Final Exam: NSG123/ NSG 123 (Latest 2024/ 2025 Update) Med Surg 1| Review with Questions and Verified Answers| 100% Correct| Grade A- Herzing
Final Exam: NSG123/ NSG 123 (Latest 2024/
2025 Update) Med Surg 1| Review with
Questions and Verified Answers| 100%
Correct| Grade A- Herzing
Q: What is systemic lupus erythematous?
Answer:
inflammatory autoimmune – affects nearly every organ — can be life-threatening
immune systems develops antibodies to body’s own cells
Q: Are white people more/less likely to have SLE? Man or woman more likey?
Answer:
Women (4-12x)
White less likely – more Afr Amer, Hispanic, Asian, Native American
Q: What are clinical manifestations of SLE?
Answer:
chronic state with acute flares
fever, fatigue, rash, join pain/swelling – oral ulcers, alopecia, Raynauds, nephritis
muscskel system, renal, nervous, CV most common
(GI/liver/ocular less involved)
Q: What is assessment/diagnosis for SLE?
Answer:
exam for edema at joints, rash, skin changes, alopecia – complete history ***malar rash on
cheeks
ANA (antinuclear antibody) in 95%
also anemia, leukocytosis
Q: T/F SLE patient should ensure regular exposure to sun to get sufficient VIt D
Answer:
False – sun/UV can cause exacerbation — SLE is photosensitive
avoid exposure or wear clothes/sunscreen
Q: Why is SLE patient at increased risk for osteoporosis?
Answer:
long-term corticosteroids increases incidence
encourage Ca/Vit D, weight-bearing exercise
Q: What is SLE goals of pharmacological treatment based on?
Answer:
1 -pain management (NSAIDs, propionic acid derivatives like ibuprofen)
2 – nonspecific immunosuppression (belimumab, corticosteroids, hydroxychloroquine, purines)
Q: Lifestyle changes for SLE?
Answer:
-avoid risk for bleeding – SOFT toothbrush (SLE=low platelets)
-rest
-avoid crowds
Q: What is diff between RA and osteoarthritis?
Answer:
OA – degenerative, morning stiffness only 30 mins, asymmetrics, cartilage loss, heberden’s nodes
RA – autoimmune, inflamed synovium, symmetrical, morning stiffness 30+ mins, extra-articular
movement
Q: What can help distinguish RA from SLE?
Answer:
Both – pain, fever, fatigue, inflamm
RA – red/warm joints, nodules, hand/foot deformity or dislocations
SLE – hair loss, butterfly rash on cheeks, weight change, photosensitive
Q: Hydroxychloroquine, prescribed for SLE can be damaging to what organ?
Symptoms would need immediate attention
Answer:
eyes – retinal cells near macula — decreased central vision
ex can’t see letter in middle of word
IRREVERSIBLE!
Q: Where is malar rash located? What disease process is it seen in?
Answer:
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What is RA (Rheumatoid Arthritis)? autoimmune in synovial fluid – 3x more common in women, usually 20s-50sgenetic predisposition – immunologically mediated joint inflammation. autoimmune reaction in synovial tissue.
