HESI MILESTONE 2 EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 HESI MILESTONE 2 EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ Pyloric Stenosis symptoms Correct Answer: -Forceful, non bilious vomiting, unrelated to feeding position -Hunger soon after vomiting -Weight loss due to vomiting -Progressive dehydration with lethargy -Possible positive family history Intussusception Correct Answer: -Telescoping of the intestines -Sudden crampy pain, severe pain, vomiting, diarrhea, jelly stools with blood, lethargy -May reduce on its own Infant congenital heart defect assessment Correct Answer: -Skin (cyanosis) -Respirations/lungs -Apical pulse -Aus heart (murmur) 2 -Lab -ECG -Angiogram Tetralogy of fallot complications Correct Answer: -Decreased pulmonary blood flow: R-L shunt -Murmur -Cyanosis, dyspnea -Digital clubbing -Polycythemia -FTT -Hypercyanotic/blue/tet spells Vomiting and diarrhea infant Correct Answer: Can easily cause dehydration which can lead to shock. IV fluids RSV distress Correct Answer: -Color (pallor, cyanosis) -Work of breathing (tachypnea) -Nose and oral cavity -Cough and other airway noises -Respiratory effort 3 -Retractions -Anxiety and restlessness -Clubbing -Hydration status -Percussion (resonant) -Auscultation (wheezing, rales) Cystic Fibrosis Complications Correct Answer: -Decreased resistance to infection -Air trapping -Decreased pancreatic enzymes -Hypersecretion of gastric acids Placenta abruptio Correct Answer: -Separation of placenta leading to compromised fetal supply -Left lateral position, strict bed rest, oxygen therapy, vitals, fundal height, continuous fetal monitoring Obstetrical emergencies Correct Answer: -Umbilical cord prolapse -Placenta previa -Placenta abruption -Uterine rupture 4 -Amniotic fluid embolism Shoulder dystocia Correct Answer: Head is delivered but shoulders become impacted above mother's symphysis pubis. Post partum hemorrhage Correct Answer: Bleeding in excess of 500cc after delivery. FUNDAL MASSAGE and put infant to breast. Place pad over vaginal opening and treat for shock, elevate hips. Tone, tissue, trauma, thrombin. Post partum blues Correct Answer: -Normal self-limiting condition that occurs within a few days postpartum. -Symptoms: sadness, insomnia, tearfulness, irritability, and anxiety. -Should resolve within 10 days. If not, then you would worry about post partum depression (presents within 4 weeks and is treated). -Postpartum psychosis can occur which presents with delusions and hallucinations to kill the infant (absolute emergency) Postpartum bleeding action Correct Answer: -Focus on underlying cause -Uterine massage 5 -Removal of retained placental fragments -Antibiotics for infection -Repair of lacerations Post partum depression action Correct Answer: Early identification, screening, prevention, and treatment is crucial. Oxytocin contraindications Correct Answer: -Fetal distress -Prematurity -Abnormal fetal presentation -Cephalopelvic disproportion -Uterine rupture predisposition Sickle cell signs of crisis Correct Answer: -Elevated temperature -Pale/listless -Limp or swollen joints -Cough, SOB, chest pain -Fatigue -Headache, loss of feeling, sudden weakness -Vision changes -Priapism 6 Normal fetal heart rate Correct Answer: 110-160 bpm Fetal heart rate decelerations Correct Answer: -Transitory decreases in the fetal heart rate baseline. -Can indicate fetal distress. -Early, late and prolonged decelerations. Late decelerations Correct Answer: -Bad (placental insufficiency) -Can be caused by maternal hypotension, gestational hypertension, placental aging, hyperstimulation (oxytocin), maternal smoking, anemia, cardiac disease) Hemophilia promoting safety Correct Answer: -At risk for changes in neuro functioning -Fatigued and inability to eat enough -Assist with ambulation -Protect from unsteady gait and dizziness Type 1 DM hyperglycemia Correct Answer: -Blurred vision, dry/flushed skin, fruity odor to breath -Needs insulin 7 -Can result in DKA Engorgement Correct Answer: -Swelling of breast from increase of bleed and lymph supply -Relieved by frequent emptying, warm showers, cold compress between feeding -Tight bra, ice, if not breast feeding Rhogam Correct Answer: Used to prevent an immune response to Rh positive blood in moms with an Rh negative blood type Meconium stained amniotic fluid Correct Answer: -Infant may have respiratory difficulties and bradycardia at birth -If vaginal birth, suction airway as soon as head is delivered IUGR ultrasound Correct Answer: -Ultrasound twice weekly after 28 weeks Jaundice Correct Answer: -Resolves in 24-72 hours -Due to increased bilirubin -Sun exposure and feeding help 8 Diabetes - fetal risk Correct Answer: -High level of glucose stimulate