Semester 3: Unit 1 exam*

focal seizure

- abnormal electrical activity that occurs in one or more parts of one brain hemisphere; partial seizure - seizure in only one limb or body part

Cellulitis

- bacterial infection of the skin marked by local heat, redness, pain, and swelling - usually affects the skin on the lower legs, but it can occur in the face, arms and other areas - most common bacteria that cause cellulitis include: Staphylcoccus Aureus, hemolytic streptococcus (Strep), Streptococcus pneumoniae (Strep) - more serious staphylococcus infection called methicillin-resistant Staphylococcus aureus (MRSA) - TX: antibiotics

Hypervolemia

- fluid overload, is the medical condition where there is too much fluid in the blood - results from fluid retention with Cushing's - bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific gravity <1.010. semi fowler's

Antibiotics to treat C diff

- vancomycin PO or rectal ONLY - fidaxomicin (Dificid) - Metronidazole (Flagyl)

β-Adrenergic Blockers

-Symptomatic relief of thyrotoxicosis (excess TS4/TS3) -Block effects of sympathetic nervous stimulation -Propranolol (Inderal) -Atenolol (Tenormin)

State four home precautions that must be taught to a patient receiving RAI (Radioactive iodine therapy) for hyperthyroidism.

1. Using private toilet facilities if possible and flushing two or three times after each use. 2. Separately laundering towels, bed linens, and clothes daily at home. 3. Not preparing food for others that requires prolonged handling with bare hands. 4. Avoiding being close to pregnant women and children for 7 days after therapy.

A normal Phenytoin (Dilatin) level is

10 to 20 mcg/mL

blood glucose levels

70-110

Lymphadenopathy (LAD)

A chronic, abnormal enlargement of the lymph nodes, usually associated with disease clinical manifestation is associated with cellulitis

Hypothyroidism

A disorder caused by a thyroid gland that is slower and less productive than normal, signs: Confusion, hearing loss, and slowness of speech

Carpopedal spasm

A spasm of the hand, thumbs, foot, or toes that accompanies tetany.

(Kahoot) Which of the following lab tests would apply to a skin infection (select all that apply) A. CBC B. C & S C. LFT D. BMP

A. CBC B. C & S

(J.S case study) What kind of diet would you recommend for a patient with Cushing's A. Diet high in protein and fat and low in sodium and carbohydrates B. Diet high in carbohydrates and low in protein and fat C. Diet high in vitamin C and zinc and low in fat D. Diet high in protein, sodium, and sugar

A. Diet high in protein and fat and low in sodium and carbohydrates

( Kahoot) Which of the following are sign(s) of infection (select all that apply) A. fever B. swelling C. sweating D. redness

A. fever B. swelling D. redness

Propylthiouracil, methimazole

Anti thyroid for Hyperthyroidism. Blocks the synthesis of thyroid hormones (T3/T4) by preventing iodination of tyrosine. Tox: Skin rash, agrtanulocytosis, aplastic anemia, hepatotoxicity.

You're educating a 25-year-old female about possible triggers for seizures. Which statement requires you to re-educate the patient about the triggers? A. "I'm at risk for seizure activity during my menstrual cycle." B. "I will limit my alcohol intake to 2 glasses of wine per day." C. "It's important I get plenty of sleep." D. "I will be sure to stay hydrated, especially during hot weather."

B. "I will limit my alcohol intake to 2 glasses of wine per day." The answer is B. The patient should avoid all alcohol because it can lead to a seizure. Hormone shifts (menstrual cycle, ovulation, pregnancy) sleep deprivation, and dehydration can lead to a seizure.

(Nurse Sarah) Which of the following patients are at risk for developing Cushing's Syndrome? A. A patient with a tumor on the pituitary gland, which is causing too much ACTH to be secreted. B. A patient taking glucocorticoids for several weeks. C. A patient with a tuberculosis infection D. A patient who is post-opt from an adrenalectomy.

B. A patient taking glucocorticoids for several weeks. Cushing syndrome occurs when your body is exposed to high levels of the hormone cortisol for a long time. Cushing syndrome, sometimes called hypercortisolism, may be caused by the use of oral corticosteroid medication.

(adaptive quiz) What clinical indicators should a nurse assess when caring for a client with hyperthyroidism? Select all that apply. A.Dry skin B. Weight loss C. Tachycardia D. Restlessness E. Constipation F. Exophthalmos

B. Weight loss C. Tachycardia D. Restlessness F. Exophthalmos (bulging eyes) Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate. Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema. Smooth, warm, moist skin and increased stools and diarrhea are associated with hyperthyroidism. Dry, coarse, scaly skin occurs with hypothyroidism because of decreased glandular function. Constipation is associated with hypothyroidism.

(powerpoints) Which is the first-line anti thyroid drug? A. Synthroid B.Propylthiouracil C. Propanolol D. Dexamethasone

B.Propylthiouracil It is an anti-thyroid drug that has a mechanism of action that is similar to methimazole (Tapazole). Graves' disease is the most common cause of hyperthyroidism.

(Kahoot) Which of the following is the most common microorganism responsible for cellulitis A. Pseudomonas B.. Helicobacter Pylori C. Staphylcoccus Aureus D. Dermophytosis

C. Staphylcoccus Aureus

A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. The nurse concludes that this medication is given to: A. Decrease the total basal metabolic rate B. Maintain the function of the parathyroids C. Block the formation of thyroxine by the thyroid gland D.Decrease the size and vascularity of the thyroid gland

D.Decrease the size and vascularity of the thyroid gland Potassium iodide aids in decreasing the vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed; it should be given no longer than 10 to 14 days before surgery because its effect is temporary

What medications are first line therapy for generalized, tonic-clonic seizures?

Dilantin (pheytonin) Topiramate Tegretol (Carbamazepine) Mysoline

viral meningitis

Enterovirus, meningitis caused by a virus and not as severe as pyrogenic meningitis

Hypothyroidism symptoms

Fatigue, lethargy. Modest weight gain with anorexia. Dry, coarse skin and cold intolerance. Swelling of face, hands, and legs. Constipation. Weakness, muscle cramps, arthralgias, paresthesias, impaired memory and hearing.

Leukemia symptoms

Fever and night sweats Headache Bleeding easily Bone or joint pain Swollen lymph nodes in the armpit, neck Getting a lot of infections weakness Losing weight

(powerpoints) Which drugs are used for generalize/focal/ tonic clonic seizures and which are used to treat absent/focal seizures? Klonopin Tegretol Zarontin Mysoline Dilantin (pheytonin) Divalproex

Generalized, tonic clonic, and focal seizures treatment: Dilantin (pheytonin) Topiramate Tegretol (Carbamazepine) Mysoline Absence and myoclonic seizures treatment: Valproate Divalproex Klonopin Ethosuximide Zarontin

Cushing's syndrome

Hypersecretion of cortisol resulting in high levels of glucose and ketosteroids in the blood TX: reduce steroid, ketoconazole

A nurse is assessing a client admitted to the hospital with a tentative diagnosis of a pituitary tumor. What signs of Cushing syndrome does the nurse identify? A. Retention of sodium and water B. Hypotension and a rapid, thready pulse C. Increased fatty deposition in the extremities D. Hypoglycemic episodes in the early morning

Increased levels of steroids and aldosterone cause sodium and water retention in clients with Cushing syndrome. HYPERTENSION, not hypotension, is expected because of sodium and water retention. The extremities thin; subcutaneous fat deposits occur in the upper trunk, especially the back between the scapulae. HYPERGLYCEMIA, not hypoglycemia, occurs because of increased secretion of glucocorticoids. Hyperglycemia is sustained and not restricted to the morning hours.