Symptoms of RA PAINjoint swelling, stiff/limited movementspongy/boggy tissueBILATERAL and SYMMETRICpain, sleep disturbance, fatigue, altered move, limited mobility, anemia, Raynaud’s, weight loss, enlarged lymph nodes
What is azothioprine? Med for RA – decreases production of antibodies at cellular level targets RA antibodies specifically
What will you find in assessment in RA? history (stiffness, tenderness, swelling)xray/ultrasound for baselineSYMMETRIC joint pain, decr motion, numbness, tinglingsynovial fluid is cloudy, milky, dark yellow – has inflammatory components
What labs do you expect in RA? Anti-CCP = diagnostic!!Rheumatoid Factor (but NOT diagnostic)ESR and CRP elevated)Anemia, high platelets due to inflammation
What is non-pharm treatment for RA? heatwarm bath/showerbraces/splitsambulation devicesmaintain joint mobility – individualized exercise program (ROM, isometric, dynamic, aerobic, SWIM)
What is pharmacological tx treating for RA?What type of med is Xeljanz? DMARD (disease modifying anti-rheumatic drug) for actual disease — ie Xeljanzcorticosteroids can be used as bridgeie methotrexate, leflunomide, sulfasalazine, hydroxychloroquine (within 3 mths of onset) — 6 weeks to start working
What labs are needed in methotrexate/DMARDs kidney, liver, CBC (anemia)modify dose for renal failureannual eye exam with sulfasalazine and hydroxychloroquine
How do salicylates (aspirin) and NSAIDs affect the disease of RA? THEY DON’T — symptoms management onlyAlso topical analgesics (capsaicin)DMARDS impact actual disease (with corticosteroids as bridge)
What body system can have complications due to RA? cardiovascular – cause of death in 40% RA patientsalso medication adverse effects
What is systemic lupus erythematous? inflammatory autoimmune – affects nearly every organ — can be life-threateningimmune systems develops antibodies to body’s own cells
Are white people more/less likely to have SLE? Man or woman more likey? Women (4-12x)White less likely – more Afr Amer, Hispanic, Asian, Native American
What are clinical manifestations of SLE? chronic state with acute flaresfever, fatigue, rash, join pain/swelling – oral ulcers, alopecia, Raynauds, nephritismuscskel system, renal, nervous, CV most common(GI/liver/ocular less involved)
What is assessment/diagnosis for SLE? exam for edema at joints, rash, skin changes, alopecia – complete history ***malar rash on cheeksANA (antinuclear antibody) in 95% also anemia, leukocytosis
T/F SLE patient should ensure regular exposure to sun to get sufficient VIt D False – sun/UV can cause exacerbation — SLE is photosensitiveavoid exposure or wear clothes/sunscreen
Why is SLE patient at increased risk for osteoporosis? long-term corticosteroids increases incidenceencourage Ca/Vit D, weight-bearing exercise
What is SLE goals of pharmacological treatment based on? 1 -pain management (NSAIDs, propionic acid derivatives like ibuprofen)2 – nonspecific immunosuppression (belimumab, corticosteroids, hydroxychloroquine, purines)
Lifestyle changes for SLE? -avoid risk for bleeding – SOFT toothbrush (SLE=low platelets)-rest-avoid crowds
What is diff between RA and osteoarthritis? OA – degenerative, morning stiffness only 30 mins, asymmetrics, cartilage loss, heberden’s nodesRA – autoimmune, inflamed synovium, symmetrical, morning stiffness 30+ mins, extra-articular movement
What can help distinguish RA from SLE? Both – pain, fever, fatigue, inflammRA – red/warm joints, nodules, hand/foot deformity or dislocationsSLE – hair loss, butterfly rash on cheeks, weight change, photosensitive
Hydroxychloroquine, prescribed for SLE can be damaging to what organ?Symptoms would need immediate attention eyes – retinal cells near macula — decreased central visionex can’t see letter in middle of wordIRREVERSIBLE!
Where is malar rash located? What disease process is it seen in? SLE – cheeks/nose
What type of medication is celecoxib? COX-2 enzyme blocker2nd generation – only blocks COX2, not COX1
Your patient is taking entanercept (Enbrel). What should they do if they have a fever? Hold medication – call doctor
Can someone with hepatic failure take ibuprofen? renal failure? NO to both!