insulin production -Leads to somatic fetal growth -Hypoglycemia -Fluid and electrolyte imbalance ABGs Correct Answer: -Arterial Blood Gases -pH 7.35- 7.45 -HCO3 (Bicarbonate) 22-26 mEq/L -PaCO2 ( CO2 or carbon dioxide content) 35-45 mm Hg -PaO2 (oxygen saturation in arteria blood)- 80-100 mm Hg CKD metabolic acidosis Correct Answer: - Can't excrete acid (mainly ammonia: NH3) - Inability to reabsorb bicarb. (HCO3) - If severe, causes kussmaul respirations Dialysis: htn and edema Correct Answer: HTN: hold hypertension meds, could go hypotensive Edema: dialysis will decrease edema Acute pancreatitis assessment 9 Correct Answer: Serum amylase & lipase levels increased, severe abdominal pain, back pain, patient appears acutely ill, rigid or board-like abdomen could indicate developing disease; Confusion, N/V, fever, jaundice, confusion, agitation, hypotension, hypovolemia, hypocalcemia, hyperglycemia, shock, tachycardia, cyanosis, cold/clammy skin acute renal failure, respiratory distress, hypoxia, dyspnea, tachypnea, abnormal ABGs, myocardial disseminated intravascular coagulation Cirrhosis ascites Correct Answer: -Accumulation of fluid in abdominal cavity -Can cause dyspnea -Treated by dietary restriction of sodium and paracentesis Alcoholic hepatitis teaching Correct Answer: -Exclusion of alcohol from diet -Alcoholics Anonymous, psych care, counseling, spiritual advisor Acute renal failure priorities Correct Answer: -Eliminate underlying cause -Maintain and monitor fluid balance (hyperkalemia) -Avoid fluid excess -Med dose adjustment -ABGs (acidosis) 10 -Dialysis NGT suction ABG Correct Answer: Can cause metabolic alkalosis Diabetes insipidus Correct Answer: -Deficiency of ADH -Causes: head trauma, brain tumor, irradiation of pituitary gland, infections of CNS, failure of renal tubules to respond to ADH -Signs: excessive urine output, intense thirst, tachycardia, hypotension, decreased urine specific gravity, decreased urine osmolality Addison crisis manifestations Correct Answer: -Hypoglycemia, sudden pain, syncope, shock, hypotension, V/D Cushing syndrome Correct Answer: -Hypersecretion of cortisol by the adrenal gland -Manifestations: moon face, hyperglycemia, hirsutism, weight gain, muscle wasting, buffalo hump -Ketoconazole Multiple sclerosis bladder Correct Answer: Inability to store urine, empty bladder, or both 11 Guillain-Barre assessment Correct Answer: -Symmetric weakness -Diminished reflexes -Ascending weakness -History of viral disease in past few weeks -Lumbar puncture Glaucoma signs and symptoms Correct Answer: -Blurred vision -Halos around lights -Difficulty focusing -Difficulty adjusting eyes in low lighting -Loss of peripheral vision -Aching/discomfort around eyes -Headache Meningitis care Correct Answer: -Dexamethasone before abx -Antibiotics -Treat dehydration, shock, seizures -If viral: bed rest, fluids, OTC meds 12 Rhythm strip analysis Correct Answer: -Ventricular rate and rhythm -QRS shape and duration -P wave in front of each QRS -P wave shape -Atrial rate and rhythm -PR interval/consistent -P:QRS ratio Cardiomyopathy care plan Correct Answer: -Identify and manage underlying cause, correct heart failure, control dysrhythmias -Systemic anticoagulation -Limit fluid intake if needed Valve replacement teaching Correct Answer: Mechanical: will need anticoagulation for life Bio: anticoagulation for 3 months, does not last as long INR goal for both: 2.5-3.5 Pulmonary embolism Correct Answer: -Obstruction of pulmonary artery by thrombus 13 -Causes: trauma, surgery, pregnancy, heart failure, age 50+, hypercoagulable states, prolonged immobility -Manifestations: tachycardia, tachypnea, hemoptysis, pulmonary htn, dyspnea, chest pain, anxiety, cough, diaphoresis, syncope, fever -Treatment: stabilize, dissolve emboli, prevent new ones Pulmonary edema Correct Answer: -Fluid in interstitial spaces and alveoli of lungs -Sudden and life threatening -Frothy pink sputum, restless, anxious, tachypnea, noisy breathing, JVD -MADDOG: meds, airway, decrease preload, diuretics, oxygen, blood gases ARDs findings Correct Answer: -Arterial hypoxemia does not respond to supplemental o2 -CXR: visible bilateral infiltrates that worsen quickly -Alveolar dead space -Stiff lungs -Crackles -BNP -Echo -Pulmonary artery cath Fractured femur assessment 14 Correct Answer: -Cannot move hip or knee -Transverse, oblique, spiral, or comminuted -Traction until surgery is performed Compartment syndrome Correct Answer: -Increase in compartment volume, decrease in compartment size -Perfusion to the tissues is impaired, causing cell death -6-8 hours after injury, up to 48 hours Ischemic stroke Correct Answer: -Most common type of stroke in older people, occurs when the flow of blood to the