1
Q
What is the hallmark sign of Bell’s Palsy?
A
Bell’s Phenomenon – inability to close the eyelid with the eyeball rolling upward when closure is attempted. It indicates cranial nerve VII inflammation causing unilateral facial paralysis.
2
Q
What is the primary treatment for Bell’s Palsy?
A
Immediate corticosteroids (within 72 hrs) tapered over 2 weeks reduce inflammation; antivirals like acyclovir may be added.
3
Q
Which nursing action protects the eye in Bell’s Palsy?
A
Use artificial tears during the day and lubricating ointment with an eye patch at night to prevent corneal drying since the eyelid cannot close.
4
Q
What is the pathophysiology of Guillain-Barré syndrome?
A
Autoimmune destruction of myelin sheath after viral/bacterial infection causing acute ascending symmetrical paralysis; may reach the diaphragm leading to respiratory failure.
5
Q
Which finding in Guillain-Barré signals respiratory failure?
A
Rising CO₂ or respiratory acidosis on ABG → respiratory muscle paralysis requires intubation/trach.
6
Q
What treatments remove harmful antibodies in Guillain-Barré?
A
Plasmapheresis (within 2 weeks) or IVIG therapy neutralize circulating antibodies; supportive respiratory care is essential.
7
Q
Which diagnostic test confirms Myasthenia Gravis?
A
Tensilon test (IV edrophonium) causes rapid improvement in muscle strength → positive for MG; shows acetylcholine receptor defect.
8
Q
When should anticholinesterase meds be given in MG?
A
Give 45 min before meals to improve swallowing muscle strength and prevent aspiration.
9
Q
Differentiate Myasthenic vs Cholinergic crisis.
A
Myasthenic = undermedicated (stress-induced weakness improves with Tensilon); Cholinergic = overmedicated (SLUDGE symptoms worsen with Tensilon); keep Atropine available.
10
Q
What is the purpose of a Transsphenoidal Hypophysectomy?
A
Surgical removal of the pituitary to treat adenoma; requires lifelong hormone replacement (T3/T4, sex hormones, glucocorticoids).
11
Q
Which findings suggest a CSF leak after hypophysectomy?
A
Clear nasal drainage with positive glucose or halo sign → CSF leak; notify provider immediately.
12
Q
What are key post-op teaching points after hypophysectomy?
A
Keep HOB ↑ 30°, avoid bending, coughing, sneezing, Valsalva, toothbrushing; use stool softeners to prevent ↑ICP.
13
Q
Describe Parkinson’s disease tremor management medications.
A
Anticholinergics (Benztropine, Trihexyphenidyl) reduce tremors and drooling; dopamine agonists (Requip, Mirapex) improve mobility; monitor for dry mouth and constipation.
14
Q
What is a major risk in ALS progression?
A
Respiratory failure due to loss of motor neurons controlling breathing muscles; patients remain cognitively intact.
15
Q
What causes Addison’s disease?
A
Adrenocortical insufficiency from destruction of the adrenal cortex → decreased cortisol and aldosterone production.
16
Q
What are key electrolyte imbalances in Addison’s disease?
A
Hyperkalemia, hyponatremia, hypoglycemia, and hypochloremia due to loss of aldosterone and cortisol.
17
Q
What are hallmark symptoms of Addison’s disease?
A
Severe hypotension, weight loss, salt craving, hyperpigmentation, and fatigue.
18
Q
What is the diet recommendation for Addison’s disease?
A
Increase sodium intake and maintain a balanced diet; avoid potassium-rich foods due to hyperkalemia risk.
19
Q
What is the purpose of fludrocortisone in Addison’s disease?
A
Replaces mineralocorticoid (aldosterone) to help retain sodium and excrete potassium, maintaining fluid balance.
20
Q
What is Addisonian crisis and how is it treated?
A
Life-threatening acute adrenal insufficiency triggered by stress or abrupt steroid withdrawal; treat with IV hydrocortisone, fluids, and electrolytes.
21
Q
What causes Cushing’s syndrome?
A
Prolonged exposure to high corticosteroid levels, either endogenous (pituitary/adrenal tumor) or exogenous (prednisone therapy).
22
Q
List common signs of Cushing’s syndrome.
