Hondros 212 Exam 3 Questions and Answers (Latest Update 2023) Rated A+, Exams of Nursing

Download Hondros 212 Exam 3 Questions and Answers (Latest Update 2023) Rated A+ and more Exams Nursing in PDF only on Docsity!

Update 2023) Rated A+

Health risk associated with obesity - correct answer ✅Depression, T2DM, metabolic syndrome, polycystic ovary disease, sleep apnea, asthma, pulmonary HTN, menstrual irregularities, infertility, gestational diabetes, huperlipidemia, sudden cardiac death, a fib, HTN, CAD, DVT, right sided HF, NASH, gallstones, GERD, kidney cancer, CKD, esophagus, pancreas, thyroid, colorectal and gallbladder cancer, breast and ovarian cancer Nutritional therapy for obesity - correct answer ✅Restricting dietary intake so that it is below energy requirements- includes all food groups Criteria guidelines for bariatric surgery - correct answer ✅BMI of 40 or more or a BMI of 35 or more with other significant co-morbidities (HTN, T2DM, HF, sleep apnea) Disadvantages of Roux-en-Y gastric bypass - correct answer ✅Leak at site of anastomosis, anemia, calcium deficiency, dumping syndrome, irreversible Dumping syndrome - correct answer ✅Gastric contents empty too rabidly into the small intestine, overwhelming its ability to digest nutrients. Symptoms include n/v, weakness, sweating, faintness and sometimes diarrhea. Pt is instructed to avoid sugary foods after surgery

Update 2023) Rated A+

Anastomosis leak - correct answer ✅tachycardia, fever, tachypnea, chest and abdominal pain Post operative care for bariatric surgery - correct answer ✅assess for cardiopulmonary complications, thrombus formation, anastomosis leaks and electrolyte imbalances, maintain the head of the bed at a minimum of a 45 degree angle to reduce abdominal pressure and increase lung expansion, pts should not consume fluids with meals Metabolic syndrome definiton - correct answer ✅is a group of metabolic risk factors that increase a person's change of developing CVD, stroke, diabetes. It is a cluster of heath problems, including obesity, HTN, abnormal lipid levels, and high blood glucose The main underlying risk factor for metabolic syndrome - correct answer ✅Insulin resistance related to excess visceral fat Criteria for metabolic syndrome - correct answer ✅Need any 3 of the 5- waist circumference- >40in in men and >35 in women, Triglycerides- >150 or

Update 2023) Rated A+

on drug treatment for high triglycerides, HDL cholesterol- <40 in men <50 in women or drug treatment for high cholesterol, BP- >130 sys >85 diastolic or on drug treatment for HTN, fasting blood glucose >100 or on drug treatment for elevated blood glucose Signs and symptoms of metabolic syndrome - correct answer ✅Impaired fasting blood glucose, HTN, abnormal cholesterol levels and obesity counterregulatory hormones- increase blood glucose levels - correct answer ✅glucagon, epinephrine, GH, cortisol C peptide in serum and urine - correct answer ✅useful clinical indicator of pancreatic b cell function and insulin levels Signs and symptoms of type 1 diabetes - correct answer ✅polyuria, polydipsia, polyphagia, weight loss may occur, weakness and fatigue signs and symptoms of type 2 diabetes - correct answer ✅poor wound healing, recurrent infections, dry skin, 3 Ps, drowsiness, hunger

Update 2023) Rated A+

Diagnosis of diabetes - correct answer ✅A1C of 6.5 or higher, fasting plasma glucose level of 126 or greater, a 2 hour plasma glucose level of 200 or greater during an OGTT using a glucose load of 75g, in a pt with classic symptoms of hyperglycemia (polyuria, polydipsia, unexplained weight loss) or hyperglycemic crisis, a random blood glucose level of 200 or more A1C (glycosylated hemoglobin) - correct answer ✅provides a measurement of blood glucose levels over the previous 2 to 3 months Diseases affecting RBCs (anemia) can influence the AIC Goal A1C for pts with diabetes - correct answer ✅less than 7. Fructosamine - correct answer ✅Is another way to assess glucose levels,, reflects glycemia in the previous 1 to 3 weeks Islet cell antoantibody - correct answer ✅testing is primarily done to help distinguish between autoimmune type 1 diabetes and diabetes from other causes Rapid acting insulin (lispro, aspart) - correct answer ✅Onset 10-30 min

