Arterial Blood Gas

NUR 265 Exam 4 Study Questions

• What is the normal arterial blood gas (ABG) range for the partial pressure of oxygen (PO2)?

• 80-100 mmHg
• What if it’s higher than 100? What if it’s lower than 80?

• Higher = too much oxygenation … lower = hypoxia

• What is the normal arterial blood gas (ABG) range for the partial pressure of carbon dioxide (PaCO2)?

• 35-45 mmHg
• What if it’s lower than 35? What is it’s higher than 45?

• Decreased = Respiratory alkalosis … increased = Respiratory Acidosis

• What is the normal range for the compensatory arterial blood gas (ABG) bicarbonate (HCO3)?

• 21-28 mEq/L
• What is it’s higher than 28? What if it’s lower than 21?

• Higher = respiratory acidosis (compensation for metabolic alkalosis) … Lower = respiratory alkalosis (compensating for metabolic acidosis)

• What is the normal range for glucose?

• 60-100 mg/dL

• What is the range of pre-diabetes for an impaired fasting glucose (IFG) test?

• 100-125 mg/dL

• What is the range of pre-diabetes for a 2 hour oral glucose tolerance (IGT) test?

• 140-199 mg/dL

• What is the normal range for a glycosylated hemoglobin (HbA1C) test?

• 4-6%

• What is the reference range for the electrolyte phosphorus?

• 3 – 4.5 mg/deciLiter

• What is the reference range for the electrolyte magnesium?

• 1.3 – 2.1 milli-Equivalents/Liter

• What is the reference range for the electrolyte chloride?

• 98 – 106 milli-Equivalents/Liter

• What is the reference range for the electrolyte calcium?

• 9 – 10.5 mg/deciLiter

• What is the reference range for the electrolyte potassium?

• 3.5 – 5 milli-Equivalents/Liter

• What is the reference range for the electrolyte sodium?

• 136 – 145 milli-Equivalents/Liter

• What is the reference range for hemoglobin?

• 14-18 gram/deciliter

• What is the reference range for hematocrit?

• 42-52%

• What is the reference range for white blood cells?

• 5,000-10,000

• What is the reference range for red blood cells?

• 4.7-6.1 million/UL

• What is the reference range for blood osmolarity?

• 285-295 mOsm/kg

• What are the normal levels for serum creatinine?

• 0.6-1.2

• What are the normal levels for BUN?

• 10-20

• What drugs is used early in the course of treatment, within 4-6 hours, after the onset of a STEMI?

• Fibrinolytic (thrombolytic)
• Upon arrival to the emergency department, how soon should the thrombolytic therapy be initiated?

• Less than 30 minutes

• What drugs are part of the fibrinolytic/thrombolytic therapy?

• (1) Reteplase (Retavase) (2) tenecteplase (TNKase)
• What are the nursing implications for TNK?[name 4]

• (1) determine clotting studies/PTT&PT (2) determine fibrinogen levels (3) determine hematocrit levels (4) determine platelet count (5) monitor for bleeding (6) monitor for neurological changes
• What neurological changes might you notice? [know all 4]

• (1) slurred speech (2) lethargy (3) confusion (4) hemiparesis or weakness/tingling on one side

• What is the drug of choice to manage pain associated with a STEMI?

• Morphine sulfate (IV)

• Is a STEMI or Non-STEMI described as a trans-mural necrosis?

• STEMI

• What is the pathological difference between a STEMI and Non-STEMI?

• A STEMI is an total, occlusive block of the coronary artery and a Non-STEMI is a partial block
• What is the difference between the 2 on an EKG?

• STEMI = ST elevation (in at least 2 precordial leads) with T-wave inversion;   Non-STEMI = no ST-elevation or pathological Q-waves

• How are STEMI’s diagnosed? Why is this method preferred?

• 12-lead EKG because you can quickly see the ST-elevation

• Would a STEMI or Non-STEMI exhibit the following symptoms?: atypical discomfort, shortness of breath or fatigue

• Non-STEMI

• Would a STEMI or Non-STEMI exhibit the following symptoms?: chest discomfort with or with radiation to arm/neck/jaw/epigastrium, shortness of breath, weakness, diaphoresis, lightheadness, nausea

• STEMI
• What should the person having these symptoms do at this point?

