Transition to Nursing Final

aldosterone

"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure

s/s of a hemorrhagic stroke

"thunderclap" headache altered LOC dizziness nausea/vomiting

beta blockers end in

-olol

ace inhibitors end in

-pril

examples of Hypotonic solutions

0.45 NaCl

normal Cr

0.6-1.2

examples of isotonic solutions

0.9 NS, LR

normal HCO3

22-26

Normal HCo3

22-28

in wound healing, when does the inflammatory phase peak?

24-48 hours after trauma

examples of hypertonic solutions

3% NaCl 5% NaCl

normal PaCO2

33-45

when should we expect a response to antibiotic therapy in bacterial pneumonia

48-72 hours

HbA1C indicative of pre-diabetes

5.7%

Hba1c indicative of DM

6.5%

normal BUN

7-20

normal pH

7.35-7.45

FEV1/FVC ratio that is diagnostic for COPD

70%

who is the pneumonia vaccination recommended for?

>65 y/o weakened immune system smokers heavy drinkers recovering from surgery or severe illness

which phrase describes the function of the limbic system? A) influence emotional behavior B) regulate autonomic functions C) facilitate automatic movements D) relay sensory and motor inputs for cerebrum

A) influence emotional behavior

which clinical manifestations indicate a client who sustained head and chest injuries from a motor vehicle accident, responded to medical treatments, and is ready for transfer to a critical care unit? A) stabilized VS and complaints of pain B) pale and alert; remains restless C) increasing temperature and apprehension D) fluctuating vital signs and drowsy, easily roused

A) stabilized VS and complaints of pain

Within which period of time would a nurse advise the client to anticipate pain relief will begin when nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina? A. 1 to 3 minutes B. 4 to 5 seconds C. 30 to 45 seconds D. 10 to 15 minutes

A. 1-3 minutes

How can the nurse prevent vomiting in a client who reports feeling nauseated after cataract surgery? A. Administer the prescribed antiemetic medication. B. Provide some dry crackers for the client to eat. C. Explain that this is expected after surgery D. Teach how to breathe deeply until the nausea subsides

A. Administer the prescribed antiemetic medication.

Which priority nursing intervention would the nurse implement for a client on diuretic therapy who has developed metabolic alkalosis? A. Fall prevention measures B. Monitoring Electrolytes C. Administering antiemetics D. Adjusting the diuretic therapy

A. Fall prevention measures

Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis? A. Monitoring for signs of hypoglycemia resulting from treatment B. Withholding glucose in any form until the situation is corrected C. Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally D. Regulating insulin dosage according to the client's urinary ketone levels

A. Monitoring for signs of hypoglycemia resulting from treatment

Which ion is the regulator of extracellular osmolarity? A. Sodium B. Potassium C. Chloride D. Calcium

A. Sodium

Which blood gas would the nurse expect an adolescent with diabetic ketoacidosis to exhibit? A. pH 7.30, CO2 40, HCO3 20 B. pH 7.35, CO2 47, HCO3 24 C. pH 7.46, CO2 30, HCO3 24 D. pH 7.50, CO2 50, HCO3 22

A. pH 7.30, CO2 40, HCO3 20

A client is hospitalized with a diagnosis of emphysema. The nurse provides teaching and would begin with which aspect of care? A. The disease process and breathing exercises B. How to control or prevent respiratory infections C. Using aerosol therapy, especially nebulizers D. priorities when performing everyday activites

A. the disease process and breathing exercises

s/s of hypernatremia

ALOC => restless, lethargy intense thirst dry swollen tongue flushed skin oliguria

which trigger would the nurse instruct the client to avoid to decrease the incidence of asthma attacks? A. Mold B. Cold Air C. Pet dander D. Air pollution E. Cigarette smoke

All of the above

what medication is given to someone with an ischemic stroke?

