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Physiological Integrity Flashcards

Master the largest NCLEX category with high-yield flashcards covering basic care and comfort, pharmacological therapies, reduction of risk potential, and physiological adaptation. Review fluid & electrolyte balance, oxygenation, burns, oncology, renal, cardiac, respiratory, and neuro nursing care. These cards sharpen your clinical judgment for the most content-heavy portion of the NCLEX RN®/PN® and help you practice high-priority scenarios with confidence.

Basic Care And Comfort Flashcards

Part 1

[{"q":"Where is ADH stored?","a":"Pituitary gland."},{"q":"What is ascites?","a":"Fluid in the abdomen (peritoneum), third spacing."},{"q":"When you have a patient who is developing ascites, you know you are supposed to measure the abdominal girth every day. If the abdominal girth increases every day, what does that tell you about the vascular space?","a":"There is still too much fluid in the vascular space, and the excess is pouring over into the abdomen."},{"q":"Define CVP. Where is CVP measured?","a":"Central Venous Pressure. It is measured in the right atrium of the heart."},{"q":"What is normal CVP?","a":"2-6 mmHg (if measured by a monitor); 3-8 cm H2O is measured with a manometer."},{"q":"What happens to the weight in hypervolemia? Why?","a":"It increases; excess fluid causes weight to increase rapidly."},{"q":"What kind of diet are you going to place a hypervolemic patient on? Explain why.","a":"Sodium-restricted to decrease fluid retention."},{"q":"If you put a hypervolemic patient on a high-sodium diet, what would happen?","a":"The patient will retain more fluid, and the condition would worsen."},{"q":"Why do we want a hypervolemic patient to be on bed rest?","a":"Bed rest induces diuresis by increasing kidney perfusion; when you are supine, you perfuse the kidneys more effectively."},{"q":"Define fluid volume deficit.","a":"Loss of water and sodium from the vascular space equally."},{"q":"What is the treatment for mild fluid volume deficit?","a":"Increase oral fluids."},{"q":"What is the treatment for severe FVD?","a":"Administer IV fluids."},{"q":"How do we get rid of excess magnesium from our body?","a":"Through our kidneys."},{"q":"Why is it so important to get the patient walking or weight-bearing with hypercalcemia?","a":"To stress the bones; this encourages calcium to return to the bones. When calcium moves back into the bones, serum calcium levels decrease."},{"q":"Why is it so important to increase fluids in hypercalcemia?","a":"To prevent kidney stones."},{"q":"Why is it so important to ensure proper water replacement with tube feedings?","a":"If you don’t give proper amounts of water, the patient can dehydrate."},{"q":"Why is it so important to assess urine output before starting IV potassium?","a":"When you are giving IV potassium, the patient must have a way to excrete the excess. The only way to excrete K is through the kidneys. If the kidneys are not working well, then K will be retained."},{"q":"What is the normal treatment for hypoxia?","a":"Give O2"},{"q":"What is the immediate treatment for respiratory alkalosis?","a":"Have the patient breathe into a bag. Re-breathe CO2. (Take it back in.)"},{"q":"Explain the Rule of Nines.","a":"Estimate of total Body Surface Area that has been burned: Head = 9; each Arm = 9; each Leg = 18; Anterior trunk = 18; Posterior trunk = 18; Genitalia = 1."},{"q":"Explain the common rule for fluid replacement after a major burn.","a":"Calculate what is needed the first 24 hours and give ½ during the first 8 hours; during the 2nd 8 hours give ¼ of total volume; during the 3rd 8 hours give ¼ of total volume."},{"q":"What is the purpose of measuring a gastric residual?","a":"To ensure that the supplement is moving through the GI tract."},{"q":"When a patient has a radiation implant, why do we put them on a low fiber diet?","a":"To help prevent dislodgment that could occur if the intestines distend."},{"q":"Why does this patient have a Foley catheter?","a":"To help keep the bladder non-distended (could promote dislodgment). If the bladder becomes distended, the implant could be pushed out."},{"q":"If you have to turn a patient with a radiation implant, how do you turn them?","a":"Log roll."},{"q":"Why do we want to keep the patient with a radiation implant on bed rest?","a":"To help prevent dislodgment."},{"q":"When a patient has a radiation implant, do you force fluids or do you restrict fluids?","a":"Increase."},{"q":"Explain the nursing care for the markings that a patient will have when they are receiving external radiation therapy.","a":"Do not wash them off or put lotion on them."},{"q":"When a patient has had an abdominal hysterectomy, what is the position of choice? And explain why.","a":"Supine would be the best position, but we have to worry about aspiration too. If the head is up too much, more blood could pool in the pelvis."},{"q":"Explain the postop care for a patient who has had a mastectomy.","a":"Elevate the arm on the affected side; protect the extremity, brush hair, squeeze a tennis ball, wall climbing – promote circulation and mobility; check for bleeding."},{"q":"Why is it so important that the mastectomy patient elevate her arm on the affected side?","a":"To prevent swelling."},{"q":"Why is it important that the patient exercise the affected side after a mastectomy?","a":"It promotes circulation and mobility."},{"q":"What is the nursing care for a patient who has lymphedema?","a":"No constriction, no blood pressure or injections, wear gloves when gardening, watch for cuts, protect the extremity."},{"q":"When a patient has a bronchoscopy, they are NPO until what returns?","a":"Gag reflex."},{"q":"Explain sputum specimen.","a":"The best time to obtain it is in the morning – it should be sterile – the patient should rinse their mouth with water first. Do not let lips touch the cup."},{"q":"When a patient has had a pneumonectomy, what is the nursing care as far as positioning and why?","a":"Position on the affected side – the affected side will fill with fluids; the good side (non-surgical side) should be up to promote lung expansion; we want the affected side to fill; avoid severe lateral positioning, as it could promote a mediastinal shift."},{"q":"Why does the patient who has had a total laryngectomy need to have a tracheostomy?","a":"Because the epiglottis has been removed (no airway protection left)."},{"q":"Why does the patient who has had a total laryngectomy have to be positioned in the Fowler’s position?","a":"To decrease edema around the airway."},{"q":"Why does the laryngectomy patient need to have NG feedings?","a":"To protect the suture line."},{"q":"Why is it important that the laryngectomy patient have frequent mouth care?","a":"To prevent mouth bacteria from moving down to the surgical site or to the lungs."},{"q":"Explain suctioning.","a":"It is a sterile procedure; hyperoxygenate before and after; stop advancement of the catheter when you meet resistance; suction on the way out and for no more than 10 seconds; watch for vagus nerve stimulation (pulse drops)."},{"q":"Explain, in your own words, an ileal conduit.","a":"When a piece of the ileum is used to make a bladder. One end of the ileum has the ureters plugged into it; the other end is brought to the abdominal surface as a stoma."},{"q":"What is the major symptom of bladder cancer?","a":"Painless hematuria."},{"q":"Why is it important that hourly outputs be monitored after a patient has had an ileal conduit?","a":"If urine output is dropping, then the surgical area could be becoming edematous, thereby causing urine backup into the kidneys and increasing the chance for renal failure."},{"q":"Is mucous in this urine normal?","a":"Yes."},{"q":"Explain how a three-way catheter works and why the prostatectomy patient has to have it.","a":"It maintains patency and flushes out clots. We do not want any clots because this could occlude the urinary tract and promote renal failure. The fluid is instilled into the bladder, flushes out blood, and then the irrigant (fluid) drains down into the Foley catheter drainage bag."},{"q":"How do Kegel exercises help prostatectomy patients?","a":"They strengthen pelvic floor muscles and help prevent incontinence."},{"q":"Why does the prostatectomy patient have to take Colace?","a":"To prevent straining – straining promotes bleeding."},{"q":"When a patient has had a fresh GI surgery, such as gastrectomy, is it okay for the nurse to manipulate the NG tube?","a":"No – this could disrupt the suture line."},{"q":"When a patient has had a thyroidectomy, why is it so important for them to support their neck?","a":"We do not want to stress the suture line."},{"q":"How do you want a thyroidectomy patient to be positioned? Explain why.","a":"In Fowler's position – to decrease edema."},{"q":"Why is it important that the hypoparathyroid patient have a diet that is limited in phosphorus?","a":"Serum phosphorus is already high."},{"q":"Why does the Addison’s disease patient need more sodium in their diet?","a":"To retain volume in the vascular space. (They’re losing their Na.)"},{"q":"Why is I & O such an important nursing intervention with the Addison’s disease patient?","a":"Because this patient has a severe fluid volume problem."},{"q":"Is the Addison’s disease patient in a fluid volume deficit or a fluid volume excess?","a":"Deficit"},{"q":"Is the Cushing’s syndrome patient in a fluid volume deficit or excess?","a":"Excess"},{"q":"When a patient has Cushing’s syndrome, their serum potassium level goes down. Why?","a":"Because they have too much aldosterone (so they retain Na and H2O and lose K+)."},{"q":"Why does the Cushing’s syndrome patient need more calcium in their diet?","a":"Because steroids decrease serum calcium levels by making you excrete it through the GI tract."},{"q":"Does the Cushing’s syndrome patient need to be on a low-sodium diet or a high-sodium diet? Explain.","a":"Low. Na makes you retain H2O. This patient doesn’t need more fluid retention because they are already in an excess."},{"q":"What is the common treatment for Type II diabetics?","a":"Diet and exercise, oral agents and\/or insulin."},{"q":"In the treatment of a diabetic, why do we have to limit the protein in their diet?","a":"Because of possible kidney damage. Diabetics tend to have kidney damage and excess glucose destroys vascularity in the kidneys. We always limit protein with kidney problems."},{"q":"When the diabetic patient exercises, why do they have to worry about hypoglycemia and how can they prevent it?","a":"Exercise lowers blood sugar; eat fruit, low-fat milk."},{"q":"Why is it important that a diabetic patient exercise when their blood sugar is at its highest?","a":"To prevent hypoglycemia."},{"q":"Why is it so important that the injection sites the diabetic patient uses be rotated?","a":"To prevent tissue damage; lipodystrophy decreases absorption."},{"q":"What are some general S\/S of hypoglycemia and what is the immediate nursing action?","a":"Shaky, weak, decreased LOC, cool clammy skin, nervousness, increased pulse, nausea, sweating, headache; Simple Sugar (PO)."},{"q":"You give an unconscious patient an amp of D50W because you think they are hypoglycemic. The patient should start to wake up. When they are awake, what should you get them to do?","a":"Eat"},{"q":"When you get the diabetic ketoacidosis patient into the emergency room, why do we start normal saline?","a":"Patient is in a fluid volume deficit."},{"q":"Explain foot care thoroughly.","a":"Clip nails straight across; be careful with lotions; inspect feet each day; dry in between toes very well; wear leather shoes all the time."},{"q":"What is going to happen to urine output when you have a patient who has decreased cardiac output?","a":"Decrease; no perfusion."},{"q":"Why is it so important that the angina patient rest frequently?","a":"To decrease the workload of the heart."},{"q":"Is it okay for a patient with angina to take their nitroglycerin prophylactically?","a":"Yes"},{"q":"Before they take their nitroglycerin, should the patient sit down or stand up? Explain.","a":"Sit down, nitroglycerin makes them dizzy; they may faint."},{"q":"Will rest or nitroglycerin relieve MI pain?","a":"No"},{"q":"When a patient goes into V-fib, what is the priority nursing action?","a":"D-fib"},{"q":"Any time you have a patient who is injected with iodine-based dye, what is the common complaint the patient will have?","a":"Warm\/flushing\/sweating"},{"q":"When a patient has a heart cath, they will have a puncture site. Where might that puncture site be? Give two locations.","a":"Femoral\/brachial"},{"q":"In post-cardiac catheterization, you have to watch the puncture site closely. What are we watching it for?","a":"Bleeding\/hematoma formation"},{"q":"When a patient has had a heart cath, you have a pertinent nursing assessment you need to do distal to the insertion site. Explain.","a":"Assess circulation. Pulses, skin temperatures; capillary refill; skin color."},{"q":"Why is it so important that we immobilize the arm on the affected side after pacemaker insertion?","a":"The wires need time to embed in the heart; if the arm is moving too much, the wires (leads) could pull out."},{"q":"Why does the pacemaker patient need to check their pulse every day?","a":"To ensure the pacemaker stays within the range it’s set on."},{"q":"What is an A-line?","a":"Arterial line – in artery – measures continuous BP on a monitor."},{"q":"What is an Allen’s test?","a":"Checks for alternate circulation prior to inserting A-line."},{"q":"Why is it so important that the distal circulation be checked when a patient has an A-line? Explain your checks that you are going to do (nursing assessment).","a":"Skin temperature, color, pulse, capillary refill – These need to be checked because the A-line could decrease heart perfusion, so the line is normally placed in the radial artery."},{"q":"If an A-line is accidentally pulled out, what is the first thing that needs to be done?","a":"Apply pressure"},{"q":"When a patient has an A-line, pressure has to be kept on the infusion bag. Why? What would happen if you didn’t keep the pressure on the infusion bag?","a":"To prevent backflow of arterial blood – If you did not place pressure on the flush bag, the high pressure of the artery would force blood back up through the tubing and fill the flush bag with blood."},{"q":"When a patient goes on a low-sodium diet and bed rest, what might happen to them?","a":"Diuresis may occur"},{"q":"Why do we give diuretics in the morning?","a":"So the patient will not be up all night using the bathroom"},{"q":"Why is it so important that a CHF patient weigh themselves every day?","a":"To monitor themselves for fluid retention."},{"q":"When a patient is in pulmonary edema, why is it important that you sit them up with their legs down?","a":"To decrease venous return."},{"q":"What is one quick check you can do on patients to see if they are going into pulmonary edema?","a":"Lung sounds."},{"q":"When you are taking care of a patient who is at risk for pulmonary edema, why do we use 10-inch blocks? Explain.","a":"To enhance pooling of blood in lower extremities; decrease venous return."},{"q":"Explain the nursing care for someone with Buerger’s disease and Raynaud’s disease.","a":"Buerger’s disease – excellent foot care and avoid the cause. Raynaud’s – avoid the cause."},{"q":"Why do Buerger’s disease patients have to do such excellent foot care?","a":"Foot care is appropriate with any peripheral vascular condition."},{"q":"Do you elevate venous disorders or lower venous disorders (such as an affected extremity)?","a":"Elevate"},{"q":"When taking care of a patient with a venous disorder, do you use warm moist heat or cold wet packs?","a":"Warm moist heat to decrease inflammation."},{"q":"What is a thoracentesis?","a":"Removal of fluid from the pleural space."},{"q":"When a patient is having a thoracentesis, where is the fluid being removed from?","a":"Pleural space."},{"q":"What has happened when a patient needs a chest tube?","a":"The lung is collapsed."},{"q":"a. Chest tubes have a water seal. First of all, what is the purpose of the water seal and what would happen if there was no water seal? b. Also in chest tubes, the chest bottle will have an air vent at the top of the bottle. What is the purpose of the air vent?","a":"a. To promote one-way flow of air out of the pleural space. If there was no water seal or if the water seal was broken, air from the outside environment could go backwards into the pleural space and re-collapse the lung. b. To let air that comes out of the pleural space escape from the bottle."},{"q":"When a patient has a chest tube, you should see fluctuation of the fluid in the water seal tubing. What does this fluctuation mean?","a":"A good connection."},{"q":"When a patient has chest tubes, hopefully the lung should do what?","a":"Re-expand."},{"q":"What would you do if the tubing became disconnected?","a":"Hook it back up unless you happen to have a sterile connector in the room. Then you would use a brand new sterile connector."},{"q":"What would happen if the water seal in the chest system is broken?","a":"Air from the outside environment would rush into the pleural space and re-collapse the lung."},{"q":"What is the first thing the nurse should do if the chest tube is accidentally dislodged from the patient?","a":"Place your hand over the insertion site."},{"q":"What is a hemothorax?","a":"Blood in the pleural space."},{"q":"What is a pneumothorax?","a":"Air in the pleural space."},{"q":"When blood or air or fluid accumulates in the pleural space, what is going to happen to the lung?","a":"Collapse."},{"q":"What should you do if a patient presents with a penetrating object to the chest?","a":"Leave it in place."},{"q":"What is a tension pneumothorax?","a":"The pressure has accumulated in the pleural space and has collapsed the lung and pushed everything to the opposite side."},{"q":"When a patient has an open pneumothorax, you are supposed to put a piece of petroleum gauze over the area. How many sides are taped down? Why do we leave one side open?","a":"Three – the fourth side acts as an air vent. There is a chance there is some air that will need to come out, so you will have to leave a way for it to come out."},{"q":"When a patient has a fractured sternum or ribs, why are the respirations so shallow? What acid-base imbalance will this put them at risk for?","a":"Because it hurts; respiratory acidosis."},{"q":"With a fractured sternum or ribs, why is the patient put on a ventilator with PEEP?","a":"To expand the chest to realign ribs."},{"q":"What is PEEP?","a":"Positive end-expiratory pressure."},{"q":"What is CPAP?","a":"Continuous positive airway pressure."},{"q":"What is the major difference between the two (PEEP and CPAP)?","a":"PEEP exerts pressure at the end of exhalation and CPAP is pressure throughout the breathing cycle."},{"q":"What is flail chest?","a":"Multiple rib fractures."},{"q":"What is paradoxical chest wall movement?","a":"When your chest does not rise and fall symmetrically; you are said to have a seesaw chest."},{"q":"When a patient has glomerulonephritis, are they in a fluid volume deficit or a fluid volume excess?","a":"Fluid volume excess."},{"q":"Explain CVA tenderness.","a":"This is costovertebral angle tenderness. It is when you tap over the kidneys and tenderness occurs."},{"q":"Why does the glomerulonephritis patient need bed rest?","a":"For diuresis."},{"q":"When determining fluid replacement for a renal disease patient (glomerulonephritis), you always give them what they lost in a 24-hour period plus 500cc. What is the purpose of adding 500 cc’s?","a":"To account for the insensible fluid loss."},{"q":"Once diuresis begins in glomerulonephritis, will the patient be at risk for a fluid volume deficit or fluid volume excess?","a":"Fluid volume deficit."},{"q":"What will protein or albumin hold onto in the vascular space?","a":"Fluid."},{"q":"Therefore, will the nephrotic syndrome patient (in the acute stages) be in a fluid volume deficit or fluid volume excess?","a":"Fluid volume deficit."},{"q":"Why will a patient who is diuresing go into a fluid volume deficit?","a":"Losing volume"},{"q":"Is hemodialysis done every day?","a":"No"},{"q":"Explain the basic nursing care for a circulatory access (A-V shunt, fistula, or graft).","a":"No blood pressures, no punctures in that extremity, do not wear a watch on that extremity, check it for adequate circulation."},{"q":"When a patient is having peritoneal dialysis, where is the fluid going into?","a":"Abdomen - Peritoneal cavity"},{"q":"What would you do if you instilled 1,000 cc’s of fluid into the peritoneal dialysis patient and only 700 cc’s came back?","a":"Turn the patient from side to side or reposition the patient."},{"q":"What should the drainage of peritoneal dialysis look like?","a":"Clear and straw colored."},{"q":"Explain in your own words a 24-hour urine.","a":"Discard the first voiding, keep all urine for the next 24 hours in a special container, and save the last voiding."},{"q":"A Creatinine Clearance test requires what type of urine specimen?","a":"24-hour urine"},{"q":"When a patient has an IVP (intravenous pyelogram), exactly what is this x-ray looking at?","a":"Kidneys, ureters, and bladder"},{"q":"What does a cystoscopy look at specifically?","a":"Urethra and bladder"},{"q":"What is the normal pre-procedure activities for a cystoscopy?","a":"Sedative and topical anesthetic"},{"q":"Explain the major S\/S post-cystoscopy?","a":"Watch for urine retention, burning is common for a couple of days due to urethra irritation, and blood-tinged urine is okay for a day or so."},{"q":"What type of specimen do you have to have to test a creatinine level on a patient?","a":"Blood"},{"q":"Any time a patient is having a transfusion reaction, what type of specimen should be obtained promptly?","a":"Urine"},{"q":"What should be done during a crisis?","a":"Hydration is No. 1; oxygen will be needed, blood transfusions will be needed, bed rest, and pain management."},{"q":"Why does the leukemia patient need bed rest?","a":"Bed rest is needed due to decreased red blood cells (hypoxia) and also to prevent trauma."},{"q":"Explain a neurovascular check.","a":"Checking pulses, color, movement, sensation, capillary refill, and skin temperature."},{"q":"In your Board Review book I explained several different things under “Cast Care,” such as ice packs should go on the sides. Go through those components under “Cast Care” and explain why we do all of those things. a. Ice packs on sides b. No indentations c. Use palms for the first 24 hours. d. Keep uncovered and dry. e. Do not rest cast on hard surface or sharp edge. f. Cover cast close to the groin with plastic. g. Elevate.","a":"A. We don’t want to indent the cast B. Could cause pressure sores under the cast C. To prevent indentations D. To allow heat to escape E. To decrease indentations or damage to the cast F. Keep it clean G. Elevate to decrease edema"},{"q":"What is skin traction? Give examples.","a":"The skin has not been penetrated. Buck’s traction and Russell’s traction are examples."},{"q":"What type of assessment is very important when a patient has skin traction? Explain why.","a":"Skin, because the skin is being pulled on."},{"q":"What is skeletal traction? Explain. Give examples.","a":"Prolonged traction using pins and wires. Steinmann pins or a Halo Vest."},{"q":"Explain how to do pin care.","a":"Use sterile technique; remove the crust."},{"q":"When a patient has a total hip replacement, there are some important things to remember about positioning. a. Explain why you want neutral rotation. b. Limit flexion. c. Want extension. d. Abduction","a":"A. Internal rotation or external rotation could dislocate the new hip B. Could dislocate the hip C. Extension minimizes hip dislocation D. Keeps the balls of the hip in the socket"},{"q":"Discuss the general nursing care for someone with the continuous passive motion machine.","a":"Assess the degree of flexion the machine is exerting; assess the patient’s pain level and tolerance of the machine."},{"q":"What are some good exercises for the total hip replacement patient?","a":"Isometrics such as gluteal and quadriceps squeezing; rocking in a rocking chair; walking and swimming."},{"q":"Why is elevation so important with an amputation (for the first 24 hours)?","a":"To decrease edema and bleeding"},{"q":"What can we do in the amputation patient to prevent hip and knee contractures?","a":"Extend the joint – prone position is a good position to extend the hip and knee."},{"q":"Describe the nursing care with someone with phantom pain?","a":"Diversional activity and pain medications are given."},{"q":"Why is weight loss so important with the osteoarthritis patient?","a":"To decrease stress on the weight-bearing joints, particularly the knees."},{"q":"When performing an assessment on the neuro patient, what is most important?","a":"LOC"},{"q":"What is the pulse pressure?","a":"Difference in systolic and diastolic blood pressure."},{"q":"Explain the post-procedure care for the cerebral angiography patient and explain why.","a":"Same care as for a heart catheterization patient – check peripheral circulation and keep the extremity still. We’re checking to see if a clot is forming, and we want to decrease movement of the extremity to reduce the chance of hemorrhage."},{"q":"What is a myelogram?","a":"An x-ray of the subarachnoid space."},{"q":"When a patient has a myelogram, are we getting into the cerebrospinal fluid?","a":"Yes"},{"q":"What is the pre-procedure care for a patient who is about to have a myelogram?","a":"The patient will be NPO and have a light sedative."},{"q":"What is an EEG?","a":"Electroencephalogram"},{"q":"What is the pre-procedure care for a patient who is going to have an EEG?","a":"Hold sedatives, no caffeine, do not make the patient NPO."},{"q":"If a patient were about to have an EEG, what would you tell them about the procedure?","a":"They will be asked to lie quietly first; then they may be asked to do such things as hyperventilate during the procedure."},{"q":"When a patient is having a lumbar puncture, do we get into cerebrospinal fluid?","a":"Yes"},{"q":"How do you position a patient for a lumbar puncture?","a":"Left side in the fetal position or propped up over the bedside table."},{"q":"Why do you put them in this position?","a":"We want to arch the back to increase the space between the discs and to thin out the meninges."},{"q":"What should cerebrospinal fluid look like?","a":"Clear and colorless"},{"q":"What is the post-procedure care of a lumbar puncture? Explain why.","a":"We want the patient to be on bed rest, lying flat so a seal can form at the puncture site. Patients should drink plenty of fluids. We should check the dressing to make sure it is not wet."},{"q":"What is an open head injury?","a":"That’s when the meninges have been broken and there is direct entry into the brain."},{"q":"What is a closed head injury?","a":"Meninges have not been broken."},{"q":"When a patient has a basal skull fracture, where is the fracture?","a":"Base of the skull"},{"q":"What is cerebrospinal rhinorrhea?","a":"Leakage of CSF from the nose."},{"q":"How do you tell CSF from other drainage?","a":"It will test positive for glucose and form a halo on a sheet or pillowcase."},{"q":"When a patient is on an osmotic diuretic, they better have two organs that are working perfectly. What are they?","a":"Heart and kidneys."},{"q":"When taking care of a head injured patient with increased intracranial pressure, why is it so important that you space your nursing interventions?","a":"Every time you do something to a head injured patient, ICP goes up."},{"q":"What should you restrict the fluids to? (How many cc’s per day?)","a":"1200 - 1500 cc per day"},{"q":"What is the pre-procedure care for a patient who is going to have an upper GI?","a":"The patient will be NPO past midnight. No smoking."},{"q":"You are taking care of a patient who is going to have an upper GI. Explain what is going to happen to the patient.","a":"The patient will have to swallow dye and x-rays will be taken."},{"q":"Your patient is going to have a barium enema. What is the pre-procedure care?","a":"Clear liquids, laxatives or enemas until clear; sometimes they have to drink a large volume of fluid to flush out the GI tract."},{"q":"How would you describe a barium enema to a patient?","a":"Just like an enema and x-rays will be taken."},{"q":"Why is it so important that the patient have a bowel movement after a barium enema?","a":"Because we don’t want the barium to stay in the body."},{"q":"What is the pre-procedure care of a gastroscopy? Explain to your patient what to expect if they are going to have a gastroscopy.","a":"NPO – pre, they will be sedated; a tube will be placed in the throat and through the esophagus into the stomach."},{"q":"When a patient has a gastroscopy, they have to be NPO until their gag reflex returns. Why?","a":"Because we do not want them to aspirate."},{"q":"How is a patient positioned during a liver biopsy?","a":"On their back with the right arm behind the head."},{"q":"How is a patient positioned post-liver biopsy? Explain why.","a":"On the right side to hold pressure."},{"q":"Why does the patient have to exhale and hold while the physician is puncturing into the liver?","a":"To get the diaphragm out of the way."},{"q":"What is a paracentesis?","a":"Removal of fluid from the peritoneal cavity."},{"q":"When a patient is having a paracentesis, what position do you put them in?","a":"Sit them up."},{"q":"Why is it important that the paracentesis patient void pre-procedure?","a":"Do not want to puncture the bladder."},{"q":"What is a peritoneal lavage and how does the pancreatitis patient benefit from this?","a":"In lavage, you instill fluid into the abdomen and then drain it back out to see if it comes back pink tinged. It helps identify internal bleeding."},{"q":"Why is rest so important with a cirrhosis patient?","a":"To rest the liver"},{"q":"Why do we measure the abdominal girth in the cirrhosis patient and what will it tell us?","a":"We are measuring the abdominal girth to see how much fluid the patient is accumulating in their abdomen. The more fluid the patient accumulates in the abdomen indicates that the vascular volume is going down."},{"q":"When a patient has liver disease, what should be done with protein in the diet?","a":"Decrease"},{"q":"Why does the liver patient need a low-sodium diet?","a":"To decrease ascites"},{"q":"Why is oxygen important with a patient who has bleeding esophageal varices?","a":"Because the patient is anemic and we want what few red blood cells they have to be hyper-oxygenated."},{"q":"Why does the patient with bleeding esophageal varices need a Sengstaken Blakemore tube?","a":"To hold pressure on the bleeding varices."},{"q":"What is the nursing care associated with a Sengstaken Blakemore tube?","a":"Keep scissors at the head of the bed; make sure the tube is not coming out. Mark the tube at the nares and observe maintenance of tube position. If respiratory distress occurs due to tube dislodgement, have scissors available to cut the tube and deflate the balloon."},{"q":"When a patient has ulcerative colitis or Crohn’s disease, do they need a high-fiber or a low-fiber diet? Why?","a":"Low fiber diet because a high fiber diet would increase motility."},{"q":"Why does the patient with ulcerative colitis or Crohn’s need to avoid cold foods and smoking?","a":"These will increase motility."},{"q":"When a patient has an ileostomy, what will the drainage be like?","a":"Continuous liquid drainage."},{"q":"Why should an ileostomy patient need to avoid rough foods or high-fiber foods?","a":"These will increase motility and therefore make the patient lose even more water."},{"q":"Why does the ileostomy patient need Gatorade?","a":"To replace fluid and electrolytes."},{"q":"When a patient has an ileostomy, what electrolyte are they losing a lot of?","a":"Potassium"},{"q":"Explain the nursing care for a colostomy.","a":"Bowel training and irrigation will be needed."},{"q":"When a patient has had any abdominal surgery, what is the position of choice and why?","a":"Elevate the head of the bed to decrease stress on the suture line."}]

