Final

What are the common signs and symptoms of ketoacidosis?

Abdominal cramping, nausea, hyperglycemia (>250 mg/dL), acidosis, ketones in urine, dehydration, fruity-scented breath, fatigue, excessive urination.

What condition is ketoacidosis most commonly associated with?

Diabetes Mellitus Type 1 (DM Type 1).

Why does acidosis occur in ketoacidosis?

The body breaks down fat for fuel, producing acidic ketones, leading to acidosis.

What fasting blood sugar level is diagnostic for diabetes?

A fasting blood sugar of 126 mg/dL or higher on more than one occasion.

Is a post-prandial blood sugar of 130-139 mg/dL considered normal?

Yes, post-prandial blood sugar 130-139 mg/dL is considered normal.

What post-prandial blood sugar level is considered abnormal?

A post-prandial blood sugar level greater than 140 mg/dL is considered abnormal.

What is the most reliable test for measuring diabetes control over the past 3 months?

Hemoglobin A1C (A1C or glycosylated hemoglobin).

How does the A1C test reflect diabetes control?

It measures the effects of glucose on hemoglobin, and since red blood cells live for about 3 months, it provides an overview of blood sugar management during that time.

What is an example of long-acting insulin?

Glargine (Lantus).

How often is long-acting insulin like Glargine (Lantus) administered?

Once daily via subcutaneous (subQ) injection.

What is the purpose of long-acting insulin?

It provides basal rate control for up to 24 hours.

When is long-acting insulin usually administered?

At bedtime.

Can long-acting insulin be mixed with other insulins in the same syringe?

No, it should never be mixed with other insulins.

Why should nurses educate patients about drug interactions with insulin or oral hypoglycemics and beta blockers?

Because beta blockers can mask symptoms of hypoglycemia.

How do beta blockers affect tachycardia in hypoglycemia?

They prevent tachycardia by decreasing heart rate, making it harder to detect hypoglycemia.

What other symptoms of hypoglycemia can beta blockers mask?

Tremors, irritability, and confusion.

Why do pre-diabetic patients need to be educated about their condition?

They have a high risk of developing diabetes.

What is one of the first interventions a nurse should provide for pre-diabetic patients?

Education on lifestyle changes such as diet and exercise.

How can lifestyle changes help pre-diabetic patients?

They help control blood sugar levels and reduce the risk of progressing to diabetes.

How does exercise benefit diabetic patients?

It helps lower blood glucose and increases insulin sensitivity.

Why should diabetic patients check their blood sugar before, during, and after exercise?

To avoid potential complications related to blood sugar fluctuations.

Why should Type 1 diabetic patients avoid exercise if ketones are present in the urine?

Ketones indicate fat breakdown for energy, and exercising can increase ketone production, leading to more acidity and making the patient feel very sick.

Why is the peak time of insulin important?

It is the time when there is the highest risk of hypoglycemia.

What is the onset and peak time of rapid-acting insulin (Lispro, Humalog, Novolog)?

Onset: 5-15 minutes, Peak: 1-1.5 hours.

What is the onset and peak time of short-acting insulin?

Onset: 30-60 minutes, Peak: 1-5 hours.

What is the onset and peak time of intermediate-acting insulin?

Onset: 1-2 hours, Peak: 6-14 hours.

Does long-acting insulin have a peak time?

No, long-acting insulin has no peak.

What should a nurse do before educating a new diabetic patient on diabetes management?

Assess the patient's knowledge of diabetes.

Why is it important to assess a diabetic patient’s knowledge before providing education?

To target education on what the patient does not know and correct any misconceptions.

What type of drug is Metformin (Glucophage)?

A biguanide oral hypoglycemic agent.

How does Metformin lower blood glucose levels?

It decreases hepatic glucose production from stored glycogen.

How does Metformin improve glucose utilization?

It increases cell sensitivity to insulin.

What is the most important intervention in the management of DKA?

IV hydration.

When is IV hydration implemented in DKA management?

It is usually the first intervention upon hospital admission.

Which condition is more dangerous, hypoglycemia or hyperglycemia?

Hypoglycemia is more dangerous.

At what blood sugar level does hypoglycemia become a concern?

Blood sugar <70 mg/dL with symptoms.

Why is severe hypoglycemia (<30 mg/dL) life-threatening?

It can lead to hypoglycemic coma and death.

What causes Diabetes Type 1?

The pancreas stops producing insulin, leading to hyperglycemia due to a total lack of insulin.

What causes Diabetes Type 2?

The body's cells become resistant to insulin, and there is a gradual decrease in insulin production.

How does insulin resistance contribute to Diabetes Type 2?

The cells no longer respond effectively to insulin, leading to high blood sugar levels despite insulin production.

Why is insulin not taken orally?

It would be destroyed by stomach acids and enzymes before being absorbed.

What is the only insulin that can be given intravenously (IV)?

Regular insulin.

What is breakthrough pain?

A sudden high-intensity pain that occurs despite continuous treatment for chronic pain.

When does breakthrough pain occur?

When a patient receiving continuous pain therapy experiences a sudden increase in pain intensity.

What is the first step a nurse should take when a patient complains of pain?

Assess the pain.

Why is assessing pain intensity important before administering medication?

It helps determine the severity of pain and guides appropriate treatment.

What tool can be used to assess pain intensity?

A numeric pain scale.

What is an important nursing role in pain management for postoperative patients?

Educating patients that they should not be afraid to take prescribed pain medication.

Why do some postoperative patients avoid taking pain medication?

