Exam 2 NR 545 (Latest 2024 / 2025) Questions & Answers with rationales, Exams of Nursing

Download Exam 2 NR 545 (Latest 2024 / 2025) Questions & Answers with rationales and more Exams Nursing in PDF only on Docsity! Exam 2 NR 545 (Latest 2024 / 2025) Questions & Answers with rationales Chest Pain AKA Angina Patho - Correct answer-Patho: Chest pain associated with decreased blood flow or ischemia to the myocardial tissue. Chest pain PA - Correct answer-Physical Assessment: chest heaviness Pressure Squeezing Fullness Pain radiates to left shoulder, arm, or jaw. Elevation of blood pressure during attack Chest pain Pharm - Correct answer-Pharm: Nitroglycerin- relaxes and widens blood vessels Dosing: 0.3-0.6mg every 5 minutes for max of 3 doses Long-term treatment to consider: ACE Inhibitors & Beta-Blockers Chest pain risks - Correct answer-Risks and complications: Acute Coronary Syndrome Myocardial Infarction - Correct answer-blood flow to the heart is minimized. Buildup of cholesterol MI Patho - Correct answer-imbalance between myocardial oxygen supply and demand Prolonged for greater than 30 minutes can lead to cardiac tissue death. MI PA - Correct answer-Pain at rest Not relieved with nitro Lightheaded Impending doom Nausea Diaphoresis Wheezing MI Dx - Correct answer-Troponins elevated, often stay elevated for one week after infarction. EKG- ST elevation or new left bundle branch block Atherosclerosis - Correct answer-when blood vessels that carry oxygen to organs and tissues is restricted. Hardening of vessels from buildup of fats, cholesterol in the artery walls Happens gradually. Formed plaque can break off and burst, triggering a blood clot. Atherosclerosis patho - Correct answer-inflammatory process that begins with damage to the endothelium often result of HTN, smoking, high cholesterol, or other risk factors. Fatty streak to fibrous plaque and then complicated lesion Atherosclerosis PA - Correct answer-modifiable risk factors Fluid retention - Drug/Dosing: Corlanor 5mg twice a day for two weeks, then 5mg per day Diuretics - Inhibits sodium chloride reabsorption - Drug/Dosing: HCTZ 12.5-50mg per day - Drug/Dosing: Lasix 20-80mg per day Antiarrhythmics - Inhibits sodium-potassium ATPase - Drug/Dosing: Digitalis 3.4-5.1mcg/kg per day Nonpharm: Salt restriction to 2gm/day Considerations: Avoid NSAIDs, antiarrhythmic drugs, calcium channel blockers Restrict fluid to 2L/day Hypertension - Correct answer-elevated blood pressure is a result of increased resistance to arterial blood flow HTN PA - Correct answer-Physical Assessment: headaches Dizziness Blurred vision Fatigue HTN Dx - Correct answer-Dx: after two consecutive clinic visits with BP readings above 130/80 potassium- Low potassium can increase BP Sodium- high sodium levels can elevate BP Blood glucose and HgA1C to assess for hyperglycemia and diabetes. Lipid panel to assess for hyperlipidemia or metabolic syndrome. Creatinine and blood urea nitrogen and ultrasound of kidneys to assess for secondary hypertension. TSH and T4 to assess for secondary hypertension due to abnormal thyroid function. HTN Tx - Correct answer-Pharm: Modifiable lifestyle changes Low sodium diet First Line Treatment Thiazides -Hydrochlorothiazide- diuretic. Thiazide diuretics inhibits sodium absorption. ACE inhibitor (ACEI) Accupril: Angiotensin-converting enzyme (ACE) inhibitors, inhibits conversion of Angiotensin I to Angiotensin II. Angiotensin receptor blocker (ARB) Valsartan- blocks Angiotensin II that constricts blood vessels. Calcium channel blockers (CCBs)- Amlodipine. Calcium channel blockers relax smooth muscles of the blood vessels and the myocardium. Ethnic considerations when prescribing: Thiazides or Calcium channel blockers (CCBs) are first line for African Americans. Angiotensin-converting enzyme (ACE I) for patients with coronary artery disease, heart failure or kidney failure. Angiotensin II receptor blockers (ARB), ACEI, Thiazides, or CCBs for Whites/Caucasian. ACEI or ARB for patients with chronic kidney disease with or without diabetes for all races and ages. ACEI, ARB, or CCBs for diabetes in non-Blacks. 