Transition to Nursing Final
aldosterone
"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure
s/s of a hemorrhagic stroke
"thunderclap" headache altered LOC dizziness nausea/vomiting
beta blockers end in
-olol
ace inhibitors end in
-pril
examples of Hypotonic solutions
0.45 NaCl
normal Cr
0.6-1.2
examples of isotonic solutions
0.9 NS, LR
normal HCO3
22-26
Normal HCo3
22-28
in wound healing, when does the inflammatory phase peak?
24-48 hours after trauma
examples of hypertonic solutions
3% NaCl 5% NaCl
normal PaCO2
33-45
when should we expect a response to antibiotic therapy in bacterial pneumonia
48-72 hours
HbA1C indicative of pre-diabetes
5.7%
Hba1c indicative of DM
6.5%
normal BUN
7-20
normal pH
7.35-7.45
FEV1/FVC ratio that is diagnostic for COPD
70%
who is the pneumonia vaccination recommended for?
>65 y/o weakened immune system smokers heavy drinkers recovering from surgery or severe illness
which phrase describes the function of the limbic system? A) influence emotional behavior B) regulate autonomic functions C) facilitate automatic movements D) relay sensory and motor inputs for cerebrum
A) influence emotional behavior
which clinical manifestations indicate a client who sustained head and chest injuries from a motor vehicle accident, responded to medical treatments, and is ready for transfer to a critical care unit? A) stabilized VS and complaints of pain B) pale and alert; remains restless C) increasing temperature and apprehension D) fluctuating vital signs and drowsy, easily roused
A) stabilized VS and complaints of pain
Within which period of time would a nurse advise the client to anticipate pain relief will begin when nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina? A. 1 to 3 minutes B. 4 to 5 seconds C. 30 to 45 seconds D. 10 to 15 minutes
A. 1-3 minutes
How can the nurse prevent vomiting in a client who reports feeling nauseated after cataract surgery? A. Administer the prescribed antiemetic medication. B. Provide some dry crackers for the client to eat. C. Explain that this is expected after surgery D. Teach how to breathe deeply until the nausea subsides
A. Administer the prescribed antiemetic medication.
Which priority nursing intervention would the nurse implement for a client on diuretic therapy who has developed metabolic alkalosis? A. Fall prevention measures B. Monitoring Electrolytes C. Administering antiemetics D. Adjusting the diuretic therapy
A. Fall prevention measures
Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis? A. Monitoring for signs of hypoglycemia resulting from treatment B. Withholding glucose in any form until the situation is corrected C. Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally D. Regulating insulin dosage according to the client's urinary ketone levels
A. Monitoring for signs of hypoglycemia resulting from treatment
Which ion is the regulator of extracellular osmolarity? A. Sodium B. Potassium C. Chloride D. Calcium
A. Sodium
Which blood gas would the nurse expect an adolescent with diabetic ketoacidosis to exhibit? A. pH 7.30, CO2 40, HCO3 20 B. pH 7.35, CO2 47, HCO3 24 C. pH 7.46, CO2 30, HCO3 24 D. pH 7.50, CO2 50, HCO3 22
A. pH 7.30, CO2 40, HCO3 20
A client is hospitalized with a diagnosis of emphysema. The nurse provides teaching and would begin with which aspect of care? A. The disease process and breathing exercises B. How to control or prevent respiratory infections C. Using aerosol therapy, especially nebulizers D. priorities when performing everyday activites
A. the disease process and breathing exercises
s/s of hypernatremia
ALOC => restless, lethargy intense thirst dry swollen tongue flushed skin oliguria
which trigger would the nurse instruct the client to avoid to decrease the incidence of asthma attacks? A. Mold B. Cold Air C. Pet dander D. Air pollution E. Cigarette smoke
All of the above
what medication is given to someone with an ischemic stroke?