Bacterial Meningitis symptoms

Initial symptoms of fever, headache, and stiff neck Followed by nausea and vomiting May progress to convulsions and coma

Potassium Iodide

SSKI, ThyroShield Antithyroid Agent used along with antithyroid medicines to prepare the thyroid gland for surgical removal, to treat hyperthyroidism, and to protect the thyroid in a radiation exposure emergency. Shrinks thyroid and decreases thyroid hormones production

types of focal seizures

Simple: No impairment of consciousness Complex: Impairment of consciousness

ACTH (adrenocorticotropic hormone)

Stimulates adrenal cortex to release glucocorticoids (cortisol) TOO MUCH=CUSHING'S TOO LITTLE=ADDISON'S

TMN staging

T0: no tumor Tis: in situ T1: <2cm T2: 2-5cm T3: >5cm T4: extension into chest wall or skin or inflammatory carcinomas N0: no evidence of lymph node metastasis N1: Positive movable ipsilateral axillary nodes N2: fixed ipsilateral axillary nodes N3: positive internal mammary nodes or clavicular nodes M0: no metastasis M1: metastasis

(nurse sarah) A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication? A. "Every morning I take this medication with a full glass of milk with my breakfast." B. "I know it is important to have my drug levels checked regularly." C. "I will report a skin rash immediately to my doctor." D. "This medication can lower my body's ability to clot and fight infection."

The answer is A. This medication should NOT be taken with milk products or antacids because it affects absorption. All the other options are correct

17-ketosteroids range

The reference range of urinary 17-ketosteroids is as follows: - Males: 10-20 mg (34-69 µmol)/24 h. - Females: 5-15 mg (17-52 µmol)/24 h - Higher levels may indicate possible Cushing syndrome, increased androgen or cortisol production, and severe stress. - Decreased levels indicate possible Addison disease and hypopituitarism.

(powerpoints) Write V next to the organism thats likely to cause viral meningitis and B next to the organism that likely to cause Bacterial meningitis Enterovirus Streptococcus pneumoniae Neisseria meningitidis Arbovirus HIV HSV Group B strep

Viral Enterovirus Arbovirus HIV HSV Bacterial Group B strep Streptococcus pneumoniae Neisseria meningitidis

Addison's disease

a condition that occurs when the adrenal glands do not produce enough cortisol or aldosterone

Thyroid storm

a relatively rare, life-threatening condition caused by exaggerated hyperthyroidism increased temp, pulse and HTN

exophthalmia

abnormal protrusion of the eyeball associated with enlargement of the thyroid, hyperthyroidism - Tinted glasses decrease photosensitive. - Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. - Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness - Cool, moist compresses are used to relieve irritation - Artificial tears are used to moisten the eyes

Graves disease

an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos

Decorticate

arms flexed, legs extended

While caring for a female client, the nursing student feels tenderness and a lump in the client's breast. The nursing student tells the registered nurse, "I think this client has breast cancer." Which statements of the registered nurse would be appropriate in accordance with the knowing element of Swanson's theory? Select all that apply. a. "Try to comfort the client." b. "Avoid making assumptions." c. "Assess the client thoroughly." d. "Check for other signs of breast cancer." e. "Try to provide support and care to the client."

b. "Avoid making assumptions." c. "Assess the client thoroughly." d. "Check for other signs of breast cancer." The knowing element of the caring process involves understanding an event. Avoiding assumptions, performing a thorough assessment of the client, and checking for other signs of breast cancer and are related to the knowing element of Swanson's theory of caring. The doing for element includes comforting the client. The caring process of being with involves the nurse providing emotional support.

(med surg) A nurse is caring for a patient who has a pressure ulcer that is treated with debridement, irrigations, and moist gauze dressings. How should the nurse anticipate healing to occur? a. Tertiary intention b. Secondary intention c. Regeneration of cells d. Remodeling of tissues

b. Secondary intention Secondary closure healing occurs when there is a large tissue defect and there has been extensive loss of cells and tissue and new tissue fills the wound. Often scars.

(med surg) A patient 1 day postoperative after abdominal surgery has incisional pain, 99.5° F temperature, slight erythema at the incision margins, and 30 mL serosanguineous drainage in the Jackson-Pratt drain. Based on this assessment, what conclusion would the nurse make? a. The abdominal incision shows signs of an infection. b. The patient is having a normal inflammatory response. c. The abdominal incision shows signs of impending dehiscence. d. The patient's physician must be notified about her condition.

b. The patient is having a normal inflammatory response.

( Med surg) The nurse assessing a patient with a chronic leg wound finds local signs of erythema and the patient complains of pain at the wound site. What would the nurse anticipate being ordered to assess the patient's systemic response? a. Serum protein analysis b. WBC count and differential c. Punch biopsy of center of wound d. Culture and sensitivity of the wound

b. WBC count and differential

(Medsurg) A nursing measure that is indicated to reduce the potential for seizures and increased intracranial pressure in the patient with bacterial meningitis is a. administering codeine for relief of head and neck pain. b. controlling fever with prescribed drugs and cooling techniques. c. keeping the room dark and quiet to minimize environmental stimulation. d. maintaining the patient on strict bed rest with the head of the bed slightly elevated

b. controlling fever with prescribed drugs and cooling techniques. Fever must be vigorously treated because it increases cerebral edema and the frequency of seizures

tetany

condition affecting nerves causing muscle spasms as a result of low amounts of calcium in the blood caused by a deficiency of the parathyroid hormone (hypocalcemia)

A client is brought to the emergency department in the midst of a persistent tonic-Clonic seizure. Diazepam (valium) is administered intravenously. The nurse anticipates that in addition to decreasing the central neural activity, what other effect of diazepam will be occurring? a. Promoting amnesia of the seizure episode b. Dilation of tracheobronchial structures c. Slowing of cardiac contractions d. Relaxation of peripheral muscles

d. Relaxation of peripheral muscles

Cushing's disease

elevated cortisol (Remember: *UP, UP, UP, DOWN, UP*) - HYPERnatremia, HYPERtension, HYPERvolemia , HYPOkalemia, HYPERglycemia

Hyperthyroidism

excessive activity of the thyroid gland produces abnormally high levels of thyroid hormone *Decreased TSH. Increased T4/3. Increased BMR

hirsutism

excessive hair growth

T4 and T3

regulates rate of cellular metabolism, Increases basal metabolic rate and body heat production

somnolence

sleepiness

TSH (thyroid stimulating hormone)

stimulates secretion of thyroid hormone

adrenalectomy

surgical removal of one or both adrenal glands to remove a benign or cancerous tumor, aid in correcting a hormone imbalance, prevent metastasis or, occasionally, prevent adrenal gland hormone excretion from exacerbating an existing condition such as breast cancer

Automatism

the performance of actions without conscious thought or intention.

Radioactive iodine therapy

use of radioactive iodine to eliminate thyroid tumors

epilepsy aura

warning before a seizure event • a 'rising' feeling in the stomach or déjà vu (feeling like you've 'been here before'); • getting an unusual smell or taste; • a sudden intense feeling of fear or joy; • a strange feeling like a 'wave' going through the head; • stiffness or twitching in part of the body, (such as an arm or hand); • a feeling of numbness or tingling; • a sensation that an arm or leg feels bigger or smaller than it actually is; or • visual disturbances such as coloured or flashing lights or hallucinations

Seizure precautions

A. Padded side rails up at all times B. Bed maintained in lowest position C. Suction set-up with Yankauer ready for use D. Oxygen set-up and mask at HOB E. O2 Saturation measures in place F. IV access G. Loose restrictive clothes H. Pillow

Clostridium difficile (C. diff)

bacterial infection, generally associated with antibiotic use, causing severe, watery loose stools

Bacterial Meningitis

inflammation of the protective membranes covering the brain and spinal cord caused by various types of bacteria

Carpopedal spasm that occurs during respiratory alkalosis is caused by a(n):

intracellular calcium shift

Which antibiotics cause C diff?

most commonly implicated agents include: - cephalosporins (cephalexin/Keflex) - fluoroquinolones (ciprofloxacin, gemifloxacin, levofloxacin) - ampicillin/amoxicillin - clindamycin

Focal aware seizure (partial simple)

no loss of consciousness patient is aware and will remember what happens (like vision changes etc.)