A
HTN, hyperglycemia, hypernatremia, hypokalemia, hypocalcemia, moon face, truncal obesity, and striae.
23
Q
How is Cushing’s disease treated?
A
Surgical removal of pituitary or adrenal tumor; if due to steroids, taper slowly to prevent Addisonian crisis.
24
Q
What is the mechanism of action of PTU?
A
Propylthiouracil inhibits thyroid hormone synthesis and blocks conversion of T4 to T3, used for hyperthyroidism and thyrotoxicosis.
25
What are expected therapeutic effects of PTU?
Decreased T3/T4 levels, reduced tachycardia, anxiety, and tremors; improvement within 1–2 weeks.
26
What is myxedema coma and its treatment?
Severe hypothyroidism crisis causing hypothermia, bradycardia, hypotension, and hypoventilation; treat with IV levothyroxine and fluids.
27
When should levothyroxine be taken?
In the morning on an empty stomach; avoid fiber laxatives and take consistently at the same time daily.
28
What are signs of levothyroxine overdose?
Symptoms of hyperthyroidism: tachycardia, chest pain, tremors, insomnia, and weight loss; notify provider immediately.
29
What is a major post-op complication after thyroidectomy?
Hypocalcemia due to parathyroid damage; monitor for tingling, Chvostek’s and Trousseau’s signs, and keep IV calcium gluconate available.
30
What are the primary treatment goals for Atrial Fibrillation?
Reduce ventricular rate (<100 bpm), prevent clot formation, and convert to sinus rhythm.
31
What is the immediate treatment for unstable Atrial Fibrillation?
Synchronized cardioversion; administer calcium channel blockers (CCBs) and heparin to prevent clots.
32
Which lab tests are monitored for warfarin therapy?
Monitor PT, INR, and CBC; therapeutic INR is 2–3. Vitamin K is the antidote for warfarin toxicity.
33
What are common side effects of ACE inhibitors?
Dry cough, angioedema, hypotension, and hyperkalemia. Avoid potassium supplements and monitor BP.
34
When are ARBs prescribed instead of ACE inhibitors?
For patients intolerant to ACE inhibitors due to cough or angioedema; monitor for hyperkalemia as well.
35
What is the mechanism of action of Digoxin?
Increases myocardial contractility and slows AV conduction, improving cardiac output and diuresis.
36
What are signs of Digoxin toxicity?
Nausea, vomiting, visual changes (yellow/green halos), bradycardia; monitor potassium and digoxin levels.
37
Differentiate left- vs right-sided heart failure symptoms.
Left HF: pulmonary congestion (dyspnea, crackles, frothy sputum). Right HF: systemic congestion (JVD, edema, ascites).
38
What are major side effects of Verapamil?
Vasodilation causes orthostatic hypotension; instruct patients to rise slowly from lying or sitting.
39
How is stable SVT treated?
Begin with vagal maneuvers; if ineffective, give adenosine rapid IV push followed by saline flush or use CCBs (verapamil, diltiazem).
40
How is unstable SVT treated?
Immediate synchronized cardioversion; use when patient is hypotensive or confused.
41
What is the appearance of VTach on an EKG strip?
Wide, regular QRS complexes appearing as tall ‘mountain’ waves; ventricular origin rhythm.
42
What is the nursing action for sustained VTach with a pulse?
Prepare for synchronized cardioversion and administer antiarrhythmics like amiodarone.
43
Which medications improve cardiac contractility in heart failure?
Digoxin, Dobutamine, Dopamine, and Milrinone improve myocardial contraction and perfusion.
44
What is the safe IV administration rate for furosemide?
No faster than 20 mg/min to prevent ototoxicity and hypotension; monitor potassium levels.
45
What is the mechanism of action of bronchodilators?
They relax bronchial smooth muscles to open airways. SABAs (e.g., Albuterol) are for rescue; LABAs (e.g., Salmeterol) for maintenance.
46
What are key steps for proper MDI (metered-dose inhaler) use?
Shake device, exhale fully, press while inhaling deeply for 2–3 seconds, hold breath 10 seconds, wait 60 seconds between puffs.
47
Why should patients rinse their mouth after using inhaled corticosteroids?
To prevent oral thrush (candidiasis) caused by local immunosuppression.
