Study Guide_Exam#1_NUR341
BLOOMFIELD COLLEGE
FRANCES M. McLAUGHLIN DIVISION OF NURSING
Study Guide
Exam #1
Exam #1 will consist of 67 questions as follows:
One question testing your competency for the calculation of drug dosage (similar to the questions in
your math exam).... this is part of the DON policy
- 3 multiple response questions (see all that apply)
- Study guide: study with emphasis and focus on the following concepts/principles for exam #1:
Topic
Iggy
ATI Review Book
Key points
& Presentations
Exam #1 (Genetics, Cancer, Fluids and Electrolytes, ABGs, Respiratory system)
One Math question (Dosage calculation)
Math skills
Genetics and
Ch. 6
Group
Different types of genetic inheritance (autosomal vs. x-linked)
Genomic
Presentation:
Pathophysiology of the genetic makeup
Relationship of
Concepts for
Genetic testing: definition, when it is required and for what type of
genetics and
Medicaldisorders.
pharmacotherapy
Surgical
Genetic counseling: requirements for counseling, nurses’ role in
(pharmacogenetics)
Nursing
counseling, psychosocial issues (legal/ethical considerations)
GINA legislation and consumers protection against discrimination as being
discussed in class and pp slides.
- Huntington's disease is an autosomal dominant disorder
- A silent mutation occurs if a base-pair is changed but the DNA still codes
for the same amino acid. This is possible as amino acids have more than
one codon (triplet) that codes for them. Insertion or deletion of one or
more base-pairs is a frameshift mutation and can change the entire
reading frame. A mutagen is an agent that increases the frequency of
mutations. A spontaneous mutation occurs when a mutation occurs but
there is no exposure to a mutagen.
- Turner Syndrome. A sex chromosome is missing, and the person's
chromosomes are 45,X. Characteristic signs are short stature, female
genitalia, webbed neck, shieldlike chest with underdeveloped breasts and
widely spaced nipples, and imperfectly developed ovaries. Turner
syndrome results from monosomy of sex chromosomes (genotype XO).
- Not all traits are produced by single genes; some traits result from several
genes acting together. These are called polygenic traits. When
environmental factors influence the expression of the trait (as is usually
the case), the term multifactorial inheritance is used. Many multifactorial
and polygenic traits tend to follow a normal distribution in populations
(the familiar bell-shaped curve).
Mutations: A silent mutation occurs if a base-pair is changed but the DNA
still codes for the same amino acid. This is possible as amino acids have
more than one codon (triplet) that codes for them. Insertion or deletion of
one or more base-pairs is a frameshift mutation and can change the entire
reading frame. A mutagen is an agent that increases the frequency of
mutations. A spontaneous mutation occurs when a mutation occurs but
there is no exposure to a mutagen.
Concepts of
Ch. 13 Fluid Imbalances:
ABG's interpretation and management.
Fluid and
Ch. 43
Fluids & Electrolytes: different types of fluids for specific diagnosis,
Electrolyte
Electrolyte
assessment, clinical manifestations, nursing care and management;
Balance.
Imbalances: Ch. 44 electrolyte imbalances in:
-
Study Guide_Exam#1_NUR341
Concepts of
Acid-Base
Balance.
Ch. 14
Acid-Base
Imbalances: Ch. 45
Sodium, Potassium, and Calcium.
Understand the Mechanisms Controlling Fluid and Electrolyte Movement
between vascular and interstitial compartments: (Osmosis, Diffusion,
Facilitated Diffusion, Active Transport)
Understand the idea behind the different pressures and how edema
develops:
Osmotic Pressure
Hydrostatic Pressure
Oncotic Pressure
Osmolality
Fluid Movement between capillaries and interstitial spaces
(compartments)
Fluid Spacing (1st, 2nd, and 3rd spacing and know examples about each type)
Regulation of Water Balance (Hypothalamic Regulation, Pituitary
Regulation, Adrenal Cortical Regulation, Renal Regulation).
