 2-4am 3. 7am

The ___1___ effect is also known as rebound hyperglycemia. It is rare and results from the evening insulin dose. The patient gets hypoglycemic around ___2___ in the morning, but counterregulatory hormones raise blood sugar back by ___3___, so the only way to find out it is happening is by checking blood sugar in the middle of the night.

1. Hypothalamus 2. Posterior pituitary

The ___1___ produces ADH which is then stored in the ___2___, from which it is released when certain changes are sensed by the body

1. anterior pituitary 2. adrenal cortex

The ___1___ releases the hormone ACTH, which stimulates the __2__ to release adrenal cortical hormones (cortisol and aldosterone)

Proprioception

The ability to tell where one's body is in space.

1. opioid 2. antispasmodic

The acute pain that accompanies pancreatitis can be controlled by __1__ medications. __2__ medications are also added because __1__ can cause spasms in the ductal system.

1. cortisol 2. aldosterone 3. androgens

The adrenal cortex releases steroid hormones such as __1__, __2__, and __3__.

1. kidneys 2. adrenal cortex 3. adrenal medulla

The adrenal glands sit on top of the ___1___ and are made of the outer portion called the __2__ and the inner portion called the __3__

1. epinephrine 2. norepinephrine

The adrenal medulla releases __1__ and __2__

Latent TB

The bacteria is surrounded by macrophages and lies dormant in the body, sometimes for years or even whole life. If your immune system weakens at some point, the bacteria could multiple thus becoming active TB. You will have no symptoms and not be able to infect other people while the disease is in its latent state.

1. catecholamines 2. metanephrine 3. 30 minutes

The best way to detect pheochromocytoma is by testing the urine and plasma for increased levels of __1__ and __2__. When drawing blood for the test, you need to take blood from an existing line or wait __3__ after sticking needle because the stick can cause a little jump in epinephrine and norepinephrine.

1. thrombolytic 2. tPA 3. 60 4. 4.5

The best way to treat an ischemic stroke is with ___1___ therapy. ___2___ is administered through an IV but there is a limited time window that you have before it is no longer effective. The goal for time from door to needle is ___3___ but can still be used up to ___4___ after the stroke.

1. bloating 2. stomach pain 3. diarrhea 4. 2 weeks

The biggest side effect of metformin is GI effects such as __1__, ___2__, and __3__. These symptoms usually decrease after __4__ of treatment.

1. stress

The body needs more energy during time of ___1___ (such as an illness) so it is important to check blood glucose more often when in these situations.

3. Vector bites Possible exposure to mosquito bites can be beneficial in the diagnosing of encephalitis secondary to West Nile virus. Change in level of consciousness (LOC), vomiting, and seizures are all symptoms of increased intracranial pressure (ICP) and do not assist in the differentiating of cause, diagnosis, or establishing nursing care.

The client presents to the walk-in clinic with fever, nuchal rigidity, and headache. Which of the following assessment findings would be most significant in the diagnosis of this client? 1. Change in level of consciousness 2. Vomiting 3. Vector bites 4. Seizures

1. patent airway 2. tracheostomy 3. semi-fowlers 4. neck

The most important consideration for a post op thyroidectomy patient to maintain a __1__. A __2__ kit should be kept by the bedside in case of emergency. The patient should be positioned in __3__ and we do not want to hyperextend their __4__.

1. shakiness 2. agitation 3. sweating 4. lightheaded

The first symptoms usually seen with hypoglycemia are __1__, __2__, __3__, and __4__

expressive aphasia (Broca's aphasia)

The inability to produce language ( despite being able to understand language). they know what they want to say, just can't get it out.

Billroth I

This form of a gastrectomy removes the distal stomach (antrum) and attaches the remaining stomach to the duodenum. It is a less serious surgical procedure

1. digestive enzymes 2. endocrine 3. exocrine

The function of the pancreas is to secrete __1__, as well as performing __2__ and __3__ functions

1. hypoxia 2. perfusion 3. IV dextrose 4. beta-blocker

The goals of treatment for thyroid storm are to prevent __1__ by providing oxygen, maintain effective __2__, and provide __3__ to replace the glucose that is lost due to increase metabolic demands. A __4__ will be administered to treat the cardiac manifestations by slowing the heart rate.

1. Havrix 2. Vaqta 3. active 4. 6-12

The hepatitis A vaccines __1__ and __2__ are available and should be given to people at high risk. It provides __3__ immunity by triggering the body to produce antibodies. Adults are given a series of 2 doses __4__ months apart. Children receive 3 doses.

1. TRH (thyrotropin-releasing hormone) 2. TSH (thyroid-stimulating hormone) 3. Thyroid hormones (T3 & T4)

The hypothalamus releases __1__ based on negative feedback mechanism, which tells the anterior pituitary to secrete __2__, which then stimulates the thyroid to release more __3__.

1. TRH - thyroid releasing hormone 2. TSH - thyroid stimulating hormone 3. T3 4. T4

The hypothalamus releases __1__, which tells the anterior pituitary gland to release __2__, which in turn tells the thyroid gland to release __3__ and __4__.

Starling's Law

The more the heart is filled during diastole the more forcefully it contracts

1. head injury

The most common cause of diabetes insipidus is __1__

1. Hashimoto's thyroiditis

The most common cause of hypothyroidism is __1__

1. H. Pylori 2. stress

The most common cause of peptic ulcer disease is __1__. It can also be caused by __2__ because the stomach is innervated by the SNS and PNS.

1. phrenic nerve 2. right shoulder 3. ambulation 4. absorbed 5. heating pad

The most common patient complaint after laparoscopic cholecystectomy is pain due to the CO2 putting pressure on the __1__ that innervates the diaphragm. The pain is referred up to the __2__. Early and frequent __3__ can help relieve this pain by allowing the CO2 to move around and allows it to be __4__ quicker. A __5__ can also be applied to help with the pain.

1. lipase 2. 48-72

The most specific lab value indicator of pancreatitis is elevated serum __1__. Amylase will also be elevated but only for __2__ hours. __1__ levels can remain elevated for days longer than amylase, which is why it is a good indicator.

1. safety 2. airway 3. suction 4. oxygen therapy

The number one nursing priority for a patient having a seizure is ___1___. Need to protect the ___2___, have ___3___ nearby, loosen clothing, and provide ___4___ afterwards.

4. Semi-Fowler's The head of the bed is elevated 15 to 30 degrees (semi-Fowler's position) to promote venous drainage and decrease intracranial pressure.

The nurse is caring for a patient having a hemorrhagic stroke. What position in the bed will the nurse maintain this patient? 1. High-Fowler's 2. Prone 3. Supine 4. Semi-Fowler's

3. Mannitol If signs and symptoms of increased ICP occur, efforts to decrease the ICP are initiated: alignment of the head in a neutral position without flexion to promote venous drainage, elevation of the head of the bed to 30 degrees (when prescribed), administration of mannitol (an osmotic diuretic), and possible administration of pharmacologic paralyzing agents.

The nurse is caring for a patient with increased ICP. As the pressure rises, what osmotic diuretic does the nurse prepare to administer? 1. Glycerin 2. Isosorbide 3. Mannitol 4. Urea

3. High in protein and low in carbohydrate A dietary intervention, referred to as the ketogenic diet, may be helpful for control of seizures in some patients. This high-protein, low-carbohydrate, high-fat diet is most effective in children whose seizures have not been controlled with two antiseizure medications, but it is sometimes used for adults who have had poor seizure control

The nurse is educating a patient with a seizure disorder. What nutritional approach for seizure management would be beneficial for this patient? 1. Low in fat 2. Restricts protein to 10% of daily caloric intake 3. High in protein and low in carbohydrate 4. At least 50% carbohydrate

1. Provide thickened commercial beverages and fortified cooked cereals. Patients with CVA or other cerebrovascular disorders should lose weight and therefore should minimize their volume of food consumption. To ensure this, the nurse may provide thickened commercial beverages, fortified cooked cereals, or scrambled eggs. Patients should avoid eating high-fat foods, and serving foods hot or tepid will not minimize the volume consumed by the patient. Foods such as peanut butter, bread, tart foods, dry or crisp foods, and chewy meats should also be avoided because they cause choking.

The nurse is providing diet-related advice to a male patient following a cerebrovascular accident (CVA). The patient wants to minimize the volume of food and yet meet all nutritional elements. Which of the following suggestions should the nurse give to the patient about controlling the volume of food intake? 1. Provide thickened commercial beverages and fortified cooked cereals. 2. Include dry or crisp foods and chewy meats. 3. Always serve hot or tepid foods. 4. Provide a high-fat diet.

1. somatropin

The prototype drug for growth hormone is __1__

1. flatulence 2. GI disturbance 3. intestinal

The two main side effects of acarbose are __1__ and __2__. It is also contraindicated in patients who have __3__ issues

1. cortisol 2. dex suppression

The two main ways to diagnose Cushing's syndrome is to check serum and urine levels of __1__, or to perform a __2__ test.

