Thyroid
What are the expected hormone levels for both hypothyroidism and hyperthyroidism? (TSH, T3, and T4)
Hypothyroidism - high TSH, low T3, low T4
Hyperthyroidism - low TSH, high T3, high T4
What are the three most common signs/symptoms in Type 1 and Type 2 diabetics?
Polyuria, polydipsia, and polyphagia
Virchow's Triad consists of what three mechanisms?
Venous stasis, endothelial injury, and hypercoagulability
One thing that nurses should remember/believe when a sickle cell patient comes to the ED c/o a vaso-occlusive crisis is?
Their pain is absolutely real and should be treat accordingly.
The RN knows that the primary differences between Hodgkin's and Non-Hodgkin's lymphoma are what?
A contiguous pattern and Reed-Sternberg cells are present in Hodgkin's lymphoma but not Non-Hodgkin's lymphoma.
The patient's PTT is >150 and PT is 2. The nurse should expect to transfuse which blood product to lower these coagulation levels?
Fresh Frozen Plasma (FFP)
What are the three phases of peri-operative nursing?
Pre-operative, intra-operative, and post-operative
How should the nurse instruct the patient on how to take their levothyroxine?
Take in the morning on an empty stomach with water at least 30-60 min before food/other medications. Take the amount prescribed, do not double up on missed doses, and make sure not to take it with calcium, iron, and PPIs because it can decrease absorption.
How should the nurse describe to their patient how their insulin pump will function?
"The insulin pump is a subcutaneous pump that will deliver a basal rate of insulin. If you check your sugar and it is high and not covered by the basal rate, you are able to bolus additional units on the pump."
The MD orders a d-dimer for someone who has a DVT in the RUE. However, the nurse knows that which study is the first-line/gold standard for DVTs?
Duplex US
What is one of the most common side effects of ferrous sulfate?
A patient at the oncologist's office presents with c/o 3wks of constipation, polyuria, fatigue, and bone pain. Labs show an elevated creatinine, Bence-Jones proteins, and proteinuria. The RN knows that the patient will be diagnosed with what disease?
Multiple myeloma
The patient is receiving 1 unit of PRBC for a Hgb of 8. During the first 15 minutes, the patient states they feel itchy and have developed a rash over their upper torso. The nurse knows that the patient is experiencing what kind of transfusion reaction?
Mild allergic transfusion reaction.
The anesthesia team comes to pick up the patient in pre-op holding for their surgery. They notice that there is no signed consent form in their chart, so they ask the RN to get one and have the patient sign it. How should the nurse respond?
They should get a hold of someone from the surgery team to come to the bedside to have the patient sign the form. The nurse can only witness.
A patient is s/p a thyroidectomy. The nurse notices that they are starting to develop facial and UE muscle twitching. How should the nurse expect to treat this?
Give calcium gluconate because they no longer have a parathyroid gland and are showing signs of hypocalcemia.
Metformin should be used cautiously in those with renal and hepatic impairment because of what rare side effects?
Lactic acidosis
A patient presents to the ED following a MVC. They present tachycardic, tachypneic, altered, cold/clammy skin, and with oliguria. The MD does a FAST exam and notices free fluid in the abdomen. They suspect that the patient hemorrhaging into their abdominal cavity. Labs are sent off and a CT scan is completed. The patient then becomes significantly hypotensive and their Hgb comes back at 5. What should the nurse expect to be ordered?
Massive Transfusion Protocol (MTP) - PRBC:FFP:Platelets ~1:1:1.
A patient is diagnosed with vitamin-deficient anemia. They ask what the line of treatment is for this. The nurse responds with:
"You will need to receive Vitamin B12 replacement. You can receive this via IM shots, oral tablets, or nasal spray."
True or False: Acute Lymphoblastic Leukemia (ALL) is more common in male older adults.
False
The nurse knows that besides oxygen support, what is the first treatment for a severe anaphylactic blood transfusion reaction?
Epinephrine IM or IV and repeat q5-15min as needed.