48
When should bronchodilators be avoided before a PFT?
Avoid 4–6 hours before testing to prevent altered results.
49
Which side effect is most common with Albuterol?
Tachycardia; monitor heart rate especially in cardiac patients.
50
What is the first-line rescue medication for acute asthma?
SABA (Albuterol or Levalbuterol); Levalbuterol preferred in cardiac patients due to less tachycardia.
51
What medications are given for status asthmaticus?
SABA, SAMA (Ipratropium), corticosteroids (IV/PO), and magnesium sulfate or theophylline if unresponsive.
52
What breathing technique improves expiration in COPD?
Pursed-lip breathing—prolongs exhalation and prevents air trapping.
53
How should oxygen be administered in COPD?
Use low-flow O2 (2–4 L NC or 40% Venturi mask) to avoid suppressing hypoxic drive; Venturi provides precise FiO2.
54
What position helps COPD patients breathe easier?
Orthopneic position (sitting and leaning forward) improves diaphragm expansion and gas exchange.
55
What dietary teaching is important for COPD clients?
High-calorie, high-protein, small frequent meals; rest 30 min before eating; increase fluids 2–3L/day to liquefy secretions.
56
What are signs of a COPD exacerbation?
Increased dyspnea, increased sputum volume or purulence—indicate infection or worsening condition.
57
What are ominous signs in acute asthma attack?
Fatigue, absent breath sounds, cyanosis, and paradoxical chest/abdominal movement indicate impending respiratory failure.
58
What lab change occurs in late COPD or respiratory failure?
Respiratory acidosis (↑CO₂, ↓pH) due to hypoventilation and air trapping.
59
Why should corticosteroid use in asthma be tapered?
Abrupt withdrawal can cause adrenal insufficiency; gradual taper prevents rebound inflammation.
60
What defines Acute Kidney Injury (AKI)?
Sudden cessation of renal function causing accumulation of waste and fluid-electrolyte imbalance.
61
What are key phases of AKI?
Onset, Oliguria, Diuresis, Recovery. Oliguria = <400 mL/day urine with fluid retention; Diuresis = high urine output but poor concentration.
62
What symptoms are seen during the Oliguric phase of AKI?
Nausea, vomiting, HTN, JVD, edema, metabolic acidosis, hyperkalemia, altered mental status.
63
What electrolyte imbalance occurs during Diuretic phase of AKI?
Hypovolemia and hypotension due to excessive fluid loss; monitor for dehydration and low BP.
64
What ABG finding indicates severe metabolic acidosis?
pH <6.9 indicates severe acidosis; sodium bicarbonate is administered for correction.
65
What causes intrarenal injury in AKI?
Direct kidney damage from nephrotoxic drugs like aminoglycosides (Gentamicin), contrast dyes, NSAIDs, or heavy metals.
66
Which antibiotics are nephrotoxic?
Aminoglycosides (Gentamicin), vancomycin, and amphotericin B can cause nephrotoxicity; monitor BUN and creatinine.
67
Why is Furosemide used in AKI?
Loop diuretic that reduces fluid overload; administer IV slowly (≤20 mg/min) to prevent ototoxicity and hypotension.
68
What is the mechanism of action of Epoetin Alfa?
Stimulates RBC production in bone marrow to treat anemia, especially in chronic kidney disease.
69
Which labs should be monitored during Epoetin therapy?
Hemoglobin and RBC levels; monitor for hypertension and tachycardia due to increased blood viscosity.
70
What are early signs of hyperkalemia?
Muscle weakness, peaked T waves on ECG, arrhythmias; treat with insulin, dextrose, or sodium polystyrene sulfonate.
71
What are key safety measures for nephrotoxic medications?
Ensure adequate hydration, avoid NSAIDs, monitor renal labs, and avoid contrast dyes if creatinine is elevated.
72
What are normal serum sodium and potassium ranges?
Na: 135–145 mEq/L; K: 3.5–5.0 mEq/L; monitor closely in AKI or diuretic use.
73
Why are AKI patients at risk for respiratory acidosis?
Fluid overload impairs gas exchange and hypoventilation increases CO₂ retention.
74
What dietary restriction is important for renal patients?
Low potassium, low sodium, and restricted protein to reduce kidney workload and prevent hyperkalemia.