1. vasopressin (ADH) 2. oxytocin 3. hypothalamus

The two major hormones secreted by the posterior pituitary gland are __1__ and __2__. Both are produced in the __3__ before traveling to the posterior pituitary for storage and release.

1. calcitonin salmon 2. alendronate

The two prototype drugs for anti-hypercalcemics are __1__ which is a calcitonin, and __2__ which is a bisphosphonate

1. Billroth I 2. Billroth II

The two types of subtotal gastrectomy are a __1__ procedure and a __2__ procedure.

What type of delivery system is most beneficial for a patient with COPD and explain why.

The venturi mask is the preferred delivery system for patients with COPD because it can deliver an extremely precise amount of oxygen with each breath, thus avoiding the risk of suppressing the hypoxic drive.

1. sliding 2. 95 3. paraesophageal

There are two main types of hiatal hernias __1__ hiatal hernia is the most common (__2__%) and occurs when the upper stomach and the gastroesophageal junction are displaced UPWARD and slide in and out of the thorax. __3__ hernia occurs when all or part of the stomach pushes through the diaphragm BESIDE the esophagus

1. metabolism 2. T3 3. T4

They thyroid gland secretes hormones that affect almost every cell in the body. The main function is to control the bodies __1__ by increasing and decreasing the amount of __2__ and __3__ secreted.

1. prednisone 2. hydrocortisone 3. missing doses or abruptly stopping 4. stress 5. illness

To replace glucocorticoids (cortisol) longterm, the patient will be prescribed __1__ or __2__. They need to be educated on the importance of not __3__. The patient also needs to inform the provider during times of increased __4__ or __5__ so that the dose can be temporarily increased.

1. IV

To reverse the metabolic acidosis that DKA causes, the patient will need to be given insulin via __1__. This allows the rate to very precisely controlled and easily modified.

1. every use 2. intermittently during feeding 3. water 4. separately 5. flushed

Tubing needs to be flushed before and after __1__, and sometimes __2__. Flushing is always done with __3__. If the tube gets clogged, you can try to milk it or use an enzymatic cleaner. When giving meds through a tube, each med needs to be given __4__ and the tubing should be __5__ between each one.

1. propylthiouracil (PTU) 2. methimazole (Tapazole) 3. 4-8 4. 6 5. 15

Two medications commonly used to treat hyperthyroidism are __1__ and __2__. They impair TH synthesis by blocking utilization of iodine. Results can take __3__ weeks to be seen, and the patient may have to take the medication for anywhere from __4__ to __5__ months, or possibly even for life.

1. puberty 2. metformin

Type 2 diabetes cannot be detected until around the age of __1__, because growth hormone works against insulin. The only oral antihyperglycemic approved for children is __2__.

1. obesity 2. diet 3. exercise 4. insulin 5. oral antihyperglycemics

Type 2 diabetes has a relatively slow onset and is usually related to __1__. Early stages can possibly be treated with changes in __2__ and __3__, but if t progresses, it will then require treatment with __4__ and __5__.

1. meals 2. bedtime

Type 2 diabetics will often check their blood glucose before ___1___ and at ___2___.

1. ketone

Type II diabetes does not usually have the __1__ production that can be seen in type I diabetes

1. 1

Type ___1___ diabetics are more likely to use an insulin pump

1. 1

Type ___1___ diabetics typically will check their blood glucose more often because they are absolutely insulin deficient

1. Endothelial damage (surgery, venipuncture, trauma) 2. Venous stasis (bed rest/immobility, age>65, long periods of standing) 3. Altered coagulation (cancers, pregnancy, oral contraceptives)

Virchow's triad consists of these three risk factors.

1. calcitonin 2. bones

__1__ is also released by the thyroid gland. It reduces the level of calcium in the body by taking it from the bloodstream and depositing it in the __2__.

1. vasodilators 2. hemodynamics 3. vital signs

When a patient is experiencing a hypertensive crisis, the main treatment is to give IV and PO ___1___. It is important to continually monitor ___2___ and ___3___.

1. 250 2. D5W 3. cerebral edema 4. 12-24

When a patient on IV insulin reaches a blood sugar level of __1__, we decrease the insulin and add ___2___ because we don't want their blood sugar to drop too fast or low, which can cause ___3___ as the fluids shift back into the cells. Blood sugar is kept at ___1___ for the first ___4___ hours.

1. early in the morning

When a patient with diabetes is having surgery, it is a good idea to schedule it __1__

1. above their heart 2. leg exercises 3. sitting

When a patient with venous insufficiency is in bed, they should periodically elevate their legs ___1___ in order to promote rapid emptying of the veins. It is also to frequently perform active and passive ___2___, especially in times of prolonged periods of ___3___.

1. CT scan 2. OR

When a possible stroke victim is brought in, they are immediately given a ___1___. if bleeding is detected, they are sent immediately to the ____2___

3. Osteoporosis Because of bone loss associated with the long-term use of antiseizure medications, patients receiving antiseizure agents should be assessed for low bone mass and osteoporosis. They should be instructed about strategies to reduce their risks of osteoporosis (AANN, 2009).

When educating a patient about the use of antiseizure medication, what should the nurse inform the patient is a result of long-term use of the medication in women? 1. Anemia 2. Osteoarthritis 3. Osteoporosis 4. Obesity

1. fat 2. urine 3. lungs 4. ketoacidosis

When glucose is unavailable for cellular metabolism, the body breaks down alternate sources of energy such as __1__. Ketones are released, and excess ketones are eliminated in the __2__ or by the __3__. Ketones in the blood are strong acids that lower the serum pH and produce __4__

As soon as they are diagnosed, they have to use medication to survive.

When is it necessary for type 1 diabetics to start using pharmacologic treatment?

1. oncotic pressure 2. kidneys 3. sodium 4. skin

When managing ascites without paracentesis, it is important to give albumin before giving diuretics. The albumin increases __1__, which drives the fluid back into the intravascular space. The diuretic works on the __2__ to remove some of the shifting fluid. A low __3__ diet is important because increased __3__ contributes to the problem of the body holding onto fluid. __4__ care is also very important because the abdomen is getting stretched so tighly.

1. air 2. regular (short/rapid) 3. intermediate

When mixing 2 insulins together in the same syringe, it is important to first inject ___1___ equivalent to needed insulin amount into each vial. the ADA recommends drawing up the ___1___ acting insulin first, and then drawing up the ___2___ insulin.

4. Perform stretching exercises and frequent position change. Tension headaches are often associated with prolonged tensed muscles. Application of cool or warm cloths and avoidance of bright lights may help to reduce the headache after occurrence. Avoiding certain foods may prevent migraine headaches, but it is not likely to prevent tension headaches.

When providing teaching to a client who reports tension headaches, which of the following instructions would be most beneficial to prevent onset of symptoms? 1. Apply cool or warm cloth to head or eyes. 2. Eliminate use of bright lights when working. 3. Avoid certain foods. 4. Perform stretching exercises and frequent position change.

1. isotonic 2. renal

When rehydrating a patient with DKA, you first want to give ___1___ fluids because they will evenly distribute throughout the intravascular and extravascular spaces. Be cautious in the elderly because they may have preexisting ___2___ issues.

1. pre-diabetes

When screening for diabetes, the goal is to find people in the __1__ stage.

1. 15 2. 15 3. 70 4. 15 5. protein 6. fat

When someone is showing symptoms of hypoglycemia, you use the "rule of __1__." Check blood sugar and treat with __2__ grams of carbs if below __3__ mg/dl. Recheck blood sugar in __4__ minutes, and repeat process of it has not risen above __3__ mg/dl. If blood sugar is still low after treating 3 times, give the patient something with __5__ or __6__ to help buffer the stomach so the sugar gets absorbed slower.

1. high alert 2. rebound hypoglycemia

When starting TPN, you must verify the order and get a second check from another nurse because it is considered a __1__ medication. It also needs to be discontinued gradually in order to avoid __2__

1. secondary 2. exogenous steroids 3. anterior pituitary 4. tumor

When the adrenal glands are not able to produce hormones due to a problem coming from somewhere else, it is called __1__ adrenal insufficiency. This can arise from abrupt withdrawal after prolonged use of ___2___, or an issue with the ___3___ not being able to secrete ACTH due to the presence of a __4__

1. hydrocortisone (Solu-Cortef) 2. IV or IM push. 3. D5NS 4. vasopressors 5. sodium

When treating a patient in Addisonian crisis, need to quickly replace cortisol by giving __1__ via __2__, followed by infusion of __3__. May also administer __4__ and __5__.

Describe differences between low flow and high flow oxygen delivery systems.

Whereas a low-flow oxygen delivery system may imprecisely deliver high concentrations of oxygen (e.g., up to 100% via a nonrebreathing mask), the Venturi mask, which is a high-flow system, is specifically designed to deliver precise but lower concentrations of oxygen (less than 30% oxygen).

