NR 354 EXAM 2 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FR, Exams of Nursing

Download NR 354 EXAM 2 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FR and more Exams Nursing in PDF only on Docsity! 1 | P a g e NR 354 EXAM 2 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST|GUARANTEED PASS|LATEST UPDATE _____ is given IV to reestablish blood flow through a blocked artery to prevent cell death in patients with the acute onset of ischemic stroke, must be given within 3 to 4½ hours of the onset of signs of ischemic stroke. tPA Check vital signs to detect internal bleeding q15min × 2, q30min × 4, q1hr × 4; Notify HCP of dyspnea, cyanosis, and restlessness, which may occur with pneumothorax; keep patient lying on right side for minimum of 2 hr to splint puncture site; Then maintain bed rest for 12-14 hr, as ordered. Liver biopsy post-op HCV requires what type of isolation precaution. Contact _____ is an RNA virus that is blood-borne and primarily transmitted percutaneously. The most common mode of HCV transmission is the sharing of contaminated needles and equipment among injection drug users. High-risk sexual behavior (e.g., unprotected sex, multiple partners), especially among MSM, is associated with increased risk for transmission. Hepatitis C virus (HCV) 2 | P a g e _____ can be transmitted in several ways: (1) perinatally from mothers infected to their infants; (2) percutaneously (e.g., IV drug use, accidental needle-stick punctures); or (3) via small cuts on mucosal surfaces and exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B virus (HBV) _____ is transmitted primarily through the fecal-oral route. It often occurs in small outbreaks caused by fecal contamination of food or drinking water. Poor hygiene, improper handling of food, crowded situations, and poor sanitary conditions are contributing factors. Hepatitis A virus (HAV) Only those who are infected with HBV can be infected with _____. It can be acquired at the same time as HBV or a person with HBV can be infected with _____ later. _____ is transmitted like HBV. It can cause a range of illness, from an asymptomatic chronic carrier state to acute liver failure. Hepatitis D virus (HDV) Like hepatitis A, the _____ is an RNA virus transmitted by the fecal-oral route. The usual mode of transmission is drinking contaminated water. _____ infection occurs primarily in developing countries Hepatitis E virus (HEV) Priority intervention for incisional cholecystectomy focuses on monitoring for _____ bleeding, infection, dehiscence The first symptom of _____ may be blurred or double vision, red-green color distortion, or even blindness in 1 eye. Many patients describe extremity muscle weakness and problems with coordination and balance. multiple sclerosis _____ _____ are dilated, tortuous veins occurring in the lower part of the esophagus because of portal hypertension, and are a common complication of liver cirrhosis. Esophageal varices Patients with esophageal varices are at risk for bleeding are often started on a nonselective β-blocker _____ to reduce the risk of hemorrhage. β-Blockers decrease high portal pressure, which decreases the risk for rupture. propranolol _____, a drug that traps ammonia in the gut, reduces ammonia formation in the intestines. This drug's laxative effect expels the ammonia from the colon. Lactulose The patient with _____ and edema is placed on a low-sodium diet. The degree of sodium restriction depends on the patient's condition. 5 | P a g e During this phase of a tonic-clonic seizure, the body stiffens for 10 to 20 seconds Tonic phase During this phase of a tonic-clonic seizure, the extremities jerk for another 30 to 40 seconds. Clonic phase Coma or unresponsiveness, absence of brainstem reflexes, and apnea all describe _____ _____ Brain death _____ _____ is an irreversible loss of all brain functions, including those of the brainstem, and is a clinical diagnosis. It occurs when the cerebral cortex stops functioning or is irreversibly destroyed. Brain death _____ is a written physician's order instructing HCPs not to attempt CPR. Do Not Resuscitate (DNR) A _____ order is a written medical order that documents a patient's wishes about resuscitation and, more important, the patient's desire to avoid CPR. Do Not Resuscitate (DNR) _____ _____ are abnormal respirations characterized by alternating periods of apnea and deep, rapid breathing Cheyne-Stokes Prolonged use of this Parkinson's