Nc4.4

Front 1

____ is also called fibrocystic disease of the pancreas, mucoviscidosis

Back 1

cystic fibrosis

Front 2

causes generalized dysfunction of the exocrine (sweat) glands that affects multiple organ systems

Back 2

cystic fibrosis

Front 3

which nervous sys is affected in cystic fibrosis?

Back 3

autonomic

Front 4

what do kids w/cystic fibrosis retain?

Back 4

NA+ and H2O

Front 5

describe the secretions in cystic fibrosis?

Back 5

thick and sticky rather than thin and slippery

Front 6

how is cystic fibrosis passed down? who gets the most?

Back 6

an autosomal recessive trait(both parents must carry).
white

Front 7

cystic fibrosis is one the most common inherited diseases and occurs equally in both sexes?

Back 7

info

Front 8

life expectancy in cystic fibrosis?

Back 8

20-30yrs

Front 9

in cystic fibrosis the cumlative effect and may loose lung tissue, Cardic involvement, Cor Pulmonale.

Back 9

info

Front 10

what is the presenting s/s of cystic fibrosis?

Back 10

Meconium ileus (bowel obstructed with meconium) at birth

Front 11

describe skin in cystic fibrosis?

Back 11

Salty taste on child's skin, bulky

Front 12

dscribe stool in cystic fibrosis?

Back 12

greasy foul-smelling stools that contains undigested food
(steatorrhea)

Front 13

what causes the airway obstruction(chronic airway infection) in cystic fibrosis?

Back 13

increased and constant production of mucus, little or no release of pancreatic enzymes (mucus plugging the pancreatic duct and its branches

Front 14

why are stools foul smelling and contain undigested food in cystic fibrosis?

Back 14

because pancreatic enzymes such as trypsinogen, lipase and amylase, do not reach the intestine to digest ingested nutrients

Front 15

what nutrients are malabsorbed in cystic fibrosis?

Back 15

fat, protein, and fat-soluble vitamins (A,D,E,K).

Front 16

Fat malabsorption results in cystic fibrosis results bulky, grey or light colored stools called?

Back 16

steatorrhea

Front 17

protein malabsorption in cystic fibrosis results in ___?

Back 17

failure to grow and gain weight

Front 18

how is cystic fibrosis dx?

Back 18

sweat chloride 2-5x normal (abnormally regulated chloride channel activity), stool specimen analysis indicated the absence of trypsin.

Front 19

T/F Virtually all CF patients (95%) require pancreatic enzyme supplements due to an inadequacy of their own pancreatic secretions (High lipase preparations

Back 19

T

Front 20

what vit and diet for cystic fibrosis?

Back 20

fat soluble, high protein

Front 21

what maybe done in cystic fibrosis with ariway obstruction?

Back 21

chest physiotherapy
(Flutter device helps aid in breathing and force secrections up)"percussion/clapping"

Front 22

what meds maybe given in cystic fibrosis for airway obstruction and infection?
given how

Back 22

mucolytic, bronchodilator (theophylline), antibiotic
nebulizer

Front 23

how should po pancreatic enzymes be given in r/t meals

Back 23

with meals

Front 24

what lung condition is common in CF?

Back 24

pneumothorax

Front 25

____involves postural drainage and mechanical devices or hands

Back 25

chest physiology(percussion/clapping)

Front 26

congenital anomaly in which the esophagus and trachea don't separate normally

Back 26

TRACHEO-ESOPAHGEAL FISTULA

Front 27

the esophagus ends in a blind pouch, with the trachea communicating by a fistula with the lower esophagus and stomach

Back 27

TRACHEO-ESOPAHGEAL FISTULA

Front 28

feeding problems w/TRACHEO-ESOPAHGEAL FISTULA?

Back 28

difficulty feeding, such as choking or aspiration, cyanosis during feeding

Front 29

respirator problems with TRACHEO-ESOPAHGEAL FISTULA?

Back 29

Respiratory distress to include tachypnea, cyanosis, sternal and substernal retractions

Front 30

what prenatal problems are seen in tracheo esophageal fistula? why?

Back 30

Maternal polyhydramnios (because fetus canÕt swallow amniotic fluid.)

Front 31

how is tracheo esophageal fistula Dx?

Back 31

abdominal x-ray shows the fistula and a gas-free abdomen

Front 32

tx for tracheo esophageal fistula?

Back 32

emergency surgical intervention to prevent pneumonia, dehydration, and fluid and electrolyte imbalances, maintenance of patent airway. Antibiotics as prophylaxis for aspiration pneumonia.

Front 33

the proximal end of the esophagus ends in a blind pouch. Food can not enter the stomach via the esophagus

Back 33

ESOPHAGEAL ATRESIA

Front 34

s/s of ESOPHAGEAL ATRESIA?

Back 34

excessive salivation and drooling due to inability to pass food through the esophagus. Regurgitation, possible aspiration

Front 35

how is ESOPHAGEAL ATRESIA dx?

Back 35

Newborns are fed first with a few sips of sterile water to detect these anomalies and to prevent the aspiration of formula or breast milk into the lungs

Front 36

how is ESOPHAGEAL ATRESIA Tx?

Back 36

surgical correction by anastomosing the esophageal ends. Repair is done in stages.

Front 37

an obstruction of the bile ducts caused by their failure to develop normally in the fetus

Back 37

BILIARY ATRESIA

Front 38

s/s of BILIARY ATRESIA

Back 38

Jaundice 2 weeks post-term
(maybe present at birth)

Front 39

BILIARY ATRESIA May be progressive or intermittent
Slow or absent weight gain

Back 39

info

Front 40

describe urine in BILIARY ATRESIA

Back 40

dark

Front 41

what happens to the liver and spleen in BILIARY ATRESIA

Back 41

Enlarged Spleen/Liver

Front 42

describe stools in BILIARY ATRESIA

Back 42

Pale or clay-colored. floating, foul-smelling stools

Front 43

how might biliary atresia be dx?

Back 43

Increased bilirubin in the blood and increased liver enzymes, abdominal ultrasound, HIDA scan, liver biopsy

Front 44

the ________ to connect the liver to the small intestine, bypassing the malformed ducts, before the baby is 10 - 12 weeks old done in biliary atresia?liver transplant later prn

Back 44

Kasai procedure

Front 45

major nsg concern w/biliary atresia?

Back 45

nutrition

Front 46

With biliary atresia, not enough bile reaches the intestine to assist with the digestion of _____ in the diet

Back 46

fats

Front 47

____ & ___ deficiencies may occur due to liver damage in biliary atresia?

Back 47

Protein,
vit

Front 48

Children with ____ disease require more calories than a normal child because of a faster metabolism.

Back 48

liver

Front 49

partial or complete defect of the lip that results in failure of the upper lip to fuse

Back 49

CLEFT LIP

Front 50

cleft lip Can range from a simple notch on the upper lip to complete cleft from the lip edge to the floor of the nostril, on either side of the midline, rarely along the midline itsel

Back 50

info

Front 51

major concern w/cleft lip?

Back 51

Increased risk for aspiration because of the increased open space in the mouth

Front 52

T/F cleft lip may be determined by prenatal ultra sound

Back 52

T

Front 53

____ performed between birth and age 3 months in cleft lip to unite the lip and gum edges in anticipation of teeth eruption

Back 53

Cheiloplasty

Front 54

how is cleft palate dx?

Back 54

mouth examination after birth if cleft palate is present without cleft lip

Front 55

cleft palate repair surgery (staphylorrhaphy) scheduled for about 18 months to allow for growth of the palate and to be done before the infant develops _____

Back 55

speech patterns

Front 56

what infections must in infant be free of in cleft palate sx?

Back 56

ear and respiratory infection

Front 57

RF of pyloric stenosis?
what races gee less?
which sex?

Back 57

3/1000
black and asian
4/1 m/f

Front 58

T/F there is an Increase incident of pyloric stenosis in breast feed and young mothers

Back 58

T

Front 59

Hypertrophy and hyperplasia of the pyloric muscle leading to narowing, obstruction, inflammation and vomiting.

Back 59

pyloric stenosis

Front 60

when do s/s of pyloric stenosis show up?

Back 60

after 2 wks

Front 61

swhat happens @ 2-4 weeks in pyloric stenosis?
6wks?

Back 61

regurgation
complete obstruction

Front 62

#1 s/s o pyloric stenosis?

Back 62

Projectile vomiting shortly after feeding

Front 63

what other s/s of pyloric stenosis?

Back 63

Vomitus non bilous and maybe blood tinged at times in pyloric stenosis, Failure to gain weight. Decreased stool. Dehydration. Abdomenal distention

Front 64

what does palpation reveal in pyloric stenosis?

Back 64

olive-shaped mass right of the umbilicus

Front 65

Treatment for pyloric stenosis?

Back 65

Pyloromyotomy

Front 66

nsg int preop pyloric stenosis:Rehydration with ____ fluid. ____ to minmize vomiting: _____ feeding, Semi upright postion aka ____

Back 66

IV
Feeding techniques
Slow
Portuguese sling

Front 67

nsg int p/o pyloric stenosis:____ posit after feeding to facilitate gastric emptying, Minimal handling after ___

Back 67

High Fowlers
feedings

Front 68

what nsg care p/o pyloric stenosis?

Back 68

Monitor VS, IV fluids, NG tubes

Front 69

Parent education p/o pyloric stenosis?

Back 69

diet from NPO to Clear liquids. Possible vomiting within 24 hour of surgery. Report all increase vomiting to MD.

Front 70

_____ is a congenital birth defect that is the malformation of the bladder and urethra, in which the bladder is turned "inside out

Back 70

Bladder Exstrophy

Front 71

in bladder exstrophy the bladder does not form into its normal round shape but instead is ____ and exposed _____ the body

Back 71

flattened
outside

Front 72

what part of the bladder fails to form correctly in bladder exstrophy?

Back 72

The lower portion of the bladder, a funnel-shaped bladder neck, made up of muscles that open and close the bladder, fails to form correctly

Front 73

describe the genitalia, anus and cat in bladder exstrophy?

Back 73

The urethra and genitalia are not formed completely (epispadius) and the anus and vagina appear anteriorly displaced

Front 74

widely separated pelvic bones seen in bladder exstrophy?

Back 74

diastasis

Front 75

coplications of bladder exstrophy?

Back 75

leaky urine; small bladder with retrograde urine = kidney infection/destruction

Front 76

how many stages to sx repair in bladder extrophy?
when may sx take place?

Back 76

3
as young as 48 hours old

Front 77

describe the 1st stage in bladder extrophy sx?

Back 77

The first stage involves internalization of the bladder and closing the abdomen

Front 78

2nd stage of sx in bladder extrophy?

Back 78

done between age 1 and 2 and involves repairing the epispadias and other genital abnormalities

Front 79

3rd stage of sx in bladder extrophy?

Back 79

done at around age 3 and involves reconstruction of the urinary tract including the bladder, and other structures of the urinary tract.

Front 80

congenital anomaly of the penis. The urethral opening may be anywhere along the ventral side of the penis

Back 80

HYPOSPADIAS

Front 81

major problem w/hypospadias?

Back 81

This conditions provides a shorter distance to the bladder, providing easier access for bacteria

Front 82

how is hypospadias dx?

Back 82

observation confirms aberrant placement of the opening

Front 83

what should be avoided in hypospadias? why?

Back 83

avoid circumsion (the foreskin may be needed later during surgical repair), no treatment, mild disorder

Front 84

hypospadias procedure in which the urethra is extended into a normal position) to restore normal urinary function

Back 84

Meatotomy

Front 85

At age ____months surgery to release the adherent chordee (fibrous band that causes the penis to curve downward) in hypospadias?

Back 85

12-18

Front 86

with analgesics for postoperative pain relief and antispasmodic agents such as _____for postoperative bladder spasms in hypospadias.

Back 86

propantheline

Front 87

____ is a genetic disorder characterized by the growth of numerous cysts in the kidneys filled w/fliud?

Back 87

POLYCYSTIC KIDNEY DISEASE

Front 88

PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to ____?

Back 88

kidney failure

Front 89

T/F PKD May be inherited or may be acquired with kidney failure

Back 89

T

Front 90

s/s of PKD?

Back 90

pain in the back and the sides, H/A, hematuria

Front 91

how is PKD dx?

Back 91

ultrasound

Front 92

tx for PKD?

Back 92

pain meds, antibiotics, anti-hypertensives, eventual kidney transplant/dialysis

Front 93

_____ is a collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum; 1% of adult men and most hydroceles are congenital and are noted in children aged 1-2 years of age

Back 93

hydrocele

Front 94

Chronic or secondary hydroceles usually occur in men older than _____ years

Back 94

40

Front 95

how is hydrocele dx?

Back 95

enlarged scrotum; adult-onset hydrocele may be secondary to orchitis or epididymitis

Front 96

______ of the bladder may lead to hydrocele

Back 96

exstrophy

Front 97

how are hydrocele tx?

Back 97

hydrocele is treated through inguinal incisions with high ligation of the patent processus vaginalis and excision of the distal sac.

Front 98

T/F prognosis for congenital hydrocele is excellent

Back 98

T

Front 99

increase in the amount of CSF in the ventricles and subarachnoid spaces of the brain

Back 99

HYDROCEPHALUS

Front 100

hydrocephalus is caused by an imbalance in the rate of production and the rate of absorption of ____

Back 100

CSF

Front 101

____ hydrocephalus is non-communicating, blocked by tumors, hemorrhage or structural abnormalities that causes fluid to accumulate in the ventricle

Back 101

Congenital

Front 102

s/s of hydrocephalus: ____ sound when the skull is percussed, _____scalp veins, _____-pitched cry, rapid increase in head circumference and full, tense, ____ fontanels, ____ of the brain.

Back 102

cracked pot
distended
high
bulging
atrophy

Front 103

Acute symptoms of hydrocephalus may include ____.

Back 103

change in the neurological state and seizure activity

Front 104

what does xray of the skull show in hydrocephalus?

Back 104

thinning of the skull with separation of the sutures and widening of fontanels

Front 105

tx for hydrocephalus?

Back 105

shunt insertion to allow CSF to drain from the lateral ventricle in the brain

Front 106

what meds maybe Rx for hydrocephalus?

Back 106

Anticonvulsants for seizures (pheobarbital, diazepam and phenytoin

Front 107

priority NX in hydrocephalus?

