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CMSRN EXAM QUESTIONS AND 100% CORRECT ANSWERS
what is the most common form of hyponatremia, due to excessive fluid intake andcausing a decreas in serum sodium concentration? ANSWER dilutional hypotnatremia
symptoms of diltuional hyponatremia ANSWER edema, confusion, weight gain treatment of dilutional hyponatremia ANSWER fluid restriction what type of hyponatremia occurs due to a loss of fluid and sodium? ANSWER truehyponatremia
symptoms of true hyponatremia ANSWER dry tissue, weight loss, hypotension,tachycardia
treatment of true hyponatremia - ANSWER replace sodium AND water (NS or LR) causes of true hyponatremia - ANSWER burns, hemorrhage, adrenal insufficiency what kind of sodium imbalance results from decreased fluid intake or loss of waterwithout sodium loss? - ANSWER hypernatremia
causes of hypernatremia - ANSWER fever, IVF w/ sodium, DI, high protein TF symptoms of hypernatremia - ANSWER dry tissues, weight gain, thirst, tachycardia,oliguria
Treatment for hypernatremia ANSWER decrease sodium, replace fluids
Which electrolyte does sodium work with? ANSWER chloride - works to maintainacid/base balance
Which labs are most important to watch with potassium abnormalities? ANSWER renal What does potassium have an inverse relationship with? ANSWER PH, insulin, calcium Causes of hyperkalemia ANSWER cell wall destruction, increased intake, potassiumsparing diuretics, renal failure, acidosis
symptoms of hyperkalemia - ANSWER irritable muscles, cardiac arrhythmias,hyperactive bowels, bladder treatment of hyperkalemia - ANSWER limit intake, kaexylate, calcium gluconate, IVglucose and insulin, dialysis what electrolyte imbalance should you avoid green leafy vegetables and citrus fruits? -ANSWER hyperkalemia what electrolyte are avocado, dried fruits, and potato skins high in? - ANSWERpotassium causes of hypokalemia - ANSWER vomiting, diarrhea, DKA, prolonged NG suction,burns, potassium wasting diuretics
symptoms of hypokalemia - ANSWER muscle flaccidity and weakness, constipation,alkalosis, shallow respirations, cardiac arrest treatment for hypokalemia - ANSWER potassium supplements, monitor magnesiumlevels normal calcium level - ANSWER 9-10. where is calcium stored? - ANSWER boneswhat vitamin is important for calcium absorption - ANSWER Vitamin D what does calcium have an inverse relationship with? - ANSWER phosphorous which electrolyte imbalance increases bleeding risk? - ANSWER hypocalcemia
treatment for hypermagnesemia - ANSWER calcium gluconate what is serum osmolality? - ANSWER how thick solution is what does it mean if serum osmolality is high? - ANSWER the patient is dry what type of solution is NS, LR? - ANSWER isotonic what does an isotonic solution do? - ANSWER expands blood volume increases blood pressure if dehydrated has same osmolarity as our cellscan cause electrolyte increase
what type of solution is D5LR, D5NS? - ANSWER hypertonic what does a hypertonic solution do? - ANSWER Pulls fluid into the intravascular spacefrom tissue, do NOT give if dehydrated
what type of solution is 1/2 NS, 1/4 NS? - ANSWER hypotonic what does a hypotonic solution do? - ANSWER contain less solute than our cells used for cellular hydrationhas more water than electrolytes given after surgery due to dehydration What organ metabolizes most nutrients? - ANSWER liver
gallbladder location - ANSWER RUQ appendix location - ANSWER RLQ stomach location - ANSWER LUQ what quadrant is indicative of IBD? - ANSWER LLQ when a diabetic has epigastric pain, what can this indicate? - ANSWER gastroparesis,MI
what does it mean if abdominal auscultation is dull? - ANSWER fluid or mass order for GI assessment? - ANSWER inspect, auscultate, peruss, palpate GERD causes/risk factors - ANSWER obesity, hiatal hernia, esophageal sphincterproblems, gastric empty delay