Alteplase (tPA)

what is aspirin used for

Anti platelet (to prevent MI and stroke)

warfarin indication

Anticoagulant

which nursing action would be included in the plan of care for a child with acute poststreptococcal glomerulonephritis? A) encouraging fluids B) monitoring for seizures C) measuring abdominal girth D) Checking for pupillary reactions

B) monitoring for seizures

which clinical manifestation is associated with hypernatremia in burns? A) fatigue B) seizures C) paresthesias D) cardiac dysrhythmias

B) seizures

A 66-year old client 24 hours post-stroke has expressive aphasia. The nurse identifies a nursing diagnosis of impaired verbal communication. An appropriate nursing intervention to help the patient communicate is to: A. ask the pt to practice facial and tongue exercises B. Ask the pt yes or no answer type questions. C. Develop a list of words the pt can read and practice reciting

B. Ask the pt yes or no answer type questions

which food item would the nurse instruct a client whose pathology report states urinary calculus is composed of uric acid to avoid? A. Milk B. Liver C. Cheese D. Vegetables

B. Liver

which is involved in the postprocedure nursing care of a child after left-side cardiac catheterization? A. Encouraging early ambulation B. Monitoring the insertion site for bleeding C. Comparing blood pressures in the two extremities D. Restricting fluids until the blood pressure has stabilized

B. Monitoring insertion site for bleeding.

which goal is priority for a client with asthma who has a prescription for an inhaled bronchodilator? A. is able to obtain pulse ox readings B. demonstrates use of metered-dose inhaler C. knows the health care provider's office hours D. can identify triggers that cause wheezing

B. demonstrates use of metered dose inhaler

Which effect of sodium bicarbonate is the nurse trying to prevent when teaching a client about the dangers of using sodium bicarbonate regularly? A. Gastric distention B. Metabolic alkalosis C. Chronic constipation D. Cardiac dysrhythmias

B. metabolic alkalosis

what lab measures urea

BUN

HCO3-

Bicarbonate

which statement will the nurse need to consider when developing the teaching plan for a client with type 2 diabetes prescribed an oral hypoglycemic medication? A) oral hypoglycemics work by decreasing absorption of carbohydrates B) oral hypoglycemics work by stimulating pancreas to produce more insulin C) Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control D) Serious adverse effects are not a problem for oral hypoglycemics

C) clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control

A client, transferred to the PACU after a transurethral resection of the prostate, has an intravenous line and a urinary retention catheter. During the immediate postoperative period, for which potentially critical complication would the nurse monitor? A) sepsis B) phlebitis C) hemorrhage D) leakage around the urinary catheter

C) hemorrhage

PO vancomycin is used for what?

C. Diff

Which factor is the likely cause of the laboratory result when arterial blood gases done on a client who is being resuscitated after a cardiac arrest show a low pH? A. Ketoacidosis B. Irregular heartbeat C. Lactic Acid Production D. Sodium bicarbonate administration

C. Lactic Acid Production

what is the purpose of encouraging active leg and foot exercises for a client who has had hip surgery? A. Maintain muscle strength B. Reduce leg discomfort C. Prevent clot formation D. improve wound healing

C. Prevent clot formation

which of these assessments would be the highest priority for the nurse to complete on a client who arrives in the emergency department with multiple crushing wounds of the chest, abdomen, and bilateral lower extremities? A. Level of consciousness B. Characteristics of pain C. Quality of respirations D. Observation of abdominal contusions

C. Quality of respirations

A client with chronic obstructive pulmonary disease has a blood pH of 7.25 and a pCO2 of 60mmHg. Which complication would the nurse suspect the client is experiencing? A. Metabolic Acidosis B. Metabolic Alkalosis C. Respiratory Acidosis D. Respiratory Alkalosis

C. Respiratory Acidosis Normal PCO2: 35-45

Which type of acid-base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation? A. Metabolic alkalosis caused by excessive production of acid metabolites B. Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide C. Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid D. Metabolic acidosis caused by the kidneys inability to compensate for increased carbonic acid formation

C. Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid

characterized by a chronic inflammatory response in the airway in lungs, resulting in persistent limitation of airflow

