N208 Med-Surg

Alcoholics will have trouble making what that will result in continuous bleeding?

Fibrin clot

Describe the process of coagulation. ______ is converted into ______, which forms a clot with _____ and _____.

Fibrinogen Fibrin Platelets; RBCs

What prevents blood clots that occur naturally from growing and causing problems, and limits the size of blood (fibrin) clots? Prevents widespread clotting.

Fibrinolysis

What are treatments for acute stroke?

Fibrinolytic therapy ("clot busters"), and embolectomy (clot removal).

In regards to tumor nomenclature, what is the prefix if the tissue of origin is fibrous connective?

Fibro

What are most headaches?

Most headaches are migraines without aura.

Reduced immunity and blood producing functions are most likely to happen in what kind of anemia?

Most likely to occur in leukemia but can also occur in any cancer that invades bone marrow.

Are benign tumors migratory? Why?

No migration or wandering of benign tissues occurs because they remain tightly bound and do not invade other body tissues.

What does N0 stand for when staging tumors?

No regional lymph node metastasis

How can tumors of the tongue be prevented?

No smoking or tobacco use, balanced diet, self-exam, regular doctor or dental visits

What is a common antiemetic drug for chemotherapy-induced nausea and vomiting?

Ondansetron (Zofran)

Partial seizures involve which hemisphere?

One cerebral hemisphere

What is one of the first symptoms of Alzheimer's?

One of the first symptoms of AD is short-term memory impairment.

Typically how many chemotherapy doses are scheduled for how many weeks?

Typically 4-12 doses are scheduled every 3-4 weeks

What gender and age are more typically affected by cluster headaches?

Typically develop in men 20-50 years old

Why are they called cluster headaches?

Typically occur daily at about the same time for months at a time, followed by remission (hence the term cluster).

What increases and decreases SVR (systemic vascular resistance)?

Vasoconstriction (i.e., decrease in blood vessel diameter) increases SVR, whereas vasodilation (increase in diameter) decreases SVR.

What are the three mechanisms that work together during hemostasis to stop the flow of blood?

Vasoconstriction; Platelet plug formation; Clotting of blood.

Is bacterial or viral worse? What causes the worst presentation?

Viral meningitis is usually self-limiting, and the patient has a complete recovery. Bacterial meningitis is potentially life threatening. Regardless of the causative organism, symptoms are the same, but meningococcal meningitis causes the most severe presentation.

What are signs and symptoms of TIA?

Visual Deficits • Blurred vision • Diplopia (double vision) • Blindness in one eye • Tunnel vision Motor Deficits • Weakness (arm, hand, or leg) • Gait disturbance (ataxic) Sensory Deficits • Numbness (face, arm, or hand) • Vertigo Speech Deficits • Aphasia • Dysarthria (slurred speech)

What is PKD?

-Fluid-filled cysts develop in the nephrons -Over time small cysts become larger and kidney function becomes less effective. -Other abdominal organs are displaced causing pain -Each cyst may rupture, bleed, or become infected, all of which can cause pain.

What is the character of pain in trigeminal neuralgia? How long does it last?

-Sudden, intense, unilateral pain; usually confined to the 2nd and 3rd branches of the 5th CN -Pain is intermittent, bouts of pain may last weeks or longer -The course of trigeminal neuralgia (TN) involves bouts of classic pain for several weeks or months followed by spontaneous remissions. The length of these remissions may vary from days to years, but attack-free periods tend to become shorter as the patient grows older. Symptoms rarely disappear permanently.

How is cancer managed?

-Surgery, Radiation Therapy, Chemotherapy, Hormonal -Manipulation -Photodynamic Therapy -Immunotherapy: Biological Response Modifiers -Targeted Therapy

What is the treatment for brain tumors?

-Treatment includes chemo, radiation, and possibly craniotomy.

What should you do or consider in assessing client's kidney function?

-Utilize terminology familiar to the patient -consider ethnicity, family history -consider workplace exposure (heavy metal-like lead) -Long term use of NSAIDs-lead to renal failure

What causes thrombocytopenia?

-Viral infections (measles, hepatitis) -Cirrhosis -Leukemia, lymphoma -Radiation -Drugs (acetaminophen, sulfa drugs)

When is restless leg syndrome worse?

-Worse when patient stays still for a period of time -Worse in the evening and at night

What is an aneurysm?

-Abnormal ballooning which develops along a weak spot on the wall of an artery. -Larger aneurysms are more likely to rupture than are smaller ones -Distal to a ruptured cerebral aneurysm the blood flow is markedly diminished -Pt may c/o a sudden, severe headache

What are acute and chronic pyelonephritis associated with?

-Acute: single episode, may result from pregnancy, obstruction or reflux -Chronic: usually associated with structural deformities, reflux, cancer, or chronic UTIs

What are some cardiovascular assessments in a patient with sickle cell anemia?

-Circulation: frequent checks of pulse ox in fingers and toes, cap refill, peripheral pulses, peripheral temp We want to frequently check pulse ox. If colder on one side, might indicate blockage on that side.

How are kidney disorders classified?

-Congenital -Obstructive -Infectious -Glomerular -Degenerative

What is continence?

-Continence is the control over time and place of urination. -Continence occurs when pressure in the urethra is greater than pressure in the bladder. For normal voiding to occur, the urethra must relax and the bladder must contract with enough pressure and duration to empty completely. -Incontinence may be severe enough to cause social or hygienic problems. It is not a normal consequence of aging or childbirth; it can be temporary or chronic. -Considered to be a major health problem in the US -Common in older adults, 85% are women -Kegal exercised may help with stress incontinence-

Normal MAP is what?

90mm/Hg

What should the nurse consider when administering a PO iron supplement? (Select all that apply). A. Stool may turn black B. Give liquid preparations through a straw C. Consider diluting a liquid iron preparation D. Constipation is a common side effect E. Iron supplements can only be administered IM

A B C D

Oh Nurse! A person with what chronic condition might have difficulty laying flat for a test? A. Huntington disease B. Parkinson's disease C. COPD D. Cerebral Palsy E. Epilepsy

A B C D E All of them

A client with myasthenia gravis has been prescribed to take pyridostigmine (Mestinon). What health teaching will the nurse include related to this drug? Select all that apply. A. "Watch for signs and symptoms of myasthenic crisis." B. "Take the drug about an hour before eating a meal." C. "Take the same dose of medication every day." D. "Take the drug with food to prevent nausea." E. "Do not take sedatives or sleeping pills while on this drug."

A B C E

Which of the following are causes of chronic pyelonephritis? (Select all that apply.) A. urine reflexes from the bladder back into the ureters B. urinary tract defects C. obstruction of one or both ureters D. hypertension E. prostate enlargement

A B C E

Oh Nurse! Which of the following will commonly cause alteration ICP? (Select all that apply.) A. Nose blowing B. Bending down to tie a shoe C. Defecation D. Urinating E. Nose blowing F. Sneezing

A B C E F

What are common assessment findings in a patient with polycystic kidney disease (PKD)? (Select all that apply.) A. hypertension B. flank pain C. unexplained weight loss D. abdominal pain

A B D

Oh Nurse! A patient is referred to the nurse for education about ALS. What information does the nurse include in the educational session? (Select all that apply.) A. It is a progressive disease involving motor function B. The cause of ALS in unknown C. Memory loss will occur but will be very gradual D. Death typically will occur several decades after diagnosis E. There is no cure for ALS F. Rilutek is a specific treatment to resolve symptoms

A B E

Oh Nurse! A patient presents with a chief complaint of a headache. He is irritable and impatient t receive treatment. He is alert and oriented, speech is clear, and he is willing and able to answer the nursee's questions. Which questions does the nurse ask to solicit additional relevant information about this patient's headache? (Select all that apply.) A. "When do the headaches occur?" B. "How often do the headaches occur?" C. "Why do you have headaches?" D. "Did you eat an unsusally large meal just before your headache?" E. "Do you experience other symptoms with the headache?"

A B E

Which of the following conditions are symptoms of kidney failure? (Select all that apply). A. diabetes B. swollen feet C. impotence D. hypertension

A, B, C, D

Which of the following can lead to acute kidney injury? A. Congestive heart failure B. Renal calculi C. Uretheral stricture D. Head injury with significant blood loss, E. Ingesting 10 grams of acetaminophen in a single dose.

A, B, C, D, E Reduced blood flow, toxins, infection, and obstruction can cause. Antifreeze can cause. Blood loss can contribute to acute kidney injury, such as letting a nose bleed for hours. Congestive heart failure: The heart is failing-it can't deal with all the blood-can't push it forward-so it gets enlarged-bmp is released-it tells kidney to pee more-its becomes less effective in time-kidneys become hypoxic.

A client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client's tumor may metastasize? (Select all that apply.) A. Brain B. Bone C. Lymph nodes D. Kidneys E. Liver

A, B, C, E Typical sites of metastasis of lung cancer include the brain, bone, liver, lymph nodes, and pancreas. Kidneys are not a typical site of lung cancer metastasis.

A nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? Select all that apply. A. Dysuria B. Enuresis C. Frequency D. Nocturia E. Urgency F. Polyuria

A,C,D, E: Dysuria, Frequency, Nocturia and urgency are symptoms of a UTI. Enuresis-bed-wetting and polyuria-are not signs of a UTI.

The nurse is caring for a group of hospitalized clients. Which client is at greatest risk for infection and sepsis? A. An 18-year-old who had an emergency splenectomy B. A 22-year-old with recently diagnosed sickle cell anemia C. A 38-year-old with hemolytic anemia D. A 40-year-old alcoholic with liver disease

A. An 18-year-old who had an emergency splenectomy Removal of the spleen causes reduced immune function. Without a spleen, the client is less able to remove disease-causing organisms, and is at increased risk for infection. Sickle cell anemia causes pain and discomfort because of the changed cell morphology, so acute pain, especially at joints, is the greatest threat to this client. A low red blood cell count with hemolytic anemia can contribute to a client's risk for infection, but this client is more at risk for low oxygen levels and ensuing fatigue. The liver plays a role in blood coagulation, so this client is more at risk for coagulation problems than for infection.

The nursing assistant is concerned about a postoperative client with blood pressure (BP) of 90/60 mm Hg, heart rate of 80 beats/min, and respirations of 22 breaths/min. What does the supervising nurse do? A. Compare these vital signs with the last several readings. B. Request that the surgeon see the client. C. Increase the rate of intravenous fluids. D. Reassess vital signs using different equipment.

A. Compare these vital signs with the last several readings. Vital sign trends must be taken into consideration; a BP of 90/60 mm Hg may be normal for this client. Calling the surgeon is not necessary at this point, and increasing IV fluids is not indicated. The same equipment should be used when vital signs are taken postoperatively.

The nurse is teaching a client with vitamin B12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the client to eat? A. Dairy products B. Grains C. Leafy vegetables D. Starchy vegetables

A. Dairy products Dairy products such as milk, cheese, and eggs will provide the vitamin B12 that the client needs. Grains, leafy vegetables, and starchy vegetables are not a source of vitamin B12.

The nurse explains to a client that which risk factor of those listed most likely contributed to the client's primary liver carcinoma? A. Infection with hepatitis B virus B. Consuming a diet high in animal fat C. Exposure to radon D. Familial polyposis

A. Infection with hepatitis B virus Hepatitis B and C are risk factors for primary liver cancer. Alcohol abuse is also a risk factor for the development of liver cancer. Consuming a diet high in animal fat may predispose a person to colon or breast cancer. Exposure to radon is a risk factor for lung cancer. Familial polyposis is a risk factor for colorectal cancer.

The client with which laboratory result is at risk for hemorrhagic shock? A. International normalized ratio (INR) 7.9 B. Partial thromboplastin time (PTT) 12.5 seconds C. Platelets 170,000/mm3 D. Hemoglobin 8.2 g/dL

A. International normalized ratio (INR) 7.9 Prolonged INR indicates that blood takes longer than normal to clot; this client is at risk for bleeding. PTT of 12.5 seconds and a platelet value of 170,000/mm3 are both normal and pose no risk for bleeding. Although a hemoglobin of 8.2 g/dL is low, the client could have severe iron deficiency or could have received medication affecting the bone marrow.

The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia? A. Monitor weight B. Trend red blood cells and hemoglobin and hematocrit C. Monitor platelets D. Observe for motor deficits

A. Monitor weight Cachexia results in extreme body wasting and malnutrition; severe weight loss is expected. Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression.

When assessing the older adult, the nurse teaches the older adult that which age-related change causes nocturia? A. Decreased ability to concentrate urine B. Decreased production of antidiuretic hormone C. Increased production of erythropoietin D. Increased secretion of aldosterone

A. Nocturia may result from decreased kidney-concentrating ability associated with aging.

Which intervention most effectively protects a client with thrombocytopenia? A. Avoiding the use of dentures B. Encouraging the use of an electric shaver C. Taking rectal temperatures D. Using warm compresses on trauma sites

B. Encouraging the use of an electric shaver The client with thrombocytopenia should be advised to use an electric shaver instead of a razor. Any small cuts or nicks can cause problems because of the prolonged clotting time. Dentures may be used by clients with thrombocytopenia as long as they fit properly and do not rub. To prevent rectal trauma, rectal thermometers should not be used. Oral or tympanic temperatures should be taken. Ice (not heat) should be applied to areas of trauma.

How does the nurse caring for a client with septic shock recognize that severe tissue hypoxia is present? A. PaCO2 58 mm Hg B. Lactate 9.0 mmol/L C. Partial thromboplastin time 64 seconds D. Potassium 2.8 mEq/L

B. Lactate 9.0 mmol/L Poor tissue oxygenation at the cellular level causes anaerobic metabolism, with the by-product of lactic acid. Elevated partial pressure of carbon dioxide occurs with hypoventilation, which may be related to respiratory muscle fatigue, secretions, and causes other than hypoxia. Coagulation times reflect the ability of the blood to clot, not oxygenation at the cellular level. Elevation in potassium appears in septic shock due to acidosis; this value is decreased and is not consistent with septic shock.

Which clinical symptoms in a postoperative client indicate early sepsis with an excellent recovery rate if treated? A. Localized erythema and edema B. Low-grade fever and mild hypotension C. Low oxygen saturation rate and decreased cognition D. Reduced urinary output and increased respiratory rate

B. Low-grade fever and mild hypotension Low-grade fever and mild hypotension indicate very early sepsis, but with treatment, the probability of recovery is high. Localized erythema and edema indicate local infection. A low oxygen saturation rate and decreased cognition indicate active (not early) sepsis. Reduced urinary output and increased respiratory rate indicate severe sepsis.

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting? A. Morphine B. Ondansetron (Zofran) C. Naloxone (Narcan) D. Diazepam (Valium)

B. Ondansetron (Zofran) Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Morphine is a narcotic analgesic or opiate; it may cause nausea. Naloxone is a narcotic antagonist used for opiate overdose. Diazepam, a benzodiazepine, is an antianxiety medication only; lorazepam, another benzodiazepine, may be used for nausea.

Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? A. Potential for lack of understanding related to side effects of chemotherapy B. Potential for injury related to sensory and motor deficits C. Potential for ineffective coping strategies related to loss of motor control D. Altered sexual function related to erectile dysfunction

B. Potential for injury related to sensory and motor deficits The highest priority is safety. Although knowing the side effects of chemotherapy may be helpful, the priority is the client's safety because of the lack of sensation or innervation to the extremities. The nurse should address the client's coping only after providing for safety. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is still the client's safety.

While assessing a client with overactive bladder, the nurse discovers the client also has the following health problems. Which health problem could be made worse by the drug tolterodine (Detrol)? A. Asthma B. Glaucoma C. Hypotension D. Diabetes mellitus

B. Tolterodine is an anticholinergic drug that can raise intraocular pressure and make some types of glaucoma worse. It is absolutely contraindicated for clients with uncontrolled narrow- or closed-angle glaucoma. It can be used with caution for clients who are being treated for open-angle glaucoma if the disease is well controlled.

Which instruction does the nurse give the client who needs a clean catch urine specimen? A. Save all urine for 24 hours. B. I will collect the first specimen of the morning. C. Do not touch the inside of the container. D. You will receive an isotope injection, then I will collect your urine.

C. A clean catch specimen is used to obtain urine for culture and sensitivity of organisms present; contamination by the client's hands will alter the specimen and results.

Which statement made by a client who has acute pyelonephritis indicates to the nurse correct understanding of the antibiotic therapy? A. "If my temperature is normal for 3 days in a row, the infection is gone and I can stop taking the drug." B. "If my temperature goes above 100° for 2 days, I should take double the dose of the drug." C. "Even if I feel completely well, I should take the drug exactly as prescribed until it is gone." D. "I should notify my prescriber to change the medication if I develop diarrhea while taking this drug."

C. Antibiotic therapy is most effective when taken for the entire course and not just when symptoms are present. Most antibiotic therapy results in some degree of diarrhea. Although additional drugs may be needed to control this side effect, it is usually unnecessary to stop the drug.

A 53-year-old postmenopausal woman is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her? A. "They can relieve your anxiety associated with incontinence." B. "They help your bladder to empty." C. "They may be used to improve urethral resistance." D. "They decrease your bladder's tone."

C. Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance.

The nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant. What procedure does the nurse follow? A. Administer intravenous corticosteroids before starting the transfusion. B. Allow the platelets to stabilize at the client's bedside for 30 minutes. C. Infuse the transfusion over a 15- to 30-minute period. D. Set up the infusion with the standard transfusion Y tubing.

C. Infuse the transfusion over a 15- to 30-minute period. The volume of platelets—200 or 300 mL (standard amount)—needs to be infused rapidly over a 15- to 30-minute period. Administering steroids is not standard practice in administering platelets. Platelets must be administered immediately after they are received; they are considered to be quite fragile. A special transfusion set with a smaller filter and shorter tubing is used to get the platelets into the client quickly and efficiently.

Which nursing activity illustrates proper aseptic technique during catheter care? A. Applying Betadine ointment to the perineal area after catheterization B. Irrigating the catheter daily C. Positioning the collection bag below the height of the bladder D. Sending a urine specimen to the laboratory for testing

C. Keep urine collection bags below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract.

When caring for the client with uremia, the nurse assesses for which of these symptoms? A. Tenderness at the costovertebral angle (CVA) B. Cyanosis of the skin C. Nausea and vomiting D. Insomnia

C. Manifestations of uremia include anorexia, nausea, vomiting, weakness, and fatigue.

The nurse is assessing an adult client's endurance in performing activities of daily living (ADLs). What question does the nurse ask the client? A. "Can you prepare your own meals?" B. "Has your weight changed by 5 pounds or more this year?" C. "How is your energy level compared with last year?" D. "What medications do you take daily, weekly, and monthly?"

C. "How is your energy level compared with last year?" Asking the client how his or her energy level compares with last year is an activity exercise question that correctly assesses endurance compared with self-assessment in the past. It is most likely to provide data about the client's ability and endurance for ADLs. The client may never have been able to prepare his or her own meals, and the ability to prepare meals does not really address endurance. The question about weight change addresses nutrition and metabolic needs, rather than ADL performance. The question about how often the client takes medication addresses nutrition and metabolic needs and focuses on health maintenance through the use of drugs, not on the client's ability to perform ADLs.

A client with possible Alzheimer's disease is scheduled to have a positron emission tomography (PET) scan. The daughter asks the nurse how this test is different from a CT scan. What is the nurse's best response? A. "The PET scan is a newer test that can see the brain more clearly." B. "The PET scan provides information about brain function rather than structure." C. "The CT scan makes a lot of noise and the PET scan is quieter." D. "The CT scan requires a contrast medium to be injected and the PET scan does not."

B

When performing an hourly assessment of a client who had a subclavian catheter placed 6 hours ago for continuous arteriovenous hemofiltration with dialysis (CAVHD), the nurse observes these findings. For which finding does the nurse stop the CAVHD? A. The right foot and ankle appear slightly more edematous than the left foot and ankle. B. Blood pressure has decreased from 148/90 to 90/60. C. Pulse oximetry is increased from 89% to 91%. D. The trachea is in a midline position.

B

Oh Nurse! A patient reports increased fatigue and stiffness of the extremities. These symptoms have occurred in the past, but resolved and no medical attention was sough. Which questions does the nurse ask to assess whether the symptoms may be associated with multiple sclerosis? (Select all that apply.) A. "Do you feel unsteady or unbalanced when you walk?" B. "Do you have a persistent sensitivity to cold?" C. "Do you ever have slurred speech?" D. "Do you wake at night and have trouble getting back to sleep?"

B C

Oh nurse! A patient presents with a diagnosis of osteosarcoma. What does the nurse know about this diagnosis? (Select all that apply). A. This patient has a benign tumor B. This patient has cancer C. This patient's disease affects their bones D. This patient's disease affects their osteocytes

B C

What are the typical clinical manifestations of anemia? (Select all that apply.) A. Decreased breath sounds B. Dyspnea on exertion C. Elevated temperature D. Fatigue E. Pallor F. Tachycardia

B, D, E, F Difficulty breathing—especially with activity—is common with anemia. Lower levels of hemoglobin carry less O2 to the cells of the body. Fatigue is a classic symptom of anemia; lowered O2 levels contribute to a faster pulse (i.e., cardiac rate) and tend to "wear out" a client's energy. Lowered O2 levels deliver less oxygen to all cells, making clients with anemia pale—especially their ears, nail beds, palms, and conjunctivae and around the mouth. Respiratory problems with anemia do not include changes in breath sounds; dyspnea and decreased oxygen saturation levels are present. Skin is cool to the touch, and an intolerance to cold is noted; elevated temperature would signify something additional, such as infection.

The health care provider prescribes the drug, estrogen (Premarin). Which risks does the nurse tell the client to expect? Select all that apply. A. Dry mouth B. Endometrial cancer C. Increased intraocular pressure D. Thrombophlebitis E. Vaginitis

B,D: Estrogen use can increase the risk for endometrial cancer and the risk for thrombophlebitis. Women who smoke-especially-should not use this drug.

The nurse is educating a group of young women who have sickle cell disease (SCD). Which comment from a class member requires correction? A. "Frequent handwashing is an important habit for me to develop." B. "Getting an annual 'flu shot' would be dangerous for me." C. "I must take my penicillin pills as prescribed, all the time." D. "The pneumonia vaccine is protection that I need."

B. "Getting an annual 'flu shot' would be dangerous for me." The client with SCD should receive annual influenza and pneumonia vaccinations; this helps prevent the development of these infections, which could cause a sickle cell crisis. Handwashing is a very important habit for the client with SCD to develop because it reduces the risk for infection. Prophylactic penicillin is given to clients with SCD orally twice a day to prevent the development of infection.

Oh Nurse! At what temperature should you set the water heater in your home? A. 100 F B. 110 F C. 120 F D. 130 F

C. 120 F (Approx. 49 C)

The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect? A. Alopecia B. Allergy C. Fever D. Chills

B. Allergy Allergy is the most common side effect of monoclonal antibody therapy (rituximab). Monoclonal antibody therapy does not cause alopecia. Although fever and chills are side effects of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

Which problem in the clients below best demonstrates the highest risk for hypovolemic shock? A. Client receiving a blood transfusion B. Client with severe ascites C. Client with myocardial infarction D. Client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion

B. Client with severe ascites Fluid shifts from vascular to intra-abdominal may cause decreased circulating blood volume and poor tissue perfusion. Volume depletion is only one reason why a person may require a blood transfusion; anemia is another. The client receiving a blood transfusion does not have as high a risk as the client with severe ascites. Myocardial infarction results in tissue necrosis in the heart muscle; no blood or fluid losses occur. Owing to excess antidiuretic hormone secretion, the client with SIADH will retain fluid and therefore is not at risk for hypovolemic shock.

The nurse is teaching a client who is receiving an antiestrogen drug about the side effects she may encounter. Which side effects does the nurse include in the discussion? (Select all that apply.) A. Heavy menses B. Smooth facial skin C. Hyperkalemia D. Breast tenderness E. Weight loss F. Deep vein thrombosis

D, F Breast tenderness and shrinking breast tissue may occur with antiestrogen therapy. Venous thromboembolism may also occur. Irregular menses or no menstrual period is the typical side effect of antiestrogen therapy. Acne may also develop. Hypercalcemia, not hyperkalemia, is typical. Fluid retention with weight gain may also occur.

The nurse has the following assignment. Which client should be encouraged to consume 2 to 3 liters of fluid each day? A. Client with chronic kidney disease B. Client with heart failure C. Client with complete bowel obstruction D. Client with hyperparathyroidism

D. A major feature of hyperparathyroidism is hypercalcemia, which predisposes to kidney stones; this client should remain hydrated.

The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body? A. Veins of the legs B. Lung C. Heart D. Abdominal cavity

D. Abdominal cavity Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity. Intravenous drugs are delivered through veins. Chemotherapy delivered into the lungs is typically placed in the pleural space (intrapleural). Chemotherapy is not typically delivered into the heart.

Which of these staff members should be assigned to a client who has benign prostatic hyperplasia and hydronephrosis and needs an indwelling catheter inserted? A. An RN float nurse who has 10 years of experience with pediatric clients B. An LPN/LVN who has worked in the hospital's kidney dialysis unit until recently C. An RN without recent experience who has just completed an RN refresher course D. An LPN/LVN with 5 years of experience in an outpatient urology surgery center

D. Catheterization of a client with an enlarged prostate, a skill within the scope of practice of the LPN/LVN, would be performed frequently in a urology center.

What does the nurse teach the client to prevent the risk for urinary tract infection (UTI)? A. Limit fluid intake. B. Increase caffeine consumption. C. Limit sugar intake. D. Drink about 3 liters of fluid daily.

D. Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs.

A health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug? A. "It will act as an antibacterial drug." B. "This drug will treat your infection, not the symptoms of it." C. "You need to take the drug on an empty stomach." D. "Your urine will turn red or orange while on the drug."

D. Phenazopyridine (Pyridium) will turn the client's urine red or orange. Care should be taken because it will stain undergarments. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed.

A client who is 6 months pregnant comes to the Prenatal Clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client? A. Discharges the client to her home for strict bedrest for the duration of the pregnancy B. Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria C. Recommends that the client refrain from having sexual intercourse until after she has delivered her baby D. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up

D. Pregnant women with UTI require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor-with adverse effects for the fetus.

The nurse is caring for a client who is in sickle cell crisis. What action does the nurse perform first? A. Apply cool compresses to the client's forehead. B. Encourage the client's use of two methods of birth control. C. Increase food sources of iron in the client's diet. D. Provide pain medications as needed.

D. Provide pain medications as needed. Analgesics are needed to treat sickle cell pain. Warm soaks or compresses can help reduce pain perception. Cool compresses do not help the client in sickle cell crisis. Birth control is not the priority for this client. Increasing iron in the diet is not pertinent for the client in sickle cell crisis.

Gums that bleed due to light brushing may indicate what?

Decreased clotting ability

An alert and oriented client is admitted to the emergency department with a moderate head injury. Which assessment finding will the nurse report immediately to the health care provider? A. Headache B. Slight dizziness C. Fatigue D. Sudden drowsiness

D

For which client living at home is intermittent self-catheterization an inappropriate method for incontinence management? A. 36-year-old woman who is blind B. 46-year-old man who has paraplegia C. 56-year-old woman who has diabetes D. 66-year-old man who has severe osteoarthritis

D

In conducting patient teaching with a patient who will undergo peritoneal dialysis at home, the nurse includes discussion of what common and significant complication of peritoneal dialysis? A. pulmonary embolism B. hypotension C. dypsnea D. peritonitis

D

The chromosomes in normal cells are what?

Diploid (euploid)

What does M1 stand for when staging tumors?

Distant metastasis

How is ALS diagnosed?

- Clinical diagnosis, no specific tests - CK may be elevated - A diagnosis of exclusion Diagnosis is based on clinical and diagnostic test findingsand by ruling out other causes of the motor changes. There is no specific test to diagnose ALS, but creatine kinase (CK) is increased. The electromyogram (EMG) demonstrates fibrillations and fasciculations of the muscles. A muscle biopsy specimen typically demonstrates small, angulated, atrophic fibers. Other diagnostic studies reveal motor strength deficits in serial muscle testing; abnormal pulmonary function test results, such as a decreased vital capacity (<2 L); and dysphagia (difficulty swallowing).

What are early signs of ALS?

- Fatigue while talking - Dysphagia (difficulty swallowing) - Fasciculations (twitching) of the face - Dysarthria (slurred speech) - No mental status changes

What is the patient's temperament in the progressive stage of hypovolemic shock? What does he often complain of?

-Patient may be confused, possible impending doom -Complains of severe thirst

What are typical symptoms of brain tumors?

-Patients typically complain of headache, N & V, visual symptoms, and seizures.

What should the nurse check for often in patients that have leukemia?

-vital signs (including temperature) -skin -breath sounds -urine for cloudiness, burning with urination

What are hematologic changes with aging?

-↓ Blood volume -↓ Levels of plasma proteins -Total RBCs and WBCs are lower -WBC count does not rise as high in response to infection in older people as it does in younger people -(Platelet count does not change with age)

Normal creatinine levels are approximately?

.4-1.2

Cancer will occur in ___ of every ___ people currently living in North America.

1 3

When is a tumor detectable?

1-cm tumor that has at least 1 billion cancer cells in it

How does regeneration of peripheral nerve after injury work?

1. After nerve transection, degeneration and retraction of the distal stump occur within 24 hours. 2. Healing begins as Schwann cells of the neurilemma proliferate from both proximal and distal stumps, forming neurilemmal cords that will guide the regenerating axon. 3. Some unmyelinated axon sprouts that are generated from the proximal stump find their way to the distal stump, guided by the neurilemmal cords. 4. The axon regrows and remyelinates.

What are four interacting factors that influence cancer development?

1. Exposure to carcinogens 2. Genetic predisposition 3. Immune function 4. Exposure to teratogenics (things that pregnant mom is exposed to that can cause cancer in fetus; cancer that originates in utero).

The systemic inflammation of SIRS leads to what?

1. Hypodynamic state from vasodilation (characterized by decreased cardiac output and increased peripheral resistance) 2. Increased release of pro-inflammatory cytokines 3. Pooling of blood, cellular hypoxia 4. Vascular damage 5. Formation of microthrombi

What are two reasons cancer is more common today than in past centuries?

1. Longer life expectancy 2. Increased exposure to substances that cause cancer

What is our goal in managing impaired swallowing in the patient with a stroke?

1. avoid aspiration, 2. NPO until "swallowing eval" is completed, 3. then promote adequate nutritional intake 4. Use thickened foods 5. Make sure patient is sitting up.

What are two advantages of the red blood cell's flattened, bioncave shape?

1. large surface area to volume ratio makes it ideal for gas diffusion 2. Ability to assume a torpedo-like shape therefore squeeze through microcirculation

What are the steps to metastasis?

1.) Malignant transformation 2.) Tumor vascularization 3.) Blood vessel penetration 4.) Arrest and invasion

What is the calculation our teacher taught us in class to calculate MAP?

1/3 SBP (systolic BP) + 2/3 DBP (diastolic BP) = MAP

Cancer is a collection of more than ____ different diseases, each caused by specific and often unique accumulation of _______ and ______ _______.

100 genetic epigenetic alteration

Skin can tolerate temperatures up to ________ without injury.

104 F or 40 C

What is the approximate life span of red blood cells?

120 days

What is the normal platelet count?

150,000 to 400,000/mm3.

What is generalized, or tonic-clonic seizures?

2 to 5 minutes, begins with tonic phase (total body rigidity) followed by clonic (rhythmic jerking) followed immediately by unconsciousness.

When can an AV graft be used after placement?

2-3 weeks after placement

What is the healing time of deep partial-thickness burns?

2-6 weeks

Never infuse potassium faster than ___ mEq/hr through IV

20

The client in shock has the following vital signs: T 99.8° F, P 132 beats/min, R 32 breaths/min, and BP 80/58 mm Hg. Calculate the pulse pressure.

22 mm Hg Pulse pressure is the difference between the systolic and diastolic pressures: 80 (systolic) - 58 (diastolic) = 22 (pulse pressure)

If both parents have sickle cell trait, and they each contribute one alveoli of the disease to their child, what is the percentage that their child will have sickle cell disease?

25% chance they have disease, 25% they have no trait, and 50% they will have trait.

Leukemia accounts for _____ percent of all new cases of cancer and _____ percent of all deaths from cancer.

2; 4

What is the normal range for potassium? Why may it be abnormal in shock (does it increase or decrease)?

3.5-5.0 mEq/L or mmol/L Increased due to dehydration, acidosis In class, teacher istated ncreased to due RBCs breaking

What is the normal range for PaCO2? Why may it be abnormal in shock (does it increase or decrease)?

35-45 mm Hg It is increased due to anaerobic metabolism

What is the average age of male breast cancer?

60 years old

A MAP of below _____ is abnormal.

70mm/Hg

A patient with chronic kidney disease (CKD) is at high risk for which electrolyte imbalance? A. elevated K+ B. low K+

A

What is capillary bed?

A capillary bed is a concentration of capillaries which supply blood to a specific organ or area of the body.

What is leukemia?

A type of cancer with uncontrolled production of immature WBCs in the bone marrow

Oh Nurse! Approximately how much does 1 liter of water weight? A. 1 kilogram B. 2 kilograms C. 1 pound D. 1/2 pound

A. 1 kilogram

When preparing the client who is undergoing urography with contrast, the nurse plans to administer which medication before the procedure? c/o flank pain, dysuria, bilat knee pain with BUN/Cr: 54/2.4 a. Acetylcysteine b. Metformin c. Captopril d. Acetaminophen

A. Acetylcysteine (an antioxidant) may be used to prevent contrast-induced nephrotoxic effects; this client has kidney impairment demonstrated by increased creatinine.

Which statement made by the client who is receiving intravesicular instillations of BCG for bladder cancer indicates to the nurse that more teaching is needed? A. "Holding my urine for at least 8 hours after the treatment keeps the drug in contact with my bladder." B. "Drinking plenty of fluids during the evening after the treatment helps get the drug out of my system." C. "Sitting to urinate for 24 hours after treatment prevents exposure of other people to the drug." D. "Avoiding intercourse for 24 hours after treatment reduces my wife's exposure to the drug."

A. Retaining urine for that long distends the bladder and increases the risk that the BCG will be absorbed systemically. In addition, the discomfort may cause the client to urinate rapidly, leading to more splashing and potentially exposing others to the BCG.

A client recovering from an open reduction of the femur suddenly feels light-headed, with increased anxiety and agitation. Which key vital sign differentiates a pulmonary embolism from early sepsis? A. Temperature B. Pulse C. Respiration D. Blood pressure

A. Temperature A sign of early sepsis is low-grade fever. Both early sepsis and thrombus may cause tachycardia, tachypnea, and hypotension.

The client has returned form a captopril renal scan. Which teaching should the nurse provide when the client returns? A."Arise slowly and call for assistance when ambulating." B. "I must measure your intake and output (I&O)." C. "We must save your urine because it is radioactive." D. "I must attach you to this cardiac monitor."

A. The drug can cause severe hypotension during and after the procedure. Warn him or her to avoid rapid position changes and of the risk for falling as a result of orthostatic (positional) hypotension.

Why does the person have pain in PKD?

Abdominal organs are displaced, and the patient has pain. The fluid-filled cysts are also at increased risk for infection, rupture, and bleeding, which increase pain.

What are chromosomal characteristics of cancer cells?

Abnormal chromosomes (aneuploidy) are common in cancer cells as they become more malignant. Chromosomes are lost, gained, or broken; thus cancer cells can have more than 23 pairs or fewer than 23 pairs. Cancer cells also may have broken and rearranged chromosomes.

What is abortive therapy

Abortive therapy is aimed at alleviating pain during the aura phase (if present) or soon after the headache has started.

What is the healing time of superficial partial-thickness burns?

About 2 weeks

Is there edema with deep full-thickness burns?

Absent

Is there pain with deep full-thickness burns?

Absent

What is the Monro-Kellie Hypothesis?

According to the Monro-Kellie Hypothesis, ICP is maintained due to a reciprocal relationship between three intracranial volumes: CSF (10%), blood (10 %), and brain tissue/interstitial fluid (80%).

What drugs cause low platelet levels?

Acetaminophen, sulfa drugs

Human lymphotrophic virus type I causes what type of malignancies?

Adult T-cell leukemia

Chronic _____ impairs blood clotting.

Alcoholism

What is Alzheimer's?

Alzheimer disease is a type is a chronic, progressive, degenerative disease.

Patients with renal carcinoma have what condition regarding their blood?

Anemia or erythrocytosis. They have one or the other. Not both. Mostly have anemia.

What are some side effects of chemotherapy?

Anemia, neutropenia, thrombocytopenia, alopecia and mucositis, myelosuppression, "chemo-brain", peripheral neuropathy, plus nausea and vomiting are expected

What causes hemorrhagic stroke?

Aneurysm, arteriovenous malformation, hypertension

What happens in hypovolemic shock if the patient is on an ace inhibitor?

Angiotensin 1 can't convert to angiotensis 2, and compensatory meausures will be less effective.

Anterior cervical discectomy requires that the pt wear what for several weeks post op?

Anterior cervical discectomy requires that the pt wear a rigid collar for several weeks post op.

What is anterior, posterior, dorsal, ventral, medial, lateral, proximal, and distal?

Anterior: Toward the front. The nose is on the anterior side of the head. Posterior: Toward the rear. The posterior side of the head is frequently covered in hair. Dorsal: In humans, toward the back of the torso. The shoulder blades are dorsal to the ribs. Ventral: In humans, toward the front of the torso. The navel is on the ventral aspect of the body. Medial: Closer to the midline, or dividing line between right and left halves, of the body. The neck is medial to the shoulder. Lateral: Farther from the midline. The eye is lateral to the nose Proximal: Closer to the point of attachment with the torso. In other words, closer to the shoulder or the hip. The elbow is proximal to the wrist. Distal: Farther from the point of attachment. The ankle is distal to the knee.

What medications can slow the absorption of folic acid?

Anticonvulsants and oral contraceptives can slow the absorption of folic acid

Yellow box

Assess for and document symptoms of disequilibrium syndrome (headache, nausea, vomiting, restlessness, decreased level of consciousness, seizures, coma) during and after HD, because early recognition and treatment with anticonvulsants and barbiturates may prevent a life-threatening situation.

What should the nurse teach the client who is undergoing a study using contrast media? A. "You will need to have anesthesia or sedation." B. "A feeling of heat or warmth occurs when the contrast is injected." C. "Expect your urine to have a pink or red tinge after the procedure." D. "You will not be able to eat or drink for 4 to 6 hours after the procedure."

B. Contrast medium causes a sensation of flushing, heat, or warmth as it circulates through the bloodstream.

Diabetics more prone to UTIs because ____

Bacteria readily feed off excess glucose excreted in urine

What is the S phase in the cycle of a cell?

Because making one cell into two cells requires twice as much of everything, including DNA, the cell must double its DNA content through DNA synthesis. This process occurs in S phase.

What happens to bones exposed to radiation therapy?

Bone exposed to radiation therapy looses density and breaks more easily than other bones.

What is uremia

Buildup of nitrogenous waste products in the blood as a result of kidney injury; it's a full blown manifestation of of kidney failure, sometimes referred to as uremic syndrome, especially if the cause of urine failure is unknown

Are lymphomas benign tumors or malignant tumors?

Cancerous

Anyone getting potassium needs to be on continuous _____ monitoring.

Cardiac

What are specific causes or risk factors in obstructive shock?

Cardiac tamponade Arterial stenosis Pulmonary embolus Pulmonary hypertension Constrictive pericarditis Thoracic tumors Tension pneumothorax

What does turbid, or cloudy urine, mean?

Cloudy urine indicates infection, sediment, or high levels of urinary protein.

Cell division in benign tumor cells is?

Continuous or inappropriate

____ is outside, ____ is inside the kidney

Cortex, Medulla

Brachytherapy uses radioactive isotopes how?

Either in solid form or within body fluids

What is cachexia?

Extreme body wasting and malnutrition often develops despite what would normally be adequate intake

What is FAST?

F Face uneven A Arm hanging down or drifting S Speech slurred T Time-call 911!

True or False Normally the adult spleen is palpable.

False

What is used to determine rectal bleed?

Fecal occult blood test

How are benign tumors named? With what suffix?

Generally named after tissue from which they arise with the suffix "-oma".

What is palliative surgery?

Goal is to improve the quality of life. Palliative surgery focuses on improving the quality of life during the survival time, not on cure. Examples include removal of tumor tissue that is causing pain, obstruction, or difficulty swallowing. The specific procedure used depends on the patient's specific problem.

What increases the risk for penile cancer?

HPV

In regards to tumor nomenclature, what is the prefix if the tissue of origin is the liver?

Hepato

What are risk factors for shock in the older client?

Hypovolemic Shock • Diuretic therapy • Diminished thirst reflex • Immobility • Use of aspirin-containing products • Use of complimentary therapies such as Ginkgo biloba • Anticoagulant therapy Cardiogenic Shock • Diabetes mellitus • Presence of cardiomyopathies Distributive Shock • Diminished immune response • Reduced skin integrity • Presence of cancer • Peripheral neuropathy • Strokes • Institutionalization (hospital or extended-care facility) • Malnutrition • Anemia Obstructive Shock • Pulmonary hypertension

Oh Nurse! What is the etiology of hypovolemic shock?

Hypovolemic shock occurs when too little circulating blood volume causes a MAP decrease that prevents total body oxygenation. Common problems leading to hypovolemic shock are hemorrhage (external or internal) and dehydration. Hypovolemic shock from external hemorrhage is common after trauma and surgery. Hypovolemic shock from internal hemorrhage occurs with blunt trauma, GI ulcers, and poor control of surgical bleeding. Hemorrhage also can be caused by any problem that reduces the levels of clotting factors. Hypovolemia as a result of dehydration can be caused by any problem that decreases fluid intake or increases fluid loss.

What are the different types of shock?

Hypovolemic shock, cardiogenic shock, distributive shock (which includes septic shock, neurogenic shock, and anaphylactic shock), and obstructive shock.

A crisis in sickle cell anemia is a response to conditions that cause what?

In response to conditions that cause local or systemic hypoxemia (deficient oxygen in the blood).

What is pyelonephritis?

Infection of the kidney

In regards to tumor nomenclature, what is the prefix if the tissue of origin is smooth muscle?

Leiomyo

Benign tumors have ________ differentiated functions.

Many

Parkinson's is more common in what gender?

More common in males than in females

Several classic symptoms that are associated with meningitis?

Nuchal rigidity (stiff neck) Kernig's sign Brudzinski's Sign

What are nursing interventions for encephalitis?

Nursing interventions for encephalitis are similar to those for meningitis with the exception of drug therapy. Supportive nursing care and prompt recognition and treatment of increased ICP are essential components of management. Maintain a patent airway to prevent the development of atelectasis or pneumonia, which can lead to further brain hypoxia (lack of oxygen).

In regards to hematology, what would be a nutritious diet?

Nutrition: High in B12, Eggs, milk, leafy green vegetables, etc.

Why does obesity cause back pain?

Obesity places increased stress on the back muscles and can cause back pain.

Kaposi's Sarcoma is considered to be an ________ infection.

Opportunistic

______ growth with _______ growth patterns occurs in benign tumor cells even though their growth is not ______.

Orderly normal needed

_________ and ________ depend on how much oxygen from arterial blood perfuses the tissue.

Oxygenation perfusion

What is the most common symptom of SCD crisis?

Pain

What is desquamation?

Peeling of dead skin

In the client with MG, what usually relieves weakness?

Rest

Oh Nurse! What is an aura?

Sense of a light or sound that may indicate that a headache or seizure is coming

Afferent neurons are also known as what?

Sensory neurons

Brain tumor may cause what impairments?

Sensory, motor, and cognitive functions are impaired when cancer spreads to the brain. Any tumor, benign or malignant, growing in the brain can destroy healthy brain tissue and cause death.

What type of shock is sepsis and septic shock?

Sepsis and septic shock is a complex type of distributive shock that usually begins as a bacterial or fungal infection and progresses to a dangerous condition over a period of days.

Platelet count < 20K can lead to what?

Spontaneous, uncontrolled bleeding.

What are examples of superficial burns?

Sunburn, flash burns (brief exposure to very high temperatures).

Will superficial partial-thickness burns and deep partial-thickness burns scar?

Superficial partial-thickness burns heals with no scar with standard care, but deep partial-thickness burns will scar.

What is the treatment for penile cancer?

Surgery, radiation, chemotherapy

Treating shock: Face is pale, lift the ______. Face is red, lift the ______.

Tail Head

What is a sonography?

Take the black probe on right, put on some lubricating gel, then put probe over the bladder, and it will beep when it sees the spot with most urine, and then it will tell you how much urine is there in the bladder. Non-invasive way instead of a cath to see how much urine is in the bladder.

What are some primary prevention measures that a nurse can implement to prevent hypovolemic shock?

Teach all people to prevent dehydration by having an adequate fluid intake during exercise and when in hot, dry environments. Urge people to prevent trauma and hemorrhage by using proper safety equipment and seat belts and being aware of hazards in the home or workplace.

What do you teach the client about ondansetron?

Teach patient to change positions slowly to avoid falls. These drugs may induce bradycardia, hypotension, and vertigo.

What does microcytic mean?

That RBCs are smaller than normal.

With what complain does a patient usually come into the Emergency Department with if they have undiagnosed esophogeal tumor?

That there is some food "stuck" in their esophagus. This is usually caused by the tumor. It creates an obstruction that doesn't allow some food to go past.

What should you document about an AV fistula?

That you feel a thrill and hear a bruit

What is the TNM system?

The American Joint Committee on Cancer developed the tumor, node, metastasis (TNM) system to describe the general anatomic extent of cancers. The stages guide treatment and are useful for prognosis and comparison of treatment results. The TNM staging systems have specific prognostic value for each solid tumor type.

What is micturition?

The act of voiding

In hypovolemic shock, does the loss of blood volume from the vascular space result in an increase or decrease in mean arterial pressure? What else does the loss of RBCs result in?

The basic problem of hypovolemic shock is a loss of blood volume from the vascular space, resulting in a decreased mean arterial pressure (MAP) and a loss of oxygen-carrying capacity from the loss of circulating red blood cells (RBCs).

What occurs to the bone marrow in patient's with leukemia?

The bone marrow becomes overcrowded with immature, nonfunctional cells (WBCs) and production of normal blood cells (RBCs and platelets) is greatly decreased.

When does breast cancer cause disruptive life function?

The breast is not a vital organ, and even if it had a large tumor in it, the primary tumor alone would not cause the patient's death. When the tumor spreads from the original site into vital areas, life functions can be disrupted and death may follow.

What is the definitive test for leukemia?

The definitive test for leukemia is an examination of cells obtained from bone marrow aspiration and biopsy.

If sepsis is stopped at the creation of microthrombi due to SIRS, is organ damage reversible? What happens if it isn't stopped? What happens because of these thrombi?

The microthrombi begin to form in some organ capillaries, causing hypoxia and reducing organ function -If sepsis is stopped now the organ damage is reversible -If sepsis is not stopped, microthrombi continue to develop. These thrombi increase organ hypoxia and generate more toxic metabolites, a vicious downward cycle; SIRS gets worse

The secretion of what two neurotransmitters cause motor movement?

The secretion of two major neurotransmitters accomplishes this process: dopamine and acetylcholine (ACh).

Weakened urinary sphincter muscles and shortened urethra in women cause what?

The shortened urethra increases the potential for bladder infections. Good perineal hygiene may prevent skin irritations and urinary tract infection (UTI).

What is the M phase in the cycle of a cell?

The single cell splits apart into two cells (actual mitosis) during M phase.

What is chemotherapy?

The treatment of cancer with chemical agents.

What are motor neurons?

They cause movement and mobility

What are compensatory measures in hypovolemic shock? When do they occur?

They occur when there is a decrease in MAP of 10-15 mm Hg from the patient's baseline value. 1. Continued sympathetic stimulation i. Moderate vasoconstriction a. Because of the arterial chemoreceptors sensing low pH levels due to increased lactic acid. ii. Increased heart rate a. ADH and the reninangiotensin-aldosterone system cause this iii. Decreased pulse pressure 2. Chemical compensation i. Renin, aldosterone, and antidiuretic hormone secretion a. Increased vasoconstriction b. Decreased urine output c. Stimulation of the thirst reflex 3. Some anaerobic metabolism in nonvital organs i. Mild acidosis ii. Mild hyperkalemia

What are the cellular characteristics of a G2 malignant tumor?

Tumor cells are moderately differentiated; they still retain some of the characteristics of normal cells but also have more malignant characteristics than do G1 tumor cells.

In the MAP calculation provided to us by our teacher (MAP=1/3 SBP + 2/3 DPB), where do the numbers 1/3 and 2/3 come from?

Two thirds of the cardiac cycle are spent in diastole, and 1/3 in systole.

What is classic hemophilia?

Type A

What type is Christmas deficiency hemophilia?

Type B

What is pyridium?

Urinary tract analgesic

Why is combination therapy used? What is the disadvantage?

Using more than one drug is more effective in killing cancer cells than using only a single drug. However, the side effects and damage caused to normal tissues also increase with combination chemotherapy.

What kinds of food contain vitamin B12?

Vitamin B12 is found in organ meat, red meat, shellfish and eggs.

How can you avoid a UTI after sex?

Wash and urinate after sex

Yellow box

When infusing platelets, do not use the standard blood administration set because the filter traps the platelets and the longer tubing increases platelet adherence to the lumen

What does migratory mean?

Whether cells wander or not throughout body.

How soon may surgery occur after diagnosis?

Within days

What does anaplastic mean?

Without form or structure

Do only malignant cells have a loose adherence?

Yes, except for one exception. The only exception for normal cells to have a loose adherence are blood cells. Red blood cells and white blood cells produce no fibronectin and do not usually adhere together.

Are all normal cells nonmigratory?

Yes, except for red blood cells.

Skin changes and hair loss due to radiation therapy are _____ and are ____ dependent.

local (only) dose

Ovarian cancer spreads _____.

quickly

Because the cardiovascular system is a closed but continuous circuit, the main factors that influence MAP are what?

• Total blood volume • Cardiac output • Size of the vascular bed

Why does repeated "crisis" episodes in sickle cell anemia have long-term damaging effects on tissues and organs?

"Repeated vaso-occlusive events of larger blood vessels have long-term damaging effects on tissues and organs. Most effects occur as a result of tissue hypoxia, anoxia, ischemia, and cell death. Tissues and organs begin to have small infarcted areas and scar tissue formation. Eventually, so many healthy cells are destroyed that organ failure results. Tissues most often affected in this way are the spleen, liver, heart, kidney, brain, joints, bones, and retina."

What are nonsurgical interventions for the client in hypovolemic shock?

-ABCs -Oxygen -IV -Consider blood products -Consider vasoconstricting drugs (in class teacher stated our body does a good job vasoconstricting already, so vasoconstricting drugs don't work as well) -Frequent vital signs and reassessment -Consider an intra-arterial catheter for continuous BP monitoring Treat the cause of the shock as soon as possible!

What do you need to ask the patient/family and assess for?

-ABCs, LOC -What were you doing at the onset? -How did the symptoms progress? -Does medical history include relevant risk factors? -During interview observe for aphasia, difficulty with speech, memory and hearing -Personality changes? (ask family) -Proprioceptive dysfunction? -Facial drooping? -Hemiparesis or hemiplegia? Ataxia? -Incontinence or urinary retention?

Why might RBC, HCT, and HGB be too low?

-Acute or chronic bleeding -RBC destruction -Nutritional deficiency (Iron, B12, or Folate) -Kidney failure

How can sensory perceptions be managed after a stroke?

-Adapting to deficits is a major patient concern -ADL assistance may be needed due to difficulty: -discriminating right from left -discriminating up from down -Caregivers should break tasks into discrete steps and give frequent verbal and tactile clues -Approach the patient from the unaffected side which should face the door of the room -To assist with short-term memory deficits stick to a structured schedule, post clocks and calendars

What are nursing interventions for the patient with Alzheimer's?

-Answer questions truthfully -Prevent overstimulation -Encourage exercise, such as walking -Promote undisturbed sleep -Provide consistency -Safety measures Our teacher said in class: Overstimulation-like radio or tv-can stress those with Alzheimer's. Change stresses them-for example, putting something on their left instead of usual right-might become combative. Undisturbed sleep-make them exercise during day. Consistency is important. Put calendar in room so they don't keep asking you what day it is. Wear name tag for them. They'll lose ability to read. Use pictures like a toilet to symbolize where the bathroom is. Keep current photographs of relatives. Medalert identification band should also be used. Always be honest, but in later stage of disease, do validation therapy. "Is my mother coming to visit?" Says the 90 year old Alzheimer's patient. You want to validate or distract them. Don't say that their mother is dead, they'll go through grieving process again. If reorient them to reality they can become combative.

What should you tell patients about dialysis access devices?

-Be careful not to bump or cut your access -Don't wear jewelry or tight clothing over access -Don't sleep with your access arm under your body -Don't lift heavy objects or place pressure on your access arm

What might cause WBCs to be too low?

-Bone marrow disorders including bone cancer -Sepsis (severe infection) -Immune disorders (for example, HIV)

What are some complications of a subclavian catheter "Vas Cath"?

-Can clog or become infected -Can cause narrowing of the vein in which it is placed

What are some altered GI structures and function in the patient with cancer?

-Cancer may obstruct or compress structures in the GI tract and thereby make absorption and elimination difficult -Tumors often increase metabolic rate and increase the need for nutrients at a time when the patient has little energy for meal preparation and eating -Tumors that invade the liver profoundly damage this organ, which has many important metabolic functions. Cancer-related reduced liver function leads to malnutrition and death.

What causes thrombocytosis (high platelet levels)?

-Cancer, especially breast and ovarian -Hemolytic anemia -Iron deficiency anemia -Rheumatoid arthritis

How can continence be managed after a stroke?

-Cause must be assessed. Possible causes: - Altered level of consciousness - Impaired innervation to bladder and/or rectum - Inability to communicate need to urinate or defecate -Typically this patient can regain function in time -Bladder training: -Position patient on commode or offer urinal Q 2 hours -Encourage 2,000 ml/fluid unless contraindicated -Determine what helps pt have a BM and follow this, if possible -Offer prune juice/high fiber diet -Remove indwelling urinary catheter as soon as possible

What are other interventions, assessments for the patient in critical care with increased ICP?

-Continue frequent ABCs and neuro checks -Consider intracranial monitoring (for example Ventriculostomy) -Nonspecific ST-segment / T wave changes may occur possibly due to stimulation of the autonomic nervous system) -Consider mannitol, lasix, anti-seizure medicine and opioids -Fever is common -Low Na+ diet -Consider vent to keep Paco2 35-38

What are clinical manifestation in the client with Alzheimer's disease?

-Decline in cognition- cognition is the ability to process, store, retrieve, and manipulate information -Apraxia- inability to use objects appropriately -Aphasia- inability to speak appropriately -Anomia- inability to find words -Agnosia- loss of sensory comprehension

Despite the severity of severe sepsis, why is it often missed in patients?

-Despite the severity this is often missed!! Why? -Because cardiac function is hyperdynamic: output is increased so the SBP is high, patient feels warm and "looks good" with little or no cyanosis. Also, WBCs may no longer be elevated (because they have been used up).

How can a crisis be prevented in sickle cell anemia?

-Drink 3-4 liters of liquid every day -Avoid alcohol and smoking -Seek assistance at the first sign of illness -Avoid travel to high elevations -Avoid planes without pressurized cabins -Avoid oral contraceptives

How can the nurse promote effective communication after a stroke?

-Early intervention by a SLP (Speech Language Pathologist) SLP greatly increases chances for optimal recovery -When communicating with an aphasic patient: - Present only one idea or thought per sentence - Speak slowly; not loudly - Use alternative forms of communication

What are nursing assessments of headaches? What should we encourage?

-Encourage use of a headache diary -Use "PQRST" or similar pain assessment tool ("COLDSPA").

What is the treatment for prerenal acute kidney injury (AKI)?

-May include a fluid challenge (500-1000 mls of NS over an hour) and furosimide. -Dialysis may improve AKI and sometimes returns kidney function to normal

What are long-term effects of the clients with traumatic brain injury?

-May loose their sense of smell, ability to taste and/or swallow, vision, temperature sensation -May have behavior changes -Cognitive impairment is common -May have a long term risk for seizure activity

What are surgical interventions for back pain? What are some open procedures?

-Minimally Invasive Surgery (MIS) Open Procedures are: -Diskectomy -Spinal fusion -Interbody cage fusion

Do people with PKD have hypertension or hypotension?

-Most people with PKD have hypertension because compression of renal vessels  activates the renin- angiotensin system.

What are some motor and sensory deficits that occur in the patient with cancer?

-Motor and sensory deficits occur when cancers invade bone or the brain or compress nerves -Motor/sensory changes occur if tumors compress nerves -Cognitive changes may occur with brain tumors or mets -Metastasis to bones often causes pain and fractures

What is the pathophysiology for back pain?

-Muscle strain -Ligament strain -Disc degeneration due to osteoarthritis -Herniation from the nucleus pulposus -Herniation can press on the sciatic nerve or even directly on the spinal cord

What are nursing concerns for hemophilia?

-Normal platelet plugs are formed at the bleeding site however clotting factor deficiency impairs the formation of stable fibrin clots -Patients may bleed excessively from minor cuts -Joint and muscle hemorrhages that lead to disability, long term problems are common -Post-op bleeding can be fatal -Regularly scheduled infusions of factors are costly but potentially prevent the patient from bleeding to death

Patients who meet one of what criteria for a major burn should receive emergency care at the nearest emergency department and then be transferred to a designated burn center as soon as possible?

-Partial-thickness burns greater than 25% TBSA (total body surface area) -Full-thickness burns greater than 10% -Any burn involving the eyes, ears, face, hands, feet, perineum -Electrical injury -Inhalation injury -Patient is older than 60 years -Burn complicated with other injuries (e.g., fractures) -Patient has cardiac, pulmonary, or other chronic metabolic disorders

Who is at increased risk for pyelonephritis?

