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NSG123 Exam 4 Review
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What symptoms may a person experience during the headache phase of a migraine?
Severe and incapacitating pain; Often associated with photophobia (light sensitivity), phonophobia (sound sensitivity), allodynia (extremely sensitive to touch)
What symptoms may a person experience during the postdrome phase of a migraine?
Pain gradually subsides, Tiredness, weakness, cognitive difficulties, mood changes (hours to days) Muscle contraction in neck and scalp, pain with exertion
What are the 2 main OTC meds for migraine treatment?
Naproxen and Acetaminophen-Aspirin-Caffeine
Sumatriptan can be taken if pregnant. True or False
False
Cranial Arteritis is pain caused by the inflammation of the cranial arteries. True or False?
True
If the patient is not tolerating Gabapentin, they should stop the medication and inform their provider. True or False?
False- should not be stopped suddenly
Carbamazepine should be taken with food to avoid GI upset. True or False?
True
Valproate is safe for those with renal failure. True or False
False- use caution
What are the 3 main medications that can be given during status epilepticus?
IV diazepam, lorazepam, fosphenytoin
Myxedema can occur in severe hypothyroidism. How is this treated?
Arterial Blood Gases (CO2), O2, Caution with IV fluids, Passive rewarming with blankets, IV thyroid hormone
How would you educate a patient on taking levothyroxine?
take on empty stomach, do not take with antacids or iron, will need regular labs, monitor for s/s of hyperthyroidism or hypothyroidism
Diabetic Ketoacidosis can occur in patients with Type 1 or Type 2 diabetes. True or False?
True (rare is T2 but possible)
After an insulin injection, the patient should rub the site to help with absorption. True or False?
False- this can increase risk of hypoglycemia.
You patient with diabetes had a bee sting and is on a prednisone taper for the week. What education does this patient need?
Prednisone can increase blood glucose. Monitor blood glucose more frequently. Report any abnormal findings.
What is the fasting glucose range indicative of diabetes?
>126
Your patient recieved 5 units aspart insulin before meals. They also have a sliding scale. 0-150: 0 units; 151-200: 3 units; 201-250: 5 units: 251+: 9 units. Their BG is 197. How many units do you administer?
8 units (5+3)
You are working in a SNF and caring for patient's with dementia. What environment is most appropriate?
Quiet, Calm, Display clocks and calendars, Limit environmental stimuli, Talk pleasantly
Donepezil is safe to take with liver failure. True or False
False- metabolized in liver
What are the 4 main clinical signs of Parkinson's Disease?
Tremor, Rigidity, Bradykinesia, Postural Changes
What symptoms may a person experience in the premonitory phase of a migraine headache?
Depression, Irritability, Feeling Cold, Food Cravings, Anorexia, Change in Activity Level, Increased Urination, Diarrhea, Constipation
Phenobarbital is safe to take in pregnancy. True to False
False
Describe Status Epilepticus
Medical Emergency, Acute prolonged activity. series of seizures without full recovery in between
What are the 4 stages of a seizure?
Prodromal, Aura, Ictal, Post-Ictal
A vagal nerve stimulator is used for treatment of seizures. This device does not prevent seizures, but does diminish the severity of the seizure. True or False?
True
You are caring for a woman of child bearing age that has epilepsy. What 2 main education points do you need to hit?
Epilepsy in the mother puts the fetus at greater risk for malformations. Effectiveness of oral contraceptives is decreased in women taking anticonvulsant meds
What are signs and symptoms of hypothyroidism?
extreme fatigue, hair loss, brittle nails, dry skin, numbness of fingers, hoarse voice, menorrhagia, constipation, CAD, high lipids, feeling cold,
You are caring for a patient with diabetes. What is their A1C goal?
<7% (some <8% per provider discretion)
Explain hypoglycemia treatment (for conscious patient). Glucose: 55
Give 15 g fast carbs. Recheck BG in 15 mins. If under 70 repeat 15g fast carbs. Recheck BG in 15 min. Repeat until BG >70. Recheck in 1 hour.
Rate the following from highest to lowest glycemic index? Mashed Potatoes, A Whole Apple, Orange Juice,
OJ, Mashed Tators, Apple
Your patient started on metformin 500mg BID. They are having diarrhea. What education will you provide this patient?
GI upset is a common side effect when starting this medication. Symptoms will lessen over time. Start at 500mg daily, then increase to BID as symptoms improve.
You are caring for a patient diagnosed with T2 DM 10 years ago. Their A1C is 9.4%. What does this tell you?
Likely uncontrolled DM. Could be due to compliance or poor medical management. Assess and Educate.