2. Enemas Enemas should be avoided in clients with increased ICP. The Valsalva maneuver causes increased ICP. Suctioning should not last longer than 15 seconds. Environmental stimuli should be minimal. If monitoring reveals that turning the client increases the ICP, rotating beds, turning sheets, and holding the client's head during turning may minimize the stimuli that cause increased ICP.

Which activity should be avoided in clients with increased intracranial pressure (ICP)? 1. Suctioning 2. Enemas 3. Position changes 4. Minimal environmental stimuli

1. Cloudy cerebral spinal fluid 3. Purpura of hands and feet The cerebral spinal fluid (CSF) will be cloudy if bacterial meningitis is the causative agent. Purpura indicates a serious complication of bacterial meningitis (disseminated intravascular coagulation) is occurring and may place the client at risk for amputation of those parts. Pain and stiffness of the extremities is not indicative of meningitis. A rise in RBCs, WBCs, and ADH would be expected.

Which assessment finding is most important in determining nursing care for a client with bacterial meningitis? Select all that apply. 1. Cloudy cerebral spinal fluid 2. Pain and stiffness of the extremities 3. Purpura of hands and feet 4. Low white blood cell (WBC) count 5. Low red blood cell (RBC) count 6. Low antidiuretic hormone (ADH) levels

2. Spatial-perceptual deficits Clients with right hemisphere stroke exhibit partial perceptual deficits, left visual field deficit, and paralysis with weakness on the left side of the body. Left hemisphere damage causes aphasia; slow, cautious behavior; and altered intellectual ability.

Which is indicative of a right hemisphere stroke? 1. Aphasia 2. Spatial-perceptual deficits 3. Slow, cautious behavior 4. Altered intellectual ability

2. Change in level of consciousness The earliest sign of increasing intracranial pressure (ICP) is a change in level of consciousness. Other manifestations of increasing ICP are vomiting, headache, and posturing.

Which is the earliest sign of increasing intracranial pressure? 1. Vomiting 2. Change in level of consciousness 3. Headache 4. Posturing

1. portal hypertension.

__1__ is another possible condition that can be caused by hepatic dysfunction due to blockage in the flow systems of the liver, which increases pressure in the portal vein.

1. radioactive iodine

__1__ is another prototype antithyroid medication, and it can be used for imaging or treatment depending on the dose.

1. Acanthosis 2. exercise 3. weight loss

__1__ is a thickening and darkening of skin in neck, axilla, and groin that is often a sign of type II diabetes. It can decrease with __2__ and __3__.

1. Billroth II 2. dumping syndrome

__1__ is a type of gastrectomy that removes 75% of the stomach and attaches the remaining stomach to the jejunum. It is a more serious surgical procedure that is used for recurrent duodenal ulcers and gastric cancer. It has the highest risk for __2__

2. Decorticate Decorticate posturing is an abnormal posture associated with severe brain injury, characterized by abnormal flexion of the upper extremities and extension of the lower extremities. Decerebration is an abnormal body posture associated with a severe brain injury, characterized by extreme extension of the upper and lower extremities

Which posture exhibited by abnormal flexion of the upper extremities and extension of the lower extremities? 1. Decerebrate 2. Decorticate 3. Flaccid 4. Normal

1. Diabetes Insipidus (DI) 2. 250 3. thirst

__1__ is caused by a deficiency of ADH, which encourages urine production, resulting in large volumes (__2__ml/hr) of dilute urine and excessive __3__.

1. Agnosia Auditory agnosia is failure to recognize significance of sounds. Agraphia refers to disturbances in writing intelligible words. Apraxia refers to an inability to perform previously learned purposeful motor acts on a voluntary basis. Perseveration is the continued and automatic repetition of an activity, word, or phrase that is no longer appropriate.

Which term refers to the failure to recognize familiar objects perceived by the senses? 1. Agnosia 2. Agraphia 3. Apraxia 4. Perseveration

4. Homonymous hemianopsia Homonymous hemianopsia occurs with occipital lobe tumors. Scotoma refers to a defect in vision in a specific area in one or both eyes. Diplopia refers to double vision or the awareness of two images of the same object occurring in one or both eyes. Nystagmus refers to rhythmic, involuntary movements or oscillations of the eyes.

Which terms refers to blindness in the right or left half of the visual field in both eyes? 1. Scotoma 2. Diplopia 3. Nystagmus 4. Homonymous hemianopsia

5 mm Hg ICP is usually measured in the lateral ventricles. Pressure measuring 0 to 10 mm Hg is considered normal. The other values are incorrect.

Which value indicates a normal intracranial pressure (ICP)? 5 mm Hg 12 mm Hg 17 mm Hg 21 mm Hg

1. myxedema coma 2. metabolic rate 3. stressor

__1__ is a very rare but almost always fatal complication of hypothyroidism. It is characterized by a severe decrease in __2__. It is sometimes seen in a patient with undiagnosed hypothyroidism who then has some for of __3__ event, such as infection or use of sedatives, which causes a progression of the condition.

1. diverticulum 2. diverticulosis 3. diverticulitis

__1__ is a weakness or outpouching in the bowel wall. When there are multiple pouches without inflammation, it is called __2__. When these pouches become inflamed, it is called __3__.

1. androgens 2. masculinization (in women)

__1__ are sex hormones such as testosterone, estrogen, and progesterone. They are important for growth and development, but over secretion can result in __2__.

1. corticosteroids

__1__ are used for short term treatment of inflammatory bowel diseases, but they do not maintain remission. An H2 blocker should be used in conjunction in order to protect the stomach

1. odor

__1__ can be a problem that can be related to the types of food that are eaten. There are also tablets or solutions that can be added to the ostomy bag in order to decrease __1__.

1. ERCP

__1__ can unfortunately be so traumatic to the pancreas that is can cause inflammation of the pancreatic ducts, leading to pancreatitis.

1. ulcerative colitis

__1__ has a distinct line between healthy and diseased tissue. It is easier to tell where the diseased tissue starts and ends.

1. regular

__1__ insulin is the only type of insulin that can be used in insulin drips.

1. basal (i.e. long-acting)

__1__ insulins should not be given in the same location as rapid acting insulins because the Ph is different and may cause the insulins not to work properly.

1. hypocalcemia 2. calcium 3. calcium gluconate

__1__ is a concern in a post thyroidectomy patient because damage to or removal of the parathyroid is a common complication. The parathyroid gland is responsible for regulating __2__ levels in the blood. Replacement of __2__ is usually done orally, unless it is severe, inwhic case __3__ is given via IV.

1. Cholelithiasis 2. cholesterol 3. bile pigments 4. calcium 5. bilirubin 6. bile salts.

__1__ is a condition where gallstones are formed in the gallbladder. These gallstones can be made of __2__, __3__, __4__, or a combination of these. they can also be caused by a change in bile composition, such as excess __5__ or a deficiency of __6__.

1. hypothyroidism 2. women 3. 40 4. 70

__1__ is a deficiency of thyroid hormones (T3 & T4). It is more common in __2__ between __3__ and __4__ years of age.

1. propranolol 2. tremors

__1__ is a drug that is used to lower blood pressure and heart rate, as well as decrease __2__ in patients with hyperthyroidism. It decreases the risk of heart attack and stroke.

1. chlorpropamide

__1__ is a first generation sulfonylurea, they are not really used anymore due to a large number of side effects.

1. peptic ulcer disease 2. duodenum 3. H. Pylori 4. pylorus

__1__ is a full thickness erosion of mucosa of esophagus, stomach, and/or duodenum. It happens most often in the __2__ due to __3__. If it is gastric, it will be located near the __4__.

1. irritable bowel syndrome 2. diarrhea 3. constipation

__1__ is a functional disorder characterized by intense intestinal contractions, altered bowel motility, and hypersensitivity. The patient can often go back and forth between __2__ and __3__.

1. Ant-diuretic Hormone (ADH) 2. kidneys.

__1__ is a hormone that decreases urine production by telling the __2__ to reabsorb water.

1. esophageal varices 2. rupture/hemorrhage

__1__ is a life threatening complication caused by portal hypertension. The vessels become dilated and can __2__.

1. Esophageal cancer 2. esophageal tissue 3. Barrett's esophagus 4. achalasia

__1__ is a malignant tumor of the esophagus. It's exact cause is unknown but it is closely associated with damage to __2__ and also __3__. It may also be caused by __4__, which is decreased esophageal motility due to failure of the lower esophagus sphincter muscle to relax.

1. metoclopramide (Reglan)

__1__ is a medication that increases gastric motility

1. TPN

__1__ is a mixture of proteins, carbs, fats, electrolytes, vitamins, trace minerals, and sterile water.

1. esophagectomy 2. high

__1__ is a procedure where a section of the esophagus is removed. It has a __2__ mortality rate. nutritional status and education is very important pre-surgery.

