Npro 2100 Exam 3

Front 1

What are the causes of sickle cell crisis?

Back 1

Cold temperature

Dehydration

Infection

Front 2

What causes hemoglobin sickling?

Back 2

Decrease oxygen saturation due to increased oxygen demands of stress, exercise, infection, cold temperature.

Front 3

Nurse response to new symptoms

Back 3

Promptly report any early signs of infection to the clinician

Front 4

How can care providers address pain issues and the possibility of substance abuse with sickle cell disease?

Back 4

Client should be encouraged to use a single primary provider to address health Care and pain Management concerns with opioids. complimentary therapies are usually insufficient to fully address pain in sickle cell disease.

Front 5

How to identify a nursing priority in an acute vaso-occlusive crisis?

Back 5

Potential complications of acute vaso-occlusive crisis includes risk of thrombosis and lack of tissue perfusion

Front 6

What are strategies to prevent sickle cell crisis?

Back 6

Standard precautions, especially hand hygiene prevents the spread of infection. Infection in a patient with sickle cell disease can contribute to sickle cell crisis.

Front 7

Symptoms of anemia/hemolytic anemia

Back 7

Premature destruction of erythrocytes results in liberation of hemoglobin into plasma. Released hemoglobin converts to bilirubin, therefore bilirubin concentration rises. This leads to tissue hypoxia which stimulates erythropoietin production. This leads to an increased reticulocyte count.

Dizziness, fatigue, lightheadedness, or malaise, fast heart rate or palpitations, brittle nails, headache, pallor, shortness of breath, or weakness

Front 8

Hydroxyurea

Back 8

Anti-metabolite anti-neoplastic.

Given to reduce frequency of painful sickle cell crisis and need for blood transfusions and adult patients with sickle cell anemia.

Side effects: diarrhea, vomiting, and nausea

Nurse teaching must advise patient to report and manage GI side effects so patient takes drug consistently.

Front 9

What are expected lab values with chronic kidney disease?

Back 9

BUN high (Normal range 8-20)

Creatinine high (Normal range 0.8-1.2)

Phosphorus high (Normal range 2.8-4.5)

Calcium low (Normal range 8.5-10.2)

Front 10

What are expected urine analysis results with renal dysfunction?

Back 10

Protein and glucose are present in the urine due to impaired filtration by the glomeruli.

Normal substances that are found in the urine are sodium chlorides bicarb, potassium, and urea.

Front 11

What are risk factors for developing end-stage renal disease?

Back 11

Diabetes mellitus

Hypertension

Chronic glomerulonephritis

Pyelonephritis

Polycystic kidney disease

Systemic lupus erythematosus

Toxic agents

Nephrotoxic medications

Front 12

What are expected electrolyte imbalances with chronic kidney disease?

Back 12

Hyperkalemia

Hyperphosphatemia

Hypocalcemia

Excess fluid volume

Front 13

Basic effects of hemodialysis treatment on electrolytes and typical plan

Back 13

Patients who have just had dialysis will likely have decreased weight due to fluids loss, decreased blood pressure, and decreased potassium levels.

Patients typically have dialysis three days/week.

Front 14

Continuous ambulatory peritoneal dialysis--risks of using this treatment and things to watch out for

Back 14

Time-consuming process

Uses a catheter into the peritoneum for dialysis

High risk of peritonitis

Front 15

What abnormal lab results indicate renal dysfunction?

Back 15

Protein in the urine

Glucose in the urine

Elevated BUN (20-50mg/dL)

Elevated creatinine

Front 16

What is an appropriate diet for chronic kidney disease or a patient with uremia?

Back 16

Low protein

Low sodium

Low potassium

Front 17

Symptoms of uremia (when BUN is greater than 200)

Back 17

Anorexia

Nausea and vomiting

Uremic fetor

Paresthesias

Dry skin

Pruritus (itching)

Uremic Frost

Asterixis (jerking motions of outstretched hands/feet)

Cognitive changes

Gait changes

Front 18

Appropriate nursing care and assessment of av fistula access for hemodialysis

Back 18

Avoid taking blood pressure and lab draws on arm where the AV fistula is located

To assess for patency ausciltate for a bruit or palpate for a thrill at the graft site

Front 19

Erythropoietin (Epoetin alfa)

Back 19

Synthetic form of erythropoietin to replace substance normally produced by healthy kidneys that stimulates bone marrow to produce red blood cells

Front 20

Furosemide

Back 20

Potent diuretic which causes loss of fluid and potassium

Front 21

Mannitol

Back 21

Osmotic diuretic

Front 22

Spironolactone

Back 22

Potassium sparing diuretic

Front 23

Acetazolamide (Diamox)

Back 23

Carbonic anhydrase inhibitor diuretic, given as a secondary treatment for edema of heart failure or drug-induced edema

Front 24

Hydrochlorothiazide (HCTZ)

Back 24

Thiazide diuretics are a mild diuretic used to reduce blood pressure

Front 25

Important teaching points for patient with hepatitis

Back 25

Must avoid taking medications that are cleared by the liver such as acetaminophen

Front 26

Care of a patient exposed to viral hepatitis A who has never had the vaccination

Back 26

Unvaccinated individuals exposed to Hep A should take IM immune globulin during incubation (within two weeks of exposure).