COPD

hypocalcemia occurs when

Ca <8.5

treatment of hypocalcemia

Ca+ diluted in D5W, given slowly

hypercalcemia occurs when

Ca+ is greater than 10.5

PaCo2

Carbon Dioxide

which response would the nurse provide to a client receiving digoxin who calls the clinic and complains of yellow vision? A) this is r/t your illness, not your medication B) this is an expected side effect; you will become accustomed to it over time C) this side effect is only temporary. You should continue the medication D) The medication may need to be discontinued. Come to the clinic this afternoon

D) The medication may need to be discontinued. Come to the clinic this afternoon.

which intervention would the nurse implement after determining that a client, who sustained a CVA, needs assistance with eating for optimum nutrition A) request that the client's food be pureed B) feed the client to conserve the client's energy C) have a family member assist the client with each meal D) encourage the client to participate in the feeding process

D) encourage the client to participate in the feeding process

which finding in a urinalysis indicates a urinary tract infection? A) crystals B) Bilirubin C) Ketones D) Leukoesterase

D) leukoesterace

Which action will the nurse take after stopping the antibiotic infusion of a client who becomes restless and flushed, and begins to wheeze during the administration of an antibiotic? A. Check the clients temperature B. Take the client's bp C. Obtain pulse ox D. Assess clients respiratory status

D. Assess clients respiratory status

Which statement must the nurse emphasize to the family when preparing a school-aged child with persistent asthma for discharge? A. A cold, dry environment is desirable. B. Limits should not be placed on the child's behavior C. The health problem is gone when symptoms subside D. Medications must be continued even when the child is asymptomatic

D. Medications must be continued even when the child is asymptomatic

Which nursing action has the highest priority when preparing to transfer an unconscious client who has sustained a head injury from the emergency department to a neurological trauma unit? A. notify the receiving unit of the transfer B. having the client's records ready for the transfer C. Verifying that the family has been notified of the transfer D. Validating availability of a bag-valve-mask during the transfer

D. Validating availability of a bag-valve mask during the transfer

A 49-year-old client is admitted with a possible stroke. Which information from the nursing assessment suggests that the nurse should consult with the HCP before giving prescribed aspirin? A. the pt has a hx of brief episodes of R-sided hemiplegia B. the pt has dysphasia C. the pt has a known hx of a. fib D. Pt reports s/s began with severe headache

D. pt reports s/s began with severe headache

characterized by an increase production and release of glucose by the liver => osmotic diuresis leads to dehydration and loss of electrolytes => increased lipolysis into fatty acid and glycerol (converted into ketones)

DKA

creatinine is increased in

HTN, renal disease, decreased GFR, increased meat consumption

vital signs in septic shock

HypoTN, increased RR, increased HR

treatment of hypercalcemia

IM calcitonin

hypokalemia occurs when

K <3.5

hyperkalemia occurs when

K >5

what is the compensatory process during acidosis?

Kidneys: produce bicarb base and increase excretion of acids (H-) Lungs: increase rate and depth of respirations to exhale carbon dioxide

causes of hypokalemia

N/V/D NG suction Diuretics anorexia alcoholism

causes of hyponatremia

N/V/D burns adrenal insufficiency excess water gain cirrhosis SIADH

PPE for airborne precautions

N95 mask

what is a neurohormone produced by the heart that is used to assess heart failure?

Natriuretic peptides (ANP, BNP)

in extreme hyperkalemia, what will an EKG show?

No P, wide QRS

thrombocytopenia occurs when

PLT is less than 150,000

calcium has a reciprocal relationship with

Phosphorus

biggest intracellular electrolyte

Potassium

what is creatinine?

Product of muscle breakdown, measurement of kidney function

what is phenytoin used for?

Seizure prevention

what is a CT angiogram?

