NUR 426 EXAM 2 QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026

NUR 426 EXAM 2 QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026 Cholesterolemia - Answers cholesterol in the blood FLACC scale - Answers face, legs, activity, cry, consolability Effluent - Answers waste fluid from dialysis? Dialysate - Answers fluid that passes through the peritoneal membrane in PD, or other membrane in HD to remove waste and add necessary substances via osmosis and diffusion Orthotics - Answers -devices to relieve pain from foot/ankle conditions -ex. shoe inserts, ankle braces, custom devices Dehiscence - Answers separation of wound edges Bruit - Answers whooshing sound heard over the AV fistula indicating proper blood flow for dialysis Oliguria - Answers less than 400 ml/24 hrs of urine output, or less than 0.5 ml/kg/hr Ventricular septal defect (VSD) - Answers hole between the right and left ventricles where blood flows from the left side to the right side Broviac central line - Answers type of tunneled central line, often for long-term use Kernicterus - Answers high levels of bilirubin in the brain causing lethargy, seizures, muscle weakness, hearing loss, and cerebral palsy Hernia - Answers tissue/organ pushes through a weak surrounding area to cause a lump/bulge Significance of high phosphorus - Answers proteins, dairy, nuts, increased renal absorption, CKD (more common in advanced CKD) Significance of low phosphorus - Answers low calcitriol (free phosphorus binds to calcium causing calcification), long-term use of phosphate binders Significance of high calcium - Answers increased calcium intake, too much Vit D Significance of low calcium - Answers low calcitriol in CKD (unable to absorb calcium, free calcium binds to phosphate causing hypocalcemia, risk for fractures, and calcifications), Vit D deficiency Significance of high magnesium - Answers potential risk with CKD (more at risk with dietary magnesium and Milk of magnesia) Significance of low magnesium - Answers poor absorption, related to hypokalemia What electrolytes are included in a CMP? - Answers calcium, sodium, potassium, bicarbonate, chloride Significance of high CMP - Answers CKD/AKI depending on the electrolyte Significance of low CMP - Answers fluid overload, also depends on the electrolyte (ex. Bicarb is low in AKI) Significance of high ALT or AST - Answers hepatitis, chronic alcohol use, cirrhosis Significance of low ALT or AST - Answers CKD, Vit B6 deficiency Significance of high WBC - Answers infection, immune response Significance of low WBC - Answers neutropenia, immunocompromised (autoimmune, chemo) Significance of high BUN - Answers kidney dysfunction, dehydration, corticosteroids, catabolism from infection, fever, severe injury, GI bleed Significance of low BUN - Answers liver damage, very low protein diet Significance of high Hgb - Answers COPD, HF, congenital heart defects (increased need for o2 carrying capacity) Significance of low Hgb - Answers hemorrhage, decreased RBC production, anemia Significance of high Hct - Answers dehydration Significance of low Hct - Answers hemorrhage, decreased RBC production, anemia Significance of high platelets - Answers platelet disorder Significance of low platelets - Answers hemorrhage, DIC, chemotherapy Significance of high creatinine - Answers kidney dysfunction Significance of low creatinine - Answers liver disease Significance of high sodium - Answers dehydration, inappropriate activation of the RAAS system Significance of low sodium - Answers fluid overload, diuretic phase of AKI Significance of high potassium - Answers CKD/AKI, potassium-sparing diuretics Significance of low potassium - Answers loop/thiazide diuretics, diarrhea, related to hypomagnesemia Significance of high lactate - Answers sepsis/infection, kidney/liver disease Significance of low lactate - Answers very rare/uncommon Significance of high BG - Answers diabetes, PD Significance of low BG - Answers hypoglycemia, insulin administration Cerebral Palsy - Answers -Permanent, non-progressive disorder; static, but symptoms can change -Dystonic: involuntary sustained muscle contraction causing twisting/repetitive movements Cerebral Palsy: Dyskinetic - Answers -Fluctuating tone -Loss of voluntary control, abnormal tone/posture/coordination; can increase with stress, normal tone during sleep -Major cause: kernicterus -Dystonic (slow/twisting movements) or athetoid (chorea-abrupt, jerky wormlike movements of limbs