NSG 210 EXAM WITH COMPLETE
SOLUTIONS (ALREADY GRADED
A+)
Treatment of digoxin toxicity - Answer-Stop med and K+ wasting diuretics
Monitor K+ levels (less than 3.5 give K+ PO)
Treat dysrhythmias with phenytoin or lidocaine
Treat bradycardia with atropine
For excessive OD activate charcoal, cholestyramine, or *digoxin immune fab * can be
used to bind and prevent absorption
Digoxin toxicity rises when - Answer-taken concurrently with tetracyclines
monitor levels and adjust dose during and after tetracycline treatment
Post partum hemorrhage - Answer-Firmly massage fundus
Monitor vital signs
Assess lochia
Assess for bleeding from lacerations, episotomy, or hematomas
Assess bladder for distention (fundus up and to right=void)
Maintain or initiate IV fluids and/or blood products
O2 2-3L/min per NC and monitor O2 sat
Elevate client's legs 20-30 degree angle
Give oxytocin, methylergonovine (not with Gestational HTN), Carbaprost and
Misoprostolu
Cystic Fibrosis - Answer-fatal autosomal recessive disease among Caucasians
European descent
Less frequently found among Hispanic-, Asian-, and African Americans.
Person must inherit a defective copy of the CF gene (one from each parent) to have CF.
Most patients are diagnosed by age 2 years, this disease may not be diagnosed until
later in life
Manifestations of CF - Answer-productive cough, wheezing, hyperinflation of the lung
fields on chest x-ray
Upper respiratory manifestations of the disease include sinusitis and nasal polyps.
Nonpulmonary manifestations include gastrointestinal problems (e.g., pancreatic
insufficiency, recurrent abdominal pain, biliary cirrhosis, vitamin deficiencies, recurrent
pancreatitis, and weight loss), CF-related diabetes, and genitourinary problems (male
and female infertility).
,Assessment/Diagnostic findings of CF - Answer-Chronic sinopulmonary disease as
manifested by chronic cough and sputum production, persistent infection consistent with
typical CF pathogens, and x-ray evidence of bronchiectasis and chronic sinusitis, often
with nasal polyps
Gastrointestinal tract and nutritional abnormalities (pancreatic insufficiency, recurrent
pancreatitis, biliary cirrhosis and portal hypertension, CF-related diabetes)
Male urogenital problems as manifested by congenital bilateral absence of the vas
deferens; reduced female fertility
Mgmt of CF - Answer-requires both acute and chronic therapy
Because chronic bacterial infection of the airways, control of infections is essential to
treatment.
For acute airway exacerbations, aggressive therapy involves airway clearance and
antibiotics based on results of sputum cultures.
As with any chronic disease, palliative care and end-of-life issues and concerns need to
be addressed
Therapeutic mgmt of CF in children - Answer-minimizing pulmonary complications,
maximizing lung function, preventing infection, and facilitating growth.
Medical mgmt of CF in children - Answer-chest physiotherapy with postural drainage
several times daily to mobilize secretions from the lungs. Physical exercise is
encouraged.
Recombinant human DNase (Pulmozyme) is given daily using a nebulizer to decrease
sputum viscosity and help clear secretions.
Inhaled bronchodilators and anti-inflammatory agents are prescribed for some children.
Aerosolized antibiotics are often prescribed and may be given at home as well as in the
hospital. Choice of antibiotic is determined by sputum culture and sensitivity results.
Pancreatic enzymes and supplemental fat-soluble vitamins are prescribed to promote
adequate digestion and absorption of nutrients and optimize nutritional status.
Increased-calorie, high-protein diets are recommended, and sometimes supplemental
high-calorie formula, either orally or via feeding tube, is needed. Some children require
total parenteral nutrition to maintain or gain weight.
Lung transplantation has been successful in some children with cystic fibrosis.
Common s/s or complaints of undiagnosed CF in children include - Answer-A salty taste
to the child's skin (resulting from excess chloride loss via perspiration)
Meconium ileus or late, difficult passage of meconium stool in the newborn period
Abdominal pain or difficulty passing stool (infants or toddlers might present with
intestinal obstruction or intussusception at the time of diagnosis)
Bulky, greasy stools
Poor weight gain and growth despite good appetite
Chronic or recurrent cough and/or upper or lower respiratory infections
Child with CF physical exam (inspection) - Answer-Observe the child's general
appearance and color. Check the nasal passages for polyps. Note respiratory rate, work
, of breathing, use of accessory muscles, position of comfort, frequency and severity of
cough, and quality and quantity of sputum produced. The child with cystic fibrosis often
has a barrel chest (anterior-posterior diameter approximates transverse diameter) (Fig.