• (1) Take nitroglycerin (2) chew a baby aspirin

• When should the person experiencing this pain call 911?

• If the pain is unrelieved after 5 minutes

• What serum marker is clinically used the most as the optimum biomarker of an STEMI? What does it tell?

• Troponin; if there is dead heart tissue
• Why is troponin reliable to detect a STEMI, compared to the other test?

• Because you could miss the rise and fall pattern of CK-MB, but troponin won’t be missed

• True or False: If a small amount of troponin is detected, the patient will receive aggressive treatment for an MI

• True

• What medications could you expect someone with heart failure to be prescribed? [name 4]

• (1) digoxin – positive inotropic/negative chronotropic  (2) dopamine/vasopressor (3)diuretics (4) ACE inhibitors (5) beta-blockers (6) vasodilators

• What drug is used as a short term measure for severe, acute cardiac failure?

• Dopamine (Intropin)
• What kind of drug is dopamine? What does it do? [name 3]

• Positive inotropic, vasopressor; (1) increase myocardial(heart muscle) contractility (2) dilate renal blood vessels (3) increases renal blood flow (4) increases urine output

• What are nursing implications related to dopamine (Intropin)? [name 5]

• (1) monitor blood pressure (2) monitor heart rate (3) monitor pulse (4) monitor EKG (5) monitor pulmonary capillary wedge pressure or PCWP (6) monitor central venous pressure (7) monitor cardiac output (8) monitor urinary output

• What are the adverse effects of dopamine (Intropin)? [know both]

• (1) hypotension (2) cardiac dysrhythmias

• What cardiac medication is used for the prevention of extension and formation of clots?

• Lovenox
• What kind of drug is it and how does it work?

• Anticoagulant; by inhibiting factors in the clotting cascade

• By which route is Lovenox administered, and what are the implications of administration?

• subQ; only to the recumbent patient in the anterolateral or posterolateral abdominal wall (reclined patient in their love-handle/muffin-top region)

• What cardiac glycoside is an positive inotrope and negative chronotrope?

• Digoxin (Lanoxin)
• What is its purpose?

• For heart failure (positive inotrope) and A-fib (negative chronotrope)

• What should the nurse monitor for?

• (1) Signs and symptoms Digoxin toxicity (2) potassium levels
• What are the signs and symptoms of digoxin toxicity?

• nausea, vomiting, anorexia, visual changes, restlessness, headache, fatigue, confusion, bradycardia.

• What are the normal/therapeutic levels for digoxin?

• 0.8-2 ng/mL

• What cardiac medication is used prophylactically for long-term complications following a heart attack?

• Abciximab [“ab-six-i-mab”] (ReoPro)
• What other conditions is it used for?

• (1) coronary artery vascularization (2) stroke

• What should the nurse monitor for?

• (1) Signs and symptoms of bleeding (2) bleeding times (PTT, PT, INR, platelets)

• What 2 loop diuretics are indicated for pulmonary edema associated with heart failure?

• (1) bemetanide (Bumex) (2) furosemide (Lasix)
• What caution should the nurse take when administering IV Lasix? Why?

• To administer slowly because it could cause hearing loss if injected rapidly

• What should nursing implications are associated with these diuretics?

• (1) monitor urinary output (2) administer slowly to avoid hearing loss (3) monitor weight daily (4) monitor serum electrolytes (potassium, sodium….)

• What 2 drugs have cardio-protective effect after a heart attack? What type of drugs are they?

• (1) trandotapril (Mavik) – ACE inhibitor (2) losartan (Cozaar) – ARB
• For what condition are these drugs indicated?

• Heart failure

• What adverse side effect should the nurse monitor for? What should the nurse make sure the patient isn’t taking?

• Hyperkalemia; potassium

• Dry cough is an important side effect to inform patients taking which drug?

• trandotapril (Mavik) – ACE inhibitor

• What kind of medication would a patient likely be started on if they are a heart failure patient that was once stabilized on ACE inhibitors and diuretics? Why?