and facial muscles) -Hearing loss, dysarthria, swallowing, drooling Cerebral Palsy: Spastic - Answers -increased tone -80% of cases, most common -Cortex is affected -Increased DTRs, hypertonia, tense/contracted muscles, flexion; follows hypotonia -One or all limbs -Spastic gait: knees pulled together/bent, feet turned in -Diplegic: legs more than arms -Hemiplegic: one side of the body -Quadriplegic: all 4 extremities, epilepsy and cognitive impairment likely -May be mixed with dyskinetic*** Cerebral Palsy: Ataxic-Non-Spastic - Answers -5% of cases -Lack of coordination/equilibrium; appears clumsy/shaky -Poor balance with walking and picking up objects -Fine motor impairment, wide based gait, challenges with quick/precise movements, intention tremor, hypotonia Cerebral Palsy: interventions - Answers -Interprofessional approach, set realistic functional goals and re-evaluate them, medications, surgery -Botox, Baclofen, benzos, meds to manage symptoms such as constipation, gabapentin, Parkinson's drugs -Dental hygiene (cavities), g-tube feeds, frequent rest, safety, braces (AFOs, dec deformity, inc gait efficiency, control alignment), manage constipation (fluids), manage chronic resp infections (dec clearance, GERD, pneumonia, tone/immobility), skin issues (PIs, nutrition, immobility), behavior management (ADHD/vision/speech) -During spastic episodes, encourage relaxation -Goal is to achieve maximum potential -Most common cause of death is resp disease such as aspiration pneumonia Cerebral Palsy: nursing assessment - Answers -gross motor delays, abnormal motor performance, altered muscle tone, abnormal posture, reflex abnormalities, speech/hearing/vision/cognitive impairment -slower to walk to stand -early unilateral hand presence, but do not show handedness before 1 year -poor feeding and gagging due to tongue thrust hard to dress/diaper because of muscle tone, rigid and unbending at hips when pulled to sitting position -not seen during sleep -Babinski reflex positive after 2 years, poor gag reflex, moro reflex positive, grasp reflex positive -primitive reflexes do not go away, gross and fine motor coordination are affected -hypertonia, increased muscle activity -muscles constantly flexed so scissor gait may be present because adductor muscles are constantly flexed -toe walk caused by calves that are always flexed which pull Achille tendon up and walk on toes -hypotonia periods can be seen in young infants with spastic cerebral palsy -arching of back (opisthotonic posturing) -hands fisted and elbows flexed Cerebral Palsy: diagnosis - Answers -clinical history -physical exam -neuroimaging (narrows etiology) -standardized developmental assessments -no dx at birth (2-5 yrs) -developmental delays at 2-4 mo Cerebral Palsy: comorbidities - Answers -epilepsy -musculoskeletal impairments -intellectual disabilities -feeding problems -visual/hearing impairment -communication difficulties Cerebral Palsy: causes - Answers -Prenatal: brain abnormalities, infection, toxic exposure -Perinatal: TBI, hypoxia, prolonged labor, stroke, bradycardia, premature birth -Postnatal: bacterial/viral meningitis, hypoxia, seizures, kernicterus, multiple births, trauma Idiopathic Spina Bifida - Answers -Neural tube defects -common risks are folic acid deficiency and maternal alcohol/drug use Spina Bifida: Cystica - Answers 2 types both have protruding sacks Spina Bifida: Cystica Meningocele - Answers sac with CSF and meninges Spina Bifida: Cystica myleomeningocele - Answers sac with CSF, meninges, and nerves Spina bifida: Occulta - Answers -part of the spinal column is missing, skin covers defect -May go undiagnosed -May see tuft of hair, sacral dimple, or birthmark over site Spina Bifida: associated issues MS - Answers -paralysis -contractures -deformities of knees/hips/feet/spine -skin breakdown -consult ortho Spina Bifida: associated issues GI/GU - Answers -neuropathic bladder -urinary incontinence (may do Mitrofanoff procedure to divert with a stoma) -control bowels with diet and regular toilet habits (antegrade enema) Spina Bifida: hydrocephalus - Answers -nonobstructive or obstructive (infection/neoplasm/trauma); shunts (VP, VA, LP) -Monitor for: increased ICP (shunt malfunction, headache, pupil changes, projectile vomit, bulging fontanelles, high-pitched cry), infection (fever, poor feeding, vomiting, seizures, dec LOC, inflammation along shunt track, abdominal distension) -Revisions for growth, obstructions, and