C. Weight and D. Smoking
(Obesity is a modifiable risk factor that is associated with coronary artery disease [CAD]; an increased fat intake contributes to an increased serum cholesterol and atherosclerosis. Smoking, which constricts the blood vessels, is
A nurse is conducting cholesterol screening for a manufacturing corporation during a health fair. A 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg) puts out his cigarette and asks the nurse how to modify his risk factors for coronary artery disease. On which risk factors should the nurse help the client focus? Select all that apply.
A. Age
B. Height
C. Weight
D. Smoking
E. Family history
D. Magnesium Sulfate
(Magnesium sulfate can be prescribed for pregnancy-induced hypertension. Lithium is used to treat body water retention. Miglitol is used to decrease blood sugar levels. Calcium gluconate is used to relieve magnesium toxicity associate
A pregnant woman reports severe headaches, chest pain, and fatigue. Upon diagnosis, the woman has hypertension. Which drug can be prescribed to reduce hypertension?
A. Lithium
B. Miglitol
C. Calcium gluconate
D. Magnesium sulfate
D. Cholesterol is a necessary body constituent and cannot be eliminated. (Cholesterol is an essential precursor of body substances such as vitamin D and steroid hormones; although the body synthesizes some cholesterol, a small amount is needed in the diet
A client is placed on a heart-healthy diet to control the intake of saturated fats and cholesterol. Which information should the nurse include in a teaching plan to explain best the dietary nature of this diet?
A. Polyunsaturated fats come from animal foods such as meat.
B. Plant sources of cholesterol must be limited in the daily diet.
C. Saturated fats come from plant foods, such as seeds and grains.
D. Cholesterol is a necessary body constituent and cannot be eliminated.
B. Skull hypoplasia
(The use of angiotensin-converting enzyme [ACE] inhibitors in the second and third trimesters of pregnancy may cause skull hypoplasia in the newborn. Antiseizure drugs may cause neural tube defects and growth delays in the newborn. War
A pregnant client with a history of hypertension is treated with an angiotensin-converting enzyme inhibitor. Which teratogenic effect of angiotensin-converting enzyme (ACE) inhibitors is the neonate at risk for?
A. Growth delay
B. Skull hypoplasia
C. Neural tube defects
D. Skeletal and central nervous system defects
B. Hemolytic anemia
(Methyldopa is used in the treatment of hypertension. It can be a precipitating factor in an autoimmune disease such as hemolytic anemia. Scopolamine transdermal, an anticholinergic, may cause dry mouth or xerostomia. Chemotherapy drug
A client is treated with methyldopa for hypertension. For which side effect should the nurse monitor the client?
A. Xerostomia
B. Hemolytic anemia
C. Thrombocytopenia
D. Lupus-like syndrome
D. Cellular Membrane
(Cholesterol is an essential structural and functional component of most cellular membranes. That it is associated with atherosclerotic plaques does not detract from its essential functions. Cholesterol is not necessary for blood clot
A client with a high cholesterol level says to the nurse, "Why can't the doctor just give me a medication to eliminate all the cholesterol in my body so it isn't a problem?" Which factor related to why cholesterol is important in the human body should the nurse include in a response to the client's question?
A. Blood clotting
B. Bone formation
C. Muscle contraction
D. Cellular membranes
You need some fat to supply the necessary fatty acids, so it's mainly just a need to cut down on the amount of fat you consume.
A client experiences elevated triglycerides and cholesterol. The client appears discouraged and says, "Well, I guess I'd better cut out all the fat and cholesterol in my diet." Which is the nurse's most appropriate response?
A. Well, yes, that will certainly lower the amount of your blood fats."
B. "That's good, but be sure to compensate by adding more carbohydrates."
C. "You need some fat to supply the necessary fatty acids, so it's mainly just a need to cut down on the amount of fat you consume."
D. "You need some cholesterol in your diet because your body cannot manufacture it, so just avoid excessive amounts.
A. I'll start eating more red meat.
The clinic nurse is teaching an adolescent about lifestyle modifications to prevent hyperlipidemia. Which statement by the adolescent indicates a need for further teaching?
A. "I'll start eating more red meat."
B. "I'm going to eat a lot of low-fat yogurt."
C. "I'll try to stop eating so much processed food."
D. "I'll start eating whole-grain bread instead of white.
A. "Increase your intake of fiber and fluid." (Fiber and fluids help prevent the most common adverse effect of constipation and its complication: fecal impaction. The medication should be taken with meals. The pulse is not affected. It reduces the inciden
Which instructions should the nurse include in the teaching plan for a client with hyperlipidemia who is being discharged with a prescription for cholestyramine?
A. "Increase your intake of fiber and fluid."
B. "Take the medication before you go to bed."
C. "Check your pulse before taking the medication."
D. "Contact your healthcare provider if your skin or sclera turn yellow.
A. Client with corneal arcus and E. Client with yellow lipid lesions on eyelids (The presence of corneal arcus, which is the whitish opaque ring around the junction of the cornea and sclera, indicates that the client has hyperlipidemia. Yellow lipid lesio
Which client is suspected to have an increased risk of hyperlipidemia? Select all that apply.
A. Client with corneal arcus
B. Client with periorbital edema
C. Client with decreased skin turgor
D. Client with paleness of conjunctivae
E. Client with yellow lipid lesions on eyelids
C. Hypotonia (Hypotonia occurs with magnesium sulfate toxicity because of skeletal and smooth muscle relaxation. Pallor, tremor, and tachycardia are not signs of magnesium sulfate toxicity.)
A client who received intravenous magnesium sulfate for preeclampsia gives birth. What clinical finding in the newborn indicates to the nurse that magnesium sulfate toxicity may have occurred?
A. Pallor
B. Tremor
C. Hypotonia
D. Tachycardia
A. Headache, C. Abdominal pain and E. Flulike symptoms (Headache, abdominal pain, and flulike symptoms are all indications of increasing severity of preeclampsia and HELLP syndrome. Constipation and vaginal bleeding are not related to preeclampsia.)
A client with preeclampsia is admitted to the labor and birthing suite. Her blood pressure is 130/90 mm Hg, and she has 2+ protein in her urine along with edema of the hands and face. Which signs or symptoms would the client display if she were developing hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome)? Select all that apply.
A. Headache
B. Constipation
C. Abdominal pain
D. Vaginal bleeding
E. Flulike symptoms
Calcium gluconate
A pregnant woman was diagnosed with hypertension and was administered magnesium sulfate. What drug should be co-administered to prevent magnesium toxicity?
B. "Have an annual urinalysis."
(African-American clients have 20% less blood flow to the kidneys because of high sodium consumption. This causes anatomical changes in the blood vessels, thereby increasing the risk of kidney failure. Therefore instructing
Which instruction would be most beneficial for an aging African-American client with hypertension?
A. "Check the pulse daily."
B. "Have an annual urinalysis."
C. "Record blood pressure weekly."
D. "Visit an ophthalmologist monthly.
D. Inform the healthcare provider if the client wishes to become pregnant.
(Simvastatin is contraindicated in pregnancy because it is capable of causing fetal damage. It is a pregnancy category X teratogen. It should be taken in the evening because most c
A healthcare provider prescribes simvastatin 20 mg daily for elevated cholesterol and triglyceride levels for a female client. Which is most important for the nurse to teach when the client initially takes the medication?
A. Take the medication with breakfast.
B. Have liver function tests every 6 months.
C. Wear sunscreen to prevent photosensitivity reactions.
D. Inform the healthcare provider if the client wishes to become pregnant.
A. Perform jaw-thrust maneuver.
B. Administer supplemental oxygen.
E. Apply direct pressure with a sterile dressing.
C. Measure client's level of consciousness.
D. Remove the client's clothing to perform a thorough physical examination.
(Facial trauma can
A client with facial trauma is admitted to the emergency department. The client has dyspnea, cyanosis, and external bleeding. What is the correct order of nursing interventions that should be performed in this situation?