What is the normal intracranial pressure range?

normal adult ICP is 5-15 mm Hg (7.5-20 cm H2O) ICP values of 20-30 mm Hg represent mild intracranial hypertension

Focal impaired awareness (complex partial)

patient will experience an alternation in consciousness and will perform an action without knowing they are doing it called automatism like lip-smacking, rubbing the hands together etc.

Generalized seizure types

petit mal/abscence (staring) myoclonic (shaking) tonic clonic/grand mal tonic (stiff) atonic (drop) status epilepticus (>5min, recurring, life threatening) *a seizure that affects both sides of the brain

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? 1.Warm the client. 2.Maintain a patent airway. 3.Administer thyroid hormone. 4.Administer fluid replacement.

2. Maintain a patent airway. Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.

A client with hyperthyroidism is being treated with propylthiouracil (PTU). What instruction should the nurse plan to include in the teaching plan regarding this drug? Select all that apply. A. "Avoid abrupt discontinuation of the medication." B. "Monitor your weight, pulse, and mood routinely." C. "You can expect an immediate response to this medication." D. "Also take an iodine replacement to aid metabolism of the drug." E. "Report side effects, such as sore throat, fever, joint pain, or oral lesions."

A. "Avoid abrupt discontinuation of the medication." B. "Monitor your weight, pulse, and mood routinely." E. "Report side effects, such as sore throat, fever, joint pain, or oral lesions." Abrupt discontinuation of the medication may result in thyroid crisis. PTU blocks the synthesis of T 3 (triiodothyronine) and T 4 (thyroxine) by preventing iodination of tyrosine. The therapeutic effect of the drug should result in increased weight, decreased pulse, and stability of mood. Sore throat, joint pain, fever, or oral lesions may indicate infection caused by drug-induced blood dyscrasias, such as leukopenia and agranulocytosis. The response to this drug may take up to 3 weeks. Over-the-counter medications and seafood containing iodine should be avoided.

You're assessing a patient who recently experienced a focal type seizure (partial seizure). As the nurse, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure? A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." B. "I remember having vision changes, but it didn't last long." C. "I woke up on the floor with my mouth bleeding." D. "After the seizure I was very sleepy, and I had a headache for several hours."

A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." The patient will experience an alternation in consciousness (hence the name focal IMPAIRED awareness) AND will perform an action without knowing they are doing it called automatism like lip-smacking, rubbing the hands together etc. With a focal onset AWARE seizure (also called partial simple seizure) the patient is aware and will remember what happens (like vision changes etc.).

(powerpoints) A patient is telling you that they once took an abx that caused them to have C-diff. They can't remember which abx though. In their med history, you see thesis abx below. Which of these abx is the most likely to cause C-diff A. Clindamycin B. Bactrim C. Azithromycin D. Flagyl

A. Clindamycin Clindamycin is more likely to cause c-diff than the other antibiotics listed here. Flagyl is actually used to treat clostridium difficile aka c-diff. Vancomycin is first line of treatment for c.diff (MOST BE PO OR RECTAL ...IV wont work for C.diff)

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? Select all that apply. A. Diarrhea B. Listlessness C. Weight loss D. Bradycardia E. Decreased appetite

A. Diarrhea C. Weight loss Excessive thyroid hormones increase the metabolic rate, causing an increase in intestinal peristalsis. Excessive thyroid hormones increase the metabolic rate, causing weight loss. Listlessness occurs with hypothyroidism because of a decreased metabolic rate. A slow pulse rate accompanies hypothyroidism, not hyperthyroidism, because of a decreased metabolic rate. Appetite increases (polyphagia) with hyperthyroidism in an effort to meet metabolic needs.

The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? Select all that apply. A. Emotional lability B. Dyspnea on exertion C. Abdominal distention D. Decreased bowel sounds E. Hyperactive deep tendon reflexes

A. Emotional lability B. Dyspnea on exertion E. Hyperactive deep tendon reflexes Lability of mood is a psychological/emotional manifestation related to excess thyroid hormones. Dyspnea with or without exertion can occur as the body attempts to meet oxygen demands related to the increased metabolic rate associated with hyperthyroidism. Hyperactive reflexes are a neurologic manifestation related to excessive production of thyroid hormones. Bowel sounds increase, not decrease, as a result of hyperperistalsis associated with the elevated metabolic rate. Abdominal distention is associated with hypothyroidism; it is related to constipation and weight gain. Hypoactive bowel sounds are related to hypothyroidism.

(Nurse Sarah)A patient with Cushing's syndrome will be undergoing an adrenalectomy. Which of the following will be included in the patient's discharge teaching after the procedure? A. Glucocorticoid replacement therapy B. Avoiding avocados and pears C. Declomycin therapy D. Signs and symptoms of Grave's Disease

A. Glucocorticoid replacement therapy

nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? Select all that apply. A. Hirsutism B. Menorrhagia C. Buffalo hump D. Dependent edema E Migraine headaches

A. Hirsutism C. Buffalo hump Excessive hairiness, especially a male pattern of hair distribution on a woman (hirsutism), occurs with Cushing syndrome because of an androgen excess. Cushing syndrome results from excess adrenocortical activity. Hypercortisolism causes fat redistribution, resulting in "buffalo hump"; it also contributes to slow wound healing, hirsutism, weight gain, hypertension, acne, thin arms and legs, and behavioral changes. Menorrhagia (excessive menstrual bleeding) does not occur; menses may cease or be scanty because of virilization. Edema does not occur except when severe heart failure is present. Headaches do not occur with this syndrome.

A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? Select all that apply. A. Hirsutism B. Menorrhagia C. Buffalo hump D. Dependent edema E. Migraine headaches

A. Hirsutism (excessive hair growth) C. Buffalo hump

(Nurse Sarah)Which of the following is not a typical sign and symptom of Cushing's Syndrome?* A. Hyperpigmentation of the skin B. Hirsutism C. Purplish striae D. Moon Face

A. Hyperpigmentation of the skin

A nurse is caring for a client after a thyroidectomy. For which signs of thyroid storm should the client be monitored? Select all that apply. A. Increased heart rate B. Increased temperature C. Decreased respirations D. Increased pulse deficit E. Decreased blood pressure

A. Increased heart rate B. Increased temperature respiratory rate increases (tachypnea) to meet the body's oxygen needs.blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during thyroid storm.

Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? Select all that apply. A. Lability of mood B. Slow wound healing C. A decrease in the growth of hair D. Ectomorphism with a moon face E. An increased resistance to bruising

A. Lability of mood B. Slow wound healing Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Hypercortisolism impairs the inflammatory response, slowing wound healing. Increased secretion of androgens results in hirsutism. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically determined body type and is unrelated to Cushing syndrome. There is increased bruising because capillary fragility results in multiple ecchymotic areas

(Custom adaptive) Which clinical manifestation is associated with cellulitis? A. Lymphadenopathy B. Occasional papules C. Vesicles that evolve into pustules D. Isolated erythematous pustules

A. Lymphadenopathy Cellulitis is accompanied by lymphadenopathy. Occasional papules are present in folliculitis. Herpes simplex viral infections evolve the vesicles into pustules. Isolated erythematous pustules occur in folliculitis bacterial infections.

