random
Describe the differences between the manifestations of systemic and local inflammation.
systemic: fever, headache, anorexia, malaise
local: redness, warmth, exudate, swelling, pain.
acute vs chronic?
labs? CRP, ESR, WBC, CBC (are not specific to the site of inflammation).
Rest: healing, minimizing pain & irritation to the area /Ice: vasoconstriction decreasing pain & edema Compression: reduces edema & pain / Elevation: improves fluid flow away from damaged area.
The nurse is discussing medication therapy with a client newly diagnosed with type 1 DM. The client asks, "why can't I just take a pill like my friend does?" Which follow up client statement indicates the client understands the nurse's explanation?
a. "Because my body does not produce insulin, I must receive the injections."
b. "I will be on insulin for a short while, then I can take the pills."
c. "The pills are not as effective as the insulin injections."
d. "When my body starts making insulin again, I can stop taking the injections."
without insulin, cells cannot absorb sugar which they need to produce energy - glucose is the primary source of energy for cells.
DM1: autoimmune - destruction of beta cells (no insulin - insulin dependent).
Type 2: insulin resistance (cells in muscles, fat and liver don't respond as they should to insulin) / PO hypoglycemic meds- metformin, sulfonylureas, meglitinides.
hypoglycemia (<60): tremors, confusion, diaphoresis, tachycardia, weakness.
hyperglycemia (>): "hot & dry sugar high", 3 Ps polyuria, polydipsia, polyphagia.
Labs: A1C (120 days), fasting BG (no caloric intake for 8 hours), 2 hour post prandial plasma glucose level (consumed 75 grams of carbs), rando glucose test, GTT (ability to process standard glucose.
What is an effect of the sympathetic nervous system?
a. bradycardia.
b. increased peristalsis.
c. tachycardia.
d. bronchoconstriction.
c.
SNS- fight or flight response: enlarge pupils, increase HR, improve delivery of o2 to other parts of the body, bronchodilation, slows digestion.
PNS- relaxes your body after periods of stress or danger: lowers HR, increased peristalsis, tightens airway muscles to reduce amount of work lungs do (bronchoconstriction).
What are causes of Acute Renal Failure?
a. diabetes and hyperglycemia.
b. short-term, high dose of toxins.
c. hypertension and atherosclerosis.
d. Long-term exposure to renal toxins.
b.
ARF (reversible): Kidneys fail to function due to ischemia or inflammation & necrosis of the tubules = obstruction & back pressure = reduced GFR & oliguria or anuria / causes: severe shock, burns, calculi, tumors, nephrotoxins / s&s: Oliguric phase, Diuretic phase, Recovery phase.
CRF (irreversible): progressive over months - years inability of kidneys to respond to changes in body fluids and electrolyte composition and an inability to produce sufficient urine.
5 stages: last stage ESRD (GFR <15) kidneys have stopped working pt needs regular dialysis or transplant.
s&s: polyuria, HTN, anemia (bc erythropoietin is not being produced), fatigue, weight loss.
fail - oliguria, neuropathy, encephalopathy, arrythmias, edema, retaining electrolytes, dry skin, metabolic acidosis.
Which of the following is a manifestation of hyponatremia?
a. edema.
b. thirst.
c. hypotension.
d. hypertension.
c.
Na- bp, blood volume, & pH balance.
Na is absorbed in the GI tract always bringing water along.
low Na s&s: hypotension, weak thready pulse, neuro changes, seizures, abdominal cramping / causes: too much water or not enough Na (V, D, NG suctioning, diuretics, Addison's).
high Na s&s: hypertension, edema, thirst, swollen dry tongue, N, V / causes: not enough water or too much Na (heat stroke, kidney failure, Cushing's).
Which mode of inheritance occurs when both parents must pass on a defective gene to produce an affected child?
a. autosomal dominant.
b. autosomal recessive.
c. x-linked recessive.
d. chromosomal disorders.
b.
autosomal recessive (h): both parents need the defective gene in order to pass it on (CF, sickle cell).
autosomal dominant (H): only 1 parent needs to have (Huntington dx, adult polycystic dx, marfan syndrome).
x-linked recessive: issue with the x chromosome / usually affected in males bc they only have 1 x chromosome (Duchenne’s muscular dystrophy, hemophilia A).
chromosomal disorders: extra or missing chromosome (trisomy 21, turner syndrome[x], Klinefelter[xxy]).