Update 2023) Rated A+

Peak- 30 min- 3hr Duration- 3 - 5 hour Short acting (regular Humulin R, Novolin R) - correct answer ✅Onset 30min- 1hr Peak- 2-5hr Duration- 5-8hr ONLY INSULIN THAT CAN BE GIVEN IV!! Intermediate acting insulin (NPH) - correct answer ✅Onset- 1.5-4hr Peak- 4-12hr Duration- 12- 18hr Gently agitate before administering Long acting insulin (glargine, detemir) - correct answer ✅Onset- 0.8-4hr no peak Duration- 16-24hr DO NOT MIX WITH ANY OTHER INSULIN

Update 2023) Rated A+

Lipodystrophy - correct answer ✅loss of subcutaneous tissue may occur if the same injection sites are used Hypertrophy - correct answer ✅is a thickening of subcutaneous tissue. It eventually regresses if the pt does not use the site for at least 6 months. Injecting into a hypertrophied area may result in erratic insulin absorption Somogyi Effect - correct answer ✅Hyperglycemia in the morning, blood sugar drops at night d/t high dose of insulin then counterregulatory hormones are secreted increasing blood glucose levels. If a pt has morning hyperglycemia, check glucose levels between 2 and 4 am for hypoglycemia to see if its d/t to somogyi effect. Pt may report headaches on awakening and recall having night sweats and nightmares. Treatment is a bedtime snack, reducing the dose of insulin or both Dawn phenomenon - correct answer ✅Hyperglycemia present on awakening (GH and cortisol are increased in the morning. Treatment is an increase in insulin or an adjustment in administration time.

Update 2023) Rated A+

Metformin - correct answer ✅Do not use in pts with kidney disease, liver disease or heart failure. Lactic acidosis is a rare complication of metformin accumulation (n,v, weakness). IV contrast media that contain iodine pose a risk for CIN, which could worsen metformin- induced lactic acidosis. To reduce the risk of CIN, DC metformin 2 days before the procedure. May be resumed 48 hrs after the procedure, assuming kidney function is normal. Do not use in people who drunk excess amounts of alcohol. Take with food to minimize GI upset Alcohol induced hypoglycemia - correct answer ✅alcohol inhibits gluconeogenesis (breakdown of glycogen into glucose) by the liver. This can cause severe hypoglycemia in patients on insulin or OAs that increase insulin secretion. Moderate alcohol consumption is fine. 1 drink for women, 2 drinks for men. Teach pts to consume carbohydrates while drinking alcohol Exercise for pts with DM - correct answer ✅The ADA recommends that people with diabetes engage in at least 150 min/wk (30min, 5 day/wk) of moderate- intensity aerobic physical activity. Resistance training 3 times a week. Pts who use insulin, sulfonylureas, or meglitinides are at a increased risk of hypoglycemia, especially if they exercise during a peak of action of a medication. The glucose lowering effects of exercise can last for 48hrs. Pts

Update 2023) Rated A+

should exercise 1 hour after a meal or have a 10-15 g carb snack and check glucose levels Type 1 diabetes and exercise - correct answer ✅In a person with type 1 diabetes who has hyperglycemia and ketones, exercise can worsen these conditions. Teach pts to delay activity if the glucose is above 250 and ketones are present in the urine Stress and diabetes - correct answer ✅Stress and illness can raise glucose levels. Teach pts with diabetes to check glucose levels q4hrs during tiems of illness Diabetic Ketoacidosis (DKA) definition - correct answer ✅is characterized by hyperglycemia, ketosis, acidosis and dehydration. Precipitating factors of DKA - correct answer ✅Illness Infection Inadequate insulin dosage Undiagnosed type 1 diabetes