medication often results in dyskinesias and "off/on" periods when the medication will unpredictably stop or start working (relapsing). Carbidopa/Levodopa _____ _____ requires ABX therapy and respiratory isolation until the cultures are negative. Bacterial meningitis For any patient with _____ _____, it is important to maintain adequate oxygenation to support brain function and prevent secondary injury. increased ICP Complications such as _____ _____ (systolic hypertension with a widening pulse pressure, bradycardia with a full and bounding pulse, irregular respirations) may be present but often do not appear until ICP has been increased for some time or is suddenly and markedly increased Cushing's triad _____ _____ is described as systolic hypertension with a widening pulse pressure, bradycardia with a full and bounding pulse, irregular respirations Cushing's triad 6 | P a g e How must a PT with increased ICP and a closed head injury be moved or rotated? Log roll In the event of a PT _____, anticipate giving phenobarbital, phenytoin (Dilantin), benzodiazepines, and/or lorazepam. seizure Patient education involving institution of oral hygiene program within 10 days of initiation of _____ therapy may minimize growth rate and severity of gingival enlargement (gingival hyperplasia). Phenytoin (dilantin) PT actively taking _____ should schedule routine dental examination to prevent gingival enlargement. Pheytoin (dilantin) Blindness over half the field of vision hemianopsia Nursing care for a PT with _____ consists of helping the PT to compensate by arranging the environment within the patient's perceptual field, such as arranging the food tray so that all foods are on the right side or the left side to accommodate for field of vision hemianopsia The following are all used for _____ _____ (1) communicating often and meaningfully (2) allowing time for the patient to comprehend and answer (3) using simple, short sentences (4) using visual cues (5) structuring conversation so that it permits simple answers by the patient (6) praising the patient honestly for improvements with speech. Stroke communication Women who have never been pregnant (nulliparity) are at higher risk. Other risk factors include increasing age, high-fat diet, increased number of ovulatory cycles (usually associated with early menarche and late menopause), HRT, and possibly the use of infertility drugs. Ovarian cancer risk factors Breastfeeding, multiple pregnancies, OCP use (more than 5 years), and early age at first birth reduce the risk for _____ _____. Ovarian cancer _____ _____ is usually detected as a lump or thickening in the breast or mammography abnormality. It occurs most often in the upper, outer quadrant of the breast, which is the location of most of the glandular tissue 7 | P a g e Breast cancer If palpable, _____ _____ is characteristically hard and may be irregularly shaped, poorly delineated, nonmobile, and nontender. Breast cancer Administration of loop or thiazide diuretics, dialysis, patiromer (Veltassa), and/or sodium polystyrene sulfonate (Kayexalate) cause _____ Potassium wasting Cerebral Edema watch for brainstem herniation Increases CSF and CPP Increased CSF causes there to be less blood in the brain, so CPP goes down. Normal ICP level 5-15 CPP MAP-ICP Glasgow Coma Scale eyes, verbal, motor 456 Max- 15 pts, below 8= coma Patient has hit their head,GCS is 15, CT results are unremarkable, what are DC instructions? -check on him every hour -monitor for HA Decorticate posturing characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex. 10 | P a g e -Left sided weakness -Spatial perceptual problems -Misunderstand directions -Left sided neglect --Remind pt. they have a left side, touch left side, look at left side, touch left side Left Sided CVA -Right sided weakness -Aphasia --Ask yes or no questions -Aware of deficit -Angry, depressed, anxious Meningitis -Nuchal rigidity -Fever -HA -Altered mental status -Photosensitive - make sure in dark room -Don't cluster care, let pt. rest -Put a mask on pt! -Place on droplet precautions -The bacteria that causes meningitis is in oral pharynx and nose, so do a swab of mouth -gold standard dx is a lumbar puncture -Test for Brudzinski or kernig Brudzinski: flex pt. neck then knees go up Kernig: if you put their leg at 90 degree angle they cant straighten their leg These responses indicate meningeal irritation -Tx Penicillin Cephalosporin They cross the blood