What is the fasting glucose range indicative of pre-diabetes?
100-125
What medication class needs to be AVOIDED with Levodopa-Carbidopa (due to hypertensive crisis)?
MAOIs
Why is carbidopa given with levodopa?
Carbidopa decreased the peripheral metabolism of levodopa- can reduce levodopa dosage
How does Donepezil work?
Inhibits acetylcholinesterase- enzyme responsible for destruction of neurotransmitter: acetylcholine. Increases acetylcholine slows neuronal degradation.
What class of medication is Memantine (Namenda)?
N-methyl-d-aspartate receptor antagonist (Alzheimer's)
During a seizure, the nurse should restrain the patient to ensure the patient's safety. True or False
False- Never restrain a patient during a seizure. Can cause further injury.
Disruptive Sleep Patterns can lead to a migraine. Does sleep affect seizure activity also?
No- Sleep is not related to the cause of a seizure
Long-term use of anit-epileptic drugs can lead to an increased risk for _______.
Osteoporosis
A patient is diagnosed with hypothyroidism. What labs would you expect? (What is high/low?)
High TSH, Low T4, Low T3
What are signs and symptoms of hyperthyroidism?
Nervousness, hyperexcitable, irritable, Heart palpitations, high HR, perspiration, flushed, tremor in hands, high appetite, wt loss, exophthalmos
Graves Disease is an autoimmune disorder that causes low levels of thyroid hormone due to lack of stimulation of the thyroid gland by immunoglobulins. True or False?
False- causes HIGH levels of thyroid hormone due to stimulation by immunoglobulins
What type of insulin is aspart? What is the time of onset?
Rapid Acting; 5-15 min
What is glucosuria and why does it occur? T1 and/or T2 Diabetes?
Glucose in the urine; More glucose in bloodstream than kidneys can reabsorb into the body; T1 & T2
What is the goal A1C for a patient with DM?
<7% (could also be <8%)
How often should a patient with diabetes have an eye exam?
Yearly
Your patient received 20 units of glargine at bedtime scheduled. You check their glucose at 9pm prior to administration of their insulin and their glucose is 88. Do you give the glargine? Why or why not?
Yes. Glargine is long-acting basal insulin. Glucose of 88 is normal.
Name 5 risk factors for developing Type 2 diabetes.
Family history, obesity, race/ethnicity; >45yo, HTN, high lipids, history of gestational dm or baby over 9#
What is the mechanism of action of Levodopa?
Dopamine Receptor Antagonist. Levodopa is converted to dopamine in the basal ganglia.
What symptoms may a person experience during the aura phase of a migraine?
Visual Disturbances: light flashes, bright spots, Numbness/Tingling of lips, face or hands; mild confusion, slight weakness of extremity, drowsiness, dizziness
Memantine is safe to take in renal failure. True or False
False
Delirium is not serious and resolves on it's own. True or False?
FALSE- Medical Emergency. Must find cause and treat before irreversible damage
You are caring for a patient with Alzheimer's disease. They have been on donepezil for 3 months but the family states they have not noticed any improvement. Should the medication be stopped? Why or why not?
Keep taking. Can take 6-12 months for improvement to be noticed. (could be slowing progression)
Name 5 causes of a seizure.
Cerebrovascular disease Hypoxemia, Fever, Head injury, HTN, CNS infections, Brain tumor, drug/alcohol w/d, allergies
Epilepsy is defined as _______.
The International League Against Epilepsy (ILAE) has defined epilepsy as at least two unprovoked seizures occurring more than 24 hours apart
What 3 hormone are released by the thyroid?
T3 (triiodothyronine), T4 (thyroxine), Calcitonin
Phenytoin (Dilantin) can cause gum hyperplasia. True or False?
True- Oral care is important!
A patient is diagnosed with hyperthyroidism. What labs would you expect? (What is high/low?)
Low TSH, High T4, High T3
Your patient just received radioactive iodine for hyperthyroidism. What discharge instructions will you provide?
Your body is emitting radiation. Avoid close contact with others and public places for several days. Avoid pregnancy 6-12 months.
How often should Insulin Pump Infusion Sets be changed?
3 days
When mixing insulin, it should be mixed from cloudy to clear. True or False?
False. Clear to Cloudy
When should a pregnant patient that is high-risk for gestational diabetes be screened?
1st prenatal visit, if neg re-screen at 24-28 weeks
Gestational Diabetes turns to Type 2 Diabetes after the patient gives birth. True or False
False- does increase risk in the future (35-60% within next 10-20 years)
What are the "3 Ps"? (Diabetes)
Polyuria, Polydipsia, Polyphagia


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