Alteplase (tPA)
what is aspirin used for
Anti platelet (to prevent MI and stroke)
warfarin indication
Anticoagulant
which nursing action would be included in the plan of care for a child with acute poststreptococcal glomerulonephritis? A) encouraging fluids B) monitoring for seizures C) measuring abdominal girth D) Checking for pupillary reactions
B) monitoring for seizures
which clinical manifestation is associated with hypernatremia in burns? A) fatigue B) seizures C) paresthesias D) cardiac dysrhythmias
B) seizures
A 66-year old client 24 hours post-stroke has expressive aphasia. The nurse identifies a nursing diagnosis of impaired verbal communication. An appropriate nursing intervention to help the patient communicate is to: A. ask the pt to practice facial and tongue exercises B. Ask the pt yes or no answer type questions. C. Develop a list of words the pt can read and practice reciting
B. Ask the pt yes or no answer type questions
which food item would the nurse instruct a client whose pathology report states urinary calculus is composed of uric acid to avoid? A. Milk B. Liver C. Cheese D. Vegetables
B. Liver
which is involved in the postprocedure nursing care of a child after left-side cardiac catheterization? A. Encouraging early ambulation B. Monitoring the insertion site for bleeding C. Comparing blood pressures in the two extremities D. Restricting fluids until the blood pressure has stabilized
B. Monitoring insertion site for bleeding.
which goal is priority for a client with asthma who has a prescription for an inhaled bronchodilator? A. is able to obtain pulse ox readings B. demonstrates use of metered-dose inhaler C. knows the health care provider's office hours D. can identify triggers that cause wheezing
B. demonstrates use of metered dose inhaler
Which effect of sodium bicarbonate is the nurse trying to prevent when teaching a client about the dangers of using sodium bicarbonate regularly? A. Gastric distention B. Metabolic alkalosis C. Chronic constipation D. Cardiac dysrhythmias
B. metabolic alkalosis
what lab measures urea
BUN
HCO3-
Bicarbonate
which statement will the nurse need to consider when developing the teaching plan for a client with type 2 diabetes prescribed an oral hypoglycemic medication? A) oral hypoglycemics work by decreasing absorption of carbohydrates B) oral hypoglycemics work by stimulating pancreas to produce more insulin C) Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control D) Serious adverse effects are not a problem for oral hypoglycemics
C) clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control
A client, transferred to the PACU after a transurethral resection of the prostate, has an intravenous line and a urinary retention catheter. During the immediate postoperative period, for which potentially critical complication would the nurse monitor? A) sepsis B) phlebitis C) hemorrhage D) leakage around the urinary catheter
C) hemorrhage
PO vancomycin is used for what?
C. Diff
Which factor is the likely cause of the laboratory result when arterial blood gases done on a client who is being resuscitated after a cardiac arrest show a low pH? A. Ketoacidosis B. Irregular heartbeat C. Lactic Acid Production D. Sodium bicarbonate administration
C. Lactic Acid Production
what is the purpose of encouraging active leg and foot exercises for a client who has had hip surgery? A. Maintain muscle strength B. Reduce leg discomfort C. Prevent clot formation D. improve wound healing
C. Prevent clot formation
which of these assessments would be the highest priority for the nurse to complete on a client who arrives in the emergency department with multiple crushing wounds of the chest, abdomen, and bilateral lower extremities? A. Level of consciousness B. Characteristics of pain C. Quality of respirations D. Observation of abdominal contusions
C. Quality of respirations
A client with chronic obstructive pulmonary disease has a blood pH of 7.25 and a pCO2 of 60mmHg. Which complication would the nurse suspect the client is experiencing? A. Metabolic Acidosis B. Metabolic Alkalosis C. Respiratory Acidosis D. Respiratory Alkalosis
C. Respiratory Acidosis Normal PCO2: 35-45
Which type of acid-base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation? A. Metabolic alkalosis caused by excessive production of acid metabolites B. Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide C. Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid D. Metabolic acidosis caused by the kidneys inability to compensate for increased carbonic acid formation
C. Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid
characterized by a chronic inflammatory response in the airway in lungs, resulting in persistent limitation of airflow
COPD
hypocalcemia occurs when
Ca <8.5
treatment of hypocalcemia
Ca+ diluted in D5W, given slowly
hypercalcemia occurs when
Ca+ is greater than 10.5
PaCo2
Carbon Dioxide
which response would the nurse provide to a client receiving digoxin who calls the clinic and complains of yellow vision? A) this is r/t your illness, not your medication B) this is an expected side effect; you will become accustomed to it over time C) this side effect is only temporary. You should continue the medication D) The medication may need to be discontinued. Come to the clinic this afternoon
D) The medication may need to be discontinued. Come to the clinic this afternoon.