1st line during pregnancy Labetalol Pathway for impulses of cardiac conduction - Correct answer-The SA node starts the sequence by causing the atrial muscles to contract. That's why doctors sometimes call it the anatomical pacemaker. Next, the signal travels to the AV node, through the bundle of HIS, down the bundle branches, and through the Purkinje fibers, causing the ventricles to contract. Coronary Artery Disease - Correct answer-damage or disease in the hearts major blood vessels Buildup of plaque Can lead to heart attack. Stenosis - Correct answer-The valve flaps become thick or stiff and sometimes can join together. The valve opening becomes narrowed. Less blood can flow through the narrowed valve. Regurgitation. - Correct answer-The valve flaps may not close tightly, causing blood to leak backward. Prolapse. - Correct answer-The valve flaps become stretched out and floppy. They bulge backward like a parachute. This condition can lead to regurgitation. Atresia. - Correct answer-The valve isn't formed. A solid sheet of tissue blocks the blood flow between the heart chambers. This type usually affects the pulmonary valve. Metabolic syndrome relationship to coronary artery disease - Correct answer-Frequency of metabolic syndrome is high in patients with coronary artery disease and is associated with severe CAD. Severity of CAD increases with presence of increasing number of metabolic abnormality. Back Pain - Correct answer-occurs due to changes or damages to the muscles. Most common low back pain involves lumbar spine. Back Pain Dx - Correct answer-Dx: imaging not recommended in first 6 weeks. XRAY MRI Back pain pharm - Correct answer-Pharm: Tylenol as a first line of pain treatment. Nonsteroidal anti- inflammatory drug (NSAID) medications, and muscle relaxants. Acetaminophen (Tylenol)- an analgesic, excreted through urine. Half-life 2-4 hours. Synovial Fluid Analysis - WBC count in the range between 5000-50,000 WBC/μL - Neutrophils MRI and ultrasound for joint imaging Rheumatoid arthritis pharm - Correct answer-Pharm: Methotrexate, a Disease Modifying Anti- Rheumatic Drug (DMARD), is the first line treatment for RA. Methotrexate inhibits DNA synthesis, repair, and cellular replication Ankylosing spondylitis - Correct answer-a type of arthritis that causes inflammation in the joints and ligaments of the spine. Hunched over back Ankylosing spondylitis s/s - Correct answer-back pain and stiffness that improves with exercise and isn't relieved by rest. pain and swelling in other parts of the body, such as the hips, knees and ribs. fatigue (extreme tiredness) Ankylosing spondylitis dx - Correct answer-Tx: anti-inflammatory and selfcare Bursitis - Correct answer-a painful condition that affects the small, fluid-filled sacs — called bursae (bur- SEE) — that cushion the bones, tendons and muscles near your joints Bursitis tx - Correct answer-Tx: Resting the affected area and using bandages and anti-inflammatory medications usually helps to make the inflammation go away. Antibiotics are used if bacteria are involved. If the symptoms don't improve, surgery to remove the inflamed bursa is considered. Headaches- - Correct answer-migraine is leading cause of disability. More common in women Headaches dx - Correct answer-Dx: CT Scan First or worst migraine New or unexplained neurologic symptoms New onset headaches in patients with cancer or HIV infection Episodic headache with hypertension, palpitations, and diaphoresis Associated symptoms: fever, stiff neck, papilledema, cognitive impairment, personality change. New onset headache after 50 years of age Magnetic Resonance Imaging (MRI) can be used when there is a suspicion of posterior fossa lesions or cerebrospinal fluid (CSF) leak is suspected. Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV) are indicated when arterial or venous lesions are suspected. headache pharm - Correct answer-Pharm: Mild-Moderate - NSAIDS (including aspirin, diclofenac, ibuprofen, Naproxen) - Acetaminophen - Caffeinated analgesic combinations (e.g. aspirin+acetaminophen + caffeine) - The following are recommended for management of moderate to severe migraine attacks: -Dihydroergotamine (DHE)- alpha adrenergic blocker that has a weaker arterial vasoconstrictor. It is also a potent 5-HT 1b/1d receptor agonist. - Triptans - Serotonin 1b/1d agonist. Inhibit the release of vasoactive peptides promote vasoconstriction and block pain pathways in the brainstem. - Sumatriptan (3, 4 or 6 mg SC and intranasal and inhaled powder formulations) Almotriptan, Eletriptan, Naratriptan, Rizatriptan, Zolmitriptan - Ubropegant (Ubrelvy) and erenumab-aooe (Aimovig), both CGRP receptor antagonists have been proven effective for acute treatment of migraine in adults. Ubropegant (Ubrelvy) has been approved for migraine treatment in children. Tension Headache - Correct answer-most common type of primary headache Tight band squeezing the head Tension Headache pharm - Correct answer-Pharm: The first line treatment is NSAIDS (including ibuprofen, aspirin, Naproxen, and Tylenol). If anxiety and depression are triggers, headaches may need treatment with antianxiety and antidepressant medications. Cerebrovascular accidents - Correct answer-occurs when a portion of the brain is deprived of oxygen rich circulatory blood. ischemic - Correct answer-oxygen deprivation cause a hypoxic state Hemorrhagic - Correct answer-typically caused by hypertension Weakening of walls of blood vessels causing a rupture TIA - Correct answer-brief episode of neurologic deficit that comes and goes quickly Disappear in less than an hour CVA Pharm - Correct answer-Pharm: TPA or TNK can only be used for ischemic stroke Should be given between 6 hours of symptoms. NEVER GIVEN WITH HEMORRHAGIC STROKE! Dementia - Correct answer-(Alzheimers, vascular, Creutzfeldt-Jakob, Lewy-body)- when cells in certain areas of brain are damaged Typically hippocampus damaged first Vascular Dementia- - Correct answer-brain cells are damaged due to a reduction of oxygen blood flow. This can be due to multiple embolic infarcts, anoxic brain damage, atherosclerosis, hypotension, and hypertensive vessel damage. The more brain tissue damaged; the more dementia is recognized. Lewy-body Dementia- - Correct answer-a progressive form of dementia in which brain cells are damaged due to a buildup of a protein called alpha-synuclein. Additionally, a loss of dopamine-producing neurons and acetylcholine is evident. This type of dementia is rapidly progressive and caused by infection by a prion - Correct answer- Creutzfeldt-Jakob disease (CJD) is a rapidly progressive, invariably fatal neurodegenerative disorder believed to be caused by an abnormal isoform of a cellular glycoprotein known as the prion protein. Responsible for secreting the matrix of bone - Correct answer-Osteoblasts are cells responsible for the secretion and deposition of bone morphogenetic proteins (BMPs) into the extracellular matrix during bone formation. This valve should be further evaluated due to a new systolic murmur heard at the 2nd intercostal space of the right sternal border - Correct answer-A bicuspid aortic valve This screening test is used to assess (rule in/rule out) a differential diagnosis of rheumatoid arthritis (RA) - Correct answer-Anti-cyclic citrullinated peptide antibody (anti-CCP) Sequence for the impulses in the cardiac conduction system pathway - Correct answer-The SA node starts the sequence by causing the atrial muscles to contract. That's why doctors sometimes call it the anatomical pacemaker. Next, the signal travels to the AV node, through the bundle of HIS, down the bundle branches, and through the Purkinje fibers, causing the ventricles to contract. You might see this on an EKG that is concerning for myocardial ischemia - Correct answer-ST elevation or new left bundle branch block Sudden onset headache known as "thunderclap