1. paracentesis 2. ultrasound 3. clear to pale yellow 4. cloudy/turbid

__1__ is a procedure where fluid is drained from the abdomen. A needle guided by __2__ is inserted into the peritoneum. The fluid drained off should be __3__ in color. If it is __4__, then it may indicate there is an infection.

1. thyroid storm (thyrotoxicosis) 1. stress 2. injury/infection 3. abrupt withdrawal of anti-thyroid medication

__1__ is a rare but dangerous complication of hyperthyroidism. It can be caused by __2__, __3__, or __3__.

1. colonoscopy 2. fecal occult blood test (FOBT) 3. digital rectal exam (DRE) 4. barium enema 5. flexible sigmoidoscopy

__1__ is the gold standard for screening for colorectal cancer. Other methods used for screening include __2__, __3__, __4__, and __5__. The problem with all of these other tests is that if they see something suspicious, you are still going to have to have a __1__.

1. Graves disease 2. autoimmune 3. women

__1__ is the most common cause of hyperthyroidism. It is an __2__ disorder that creates antibodies to TSH receptors, which cases overstimulation of thyroid gland and excess production of T3 and T4. It is most common in __3__.

1. EGD 2. bronchoscopy

__1__ is the most common form of diagnostic test to detect esophageal cancer. __2__ may be used to see if it has metastasized into the lungs.

1. levothyroxine (Synthroid)

__1__ is the prototype drug used to treat hypothyroidism

1. Hyperthyroidism 2. Graves disease

__1__ is the result of oversecretion of T3 and T4 hormones. The most common cause of __1__ is __2__ disease.

1. appendicitis 2. peritonitis 3. septic shock

__1__ is usually caused by an obstruction of the appendix. There is a risk for gangrene or rupture of the appendix, which could lead to __2__ or __3__.

1. dumping syndrome 2. pancreas

__1__ is when undigested food end up in the small intestines and the body tries to compensate by pulling fluid from intravascular space into the small intestines. The __2__ goes into overdrive. The patient can have tachycardia, hypotension, abdominal cramping, weakness, dizziness

1. TSH 2. thyroid hormones (T3 & T)

__1__ levels are increased in hypothyroidism because the level of __2__ is low, so the pituitary gland is trying to compensate.

1. necrosis 2. 48-72 3. purplish, very dark red, dusky, or pale. 4. moisture

__1__ of the stoma is caused by a lack of blood supply (and thus oxygen) to the stoma. The highest risk is __2__ hours post-op. It is very important to frequently assess the stoma because you really want to catch it early before it gets to the point of necrosis. The surgeon should be notified immediately if this is suspected. Signs of this include a stoma that is __3__ in color and has a decrease in __4__.

1. Dobhoff 2. Flexiflo

__1__ or __2__ are small bore feeding tubes that are more comfortable for the patient. They are really only used for feeding and are not good for lavage, decompression, or drainage.

1. bone 2. acetaminophen 3. NSAIDS

__1__ pain is a side effect when taking calcitonin salmon, and it should be treated with __2__. The patient should not use __3__ for pain because they increase osteoclasts which break down bones.

1. skin 2. skin protectants 3. barrier pastes

__1__ problems are very common with ostomies. Leakage from poor fit can cause irritation. mechanical injuries can also occur from tape and appliance removal. It is important to use __2__ and __3__ in order to help minimize these complications.

1. adrenaline 2. water 3. 20

__1__ release when exercising can cause a surge in blood sugar, but it is not necessary to treat it. They should drink some __2__ and it should start to normalize after __3__ minutes

1. Turner's 2. Cullen's

__1__ sign is when there is purple/blue bruising in the lower flank area. __2__ sign is when there is purple/blue bruising in the area around the umbilicus

1. iodine 2. potassium 3. short term 4. thyroidectomy

__1__ solutions such as __2__ iodide work similarly to radioactive iodine in that they inhibit the release of T3 & T4, but they are only good for __3__ solutions. They can be given approximately 10 days prior to a __4__ in preparation for the procedure.

1. Clonidine 2. heart rate 3. blood pressure

__1__ suppression test is another way to test for pheochromocytoma. __1__ is an alpha 2 agonist which should significantly decrease __2__ and __3__. if you do not see a change after administering, it means there is a underlying problem.

1. gastric 2. vomiting 3. duodenal 4. 3am

__1__ ulcer pain and symptoms happen in the presence of food, and is often relieved by __2__. __3__ ulcer pain and symptoms happen when the stomach is empty, like at __4__.

1. 90-100 2. fat 3. protein

__1__% of digestible starches and sugar we eat appear in the blood as glucose within a couple hours after eating. __2__ and __3__ do not affect glucose after a meal as fast as foods which contain carbohydrates.

1. ketones 2. insulin 3. energy

___1___ are by-products of fat breakdown, and their accumulation in the urine is a signal that there is an insufficiency of ___2___, control of type 1 diabetes is deteriorating, and the body is starting to break down stored fat for ___3___.

1. status epilepticus 2. cerebral hypoxia

___1___ is a condition in which seizure lasts longer than 5 minutes or repeated seizures occurring over a period of 30 minutes or longer. it is a medical emergency and the biggest concern is ___2___

1. pericarditis 2. chest pain 3. friction rub

___1___ is inflammation of the membrane surrounding the heart. The most characteristic symptom is ___2___ and you will be able to auscultate ___3___ at lower left sternal border.

1. myocarditis 2. viral 3. NSAIDs

___1___ is inflammation of the muscle of the heart, it is usually ___2___ in origin. ___3___ are contraindicated because they can actually make the selling worse.

1. altered level of consciousness

___1___ is is the most sensitive indicator of underlying neurologic function

1. Glascow Coma Scale (GCS) 2. 15 3. 7 4. 3

___1___ is neurologic assessment of a patient's best verbal response, eye opening, and motor function. A score of ___2___ indicates the patient is fully alert and functioning. A score of ___3___ or less indicates a coma state. A score ____4___ is the lowest score possible.

1. intracranial pressure 2. 0 3. 10

___1___ is the amount of pressure inside the skull, normally should be between ___2___ and ___3___ mmHg

1. prevention 2. vaccine

___1___ is the most important "treatment" for meningitis, so should get the ___2___.

1. raised 2. straw 3. coughing 4. sneezing 5. humidified 6. oral hygiene

a patient who has had a pituitary tumor removed through transsphenoidal hypophysectomy should have the HOB __1__ to decrease pressure and promote drainage. The patient should avoid using __2__ when drinking due to risk of trauma to surgical area. The patient should also avoid __3__, __4__, or any other activity that raises ICP. It is good practice to make sure the air/oxygen is __5__ and provide good __6__.

1. CSF

a patient who has had a pituitary tumor removed through transsphenoidal hypophysectomy will need to have their nasal drip pad monitored for a halo sign, which is a drop of blood with a clear/yellowish halo around it. This indicates the patient is leaking __1__.

1. extremities 2. clubbing

a patient with long term hyperthyroidism may have swelling of the __1__ and may also have __2__ of the fingers.

tPA (tissue plasminogen activator)

a powerful chemical that dissolves blood clots in vessels supplying the brain

Generalized seizures

a seizure that affects both sides of the brain

1. 120

a serum sodium level of less than __1__ mEq/L leads to cerebral edema

dilutional hyponatremia

a serum sodium that is low not because of an absolute lack of sodium but because of an excess of water

seizure

a sudden, abnormal, uncontrolled electrical discharge from the cerebral neurons in the brain

Nissen fundoplication

a surgical technique used to suture the fundus of the stomach around the esophagus to prevent reflux.

embolic stroke

a type of ischemic stroke that causes a clot to travel to the brain (not formed in the brain), mostly from the left side of the heart, can be caused by AFIB

ischemic stroke

a type of stroke that occurs when the flow of blood to the brain is blocked

hemorrhagic stroke

a type of stroke that occurs when there is a rupture of a blood vessel in the brain

pernicious anemia

a vitamin B12-deficiency that requires supplementation either through diet or injection

1. hypertonic 2. urine 3. hyponatremia

administering __1__ saline to a patient with SIADH helps pulls fluid out of the cells (and off of the brain) and into the __2__. Also helps correct __3__.

1. 300-500 2. 200 3. on the bed

after a cholecystectomy, the T-tube will drain around __1__ ml in the first 24 hours. This amount should decrease to less than __2__ml after 3-4 days. The drainage bag needs to be left __3__, because we don't want too much gravity to cause bile to drain off to quickly. As edema starts to subside, the bile will start flowing around the T-tube like it is supposed to.

1. right side 2. 15-30 3. bed rest

after a liver biopsy, the patient will be positioned on their __1__, which helps increase pressure on the liver to decrease bleeding risk, which is the primary concern after the procedure.. The HOB should be maintained at __2__ degrees unless otherwise contraindicated. The patient will be on __3__ for a short period of time and activity should be limited.

