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NUR 1230 FINAL EXAM 2024 | ALL QUESTIONS AND
CORRECT ANSWERS | VERIFIED ANSWERS |
ALREADY GRADED A+ | LATEST VERSION
What happens with infants and young children when they experience cyanosis due to Tetralogy of Fallot? ------CORRECT ANSWER---------------- Infants having a Tet spell, where everything is constricting and it can be brought on by being emotional and when they cry they become cyanotic, you want to put them over your shoulder, knee, chest to get that blood flow back to heart and lungs (specifically the lungs)
- Young kids who had cyanosis; squatting is done involuntary to bring blood back up to the lungs and heart (specifically the lungs) Disorders with Increased Pulmonary Blood Flow: ------CORRECT ANSWER---------------TOO MUCH BLOOD IS GETTING TO THE LUNGS AND CAN LEAD TO CONGESTIVE HEART FAILURE
- Atrial Septal Defect (ASD): too much blood is getting to the lungs
- Ventricular Septal Defect (VSD): *NUMBER ONE CONGENITAL HARD DEFECT Mixing of blood and too much is going back to the lungs- VSD is a hole in the heart Patent Ductus Arteriosis (PDA): the connection between pulmonary artery and aorta; so blood flow is going to be in upper extremities and like a hole this blood flow is going back into the lungs
- causes heart failure and pulmonary hypertension Congenital Heart Disease- Obstructive Disorders: Coarctation of the Aorta - -----CORRECT ANSWER---------------Background: innominats go to the carotid, upper extremities, and the brain
Coarct=narrowing **Coarctation of the Aorta= narrowing of the aorta; which reduced blood flow to the body Narrowing occurs on the aortic arch and 99% of narrowing is after this
- Blood pressure of upper extremities will be normal and blood pressure of lower extremities will be significantly lower- because the blood flow is not getting there because its narrow
- Diminished blood flow, cyanosis in lower area, poor perfusion in lower extremities, MURMUR is heard *Congenital Heart Defects: Mixed Defects- Transposition of the Great Arteries ------CORRECT ANSWER---------------Background: In the normal heart the pulmonary artery comes off the right ventricle and the aorta comes off the left ventricle
- In Transposition of the Great Arteries they are SWITCHED: So the aorta now comes off the right ventricle and the pulmonary artery comes off the left ventricle *So this results in deoxygenated blood going into the body *THIS IS AN EMERGENCY- when these kids are born they need to go into surgery right away and you only have 4-6 minutes *so they will give them a medicine to open all of the ducts- foramen ovale and ductus arteriosis and they will start it immediately once their born to get blood flow to the brain and body *These kids are born blue and they are happy Congenital Heart Defects- Mixed Defects: Hypoplastic Left Heart Syndrome ------CORRECT ANSWER---------------Background: normally the left ventricle pumps out blood
Consequences of congenital heart defects? ------CORRECT ANSWER------ ---------Heart failure How are we going to treat heart failure? ------CORRECT ANSWER------------ ----Oxygenation
- Adequate nutrition
- Promoting rest ****Use of medication called Digoxin:
- increases heart rate and makes each heart beat the most effective,
- Before giving medication we want to check HR (cannot be below 100), check potassium levels (can cause hyperkalemia), and digoxin levels to make sure its not toxic
- If you give the child digoxin and they throw up you HOLD the dose
- Do not give med in formula because you need to make sure whole med is given
- Side effects of med: nausea, vomiting, halo effect
- Given PO, not IV amount and solution used to flush NGT ------CORRECT ANSWER------------ ---30MLs water BMI considered morbid obesity ------CORRECT ANSWER---------------> hypo or hyperthyroid? heat intolerance, nervousness, tachycardia, weight loss, HTN, diarrhea, fever, exophthalmos ------CORRECT ANSWER---------- -----hyperthyroidism
the organ that produces and secretes insulin ------CORRECT ANSWER----- ----------pancreas 2 class of medication used to treat pain and burning from diabetic neuropathy ------CORRECT ANSWER---------------anticonvulsants (gabapentin) and tricyclic antidepressants action that triggers gastric ulcer pain ------CORRECT ANSWER--------------- eating medical term for gall stones ------CORRECT ANSWER--------------- cholelothiasis patient position when receiving tube feeding ------CORRECT ANSWER------ ---------HOB elevated at least 30 degrees highest nursing priority when caring for a post op bariatric surgery patient -- ----CORRECT ANSWER---------------airway management hypo or hyperthyroid - Hashimoto's disease ------CORRECT ANSWER------- --------hypothyroid type of diabetes that can be controlled with diet, exercise, and weight loss and therefore eliminate the need for medications ------CORRECT ANSWER---------------type 2 diabetes