• Beta-blockers because they are cardioselective
• What action do beta-blockers such as bisoprolol [“bis-o-pro-lol”] (Zebeta)?

• (1) decrease the workload of the heart (2) decreases oxygen demands

• What signs should the nurse monitor for?

• Worsening heart failure

• What are adverse effects of as bisoprolol [“bis-o-pro-lol”] (Zebeta)? HINT:: think of beta cells, think of dilation [know all]

• (1) bradycardia (2) bronchospasm (3) hypotension

• You have a heart failure patient who is taking nesiritide (Natrecor). What kind of drug is it?

• Vasodilator
• What is the nursing implication for administration?

• Continuous IV infusion (to keep blood vessels dilated)

• What should the nurse monitor for the patient taking Natrecor? HINT:: think about what happens to the blood

• (1) blood pressure (2) urine output

• You have a patient that is post-heart transplant, what medication do you expect them to be on to prevent allogenic organ rejection? [drug class and name]

• Immunosuppressant – cyclosporine (Sandimmune or Gengraf)
• Why not?

• Why not predinose?

• It can be given at the same time too

• What are the most common adverse effects? [know all]

• (1) nephrotoxicity (2) infection (3) hypertension

• What should the patient avoid while taking this medication? Why?

• Grapefruit juice because it rises the cyclosporine levels and increases the risk of toxicity

• What medication is indicated for hyperkalemia?

• Sodium polystyrene sulfonate (Kayexalate)
• What is the action of Kayexalate?

• Exchanges sodium ions for potassium ions in intestines

• What should the nurse monitor for? What are the symptoms?

• Hyperkalemia – (1) fatigue (2) muscle weakness (3) peaked t-waves

• What other problems can be caused by taking kayexalate?

• (1) constipation (2) impaction

• What are 5 types of heart failure?

• (1) systolic (2) diastolic (3) ejection fraction (4) left-sided (5) right-sided
• Which type of heart failure is the most common, and a problem with contraction and ejection of blood?

• Systolic

• Which type of heart failure involves decreased percentage of blood ejected from the heart?

• Ejection fraction
• What is the normal range for ejection fraction?

• 50-70%

• Which type of heart failure involves systemic congestion?

• Right-sided
• What are the symptoms of right-sided heart failure?
• What are the typical causes of right-sided heart failure?

• Left ventricular failure [left sided failure can cause right-sided failure], right ventricular MI/heart attack, pulmonary hypertension

• Which type of heart failure would you expect if the patient exhibits: ascite, increased abdominal girth, hepatomegaly, dependent edema, and jugular vein distention?

• Right-sided heart failure

• Which type of heart failure involves the lungs?

• Left-sided

• Left sided heart failure leads to what problem?

• Dyspnea

• What are the typical causes of left-sided heart failure?

• Hypertension/high blood pressure, coronary artery disease, valvular disease

• Which type of heart failure would you expect if the patient exhibits: weakness, fatigue, dizziness, acute confusion, pulmonary congestion, breathlessness, oliguria [“ol-lig-your-E-uh”]?

• Left-sided heart failure

• What type of heart failure is a problem with the heart relaxing and filling with blood?

• diastolic

• Fill in the Blanks:

• After the blood has circulated through the body, losing its oxygen and collecting carbon dioxide it enter the vena cava into the right atrium of the heart. The right atrium contracts and pumps the blood through the tricuspid valve and into the right ventricle, which then pumps the blood through the pulmonary artery into the lungs. In here, tiny blood vessels called capillaries absorb carbon dioxide from the lungs and replace it with oxygen. The oxygenated blood flows through the pulmonary vein and into the left atrium. The oxygenated blood pumps through the mitral valve and into the left ventricle. The left side of the heart contracts the strongest to send blood out of the left ventricle and through the aortic arch on its way to the body.
• If the left ventricle loses its contractility what happens and why? (trace the blood backwards thru the heart)

• Dyspnea (“disp-nee-uh”) because the heart gets backed up into the lungs

• If the right ventricle loses contractility, what happens and why?

