Advanced Med-Surg Principles Jersey College Final Questions and Answers

Advanced Med-Surg Principles Jersey College Final Questions and Answers Ch 13: What helps to regulate muscle contraction and relaxation? - calcium Ch 13: What affects threshold potential? - calcium Ch 13: What contributes to muscle weakness and come? - hypercalcemia Ch 13: What contributes to muscle irritability and tetany? - hypocalcemia Ch 13: What helps with carb and protein metabolism, and affects neuromuscular function and produces vasodilation? - magnesium Ch 13: What lowers the resting membrane potential and makes cells less irritable which could result in an ileus? - hypokalemia Ch 13: What may cause diarrhea, irritability, muscle weakness, and EKG changes (such as tall tented T waves, absent P waves, prolonged PR interval and QRS duration)? - hyperkalemia Ch 13: What may cause muscle weakness, EKG changes (inverted T waves and ST depression), a weak irregular pulse, paralytic ileus, tachydysrhythmias (premature ventricular contractions (PVCs) and ventricular tachycardia (VT)), constipation, and U waves? - hypokalemia Ch 13: What do pts with hypernatremia present with? - thirst - dry muscous membranes - lethargy - restlessness - tachycardia - HTN Ch 13: What are S/S of hypocalcemia? - tetany (a classic sign) - muscle twitching - bronchospasms - laryngeal spasms - seizures - hyperirritability Ch 13: What is a classic sign of low mag (hypomagnesemia)? - tetany Ch 13: What are the clinical manifestations of hyponatremia? - constant headaches - seizures - lethargy - tachycardia - decreased BP - thready pulse - hyperactive bowel sounds - abdominal cramps Ch 13: What slows the depolarization of the cell membrane? - hyponatremia Ch 13: What shifts fluid from the extracellular to the intracellular compartment? - hyponatremia Ch 13: What is lossed from the GI (vomiting, diarrhea, suctioning), renal (diuretics, adrenal insufficiency, kidney disease), and integumentary systems (ascites, burns, peripheral edema)? - sodium Ch 13: What happens in hyponatremia? - there is a reduction in intravascular volume so BP decreases Ch 13: What should you do in the setting of hyponatremia with fluid overload? - restrict fluids Ch 13: What do you monitor in the setting of hyponatremia? - LOC - vital signs - I's & O's - weight Ch 13: What can sever hyponatremia result in? - seizures - coma - respiratory arrest Ch 13: What increases serum osmolality and pulls water out of the cells? - hypernatremia Ch 13: What puts a pt at risk for hypernatremia? - excessive sodium intake - excessive sodium retention - loss in fluid from being NPO - from an illness (ie: hyperglycemia, watery diarrhea, DI, or diarrhea) Ch 13: Who is at a greater risk for hypernatremia? - the elderly due to an impaired thirst mechanism Ch 13: What do you prepare in the setting of hypernatremia? depending on the serum osmolarity infuse: - hypotonic IV fluids (.45%) - isotonic IV fluids (0.9%) Ch 13: What is a decrease in serum sodium level (hyponatremia) followed by? - a decrease in serum osmolality (270 mOsm/L) Ch 13: What is an increase in serum sodium level (hypernatremia) followed by? - an increase in serum osmolality (300 mOsm/L) Ch 13: What does hypokalemia result from? - loss of potassium from the kidneys - burns - shifted into the cell Ch 13: What is cardiac arrest a complication of? - potassium imbalances Ch 13: What do you check prior to administering potassium? - renal function Ch 13: What foods would you educate a pt on that are high in potassium? - avocados - bananas - cantaloupe - broccoli - dried fruit Ch 13: What do you NEVER administer as an IV push? - potassium Ch 13: What do you reduce hyperkalemia with? - insulin - sodium bicarb - kayexalate - diuretics Ch 13: What are two classic signs of hypocalcemia? - Chostek's sign ("C" for cheek) - Trousseau's sign (happens when inflating a BP cuff) Ch 13: What are three main causes of hypocalcemia? 