when mixing short and intermediate insulin, air gets injected into which insulin vial first ------CORRECT ANSWER---------------NPH (intermediate) acting insulin illness caused by the ingestion of fecal contaminated food or eater and can be spread from person to person through saliva ------CORRECT ANSWER- --------------H. pylori the cause of shoulder pain after laparoscopic cholecystectomy ------ CORRECT ANSWER---------------injection of CO2 into the abdomen during the procedure normal gastric pH level ------CORRECT ANSWER--------------- 1 - 5. 3 types of bariatric sugery ------CORRECT ANSWER---------------gastric bypass, vertical sleeve, gastric band the endocrine system consists of the 8 glands ------CORRECT ANSWER--- ------------thyroid, parathyroid, pituitary, pancreas, hypothalamus, adrenal, testes, ovaries the major organ that converts insulin to active status ------CORRECT ANSWER---------------pancreas
what organ can store glucose ------CORRECT ANSWER---------------liver diabetic medication that must be held 24 hours before and 48 hrs after a CT scan ------CORRECT ANSWER---------------metformin 3 types of peptic ulcers ------CORRECT ANSWER---------------gastric, duodenal, stress 5 potential serious complications of pancreatitis if left untreated ------ CORRECT ANSWER---------------coagulopathy, pleural effusion, hypovolemia, shock, paralytic ileus when calculating tube feedings, number of milliliters (ml) in each ounce -----
- CORRECT ANSWER--------------- 30 morbid obesity negatively affects these 3 major body systems ------ CORRECT ANSWER---------------cardiovascular, respiratory, skeletal glands responsible for the secretion of calcium and 3 s/s that it is not working properly ------CORRECT ANSWER---------------parathyroid gland dry skin, brittle nails, tetany, numbness or tingling Difficulty swallowing
- Shortness of breath and wheezing
- Seizures
- Heart rhythm problems
- Cardiomyopathy
- Fatigue
- confusion
from others in the household, take a laxative on days 2 and 3 after receiving treatment to help excrete contaminated stool faster tachycardia, N/V, and abdominal cramping 15 minutes after eating are symptoms of this after bariatric surgery ------CORRECT ANSWER------------ ---dumping syndrome 4 methods for administering tube feeding ------CORRECT ANSWER---------- -----continuous, cyclic, intermittent, bolus 3 most common symptoms of aspiration ------CORRECT ANSWER----------- ----coughing, SOB, decreased O2 saturations priority nursing care for a patient with pancreatitis in the first 24hrs ------ CORRECT ANSWER---------------maintain NPO status, place NGT, pain control risk factors for cholelithiasis ------CORRECT ANSWER---------------female obesity, age, pregnancy, high fat / high cholesterol diet, sedentary lifestyle, rapid weight loss, diabetes 3 most common symptoms of asipration ------CORRECT ANSWER----------- ----coughing, SOB, decreased O2 saturations nursing measures to prevent post-op complication after gastric surgery -----
- CORRECT ANSWER---------------use of bariatric equipment, abdominal
binder, administer anticoagulants, remove foley after 24hrs, SCD's, semi- fowler positioning, monitor O2 sats (C&DB), mobilization medication given to treat hypocalcemia ------CORRECT ANSWER------------ ---calcium gluconate microvascular complications of DM ------CORRECT ANSWER--------------- retinopathy neuropathy nephropathy regular insulin onset, peak, and duration ------CORRECT ANSWER----------- ----30 min, 2-3 hours 3-6 hrs common symptoms of perforated ulcer ------CORRECT ANSWER------------- --severe upper abdominal pain, vomiting, tender/rigid abdomen, fetal positioning common description of pancreatitis pain ------CORRECT ANSWER----------- ----sudden, intense, severe abdominal pain, radiates to the back, L flank and shoulder improves in fetal position nursing assessment to determine correct positioning of NGT consists of what ------CORRECT ANSWER---------------auscultate air into NGT while listening for gurgling over the stomach, check that tube is inserted at the correct CM mark as last chest Xray, aspiration of gastric contents