• JVD (jugular vein distention) because the superior vena cava gets backed up

• What should you teach your heart failure patients to avoid?

• (1) over the counter medications (2) large amounts of caffeine (3) isometric exercises that increase pressure on in the heart
• What are exercises that are considered isometric? [name 2]

• (1) push-ups (2) leg lifts (3) bicep curls (4) chin-ups

• What should you teach your heart failure patients about their diet? [name 3]

• (1) low sodium (2) low-fat (3) low-cholesterol (4) rich in potassium because diuretics can cause hypokalemia

• What should you teach your heart failure patients about activity?

• Balance it with rest

• What should you teach heart failure patients about weight?

• (1) monitor weight daily (2) fluid retention/edema

• What is pericarditis?

• Acute inflammation of the pericardium (sac around the heart)

• What would a nurse find upon assessment for a patient that would be diagnosed with pericarditis? [name 6]

• (1) precordial pain that radiates to left side of neck, shoulder, or back (2) grating pain that is aggravated by breathing, coughing, and swallowing (3) pain worse in supine position, relieved by leaning forward (4) pericardial friction rub (5) fever (6) chills (7) elevated white blood cells (8) ST elevation (9) A-fib

• What interventions are implemented for pericarditis? [know 3]

• (1) high-Fowler’s or leaning forward (2) NSAIDS or corticosteroids (3) Auscultate for pericardial friction rub

• What is the major complication for a patient with pericarditis? How is it characterized? [name 3]

• (1) pulsus paradoxus; weak pulse on inspiration and strong pulse on expiration (2) increased central venous pressure (3) JVD with clear lungs (4) distant muffled breath sounds (5) decreased cardiac output
• What is done to remove the fluid around the heart?

• Pericardiocentesis

• What is endocarditis?

• Inflammation of the inner lining of the heart and valves

• What would a nurse find upon assessment for a patient that would be diagnosed with endocarditis? [name 6]

• (1) fever (2) weight loss (3) cardiac murmurs (4) embolic complications (5) petechiae (6) splinter hemorrhages in the nail beds (7) reddish, tender lesions on the pads of the fingers, hands, and toes (8) Non-tender hemorrhages lesions fingers, toes, nose, earlobes (9) clubbed fingers
• What could cause all of this?

• Dental procedure

• What complications could arise from endocarditis?

• (1) heart failure (2) emboli/clot to various organ

• What interventions could be implemented for a patient with endocarditis? [name 5]

• (1) adequate rest and activity to prevent clot from forming (2) antiembolic/compression stockings (3) monitor for heart failure (4) monitor for signs of embolism (5) monitor for nodes (6) evaluate blood cultures (7) administer IV antibiotics

• What should a nurse include in discharge teaching for a patient with infective endocarditis? [name 4]

• (1) reporting signs of infection (2) soft toothbrush (3) good oral hygiene (4) use antibiotic ointment well (5) request prophylactic antibiotics before every invasive procedure (6) report signs of embolic event (7) report signs of heart failure

• What signs could a patient with acute kidney injury experience? [name 3]

• (1) infrequent urination…less urine (2) back pain (3) flank pain (4) cola-colored urine (5) blood in urine

• What should you interpret and how should you respond to a patient experiencing altered urinary elimination as a result of acute kidney injury? [name 5]

• (1) ask how long symptoms have been present (2) determine input and output/I&O’s (3) assess for tachycardia (4) weigh the patient (5) find out if the patient has gained or lost weight (6) assess for pulmonary congestion in lungs (7) check for edema

• What lab values should be checked for a patient with acute kidney injury? [name 4]

• (1) complete blood count (2) hemo-concentration (3) BUN (4) serum creatinine (5) serum potassium…elevated (6) serum osmolarity…abnormal

• How should the nurse respond to kidney disease, acute or chronic? [name all]

• (1) monitor urine output (2) ensure the patient is hemodynamically stable (3) monitor for fluid overload
• On what should you reflect?

• (1) observe for improved urine output (2) think about what could have caused the problem and steps to prevent it again (3) think about patient teaching to reduce their risk

• True or False: Peritoneal dialysis is a clean technique.