75
What is the hallmark characteristic of Osteoarthritis (OA)?
Degeneration of articular cartilage causing pain aggravated by activity and relieved by rest.
76
What are nonpharmacologic pain management strategies for OA?
Balance rest and activity, apply ice for ROM, moist heat for stiffness, use assistive devices, remove scatter rugs, wear supportive shoes.
77
What are key patient teaching points for home safety in OA?
Install grab bars, stair rails, and use night lights to prevent falls; avoid clutter.
78
What causes Rheumatoid Arthritis (RA)?
Autoimmune inflammation of the synovial membrane causing symmetrical joint pain and deformity.
79
What labs confirm Rheumatoid Arthritis?
Elevated Rheumatoid factor, anti-CCP, ANA, ESR, and CRP indicate autoimmune inflammation.
80
What are common symptoms of RA?
Morning stiffness >1 hr, symmetrical joint swelling, pain, fatigue, and nodules over joints.
81
What are first-line drugs for RA?
NSAIDs for pain, corticosteroids for flare-ups, DMARDs (Methotrexate, Hydroxychloroquine) to slow disease progression.
82
What are the risks associated with Methotrexate?
Bone marrow suppression and hepatotoxicity; monitor CBC and LFTs; avoid alcohol and pregnancy (Category D drug).
83
What are side effects of corticosteroid therapy?
Hyperglycemia, hypertension, infection risk, GI bleeding, and osteoporosis; taper gradually to avoid Addisonian crisis.
84
What are signs of corticosteroid withdrawal?
Weakness, hypotension, nausea, severe fatigue—indicate Addisonian crisis due to adrenal suppression.
85
Why should Hydrocortisone doses be increased during stress?
Adrenal glands normally increase cortisol; supplementing prevents Addisonian crisis during illness or surgery.
86
What are safety precautions for immunosuppressed RA patients?
Avoid large crowds, monitor for infection, and maintain up-to-date vaccinations (no live vaccines).
87
What non-pharmacologic therapies help RA?
ROM exercises, scheduled rest periods, heat/cold therapy, and joint splints to reduce inflammation.
88
What are side effects of Hydroxychloroquine?
Retinal damage causing blurred vision; requires eye exams every 6 months.
89
What education should be given about corticosteroid tapering?
Never stop abruptly; taper to allow adrenal recovery and prevent life-threatening Addisonian crisis.
90
What is cholelithiasis?
Presence of gallstones (cholesterol or pigment) that can obstruct bile flow and cause cholecystitis.
91
What are major risk factors for cholelithiasis?
‘4 Fs’ – Female, Forty, Fat, Fertile; also high-cholesterol diet, rapid weight loss, and certain medications.
92
What is the treatment of choice for symptomatic cholelithiasis?
Laparoscopic cholecystectomy (gallbladder removal).
93
What is the most common post-op discomfort after cholecystectomy?
Gas pain from CO₂ used during surgery; relieved by ambulation or Sims position.
94
What dietary modifications are needed after cholecystectomy?
Low-fat, small frequent meals; avoid fried foods, gas-forming vegetables, and fatty meats.
95
Which signs indicate postoperative infection or peritonitis?
Fever, chills, abdominal rigidity, warmth, redness, and distension near incision site or drains.
96
What are post-op care priorities after cholecystectomy?
Encourage ambulation, assess drains (T-tube/JP), monitor for bile leakage, and manage pain.
97
What foods should be avoided post-cholecystectomy?
High-fat, fried, gas-producing foods (beans, cabbage, broccoli, cauliflower).
98
What is the function of bile?
Bile aids in fat digestion and absorption; obstruction leads to fat malabsorption and steatorrhea.
99
Why is ambulation important after abdominal surgery?
Promotes gas expulsion, prevents DVT, and enhances peristalsis for bowel recovery.
100
What signs indicate bile duct obstruction?
Jaundice, clay-colored stools, dark urine, and itching (pruritus).
101
What nursing position relieves post-op shoulder pain from CO₂?
Sims position—left side with right knee flexed to promote gas escape.
102
What are dietary recommendations to prevent gallstones?
Maintain healthy weight, avoid high-fat and high-cholesterol diets, and eat regular meals.