A. Perform jaw-thrust maneuver.
B. Administer supplemental oxygen.
C. Measure client's level of consciousness.
D. Remove the client's clothing to perform a thorough physical examination.
E. Apply direct pressure with a sterile dressing.
B. Stop administering the medication.
(Morphine sulfate is an opioid analgesic and can depress the central nervous system, which results in respiratory depression. A respiratory rate of 8 breaths per minute indicates respiratory depression, and the nurse
The nurse finds the respiratory rate is 8 breaths per minute in a client who is on intravenous morphine sulfate. What should the nurse do immediately in this situation?
A. Measure other vital signs.
B. Stop administering the medication.
C. Elevate the head of the client's bed.
D. Report to the primary healthcare provider.
B. Inform the healthcare provider of the client's status and prepare to start an IV line. ()
An adult client is brought to the emergency department by a friend who states, "We were all partying at a club, and all of a sudden my friend collapsed." Vital signs revealed a temperature of 99.2� F, pulse of 152, respiratory rate of 32, blood pressure of 163/92. After performing a physical assessment and collecting a health history from the client, what action should the nurse take next?
A. Reassess the client and allow the friend to stay.
B. Inform the healthcare provider of the client's status and prepare to start an intravenous (IV) line.
C. Assign the client to a private room and put a cool cloth on the client's forehead.
D. Place the client in a dimly lit room and perform a neurologic assessment every 15 minute
C. Severe hypothermia
(Bradycardia along with severe hypotension and decreased respiratory rate suggest the nurse is treating the client for severe hypothermia. Frostbite injuries can be superficial, partial, or full thickness and occur when body tissue f
The client, who takes part in mountaineering, shows signs of bradycardia along with severe hypotension and a decreased respiratory rate. For which condition is the nurse treating the client?
A. frost bite
B. Mild hypothermia
C. Severe hypothermia
D. Moderate hypothermia
C. Neonates
(The physical characteristics of the larynx and small airway diameter, the structure of the respiratory system, and the high metabolic rate of neonates place them at a higher risk than infants, children, or adolescents of developing respirator
Which group of the pediatric population is at a higher risk of developing respiratory complications upon administration of general anesthesia?
A. Infants
B. Children
C. Neonates
D. Adolescents
B. Bordetella pertussis
(This disease is caused by Bordetella pertusis. Pertussis is a respiratory tract infection that begins with the common cold and progresses to whooping cough. The client also develops coughing fits that last for several minutes. Inh
The nurse is caring for a client with a respiratory tract infection that started with a common cold but has progressed to whooping cough. The client also has coughing fits that last for several minutes. Which organism is responsible for the client's condition?
A. Bacillus anthracis
B. Bordetella pertussis
C. Streptococcus pneumoniae
D. Mycobacterium tuberculosis
A. Starting an intravenous line
B. Drawing a blood sample for a complete blood count and differential
D. Assessing oxygen saturation of the blood and administering oxygen by mask if it is below 94%
F. Assessing the child's temperature and administering an
A 3-year-old child is brought to the emergency department after the sudden onset of high fever, drooling, and respiratory distress. What nursing actions should the nurse perform? Select all that apply.
A. Starting an intravenous line
B. Drawing a blood sample for a complete blood count and differential
C. Examining the child's throat with a flashlight and tongue depressor for swelling
D. Assessing oxygen saturation of the blood and administering oxygen by mask if it is below 94%
E. Asking the parents to remain in the waiting room during the examination and interventions
F. Assessing the child's temperature and administering an antipyretic if the rectal temperature is higher than 101� F (38.3� C)
B. Stopping the infusion and starting an infusion of dextrose and water
(The client's slow pulse, respirations, and flushed face are signs of magnesium sulfate toxicity. The infusion should be stopped and the intravenous site maintained with an infusion o
A nurse is monitoring a client with severe preeclampsia who is receiving an infusion of magnesium sulfate. Assessment reveals a pulse rate of 55 beats/min, a respiratory rate of 10 breaths/min, and a flushed face. What are the next nursing actions?
A. Continuing the infusion and notifying the primary healthcare provider
B. Stopping the infusion and starting an infusion of dextrose and water
C. Continuing the infusion and documenting the findings in the clinical record
D. Decreasing the rate of the infusion and obtaining blood for a magnesium level
C. Administer 100% oxygen to the client.
(Before suctioning, regardless of the means, oxygen should be administered, because the suctioning procedure depletes oxygen from the respiratory tract, causing a potential drop in oxygen saturation levels. In a cl
The nurse is preparing to perform endotracheal suctioning of a client with respiratory difficulties. Before beginning the procedure, what should the nurse do?
A. Ask the client to take several deep breaths.
B. Instruct the client to cough before suctioning.
C. Administer 100% oxygen to the client.
D. Change the suctioning equipment to ensure sterility.
A. Dyspnea (Bleeding from the airway, aphonia, hoarseness, and subcutaneous emphysema are the clinical manifestations of laryngeal trauma. Maintaining a patent airway is a priority; therefore, dyspnea should be corrected to prevent life-threatening conseq
The nurse is assessing a client with a laryngeal trauma. This client presents with hemoptysis, aphonia, hoarseness, dyspnea, and subcutaneous emphysema. Which condition of the client stands first in the priority list?
A. Dyspnea
B. Aphonia
C. Hoarseness
D. Subcutaneous emphysema
curb 65
Point scoring system used for evaluating the risk of mortality with pneumonia
16
What is the minimum respiratory rate in a normal adolescent?
B. Ear infection
C. Acute sinusitis
E. Inflammation of the tonsils
(The toddler-age client remains at risk for ear infection [otitis media], acute sinusitis, and inflammation of the tonsils or tonsillitis; therefore, the nurse should assess the toddler-ag
Which respiratory infections should the nurse monitor the toddler-age client for based on structural differences during this stage of development? Select all that apply.
A. Bronchiolitis
B. Ear infection
C. Acute sinusitis
D. Laryngotracheobronchitis
E. Inflammation of the tonsils
2. Rh positive with a negative Coombs result
(All Rh-negative mothers with Rh-positive infants are candidates for Rho[D] immune globulin; a negative Coombs test result verifies an absence of Rh antibodies, indicating that the Rho[D] immune globulin will b
Rho(D) immune globulin (RhoGAM) is prescribed for an Rh-negative client who has just given birth. Before giving the medication, the nurse verifies the newborn's Rh factor and reaction to the Coombs test. Which combination of newborn Rh factor and Coombs test result confirms the need to give Rho(D) immune globulin?
A. Rh positive with a positive Coombs result
B.Rh positive with a negative Coombs result
C.Rh negative with a positive Coombs result
D.Rh negative with a negative Coombs result
C. Placing the prescribed as-needed warm, wet compress on the elbow
A 16-year-old girl with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis) and has a patient-controlled analgesia (PCA) pump. She complains of pain (5 on a scale of 1 to 10) in her right elbow. The nurse observes that the pump is "locked out" for another 10 minutes. What action should the nurse implement?
A. Turning on the television for diversion
B. Calling the primary healthcare provider for another analgesic prescription
C. Placing the prescribed as-needed warm, wet compress on the elbow
D. Informing her gently that she must wait until the pump reactivates to get more medication
B. Chicken
C. Broccoli
D. Lean steak
Which iron-rich foods should the nurse recommend for a toddler-age client who is diagnosed with iron deficiency anemia? Select all that apply.
A. Carrots
B. Chicken
C. Broccoli
D. Lean steak
E. Whole milk
B. Intravenous fluids
A 10-year-old child with sickle cell anemia is admitted to the unit in vaso-occlusive crisis (VOC). After the child has been given the prescribed analgesic, which intervention is the priority to minimize the effects of the crisis?
