NURS 366 EXAM 3 QUESTIONS WITH COMPLETE
SOLUTIONS
Abdomen injuries Correct Answers Ruptured liver/spleen
Intestinal perforation
Intramural hematoma duodenum
Pancreas/kidney/bladder injury
Ruptured blood vessel/chylous ascites
Foreign bodies
Accutane Correct Answers Reserved for severe cases of cystic
acne non-responsive to other treatments. Prescribed and
monitored by dermatologist. Multiple side effects, monitor for
depression and SI. Monitor cholesterol and triglyceride levels.
Teratogenic
Dry skin, nasal irritation, photosensitivity, headaches, dry eyes,
decreased night vision, arthralgia
Acne Correct Answers Inflammatory disorder of sebaceous
glands. More common in teens but seen in adults. Flare can
occur before menses, with use of corticosteroids, or birth control
pills.
Clinical manifestations: blackheads, whiteheads, pustules,
nodular acne. On face, neck, back, chest
Treatment: extractions, topical creams, systemic antibiotics,
Accutane (form of vitamin A) - long lasting remission. Not
always has to do with hygiene and diet
Acne Correct Answers Predominately in adolescents. More
common in boys.
,Does not have anything to do with dietary intake, but can be
caused by exposure to oils in cooking grease. Certain cosmetic
ingredients can cause outbreaks
Patho: testosterone stimulates sebaceous glands to enlarge,
produce oil and plug pores.
Comedogenesis: formation of comedones, non-inflammatory
lesions. Open: black heads. Closed: white heads
Inflammatory: papules, pustules, nodules, cysts
Therapeutic management: general measures/overall health,
cleansing 1-2 times a day, shampooing and hair. Treatment
dependent on type of acne present
Medications: treatment success dependent on teen. Topical
creams, gels, liquids, washes, and antibiotics. Oral antibiotics,
oral contraceptive pills, Accutane (cystic acne)
Acute gastritis Correct Answers Causes: alcoholism, severe
trauma, severe stress, ingestion of caustic substances,
medications (NSAIDs, ASA), radiation, excessive tea/coffe and
bacteria
Repsonsible for 10-30% of all GI bleeds
Patho: erosion of gastric mucosa
Symptoms: weight loss, nausea, vomiting, diarrhea, epigastric
pain, fever GI bleed, dyspepsia, epigastric discomfort,
flatulence, early satiety, bloating
Treatment: remove the causative agent, NPO/IV fluids, antacids,
H2 blockers, IV fluids, antiemetics
Acute hemorrhagic pancreatitis Correct Answers Life-
threatening. Escape of activated pancreatic enzymes into the
pancreas and surrounding tissue causing autodigestion and
hemorrhage
,Associated factors: biliary tract obstruction (gallstones), alcohol
abuse (potent stimulator of pancreatic secretions - known to
cause partial obstruction of the sphincter or Oddi),
hyperlipidemia, hyperparathyroidism, viral infections,
abdominal and surgical trauma, steroids and diuretics
Diagnosis: CT, MRI, total serum amylase levels (rise within first
24 and stay elevated for 48 to 72), serum lipase (rise within first
24 and stays elevated for 5 to 14 days), elevated WBC,
hyperglycemia (islet cell damage), elevated serum bilirubin
Treatment: pain relief - Demerol causes fewer spasms of
sphinter of Oddi than morphine, putting the pancreas to rest -
NPO until bowel sounds present, gastric suctioning, TPN,
restoration of lost plasma volume - IV fluids and electrolytes.
Need to check if there has been damage to islet cells causing
diabetes
Administering vaccines Correct Answers All IM except MMR
is subq and flu is ID. Polio can be IM or subq. Rotavirus is oral.
Varicella and zoster are subq. MMRV is subq
Subq:
Infants: 5/8" vastus lateralis
12 months or older: 5/8" vastus lateralis or back of arm
IM:
Newborn: 5/8" vastus lateralis
Infants: 1" vastus lateralis
Toddlers: 5/8-1 3/4" deltoid or vastus lateralis
Children 3-18: 5/8-1 3/4" deltoid or vastus lateralis
, Adults: 1 - 1 1/2" deltoid
Adverse child experiences Correct Answers ACEs include
abuse (emotional, physical, sexual), neglect, and household
dysfunction (mother treated violently, mental illness, substance
abuse, parental separation or divorce, prison)
As the number of ACE increases, the risk for the following
health outcomes increases: alcoholism, COPD, depression, fetal
death, illicit drug use, ischemic heart disease, liver disease, risk
for intimate partner violence, multiple sex partners, suicide
attempts, unintended pregnancies
Aging changes Correct Answers Skin injuries and infection
become more common - epidermis thins as stem cell activity
declines
The sensitivity of the immune system is reduced - amount of
macrophages residing in skin decreases
Muscles become weaker, and bone strength decreases.