Back 107

Risk for injury

Front 108

a metabolic disorder that is caused by an enzyme deficiency resulting in the accumulation of phenylalanine and its metabolites (as phenylpyruvic acid) in the blood and their excess excretion in the urine, that is inherited as an autosomal recessive trait

Back 108

PKU

Front 109

what does PKU lead to?

Back 109

severe mental retardation, seizures, eczema, and abnormal body odor unless phenylalanine is restricted from the diet beginning at birth

Front 110

2 other names of PKU?

Back 110

phenylpyruvic amentia, phenylpyruvic oligophrenia

Front 111

goal of Tx in PKU?

Back 111

Treatment is to lower pku levels to prevent mental retardation

Front 112

foods to avoid in PKU?

Back 112

no protein/milk/nutrasweet

Front 113

Foods allowed in measured amounts in PKU?

Back 113

fruits, vergatables, cerals and grains

Front 114

T/FDiet is considered life long in PKU

Back 114

T

Front 115

____ or tri-somy 21 chromosomal aberration characterized by mental retardation, dysmorphic facial features.

Back 115

down's

Front 116

Most w/down's also have congenital ____ defects, are predisposed to ____ infections, chronic _____ leukemia, and have a weak immune response to infection

Back 116

heart
respiratory
myelogenous

Front 117

____ (marbling and speckling of the iris is a common s/s of downs

Back 117

Brushfield's spots

Front 118

other s/s of down's:,sensory? ___ nose and ears, mild to moderate retardation, ____ tongue, short stature with hands, ___ crease of palms, small head with slow brain growth, upward slanting ___

Back 118

my__opia, cataracts, nystagmus, strabismus
flat
low-set
protruding
pudgy
simian
eyes

Front 119

what is Tx of down's based on?

Back 119

treatment for coexisting conditions (congenital heart problems, visual defects, or hypothyroidism

Front 120

_____ results from an abnormal development of the hip socket

Back 120

DYSPLASIA OF THE HIP

Front 121

when does hip dysplasia occur?

Back 121

It occurs when the head of the femur is still cartilaginous and the acetabulum (socket) is shallow

Front 122

causes of hip dysplasia?

Back 122

breech delivery, fetal position in utero, genetic predisposition, and laxity of the ligaments

Front 123

how hip dysplasia dx?

Back 123

increased number of folds on the posterior thigh of the affected side when the child is supine with knees bent, appearance of a shortened limb on the affected side, restricted abduction of the hip

Front 124

___ sign (a click is felt when the infant is placed supine with hips flexed 90 degrees, knees fully flexed, and the hip brought into midabduction seen in hip dysplasia?

Back 124

Barlow's

Front 125

____ click is present. (It can be felt by the fingers at the hip area as the femur head snaps out of and back into the acetabulum seen in hip dysplasia?

Back 125

Ortolani's

Front 126

____ test is positive in hip dysplasia?

Back 126

Trendelenburg's

Front 127

what happens when the child stands on the affected leg in hip dysplasia?

Back 127

the opposite pelvis dips to maintain erect posture

Front 128

tx for hip dysplasia?

Back 128

hip-spica cast or corrective surgery for older children

Front 129

what type traction and diapering for hip dysplasia?, harness

Back 129

Bryant's traction and triple-cloth diapering

Front 130

what type harness for hip dysplasia to keep the hips and knees flexed and the hips abducted? how long

Back 130

Pavlik
at least 3 months.

Front 131

____ of the foot is turned inward and downward at birth and remains stuck in this position, resisting realignment.

Back 131

CLUB FOOT -( Talepesis Equinovaus

Front 132

____ is the most common disorder of the legs that children are born with. It can range from mild and flexible to severe and rigid.

Back 132

club foot

Front 133

The cause of club foot is not known, but the condition may be inherited in some cases

Back 133

info

Front 134

who gets club foot more?

Back 134

male w/family hx

Front 135

tx for club foot?

Back 135

Gentle manipulation (stretching) and recasting occurs every week to improve the position of the foot

Front 136

how many casts(tx) are usually necessary to tx club foot? how long does the final cast stay on?

Back 136

5-10
3 wk

Front 137

after club foot realignment, the correction is maintained with a special type of brace, consisting of shoes attached to a bar called _____

Back 137

Dennis Browne

Front 138

The best results are obtained when the dennis brown brace is worn nearly fulltime for ___months, and then at night and during naps for up to ____ years.

Back 138

3
3

Front 139

surgery if the manipulation process is not successful, or if the deformity returns. Continued evaluation is recommended until the foot is fully grown.(club foot)

Back 139

info

Front 140

____ more common and less severe, characterized by incomplete closure of one or more vertebrae without protrusion of the spinal cord or meninges

Back 140

Spina bifida occulta

Front 141

where is the dimple seen in spina bifida occulta?(),

Back 141

found on the skin over the spinal defect

Front 142

what neuro defects maybe seen in spina bifida occulta?

Back 142

no neurologic dysfunction except occasional foot weakness or bowel and bladder disturbances

Front 143

_____ is soft fatty deposits that maybe seen in spina bifida occulta?, ulcerations,

Back 143

Port wine nevi

Front 144

where is the tuft of hair commonly seen in spina bifida occulta?

Back 144

the skin over the spinal defect.

Front 145

what are the 2 types of spina bifida cystica?

Back 145

Meninogocele, Myelomeningocele

Front 146

___which usually has no neurologic dysfunction and a saclike structure protruding over the spine

Back 146

Meninogocele

Front 147

_____(the worse) has an external sac -usually at lumbar- that contains meninges, CSF, and a portion of the spinal cord or nerve roots

Back 147

Myelomeningocele

Front 148

s/s of spina bifida cystica?

Back 148

hydrocephalus, permanent neurologic dysfunction (paralysis, bowel and bladder incontinence), possible mental retardation, clubfoot, curvature of the spine and Arnold-Chiari syndrome

Front 149

an obstruction may prevent information from passing freely from around the brain into the spinal canal seen in spina bifida cystica?

Back 149

Arnold-Chiari syndrome

Front 150

what is used to show neural tube defect in spina bifida cystica?

Back 150

amniocentesis and ultra sound

Front 151

___ alpha-fetoprotein (AFP) levels in the mother's blood may mean spina bifida cystica?

Back 151

elevated

Front 152

____ measurement can be used to confirm the diagnosis of spina bifida cystica?

Back 152

Acetylcholinesterase

Front 153

nsg care in r/t infant and defect in spina bifida cystica?

Back 153

handling the infant with care and not applying pressure to the defect

Front 154

care of the sac in spina bifida cystica: Intact, Moist and warm, ____ position to prevent tension trauma to sac

Back 154

prone

Front 155

Post Op care in spina bifida cystica includes?

Back 155

Montior for ICP. Measure head circumference daily to watch for signs of hydrocephalus

Front 156

menigitis maybe seen in spina bifida, what s/s to look for?

Back 156

nuchal rigidity and fever

Front 157

what is the goal of sx in spina bifida?

Back 157

Surgery whose goal is not to repair faulty spinal cord, but to preserve existing function

Front 158

number 1 concern w/spina bifida?

Back 158

prevent menigitis?

Front 159

what is done in spina bifida if hydrocephalus is present?

Back 159

shunt

Front 160

T/F Women who have spina bifida and parents who have one affected child have increase risk of having children with neural tube defects.

Back 160

T

Front 161

children w/spina bifida greater risk for ___ allergy than the general population

Back 161

latex

Front 162

____can be achieve by self-catheterization for kids 6-7y/o w/spina bifida?

Back 162

Continence

Front 163

_____ and ____if prescribed are used to help children retain urine rather than dribbling in spina bifida?

Back 163

Tofranil, Ephed II

Front 164

what to do in r/t bm and o/p w/spina bifida?

Back 164

Assist with bowel training program, stool softeners, supp or enemas, may be used, encourage intake of high fiber, high fluid diet;

Front 165

neuromuscular disorder resulting from damage to or defect in the part of the brain that controls motor function. Common in children born prematurely and can not be cured

Back 165

cerebral palsy(CP)

Front 166

what is Tx of CP aimed @?

Back 166

interventions that encourage optimum development

Front 167

what are the five types of cerebral palsy

Back 167

Ataxia, Athetoid, Spastic, Rigidity type, Mixed

Front 168

CP that is uncommon, disturbances in movement and balance w/involuntary, incoordinate motion with varying degrees of muscle tension

Back 168

Ataxia

Front 169

what face and mouth problems in Ataxia CP?

Back 169

. Facial grimacing, poor swallowing and tongue movements cause drooling and poor speech articulation

Front 170

intelligence for ataxia CP?

Back 170

average

Front 171

most common CP where hyperactive deep tendon reflexes, rapid involuntary muscle contraction and relaxation

Back 171

Spastic

Front 172

Describe the legs and toes in spastic CP?

Back 172

Child's legs are crossed and the toes are pointed down, so the child stands on his toes

Front 173

CP w/rigid postures and lace of active movement

Back 173

rigidity type

Front 174

severe disability involving more than one type of CP

Back 174

mixed

Front 175

causes of CP?

Back 175

anoxia before, during or after birth, infection and trauma

Front 176

s/s of CP(all types)?

Back 176

abnormal muscle tone and coordination, dental anomalies, mental retardation, seizures, speech, vision or hearing disturbances

Front 177

____ studies determine the site of brain impairment in CP

Back 177

neuroimaging

Front 178

___ and ___ to R/o other causes of CP?

Back 178

Cytogenic and metabolic studies

Front 179

what meds to control spasticity and seizures in CP?

Back 179

Muscle relaxants, anticonvulsants

Front 180

___ is a genetic disorder that occurs only in males, marked by muscular deterioration that progresses throughout childhood. It is due to a defect on the X chromosome. There is no known cure

Back 180

MUSCULAR DYSTROPHY

Front 181

s/s of MD?

Back 181

begins with pelvic girdle weakness, indicated by waddling gait and falling, cardiac or pulmonary failure, eventual muscle weakness and wasting

Front 182

____ sign which is the use of hands to push self up from the floor seen in MD?

Back 182

Gowers'

Front 183

_____ demonstrates short, weak bursts of electrical activity in affected muscles in MD?

Back 183

electromyography

Front 184

what does Muscle biopsy show in MD?

Back 184

varied muscle fiber sizes and fat and connective tissue deposits

Front 185

tx for MD?

Back 185

physical therapy, surgery to correct contractures, use of devices to preserve mobility.

Front 186

what type diet?

Back 186

high-fiber, high-protein, and low, calorie d

Front 187

lateral curvature of the spine, common among females. Identified at puberty and throughout adolescence

Back 187

scolios

Front 188

____ involves an absence in the autonomic ganglia of the smooth muscle in a section of the large intestine, with resulting loss of peristaltic function in this part and dilatation of the colon proximal to the aganglionic part -- called also _____?

Back 188

Hirschsprung's Disease
congenital megacolon

Front 189

Tx for hirschsprungs

Back 189

That non-functioning section of bowel is surgically removed to correct the problem

Front 190

describe the sequence of problems in hirschsprungs

Back 190

faliure of internal rectal sphincter to relax) > absents of peristaslsis > accumlation of intestinal contents > distention of bowel proximal to defect> megacolon

Front 191

who gets hirschsprungs?
accounts for what % of neonate obstructions?

Back 191

males and downs

25

Front 192

s/s of hirschsprungs in neonate?

Back 192

Faliure to pass meconium with 24-48 hours after birth; overflow type diarrhea

Front 193

neonate:
what does the vomit look like in hirschsprungs?
does baby refuse to eat?
what happens to belly?

Back 193

bile stained

yes
distented

Front 194

s/s of hirschsprungs in infancy?

Back 194

Constipation with explosive episodes of diarrhea,Abdomen distended

Front 195

s/s of hirschprungs in childhood?

Back 195

More Chronic Constipation, Ribbon like stools which are foul smelling, abdomen distended, Poor nourished child, Anemic

Front 196

how is hirschsprungs dx?

Back 196

X-Ray, Barium Enema

Front 197

what does barium look like on xray?

Back 197

white

Front 198

Barium Enema {Barium is a dry, white, chalky, metallic powder that is mixed with water to make barium liquid. Barium is an x-ray absorber and appears white on x-ray film. When instilled via the rectum, barium coats the inside wall of the large intestine so that the inside wall lining, size, shape, contour, and the colon's atency are visible on x-ray

Back 198

read over

Front 199

what may result if barium is not eliminated from body?

Back 199

constipation or impaction

Front 200

___ to test neuro reflexes in hirschsprungs

Back 200

Manometry

Front 201

what does Rectal Biospy show in hirschsprungs?

Back 201

Histologic evidence of aganglionic cell

Front 202

what may be done for acute case of hirschsprungs?

Back 202

Surgery with removal of aganglionic colon, temporary colostomy

Front 203

pt teaching for chronic hirschsprungs?

Back 203

stool softeners, Isotoinc enema, low residue diet to decrease bulk

Front 204

Nursing interventions: Pre -Op in hirschsprungs?

Back 204

Rehydration, informed consent, NPO and no rectal temps

Front 205

Post Op care in hirschsprungs?

Back 205

Monitor site, bowel sounds, rehydrate, NG Tube, Parent education regarding colostomy.

Front 206

T/F Both parents must be carriers to have a child with tay sachs

Back 206

T

Front 207

Every on in 4 chance of having child with diease and a 2 in 4 chance of a child who is a carrier(tay sach)

Back 207

info

Front 208

Fatty substance called Ganglioside GM2 acculate in the nerve cells in the brain and the enzyme hexosamindiase A (Hex-A) is lacking to break GM2 down

Back 208

tay sach's

Front 209

Infants appear to be developing normally. As nerve cells acculate fatty material child starts to regress. loss of motor skills and mental function

Back 209

tay sachs

Front 210

what happens to pt in tay sachs? die by what age?
Tx?

Back 210

child becomes blind, deaf, mentally retarded, paralyzed and non responsive to environment. 5y/o. none

Front 211

the child w/tay sachs looks like a child w/____?

Back 211

downs

Front 212

Appearance of Downs Syndrome child: Occiptal Flat, Eyes slanted upward Bridge of Nose: flat Mouth: Small Tongue: Larger and protruding Ears: Low set Limbs: short Stature: short and stocky. Muscle tone: Hypotonic Transverse palamar crease on hands and feet

Back 212

info but know

Front 213

___ Midline defect of the abdominal wall that results in herination of the bowel and intrabdominal contents into the umbilical cord

Back 213

Omphalocele

Front 214

are Maternal AFP levels are elevated in omphalocele?