brain barrier 11 | P a g e Dexamethasone - decreases swelling -Complications: encephalopathy Lumbar Puncture -Healthy: CSF = clear -Position on side in fetal position since they do it between L3 and L4 or L4 and L5, putting in this position opens vertebrae so needle can get in between -Post procedure: lay flat for 4-6 hours, lots of fluid to replace CSF, monitor VS, encourage fluids, check site to make sure it is not leaking CSF (if leaking, will get a massive HA) -Change in mental status: don't do it, could mean increase ICP since can herniate -Patient feels pressure while doing lumbar puncture -Meningitis: will see cloudy, decreased glucose, increased protein since bacteria are eating all the glucose and protein is a biproduct of bacteria, increased WBC's - do gram stain Halo on Pillow Parkinson's disease -depletion of dopamine -sx:Shuffling gait - don't swing arms when walking, rigidity in arms, Pill rolling, Flat affect, Masklike, Tremors - tx: deep brain stimulator to block tremors from happening, Bradykinesia (don't rush pt, be patient) drug therapy parkinsons -goal: increase dopamine and decrease ACH -Carbidopa/levidopa Only works for a couple of years Causes extrapyramidal sx Tardive dyskinesia Has on and off syndrome Short half life so has to be dosed frequently since when at peak of drug pt. feels good and then drops and have to take more, then off and on, missed doses: pt. gets really sick 12 | P a g e Important to follow same medication times If you take B vitamins with it it minimizes effect so don't take B vitamins Parkinson's NI Watch for falls! - a lot of them die from falls Keep pt. as independent as they can be Myasthenia Gravis Sx: Droopy eyes, diplopia, Ptosis, Small mm get weak is early sign, Get worse as day goes on -Biggest concern is aspiration -Important that meds are scheduled to peak at time when pt. needs muscle to be strong - meal times -Exercise does not make better, problem is ACH, exercise makes worse -Listen breath sounds and watch for resp. distress MG drug therapy -Pyridostigmine (mestinon) -Dx MG with tensilon test - give tensilon IV, if sx resolve then this is positive for MG - tensilon is a cholinergic drug, can have a cholinergic reaction so have atropine on hand in case, tensilon will not be the permanent drug they are one, this is just testing drug -Put on mestinon -All drugs end in stigmine for MG Myasthenic Crisis --Pt. hasn't been diagnosed with MG Or has not been taking meds (not enough mestinon in system) -Sx -Increased HR, BP, and RR -Trouble swallowing -Will get better if give tensilon or drugs 15 | P a g e 6 Moves spontaneously 5 Moves to painful stimuli 4 Withdraws/flexion to pain 3 Flexion (decorticate) 2 Extension (decerebrate) 1 No movement tPA (tissue plasminogen activator) tPA is administered IV to reestablish blood flow through a blocked artery to prevent cell death in patients with the acute onset of ischemic stroke. tPA must be administered within 3 - 4 and half hours of the onset of clinical signs of ischemic stroke. Patients are screened carefully before tPA can be given. Screening includes a noncontrast CT scan or MRI to rule out hemorrhagic stroke; blood tests for glucose level and coagulation disorders; screening for recent history of gastrointestinal bleeding, stroke, or head trauma within the past 3 months; major surgery within 14 days; or recent active internal bleeding within 22 days. Nimodipine -calcium channel blocker, which is given to patients with SAH to decrease the effects of vasospasm and minimize cerebral damage. Nimodipine restricts the influx of calcium ions into cells by reducing the number of open calcium channels. Although nimodipine is a calcium channel blocker, its exact mechanism of action in reducing vasospasm is not well understood. -Assess BP and apical pulses before administration. • If pulse is ≤60 beats/min or systolic BP is <90 mm Hg, hold medication and contact physician. Carbamazepine (Tegretol) -The primary drugs to treat generalized tonic-clonic and focal seizures are phenytoin (Dilantin), carbamazepine (Tegretol), phenobarbital, divalproex, and primidone (Mysoline). The drugs used to treat absence and myoclonic seizures include ethosuximide (Zarontin), divalproex, and clonazepam (Klonopin). -DA for Tegretol: • Do not take with grapefruit juice. • Instruct patient to report visual abnormalities. • Abrupt withdrawal after long-term use may precipitate seizures. β-Interferon -drug therapy for