HLTH310 Midterm

T

Cimetidine may decrease the effects of drugs that require an acidic environment? True/False

F

Clients with renal failure should take magnesium-based antacids. True/False

T

Compartment syndrome is a potentially serious complication caused by an increase in pressure in a limited space that compromises circulation and innervation. True/False

Sympathomimetic

Dilates the bronchi and increase the rate and depth of respiration. They relieve reversible bronchospasm by relaxing the smooth muscles of the bronchi. Medications in this class include Epinephrine and Albuterol.

obesity

slows gastric emptying, increases risk of sleep apnea, and represents poor dietary and exercise habits

obstructive sleep apnea

soft tissue of oropharynx occludes the airway, triggering pauses in respirations and resulting in hypoxia

15 minutes

tPA infusion site should be checked every ____________ in the first hour

thrombolytic agent

tPA is a? - converts *plasminogen to plasmin* by *binding to fibrin* -- dissolves blood clots

6 months - 1 year

time to heal from stroke deficits

creatine kinase

useful tool for determining presence of brain tissue injury

struvite stones

form when ammonium magnesium phosphate is accompanied by an *increase* in urine pH; often develop in conjunction with *UTI*

xanthines

help prevent reoccurence of calcium oxalate stones by inhibiting enzyme that synthesizes uric acid

smoking

increases gastric acidity and decreases sphincter tone, allowing for increased gastric reflux

creatinine

increases if GFR decreases - can be used to indicate change in glomerular function

nicotine

increases metabolism of xanthines in the liver -- dosage must be increased

coffee ground emesis

indicates limited gastric bleeding

aminoglycosides

interferes with bacterial protein synthesis by binding to ribosomal subunits - *gentamicin* - peak *30* min IV

alcohol

irritates gastric mucosa; empty calories tend to replace healthy foods leading to weight gain

tiotropium

long-acting with a rapid onset and is used only once per day (spiriva)

respiratory failure

most serious complication with asthma

<120/<80

normal BP

hemorrhagic stroke

occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed

PPIs

omeprazole, lansoprazole, esomeprazole (prilosec, prevacid, nexium)

calcium stones

oxalate and phosphate; calcium remains in the kidneys and forms ______ _______

30 minutes

pantoprazole should be ____ _______ prior to eating or drinking

elevated

120-129/<80

stage 1

130-139/80-89

paroxysmal atrial fib

5x higher risk of CVA, should be placed on prophylactic anticoag therapy

stage 2

>140/>90

D

A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the client's following statements indicates a need for further health promotion teaching? Select one: a. "I'm planning to lose 15 pounds before the end of this year." b. "I'm trying to cut back on the amount of salt that I cook with and add to my food." c. "I've starting going to the gym before work three times a week." d. "I'm resolving to eat organic foods from now on and to drink a lot more water"

A

A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which of the following measures should the client integrate into his lifestyle to reduce the risk of recurrence? Select one: a. Increased fluid intake and dietary changes b. Weight loss and blood pressure control c. Increased physical activity and use of over-the-counter diuretics d. Regular random blood glucose testing

A, C, D, E

A client is prescribed a proton pump inhibitor to treat erosive gastritis. when educating the client regarding potential side effects you will be sure to include: Select all that apply. Select one or more: a. Flatulence b. Blurred Vision c. Constipation d. Abdominal Pain e. Headache

D

A client presents to the walk-in clinic reporting vomiting and burning in the mid-epigastric region. The nurse suspects peptic ulcer disease and knows that to confirm peptic ulcer disease, the provider is likely to order a diagnostic test to detect the possible presence of what? Select one: a. Decreased stomach acid secretion b. Upper gastrointestinal bleeding c. Gastric irritation caused by nonsteroidal anti-inflammatory drugs (NSAIDs) d. Infection with Helicobacter pylori