headache) that is a medical emergency - Correct answer-Workup for subarachnoid hemorrhage In this condition, the vertebral joints first become inflamed followed by fibrosis and calcification or fusion of the joints - Correct answer-Ankylosing spondylitis (AS), a common type of spondyloarthropathy, is a chronic inflammatory autoimmune disease that mainly affects spine joints, causing severe, chronic pain; additionally, in more advanced cases, it can cause spine fusion. The patient complains of an excruciating left sided headache which occurs twice a day and lasts about 30 minutes- 2 hours. The pain is located around his eye, forehead and cheek. The nurse suspects which type of headache? - Correct answer-Cluster These musculoskeletal changes are consistent with a positive diagnosis of rheumatoid arthritis (RA) - Correct answer-Stiffness in more than one joint. Tenderness and swelling in more than one joint. The same symptoms on both sides of the body (such as in both hands or both knees). Weight loss. A positive rheumatoid factor test result shows that you have a high level of rheumatoid factor in your blood This condition is the result of progressive cortical atrophy, neurofibrillary tangles and senile plaques - Correct answer-Alzheimer's This class of medication relaxes blood pressure and reduce the work and pressure the heart must overcome to circulate oxygenated blood to the body (increases cardiac output) - Correct answer-ACE Inhibitor This type of dementia is a progressive form and associated with build-up of alpha-synuclein - Correct answer-Dementia with Lewy bodies is often shortened to DLB. In DLB, small round clumps of protein build up inside nerve cells in the brain. One of these proteins is called alpha-synuclein, and the clumps it forms are called Lewy bodies. Considered an autoimmune disorder causing chronic systemic inflammatory disease - Correct answer-RA This condition may develop shortly after a fracture occurs when there is more extensive inflammation such as with crush injuries - Correct answer-Compartment Syndrome This imaging is used to assess for vegetation on cardiac valves and examine the structure and function of the heart - Correct answer-Echocardiography Symptoms of severe exacerbation of heart failure - Correct answer-· Shortness of breath with activity or when lying down. · Fatigue and weakness. · Swelling in the legs, ankles and feet. · Rapid or irregular heartbeat. · Reduced ability to exercise. · Wheezing. · A cough that doesn't go away or a cough that brings up white or pink mucus with spots of blood. · Swelling of the belly area This blood test is used to assess and/or diagnose heart failure - Correct answer-BNP (B-type natriuretic peptides) tests Warning signs of cerebrovascular accident (CVA) - Correct answer-· Numbness or weakness in your face, arm, or leg, especially on one side. · Confusion or trouble understanding other people. · Difficulty speaking. · Trouble seeing with one or both eyes. Diagnostic test used to evaluate for septic arthritis - Correct answer-Analysis of synovial fluid obtained via arthrocentesis This occurs with osteoarthritis with bony enlargements of the interphalangeal joint - Correct answer- Heberden's & Bouchard's Nodes This type of fracture is more common in the softer bones of children - Correct answer-Greenstick Angina occurs due to the which of the following? - Correct answer-when the arteries that supply your heart muscle with blood and oxygen are narrowed by a fatty substance called plaque. It means less blood flows to your heart muscle and can cause angina symptoms. Tightness or pressure in the chest and may radiate to the neck and left arm - Correct answer-Angina Location of Cerebrospinal fluid (CSF) cerebrovascular accidents - Correct answer-Between brain and skull This type of dementia is damaged brain cells due to a reduction of oxygenated blood flow. It commonly occurs in persons over 70 years of age, particularly those with hypertension - Correct answer-Vascular Dementia