MS • Rotate injection sites with each dose. • Assess for depression and suicidal ideation. • Instruct patient to wear sunscreen and protective clothing while exposed to sun. 16 | P a g e • Inform the patient that flu-like symptoms are common after initiation of therapy. Carbidopa/Levodopa (Sinemet) -drug therapy for PD • Monitor for signs of dyskinesia. • Effects may be delayed for several weeks to months. • Instruct patient or caregiver to report any uncontrolled movement of face, eyelids, mouth, tongue, arms, hands, or legs; mental changes; palpitations; severe nausea and vomiting; and difficulty urinating. Bromocriptine (Parlodel) -drug therapy for PD - should not be used as first line • Patient may become dizzy or faint due to orthostatic hypotension, especially after the first dose. • Notify physician immediately if a severe headache develops that does not improve or continues to get worse. Drug therapy MG Pyridostigmine (Mestinon) is the most successful drug of this group in the long-term treatment of MG. Liver Issues - Glucose -the liver helps metabolize glucose, so with liver failure, will have blood sugar issues Liver Issues - Protein -liver cannot properly metabolize proteins so excess ammonia builds up causing hepatic encephalopathy -also get ascites/peripheral edema from excess albumin Liver Issues - Vitamins/Iron -cannot store with liver failure, so will need supplementation Liver Issues - Drug metabolism -cannot metabolize drugs that are metabolized in liver so if given these medications will stay in systems for day Liver Issues - Bile formation -gallbladder stores Liver Issues - Bilirubin -excess bilirubin excretion resulting in jaundice Liver Issues - Clotting factors 17 | P a g e -problem with clotting factors, thrombin, PT, PTT so in result patient at risk for bleeding, DO NOT give NSAIDS since this could make bleeding worse Liver Issues - Blood not filtered -blood is not being filtered so itchy, pruritic skin results Liver Biopsy -liver will bleed -position pt. on affect side (rt. side) Liver Failure CM -hepatomegaly -splenomegaly -ascites -varices -dyspepsia -anemia -clay colored stools (no bile) -spider angiomas -caput medusa (distended veins around umbilicus) -asterixis (flapping tremor with encephalopathy) -palmar erythema -fetor hepaticus -will develop portal HTN (this causes the hepatomegaly, splenomegaly, ascites, varices) TIPS procedure Relives portal hypertension by shunting blood from portal vein to hepatic vein (bypassing liver) Acites - Comes in to hospital from dyspnea -So much fluid in belly it is pushing up into diaphragm -TX: Paracentesis - Effective if pt. has relief from dyspnea - Elevate HOB -Watch bladder for puncture so void first -Sign consent -Make sure platelets arent less than 50,000 - Monitor INR shouldn't be 5 20 | P a g e -blood borne, sex, IV drug use -tx is NOT affordable - ribavirin (causes some bleeding, if pt. is all of a sudden pale: think bleeding) -1 -2 weeks before sx appear -many will develop chronic hep c and will remain infectious Ribavirin (Rebetol, Copegus, Ribasphere) • May cause severe birth defects. During treatment, pregnancy must be avoided both by women taking the drug and by women whose male partners are taking the drug. • Monitor hemoglobin and hematocrit as it may cause anemia. Cholelithiasis -tx for stones is to dissolve stones which takes almost a year to work Cholecystitis -stones in gallbladder blocking bile duct can be a cause -female, fat, forty, fertile, fair -RUQ that radiates to right shoulder -fever and increased WBC -pain gets worse after fatty meal -dark urine -epigastric distress -clay colored stool ONLY if blockage of bile duct laparscopic cholecystectomy -wont have a dressing -will have steri strips -wait till they fall off -no shower for 48 hours -can go back to work in 1-2 weeks -wait a week before lifting anything that is heavy -if they stay in hospital overnight: post op care, address ABC's, IS to avoid atelectasis, ambulate, pain meds, progress diet (low fat) open cholecystectomy -will do this if they have a gangrenous gall bladder, super inflamed or cancer -have a drainage bag with a T tube to drain the bile, expect the bile to green. measure as output, not more than 100ML's/shift, should not be purulent, brown, or bloody if it is then call doc Acetaminophen (Tylenol) • Drug is safe if taken at recommended levels. However, its prevalence in a variety of pain relievers, fever reducers, and cough medicines may mean that patients do not realize they are taking several drugs that all contain acetaminophen and overdose may occur. 