103
What labs confirm bile obstruction or liver dysfunction?
Elevated bilirubin, AST, ALT, and alkaline phosphatase levels.
104
What complications may occur if bile leakage is not managed?
Peritonitis, abscess formation, or sepsis due to bile-induced irritation and infection.
105
What is pancytopenia?
Reduction in all major blood cell types (RBCs, WBCs, platelets) usually due to bone marrow suppression from chemotherapy.
106
What are complications of pancytopenia?
Infection (neutropenia), anemia (fatigue), and bleeding (thrombocytopenia); monitor CBC closely.
107
What is neutropenia and how is it managed?
Low WBC count; place patient on neutropenic precautions—no plants, raw foods, or sick visitors.
108
What is brachytherapy?
Internal radiation where a radioactive source (pellets) is placed close to the tumor site for localized treatment.
109
What are radiation safety principles for brachytherapy?
Time (limit exposure), Distance (6 feet), Shielding (lead apron facing source), and proper signage on door.
110
Who should not visit a brachytherapy patient?
Pregnant individuals and children under 18 due to radiation risk.
111
What should a nurse do if a radiation implant becomes dislodged?
Use long-handled tongs to place implant in lead-lined container, keep in room, and notify radiation officer.
112
What is cancer staging used for?
Determines tumor size (T), lymph node involvement (N), and metastasis (M) to guide treatment and prognosis.
113
What is carcinoma in situ?
Localized preinvasive cancer that has not spread to surrounding tissue; early-stage and highly curable.
114
Why does chemotherapy cause bone marrow suppression?
Targets rapidly dividing cells, including bone marrow, leading to decreased WBC, RBC, and platelet production.
115
What lab abnormalities are common during chemotherapy?
Low WBC, Hgb, Hct, and platelet counts; monitor for infection and bleeding.
116
What should immunocompromised patients avoid?
Crowds, raw or undercooked food, flowers, and sharing equipment; use strict hand hygiene.
117
What are precautions for immunocompromised patients’ environment?
Private room, no live plants, single-use equipment, and visitors must be healthy and masked.
118
What is the primary goal of infection prevention in neutropenia?
Prevent exposure to pathogens by limiting contact and maintaining aseptic technique.
119
What PPE should be used for handling chemotherapy agents?
Double gloves, gown, and eye protection; dispose of materials in chemo-specific containers.
120
What are dietary recommendations for arteriosclerosis?
Low-fat, low-sodium diet; increase fiber, fruits, vegetables, and maintain healthy weight to reduce plaque buildup.
121
What are ototoxic medications to monitor?
Loop diuretics (Furosemide) and aminoglycosides (Gentamicin) can cause hearing loss; administer IV Lasix slowly (≤20 mg/min).
122
What is the indication for fludrocortisone?
Used in Addison’s disease to replace mineralocorticoid (aldosterone) for sodium retention and potassium excretion.
123
What are the side effects of prednisone?
Hyperglycemia, hypernatremia, hypokalemia, hypertension, infection risk, GI bleeding; taper gradually to avoid adrenal crisis.
124
What are safety considerations for long-term corticosteroid use?
Monitor glucose and BP, use lowest effective dose, supplement calcium and vitamin D to prevent osteoporosis.
125
What is the mechanism of MAO-B inhibitors?
Inhibit dopamine breakdown, prolonging dopamine activity in Parkinson’s disease (e.g., Selegiline, Rasagiline).
126
What foods must be avoided with MAO-B inhibitors?
Tyramine-rich foods like cheese, wine, and smoked meats; risk of hypertensive crisis.
127
When should Selegiline be administered?
Before noon to prevent insomnia, as it increases CNS stimulation.
128
What is the mechanism of Digoxin?
Increases cardiac contractility, slows AV node conduction, improves output; monitor for bradycardia and toxicity.
129
What labs should be monitored with Digoxin?
Serum digoxin level (0.5–2 ng/mL) and potassium; hypokalemia increases toxicity risk.
130
What are signs of Digoxin toxicity?
Visual halos, nausea, vomiting, confusion, bradycardia; hold dose and notify provider.
131
What medications improve contractility in heart failure?
Digoxin, Dobutamine, Dopamine, and Milrinone enhance myocardial contraction and perfusion.