This is a CT scan (a bunch of Xrays taken at different angles and projected into a 3D image) with radiolabeled materials in the blood stream to allow imaging of veins and arteries. CT angiograms are used to diagnose pulmonary embolisms (it's impossible to visually see a clot in the lungs, so we use xrays and computing to create a model).

example of tertiary intention

abdominal wound initially left open until infection is resolved and then closed

in terms of gas exchange, what does Hgb and Hct tell us?

ability to transport O2

these help to keep the pH of body fluids in normal range in spite of continuous production of metabolic acids by cells

acid buffering

cellular metabolism generates carbonic acid in the form of CO2 and water

acid production

what is community acquired pneumonia?

acquired in community or hospital setting within first 48 hours of hospitalization

condition characterized by adrenal insufficiency

addison's

where is cortisol produced

adrenal glands

what type of transmission is TB

airborne

What precautions does the nurse need to follow when caring for a patient with active TB

airborne precautions

monitoring of a person with ischemic stroke

all the same as hemorrhagic PLUS CT angiogram

early sign of sepsis/shock

altered LOC

risk fx for an ischemic stroke

artery thrombosis HTN hyperlipidemia a-fib DM

serum lipids measure risk for

atherosclerosis

which is worse -- viral or bacterial pneumonia

bacterial

increase in neutrophils indicates

bacterial infection

what drugs are used to prevent seizures

benzodiazepines

gold standard for management of hypercalcemia r/t cancer

bisphosphonate

PLT, PTT, PT, and INR are all

bleeding factors

impairment of arterial perfusion happens when

blood cant get down to where it needs to go => intermittent claudication, weak/absent pulse, round, smooth necrotic sores

impairment of venous perfusion happens when

blood cant return to the heart => pulse present, wounds with pus, swelling

What is creatinine

breakdown product from muscle and protein metabolism

albuterol

bronchodilator used during acute asthma exacerbations

examples of IV calcium

calcium gluconate calcium chloride

Ca+ is given slowly to prevent

cardiac arrest

s/s of hypokalemia

cardiac arrhythmias anxiety lethargy coma weakness

impairment of central perfusion occurs when

cardiac output is inadequate

fluid buildup around the brain

cerebral edema

first sign of change in ICP

changes in mental status of motor function

sick day rules for blood glucose monitoring

check blood glucose more often when sick

airway inflammation with productive cough and excessive sputum production

chronic bronchitis

CAP

community acquired pneumonia

Fluticasone

corticosteroid used to decrease inflammation r/t asthma. Used every day

example of glucocorticoids

cortisol

what lab values assess cellular and tissue damage?

creatinine kinase (CK) Troponin Lactic dehydrogenase (LDH)

what lab is very important to get when suspecting a patient with septic shock?

culture and sensitivity

condition characterized by excess cortisol production

cushings syndrome

in DIC, d-dimer is ___ and PT is ____

d-dimer is increased and PT is decreased

s/s of addisons

darkened skin low BP fatigue hyponatremia hypoglycemia

mannitol use

decrease ICP

s/s of hyponatremia

decreased LOC, increased BP, cerebral edema, crackles

why are older adults at greater risk for fluid and electrolyte disturbances?

decreased thirst sensation decreased kidney function

tough connective tissue, has hair follicles, sweat glands

dermis

treatment of diabetes insipidus

desmopressin

vasopressin is used in what common disease

diabetes insipidus

causes of hyperkalemia

diet high in K+, ACE inhibitors, burn patients

dysphagia

difficulty swallowing

s/s of Diabetes insipidus

diluted urine (decreased urine specific gravity) hyperosmolality, hypernatremia dehydration decreased BP

diplopia

double vision

urinary impact of septic shock

dysuria, frequency, urgency, dark in color, foul odor

minerals in the body that have electric charge

electrolytes

alveolar destruction related to chronic inflammation resulting in decreased surface area for gas exchange

emphysema

causes of hypernatremia

excess intake excess H2O loss DI cushings syndrome

polycythemia

excess of red blood cells

reversal agent for andexxa

factor 10a

s/s of DKA

fatigue, weakness, polyuria, blurred vision, orthostatic hypotension, fruity breath, Kussmaul respirations, AMS

eating disorder triad

female, young, athlete

s/s of a pt with bacterial pneumonia

fever > 101 productive cough increased WBC count CXR with notable infiltrates

s/s of active TB

fever chills night sweats persistent cough hemoptysis chest pain and SOB

as they relate to infection, how are proteins important?

