NUR2790 Nursing3 Final Exam with Complete Solution

Non-modifiable risk factors for stroke? - ANSWER Age, family history, gender, sex, DM1 Modifiable risk factors for stroke? - ANSWER DM2, **HTN**, smoking, , sickle cell What should you teach a client about risk factors for stroke? - ANSWER **Monitor/control blood pressure**, Quit smoking, need to follow a healthy balanced diet, stop drinking/drug use, decrease BMI Diagnostic tests to evaluate stroke? - ANSWER CT, MRI, PET Scan INR, PT, aPTT, Creatinine, allergies, BMP, CBC What is the purpose of making sure a patient has normal creatinine lab before an MRI? - ANSWER To make sure their kidneys are working properly so they can flush out the dye Meds to prevent stroke? - ANSWER Neuroprotective, anti-platelets, anticoagulants If TPA is not an option, what else would you use? - ANSWER Heparin, Coumadin, Aspirin Describe the administration requirements of TPA? - ANSWER Administer within TPA 60 minutes of ER admission. MUST administer within 3 hours of signs/symptoms of stroke. Causes of TBI? - ANSWER SIDS, MVA, Falls, Sports, ETOH, drug use **MVA most common throughout all ages Describe and give examples of mild brain injury. - ANSWER -No long-lasting effects, rapid recovery -Concussion, Describe and give examples of moderate brain injury. - ANSWER -LOC (few minutes to hours) -Confusion (days even weeks) -Complete recovery or able to adapt to disability -Severe concussion Give examples of severe brain injury? - ANSWER -Prolonged LOC (days, weeks, months) -Severe deficits -Limited recovery -Permanent disability IE: vegetative state, coma, brain death Methods to decrease increased intracranial pressure? - ANSWER Mannitol Elevated head of bed No bending at waist Decrease stimuli/stress/straining/coughing Give oxygen, corticosteroids Bed rest **Align head/neck with rest of body Start IV What should be avoided in patients with ICP? - ANSWER Stimuli/stress/straining No smoking Give stool softeners/laxatives **No unnecessary suctioning!! **No lying flat! **No elevation of feet! What are three categories of tx for brain tumors? - ANSWER Surgery Radiation Chemo Treatments for embolytic stroke? - ANSWER **TPA, **If someone is unable to get TPA: heparin/ASA, shunts, angioplasty Sxs of hepatitis A. - ANSWER Mild flu-like sxs Most common reasons for hep A? - ANSWER Fecal/oral route Contaminated food/water More common in pediatrics Sxs of hepatitis B - ANSWER Jaundice N/V, anorexia Rash Changes in stool (light colored) dark colored urine Most common reasons for hepatitis B? - ANSWER Dirty needles, drug use, tattoos, needle-stick Sxs of hepatitis C? - ANSWER Mod-severe like flu symptoms Most common reasons for hepatitis C? - ANSWER Blood and plasma to skin/mucus Sxs of hepatitis D? - ANSWER Asymptomatic, co-infections may be more severe **In order to have D you must have B! Most common reasons for hep D? - ANSWER Blood/plasma, similar to hep b Sxs of hepatitis E? - ANSWER Mild flu like sxs Abdominal pain Fatigue Dark urine Causes of cirrhosis of the liver - ANSWER 1st) ETOH 2nd) post necrotic biliary 3rd)Right-sided heart failure Hepatitis B Biliary (blocked bile ducts) Hereditary Hepatotoxic drugs Males more common than females Primary treatment for elevated ammonia levels? - ANSWER Lactulose? What is the normal ammonia level? - ANSWER 15-45 (per NIH, not our book) What is the normal aPTT? - ANSWER 25-35 is ? the control What is the normal A1C? - ANSWER 4.5-6 What is the normal BUN? - ANSWER 8-20 What is the normal Calcium? - ANSWER 8.5-10.5 What is the normal chloride? - ANSWER 97-107 What is the normal creatinine? - ANSWER 0.6-1.2 What is the normal digoxin? - ANSWER 0.8-2 What is the normal Mg level? - ANSWER 1.8-3.0 What is the normal phosphorus level? - ANSWER 3-4.5 What is the normal WBC count? - ANSWER 5-10K Complications of a liver biopsy? - ANSWER #1-Bleeding/hemorrhage (most important!!) Infection, pain, N/V What organ is a major site for metastasis? - ANSWER Liver Common reasons for liver transplant (for an adult)? - ANSWER Cirrhosis, Common reasons for liver transplant (for children)? - ANSWER Biliary atresia What is the prevention method for hep b? - ANSWER Safe needle practices Vaccinations Get titer checked Prevent infection Safe sex practices List the phases of