A. Isotonic exercises
B. Intravenous fluids
C. Oxygen by nasal cannula
D. Cold compresses to affected areas
D. Half a cup of cooked spinach
The nurse is teaching a prenatal class to expectant mothers in their first trimester of pregnancy. In addition to discussing the need for 0.6 mg/day of folic acid replacement, which dietary choice that is high in folic acid should the nurse recommend?
A. One egg
B. Slice of bread
C. Half a cup of corn
D. Half a cup of cooked spinach
B. Evidence of urinary tract infection
C. Symptoms of hypoglycemia
(Pregnant clients with sickle cell anemia are particularly vulnerable to infections, especially of the genitourinary tract; urine specimens should be examined frequently. A client with sic
A pregnant client with sickle cell anemia visits the clinic each month for a routine examination. What additional assessment should be made during every visit? Select all that apply.
A. Signs of hypothyroidism
B. Evidence of urinary tract infection
C. Symptoms of hypoglycemia
D. Presence of hyperemesis gravidarum
E. Evidence of carpal tunnel syndrome
A. Microcytic red blood cells
D. Slightly reduced reticulocyte count
In iron-deficiency anemia the red blood cells are microcytic, with a decreased mean corpuscular volume. The reticulocyte count is within the expected range or slightly reduced. The red b
When reviewing the results of a toddler's complete blood count, a nurse concludes on the basis of decreased hemoglobin and hematocrit levels that the child has iron-deficiency anemia. Which other laboratory findings are indicative of iron-deficiency anemia? Select all that apply.
A. Microcytic red blood cells
B. Hyperchromic red blood cells
C. Low total iron-binding capacity
D. Slightly reduced reticulocyte count
E. Increased erythrocyte sedimentation rate
D. Determining parental knowledge about infection
(The spleen plays a role in immunity. Initially the spleen enlarges and becomes congested with accumulated sickled red blood cells; in time, fibrous material replaces the tissue in the spleen, and by age 5
A nurse in the pediatric clinic is evaluating a 6-year-old child with sickle cell anemia whose spleen autoinfarcted by age 4. What is the priority nursing care at this time?
A. Monitoring for signs of jaundice
B. Assessing the abdomen frequently
C. Monitoring serial hematocrit readings
D. Determining parental knowledge about infection
B. plasma volume increase
(There is a 30% to 50% increase in maternal plasma volume at the end of the first trimester, leading to hemodilution and a decrease in the concentrations of hemoglobin and erythrocytes. Erythropoiesis increases after the first tr
How does the nurse explain physiologic anemia to a pregnant client?
A. Erythropoiesis decreases.
B. Plasma volume increases.
C. Utilization of iron decreases.
D. Detoxification by the liver increases
D. Motorboat rides around the lake (Motor boating is a relatively passive activity that will not increase the child's oxygen demands, which can precipitate sickling and therefore a painful episode. Mountain lakes are usually cold; temperature extremes can
The mother of a 13-year-old child with sickle cell anemia tells the nurse that the family is going camping by a lake this summer. She asks what activities are appropriate for her child. Which activity should the nurse suggest?
A. Swimming in the lake
B. Soccer with the family
C. Climbing the mountain trails
D. Motorboat rides around the lake
B. Encourage foods high in protein, iron, vitamin C, and folate.
(Increased intake of protein, iron, folate, and vitamin C provides nutrients needed for maximum iron absorption and hemoglobin production. The other interventions do not address the patient'
A patient has anemia related to inadequate intake of essential nutrients. Which intervention would be appropriate for the nurse to include in the plan of care for this patient?
A. Plan for 30 minutes of rest before and after every meal.
B. Encourage foods high in protein, iron, vitamin C, and folate.
C. Instruct the patient to select soft, bland, and nonacidic foods.
D. Give the patient a list of medications that inhibit iron absorption.
C. Folic acid
(Folic acid acts as a necessary coenzyme in the formation of heme, the iron-containing protein in hemoglobin. Calcium is not involved in the production of red blood cells. Thiamine is a coenzyme in carbohydrate metabolism. Riboflavin is a co
While counseling the parents of an adolescent with anemia related to an inadequate diet, a nurse explains that several different nutrients, including protein, iron, and vitamin B 12, are involved. What other nutrient should the nurse include in the teaching?
A. Calcium
B. Thiamine
C. Folic acid
D. Riboflavin
c. Deferoxamine
(A client with sickle cell anemia requires frequent blood transfusions and is at an increased risk for iron toxicity. Deferoxamine is an intravenous medication that chelates with the iron and reduces iron overload or hemochromatosis in the
The nurse observes that a client with sickle cell anemia and on a blood transfusion regimen has cardiac dysrhythmias due to iron overdose toxicity. Which medication is most beneficial to this client?
A. Deferasirox
B. Deferiprone
C. Deferoxamine
D. Ferrous gluconate
C. Intramuscular injections once a month will maintain control. (Intramuscular injections bypass the vitamin B 12 absorption defect [lack of intrinsic factor, the transport carrier component of gastric juices]. A monthly dose usually is sufficient because
When discussing the therapeutic regimen of vitamin B 12 for pernicious anemia with a client, what teaching does the nurse provide?
A. Weekly Z-track injections provide needed control.
B. Daily intramuscular injections are required for control.
C. Intramuscular injections once a month will maintain control.
D. Oral vitamin B 12 tablets taken daily will provide symptom control
A. Do you use 2% cow's milk?
C. Do you use whole cow's milk?
D. Do you use alternate milk products?
(The use of 2% or whole cow's milk in an infant younger than 12 months is not recommended because it may cause intestinal bleeding, anemia, and allergic re
The mother of an 11-month-old infant reports that the baby has allergies. After an assessment, the primary healthcare provider also suspects anemia. Which questions would the primary healthcare provider most likely ask the mother? Select all that apply.
A. Do you use 2% cow's milk?
B. Do you breastfeed?
C. Do you use whole cow's milk?
D. Do you use alternate milk products?
E. Do you provide 18 to 21 ounces of breast milk per day?
A. "I realize it is important to take this medication because it will cure my anemia."
(Epoetin will increase a sense of well-being, but it will not cure the underlying medical problem; this misconception needs to be corrected. Seizures are a risk during
A client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary?
A. "I realize it is important to take this medication because it will cure my anemia."
B. "I know many ways to protect myself from injury because I am at risk for seizures."
C. "I recognize that I may still need blood transfusions if my blood values are very low."
D. "I understand that I will still have to take supplemental iron therapy with this medication.
C. Bilateral involvement
A client reports a history of bilateral blanching and pain in the fingers on exposure to cold. When rewarmed, the fingers become bright red and "tingly" with a slow return to their usual color. The client smokes one to two packs of cigarettes per day. Which sign or symptom leads the nurse to determine that the client has Raynaud disease and not Raynaud phenomenon?
A. Tingling sensation
B. Skin color changes
C. Bilateral involvement
D. Changes in skin temperature
A. Rise quickly above preoperative levels
(Once the excessive secretion of aldosterone is stopped, the blood pressure gradually drops to a near normal level)
What change in blood pressure (BP) should the nurse anticipate after a client has an aldosteronoma surgically removed?
A. Rise quickly above preoperative levels
B. Fluctuate greatly during this entire period
C. Gradually return to expected levels for an adult
D. Drop very low before increasing rapidly to expected level
C. Experience a feeling of warmth during the procedure
(A warm flushing sensation that lasts approximately 30 seconds will occur when the contrast medium is injected. Medication is given for mild sedation; clients are drowsy but awake enough to follow ins
A client with a history of angina is scheduled for a cardiac catheterization. Catheter entry will be through the femoral artery. What should the nurse tell the client to expect?