40.13). Clubbing of the nail beds might also be present. Note whether rectal prolapse is
present. Does the child appear small or thin for his or her age? The child might have a
protuberant abdomen and thin extremities, with decreased amounts of subcutaneous
fat. Observe for the presence of edema (sign of cardiac or liver failure). Note distended
neck veins or the presence of a heave (signs of cor pulmonale).
Child with CF physical exam (auscultation) - Answer-may reveal a variety of
adventitious breath sounds. Fine or coarse crackles and scattered or localized
wheezing might be present. With progressive obstructive pulmonary involvement,
breath sounds might be diminished. Tachycardia might be present. Note the presence
of a gallop (might occur with cor pulmonale). Note the adequacy of bowel sounds.
Child with CF physical exam (percussion) - Answer-usually yields hyperresonance due
to air trapping. Diaphragmatic excursion might be decreased. Percussion of the
abdomen might reveal dullness over an enlarged liver or mass related to intestinal
obstruction.
Child with CF physical exam (palpitation) - Answer-might yield a finding of asymmetric
chest excursion if atelectasis is present. Tactile fremitus may be decreased over areas
of atelectasis. Note if tenderness is present over the liver (might be an early sign of cor
pulmonale).
Pre-eclampsia - Answer-most common hypertensive disorder of pregnancy, develops
with proteinuria after 20 weeks' gestation
Eclampsia - Answer-Onset of seizure activity in a woman with preeclampsia.
Gestational Hyperternsion - Answer-blood pressure elevation (140/90 mm Hg) identified
after 20 weeks' gestation without proteinuria.
Blood pressure returns to normal by 12 weeks' postpartum.
Supplementation with this during the 1st trimester significantly reduces gestation HTN
and fetal distress in primigravida women? - Answer-Progesterone
S/S of severe preeclampsia - Answer->160/110 BP
W/out seizures
Headache
Oliguria
Blurred vision, scotomata (blind spots)
Pulmonary edema
Thrombocytopenia (platelet count <100,000 platelets/mm3)
Cerebral disturbances
SOLUTIONS (ALREADY GRADED
A+)
Treatment of digoxin toxicity - Answer-Stop med and K+ wasting diuretics
Monitor K+ levels (less than 3.5 give K+ PO)
Treat dysrhythmias with phenytoin or lidocaine
Treat bradycardia with atropine
For excessive OD activate charcoal, cholestyramine, or *digoxin immune fab * can be
used to bind and prevent absorption
Digoxin toxicity rises when - Answer-taken concurrently with tetracyclines
monitor levels and adjust dose during and after tetracycline treatment
Post partum hemorrhage - Answer-Firmly massage fundus
Monitor vital signs
Assess lochia
Assess for bleeding from lacerations, episotomy, or hematomas
Assess bladder for distention (fundus up and to right=void)
Maintain or initiate IV fluids and/or blood products
O2 2-3L/min per NC and monitor O2 sat
Elevate client's legs 20-30 degree angle
Give oxytocin, methylergonovine (not with Gestational HTN), Carbaprost and
Misoprostolu
Cystic Fibrosis - Answer-fatal autosomal recessive disease among Caucasians
European descent
Less frequently found among Hispanic-, Asian-, and African Americans.
Person must inherit a defective copy of the CF gene (one from each parent) to have CF.
Most patients are diagnosed by age 2 years, this disease may not be diagnosed until
later in life
Manifestations of CF - Answer-productive cough, wheezing, hyperinflation of the lung
fields on chest x-ray
Upper respiratory manifestations of the disease include sinusitis and nasal polyps.
Nonpulmonary manifestations include gastrointestinal problems (e.g., pancreatic
insufficiency, recurrent abdominal pain, biliary cirrhosis, vitamin deficiencies, recurrent
pancreatitis, and weight loss), CF-related diabetes, and genitourinary problems (male
and female infertility).
,Assessment/Diagnostic findings of CF - Answer-Chronic sinopulmonary disease as
manifested by chronic cough and sputum production, persistent infection consistent with
typical CF pathogens, and x-ray evidence of bronchiectasis and chronic sinusitis, often
with nasal polyps
Gastrointestinal tract and nutritional abnormalities (pancreatic insufficiency, recurrent
pancreatitis, biliary cirrhosis and portal hypertension, CF-related diabetes)
Male urogenital problems as manifested by congenital bilateral absence of the vas
deferens; reduced female fertility
Mgmt of CF - Answer-requires both acute and chronic therapy
Because chronic bacterial infection of the airways, control of infections is essential to
treatment.