brain is blocked by the narrowing or blockage of a carotid artery. -Symptoms: numbness, weakness, on one side of body, confusion, trouble speaking, visual disturbances, headache Stroke - broca's area Correct Answer: -Expressive aphasia -Most common with damage or injury to left side of brain Aggression response Correct Answer: -Inform clients of rule or limit -Explain consequences if clients exceed limit -State expected behavior 15 -Time out Duty to warn Correct Answer: Mental health professional's responsibility to break confidentiality and notify the potential victim whom a client has specifically threatened. Alcohol Withdrawal Correct Answer: -Usually begin 4-12 hours after cessation -Symptoms: coarse hand tremors, sweating, elevated pulse and bp, insomnia, anxiety, nausea/vomiting -Severe symptoms: hallucinations, seizures, delirium -Lorazepam, chlordiazepoxide, diazepam -CIWA Methadone Correct Answer: -Synthetic opiate -Substitutes herion -Patient becomes addicted to methadone instead of heroin Anxiety drug risks Correct Answer: -Sedation, fatigue, high potential for abuse and dependence (Benzos) 16 -Dizziness, agitation, drowsiness, weakness, nausea, vomiting, paradoxical excitement or euphoria (nonbenzo) Delirium care Correct Answer: -Protection from injury -Management of confusion -Meet physiological and psychological needs -Determine and treat underlying cause Alzheimer's hallucinations Correct Answer: Visual hallucinations are most common and generally unpleasant. Schizophrenia care Correct Answer: -Be sincere and honest when communicating with client -Be consistent in setting expectations, enforcing rules, etc -Do not make promises that you cannot keep -Encourage client to talk with you -Explain procedures and make sure client understands the procedures -Give positive feedback for the client's successes -Recognize client's delusions as the client's perception -Do not argue with client or try to convince delusions are false -Interact with client on basis of real things 17 Schizophrenia treatment evaluation Correct Answer: -Dystonia, pseudoparkinsonism, akathisia, neuroleptic malignant syndrome, tardive dyskinesia -High rate of relapse when drug therapy is discontinued Grief therapeutic response Correct Answer: Observe and listen for cognitive, emotional, spiritual, behavioral, and physiologic cues Therapeutic communication abuse victim Correct Answer: -Be particularly sensitive to patient's need to feel safe, secure, and in control of their body -Maintain patient's personal space -Assess patient's anxiety level -Ask permission before them obsessive-compulsive disorder (OCD) Correct Answer: a disorder in which repetitive, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) designed to fend off those thoughts interfere significantly with an individual's functioning ADHD exam Correct Answer: -Finishing projects 18 -Organizing tasks -Remembering appointments -Avoid starting tasks -Fidget or squirm -Overly active -Interrupt others -Finish sentence for others -Difficulty taking turns General anesthesia - post anesthesia care Correct Answer: -maintaining patent airway -maintaining cardiovascular stability -Hemorrhage -Relieving pain and anxiety Asthma- Leukotriene modifiers Correct Answer: (Montelukast) Strong chemical mediators of bronchoconstriction and inflammation; effective in many patients who do not respond to other therapies. Used for long term asthma treatment, only oral tablet approved for management of exerciseinduced asthma Asthma inhaler 19 Correct Answer: Pressurized device that releases a "puff" of medication for inhalation, one dose at a time. Beta2-andrenergic agonists (albuterol) and corticosteroids may be inhaled for asthma Pneumonia- action Correct Answer: Prevention: PCV13 for 65+ and 19+ with weakened immune system. PPSV23 for 65+ and 19-64yr smokers, chronic heart, lung, or liver disease, or alcoholism. Treatment of viral pneumonia is supportive, encourage hydration. Antibiotic if bacterial COPD oxygen flow rate Correct Answer: Using the lowest amount of oxygen needed to maintain an acceptable PaO2 level and treating the underlying condition and prevent oxygen toxicity. O2 above 90% at rest is acceptable for COPD COPD treatment Correct Answer: Smoking cessation, pneumococcal and flu vaccines, systemic or inhaled corticosteroids, oxygen, inhaled beta-agonists and anticholinergics asthma triggers Correct Answer: fumes, smoke, dust, dust mites, roaches, certain types of cloth, pets, horses, detergents, soaps, certain foods, molds, and pollens 20 Small bowel obstruction-actions Correct Answer: Decompression of the bowel through an NG tube. sometimes surgery is necessary to remove blockage Ulcerative colitis symptoms Correct Answer: abdominal