Update 2023) Rated A+

Poor self-management Neglect If DKA is not treated - correct answer ✅pt will develop severe depletion of sodium, potassium, chloride, magnesium and phosphate. Eventually, hypovolemia followed by shock will happen along with renal failure. Untreated, the pt becomes comatose from dehydration, acidosis and electrolyte imbalance Manifestations of DKA - correct answer ✅dehydration, dry mucous membranes, tachycardia and orthostatic hypotension. Early symptoms include lethargy and weakness. As the pt becomes dehydrated he skin becomes dry and loose, and the yes become soft and sunken. abdominal pain be present along with anorexia, n/v, breath like juicy fruit, KUSSMAUL RESPIRATIONS- rapid, deep breathing associated with dyspnea, thirsty, frequent urination Laboratory finding of DKA - correct answer ✅glucose level of 250 or greater, pH less than 7.30, and bicarb level less than 16. Moderate to large ketones are present in the urine and serum

Update 2023) Rated A+

Care of DKA - correct answer ✅First goal of therapy is to establish IV access and begin fluid and electrolyte replacement. Give 0.9 to raise BP and restore urine output to 30 to 60 ml/hr. When blood glucose levels reach 250 5 or 10% dextrose is added. Obtain serum potassium level before starting insulin. Monitor fluid balance and potassium balance!! Hyperosmolar Hyperglycemic Syndrome (HHS) - correct answer ✅_is a life- threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion. Causes of HHS - correct answer ✅UTIs, pneumonia, sepsis, any acute illness and newly diagnosed T2DM, impaired thirst sensation Risk of HHS - correct answer ✅The higher the glucose level increase serum osmolality and cause more severe neurologic manifestations such as somnolence, coma, SEIZURES, hemiparesis and aphasia Laboratory findings of HHS - correct answer ✅glucose level of 600 or more, increased serum osmolality. Ketone bodies are absent or minimal in both urine and blood

Update 2023) Rated A+

Treatment of HHS - correct answer ✅similar to DKA, Immediate IV administration of REGULAR insulin and 0.9. HHS usually requires large volumes of fluid replacement. If glucose levels reach 250 give dextrose to prevent hypoglycemia signs and symptoms of hypoglycemia - correct answer ✅Shaking Fast HR Sweating Anxious Dizziness Hunger Impaired vision Weakness, fatigue Headache Irritable Treatment of hypoglycemia - correct answer ✅A glucose level of less than 70 is treated by ingesting 15g of a simple (fast-acting) carbohydrate, such as 4 to

Update 2023) Rated A+

6oz of juice or a regular soft drink. gels or tablets containing specific amounts of glucose. Recheck the glucose levels 15min later, if the glucose is still under 70, give another 15g and recheck the glucose in 15 minutes. In an acute setting you may give 20 to 50ml of 50% dextrose IV. 1mg of glucagon by IM or subcut in deltoid muscle. Nausea is a common reaction after glucagon injection, to prevent aspiration if vomiting occurs turn the pt on the side until they are alert. Macrovascular Complications of Diabetes - correct answer ✅Diseases of the large and medium sized blood vessels that occur at greater frequency and with an earlier onset. Macrovascular diseases include cerebrovascular, cardiovascular and peripheral vascular disease. Prevention of macrovascular complications - correct answer ✅Yearly screening for CVD in pts with diabetes. Decrease risk factors- obesity, smoking, HTN, high fat intake and sedentary lifestyle. Pts need control over glucose levels. Optimizing BP really helps! Treat HTN. Screening for dyslipidemia and starting statin therapy as needed

Update 2023) Rated A+

Microvascular complications - correct answer ✅Thickening of the vessel membranes in the capillaries and arterioles in response to conditions of chronic hyperglycemia Diabetes-related retinopathy - correct answer ✅leading cause of blindness. proliferative diabetic retinopathy - correct answer ✅the most common form, partial occlusion of the small blood vessels in the retina causes microaneurysms to develop in the cap walls. Capillary fluids leak out, causing retinal edema and eventually hard exudates and intraretinal hemorrhages. Can be mild or severe-- if the center of the retina (macula) is affected, vision loss is severe Proliferative retinopathy - correct answer ✅the most severe form, involves the retina and vitreous. When the retinal capillaries become occluded, the body compensates by forming new blood vessels to supply the retina (neovascularization). The new blood vessels are fragile and hemorrhage. eventually light is prevented from reaching the retina. The pt sees black or red spots or lines. Retinal detachment can occur