-Patients with diabetes (don't feel the need to pee) -bladder atony increases risk for pyelonephritis -Women have more pylo than men (shorter path and more UTIs), although after age 65 the incidence in men increases significantly

Why might RBC, HCT, and HGB be too high?

-Polycythemia Vera -Dehydration -Smoking -Lung Disease

What are common complications of long term spinal cord injury?

-Pressure ulcers -Septicemia -Pneumonia -Pulmonary emboli

How may the patient present in glomerulonephritis?

-Pt may be edematous with fluid overload and hypertension

What are general disease-related consequences of cancer?

-Reduced Immunity and Blood-Producing Functions -Altered GI structure and Function -Motor and Sensory Deficits -Reduced Oxygenation

What are key interventions for the patient who has kidney trauma?

-Replace fluid -Frequent vital signs (as often as every 5 minutes) -Strict Is and Os (output should be at least 0.5 mL/kg/hr.

What are signs of a transfusion reaction?

-SOB -Fever and chills -Itching -Apprehension -Chest or back pain -Impending doom -DIC (DIC-disseminated intravascular coagulation-lots of clots and bleeding at the same time. Eventually your clotting factors used up and you bleed out).

What are findings in urolithiasis?

-Severe renal colic (pain) -Nausea,vomiting, pallor and diaphoresis may accompany the pain - UA, IV urography, renal ultrasonography -Noncontrast CT has the highest sensitivity for identification of urinary tract stones -Oliguria or anuria suggest obstruction which is in emergency -If you suspect obstruction look for bladder distension

What are normal changes in the nervous system for older adults?

-Slower processing time -Recent memory loss -Decreased touch sensation -Change in perception of pain -Change in sleep patterns -Altered balance and/or decreased coordination -Increased risk for infection

The ______ route delivers drugs into the spinal canal, and the _______ route delivers drugs directly into the ventricles of the brain. Intraperitoneal instillations place the drugs within the _______ cavity, most often for ovarian cancer. Drugs for bladder cancer can be instilled directly into the bladder (_______ route). For a few cancer types, _______ infusions may be used to deliver a higher dose locally. This technique is not common and is used mostly for bone cancers and, on a limited basis, for head and neck cancer.

intrathecal intraventricular abdominal intravesicular intra-arterial

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? A. "Blood in my urine has become less noticeable; maybe I don't need this procedure." B. "I have been taking cephalexin (Keflex) for an infection." C. "I previously had several ESWL procedures performed." D. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."

D. Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure. The ESWL will have to be rescheduled for this client.

When planning an assessment of the urethra, what does the nurse do first? A. Examines the meatus B. Notes any unusual discharge C. Records the presence of abnormalities D. Dons gloves

D. Before examination begins, body fluid precautions (gloves) must be donned first.

A client has a glioblastoma. The nurse begins to plan care for this client with which type of cancer? A. Liver B. Smooth muscle C. Fatty tissue D. Brain

D. Brain The prefix "glio-" is used when cancers of the brain are named. The prefix "hepato-" is included when cancers of the liver are named. The prefix "leiomyo-" is included when cancers of smooth muscle are named. The prefix "lipo-" is included when cancers of fat or adipose tissue are named.

A client with hypovolemic shock has these vital signs: temperature 97.9° F; pulse 122 beats/min; blood pressure 86/48 mm Hg; respirations 24 breaths/min; urine output 20 mL for last 2 hours; skin cool and clammy. Which medication order for this client does the nurse question? A. Dopamine (Intropin) 12 mcg/kg/min B. Dobutamine (Dobutrex) 5 mcg/kg/min C. Plasmanate 1 unit D. Bumetanide (Bumex) 1 mg IV

D. Bumetanide (Bumex) 1 mg IV A diuretic such as bumetanide will decrease blood volume in a client who is already hypovolemic; this order should be questioned because this is not an appropriate action to expand the client's blood volume. The other orders are appropriate for improving blood pressure in shock, and do not need to be questioned.

When caring for an obtunded client admitted with shock of unknown origin, which action does the nurse take first? A. Obtain IV access and hang prescribed fluid infusions. B. Apply the automatic blood pressure cuff. C. Assess level of consciousness and pupil reaction to light. D. Check the airway and respiratory status.

D. Check the airway and respiratory status. When caring for any client, determining airway and respiratory status is the priority. The airway takes priority over obtaining IV access, applying the blood pressure cuff, and assessing for changes in the client's mental status.

An 80 year old person presents with a possible infection. What nursing assessment finding would you anticipate (select all that apply)? A. Fever B. Chills C. Leukocytes D. Confusion E. Behavioral changes

D. Confusion E. Behavioral changes

Why is the thymus often removed in clients with MG?

Some patients with MG have a thymoma, and therefore patients are assessed for this condition. The thymus, an H-shaped gland located in the upper mediastinum beneath the sternum, is one organ in which AChR antibodies are formed. Although a thymoma can often be seen on routine frontal and lateral chest x-rays, a CT scan is also done. For patients with MG, thymectomy (removal of the thymus gland) is usually performed early in the disease. The procedure is not always immediately effective, and it may take several years for remission to occur—if it occurs at all. Those who have surgery within 2 years of the onset of myasthenic symptoms show the most improvement.

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? A. Encouraging them to drink fluids B. Irrigating all catheters daily with sterile saline C. Recommending catheters should be placed in all clients D. Re-evaluating periodically the need for indwelling catheters

D. Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTI in the hospital setting.

What is decorticate and decerebrate posturing? What is worse, decorticate, decerebrate, or flaccid?

Decortication (toward the core)-flexor posturing. Decerebration (lots of E's)-extensor posturing Decortication less worse than decerebrate, which is less worse than flaccid.

What complications could cause kidney failure after being given contrast media?

Diabetic nephropathy, class IV heart failure, dehydration, concomitant use of potentially nephrotoxic drugs such as the aminoglycosides or NSAIDs, and cirrhosis.

How is uterine cancer diagnosed?

Diagnosed with transvaginal ultrasound and endometrial biopsy.

How can Alzheimer's be diagnosed?

Diagnosis is made at autopsy, which confirms the presence of neurofibrillary tangles Certain tests may make us suspicious for AD and R/O other causes of dimentia, for example CBC, PET Scan, CT scan. Alzheimer's is a diagnosis of exclusion.

Why would oxygen help headaches?

Dialation causes pain, so O2 constricts the veins.

What does very pale yellow urine mean?

Dilute urine

Can the cells that sickle in sickle cell disease return to their original shape?

Some sickle cells, after the crisis passes, the cell will go back to a rounded shape, but these cells are weakened and they don't last long.

Septic, neurogenic, and anaphylactic shock are what kind of shock?

Distributive shock

What is continuous renal replacement therapy?

Done 24/7, usually in the ICU because critical patients tolerate this better than HD and PD. Not done often. Patient is critical, and can't afford to have their fluid removed all at once. This is continuous because it only removes a small amount of fluid at a time.

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Dopamine agonists are associated with adverse effects such as orthostatic (postural) hypotension, hallucinations, sleepiness, and drowsiness. Remind patients to avoid operating heavy machinery or driving if they have any of these symptoms. Teach them to change from a lying or sitting position to standing by moving slowly. The health care provider should not prescribe drugs in this class to older adults because of their severe adverse drug effects.

What is the Babinski's sign?

Dorsiflexion of the great toe and fanning of the other toes (Babinski's sign) is abnormal in anyone older than 2 years and represents the presence of central nervous system (CNS) disease. The term "positive Babinski's sign" (abnormal response) and "negative Babinski's sign" (normal response) are clinically used terms but are not correct. Babinski's sign is a pathologic, or abnormal, reflex.

Nursing management of the patient undergoing treatment for Hodgkin's lymphoma in regards to drug side-effects when focusing on the acute side effects of therapy?

Drug-induced pancytopenia, which increases the risk for infection, anemia, and bleeding

What is there a decrease of in Parkinson's? What is the result of this?

Due to a decrease in dopamine the client looses ability to control voluntary movement.

Why might a patient that is paralyzed from the waist down have a pressure ulcer?

Due to decreased or absent sensation the patient may be unaware of the need to reposition themselves or may not be motivated to reposition. Repositioning should be done more than once each hour. Gel cushions do not replace the need for frequent repositioning.

Why is bladder cancer often a late diagnosis?

Due to the bladder being a hollow organ. Tumor may grow inward and mimic a UTI.

Why do patient's have high blood pressure when they have renal carcinoma?

Due to the renal-angiotensin system is adversely effected.

True or False Sickle cell disease is an acute and idiopathic disorder

False It is a chronic and genetic disease

True or False Shock is limited to how the cardiovascular system responds when too little oxygen is delivered to tissues.

False It represents the "whole-body" response that occurs when too little oxygen is delivered to the tissues All body organs are affected by shock and either work harder to adapt and compensate for reduced oxygenation or fail to function because of hypoxia.

True or False Manifestations of every type of shock are the same.

False Manifestations of every type of shock are similar (but not always exactly the same) These common manifestations result from physiologic adjustments (compensatory mechanisms) in the attempt to ensure continued oxygenation of vital organs. These adjustment actions are performed by the sympathetic nervous system, triggering the stress response and activating the endocrine and cardiovascular systems. Manifestations unique to any one type of shock result from specific tissue dysfunction.

True or False Pancreatic cancer is usually diagnosed before there is metastasis and has a high survival rate.

False Most pancreatic cancer have metastasized by time of diagnosis. 5 year survival rate is 4%.

True or False Nausea and vomiting should be treated once client undergoing chemotherapy has symptoms.

False Nausea and vomiting should be treated prophylactically in the client undergoing chemotherapy.

True or False Esophageal cancer is easily treatable.

False Not always treatable since symptoms are come late, and the cancer has already metastasized.

True or False Kaposi's Sarcoma is common.

False Rare in people who are HIV negative

True or False Responsibility for monitoring the patient during chemo administration rests with all doctors providing care

False Responsibility for monitoring the patient during chemo administration rests with all nurses providing care

True or False In nonprogressive stage of hypovolemic shock, patients are usually calm due to blood loss.

False Restlessness and anxiety are common.

True or False Uterine cancer is usually a late diagnosis.

False Usually early diagnosis because of vaginal bleeding with back pain.

True or False Penile cancer is common

False Very rare (<20,000 cases/yr in USA)

True or False When breast cancer spreads to the lungs, the patient has both breast and lung cancer.

False When breast cancer spreads to the lung, it is still breast cancer in the lung—not lung cancer. Even though the tumor is now in another organ, it is still a cancer from the original altered tissue.

True or False: Women have the same blood cell count as men.

False At all ages, women have lower blood cell counts than do men. This difference is greater during menstrual years because blood loss from menstruation may occur slightly faster than blood cell production. This gender difference also may be related to a blood dilution caused by fluid retention from female hormones.

True or False Chemotherapy has a localized effect.

False Effects of chemo are systemic

True or False Shock is classified by the functional impairment it causes.

False The shock classification gives us information about the functional impairment that results from the inadequate tissue profusion.

True or False In nonprogressive stage of hypovolemic shock, tissue damage is occurring to vital organs.

False Tissue damage is occurring in non-vital organs.

True or False Cancer cells have a longer G0 phase than normal cells.

False. They have very little G0 phase in mitosis.

True or False Metastasis is not unique to cancer cells.

False. This ability to spread (metastasize) is unique to cancer cells and a major cause of death.

True or False Migraines have varying lengths of pain when the reoccur.

False. Usually pain is in the same place and lasts the same length. Sometimes migraine headaches are really incapacitating.

True or False Cancer that metastasizes to bone is often painless.

False. It often causes pain and fractures.

True or False: Pigment loss and skin yellowing are not common changes associated with aging.

False. It is a normal change as one gets older. Pallor in an older adult may not be a reliable indicator of anemia. Laboratory testing is required. Yellow-tinged skin in an older adult may not be a reliable indicator of increased serum bilirubin levels. Laboratory testing is required.

True or False: Thickened or discolored nails are not normal in an older adult.

False. It is a normal change in an older adult. Use another body area, such as the lip or skin around nail, to assess central capillary refill.

What care do you provide for the patient who is having a seizure?

• ABCs • Protect the patient from injury. • Do not force anything into the patient's mouth. • Turn the patient to the side to keep the airway clear. • Loosen any restrictive clothing the patient is wearing. • Maintain the patient's airway and suction as needed. • Do not restrain or try to stop the patient's movement; guide movements if necessary. • Record the time the seizure began and ended. • At the completion of the seizure: • Take the patient's vital signs. • Perform neurologic checks. • Keep the patient on his or her side. • Allow the patient to rest. • Document the seizure. Our teacher said: Prepare to deliver ativan or valium.

True or False Women with sickle cell disease are encouraged to use oral contraceptives to prevent pregnancy.

False. Oral contraceptives can trigger a crisis, so women are encouraged to use barrier protection (two forms are suggested), instead of birth control pills. This is because some of the drugs given for sickle cell disease are dangerous for the unborn child.

What are the processes that take place in a tumor for progression to occur?

First, the tumor must develop its own blood supply. In the early stages, the tumor receives nutrition only by diffusion. After the tumor reaches 1 cm, however, diffusion is not efficient. The tumor then makes substances that trigger nearby capillaries to grow new branches into the tumor, ensuring the tumor's continued nourishment and growth. As tumor cells continue to divide, some of the new cells change features from the original, initiated cancer cell and form groups that differ from the original cancer cell. Some of the differences provide these cell groups with advantages (selection advantages) that allow them to live and divide no matter how the conditions around them change. These tumor changes may allow it to become more malignant. Over time, the tumor cells have fewer and fewer normal cell features.

Frontal lobe impairment causes what problems in those with Alzheimer's?

Frontal lobe impairment causes problems with judgment, an inability to make decisions, decreased attention span, and a decreased ability to concentrate. As the disease progresses to a later stage, the patient loses all cognitive abilities, is totally unable to communicate, and becomes less aware of the environment.

What is uremia?

Full-blown manifestations of kidney failure; sometimes referred to as the uremic syndrome, especially if the cause of the renal failure is unknown. A buildup of nitrogenous waste products in the blood as a result of kidney failure defines uremia

What is Gamma Knife radiosurgery?

Gamma Knife radiosurgery is a type of radiation therapy used to treat tumors and other abnormalities in the brain. In Gamma Knife radiosurgery, specialized equipment focuses close to 200 tiny beams of radiation on a tumor or other target. Although each beam has very little effect on the brain tissue it passes through, a strong dose of radiation is delivered to the site where all the beams meet. The precision of Gamma Knife radiosurgery results in minimal damage to healthy tissues surrounding the target. In some cases, Gamma Knife radiosurgery may have a lower risk of side effects compared with other types of radiation therapy. Also, Gamma Knife radiosurgery is often a safer option than is traditional brain surgery. Gamma Knife radiosurgery is usually a one-time therapy completed in a single day.

How long can a patient be in the progressive stage of hypovolemic shock?

-This is a life threatening situation that cannot be sustained for long without interventions to reverse the cause of the shock. The progressive stage of shock is a life-threatening emergency. Vital organs can tolerate this situation for only a short time before being damaged permanently. Immediate interventions are needed to reverse the effects of this stage of shock. Tolerance varies from person to person and depends on age and health. The patient's life usually can be saved if the conditions causing shock are corrected within 1 hour or less of the onset of the progressive stage.

What are some treatments for glomerulonephritis?

-Treatment: control HTN, balance Is and Os, antibiotics, consider plasmapheresis and consider temporary dialysis

How might tumors reduce oxygenation?

-Tumors can obstruct the airway and decrease lung capacity -Tumors can press on blood and lymph vessels in the chest, blocking blood flow and potentially resulting in dyspnea and pulmonary edema -Tumors can thicken the alveolar membrane and damage pulmonary blood vessels, reducing gas exchange. With any lung tumor (primary or metastatic), patients have hypoxia and poor tissue oxygenation.

How might tumors cause dyspnea and pulmonary edema?

-Tumors can press on blood and lymph vessels in the chest, blocking blood flow and potentially resulting in dyspnea and pulmonary edema

What effect do tumors have on metabolism and nutrition?

-Tumors often increase metabolic rate and increase the need for nutrients at a time when the patient has little energy for meal preparation and eating -Tumors that invade the liver profoundly damage this organ, which has many important metabolic functions. Cancer-related reduced liver function leads to malnutrition and death.

What are some psychosocial aspects of the patient who has just had a stroke?

-Typical person who has a stroke is >60 YO, hypertensive, and may not be financially prepared for the repercussions of a stroke -May have emotional lability due to stroke

What is an arteriovenous malformation (AVM)?

-Uncommon, occurs during embryonic development -A tangled or spaghetti-like mass of malformed, thin-walled, dilated vessels -The congenital absence of capillaries is abnormal (recall capillaries serve to lower the pressure between atrial and venous systems) and sometimes rupture results.

What are possible causes of urolithiasis?

-Urinary stasis -Urinary retention -Damage to lining of the urinary tract -Dehydration -Decreased inhibitor substances in the urine that would otherwise prevent supersaturation and crystal aggregation -Metabolic problems causing excessive amounts of calcium to be absorbed through the intestinal tract

Why do symptoms of a spinal cord tumor depend on the location and the speed of growth?

-Usually result from metastasis -Symptoms depend upon location and speed of growth -The cord can often accommodate a slow growing lesion. The cord may become significantly displaced but the patient has surprisingly few symptoms. -If the turmor grows rapidly it can quickly lead to spinal cord compression with resulting numbness and paralysis.

What assessments should be done often in the patient that has leukemia?

-Vital signs: they might not have fever-might only go up half a degree-be significant. Check the skin-only defense mechanism left for person undergoing induction therapy. -Skin -Breath sounds -Can get UTI easily.

What isotopes of radiation should be a concern when regarding waste products?

-When isotopes are suspended in a fluid (PO or IV) the isotopes are eventually eliminated in waste products therefore waste is radioactive and should not be handled by anyone. -Solid, implanted sources of radiation such as needles or seeds also cause the patient to emit radiation. However these solid sources are not eliminated through waste products therefore urine and stool are not hazardous to others.

What are risk factors for uterine cancer?

-Women in reproductive years -Hypertension -Diabetes -Smoking -Obesity -Family history -Tamoxifen use

Who gets urolithiasis?

-Young adults or early middle adulthood -More men than women -More common in whites -Common in southeast US and Las Vegas -People who have had the problem -previously are likely to have it again Why do people in las vegas? Come from Ohio to the desert and don't drink enough fluid, or drinking too much alcohol.

Due to reduced platelet function in the patient with leukemia, they may have. . . ?

-tendency to bruise -nose bleeds -bleeding from gums, rectum

How can Tumor Lysis Syndrome (TLS) be prevented and/or managed?

Hydration prevents and manages TLS. Hydration dilutes the serum potassium level and increases the kidney filtration and flow rates. These actions prevent the precipitation of uric acid crystals, increase the excretion of potassium, and flush any kidney precipitate. With tumors known to be very sensitive to cancer therapy, instruct patients to drink at least 3000 mL (5000 mL is more desirable) of fluid the day before, the day of, and for 3 days after treatment. Some fluids should be alkaline (sodium bicarbonate) to help prevent uric acid precipitation. Stress the importance of keeping fluid intake consistent throughout the 24-hour day, and help patients draw up a schedule of fluid intake. Because some patients have nausea and vomiting after cancer therapy and may not feel like drinking fluids, stress the importance of following the antiemetic regimen. Instruct patients to contact the cancer clinic immediately if nausea prevents adequate fluid intake so parenteral fluids can be started. For more severe hyperkalemia, IV infusions containing glucose and insulin may be given. Patients who have severe hyperkalemia and hyperuricemia may need dialysis.

In regards to hematology, what would you want to know about family history of a patient?

If anyone in the family has a history of anemia. An accurate family history is important because many disorders affecting blood and blood clotting are inherited. Ask whether anyone in the family has had hemophilia, frequent nosebleeds, postpartum hemorrhages, excessive bleeding after tooth extractions, or heavy bruising after relatively mild trauma. Ask whether any family member has sickle cell disease or sickle cell trait. Although sickle cell disease is seen most often among African Americans, anyone can have the trait.

What happens when MAP falls below 70mm/Hg?

If it falls below this number for an appreciable time, vital organs will not get enough oxygen perfusion, and will become hypoxic.

What should you do if the patient states that infusing potassium is painful?

If patient says it hurts turn IV off and inspect the site

Do cancer cells differ in their response to radiation than normal cells? Why or why not?

If the dose of radiation is high enough, normal cells are killed immediately. This does not happen with cancer radiation therapy because cells within a tumor absorb the radiation dose slightly differently. Therefore their overall response to the radiation is slightly different. A few cells die immediately, and more die within the next 24 hours as they attempt to divide. Some cells become sterile as a result of this single treatment. Still other cells repair the radiation-induced damage and recover.

In hypovolemic shock, if after compensatory measures the MAP continues to decrease, what happens? Is it reversible? What if it continues?

If the initiating events continue and MAP decreases further, some tissues function under anaerobic conditions. This condition increases lactic acid levels. This causes electrolyte and acid-base imbalances with tissue-damaging effects and depressed heart muscle activity. These effects are temporary and reversible if the cause of shock is corrected within 1 to 2 hours after onset. When shock conditions continue for longer periods without help, the resulting acid-base imbalance, electrolyte imbalances, and increased metabolites cause so much cell damage in vital organs that multiple organ dysfunction syndrome (MODS) occurs and recovery from shock is no longer possible.

Why should those with sickle cell anemia seek assistance at the first sign of pain?

If the patient has pain they need to come to the hospital as soon as possible so we can give them fluid and oxygen. Pain is telling the patient there is a problem with circulation, and if the problem isn't fixed, ischemia and necrosis can't be prevented.

Why do patients have to stay in precisely the same position for treatment in teletherapy?

If the patient is not in exactly the same position, the radiation could kill healthy cells and not malignant.

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If the stroke patient's SBP is more than 200 mm Hg, notify the health care provider immediately to prescribe a continuous IV antihypertensive medication. Monitor the patient's BP and mean arterial pressure (MAP) every 5 minutes until the SBP is between 140 and 150 mm Hg to maintain brain perfusion. An ICP monitoring system may be used to ensure that cerebral perfusion pressure (CPP) is maintained.

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If the urethral opening is bleeding, consult with the physician before attempting urinary catheterization

What is the normal range of platelets?

150,000 to 400,000/mm3.

In regards to hematology, what would you ask the patient about recent medication use?

If they are on any antibiotics, because these drugs can lead to clotting problems or bone marrow depression. Ask the patient about use of blood "thinners" and NSAIDs, which change blood clotting activity. Such drugs include anticoagulants, fibrinolytics, and platelet inhibitors. These drugs are referred to as "blood thinners" although they do not change blood thickness or viscosity.

What are conditions predisposing to septic shock and sepsis?

• Malnutrition • Immunosuppression • Large, open wounds • Mucous membrane fissures in prolonged contact with bloody or drainage-soaked packing • GI ischemia • Exposure to invasive procedures • Malignancy • Older than 80 years • Infection with resistant microorganisms • Receiving cancer chemotherapy • Alcoholism • Diabetes mellitus • Chronic kidney disease • Transplantation recipient • Hepatitis • HIV/AIDS

Why might a patient with a long term spinal cord injury be at risk for a pulmonary embolism?

In ambulatory people, normal lower extremity muscular contractions help prevent DVTs (deep vein thrombosis) which often lead to PEs (pulmonary emboli).

What is emergency care for the patient with autonomic dysreflexia?

• Place patient in sitting position (first priority!). • Page/notify health care provider. • Loosen tight clothing on the patient. • Assess for and treat the cause. • Check the urinary catheter tubing (if present) for kinks or obstruction. • If a urinary catheter is not present, check for bladder distention and catheterize immediately if indicated. • Place anesthetic ointment on tip of catheter before insertion. • Check the patient for fecal impaction; if present, disimpact immediately using anesthetic ointment. • Check the room temperature to ensure that it is not too cool or drafty. • Monitor blood pressures every 10 to 15 minutes. • Give nitrates or hydralazine (Apresoline, Novo-Hylazin) as prescribed.

What are some nursing interventions for the patient with myelosuppression and neutropenia?

• Place the patient in a private room whenever possible. • Use good handwashing technique or use alcohol-based hand rubs before touching the patient or any of the patient's belongings. • Ensure that the patient's room and bathroom are cleaned at least once each day. • Do not use supplies from common areas for patients with myelosuppression and neutropenia. For example, keep a dedicated box of disposable gloves in his or her room and do not share this box with any other patient. Provide single-use food products, individually wrapped gauze, and other individually wrapped items. • Limit the number of health care personnel entering the patient's room. • Monitor vital signs every 4 hours, including temperature. • Inspect the patient's mouth at least every 8 hours. • Inspect the patient's skin and mucous membranes (especially the anal area) for the presence of fissures and abscesses at least every 8 hours. • Inspect open areas, such as IV sites, every 4 hours for manifestations of infection. • Change wound dressings daily. • Obtain specimens of all suspicious areas for culture (as specified by the agency), and promptly notify the physician. • Assist the patient in coughing and deep-breathing exercises. • Encourage activity at a level appropriate for the patient's current health status. • Change IV tubing daily, or according to unit protocol. • Keep frequently used equipment in the room for use with this patient only (e.g., blood pressure cuff, stethoscope, thermometer). • Limit visitors to healthy adults. • Use strict aseptic technique for all invasive procedures. • Monitor the white blood cell count, especially the absolute neutrophil count (ANC), daily. • Avoid the use of indwelling urinary catheters. • Keep fresh flowers and potted plants out of the patient's room. • Teach the patient to avoid eating raw fruits and vegetables; undercooked meat, eggs, and fish; pepper; and paprika.

What patient education could the nurse provide for the patient with chemo-induced peripheral neuropathy?

• Protect feet and other body areas where sensation is reduced (e.g., do not walk around in bare feet or stocking feet; always wear shoes with a protective sole). • Be sure shoes are long enough and wide enough to prevent creating sores or blisters. • Buy shoes in the afternoon or evening to accommodate any size change needed for foot swelling. • Provide a long break-in period for new shoes; do not wear new shoes for longer than 2 hours at a time. • Avoid pointed-toe shoes and shoes with heels higher than 2 inches. • Inspect your feet daily (with a mirror) for open areas or redness. • Avoid extremes of temperature; wear warm clothing in the winter, especially over hands, feet, and ears. • Test water temperature with a thermometer when washing dishes or bathing. Use warm water rather than hot water (less than 105° F). • Use potholders when cooking. • Use gloves when washing dishes or gardening. • Do not eat foods that are "steaming hot"; allow them to cool before placing them in your mouth. • Eat foods that are high in fiber (e.g., fruit, whole grain cereals, vegetables). • Drink two to three liters of fluid (nonalcoholic) daily unless your health care provider has told you to restrict fluid intake. • Get up from a lying or sitting position slowly. If you feel dizzy, sit back down until the dizziness fades before standing; then stand in place for a few seconds before walking or using the stairs. • Look at your feet and the floor or ground where you are walking to assess how the ground, floor, or step changes to prevent tripping or falling. • Avoid using area rugs, especially those that slide easily. • Use handrails when going up or down steps.

What are clinical manifestations of UTIs in older adults?

• The only symptom may be something as vague as increasing mental confusion or frequent, unexplained falls. • A sudden onset of incontinence or a worsening of incontinence may be the only symptom of an early UTI. • Fever, tachycardia, tachypnea, and hypotension, even without any urinary symptoms, may be signs of urosepsis. • Loss of appetite, nocturia, and dysuria are common symptoms.

What education does the nurse provide to the patient undergoing radiation therapy on how to care for skin?

• Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiologist. • Use your hand rather than a washcloth to be gentler. • Rinse soap thoroughly from your skin. • If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them. • Dry the irradiated area with patting motions rather than rubbing motions; use a clean, soft towel or cloth. • Use only powders, ointments, lotions, or creams on your skin at the radiation site that are prescribed by the radiation oncology department. • Wear soft clothing over the skin at the radiation site. • Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site. • Avoid exposure of the irradiated area to the sun. • Protect this area by wearing clothing over it. • Try to go outdoors in the early morning or evening to avoid the more intense sun rays. • When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when the sun's rays are most intense (10 AM to 7 PM). • Avoid heat exposure.

What dose, what route, and how often should ondasetron be given for chemotherapy-induced nausea and vomiting?

8 mg IV or orally every 8hr

What is the normal range for PaO2? Why may it be abnormal in shock (does it increase or decrease)?

80-100 mm Hg It is decreased in shock due to anaerobic metabolism

What is the MAP of 120/72?

88

What is the MAP of 132/66?

88

Platelet count of what can lead to spontaneous, uncontrolled bleeding?

<20K

Oh Nurse! The nurse is caring for an older adult who is at risk for falling related to altered balance after a recent stroke. Which initial interventions does the nurse employ for the patient? (Select all that apply.) A. Instruct patient to move slowly when changing positions. B. Instruct the patient to call for assistance before getting out of bed. C. Store personal items out of sight to prevent theft and instruct the patient to call for help. D. Assign a sitter to stay with the patient and assist as needed.

A B

Oh Nurse! Cells with rapid growth are most sensitive to chemo. Is this good or bad? A. Good B. Bad

A B It's good in that we want to kill the cancer cells, but it is also bad because we don't want our patient's hair to fall out, or their digestive lining to hurt.

Oh Nurse! Which tests require that the patient lay supine during the procedure? (Select all that apply.) A. CT B. PET C. Cerebral Angiography D. X-ray E. Evoked potentials

A B C

Oh Nurse! Common causes of neck pain include old: (Select all that apply.) A. Age B. Herniation of the nucleus pulposus C. Poor posture D. Bone spur E. Walking

A B C D

Oh Nurse! Which of the following is a risk factor for a stroke? A. Diabetes B. Substance Abuse (such as cocaine) C. Hypertension D. Obesity. E. Hypotension

A B C D

Oh Nurse! Which of the following is a risk factor for a stroke? A. A-fib B. Sleep apnea C. Prior stroke D. High blood pressure E. Low cholesterol.

A B C D A-fib-can cause emboli—when atrium is quivering in a-fib-there is a pocket of blood that pools and it clots and it can move forward and go to brain. It's important when a patient is taking Coumadin that the right amount is given so that the blood doesn't clot. Sleep apnea-Hypoxic episodes-numerous. Sleep apnea typically associated with obesity.

Oh Nurse! Which of the following can cause back pain? A. Smoking B. Obesity C. Lifting nursing textbooks D. Pregnancy

A B C D All of them Smoking-bones become osteoporotic.

Oh Nurse! What does the nurse do to implement bowel and bladder retraining for a patient with spinal cord injury (SCI)? (Select all that apply.) A. Ensure that the patient gets a sufficient quantity of fluids each day. B. Assist the patient in developing a schedule C. Teach the patient about high-fiber foods D. Teach the patient that continence is dependent on spinal cord healing. E. Measure bladder residual with a bladder ultrasound device.

A B C E

The patient has partial gastrostomy for weight loss. Which of the following nutrition related teaching points would you include in their follow-up visit? A. You will need to come in for monthly B12 shots B. You may feel more fatigued because your smaller stomach is less able to absorb B12, a vitamin needed to make RBCs C. Numbness and tingling in your hands and feet is a sign of possible B12 deficiency D. Less B12 will help you to loose more weight E. Vitamin B12 is found in red meat, organ meats, spinach, and eggs

A B C E

Oh Nurse! Which factors are potential contraindications for having an MRI? A. Cardiac pacemaker B. Implanted infusion pump C. Contact lenses D. Recent tattoo E. Confusion or agitation

A B E

The nurse is planning care for a patient who undergoes dialysis three times each week due to end stage renal failure (ESRF). The nurse understands that dialysis removes excess water and toxins from the blood but dialysis does not compensate for loss of other kidney functions. What other kidney functions should concern the nurse? (Select all that apply.) A. In the healthy kidney renin assists in blood pressure control by causing the conversion of angiotensin one to angiotensin two. B. A kidney that is healthy releases antidiuretic hormone (ADH) which enhances the body's ability to concentrate urine. C. The healthy kidney parenchyma secretes activated vitamin D which promotes absorption of calcium in the GI tract. D. When the kidney fails the renal hormone erythropoietin is not secreted therefore the patient on dialysis is likely to be anemic.

A C D

How can a single cell grow into an invasive cancer?

A cancer cell becomes a cancer cell once DNA is damaged (initiation), usually by a carcinogen. This irreversible event is not a threat unless the cancer cell can divide. Once it can (hyperplasia), this leads to dysplasia (enlargement due to cell division). The cancer cell can become a tumor through promotion, and as it divides and grows, the new cells change features from the original, initiated cancer cell, and become more malignant. The tumor develops its own blood supply. This leads to cancer in situ, which is an early stage cancer in which the cancerous growth or tumor is still confined to the site from which it started, and has not spread to surrounding tissue or other organs in the body. If allowed to continue, the cancer cells break off and establish remote colonies (metastasis).

What would a low reticulocyte count indicate in those with anemia?

A low reticulocyte count indicates some condition is affecting production of RBCs, for example bone marrow damage or disorder or a nutritional deficiency iron, B12, or folate).

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In any acute care setting, preventing volume depletion is a nursing priority because this is the most common cause of AKI. Recognizing the manifestations of volume depletion (low urine output, decreased systolic blood pressure, decreased pulse pressure, orthostatic hypotension, thirst, rising blood osmolarity) and intervening early to restore volume can reverse AKI and prevent permanent kidney damage.

The nurse includes which factors in teaching regarding the typical warning signs of cancer? (Select all that apply.) A. Persistent constipation B. Scab present for 6 months C. Curdlike vaginal discharge D. Axillary swelling E. Headache

A, B, D Change in bowel habits, a sore that does not heal, and a lump or thickening in the breast or elsewhere are all potential warning signs of cancer. Curdlike vaginal discharge represents a yeast infection. Headache is not a warning sign, but may be present with multiple problems.

What systemic effects might the nurse expect to assess in a patient with renal carcinoma? A. erythrocytosis B. hematuria C. diabetes D. anemia E. hypertension

A, B, D, E erythrocytosis, hematuria, anemia, hypertension, not diabetes

The nurse is teaching a client with newly diagnosed anemia about conserving energy. What does the nurse tell the client? (Select all that apply.) A. "Allow others to perform your care during periods of extreme fatigue." B. "Drink small quantities of protein shakes and nutritional supplements daily." C. "Perform a complete bath daily to reduce your chance of getting an infection." D. "Provide yourself with four to six small, easy-to-eat meals daily." E. "Perform your care activities in groups to conserve your energy." F. "Stop activity when shortness of breath or palpitations are present."

A, B, D, F It is critical to have others help the anemic client who is extremely tired. Although it may be difficult for him or her to ask for help, this practice should be stressed to the client. Drinking small protein or nutritional supplements will help rebuild the client's nutritional status. Having four to six small meals daily is preferred over three large meals; this practice conserves the body's expenditure of energy used in digestion and assimilation of nutrients. Stopping activities when strain on the cardiac or respiratory system is noted is critical. A complete bath should be performed only every other day; on days in between, the client can be taught to take a "mini" sponge bath, which will conserve energy and still be safe in preventing the risks for infection. Care activities should be spaced every hour or so rather than in groups to conserve energy; the time just before and after meals should be avoided.

When monitoring a client with suspected syndrome of inappropriate antidiuretic hormone (SIADH), the nurse reviews the client's medical record, which contains the following information. The nurse notifies the health care provider for which signs and symptoms consistent with this syndrome? (Select all that apply.) Neuro: Episodes of confusion Cardiac: Pulse 88 and regular Musculoskeletal: Weakness, tremor Na: 115, K: 4.2, Creatinine: 0.8 ondansetron (Zofran) cyclophosphamide (Cytoxan) A. Hyponatremia B. Mental status changes C. Azotemia D. Bradycardia E. Weakness

A, B, E Antidiuretic hormone (ADH) is secreted or produced ectopically, resulting in water retention and sodium dilution. Dilutional hyponatremia results from ADH secretion, causing confusion and changes in mental status. Weakness results from hyponatremia. Azotemia refers to buildup of nitrogenous waste products in the blood, typically from renal damage. Bradycardia is not part of the constellation of symptoms related to SIADH; tachycardia may result from fluid volume excess.

A patient is diagnosed with glomerulonephritis. What nursing assessment findings would the nurse be expected to observe? A. Hypertension B. Edema C. Leg Pain D. Hypotension E. Flank Pain

A, B, E Hyptension, Edema, Flank Pain

Which of the following vital signs would the nurse expect to note in a patient with a history of SCD (select all that apply). A. Slightly fast heart rate B. Slightly slow heart rate C. Slightly low BP D. Slightly high BP

A, C Heart rate may be rapid and blood pressure low to average, with a decreased pulse pressure, because breakage of RBCs leads to anemia. Anemia results in a less viscous (thinner) blood that moves more rapidly through the heart and blood vessels under lower pressures than does blood with normal viscosity.

When caring for the client receiving cancer chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? (Select all that apply.) A. Bruises B. Fever C. Petechiae D. Epistaxis E. Pallor

A, C, D Bruising, petechiae, and epistaxis (nosebleeds) are symptoms of a low platelet count. Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.

Which potential side effects does the nurse include in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? (Select all that apply.) A. Fatigue B. Changes in color of hair C. Change in taste D. Changes in skin of the neck E. Difficulty swallowing

A, C, D, E Radiation therapy to any site produces fatigue in most clients, and may cause clients to report changes in taste. Radiation side effects are site-specific; the larynx is in the neck, so changes in the skin of the neck may occur. Dysphagia (difficulty swallowing) may occur from radiation to the throat area. Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair; this does not normally occur with radiation therapy.

What are the common assessment findings in a patient with PKD? A. Hypertension B. Unexplained weight loss C. Constipation D. Abdominal Pain E. Blood Urine

A, C, D, E. Hyptertension, constipation, abdominal pain, bloody urine (because tiny blood vessels are squished and damaged). Not unexplained weight loss-there is weight gain.

A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. She is started on antibiotics and sent home. She returns to the clinic 3 days later-with the same symptoms. When asked about the previous UTI and medication regimen, she states, "I only took the first dose because after that, I felt better." How does the nurse respond? A. "Not completing your medication can lead to return of your infection." B. "That means your treatment will be prolonged with this new infection." C. "This means you will now have to take two drugs instead of one." D. "What you did was okay; however, let's get you started on something else."

A. Not completing the drug regimen can lead to recurrence of an infection and to bacterial drug resistance.

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? A. Administers morphine sulfate 4 mg IV B. Begins an infusion of metoclopramide (Reglan) 10 mg IV C. Obtains a urine specimen for urinalysis D. Starts an infusion of 0.9% normal saline at 100 mL/hr

A. Morphine administered IV will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.

The nurse is assessing a newly admitted client with thrombocytopenia. Which factor needs immediate intervention? A. Nosebleed B. Reports of pain C. Decreased urine output D. Increased temperature

A. Nosebleed The client with thrombocytopenia has a high risk for bleeding. The nosebleed should be attended to immediately. The client's report of pain, decreased urine output, and increased temperature are not the highest priority.

Will patients have episodes of hypoglycemia or hyperglycemia in diabetic nephropathy? What does this do for the need of insulin?

As nephropathy progresses patients may have frequent episodes of hypoglycemia and a reduced need for insulin. Explain that the kidneys metabolize and excrete insulin. When kidney function is reduced, the insulin is available for a longer time and thus less of it is needed. Unfortunately, many patients believe this means their diabetes is improving. The result is a more rapid progression to ESKD. Hypoglycemia: If holes are too big, they excrete a large amount of glucose. Everything they eat is going out in the urine. So they get rid a little more of insulin, but they are getting rid of tons of glucose every time they are going to the bathroom. Dialysis makes it seem like they might not have any diabetes anymore, but that is false.

How does the paralysis usually present?

Ascending paralysis (usually). Healing occurs in reverse; the neurons affected last are the first to recover.

What are the nursing implications for the older with change in sleep patterns? Why?

Ascertain sleep patterns and preferences. Ask if sleep pattern interferes with ADLs. Adjust the patient's daily schedule to his or her sleep pattern and preference as much as possible (e.g., evening versus morning bath). Most older adults require less sleep than do younger adults. However, frequent rest periods are needed.

When should at-risk and non-risk adults be screened for the nationwide diagnostic screening for colon cancer?

At 40 years old for at-risk At 50 years old for non-risk

A patient with a urinary tract infection (UTI) is prescribed phenazopyridine. Which instructions would the nurse give the patient? A. "This drug will take care of the infection causing your symptoms." B. "Your urine may turn reddish orange and may cause staining of your clothes." C. "Take the drug before meals to minimize GI symptoms." D. "Always keep this drug and use it at the first symptom of a UTI."

B

How does aspirin interfere with blood clotting? A. Prevents vitamin K synthesis B. Inhibits the activation of platelets C. Increases the rate of platelet destruction D. Prevents fibrin molecules from assembling into long strands

B

Oh nurse! What early symptom does the nurse expect to observe in a 50-year-old patient recently diagnosed with ALS? A. bowel and bladder incontinence B. Arm weakness and dysphagia C. Blurred vision and headaches D. Forgetfulness and decreased attention span

B

What is the most important precaution for the nurse to teach the client with continuing kidney impairment on discharge after treatment for acute kidney injury? A. Avoid fluids that contain either alcohol or caffeine. B. Weigh yourself daily and report any rapid weight gain. C. Drink at least 3 liters of fluid daily to prevent dehydration. D. Use a dipstick to check for glucose in your urine at least once daily.

B

Oh Nurse! You suspect a patient is using alternative medicine that could conflict with their prescribed medicine. How would you handle this? (Select all that apply.) A. Consult with the Poison Control Hotline B. Assure the patient that you understand certain alternatives medicines are common in certain cultures. C. Explain that mixing prescribed medicine with alternative medicine is always dangerous; you are just looking out for the patient's safety. D. Directly ask the patient if they are taking any remedies which have not been prescribed by physician. E. Work to earn the patient's trust.

B D

Which tests have weight restrictions? A. X-ray B. CT C. PET D. MRI E. Cerebral Angiography

B D

A client with a history of seizures is placed on seizure precautions. What emergency equipment will the nurse provide at the bedside? Select all that apply. A. Padded tongue blade B. Oxygen setup C. Nasogastric tube D. Suction setup E. Artificial oral airway

B D E

Oh Nurse! The nurse is giving home care instructions to a patient who will be discharged with a halo device. What does the nurse instruct the patient to avoid? A. Going out in the cold B. Swimming and contact sports C. Sexual activity D. Bathing in the tub E. Driving

B E

What are serious side effects of antiviral agents prescribed for a client with acute myelogenous leukemia? (Select all that apply.) A. Cardiomyopathy B. Nephrotoxicity C. Ototoxicity D. Stroke E. Diarrhea

B, C Antiviral agents, although helpful in combating severe infection, have serious side effects, especially nephrotoxicity and ototoxicity. Cardiomyopathy and stroke are not serious side effects of antiviral agents. Diarrhea is a mild side effect associated with antibiotic therapy.

What is emergency care in cholinergic crisis in the patient with MG?

In cholinergic crisis, do not give anticholinesterase drugs while the patient is maintained with mechanical ventilation. Atropine 1 mg IV may be given and repeated, if necessary. When atropine is prescribed, observe the patient carefully. Secretions can be thickened by the drug, which causes more difficulty with airway clearance and possibly the development of mucous plugs. Unless complications such as pneumonia or aspiration develop, the patient in crisis improves rapidly after the appropriate drugs have been given. Continue to provide assistance as necessary because he or she tires easily after minimal exertion.

What electrolytes are taken off by dialysis? What electrolytes are being replaced? Why?

In general, NA and K are taken off by dialysis, and Ca and bicarb are being replaced. One of the kidneys function is acid base balance, and that's why bicarb is being replaced-absorb hydrogen ions keep ph normal.

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In inpatient health care agencies, apply physical restraints such as waist belts and geri-chairs with lapboards only as a last resort because they often increase patient restlessness and cause agitation. Federal regulations in long-term care facilities in the United States mandate that all residents have the right to be free of both physical and chemical restraints. In addition, all health care agencies accredited by The Joint Commission are required to use alternatives to restraints before resorting to any physical or chemical restraint.

What may patients do and how may they act in the early stage of Alzheimer's disease?

In people with Alzheimer's disease (AD), the cognitive changes and biochemical and structural dysfunctions affect personality and behavior. In the early stage, patients often recognize that they are experiencing memory or cognitive changes and may attempt to hide the problems. They begin the grieving process because of anticipated loss, experiencing denial, anger, bargaining, and depression at varying times. Older patients typically think the changes are part of "old age."

What is the G2 phase in the cycle of a cell?

In this phase, the cell makes important proteins that will be used in actual cell division and in normal physiologic function after cell division is complete.

What is unilateral body neglect?

In this syndrome, the patient is unaware of the existence of his or her left or paralyzed side. The typical picture is that of the patient sitting in a wheelchair and leaning to the left with the arm caught in the wheelchair wheel. When questioned, the patient often states that everything is fine and believes that he or she is sitting up straight in the chair. The patient may wash or dress only one side of the body.

What is anomia?

Inability to find words

What is aphasia?

Inability to speak appropriately

What is apraxia?

Inability to use objects appropriately

What are some complications of sickle cell disease?

The patient can get sores that don't heal in distal extremities. As many as 75% of adults with SCD have open sores or ulcers on the lower legs that are caused by poor tissue perfusion. They can be malnourished-nutrition not a priority when you have so much pain. Edema in hands-can cause ischemia. Priapism-erection that won't go away-fairly common in males with SCD-because blood goes to penis, and it doesn't get "out" because of clots, so it stays hard. IV angiocath to try to drain fluid-Glucagon IM can work for this sometimes. This is an EMERGENCY.

Increase in plasma osmolality (dehydration) or decrease in circulating fluid volume (trauma) can cause what?

Increase in plasma osmolality (dehydration) or decrease in circulating fluid volume (trauma) can trigger this cascade: Dehydration or loss of blood causes increased thirst, leading to increased fluid intake, secretion of antidiuretic hormone, which leads to a decrease in fluid output (decreased urine production) and an increase in water retention, which leads to an increase in circulating fluid volume, and decrease in plasma osmolarity (solutes in solution), which then leads to a decrease in thirst and a decrease in ADH.

What is polyuria?

Increased urine output; total urine output usually greater than 2000 mL in 24 hours

What does T1, T2, T3, T4 mean when staging tumors?

Increasing size and/or local extent of the primary tumor

What does too high levels of MCV usually indicate?

Indicates RBCs are larger than normal

What does low MCV usually indicate?

Indicates RBCs are smaller than normal.

What are the nursing implications for the older with altered balance and/or decreased coordination? Why?

Instruct the patient to move slowly when changing positions. If needed, advise the patient to hold on to handrails when ambulating. Assess the need for an ambulatory aid, such as a cane. The patient may fall if moving too quickly. Assistive and adaptive aids provide support and prevent falls.

What is ALS?

It is an adult-onset upper and lower motor neuron disease. It is characterized by progressive weakness, muscle wasting, and spasticity that eventually leads to paralysis. Beginning in one area of the body, motor weakness and deterioration spread until the entire body is involved, including the ability to talk, swallow, and breathe. As a result of loss of lower motor neurons (LMNs) found in the spinal cord and brainstem, the muscles to which they connect weaken, atrophy, and die.

What are compensation mechanisms for increased ICP?

Limited compensation for ↑ ICP includes: 1. CSF reabsorption into arachnoid villa 2. Vascular constriction 3. Brain compression Vasoconstriction and/or a decrease in CSF to be compensated for the need of extra space due to the reciprocal relationship. This keeps ICP normal.

On the Oral Mucositis scale, what is grade 3?

Liquid diet

The mitotic index in a normal cell is what?

Low

Would leukemia or lymphoma cause high or low platelet levels?

Low

Would nutritional deficiencies cause high or low reticulocyte levels?

Low

Why does an increase of cardiac output cause an increase in the MAP?

MAP is the pressure needed for the heart to pump blood out (cardiac output) against the vascular resistance (SVR), so when the cardiac output increases, the MAP increases as well.

What causes MG? Is it hereditary?

MG is caused by an autoantibody attack on the acetylcholine receptors (AChRs) in the muscle end plate membranes. As a result, nerve impulses are not transmitted to the skeletal muscle at the neuromuscular junction and the muscles cannot contract. Although the disease is not hereditary, there is a small familial incidence.

What is an MRI? Does the patient have to be laying down? Is there a weight limit? Are there any contraindications?

Magnetic resonance imaging (MRI) produces images that are better than the CT scan. It does not use ionizing radiation but, instead, relies on magnetic fields. Multiple sets of images are taken that are used to determine normal and abnormal anatomy. Images may be enhanced with the use of gadolinium, a non-iodinebased contrast medium. MRIs of the spine have largely replaced CT scans and myelography for evaluation. Some facilities have a functional MRI (fMRI) machine that can assess blood flow to the brain rather than merely show its anatomical structure. MRI may also be contraindicated in patients who are confused or agitated, have unstable vital signs, are on continuous life support, or have older tattoos (which contain lead). Our teacher said in class: Magnetic Resonance Imaging-similar to CT scan but really confining. They have to be in the tunnel for an hour. Continuous loud buzzing. It's very annoying and difficult. Might give pt a sedative. MRI-it is one big magnet-if you get to close to something that is metal-sucks it to them. MRI safety-make sure there isn't anything metal nearby. Various zones of safety around MRI. Can't pass by zones 2 or 3 unless you do an MRI checklist. When we know pt is going to MRI-consider this-Prior to obtaining consent for any procedure be certain your patient is alert, oriented, and has not been recently medicated with a drug that will potentially adversely affect their ability to participate in the consent process. Read the entire thing to them-make sure they understand each question-might not be literate, so don't just give it to them. MRI gives us an image that gives us more information that a CAT scan-same considerations-pt is supine and there is a weight limit.

What are assessment findings in RLS?

The patient reports intense burning or "crawling-type" sensations in the legs and therefore feels the need to move them repeatedly. These symptoms are worse in the evening and at night and when the patient is still for a period of time. Patients feel they need to move to relieve the symptoms. Many move their legs periodically while sleeping. For that reason, they often refer to themselves as "night walkers."

The focus on patients with neutropenia remains on keeping the patient's what under control?

The patient's own normal flora under control and preventing transmission of organisms from other people to him or her.

What causes thrombolic stroke?

Most commonly associated with the development of atherosclerosis in either intracranial or extracranial arteries (usually the carotid arteries). Atherosclerosis is the process by which fatty plaques develop on the inner wall of the affected arterial vessel. Rupture of one or more plaques exposes foam cells to clot-promoting elements in the blood. The end result is clot formation. If the clot is of sufficient size, it may interrupt blood flow to the brain tissue supplied by the vessel, causing an occlusive stroke.

In the neutropenic patient on chemo, what hygiene at least q12 hours is essential?

Mouth care and washing of the axillary and perianal regions.

Why do patients often develop mucositis when undergoing chemotherapy?

Mucositis (sores in mucous membranes) often develops in the entire GI tract, especially in the mouth (stomatitis). Normally, the lining of the GI tract undergoes rapid cell division and quickly replaces cells. Chemotherapy kills mucous membrane cells more rapidly than they are replaced, resulting in sores. Mouth sores are painful and interfere with eating and general quality of life

What are neurotransmitters?

Neurotransmitters are the brain chemicals that communicate information throughout the brain and body. They relay signals between neurons.

Are there blisters with superficial burns?

No

Are there grafts required with superficial partial-thickness burns?

No

Will dialysis return kidney function to normal if the patient has dialysis?

No

Would lifting the legs help those in cardiogenic shock?

No

Would your patient still need dialysis if they have a transplant?

No

On the Oral Mucositis scale, what is grade 0?

No changes

What lab test can confirm a diagnosis of stroke?

No definitive lab tests confirm diagnosis. CBC is useful in getting clotting time and to get baseline data-not dx

What does M0 stand for when staging tumors?

No distant metastasis

What does T0 stand for when staging tumors?

No evidence of primary tumor.

Why does nocturia occur in the older adults?

Nocturia may occur from decreased renal concentrating ability associated with aging. The desire to maintain continence prompts people to seek the bathroom. Falls and injuries are common among older patients seeking bathroom facilities. Excessive fluid intake at night may increase nocturia. Some drugs increase urine output;

What are common assessments in PKD?

Nocturia, proteinuria, and constipation. Chronic hypterension causes damage to the fragile and specialized capillaries in the glumerulus causing holes so protein can leak through). These patients are constipated because organs are getting squished by kidney. If they start to retain fluid and their weight spikes, their kidneys might not work right and might go into dialysis.

What are nonsurgical management for back pain? What are other medical interventions?

Nonsurgical management may include NSAIDs and anti-inflammatory drugs, PT, heat or cold application, water therapy, and weight control. -Occasionally epidural injection and/or antiepileptic drugs may be prescribed -Surgery by an orthopedic surgeon or neurosurgeon may be needed

What does an ammonia smell in urine indicate?

Normal aroma

Neoplastic cells originate from what?

Normal body cells

What is euploidy? What is diploidy?

Normal chromosomes (euploidy) is a feature of most normal human cells. These cells have 23 pairs of chromosomes, the correct number for human beings. The state of being diploid, that is having two sets of the chromosomes (and therefore two copies of genes). 23 pairs of chromosomes is the normal diploid number.

What is incidence? What is prevalence?

Our teacher said in class: "Incidence is a new diagnosis, while prevalence means it's already a problem." Incidence and prevalence are both measures of the extent of disease in a population. Incidence tells us about a change in status from non-disease to disease, thus being limited to new cases. Prevalence includes both new cases and those who contracted the disease in the past and are still surviving; it is the proportion of cases in the population at a given time rather than rate of occurrence of new cases. Thus, incidence conveys information about the risk of contracting the disease, whereas prevalence indicates how widespread the disease is.

Can the patient move around when having a lumbar puncture? How many test tubes of CSF is taken from a lumbar puncture? Why? What do we look for? Why should the patient not stand up after having a lumbar puncture?

Our teacher said in class: Lumbar puncture-cerebral spinal fluid surrounds the spine and the brain. If we want a sample of the CSF in your head, rather make a hole in back than of the head. The patient has to lay completely still. We help the patient to stay still. Rarely there is negative from this test-needle might go to into different place-so get consent from the patient or parent of the patient. Make sure they understand it completely. The sterile hollow needle allows the CSF to drain out into four or five test fluids-sometimes the first or second test tube are contaminated with blood due to the puncture from the needle of the skin. So usually the third or fourth one is used. Make sure we don't mix up the test tubes. Also, because CSF is so difficult to get, we hand deliver this to the lab. We look for white blood cells (if there are more than expected their might be bacteria in there. If there is less glucose, bacteria might be eating the glucose. We can roughly measure the pressure of the CSF by putting needle at the end of the hollow needle. Patient should not stand for a couple of hours-urinate before procedure, because if they get up they may get excruciating headache. Inspect site to make sure it's not leaking.

What is status epilepticus?

Our teacher said in class: Status means it keeps going without stopping. Or if they keep having seizures over and over. Usually give Ativan or Valium. Get to ER. Book says: Status epilepticus is a medical emergency and is a prolonged seizure lasting longer than 5 minutes or repeated seizures over the course of 30 minutes. It is a potential complication of all types of seizures. Seizures lasting longer than 10 minutes can cause death!

Why do the morbidly obese (especially women) have increase risk or mortality for cancer?

Our teacher stated in class that the morbidly obese (especially women) have more increase risk for cancers, perhaps because they don't come in to the hospital because they are embarrassed and ashamed.

What should you do in the OR for the patient there for cancer?

Our teacher stated in class: "If we have patient in OR who is there for cancer, take our therapeutic communication to a higher level since they are more anxious since there may be a sudden change in lifestyle, sudden change in appearance, and sudden dx of cancer. Regardless of treatment type, cancer always affects a person's physical and psychological functioning. Consider the changes in the lifestyle in the parent of a child with cancer. Sometimes a child has to go to a specialty cancer hospital 1000 miles away and only one parent goes with, and and the other parent stays home and works and takes care of their other children. The parent who goes with is 24/7 at bedside-gets no break. Really tough. What about the teenager who has cancer and now can't go to prom, or can't work their first job, or nursing student who has to drop out of nursing school for a year to treat for cancer? Think of how disfiguring it will be to take out that tissue and surrounding tissue? This is why we need to take our therapeutic communication to a higher level."

Why are diazepam (Valium) and phenytoin (Dilantin) given, lorazepam (Ativan) given?

Our teacher stated in class: Diazepam and phenytoin are actively prescribed for people who are actively seizing-they will stop course of seizure if given by IV-not more than 1 mg per minute IVP. So know valium and Ativan are given for active seizures. Also know dilanatin-very common PO medication for home maintenance to prevent seizures. Can be given IV in the emergency department-give 'em Dilantin to jump start them.

What treatment only works in the early phase of GBS?

Plasmapheresis

What is plasma pharesis? Can it help GB and MG?

Plasmapheresis is a method by which antibodies are removed from the plasma to decrease symptoms. This is used as short-term management of an exacerbation. Six exchanges occur over a 2-week period with follow-up exchanges weekly or monthly as needed. This procedure is usually done on an ambulatory care basis. It helps improve symptoms of GB and MG.

What is plasmapharesis in regards to glomerulonephritis?

Plasmapheresis: plasma that we're removing from the blood, and put them back into the patient. Might be able to fix this problem. Remove antigens in the serum that are related to the infection that is causing the problem.

Petechiae may be due to _____.

Platelet deficiency

What are thrombocytes?

Platelets

Describe platelet plug formation.

Platelets are activated by cytokines and by contact with collagen. They become more sticky and attract more platelets, creating a platelet plug.

Why would the patient be put on bleeding precautions and on aspirin in polycythemia vera?

Platelets are immature and inefficient in patients with polycythemia vera. Patient given aspirin so increased numbers of viscous RBCs don't stick together.

What is a PET scan? Patient is injected with what? Is it useful for detecting fast or slow growing cancers?