hepatitis? - ANSWER Preicteric (aka prodromal phase) Icteric Posticteric What happens in the Preicteric (prodromal) phase of hepatitis ? - ANSWER Time of the infection enters the body to the onset of s/sx Sx = fever, malaise n/v, decreased tolerance to smells, joint pain, itching What happens in the Icteric phase of hepatitis? - ANSWER Jaundice sets in Bile from liver is slowed/blocked (cholestasis) Dark urine Lighter stool color What happens in the Posticteric phase? - ANSWER Recovery phase Jaundice decreases Liver starts to repair itself Etiology and pathophysiology of hemochromatosis? - ANSWER Absorbing too much iron Inherited dz Typically comes from food Iron will eventually accumulate in liver, heart, joints, thyroid, testicles What can hemochromatosis result in? - ANSWER Liver failure, cirrhosis, liver cancer, CHF, cardiac arrhythmias, hypothyroidism, DM Tests for diagnosis of hemochromatosis? - ANSWER LFTs, Liver biopsy Treatment for hemochromatosis? - ANSWER Decreased iron load in the body (avoid red meat, lentils, iron-enriched breads and pasta, vitamin c, peas, shellfish, avoid anything that causes additional liver damage such as ETOH/Drugs). When do women typically get hemochromatosis? - ANSWER Post-menopause (ie: blood stops getting lost from the body) S/Sx of liver disease - ANSWER Jaundice **Hyponatremia (due to increased fluids in the body) Ascites Impaired metabolism Hypocalcemia Hypertension Increased risk of bleeding Issues w/potassium (hyper/hypo) Complications of shunt placement for portal HTN? - ANSWER **Pulmonary edema Hemorrhage Infection Patient education regarding Macrovesicular fatty liver? - ANSWER Avoid ALL ETOH!! Low fat diet Patient education regarding microvesicular fatty liver? - ANSWER Rest Small, frequent meals S/Sx of Macrovesicular fatty liver? - ANSWER Asymptomatic RUQ pain/tenderness Some jaundice Fatigue S/sx of microvesicular fatty liver? - ANSWER Very fatigue N/V S/sx of carpal tunnel? - ANSWER Numbness/tingling fingers Pain, swelling, fatigue S/Sx of rotator cuff tear? - ANSWER Pain, swelling, pain with ROM, pain with lifting arm What puts people at increased risk of carpal tunnel? - ANSWER A lot of typing What occupations put pts at increased risk of rotator cuff tear? - ANSWER Sports, ie: baseball pitchers Construction Pt education for ibuprofen? - ANSWER Take w/food Do not take if stomach ulcers Max dose is 2400mg/d **Can cause/increase bleeding Avoid ETOH Patient education/nurse cares regarding care of a fractured arm? - ANSWER Stabilize it (Cast, splint) Pain meds RICE CNS checks (pulse, numbness/tingling, color, CRT) Follow restrictions Report edema Treatment for carpal tunnel? - ANSWER Wrist splints x 6 weeks After splinting (if no success), then corticosteroids After corticosteroids, then surgery Serious complications for a fracture? - ANSWER Severe pain after treatment (think compartment syndrome) Unable to move digits Pt education for a meniscal injury? - ANSWER RICE Proper fitting shoes **Stretch before/after exercise Follow activity restrictions!! Typically 4-6 weeks May need knee immobilizer x 4-6 weeks Examples of prevention of stress fractures? (look at box 60-4) - ANSWER Avoid over-training Proper foot-wear Proper ergonomic movements Adequate warm-ups Not necessarily overweight (can go either weight) Gradual increase of intensity (10% per week) S/Sx of infection? - ANSWER Fever, redness, drainage, edema, tenderness, pain, tachycardia, tachypnea, increased WBC What should you do for/with a patient with ICP? - ANSWER Align head/neck with rest of the body, pacing cares, decrease stress/stimuli (ie: coughing, straining, bending at waist), head of bed elevated, stool softeners/laxative, limit suctioning, use mannitol (osmotic diuretic), bed rest Early indications of alteration in intracranial regulation? - ANSWER Changes in LOC, pupil changes, increase in urine output Late indications of alteration in intracranial regulation? - ANSWER HTN, decreased heart/respiratory rate, increased BP Describe the Glascow Coma Scale - ANSWER Assesses verbal, eye opening and best motor response What is the highest score on the Glascow Coma Scale? - ANSWER 15? What is the lowest score on the Glascow Coma Scale? - ANSWER 3 What is the typical scoring for a comatose patient (in