Back 214

no

Front 215

____ will develop within the omphalocele sac

Back 215

Ascties

Front 216

_____ causes an interruption of blood flow to the fingers, toes, nose, and/or ears when a spasm occurs in the blood vessels of these areas

Back 216

Raynaud's Disease

Front 217

what causes raynauds to flare?

Back 217

cold or stress

Front 218

describe the color in raynauds?

Back 218

turns white, then blue, then bright red over the course of the attack

Front 219

what other s/s may be seen in raynauds?

Back 219

tingling, swelling, or painful throbbing

Front 220

T/F attacks in raynauds may last from minutes to hours and the areas may develop infection and ulceration.

Back 220

T

Front 221

who gets raynauds more

Back 221

female

Front 222

what is Tx of raynauds centered around?

Back 222

minimizing or preventing exposure to cold and vasodilating medications.

Front 223

____ is when Classic Factor 8 defect.
Hemophilla B or ____defect "A" most common

Back 223

Hemophilla A
Chirstmas Disease. Factor 9 defect

Front 224

Both have similiar symptoms, but "B" is simpler and milder

Back 224

info

Front 225

Mothers are the carriers and the infant ___ are affected w/hemophilia

Back 225

sons(X gene)

Front 226

concern w/hemophilias

Back 226

Bleeding around vital structures, even bleeding into brain

Front 227

where is bleeding most commonly seen in hemophila? results in?

Back 227

Hemarthorsis, bleeding into joints causing large joints and leading to decreased cartilage(arthritis)

Front 228

interventions for active bleed in joint in hemophila?

Back 228

rest joint and immobilize

Front 229

what to do in hemophilia after bleed as stopped in joints?

Back 229

gradual movement to prevent contractors

Front 230

T/F platelets are normal in hemophilia

Back 230

T

Front 231

Drugs: Factor 8 : Humafac or Koate Factory 9: Prolox or Konyne.

Back 231

info but know and look up

Front 232

3 C's associated w/hemophilia?

Back 232

cough, cyanosis, choking

Front 233

_____occurs when the maternal antibodies attach to the Rh site on the fetal red blood cells making them susceptible to destruction by phagocytes

Back 233

erythroblastcystosis fetalis

Front 234

what happens in infant in erythroblastcystosis fetalis

Back 234

The fetal system reponds by increased red bood cell production then rapid and early destruction of erythocytes results in a marked increase in immature RBC that do not have the functional capapbilities of matrue cells and results in mulitorgan failure

Front 235

what are the risks to the infant in Rh incompatibility?

Back 235

bleeding tendencies due to assoiated thrombocytopenia and hypoxic damage to the capillaries

Front 236

how does baby get hypoglycemia in Rh incompatibility?

Back 236

Also hyperplasia of the adrenal cortex and pancreatic islet,

Front 237

hernia of a bladder and especially the urinary bladder into the vagina : vesical hernia

Back 237

cystocele

Front 238

a decrease in the # of platelets in the circulating blood, major concern is bleeding

Back 238

Thrombocytopenia

Front 239

disorder of young adults, presence of Reed-Sternberg cells, involves lymph nodes, spleen and liver, progress depends on stage of disease.

Back 239

Hodgkin’s Disease

Front 240

w/Lasix (furosemide) and Lanoxin (digoxin)what needs to be watched for?

Back 240

potassium-wasting diuretics, high risk for hypokalemia. Mo nitor for decreased serum potassium levels.

Front 241

– fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesia and dysrhythmias.

Back 241

Hypokalemia

Front 242

tingling of the fingers and toes

Back 242

low Ca+

Front 243

diarrhea and intestinal colic

Back 243

hypoK+

Front 244

Alupent (metaproterenol sulfate) is a ____

Back 244

adrenergic type of bronchodilator

Front 245

Vanceril (beclomethasone) is a ___

Back 245

glucocorticoid(steroid)

Front 246

which to give 1st bronchodilator or steroid? why?

Back 246

bronchodilator.
The bronchodilator widens the air passages and allows the glucocorticoid to work more effectively

Front 247

____– a bronchodilator for bronchitis, to relax relax smooth muscles of the bronchioles

Back 247

Aminophylline (theophylline)

Front 248

_____ causes orange-red discoloration of body fluids, should always be taken with food or antacids, doses sh ould not be doubled, take as directed by physician.

Back 248

Rifadin (rifampin)

Front 249

what R med if administered rapidly may cause tachycardia

Back 249

theophyline

Front 250

what med prolongs fibrin clot formation? affects which lab?

Back 250

heparin
PTT (partial thromboplastin time

Front 251

anticoagulant that prolongs prothrombin time (PT) for overdose, antidote is ?

Back 251

coumadin
vit K

Front 252

what med decreases platelet aggregation

Back 252

Aspirin

Front 253

necessary for formation of prothrombin and used as an antidote for Coumadin

Back 253

vit K

Front 254

– extremely low white blood cell count (WBC’s)

Back 254

Neutropenia

Front 255

dysrhymia that the result of an irritable myocardium and the hallmark is a wide, distorted QRS complex indicating abnormal conduction through the ventricles.

Back 255

Premature ventricular contractions (PVCs

Front 256

a progressively increasing P-R interval is indicative of a conduction defect through the AV node.

Back 256

Second Degree AV block Mobitz Type 1

Front 257

pain w/MI can not be relieved w/?

Back 257

nitro

Front 258

which cardiac enzyme is specific to the heart muscle and elevated levels indicates cellular necrosis or death

Back 258

troponin 1

Front 259

what is the goal of therapy w/nitro? does it affect dysrthymias?

Back 259

goal of therapy is relief of pain. It dilates peripheral and coronary arteries, thereby increasing blood flow to the heart. Has no effect on dysrhythmias.

Front 260

what is major problem w/chf?

Back 260

primary problem is heart becomes an inefficient pump; blood and fluids back up into the lungs causing adventitious breath sounds

Front 261

why do pt w/chf gain wt?
describe o/p in chf?

Back 261

fluid retention.
< urinary output by day, and > output at night

Front 262

what happens w/excess fluid in CHF when pt reclines?

Back 262

reabsorbed and eliminated by the kidneys

Front 263

As cardiac output falls in chf, blood flow to the kidneys ___ causing decreased glomerular flow. Kidneys interpret this as ____ and attempt to correct it by holding on to fluids

Back 263

decreases
hypovolemia

Front 264

in chf the Kidneys > production and release of ____ causing sodium retention

Back 264

aldosterone

Front 265

what med to control the dysrhythmias of MI? thrombolytic agent administered intravenously to loosen the clot blocking the coronary artery. Best within the first ___hours following onset of MI?

Back 265

Activase (thrombolytic enzyme alteplase)
6

Front 266

blocks beta-adrenergic stimulation and causes a decreased heart rate, blood pressure and decreases the force of myocardial contraction.

Back 266

Inderal (propranolol)

Front 267

___ is an adrenergic and increases blood pressure and heart rate

Back 267

Epinephrine

Front 268

how do Drugs that < peripheral arterial resistance affect afterload?

Back 268

decrease

Front 269

– resistance to blood flow

Back 269

Afterload

Front 270

– amount of blood ejected by the heart with each beat

Back 270

Stroke volume

Front 271

– filling pr essure of the heart

Back 271

Preload

Front 272

cardiac sx to assess extent and severity of coronary artery blockage? what is done w/results?

Back 272

Cardiac Catheterization.
Medical mgmt, angioplasty or coronary bypass surgery based on results.

Front 273

– indicates the lung has collapsed and will hear no air movement on auscultation.

Back 273

Pneumothorax

Front 274

Bronchoscopy – complications:

Back 274

cyanosis, dyspnea, stridor, hemoptysis, hypotension, tachycardia, dysrhymias

Front 275

hypoxemia, hypercapnia, dyspnea at rest and on exertion, O2 desaturation w/exercise and use of accessory muscles of respiration

Back 275

COPD

Front 276

what does cxr show in copd?

Back 276

hyperinflated lungs due to trapped air

Front 277

hallmark symptom is sudden onset of chest pain, dyspnea second most common symptom

Back 277

pulmonary embolus

Front 278

s/s of Pulmonary edema – symptoms include

Back 278

crackles hea rd upon auscultation

Front 279

characterized as an inflammation of the bronchioles, with air trapped in the small airways

Back 279

asthma

Front 280

hoarseness occurs early, because the tumor prevents the accurate approximation of the vocal cords during phonation, foul breath spitting up blood are late symptoms

Back 280

laryngeal(voice) CA

Front 281

Large extrinsic tumors produce difficulty and pain in swallowing. Nagging cough not related to this.

Back 281

laryngeal(voice) CA

Front 282

- post operative complication prevented by interventions such as deep breathing, coughing, turning, and using spirometer.

Back 282

Atelectasis

Front 283

- post operative complication due to depression of the gag reflexes during and immediately after general anesthesia.

Back 283

Aspirtation Pneumonia

Front 284

– heard over aortic area upon auscultation is sign of abnormal cardiovascular finding

Back 284

Heart murmur

Front 285

– heard over aortic area upon auscultation is sign of abnormal cardiovascular finding

Back 285

Heart murmur

Front 286

– pain produced by myocardial ischemia

Back 286

Angina Pectoris

Front 287

Abdominal aortic aneurysm – s/s include

Back 287

pulsating abdominal mass, low back pain, lower abdominal pain.

Front 288

Rheumatic endocarditis - caused by

Back 288

Group A streptococcus organism

Front 289

– potent inotropic agent that increases myocardial contractility, which leads to improved cardiac output and improved tissue perfusion

Back 289

Intropin (dopamine hydrochloride)

Front 290

At moderate doses, can maintain BP above 90 mmHg in pts with shock

Back 290

Intropin (dopamine hydrochloride)

Front 291

Also dilates the renal and mesenteric arteries, supporting renal perfusion

Back 291

Intropin (dopamine hydrochloride)

Front 292

High doses is a vasoconstrictor and may cause serious side effects, and not usually administered in high doses.

Back 292

Intropin (dopamine hydrochloride)

Front 293

the inability to absorb B12 due to a deficiency in intrinsic factor in the stomach

Back 293

Pernicious anemia

Front 294

___ attaches to B12 in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestines.

Back 294

Intrinsic factor

Front 295

– bone scan to detect increased metastatic activity

Back 295

Radioisotope

Front 296

– is performed using the results of all diagnostic studies including tumor grading and tumor markers and determines the direction of the medical mgmt of a malignancy

Back 296

Staging of a malignancy

Front 297

- a malignant tumor developing in the uterus from trophoblast

Back 297

Choriocarcinoma

Front 298

Following the removal of a hydatidiform mole pt’s HCG levels should be monitored for ___yrs.

Back 298

1 –2

Front 299

Digitalis – pt experiencing sinus bradycardia relating to digitalis toxicity should be given ___

Back 299

Atropine

Front 300

what med blocks vagus nerve stimulation resulting in an increased heart rate

Back 300

Atropine

Front 301

- channel blocker will decrease heart rate

Back 301

Calan (verapamil)

Front 302

– an antidysrhythmic and used for tachyarrhythmias

Back 302

Quinidine

Front 303

a permanent urinary diversion wh ere a portion of the ileum is surgically resected and one end of the segment is closed.

Back 303

Ileal conduit

Front 304

The ___ are surgically attached to this segment in the ileum and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma in ileal conduit?

Back 304

ureters

Front 305

– a tumor that arises from the sympathetic nervous system

Back 305

Neuroblastoma

Front 306

Most common form of extra-cranial solid tumor of childhood

Back 306

Neuroblastoma

Front 307

Neuroblastoma primarily affects what group?

Back 307

peds

Front 308

a malignant tumor of the kidney that primarily affects children and is made up of embryonic elements – also called nephroblastoma

Back 308

wilm's tumor

Front 309

s/s of wilm's tumor?

Back 309

Hypertension and vomiting

Front 310

- a sarcoma derived from bone or containing bone tissue, recurrent tumors may result in amputation -- called also

Back 310

Osteosarcoma
osteogenic sarcoma

Front 311

- a tumor that invades the shaft of a long bone and that tends to recur and metastasizes frequently to the lungs

Back 311

Ewing’s sarcoma

Front 312

- a neoplastic disease that is characterized by progressive enlargement of lymph nodes, spleen, and liver and by progressive anemia

Back 312

Hodgkin’s Disease

Front 313

– involves an absence in the autonomic ganglia of the smooth muscle in a section of the colon.

Back 313

Hirschsprung’ s Disease

Front 314

what is done in sx to fix hirschsprung's?

Back 314

non-functioning section of bowel is surgically removed

Front 315

____ is caused by congenital absence of ganglion cells in the muscular wall of the distal part of the colon with resulting loss of peristaltic function in this part and dilatation of the colon proximal to the aganglionic part.
called also

Back 315

Megacolon
congenital megacolon

Front 316

- an abnormal increase in the amount of cerebrospinal fluid within the cranial cavity that is accompanied by expansion of the cerebral ventricles, enlargement of the skull and especially the forehead, and atro phy of the brain

Back 316

Hydrocephalus

Front 317

priority NX for hydrocephalus? why?

Back 317

risk for injury
change in the neurological state and seizure activity.

Front 318

a metabolic disorder that is caused by an enzyme deficiency resulting in the accumulation of phenylalanine and its metabolites (as phenylpyruvic acid) in the blood and their excess excretion in the urine, that is inherited as an autosomal recessive trait, and that causes usually severe mental retardation, seizures, eczema, and abnormal body odor unless phenylalanine is restricted from the diet beginning at birth?
also called?

Back 318

PKU
phenylpyruvic amentia, phenylpyruvic oligophrenia

Front 319

– a sac-like structure outside the body and contains cerebrospinal fluid and the meninges

Back 319

Myelomeningocele

Front 320

– a sac containing cerebrospinal fluid and may contain the meninges, but does not contain neural tissue.

Back 320

Meningocele

Front 321

- hernia of a bladder and especially the urinary bladder : vesical hernia

Back 321

Cystocele

Front 322

a common disease especially in Caucasian populations that appears usually in early childhood, is inherited as a recessive monogenic trait, involves functional disorder of the exocrine glands, and is marked especially by faulty digestion due to a deficiency of pancreatic enzymes, by difficulty in breathing due to mucus accumulation in airways, and by excessive loss of salt in the sweat? aka?