Functions of Aldosterone on fluid & electrolyte balance …. Sodium and
potassium.
Fluid imbalances ( Hypovolemia and Hypervolemia): know causes and
treatment for each type. Difference between hypertonic and hypotonic
and effect on the cell contents (swell vs. shrink).
Electrolytes (again follow the PPs as a guide to the textbook content;
remember the normal values for the sodium, potassium, and calcium).
Acid–Base Balance and Arterial Blood Gases (know the normal values of
the ABG's and the 4 abnormalities; metabolic and respiratory), you will be
asked to identify the acid-base imbalance from the given values of the
PaO2, PaCO2, pH, and HCO3) and other questions about the treatment of
each type of these imbalances. Which electrolyte-containing fluids should
be used for managing a patient with acidosis vs. alkalosis.
- Relationship between chloride (hypochloremia or hyperchloremia) and
Bicarbonate.
- Relationship between Acidosis and Hyperkalemia
- The role of plasma proteins and the oncotic colloidal pressure: Lost or
diminished plasma albumin production (e.g., from liver disease or protein
malnutrition) contributes to decreased plasma oncotic pressure. Plasma
proteins are lost in glomerular diseases of the kidney, serous drainage
from open wounds, hemorrhage, burns, and cirrhosis of the liver. The
decreased oncotic attraction of fluid within the capillary causes filtered
capillary fluid to remain in the interstitial space, resulting in edema.
- Capillaries become more permeable with inflammation and immune
responses, especially with trauma such as burns or crushing injuries,
neoplastic disease, and allergic reactions. Proteins escape from the
vascular space and produce edema through decreased capillary oncotic
pressure and interstitial fluid protein accumulation. (Huether 100)
- Tonicity describes the effective osmolality of a solution. (The
terms osmolality / osmolarity and tonicity may be used interchangeably.)
Solutions have relative degrees of tonicity. An isotonic solution (or
isosmotic solution) has the same osmolality or concentration of particles
(285 mOsm) as the ICF or ECF. A hypotonic solution has a lower
Study Guide_Exam#1_NUR341
concentration and is thus more dilute than body fluids. A hypertonic
solution has a concentration of more than 285 to 294 mOsm/kg. The
concept of tonicity is important when correcting water and solute
imbalances by administering different types of replacement solutions.
(Huether 17)
- Difference between Hydrostatic pressure (pushes fluids out of the
compartment) and Oncotic (colloidal) pressure (pulls fluids into the
compartment). Patients with hypoproteinemia (low plasma protein) will be
at risk of developing edema.
- Edema is excessive accumulation of fluid within the interstitial spaces.
The forces favoring fluid movement from the capillaries or lymphatic
channels into the tissues are increased capillary hydrostatic pressure,
decreased plasma oncotic pressure, increased capillary membrane
permeability, and lymphatic channel obstruction. (McCance 100)
- Relationship between Acidosis and Hyperkalemia
Review and practice ABG’s
Hypertonic solutions cause water retention, so the patient should be
monitored for symptoms of fluid excess. Crackles in the lungs may indicate
the onset of pulmonary edema and are the most serious of the symptoms
of fluid excess listed. Bounding peripheral pulses, peripheral edema, or
changes in urine output also are important to monitor when administering
hypertonic solutions, but they do not indicate acute respiratory or cardiac
decompensation.
spironolactone is a potassium-sparing diuretic, patients should be taught
to choose low potassium foods such as apple juice rather than foods that
have higher levels of potassium, such as citrus fruits. Because the patient is
using spironolactone as a diuretic, the nurse would not encourage the
patient to increase fluid intake. Teach patients to avoid salt substitutes,
which are high in potassium.
Risk factors for acid-base imbalances in the older adult include chronic
kidney disease and pulmonary disease
Potassium is given IV for severe hypokalemia. The drug is available in
different concentrations, and this drug carries a high alert warning as a
concentrated electrolyte solution. The Joint Commission has mandated
that concentrated potassium be diluted and added to IV solutions only in
the pharmacy by a registered pharmacist and that vials of concentrated
potassium not be available in patient care areas. Before infusing any IV
solution containing potassium chloride (KCl), check and re-check the
dilution of the drug in the IV solution container.
