NUR2392 Multidimensional Care II Exam 2 with correct answers., Exams of Nursing

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NUR2392 Multidimensional Care II Exam

2 with correct answers

Uncompensated - correct answer-pH and one other value is abnormal Partial compensation - correct answer-pH, CO2, and HCO3 are all off Full compensation - correct answer-pH is normal Acidosis - correct answer-reduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and smooth muscle. Alkalosis - correct answer-increases the sensitivity of excitable tissues allowing them to OVERRESPOND without stimulation ABG considerations - correct answer-- Assess cardiovascular w/ acidosis (cardiac arrest from hyperkalemia)

• Assess neuro status
• Fall precautions Bicarb HC03 - correct answer-kidney compensation (slow and powerful) Respiratory PaC02 - correct answer-Respiratory compensation (fast but limited) Metabolic acidosis causes - correct answer-DKA, Starvation, diarrhea, kidney failure, dehydration, liver failure, pancreatitis, heavy exercise, seizure activity, fever, hypoxia, ischemia, ethanol/methanol intoxication Metabolic acidosis signs and symptoms - correct answer-bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, kussmal resp (with resp compensation), warm, flushed, dry skin.

Metabolic acidosis treatment - correct answer-hydration and medication to treat underlying problems (DKA - give insulin). Metabolic alkalosis causes - correct answer-antacids, blood transfusion, sodium bicarbonate, total parenteral nutrition (TPN), prolonged vomiting, nasogastric suctioning, hypercortisolism, hyperaldosteronism, Loop/Thiazide diuretics. Metabolic Alkalosis s/s - correct answer-anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU, parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, decreased respiratory effort (muscle weakness). metabolic alkalosis treatment - correct answer-restore fluid/electrolyte imbalances Respiratory acidosis cause - correct answer-Opioids, anesthetics, electrolyte imbalance, inadequate chest expansion, muscle weakness, airway obstruction, alveolar-capillary block. Respiratory acidosis s/s - correct answer-bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, ineffective respirations, pale-to-cyanotic dry skin. Respiratory acidosis treatment - correct answer-(Assess airway) Improve gas exchange, drug therapy (bronchodilators, anti-inflammatory), oxygen therapy (lowest flow possible), ventilation. Respiratory alkalosis cause - correct answer-Hyperventilation (fear, anxiety), mechanical ventilation, salicylate toxicity, high altitudes, early-stage acute pulmonary issues. respiratory alkalosis s/s - correct answer-anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU (hypocalcemia), parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, hyperventilation respiratory alkalosis treatment - correct answer-restore fluid/electrolyte imbalances

How do acid/base imbalances affect electrolytes - correct answer-- Potassium levels increase in acidosis as the body attempts to maintain electroneutrality during buffering.

• Potassium is elevated in acute respiratory acidosis and normal/low in chronic respiratory acidosis when kidney compensation is present
• Alkalosis = hypocalcemia and hypokalemia
• Acidosis = HYPERkalemia alkalosis - correct answer-hypocalcemia and hypokalemia acidosis - correct answer-HYPERkalemia Upper GI consists of - correct answer-mouth, pharynx, esophagus, stomach, and duodenum. Barret's Epithelium - correct answer-premalignant; columnar epithelium that develops in lower esophagus Zollinger-Ellison syndrome (dumping syndrome) - correct answer-happens in PT with gastrectomy, from rapid emptying of food contents into the small intestine. Dumping syndrome S/S - correct answer-nausea, distension, cramping pains, diarrhea within 15 minutes after eating Leukoplakia - correct answer-thickened, white, firmly attached patches; slightly raised/rounded; most benign Erythroplakia - correct answer-precancerous, red, velvety, the floor of mouth, tongue, palate, mandibular mucosa; difficult to distinguish oral cancer - correct answer-- 90% are squamous cell carcinomas from epithelium surface
• Squamous cells are found on the lips, tongue, basal mucosa, and oropharynx
• Grow slowly.

• Patients who use tobacco products, consume alcohol, have a poor diet, use mouthwash with high alcohol content, and have poor dental hygiene. Early sign of oral cancer - correct answer-- Erythroplasia is early sign
• Present on lips, tongue, buccal mucosa, oropharynx oral cancer s/s - correct answer-bleeding from the mouth poor appetite difficulty chewing/swallowing unplanned weight loss thick or absent saliva painless oral lesions RED RAISED ERODED thick/lump in the cheek oral cancer treatment - correct answer-surgical excision, radiation and surgery, chemotherapy; Promote gas exchange Stomatitis - correct answer-painful inflammation within the oral cavity, occurring in single or multiple areas. The inflammation erodes the protective lining of the mouth. stomatitis risk - correct answer-patient with viral infections, use of tobacco, consuming irritating foods or chemicals, chemotherapy, or radiation. Candidiasis - correct answer-Fungal infection resulting from overgrowth of Candida albicans, a normal flora. Can occur in patients on antibiotics, steroids, radiation treatments, or antirejection medications. primary stomatitis - correct answer-Common; ulcers; Aphthous ulcers or canker sores