21 | P a g e • Acute liver failure can occur as a result of overdosing, either intentionally or unintentionally. • The FDA has asked drug manufacturers to limit the strength of acetaminophen in prescription drug products to 325 mg per tablet, capsule, or other dosage unit, making these products safer. • Combining the drug with alcoholic beverages increases the risk of liver damage. Which sided stroke has impaired speech/language aphasia; impaired right/left discrimination; slow performance/cautious,; depression/anxiety; impaired comprehension. Left-Sided Which sided stroke has spatial perception deficits; denying/minimizing; rapid performance/short attention; impulsiveness; impaired judgment; impaired time. Right-sided _____ are the confirming diagnostic studies for stroke. CT; CT angiogram; CT/MRI perfusion and diffusion imaging; MRI; Magnetic resonance angiography (MRA) _____ are the confirming laboratory studies for stroke. Prothrombin time, activated partial thromboplastin time; CBC (including platelets); Electrolyte panel with blood glucose; Lipid profile; Renal and hepatic studies Recombinant tissue plasminogen activator (tPA) is used to produce localized fibrinolysis by binding to the fibrin in the thrombi, and is the immediate treatment for _____ _____. Ischemic stroke Aspirin at a dose of 325 mg may be started within 24 to 48 hours after the onset of an _____ stroke. ischemic Anticoagulants and platelet inhibitors are contraindicated in patients with _____ strokes. hemorrhagic The main drug therapy for patients with _____ stroke is the management of hypertension. hemorrhagic The _____ _____ of a spinal cord injury (SCI) is initial physical disruption of the spinal cord. primary injury The _____ _____ of a spinal cord injury is from processes, such as ischemia, hypoxia, hemorrhage, edema secondary injury 22 | P a g e _____ _____ may occur shortly after acute SCI. It is characterized by loss of deep tendon and sphincter reflexes, loss of sensation, and flaccid paralysis below the level of injury. Spinal shock _____ _____ involvement results in total loss of sensory and motor function below the level of injury. Complete cord _____ _____ involvement results in a mixed loss of voluntary motor activity and sensation and leaves some tracts intact. Incomplete cord SCI at C1-C3 Often fatal; Movement in neck and above, loss of innervation to diaphragm, absence of independent respiratory function SCI at C4 Sensation and movement in neck and above; May be able to breathe without ventilator SCI at C5 Full neck, partial shoulder, back, biceps; Gross elbow, inability to roll over or use hands; ↓ Respiratory reserve SCI at C6 Shoulder and upper back abduction and rotation at shoulder; Full biceps to elbow flexion, wrist extension, weak grasp of thumb; ↓ Respiratory reserve SCI at C7-C8 All triceps to elbow extension, finger extensors and flexors; Good grasp with some decreased strength; ↓ Respiratory reserve SCI at T1-T6 Full innervation of upper extremities; Back, essential intrinsic muscles of hand; Full strength and dexterity of grasp; ↓ Trunk stability, decreased respiratory reserve SCI at T6-T12 Full, stable thoracic muscles and upper back; Functional intercostal muscles, resulting in ↑ respiratory reserve SCI at L1-L2 Varying control of legs and pelvis; Instability of lower back SCI at L3-L4 Quadriceps and hip flexors; Absence of hamstring function, flail ankles 25 | P a g e Manifestations of _____ _____ _____ include jaundice, coagulation abnormalities, clay colored stools, ascites, and pruitis. Changes in cognitive function are often the first clinical sign. acute liver failure With _____ serum bilirubin is high, and the PT time is prolonged. Liver enzyme levels (AST, ALT) are often markedly increased acute liver failure The _____ genetic marker test is positive in 80% of women with epithelial ovarian cancer. CA-125 Pelvic or abdominal pain, bloating, urinary urgency or frequency, and difficulty eating or feeling full quickly are the vague and non-specific s/sx of _____ ovarian cancer The gold standard for monitoring _____ is the ventriculostomy, in which a specialized catheter is inserted into the lateral ventricle and coupled to an external transducer ICP _____ is an osmotic diuretic given IV, and decreases ICP in 2 ways: plasma expansion and