Patho & Pharm EAQ #2
During an 8-hour shift a client drinks two 6-ounce (180 mL) cups of tea and vomits 125 mL of fluid. Intravenous fluids absorbed equaled the urinary output. What is the client's fluid balance during this 8-hour period? Record your answer using a whole number. ___ mL
235 mL client intake 360 mL (12oz x 30 mL= 360 ml) loss was 125 mL fluid 360 mL - 125 mL - 235 mL
Phenytoin, an anti-seizure drug is active against all seizures except which one?
Absent
What is plasma drug levels?
All have established therapeutic levels
What kind of spectrum drug is Phenytoin?
Broad spectrum
What are the characteristics of Phenytoin?
Can suppress seizures without suppressing respirations. Selectively inhibits sodium channels re-entry back into the neuron and prevent spread of seizure from a hyperactive focus.
How early does prodrome symptoms occur?
Days or hours before seizure
Which diagnosis is a client most likely to have who has an arterial blood gas report indicating that pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L (20 mmol/L)?a) Panic attackb) Persistent vomitingc) Diabetic ketoacidosisd) Advanced emphysema
Diabetic ketoacidosis
What are the areas to monitor for seizure disorders?
Drug evaluation, plasma drug level, promoting compliance, withdrawing AED
What is promoting compliance?
Educate about the chronicity of the process
What are some findings of postictal phase?
Headache, drowsiness, nausea, muscle soreness, no memory of seizure event, retrograde amnesia
What is postictal phase?
Individual may regain consciousness or drift into a deep comalike state. Disorientation and confusion are common,. If allowed, patient may sleep for several hours.
What is prodome phase?
May last 10-15 seconds and is followed by clonic activty in which there is often violent by rhythmic muscular contractions -eyerolls, face grimaces, pulse rate accelerates, salivation increases, pt may become diaphoretic (increase sweating)
An ABG report indicates the client's pH is 7.25, PCO2 is 35 mmHg, and HCO3 is 20 mEq/L. Which disturbance would the nurse identify based on these results?- Metabolic acidosis- Metabolic alkalosis- Respiratory acidosis- Respiratory alkalosis
Metabolic acidosis
What are some symptoms that may show someone is showing signs of prodrome phase?
Person may feel odd, take blood pressure, blood sugar, changes in personality
What are the four most common drugs for epileptic seizures?
Phenytoin-Dilantin Carbamazepine-Tegretol Phenoarbital Valproric acid- depakote
An aura can be both what?
Physical sensation (smell, taste) or a mental image (color)
Which phase is the phase where during a seizure, person at risk for injury from initial fall, includes muscle contractions of clonic phase?
Postictal phase
If a patient is in tonic phase, what is a potential risk of injury?
Potential head injury, bleeding which patient may aspirate from biting tongue
When a client with chronic obstructive pulmonary disease has a new prescription for daily low-dose prednisone, which information will the nurse include when teaching the client?
Report any black stools to healthcare provider
If a patient abruptly stops taking their antiepileptic medication, what can that cause?
Seizure
A client is experiencing persistent vomiting, and serum electrolytes have been prescribed. The nurse should monitor which laboratory results?1Sodium and chloride levels2Bicarbonate and sulfate levels3Magnesium and protein levels4Calcium and phosphate levels
Sodium and chloride levels
List the steps of how antiepileptic drugs work.
Suppress discharge of neurons, suppress propagation of seizure activity, sodium influx suppression, calcium influx suppression, potentiation of GABA (gamma aminobutyric acid)
What are treatments for seizure disorders?
Treatment depends on type, onset, status, age of patient. The drug ideally should be effective against more than one type of seizures. Should be well tolerated and cheap because the person taking it will need to do so for a long time if not for life.
What is the clonic phase?
Usually lasts 1-2 mins with gradual decline in the amplitude of clonic jerks. Individual remains apneic (condition of temporarily stop breathing) until end of clonic phase which is marked by a deep inspiration
What is a clinical manifestation of a patient in clonic phase?