Positron emission tomography (PET). Its benefit over a CT scan or MRI is that it provides information about the function of the brain, specifically glucose and oxygen metabolism and cerebral blood flow. Current CT scanners provide information about the structure of the central nervous system (CNS). The newest PET machines are combination CT-PET scanners that fuse images together to produce better information about the type and location of brain dysfunction. The physician or nuclear medicine technologist injects the patient with IV deoxyglucose, which is tagged to an isotope. The isotope emits activity in the form of positrons, which are scanned and converted into a color image by computer. The more active a given part of the brain, the greater the glucose uptake. This test is used to evaluate drug metabolism and detect areas of metabolic alteration that occur in dementia, epilepsy, psychiatric and degenerative disorders, neoplasms, and Alzheimer's disease. The level of radiation is equivalent to that of five or six x-rays but much less than exposure during CT. Teach the patient that he or she will be NPO the night before morning testing and 4 hours before afternoon testing. Patients with diabetes have their test in the morning before taking their antidiabetic drugs. During this 2- to 3-hour procedure, the patient may be blindfolded and have earplugs inserted for all or part of the test. He or she is asked to perform certain mental functions to activate different areas of the brain. Older adults and patients with mental health/behavioral health problems may be too anxious to have a PET scan. Our teacher said in class: PET-pet scan is in color-patient is injected with isotope tracer and organs that have a higher rate of metabolism takes up more of it, so areas are different color. Can see significant color on pet scans since cancer is highly metabolized and absorbs the glucose. So for example, if we suspect they have a prostate exam, it is slow growing, so it is not functioning at a high metabolic rate, so PET scan might not be useful. But for fast growing cancers, really useful.

What is promotion in carcinogenesis?

Promotion - enhancement of tumor growth by promoters, some of which are normal hormones. Promoters are substances that promote or enhance growth of the initiated cancer cell.

What is reconstructive or rehabilitative surgery?

Reconstructive or rehabilitative surgery increases function, enhances appearance, or both. Examples include breast reconstruction after mastectomy, replacement of the esophagus, bowel reconstruction, revision of scars, and placement of penile implants

What are some signs and symptoms of colon cancer?

Rectal bleeding, anemia, change in stool consistency/appearance, decreased H&H due to intermittent bleeding

What is prophylactic surgery?

Removes "at risk" tissue It is performed when a patient has either an existing premalignant condition or a family history that strongly predisposes the person to development of a specific cancer. For example, removing a benign polyp from the colon before it can develop into colon cancer is a prophylactic action.

What is curative surgery?

Removes all cancerous tissue Surgery alone can result in a cure rate of 27% to 30% when all visible and microscopic tumor is removed or destroyed. Usually curative if it is stage I and hasn't spread.

In regards to tumor nomenclature, what is the prefix if the tissue of origin is kidney?

Renal

Does the patient have a temperature in SIRS?

Some patients have a low-grade fever and others have a high fever. Still others may have a below-normal body temperature. Fever and hypotension result directly from SIRS.

What are sources of emboli?

The usual source of emboli is the heart. Emboli can occur in patients with nonvalvular atria fibrillation, ischemic heart disease, rheumatic heart disease, mural thrombi after a myocardial infarction (MI), or insertion of a prosthetic heart valve. Another source of emboli may be plaque that breaks off from the carotid sinus or internal carotid artery. Emboli tend to become lodged in the smaller cerebral blood vessels at their point of bifurcation or where the lumen narrows.

What is the treatment for ALS?

There is no known cause, no cure, no specific treatment, no standard pattern of progression, and no method of prevention.

How can Huntington disease be prevented?

There is no known cure or treatment for HD. The only way to prevent transmission of the gene is for those affected to avoid having biologic children.

What are the new tumors from metastasis called?

These additional tumors are called metastatic or secondary tumors. Even though the tumor is now in another organ, it is still a cancer from the original altered tissue. For example, when breast cancer spreads to the lung and the bone, it is still breast cancer in the lung and bone—not lung cancer and not bone cancer.

What can cause hypovolemic shock (that could be prevented)?

These are what we talked about in class: NPO can cause, hiking in desert can cause (dehydration), alcohol can cause, lack of seat belts and and child safety seat can cause if get in an accident No shoes, no clothes: risk for head injury, hit by a car, road rash. Children can get second degree burns on feet because parents forgot tar is hot if they walk barefoot.

The oxygenation and perfusion problems of hypovolemic shock lead to what cellular conditions and what cellular metabolism?

These oxygenation and perfusion problems lead to cellular anaerobic (without oxygen) conditions and abnormal cellular metabolism.

Can deep partial-thickness burns convert to full-thickness burns? Why or why not?

These wounds can convert to full-thickness wounds when tissue damage increases with infection, hypoxia, or ischemia. Progression to deeper injury can occur from hypoxia and ischemia. Adequate hydration, nutrients, and oxygen are needed for regrowth of skin cells and prevention of conversion to deeper burns.

What is the appearance of cancer or malignant cells?

They are anaplastic in appearance. As a cancer cell becomes more malignant, it becomes smaller and rounded. This appearance change can make diagnosis of cancer type difficult, because many different types of cancer cells look alike.

Why are those with Parkinson's usually constipated?

They are constipated since they have difficulty drinking-usually dehydrated. Often get constipated and peristalsis is less active due to this.

True or False Long term effects of radiation therapy are limited to the tissues exposed to radiation.

True

True or False Loss of RBCs and/or serum decreases the ability of the blood to oxygenate the tissue that it does reach; anaerobic conditions may result.

True

True or False Most often, shock is a result of cardiovascular problems.

True

True or False Only one cell has to undergo malignant transformation for cancer to begin.

True

True or False Pancreatic cancer is difficult to diagnose and is usually diagnosed in late stage.

True

True or False Poor income may be correlated with poor diet

True

True or False Risk for sepsis should be considered for the patient in crisis with sickle cell disease.

True

True or False: Skin dryness is a normal result of aging

True

True or False: WBC count does not rise as high in response to infection in older people as it does in younger people

True

True or false Colon cancer is often hereditary

True

Why do symptoms come late in esophageal cancer?

Tumor grows inward into hollow organ, so no symptoms until blockage. Patient usually comes into ER with complaint that food is stuck in their esophagus.

What percentages of nephrons are destroyed before a person is symptomatic in acute kidney injury or chronic kidney disease?

With sudden decline of kidney function (acute) a person can be symptomatic when 50% of nephrons are destroyed. With gradual decline of kidney function (chronic) a person can be asymptomatic until 95% off nephrons are destroyed.

Do benign tumor cells have contact inhibition?

Yes

Is penile cancer usually treatable?

Yes

Is there pain with deep partial-thickness burns?

Yes

Is there a genetic test for some cancers?

Yes-slight alteration in one of the chromosomes that are indicative of getting that cancer that results in a positive marker. Patients should receive genetic counseling.

Oh Nurse! Are these ladies at risk for shock? (Picture of elderly women at a long-term care facility).

Yes. Our Iggy book says: "For example, older patients in long-term care settings are at risk for sepsis and shock related to urinary tract infections." Our teacher stated, they may be dehydrated-facility not providing beverage of choice, can't go to bathroom, so they might be in hypovolemic shock due to dehydration. Might have UTI- you see confusion in the elderly with UTI-urosepsis may occur. Thirst receptors decrease as we get older.

Are benign tumors euploid? What is the diploidy?

Yes; 23 pairs Normal chromosomes (euploid) are usually found in benign tumor cells, although there are exceptions. Most of these cells have 23 pairs of chromosomes (diploid), the correct number for humans.

What infection(s) can happen if you take antibiotics?

You can get a yeast infection-it is a fungus, and it grows because you wipe out the natural flora. Antibiotics can also cause a UTI.

The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom? A. Vomiting B. Back pain C. Frequent urination D. Cyanosis of the toes

B. Back pain Typical sites of breast cancer metastasis include bone (manifested by back pain), lung, liver, and brain. Signs of metastasis to the spine may include numbness, pain, paresthesias and tingling, and loss of bowel and bladder control, but not vomiting. Although frequent urination may be a sign of bladder cancer, incontinence is more indicative of spinal metastasis. Cyanosis of the toes indicates decreased tissue perfusion, often related to atherosclerotic disease.

Yellow box

Be sure to support the affected flaccid arm of the stroke patient, and teach UAP to avoid pulling on it. Position the arm on a pillow while the patient is sitting to prevent it from hanging freely, which could cause shoulder subluxation. The physical or occupational therapist provides a sling-like device to support the arm during ambulation.

Yellow box

Because changes in systolic blood pressure are not always present in the initial stage of shock, use changes in pulse rate and quality as the main indicators of shock presence or progression.

Yellow box

Because repeated compression can result in the loss of the vascular access, avoid taking the blood pressure or performing venipunctures in the arm with the vascular access. Do not use AV fistula or graft for delivery of IV fluids.

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Because respiratory compromise often occurs in myasthenic patients, encourage family members to learn resuscitation procedures. A manual resuscitation bag, suctioning equipment, and oxygen should be available in the home for patients susceptible to crises. Teach family members in the proper use of equipment.

Why is radiation therapy usually given in two divided doses?

Because the cancer cells vary in their response.

Six weeks after hematopoietic stem cell transplantation for leukemia, the client's white blood cell (WBC) count is 8200/mm3. What is the nurse's best action in view of this laboratory result? A. Notify the health care provider immediately. B. Assess the client for other symptoms of infection. C. Document the laboratory report as the only action. D. Remind the client to avoid crowds and people who are ill.

C

The trauma center nurse is instructed to insert a Foley catheter into a patient who sustained a head injury after falling off a skateboard. The nurse notices blood in the uretheral opening. How should the nurse proceed? A. Insert the Foley catheter more slowly than usual due to the blood in the urethral opening. B. Insert the Foley catheter promptly because the patient needs a head CT emergently. C. Don't insert the Foley catheter. Inform the Trauma team of the blood in the urethral opening. D. Don't insert the Foley catheter because it is contraindicated in a head injury.

C

Which precaution is most important for the nurse to teach a client receiving radiation therapy for head and neck cancer? A. Avoid eating red meat during treatment. B. Pace your leisure activities to prevent fatigue. C. See your dentist twice yearly for the rest of your life. D. Avoid using headphones or headsets until your hair grows back

C

Which statement is true concerning polycystic kidney disease (PKD)? A. Children are rarely diagnosed with PKD because of the correlation between smoking and development of the cysts. B. Women are more likely than men to get PKD because the renal cysts are often related to fibroids which are common in the uterus. C. Patients with PKD often have hypertension because the enlarged cysts cause the renin-angiotensin system to be activated. D. Patients who smoke are more likely to get PKD than the general population because the cysts are a direct result of tabacco use.

C

Which statement made by a client who has acute pyelonephritis indicates to the nurse correct understanding of the antibiotic therapy? A. "If my temperature is normal for 3 days in a row, the infection is gone and I can stop taking the drug." B. "If my temperature goes above 100° for 2 days, I should take double the dose of the drug." C. "Even if I feel completely well, I should take the drug exactly as prescribed until it is gone." D. "I should notify my prescriber to change the medication if I develop diarrhea while taking this drug."

C

Which actions should the nurse initiate for the patient who had a left radical mastectomy? A. Have the patient view the incision site as soon as possible. B. Initiate strengthening exercises of the left arm within 24 hours of surgery. C. Insert all intravenous (IV) access sites on the right arm. D. Elevate the left arm above the head.

C Comment about D- Only ROM of the lower left arm should be initiated within 24 hours of surgery. The upper arm can be exercised after drains have been removed. (Note: the term "radical" as applied to cancer surgery indicates that tissue near the cancer is aggressively removed. Example: a radical mastectomy involves removal of the breast along with lymph nodes in the armpit and tissue under the breast.)

A hematology unit is staffed by RNs, LPN/LVNs, and unlicensed assistive personnel (UAP). When the nurse manager is reviewing documentation of staff members, which entry indicates that the staff member needs education about his or her appropriate level of responsibility and client care? A. "Abdominal pain relieved by morphine 4 mg IV; client resting comfortably and denies problems. B.C., RN" B. "Ambulated in hallway for 40 feet and denies shortness of breath at rest or with ambulation. T.Y., LPN" C. "Client reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP" D. "Vital signs 37.0° C, heart rate 60, respiratory rate 20, blood pressure 110/68, and oximetry 98% on room air. L.D., UAP"

C. "Client reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP" Determination of the need for oxygen and administration of oxygen should be done by licensed nurses who have the education and scope of practice required to administer it. All other documentation entries reflect appropriate delegation and assignment of care.

A 52-year-old client relates to the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic? A. "Don't worry, most lumps are discovered by women during breast self-examination." B. "Does anyone in your family have breast cancer?" C. "Finding a cancer in the early stages increases the chance for cure." D. "Have you noticed a lump or thickening in your breast?"

C. "Finding a cancer in the early stages increases the chance for cure." Providing truthful information addresses the client's concerns. Mammography can detect lumps smaller than those discovered by palpation. Asking about family history or symptoms is not therapeutic because it does not address the client's fear of cancer.

Which statement made by a client allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment plan? A. "I may lose my hair during this treatment." B. "I must be positioned in the same way during each treatment." C. "I will have a radioactive device in my body for a short time." D. "I will be placed in a semiprivate room for company."

C. "I will have a radioactive device in my body for a short time." Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific; this client is unlikely to experience hair loss from treating ovarian cancer with radiation. The client undergoing teletherapy (external beam radiation), not brachytherapy, must be positioned precisely in the same position each time. The client who is receiving brachytherapy must be in a private room.

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? A. Functional B. Overflow C. Stress D. Urge

C. Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence

A 32-year-old client recovering from a sickle cell crisis is to be discharged. The nurse says, "You and all clients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the health care provider will request? A. Cefaclor (Ceclor) B. Gentamicin (Garamycin) C. Penicillin V (Pen-V K) D. Vancomycin (Vancocin)

C. Penicillin V (Pen-V K) Prophylactic therapy with twice-daily oral penicillin reduces the incidence of pneumonia and other streptococcal infections and is the correct drug to use. It is a standard protocol for long-term prophylactic use in clients with sickle cell disease. Cefaclor (Ceclor) and vancomycin (Vancocin) are antibiotics more specific for short-term use and would be inappropriate for this client. Gentamicin (Garamycin) is a drug that can cause liver and kidney damage with long-term use.

Which problem places a client at highest risk for sepsis? A. Pernicious anemia B. Pericarditis C. Post kidney transplant D. Client owns an iguana

C. Post kidney transplant The post-kidney transplant client will need to take lifelong immune suppressant therapy and is at risk for infection from internal and external organisms. Pernicious anemia is related to lack of vitamin B12, not to bone marrow failure (aplastic anemia), which would place the client at risk for infection. Inflammation of the pericardial sac is an inflammatory condition that does not pose a risk for septic shock. Although owning pets, especially cats and reptiles, poses a risk for infection, the immune-suppressed kidney transplant client has a very high risk for infection, sepsis, and death.

The client is in the emergency department (ED) for an inability to void and for bladder distention. What is most important for the nurse to provide to the client? A. Increased oral fluids B. IV fluids C. Privacy D. Health history forms

C. Provide privacy, assistance, and voiding stimulants, such as warm water over the perineum, as needed, for the client with urinary problems.

The nurse is preparing to admit a patient with urge incontinence. In writing the nursing care plan, the nurse writes interventions that target which manifestation? A. Involuntary loss of urine without warning or stimulus. B. Loss of urine when coughing or sneezing. C. Inability to empty bladder. D. Inability to inhibit urine flow long enough to reach the toilet.

D

A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause? A. A diagnosis of diabetes treated with insulin and diet B. An exercise regimen of jogging 3 miles four times a week C. A history of cardiac disease D. Advancing age

D. Advancing age Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases. Diabetes is not known to cause lung cancer. Regular exercise is not a risk factor for lung cancer, nor does having cardiac disease predispose a person to lung cancer.

A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time? A. Explain that this occurs in some clients and is usually permanent. B. Inform the client that a small glass of wine may help her relax. C. Protect the client from infection. D. Allow the client an opportunity to express her feelings.

D. Allow the client an opportunity to express her feelings. Although no specific intervention for this side effect is known, therapeutic communication and listening may be helpful to the client. Evidence regarding problems with concentration and memory loss with chemotherapy is not complete, but the current thinking is that this process is usually temporary. The client should be advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. Chemotherapeutic agents are implicated in central nervous system function in this scenario, not infection.

Which laboratory test result for a client who is about to have a nephrostomy for hydronephrosis does the nurse report immediately to the physician? A. Serum sodium 137 mEq/L B. Serum potassium 4.8 mEq/L C. Blood urea nitrogen (BUN) 23 mg/dL D. International normalized ratio (INR) 4.6

D. Although the sodium and BUN levels are slightly higher than normal, they are within the ranges expected with hydronephrosis. The INR, however, is seriously elevated and indicates a dangerously long clotting time with a greatly increased risk for bleeding. It must be corrected before surgery.

The nurse assesses the client with which hematologic problem first? A. A 32-year-old with pernicious anemia who needs a vitamin B12 injection B. A 40-year-old with iron deficiency anemia who needs a Z-track iron injection C. A 67-year-old with acute myelocytic leukemia with petechiae on both legs D. An 81-year-old with thrombocytopenia and an increase in abdominal girth

D. An 81-year-old with thrombocytopenia and an increase in abdominal girth An increase in abdominal girth in a client with thrombocytopenia indicates possible hemorrhage; this warrants further assessment immediately. The 32-year-old with pernicious anemia, the 40-year-old with iron deficiency anemia, and the 67-year-old with acute myelocytic leukemia do not indicate any acute complications, so the nurse can assess them after assessing the client with thrombocytopenia.

Why do these kidney manifestations of shock occur?

Kidney and urinary changes occur with shock to compensate for decreased MAP by saving body water through decreased filtration and increased water reabsorption. Assess urine for volume, color, specific gravity, and the presence of blood or protein. Decreased urine output is a sensitive indicator of early shock. Measure urine output at least every hour. In severe shock, urine output may be absent. Of the four vital organs (heart, brain, liver, and kidney), only the kidney can tolerate hypoxia and anoxia for up to 1 hour without permanent damage. When hypoxia or anoxia persists beyond this time, patients are at risk for acute kidney injury (AKI) and kidney failure. Increased specific gravity (more waste products), more sugar in urine and bloodstream (fight or flight response kidney tells liver to release sugar since we're in fight or flight).

What does elevated creatinine levels mean?

Kidney failure

What is nephroliathiasis?

Kidney stones

What is renal calculi?

Kidney stones

KUB

Kidney, ureter, bladder x-ray; best if standing

Why should hydration status be checked before injected constrast medium?

Kidneys might not be able to excrete the dye.

What is agnosia?

Loss of sensory comprehension

What causes low levels of MCHC

Mirrors MCV results (Iron deficiency anemia and Thalassemia); small red cells would have a lower value.

Yellow box

Monitor the patient closely because drugs that dilate coronary blood vessels, such as nitroprusside, can cause systemic vasodilation and increase shock if the patient is volume depleted.

Yellow box

Monitor the patient with acute spinal cord injury at least hourly for: • Severe bradycardia • Warm, dry skin • Severe hypotension Notify the physician immediately if these symptoms occur, because this problem is an emergency! Neurogenic shock is treated symptomatically by restoring fluids to the circulating blood volume and providing supportive care to stabilize the patient

What are the most common extranodal (outside the lymph node) sites in non-Hodgkin's lymphoma?

Most common extranodal sites are the GI tract, skin, and bone marrow

Are noncancerous cells anchorage dependent? Are malignant cells?

Noncancerous cells are anchorage dependent. Cancerous cells are anchorage independent and can proliferate suspended in soft agar.

Normal cells have what kind of cell division?

None or slow

Diastat (diazepam rectal gel delivery system) given? Usually given to who? What approach do we use?

Our teacher said in class: Diastat-rectal valium-big syringe (piston syringe) is preloaded and is prescribed for children-diastat to be given if child has more than 2 minute seizure-the problem is diastat will make them sleep for 10-12 hours-they might stop breathing-might come into hospital after diastat is given. Turn child on side. Use 1-2-3 approach.

What is a complication of vancomycin?

Our teacher said in class: Vancomycin: third generation-don't have much else that works if you get to this point of antibiotics. Timing is important-watch for red man syndrome-the pt will complain they don't feel right and they get red. Stop the drug. Sometimes if there is not an alternative drug, cut rate in half so they can tolerate the drug. Benadryl and vanco at same time given sometimes too.

What are some seizure precautions?

Our teacher said in class: seizure precautions-plan ahead-pad the bed, or have a mattress on the floor, have ambubag or a bag valve mask that is the proper size if the patient stops breathing post-pictally, suctioning (no spoon or padded tongue blade -don't pry teeth open), turn patient on side. Our books says: Seizure precautions include ensuring that oxygen and suctioning equipment with an airway are readily available. If the patient does not have an IV access, insert a saline lock, especially if he or she is at significant risk for generalized tonic-clonic seizures. The saline lock provides ready access if IV drug therapy must be given to stop the seizure

Why should you give rocephin on time?

Our teacher stated in class: Give on time because if you don't the drug level will drop and the blood infection can get worse. Don't let the therapeutic level drop-give doses on time. Rocephin is painful if given by shot.

Why is prostate cancer often a late finding in men?

Our teacher stated that men tend to come to healthcare later than women.

Do multiple sclerosis patients progress at the same rate?

Patients progress at different rates and over different lengths of time. However, as the severity and duration of the disease progress, the periods of exacerbation become more frequent.

How do patients typically die in Huntington disease?

Patients typically die from pneumonia, heart failure, or other complication of immobility

What are some signs or characteristics of non-Hodgkin's lymphoma?

Patients usually have swollen lymph nodes (called lymphadenopathy) or tumor spread to other organs at the time of diagnosis

What is the color of superficial burns?

Pink to red

What is an example of a congenital kidney disorder?

Polycystic Kidney Disease (PKD)

What are evoked potentials? What do they measure? What are they used to test for?

Evoked potentials measure the electrical signals to the brain generated by hearing, touch, or sight. These tests are used to assess sensory nerve problems and confirm neurologic conditions including multiple sclerosis, brain tumor, acoustic neuroma (small tumors of the inner ear), and spinal cord injury. Evoked potentials are also used to test sight and hearing (especially in infants and young children), monitor brain activity in coma patients, and confirm brain death. One set of electrodes is attached to the patient's scalp using conducting paste, and the second set is attached to the part of the body to be tested. A stimulus is applied, and the amount of time it takes for the impulse generated by the stimulus to reach the brain is recorded. Under normal circumstances, the process of signal transmission is instantaneous. Our teacher said in class: Evoked potentials-this determines how fast the brain responds to change in light and sound. Early cognitive delays might be assessed with evoked potentials.

What is robotic surgery?

Facilitates complex procedures with higher precision

Type B (Christmas Disease) hemophilia is deficient in what factor?

Factor IX

True or False Patients with ALS are able to live a normal life span with treatment.

False Death typically occurs within 3 years of diagnosis due to respiratory failure

True or False In patients with G6PD anemia, newly produced RBCs are deficient in levels of G6PD

False. They have sufficient levels of G6PD when the RBCs are newly produced.

What usually precedes GBS? What are some examples?

Frequently preceded by a prodromal event ie the flu, GI illness, truama or surgery 1 to 3 weeks prior to illness.

When does the patient have chronic back pain?

If the pain continues for 3 months or if repeated episodes of pain occur, the patient has chronic back pain.

Is Kaposi's Sarcoma treatable?

In parts of the world where HAART drugs to treat HIV are available this type of cancer advances slowly and is treatable

Why would a patient with leukemia also have anemia and thrombocytopenia?

In patients with leukemia, the bone marrow becomes overcrowded with immature, nonfunctional cells and production of normal blood cells and platelets is greatly decreased.

What is rehabilitative surgery?

Increases function

What does N1, N2, N3 stand for when staging tumors?

Increasing involvement of regional lymph nodes

Yellow box

Instruct the patient to eat meals 45 minutes to 1 hour after taking ChE inhibitors to avoid aspiration. This is especially important if the patient has bulbar involvement. Drugs containing magnesium, morphine or its derivatives, curare, quinine, quinidine, procainamide, or hypnotics or sedatives should be avoided because they may increase the patient's weakness. Antibiotics such as neomycin and certain tetracyclines impair transmitter release and also increase myasthenic symptoms.

What is an AV fistula?

It is an abnormal connection between two tissues, such as between the radial artery and vein.

What is the treatment of postrenal acute kidney injury (AKI)?

Relieving the obstruction

What are the nursing implications for the older with decreased touch sensation? Why?

Remind the patient to look where his or her feet are placed when walking. Instruct the patient to wear shoes that provide good support when walking. If the patient is unable, change his or her position frequently (every hour) while he or she is in bed or the chair. Decreased sensation may cause the patient to fall.

What is the treatment for colon cancer?

Removal of part or all of colon

What is the diagnostic test for GBS?

There isn't one. Diagnosed based on symptoms.

Where are thrombocytes formed? What hormone do they respond to?

They are formed in the marrow in response to Thromboprotien (TPO), a hormone produced by the liver. TPO is secreted when platelet levels are low.

What are the markings, or "tattoo" for in teletherapy?

They are position-fixing markings to ensure the proper position each day of treatment. They may not be able to wash their marking, or "tattoo".

Why do patients with sickle cell anemia have shorter lifespans?

They are prone to strokes; their spleen and liver and kidneys are more prone to fail. This is because those tissues will eventually die since over long periods of time--everytime the patient has a crisis and the sickled cells get stuck--the tissue distal to that becomes ischemic and then can become necrotic.

Is there pain with superficial burns?

Yes

Is there pain with superficial partial-thickness burns?

Yes

Will there be grafts required for full-thickness burns?

Yes

Is there pain with full-thickness burns?

Yes and no

Is there an increase in WBCs with SIRS?

Yes, usually. The book says usually in this stage, the patient has the elevated WBC count expected with a systemic infection.

Can you use subvlavian catheter "Vas Cath" for IV fluids?

Reserve port only for dialysis, unless it is a Trialysis catheter, and then you can use one for IV fluids. Keep ports covered.

The skin is our largest organ and serves many functions. What are some of those functions?

Teacher stated in class: Skin keeps our fluid and electrolytes were they're supposed to be, maintains temperature, prevents infection, vitamin D absorption. If skin is burned, those functions are gone, so nurse has to do what skin now can't do.

Parkinson's is a debilitating disease affecting motor ability and is characterized by what four cardinal symptoms?

tremor, rigidity, bradykinesia or akinesia (slow movement/no movement), and postural instability.

What are teaching for self-management after a stroke?

Teaching for Self-Management -Teach caregivers about post-stroke depression -Teaching should include drugs therapy, safety with eating, transferring, ambulating, and ADLs. -Teach that another stroke is possible -Teach what is possible!

What are some early neuromuscular manifestations of shock?

• Anxiety • Restlessness • Increased thirst

What should you ask a patient before using a contrast medium?

• Ask the patient if he or she has ever had a reaction to contrast media • Ask the patient about a history of asthma. • Ask the patient about known hay fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. • Ask the patient to describe any specific allergic reactions (e.g., hives, facial edema, difficulty breathing, bronchospasm). • Assess for a history of kidney impairment and for conditions that have been implicated in increasing the chance of developing kidney failure after contrast media • Ask the patient if he or she is taking metformin (Glucophage). • Assess hydration status by checking blood pressure, heart and respiratory rates, mucous membranes, skin turgor, and urine concentration. • Ask the patient when he or she last ate or drank anything.

What are some kidney manifestations of shock?

• Decreased urine output • Increased specific gravity • Sugar and acetone present in urine

What are specific causes or risk factors in hypovolemic shock (dehydration)?

• Vomiting • Diarrhea • NPO • Heavy diaphoresis • Diuretic therapy • Nasogastric suction • Diabetes insipidus • Hyperglycemia

What is the Reed-Sternberg cell?

It's a marker for Hodgkin's lymphoma.

What does glossitis mean?

It's an inflammation of the tongue often making the surface of the tongue appear smooth

What are signs/symptoms of pancreatic cancer?

Jaundice, clay-colored stool, dark/frothy urine, migratory thrombophlebitis

What electrolyte is mostly excreted through the kidneys?

K+

Yellow box

Keep a manual resuscitation (breathing) bag (e.g., Ambu), equipment for oxygen administration, and endotracheal intubation equipment at the bedside of the patient with myasthenia gravis in case of respiratory distress!

Yellow box

Keep equipment for performing an endotracheal intubation at the bedside of the patient with Guillain-Barré syndrome, and have a mechanical ventilator readily available in case of respiratory emergency.

In nonprogressive stage of hypovolemic shock, what compensatory mechanisms are activated?

Kidney and hormonal compensatory mechanisms are activated because cardiovascular responses (initial stage) alone are not enough to maintain MAP and supply oxygen to vital organs.

What type of cancer has uncontrolled production of immature WBCs in the bone?

Leukemia

Patients with leukemia tend to have what cardiovascular changes?

Leukemia patients tend to have heart murmurs since blood is viscous and might go backwards. Have bruits in distal pulses and neck because the blood is viscous (due to a high WBC count). Cap refill is slow and blood pressure is elevated and the pulse is bounding and increased.

Why is the drug Carbadopa usually given with Levadopa (combined called Sinemet) for Parkinson's?

Levadopa changes into dopamine in the blood stream, which is helpful in the brain. However, in the peripheral circulation, covenrsion of levadopa to dopamine causes nausea. Therefore, the drug Carbadopa is usually given in combination. The carbadopa cannot cross the blood-brain barrier, and in the peripheral circulation the carbadopa prevents conversion of levodopa to dopamine.

What is the most common medication for Parkinson's disease?

Levadopa is the most commonly Rx med

What is the life span of cells that sickle in sickle cell disease?

Life span of cells that sickle is as short as 2 weeks

Giving potassium IM or SubQ can cause ____.

Local necrosis

What kind of adherence do cancer cells have? Why?

Loose adherence is typical for cancer cells because they do not make fibronectin. As a result, cancer cells easily break off from the main tumor.

Would acetaminophen or sulfa drugs cause high or low platelet levels?

Low

Would bone marrow damage cause high or low reticulocyte levels?

Low

Would cirrhosis cause high or low platelet levels?

Low

Would radiation cause high or low platelet levels?

Low

B12 deficiency can cause a _________ tongue.

Smooth

Electrolytes typically include what?

Sodium Potassium Chloride Bicarb

Do immune disorders cause too high or too low WBCs?

Too low

Do severe infections cause too high or too low WBCs?

Too low

Does HIV cause too high or too low WBCs?

Too low

Does bone cancer cause too high or too low WBCs?

Too low

Does kidney failure cause RBC, HCT, and HGB to be too high or too low.

Too low

Does sepsis cause too high or too low WBCs?

Too low

What is leukopenia?

Too low WBCs

What does the body make too much off in polycythemia vera?

Too many RBCs (and in some cases too many WBCs and platelets).

What does erythrocytosis mean?

Too much or too little red blood cells Erythro: Red Cyt: Cell Osis: Process or condition

Is total body fluid affected in obstructive shock?

Total body fluid is not affected.

What is anuria?

Total urine output of less than 100 mL in 24 hours

What does cytotoxic mean?

Toxic to living cells; cell-damaging

Why do normal cells divide (undergo mitosis)?

(1) to develop normal tissue or (2) to replace lost or damaged normal tissue. Even when they are capable of mitosis, normal cells divide only when body conditions, including the need for more cells, adequate space, and sufficient nutrients and other resources, are just right.

B12 deficiency anemia is also called ____________ because . . . ?

Also called macrocytic anemia because the RBCs tend to be abnormally large.

What are some causes of seizures?

- brain lesions - acute alcohol withdrawal - electrolyte disturbances (ex: ↑K+) - street drug overdoses - head trauma

Platelet count of what leads to prolonged bleeding?

<50K

Normal GFR

> 100

In the nonprogressive stage of hypovolemic shock, a decrease in MAP of _______ mm/Hg below baseline is detected by _________ in the aortic arch and carotid sinus. This information is transmitted to the brain; additional compensatory mechanisms are initiated.

-10-15 -baroreceptors

In the initial stage of hypovolemic shock, what are the circulatory compensations? Is it effective in this early stag?

-A slight increase in heart rate and respiratory rate may be noted (cardiovascular compensation). -A slight increase in DBP (diastolic BP) might be noted. In this early stage cardiovascular compensatory mechanisms are so effective that oxygenated blood flow to vital organs is maintained.

What do we assess in patients with head injuries?

-ABC's, assume cervical injury -Look for hypotension, hypoxemia, hypercapnia -Change in level of consciousness -Change in personality (ask family) -Check pupils (may have anasocoria-difference in pupils that may indicate head injury), look for CSF leakage

What are primary considerations for neck tumors?

-Airway -Nutrition

What are interventions for the client with increased ICP?

-Frequent reassessment of ABCs and neuro checks -HOB usually ↑ 30°, avoid neck flexion -Slow, gentle turning -Avoid coughing, straining, loud noise -Report subtle changes -Baseline labs, CT

What are late signs of multiple sclerosis?

-Impaired motor function -Urine retention or incontinence -Cognitive problems

What are some integumentary changes in the patient with leukemia?

-Petechiae -Skin cool and pale

What is acute glomerulonephritis usually related to?

-Usually related to a recent infection such as URI (strep throat) or UTI or invasive procedure such as surgery.

Severe sepsis that leads to multiple organ system syndrome (MODS) (septic shock) has what occurring?

1. Cell anoxia and cell deathin more vital organs 2. Failure of nonvital organs 3. Reduced function and failure of vital organs 4. Widespread bleeding

SIRS that leads to severe sepsis has what occurring?

1. Cell anoxia, cell death 2. Organ failure 3. Release of metabolites 4. Microthrombi form, consuming platelets and clotting factors 5. Triggers more pro-inflammatory cytokines

What are benign tumors?

Benign tumors are tumors that are not considered to be cancerous.

True or False Hypovolemic shock from most causes cannot be prevented.

False It can be prevented from most causes.

Cancer left untreated may cause four primary concerns. What are they?

1. Reduced Immunity and Blood Producing Functions 2. Altered GI Structure and Function 3. Motor and Sensory Deficits 4. Reduced Oxygenation

A patient explains to the nurse "I was too sick to get to dialysis on Tuesday, but I'm here for my regular appointment today (on Thursday). I'm feeling nausea and my feet are weak." The nurse anticipates which lab finding? A. K+ is 6.8 meq/dL B. K+ is 4.2 meq/dL C. K+ is 5.2 meq/dL D. K+ is 3.1 meq/dL

A

Would viral infections such as measles or hepatitis cause high or low platelet levels?

Low

What does thrombocytopenia mean?

Low platelet count

What is the normal range for lactic acid? Why may it be abnormal in shock (does it increase or decrease)?

3-7 mg/dL 0.3-0.8 mmol/L Increased due to anaerobic metabolism with buildup of metabolites

What is the healing time with superficial burns?

3-6 days

At what rate should you start infusing packed red blood cells?

50cc over 15-30 minutes

A client newly diagnosed with acute leukemia asks why he is at such extreme risk for infection when his white blood cell count is so high. What is the nurse's best response? A. "Even though you have many white blood cells, they are too immature to fight infection." B. "For now, your risk is low; however, when the chemotherapy begins, your risk for infection will be high." C. "These white blood cells are cancerous and live longer than normal white blood cells, so they are too old to fight infection." D. "It is not the white blood cells that provide protection; it is the red blood cells, which are very low in your blood right now."

A

In regards to tumor nomenclature, what is the prefix if the tissue of origin is lymphoid tissue?

Lympho

What is the normal range for pH? Why may it be abnormal in shock (does it increase or decrease)?

7.35-7.45 It is decreased in shock due to insufficient issue oxygenation causing anaerobic metabolism and acidosis.

How long will blood be held for a patient?

72 hours A blood specimen from the recipient is obtained for crossmatching within 72 hours prior to the transfusion. Blood that's donated has a short shelf life, so is only set aside for 72 hours for a patient.

What level of potassium is lethal?

8

A woman whose hemoglobin S levels are less than 1% has a brother with sickle cell disease (SCD) and both parents have been diagnosed as carriers for the disorder. She asks what her risks are of having a child with sickle cell disease. What is the nurse's best response? A. "Because you do not have the trait, you cannot have a child with SCD regardless of your partner's sickle cell status." B. "Because both your parents have the trait, it is possible for you to have a child with SCD if your partner actually has the disease." C. "Because your brother actually has SCD, the risk for your children having SCD is 50% with each pregnancy." D. "Because you are a woman, your daughters will each have a 50% risk for having the disease, and all of your sons will be carriers of the trait."

A

During a client's neurologic assessment, the nurse finds that he is arousable only if his trapezius muscle is pinched. How will the nurse document this client's level of consciousness? A. "Stuporous" B. "Lethargic" C. "Comatose" D. "Drowsy"

A

Oh Nurse! A family members asks "how do you know my father had a stroke?" You explain that the following were used in making the dx: A. CT scan B. EKG C. CBC D. Head x-ray E. Lumbar puncture

A

Oh Nurse! Which one of the following is included in a CBC? A. Platelet count B. Potassium C. Serum ammonia D. INR

A

The client with end-stage kidney disease (ESKD) appears to have pulmonary edema. Which intervention does the nurse perform first? A. Raise the head of the bed B. Apply oxygen by nasal cannula C. Notify the Rapid Response Team D. Measure oxygen saturation by pulse oximetry

A

Which assessment is most important for the nurse to perform for the client receiving one unit of packed red blood cells from an autologous donation? A. Temperature B. Blood pressure C. Oxygen saturation D. IV site for hives

A

Which assessments are most important for the nurse to perform when monitoring a client after a retrograde cystogram? A. Temperature and urine character B. Kidney tenderness and flank pain C. 24-hour urine volume, BUN and creatinine levels D. Angioedema and other indicators of systemic allergic response

A

Which laboratory blood test result for a client undergoing hematologic assessment does the nurse report immediately to the prescriber? A. Red blood cell count 1.2 million/mm3 B. Platelets 185,000/mm3 C. Hematocrit 36% D. INR 1.2

A

Which nursing intervention is appropriate when caring for a client with Alzheimer's disease? A. Provide a large clock and calendar. B. Place the client in a geri-chair to prevent wandering. C. Insert a urinary catheter to prevent incontinence. D. Place the client in the nurses' station

A

Which precaution is most important for the nurse to teach a client with autoimmune thrombocytopenic purpura who is receiving corticosteroid therapy to control the disease? A. "Avoid contact sports and any activity that could cause injury." B. "Report any rash to your health care provider immediately." C. "Be sure to drink at least 3 liters of water daily." D. "Take a low-dose aspirin daily with food."

A

Which statement made by the client who is receiving intravesicular instillations of BCG for bladder cancer indicates to the nurse that more teaching is needed? A. "Holding my urine for at least 8 hours after the treatment keeps the drug in contact with my bladder." B. "Drinking plenty of fluids during the evening after the treatment helps get the drug out of my system." C. "Sitting to urinate for 24 hours after treatment prevents exposure of other people to the drug." D. "Avoiding intercourse for 24 hours after treatment reduces my wife's exposure to the drug."

A

Which vital sign change in a client with hypovolemic shock indicates to the nurse that the therapy is effective? A. Urine output increase from 5 mL/hr to 25 mL/hr B. Pulse pressure decrease from 35 mm Hg to 28 mm Hg C. Respiratory rate increase from 22 breaths/min to 26 breaths/min D. Core body temperature increase from 98.2° F (36.8° C) to 98.8°F (37.1° C)

A

Oh nurse! Does the suffix -oma mean cancer? A. generally No B. Yes

A -oma means tumor. Our professor states that tumor doesn't always mean cancer. Let the patient know that tumor might not mean cancer-clarify what it means; it could be benign.

Oh Nurse! When assessing a person diagnosed with Parkinson's Disease, the nurse expects to note which of the following? A. Slow gait B. Frequent diarrhea C. Frequent falls D. Apathetic facial expressions E. Drooling

A C D E Not frequent diarrhea since they have difficulty drinking-usually dehydrated. Often get constipated and peristalsis is less active

When caring for a client with myasthenia gravis, which of these nursing activities may be safely delegated to a nursing assistant? Select all that apply. A. Feeding dinner to the client B. Teaching the family about drug therapy C. Assisting with client communication D. Consulting with the physical therapist E. Assisting with ambulation F. Recording food and fluid intake

A C E F

The med-surg nurse is aware her patient will be going to his scheduled dialysis appointment in 1 hour. Which of the following 10 AM medications should the nurse consider "holding" because they will otherwise be "dialyzed off" (eliminated) during hemodialysis? (Select all that apply.) Note: many drug handbooks include a list of "dialyzed drugs" A. aspirin B. digoxin C. nitroglycerine D. acetaminophen

A D

What does a "left shift" mean?

A "left shift" is a phrase used to note that there are a high number of young, immature white blood cells present. Most commonly, this means that there is an infection or inflammation present and the bone marrow is producing more WBCs and releasing them into the blood before they are fully mature.

What is a basilar skull fracture? What are assessment findings?

A basilar skull fracture occurs at the base of the skull. Assessment findings may include: Battle signs Raccoon's eyes (late finding) CSF leakage from nose or ears

What is a herniated nucleus pulposus (HNP)? What are signs and symptoms of a herniated disc?

A bulging or herniated nucleus pulposus (HNP) in the lumbosacral area can press on the adjacent spinal nerve (usually the sciatic nerve), causing severe burning or stabbing pain down into the leg or foot. The specific area of pain depends on the level of herniation. Painful muscle spasms of the affected leg also may occur. In addition to pain, numbness and tingling may be felt in the affected leg because spinal nerves have both motor and sensory fibers. The HNP may press on the spinal cord itself, causing leg weakness and bowel and bladder dysfunction. Sacral spinal nerves are part of the reflex system for the bowel and bladder. They also contain parasympathetic nerve fibers, which help control bowel and bladder function.

When is a cancer cell a threat?

A cell becomes a cancer cell once DNA is damaged (initiation), usually by a carcinogen. This irreversible event is not a threat unless the cancer cell can divide. The cancer cell can become a tumor through promotion.

What is pancytopenia?

A concurrent deficiency of WBCs and platelets

What is a deceleration injury?

A deceleration injury occurs when the moving head is suddenly stopped or hits a stationary object.

What do baroreceptors detect?

A decrease in MAP of 5 to 10 mm Hg below the patient's normal baseline value. Baroreceptors (pressure receptors) can detect instantaneous change in blood pressure-that's why young people can move from laying down and then standing up without getting dizzy (this produces a decrease in the stretch of the baroreceptors with a resultant increase in heart rate and sympathetically induced vasoconstriction that causes an increase in peripheral vascular resistance). Older people can't do this cause their baroreceptors don't work as well.

What is an autoimmune disease?

A disease produced when the body's normal tolerance of the antigens on its own cells is disrupted. One current theory is the problem results when the body's antigens have a strong similarity to foreign antigens.

How long does the platelet plug last?

A few hours

How long until the new transplanted kidney starts making urine?

Almost always immediately, even in the OR!

What is an AV graft, or shaft?

A graft is a tissue or organ taken from one place/person and put into another place/person. A graft can also be synthetic, in the case when a patient needing dialysis access gets an AV graft. An AV graft is a strong artificial tube inserted by a surgeon underneath the skin of your forearm, upper arm or thigh. One end of the tube connects to one of your arteries, and the other end connects to one of your veins (in the same limb).

What is non-Hodgkin's lymphoma?

A group of diseases that includes all lymphoid cancers that do not have the Reed-Sternberg cell (which is found in Hodgkin's lymphoma).

What make burns partial-thickness wound (second degree burn)?

A partial-thickness wound involves the entire epidermis and varying depths of the dermis.

What is the nuclear-cytoplasmic ratio in cancer cells?

A large nuclear-cytoplasmic ratio occurs in cancer cells with the cancer cell nucleus being larger than that of a normal cell and the cancer cell being small. The nucleus occupies much of the space within the cancer cell, creating a large nuclear-to cytoplasmic ratio.

How does a local infection progress to death?

A local infection leads to a systemic infection (early sepsis), which leads to SIRS (systemic inflammatory response syndrome), which leads to organ failure (severe sepsis), which leads to multiple organ system syndrome (MODS) septic shock), which leads to death.

What is a migraine headache? What is it characterized by? What other symptoms are present?

A migraine headache is a chronic, episodic disorder with multiple subtypes. It is characterized by an intense pain in one side of the head (unilateral) worsening with movement and occurs with either photophobia (sensitive to light) or phonophobia (sensitive to noise). Either moderate to severe nausea or vomiting is also present

How long do migraines last?

A migraine is classified as a long-duration headache because it usually lasts 4 to 72 hours.

What does anchorage dependence mean?

A need for contact and anchorage to a stable surface by some cells in order for them to grow, function, and divide, especially when grown in cell cultures. Anchorage dependence is necessary for cells to spread or divide (mitosis).

Why would a paraplegic use a sonography?

A paraplegic might need it who caths himself-might cath himself every 4-6 hours, and uses this to see if there is anything in bladder.

Benign tumors have what nuclear-to-cytoplasmic ratio?

A small nuclear-to-cytoplasmic ratio is a feature of benign tumors just like completely normal cells.

What does a small nuclear-to-cytoplasmic ratio mean?

A small nuclear-to-cytoplasmic ratio means that the nucleus of a normal cell does not take up much space inside the cell. The size of the normal cell nucleus is small compared with the size of the rest of the cell, including the cytoplasm.

What is urgency?

A sudden onset of the feeling of the need to void immediately; may result in incontinence if the patient is unable to get to toileting facilities quickly

Yellow box

A temperature elevation of even 1° F (or 0.5° C) above baseline is significant for a patient with leukopenia and indicates infection until it has been proven otherwise. Report this finding to the health care provider at once

What is the most appropriate way to collect urine?

A voided specimen should be clean catch, first urine in the morning (more concentrated). Wash hands first, stand over toilet and spread their legs out, and put a little bit of pee in toilet first, and then catch the middle pee. This beginning pee has some contamination from outside of vagina. All urine should be a mid-stream catch.

Which client with a long-term urinary problem does the nurse refer to community resources and support groups? Select all that apply. A. 32-year-old with a cystectomy B. 44-year-old with a Kock pouch C. 48-year-old with urinary calculi D. 78-year-old with urinary incontinence E. 80-year-old with dementia

A,B,D: The client with a cystectomy and a Kock pouch, and a urinary incontinence would benefit from community resources and support groups. Others who have had their bladders removed are good sources for information and for help in establishing coping mechanisms.

The nurse is teaching a client about induction therapy for acute leukemia. Which client statement indicates a need for additional education? A. "After this therapy, I will not need to have any more." B. "I will need to avoid people with a cold or flu." C. "I will probably lose my hair during this therapy." D. "The goal of this therapy is to put me in remission."

A. "After this therapy, I will not need to have any more." Induction therapy is not a cure for leukemia, it is a treatment; therefore, the client needs more education to understand this. Because of infection risk, clients with leukemia should avoid people with a cold or flu. Induction therapy will most likely cause the client with leukemia to lose his or her hair. The goal of induction therapy is to force leukemia into remission.

A client has a bone marrow biopsy done. Which nursing intervention is the priority postprocedure? A. Applying pressure to the biopsy site B. Inspecting the site for ecchymoses C. Sending the biopsy specimens to the laboratory D. Teaching the client about avoiding vigorous activity

A. Applying pressure to the biopsy site The initial action should be to stop bleeding by applying pressure to the site. Inspecting for ecchymoses, sending specimens to the laboratory, and teaching the client about activity levels will be done after hemostasis has been achieved.

When assessing a client with pyelonephritis, the nurse recognizes that which of these conditions may predispose the client to the problem? A. Spinal cord injury B. Cardiomyopathy C. Hepatic failure D.Glomerulonephritis

A. Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones.

The client with which problem is at highest risk for hypovolemic shock? A. Esophageal varices B. Kidney failure C. Arthritis and daily acetaminophen use D. Kidney stone

A. Esophageal varices Esophageal varices are caused by portal hypertension; the portal vessels are under high pressure and are prone to rupture, causing massive upper gastrointestinal tract bleeding and hypovolemic shock. As the kidneys fail, fluid is typically retained, causing fluid volume excess, not hypovolemia. Nonsteroidal anti-inflammatory drugs such as naproxen and ibuprofen, not acetaminophen, predispose the client to gastrointestinal bleeding and hypovolemia. Although a kidney stone may cause hematuria, there is not generally massive blood loss or hypovolemia.

What does epogen stimulate? A. Growth of red blood cells B. Increased release of renin C. Growth of WBCs D. Increased platelets

A. Growth of red blood cells Can be used to stimulate RBC growth after a patient experiences a crisis in sickle cell disease.

The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression? A. Hemoglobin of 7.4 and hematocrit of 21.8 B. Potassium level of 2.9 mEq/L and diarrhea C. 250,000 platelets/mm3 D. 5000 white blood cells/mm3

A. Hemoglobin of 7.4 and hematocrit of 21.8 Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; the client with a hemoglobin of 7.4 and hematocrit of 21.8 has anemia demonstrated by low hemoglobin and hematocrit. The client with diarrhea and a potassium level of 2.9 mEq/L has hypokalemia and electrolyte imbalance. The client with 250,000 platelets/mm3 and the client with 5000 white blood cells/mm3 demonstrate normal values.

Which urinary assessment information indicates the potential need for increased fluids in the client? A. Increased blood urea nitrogen B. Increased creatinine C. Pale-colored urine D. Decreased sodium

A. Increased blood urea nitrogen (BUN) can indicate dehydration.

When the nurse is counseling a 60-year-old African-American male client with all of these risk factors for lung cancer, teaching should focus most on which risk factor? A. Tobacco use B. Ethnicity C. Gender D. Increased age

A. Tobacco use Although all of these are risk factors for lung cancer, the client's tobacco use is the only factor that he can change. Ethnicity, gender, and increasing age are associated with lung cancer, but they are not modifiable risks.

Which clients are at immediate risk for hypovolemic shock? (Select all that apply.) A. Unrestrained client in motor vehicle accident B. Construction worker C. Athlete D. Surgical intensive care client E. 85-year-old with gastrointestinal virus

A. Unrestrained client in motor vehicle accident D. Surgical intensive care client E. 85-year-old with gastrointestinal virus The client who is unrestrained in a motor vehicle accident is prone to multiple trauma and bleeding. Surgical clients are at high risk for hypovolemic shock owing to fluid loss and hemorrhage. Older adult clients are prone to shock; a gastrointestinal virus results in fluid losses. Unless injured or working in excessive heat, the construction worker and the athlete are not at risk for hypovolemic shock; they may be at risk for dehydration.

Oh Nurse! Can more than one type of shock be present at the same time? (Picture of guy who drove himself into a tree). A. Yes B. No

A. Yes Guy in picture is suffering from an MI. He tried to drive himself to hospital, but instead drove into tree. He now has cardiogenic (MI) and hypovolemic (because of the accident-trauma) shock.

When does ABO incompatibility occurs?

ABO incompatibility occurs when the patient is blood type O and the donor blood is type A, B, or AB. Types A, B, and AB blood contain a protein component (antigen) that is not present in type O blood. It can also occur when a person with type A blood forms antibodies against type B blood.

What causes acute lumbosacral pain?

Acute pain is caused by muscle strain or spasm, ligament sprain, disk (also spelled "disc") degeneration (osteoarthritis), or herniation of the nucleus pulposus from the center of the disk.

Acute back pain usually results from what?

Acute back pain usually results from injury or trauma. The patient typically hyperflexes or twists the back during a vehicular crash, or the injury occurs when the patient lifts a heavy object.

What is the duration of acute kidney injury or chronic kidney disease?

Acute is 2-4 weeks, less than 3 months. Chronic is permanent.

What is the prognosis of acute kidney disease or chronic kidney disease?

Acute is good for return of kidney function with supportive care; high mortality in some situations Chronic is permanent-no reversing. It is fatal without a renal replacement therapy such as dialysis and transplant surgery.

What is the difference in onset between acute kidney injury or chronic kidney disease?

Acute kidney injury is sudden (occurs in hours to days). Chronic is gradual (months to years).

What are the characteristics of Bell's Palsy?

Acute maximum paralysis is attained within 48 hours in about half the patients and within 5 days in almost all of them. Pain behind the ear or on the face may occur before paralysis by a few hours or days. The disorder involves a drawing sensation and paralysis of all facial muscles on the affected side. The patient cannot close his or her eye, wrinkle the forehead, smile, whistle, or grimace. He or she may also lose the ability for the eye to tear or may have excessive tearing. The face appears mask-like and sags. Taste is usually impaired to some degree, but this symptom seldom persists beyond the second week of paralysis. Tinnitus (ringing in the ears) may also occur. Most patients go into remission within 3 months.

When should you give Acyclovir (Zovirax) to the patient with encephalitis? Are there other drugs or treatments for encephalitis?

Acyclovir (Zovirax) if the encephalitis is associated with the Herpes virus (otherwise no recommended drugs). Treat the symptoms. Strict I&Os.

In regards to tumor nomenclature, what is the prefix if the tissue of origin is epithelial glands?

Adeno

What is HbA?

Adult hemoglobin

What are nursing concerns for the rigid collar?

Airway, skin breakdown under the collar.

What are the affects on the glomeruli in glomerulonephritis, in regards to GFR and protein?

Affects on glomeruli include ↓GFR and ↑proteinuria

Why are African Americans at risk for a lower GFR as they age than whites?

African Americans have more rapid age-related decreases in GFR than do white people (Brenner, 2008). Kidney excretion of sodium is less effective in hypertensive African Americans who have high sodium intake, and the kidneys have about 20% less blood flow as a result of anatomic changes in small renal vessels and intrarenal responses to renin. Thus African-American patients are at greater risk for kidney failure than are white patients. Yearly health examinations should include urinalysis and checking for the presence of microalbuminuria.

After a burn injury, why does major fluid loss occur?

After a burn injury, massive fluid loss occurs through evaporation. Evaporation through burn-injured skin occurs four times as rapidly as through intact skin.

Yellow box

After nephrostomy, notify the physician immediately when the drainage decreases or stops, drainage becomes cloudy or foul-smelling, the nephrostomy site leaks blood or urine, or the patient has back pain.

Yellow box

After surgical spinal fusion, assess the patient's neurologic status and vital signs at least every hour for the first 4 to 6 hours and then, if the patient is stable, every 4 hours. Assess for complications of surgery, such as hematoma and edema. Look for swelling under the skin.

Why should smoking, alcohol, high elevations be avoided in sickle cell anemia?

Alcohol inhibits ADH and cause the patient to urinate more and lose fluid, leading to dehydration and then to a crisis. Smoking is vasoconstrictor, and can cause hypoxemia, leading to a crisis. High elevations can cause vasoconstriction.

Oh Nurse! Patients with which of the following are prone to getting restless leg syndrome? A. Kidney disease B. Sleep deprivation C. Diabetics D. Spinal cord damage

All of them A B C D

Oh nurse! Which pathology can cause cardiac muscle cell hypertrophy? (Select all that apply) A. Illicit drug abuse B. Sickle cell disease C. Chronic renal failure D. Heart failure

All of them A B C D

What causes intrarenal acute kidney injury? What is it also known as?

Also known as acute tubular necrosis-causes include infection, drugs, and tumors

Why might a patient with long term spinal cord injury have septicemia?

Also known as sepsis, this is a life threatening blood infection that worsens quickly and can be fatal. This usually originates from an infection someplace in the body. In a person with a long term spinal cord injury sepsis may originate from an untreated UTI or pressure ulcer.

What are two common systemic side effects of radiation therapy?

Altered taste sensations and fatigue

What age is MG most common in? What gender?

Although MG can present at any age, it is less commonly seen in the United States than Guillain- Barré syndrome. Book says: The incidence is equal between men and women. Teacher says: Women get this 3x more often than men. Teacher states: Rare before age 10 and after age 60. Many support groups for this group. This strikes younger people-can happen to teens too.

If there are different causes of shock, why are the manifestations the same?

Although the causes and initial manifestations associated with the different types of shock vary, eventually the effects of hypotension and anaerobic cellular metabolism (metabolism without oxygen) result in the common key features of shock

In what population is Bell's Palsy more common in?

Although the incidence may be slightly higher among people with diabetes, Bell's palsy occurs in all ages; however, it is more commonly seen in young adults. Affects men and women ages 20 to 40.

What is the most common type of dementia?

Alzheimer's

Lou Gehrig's disease is also known as what?

Amyotrophic Lateral Sclerosis (ALS)

What age group does ALS occur in?

Amyotrophic lateral sclerosis commonly affects people between the ages of 40 and 60 years, but it may also begin in younger and older age-groups. The incidence increases with each decade of life.

What is a seizure?

An abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain.

What is an acceleration injury?

An acceleration injury is caused by an external force contacting the head, suddenly placing the head in motion.

How does photodynamic therapy work?

An agent that sensitizes cells to light is injected IV. The agent enters all cells but hangs around in cancer cells longer than in normal cells. Typically in 48-72 hours the drug is highly concentrated in cancer cells and absent in other cells. At this time, a laser light is focused on the tumor. The light activates a chemical reaction with those cells retaining the sensitizing drug and irreversible cell damage occurs.

What is an embolus?

An embolic stroke is caused by a thrombus or a group of thrombi that break off from one area of the body and travel to the cerebral arteries via the carotid artery or vertebrobasilar system.

What is a reticulocyte?

An immature red blood cell

Yellow box

An increase of serum creatinine 1.5 times above baseline or a decrease of urine output to <0.5mL/kg/hr for 6 or more hours places a patient at risk for acute kidney injury. Monitor both baseline and trend values to determine risk for and actual kidney damage, especially among patients exposed to agents that can cause kidney dysfunction. Inform the health care provider of increased serum creatinine and decreased urine output values promptly.

Can an infection usually precede glomerulonephritis?

An infection may precede glomerulonephritis by 10 days

What is anaplasia when describing cancer cells?

Anaplasia is the cancer cells' loss of the specific appearance of their parent cells. They are anaplastic.

Patients with uterine cancer may have _____ due to bleeding.

Anemia

What causes high levels of MCV?

Anemia caused by vitamin B12 or Folate deficiency

True or False Benign prostatic hyperplasia (BPH) is an abnormal growth.

False It is a benign growth as the cells increase in size not number.

Our teacher stated in class that burn victims can go to the ER, but burns of what body parts warrant a trip to a specialized burn care center? Why?

