CEN Exam chapter 004 Test Bank practice ACTUAL Questions

CEN Exam chapter 004 Test Bank practice ACTUAL Questions & Answers / VERIFIED

"Adrenergic" is associated with the ______ system correct answers Sympathetic

"Cholinergic" is associated with the ______ system correct answers Parasympathetic

Activation of the RAAS system leads to...? correct answers Increased water and sodium reabsorption (decreased UO)

Beta-one receptors stimulate the...? correct answers Heart

Beta-two receptors stimulate the...? correct answers Lungs

What is hematologic factors are high in renal failure? correct answers The 3 Ps!

Potassium Phosphorous Positive Ions (Acidosis)

(Sodium and calcium are low)

Potassium is closely related with what electrolyte? correct answers Mg

Magnesium is closely related with what electrolyte? correct answers K+

Calcium is inversely related to? correct answers Phosphate and potassium

Phosphate is inversely related to?

closely related to? correct answers Inverse: Calcium

Direct: Potassium

What medication do we never give in thyroid storm? correct answers ASA

What are the s/s of hyponatremia? correct answers swelling, confusion, apathy, sense of doom, *muscle cramps*

What are we worried about when correcting hyponatremia? correct answers Correcting sodium too rapidly can cause central pontine myelinolysis (flaccid paralysis, dysarthria, dysphagia, hypotension)

What are the s/s of hypernatremia? correct answers AMS (fatigue, lethargy, confusion, coma), weakness, diarrhea (think of how you feel after eating McDonalds^^^)

What are the early s/s of hyperkalemia? correct answers muscular excitability, irritability, N/V/D

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What are the late s/s hyperkalemia? correct answers *fatigue*, weakness, distal limb paresthesia, tetany, respiratory depression, ascending paralysis

What are the cardiovascular s/s of hyperkalemia? correct answers 1. Peaked T wave

• Elongated PR interval
• Absent P wave
• Enlarging QRS complex
• Sin wave (very bad sign)

How do we treat hyperkalemia? correct answers 1. Stabilize cardiac membrane with CaCl or Ca Gluconate

• Shift potassium into the cells with high dose albuterol (15-25mg) and Insulin 10units IV push with

100mL of 50% dextrose IV push

• Remove potassium from the cells (HD, NS and furosemide, Ion exchange resin like kayexalate)

What are the s/s of hypokalemia? correct answers Frequently asymptomatic. Weakness, hyporeflexia, latent tetany, paralysis to the lower extremities, respiratory failure, paresthesia. Prominent U wave on the ECG causing a "camel-hump" appearance to the T-wave, ST depression

**treat hypokalemia with magnesium too since they often coincide

What are the s/s of hypermagnesemia? correct answers Neuromuscular depression, decreased DTR, constipation, N/V, fatigue, tall T waves, depressed ST segmants

How do we treat hypermagnesemia? correct answers 1. Reduce serum mag (fluids and loop diuretics)

• Reduce ingestion of magnesium (dark leafy greens, nuts, seeds, fish, beans, whole grains, avocados,

yogurt, bananas, dried fruit, dark chocolate

• Dialysis (give calcium while awaiting dialysis)

What are the s/s of hypomagnesemia? correct answers Mild to moderate is usually asymptomatic

Severely low causes *neuromuscular excitability*: tetanic contractions, perioral or finger paresthesia, positive Chvostek's sign, positive trousseaus's sign, seizures. Prolonged PR interval, widened QRS complex

What are the s/s of hypocalcemia? correct answers *The same as hyperphosphatemia*

Neuromuscular excitability (positive Chvosteks and trousseaus), shortened ST segment, and widened T wave

How do we treat hypocalcemia? correct answers 1-2 amps of 10% calcium gluconate mixed with D5W over 10-20 minutes

(Remember potassium rises with low calcium!)