A, C, E

A client takes an ACE inhibitor along with hydrochlorothiazide (HCTZ) for hypertension. While reviewing morning lab work, which lab values would you bring to the Primary care providers attention? Select all that apply Select one or more: a. Sodium 132 b. Potassium 3.8 c. Glucose 125 d. Creatinine 0.8 e. Magnesium 1.3

B

A client's primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this agent achieve its therapeutic effect? Select one: a. By inhibiting the conversion of angiotensin I to angiotensin II b. By decreasing vascular volume by increasing sodium and water excretion c. By inhibiting the movement of calcium into arterial smooth muscle cells d. By blocking the release of antidiuretic hormone from the posterior pituitary

C

A patient in the ICU has received tPA. Before the administration of any anticoagulant or antiplatelet therapy, the nurse would expect to wait how many hours before beginning the first dose? Select one: a. 48 b. 36 c. 24 d. 12

D

A patient presenting to the Emergency Department with an acute kidney stone is prescribed morphine, Reglan, and an IV fluid bolus. The client states to the nurse "I hate needles do I really need to have an IV?" The nurse's best response to the client is: Select one: a. "IV's are necessary for the administration of pain medication." b. "IV's are necessary if you want the kidney stone removed." c. "IV's are not necessary. I will let the Provider know you hate needles." d. "IV 's are necessary for signs of dehydration and to decrease the nephrotoxic effects of IV contrast agents."

-pril

ACE inhibitors

-tan

ARB inhibitors

A

According to the most recent guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, A client with a blood pressure (BP) of 160/102 while in the office fall under which classification? Select one: a. Stage 2 b. Stage 1 c. Elevated d. Hypertensive urgency

F

Activase® can be referred as Recombinant Tissue Plasminogen Activator, rt-PA, t-PA, Activase®, or Activase® . It is the only medication currently approved by the FDA for use with hemorrhagic stroke. True/False

F

Activase® is an antiplatelet medication which will keep future clots from forming. True/False

F

Adrenal insufficiency is most likely to occur with local or low doses of inhaled corticosteroids. True/False

B, C, D

Albuterol (Ventolin, Proventil) is a fast-acting beta2 agonist that relaxes bronchial smoot muscles and open airways (bronchodilation) and increase ciliary movement to help clear secretions. When educating a client regarding the side effects of albuterol you would be certain to include? Select all that apply. Select one or more: a. decreased BP b. Increased BP c. tachycardia d. shakiness e. drowsiness

C

Betty is a 16-year-old high-school cross country runner. She has been recently prescribed an inhaled sympathomimetic drug for a teenage exercise-induced asthma. What should the client be instructed to do? Select one: a. Use the inhaler as soon as the symptoms start. b. Use the inhaler 2 to 3 hours before exercising to ensure peak effectiveness. c. Use the inhaler 30 to 60 minutes before exercising. d. Use the inhaler every day at the same time each day

ARB inhibitors

Blocks angiotensin II hormone from binding with receptors in the blood vessels. These actions block the BP-raising effects of the renin-angiotensin system and lowers BP

Anticholinergics

Blocks the vagal effect which relaxes smooth muscle in the bronchi and leads to bronchodilation. Medications in this class include Ipratropium and Turdorza

B, C, D

Brad, is a 25-year-old male who arrives at the walk-in clinic stating "I think I have a kidney stone". If a client with a kidney stone has the "classic" ureteral colic, the client will describe his pain as? Select all that apply. a. Diffuse over the entire lower back and legs b. In the flank and upper outer quadrant of the abdomen c. Excruciating d. Acute, intermittent e. Epigastric and rib pain

T

Caffeine is considered a xanthine, which has bronchodilating effects similar to those of theophylline. Select one: True False

corticosteroids

Decreases inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity. Medications in this class include Prednisone and Beclamethasone.

BID

Flovent is typically dosed?