Update 2023) Rated A+

Care for retinopathy - correct answer ✅dilated eye examination at the time of diagnosis and annually afterwards. T1DM- q 5 years. Prevent by maintaining healthy glucose levels and managing HTN, laser photocoagulation therapy can reduce the risk for vision loss. A pt who develops vitreous hemorrhage and retinal detachment may undergo vitrectomy is he aspiration of blood, membraine and fibers from inside the side. A flucinolone acetonide intraviteal implant (iluvien) is used to treat retinopathy Diabetic- related Neuropathy - correct answer ✅is nerve damage that occurs because of the metabolic imbalances associated with diabetes. The most common types is sensory neuropathy- loss of protection sensation in the lower extremities. Increases the risk for amputations Sensory Neuropathy - correct answer ✅loss of sensation, abnormal sensations, pain and paresthesias. Pain is describes as burning, cramping, crushing or tearing. It is usually worse at night. Pt may report walking on pillows on numb feet. The skin may become so sensitive the pt cannot tolerate light pressure from bed sheets. Foot injury and ulcerations can happen without the pt knowing

Update 2023) Rated A+

treatment of sensory neuropathy - correct answer ✅Managing DM is the only treatment. Capsacin, gabapentin, Lyrica, Cymbalta Risk associated with autonomic neuropathy - correct answer ✅hypoglycemia unawareness, bowel incontinence and diarrhea and urinary retention. Gastroparesis (delayed gastric emptying)- can cause anorexia, n/v, GERD, can trigger hypoglycemia, cardiovascular complication include postural hypotension, resting tachycardia and painless MI. Erectile dysfunction, vaginal infections in women and neurogenic bladder Hyperthyroidism (Graves's Disease) - correct answer ✅excessive activity of the thyroid gland with sustained increase in synthesis and release of thyroid hormones. Causes include toxic nodular goiter, thyroiditis, excessive iodine intake pituitary tumors and thyroid cancer. Monitor pts getting iodinated contrast media!! thyrotoxicosis - correct answer ✅physiologic effects or clinical syndrome of hypermetabolism resulting from excess circulating levels of T4 and T3. Usually occurs with hyperthyroidism

Update 2023) Rated A+

Subclinical hyperthyroidism - correct answer ✅Occurs when the pt has a serum TSH level below 0.4 but normal T3 and T4 levels Grave's Disease (hyperthyroidism) - correct answer ✅is an autoimmune disease of unknown cause characterized by diffuse thyroid enlargement and excess thyroid hormone secretion. pt develops antibodies to the TSH receptor. Is characterized by remissions and exacerbations. May result in destruction of thyroid tissue resulting in hypothyroidism. is associated with other autoimmune disorders (RA, lupus celiac disease, addisons) Manifestations of hyperthyroidism (Gave's Disease) - correct answer ✅It directly increases metabolism and tissue sensitivity to sympathetic nervous system stimulation. Goiter Bruit in thyroid gland Exophthalmus Clubbing of the fingers Tremors Diarrhea menstrual changes (amenorrhea)

Update 2023) Rated A+

fine straight hair tachycardia HTH breast enlargement weight loss muscle wasting localized edema Heat intolerence Nervousness thin brittle nails Labs indicating hyperthyroidism - correct answer ✅low protein, lipids, carbs, vitamins, vital signs are going to be HIGH, decreased TSH levels, increased thyroxine, LDL is low acute thyrotoxicosis (thyroid storm) - correct answer ✅is an acute, severe and rare condition that occurs when excess amounts of thyroid hormones are released into the circulation. Results from stressors- infection, trauma, surgery, pts having a thyroidectomy

Update 2023) Rated A+

Manifestation of thyrotoxicosis (thyroid storm) - correct answer ✅severe tachycardia, HF, shock, hyperthermia, agitation, delirium, seizures, abdominal pain, vomiting, diarrhea, coma Treatment of hyperthyroidism - correct answer ✅managing respiratory distress, reducing fever, replacing fluid, and eliminating and managing stressors. Antithyroid drugs- propylthiouracil, methimazole. Iodine is used with other antithyroid drugs to prepare the pt for a thyriodectomy or the treatment of thyrotoxicosis. B- adrenergic blockers (propranolol, atenolol in pt with heart and lung disease) thyroidectomy Signs of iodine toxicity - correct answer ✅- Swelling of buccal mucosa and other mucous membranes.