Part 2

[{"q":"N\/I for DT?","a":"Private room near nurses \/ NPO → clear liquids \/ Strict bed rest \/ Restraints \/ Tranquilizer \/ Multivitamin (B1) \/ Antihypertensive"},{"q":"N\/I for AWS?","a":"Semi-private \/ Regular diet \/ Ad-lib activity \/ No restraints \/ Tranquilizer \/ Multivitamin (B1) \/ Antihypertensive"},{"q":"2-point restraint is?","a":"One arm + opposite leg."},{"q":"N\/I for restraints?","a":"Check every 15 minutes, rotate every 2 hours."},{"q":"Apical chest tube placed?","a":"High (air)."},{"q":"Basilar chest tube placed?","a":"Low (blood)."},{"q":"Post-surgery chest tube assumption?","a":"Unilateral pneumohemothorax."},{"q":"Pneumonectomy chest tube?","a":"No."},{"q":"Water seal breaks steps?","a":"Clamp → Cut → Submerge in NS → Unclamp."},{"q":"Best thing (not first) if seal breaks?","a":"Submerge in NS."},{"q":"Chest tube comes out steps?","a":"Hand cover → Vaseline gauze → Sterile dressing → Tape 3 sides."},{"q":"Clamp chest tube max time?","a":"15 seconds (no order)."},{"q":"Use what to clamp chest tube?","a":"Rubber-tipped double clamps."},{"q":"1 fingerwidth = ?","a":"1 cm."},{"q":"Proper crutch elbow flexion?","a":"30°."},{"q":"Crutches below armpit?","a":"2–3 fingerwidths."},{"q":"2-point gait?","a":"One crutch + opposite foot → other crutch + other foot."},{"q":"3-point gait?","a":"Both crutches + bad leg → good leg."},{"q":"4-point gait?","a":"One crutch → opposite foot → other crutch → other foot."},{"q":"Swing-through gait?","a":"For 2 braced legs: move crutches, then hop."},{"q":"Even-numbered gaits used when?","a":"Bilateral weakness."},{"q":"2-pt gait is for?","a":"Mild bilateral problem."},{"q":"4-pt gait is for?","a":"Severe bilateral problem."},{"q":"Odd-numbered gait used when?","a":"Unilateral problem."},{"q":"Stairs with crutches rule?","a":"UP with GOOD, DOWN with BAD."},{"q":"Crutches move with?","a":"Bad leg."},{"q":"Cane held on?","a":"Strong side."},{"q":"Cane advances with?","a":"Weak side (for wide base)."},{"q":"Walker use?","a":"Pick up → set down → walk to it."},{"q":"Calories\/day Type II?","a":"1200–1800."},{"q":"Feedings\/day Type II?","a":"6."},{"q":"Tx hypoglycemia conscious?","a":"Rapid carb or carb + protein\/starch."},{"q":"Tx hypoglycemia unconscious?","a":"Glucagon IM or Dextrose IV."},{"q":"Rapid carb examples?","a":"Juice, candy, icing, honey, syrup."},{"q":"HHNK Tx?","a":"Rehydrate (no insulin)."},{"q":"Hiatal hernia Tx?","a":"High Fowler’s \/ increase fluids \/ increase carbs."},{"q":"Dumping syndrome Tx?","a":"Side-lying \/ decrease fluids with meals \/ decrease carbs (increase protein)."},{"q":"Pre-op thoracic laminectomy assessment?","a":"1. Cough \/ 2. Bowel sounds."},{"q":"Pre-op lumbar laminectomy assessment?","a":"1. Voiding \/ 2. Leg motor-sensory."},{"q":"#1 post-op answer on NCLEX?","a":"Log roll patient."},{"q":"Post-op laminectomy activity restrictions?","a":"No dangling \/ May stand, walk, lie \/ Don’t sit >30 min."},{"q":"Which laminectomy incision site is more painful?","a":"Hip site."},{"q":"Default restriction timeframe if not given?","a":"6 weeks."},{"q":"Laminectomy discharge teaching (temporary)?","a":"No sitting >30 min \/ Lie flat & log roll \/ No driving \/ No lifting >5 lb (for 6 weeks)."},{"q":"Permanent restrictions after laminectomy?","a":"No lifting by bending at the waist \/ No jerky activities (rides, horses) \/ Cervical: no lifting above head."},{"q":"Treat morning sickness (1st trimester)?","a":"Dry carbohydrates."},{"q":"Treat urinary incontinence (1st & 3rd)?","a":"Void q2h."},{"q":"Treat dyspnea (2nd & 3rd)?","a":"Tripod position."},{"q":"Treat back pain (2nd & 3rd)?","a":"Pelvic tilt exercises."},{"q":"Most valid sign of labor?","a":"Regular contractions."},{"q":"Dilation is?","a":"Cervical opening (0–10 cm)."},{"q":"Effacement is?","a":"Cervical thinning (0–100%)."},{"q":"Station is?","a":"Fetal part relation to ischial spines (+ = below, good; – = above, bad)."},{"q":"Engagement is?","a":"Station 0."},{"q":"Lie is?","a":"Relation of baby’s spine to mother’s spine (parallel = good, transverse = bad)."},{"q":"Presentation is?","a":"Part of fetus entering birth canal first."},{"q":"1st stage of labor is?","a":"Labor."},{"q":"2nd stage of labor is?","a":"Delivery of baby."},{"q":"3rd stage of labor is?","a":"Delivery of placenta."},{"q":"4th stage of labor is?","a":"Recovery (first 2 hours after placenta)."},{"q":"How do you treat painful back labor?","a":"Knee to chest position \/ Use your fist and press on the patient's sacrum."},{"q":"How do you treat prolapsed cord?","a":"Push head back in \/ Position in knee-chest position or Trendelenburg."},{"q":"The second stage of labor and delivery is all about?","a":"Order."},{"q":"What do you do in order for the second stage?","a":"Deliver the head \/ Suction mouth then nose \/ Check for nuchal cord \/ Deliver shoulders and body \/ Apply ID band."},{"q":"During the third stage of labor and delivery you do what two things?","a":"Ensure the placenta is intact (if not → hemorrhage first, infection second) \/ Check for three vessels (2 arteries, 1 vein = AVA)."},{"q":"What are the 4 things you do 4 times an hour during the 4th stage?","a":"VS – check for shock \/ Fundus – if boggy, massage; if displaced, void\/cath \/ Perineal pad – excessive lochia = saturated pad in 15 min (911) \/ Roll patient to check for bleeding."},{"q":"The uterus should be like what after delivery?","a":"Firm (not boggy) \/ Fundal height = days postpartum \/ Midline (if not, catheterize)."},{"q":"Lochia color rubra?","a":"Red (rub it red)."},{"q":"Lochia color serosa?","a":"Pink (rose pink)."},{"q":"Lochia color alba?","a":"White (albino white)."},{"q":"Moderate lochia is?","a":"4–6 inches on pad in 1 hour."},{"q":"Excessive lochia is?","a":"Saturated pad in 15 minutes."},{"q":"Extremity assessment postpartum should include?","a":"Pulses \/ Edema \/ Signs of thrombophlebitis (bilateral calf circumference – unequal calves suggest DVT)."},{"q":"Postpartum assessment should include what?","a":"Uterus \/ Lochia \/ Extremities."},{"q":"Milia is?","a":"Distended sebaceous glands appearing as tiny white spots on the baby's face."},{"q":"Epstein's pearls are?","a":"Small white epithelial cysts on the baby's gums."},{"q":"Mongolian spots are?","a":"Bluish-black macules on the buttocks\/thighs of darker-skinned neonates."},{"q":"Erythema toxicum neonatorum is?","a":"Benign red papular rash on the torso, disappears after a few days."},{"q":"Hemangioma is?","a":"Benign tumor of capillaries."},{"q":"Vernix caseosa is?","a":"Whitish, cheese-like substance covering the unborn baby's skin."},{"q":"Acrocyanosis is?","a":"Normal cyanosis of the baby's hands\/feet in the first 7–10 days."},{"q":"For IM injection, needle must be?","a":"Gauge 21 (ends with 1), length 1 inch."},{"q":"For SubQ injection, needle must be?","a":"Gauge 25 (ends with 5), length 5\/8 inch."},{"q":"ACE of spades answer for Nutrition?","a":"Choose chicken or fish."},{"q":"Never choose what for children’s food?","a":"Casserole."},{"q":"For a toddler, pick what kind of food?","a":"Finger food."},{"q":"For a preschooler, ____ meals\/day is OK?","a":"1 meal\/day."},{"q":"First thing you do in Med-Surg?","a":"Airway."},{"q":"In Peds always give?","a":"More time."}]

Pharmacological And Parenteral Therapies Flashcards

Part 1

[{"q":"How can IV fluids with sodium induce hypervolemia?","a":"Because sodium makes you retain water."},{"q":"Alka-Seltzer contains a lot of what?","a":"Sodium"},{"q":"How can Alka-Seltzer throw you into hypervolemia?","a":"Alka-Seltzer has a lot of sodium, so if you are taking Alka-Seltzer, the sodium will make you retain fluid in the vascular space."},{"q":"Fleets enemas contain a lot of what?","a":"Sodium"},{"q":"How can a fleets enema throw you into hypervolemia?","a":"Increase in sodium intake, therefore you retain fluid in the vascular space."},{"q":"Diuretics are given to the hypervolemic patient. Explain why.","a":"Because the patient has too much volume and they need to diurese."},{"q":"Lasix is a common diuretic. What is the major electrolyte imbalance you have to watch for?","a":"Hypokalemia."},{"q":"What is the major electrolyte imbalance you have to watch for with thiazide diuretics?","a":"Hypokalemia."},{"q":"Aldactone is a potassium-sparing diuretic. What is the major electrolyte imbalance you have to watch for with this drug?","a":"Hyperkalemia."},{"q":"What class of IV solution would be good for someone who is hypovolemic? Explain why and give examples.","a":"Isotonic solutions are appropriate because they go into the compartment in which they are administered and stay there, thereby increasing the vascular volume. Examples include 0.9% Normal Saline or Lactated Ringer's (LR)."},{"q":"Why would you dialyze someone who has hypermagnesemia?","a":"To help the patient eliminate excess magnesium."},{"q":"Why do you give calcium gluconate to someone who has hypermagnesemia?","a":"Calcium gluconate is the antidote for any magnesium toxicity, regardless of how it occurs; the calcium will antagonize the magnesium, thereby decreasing the chance for arrhythmias."},{"q":"Why is it so important to discontinue the magnesium sulfate infusion if a patient begins to have flushing and sweating?","a":"Flushing and sweating can easily occur when one is receiving magnesium; however, these could be signs that the patient is becoming toxic. Magnesium causes vasodilation, which makes you feel flushed and warm, and also lowers blood pressure."},{"q":"How can D5W make someone’s serum sodium go down?","a":"Water dilutes blood."},{"q":"What are some IV fluids that have sodium?","a":"NS; LR"},{"q":"How can renal failure cause hyperkalemia?","a":"Not excreting K."},{"q":"How can Aldactone cause hyperkalemia?","a":"K-sparing diuretic; therefore, serum K goes up."},{"q":"When you have a hyperkalemic patient, why do we dialyze them?","a":"To remove excess K+."},{"q":"Why do we give the hyperkalemic patient calcium gluconate?","a":"Calcium gluconate protects the heart from life-threatening arrhythmias."},{"q":"Why do we give the hyperkalemic patient glucose and insulin?","a":"Insulin will drive the K out of the vascular space back into the cell, thereby lowering the serum K level. However, the blood sugar will drop too, so we have to give additional glucose to prevent hypoglycemia."},{"q":"What is the action of insulin on the blood sugar and what is the action of insulin on the serum potassium level?","a":"See 127."},{"q":"How does Kaexalate work?","a":"It exchanges Na for K in the GI tract; therefore, it lowers the K+ level. Na increases."},{"q":"Do you give Kaexalate for hyperkalemia or hypokalemia?","a":"Hyperkalemia"},{"q":"When you give Kaexalate, you can expect the serum potassium level to go down; therefore, what will happen to the serum sodium level? Explain.","a":"Goes up. Kaexalate exchanges Na for K; therefore, Na level goes up."},{"q":"How does Aldactone help hypokalemia?","a":"Aldactone makes you retain K."},{"q":"What are some of the major side effects of oral potassium supplements?","a":"GI upset."},{"q":"What is a drug that is given in respiratory acidosis to quickly correct the acidosis?","a":"IV Na Bicarb."},{"q":"What is the problem chemical?","a":"CO2"},{"q":"What is the bicarb level going to do in respiratory alkalosis?","a":"Decrease"},{"q":"How will sedation affect respiratory alkalosis?","a":"Decrease respiratory rate; retain CO2."},{"q":"How can resuscitation induce metabolic alkalosis?","a":"Patient gets a lot of Na+ bicarb in a code."},{"q":"What is the treatment for carbon monoxide poisoning? Explain why.","a":"100% O2. Because the patient is hypoxic. By giving 100% O2, we are increasing the probability that O2 will bind with the hemoglobin before carbon monoxide can."},{"q":"How will an IV with albumin help fight shock?","a":"It helps hold fluid in the vascular space."},{"q":"Explain the difference between the tetanus toxoid and the tetanus immune globulin.","a":"The immune globulin gives immediate protection because it is the injection of antibodies (passive immunity). Toxoid: the body has to make antibodies (active immunity)."},{"q":"Why do patients with burns have to take Mylanta and Tagamet?","a":"For stress ulcers."},{"q":"Why are multiple antibiotics used when treating burns?","a":"To prevent resistance of bacteria. We don’t want bacteria to build tolerance."},{"q":"What is a vesicant?","a":"A chemo drug. If a vesicant infiltrates, it will cause massive tissue necrosis."},{"q":"What do you do if a vesicant infiltrates?","a":"Stop the infusion, apply ice packs to promote vasoconstriction and decrease absorption of the drug."},{"q":"Give examples of the antithyroid drugs:","a":"Propacil, PTU, Tapazole."},{"q":"When someone has been given radioactive iodine, what do you expect to happen to their thyroid hormone levels?","a":"Decrease."},{"q":"When a patient has been placed on an antithyroid, what do you expect to happen to their thyroid hormone levels?","a":"Decrease."},{"q":"Why do we give iodine compounds preoperatively?","a":"They decrease vascularity and decrease the chance of hemorrhage."},{"q":"How do you treat hypothyroidism?","a":"Give thyroid hormones – Synthroid, Proloid, Cytomel."},{"q":"When a patient has started on drug therapy for hypothyroidism, is it temporary or permanent?","a":"Permanent."},{"q":"Explain how Amphojel works for the hypoparathyroid patient.","a":"Amphojel binds with phosphorus, which decreases phosphorus levels and increases calcium levels."},{"q":"What are the four major actions of glucocorticoids?","a":"Change mood, break down protein\/fat, alter defense mechanisms (suppress the immune system), and inhibit insulin."},{"q":"When you hear the word mineralocorticoid, what is the major word you need to think of?","a":"Aldosterone."},{"q":"What is another name for glucocorticoids, mineralocorticoids, or sex hormones?","a":"Steroids – adrenocorticotropic hormones (ACTH), cortisol."},{"q":"Why do steroids drive your blood sugar up?","a":"They inhibit insulin, causing blood sugar to rise."},{"q":"When a patient has Cushing’s syndrome, do they have too many steroids or not enough steroids?","a":"Too many"},{"q":"In the diabetic patient, what is absent that makes their blood sugar go up?","a":"Insulin."},{"q":"What is the normal action of insulin? (How does it work?)","a":"Carries glucose out of the vascular space to the cell. Decreases blood sugar."},{"q":"Explain how oral hypoglycemic agents work and give examples.","a":"They stimulate the pancreas to make insulin. Micronase – Diabeta, Glucotrol."},{"q":"Why will an oral hypoglycemic agent not work in a Type I diabetic?","a":"Because they don’t produce insulin; the pancreas is not working. Type I’s can’t produce insulin even with stimulation."},{"q":"When you start giving a patient insulin, what is going to happen to their blood sugar?","a":"Decrease"},{"q":"When you give somebody insulin, why should they not have ketones and glucose in their urine?","a":"Because insulin should lower blood sugar. Therefore, there shouldn’t be any excess glucose in the urine. Also, insulin should keep the body from breaking down body fat. (The body will be using glucose instead of fat for energy.)"},{"q":"If you are giving somebody insulin and they do have glucose and ketones in their urine, what needs to be done to the dose of the insulin?","a":"Increased"},{"q":"Why do we draw up regular insulin first?","a":"Draw the clear insulin up first to prevent contamination of the regular (clear) insulin with a medication or long-acting insulin (cloudy). Remember clear\/regular insulin is the only insulin that can be given IV."},{"q":"What is the only type of insulin that can be given IV?","a":"Regular"},{"q":"Explain the peaks of the three different classes of insulin.","a":"Rapid – 2-4 hours; Intermediate (NPH) – 7-12 hours; Long-acting (Protamine Zinc) – 18+ hours."},{"q":"When insulin is at its peak, that means the insulin is working really hard; therefore, what is going to happen to the blood sugar at the peak time?","a":"Decrease – risk for hypoglycemia."},{"q":"When patients have given themselves insulin, they need to know when insulin peaks because what is the major complication of the peak time?","a":"Hypoglycemia"},{"q":"When a diabetic patient is sick, their blood sugar is going to go up; therefore, what do they need to do with the dose of their insulin?","a":"Increase"},{"q":"Do we aspirate insulin? Why?","a":"No – tissue damage."},{"q":"Are D50W and injectable glucagon temporary or permanent increases in the blood sugar?","a":"Temporary"},{"q":"Why is it so important that a diabetic patient eat regularly and take their insulin regularly?","a":"To prevent hypoglycemia – keep blood sugar within normal limits."},{"q":"When you give somebody insulin, what do you expect it to do to their blood sugar? Why?","a":"Decreases – insulin drops the blood sugar."},{"q":"When you give somebody insulin, what do you expect it to do to their serum potassium level? Explain why.","a":"Decreases – because insulin makes potassium leave the serum and go into the cell."},{"q":"How does normal saline work?","a":"Since normal saline is isotonic, it will go into the vascular space and stay and build up."},{"q":"When you get the DKA patient into the emergency room, you are going to see the doctor order IV push insulin; therefore, what is going to start happening to the blood sugar rapidly?","a":"Decrease"},{"q":"When the blood sugar drops to about 300 (I know this is still too high), why do we switch the IV fluids to D5W in place of normal saline?","a":"To prevent throwing the patient into a hypoglycemic state."},{"q":"How could you throw a DKA patient into hypoglycemia?","a":"By decreasing blood sugar rapidly with insulin."},{"q":"Why is nitroglycerine given?","a":"To relieve the pain – it vasodilates which increases blood\/oxygen to the heart."},{"q":"When you give somebody nitroglycerine, more ____________ is going to get to the heart?","a":"Blood flow – oxygen"},{"q":"How do you teach a patient to take their nitroglycerine?","a":"1 every 5 minutes for up to 15 minutes (3 doses max)."},{"q":"Why should nitroglycerine burn?","a":"Some preparations of nitroglycerine burn and that is normal."},{"q":"Why do patients with angina need beta blockers? List several examples.","a":"They decrease the workload of the heart and decrease contractility; decrease blood pressure. Inderal – Lopressor"},{"q":"Why do angina patients need calcium channel blockers? List several examples.","a":"Decrease blood pressure; decrease workload of the heart. Verapamil, Calan, Procardia. These drugs also dilate coronary arteries, which enhances blood flow to the heart."},{"q":"Explain cardiac enzymes and include: a. Why do we have to draw the isoenzymes? b. Tell me the time frames for which these peak (CPK and LDH). c. Tell me about Troponin.","a":"a. To determine if heart muscle, skeletal muscle, or brain is affected. b. CPK – immediately increases 4-6 hours; peaks 18-24 hours. LDH – detects further back 48-72 hours; peaks. c. High specificity for myocardial cell injury; always normal in non-cardiac muscle diseases; elevates sooner and stays elevated longer."},{"q":"When a patient has had a MI, what is the drug of choice?","a":"Nitroglycerin"},{"q":"What drug is sometimes started IV on a MI patient to prevent things like PVCs or V-tach or V-fib?","a":"Lidocaine"},{"q":"When a patient is given lidocaine, why can they develop neuro changes?","a":"They develop lidocaine toxicity."},{"q":"When a patient goes into a third-degree block, what are the major drugs that are used?","a":"Atropine\/Epi – pacemaker"},{"q":"How do thrombolytics work? Give me three examples of common thrombolytics.","a":"They dissolve the clot that is blocking blood flow to the heart muscle. They decrease the size of the infarction. Streptokinase, TPA, Eminase"},{"q":"What do artificial pacemakers do?","a":"Depolarize heart muscle – shoot electricity through muscle."},{"q":"Explain the difference between a demand and a fixed-rate pacemaker.","a":"Demand – kicks in only when the patient needs it. Fixed – fires at a fixed rate constantly."},{"q":"You really need to get worried about a pacemaker malfunctioning when the rate of the pacemaker does what?","a":"If the rate decreases at all."},{"q":"Why does the pacemaker patient have to avoid microwaves and MRIs?","a":"They can alter or damage the pacemaker."},{"q":"Explain how digitalis works.","a":"Digitalis slows down the heart rate, which gives the ventricles more time to fill with blood. Then the heart can squeeze down with a stronger contraction on more blood; therefore, it increases cardiac output."},{"q":"When you start giving a patient Digoxin, should their cardiac output go up or down?","a":"Up."},{"q":"Why does a congestive heart failure patient need Lasix?","a":"To decrease the circulating volume"},{"q":"When a patient is in pulmonary edema, why do we give them Digoxin?","a":"Given to strengthen the contraction more and increase cardiac output."},{"q":"When a patient is in pulmonary edema, why do we give them Aminophylline?","a":"Aminophylline is a bronchodilator given to help the patient breathe better."},{"q":"What are some common side effects of Aminophylline?","a":"Nervousness and tachycardia"},{"q":"When a patient is in pulmonary edema, why do we give them morphine?","a":"To vasodilate; therefore decreasing preload and afterload; and to decrease anxiety."},{"q":"How much morphine do we give them?","a":"About 2 milligrams"},{"q":"How will angioplasty help an arterial problem?","a":"Angioplasty will restore oxygenated blood flow to an area. (opens up the artery)"},{"q":"What type of line will be put into the patient to monitor the right side of the heart?","a":"Swan-Ganz Catheter."},{"q":"How will Heparin help the patient who has developed a pulmonary embolus?","a":"It will decrease the formation of new clots and keep the clot that has already developed from getting any larger."},{"q":"With a fractured sternum or ribs, why do we give non-narcotic analgesics?","a":"We do not want to depress the respirations even more."},{"q":"One of the major drugs used for TB is INH (Isoniazid). What is the major side effect? And what vitamin can be given to prevent that major side effect?","a":"Peripheral neuritis – B6"},{"q":"When a patient has nephrotic syndrome, it is not uncommon for them to be placed on prednisone. Why?","a":"To decrease inflammation and reduce the size of the holes in the glomerulus so protein can no longer leak out."},{"q":"If a patient is allergic to Heparin, they cannot be hemodialyzed. Why?","a":"Because heparin is used during the procedure."},{"q":"Why can’t a patient who has an alternate circulatory access device have blood pressures or venipunctures in that extremity?","a":"Because these could cause a clot to occur in the circulatory access device."},{"q":"Explain in your own words what peritoneal dialysis is.","a":"Fluid is instilled into the abdomen. Fluid stays in for a period of time, then it is drained out of the abdomen along with all of the excess electrolytes and toxins that have accumulated in the patient’s body."},{"q":"Why can’t a patient with CHF or poor kidneys have whole blood?","a":"Because they cannot handle the volume of blood. They have to have packed red blood cells."},{"q":"Why do we have to agitate platelets when we are administering them?","a":"Because they will aggregate together."},{"q":"Why do we give Albumin or Dextran in shock? How do these work?","a":"These are forms of protein which will hold fluid in the vascular space."},{"q":"What should you do if your patient begins to have a transfusion reaction?","a":"Stop the blood; start some saline."},{"q":"How long do you have to get it infused?","a":"4 hours"},{"q":"Explain the major symptoms of a febrile or septic blood transfusion reaction (include treatment).","a":"Febrile reaction symptoms: sudden chills and fever, headache, flushing, anxiety, muscle pain. Cause: sensitivity to donor’s blood products. TX: Antipyretics. Septic reaction - contaminated blood has been used. Patient immediately has fever, chills, low blood pressure, and shock. TX: IV antibiotics and symptomatic treatment."},{"q":"Explain the major S\/S of an allergic reaction with a blood transfusion (include treatment).","a":"Allergic reaction: symptoms – flushing, itching, urticaria, hives. TX: Benadryl. Cause: Sensitivity to blood product."},{"q":"What are the major symptoms you need to watch for that would indicate a patient is having a hemolytic reaction during a blood transfusion?","a":"Back pain is number one. Chills, fever, flushing, increased pulse, increased RR, blood pressure decreases."},{"q":"Why do hemolytic reactions occur?","a":"Incompatible blood; stop the blood; start the saline; get a urine specimen; save the blood; call the doctor; call the blood bank; get vital signs and prepare to flush out the kidneys with Mannitol."},{"q":"Why do we give Mannitol when a patient is having a hemolytic reaction?","a":"To flush out the kidneys."},{"q":"What can be given with iron to increase the absorption?","a":"Vitamin C."},{"q":"What are some major side effects of iron (ferrous sulfate)?","a":"GI upset and constipation."},{"q":"What can iron do to the teeth?","a":"Stain."},{"q":"What does iron do to the stools?","a":"Makes stools very dark."},{"q":"Why do we give iron IM Z-track method?","a":"We want to trap the injection fluid deep into the muscle. We do not want it leaking out into the tissue – it can stain the skin."},{"q":"Why are IM injections of B-12 effective with pernicious anemia? Why does oral B-12 not work in this patient?","a":"Because they can absorb IM B-12 without intrinsic factor. Without intrinsic factor, you cannot absorb B-12; therefore, you would not develop normal red blood cells."},{"q":"Why does the leukemia patient need PRBCs?","a":"To replace red blood cells – to fight anemia."},{"q":"Why does the leukemia patient need platelets?","a":"To replace the platelets – help with clotting and control bleeding."},{"q":"Why is the rheumatoid arthritis patient placed on aspirin, prednisone, or NSAIDs?","a":"To decrease inflammation"},{"q":"Why is the rheumatoid arthritis patient placed on chemotherapy?","a":"To decrease the immune system since rheumatoid arthritis is an “immune” response"},{"q":"What is the general treatment for osteoarthritis? Explain why.","a":"Lose weight, non-steroidal medications, steroids, and rest."},{"q":"What are the three major drugs used for gout? Explain how they work.","a":"Colchicine to decrease pain and swelling; Zyloprim to decrease uric acid levels; and Probenecid to decrease uric acid levels."},{"q":"It is important that you ask this patient who is about to have cerebral angiography if they are allergic to something. What is it?","a":"Iodine"},{"q":"Why is it so important in the myelogram patient that we increase the fluids?","a":"To help the patient get rid of the dye (dye is excreted through the kidneys) and also to help replace any cerebrospinal fluid that could have been lost during the procedure."},{"q":"How is this complication treated?","a":"Bed rest, fluids, pain medications, and a blood patch may need to be done."},{"q":"Tensilon is used to help diagnose myasthenia gravis. Explain what will be done.","a":"Tensilon increases nerve impulses. The patient will be injected with Tensilon and if they have myasthenia, they will improve immediately."},{"q":"Why are Prostigmin and Mestinon used to treat myasthenia gravis?","a":"These drugs increase acetylcholine concentration at the myoneural junctions to facilitate transmission of impulses across the nerves, therefore increasing muscle tone."},{"q":"Why do we give steroids to the myasthenia patient?","a":"Myasthenia is thought to be an autoimmune problem; therefore, steroids are given to decrease the immune response."},{"q":"Why do we give the pancreatitis patient steroids?","a":"To decrease inflammation"},{"q":"Why do we give the pancreatitis patient Tagament and antacids?","a":"To decrease acid in the stomach"},{"q":"Why do you have to avoid narcotics in any liver patient?","a":"Because the liver cannot metabolize narcotics."},{"q":"What are the two major drugs used in hepatic coma? Explain why.","a":"Neomycin and Lactulose because they decrease ammonia."},{"q":"Explain how Vasopressin works.","a":"It decreases the blood pressure in the liver and hopefully the bleeding will subside."},{"q":"What is one of the complications of giving Vasopressin?","a":"Causes vasoconstriction in other parts of the body."},{"q":"What is another name for Vasopressin?","a":"Pitressin"},{"q":"What is one of the major antibiotics given for ulcerative colitis and Crohn’s disease? How does this drug help?","a":"Gantrisin, which is a sulfonamide (antibiotic) to decrease infection and inflammation."},{"q":"Why does the patient with ulcerative colitis or Crohn’s disease need steroids?","a":"To decrease inflammation."},{"q":"Why do we give the peptic ulcer patient antacids? What type of antacids would be the best—liquid or tablet?","a":"To decrease acid; liquid to coat the stomach."},{"q":"Why do we give the patient with peptic ulcer disease H-2 receptor antagonist? List some examples.","a":"To decrease acid; Tagamet, Pepcid, Zantac."},{"q":"Why do we give the peptic ulcer patient Carafate?","a":"To form a barrier over the wound so acid cannot get on the wound."}]