The nurse is obtaining a health history of a 36-year-old female who reports an increase in appetite, weight loss, intolerance to heat, & nervousness. On assessment the client is noted to have thin hair. Based on this information, the nurse should suspect which disorder?
a. hypothyroidism.
b. hyperthyroidism.
c. addison's.
d. cushing's.
b. hyperthyroidism.
hyperthyroidism (overactive thyroid-low TSH, elevated T3 & T4): autoimmune dx is graves / s&s: bulging eyes, high BP & HR, sweating, diarrhea, amenorrhea, irritable, hot, weight loss, goiter / cx: thyroid storm (s&s are excessive).
dx: labs, imaging.
hypothyroidism: (elevated TSH, low T3 & T4): autoimmune is Hashimoto's dx / s&s: hair loss, lethargy, dry skin, constipated, weight gain, low HR, cold intolerance, face & eyelid edema / cx: myxedema coma.
Which of the following are manifestations of IICP? (SATA).
a. unilateral weakness.
b. headache.
c. decreased LOC.
d. projectile vomiting.
e. cushing's triad.
f. pupil abnormalities.
b, c, d, e, & f.
brain is encased in the rigid nonexpendable skull, any increase in fluid volume causes an increase in pressure in the brain / compression of brain tissue & blood vessels = decreased oxygenation & blood flow.
causes: meningitis, brain tumors, trauma, hemorrhage, hydrocephalus.
s&s: projectile vomiting (result of the pressure stimulating the emetic center in the medulla), seizures, posturing, pupil changes bc CN 3 is compressed, Cushing's (irregular resp, bradycardia, & high SBP).
dx: CT, MRI, Lumbar puncture – test CSF (CSF pressure will be elevated / Pinkish in color with erythrocytes – hemorrhage / Cloudy, yellow fluid – infection / Abnormal protein levels – neoplasm), Ventriculostomy – tube used to measure pressure in the head – can drain extra fluid.
A nurse is education clients on preventing UTIs. What should the nurse include?
a. soak in a bubble bath weekly.
b. wipe perineal area from back to front.
c. limit water intake.
d. empty the bladder before and after sexual intercourse.
d.
virulent form of E. coli can adhere to the bladder mucosa causing a urinary infection.
r/f: women, poor hygiene, baths, urinary retention, constipation, elderly, foley caths, prostate enlargement.
s&s: burning upon urination, cloudy smelling urine, older adults may appear confused.
dx: history, UA, US, urine dipstick (tests for leukocytes & nitrates).
pH: 7.27 / PaCO2: 49 / HCO3: 24
respiratory acidosis or alkalosis?
metabolic acidosis or alkalosis?
respiratory acidosis with partial comp.
ex: COPD, anesthesia, OD.
Select the findings of malignant tumors (SATA).
a. differentiated.
b. slow growing.
c. encapsulated.
d. invasive (metastasis).
e. varied size and shape.
f. fast growing.
d, e, & f.
Benign: Similar to normal cells / Growth: relatively slow / Remains local / Rarely life threatening.
Malignant: Varied in shape and size / Rapid growth / Metastasizes / Systemic effects / Life threatening.
Which statements are true with Diabetic Ketoacidosis? (SELECT ALL THAT APPLY)
a. ketones in urine.
b. caused by type I diabetes.
c. dehydration.
d. metabolic Alkalosis.
e. caused by type II diabetes.
f. metabolic Acidosis.
a, b, c, & f.
DKA (caused by illness, stress, inadequate management) dehydration, metabolic acidosis, sugar >300, Kussmauls resp, fruity odor breath, hyperkalemia, polyuria, thirsty ~ tx insulin, fluids, electrolyte replacement, when BG hits 250 = dextrose bc we don’t want pt to get hypoglycemic too quickly = cerebral edema, insulin causes hypokalemia bc insulin causes K to shift into cells.
HHS is caused by type 2 diabetes / don't have ketones / characterized by dehydration & hyperglycemia >600.
Which disease process is noted to cause a reduction in oxygen transport in the blood?
a. anemia.
b. congestive heart failure.
c. polycythemia.
d. disseminated intravascular coagulation.
a. decrease in hemoglobin content reduces oxygen transport in the blood.
(polycythemia: too many RBCs / DIC: blood clots are excessively formed in the body's blood vessels).
r/f: chronic blood loss, insufficient iron intake, severe liver disease, genetic, alcoholism.
s&s: fatigue, tachycardia, pallor, dyspnea.
dx: blood tests (hgb, hct, iron, vitamin b12).