1. temporary 2. mild 3. severe

after a lumbar puncture, it is normal to have a ____1___, ___2___ headache, but a ____3___ headache is a bad sign and may indicate a leak of CSF

1. blood pressure 2. Addisonian crisis

after an adrenalectomy, a patients __1__ must be monitored closely. They are also at risk for __2__ because their adrenal gland may not be able to function properly anymore

1. paralytic ileus 2. absent bowel sounds from ileus 3. distended belly 4. nausea/vomiting 5. NG tube

after bowel resection, a big risk is for __1__, which is a condition where the ileum stops working. Signs of paralytic ileus include __2__, __3__, and __4__. If this happens, the patient will need to have a __5__ placed for bowel rest and decompression. The first sign that peristalsis has returned is when the patient starts passing gas.

1. leak at anastomosis 2. pulmonary aspiration

after esophagectomy, patient should be kept NPO until X-ray confirms no __1__ or __2__

1. CSF 2. prone 3. fatal

after the lumbar puncture, there is a risk of ___1___ leaking from the puncture site, so the patient is positioned ___2___ to use gravity to help prevent leakage until the puncture site closes. Losing too much CSF can be ___3__.

1. mineralocorticoid 2. water 3. sodium 4. potassium

aldosterone is a type of __1__ which regulates blood pressure through the RAAS by telling the kidneys to reabsorb __2__ and __3__, as well as excrete __4__.

1. 3-5 years

alendronate should not be used for longer than __1__ due to the risk for esophagitis.

1. after meal control 2. inflammatory bowel diseases

alpha-glucosidase inhibitors (acarbose) block or delay the absorption of sugar in the intestines which is why they are good for ___1___. They are contraindicated in patients with ___2___ because they lack the proper digestive enzymes to make the medication work.

Asterixis

also known as "liver flap" it is a neurological dysfunction that causes tremors in the hands, and the hands flap downward when the patient tries to hold them upright.

1. cease 2. starts putting out urine again

although a patient with DKA will initially have polyuria, once they reach a certain point of dehydration, urine output will __1__ as the body tries to conserve fluids. You know your rehydration is working when the patient ___2__

1. onset 2. peak 3. postprandial hyperglycemia

although it is not crucial that intermediate insulin be taken with a meal, the patient should eat some food around the time of ___1___ and ___2___. Intermediate insulin is used to control ___3___.

1. sodium 2. water 3. potassium

antidiuretic hormone (ADH) tells the kidneys to retain __1__ and __2__, and to excrete __3__.

1. bile stasis 2. obesity 3. pregnancy 4. NPO for long period

anything that leads to __1__, which is slowing down of the biliary system can cause gallstones. The risk for them can also be increased by __2__, __3__, or __4__.

1. asymptomatic

aortic regurgitation is often ___1___ in most patients.

1. increases 2. decreases

as afterload 1. (increases/decreases), stroke volume 2. (increases/decreases)

Transient Ischemic Attack (TIA)

brief episode of loss of blood flow to the brain, usually caused by a partial occlusion that results in temporary neurologic deficit (impairment); often precedes a CVA

Ecchymosis

bruising

1. heart failure 2. stroke 3. ruptured aneurysm 4. kidney failure

because pheochromocytoma causes excess stimulation of SNS which in turn triggers severe hypertension, it puts patients at a very high risk for __1__, __2__, __3__, and __4__

1. bruit

because the thyroid gland is highly vascular, you may be able to auscultate a __1__ over the thyroid gland of a patient with hyperthyroidism.

1. brain tissue 2. blood 3. CSF

because there is a limited amount of space in the skull, any increase in ___1___, ___2___, or ___3___ can cause a change in volume and pressure within the skull.

1. heart rate 2. blood pressure

beta blockers may need to be held if the patient has ___1___ or ___2___ that is too low

1. renal 2. liver 3. heart 4. alcohol

biguanides (metformin) is contraindicated in patient with ___1___ disease, ____2____ disease, and ___3___ disease. they should also avoid the consumption of ___4___.

1. 48 2. BUN 3. creatinine

biguanides (metformin) sensitize the tissue to insulin, it is important to remember that a patient who takes metformin must be off for ____1___ hours before and after receiving IV contrast dye, should also check ___2___ and ___3___ labs.

1. red blood cells 2. stool 3. jaundice 4. clay 5. dark

bilirubin is a product of breakdown of __1__, and it gives bile it's dark pigment. It is normally excreted through the __2__. If there is an obstruction in the liver circulation, the bilirubin stays in the body/blood and the patient becomes __3__. The stool will actually look __4__ colored because of the lack of bilirubin in the stool. The urine will be very __5__ because the bilirubin in the blood stream is being filtered by the kidneys.

1. renal dysfunction 2. fluid intake

calcitonin salmon can cause __1__ because calcium gets filtered through the kidneys. The patient should be aware that they should increase __2__.

1. calcium 2. phosphate

calcitriol regulates absorption of __1__ and __2__ from the small intestines. It also increases bone resorption and reabsorption of phosphate in the renal tubules.

1. kidney stones 2. blood stream 3. bones

calcitriol should be used cautiously in patients with a history of __1__. It is also important to stress the importance of weight bearing exercises, because it pulls calcium from the __2__ and into the __3__, which is the ideal place you want your calcium.

2. central line

calcium gluconate IV must be given through __2__ because it can cause vasospasm.

1. adrenalectomy 2. epinephrine 3. norepinephrine 4. bleeding

definitive long term treatment for pheochromocytoma would be to perform an __1__. It is a high risk procedure because when the tumor is resected, it will release a surge of __2__ and __3__ into the body, causing a jump in blood pressure and heart rate. The risk for __4__ is also high due to the hypertension.

1. acute illness

desmopressin should not be taken during __1__, because during this time, you are not eating or drinking properly, which can cause fluid and electrolyte imbalances.

1. water reabsorption 2. urine formation 3. neurogenic diabetes insipidus

desmopressin works by having an antidiuretic effect thus increasing __1__ and decreasing __2__. It is primarily used to treat __3__.

retinopathy

destruction of the capillaries in the eyes which decreases oxygen to the retina and causes damage and blindness

1. whole grains 2. brown rice

diabetics should focus on getting their carbohydrates from "good" sources such as ____1___ and ___2___. If it is white, it probably isn't good.

1. olive oil 2. nuts 3. soy

diabetics should focus on getting their fat from "good" sources such as ___1___, ___2___, and ___3___. Avoid saturated and trans fats

1. poultry 2. fish 3. eggs

diabetics should focus on getting their protein from lean sources such as ___1___, ___2___, _and __3___. Avoid red meat.

Nitrosamines

dietary carcinogen contained in cured meats

1. moderate-low fat 2. high carbs 3. high calories 4. evaluate individual protein tolerance 5. small frequent meals 6. fluid & electrolyte balance 7. avoid alcohol 8. increase Vit K if PT is elevated

dietary considerations for patients with acute hepatitis.

1. Celiac

disorders of malabsorption such as __1__ disease is are defined by the inability to digest 1 or more of the major vitamins, minerals, or nutrients.

1. later in life 2. fiber 3. fluids

diverticulosis is more common for people __1__, and can be caused by not enough __2__ or __3__ in diet.

1. hypovolemia 2. hypotension 3. shock

during a paracentesis, you need to assess the patient is tolerating the procedure. It causes a massive fluid shift, which can cause __1__, __2__, and __3__. It is important not to drain too fast. Vitals are monitored frequently, as is level of consciousness.

1. Systemic

effects of right sided heart failure tend to be more ___1___ in nature

1. biliary ducts 2. bile duct 3. dye 4. gallstones 5. blockages

endoscopic retrograde cholangiopancreatography (ERCP) is an invasive, endoscopic procedure where a tube is inserted into the __1__ via the common __2__. Then __3__ can be injected to see the entire biliary tree and check for blockages. It can also be used for treatment, like removing __4__ or __5__.

1. receptor sites 2. RNA/DNA

hormones can either attach to a __1__ to produce a response or enter a cell and alter __2__ in order to alter cellular function

1. Parathyroid Hormone (PTH) 2. hypercalcemia

hyperparathyroidism is caused by excess production of __1__. The main symptom of this is __2__.

1. accidental removal of parathyroid gland during thyroidectomy

hypoparathyroidism is most commonly caused by __1__

1. thyroid gland 2. TSH 3. anterior pituitary gland 4. T3 5. T4

hypothyroidism is mainly due to a poorly functioning thyroid gland or low secretion of __2__ by the __3__, which in turn causes low secretion of __4__ and __5__ by the thyroid gland.

1. nausea/vomiting

if a patient is taking radioactive iodine, it is important to stop treatment if the patient starts to experience __1__.

1. Antidiuretic hormone (ADH)

if there is disease or injury of the posterior pituitary gland, it causes an insufficient amount of __1__ to be released, which leads to diabetes insipidus.