Part 2

[{"q":"If my pH is up my potassium (K+) is?","a":"Down"},{"q":"If my pH is down my potassium (K+) is?","a":"Up"},{"q":"Vitamin B1 helps breakdown?","a":"Alcohol."},{"q":"Antabuse onset & duration?","a":"2 weeks."},{"q":"5 uppers?","a":"Caffeine \/ Cocaine \/ Methamphetamines \/ PCP-LSD \/ ADHD meds"},{"q":"Downers are?","a":"Everything else."},{"q":"Aminoglycosides end in?","a":"“-mycin” (e.g. vancomycin)."},{"q":"If it has \"thro\" in it?","a":"Throw it out (not aminoglycoside)."},{"q":"Toxic effects of aminoglycosides?","a":"Ototoxicity \/ Nephrotoxicity \/ CN VIII damage (hearing, balance)."},{"q":"Monitor with aminoglycosides?","a":"Hearing, balance, tinnitus, creatinine."},{"q":"Frequency aminoglycosides?","a":"every 8 hours."},{"q":"Route aminoglycosides?","a":"IM or IV."},{"q":"Aminoglycosides PO for?","a":"Hepatic encephalopathy \/ Pre-op bowel surgery."},{"q":"Who can sterilize bowel?","a":"“Neo”, “Kan”."},{"q":"Trough level drawn?","a":"30 minutes before the next dose."},{"q":"Peak SL?","a":"5–10 minutes after dissolved."},{"q":"Peak IV?","a":"15–30 minutes after infusion."},{"q":"Peak IM?","a":"30–60 minutes after injection."},{"q":"Peak\/trough depend on?","a":"Route (not drug)."},{"q":"CCBs are like?","a":"Valium for the heart."},{"q":"CCB treat (6 A’s)?","a":"Antihypertensive \/ Anti-anginal \/ Anti-atrial arrhythmia \/ SVT"},{"q":"CCB side effects (2 H’s)?","a":"Headache, hypotension."},{"q":"90% of CCB end in?","a":"“-dipine” or “-zem”."},{"q":"Hold CCB if?","a":"SBP ≤100."},{"q":"Treat PVC?","a":"Lidocaine \/ Amiodarone."},{"q":"Treat V-Tach?","a":"Lidocaine \/ Amiodarone."},{"q":"Treat SV arrhythmias?","a":"Adenosine \/ Beta-blockers \/ CCB \/ Digoxin."},{"q":"Treat V-Fib?","a":"Defibrillate."},{"q":"Treat Asystole?","a":"Epinephrine + Atropine (reverse order)."},{"q":"Treat A-Fib first?","a":"Heparin (then ABCD medications)."},{"q":"Type I diabetes?","a":"Insulin dependent \/ Juvenile \/ Ketosis prone."},{"q":"Type II diabetes?","a":"Non-insulin \/ Adult \/ Non-ketosis prone."},{"q":"Treat Type I (DIE)?","a":"Diet (3rd) \/ Insulin (1st) \/ Exercise (2nd)."},{"q":"Treat Type II (DOA)?","a":"Diet (1st) \/ Oral meds (3rd) \/ Activity (2nd)."},{"q":"2 drugs ↑ blood sugar?","a":"Glucagon, Epinephrine."},{"q":"More exercise → need?","a":"Less insulin."},{"q":"Less exercise → need?","a":"More insulin."},{"q":"4 insulin types?","a":"Regular \/ NPH \/ Humalog \/ Lantus."},{"q":"Regular insulin onset?","a":"1 hour."},{"q":"Regular insulin peak?","a":"2 hours."},{"q":"Regular insulin duration?","a":"4 hours."},{"q":"NPH insulin onset?","a":"6 hours."},{"q":"NPH insulin peak?","a":"8–10 hours."},{"q":"NPH insulin duration?","a":"12 hours."},{"q":"Humalog onset?","a":"15 minutes."},{"q":"Humalog peak?","a":"30 minutes."},{"q":"Humalog duration?","a":"3 hours."},{"q":"Only safe insulin at bedtime?","a":"Lantus (Glargine)."},{"q":"Fastest insulin?","a":"Humalog."},{"q":"DKA Tx?","a":"IV fluids (fast) + Regular insulin."},{"q":"Lithium therapeutic?","a":"0.6–1.2."},{"q":"Lithium toxic?","a":">2.0."},{"q":"Digoxin therapeutic?","a":"1–2."},{"q":"Digoxin toxic?","a":">2.0."},{"q":"Aminophylline therapeutic?","a":"10–20."},{"q":"Aminophylline toxic?","a":">20."},{"q":"Dilantin therapeutic?","a":"10–20."},{"q":"Dilantin toxic?","a":">20."},{"q":"Dilantin is?","a":"Anticonvulsant."},{"q":"Aminophylline is?","a":"Airway antispasmodic."},{"q":"Digoxin is?","a":"CHF, atrial arrhythmia."},{"q":"Lithium is?","a":"Anti-mania."},{"q":"Never push what electrolyte?","a":"K+."},{"q":"To decrease K+ quickly?","a":"D5W + R insulin (buys time)."},{"q":"To remove K+?","a":"Kayexalate (slow)."},{"q":"Max K+ per IV liter?","a":"40 mEq."},{"q":"Graves Tx options?","a":"Radioiodine \/ PTU \/ surgery."},{"q":"Thyroidectomy types?","a":"Total \/ subtotal."},{"q":"Total Thyroidectomy needs?","a":"Lifelong hormone replacement."},{"q":"Thyroid storm Tx?","a":"O2, cooling (ice packs)."},{"q":"Tx hypothyroidism?","a":"Hormone replacement."},{"q":"Hypothyroid NPO pre-op → still give?","a":"Thyroid meds."},{"q":"Addison’s Tx?","a":"Steroids (“-sone”)."},{"q":"Cushing’s Tx?","a":"Adrenalectomy."},{"q":"INR monitors what?","a":"Coumadin\/Warfarin therapy."},{"q":"INR therapeutic level?","a":"2–3."},{"q":"If INR >4 you?","a":"Hold Warfarin, assess for bleeding, prepare Vitamin K, and call the doctor."},{"q":"If potassium &lt;3.5 you?","a":"Assess heart, prepare potassium, and call the doctor."},{"q":"If potassium 5.4–5.9 you?","a":"Hold potassium (IV), assess heart, prepare D5W with insulin, and call the doctor."},{"q":"If potassium >6 you?","a":"Assess; if symptomatic, call Rapid Response; if not, follow the same protocol as for 5.4–5.9."},{"q":"If pH &lt;6 you?","a":"Assess vitals and call the doctor ASAP."},{"q":"If Hgb &lt;8 you?","a":"Assess bleeding, prepare blood, and call the doctor."},{"q":"If CO2 in 50’s?","a":"Assess respirations, encourage pursed-lip breathing, prolong exhalation; if not working, call the doctor."},{"q":"If CO2 in 60’s (respiratory failure)?","a":"Assess, encourage pursed-lip breathing, prepare for intubation, and call RT and the doctor."},{"q":"If PO2 70–77?","a":"Assess and give O2."},{"q":"If PO2 &lt;60?","a":"Assess, give O2, prepare for intubation, and call RT and the doctor."},{"q":"If O2 sat &lt;93?","a":"Assess and give O2."},{"q":"If platelets &lt;90,000?","a":"Check for bleeding and implement bleeding precautions."},{"q":"If platelets &lt;40,000?","a":"Prepare for transfusion and call the doctor."},{"q":"Do not give what type of pain medication to a woman in labor if the medication is likely to peak when the baby is born?","a":"Systemic medications (IM, IV, Oral)."},{"q":"Tocolytics do what to labor?","a":"Stop contractions."},{"q":"What are the two tocolytics?","a":"Terbutaline (Brethine) \/ Nifedipine (Procardia)."},{"q":"What are the two oxytocics?","a":"Pitocin (Oxytocin) \/ Cervidil (Prostaglandin)."},{"q":"Side effects of Pitocin?","a":"Hyperstimulation (>90s, &lt;2min apart). If FHR &lt;110, stop it. If FHR is normal, slow it. Also used for postpartum hemorrhage."},{"q":"Side effects of Cervidil?","a":"Effacement leading to contractions."},{"q":"What are the two neonatal lung medications?","a":"Betamethasone \/ Survanta."},{"q":"How do you give Betamethasone?","a":"To the mother \/ Before delivery \/ IM."},{"q":"Side effect of Betamethasone?","a":"Increases maternal glucose (monitor blood sugar)."},{"q":"How do you give Survanta?","a":"To the baby \/ After delivery \/ Inhalation."},{"q":"Humulin 70\/30 is what?","a":"70% N insulin + 30% R insulin."},{"q":"When drawing up insulins it's?","a":"RN → Regular first, then N."},{"q":"If pressurizing vials for insulin draw-up you?","a":"Insert air in NR order, but draw up in RN order."},{"q":"What routes can you give Heparin?","a":"IV or SubQ."},{"q":"How quickly does Heparin work?","a":"Immediately."},{"q":"What do you monitor with Heparin?","a":"PTT."},{"q":"Antidote for Heparin?","a":"Protamine sulfate."},{"q":"Heparin is what pregnancy class?","a":"Class C."},{"q":"How is Coumadin given?","a":"Oral only."},{"q":"How long for Coumadin to work?","a":"3–5 days."},{"q":"What do you monitor with Coumadin?","a":"PT-INR."},{"q":"Antidote for Coumadin?","a":"Vitamin K."},{"q":"Coumadin is what pregnancy class?","a":"Class X."},{"q":"All K+ wasting diuretics end in?","a":"\"-x\" (if it ends in X, it wastes K+; others are K+ sparing)."},{"q":"What is Baclofen (Lioresal, Flexeril)?","a":"Muscle relaxant."},{"q":"Side effects of Baclofen\/Flexeril?","a":"Drowsiness and muscle weakness."},{"q":"If you know what a drug does, choose side effect in the ____ system?","a":"Same body system."},{"q":"If you don’t know the drug, and it’s PO, choose what side effect?","a":"GI side effect."}]

Physiological Adaptation Flashcards

Part 1

[{"q":"How can congestive heart failure throw you into hypervolemia (or fluid volume excess)?","a":"Decrease in cardiac output, decrease in kidney perfusion, decrease in urine output, too much fluid in the vascular space."},{"q":"How can renal failure throw you into fluid volume excess?","a":"If your kidneys are not working, then the fluid will be retained in the vascular space."},{"q":"What is the normal action of aldosterone?","a":"Aldosterone makes you retain sodium and water in the vascular space."},{"q":"How can aldosterone throw you into hypervolemia?","a":"If you have too much aldosterone, then you are retaining too much sodium and water."},{"q":"What is the name of the disease a patient can have that will induce hypervolemia due to too much aldosterone?","a":"Primary hyperaldosteronism or Cushing's syndrome."},{"q":"What is the normal action of ADH, and what does ADH stand for?","a":"Antidiuretic hormone. Makes you retain water in the vascular space."},{"q":"How can ADH throw you into hypervolemia?","a":"If you have too much ADH, you retain too much water in the vascular space (SIADH)."},{"q":"What will the effects be on the body if a patient is producing too much ADH and what is the name of this disease?","a":"If you have too much ADH, you will retain too much water; this condition is called SIADH."},{"q":"What will the effects be on the body if the patient does not have enough ADH and what is the name of this disease?","a":"Diabetes Insipidus—diuresis—shock (losing water)."},{"q":"What happens to your veins when you are hypervolemic?","a":"They distend (become full)."},{"q":"Why does the hypervolemic patient develop edema?","a":"The vascular space gets full and reaches a point where it can’t hold anymore, causing fluid to leak into the tissues."},{"q":"Why does the hypervolemic patient develop ascites?","a":"The vascular space gets so full it can’t hold any more, so the fluid leaks into the abdomen, resulting in decreased vascular volume."},{"q":"If a patient is hypervolemic, what will happen to the CVP?","a":"It increases (more volume = more pressure)."},{"q":"If a patient is hypovolemic, what will happen to the CVP?","a":"It decreases (less volume = less pressure)."},{"q":"If a patient has a high CVP, what does that tell us is probably going on in the vascular space?","a":"The vascular space is overloaded with fluid."},{"q":"If a patient is hypervolemic, what are the lung sounds like and why?","a":"Wet: Shortness of breath can occur due to fluid in the lungs."},{"q":"Why does the patient who is hypervolemic develop polyuria?","a":"The kidneys are trying to compensate by getting rid of the excess fluid."},{"q":"What happens to the blood pressure and pulse with hypervolemia and explain why?","a":"Blood pressure increases because there is so much volume; the pulse increases as the heart is trying to pump faster and harder to keep the blood moving forward; we would rather the blood go forward instead of backwards into the lungs."},{"q":"Which two organs are affected by FVE\/FVD? Are they weakened by aging?","a":"Heart and kidneys; yes."},{"q":"How can GI losses affect your vascular space?","a":"Excessive GI loss can reduce the volume in the vascular space; anytime you lose fluid from your body, no matter where it comes from, the vascular space can eventually be depleted."},{"q":"What is third spacing?","a":"Fluid leaves the vascular space and goes somewhere where it does you no good (tissue and abdomen)."},{"q":"How can ascites induce hypovolemia?","a":"Fluid leaves the vascular space and goes out into the abdomen; therefore, the vascular volume goes down."},{"q":"How can burns induce hypovolemia?","a":"Fluid leaves the vascular space and goes to the tissue (edema occurs) or out of the body completely."},{"q":"The diabetic patient will develop polyuria. Why?","a":"Because they are trying to get rid of the particles (excess glucose particles) in the vascular space. The glucose has to go out in volume (with fluid). You have never just excreted a sugar particle!"},{"q":"How does this polyuria affect the vascular space?","a":"It decreases volume in the vascular space."},{"q":"The person with polyuria will eventually develop what life-threatening complication?","a":"Shock."},{"q":"What changes will you see in the urine output that will indicate the body is compensating?","a":"After someone has had polyuria for a long time, the vascular volume will eventually deplete, and now the patient is in shock. The kidneys are not being perfused well at this point, so they make less urine. Also, the kidneys could start trying to conserve what little fluid is left in the body, therefore decreasing urine output as well. With either of these conditions, the urine output will switch to oliguria and could possibly go all the way to anuria. If either of these occur, I would have to start worrying about renal failure."},{"q":"If you are hypovolemic, what happens to your blood pressure and pulse? Tell why.","a":"Blood pressure decreases due to less volume, resulting in less pressure. The pulse increases, but it is weak and thready because your heart is trying to pump what little fluid you have around the body to perfuse vital organs."},{"q":"What happens to your CVP? Explain why.","a":"It decreases; less volume equals less pressure."},{"q":"What happens to your veins? Explain why.","a":"They become smaller because there is not much volume to distend them."},{"q":"Why do the extremities of a patient who is hypovolemic become cool?","a":"Peripheral vasoconstriction helps shunt blood to vital organs; when you vasoconstrict peripherally, the skin gets cool."},{"q":"And what is going to happen to the urine specific gravity if a patient is hypovolemic?","a":"It increases; the kidneys will not be producing much urine, so what little urine is excreted will be very concentrated."},{"q":"Renal failure can cause hypermagnesemia. Explain why.","a":"Because magnesium is excreted by the kidneys, and if your kidneys are not functioning, you will retain magnesium in your blood."},{"q":"Magnesium acts like a _____________________.","a":"Sedative."},{"q":"If a patient has hypermagnesemia, what will happen to their DTRs, respirations, and level of consciousness?","a":"They will decrease."},{"q":"Could they have a life-threatening arrhythmia?","a":"Yes, because magnesium affects all muscles in the body (sedative effect)."},{"q":"What is going to happen to their muscle tone?","a":"Muscles will be weak and flaccid."},{"q":"Why does the patient who has hypermagnesemia develop flushing and warmth?","a":"Because vasodilation occurs when you have high magnesium levels."},{"q":"What kind of effect will this have on the blood pressure?","a":"The vasodilation will cause the blood pressure to decrease. Vasodilation always lowers blood pressure."},{"q":"Why would you put somebody (on a ventilator) who has hypermagnesemia?","a":"They could go into respiratory distress because respiratory muscles could become depressed due to the sedative effect."},{"q":"Why do we have to be very careful with renal patients in relation to hypermagnesemia?","a":"Because they cannot excrete excess magnesium."},{"q":"In what part of the GI tract do you have a lot of magnesium?","a":"In the intestines, specifically the lower GI tract."},{"q":"If you have a patient with hypomagnesemia, what will their muscles be like?","a":"Tight, hyper-excitable, and rigid."},{"q":"Could they have a seizure?","a":"Yes."},{"q":"Why does the patient have a positive Chvostek's and Trousseau's sign if they have hypomagnesemia, and what will happen to the DTRs?","a":"Because the muscles are tight and hyperexcitable, the DTRs will increase."},{"q":"How does calcium act?","a":"Like a sedative."},{"q":"Calcium has an inverse relationship with what other electrolyte?","a":"Phosphorus."},{"q":"How does this affect the bloodstream?","a":"Hyperphosphatemia leads to hypocalcemia, while hypophosphatemia leads to hypercalcemia."},{"q":"How does vitamin D help calcium?","a":"It helps utilize calcium."},{"q":"What is the normal action of parathormone?","a":"It increases serum calcium levels by pulling calcium from the bone and putting it into the blood."},{"q":"Hyperparathyroidism can induce hypercalcemia. Explain how.","a":"With hyperparathyroidism, you have too much parathyroid hormone (PTH). PTH causes calcium to be pulled from the bone and released into the blood, resulting in elevated serum calcium levels."},{"q":"If a patient has too much calcium in their blood, what kind of muscle tone will they have?","a":"Weak."},{"q":"What will their DTRs be like?","a":"Decreased."},{"q":"Could they have a kidney stone? Why?","a":"Yes, because excess calcium in the blood promotes stone formation."},{"q":"What do steroids do to your serum calcium level?","a":"Steroids lower the serum calcium level by causing you to excrete calcium through the GI tract."},{"q":"How does hypoparathyroidism affect your serum calcium level?","a":"If you are hypoparathyroid, you do not have enough PTH. Without sufficient PTH, serum calcium cannot increase and may only decrease."},{"q":"How could a radical neck dissection\/thyroidectomy affect the serum calcium level?","a":"With these two surgeries, the doctor could accidentally remove one or more of your parathyroid glands. If so, you would not have as much PTH as you used to, leading to decreased serum calcium levels."},{"q":"List five symptoms of hypocalcemia and explain why the patient has these symptoms. a. b. c. d. e.","a":"A. Muscle tone – rigid and tight due to decreased sedative effect. B. Laryngospasm – airway smooth muscle lacks sedative. C. Positive Chvostek's sign – muscles are tight due to lack of sedative. D. Positive Trousseau's sign – muscles are tight due to lack of sedative. E. Arrhythmias – no sedative leads to tight muscles."},{"q":"Why does the patient who is hypernatremic have dry sticky mucous membranes and why are they thirsty?","a":"They have too much Na; not enough water."},{"q":"There is one organ in the body that really does not like it when sodium is out of balance. What is it?","a":"Brain"},{"q":"What organs must be working properly to help maintain your normal potassium level in your blood?","a":"Kidneys"},{"q":"What are the major symptoms of hyperkalemia?","a":"Muscle weakness, arrhythmias."},{"q":"When a patient with a potassium imbalance has an arrhythmia, they are very dangerous. Why? What types of arrhythmias will the patient have?","a":"Life-threatening; V-tach, V-fib, asystole."},{"q":"What are the S\/S of hypokalemia?","a":"Muscle cramps, muscle weakness, arrhythmias."},{"q":"In respiratory acidosis or alkalosis, what are the problem organs?","a":"Lungs."},{"q":"In respiratory acidosis or alkalosis, who is going to compensate?","a":"Kidneys."},{"q":"In metabolic acidosis or alkalosis, what are the problem organs?","a":"Kidneys."},{"q":"In metabolic acidosis or alkalosis, who is going to compensate?","a":"Lungs."},{"q":"When you think of the lungs, what chemical needs to pop into your mind?","a":"CO2"},{"q":"When you think of the kidneys, what chemicals need to pop into your mind?","a":"Bicarb and hydrogen"},{"q":"Can CO2 be a chemical that makes you sick and be a chemical that makes you compensate?","a":"Yes"},{"q":"Can bicarb and hydrogen be chemicals that make you sick and be chemicals that make you compensate?","a":"Yes"},{"q":"What is the only way you can have a buildup of CO2 in your blood?","a":"Not exhaling properly."},{"q":"What is the only way to lower CO2 in the blood?","a":"Exhale"},{"q":"In respiratory acidosis, which organs are not working right? Who is going to compensate? How does the compensation work?","a":"Lungs. Kidneys. The bicarb level will start to go up in the arterial blood and make the pH less acidic."},{"q":"In respiratory acidosis, what has happened to the CO2 level in your blood? How did it get that way? Give examples.","a":"It has gone up. Slow or shallow breathing makes the CO2 level increase in the blood. Ex: too much narcotic, post-op, pain."},{"q":"In respiratory acidosis, how is the patient breathing? And how does this affect the CO2 level in the blood?","a":"Slowly; makes the CO2 level increase in the blood."},{"q":"In respiratory acidosis, how many days does it take for the bicarb level to change?","a":"Three days"},{"q":"What is going to happen to the bicarb level in respiratory acidosis?","a":"Increases"},{"q":"When someone gets very acidotic, what happens to their level of consciousness?","a":"Decreases: Anytime the pH is out of balance (whether it is too high or too low) the brain is unhappy."},{"q":"When you have a patient in respiratory acidosis, what is the primary thing that has to be fixed? Explain some ways this can be fixed.","a":"The breathing has to be fixed. How we fix it depends on the cause. If they have a pneumothorax...chest tubes. If they have thick pulmonary secretions...push fluids to liquefy secretions. If they have shallow respirations...turn, cough, deep breathe, incentive spirometry. Whatever it takes to fix the problem. Every patient is different."},{"q":"What are the early signs of hypoxia?","a":"Restlessness and tachycardia; not enough O2 to the brain; the heart senses that the body needs more O2, so the pulse increases to pump out more O2 to the body."},{"q":"What are late signs of hypoxia?","a":"Cyanosis (hemoglobin not being saturated); bradycardia; the heart is tired."},{"q":"Explain why the patient gets all of these symptoms.","a":"See 168 and 169."},{"q":"In respiratory alkalosis, what are the problem organs?","a":"Lungs"},{"q":"How does this chemical affect the body in regard to acidosis or alkalosis?","a":"If you have too much CO2 in the body, you will be acidotic. If you do not have enough CO2 in the body, you will be alkalotic."},{"q":"When someone is in respiratory alkalosis, what organs are going to compensate? With what chemicals are they going to compensate? Explain the compensation.","a":"Kidneys – They are going to excrete bicarb and retain hydrogen."},{"q":"When someone is in respiratory alkalosis, how do they have to be breathing?","a":"Hyperventilating. (This is what caused their problem to start with.)"},{"q":"How does their breathing throw them into alkalosis?","a":"They are exhaling out too much CO2."},{"q":"What has happened to the pH in respiratory alkalosis?","a":"Increased"},{"q":"Which organs are responsible for affecting this bicarb level?","a":"Kidneys"},{"q":"How can an overdose of aspirin induce respiratory alkalosis?","a":"Aspirin stimulates the respiratory center; therefore, making you breathe rapidly. (Blow off CO2)"},{"q":"If you have a patient who is on the ventilator and the respiratory rate is set too high, will the patient go into respiratory acidosis or respiratory alkalosis? Explain why.","a":"Respiratory alkalosis, because they are breathing off too much CO2."},{"q":"In metabolic acidosis, which organs have messed up? Therefore, what chemicals are altered?","a":"Kidneys. Bicarb and hydrogen."},{"q":"What has happened to the pH and why?","a":"Decreased. Retaining too much hydrogen and excreting too much base (bicarb)."},{"q":"Which organs are going to try to compensate? With what chemical will they compensate?","a":"Lungs; CO2."},{"q":"If you have a patient who is in acidosis, do you want that patient to retain CO2, to compensate, or do you want this patient to lose more CO2?","a":"Lose."},{"q":"CO2 is a what?","a":"Acid"},{"q":"If you have a patient in metabolic acidosis, what is going to happen to their respiratory rate and why?","a":"Increase – to blow off CO2."},{"q":"Would this be an expected reaction or would this be an adverse reaction?","a":"Expected"},{"q":"How can a DKA patient go into metabolic acidosis?","a":"In DKA, the cells are not getting enough glucose because there is not enough insulin to carry the sugar into the cell. The cells are starving, so they start breaking down fat and protein for energy. When you break down fat, you get ketones. Ketones are acids. So the patient gets acidotic."},{"q":"How can an anorexic or bulimic patient go into metabolic acidosis?","a":"When you are starving, you start breaking down fat. Fat breakdown produces ketones, and ketones are acids."},{"q":"What are ketones and how do they affect the blood?","a":"Acids – make your blood acidic."},{"q":"How can diarrhea induce metabolic acidosis?","a":"Lower GI is base; when you are losing your base in the form of diarrhea, you are left with acid."},{"q":"In any type of acidosis, what is going to happen to the serum potassium level? Therefore, what is the major electrolyte imbalance they will have and what is the major side effect they will have?","a":"Increase – hyperkalemia – muscle weakness and life-threatening arrhythmias."},{"q":"In metabolic alkalosis, which organs are messed up or altered? Therefore, what chemicals are going to be altered?","a":"Kidneys – bicarb and hydrogen."},{"q":"In metabolic alkalosis, which organs are going to compensate? What chemical are they going to compensate with?","a":"Lungs – CO2."},{"q":"In metabolic alkalosis, you know the kidneys are impaired; therefore, the lungs will compensate with CO2. Do you want this patient to retain more CO2 or lose more CO2? How will their breathing be affected by this compensation and why?","a":"Retain – their respiratory rate will decrease to retain CO2."},{"q":"How can vomiting or a NG tube suction induce metabolic alkalosis?","a":"When you lose stomach acid, you are left alkaline inside."},{"q":"Why do we have to worry about hypokalemia in the alkalotic patient?","a":"The potassium level always goes down in alkalosis."},{"q":"If someone has been burned, fluid seeps out into the tissue, why?","a":"Increased capillary permeability. (Vessels are leaking.)"},{"q":"When the fluid seeps out into the tissue, what happened to the blood pressure and the pulse? Explain why.","a":"Pulse increases to compensate for decreased volume. Blood pressure decreased because there is no volume. (Less volume = less pressure)"},{"q":"Why does the cardiac output decrease when the fluid seeps out into the tissue?","a":"Volume is decreased in the vascular space; therefore, there is less volume to pump out."},{"q":"During this phase (when the fluid is seeping out into the tissue), is this patient in a fluid volume deficit or fluid volume excess?","a":"Deficit."},{"q":"When a patient is in a fluid volume deficit, why does their urine output decrease?","a":"Either because of decreased perfusion or the kidneys are trying to hold on to what volume they have left."},{"q":"After a major burn, when fluid is seeping out into the tissue, why is it important that ADH and aldosterone are secreted?","a":"These help retain Na+ and H2O and increase vascular volume."},{"q":"What is a paralytic ileus?","a":"The GI tract shuts down."},{"q":"Why can a patient with an electrical burn have kidney failure?","a":"Toxins build up and damage the kidneys. Electricity destroys any circulation; kidneys are very vascular."},{"q":"What is a major nursing diagnosis for a patient who is receiving external radiation therapy?","a":"Alteration in skin integrity."},{"q":"List basic side effects of chemotherapy.","a":"Alopecia, decrease in appetite; nausea\/vomiting, pancytopenia, impaired taste, decreased WBC."},{"q":"What is the danger of a vesicant infiltrating?","a":"Tissue necrosis."},{"q":"What is one of the major complications post-hysterectomy and why?","a":"Hemorrhage; pelvic congestion of blood."},{"q":"When a patient has had a mastectomy, not only is the breast removed but another system is removed. What is it?","a":"The lymphatic system."},{"q":"Explain the pathophysiology behind an enlarged prostate (benign prostatic hypertrophy).","a":"The enlarged prostate is squeezing the urethra, therefore cutting off urine flow."},{"q":"What are the symptoms? Why do they get these symptoms?","a":"Hesitancy, nocturia, frequency, retention, bladder infection – because the urine pathway is blocked; the prostate restricts the urethra."},{"q":"What is another name for hypothyroidism?","a":"Myxedema."},{"q":"When someone is hypothyroid, what has happened to their thyroid hormone levels?","a":"They are decreased."},{"q":"What are the signs and symptoms of hypothyroidism?","a":"Fatigue, gastrointestinal slowing, increased weight, slow speech, cold intolerance."},{"q":"What is cretinism?","a":"Hypothyroidism present at birth (retardation can occur)."},{"q":"When somebody is hyperparathyroid, what is the major electrolyte imbalance they have?","a":"Hypercalcemia."},{"q":"Why do you have to worry about the bones of a patient with hyperparathyroidism?","a":"Because calcium is being pulled from the bones and put into the blood, leading to osteoporosis."},{"q":"Why does the hyperparathyroid patient have kidney stones?","a":"There is too much calcium in the blood."},{"q":"What is the major electrolyte imbalance a hypoparathyroid patient will have?","a":"Hypocalcemia."},{"q":"When a patient has pheochromocytoma, what is the major problem they have?","a":"There is a problem with the adrenal medulla – benign tumors that secrete norepinephrine, which increases blood pressure and heart rate."},{"q":"How does aldosterone work?","a":"It makes you retain sodium and water."},{"q":"If a patient is making too much aldosterone, what is going to happen to the vascular space? Explain why.","a":"Blood volume increases due to retaining sodium and water."},{"q":"Explain briefly the basic pathophysiology of Addison’s disease.","a":"The body doesn’t have enough steroid (aldosterone) – sodium and water are lost, and potassium is retained (think shock and hyperkalemia)."},{"q":"When you think of Addison’s disease, what is the chemical I told you to focus on?","a":"Aldosterone."},{"q":"What is the major electrolyte imbalance a patient with Addison’s disease will have?","a":"Hyperkalemia."},{"q":"What are the signs and symptoms of hyperkalemia?","a":"Muscle weakness, decreased bowel sounds, anorexia, gastrointestinal upset, and arrhythmias."},{"q":"Why does the Addison’s disease patient have trouble with shock?","a":"Losing volume; not enough aldosterone."},{"q":"What happens to the Addison’s disease patient’s blood pressure?","a":"Decreases"},{"q":"When a patient has Cushing’s syndrome, explain briefly, in your own words, what they will look like?","a":"Moon face, buffalo hump, women with male traits, fluid volume excess, skinny arms\/legs, large abdomen."},{"q":"Why does the Cushing’s syndrome patient experience the following? a. Growth arrest b. Thin extremities and skin c. Increased risk for infection d. Hyperglycemia e. Psychosis to depression (changes in mood)","a":"Too many glucocorticoids will result in all these situations."},{"q":"Why does the Cushing’s syndrome patient develop high blood pressure?","a":"Fluid volume excess."},{"q":"Why does the Cushing’s syndrome patient develop congestive heart failure?","a":"Because they are in a fluid volume excess."},{"q":"Why does the Cushing’s syndrome patient have ketones in their urine and glucose in their urine?","a":"Sugar – because insulin is inhibited and blood sugar increases and excess spills into urine. Fats are being broken down and this produces ketones."},{"q":"Why does the Cushing’s syndrome patient not have protein in their urine? Is it normal to have protein in the urine?","a":"It’s not normal – only have protein if there is glomerular damage. The Cushing’s patient does not have glomerular damage."},{"q":"In the diabetic patient, why does the glucose build up in their blood?","a":"Because there is no insulin."},{"q":"In the diabetic patient, why does their body start breaking down protein and fat?","a":"The cells are starving for energy, so we try to get energy from other sources."},{"q":"Anytime you break down fat, you are going to get production of what?","a":"Ketones"},{"q":"Ketones are what?","a":"Acids"},{"q":"What is the major acid-base imbalance the diabetic patient can develop and explain why.","a":"Metabolic acidosis. Because fat is being broken down for energy and this produces ketones which are acids; therefore, more acids in the blood."},{"q":"Why does the diabetic develop the following symptoms? a. Polyuria b. Weight loss c. Polydipsia d. Polyphagia","a":"a. Kidneys are trying to excrete glucose. b. Losing a lot of fluid. c. They have excessive thirst from losing volume. d. They are hungry because brain cells are starving."},{"q":"Why does a Type II diabetic have problems with wounds that will not heal or repeated vaginal infections?","a":"Blood sugar is high and bacteria can grow rampantly."},{"q":"Why are diabetics prone to coronary artery disease?","a":"There is a lot of glucose in the blood and it deposits just like fat (arteriosclerosis occurs)."},{"q":"What is going to happen to anybody’s blood sugar when they are sick or stressed?","a":"Increase"},{"q":"If a diabetic patient gets sick and they do not increase the dose of their insulin, what are they going to go into (major complication)?","a":"DKA"},{"q":"Why is hypoglycemia considered to be more dangerous than hyperglycemia?","a":"Because brain cells need glucose to survive."},{"q":"If you walk into a diabetic patient’s room and they are unconscious, do you treat the patient like they are hypoglycemic or hyperglycemic?","a":"Hypoglycemic"},{"q":"Why does the diabetic patient sometimes develop Kussmaul’s respirations?","a":"They are trying to blow off CO2 to compensate for the acidosis."},{"q":"Explain the basic pathophysiology behind diabetic ketoacidosis.","a":"Not enough insulin – blood sugar increases – polyuria, polydipsia, polyphagia – fat breakdown (acidosis) – Kussmaul’s respirations."},{"q":"When you get a diabetic ketoacidosis patient into the hospital, they may have polyuria, anuria, or oliguria. Please explain, in the proper sequence, why the patient starts with polyuria, then converts to oliguria and anuria.","a":"Polyuria – trying to get rid of sugar in the body. Polyuria causes vascular volume to decrease. Kidneys aren’t being perfused as well, so oliguria occurs and possibly anuria could occur."},{"q":"What could the patient’s blood sugar be with DKA?","a":"Increased >"},{"q":"Diabetic patients have problems with their vascular system. Why? Give examples.","a":"They have poor circulation everywhere due to increased sugar deposition. Sugar deposits like fat (retinopathy, kidney problems, nerve damage, amputations)."},{"q":"What is cardiac output?","a":"The amount of blood being pumped out of the left ventricle with each beat."},{"q":"If your cardiac output is decreased, do you perfuse as well as you normally do?","a":"No"},{"q":"If you are taking care of a patient with decreased cardiac output, what is going to happen to their level of consciousness?","a":"Decrease"},{"q":"Could they start complaining of chest pain?","a":"Yes"},{"q":"Why does a patient’s (whose cardiac output is low) skin feel cool and clammy?","a":"Because there is no perfusion. (Peripheral vasoconstriction in an effort to shunt blood to vital organs.)"},{"q":"When you are taking care of a patient who has decreased cardiac output, why do they get short of breath and have wet lung sounds?","a":"The heart is not pumping the fluid out to the body, so it backs up to the lungs."},{"q":"When you are taking care of a patient who has decreased cardiac output, why do their peripheral pulses diminish?","a":"Because the heart is not pumping out to the periphery."},{"q":"When you have a patient with decreased cardiac output, why does their blood pressure drop?","a":"Because the heart is not pumping out as much volume. Less volume = less pressure."},{"q":"How will bradycardia affect cardiac output?","a":"Decrease, because the heart is not pumping out much volume; the heart is pumping slowly."},{"q":"How can tachycardia (i.e., heart rate > 150) affect cardiac output?","a":"Decrease – ventricles can’t fill up; don’t have time to fill because the heart is beating so fast."},{"q":"When someone has had an MI, how can this affect cardiac output and why?","a":"Cardiac output decreases – dead muscle doesn’t pump well."},{"q":"If my blood pressure is really high, how will this affect cardiac output and why?","a":"Decrease – heart can’t pump as much blood out against the high pressure."},{"q":"What is preload?","a":"The amount of blood returning to the right side of the heart."},{"q":"If you increase preload, what do you do to the workload of the heart?","a":"Increase"},{"q":"List some ways preload can be increased.","a":"Trendelenburg position; hypervolemia; supine; elevate legs."},{"q":"List some ways preload can be decreased.","a":"Standing upright; hypovolemia; less volume; lower legs, raise head of bed."},{"q":"Explain afterload in your own words.","a":"Amount of pressure in the aorta that the ventricle has to pump against."},{"q":"If you increase afterload, what do you do to cardiac output?","a":"Decrease"},{"q":"If cardiac output is decreasing, that means the blood is not moving forward. If blood is not moving forward, then it has got to go backwards, so therefore where is it going to wind up?","a":"Lungs"},{"q":"What is angina?","a":"Decreased blood flow to the myocardium causing ischemia."},{"q":"Explain the pain a patient has with angina.","a":"Blood flow decreases (decreased oxygen) and causes chest pain (pressure sensation)."},{"q":"With a MI (myocardial infarction), why does the patient have necrosis?","a":"Because of decreased blood flow and oxygen to the myocardium."},{"q":"Explain how MI pain feels.","a":"Severe, non-stop pain; chest pressure; radiation to the left arm and jaw."},{"q":"Why does an MI patient get cold, clammy, and their blood pressure drop?","a":"Decreased CO (dead tissue doesn’t pump well)."}]