Back 322

CF
fibrocystic disease of the pancreas, mucoviscidosis

Front 323

T/FAntineoplastic agents have more of an effect on the tumor cells than n ormal cells because of their rapid growth

Back 323

T

Front 324

Those normal tissue cells that are the most effected by chemo are bone marrow (seen in low blood counts), hair follicles (seen by way of hair loss) and the GI mucosal epithelium (accounting for nausea, vomiting, loss of appetite, and diarrhea).

Back 324

info but KNOW

Front 325

It is a very narrow margin deciding the right dose to use for destroying the tumor cells in order to have the lease affect on normal healthy cells.

Back 325

info

Front 326

Endocrine antineoplastic chemotherapy such as ____ is what is considered additive or ablative therapy

Back 326

Tamoxifen

Front 327

T/F tamoxifen is not a cure but provides palliative therapy as effectively as does an oopherectomy( removal of ovaries

Back 327

T

Front 328

when is tamoxifen most effective?

Back 328

It is most effective when used to prolong disease free survival in breast cancer therapies.

Front 329

It is important to be alert to the signs and symptoms that may accompany the use of antineoplastics such as increased fluid retention leading to CHF, as well as, increased susceptability to infe ctions due to immunosuppression. Additional medications may need to be given to help resolve CHF. Good handwashing techniques before and after giving care will help to reduce possible introduction of infection.

Back 329

info but know

Front 330

It is recommended that care be given to prevent undue cytotoxic exposure, by wearing disposable ____ gloves when handling the medication.

Back 330

nonpermeable

Front 331

– a disorder of diffuse activation of the clotting cascade that results in depletion of clotting factors in the blood

Back 331

Disseminated Intravascular Coagulation (DIC)

Front 332

describe how DIC occurs?

Back 332

occurs when the blood clotting mechanisms are activated throughout the body instead of being localized to an area of injury. Small blood clots form throughout the body, and eventually the blood clotting factors are used up and not available to form clots at sites of tissue injury. Clot dissolving mechanisms are also increased

Front 333

DIC may be stimulated by many factors including?

Back 333

infection in the blood by bacteria or fungus, severe tissue injury as in burns and head injury, cancer, reactions to blood transfusions, and obstetrical complications such as retained placenta after delivery.

Front 334

Risk factors for DIC are?

Back 334

recent sepsis, recent injury or trauma, recent surgery or anesthesia, complications of labor and delivery, leukemia or disseminated cancer, recent blood transfusion reaction, and severe liver disease.

Front 335

Symptoms of DIC?

Back 335

Bleeding, possibly from multiple sites in the body, Thrombosis formation evidenced by bluish coloration of the fingers, Sudden onset of bruising

Front 336

what do labs show in DIC?

Back 336

Elevated fibrin and/or fibrinogen degradation products, Decreased serum fibrinogen, Increased prothrombin time, Increased PTT, Platelet count, Thrombin time test

Front 337

what is the goal of tx in DIC?

Back 337

The objective of treatment is to determine the underlying cause of DIC and provide treatment for it.

Front 338

what maybe done to relieve DIC?

Back 338

Replacement therapy of the coagulation factors is achieved by transfusion of fresh frozen plasma

Front 339

____may also be used if fibrinogen is significantly decreased in DIC?

Back 339

Cryoprecipitates

Front 340

___ a medication used to prevent thrombosis, is sometimes used in combination with replacement therapy in DIC?

Back 340

Heparin

Front 341

Vitamin ___ is deficient in Lung cancer

Back 341

C

Front 342

what med is used for asthmatic children, it is a mast cell stabilizer, it prevents allergic reactions

Back 342

Intal (cromolyn sodium)

Front 343

s/sx of iron deficiency

Back 343

anemia are pallor, sensitivity to cold, weakness, and fatigue

Front 344

Monitor _____ in Liver Cancer

Back 344

alkaline phosphatase

Front 345

S/sx of liver tumor include

Back 345

dull ache, RUQ , epigastrium and back pain

Front 346

If the portal vein is blocked in Liver cancer then ___ will be the complication, if the large bile duct becomes obstructed, the result will be _____.

Back 346

ascites
obstructive jaundice

Front 347

S/sx of pernicious anemia include

Back 347

tingling and paresthesia of hands and feet, weight loss, anorexia, and dyspepsia

Front 348

Tx for pernious anemia is a diet high in ___ & ___, restricting ____ or extremely hot foods. Increased intake of vitamins

Back 348

iron and protein
highly seasoned
B12 and B 6, C and folic acid.

Front 349

S/sx of R sided heart failure include .

Back 349

edema, swelling, dependent edema, distended neck vein, nocturia, weakness, hepatomegaly and weight gain

Front 350

S/sx of R sided heart failure include .

Back 350

edema, swelling, dependent edema, distended neck vein, nocturia, weakness, hepatomegaly and weight gain

Front 351

S/sx of L sided heart failure (think pulmonary) include

Back 351

SOB< dyspnea, moist cough, crackles and gallop rhythm (S3 and S40, crackles, coughing, tachycardia, and fatigue-ability.

Front 352

childhood tumor of the kidney

Back 352

Wilm’s Tumor

Front 353

S/sx of wilm's tumor?

Back 353

palpable firm, smooth mass in the abdomen, hypertension, vomiting.

Front 354

why palpation contraindicated in wilm's tumor?

Back 354

it could cause rupture and seeding

Front 355

Post op concern in wilm's tumor

Back 355

decreased urine output.

Front 356

S/sx of ____ tumors includes hypermenorrhea, (dysmenorrhea or leukorrhea may occur) pain, backache, constipation, urinary frequency or urgency or intestinal obstruction.

Back 356

uterine fibroid

Front 357

Hx of pt undergoing heart catherization should include allergy to _____ because of use of dye during the procedure

Back 357

shellfish

Front 358

invasive procedure where they thread a hollow catheter through the femoral artery/vein

Back 358

Angioplasty

Front 359

during ____ a balloon tipped catheter is introduced and used during inflation to “crack” plaque in the vessel and reduce vessel stenosis to not more than 20%.

Back 359

Angioplasty

Front 360

chronic reactive airway disease

Back 360

asthma

Front 361

____ asthma is an antigen antibody reaction to pollen, dander, feathers, food, house dust and mites

Back 361

Extrinsic

Front 362

S/sx of asthma include

Back 362

tachypnea, tachycardia, dyspnea, wheezing, hypoxemia, diaphoresis, used of accessory muscles

Front 363

what to have child w/asthma do to increase vital capacity?

Back 363

to blow pinwheels to incrase vital capacity

Front 364

An undesirable s/e of premarin used to treat prostate cancer is?

Back 364

gynocomastia (increased breast size.)

Front 365

why is Constant irrigation is used post op of TURP?

Back 365

to prevent obstruction of urine flow, and to prevent clot formation

Front 366

S/sx of pulmonary embolism include

Back 366

sudden onset of dyspnea, tachypnea, crackles, chest pain, cough, hemoptysis, tachycardia, anxiety.

Front 367

what test to dx pulmonary embolism?

Back 367

V/Q lung scan

Front 368

____ disease is a form of peripheral vascular disease

Back 368

Raynaud’s

Front 369

who gets raynauds?

Back 369

women between puberty and age 40

Front 370

what usually precipitates the episodic vasospasm of raynauds?

Back 370

stress or cold exposure

Front 371

Raynaud's s/sx include?

Back 371

tingling and numbness, blanching unrelieved by warming.

Front 372

Digoxin is a ___?

Back 372

cardiac glycoside

Front 373

how does dig work?

Back 373

It increases cardiac output and contractility (slows the rate

Front 374

blood level for dig?

Back 374

Therapeutic range is 0.8 to 2.0 ng/ml, toxicity> 2.4ng/ml

Front 375

s/sx of dig toxicity?

Back 375

S/e include nausea, vomiting, cardiac dysrhythmias, hypotension, yellow-green halos, blurred vision

Front 376

T/F Md should be contacted for irregular heart beats and muscle weakness which could indicate hypokalemia w/dig?

Back 376

T

Front 377

what to monitor for if dig is taken with lasix?

Back 377

watch out for cardiac dysrhythmias

Front 378

Capoten is an ___?

Back 378

ACE inhibitor

Front 379

how does capoten work?

Back 379

It decreases the work of the heart by promoting vasodilation and diuresis (while retaining potassium)

Front 380

what labs to monitor w/capoten?

Back 380

Monitor serum creatine and urine creatine clearance

Front 381

S/E of capoten include?

Back 381

S/e include hypotension, hypovolemia, and hyponatremia

Front 382

T/F Taking capoten with food reduces absorption by up to 30%.

Back 382

T

Front 383

Dopamine is a ____. It will increase B/P and cardiac output through blood vessel _______

Back 383

vasopressor
vasoconstriction

Front 384

what narc is used for severe pain because it depresses the pain impulse transmission at the spinal cord

Back 384

Morphine

Front 385

what med is used to inhibit cell division, common in tx of breast ca.

Back 385

Tamoxifen

Front 386

what to have woman do in r/t arm after mastectomy?

Back 386

After mastectomy elevate the arm on the affected side to reduce tension on surgical incision, promote circulation and prevent venous congestion.

Front 387

values in tumor lysis include

Back 387

increased potassium, increased phosphate and uricemia with decreased calcium

Front 388

Nursing priorities immediately following surgery include recovery from general anesthesia?

Back 388

patent airway, prevention of aspiration, effective breathing pattern) and pain management.

Front 389

accelerated clotting process caused depletion of circulating clotting factors and platelets which can provoke severe hemorrhage

Back 389

DIC

Front 390

lab test to dx DIC:
PT?
PTT?
Platelet count?
Fibrinogen?

Back 390

PT greater than 15 seconds, PTT greater than 60-80 seconds, patelets less than 100,000/ul, fibrinogen level less than 150 mg/dl

Front 391

what test is specific for DIC?

Back 391

positive D-dimer test specific for DIC

Front 392

T/F There is an decreased survival rate in chrondosarcoma following amputation

Back 392

F
increase

Front 393

S/sx of chronic arterial occlusion include?

Back 393

intermittent claudication, achy, cramping like pain, fatigue or weakness relieved with rest.

Front 394

what increases pain in arterial occlusion?

Back 394

Pain increases with elevation, limbs usually legs hand over the bed at noc to reduce pain

Front 395

_____ is a common pneumonia. Incidence is greatest in patients with AIDS, and immunosuppression because of cancer tx

Back 395

Pneumocystis carinii

Front 396

T/F in PCP the mortality rate is 60-80%, complications include respiratory failure

Back 396

T

Front 397

Prevent skin breakdown by

Back 397

repositioning every 2 hours

Front 398

S/sx of Pyloric Stenosis includes

Back 398

projectile vomiting, weight loss and constipation

Front 399

who gets pyloric stenosis?

Back 399

Defect is common in male infants between ages 1-6 months

Front 400

2 foods tha reduce colostomy odor?

Back 400

Spinach and parsley reduce colostomy odor

Front 401

Thrombocytopenia is reduced ____. Normal is _____
____is serious,
_____ may be life threatening.

Back 401

platelets
150,000-400, 000mm3.
<20,000
< 10,000

Front 402

____ is done to deliver a high dose to a localized area. how long left in place?

Back 402

Implantable internal radiation.
48-72 hrs

Front 403

what to do for internal radiation pt?

Back 403

should minimize their exposure TIME, stand at the side of the bed out of the direct line of radiation, keep their DISTANCE (radiation loses its intensity) and use of lead SHIELDS

Front 404

how often should placement of internal radiation device be checked

Back 404

every 4 hours

Front 405

what should the RN always avoid in internal radiation device?

Back 405

NEVER TOUCH THE RADIATION SOURCE WITH YOUR BARE HAND

Front 406

S/sx of MI?

Back 406

crushing substernal pain that may radiate to the jaw, back and arms

Front 407

different btwn MI and angina

Back 407

last longer and no relieved by nitro.

Front 408

____ is the classic symptom of arteriosclerotic heart disease

Back 408

Angina

Front 409

what is the cause of angina?

Back 409

inadequate oxygenation of the heart due to decreased blood flow to the cardiac vessels that feed the heart.

Front 410

how does nitro work?

Back 410

reduces the pain of angina by dilating the coronary arteries and improving blood flow to the heart muscle

Front 411

should pt keep nitro at all times? what to do if pain lasts longer than 20min? how should nitro be stored? what should pt experience when taking nitro SL?

Back 411

yes
call ems
cool dark dry place
slight burning/stinging sensation

Front 412

surgical removal of some or all of the larynx?
preop teaching for?

Back 412

laryngectomy
alternate methods of communication (writing, lipspeakin and word boards

Front 413

____ is a developmental anomaly of the placenta. A chorionic tumor

Back 413

Hydatiform mole

Front 414

SE of mole?

Back 414

rapid uterine growth, extremely elevated HCG and US that fails to reveal a fetal skeleton.

Front 415

T/F w/chest tubes bubbling in the water seal chamber should decrease as the need for the chest tube resolves

Back 415

T

Front 416

what does constant bubbling in chest tubes mean?

Back 416

loose connection, and prompt correction (hemastat at the bedside) is necessary

Front 417

what to do if chest tube becomes dislodged?

Back 417

cover the opening immediately with petroleum gauze and apply pressure then call MD

Front 418

what to assess for @ insertion site w/chest tubes?

Back 418

subcutaneous emphysema and contact the doctor if it increases

Front 419

NSG int r/t chest tubes?

Back 419

Assure integrity of the system, measure the drainage, place below the level of the chest even during ambulation.

Front 420

p/o pneumectomy care?

Back 420

Position on operative side to promote full expansion of unaffected lung and to assist in drainage of secretions from operative site. Perform arm exercises to minimize complications and prevent degenerative changes in the joints. The patient should take frequent rest periods, avoid heavy lifting and prevent infection and stop smoking

Front 421

S/sx of pneumothorax include?
TX?

Back 421

diminished or absent breath sounds, dyspnea, tachypnea, subcutaneous emphysema, cough, sharp pain that increased with exertion. Bronchus deviated from midline. Tx-chest tube.

Front 422

Vesicular I>E, both lungs soft and low, Bronchovesicular equal I/E anterior between scapulae, Bronchial E>I loud and relatively high pitch, Tracheal I/E equal very loud.