(powerpoints) The skin is the largest organ of the body and manages which several functions critical for life: (select all that apply) A. Manages temperature B. Control basal metabolic rate C. Conservations of fluids D. Protection from infection

A. Manages temperature C. Conservations of fluids D. Protection from infection

(Adaptive quiz) What is the role of a Licensed Practical Nurse (LPN) while caring for the client with a cast or traction? Select all that apply. A. Monitoring skin integrity around the cast B. Marking circumference of any drainage on the cast C. Teaching the client and caregiver range-of-motion (ROM) exercises D. Performing neurovascular assessments on the affected extremity E. Checking color, temperature, capillary refill, and pulses distal to the cast

A. Monitoring skin integrity around the cast B. Marking circumference of any drainage on the cast E. Checking color, temperature, capillary refill, and pulses distal to the cast The role of a Licensed Practical Nurse (LPN) while caring for the client with a cast or traction is monitoring skin integrity around the cast, marking circumference of any drainage on the cast, and checking color, temperature, capillary refill, and pulses distal to the cast. The role of the Registered Nurse (RN) while caring for the client with a cast or traction is teaching the client and caregiver range-of-motion (ROM) exercises and performing neurovascular assessments on the affected extremity.

While in the playroom a school-aged child exhibits twitching of the right arm and leg that almost immediately progresses to a generalized tonic-clonic seizure with clenched jaws. What is the best action for the nurse to take after moving the child to the floor? A. Moving objects away from the child B. Taking the other children to their rooms C. Inserting a plastic airway into the child's mouth D. Positioning a large pillow under the child's head

A. Moving objects away from the child Safety is the priority during the seizure and objects should be moved away from the child. It is unsafe to leave the child during the seizure to take other children to their rooms. Attempting to open clenched jaws may result in injury to the child's teeth and jaw. Positioning a large pillow under the child's head may cause airway occlusion by forcing the neck onto the chin; a small, flat blanket will be more effective.

(powerpoints) Insulin lowering blood glucose when levels are high; glucagon raising blood glucose when levels are low is example of: A. Negative feedback B. Positive feedback C. Biological rhythms D. Central nervous system

A. Negative feedback Negative feedback: A process that creates a counteractive response (balance)

You have a patient who has a brain tumor and is at risk for seizures. In the patient's plan of care you incorporate seizure precautions. Select below all the proper steps to take in initiating seizure precautions: A. Oxygen and suction at bedside B. Bed in highest position C. Remove all pillows from the patient's head D. Have restraints on stand-by E. Padded bed rails F. Remove restrictive objects or clothing from patient's body G. IV access

A. Oxygen and suction at bedside E. Padded bed rails F. Remove restrictive objects or clothing from patient's body G. IV access The answers are A, E, F, and G. The bed needs to be in the LOWEST position possible, a pillow should be underneath the patient's head to protect it from injury, AVOID using restraints (this can cause musculoskeletal damage).

( Kahoot) What nutrient is most important in tissue regeneration A. Protein B. Fat C. Carbohydrate D. Fiber

A. Protein

A nurse is assessing a client admitted to the hospital with a tentative diagnosis of a pituitary tumor. What signs of Cushing syndrome does the nurse identify? A. Retention of sodium and water B. Hypotension and a rapid, thready pulse C. Increased fatty deposition in the extremities D. Hypoglycemic episodes in the early morning

A. Retention of sodium and water Increased levels of steroids and aldosterone cause sodium and water retention in clients with Cushing syndrome. Hypertension, not hypotension, is expected because of sodium and water retention. The extremities will be thin; subcutaneous fat deposits occur in the upper trunk, especially the back between the scapulae. Hyperglycemia, not hypoglycemia, occurs because of increased secretion of glucocorticoids. Hyperglycemia is sustained and not restricted to the morning hours.

A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply. A. Tremors B. Bradycardia C. Somnolence D. Heat intolerance E. Decreased blood pressure

A. Tremors D. Heat intolerance all others are sign of hypothyroidism

A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? Select all that apply. A. Use tinted glasses. B. Use warm, moist compresses. C. Elevate the head of the bed 45 degrees. D. Tape eyelids shut at night if they do not close. E. Apply a petroleum-based jelly along the lower eyelid.

A. Use tinted glasses. C. Elevate the head of the bed 45 degrees. D. Tape eyelids shut at night if they do not close. Tinted glasses decrease light impacting on the eyes and protect eyes that are photosensitive. Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears are used to moisten the eyes, not a petroleum-based jelly

A client has a new diagnosis of hyperthyroidism. Which skin conditions should the nurse expect when performing a physical assessment? Select all that apply A. Warm B. Moist C. Pale D. Smooth E. Coarse F. Dry

A. Warm B. Moist D. Smooth Hyperfunction of the thyroid gland causes diaphoresis, which makes the skin moist. Hyperthyroidism also causes smooth and warm skin. Pale, coarse, and dry skin is found with hypothyroidism.

Which of the following patients presents the most significant risk factors for the development of Clostridium difficile infection? a) A 44-year-old patient who is paralyzed and whose coccyx ulcer has required a skin graft b) A patient with renal failure who receives hemodialysis three times weekly c) A 30-year-old patient who has recently contracted human immunodeficiency virus after engaging in high-risk sexual behavior d) An 81-year-old patient who has been receiving multiple antibiotics for the treatment of sepsis

Answer: d Old age and recent, long-term antibiotic therapy are significant risk factors for C. difficile infection. These supersede the risks posed by recent HIV infection, skin grafts, and hemodialysis.

(medsurg) Which diet would be recommended for a patient with hyperthyroidism? A. Highly seasoned and high-fiber foods B. A high-calorie diet (4000 to 5000 cal/day) C. Caffeine-containing liquids such as coffee, tea, and cola D. Low carbohydrate diet to compensate for decreased metabolism

B. A high-calorie diet (4000 to 5000 cal/day) A high-calorie diet (4000 to 5000 cal/day) Snacks high in protein, carbohydrates, minerals, and vitamins Protein content should be 1 to 2 g/kg of ideal body weight. Increase carbohydrate intake to compensate for increased metabolism. Avoid highly seasoned and high-fiber foods because these foods can further stimulate the already hyperactive GI tract. Avoid caffeine-containing liquids such as coffee, tea, and cola to decrease the restlessness and sleep disturbances associated with these fluids.

(med surg) Which of the following are a nursing diagnosis for hyperthyroidism (select all that apply) A. Risk for excess fluid volume related to retention of sodium and water due to excessive cortisol and aldosterone B. Activity intolerance related to fatigue and heat intolerance C. Risk of injury related to LOC during seizure activity D. Imbalanced nutrition: less than body requirements related to hypermetabolism and inadequate food intake

B. Activity intolerance related to fatigue and heat intolerance D. Imbalanced nutrition: less than body requirements related to hypermetabolism and inadequate food intake

(Nclex book) Which of the following interventions would be most helpful in managing a patient newly admitted with cellulitis of the right foot? A. Limiting ambulation to 3 times daily B. Applying warm moist heat C. Keeping the foot at or below heart level D. Wrapping the foot snugly in warm blankets

B. Applying warm moist heat The applications of warm moist heat speed the resolution of the inflammation and infection when accompanied by appropriate antibiotic therapy. It does this by increasing local circulation to the affected area to bring macrophages to the area and carry off cellular debris

(Medsurg) Which drug is the preferred β-adrenergic blocker for use in the hyperthyroid patient with asthma or heart disease? A. Inderal (propranolol) B. Atenolol C. Propylthiouracil D. Methimazole

B. Atenolol Atenolol is the preferred β-adrenergic blocker for use in the hyperthyroid patient with asthma or heart disease.

Which physiological responses should a nurse expect when assessing a client with hyperthyroidism? Select all that apply. A.Bradycardia B. Blurred vision C. Cold intolerance D. Increased appetite E. Widened pulse pressure

B. Blurred vision D. Increased appetite E. Widened pulse pressure Blurred vision may occur as a result of exophthalmos. The appetite increases in an attempt to meet the caloric needs of the body. As the systolic pressure increases, it causes a widened pulse pressure (the difference between the systolic and diastolic blood pressures). Tachycardia, not bradycardia, occurs because of the increased metabolic rate. Intolerance to heat, not cold, occurs because of the increased metabolic rate.