Part 2

[{"q":"Why does the MI patient’s white count go up?","a":"Inflammatory response."},{"q":"Why does their temperature go up?","a":"Inflammatory response."},{"q":"If a MI patient performs the Valsalva, which nerve can be stimulated?","a":"Vagus"},{"q":"If you stimulate the vagus nerve long enough, what is going to happen to the heart rate?","a":"Decrease"},{"q":"What happens to the size of the complex when the vagus nerve is stimulated?","a":"Widens; could lead to asystole."},{"q":"What is your natural pacemaker?","a":"SA Node"},{"q":"Can the electrical part of your heart be working and the mechanical not?","a":"Yes, but not for long."},{"q":"What are the major symptoms of left-sided failure and explain why?","a":"Dyspnea, cough, pulmonary congestion, blood-tinged sputum; restlessness, tachycardia; blood backs up into the lungs."},{"q":"Why does a patient in left-sided failure have restlessness and tachycardia?","a":"Because they are hypoxic."},{"q":"Why does a patient with left-sided failure have nocturnal dyspnea?","a":"When they lie down, more blood can go back up to the heart and lungs."},{"q":"Why does the patient with left-sided failure basically have pulmonary symptoms?","a":"Blood is backing up in the lungs."},{"q":"What are the major symptoms of right-sided failure?","a":"Enlarged organs, edema, weight gain, distended neck veins, ascites; blood backs up into the venous system, engorging everything."},{"q":"When a patient is in right-sided failure, is the blood backing up into the arterial system or the venous system?","a":"Venous"},{"q":"What does a Swan Ganz catheter measure inside the heart?","a":"Pressures"},{"q":"If volume is building up in the right side of the heart, what measurements (in regard to the Swan Ganz catheter) are going to be affected and why?","a":"Any pressure reading on the right side of the heart. More volume = more pressure."},{"q":"What is the wedge pressure?","a":"Indirect reading of left side of heart (left-sided pressures)."},{"q":"Why does the patient in heart failure develop cardiomegaly?","a":"Because the heart muscle is pumping so hard, it hypertrophies."},{"q":"When you slow down someone’s heart rate, you give the ventricles more time to do what?","a":"Fill with blood."},{"q":"When your heart squeezes down with more force and strength and on more blood, what is going to happen to cardiac output? What is going to happen to kidney perfusion?","a":"Cardiac output increases. Kidney perfusion is going to also increase."},{"q":"Anytime you increase kidney perfusion, what is probably going to happen to urine output?","a":"Urine output will increase."},{"q":"When you increase a patient’s cardiac output, what is actually happening inside the heart?","a":"More blood is being ejected from the left ventricle to the systemic circulation."},{"q":"When you increase a patient’s cardiac output, should they appear better oxygenated or less oxygenated?","a":"Better oxygenated"},{"q":"When you start giving somebody Dig, we expect their cardiac output to increase; therefore, what should happen to their: a. level of consciousness? b. lung sounds? c. urine output? d. skin? e. peripheral pulses? f. blood pressure?","a":"A. increase B. lungs should be dry C. urine output will increase D. skin should feel warmer E. should improve F. should go up"},{"q":"What is pulmonary edema?","a":"The sudden onset of fluid accumulation in the lungs leading to severe hypoxia."},{"q":"How does a patient develop pulmonary edema?","a":"The left ventricle is failing, so the blood is not being pumped forward into the systemic circulation; therefore, the blood backs up into the lungs."},{"q":"What are the major S\/S of pulmonary edema?","a":"Sudden onset, breathlessness, hypoxia, pink frothy sputum, tachycardia."},{"q":"When does pulmonary edema usually occur and why?","a":"At night – because when lying down preload increases, so we are dumping more blood into the right side of the heart and into the lungs."},{"q":"What is intermittent claudication?","a":"The pain that develops as a result of inadequate oxygenation in an extremity associated with arterial problems."},{"q":"Explain how intermittent claudication develops.","a":"When oxygenated blood cannot get to an area, the patient is going to switch in that extremity from aerobic metabolism to anaerobic metabolism. The product of anaerobic metabolism is a buildup of lactic acid. The lactic acid is what promotes the pain."},{"q":"When a patient has an arterial problem, that means the oxygen\/blood are having a hard time getting to the tissue, so therefore different S\/S develop. Explain the S\/S.","a":"Coldness, numbness, decreased pulses, atrophy of the extremity occur because oxygenated blood is not getting to the extremity. You may even see ischemia and gangrene."},{"q":"Could a patient with an arterial problem develop ischemia and necrosis in the affected extremity? Explain.","a":"Yes - Because oxygenated blood is not getting there."},{"q":"Whether you are studying Buerger’s disease or Raynaud’s disease, what is the key word that I told you to remember?","a":"Vasoconstriction"},{"q":"In Buerger’s disease and Raynaud’s disease, there is significant vasoconstriction. What types of things bring on the vasoconstriction in Buerger’s and Raynaud’s disease?","a":"Emotional upset, smoking, coldness"},{"q":"When a patient has a venous disorder, are they having trouble with oxygenation of the affected extremity?","a":"No"},{"q":"Explain or list some different venous problems a patient can have.","a":"Phlebitis, thrombophlebitis, deep vein thrombosis"},{"q":"Explain the pathophysiology behind a venous disorder.","a":"The blood can get to the area. The problem is once it gets there, it cannot get away. So you get stagnation of blood flow in one area."},{"q":"What is the pleural space?","a":"It is the potential space between the visceral and parietal pleura."},{"q":"When the pleural space fills with fluid, what happens to the lung?","a":"Collapse."},{"q":"When a patient has a pulmonary embolus, why does their pulse go up?","a":"Hypoxia."},{"q":"When a patient has a pulmonary embolus, describe their chest pain.","a":"Sharp, stabbing."},{"q":"When a patient has a pulmonary embolus, the blood pressure is going to go up in their lungs. What effect will that have on the right side of the heart?","a":"It will increase the workload on the right side of the heart."},{"q":"With a pulmonary embolus, the patient will have fever and their WBC count will go up. Why?","a":"Inflammation."},{"q":"Why does the PO2 go down with a pulmonary embolus?","a":"Hypoxia."},{"q":"With a mediastinal shift, what will happen to the trachea?","a":"Tracheal deviation."},{"q":"Why does the patient with flail chest develop paradoxical chest wall movement?","a":"Because of the broken ribs."},{"q":"What is the definition of cardiac tamponade?","a":"When fluid is accumulating in the pericardial sac."},{"q":"With cardiac tamponade, the blood pressure goes down and the CVP goes up. Explain why.","a":"Blood pressure goes down because you are hemorrhaging. CVP goes up because as the sac fills around the heart, this puts pressure on the heart, squeezing the heart. Therefore, the pressure inside the heart goes up, making the CVP go up."},{"q":"Why do the heart sounds sound muffled with cardiac tamponade?","a":"Because of all the blood around the heart."},{"q":"With cardiac tamponade, why does a patient go into shock?","a":"Because they are hemorrhaging."},{"q":"What are the major side effects of Rifampin?","a":"Fever; body fluids turn red or orange."},{"q":"When a patient is on streptomycin, what are two possible side effects?","a":"Ototoxicity and nephrotoxicity."},{"q":"What is the major cause of glomerulonephritis?","a":"Streptococcus."},{"q":"When a patient has glomerulonephritis, why do they develop malaise and headache?","a":"Build-up of toxins."},{"q":"When a patient has glomerulonephritis, why does their urine output go down?","a":"Because the kidneys are failing."},{"q":"When a patient has glomerulonephritis, why does their BUN and creatinine go up?","a":"They are unable to excrete the urea and creatinine through the kidneys."},{"q":"When a patient has glomerulonephritis, why do they get protein in the urine?","a":"Because the glomerulus has holes in it, so protein can leak out."},{"q":"In glomerulonephritis, why does the blood pressure go up?","a":"Retaining fluid."},{"q":"And what will happen to the urine specific gravity?","a":"Increases."},{"q":"In glomerulonephritis, why are the patient’s red blood cells affected?","a":"Erythropoietin can be altered."},{"q":"With any type of kidney disease, it is not uncommon for the BUN to be elevated; therefore, why do we limit the protein in the diet?","a":"Because protein increases your urea level in your blood."},{"q":"If you gave a patient with any type of renal disease protein in their diet, what will happen to the BUN?","a":"Increase."},{"q":"When a patient is in the acute stages of glomerulonephritis, do you think their serum potassium level will be increased or decreased? What about the magnesium? What about the phosphorus level?","a":"Potassium and magnesium will be increased in the blood, as will the phosphorus because the patient is unable to excrete the electrolytes as they should."},{"q":"When a patient has nephrotic syndrome, what is the major element that is leaking out into their urine?","a":"Protein."},{"q":"If a patient does not have protein or albumin in their vascular space (blood), what is going to happen to all the fluid that is supposed to stay in their vascular system?","a":"It goes out into the interstitial space tissue."},{"q":"How does this affect the vascular space?","a":"Decreases the volume in the vascular space."},{"q":"When a patient has nephrotic syndrome, they develop total body edema. What is the proper term for total body edema?","a":"Anasarca."},{"q":"How can bradycardia cause renal failure?","a":"Decreased perfusion."},{"q":"How can hypovolemia cause renal failure?","a":"Decreased perfusion."},{"q":"How can shock cause renal failure?","a":"Decreased perfusion."},{"q":"How can decreased cardiac output cause renal failure?","a":"Decreased perfusion."},{"q":"How can glomerulonephritis, nephrotic syndrome, or diabetes cause renal failure?","a":"Vascular damage."},{"q":"How can a kidney stone cause renal failure?","a":"Urine can be trapped in the kidney."},{"q":"How can ureteral swelling cause renal failure?","a":"Urine can be trapped in the kidney."},{"q":"How can a tumor or an enlarged prostate cause renal failure?","a":"Urine can be trapped in the kidney."},{"q":"When a patient is in renal failure, why does their BUN and creatinine go up?","a":"Because the patient is unable to excrete urea and creatinine."},{"q":"What happens to the specific gravity in renal failure?","a":"It usually goes up, but it can also become fixed. When it becomes fixed, this means that the patient’s urine specific gravity does not respond to high volumes of fluids or restriction of fluids; it stays the same."},{"q":"Why can a renal failure patient become anemic?","a":"Because erythropoietin can be altered."},{"q":"Why does the renal failure patient’s blood pressure go up?","a":"Because they are retaining fluid."},{"q":"Why is the renal failure patient at risk for congestive heart failure?","a":"Because they are retaining fluid."},{"q":"Why does the renal failure patient develop anorexia, nausea, and vomiting?","a":"Because of the build-up of toxins."},{"q":"Why does the renal failure patient develop an itching frost?","a":"Urea builds up in the blood and eventually accumulates on the skin."},{"q":"Why does a renal failure patient have to worry about osteoporosis?","a":"Because the renal failure patient retains phosphorus; therefore, that makes them excrete their calcium, which lowers the serum calcium, and then the patient starts pulling calcium from the bone."},{"q":"There are two phases of renal failure. The first phase is an oliguric phase. If a patient is oliguric, what has happened to the urine output?","a":"Urine output has decreased."},{"q":"Why does the oliguric patient develop hyperkalemia?","a":"Unable to excrete potassium"},{"q":"The second phase of renal failure is called the diuretic phase. When a patient is diuresing, what has happened to their urine output?","a":"Increasing"},{"q":"If a patient goes into a fluid volume deficit, what will happen to their blood pressure?","a":"Decrease"},{"q":"What will happen to their heart rate? Explain why.","a":"Increase – trying to compensate for the decrease in volume."},{"q":"When a patient is diuresing, their serum potassium level goes down (hypokalemia). Explain why.","a":"Because potassium is being excreted through the kidneys."},{"q":"When a patient has CAPD, why do they have a constant sweet taste and why do they have anorexia?","a":"The dialysate that is used is of high glucose content."},{"q":"What are the major signs of kidney stones?","a":"Hematuria and pain"},{"q":"Why is the serum creatinine not affected by what we eat?","a":"Because creatinine is constantly produced in our bodies due to skeletal muscle breakdown."},{"q":"Is the BUN affected by what we eat?","a":"Yes"},{"q":"In sickle cell, what is happening to the red blood cells and why?","a":"The shape of the red blood cell is changing due to hypoxia."},{"q":"Are patients who have sickle cell hypoxic?","a":"Yes"},{"q":"Why do sickled cells become tangled so easily?","a":"Due to the shape, they start hanging together."},{"q":"Why is a sickle cell patient always anemic?","a":"Because their red blood cells sickle. So their red blood count decreases."},{"q":"Why does a sickle cell patient develop jaundice?","a":"Jaundice develops when the overabundance of sickle cells are fragile and rapidly destroyed in circulation, releasing the bilirubin."},{"q":"Why does a sickle cell patient develop heart problems?","a":"Since the patient is hypoxic, they stay tachycardic most of the time; therefore, this stresses the heart."},{"q":"Why does the sickle cell patient have to be on folic acid?","a":"To help them make red blood cells."},{"q":"What is anemia?","a":"A decrease in red blood cells."},{"q":"When you do not have enough red blood cells, the patient will be hypoxic. Why?","a":"There aren’t enough RBCs to carry the oxygen."},{"q":"How can hemorrhage cause anemia?","a":"Losing red blood cells."},{"q":"How can poor nutrition cause anemia?","a":"Not forming red blood cells."},{"q":"How can decreased erythropoietin cause anemia?","a":"Without erythropoietin, immature red blood cells cannot mature."},{"q":"When a patient is anemic, why does their heart beat fast (tachycardia)?","a":"Because they are hypoxic."},{"q":"When a patient has anemia, why do they have shortness of breath?","a":"Because they are hypoxic."},{"q":"When a patient is anemic, why do they have a pale conjunctiva?","a":"They do not have enough red blood cells."},{"q":"Why do anemic patients develop heart problems?","a":"The heart is always stressed due to chronic hypoxia."},{"q":"Why do anemic patients feel weak and tired?","a":"Hypoxia."},{"q":"Patients with iron-deficient anemia develop poor red blood cells (anemia) due to the fact that they do not have enough iron in their diet. What are some foods that are high in iron?","a":"Organ meat, egg yolk, seafood, enriched bread, whole wheat cereals, legumes, green leafy vegetables, dried fruit, sunflower seeds, molasses, almonds, pecans, cashews, apricots, broccoli, prunes, brussels sprouts, raisins, brewer’s yeast, wild rice, Swiss cheese, yogurt, wheat germ, and bananas."},{"q":"When a patient has had pernicious anemia, what vitamin are they deficit in?","a":"Vitamin B-12."},{"q":"After what surgery can a patient develop pernicious anemia? Explain why.","a":"Gastrectomy - Because they have lost their intrinsic factor. Without intrinsic factor, you cannot absorb oral B-12; therefore, you would not develop normal red blood cells."},{"q":"What are the two odd signs you get with pernicious anemia?","a":"Red swollen tongue and neurological changes."},{"q":"What is the major diagnostic test for pernicious anemia?","a":"Schilling's Test."},{"q":"Will the Schilling’s test tell you about any other type of anemia besides pernicious anemia?","a":"No."},{"q":"What is the first thing you need to think of when you think of leukemia?","a":"Large amounts of immature white blood cells."},{"q":"Why does the leukemic patient develop anemia?","a":"Because there are so many immature white cells, there’s no room for red blood cells."},{"q":"Why does the leukemic patient develop thrombocytopenia?","a":"There is no room for platelets."},{"q":"Why does the leukemia patient develop weakness and fatigue?","a":"Hypoxia."},{"q":"Why does the leukemia patient have S\/S such as bleeding, bruises, or petechiae?","a":"Decreased platelets."},{"q":"Hemophilia is an inherited disease. Does it affect males or females?","a":"Males."},{"q":"Hemophiliacs are sometimes called “free bleeders.” Explain the major symptoms a hemophiliac will have.","a":"Large spreading bruises. They may bleed into the joints or into the muscles of the GI tract."},{"q":"When a patient is having bleeding into the joints, what is the proper term for this?","a":"Hemarthrosis."},{"q":"What are some of the purposes of traction?","a":"To realign bones; to decrease muscle spasms and to immobilize."},{"q":"What is phantom pain?","a":"Pain that is experienced in the amputated extremity. The pain is real to the patient."},{"q":"Rheumatoid arthritis is an altered immune response. What are some S\/S of rheumatoid arthritis?","a":"Swollen joints, fatigued patients, increased white count, reddened fingers due to inflammation, morning stiffness (stiffness lasting longer than 30 minutes), and a low-grade temperature."},{"q":"With rheumatoid arthritis, what happens to the pain with stress?","a":"Increases"},{"q":"Is rheumatoid arthritis seen more in males or females?","a":"Females"},{"q":"List the S\/S separately and explain why the patient develops each symptom.","a":"All signs and symptoms are due to inflammation. Morning stiffness, motion pain, tenderness in at least one joint, swelling of at least one joint, symmetrical joint swelling"},{"q":"Why is it so important that the rheumatoid arthritis patient’s joints stay in proper position?","a":"Because the joints tend to contract with inflammation."},{"q":"What is the difference in rheumatoid arthritis and osteoarthritis?","a":"Rheumatoid arthritis is an immune response whereas osteoarthritis is a degenerative disorder."},{"q":"What is gout?","a":"When uric acid crystals accumulate in an area of little blood flow"},{"q":"What are the S\/S of gout?","a":"Pain, redness, inflammation"},{"q":"When a patient is having a cerebral angiography, it is not uncommon for them to complain of warmth in the face. Explain why.","a":"The dye causes a flushed feeling."},{"q":"What are some general symptoms of meningitis?","a":"Fever, chills, headache, vomiting, stiff neck (nuchal rigidity), photophobia, Kernig’s sign, Brudzinski’s sign because the meninges have been punctured into, so an infection could have been introduced."},{"q":"Explain S\/S of a basal skull fracture.","a":"Bleeding in the eyes, ears, nose, and throat."},{"q":"What is Battle’s sign?","a":"Bruising on the mastoid; indicates a basal skull fracture."},{"q":"What are raccoon eyes?","a":"Bruises around the eyes."},{"q":"Explain the S\/S of a concussion.","a":"May become unconscious for a couple of seconds or may just get dizzy for a couple of seconds or see spots."},{"q":"What happens to intracranial pressure (ICP) when the patient sits up and lies down?","a":"When the patient sits up, ICP goes down; when they lie down, ICP goes up."},{"q":"What is posturing?","a":"A sign of severe neurological damage. Be sure to look at a picture in your med-surg book."},{"q":"Explain the two different types of posturing.","a":"A. Decerebrate – when the spine is arched and you have plantar flexion (worst type). B. Decorticate – when arms are flexed inwardly to the core of the body. The legs are extended with plantar flexion."},{"q":"Why are osmotic diuretics used in the treatment of intracranial pressure? Explain exactly how they work.","a":"To pull fluid off the brain. Osmotic diuretics pull fluid off of the brain into the vascular system and the excess fluid is excreted through the kidneys."},{"q":"Why are patients with increased intracranial pressure given steroids?","a":"To decrease cerebral edema"},{"q":"How can hyperventilation decrease intracranial pressure?","a":"Hyperventilation causes cerebral vasoconstriction and decreases cerebral blood flow to decrease ICP."},{"q":"What would happen to the intracranial pressure if the temperature were to exceed?","a":"ICP would go up"},{"q":"What is the purpose of a barbiturate induced coma?","a":"To decrease cerebral metabolism, therefore decreasing ICP."},{"q":"Why is it so important to restrict the fluids in a head injured patient?","a":"Too many fluids will increase ICP."},{"q":"If a patient were to become bradycardic, what would happen to the cerebral perfusion? Explain why.","a":"Decrease because not as much blood would be pumped out by the left ventricle; therefore, not as much blood would make it to the brain."},{"q":"If a patient were to develop an increased blood pressure, what will happen to cardiac output? Explain how this would affect cerebral perfusion?","a":"The higher the blood pressure is, cardiac output goes down; therefore, cerebral perfusion would decrease."},{"q":"What is myasthenia gravis?","a":"Defect in impulse transmission."},{"q":"When a patient has impulse problems, what is going to happen to their muscle tone?","a":"Muscle tone decreases."},{"q":"Explain the S\/S of myasthenia and explain why the patient develops these symptoms.","a":"Extreme muscle weakness that increases with effort and eases with rest; there is symmetrical involvement, diplopia, ptosis, sleepy mask-like expression, dysphonia, chewing, and swallowing problems, and the diaphragm and respiratory muscles can be affected. All of these symptoms are due to a decrease in muscle tone."},{"q":"Why do we have to worry about the airway with myasthenia gravis?","a":"Because the respiratory muscles could become affected."},{"q":"Why do we have to worry about aspiration with the myasthenia gravis patient?","a":"Because the patient may not be able to swallow as well as they did before."},{"q":"If a patient with myasthenia gets too tired or takes an over-the-counter medicine, what could happen?","a":"These things could promote a crisis."},{"q":"What is the difference in the myasthenic crisis and a cholinergic crisis? How do you differentiate them?","a":"In the myasthenic crisis, the patient has not had enough medicine. In a cholinergic crisis, the patient has had too much medicine. To differentiate, you inject with Tensilon again. If the patient improves after the Tensilon injection, it is a myasthenic crisis. If the patient gets worse, it is a cholinergic crisis."},{"q":"When a patient is in a crisis with myasthenia, why would you prepare them for the ventilator?","a":"Because of the progressive decreased tone in the respiratory muscles."},{"q":"What would be a major sign of perforation post-gastroscopy?","a":"Pain"},{"q":"What are the two major functions of the pancreas?","a":"Endocrine - insulin; Exocrine – digestive enzymes"},{"q":"What is the major cause of pancreatitis?","a":"Gallbladder disease and alcoholism."},{"q":"How can gallbladder disease cause pancreatitis?","a":"A gallstone can block the pancreatic duct, trapping the enzymes inside the pancreas."},{"q":"List all of the symptoms of pancreatitis. (explain WHY these occur) a. Abdominal distention and ascites b. Abdominal mass c. Rigid board-like abdomen d. Bruising e. Fever f. Nausea\/vomiting g. Jaundice h. Hypotension i. Serum lipase and amylase (up or down?) j. WBC’s (up or down?) k. Blood sugar (up or down?) l. SGOT, SGPT (up or down?) m. PT, PTT (shorter or prolonged?) n. Serum bilirubin (up or down?) o. H\/H (up or down?)","a":"A. Losing fluid into the abdomen. B. A large pancreas. C. Possible hemorrhage D. Possible hemorrhage E. Inflammation F. Inflammation G. Liver involvement H. Bleeding or ascites I. Increases J. Increases K. Increases L. Increases M. Prolonged N. Increases O. Increases if dehydrated; decreases if bleeding"},{"q":"Is it possible that a pancreatitis patient might have to have insulin? Explain why.","a":"Yes – because the pancreas is altered."},{"q":"What is cirrhosis?","a":"Liver cells are destroyed and are replaced with connective and scar tissue; therefore the blood pressure in the liver goes up and the patient has portal hypertension."},{"q":"When a patient has cirrhosis, what happens to the blood pressure in their liver and what is the proper term for this?","a":"Increased – portal hypertension"},{"q":"Explain the S\/S of cirrhosis and also explain why the patient develops each symptom.","a":"Firm, nodular liver – due to connective and scar tissue. Abdominal pain – liver capsule has been stretched. Chronic dyspepsia – GI tract is altered. Change in bowel habits – GI tract is altered. Ascites – liver is not producing albumin as it should; therefore we lose fluid out of the vascular space into the abdomen. Increased SGOT & SGPT – liver enzymes are increased because the liver is altered."},{"q":"Why does the cirrhosis patient sometimes develop hepatic encephalopathy and coma?","a":"A build-up of ammonia"},{"q":"Where is the first place a cirrhosis patient might develop jaundice?","a":"Sclera"},{"q":"What chemical builds up in the blood that makes a patient go into a hepatic coma?","a":"Ammonia"},{"q":"How did that chemical develop?","a":"Because the liver is unable to convert ammonia to urea."},{"q":"What are symptoms of a hepatic coma? Explain why the patient develops these symptoms?","a":"Minor mental changes; decreasing LOC, asterixis, decreased reflexes; slowing EEG and fetor. All of these symptoms are due to a build-up of ammonia in the blood."},{"q":"If a patient is in hepatic failure and eats protein, what is going to happen to the ammonia level in their blood? Explain why.","a":"Increase because the liver cannot convert ammonia to urea."},{"q":"What are bleeding esophageal varices?","a":"Protruding vessels in the esophagus waiting to rupture."},{"q":"Why does a patient develop bleeding esophageal varices?","a":"The back pressure in the liver forces the vessels in the esophagus to protrude."},{"q":"What is the difference in ulcerative colitis and Crohn’s disease?","a":"Ulcerative colitis is a large intestine disease. Crohn’s disease is a small intestine disease."},{"q":"What are the symptoms of ulcerative colitis and Crohn’s disease?","a":"Diarrhea, rectal bleeding, weight loss, vomiting, cramping, dehydration, blood in stool, anemia, rebound tenderness, and fever."},{"q":"What is another name for Crohn’s disease?","a":"Regional Enteritis"},{"q":"What is the surgical treatment for ulcerative colitis?","a":"They may do a total colectomy or a Koch’s pouch, or they could just remove the part that is damaged and re-hookup everything normally."},{"q":"What is the surgical treatment for Crohn’s disease?","a":"May remove the entire small intestine or only the affected area."},{"q":"Why does a patient develop appendicitis?","a":"Because the appendix fills with bowel contents and becomes inflamed and can rupture."},{"q":"Explain symptoms of peptic ulcers.","a":"Burning pain in the mid-epigastric area. The pain may radiate to the back."},{"q":"What is the difference in a peptic ulcer and a duodenal ulcer?","a":"The location."},{"q":"What is dumping syndrome?","a":"When the stomach empties too rapidly after a gastrectomy or gastric bypass."}]