Use a controller for solution delivery, maintaining an infusion rate not
faster than 5 to 10 mEq of potassium per hour.
Prevent accidental overdose of IV potassium by checking and re-checking
the concentration of potassium in the IV solution, ensuring that the
maximum concentration is no greater than 1 mEq/10 mL of
solution. (Ignatavicius 185)
Assess for hypocalcemia by testing for Trousseau's and Chvostek's signs
Study Guide_Exam#1_NUR341
Topic
Iggy
ATI Review Book
Key points
& Presentations
Exam #1 (Genetics, Cancer, Fluids and Electrolytes, ABGs, Respiratory system)
Concepts of
Ch. 20 General Principles
Care for
of Cancer: Ch.89
Patients with
Cancer Screening
Cancer
and Diagnostic
Procedures: Ch.90
Cancer Treatment
Options: Ch.91
Cancer Disorders:
Ch.92
Pain Management
for Clients Who
Have Cancer
Concepts of
Ch. 27 Respiratory
Asthma and COPD: assessment, clinical manifestations, management and
Care for
Diagnostic
nursing care.
Patients with
Procedures: Ch.17
Use of different Oxygen delivery methods (mask, N/C, venturi…etc) and
Noninfectious
Asthma: Ch. 21
patient safety (educating the patient while on Oxygen especially at
Lower
COPD: Ch. 22
home)
Respiratory
Inclusion / exclusion criteria for Flu and Pneumonia vaccines (see also CDC
Problems:
recommendations for these vaccines)
- Asthma
The recommended frequency for the administration of Flu and Pneumonia
- Gas
vaccines.
Exchange
The flu vaccine is made using duck eggs.
Concept
Exemplar:
Seasonal influenza, or “flu,” is a highly contagious acute viral respiratory
Chronic
infection that can occur in adults of all ages. The initial manifestations of
Obstructive
avian influenza are similar to other respiratory infections—cough, fever,
Pulmonary
and sore throat. These progress rapidly to shortness of breath and
Disease
pneumonia. In addition, diarrhea, vomiting, abdominal pain, and bleeding
(COPD)
from the nose and gums occur. Use the antiviral drug oseltamivir (Tamiflu)
- Lung Cancer
or zanamivir (Relenza) within 48 hours of contact with the infected patient.
Study Guide_Exam#1_NUR341
Concepts of
Care for
Patients with
Infectious
Respiratory
Problems:
- Seasonal
Influenza
- Pandemic
Influenza
- Gas
Exchange
Concept
Exemplar:
Pneumonia
- Infection
Concept
Exemplar:
Pulmonary
Tuberculosis
Ch. 28
Acute Respiratory
DisordersPneumonia: Ch.20
Tuberculosis: Ch.23
No effective treatment for this infection currently exists. Antibiotics and
antiviral drugs cannot kill the virus or prevent its replication. Interventions
are supportive to allow the patient's own immune system to fight the
infection. Vaccinations for the prevention of influenza are widely available.
The vaccine is changed every year on the basis of which specific viral
strains are most likely to pose a problem during the influenza season (i.e.,
late fall and winter)
Inhalation and respiratory medications including terbutalin (Brehtaire)
bronchodilator: indications and side effects.
Confirmed lab / diagnostic test for the resolution of pneumonia.
Management and pharmacotherapy for TB: side effects of medications
Course of TB treatment and side effects of drugs used for TB (INH,
Rifampin, PZA, …etc).
Clinical manifestations of pneumococcal pneumonia.
Thoracentesis: preparation of a client and nursing care.
Fundamental principles for the proper use of inhalers; patient teaching
(fundamentals of nursing)
Early signs and symptoms of Lung cancer.