Secondary to reduced calcium and phosphate absorption due to
decline in vitamin D production
Sensitivity to sun exposure increases - produce less melanin
because melanocyte activity declines (pale skin)
The skin becomes dry and often scaly - glandular activity
declines, reducing oil and sweat
Hair thins and changes color - follicles stop functioning or
produce thinner, finer hairs. Decreased melanocyte activity
creates gray hair
Sagging and wrinkling of the skin - dermis becomes thinner, and
the elastic fiber network decreases in size. The skin becomes
weaker and less resilient
SOLUTIONS
Abdomen injuries Correct Answers Ruptured liver/spleen
Intestinal perforation
Intramural hematoma duodenum
Pancreas/kidney/bladder injury
Ruptured blood vessel/chylous ascites
Foreign bodies
Accutane Correct Answers Reserved for severe cases of cystic
acne non-responsive to other treatments. Prescribed and
monitored by dermatologist. Multiple side effects, monitor for
depression and SI. Monitor cholesterol and triglyceride levels.
Teratogenic
Dry skin, nasal irritation, photosensitivity, headaches, dry eyes,
decreased night vision, arthralgia
Acne Correct Answers Inflammatory disorder of sebaceous
glands. More common in teens but seen in adults. Flare can
occur before menses, with use of corticosteroids, or birth control
pills.
Clinical manifestations: blackheads, whiteheads, pustules,
nodular acne. On face, neck, back, chest
Treatment: extractions, topical creams, systemic antibiotics,
Accutane (form of vitamin A) - long lasting remission. Not
always has to do with hygiene and diet
Acne Correct Answers Predominately in adolescents. More
common in boys.
,Does not have anything to do with dietary intake, but can be
caused by exposure to oils in cooking grease. Certain cosmetic
ingredients can cause outbreaks
Patho: testosterone stimulates sebaceous glands to enlarge,
produce oil and plug pores.
Comedogenesis: formation of comedones, non-inflammatory
lesions. Open: black heads. Closed: white heads
Inflammatory: papules, pustules, nodules, cysts
Therapeutic management: general measures/overall health,
cleansing 1-2 times a day, shampooing and hair. Treatment
dependent on type of acne present
Medications: treatment success dependent on teen. Topical
creams, gels, liquids, washes, and antibiotics. Oral antibiotics,
oral contraceptive pills, Accutane (cystic acne)
Acute gastritis Correct Answers Causes: alcoholism, severe
trauma, severe stress, ingestion of caustic substances,
medications (NSAIDs, ASA), radiation, excessive tea/coffe and
bacteria
Repsonsible for 10-30% of all GI bleeds
Patho: erosion of gastric mucosa
Symptoms: weight loss, nausea, vomiting, diarrhea, epigastric
pain, fever GI bleed, dyspepsia, epigastric discomfort,
flatulence, early satiety, bloating
Treatment: remove the causative agent, NPO/IV fluids, antacids,
H2 blockers, IV fluids, antiemetics
Acute hemorrhagic pancreatitis Correct Answers Life-
threatening. Escape of activated pancreatic enzymes into the
pancreas and surrounding tissue causing autodigestion and
hemorrhage
,Associated factors: biliary tract obstruction (gallstones), alcohol
abuse (potent stimulator of pancreatic secretions - known to
cause partial obstruction of the sphincter or Oddi),
hyperlipidemia, hyperparathyroidism, viral infections,
abdominal and surgical trauma, steroids and diuretics
Diagnosis: CT, MRI, total serum amylase levels (rise within first
24 and stay elevated for 48 to 72), serum lipase (rise within first
24 and stays elevated for 5 to 14 days), elevated WBC,
hyperglycemia (islet cell damage), elevated serum bilirubin
Treatment: pain relief - Demerol causes fewer spasms of
sphinter of Oddi than morphine, putting the pancreas to rest -
NPO until bowel sounds present, gastric suctioning, TPN,
restoration of lost plasma volume - IV fluids and electrolytes.
Need to check if there has been damage to islet cells causing
diabetes
Administering vaccines Correct Answers All IM except MMR
is subq and flu is ID. Polio can be IM or subq. Rotavirus is oral.
Varicella and zoster are subq. MMRV is subq
Subq:
Infants: 5/8" vastus lateralis
12 months or older: 5/8" vastus lateralis or back of arm
IM:
Newborn: 5/8" vastus lateralis
Infants: 1" vastus lateralis
Toddlers: 5/8-1 3/4" deltoid or vastus lateralis
Children 3-18: 5/8-1 3/4" deltoid or vastus lateralis
, Adults: 1 - 1 1/2" deltoid
Adverse child experiences Correct Answers ACEs include
abuse (emotional, physical, sexual), neglect, and household
dysfunction (mother treated violently, mental illness, substance
abuse, parental separation or divorce, prison)
As the number of ACE increases, the risk for the following
health outcomes increases: alcoholism, COPD, depression, fetal
death, illicit drug use, ischemic heart disease, liver disease, risk
for intimate partner violence, multiple sex partners, suicide
attempts, unintended pregnancies
Aging changes Correct Answers Skin injuries and infection
become more common - epidermis thins as stem cell activity
declines
The sensitivity of the immune system is reduced - amount of
macrophages residing in skin decreases
Muscles become weaker, and bone strength decreases.
Secondary to reduced calcium and phosphate absorption due to
decline in vitamin D production
Sensitivity to sun exposure increases - produce less melanin
because melanocyte activity declines (pale skin)
The skin becomes dry and often scaly - glandular activity
declines, reducing oil and sweat
Hair thins and changes color - follicles stop functioning or
produce thinner, finer hairs. Decreased melanocyte activity
creates gray hair
Sagging and wrinkling of the skin - dermis becomes thinner, and
the elastic fiber network decreases in size. The skin becomes
weaker and less resilient