• Excessive salivation.
• N&V.
• Skin reactions. Radioactive Iodine therapy - correct answer ✅treatment of choice for nonpregnant individuals, damages or destroys thyroid tissue, has a delayed

Update 2023) Rated A+

response (3mo) many pts have posttreatment hypothyroidism and require lifelong thyroid hormone therapy. A pregnancy test must be done on all pts who have menstrual cycles, may cause dryness and irritation in the mouth and throat (may gargle salt water 3 to 4x a day) Teaching for radioactive iodine therapy - correct answer ✅use private bathrooms whenever possible, flushing 2 or 3 times after use, separately laundering clothes daily at home, not preparing food for others that requires prolonged handling with bare hands, avoid being close to pregnant women or children for 7 days after therapy thyroidectomy - correct answer ✅is done for those who 1. have a large goiter causing tracheal compression, 2. lack of response to antithyroid therapy or 3. thyroid cancer or when a person is not a candidate for RAI subtotal thyroidectomy - correct answer ✅removal of most of the thyroid to relieve hyperthyroidism nutritional therapy for hyperthyroidism - correct answer ✅with the increased metabolic rate a high caloric diet (4000-5000) may be needed to satisfy hunger, prevent tissue breakdown and decrease weight loss. 6 full meals a

Update 2023) Rated A+

day and snack high in protein, carbohydrates, minerals and vitamins, protein (1 to g/kg) increased carb intake. Teach the pt to avoid highly seasoned and high fiber foods and caffeine (diarrhea) Nursing care for acute thyrotoxicosis - correct answer ✅aggressive treatment, give thyroid medications and block thyroid production. Monitor for dysrhythmias, and decompensation, ensuring adequate oxygenation and giving IV fluids to replace fluid and electrolyte losses. Provide a calm, quite, cool room away from ill pts and noisy high traffic areas, using light covering and changing the linin often if pt is sweating and encouraging and assisting with exercise involving large muscle groups (muscle wasting), the pt should sit upright as much as possible Nursing care for thyroid surgery - correct answer ✅before surgery, antithyroid drugs, iodine and b adrenergic blockers may be given to achieve a euthryoid state. Iodine also decreases the vascularization of the thyroid gland, decreasing the risk for hemorrhage, show the pt how to support the head manually while turning in bed to minimize stress on the suture line, teach the pt to perform neck range of motion exercises

Update 2023) Rated A+

postoperative care for thyroidectomy - correct answer ✅complications include hypothyroidism, damage to or inadvertent removal of parathyroid gland, hypoparathyroidism, hypocalcemia.- to treat tetany, IV calcium gluconate should be availabl hemorrhage, injury to the recurrent or superior laryngeal nerve damage leads to vocal cord paralysis- laryngeal stridor, infection, thrombotoxicosis $$keep o2 and suction equipment in room$$ Keep the pt in a semi-fowlers and support the head with pillows hypothyroidism - correct answer ✅deficiency of thyroid hormones that causes a general slowing of metabolic rate. TSH is greater than 4.5 but the t4 levels are normal Causes of hypothyroidism - correct answer ✅Primary- destruction of the thyroid tissue or defective hormone synthesis, secondary- is caused by pituitary disease with decreased TSH secretion or hypothalamic dysfunction with decreased TRH secretion. Iodine deficiency is the most common cause Manifestations of hypothyroidism - correct answer ✅slowing of body processes, pt is often tired and lethargic, personality and mental changes,