• False; sterile

• True or False: Patients with chronic kidney disease are at risk for pathological fractures and should be handled gently during care.

• TRUE

• What should you assess any patient at risk for dehydration or hypovolemia for?

• Adequate kidney perfusion

• TRUE or FALSE: any patient with an AV fistula in their right arm should have their blood pressure taken in their left arm.

• True

• True or False: AV fistulas are good sites to administer IV medications.

• False! Never use an AV fistula to give IV

• Encourage patients with chronic kidney disease or kidney failure to follow fluid and dietary restrictions regarding what 3 nutrients?

• (1) sodium (2) potassium (3) protein

• What are the most common complications associated with peritoneal dialysis?

• (1) peritonitis from neglecting sterile technique, which can be life-threatening! (2) pain  (3) poor flow from the dialysate (4) dialysate leakage (5) infection from particulate called effluence

• What aspects of nursing care for a peritoneal dialysis patient should be important?

• (1) vitals (2) weight (3) labs (4) dwell time/how long the dialysate is in (5) flow and patency (6) respiratory comfort

• What are the signs and symptoms of peritonitis        ? [name 5]

• (1) fever (2) nausea (3) vomiting (4) cloudy dialysate (5) abdominal tenderness (6) general malaise (7) abdominal pain

• What should you teach patients with kidney disease who take immunosuppressive therapies to check for daily?

• Signs of infections - (1) fever (2) general malaise (3) nausea (4) vomiting

• What should the nurse assess for in a chronic kidney patient to ensure psychosocial integrity?

• For depression or non-acceptance of diagnosis or treatment plan

• It is a priority for the nurse to teach a patient in the early stages of kidney disease about the manifestations of what?

• Dehydration

• It is a priority for the nurse to teach a patient in the later stages of kidney disease about the manifestations of what?

• Fluid overload and hyperkalemia

• A patient comes back from hemodialysis and is scheduled for an invasive procedure. How much time should pass before the hemodialysis patient can have their procedure?

• 4-6 hours

• What is a priority for the neutropenia patient to ensure a safe and effective care environment?

• Good Handwashing technique to avoid infection

• What is a priority for the thrombocytopenia patient to ensure a safe and effective care environment?

• Bleeding precautions

• What is brachytherapy?

• A type of radiation therapy (for cancer patients) where the patient emits radiation (or the patient is the source of radiation)
• True or False: If the patient emits radiation, then the patient’s body fluids and waste, like sweat/semen/urine, are all radioactive.

• TRUE

• What are the 3 rules of thumb, or the 3 things to keep in mind, for a patient on brachytherapy?

• (1) distance (2) time (3) shielding

• True or False: A patient receiving brachytherapy is best on bed rest with a foley catheter.

• True
• Why?

• The less they get up, then the less they spread the radiation around their private room and to avoid bladder distention

• What equipment is most important to keep in the room of a patient getting brachytherapy? [know all]

• (1) lead-lined gloves (2) a lead-lined apron (3) a lead-box (4) tongs
• What should the nurse keep in mind about the apron?

• That the back in open, so to never turn their back on the patient to avoid exposure

• What kind of diet should this patient be on if they have an ovarian implant and why?

• Low fiber/residue diet because (1) discourage bowel movements that could dislodge the implant (2) to maintain strict bed rest

• Your patient is receiving brachytherapy and has a pregnant wife and 4 kids ranging from 8 to 18. What do you tell him?

• That it is too dangerous for his pregnant wife and kids under 16 yrs old to be exposed to radiation while he’s undergoing therapy\\

• A nurse has a patient getting brachytherapy. What should she wear at ALL times?

• A dosimeter

• What should a radiation patient keep in mind about their skin?

• (1) radiation causes superficial or superficial partial-thickness burns (2) not to put any lotions, aloe, cream, etc. on their skin unless prescribed (3) avoid direct sun exposure

• What is teletherapy?

• A type of radiation therapy (for cancer patients) where a beam is aimed at the markings on the patient’s body to target the tumor
• What should the nurse keep in mind about these markings?

• Not to wash them off!