A. Remain fully alert during the procedure
B. Ambulate shortly after the procedure
C. Experience a feeling of warmth during the procedure
D. Be placed in a semi-Fowler position for 12 hours after the procedure
A. Amiodarone bolus
(Amiodarone suppresses ventricular activity; therefore, it is used for treatment of premature ventricular complexes (PVCs) and ventricular tachycardia. It works directly on the heart tissue and slows the nerve impulses in the heart. Ep
A client's cardiac monitor indicates ventricular tachycardia. The nurse assesses the client and identifies an increase in apical pulse rate from 100 to 150 beats per minute. What is an appropriate treatment plan?
A. Amiodarone bolus
B. Intracardiac epinephrine
C. Insertion of a pacemaker
D. Cardiopulmonary resuscitation (CPR)
A. Tremors
(Tremors are a precursor to the major adverse effects of seizures. Although anorexia may occur, it is not a dangerous side effect. Bradycardia, which may lead to heart bock, may occur. Hypotension may occur.)
What potentially dangerous adverse effect of an intravenous titrated drip of lidocaine should the nurse immediately report to the healthcare provider?
A. Tremors
B. Anorexia
C. Tachycardia
D. Hypertension
B. increased temperature
D. decreased oxygen saturation level
E. sudden onset of SOB
(When perfusion in the lung is interrupted the exchange of carbon dioxide and oxygen is impaired; as a result, the client's oxygen saturation level will decrease. Because
A client has a hysterectomy, salpingo-oophorectomy, tumor removal, and multiple abdominal biopsies for ovarian cancer. For which clinical manifestations indicating that the client may be experiencing a pulmonary embolus should the nurse assess the client? Select all that apply.
A. Flushed face
B. Increased temperature
C. Severe abdominal pain
D. Decreased oxygen saturation level
E. Sudden onset of shortness of breath
C. Pulse rate at least at the preset rate
(On-demand pacing initiates impulses when the client's pulse rate begins to fall below the preset rate. A rate below this indicates malfunction of the pacemaker. The client's heart rate may still be irregular. The
The nurse is assessing the pulse of a client with an on-demand pacemaker. What should the nurse identify when a client's on-demand pacemaker is functioning effectively?
A. Pulse regular rhythm
B. Pulse palpable at all sites
C. Pulse rate at least at the preset rate
D. Pulse equal to the pacemaker setting
D. Rest periodically throughout the day
(Rest decreases demand on the heart and will prevent fatigue. Sleeping with the head slightly elevated facilitates respiration. The client needs potassium. A low-potassium diet when the client is taking digoxin pred
What will the nurse include when developing a teaching plan for a client receiving digoxin for left ventricular failure?
A. Sleep flat in bed
B. Follow a low-potassium diet
C. Take the pulse three times a day
D. Rest periodically throughout the day
A. Burns
C. Osteomyelitis
D. Diabetic ulcers
(Hyperbaric oxygen therapy is the administration of oxygen under pressure, raising the tissue's oxygen concentration. Burns, osteomyelitis, and diabetic ulcers are treated by hyperbaric oxygen therapy. Skin can
Which life-threatening wounds are treated with hyperbaric oxygen therapy? Select all that apply.
A. Burns
B. Skin cancer
C. Osteomyelitis
D. Diabetic ulcers
E. Myocardial infarction
B. Ankle edema
(Ankle edema results from increased venous pressure. Pigmentation, not pallor, may occur with varicosities. Yellowed toenails occur with arterial, not venous, insufficiency. Diminished pedal pulses occur with arterial, not venous, insuffici
A client with varicose veins is scheduled for surgery. Which clinical finding does the nurse expect to identify when assessing the lower extremities of this client?
A. Pallor
B. Ankle edema
C. Yellowed toenails
D. Diminished pedal pulses
A. Fluid retention
(Fluid retention is reflected by an excessive weight gain in a short period. Inadequate cardiac output decreases blood flow to the kidneys and thus leads to increased intracellular fluid and hypervolemia. Although this assessment may ad
The parent of a 5-month-old infant with heart failure questions the necessity of weighing the baby every morning. What does the nurse say that this daily information is important in determining?
A. Fluid retention
B. Kidney function
C. Nutritional status
D. Medication dosage
C. "Take your medicine exactly as prescribed."
(The most effective way to lower the blood pressure is to take the prescribed medication daily. It is not necessary to take daily blood pressure measurements unless specifically prescribed to do so by the pri
A client is newly diagnosed with hypertension. The primary healthcare provider prescribes an antihypertensive medication to be taken once in the morning and a 2 gram sodium diet. What is most important for the nurse to teach the client about lowering the blood pressure?
A. "Avoid adding salt to cooked foods."
B. "Use less salt when preparing foods."
C. "Take your medicine exactly as prescribed."
D. "Measure your blood pressure every morning.
A. Aspirating gastric contents
A nurse is caring for several clients in the intensive care unit. Which is the greatest risk factor for a client to develop acute respiratory distress syndrome (ARDS)?
A. Aspirating gastric contents
B. Getting an opioid overdose
C. Experiencing an anaphylactic reaction
D. Receiving multiple blood transfusions
D. Upper respiratory infection
A client with type 1 diabetes who has been adhering to a prescribed insulin regimen is admitted to the hospital in ketoacidosis. Which factor may have precipitated the ketoacidosis?
A. Increased exercise
B. Decreased food intake
C. Working the night shift
D. Upper respiratory infection
C. Mechanical ventilation
A client who is admitted with emphysema has a PaCO 2 of 60. To address the abnormal arterial blood gas value, what type of prescription does the nurse expect to receive?
A. Mucolytics
B. Bronchodilators
C. Mechanical ventilation
D. Intermittent positive-pressure breathing (IPPB)
C. "I should drink more water and other thin liquids.
A nurse teaches a client scheduled for a tracheostomy about ways to prevent aspiration during swallowing. Which statement of the client indicates the need for further teaching?
A. "I should eat smaller and more frequent meals."
B. "I should avoid eating meals when I am fatigued."
C. "I should drink more water and other thin liquids."
D. "I should keep emergency suctioning equipment close at hand.
D. Monitor serum carbon dioxide levels routinely
After an anterior fossa craniotomy, a client is placed on controlled mechanical ventilation. To ensure adequate cerebral blood flow, which action should the nurse take?
A. Clear the ear of draining fluid.
B. Discontinue anticonvulsant therapy.
C. Elevate the head of the bed 30 degrees.
D. Monitor serum carbon dioxide levels routinely
D. Prolonged expiratory phase
What physiologic alteration does the nurse expect when assessing a 6-month-old infant with bronchiolitis (respiratory syncytial virus [RSV])?
A. Decreased heart rate
B. Intercostal retractions
C. Increased breath sounds
D. Prolonged expiratory phase
A. placing the stethoscope over bony prominences
Which action performed by the nursing student during the chest examination of a client needs correction?
A. placing the stethoscope over bony prominences
B, Palpating two ribs inferiorly in the midaxillary line
C. Dividing the anterior and posterior lungs into thirds
D. Listening to at least one cycle of inspiration and expiration
A. Assess vital signs
A client enters the emergency department reporting shortness of breath and epigastric distress. What should be the triage nurse's first intervention?
A. Assess vital signs.
B. Insert a saline lock.
C. Place client on oxygen.
D. Draw blood for troponins.
D. Eighth cranial nerve's vestibular branch
After receiving streptomycin sulfate for 2 weeks as part of the medical regimen for tuberculosis, the client states, "I feel dizzy and I can't hear as well as usual." The nurse withholds the drug and promptly reports the problem to the healthcare provider. Which part of the body does the nurse determine is being affected as indicated by the symptom reported by the client?
A. Pyramidal tracts
B. cerebellar tissue
C. Peripheral motor end-plates
D. Eighth cranial nerve's vestibular branch
b. Palpating the neck or face
A client develops subcutaneous emphysema after a chest injury with suspected pneumothorax. What assessment by the nurse is the best method for detecting this complication?