Back 422

KNOW

Front 423

____ is the inflammation of both layers of the pleurae. Causes include

Back 423

Pleuritis.
pneumonia, TB, collagen disease, primary and metastatic cancers and thoracotomy.

Front 424

____ shock is compromised tissue perfusion and reduced cardiac output because the heart fails to adequately pump

Back 424

Cardiogenic

Front 425

causes of cardiogenic shock?

Back 425

MI, heart failure, myocarditis, cardiomyopathy and advanced heart block

Front 426

what might Tx of cardiogenic shock consist of?

Back 426

Tx can include digoxin, dopamine, diuretics, vasodilators and vasopressors, increased oxygen to maximize cardiac, pulmonary, renal fx and Use of IABP (intra-aortic balloon pum) may be used

Front 427

In IABP coronary artery perfusion is increased with the aortic valve closes and the balloon inflates during diastole. The balloon is inserted through the femoral artery into the descending aorta

Back 427

info but know

Front 428

____ crisis is a vaso-occlusive episode and it is very painful

Back 428

Sickle cell

Front 429

Interventions during sickle cell crisis include?

Back 429

warm compresses to painful areas, (cold aggravates the condition), maintaining bed rest to reduce workload on the heart, and increased fluid intake to prevent dehydration which can precipitate a crisis

Front 430

pt teaching to avoid sickle cell crisis?

Back 430

avoid strenuous exercise , high altitude, unpressurized aircraft, cold and vasoconstrictive drugs.

Front 431

_____ is a diffuse endothelioma or endothelial myeloma forming a fusiform swelling on a long bone

Back 431

Ewing ’s sarcoma

Front 432

The largest risk factor in cervical cancer is ____? It can be detected by a ____. Unlike uterine cancer that requires a ____ and the use of ____ test.

Back 432

multiple partners
pap smear
biopsy
Schiller’s

Front 433

bradycardia in a newborn (<100), up to 3 months (<80), 3months to 2 years (<70), 2-10 years (<55), adult (<60

Back 433

info but know

Front 434

uterine fibroids, hydatiform moles, fibrocystic disease of the breast, pyloric stenosis and prostatic hyperplasia are all ____?

Back 434

Benign tumors

Front 435

After the treatment of Basal Cell epithelioma patients should be instructed to___?

Back 435

avoid sun exposure, use of protective clothing (such as hats, gloves), used of sunscreens (zinc oxide is best) and have all lesions checked promptly.

Front 436

Squamous cell carcinoma usually affects ___ males over the age of 60

Back 436

caucasian

Front 437

causes of Squamous cell carcinoma?

Back 437

. Causes include sun exposure, x-ray therapy, arsenic ingestion (gardener), carcinogen exposure (tar and oil) and chronic skin irritation and inflammation.

Front 438

which squamous cell lesions have poor prognosis?

Back 438

lip and ear

Front 439

___ is an immunosuppressant anti-neoplastic. Give ___ 24-48 hours after tx to prevent reversal of bone marrow and GI toxicity.

Back 439

Folex (methotrexate)
Ca+

Front 440

Nursing care for stomatitis:

Back 440

Careful mouth care with soft bristled brushes, restriction of foods that may cause trauma or be difficult to chew. Continuous lubr ication of lips. Avoid extreme food temp and spicy foods. Consume foods that are soft and easy to chew.

Front 441

what to avoid in pku diet?

Back 441

protein/milk/ nutrasweet

Front 442

Lab values for chemo pt: CEA> ___ ng, elevated ____, and Beta ___, ACTH, UA would reveal ___ protein, melanin, Decreased platelet count.

Back 442

10
AFP
HCG
Bence Jones

Front 443

CA patient nutrition:

Back 443

small, frequent, high nutrient foods, eat prior to chemo/rad tx. Food consistency should be tolerated and swallowed well, encourage supplemental feeding and reduce lactose in the diet.

Front 444

Cancer protection(diet):

Back 444

Increased intake of fresh vegetables, especially cabbage, increase intake of Vitamin A/C, decrease fat, salt, cured, smoked, nitrate foods, decrease alcohol and tobacco use.

Front 445

life span of rbc?

Back 445

7-10d

Front 446

Tetralogy of Fallot aka cyanotic heart disease is associated with ___ and use of ____?

Back 446

FAS
thalidomide

Front 447

goal of tx in CF?

Back 447

improve O2

Front 448

s/s of CF?

Back 448

S/sx salty taste on child’s skin (sweat chloride 2-5 x normal), bulky, greasy foul-smelling stools that contain undigested food. Mal-absorption due to enzyme deficiency.

Front 449

Hirschsprung’ s disease (barium enema bad) considered hereditary

Back 449

info

Front 450

in ___ the Bowel segment contracts but feces cannot be pushed forward because the bowel is unable to completely relax, leading to intractable constipation and sometimes overflow diarrhea?

Back 450

hirschsprungs

Front 451

T/F in hirschsprungs the Corrective surgery to pull-through normal ganglionic tissue to the anus or management with colonic lavage is necessary to keep the bowel empty.

Back 451

T

Front 452

know that losing excess weight is a way to treat ___?

know that smoking is a major cause of ____

Back 452

hypertension

HTN

Front 453

what is the difference between how a acute and chronic arterial occlusion feels?

Back 453

because there is time for development of collateral circulation in chronic.

Front 454

know that a pulsatile mass in the abdomen is a sign of an ____?

Back 454

abdominal aortic aneurysm

Front 455

know that having a person with orthopnea ____ helps them breathe better

Back 455

hang their legs over the edge of the bed

Front 456

know that ascites is a sign of ___ side heart failure.

describe the tongue in iron deficient anemia?

Back 456

right

red, smooth and sore

Front 457

T/F IM B-12 shots are used to treat deficiency

Back 457

T

Front 458

know that you should check ____ in sickle cell anemia patients.

Back 458

“H&H” hemoglobin and hematocrit

Front 459

describe the skin in impaired circulation?

Back 459

shiny, cool skin is a sign of impaired circulation

Front 460

sudden onset of chest pain and difficulty breathing is a sign of ___?

Back 460

a pulmonary embolism

Front 461

that if a patient is on lasix (furosemide) and digoxin that they should be
watched for ____

Back 461

hypokalemia

Front 462

that a person taking catopen should ____

Back 462

change positions slowly

Front 463

___ is best way to diagnose a pulmonary embolism

Back 463

arteriography

Front 464

ph is down and paco2 is up=

that sometimes suctioning is used to remove secretions

Back 464

respiratory acidosis

info

Front 465

____ breathing is taught to COPD patients to help them prolong the expiratory cycle and have more positive airway pressure.

Back 465

pursed lip

Front 466

definitive sign of COPD is decrease in ___?

Back 466

FEV (forced expiratory volume

Front 467

signs of an air leak in a chest tube

Back 467

-constant bubbling

Front 468

pink-frothy sputum is a sign of ___

Back 468

pulmonary edema

Front 469

pulmonary hypertension is a cause of ____ side heart failure

Back 469

right

Front 470

____ sarcoma is more common in immune suppressed persons

Back 470

Kaposi’s

Front 471

why are steriods given in asthma?

Back 471

to reduce inflammation

Front 472

what to watch for in pt getting steriods?

Back 472

s/s of infection

Front 473

___ tumors may cause abnormal vaginal bleeding

Back 473

fibroid

Front 474

know definition of HPS (hypertrophic pyloric stenosis)

Back 474

look up

Front 475

failure to thrive is a sign of _____.

Back 475

HPS

Front 476

40th birthday present for men?

Back 476

bph

Front 477

most common sign of bladder CA?

Back 477

painless hematuria

Front 478

what might hip pain 1 mo after sx in prostate CA mean?

Back 478

spread to the bone.

Front 479

which hormone is assoc w/breast CA?

Back 479

estrogen

Front 480

SIADH causes what E imbalance?

Back 480

low Na

Front 481

for a child with Wilm’s tumor labs should be checked for __

Back 481

anemia

Front 482

you should never palpate the abdomen of a child with ____ tumor

Back 482

Wilm’s

Front 483

teenage boy with chronic leg pain may have ____ sarcoma

Back 483

Ewing’s

Front 484

T/F treating chrondosarcomas with amputation increases survival

Back 484

T

Front 485

exposure to ____ is risk factor for cervical cancer

Back 485

hpv

Front 486

which 2 cells are greatly affected by radiation because they grow fast?

Back 486

GI and hair

Front 487

what does chemo due to bone marrow

Back 487

suppresses it

Front 488

if a chemo drugs extravasated to ____ the infusion and place ___ on the site

Back 488

stop
ice

Front 489

sickle cell crisis can be treated with ___ moist compresses

Back 489

hot

Front 490

after a prostate surgery the major intervention is to check for ___ and ___

Back 490

bleeding and shock

Front 491

describe a healthy stoma

how often to do bse?

Back 491

beefy red

monthly after period

Front 492

s/s of patent ductus arteriosis?

Back 492

constant murmur

Front 493

what posit for symptomatic TET babies?

Back 493

knee-chest position-like squatting

Front 494

chest physiotherapy is an important part of ___ treatment

Back 494

CF

Front 495

nursing dx of hirschspring’s disease is?

Back 495

risk for injury related to lack of intestinal motility”

Front 496

Down’s syndrome children are often mentally challenged

60. know about clubfoot-nursing interventions

know about DDH (developmental dysplasia of hip)

Back 496

info


look up

Front 497

a _____ should be kept moist

Back 497

meningeoclele

Front 498

children with a meningeocele usually have ____ problems

Know what CP (cerebral palsy) and MD

Back 498

neuro


look up

Front 499

that patients with leukemia should be checked for ___?

Back 499

thrombocytopenia

Front 500

pt teaching to decrease oxygen demand.

Back 500

pace activities or do them in the morning

Front 501

T/F nitro can be taken before hard work

Back 501

T

Front 502

a patient with neutropenia should not eat ___

Back 502

raw veggies

Front 503

why is O2 given @ low rate in COPD?

Back 503

to keep from suppressing their drive to breathe.

Front 504

a patient with coronary artery disease should avoid exercising outside
when it is _____

Back 504

very hot or very cold

Front 505

T/F that orchiectomy does not cause impotence

Back 505

T

Front 506

what should pt do if wakes up and HR is below 60

Back 506

call md

Front 507

muscle weakness is a sign of which E imbalance?

Back 507

hypokalemia

Front 508

concern p/o wilm's tumor?

undesirable sign of hormone therapy for inoperable prostate cancer
is ____

Back 508

o/p

gynomastia

Front 509

what is the purpose of constant irrigation of catheter after TURP?

Back 509

to prevent occlusion of urine flow

Front 510

cold fingers =____

Back 510

raynauds

Front 511

immediate intervention after treatment for basal cell carcinoma treatment?

Back 511

all lesions should be checked promptly

Front 512

what type care is important in CA Tx?

CEA (Carcinoembryonic antigen) is a lab used to
dx _____.

Back 512

po


cancer

Front 513

To avoid an error of parallax when taking a client's blood pressure, the nurse should

Back 513

An improper reading of the level of mercury will be obtained if the reader is
not perpendicular to the column. An error of parallax results when an object is
displaced by an observer's altered position

Front 514

The nurse explains to a client that the mechanism mediating long term blood
pressure regulation is the

Back 514

If there is a decrease in urinary output with increased conservation of body
fluid, the blood pressure will be increased and vice versa

Front 515

When taking a client's apical pulse the nurse should place the stethoscope

Back 515

The heart's apex is between the 5th and 6th ribs at the midclavicular line. It is
closest to the chest wall here, so auscultation is easier

Front 516

The nurse institutes safety precautions for a client receiving oxygen because
oxygen

Back 516

An open flame or spark from static electricity can initiate an explosion and
fire in the presence of higher than normal oxygen

Front 517

When instituting oxygen therapy, the nurse recognizes that the method of
oxygen administration least likely to increase apprehension in the client is

Back 517

oxygen via nasal cannula is the most comfortable and least intrusive,
because the cannula extends minimally into the nose

Front 518

The nurse identifies a commonality between the strain on a client's heart with prolonged anemia or polycythemia to be

Back 518

With anemia there is a greater return of blood to the heart from the
peripheral vessels; the greater volume of blood returning to the heart stretches
it and results in greater cardiac output. With polycythemia the heart must work
harder to propel the more viscous blood through the circulatory system

Front 519

A client with pyrexia will most likely demonstrate

Back 519

The pulse increases to meet increased tissue demands for oxygen in the
febrile state

Front 520

The nurse asses that a client's pulse pressure is decreasing. This would be
evaluated by calculating the

Back 520

- pulse pressure is obtained by subtracting the diastolic from the systolic
readings after the blood pressure has been recorded

Front 521

Following open heart surgery a client develops a temperature of 102°F. The
nurse notifies the physician because elevated temperature

Back 521

temperatures of 102°F or greater lead to an increased metabolism and
cardiac workload

Front 522

The nurse should teach clients with peripheral vascular disease to stop
smoking because nicotine

Back 522

Constriction of the peripheral blood vessels and the resulting increase in
blood pressure impair circulation and limit the amount of oxygen being
delivered to body cells, particularly in the extremities

Front 523

With chronic occlusive arterial disease the precipitating cause for ulceration and gangrenous lesions often is

Back 523

injured tissue cannot heal properly because of cellular deprivation of
oxygen and nutrients; ulceration and gangrene may result; diminished
sensation decreases awareness of injury

Front 524

When obtaining data from a client with thromboangitis obliterans (Buerger's
disease), the nurse would expect the client to demonstrate or report

Back 524

Buerger's disease is characterized by vascular inflammation, usually in the
lower extremities, leading to thrombus formation. As a result of impaired
circulation, there is a burning pain and intermittent claudicaation

Front 525

A simple test for varicose veins is the

Back 525

the trendelenburg test evaluates the backflow of blood through defective
valves. If, after raising the legs to empty the veins, the client stands and the
veins fill from above the site of the suspected varicosity, the diagnosis is
supported

Front 526

Following a vein ligation and stripping, the client should be positioned

Back 526

the legs should be elevated to promote venous return by gravity

Front 527

Prolonged bed rest after surgery appears to promote hemostasis, particularly
in the deep veins of the calves. The most likely pathologic result of such
hemostasis may be thrombus formation and

Back 527

the pulmonary capillary beds are the 1st small vessels (capillary beds) that
the embolus encounters once it is released from the calf veins

Front 528

the 1st positive deflection after the P wave on the ECG

Back 528

R wave

Front 529

atrial depolarization and the time for an impulse to travel through the AV node and the bundle of His

Back 529

PR interval

Front 530

atrioventricular (AV) node normally depolarizes at a rate of

Back 530

(40-60)
60-100

Front 531

The ability of cardiac cells to spontaneously depolarize without being
stimulated by a nerve describes the property of

Back 531

automaticity

Front 532

The dominant pacemaker of the heart is the

Back 532

sinoatrial (SA) node

Front 533

in LEAD ____ the left leg is positive and the right arm is negative

Back 533

II

Front 534

The waveform that reflects ventricular repolarizarion is the

Back 534

T wave

Front 535

The PR interval is measured

Back 535

beginning of the P wave to the beginning of the QRS complex

Front 536

The PR interval normally measures

Back 536

0.12-0.20 second

Front 537

The ability of cardiac cells to transfer an impulse from cell to cell is
called

Back 537

conductivity

Front 538

The duration of a normal QRS complex is

Back 538

0.08-0.12 second

Front 539

The vertical axis on ECG paper measures ___. Each small square equals

Back 539

voltage, 1 mm (0.1 mV)

Front 540

The horizontal axis on ECG paper measures ___. Each small square

Back 540

time, 0.04 second

Front 541

Purkinje fibers normally depolarize at a rate of

Back 541

20-40/minute

Front 542

The ability of cardiac cells to respond to an electrical stimulus is called

Back 542

contractility

Front 543

The sinoatrial (SA) node normally depolarizes at a rate of

Back 543

60-100

Front 544

The process that occurs when the cell membrane actively pumps sodium
out of the cell and potassium into the cell, thus returning the cell to its resting state, is called

Back 544

repolarization

Front 545

The process that occurs when an electrical stimulus causes sodium rush
into a resting cell, changing the cell's electrical potential from negative to positive is called

Back 545

depolarization

Front 546

The 1st negative deflection after the R wave is the

Back 546

S wave

Front 547

Which of the following statements are correct concerning the determination of heart rate from a rhythm strip?