1 - end-stage renal disease 2 - malabsorption 3 - post thyroidectomy Ch 13: What is a oncologic emergency? What is it marked by? - hypercalcemia is marked by: - progressive change in LOC - hyporeflexia (muscles don't respond to stimuli) - ileus (a painful obstruction of the ileum/intestine) - constipation - polyuria 9abnormally large volumes of dilute urine) - polydipsia (abnormally great thirst) Ch 13: What do you assess with hypermagnesemia or when administering mag sulfate? - DTR (deep tendon reflexes) - RR (respiratory rate) Ch 13: Replacing fluid loss from profuse diaphoresis without providing electrolytes could lead to? - complications R/T overhydration (hyponatremia) Ch 13: What can IV calcium administration cause? - cardiac arrest Ch 13: What foods would you educate the pt on that are high in calcium and mag? - dairy products - dark green leafy veggies Ch 13: What med promotes fluid reabsorption by the kidneys? - vasopressin (antidiuretic hormone) Ch 13: What is the primary determinant of whether urine is dilute or concentrated? - antidiuretic hormone Ch 13: What are major factors in determining the serum osmolality? - sodium - glucose - BUN (blood urea nitrogen) Ch 13: What do you administer in the setting of acute hyponatremia? - 3% hypertonic fluid as ordered Ch 13: What moves fluid from the intravascular compartment to the intracellular? - hydrostatic pressure Ch 13: Who has a higher percentage of fluid volume to surface area and small shifts in intravascular volume increases their risk for FVD (fluid volume deficit)? - children Ch 13: What is triggered by a decrease in renal perfusion which results in an increase in blood volume and pressure (increased in perfusion)? - the R-A-A cascade (renin, angiotensin, & aldosterone) Ch 13: What will dehydration, an elevated BUN, protein level, or hyperglycemia increase? - osmolarity (300 mOsm/L) Ch 13: What can rapid infusion of an IV solution in the elderly cause? - increased risk of PE (pulmonary edema) Ch 13: What creates hemocentarion which is evidenced by an increase in Hct & Hgb? - dehydration - hypovolemia Ch 13: What two things increase in the setting of dehydration? - urine specific gravity (USG) - serum sodium Ch 13: What can changes in fluid volume effect in blood volume and can contribute to? either: - HTN - hypotension CH 13: What are the clinical manifestations of dehydration? - hypernatremia - orthostatic hypotension - a drop in central venous pressure - confusion - weakness - thirst - weight loss - oliguria (abnormally small amounts of urine) - sunken eyeballs - tachycardia - thready pulse Ch 13: What can pts with hypovolemia present with? - HTN - tachypnea - tachycardia - dyspnea - crackles - edema - distended neck veins Ch 13: What is a complication of fluid volume overload? - pulmonary edema Ch 13: What creates a state where cells are not perfused (cardiogenic/heart pump fails; hypovolemic/intravascular volume drops; distributive/wide spread vasodilation along with increased capillary permeability)? - shock Ch 13: What can a loss in fluid volume lead to? - drop in perfusion - hypovolemic shock - death Ch 13: Why would you change a pt's position slowly? - to prevent orthostatic hypotension Ch 13: A loss oc 25% of the intravascular volume could lead to? - shock Ch 13: What would you do for pts at risk for shock? - monitor their vitals closely Ch 13: What may happen in the setting of liver failure with fluid volume? - fluid volume overload may occur Ch 13: What can edema result from? - increase in hydrostatic pressure - decrease in oncotic pressure Ch 13: What med should NEVER be used in the presence of renal failure? - potassium sparing diuretics Ch 13: What can be given to relax smooth muscle? - mag sulfate (is a calcium antagonist) Ch 13: What is the antidote for tetany or