•  What should the nurse do if the patient with brachytherapy calls the nurse’s station to tell her nurse that her implant fell out and hit the floor?

• Put on the (1) lead-apron (2) lead-gloves and grab the (3) tongs to put the implant in the (4) lead box then call the (5) HASMAT team to irradiate the room

• What does xerostomia [“zero-stoe-mia”]mean?

• Dry mouth

• What systemic effects does radiation have on the patient’s body?

• (1) hair loss (2) skin changes (3) taste – aversion to red meat (4) debilitating fatigue
• Which changes are permanent?

• Hair loss and skin changes

• How does chemotherapy rid cancer?

• Its cytotoxic so it kills cells that multiply rapidly
• How could this be a problem? [know all]

• It could also get healthy body cells like, (1) integumentary, (2) bone marrow, and (3) GI cells

• What should be cautioned about chemotherapy, and why?

• Giving multiple agents that attack the same organ, because it can cause organ failure

• What is done to make chemotherapy more effective?

• Giving agents that enter the cell cycle in different phases

• Regarding chemotherapy, what’s nadir?

• When bone marrow activity and white blood cells are at critically low levels

• What route is chemotherapy usually administered?

• IV

• What is extravasation?

• Infiltration of chemotherapy; when chemotherapy drugs leak into the surrounding tissues and lead to the tissues being destroyed
• Why does this happen? [know underlined word]

• Because the drugs are a vesicant (chemical that destroys tissue)

• True or False: this is a medical emergency!

• TRUE

• What does chemotherapy do to bone marrow?

• Depresses it
• What conditions does this lead to?        [name all]

• (1) anemia – decreased red blood cells (2) neutropenia – decreased white blood cells (3) thrombocytopenia - decreased platelets

• Anemia, Neutropenia, or Thrombocytopenia?: occult blood in the stool?

• Thrombocytopenia

• Anemia, Neutropenia, or Thrombocytopenia?: fresh fruit salad

• Neutropenia

• Anemia, Neutropenia, or Thrombocytopenia?: fatigue and shortness of breath

• Anemia

• Anemia, Neutropenia, or Thrombocytopenia?: no IM injections

• Thrombocytopenia

• Anemia, Neutropenia, or Thrombocytopenia?: no enemas or rectal temperatures

• Thrombocytopenia

• The chemotherapy patient is at high risk of infections. Which type of distributive shock is the patient mostly likely to experience?

• Septic shock
• What most likely causes the infections?

• Super infections (over growth )from their own body’s normal flora

• What should the nurse monitor to keep the chemotherapy patient safe from infection?

• (1) ANC (absolute neutrophil count) (2) temperature

• What GI conditions could develops can develop in a chemotherapy patient?

• Stomatisis and mucositis

• True or False: hair loss during chemotherapy is permanent?

• False; it can grow back, but often a different color and/or texture

• What is CIPN?

• Chemotherapy-induced peripheral neuropathy; numbness in feet and hands
• What is the priority concern with a patient who has developed this?

• Preventing injury because they may not feel it
• How do they prevent injury?

• (1) cleans and inspects feet daily (2) wears properly fitting shoes (3) avoids walking bare foot (4) trims toenails properly (5) reports non-healing broken areas of the skin of feet

• What are the oncological emergencies to be aware of? [know all ☹]

• (1) Sepsis (2) DIC (3) SIADH (4) spinal cord compression (5) hypercalcemia (6) superior vena cava syndrome (7) tumor lysis syndrome
• Why is it a possibility that sepsis and DIC can be an oncological emergency?        

• Because the cancer patient is immunosuppressed

• What condition does SIADH cause?

• Dilutional hyponatremia
• What cancer is SIADH associated with?

• Small cell lung cancer

• What cancer is associated with spinal cord compression?

• Prostate cancer
• What do you assess for this?

• Motor and sensory

• What manifestations could a nurse expect? [name 3]

• (1) back pain (2) muscle weakness or heaviness (3) tingling (4) unsteady gait (5) can’t tell hot from cold
• How is it treated?