Back 547

To calculate the heart rate using the six-second count method,
count the number of complete complexes between two vertical

Front 548

a straight, flat line recorded on the ECG when the electrical activity of
the heart is nor being detected

Back 548

isoelectric line

Front 549

What information can be obtained from a single monitoring lead

Back 549

the effectiveness of myocardial contraction

Front 550

The dysrhythmia commonly related to the respiratory cycle- gradually
increased with inspiration and decreasing rate with expiration is

Back 550

sinus dysrhythmia

Front 551

List 5 steps used in ECG rhythm analysis

Back 551

rate, regularity, P wave (presence, absence, relation to QRS,deflection),
PR interval, QRS interval

Front 552

An electrical impulse moving directly toward a positive electrode will
create a(n) _________ deflection on ECG paper.

Back 552

upward

Front 553

Which of the following may produce artifact on the ECG

Back 553

Muscle tremors
loose electrodes
respirations

Front 554

The electrocardiogram is used to

Back 554

evaluate electrical activity of the heart

Front 555

The 3 primary function of the AV node includes which of the following

Back 555

1 delays conduction to allow the atria to empty their contents into the ventricles
2. act as a “stop gate”
3. act as an escape pacemaker if a higher pacemaker site fails

Front 556

In normal sinus rhythm, the P wave should have the following 3
characteristics

Back 556

be present before every QRS complex, uniform size and shape, upward
deflection

Front 557

When a client is receiving anticoagulants, the nursing care should include
observations for:

Back 557

epistaxis

Front 558

client is receiving Dicumarol, a coumarin derivative. The test that would
be most specific for calculating the daily dosage of this anticoagulant
would be the

Back 558

prothrombin time

Front 559

client with coronary artery disease has a sudden episode of cyanosis
and a change in respirations. The nurse starts oxygen administration
immediately. In this situation

Back 559

the nurse's observations were sufficient to begin administration of the
oxygen

Front 560

.When preparing a client for discharge following surgery for a coronary
artery bypass graft, the nurse should teach that there will be

Back 560

The client is up more at home so edema usually increases

Front 561

The nurse suspects a client is in cardiogenic shock. The nurse understands
that this type of shock is

Back 561

shock may have different etiologies, but always involves a drop in BP
and failure of the peripheral circulation because of sympathetic nervous
system involvement

Front 562

The nurse assists the physician in treating a client in shock. One modality
of treatment that employs the physical law explaining the increased
venous return accompanying mild vasoconstriction underlies the use of

Back 562

adrenalin is used to treat shock because the induced arterial
constriction reduces blood pooling and increases venous return and
cardiac output

Front 563

The nurse finds an injured person, sitting in a chair obviously in shock.
The nurse should

Back 563

this position is useful in treating shock because it promotes gracity
induced venous return. Warmth and fluids are also supportive to the
person

Front 564

The adaptations of a client with Adams-Stokes syndrome would most
likely include

Back 564

Adams-Stokes syndrome is a result of complete AV block. The
ventricles take over the pacemaker function in the heart, but at a much
slower rate than that of the SA node. As a result there is a decreased
cerebral circulation, causing syncope

Front 565

The nurse is aware that the term bradycardia means

Back 565

<60 bpm

Front 566

The nurse should prioritize care and provide treatment first for a client with?

Back 566

ventricular fibrillation will cause irreversible brain damage then death
within minutes because the heart is not pumping blood

Front 567

List in order, the structures of the heart as blood would pass beginning at the right atrium

Back 567

tricuspid valve
pulmonary artery
pulmonary vein
mitral valve
left ventricle

Front 568

Which of the following would cause the heart rate to decrease

Back 568

Vagal stimulation

Front 569

All of the following are properties of the cardiac muscle cells except

Back 569

secretion

Front 570

Place the following in order as a normal cardiac electrical impulse would travel through them

Back 570

SA node
Intra-atrial pathways
AV junction
Bundle of His
Purkinje fibers

Front 571

Which of the following is considered the dominant pacemaker of the heart

Back 571

SA node

Front 572

When the Purkinje fibers function as an escape pacemaker, you would expect the

Back 572

20-40 beats/minute

Front 573

The functions of the AV node include which of the following

Back 573

Delays the conduction to allow the atria to empty their contents into the
ventricles
2. Acts as a “stop gate”
3. Acts as an escape pacemaker

Front 574

The electrocardiogram shows

Back 574

electrical activity of the heart
3. rate and rhythm of the heart

Front 575

The P wave of the normal EKG represents

Back 575

atrial depolarization

Front 576

The normal PR interval is

Back 576

0.12-.20 sec

Front 577

A “sawtooth” waveform is a distinct characteristic of which of the following
rhythms?

Back 577

atrial flutter

Front 578

The P wave in a normal sinus rhythm should have which of the following characteristics?

Back 578

upright
2. regular in rate
3. similar in shape to each other
preceding the QRS complex

Front 579

Dysrhythmias can be caused by which of the following

Back 579

ischemia
2. hypoxia
3. acidosis
4. electrolyte imbalance
5. myocardial infarction

Front 580

The nurse understands that in the absence of pathology, a client's respiratory center is stimulated by

Back 580

the respiratory in the medulla responds primarily to increased carbon
dioxide concentration in the blood

Front 581

The efficacy of the abdominal-thoracic thrust (Heimlich maneuver) to
expel foreign object in the larynx demonstrates the gas volume related to the individual's

Back 581

the residual volume is the amount of air remaining in the lungs after
maximum exhalation

Front 582

A client states that the physician said the tidal volume is slightly
diminished and asks the nurse what this means. The nurse explains that tidal volume is the amount of air

Back 582

tidal volume is defined as the amount of air exhaled normally after a
normal inspiration

Front 583

Air rushes into the alveoli as a result of the

Back 583

thoracic pressure is reduced because thoracic volume is increased as
the diaphragm descends

Front 584

A client is scheduled for a pulmonary function test. The nurse explains
that during the test the respiratory therapist will ask the client to
breathe normally to measure the

Back 584

5) 1- tidal volume is the amount of air inhaled and exhaled while breathing
normally

Front 585

Oxygen dissociation from the hemoglobin and therefore oxygen delivery to the tissues are accelerated by

Back 585

6) 3- the lower the PO2 and the higher the PCO2 , the more rapidly oxygen
dissociates from the oxyhemoglobin molecule

Front 586

With an oxygen debt, muscle shows

Back 586

7) 1- with an oxygen debt, a muscle would show primarily low levels of oxygen
and low levels of ATP caused by the low levels of aerobic respiration and
high levels of lactic acid formation

Front 587

A nurse initially will use an Ambu-Bag in the intensive care unit when

Back 587

8) 1- An Ambu-Bag is a piece of equipment that can be compressed at regular
intervals by hand for temporary ventilation of the client in respiratory
arrest

Front 588

To facilitate maximum air exchange, a client should be placed in

Back 588

the orthopneic position is a sitting position that permits maximum lung
expansion for gaseous exchange, because the abdominal organs do not
provide pressure against the diaphragm and gravity facilitates the
descent of the diaphragm

Front 589

A client begins to expectorate blood. The nurse describes this episode as

Back 589

10)3- hemoptysis is expectoration of blood-stained sputum derived from the
lungs, bronchi, or trachea

Front 590

The position in which a client with dyspnea should be placed is

Back 590

11)3- orthopneic position refers to sitting up and leaning slightly forward,
which drops the diaphragm, allowing the lungs more room for expansion

Front 591

Radium is stored in lead containers because

Back 591

Radium atoms are unstable and spontaneously disintegrate. This
disintegration produces potentially harmful radiation; lead is a barrier to these radiations

Front 592

A systemic drug that may be prescribed to produce diuresis and inhibit
formation of aqueous humor is

Back 592

Acetzilamide (Diamox) is a carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure

Front 593

A client is receiving an antihypertensive drug intravenously for control of
severe hypertension. The client's blood pressure is unstable and is at 160/94
before the infusion. Fifteen minutes after the infusion is started the blood
pressure rises to 180/100. The response to the drug would be described as

Back 593

paradoxical response to a drug is directly opposite to the desired
therapeutic effect

Front 594

A client is to be discharged on a diuretic and digitalis. The nurse reviewing the
client's diet would be especially careful to look for adequate sources of
potassium because

Back 594

toxic levels of digitalis overstimulate the vagus nerve, leading to depressed
conduction through the AV node (AV block of any degree) as well as SA node
depression (sinus bradycardia). In addition, ectopic pacemakers are
accelerated, leading to premature beats. Such pathologic effects are
enhanced by low serum potassium levels from diuretics, vomiting, and
nasogastric drainage as well as by chronic arterial hypoxemia and impaired
renal function.

Front 595

A client complains of fatigue and dyspnea and appears jaundiced. The nurse
questions the client about medications taken routinely. In light of the symptoms, the nurse should be most concerned about

Back 595

methyldopa is associated with acquired hemolytic anemia and should be
discontinued to prevent progression and complications

Front 596

A client is receiving amniophylline intravenously to relieve sever asthma. The
nurse should observe for

Back 596

Amniophylline, a theophylline derivative, promotes diuresis and relaxes
smooth muscles, resulting in hypotension

Front 597

Before giving a client digoxin, the nurse should obtain the

Back 597

Because digoxin slows the heart, the apical pulse should be counted for 1
minute before administration. If apical rate is below 60 (bradycardia), digoxin
should be withheld because its administration could further depress the heart
rate. If the heart rate is above 120, digoxin should be withheld because the
client may be in digitalis toxicity.

Front 598

The nurse should teach a client to suspect that nitroglycerin SL tablets have
lost their potency when

Back 598

Nitroglycerin tablets are affected by light, heat, and moisture. A loss of
potency can occur after 3 months, reducing the drug's effectiveness in
relieving pain. A new supply should be obtained routinely.

Front 599

Evaluation of the effectiveness of nitroglycerine SL is based on

Back 599

Cardiac nitrates relax the smooth muscles of the coronary arteries so that
they can dilate and deliver more blood to relieve ischemic pain.

Front 600

The drug the nurse should expect the physician to order if symptoms of
Dicumarol overdose are observed would be

Back 600

Dicumarol depresses prothrombin activity and inhibits the formation of
several of the clotting factors by the liver. Its antagonist is vitamin K, which is
involved in prothrombin formation.

Front 601

The loop diuretics alter active transport systems in the kidney tubules,
resulting in increased excretion of sodium, and secondarily, water. The
principle explaining secondary water loss(diuresis) is

Back 601

The presence of excess sodium (a solute) in the nephric tubules effectively
decreases the water concentration of the glomerular filtrate and urine; water
passively diffuses (osmosis) from the kidney tubule cells into the urine to
equalize the water concentration.

Front 602

A client receiving hydrochlorothyazide (hydroDIURIL) asks what this drug
actually does. The nurse explains that the planned therapeutic effect of the
drug is to

Back 602

Hydrochlorothiazide (hydroDIURIL) inhibits sodium reabsorption in the
nephron, causing an increased excretion of sodium and chloride

Front 603

When teaching a client receiving prazosin (Minipress) for hypertension why
orthostatic hypotension occurs, the nurse knows that this antihypertensive
causes vasodilation by

Back 603

Prazosin blocks the response to norepinepherine bound to alphaadrenergic
receptors relaxing smooth muscle in peripheral vessels, increasing
circulation and decreasing blood pressure

Front 604

In a patient with leukemia, the blood level is affected is ____.

Back 604

wbc

Front 605

A mother cannot afford to buy meat for her family. You suggest she buy ____

Back 605

corn and beans.

Front 606

A mastectomy patient would show the beginnings of acceptance when she ____

Back 606

touches the wound

Front 607

Compensation for respiratory acidosis would show increased ____

Back 607

hc03

Front 608

A patient receiving a blood transfusion develops a fever. The nursing action is to _____

Back 608

stop the transfusion and infuse with normal saline.

Front 609

The most important nursing measure intervention hen caring for a patient who is receiving intravenous nitroprusside sodium for sever hypertension would be to compare ____

Back 609

serial blood pressure readings.

Front 610

. Expect that a patient with a new colostomy is ready to start self care would be ____

Back 610

looking at and touching her colostomy

Front 611

For a child with WBC of 12K, RBC 4 million, Hgb 8, and a resp of 24, you would _____?