pain; the presence of diarrhea, fecal urgency, or tenesmus; nausea, anorexia, weight loss GERD instructions Correct Answer: educate patient to avoid situations that decrease lower esophageal sphincter pressure or cause irritation; tobacco cessation, limit alcohol, weight loss, elevate HOB, avoid eating before bed, alter diet Pre op labs Correct Answer: Chest xray, ECG, urinalysis, WBC, glucose, Potassium, CBC, coag studies PT/PTT Diverticulosis signs and symptoms Correct Answer: Presence of multiple diverticula without inflammation or symptoms. Sometimes constipation, diarrhea, nausea, bloating/abdominal distention occurs but mostly always an incidental finding on a colonoscopy 21 Diverticulitis NPO Correct Answer: For severe symptoms withholding oral intake, administering IV fluids, and instituting nasogastric (NG) suctioning if vomiting or distention occurs are used to rest the bowel IBD peritonitis Correct Answer: leakage of contents from abdominal organs into abdominal cavity, usually as a result of inflammation (IBD can cause this to occur) PUD NGT Correct Answer: GI bleed: to distinguish fresh blood from material resembling coffee grounds, to aid in removal of clots and acid, and to prevent n/v through suction decompression, and to monitor further bleeding. During surgery, stomach contents are drained with NG tube. Gastric outlet obstruction: NG inserted to decompress the stomach HF symptoms Correct Answer: the cardinal manifestations of HF are dyspnea; fatigue, which may limit exercise tolerance; and fluid retention, which may lead to congestion, evidenced by pulmonary and peripheral edema Left sided HF symptoms 22 Correct Answer: cough, crackles, tachypnea, tachycardia, fatigue, cyanosis, exertional dyspnea Right sided HF symptoms Correct Answer: JVD, edema, ascites, weight gain, enlarged liver and spleen HF Digoxin Correct Answer: (Digitalis) Improves cardiac contractility; decreases symptoms of HF. Observe patient for decreased HR and toxicity (visual disturbances, anorexia, nausea, confusion, bradycardia) Digoxin is enhanced in the presence of hypokalemia. Arterial insufficiency diabetic Correct Answer: Distal occlusive disease is a arterial insufficiency often seen in diabetics Thrombocytopenia labs Correct Answer: 50,000/mm3 minor (excessive bleeding may occur with surgery) 20,000/mm3 moderate (petechiae, bleeding gums, excessive menstrual bleeding) 5,000/mm3 severe (spontaneous and potentially fatal bleeding in CNS and GI can occur) blood transfusion-action 23 Correct Answer: 06.03.05 chart 28-3 Complication HTN high risk Correct Answer: The goal of hypertension treatment is to prevent complications (target organ damage) Benign prostatic hyperplasia BPH Correct Answer: noncancerous enlargement or hypertrophy of the prostate, one of the most common diseases in aging men. Smoking, heavy alcohol consumption, obesity, reduced activity level, hypertension, heart disease, diabetes, and a Western diet (high in animal fat and protein and refined carbohydrates, low in fiber) are risk factors for BPH Urolithiasis (kidney stone) lithotripsy Correct Answer: shock wave that encounters a substance of different intensity (a renal calculus), a compression wave causes the surface of the stone to fragment making it easier to void Seizure unconscious client Correct Answer: protect patients head turn patient to the side loosen constrictive clothing ease patient to floor 24 do not restrain do not place any objects in mouth observe / record details of event (onset, course, nature) AFTER SEIZURE: reposition patient to open / maintain airway Hypothyroidism Correct Answer: Symptoms: fatigue and lethargy that may interfere with activities of daily living, weight gain without an increased intake of calories, cold intolerance, dry skin, and, in some patients, a deepening of the voice. Levothyroxine is the drug of choice; general range is 75-150mcg per day DM poor compliance Correct Answer: Not checking blood sugars, not treating high blood sugars Type 1 DM tight control Correct Answer: Tight control is a method of intensive diabetes self-management that involves keeping blood glucose levels as close as possible to normal without causing severe or frequent episodes of hypoglycemia (low blood sugar), in the aim of preventing complications of diabetes. Rheumatoid arthritis diagnosis Correct Answer: Antibodies to cyclic citrullinated peptide (anti-CCP) have a specificity of approximately 95% at detecting RA. 25 IV fluids hypertonic Correct Answer: Hypertonic solutions pull water from the interstitial and intracellular compartments into the bloodstream. These solutions draw water out of intracellular compartments causing cellular dehydration (SHRINKS CELLS). 3% NaCl and IV mannitol