• With corticosteroids

• What are the early manifestations of hypercalcemia? [ know all ]

• (1) fatigue (2) loss of appetite (3) nausea (4) vomiting (5) constipation (6) increased urinary output
• How can the calcium levels be lowered?

• Hydration

• What can ensure the safety of this patient during care?

• Draw sheet

• What is superior vena cava syndrome?

• Compression or obstruction of the vena cava by a tumor or clots
• Why is it a concern?

• Because it’s painful and life-threatening

• In what cancer patients is this syndrome mostly like to occur?

• Lymphomas, lung cancer, breast cancer [cancers of the neck and chest]

• What are the EARLY manifestations? [know all]

• [congestion in and above the chest] (1) edema of the face, especially around eyes (2) tightness of shirt/blouse

• What are the LATE manifestations? [know all]

• (1) hemorrhage (2) cyanosis (3) change in mental status (4) decreased cardiac output (5)hypotension (6) death if unrelieved

• What is tumor lysis syndrome?

• When the cancer cell bursts from treatment
• Why is this good?

• Because the tumor is being destroyed

• Why is this an emergency? [know all] [THINK::: the conditions it causes]

•  (1) potassium is released – hyperkalemia (2) nucleotides are released (3) increased uric acid from the liver (4) renal failure
• What are the signs of hyperkalemia?

• (1) tall peaked tented T-waves (2) flat P-waves (3) bradycardia (4) GI hypermobility

• How is this condition treated?

• (1) Hydrating the patient – 3000-5000mL, with some baking sodium/sodium bicarbonate to help decrease uric acid precipitation (2) allopurinol – decreases uric acid (3) kayexalate for hyperkalemia (4) glucose and insulin drip to decrease hyperkalemia

• What is a frozen section biopsy and why can it be helpful?

• When the sample is looked at in the operation room, because if the patient consented, they can remove the tumor immediately without performing a 2nd surgery

• What are advanced directives?

• Legal documents with end-of-life care specific to the patients preferences

• True or False: benign tumors grow back.

• False; they do not

• True or False: benign tumors can cause death

• True

• True or False: malignant cells go through the normal cells cycle, but lose differentiation so they serve no purpose in the body,

• True

• True or False: both benign and malignant cells go through the normal cell cycle

• True

• True or False: malignant tumors can grow back after being surgically removed

• True

• Malignant or Benign: Rapid growing?

• Malignant

• Malignant or Benign: do not mets?

• Benign

• Malignant or Benign: cells are immortal

•  malignant         

• Malignant or Benign: able to form their own capillary beds

• Malignant
• Why do they do this?

• To get more nutrients/ divert normal blood flow to feed themselves

• What does this do to the normal body cells?

• Cause the normal cells to starve

• What is the annual screening for colorectal cancer?

• Occult blood in stool test

• Is avoiding exposure to known carcinogenics considered primary or secondary prevention?

• Primary

• Is a mammogram considered primary or secondary prevention?

• Secondary

• What is a primary tumor?

• The parent/original tumor

• What is a secondary tumor?

• Addition tumors

• True or False: a patient was diagnosed with pancreatic cancer in 2011. Today she finds out that it has mets to her lungs, so now she has pancreatic and lung cancer.

• False; the primary cancer is pancreatic, lung cancer is secondary

• What is the greatest risk for factor for developing cancer?

• Aging

• True or False: Stomach cancer is more likely to occur in a smoker rather than a non-smoker

• True

• Name 6 types of cancer that are associated with tobacco use.

• (1) lung (2) oral cavity (3) pharyngeal (throat) (4) laryngeal (voice-box) (5) esophageal (6) pancreatic (7) cervical (8) kidney (9) bladder (10) liver (11) stomach (12) myeloid leukemia

• What are the 7 warning signs of cancer? [THINK CAUTION]

• (C) Changes in bowel/bladder habits (A) a sore throat  that won’t heal (U) unusual bleeding/discharge (T) thickening or a lump (I) indigestion or difficulty swallowing (O) obvious change in a wart/mole (N) nagging cough or hoarseness

• What are the 2 common sites that breast cancer can mets to?

• (1) bone (2) lung

• What is the most common site that lung cancer will mets to?