A client who had a tonic-clonic seizure of unknown etiology is to begin taking phenytoin. What instructions will the nurse give to the client? A. Take the medication on an empty stomach. B. Brush the teeth and gums three times daily. C. Stop taking the drug if abdominal pain occurs. D. Note any change in pulse and respiratory rates.

B. Brush the teeth and gums three times daily. Adequate dental hygiene is essential to control or prevent the common side effect of hypertrophy of the gums. The medication should be taken with food to decrease gastrointestinal side effects. The healthcare provider should be consulted before the drug is discontinued or the dosage is adjusted; usually in this situation, a gradual dosage reduction is prescribed. Changes in pulse and respiratory rates are unrelated to phenytoin therapy.

After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client's adaptations? A. Potassium iodide B. Calcium gluconate C. Magnesium sulfate D.Potassium chloride

B. Calcium gluconate The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia

(Med surg) Select the nursing diagnosis which are approbate for C-diff. (select all that apply) A. Ineffective breathing pattern r/t neuromuscular impairment B. Diarrhea r/t acute infectious process C. Deficient fluid volume r/t excessive fluid loss and decreased fluid intake D. Risk of injury r/t to LOC during seizure activity

B. Diarrhea r/t acute infectious process C. Deficient fluid volume r/t excessive fluid loss and decreased fluid intake

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? A.Urine output B. Glucose level C. Serum potassium D. Immune response

B. Glucose level Increased gluconeogenesis may lead to hyperglycemia and glycosuria, which can produce urinary frequency; protein catabolism will cause muscle weakness. As sodium ions are retained, potassium is excreted; the result is hypokalemia. Edema occurs because of sodium retention. Hypotension and sodium loss are signs of Addison syndrome; in Cushing syndrome retention of sodium and fluids leads to hypervolemia and hypertension. Muscle wasting results from increased protein catabolism; however, hyperglycemia rather than hypoglycemia will result from increased gluconeogenesis.

( nurse sarah) You're patient is scheduled for an EEG (electroencephalogram). As the nurse you will: A. Keep the patient nothing by mouth. B. Hold seizure medications until after the test. C. Allow the patient to have coffee, milk, and juice only. D. Wash the patient's hair prior to the test. E. Administer a sedative prior to the test.

B. Hold seizure medications until after the test. D. Wash the patient's hair prior to the test. An EEG is a painless procedure that will assess the patient's brain activity (if a seizure occurs during the test this can allow the physician to determine what type of seizure it is). Therefore, the nurse would hold seizure medications (this can affect the test) and would NOT allow the patient to have caffeine like coffee or stimulant drugs (the patient can eat prior to the test just NO caffeine). The patient's hair should be cleaned prior to the test so the technician can apply the electrodes and get them to stick to the scalp easily. A sedative is not needed before this test

A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiologic responses? A. Pituitary hypoplasia B. Hyperplasia of the adrenal cortex C. Deprivation of adrenocortical hormones D. Insufficient adrenocorticotropic hormone (ACTH) production

B. Hyperplasia of the adrenal cortex Hyperplasia of the adrenal cortex leads to increased secretion of cortical hormones, which causes signs of Cushing syndrome. Pituitary hypoplasia is a malfunction of the pituitary that will result in Simmonds disease (panhypopituitarism), which has clinical manifestations similar to those for Addison disease. Cushing syndrome results from excessive cortical hormones. ACTH stimulates production of adrenal hormones. Inadequate ACTH will result in Addisonian signs and symptoms.

A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will? A. Assess the patient for a rash B. Initiate seizure precautions C. Hold the next dose of Phenytoin D. Continue to monitor the patient

B. Initiate seizure precautions A normal Phenytoin level is 10 to 20 mcg/mL. The patient's level is low; therefore, the patient is at risk for seizures. The nurse should initiate seizure precautions. Remember a patient being under medicated is a trigger for developing a seizure.

A client with newly diagnosed hyperthyroidism is treated with propylthiouracil, an antithyroid drug, along with potassium iodide. What should the nurse take into consideration when caring for the client? A. Iodide solutions must be diluted in water and taken on an empty stomach. B. Monitoring for signs of infection or bleeding is necessary. C. Postoperative hemorrhage is a common complication if these drugs are used before a thyroidectomy. D. These drugs will be discontinued as soon as the temperature and pulse rate return to the expected range.

B. Monitoring for signs of infection or bleeding is necessary. Propylthiouracil can cause depression of leukocytes and platelets. Propylthiouracil and potassium iodide should be given with juice or food to prevent gastric irritation. Drug therapy decreases the risk of postoperative hemorrhage because this drug regimen decreases the size and vascularity of the thyroid gland. Drug therapy is continued for at least 6 to 8 weeks, even if the client's temperature and pulse return to the expected range.

nurse is caring for a client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? Select all that apply. A. Polyuria B. Obese trunk C. Hypotension D. Sleep disturbance E. Thin arms and legs

B. Obese trunk D. Sleep disturbance E. Thin arms and legs Truncal obesity is a key feature of Cushing syndrome. Sleep disturbance is caused by the altered diurnal secretion of cortisol. Thin arms and legs are caused by protein catabolism, which causes muscle wasting. Polyuria is associated with diabetes mellitus and primary aldosteronism, not Cushing syndrome. Obesity is caused by the overproduction of adrenal cortisol hormone associated with Cushing syndrome. Hypertension, not hypotension, is associated with Cushing syndrome because of sodium and water retention.

(powerpoints)The health care provider prescribes propylthiouracil (PTU) for a client with the diagnosis of Graves' disease. What should the nurse teach the client when discussing the self-administration of this medication? A. Increase sources of calcium B. Observe for signs of infection C. Take the drug through a straw D. Wear sunglasses when exposed to sunlight

B. Observe for signs of infection Agranulocytosis is a rare but serious complication of thyroid hormone antagonist medications → body is defenseless against bacteria and infection.. monitor signs of infection such as fever, mouth ulcers, pharyngitis

(Nurse Sarah)In Cushing's disease, the _______ is secreting too much ACTH (Adrenocorticotropic hormone) which is causing an increase in cortisol production. A. Adrenal cortex B. Pituitary gland C. Thyroid gland D. Hypothalamus

B. Pituitary gland

A child sitting on a chair in a playroom starts to have a tonic-clonic seizure with a clenched jaw. What is the best initial action by the nurse? A. Trying to open the jaw B. Placing the child on the floor C. Calling out for assistance from staff D. Placing a pillow under the child's head

B. Placing the child on the floor Placing the child on the floor limits the danger of falling and striking the head. Attempting to open the jaw is unsafe; it may result in injury. Protecting the child is the priority; assistance at this time is futile. Placing a pillow under the child's head may cause airway occlusion by forcing the chin onto the neck.

A client with hyperthyroidism asks the nurse about the tests that will be prescribed. Which diagnostic tests should the nurse include in a discussion with this client? A. Thyroxine (T 4) and x-ray films B. Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T 3) C. Thyroglobulin level and PO 2 D. Protein-bound iodine and sequential multichannel autoanalyzer (SMA)

B. Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T 3) A decreased TSH assay together with an elevated T 3 level may indicate hyperthyroidism. X-ray results will not indicate thyroid disease, and elevation of T 4 level might indicate hyperthyroidism. However, this may be a false reading because of the presence of thyroid-binding globulin (TBG) and is inadequate for diagnosis when used alone. PO 2 is not specific to thyroid disease, and the thyroglobulin level is most useful to monitor for recurrence of thyroid carcinoma or response to therapy. The results with the SMA are not specific to thyroid disease; the protein-bound iodine test is not definitive because it is influenced by the intake of exogenous iodine.