Part 3

[{"q":"What is increased intracranial pressure (ICP)?","a":"A rise in pressure within the skull that reduces cerebral perfusion and compresses brain tissue."},{"q":"What are early signs of increased ICP?","a":"Headache, restlessness, confusion, and changes in level of consciousness."},{"q":"What are late signs of increased ICP?","a":"Fixed and dilated pupils, bradycardia, widened pulse pressure, and abnormal posturing."},{"q":"What is Cushing’s triad?","a":"Hypertension with widened pulse pressure, bradycardia, and irregular respirations—indicating increased ICP."},{"q":"Why should a client with increased ICP be placed in semi-Fowler’s position?","a":"To promote venous drainage from the brain without compromising perfusion."},{"q":"Why should neck flexion and tight tracheostomy ties be avoided in ICP?","a":"They impede venous return and further increase intracranial pressure."},{"q":"Why should sneezing, coughing, and the Valsalva maneuver be avoided in ICP?","a":"These actions increase thoracic pressure and raise ICP."},{"q":"Why should the environment be kept quiet for a client with increased ICP?","a":"Stimulation can increase cerebral metabolism and worsen swelling."},{"q":"Why is mannitol used for increased ICP?","a":"It is an osmotic diuretic that draws fluid from brain tissue into the bloodstream."},{"q":"Why are corticosteroids sometimes prescribed for brain tumors?","a":"To reduce cerebral edema and inflammation."},{"q":"Why is hyperventilation sometimes used temporarily in ICP management?","a":"It lowers CO₂ levels, causing cerebral vasoconstriction and decreased ICP."},{"q":"What are common causes of head injury?","a":"Motor vehicle accidents, falls, sports injuries, and assaults."},{"q":"What is the major concern after any head injury?","a":"Increased intracranial pressure and secondary brain injury."},{"q":"Why should cerebrospinal fluid leakage from nose or ears be reported immediately?","a":"It indicates a basilar skull fracture and risk for meningitis."},{"q":"How can cerebrospinal fluid be identified?","a":"It tests positive for glucose or forms a “halo” ring on absorbent material."},{"q":"Why should the head of the bed be elevated after a head injury?","a":"To reduce cerebral edema and promote venous drainage."},{"q":"Why should narcotics be used cautiously after a head injury?","a":"They may mask neurological changes."},{"q":"Why are ICP monitoring devices used?","a":"To measure and guide treatment for elevated intracranial pressure."},{"q":"What are signs of brain herniation?","a":"Dilated, non-reactive pupils, loss of brainstem reflexes, coma, and respiratory arrest."},{"q":"What does a positive Babinski reflex indicate in an adult?","a":"Severe neurological damage or brain injury."},{"q":"What is meningitis?","a":"Inflammation of the meninges surrounding the brain and spinal cord."},{"q":"What are classic signs of meningitis?","a":"Fever, headache, nuchal rigidity, photophobia, and vomiting."},{"q":"What diagnostic test confirms meningitis?","a":"Lumbar puncture showing elevated protein and low glucose in cerebrospinal fluid."},{"q":"Why should a client with suspected increased ICP never undergo lumbar puncture?","a":"It can cause brain herniation."},{"q":"What isolation precautions are used for bacterial meningitis?","a":"Droplet precautions until antibiotics have been given for at least 24 hours."},{"q":"What are signs of meningeal irritation?","a":"Positive Brudzinski’s and Kernig’s signs."},{"q":"Why is broad-spectrum antibiotic therapy started immediately in meningitis?","a":"To reduce morbidity and mortality before culture results return."},{"q":"What is the priority nursing action when a client has a seizure?","a":"Protect the airway, turn the client on the side, and note the time and duration of the seizure."},{"q":"What should never be done during a seizure?","a":"Do not restrain the client or place anything in the mouth."},{"q":"What is status epilepticus?","a":"Continuous or recurrent seizures without recovery between episodes, lasting more than 5 minutes."},{"q":"What is the immediate treatment for status epilepticus?","a":"Administer benzodiazepines such as lorazepam or diazepam."},{"q":"What safety measures should be implemented for clients with seizure disorders?","a":"Padded side rails, bed in lowest position, and suction and oxygen equipment at bedside."},{"q":"What are potential complications of spinal cord injury?","a":"Paralysis, autonomic dysreflexia, infection, and impaired bladder and bowel control."},{"q":"What is autonomic dysreflexia?","a":"A life-threatening sympathetic response to stimuli below a spinal injury, causing hypertension and bradycardia."},{"q":"What are common triggers of autonomic dysreflexia?","a":"Bladder distention, fecal impaction, or tight clothing."},{"q":"What is the immediate nursing action for autonomic dysreflexia?","a":"Sit the client upright, remove the stimulus, and notify the provider."},{"q":"What are signs of autonomic dysreflexia?","a":"Sudden severe headache, flushed face, nasal congestion, sweating above the lesion, and piloerection."},{"q":"What is the goal of rehabilitation after spinal cord injury?","a":"To maximize independence and prevent complications such as contractures and pressure injuries."},{"q":"Why is temperature regulation affected after spinal cord injury?","a":"Loss of sympathetic control prevents normal vasodilation and sweating."},{"q":"What is the Glasgow Coma Scale used for?","a":"To assess the level of consciousness based on eye, verbal, and motor responses."},{"q":"What score on the Glasgow Coma Scale indicates a coma?","a":"A score of 8 or less."},{"q":"What does decorticate posturing indicate?","a":"Damage to the cerebral hemispheres."},{"q":"What does decerebrate posturing indicate?","a":"Damage to the brainstem and a more severe injury."},{"q":"Why is temperature control critical in clients with brain injury?","a":"Fever increases cerebral metabolism and oxygen demand."},{"q":"Why should hypotonic fluids be avoided in clients with increased ICP?","a":"They increase cerebral edema by allowing fluid to shift into brain tissue."},{"q":"Which IV solution is safest for a client with head trauma?","a":"Isotonic saline (0.9% NaCl)."},{"q":"Why is frequent neurological assessment essential after head injury?","a":"To detect early signs of deterioration and prevent secondary brain injury."},{"q":"What is thoracentesis?","a":"A procedure to remove fluid or air from the pleural space using a needle inserted into the chest wall."},{"q":"Why is a thoracentesis performed?","a":"To relieve pressure, improve breathing, and obtain fluid for diagnostic testing."},{"q":"What position should the client be in for a thoracentesis?","a":"Sitting upright, leaning forward over a bedside table to expand the intercostal spaces."},{"q":"What should be done before a thoracentesis?","a":"Obtain informed consent and baseline vital signs."},{"q":"What should be done after a thoracentesis?","a":"Apply a sterile dressing, monitor breath sounds, and assess for pneumothorax."},{"q":"What is a pneumothorax?","a":"Air in the pleural space that collapses the lung."},{"q":"What are signs of pneumothorax?","a":"Shortness of breath, decreased breath sounds on one side, and unequal chest expansion."},{"q":"What is a tension pneumothorax?","a":"Air enters the pleural space and cannot escape, causing pressure on the heart and opposite lung."},{"q":"What are signs of tension pneumothorax?","a":"Severe respiratory distress, tracheal deviation, distended neck veins, and hypotension."},{"q":"What is the immediate treatment for a tension pneumothorax?","a":"Insert a large-bore needle into the second intercostal space to release trapped air."},{"q":"What is a hemothorax?","a":"Accumulation of blood in the pleural space."},{"q":"Why is a chest tube inserted?","a":"To remove air, fluid, or blood from the pleural space and re-expand the lung."},{"q":"What are the three chambers of a chest drainage system?","a":"Collection chamber, water seal chamber, and suction control chamber."},{"q":"What does continuous bubbling in the water seal chamber indicate?","a":"An air leak."},{"q":"What should be done if continuous bubbling is observed in the water seal chamber?","a":"Check for air leaks and secure all connections."},{"q":"What does tidaling in the water seal chamber indicate?","a":"Normal fluctuation of fluid with respiration, showing the system is patent."},{"q":"Why should the chest drainage system be kept below the level of the chest?","a":"To prevent fluid from flowing back into the pleural space."},{"q":"What should be done if the chest tube becomes disconnected?","a":"Place the end in sterile water to restore the water seal temporarily."},{"q":"What should be done if the chest tube is accidentally pulled out?","a":"Cover the site with a gloved hand or occlusive dressing and call the provider."},{"q":"Why is daily chest X-ray important for clients with chest tubes?","a":"To confirm lung re-expansion and tube position."},{"q":"What is the purpose of thoracentesis fluid analysis?","a":"To identify infection, cancer, or cause of effusion."},{"q":"Why is coughing and deep breathing encouraged after thoracic surgery?","a":"To prevent atelectasis and pneumonia."},{"q":"Why should incentive spirometry be used after surgery?","a":"To promote lung expansion and improve oxygenation."},{"q":"What are signs of respiratory distress?","a":"Restlessness, tachypnea, use of accessory muscles, and cyanosis."},{"q":"What is pulmonary embolism (PE)?","a":"A blockage in a pulmonary artery, usually caused by a blood clot."},{"q":"What are classic signs of pulmonary embolism?","a":"Sudden dyspnea, chest pain, tachycardia, anxiety, and low oxygen saturation."},{"q":"Why is the client with PE placed in high Fowler’s position?","a":"To maximize lung expansion and improve oxygen exchange."},{"q":"What is the immediate treatment for pulmonary embolism?","a":"Administer oxygen, anticoagulants, and possibly thrombolytics."},{"q":"What medication prevents pulmonary embolism?","a":"Heparin or enoxaparin."},{"q":"What is a common side effect of heparin therapy?","a":"Bleeding."},{"q":"What is the antidote for heparin overdose?","a":"Protamine sulfate."},{"q":"What is acute respiratory distress syndrome (ARDS)?","a":"A sudden, severe form of respiratory failure due to noncardiac pulmonary edema."},{"q":"What are common causes of ARDS?","a":"Sepsis, trauma, near drowning, and aspiration."},{"q":"What is a key finding on a chest X-ray in ARDS?","a":"Bilateral “white-out” infiltrates."},{"q":"Why is oxygen alone often insufficient in ARDS?","a":"The alveoli are filled with fluid and cannot participate in gas exchange effectively."},{"q":"What is the purpose of mechanical ventilation in ARDS?","a":"To maintain oxygenation and reduce the work of breathing."},{"q":"What is PEEP?","a":"Positive End-Expiratory Pressure—maintains alveolar inflation and improves oxygenation."},{"q":"Why can high levels of PEEP be dangerous?","a":"They can decrease cardiac output and cause barotrauma."},{"q":"What is CPAP?","a":"Continuous Positive Airway Pressure—provides constant airway pressure for spontaneous breathing clients."},{"q":"What is BiPAP?","a":"Bilevel Positive Airway Pressure—provides higher pressure during inspiration and lower pressure during expiration."},{"q":"Why should suctioning be limited in clients on ventilators?","a":"It increases ICP and causes hypoxia if prolonged."},{"q":"Why is mouth care important for ventilated clients?","a":"To prevent ventilator-associated pneumonia (VAP)."},{"q":"What are early signs of hypoxia?","a":"Restlessness, anxiety, and tachycardia."},{"q":"What are late signs of hypoxia?","a":"Cyanosis and bradycardia."},{"q":"Why is the tripod position used in respiratory distress?","a":"It helps expand the chest and ease breathing effort."},{"q":"What is the difference between hypoxemia and hypoxia?","a":"Hypoxemia is low oxygen in the blood; hypoxia is low oxygen in the tissues."},{"q":"Why is oxygen humidified when delivered by nasal cannula?","a":"To prevent drying and irritation of the nasal mucosa."},{"q":"What is the maximum safe oxygen flow rate for a client with COPD?","a":"2 liters per minute, to avoid suppressing the respiratory drive."},{"q":"Why is pursed-lip breathing taught to COPD clients?","a":"It prolongs exhalation and prevents airway collapse."},{"q":"Why is postural drainage used?","a":"To mobilize secretions and improve airway clearance."},{"q":"What is the purpose of chest physiotherapy?","a":"To loosen and move secretions from the lungs."},{"q":"What should be done before chest physiotherapy?","a":"Administer a bronchodilator to open airways."},{"q":"Why are clients with respiratory disease encouraged to stop smoking?","a":"Smoking damages cilia, reduces oxygenation, and increases infection risk."},{"q":"What is the best indicator of respiratory improvement?","a":"Rising oxygen saturation and reduced work of breathing."},{"q":"Why must fractures be immobilized promptly?","a":"To prevent further tissue damage, bleeding, and displacement."},{"q":"What type of embolus is a concern after a long bone fracture?","a":"Fat embolus."},{"q":"What are signs of a fat embolus?","a":"Petechiae on the chest, hypoxia, confusion, and patchy infiltrates on chest x-ray, usually within 24–72 hours."},{"q":"How should an open fracture be managed initially?","a":"Cover it with a sterile dressing to reduce contamination and bleeding."},{"q":"What is a neurovascular check?","a":"Assessment of circulation, movement, sensation, capillary refill, and pulses distal to an injury."},{"q":"What are the 5 Ps of neurovascular assessment?","a":"Pain, pallor, pulselessness, paresthesia, and paralysis."},{"q":"What is compartment syndrome?","a":"Increased pressure within a muscle compartment that compromises circulation and tissue viability."},{"q":"What is the first nursing action if compartment syndrome is suspected?","a":"Loosen the cast or bandage and notify the provider urgently."},{"q":"Why is traction used in orthopedics?","a":"To align fractures, reduce muscle spasms, and maintain immobilization."},{"q":"What must remain free when using traction weights?","a":"The weights must hang freely to provide continuous traction."},{"q":"What is the difference between skin and skeletal traction?","a":"Skin traction uses straps or boots on the skin; skeletal traction uses pins or wires inserted into bone."},{"q":"What is pin care and why is it necessary?","a":"Sterile cleaning around skeletal traction pins to prevent infection."},{"q":"Why is elevation important after amputation (first 24 hours)?","a":"To reduce edema and bleeding."},{"q":"What is phantom limb pain?","a":"Pain perceived in the limb that was amputated; a real and treatable phenomenon."},{"q":"How can phantom limb pain be managed?","a":"Analgesics, mirror therapy, and nonpharmacologic interventions such as distraction."},{"q":"What is the purpose of a continuous passive motion (CPM) machine after joint replacement?","a":"To promote joint mobility and prevent stiffness."},{"q":"Why must hip replacement clients avoid certain positions?","a":"To prevent dislocation—avoid extreme flexion, adduction, and internal rotation as ordered."},{"q":"What are important cast care instructions?","a":"Keep the cast dry, avoid inserting objects, use palms for the first 24 hours, and monitor for increased pain or swelling."},{"q":"What is the priority assessment after applying a cast?","a":"Neurovascular checks distal to the cast including pulses, color, temperature, capillary refill, and sensation."},{"q":"How do you recognize a dislocated prosthetic hip?","a":"Sudden pain, limb shortening, and inability to move the extremity."},{"q":"Why must the residual limb be elevated after amputation?","a":"To reduce edema and promote venous return."},{"q":"When should a tourniquet be available after amputation?","a":"Immediately at bedside in case of hemorrhage."},{"q":"What are expected long-term concerns after orthopedic surgery?","a":"Risk of deep vein thrombosis, infection, impaired mobility, and chronic pain."},{"q":"How is DVT prevented after orthopedic surgery?","a":"Early ambulation, anticoagulation as ordered, and compression devices."},{"q":"What is osteomyelitis and how is it treated?","a":"Bone infection treated with prolonged IV antibiotics and sometimes surgical debridement."},{"q":"Why is pin site redness and drainage significant?","a":"It may indicate infection requiring prompt attention."},{"q":"What should be done if a cast feels tight and circulation is compromised?","a":"Elevate the extremity, open or bivalve the cast per protocol, and notify the provider."},{"q":"What is the major cause of glomerulonephritis?","a":"A streptococcal infection, often following strep throat or skin infection."},{"q":"What happens to urine output in glomerulonephritis?","a":"It decreases due to impaired renal filtration."},{"q":"What are the typical signs of glomerulonephritis?","a":"Hematuria, proteinuria, edema, hypertension, and dark (cola-colored) urine."},{"q":"Why does blood pressure increase in glomerulonephritis?","a":"Fluid retention and sodium accumulation increase vascular volume."},{"q":"Why does BUN and creatinine rise in glomerulonephritis?","a":"The kidneys cannot adequately excrete waste products."},{"q":"Why is rest important in glomerulonephritis?","a":"To promote renal recovery and reduce metabolic demand on the kidneys."},{"q":"What diet is recommended for glomerulonephritis?","a":"Low sodium and low protein to control edema and reduce waste buildup."},{"q":"Why should clients with glomerulonephritis monitor weight daily?","a":"Weight gain may indicate fluid retention."},{"q":"What is the primary nursing concern during the oliguric phase of renal disease?","a":"Fluid volume excess and hyperkalemia."},{"q":"What is nephrotic syndrome?","a":"A condition causing massive protein loss in urine due to glomerular damage."},{"q":"What is the main symptom of nephrotic syndrome?","a":"Generalized edema (anasarca) due to hypoalbuminemia."},{"q":"Why does hypoalbuminemia occur in nephrotic syndrome?","a":"Protein leaks into the urine through damaged glomeruli."},{"q":"Why are corticosteroids prescribed in nephrotic syndrome?","a":"To reduce inflammation and decrease protein loss."},{"q":"What type of diet is recommended for nephrotic syndrome?","a":"High protein (to replace losses) and low sodium (to reduce edema)."},{"q":"Why does nephrotic syndrome cause risk for blood clots?","a":"Loss of proteins alters coagulation, increasing clotting tendency."},{"q":"What happens to urine specific gravity in renal failure?","a":"It may become fixed and unresponsive to fluid changes."},{"q":"Why does renal failure cause anemia?","a":"The kidneys fail to produce enough erythropoietin, reducing red blood cell production."},{"q":"Why does renal failure cause pruritus (itching)?","a":"Urea and waste products accumulate in the blood and excrete through the skin."},{"q":"Why is phosphorus restricted in renal failure?","a":"To prevent hypocalcemia and bone demineralization."},{"q":"Why does renal failure cause osteoporosis?","a":"Phosphorus retention lowers calcium, stimulating bone resorption."},{"q":"What electrolyte imbalance is most dangerous in renal failure?","a":"Hyperkalemia, which can cause life-threatening arrhythmias."},{"q":"Why must potassium levels be monitored closely in renal clients?","a":"Elevated potassium can cause cardiac arrest."},{"q":"What is dialysis?","a":"A treatment that filters waste products and fluid from the blood when kidneys cannot."},{"q":"What is hemodialysis?","a":"Blood is circulated through a machine that removes toxins and excess fluid."},{"q":"How often is hemodialysis performed?","a":"Usually three times per week."},{"q":"Why is heparin used during hemodialysis?","a":"To prevent clotting in the dialysis circuit."},{"q":"What is the antidote for heparin?","a":"Protamine sulfate."},{"q":"Why should blood pressure and weight be measured before and after dialysis?","a":"To assess fluid removal and hemodynamic stability."},{"q":"Why must a bruit and thrill be checked in an AV fistula or graft?","a":"They indicate patency and blood flow through the access."},{"q":"What are safety precautions for an arm with an AV fistula or graft?","a":"No blood draws, IVs, or blood pressure measurements in that arm."},{"q":"What is peritoneal dialysis?","a":"Dialysis using the peritoneal membrane as a filter inside the abdominal cavity."},{"q":"What is the most common complication of peritoneal dialysis?","a":"Peritonitis, indicated by cloudy dialysate, fever, or abdominal pain."},{"q":"What should peritoneal dialysis outflow look like?","a":"Clear and straw-colored; cloudy fluid indicates infection."},{"q":"What should be done if outflow is less than inflow during peritoneal dialysis?","a":"Reposition the client or have them turn side to side."},{"q":"Why should the peritoneal dialysis client increase protein intake?","a":"Protein is lost during each dialysis exchange."},{"q":"Why should the peritoneal dialysis client increase fiber intake?","a":"Constipation can interfere with dialysate flow."},{"q":"What are signs of renal calculi (kidney stones)?","a":"Severe flank pain, hematuria, nausea, and vomiting."},{"q":"Why is fluid intake increased for kidney stones?","a":"To help flush the urinary tract and prevent stone formation."},{"q":"What are common causes of kidney stones?","a":"Dehydration, high calcium or uric acid levels, and infection."},{"q":"What are signs of urinary tract infection (UTI)?","a":"Dysuria, frequency, urgency, suprapubic pain, and cloudy urine."},{"q":"Why are women more prone to UTIs?","a":"The female urethra is shorter and closer to the anus."},{"q":"What are ways to prevent UTIs?","a":"Drink fluids, void frequently, wipe front to back, and avoid tight clothing."},{"q":"Why is phenazopyridine prescribed in UTIs?","a":"It relieves urinary discomfort but causes orange-colored urine."},{"q":"What is the best indicator of kidney function?","a":"Serum creatinine level."},{"q":"Why is creatinine more reliable than BUN?","a":"It is not affected by diet or hydration status."},{"q":"What does an elevated creatinine level indicate?","a":"Impaired kidney function or renal failure."},{"q":"If someone has been burned, fluid seeps out into the tissue. Why?","a":"Because of increased capillary permeability causing vessels to leak."},{"q":"When fluid seeps into the tissue, what happens to the blood pressure and pulse? Explain why.","a":"Pulse increases to compensate for the decreased volume, while blood pressure decreases because of fluid loss."},{"q":"Why does cardiac output decrease when fluid seeps out into the tissue?","a":"There is less volume in the vascular space, so the heart pumps out less blood."},{"q":"During this phase, is the client in a fluid volume deficit or fluid volume excess?","a":"Fluid volume deficit."},{"q":"When a client is in a fluid volume deficit, why does urine output decrease?","a":"Decreased renal perfusion causes the kidneys to conserve fluid."},{"q":"After a major burn, why is it important that ADH and aldosterone are secreted?","a":"They help retain sodium and water, increasing vascular volume."},{"q":"What is the treatment for carbon monoxide poisoning? Explain why.","a":"100% oxygen, because it replaces carbon monoxide on hemoglobin and corrects hypoxia."},{"q":"When a client has upper body burns, why is the airway a concern?","a":"Airway damage and edema can occur, leading to obstruction."},{"q":"What are the signs of airway injury in a burn client?","a":"Singed nasal or facial hair, soot on the face, dark secretions, coughing black mucus, or oral blisters."},{"q":"Explain the Rule of Nines.","a":"It estimates body surface area burned: Head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, genitalia 1%."},{"q":"Using the Consensus formula, what percentage of fluid is given in the first 8, 16, and 24 hours?","a":"Give half of total fluid in first 8 hours, one-fourth in the second 8 hours, and one-fourth in the last 8 hours."},{"q":"What is the best measurement to evaluate fluid volume status in a burn client?","a":"Daily intake and output measurements."},{"q":"How does IV albumin help treat shock?","a":"It increases oncotic pressure and holds fluid in the vascular space."},{"q":"Explain the difference between tetanus toxoid and tetanus immune globulin.","a":"Toxoid provides active immunity by forming antibodies; immune globulin provides immediate passive immunity with injected antibodies."},{"q":"What is the purpose of an escharotomy?","a":"To relieve pressure and restore circulation in burned tissue."},{"q":"Which electrolyte imbalance is common after burns?","a":"Hyperkalemia, because damaged cells release potassium into the blood."},{"q":"Why do burn clients receive GI protectants such as antacids or PPIs?","a":"To prevent stress ulcers."},{"q":"What is the purpose of checking gastric residual in burn clients?","a":"To ensure feeding tolerance and that the GI tract is moving."},{"q":"Why are multiple antibiotics used in burn treatment?","a":"To prevent bacterial resistance."},{"q":"In an electrical burn, what arrhythmia is the client at highest risk for?","a":"Ventricular fibrillation."},{"q":"How long is a client with an electrical burn at risk for life-threatening arrhythmias?","a":"For the first 24 hours."},{"q":"Why can electrical burn clients develop kidney failure?","a":"Muscle breakdown releases toxins that damage the kidneys."},{"q":"What are the two types of cancer?","a":"Solid tumors and hematologic malignancies."},{"q":"What is the number one cause of preventable cancer?","a":"Tobacco use."},{"q":"What is the most important risk factor for cancer?","a":"Aging."},{"q":"Name three examples of primary prevention for cancer.","a":"Avoid smoking, exercise regularly, maintain normal weight, limit alcohol, get vaccinated for Hepatitis B and HPV, and avoid carcinogens."},{"q":"Name three examples of secondary prevention for women.","a":"Monthly breast self-exam starting at 20, yearly clinical exam after 40, Pap smear starting at 21, colonoscopy at 50, and yearly fecal occult blood test at 50."},{"q":"Name three examples of secondary prevention for men.","a":"Testicular self-exam, annual clinical exam, PSA and digital rectal exam starting at 50, colonoscopy every 10 years, fecal occult blood yearly."},{"q":"Give two examples of tertiary prevention for cancer clients.","a":"Support groups and rehabilitation programs."},{"q":"What does the acronym CAUTION stand for in cancer warning signs?","a":"Change in bowel\/bladder habits, A sore that doesn’t heal, Unusual bleeding\/discharge, Thickening\/lump, Indigestion\/difficulty swallowing, Obvious change in mole, Nagging cough\/hoarseness."},{"q":"What is the number one symptom reported by cancer clients?","a":"Fatigue."},{"q":"Why does a total laryngectomy client need a tracheostomy?","a":"Because the epiglottis and airway protection are removed."},{"q":"Why should the laryngectomy client be positioned in Fowler’s position?","a":"To decrease edema around the airway."},{"q":"Why are NG feedings used for the laryngectomy client?","a":"To protect the surgical suture line."},{"q":"Why must the laryngectomy client have frequent mouth care?","a":"To prevent bacterial migration to the lungs or surgical site."},{"q":"Which activities are restricted for a client with a total laryngectomy?","a":"No whistling, no drinking through a straw, no smoking, and no swimming."},{"q":"What are the three primary goals of cancer treatment?","a":"Cure, control, and palliation."},{"q":"List four purposes of surgery in cancer care.","a":"Prevention, diagnosis, treatment, and reconstruction."},{"q":"Describe postoperative care after mastectomy.","a":"Elevate affected arm, protect from injury, encourage exercises like wall climbing or squeezing a ball, and monitor for bleeding."},{"q":"Why elevate the arm on the affected side after mastectomy?","a":"To promote lymphatic drainage and prevent swelling."},{"q":"Why encourage exercise after mastectomy?","a":"To promote circulation and mobility."},{"q":"Give discharge precautions after mastectomy.","a":"No blood pressure or injections in the affected arm, wear gloves for gardening, avoid cuts or injuries."},{"q":"What three factors determine if cancer surgery was successful?","a":"Whether all cancer was removed, if spread was present, and if margins were adequate."},{"q":"What are the three main radiation safety principles?","a":"Time, distance, and shielding."},{"q":"How should nurses be assigned to internal radiation clients?","a":"Rotate daily, and one nurse should care for only one radiation client per shift."},{"q":"Why is a low-fiber diet prescribed for internal radiation clients?","a":"To prevent bowel distention and dislodgment of the implant."},{"q":"Why does the client have an indwelling catheter during internal radiation?","a":"To prevent bladder distention that could dislodge the implant."},{"q":"Why must the client be on bed rest during internal radiation?","a":"To avoid implant displacement."},{"q":"What should be done if a radiation implant becomes dislodged?","a":"Use forceps to place it in a lead container and notify the radiation department."},{"q":"How should the nurse care for markings from external radiation?","a":"Do not wash or apply lotion; protect the area from sunlight and UV exposure for one year."},{"q":"List common side effects of chemotherapy.","a":"Alopecia, nausea, vomiting, anorexia, pancytopenia, and impaired taste."},{"q":"Which body systems are most affected by chemotherapy?","a":"Blood, gastrointestinal, skin, and hair systems."},{"q":"What equipment is needed when handling chemotherapy drugs?","a":"Chemotherapy gown, double gloves, and goggles or mask if splashing risk exists."},{"q":"How is a chemotherapy spill managed?","a":"Use a chemo spill kit with protective equipment and dispose of waste in yellow chemo containers."},{"q":"What is a vesicant?","a":"A chemo drug that causes tissue necrosis if it infiltrates."},{"q":"What should be done if a vesicant infiltrates?","a":"Stop the infusion and apply ice packs to reduce absorption."},{"q":"What are signs of organ transplant rejection?","a":"Abdominal pain, nausea, vomiting, jaundice, dark urine, rash, or itching."