132
What ABG pattern indicates respiratory acidosis?
↓pH, ↑PaCO₂ seen in COPD or Guillain-Barré; treat underlying hypoventilation.
133
What are signs and symptoms of Graves’ disease?
Tachycardia, tremors, weight loss, heat intolerance, exophthalmos, goiter—caused by autoimmune hyperthyroidism.
134
Why must corticosteroids be tapered slowly?
Abrupt discontinuation causes adrenal insufficiency (Addisonian crisis); taper allows adrenal gland recovery.
135
What is the earliest sign of increased intracranial pressure (ICP)?
A change in level of consciousness (LOC) indicates rising ICP before vital or motor changes appear.
136
What are normal Glasgow Coma Scale (GCS) score ranges?
Score 15 = normal, 8 or below = coma, 3 = deep coma; assesses eye, verbal, and motor responses.
137
Differentiate SIADH vs. Diabetes Insipidus.
SIADH: low urine output, low Na⁺, concentrated urine. DI: high urine output, high Na⁺, dilute urine.
138
What is a thyroid storm and its management?
Severe hyperthyroidism → fever, tachycardia, agitation. Treat with PTU, beta-blockers, cooling, and IV fluids.
139
What are post-op priorities after adrenalectomy?
Monitor for hypotension, electrolyte imbalance, infection, and lifelong steroid replacement therapy.
140
What does ST elevation indicate on EKG?
Myocardial infarction (STEMI); treat with MONA-B: Morphine, O₂, Nitrates, Aspirin, Beta-blocker.
141
What are key cardiac enzymes for MI diagnosis?
Troponin (rises 4–6 hr), CK-MB, Myoglobin; troponin is most specific for cardiac damage.
142
Differentiate the types of shock.
Hypovolemic: low volume. Cardiogenic: pump failure. Septic: infection → vasodilation. All cause poor tissue perfusion.
143
How to interpret respiratory acidosis?
↓pH, ↑PaCO₂ → caused by hypoventilation (COPD, airway obstruction).
144
Rank oxygen delivery devices from least to most O₂.
Nasal cannula → simple mask → Venturi → nonrebreather → intubation (mechanical ventilation).
145
What ABG pattern occurs in metabolic acidosis?
↓pH, ↓HCO₃⁻ (e.g., AKI, DKA, diarrhea). Compensated by ↑respirations to blow off CO₂.
146
What are dialysis indications?
Severe hyperkalemia, metabolic acidosis (pH <7.1), fluid overload, or uremic symptoms (confusion, pericarditis).
147
What is the difference between CKD and AKI?
AKI = sudden, reversible; CKD = gradual, irreversible; both cause ↑BUN/Cr and ↓GFR.
148
What are warning signs of compartment syndrome?
Unrelieved pain, paresthesia, pallor, paralysis, pulselessness → fasciotomy required.
149
What are signs of fat embolism?
SOB, confusion, petechiae on chest/neck; seen after long bone fracture; requires O₂ and immobilization.
150
What foods should be avoided in gout?
Purine-rich foods (organ meats, shellfish, alcohol); encourage hydration with allopurinol use.
151
What are signs of pancreatitis?
Severe LUQ pain radiating to back, ↑amylase/lipase, NPO status, fetal position for comfort.
152
Differentiate Hepatitis A vs. B/C transmission.
A = fecal-oral route; B/C = bloodborne or sexual contact; vaccinate for A and B.
153
What are key anemia findings?
Iron-deficiency: pallor, fatigue. B12: glossitis, paresthesia. Aplastic: pancytopenia.
154
What are the 6 Rights of Medication Administration?
Right patient, drug, dose, route, time, documentation; cornerstone of medication safety.
Med Surg 2
flashcards
Decks in class (17)
# Cards
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Week 1 Medications71
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week 1 lecture157
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Week 1 Chemo Man20
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week 2 cardiac anatomy and physiology of heart38
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Week 2 Cardiac91
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week 2 cardiac ATI115
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week 2 cardiac drugs120
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week 3 meds61
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week 3 lecture228
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week 3 ati157
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week 3 questions140
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midterm review94
-
midterm medications180
-
midterm neuro40
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week 6 endocrine135
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week 7177
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Final Exam154