Update 2023) Rated A+

including impaired memory, slow speech, decreased inituiative and somnolence, many appear depressed, weight gain Complications of hypothyroidism - correct answer ✅decreased cardiac contractility, decreased cardiac output, high serum cholesterol and triglyceride levels, myxedema coma is a medical emergency- can be caused by infection, drugs (especially opiates, barbituates and tranquillizers, exposure to cold and trauma- characterized by subnormal temperature, hypotension and hypoventilation- cardiovascular collapse can result myxedema - correct answer ✅caused by extreme deficiency of thyroid secretion, results from accumulation of hydrophilic mucopolysaccharies in the dermis and other tissues, it alters the physical appearance of skin and subcut tissues with puffiness, facial and preorbital edema and a masklike effect, cold and dry skin, hoarseness, hair loss, constipation, cold intolerence treatment of hypothyroidism - correct answer ✅A low calorie diet can promote weight loss or prevent weight loss. LEVOTHYROXINE is the drug of choice

Update 2023) Rated A+

nursing care for hypothyroidism - correct answer ✅use gentle soap and moisturize often to prevent skin breakdown, frequent position changes and low pressure mattress help maintain skin integrity, assess vital signs, body weigh, I&Os, edema. Cardiac assessment Teaching for hypothyroidism - correct answer ✅stress the need for lifelong drug therapy and avoiding abruptly stopping drugs Cushing's syndrome - correct answer ✅a condition caused by prolonged exposure to high levels of cortisol Manifestations of Cushing's syndrome - correct answer ✅weight gain, trunchal obesity, moon face, hyperglycemia, muscle wasting causes weakness, a loss of bone matrix causes osteoporosis and back pain, loss of collagen makes the skin weaker, thinner and more easily bruised, purplish red striae, thinning of hair, red cheeks, buffalo hump, supraclavicular fat paid, slow wound healing and acne, may cause hypokalemia and HTN from fluid retention- includes sex hormone!!! Hypervolemia

Update 2023) Rated A+

Diagnostics for Cushing's - correct answer ✅1. midnight or late night salivary cortisol 2. low-dose dexamethasone suppression test and 3. 24 hr urine corisol-- levels higher than 100 indicate cushing's treatment of Cushing's - correct answer ✅if the underlying cause is a pituitary adenoma- removal of pituitary tumor using the transsphenoidal approach, readiation, an adrenalectomy is done if Cushing syndrome is caused by adrenal tumors or hyperplasia, drugs- ketoconazole, mitotane, hydrocortisone or prednisone may be needed to avoid adrenal insufficiency, if development is because of prolonged use of corticosteriods- DECREASE GRADUALLY Nursing care- acute care - correct answer ✅assessment focuses on signs and symptoms of hormone and drug toxicity and complicating conditions (CVD, DM, infection) Monitor vital signs, daily weight, glucose and signs and symptoms of inflammation, monitor for signs and symptoms of thromboembolic events, PE (sudden chest pain, dyspnea, tachypnea) preoperative care of cushing's syndrome - correct answer ✅the pt should be brought to optimal condition HTN and hyperglycemia must be controlled,

Update 2023) Rated A+

hypokalemia must be corrected with diet and potassium supplements, a high protein died helps correct protein depletion postoperative care for Cushing's - correct answer ✅manipulating glandular tissue during surgery may release large amounts of hormones, monitor bp, fluid balance, electrolyte levels, High levels of corticosteroids are given IV during surgery and for several days afterward, monitor I&Os, obtain morning urine for testing of cortisol levels, pt is on bedrest until BP stabilizes adrenal insufficiency - correct answer ✅vomiting, increased weakness, dehydration and hypotension teaching for Cushing's syndrome - correct answer ✅teach the pt to always wear a medic alert bracelet, avoid exposure to extreme temperatures, infections, and emotional situations, teach pts to adjust corticosteroid replacement therapy to their own stress levels Manifestations of Addison's Disease - correct answer ✅Weight loss, emaciation, hypotension, tendency to develop refractory shock, vasodilation, anorexia, n/v, cramping abdominal pain, diarrhea, tendency of coexisting autoimmune disease, hyponatremia, insulin sensitivity, fever,