osmotic effect. Mannitol _____ is another option to treat increased ICP. It produces massive movement of water out of edematous swollen brain cells and into blood vessels. Hypertonic saline solution The _____ is a quick, practical, and standard system for assessing the LOC. Glasgow Coma Scale (GCS) _____ is a surgical procedure involving the removal of prostate tissue using a resectoscope inserted through the urethra. Transurethral resection of the prostate (TURP) Bleeding, clot retention, and chronic venous insufficiency (CVI) are complications with _____. Transurethral resection of the prostate (TURP) Mastectomy post-op Elevate arm, assess drainage and tubes, prevention of hematoma, support and education; assess for infection, bleeding, patient adjustment After a PT has had a mastectomy, what should not be done? no BP readings, venipunctures, or injections on the affected arm, if possible. 26 | P a g e Before any treatment of a stroke can begin, what has to be completed. CT scan to determine type of stroke. Which sided stroke has impaired speech/language aphasia; impaired right/left discrimination; slow performance/cautious,; depression/anxiety; impaired comprehension. Left-Sided Which sided stroke has spatial perception deficits; denying/minimizing; rapid performance/short attention; impulsiveness; impaired judgment; impaired time. Right-sided _____ are the confirming diagnostic studies for stroke. CT; CT angiogram; CT/MRI perfusion and diffusion imaging; MRI; Magnetic resonance angiography (MRA) _____ are the confirming laboratory studies for stroke. Prothrombin time, activated partial thromboplastin time; CBC (including platelets); Electrolyte panel with blood glucose; Lipid profile; Renal and hepatic studies Recombinant tissue plasminogen activator (tPA) is used to produce localized fibrinolysis by binding to the fibrin in the thrombi, and is the immediate treatment for _____ _____. Ischemic stroke Aspirin at a dose of 325 mg may be started within 24 to 48 hours after the onset of an _____ stroke. ischemic Anticoagulants and platelet inhibitors are contraindicated in patients with _____ strokes. hemorrhagic The main drug therapy for patients with _____ stroke is the management of hypertension. hemorrhagic The _____ _____ of a spinal cord injury (SCI) is initial physical disruption of the spinal cord. primary injury The _____ _____ of a spinal cord injury is from processes, such as ischemia, hypoxia, hemorrhage, edema secondary injury _____ _____ may occur shortly after acute SCI. It is characterized by loss of deep tendon and sphincter reflexes, loss of sensation, and flaccid paralysis below the level of injury. Spinal shock 27 | P a g e _____ _____ involvement results in total loss of sensory and motor function below the level of injury. Complete cord _____ _____ involvement results in a mixed loss of voluntary motor activity and sensation and leaves some tracts intact. Incomplete cord SCI at C1-C3 Often fatal; Movement in neck and above, loss of innervation to diaphragm, absence of independent respiratory function SCI at C4 Sensation and movement in neck and above; May be able to breathe without ventilator SCI at C5 Full neck, partial shoulder, back, biceps; Gross elbow, inability to roll over or use hands; ↓ Respiratory reserve SCI at C6 Shoulder and upper back abduction and rotation at shoulder; Full biceps to elbow flexion, wrist extension, weak grasp of thumb; ↓ Respiratory reserve SCI at C7-C8 All triceps to elbow extension, finger extensors and flexors; Good grasp with some decreased strength; ↓ Respiratory reserve SCI at T1-T6 Full innervation of upper extremities; Back, essential intrinsic muscles of hand; Full strength and dexterity of grasp; ↓ Trunk stability, decreased respiratory reserve SCI at T6-T12 Full, stable thoracic muscles and upper back; Functional intercostal muscles, resulting in ↑ respiratory reserve SCI at L1-L2 Varying control of legs and pelvis; Instability of lower back SCI at L3-L4 Quadriceps and hip flexors; Absence of hamstring function, flail ankles CT scan is the preferred imaging study to diagnose the location and degree of injury and the degree of _____ _____ _____. spinal canal compromise 30 | P a g e With _____ serum bilirubin is high, and the PT time is prolonged. Liver enzyme levels (AST, ALT) are often markedly increased acute liver failure The _____ genetic marker test is positive in 80% of women with epithelial ovarian cancer. CA-125 