A. Percussing the neck and chest
B. Palpating the neck or face
C. Auscultating for abnormal breath sounds
D. Observing for asymmetry of chest movement
A Suction supplies
A client who had a laryngectomy for cancer of the larynx is being transferred from the postanesthesia care unit to a surgical unit. Which is the most important equipment that the nurse should place in the client's room?
A Suction supplies
B Writing materials
C Tracheostomy set
D Incentive spirometer
C. Increased blood viscosity
A client is admitted with a higher than expected red blood cell (RBC) count. What physiologic alteration does the nurse expect will result from this clinical finding?
A. Increased serum pH
B. Decreased hematocrit
C. Increased blood viscosity
D. Decreased immune response
C. Decreased cardiac output because of mediastinal shift
A client has a right upper lobectomy to remove a cancerous lesion. After the surgery, the nurse monitors the client for the most life-threatening complication, which is what?
A. Hemothorax caused by decreased thoracic drainage
B. Dyspnea caused by increased intrathoracic pressure
C. Decreased cardiac output because of mediastinal shift
D. Pneumothorax caused by increased abdominal pressure
d. Trauma from mechanical, chemical, or thermal sources
A nurse is caring for a client with chronic occlusive arterial disease. Which precipitating cause is the nurse most likely to identify for the development of ulceration and gangrenous lesions?
A. emotional stress, which is short-lived
B. Poor hygiene and adequate protein intake
C. Stimulants such as coffee, tea, or cola drinks
D. Trauma from mechanical, chemical, or thermal sources
A. Total sleep averages 12 hours at night.
A nurse is teaching a group of parents about sleeping patterns of children between the ages of 4 and 5 years old. Which information would the nurse provide?
A. Total sleep averages 12 hours at night.
B. The child normally takes several naps during the day.
C. It is common for the child to sleep soundly during the night.
D. During this period, the child may be unwilling to go to bed at night
B. Interrupt the infusion and notify the primary healthcare provider of the aPTT result.
After a deep vein thrombosis developed in a postpartum client, an intravenous (IV) infusion of heparin therapy was instituted 2 days ago. The client's activated partial thromboplastin time (aPTT) is now 98 seconds. What should the nurse do next?
A. Increase the IV rate of heparin.
B. Interrupt the infusion and notify the primary healthcare provider of the aPTT result.
C. Document the result on the medical record and recheck the aPTT in 4 hours.
D. Call the primary healthcare provider to obtain a prescription for a low-molecular-weight heparin.
D. There is leakage of red blood cells (RBCs) through the vascular wall
A client with a long history of bilateral varicose veins questions a nurse about the brownish discoloration of the skin on the lower extremities. What should the nurse include in the response to the client's question?
A. The arterial blood supply is inadequate.
B. There is delayed healing in the area after an injury.
C. The production of melanin in the area has increased.
D. There is leakage of red blood cells (RBCs) through the vascular wall
Respiratory acidosis
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a PCO 2 of 60 mm Hg. What complication does the nurse conclude the client is experiencing?
D. Right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding of the aorta
The parents of an infant with tetralogy of Fallot ask the nurse to explain what is wrong with their baby's heart. Before explaining the problem in a way that they will understand, the nurse remembers that tetralogy of Fallot includes what features?
A. Tricuspid atresia, ventricular septal defect, atrioventricular canal, and coarctation of the aorta
B. Overriding of the aorta, aortic stenosis, patent ductus arteriosus, and mitral valve insufficiency
C. Atrial septal defect, right ventricular hypertrophy, patent ductus, and mitral valve insufficiency
D. Right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding of the aorta
A. Identifies the specific location of the defect
A 5-year-old child with a ventricular septal defect (VSD) is scheduled for cardiac catheterization. The parents ask the nurse why this test is being done. While formulating a reply, what does the nurse recall is the function of the test?
A. Identifies the specific location of the defect
B. Confirms the presence of a pansystolic murmur
C. Reveals the degree of cardiomegaly that is present
D. Establishes the presence of ventricular hypertrophy
A. Digoxin
One week after being hospitalized for an acute myocardial infarction, a client reports loss of appetite and feeling nauseated. Which of the client's prescribed medications should be withheld and the healthcare provider notified?
A. Digoxin
B. Propranolol
C. Furosemide
D. Spironolactone
b. Dusky-colored stoma
The nurse is providing postoperative care 8 hours after a client had a total cystectomy and the formation of an ileal conduit. Which assessment finding should be reported immediately?
A. Edematous stoma
B. Dusky-colored stoma
C. Absence of bowel sounds
D. Pink-tinged urinary drainage
Virchow Triad
risks for DVT (venous clot):
1. Endothelial damage aka vessel wall injury (e.g. surgery, trauma, venous caths)
2. Venous stasis (immobilization, surgery, severe heart failure)
3. Hypercoagulable state (birth control, cancer, polycythemia, pregnancy)
Rhabdomyolysis
statins can cause this to happen to the muscles
Atherosclerosis
narrowing of the coronary arteries due to buildup of debris along the artery walls
arteriosclerosis
hardening of the walls of an artery or arteries
20 weeks
pregnancy induced HTN (PIH), 10% of all pregnancies, happens at 20 weeks or later
preclampsia
HTN w/ systemic effects
proteinuria, oliguria (pee less), hyperflexia (twitching), headache, blurred vision, inc ast/alt, clonus (involuntary muscles spasm), edema, swelling of airway, epigastric pain, organ injury
resolves 48 hrs postpartum
eclampsia
complication of preeclampsia, seizures, start on mgso4 often have them on fluid restriction to reduce pulmonary edema. can also lead to ARF (acute renal failure), hepatic swelling for mom. And for fetus can lead to abruptio placentae, intrauterine growth restriction (IUGR), premie delivery, and fetal death
mgso4
dec RR and absent deep tendon reflexes is an indicator of ___ toxicity. given to dev seizure threshold. indicated in eclampsia. antidote is 10ml of 10% Ca gluconate, IV slow.
HELLP
Hemolysis, Elevated liver enzymes, Low platelets
90% have malaise and epigastric pain, 50% have N/V
can cause multisystem failure
if its less <36 wks then it can cause fetal issues
only cure is delivery
tx: prevention of eclampsia, mgso4 to prevent seizure
DIC
worst result of preeclampsia
fibrates
antihyperlipidemic, inc HDLs, dec triglycerides,
side effect of gallstones,
Bile Acid Sequestrants
dec cholesterol, dec ldls,
side effect, can inc triglycerides and cause dec absorption of fat soluble vits (KADE)
CAD (coronary artery disease)
build up of plaque in arteries of heart can lead to ischemia, MI, and heart failure. dx w/ homocysteine, lipid labs, stress test, ekg, cardiac cath. tx w/ beta blockers, CCBs, ACE inhibitors, statins, nitrates, diet, exer
PVD (peripheral vascular disease)
build up of plaque in arteries of extremities. assess for thin skin, dec hair on extremities, dec pulses strength on extremities, thicker toenails, discoloration and breakdown of skin, coolness, pallor, pain, paresthesia, intermittent claudication, edema.
CVI and PAD included under this umbrella
CVI (chronic venous insufficiency)
occurs when venous walls aren't effective in returning blood flow. assess for itching, dull pain, cramping, weeping dermatitis, thick and fibrous tissue, recurrent ulceration of ankles, lots of edema, hyperpigmentaion, pulses are present (arteries work), status dermatitis
pt edu: avoid crossing legs, avoid pressure on the back of the knee, avoid COLD temps, perform skin care, elastic hose, pain mgmt. A type of PVD
arterial ulcers
located in areas of pressure (tips of toes etc), painful deep (maybe to the joint), circular, wound bed pale to black, little to no edema
venous ulcers
usually located on inside of ankle, tend to be superficial, generally not painful, irregular borders, wet wounds, wound bed granular or yellow fibrous
PAD (peripheral arterial disease)
caused most often by plaque, more common in men, the elderly, and diabetics.