regards to the Glascow Coma Scale)? - ANSWER 8 or less Causes of hyponatremia? - ANSWER Diuretics, SIADH, fluid overload Priority pts: SIADH, tumor releasing ADH! S/Sx of hyponatremia? - ANSWER ****Change in LOC Seizures Coma Crackles Muscle cramping S/Sx of hypokalemia? - ANSWER Flat T Waves Metabolic alkalosis ***Muscle weakness Decreased LOC N/V Postural hypertension ***Dysrhythmias S/Sx of hypocalcemia? - ANSWER Hyperactive reflexes Positive Chvotsky sign!!!! **Common in acute pancreatitis!! Trossau's sign Acid/Base r/t diarrhea (what is happening)? - ANSWER Metabolic acidosis due to loss of base Hypokalemia pH is going to be acidic Describe the three different methods of cancer prevention? - ANSWER Primary: Vaccinations, sunscreen, diet, exercise Secondary: Screenings/warning signs Tertiary: Chemo, CAUTION, prevent reoccurrence! Assessment pre-bone marrow transplant? - ANSWER Look for signs of infection (ie; temp) A patient with COPD with an acute respiratory infection, what ABG lab values would you see? - ANSWER **************************************************** ***************Look up on my own! Review CAUTION - ANSWER Risk factors for cancer overall? - ANSWER ****************************************************** ***************Look up on my own! What is the role of the SA node? - ANSWER Primary pacemaker of the heart What is the intrinsic rate of the SA node? - ANSWER 60-100 What is the role of the AV node? - ANSWER Backup pacemaker to the SA node What is the intrinsic rate of the AV node? - ANSWER 40-60 What is the bundle of HIS's function? - ANSWER Sends impulses from the AV node into the ventricles What do the Purkinje fibers do? - ANSWER The third and final pacemaker of the heart Distributes electrical impulses through the ventricles What is the intrinsic rate of the Purkinje fibers? - ANSWER 20-40 What is the importance of HGB? - ANSWER Transportation of O2 to the tissues What are the normal values of HGB? - ANSWER 12-15 What are other key points to HGB? - ANSWER If ? is asking for perfusion, you would look at CRT, vitals, etc. If ? is stating impaired gas exchange, hgb would play into that. **? review exam 2 Why would a newborn be at increased risk for developing anemia? - ANSWER Depletion of RBCs/HGB **They have to get rid of their immature RBCs otherwise they get jaundice then waiting for the body to start producing mature RBC/HGB Pt education for warfarin - ANSWER No sharp objects, observe for s/sx of bleeding, no fluctuation in the amount of vitamin K in their diet (must be consistent)!! Range is 2-3 What is the normal platelet count? - ANSWER 150-450K What type of patients are commonly on Warfarin? - ANSWER Stent/valve patients, DVT, A fib, hip replacements Pt education regarding a low platelet count? - ANSWER No physically harmful activities, electric razors, soft tooth brush What are some things to keep in mind regarding the bereavement process? - ANSWER Everyone grieves differently, crying is normal, adaption at different stages What is the definition of a sentinel event? - ANSWER Something that should never happen in a hospital. Death Serious injury Who is part of professional collaboration vs care coordination? - ANSWER Professional: RN, MD, Care coordination: can include people who are not professionals (care team, family, etc) Priority care for burns - ANSWER Fluid replacement Time of contact with burning agent Prevent infection Airway What are the different stages and priority of burns? - ANSWER Emergent: Airway, oxygen Acute: continue fluids, Prevent infection Rehab: Maintain highest level of functioning Uses for Atropine - ANSWER Symptomatic bradycardia, given pre-op for secretions to prevent aspiration Uses for Digoxin - ANSWER To increase contractility Uses for Lidocaine - ANSWER Dysrhythmias, numbing agent Uses for Metoprolol - ANSWER Decrease heartrate and BP Uses for normal saline - ANSWER Dehydration, fluid replacement Uses for LR? - ANSWER Hypovolemic shock Uses for 5% dextrose in water? - ANSWER Increases colloid pressure Use if TPN runs outs Uses 5% dextrose in 0.45% normal saline? - ANSWER DKA We want to slowly lower their glucose level while maintaining their fluid balance Nursing interventions for septic shock? - ANSWER Blood cultures!! 2 sets!! (Anaerobic and aerobic)