drug therapy for GERD ------CORRECT ANSWER---------------antacids (TUMS), proton pump inhibitors (Prilosec), histamine blockers (Zantac) 3 labs drawn to assess the function of the thyroid gland ------CORRECT ANSWER---------------T3, T4, TSH What is cerebral palsy? ------CORRECT ANSWER---------------Abnormal develop of, or damage to, the motor areas of the brain; results in brains ability to control movement and posture Is cerebral palsy progressive or non-progressive? ------CORRECT ANSWER---------------It is non-progressive
- once the baby is born the disease does not progress/get worse Therapeutic management of cerebral palsy ------CORRECT ANSWER------- --------- Get child to the highest functioning capacity
- Do mobility with child till resistance or pain **Pharmacological management- Baclofen? ------CORRECT ANSWER------ ---------- A neuromuscular relaxer - Especially helps with Spastic Cerebral Palsy
- Can be given orally or is a pump implanted underneath the skin, which can be controlled with a handheld device or even an app on the phone What kind of diets are people with cerebral palsy on? ------CORRECT ANSWER---------------They may be on liquid or a puree diet
- Children with cerebral palsy don't just have difficulty walking, but also with swallowing and chewing. Make sure a swallow test is done. Do not have anyone feed child solid food unless it has been cleared.
Nursing Management for Cerebral Palsy: ------CORRECT ANSWER---------- -----Brace them to prevent contractors (contractors are due to improper positioning and no ROM exercises and surgery is needed to get them cut) Nursing Management for Cerebral Palsy: ------CORRECT ANSWER---------- -----Promote mobility, by using Hippotherapy (with a horse) What is Spina Bifida? ------CORRECT ANSWER---------------An opening in your back where the spinal cord is exposed or protruding. Any place where that defect is- from there down you have paralysis Side effects of Spina Bifida: ------CORRECT ANSWER---------------- Bowel and Bladder incontinence
- No sexual function Is Spina Bifida reversible? ------CORRECT ANSWER---------------It is IRREVERSIBLE!! Prevention of Spina Bifida: ------CORRECT ANSWER---------------At least a year before you get pregnant you should take Folic Acid
- also recommended for adolescent girl **How many types of Spina Bifida are there? ------CORRECT ANSWER----- ----------There are 3 types of Spina Bifida
- We want to wrap the sac sterile, warm saline and cause from prevent it from drying out from the radiant warmer
- We want to change dressing so baby does not get hypothermia
- Keep it sterile as much as possible and avoid touching it Parent education for Meningocele and Myelomeningocele ------CORRECT ANSWER---------------- Kid will be in a WHEELCHAIR for the rest of their life
- Parent will need to know how to straight cath and look out for signs of a UTI
- Provide parent with outside resources What is the difference between Meningocele and Myelomeningocele? ------ CORRECT ANSWER---------------The difference between the two is that with meningocele you may or may not have paralysis( but most likely will). With myelomeningocele there will FOR SURE be paralysis What is Scoliosis? ------CORRECT ANSWER----------------Curvature of the spine from the normal position
- Can be congenital(most likely is congenital) (occurs before 6 months)*
- Due to genetic or intrauterine positioning or forces When are children checked for scoliosis? ------CORRECT ANSWER---------- ------ We check babies by putting them on their stomach and putting a finger along spine
- Then they checked again during puberty when going in for wellness check up and we have them bend forward How do we diagnosis Scoliosis? ------CORRECT ANSWER--------------- Xrays or examination(Adam or Cobb foward bend test)
Where is Scoliosis more common? ------CORRECT ANSWER---------------- Left sided more common in infants
- Girls with right sided have poor prognosis **Nursing interventions for Scoliosis: ------CORRECT ANSWER--------------- Bracing
- Need to wear brace for prolonged period of time throughout the day
- Do not put any powders or creams underneath brace
- Make sure they wear a cotton shirt underneath the brace
- Watch for skin breakdown ** If it is a significant case of scoliosis they need to cast or do surgical interventions with rods or spinal fusion What can scoliosis effect? ------CORRECT ANSWER---------------- Scoliosis pushes on organs and it can interfere with BREATHING, digestion, etc.