How is hypovolemia (fluid volume deficient) different than dehydration? dehydration – was lost alone (Na+ increases)FVD – loss of ECF exceeds intake of fluid (water and electrolytes lost in same proportion)
What can cause FVD/hypovolemia? **NG suctioningvomit/diarrhea, fistulafever, sweating, burnsblood loss 3rd space shiftsdecr intakediabetes insipidus, DM Labs in FVD? incr H&Hincr urine specific gravityincr BUN, creatinineconcentrated urine, less outputdecr urine sodium What can cause FVE/hypervolemia? kidney injury, HF, cirrhosisfluid shifts (tx of burns)too much Na+ fluid givenprolonged corticosteroidsevere stresshyperaldosteronism What labs in FVE? Decr H&HDecr urine omolarity, spec gravityDecr urine sodium In which type of fluid imbalance would you see ascites and bounding pulse? excess/hypervolemiaedema, acute weight gain, JVDSOB, cough, cracklesincr BP, urine output In which fluid imbalance would you see prolonged cap filling time and (decreased?) temp? deficient/hypovolemiaoliguria/concentrated urinelow CVPdecr BP, dizzyflat neck veinscool, clammy, pale What happens to serum sodium in hypervolemia? Stays the same — reminder, retaining water and sodium at same proportions in ECFoften secondary to increase in sodium, so body increases water to compensate How is hypovolemia treated? ideal – oral fluids, consider pt likes – consider lost fluid and may need to replace electrolytesenteral or parenteral supplementation if can’t be oral.—isotonic to increase ECF What 3 isotonic solutions can be given for hypovolemia? 0.9% NaCl — only solution given with blood productsLactated Ringers (Na, K, Ca, Cl) – burns, bile/diarrhea, acute blood loss. NOT in alkalosis (breaks down to HCO3 ), not in kidney injury5% dextrose – no electrolytes – use in hypernatremia, NOT postop, head injury, caution renal/cardiac — converts to hypotonic What hypotonic solution can be given? 0.45% NaCl -free water – aids kidneystx hypertonic dehydration/NaCl depletion, gastric fluid losscaution – causes fluid shifts into cells (CV collapse, intracranial pressure) What are hypertonic solutions? 3% NaCl, 5% NaClIncrease ECF/decr cellular swelling/decr ICFcritical hyponatremia GIVE SLOW – can cause pulm edema What are colloid solutions? dextran in NS or D5W — usehypovolemia in early shockdecr clotting abilityremains for 24 hoursCI – hemorrhage, renal, severe dehydr, thrombocytopenia Interventions for hypervolemia restrestrict Namonitor parenteral fluidadmin meds What is ascites? edema in peritoneal cavity from HF, nephrotic syndr, cirrhosis, some tumorsSOB – pressure What is anasarca? severe generalized edema How is isotonic solution different than colloidal solution? isotonic – water with soluble mineral saltscolloid – fluid containing insoluble large particles (ie protein) – ie plasma — exert oncotic pressure In what population should D5W be used with caution? those with risk for incr intracranial pressureNOT for fluid resuscitation – can cause hyperglycemia What are systemic complications of IV? -fluid overload-air embolism-infection What are local complications of IV? phlebitis infiltration, extravasation, thrombophlebitis, hematomaclotting, obstruction What are signs of infection during infusion? -abrupt temp elevation, chills-backache-HA-incr pulse, resp-N/V/Derythema, edema, induration/drainage at site What is normal pH? HCO3? CO2? pH 7.35-7.45HCO3 22-26CO2 35-45 What 3 mechanisms maintain pH? buffer systemkidneyslungs What type of solution is given in fluid volume deficit? isotonic – replace the fluid at regular concentration What symptoms are seen in hypoxia? looks like alcohol intox — lack of coordination, impaired judgementfatigue, drowsy, apathy, delayed reaction 3 places ECF is found interstitial fluidplasmatranscellular fluid (CSF, GI, synovial, peritoneal, intraocular, pericardial) What happens to cells when we give hypotonic solution? SWELLhypo/hippohigher solute inside, higher water outside… so water moves into cell What happens to cells with hypertonic solution? Cell shrinkshigher solute outside/higher water inside… so water moves out What kind of fluid is 0.33% and 0.45% NaCl? What happens to cells? hypotoniccells swell – hypo/hippo What can result from diuretic use? electrolyte imbalanceespecially hypokalemia – K supplements may be neededhyponatremia, decr mag What causes resp acidosis? decr respirations (anesth, drugs)COPDpneumoniaatelectrasis