Your providing care to a patient with C. Diff. After removing the appropriate PPE, you would perform hand hygiene by: A. Using hand sanitizer B. Using soap and water C. Using soap and water only if hands are soiled but can use hand sanitizer D. Using either hand sanitizer or soap and water

B. Using soap and water Contact precautions: gloves and gown, wash hands, disposable equipment

Leukemia

Blood condition of white cells; malignant (cancerous) condition. systemic altered inflammatory response in impaired wound healing

A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus? A. Cortical hormones stimulate rapid weight loss. B. Tissue catabolism results in a negative nitrogen balance. C. Glucocorticoids accelerate the process of gluconeogenesis. D. Excessive adrenocorticotropic hormone (ACTH) secretion damages pancreatic tissue.

C) Glucocorticoids accelerate the process of gluconeogenesis. Excess glucocorticoids cause hyperglycemia, and signs of diabetes mellitus may develop ACTH, which causes sodium retention and subsequent weight gain. Although muscle wasting is associated with excessive corticoid production, this will not cause diabetes mellitus. ACTH affects the adrenal cortex, not the pancreas.

For which client response should the nurse monitor when assessing for complications of hyperparathyroidism? A. Tetany B. Seizures C. Bone pain D. Graves disease

C. Bone pain Hyperparathyroidism causes calcium release from the bones, leaving them porous, weak, and painful Tetany is associated with HYPOcalcemia

( Kahoot) What does a red streak running from a wound towards the body core mean? A. Fungal super-infection B. Secondary bacterial infection C. Cellulitis D. A scratch from itching at the site

C. Cellulitis

Which treatment intervention should be provided to a client diagnosed with Cushing's disease? A. Increase cortisol levels B. Increase sodium levels C. Decrease blood glucose levels D. Decrease serum calcium levels

C. Decrease blood glucose levels Cushing's disease affects the glucose metabolism and results in reduced glucose uptake by tissues and increased blood glucose levels; therefore interventions to regulate blood glucose levels should be undertaken. Hypersecretion of cortisol causes Cushing's disease; therefore interventions should be aimed at decreasing the cortisol levels. Sodium levels are elevated in hypercortisolism; therefore interventions to decrease these levels should be initiated. Measures to increase the low serum calcium levels in Cushing's disease will be beneficial to the client.

(power points) Which labs are you likely to see on a patient who has hyperthyroidism (select all that apply) A. Increased TSH B. Decreased T4/T3 C. Decreased TSH D. Increased T4/T3 E. Increased BMR (basal metabolic rate)

C. Decreased TSH D. Increased T4/3 E. Increased BMR (basal metabolic rate) (TSH is low meaning its not working very hard but for some reason its signaling the thyroid to be overactive and produce alot of T4/T3)...Note: TSI thyroid stimulating immunoglobulin) will be elevated in Graves since the immune system is attacking the thyroid

Which neurologic manifestation in a client is associated with hyperthyroidism? A. Confusion B. Hearing loss C. Exophthalmos D. Slowness of speech

C. Exophthalmos In hyperthyroidism, edema in the extraocular muscles and increased fatty tissue behind the eye leads to exophthalmos. Confusion, hearing loss, and slowness of speech are caused by hypothyroidism.

(nurse sarah) An 8-year-old child, who is not responding to anti-seizure medications, is prescribed to start a ketogenic diet. This diet will include: A. High carbohydrates and high fat B. Low fat, high salt, and high carbohydrates C. High fat and low carbohydrates D. High glucose, high fat, and low carbohydrates

C. High fat and low carbohydrates The answer is C. This is a type of diet used in the pediatric population with epilepsy whose seizures cannot be controlled by medication. It is a high fat and low carb diet.

(Power points) A patient with Cushing's is about to undergo a adrenalectomy. What should the nurse anticipate post surgery? A. Hypertension B. Fat deposits on neck C. Hypotension D. Hyperglycemia

C. Hypotension ( this due to loss of aldosterone) The others are s/sx that are consistent with Cushing's

The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. The nurse explains that this drug: A. Increases the uptake of iodine B. Causes the thyroid gland to atrophy C. Interferes with the synthesis of thyroid hormone D. Decreases the secretion of thyroid-stimulating hormone (TSH)

C. Interferes with the synthesis of thyroid hormone PTU, used in the treatment of hyperthyroidism, blocks the synthesis of thyroid hormones by preventing iodination of tyrosine

The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. The nurse explains that this drug: A. Increases the uptake of iodine B. Causes the thyroid gland to atrophy C. Interferes with the synthesis of thyroid hormone D.Decreases the secretion of thyroid-stimulating hormone (TSH)

C. Interferes with the synthesis of thyroid hormone Propylthiouracil is a thyroid hormone antagonist that inhibits thyroid hormone synthesis by decreasing the use of iodine in the manufacture of these hormones. PTU does not affect the vascularity of the thyroid gland. Iodine-containing agents are given for severe hyperthyroidism and before a thyroidectomy. PTU does not affect the amount of already formed thyroid hormones.

Your patient has a history of epilepsy. While helping the patient to the restroom, the patient reports having this feeling of déjà vu and seeing spots in their visual field. Your next nursing action is to? A. Continue assisting the patient to the restroom and let them sit down. B. Initiate the emergency response system. C. Lay the patient down on their side with a pillow underneath the head. D. Assess the patient's medication history.

C. Lay the patient down on their side with a pillow underneath the head. The patient is reporting signs and symptoms of an aura (this is a warning sign before a seizure event). Lay the patient down on their side with a pillow underneath the head and remove any restrictive clothing. Also, time the seizure. If the seizure lasts more than 5 minutes or if the patient starts to have seizures back-to-back activate the emergency response system

(Medsurg) Which organism is Known for causing a rash and/or petechiae in bacterial meningitis? A. Streptococcus pneumoniae B.Neisseria meningitidis C. Meningococcus D. Enterovirus

C. Meningococcus If the infecting organism is a meningococcus, a skin rash is common, and petechiae may be seen on the trunk, lower extremities, and mucous membranes. A Tumbler test can be done by pressing the base of a drinking glass against the rash. The rash does not blanch or fade under pressure.

A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action? A.Have the client assessed for an enlarged prostate. B. Obtain a urine specimen from the client to test for ketonuria. C. Perform a finger stick to test the client's blood glucose level. D. Assess the client's lower extremities for the presence of pitting edema.

C. Perform a finger stick to test the client's blood glucose level.

(Custom adaptive) A registered nurse is evaluating a new nurse who is preparing to administer intravenous fluids to a client. Which action made by the new nurse indicates the registered nurse needs to intervene? A. Washing hands with antibacterial soap B. Using chlorhexidine at the site of insertion C. Shaving the client's skin at the insertion site D. Applying skin protectant solutions at the site of insertion

C. Shaving the client's skin at the insertion site Shaving the area of injection leads to microabrasions, which can result in infections and needs to be corrected. Clipping the hair is the correct procedure. The new nurse should wash his or her hands with antibacterial soap before performing venipuncture to maintain an antiseptic environment. Chlorhexidine, a skin disinfectant, may be used at the insertion site to prevent infection and sepsis. A skin protectant solutions may be used to protect the skin and dressing and to improve the adherence of the dressing to the skin.

Your patient has entered the post ictus stage for seizures. The patient's seizure presented with an aura followed by body stiffening and then recurrent jerking. The patient had incontinence and bleeding in the mouth from injury to the tongue. What is an expected finding in this stage based on the type of seizure this patient experienced? A. Crying and anxiety B. Immediate return to baseline behavior C. Sleepy, headache, and soreness D. Unconsciousness

C. Sleepy, headache, and soreness Based on the findings during the seizure the patient experienced a tonic-clonic seizure. In the post ictus stage (after the seizure) the patient is expected to be sleepy (very tired), have soreness, and a headache. The nurse should let the patient sleep.