You're educating a group of nursing students about the different stages of a pressure injury. Which statement is correct about a stage 3 pressure injury?
a. there is full loss of skin tissue that can extend to the muscle, bone, or tendon.
b. a hallmark of a stage 3 pressure injury is that the skin will be intact, but it does not blanch.
c. the skin will not be intact and there will be full loss of skin tissue that can extend to the subcutaneous tissue.
d. the wound edges will never roll away (epibole) as with a stage 2 pressure injury.
c.
•Stage 1: intact skin with localized non-blanchable erythema / does not turn white.
•Stage 2: partial thickness wound / top layer of the skin is lost & may look like a blister.
•Stage 3: full thickness wound, subcutaneous tissue may be visible.
•Stage 4: full thickness with exposed bone, tendon, or muscle.
•Unstageable happens when there is slough (yellow, tan) or eschar (brown, black) present.
Which signs & symptoms could present with fluid volume deficit in an adult patient? (SATA).
a. pitting edema.
b. crackles.
c. dehydration.
d. orthostatic hypotension.
e. weak pulse.
f. confusion.
g. weight loss.
c, d, e, f, & g.
hypovolemia (out of Na & water): thirsty, dry sticky mucous membranes / serious in infants & older adults (increased risk for fluid issues).
hypervolemia: rf: HF, KF, SIADH, infants (70% of body is water) / s&s: edema, confusion, crackles, pulm congestion, bounding pulse, JVD, tachycardia, high BP, little to no UO / labs: decreased HCT, decreased Na (more H20 > Na).
3rd spacing (excessive fluid in nonfunctional areas): rf: transfusion rx, anaphylactic shock / s&s: edema, SOB, increased RR / ascites [high pressure in certain veins in the liver & low albumin in the blood] [caused by liver issues] - fluid in abdominal cavity.
Which of the following are risk factors for development of a DVT? (SATA)
a. hypoalbuminemia.
b. increased coagulability of the blood.
c. pulmonary edema.
d. immobility.
e. surgery.
b, d, & e.
DVT (clot formation in the leg due to lack of blood flow) / s&s: pain, warmth, redness, swelling.
Stasis of blood (surgery, immobility, traveling for long hours, afib) / Hypercoagulability (OC use, postpartum, cancer) / Endothelial damage to the vein (PICC lines, IVs, vesicant meds).
DVT can lead to a PE (clot that obstructs pulm artery or a branch blocking blood flow through lung tissue / s&s: SOB, coughing up blood, chest pain, low Spo2, tachycardia, tachypnea / dx: MRI, doppler U/S & venography determine source of clot.)
The nurse is teaching a client about risk factors for the development of atherosclerosis. The nurse should educate on....? (SATA).
a. sedentary lifestyle & obesity.
b. high cholesterol levels.
c. young age.
d. smoking.
e. high HDL levels.
a, b, d.
CAD umbrella term for diseases that cause narrowing of coronary arteries leading to poor perfusion to the heart tissue.
Narrowed artery leading to decreased oxygen and blood flow.
Atherosclerosis – fatty plaque buildup in arteries = narrowing.
r/f: Age, lifestyle, smoking genetics, obesity, DM, modifiable vs nonmodifiable.
s&s: chest pain, SOB, hypertension, tachycardia.
Dx: angiogram (uses x-ray images to see any blockages in blood vessels), blood tests (LDL, cholesterol, triglycerides).
A 67-year-old male patient with COPD is receiving oxygen at 1L/min per nasal cannula. Which statement by the nurse best explains to the daughter how this therapy prevents respiratory depression?
a. "your father's breathing effort is driven by lower oxygen levels."
b. "your father's breathing effort is driven by a low carbon dioxide level.
c. "your father will retain metabolic acidosis if the o2 level is too high."
d. "your father will breathe best when he has a moderately high o2 level."
a. pt w copd tend to have low o2 levels & high co2 levels. cannot tolerate high levels of o2 bc hypoxia becomes the main stimulus for ventilation in pt with chronic hypercapnia. increasing o2 levels would decrease the stimulus to breathe.
COPD - emphysema (destruction of alveolar walls) & chronic bronchitis (affects the bronchi).
r/f: smoking, air pollution, chronic lung disorders, genetics.
s&s: dyspnea, hyperinflation, barrel chest, clubbing of finger, orthopnea, tripod position, fatigue, wheezing, pursed lip breathing.
dx: CXR, PFT.
Identify the disease for each of the following: scabies, urticaria, HS1, atopic dermatitis, Kaposi sarcoma.