Back 611

limit activity

Front 612

A patient on diuretics needs further teaching instruction if she states____?

Back 612

" I void every fours."

Front 613

For a patient with a radical neck dissection, the immediate concern is ____

Back 613

respiratory distress

Front 614

The symptoms usually associated with respiratory acidosis are _____?

Back 614

irritability, headache, and confusion.

Front 615

Following laryngectomy, to decrease anxiety and fear you would teach the patient and family ____?

Back 615

esophageal speech

Front 616

Your patient whoi had had a pneumonectomy refuses to move or do exercises. You should give ____?

Back 616

pain medication 30 minutes before activity.

Front 617

A habit that would increase a patient's risk of colon cancer would be a _____ diet

Back 617

high fat

Front 618

At risk to have varicose veins would be a patient who was an _____?

Back 618

OR nurse for 15 years

Front 619

A patient taking digoxin and lasix should call the physician when he experiences ____?

Back 619

muscle weakness

Front 620

A patient with fibrocystic breast disease should not include ____ and ____.

Back 620

caffeine and salt

Front 621

A weight gain of four pounds in 24 hours would most likely be caused by ___

Back 621

chf

Front 622

A clinical laboratory finding for a patient with rheumatic fever is increased ____

Back 622

esr

Front 623

In a baby having difficulty in breating, the nurse wil see ____

Back 623

substernal retractions

Front 624

Nicotine in cigarettes causes decreased ciliary ____

Back 624

cleaning action

Front 625

The most common complication of pancytopenia in patients on chemotherapy would be ____&____?

Back 625

infection and bleeding tendencies.

Front 626

A patient is receiving cytoxan chemotherapy for ovarian cancer. The lab value that would indicate the need for you to contact the physician is platelet count of _____.

Back 626

50k/mm3

Front 627

To evaluate a patient for chest pain, the nurse should ask, ____?

Back 627

Are you having chect pain?"

Front 628

Clinical signs of respiratory distress in the newborn are _____

Back 628

nasal flaring, expiratory grunting, and see-saw retraction.

Front 629

nursing diagnosis for a female patient with a diagnosis of uterine cancer would be

Back 629

Body image disturbance

Front 630

A 78 year old patient with lung cancer is admitted following 48 hours of nausea and vomiting. He has shallow breathing and an irregular pulse. You expect imbalance?

Back 630

respiratory alkalosis

Front 631

The drug classification that would be most effective for increasing cardiac output would be a ____

Back 631

calcium antagonist.

Front 632

The most likely cause of a decreased PO2 level in a patient with bilateral pneumonia is that the ____

Back 632

alveoli are blocked by secretions preventing adequate exchange of gases.

Front 633

To obtain an urine specimen from an infant, you should use a ____

Back 633

specimen bag.

Front 634

The discharge health teaching for a patient with a tracheal stoma secondary to pneumonia is to ___

Back 634

humidify the air at home.

Front 635

Upom auscultation of the lungs you would expect to hear vesicular breath sounds at the base of the ____ and bronchovesicular sounds between the _____& _____

Back 635

lungs

scapulae and lateral to the sternum.

Front 636

Upper abd. distention is most closely associated with what congenital disease.

Back 636

puloric stenosis

Front 637

A patient is admitted to the ER with dyspnea, stridor, and wheezing. These symptoms indicate ___?

Back 637

asthma.

Front 638

Sickle cell crisis is vaso-____.

Back 638

occlusive

Front 639

For a child in a mist tent, you should ____

Back 639

change her clothes

Front 640

A patient with emphysema develops right-sided heart failure. This is most likely caused by increased ____

Back 640

vascular resistance.

Front 641

An adverse reaction to Digoxin is ___

Back 641

nausea and vomiting.

Front 642

Tamoxifen acts as an estrogen ____ and is used in adjunct treatment for breast cancer.

Back 642

antagonist

Front 643

Sickle cell crisis is vaso-____.

Back 643

occlusive

Front 644

For a child in a mist tent, you should ____

Back 644

change her clothes

Front 645

A patient with emphysema develops right-sided heart failure. This is most likely caused by increased ____

Back 645

vascular resistance.

Front 646

An adverse reaction to Digoxin is ___

Back 646

nausea and vomiting.

Front 647

Tamoxifen acts as an estrogen ____ and is used in adjunct treatment for breast cancer.

Back 647

antagonist

Front 648

For a patient with cancer of the mouth, have her gargle with ____ and use _____ swish for pain.

Back 648

normal saline
lidocaine

Front 649

The bleeding associated with leukemia is usually caused by decreased _____

Back 649

platelets.

Front 650

Elevated lab values post MI are CPK, CK-MB, LDH 1 greater than _____.

Back 650

LDH 2

Front 651

T/F For a patient with PVD, do not elevate on a pillow and do not use ice compresses

Back 651

T

Front 652

T/F Grade 111 cancer means the cells are likely to mets

Back 652

T

Front 653

The symptoms of pneumocystic carinii are ____&____

Back 653

dyspnea and non productive cough

Front 654

A patient diagnosed with stomach cancer should avoid ____ & ____ in his diet

Back 654

gravy and sauce

Front 655

Iron is injected into a pt. by refracting the skin over the muscle of the upper quadrant of the buttock

Back 655

z track

Front 656

An increased alkaline phosphatase may signal ____ cancer of the prostate

Back 656

metastic

Front 657

A clinical sign of PVD is no ___

Back 657

pedal pulse

Front 658

Findings of concern in an infant with hypoxia and in oxygen therapy would be _____.

Back 658

arterial PaO2

Front 659

Nitrogen balance is used to estimate the balance between intake and utilization of ____ in the body.

Back 659

protein

Front 660

A sign of resp distress in newborns is expiratory ___.

Back 660

grunting

Front 661

For a pt. with emphysema, somking decreases ____

Back 661

ciliary action

Front 662

Following a pneumonectomy, instruct the pt. to do arm exercises to prevent ____

Back 662

frozen shoulder

Front 663

Ascites develops because of a blocked ____ vein.

Back 663

portal

Front 664

A nurse is assisting a physician in the ER to suture a laceration on the upper eye. The doc does not explain the procedure to the pt. The nurse should ask to speak with the doc before assisting.

Back 664

info

Front 665

A clinical manifestation of a MI is numbness in the ___

Back 665

jaw

Front 666

Before obtaining a sputum culture, give am care or at least have the pt. ____

Back 666

rinse the mouth.

Front 667

The aspect of ABG's that would be of most concern is ____.

Back 667

ph

Front 668

ARDS usually develops in the ___ patient.

Back 668

premature

Front 669

Rotating tourniquets are used for the client experiencing pul edema or severe chf. The longest time to put tourniquets on each extremity is ___ minutes.

Back 669

45

Front 670

Clinical signs of a TIA attack involve ____ and ___ function.

Back 670

sensory and motor

Front 671

Clinical manifestations of ____-sided heart failure are edema, distended neck veins, nocturia, weakness, and hepatomegaly.

Back 671

right

Front 672

what should pt experience when taking nitor SL

Back 672

Ntg should cause a slight burning/stinging sensation under the tongue when it is potent.

Front 673

A pt. with an on demand pacer set at 60 should notify his doc if ____

Back 673

pulse is less than 60

Front 674

Timolol is contraindicated for use in ___

Back 674

copd

Front 675

Following a prostatectomy the purpose of irrigation of the bladder is to decrease pressure of the ___.

Back 675

bladder

Front 676

After a cardiac catheter procedure, the nurse should observe for bleeding at the ____.

Back 676

puncture site

Front 677

Calcium channel blockers are given to reduce spasms of ____

Back 677

coronary arteries

Front 678

The post radical-mastectomy patient should be positioned how ?

Back 678

with the affected arm on pillows with the hand elevated.

Front 679

Bacterial pneumonia has clinical manifestations of productive cough with ____ sputum.

Back 679

purulent

Front 680

For a pt. on diuretics, the foods to be allowed would include ___

Back 680

citrus fruits

Front 681

The physiology of angina is that myocardial oxygen demands exceeds ____

Back 681

myocardial oxygen

Front 682

Included in a diet for pernicious anemia would be ____

Back 682

orange juice, raisins, and a turkey sandwich

Front 683

The purpose of TURP irrigation every half hour is to check for patency of the ___ and to prevent

Back 683

urethra
clot formation

Front 684

Chondromasarcoma is a malignant tumor of the ___ cartilage. The common sites are___ and ____ with mets to ____

Back 684

hyaline
ribs and pelvis
lungs.

Front 685

You know your patient understands about mild restriction of sodium intake when he states" I buy bottled water because we have a water softner."

Back 685

info

Front 686

A clinical sign of cervical cancer is post menopausal ____

Back 686

bleeding

Front 687

4 Side effects of doxorubicin are

Back 687

alopecia, hepatic dysfunction, red urine, and cardiomyopathy

Front 688

During a colostomy irrigation the patient complains of incomplete evacuation. The nursing action shoould be to ____.

Back 688

irrigate with NS

Front 689

For a patient on a vent who becomes restless, the nurse should ____

Back 689

suction the pt

Front 690

Advise a pt. with MI not to walk in what type weather?

Back 690

extreme cold, hot, or windy climates.

Front 691

____ indicates laryngeal obstruction

Back 691

Stidor

Front 692

A pt, whose cancer has mets is experiencing low back pain. This is due to decompression of the ___

Back 692

spinal cord

Front 693

The most common position for a pt. following a radical mastectomy is ___

Back 693

semi - fowlers position with the hand on the affected side kept elevated above the elbow.

Front 694

Common clinical manifestations of pancytopenia in a pt. undergoing chemotherapy are ____ and ____

Back 694

hemorrhage and infection

Front 695

NTG should be kept in a ___

Back 695

dark glass container, tightly closed

Front 696

A pt. with breast cancer one-week post mastectomy has an elevated serum calcium level. The reason for this is the cancer has ___

Back 696

mets.

Front 697

You discharge instructions for a pt. with basal cell carcinoma would include ____

Back 697

wearing sunscreen when out in the sun to protect from ultraviolet rays.

Front 698

Whem giving an iron injection, retract the skin.

Back 698

z track

Front 699

For a child diagnosed with iron deficiency anemia and who drinks milk only, you would see a hgb of ___

Back 699

8mg/dl or lower.

Front 700

At risk for cervical cancer would be the pt. with ____

Back 700

STD's

Front 701

A clinical lab finding for a pt. with rheumatoid arthritis is increased ___

Back 701

ESR

Front 702

A pt recovering from an MI asks the nurse when he can hve sex. The nurses reply is ____

Back 702

when you can climb a flight of stairs without experiencing resp distress.

Front 703

Discharge instructions for a pt. going home after a lkaryngectomy should include ___

Back 703

that the air should be humidified

Front 704

The statement most appropriate to make to a 5 year old child who is about to undergo a cardiac cath is ____

Back 704

when the special medication is put into the tube, it will feel warm.

Front 705

A patient woth uterine cancer would have the clinical sign of ___

Back 705

post menopausal bleeding

Front 706

A pt. with hypertensive crisis is on Nipride IV therapy. To check if the IV is effective the nurse should take ____

Back 706

serial BP readings.

Front 707

A clinical sign of PVD would be mild pain ___

Back 707

following exercise

Front 708

Laryngotracheobronchitis tx includes ____

Back 708

postural drainage before meals

Front 709

Painless hematuria is an early sign of cancer of the ____.

Back 709

bladder

Front 710

The primary nursing goal for a pt. with HTN is to describe _____

Back 710

the medication and treatment regimens

Front 711

In a pt. diagnosed with mild thrombophlebitis,the nurse would expect mild ____

Back 711

cramping upon exertion

Front 712

Side effects of bronchodialators is

Back 712

tachycardia and headache

Front 713

A pt. with emphysema shows that he has understood the nurses health teaching by using ____

Back 713

pursed lip breathing during activity.

Front 714

Late symptoms of renal cancer are ____?

Back 714

hematuria, flank pain and palpable mass in the flank.

Front 715

A radiation blister appears on a pt. 2 weeks after tx. You know that ____

Back 715

this is normal but you also notify the physician

Front 716

Administration of spironolactone is most likely to cause what E imbalance

Back 716

hyperkalemia

Front 717

___ is the difference between apical and radial pulses.

Back 717

Pulse deficit

Front 718

what is the difference between acute and chronic arterial disease

Back 718

chronic arterial disease there has been enough time to build up collateral circulation.

Front 719

For a 2 year old child with Wilms tumor, you should ___

Back 719

avoid palpation of the mass

Front 720

Following a mastectomy, instruct the pt. to do arm exercises to prevent a ___

Back 720

frozen shoulder

Front 721

A pt. on coumadin does not need to eat ____

Back 721

green leafy veggies.

Front 722

You position a pt. with thrombophlebitis in the ____ position

Back 722

Trendlenburg

Front 723

If a pt's PO2 is 60mm Hg, the test needed to confirm this result is ___

Back 723

HGB

Front 724

The difference between angina and MI is duration of the ___.

Back 724

pain

Front 725

what lab to monitor for coumadin

Back 725

pt/inr

Front 726

___ occurs when clotting of small vessels throughout the body causes depletion of platelets and other clottiing factors leading to generalized bleeding from multiple sites.

Back 726

DIC

Front 727

In a pt. with a hypertensive crisis you would expect to find what sensory problem?

Back 727

blurred vision

Front 728

The best assessment history for a pt. diagnosed with melanoma would find that the pt. has always worked ___.

Back 728

outdoors

Front 729

The health teaching for a pt. using steroids is that the medication may ____

Back 729

mask signs of infection.

Front 730

The best way to help an infant with pyloric stenosis to retain his feedings would be to ____

Back 730

place him on his left side with the head elevated after feedinsg.

Front 731

what % of htn is primary(unk cause? accelerarted =____.
s/s?
dx?

Back 731

95.
htn crisis
usually asymptomatic
140/90

Front 732

meds to tx htn:
beta blockers end w/___?
how do they work?

Back 732

OLOL
Decrease Heart Rate
Decrease BP
Decreases PVR
decreases 02 consumption of the heart

Front 733

SE if beta blockers?

Back 733

Bronchospasms, Bradycardia, Fatigue, heart failure, Sexual dysfunction

Front 734

Use beta blockers cautiously in which pts?

Back 734

Respiratory Diseases [COPD-Asthma], CHF, & heart blocks

Front 735

pt teaching w/beta blockers?

