NUR-631 MIDTERM STUDY GUIDE EXAM 2024, Exams of Nursing

Download NUR-631 MIDTERM STUDY GUIDE EXAM 2024 and more Exams Nursing in PDF only on Docsity! 1 NUR-631 MIDTERM STUDY GUIDE EXAM 2024 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST|GUARANTEED PASS |LATEST UPDATE sex-linked recessive X-linked recessive inheritance is a way a genetic trait or condition can be passed down from parent to child through mutations (changes) in a gene on the X chromosome. In males (who only have one X chromosome), a mutation in the copy of the gene on the single X chromosome causes the condition. metabolic acidosis decreased pH in blood and body tissues as a result of an upset in metabolism. Metabolic acidosis develops when too much acid is produced in the body. It can also occur when the kidneys cannot remove enough acid from the body. metabolic alkalosis elevation of HCO3- usually caused by an excessive loss of metabolic acids. ABG HCO3 functions as an alkalotic substance. CO2 functions as an acidic substance. Therefore, increases in HCO3 or decreases in CO2 will make blood more alkalotic. The opposite is also true where decreases in HCO3 or an increase in CO2 will make blood more acidic. CO2 levels are physiologically regulated by the pulmonary system through respiration, whereas the HCO3 levels are regulated through the renal system with reabsorption rates. 2 respiratory acidosis A drop in blood pH due to hypoventilation (too little breathing) and a resulting accumulation of Co2. respiratory alkalosis Arise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2. Down Syndrome (Trisomy 21) A genetic disorder caused by the presence of all or part of a third copy of chromosome 21. Non- disjunction during anaphase. Acute Myeloid Leukemia (AML) increased risk A flattened face, especially the bridge of the nose Almond-shaped eyes that slant up A short neck Small ears A tongue that tends to stick out of the mouth Tiny white spots on the iris (colored part) of the eye Small hands and feet Simeon crease Small pinky fingers that sometimes curve toward the thumb Poor muscle tone or loose joints Shorter in height as children and adults Klinefelter Syndrome (XXY) Male has extra X chromosome causing underdeveloped sex organs, breast development, large hands, and long arms and legs, infertility. cystic fibrosis -A genetic disorder that occurs in people with two copies of a certain recessive allele. -Progressive, genetic disease that affects the lungs, pancreas, and other organs. -Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause the CFTR protein to become dysfunctional. When the protein is not working correctly, it's unable to help move chloride — a component of salt — to the cell surface. Without the chloride to attract water to the cell surface, the mucus in various organs becomes thick and sticky. Turner Syndrome X linked chromosome disorder Short stature Webbed neck Asthma Inflammatory disorder of the airway. Asthma is a chronic (long-term) condition causing increased airway hyper-responsiveness and recurrent episodes of airway obstruction and inflammation with frequent remodeling. 5 Immune thrombocytopenic purpura (ITP) is a rare autoimmune disorder that causes you to have low platelet levels. Autoantibodies attack platelets. S/S skin that bruises very easily a skin rash of small red dots (petechiae) bleeding from any area of Fatigue Treat: corticosteroids intravenous immunoglobulin (IVIG) - this is a blood product that consists of concentrated antibodies. It is thought that the autoantibodies might be 'swamped' by IVIG, reducing their ability to target platelets. Second-line treatments (those used if the first-line treatments do not work) include: splenectomy thrombopoietin analogues - treatment to increase production of new platelets in the bone marrow monoclonal antibodies to CD20 - an injection treatment targeting antibody-producing cells. Polycythemia Vera (PV) Type of blood cancer, causes your bone marrow to make too many red blood cells. These excess cells thicken your blood, slowing its flow, which may cause serious problems, such as blood clots and enlarged spleen S/S Itchiness Numbness, tingling, burning, or weakness in your hands, feet, arms or legs fullness soon after eating and bloating or pain in your left upper abdomen due to an enlarged spleen Unusual bleeding, such as a nosebleed or bleeding gums Painful swelling