High or Low and Cancer
A patient presents with fatigue and constipation, a calcium level of 12.2 mg/dL, and ECG findings of a shortened QT interval. What electrolyte imbalance is occurring, and identify at least two appropriate interventions to support this patient?
Hypercalcemia
Administer IV normal saline to promote hydration and increase calcium excretion.
Give a loop diuretic (e.g., furosemide) to enhance renal calcium excretion.
Calcitonin inhibits bone resorption and increases renal calcium excretion.
Bisphosphonates inhibit osteoclast activity to prevent further calcium release from bone.
Cardiac Monitoring is important to assess for potential complications of shortened QT intervals, dysrhythmias, and heart block.
A 24-year-old college student presents to the emergency department with fever, severe headache, neck stiffness, and photophobia. Vital signs show temperature 102.5°F, heart rate 110 bpm, and blood pressure 100/60 mmHg. The provider suspects meningitis. Identify the diagnostics and treatments for this condition.
•Elevate the head of the bed to reduce ICP.
•Monitor neurological status closely
Medications: lorazepam, phenytoin, Decadron, IV fluids, antibiotics
A patient is admitted with acute pancreatitis and reports severe abdominal pain. What medications should the nurse expect the provider to administer?
IV analgesics (morphine, hydromorphone)
Antiemetics (ondansetron)
IV fluids
Proton pump inhibitors (omeprazole)
Pancreatic Enzymes (Pancrelipase)
Starting with the superior vena cava and ending in the left ventricle, identify the correct sequence of blood flow through the heart.
superior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary artery, lungs, pulmonary veins, left atrium, mitral valve, left ventricle
Describe the three causes of acute renal failure
•Prerenal: Decreased blood flow to the kidneys
•Interrenal: damage to the functional part of the kidney, the parenchyma
•Postrenal: involves the urinary system below the kidney, preventing the urine from draining
A postoperative patient arrives with tachycardia, hypotension, cool skin, and decreased urine output. The surgical dressing is saturated with severe drainage. What condition should the nurse suspect, and what are two priority interventions to support this patient?
•Hypovolemic Shock
2 large-gauge IV lines (or intraosseous if needed)
•Crystalloids: lactated Ringer’s, 0.9% NS
•Colloids: albumin (not hetastarch/dextran)
•Blood products
A 68-year-old patient admitted with pneumonia is confused, diaphoretic, and weak. The provider suspects sepsis. Identify four clinical manifestations of sepsis.
Fever, Tachycardia, Hypotension, Altered mental status/confusion, Tachypnea, Diaphoresis, Oliguria
A patient presents with right upper quadrant (RUQ) pain that worsens after eating fatty foods, accompanied by nausea and vomiting. Physical examination reveals tenderness in the RUQ and a positive Murphy’s sign. Laboratory results show mildly elevated liver enzymes. What is the most likely diagnosis, and which imaging test would confirm it?
Cholecystitis
Imaging: Ultrasound, HIDA scan, CT, MRCP, ERCP
Describe the pathophysiology of coronary artery disease
Atherosclerosis causes the coronary arteries to narrow, reducing the flow of blood, oxygen, and essential nutrients to the heart muscle.
This BPH medication works by shrinking the prostate over time through inhibition of the 5-alpha-reductase enzyme, while the other medication does not reduce prostate size but instead relaxes smooth muscle in the bladder neck and prostate to improve urinary flow.
Finasteride and Tamsulosin (Flomax)
A patient tests positive for a BRCA1 mutation. What types of cancer this patient is at increased risk for.
Breast cancer, prostate cancer, pancreatic cancer
This autoimmune arthritis often involves small joints of the hands and wrists symmetrically, and patients report morning stiffness.
Rheumatoid Arthritis (RA)
Based on risk factors and mode of transmission, determine which type of hepatitis each patient is most likely to have:
Patient X: History of intravenous drug use with no recent travel.
Patient M: Recently traveled to a developing country and consumed street food.
Patient X: Hepatitis C (bloodborne)
Patient M: Hepatitis A (fecal-oral)
Describe Type I, Type II, and Type III heart block
•If the R is far from the P, then you have a first-degree.