Any burn of digits, head, or perianal area, and extreme age (young or old) warrant a trip to specialized burn care center because you want to retain function of these areas.

Who should use appropriate PPE when handling chemo drugs?

Anyone and everyone Most chemotherapy drugs, even oral drugs, are absorbed through the skin and mucous membranes. As a result, the health care workers who prepare or give these drugs (especially nurses and pharmacists) are at risk for absorbing them. Appropriate PPE includes eye protection, masks, double gloves or "chemo" gloves, and gown.

Who should use appropriate PPE when handling chemo drugs?

Anyone handling chemo drugs must use appropriate PPE

Why are diabetics at high risk for renal disease?

Anyone who has been a diabetes for 20 or more years they are at high risk, especially if they have high glucose episodes repeatedly. This is because glucose is a large molecule, and if they go through tiny blood vessels, it causes damage over time.

What is apoptis?

Apoptosis is programmed cell death. Not only do normal cells have to divide only when needed and perform their specific differentiated functions, some cells also have to die at the appropriate time to ensure optimum body function.

What would make the provider think meningitis is viral in origin when analyzing the CSF?

Appearance is clear Increased white blood cells Protein is only slightly increased Glucose is most often normal CSF pressure varies

What would make the provider think meningitis is bacterial in origin when analyzing the CSF?

Appearance is cloudy and turbid White blood cells are increased Protein is increased Glucose is decreased CSF pressure is elevated

What happens as a result of the inflammatory response becoming the enemy?

As a result there is widespread vasodilation and blood pooling.

What happens to the G6PD as it gets used in patients with G6PD deficiency anemia?

As the G6PD gets used it is not replaced (as it would be in people without this disease).

What are progressive signs of ALS?

As the disease progresses, muscle atrophy, particularly of the trapezius and sternocleidomastoid muscles, develops. Eventually the respiratory muscles become involved, leading to respiratory compromise, pneumonia, and death.

What are the nursing implications for the older with change in perception of pain? Why?

Ask the patient to describe the nature and specific characteristics of pain. Monitor additional assessment variables to detect possible health problems. Accurate and complete nursing assessment ensures that the interventions will be appropriate for the older adult

Yellow box

Aspiration or biopsy procedures are invasive, and sterile precautions are observed.

What drugs can cause symptoms in those with G6PD anemia?

Aspirin, sulfonimides

Yellow box

Assess breath sounds every 2 to 4 hours during the first few days after spinal cord injury, and document and report any adventitious or diminished sounds. Monitor vital signs carefully, and watch for changes in respiratory pattern.

Yellow box

Assign a registered nurse rather than a licensed practical nurse/licensed vocational nurse (LPN/LVN) or unlicensed assistive personnel (UAP) to assess the vital signs of a patient who is at risk for or suspected of having hypovolemic shock.

What should be avoided if the client has diabetic nephropathy?

Avoid X-ray contrast media & dehydration

What are some primary preventions of cancer?

Avoid known or potential carcinogens Modify associated factors Removal of "at risk" issues

What is nocturia?

Awakening prematurely from sleep because of the need to empty the bladder

A 40-year-old African-American woman is newly diagnosed with mild chronic kidney disease (CKD). She is otherwise very fit and healthy,and no one in her family has CKD. She asks the nurse whether any of the following factors could have caused this problem. Which factor should the nurse indicate may have influenced the development of CKD? A. She has followed a vegetarian diet that includes eggs but no dairy products for the past 3 years. B. She has taken 220 mg of naproxen twice daily for 3 years. C. Her mother and older sister have type 2 diabetes. D. She drinks 3 liters of water daily.

B

A 67-year-old client who had an abdominal x-ray as part of preadmission testing for a gastrointestinal problem has just been told that he has a horseshoe-shaped kidney. He is very upset, telling the nurse that he has never had any health problems until the past month and now feels that he is "falling apart." What is the nurse's best response? A. Remind him that it was lucky that he was being x-rayed anyway and that the problem was found at an early stage. B. Reassure him that it is unlikely that the kidney shape is important since he has not had other kidney problems. C. Ask him whether anyone else in his family has ever been diagnosed with a horseshoe-shaped kidney. D. Reassure him that his health care provider will request a consultation with a kidney specialist.

B

A client was admitted this morning with an incomplete spinal cord injury and is placed in a halo fixator vest after surgery. Which assessment finding will the nurse report immediately to the health care provider? A. Pulse rate of 78 beats/min B. Blood pressure of 88/42 mm Hg C. Pain level of 4 on a 0-to-10 pain scale D. Loosened halo vest

B

Which action is most important for the nurse to implement to prevent nausea and vomiting in a client who is prescribed to receive the first round of IV chemotherapy? A. Keep the client NPO during the time chemotherapy is infusing. B. Administer antiemetic drugs before administering chemotherapy. C. Ensure that the chemotherapy is infused over a 4- to 6-hour period. D. Assess the client for manifestations of dehydration hourly during the infusion period.

B

Which newly admitted client does the nurse consider to be at highest risk for development of sepsis? A. 75-year-old man with hypertension and early Alzheimer's disease B. 68-year-old woman 2 days postoperative from bowel surgery C. 80-year-old community-dwelling man with no other health problems undergoing cataract surgery D. 54-year-old woman with moderate asthma and severe degenerative joint disease of the right knee

B

Which precaution is most important for the nurse to teach a client with leukemia to prevent an infection by autocontamination? A. Take antibiotics exactly as prescribed. B. Perform mouth care three times daily. C. Avoid the use of pepper and raw foods. D. Report any burning on urination immediately.

B

Which statement by a client about preventing stroke indicates a need for further teaching by the nurse? A. "I am going to join Alcoholics Anonymous to help me stop drinking." B. "I only smoke cigars, which is better than smoking cigarettes." C. "I need to walk at least 5 days a week to increase my exercise level." D. "I need to lose at least 30 pounds to get my BMI into normal range."

B

While assessing a client with overactive bladder, the nurse discovers the client also has the following health problems. Which health problem could be made worse by the drug tolterodine (Detrol)? A. Asthma B. Glaucoma C. Hypotension D. Diabetes mellitus

B

A patient recovering from Hodgkin's lymphoma develops radiation pneumonitis 3 months after radiation treatment. For which symptoms of radiation pneumonitis should the nurse observe the patient? A. Bradypnea, cough, and decreased urine output B. Cough, fever, and dypsnea C. Tachypenia, hypotension, and fever D. Cough, tahycardia, and altered mental status

B Radiation pneumonitis is radiation induced lung disease that is fairly common after radiation to the chest. Decreased surfactant to the lung leads to cough, fever, and dyspnea.

Oh Nurse! Which neurons trigger muscle movement? (Select all that apply.) A. Afferent B. Motor C. Efferent D. Sensory

B C

Oh Nurse! What are complications of immobility? (Select all that apply.) A. Unilateral body neglect B. Pressure ulcers C. Vitamin D deficiency D. DVT E. Pneumonia

B C D E

True or False Shock is a disease rather than a condition.

False It is a condition rather than a disease.

What cancers cause motor and/or sensory changes?

Bone and brain cancer

Hypercalcemia occurs in patients with what cancer? Why? What are the symptoms?

Bone cancer or mets to the bones. Calcium is released from bones to the bloodstream. Excess serum calcium causes fatigue, loss of appetite, nausea & vomiting.

The nurse is teaching a client about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure? A. "The doctor will place a small needle in your back and will withdraw some fluid." B. "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." C. "You will be alone because the procedure is sterile; we cannot allow additional people to contaminate the area." D. "You will be sedated, so you will not be aware of anything."

B. "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." It is accurate to describe a crunching sound or scraping sensation. Proper expectations minimize the client's fear during the procedure. A very large-bore needle is used for a bone marrow biopsy, not a small needle; the puncture is made in the hip or in the sternum, not the back. The nurse, or sometimes a family member, is available to the client for support during a bone marrow biopsy. The procedure is sterile at the site of the biopsy, but others can be present without contamination at the site. A local anesthetic agent is injected into the skin around the site. The client may also receive a mild tranquilizer or a rapid-acting sedative (such as lorazepam [Ativan]) but will not be completely sedated.

After reviewing the laboratory test results, the nurse calls the health care provider about which client? A. A 44-year-old receiving warfarin (Coumadin) with an international normalized ratio (INR) of 3.0 B. A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 C. A 49-year-old with hemophilia and a platelet count of 150,000/mm3 D. A 52-year-old who has had a hemorrhage with a reticulocyte count of 0.8%

B. A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 The client with a fever is neutropenic and is at risk for sepsis unless interventions such as medications to improve the WBC level and antibiotics are prescribed. The INR of 3.0 in the 44-year-old indicates a therapeutic warfarin level. A platelet count of 150,000/mm3 in the 49-year-old is normal. An elevated reticulocyte count in the 52-year-old is expected after hemorrhage.

A nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? A. 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) B. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours C. 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy D. 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

B. Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client may be oversedated and may not be aware of any discomfort caused by bladder distention.

A 40-year-old person presents with a platelet level of 40,000/mm³. What is your priority? A. Fever B. Bleeding precautions C. Risk for infection D. Confusion

B. Bleeding precautions

Which factor is an indicator for a diagnosis of hydronephrosis? A. History of nocturia B. History of urinary stones C. Recent weight loss D. Urinary incontinence

B. Causes of hydronephrosis or hydroureter include tumors, stones, trauma, structural defects, and fibrosis.

The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding? A. Easy bruising B. Dyspnea C. Night sweats D. Chest wound

B. Dyspnea Dyspnea is a sign of lung cancer, as are cough, hoarseness, shortness of breath, bloody sputum, arm or chest pain, and dysphagia. Easy bruising is a nonspecific finding. Night sweats is a symptom of the lymphomas. A chest wound is not specific to lung cancer.

A recently admitted client who is in sickle cell crisis requests "something for pain." What does the nurse administer? A. Intramuscular (IM) morphine sulfate B. Intravenous (IV) hydromorphone (Dilaudid) C. Oral ibuprofen (Motrin) D. Oral morphine sulfate (MS-Contin)

B. Intravenous (IV) hydromorphone (Dilaudid) The client needs IV pain relief, and it should be administered on a routine schedule (i.e., before the client has to request it). Morphine is not administered intramuscularly (IM) to clients with sickle cell disease (SCD). In fact, all IM injections are avoided because absorption is impaired by poor perfusion and sclerosed skin. Nonsteroidal anti-inflammatory drugs may be used for clients with SCD for pain relief once their pain is under control; however, in a crisis, this choice of analgesic is not strong enough. Moderate pain may be treated with oral opioids, but this client is in a sickle cell crisis; IV analgesics should be used until his or her condition stabilizes.

The charge nurse is making client assignments for the day shift. Which client would be best to assign to an LPN/LVN? A. A client who has just returned from having a kidney artery angioplasty B. A client with polycystic kidney disease who is having a kidney ultrasound C. A client who is going for a cystoscopy and cystourethroscopy D. A client with glomerulonephritis who is having a kidney biopsy

B. Kidney ultrasounds are noninvasive procedures without complications; the LPN/LVN can provide this care.

The nurse is reviewing complete blood count (CBC) data for a 76-year-old client. Which decreased value causes concern because it is not age-related? A. Hemoglobin level B. Platelet (thrombocyte) count C. Red blood cell (RBC) count D. White blood cell (WBC) response

B. Platelet (thrombocyte) count Platelet counts do not generally change with age. Hemoglobin levels in men and women fall after middle age; iron-deficient diets may play a role in this reduction. Total RBC and WBC counts (especially lymphocyte counts) are lower in older adults. The WBC count does not rise as high in response to infection in older adults as it does in younger people.

The RN is caring for a client who has just had a kidney biopsy. Which of these actions should the nurse perform first? A. Obtain BUN and creatinine. B. Position the client supine. C. Administer pain medications. D. Check urine for hematuria.

B. The client is positioned supine for several hours after a kidney biopsy to decrease the risk for hemorrhage.

A 67-year-old client who had an abdominal x-ray as part of pre-admission testing for a gastrointestinal problem has just been told that he has a horseshoe-shaped kidney. He is very upset, telling the nurse that he has never had any health problems until the past month and now feels that he is "falling apart." What is the nurse's best response? A. Remind him that it was lucky that he was being x-rayed anyway and that the problem was found at an early stage. B. Reassure him that it is unlikely that the kidney shape is important since he has not had other kidney problems. C. Ask him whether anyone else in his family has ever been diagnosed with a horseshoe-shaped kidney. D. Reassure him that his health care provider will request a consultation with a kidney specialist.

B. Variations in the number and shape of the kidneys are relatively common. Most variations are not harmful and do not require further assessment. The fact that this client is 67 years old and has had few health problems is a good indication that this is just an incidental finding on x-ray and has no meaning for his kidney health.

Which percussion technique does the nurse use to assess the client with reports of flank pain? A. Places fingers outstretched over the flank area and percusses with fingertips B. Places one hand with palm down flat over the flank area and uses the other fisted hand to thump the hand on the flank C. Places one hand with the palm up over the flank area and cups the other hand to percuss the hand on the flank D. Quickly taps the flank area with cupped hands

B. While the client assumes a sitting, side-lying, or supine position, form one of the hands into a clenched fist. Place the other hand flat over the costovertebral (CVA) angle of the client. Then, quickly deliver a firm thump to the hand over the CVA area.

How is bone marrow important in regards to white blood cells?

Bone marrow selectively retains immature WBCs as a reserve pool that can be rapidly mobilized in response to the bodies' needs.

How is MG diagnosed?

Because the incidence of MG is rare, diagnosis may be delayed or missed. An experienced clinician can diagnose the disease from the history and physical examination findings. MG may be immediately confirmed by the patient's response to cholinergic drugs. A standard series of laboratory studies is usually performed for patients with known or suspected MG.

Why are patients not radioactive and therefore not hazardous in teletherapy?

Because the source is external, the patient is not radioactive and is not hazardous to others.

Why is stomach cancer a late diagnosis?

Because the stomach is a hollow organ

Why should jewelry be taken off if not on an area with burned skin?

Because there will be swelling (edema).

When do motor changes occur for the patient with bone cancer?

Bone metastasis causes pain, fractures, spinal cord compression, and hypercalcemia, each of which reduces mobility.

Breast cancer usually metastasizes where?

Bone* Lung* Liver Brain *Most common site of metastasis for the specific malignant neoplasm.

What can happen if you have a kidney infection or if you don't drink and pee often?

Bacteria will grow and grow and you are more likely to have an infection because the urine is static.

What is Vesicoureteral reflux?

Bacteria-laden urine is forced backward from the bladder up into the ureters and kidneys, where pyelonephritis can develop. Reflux of sterile urine can cause kidney scarring, which may promote kidney dysfunction.

What does an increase in WBC and a decrease in glucose in the CSF indicate?

Bacterial infection

What is first given for UTIs?

Bactrim

By destroying blood cells, the spleen helps balance what ?

Balance blood cell production

Yellow box

Be alert for symptoms of increased ICP in the stroke patient, and report any deterioration in the patient's neurologic status to the health care provider immediately! The first sign of increased ICP is a declining level of consciousness (LOC).

What are the differences between alert, lethargic, stuporous, and comatose?

Be aware that a change in LOC (level of consciousness) is the first indication that central neurologic function has declined! The patient who is described as alert is awake and responsive. A patient may be alert but not oriented to person, place, or time. Patients who are less than alert are labeled lethargic, stuporous, or comatose. A lethargic patient is drowsy or sleepy but is easily awakened. One who is arousable only with vigorous or painful stimulation is stuporous. The comatose patient is unconscious and cannot be aroused.

What are benign tumor cells?

Benign tumor cells are normal cells growing in the wrong place or at the wrong time.

What is the life expectancy for the patient with multiple sclerosis?

Book says: Patients with MS have a normal life expectancy as long as the effects of the disease are treated. Teacher says: Life expectancy is 85% of normal.

Is it either viral or bacterial in origin?

Both

Generalized seizures involve which hemisphere?

Both hemispheres

How do biological response modifiers work?

Biological response modifiers (BMRs) work by stimulating the immune system to recognize cancer cells and take action to eliminate or destroy them.

How is thyroid cancer diagnosed?

Biopsy, radioiodine scan, PET scan, CT, MRI to c/o mets, ultrasound, chest x-ray

What is the color with deep full-thickness burns?

Black

What is the color of full-thickness burns?

Black, brown, yellow, white, red

Would a black patient or a white patient be at risk for a lower GFR?

Blacks, Hispanics, native americans-their GFR decreases faster as they age, faster than whites

If you have frequent UTI, what might that indicate?

Bladder cancer

For uterine (endometrial) cancer, post-menopausal _____ is cancer until proven otherwise.

Bleeding

What precautions are patients with leukemia on?

Bleeding, infection, neutropenic precautions Patients with leukemia don't have enough platelets since their bone marrow is busy making WBCs, therefore they are on bleeding precautions. Even though patients have increased number of WBCs, the WBCs are immature and can't fight off infection effectively. Neutropenic precautions to protect them from pathogens.

What is an ischemic stroke?

Blockage An acute ischemic stroke (AIS) is caused by the occlusion (blockage) of a cerebral artery

Blood components require at least what size gauge?

Blood components are viscous requiring an IV of at least 20-gauge or bigger (bigger IV = smaller gauge) Yellow is 24 gauge, blue is 22 gauge, pink is 20 gauge, green is 18 gauge, and grey is 16 gauge

Dry or itchy skin may indicate what?

Blood disease

What is the first major sign of bladder cancer?

Blood in the urine

What is hemodialysis?

Blood is removed through one tube, filtered, then returned through another tube. Procedure typically takes 3-4 hours and is done every 2 or 3 days.

What is orthostatic hypotension?

Blood pressure goes down as they stand up, and heartrate goes up. That is positive orthostatic test. If patient is on a beta blocker, heart rate is the same-can't increase your heart rate in response to stress-the ability is blocked.

How is blood pressure effected by dialysis?

Blood pressure: take fluid off so bp might be too low when coming back from dialysis-measure before and after.

True or False Bowel and bladder problems are commonly seen in Parkinson's disease?

Bowel and bladder problems are commonly seen in PD due to malfunction of the autonomic nervous system, which regulates smooth muscle activity. Patients can exhibit symptoms of either urinary incontinence or difficulty urinating. Constipation can occur due to the slow motility of the GI tract or because of poor dietary habits and poor fluid intake.

What are treatments for thyroid cancer?

Brachytherapy, surgery, chemotherapy, radioactive iodine

_______ is an "ominous sign" in a child who is in shock.

Bradycardia Our teacher also said that decreased heart rate and decreased o2 sat is an ominous sign in children- might mean cardiac arrest

Skin melanoma usually metastasizes where?

Brain

A client being treated for advanced breast cancer with chemotherapy reports that she must be allergic to one of her drugs because her entire face is swollen. What assessment does the nurse perform? A. Asks whether the client has other known allergies B. Checks the capillary refill on fingernails bilaterally C. Examines the client's neck and chest for edema and engorged veins D. Compares blood pressure measured in the right arm with that in the left arm

C

What does cardiac output equal?

CO (cardiac output)=HR (heartrate) X SV (stroke volume).

A client receiving high-dose chemotherapy who has bone marrow suppression has been receiving daily injections of epoetin alfa (Procrit). Which assessment finding indicates to the nurse that today's dose should be held and the health care provider notified? A. Hematocrit of 28% B. Total white blood cell count of 6200 cells/mm3 C. Blood pressure change from 130/90 mmHg to 148/98 mmHg D. Temperature change from 99° F (37.2° C) to 100° F (37.8° C)

C

The Epstein-Barr virus causes what type of malignancies?

Burkitt's lymphoma, B-cell lymphoma, nasopharyngeal carcinoma

What is a flash burn?

Burn caused by intense flash of light, electric current, or thermal radiation.

Why is there decreased bladder capacity in older adults?

By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided. A quick response may alleviate episodes of urinary stress incontinence.

A client returns from the postanesthesia care unit (PACU) after a craniotomy for removal of a right frontal lobe tumor. How will the nurse position the client after surgery? A. Flex the client's knees to decrease intra-abdominal pressure. B. Keep the client on the right side to prevent surgical site bleeding. C. Elevate the client's head to at least 30 degrees to promote venous drainage. D. Log roll the client, and keep the head elevated at no more than 15 degrees.

C

A client with Alzheimer's disease asks the nurse to find her mother, who is deceased. What is the nurse's best response? A. "Your mother died over 20 years ago." B. "I'll find your mother as soon as I finish passing meds." C. "What did your mother look like?" D. "I'll ask your daughter to find your mother."

C

A client with a confirmed acute ischemic stroke is admitted to the medical unit after evaluation in the emergency department. What is the nurse's priority action on admission? A. Ask the nursing technician to weigh the client and record it. B. Consult with the physical therapist about the client's rehabilitative care. C. Keep the client NPO until the swallowing assessment is complete. D. Give warfarin and check activated thromboplastin levels.

C

A client's urinalysis shows all of the following results. Which result does the nurse report to the health care provider? A. pH 5.8 B. Osmolarity 450 C. Nitrites present D. Sodium 5mEq/L

C

Oh Nurse! A patient on chemo is scheduled to be washed. The patient tells the nurse "I really don't want to wash up. I'm too tired." What is the best response by the nurse? A. "You had a bath this morning. Why don't you try to sleep and we will help you wash again tomorrow?" B. "I understand you are tired. Please rest now so you can wash up later." C. "I understand you are tired. The chemo reduces your white blood cells therefore washing is needed to prevent illness." D. "Being tired is understandable when you are on chemo. I will send in your favorite CNA to assist in washing."

C

Oh Nurse! The nurse is instructing a patient to perform a testicular self-examination. Which of the following should the nurse include in the instructions? A. Do the testicular exam at least once every 6 months. B. Gently feel the testicle with one finger to feel for a growth. C. The best time for the exam is after a shower. D. Examine the testicles while lying down.

C

Oh Nurse! Which neurological disorder is most likely to require hourly sensory assessment of a patient? A. Parkinson's disease B. Alzheimer's diseae C. Guillian-Barre syndrome D. Huntington disease

C

The client admitted to the emergency department 1 hour after a motorcycle crash has all of the following laboratory test results. Which result does the nurse report to the health care provider immediately? A. Blood glucose level of 138 mg/dL B. Blood urea nitrogen of 22 mg/dL C. Blood osmolarity of 330 mOsm D. Serum potassium of 4.9 mEq/L

C

The client prescribed cephalexin (Keflex) for cystitis reports that she has had a severe allergic reaction to penicillin in the past. What is the nurse's best action? A. Reassure the client that Keflex is not penicillin. B. Place an allergy alert band on the client's wrist. C. Notify the prescriber before administering the first Keflex dose. D. Highlight this important information in the client's medical record.

C

The nurse observes that a patient has difficulty initiating the flow of urine, even when the bladder is full and the urge to void is present. What is the best term to describe this assessment finding? A. dysuria B. urgency C. hesitancy D. frequency

C

Oh Nurse! Which of the following is appropriate nursing care for a clinic patient with a migraine headache? (Select all that apply) A. Assist the patient to a brightly lit area in the waiting room. B. Offer a cup of coffee to relieve anxiety. C. Assign the patient to a darkened room D. Ask if the patient has done anything about the headache. E. Ask the patient about recent Botox treatment.

C D E Teacher said: Caffeine might be a trigger for a migraine, even if it is used to treat headaches. Botox is sometimes used to treat migraines.

What are the seven warning signs of cancer?

C Changes in bowel or bladder habits A A sore that does not heal U Unusual bleeding or discharge T Thickening or lump in the breast or elsewhere I Indigestion or difficulty swallowing O Obvious change in a wart or mole N Nagging cough or hoarseness

Which of the following would alarm the nurse immediately after return of the client from the operating room for cystoscopy performed under conscious sedation? A. Pink-tinged urine B. Urinary frequency C. Temperature of 100.8 D. Client lethargic

C. Fever, chills, or an elevated white blood cell (WBC) count suggests infection after an invasive procedure; notify the provider.

A 56-year-old client admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. An infection develops. What knowledge does the nurse use to determine that the appropriate antibiotic has been prescribed for this client? A. Evaluating the client's liver function tests (LFTs) and serum creatinine levels B. Evaluating the client's white blood cell (WBC) count level C. Checking the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection D. Recognizing that vancomycin (Vancocin) is the drug of choice used to treat all infections in clients with AML

C. Checking the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection Checking the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection is the best action to take. Drug therapy is the main defense against infections that develop in clients undergoing therapy for AML. Agents used depend on the client's sensitivity to various antibiotics for the organism causing the infection. Although LFTs and kidney function tests may be influenced by antibiotics, these tests do not determine the effectiveness of the antibiotic. Although the WBC count is elevated in infection, this test does not influence which antibiotic will be effective in fighting the infection. Vancomycin may not be effective in all infections; culturing of the infection site and determining the organism's sensitivity to a cohort of drugs are needed, which will provide data on drugs that are capable of eradicating the infection in this client.

Which instruction is most appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy? A. Bathe in cold water. B. Wear cotton gloves when cooking. C. Consume a diet high in fiber. D. Make sure shoes are snug.

C. Consume a diet high in fiber. A high-fiber diet will assist with constipation due to neuropathy. The client should bathe in warm water, not hotter than 96° F. Cotton gloves may prevent harm from scratching; protective gloves should be worn for washing dishes and gardening. Wearing cotton gloves while cooking can increase the risk for burns. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy.

When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which of these? A. Abdominal girth B. Presence of urinary infection C. History of hysterectomy D. Hematuria

C. The scanner must be in the scan mode for male clients to ensure the scanner subtracts the volume of the uterus from the measurement.

The nurse is teaching the client how to provide a "clean catch" urine specimen. Which statement by the client indicates that teaching was effective? A. "I must clean with the wipes and then urinate directly into the cup." B. "I will have to drink 2 liters of fluid before providing the sample." C. "I'll start to urinate in the toilet, stop, and then urinate into the cup." D. "It is best to provide the sample while I am bathing."

C. To provide a clean catch urine sample, the client should initiate voiding, then stop, then resume voiding into the container. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra.

The nurse is caring for a patient with nephrostomy. Which of the following assessment findings is the highest priority? A. Urine is cloudy B. Urine if foul smelling c. Urine is absent D. Urine is bloody

C. Urine is absent.

The oncology nurse should use which intervention to prevent disseminated intravascular coagulation (DIC)? A. Monitoring platelets B. Administering packed red blood cells C. Using strict aseptic technique to prevent infection D. Administering low-dose heparin therapy for clients on bedrest

C. Using strict aseptic technique to prevent infection Sepsis is a major cause of DIC, especially in the oncology client. Monitoring platelets will help detect DIC, but will not prevent it. Red blood cells are used for anemia, not for bleeding/coagulation disorders. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.

A nurse is educating a female about hygiene measures to reduce her risk for urinary tract infection. What does the nurse instruct the client to do? A. "Douche-but only once a month." B. "Use only white toilet paper." C. "Wipe from your front to your back." D. "Wipe with the softest toilet paper available."

C. Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection.

The nurse receives report on a client with hydronephrosis. Which laboratory study should the nurse monitor? A. Hemoglobin and hematocrit (H&H) B. White blood cell (WBC) count C. Blood urea nitrogen and creatinine D. Lipid levels

C. With back pressure on the kidney, glomerular filtration is reduced or absent resulting in permanent kidney damage; BUN and creatinine are kidney function tests.

When does chronic kidney disease (CKD) become end stage renal disease (ESRD)?

CKD becomes ESRD (End Stage Renal Disease) when kidney function is too poor to sustain life

The Hepatitis B virus causes what type of malignancies?

Primary liver carcinoma

What imaging test can diagnose a stroke?

CT without contrast is the most important diagnostic tool. May be repeated after 24 hours to determine if problem is worsening.

How are tumors of the neck diagnosed?

CT, MRI, Biospy, laryngoscopy

Dosages for most chemotherapy drugs are calculated how?

Calculated based upon the type of cancer and BSA. Dosages for most chemotherapy drugs are calculated according to the type of cancer and the patient's size. Usually, calculations are based on milligrams per square meter of total body surface area (TBSA), which considers both the patient's height and weight.

What are malignant cells?

Cancer (malignant) cells are abnormal, serve no useful function, and are harmful to normal body tissues.

Exposure to what is responsible for about 80% of cancer in North America.

Carcinogens

What does T(is) stand for when staging tumors?

Carcinoma in situ (hasn't metastasized yet)

What is the difference between carcinomas, sarcomas, blastomas, lymphomas, and leukemia?

Carcinomas are tumors of glandular or epithelial tissue; sarcomas are tumors of connective tissue, muscle, and bone; blastomas are tumors of less differentiated, embryonal tissues; lymphomas are tumors of the lymphatic system; leukemia is a tumor of blood-forming cells.

When does cardiogenic shock occur?

Cardiogenic shock occurs when the actual heart muscle is unhealthy and pumping is directly impaired. It is shock-pump failure, fluid volume is not affected.

Why do these cardiovascular manifestations of shock occur?

Cardiovascular changes that occur with hypovolemic shock start with decreased mean arterial pressure (MAP) leading to compensatory responses. Thus the earliest clinical signs of hypovolemic shock are cardiovascular. Assess the central and peripheral pulses for rate and quality. In the initial stage of hypovolemic shock, the pulse rate increases to keep cardiac output and MAP at normal levels, even though the actual stroke volume (amount of blood pumped out from the heart) per beat is decreased. Increased heart rate is the earliest manifestation of shock. Because stroke volume is decreased, the peripheral pulses are difficult to palpate and are blocked with light pressure. As shock progresses, peripheral pulses may be absent.

Most often, shock is a result of what problem?

Cardiovascular problem

In regards to hematology, what should the nurse be aware of when doing a cardiovascular assessment?

Cardiovascular: Often the heart enlarges (cardiomegaly) if anemia is ongoing. PMI might be displaced-might be lateral and more superior if it is enlarged.

CAUTI

Catheter associated UTI

Which laboratory test result for a client who is about to have a nephrostomy for hydronephrosis does the nurse report immediately to the physician? A. Serum sodium 137 mEq/L B. Serum potassium 4.8 mEq/L C. Blood urea nitrogen (BUN) 23 mg/dL D. International normalized ratio (INR) 4.6

D

The Hepatitis C virus causes what type of malignancies?

Primary liver carcinoma, possibly B-cell lymphomas

What is the cause of Bell's Palsy?

Cause may be unknown, due to recent dental trauma, or due to dormant herpes simplex virus.

What is Barrett's esophagus?

Caused by GERD. Cuboidal cells become columnar in esophagus due to low ph due to GERD. It is considered to be pre-cancerous. Barrett's esophagus is a results of a patient that has GERD for long periods of time because the esophagus can't handle the stomach acid and it changes into a pre-cursor for esophageal cancer.

What is postrenal acute kidney injury?

Caused by obstruction to outflow

What causes prerenal acute kidney injury?

Caused by poor blood flow to the kidneys

Folic acid deficiency anemia is caused by what?

Caused by poor nutrition, bowel problems leading to lack of absorption (for example Crohn's Disease), and alcoholism.

What causes non-pitting edema?

Causes include: disorders of lymphatic system, morbid obesity, pretibial myxedema, burns (proteins leak out of capillaries).

What causes pitting edema?

Causes includes increased hydrostatic pressure and decreased oncotic pressure in the vasculature-third spacing fluid.

Why do the cells in sickle cell disease become sickle in shape?

Cells become sickle in shape due to hypoxia

What happens to cells with reduced amounts of G6PD?

Cells with reduced amounts of G6PD break more easily, especially during exposure to some drugs (aspirin, sulfonimides).

Primary brain cancer usually metastasizes where?

Central nervous system

Why is cerebral angiography done? Is the patient able to stand up, or does she have to lay down?

Cerebral angiography (arteriography) is done to visualize the cerebral circulation to detect blockages in the arteries or veins in the brain, head, or neck. A contrast medium is injected into an artery (usually the femoral) to identify aneurysms, traumatic injuries, strictures/occlusions, tumors, blood vessel displacement from edema, and arteriovenous (AV) malformations. The patient is placed on an examining table and made as comfortable as possible. Patient needs to be able to lay down.

What is the most common brain tumor?

Cerebral tumors are the most common

Which laboratory value in a client with sickle cell disease does the nurse report immediately to the health care provider? A. Hematocrit 24% B. Hemoglobin S (HbS) 78% C. Platelet count 260,000/mm3 D. White blood cell (WBC) count 20,000/mm3

D

Why do these neuromuscular and central nervous system manifestations occur?

Central nervous system changes with shock first manifest as thirst. Thirst is caused by stimulation of the thirst centers in the brain in response to decreased blood volume. Assess the patient's level of consciousness (LOC) and orientation. Central nervous system changes of hypovolemic shock are caused by cerebral hypoxia. In the initial and nonprogressive stages, patients may be restless or agitated and may be anxious or have a feeling of impending doom that has no obvious cause. As hypoxia progresses, confusion and lethargy occur. Lethargy progresses to somnolence and loss of consciousness as cerebral hypoxia worsens with shock progression. Skeletal muscle changes during shock are muscle weakness and pain in response to tissue hypoxia and anaerobic metabolism, which are later manifestations. Weakness is generalized and has no specific pattern. The electrolyte changes of shock worsen muscle weakness by decreasing action potentials. Then deep tendon reflexes are decreased or absent. Assess muscle strength by having the patient squeeze your hand and by trying to keep his or her arms flexed while you attempt to straighten them. Assess deep tendon reflexes by lightly tapping the patellar tendons and Achilles tendons with a reflex hammer and observing the degree of reflexive movement.

What are the signs and symptoms of brain tumors?

Cerebra edema, increased ICP, neurological defects, headaches (worse in AM), nausea, vomiting, vision changes, seizures, AMS (altered mental status), papilledema (optic disk swelling), pituitary dysfunction (SIADH, Diabetes Insipidus, fluid and electrolyte imbalance).

Human papilloma virus causes what type of malignancies?

Cervical carcinoma, vulvar carcinoma, and other anogenital carcinomas

Cervical neck pain most often is the result of what?

Cervical neck pain most often results from a bulging or herniation of the nucleus pulposus (HNP) in an intervertebral disk.

What is the first indicator of neurological decline?

Change in level of consciousness (LOC)i s the first indicator of neurologic decline.

What is mean by saying a person with Parkinson's may have a mask-like face? What causes it?

Changes in facial expression or a mask-like face with wide-open, fixed, staring eyes is caused by rigidity of the facial muscles

How is restless leg syndrome (RLS) characterized?

Characterized by paresthesia (burning, prickly sensation) with an irresistible urge to move legs.

In regards to hematology, what would you assess about the client's head and neck?

Check for pallor or ulceration of the mouth mucosa. The tongue may be completely smooth in pernicious anemia and iron deficiency anemia or smooth and beefy red in nutritional deficiencies. These manifestations may occur with fissures at the corners of the mouth. Assess for jaundice of the sclera. Inspect and palpate all lymph node areas. Document any lymph node enlargement, including whether palpation of the enlarged node causes pain and whether the enlarged node moves or remains fixed with palpation.

Where should the nurse be when a patient has dialysis?

Check on them as often as you do other patients. Or call up there, see how they are doing.

What are the three categories of carcinogens?

Chemical, physical, viral

What is chemical-induced distributive shock? What are the three common origins of chemical-induced distributive shock?

Chemical-induced distributive shock has three common origins: anaphylaxis (massive vasodilation), sepsis, and capillary leak syndrome. It occurs when certain body chemicals or foreign substances in the blood and vessels start widespread changes in blood vessel walls. The chemicals are usually exogenous (originate outside the body), but this type of shock also can be induced by substances normally found in the body (endogenous), such as excessive amounts of the mediator histamine.

What can cause mucositis?

Chemotherapy

What are some treatments for brain tumors?

Chemotherapy Surgery

Why does having a systemic effect make chemotherapy useful?

Chemotherapy is useful in treating cancer because its effects are systemic, providing the opportunity to kill metastatic cancer cells that may have escaped local treatment.

What are the side effects of hormonal manipulation? Why?

Chest and facial hair in women, gynecomastia (breast growth) and bone loss in men. Androgens and the antiestrogen receptor drugs cause masculinizing effects in women, while feminine manifestations appear in men who take estrogens, progestins, or antiandrogen receptor drugs. For men and women receiving androgens, acne may develop, hypercalcemia is common, and liver dysfunction may occur with prolonged therapy. All patients who take estrogen or progestins are at increased risk for venous thromboembolism.

What is a coup contusion?

Contusion due to direct impact A contusion is bruising of the brain tissue usually found at the site of impact (coup injury) or in a line opposite the site of impact (contracoup injury).

How can you give psychological support to the patient who has just undergone surgery for cancer?

Coordinate with the health care team to support the patient. Encourage the patient and family to express their concerns. Help the patient accept changes in appearance or function by encouraging him or her to look at the surgical site, touch it, and participate in dressing changes. Provide information about support groups such as those sponsored by the American Cancer Society. Discuss having a person who has coped with the same issues come for a visit. Such visits can be valuable in showing the patient that many aspects of life can be the same after cancer treatment. If the patient is open to this type of support, arrange for a visit. For patients who have persistent sadness or depression as a result of appearance changes from cancer surgery, a referral to a mental health counselor and drug therapy may be needed.

What are anticholinesterase drugs?

Cholinesterase (ChE) inhibitor drugs are the first-line management of MG. These drugs are also referred to as anticholinesterase drugs or antimyasthenics. They enhance neuromuscular impulse transmission by preventing the decrease of ACh by the enzyme ChE. This increases the response of the muscles to nerve impulses and improves muscle strength. The ChE inhibitor drug of choice is pyridostigmine (Mestinon, Regonol). Expect day to- day variations in dosage depending on the patient's changing symptoms. Administer ChE inhibitors with a small amount of food to help alleviate GI side effects.

In regards to tumor nomenclature, what is the prefix if the tissue of origin is cartilage?

Chondro

Sickle cells disease can result in what comorbidities?

Chronic anemia, pain, disability, organ damage, risk for infection, and early death

What is given for repeat UTIs?

Cipra and Levaquin are Fluoroquinolones given for repeat UTIs-not first line of drug choice. Bactrim is.

How long do thrombocytes circulate in the blood?

Circulates for about 10 days

Which statement made by a client with folic acid deficiency anemia indicates to the nurse a correct understanding of self-management for this health problem? A. "If my fingers and toes become numb, I will notify my health care provider immediately." B. "I will stop playing contact sports or any activity that increases my risk for injury." C. "My diet now includes more carrots, cauliflower, and apples." D. "I have stopped drinking alcohol completely."

D

How long do cluster headaches last? When do they occur?

Cluster headaches are manifested by brief (30 minutes to 2 hours). They are brief.

When in the disease process does cognitive impairment occur in the patient with MS?

Cognitive impairment may occur early in the disease process. Many patients have some degree of neuropsychological dysfunction during the course of their disease. Areas affected include attention, memory, problem solving, auditory reasoning, handling distractions, visual perception, and use of speech.

What is the second leading cause of cancer death in the USA?

Colon cancer

What is the treatment for rectal cancer?

Colon resection (results in colonostomy).

Liver cancer is most often a metastasis from where?

Colon, lung, breast, kidney, or other GI cancers

What is the definitive test for diagnosis of rectal cancer?

Colonoscopy

What is combination therapy?

Combination chemotherapy is the use of multiple drugs together. Typically they are timed so nadirs (time when WBCs are expected to be at their lowest levels) don't occur simultaneously.

What differentiates into only one cell type?

Committed stem cell

The client with diabetes who also has persistent proteinuria asks what he could do to prevent eventual kidney failure. What is the nurse's best response? A. "Wear pads and other protective gear around your lower back when engaging in contact sports." B. "Drink at least 3 L of water daily and avoid carbonated beverages." C. "Limit your intake of proteins to less than 100 g daily." D. "Keep your blood glucose levels in the target range."

D

What's a common finding in Hodgkin's lymphoma? Is it painful?

Common finding is a large painless node

B12 deficiency anemia is common in what type of diet and diets lacking what?

Common in people on vegetarian diets and on diets lacking dairy products.

What are common problems leading to hypovolemic shock?

Common problems leading to hypovolemic shock are hemorrhage and dehydration.

What are common symptoms of meningitis?

Common symptoms (the same regardless of the cause) include fever, photophobia, URI symptoms, AMS (altered mental status), headaches, myalgias (muscle aches), N & V, seizures, decreased muscle tone and sometimes a maculopapular rash and ICP (intracranial pressure).

In the progressive stage of hypovolemic shock, are the compensatory mechanisms able to deliver sufficient oxygen?

Compensatory mechanisms are functioning but can no longer deliver sufficient O2, not even to vital organs Vital organs are getting hypoxic, non-vital organs ischemic

What does dark amber urine mean?

Concentrated urine

What is aplastic anemia?

Condition that occurs when your body stops producing enough new blood cells due to bone marrow injury.

When can a subvlavian catheter "Vas Cath" be used after it is placed? How can you confirm placement?

Confirm placement using x-ray-can be then used immediately. In emergency, can be done at the bedside.

What are conservative treatments for cervical neck pain?

Conservative treatment for acute neck pain is the same as described for low back pain except the exercises focus on the shoulders and neck. The physical therapist teaches the patient the correct techniques for performing "shoulder shrug," "shoulder squeeze," and "seated rowing." If these treatments do not work, some health care providers prescribe a soft collar to stabilize the neck, especially at night. Using the collar longer than 10 days leads to increased pain and decreased muscle strength and range of motion. For that reason, some health care providers do not recommend collars for cervical disk problems.

What history should you get for your patient when assessing risk factors for hypovolemic shock? Why are these important?

Consider age, history of recent surgery, recent diarrhea/vomiting, ulcers, use of diuretics, fluid intake for the past 24 hours, and urine output. Book says: Age is important because hypovolemic shock from trauma is more common in young adults and other types of shock are more common in older adults. Ask patients about recent illness, trauma, procedures, or chronic health problems that may lead to shock. These problems include GI ulcers, general surgery, hemophilia, liver disorders, and prolonged vomiting and diarrhea. Ask about the use of drugs such as aspirin, other NSAIDs, and diuretics that may cause changes leading to hypovolemic shock. Ask about fluid intake and output during the previous 24 hours. Information about urine output is especially important because urine output is reduced during the first stages of shock, even when fluid intake is normal.

What is a good indicator of renal function?

Creatinine

What is crossmatching of blood? What is type and screen?

Crossmatching is testing of the donor's blood and the recipient's blood for compatibility. Type and screen determines both the ABO-Rh of the patient and screens for the presence of the most commonly found unexpected antibodies.

The wife of a client with severe chronic kidney disease who has a Kussmaul pattern of respiration asks the nurse about giving the client oxygen to ease his respirations. What is the nurse's best response? A. "That is a good idea and I will check with the physician right away." B. "The oxygen mask or tube may increase his risk for skin breakdown." C. "He will probably need a high flow of oxygen because he is also anemic." D. "Oxygen will not help his respirations and could make his acidosis worse."

D

When does distributive shock occur?

Distributive shock occurs when blood volume is not lost from the body but is distributed to the interstitial tissues where it cannot circulate and deliver oxygen.

When providing discharge teaching to a client after a lumbar laminectomy, the nurse teaches him or her to call the surgeon immediately for which potential complication? A. Discomfort at the incision site B. Decreased appetite in the morning C. Slight redness and itching at the incision site D. Clear drainage from the incision site

D

Which clinical manifestation reported by a client suggests to the nurse that anemia is a possibility? A. Difficulty sleeping B. Cold hands and feet C. Chronic headaches D. Shortness of breath

D

What are platelets activated by?

Cytokines

What is cytoreductive surgery?

Cytoreductive, also called debulking - removes part of but not all of the tumor. Increases the likelihood that other surgeries will be successful.

What is cytotoxic edema?

Cytotoxic edema (aka cellular edema) may occur as a result of a hypoxic insult which adversely affects functioning of the Na+ / K+ pump. When the pump fails Na+ enters brain cells pulling water with it.

A client diagnosed with widespread lung cancer asks the nurse why he must be careful to avoid crowds and people who are ill. What is the nurse's best response? A. "With lung cancer, you are more likely to develop pneumonia and could pass this on to other people who are already ill." B. "When lung cancer is in the bones, it becomes a bone marrow malignancy, which stops producing immune system cells." C. "The large amount of mucus produced by the cancer cells is a good breeding ground for bacteria and other microorganisms." D. "When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection."

D

A client is admitted to the critical care unit with possible Guillain-Barré syndrome. Which assessment is the most important for this client? A. Nutritional status assessment B. Nervous system assessment C. Mental status assessment D. Respiratory system assessment

D

Why are the manifestations of most types of shock the same regardless of what specific events or condition caused the shock to occur? A. The blood, blood vessels, and heart are directly connected to each other so that when one is affected, all three are affected. B. Because blood loss occurs with all types of shock, the most common first manifestation is hypotension. C. Every type of shock interferes with oxygenation and metabolism of all cells in the same sequence. D. The sympathetic nervous system is triggered by any type of shock and initiates the stress response.

D

A nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates correct understanding of these procedures? A."If I restrict my oral intake of fluids, the adjustment will be easier." B. "I must go to the restroom more often because my urine will be excreted through my anus." C. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." D. "I will have to drain my pouch with a catheter."

D. For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter.

A client who has been newly diagnosed with leukemia is admitted to the hospital. Avoiding which potential problem takes priority in the client's nursing care plan? A. Fluid overload (overhydration) B. Hemorrhage C. Hypoxia D. Infection

D. Infection The main objective in caring for a newly diagnosed client with leukemia is protection from infection. Fluid overload, hemorrhage, and hypoxia are not priority problems for the client with leukemia.

Which statement about the process of malignant transformation is correct? A. Mutation of genes is an irreversible event that always leads to cancer development in the initiation phase. B. Insulin and estrogen enhance the division of an initiated cell during the promotion phase. C. Tumors form when carcinogens invade the gene structure of the cell in the latency phase. D. Nutrition of cancer cells is provided by tumor angiogenesis factor (TAF) in the promotion stage.

D. Nutrition of cancer cells is provided by tumor angiogenesis factor (TAF) in the promotion stage. The promotion phase consists of progression when the blood supply changes from diffusion to TAF. Insulin and estrogen increase cell division. If cell division is halted, mutation of genes does not lead to cancer development in the initiation phase. In the initiation phase, carcinogens invade the DNA of the nucleus of a single cell. A 1-cm tumor consists of 1 billion cells. The latency phase occurs between initiation and tumor formation.

Which would be an appropriate task to delegate to unlicensed assistive personnel (UAP) working on a medical-surgical unit? A. Administering erythropoietin to a client with myelodysplastic syndrome B. Assessing skin integrity on an anemic client who fell during ambulation C. Assisting a client with folic acid deficiency in making diet choices D. Obtaining vital signs on a client receiving a blood transfusion

D. Obtaining vital signs on a client receiving a blood transfusion Obtaining vital signs on a client is within the scope of practice for UAP. Administering medication, assessing clients, and assisting with prescribed diet choices are complex actions that should be done by licensed nurses.

The home health nurse is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment finding is most important to communicate to the transplant team? A. Temperature of 96.6° F B. Reports of joint pain C. Pink and dry oral mucosa D. Palpable lump in the client's axilla

D. Palpable lump in the client's axilla Clients taking immunosuppressive drugs to prevent rejection are at increased risk for the development of cancer; any lump should be reported to the physician. Fever should be reported to the physician, but this client's temperature is normal. It is not necessary to report joint pain to the transplant team; it is not a sign of rejection and is not a complication of transplant. A pink and dry oral mucosa may be a sign of dehydration, but it is not necessary to report this to the transplant team.

An outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection? A. Storing drugs in dark locations at room temperature B. Wearing soft clothing C. Wearing a hat and sunglasses when going outside D. Reducing all direct and indirect sources of light

D. Reducing all direct and indirect sources of light Lighting of all types must be kept to a minimum with clients receiving photodynamic therapy; it can lead to burns of the skin and damage to the eyes because these clients' eyes are sensitive to light. Any drug that the client is prescribed should be considered for its photosensitivity properties; drugs should be stored according to the recommendations, but this is not the primary concern for this client. Clothing must cover the skin to prevent burns from direct or indirect light; texture is not a concern for the client receiving this treatment. The client will be homebound for 1 to 3 months after the treatment and should not go outside.

What is the most important environmental risk for developing leukemia? A. Direct contact with others with leukemia B. Family history C. Living near high-voltage power lines D. Smoking cigarettes

D. Smoking cigarettes According to the American Cancer Society (ACS), the only proven lifestyle-related risk factor for leukemia is cigarette smoking. Leukemia is not contagious. Genetics is a strong indicator, but it is not an environmental risk factor. According to the ACS, living near high-voltage power lines is not a proven risk factor for leukemia.

What are diagnostic studies for acute kidney injury?

Diagnostic studies include serum creatinine, BUN, K+ and radiology studies to observe size of kidney and possible obstruction. Renal biopsy if cause is uncertain.

A nurse is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts? A. Children's terms that are easily understood B. Slang words and terms that are heard "socially" C. Technical and medical terminology D. Words that the client uses

D. The nurse should use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client.

A client is scheduled for a bone marrow aspiration. What does the nurse do before taking the client to the treatment room for the biopsy? A. Clean the biopsy site with an antiseptic or povidone-iodine (Betadine). B. Hold the client's hand and ask about concerns. C. Review the client's platelet (thrombocyte) count. D. Verify that the client has given informed consent.

D. Verify that the client has given informed consent. Verifying informed consent must be done before the procedure can be performed. A signed permit must be on the client's chart. Cleaning the biopsy site is done before the procedure, but this is not done until consent is verified; it will be done just before the procedure is performed. Holding the client's hand and offering verbal support may be done during the procedure, but the procedure cannot be completed until the consent is signed. Reviewing the client's platelet count is not imperative.

The nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out? A. Coughing and deep breathing B. Evidence of pus C. Fever of 102° F or higher D. Wheezes or crackles

D. Wheezes or crackles Wheezes or crackles in the neutropenic client may be the first symptom of infection in the lungs. Coughing and deep breathing are not indications of infection, but can help prevent it. The client with leukopenia, not neutropenia, may have a severe infection without pus or with only a low-grade fever.

The nurse is caring for postoperative clients at risk for hypovolemic shock. Which condition represents an early symptom of shock? A. Hypotension B. Bradypnea C. Heart blocks D. Tachycardia

D. tachycardia Heart and respiratory rates increased from the client's baseline level or a slight increase in diastolic blood pressure may be the only objective manifestation of this early stage of shock. Catecholamine release occurs early in shock as a compensation for fluid loss; blood pressure will be normal. Early in shock, the client displays rapid, not slow, respirations. Dysrhythmias are a late sign of shock; they are related to lack of oxygen to the heart.

GBS patients are at risk for what kind of nutrition. What does this lead to?

Decreased gastric motility, dysphagia, and depression can cause malnutrition. Collaborate with the dietitian to develop an individualized plan. The patient may require little assistance with feeding or may be totally dependent. If he or she cannot safely swallow food or liquids, enteral nutrition via feeding tube is prescribed. Weigh the patient three times a week, and monitor serum prealbumin each week. Malnutrition places patients at risk for pressure ulcers, especially when they are immobile.

What does a decreased specific urine gravity indicate?

Decreased in chronic kidney disease, diabetes insipidus, malignant hypertension, diuretic administration, and lithium toxicity.

What is Disseminated Intravascular Coagulation (DIC)? What triggers it?

DIC involves extensive, abnormal clotting that uses up clotting factors and platelets. What follows next is extensive bleeding. Practice strict adherence to aseptic techniques during invasive procedures to avoid this life threatening problem. Triggered by many severe illnesses including cancer. In patients with cancer, DIC often is caused by gram-negative sepsis, by the release of thrombin or thromboplastin (clotting factors) from cancer cells, or by blood transfusions.

What is oliguria?

Decreased urine output; total urine output between 100 and 400 mL in 24 hours

Tumors that obstruct the airway has what effect on lung capacity?

Decreases it

What makes a burn a deep partial-thickness wound?

Deep partial-thickness wounds extend deeper into the skin dermis, and fewer healthy cells remain.

What are some manifestations of Heparin-Induced Thrombocytopenia that are often noted with decreased platelet count?

DVT and PE are often but not always noted with the decreased platelet count

What is the first sign of diabetic nephropathy and does damage start before or after first sign?

Damage starts before the first sign which is albuminuria Albuminuria: Because it's a big molecule and it shouldn't be going through. Diabetics and hypertension are common together, and fragile capillaries inside the glomerules can't handle the high pressure so albuminuria can leak through.

When an injury occurs, what releases a chemical signal to begin the process of hemostasis?

Damaged endothelial cells

What does dark brown or red urine mean?

Dark red or brown indicates blood in the urine. Brown also may indicate increased urinary bilirubin level. Red also may indicate the presence of myoglobin.

When does death from GBS occur?

Death is due to respiratory complications or complications of bedrest.

Degree of tissue damage is related to what three things?

Degree of tissue damage is related to: 1. Agent causing the burn 2. Temperature of heat source 3. How long skin was exposed

The nurse notices a patient lost 2 pounds in 24 hours. What is the most likely explanation for this finding?

Dehydration

What is the most common cause of a crisis in sickle cell anemia?

Dehydration

What is the most common cause of too high hematocrit?

Dehydration

If creatinine is normal but BUN is high, what should we suspect? If both are high what should we suspect?

Dehydration Kidney disease

When does dementia occur in Parkinson's?

Dementia is a late sign

What is diagnostic surgery?

Diagnostic surgery (biopsy) is the removal of all or part of a suspected lesion for examination and testing. It provides proof of the presence of cancer. Professor stated in class: "Biopsy is an in and out procedure. Might be done in 10-15 minutes-just use a needle. Some people ask why they don't remove the tissue instead of a doing just a biopsy, but surgery is more aggressive, and the tissue might end up being benign."

What factors contribute to urge incontinence?

Depression, drugs that alter mental status or ambulate, don't have a place to go

What are dermatomes?

Dermatomes represent sensory input from spinal nerves to specific areas of the skin. For example, the patient with an injury to cervical spinal nerves C6 and C7 has sensory changes in the thumb, index finger, middle finger, middle of the palm, and back of the hand.

What is required for there to be blisters when burned?

Dermis

How are cluster headaches described?

Described as excruciating, and nonthrobbing.

What are interventions for obstructive renal disorders?

Determine the cause which may be a tumor, stone, trauma, structural defect, or fibroid. -If the cause is a stone consider removal.

What typically causes chronic kidney injury?

Diabetes and/or hypertension. Glycemic control is so important.

What is a degenerative renal disorder?

Diabetic Nephropathy

What is diastat?

Diastat is rectal valium

What are other risk factors for stomach cancer?

Diet (eating processed/salted/pickled foods)

What should diet typically consist of in chronic kidney disease?

Diet typically should be low in Na+, K+, and protein with limited fluid. Vitamin supplements are needed.

What does differentiated function mean?

Differentiated function means that every normal cell has at least one special function it performs to contribute to whole-body function. For example, skin cells make keratin, liver cells make bile, cardiac muscle cells contract, nerve cells conduct impulses, and red blood cells make hemoglobin.

What is hesitancy?

Difficulty in initiating the flow of urine, even when the bladder has sufficient urine to initiate a void and the sensation of the need to void is present

What are signs and symptoms of liver cancer?

Diffuse, nodular, or single nodule Tumors compress surrounding tissue and invade blood supply, so there may be necrosis and hemorrhage.

What is dysuria?

Discomfort or pain associated with micturition

What is diskectomy?

Diskectomy-removal of herniated disk

You should dispose of chemo in what color bin?

Dispose of chemo in a yellow bin

What can missing doses of chemotherapy lead to?

Disrupting the schedule or reducing dosages has a negative impact on therapy outcomes and leads to drug resistance among cancer cells, disease progression, and reduced survival.

What does M stand for when staging tumors?

Distant Metastasis (M)

Yellow box

Do not assume that complementary therapies alone will provide adequate pain relief. Analgesics are needed to manage sickle cell pain.

Yellow box

Do not use blood administration tubing to infuse stems cells because the cells could get caught in the filter, resulting in the patient receiving fewer stem cells

Why is a lumbar puncture (LP) contraindicated in a person with increased intracranial pressure?

Don't do an LP (lumbar puncture) because if you are taking fluid out of the spine it affects the pressure of the head. Like if a balloon is full of water, and it's under a high pressure-maximum amount of water without bursting-if you hit with pin water squirts with everywhere. So if a brain has increased cranial pressure, the brain can herniate. So LP is contraindicated.

In regards to hematology, what should the nurse keep in mind when doing an abdominal assessment?

Don't palpate spleen if enlarged-might rupture. Spleen shouldn't be palpable-if it is, something hematological is going on.

What are the medications for the patient with Alzheimer's?

Donazepil (Aricept) (most commonly used), rivastigmine (Exelon), Tacrine (Cognex), improve memory Namenda (slows progression of the disease by a few months).

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Doses of digoxin are generally much lower than for most drugs. When digoxin is administered to older adults with kidney disease, the prescribed dose may be even lower (0.0625-0.125mg). Check and re-check the dosage before administering digoxin to a patient with kidney disease.

How can you prevent cystitis?

Drink 8-10 glasses a day Women should wipe front to back Avoid vaginal deodorants and bubble baths Urinate after intercourse

What does pyridium do?

Drug reduces bladder pain and burning on urination by exerting a topical analgesic or local anesthetic effect on the mucosa of the urinary tract.

Why are the incidences of Heparin-Induced Thrombocytopenia (HIT) increasing?

Due to increased heparin use

What is a primary concern during IV chemo?

During IV chemo - extravasation prevention is a primary concern. Extravasation occurs when drug leaks into the surrounding tissues (also called infiltration).

What is the outer layer of skin called?

Epidermis

What is the G0 period in the cycle of a cell?

During the G0 period, cells actively carry out their functions but do not divide. Normal cells spend most of their lives in the G0 state rather than in a reproductive state.

What patient education should the nurse provide to the client with thrombocytopenia?