symptoms of GERD -ANSWER -Dyspepsia -Chest pain-Esophagitis -Hoarseness in the am-Persistent heartburn -Dysphagia -Can mimic heart attack symptoms. treatment for GERD -ANSWER sleep with head elevated, used H2- receptor blockers(pepcid, zantac) or proton pump inhibitors (prilosec)., meal timing
NGT and pain meds, surgical repair) which inflammatory bowel disease involves the WHOLE bowel system, has cobblestonebowel, has all layers of the bowel with NO rectal bleeding - ANSWER crohns disease
Which inflammatory bowel disease involves the LEFT colon, begins at the rectums andascends, has superficial ulcerations and has either bloody diarrhea or formed stool with streaks? ANSWER ulcerative colitis Diet for Inflammatory Bowel Disease ANSWER High protein, high calorie (3,000+ a day),low fiber, low roughage/residue
causes for large bowel obstruction ANSWER MOST COMMON is neoplasm, diverticulitis,strictures, abscesses
causes of small bowel obstruction - ANSWER adhesions, hernias, polyps, ileus,lymphoma
which of the following bowel obstructions is characterized by gradual onset, pain is lowgrade, absence of stool, distention, high bitches bowel sounds - ANSWER large bowel obstruction which of the following bowel obstructions is characterized by rapid onset, crampycolicky pain, emesis, distention, high pitched bowel sounds - ANSWER small bowel obstruction which type of bowel obstruction is more likely to need surgical intervention? - ANSWERlarge bowel obstruction
sac like herniation of large bowel that can get food or fecal matter trapped and lead toinflammation/infection? - ANSWER diverticulitis
complications of diverticulitis - ANSWER perforation, peritonitis, bleeding Causes of cholecystitis - ANSWER gall stones, bile stasis what type of infection manifests with RUQ pain, N/V, biliary colic, fever, and murphyssign? - ANSWER cholecystitis
Palpation under rib causes cessation of inspiration; sign + indication? - ANSWERmurphys sign, indicates cholecystitis
what type of diet should a patient with cholecystitis eat? - ANSWER low fat what kind of infection presents with belly button and RLQ pain (acute), reboundtenderness, fever, N/V, elevated WBC, decreased appetite, gas/bloating? - ANSWER appendicitis what sign is indicative of pancreatitis and shows as a gray color on the flank-looks likeold bruise? -ANSWER grey turner sign
Diet for pancreatitis-after NPO status-ANSWER High carb and protein, low fat. which organ in the GI tract produces antibodies, prothrombin, fibrinogen, albumin,metabolizes glucose-stores and releases, bile salt formation, detox of noxious agents-ANSWER liver which organ is toxic to Tylenol (acetaminophen) and cause hemorrhage/damage? -ANWER liver
which hepatitis do you need to report to health dept? - ANSWER hepatitis A
medications for liver failure? - ANSWER lactulose and rifaximin diet for patients with bariatric surgery ANSWER high protein and nutrients, smallfrequent fluids
which type of nutrition is indicated for a patient who has a functional GI tract,inadequate intake for 3-5 days, and has inability to increase Po intake? ANSWER enteral nutrution contrainidications for enteral nutrition? ANSWER complete intestinal obstruction, lackof access, intractable vomiting or diarrhea, ileus, massive GI bleed, fistula, GI ischemia
which form of nutrition is indicated when nutritional support is needed for > 10 days andthe nutrient requirements are increased due to disorders of the GI tract? - ANS parenteral nutrition contraindications for parenteral nutrition? - ANS functioning GI tract, absence of venousaccess
which pulmonary disorder produces grayish/white/blood streaked mucus/purulentsputum? - ANS tuberculosis
ABG: pH low - ANS acidosis ABG normal pH - ANS 7.35-7. ABG: pH high - ANS alkalosis ABG: PCO2 range - ANSWER 35-