1. azathioprine (Imuran) 2. 6 3. infection 4. blood dyscrasias

immunosuppressive medications such as __1__ are also used for treatment of irritable bowel diseases. It is usually given IV and may take up to __2__ months to help. Two adverse effects with this medication are risk of __3__ and __4__.

1. lumbar puncture 2. subarachnoid 3. cerebrospinal fluid

in a ___1___ procedure, a needle is inserted into the ___2___ space of the spinal column between the lumbar vertebrae. It is used to extract and examine ___3___.

1. NG tube 2. aspiration

in a patient with DKA, you may have to insert a ___1__ because the patient may have an altered LOC and is vomiting, thus there is a risk of ___2___.

1. 30 2. midline 3. stimuli

in a patient with increased ICP, it is important to maintain head of bed at ___1___ degrees, keep the head at ___2___, and avoid excessive ___3___

1. 220

in ischemic stroke victims, we often let their blood pressure go up to ___1___ systolic in order to help perfusion. need to make sure we lower it back once the clot is cleared.

1. eating

in order to prevent DKA in times of stress, patients should know that they need to take their insulin even if not ___1___, because the stress is going to increase the blood sugar anyways.

1. nausea 2. alcohol 3. high biologic

in patients with acute hepatitis, nutrition is essential for recovery, and it is made harder by __1__, that is often worse later in the day. We want to make sure they are avoiding __2__ and we want them to consume __3__ protein, which is found in things such as eggs, lean meats, and fish.

1. Albumin 2. 3 3. oncotic 4. edema

in patients with hepatic dysfunction, __1__ will be decreased due to altered protein synthesis and anything less than __2__ is bad. this decrease will cause __3__ pressure to decrease, which causes fluid to move out of the intravascular space and into the interstitial space (3rd spacing), causing __4__.

1. isolation 2. hygiene 3. toileting 4. immunocompromised.

in patients with hepatitis, __1__ is not necessary, but careful precautions must be taken in regards to __2__ and __3__. We would not want to put them in a room with another patient who is __4__.

1. tachycardia 2. palpitations 3. diarrhea

in patients with hyperthyroidism, the cardiovascular system is ramped up, causing symptoms such as __1__ and __2__. The GI system is also ramped up causing __3__ due to increased peristalsis

1. elevating 2. edema

in patients with venous ulcers, ___1___ the legs can help decrease dependent ___2___.

1. antiepileptic 2. seizure 3. seizure threshold

in some cases, ___1___ medications such as phenytoin will be given post stroke becuase there is an increased risk for ___2___ due to a decrease in the ___3___

1. tumors

in treating esophageal cancer, an endoscopic procedure may be used to resect superficial __1__

1. 2

in type ___1___ diabetes, the pancreas can produce insulin but the body tissues are resistant to insulin and not enough is able to made to control glucose levels. At some point, it may progress to decreased insulin production because the body is not using the insulin.

1. perfusion 2. ischemia 3. cell death 4. edema

increased ICP can decrease cerebral ____1___, cause ___2___, ___3___, and further ___4__

Hyperosmolality

increased concentration of solutes within the fluid

1. stretched out 2. less effective

increased preload cannot be sustained indefinitely, over time, the tissues become ___1___ and ___2___

1. long acting 2. pancreatitis 3. hypoglycemia

incretin mimetic agents (exenatide [Byetta]) may be used with ___1___ insulins such as Lantus in clients who have limited success with oral meds. They can increase the risk of ___2___ due to slowed gastric emptying time. They can also increase risk of ___3____ if used with sulfonylureas or metformin because of glucagon suppression.

endocarditis

inflammation of the inner lining of the heart

Meningitis

inflammation of the meninges of the brain and spinal cord, can be caused by bacteria, virus, or fungi.

1. Crohn's 2. ulcerative colitis

inflammatory bowel diseases encompass both __1__ disease and __2__.

1. Humalog 70/30 2. Novolog 70/30

intermediate acting insulin can come premixed with short acting insulin called ___1___ or ___2___.

1. Humulin N (NPH) 2. Novolin N (NPH)

intermediate acting insulins include ___1___ and ____2___

1. euthyroid 2. cardiac output 3. hemorrhage 4. MI

iodine solutions are important to give prior to thyroid surgery because we want to achieve a state of __1__, because we don't want to perform surgery on a patient with increased __2__ due to overstimulation from hyperthyroidism. This can increase the risk for __3__ and __4__.

Tumor necrosis factor (TNF)

is a protein that contributes to inflammatory processes in the bowel.

sclerotherapy

is an endoscopic procedure where bleeding is stopped internally by using an injection of a chemical irritant into a vein to produce inflammation and fibrosis that destroys the lumen of the vein

1. 500 2. 2 hours 3. abdominal distension 4. pain 5. emesis 6. diarrhea

it is important to check volume left in stomach (GRV) before feeding. Less than __1__ml is generally ok, but it can vary depending on patient specific factors such as aspiration risk. If the residual is high, wait __2__ and check again. It is also important to consider other indicators that patient is not tolerating feeding such as __3__, __4__, __5__, and __6__.

1. isolation precautions

it is important to institute ___1___ with meningitis patients because transmission is possible.

1. mask the symptoms of rupture

it is important to manage pain in patients with appendicitis, but you want to be careful not to give too much because it can __1__.

1. I&O 2. daily weights

it is important to monitor __1__ (should be equal) and __2__ (should be increasing) in patients taking desmopressin.

1. 10-20 2. fruit juice

it may take __1__ minutes for a patient to regain consciousness after being administered glucagon. Once the patient wakes up, you should check blood sugar and give __2__ if warranted by blood sugar.

1. invasive 2. complications 3. recovery time 4. CO2

laparoscopic cholecystectomy is the procedure of choice because it is less __1__, has less __2__, and has a shorter __3__. During the procedure, __4__ is injected into the abdomen to help the surgeon visualize the internal abdomen.

1. infection 2. septic shock

leakage from surgical incision (aka leaking anastomosis) can cause __1__ (peritonitis or mediastinitis) which can lead to __2__.

1. hypoglycemia unawareness

leaving hypoglycemia untreated can lead to __1__, which means you will have a harder time recognizing when you are hypoglycemic.

1. A

levothyroxine is a pregnancy category __1__

1. cardiovascular

levothyroxine should be used cautiously in patients who have preexisting __1__ issues

1. sucralfate

levothyroxine should not be given with __1__ and other binding agents

1. beta 2. glucagon 3. GI 4. appetite

liraglutide acts on __1__ cells to increase insulin release, decreases __2__ release, slows __3__ absorption, and stimulates satiety center to decrease __4__.

1. subcutaneously 2. slow 3. 8-12 4. 24

liraglutide is administered __1__. It has a __2__ onset, peaks in __3__ hours, and has a duration of __4__ hours.

1. soundwaves 2. pancreatitis

lithotripsy is a procedure that uses __1__ to break apart gallstones, it is not as commonly performed. ERCP can be used to remove gallstones or enlarge the opening to allow the stones to pass. there is an increased risk for __2__ due to trauma caused by the procedure.

1. once daily 2. at the same time every day

long acting insulins are given ___1___ at any time of the day. It is important to give it ___2___ to avoid overlap of action

1. Lantus (GLARGINE) 2. Levemir (DETEMIR)

long acting insulins include ___1___ and ___2__

1. Lantus (glargine) 2. Levemir (detemir)

long acting insulins include ___1___ and ___2__

1. severe headache like a "thunderclap" 2. early and sudden change to LOC 3. nausea/vomiting

manifestations of hemorrhagic stroke can be similar to ischemic stroke, but 3 unique symptoms are

fasting blood glucose

measurement of blood sugar after fasting for 8 hours

Urine Specific Gravity

measurement of the kidney's ability to concentrate and excrete urine by comparing the density of urine with the density of distilled water

1. food 2. meals

meglitinides stimulate beta cells to make insulin, it is important to remember that they act in the presence of ___1__, so it is especially important to take them 3 times daily before ___2___

1. CSF 2. lumbar puncture

meningitis is diagnosed by examining the ___1___ via a ___2___.

1. Polycystic Ovarian Syndrome 2. insulin 3. testosterone

metformin can be used as an adjunct treatment for women with __1__, because it decreases __2__ resistance and decreases the level of __3__.

1. vomiting 2. IV contrast dye

metformin has the potential to cause lactic acidosis, so you need to warn patients to be careful if they are __1__ or going to have a test with __2__.

1. metabolism 2. insulin 3. liver

metformin works by improving __1__, decreasing __2__ resistance, and decreases sugar released by the __3__.

MCA

middle cerebral artery

1. hangover

monitor patients taking desmopressin for "__1__" symptoms.

1. thrombus 2. anticoagulants

most patients with tissue valve replacements are at a lower risk for ___1___ and thus will only have to have ____2___ for 3 months.