of one joint, often the big toe Shortness of breath and difficulty breathing when lying down Treat: Blood letting Disseminated Intravascular Coagulation (DIC) Complex, acquired disorder in which clotting and hemorrhage simultaneously occur Treat with heparin Hemophilia An X-linked recessive disorder in which blood fails to clot properly, leading to excessive bleeding if injured. Hemophilia A deficiency of factor VIII Hemophilia B (Christmas disease) deficiency of factor IX Von Willebrand Disease 6 bleeding disorder caused by a deficiency of von Willebrand factor, a "sticky" protein that lines blood vessels and reacts with platelets to form a plug that leads to clot formation Blood Compatibility Remember this by what factor they have a or B or both AB or neither o patient doesn't have that factor they can't receive the blood Type A is one of the most common types and contains B antibodies, therefore people with this type can only receive blood that is Type A or O Type B is one of the rarest types and contains A antibodies, therefore people with this type can only receive blood that is Type B or O Type AB is one of the rarest types and does not contain any antibodies, which means people with this type can receive blood that is any type without having a reaction Type O is known as the universal donor and is one of the most common types. It contains both A and B antibodies, and therefore people with this type can only receive blood that is Type O, or else agglutination of the blood cells may occur. If patient has A and B alleles what is their blood type AB Rh type Either positive or negative, refers to the presence of a specific antigen in the patient's blood. Differences between the maternal and fetal rH type may result in an immune response that is dangerous to the fetus ( Erythoblastosis Fetalis) If rH type does not match, mother is given Rhogam. Erythropoiesis process of making red blood cells (erythrocytes) in the bone marrow. Erythropoiesis ensures you have the right number of blood cells — not too few or too many. Red blood cells are important because they: Transport oxygen you breathe in through your lungs to tissues throughout your body. Transport carbon dioxide from tissues throughout your body to your lungs so you can breathe it out. Erythropoiesis is one type of hematopoiesis. Hematopoiesis is your body's process of making all three types of blood cells: red blood cells (erythropoiesis), white blood cells (leukopoiesis) and platelets (thrombopoiesis). vasospasm involuntary contraction of a blood vessel Vascular spasm occurs whenever there is an injury or damage to the blood vessels. This will trigger a vasoconstriction, which could eventually stop the blood flow. Platelets plug 7 platelets stick to endothelium and collagen, they clump and release ADP (help platelets adhere), serotonin (maintain vasoconstriction), prostaglandins, and phospholipids (maintain vasoconstriction and activate clotting chemicals) clotting cascade 1)Platelet finds exposed collagen of damaged vessel 2) Platelet releases chemical that causes neighboring platelets to adhere to each other (platelet plug) 3)collected platelets and damaged tissue both released thromboplastin 4) Thromboplastin and calcium and vit.K converts inactive prothrombin to its active form thrombin 5) Thrombin converts fibrinogen into fibrin 6) fibrin threads coat damaged area and trap blood cells to form clot white blood cells (leukocytes) respond to injury or infection Neutrophils A type of white blood cell that engulfs invading microbes and contributes to the nonspecific defenses of the body against disease. Lymphocytes The two types of white blood cells that are part of the body's immune system: B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections; T lymphocytes form in the thymus and other lymphatic tissue and attack cancer cells, viruses, and foreign substances. Monocytes An agranular leukocyte that is able to migrate into tissues and transform into a macrophage. Eosinophils disease-fighting white blood cell parasitic infection an allergic reaction cancer Basophils A type of immune cell that has granules (small particles) with enzymes that are released during allergic reactions and asthma. A basophil is a type of white blood cell and a type of granulocyte. Never Let Monkeys Eat Bananas said uncle BEN Neutrophils Lymphocytes Monocytes Basophils