Pelvic or abdominal pain, bloating, urinary urgency or frequency, and difficulty eating or feeling full quickly are the vague and non-specific s/sx of _____ ovarian cancer The gold standard for monitoring _____ is the ventriculostomy, in which a specialized catheter is inserted into the lateral ventricle and coupled to an external transducer ICP _____ is an osmotic diuretic given IV, and decreases ICP in 2 ways: plasma expansion and osmotic effect. Mannitol _____ is another option to treat increased ICP. It produces massive movement of water out of edematous swollen brain cells and into blood vessels. Hypertonic saline solution The _____ is a quick, practical, and standard system for assessing the LOC. Glasgow Coma Scale (GCS) _____ is a surgical procedure involving the removal of prostate tissue using a resectoscope inserted through the urethra. Transurethral resection of the prostate (TURP) Bleeding, clot retention, and chronic venous insufficiency (CVI) are complications with _____. Transurethral resection of the prostate (TURP) Mastectomy post-op Elevate arm, assess drainage and tubes, prevention of hematoma, support and education; assess for infection, bleeding, patient adjustment After a PT has had a mastectomy, what should not be done? no BP readings, venipunctures, or injections on the affected arm, if possible. Before any treatment of a stroke can begin, what has to be completed. CT scan to determine type of stroke. 31 | P a g e _____ is given IV to reestablish blood flow through a blocked artery to prevent cell death in patients with the acute onset of ischemic stroke, must be given within 3 to 4½ hours of the onset of signs of ischemic stroke. tPA Check vital signs to detect internal bleeding q15min × 2, q30min × 4, q1hr × 4; Notify HCP of dyspnea, cyanosis, and restlessness, which may occur with pneumothorax; keep patient lying on right side for minimum of 2 hr to splint puncture site; Then maintain bed rest for 12-14 hr, as ordered. Liver biopsy post-op HCV requires what type of isolation precaution. Contact _____ is an RNA virus that is blood-borne and primarily transmitted percutaneously. The most common mode of HCV transmission is the sharing of contaminated needles and equipment among injection drug users. High-risk sexual behavior (e.g., unprotected sex, multiple partners), especially among MSM, is associated with increased risk for transmission. Hepatitis C virus (HCV) _____ can be transmitted in several ways: (1) perinatally from mothers infected to their infants; (2) percutaneously (e.g., IV drug use, accidental needle-stick punctures); or (3) via small cuts on mucosal surfaces and exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B virus (HBV) _____ is transmitted primarily through the fecal-oral route. It often occurs in small outbreaks caused by fecal contamination of food or drinking water. Poor hygiene, improper handling of food, crowded situations, and poor sanitary conditions are contributing factors. Hepatitis A virus (HAV) Only those who are infected with HBV can be infected with _____. It can be acquired at the same time as HBV or a person with HBV can be infected with _____ later. _____ is transmitted like HBV. It can cause a range of illness, from an asymptomatic chronic carrier state to acute liver failure. Hepatitis D virus (HDV) Like hepatitis A, the _____ is an RNA virus transmitted by the fecal-oral route. The usual mode of transmission is drinking contaminated water. _____ infection occurs primarily in developing countries Hepatitis E virus (HEV) Priority intervention for incisional cholecystectomy focuses on monitoring for _____ bleeding, infection, dehiscence 32 | P a g e The first symptom of _____ may be blurred or double vision, red-green color distortion, or even blindness in 1 eye. Many patients describe extremity muscle weakness and problems with coordination and balance. multiple sclerosis _____ _____ are dilated, tortuous veins occurring in the lower part of the esophagus because of portal hypertension, and are a common complication of liver cirrhosis. Esophageal varices Patients with esophageal varices are at risk for bleeding are often started on a nonselective β-blocker _____ to reduce the risk of hemorrhage. β-Blockers decrease high portal pressure, which decreases the risk for rupture. propranolol _____, a drug that traps ammonia in the gut, reduces ammonia formation in the intestines. This drug's laxative effect expels the