• The brain

• What is the most common site that colorectal cancer will mets to?

• The liver

• What are the 2 most common sites that prostate cancer will mets to?

• (1) spine/bone (2) pelvic nodes

• What are dietary habits that can reduce the risk of cancer? [name 6]

• (1) avoid excessive animal fat (2) avoid nitrate like processed meats and bacon (3) minimize red meat intake (4) alcohol consumption of 1-2/day (5) eat more bran/non-soluable fiber (6) eat more cruciferous vegetables (broccoli, cauliflower, brussel sprouts, cabbage) (7) eat foods high in vitamin A (8) eat foods high in vitamin C

• What does TNM stand for in cancer?

• T = tumor , N =  regional lymph node, M = metastasize
• If the tumor is still in the tissue it originated, what abbreviation could be seen?

• Tis

• If someone’s chart reads T2N1M1, what is happening?

• They still have cancer in the original tissue (2) its getting bigger (3) it spread to 1 regional lymph node (4) it metastasized one other tissue

• What is cachexia?

• Extreme body wasting and malnutrition despite caloric intake

• What is the normal red blood cell count?

• 4.7-6.1 million/UL

• What is the normal platelet count?

• 150,000 – 400,000/mm

• What is the normal white blood cell  count?

• 5,000-10,000
• What is the range in which the white blood cell count has made the patient immunosuppressed?
• 2000        

• What is mucositis?

• Sore in the mucus membranes

• What is stomatitis?

• Inflamed mouth and lips

• What is the normal range for CD4+T cells?

• 500-1,500 cells

• True or False: The treatment for HIV, HART, actually kills the virus.

• False‼‼!
• What does HART stand for?

• High-effective AntiRetroviral Therapy

• What is used to diagnose AIDS?        

• (1) presence of opportunistic infection (2) CD4 count less than 200

• True or False: HIV can be transmitted by sharing a fork with an infected person at dinner.

• FALSE

• What is the most common way that a healthcare professional can contract the HIV virus?

• Needle/sharps sticks

• What is the most common opportunistic infection in people infected with HIV?

• PCP (pneumocystis jiroveci pneumonia)

• What is the most common communicable disease that patients with the HIV virus are likely to catch?

• TB (tuberculosis)
• What are the symptoms?

• (1) cough (2) dyspnea (3) chest pain (4) fever (5) chills (6) night sweats (7) weight loss (8) anorexia

• True or False: Until a test, other than a PPD, comes back negative for TB in a patient with AIDS who is exhibiting symptoms of TB, then standard precautions and aireborne precautions should be maintained?

• True
• Why is the PPD not reliable?

• Because their immune response is compromised (no inflammatory response)

• What is the most common AIDS related malignancy?

• Kaposi’s sarcoma

• What is an ELISA?

• An inexpensive, but accurate, test for HIV
• A nurse comes down to the ER complaining of a needle stick. How long should have gone by before she is tested?

• 6-12 weeks

• What is a Western blot test?

• A test used to confirm the results of the ELISA, after a positive result.

• What is a viral load?

• A measurement of HIV genetic material
• Why it is used?

• To keep track of CD4 count

• What is a primary survey?

• The initial assessment of a trauma patient

• What is the purpose of triage and how what is it based upon?

• To rapidly sort patients into categories; based on their acuity and survival potential

• Which triage category receives a red tag?

• Class I/Emergent/Immediate threat to life

• Which triage category receieves a black tag?

• Class IV Expectant/Allowed to die/No treatment until others receive care/ Dead

• Which triage category receives a yellow tag?

• Class II/Major injuries

• Which triage category receives a green tag?

• Class III/Minor injuries

• What is systemic scerlosis?

• An uncommon chronic inflammatory autoimmune connective tissue disease
• What does CREST stand for?

• (C) calcinosis = calcium deposits (R) Reynaud’s phenomenon (E) Esophageal dysmotility (S) sclerodactyly = tight,waxy, hardened fingers (T) telangiectasia = spider veins

• What occurs during  a trans-phenoidal hypophysectomy?

• Part of the pituitary gland is removed through the nose
• What is this patient at risk for?

• Infection‼!