Granulated=basophils, eosinophils and neutrophils Macrophages 10 immune complex reactions and involves IgG, IgM, and sometimes IgA antibodies. The build-up of these immune complexes results in complement system activation, which leads to polymorphonuclear leukocytes (PMNs) chemotaxis and eventually causing tissue damage. examples: Systemic lupus or Rheumatoid arthritis Type 4 hypersensitivity reaction delayed-type and involves of T-cell-mediated reactions. T-cells or macrophages are activated as a result of cytokine release, leading to tissue damage Example: leprosy, graft vs host disease, celiac Thyroid regulates metabolism Parathyroid in the neck; controls the calcium levels in your body, and normals the bone growth Cortisol stress hormone released by the adrenal cortex Growth Hormone (GH) regulates the growth of the body. Released by anterior pituitary. Linear bone growth. Prolactin stimulates milk production. Anterior pituitary. Calcitonin Lowers blood calcium levels. Made in thyroid. PTH (parathyroid hormone) Secreted by the parathyroid gland and raises blood calcium levels. Insulin A protein hormone synthesized in the pancreas that regulates blood sugar levels by facilitating the uptake of glucose into tissues Glucagon A protein hormone secreted by pancreatic endocrine cells that raises blood glucose levels; an antagonistic hormone to insulin. Glycogen Storage form of glucose. Stored in liver. Glucagon stimulates liver to release into bloodstream when blood sugar is low. 11 FSH and LH regulate processes in the gonads and the production of sex hormones. Use positive feedback loop. Melatonin A hormone manufactured by the pineal gland that produces sleepiness. Circadian rhythm. Thymosin stimulates the maturation of lymphocytes into T cells of the immune system Oxytocin (OT) secreted by the posterior lobe of the pituitary gland; stimulates contraction of the uterus during labor and childbirth ADH antidiuretic hormone (vasopressin). Sodium reabsorption. epinephrine and norepinephrine aid body during stress by raising heart rate, blood pressure, and respiration. Made in adrenal medulla. pineal gland secretes melatonin adrenal glands a pair of endocrine glands just above the kidneys. Medulla: secrete the hormones epinephrine (adrenaline) and norepinephrine (noradrenaline), which help to arouse the body in times of stress in the Cortex:aldosterone (a mineralocorticoid), cortisol (a glucocorticoid), and androgens and estrogen (sex hormones). thyroid gland produces hormones that regulate metabolism, body heat, and bone growth. parathyroid glands small pea-like organs that regulate calcium and phosphate balance in blood, bones, and other tissues thymus gland lymphoid organ in the mediastinum that conditions T cells to react to foreign cells and aids in the immune response hypothalamus gland function is to control the pituitary gland. one of the main regulators of the endocrine system. pituitary gland 12 The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands. anterior pituitary makes and releases hormones under regulation of the hypothalamus posterior pituitary ADH and oxytocin hydrophobic hormones Hydrophobic (fat soluble) hormones like the steroid hormones do not attach to surface receptors. They break off from their blood transport proteins and then pass right through the cell and nuclear membranes attaching to receptors near or on specific regions of DNA (genes). hydrophilic hormones Hydrophilic (water soluble) hormones like epinephrine, norepinephrine, dopamine, glucagon, and ADH, attach to receptors on the cell surface. positive feedback loop Causes a system to change further in the same direction. FSH & LH negative feedback loop A feedback loop that causes a system to change in the opposite direction from which it is moving. Most systems use negative feedback. Ex: blood sugar, temperature diabetes insipidus (DI) ADH ( Vasopressin) fails to properly regulate your body's level of water, and allows too much urine to be produced and passed from your body. There are 2 main types of diabetes insipidus: cranial diabetes insipidus - where the body does not produce enough AHD so excessive amounts of water are lost in large amounts of urine nephrogenic diabetes insipidus - where ADH is produced at the right levels, but, for a variety of reasons, the kidneys do not respond to it in the normal way Urine osmo low Serum plasma osmo high SIADH Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which the body makes too much antidiuretic hormone (ADH). This hormone helps the kidneys control the amount of water your body loses through the urine. SIADH causes the body to retain too much water. 