fighting infection and rebuilding tissue

in moderate hypokalemia what will an EKG show?

flat T-wave and a U wave

process by which O2 is transported to cells and CO2 is transported from cells

gas exchange

counterregulatory hormones to insulin

glucagon and cortisol

how does stress impact the immune system?

glucocorticoid release causes compromise

adrenals release

glucocorticoids, aldosterone, and sex hormones

phase in wound healing that lasts from days 5-21; characterized by epithelialization

granulation

HACP

healthcare associated pneumonia

presbycusis

hearing loss r/t age

risk factors of a hemorrhagic stroke

hemorrhage, cerebral aneurysm, arteriovenous malformation, anticoagulants, illicit drugs

bleeding into and around the brain; increased ICP; herniation

hemorrhagic stroke

indication for lactulose

high ammonia r/t hepatitis

does cushings disease put you at higher or lower risk of hyperglycemia?

higher

pituitary, thyroid, pancreas, ovaries/testes, adrenals, parathyroid, and hypothalamus are all

hormonal regulation glands

glucocorticoid

hormone from the adrenal cortex that raises blood sugar and reduces inflammation

HAP

hospital acquired pneumonia

characterized by the build up of fluid in the ventricles deep within the brain

hydrocephalus

removal of the thyroid can result in what

hypercalcemia

s/s of cushing's

hyperglycemia hypokalemia rosy cheeks HTN

in what condition would 0.45% NaCl be indicated

hypernatremia

can hyper or hypoventilation help increased ICP

hyperventilation

fat and adipose tissue, connective tissue

hypodermis

in what condition would 3% NaCl, 0.9NS, and LR be indicated?

hyponatremia

cause of hypocalcemia

hypoparathyroidism, pituitary tumor

why do people with sepsis/shock exhibit altered LOC

hypoperfusion and hypoxia

when albumin is decreased, there is

impaired wound healing

why is glucose high in cushings disease?

in cushing's, the adrenals release too much cortisol => upregulates glucose

cushings triad is characterized as

increased BP, decreased HR, decreased RR

why are neonates and infants at greater risk for fluid and electrolyte disturbances?

increased metabolic rate, increased RR, and increased water usage

BUN is increased in

increased protein intake GI bleed infection steroid use renal disease

impairment of gas exchange occurs when....

ineffective ventilation ineffective O2 carrying capacity inadequate perfusion

C-reactive protein measures

inflammation

three phases of wound healing

inflammatory granulation maturation

hormone to lower glucose

insulin

mechanisms and conditions that impact intracranial processing and functioning

intracranial regulation

in extreme hypokalemia, what will an EKG show?

inverted T wave, prominent U-wave

characterized by decreased blood flow to the brain which results in cell/tissue death

ischemic stroke

where does acid buffering occur?

kidneys

how quick does compensatory mechanisms work in acidosis?

kidneys -- hours to days lungs -- immediately

how do kidneys contribute to acid excretion?

kidneys hold onto bicarb base and excrete hydrogen acid

what are the compensatory mechanisms that occur in alkalosis?

kidneys: retain metabolic acids and increase excretion of bicarbonate lungs: decrease rate and depth of breathing

why do people with kidney disease have anemia?

lack of erythropoietin

monitoring of a pt with hemorrhagic stroke

last known normal speech strength cardiac neuro checks glucose CT

cushings triad is a ___ sign of increased ICP

late

TB lives without illness exposure to TB virus asymptomatic can't spread it to others + TB skin or blood test

latent TB

when a patient is having a seizure, what should you do?

lay pt on side; monitor time; pillow placed under head

strabismus

lazy eye

defined as the volume of blood carried to specific tissues

local perfusion

s/s of a pt with viral pneumonia

low grade temp non-productive cough WBC normal to slight elevation CXR with minimal changes

in addisons, are you at higher or lower risk for developing hyperglycemia?

lower

where does acid excretion occur?

lungs and kidneys

what drug is used to reduce cerebral edema?

mannitol

phase in wound healing that lasts for months; collagen fiber is remolded, scar formation and contraction occurs

maturation

western bolt

most common confirmation test for HIV in the US

who are at highest risk for impaired fluid and electrolytes?