A nurse is caring for a school-aged child who has had a tonic-clonic seizure. How should the nurse describe the clonic phase? A. Generalized rigidity B. Loss of consciousness C. Spasmodic body jerking D. Tremors of upper extremities

C. Spasmodic body jerking

(Powerpoints) If a patient develops Cushing's syndrome due to steroid use all of the following may happen EXECPT: A. Gradual discontinuation of steroid use B. Reduction of steroid dose C. Stop steroid use right away D. Conversion to alternate day regimen

C. Stop steroid use right away ALWAYS slowly discontinuation of steroids

Neutropenic precautions

Children with leukemia most often die of infection; a low neutrophil count is associated with myelosuppressant therapy. Placing the child in a private room, restricting ill visitors, and using strict hand washing techniques are the best ways to minimize complications. Encouraging a well-balanced diet, including iron-rich foods, and helping the child avoid overexertion are not appropriate measures to prevent infection resulting from neutropenia; they are appropriate for treating the anemia. Avoiding rectal temperatures, limiting injections, and applying direct pressure for 5 minutes after venipuncture are not appropriate measures to prevent infection resulting from neutropenia; they are more appropriate for preventing bleeding. Offering a moist, bland, soft diet; using toothettes rather than a toothbrush; and providing frequent saline mouthwashes are not appropriate measures to prevent infection resulting from neutropenia; they are used to ease and treat stomatitis.

(med surg) To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to: a. increase calcium intake to 1500 mg/day. b. perform glucose monitoring for hypoglycemia. c. obtain immunizations due to high risk of infections. d. avoid abrupt position changes because of orthostatic hypotension.

Correct answer: a Rationale: Because patients often receive corticosteroid treatment for prolonged periods (more than 3 months), corticosteroid-induced osteoporosis is an important concern. Therapies to reduce the resorption of bone may include increased calcium intake, vitamin D supplementation, bisphosphonates (e.g., alendronate [Fosamax]), and institution of a low-impact exercise program. Corticosteroids used in greater than physiologic doses also may reduce the immune response to vaccines. Physicians should wait at least 3 months after discontinuation of therapy before administering a live-virus vaccine to patients who have received high-dose, systemic steroids for greater than or equal to 2 weeks.

(Medsurg) The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is.. a. once a day at bedtime. b. every other day on awakening. c. on arising and in the late afternoon. d. at consistent intervals every 6 to 8 hours.

Correct answer: c Rationale: As replacement therapy, glucocorticoids are usually administered in divided doses: two thirds in the morning and one third in the afternoon. This dosage schedule reflects normal circadian rhythm in endogenous hormone secretion and decreases the side effects associated with corticosteroid replacement therapy.

(med surg) After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops a. muscle weakness and weight loss. b. hyperthermia and severe tachycardia. c. hypertension and difficulty swallowing d. laryngospasms and tingling in the hands and feet

Correct answer: d Rationale: Painful tonic spasms of smooth and skeletal muscles can cause laryngospasms that may compromise breathing. These spasms may be related to tetany, which occurs if the parathyroid glands are removed or damaged during surgery, which leads to hypocalcemia.

Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply) a. restricting protein intake b. monitoring blood glucose levels. c. observing for signs of hypotension. d. administering medication in equal doses. e. protecting patient from exposure to infection.

Correct answers: b,e Rationale: Hyperglycemia occurs with Cushing's disease because of glucose intolerance (associated with cortisol-induced insulin resistance) and increased gluconeogenesis by the liver. High levels of corticosteroids increase susceptibility to infection and delay wound healing.

Glucocorticoids

Cortisol and Cortisone are types of these hormones, produced in the Adrenal cortex, which increase blood glucose levels through stimulation of gluconeogenesis and the decrease of protein synthesis. They also reduce the body's immunological and inflammatory responses.

A 7-year-old male patient is being evaluated for seizures. While in the child's room talking with the child's parents, you notice that the child appears to be daydreaming. You time this event to be 10 seconds. After 10 seconds, the child appropriately responds and doesn't recall the event. This is known as what type of seizure? A. Focal Impaired Awareness (complex partial) B. Atonic C. Tonic-clonic D. Absence

D. Absence This is an absence seizure and is most common in children. The hallmark of it is staring that appears to be like a daydreaming state. It is very short and the post ictus stage of this type of seizure is immediate.

( Kahoot) What is the strongest defense against infection ? A. tissue integrity B. strong immune system C. adequate nutrition D. All of the above

D. All of the above

(adaptive quiz) The urinalysis results of a female client shows the 17-ketosteroids value as 25 mg/24 hr. Which condition should the nurse monitor for in this client? A. Addison disease B. Ovarian neoplasms C. Ovarian dysfunction D. Cushing syndrome

D. Cushing syndrome Urinary steroids such as 17-ketosteroids range from 6 to 17 mg/24 hr in females. Higher levels may indicate possible Cushing syndrome, increased androgen or cortisol production, and severe stress. Decreased levels of 17-ketosteroids indicate possible Addison disease and hypopituitarism. Decreased levels of total urinary estrogen indicate possible ovarian dysfunction. Elevations of urinary pregnanediol indicate possible luteal ovarian cysts, ovarian neoplasms, and adrenal disorders.

A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. The nurse concludes that this medication is given to: A. Decrease the total basal metabolic rate B. Maintain the function of the parathyroids C. Block the formation of thyroxine by the thyroid gland D. Decrease the size and vascularity of the thyroid gland

D. Decrease the size and vascularity of the thyroid gland Potassium iodide aids in decreasing the vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed; it should be given no longer than 10 to 14 days before surgery because its effect is temporary

Client is admitted to the hospital with the diagnosis of cancer of the thyroid, and a thyroidectomy is scheduled. What is important for the nurse to consider when caring for this client during the postoperative period? A. Hypercalcemia may result from parathyroid damage. B. Hypotension and bradycardia may result from thyroid storm. C. Tetany may result from underdosage of thyroid hormone replacement. D. Hoarseness and airway obstruction may result from laryngeal nerve damage.

D. Hoarseness and airway obstruction may result from laryngeal nerve damage. Laryngeal nerve injury can cause laryngeal spasms, resulting in airway obstruction. Parathyroid damage results in hypocalcemia, not hypercalcemia. Thyroid storm (thyroid crisis) is characterized by the release of excessive levels of thyroid hormone, which increases the metabolic rate. An increase in the metabolic rate increases vital signs, resulting in hypertension, not hypotension, and tachycardia, not bradycardia. Tetany is caused by a decrease in parathormone, a parathyroid hormone, not a thyroid hormone.

A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. What response should the nurse assess this client for? A. Hypovolemia B. Hyperkalemia C. Hypoglycemia D. Hypernatremia

D. Hypernatremia A client with Cushing syndrome secretes excess amounts of cortisol, a corticosteroid that acts to retain sodium and water, resulting in hypernatremia and edema. Hypervolemia, not hypovolemia, is caused by fluid retention. Hypokalemia, not hyperkalemia, occurs because potassium is lost when there is sodium retention. Hyperglycemia, not hypoglycemia, results from cortisol-induced glucose intolerance.

A client with diabetes who is receiving long-term corticosteroid therapy is admitted to the hospital with leg ulcers. What increased risk does the nurse consider when assessing this client? A. Weight loss B. Hypoglycemia C. Decreased blood pressure D. Inadequate wound healing

D. Inadequate wound healing Because the antiinflammatory response is depressed as a result of increased cortisol levels, the wounds of clients receiving long-term corticosteroid therapy tend to heal slowly. A common finding associated with long-term corticosteroid use is weight gain, caused not only by fluid retention but also by alterations in fat, carbohydrate, and protein metabolism. Persistent hyperglycemia (steroid diabetes) occurs because of altered glucose metabolism. Hypertension, not hypotension, occurs as a result of sodium and fluid retention.