which intervention would the nurse implement after determining that a client, who sustained a CVA, needs assistance with eating for optimum nutrition A) request that the client's food be pureed B) feed the client to conserve the client's energy C) have a family member assist the client with each meal D) encourage the client to participate in the feeding process
D) encourage the client to participate in the feeding process
which finding in a urinalysis indicates a urinary tract infection? A) crystals B) Bilirubin C) Ketones D) Leukoesterase
D) leukoesterace
Which action will the nurse take after stopping the antibiotic infusion of a client who becomes restless and flushed, and begins to wheeze during the administration of an antibiotic? A. Check the clients temperature B. Take the client's bp C. Obtain pulse ox D. Assess clients respiratory status
D. Assess clients respiratory status
Which statement must the nurse emphasize to the family when preparing a school-aged child with persistent asthma for discharge? A. A cold, dry environment is desirable. B. Limits should not be placed on the child's behavior C. The health problem is gone when symptoms subside D. Medications must be continued even when the child is asymptomatic
D. Medications must be continued even when the child is asymptomatic
Which nursing action has the highest priority when preparing to transfer an unconscious client who has sustained a head injury from the emergency department to a neurological trauma unit? A. notify the receiving unit of the transfer B. having the client's records ready for the transfer C. Verifying that the family has been notified of the transfer D. Validating availability of a bag-valve-mask during the transfer
D. Validating availability of a bag-valve mask during the transfer
A 49-year-old client is admitted with a possible stroke. Which information from the nursing assessment suggests that the nurse should consult with the HCP before giving prescribed aspirin? A. the pt has a hx of brief episodes of R-sided hemiplegia B. the pt has dysphasia C. the pt has a known hx of a. fib D. Pt reports s/s began with severe headache
D. pt reports s/s began with severe headache
characterized by an increase production and release of glucose by the liver => osmotic diuresis leads to dehydration and loss of electrolytes => increased lipolysis into fatty acid and glycerol (converted into ketones)
DKA
creatinine is increased in
HTN, renal disease, decreased GFR, increased meat consumption
vital signs in septic shock
HypoTN, increased RR, increased HR
treatment of hypercalcemia
IM calcitonin
hypokalemia occurs when
K <3.5
hyperkalemia occurs when
K >5
what is the compensatory process during acidosis?
Kidneys: produce bicarb base and increase excretion of acids (H-) Lungs: increase rate and depth of respirations to exhale carbon dioxide
causes of hypokalemia
N/V/D NG suction Diuretics anorexia alcoholism
causes of hyponatremia
N/V/D burns adrenal insufficiency excess water gain cirrhosis SIADH
PPE for airborne precautions
N95 mask
what is a neurohormone produced by the heart that is used to assess heart failure?
Natriuretic peptides (ANP, BNP)
in extreme hyperkalemia, what will an EKG show?
No P, wide QRS
thrombocytopenia occurs when
PLT is less than 150,000
calcium has a reciprocal relationship with
Phosphorus
biggest intracellular electrolyte
Potassium
what is creatinine?
Product of muscle breakdown, measurement of kidney function
what is phenytoin used for?
Seizure prevention
what is a CT angiogram?