hypermagnesemia? - calcium gluconate Ch 13: What are used to treat fluid overloand but electrolytes are lossed along with fluid? - diuretics Ch 14: What does a decrease in pulse pressure (30 mm Hg) suggest? - decrease in stroke volume - decrease in CO (cardic output) Ch 14: What does an increase in pulse pressure suggest? - increase in stroke volume - increase in CO (cardiac output) Ch 14: What is the normal central venous pressure? - 4 to 12 mm Hg Ch 14: What do higher levels of central venous pressure (12 mm Hg) suggest? - an increased in right atrial pressure (Fluid volume overload Ch 14: What do lower levels of central venous pressure (4 mm Hg) suggest? - a drop in right atrial pressure (shock) Ch 14: CO (cardiac output) x (times) peripheral vascular resistance = - blood pressure Ch 14: What are two vasoconstrictors that increase BP? - norepinephrine (Levophed) - vasopressin (Pitressin) Ch 14: What three things are necessary for cerebral perfusion? - adequate CO - adequate BP - intact vessels Ch 14: How do you calculate pulse pressure? - systolic minus diastolic = pulse pressure Ch 14: What two things is pulse pressure a reflection of? - stroke volume - CO Ch 14: What is normal pulse pressure? - 30 to 40 mm Hg Ch 14: What meds stimulate alpha-adrenergic receptors causing blood vessels to constrict? - vasoactive meds (alpha receptors, beta receptors, dopamine) Ch 14: What vasoactive meds increase the HR and force the contraction? - beta-1 receptors Ch 14: What vasoactive meds result in vasodilation of blood vessels supplying the heart and skeletal muscles, and bronchiole dilation? - beta-2 receptors Ch 14: Why would you monitor a pt closely when administering a colloidal solution? - an anaphlyactic reaction could occur Ch 14: What do PPI's (proton pump inhibitors) end in? - prazole (ie: pantoprazole) Ch 14: What is the purpose of PPI's (proton pump inhibitors)? - decrease gastric acid secretion Ch 14: What two meds do you give a pt in anaphylactic shock? - epi - antihistamines Ch 14: What four meds work to inprove contractility, stroke volume, and CO? - dobutamine (Dobutrex) - epi (Adrenalin) - dopamine (Intrpoin) - milrinone (Primacor) Ch 14: What meds would you administer to clients in septic shock? - norepinephrine - antibiotics - herparin - followed by clotting factors Ch 14: What can inadequate tissue perfusion lead to? - multiple organ failure - ARDS - renal failure - MI - liver failure Ch 14: What organ is typically the first to decline in multiple organ dysfunction syndrome? - the lungs CH 14: What are the three stages of shock? 1 - compensatory 2 - progressive 3 - refractory (the earlier the intervention the better the chance of survival) Ch 14: What happens as shock progresses? - HR increases - systolic BP drops below 90 mm Hg - RR increases - urine output decreases - skin is clammy, cold, and pale Ch 14: Why would you monitor for risk of shock closely before the BP drops? - because tissue damage will have already occurred once the BP drops Ch 14: What are two interventions of early shock? - IV fluids - O2 Ch 14: What do early signs of shock result from? stimulation of the SNS and could include: - decrease in urinary output - cool clammy skin - increase in BP - tachycardia Ch 14: What does the body use to create clots? - fibrinogen Ch 14: What happens when the body's supply of fibriogen is exhausted? - pt hemorrhages - blood oozes out of membranes and any puncture sites Ch 14: What stage of shick do pts fail to respond to treatments? - refractory/irriversible stage Ch 14: What can hypovolemic shock be caused by? - hemorrhage - dirrahea - dehydration Ch 14: What should you do in the setting of hypovolemic shock? - provide volume replacement prior to vasopressors to optimize BP Ch 14: What meds do you prepare to administer to a pt in cardiogenic shock to reduce afterload? - inotropic agents - vasopressors