- Girls with right sided scoliosis it can affect their lungs and liver What is Sickle Cell Disease? ------CORRECT ANSWER---------------Cells sickle (RBC), blood becomes more viscous, cells clump together preventing normal blood flowing to the tissues of that area and PAIN CRISIS results as circulation is decreased to the area What happens in Sickle Cell Disease? ------CORRECT ANSWER------------- --- Cells get trapped in small and big places
- Can cause infarc= death to the tissue
- Classically they get pain in their joints: fingers, elbows, knees, hips
What are the Sickle Cell Pain Crisis Triggers? ------CORRECT ANSWER--- ------------#1 trigger: DEHYDRATION- because if you dehydrated you have a lack of plasma (the liquid in our blood) now you have sluggy red blood cells that are not the right shape and not flowing good #2 trigger: Stress #3 trigger: Infection #4 trigger: Smoking #5 trigger: change in altitude Managing the Sickle Cell Crisis: ------CORRECT ANSWER---------------# thing you want to do is order fluids, this is the FIRST thing you do is start them on IV fluid (DONT GIVE PAIN MEDS UNTIL YOU HYDRATE THEM)**(going to be priority question on test so make sure you pick the first thing you do is hydrate them then treat the pain) #2: Treat the pain with pain meds such as morphine and hydroxyurea #3: Have the patient move, it prevents sickle cells from sitting in the joint #4: Prevent infection Is Sickle Cell Disease lifelong or deadly? ------CORRECT ANSWER---------- -----The disease is lifelong and children can die because of infarcs, damage to the liver, and they can STROKE easily Poor perfusion in children: ------CORRECT ANSWER---------------- Infants: with cardiac disease are poor feeders because its very hard to suck, swallow, and breathe at the same time and as a result as poor feeding they have poor weight gain and then they are failure to thrive
- Toddlers and children: they may squat and have developmental delays, and FATIGUE IS A BIG PROBLEM
**Which type of cyanosis is the most concerning? ------CORRECT ANSWER---------------Circum oral (around the mouth) How does blood flow through the heart? ------CORRECT ANSWER----------- ----Inferior and superior vena cava (1) dump blood into the right atrium (2) Right ventricle (3) 2 pulmonary arteries (4) that lead to the lungs (5) where blood becomes oxygenated Pulmonary veins (6) bring blood from the lungs back to the left atrium (7) Left ventricle (8) is large and muscular to pump blood into the aorta (9) and to the rest of the body (10) Eventually blood will be pumped back to each vena cava (1) blood comes in from the upper part of he body to the superior vena cava into the right atrium, the inferior vena cava comes from the lower part of the body, right atrium, right ventricle, pulomary artery (unoxyegnated) to the lungs and then gets oxygenated anc omes back through pulmonary veins with are xoygenated to the left atrium to the left venrtricle and out to the aorta (innomient arties which suplly your upper extremities) **Congenital Heart Disease- Right sided heart failure symptoms (need to know difference between right and left) ------CORRECT ANSWER------------- --- JVD (jugular vein distention)
- Edema
- Liver congestion (because inferior vena cava provides to the liver and lower extremities, so too much blood in the liver because its backing up into it) **Congenital Heart Disease- Left Sided heart failure symptoms ------ CORRECT ANSWER---------------So blood is backing into the lungs (due to pulmonary congestion)