neonates and infants developmentally delayed elderly health disparities

consequences of hyperglycemia

neuro changes; dehydration r/t polyuria; DKA; retinopathy; nephropathy; peripheral neuropathy; HTN; cardiovascular and peripheral vascular disease

can you spread latent TB

no

should you give a pt with hypoglycemia candy?

no

are fluid and electrolyte disturbance s/s specific or nonspecific?

nonspecific

diabetes insipidus patho

not enough ADH results in increased diuresis

why is glucose lower in addisons?

not enough cortisol released from adrenal => decrease in glucose => add cortisol

assessment findings of someone with an ischemic stroke

numbness or weakness in face, arm, leg slurred speech

acid base balance is the process of regulating what 3 things?

pH bicarbonate concentration partial pressure of CO2

s/s of an arterial clot

pain paresthesia pulselessness pallor cool skin

where is glucagon produced?

pancreas

calcium is regulated by

parathyroid hormone and calcitonin

the flow of blood through arteries and capillaries, delivers nutrients and O2 to cells

perfusion

increase in monocytes indicates

phagocytosis

how do T-lymphocytes react to infection?

phagocytosis => bacteria destruction

why should someone with hypocalcemia avoid taking drugs that contain phosphorus?

phosphorus will lower calcium levels (inverse relationship)

calcium channel blockers end in

pine

an acute lung infection that results in inflammation of the bronchioles and alveoli (impairment of the muco-ciliary mechanism)

pneumonia

what is HAP

pneumonia acquired 48 hours or longer after admission to hospital

where is ADH produced?

posterior pituitary

goal of treatment of increased ICP

prevent secondary injury to brain and maintain cerebral perfusion

what type of intention: - wound margins well approximated - surgical incision and lacerations - most rapid healing time

primary intention

ECG monitoring of someone with hypocalcemia will show

prolonged ST segment prolonged QT interval

what is essential for treatment of bacterial pneumonia

prompt treatment with antibiotics

reversal agent for heparin

protamine sulfate

s/s of a venous clot

redness edema pain emboli

in COPD, what will an ABG show?

respiratory acidosis

treatment of hypernatremia

restrict PO intake of Na+ hypotonic solutions to prevent ICP increase

what type of intention: - wound margins not well approximated, required formation of granulation tissue - pressure ulcers/burns - longer period to heal

secondary intention

IV vancomycin is used for what?

sepsis

what type of diet should people with type 2DM follow?

small frequent meals

biggest extracellular electrolyte

sodium

hypernatremia occurs when

sodium is >145

hyponatremia occurs when

sodium is less than 135

VAP is acquired when

someone acquires pneumonia after at least 48 hours of being on a ventilator.

s/s of SIADH

sticky, thick urine hypoosmolality plus hyponatremia seizures severe high blood pressure

treatment of SIADH

stop all fluids 3% NS eat salt

what should you give a pt with hypoglycemia?

sugar and a protein (not candy)

big clinical sign of excessive bleeding

tachycardia and hypotension

what type of intention: - wound healing delayed (delayed primary closure)

tertiary intention

assessment findings on someone with hypocalcemia

tetany chvostek's sign trouseeaus sign

every part of the GI tract except for what plays a role in breakdown and absorption of food?

the colon

central perfusion is

the force of blood generated by the heart

what is the treatment for viral pneumonia

there isn't really any

how do B-lymphocytes react to infection?

they produce antibodies

excessive clotting results in

thrombi

SIADH patho

too much ADH leads to fluid retention

increase in lymphocytes indicates

viral infection

reversal agent for warfarin

vitamin K

what is urea

waste product of protein metabolism

what happens to the cell during hyponatremia

water moves from extracellular space to intracellular space => cell swells

medical management of TB

weeks to months of multiple medications - INH - Rifampin - Pyrazinamide - Ethambutol

in moderate hyperkalemia, what will an EKG show?

wide QRS, peaked T-wave

when sodium is down

you're about to drown

when sodium is high

you're very dry