This is a CT scan (a bunch of Xrays taken at different angles and projected into a 3D image) with radiolabeled materials in the blood stream to allow imaging of veins and arteries. CT angiograms are used to diagnose pulmonary embolisms (it's impossible to visually see a clot in the lungs, so we use xrays and computing to create a model).
example of tertiary intention
abdominal wound initially left open until infection is resolved and then closed
in terms of gas exchange, what does Hgb and Hct tell us?
ability to transport O2
these help to keep the pH of body fluids in normal range in spite of continuous production of metabolic acids by cells
acid buffering
cellular metabolism generates carbonic acid in the form of CO2 and water
acid production
what is community acquired pneumonia?
acquired in community or hospital setting within first 48 hours of hospitalization
condition characterized by adrenal insufficiency
addison's
where is cortisol produced
adrenal glands
what type of transmission is TB
airborne
What precautions does the nurse need to follow when caring for a patient with active TB
airborne precautions
monitoring of a person with ischemic stroke
all the same as hemorrhagic PLUS CT angiogram
early sign of sepsis/shock
altered LOC
risk fx for an ischemic stroke
artery thrombosis HTN hyperlipidemia a-fib DM
serum lipids measure risk for
atherosclerosis
which is worse -- viral or bacterial pneumonia
bacterial
increase in neutrophils indicates
bacterial infection
what drugs are used to prevent seizures
benzodiazepines
gold standard for management of hypercalcemia r/t cancer
bisphosphonate
PLT, PTT, PT, and INR are all
bleeding factors
impairment of arterial perfusion happens when
blood cant get down to where it needs to go => intermittent claudication, weak/absent pulse, round, smooth necrotic sores
impairment of venous perfusion happens when
blood cant return to the heart => pulse present, wounds with pus, swelling
What is creatinine
breakdown product from muscle and protein metabolism
albuterol
bronchodilator used during acute asthma exacerbations
examples of IV calcium
calcium gluconate calcium chloride
Ca+ is given slowly to prevent
cardiac arrest
s/s of hypokalemia
cardiac arrhythmias anxiety lethargy coma weakness
impairment of central perfusion occurs when
cardiac output is inadequate
fluid buildup around the brain
cerebral edema
first sign of change in ICP
changes in mental status of motor function
sick day rules for blood glucose monitoring
check blood glucose more often when sick
airway inflammation with productive cough and excessive sputum production
chronic bronchitis
CAP
community acquired pneumonia
Fluticasone
corticosteroid used to decrease inflammation r/t asthma. Used every day
example of glucocorticoids
cortisol
what lab values assess cellular and tissue damage?
creatinine kinase (CK) Troponin Lactic dehydrogenase (LDH)
what lab is very important to get when suspecting a patient with septic shock?
culture and sensitivity
condition characterized by excess cortisol production
cushings syndrome
in DIC, d-dimer is ___ and PT is ____
d-dimer is increased and PT is decreased
s/s of addisons
darkened skin low BP fatigue hyponatremia hypoglycemia
mannitol use
decrease ICP
s/s of hyponatremia
decreased LOC, increased BP, cerebral edema, crackles
why are older adults at greater risk for fluid and electrolyte disturbances?
decreased thirst sensation decreased kidney function
tough connective tissue, has hair follicles, sweat glands
dermis
treatment of diabetes insipidus
desmopressin
vasopressin is used in what common disease
diabetes insipidus
causes of hyperkalemia
diet high in K+, ACE inhibitors, burn patients
dysphagia
difficulty swallowing
s/s of Diabetes insipidus
diluted urine (decreased urine specific gravity) hyperosmolality, hypernatremia dehydration decreased BP
diplopia
double vision
urinary impact of septic shock
dysuria, frequency, urgency, dark in color, foul odor
minerals in the body that have electric charge
electrolytes
alveolar destruction related to chronic inflammation resulting in decreased surface area for gas exchange
emphysema
causes of hypernatremia
excess intake excess H2O loss DI cushings syndrome
polycythemia
excess of red blood cells
reversal agent for andexxa
factor 10a
s/s of DKA
fatigue, weakness, polyuria, blurred vision, orthostatic hypotension, fruity breath, Kussmaul respirations, AMS
eating disorder triad
female, young, athlete
s/s of a pt with bacterial pneumonia
fever > 101 productive cough increased WBC count CXR with notable infiltrates
s/s of active TB
fever chills night sweats persistent cough hemoptysis chest pain and SOB
as they relate to infection, how are proteins important?
