NUR 265 EXAM 4 QUESTIONS
WITH REVISED AND UPDATED
ANSWERS
Complication: spinal chord compression hallmark sign - Answer-back pain*
-will progress to neuromuscular weakness
-loss of sensation
-burning pain
-paralysis
Complication: spinal chord compression TX - Answer-high dose corticosteroids,
radiation, and spinal stabilization surgery (if caused by bone cancer)
Complication: Hypercalcemia - Answer-certain cancers release PTH stimulating bones
to release calcium, elevating serum calcium levels
Complication: hypercalcemia Early symptoms - Answer--skeletal pain
-kidney stones
-altered cognition
Complication: hypercalcemia late symptoms - Answer--ECG changes
-Dehydration
-severe muscle weakness
-loss of deep tendon reflexes
Complication: Hypercalcemia Tx - Answer--treat with Normal saline IV
-then......treat with furosemide to pull off the excess calcium
Complication: superior vena cava syndrome - Answer-tumor or clot compresses SVC
and limits blood flow into right atrium; can be acute or slow onset
Complication: superior vena cava syndrome--- EARLY SIGN - Answer--periorbital
edema upon waking
-edema/tightness of the collar
Complication: superior vena cava syndrome--- LATE SIGN - Answer--redness to upper
chest, neck, and face
-engorged blood vessels above the blockage (EXTREME JVD)
-edema in arms and hands******
-dyspnea
-narrowing of trachea (stridor; this is an emergency)
,complication: superior vena cava syndrome Tx - Answer--treated with TPA if caused by
clot
-high dose radiation if caused by tumor
-may stent SVC
Complication: tumor lysis syndrome--EARLY SIGN - Answer--cloudy urine
Complication: tumor lysis syndrome - Answer-many tumor cells causing increased
potassium and hyperuricemia
--chemo is working way tooo well
complication: tumor lysis syndrome--LATE SIGN - Answer--AKI
-cardiac dysrhythmia
Complication: tumor lysis syndrome Tx - Answer--adequate hydration 3-5L(3000-
5000ml/day) ***during or after chemo
-isotonic fluids (normal saline)
-may require hemodialysis
-SIT them UP!!******
-allopurinol to decrease uric acid
Cardiac tamponade - Answer-tumor direct pressure in or around pericardial sac
resulting in decreased venous return and sudden drop in cardiac output
cardiac tamponade: assess - Answer--JVD (fluid overload with clear lungs)
-decreased HR and CO
-dyspnea
-hypotension
-heart sounds are distant and muffled
End of life: decision making - Answer-the only right decision is the one that the
client/family makes.
-DNR does not matter in EMS or OR exemption
Stroke - Answer-Emergent*
mass causality --emergent
chest pain - Answer-Emergent
positive influenza - Answer-not respiratory distress--non urgent
respiratory distress--urgent
respiratory failure--emergent
urgent/nonurgent and flu postive give mask and have them wait in waiting room
meningitis (nuchal rigidity) - Answer-stick in room
, DROPLET PRECAUTIONS
Knife sticking out of head - Answer-GO TO OR/SURGERY
suspecting violence in death - Answer-leave lines in place***
call coroner
dont let people alone with body
hypothermia - Answer-warm fluids**
warm from inside out--starting at trunk***
mild--mental slowness, shivers, slurred speech**
moderate--confusion, slower**
ABCDE - Answer-A-airway; jaw thrust maneuver
B-breathing; bag valve mask (not worried about artificial airway)
C-circulation; cardiac assessment, heart monitor, pulse..looking for bleeding and
hanging fluids
D- disability--GCS
E- exposure--cutting clothes off, preventing hypothermia
fungal pneumonia - Answer-probably have AIDS**
transmission? ---NO
respiratory--maintain airway
HARRT - Answer-take 90% of the time**
take within 24-36 hours after exposure
will this prevent from getting opportunistic infection?-----NO
nutrition with AIDS - Answer-high calorie, high protein, low fat
no buffet
no raw foods
anti-bacterial soap
clean in bleach or diswasher once per week
thrush - Answer-allowed to have sugary things but need to rinse mouth out with water
after
white patches**
nothing taste good**
Acute graft rejection: Kidneys - Answer--creatnine is elevated and may or may not be
producing urine
-notify surgeon if HYPOTENSION occurs or excessive diuresis
acute graft rejection - Answer-fever**
pain**