S+S: elevating leg is painful, resting leg pain common at night, intermittent claudication, cold/numb limb, dec pulse or absent, thick nails and hair loss, wounds, pallor
tx: trental (inc flexibility of RBCs), plental (vasodilator and antiplatelet) ASA or antiplatelet (plavix). sometimes surgery (bypass grafts) or amputation
nurs consider: pulse checks q 1-2 hrs, monitor vitals, fluids, hematoma formation, infection, pain mgmt
arterial clot
sudden occlusion, results from iatrogenic (due to medical intervention) injury, trauma, or long periods of sitting.
6 p's (pulselessness, pallor, paralysis, paresthesia, poikilothermia, pain)
tx: embolectomy, anticoags, thrombolytic
nurs consider: bedrest, keep leg level, monitor for bleeding (due to anticoag and thrombolytic), pulses and vitals
DVT (deep vein thrombosis)
assess for virchow triad, edema, tender, +homan (don't perform anymore), +d-dimer, inc warmth, redness
nurs consider: monitor PTT and PT/INR, bleeding, pain mgmt, ROM on bedrest, elevate extremity
prevention: LMWH, ambulation, compression therapy
leads to venous stasis and blood pooling
Raynaud's phenomenon
a peripheral arterial occlusive disease in the fingers and toes characterized by tingling, numbness, cold temperature, and discoloration
avoid vasoconstrictors (caffeine, nicotine and cold temp)
pulmonary bronchiole constriction, poss. foreign body, pulmonary embolism, pneumothorax, pneumonia
5 p's of dyspnea
# of packs/day x # of years smoked
Pack years=
Cheyne-Stokes
grad inc and dev in resp w/ periods of apnea (inc ICP and brain stem inj)
biots
rapid and deep gasps w/ short pauses (spinal meningitis, many cns causes, head inj)
kussmaul
tachypnea and hypernea (renal fail, metabolic acidosis, DKA)
apeustic
prolonged inspiratory phase w/ short expiratory phase (lesion in brain stem)
vital capacity
the maximum amount of air that can be exhaled after a maximum inhalation
residual volume
Amount of air remaining in the lungs after a forced exhalation
tidal volume
Amount of air that moves in and out of the lungs during a normal breath
spirometry
a measurement of breathing
respiratory acidosis
lungs are retaining co2
hypoventilation leading to hypoxia. dec BP. dyspnea (can't catch breath). hyperkalemia leading to dysrhythmia. headache, drowsiness, dizzy, disoriented, muscle weakness and hyperreflexia
low pH and high pco2
causes are anesthia, drug OD, COPD, pneumonia, atelectasis
respiratory alkalosis
loss of o2 from lungs
hyperventilation (deep rapid breathing), tachycardia, dec or norm BP, hypokalemia, seizure, numbness and tingling of extremities, lethargy and confusion, lightheadedness, N/V
high pH and low pco2
causes are hyperventilation (anxiety), PE, fear, mechical ventilation
metabolic alkalosis
inc in acid or dec in base
compensatory hypoventilation, hypokalemia, tachycardia leading to dysrhythmia, tremor and cramping, tingling in phalanges, N/V and diarrhea, confusion (dec LOC, dizzy, irritable)
causes are sever vomiting excessive GI suctioning, diuretics, excessive NaHCO3
metabolic acidosis
dec ability of kidney to excrete acid or conserve base
kussmaul resp (compensatory hyperventilation), dec BP hyperkalemia, muscle twitching, N/V and diarrhea, confusion (dec LOC, drowsiness) warm flushed skin (vasodilation)
causes DKA sever diarrhea, renal failure, shock
rsv (respiratory syncytial virus)
labored breathing and fever.
dx w/ chest xray and mucus test
infant
croup
upper respiratory obstruction (laryngo-tracheobronchitis) can be caused by RSV or other virus, hoarse barking cough (esp @night), inspiratory stridor
young child
asthma
tiggered by hypersensitivity, exer, air pollutants, resp inf, hypoxemia (tachycardia, inc restlessness, tachypnea). Assess for cough, inc mucus, SOB, tight chest, wheezing, prolonged expiration. If not resolved after 30 minutes go to Dr. cause it is status asthmaticus
cor pulmonale
right-sided heart failure arising from chronic lung disease
COPD
easily fatigued, freq respiratoy inf, use accessory muscles, orthopenic (SOB when lying down), wheezing, pursed lip, chronic cough, barrel chest, dyspnea, prolonged expiration, bronchitis (inc sputum), clubbing,
assoc w/ smoking
cystic fibrosis
salty taste on skin, polyps in nose, fatigue, chronic cough, recurrent, upper resp inf, mucus, dec absorption of vits and enzymes, abd distention, dec digestion (malabsorption), rectal prolapse, fatty stool and stinky, treat w/ dec fat and inc Na and pulm therapy, and meds (antibiotic, liposoluable vits (KADE), aerosol bronchodilators, mucolytics, panc enzymes.
genetics (recessive) can cause infertility, diabetes
no cure, symptoms appear w/in 1st yr of life (newborn screening)
TB
progressive fatigue, malaise, anorexia, chills, wt loss, chronic wet cough, night sweats, hemoptysis (cough up blood from lung), pleuritic chest pain, low grade temp
tx: meds 6-12 mo minimum; rifampin (discolored body secretions), isoniazide (lethargy, nausea and anorexia), pyrazinamide (lethargy, loss of appetite), streptomycin or thanbutol (visual disturbance)
mantoux skin test and dx done thru chest xray
rifampin
discolored body secretions, used to treat TB
isoniazide
lethargy, nausea and anorexia. used to treat TB
pyrazinamide
lethargy, loss of appetite, used to treat TB
streptomycin or thanbutol
visual disturbance, used to treat TB
mantoux
pos result if its greater than or equal to 15 mm induration w/ no risk factor
pos result if its greater than or equal to 10 mm, being in high prevelance area
pos result if its greater than or equal to 5 mm; for HIV+, recent TB contact, organ transplant
Epiglottitis
airway inflammation leading to obstruction, inc pulse, restlessness, retractions (of chest walls), anxiety inc, inspiratory stridor, drooling
tx: dec anxiety, dont examine the throat, endotrachial tube, cool mist humidifying, o2 , npo, IV fluid
pertussis
whooping cough. bacterial infection, contagious, dangerous
less than 1 yr old
acute bronchitis
inflamed bronch and usually trachea, extension of upper resp inf, usually viral and can be bacterial or irritant.