ABG: PCO2 low - ANSWER alkalosis ABG: PCO2 high - ANSWER acidosis ABG: HCO3 (bicarb) range - ANSWER 22- ABG: HCO3 low - ANSWER acidosis ABG: HCO3 high - ANSWER alkalosis ABG: PO2 range - ANSWER 80- ABG: PO2 low - ANSWER hypoxemia ABG: PO2 high - ANSWER on O ABG: SaO2 range - ANSWER 95- ABG: SaO2 low - ANSWER hypoxemia ABG in metabolic acidosis - ANSWER decreased pH, decreased bicarb (HCO3) ABG in metabolic alkalosis - ANSWER increased pH, increased bicarb (HCO3) ABG in respiratory acidosis - ANSWER decreased pH, increased PCO ABG in respiratory alkalosis - ANSWER increased pH, decreased PCO
Which pulmonary disease would the nursing assessment reveal the following: localcrackles, exp wheezes, tachypnea and hacking/rasping/productive cough with thick mucoid sputum - ANSWER chronic bronchitis Which pulmonary disease would the nursing assessment reveal the following: finecrackles, tachypnea/dyspnea, mildly hypoxic, little to no sputum - ANSWER emphysema
Diet for patient with COPD? - ANSWER high protein, high calorie Which of the following asthma medications are used for maintenance? ANWER antiinflammatory, long acting bronchodilators, singulair
Which of the following asthma medications are used for rescue? ANWER short actingbronchodilators, theophyllines
What type of bacterial pneumonia is most common? ANWER steptococcus pneumoniae Which rare type of pneumonia is also one that requires isolation? ANWERmeningococcal pneumonia
Treatment of pneumothorax ANWER reestablish negative pressure: chest tube, needleaspiration, oxygen
should the water seal chamber of a chest tube always have bubbles in them? -ANSWERNO- may have tidaling but shouldn't have continuous
what is the name of the risk factor identification method for pulmonary embolism thatconsiders blood stasis, endothelial damage and hypercoagulation? -ANSWER virchows triad
what is the respiratory condition characterized by pink frothy sputum, crackles,dyspnea and feeling of fear? -ANSWER pulmonary edema
in what organ are platelets stored? - ANS spleen What WBC is the first line of defense? - ANS neutrophils what WBC is the most effective bacterial killer? - ANS monocytes/macrophages What type of lymphocyte attacks and destroys infected body cells? - ANS T lymphocyte what kind of lymphocyte become an antibody when exposed to something seen as a longterm threat? - ANS B lymphocyte
which kind of anemia is caused by deficiency of B12? - ANSWER pernicious pressure ulcer: skin discoloured purple or maroon from pressure/sheer - ANSWER DTI pressure ulcer: skin intact, non blanchable redness usually over bony prominence -ANSWER stage 1: prevention, turns
pressure ulcer: partial thickness loss of dermis, shallow open injury - ANSWER stage 2:cover with hydrocolloid
Pressure Injury: Full thickness tissue loss but no exposure of bone, muscle, or tendon.ANSWER Stage 3: may require debridement or surgical consult
Pressure Injury: Full thickness tissue loss with exposed bone, muscle and/or tendon.ANSWER Stage 4
Which of the following cholesterol medications can cause rhabdomyolysis? - ANSWERstatins
Umbrella term for any condition where adequate blood supply to the heart muscle isblocked? - ANSWER acute coronary syndrome
How high do you want to keep somebody's O2 sats after an MI? - ANSWER 94% or higher which type of MI is caused by complete occlusion (acute coronary syndrome)? -ANSWER STEMI
which type of MI is caused by partial occlusion? - ANSWER NSTEMI medical treatment for MI? (MONA) - ANSWER morphine, oxygen, nitrates, aspirinwhat type of congestive heart failure is caused by problems in the lungs - ANSWER left ventricular heart failurewhat type of congestive heart failure manifests as edema? - ANSWER right ventricular heart failure (diastolic) which kind of heart failure is manifested by the following S/S: orthopnea, dyspnea withexertion, crackles, s3/s4 sounds, systolic murmur - ANSWER left ventricular heart failure which kind of heart failure is manifested by the following S/S: JVD, dependent edema,hepatomegaly, abd distention - ANSWER right ventriclar heart failure