Adverse effects of Chemotherapy and Radiation therapy.
Mycobacterium tuberculosis is a gram-positive, acid-fact bacillus that is
usually spread person to person by airborne droplets produced by
speaking and coughing
PPD test reading: interpretation of reading, how to measure it, and how
many times to be repeated
Interpretation of PPD test results for patients who are
immunocompromised such as with HIV/AIDS
Confirmatory diagnostic study for Pulmonary TB: AFB sputum test
collected early morning hours. TB is confirmed when the results of the 3
sputum specimens obtained on 3 consecutive days are positive. The time
to stop/discontinue (D/C) the Airborne precautions (isolation w/ negative
pressure) is done when the 3 specimens are negative (sputum for AFB).
Patients who have received the BCG vaccine will have a positive Mantoux
test. Another method for screening (such as a chest x-ray) will need to be
used in determining whether the patient has a TB infection
When clients have a CD4+ count below 200 cells/mm3, their PPD test
results may be negative even when active tuberculosis (TB) is present,
because they have too few cells to mount an immune response to the test.
Therefore, airborne precautions should be used with any client who is
immunocompromised and presents with symptoms of TB until TB is ruled
out with other tests.
To reduce antibiotic resistant tuberculosis, the patient must take multiple
drugs for 2 to 6 months or longer. If patients need to be out of the
negative-pressure room, they must wear a standard isolation mask to
prevent exposure to others. Teach patients to cover the nose and mouth
with a paper tissue every time they cough, sneeze, or produce sputum. If a
person has a positive reaction to the TST, he or she should not be tested
again because the sensitivity to tuberculin persists throughout life. Nurses
Study Guide_Exam#1_NUR341
Topic
Iggy
ATI Review Book
Key points
& Presentations
Exam #1 (Genetics, Cancer, Fluids and Electrolytes, ABGs, Respiratory system)
and visitors must wear high-efficiency particulate air (HEPA) masks
whenever entering the patient's room
Generally, individuals positive for HIV should not receive live vaccines.
Administration of inactivated influenza vaccine is recommended annually
in all individuals positive for HIV. Live attenuated influenza vaccine was
FDA approved in 2003 in an intranasal formulation but is contraindicated in
individuals with immunocompromise. The varicella and MMR vaccines
should not be administered to patients with severely symptomatic HIV
infection. The OPV is no longer recommended for use in the United States
despite its continued use in many other parts of the world. Instead,
inactivated polio vaccine (IPV) is recommended and is safe for use in HIVpositive individuals. (2006, available at: www.cdc.gov
Low-grade fever may indicate infection or acute rejection, so the patient
should notify the health care provider immediately if the temperature is
elevated. Patients require frequent follow-up visits with the transplant
team; annual health care provider visits would not be sufficient. Home
oxygen use is not an expectation after lung transplant. Shortness of breath
should be reported
Oxygen saturation would be expected to improve after a thoracentesis.
Albuterol is a rapidly acting bronchodilator and is the first-line medication
to reverse airway narrowing in acute asthma attacks. The other
medications work more slowly.
Patients with lung cancer are at risk for pneumonia. Therefore, they need
to be vaccinated for influenza vaccine (annually) and pneumococcal
vaccine (every 5 yars).
Pone important nursing preparation is to hold Bronchodilators before
pulmonary function testing (PFT) so that a baseline assessment of airway
function can be determined.
Patients with COPD improve the mechanics of breathing by sitting up in the
“tripod” position. Resting in bed with the head elevated would be an
alternative position if the patient was confined to bed, but sitting in a chair
allows better ventilation.
A forced expiratory technique (huff coughing) clears secretions with less
change in pleural pressure and less likelihood of bronchial collapse. Before
coughing is initiated, ensure the patient is breathing deeply from the
diaphragm. You should place hands on the lower lateral chest wall and
then ask the patient to breathe deeply through the nose, and you should
feel the hands move outward, which represents a breath from the
diaphragm
Good Luck