tx: symptomatic
chronic bronchitis
cyanotic or dusky, chronic cough w/ sputum, hypoxia and hypercapnia, acidosis, edema, inc RR, dyspnea on exertion, smoking, clubbing, cardiomegaly, access muscle use, cor pulmonale
emphysema
inc co2 retention (pink), not much cyanosis, pursed lip breathing, dyspnea, hyperresonance in percussion, orthopenic, barrel chest, exertion dyspnea, prolonged expiratory time, short sentence when speaking, anxious, accessory muscle, thin appearance
Pneuomothorax
air in pleural causing lung collapse, dyspnea, anxiety, inc HR, pleural pain, asymmetrical chest wall expansion, dec breath sounds
tx w/ chest tube and o2
dx by chest xray and ABGs
caused by ruptured bleb (COPD) or thoracentesis or trauma (stab), 2ndary inf
pneumonia
obstruction of bronchioles, dec gas exchng, and inc secretion, productive cough (yellow and bloody sputum), opportunistic inf, fever, chills, inc HR, dyspnea, pleural pain, malaise, respiratory distress, dec breath sounds,
dx by sputum, chest xray, abgs
comm acquired or hospital acquired
lobar (upper lung) or bronchiole (lower lung)
atrovent
Anticholinergic to relax sm tiss of airway and dec mucus secretion by blocking parasympathetic effect
mucolytics
react w/ mucus to make it more fluid and easier to expel
postural drainage
using gravity to move mucus out of lungs
tracheostomy
stoma in neck for alternate airway breathing
calories protein
people w/ emphysema or cf need inc __ and inc ___ in smaller meals so they can get proper nutrition b4 getting too tired to eat
CO
inc HR = inc __
SV
dec HR = dec __
inc preload
leads to dec HR, inc contractility, inc ventric compliance, dec venous compliance, inc aortic pressure
dec preload
leads to dec afterload, dec CV pressure, inc HR, dec contractility (afib), valve stenosis, cardiac myopathy
systolic
__ failure ventricle doesnt squeeze out or eject blood
diastolic
__ failure ventricle doesnt relax, the valve doesnt fill preload dec and afterload dec
left
__ sided failure
dec tissue perfusion, from dec CO and pulm congestion. cant leave __ side so it backs up into lungs. neuro dec, fatigue, crackles, dec o2, dizzy. lung stuff. effected by dec contractility. inc afterload
right
__ sided failure
aka cor pulmonale, inc vol and pressure in venous system, dec pumping in lungs, inc distension in rt ventricles and atrium, backs up into the body. edema, nausea, ascites, JVD, and fatigue
high output
fever - high metabolic. so demand is higher but co is staying norm
brain
compensates for heart failure by inc HR leading to inc CO
kidneys
they compensate for heart failure by inc preload leading to inc CO
heart growth
compensates for heart failure by inc hypertrophy leading to inc CO
bnp
compensates for heart failure by inc vasodilation and diuresis
raas
compensates for heart failure by inc vasoconstriction
mawds
meds, activity, weight, diet, note new symptoms
I II
class _ and _ heart failure in pregnancy. limit exercise, avoid excessive weight gain, prevent anemia, prevent upper respiratory infection, careful assessment for chest pain, tachypnea, exhaustion, rales
III IV
class _ and _ heart failure in pregnancy. protect fetus from hypoxia, bed rest in third trimester. high risk for thrombus. Pregnant mothers cant use warfarin so hep is given also other meds are Antidysrhythmics, Antiinfectives, Duiretics (no lasix or thiazides)
massage
in pregnant women with heart failure, vaginal delivery is perferred. vacuum might be required to help mom push (due to mom having impaired oxygenation). don't __ uterus and avoid abrupt position chng. post partum, monitor I+O, stress mgmt and breast feeding capability. take iron and folic acid to prevent anemia
shunting
blood flow through abnormal opening
gradient
pressure higher on one side vs other (lt)
inc pulmonary flow
acyanotic, sats norm. ASD, VSD, AV canal, PDA. lung stuff (murmur, lung congestion, activity and feeding tolerance)
obstructive
acyanotic, sats norm. pulmonary valve stenosis, aortic valve stenosis and coarctation of aorta. body stuff (peripheral edema, JVD, murmur, activity and feeding intolerance)
dec pulmonary flow
cyanotic, sats low. tetralogy of fallot and tricuspid atresia. rt to lt shunt. Blue, reduced o2, clubbing, polycythemia, hypercyanotic spell. dont give o2
hypercyanotic
__ aka tet spells occur with decreased pulmonary flow disorders
tx: knee chest position, dec stress
mixed
cyanotic, sats low. Transposition great arteries, truncus arteriosis, hyperplastic lt vent
Indomethacin
Prostaglandin inhibitor, may help to get the PDA closed
Prostaglandins
keep open pda and foramen ovale
tga
mixed. severe cyanosis (inc HR, inc RR, poor feeding, cool extremities, dec growth); watch HR, rhythm, and o2; alprostadil (prostaglandin) KO;
tx is procedure to correct: balloon atrial sepostomy (temp) arterial switch procedure
Truncus arteriosus
mixed. cyanosis (inc RR, heart fail, pulmonary HTN, fatigue, poor feeding and activity, dec CO, cold, clammy, sweaty, edema, murmur, dont give o2)
tx: surgery w/in first 2 wks (close vsd, seperate artery), meds for heart fail (dig, diuretic, ace inhibitor), feeding tube or high calories, lung sounds, sat
Hypoplastic Left Heart Syndrome
mixed. cyanosis. KO, until surgery. pulm artery gets both kinds of blood and aorta is empty. mid 80s sat, dont give o2, murmur, feed and activity intolerance
reticulocytes
should be high w/ anemia, # of immature RBCs. if it isnt high and pt has anemia then there is an issue w/ marrow and kidneys
coombs
antibodies to possible blood transfusion (check in anemia and for rh compatability)
iron
60-80 mcg/dl
4.2-6
mil/mm3 RBCs norm
H/H
15-16 and three times that in a percent
hemolytic
type of anemia includes sickle cell, spherocytosis, thalassemia, g6pd deficit, acquired
megaloblastic
type of anemia includes b12 and folic acid deficit
spherocytosis
abnormal protein lead to loss of membrane surface so the spleen kills them cause they dont look normal (inc MCHC). leads to hyperbilirubinemia. assess for tea colored urine. might have to do splenectomy.
hgb s
Sickle Cell Blood Test
o2
in sickle cell, the rbcs are abnormally shaped because of less __
lifespan
in sickle cell, the ___ of the cells is drastically lower
sickle cell
leads to organ damage (esp in spleen). higher inf risk. towering of the skull. And the median life span is mid to late 40s. Other S+S are vision probs, necrosis of bones and joints (causing pain), gallstones, splenomegaly, dilute urine, priapism, chronic ulcers
hypoxia
____, dehydration, infection, venous stasis, preg, ETOH, too low or too high temp, inc altitude, acidosis, strenuous exercise, stress, and anesthesia are all causes of sickle cell
vaso-occlusive, aplastic, sequestration, acute chest
4 types of sickle cell crisis
vaso-occlusive
type of crisis where ischemia and pain caused by sickle-shaped red blood cells that obstruct blood flow to a portion of the body.
aplastic crisis
type of crisis where the marrow is not producing enough rbcs due to sickle cell anemia
Sequestration
type of crisis where painful splenomegaly is caused by lysis of sickle cells
acute chest
type of crisis where sickle cells clot up in pleura, caused normally by inf, emergency situation
hydration, oxygen and pain relief
what three treatments for sickle cell crisis
maternal
___ effects of sickle cell: dec placental perfusion, fetal effects, inc stroke risk, inc infertility risk, inc risk of crisis, thrombophlebitis, meningitis, dec breast milk production
prevention
___ measures of sickle cell crisis: o2, rest, hydration, monitor blood levs, inc folic acid (4x more than norm), vaccinations, avoid high or low temps, low impact exercise 3x a wk
Hydroxyurea
chemodrug for maintenance of sickle cell
Iron chelation
we can do blood transfusions every 2 mo to get cells that last longer so the body wont make more sickled ones, need to perform ____ ____ along with them
penicillin
can be given orally to prevent infection that may lead to sickle cell crisis
101.3
temp higher than __ requires immediate med attn if you have sickle cell
thalassemia
hemolytic anemia. Inherited defect in ability to produce hemoglobin bcuz your are missing either alpha or beta chain. damaged cells keep getting made and destroyed.
assess for poor growth, pubertal deficit, pale of yellowed skin, splenomegaly, pain crisis, towering of head, thinning cortical bone in thigh, osteoporosis
tx
__ for thalassemia includes blood transfusion to keep hgb up, iron chelation, splenectomy
minor
missing either 1 alpha or 1 beta in thalassemia
major
missing both of the alphas or both of the betas in thalassemia
g6pd
hemolytic anemia. 10% black, mostly men, recessive. missing this gene. cells that are made can be broken apart easily.