organ dysfunction**
WITH REVISED AND UPDATED
ANSWERS
Complication: spinal chord compression hallmark sign - Answer-back pain*
-will progress to neuromuscular weakness
-loss of sensation
-burning pain
-paralysis
Complication: spinal chord compression TX - Answer-high dose corticosteroids,
radiation, and spinal stabilization surgery (if caused by bone cancer)
Complication: Hypercalcemia - Answer-certain cancers release PTH stimulating bones
to release calcium, elevating serum calcium levels
Complication: hypercalcemia Early symptoms - Answer--skeletal pain
-kidney stones
-altered cognition
Complication: hypercalcemia late symptoms - Answer--ECG changes
-Dehydration
-severe muscle weakness
-loss of deep tendon reflexes
Complication: Hypercalcemia Tx - Answer--treat with Normal saline IV
-then......treat with furosemide to pull off the excess calcium
Complication: superior vena cava syndrome - Answer-tumor or clot compresses SVC
and limits blood flow into right atrium; can be acute or slow onset
Complication: superior vena cava syndrome--- EARLY SIGN - Answer--periorbital
edema upon waking
-edema/tightness of the collar
Complication: superior vena cava syndrome--- LATE SIGN - Answer--redness to upper
chest, neck, and face
-engorged blood vessels above the blockage (EXTREME JVD)
-edema in arms and hands******
-dyspnea
-narrowing of trachea (stridor; this is an emergency)
,complication: superior vena cava syndrome Tx - Answer--treated with TPA if caused by
clot
-high dose radiation if caused by tumor
-may stent SVC
Complication: tumor lysis syndrome--EARLY SIGN - Answer--cloudy urine
Complication: tumor lysis syndrome - Answer-many tumor cells causing increased
potassium and hyperuricemia
--chemo is working way tooo well
complication: tumor lysis syndrome--LATE SIGN - Answer--AKI
-cardiac dysrhythmia
Complication: tumor lysis syndrome Tx - Answer--adequate hydration 3-5L(3000-
5000ml/day) ***during or after chemo
-isotonic fluids (normal saline)
-may require hemodialysis
-SIT them UP!!******
-allopurinol to decrease uric acid
Cardiac tamponade - Answer-tumor direct pressure in or around pericardial sac
resulting in decreased venous return and sudden drop in cardiac output
cardiac tamponade: assess - Answer--JVD (fluid overload with clear lungs)
-decreased HR and CO
-dyspnea
-hypotension
-heart sounds are distant and muffled
End of life: decision making - Answer-the only right decision is the one that the
client/family makes.
-DNR does not matter in EMS or OR exemption
Stroke - Answer-Emergent*
mass causality --emergent
chest pain - Answer-Emergent
positive influenza - Answer-not respiratory distress--non urgent
respiratory distress--urgent
respiratory failure--emergent
urgent/nonurgent and flu postive give mask and have them wait in waiting room
meningitis (nuchal rigidity) - Answer-stick in room
, DROPLET PRECAUTIONS
Knife sticking out of head - Answer-GO TO OR/SURGERY
suspecting violence in death - Answer-leave lines in place***
call coroner
dont let people alone with body
hypothermia - Answer-warm fluids**
warm from inside out--starting at trunk***
mild--mental slowness, shivers, slurred speech**
moderate--confusion, slower**
ABCDE - Answer-A-airway; jaw thrust maneuver
B-breathing; bag valve mask (not worried about artificial airway)
C-circulation; cardiac assessment, heart monitor, pulse..looking for bleeding and
hanging fluids
D- disability--GCS
E- exposure--cutting clothes off, preventing hypothermia
fungal pneumonia - Answer-probably have AIDS**
transmission? ---NO
respiratory--maintain airway
HARRT - Answer-take 90% of the time**
take within 24-36 hours after exposure
will this prevent from getting opportunistic infection?-----NO
nutrition with AIDS - Answer-high calorie, high protein, low fat
no buffet
no raw foods
anti-bacterial soap
clean in bleach or diswasher once per week
thrush - Answer-allowed to have sugary things but need to rinse mouth out with water
after
white patches**
nothing taste good**
Acute graft rejection: Kidneys - Answer--creatnine is elevated and may or may not be
producing urine
-notify surgeon if HYPOTENSION occurs or excessive diuresis
acute graft rejection - Answer-fever**
pain**
organ dysfunction**