During the time your platelet count is low: • Use an electric shaver. • Use a soft-bristled toothbrush. • Do not have dental work performed without consulting your cancer health care provider. • Do not take aspirin or any aspirin-containing products. Read the label to be sure that the product does not contain aspirin or salicylates. • Do not participate in contact sports or any activity likely to result in your being bumped, scratched, or scraped. • If you are bumped, apply ice to the site for at least 1 hour. • Avoid hard foods that would scrape the inside of your mouth. • Eat warm, cool, or cold foods to avoid burning your mouth. • Check your skin and mouth daily for bruises, swelling, or areas with small reddish purple marks that may indicate bleeding. • Notify your cancer health care provider if you: • Are injured and persistent bleeding results • Have excessive menstrual bleeding • See blood in your urine or bowel movement • Avoid anal intercourse. • Take a stool softener to prevent straining during a bowel movement. • Do not use enemas or rectal suppositories. • Avoid bending over at the waist. • Do not wear clothing or shoes that are tight or that rub. • Avoid blowing your nose or placing objects in your nose. If you must blow your nose, do so gently without blocking either nasal passage. • Avoid playing musical instruments that raise the pressure inside your head, such as brass wind instruments and woodwinds or reed instruments.

What teaching can the nurse provide to the patient who has myelosuppression and neutropenia?

During the times your white blood cell counts are low: • Avoid crowds and other large gatherings of people who might be ill. • Do not share personal toilet articles, such as toothbrushes, toothpaste, washcloths, or deodorant sticks, with others. • If possible, bathe daily, using an antimicrobial soap. If total bathing is not possible, wash the armpits, groin, genitals, and anal area twice a day with an antimicrobial soap. • Clean your toothbrush at least weekly by either running it through the dishwasher or rinsing it in liquid laundry bleach (and then rinsing the bleach out with hot running water). • Wash your hands thoroughly with an antimicrobial soap before you eat and drink, after touching a pet, after shaking hands with anyone, as soon as you come home from any outing, and after using the toilet. • Avoid eating salads; raw fruits and vegetables; undercooked meat, fish, and eggs; and pepper and paprika. • Wash dishes between use with hot, sudsy water, or use a dishwasher. • Do not drink water, milk, juice, or other cold liquids that have been standing at room temperature for longer than an hour. • Do not reuse cups and glasses without washing. • Do not change pet litter boxes. • Take your temperature at least once a day and whenever you do not feel well. • Report any of these signs or symptoms of infection to your physician immediately: • Temperature greater than 100° F. • Persistent cough (with or without sputum) • Pus or foul-smelling drainage from any open skin area or normal body opening • Presence of a boil or abscess • Urine that is cloudy or foul smelling or that causes burning on urination • Take all prescribed drugs. • Wear clean disposable gloves underneath gardening gloves when working in the garden or with houseplants. • Wear a condom (if you are a man) when having sex. If you are a woman having sex with a male partner, ensure that he wears a condom.

What is the cause of Hodgkin's lymphoma?

Exact cause is unknown, but some researchers believe it's caused by toxins, viruses, or genetic component.

What labs would you expect in a client with sickle cell disease?

Expect Hct between 20% and 30% ↑WBC's (due to chronic inflammation) ↑Reticulocyte count (immature RBCs)

What is the cause of Parkinson's disease?

Exact cause unknown, possible genetic and environmental factors. Our teacher said in class: Pesticide might cause, so it is seen in more rural areas than urban.

What are some examples of benign tumor cells?

Examples include moles, uterine fibroid tumors, skin tags, endometriosis, and nasal polyps.

What are signs and symptoms of superior vena cava syndrome?

Early manifestations occur when the patient arises after a night's sleep and include edema of the face, especially around the eyes, and tightness of the shirt or blouse collar. As the compression worsens, the patient develops engorged blood vessels and erythema of the upper body, edema in the arms and hands, dyspnea, and epistaxis. Late manifestations include hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension. Death results if compression is not relieved.

What is an EMG used for?

Electromyography (EMG) is used to identify nerve and muscle disorders as well as spinal cord disease. Our teacher said in class: EMG-muscles (myo)-some diseases have less electrical activity in the muscles, so we can see how fast the muscle twitches or responds.

Why should rigorous activity be avoided in the patient with MS?

Emphasize the importance of avoiding rigorous activities that increase body temperature. Increased body temperature may lead to increased fatigue, diminished motor ability, and decreased visual acuity resulting from changes in the conduction abilities of the injured axons.

What are nursing interventions for a decreased bladder capacity in older adults?

Encourage the patient to use the toilet, bedpan, or urinal at least every 2 hr Respond as soon as possible to the patient's indication of the need to void.

What is reconstructive surgery?

Enhance appearance

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Ensure that the patient who is prescribed metformin does not receive the drug after a procedure requiring IV contrast material until adequate kidney function has been determined.

What are interventions for the older adult who has nocturia?

Ensure the availability of a toilet, bedpan, or urinal. Ensure adequate nighttime lighting and a hazard-free environment Discourage excessive fluid intake for 2-4 hr before the patient retires for the evening. Evaluate drugs and timing.

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Ensuring that urinary catheters are used appropriately and discontinued as early as possible is everyone's responsibility. Do not allow catheters to remain in place for staff convenience.

What is G6PD?

Enzyme which metabolizes glucose to help generate energy in RBCs

Where is a epidural hematoma located?

Epi means above-epidural is above the dora but below the bone. Epidural is a ruptured artery usually. Epidural hematoma results from arterial bleeding and is often caused by a fracture of the temporal bone which houses the middle meningeal artery. Patient may have lucid interval followed by unconsciousness within minutes off the injury.

What growth factor is needed for a committed stem cell to differentiate into only one cell type, such as red blood cells?

Erythropoietin

What does erythropoietin do?

Erythropoietin: a hormone secreted by the kidneys that increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues Patients don't have this in chronic kidney disease-machine doesn't compensate making erythropoietin, so give patient a drug that stimulates bone marrow to make more RBCs

What are escharotomies and fasciotomies? Why are they needed?

Escharotomies are incisions through the eschar, and fasciotomies are incisions through eschar and fascia that may be needed to relieve pressure and allow normal blood flow and breathing.

What is often a silent tumor that has extensive mets upon diagnosis?

Esophageal Cancer

Why can diabetes cause UTI?

Excess glucose in urine provides a rich medium for bacterial growth (If diabetics have more glucose in the blood, and they leak into the urine due to the excess pressure, than the high glucose feeds the bacteria in the urine). Peripheral neuropathy affects bladder innervation and leads to a flaccid bladder and incomplete bladder emptying (so a diabetic may not feel the urge to void as early with the same amount of urine)

Increased SBP may be due to what?

Excessive RBCs

What happens to the RBCs in immunohemolytic anemia?

Excessive destruction of RBCs followed by acceleration of erythropoiesis (making of RBCs)-lots or reticulocytes made.

What is the function of thrombocytes?

Essential for blood coagulation and control of bleeding

What are common symptoms in non-Hodgkin's lymphoma?

Fever, night sweats, and weight loss are common

After the burn heals, the injury may still cause what complications?

Even after healing, the burn injury may cause late complications such as contracture formation and scarring.

When should a colonoscopy be done?

Every 5 years after 50 years old. It should be done earlier for first degree relative of someone with rectal cancer.

How often should you sit clients on toilet for bladder retraining?

Every two hours

What should you expect lab values to be in obstructive renal disorders?

Expect creatinine to increase and GFR to initially increase, then later decrease due to damage. GFR is first high due to pressure that causes fluid to be pushed through fast so GFR is high, but then damage causes it to be low.

In the early stage of Alzheimer's, how should you explain things to the client?

Explain changes in routine to the patient before they occur, repeating the explanation immediately before the changes take place. Clocks and single-date calendars also help the patient maintain day-to-day orientation to the environment in the early stages of the disease process. For the patient with early disease, reality orientation is usually appropriate. Teach family members and health care staff to frequently reorient the patient to the environment. Remind the patient what day and time it is, where he or she is, and who you are.

What is performed to diagnose, treat, and stage the tumor(s) in ovarian cancer?

Exploratory laparotomy

What is expressive aphagia?

Expressive aphagia: Can't express their thoughts completely silent, but can understand what you are saying.

Extent of systemic problems related to burns is dependent upon what?

Extent of systemic problems related to burns is dependent upon the patient's age, general health, extent and depth of injury, and body area injured.

What are kussmaul respirations? How do Kussmaul respiration help with acid-base balance?

Fairly quick breathing to excrete more hydrogen ions than normal breathing would excrete. See in kidney failure and head trauma-excessive hydrogen ions

True or False Chronic diarrhea is not a cause of vitamin B12 deficiency anemia.

False

True or False Hematocrit and Hemoglobin do not mirror RBC results

False

True or False Ploidy classification is more useful to healthcare providers than staging malignant tumors.

False

True or False Is the patient undergoing chemotherapy a hazard to others?

False At no time is the patient an infection hazard to other people; however, other people can be an infection hazard to the patient.

True or False Primary brain tumors often metastasize

False Barely metastasize

True or False Botox causes headaches.

False Botox can relieve headache pain.

True or False Males get breast cancer as often as women.

False Breast cancer in men is rare.

True or False Chemotherapy in pill form is less toxic than its IV counterpart.

False It is just as toxic as chemo given by an IV. But often nurses think "this is just a pill" so nurses are more lax about it. But chemo is just as toxic, and has to be give with precision in timing, and precision in handling, just like the chemo bag drugs. If we send patient home with chemo pills, be very instructive that they need to take it EXACTLY on time. They can't miss any dose or it is less effective! Nurses have to give it on time too! Any drug that is PO (chemo) be treated with same diligence and respect as any other chemo.

True or False Prostate cancer is fast growing

False It is slow growing; insidious

True or False Alopecia is permanent when caused from chemotherapy.

False It is temporary - regrowth starts about 1 month after completion of chemo

True or False Only one type of shock can be present at the same time.

False More than one type of shock can be present at the same time.

True or False An immunocompromised individual is not at more risk for developing cancer.

False. A healthy immune system recognizes damaged DNA and gets rid of that cell. In the immunocompromised individual, their immune system might not recognize or be able to get rid of the cell, such as with the client with HIV.

True or False The blood in polycythemia is very thin.

False. Blood is viscous.

True or False G6PD anemia is characterized by by periods of exacerbations and intermissions

False. Is only triggered by causative agents.

True or False: There are three different types of hemophilia.

False. There are two types of hemophilia.

What can be debilitating side effect of radiation therapy that can last for months?

Fatigue

In regards to hematology, why would fatigue be a symptom of interest?

Fatigue is often a complaint of anemia

What other name does Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency Anemia go by and why?

Favism, because eating fava beans, or flat beans, can contribute to the disease.

What is frequency?

Feeling the need to void often, usually voiding small amounts of urine each time; may void every hour or even more frequently

What are the risk factors for thyroid cancer?

Female (age 40s-50s), low iodine diet, radiation exposure, genetics

Why does the patient have anemia in multiple myeloma?

Fewer functioning RBCs, WBCs and platelets (since the bone marrow is "busy" overproducing antibodies) are made leading to anemia, increased risk for infection, and bleeding.

What is the normal range for hemoglobin for males and females? Why may it be abnormal in shock (does it increase or decrease)?

Females: 12-16 g/dL Males: 14-18 g/dL Increased due to fluid shift, dehydration Decreased due to hemorrhage

What is the normal range for hematocrit for males and females? Why may it be abnormal in shock (does it increase or decrease)?

Females: 37%-47% Males: 42%-52% Increased due to fluid shift, dehydration Decreased due hemorrhage

What is HbF?

Fetal hemoglobin

Bactrim

First choice for antibiotics for UTI

What is the first and second cause of female cancer deaths.

First is lung cancer. Second is breast cancer.

In the late stage of Alzheimer's, should you orient patient to reality like you do in the early stages?

For the patient in the later stages of AD, reality orientation does not work and often increases agitation. The health care team uses validation therapy for the patient with moderate or severe AD. In validation therapy, the staff member recognizes and acknowledges the patient's feelings and concerns. For example, if the patient is looking for a deceased mother, ask him or her to talk about what Mother looks like and what she might be wearing. This response does not argue with the patient but also does not reinforce the patient's belief that Mother is still living.

What is receptive aphagia?

Receptive: Don't understand what you're saying, but is talking.

Approximately ____ percent of female breast cancer occurs before age 40

Five

What are examples of deep full-thickness burns?

Flames, electricity, grease, tar, chemicals

Is flank pain always present in renal carcinoma? Is it an early or late sign?

Flank pain is not always present, and it is a late sign

The bone marrow of what bone produces stem cells?

Flat bones

Has the fluid shifted in distributive shock? Has the total body fluid changed?

Fluid is shifted (but the total fluid volume is normal or increased.

In capillary leak syndrome, why does the fluid shift into the interstitial tissues (third spacing)? What problems cause fluid shifts?

Fluid shifts result from increased size of capillary pores, loss of plasma osmolarity, and increased hydrostatic pressure in the blood. Problems causing fluid shifts include severe burns, liver disorders, ascites, peritonitis, paralytic ileus, severe malnutrition, large wounds, hyperglycemia, kidney disease, hypoproteinemia, and trauma.

Is fluid volume affected in cardiogenic shock?

Fluid volume is not affected

Sometimes it's a challenge to get IV access in clients with sickle cell disease. If they receive a permanent port, how do the patients keep it patent?

Flush it once a month with heparin

What is the treatment for folic acid anemia?

Folic acid replacement therapy

For the patient in SCD crisis, the nurse should review the previous 24 hours for potential triggers, such as . . . ?

Food & fluid intake, environmental, temperature extremes, stress, airplane travel

How long can an AV graft be used?

For several years if taken well cared of

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For the patient after back surgery, inspect the surgical dressing for blood or any other type of drainage. Clear drainage may mean cerebrospinal fluid (CSF) leakage. The loss of a large amount of fluid may cause the patient to report having a sudden headache. Report signs of any drainage to the surgeon immediately. Bulging at the incision site may be due to a CSF leak or a hematoma, both of which should also be reported to the surgeon.

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For the patient with MS who has cognitive impairment, assist with orientation by placing a single-date calendar in his or her room. Give or encourage the patient to use written lists or recorded messages. To maintain an organized environment, encourage him or her to keep frequently used items in familiar places.

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For the patient with a spinal cord tumor, report any change in motor and sensory status immediately to the physician or Rapid Response Team. Swelling or tumor invasion can damage the spinal nerves that help control the diaphragm, and respiratory failure can result.

Where are white blood cells formed, and from what stem cell?

Formed in the marrow of flat bones from Hematopoietic stem cells.

What does a foul odor of urine indicate?

Foul smell indicates possible infection, dehydration, or ingestion of certain foods or drugs.

Those with Glucose-6-Phosphate Dehydrogenase Deficiency Anemia are deficient in what?

G6PD

What predicts if someone loses kidney function?

GFR, not creatinine

Melanoma usually metastasizes where?

GI tract Lymph nodes Lung Brain

What type of rays are most commonly used in radiation therapy? Why?

Gamma rays Three different types of energy, or rays, are produced by radioactive elements: gamma rays, alpha particles, and beta particles. These energies vary in their ability to penetrate tissues and damage cells. Gamma rays are used most commonly for radiation therapy because of their ability to deeply penetrate tissues. Beta particles are weaker and must be placed within or very close to the cancer cells for cancer therapy. Alpha particles are not used as cancer therapy.

How does Hodgkin's lymphoma generally spread?

Generally spreads from one group of cells to the next in an orderly fashion.

How is non-Hodgkin's lymphoma's spread differently than in Hodgkin's lymphoma?

Generally spreads through the lymphatic system in a less orderly fashion than Hodgkin's lymphoma.

Where does Hodgkin's lymphoma generally start?

Generally starts in a single lymph node or chain of nodes. The tissue in the node becomes cancerous.

Why is genetic counseling important to those with a parent with Huntington disease?

Genetic counseling is important for children of patients with the disease. People at risk for the disease can be tested to determine whether the gene mutation is present. Before the testing procedure is undertaken, counseling is necessary to ensure that the patient has voluntarily decided in favor of testing and is not being pressured by family or friends. In addition, counseling helps determine whether the benefits of knowing the results outweigh the risks of a positive result (e.g., depression or suicide).

In regards to tumor nomenclature, what is the prefix if the tissue of origin are glial cells (brain)?

Glio

What is an immunological kidney disorder?

Glomerulonephritis-inflammation of the glomerulus

What are our goals for improving immobility and self-care?

Goals: 1. Begin rehab as soon as possible, 2. Prevent complications of immobility such as DVT, pneumonia, pressure ulcers, and shoulder subluxation

What is the cellular characteristic of a Gx malignant tumor?

Grade cannot be determined.

Why are malignant tumors graded?

Grading is needed because some cancer cells are "more malignant" than others, varying in their aggressiveness and sensitivity to treatment. Some cancer cells barely resemble the tissue from which they arose, are aggressive, and spread rapidly. These cells are a "high-grade" cancer. On the basis of cell appearance and activity, grading compares the cancer cell with the normal parent tissue from which it arose. It is a means of evaluating the patient with cancer for prognosis and appropriate therapy. Grading also allows health care professionals to evaluate the results of management and compare local, regional, national, and international statistics.

What occurs in Alzheimer's?

Gradually increasing cognitive impairment & severe physical impairment followed by death due to complications of immobility

What are risk factors for penile cancer?

Greater than 60 years old, phimosis (can't pull foreskin back), bad hygiene, multiple sexual partners, tobacco use

Does esophageal cancer grow slowly? Why or why not?

Grows rapidly due to rich supply of lymph tissue in the esophageal mucosa and hollow tube structure

What is Guillain-Barré syndrome (GBS)?

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy (AIDP) that affects the peripheral nervous system, causing motor weakness and sensory abnormalities.

What is the greatest risk factor for stomach cancer?

H. pylori

If a patient has a burnt trachea, should they go to the closest hospital, or go to a burn care center?

If a burn patient has airway involvement, go to closest hospital. ABCs are more important than burned skin. If patient has burnt trachea, major emergency. After they're stabilized, then can transfer.

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Habit training is undermined when unlicensed assistive personnel (UAP) apply absorbent briefs or tell patients to "just wet the bed." This practice also increases the risk for falls because patients may try to get out of bed unassisted to use the toilet. Work with all staff members, including UAP, to implement consistently the toileting schedule for habit training.

Where does hyperplasia occur normally?

Hair, skin, stomach lining.

Human lymphotrophic virus type II causes what type of malignancies?

Hairy cell leukemia

If patient has breast cancer, what should you take a CT of?

Head and spine

In regards to tumor nomenclature, what is the prefix if the tissue of origin are blood vessels?

Hemangio

What is the ideal solution/treatment for patients with leukemia?

Hematopoietic stem cell transplantation (HSCT) (transplantation of bone marrow or stem cells from a sibling or matched unrelated donor), or sometimes called bone marrow transplantation (BMT), remains the preferred and most successful method of treatment. It offers curative potential or prolonged disease-free survival. However, it comes with considerable risk for mortality and is not an appropriate alternative for all patients.

What is hemiparesis? Hemiplagia? Paraplagia? Ataxia?

Hemiparesis-one half side weakness Hemiplegia (paralysis on one side) Paraplagia (upper or lower paralysis) Ataxia (Lack of muscle control)

What are the three types of dialysis?

Hemodialysis (HD) Peritoneal dialysis (PD) Continuous renal replacement therapy (CRRT)

Immunohemolytic anemia is what type of anemia?

Hemolytic

The reduced life-span of cells that sickle in sickle cell anemia results in what kind of anemia?

Hemolytic (blood cell-destroying)

In what hematologic disease do patients bleed excessively from minor cuts?

Hemophilia

What would you call a malignant tumor of the liver? What if it is a benign tumor?

Hepatosarcoma Hepatoma

What is the mitotic index of cancer cells?

High

Would bleeding cause high or low reticulocyte levels?

High

Would cancer cause high or low platelet levels?

High

Would hemolysis cause high or low reticulocyte levels?

High

Would hemolytic anemia cause high or low platelet levels?

High

Would iron deficiency anemia cause high or low platelet levels?

High

Would rheumatoid arthritis cause high or low platelet levels?

High

Would taking iron supplementation for iron deficiency anemia cause high or low reticulocyte levels?

High

What does thrombocytosis mean?

High platelet levels

What is the patient with unilateral body neglect at high risk for?

High risk for falls

Should you hang normal saline higher or lower than the packed red blood cells?

Higher

Most chemo drugs are given _____ and some are instilled directly into _____ ______. Other chemo drugs may be given in _____ form.

IV body cavities pill

Hodgkin's Lymphoma affects which age group? What age group does it peak in?

Hodgkin's lymphoma is a cancer that can affect any age group, however it seems to peak in: teens and young adults and adults in their 50s and 60s.

Can hormonal manipulation cure cancers?

Hormonal manipulation can help control some types of cancer for many years but does not cure the disease

What is cell adherence?

How closely (or loosely) cells bind to one another. Cells can have tight or loose adherence.

What is Huntington disease?

Huntington disease (HD), sometimes referred to as Huntington's disease or Huntington's Chorea, is an hereditary disorder transmitted as an autosomal dominant trait at the time of conception. This movement disorder causes both neurologic and behavioral symptoms.

What is the treatment for those with G6PD anemia?

Hydration to avoid kidney damage

What are some obstructive renal disorders?

Hydronephrosis Hydroureter Urethral stricture

When is extravasation a primary concern?

IV infusion of chemotherapy

What drug (besides pain medication) may be given to the patient with sickle cell disease?

Hydroxyurea has been successfully used to reduce the number of sickling and pain episodes. Hydroxyurea works by stimulating fetal hemoglobin (HbF) production. HbF is present during fetal development, but its production is turned off before birth. Increasing the level of HbF reduces sickling of red blood cells in patients with sickle cell disease. However, this drug is associated with an increased incidence of leukemia. This drug also decreases WBCs. Hydroxyurea also suppresses bone marrow function, and regular follow-up to monitor complete blood counts (CBCs) for drug toxicity is important. Hydroxyurea also causes birth defects and should not be taken by anyone who is pregnant or likely to become pregnant (this is why it is recommended that sexually active women use two forms of barrier protection).

Bone metastasis causes what electrolyte imbalance?

Hypercalcemia

What can be used to look for blockage in urolithiasis?

IV urography-look for blockage. Ultrasound can be used to see the stone-saves waiting and dx time. Noncontrast CT is more likely than ultrasound to pick up stounds

Never give potassium ___ since this can cause cardiac arrest.

IVP

How does AV fistula compare to other dialysis access devices for length of time used?

Less likely to clot, and to last longer than other ports.

What is the growth characteristic of benign tumors?

Hyperplastic expansion

____ may be the cause or the result of chronic kidney disease?

Hypertension

What is hypertrophy? What is hyperplasia?

Hypertrophy is growth that causes tissue to increase in size by enlarging each cell. Growth that causes tissue to increase in size by increasing the number of cells is hyperplasia.

When does hypovolemic shock occur?

Hypovolemic shock occurs when too little circulating blood volume causes a MAP decrease, resulting in inadequate total body oxygenation. It is total body fluid decreased in all fluid compartments.

Intermittent sickle cell "crisis" in sickle cell disease is provoked by what?

Hypoxia

What are specific causes or risk factors in chemical-induced distributive shock?

I. Anaphylaxis II. Sepsis III. Capillary leak i. Burns ii. Extensive trauma iii. Liver impairment iv. Hypoproteinemia

What are specific causes or risk factors in cardiogenic shock?

I. Myocardial infarction II. Cardiac arrest III. Ventricular dysrhythmias i. Atrial Fibrillation/Atrial Flutter ii. Tachycardia IV. Cardiac amyloidosis V. Cardiomyopathies i. Viral ii. Toxic VI. Myocardial degeneration

What are specific causes or risk factors in hypovolemic shock (hemorrhage)?

I. Trauma II. GI ulcer III. Surgery IV. Inadequate clotting i. Hemophilia ii. Liver disease iii. Malnutrition iv. Bone marrow suppression v. Cancer vi. Anticoagulation therapy

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

ICP is maintained at its normal level of 10 - 15 mm/Hg despite periodic changes such as straining during defecation.

What is the survival rate of liver cancer?

Less than 20%

What happens to the patient with a brain injury if you give them fluids?

If a patient has a brain injury and you give fluids, you'll flood their vascular system-you want blood vessels to shrink so there is room for the increased ICP

What should you do if a patient has repeat UTIs?

If a patient has repeated UTIs and we think something else is going on-scope patient to make sure they don't have bladder cancer to make sure nothing is going on. Cystoscopy may reveeal: ulcers, small bladder, cancer. Cystoscope passed down the the urethra of the penis past the prostate into the bladder. Doctor looks down systoscope.

Why can dehydration cause a crisis in sickle cell anemia?

If a person is dehydrated and they don't have enough fluids in their vascular system, the RBCs become sickled, sticky, and stuck.

How does hormonal manipulation work?

If a tumor depends on hormone A for growth and a large quantity of hormone B (similar to A) is given to the patient, hormone B will interfere with the tumor's uptake of hormone A or will limit the amount produced. As a result, tumor growth is slowed and survival time increase.s

Should more bandages be added to a bleeding wound, or should the bandages be removed once they are saturated, and new bandages placed?

If you remove the bandages, the platelet plug might be removed as well since it is very fragile and bleeding might start again. Apply pressure, elevated, and don't remove bandages.

What are neutrophils?

Immature white blood cells

What should the nurse report immediately after surgical management of back pain?

Immediately report urinary retention or fluid leakage (possible CSF) around dressing.

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In addition to frequent monitoring of vital signs, carefully observe for signs of intracerebral hemorrhage and other signs of bleeding during administration of rtPA.

What is Heparin-Induced Thrombocytopenia (HIT)?

Immune-mediated reaction to heparin. Thrombocytopenia is deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury.

Nursing management of the patient undergoing treatment for Hodgkin's lymphoma in regards to the liver when focusing on the acute side effects of therapy.

Impaired liver function either by metastasis to the liver or by chemotherapy drugs

Oh Nurse! What directly contributed to the decrease in house fires in the US during the past 30 years?

In 1991, legislation was passed requiring one smoke detector in every sleeping room.

Where is liver cancer most common?

In Africa and Asia where chronic liver disease is present

A decrease in what neurotransmitter and an increase in what other neurotransmitter result in what in Huntington disease?

In HD, there is a decrease in the amount of gammaaminobutyric acid (GABA), an inhibitory neurotransmitter in the basal ganglia. GABA depletion causes increased activity of the thalamus and other parts of the brain. There may also be an increase in glutamate, a major excitatory neurotransmitter. The result of these chemical changes in the brain is brisk, jerky, purposeless movements, particularly of the hands, face, tongue, and legs, which the patient cannot stop.

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In addition to monitoring respiratory function and providing bronchial hygiene, observe for signs of pneumothorax or hemothorax for the patient having a thymectomy, including: • Chest pain • Sudden shortness of breath • Diminished or delayed chest wall expansion • Diminished or absent breath sounds • Restlessness or a change in vital signs (decreasing blood pressure or a weak, rapid pulse) Provide oxygen to the patient, and raise the head of the bed to at least 45 degrees. Then report any of these signs and symptoms to the surgeon or Rapid Response Team immediately!

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In severe cases of encephalitis, the patient may have increased ICP resulting from cerebral edema, hemorrhage, and necrosis of brain tissue. Monitor vital signs for indications of a widened pulse pressure, bradycardia, and irregular respirations. The pupils become increasingly dilated and less responsive to light. Left untreated, increased ICP leads to herniation of the brain tissue and possibly death.

What is targeted therapy?

In targeted therapy, drugs are designed to interfere with specific molecules necessary for tumor growth and progression. Traditional cytotoxic chemotherapies usually kill all rapidly dividing cells in the body by interfering with cell division. A primary goal of targeted therapies is to fight cancer cells with more precision and potentially fewer side effects.

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In the ED, evaluate the stroke patient within 10 minutes of arrival. This same standard applies to patients already hospitalized for other medical conditions who have a stroke. The priority is assessment of ABCs—airway, breathing, and circulation. Many hospitals have designated stroke teams and centers that are expert in acute stroke management.

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In the initial phase of Guillain-Barré syndrome, monitor the patient closely (usually in a critical care unit) for signs of respiratory distress, such as dyspnea, air hunger, adventitious breath sounds, decreased oxygen saturation, and cyanosis. In addition, assess respiratory rate, rhythm, and depth every 1 to 2 hours. In collaboration with the respiratory therapist (RT), check vital capacity every 2 to 4 hours and auscultate the lungs at 4-hour intervals. Monitor the patient's ability to cough and swallow for any change. Assess cognitive status, especially in older adults; a decline often indicates hypoxia.

What would a high reticulocyte count indicate in the presence of anemia?

In the presence of anemia, a high reticulocyte count generally indicates a problem outside the bone marrow such as bleeding, hemolysis, or a response to treatment (for example iron supplementation for iron deficiency anemia.

What is the G1 phase in the cycle of a cell?

In this phase, the cell is getting ready for division by taking on extra nutrients, making more energy, and growing extra membrane. The amount of cytoplasm also increases.

Why do obstructions, such as too big tampons in the vagina, constipation, or pregnancy, cause UTI?

Incomplete bladder emptying creates a continuous pool of urine in which bacteria can grow, prevents flushing out of bacteria, and allows bacteria to ascend more easily to higher structures. Bacteria have a greater chance of multiplying the longer they remain in residual urine. Overdistention of the bladder damages the mucosa and allows bacteria to invade the bladder wall.

How can incontinent pads cause UTI?

Incontinant pads can cause UTI because of the plastic backing can cause bacteria to grow. The problem with a plastic backed is it promotes moisture retained by patient. So some hospitals don't use chux.

Neutrophils ________ at the start of an infection.

Increase

What causes protein in urine?

Increased amounts may indicate stress, infection, recent strenuous exercise, or glomerular disorders.

What is azotemia?

Increased blood urea nitrogen and serum creatinine levels suggestive of kidney impairment but without outward symptoms of kidney failure

What is an early sign/symptom of stomach cancer?

Indigestion, abdominal discomfort, gastric/back pain, feeling full

Stem cell transplantation is standard treatment for the patient with leukemia who has a closely matched donor and who is in temporary remission after induction therapy. What is induction therapy?

Induction therapy decreases the number of leukemia cells to an undetectable level by killing off everything in your bone marrow-WBC, RBC, stem cells, and platelets. Patient is put on bleeding and infection precautions. Prolonged hospitalizations are common while the patient is neutropenic. Recovery of bone marrow function requires at least 2 to 3 weeks, during which time the patient must be protected from life-threatening infections.

Where is the pain in cluster headaches?

Intense unilateral pain; pain is typically oculotemporal or oculofrontal.

What is interbody cage fusion?

Interbody cage fusion-bone is removed and cage like device implanted.

Many patients remain at home during periods of neutropenia and are at continuing risk for what?

Infection

Yellow box

Infection is common in patients who have a neobladder. Teach patients and family members the manifestations of infection and the importance of reporting the infection immediately to the surgeon.

What results from neutropenia? What does this place the patient at risk for.

Infection risk results from neutropenia, placing the patient at extreme risk for sepsis

What are some infectious complications of hemophilia therapy?

Infectious complications of hemophilia therapy include hepatitis B, hepatitis C, cytomegalovirus, and HIV. Those precipitated clotting factors derived from pooled human serum (from as many as 30 donors) do have some risk for viral contamination, even with the use of many techniques to purify the drug.

What is Syndrome of Inappropriate Antidiuretic Hormone - SAIDH?

It is an excessive secretion of ADH without normal physiologic stimuli for its release.

What is encephalitis?

Inflammation of the brain & meninges

What are the initial symptoms of ovarian cancer?

Initial symptoms are vague: indigestion, abdominal pain or bloating and urinary frequency.

What are initial signs of increased ICP? What are late signs of ICP?

Initial: -Hypotension, hypoxemia, hypercapnia -Subtle changes in neuro exam Late: Cushing's Triad is a late sign of ↑ ICP: 1. hypertension 2. widened pulse pressure 3. bradycardia

What is initiation in carcinogenesis?

Initiation - DNA is damaged, perhaps in only a single cell. Initiation is the first step in carcinogenesis. If growth conditions are right, widespread metastatic disease can develop from just one cancer cell.

Injury to the pluripotent stem cells in aplastic anemia may be caused by what?

Injury may be caused by long-term exposure to toxic agents, a virus, or may be unknown

In aplastic anemia, deficiency of RBCs are due to injury of what?

Injury to pluripotent (immature) stem cells

What are intra-arterial catheters? What's the pressure bag for?

Intra-arterial catheters allow continuous blood pressure monitoring and are an access for arterial blood sampling. They are inserted into an artery (radial, brachial, femoral, or dorsalis pedis). The catheter is attached to pressure tubing and a transducer, which converts arterial pressure into an electrical signal seen as a waveform on an oscilloscope and as a digital numeric value. The pressure bag provides pressure so that the blood doesn't shoot out of the artery.

What does an increased specific urine gravity indicate?

It is increased in decreased kidney perfusion, inappropriate antidiuretic hormone secretion, or congestive heart failure.

What is dose-dense chemotherapy?

It is often used for aggressive cancer. It means giving higher doses more often (more often that 4-12 doses in 3-4 weeks). More intense side-effects result than traditional dosing schedules.

What is the most common anemia worldwide?

Iron deficiency anemia

How can the nadir (when WBCs are at their lowest level) be calculated?

It occurs at different times for different drugs. To reduce immunosuppression, combination chemotherapy avoids using drugs with nadirs that occur at or near the same time. It is calculated between the start and completion of chemo, the number of WBCs, the patient's age, condition, and drug, so if two types of drugs are selected to be the best combination, the above parameters are calculated so that the patient doesn't have a plunge in WBCs simultaneously.

What substances are needed to form RBCs and hemoglobin?

Iron, Vitamin B12, and Folic Acid

Why can sexual activity cause UTI?

Irritation of the perineum and urethra during intercourse can promote migration of bacteria from the perineal area to the urinary tract in some women. Spermicides can alter vaginal pH, increasing potential numbers of pathogens. Inadequate vaginal lubrication may exacerbate potential urethral irritation. Bacteria may be introduced into the man's urethra during anal intercourse or during vaginal intercourse with a woman who has a bacterial vaginitis.

What is the most common type of stroke?

Ischemic

Why does a "crisis" in sickle cell anemia cause pain?

It results in pain because if the sickled cells are clogging blood vessels, and RBC can't deliver oxygen, there will be ischemia and necrosis maybe, resulting in neuropathic pain. "The cells become rigid, and clump together, causing the RBCs to become "sticky" and fragile. These clumps form masses of sickled RBCs that block blood flow. This blood vessel obstruction, known as a vaso-occlusive event (VOE), leads to further tissue hypoxia (reduced oxygen supply) and more sickle-shaped cells, which then leads to more blood vessel obstruction and ischemia."

What is a hemorrhagic stroke?

It's a bleed in the brain. In this type of stroke, vessel integrity is interrupted and bleeding occurs into the brain tissue or into the space surrounding the brain (usually intracerebral or subarachnoid).

GBS is more common in which gender and which race?

It affects both genders equally and peak after age 55 years. Euro-Americans have the disease more often than other racial or ethnic groups. Teacher says: 50% more common in whites than blacks.

Is leukemia acute or chronic?

It can be both

What causes distributive shock?

It can be caused by a loss of sympathetic tone, blood vessel dilation, pooling of blood in venous and capillary beds, and increased capillary leak. All these factors can decrease mean arterial pressure (MAP) and may be started by nerve changes (neural-induced) or the presence of some chemicals (chemical-induced).

How can Alzheimer's be prevented?

It can't

How can Parkinson's be prevented?

It can't be. No known prevention or cure

What are some benefits for healthcare professionals for grading or staging malignant tumors?

It enhances communication-communicates a lot of information. Makes it easier to categorize information data-so if physician wants to research malignant tumors, (s)he can look under grade three ovarian cancer to get more information. Communication over distance: For example, a patient is diagnosed with grade 3 cancer. A physician in a rural area can look up to see whether patient will benefit from aggressive cancer treatment or not, vs grade 4, where palliative treatment is best. Enhances research and collaboration between health care providers.

What is brachytherapy?

It is "short" or "close" therapy. The radiation source comes into direct, continuous contact with tumor tissue. The tumor gets a high dose and surrounding, normal tissue gets a limited dose.

Is endometriosis a benign tumor, or are endometriosis cells normal or cancerous. What are specific differentiated functions of endometriosis.

It is a benign tumors. In endometriosis, a type of benign tumor, the normal lining of the uterus (endometrium) grows in an abnormal place (e.g., on an ovary, on the peritoneum, or in the chest cavity). This displaced endometrium acts just like normal endometrium by changing each month under the influence of estrogen. When the hormone level drops and the normal endometrium sheds from the uterus, the displaced endometrium, wherever it is, also sheds.

What is "chemo brain"? Is it permanent?

It is a change in cognitive function. "Chemo brain" reduces the ability to concentrate, the patient has memory loss, and difficulty learning new information. This is likely to subside with time.

How do you inject Imitrex?

It is a self contained syringe that allows the pt to give themselves an injection to abort the pain.

Longest organ donor list

Kidney donor list

Repeated kidney infections can lead to what?

Kidney failure

How is multiple sclerosis diagnosed?

LP - Increased protein Evoked potential studies-abnormal CT Scan- increased density of white matter MRI - shows areas of demyelination and plaques

Hematuria (blood in urine) in patients with renal carcinoma is an early or late sign?

Late

What is important for the nurse to remember in photodynamic therapy?

Lighting of all types is kept to a minimum. Even the use of a penlight or the sensor on a pulse oximeter can lead to burns for the patient who has been injected with a photosensitizer. Turn down the light intensity of the readouts on electronic monitoring equipment to as low as possible and ensure that it is not facing the patient. When the patient is transported, reducing hallway lighting and avoiding windows are essential. An especially important member of the team to consult is the pharmacist. Any drug the patient is prescribed must be considered for its photosensitizing properties. For example, certain antibiotics (tetracycline and erythromycin) increase photosensitivity as do many antihypertensive drugs. When these drugs are taken by the patient receiving PDT, the intensity of the photosensitivity is increased and the patient's risk for harm also is increased.

Patients with any cancer affecting bone are likely to have what comorbidities?

Likely to have anemia, thrombocytopenia, and high risk for infection

In regards to tumor nomenclature, what is the prefix if the tissue of origin is fat/adipose tissue?

Lipo

How is urolithiasis treated?

Lithotripsy is sound waves-pt in swimming pool and soundwaves are emitted, and they go exactly were kidney stones are (where we think they are), and it works. Is done in the OR. It works, and is noninvasive, and breaks down the stone. We encourage lots of fluid, except in patients where its contraindicated, like patients with heart problems. -Consider stents -Encourage 3 liters of fluid per day to prevent future stones (unless otherwise contraindicated) -Walking encourages passage of stones

Colon cancer often metastasizes to the _______.

Liver

Pancreas cancer usually metastasizes where?

Liver Lungs

Colorectal cancer usually metastasizes where?

Liver* Lymph nodes Adjacent structures *Most common site of metastasis for the specific malignant neoplasm.

Where does stomach cancer often metastasize to?

Liver, pancreas, colon

What is a lumbar puncture used to measure for? Where is it inserted? When is it contraindicated?

Lumbar puncture is the insertion of a spinal needle into the subarachnoid space between the third and fourth (sometimes the fourth and fifth) lumbar vertebrae. A lumbar puncture (LP) is used to: • Obtain cerebrospinal fluid (CSF) pressure readings with a manometer • Obtain CSF for analysis • Check for spinal blockage caused by a spinal cord lesion • Inject contrast medium or air for diagnostic study • Inject spinal anesthetics • Inject selected drugs Because of the danger of sudden release of CSF pressure, a lumbar puncture is not done for patients with symptoms indicating severely increased ICP. The procedure is also not performed in patients with skin infections at or near thepuncture site because of the danger of introducing infective organisms into the CSF.

How is meningitis diagnosed?

Lumbar puncture, CBC, and for patients with signs of AMS a CT

Ovarian cancer usually metastasizes where?

Lungs Liver

Stem cell transplantation can be used for which disorders?

Lymphoma, leukemia, multiple myeloma, aplastic anemia, sickle cell disease, and many solid tumors.

Oh Nurse! What nursing care is relevant to the patient with suspected meningitis?

Maintain a dark environment, administer antibiotics as prescribed, frequent reassessment, treat pain. Do not keep in a warm environment-pivotal to keep in a cold environment.

What do we want to prevent in patients with GBS?

Make sure they don't get foot drop-keep foot propped up in an up position. Avoid complications of bed rest.

What are examples of secondary cancer prevention?

Mammograms, colonoscopies, PSA (prostate-specific antigen), annual fecal occult blood

How is iron deficiency anemia managed with food?

Management of iron deficiency anemia involves increasing the oral intake of iron from food sources (e.g., red meat, organ meat, egg yolks, kidney beans, leafy green vegetables, and raisins). An adequate diet supplies about 10 to 15mg of iron per day

How may the patient present in the refractory stage? What are signs and symptoms?

Manifestations are a rapid loss of consciousness; nonpalpable pulse; cold, dusky extremities; slow, shallow respirations; and unmeasurable oxygen saturation.

Manifestations of folic acid deficiency anemia are similar to those of what other deficiency?

Manifestations are similar to those of vitamin B12 deficiency but without nervous system problems

What are examples of promoters?

Many normal hormones and body proteins, like insulin and estrogen, can act as promoters and make altered cells divide more frequently.

What drugs are used for RLS?

Many of the drugs prescribed for RLS are also used for either Parkinson disease (PD) or epilepsy. Dopamine agonists such as pramipexole (Mirapex) and ropinirole (Requip) are oral drugs used extensively. Gabapentin enacarbil (Solzira) is an antiepileptic drug (AED) that was recently approved by the FDA for RLS. These agents are usually taken at bedtime. Some patients have had success with Sinemet, a combination of levodopa and carbidopa. This drug is often given with other medications to be more effective in reducing the symptoms of the disease. The usual dosage is between 50 and 200 mg at bedtime each day. Other classes of drugs for managing RLS include benzodiazepines, such as diazepam (Valium), and opioids as a last resort. Two other AEDs, carbamazepine (Tegretol) and gabapentin (Neurontin), have been particularly effective and are taken in divided doses throughout the day.

What happens with G6PD anemia is triggered?

Many older RBCs break, resulting in anemia and jaundice

What are some causes (triggers) of migraine headaches?

Many patients find that certain factors, or triggers, such as caffeine, red wine, stress, and monosodium glutamate (MSG) tend to cause migraine headache attacks. Each patient is different regarding which environmental factors trigger headaches. For some patients, being stressed or a change in weather can lead to an attack. Our teacher said chocolate and coffee in class.

What are some complementary and alternative therapies

Massage, aromatherapy, healing touch, magnets, meditation, St. John's Wort

What is the maximum dose of Tylenol?

Maximum dose is 3 grams in 24 hours

How can immunohemolytic anemia be acquired?

May be acquired in response to trauma, viral infection, or exposure to drugs or chemicals

How fast does non-Hodgkin's lymphoma grow?

May be indolent (slow growing) or aggressive

Are brain tumors malignant or benign?

May be malignant or benign

What can provoke trigeminal neuralgia?

May be provoked by dental or ear infection

What is MAP?

Mean Arterial Pressure is the average arterial BP

GFR

Measurement of kidney function that takes age, race, and gender into account

In regards to tumor nomenclature, what is the prefix if the tissue of origin are meninges?

Meningioma

What is meningitis?

Meningitis is an inflammation of the meninges that surround the brain and spinal cord

What is the type of meningitis that occurs in outbreaks?

Meningococcal meningitis. It is most likely to occur in areas of high population density, such as college dormitories, military barracks, and crowded living areas. It also affects people with compromised immune systems and those with spleen damage or who have no spleen.

What is metastasis in carcinogenesis?

Metastasis - cancer cells break of and establish remote colonies

Why should metformin be stopped before having a constrast medium injected?

Metformin must be discontinued at least 24 hours before any study using contrast media because the life-threatening complication of lactic acidosis, although rare, could occur

Why might a patient with Parkinson's not eat? Why should a high calorie diet be provided to them?

Might not eat because of drooling problem. High caloric food should be provided because their constant movement is expending energy.

What are the three categories of migraine headaches? What is an aura? When does it occur?

Migraines fall into three categories: migraines with aura, migraines without aura, and atypical migraines. An aura is a sensation such as visual changes that signals the onset of a headache or seizure. In a migraine, the aura occurs immediately before the migraine episode. Atypical migraines are less common and include menstrual and cluster migraines.

What are the varying levels of traumatic brain injury?

Mild TBI..........GCS 13 to 15 - LOC up to 15 min Moderate TBI...GCS 9 to 12 - LOC up to 6 hours Severe TBI........GCS 3 to 8 - LOC > 6 hours

Why is minimally Invasive Surgery (MIS) preferable?

Minimally Invasive Surgery (MIS) is preferably because anesthesia is local, complications are fewer, and the patient is usually discharged in 24 hours or less with just a band-aid at the site.

What are the nursing implications for the older with increased risk of infection? Why?

Monitor carefully for infection. Older adults often have structural deterioration of microglia, the cells responsible for cell-mediated immune response in the central nervous system (CNS).

What are interventions for the older adult with deceased glomerular filtration rate?

Monitor hydration status; Ensure adequate fluid intake; Administer potentially nephrotoxic agents or drugs carefully.

Yellow box

Monitor the patient with severe CKD or ESKD closely for drug-related complications, and ensure that dosages are adjusted as needed.

What insect can cause encephalitis? What are prevention methods?

Mosquitoes. Teach people who live in mosquito-infested areas to protect themselves and their families from West Nile virus infections.There is no curative treatment for West Nile viral encephalitis. Protect yourself by: • Limit your time outside between dusk and dawn when mosquitoes are out. • Wear protective clothing, including long sleeves and pants. • Use an insect repellent containing DEET when outdoors. • Remove areas of standing water from flower pots, trash cans, and rain gutters. • Check window and door screens for holes that need repair. • Keep hot tubs and pools clean and properly chlorinated

What are key features of MG?

Motor Manifestations • Progressive muscle weakness (proximal) that usually improves with rest • Poor posture • Ocular palsies • Ptosis • Weak or incomplete eye closure • Diplopia • Respiratory compromise • Loss of bowel and bladder control • Fatigue Sensory Manifestations • Muscle achiness • Paresthesias • Decreased sense of smell and taste

Efferent neurons are also known as what?

Motor nerve cells

When do sensory changes occur for the patient with bone cancer?

Motor/sensory changes occur if tumors in bone cancer compress nerves or the spinal cord

What should you as a nurse not do to an arm that as an access device?

No BP measurement No phlebotomy Nothing circumferential

What is the leading cause of neuro disability between ages 20 and 40?

Multiple sclerosis

What is multiple sclerosis?

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the myelin sheath and conduction pathway of the central nervous system (CNS).

On the Oral Mucositis scale, what is grade 4?

No alimentation (nothing by mouth-enteral feedings)

What is myasthenia gravis (MG)?

Myasthenia gravis (MG) is an acquired autoimmune disease characterized by fatigue and weakness primarily in muscles innervated by the cranial nerves, as well as in skeletal and respiratory muscles

What causes myasthenic crisis?

Myasthenic crisis is often caused by some type of infection. For other patients, increasing muscle weakness leads to an overdose of anticholinesterase drugs. As a result, the patient may experience a mixed crisis. The Tensilon test, although not always conclusive, is an important procedure for differentiation. Tensilon produces a temporary improvement in myasthenic crisis but worsening or no improvement of symptoms in cholinergic crisis. The priority for nursing management of the patient in myasthenic crisis is maintaining adequate respiratory function.

What is destroyed in GBS?

Myelin sheath is destroyed

What is the most common cause of cardiogenic shock?

Myocardial infarction is the most common cause of direct pump failure

What kind of diet may the patient with leukemia be on? What are some precautions of that diet?

Neutropenic diet-no raw vegetables-everything cooked so no bacteria on foods. Neutropenic precautions include a private room with hepa filter (air is exchanged frequently-clean air comes into room), wear mask gown and gloves to make sure healthcare workers and visitors don't infect the patient, no flowers because stationary water can have bacteria in it.

What are the most common type of white blood cells?

Neutrophils

How does the care we provide cause acute kidney injury (AKI)?

NPO order or medications

Does platelet count change with age?

No

What are late signs/symptoms of stomach cancer?

Nausea, vomiting, iron deficiency anemia, epigastric mass, enlarged lymph nodes, fatigue, weight

What are signs and symptoms of thyroid cancer?

Neck pain, lump in neck, difficulty swallowing, persistent cough, hoarse voice, wheezing, shortness of breath

What are some nursing considerations and patient education for thyroid cancer?

Need own toilet during brachytherapy, use salt w/ iodine, wear lead protective gear, thyroid supplement post treatment.

B12 is needed for normal ______ function.

Nerve

What is neural-induced distributive shock?

Neural-induced distributive shock is a loss of MAP that occurs when sympathetic nerve impulses controlling blood vessel smooth muscle are decreased and the smooth muscles relax, causing vasodilation. This blood vessel dilation can be a normal local response to injury, but shock results when vasodilation is widespread.

In regards to tumor nomenclature, what is the prefix if the tissue of origin is nerve tissue?

Neuro

Benign tumor of nerve tissue is called what? What if it is malignant?

Neuroma Neurosarcoma

What is the basic unit of the nervous system that transmits impulses ("messages")?

Neuron

Is there eschar with superficial burns?

No

Is there eschar with superficial partial-thickness burns?

No

Yellow box

Never add to or infuse other drugs with blood products because they may clot the blood during transfusion

Yellow box

Never move or turn the patient by holding or pulling on the halo device. Do not adjust the screws holding it in place. Check the patient's skin frequently to ensure that the jacket is not causing pressure. Pressure is avoided if one finger can be inserted easily between the jacket and the patient's skin. Monitor the patient's neurologic status for changes in movement or decreased strength

What is neoplasia?

New growth not needed for normal development of dead or replacement of damaged tissue Some tissues and organs stop growing by cell division after development is complete. For example, heart muscle cells no longer divide after fetal life; the number of heart muscle cells is fixed at birth. The size of the heart increases as the person grows because each cell gets larger (hypertrophy), but the number of heart muscle cells does not increase.

Are deep partial-thickness burns blanchable (lighten when pressure is applied)?

No

Are grafts required with superficial burns?

No

Are normal cells migratory?

No

Are there blisters with deep full-thickness burns?

No

What does pale yellow urine mean?

Normal urine color

How does checking a patient's A1C work with regards to glucose and red blood cells?

Normally glucose should not stick to hemoglobin molecules (except once in a while-3-4%). Once it is stuck, it is stuck till the end of the lifespan-120 days. If person is hyperglycemic, more percentage of glucose sticks to hemoglobin (that's what we measure). If they then decide to control diabetes, we will check them at 3-4 months to see improvement.

Can cytoreductive (or debulking) surgery result in a cure?

Not by itself

Yellow box

Notify the health care provider or the Rapid Response Team for any patient who has vital signs or other conditions that meet the sepsis with SIRS criteria.

Yellow box

Notify the physician immediately about hypotension or excessive diuresis in the patient who has had a kidney transplant, because hypotension reduces blood flow and oxygen to the new kidney, threatening graft survival.

What are interventions for Bell's Palsy?

Nursing care is directed toward managing the major neurologic deficits and providing psychosocial support. Because the eye does not close, the cornea must be protected from drying and subsequent ulceration or abrasion. Teach the patient to manually close the eyelid at intervals and to instill artificial tears during the day. An ointment to supply moisture can be used at night. The eye may be patched or taped closed at bedtime. The patient may be unable to chew, sip fluids through a straw, or control drooling on the affected side. Thus mealtime may become a problem. Encourage the patient to eat and drink using the unaffected side of the mouth. Frequent, small meals may be better tolerated, and patients may require a soft diet. Explain how to use simple techniques of massage; the application of warm, moist heat; and facial exercises. In some cases, physical therapy is prescribed for these treatments. As muscle tone improves, teach the patient to grimace, wrinkle the brow, force the eyes closed, whistle, and blow air out of the cheeks three or four times daily for 5 minutes in front of a mirror.

Nursing management of the patient undergoing treatment for Hodgkin's lymphoma?

Nursing management of the patient undergoing treatment for HL focuses on the acute side effects of therapy, especially: • Drug-induced pancytopenia, which increases the risk for infection, anemia, and bleeding • Severe nausea and vomiting, which impairs nutrition • Skin problems at the site of radiation • Constipation or diarrhea • Impaired liver function either by metastasis to the liver or by chemotherapy drugs • Permanent sterility for male patients receiving radiation to the abdominopelvic region in the pattern of an inverted Y in combination with specific chemotherapy drugs (The patient is informed of this side effect and given the option to store sperm in a sperm bank before treatment.) • Secondary cancer development as a result of HL treatment (Long-term follow-up includes screening for recurrence, as well as the possible development of a secondary cancer.)

What is the nursing priority in chemo-induced peripheral neuropathy? Why?

Nursing priority is to prevent injury. Loss of sensation increases the patient's risk for injury because he or she may not be aware of excessive heat, cold, or pressure. The risk for injury to the feet is very high. Falls are more likely because the patient cannot feel changes in terrain and because of orthostatic hypotension.

What are interventions for the older adult that retain urine?

Observe the patient for urinary retention (e.g., bladder distention) or urinary tract infection (e.g., dysuria, foul odor, confusion). Provide privacy, assistance, and voiding stimulants such as warm water over the perineum as needed. Evaluate drugs for possible contribution to retention.

Yellow box

Observe the patient with an upper SCI (above the level of T6) for signs of autonomic dysreflexia (hyperreflexia). Although it does not occur frequently, autonomic dysreflexia is an excessive, uncontrolled sympathetic output. It is characterized by severe hypertension, bradycardia, severe headache, nasal stuffiness, and flushing. The cause of this syndrome is a noxious stimulus—usually a distended bladder or constipation. This is a neurologic emergency and must be promptly treated to prevent a hypertensive stroke!

What is hydronephrosis?

Obstruction at or near the pelvis causes the kidney to distend. Urine continues to be made and damage to tubules can occur in hours.

What is urethral stricture?

Obstruction causes bladder distention before hydroureter and hydronephrosis.

What is hydroureter?

Obstruction someplace in the ureter results in proximal dilation as urine accumulates.

What causes obstructive shock?

Obstructive shock is caused by problems that impair the ability of the normal heart muscle to pump effectively. The heart itself remains normal, but conditions outside the heart prevent either adequate filling of the heart or adequate contraction of the healthy heart muscle. Basically, cardiac function is decreased due to some non-cardiac cause (indirect pump failure).

What are considerations for the older adult regarding chemotherapy induced nausea and vomiting?

Older patients may receive lower doses of chemotherapy because it was thought that they would not be able to tolerate the side effects of chemotherapy-induced nausea and vomiting (CINV). Studies have shown that older patients do not have greater CINV than younger patients, and their chemotherapy regimens should not be altered on this basis alone. However, the older adult can become dehydrated more quickly if CINV is not controlled. Teach older adults to be proactive with taking their prescribed antiemetics and to contact their health care provider if the CINV either does not resolve within 12 hours or becomes worse.

Sterile urine sample

Obtained via catheterization

Superior vena cava syndrome occurs most often with what type of cancers?

Occurs most often in patients with lymphomas, lung cancer, and breast cancer.

When does Tumor Lysis Syndrome occur?

Occurs when large numbers of tumor cells are destroyed rapidly. Intracellular contents, including potassium and purines (from DNA) cause hyperkalemia and excess uric acid. The uric acid can form crystals which can precipitate in kidneys.

When does Superior Vena Cava Syndrome occur?

Occurs when the SVC (superior vena cava) is obstructed by tumor growth or clots in the vessel. Painful and life threatening, manifestations result from blockage of venous return from the upper body.

Leukemia occurs in which type of cells?

Often occurs in stem cells, or precursor leukocyte cells

Are older adults even greater risk for chemotherapy-induced neutropenia? Why or why not?

Older adults are at even greater risk for chemotherapy-induced neutropenia because of age-related changes in bone marrow function. Using growth factors, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), before neutropenia occurs rather than later can reduce the severity of neutropenia and the risk for infectious complications.

What is mucositis?

Open sores on mucous membranes

How is hypercalcemia treated?

Oral hydration may be enough to reduce calcium levels and relieve symptoms. Normal saline is used when parenteral hydration is needed. Many drugs, such as oral glucocorticoids, calcitonin, diphosphonate, gallium nitrate, and mithramycin, lower serum calcium, but only temporarily. When cancer-induced hypercalcemia is life threatening or occurs with kidney disease, dialysis can temporarily reduce serum calcium levels.

In regards to tumor nomenclature, what is the prefix if the tissue of origin is bone?

Osteo

What percent of the US has restless leg syndrome? What gender has it more?

Over 10% of the population in the United States have the problem, and women are affected twice as often as men.

What are signs and symptoms of neck tumors

Painless hoarseness, mouth sores, non-resolving mass in neck, coughing, swallowing difficulty, non-resolving sore throat, unexplained voice change

What is the most common manifestation of testicular cancer?

Painless lump is the most common manifestation

What is our goal as nurses when it comes to our patients and sepsis?

Our goal as nurses is to recognize sepsis and intervene early.

What is our goal as nurses in regards to cancer?

Our goal is to prevent cancer (tell patient how to avoid) and to promote early dx

What is epigenetic?

Our professor said in class: "Epigenetic is change in the gene form that does not necessarily involve a change in gene sequence." Defined as "the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself (the primary DNA sequence). It is modifications to chromosomes that alter gene-expression patterns."

What is our role as nurses for our patients regarding cancer?

Our role is twofold, all of us will encounter people who have cancer. Our role is to promote early diagnosis and to promote prevention.

Should burn blisters be popped?

Our teacher said in class that blisters are the best protection for the raw skin underneath. In the book, it says that small blisters are often left intact if they are not located over a joint. Large blisters usually are opened and débrided to promote healing.

Why is it a good idea to sit patients up if they have cardiogenic shock? Is output higher or lower than normal? Will they have pulmonary edema? What is a good drug for cardiogenic shock? (This is what our teacher said in class. Not on the PPT).