1. most associated with HIV & AIDS.
2. commonly known as hives.
3. caused by a mite.
4. commonly known as cold sores.
5. commonly known as eczema.
1.Kaposi sarcoma / 2. Urticaria / 3. Scabies / 4. Herpes simplex 1 /5. Atopic derm.
Which of the following is a cause of respiratory acidosis?
a. hyperventilation.
b. anxiety.
c. diabetic ketoacidosis.
d. COPD.
d,
pneumonia, OD (resp acidosis is when the body is retaining CO2 / pale, dizziness, hypoventilation [hypoxia], pale skin, rapid shallow resp, hyperkalemia.
a, b, & mechanical ventilation cause resp alkalosis (body is losing CO2 / hyperventilation, tachy, anxious, hyper reflexes, seizures, hypokalemia, numbness).
c, DKA, diarrhea, dehydration, renal failure is metabolic acidosis (too much acid, too little bicarb / flushed skin, warm, Kussmauls resp, N, V, hyperkalemia, muscle twitching, decreased reflexes.
met alka. antacids, V, NG suctioning. (too much bicarb, too little acid / hypokalemia, confusion, N, V, dizzy, tremors, muscle cramps, & tingling (low ca).
Which of the following are risk factors for osteoporosis? (SATA)
a. aging.
b. excessive wear and tear on joints.
c. sedentary lifestyle.
d. excessive use of glucocorticoids.
e. deficit of calcium and vitamin D.
f. cigarette smoking.
a, c, d, e, & f.
b- osteoarthritis.
bone resorption exceeds bone formation = thin, fragile bones / decrease in bone mass & density.
s&s: back pain, fractures, abnormal curvatures of the spine, loss of height.
rf: women, old age, Cushing's syndrome, sedentary life, deficiency in vitamin D & calcium.
dx: bone density scans, x-ray.
The client in the emergency department who is diagnosed with acute MI asks the nurse to explain how this occurred. The nurse should respond that an MI usually results from which pathophysiological mechanism?
a. obstruction of coronary artery with death of tissue distal to blockage.
b. spasm of a coronary artery causing temporary decreased blood supply.
c. a slow HR leading to decreased BP to myocardium.
d. dilation of the ventricular wall causing decreased blood supply.
a.
MI (total blockage – necrosis).
r/f: chronic HTN, atherosclerosis, smoking, poor diet/lifestyle, family hx, genetics.
s&s: pallor, dizziness, diaphoresis, chest pain that radiates to jaw and left arm, SOB, anxious,
dx: ecg, cardiac biomarkers - CK, CK-MB, troponin (highest known sensitivity / protein that is released & elevated during cardiac injury / released soon after MI and stays in body days after), MRI, CT.
complications: cardiogenic shock (heart is unable to pump effectively), CHF, thromboembolism (may result from a thrombus that develops over the infarct).
Match the definition to the correct type of dementia:
1. due to changes in the brain, plaques and tangles.
2. due to damage to the blood vessels.
3. rare; found in young people.
4. protein deposits are released which then affect brain regions involved in thinking, memory, and movement.
1. Alzheimer's / 2. vascular / 3. frontotemporal / 4. lewy body.
r/f: unknown, genetics, vascular disease, toxins.
s&s: gradual loss of memory, behavioral changes, confusion, indifferent, wandering, ADLs become difficult, incontinent, does not recognize family.
The nurse is obtaining a health history on a patient recently diagnosed with CRF. What predisposing health problem should the nurse expect to hear if this pt has the most common cause of CRF?
a. cystic kidney disease.
b. hypertension.
c. glomerulonephritis.
d. diabetic nephropathy.
d. causes glomerulosclerosis & thickening of the glomerular basement membrane & is the most common cause of CRF.
cystic kidney disease, glomerulonephritis, & hypertension are fewer common causes.
After obtaining an ECG on a client, you notice ST depression, inverted T wave, and a prominent u wave. What do you expect??
a. hypokalemia.
b. hyperkalemia.
c. hypocalcemia.
d. hypercalcemia.
a.
hypokalemia: (k - heart & muscle contraction). causes: not enough K or shifting into cells – vomiting, NG suctioning, wound drainage, malnutrition, diuretics, Cushing’s, insulin / s&s: “low & slow”, constipated (=paralytic ileus), lethargy, muscle cramping, thready pulse.
hyperkalemia: causes: kidney disease, meds, Addison's disease / s&s: "tight & contracted", diarrhea, abd cramping, peaked T waves, muscle twitching.