1. 60 2. 120

normal non fasting blood sugar should fall between __1__ mg/dl to __2__ mg/dl

1. 100

normal range for fasting blood glucose (FBG) should be less than ___1___ mg/dL

men: 0.7-1.2 mg/dl women: 0.5-1 mg/dl

normal range for serum creatinine for men and women

1. sepsis 2. jejunostomy 3. pancreatic enzymes

nutrition is a very important concern for a patient with pancreatitis. TPN/lipids may need to be used, but it increases the patient's risk for __1__. Enteral nutrition is the best route if the gut can handle it. feeding through __2__ is often possible because it is far enough down the GI tract that feeding through it will not cause activation of __3__.

1. small 2. frequent 3. fiber (low residue) 4. protein 5. calories

nutrition management is a very important component of living with inflammatory bowel diseases. In general, patients should eat __1__ __2__ meals that are low in __3__, high in __4__ & __5__.

1. bleeds easily 2. bloody stool

one characteristic of Ulcerative colitis is friable mucosa, which means that the mucosa __1__ and the patient will often have __2__ as a result.

1. imbalanced nutrition: less than body requirements.

one of the most important nursing diagnoses related to acute hepatitis is __1__.

1. aldosterone

one thing that contributes to ascites is elevated levels of the hormone __1__. The body thinks it needs to hold on to fluid, so it will increase aldosterone levels to try to compensate, but this actually makes things worse

Onset: 2-4 hours Peak: 6-8 hours Duration: 10-12 hours

onset, peak, and duration for intermediate acting insulins

Onset: 1-2 hours Peak: continuous (no peak) Duration: 19-24 hours

onset, peak, and duration for long acting insulins

Onset: 1-6 hours Peak: continuous (no peak) Duration: 24-36 hours

onset, peak, and duration for long acting insulins

Onset: 5-15 minutes Peak: 30-60 minutes Duration: 2-4 hours

onset, peak, and duration for rapid acting insulins

Onset: 5-15 minutes Peak: 30-90 minutes Duration: 2-4 hours

onset, peak, and duration for rapid acting insulins

Onset: 30-60 minutes Peak: 2-4 hours Duration: 4-6 hours

onset, peak, and duration for short acting insulins

1. Postmenopausal

osteoporosis is a problem that is commonly faced by women who are __1__

1. liquid 2. alkaline

output from an ileostomy is typically a large amount of __1__ along with mushy, semi-formed stool. Skin protection is essential because of an increased risk of skin breakdown due to the highly __2__ output of the ileostomy.

Odynophagia

painful swallowing

1. photodynamic 2. esophageal dilation 3. esophageal stent

palliative treatment for esophageal cancer includes __1__ therapy, which uses the injection of a light sensitive drug to decrease the size of a tumor. __2__ or __3__ might also be used in order to allow the patient to eat.

1. alpha

pancreatic __1__ cells produce glucagon release when the blood sugar is low

1. beta

pancreatic __1__ cells produce insulin

1. delta

pancreatic __1__ cells produce somatostatin, which is believed to regulate insulin and glucagon

1. duodenum

pancreatic enzymes should normally be activated in the __1__

1. pleural effusion 2. atelectasis 3. pneumonia

pancreatitis can have pulmonary complications such as __1__, __2__, and __3__. They are caused by exudate from pancreatic enzymes leaking into transdiaphragmatic lymph channels. The severe pain associated with pancreatitis can also impair breathing. These respiratory issues should be managed by incentive spirometry, TCDB, and placement in semi-fowler's position.

hemiplegia

paralysis of one side of the body

1. GI 2. calcium 3. vitamin D

patient taking calcitriol may need a nutritional consult for severe __1__ effects. They also may need to add __2__ and __3__ to their diet, in addition to taking supplements.

1. GI surgery in the abdominal cavity 2. esophagectomy 3. peritoneal dialysis

patient who have had these 3 procedures are more at risk for peritonitis

1. infective endocarditis 2. dental procedures

patient with mechanical valves are at a higher risk for ____1___ and thus must take prophylactic antibiotics before all ____2___.

1. histamine 2. infection

patient with necrotizing pancreatitis have dehydration that is caused by the release of __1__ due to the inflammation. __1__ causes vasodilation which causes fluid to shift into the "3rd space" which contributes to dehydration. This process can really apply to any patient with a serious __2__.

1. 1 2. insulin 3. 2

patient with type ___1__ diabetes are more at risk for diabetic ketoacidosis because their body does not produce ANY ___2___. A person with type ___3___ diabetes usually doesn't reach this threshold because their body still produces some ___2___.

1. Glisson's capsule 2. right shoulder

patients can have a lot of pain both during and after a liver biopsy. This is due to the puncture of the __1__, and the pain if often referred up to the __2__.

1. wound healing

patients with Cushing's disease can have poor __1__ due to increased blood sugar

1. Carbohydrates 2. glucagon

patients with mild to moderate hypoglycemia should be given ___1___, or __2__ if unable to take things by mouth.

1. last as long 2. harder

patients with tissue valve replacement should be aware that the valve does not ___1___ as a mechanical valve and it gets ___2___ to replace each time.

Incretins

peptides that are produced in the GI tract in response to food that help to modulate insulin and glucagon activity

1. sanitation workers 2. food handlers 3. daycare workers 4. healthcare providers 5. fishermen 6. farmers 7. travelers to developing countries 8. family member of confirmed cases

persons at high risk for Hep A infection include these 8 categories

1. chest x-ray 2. gastric PH

placement of NG tubes must be verified via __1__ in the real world, though ATI still says to verify by checking __2__

1. Hepatitis B vaccine 2. immune globulin

post exposure treatment for hepatitis B includes a combination of __1__ and __2__.

1. NG tube 2. active bowel sounds 3. passing gas 4. clear liquid

post-op appendectomy, the patient may have an __1__ until the bowel "wakes up." You know peristalsis has returned when you hear __2__ and the patient begins __3__. One this occurs, you can start with __4__ diet and advance as tolerated.

1. sitting in semi-fowlers 2. abdomen 3. breathing

post-op appendectomy, the patient should be positioned __1__ in order to decrease pressure on the __2__ and increase __3__.

1. glucose concentrations 2. meals.

pramlintide (Symlin) is an injectable diabetes medication that regulates ___1___ after ___2___ by slowing gastric emptying and suppressing glucagon.

1. check gastric residual volume (GRV) 2. place patient at 30 degrees 3. perform abdominal assessment 4. flush tubing

prior to feeding via enteral method, it is important to do these 4 things

1. WBC's 2. infection

propylthiouracil and methimazole can cause a dangerous drop in __1__, so need to monitor for signs of __2__.

1. the same time every day 2. discontinued

propylthiouracil and methimazole should be taken at __1__ with meals. They should not be abruptly __2__.

1. thyroid hormone 2. T4 3. T3

propylthiouracil and methimazole work by blocking production of __1__ and blocking conversion of __2__ into __3__.

1. bile salts 2. cholestyramine (Questran)

pruritus is a common clinical manifestation with hepatic dysfunction, because increased __1__ in the skin increase itching. There are medications such as __2__ and other measures that can be used to achieve the goal to promote comfort and maintain skin integrity.

1. thyroid producing 2. 10

radioactive iodine is taken up by the thyroid, and kills the __1__ cells which are causing too much TH to be released. This causes a decrease in the amount of TH that is circulating in the body. The patient will need to be isolated for __2__ days. They should also drink lots of fluids.

1. pregnancy 2. breastfeeding

radioactive iodine treatment is absolutely contraindicated in __1__ during and for 6 months after the treatment. The patient must also stop __2__ 6 weeks prior to treatment.

1. regular 2. absorption problems 3. 5-15

rapid acting insulins produce a more rapid effect that is of shorter duration than ___1___ insulins and minimize ___2___. They should be injected no more than ___3___ minutes prior to eating.

prandial

relating to a meal

1. cortisol 2. aldosterone

remember the word ADD in Addison's disease, you have decreased secretion of ___1___ PLUS __2__

cirrhosis of the liver

scarring of the liver, which leads to the buildup of scar tissue

1. 1.5 2. 1.4

serum creatinine should be checked before starting a patient on metformin. It should not be given for s serum creatinine greater than __1__ mg/dl in men and greater than __2__ mg/dl in women

275-290

serum osmolality normal range

135-145 mEq/L

serum sodium normal range

1. necrotizing

severe pancreatitis is also known as __1__ pancreatitis

1. Humulin R (REGULAR) 2. Novolin R (REGULAR)

short acting insulins include ___1___ and ___2___

1. Humulin R (regular) 2. Novolin R (regular)

short acting insulins include ___1___ and ___2___

1. 15 2. 30 3. intermediate insulins 4. IV

short-acting insulins (regular insulin) are usually given ___1___ to __2__ minutes before a meal, either alone or in combination with ___3___. Regular insulin can be administered via ___4___.