The signal’s slow, but every beat goes.
Just a delay, and nothing froze.
•Longer, longer, longer, drop! Then you have Wenckebach.
The PR grows until one’s missed.
A cycle that you can’t resist.
•If some Ps just don’t get through, then you have Mobitz II.
No warning signs, just sudden skips.
This one’s risky, watch those dips.
•If Ps and Qs don’t agree, then you have third-degree.
Atria and ventricles beat alone.
No connection, each on their own.
Name two labs to determine chronic renal failure severity.
Serum creatinine
Blood urea nitrogen (BUN)
Glomerular filtration rate (GFR)
Electrolytes (especially potassium, phosphorus, sodium)
Hemoglobin/Hematocrit (for anemia of renal disease)
A patient with pancreatic cancer is scheduled to start radiation therapy. Identify three key education points the nurse should include to prepare the patient.
Skin care at the treatment site: keep the area clean and avoid irritants.
Managing fatigue: plan for rest periods and energy conservation.
Monitoring for side effects: such as nausea, vomiting, diarrhea, or changes in appetite, and when to notify the healthcare provider.
A patient presents with fatigue, unintentional weight loss, and splenomegaly. Laboratory results show overproduction of mature granulocytes and the presence of the Philadelphia chromosome (BCR-ABL mutation). What condition does this suggest?
Chronic Myeloid Leukemia (CML)
During surgery, a patient under general anesthesia develops rapidly rising body temperature, muscle rigidity, tachycardia, and dark urine. The perioperative nurse suspects a rare but life-threatening condition triggered by certain anesthetic agents.
Malignant hyperthermia
What device is placed between the legs to maintain proper alignment following a total hip replacement?
Abduction pillow
A client with heart failure has a daily fluid restriction of 1,500 mL. During the 7:00 AM to 7:00 PM shift, the client consumed:
8 oz milk
6 oz broth
4 oz juice
2 oz water with medications
How much fluid in milliliters can the 7:00 PM to 7:00 AM nurse safely give the client?
900 mL
A patient with heart failure weighed 92 kg yesterday. This morning, the patient’s weight is 90.4 kg. One liter of fluid is approximately 1 kg.
How much fluid (in milliliters) has the patient lost?
1,600 mL
A patient with severe anemia presents with fatigue, pallor, and shortness of breath. The provider orders a packed red blood cell transfusion. What laboratory test should the nurse check to determine the need for a blood transfusion, and what are two nursing actions before starting the transfusion?
Diagnostics: Hemoglobin and hematocrit (H&H)
Interventions:
Verify patient identity and blood type to ensure compatibility.
Assess baseline vital signs before starting the transfusion.
Monitor for transfusion reactions during and after the transfusion
Before any surgical procedure, the nurse ensures the patient understands the procedure, risks, benefits, and alternatives, and confirms that consent has been signed voluntarily. This process is essential to protect the patient’s autonomy and legal rights.
Informed consent
What disorder presents with ascending symmetrical paralysis often following a viral infection?
What disorder involves autoimmune destruction of the neuromuscular junction, leading to fatigable weakness?
What disorder causes patchy CNS demyelination, resulting in episodes of visual changes and motor deficits?
Guillain-Barré Syndrome, Myasthenia Gravis, and Multiple Sclerosis?
Identify at least two key differences between addisons and cushings manifestations.
Addisons
•Loss of mineralocorticoids: hyponatremia (increased excretion of sodium), chloride, and water, and hyperkalemia (increased retention of potassium).
•Loss of glucocorticoids: hypoglycemia, muscle weakness, lethargy, GI symptoms (anorexia, weight loss, nausea, vomiting).
•Increased ACTH: hyperpigmentation of skin and mucous membranes.
Key Safety concern: Addisonian crisis
Cushings Key identifiers: central obesity, “moon face”, fatty “buffalo hump” in the neck and supraclavicular areas, heavy trunk, thin extremities, acne, oily skin, ↑wt. gain, hyperglycemia