A client is admitted to the hospital with a diagnosis of Cushing syndrome. What signs and symptoms will the client most likely exhibit? A. Hyperkalemia and edema B. Hypotension and sodium loss C. Muscle wasting and hypoglycemia D. Muscle weakness and frequent urination

D. Muscle weakness and frequent urination Increased gluconeogenesis may lead to hyperglycemia and glycosuria, which can produce urinary frequency; protein catabolism will cause muscle weakness. As sodium ions are retained, potassium is excreted; the result is hypokalemia. Edema occurs because of sodium retention. Hypotension and sodium loss are signs of Addison syndrome; in Cushing syndrome retention of sodium and fluids leads to hypervolemia and hypertension. Muscle wasting results from increased protein catabolism; however, hyperglycemia rather than hypoglycemia will result from increased gluconeogenesis.

Rigid flexion with the arms held tightly to the body; flexed elbows, wrists, and fingers; plantar flexed feet; legs extended and internally rotated; and possibly the presence of fine tremors or intense stiffness. This is known as decerebrate true or false ?

FALSE Decorticate or flexion posturing is seen with severe dysfunction of the cerebral cortex or lesions to corticospinal tracts above the brainstem. Typical posturing includes rigid flexion with the arms held tightly to the body; flexed elbows, wrists, and fingers; plantar flexed feet; legs extended and internally rotated; and possibly the presence of fine tremors or intense stiffness. Decerebrate posture or extension posturing is a sign of dysfunction at the level of the midbrain or lesions to the brainstem. It is characterized by rigid extension and pronation of the arms and legs, flexed wrists and fingers, a clenched jaw, an extended neck, and possibly an arched back. Unilateral decerebrate posture is often caused by tentorial herniation.

True or False: A patient who is experiencing a tonic-clonic seizure is experiencing a focal (partial) seizure

FALSE: A patient who is experiencing a tonic-clonic seizure is experiencing a GENERALIZED seizure. This type of seizure affects both sides of the brain.

Which antiepileptic drug is used as the first-line treatment for absence seizures?

FIRST LINE: Absence (Petit Mal) 1. Ethosuximide 2. Valproate 3. Zarontin 4. Divalproex 5. Klonopin

You're assessing your patient load for the patients who are at MOST risk for seizures. Select all the patients below that are at risk: A. A 32-year-old with a blood glucose of 20 mg/dL. B. A 63-year-old whose CT scan shows an ischemic stroke. C. A 72-year-old who is post opt day 5 from open heart surgery. D. A 16-year-old with bacterial meningitis. E. A 58-year-old experiencing ETOH withdrawal.

The answers are A, B, D, and E. All the patients are at risk except option C. Remember all the risk factors: illness (especially CNS types like bacterial meningitis), fever, electrolyte/metabolic issues (low blood sugar, acidosis etc), ETOH (alcohol) withdraw, brain injury, STROKE, congenital brain defects, tumors etc.

The nurse is performing a breast assessment. Which statement made by the client indicates the risk of breast cancer? Select all that apply. a. "I had a late onset of menarche." b. "My first child was born when I was 32." c. "I noticed a slight discharge from a nipple." d. "I perform breast self-examinations frequently." e. "I consume two to four glasses of alcohol a day."

b. "My first child was born when I was 32." c. "I noticed a slight discharge from a nipple." d. "I consume two to four glasses of alcohol a day." Clients who gave birth to a first child after the age of 30 are at a risk of breast cancer. Discharge from the nipple may indicate an early symptom of breast cancer. Consuming two to four glasses of alcohol daily may also increase the risk of breast cancer. An early onset of menarche is a risk factor for breast cancer. Performing breast self-examinations frequently may help to identify the early stages of breast cancer.

(med surg) A patient in the unit has a 103.7° F temperature. Which intervention would be most effective in restoring normal body temperature? a. Use a cooling blanket while the patient is febrile. b. Administer antipyretics on an around-the-clock schedule. c. Provide increased fluids and have the UAP give sponge baths. d. Give prescribed antibiotics and provide warm blankets for comfort.

b. Administer antipyretics on an around-the-clock schedule.

A laboratory report shows that a client tested positive for human epidermal growth factor (HER), and a medical report reveals the presence of advanced breast cancer. Which medication would be used to treat this condition? a. Erlotinib b. Lapatinib c. Rituximab d. Tositumomab

b. Lapatinib HER-2 is overexpressed in clients with advanced breast cancer. Lapatinib inhibits epidermal growth factor-r (EGFR)-tyrosine kinase (TK) and binds HER-2. Erlotinib is an EFGR-TK inhibitor prescribed to treat non-small cell lung cancer and advanced pancreatic cancer. Rituximab and tositumomab are administered to treat non-Hodgkin's lymphoma.

A nurse is reviewing the health history and laboratory results of a school-aged child admitted to the pediatric unit with acute nonlymphoid leukemia (acute myeloid leukemia). What clinical findings does the nurse expect? Select all that apply. a. Oliguria b. Listlessness c. Few stem cells d. Difficulty swallowing e. Bone marrow depression

b. Listlessness e. Bone marrow depression Listlessness in a child with leukemia is caused by anemia; anemia is expected in children with leukemia because of generalized bone marrow depression. Depressed bone marrow production of formed elements of blood is characteristic of nonlymphoid leukemia; it leads to neutropenia and increases susceptibility to infection. Urine output will be within expected limits; there is no kidney involvement at this stage of the disease. There are more, not fewer, stem cells in the peripheral blood and bone marrow; the production of mature blood cells is depressed. The swallowing reflex is not affected.

antithyroid agents

block production of thyroid hormones in patients with hypersecretion disorders, Graves disease ex: carbimazole (in the UK), methimazole (in the US), and propylthiouracil/PTU Monitor body for signs of infection

(Med surg) Which one of the orders should a nurse question in the plan of care for an elderly immobile stroke patient with a stage III pressure ulcer? a. Pack the ulcer with foam dressing. b. Turn and position the patient every hour. c. Clean the ulcer every shift with Dakin's solution. d. Assess for pain and medicate before dressing change.

c. Clean the ulcer every shift with Dakin's solution. Topical antimicrobials and antibactericidals (e.g., povidone-iodine [Betadine], Dakin's solution [sodium hypochlorite], hydrogen peroxide [H2O2], and chlorhexidine [Hibiclens]) should be used with caution in wound care because they can damage the new epithelium of healing tissue and delay healing.

(Custom adaptive) What would the nurse state is a cause of systemic altered inflammatory response in impaired wound healing? a. Uremia b. Cirrhosis c. Leukemia d. Hypovolemia

c. Leukemia Leukemia is a cause of systemic altered inflammatory response in impaired wound healing. Uremia, cirrhosis, and hypovolemia are systemic impaired cellular proliferation responses in impaired wound healing.

The nurse on the clinical unit is assigned to four patients. Which patient should she assess first? a. Patient with a skull fracture whose nose is bleeding b. Older patient with a stroke who is confused and whose daughter is present c. Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0-to-10 scale d. Patient who had a craniotomy for a brain tumor and who is now 3 days postoperative and has had continued vomiting

c. Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0-to-10 scale Bacterial meningitis is a MEDICAL EMERGENCY

An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to a. monitor blood glucose levels. b. restrict fluid and sodium intake. c. administer potassium-sparing diuretics. d. advise the patient to make postural changes slowly

c. administer potassium-sparing diuretics. Rationale: Before surgery, patients should be treated with potassium-sparing diuretics (spironolactone [Aldactone], eplerenone [Inspra]) to normalize serum potassium levels. Spironolactone and eplerenone block the binding of aldosterone to the mineralocorticoid receptor in the terminal distal tubules and collecting ducts of the kidney, thus increasing sodium excretion, water excretion, and potassium retention. Oral potassium supplements may also be necessary.

Hyperaldosteronism

excessive output of aldosterone from the adrenal gland, leading to increased sodium and water retention and loss of potassium TX: K-sparing diuretics (Spironolactone, eplerenone)

Decerebrate

extension away from body, pronation of arms/legs

tonic-clonic seizure

generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups

The normal white blood cell count

generally 4000 to 11,000/μl

Droplet precautions

gown, gloves, mask