The anesthesia team tells the patient that they will be sedated and have a breathing tube for their surgery. This is what kind of sedation?
The nurse is taking care of a patient who is in the ICU d/t myxedema coma. This was triggered because the patient developed a serious bacterial pneumococcal infection. The nurse should expect to be administering which THREE important classes of medications to this patient?
Thyroid hormone replacement (IV Levothyroxine/Synthroid), glucocorticoid (IV Hydrocortisone/Solu-Cortef), and antibiotic (Ceftriaxone/Rocephin)
A patient with DM2 in the ICU develops a blood sugar of 650 and serum osmolality of 320. The patient is losing liters of fluid because of the polyuria that is occurring. The nurse knows that which action is the top priority for this patient?
Replete the fluid loss with 0.9% NS. Usually give 1-1.5 L in the first hour for a total of 8-12 L replaced over 24 hours.
What are important educational points to go over with your patient who has been diagnosed with a DVT?
Elevate the affected leg, do NOT massage, ambulate/gentle exercise, compression therapy, and hydration
A dietician is educating a patient who has iron-deficiency anemia on heme-rich and Vitamin C-rich foods to add to their diet. These foods would include what?
Red meat, poultry, fish, green-leafy vegetables, beans, etc.
What does neutropenic precautions entail?
Wearing a mask in public, frequently washing your hands, avoiding large crowds, safely preparing food, and avoid contact with sick individuals.
The MD asks that the nurse premedicate their patient who has a history of febrile transfusion reactions because they are about to receive a unit of platelets. The nurse knows that they will be administering which two medications?
The nurse instructs the patient post-operatively how to use the incentive spirometer (IS). The patient asks why they have to keep using this because it hurts to take deep breaths. The nurse responds by saying:
"You should do 5 repetitions with the IS at least 8-10 times every waking hour. This helps expand the thoracic cavity and is one of the best ways to prevent HAP. I know that it hurts to take deep breaths, and we will cover your pain with the prescribed pain medications."
A patient presents to the ED with the following vitals: T 104 F, RR 40, HR 150, BP 200/95, and SPO2 89%. They also c/o diaphoresis, diarrhea, tremors, and bulging eyes. The RN realizes that the patient might be in a thyroid storm. What is the first treatment the RN should expect to do?
Administer a nonselective Beta-Blocker (i.e., Propanolol).
A patient presents with a blood sugar of 350, K of 3, and blood and urine are positive for ketones. The RN notices that the patient is having rapid, deep respirations, and informs the MD who orders an ABG. The ABG results are as follows: pH 7.28, CO2 35, HCO3 16, and pO2 80. The MD wants to bolus insulin and start a gtt, but the RN knows that they should do what first?
Replete the K
A patient goes into DIC. The nurse knows that the patient will need volume repletion (blood and IVF) as well as anticoagulation. However, the nurse should always remember that in order to get ahead of fatal complications of DIC, what should be done?
Treat the underlying cause/trigger that started the DIC cascade.
The patient with sickle cell anemia is prescribed Hydroxyurea and home O2 as needed. The patient knows that these two treatments help prevent/inhibit what?
They both prevent/inhibit the sickling that occurs with the RBCs.
The nursing student knows that treatment for Chronic Myeloid Leukemia (CML) includes what?
Chemotherapy (TKIs and cytoreductive agents) and stem cell transplant
The patient received a unit of platelets about an hour ago for a PLT level of 100. The patient starts to c/o of chills, flank pain, chest tightness, and shortness of breath. The nurse notices that their urine has turned pink-tinged and the patient is tachycardic and hypotensive. What should the nurse expect to do?
Stop the transfusion, infuse only 0.9% NS through the IV, use other IV fluids (LR and/or albumin), use vasopressors if needed, prevent DIC from occurring, and "bag and tag" the unit of blood.
The nurse notices that their post-operative patient's UOP has dropped to about 10-15mL/hr. Their Hgb is stable, so the nurse might expect to give:
IV fluids (NS, LR, albumin)