secondary stomatitis - correct answer-results from infection (opportunistic infection, virus, fungi, immunocompromised from chemo, radiation, steroid medications) - Candida albicans stomatitis causes - correct answer-infection, allergy, deficient vitamin B, folate, zinc, iron, systemic disease, irritants (alcohol/tobacco) gastritis - correct answer-inflammation of the gastric mucosa lining. erosive or non-erosive. Most common stomach disorder. Categorized as Type A as a result of an autoimmune condition Type B which is caused by the bacteria Helicobacter Pylori. Caused by bacterial infections, overuse of NSAIDs, use of alcohol, stress, andage. type a gastritis - correct answer-autoimmune condition type b gastritis - correct answer-caused by h pylori gastritis caused by - correct answer-Caused by bacterial infections (h. pylori), overuse of NSAIDs, use of alcohol, stress, and age. erosive gastritis - correct answer-alcoholics and NSAID use. pain immediately after eating. nonerosive gastritis - correct answer-most often caused by infection w helibacter pylori (H. pylori) Acid autodigestion - correct answer-Prostaglandins provide protective mucosal barrier that prevents stomach from digesting itself. hiatal hernia - correct answer-a condition in which a portion of the stomach has passed through the diaphragmatic opening into the chest.

Classified as sliding or paraesophageal. Can occur in patients who have experienced trauma or injury to the area, are over the age of 50, or are obese. sliding hernia s/s - correct answer-heart burn, regurgitation, pain, dysphagia, eructation Paraesophageal hernia s/s - correct answer-feeling full, breathlessness, feeling suffocation, chest pain, worsening in recumbent position Hernia Diagnostic Tests - correct answer-barium swallow hernia treatment - correct answer-lifestyle change (weight loss, smaller meal, limit fat, fried, caffeine), Antacids, proton pump inhibitor

• nutrition and swallowing therapy GERD - correct answer-due to the backward flow of gastrointestinal contents into the esophagus CAused by: slowed motility, esophageal sphincter dysfunction, and gastric emptying delay. This backward flow results in inflammation and erosions of the epithelium. Can occur in patients with obesity, poor diet, use of tobacco, connective tissue disorders, delayed stomach emptying, and use of nonsteroidal anti-inflammatory drugs (NSAID). Barret's esophagitis - correct answer-Precancerous lesion associated with GERD GERD s/s - correct answer-indigestion, regurgitation, eructation, flatulence GERD treatment - correct answer-sit up 1hr after meal, balancing nutrition, antacid, proton pump inhibitor GI bleed - correct answer-most often a result of gastroduodenal ulcer disease, esophagitis, and varices. Can occur with overuse of (NSAIDs) and the use of alcohol and tobacco.

GI bleed s/s - correct answer-rigid, hard abdomen(board-like) decreased BP coffee ground emesis black tar stools bloody stool Peptic Ulcer Disease (PUD) - correct answer-development of a circumscribed lesion (ulcer) in the mucosal membrane of the lower esophagus, stomach, duodenum, or jejunum. These lesions can be duodenal or gastric. Gastric ulcers are a result of Helicobacter pylori. Can occur in patients who consume a spicy diet, use tobacco, consume alcohol, and overuse of (NSAIDs). PUD diagnostics - correct answer-Labs/Diagnostics- H pylori test, chest, abdomen x-ray, EGD, nuclear med test if Gi bleed suspected complications of peptic ulcer disease - correct answer-hemorrhage, perforation, pyloric obstruction, intractable disease gastric cancer - correct answer-malignant cell growth in the stomach. Most commonly affected areas are the pylorus and antrum. Prognosis is dependent on the stage of the disease. Can occur in patients who consume a diet high in smoked and salted foods, positive family history, and use tobacco. gastric cancer risks - correct answer-H. pylori, pernicious anemia, polyps, gastritis, achlorhydria; more males than female over 50 Gastric Cancer Treatment - correct answer-Treatment- Radiation (local), chemo (systemic), gastrectomy or subtotal (partial) gastrectomy

Diagnostic studies for upper GI - correct answer-Barium swallow with fluoroscopy - allows visualization of the esophagus in order to determine possible abnormalities. Esophagastroduodenoscopy (EGD) or Upper GI endoscopy - allows direct visualization of the esophagus to determine abnormalities. Biopsy can also be obtained during the procedure. Biopsy - removal of cells in order to determine the presence of malignancy. Barium swallow with fluoroscopy - correct answer-allows visualization of the esophagus in order to determine possible abnormalities. Esophagastroduodenoscopy (EGD) or Upper GI endoscopy - correct answer-allows direct visualization of the esophagus to determine abnormalities. endoscopy - correct answer-allows direct visualization of the esophagus to determine abnormalities. biopsy - correct answer-removal of cells in order to determine the presence of malignancy. Upper GI lab studies - correct answer-Complete blood count - to determine fluid status, presence of infection, and clotting abilities. Serum Chemistry tests - to assess for electrolyte imbalances. Coagulation studies - to determine clotting ability. Blood urea nitrogen - to evaluate volume status. Tumor markers - to assess for the presence of gastrointestinal cancer. CBC (complete blood count) - correct answer-to determine fluid status, presence of infection, and clotting abilities. serum chemistry test - correct answer-to assess for electrolyte imbalances. Coagulation studies - correct answer-to determine clotting ability.

blood urea nitrogen (BUN) - correct answer-to evaluate volume status. tumor markers - correct answer-to assess for the presence of gastrointestinal cancer. PaO2 normal range - correct answer-80-100 mm Hg SpO2 normal - correct answer-95-100%