Front 27

Expected elevated liver and bleeding times with hepatitis and liver dysfunction

Back 27

AST and ALT lab values would be increased

ALT above 56u/L

AST above 40u/L

Prolonged prothrombin time due to decrease absorptions of vitamin k and decrease production of prothrombin by infected liver

Normal prothrombin time: 11-13.5 sec

Front 28

What are priority assessments of a patient with portal hypertension?

Back 28

Daily weight

Abdominal girth measurements

Front 29

Anticipated care of a patient with ascites

Back 29

Orders for diuretics along with sodium restriction

Front 30

Complications of cirrhosis

Back 30

High risk of internal bleeding.

Immediate evaluation by a clinician is important after any falls or accidents due to risk of internal bleeding

Front 31

Nutritional plan for ascites

Back 31

Reduce sodium intake

Front 32

Symptoms of obstructive jaundice

Back 32

Deep orange, foamy urine.

If bile duct is obstructed from an inflammatory process within the liver, bile will be absorbed into the blood and carry throughout the entire body. bile is excreted in the urine which becomes deep orange and foamy.

Front 33

Testing to confirm diagnosis of esophageal varices

Back 33

Endoscopy to confirm engage progression of esophageal varices.

Front 34

Care of patient with esophageal varices

Back 34

Likely orders for volume expanders to restore fluid volume because of intravascular volume depletion

Front 35

Post procedure care following endoscopy

Back 35

Nurse should keep the client NPO until their gag reflex returns; lidocaine gel is used to numb the patient's throat prior to the endoscopy and food and fluids are contraindicated until gag returns

Front 36

Post-op care following cholecystectomy

Back 36

In immediate post-op period, a finding of abdominal tenderness and rigidity should be reported immediately to clinician because it may indicate bleeding from puncture or nicking of a major blood vessel during the surgery

Front 37

Can a patient have surgery during acute cholecystitis?

Back 37

Surgery intervention is delayed until acute symptoms subside

Front 38

Teaching post laparoscopic cholecystectomy related to diet and recovery period

Back 38

Low-fat foods high in carbohydrate and protein to promote healing. No need to increase fiber.

Front 39

Symptoms of gallstones

Back 39

Nausea

Right upper quadrant pain

Elevated ALP occurs in uncomplicated cholelithiasis

Front 40

Symptoms of blocked common bile duct

Back 40

Jaundice; obstruction of common bile duct results in reflex of bile into liver which produces jaundice.

Physical obstruction also causes conjugated hyperbilirubinemia

Front 41

Potential complications following pancreatic surgery/removal of pancreas. Nutritional needs?

Back 41

Risk for imbalanced nutrition

Malabsorption

Hyperglycemia

Nutritional needs include pancreatic enzyme replacement, low-fat diet, vitamin supplements

Front 42

Signs and symptoms of chronic pancreatitis

Back 42

Recurring acute attacks of severe upper abdominal and back pain plus vomiting

Front 43

Care of the patient with chronic pancreatitis

Back 43

Onset of acute symptom attack warrants hospital treatment as soon as possible

Front 44

Signs and symptoms of acute pancreatitis and pancreatic necrosis

Back 44

Pancreatic necrosis is major cause of morbidity and mortality with acute pancreatitis because of resulting hemorrhage, septic shock, and multiple organ dysfunction syndrome.

Signs of shock include hypotension tachycardia and fever.

Front 45

Lactulose

Back 45

Given to patient with hepatic encephalopathy secondary to cirrhosis to bind ammonia. Expected outcome is that patient will have two to three soft bowel movements per day to decrease patients ammonia level.

Front 46

Ursodexoycholic acid (UDCA)

Back 46

Prescribed to dissolve small, radiolucent gallstones composed primarily of cholesterol. Can reduce size of existing stones, dissolve small stones, and present new stones from forming. Needs to be taken consistently for 6 to 12 months to dissolve stones and monitoring of clients and straining of urine is required during this time.