They fear dependence and may choose to suffer through the pain instead.

Why is it important for patients to take pain medication as prescribed?

Proper pain management promotes healing.

What is a priority nursing action for a patient receiving opiate pain medication via a PCA pump?

Assess respiratory rate.

Why is respiratory rate assessment important for patients on a PCA pump?

Opiates can cause respiratory depression.

What is the antidote for opioid-induced respiratory depression?

Narcan (naloxone).

What should the nurse do if a patient on a PCA pump develops respiratory depression?

Administer Narcan (naloxone) as soon as possible.

What are complementary alternative therapies?

Non-pharmacological modalities used alongside or instead of main therapy.

Can complementary alternative therapies be used with conventional treatments?

Yes, they can be used in conjunction with conventional treatments.

What are some examples of complementary alternative therapies?

Acupuncture, Therapeutic Touch, Healing Touch, Biofeedback, Hypnotherapy.

What is Tylenol commonly used for?

It is an analgesic used to relieve muscle and joint pain, such as in arthritis.

Why does Tylenol have a maximum daily dose?

To prevent hepatotoxicity caused by the accumulation of toxic byproducts in the liver.

What is the maximum daily dose of Tylenol for a normal patient?

4 grams per day.

What is the maximum daily dose of Tylenol for the elderly?

Around 2.5-3 grams per day.

Why should Tylenol be avoided in patients with liver disorders or alcohol use?

It can intensify hepatotoxic effects and increase the risk of liver damage.

What is the GFR level in End Stage Renal Disease (ESRD)?

Less than 15 mL/min.

Why does ESRD lead to multiple complications?

The kidneys lose their ability to filter waste and maintain balance in the body.

What are some complications of ESRD?

Nausea, vomiting, loss of appetite, fatigue, weakness, anemia, bone pain, and pruritus.

Why do ESRD patients experience bone pain?

Due to loss of calcium from the bones.

What causes pruritus (itching) in ESRD patients?

Increased nitrogen waste products in the blood.

What electrolyte imbalances can be observed in Acute Kidney Injury (AKI)?

Hyperkalemia (potassium), hyperphosphatemia (phosphate), hypocalcemia (calcium), and hyponatremia or normal sodium levels.

What is azotemia?

The buildup of nitrogenous waste products (urea, BUN, creatinine) in the blood.

In which conditions can azotemia be observed?

Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD).

What waste products accumulate in the blood due to azotemia?

Urea, Blood Urea Nitrogen (BUN), and Creatinine.

What is Rifampin (Rifadin) used to treat?

Tuberculosis (TB).

What unique side effect does Rifampin cause?

Reddish-orange discoloration of bodily secretions (urine, tears, sweat, saliva).

Why is patient education important for Rifampin therapy?

To prevent distress, as the discoloration can be alarming if unexpected.

Can Rifampin affect contact lenses?

Yes, it can stain and destroy contact lenses.

Will the discoloration from Rifampin stop after discontinuing the medication?

Yes, the effect is temporary and stops once the medication is discontinued.

Why are most tuberculosis (TB) treatments considered hepatotoxic?

They consist of multiple antibiotics that can increase the risk of liver toxicity.

Why is the likelihood of liver toxicity higher in TB treatment?

Patients must take more than one antibiotic simultaneously, increasing the strain on the liver.

What symptom should TB patients watch for as a sign of liver compromise?

Yellow-tinged skin (jaundice).

What should a patient do if they develop jaundice while on TB treatment?

Report it to their physician immediately.

What type of room is required for tuberculosis-positive patients?

A negative pressure room.

Why is a negative pressure room necessary for TB patients?

It prevents the spread of Mycobacterium tuberculosis to other patients and staff.

What type of mask must staff wear before entering a TB patient's room?

An N-95 mask.

Why must staff be fit-tested for N-95 masks?

To ensure a proper seal for effective protection against airborne TB particles.

Will a regular face mask protect staff from TB infection?

No, a face mask is not sufficient; only an N-95 mask provides proper protection.

Does a positive PPD (Mantoux) test indicate active tuberculosis?

No, it only indicates exposure to the TB bacteria (inactive)

What further testing is needed to confirm active TB after a positive PPD?

A chest X-ray and sputum culture.

When can airborne isolation be discontinued for a patient with active tuberculosis (TB)?

After three negative sputum smears for acid-fast bacilli.

Why are three negative sputum smears required before stopping isolation?

To ensure the patient is no longer contagious.

What type of drugs are commonly used as bronchodilators for asthma?

Sympathomimetic drugs.

What are common side effects of bronchodilators?

Tremors and tachycardia.

What is an example of a rescue inhaler used during an acute asthma attack?

Albuterol (Proventil).

What type of inhalers are commonly prescribed for long-term asthma management?

Corticosteroid inhalers (e.g., Beclomethasone).

How do corticosteroid inhalers help manage asthma?

They reduce inflammation in the airways.

Why should patients rinse their mouths after using a corticosteroid inhaler?

To prevent oral candidiasis (thrush).

What is the diagnostic criteria for Chronic Obstructive Pulmonary Disease (COPD)?

A productive cough for at least 3 months per year for at least 2 consecutive years.

Why is a chronic productive cough significant in diagnosing COPD?

It indicates long-term airway inflammation and mucus production, common in COPD.

What breathing technique can help COPD patients manage their symptoms?

Pursed-lip breathing.

What position can help COPD patients improve breathing?

The tripod position.

What are key components of COPD management?

Pursed-lip breathing, tripod position, and pharmacotherapy.