15 Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels. Admin of insulin at a later time in day will coordinate insulin peak with the hormone release. cardiogenic shock A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. Cause MI, myocarditis, arrhythmias, congenital heart disease, cardiomyopathy, valve stenosis S/S Altered mental status, hypotension, arrhythmia, diminished pulses, dyspnea, peripheral edema, jugular venous distention, and orthopnea, cold clammy skin Treat: Treat underlying cause Angioplasty Thrombolytics Vasopressors IABP Decrease isotonic fluids Obstructive Shock Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues. Causes: Tension pneumothorax Cardiac tamponade Beck's triad decrease SBP, diminished heart sounds, JVD Pulmonary embolus S/S hypotension, tachycardia, and/or hypoxia. A physical exam include be thorough, including jugular vein exam, cardiac and lung exams, and assessing skin tone and temperature. Response to fluids may aid in diagnosis Treat: Isotonic fluids O2 Vasopressors Treat underlying cause Distrubtive shock distributive shock, also known as vasodilatory shock, causes inadequate tissue perfusion. In distributive shock, systemic vasodilation leads to decreased blood flow to the brain, heart, and kidneys damaging vital organs. Additionally, fluid leaks from the capillaries into the surrounding tissues neurogenic shock 16 consequence of spinal cord injury (SCI). This occurs due to the sudden loss of sympathetic tone, with preserved parasympathetic function, leading to autonomic instability. Neurogenic shock is mostly associated with cervical and high thoracic spine injury. Causes: Spinal cord injury, Guillain-Barre syndrome, autonomic nervous system toxins, transverse myelitis, and other neuropathies. The pediatric population reports neurogenic shock in children with trisomy 21, skeletal dysplasia, and tonsillopharyngitis. S/S It manifests as decreased cardiac output, hypotension, bradyarrhythmia, and temperature dysregulation (hypothermia) due to peripheral vasodilatation following an injury to the spinal cord. Treat: Atropine Warming Vasopressors Treat underlying cause septic shock infectious microorganisms in the bloodstream induce a profound inflammatory response causing hemodynamic decompensation. The pathogenesis involves a complex response of cellular activation that triggers the release of a multitude of proinflammatory mediators. This inflammatory response causes activation of leukocytes and endothelial cells, as well as activation of the coagulation system. The excessive inflammatory response that characterizes septic shock is driven primarily by the cytokines tumor necrosis factor alpha (TNF-α) and interleukin-1 (IL-1), which are produced by monocytes in response to an infection. S/S Tachycardia Fever or hypothermia (low body temperature). Shaking or chills. Warm, clammy or sweaty skin. Confusion Tachypnea Shortness of breath. Sepsis to shock: Increased cardiac output Hypotension Decreased urine output Heart palpitations Cool and pale limbs Skin rash. Treat: Fluids Antibiotics Vasopressors anaphylactic shock 17 A severe reaction that occurs when an allergen is introduced to the bloodstream of an allergic individual. Characterized by bronchoconstriction, labored breathing, widespread vasodilation, circulatory shock, and sometimes sudden death. S/S Respiratory symptoms (dyspnea, wheezing, stridor, hypoxemia, inability to maintain patency; persistent cough and/or throat clearing can be heralding symptoms) Hypotension (systolic less than 90 mm Hg or a decrease of greater than 30% from baseline) Signs or symptoms of end-organ dysfunction, for example, hypotonia, syncope, incontinence Likely exposure to an antigen and symptoms involving any 2 of the following body systems: Integumentary symptoms: Skin or mucosal layer (rash, pruritus, erythema, hives, swelling of the face, lips, tongue, Gastrointestinal symptoms: Persistent painful cramps or vomiting Treat: Fluids Epinephrine IM Corticosteroids Antihistamines Bronchodilator Vasopressors Glucagon ( reversal for beta blockers) hypovolemic shock A condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion. Nucleus Control center of the cell Nucleolis where ribosomes are made Mitochondria Powerhouse of the cell, organelle that is the site of ATP (energy) production phosolipid bilayer a thin polar membrane made of two layers of lipid molecules. This stops water-soluble molecules from crossing the cell membrane Golgi complex organelle that modifies, packages, and transports material out of the cell. Lysosomes cell organelle filled with enzymes needed to break down certain materials in the cell 20 Hyperpolarization an increase in the membrane potential of a cell, relative to the normal resting potential threshold potential The minimum membrane potential that must be reached in order for an action potential to be generated. repolarization phase membrane potential returns toward the resting membrane potential and becomes more negative Protein What the body uses to transport something across cell membrane Exotoxins ( bacteria growth) toxic substances that bacteria secrete into their environment Endotoxins released only when bacteria die and their cell walls break down osmotic pressure the pressure that would have to be applied to a pure solvent to prevent it from passing into a given solution by osmosis, often used to express the concentration of the solution. oncotic pressure The osmotic pressure in the blood vessels due only to plasma proteins (primarily albumin) --> causes water to rush back into capillaries at end. Hydrostatic pressure (HP) What is needed to get get fluid to move from the arterial end of capillary into interstitial space. Hypernatremia causes excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions Sodium levels 135-145 mEq/L Hypernatremia S/S Cells shrinking due to water leaving the cells to balance out sodium level in blood. Risk of confusion, convulsion, cerebral hemorrhage (SAH), coma. You are 'fried' or S.A.L.T. F - Fever (low grade), flushed skin R - Restless (irritable) 21 I - Increased fluid retention and increased BP E - Edema (peripheral and pitting) D - Decreased urinary output, dry mouth S = Skin flushed A = Agitation L = Low-grade fever T = Thirst Hyponatremia s/s SALTLOSS Stupor/coma Anorexia ( nausea & vomiting) Lethargy Tendon Reflexes ( decreased) Limp Muscles Orthostatic Hypotension Seizure/Headache Stomach Cramping Hyponatremia causes Inadequate sodium intake (nothing by mouth) Gastrointestinal suction Excessive intake of water Irrigation of gastrointestinal tubes with plain water Potent diuretics Increased perspiration Draining skin lesions Burns Nausea and vomiting Diabetic ketoacidosis (metabolic acidosis) Syndrome of inappropriate antidiuretic hormone secretion Retention of fluid, such as with kidney or heart failure atrophy (n.) the wasting away of a body organ or tissue; any progressive decline or failure; (v.) to waste away hypertrophy increase in cell size Hyperplasia increase in number of cells. Example: breast tissue gets bigger during pregnancy. Metaplasia 22 Mature cell type is replaced by a different mature cell type. Reversible. Example: smoker Dysplasia abnormal development or growth of cells, tissues, or organs. Not reversible. Example Cancer. anaplasia loss of differentiation of cells; reversion to a more primitive cell type Wilson disease (hepatolenticular degeneration) disease defined by impaired excretion of copper in the bile (leading to deposition in the liver and brain). Lack ATP7B so copper can't bind. Key term; Kayser-Fleisher ring. Dark ring (copper deposits) encircles cornea Apoptosis programmed cell death Autosomal Pertaining to a chromosome that is not a sex chromosome. sex-linked gene located on the X or Y chromosome recessive allele Describes a trait that is covered over, or dominated, by another form of that trait and seems to disappear. Rare. Dominant An allele that is always expressed. autosomal dominant Name the pattern of genetic transmission characterized thus: both M and F are affected; M may transmit to M; each generation has at least one affected parent; and one mutant allele may produce the disease. autosomal recessive two copies of an abnormal gene must be present in order for the disease or trait to develop sex linked dominant inheritance Inheritance of a genetic trait located on the sex chromosomes, like autosomal dominant Hypoglycemia, followed by rebound hyperglycemia, is observed in those with what? Somogyi Effect