fighting infection and rebuilding tissue
in moderate hypokalemia what will an EKG show?
flat T-wave and a U wave
process by which O2 is transported to cells and CO2 is transported from cells
gas exchange
counterregulatory hormones to insulin
glucagon and cortisol
how does stress impact the immune system?
glucocorticoid release causes compromise
adrenals release
glucocorticoids, aldosterone, and sex hormones
phase in wound healing that lasts from days 5-21; characterized by epithelialization
granulation
HACP
healthcare associated pneumonia
presbycusis
hearing loss r/t age
risk factors of a hemorrhagic stroke
hemorrhage, cerebral aneurysm, arteriovenous malformation, anticoagulants, illicit drugs
bleeding into and around the brain; increased ICP; herniation
hemorrhagic stroke
indication for lactulose
high ammonia r/t hepatitis
does cushings disease put you at higher or lower risk of hyperglycemia?
higher
pituitary, thyroid, pancreas, ovaries/testes, adrenals, parathyroid, and hypothalamus are all
hormonal regulation glands
glucocorticoid
hormone from the adrenal cortex that raises blood sugar and reduces inflammation
HAP
hospital acquired pneumonia
characterized by the build up of fluid in the ventricles deep within the brain
hydrocephalus
removal of the thyroid can result in what
hypercalcemia
s/s of cushing's
hyperglycemia hypokalemia rosy cheeks HTN
in what condition would 0.45% NaCl be indicated
hypernatremia
can hyper or hypoventilation help increased ICP
hyperventilation
fat and adipose tissue, connective tissue
hypodermis
in what condition would 3% NaCl, 0.9NS, and LR be indicated?
hyponatremia
cause of hypocalcemia
hypoparathyroidism, pituitary tumor
why do people with sepsis/shock exhibit altered LOC
hypoperfusion and hypoxia
when albumin is decreased, there is
impaired wound healing
why is glucose high in cushings disease?
in cushing's, the adrenals release too much cortisol => upregulates glucose
cushings triad is characterized as
increased BP, decreased HR, decreased RR
why are neonates and infants at greater risk for fluid and electrolyte disturbances?
increased metabolic rate, increased RR, and increased water usage
BUN is increased in
increased protein intake GI bleed infection steroid use renal disease
impairment of gas exchange occurs when....
ineffective ventilation ineffective O2 carrying capacity inadequate perfusion
C-reactive protein measures
inflammation
three phases of wound healing
inflammatory granulation maturation
hormone to lower glucose
insulin
mechanisms and conditions that impact intracranial processing and functioning
intracranial regulation
in extreme hypokalemia, what will an EKG show?
inverted T wave, prominent U-wave
characterized by decreased blood flow to the brain which results in cell/tissue death
ischemic stroke
where does acid buffering occur?
kidneys
how quick does compensatory mechanisms work in acidosis?
kidneys -- hours to days lungs -- immediately
how do kidneys contribute to acid excretion?
kidneys hold onto bicarb base and excrete hydrogen acid
what are the compensatory mechanisms that occur in alkalosis?
kidneys: retain metabolic acids and increase excretion of bicarbonate lungs: decrease rate and depth of breathing
why do people with kidney disease have anemia?
lack of erythropoietin
monitoring of a pt with hemorrhagic stroke
last known normal speech strength cardiac neuro checks glucose CT
cushings triad is a ___ sign of increased ICP
late
TB lives without illness exposure to TB virus asymptomatic can't spread it to others + TB skin or blood test
latent TB
when a patient is having a seizure, what should you do?
lay pt on side; monitor time; pillow placed under head
strabismus
lazy eye
defined as the volume of blood carried to specific tissues
local perfusion
s/s of a pt with viral pneumonia
low grade temp non-productive cough WBC normal to slight elevation CXR with minimal changes
in addisons, are you at higher or lower risk for developing hyperglycemia?
lower
where does acid excretion occur?
lungs and kidneys
what drug is used to reduce cerebral edema?
mannitol
phase in wound healing that lasts for months; collagen fiber is remolded, scar formation and contraction occurs
maturation
western bolt
most common confirmation test for HIV in the US
who are at highest risk for impaired fluid and electrolytes?