},{"q":"List six ways to prevent infection in a chemotherapy client.","a":"Private room, strict hand hygiene, limit visitors, change IV dressings daily, no fresh plants or raw fruits, monitor temperature closely."},{"q":"What is the best way to assess neutropenia?","a":"Calculate the absolute neutrophil count (ANC)."},{"q":"List three risk factors for neutropenia.","a":"Advanced cancer, malnutrition, and certain chemotherapy drugs."},{"q":"Why are cancer clients at risk for deep vein thrombosis?","a":"Prolonged bedrest, tumor compression, or certain chemotherapy agents."},{"q":"What should be assessed for thrombocytopenia?","a":"Bleeding, petechiae, bruising, headache, or changes in level of consciousness."},{"q":"What does leukoreduction do?","a":"Makes blood products CMV-negative and safer for immunocompromised clients."},{"q":"List nonpharmacologic treatments for chemotherapy-induced nausea and vomiting.","a":"Ginger, aromatherapy, acupuncture, relaxation, and distraction."},{"q":"What drug class is the gold standard for cancer pain?","a":"Opioids."},{"q":"List accepted complementary therapies for cancer pain.","a":"Acupuncture, massage, hydrotherapy, distraction, and cannabis."},{"q":"What are the major symptoms of hyperthyroidism?","a":"Nervousness, weight loss, heat intolerance, excessive sweating, exophthalmos, increased appetite, rapid gastrointestinal activity, hypertension, irritability, and decreased attention span."},{"q":"What is the most common cause of hyperthyroidism?","a":"Graves’ disease."},{"q":"Why do clients develop symptoms of hyperthyroidism?","a":"Because of excess production of thyroid hormones (T3 and T4), which accelerate metabolic activity."},{"q":"What happens to the heart’s workload in hyperthyroidism?","a":"It increases due to elevated heart rate and blood pressure."},{"q":"What dietary element is required to make thyroid hormones?","a":"Iodine."},{"q":"How do antithyroid drugs work?","a":"They inhibit the synthesis of thyroid hormones, reducing excessive hormone production."},{"q":"Give two examples of antithyroid drugs.","a":"Methimazole and propylthiouracil (PTU)."},{"q":"Why are iodine compounds given preoperatively for thyroid surgery?","a":"To reduce thyroid vascularity and minimize bleeding risk during surgery."},{"q":"Why should iodine solutions be given with milk or juice and a straw?","a":"To prevent staining of the teeth."},{"q":"Why are beta blockers prescribed for hyperthyroid clients?","a":"To reduce heart rate, blood pressure, and anxiety associated with increased adrenergic activity."},{"q":"How does radioactive iodine therapy work?","a":"It destroys overactive thyroid cells to reduce hormone production."},{"q":"What is a major complication of radioactive iodine therapy?","a":"Thyroid storm due to rebound hyperthyroidism."},{"q":"After a thyroidectomy, why should clients support their neck when moving?","a":"To prevent tension on the surgical suture line."},{"q":"In what position should a thyroidectomy client be placed?","a":"Fowler’s position to reduce neck edema."},{"q":"Why check for bleeding behind the neck after thyroidectomy?","a":"Blood may pool posteriorly and cause airway compression."},{"q":"Why must a tracheostomy set be kept at the bedside after thyroidectomy?","a":"In case of airway obstruction from swelling or laryngospasm."},{"q":"How is recurrent laryngeal nerve damage assessed after thyroid surgery?","a":"By listening for hoarseness or voice changes."},{"q":"Why assess for accidental parathyroid removal during thyroidectomy?","a":"Because parathyroids are near the thyroid and may be removed accidentally, causing hypocalcemia."},{"q":"What are signs of parathyroid removal or hypocalcemia?","a":"Muscle rigidity, tetany, positive Trousseau’s and Chvostek’s signs."},{"q":"Why is a quiet environment important for hypocalcemic clients?","a":"To minimize stimulation and prevent seizures."},{"q":"Why should a tracheostomy tray be available for hypocalcemic clients?","a":"Because laryngospasm can occur from hypocalcemia, leading to airway obstruction."},{"q":"Why should a hypoparathyroid client follow a low-phosphorus diet?","a":"Because serum phosphorus is already elevated."},{"q":"What is the main problem in pheochromocytoma?","a":"Tumors of the adrenal medulla secrete excessive epinephrine and norepinephrine, causing hypertension and tachycardia."},{"q":"What diagnostic test is used for pheochromocytoma?","a":"The 24-hour urine test for vanillylmandelic acid (VMA), which measures catecholamine levels."},{"q":"What are the four main effects of glucocorticoids?","a":"They alter mood, break down proteins and fats, suppress the immune response, and inhibit insulin."},{"q":"What is the key function of mineralocorticoids?","a":"Sodium and water retention through aldosterone."},{"q":"Why do steroids increase blood glucose levels?","a":"They inhibit insulin, leading to higher serum glucose."},{"q":"If a client produces too much aldosterone, what happens to the vascular space?","a":"Blood volume increases due to sodium and water retention."},{"q":"Briefly explain Addison’s disease.","a":"The adrenal glands fail to produce enough corticosteroids, leading to sodium and water loss, potassium retention, and risk of shock."},{"q":"What electrolyte imbalance occurs in Addison’s disease?","a":"Hyperkalemia."},{"q":"What are the signs and symptoms of hyperkalemia?","a":"Muscle weakness, decreased bowel sounds, nausea, arrhythmias, and cardiac irregularities."},{"q":"Why can Addison’s disease cause life-threatening arrhythmias?","a":"Because of dangerously high potassium levels."},{"q":"Why does Addison’s disease cause shock?","a":"Loss of sodium and water leads to hypovolemia and hypotension."},{"q":"Why does the Addison’s client need more sodium in their diet?","a":"To help retain vascular volume and prevent dehydration."},{"q":"Why is strict intake and output monitoring essential in Addison’s disease?","a":"Because of the severe risk of fluid imbalance."},{"q":"What happens to blood pressure in Addison’s disease?","a":"It decreases due to hypovolemia."},{"q":"Describe the appearance of a client with Cushing’s syndrome.","a":"Moon face, buffalo hump, thin arms and legs, central obesity, and fluid retention."},{"q":"Explain why Cushing’s clients experience thin skin and muscle wasting.","a":"Because cortisol causes protein breakdown and muscle catabolism."},{"q":"Why are Cushing’s clients at high risk for infection?","a":"Cortisol suppresses immune and inflammatory responses."},{"q":"Why do Cushing’s clients have high blood sugar levels?","a":"Because cortisol promotes gluconeogenesis and insulin resistance."},{"q":"Why is the Cushing’s client often hypertensive?","a":"Excess aldosterone causes sodium and water retention, increasing blood volume and pressure."},{"q":"Why is serum potassium low in Cushing’s syndrome?","a":"Aldosterone promotes potassium excretion."},{"q":"Why do Cushing’s clients need extra dietary calcium?","a":"Because steroids increase calcium loss through the GI tract, causing bone demineralization."},{"q":"Should Cushing’s clients follow a low-sodium or high-sodium diet?","a":"Low-sodium, to prevent further fluid retention."},{"q":"Why might glucose and ketones appear in the urine of a Cushing’s client?","a":"Because high cortisol levels cause hyperglycemia and fat breakdown, producing ketones."},{"q":"What is the basic problem in diabetes mellitus?","a":"Insufficient insulin leads to glucose buildup in the blood."},{"q":"Why does the body break down protein and fat in diabetes?","a":"Cells lack glucose for energy, so the body uses alternate energy sources."},{"q":"What do fat breakdown products produce in diabetes?","a":"Ketones, which are acidic."},{"q":"What acid–base imbalance occurs in diabetic ketoacidosis (DKA)?","a":"Metabolic acidosis due to ketone accumulation."},{"q":"Explain the classic signs of diabetes: polyuria, polydipsia, polyphagia.","a":"Polyuria—kidneys excrete glucose; polydipsia—thirst from fluid loss; polyphagia—hunger because cells lack glucose."},{"q":"How does metformin work?","a":"It improves insulin sensitivity and decreases hepatic glucose production."},{"q":"Why don’t oral antidiabetic drugs work in Type 1 diabetes?","a":"Because the pancreas produces no insulin."},{"q":"Why do Type 2 diabetics experience slow-healing wounds and recurrent infections?","a":"Hyperglycemia promotes bacterial growth and impairs circulation."},{"q":"What is the typical treatment plan for Type 2 diabetes?","a":"Diet, exercise, oral medications, and sometimes insulin."},{"q":"Why is dietary protein restricted in diabetic clients?","a":"To prevent further kidney damage from protein overload."},{"q":"Why are diabetics at risk for coronary artery disease?","a":"Chronic hyperglycemia leads to atherosclerosis."},{"q":"Why can exercise cause hypoglycemia in diabetics?","a":"Physical activity lowers blood glucose; eating before exercise prevents drops."},{"q":"When is it best for diabetics to exercise?","a":"When blood glucose is at its peak to avoid hypoglycemia."},{"q":"Which type of insulin can be given intravenously?","a":"Regular insulin."},{"q":"How often is long-acting insulin such as glargine administered?","a":"Once daily."},{"q":"What indicates that insulin dosing is properly adjusted?","a":"No glucose or ketones in the urine."},{"q":"What types of insulin are used in basal-bolus therapy?","a":"Long-acting insulin for basal coverage and rapid-acting insulin before meals."},{"q":"What does a hemoglobin A1C of 8% indicate?","a":"Poor blood glucose control over the past three months."},{"q":"What insulin type is used in insulin pumps?","a":"Rapid-acting insulin."},{"q":"How does basal-bolus insulin mimic normal pancreatic function?","a":"Basal insulin provides steady coverage; bolus insulin covers meal-related spikes."},{"q":"What happens to blood sugar during insulin peak time?","a":"It decreases, creating a risk for hypoglycemia."},{"q":"How can hypoglycemia be prevented?","a":"Eat meals and snacks on time, avoid skipping insulin doses."},{"q":"Why should injection sites be rotated in insulin therapy?","a":"To prevent lipodystrophy and ensure consistent absorption."},{"q":"What happens to blood sugar during illness or stress?","a":"It increases."},{"q":"What should a diabetic do if ill or stressed?","a":"Increase insulin as prescribed and monitor glucose frequently."},{"q":"What major complication can occur in Type 1 diabetes if uncontrolled?","a":"Diabetic ketoacidosis (DKA)."},{"q":"What are early signs of hypoglycemia and what is the immediate action?","a":"Shakiness, sweating, confusion—give simple carbohydrates."},{"q":"What should follow simple carbohydrate treatment for hypoglycemia?","a":"Complex carbs and protein to maintain stable glucose."},{"q":"Explain the 15-15-15 rule for hypoglycemia.","a":"Eat 15g of carbs, recheck blood sugar in 15 minutes, repeat if still low."},{"q":"Why is hypoglycemia more dangerous than hyperglycemia?","a":"Because the brain depends on glucose and can be permanently damaged by deprivation."},{"q":"If a diabetic client is unconscious, should they be treated as hypoglycemic or hyperglycemic?","a":"Treat as hypoglycemic—it is safer."},{"q":"Explain the basic pathophysiology of diabetic ketoacidosis.","a":"Insulin deficiency leads to hyperglycemia, dehydration, fat breakdown, acidosis, and Kussmaul respirations."},{"q":"Why monitor blood glucose and potassium in DKA?","a":"Insulin therapy lowers both serum glucose and potassium, risking hypokalemia."},{"q":"What effect does insulin have on serum potassium?","a":"It drives potassium into cells, lowering serum levels."},{"q":"Why monitor the ECG in DKA?","a":"To detect arrhythmias caused by potassium shifts."},{"q":"Why measure hourly urine output in DKA?","a":"To monitor renal perfusion and detect worsening dehydration."},{"q":"What is the concern if urine output falls to oliguria or anuria?","a":"Kidney failure due to poor perfusion."},{"q":"Describe proper diabetic foot care.","a":"Inspect feet daily, cut nails straight, dry between toes, avoid barefoot walking, and wear proper shoes."},{"q":"Define preload and afterload.","a":"Preload is the amount of blood returning to the right side of the heart and the stretch it causes. Afterload is the pressure the left ventricle must pump against to eject blood into the aorta."},{"q":"What is cardiac output?","a":"The amount of blood pumped from the left ventricle each minute."},{"q":"If cardiac output decreases, how is tissue perfusion affected?","a":"It decreases, leading to poor oxygen delivery to tissues."},{"q":"What factors affect cardiac output?","a":"Heart rate, blood volume, and myocardial contractility."},{"q":"How does decreased cardiac output affect level of consciousness?","a":"It decreases cerebral perfusion, causing confusion or restlessness."},{"q":"Can decreased cardiac output cause chest pain?","a":"Yes, because of myocardial ischemia."},{"q":"Why does a client with low cardiac output have cool, clammy skin?","a":"Peripheral vasoconstriction occurs to shunt blood to vital organs."},{"q":"Why do clients with low cardiac output have shortness of breath and crackles?","a":"Blood backs up into the lungs, causing pulmonary congestion."},{"q":"Why do peripheral pulses diminish with low cardiac output?","a":"Reduced stroke volume decreases perfusion to the extremities."},{"q":"How does decreased cardiac output affect urine output?","a":"Renal perfusion drops, leading to oliguria."},{"q":"Why does blood pressure drop with decreased cardiac output?","a":"Less volume is ejected from the heart, reducing arterial pressure."},{"q":"How does bradycardia affect cardiac output?","a":"It decreases cardiac output because fewer contractions occur per minute."},{"q":"How does extreme tachycardia affect cardiac output?","a":"It decreases output because the ventricles don’t have enough time to fill."},{"q":"How does myocardial infarction affect cardiac output?","a":"Dead myocardial tissue cannot contract effectively, decreasing output."},{"q":"How does high blood pressure affect cardiac output?","a":"Increased afterload makes it harder for the heart to pump, lowering output."},{"q":"What is chronic stable angina?","a":"Chest pain caused by decreased blood flow to the myocardium during exertion."},{"q":"Describe the pain of angina.","a":"Pressure or heaviness in the chest that may radiate to the left arm or jaw, relieved by rest or nitroglycerin."},{"q":"Why is nitroglycerin given for angina?","a":"It dilates coronary arteries, improving oxygen delivery and reducing pain."},{"q":"How should nitroglycerin be taken?","a":"One tablet every five minutes, up to three doses; sit down before taking to avoid dizziness."},{"q":"What is a common side effect of nitroglycerin?","a":"Headache due to vasodilation."},{"q":"How does nitroglycerin affect blood pressure?","a":"It lowers blood pressure through vasodilation."},{"q":"Why are beta blockers given for angina?","a":"They reduce heart rate, contractility, and oxygen demand."},{"q":"Why is aspirin used for angina?","a":"It prevents platelet aggregation and reduces the risk of thrombus formation."},{"q":"What should clients with angina avoid?","a":"Overeating, caffeine, cold exposure, and stress, as they increase cardiac workload."},{"q":"What should clients do before taking nitroglycerin?","a":"Sit or lie down to prevent fainting from hypotension."},{"q":"Why must clients be asked about iodine allergies before cardiac catheterization?","a":"Because contrast dye contains iodine."},{"q":"What is a normal sensation during iodine dye injection?","a":"A warm, flushed feeling."},{"q":"What is the priority assessment after cardiac catheterization?","a":"Check the puncture site for bleeding and assess distal circulation."},{"q":"Why does myocardial infarction cause necrosis?","a":"Blocked coronary blood flow deprives the myocardium of oxygen, leading to cell death."},{"q":"Is MI pain relieved by rest or nitroglycerin?","a":"No, MI pain is persistent and severe."},{"q":"Describe MI pain.","a":"Intense, crushing, continuous pain that may radiate to the jaw, arm, or back."},{"q":"Why does a client having an MI become cold and clammy?","a":"Decreased cardiac output activates the sympathetic nervous system."},{"q":"Which cardiac biomarker confirms MI after several hours?","a":"Troponin."},{"q":"Is a negative myoglobin result good or bad?","a":"Good, it indicates no muscle injury."},{"q":"Which arrhythmia poses the greatest risk after MI?","a":"Ventricular fibrillation."},{"q":"What is the priority intervention for ventricular fibrillation?","a":"Immediate defibrillation."},{"q":"What drug is used if VFib persists after defibrillation?","a":"Amiodarone."},{"q":"What medications are typically given to a client with chest pain on arrival to the emergency department?","a":"Oxygen, chewable aspirin, nitroglycerin, and morphine."},{"q":"How do thrombolytic drugs work?","a":"They dissolve clots blocking coronary arteries to restore blood flow."},{"q":"Give examples of thrombolytic agents.","a":"Streptokinase, tissue plasminogen activator (tPA), and reteplase."},{"q":"What is the major risk of thrombolytic therapy?","a":"Hemorrhage."},{"q":"What history must be reviewed before giving thrombolytics?","a":"Any recent surgery, trauma, stroke, or bleeding disorders."},{"q":"What nursing action is important after thrombolytic therapy?","a":"Minimize punctures and invasive procedures to prevent bleeding."},{"q":"What is angioplasty and its main complication?","a":"Balloon dilation of coronary arteries; the main risk is reocclusion or MI."},{"q":"How does increased preload affect cardiac workload?","a":"It increases workload because the heart must pump a larger volume."},{"q":"How can preload be increased?","a":"Supine position, leg elevation, or hypervolemia."},{"q":"How can preload be decreased?","a":"Upright positioning, hypovolemia, or lowering legs."},{"q":"What happens to cardiac output when afterload increases?","a":"It decreases because the heart pumps against higher resistance."},{"q":"If blood does not move forward from the left ventricle, where does it back up?","a":"Into the lungs."},{"q":"What are signs of left-sided heart failure?","a":"Dyspnea, orthopnea, pulmonary congestion, crackles, and cough with pink frothy sputum."},{"q":"Why does left-sided failure cause tachycardia and restlessness?","a":"Hypoxia stimulates the sympathetic nervous system."},{"q":"Why does lying flat worsen dyspnea in left-sided failure?","a":"It increases venous return, worsening pulmonary congestion."},{"q":"What are signs of right-sided heart failure?","a":"Jugular vein distention, edema, ascites, hepatomegaly, and weight gain."},{"q":"Where does blood back up in right-sided heart failure?","a":"Into the venous system."},{"q":"What does a Swan-Ganz catheter measure?","a":"Pressures inside the heart to evaluate preload and afterload."},{"q":"What is the purpose of an arterial line (A-line)?","a":"Continuous blood pressure monitoring and arterial blood sampling."},{"q":"Why must distal circulation be checked when an A-line is in place?","a":"To ensure arterial perfusion is not compromised."},{"q":"What should be done if an A-line is accidentally removed?","a":"Apply firm pressure to the insertion site immediately."},{"q":"Why must pressure be maintained in the A-line flush system?","a":"To prevent arterial backflow and maintain patency."},{"q":"Why does the heart enlarge in chronic heart failure?","a":"The myocardium hypertrophies to compensate for increased workload."},{"q":"Which two medication groups are standard for treating heart failure?","a":"ACE inhibitors and ARBs."},{"q":"How does digoxin work?","a":"It slows heart rate and increases contractility, improving cardiac output."},{"q":"Why is digoxin used cautiously in the elderly?","a":"Decreased renal function increases the risk of toxicity."},{"q":"What clinical improvements indicate effective heart failure therapy?","a":"Increased urine output, warm skin, improved pulses, better mentation, and stable blood pressure."},{"q":"Why is furosemide used in heart failure?","a":"To reduce fluid overload by promoting diuresis."},{"q":"Why are diuretics given in the morning?","a":"To prevent nocturia and sleep disruption."},{"q":"What is the heart’s natural pacemaker?","a":"The sinoatrial (SA) node."},{"q":"What is the function of an artificial pacemaker?","a":"It delivers electrical impulses to stimulate heart contractions."},{"q":"What is the difference between a demand and a fixed-rate pacemaker?","a":"A demand pacemaker fires only when needed; a fixed-rate fires continuously."},{"q":"When should pacemaker malfunction be suspected?","a":"If the heart rate drops below the set rate."},{"q":"Why must the arm on the pacemaker side be immobilized temporarily?","a":"To prevent dislodging the pacing leads."},{"q":"Why should pacemaker clients check their pulse daily?","a":"To ensure the pacemaker is maintaining the prescribed rate."},{"q":"Why must pacemaker clients avoid electromagnetic fields?","a":"They can interfere with pacemaker function (e.g., MRI machines, airport security)."},{"q":"What does sudden weight gain in a heart failure client indicate?","a":"Fluid retention and risk for pulmonary edema."},{"q":"What is pulmonary edema?","a":"Acute fluid accumulation in the lungs causing severe respiratory distress and hypoxia."},{"q":"Why does pulmonary edema occur?","a":"Left ventricular failure causes blood to back up into the lungs."},{"q":"When does pulmonary edema commonly occur?","a":"At night when lying flat increases venous return."},{"q":"What are signs of pulmonary edema?","a":"Sudden breathlessness, restlessness, anxiety, and frothy sputum."},{"q":"Why is oxygen administered in pulmonary edema?","a":"To improve oxygenation impaired by alveolar fluid."},{"q":"What position helps relieve pulmonary edema?","a":"Sitting upright with legs down to reduce venous return."},{"q":"What are hallmark signs of cardiac tamponade?","a":"Increased central venous pressure (CVP) and decreased blood pressure."},{"q":"Why do these signs occur in tamponade?","a":"Fluid compresses the heart, preventing proper filling and lowering output."},{"q":"What events can lead to cardiac tamponade?","a":"Trauma, pericarditis, post-CABG bleeding, or right ventricular biopsy."},{"q":"What is intermittent claudication?","a":"Pain in the extremities caused by inadequate oxygenation from arterial insufficiency."},{"q":"What are signs of arterial insufficiency?","a":"Coldness, pallor, weak pulses, atrophy, and risk of ischemia or gangrene."},{"q":"How does angioplasty help arterial disorders?","a":"It opens blocked arteries, restoring oxygenated blood flow."},{"q":"What is the main problem in venous disorders?","a":"Blood reaches the extremity but cannot return effectively, leading to pooling."},{"q":"How are venous disorders treated?","a":"Elevate the affected limb, use compression, and administer anticoagulants if needed."},{"q":"How do TED hose help venous disorders?","a":"They improve venous return and reduce stasis."},{"q":"What type of heat therapy is recommended for venous disorders?","a":"Warm, moist heat to promote circulation and decrease inflammation."},{"q":"How can DVT be prevented?","a":"Early ambulation and adequate hydration."},{"q":"What are the main functions of the pancreas?","a":"It produces digestive enzymes and regulates blood glucose through insulin and glucagon secretion."},{"q":"What are the two major causes of pancreatitis?","a":"Gallstones and alcohol abuse."},{"q":"Why does autodigestion occur in pancreatitis?","a":"Pancreatic enzymes activate prematurely and begin digesting pancreatic tissue."},{"q":"What are the classic signs of pancreatitis?","a":"Abdominal pain radiating to the back, nausea, vomiting, fever, and elevated amylase and lipase levels."},{"q":"Why does pain in pancreatitis worsen after eating?","a":"Food stimulates enzyme secretion, increasing inflammation and pain."},{"q":"Why are narcotics like morphine used cautiously in pancreatitis?","a":"They may cause spasm of the sphincter of Oddi, worsening pain."},{"q":"Why are anticholinergics prescribed in pancreatitis?","a":"They reduce gastric secretions and decrease pancreatic stimulation."},{"q":"Why is the client kept NPO during acute pancreatitis?","a":"To rest the pancreas and prevent further enzyme release."},{"q":"Why is NG suction used in pancreatitis?","a":"To remove gastric secretions and prevent stimulation of pancreatic enzymes."},{"q":"Why is insulin often required during acute pancreatitis?","a":"Pancreatic damage decreases insulin production."},{"q":"Why are alcohol and greasy foods restricted after pancreatitis?","a":"They can trigger enzyme secretion and cause relapse."},{"q":"Why do liver enzymes rise in liver disease?","a":"Damaged hepatocytes release enzymes like ALT and AST into the bloodstream."},{"q":"What is the primary function of the liver?","a":"Metabolism of drugs, detoxification, production of bile, and synthesis of clotting factors."},{"q":"Why do liver failure clients bleed easily?","a":"The liver cannot produce enough clotting factors."},{"q":"Why does a cirrhosis client develop ascites?","a":"Portal hypertension and low albumin cause fluid to leak into the peritoneal cavity."},{"q":"Why does cirrhosis cause jaundice?","a":"The liver cannot conjugate and excrete bilirubin properly."},{"q":"What is a major complication of cirrhosis?","a":"Esophageal varices due to portal hypertension."},{"q":"Why are esophageal varices dangerous?","a":"They can rupture and cause massive bleeding."},{"q":"Why are beta blockers used in cirrhosis?","a":"To reduce portal hypertension and prevent variceal rupture."},{"q":"Why are laxatives given to cirrhosis clients?","a":"To decrease ammonia absorption by emptying the intestines."},{"q":"Why is lactulose used in hepatic encephalopathy?","a":"It traps ammonia in the gut and promotes excretion, reducing confusion."},{"q":"What are early signs of hepatic encephalopathy?","a":"Mental confusion, hand tremors (asterixis), and slowed speech."},{"q":"Why should a cirrhosis client avoid protein-rich foods?","a":"Protein breakdown increases ammonia levels, worsening encephalopathy."},{"q":"Why is paracentesis performed in ascites?","a":"To remove excess peritoneal fluid and relieve pressure."},{"q":"What should be done before paracentesis?","a":"Have the client void to prevent bladder puncture."},{"q":"Why should vital signs be monitored during paracentesis?","a":"Rapid fluid removal can cause hypotension and shock."},{"q":"Why are patients with cirrhosis advised to avoid acetaminophen?","a":"The drug is hepatotoxic and can worsen liver injury."},{"q":"What is the primary cause of peptic ulcer disease?","a":"Helicobacter pylori infection and NSAID use."},{"q":"What relieves pain in duodenal ulcers?","a":"Eating food or taking antacids."},{"q":"What aggravates pain in gastric ulcers?","a":"Eating food increases gastric acid and worsens pain."},{"q":"What lifestyle factors worsen peptic ulcers?","a":"Smoking, alcohol, caffeine, and stress."},{"q":"What foods should be avoided in ulcer clients?","a":"Spicy, acidic, or irritating foods like citrus, coffee, and pepper."},{"q":"What are signs of GI bleeding?","a":"Hematemesis, melena, low blood pressure, and tachycardia."},{"q":"What does bright red vomit indicate?","a":"Active upper GI bleeding."},{"q":"What is the goal of antacid therapy?","a":"To neutralize gastric acid and reduce irritation of the mucosa."},{"q":"Why are proton pump inhibitors used for ulcers?","a":"They inhibit gastric acid secretion and allow mucosal healing."},{"q":"What is a major complication of a peptic ulcer?","a":"Perforation leading to peritonitis."},{"q":"What are signs of peritonitis?","a":"Abdominal rigidity, severe pain, fever, and rebound tenderness."},{"q":"What is ulcerative colitis?","a":"Chronic inflammation of the colon causing ulceration and bloody diarrhea."},{"q":"What is Crohn’s disease?","a":"Inflammatory bowel disease that can affect any part of the GI tract, leading to thickened intestinal walls."},{"q":"What diet is recommended for ulcerative colitis?","a":"Low-fiber, high-protein diet to rest the bowel."},{"q":"Why are steroids used in ulcerative colitis?","a":"To reduce intestinal inflammation."},{"q":"Why are antidiarrheals avoided in ulcerative colitis?","a":"They can cause toxic megacolon by retaining stool."},{"q":"What is the primary surgical treatment for ulcerative colitis?","a":"Total colectomy with ileostomy."},{"q":"How does stool differ between an ileostomy and a colostomy?","a":"Ileostomy output is liquid and continuous; colostomy output is more formed."},{"q":"What foods should an ileostomy client avoid?","a":"High-fiber foods like nuts, seeds, and corn that may cause obstruction."},{"q":"Why are fluids important for ileostomy clients?","a":"They lose large amounts of fluid and electrolytes."},{"q":"What is appendicitis?","a":"Inflammation of the appendix, usually due to obstruction."},{"q":"What is the classic symptom of appendicitis?","a":"Pain starting around the umbilicus and shifting to the right lower quadrant."},{"q":"Why is appendicitis dangerous if untreated?","a":"It can lead to rupture and peritonitis."},{"q":"What should not be applied to the abdomen in suspected appendicitis?","a":"Heat, because it can increase inflammation and risk of rupture."},{"q":"Why are opioids used cautiously before appendectomy?","a":"They can mask changes in pain that signal rupture."},{"q":"Why is postoperative ambulation important after abdominal surgery?","a":"It promotes peristalsis and prevents gas buildup and pneumonia."},{"q":"What is the primary goal in treating hiatal hernia?","a":"To prevent reflux by elevating the head of the bed and avoiding large meals."},{"q":"Why are antacids and PPIs used in GERD?","a":"They reduce acid reflux and esophageal irritation."},{"q":"What lifestyle changes help control GERD?","a":"Eat small meals, avoid lying down after eating, avoid alcohol, caffeine, and smoking."},{"q":"Why is bariatric surgery used for morbid obesity?","a":"It limits stomach capacity, promoting weight loss and reducing comorbidities."},{"q":"What is dumping syndrome?","a":"Rapid gastric emptying causing weakness, dizziness, and diarrhea after eating."},{"q":"How can dumping syndrome be prevented?","a":"Eat small, frequent meals and avoid fluids with meals."}]