breaks Spina Bifida: common sensitivity - Answers latex Spina Bifida: before surgery - Answers -Keep sac moist/sterile (saline-soaked, non-adherent dressing Q2 hr, do not pull if sticky) -Skin care, protect from urine/feces -Prone position with hips flexed/legs abducted -Keep in isolette -Latex precautions, no latex pacifier -educate/support family -Prevent rupture of sac to avoid infection/neuro issues (possible neuro deficit is most important for functional ability) Spina Bifida: after surgery - Answers -Assess surgical site and head circumference (risk for hydrocephalus) -Monitor VS/neuro VS -Encourage contact with parents/caregivers -Positioning (prone/hips flexed) -Skin care -Feeding is okay Examine issues that a client with a disability manages in order to live as independently as possible - Answers -severity of disability -type of disability- physical, visual/hearing, psychiatric/mental health, cognitive/intellectual, communication, combo of any or all the above -whether disability is visible or not to others -less healthcare available, lower quality for those with disabilities -thinner margin of safety -negative attitudes -poor communication -compromised care -fear about hospitalization- fear of being left out, sense of vulnerability, lack of control Cellulitis - Answers -Inflammation of subcutaneous tissues, can include deep inflammation due to bacterial enzymes -Primary or secondary infection often following a break in the skin, may need a C/S -Hot, tender, red with diffuse borders (mark around area); fever, chills, malaise Cellulitis: interventions - Answers -Topical interventions: warm/cool compresses, immobilization, elevation -Systemic interventions: systemic antibiotics, may require hospitalization for IV antibiotics, can progress to gangrene in untreated Risk factors for sepsis - Answers -immunosuppression -use of antibiotics or corticosteroids -older age/infancy -invasive devices (catheters, CVADs) -long hospital stay -diabetes -chronic kidney/liver disease Sepsis: pathophysiology - Answers -Begins as a bacterial or fungal infection -Dysregulated host response to infection leading to organ failure Sepsis: clinical manifestations - Answers -Confusion -unusual behavior -fever -hypoxia -HOTN -tachypnea -non-specific -generally feeling unwell Sepsis: diagnosis - Answers -Blood cultures x2 -Serum lactate (over 4 is sepsis) -CXR -Pancultures (urine, sputum, stool, wound) -Blood gases (resp alk, met acidosis, resp acidosis) -Coags, CMV, EBV, fungal blood tests Sepsis: clinical management - Answers -Rapid antibiotic therapy after cultures -Maintain tissue oxygenation with hemodynamic support -Nutrition/metabolic needs -Support failing organs -Prevent complications SIRS/MODS: Respiratory - Answers -ARDS -dec compliance -dyspnea -refractory hypoxemia -pulmonary HTN SIRS/MODS: CV - Answers -dec BP/MAP/SVR -inc HR/CO/S -massive vasodilation -biventricular failure SIRS/MODS: CNS - Answers -confusion -disorientation -delirium -fever -seizures SIRS/MODS: endocrine - Answers hyper to hypoglycemia SIRS/MODS: renal - Answers -hypoperfusion -ATN SIRS/MODS: hepatic - Answers -inc liver enzymes -jaundice -inc ammonia SIRS/MODS: hematologic - Answers -inc bleeding times and d-dimer -dec platelets Sepsis: emerging research and evidence based interventions - Answers -antibiotics should be broad spectrum -fluid boluses as appropriate, crystalloid solutions recommended (ex. LR or Plasma-Lyte) -goal MAP of 65 -glucocorticoids not recommended -vasopressors for hemodynamic stability, norepi is first line -lactate above 4= sepsis -no benefit from colloids Sepsis: septic shock - Answers -circulatory -cellular, and metabolic abnormalities -fluid-refractory HOTN requiring pressors Sepsis to SIRS - Answers -Widespread inflammation: hormonal/tissue/vascular changes, abnormal clotting/micro-emboli, cytokine release, hyperglycemia -HOTN, increased capillary permeability, activation of coagulation cascade -Caused by infection*, injury, infarction, ischemia (sepsis is SIRS caused by infections*) SIRS: signs and symptoms - Answers defined as two or more: -36temp38 -HR90 -RR20 -4000WBC12000 -neutrophil10% SIRS to MODS - Answers -2+ organ systems fail, respiratory is often first to go due to inc o2 demand -HOTN, hypoperfusion, micro-emboli, incorrect blood shunting -AKI, liver dysfunction (hypermetabolism) -Homeostasis cannot be achieved without intervention Renal system functions: kidneys - Answers Filter blood plasma