How do we treat hyperphosphatemia? correct answers Limit phosphate intake, give oral phosphate binding agents such as aluminum hydroxide (antacids), increased excretion (IV fluids, diuretics)

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What are the s/s of hypercalcemia? correct answers *Same as hypohosphatemia*

Neuromuscular depression (Decraed DTRs, constipation, N/V), prolonged ST, and QT intervals

How do we treat hypercalcemia? correct answers Treat underlying cause, NS infusion, *glucocorticoids, calcitonin*

how do we treat hypophosphatemia? correct answers High phosphate diet, oral potassium phosphate, IV sodium phosphate (Watch for hypocalcemia!)

What is azotemia? correct answers Elevated BUN and creatinine, seen in renal failure

What are the low and high functions of the thyroid known as? correct answers Low: hypothyroidism

Severely low: myxedema coma

High: hyperthyroidism

Severely high: thyroid storm

What are the low and high functions of the pancreas known as? correct answers Low: DKA

Severely low: HHS

High: hypoglycemia

What are the low and high functions of the adrenal gland known as? correct answers Low: Addison's disease

Severely low: Addison's crisis

High: Cushing's

How do we treat thyroid storm? correct answers •Reverse hyperthermia (acetaminophen, NOT ASA) •Beta-blockers to decrease HR

Treating the thyroid:

• Inhibit thyroid hormone synthesis with PTU (propylthiouracil) or Methimazole (Tapazole)

• Slow thyroid hormone release with Iodine (Lugol's solution) one hour later

What is the treatment for hypoglycemia? correct answers •Conscious with a gag reflex: administer 15g of rapid-acting carbohydrate and repeat if the patient does not improve within ten minutes

•Unconscious patient: IV dextrose 25-50ml (50% for adults, 25% for children, 10-12.5% for neonates). IV of D5W

•Patient without IV: IM glucagon (**May stimulate vomiting!)

What electrolyte imbalances are seen in DKA and HHS? correct answers Low NA, Cl, and Bicarb High potassium 3 / 4

What fluid issues do DKA and HHS patients have? correct answers They are tissue dehydrated and vascular overhydrated

When do we start replacing potassium in DKA/HHS patients? correct answers When it drops below 5mEq

What are the s/s of addison's crisis? correct answers Low BG, low NA, high K dehydration, weakness, fatigue, hypotension

What are the s/s of cushing's? correct answers High BG, high NA, low K Immunocompromised, poor wound healing

How do we treat cushing's? correct answers Decrease steroid use

How do we treat Addison's? correct answers Hypovolemia-> oxygen, vasopressors, fluid Hyperkalemia->calcium, albuterol, kayexalate, insulin/dextrose (D/t hypoglycemia in these patient's, insulin may not be apporpirate) Hyponatremia/Hypochloremia->IV NS Hypoglycemia->Dextrose 50% Low aldosterone and cortisol-> IV hydrocortisone (solu-cortef) and IV Dexamethasone (decadron)

What are the names for decreased and elevated...

RBC WBC Platelets ? correct answers Decreased - Increased

RBC: anemia - polycythemia

WBC: leukopenia - leukocytosis

Platelet: thrombocytopenia - thrombocytosis

What are the s/s of sickle cell? correct answers Acute, severe pain described as throbbing, achy, sharp, or dull.Destruction of sickled cells (anemia, weakness, pallor, jaundice) Priapism

What are the treatments for sickle cell? correct answers NSAIDs, APAP, Ultram, Hydroxyurea (stimulates production of healthy new cells), rehydration, consider blood transfusions

What is the treatment for thrombocytosis? correct answers Low dose ASA Treat underlying cause

What is the treatment for thrombocytopenia? correct answers Prednisone for immune causes D/C drug-induced causes (chemo) If >30,000, discharge with avoiding high-risk activities If <30,000 admission with platelet transfusion

What drugs can we administer to stimulate neutrophil production in immunocompromised patients?correct answers -Granulocyte colony-stimulating factor (neupogen)

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