Reduction Of Risk Potential Flashcards

Part 1

[{"q":"What will happen to your weight with hypovolemia and why?","a":"It will decrease because there is less volume."},{"q":"If you are hypovolemic, why will your urine output eventually decrease?","a":"Decreased perfusion due to hypovolemia can cause a decrease in kidney perfusion, or the patient may be trying to conserve fluid."},{"q":"Why do you do hourly outputs on someone who is hypovolemic?","a":"To ensure the kidneys are receiving adequate perfusion."},{"q":"How can diarrhea induce hypomagnesemia?","a":"Because magnesium is present in the intestine."},{"q":"Why are alcoholics prone to hypomagnesemia?","a":"We obtain a lot of our magnesium through our diet, and alcoholics often do not eat. Additionally, alcohol causes diuresis, and magnesium is excreted through the kidneys. The alcoholic is not eating and is diuresing a lot."},{"q":"Why is it so important to check renal function prior to giving IV magnesium?","a":"Because magnesium is excreted by the kidneys; we must ensure our patients can excrete the excess."},{"q":"If you are taking care of a patient with hypomagnesemia, why do you have to take seizure precautions?","a":"Because their muscles are tight and hyperexcitable, the possibility of a seizure is likely."},{"q":"If a patient has hyperphosphatemia, what other electrolyte imbalance will they have?","a":"Hypocalcemia."},{"q":"If a patient has hypophosphatemia, what other electrolyte imbalance will they have?","a":"Hypercalcemia"},{"q":"What will their symptoms look like?","a":"Weak muscle tone, decreased DTRs, slow GI tract, sedation."},{"q":"If you have a patient whose blood is very dilute; in other words, it is filled with water, what will happen to their serum sodium level? And explain why.","a":"Na level decreases because sodium is measured in relation to water (diluted). The more water you have, the lower the Na goes."},{"q":"If you have a patient who is very dehydrated, what will happen to their serum sodium level? Explain why.","a":"Increase because of the concentration. The more concentrated your blood is, the higher the Na goes."},{"q":"If you have a patient who is dehydrated, what will happen to their H&H? Explain why.","a":"If you are dehydrated, then the blood is concentrated (not enough water). Concentration makes most numbers go up, so the Hemoglobin and Hematocrit would go up."},{"q":"Why is it so important when you are trying to lower someone’s serum sodium level that you dilute the patient with IV fluid gradually?","a":"Because the brain cells cannot handle rapid Na shifts."},{"q":"If you have a patient who is becoming dehydrated, what will begin to happen to their sodium level? And what should you do before the patient becomes hypernatremic?","a":"Increase; increase fluids."},{"q":"If a patient is hyponatremic, what is their blood like? Concentrated or dilute? Why?","a":"Dilute – They have too much water and not enough Na."},{"q":"How can drinking too much water make your serum sodium go down?","a":"When you take in an excessive amount of water, the blood becomes diluted, and this would make the serum Na go down."},{"q":"When you have a hyponatremic patient, it is important that you restrict water. Explain why.","a":"Because the body has too much water, and restricting water helps increase Na."},{"q":"How can vomiting induce hypokalemia?","a":"K+ lives in the stomach, so vomiting gets rid of K+."},{"q":"Why is it so important that you monitor the digoxin patient closely for hypokalemia or other electrolyte imbalances?","a":"When any electrolyte gets out of balance, this makes a patient prone to digoxin toxicity. However, the imbalance that will promote toxicity the most is hypokalemia."},{"q":"When a patient has a high CO2 level in their blood, what is going to happen to the oxygen level in their blood?","a":"Decreases"},{"q":"When a patient has an electrical injury, they are at a high risk for what arrhythmia?","a":"V-fib."},{"q":"How long is the patient at risk for life-threatening arrhythmias?","a":"24 hours."},{"q":"Why must a patient’s white blood count be at least 3,000 before they will receive their chemo?","a":"The chemo is going to decrease the white blood count even more."},{"q":"What are some complications of a bronchoscopy that you need to watch for?","a":"Respiratory distress, hoarseness, dysphagia, subcutaneous emphysema."},{"q":"Why are ulcerative colitis and Crohn’s disease considered to be risk factors for colon cancer?","a":"Chronic irritation."},{"q":"What is the major lab work assessed when prostate cancer is suspected?","a":"PSA – prostate-specific antigen and the acid phosphatase."},{"q":"What is the most common complication of a TURP?","a":"Hemorrhage."},{"q":"When a patient has had a TURP, why do they not have to worry about impotency and infertility?","a":"No nerve involvement – no incision."},{"q":"Why is it important that the prostatectomy patient avoid sitting, driving, strenuous exercise, and lifting?","a":"To prevent hemorrhage."},{"q":"What is one of the major signs diagnostically of stomach cancer?","a":"No HCl in the stomach."},{"q":"Why do we check for bleeding behind the neck with a thyroidectomy patient?","a":"This is where pooling could occur."},{"q":"Why do we keep a trach set at the bedside with a thyroidectomy patient?","a":"It is needed for emergency airway; laryngospasm could occur."},{"q":"How do you assess for recurrent laryngeal nerve damage in the thyroidectomy patient?","a":"Listen for hoarseness."},{"q":"Why do we have to assess for parathyroid removal in the thyroidectomy patient?","a":"Because they are close to the thyroid; they could have been accidentally removed."},{"q":"How do you assess for parathyroid removal?","a":"Watch for muscle rigidity – tight muscles; tetany. Look for signs and symptoms of hypocalcemia."},{"q":"What are the signs and symptoms of parathyroid removal?","a":"Any sign of hypocalcemia."},{"q":"What is the major diagnostic test for pheochromocytoma? Explain.","a":"VMA – vanillylmandelic acid test – 24-hour urine specimen; looking for increased levels of epinephrine\/norepinephrine."},{"q":"When a patient has diabetic ketoacidosis, why is it so important that we measure the blood sugar and the potassium hourly?","a":"Because insulin transports the sugar and potassium back into the cell. Now we are worried about hypokalemia and hypoglycemia."},{"q":"Why is it so important that we monitor the diabetic ketoacidotic patient’s EKG so closely?","a":"Risk for hypokalemia; chance of arrhythmias."},{"q":"Why are we measuring hourly output on the diabetic ketoacidosis patient?","a":"Because polyuria could turn to oliguria then anuria (renal failure)."},{"q":"When a patient has oliguria and anuria, what do you really have to start worrying about and why?","a":"Kidney failure – because the kidneys aren’t being perfused properly."},{"q":"What is angioplasty and what is the major complication of angioplasty?","a":"Balloon to open coronary arteries to enhance blood flow – MI."}]

Part 2

[{"q":"Why is it so important that the angina patient avoid isometric exercise, overeating, caffeine, or any drugs that increase the heart rate and avoid cold weather?","a":"Because these increase the workload of the heart."},{"q":"What is the major complication of a thrombolytic?","a":"Hemorrhage"},{"q":"Before you give a thrombolytic, you are supposed to get a good history. What did I tell you to focus on (what type of diseases or illnesses)?","a":"Any past bleeding problems, stroke, pregnancy, surgery, bleeding ulcer."},{"q":"After someone has received a thrombolytic, why is it so important that we decrease puncture sites?","a":"To prevent hemorrhage. They will bleed at any puncture site."},{"q":"Why is it so important that you ask the patient if they are allergic to iodine before they go for a heart catheterization?","a":"Because contrast dye is used and it contains iodine."},{"q":"If a CHF patient notices their weight increasing, what could that put them at risk for?","a":"Pulmonary edema"},{"q":"Why is it so important that we hurry up and decrease the circulating volume in the pulmonary edema patient?","a":"Because they cannot handle the volume of blood in their lungs."},{"q":"Why are the elderly, the very young, MI patients, or kidney patients at risk for going into fluid volume overload or pulmonary edema?","a":"Because these patients may not have the ability to pump extra fluid or to excrete extra fluid."},{"q":"Any time you are pulling fluid from a patient’s body (thoracentesis, paracentesis, Foley catheter), you are putting the patient at risk for going into a fluid volume deficit or fluid volume excess. Why?","a":"Fluid volume deficit anytime you pull fluid from the body, the vascular space could deplete."},{"q":"There is a possibility with a thoracentesis that a pneumothorax could occur. Why?","a":"Because the doctor could puncture all the way into the lung."},{"q":"If a break in the chest system occurs, air from the outside can rush into the pleural space and cause what life-threatening complication?","a":"Pneumothorax."},{"q":"How can dehydration promote an embolus?","a":"Blood becomes thick and could form a clot."},{"q":"How can venous stasis promote a pulmonary embolus?","a":"Because a thrombus can form, dislodge, and go to the lungs."},{"q":"How can birth control pills promote a pulmonary embolus?","a":"Birth control pills make your blood thick."},{"q":"What is the name of the bacteria that causes TB?","a":"Mycobacterium tuberculosis."},{"q":"What type of light will kill TB?","a":"Ultraviolet light."},{"q":"When a patient is on INH, what lab work has to be monitored?","a":"Liver enzymes"},{"q":"When a patient is on INH, what should be eliminated from their diet?","a":"Alcohol"},{"q":"What lab work should be monitored with Rifampin?","a":"Liver enzymes"},{"q":"How would you monitor for these side effects?","a":"Nephrotoxicity – BUN and creatinine; Ototoxicity – hearing (ringing and pain in the ears)."},{"q":"What would be S\/S of infection with peritoneal dialysis?","a":"Cloudy or dark fluid return."},{"q":"What types of things will bring on a crisis in a sickle cell patient? Explain why.","a":"Any type of stress which increases oxygen demand; decreased O2 concentration causes the sickling process."},{"q":"What is the common cause of death for the sickle cell patient?","a":"Infection"},{"q":"When a patient has leukemia, they are at high risk for infection. Why?","a":"Because you cannot fight infection with immature white cells."},{"q":"What type of emboli do you worry about with a fracture?","a":"Fat."},{"q":"Give S\/S of a fat embolus?","a":"Petechiae over the chest; conjunctival hemorrhages, patchy infiltrates on chest x-ray, usually occurs within the first 36 hours of an injury."},{"q":"What is compartment syndrome?","a":"When circulation is being cut off to an extremity"},{"q":"If you suspect a compartment syndrome, what should you do first?","a":"Loosen the cast"},{"q":"When a patient with an orthopedic injury complains of pain, what is the first thing you should do?","a":"Neurovascular check"},{"q":"Weight on traction should hang freely. Explain why.","a":"If the weights are not hanging freely, then the amount of traction being applied is not what the doctor has ordered."},{"q":"Why is it so important that the total hip replacement patient avoid flexion?","a":"The hip could be dislocated."},{"q":"Give examples of things a total hip replacement patient should avoid specifically related to flexion.","a":"Bending over, sitting in a low chair, climbing stairs."},{"q":"Why is it important that we keep a tourniquet at the bedside with amputation?","a":"In case of hemorrhage"},{"q":"What happens to the pulse pressure with increased intracranial pressure?","a":"It widens."},{"q":"If a neuro patient complains of a headache, what would this mean?","a":"Increased intracranial pressure"},{"q":"Explain the doll’s eye reflex.","a":"When the eyes move the opposite way that the head is turned. Assesses brain stem function"},{"q":"Explain the ice water calorics test.","a":"When ice water is instilled into the ear canal by the physician to assess brain stem function. Normal response would be to look towards the painful stimuli."},{"q":"Explain the Babinski and what is the difference for a child less than one year of age and anyone greater than one year of age.","a":"When the bottom of the foot is stroked, you watch to see what the toes are going to do. In a child less than 1 year, a positive Babinski is okay --- + Babinski means toes fan out. Anyone greater than 1 year of age, we want the toes to curl up. This would be a negative Babinski."},{"q":"Why is it so important that a patient who is about to have cerebral angiography be well hydrated?","a":"To help the patient excrete the dye through the kidneys."},{"q":"Why is it so important that we assess the peripheral pulses before cerebral angiography?","a":"Post-procedure, we will need to check the circulation in the extremity to make sure a clot did not form distal to the puncture site, so baseline data should be collected pre-procedure."},{"q":"Why is it important that we watch for an embolus after cerebral angiography? Explain what you would watch for specifically in your patient.","a":"Because a clot could form and go to the brain. We’re looking for a change in LOC or any motor or sensory deficits, and one-sided weakness or paralysis."},{"q":"Why is the patient who has had a myelogram or any procedure where you have gotten into cerebrospinal fluid at risk for meningitis?","a":"Because the meninges have been punctured, so an infection could have been introduced."},{"q":"What are some reasons for doing a lumbar puncture?","a":"To check for blood, to measure pressures, and to obtain a specimen."},{"q":"What is the most common complication of a lumbar puncture?","a":"Headache"},{"q":"What is a fatal complication of a lumbar puncture?","a":"Herniation."},{"q":"If a patient has an epidural hematoma, explain the sequence of events that will occur and why the patient has these changes.","a":"The patient loses consciousness, then wakes up after going through a recovery period; but then as the bleeding in the head increases, the patient starts having neuro changes and they possibly will pass out again."},{"q":"What is the treatment for an epidural hematoma?","a":"Stop the bleeding; control the ICP."},{"q":"When a patient has a subdural hematoma, explain the sequence of events that can occur (S\/S).","a":"With a subdural hematoma, it can be acute or chronic. If it is an acute bleed, the ICP is going to go up rapidly due to the rapid bleeding; therefore, we must control the bleeding and control the ICP. If it is a chronic bleed, this one can present itself as other things (stroke) as they are bleeding slowly."},{"q":"With which fracture is the patient most at risk for infection?","a":"Open"},{"q":"With a neuro patient, why do we want to avoid narcotics?","a":"Because we do not want to mask the neuro checks."},{"q":"What would be a potential nursing diagnosis for a patient receiving an osmotic diuretic?","a":"Potential for fluid volume deficit"},{"q":"Why do we avoid restraints, bowel and bladder distension, hip flexion, valsalva, isometrics, suctioning, and coughing in the head injured patient?","a":"All of these things increase ICP."},{"q":"Your patient is going to have a liver biopsy. What clotting studies should be checked? Please explain why.","a":"PT; PTT – One of the main functions of the liver is to help our blood to clot. After puncturing into the liver, there is a chance our blood may not clot as quickly as it should."},{"q":"Why is it so important to monitor the vital signs pre- and post-paracentesis?","a":"Because you are worried about throwing the patient into a fluid volume deficit."},{"q":"During a paracentesis, the patient could be thrown into a fluid volume deficit or fluid volume excess?","a":"Deficit"},{"q":"Why does the respiratory status have to be monitored specifically for the pancreatitis patient?","a":"Because the ascites could be pressing up on the diaphragm."},{"q":"What is the major electrolyte imbalance a pancreatitis patient can get into? Explain why.","a":"Hypocalcemia – The pancreas is filled with calcium, but when it starts digesting itself we lose our calcium; therefore the serum calcium goes down."},{"q":"Why are we worried about I & O and daily weights with the cirrhosis patient?","a":"Because we have a patient with a fluid volume problem due to the ascites"},{"q":"Why are we worried about prevention of bleeding in the cirrhosis patient?","a":"Because the liver is altered; therefore the patient is at high risk for hemorrhage."},{"q":"Why is the ileostomy patient at risk for kidney stones?","a":"Because they are always a little dehydrated."},{"q":"Why is it important that the peptic ulcer patient decrease stress?","a":"Because stress increases stomach acid."},{"q":"Why is it important that the peptic ulcer patient stop smoking?","a":"Smoking increases stomach acid."}]