T

For clients with an NG tube, antacid dosing is based on the pH level. True/False

T

Gastric and duodenal ulcers are more common than esophageal ulcers. True/False

T

H. pylori is the causative agent in most cases of chronic gastritis? True/False

F

Herbal supplements are safe to take and have no effect on GERD drugs. True/False

mast cell stabilizers

prevents the release of inflammatory and bronchoconstricting substances when the mast cells are stimulated to release these substances because of irritation or the presence of an antigen. They inhibit acute responses to cold air, exercise, and sulfur dioxide. - *cromolyn*

T

Hypersecretion of gastric acid can be compounded by calcium? True/False

T

IV aminophylline is no longer used to treat acute asthma attacks. True/False

F

In early stages of COPD, clients are likely to need corticosteroid therapy True/False

blood pressure

primary concern after administration of tPA is control of?

thiazide diuretics

Inhibits reabsorption of sodium and chloride mostly in the distal tubules which result in increased excretion of water and sodium, potassium, and hydrogen ions.

T

It is essential that stroke recognition, the causative factor of a stroke be determined, and that treatment begins within a 3 hour time frame. True/False

F

It is safe to administer Activase to a patient with a systolic blood pressure of 190 mm Hg. True/False

T

Mylanta is safe for children and infants. True/False

150mg BID

ranitidine recommended dose for GERD

H2RAs

ranitidine, cimetidine, famotidine (zantac, tagamet, pepcid)

medical expulsive therapy

reduces pain during stone passage, increases frequency of passing stones, reduces need for surgery

T

Rapid reperfusion of the penumbra (the area surrounding the ischemic event) will limit the extent of injury to the brain. True/False

xanthines

Relaxes smooth muscle by inhibiting the release of slow-reacting substance of anaphylaxis (SRSA) and histamine, thus, decreasing the bronchial swelling and narrowing that occurs as a result of these two chemicals. Medications in this class include Theophylline and Aminophylline.

leukotriene receptor antagonists

Selectively and competitively blocks or antagonize receptors for the production of _________ D4 and E4, components of SRSA. As a result, these drugs block many of the signs and symptoms of asthma, such as neutrophil and eosinophil migration, neutrophil and monocyte aggregation, leukocyte adhesion, increased capillary permeability, and smooth muscle contraction. Medications in this class include Singulair and Accolate.

respiratory failure

s/s: - breathlessness at rest - muteness - RR >30 - paradoxical thoracoabdominal movement - few or absent breath sounds - bradycardia - absent pulsus paradoxus

clopidogrel

side effects: neutropenia, chest pain, headache, rash, agranulocytosis, myalgia, thrombocytopenic purpura

T

Sucralfate provides a barrier between ulcers and gastric secretions? True/False

F

The cardiovascular system is an open system that depends on external stimuli to pump blood and control vascular pressures. True/False

C

The nurse practitioner instructs the client to use over-the-counter ranitidine instead of cimetidine. What risk is decreased when using ranitidine rather than cimetidine? Select one: a. bradycardia b. Headache c. drug-to-drug interaction d. diarrhea

A, B, C

The physician reduces the dose of gentamicin to 1 mg/kg q12h and orders daily creatinine and BUN levels, as well as trough gentamicin levels after day 2. You will monitor F.F. for what signs of gentamicin toxicity? Select all that apply. a. Tinnitusb. Headachec. Dizzinessd. Hypotensione. Restlessness

A

The physician suspects that a client with kidney stones has developed magnesium ammonium phosphate (struvite) stones based on which of the following urinalysis results? a. Increased pH b. High glucose c. Increased protein d. Presence of cysteine particles e. Elevated uric acid

T

The primary control of peripheral resistance is from the constriction and relaxation of the arterioles. True/False

F

Theophylline can usually be given without adjustments in clients with impaired renal function. True/False

F

Thickening of the muscles in the arterial system causes a stronger, more effective cardiovascular system. True/False

leukotriene receptor antagonists

Toxicity may occur if these drugs are combined with calcium-channel blockers, cyclosporine, or aspirin