avoid: oxidative stress meds (sulfas, aspirin, thiazide diuretics, inc vit c, and benzene [pain med]). avoid fava beans. infections can cause cell lysis.
tx: hydration and transfusion
assess for: tea colored urine, splenomegaly, and hepatomegaly
iron deficit
type of anemia w/ low MCV and low MCHC (sm pale)
caused by dec intake, inc loss or blood loss, dec GI absorption, periods of inc growth (4-6 mo, 9-24 mo, adolescence)
assess for fissures in the mouth, pallor, weakness or fatigue, ferritin less than 10, diet
vit c
treat iron deficit anemia by taking iron on empty stomach if it can be tolerated. if not, take it with food and ___.
stain teeth
liquid iron supplementation for iron deficiency anemia can cause thick, tarry, green stools and can also ___ ___.
iron rich
foods that are ___ ____ are rasins, leafy greens, lentils, eggs, meat
elderly
people at risk for iron deficit anemia include females on menses, the ___, people on a poor diet, people w/ blood loss (ulcers)
b12
type of megaloblastic anemia, (inc MCV and dec MCHC)
causes can be a vegan diet, dairy free diet, sm bowel resection (due to dec absorption), chronic diarrhea, or can be pernicious
assess for fatigue, glossitis, neuro (numb fingers and off balance)
tx: swallow radioactive b12 then test stool for it to see if you didnt absorb it. if you did absorb then it would show up in the blood.
pernicious anemia
lack of intrinsic factor in stomach, so you can't absorb the b12 you eat
b12 rich
foods that are __ ___ leafy green, seafood, beef, milk, eggs, nuts
folic acid
type of megaloblastic anemia (MCV inc), this substance is critical in DNA synthesis and red cell maturation, need 50 mcg q day and need 5-10x more when you are preggo
causes: celiacs, malnutrition, alcoholism (dec absorption), anticonvulsants, oral contraceptives
can cause: spontaneous abortion, abruptio placentae, pallor, fatigue
folic acid rich
foods that are ___ ___ __ are leafy greens, greens, beans, citrus, and yeast
aplastic anemia
The type of anemia caused by an inability of the stem cells in bone marrow to produce erythrocytes. not hemolytic (so no jaundice)
assess: pale and fatigue, dec RBC, dec H/H, dec reticulocyte, dec PLT and WBC
causes: genetics, radiation, inf, depression
dx: bone marrow biopsy, autoimmune destruction of bone marrow
atgam
tx for aplastic anemia, it is a drug that stops all antibody production. Common for pt to anaphylax; give w/ hydrocortisone, epi, Benadryl, tylenol
stem cell transplant
cure for aplastic anemia
chronic disease
anemia of __ __, inflammatory diseases (cancer, autoimmune, SLE, IBD, CKD). cytokine production shortens life span, and dec production of RBC and dec response to erythropoietin and dec serum iron
polycythemia
too many RBCs
relative (dehydrate) or absolute (making too much [not related to blood volume])
hct > 50%
polycythemia vera
cancer causing marrow to make too many RBCs, WBCs, and PLTs
hct > 55%
clotting, slow blood flow, causing less perfusion (dec o2 supply to organ and tiss), painful or itchy hands and feet, dark (red or purple) skin, inc cv workload, inc HF risk, backed up kidneys and liver, gout and hyperkalemia
phlebotomy
tx for polycythemia ____ (take out RBCs), hydration, prevent vasoconstriction (dont get cold), elevate ft to inc venous return
secondary
___ polycythemia: inc erythropoietin from hypoxia bcuz more RBCs are made
24-28
__ - __ wks to give rhogam and anytime after that where trauma occurs that may cause fetal and mom blood transfer (including after invasive procedures during pregnancy)
rh-
rhogam is given to every __ mom
erythroblastosis fetalis
hemolysis occurs, severe anemia, hepatosplenomegaly, hydrops fetalis (dec production of albumin causing massive edema) baby swollen up
menses
heavy __ is a potential cause of anemia
pregnant
give rhogam 28 wks into 1st pregnancy bcuz we can't be sure you havent been __ b4 or had any small trauma that can inc the risk of antibodies
high
a pt w/ anemia is shown to not be able to tolerate exercise based on a __ HR
spleen liver
in sequestration sickle cell crisis, RBCs get stuck in the ___ and ___
neuro
with b12 deficit there can be __ symptoms which only occur with this type of anemia
dec
a norm chng in blood val for older adults is a __ hgb
vaccines
pt who has sickle cell needs to get up to date ___ to dec chance of inf
hands feet
the people who suffer from vaso-occlussive crisis may experience painful and swollen joints, ___ and ___.
vasodilation
we can treat pain in sickle cell crisis by adding heat to promote __
milk
something that toddlers are starting to drink and is a poor source of iron. for this reason, iron deficiency is common
04-Jun
fetal iron stores are completely depleted by __ - __ mo. and it can be stored during fetal development
vasoconstriction
dont give someone in sickle cell crisis ice packs because it can cause
marrow
to determine if anemia is a __ problem, look at PLT and WBC labs
Erythropoietin
to determine if anemia is a __ production is a problem in the kidneys, look at the renal labs
beefy red
__ __ tongue is a hallmark symptom in b12 deficit anemia and we tx by inc green leafy veggies in diet
HR inc
anemia inc __ which then __ CO
hypochromic
thalassemia is ___ and microcytic
congenital
aplastic anemia can be __ or acquired
ivig
an immunoglobulin given for autoimmune disorders so that your body doesn't create its own harmful antibodies
osteopenia
poor bone perfusion and inf risk form asplenia are causes of ___ (preosteoporosis) and osteomyelitis (inflamm) in a sickle cell pt
rapid response
if a sickle cell pt has acute chest syndrome, call a ___ ___ team
vibratory
glossitits, parastheisa of the ft and hands, loss of __ sense, spastic ataxia (neuro stuff) are all indicators of vit b12 deficit anemia
skin
dark flushed ___, peripheral cyanosis, headache, dizziness, pruritis, pain, hearing and vision loss are indications of polycythemia vera
rbcs
COPD and hypoplastic lt heart syndrome are causes of polycythemia bcuz the body had poor oxygenation so it had to make more __
nail
dont assess for jaundice in the __ bed
normal
MCV is low (microcytic) and MCHC is __ in b12 and folic acid deficit
small pale
in iron deficit anemia the rbcs are __ and __
CKD
autoimmune disease of the renal system that causes erythropoietin production to be less, leading to anemia
overload
assess for iron __, inc bilirubin, tea colored urine, jaundice, anemia, fatigue in g6pd because it is hemolytic
ferritin
in iron deficiency anemia along with a low hgb, low mcv, and low mchc, you will also have a low __
hyperchromic
you will have __ rbcs (MCHC) with normal MCV in spherocytosis
acute
if you have anemia but w/ low retic count then that indicates __ blood loss
breastfeeding
hyperbilirubinemia risks in infants are hematoma, abo compatibility, and ___ (due to slowed GI motility)
Desferoxamine
What medication is used to treat iron overdose?
calcium
dont take iron supplementation with foods that are high in __
toradol
is an nsaid given for sickle cell crisis. but dont give it for longer than 5 days because this can cause renal compromise
25
what are the odds that a child, born from parents who both have the sickle cell trait, will get the disease? __%
not
a child is __ at a high risk of getting cholitis if they have sickle cell anemia
RDW
diff in size of RBCs. if you have a high __ then there is an issue w/ iron deficit, but it can go down if tx is effective
inc
there are __ reticulocytes shown in spherocytosis
bypass
gastric __ surgery can lead to pernicious anemia (b12)
shilling
tag the b12 then see if it is in the blood or the stool to determine if you have pernicious anemia. what is the name of this test?
folate
should be taken by any woman who could become preggo
hydrops fetalis
dec production of albumin causing massive edema
blood
jahova witnesses may not want rhogam because it is a __ product