ammonia from the colon. Lactulose The patient with _____ and edema is placed on a low-sodium diet. The degree of sodium restriction depends on the patient's condition. ascites When treating esophageal varices, a noted negative _____ shows correct treatment with propranolol. guaiac In more than half of patients, the first muscles involved with _____ _____ are the ocular muscles, causing ptosis (drooping of the eyelids) in 1 or both eyes and double vision myasthenia gravis Periods of rest between activities, and medications need to have the peak effect at mealtime is the PT Education for _____ _____ myasthenia gravis When a stone is lodged in the ducts or when stones are moving through the ducts, spasms may result in response to the stone. This sometimes causes severe pain, which is termed _____ _____, even though the pain is rarely colicky. biliary colic If _____ occurs with cirrhosis, assess the patient for hemorrhage, call the HCP, and be ready to transfer the patient to the endoscopy suite and/or assist with equipment to control the bleeding. Maintain the patient's airway. Patients with bleeding varices are usually admitted to the intensive care unit (ICU). hematemesis 35 | P a g e _____ _____ are abnormal respirations characterized by alternating periods of apnea and deep, rapid breathing Cheyne-Stokes Prolonged use of this Parkinson's medication often results in dyskinesias and "off/on" periods when the medication will unpredictably stop or start working (relapsing). Carbidopa/Levodopa _____ _____ requires ABX therapy and respiratory isolation until the cultures are negative. Bacterial meningitis For any patient with _____ _____, it is important to maintain adequate oxygenation to support brain function and prevent secondary injury. increased ICP Complications such as _____ _____ (systolic hypertension with a widening pulse pressure, bradycardia with a full and bounding pulse, irregular respirations) may be present but often do not appear until ICP has been increased for some time or is suddenly and markedly increased Cushing's triad _____ _____ is described as systolic hypertension with a widening pulse pressure, bradycardia with a full and bounding pulse, irregular respirations Cushing's triad How must a PT with increased ICP and a closed head injury be moved or rotated? Log roll In the event of a PT _____, anticipate giving phenobarbital, phenytoin (Dilantin), benzodiazepines, and/or lorazepam. seizure Patient education involving institution of oral hygiene program within 10 days of initiation of _____ therapy may minimize growth rate and severity of gingival enlargement (gingival hyperplasia). Phenytoin (dilantin) PT actively taking _____ should schedule routine dental examination to prevent gingival enlargement. Pheytoin (dilantin) Blindness over half the field of vision hemianopsia 36 | P a g e Nursing care for a PT with _____ consists of helping the PT to compensate by arranging the environment within the patient's perceptual field, such as arranging the food tray so that all foods are on the right side or the left side to accommodate for field of vision hemianopsia The following are all used for _____ _____ (1) communicating often and meaningfully (2) allowing time for the patient to comprehend and answer (3) using simple, short sentences (4) using visual cues (5) structuring conversation so that it permits simple answers by the patient (6) praising the patient honestly for improvements with speech. Stroke communication Women who have never been pregnant (nulliparity) are at higher risk. Other risk factors include increasing age, high-fat diet, increased number of ovulatory cycles (usually associated with early menarche and late menopause), HRT, and possibly the use of infertility drugs. Ovarian cancer risk factors Breastfeeding, multiple pregnancies, OCP use (more than 5 years), and early age at first birth reduce the risk for _____ _____. Ovarian cancer _____ _____ is usually detected as a lump or thickening in the breast or mammography abnormality. It occurs most often in the upper, outer quadrant of the breast, which is the location of most of the glandular tissue Breast cancer If palpable, _____ _____ is characteristically hard and may be irregularly shaped, poorly delineated, nonmobile, and nontender. Breast cancer Administration of loop or thiazide diuretics, dialysis, patiromer (Veltassa), and/or sodium polystyrene sulfonate (Kayexalate) cause _____ Potassium wasting