Our teacher said in class that: In cardiogenic shock: patient's have so much fluid if they lay down they'll drown. Output lower than normal-heart is failing in cardiogenic shock. Pulmonary edema intertwined. Size of vascular bed engorged. So much fluid, see foam coming out of endotracheal tube. Morphine good drug since it causes periperhal vasodilation. Their breathing slows down, but we can breathe for them-keeps it from pooling.

Why should you ask a patient if they have a history have asthma before giving them a contrast media?

Patients with asthma have been shown to be at greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe.

Most infections during neutropenia result from what?

Overgrowth of the patient's own normal flora

What are O2 sat changes in the patient in shock?

Oxygen saturation is assessed through pulse oximetry. Pulse oximetry values between 90% and 95% occur with the nonprogressive stage of shock, and values between 75% and 80% occur with the progressive stage of shock. Any value below 70% is considered a life-threatening emergency and may signal the refractory stage of shock.

Photodynamic therapy (PDT) is most often used for what type of cancers?

PDT for cancer therapy is used most often for non-melanoma skin cancers, ocular tumors, GI tumors, and lung cancers located in the airways.

What is renal colic?

Pain associated with kidney irritation that radiates to the perineal area.

What is the most important part of managing pancreatic cancer?

Pain management

What is usually the first sign of PKD?

Pain-flank pain usually

Typically but not always the patient simultaneously has __________ in aplastic anemia.

Pancytopenia

What is a benign tumor of the epithelial layer of skin, mucous membranes, and organ linings called? What if it was malignant?

Papilloma Squamous cell carcinoma of skin, bladder, lungs, cervix

How can pressure ulcers be prevented in patients with GBS?

Pay special attention to skin care, including interventions to prevent skin breakdown. Instruct UAP to turn the patient a minimum of every 2 hours. Assess the skin for any areas of redness that may lead to pressure ulcers. If the bed does not have a pressure-reducing mattress, use a mattress overlay to help prevent skin breakdown. Document changes in the patient's skin condition every 8 to 12 hours while in the acute care setting and at least daily in a transitional care or rehabilitation setting. If an ulcer develops, implement aggressive interventions to manage the wound.

Since B12 is needed for normal nerve function, a deficiency can also cause ________ in hands and feet.

Parenthesis (tingling)

What is Parkison's disease?

Parkinson disease (PD), also referred to as Parkinson's disease and paralysis agitans, is a progressive neurodegenerative disease that is the one of the most common neurologic disorders of older adults. It is a debilitating disease affecting motor ability and is characterized by four cardinal symptoms: tremor, rigidity, bradykinesia or akinesia (slow movement/ no movement), and postural instability

What is the treatment for liver cancer?

Partial hepatectomy, transplant, radiation (chemo usually not primary treatment), control pain, manage liver failure, help patient cope.

Is the patient hypokalemic in the nonprogressive stage of hypovolemic shock? Why or why not?

Patient may be hyperkalemic due to the breaking of RBCs.

What "constitutional symptoms" might a patient with Hodgkin's lymphoma have?

Patient may have "constitutional symptoms" such as drenching night sweats unexplained weight loss

Oh Nurse! Which nursing safety concerns come to mind when you when it comes to caring for patients with Parkinson's?

Patient's with Parkinson's may need close observation during meal time due to the rigidity in their facial muscles that cause difficulties in chewing and swallowing, particularly if the pharyngeal muscles are involved. As a result, the patient may have inadequate nutrition. Uncontrolled drooling may occur. Men need assistance shaving due to tremors. They also have risk for falls.

How would a patient's skin look if they have polycythemia? Why?

Patients appear plethoric (dark, flushed appearance) due to poor tissue oxygenation.

In regards to hematology, what should the nurse look for when doing a respiratory assessment?

Patients breathe faster if they are anemic since there are fewer red blood cells; short of breath.

Can a person with Sickle Cell Disease catch malaria?

People with sickle cell trait are less likely to get malaria than the general population however they can still get malaria. People with sickle cell disease can get malaria just like anyone else.

Yellow box

Perform frequent neurovascular assessments after surgical nerve repair, including checking the skin around the splints and casts (hourly, initially) for tightness, warmth, and color. If the patient reports discomfort, tingling, or coolness or if the color is blanched, the cast or splint may be too tight (constricted). Inform the physician immediately about constriction and any indication of drainage under a splint or cast. Because sensation may be absent or inhibited, teach the patient to protect the involved areas from temperature extremes and other sources of potential trauma.

What is postictal?

Period of time after the seizure

Nursing management of the patient undergoing treatment for Hodgkin's lymphoma in regards to males when focusing on the acute side effects of therapy.

Permanent sterility for male patients receiving radiation to the abdominopelvic region in the pattern of an inverted Y in combination with specific chemotherapy drugs (The patient is informed of this side effect and given the option to store sperm in a sperm bank before treatment.)

Tongue may be smooth in what?

Pernicious or B12 deficiency anemia

What is a systemic side effect?

Pertaining to the whole body rather than to a localized area or regional part of the body.

What is the color of superficial partial-thickness burns?

Pink to red

X-rays are used to determine what? Does the patient have to remain still, or are they free to move? Does the patient have to lay down, or can they stand?

Plain x-rays of the skull and spine are used to determine bony fractures, curvatures, bone erosion, bone dislocation, and possible calcification of soft tissue, which can damage the nervous system. The patient must remain still during the procedure. Our teacher stated in class that head and spinal x-rays-can be done with patient standing, but not every patient is able to stand, so we can bring a portable x-ray machine. An x-ray can be taken when the patient is supine. Gives info of bone, but not soft tissue. Can see metal, rock, bone, maybe wood.

In regards to hematologic changes with aging, what changes occur in the levels of plasma protein?

Plasma protein levels decrease

Ploidy classifies tumors as what?

Ploidy classifies tumor chromosomes as normal or abnormal.

How does Heparin-Induced Thrombocytopenia (HIT) present? Within how many days?

Presents as an unexplained drop in platelet count within 100 days of heparin treatment

What is the common age of Alzheimer's?

Possible at age 40, more common after 65.

What are possible interventions for trigeminal neuralgia?

Possible interventions include medications and radiation administered by a Gamma Knife.

In hemophilia, what should the nurse be concerned about post-op?

Post-op bleeding

How is a diagnosis made in glomerulonephritis?

Precise dx is made by renal biopsy

What are predisposing factors for meningitis?

Predisposing factors may include basilar skull fracture, head/neck surgery, ear infection, sinusitis, AIDS, and tongue piercing

Should you give the patient in hypovolemic shock fluids? If no, why? If yes, how much?

Professor in class said: Yes, give them some IV fluids, but not too much. 1 maybe 2 liters of fluid if pt has blood loss, because more fluid we give them, the more we dilute their clotting factors, so they can't clot the blood, especially on the insdie-a lot of fluid impedes body's clotting ability by diluting clotting factors.

If patient has mucositis, where else do the most likely have it?

Professor in class stated "In their esophagus."

What are different types of acute kidney injury (AKI)?

Prerenal (before kidney) Intrarenal (inside kidney) Postrenal (after kidney)

What does Mx stand for when staging tumors?

Presence of distant metastasis cannot be assessed.

What are baroreceptors? Where are they located?

Pressure-sensitive nerve receptors (baroreceptors) in the aortic arch and carotid sinus.

How can chronic back and neck pain be prevented?

Prevention includes good posture, proper lifting, exercise, maintaining healthy weight, avoiding very high heels for prolonged periods of time, not smoking, and proper ergonomics.

After a patient is burned, what is vitally important? Why?

Prevention of infection and closure of the burn wound are vitally important. A lack of or delay in wound healing is a key factor for all systemic problems and a major cause of disability and death among patients who are burned.

What is the nursing priority for transfusion therapy?

Prevention or early recognition of adverse transfusion reactions

What is most important in those with G6PD anemia?

Prevention-avoid triggers

What are the two type of traumatic brain injuries?

Primary Brain Injuries result from direct impact. Examples include skull fractures, concussions, and contusions. In Secondary Brain Injuries the damage results from hypoxia, swelling or infection (indirectly resulting from the primary injury

What is primary prevention of cancer?

Primary prevention of cancer involves avoiding exposure to known causes of cancer.

What does T stand for when staging tumors?

Primary tumor (T)

What does Tx stand for when staging tumors?

Primary tumor cannot be assessed

What are priority interventions for the client in sickle cell crisis?

Priority ABC, oxygen, pain, and hypotonic IV fluids. O2 so RBCs that do function have more oxygen to bring to body.

What is progression in carcinogenesis?

Progression - cancer cells change and become more malignant over time

What are the main symptoms in Huntington disease?

Progressive mental status changes, leading to dementia, and choreiform movements (rapid, jerky movements, almost seizure-like).

What is dementia?

Progressive, irreversible decline in mental function

Platelet counts < 50K lead to what?

Prolonged bleeding

MODS leads to death when?

Prolonged organ failure Extensive, irreversible damage Recovery not possible

What is the antidote for heparin?

Protamine sulfate

How do white blood cells offer protection?

Protection through inflammation and immunity

____ seen in urinalysis with uncontrolled hypertension

Proteinuria

What does the liver produce?

Prothrombin and most blood clotting factors

Is fever common in cystitis or pylenophretitis?

Pylenophretitis

What are the nursing implications for the slower processing time in older adults? Why?

Provide sufficient time for the affected older adult to respond to questions and/or direction. Allowing adequate time for processing helps to differentiate normal findings from neurologic deterioration.

What are nursing concerns that may not be as pressing with other types of surgery (for patients without cancer)?

Psychological support and maintenance of maximum function Unlike surgery performed for many other reasons, cancer surgery often involves the loss of a specific body part or its function. Sometimes whole organs are removed, such as the kidney, lung, breast, testes, leg, or tongue. Any organ loss reduces function. The amount of function lost and how much the loss affects patients depend on the location and extent of the surgery. Some cancer surgery results in major scarring or disfigurement. Patients are anxious about the chances of surviving the cancer and also may be grieving about a change in appearance or lifestyle.

In the progressive stage of hypovolemic shock, describe the pulse, blood pressure, skin color, and pH.

Pulse is rapid and weak, BP low, skin pale, pH decreasing

What is pyuria?

Puss in the urine

How should you put on and take of clothes in the patient with stroke?

Putting clothing on: Dress the weak arm first Taking clothes off: Weak arm last

What is an infection of the kidney called?

Pyelonephritis

What is an infectious kidney disorder?

Pyelonephritis

What labs should you look for in pyelonephritis?

Pyuria (puss in urine), positive for leuokcyte esterace, positive for nitrate, positive for WBCs and bacteria

What are stem cells capable of becoming?

RBCs, WBCs, or platelets. What each stem cell becomes depends upon the bodies needs

What are some assessment findings in the patient with liver cancer?

RUQ pain or mass Epigastric fullness Fatigue and malaise Jaundice, splenomegaly

What can happen to normal tissue if it is exposed to radiation?

Radiation damage to normal tissues during cancer therapy can start inflammatory responses that lead to tissue fibrosis and scarring. These effects may appear years after radiation treatment. For example, women who receive radiation therapy for uterine cancer may develop radiation-induced changes in the colon (which also was irradiated) years later, resulting in constipation and obstruction.

What is teletherapy?

Radiation is delivered from a source outside the patient.

Cell division in cancer cells are what? Why?

Rapid or continuous Rapid or continuous cell division occurs in many types of cancer cells because they re-enter the cell cycle for mitosis almost continuously. In addition, some cancer cells have a short generation time (2 to 4 hours), but most cancer cells have a generation time similar to that of the parent cells. These cells also do not respond to signals for apoptosis. Most cancer cells have a lot of the enzyme telomerase, which maintains telomeric DNA. As a result, cancer cells do not respond to apoptotic signals and have an unlimited life span (are "immortal").

Are there blisters with deep partial-thickness burns?

Rare

How often should a colonoscopy be done? When should it be done?

Recommended every 10 years beginning at age 50. Doctor can see if there are polyps, which are benign tumors, and if there is one that looks suspicious, take it out or do a biopsy. If all polyps don't look the same, come back next year for colonoscopy. If patient has crohn's disease, they need a colonoscopy. If the patient has sibling with polyps or colon cancer, patient should have a colonoscopy.

What are common signs and symptoms?

Rectal bleed, anemia, change in stool consistancy or shape, gas pains/cramping, narrowing of stool

What are erythrocytes?

Red blood cells

What is the color of deep partial-thickness burns?

Red to white

How can you help the patient who has undergone surgery for cancer maintain maximum function?

Reduced function may be an outcome for some types of cancer surgery. For example, a modified radical mastectomy for breast cancer can lead to muscle weakness and reduced arm function on the surgical side. Performing specific exercises after surgery can reduce functional loss. These exercises can be painful, and the patient needs encouragement to perform them. Teach the patient about the importance of performing and increasing the intensity of the exercises to regain as much function as possible and prevent complications. Coordinate with the physical therapist, occupational therapist, and family members to plan strategies individualized to each patient to regain or maintain optimal function.

What is neutropenia? What causes it?

Reduced neutrophils. Chemotherapy causes it.

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Refer the patient with amyotrophic lateral sclerosis to a hospice program for palliative care. The hospice team works closely with the family to ensure the patient's comfort and respiratory support. The team collaborates with the health care provider to ensure that the patient has the needed drug therapy and pain control, as well as quality of life for the patient and family.

What does N stand for when staging tumors?

Regional Lymph Nodes (N)

What does Nx stand for when staging tumors?

Regional lymph nodes cannot be assessed

What is the treatment for hemophilia?

Regularly scheduled infusions of factors are costly but potentially prevent the patient from bleeding to death

What are the nursing implications for the older with recent memory loss? Why?

Reinforce teaching by repetition and written teaching aids. Greatest loss of brain weight is in the white matter of the frontal lobe. Intellect is not impaired, but the learning process is slowed. Repetition helps the patient learn new information and recall it when needed.

What is the most common complication of kidney transplant?

Rejection

Some bacteria is ________ by the spleen.

Removed

Exposure to tobacco and lead increase people's risk for what?

Renal carcinoma

How does the renin-angiotensin system work?

Renin is a hormone that is produced to help regulate blood flow, GFR, and blood pressure. When blood volume, blood pressure, or blood sodium is low, Renin converts to angiotensin I. and then through a series of reactions - secretes aldosterone, which increases kidney reabsorption of sodium and water, restoring blood pressure, blood volume, and blood sodium levels. It also promotes excretion of potassium.

"Chemo brain" is reported most often in patients with what kind of cancer?

Reported most often in women undergoing chemotherapy for breast cancer, although it is not limited either to women or to breast cancer treatment. The fact that it is reported more in this population reflects the issues that breast cancer is very common, it is often treated with high-dose chemotherapy, and most patients with breast cancer survive a long time after therapy.

Why do these respiratory manifestations of shock occur?

Respiratory changes with shock are an adaptive or compensatory response to help maintain oxygenation when tissue perfusion is decreased. Assess the rate, depth, and ease of respiration. Respiratory rate increases during hypovolemic shock to ensure that oxygen intake is increased so that it can be delivered to critical tissues. When shock progresses to the stage at which lactic acidosis is present, the respiratory depth also increases.

Kidneys are where?

Retroperitoneal

Rigid facial muscles lead to what in Parkinson's?

Rigidity of facial muscles leads to difficulty chewing and swallowing, sometimes uncontrolled drooling.

What is the only drug approved for the use of ALS?

Riluzole (Rilutek) is the only drug approved by the Food and Drug Administration for use with ALS patients. It is not a cure, but it does extend survival time. The usual dose is 50 mg twice daily. Teach patients to take the drug without food and when the stomach is empty. Teach the patient how to detect signs and symptoms of liver toxicity, such as vomiting and jaundice, that the drug may cause. Remind them to have frequent liver enzyme tests, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as directed by the health care provider.

In regards to tumor nomenclature, what is the prefix if the tissue of origin is skeletal muscle?

Rhabdo

____ kidney is slightly lower, because of liver

Right

What happens to the potassium and lactic acid levels in the progressive stage of hypovolemic shock?

Rising K+ and rising lactic acid levels

What are risk factors for breast cancer?

Risk factors: First degree relative (mother, sister, daughter) with breast cancer, nulliparity, and HRT (hormone replacement therapy), early menstruation, obesity.

Oh Nurse! The patient with GB may have motor weakness only, or may have motor weakness with some sensory abnormalities. What are the nursing implications of a disease with motor weakness only?

Risk for falls, depression, temperature sensation (can't tell if too hot or cold).

The decreasing stomach acid in stomach cancer creates what risk?

Risk for infection

What problem is the major dose-limiting side effect of cancer chemotherapy?

Risk for sepsis due to risk of infection from neutropenia (caused by chemotherapy).

What are commonly prescribed drugs for meningitis?

Rocephin, Vancomycin

What are oncologic emergencies?

SIADH, Spinal Cord Compression, Hypercalcemia, Superior Vena Cava Syndrome, Tumor Lysis Syndrome

Organisms in the blood multiply and _____ is triggered.

SIRS (systemic inflammatory response syndrome)

What can be done for superior vena cava?

SVC syndrome is a late-stage manifestation; the tumor is usually widespread. High-dose radiation therapy to the upper chest area may be used to provide temporary relief. Surgery is rarely performed for this condition. A metal stent can be placed in the vena cava in an interventional radiation department to relieve swelling. Follow-up angioplasty can keep this stent open for a longer period.

What interventions can be done for the patient with Parkinson's?

Safe environment Prevent choking Use hard back chairs Encourage independence in self-care Maintain adequate nutrition Increase fiber, increase fluids Stool softners Improve communication abilities ROM Increase HOB at least 30°

What are examples of superficial partial-thickness burns?

Scalds, flames, brief contact with hot objects

What are examples of deep partial-thickness burns?

Scalds; flames; prolonged contact with hot objects, tar, grease, chemicals

What are examples of full-thickness burns?

Scalds; flames; prolonged contact with hot objects, tar, grease, chemicals, electricity

What are examples of flat bones?

Scapula Sternum

What is nephrosclerosis?

Sclerosis means hardening, so it's hardening of the kidney.

What would you see on an EKG in a patient with Tumor Lysis Syndrome? Why? What other symptoms

See the following as a result from HYPERKALEMIA Tall T waves Flat P waves Hallmark widened QRS complex Also see Bradycardia and GI hypermotility.

What are some brachytherapy devices that can be placed into the tissues and stay in place by themselves?

Seeds or needles

Wha are fluoroquinolones used to treat? What line of defense are they?

Second choice for antibiotics for UTI-second line of defense

Nursing management of the patient undergoing treatment for Hodgkin's lymphoma in regards to other cancers when focusing on the acute side effects of therapy.

Secondary cancer development as a result of HL treatment (Long-term follow-up includes screening for recurrence, as well as the possible development of a secondary cancer.)

What is secondary prevention of cancer?

Secondary prevention of cancer involves screening for early detection.

What is sepsis? What is SIRS?

Sepsis is a condition in which infectious microorganisms have entered the bloodstream. As the numbers of organisms increase, an inflammatory response, known as systemic inflammatory response syndrome (SIRS)

What is sepsis?

Sepsis is a widespread infection that triggers a whole-body inflammatory response.

When does sepsis lead to distributive shock? What is septic shock?

Sepsis leads to distributive shock when infectious microorganisms are present in the blood. This form of shock is most commonly called septic shock.

What is septic shock?

Septic Shock is the stage of SIRS when multiple organ failure is evident and uncontrolled bleeding occurs. -Death rate exceeds 50% -Severe hypovolemic shock due to bleeding -Decreased cardiac function due to cardiac cellular ischemia -Clinical manifestations resemble the late (refractory) stage of hypovolemic shock.

What happens to a patient's serum K levels after they received a blood transfusion?

Serum potassium levels will spike because most potassium is inside your cells so when patient receives blood from donor, some of the blood cells break while going into patient (because of the size of the size of the needle; might be too small). Other reasons blood breaks while transfusing is if the blood is old. If you have an older patient, advocate getting blood that has been on shelf for one week or less-as blood cells break then potassium leaks into the blood, and you are infusing potassium into patient. What other fluid / electrolyte changes happen? Giving them a lot more fluid, to give an OA units of blood, follow with Lasix, to get off extra fluid so they don't have extra fluid. Listen to lungs often, make sure they aren't having a hard time breathing. If OA has hard time breathing, could either be transfusion reaction or extra fluid.

Is there edema with full-thickness burns?

Severe

What are side effects of biological response modifiers?

Side effects of BRMs include capillary leakage, fluid shifts, and severe edema which will usually subside

Nursing management of the patient undergoing treatment for Hodgkin's lymphoma in regards to nutrition and digestive health when focusing on the acute side effects of therapy?

Severe nausea and vomiting, which impairs nutrition; Constipation or diarrhea.

Severe sepsis comes after SIRS. What happens in severe sepsis?

Severe sepsis is the progression of sepsis with an amplified inflammatory response -All tissues are hypoxic to some degree -Some organs are experiencing cell death -Microthrombi formation is widespread, using much of the available platelets and clotting factors, a condition known as DIC (disseminated intravascular coagulation) -This continued stress response triggers the release of glucose from the liver resulting in hyperglycemia. The more severe the response the higher the blood glucose

-Severity of the burn is determined by what two things?

Severity of the burn is determined by: 1. How much of the body surface area (BSA) is involved 2. Depth of the burn

Why is shock considered a syndrome? The syndrome is started when what is impaired?

Shock is a "syndrome" because the cellular, tissue, and organ events occur in a predictable sequence. Any problem that impairs oxygen delivery to tissues and organs can start the syndrome of shock and lead to a life-threatening emergency

What is shock?

Shock is defined as inadequate tissue perfusion. Our book defines it as "widespread abnormal cellular metabolism that occurs when oxygenation and tissue perfusion needs are not met to the level necessary to maintain cell function."

What is usually "worse"? Sickle cell disease or sickle cell trait?

Sickle cell disease

What shape are the cells in SCD?

Sickle in shape

What are signs of decreased HgB?

Signs of ↓ HgB include pale skin, gums, and palmar creases

What are partial, or focal, seizures?

Similar to generalized but involve one body part, may not be followed by unconsciousness.

What does MAP equal?

Since MAP is a product of Cardiac Output (CO) and Systemic Vascular Resistance (SVR) [MAP = CO x SVR]

Why do these integumentary manifestations of shock occur?

Skin changes occur because of reduced blood flow in the skin. An early compensatory mechanism is skin blood vessel constriction, which reduces skin perfusion. This allows more blood to circulate to the vital organs, which cannot tolerate low oxygen levels.

What happens to the skin in the path of radiation?

Skin in the path of radiation becomes very dry and can break down. This skin is very sensitive to sun damage.

Yellow box

Skin in the radiation path is more sensitive to sunburn and damage. Advise against direct skin exposure to the sun during treatment and for at least 1 year after completing radiation therapy.

What is the nuclear-to-cytoplasmic ratio of normal cells?

Small

In iron deficiency anemia, what happens to the size of the RBCs, and why?

Small RBC's due to not enough Iron available for Hgb

Why can smoking cause back pain?

Smoking has been linked to disk degeneration, possibly caused by constriction of blood vessels that supply the spine.

Why is giving a soft collar debatable?

Soft collar is debatable if it works. It might be a placebo effect to prescribe because the neck can still rotate on its axis in the soft collar. Sometimes its okay to keep head aligned for sleeping.

_____ isotopes are not eliminated in stool or urine.

Solid

Cancer cells have ______ or ______ differentiated functions.

Some no

What happens to the cancer cells in radiation therapy?

Some cancer cells damaged by radiation therapy die immediately, others die within 24 hours, still others repair themselves.

Why is hormonal manipulation used to treat cancers?

Some hormones make hormone-sensitive tumors grow more rapidly. Thus decreasing the amount of these hormones to hormone-sensitive tumors can slow the cancer growth rate.

Should cotton be used to stop bleeding?

Sometimes the cotton fibers stick to injury, and when the cotton is removed the patient starts bleeding again.

What is the function of neutrophils?

Soon after bacterial invasion or tissue injury they migrate out of the capillaries into the damaged tissue, where they ingest and destroy contaminating microorganisms and debris.

On the Oral Mucositis scale, what is grade 1?

Soreness/erythema

What are signs and symptoms of penile cancer?

Sores, discharge, bleeding. lumps, irritation, redness

Normal cells have what kind of appearance?

Specific morphologic features

What does specific morphology mean?

Specific morphology is the feature in which each normal cell type has a distinct and recognizable appearance, size, and shape.

Benign tumors have what kind of appearance?

Specific morphology occurs with benign tumors. They look like the tissues they come from, retaining the specific morphology of parent cells.

What should the nurse consider as a possibility when a cancer patient has new onset of neuro deficits. What treatment might the patient undergo?

Spinal Cord Compression Treatment may be palliative.

What is spinal fusion?

Spinal fusion-chips of bone are removed (typically from the illiac crest) and grafted between vertebrae for support and strength.

The _____ helps balance blood cell production with blood cell destruction

Spleen

In regards to tumor nomenclature, what is the prefix if the tissue of origin is epithelial layer of skin, mucous membranes, and organ linings?

Squamous

What is oncogenesis?

Stages of Carcinogenesis = Oncogenesis Carcinogenesis and oncogenesis are other names for cancer development.

Why are cancers staged?

Staging determines the exact location of the cancer and its degree of metastasis at diagnosis. Staging is important because, for most cancers, the smaller the cancer is at diagnosis and the less it has spread, the greater the chances are that treatment will result in a cure.

What genetic diseases lead to glomerulonephritis?

Systemic Lupus Erythematosus: "lupus" Sickle-cell

The bone marrow of flat bones produce what?

Stem Cells

What are immature, unspecialized (undifferentiated) cells?

Stem Cells

Urolithiasis

Stone in the urinary tract

What is Urolithiasis?

Stone in the urinary tract

What is hydroureter? What is hydronephrosis?

Stones that form in the kidney and then pass into the ureter often lodge in areas where the ureter bends or slightly changes shape. When the stone occludes the ureter and blocks the flow of urine, the ureter dilates. Enlargement of the ureter is called hydroureter. If the obstruction is not removed, urinary stasis can cause infection and impair kidney function on the side of the blockage. As the blockage persists, hydronephrosis (enlargement of the kidney caused by blockage of urine lower in the tract and filling of the kidney with urine) and permanent kidney damage may develop.

What are dialysis access devices?

Subclavian Catheter "Vas Cath", AV fistula, AV graft (or shunt)

What is a subdural hematoma?

Subdural is under the dura. Slow onset-older person who falls at home, says their fine, and then later it is unconscious. It is a venous bleed-slow and insidious. Subdural hematoma is usually due to a venous bleed. Slow onset may not be evident until 48 hours two weeks or even months after the injury. High mortality because often unrecognized initially.

What are carcinogens?

Substances that change the activity of a cell's genes so that the cell becomes a cancer cell are carcinogens.

Why should you ask the patient if they have ever had a reaction to a contrast media?

Such a patient has the highest risk for having another reaction

The tissue destruction caused by a burn injury leads to many local and systemic problems. Such problems include what?

Such problems include fluid and protein losses, sepsis, and changes in metabolic, endocrine, respiratory, cardiac, hematologic, and immune functioning

What makes a superficial partial-thickness wound?

Superficial partial-thickness wounds are caused by injury to the upper third of the dermis, leaving a good blood supply.

What is myelosuppression? What causes it?

Suppression of bone marrow function. Chemotherapy causes it-In addition to killing cancer cells, chemotherapy also destroys circulating blood cells and reduces replacement of these cells by suppressing bone marrow function. The numbers of all circulating leukocytes, erythrocytes, and platelets are decreased. Reduced leukocyte numbers, especially reduced neutrophils (neutropenia), greatly increase the risk for infection. Decreased erythrocytes and platelets cause hypoxia, fatigue, and an increased tendency to bleed.

How are tumors of the tongue treated?

Surgical removal Radiation Chemotherapy

In hypovolemic shock, what decrease in MAP is the progressive stage?

Sustained decrease in MAP of more than 20 mm/Hg

What are the symptoms of acute kidney injury?

Symptoms are hot and sweaty, edematous (fluid is in the wrong place), nausea, vomiting. Acute is that the patient might sometimes be able to recover.

When do symptoms in Huntington disease begin? What gender is most affected?

Symptoms begin between ages 35 and 50, males and females equally affected.

Symptoms of SIADH result from what? What are the symptoms?

Symptoms result from hyponatremia (due to diluted sodium) and include nausea, vomiting, and abdominal cramps. The patient will be thirsty due to low sodium levels detected by osmoreceptors. Might see JVD, expathalomous, pounding heart rate.

What is a TIA?

T Transient I Ischemic A Attack -By definition, symptoms resolve within 24 hours. -Sometimes called a "mini stroke" -A warning, patient is at high risk for a stroke It's a temporary neurologic dysfunction resulting from a brief interruption in cerebral blood flow, possibly due to cerebral vasospasm or systemic arterial hypertension.

TIA is a warning for what?

TIA is a warning that a patient might have a real stroke down the road

What should you teach patients about their alopecia?

Teach patient to prevent injury and use sunscreen head to toe (including scalp) since those who have chemotherapy are more prone to sunburns. Reassure them that their will grow back (unless they have radiation in that area). Let them know that their hair might grow back thicker, and might have altered color. Consider obtaining a wig before it is needed.

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Teach patients and families about the importance of adhering to the anti-rejection drug regimen to prevent transplant rejection

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Teach patients taking MAOIs about the need to avoid foods, beverages, and drugs that contain tyramine, including cheese and aged, smoked, or cured foods and sausage. Remind them to also avoid red wine and beer to prevent severe headache and life-threatening hypertension. Patients should continue these restrictions for 14 days after the drug is discontinued.

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Teach patients taking the extended-release forms of anticholinergic drugs to swallow the tablet or capsule whole without chewing it or crushing it. Chewing or crushing the tablet/capsule ruins the extended-release feature, allowing the entire dose to be absorbed quickly, which increases drug side effects.

How can unilateral body neglect be improved?

Techniques to Help Improve Neglect 1. Approach the stroke patient from the affected side causing them to have to attend to that side. If they do not look at you, gently turn their head toward you. Sit on the affected side when interacting with the stroke patient. 2. Put objects on the affected side to make the patient search for them. This applies to things like the tv remote, a glass of water, the phone, etc. This does not apply to the nurses call light though. Patients need to be able to call for help. 3. Touch the affected side or bring the patient's non-affected hand over to touch their affected side. This is to help make them aware of that side via touch. 4. Incorporate the affected limb into activities. An example would be the caregiver guiding the affected arm through an activity such as stroking the family pet, reaching for an object, or wiping off a table.

What are the two means by which radiation therapy is delivered?

Teletherapy and brachytherapy

What is the likely cause of migraine headaches?

The cause of migraine headaches is likely a combination of vascular, genetic, neurologic, hormonal, and environmental factors. It is generally agreed that migraine headaches are mediated via the trigeminal vascular system and its central projections. Women often have migraines during their menstrual cycle.

What is the cause of ALS?

The cause of the disease is unknown but is likely due to interactions of genetic, viral, and environmental factors.

The cerebrospinal fluid (CSF) is analyzed for what?

The CSF is analyzed for cell count, differential count, and protein. Glucose concentrations are determined, and culture, sensitivity, and Gram stain studies are performed.

What is the Glasgow Coma Scale?

The GCS establishes baseline data in each of these areas: eye opening (4), motor response (6), and verbal response (5). The patient is assessed and assigned a numeric score for each of these areas. A score of 15 represents normal neurologic functioning. A score of 7 represents a comatose state. Thus the lower the score, the lower the patient's LOC. Thus thelower the score, the lower the patient's LOC. For patients who are intubated and cannot talk, record their score with a "t" after the number. The best possible score for this patient would be 11t.

Why would a patient with leukemia be at risk for infection if their WBCs are greatly elevated?

The WBCs are not able to provide infection protection since they are immature and nonfunctional cells

What is hemophilia?

The ability of the blood to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury.

What is generation time?

The amount of time needed for one cell to divide completely into two cells is the generation time. For normal cells, the generation time varies by tissue and organ type.

What are arterial chemoreceptors? Where are they located? What do they have to do with hypovolemic shock?

The arterial chemoreceptors are chemosensitive cells that monitor the oxygen, carbon dioxide, and hydrogen ion content of the blood. They are located in the carotid bodies (taken from Porth-it's what our teacher talked about in class briefly). Our teacher said that: Carotid body can detect slight change in pH-so since lactic acid is building up, the carotid body is recognizing pH change. Because of this, they induce widespread vasoconstriction.

What are normal brain changes in the older adult? How does the brain change with Alzheimer's disease (AD)?

The brain of the older adult usually weighs less and occupies less space in the cranial vault than does the brain of a younger person. In the presence of AD, these normal changes are greatly accelerated. Neurons in the brain are more twisted and tangled with Alzheimer's Disease. Brain weight is reduced further. Marked atrophy of the cerebral cortex and loss of cortical neurons occur. The cerebral sulci and fissures, as well as the ventricles, are enlarged more than those of persons of the same age without AD.

What is mean by "tunneling" of a venous access catheter?

The entrance into the skin and blood vessel are as far apart as possible to prevent infection. Tunneling helps prevent infection.

The most significant laboratory test used in the diagnosis of meningitis is the analysis of what?

The cerebrospinal fluid (CSF)

What are interventions for MG?

The classic presentation of MG is muscle weakness that increases when the patient is fatigued and limits his or her mobility and ability to participate in activities. Management for this disease falls into two categories: • Treatment that affects the symptoms of MG without influencing the actual course of the disease (anticholinesterases or cholinergic drugs) • Therapeutic efforts for inducing remission, such as the administration of immunosuppressive drugs or corticosteroids, plasmapheresis, and thymectomy (removal of the thymus gland)

How does sepsis and SIRS differ? What triggers SIRS?

The client has sepsis when the infectious organisms have entered the bloodstream. SIRS is the systemic inflammatory response when the infectious organisms increase. SIRS is triggered as a result of infection escaping local control

What is eschar?

The eschar is dead tissue; it must slough off or be removed from the wound before healing can occur.

In multiple myeloma, how does the increase in antibodies affect the body?

The excess antibodies are released into the blood, increasing the serum protein levels and clogging blood vessels in the kidneys.

What might the patient not due out of fear that the pain in trigeminal neuralgia will come back?

The fear of precipitating attacks often causes patients to avoid talking, smiling, eating, or attending to hygienic needs such as shaving, washing the face, and brushing the teeth. The pain can cause uncontrollable facial twitching.

What is malignant transformation?

The process of changing a normal cell into a cancer cell is called malignant transformation, occurring through the steps of initiation, promotion, progression, and metastasis.

Describe the process of fibrinolysis.

The process starts by activating plasminogen to plasmin. Plasmin, an enzyme, then digests fibrin, fibrinogen, and prothrombin (fibrin clot), controlling the size of the fibrin clot. This lead to fibrin degradation products.

What is neoplasia, or neoplastic cells?

The formation or presence of a new, abnormal growth of tissue.

What is the function of the frontal lobe?

The frontal lobe is found at the front of the head near the temples and forehead. It processes voluntary muscle movements and higher functioning actions such as thought and speech. It also helps control mood, planning for the future, setting goals, and making judgments.

What happens to the kidneys in glomerulonephritis?

The glomeruli are injured

What are considerations of antiepileptic drugs for the older adult?

The health care provider prescribes antiepileptic drug (AEDs) for the older adult that: • Have minimal possibility of toxicity • Cause few side effects • Are available in oral route for dosing • Are easily metabolized and absorbed • Have a long half-life with infrequent dosing to prevent missed dose • Are readily excreted • Require minimal protein binding, because older adults lose protein and a therapeutic dose may be toxic to them • Cause minimal to no weight gain to prevent complications that may be associated with heart disease

Why is protein seen in urine in those with hyptertension?

The increased pressure causes holes to form in the glomerulus, causing the leakage of protein.

The client was delivered to the hospital by a friend. The client has a gunshot wound to the head. Would the first CBC lab result be normal or abnormal? What if he was taken to the hospital by an ambulance?

The initial CBC would be normal because the concentration of particles in blood is normal even if he was in hypovolemic shock; if an ambulance gave him a liter of fluid on the way, CBC would be low since it is diluted by the liter of fluid.

What are sensory neurons?

They cause sensation

What is a contrecoup contusion?

The injury sustained when the back of the brain hits the the skull from an injury to the front of the head. A contusion is bruising of the brain tissue usually found at the site of impact (coup injury) or in a line opposite the site of impact (contracoup injury).

What is the purpose of the myelin sheath?

The insulating envelope of myelin surrounds the core of a nerve fiber or axon and that facilitates the transmission of nerve impulses.

What is urge incontinence?

The involuntary loss of urine associated with a strong desire to urinate. Patients cannot suppress the signal from the bladder muscle to the brain that it is time to urinate.

What is stress incontinence?

The involuntary loss of urine during activities that increase abdominal and detrusor pressure. Patients cannot tighten the urethra sufficiently to overcome the increased detrusor pressure; leakage of urine results. Clinical manifestations are urine loss with physical exertion, cough, sneeze, or exercise. Usually only small amounts of urine are lost with each exertion.

What is the refractory stage also known as?

The irreversible stage

How does the kidney look in the person who has PKD?

The kidney tissue is eventually replaced by nonfunctioning cysts, which look like clusters of grapes. The kidneys become very large. Each cystic kidney may enlarge to two or three times its normal size, becoming as large as a football, and may weigh 10 pounds or more each.

What is a "crisis" in sickle cell anemia?

The patient with SCD has periodic episodes of extensive cellular sickling, called crises

How often does someone have a crisis in sickle cell disease?

The patient with SCD has periodic episodes of extensive cellular sickling, called crises. The crises have a sudden onset and can occur as often as weekly or as seldom as once a year.

What are the most common causes of SAIDH in the cancer patient?

The most common causes are tumors such as small cell carcinoma of the duodenum, stomach, pancreas, and cancer of the lung.

What are the most common causes of obstructive shock?

The most common causes of obstructive shock are pericarditis and cardiac tamponade

What are risk factors for getting restless leg syndrome (RLS)?

The most common type is associated with peripheral and central nerve damage in the legs and spinal cord. Many of those affected with primary RLS have a positive family history, indicating a possible genetic basis. The incidence is higher in patients who have diabetes mellitus type 2 and chronic kidney disease. Other potential risk factors include: • Polyneuropathies • Advanced age • Sleep deprivation • Drugs such as antinausea drugs, antipsychotic drugs, and selective serotonin reuptake inhibitors • Caffeine and alcohol

What is HbS?

The most common type of abnormal hemoglobin and the basis of sickle cell trait and sickle cell anemia. Those with sickle cell disease will have HbS instead of HbA (adult hemoglobin) or HbF (adults have some of this). If the patient's hemoglobin cells are more than 40% HbS, they have sickle cell anemia. If it is less than 40%, they have sickle cell trait.

Do cancer cells migrate? Why or why not?

They do migrate. Migration occurs because cancer cells do not bind tightly together and have many enzymes on their cell surfaces. These features allow the cells to slip through blood vessel walls and between tissues, spreading from the main tumor site to many other body sites.

Do cancer cells exhibit contact inhibition?

They do not. They continue to divide, piling up on each other.

What normal cells are most affected by chemotherapy?

The normal cells most affected by chemotherapy are those that divide rapidly, including skin, hair, intestinal tissues, spermatocytes, and blood-forming cells.

Why might a patient that is paralyzed have a increased risk for pneumonia?

The normal sigh and cough mechanisms for preventing pneumonia may be limited. Encourage use of incentive spirometer in patients who are able to utilize this device.

Why are those with Sickle Cell Disease at risk for sepsis and infection?

The patient with SCD is at greater risk for bacterial infection because of decreased spleen function resulting from anoxic damage to the spleen. Over time, the spleen may become completely nonfunctional. Expected outcomes of interventions include preventing infection, controlling infection, and starting treatment early for specific infections. The patient who develops a fever should have diagnostic testing for sepsis including CBC with differential, blood cultures, reticulocyte count, urine culture, and a chest x-ray. Usually these patients are started on prophylactic antibiotics.

Why is the change in patter of a seizure significant?

The pattern for seizures are usually the same. When pattern changes this is significant. Might indicate change in pathology. Important to time seizure and observe what body part first presents when seizure starts.

What is the mitotic index?

The percentage of actively dividing cells; the ratio of the number of cells undergoing mitosis (cell division) to the number of cells not undergoing mitosis

When do cluster headaches occur?

They generally occurs in the spring and fall without warning.

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The nurse who will be actually administering the blood products must be one of the two professionals comparing the patient's identification with the information on the blood component bag.

In those with hemophilia, why do they have complications with joints and muscles that lead to disability?

They get problem in joints and muscles due to bleeds in tiny blood vessels that we all get, but that they can't stop the bleeding.

What kind of growth do cancer cells have?

They have persistent growth; they invade.

What is the function of the occipital lobe?

The occipital lobe is located in the posterior of the brain and assists in the processing of visual information.

Oh nurse! What is meant by the term "primary tumor"?

The original tumor is called the primary tumor. It is usually identified by the tissue from which it arose (parent tissue), such as in breast cancer or lung cancer.

What causes peripheral nerve trauma? What peripheral nerves are often more affected?

The peripheral nerves are subject to injuries associated with mechanical or vehicular accidents, sports, the injection of particular drugs, military conflicts or wars, and acts of violence (e.g., knife or gunshot wounds). Specific mechanisms of injury include: • Partial or complete severance of a nerve or nerves • Contusion, stretching, constriction, or compression of a nerve or nerves • Ischemia to nerves • Electrical, thermal, or radiation injury to one or more nerves Most commonly affected are the median, ulnar, and radial nerves of the arms and the peroneal, femoral, and sciatic nerves of the legs.

How do the RBCs get destroyed in immunohemolytic anemia?

The person's own antibodies attack RBCs for unknown reasons.

What is the function of the parietal lobe?

The parietal lobe is found behind the frontal lobe. It processes spatial awareness and receives and processes information about temperature, taste, touch, and movement coming from the rest of the body. Reading and arithmetic are also processed in this lobe.

As a result of the widespread vasodilation and blood pooling, what happens to the patient?

The patient has mild hypotension, a low urine output, and an increased respiratory rate. These responses are compensatory mechanisms in response to impaired oxygenation however they result in decreased cardiac output.

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The priority nursing interventions for the patient with neutropenia are protecting him or her from infection within the health care system and teaching the patient and family how to reduce infection in the home. Total patient assessment, including skin and mucous membrane inspection, lung sounds, mouth assessment, and close inspection of venous access device insertion sites, should be performed every 8 hours by a registered nurse for hospitalized patients.

The rate of evaporation is in proportion to what?

The rate of evaporation is in proportion to the total body surface area (TBSA) burned and the depth of injury.

What causes anemia in sickle cell anemia?

The reduced life-span of the cells that sickle (2 weeks versus 120-day life span).

When does the refractory stage occur?

The refractory stage or irreversible stage of shock occurs when too much cell death and tissue damage result from too little oxygen reaching the tissues. Vital organs have overwhelming damage. The body can no longer respond effectively to interventions, and shock continues.

In regards to the capillary bed and MAP, what if the size of capillary bed increases, but it has the same blood volume. What is the result?

The result is a decreased mean arterial pressure (MAP) and a decreased blood flow.

In regards to the capillary bed and MAP, what if the size of capillary bed is normal, but has decreased blood volume?

The result is a decreased mean arterial pressure (MAP) and a decreased rate of blood flow.

In regards to the capillary bed and MAP, what if the size of capillary bed is increased, and has decreased blood volume?

The result is a large drop in mean arterial pressure (MAP) and a very sluggish blood flow.

In regards to the capillary bed and MAP, what if the size of capillary bed decreases, but has the same blood volume?

The result is an increased mean arterial pressure (MAP) and an increased rate of blood flow.

What is the result of anaphylaxis on blood vessel tone and cardiac output?

The result is widespread loss of blood vessel tone and decreased cardiac output.

What type of adherence are benign tumors? Why?

They have tight adherence. Tight adherence of benign tumor cells to each other occurs because they continue to make fibronectin. In addition, many benign tissues are "encapsulated," or surrounded with fibrous connective tissue, helping to hold the benign tissue together.

In a client that comes in for trauma, why is it important to look under them?

They may have extensive blood loss evident underneath them.

Changes in speech pattern are common in PD (Parkinson's disease) patients. How might they speak?

They may speak very softly, slur or repeat their words, use a monotone voice or a halting speech, hesitate before speaking, or exhibit a rapid speech pattern.

What is multiple organ dysfunction syndrome (MODS)?

The sequence of cell damage caused by the massive release of toxic metabolites and enzymes is termed multiple organ dysfunction syndrome (MODS). Once the damage has started, the sequence becomes a vicious cycle as more dead cells break open and release harmful metabolites. These trigger small clots (microthrombi) to form, which block tissue oxygenation and damage more cells, thus continuing the devastating cycle. Liver, heart, brain, and kidney functions are lost first. The most profound change is damage to the heart muscle. One cause of this damage is the release of myocardial depressant factor (MDF) from the ischemic pancreas.

What does nuclear-to-cytoplasmic ratio mean?

The size of the cell nucleus compared with the size of the rest of the cell, including the cytoplasm.

How do the small arteries and veins increase or decrease in diameter? When does blood pressure increase or decrease?

The small arteries and veins connected to capillaries can increase in diameter by relaxing the smooth muscle in vessel walls (dilation) or decrease in diameter by contracting the muscle (vasoconstriction). When blood vessels dilate and total blood volume remains the same, blood pressure decreases and blood flow is slower. When blood vessels constrict and total blood volume remains the same, blood pressure increases and blood flow is faster.

What organ removes thrombocytes?

The spleen

What removes old and imperfect RBCs?

The spleen

What tissue on average is most damaged by sickle cell disease?

The spleen

Where should a patient older than 60 years be seen for a burn?

They should receive emergency care at the nearest emergency department and then be transferred to a designated burn center.

Where should a burn patient that has cardiac, pulmonary, or other chronic metabolic disorders receive care?

They should receive emergency care at the nearest emergency department and then be transferred to a designated burn center.

What does hemostasis mean?

The stopping of the flow of blood; blood clotting

What is the function of the temporal lobes?

The temporal lobes are located in the area of the brain parallel to the ears. They process hearing, memory, and language functions.

What is polycythemia?

The term polycythemia means the number of RBCs is greater than normal. Can be temporary or chronic.

What is latency period? How long does it last?

The time between a cell's initiation and the development of an overt tumor is called the latency period, which can range from months to years.

What is the treatment for anaphylaxis. What did our teacher say was the dose?

The treatment is epinephrine. The dose for the child above 60 lbs is 0.3 mg sub q (adult dose), but epipen is often IM. Hold for count of 10-go in through clothing. Not a disaster for getting adult dose to child under 60 lbs-just have a fast heartrate for a while.

What should be done when the patient with Parkinson's disease has reached a tolerance with their medications?

The treatment of PD drug toxicity or tolerance includes: • A reduction in drug dosage • A change of drug or in the frequency of administration • A drug holiday (particularly with levodopa therapy) During a drug holiday, which typically lasts up to 10 days, the patient receives no drug therapy for PD. Carefully monitor the patient for symptoms of PD during this time, and document assessment findings.

What assessment finding might you make in a patient with Huntington disease?

The triad of dominant inheritance, choreoathetosis (neuromuscular symptoms), and dementia is the hallmark of the disease. The symptoms exhibited by the patient vary in range and severity, age of onset, and rate of progression. Observe for clinical manifestations, which include chorea (jerky movements), poor balance, hesitant or explosive speech, dysphagia (difficulty swallowing), impaired respiration, and bowel and bladder incontinence. Mental status changes include decreased attention span, poor judgment, memory loss, personality changes, and dementia (later in the disease process). Perform a complete neurologic assessment.

What are signs and symptoms for the patient with encephalitis?

The typical patient with encephalitis has a fever and reports nausea, vomiting, and a stiff neck. Assess for other clinical manifestations, including: • High fever • Changes in mental status (e.g., agitation) • Motor dysfunction (e.g., dysphagia [difficulty swallowing]) • Focal (specific) neurologic deficits • Photophobia (light sensitivity) and phonophobia (noise sensitivity) • Fatigue • Symptoms of increased ICP (e.g., decreased LOC) • Joint pain • Headache Assess LOC using the Glasgow Coma Scale. The patient may be lethargic, stuporous, or comatose. Mental status changes are more extensive in the patient with encephalitis than with meningitis. Changes include acute confusion, irritability, and personality and behavior changes (especially noted in the presence of herpes simplex). Signs of meningeal irritation include the presence of nuchal (neck) rigidity and motor changes that vary from a mild weakness to hemiplegia. The patient may have muscle tremors, spasticity, an ataxic gait (postencephalitic parkinsonism), myoclonic jerks, and increased deep tendon reflexes. Seizure activity is common. Nausea, vomiting, headache, and vertigo also may occur. Observe for cranial nerve involvement, such as ocular palsies (paralysis), facial weakness, and nystagmus (involuntary lateral eye movements). The herpes zoster lesion affects cranial and spinal nerve root ganglia, which is clinically manifested by a rash, severe pain, itching, burning, or tingling in the areas innervated by these nerves

In encephalitis, the virus invades the brain and then produces, causing what response? What does the resulting edema cause?

The virus invades the brain and then reproduces, causing an inflammatory response. Resulting edema can cause compression of blood vessels, increased ICP, hemorrhage and cell death

What are the signs of dehydration?

Their head will have dry mucous membranes, headache, sunken eyes/pupils, mental status changes (confusion, especially in older adults), no JVD, color, cap refills, temperature of hands, urine output decreased, foul smelling urine.

What happens if the cause of shock is corrected and the MAP returns to normal in the refractory stage of hypovolemic shock?

Therapy is not effective in saving the patient's life, even if the cause of shock is corrected and MAP temporarily returns to normal.

What are the stages of Huntington disease?

There are three stages of HD, each lasting roughly 5 years, corresponding to the average 15-year course of the disease. Stage 1 is the onset of neurologic or psychological symptoms. Stage 2 is characterized by an increasing dependence on others for care. Stage 3 results in loss of independent function.

Is there a decrease in RBCs in a patient with dehydration?

There is a loss of the serum part of blood, resulting in a decrease of blood volume from the vascular space.

What happens in multiple myeloma?

There is an overgrowth of the lymphocyte plasma cells in the bone marrow. These cancerous cells overproduce antibodies.

What are characteristics of MG?

This autoimmune disease of the neuromuscular junction may take many forms—from mild disturbances of the ocular muscles to a rapidly developing, generalized weakness that may lead to death from respiratory failure. It has remissions and exacerbations (worsening or "flare-ups"). Skeletal & respiratory muscle weakness. Muscles of facial expression, chewing, and speech are affected in most clients The most common symptoms are related to involvement of the levator palpebrae or extraocular muscles. Assess for ptosis, diplopia, and weak or incomplete eye closure. These symptoms may last only a few days at the onset and then resolve, only to return weeks or months later. Pupillary responses to light and accommodation are usually normal. For most patients, the muscles of facial expression, chewing, and speech are affected (bulbar involvement). Note the patient's smile, which may be transformed into a snarl. The jaw may hang so that the patient must prop it up with the hand. Chewing and swallowing difficulties, choking, and regurgitation of fluids through the nose may lead to considerable weight loss.

How is multiple sclerosis characterized?

This chronic disease is characterized by periods of remission and exacerbation (flare).

Transformation of a normal cell into a cancer cell involves what?

Transformation of a normal cell into a cancer cell involves mutation of the genes (DNA) of the normal cell.

What do anaerobic conditions causes an increase in what? What do these substances do?

This condition increases lactic acid levels and other harmful metabolites (e.g., protein-destroying enzymes, oxygen free radicals). These substances cause electrolyte and acid-base imbalances with tissue-damaging effects and depressed heart muscle activity.

In hypovolemic shock, baroreceptors sense a decrease in MAP. What are the compensatory measures that take place because of this? If the events that caused the initial decrease in MAP are halted now, would the compensatory measures be enough? If the MAP would decrease further, what would happen?

This information (decrease in MAP) is transmitted to brain centers, which stimulate adjustments (compensatory mechanisms) that help ensure continued blood flow and oxygen delivery to vital organs while limiting blood flow to less vital areas. The movement of oxygenated blood into selected areas while bypassing others ("shunting") results in some shock manifestations. If the events that caused the initial decrease in MAP are halted now, compensatory mechanisms provide adequate oxygenation and perfusion without outside intervention.

Oh Nurse! What is autonomic dysreflexia?

This is an acute or recent spinal cord injury. If someone had an injury yesterday, they were paralyzed from t7 down, then their bp skyrockets and there is bradycardia. There is a sympathetic response to a trigger (like bladder is full and can't open it) but the message can't get up past the level of injury, and they have sympathetic reaction. Can die of hypoxia. Cure is to put in a Foley catheter. Sometimes it is triggered by constipation because their peristalsis is decreased or absent. It's an emergency.

What is A&O?

This is described as A (awake) A (alert) and O (oriented) times 0, 1, 2, 3 or 4 if the patient knows who they are, where they are, what date or time it is and recent events. A&OX4. The person knows person, place, time and event. A&OX3. The person knows person, place and time, but not event.

Why are normal cells nonmigratory?

This occurs in normal cells because they are tightly bound together, which prevents cell wandering from one tissue into the next.

What are types of ischemic stroke?

Thrombolic (clot) and embolic (dislodged clot)

What complication may occur in the patient that has polycythemia.

Thrombosis (clot formation) may occur, as well as hypertension.

Normal cells have what kind of adherence?

Tight

How does tight adherence occur? What is an example?

Tight adherence occurs because normal cells make proteins that protrude from the membranes, allowing cells to bind closely and tightly together. One such protein is fibronectin, which keeps most normal tissues bound tightly to each other.

What is the purpose of radiation therapy?

To destroy cancer cells and have a minimal damaging effect on surrounding normal cells. The effects of radiation are seen only in the tissues in the path of the radiation beam.

Does dehydration cause RBC, HCT, and HGB to be too high or too low?

Too high

Does inflammation cause too high or too low WBCs?

Too high

Does lung disease cause RBC, HCT, and HGB to be too high or too low?

Too high

Does polycythemia vera cause RBC, HCT, and HGB to be too high or too low?

Too high

Does smoking cause RBC, HCT, and HGB to be too high or too low?

Too high

Would a heart attack cause too high or too low WBCs?

Too high

Would leukemia cause too high or too low WBCs?

Too high

What is leukocytosis?

Too high WBCs

Do bone marrow disorders cause too high or too low WBCs?

Too low

_______ use is a causative or permissive factor in 30% of all cancers.

Tobacco

What are risk factors of a tumor of the tongue?

Tobacco exposure/use, alcohol use, HPV infection, smoking, FH, sun exposure, diet

What are dermal appendages?

Together, the sweat and oil glands and the hair follicles are the dermal appendages

What are signs and symptoms of a tumor of the tongue?

Tongue/jaw pain, lump/thickening, white/red patches, hard to move tongue/jaw hard to chew/swallow

Do allergies cause too high or too low WBCs?

Too high

Do common infections causes cause too high or too low WBCs?

Too high

What do you treat first in kidney stones?

Treat pain first, and then get KUB

Often cancer has spread by the time of diagnosis therefore surgery may be just one aspect of the _______ plan?

Treatment Surgery is often a useful part of diagnosis, treatment, follow-up, and rehabilitation.

What is the treatment for polycythemia?

Treatment involves drinking 3 liters of fluid/day

What is the treatment for polycythemia vera?

Treatment involves drinking 3 liters of fluid/day, Pheresis 2-3x/week, bleeding precautions and daily aspirin.

What is the treatment of choice for aplastic anemia?

Treatment of choice is stem cell transplant

What are some prescription drugs for headaches that the teacher mentioned in class?

Triptan group drugs. For example, Imitrex. Some beta blockers and Ca++ channel blockers .

Respond to the following statement by selecting True or False: The kidney is a retroperitoneal organ. True False

True

True or False Alopecia is unavoidable during chemotherapy.

True

True or False Any type of pump failure decreases cardiac output and MAP.

True

True or False Back pain is one of the most common reasons for visiting a health care provider.

True

True or False Benign tumors grow by hyperplastic expansion

True

True or False Capillary leak syndrome leads to sepsis

True

True or False In nonprogressive stage of hypovolemic shock, stopping the condition that caused shock may prevent the problem from progressing.

True

True or False In nonprogressive stage of hypovolemic shock, the patient will often complain of thirst.

True

True or False Serum ferritin may be less than normal in iron deficiency anemia.

True

True or False Some diseases affect the myelin sheath, and others affect neurotransmitters.

True

True or False Testicular cancer is rare.

True

True or False Testicular cancer often does not metastasize

True

True or False The cost for hemophilia therapy can be a prohibitive factor.

True

True or False The older you get, the more incidences of cancer occur.

True

True or False The patient with bacterial meningitis may experience increased ICP, and seizure activity may occur.

True

True or False The skin and skeletal muscles can tolerate low levels of oxygen for hours without dying or being damaged.

True

True or False Tumors that metastasize from the primary site into another organ are still designated as tumors of the originating tissue.

True

True or False When the drugs given are vesicants (chemicals that damage tissue on direct contact), the results of extravasation can include pain, infection, and tissue loss.

True

True or False: If an older adult has pneumonia, they might not have an increased WBC count, especially if it is caused by a virus.

True

True or False: Progressive loss of body hair is a normal facet of aging.

True

True or False Another skin manifestation of SCD is jaundice. Why or why not?

True Another skin manifestation of SCD is jaundice. Jaundice results from RBC destruction and release of bilirubin. Bilirubin is present inside RBCs and released when fragile cells are damaged, leading to jaundice. To assess for jaundice in patients with darker skin, inspect the roof of the mouth for a yellow appearance. Yellow-tinged sclera may be misleading because of normal deposits of fat that appears yellowish in contrast to the dark skin around the eye. Examine the sclera closest to the cornea to assess jaundice more accurately. The palms and soles of dark-skinned patients may appear yellow if calloused and could be mistaken for jaundice. Jaundice often causes intense itching.

True or False Cancers are classified by the type of tissue from which they arise

True Make up the prefix in the nomenclature

True or False Patients with head injuries are at increased risk for syndrome of inappropriate anti-diuretic hormone (SIADH) and diabetes insipidus (DI).