Violent rhythmic muscle contraction
What are the pharmacokinetics of Phenytoin?
Wide patient to patient variation in absorption and metabolism. Has a very narrow index. Can become toxic with a small increase and sub therapeutic with a small decrease. Absorption varies between different oral formulations.
What is withdrawing AED?
Withdrawing from antiepileptic drug use slowly over 6 weeks to several months
Assessment findings of a client with smoke inhalation include a negative chest x-ray and arterial blood gases that show a PO2 of 85 mmHg, a PCO2 of 45 mmHg, and a pH of 7.35. Which interventions would the nurse anticipate will be prescribed? Select all that apply. One, some or all responses may be correct a. coughing b. deep breathing c. bronchodilators d. humidified oxygen e. bronchial suctioning
a. coughing, b. deep breathing, d. humidified oxygen Coughing moves secretions toward the mouth to be expectorated. Deep breathing expands the alveoli and increases the amount of oxygen being delivered to the alveolar capillary beds. Humidified oxygen increases the amount of oxygen that is being delivered to the alveolar capillary beds.
Which statement explains why metabolic acidosis develops with kidney failure? a. inability of renal tubules to secrete hydrogen ions and conserve bicarbonate b. depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention c. inability of renal tubules to reabsorb water to dilute the acid contents of blood d. impaired glomerular filtration, causing retention of sodium and metabolic waste products
a. inability of renal tubules to secrete hydrogen ions and conserve bicarbonate Bicarbonate buffering is limited, hydrogen ions accumulate and acidosis results.
A client with chronic obstructive pulmonary disease (COPD) reports chest congestion, especially upon awakening in the morning. To address the concern, the nurse would make which suggestion? a. use a clean and disinfected humidifier in the bedroom b. sleep with two or more pillows c. cough regularly even if the cough does not produce sputum d. cough and deep breathe each night before going to sleep
a. use a clean and disinfected humidifier in the bedroom A humidifier will help liquefy secretions and promote expectoration. Pillows don't relieve chest congestion. Nonproductive cough should be avoided because it is irritating and exhausting.
Which conditions may result from immunoglobulin IgE antibodies on mast cells reacting with antigens? Select all that apply.Correct 1AsthmaCorrect 2Hay fever3Sarcoidosis4Myasthenia gravis5Rheumatoid arthritis
asthma, hay fever Clinical conditions such as asthma and hay fever are considered type I hypersensitive reactions that are mediated by a reaction between IgE antibodies with antigens. It results in the release of mediators such as histamines. Type IV hypersensitivity reactions such as sarcoidosis result from reactions between sensitized T cells with antigens. Myasthenia gravis results from a type II hypersensitivity reaction that occurs due to an interaction between immunoglobulin IgG and the host cell membrane. Rheumatoid arthritis is a type III hypersensitivity reaction that results from the formation of immune complexes between antigens and antibodies that results in inflammation.
A patient has a tonic-clonic seizure. What type of seizure did the patient experience? a. petite mal b. grand mal c. myoclonic d. drop attack
b. Grand mal
When a client with chronic obstructive pulmonary disease (COPD) reports a 5lb (2.3kg) weight gain in 1 week, the nurse will assess for other signs and symptoms of which complication? a. polycythermia b. cor pulmonale c. compensated acidosis d. left ventricular failure
b. cor pulmonale Fluid retention and weight gain caused by right ventricular failure is a clinical manifestation of cor pulmonale or right ventricular caused by pulmonary hypertension associated with COPD. Polycythemia may be caused by COPD but it does not cause weight gain. Compensated respiratory acidosis is caused by COPD but is would not lead to weight gain. Left ventricular failure may lead to weight gain but is not a complication of COPD
A client appears anxious, exhibiting 40 shallow respirations per minute. The client reports dizziness, light headedness, and tingling sensations of the fingertips and around the lips. The nurse concludes that the client's symptoms are most likely related to which conditions? a. eupnea b. hyperventilation c. Kussmal respirations d. carbon dioxide intoxication
b. hyperventilation The client is hyperventilating and blowing off excessive carbon dioxide, which leads to these adaptations; if uninterrupted this can result in respiratory alkalosis.