D

Which self-medicating behavior would most likely predispose a person to having a gastric ulcer? Select one: a. Taking low-dose aspirin at 8 p.m. Friday and an NSAID at 8 a.m. Saturday every week b. Taking four extra-strength Tylenol (acetaminophen) a day for four days c. Taking a single dose of Advil (ibuprofen) about three days every week d. Taking a double dose of Aleve (naproxen) twice daily about six days per week

F

Women are more prone to develop duodenal ulcers. True/False

A

You are caring for a client with a history of hypertension that is now controlled by taking benazepril. Benazepril decreases vasoconstriction by having a vasodilating effect on arteries and veins and belongs to which class of medications? Select one: a. Angiotensin Converting Enzyme inhibitors b. Calcium channel blockers c. Beta-blockers d. Angiotensin II receptor blockers

clopidogrel

________ + aspirin is the current recommendation to prevent platelet aggregation post CVA

ischemic stroke

a type of stroke that occurs when the flow of blood to the brain is blocked

ipratropium

side effects: blurred vision, bitter taste, urinary retention, dry nasal passage

H2RAs

side effects: headache, constipation, dry mouth, dry skin, diarrhea, rashes

vasodilators

act directly on vascular smooth muscle to cause muscle relaxation, leading to _______ and drop in BP

asthma

acute, subacute, or chronic, and the presence of bronchoconstriction, airway edema, and mucus secretion contributes to airflow obstruction and bronchial reactivity.

IV hydration

additional tx method for kidney stones; minimizes nephrotoxic effects of IV contrast agents and promotes hydration

beta agonist

asthma drug to administer 1st

PPIs

side effects: headache, constipation, flatulence, abdominal pain, diarrhea, nausea, vomiting

benazepril

side effects: headache, cough, dizziness, orthostatic hypotension

flovent

side effects: hoarseness, throat irritation, thrush, nausea

metaproterenol

side effects: nervousness, weakness, throat irritation, HTN, cardiac arrest (Alupent, SAB-2RA)

NSAIDs

block production of prostaglandins which decrease production of protective mucous coating that lines the gastric mucosa

-pine

calcium channel blockers

antiplatelet agent

clopidogrel is a? - inhibits platelet aggregation

staghorn stones

complications include: - altered blood glucose - damage to renal tubules - decreased GFR

fibrinolytic therapy

contraindications include: - current intracranial hemorrhage - subarachnoid hemorrhage - active internal bleeding - recent intracranial surgery or head trauma - intracranial conditions - bleeding diathesis - severe uncontrolled HTN

gentamicin

contraindications: - pregnancy, lactation, hypersensitivity

calcium channel blockers

decrease blood pressure by preventing the movement of ________ into the cardiac and smooth muscles when the cells have been stimulated

histamine 2 receptor antagonists

decrease gastric acid production by blocking H2 receptors in gastric cells

proton pump inhibitors

decrease gastric acid secretion by inhibiting H+ pump in parietal cells

ACE inhibitors

designed to decrease blood pressure by *blocking the conversion of angiotensin I to angiotensin II* are called

diuretics

designed to decrease blood pressure by increasing the excretion of sodium and water from the kidneys.

stroke volume

determined by the amount of blood that is pumped out of the ventricles with each heartbeat.

uric acid stones

develop as a result of low urine volume and decreased urine pH

sympathomimetics

dilate the bronchi and increase the rate and depth of respiration

statins

dramatically reduce incidence of first and second CVAs d/t *stabilization of the endothelial wall* and *prevention of plaque ruptures*

pulsus paradoxus

drop in blood pressure >10 mmHg with inspiration

alpha blockers

facilitate passage of stones due to relaxing effects on muscle of ureter and lower urinary tract

purine

foods high in ______ increase risk of uric acid stones (shellfish, fish, red meat, organ meat)