-diastolic) -olol - ANSWER beta blocker: decrease workload of the heart
-pril - ANSWER ACE inhibitor: decrease preload and afterload -sartan - ANSWER ARB: decrease preload and afterload -pine - ANSWER calcium channel blocker: negative inotropic effect that decreases forceof contraction
which type of vascular disease results in a lack of oxygen to tissues: loss of hair,extremities cool/pale - ANSWER PAD
which type of vascular disease results in inability to remove waste products: edema,wounds that won't heal - ANSWER PVD treatment for PAD? - ANSWER thrombolytics, stents, bypass treatment for PVD? - ANSWER antiplatelets, diuretics Antidote for Coumadin - ANSWER Vitamin K type of shock: decrease in cardiac OP, decreased tissue perfusion and elimination ofwaste (decreased UOP), results from MI/severe cardiomyopathy/cardiac injury - ANSWER cardiogenic type of shock: most common- from massive blood loss - ANSWER hypovolemic stage of hypovolemic shock that the cardiac output and BP are maintained - ANSWERcompensated
stage of hypovolemic shock that evidence of decrease in cardiac OP, changes in BP arepresent - ANSWER uncompensated
treatment for SIADH? - ANSWER alleviate cause, fluid restriction/diuretics, daily weights what are two important nursing considerations when managing a thyroid storm? -ANSWER do not give ASA, do not treat increased temp
which endocrine gland stores and maintains calcium? - ANSWER parathyroid which endocrine gland produces epi and norepinephrine? - ANSWER adrenal medulla which endocrine gland is responsible for steroid hormones aldonge, cortisol,testosterone - ANSWER adrenal cortex
What endocrine insufficiency is caused by under secretion of steroids from the adrenalcortex r/t tumor? - ANSWER primary (adrenal) addisons disease
What endocrine insufficiency is caused by under secretion of ACTH r/t tumor? -ANSWER secondary (pituitary) addisons disease
How do you treat addisons disease? - ANSWER steroid replacement What endocrine insufficiencies are related to the adrenal glands? - ANSWER addisonsand cushings
what endocrine insufficiency is caused by over secretion of steroids from the adrenalcortex r/t tumor? - ANSWER primary (adrenal) cushings
what endocrine insufficiency is caused by over secretion of ACTH? - ANSWERsecondary (pituitary) cushings
how do you treat cushings disease? - ANSWER surgery for tumor removal, steroid taper what category of insulin are lantus, levemir, and NPH? - ANSWER basal what category of insulin are regular, humalog, novalog? - ANSWER prandial/bolus How long do you hold metformin after giving IV dye? - ANSWER 48 hours Which of the following insulins has an onset of 10-20 minutes, peak of 1-3hrs, and aduration of 3-5 hrs? - ANSWER novolog
Which of the following insulins has an onset of 30 minutes, peak of 2-5 hrs, and aduration of 5-8 hours? - ANSWER regular
which insulin has an onset of 1-3 hrs, peak of 6-12 hrs and a duration of 16-24 hrs? -ANSWER intermediate (NPH)
which insulin has an onset of 1hr and duration of 24-48hrs w/ no peak? - ANSWER longacting (lantus)
causes of death from DKA? - ANSWER dysrhythmias from hyperkalemia or acidosis what type of breathing is rapid and deep, a compensation of metabolic acidosis, andfruity/sweet smelling? - ANSWER kussmaul respirations
treatment for DKA - ANSWER IV insulin, IVF, treat high potassium with IVinsulin/kaexylate-will likely need to replace again once drops
are patients more likely to die from DKA or HHS? - ANSWER HHS