Which food item would the nurse instruct a client whose pathology report states a urinary calculus is composed of uric acid to avoid? a. milk b. liver c. cheese d. vegetables
b. liver A low-purine diet controls the development of uric acid stones. Patients should stay away from foods high in purine, like organ meats and extracts. Client should avoid milk if they had calcium stones and not uric acid stones. Client should avoid cheese or animal protein if they had cysteine stones not uric acid stone.
When a client is newly diagnosed with chronic obstructive pulmonary disease (COPD), which action by the nurse has the highest priority? a. teach the client how to use the prescribed inhalers b. discuss the normal progression of the disease process c. ask whether the client is interested in quitting smoking d. explain the purpose of a pulmonary rehabilitation program
c. ask whether the client is interested in quitting smoking Smoking cessation slows the progression of COPD and is the most important action that the client can take to maintain lung function. Although the patient may not be ready to stop smoking, the nurse will assess the client's interest in smoking cessation at every encounter.
Which prescribed hemodialysis protocol would the nurse implement when a client with end stage renal failure beginning hemodialysis for the first time, reports nausea and a headache, and then appears to become confused? a. administer an alalgesic for the headache b. administer an antimetic for nausea c. decrease rate of hemodialysis exchange d. discontinue the procedure immediately
c. decrease rate of hemodialysis exchange headache, nausea, and confusion are signs and symptoms of disequalibrium syndrome which results from rapid changes in composition of extracellular fluid.
The nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mmHg, PCO2 35 mmHg, and pH of 7.37. These findings indicate that the client is experiencing which condition? a. respiratory alkalosis b. poor oxygen perfusion c. normal acid base balance d. compensated metabolic acidosis
c. normal acid base balance
Which process is the origin of metabolic acidosis caused by aspirin toxicity? a. deep, rapid breathing b. higher pH of gastric contents c. rapid absorption of salicylate d. increased renal excretion of bicarbonate
c. rapid absorption of salicylate Rapid absorption of acetylsalicylic acid (aspirin) causes the stomach contents to become more acidic, leading to metabolic acidosis. Hyperventilation is the body's attempt to blow off excess hydrogen ions; carbon dioxide is converted to hydrogen ions by the way of the carbonic anhydrase reaction. The pH of stomach contents decreases with aspirin toxicity, becoming more acidic resulting in metabolic acidosis.
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and PCO2 of 60 mmHg. These blood gas results require nursing attention because they indicate which condition? a. metabolic acidosis b. metabolic alkalosis c. respiratory acidosis d. respiratory alkalosis
c.respiratory acidosis
A client with obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a partial pressure of carbon dioxide (PCO2) of 60 mmHg. 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 The pH indicates acidosis; the PCO2 level is the parameter for respiratory function. The expected PCO2 is 40 mmHg. These results do not indicate a metabolic disorder or indicate respiratory alkalosis.
Which complication is the most serious for a client with kidney failure? a. anemia b. weight loss c. uremic frost d. hyperkalemia
d. hyperkalemia Decreased glomerular filtration leads to hyperkalemia which may cause lethal dysrhythmias such as cardiac arrest.
Which technique using a metered dose inhaler (MDI) by a client with chronic obstructive pulmonary disease would cause a nurse to conclude that additional teaching is needed? a. places the tip of the inhaler just past the lips b. holds the inspired breath for at least 3 seconds c. activates the inhaler during inspiration d. inhales rapidly with the lips sealed around the nebulizer opening
d. inhales rapidly with the lips sealed around the nebulizer opening The client should inhale slowly rather than rapidly to optimize delivery of nebulized medication into the lungs.
What is drug evaluation?
effectiveness: control of seizures, adjustment of dose
What is a clinical manifestation in a tonic phase?
muscle rigidity
What is the aura phase of a seizure?
warning that a seizure is going to happen -significant because may be a clue to location of epileptogenic focus