1. numbness 2. coldness 3. intermittent claudication

significant symptoms of arterial occlusion is a feeling of ___1___ or ____2___ in the extremities which may accompany ___3___ as a result of reduced arterial flow.

1. Candida 2. dry 3. antifungal powder

skin around ostomies is susceptible to infections from the fungus __1__ due to excess moisture, antibiotic use, and immunosuppression. It is important to try to keep the skin as __2__ as possible, and to apply a __3__ if infection occurs.

1. thyroid hormone production

somatropin can block __1__ , thus leading to hypothyroidism. Watch for signs of hypothyroidism.

1. inflammation 2. autoimmune

somatropin can cause the body to develop antibodies, which can cause __1__ and an __2__ response at the injection site or all over the body.

1. the refrigerator

somatropin is stored in __1__.

1. skeletal growth 2. internal organs

somatropin replaces human growth hormone, which stimulates __1__, and growth of __2__.

1. colon resection 2. colostomy

some patients with diverticulitis will need surgery such as a __1__ or a temporary __2__ while the bowels are healing.

Chvostek's sign

spasm of the facial muscles produced by sharply tapping over the facial nerve in front of the parotid gland and anterior to the ear; suggestive of latent tetany in patients with hypocalcemia

1. in & outs 2. weights 3. medical alert bracelet

strict monitoring of __1__ and daily __2__ is very important in a patient with diabetes insipidus. It is also important for the patient to wear a __3__.

1. the entire colon is removed. 2. ileostomy

surgery may provide a cure for patients who have ulcerative colitis if __1__. This patient will require an __2__

1. thyroidectomy 2. cardiac 3. bleeding 4. anticoagulants

surgical intervention for hyperthyroidism may be necessary, the procedure to remove the thyroid is called a __1__. The pre-op preparation can take 2-3 months because the patient must be euthyroid in order to decrease the risk of __2__ complications and __3__. The patient will also need to discontinue __4__.

Carotid Endarterectomy (CEA)

surgical procedure to remove blockage from the internal carotid artery with goal of reducing risk of stroke

1. disorientation 2. unresponsiveness 3. cool/clammy skin

symptoms seen in more severe cases of hypoglycemia include ___1___, __2__, and __3__.

1. hyperthyroidism

taking too much levothyroxine can cause __1__, so patients need to be aware to watch for symptoms such as elevated heart rate and blood pressure.

Afterload

the amount of resistance to ejection of blood from the ventricle

Active TB

the bacteria are actively multiplying and causing symptoms in the body. You are also able to spread the disease to other people

1. hypothyroidism.

the biggest concern of taking antithyroid medications is over medication which can result in __1__

bone resorption

the breakdown of bone by osteoclasts which releases calcium into the blood

1. epinephrine 2. bronchi 3. pupils 4. coronary arteries

the catecholamine __1__ causes an increase in heart rate and cardiac output and blood pressure. It also causes dilation of __2__, __3__, and __4__.

1. norepinephrine 2. blood pressure

the catecholamine __1__ causes vasoconstriction which increases __2__ and peripheral resistance

1. meals 2. lying down 3. alcohol 4. tobacco

the clinical manifestation can vary depending on the severity of the hiatal hernia, but in general, the pain is worse after __1__, after __2__, or after using __3__ or __4__.

1. 25% 2. 160/100 mmHg

the goal for hypertensive crisis treatment is to reduce blood pressure by ___1___% over the first hour, and then reduce it to ____2___ over the next 6 hours.

1. infectious

the hormone cortisol has a major role in the bodies __1__ response

Insulin duration

the length of time the insulin remains in effect in the body

1. homeostasis

the main function of the endocrine system is to maintain normal __1__

1. propylthiouracil 2. methimazole

the medication __1__ can be given during the 1st trimester of pregnancy, but must be switch to __2__ after that.

1. side lying with knees flexed 2. semi-fowler's at 45 degree angle

the most comfortable position for a patient with pancreatitis is either __1__ or __2__ to relieve pressure on the diaphragm.

1. alcohol intake

the most common cause of pancreatitis in the US is __1__.

1. starchy 2. potatoes 3. peas 4. corn

the only vegetables that are included in carbohydrate counts are __1__ vegetables such as __2__, __3__, and __4__.

1. parathyroid hormone (PTH) 2. calcium 3. phosphate

the parathyroid gland secretes __1__ which regulates the level of __2__ and __3__ in the body.

Sitagliptin (Januvia)

the prototype DPP-4 inhibitor

1. calcitriol

the prototype anit-hypocalcemia agent is __1__

Virchow's triad

the three biggest risk factors for VTE is referred to as ___1___.

1. Thyroid hormones (T3 & T4) 2. iodine 3. metabolic 4. vascular

the thyroid gland is responsible for producing, storing, and releasing __1__. Dietary __2__ is required for this gland to function properly. The thyroid gland help regulate the body's __3__ rate. It is also a highly __4__ organ.

1. hypothalamus 2. temperature

thermoregulation is regulated by the ___1___ so there may be issues with a neuro patient. the nurse has to help control their ___2___.

Sodium and Sugar levels low, Salt cravings Tired & weak Electrolyte imbalance (hyperkalemia, hyponatremia, hypercalcemia) Reproductive changes lOw blood pressure Infection & Increased pigmentation Diarrhea/nausea, Depression

to remember the signs and symptoms of Addison's disease, remember the phrase "low STEROID hormones"

1. fluid intake 2. hypertonic 3. diuretic 4. underlying cause

treatment for a patient with SIADH should include restricting __1__, administering __2__ IV fluids, and administering a __3__ medication. Ultimately, you will need to find and treat the __4__ though.

1. 1 2. beta cells 3. 30 4. 5-10

type ___1___ diabetes is defined by absolute insulin deficiency due to destruction of pancreatic ___2___. It is is more common in people under age ___3___ and makes up about ___4___% of all diabetes cases.

thrombotic stroke

type of stroke caused by a blood clot blocking an artery in the brain

1. cloudy 2. white 3. rolling in the hand

unlike all other insulins, Intermediate acting insulin solution will appear ___1___ and ___2___, and should be thoroughly mixed by ___3___ before drawing up the solution.

1. medical emergency 2. blood flow 3. atherosclerotic plaque 4. MONA

unstable angina is a ___1___ and requires immediate intervention. It is caused by reduced ___2___ in the coronary artery, often due to a rupture of an ___3___. This patient should be immediately transported to the hospital where they can start ___4___ therapy.

1. hyperglycemia 2. kidneys (urine) 3. dehydration

unused glucose in the blood stream leads to ____1___, and the body tries to get rid of it through the ___2___, which leads to a chronic state of ____3__.

1. unequal 2. absent 3. elevated 4. ruddy 5. cyanotic 6. bruit

upon examination, a patient with arterial artery occlusion may have ____1___ or ____2___ pulses in the extremities. The affected extremity may be cool and pale when ___3___ or ____4___ and ___5___ when placed in a dependent position. you may be able to auscultate a ___6___.

75-200 mEq/24 hours

urine sodium normal range

Sudden pain in stomach, back, legs Syncope Shock Super low blood volume Severe vomiting/diarrhea &headache

use the 5 S's of Addisonian crisis to remember the symptoms.

1. vasoconstrictor 2. mesenteric 3. myocardial ischemia

vasopressin is a potent __1__ that is given either IV or into the __2__ artery. There is a risk of __3__ when using this medication

1. acyclovir 2. amphotericin 3. anticonvulsants

viral encephalitis is treated with a slow infusion of IV __1___, and fungal encephalitis is treated by antifungals such as ___2___. ___3___ should be given due to seizure risk.

hemiperesis

weakness on one side of the body

1. edematous 2. dehydrated

when a patient is "3rd spacing," they will look very __1__, but they are actually __2__ due to a lack of fluid in the intravascular space.

1. ileostomy

when an ostomy must be made in the small intestine, it is preferred to be an __1__ because it allows food to have maximum absorption time.

Insulin onset

when insulin first begins to act in the body

Insulin peak

when the insulin is exerting maximum action in the body

1. glucose 2. hyperglycemia 3. the urine 4. protein

when there is a deficiency of insulin, __1__ is unable to enter the cell and remains in the blood, causing __2__. when serum glucose levels exceed renal threshold, glucose spills into __3__. Cells break down __4__ for conversion to glucose by the liver (glucogenesis).

1. start putting out urine.

when treating DKA, potassium is only replaced once you see the patient ___1___, because that means the you can now assess the true level of potassium, which will be low.

1. glucose 2. insulin 3. food eaten

when you eat food, it gets broken down into __1__ and blood sugar increases. In response, your pancreas releases __2__ which allows glucose to enter the cells, resulting in a decrease in blood sugar. The amount of insulin released is dependent upon the amount of __3__.

esophageal hiatus

where the esophagus passes through the diaphragm

1. mitral regurgitation

you may auscultate a systolic heart murmur at the PMI location in a patient with ____1___.