True The patient with TBI is at risk for diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone (SIADH) because the pituitary gland may be injured or compressed from cerebral edema.

True or False ALS involved the motor system only.

True Unlike with many other neural degenerative diseases, the sensory and autonomic nervous systems are not involved.

True or False Migraines are episodic.

True. They come and go.

True or False Iron is stored in the liver and bones

True We have lots of iron that we store in our liver and bones, but HgB have priority. If you don't have enough in your diet, your body will take stored iron in liver and bones to use for HgB, but you still might not have enough, leading to iron deficiency anemia.

True or False Resection of the small bowel can lead to vitamin B12 deficiency anemia.

True. This is caused by problems leading to poor availability of Vitamin B12 for example resection (removal) of the small bowel or stomach, and chronic diarrhea.

What are the cellular characteristics of a G4 malignant tumor?

Tumor cells are poorly differentiated and retain no normal cell characteristics. Determination of the tissue of origin is difficult and perhaps impossible.

What are the cellular characteristics of a G3 malignant tumor?

Tumor cells are poorly differentiated, but the tissue of origin can usually be established. The cells have few normal cell characteristics.

What are the cellular characteristics of a G1 malignant tumor?

Tumor cells are well differentiated and closely resemble the normal cells from which they arose. This grade is considered a low grade of malignant change. These tumors are malignant but are relatively slow growing.

What kind of tumors are most sensitive to chemotherapy?

Tumors with rapid growth.

What are some interventions for the patient having a seizure?

Turn patient's head or body to the side. Many people have periods of apnea after the seizure-some people might die. Assume patient is apneic after seizure, put on oxygen. ABC's and turn patient onto side. Be prepared to suction-must be on bedside. Don't pry mouth open at all. Important to time seizure and observe what body part first presents when seizure starts. Compare the patter of seizures to see if they are the same.

What drugs are typically prescribed for MG?

Two groups of drugs are typically prescribed for the treatment of myasthenia gravis (MG): anticholinesterases and immunosuppressants. Be sure to give these drugs on time to maintain blood levels and thus improve muscle strength.

Yellow box

Two of the fluoroquinolone antibiotics, Tequin and Noroxin, are designated as sound-alike, look-alike agents with other drugs and could easily be administered in error. Take care to not confuse Tequin wit Tegretol, an oral anticonvulsant, or with Ticlid, a platelet inhibitor. Take care to not confuse Noroxin with Neurontin, an oral anticonvulsant.

How many ccs are there in a "unit" of Packed Red Blood Cells (PRBCs)? How long should you administer one unit over?

Typically there are 200-250 ccs in a "unit" of Packed Red Blood Cells (PRBCs). Administer one unit over 2-4 hours unless instructed otherwise.

What should the urinalysis (UA) be positive for in glomerulonephritis?

UA (urinalysis) may be + for  RBCs and protein

What are the two most common reasons for seeking care?

UTI or URI (upper respiratory infection).

What is an infection of the bladder called?

UTI or cystitis

On the Oral Mucositis scale, what is grade 2?

Ulceration/solid foods

What is an infection of the urethra?

Urethritis

How is pancreatic cancer usually diagnosed?

Ultrasound or CT

What is polycythemia vera?

Uncommon, slow growing blood cancer in which the body makes too many RBCs (and in some cases too many WBCs and platelets).

Why are the early signs of sepsis/SIRS missed? What happens if the problem is caught early?

Unfortunately the early symptoms are subtle and have a relatively short duration so they are often missed or misdiagnosed If the problem is caught early and treated aggressively the progression can be stopped.

What is Bell's Palsy?

Unilateral facial paralysis due to inflammation of the 7th cranial nerve.

What is universal aphagia?

Universal: Don't understand and doesn't talk.

What is a cause of brain tumors?

Unknown

What is the exact cause of Alzheimer's disease?

Unknown

What are unclassified, or idiopathic seizures?

Unknown cause, and doesn't fit other seizure types

Why does an increase in age cause a UTI?

Urinary stasis may be caused by incomplete bladder emptying as a result of an enlarged prostate in men and cystocele and prolapse in women. Neuromuscular conditions that cause incomplete bladder emptying, such as Parkinson disease and strokes, affect older adults more frequently. The use of anticholinergic drugs in older adults contributes to delayed bladder emptying. Fecal incontinence contributes to poor perineal hygiene. Hypoestrogenism in older women adversely affects the cells of the vagina and urethra, making them more susceptible to infections.

Tendency to retain urine in older adults result in what?

Urinary stasis may result in a UTI. UTIs may become bloodstream infections, resulting in urosepsis or septic shock. Nursing interventions can help initiate voiding. Anticholinergic drugs promote urinary retention.

Causes of urolithiasis

Urinary stasis, damage to lining of the urinary tract, dehydration, metabolic problems

What is hematuria?

Urine that contains blood

What is turbidity?

Urine that is hazy in color

What should you tell patient about pyridium?

Urine will turn red orange or red; may stain clothes.

What can blood run with in an IV? What IV tubing should be used?

Use 0.9% saline and "Y" IV tubing with a filter

Yellow box

Use only normal saline for infusion with blood or blood products because the calcium in Ringer's lactate induces clotting of the infusing blood.

What is systemic vascular resistance (SVR)?

Vascular resistance refers to the resistance that must be overcome to push blood through the circulatory system and create flow. The resistance offered by the peripheral circulation is known as the systemic vascular resistance (SVR).

What is peritoneal dialysis?

Uses the peritoneum as the dialyzing membrane. Procedure may be done at home every night while sleeping. Peritoneal dialysis: does not have filter in machine. Fluid that has a high concentration of sugar-this sugar goes into the peritoneal cavity and hangs out there for an hour or two, and then the fluid goes out and into a drainage bag-the sugar (because it's large) pulls toxins out of intestines through osmosis. Patients can do this at home, if they have caregiver or partner there. Often done at home. Do better with transplants. If peritoneal gets infected, sometimes they can't do PD again. One catheter stays in belly, so it can get infected. Can remove excess fluids and toxins. Removes toxins better than HD. PD costs less than HD.

What usually causes encephalitis?

Usually caused by a virus that travels to the CNS via blood or along nerves

What does your kidney excrete? What happens if you can't excrete it?

Usually excrete uremia in our kidneys. If can't, can excrete out of mouth and skin, so patient who are on dialysis tend to have bad breath. If they are dark in appearance, they appear chalky

Are diuretics usually effective with non-pitting edema?

Usually not effective.

Where does Kaposi's Sarcoma (KS) usually originated?

Usually originates in cells that line lymph or blood vessels

How can a magnet be used to stop a seizure?

VNS (vegus nerve stimulator) Outpatient procedure-install post generate with a battery under the skin, almost like a pacemaker, and thread wire to vegus nerve. Vagus nerve is overstimulated during seizure, so this can hopefully stop the seizure. Use magnet to activate-stops all the overstimulation of the vagus nerve-wave magnet near pulse generator to stop seizure. Does not help everyone.

Does exposure for prolonged periods with very mild temperature causes burns?

Yes

What are the two types of edema to increase ICP?

Vasogenic edema Cytotoxic edema

What is vasogenic edema?

Vasogenic edema, commonly involved in ↑ ICP in the adult, involves an increase in brain tissue volume. The cause is abnormal permeability of the walls of the cerebral vessels which allows protein-rich plasma to leak into the extracellular space of the brain.

What is often the first sign/symptom of multiple sclerosis?

Visual changes, such as: Typical clinical findings from assessment of the patient's visual acuity, visual fields, and pupils include: • Blurred vision • Diplopia (double vision) • Decreased visual acuity • Scotomas (changes in peripheral vision) • Nystagmus (involuntary rapid eye movements)

What is the difference between pernicious anemia vs vitamin B12 deficiency anemia?

Vitamin B12 deficiency is a lack of B12, while in pernicious anemia, there isn't a lack of B12 but the body has difficulty absorbing the B12.

Diets low in what may result in decreased ability to clot blood?

Vitamin K

What does a proper functioning liver form in the intestines?

Vitamin K

Clean-catch

Void some and then collect in cup; try to cleanse peri-area prior; "mid-stream"

When does white blood cells production increase?

WBC production increases in response to infection, steroids, strenuous exercise, convulsive seizures, pain

CBCs usually include what?

WBCs RBCs Hgb Hct Platelets Other tests that might may also be included: WBC differential Reticulocytes

In the initial stage of hypovolemic shock, are the compensatory measures all cardiovascular?

Yes

Is an AV graft more likely to clot or get infected than a fistula?

Yes

Is glucose or protein an abnormal finding?

Yes

What is the cardinal assessment finding of SIADH?

Water retention.

Why are there so many CAUTI in hospitals?

We might have so many catheter related infection because nurses doesn't have time to walk patient to the bathroom when catheter should come out, so they keep catheter in.

What causes stress incontinence?

Weakening of bladder neck supports; associated with childbirth. Intrinsic sphincter deficiency caused by such congenital conditions as epispadias (abnormal location of the urethra on the dorsum of the penis) or myelomeningocele. Acquired anatomic damage to the urethral sphincter (from repeated incontinence surgeries, prostatectomy, radiation therapy, and trauma).

What is the healing time for deep full-thickness burns?

Weeks to months

What is the healing time with full-thickness burns?

Weeks to months

What are some signs and symptoms of leukemia?

Weight loss, nausea, enlarged spleen, weakness from anemia

Growth in normal cells are what?

Well-regulated

Can we live without a spleen?

Yes, because other parts of the body would take over the spleen's function.

Can the epidermis grow back after a burn injury?

Yes. This layer can grow back after a burn injury because the epidermal cells surrounding sweat and oil glands and hair follicles extend into dermal tissue and regrow to heal partial thickness wounds

Should you put oxygen on a patient in shock even if their O2 sats are in the normal range?

Yes. Always give oxygen when patient is in shock.

Is there edema with superficial partial-thickness burns?

Yes. Mild to moderate

Can a person who has Rh + blood receive a transfusion from a donor with Rh - blood?

Yes, but not the other way around. An Rh-negative person is born without the Rh-antigen on his or her RBCs and does not form antibodies unless he or she is specifically sensitized to it. Sensitization can occur with RBC transfusions from an Rh-positive person or from exposure during pregnancy and birth. Once an Rh-negative person has been sensitized and antibody development has occurred, any exposure to Rh-positive blood can cause a transfusion reaction. Antibody development can be prevented by giving anti Rh-immunoglobulin as soon as exposure to the Rh antigen is suspected. People who have Rh-positive blood can receive an RBC transfusion from an Rh-negative donor, but Rh-negative people should not receive Rh-positive blood.

What makes burns superficial-thickness wounds (first degree burn)?

When the epidermis is the only part of the skin that is injured. The epithelial cells and basement membrane, needed for total regrowth, remain present

What is a normal immune system's response to an infection?

When the immune system is normal and infection is confined to a local area, invasion by the organism initiates a local response designed to keep the organism from spreading. Part of this normal response includes capillary leakage which allows plasma to leak into the tissues. This causes localized swelling and dilutes any toxins that have entered the area. One benefit of this response is that it limits the organisms to a local area. Fever, tachycardia, and decreased urine are not part of this response.

Why does an increase of the capillary bed (vasodilation) cause a decrease of the MAP?

When the vessels dilate, there is less resistance for the blood pushing out of the heart to overcome, so the MAP (MAP=CO X SVR) decreases.

Is there eschar with deep full-thickness burns?

Yes, hard and inelastic

Is there eschar with full-thickness burns?

Yes, hard and inelastic

Can surgery "cure" cancer?

Yes, if the cancer is confined to the removed tissue

Is there edema in superficial burns?

Yes, mild

Is there edema with deep partial-thickness burns?

Yes, moderate

Is there eschar with deep partial-thickness burns?

Yes, soft and dry

Do corticosteroids alter blood glucose?

Yes, they do

Do patients usually recover quickly with acute glomerulonephritis?

Yes, usually patients recover quickly

Each type of ______ has a specialized function.

White blood cells

What are leukocytes?

White blood cells

Large quantities of _______ can be stored in the ____.

Whole blood; liver

What is chemo-induced peripheral neuropathy? Is it permanent?

Widespread, most often includes decreased sensation of hands and feet, orthostatic hypotension, erectile dysfunction, neuropathic pain, and severe constipation. This is often a long-term consequence of chemo and may be permanent.

Why does the glomerular filtration rate decrease in older adults?

With aging, the ability of the kidneys to regulate water balance is decreased. The kidneys are less able to conserve water when necessary. Dehydration results in decreased renal blood flow and increases the nephrotoxic potential of many agents. Acute or chronic kidney failure may result.

Is the patient who undergoes brachytherapy a danger to others?

With all types of brachytherapy the patient emits radiation and is a hazard to others.

What cranial nerve is affected with GBS?

With any of the variants, cranial nerve involvement most often affects the facial nerve (cranial nerve VII). Assess the patient's ability to smile, frown, whistle, or drink from a straw. In addition to monitoring the functions of cranial nerve VII, assess the patient for dysphagia (difficulty swallowing). Less frequently affected cranial nerves include the glossopharyngeal (IX), vagus (X), accessory (XI), and hypoglossal (XII) nerves. The patient's inability to cough, gag, or swallow results from the involvement of cranial nerves IX and X.

How does the spleen balance blood cell production?

With blood cell destruction

How is a breast self-exam done?

With fingertips close together, gently probe each breast in one of these three patters. Monthly breast self-exams should always include: visual inspection (with and without a mirror) to note any changes. Manual inspection s done in standing and reclining positions to note any unusual lumps or thickness.

Is GBS permanent?

With good nursing care these patients generally recover in 6 months.

When does the systemic inflammation of SIRS become an enemy to the patient?

With the organisms and their toxins in the bloodstream at this point and entering other body areas, the inflammatory responses become an enemy, leading to extensive hormonal, tissue, and vascular changes and oxidative stress that further impair oxygenation and tissue perfusion.

What does anaerobic mean?

Without oxygen

When are women at less risk for ovarian cancer?

Women who have had children, used oral contraception for at least 5 years, and breast-fed their children have less risk for this disease.

What groups of people does iron deficiency anemia affect more?

Women, older adults, and people with inadequate diets

What are recommended screenings to test for prostate cancer? Are they always reliable?

Yearly prostate-specific antigen (PSA) test and digital rectal examination (DRE) for men older than 50 years. A biopsy is done if any findings are suspicious. Not always reliable. Some men with PSA levels below 4.0 ng/mL (4 or less is normal) have prostate cancer and many men with higher levels do not have prostate cancer. In addition, various factors can cause a man's PSA level to fluctuate. For example, a man's PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugs—including drugs used to treat BPH—lower a man's PSA level.

How often should mammograms be done?

Yearly, and start at age 35 with no risk factors. Encourage patient to keep their films of mammogram so they can compare the two when they move to new facility. Mammograms not completely reliable.

Are superficial partial-thickness burns blanchable (lighten when pressure is applied)?

Yes

Are there blisters with superficial partial-thickness burns?

Yes

Are there grafts required with deep full-thickness burns?

Yes

Can a bone marrow aspiration be done at bedside?

Yes

Why is PKD congenital?

You are born with it-can do genetic testing since it runs in families-high rate among siblings.

In nonprogressive stage of hypovolemic shock, why does the pH decrease?

pH may decrease due to anaerobic metabolism. This causes an increase in respiration.

What is aneuploidy?

abnormal chromosomes

Stomach cancer is mostly ________, developing from the _______ cells of the inner stomach lining.

adenocarcinomas Mucosal

Chemotherapy used along with surgery or radiation is termed ______ therapy.

adjuvant Definition of adjuvant therapy: applied after initial treatment for cancer, especially to suppress secondary tumor formation

When the ____ arteriole is constricted or the ____ arteriole is dilated, pressure in the glomerular capillaries falls and filtration decreases

afferent, efferent

A key feature of cancer cells is the loss of _________. These cells have an ______ life span.

apoptosis infinite

The subdural space is located between the dura mater and the middle layer, the _________.

arachnoid

Normal cells suspended in soft agar cannot _____ and therefore cannot _______.

attach proliferate

Bone exposed to radiation therapy looses _____ and breaks ______ easily than other bones.

density more

When burn injury occurs, skin can regrow as long as parts of the ______ are present.

dermis

Most tumors arise from ______ that are capable of _____ ________.

cells cell division

Since brain tumors compress on normal brain tissue, what is the result?

cerebral edema, ↑ ICP, and possible neurological deficits

Any blood ______ can be removed from a donor and transfused to a recipient.

component

Written patient ________ is required prior to administration of any blood component.

consent

In regards to hematologic changes with aging, blood volume _______.

decreases

In benign tumors, cells are fairly well _______ and don't _____ to ______ locations.

differentiated spread distant

Sepsis is the major ______ ______ side effect of cancer chemotherapy.

dose limiting

The meninges form the protective covering of the brain and the spinal cord. The outside layer is the _______.

dura mater

Acetycholine producing neurons transmit ________ messages throughout the basal ganglia. Dopamine ________ the function of these neurons, allowing control over voluntary movement. This system of checks and balances allows for refined, coordinated movement, such as picking up a pencil and writing.

excitatory inhibits

Benign tumors grow by _________, whereas malignant tumors grow by ________.

expansion invasion

Normal cells have a ______ lifespan.

finite

Isotopes suspended in _____ are eventually eliminated in stool and urine.

fluid

Diabetics who maintain good ___ ___ can delay or possibly prevent diabetic nephropathy.

glycemic control

Malignant tumors have rapid ______ rate and disorganized ________. _______ nearby blood vessels & lymphatics, spread ________ from origin.

growth tissue Invade far

PET scans visualize areas of _____ ______.

high metabolism

In shock, _______ heart rate is an early sign. _______ blood pressure is a late sign.

increased Decreased

What is urosepsis?

infection of the whole body that is related to urine. Total body infection that was introduced to blood from the urine.

A health care provider's _______ is required prior to administration of any blood component

prescription

Skin changes and hair loss are ______ but are often _____ depending on the total absorbed dose.

local permanent

Specific functions are _______ partially or _______ in cancer cells. Cancer cells serve _____ _____ purpose.

lost completely no useful

The mitotic index for benign tumors are _______.

low

In ovarian cancer, survival rates are ____ because this is often a ____ diagnosis.

low late

The size of the vascular bed is inversely (negatively) related to MAP. This means that increases in the size of the vascular bed ______ MAP and decreases ______ MAP.

lower raise

Often the spinal cord tumor or other bone cancers are a metastasis of _____ and ______ cancer.

lung breast

Contrast dye can be _____

nephrotoxic

Normal cells have ______ differentiated functions

many

Benign tumors end in ______, while solid cancerous tumors end in _______, ________, and _______.

oma carcinoma sarcoma blastoma

______ and _______ growth is a very important feature of normal cells.

orderly well-regulated

Oncogenes (a gene that has the potential to cause cancer; in tumor cells, they are often mutated or expressed at high levels) that are _______ can cause a _____ to develop into a ______.

overexpressed (means making too many copies) cell tumor

A _______ is a physician who looks at the tissue under a microscope and determines whether or not the tissue contains cancer.

pathologist

Normal ______ are formed at the bleeding site in hemophilia. However, in the patient with hemophilia, clotting deficiency impairs the formation of _____.

platelet plugs; fibrin clots

Situated between the arachnoid and pia mater is the ___________, where CSF circulates.

subarachnoid space

A diet high in ______ and ______ is often prescribed to help him or her maintain weight and to provide the nutrients needed for energy and cellular repair.

protein carbohydrates

Total blood volume and cardiac output are directly related to MAP, so increases in either total blood volume or cardiac output _____ MAP. Decreases in either total blood volume or cardiac output _____ MAP.

raise lower

Ovarian cancer grows ______.

rapidly

Headaches are often _______ and commonly associated with ______, ________, and _________.

temporary URIs stress allergies

In ______ the offending organisms have entered the blood stream.

sepsis

The reduced MAP ______ blood flow, resulting in _______ tissue perfusion. The loss of RBCs _______ the ability of the blood to oxygenate the tissue it does reach.

slows decreased decreases (This ↓ in MAP slows blood flow and decreases profusion).

Brachytherapy uses radioactive isotopes either in _____ form or within ______ _____.

solid body fluids

Patient's with testicular cancer should consider _____ storage as soon as possible after diagnosis.

sperm

In teletherapy, patient must be able to _____ in the _____ position for every treatment.

stay same

Differences in skin __________ in various body parts affect injury.

thickness

Differences in skin _______ also affect burn depth.

thickness Differences in skin thickness in various parts of the body also affect burn depth. In areas where the skin is thin (e.g., eyelids, ears, nose, genitalia, tops of the hands and feet, fingers, and toes), a short exposure to high temperatures causes a deep burn injury. The skin is thinner in older adults, which increases their risk for greater burn severity, even at lower temperatures of shorter duration.

Growth may continue beyond an appropriate _____ or occur in the wrong _____, but the rate of growth is ______ in benign tumors.

time place normal

Cancer cells have an ______ lifespan.

unlimited Considered immortal

Continence occurs when pressure in the ____ is ___ than pressure in the ___.

urethra, greater, bladder

What are signs and symptoms of GBS?

• Most common clinical pattern is ascending paralysis. • Weakness, paresthesias, and leg pain begin in the lower extremities and progress upward to include the trunk and arms or affect the cranial nerves. • Symptoms of an ascending flaccidity or weakness that evolves over hours to several days (1 to 10 days). • Mild paresis to total quadriplegia. • Some degree of respiratory compromise. • Deep tendon reflexes are absent in limbs that become paralyzed. • Labile BP • Cardiac dysrhythmias • Tachycardia • Loss of bowel/bladder control

What are specific causes or risk factors in neural-induced distributive shock?

• Pain • Anesthesia • Stress • Spinal cord injury • Head trauma

What are some integumentary manifestations of anemia?

• Pallor, especially of the ears, the nail beds, the palmar creases, the conjunctivae, and around the mouth • Cool to the touch • Intolerance of cold temperatures • Nails become brittle and may lose the normal convex shape; over time, nails become concave and fingers assume clublike appearance

What are some integumentary manifestations of shock?

• Cool to cold • Pale to mottled to cyanotic • Moist, clammy • Mouth dry; pastelike coating present

What are some late neuromuscular manifestations of shock?

• Decreased central nervous system activity (lethargy to coma) • Generalized muscle weakness • Diminished or absent deep tendon reflexes • Sluggish pupillary response to light

What is a typical onset age for Polycystic Kidney Disease (PKD)?

30-50

What can the nurse to that is essential to a positive outcome in the patient in the nonprogressive stage of hypovolemic shock?

Frequent nursing assessment and observations of trends is essential to a positive outcome

What are some nursing interventions/precautions for the client with meningitis?

Frequent reassessment, antibiotics asap and on schedule, avoid transmission of disease (usually droplet precautions including a private room).

What is important to assess in the patient with back pain?

Assess pain and ask if the patient has inability to void, paresthesia (tingling) or numbness Ask whether paresthesia (tingling sensation) or numbness is present in the involved leg. Both extremities may be checked for sensation by using a pin or paper clip and a cotton ball for comparison of light and deep touch. The patient may feel sensation in both legs but may experience a stronger sensation on the unaffected side. Those with severe problems may lose both bowel and bladder control from sacral spinal nerve involvement.

Can you use fibrinolytic therapy for a hemorrhagic stroke? Within what time frame can it be given?

No! Only for ischemic. Give within 3 hours of onset of stroke.

What integumentary assessments would you make in a patient in shock?

Assess the skin for temperature, color, and moisture. With shock, it feels cool or cold to the touch and is moist. Color changes appear first in oral mucous membranes and in the skin around the mouth. Pallor or cyanosis is best assessed in the oral mucous membranes in dark-skinned patients. Other color changes are noted first in the skin of the extremities and then in the central trunk area. The skin feels clammy or moist to the touch, not because sweating increases but because the normal fluid lost through the skin does not evaporate well on cold skin. As shock progresses, skin becomes mottled. Lighterskinned patients have an overall grayish blue color and darker-skinned patients appear darker, without an underlying reddish glow.

Are cancer cells easily differentiated under a microscope?

No, because they are anaplastic (without form and shape). Loss of specific shape makes diagnosis difficult as they don't have a specific morphology (they don't retain the specific morphology of parent cells).

Why are people with spinal cord injuries likely to die from kidney failure?

Can't feel the infection so it goes up into the kidneys. They use catheter frequently and that can cause frequent UTIs.

What happens in arrest and invasion during metastasis?

Cancer cells clump up in blood vessel walls and invade new tissue areas. If the new tissue areas have the right conditions to support continued growth of cancer cells, new tumors (metastatic tumors) will form at this site.

How do cancer cells expand?

Cancer cells expand by mitosis and invade other tissues, both close by and more remote from the original tumor. Invasion and persistent growth make untreated cancer deadly.

Why might a cancer patient lose weight?

Cancer cells grow quickly, thereby using lots of energy.

What happens in blood vessel penetration during metastasis?

Cancer cells have broken off from the main tumor. Enzymes on the surface of the tumor cells make holes in the blood vessels, allowing cancer cells to enter blood vessels and travel around the body.

What happens in tumor vascularization during metastasis?

Cancer cells secrete tumor angiogenesis factor (TAF), stimulating the blood vessels to bud and form new channels that grow into the tumor.

What is multiple myeloma?

Cancer involving WBCs and mature lymphocytes called plasma cells which secrete antibodies

Why would cancer make absorption and elimination difficult?

Cancer may obstruct or compress structures in the GI tract

Why is the cancer patient at risk for sepsis?

Cancer patients are at risk for this blood stream infection due to low WBC counts and low immune function.

When can an AV fistula be used?

Cannot be used until several months (sometimes longer) after procedure. Can be made on an outpatient basis.

Is a cancer cell always a health threat?

No, if dna is damaged (initiation), even though it is irreversible, it is not a health threat unless it can divide.

What is capillary leak syndrome? Under what kind of shock does it fall?

Capillary leak syndrome is the response of capillaries to the presence of biologic mediators that change blood vessel integrity and allow fluid to shift from the blood vessels into the interstitial tissues. Once in the interstitial tissue, these fluids are stagnant and cannot deliver oxygen or remove tissue waste products. It is a type of distributive shock.

Why should the patient be asked if they are allergic to seafood before being given contrast medium?

Contrast reactions have been reported to be as high as 15% in these patients.

Is initiation reversible?

No, it is an irreversible event.

Is urine collection hat sterile?

No, it is not.

Is a sonography an invasive test?

No, it's non-invasive

Does an increase in BUN always mean kidney failure?

No, other things can raise BUN

In the elderly, is decreased skin turgor a reliable sign of hypovolemic shock?

No, since decreased skin turgor can be a normal sign in older adults.

Is a PET scan a reliable test for prostate cancer?

No, since it is slow growing.

For 24 hour urine catch, should you catch the first urine of the day?

No, since that is urine for the previous day. Can use next morning's first urine since that would be urine made the previous day, within the 24 hour period.

Do you have to stand for a KUB x-ray?

No, you don't have to stand, but the image is clearer.

Can you run other medication with potassium?

No.

Is eschar always related to burns?

No. Eschar can be related to diabetes and doesn't need to be sloughed out. Eschar can include fascia, muscles, and bones; not just dermis and epidermis.

Does chemotherapy target both cancer cells and normal cells? Why or why not?

No. It has some selectivity for killing cancer cells over normal cells. This killing effect on cancer cells is related to the ability of chemotherapy to damage DNA and interfere with cell division. Tumors with rapid growth are most sensitive to chemotherapy

Are the increased number of white blood cells in leukemia able to provide infection protection?

No. The increased number of WBCs are immature and can't fight off infection effectively.

The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility? A. Testing of stool specimens for occult blood B. Teaching about the importance of dietary fiber C. Referring clients for colonoscopy procedures D. Giving vitamin and mineral supplements

A. Testing of stool specimens for occult blood Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants. Client education is within the scope of practice of the RN, not of the LPN or nursing assistant. Referral for further care is best performed by the RN. Administration of medications is beyond the nursing assistant's scope of practice and should be done by licensed nursing personnel.

Which assessments are most important for the nurse to perform when monitoring a client after a retrograde cystogram? A. Temperature and urine character B. Kidney tenderness and flank pain C. 24-hour urine volume, BUN and creatinine levels D. Angioedema and other indicators of systemic allergic response

A. The retrograde cystogram involves instilling a contrast dye directly into the bladder through the urethra. Infection is the primary concern from instruments entering the bladder. The dye does not enter the bloodstream, and systemic allergic responses do not occur. The kidneys are not involved in this imaging.

A nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences of them. Which client statement shows correct understanding of what the nurse has taught? A. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." B. "It is a good idea for me to reduce germs by taking a tub bath daily." C. "Trying to get to the bathroom to urinate every 6 hours is important for me." D. "Urinating 1000 mL on a daily basis is a good amount for me."

A. To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day.

What does angiotensin II do?

Angiotensin II functions in both the short- and long-term regulation of blood pressure. It is a strong vasoconstrictor, particularly of arterioles and, to a lesser extent, of veins. Constriction of the arterioles increases the peripheral vascular resistance, thereby contributing to the short-term regulation of blood pressure. Angiotensin II also reduces sodium excretion by increasing sodium reabsorption by the proximal tubules of the kidney. A second major function of angiotensin II, stimulation of aldosterone secretion from the adrenal gland, contributes to the long-term regulation of blood pressure by increasing salt and water retention by the kidney.

Encephalitis can be life-threatening or lead to what disabilities?

Can be life threatening or lead to disabilities such as learning disabilities, memory deficits

Are there blisters with full-thickness burns?

No

Who is more at risk for both acute and chronic lumbrosacral pain?

Older adults are at high risk for both acute and chronic LBP. Petite, Euro-American women are at high risk for vertebral compression fractures from osteoporosis, which cause severe pain and decreased mobility.

How long does a bone marrow aspiration procedure last?

The procedure usually lasts from 5 to 15 minutes. The type and the amount of anesthesia or sedation depend on the physician's preference, the patient's preference and previous experience with bone marrow aspiration and biopsy, and the setting. A local anesthetic agent is injected into the skin around the site. The discomfort of the local anesthetic is reduced when buffered anesthetic agents, such as lidocaine, are used.

What are some gastrointestinal manifestations of shock?

• Decreased motility • Diminished or absent bowel sounds • Nausea and vomiting • Constipation

What are some respiratory manifestations of anemia?

• Dyspnea on exertion • Decreased oxygen saturation levels

What are some respiratory manifestations of shock?

• Increased respiratory rate • Shallow depth of respirations • Increased PaCO2 • Decreased PaO2 • Cyanosis, especially around lips and nail beds

What are some cardiovascular manifestations of anemia?

• Tachycardia at basal activity levels (increases tissue perfusion), increasing with activity and during and immediately after meals • Murmurs and gallops heard on auscultation when anemia is severe • Orthostatic hypotension

Nursing management of the patient undergoing treatment for Hodgkin's lymphoma in regards to the skin when focusing on the acute side effects of therapy?

Skin problems at the site of radiation

In regards to hematology, what would the nurse assess in the skin?

Skin: is it dryer than you would expect for the age? Are the gums really pale? Are their petechiae-pinpoint micro hemorrhages due to clot blood (which are caused by a deficiency in platelets). Is there ecchymosis (a discoloration of the skin resulting from bleeding underneath, typically caused by bruising)?

What are risk factors for stroke?

Smoking is a risk factor, obesity, diabetes (more likely to die or have a bad outcome if blood glucose is high), age, race, hypertension, family history, first degree relative with hx of a stroke, African American, older age, birth control pills.

What is a risk factor for esophageal cancer?

Smoking, alcohol, obesity, untreated chronic GERD, Barrett's esophagus, and diets chronically deficient in fresh fruit and vegetables

How can hormone antagonist slow tumor growth?

Some drugs are hormone antagonists that compete with natural hormones at the receptors. When hormone antagonists are given, they bind to the specific hormone receptor on or in the tumor cell and prevent the needed hormone from binding to the receptor. If a tumor needs a certain hormone to grow and the hormone can enter or activate the cell only through a receptor, hormone antagonists can slow tumor growth.

What happens in malignant transformation during metastasis?

Some normal cuboidal cells have undergone malignant transformation and have divided enough times to form a tumorous area within the cuboidal epithelium.

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Teach older adults and their families to monitor for side and adverse effects of tricyclic antidepressants, including urinary retention (which can lead to infection), constipation, dry mouth, drowsiness, and acute confusion. Instruct them to notify their health care provider to report these changes, but do not stop these drugs abruptly.

What should you teach the patient about when to take iron supplements?

Teach patients to take iron supplements between meals for better absorption and to avoid GI distress

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Teach patients with mild CKD that carefully managing fluid volume, blood pressure, electrolytes, and other kidney-damaging diseases (e.g., hypertension, diabetes mellitus) by following prescribed drug and nutrition therapies can prevent damage and slow the progression to ESKD.

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Teach sexually active women of childbearing age to use at least two methods of birth control while taking hydroxyurea and for 1 month after the drug is discontinued because this drug can cause severe birth defects.

What can we educate the patient with restless leg syndrome about?

Teach ways to decrease insomnia such as limiting caffeine, nicotine, and alcohol and setting a routine bedtime.

Why does the heart beat faster in compensatoy measures in hypovolemic shock?

Teacher stated in class: So the heart doesn't take initiative to go faster, it needs instructions to say : go faster. The reninangiotensin-aldosterone system and vasopressin (ADH) have the effect of directly stimulating an increase in heart rate, cardiac contractility, and vascular tone. The kidneys and baroreceptors sense an ongoing decrease in MAP and trigger the release of renin, antidiuretic hormone (ADH), aldosterone, epinephrine, and norepinephrine to start kidney compensation. Renin, secreted by the kidney, causes decreased urine output, increased sodium reabsorption, and widespread blood vessel constriction. Renin converts to angiotensinogen, then to angiotensin I, and then to angiotensin II. ADH increases water reabsorption in the kidney, further reducing urine output, and also causes blood vessel constriction in the skin and other less vital tissue areas. Aldosterone holds onto potassium. This all leads to increased stroke volume. Together these actions compensate for shock by maintaining the fluid volume within the central blood vessels.

How do patients with MG usually die?

Tend to die of respiratory failure

Lung cancer usually metastasizes where?

Brain* Bone Liver Lymph nodes Pancreas Adrenal *Most common site of metastasis for the specific malignant neoplasm.

What is the most commonly diagnosed cancer in women?

Breast cancer

What is the number one risk for African American women?

Breast cancer

Oh Nurse! Which statement is included in an assessment of a patient's mental status? A. Reports of pain, discomfort, or weakness B. Ability to hear and see within normal limits C. Appropriateness of clothes to weather conditions D. Ability to push and pull against resistance

C

What causes high levels of MCHC?

Mirrors MCV results (Anemia caused by vitamin B12 or Folate deficiency); macrocytic RBCs are large so they tend to have a higher MCH.

What is second-look surgery?

"Rediagnosis" after treatment. The purpose is to assess the disease status in patients who have been treated and have no symptoms of remaining tumor. The results of this surgery are used to determine whether a specific therapy should be continued or discontinued. This type of surgery is most commonly used with ovarian cancer.

Multiple sclerosis is more common in what climate?

More common in colder climates

What gender is ALS more common in?

More common in men than women

What are major risk factors for neck tumors?

-Long-term alcohol use -Smoking

What signs will the patient have in severe sepsis?

-Lower 02 Sat, increased respiratory rate, decreased or absent urine output, and decreased mental status. -At this point the downhill course leading to septic shock is rapid

Heparin-Induced Thrombocytopenia (HIT) is most common with what kind of heparin?

More common with unfractionated heparin (Heparin), can also occur with low-molecular weight heparin (enoxaparin).

Diabetic nephropathy is more severe in patients who have?

More severe in patients with uncontrolled hyperglycemia

How should a testicular self-examination be done?

-Examine your testicles monthly immediately after a bath or a shower, when your scrotal skin is relaxed. -Cup one testicle at a time using both hands. -Examine each testicle by gently rolling it between your thumbs and fingers. Testicular tumors tend to appear deep in the center of the testicle. -Familiarize yourself with the spermatic cord and epididymis tube like structures that connect on the back side of each testicle. -Look and feel for any lumps; smooth, rounded masses; or any change in the size, shape, or consistency of the testes. -It is normal for one testis to be slightly larger than the other. -Report any lump or swelling to your doctor as soon as possible.

What are safety interventions for the client with Huntington disease?

-Fall risk precaution -Diet modification: Consider texture modification as disease progresses, thickened liquids, cut food into bite size pieces -LOC: Increase supervision as disease progresses -Assist with shaving

What are safety considerations for the patient with ALS?

-Falls/Poor Mobility -Respiratory Arrest -Choking/Aspiration -Adequate Nutrition -Respiratory Acidosis -Skin Breakdown

What are early signs of multiple sclerosis?

-Fatigue, especially in the legs -Persistent sensitivity to temperature -Ataxia (↓muscle coordination) -Diplopia (double vision) -Nystagmus (involuntary, rapid eye movement) -Hyperactive DTRs (deep tendon reflexes)

What are brain abscesses? What are the causes? What are the symptoms?

-In general, organisms from the ear or sinus enter the brain by traveling along the cerebral veins. -Clots from the heart or from a dental infection can enter the systemic circulation and travel to the brain. -Another cause is penetrating trauma -Patient may have headache, fever, neuro deficits; later they may be lethargic -Temporal field blindness may occur -May be noted on CT scan

Why might WBCs be too high?

-Infection, most commonly bacterial or viral -Inflammation, allergies, asthma, heart attack -Leukemia

What are the stages of adaptive response and events during hypovolemic shock?

-Initial Stage -Nonprogressive Stage or Compensatory Stage -Progressive Stage -Refractory Stage

What are contributing factors for back pain?

-Injury due to trauma -Injury due to lifting -Obesity -Smoking -Pregnancy -Congenital spine conditions for example, scoliosis -Osteoporosis -Twisting -Nursing!

What might cause too low levels of MCV?

-Iron deficiency anemia -Thalassemia

What are potential adverse effects of anticholinesterase drugs?

A potential adverse effect of ChE inhibitors is cholinergic crisis. Sudden increases in weakness and the inability to clear secretions, swallow, or breathe adequately indicate that the patient is experiencing crisis. Teach the patient and family to monitor for these two types of crises: 1. Myasthenic crisis—an exacerbation (flare-up or worsening) of the myasthenic symptoms caused by not enough anticholinesterase drugs 2. Cholinergic crisis—an acute exacerbation of muscle weakness caused by too many anticholinesterase drugs Tensilon testing may be used also to help determine whether increasing weakness in the previously diagnosed myasthenic patient is due to a cholinergic crisis (too much cholinesterase inhibitor drugs) or a myasthenic crisis (too little cholinesterase inhibitor drugs).

What are the risk factors for the development of leukemia? (Select all that apply.) A. Bone marrow hypoplasia B. Chemical exposure C. Down syndrome D. Ionizing radiation E. Multiple blood transfusions F. Prematurity at birth

A, B, C, D Reduced production of blood cells in the bone marrow is one of the risk factors for developing leukemia. Exposure to chemicals through medical need or by environmental events can also contribute. Certain genetic factors contribute to the development of leukemia; Down syndrome is one such condition. Radiation therapy for cancer or other exposure to radiation, perhaps through the environment, also contributes. There is no indication that multiple blood transfusions are connected to clients who have leukemia. Although some genetic factors may influence the incidence of leukemia, prematurity at birth is not one of them.

A distant family member arrives to visit a female client recently diagnosed with leukemia. The family member asks the nurse, "What should I say to her?" Which responses does the nurse suggest? (Select all that apply.) A. "Ask her how she is feeling." B. "Ask her if she needs anything." C. "Tell her to be brave and to not cry." D. "Talk to her as you normally would when you haven't seen her for a long time." E. "Tell her what you know about leukemia."

A, B, D Asking the client how she is feeling is a broad general opening and would be nonthreatening to the client. Asking if she needs anything is a therapeutic communication of offering self and would be considered to be therapeutic and helpful to the client. The family member should talk to her as she normally would when she hasn't seen her in a long time. There is no need to act differently with the client. If she wants to offer her feelings, keeping a normal atmosphere facilitates that option. Acting as if things are "different" because she has cancer takes the control of the situation from the client. Telling her to be brave and not to cry is callous and unfeeling; if the client is feeling vulnerable and depressed, telling her to "be brave" shuts off any opportunity for her to express her feelings. There is no need to inform the client about her disease, unless she asks about it. Opening the conversation with discussion about leukemia should be the client's prerogative.

The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which interventions does the nurse plan to implement? (Select all that apply.) A. Assess for fever. B. Observe for bleeding. C. Administer pegfilgrastim (Neulasta) - a biologic response modifier D. Do not permit fresh flowers or plants in the room. E. Do not allow the client's 16-year-old son to visit. F. Teach the client to omit raw fruits and vegetables from the diet.

A, C, D, F Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune-suppressed client. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms. Thrombocytopenia, or low platelet levels, causes bleeding, not low neutrophils (a type of white blood cell). The client is at risk for infection, not the visitors, if they are well; however, very small children, who may get frequent colds and viral infections, may pose a risk.

A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. What information does a nurse provide about taking her prescribed Bactrim? Select all that apply. A. "Be certain to wear sunscreen and protective clothing." B. "Drink at least 3 liters of fluids every day." C. "Take this drug with 8 ounces of water." D. "Try to urinate frequently to keep your bladder empty." E. "You will need to take all of this drug to get the benefits."

A,B,C,E: Wearing sunscreen and protective clothing is important to do while on this drug. Increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules. Fluid intake prevents this complication. Clients should be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon. Emptying the bladder is important-but not keeping it empty-as is stated here. The client should be advised to urinate every 3 to 4 hours or More often if he or she feels the urge

The client is scheduled for intravenous urography. During the assessment, the nurse notes a previous reaction of urticaria, itching, and sneezing to contrast dye. Which precautions does the nurse take? Select all that apply. A. Ensures that an antihistamine and a steroid are prescribed B. Documents the reaction on the chart C. Uses no contrast dye for the procedure D. Cancels the procedure E. Ensures that the health care provider is aware of the reaction

A,B,E: Suppression of immune and allergic responses should be undertaken. Allergies and suspected allergies must be documented in the medical record. The nurse must notify the provider of the previous response and obtain requests for antihistamine and corticosteroid. Contrast will give a more clear picture; if the provider believes it is necessary, suppression of the immune response is an acceptable intervention. The scope of practice for professional nursing does not include prescribing or canceling procedures.

Which client with an indwelling urinary catheter does a nurse re-assess to determine whether the catheterization needs to be continued or can be discontinued? Select all that apply. A. Three-day postoperative client B. Client in the step-down unit C. Comatose client with careful monitoring I/Os D. Incontinent client with perineal skin breakdown E. Incontinent long-term care older adult

A,B,E: Three days after surgery, the client probably should be able to urinate on his or her own. If the surgery was a bladder or urethral repair, then discontinuing the catheter might not be a consideration so soon. However, most clients do not need long-term catheterization after they have surgery. The incidence of complications (colonization of bacteria) begins to increase after 48 hours postinsertion.The client who is out of an intensive care situation is definitely one who should be considered for discontinuation of his or her catheter. He or she should be somewhat ambulatory and able to get to a bedside commode.The comatose client who is on strict I&O needs to have a urinary catheter in place to keep accurate account of his or her fluid balance.

The nurse is teaching a 47-year-old woman about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions? A. "My mother and grandmother had breast cancer, so I am at risk." B. "I get a mammogram every 2 years since I turned 30." C. "A clinical breast examination is performed every month since I turned 40." D. "A computed tomography (CT) scan will be done every year after I turn 50."

A. "My mother and grandmother had breast cancer, so I am at risk." A strong family history of breast cancer indicates a risk for breast cancer. Annual rather than biannual screening may be indicated for a strong family history. An annual mammogram is performed after age 40 or in younger clients with a strong family history. The client may perform a self-breast examination monthly; a clinical examination by a health care provider is indicated annually. Annual CT breast scans after age 50 are not a current recommendation.

Which information must the organ transplant nurse emphasize before a client is discharged? A. "Taking immunosuppressant medications increases your risk for cancer and the need for screenings." B. "You are at increased risk for cancer when you reach 60 years of age." C. "Immunosuppressant medications will decrease your risk for developing cancers." D. "After 6 months, you may stop immunosuppressant medications, and your risk for cancer will be the same as that of the general population."

A. "Taking immunosuppressant medications increases your risk for cancer and the need for screenings." Use of immunosuppressant medications to prevent organ rejection increases the risk for cancer. Advanced age is a risk factor for all people, not just for organ transplant recipients. Immunosuppressant medications must be taken for the life of the organ; the risk for developing cancer remains.

Which client is at greatest risk for having a hemolytic transfusion reaction? A. A 34-year-old client with type O blood B. A 42-year-old client with allergies C. A 58-year-old immune-suppressed client D. A 78-year-old client

A. A 34-year-old client with type O blood Hemolytic transfusion reactions are caused by blood type or Rh incompatibility. When blood that contains antigens different from the client's own antigens is infused, antigen-antibody complexes are formed in the client's blood. Type O is considered the universal donor, but not the universal recipient. *The client with allergies would be most susceptible to an allergic transfusion reaction. The immune-suppressed client would be most susceptible to a transfusion-associated graft-versus-host disease. The older adult client would be most susceptible to circulatory overload.*

An RN from pediatrics has "floated" to the medical-surgical unit. Which client is assigned to the float nurse? A. A 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells B. A 50-year-old with pancytopenia needing assessment of risk factors for aplastic anemia C. A 55-year-old with folic acid deficiency anemia caused by alcohol abuse who needs counseling D. A 60-year-old with newly diagnosed polycythemia vera who needs teaching about the disease

A. A 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells Because sickle cell disease is commonly diagnosed during childhood, the pediatric nurse will be familiar with the disease and with red blood cell transfusion; therefore, he or she should be assigned to the client with sickle cell disease. Aplastic anemia, folic acid deficiency, and polycythemia vera are problems more commonly seen in adult clients who should be cared for by nurses who are more experienced in caring for adults.

A client is exhibiting signs and symptoms of early shock. What is important for the nurse to do to support the psychosocial integrity of the client? (Select all that apply.) A. Ask family members to stay with the client. B. Call the health care provider. C. Increase IV and oxygen rates. D. Remain with the client. E. Reassure the client that everything is being done for him or her.

A. Ask family members to stay with the client. D. Remain with the client. E. Reassure the client that everything is being done for him or her. Having a familiar person nearby may provide comfort to the client. The nurse should remain with the client who is demonstrating physiologic deterioration. Offering genuine reassurance supports the client who is anxious. The health care provider should be notified, and increasing IV and oxygen rates may be needed, but these actions do not support the client's psychosocial integrity.

A 56-year-old client admitted with a diagnosis of acute myelogenous leukemia is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this therapy? A. Bone marrow suppression B. Liver toxicity C. Nausea D. Stomatitis

A. Bone marrow suppression Intravenous cytosine arabinoside and daunorubicin are a commonly prescribed course of aggressive chemotherapy, and bone marrow suppression is a major side effect. The client is even more at risk for infection than before treatment began. Liver toxicity, nausea, and stomatitis are not the major problems with this therapy.

A client is admitted to the hospital with two of the systemic inflammatory response syndrome variables: temperature of 95° F (35° C) and high white blood cell count. Which intervention from the sepsis resuscitation bundle does the nurse initiate? A. Broad-spectrum antibiotics B. Blood transfusion C. Cooling baths D. NPO status

A. Broad-spectrum antibiotics Broad-spectrum antibiotics must be initiated within 1 hour of establishing diagnosis. A blood transfusion is indicated for low red blood cell count or low hemoglobin and hematocrit; transfusion is not part of the sepsis resuscitation bundle. Cooling baths are not indicated because the client is hypothermic, nor is this part of the sepsis resuscitation bundle. NPO status is not indicated for this client, nor is it part of the sepsis resuscitation bundle.

The older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? A. "Have you tried using the toilet at least every couple of hours?" B. "How does that make you feel?" C. "We can fix that." D. "That happens when we get older."

A. By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control.

The RN working on an oncology unit has just received report on these clients. Which client should be assessed first? A. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature B. Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy C. Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour D. Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast

A. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people; the nurse should see the client with chemotherapy-induced neutropenia first. The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.

The nurse reviews the medical record of a client with hemorrhagic shock, which contains the following information: Pulse 140 beats/min and thready, ABG respiratory acidosis, Blood pressure 60/40 mm Hg, Lactate level 7 mOsm/L, Respirations 40/min and shallow. All of these provider prescriptions are given for the client. Which does the nurse carry out first? A. Notify anesthesia for endotracheal intubation. B. Give Plasmanate 1 unit now. C. Give normal saline solution 250 mL/hr. D. Type and crossmatch for 4 units of packed red blood cells (PRBCs).

A. Notify anesthesia for endotracheal intubation. Establishing an airway is the priority in all emergency situations. Although administering Plasmanate and normal saline, and typing and crossmatching for 4 units of PRBCs are important actions, airway always takes priority.

The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion? (Select all that apply.) A. Limit sodium intake. B. Avoid beef and processed meats. C. Increase consumption of whole grains. D. Eat "colorful fruits and vegetables," including greens. E. Avoid gas-producing vegetables such as cabbage.

B, C, D Consuming bran and whole grains and avoiding red meat and processed foods such as lunchmeats can reduce cancer risk. Consuming foods high in vitamin A, including apricots, carrots, and leafy green and yellow vegetables, can also reduce cancer risk. Reducing sodium is helpful in the treatment of hypertension and heart and kidney failure; no evidence suggests that lowering of sodium intake decreases the incidence of cancer. Eating cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, and cabbage may actually reduce cancer risk.

What are the common cancers related to tobacco use? (Select all that apply.) A. Cardiac cancer B. Lung cancer C. Cancer of the tongue D. Skin cancer E. Cancer of the larynx

B, C, E Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are the most likely to develop cancer. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds.

When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function? (Select all that apply.) A. Explain to the client that the colostomy is only temporary. B. Encourage the client to participate in changing the ostomy. C. Obtain a psychiatric consultation. D. Offer to have a person who is coping with a colostomy visit. E. Encourage the client and family members to express their feelings and concerns.

B, D, E Encouraging the client to participate in changing the ostomy is an appropriate way for the client to become familiar with the ostomy and its care. A visit from a person who is successfully coping with an ostomy can demonstrate to the client that many aspects of life can be the same after surgery. Offering to listen to feelings and concerns is part of a therapeutic relationship and therapeutic communication. Ostomies may be temporary for bowel rest, such as after a perforation, but are typically permanent for cancer treatment. Obtaining a psychiatric consultation may need to be done for clients with persistent depression, but would not be done immediately.

The nurse in the urology clinic is providing teaching for a female client with cystitis. Which of these should be included in the teaching plan? Select all that apply. A. Cleanse the perineum from back to front after using the bathroom. B. Try to take in 64 ounces of fluid each day. C. Be sure to complete the full course of antibiotics. D. If your urine remains cloudy, call the clinic. E. Expect some flank discomfort until the antibiotic has worked.

B,C,D: Between 64 and 100 ounces (2 to 3 liters) of fluid should be taken daily to dilute bacteria and prevent infection. Not completing the course of antibiotics could suppress the bacteria, but would not destroy all bacteria, causing the infection to resurface. For persistent symptoms of infection, the client should contact the provider. The perineal area should be cleansed from front to back or "clean to dirty" to prevent infection. Cystitis produces suprapubic symptoms; flank pain occurs with infection or inflammation of the kidney.

When assessing the client with pyelonephritis, which finding does the nurse anticipate will be present? Select all that apply. A. Suprapubic pain B. Vomiting C. Chills D. Dysuria E. Oliguria

B,C,D: Burning (dysuria), urgency, and frequency, Chills along with fever, Nausea and vomiting are symptoms of pyelonephritis. Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.

Pt is diagnosed with stress incontinence and is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? Select all that apply. A. Administer the drug at bedtime. B. Encourage increased fluids. C. Increase fiber. D. Limit the intake of dairy products. E. Offer hard candy for "dry" mouth.

B,C,E. Anticholinergics cause dry mouth and constipation. Increasing fluids and fiber will help.

Which interventions are helpful in preventing bladder cancer? Select all that apply. A. Drinking 2½ liters of fluid a day B. Showering after working with or around chemicals C. Stopping the use of tobacco D. Using pelvic floor muscle exercises E. Wearing a lead apron when working with chemicals F. Wearing gloves and a mask when working around chemicals and fumes

B,C,F: Certain chemicals are known to be carcinogenic in evaluating the risk for bladder cancer. Bathing after exposure and Protective gear is advisable.Tobacco use is one of the highest if not the highest risk factor in the development of bladder cancer.

The nurse is assessing the endurance level of a client in a long-term care facility. What question does the nurse ask to get this information? A. "Are your feet or hands cold, even when you are in bed?" B. "Do you feel more tired after you get up and go to the bathroom?" C. "How much exercise do you get?" D. "What is your endurance level?"

B. "Do you feel more tired after you get up and go to the bathroom?" Asking about feeling tired after using the bathroom is pertinent to the client's activity and provides a comparison. The specific activity helps the client relate to the question and provide needed answers. Asking about cold feet or hands does not address the client's endurance. The hospitalized client typically does not get much exercise; this would be a difficult assessment for a client in long-term care facility to make. Asking the client about his or her endurance level is too vague; the client may not know how to answer this question.

The nurse is assessing a client for hematologic function risks and seeks to determine whether there is a risk that cannot be reduced or eliminated. Which clinical health history question does the nurse ask to obtain this information? A. "Do you seem to have excessive bleeding or bruising?" B. "Does anyone in your family bleed a lot?" C. "Tell me what you eat in a day." D. "Where do you work?"

B. "Does anyone in your family bleed a lot?" An accurate family history is important because many disorders that affect blood and blood clotting are inherited; genetics cannot be changed. Excessive bleeding or bruising is a symptom, not a risk. Diet can affect risk, but it is a health behavior that can be changed. Work habits can be a risk, such as working near radiation, but these are behaviors that can be changed.

Which client statement indicates that stem cell transplantation that is scheduled to take place in his home is not a viable option? A. "I don't feel strong enough, but my wife said she would help." B. "I was a nurse, so I can take care of myself." C. "I will have lots of medicine to take." D. "We live 5 miles from the hospital."

B. "I was a nurse, so I can take care of myself." Stem cell transplantation in the home setting requires support, assistance, and coordination from others. The client cannot manage this type of care on his own. The client must be emotionally stable to be a candidate for this type of care. It is acceptable for the client's spouse to support the client undergoing this procedure. It is not unexpected for the client to be taking several prescriptions. Five miles is an acceptable distance from the hospital, in case of emergency.

The nurse reviews the chart of a client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means? A. "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is present." B. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." C. "This type of tumor in the brain is small with some lymph node involvement; another tumor is present somewhere else in your body." D. "Glioma means this tumor is benign, so I will have to ask your health care provider the reason for the chemotherapy and radiation."

B. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred. NX means that no regional lymph nodes can be assessed. A glioma is a benign tumor of the brain, but the client is diagnosed with a glioblastoma, which means a malignant tumor of the glial cells of the brain.

A client with anemia asks the nurse, "Do most people have the same number of red blood cells?" How does the nurse respond? A. "No, they don't." B. "The number varies with gender, age, and general health." C. "Yes, they do." D. "You have fewer red blood cells because you have anemia."

B. "The number varies with gender, age, and general health." Telling the client that the number of red blood cells (RBCs) varies with gender, age, and general health is the most educational and reasonable response to the client's question. Although telling the client that people do not have the same number of RBCs is true, it is not informative, and there is a better answer. While it may be true that the client has fewer red blood cells because of anemia, it does not answer the client's general question.

The nurse is reinforcing information about genetic counseling to a client with sickle cell disease who has a healthy spouse. What information does the nurse include? A. "Sickle cell disease will be inherited by your children." B. "The sickle cell trait will be inherited by your children." C. "Your children will have the disease, but your grandchildren will not." D. "Your children will not have the disease, but your grandchildren could."

B. "The sickle cell trait will be inherited by your children." The children of the client with sickle cell disease will inherit the sickle cell trait, but may not inherit the disease. If both parents have the sickle cell trait, their children could get the disease.

Which client does the nurse assign as a roommate for the client with aplastic anemia? A. A 23-year-old with sickle cell disease who has two draining leg ulcers B. A 28-year-old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol) C. A 30-year-old with leukemia who is receiving induction chemotherapy D. A 34-year-old with idiopathic thrombocytopenia who is taking steroids

B. A 28-year-old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol) Because clients with aplastic anemia usually have low white blood cell counts that place them at high risk for infection, roommates such as the client with G6PD deficiency anemia should be free from infection or infection risk. The client with sickle cell disease has two draining leg ulcer infections that would threaten the diminished immune system of the client with aplastic anemia. The client with leukemia who is receiving induction chemotherapy and the client with idiopathic thrombocytopenia who is taking steroids are at risk for development of infection, which places the client with aplastic anemia at risk, too.

Which clinical manifestation in the client with pyelonephritis indicates that treatment has been effective? A. Decreased urine output B. Decreased urine white blood cells C. Increased red blood cell count D. Increased urine specific gravity

B. A decreased presence of white blood cells indicates the eradication of infection.

When caring for the client with hyperuricemia associated with tumor lysis syndrome (TLS), for which medication does the nurse anticipate an order? A. Recombinant erythropoietin (Procrit) B. Allopurinol (Zyloprim) C. Potassium chloride D. Radioactive iodine-131 (131I)

B. Allopurinol (Zyloprim) TLS results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances; allopurinol decreases uric acid production and is indicated in TLS. Recombinant erythropoietin is used to increase red blood cell production and is not a treatment for hyperuricemia. Administering additional potassium is dangerous. Radioactive iodine-131 is indicated in the treatment of thyroid cancer, not TLS.