Back 735

Caution with diabetics & PVD.
Take with meals
Don't stop suddenly
Don't take with nasal decongestants/OTC cold meds

Front 736

the alpha blockers are also used to Tx?

how do they work?

Back 736

bph


Decrease PVR by dilating arterioles and veinioles

Front 737

what are the alpha blockers?

Back 737

cardura
minipres
Terazosin
aldomet
hytrin

Front 738

how does clonidine work?

Back 738

stimulates alpha-adrenoreceptors in the brain stem. This action results in reduced sympathetic outflow from the central nervous system and in decreases in peripheral resistance, renal vascular resistance, heart rate, and blood pressure.

Front 739

SE clonidine?

Back 739

Syncope, othro hypotension, weak, palpitations, sexual dysfunction

Front 740

pt teaching for clonidine?

Back 740

Change positions slowly; Can have first dose syncope, maintain recumbent for 90 minutes. Wear medical identification tag. Full therapeutic effects may require several weeks of therapy. Avoid high sodium foods.

Front 741

s/s of PVD include ___ edema, burning, itching, prominent ____ veins, ulcers and skin changes. ____ is used to look at veins via radiographic dye.

Back 741

moderate
superficial
Venogram

Front 742

goal of tx in pvd?


Complications include

Back 742

aimed at vasodilation, pain relief, and maintaining skin integrity.

gangrene, and pressure sores.

Front 743

what should be avoided in PVD?

Back 743

Do NOT use a heating pad to keep extremities warm.

Front 744

what meds for pvd?

Back 744

antiplatelet (aspirin), vasodilators (Trental), anticoagulants (Coumadin), Lipid reducers (Questran, Mevacor).

Front 745

NSG and pt teaching for PVD?

Back 745

Encourage walking and other leg exercise, watch for signs of decreased peripheral circulation. Avoid temperature extremes, prolonged standing, constrictive clothing or crossing the legs at the knee when seated. Provide instruction about foot care and exercise programs. Develop a plan for smoking cessation. Increased incidence of peripheral vascular disease in older adults.

Front 746

hardening of the arteries

plaques; homocystine is linked with CAD and plaque levels

Back 746

Arteriosclerosis

Atherosclerosis

Front 747

vascular disease linked to cigarette smoking and Jewish ancestry between the ages of 20-40

Back 747

Buegers disease

Front 748

most common s/s of Buerger's Disease

Back 748

Intermittent claudication (limping that occurs from leg cramps) is the most common symptom

Front 749

tx of buergers is aimed at

describe to how to do buerger-allen exercises for relief?

Back 749

tx s/s

Begin with the patient lying flat in bed with legs elevated above the level of the heart for 2 minutes or until blanching takes place. Then exercise the feet 3 minutes until the legs are pink. Next, instruct the patient to lie flat for 5 minutes. These exercises may be repeated 3 times/day.

Front 750

episodic vasospasms precipitated by stress and exposure to cold. Common in women between puberty and age 40.
what body part is mostly affected?

Back 750

raynauds


hands

Front 751

when is blancing in raynauds relieved?

Back 751

when heat is applied

Front 752

--High levels of cholesterol in the blood increase the risk of plaque formation. Use statins and standard healthy living.

Back 752

"Dyslipidemia"

Front 753

Total Cholesterol___
LDL ___
HDL ___
what should ldl to hdl ratio be?
VLDL (triglycerides) ____ of Total Cholesterol?
Triglycerides Men __
Women ____
Lipids should be drawn after ___ Hour fast.

Back 753

140-200
<130
35-85
3.5:1
25-50% of total chol.
40-160
35-135
12

Front 754

AHA recommends less than __% fat in diet and less than ___mg of cholesterol; less of each after MI. ____ has been shown to modestly reduce total cholesterol and LDL cholesterol levels. Alcohol has a beneficial effect on ____.

Back 754

30
300
Soluble fiber
HDL

Front 755

how do statins work?

Back 755

inhibit the enzyme required for hepatic synthesis of cholesterol

Front 756

tx of CAD includes decreasing ___ and ___lipid levels (clofibrate, cholestyramine (Questran)), modify diet to limit ___ __ and ___and quit smoking. Limit alcohol intake to __ ounces.
Complications include?

Back 756

lipid and htn
meat, dairy and high-fat foods, 2

angina, MI, CHF, and arrhythmias.

Front 757

ANGINA- usually lasts ___ minutes. Associated with ____. STABLE angina is predictable and controlled with nitroglycerin and rest. ___ is not predictable and may occur even at rest.

Back 757

3-5
physical exertion, emotional excitement and exposure to cold
UNSTABLE

Front 758

what does ekg show in angina?

Back 758

Dx- EKG: ST depression, T wave inversion during acute pain

Front 759

NSG for nitro paste

Back 759

do not rub it in and rotate sites

Front 760

meds to tx angina?

Back 760

beta blockers, Ca blockers, nitrates

Front 761

calcium channel blockers:

Back 761

(Verapamil, Cardizem, Procardia

Front 762

pt teaching for angina?

Back 762

keeping nitro available at all times, use at the first sign of pain and stop and rest until pain subsides. Seek medical attention if pain lasts more than 20 minutes. Instruct the patient about risk factors for MI

Front 763

precipitators to angina?

Back 763

exposure to cold, emotional upset or excitement, exertion, smoking, heavy meals, and rushing about as well as decongestants, diet pills, caffeine and nicotine

Front 764

best ways to prevent angina?

Back 764

Prevention is the best treatment and includes reducing risk factors, reducing calories, fats, salt and getting regular exercise.

Front 765

Complications opf angina include?

Back 765

arrhythmias, CHF, and MI.

Front 766

what are the Three types of ABDOMINAL AORTIC ANEURYSMs?
which is most common and deadly?

Back 766

Ascending (most common and deadly), Descending or Transverse

Front 767

s/s of AAA?

Back 767

Sx- Bradycardia, pericardial friction rub, pulse intensity disparity

Front 768

how is AAA dx?

is it life threatening?

Back 768

xray

yes

Front 769

TX for AAA?

Back 769

decreasing hypertension, myocardial contractility, pain control and relief of respiratory distress while preparing for surgical intervention

Front 770

Sx for AAA where removal of a portion of weakened arterial wall with an end-to-end anastomosis to a prosthetic graft.

Back 770

Abdominal aneurysm resection

Front 771

lack of oxygen supply that leads to thrombosis and tissue necrosis and localized edema

Back 771

gangrene

Front 772

S/sx-severe localized pain, discoloration and swelling that usually occurs within 72 hours of surgery or trauma are s/s of ____?

Back 772

gangrene

Front 773

characterized by gradual, insidious compression/obstruction of the superior vena cava (SVC

Back 773

SVC syndrome

Front 774

what is SVC most commonly assoc w/?

Back 774

malignancy (90%) pressing on the weak SVC, and thrombi

Front 775

s/s of SVC syndrome?

Back 775

Dyspnea is the most common symptom, followed by trunk or extremity swelling

Front 776

what is Tx SVC syndrome geared towards?

Back 776

tx underlying cause
(Therefore, treatment might include radiation treatment, antibiotics, chemotherapy clot-busting (thrombolytic) drugs, blood thinners (anticoagulation), and balloon angioplasty and even surgery)

Front 777

Left-sided heart failure=

Back 777

lung problems

Front 778

other abnormalities seen w/L side chf?

Back 778

crackles, and gallop rhythm: S3 and S4

Front 779

Right-sided heart failure =

Back 779

systemic(edema in the body)

Front 780

in CHF Elevated left ventricular preload may be identified by positive hepatojugular tests --This sign consists in a distension of the superficial veins of the neck, occurring when firm pressure is exerted over the liver in the direction of the spinal column

Back 780

info but know

Front 781

most common causes of L chf?

Back 781

coronary arteries, hypertension, cardiomyopathy and rheymatic heart disease

Front 782

how is chf dx?

Mean arterial blood pressure is rough indicator of left ___ afterload.

Back 782

cxr

ventricular

Front 783

_____ is regular failure. Diastolic is failure to fill adequately, due to failure to relax the ventricles or stenosis.

Back 783

Systolic

Front 784

Rx for CHF includes, low-sodium diet, fluid restriction, IABP (Intra-Aortic Balloon Pump), O2 therapy, ACE inhibitors (captopril, lisinopril), angiotensin receptor blocker (ARB -- Cozaar, Diovan) morphine sulfate, digoxin, Inotropic agents (dopamine, dobutamine, amrinone milrinone--all may vasodilate and pt must be monitored for this.), Diuretics (lasix), Nitrates, and vasodilators. Beta Blockers, calcium channel blockers

Back 784

info but know

Front 785

NSG in CHF:keep the patient in ___position to increase chest expansion and improve ventilation. Administer __ to enhance arterial oxygenation. Monitor patient for fluid gain to assess worsening; "restrict fluids after ___ days of weight gain." Plan periods of relaxation for patients with cardiac failure. Restrict fluid intake after two consecutive days of weight gain

Back 785

semi-fowler's
O2
2

Front 786

in chf as cardiac output falls, blood flow to the kidneys falls causing ___ glomerular flow. Kidneys interpret this as ____ and attempt to correct it by holding on to fluids. Kidneys > production and release of ___ causing sodium retention

Back 786

decreased
hypovolemia
aldosterone

Front 787

Hx of pt undergoing heart catherization should include allergy to ___ because of use of dye during the procedure.

Back 787

shellfish

Front 788

Class___ drugs are less likely to promote longevity of life.
they include?

Back 788

I



sodium channel blockers.

Front 789

Class II drugs are ___ blockers

Back 789

beta -

Front 790

Class III drugs are ___ channel blockers

Back 790

potassium

Front 791

Class IV ___ channel blockers

Back 791

calcium

Front 792

pacemaker codes:
First letter identifies ____ being paced.
Second letter describes the chambers being ___
Third letter describes ____

Back 792

chambers


sensed





type of response by pacemaker to what is sensed

Front 793

meds:
___ is an antidysrhythmic and used for tachyarrhythmias
___ for the management of ventricular arrhythmias unresponsive to less toxic agents.
___ for life-threatening ventricular dysrhythmias

--for A-fib, A-flutter

Back 793

Quinidine

amiodarone

procainamide

Betapace

Front 794

_____ Relating to or influencing the conductivity of nerve fibers or cardiac muscle fibers; P to T time

Back 794

Dromotropic

Front 795

___ effects are ones that change the heart rate; P to P time

Back 795

Chronotropic

Front 796

antiarrhythmic agent, cardiotonic and inotropic agent for CHF

Back 796

digoxin

Front 797

how does dig work?

Back 797

Increase the force of myocardial contraction, prolongs refractory period of the AV node, decrease conduction through the SA and AV nodes

Front 798

desired results of dig?

Back 798

increase cardiac output and slow the hear rate; improves blood flow to the kidneys, which promotes diuresis

Front 799

dig level

what drug potentiates dig SE?

Back 799

0.5-2.0

lasix

Front 800

Loading and maintenance doses should be reduced in clients with ___ failure and closely monitored. Digoxin immune fab ___ is the antidote.

Back 800

renal


(Digibind)

Front 801

s/s of dig toxicity?

Back 801

fatigue, headache, weakness, blurred vision, yellow vision, arrhythmias, bradycardia, ECG changes, anorexia, nausea, vomiting, diarrhea, gynecomastia, thrombocytopenia

Front 802

when to hold dig?

what foods to have pt eat?

Back 802

<50 or >120

hi K+

Front 803

Always consider what drug in any patient on digoxin who presents with symptomatic bradycardia..

Back 803

atropine

Front 804

T/F Women: studies have shown that postmenopausal women on hormone replacement therapy (HRT) with estrogen alone or estrogen and progestin had increased rates of thrombolytic events such as myocardial infarction (MI) and stroke, as well as breast cancer. Because of these risks to women, the AHA no longer recommends HRT to prevent or manage CAD, and its use to prevent and treat osteoporosis is under scrutiny

Back 804

T

Front 805

Concurrent ___segment elevation on the ECG is far less likely during MI

Back 805

ST

Front 806

During an acute MI, discomfort is more likely to occur in her neck, back, arm, shoulder, jaw, or throat, possibly accompanied by symptoms such as nausea and vomiting, indigestion, upper abdominal pain, dyspnea, fatigue, diaphoresis, dizziness, or fainting

Back 806

info but know

Front 807

T/F A woman who is elderly or who has diabetes may not experience any pain during an MI.

Back 807

T

Front 808

EKG in MI: enlarged __ wave, elevated __ segment, __ wave inversion

Back 808

Q
ST
T

Front 809

what happens to cardiac enzymes in MI

Back 809

increase

Front 810

cardiac isoenzyme specific to cardiac, and therefore, diagnostic).

Back 810

CK-MB fraction

Front 811

__ - is specific to the heart muscle and elevated levels indicates cellular necrosis or death

Back 811

Troponin 1

Front 812

Medical management of MI includes beta-adrenergic blockers (propranolol-Inderal, Lopressor) * contraindicated if patient also has ___?

Back 812

CHF, hypotension or bronchospasm

Front 813

Thrombolytic therapy in MI includes the use of __?

Back 813

Streptase, Activase, and Eminase

Front 814

when are clot busters contraindicated?

Back 814

These are contraindicated if the patient has had recent surgery, or experienced a fall or head wound concurrent with the MI

Front 815

___ is used in angiography to locate blockage, and stent is used to open/keep open arteriies.

Back 815

Thallium 1000

Front 816

Plan of care post MI should include discussions on ___?

Back 816

the resumption of patientÕs sexual activities (based on endurance- ability to climb 2 flights of stairs without pain, sob).

Front 817

VALVULAR HEART DISEASE- Three main types: ___ or narrowing, ___ closure of the valve, and ___ of the valve.

Back 817

stenosis
incomplete
prolapse

Front 818

Aortic insufficiency : Causes include

Back 818

enocarditis, hypertension, rheumatic fever, and syphilis

Front 819

in aortic insuffiency echocardiography shows L ventricular ___. ___ shows L ventricular enlargement and pulmonary vein congestion.

Back 819

enlargement

x-ray

Front 820

in ___ insufficiency:the atrium enlarges , the ventricle dilates

Back 820

Mitral

Front 821

causes of mitral insufficency?

Back 821

Causes include L ventricular failure, mitral valve prolapse, and rheumatic fever