neonates and infants developmentally delayed elderly health disparities
consequences of hyperglycemia
neuro changes; dehydration r/t polyuria; DKA; retinopathy; nephropathy; peripheral neuropathy; HTN; cardiovascular and peripheral vascular disease
can you spread latent TB
no
should you give a pt with hypoglycemia candy?
no
are fluid and electrolyte disturbance s/s specific or nonspecific?
nonspecific
diabetes insipidus patho
not enough ADH results in increased diuresis
why is glucose lower in addisons?
not enough cortisol released from adrenal => decrease in glucose => add cortisol
assessment findings of someone with an ischemic stroke
numbness or weakness in face, arm, leg slurred speech
acid base balance is the process of regulating what 3 things?
pH bicarbonate concentration partial pressure of CO2
s/s of an arterial clot
pain paresthesia pulselessness pallor cool skin
where is glucagon produced?
pancreas
calcium is regulated by
parathyroid hormone and calcitonin
the flow of blood through arteries and capillaries, delivers nutrients and O2 to cells
perfusion
increase in monocytes indicates
phagocytosis
how do T-lymphocytes react to infection?
phagocytosis => bacteria destruction
why should someone with hypocalcemia avoid taking drugs that contain phosphorus?
phosphorus will lower calcium levels (inverse relationship)
calcium channel blockers end in
pine
an acute lung infection that results in inflammation of the bronchioles and alveoli (impairment of the muco-ciliary mechanism)
pneumonia
what is HAP
pneumonia acquired 48 hours or longer after admission to hospital
where is ADH produced?
posterior pituitary
goal of treatment of increased ICP
prevent secondary injury to brain and maintain cerebral perfusion
what type of intention: - wound margins well approximated - surgical incision and lacerations - most rapid healing time
primary intention
ECG monitoring of someone with hypocalcemia will show
prolonged ST segment prolonged QT interval
what is essential for treatment of bacterial pneumonia
prompt treatment with antibiotics
reversal agent for heparin
protamine sulfate
s/s of a venous clot
redness edema pain emboli
in COPD, what will an ABG show?
respiratory acidosis
treatment of hypernatremia
restrict PO intake of Na+ hypotonic solutions to prevent ICP increase
what type of intention: - wound margins not well approximated, required formation of granulation tissue - pressure ulcers/burns - longer period to heal
secondary intention
IV vancomycin is used for what?
sepsis
what type of diet should people with type 2DM follow?
small frequent meals
biggest extracellular electrolyte
sodium
hypernatremia occurs when
sodium is >145
hyponatremia occurs when
sodium is less than 135
VAP is acquired when
someone acquires pneumonia after at least 48 hours of being on a ventilator.
s/s of SIADH
sticky, thick urine hypoosmolality plus hyponatremia seizures severe high blood pressure
treatment of SIADH
stop all fluids 3% NS eat salt
what should you give a pt with hypoglycemia?
sugar and a protein (not candy)
big clinical sign of excessive bleeding
tachycardia and hypotension
what type of intention: - wound healing delayed (delayed primary closure)
tertiary intention
assessment findings on someone with hypocalcemia
tetany chvostek's sign trouseeaus sign
every part of the GI tract except for what plays a role in breakdown and absorption of food?
the colon
central perfusion is
the force of blood generated by the heart
what is the treatment for viral pneumonia
there isn't really any
how do B-lymphocytes react to infection?
they produce antibodies
excessive clotting results in
thrombi
SIADH patho
too much ADH leads to fluid retention
increase in lymphocytes indicates
viral infection
reversal agent for warfarin
vitamin K
what is urea
waste product of protein metabolism
what happens to the cell during hyponatremia
water moves from extracellular space to intracellular space => cell swells
medical management of TB
weeks to months of multiple medications - INH - Rifampin - Pyrazinamide - Ethambutol
in moderate hyperkalemia, what will an EKG show?
wide QRS, peaked T-wave
when sodium is down
you're about to drown
when sodium is high
you're very dry