What are symptoms of resp acidosis? “””can’t catch breath””rapid/shallowhypovent – hypoxiadecr BP (vasodilation)HAhyperkalemia – dysrhythmia” What causes resp alkalosis? hyperventilation anxiety, PE, fearmechanical ventilation What does pH measure? concentration of hydrogen What is important in starting IVs, to avoid phlebitis and other complications? wash hands! wear gloves! What are symptoms of resp alkalosis? seizuresHYPERventilationdeep, rapid breathingtachyhypokalemia – numbness, tinglinglightheaded, confusionN/V What do kidneys excrete to regular pH? ammonia and phosphate What causes metabolic acidosis? DKAsevere diarrhearenal failureshock What are goals of osteoarthritis treatment? 1st pain –Tylenol, aspirin, ibuprofen, COX2, topical creams, corticosteroidsSurgery if severe/can’t be managed What are 5 risk factors for osteoarthritis? femaleolderobeseoccupationsportshx of joint injurygenetics What are symptoms of metabolic acidosis? HAdecr BPhyperkalemiawarm, flushed (vasodilation)N/V/Dchanges in LOCKussmaul (compensatory hypervent) What are causes of metabolic alkalosis? severe vomitingexcessive GI suctiondiureticsexcessive NaHCO3 What are symptoms of metabolic alkalosis? restless, then lethargytachycompensatory hypoventconfusionN/V/Dtremors, cramps, tingling Your patient has FVE – what happens to hemoglobin? hematocrit? “LOWnormal = 12-17 hemoglobin**36-48 (women) – RBC are “”diluted”””
What happens to respirations in respiratory acidosis? rapid, shallowie COPD, pneumoniadecr BP
Should you give LR to someone with hyperkalemia? no – LR contains K
What kind of fluid is LR? isotonic0.9% NaCl, D5W, LR are isotonic
Your hyponatremic patient receiving NS now has incr pulse, resp, BP… SOB, crackles.What should you do? reduce rate of infusion — you’ve created overload
What are risk factors for osteoporisis? small-framed womenAsian and Caucasianaromatase inhibitors (breast cancer)autoimmune diseasebariatric surgery/GI probs )nutrition – calories, Ca, Vit D)
How is osteoporosis diagnosed? DEXA (dual energy xray absorptiometry)not detected on regular xray until later
When is calcium/Vit D contraindicated? -bone mets-V fib-hypercalcemiaAvoid with iron, tetracycline, cipro, phenytoin
Patient education for osteoporisis Ca, Vit D, weight-bearing exerciseavoid fractures, fiber/fluid for constfor pain – rest supine or side-lying, knee flexion, move trunk as unitprevent injury – keep exercise, preferable outside for Vit D
Why do patients with osteoporosis need high fiber? constipation related to immobility, medsvertebral collapse can cause paralytic ileus — monitor bowels, I/O
What meds are given for osteoporosis? Ca/Vit D supplement, take with Vit alendronate (Fosamax)(keep taking in dietary Ca too)
What meds should be given separately from Ca supplment? atenololfluoroquinolonesphenytoiniron2-3 hours from tetracycline
Why should you take Vit D with calcium for osteoporosis? Vit D helps with absorption
What is Foxamax? How does it work? What does it treat? alendronate – a bisphosphonate — binds to bone to inhibit Ca resorption from bonefor hypercalcemia, osteoporosis, Paget’s disease (adults only)
How should alendronate be taken? at waking – full glass water ONLY – 30 mins before anything else (longer is better)SIT UP for 30 mins after — reduces esophageal irritation
What does calcitonin do? lowers serum Ca by inhibiting bone resorption most effective in hypercalcemia due to hyperparathyroidism, immobilization, neoplasm
How are blood tests used in OA? not helpful in dx, but can rule out autoimmune reason (ie RA)xray show narrowing of joint space, thickened bone
What is non-pharm education for OA? lose weightexerciseuse assistive devicesbegin exercise in moderation, slowly – take analgesic if necessaryalternative therapies
What are risk factors for OA? agefemalesOBESITY – modifable!occupation – laborious sportshx of injury, muscle weakness
What causes gout? hyperuricemia uric acid is by-product of purine breakdown — crystal deposits develop in joints
What are diet recommendations for gout? avoid purine foods – organ meats, seafoodavoid alcohol
How is acute gout attack managed with meds? colchicine NSAIDcorticosteroid
What is long-term gout med management? Xanthine oxidase inhibitor -allopurinol or febuxostatprobenecid – increases urinary excretion of uric acidcolchicine – causes GI upset if used chronically