For acute airway exacerbations, aggressive therapy involves airway clearance and
antibiotics based on results of sputum cultures.
As with any chronic disease, palliative care and end-of-life issues and concerns need to
be addressed
Therapeutic mgmt of CF in children - Answer-minimizing pulmonary complications,
maximizing lung function, preventing infection, and facilitating growth.
Medical mgmt of CF in children - Answer-chest physiotherapy with postural drainage
several times daily to mobilize secretions from the lungs. Physical exercise is
encouraged.
Recombinant human DNase (Pulmozyme) is given daily using a nebulizer to decrease
sputum viscosity and help clear secretions.
Inhaled bronchodilators and anti-inflammatory agents are prescribed for some children.
Aerosolized antibiotics are often prescribed and may be given at home as well as in the
hospital. Choice of antibiotic is determined by sputum culture and sensitivity results.
Pancreatic enzymes and supplemental fat-soluble vitamins are prescribed to promote
adequate digestion and absorption of nutrients and optimize nutritional status.
Increased-calorie, high-protein diets are recommended, and sometimes supplemental
high-calorie formula, either orally or via feeding tube, is needed. Some children require
total parenteral nutrition to maintain or gain weight.
Lung transplantation has been successful in some children with cystic fibrosis.
Common s/s or complaints of undiagnosed CF in children include - Answer-A salty taste
to the child's skin (resulting from excess chloride loss via perspiration)
Meconium ileus or late, difficult passage of meconium stool in the newborn period
Abdominal pain or difficulty passing stool (infants or toddlers might present with
intestinal obstruction or intussusception at the time of diagnosis)
Bulky, greasy stools
Poor weight gain and growth despite good appetite
Chronic or recurrent cough and/or upper or lower respiratory infections
Child with CF physical exam (inspection) - Answer-Observe the child's general
appearance and color. Check the nasal passages for polyps. Note respiratory rate, work
, of breathing, use of accessory muscles, position of comfort, frequency and severity of
cough, and quality and quantity of sputum produced. The child with cystic fibrosis often
has a barrel chest (anterior-posterior diameter approximates transverse diameter) (Fig.
40.13). Clubbing of the nail beds might also be present. Note whether rectal prolapse is
present. Does the child appear small or thin for his or her age? The child might have a
protuberant abdomen and thin extremities, with decreased amounts of subcutaneous
fat. Observe for the presence of edema (sign of cardiac or liver failure). Note distended
neck veins or the presence of a heave (signs of cor pulmonale).
Child with CF physical exam (auscultation) - Answer-may reveal a variety of
adventitious breath sounds. Fine or coarse crackles and scattered or localized
wheezing might be present. With progressive obstructive pulmonary involvement,
breath sounds might be diminished. Tachycardia might be present. Note the presence
of a gallop (might occur with cor pulmonale). Note the adequacy of bowel sounds.
Child with CF physical exam (percussion) - Answer-usually yields hyperresonance due
to air trapping. Diaphragmatic excursion might be decreased. Percussion of the
abdomen might reveal dullness over an enlarged liver or mass related to intestinal
obstruction.
Child with CF physical exam (palpitation) - Answer-might yield a finding of asymmetric
chest excursion if atelectasis is present. Tactile fremitus may be decreased over areas
of atelectasis. Note if tenderness is present over the liver (might be an early sign of cor
pulmonale).
Pre-eclampsia - Answer-most common hypertensive disorder of pregnancy, develops
with proteinuria after 20 weeks' gestation
Eclampsia - Answer-Onset of seizure activity in a woman with preeclampsia.
Gestational Hyperternsion - Answer-blood pressure elevation (140/90 mm Hg) identified
after 20 weeks' gestation without proteinuria.
Blood pressure returns to normal by 12 weeks' postpartum.
Supplementation with this during the 1st trimester significantly reduces gestation HTN
and fetal distress in primigravida women? - Answer-Progesterone
S/S of severe preeclampsia - Answer->160/110 BP
W/out seizures
Headache
Oliguria
Blurred vision, scotomata (blind spots)
Pulmonary edema
Thrombocytopenia (platelet count <100,000 platelets/mm3)
Cerebral disturbances