A client with septic shock has been started on dopamine (Intropin) at 12 mcg/kg/min. Which response indicates a positive outcome? A. Hourly urine output 10 to 12 mL/hr B. Blood pressure 90/60 mm Hg and mean arterial pressure 70 mm Hg C. Blood glucose 245 mg/dL D. Serum creatinine 3.6 mg/dL

B. Blood pressure 90/60 mm Hg and mean arterial pressure 70 mm Hg Dopamine improves blood flow by increasing peripheral resistance, which increases blood pressure—a positive response in this case. Urine output less than 30 mL/hr or 0.5 mL/kg/hr and elevations in serum creatinine indicate poor tissue perfusion to the kidney and are a negative consequence of shock, not a positive response. Although a blood glucose of 245 mg/dL is an abnormal finding, dopamine increases blood pressure and myocardial contractility, not glucose levels.

A nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? A. "A small-lumen catheter will help prevent injury to my urethra." B. "I will use a new, sterile catheter each time I do the procedure." C. "My family members can be taught to help me if I need it." D. "Proper handwashing before I start the procedure is very important."

B. Catheters are cleaned and re-used. Proper handwashing and cleaning of the catheter have shown no increase in bacterial complications. Catheters are replaced when they show signs of deteriorating.

Which laboratory result is seen in late sepsis? A. Decreased serum lactate B. Decreased segmented neutrophil count C. Increased numbers of monocytes D. Increased platelet count

B. Decreased segmented neutrophil count A decreased segmented neutrophil count is indicative of late sepsis. Serum lactate is increased in late sepsis. Monocytosis is usually seen in diseases such as tuberculosis and Rocky Mountain spotted fever. An increased platelet count does not indicate sepsis; late in sepsis, platelets may decrease due to consumptive coagulopathy.

Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately? A. New onset of fatigue B. Edema of arms and hands C. Dry cough D. Weight gain

B. Edema of arms and hands Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention. New onset of fatigue may likely be an early manifestation of hypercalcemia, which usually develops slowly, but because it is an early manifestation, this is not the priority. Dry cough is not a manifestation that is specific to an oncologic emergency; however, it may be a side effect of chemotherapy. Weight gain could be an early sign of syndrome of inappropriate antidiuretic hormone; although this should be addressed, it is an early sign so it is not the priority.

The nurse plans to administer an antibiotic to a client newly admitted with septic shock. What action does the nurse take first? A. Administer the antibiotic immediately. B. Ensure that blood cultures were drawn. C. Obtain signature for informed consent. D. Take the client's vital signs.

B. Ensure that blood cultures were drawn. Cultures must be taken to identify the organism for more targeted antibiotic treatment before antibiotics are administered. Antibiotics are not administered until after all cultures are taken. A signed consent is not needed for medication administration. Monitoring the client's vital signs is important, but the antibiotic must be administered within 1 to 3 hours; timing is essential.

The nurse is caring for a client with sickle cell disease. Which action is most effective in reducing the potential for sepsis in this client? A. Administering prophylactic drug therapy B. Frequent and thorough handwashing C. Monitoring laboratory values to look for abnormalities D. Taking vital signs every 4 hours, day and night

B. Frequent and thorough handwashing Prevention and early detection strategies are used to protect the client in sickle cell crisis from infection. Frequent and thorough handwashing is of the utmost importance. Drug therapy is a major defense against infections that develop in the client with sickle cell disease, but is not the most effective way that the nurse can reduce the potential for sepsis. Continually assessing the client for infection and monitoring the daily complete blood count with differential white blood cell count is early detection, not prevention. Taking vital signs every 4 hours will help with early detection of infection, but is not prevention.

A newly admitted client has an elevated reticulocyte count. Which disorder does the nurse suspect in this client? A. Aplastic anemia B. Hemolytic anemia C. Infectious process D. Leukemia

B. Hemolytic anemia An elevated reticulocyte count in an anemic client indicates that the bone marrow is responding appropriately to a decrease in the total red blood cell (RBC) mass and is prematurely destroying RBCs. Therefore, more immature RBCs are in circulation. Aplastic anemia is associated with a low reticulocyte count. A high white blood cell count is expected in clients with infection. A low white blood cell count is expected in clients with leukemia.

A 32-year-old client is recovering from a sickle cell crisis. His discomfort is controlled with pain medications and he is to be discharged. What medication does the nurse expect to be prescribed for him before his discharge? A. Heparin (Heparin) B. Hydroxyurea (Droxia) C. Tissue plasminogen activator (t-PA) D. Warfarin (Coumadin)

B. Hydroxyurea (Droxia) Hydroxyurea (Droxia) has been used successfully to reduce sickling of cells and pain episodes associated with sickle cell disease (SCD). Clients with SCD are not prescribed anticoagulants such as heparin or warfarin (Coumadin). t-PA is used as a "clot buster" in clients who have had ischemic strokes.

The nurse is transfusing 2 units of packed red blood cells to a postoperative client. What post-transfusion electrolyte imbalance does the nurse want to rule out? A. Hypercalcemia B. Hyperkalemia C. Hypomagnesemia D. Hyponatremia

B. Hyperkalemia During transfusion, some cells are damaged. These cells release potassium, thus raising the client's serum potassium level (hyperkalemia). This complication is especially common with packed cells and whole-blood products. High serum calcium levels, low magnesium levels, or low sodium levels are not expected with blood transfusions.

How does the nurse recognize that a positive outcome has occurred when administering plasma protein fraction (Plasmanate)? A. Urine output 20 to 30 mL/hr for the last 4 hours B. Mean arterial pressure (MAP) 70 mm Hg C. Albumin 3.5 g/dL D. Hemoglobin 7.6 g/dL

B. Mean arterial pressure (MAP) 70 mm Hg Plasmanate expands the blood volume and helps maintain MAP greater than 65 mm Hg, which is a desired outcome in shock. Urine output should be 0.5 mL/kg/hr, or greater than 30 mL/hr. Albumin levels reflect nutritional status, which may be poor in shock states due to an increased need for calories. Plasmanate expands blood volume by exerting increasing colloid osmotic pressure in the bloodstream, pulling fluid into the vascular space; this does not improve an abnormal hemoglobin.

A postoperative client is admitted to the intensive care unit with hypovolemic shock. Which nursing action does the nurse delegate to an experienced nursing assistant? A. Obtain vital signs every 15 minutes. B. Measure hourly urine output. C. Check oxygen saturation. D. Assess level of alertness.

B. Measure hourly urine output. Monitoring hourly urine output is included in nursing assistant education and does not require special clinical judgment; the nurse evaluates the results. Obtaining vital signs, monitoring oxygen saturation, and assessing mental status in critically ill clients requires the clinical judgment of the critical care nurse because immediate intervention may be needed.

The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome should the nurse teach the client is the goal of palliative surgery? A. Cure of the cancer B. Relief of symptoms or improved quality of life C. Allowing other therapies to be more effective D. Prolonging the client's survival time

B. Relief of symptoms or improved quality of life The focus of palliative surgery is to improve quality of life during the survival time. Curative surgery removes all cancer cells, visible and microscopic. Debulking is a procedure that removes some cancerous tissue, allowing other therapies to be more effective. Many therapies, such as surgery, chemotherapy, and biotherapy, increase the client's chance of cure and survival, but palliation improves quality of life.

The nurse assesses multiple clients who are receiving transfusions of blood components. Which assessment indicates the need for the nurse's immediate action? A. A partial thromboplastin time (PTT) that is 1.2 times normal in a client who received a transfusion of fresh-frozen plasma (FFP) B. Respiratory rate of 36 breaths/min in a client receiving red blood cells C. Sleepiness in a client who received diphenhydramine (Benadryl) as a premedication D. Temperature of 99.1° F (37.3° C) for a client with a platelet transfusion

B. Respiratory rate of 36 breaths/min in a client receiving red blood cells An increased respiratory rate indicates a possible hemolytic transfusion reaction; the nurse should quickly stop the transfusion and assess the client further. Because FFP is not usually given until the PTT is 1.5 times above normal, a PTT that is 1.2 times normal indicates that the FFP has had the desired response. Sleepiness is expected when Benadryl is administered. Temperature elevations are not an indication of an allergic reaction to a platelet transfusion, although the nurse may administer acetaminophen (Tylenol) to decrease the fever.

Which activity performed by the community health nurse best reflects primary prevention of cancer? A. Assisting women to obtain free mammograms B. Teaching a class on cancer prevention C. Encouraging long-term smokers to get a chest x-ray D. Encouraging sexually active women to get annual Papanicolaou (Pap) smears

B. Teaching a class on cancer prevention Primary prevention involves avoiding exposure to known causes of cancer; education assists clients with this strategy. Mammography is part of a secondary level of prevention, defined as screening for early detection. Chest x-ray is a method of detecting a cancer that is present—secondary prevention and early detection. A Pap smear is a means of detecting cervical cancer early—secondary prevention.

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instructions does the nurse provide for postprocedure home care? A. "After 12 hours, your toilet should be cleaned with a 10% solution of bleach.". B. "Do not share your toilet with family members for the next 24 hours." C. "Please be sure to stand when you are urinating." D. "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."

B. The toilet should not be shared for 24 hours following the procedure because others using the toilet could be infected with the live virus that was instilled into the client. If the toilet must be shared, then specific cleaning precautions need to be taken each time the client uses the toilet. The best scenario is for the client not to share the toilet.

Prostate cancer usually metastasizes where?

Bone (especially spine and legs)* Pelvic nodes *Most common site of metastasis for the specific malignant neoplasm.

What patient education do you provide to the client undergoing photodynamic therapy?

Before Photosensitization • Bring protective clothing (e.g., shirts with long sleeves and high collars, long pants or skirt, gloves, socks, wide-brimmed hat) and UV-protective sunglasses with you when you come to be injected with the photosensitizing agent. • If possible, have someone else drive you home so that you can place a sheet or light blanket over yourself. • Plan to avoid leaving your home during daylight hours for anywhere from 1 to 3 months. • Cover all windows with light-blocking shades or heavy drapes/curtains. • Replace high-wattage light bulbs with lower-wattage ones, and use as few as possible. After Photosensitization • Remember that the photosensitizing effects last from 1 to 3 months. • Continue to wear all protective clothing, avoid sunlight in any form, and avoid high-wattage indoor lights. • Drink plenty of water to prevent becoming dehydrated. • Do not take any newly prescribed or over-the-counter drugs without contacting the physician who performed the photodynamic therapy. Some drugs make the light sensitivity even worse; others interact with the photosensitizing drug. • When you do start to re-expose yourself to sunlight and other bright lights, do so slowly. Start out exposing only about 1 inch of your skin to sunlight at a time. • Start out with only 10 minutes, and increase the time only by about 5 minutes each day. • Remember that sunscreen will not prevent severe sunburn during this time. • If you experience pain or blistering, notify the photodynamic therapy health care team. • Continue to wear dark glasses, even indoors, until you no longer have eye pain when in a normally lighted environment. • When you no longer are photosensitive, see an ophthalmologist to check whether your retina has any damage.

Why aren't there blisters in deep partial-thickness burns?

Blisters usually do not form because the dead tissue layer is thick, sticks to the underlying dermis, and does not readily lift off the surface.

What happens in a migraine?

Blood vessels in the brain overreact to a triggering event, causing spasm in the arteries at the base of the brain. This response is followed by arterial constriction and a decrease in cerebral blood flow. Cerebral hypoxia may occur. Platelets clump together, and serotonin, a vasoconstrictor, is released. Other arteries dilate, which triggers the release of prostaglandins (chemicals that cause inflammation and swelling) and other substances that increase sensitivity to pain. Research suggests a role of excessive synaptic glutamate release or decreased removal of glutamate and potassium from the synaptic cleft

A client on anticoagulant therapy is being discharged. Which statement indicates that the client has a correct understanding of this therapy's purpose or action? A. "It is to dissolve blood clots." B. "It might cause me to get injured more often." C. "It should prevent my blood from clotting." D. "It will thin my blood."

C. "It should prevent my blood from clotting." Anticoagulants work by interfering with one or more steps involved in the blood clotting cascade. Thus, these agents prevent new clots from forming and limit or prevent extension of formed clots. Anticoagulants do not dissolve clots, fibrinolytics do. Anticoagulants do not cause more injuries, but may cause more bleeding and bruising when the client is injured. Anticoagulants do not cause any change in the thickness or viscosity of the blood.

A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the nurse. Which statement by the client is most important to communicate to the health care provider? A. "I am allergic to iodine." B. "My urinary stream is very weak." C. "My legs are numb and weak." D. "I am incontinent when I cough."

C. "My legs are numb and weak." Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur. Prostate cancer may frequently metastasize to the bone, specifically the spine. Allergy to iodine should be reported when contrast media will be used, but dye is not used in radiation therapy. A weak urinary stream and incontinence are common clinical manifestations of prostate cancer. Incontinence associated with coughing is typical of stress incontinence and is not a complication of cancer.

The clinic nurse is discharging a 20-year-old client who had a bone marrow aspiration performed. What does the nurse advise the client to do? A. "Avoid contact sports or activity that may traumatize the site for 24 hours." B. "Inspect the site for bleeding every 4 to 6 hours." C. "Place an ice pack over the site to reduce the bruising." D. "Take a mild analgesic, such as two aspirin, for pain or discomfort at the site."

C. "Place an ice pack over the site to reduce the bruising." Ice to the site will help limit bruising and tissue damage during the first 24 hours after the procedure. Contact sports and traumatic activity must be excluded for 48 hours, or 2 days. The client should carefully monitor the site every 2 hours for the first 24 hours after the procedure. A mild analgesic is appropriate, but it should be aspirin-free; acetaminophen (Tylenol) would be a good choice.

A client with a low platelet count asks why platelets are important. How does the nurse answer? A. "Platelets make your blood clot." B. "Blood clotting is prevented by your platelets." C. "The clotting process begins with your platelets." D. "Your platelets finish the clotting process."

C. "The clotting process begins with your platelets." Platelets begin the blood clotting process by forming platelet plugs, but these platelet plugs are not clots and cannot provide complete hemostasis. Platelets do not clot blood; they are a part of the clotting process or cascade of coagulation. Platelets do not prevent the blood from clotting; rather they function to help blood form clots. Platelets do not finish the clotting process, they begin it.

A client with leukemia is being discharged from the hospital. After hearing the nurse's instructions to keep regularly scheduled follow-up provider appointments, the client says, "I don't have transportation." How does the nurse respond? A. "A pharmaceutical company might be able to help." B. "I might be able to take you." C. "The local American Cancer Society may be able to help." D. "You can take the bus."

C. "The local American Cancer Society may be able to help." Many local units of the American Cancer Society offer free transportation to clients with cancer, including those with leukemia. Suggesting a pharmaceutical company is not the best answer; drug companies typically do not provide this type of service. Although the nurse offering to take the client is compassionate, it is not appropriate for the nurse to offer the client transportation. Telling the client to take the bus is dismissive and does not take into consideration the client's situation (e.g., the client may live nowhere near a bus route).

A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which client is most appropriate to assign to the new graduate? A. A 30-year-old with acute lymphocytic leukemia who will receive combination chemotherapy today B. A 40-year-old with chemotherapy-induced nausea and vomiting who has had no urine output for 16 hours C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) D. A 72-year-old with tumor lysis syndrome who is receiving normal saline IV at a rate of 250 mL/hr

C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to correct anemia. The clients with acute lymphocytic leukemia and chemotherapy-induced nausea are complex clients requiring a nurse certified in chemotherapy administration. The client with tumor lysis syndrome has complicated needs for assessment and care and should be cared for by an RN with more oncology experience.

Which client does the medical unit charge nurse assign to an LPN/LVN? A. A 23-year-old scheduled for a bone marrow biopsy with conscious sedation B. A 35-year-old with a history of a splenectomy and a temperature of 100.9° F (38.3° C) C. A 48-year-old with chronic microcytic anemia associated with alcohol use D. A 62-year-old with atrial fibrillation and an international normalized ratio of 6.6

C. A 48-year-old with chronic microcytic anemia associated with alcohol use Chronic microcytic anemia is not considered life-threatening and can be assigned to an LPN/LVN. The clients with a bone marrow biopsy with conscious sedation, a history of splenectomy and a temperature, and atrial fibrillation require more complex assessment or nursing care and should be assigned to RN staff members.

When reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomography (CT) angiography with contrast, it is essential for the nurse to perform which intervention? A. Obtain a thyroid-stimulating hormone (TSH) level. B. Report the blood urea nitrogen (BUN) and creatinine. C. Hold the metformin 24 hours before and on the day of the procedure. D. Notify provider regarding blood glucose and hemoglobin A1c values.

C. Before studies with contrast media are performed, the nurse must withhold metformin, which may cause lactic acidosis.

The client prescribed cephalexin (Keflex) for cystitis reports that she has had a severe allergic reaction to penicillin in the past. What is the nurse's best action? A. Reassure the client that Keflex is not penicillin. B. Place an allergy alert band on the client's wrist. C. Notify the prescriber before administering the first Keflex dose. D. Highlight this important information in the client's medical record.

C. Cephalexin is a cephalosporin and has a chemical structure very similar to the structure of penicillin. Often a person who is allergic to penicillin is also allergic to cephalosporins. Even if the prescriber wishes to proceed with cephalosporin therapy, he or she may first prescribe premedication to reduce the risk for an allergic response

Which finding alarms the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3? A. Increasing shortness of breath B. Diminished bilateral breath sounds C. Change in mental status D. Weight gain of 4 pounds in 1 day

C. Change in mental status A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia. Diminished breath sounds may be related to many factors, including poor respiratory excursion, infection, and atelectasis, which is not related to thrombocytopenia. A large weight gain in a short period may be related to kidney or heart failure; bleeding is the major complication of thrombocytopenia.

Which action does the nurse delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a female client with anemia? A. Asking the client about the amount of blood loss with each menstrual period B. Checking for sternal tenderness while applying fingertip pressure C. Determining the respiratory rate before and after the client walks 20 feet D. Monitoring her oral mucosa for pallor, bleeding, or ulceration

C. Determining the respiratory rate before and after the client walks 20 feet Assessment of the respiratory rate before and after ambulation is within the scope of practice for UAP; UAP will report this information to the RN. Asking the client about the amount of blood loss with each menstrual period, checking for sternal tenderness, and monitoring oral mucosa require skilled assessment techniques and knowledge of normal parameters and should be done by the RN.

The nurse is caring for a client in the refractory stage of cardiogenic shock. Which intervention does the nurse consider? A. Admission to rehabilitation hospital for ambulatory retraining B. Collaboration with home care agency for return to home C. Discussion with family and provider regarding palliative care D. Enrollment in a cardiac transplantation program

C. Discussion with family and provider regarding palliative care In this irreversible phase, therapy is not effective in saving the client's life, even if the cause of shock is corrected and mean arterial pressure temporarily returns to normal. A discussion on palliative care should be considered. Rehabilitation or returning home is unlikely. The client with sustained tissue hypoxia is not a candidate for organ transplantation.

A nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? A. "I must avoid drinking carbonated beverages." B. "I need to douche vaginally once a week." C. "I should drink 2½ liters of fluid every day." D. "I will not drink fluids after 8 PM each evening."

C. Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis.

When a diabetic client returns to the medical unit after IV urography, all of these interventions are prescribed. Which action will the nurse take first? A. Give lisper (Humalog) insulin, 12 units subcutaneously. B. Request a breakfast tray for the client. C. Infuse 0.45% normal saline at 125 mL/hr. D. Administer captopril (Capote).

C. Fluids are needed because the dye has an osmotic effect, causing dehydration and potential kidney failure.

A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the nurse expect the health care provider to prescribe? A. Nitrofurantoin after intercourse B. Premarin C. Trimethoprim/sulfamethoxazole D. Trimethoprim with intercourse

C. Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole or fosfomycin is effective in treating uncomplicated, community-acquired UTI in women.

A cognitively impaired client has urge incontinence. Which method for achieving continence does a nurse include in the client's care plan? A. Bladder training B. Credé method C. Habit training D. Kegel exercises

C. Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.

When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication? A. Drug toxicity B. Polycythemia C. Infection D. Dose-limiting side effects

C. Infection The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase. Drug toxicity can develop when drug levels exceed peak concentrations. Polycythemia refers to an increase in the number of red blood cells; typically chemotherapy causes reduction of red blood cells or anemia. Dose limiting side effects occur when the dose or frequency of chemotherapy need to be altered or held, such as in the case of severe neutropenia or neurologic dysfunction .

The nurse is caring for a client with neutropenia who has a suspected infection. Which intervention does the nurse implement first? A. Hydrate the client with 1000 mL of IV normal saline. B. Initiate the administration of prescribed antibiotics. C. Obtain requested cultures. D. Place the client on Bleeding Precautions.

C. Obtain requested cultures. Obtaining cultures to identify the infectious agent correctly is the priority for this client. Hydrating the client is not the priority. Administering antibiotics is important, but antibiotics should always be started after cultures are obtained. Placing the client on Bleeding Precautions is unnecessary.

When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful? A. Administering a biological response modifier B. Encouraging oral care with commercial mouthwash C. Providing oral care with a disposable mouth swab D. Maintaining NPO until the lesions have resolved

C. Providing oral care with a disposable mouth swab The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care. Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. Keeping the client NPO is not necessary because nutrition is important during cancer treatment; a local anesthetic may be prescribed for comfort.

The nurse is to administer packed red blood cells to a client. How does the nurse ensure proper client identification? A. Asks the client's name B. Checks the client's armband C. Reviews all information with another registered nurse D. Verifies the client's room number

C. Reviews all information with another registered nurse With another registered nurse, verify the client by name and number, check blood compatibility, and note expiration time. Human error is the most common cause of ABO incompatibility reactions, even for experienced nurses. Asking the client's name and checking the client's armband are not adequate for identifying the client before transfusion therapy. Using the room number to verify client identification is never appropriate.

What typical sign/symptom indicates the early stage of septic shock? A. Pallor and cool skin B. Blood pressure 84/50 mm Hg C. Tachypnea and tachycardia D. Respiratory acidosis

C. Tachypnea and tachycardia Signs of systemic inflammatory response syndrome, which precedes sepsis, include rapid respiratory rate, leukocytosis, and tachycardia. In the early stage of septic shock, the client is usually warm and febrile. Hypotension does not develop until later in septic shock due to compensatory mechanisms. Respiratory alkalosis occurs early in shock because of an increased respiratory rate.

The certified wound, ostomy, continence nurse (CWOCN) or enterostomal therapist (ET) teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities? A. Nutritional and dietary care B. Respiratory care C. Stoma and pouch care D. Wiping from front to back (asepsis)

C. The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms.

A client's urinalysis shows all of the following results. Which result does the nurse report to the health care provider? A. pH 5.8 B. Osmolarity 450 C. Nitrites present D. Sodium 5 mEq/L

C. The osmolarity, pH, and sodium concentration are within normal ranges. Nitrites are not usually present in urine. Many types of bacteria, when present in the urine, convert nitrates (normally found in urine) into nitrites. A positive finding indicates a urinary tract infection.

The nurse corrects the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? A. The student scrubs the hub of IV tubing before administering an antibiotic. B. The nurse overhears the student explaining to the client the importance of handwashing. C. The student teaches the client that symptoms of neutropenia include fatigue and weakness. D. The nurse observes the student providing oral hygiene and perineal care.

C. The student teaches the client that symptoms of neutropenia include fatigue and weakness. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected. Asepsis with IV lines is an appropriate action. Handwashing is an essential component of client care, especially when the client is at risk for neutropenia. Hygiene and perineal care help prevent infection and sepsis.

A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration should be cared for by which staff member? A. An RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma B. An RN who is caring for a client who just returned after having renal artery balloon angioplasty C. An RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy D. An RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

C. This RN is caring for the most stable client and will have time to do the frequent monitoring and interventions that are needed for the newly admitted client.

What are the cranial nerves?

CRANIAL NERVE ORIGIN TYPE FUNCTION I: Olfactory Type: Sensory Function: Smell II: Optic Type: Sensory Function: Central and peripheral vision III: Oculomotor Type: Motor to eye muscles Function: Eye movement via medial and lateral rectus and inferior oblique and superior rectus muscles; lid elevation via the levator muscle Type: Parasympathetic-motor Function: Pupil constriction; ciliary muscles IV: Trochlear Type: Motor Function: Eye movement via superior oblique muscles V: Trigeminal Type: Both Function: Sensation from skin of face and scalp and mucous membranes of mouth and nose Muscles of mastication (chewing) VI: Abducens Type: Motor Function: Eye movement via lateral rectus muscles VII: Facial Type: Both Function: Pain and temperature from ear area; deep sensations from the face; taste from anterior two thirds of the tongue; Muscles of the face and scalp; Lacrimal, submandibular, and sublingual salivary glands VIII: Vestibulocochlear Type: Sensory Hearing Equilibrium IX: Glossopharyngeal Type: Both Function: Pain and temperature from ear; taste and sensations from posterior one third of tongue and pharynx; Skeletal muscles of the throat; Parotid glands X: Vagus Type: Both Function: Pain and temperature from ear; sensations from pharynx, larynx, thoracic and abdominal viscera; Muscles of the soft palate, larynx, and pharynx; Thoracic and abdominal viscera; cells of secretory glands; cardiac and smooth muscle innervation to the level of the splenic flexure XI: Accessory Type: Motor Function: Skeletal muscles of the pharynx and larynx and sternocleidomastoid and trapezius muscles XII: Hypoglossal Type: Motor Function: Skeletal muscles of the tongue

How does kidney failure effect the calcium phosphate balance and vitamin D production.

Calcium and phosphorus balance is disrupted by CKD. A complex, balanced normal relationship exists between calcium and phosphate and is influenced by vitamin. The kidney produces calcitriol, the active form of vitamin D, which then enhances intestinal absorption of calcium. In CKD, phosphate retention and a deficiency of active vitamin D disrupt the calcium and phosphate balance. Normally, excessive dietary phosphate is excreted by the kidneys in the urine. Parathyroid hormone (PTH) controls the amount of phosphate in the blood by causing tubular excretion of phosphate when there is an excess. An early effect of CKD is reduced phosphate excretion. As plasma phosphate levels increase (hyperphosphatemia), calcium levels decrease (hypocalcemia). Chronic low blood calcium levels stimulate the parathyroid glands to release more PTH. Under the influence of additional PTH, calcium is released from storage areas in bones (bone resorption), which results in bone density loss. The extra calcium from the bone is needed to balance the excess plasma phosphate level. The problem of low blood calcium levels is made worse with severe CKD because kidney cell damage also reduces production of active vitamin D. Thus less calcium is absorbed through the intestinal tract in the absence of sufficient vitamin D.

When can headaches be life-threatening?

Can be serious and life-threatening, especially when associated with abnormal neuro assessment findings

Are there grafts required with deep partial-thickness burns?

Can be used if healing is prolonged

What pain medication can you give for a urolithiasis?

Can get toradol and a little morphine, and pain goes away, can almost dx kidney stones alone.

What is photodynamic therapy?

Can reduce the size of certain tumors and destroy others. Photodynamic therapy (PDT) is the selective destruction of cancer cells through a chemical reaction triggered by types of laser light. It can be used to destroy some cancers, reduce the size of tumors and then allow more complete tumor removal by surgery, and shrink tumors in airways or the esophagus to relieve obstruction.

What is a computed tomography (CT) scan? Is the patient allowed to move with a CT scan? Do they have to lay flat? Are there any weight restrictions?

Computed tomography (CT) scanning is an accurate, quick, easy, noninvasive, painless, and least expensive method of diagnosing neurologic problems. With the aid of a computer, pictures are taken at many horizontal levels, or slices, of the brain or spinal cord. The cross-sectional slices build up threedimensional pictures of the brain or spinal cord. A contrast medium may be used to enhance the image. CT scans distinguish bone, soft tissue (e.g., the brain, vascular system, and ventricular system), and fluids such as cerebrospinal fluid (CSF) or blood. Tumors, infarctions, hemorrhage, hydrocephalus, and bone malformations can also be identified. A CT scan may be performed after a myelogram. The patient is placed on a movable table in a head-holding device. He or she must remain completely still during the test, which may be difficult. The table is positioned in the machine—a large, donut-shaped structure. Depending on the scan, the patient may be completely enclosed or in a more open situation. A noncontrast series of pictures are taken first. Then, if needed, the patient is withdrawn from the scanner and given an injection of the iodinated contrast medium. The scan is then repeated. Each set of head scans takes less than 5 minutes in newer scanners take about 10 minutes per body section (cervical, thoracic, lumbar) and are less likely to require contrast injection. After a standard CT scan, imaging software digitally removes images of soft tissue so that only images of bone remain. Through the use of this technology, bone deformities, trauma, and birth defects are more easily identified. Our teacher said in class:-(Increase of ct scan can cause cancer). To undergo ct scan, patient has to lay completely supine. Head has to be completely still with no pillow. Technician positions patient then leaves the room, stays behind lead wall, and does the scan. Can't stay in room with patient during the procedure-have to be by themselves. If they can't or can't stay still they might not be able to undergo the procedure. It is short-maybe five minutes-and can talk with a microphone. Machine takes pictures from head down-it's like slicing head into numerous pictures and slices-gives tremendous amounts of information. One of the problems is that the weight capacity is 300 lbs. Some facilities have higher weight capacity, but not all. If a patient is going to CT and you know they are heavier than the weight baring load, might have to transfer them to another facility.

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Consider any temperature elevation in a patient with neutropenia a sign of infection. Report it to the health care provider immediately, and implement standard infection protocols.

Does contact inhibition occur in cancer cells?

Contact inhibition does not occur in cancer cells, even when all sides of these cells are in continuous contact with the surfaces of other cells. This persistence of cell division makes the disease difficult to control.

What is contact inhibition?

Contact inhibition is a growth mechanism which functions to keep cells growing into a layer one cell thick (a monolayer); it is the stopping of further rounds of cell division when the dividing cell is completely surrounded and touched (contacted) by other cells. Of the normal cells that can divide, each cell divides only when some of its surface is not in direct contact with another cell. Once a normal cell is in direct contact on all surface areas with other cells, it no longer undergoes mitosis. Thus normal cell division is contact inhibited.

The nurse is preparing a teaching plan for a client with migraine headaches who is receiving propranolol (Inderal) for migraine headaches. What health teaching by the nurse is important for the client? A. "Take this drug only when you have symptoms at the beginning of a migraine headache." B. "This drug is low dose, so you don't have to worry about your heart rate or blood pressure." C. "This drug will relieve the pain during the aura phase soon after a headache has started." D. "Take this drug as prescribed every day, even when feeling well, to prevent a migraine."

D

A client receiving IV sodium heparin after a dose of rtPA (Retavase) begins to have severe epistaxis. What is the nurse's first action? A. Slow the heparin infusion to keep the vein open. B. Call the health care provider immediately. C. Check the INR and prothrombin time levels. D. Stop the infusion immediately.

D

An 82-year-old client with anemia is requested to receive 2 units of whole blood. Which assessment findings cause the nurse to discontinue the transfusion because it is unsafe for the client? (Select all that apply.) A. Capillary refill less than 3 seconds B. Decreased pallor C. Flattened superficial veins D. Hypertension E. Hypotension F. Rapid, bounding pulse

D, E, F In an older adult receiving a transfusion, hypertension is a sign of overload, low blood pressure is a sign of a transfusion reaction, and a rapid and bounding pulse is a sign of fluid overload. In this scenario, 2 units, or about a liter of fluid, could be problematic. Capillary refill time that is less than 3 seconds is considered to be normal and would not pose a problem. Increased (not decreased) pallor and cyanosis are signs of a transfusion reaction, while swollen (not flattened) superficial veins are present in fluid overload in older adult clients receiving transfusions.

The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse's instructions? A. "Cigarette smoking always causes lung cancer." B. "Taking multivitamins will prevent me from developing cancer." C. "If I have only one shot of whiskey a day, I probably will not develop cancer." D. "I need to report the pain going down my legs to my health care provider."

D. "I need to report the pain going down my legs to my health care provider." Pain in the back of the legs could indicate prostate cancer in an older man. Cigarette smoking is implicated in causing lung cancer and other types of cancer, but it does not always cause cancer. Investigation is ongoing about the efficacy of vitamins A and C in cancer prevention. Limiting alcohol to one drink per day is only one preventive measure.

A client with thrombocytopenia is being discharged. What information does the nurse incorporate into the teaching plan for this client? A. "Avoid large crowds." B. "Drink at least 2 liters of fluid per day." C. "Elevate your lower extremities when sitting." D. "Use a soft-bristled toothbrush."

D. "Use a soft-bristled toothbrush." Using a soft-bristled toothbrush reduces the risk for bleeding in the client with thrombocytopenia. Avoiding large crowds reduces the risk for infection, but is not specific to the client with thrombocytopenia. Increased fluid intake reduces the risk for dehydration, but is not specific to the client with thrombocytopenia. Elevating extremities reduces the risk for dependent edema, but is not specific to the client with thrombocytopenia.

A client with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this client's problem? A. "Ask your doctor to prescribe more medication." B. "It is too soon for additional medication to be given." C. "I'll turn on some soothing classical music for you." D. "Would you like to try some relaxation techniques?"

D. "Would you like to try some relaxation techniques?" Because most clients with multiple myeloma have local or generalized bone pain, analgesics and alternative approaches for pain management, such as relaxation techniques, are used for pain relief. This also offers the client a choice. Before prescribing additional medication, other avenues should be explored to relieve this client's pain. Even if it is too soon to give additional medication, telling that to the client is not helpful because it dismisses the client's pain concerns. Although music therapy can be helpful, this response does not give the client a choice.

A client with anemia asks, "Why am I feeling tired all the time?" How does the nurse respond? A. "How many hours are you sleeping at night?" B. "You are not getting enough iron." C. "You need to rest more when you are sick." D. "Your cells are delivering less oxygen than you need."

D. "Your cells are delivering less oxygen than you need." The single most common symptom of anemia is fatigue, which occurs because oxygen delivery to cells is less than is required to meet normal oxygen needs. Although assessment of sleep and rest is good, it does not address the cause related to the diagnosis. While it may be true that the client isn't getting enough iron, it does not relate to the client's fatigue. The statement about the client needing rest because of being sick is simply not true.

Which problem places a person at highest risk for septic shock? A. Kidney failure B. Cirrhosis C. Lung cancer D. 40% burn injury

D. 40% burn injury The skin forms the first barrier to prevent entry of organisms into the body; this client is at very high risk for sepsis and death. Although the client with kidney failure has an increased risk for infection, his skin is intact, unlike the client with burn injury. Although the liver acts as a filter for pathogens, the client with cirrhosis has intact skin, unlike the burned client. The client with lung cancer may be at risk for increased secretions and infection, but risk is not as high as for a client with open skin.

The nurse is starting the shift by making rounds. Which client does the nurse decide to assess first? A. A 42-year-old with anemia who is reporting shortness of breath when ambulating down the hallway B. A 47-year-old who recently had a Rumpel-Leede test and is requesting a nurse to "look at the bruises on my arm" C. A 52-year-old who has just had a bone marrow aspiration and is requesting pain medication D. A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism

D. A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism The client with the nosebleed may be experiencing the bleeding as a result of excessive anticoagulation and should be assessed for the severity of the situation first. The client with anemia and the client who had a Rumpel-Leede test are more stable, and can be assessed later. Making clients wait for pain medication is not desirable, but in this scenario, the client who is bleeding is the higher priority. The client waiting for pain medication should be next on the nurse's "to do" list.

The nurse presents a cancer prevention program to teens. Which instruction will have the greatest impact in cancer prevention? A. Avoid asbestos. B. Wear sunscreen. C. Get the human papilloma virus (HPV) vaccine. D. Do not smoke cigarettes.

D. Do not smoke cigarettes. All of these actions are part of cancer prevention; however, tobacco is the single most important source of preventable carcinogenesis. Asbestos may be found in older homes and buildings. Most schools have been through an asbestos abatement program so should not pose a risk. It would be important to share with teens who may be involved in the construction industry during the summer to be aware of asbestos risks. Although asbestos may present a risk for lung cancer, it is not a likely exposure for teens. Lifetime exposure to the sun and the use of tanning beds will increase the risk for cancer, but not as much as tobacco use. The HPV vaccine will decrease the risk for cervical cancer, but will not have as much of an impact on cancer prevention as avoiding tobacco.

A nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by a health care provider, for a client with a urinary tract infection (UTI) does the nurse question? A. Bactrim B. Cipro C. Noroxin D. Tegretol

D. Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin and Tegretol. The former is used for UTI, and the latter is prescribed as an oral anticonvulsant.

The client had IV urography 8 hours ago. Which nursing intervention is the priority for this client? A. Maintaining bedrest B. Medicating for pain C. Monitoring for hematuria D. Promoting fluid intake

D. Ensure adequate hydration by urging the client to take oral fluid or by giving IV fluids. Hydration reduces the risk for kidney damage.

The nurse is assessing the nutritional status of a client with anemia. How does the nurse obtain information about the client's diet? A. Asks the client to rate his or her diet on a scale of 1 (poor) to 10 (excellent) B. Determines who prepares the client's meals and plans an interview with him or her C. From a prepared list, finds out the client's food preferences D. Has the client write down everything he or she has eaten for the past week

D. Has the client write down everything he or she has eaten for the past week Having the client provide a list of items eaten in the past week is the most accurate way to find out what the client likes and dislikes, as well as what the client has been eating. It will provide information about "junk" food intake, as well as protein, vitamin, and mineral intake. Rating scales are good for subjective data collection about some conditions such as pain, but the subjectivity of a response such as this does not provide the nurse with specific data needed to assess a diet. Interviewing the food preparer is time-consuming and poses several problems, such as whether a number of people are preparing meals, or if the client goes "out" for meals. Determining food preferences from a prepared list provides information about what the client enjoys eating, not necessarily what the client has been eating; for instance, the client may like steak but may be unable to afford it.

Which client does the nurse manager on a medical unit assign to an experienced LPN/LVN? A. 42-year-old with painless hematuria who needs an admission assessment B. 46-year-old scheduled for cystectomy who needs help in selecting a stoma site C. 48-year-old receiving intravesical chemotherapy for bladder cancer D. 55-year-old with incontinence who has intermittent catheterization prescribed

D. Insertion of catheters is within the education and legal scope of practice for LPNs/LVNs.

For which client living at home is intermittent self-catheterization an inappropriate method for incontinence management? A. 36-year-old woman who is blind B. 46-year-old man who has paraplegia C. 56-year-old woman who has diabetes D. 66-year-old man who has severe osteoarthritis

D. Intermittent self-catheterization requires significant manual dexterity to reach the area and perform the catheterization without contaminating the catheter. A person with severe osteoarthritis is not likely to be able to perform this technique safely. The technique does not require vision or the use of the lower extremities. A person with diabetes would be at increased risk for infection and would need to understand how to avoid contamination.

Which type of cancer has been associated with Down syndrome? A. Breast cancer B. Colorectal cancer C. Malignant melanoma D. Leukemia

D. Leukemia Leukemia is associated with Down syndrome and Turner syndrome. Breast cancer is often found clustered in families, not in association with Down syndrome. Colorectal cancer is associated with familial polyposis. Malignant melanoma is associated with familial clustering and sun exposure.

Which action does the nurse delegate to unlicensed assistive personnel (UAP)? A. Drawing a partial thromboplastin time from a saline lock on a client with a pulmonary embolism B. Performing a capillary fragility test to check vascular hemostatic function on a client with liver failure C. Referring a client with a daily alcohol consumption of 12 beers for counseling D. Reporting any bleeding noted when catheter care is given to a client with a history of hemophilia

D. Reporting any bleeding noted when catheter care is given to a client with a history of hemophilia Reporting findings during routine care is expected and required of unlicensed staff members. Drawing a partial thromboplastin time, performing a capillary fragility test, and referring a client for alcohol counseling are more complex and should be done by licensed nursing staff.

A client who is receiving a blood transfusion suddenly exclaims to the nurse, "I don't feel right!" What does the nurse do next? A. Call the Rapid Response Team. B. Obtain vital signs and continue to monitor. C. Slow the infusion rate of the transfusion. D. Stop the transfusion.

D. Stop the transfusion. The client may be experiencing a transfusion reaction; the nurse should stop the transfusion immediately. Calling the Rapid Response Team or obtaining vital signs is not the first thing that should be done. The nurse should not slow the infusion rate, but should stop it altogether.

Which nurse should be assigned to care for an intubated client who has septic shock as the result of a methicillin-resistant Staphylococcus aureus (MRSA) infection? A. The LPN/LVN who has 20 years of experience B. The new RN who recently finished orienting and is working independently with moderately complex clients C. The RN who will also be caring for a client who had coronary artery bypass graft (CABG) surgery 12 hours ago D. The RN with 2 years of experience in intensive care

D. The RN with 2 years of experience in intensive care The RN with current intensive care experience who is not caring for a postoperative client would be an appropriate assignment. Care of the unstable client with intubation and mechanical ventilation is not within the scope of practice for the LPN/LVN. A client who is experiencing septic shock is too complex for the new RN. Although the RN who is also caring for the post-CABG client is experienced, this assignment will put the post-CABG client at risk for MRSA infection.

The client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the provider visited the client the day before. What action does the nurse take? A. Asks the client to sign the informed consent B. Cancels the procedure C. Asks the client's spouse to sign the form D. Notifies the department and the provider

D. The client may be asked to sign the consent form in the department; notifying both the provider and the department ensures communication across the continuum of care, with less likelihood of omission of information.

The client with diabetes who also has persistent proteinuria asks what he could do to prevent eventual kidney failure. What is the nurse's best response? A. "Wear pads and other protective gear around your lower back when engaging in contact sports." B. "Drink at least 3 L of water daily and avoid carbonated beverages." C. "Limit your intake of proteins to less than 100 g daily." D. "Keep your blood glucose levels in the target range."

D. The presence of persistent proteinuria indicates kidney damage has already occurred and is likely to eventually progress to kidney failure. Although kidney failure cannot be prevented, the decline in kidney function can be slowed with tight glycemic control. The severity of diabetic kidney disease is related to the degree of hyperglycemia the client generally experiences. With poor control of hyperglycemia, the complicating problems of atherosclerosis, hypertension, and neuropathy (which promote loss of bladder tone, urinary stasis, and urinary tract infection) are more severe and more likely to cause additional kidney damage sooner.

Which technique does the nurse use to obtain a sterile urine specimen from the client with a Foley catheter? A. Disconnects the Foley catheter from the drainage tube and collects urine directly from the Foley B. Removes the existing catheter and obtains a sample during the process of inserting a new Foley C. Uses a sterile syringe to withdraw urine from the urine collection bag D. Clamps the tubing, attaches a syringe to the specimen, and withdraws at least 5 mL of urine

D. This is the correct technique for obtaining a sterile urine specimen from the client with a Foley catheter.

An older adult woman confides to a nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? A. "Don't worry about it. You need them." B. "Shop at night-when stores are less crowded." C. "Tell everyone that they are for your husband." D. "That is tough. What do you think might help?"

D. This response acknowledges the client's concerns and attempts to help the client think of methods to solve her problem.

The client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve? A. Decreases bacterial count B. Destroys white blood cells C. Enhances the action of antibiotics D. Provides comfort

D. Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis.

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection (UTI). Which nursing action can the home health RN delegate to a home health aide? A. Assisting the client in developing a schedule for when to take prescribed antibiotics B. Inserting a straight catheter as necessary if the client is unable to empty the bladder C. Teaching the client how to use the Credé maneuver to empty the bladder more fully D. Using a bladder scanner (with training) to check residual bladder volume after the client voids

D. Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill.

The nurse is mentoring a recent graduate RN about administering blood and blood products. What does the nurse include in the data? A. Obtain the client's initial set of vital signs (VS) within the first 10 minutes of the infusion. B. Remain with the client who is receiving the blood for the first 5 minutes of the infusion. C. Use a 22-gauge needle to obtain venous access when starting the infusion. D. Verify with another RN all of the data on blood products.

D. Verify with another RN all of the data on blood products. All data are checked by two RNs. Human error is the most common cause of ABO incompatibilities in administering blood and blood products. Initial VS should be recorded before the start of infusion of blood, not after it has begun. The nurse remains with the client for the first 15 to 30 minutes (not 5) of the infusion. This is the period when any transfusion reactions are likely to happen. A 20-gauge needle (or a central line catheter) is used; the 22-gauge needle is too small.

The nurse is transfusing a unit of whole blood to a client when the health care provider requests the following: "Furosemide (Lasix) 20 mg IV push." What does the nurse do? A. Add furosemide to the normal saline that is infusing with the blood. B. Administer furosemide to the client intramuscularly (IM). C. Piggyback furosemide into the infusing blood. D. Wait until the transfusion has been completed to administer furosemide.

D. Wait until the transfusion has been completed to administer furosemide. Completing the transfusion before administering furosemide is the best course of action in this scenario. Drugs are not to be administered with infusing blood products; they can interact with the blood, causing risks for the client. Stopping the infusing blood to administer the drug and then restarting it is also not the best decision. Changing the admission route is not a nursing decision.

A nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? A. "For the best effect, perform all your exercises while you are seated on the toilet." B. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." C. "Results should be visible to you within 72 hours." D. "You know that you are exercising correct muscles if you can stop urine flow in midstream."

D. When the client can start and stop the urine stream, the pelvic muscles are being used.

What period of time can chronic glomerulonephritis occur?

May occur over 20-30 years and exact etiology may be unknown. May or may not diagnose until it is too late and patient has renal failure.

What does macrocytic mean?

Means RBCs are larger than normal

In regards to tumor nomenclature, what is the prefix if the tissue of origin is pigment producing skin?

Melano

What is common about migraine sufferers? What gender is affected the most? What are migraine sufferers also at risk for?

Migraines tend to be familial, and women are affected more commonly than men. Women with anxiety and depressive personalities are particularly predisposed to migraines and other chronic health problems. Migraine sufferers are also at risk for stroke and epilepsy.

What are some secondary prevention measures that a nurse can implement to prevent hypovolemic shock?

Secondary prevention of hypovolemic shock is a major nursing responsibility. Keep in mind that just being a patient in the acute care setting is a risk factor. Identify patients at risk for dehydration, and assess for early manifestations. This is especially important for those who have reduced cognition or reduced mobility or who are on NPO status. Assess all patients who have invasive procedures or trauma for obvious or occult bleeding. Compare pulse quality and rate with baseline. Compare urine output with fluid intake. Check vital signs for patients who have persistent thirst. Assess for shock in any patient who develops a change in mental status, an increase in pain, or an increase in anxiety. When patients have invasive procedures or ambulatory surgery and then go home, teach them and their families the manifestations of shock. Stress the importance of seeking immediate help for obvious heavy bleeding, persistent thirst, decreased urine output, light-headedness, or a sense of impending doom (a feeling that something bad is happening or going to happen).

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The Tensilon test can cause ventricular fibrillation and cardiac arrest, but these reactions rarely occur. Be sure that atropine sulfate, the antidote for Tensilon, is available in case these complications occur.

What seizure management care can the nurse provide?

Turn the patient on the side during a generalized tonic-clonic or complex partial seizure because he or she may lose consciousness. If possible, turn the patient's head to the side to prevent aspiration and allow secretions to drain. Remove any objects that might injure the patient. It is not unusual for the patient to become cyanotic during a generalized tonic-clonic seizure. The cyanosis is generally self-limiting, and no treatment is needed. Some health care providers prefer to give the high-risk patient (e.g., older adult, critically ill, or debilitated patient) oxygen by nasal cannula or facemask during the postictal phase. He or she is not restrained because this may cause injury and may worsen the situation, causing more seizure activity. For any type of seizure, carefully observe the seizure and document assessment findings.

What is Type A hemophilia? What factors is deficient in Type A?

Type A (classic hemophilia)-deficiency of Factor VIII, (accounts for about 80% of cases)

Who is typically excluded from getting a kidney transplant?

Typically excluded from the list are persons with age >70, cancer, chronic heart and lung disease

Typically, who is the only one who can administer chemo?

Typically only the Oncology Certifed RN can administer chemo.

How are tumors of the tongue diagnosed?

Typically oral exam (dental), biopsy

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Uterine (endometrial) cancer usually grows slowly and can be found early if the woman experiences and reports post-menopausal bleeding. It can be a late diagnosis in a menopausal woman who mistakes uterine bleeding for her normal period being prolonged, coming early, or late and therefore does not report the bleeding.

People with G6PD anemia are asymptomatic until what?

Until they develop an infection, take certain drugs (aspirin, sulfonimides) or eat flat bean

Bell's Palsy usually resolved in what time frame?

Usually resolves within 3 months.

What age group and gender does multiple myeloma usually affect?

Usually strikes after age 65, men > woman

How can catheter-related infections be minimized?

• Assess patients daily for those who no longer need indwelling catheters. • Consider appropriate alternatives to an indwelling catheter. • Use aseptic routine when handling catheter devices; manipulation can promote an environment favorable to pathogens. • Select a small-size catheter (14 to 18 Fr with a 5-mL balloon). • Use strict sterile technique to insert the catheter (in the hospital setting); a break in technique can introduce pathogens into the urinary tract. • Do not inject more than 10 mL into the balloon. • Maintain a closed-system irrigation by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract. • Avoid routine catheter irrigation. • Keep urine collection bags below the level of the bladder at all times; elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract. • Secure the catheter to the patient's thigh (women) or lower abdomen (men); catheter movement can cause urethral friction and irritation. • Perform daily catheter care by washing the perineum and proximal portion of the catheter with soap and water and drying gently (removes pathogens and reduces pathogenic population). • Consider the use of coated catheters for patients requiring indwelling catheters for more than 3 to 5 days. This coating reduces bacterial colonization along the catheter

What are some interventions to minimize behavioral problems in those with Alzheimer's disease?

• Assist the patient to remain oriented as long as possible. • Place single-date calendars in patient's room and in kitchen. • Use large-face clocks with a neutral background. Communicate with the patient based on his or her ability to understand. • As the disease progresses, use simple language and explain activity before the patient needs to carry it out. • Break complex tasks down to simple steps. Encourage the patient to be as independent as possible in ADLs. • Place complete outfits for the day on hangers; have the patient select one to wear. • Develop and maintain a predictable routine (e.g., meals, bedtime, morning routine). When a problem behavior occurs, use distraction to divert patient to another activity.

What are some dietary habits to reduce the risk of cancer?

• Avoid excessive intake of animal fat. • Avoid nitrites (prepared lunch meats, sausage, bacon). • Minimize your intake of red meat. • Keep your alcohol consumption to no more than one or two drinks per day. • Eat more bran. • Eat more cruciferous vegetables, such as broccoli, cauliflower, brussels sprouts, and cabbage. • Eat foods high in vitamin A (e.g., apricots, carrots, leafy green and yellow vegetables) and vitamin C (e.g., fresh fruits and vegetables, especially citrus fruits).

In the initial stage, is there a decrease or increase of mean arterial pressure (MAP)? By how much? Is there increased or decreased sympathetic stimulation? Is there vasoconstriction or vasodilation? What happens to the heart rate?

• Decrease in baseline mean arterial pressure (MAP) of 5-10 mm Hg • Increased sympathetic stimulation • Mild vasoconstriction • Increased heart rate

What are some cardiovascular manifestations of shock?

• Decreased cardiac output • Increased pulse rate • Thready pulse • Decreased blood pressure • Narrowed pulse pressure • Postural hypotension • Low central venous pressure • Flat neck and hand veins in dependent positions • Slow capillary refill in nail beds • Diminished peripheral pulses

How can urinary tract infections be prevented?

• Drink at least 2 to 3 L of sugarless fluid every day. • Be sure to get enough sleep, rest, and nutrition daily. • [For women] Clean your perineum (the area between your legs) from front to back. • [For women] Avoid using or wearing irritating substances, such as bubble bath, nylon underwear, and scented toilet tissue. Wear loose-fitting cotton underwear. • [For women] Empty your bladder before and after intercourse. • For both women and men, gently wash the perineal area before intercourse. • Avoid the use of scented or flavored lubricants. • If you experience burning when you urinate, if you have to urinate frequently, or if you find it difficult to begin urinating, notify your physician or other health care provider right away, especially if you have a chronic medical condition (e.g., diabetes) or are pregnant. • Empty your bladder as soon as you feel the urge to urinate. • Empty your bladder regularly (more often than every 4 hours), even if you do not feel the urge to urinate. • You may try these home therapies: • Cranberry juice (pure), 50 mL daily • Apple cider vinegar, 2 tablespoons three times daily in juice • Vitamin C, 500 mg daily to acidify the urine • To prevent recurrent infection: • Take your prescribed antibiotic or other drug as directed, even after the symptoms go away. • Schedule a follow-up appointment for 10 to 14 days after you finish taking the drug. At your follow-up visit, another urine sample may be taken for analysis or culture.

What teaching should be provided to the patient with mucositis?

• Examine your mouth (including the roof, under the tongue, and between the teeth and cheek) every 4 hours for fissures, blisters, sores, or drainage. • If sores or drainage is present, see your health care provider to have these areas cultured. • Brush the teeth and tongue with a soft-bristled brush or sponges every 8 hours and before meals. • Rinse the mouth with a solution of one-half peroxide and one-half normal saline every 12 hours. • Avoid the use of mouthwashes that contain alcohol or glycerin. • Rinse your mouth four times daily with a bland rinse. • Drink 2 or more liters of water per day if another health problem does not require limiting fluid intake. • Take antimicrobial drugs as prescribed. • Use topical analgesic drugs as prescribed or as needed. • "Swish and spit" room-temperature tap water or normal saline as needed. • Apply a water-based moisturizer to your lips after each episode of mouth care and as needed. • Use prescribed "artificial saliva" or mouth moisturizers as needed. • Avoid using tobacco or drinking alcoholic beverages. • Avoid spicy, salty, acidic, dry, rough, or hard food. • Cool liquids to prevent burns or irritation. • If you wear dentures, use them only during meals. When not in place, soak dentures in an antimicrobial solution. Rinse thoroughly before placing them in your mouth.

What are rare clinical manifestations of UTI?

• Fever • Chills • Nausea or vomiting • Malaise • Flank pain

What are key features of acute pyelonephritis?

• Fever • Chills • Tachycardia and tachypnea • Flank, back, or loin pain • Tender costovertebral angle (CVA) • Abdominal, often colicky, discomfort • Nausea and vomiting • General malaise or fatigue • Burning, urgency, or frequency of urination • Nocturia • Recent cystitis or treatment for urinary tract infection (UTI)

How would the nurse care for the patient with meningitis?

• Follow ABCs (airway, breathing, circulation). • Take vital signs and perform neurologic checks every 2 to 4 hours, as required. • Perform cranial nerve assessment, with particular attention to cranial nerves III, IV, VI, VII, and VIII, and monitor for changes. • Manage pain with drug and nondrug methods. • Perform vascular assessment, and monitor for changes. • Give drugs and IV fluids as prescribed, and document the patient's response. • Record intake and output carefully to maintain fluid balance and prevent fluid overload. • Monitor body weight to identify fluid retention early. • Monitor laboratory values closely; report abnormal findings to the physician or nurse practitioner promptly. • Position carefully to prevent pressure ulcers. • Perform range-of-motion exercises every 4 hours as needed. • Decrease environmental stimuli: • Provide a quiet environment. • Minimize exposure to bright lights from windows and overhead lights. • Maintain bedrest with head of bed elevated 30 degrees. • Maintain Transmission-Based Precautions per hospital policy (for bacterial meningitis). • Monitor for and prevent complications: • Increased intracranial pressure • Vascular dysfunction • Fluid and electrolyte imbalance • Seizures

What are common clinical manifestations of UTI?

• Frequency • Urgency • Dysuria • Hesitancy or difficulty in initiating urine stream • Low back pain • Nocturia • Incontinence • Hematuria • Pyuria • Bacteriuria • Retention • Suprapubic tenderness or fullness • Feeling of incomplete bladder emptying

What are nursing interventions for the patient with thrombocytopenia?

• Handle the patient gently. • Use and teach UAP to use a lift sheet when moving and positioning the patient in bed. • Avoid IM injections and venipunctures. • When injections or venipunctures are necessary, use the smallest gauge needle for the task. • Apply firm pressure to the needle stick site for 10 minutes or until the site no longer oozes blood. • Apply ice to areas of trauma. • Test all urine and stool for the presence of occult blood. • Observe IV sites every 4 hours for bleeding. • Instruct patients to notify nursing personnel immediately if any trauma occurs and if bleeding or bruising is noticed. • Avoid trauma to rectal tissues: • Do not administer enemas. • If suppositories are prescribed, lubricate liberally and administer with caution. • Measure the patient's abdominal girth daily. • Instruct the patient and UAP to use an electric shaver rather than a razor. • When providing mouth care or supervising others in providing mouth care: • Use a soft-bristled toothbrush or tooth sponges. • Do not use water pressure gum cleaners. • Make certain that dentures fit and do not rub. • Instruct the patient not to blow the nose or insert objects into the nose. • Instruct UAP and the patient that the patient should wear shoes with firm soles whenever ambulating. • Keep pathways and walkways clear and uncluttered

Many patients with AD tend to wander and may easily become lost. What are some interventions for wandering?

• Identify the patients most at risk for wandering through observation and history provided by family. • Provide appropriate supervision, including frequent checks (especially at shift-change times). • Place the patient in an area that provides maximum observation, but not in the nurses' station. • Use family members, friends, volunteers, and sitters as needed to monitor the patient. • Keep the patient away from stairs or elevators. • Do not change rooms to prevent increasing confusion. • Avoid physical or chemical restraints. • Assess and treat pain. • Use re-orientation methods and validation therapy, as appropriate. • Provide frequent toileting and incontinence care as needed. • If possible, prevent overstimulation, such as excessive noise; use soft music and nonglare lighting if possible.

What are some neurological manifestations of anemia?

• Increased somnolence and fatigue • Headache

What is trigeminal neuralgia?

• Is a disease that affects the trigeminal, or fifth cranial, nerve. • Occurs more often in people older than 50 years and in women more often than men. • Causes a specific type of facial pain, which occurs in sudden, intense facial spasms. • Is usually provoked by minimal stimulation of a trigger zone (like dental procedures). • Is unilateral (one-sided) and confined to the area innervated by the trigeminal nerve, most often the second and third branches. • Is familial due to an inherited pattern of blood vessel formation. Patients younger than 30 years with pain in more than one branch of the trigeminal nerve may be further evaluated to rule out the possibility of a tumor or multiple sclerosis.