Physiological Integrity – Labor, Delivery, and Postpartum Complications

[{"q":"What are the characteristics of true labor?","a":"Unlike false labor, true labor produces regular rhythmic contractions, abdominal discomfort, progressive descent of the fetus, bloody show, and progressive effacement and dilation of the cervix."},{"q":"How can a mother safely break a breastfeeding infant’s suction?","a":"To help a mother break the suction of her breast-feeding infant, the nurse should teach her to insert a finger at the corner of the infant’s mouth."},{"q":"What can administering high levels of oxygen to a premature neonate cause?","a":"Administering high levels of oxygen to a premature neonate can cause blindness as a result of retrolental fibroplasia."},{"q":"What is amniotomy?","a":"Amniotomy is artificial rupture of the amniotic membranes."},{"q":"What is the average weight gain during pregnancy?","a":"During pregnancy, weight gain averages 25 to 30 lb (11 to 13.5 kg)."},{"q":"What is the effect of rubella infection during the first trimester?","a":"Rubella has a teratogenic effect on the fetus during the first trimester and can produce abnormalities in up to 40% of cases without interrupting the pregnancy."},{"q":"What test measures immunity to rubella?","a":"Immunity to rubella can be measured by a hemagglutination inhibition test (rubella titer). A titer greater than 1:8 indicates immunity in a woman."},{"q":"What does 'floating' mean when describing fetal descent?","a":"When used to describe the degree of fetal descent during labor, floating means the presenting part isn’t engaged in the pelvic inlet but is freely movable above it."},{"q":"What does 'engagement' mean in labor?","a":"Engagement occurs when the largest diameter of the presenting part has passed through the pelvic inlet."},{"q":"What does fetal station indicate?","a":"Fetal station indicates the location of the presenting part in relation to the ischial spines, measured in centimeters above (-) or below (+) the spines."},{"q":"What position provides comfort during the first stage of labor?","a":"During the first stage of labor, the side-lying position usually provides the greatest degree of comfort, although the patient may assume any comfortable position."},{"q":"What should be done if the umbilical cord is around the neonate’s neck and cannot be loosened?","a":"If the umbilical cord can’t be loosened and slipped from around the neonate’s neck, it should be clamped with two clamps and cut between the clamps."},{"q":"What does the Apgar score indicate?","a":"An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate distress, and 0 to 3 indicates severe distress."},{"q":"How is Moro’s reflex elicited?","a":"To elicit Moro’s reflex, the nurse holds the neonate and suddenly drops the head backward; normally, the neonate abducts and extends extremities, then adducts and flexes them."},{"q":"What defines pregnancy-induced hypertension (preeclampsia)?","a":"Pregnancy-induced hypertension is an increase in BP of 30\/15 mm Hg over baseline or BP of 140\/95 mm Hg on two occasions at least 6 hours apart with edema and albuminuria after 20 weeks’ gestation."},{"q":"What are positive signs of pregnancy?","a":"Positive signs of pregnancy include ultrasound evidence, fetal heart tones, and fetal movement felt by the examiner (usually after 4 months)."},{"q":"What is Goodell’s sign?","a":"Goodell’s sign is softening of the cervix."},{"q":"When does quickening occur?","a":"Quickening, a presumptive sign of pregnancy, occurs between 16 and 19 weeks’ gestation."},{"q":"What is the proper method to estimate the date of delivery using Nägele’s rule?","a":"Count backward 3 months from the first day of the last menstrual period and add 7 days to estimate the date of delivery."},{"q":"What is the purpose of administering vitamin K to newborns?","a":"Vitamin K is administered to neonates to prevent hemorrhagic disorders because a neonate’s intestine can’t synthesize vitamin K."},{"q":"What causes respiratory distress syndrome in premature infants?","a":"Respiratory distress syndrome develops in premature infants because their pulmonary alveoli lack surfactant."},{"q":"What are the three phases of a uterine contraction?","a":"The three phases of a uterine contraction are increment, acme, and decrement."},{"q":"What is the gynecoid pelvis?","a":"The gynecoid pelvis is the most ideal type for delivery; other types include platypelloid, anthropoid, and android."},{"q":"Why should pregnant women avoid alcohol?","a":"Pregnant women should be advised that there is no safe level of alcohol intake."},{"q":"What is Fetal Alcohol Syndrome (FAS)?","a":"Fetal alcohol syndrome presents in the first 24 hours after birth and produces lethargy, seizures, poor sucking reflex, abdominal distention, and respiratory difficulty."},{"q":"How can respiratory distress be identified in a premature neonate?","a":"In a premature neonate, signs of respiratory distress include nostril flaring, substernal retractions, and inspiratory grunting."},{"q":"What is the male and female chromosome combination?","a":"The male sperm contributes an X or a Y chromosome, while the female ovum contributes an X chromosome; fertilization produces XX (female) or XY (male)."},{"q":"What is organogenesis?","a":"Organogenesis occurs during the first trimester of pregnancy, specifically days 14 to 56 of gestation."},{"q":"What are the four stages of labor?","a":"Stage 1: onset to full dilation; Stage 2: full dilation to birth; Stage 3: birth to placenta expulsion; Stage 4: postpartum stabilization up to 4 hours."},{"q":"When is a neonate considered premature?","a":"A premature neonate is one born before the end of the 37th week of gestation."},{"q":"What is the classic triad of preeclampsia symptoms?","a":"The classic triad of preeclampsia includes hypertension, edema, and proteinuria; severe cases may show hyperreflexia, visual disturbances, and epigastric pain."},{"q":"What is eclampsia?","a":"Eclampsia is the occurrence of seizures in a woman with pregnancy-induced hypertension that are not caused by another cerebral disorder."},{"q":"What differentiates abruptio placentae from placenta previa?","a":"Abruptio placentae causes painful vaginal bleeding, while placenta previa causes painless bleeding."},{"q":"What medication prevents postpartum hemorrhage caused by uterine atony?","a":"Methylergonovine (Methergine) is an oxytocic agent used to prevent and treat postpartum hemorrhage due to uterine atony or subinvolution."},{"q":"What are Braxton Hicks contractions?","a":"Braxton Hicks contractions are irregular, painless abdominal contractions that do not cause cervical change."},{"q":"What does variable deceleration in fetal heart rate indicate?","a":"Variable decelerations indicate umbilical cord compression or prolapse during fetal monitoring."},{"q":"What are the components of a biophysical profile?","a":"The biophysical profile assesses fetal breathing, body movement, tone, reactive heart rate, and amniotic fluid volume by ultrasound."},{"q":"What is HELLP syndrome?","a":"HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome is a severe variation of pregnancy-induced hypertension."},{"q":"What is uterine atony?","a":"Uterine atony is the failure of the uterus to remain firmly contracted after delivery and is the leading cause of postpartum hemorrhage."},{"q":"What is the major cause of uterine atony?","a":"A full bladder is the major cause of uterine atony after delivery."},{"q":"What causes neonatal hypoglycemia?","a":"Neonatal hypoglycemia can result from prematurity, postmaturity, small or large gestational size, and maternal diabetes, causing jitteriness and seizures."},{"q":"What is the normal range for neonatal blood glucose?","a":"The normal blood glucose level for neonates is 45 to 90 mg\/dl."},{"q":"What does meconium in the amniotic fluid indicate?","a":"The presence of meconium in amniotic fluid indicates possible fetal distress and risk of meconium aspiration."},{"q":"What is caput succedaneum?","a":"Caput succedaneum is edema under the fetal scalp from labor pressure that resolves spontaneously and does not cross suture lines."},{"q":"What is the purpose of oxytocin (Pitocin) administration during labor?","a":"Oxytocin stimulates uterine contractions and may be used to induce labor or strengthen contractions during delivery."},{"q":"What should be done if a mother becomes hypotensive during labor?","a":"If a woman suddenly becomes hypotensive during labor, increase IV fluid rate and place her on her left side."},{"q":"What should be done if contractions last longer than 90 seconds during oxytocin infusion?","a":"The oxytocin infusion should be stopped immediately if contractions last 90 seconds or longer."},{"q":"What are the signs of magnesium sulfate toxicity?","a":"Signs include respiratory depression, absent reflexes, and decreased urine output; respiratory rate and reflexes must be monitored."},{"q":"What is the normal heart rate of a neonate?","a":"A neonate’s normal apical pulse rate averages 120 to 160 beats per minute."},{"q":"What is the most common reason for cesarean birth?","a":"The most common reasons are malpresentation, fetal distress, cephalopelvic disproportion, pregnancy-induced hypertension, or failure to progress in labor."},{"q":"When should the mother begin breastfeeding after birth?","a":"If the neonate is stable, breastfeeding should begin within the first hour of life."},{"q":"What causes postpartum hemorrhage in a multiparous woman?","a":"Overstretched uterine muscles in multiparous women may not contract efficiently, increasing bleeding risk."},{"q":"What indicates postmaturity in a neonate?","a":"Long, brittle fingernails and desquamation (skin peeling) indicate postmaturity."},{"q":"How can postpartum gas pain be relieved?","a":"Ambulation helps relieve gas pain and flatulence in postpartum patients."},{"q":"What is the cause of respiratory distress syndrome in neonates born via cesarean?","a":"Cesarean-delivered neonates have higher risk of respiratory distress due to retained lung fluid and lack of thoracic compression."},{"q":"What is the role of prostaglandin gel in labor induction?","a":"Prostaglandin gel is applied to ripen an unfavorable cervix before induction with oxytocin."},{"q":"What are signs of respiratory distress in neonates?","a":"Expiratory grunting, sandpaper breath sounds, and seesaw chest movements are signs of neonatal respiratory distress."},{"q":"What is the priority nursing action after rupture of membranes?","a":"The nurse must immediately assess fetal heart rate to check for cord prolapse."},{"q":"What defines a complete abortion?","a":"A complete abortion occurs when all products of conception are expelled from the uterus."},{"q":"What is hydramnios (polyhydramnios)?","a":"Hydramnios is an excessive amount of amniotic fluid, more than 2,000 ml in the third trimester."},{"q":"What characterizes the transition phase of the first stage of labor?","a":"The cervix is dilated 8 to 10 cm, and contractions occur every 2–3 minutes lasting about 60 seconds."},{"q":"What defines a reactive nonstress test?","a":"A reactive (negative) nonstress test shows two or more fetal heart-rate accelerations of 15 beats per minute above baseline within 20 minutes."},{"q":"What defines a nonreactive nonstress test?","a":"A nonreactive (positive) nonstress test shows fewer than two fetal heart-rate accelerations of 15 beats per minute in 20 minutes."},{"q":"Why is a nonstress test performed?","a":"It is used to assess fetal well-being in pregnancies complicated by diabetes, hypertension, prolonged gestation, or poor outcomes."},{"q":"How much water should a pregnant woman drink daily?","a":"A pregnant woman should drink at least eight 8-oz glasses (about 2,000 ml) of water daily."},{"q":"How can a breastfeeding mother maintain milk supply?","a":"Stress, dehydration, and fatigue may reduce a mother’s milk supply; adequate rest and hydration help maintain production."},{"q":"What is placenta previa?","a":"Placenta previa is abnormal low implantation of the placenta that encroaches on or covers the cervical os."},{"q":"What is abruptio placentae?","a":"Abruptio placentae is premature separation of a normally implanted placenta, causing pain, vaginal bleeding, and a board-like abdomen."},{"q":"What is the classic difference between abruptio placentae and placenta previa?","a":"Abruptio placentae causes painful bleeding; placenta previa causes painless bleeding."},{"q":"What are the normal stages of lochia?","a":"Lochia rubra (first few days, blood), serosa (4–7 days, serous), alba (7–10 days, leukocytes and decreased blood)."},{"q":"What is colostrum?","a":"Colostrum is the first breast secretion after delivery, rich in antibodies and protein."},{"q":"How does the uterus change during pregnancy?","a":"The uterus lengthens from 6.3 cm before pregnancy to 32 cm at term."},{"q":"What is the true conjugate?","a":"The true conjugate equals the diagonal conjugate minus 1.5 cm (≈10.5 cm), allowing the fetal head (≈10 cm) to pass."},{"q":"What should the nurse do in an emergency delivery to protect the fetus’s head?","a":"Apply gentle pressure to control descent and prevent rapid pressure changes in the molded skull."},{"q":"What pelvic measurement represents the smallest outlet diameter?","a":"The intertuberous diameter—the transverse distance between the ischial tuberosities—is the smallest outlet measurement."},{"q":"Why is methylergonovine (Methergine) administered postpartum?","a":"It prevents or treats postpartum hemorrhage by stimulating uterine contractions."},{"q":"How should methylergonovine (Methergine) be administered in emergencies?","a":"Inject 0.2 mg I.V. over 1 minute while monitoring blood pressure and uterine contractions."},{"q":"What is precipitate labor?","a":"Precipitate labor lasts only about 3 hours and ends with rapid delivery of the neonate."},{"q":"What is pica during pregnancy?","a":"Pica is a craving for nonfood items such as dirt, chalk, starch, or hair, which can endanger the fetus."},{"q":"Why should a pregnant woman take folic acid?","a":"Folic acid is needed for rapid cell division and helps prevent neural-tube defects."},{"q":"What is clomiphene (Clomid) used for?","a":"Clomiphene induces ovulation and may lead to multiple births."},{"q":"When is cervical suturing (cerclage) usually performed?","a":"Between 14 and 18 weeks to treat an incompetent cervix, removed by 35 weeks."},{"q":"What are the FDA drug risk categories for pregnancy?","a":"A (no risk), B (no animal risk), C (adverse in animals), D (evidence of risk but possible benefit), X (clear fetal anomalies and unacceptable risk)."},{"q":"What are symptoms of a ruptured ectopic pregnancy?","a":"Sharp lower-abdominal pain, spotting, rigidity, rapid respirations, tachycardia, and signs of shock."},{"q":"What are the mechanics of delivery?","a":"Engagement, descent and flexion, internal rotation, extension, external rotation (restitution), and expulsion."},{"q":"What is McDonald’s sign?","a":"A probable sign of pregnancy: ease in flexing the uterine body against the cervix."},{"q":"What is the risk of introducing air during oral sex in pregnancy?","a":"Air embolism may occur; partners should avoid blowing air into the vagina."},{"q":"What is the effect of cytomegalovirus infection in pregnancy?","a":"It can be transmitted to the fetus and cause congenital infection; pregnant staff should avoid exposure."},{"q":"What is fetal demise?","a":"Fetal demise refers to death of the fetus after viability."},{"q":"What increases insulin needs during pregnancy?","a":"Placental hormones have anti-insulin effects, so insulin requirements rise during the third trimester."},{"q":"What are common congenital defects in infants of diabetic mothers?","a":"Skeletal abnormalities and ventricular septal defects; malformations occur three times more often than in nondiabetic infants."},{"q":"What indicates preeclampsia in a patient?","a":"Puffiness around the eyes or hand edema, such as difficulty wearing rings, may signal preeclampsia."},{"q":"How does postpartum blood pressure change in preeclampsia?","a":"Blood pressure usually returns to normal during the puerperal period."},{"q":"What lab test detects maternal antibodies attached to neonatal RBCs?","a":"The direct antiglobulin (Direct Coombs’) test detects antibodies on neonatal red cells."},{"q":"What causes nausea and vomiting in early pregnancy?","a":"Rising levels of human chorionic gonadotropin (hCG) during the first trimester."},{"q":"What should a patient report after abortion?","a":"Bright-red clots, bleeding >7 days, foul discharge, fever > 100 °F, severe cramping, nausea, or vomiting."},{"q":"How long is normal pregnancy?","a":"About 280 days, 40 weeks, 9 calendar months, or 10 lunar months."},{"q":"What is normal initial neonatal weight loss?","a":"5 % to 10 % of birth weight during the first few days."},{"q":"What are normal neonatal hemoglobin values?","a":"Hemoglobin 17 to 20 g\/dL."},{"q":"What is the Apgar score used for?","a":"To assess neonatal respiratory effort, heart rate, muscle tone, reflex irritability, and color at 1 and 5 minutes after birth."},{"q":"How does maternal hypertension affect fetal blood gases?","a":"It decreases placental blood flow, raising fetal CO₂ and lowering fetal pH."},{"q":"What does lightening refer to?","a":"Settling of the fetal head into the brim of the pelvis near term."},{"q":"What is molding?","a":"The process by which the fetal head changes shape to pass through the birth canal."},{"q":"Why is oxytocin added to IV solution postpartum?","a":"To promote uterine involution and stimulate lactation after the placenta is delivered."},{"q":"What is supine hypotensive syndrome?","a":"Compression of the inferior vena cava by the uterus when lying supine, reducing venous return and causing hypotension."},{"q":"How is supine hypotension treated?","a":"Have the patient lie on her left side to relieve vena-cava pressure."},{"q":"What is the effect of relaxin during pregnancy?","a":"It relaxes pelvic connective tissue and joints to facilitate fetal passage during delivery."},{"q":"What causes dependent edema in pregnancy?","a":"Increased femoral venous pressure from 10 to 18 mm Hg causes dependent edema."},{"q":"What is hemodilution of pregnancy?","a":"Increased plasma volume relative to red-cell mass lowers hematocrit, creating physiologic anemia of pregnancy."},{"q":"What is the normal mean arterial pressure threshold for hypertension in pregnancy?","a":"A mean arterial pressure > 100 mm Hg after 20 weeks is hypertensive."},{"q":"What is the purpose of Kegel exercises postpartum?","a":"To strengthen perineal muscles and improve urinary control."},{"q":"What is subinvolution?","a":"Failure of the uterus to return to its normal size, often due to bladder distention or retained tissue."},{"q":"What are possible causes of fundal height smaller than expected?","a":"Growth retardation, missed abortion, transverse lie, or false pregnancy."},{"q":"What causes fundal height larger than expected?","a":"Multiple gestation, polyhydramnios, uterine myomata, or a large baby."},{"q":"What are the risks of amniocentesis?","a":"Spontaneous abortion, trauma, premature labor, infection, and Rh sensitization."},{"q":"What should be monitored after amniocentesis?","a":"Abdominal cramping or vaginal bleeding may indicate complications."},{"q":"What is the difference between gravida and para?","a":"Gravida = number of pregnancies (total); Para = number reaching viability (≥20 weeks)."},{"q":"What are the stages of uterine contraction?","a":"Increment (rising tension), acme (peak), decrement (relaxation)."},{"q":"What are signs of narcotic withdrawal in a neonate?","a":"Tremors, restlessness, high-pitched cry, irritability, poor sleep, and feeding difficulty."},{"q":"What are neonatal signs of heroin withdrawal?","a":"Begin several hours to 4 days after birth; include tremors, irritability, and poor feeding."},{"q":"When do methadone-withdrawal symptoms appear in neonates?","a":"From 7 days to several weeks after birth."},{"q":"What is the treatment for neonatal narcotic withdrawal?","a":"Drugs such as phenobarbital, paregoric, or diazepam may be prescribed; a dark, quiet environment is provided."},{"q":"What should be done after delivery of the placenta?","a":"Massage the uterus to stimulate contraction and prevent hemorrhage."},{"q":"What is the purpose of neonatal phototherapy?","a":"To reduce bilirubin levels in jaundiced infants; eyes and genitals must be covered during exposure."},{"q":"What is lanugo?","a":"Fine fetal hair covering the body until about 20 weeks, then disappearing from the face, trunk, and limbs."},{"q":"What is the normal specific gravity of neonatal urine?","a":"1.003 to 1.030; lower = overhydration, higher = dehydration."},{"q":"What is the neonatal period?","a":"The first 28 days after birth, also called the first month of life."},{"q":"What is the normal neonatal body temperature range?","a":"98° to 99° F (36.7°–37.2° C)."},{"q":"What are normal neonatal respirations?","a":"40 to 60 breaths per minute; count for a full minute."},{"q":"What is the normal length and weight of a full-term newborn?","a":"A full-term neonate typically weighs 5 to 9 lb (2 to 4 kg), measures 18 to 22 inches (45.5–56 cm) in length, and has a head circumference 1 inch larger than the chest."},{"q":"What is the normal neonatal head circumference compared to chest circumference?","a":"The head circumference is normally 2 to 3 cm greater than the chest circumference."},{"q":"When does the anterior fontanel close?","a":"The diamond-shaped anterior fontanel closes between 12 and 18 months of age."},{"q":"When does the posterior fontanel close?","a":"The triangular posterior fontanel closes by about 2 months of age."},{"q":"What does a tuft of hair over a newborn’s spine indicate?","a":"A tuft of hair over the spine is an abnormal finding and may indicate spina bifida."},{"q":"What is the normal neonatal water content?","a":"The percentage of water in a neonate’s body is about 78% to 80%."},{"q":"How should a neonate be positioned for nasotracheal suctioning?","a":"Position with neck slightly hyperextended in a “sniffing” position, chin up and head tilted back slightly."},{"q":"What are signs of postmature neonates?","a":"Long, brittle fingernails and desquamation (skin peeling) are common in postmature infants."},{"q":"What indicates chromosomal abnormalities in neonates?","a":"Low-set ears may indicate chromosomal abnormalities such as Down syndrome."},{"q":"When is meconium normally passed?","a":"Meconium is usually passed in the first 24 hours after birth, but may take up to 72 hours."},{"q":"Why should boys born with hypospadias not be circumcised?","a":"Because the foreskin may be needed for reconstructive surgery."},{"q":"When are hepatitis B vaccine and immune globulin given to newborns?","a":"Hepatitis B vaccine is usually given within 48 hours of birth, and immune globulin within 12 hours if the mother is HBsAg positive."},{"q":"What is the primary cause of diaphragmatic hernia symptoms in neonates?","a":"The herniated organs compress and displace the lungs and heart, causing respiratory distress shortly after birth."},{"q":"What is neonatal jaundice within 24 hours called?","a":"Pathological jaundice; it may indicate erythroblastosis fetalis."},{"q":"What does neonatal acrocyanosis indicate?","a":"Acrocyanosis (blueness of hands and feet) is normal in neonates due to immature peripheral circulation."},{"q":"What is ophthalmia neonatorum and how is it prevented?","a":"A severe eye infection caused by maternal gonorrhea; prevented with erythromycin, tetracycline, or silver nitrate instilled at birth."},{"q":"How should the neonate be positioned after birth to drain mucus?","a":"Place the neonate in a 30-degree Trendelenburg position to facilitate mucus drainage."},{"q":"How should heat loss be prevented in newborns?","a":"Keep the neonate under a radiant warmer or wrap in a warmed blanket; expose only one body part at a time."},{"q":"How many vessels are in a normal umbilical cord?","a":"The umbilical cord normally has two arteries and one vein."},{"q":"What is the proper way to provide umbilical cord care?","a":"Clean the cord area with alcohol after every diaper change to prevent infection and promote drying."},{"q":"What is the purpose of neonatal phototherapy eye and genital protection?","a":"To protect from light exposure and prevent damage during treatment."},{"q":"What is mongolian spot?","a":"A bluish or brown patch commonly on the sacrum or buttocks in nonwhite infants, disappearing by age 2–3 years."},{"q":"What is vernix caseosa?","a":"A cheeselike substance covering the fetus’s skin in utero, protecting it; may be rubbed in or washed off in 1–2 baths."},{"q":"What is Harlequin sign in neonates?","a":"When lying on one side, the dependent side appears red and the upper side pale; due to immature vasomotor control."},{"q":"What is cutis marmorata?","a":"Mottling or purple discoloration of infant skin caused by a transient vasomotor response to cold."},{"q":"What is Ortolani’s sign?","a":"An audible click or palpable jerk on thigh abduction indicating congenital hip dislocation."},{"q":"What are features of Down syndrome in neonates?","a":"Hypotonia, slanted eyes, excess neck skin, flat facial features, small genitalia, simian crease, and absence of Moro reflex."},{"q":"What are causes of postpartum hemorrhage?","a":"Uterine atony, retained tissue, trauma, or coagulopathies."},{"q":"What is the leading cause of maternal death in the United States?","a":"Pregnancy-induced hypertension is a leading cause of maternal death."},{"q":"What is the Guthrie test used for?","a":"It is a screening test for phenylketonuria, most reliable between the second and sixth days after birth after protein ingestion."},{"q":"What indicates fetal well-being in the biophysical profile?","a":"Normal fetal breathing movements, tone, movements, reactive heart rate, and adequate amniotic fluid."},{"q":"What is the difference between physiological and pathological jaundice?","a":"Physiological appears after 24 hours; pathological within 24 hours and indicates disease."},{"q":"What is the function of the placenta during pregnancy?","a":"Acts as a fetal lung, enabling gas exchange; interruption causes fetal acidosis and hypoxia."},{"q":"When should vaginal exam be avoided in pregnancy?","a":"When vaginal bleeding is undiagnosed until placenta previa is ruled out by ultrasound."},{"q":"What causes a high alpha-fetoprotein (AFP) level?","a":"Neural tube defects; low levels are associated with Down syndrome."},{"q":"What defines macrosomia in infants of diabetic mothers?","a":"Excessive birth weight due to increased insulin and fat deposition in the fetus."},{"q":"What is the purpose of Rho(D) immune globulin administration?","a":"To prevent Rh sensitization in an Rh-negative mother after delivering an Rh-positive infant."},{"q":"What happens if a pregnant woman is rubella nonimmune (titer &lt;1:8)?","a":"She should be immunized after delivery and avoid pregnancy for 3 months."},{"q":"What is HELLP syndrome?","a":"Hemolysis, elevated liver enzymes, and low platelets—a severe variant of preeclampsia requiring immediate medical attention."},{"q":"What is uterine inversion?","a":"A rare but life-threatening condition where the uterus turns inside out, causing hemorrhage and shock."},{"q":"What defines fetal engagement?","a":"The largest diameter of the fetal head has passed through the pelvic inlet."},{"q":"What is the role of prolactin?","a":"Prolactin stimulates and sustains milk production in the postpartum period."},{"q":"What are signs of preterm labor?","a":"Uterine contractions, pelvic pressure, low back pain, and cervical dilation before 37 weeks."},{"q":"What is the purpose of tocolytic therapy?","a":"To suppress premature labor contractions using agents like terbutaline, ritodrine, or magnesium sulfate."},{"q":"What are contraindications to tocolytic therapy?","a":"Fetal death, distress, or severe maternal hemorrhage."},{"q":"What is the most urgent neonatal surgical emergency?","a":"Diaphragmatic hernia due to respiratory compromise."},{"q":"What is meconium aspiration?","a":"Inhalation of meconium-stained amniotic fluid causing respiratory distress after birth."},{"q":"What is the significance of 3-vessel cord anomalies?","a":"A single umbilical artery may indicate congenital anomalies."},{"q":"What are signs of retained placenta?","a":"Continued vaginal bleeding and failure of the uterus to contract firmly after delivery."},{"q":"What is the postpartum stabilization phase?","a":"The 4th stage of labor lasting up to 4 hours after placenta delivery, allowing mother’s recovery and observation."},{"q":"Why is ambulation encouraged postpartum?","a":"Promotes circulation, prevents thrombosis, and relieves gas pain."},{"q":"What are the characteristics of premature infants?","a":"Thin, shiny skin, weak cry, poor muscle tone, and minimal subcutaneous fat."},{"q":"What are the normal fetal heart rate parameters?","a":"120–160 bpm baseline, accelerations indicate well-being, decelerations indicate possible distress."},{"q":"What does late deceleration in fetal heart rate indicate?","a":"Fetal hypoxia from uteroplacental insufficiency."},{"q":"How should the nurse respond to late decelerations?","a":"Turn mother on her left side, administer oxygen 8–10 L\/min, and notify the physician."},{"q":"What defines variability in fetal heart rate?","a":"Fluctuations from the baseline (120–160 bpm) indicating fetal autonomic function and oxygenation."},{"q":"What should be done for a prolapsed umbilical cord?","a":"Relieve pressure by positioning the mother in knee-chest or Trendelenburg, and maintain manually until delivery."},{"q":"What is a probable cause of infertility in men tested for sperm count?","a":"Low sperm motility or insufficient abstinence period before collection (&lt;48 hours)."},{"q":"What defines oligohydramnios?","a":"Amniotic fluid volume less than 500 ml in the third trimester, often due to renal abnormalities."},{"q":"What defines polyhydramnios?","a":"Excess amniotic fluid (>2000 ml), associated with maternal diabetes and fetal anomalies."},{"q":"What are signs of magnesium sulfate toxicity?","a":"Respiratory depression, absence of deep tendon reflexes, decreased urine output (&lt;30 ml\/hr)."},{"q":"What indicates preterm labor risk?","a":"History of previous preterm births, uterine anomalies, or multiple gestation."},{"q":"What is the normal fetal station at the level of ischial spines?","a":"Station 0."},{"q":"How is fetal descent measured?","a":"In centimeters relative to the ischial spines: negative above, positive below."},{"q":"What defines station +5?","a":"The presenting part is at the vaginal opening, ready for delivery."},{"q":"What defines station –5?","a":"The presenting part is still at the pelvic inlet, high in the pelvis."}]

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